Medical Record of Big Visit
I finally got the medical record of my visit. It is written in finnish, so translation is mine with the help of Google translate, so it might not be as accurate it could be as the language is very complicated (lots of passive forms and so). I have added some notes or omitted parts of text in between, which are marked [like this]. The diagnose was also added to national health database system finally.
Note: Third person (he/she/it) in finnish is gender neutral (hän) so I have translated those as "he" as it is most accurate in this point still.
30.11.2017 TRANS-clinic (YSPT), initial estimate
Reason of entry
Reference has been received about patient from psychiatrist [name censored]. Has been in psychiatric estimation in the occupational health care because of depression. Told there about gender identity problem and that caused the reference. Also severe depression found.
Prerequisites (anamnesis)
Has been in YSPT last time 2009-2011 in examination. Patient tells that broke up with his spouse in 1/2017. The same person he had relationship already in last examination. Spouse found new man for herself. Patient lived with common townhouse apartment [rivitaloasunto in finnish] couple of months before founding his own apartment. Tells that he is still friend with ex-spouse and is friend with this new spanish man. Tells that has not been able to be jealous. Patient describes that the now ended relationship wasn't "the healthiest" and is gratified that has ended.
It was pondered why didn't proceed after last examination period in the process. Patient tells that didn't understood all the questions [completely in full extent] in the last period. Evaluates being unsure and was finding himself still. Tells that tried to integrate [to life with spouse] because of spouse. Ex-spouse have however told for example that patient will be ugly woman. Patient tells that have thinked about going to the process during all the years anyway, and have been quite sure about it last three years. Problem has been unbearable all these 3 years. During last 1.5 years patient tells that he have thinked about "everything possible from the role of women in society to leg hairs". Patient states being more mature now and knows what he wants now. He estimates that the depression is caused by gender dysphoria and has gotten better now when he can be what he is. It shows at least as it is easier in work.
Discussion that if end of relationship could have been a trigger to re-appearing gender identity problems. Patient doesn't think it as possibility. This theory cannot be tested very clearly and needs patient motivation to inspect the matter more deeply. He also tells that he has suffered from gender dysphoria during the whole relationship. In this light break-up shows up mainly as an opportunity to start implementing own experience in practice. After break-up patient had little bit suicidal thoughts but nothing serious according to him. Has learned to be alone.
Has told to his parents living in Valkeakoski about the matter in 7/2017. [#4] After initial shock they have related neutrally to the matter. Has told to big brother living in Rovaniemi after telling to parents; big brother relates neutrally to matter. Has received support from closest friends. Has blogged about the situation as well. Boss and closest colleagues knows about the matter as well. Is datanome [finnish upper secondary education, more accurate term is "vocational qualification in business information technology"] and enjoys his work as systems specialist. The work community is relaxed and nice. Decided new female name for himself in 7/2017 [#1]
Patient has been somewhat in contact with his junior high school best friend. That person has fixed her gender 3-4 years ago. Patient tells that he hasn't been in touch with his friend in a long time after moving away from Valkeakoski. Tells now that no wonder why they were friends back then. Some kind of signs about gender dysphoria was there with both back in then during school.
Patient tells that penis harms wearing women's clothes. He expects SRS to be done after 2 years. Patient wishes HRT and is aware about the risk of embolism. Has thinked about how auricular migraine affects the matter. Describes how he had some kind of hot waves and "softness in head" in 7/2017 [#2] and the following two weeks was best time healthwise. He expects that HRT will help feel easier. Now he thinks that testosterone prevents f.ex. crying, even when he wants to cry in time to time. Thinks he will lose weight by muscles getting smaller. I tell that in practice, many people seem to gain weight due to increased fat content. Waits breast growth and skin softening as well. Patient tells with satisfaction that he has narrow shoulders for a man and only problem concerning bones is the 45 EU shoe size. Wishes beard removal and plans to go to pubic hair removal in private sector. Friend has told that that area hair will harm in SRS, which will be at least partly true with some surgery techniques. Has practiced his voice with instructions from YouTube.
Health determinants
Suffers from cumbersome auricular migraine, has medication to it. Sleep apnea was also found, with no CPAP treatment. Has lost 26 kg within the year; thinks voxra has helped in this.
Patient suffers from mild depression according to pre-filled SCL-90 symptom questionnaire; current depression can not be estimated to have a significant impact on the patient's ability to decide on matters related to his care. According to the profile of the TAS-20 alexity survey, the patient does not have any special difficulties in identifying or saying their own feelings. According to Life Situation Survey patient isn't very happy to his current life situation.
Doesn't smoke. Audit 2 points.
Current state (status)
Patient is in orderly and peaceful manner at the reception. Conversation reciprocal. Nothing referring to a serious mental illness.
Current medication
Lamotrigin 75 mg in the morning and 50 mg in the evening, Orloc 5 mg in the morning, Noritren 25 mg in the evening, Voxra 150 mg in the morning. Additionally uses vitamins and dietary minerals.
Plan
The person in question is of legal age and is non-psychotic, whose gender dysphoria has existed for many years.I don't see any objections in that he continues to gender fix process as he wishes. I will write referral to PGH for hormone therapy assessment, to PIT for epilation assessment and to PFO for voice therapy assessment. He wants to change his name when voice is more passing. TRANS-clinic follow-up will be agreed that he will visit here in late winter at nurse reception and follow-up care conference like so that the signatory is involved in end of spring of 2018. With the approval of patient a copy of this text will be sent to his occupational doctor.
Diagnoses
- F64.0 Transsexualism
Note: Third person (he/she/it) in finnish is gender neutral (hän) so I have translated those as "he" as it is most accurate in this point still.
30.11.2017 TRANS-clinic (YSPT), initial estimate
Reason of entry
Reference has been received about patient from psychiatrist [name censored]. Has been in psychiatric estimation in the occupational health care because of depression. Told there about gender identity problem and that caused the reference. Also severe depression found.
Prerequisites (anamnesis)
Has been in YSPT last time 2009-2011 in examination. Patient tells that broke up with his spouse in 1/2017. The same person he had relationship already in last examination. Spouse found new man for herself. Patient lived with common townhouse apartment [rivitaloasunto in finnish] couple of months before founding his own apartment. Tells that he is still friend with ex-spouse and is friend with this new spanish man. Tells that has not been able to be jealous. Patient describes that the now ended relationship wasn't "the healthiest" and is gratified that has ended.
It was pondered why didn't proceed after last examination period in the process. Patient tells that didn't understood all the questions [completely in full extent] in the last period. Evaluates being unsure and was finding himself still. Tells that tried to integrate [to life with spouse] because of spouse. Ex-spouse have however told for example that patient will be ugly woman. Patient tells that have thinked about going to the process during all the years anyway, and have been quite sure about it last three years. Problem has been unbearable all these 3 years. During last 1.5 years patient tells that he have thinked about "everything possible from the role of women in society to leg hairs". Patient states being more mature now and knows what he wants now. He estimates that the depression is caused by gender dysphoria and has gotten better now when he can be what he is. It shows at least as it is easier in work.
Discussion that if end of relationship could have been a trigger to re-appearing gender identity problems. Patient doesn't think it as possibility. This theory cannot be tested very clearly and needs patient motivation to inspect the matter more deeply. He also tells that he has suffered from gender dysphoria during the whole relationship. In this light break-up shows up mainly as an opportunity to start implementing own experience in practice. After break-up patient had little bit suicidal thoughts but nothing serious according to him. Has learned to be alone.
Has told to his parents living in Valkeakoski about the matter in 7/2017. [#4] After initial shock they have related neutrally to the matter. Has told to big brother living in Rovaniemi after telling to parents; big brother relates neutrally to matter. Has received support from closest friends. Has blogged about the situation as well. Boss and closest colleagues knows about the matter as well. Is datanome [finnish upper secondary education, more accurate term is "vocational qualification in business information technology"] and enjoys his work as systems specialist. The work community is relaxed and nice. Decided new female name for himself in 7/2017 [#1]
Patient has been somewhat in contact with his junior high school best friend. That person has fixed her gender 3-4 years ago. Patient tells that he hasn't been in touch with his friend in a long time after moving away from Valkeakoski. Tells now that no wonder why they were friends back then. Some kind of signs about gender dysphoria was there with both back in then during school.
Patient tells that penis harms wearing women's clothes. He expects SRS to be done after 2 years. Patient wishes HRT and is aware about the risk of embolism. Has thinked about how auricular migraine affects the matter. Describes how he had some kind of hot waves and "softness in head" in 7/2017 [#2] and the following two weeks was best time healthwise. He expects that HRT will help feel easier. Now he thinks that testosterone prevents f.ex. crying, even when he wants to cry in time to time. Thinks he will lose weight by muscles getting smaller. I tell that in practice, many people seem to gain weight due to increased fat content. Waits breast growth and skin softening as well. Patient tells with satisfaction that he has narrow shoulders for a man and only problem concerning bones is the 45 EU shoe size. Wishes beard removal and plans to go to pubic hair removal in private sector. Friend has told that that area hair will harm in SRS, which will be at least partly true with some surgery techniques. Has practiced his voice with instructions from YouTube.
Health determinants
Suffers from cumbersome auricular migraine, has medication to it. Sleep apnea was also found, with no CPAP treatment. Has lost 26 kg within the year; thinks voxra has helped in this.
Patient suffers from mild depression according to pre-filled SCL-90 symptom questionnaire; current depression can not be estimated to have a significant impact on the patient's ability to decide on matters related to his care. According to the profile of the TAS-20 alexity survey, the patient does not have any special difficulties in identifying or saying their own feelings. According to Life Situation Survey patient isn't very happy to his current life situation.
Doesn't smoke. Audit 2 points.
Current state (status)
Patient is in orderly and peaceful manner at the reception. Conversation reciprocal. Nothing referring to a serious mental illness.
Current medication
Lamotrigin 75 mg in the morning and 50 mg in the evening, Orloc 5 mg in the morning, Noritren 25 mg in the evening, Voxra 150 mg in the morning. Additionally uses vitamins and dietary minerals.
Plan
The person in question is of legal age and is non-psychotic, whose gender dysphoria has existed for many years.I don't see any objections in that he continues to gender fix process as he wishes. I will write referral to PGH for hormone therapy assessment, to PIT for epilation assessment and to PFO for voice therapy assessment. He wants to change his name when voice is more passing. TRANS-clinic follow-up will be agreed that he will visit here in late winter at nurse reception and follow-up care conference like so that the signatory is involved in end of spring of 2018. With the approval of patient a copy of this text will be sent to his occupational doctor.
Diagnoses
- F64.0 Transsexualism