Following ICD-11, Rebuilding Mental Health Care for Transgender Persons: Leads from Field Experimentations in Lille, France

Baleige, Anna; Chenelière, Marie de la; Dassonneville, Cyane; Martin, Marie-Jeanne

doi:10.1089/trgh.2020.0143

Cited by 9 publications

(32 citation statements)

References 16 publications

(51 reference statements)

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“…Such developments, involving a depathologization (or more precisely a de-psychopathologization) of transgender identities, are fundamentally important on a number of grounds. In the field of health care, they may have helped support a care model that emphasizes patients’ active participation in decision-making about their own health care, supported by primary health care professionals (HCPs) (Baleige et al., 2021 ). It is reasonable to suppose these developments may also promote more socially inclusive policies such as legislative reform regarding gender recognition that facilitates a rights-based approach, without imposing requirements for diagnosis, hormone therapy and/or surgery.…”

Section: Chapter 2 Global Applicabilitymentioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,081

492

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Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for t...

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Section: Chapter 2 Global Applicabilitymentioning

confidence: 99%

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Coleman

Radix

Bouman

et al. 2022

International Journal of Transgender Health

1,081

492

View full text Add to dashboard Cite

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“…The shift in care delivery models is partly based on the depsychopathologization of TGD persons in the eleventh revision of the International Classification of Diseases (ICD-11) [ 5 ]. ICD-11 brought along epistemic transformations characterized by a politicization of classificatory considerations [ 6 , 7 ] while maintaining an appearance of neutrality focused on classification comparisons [ 6 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…In this context, depsychopathologization is best understood as part of a paradigm shift, rather than a natural evolution of medical epistemologies [ 8 ]. Thus, it appeared both as a violation of basic human rights [ 7 ] and as an unnecessary burden on the lives of TGD individuals and clinical practice [ 4 , 5 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…Out of the six field studies conducted for ICD-11 [ 9 ], one was carried out in France in a multidisciplinary primary healthcare provider (Maison Dispersée de Santé, now MDS), based on risk-reduction and the free and informed consent model [ 4 ], and working closely with local TGD organizations [ 5 , 10 ]. This study drew on a participatory aspect.…”

Section: Introductionmentioning

confidence: 99%

“…However, while these dynamics demonstrated the possibilities of providing free and informed consent-based health care [ 5 , 10 ], the study did not address power dynamics inherent to participatory research [ 15 ], especially on such a politicized subject [ 16 ]. In fact, beyond the systemic transphobia built into the research pipelines [ 14 ], incongruence between TGD consultants and research professionals was documented during the study’s implementation and subsequent stages [ 14 ], leading to their gradual, then definitive, withdrawal [ 9 , 10 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

Baleige

Guernut

Denis

2022

IJERPH

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Depsychopathologization of transgender and gender diverse (TGD) individuals in the eleventh revision of the International Classification of Diseases (ICD-11) called for a shift in care delivery models, based on free and informed consent. Public health policies face epistemic and discriminatory challenges and consensus built on evidence-based data is needed. TGD communities were consulted but did not actively participate in ICD-11 and the following public health debates. There is a need for TGD perspective—both in research and practice. This study draws on a peer-led participatory approach and explores TGD participants’ recommendations based on unexploited French data from ICD-11, in which 72 TGD gave feedback on public policies. Lexicometric analyses were conducted using the ALCESTE method and resulted in a two-step double Descending Hierarchical Classification. Sex, gender, and health consumption were analyzed as secondary variables. The first classification highlighted five main topics: care pathways, training of professionals, access, literacy, and civil status change, developed into 12 targets in the second classification. While sex and gender appeared to have little impact on discourses, recommendations varied according to received care. This study supports the growing scientific consensus of a public health approach to face TGD health challenges and emphasizes TGD individuals’ expertise.

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Update on bioethical, medical and fertility issues in gender incongruence during transition age

Conflitti

Spaziani²,

Pallotti

et al. 2023

J Endocrinol Invest

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Purpose Many issues still remain unresolved in the management of pubertal patients with gender incongruence (GI). The aim of this review is to discuss the main aspects of the treatment of these patients to provide a practical approach for clinicians. Methods A comprehensive literature search within PubMed was performed to provide updates of available evidence regarding the impact on bioethical, medical and fertility issues in gender incongruence during transition age. Results Gender Affirming Hormone Treatment (GAHT) and Gender Affirming Surgery (GAS) can induce unsatisfaction with change, future regrets, and the risk of infertility. This raises ethical issues especially in the management of pubertal patients that remain unresolved. Therapy with GnRH analogues (GnRHa) is intended to delay puberty, so as to give the adolescent a longer period of time to decide whether to continue with the treatments. At the level of physical changes, this therapy may have an effect on bone mineralization and body composition; however, long-term longitudinal data are not yet available. An important feature related to the use of GnRHa is the risk of fertility. Gamete cryopreservation is the most established method of fertility preservation (FP) and should be counselled to transgender adolescents. However, these patients are not always interested in having biological children. Conclusion Based on the current evidence, there is a need to conduct further research to clarify certain issues and to standardize clinical practice and improve counselling in transgender adolescent decision making and avoid regrets in the future.

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Following ICD-11, Rebuilding Mental Health Care for Transgender Persons: Leads from Field Experimentations in Lille, France

Cited by 9 publications

References 16 publications

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Impact of Depsychopathologization of Transgender and Gender Diverse Individuals in ICD-11 on Care Delivery: Looking at Trans Expertise through a Trans Lens

Update on bioethical, medical and fertility issues in gender incongruence during transition age

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