At a presentation at the Houston Transgender Center last Saturday Colt Meier, doctoral candidate at the University of Houston, and Levi Herman presented information on the World Professional Association of Transgender Health’s new Standards of Care 7. The new Standards of Care, released last month, offer a multidisciplinary guide to healthcare professionals working with “transexual, transgender and gender nonconforming” individuals.
According to Meier, the new standards represent a clear departure from the “gatekeeping” approach to trans medicine that had developed under the previous standards “The old [standards] used to be about what trans people have to do to get what they need,” said Meier. “The new ones are about how health professionals should help trans people.”
The new Standards of Care replace the association’s previous version, released in 2001, and reflect an additional decade of scholarly research on the trans community. Meier says that the previous standards were intended to be guidelines, not rules, but that many doctors took the general recommendations of the standards as being unyielding, and assumed that they should be applied to all trans patients. In publishing the new standards WPATH made it clear that, while the standards represent the best medical advice available, they should not be used as a “one size fits all” solution. For instance, the standards recommend that trans people who seek genital surgery or hormone therapy as part of their transition receive psychiatric care, but explicitly state that “psychotherapy is not an absolute requirement for hormone therapy and surgery.”
One of the biggest changes to come out of the new standards is an unambiguous statement on the ethics of medical professional’s efforts to dissuade trans people of the belief that their true gender is not in line with the gender they were assigned at birth. Attempts to change a person’s gender identity are “no longer considered ethical” under the new standards.
The earliest standards of care were published in 1979. According to Meier much of the early research was done by non-trans people and involved certain assumptions about the desired outcome of people seeking to transition. “Much of the research focused on people who had had genital surgery, which is just one form of surgery,” says Meier, adding that not all transgender people desire genital surgery to complete their transition. Because only a small segment of the community was included in the research the results did not reflect the full diversity of the trans experience. Additionally, in the early days there was an assumption that the purpose of gender transition was to allow the person transitioning to live as a heterosexual, with some doctors refusing to provide treatment to female identified, male bodied persons who where attracted to women. Meyer says that assumptions like this can cause participants in research studies to “tell the researcher what they want to hear,” so that the trans person is able to receive the medical care they need.
As more trans people have become involved in the research a broader picture of the community and its medical needs has come to light. For instance Herman says that “we’ve found is that when trans people conduct studies of the incidence of trans people they find far greater numbers. Perhaps because they are better able to work within the trans community.” Meier and Herman both say that there is a great need for additional research.
The full text of the new Standards of Care can be found on WPATH’s website.