I believe that surgeries of all kinds can and do make an enormous difference in the lives of trans people. But I also believe that surgery’s only prerequisite should be a simple demonstration of want. Beyond this, no amount of pain, anticipated or continuing, justifies its withholding."

Andrea Long Chu, The New York Times

Hormones

WPATH Criteria for hormones & top surgeries

Re-interpretation

The Path to Patient-Centred Care

  • WPATH Criteria for hormones & top surgeries

    Persistent, well-documented gender dysphoria

  • Re-interpretation

    Discuss patient’s gender identity and transition goals; Avoid using DSM criteria to diagnose “gender dysphoria”

  • The Path to Patient-Centred Care

    Patients are best positioned to define their gender identities; Research has demonstrated that when a diagnosis is required to access medical treatments, trans people will strategically recite gender dysphoria diagnostic criteria

  • WPATH Criteria for hormones & top surgeries

    Capacity to make a fully informed decision and to give consent for treatment

  • Re-interpretation

    Emphasize patient autonomy and collaboration in medical decision-making;

    Some clinicians have patients sign an “informed consent form” to orient conversations with patients, and to keep in the patient’s chart

  • The Path to Patient-Centred Care

    When patients have information on known risks, benefits and alternative options to treatments they are well- positioned to make an autonomous decision.

  • WPATH Criteria for hormones & top surgeries

    If significant medical or mental health concerns are present, they must be reasonably well controlled

  • Re-interpretation

    Contextualize within the patient’s history; Involve patients in determining whether their mental health is “well-controlled"; research associates access to hormones with an improvement in mental health and wellness outcomes2 3

  • The Path to Patient-Centred Care

    Involve patients in determining readiness for hormones; When patients have information on known risks, benefits and alternative options they are in a position to make an autonomous decision.

Surgeries

WPATH Criteria for Hysterectomy, Salpingo-Oophorectomy, and Orchiectomy

Re-interpretation

The Path to Patient-Centred Care

  • WPATH Criteria for Hysterectomy, Salpingo-Oophorectomy, and Orchiectomy

    Persistent, well documented gender dysphoria

  • Re-interpretation

    Discuss patient’s gender identity and transition goals; Avoid using DSM criteria to diagnose “gender dysphoria”

  • The Path to Patient-Centred Care

    Patients are best positioned to understand and define their gender identities; Research has demonstrated that when it is required to access medical treatments, trans people will strategically recite diagnostic criteria to obtain a diagnosis.;

    Patient-Provider trust and collaboration is improved

  • WPATH Criteria for Hysterectomy, Salpingo-Oophorectomy, and Orchiectomy

    Capacity to make a fully informed decision and to give consent for treatment

  • Re-interpretation

    Emphasize patient autonomy and collaboration in medical decision-making; Use decision-making aids to assist patient in selecting surgical procedures/techniques;

    Some clinicians may feel more confident having patients sign an “informed consent form” to orient conversations with patients, and to keep in the patient’s chart

  • The Path to Patient-Centred Care

    When patients have information on known risks, benefits and alternative options to treatments they are well-positioned to make an autonomous decision

  • WPATH Criteria for Hysterectomy, Salpingo-Oophorectomy, and Orchiectomy

    If significant medical or mental health concerns are present, they must be well controlled

  • Re-interpretation

    Contextualize within the patient’s history; Involve patients in determining whether their mental health is “well-controlled”; research associates access to surgeries with an improvement in mental health and wellness outcomes2 3

  • The Path to Patient-Centred Care

    Involve patients in determining readiness for surgeries; When patients have information on known risks, benefits and alternative options they are in a position to make an autonomous decision.

  • WPATH Criteria for Hysterectomy, Salpingo-Oophorectomy, and Orchiectomy

    12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the individual)

  • Re-interpretation

    Explain medical rationale for this criterion; Follow informed consent procedures, emphasizing patient autonomy; For orchiectomy with transfeminine spectrum people/trans women, explore desire for future vaginoplasty techniques that require scrotal tissue.

  • The Path to Patient-Centred Care

    Patient-Provider trust and collaboration is improved when clinicians explain the medical rationale for WPATH criteria

WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

Re-interpretation

The Path to Patient-Centred Care

  • WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

    Persistent, well documented gender dysphoria

  • Re-interpretation

    Discuss patient’s gender identity and transition goals; Avoid using DSM criteria to diagnose “gender dysphoria”

  • The Path to Patient-Centred Care

    Patients are best positioned to understand and define their gender identities; Research has demonstrated that when it is required to access medical treatments, trans people will strategically recite diagnostic criteria to obtain a diagnosis.

  • WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

    Capacity to make a fully informed decision and to give consent for treatment

  • Re-interpretation

    Emphasize patient autonomy and collaboration in medical decision-making; Use decision-making aids to assist patient in selecting surgical procedures/techniques

  • The Path to Patient-Centred Care

    When patients have information on known risks, benefits and alternative options to treatments they are well- positioned to make an autonomous decision.;

    Patient-Provider trust and collaboration is improved

  • WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

    If significant medical or mental health concerns are present, they must be well controlled

  • Re-interpretation

    Contextualize within the patient’s history; Involve patients in self-determining whether their mental health is “well-controlled”; research associates access to surgeries with an improvement in mental health and wellness outcomes2 3;

    Some clinicians may feel more confident having patients sign an “informed consent form” to orient conversations with patients, and keep in the patient’s chart

  • The Path to Patient-Centred Care

    Involve patients in determining readiness for surgeries; When patients have information on known risks, benefits and alternative options they are in a position to make an autonomous decision;

    Patient-Provider trust and collaboration is improved

  • WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

    12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless hormones are not clinically indicated for the individual)

  • Re-interpretation

    Explain medical rationale for this criterion; Follow informed consent procedures emphasizing patient autonomy and collaboration in medical decision-making ;

    For orchiectomy with transfeminine/trans women, explore desire for future vaginoplasty techniques that require scrotal tissue.

  • The Path to Patient-Centred Care

    Patient-Provider trust and collaboration is improved when clinicians explain the medical rationale for WPATH criteria

  • WPATH Criteria for Metoidioplasty or Phalloplasty, and Vaginoplasty

    12 continuous months of living in a gender role that is congruent with their gender identity.

  • Re-interpretation

    Discuss patient’s gender identity and transition goals; Give patients autonomy in self-determining if they have lived in a gender congruent role; Contextualize this criterion with respect to patient’s unique circumstance; Avoid asking employers/friends/family for guarantor letters or other “proof” of a patient’s gender role.

  • The Path to Patient-Centred Care

    This criterion could be flexibly applied given that some trans people who desire TRS may have non-binary gender identities, or may be unable to safely navigate the world in a gender congruent role 100% of the time;

    Patient-Provider trust is improved when collaborating together.

Footnotes
  1. Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, G., DeCuypere, J… & Zucker, K. (2012). Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. International Journal of Transgenderism 13(4), 165-232.
    ↩︎
  2. Bauer, G. R., Scheim, A. I., Pyne, J., Travers, R., & Hammond, R. (2015). Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in ontario, Canada. BMC Public Health 15(525),1-15. ↩︎ ↩︎ ↩︎
  3. Tomita, T., Testa, R.J. & Balsam, K.F. (2018). Gender-affirming medical interventions and mental health in transgender adults. Psychology of Sexual Orientation and Gender Diversity. DOI: http://dx.doi.org/10.1037/sgd0000316. ↩︎ ↩︎ ↩︎