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World Professional Association for Transgender Health Releases New, Improved Standards of Care


The new standards drastically improve transgender individuals’ access to transition-related health care by reducing the number of hoops.

CREDIT: iStockphoto / Sean Locke

At the annual Southern Comfort Conference in Atlanta, the World Professional Association for Transgender Health unveiled new guidelines for transition-related medical care and therapeutic assistance for transgender patients.

The new publication [PDF], which was hailed by transgender advocates, allows room for greater flexibility, loosens requirements for access to care, and provides clear advocacy on transgender and gender nonconformity issues. With the changes, the relationship between transgender patients and their doctors—who control access to life-saving medical care—advances from adversarial to cooperative.

The World Professional Association for Transgender Health (WPATH) is the premier transgender gatekeeper organization, dictating protocol to healthcare providers worldwide. Originally called the Harry Benjamin Society after a pioneering medical doctor, the association issues Standards of Care that govern the process by which transgender people can access hormonal and surgical interventions. This week’s release constitutes the seventh published set of standards; the first edition was released in 1979.

The new standards drastically improve transgender individuals’ access to transition-related health care by reducing the number of hoops.

Instead of requiring therapy for both hormones and surgery, along with real-life experience (time lived as one’s gender) for beginning hormones, the 7th edition suggests therapy but clarifies that it is optional; instead, an evaluation by a provider will suffice. An “informed consent” model for hormonal treatment, already in use by clinics across the United States, now falls firmly within the guidelines.

Perhaps most importantly, the standards unambiguously state the necessity of doctor support and political equality.

The standards include not only a blanket opposition to “reparative therapy,” which aims to make transgender people comfortable in the gender they were assigned at birth, but also an admonition to mental health providers: One of their most important roles is that of an advocate. The standards read:

Transsexual, transgender, and gender nonconforming people may face challenges in their professional, educational, and other types of settings as they actualize their gender identity and expression. Mental health professionals can play an important role by educating people in these settings regarding gender nonconformity and by advocating on behalf of their clients. This role may involve consultation with school counselors, teachers, and administrators, human resources staff, personnel managers and employers, and representatives from other organizations and institutions. In addition, health providers may be called upon to support changes in a client’s name and/or gender marker on identity documents such as passports, driver’s licenses, birth certificates, and diplomas.

In the past, the WPATH standards have been criticized by transgender activists and bloggers as overly restrictive and pathological.

Transgender people who did not fit the particular model, including those who did not identify as a binary male-female gender, were denied treatment at clinics that used the association’s standards—including surgeons who offer transition-related procedures and operate based on WPATH recommendations.

Costly therapy placed the price of transition out of range for many low-income trans people (who are much more likely to be unemployed, underemployed, and homeless than non-trans people).  And those who could not or would not follow a specific protocol or present a certain way were forced to lie or “fake it” in an attempt to convince doctors that they were worthy of health care.

“The previous versions of the [Standards of Care] were always perceived to be about the things that a trans person must do to satisfy clinicians, this version is much more clearly about every aspect of what clinicians ought to do in order to properly serve their clients,” said Standards of Care International Advisory Committee member Christine Burns.  “That is a truly radical reversal . . . one that serves both parties very well.”

It’s that model of a doctor-patient collaboration that highlights the root of the changes: The gender dysphoria suffered by transgender people is a condition to be managed and approached on an individual basis, not a disease or problem to be medicated away.

Transsexuality and transgender identification are no longer negative conditions in and of themselves, but the distress that can sometimes result is worth treating. “Being transsexual, transgender, or gender nonconforming is a matter of diversity, not pathology,” boasts an early segment of the standards.

The new recommendations for care are in line with this vision, and the change carries enough authority to significantly improve the lives of transgender people worldwide.

Shay O'Reilly is a reporter with Campus Progress. Follow him on Twitter @shaygabriel.

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