Informed Consent in Trans Health Care

Informed Consent is a newer model of transgender healthcare that simplifies access to hormone replacement therapy for trans people. This model of health care is often done by Medical professionals in a cross-disciplinary environment (a health care center with both medical doctors and psychologists) who work with trans people to begin hormone therapy and other healthcare procedures after ensuring that the clients are able to make responsible decisions for themselves about their care.

Under informed consent;

  • You talk with a medical care provider (a physician or a nurse practitioner) to review the medical / physical risks of transition and rule out any medical conditions that could cause problems.
  • Go over a checklist of risks and effects
  • Get bloodwork done
  • Sign a consent form that states that you are making the decision to take hormones consciously, of sound mind and conviction.
  • Undergo a fairly short psychological evaluation to rule out other mental health conditions may also occur.

Protocols for this method of health care have been developed at several community health centers around the country (Callen Lorde Community Health Center, 2000, 2011; Fenway Community Health Transgender Health Program, 2007; Tom Waddell Health Center, 2006) and are consistent with the WPATH Standards of Care, Version 7.

The Howard Brown Center in Chicago has a PDF document outlining their protocol.

How is this different than the traditional model?

In the traditional model of care, doctors require a certification letter from a licensed counselor or therapist indicating that their client suffers from gender dysphoria and needs gender-related medical treatments. Counselors may work with clients for months to arrive at that diagnosis.

Non-conformity of gender identity used to be considered a mental illness – gender identity disorder – and as such, treating it with medical interventions required months of counseling beforehand.

In 2013, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) reclassified Gender Dysphoria, noting that gender nonconformity is not in itself a mental disorder. The distress of gender dysphoria is still considered clinically significant, however, and can require medical intervention for clients who desire it.

In 2011, the The World Professional Association for Transgender Health (WPATH) revised their recommended Standards of Care to support a second model of care that allows providers to begin therapeutic care for gender dysphoria after ensuring that clients understand that feminizing/masculinizing hormone therapy may lead to irreversible physical changes, and that the client has been screened for acute or current mental health concerns.

Is this model of health care legal?

Absolutely. Adult clients who can demonstrate their mental competency and who have means to pay for health care treatments should not be required to meet unreasonable standards to have access to health care they need. Cross-sex medical treatments to treat Gender Dysphoria are considered a medical necessity by most psychologists.

Minors are viewed differently both legally and medically – but parental consent will probably be required for those under 18.

Informed consent may not be for everyone

If you are still trying to figure out whether you want to transition, by all means, talk to a therapist or psychologist. Hormone treatments to achieve transition have irreversible side effects, and you should be fully informed about the changes you are going to undergo. Transition will affect you and all the people around you, and talking through the changes you will be undergoing will be of great benefit to you. The traditional model of transition care can be a safe and healthy route to access care.

Can I ask a doctor here in Indiana to treat me under the informed consent model?

That is up to the doctor. Any MD can prescribe hormone therapy treatment to you, including your primary care physician. Often an endocrinologist is preferred because they have more experience monitoring blood work and how hormones interact, but a PCP can undertake your care if they agree.

The informed consent model was developed at cross-disciplinary health care clinics where medical doctors and license therapists and counselors were on hand to follow an established protocol and to make assessments of a client’s health and well-being before beginning treatment.

Your doctor may not work closely with mental health professionals directly in their practice and may not feel qualified to assess your mental health before beginning treatment.

Are there Informed Consent Clinics in Indiana?

Not at this time, but there are clinics in Chicago and Michigan who operate under the Informed Consent Model of care, and trans folks from Indiana have experience with working with those clinics. Some trans folks in Indiana visit the Howard Brown Clinic or the Chicago Women’s Health Center in Chicago.

Informed Consent

Why do people opt for the Informed Consent Model?

The “traditional system” of trans care held a potential for abuse of trans people. In the past, care providers who did not understand gender dysphoria or the needs of trans people could be abusive to trans clients and ask them to do things they should not be required to do before allowing them hormone therapy or access to gender-confirming surgeries. Your mental and physical care providers should never –

  • delay medical assistance with transition for years (or even decades)
  • ask you to pay for lengthy or expensive amounts of psychotherapy
  • ask you to go “full time” before getting hormones, a practice that is highly discriminatory to those who do not “pass” before hormones and has absolutely no diagnostic or deterministic value
  • police your clothes, hair style, or ability to “fit” into the gender you identify with
  • ask you to divorce your partner
  • ask you to cut off communication from everyone in your life (friends, siblings, children, parents, spouses, etc) thereby eliminating your support networks at a time when you need it most.
  • ask you to go and have anonymous sex at a gay bar to “see if you are gay”

Mental and physical care providers should also never withhold treatment from you if you:

  • Do not fit in the gender binary (genderqueer, etc)
  • If you are “non op” and don’t plan to have gender-confirming surgeries
  • If you (in the opinion of the psychologist) have issues passing / didn’t look androgynous
  • If you don’t dress and act overly feminine/masculine
  • If your sexual orientation isn’t “straight” after your transition
  • If you are experiencing depression, self harm or suicidal ideation as a result of dysphoria or loss of family, friends, jobs, social status and privilege. Medical interventions are intended to help treat dysphoria, and withholding them creates a greater problem.

In some cases, trans people who have already transitioned and have long been under the care of physicians will move and have trouble finding a new primary care physician or endocrinologist who will treat them without undergoing months of counseling.

These are examples of abuse that mental and physical healthcare providers have carried out in the past against trans clients in their care under the traditional model. The informed consent model prefers not to pathologize trans clients.

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