If you are interested in accessing mental or physical health care to achieve a gender transition, or have a loved-one who is doing so, an important first step is reading and understanding the WPATH Standards of Care.
These are the guidelines that many psychologists, psychiatrists and medical professionals use in providing health care options to trans and gender-diverse individuals. The guidelines are not laws; they were built by the World Professional Association for Transgender Health (WPATH), with the combined efforts of health care professionals and trans persons. They are intended to help trans and gender-diverse persons obtain the best medical care available while preserving their dignity, worth and equality.
The Standards of Care document has undergone several revisions and is currently on Revision number 7, updated in 2011. the original version was published in 1979 with revisions made in 1980, 1981, 1990, 1998 and 2001.
Some key subjects the guidelines cover:
- The Difference Between Gender Nonconformity and Gender Dysphoria
- Epidemiologic Considerations
- Overview of Therapeutic Approaches for Gender Dysphoria
- Assessment and Treatment of Children and Adolescents with Gender Dysphoria
- Mental Health
- Hormone Therapy
- Reproductive Health
- Voice and Communication Therapy
- Postoperative Care and Follow-Up
- Lifelong Preventive and Primary Care
- Applicability of the Standards of Care to People Living in Institutional Environments
- Applicability of the Standards of Care to People with Disorders of Sex Development
The guidelines cover how trans and gender-diverse persons may access these various healthcare options, what the role of health-care providers should and should not be in helping them obtain the best medical care, and what risks may be associated with various types of health and wellness care.
Talk about the Standards of Care with your providers
After reading the Standards of Care, when you speak to a mental or physical health care provider, ask them about their understanding of the WPATH SOC. You may wish to print out all or part of the 112 page document to discuss with your provider. Not all health care providers are familiar with the SOC, so you may want to avoid health care providers who do not seem to understand or be interested in these guidelines.
Primary Care Physicians
Trans and gender-diverse people who are accessing medical transitional services will want to ensure that their primary care providers are familiar with the Standards of Care as well.
Key Revisions Made to the SOC in 2011
- Psychotherapy is no longer a requirement to receive hormones and surgery, although it is suggested. It used to be a minimum amount of psychotherapy was needed. Now an assessment is still required but that can be done by the prescribing hormone provider.
- Strong affirmation that attempts to change a person’s gender identity through “reparative” therapy are ineffective and unethical.
- Strong affirmation that transition-related treatments such as hormone therapy and surgery are medically necessary for many individuals and should be covered by insurance.
- A number of community health centers in the U.S. have developed protocols for providing hormone therapy based an approach known as the Informed Consent Model. These protocols are consistent with version 7 revisions of WPATH’s standards of care. Access is more open and acknowledges transgender care is being provided in community health centers. This makes it easier to access hormones. There are no informed consent clinics located in Indiana, although there are clinics in Illinois, Michigan and Ohio.
- Near elimination of the “real-life experience” requirement as a prerequisite criteria for medical transition in adults, with the exception of some genital surgeries.
- There are now different standards for surgery, as well. For example, a transgender man who wants a hysterectomy no longer has to live one year as a male in order to receive the surgery. Likewise, a transgender woman who wants her testicles removed does not have to live one year as a female. For people who want genital reconstructive surgery, however, the standards of care recommend living a year in the role of the gender they are transitioning.
- Another major change is that the standards allow for a broader spectrum of identities – they are no longer follow a strict gender binary. There is no one way of being transgender and it does not have to mirror the idea of a change of their sex. These standards allow for a gender non-binary person to have breasts removed without ever taking hormones.
The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender-nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population.
WPATH recognizes that health is dependent upon not only good clinical care but also social and political climates that provide and ensure social tolerance, equality, and the full rights of citizenship. Health is promoted through public policies and legal reforms that promote tolerance and equity or gender and sexual diversity and that eliminate prejudice, discrimination, and stigma. WPATH is committed to advocacy for these changes in public policies and legal reforms.