WPATH announces new standards of care for transgender and gender nonconforming people

[stephanie_TG (imported)]

SEPTEMBER 25, 2011 19:57

There were champagne toasts and rounds of applause as the World Professional Association for Transgender Health released on Sunday its newest Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People at a symposium at the Emory Conference Center in Atlanta.

WPATH revision committee chair Eli Coleman launched the 7th version of the standards of care to some 300 people who attended the symposium as part of a partnership with the Gay & Lesbian Medical Association and the Southern Comfort Conference, the largest transgender conference in the nation that takes place annually in Atlanta.

"This is a momentous occasion," Coleman said before he conducted a brief outline of the standards of care.

"This was a very, very important task. Just the title is a fundamental change — you do not see Gender Identity Disorder," Coleman said to a warm round of applause from transgender people and physicians and psychotherapists who work with transgender individuals.

"We've made a clear statement that gender nonconformity is not pathological," a pronouncement greeted with another round of applause from attendees.

"We've set a whole different tone. It's more about what the professionals have to do" and not about transgender people having to prove their health needs to the professionals, he explained.

And when Coleman announced that the new standards of care state in no uncertain terms that "reparative therapy is unethical," there was even more applause.

"This is no longer about hormones and surgery — it's about health in a holistic sense," Coleman said.

Walter Bockting, the outgoing president of WPATH, said in an interview before the launch that the version 7 of the standards of care represents a significant departure from the past six versions — the original version was published in 1979 with revisions made in 1980, 1981, 1990, 1998 and 2001.

"Some of the changes we've made really incorporate the latest science," Bockting said. "Research in this area is really increasing so it is still a growing area but there has been a boom in research publications. Our standards of care are more evidence based."

Some key revisions:

• 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. An assessment is still required but that can be done by the prescribing hormone provider," Bockting explained.

• 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.

"The SOC are flexible clinical guidelines; they allow for tailoring of interventions to the needs of the individual receiving services and for tailoring of protocols to the approach and setting in which these services are provided," Coleman explained.

"Access is more open and acknowledges transgender care is being provided in community health centers. This certainly makes it easier to access hormones," Bockting added.

• 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, Bockting explained, is that the standards "allow for a broader spectrum of identities – they are no longer so binary."

"There is no one way of being transgender and it doesn't have to mirror the idea of a change of their sex," Bockting explained.

"These standards allow for a gender queer person to have breasts removed without ever taking hormones," he said.

The WPATH conference in Atlanta, along with the Southern Comfort Conference and the conference of the Gay & Lesbian Medical Association, was a joint effort to show the world what is being done in the area of LGBT health.

But, Bockting added, the new WPATH standards of care also show the tremendous effort that transgender people themselves are doing to ensure their access to healthcare.

"Oftentimes the standards of care were perceived as a barrier even though they were meant as access to care for hormone therapy and surgery," he said.

"The new standards showcase the important role [transsexual, transgender, and gender nonconforming people] have played in changing the landscape of transgender health in the U.S.," Bockting added.

[Cainanite (imported)]

This is good news.

I don't know why, but I have always hated the term "Gender Identity Disorder". When I try to break it down, I can't quite. Clearly it is a term meant to be innocuous, but it seemed like they were trying to say to me, I was defective as a person. I'm not defective, I just don't have the physical body I should have. When I close my eyes, I see myself one way, when I open them, I see something different in the mirror. Saying it is a disorder is like saying my desires for how I want my body to be, is itself wrong. It is my bloody body! It's not a disorder to want to be comfortable in it.

I'll withhold my judgment on the part that says,

"allow for a broader spectrum of identities – they are no longer so binary."

Does that broader spectrum allow for someone who merely desires the loss of their testicles? Is it still a disorder for an asexual man to desire an asexual body? Do they recognize the option "neither", to the question of sexual identity as valid? Or do I have to class myself as homosexual, leaning to female transgender to qualify? I'd like more details on what that spectrum recognizes before I celebrate too much.

All in all, this looks to be a major step forward. I look forward to reading more about it, and if this will have an effect where I live in Canada.

[stephanie_TG (imported)]

SEPTEMBER 25, 2011 19:57

There were champagne toasts and rounds of applause as the World Professional Association for Transgender Health released on Sunday its newest Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People at a symposium at the Emory Conference Center in Atlanta.

WPATH revision committee chair Eli Coleman launched the 7th version of the standards of care to some 300 people who attended the symposium as part of a partnership with the Gay & Lesbian Medical Association and the Southern Comfort Conference, the largest transgender conference in the nation that takes place annually in Atlanta.

"This is a momentous occasion," Coleman said before he conducted a brief outline of the standards of care.

"This was a very, very important task. Just the title is a fundamental change — you do not see Gender Identity Disorder," Coleman said to a warm round of applause from transgender people and physicians and psychotherapists who work with transgender individuals.

"We've made a clear statement that gender nonconformity is not pathological," a pronouncement greeted with another round of applause from attendees.

"We've set a whole different tone. It's more about what the professionals have to do" and not about transgender people having to prove their health needs to the professionals, he explained.

And when Coleman announced that the new standards of care state in no uncertain terms that "reparative therapy is unethical," there was even more applause.

"This is no longer about hormones and surgery — it's about health in a holistic sense," Coleman said.

Walter Bockting, the outgoing president of WPATH, said in an interview before the launch that the version 7 of the standards of care represents a significant departure from the past six versions — the original version was published in 1979 with revisions made in 1980, 1981, 1990, 1998 and 2001.

"Some of the changes we've made really incorporate the latest science," Bockting said. "Research in this area is really increasing so it is still a growing area but there has been a boom in research publications. Our standards of care are more evidence based."

Some key revisions:

• 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. An assessment is still required but that can be done by the prescribing hormone provider," Bockting explained.

• 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.

"The SOC are flexible clinical guidelines; they allow for tailoring of interventions to the needs of the individual receiving services and for tailoring of protocols to the approach and setting in which these services are provided," Coleman explained.

"Access is more open and acknowledges transgender care is being provided in community health centers. This certainly makes it easier to access hormones," Bockting added.

• 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, Bockting explained, is that the standards "allow for a broader spectrum of identities – they are no longer so binary."

"There is no one way of being transgender and it doesn't have to mirror the idea of a change of their sex," Bockting explained.

"These standards allow for a gender queer person to have breasts removed without ever taking hormones," he said.

The WPATH conference in Atlanta, along with the Southern Comfort Conference and the conference of the Gay & Lesbian Medical Association, was a joint effort to show the world what is being done in the area of LGBT health.

But, Bockting added, the new WPATH standards of care also show the tremendous effort that transgender people themselves are doing to ensure their access to healthcare.

"Oftentimes the standards of care were perceived as a barrier even though they were meant as access to care for hormone therapy and surgery," he said.

"The new standards showcase the important role [transsexual, transgender, and gender nonconforming people] have played in changing the landscape of transgender health in the U.S.," Bockting added.

The World Professional Association for Transgender Health

(WPATH) released it’s 7th Version of

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

(SOC) in Atlanta today. The previous Version 6 was published in 2001. Overall, this newest SOC represents significant forward progress in respecting trans people and affirming the necessity of medical transition care for trans and transsexual individuals who need it. Although controversies and issues of transition care access remain in the SOC7, WPATH has announced a more frequent update process that will hopefully be more responsive to emerging evidence and clinical experience in the future.

First published in 1979, the SOC has provided clinical guidance to medical and mental health providers serving trans people, with an emphasis on transsexual individuals seeking hormonal and/or surgical transition care. In many parts of the world, particularly North America and Europe, the SOC has played a role in enabling access to medical transition care and in enabling medical and surgical practitioners to provide it. However, the SOC has been controversial among trans communities and supportive care providers. For example, prior versions have been critized for unreasonable barriers to medical transition care, pathologizing language of “disordered” gender identities and “gender‐disturbed children,” maligning pronouns and terms for transitioned individuals, and compulsory psychotherapy requirements. Fortunately, successive revisions of the SOC have trended toward greater respect for trans and transsexual people and fewer unjustified barriers to transition care. For example, mandatory urological examinations were dropped from the 4th Version in 1990, and mandatory psychotherapy requirements for those needing access to hormonal or surgical transition care were dropped from the 5th SOC in 1998.

Gender Conversion Psychotherapies are Unethical

Perhaps the most historic change in the SOC7 appears in the section of ethical guidelines:

Treatment aimed at trying to change a person’s gender identity and lived gender expression to become more congruent with sex assigned at birth has been attempted in the past (Gelder & Marks, 1969; Greenson, 1964), yet without success, particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.

Though long overdue, this condemnation of gender-conversion or gender-reparative psychotherapies sets a new ethical standard for the mental health professions. Sexual orientation conversion therapies have been rejected by the American Psychiatric Organization, the American Psychological Association, the American Medical Association, the National Association of Social Workers and many other professional associations for over a decade. Yet the mental health and medical professions have maintained a double standard for trans, transsexual and gender nonconforming people victimized by analogous gender-reparative therapies that are equally harmful.

I commend the WPATH leadership and the SOC committees for taking this historic step and call upon the American Psychiatric Association and other professional associations to follow WPATH’s leadership on this important issue.

De-psychopathologisation of Gender Difference

The 7th Version of the SOC goes further than prevous versions in employing respectful language and dispelling false myths that equate nonconformity to birth-assigned sex and gender roles with mental illness. A section entitled, “Being Transsexual, Transgender, or Gender Nonconforming Is a Matter of Diversity, Not Pathology,” prominently notes:

WPATH released a statement in May 2010 urging the de-psychopathologization of gender nonconformity worldwide (WPATH Board of Directors, 2010). This statement noted that “the expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon [that] should not be judged as inherently pathological or negative.”

We can only hope that the American Psychiatric Association and World Health Organizations will take guidance from this principle in future revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD).

The de-psychopathologization principle is underscored by statements that, “Psychotherapy is not an absolute requirement

for hormone therapy and surgery,

” first introduced in Versions 5 and 6–

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy – although highly recommended – is not a requirement.

The new standard clarifies gender dysphoria, from a greek root for distress, as the focus of treatment, replacing pathologizing language of “disordered” gender identity. Gender dysphoria is painful distress with one’s current physical sex characteristics or assigned or ascribed social gender role. Social role transition to a congruent, affirmed gender role and hormonal and/or surgical transition treatments (for those who need them) are well proven in relieving this distress. The SOC7 notes,

transsexual, transgender, and gender nonconforming

individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available.

The American Psychiatric Association has already proposed to replace the defamatory diagnostic title of “gender identity disorder” with Gender Dysphoria in the pending 5th Edition of the DSM.

Other Positive Changes

The tone and language of the SOC7 are more positive than in previous versions, with more emphasis on care and less emphasis on barriers to care. Some highlights include:

Concise and more cogent criteria for access to hormonal and surgical transition care.

Relaxation of the age 18 restriction for access to hormonal transition care.

Removal of the three month requirement for either “real life experience” (living in a congruent gender role) or psychotherapy before access to hormonal care.

Clarification that “the presence of co-existing mental health concerns does not necessarily preclude access to feminizing/masculinizing hormones .”

Removal of barriers to surgical care because of family intolerance or interpersonal issues.

An expanded role for medical health professionals in granting access to hormonal therapies.

Acknowledgement of informed consent model protocols, developed at community health centers worldwide for hormonal transition care.

Emphasis of cultural competence and sensitivity for care providers.

Expanded and clarified information on puberty delaying treatment for gender dysphoric adolescents.

Clarification on the role of the SOC as flexible clinical guidelines that may be tailored for individual needs and local cultures.

Issues for Future Revisions

Although the 7th Version of the SOC is significantly improved over previous versions, there remain issues of concern to trans communities and their allies. One issue is promotion of a widely held myth that gender dysphoria in children will persist in only a small minority by adolescence, in other words, that gender identity in children is malleable and impersistent. These statements in the SOC are based on studies that conflated mere nonconformity of gender expression in children with the distress of gender dysphoria: painful distress with born sex characteristics or assigned gender roles. Among a new generation of gender dysphoric children from supportive families, children who have actually transitioned to affirmed roles congruent with their gender identities, there is so far very little evidence of impersistence. Hopefully, future revisions of the Standards of Care will quickly incorporate research findings on these new populations of affirmed youth, as they become available.

[kristoff]

Anyone who wants a PDF of the new SOC can send me an email capable of receiving PDF files, and I will be happy to send them. Otherwise, the SOC's will be on WPATH site sometime later today. Be sure to make them available to your health care providers where needed. If you cannot PM me, send an email to EAKristoff @ hotmail.com.

[stephanie_TG (imported)]

thank you for viewing the thread kristoff

[kristoff]

thank you for viewing the thread kristoff

You're welcome. The WPATH conference has been interesting. Jesus, eunuchunique, and I all presented papers at the conference this AM. More later.

[janekane (imported)]

The WPATH SOC changes I understand have been accepted are nicely compatible with the research I have been doing, and, to me, represent a noteworthy improvement in reducing the abuse(s) some folks experience from social folkways, and even moreso, from certain social mores. When mores devalue, deindividuate, and depersonalize people whose lives are profoundly of diversity rejected by social mores, one or another form of abuse, so I find, becomes inescapable.

I am familiar with the professional membership requirements of WPATH, and find that I easily meet those requirements. When I can scrape together the necessary collection of fiat pennies, I plan to request, and expect to be granted, full WPATH membership. Will such happen? Wait and see?

In 1986, I found the HBIGDA SOC to be unduly abusive by requiring me to live in a gender role unsuited to my life, and the latest WPATH SOC allow me to become an SOC-valid person? It seems promising to me, and I am grateful to our WPATH presenters for their efforts and accomplishments.

[loveableleopardy (imported)]

Interesting........just had a bit of a skim through - very tired this morning.

I'd forgotten about this conference, but my doctor said that he was going to this and would even bring up my case, which he sees as unique. So perhaps it will be more possible now for me to be given permission to try Androcur? Another interesting thing is do I now want to?

Deep down that answer is yes, so I will need to book in another appointment at some stage and see what happens.

I am sooo tired right now (largely from sex); couldn't imagine Androcur making me anymore so;)

[ned123 (imported)]

Well from what I can tell so far this is a wonderful step forward. Finally breaking away from the binary approach to gender. There is a huge spectrum and range and it is great to see that this is being recognized. The move towards informed consent has been progressing for some time, and looks like it is now fully accepted. the move away from the "disorder"model is a very positive thing. I think there are many people out there who had no where to turn because they didn't fit the classic and very limited definition of GID or transexual. There are many gender varients and it seems now each is recognized as valid. Now that various services from hormones to surgery are made available without the oppressive gatekeeper, and hoop jumping, life will improve greatly for many people. In terms of overall public health this is a great step forward. Now if we can just get DSM to back off, the first steps of normalizing the gender spectrum will get underway.

[kristoff]

One of the papers presented as part of the Male to Eunuch GID and BIID section of the WPATH Conference can be read here. Other parts of the presentation have been posted here before - the results of the EA survey.

http://www.eunuch.org/forums/showthread ... Castration