“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 medical professionals who work with them.

“We’ve made a clear statement that gender nonconformity is not pathological,” he said, 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, Coleman said.

And when Coleman announced that the new standards of care state clearly “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.

First revisions in 10 years

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 noted.

• A number of community health centers in the U.S. have developed protocols for providing hormone therapy based on an approach known as the Informed Consent Model. These protocols are consistent with version 7 revisions of WPATH’s standards of care. “The standards of care 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 said, 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 said.

“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 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 said.

New standards ‘moving in the right direction’

Mara Keisling, founding executive director of the National Center for Transgender Equality, said the new standards of care are a “really important step forward.”

“The standards of care all along have allegedly been there to help trans people use the health care system to live fulfilling lives and healthier lives,” she said after the launch. “The new standards of care are a really, really good step in that direction. There have always been real shortcomings and a lot of them are addressed — everything from overall tone and overall purpose to tiny specific things.

“Now it’s less about trying to prove to health care providers that you deserve to be able to transition to instead providing guidance for both patients and health care providers to make sure the person can move forward in their life in productive ways,” she said.

There is still more work to be done, she added, especially because trans people are more likely to be poor, unemployed or underemployed and not have health insurance.

“And when we do have insurance, there are exemptions to our care or we get turned away,” she said. “There’s a lot more work to be done to make health care accessible to trans people. This is a really important part of that and I’m glad it happened.”

Lyle Blake of Santa Cruz, Calif., founder and COO of the Chicago-based Gender Identity Foundation for Transmen, came to Atlanta for the Southern Comfort Conference and the combined symposium held on Sept. 25.

“One of things I like is the closer connection between the informed consent model and the standards of care that are aligned with the same intent,” he said. “The standards of care are moving away from clients having to put clinicians at ease about their own care.”

For Shawn Crincoli, an associate law professor at Touro Law in New York, the revised standards of care are “excellent.”

“It’s moving in the right direction in terms of de-medicalizing and de-pathologizing gender dysphoria,” Crincoli said.

“I think it will help a lot of people, particularly people who don’t have easy access to health care, and it moves toward treating a disadvantaged population more generally.”

 

Top photo: Dr. Vin Tangpricha (far left), associate professor of medicine at Emory and local chair of the WPATH symposium, celebrates with Eli Coleman (center) and Walter Bockting, who both worked on version 7 of the standards of care.

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