The Standards of care for gender identity disorders are non-binding protocols outlining the usual treatment for individuals who wish to undergo hormonal or surgical transition to the other sex. Clinicians' decisions regarding patients' treatment are often influenced by this standard of care (SOC).
Prior to the advent of the first SOCs, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before the 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment." These standards are still the most well-known; however, other sets of SOCs, protocols and guidelines do exist, especially outside the USA.
Included in the guidelines are sections on epidemiology, mental health professionals, treatment of children, adolescents and adults, hormone replacement therapy, the Real-Life Experience (RLE), which was formerly called the Real-Life Test, and surgery.
The current revision recommends that mental health professionals document a patient's relevant history in a letter, which should be required by medical professionals prior to physical intervention. One letter is required for hormone replacement therapy or either augmentation mammoplasty or male chest reconstruction. Two additional letters are needed for genital surgeries.
The Eligibility Criteria and Readiness Criteria give certain very specific minimum requirements as prerequisites to HRT or SRS. For this and other reasons, the WPATH-SOC is a highly controversial and often maligned document among patients seeking medical intervention (hormones, and/or surgery), who state that their legally protected right to proper medical care and treatment is unjustly and unduly withheld or even denied based on the SOC.
WPATH-SOC sections One through Four are introductory in nature, explaining (section I) the purpose, intent, and need for the SOC, (section II) epidemiological considerations relating to transsexual people, (section III) diagnostic nomenclature, and (section IV) the job of the mental health professional.
Sections Five through Eight begin the actual guide to treatment. They specifically address the manner in which to diagnose transsexualism in both minors and adults, the manner in which to document the diagnoses and recommendations ("The Letter") and also covers requirements and treatment using hormones, including use and effects of hormones.
Section Nine covers "The Real-life Experience," formerly the "Real Life Test".
WPATH-SOC sections Ten through Twelve specifically cover the surgical treatment of transsexual people. Section Twelve, titled "Genital Surgery," deals directly with all concerns about sex reassignment surgery. It includes six "Eligibility Criteria" and two "Readiness Criteria", which are intended to be used by professionals for both diagnosis and guidance before providing patients "letters of recommendation."
The Thirteenth and final section covers "post-transition follow-up".
A criticism levied against surgeons who perform SRS deals with the rare non-SOC practice requiring patients to divorce their spouse before the surgery is performed.
Treatment according to older SOCs is often reserved for transsexual people only, not for other transgender people, who might not want to undergo the complete set of treatments, or who see themselves outside a binary gender system. Such older SOCs are often used to withhold medical interventions from transgender people altogether.
A dramatic elevation in surgical and post-surgical risks as well as an increased possibility of post-surgical dissatisfaction is often the exchange for lower costs and fewer pre-surgical requirements such as weight limits. In other regions, notably Latin America, surgeons follow no particular set standards and use their own criteria for eligibility for surgery.
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