Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People

Abstract

The World Professional Association for Transgender Health (WPATH) I is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, advocacy, public policy, and respect for transgender health. The vision of WPATH is to bring together diverse professionals dedicated to developing best practices and supportive policies worldwide that promote health, research, education, respect, dignity, and equality for transsexual, transgender, and gender nonconforming people in all cultural settings. One of the main functions of WPATH is to promote the highest standards of health care for individuals through the articulation of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People. The SOC are based on the best available science and expert professional consensus. II Most of the research and experience in this field comes from a North American and Western European perspective; thus, adaptations of the SOC to other parts of the world are necessary. Suggestions for ways of thinking about cultural relativity and cultural competence are included in this version of the SOC. 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 I Formerly the Harry Benjamin International Gender Dysphoria Association II The Standards of Care (SOC), Version 7 represents a significant departure from previous versions. Changes in this version are based upon significant cultural shifts, advances in clinical knowledge, and appreciation of the many health care issues that can arise for transsexual, transgender, and gender nonconforming people beyond hormone therapy and surgery (Coleman, 2009a, b, c, d). The Standards of Care 7TH VERSION World Professional Association for Transgender Health for 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. The Standards of Care 7TH VERSION ...

Gender identity, gender assignment and reassignment in individuals with disorders of sex development: a major of dilemma

“…In particular, this should be performed by a MHP skilled in GD in children and adolescents to assess the child's gender identity, the presence of GD, and psychosocial functioning. In case of GD in DSD conditions where no clear gender identity outcome can be predicted, the prescription of GnRHa, following the WPATH and the Endocrine Society guidelines [88,89], should also be considered. Such option could allow the child and family to gain time to clarify gender issues and reassignment decision making.…”

“…This option may be particularly relevant in case of GD in DSD conditions where no clear gender identity outcome can be predicted (see Table 1). In line with the Standards of Care of the World Professional Association for Transgender Health [89], it is recommended starting GnRHa when adolescents have experienced puberty to at least Tanner stage 2, because of the important diagnostic value of the negative emotional effects related to the first pubertal changes [51,89,90]. In particular conditions (such as in case of a gender assignment at birth different from the recommended one), an earlier treatment with GnRHa may be also considered.…”

“…A similar exhaustive psychosocial and medical assessment can guide team decisions about gender reassignment, timing of surgery, and sex hormone replacement [72]. In particular-when gonads are still present and possibly functioning-if eligibility criteria are fulfilled (see Table 2) [51,89,90], puberty may be temporary suspended by using gonadotropin-releasing hormone analogues (GnRHa). This treatment leads to a gradual regression of sex characteristic development, aiding in prolonging the diagnostic phase, whereas the body remains in a neutral early pubertal state.…”

“…In case of GD persistence and if eligibility criteria are met (see Table 2), puberty induction in accordance with the adolescent gender identity should be considered [51,89,90].…”

Utilization of the Veterans Affairs’ Transgender E-consultation Program by Health Care Providers: Mixed-Methods Study (Preprint)

“…Transgender individuals experience numerous health disparities [1], including health risk (e.g., victimization [2], health outcomes (e.g., depression, HIV [3]), and barriers to health care access [4], all of which can create complex care needs. Moreover, transgender individuals often require medical care specific to their gender affirmation (i.e., having their lived gender experience reflect their gender identity), including mental health services, evaluations for hormone therapy, prescription and monitoring of hormones, gender affirming surgery and post-operative care, and specialty services such as urology, endocrinology, and speech therapy [5]. In addition to specific services, there are unique needs related to documentation, particularly around sex assigned at birth, which health systems often link to other important medical services, including lab test values, medication dosages, and critical health screens such as breast or prostate exams.…”