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New standards of care issued
I feel this is relevant to any discussion about labels. Removing pathologising labels is part of what must be done
Moderator
Quote:This post has been moved.. because it is too important to be lost as an off-topic post at the end of a thread!WPATH announces new standards of care for transgender and gender nonconforming people
by Dyana Bagby
September 25, 2011 19:57There 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.
Ushers brought out champagne flutes to attendees and to members of the standards of care revision committee and all raised several toasts after version 7 was announced.
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.
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11 Replies
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For those interested in reading the 7th edition.
You can read it here: -
Thanks Amanda, an important read for many of us, the tide is slowly moving towards understanding and acceptance it seems.
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Thank you for placing this post in a more prominent place. I knew it was too important not to post.
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Of course the changes to SOC are welcomed, and the trend towards a more flexible approach has been a long time coming. However, there is always room for improvement, like more accommodation for intersex issues.
An intersex commentator has criticised the new standard (notwithstanding the use of the term “Gender Nonconforming” by WPATH):
Quote:Where Trans have fought tooth and nail to have trans de pathologised, yet Intersex are left with the stigma of Disorders of sex development in this WPATH standard for those who reject birth assignments. How come it is pathologising for Trans to have gender Identity Disorder as a completely unacceptable stigmatising descriptor and yet all of those Trans activist over at WPATH see nothing wrong in pathologising us. Some solidarity is needed here folk . If it is no good for you it is no good for us.As for removing pathologising labels, I see WPATH has stuck with the descriptor “Transsexual, Transgender, and Gender Nonconforming People”, so whether or not this is truly removing labels or not, it seems to me to be perpetuating the schism that “transgender” is an umbrella term at the expense of the transsexual separatists, but hey that’s me making a general observation and not pushing any agenda (and I’m not posting this to open any can of worms or generate heated debate about labels).
Also, from the web, are some criticisms and food for thought:
Quote:Thesis 1:
“Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth” (SOC 7)Answer:
“Fine. But why does WPATH call a transsexual girl a ‘b…oy’ and a a transsexual boy ‘girl’ when this causes ‘gender dysphoria’? We believe that there would be a simple solution to stop something like ‘gender dysphoria’. To accept sexual minorities. ‘gender dyphoria’ is the side-effect of a trans-, homo-, and interphobic society. And the WPATH is part of that transphobia. ‘gender dysphoria’ is an invention of sexologists who originally caused that distress.”Thesis 2:
“Some people experience gender dysphoria at such a level that the distress meets criteria for a formal diagnosis that might be classified as a mental disorder.” (SOC 7)Answer:
“Sexologists from the WPATH spread the rumour that body modifications need the formal diagnosis of a mental disorder. We call that a big lie. If sexual deviations would be accepted in society and selft-determination would be part of the laws in the countries of the world, other WHO-ICD-Codes (International Statistical Classification of Diseases and Related Health Problems) would be possible to ensure medical care without a diagnosis from a psychiatrist. So it is self-evidently, that people from WPATH are not willing to support reforms of laws or movements who fight for the right of sexual variant people, that they can change their civil status or other gender markers without the help of a sexologist.”I trust that some of you may find this interesting.
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Thank you Virginia. You make & cite some very valid points. It’s so easy to focus on the ‘ME’ issues, because this is what impacts on my life, & loose sight of the issues impacting on others.
I’m not interested in any of these inane labels other than the one I apply to myself. For me, that’s female. Each & every one of us should be allowed to self-identify, & be accepted & supported in that autonomy. Slowly, we’re achieving this. Umbrellas don’t stop all of the rain.
Have a look at this.
http://edition.cnn.com/2011/09/27/health/transgender-kids/index.html
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Christina – I don’t think there are many amongst us who would argue that we should just get on with our lives without labels, and because we are all different, it is difficult to have any meaningful label. But as for the sentiment that umbrellas don’t stop all of the rain, that’s the very point.
How do you even start to stop the rain? Living our lives within our own definitions will not stop discrimination (like being asked not to go to a pub because other patrons may be offended), trans people not getting jobs, trans people being discriminated and vilified in the work place when they do get jobs, trans people being put in the prison of their natal sex irrespective of anything else, trans people not getting the right health services through ignorance or discrimination (I once had an appointment to see a genetics person and was sent to an FTM expert, and wasted a half a day) and these are just a few of the harms the trans community suffers. Add them all up, and you’ve got “rain”.
I guess there are many who are not directly affected by the rain, but that shouldn’t stop everyone who is in the community supporting change. You don’t have to be an indigenous to support indigenous rights. And how do you seek change if you can’t even describe your group? Oh, labels. Or shall we call them descriptors?
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For many years, partly tongue in cheek, but mostly in all seriousness, I asserted I was born with a long arm deletion of an X chromosome – I wish it were that simple. Seriously though, this is an option not considered by the geneticists. It looks like a Y chromosome, therefore it is.
The labels are solely so we can be pathologised. This includes the intersexed, & WPATH has conformed with this thinking. It’s easy. We’re able to point to something at variance to “normal”.
I was born with a 3rd palmar crease. It’s called ‘a Sydney line”. What’s the significance – nothing at all. It’s a “normal variant”.
Other than that I’ve lived with a lot of stress & been subjected to large amounts of personal abuse, including physical violence, my gender expression is a “normal variant”. It doesn’t impact of itself upon my physical, mental of intellectual competence – & in fact there is evidence that my intellectual abilities will be 2 standard deviations above average, & I’m more likely to be left handed. Again, another “normal variant”, in the past seen as demonic possession & lots of other denigrations.
We are all “normal”, just different from the majority. But even then I’ll dispute that I’m different. I have hazel eyes & (had) blonde hair. Far more people have brown eyes & black hair, unless your ancestry comes from parts of Europe. I’ve passed on the ranga gene – I have Neanderthal ancestry. I’m very normal.
We allow ourselves to focus too much on what makes us different. I’ve seen huge changes over the past 40 years, across a wide range. In 1973, the word ‘ethnic’ went from not existing in the Australian vocabulary to being a highly offensive & derogratory word. The government established the Dept of Ethnic Affairs. Labels will always be used to stigmatise & pathologise us. Working in Mental Health I witnessed the word “client” become of term of derision.
I waffle. Don’t quite know what point I’ve made, but I do hope it makes some kind of sense
Arohanui & Blessings
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I do share your sentiments, Christina, about the undue focus being on the abnormality as opposed to the subtle variations of normality. But therein lies the problem.
There seems to be an invisible line at which abnormality is accepted and not accepted. People fawn over children born with Downs Syndrome but seldom an Intersex child. And it seems that many “invisible abnormalities” are accepted unquestionably (e.g. those with third palmar creases).
And we may not necessarily have been personally confronted with too many instances of vilification, or discrimination about our trans existence, but there are many that clearly have been. Check this out:
http://www.transequality.org/PDFs/Executive_Summary.pdf
Sure, there are lies, lies and statistics, and the survey may not be completely accurate scientifically, but I think the message is loud and clear. Trandgender and gender non-conforming people face injustice at every turn. Not many of those people who are in the invisible abnormality category have the rate of suicide as those in the trans community. And it’s not because of a special preponderance towards suicide, I’m sure.
So what do we, as a community want to do about this? If anyone is going to make any change you have to describe yourself. Hence labels. Sure labels are not useful for social interaction – the continuum is the continuum. We are many and varied. But beneath all of this is a golden thread of common attributes – like the one ring that rules them all – this thread binds us together, and we need that thread (irrespective of what you call it – thread, label, umbrella, descriptor) to make our lives better.
So, that’s my waffle … nothing in the way of virulent debate and character assassinations intended. Just healthy (I hope) contemplation about our state of being, and wanting a better world for us (it’s not about me). I, like everybody else I’m sure, wish we had no reason to have to have a need for a label, but until there is a survey that shows that all of these inequalities no longer pevail, I suspect that a label will be necessary.
Moderator
Quote:A gentle reminder is probably in order – that THIS thread is about the Standards of Care!! Lest it strays more solidly into label-land!!! -
In another thread, http://forum.tgr.net.au/cms/forum/F176/4574-574
I highlighted the proven high incidence of people self-administering prescription hormones.
This triggered an observation that is probably best discussed here to avoid hi-jacking the original thread.Quote:the “rules” need adjusting to be more reflective of the needs of those who need to take hormones. Adjustments have been made and guidelines from WPATH and DSM are far less restrictive than they used to be regarding this. That is not to say further refinement is not required.This comment sent me back looking at the Standards of Care again.
I will be the first to admit that I haven’t read all of the 120 pages in the the document. Largely because I have found that its focus on the standards of a care for a small minority of gender diverse people (those who wish to change their born sex) just leaves me asking “so – what about me?”.So let’s look to see if the SOC offers any route to normalising hormone use widely across our community.
Well, section 8 which covers hormone therapy starts in an encouraging way. After telling us that hormones are there to treat “gender dysphoria” (something discussed earlier in this thread) the DOC continues:
Quote:Some people seek maximum feminization/
masculinization, while others experience relief with an androgynous presentation resulting from
hormonal minimization of existing secondary sex characteristicsThen the SOC moves onto its criteria for Hormone Therapy.
Quote:1. Persistent, well-documented gender dysphoria;
2. Capacity to make a fully informed decision and to consent for treatment;
3. Age of majority in a given country (if younger, follow the Standards of Care outlined in section
VI);
4. If significant medical or mental health concerns are present, they must be reasonably wellcontrolled.That brings you crashing down to earth – because, no surprise, their criteria for hormone use is a psychological evaluation that you are “sick”. This isn’t progressive at all..it is the status quo of restricting access to hormones to those who present as being “sick” with major issues about being born male.
The TgR survey demonstrates this is denying a large number of people in our community appropriate medical care.
Then there is hope…a paragraph starts….
Quote:In selected circumstances, it can be acceptable practice to provide hormones to patients who have
not fulfilled these criteria.And it tells us that one way is to engage in “ilicit or unsupervised” hormone use to establish yourself in your affirmed gender.
Guess what! WPATH says that if you are inter-gender/gender queer/inter-sex/choose your own label and you can’t jump through the hoops of their guidelines then….
Resort to “ilicit or unsupervised” hormone use… And the TgR survey seems to indicate that is happening!
Of course if somewhere else in the 120 pages there is something I have missed skimming through – then please let me know.
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I can’t resist. I will play devils advocate.
I disagree with the interpretation that WPATH is implying that some one with Gender Dysphoria is “sick”. Additionally one does not have to have “major issues” with their gender being different from their physical sexual characteristics but someone with GD experiences “discomfort or distress” over this incongruence. This discomfort or distress may be only mild, it may be inconsistent or it may be significant. GD is no more an “sickness” than anxiety but like anxiety it can be identified and described and it will have an impact on quality of life.
The full paragraph with regards to exceptional circumstances is as follows:
“In selected circumstances, it can be acceptable practice to provide hormones to patients who have
not fulfilled these criteria. Examples include facilitating the provision of monitored therapy using
hormones of known quality as an alternative to illicit or unsupervised hormone use or to patients
who have already established themselves in their affirmed gender and who have a history of prior
hormone use.”My interpretation here is this. Firstly I believe the intent behind the “selected circumstances” paragraph is to ensure that patients who are at risk of accessing unprescribed hormones (e.g. have done so previously) can be supplied with a prescription UNTIL an appropriate diagnosis of their psychosocial health and gender nonconformity is made and appropriate treatments initiated. Now it is entirely plausible that one of those treatments may well be hormone therapy but that needs to be done by an appropriately qualified person in a careful manner. The “selected cases” clause in this circumstance is aimed at reducing potential unintended self harm.
The reason for the “selected case” of the individual who is already established in their affirmed gender is I believe to enable those individuals to complete the process of transition to a point that they are happy. Surely they must by definition have GD then? Maybe not. I mean if they are already established in their preferred gender then the individual may not ever particularly feel “distress or discomfort” over their physical sex characteristics. Why then would that individual wish to modify their physical bodies with hormone programs. I’m not really sure to be honest but maybe to maintain physical characteristics or develop them further to improve their quality of life in much the same way as someone may get cosmetic surgery.The question I suspect that is being asked here is “who should decide who, when and how an individual goes on to HRT, the individual or the individuals health carer?”. It is arguable that the principal decision maker should be the individual. However many (indeed possibly most) individuals are not well equipped to make a full assessment of the risks, benefits and need for treatment. One only needs to look at the use of antibiotics. Numerous studies over the years have demonstrated that when given free choice, even with appropriate education, a large percentage of individuals will elect to use antibiotics despite the fact that they will have no therapeutic benefit. However we also know that if the decision is exclusively up to the health carer that outcomes are poor and compliance with treatment programs is poor.
The WPATH guidelines emphasise the fact that the best way to achieve improved quality of life is through the close cooperative partnership between an individual and an appropriately qualified health care team.
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Quote:Of course if somewhere else in the 120 pages there is something I have missed skimming through – then please let me know.
It would be nice to have news that contradicts what you saw in skimming through the document.
What you described is the same as what members of the Yahoo Group, TS Do It Yourself Hormones, have discovered examining the document.
In the opinion of members of TSDIYH, the document affirms the continued use of medical practitioners and health insurance corporations as gate keepers, whose defined task is to keep the gates closed.
So in consequence, the very people that WPATH should have been trying to have its SOC have relevance for, instead, it again is continuing to drive them away into self diagnosis and self prescription.Jenifur Charne
