I don’t think they thought I was ready for surgery… They wouldn’t hear me out… I felt like they didn’t believe me. Until I was like “I’m in therapy, and I’m in this” and… I felt like at that point they can’t deny me because I’m doing everything they asked and telling them everything they want to hear. And at that point I’d been presenting as female for almost 4 years [3 years beyond the WPATH requirement for lower surgery].
Trans patient, quoted in MacKinnon et al., (2020), International Journal of Mental Health
Decision aid for genital reconstruction surgery in transmasculine spectrum people and trans men.
Rainbow Health Ontario (RHO) is a province-wide program of Sherbourne Health that works to promote the health of Ontario’s LGBT2SQ communities and improve their access to services. RHO creates resources, provides information and consultation services, delivers education and training, and supports research to develop evidence-based practice and informed public policy.
Action Santé Travesties et Transsexuel(le)s du Québec (ASTTeQ) is a community trans health group, which aims to promote the health and well-being of trans people through peer support and advocacy, education and outreach, and community empowerment and mobilization. Follow the link for ASTTeQ’s handbook for health care and social service providers working with trans people.
CATIE strengthens Canada’s response to HIV and hepatitis C by bridging research and practice. We As Canada’s official knowledge broker for HIV and hepatitis C, CATIE connects healthcare and community-based service providers with the latest science, promotes good practices for prevention and treatment programs, and offers health resources for trans people.
Trans Care BC supports the delivery of equitable and accessible care, surgical planning, and peer and community support for trans people across British Columbia.
Abernathey, M. (2016, March 11). Gatekeepers vs. Informed Consent: Who Decides When a Trans Person Can Medically Transition? Retrieved from https://slate.com/human-interest/2016/03/transgender-patients-and-informed-consent-who-decides-when-transition-treatment-is-appropriate.html.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders(5thed.). Washington, DC: Author.
Ashley, F. (2019). Gatekeeping hormone replacement therapy for transgender patients is dehumanising. Journal of Medical Ethics. DOI: 10.1136/medethics-2018-105293.
Asscheman, H., Giltay, E.J., Megans, J.A., de Ronde, W.P., van Trotsenburg, M.A, & Gooren, L.J. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology 164(4), 635-642. DOI: 10.1530/EJE-10-1038.
Barry, M.J., & Edgman-Levitan, S. (2012). Shared decision making – The pinnacle of patient-centred care. New England Journal of Medicine 366(9), 780-781.
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.
Beauchamp, T.L., & Childress, J. (1979). Principles of Biomedical Ethics, New York: Oxford University Press.
Berg, M. (1997). Problems and promises of the protocol. Social Science and Medicine 44(8), 1081-1088.
Bockting, W. (2009). Are gender identity disorders mental disorders? Recommendations for revisions of the world professional association for transgender health’s standards of care.International Journal of Transgenderism 11, 53-62.
Bouman, W.P., Richards, C., Addinall, I., de Montis, A. Arceus, J…. & Wilson, D. (2014). Yes and yes again: Are standards of care which require two referrals for genital reconstructive surgery ethical? Sexual and Relationship Therapy 29(4), 377-389.
Budge, S. L. (2015). Psychotherapists as gatekeepers: An evidence-based case study highlighting the role and process of letter writing for transgender clients. Psychotherapy 52(3), 287-297.
Canadian Medical Association (2004). Code of Ethics. Retrieved February 12 2019.
Cavanaugh, T., Hopwood, R., & Lambert, C. (2016). Informed consent in the medical care of transgender and gender-noncomforming patients. AMA Journal of Ethics 18(11), 1147-1155.
Chang SC, Singh AA, Dickey LM. (2018). A Clinician’s Guide to Gender-Affirming Care: Working with Transgender & Gender-Nonconforming Clients. Oakland, California: Context Press.
Chu, A. L. (2018, November 24). My New Vagina Won’t Make Me Happy. Retrieved from https://www.nytimes.com/2018/11/24/opinion/sunday/vaginoplasty-transgender-medicine.html?rref=collection%2Fsectioncollection%2Fsunday&action=click&contentCollection=sunday®ion=stream&module=inline&version=latest&contentPlacement=4&pgtype=sectionfront
Coleman, E. (2009). Toward version 7 of the World Professional Association for Transgender Health’s Standards of Care. International Journal of Transgenderism 11, 1-7. DOI: 10.1080/15532730902799912.
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.
Conrad, P. (2007). The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: John Hopkins University Press.
Costa, R., & Colizzi, M. (2016). The effects of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: A systematic review. Neuropsychiatric Disease and Treatment 12, 1953-1966.
Deutsch, M.B. (2012). Use of the informed consent model in the provision of cross-sex hormone therapy: A survey of the practices of selected clinics. International Journal of Transgenderism 13(3), 140-146.
Dewey, J.M. (2013). Challenges of implementing collaborative models of decision making with trans-identified patients. Health Expectations 18, 1508-1518.
Diamond-Brown, L. (2018). “It can be challenging, it can be scary, it can be gratifying”: Obstetricians’ narratives of negotiating patient choice, clinical experience, and standards of care in decision-making. Social Science & Medicine 205, 48-54.
Ehrbar, R.D. & Gorton, R.N. (2010). Exploring provider treatment models in interpreting the standards of care. International Journal of Transgenderism 12(4), 198-210.
Glynn, T.R., Gamarel, K.E., Kahler, C.W., Iwamoto, M., Operario, D., & Neemoto, T. (2016). The role of gender affirmation in psychological well-being among transgender women. Psychology of Sexual Orientation and Gender Diversity 3, 336-344.
Johnson, A. H. (2015). Normative accountability: How the medical model influences transgender identities and experiences. Sociology Compass 9(9), 803-813.
Kirkey, S. (2019, April 26). Drop ‘dehumanizing; mental health assessments for trans youth wanting hormone therapy, McGill bioethicist argues. Retrieved from https://montrealgazette.com/news/drop-dehumanizing-mental-health-assessments-for-trans-youth-wanting-body-altering-hormone-therapy-mcgill-bioethicist-argues/wcm/79ca6184-a2dd-47fb-8573-a746bdbef8bf.
Lev, A.I. (2013). Gender dysphoria: Two steps forward, one step back. Clinical Social Work Journal 41, 288-296.
MacKinnon, K.R. (2018). Pathologising trans people: Exploring the roles of patients and medical personnel. Theory in Action 11(4), 74-96. DOI:10.3798/tia.1937-0237.1826.
MacKinnon, K.R., Ng, S.L., Grace, D., Sicchia, S.R., & Ross, L.E. (2019). Protocols as curriculum?: Learning health advocacy skills by working with transgender patients in the context of gender-affirming medicine. Advances in Health Sciences Education. DOI: doi.org/10.1007/s10459-019-09899-0.
McQueen, P. (2017). The role of regret in medical decision-making. Ethical Theory and Moral Practice 20(5), 1051-1065.
Moffett, P., & Moore, G. (2011). The standard of care: Legal history and definitions: the bad and good news. Western Journal of Emergency Medicine 12(1), 109-112.
Parola, N., Bonierbale, M., Lemaire, A., Aghababian, V., Michel, A., & Lançon, C. (2010) Study of quality of life for transsexuals after hormonal and surgical reassignment. Sexologies 19(1), 24-28.
Porch, M., Stukalin, R., & Weisbrod, H. (2014). Complex cases in community mental health: Stories from the castro and the tenderloin. Journal of Gay & Lesbian Mental Health 18, 393-411. DOI: 10.1080/19359705.2014.938582.
Reisner, S. L., Bradford, J., Hopwood, R., Gonzalez, A., Makadon, H., Todisco, D… & Mayer, K. (2015). Comprehensive transgender healthcare: The gender affirming clinical and public health model of fenway health. Journal of Urban Health 92(3), 584-592. DOI:10.1007/s11524-015-9947-2.
Shuster, S.M. (2016). Uncertain expertise and the limitations of clinical guidelines in transgender healthcare. Journal of Health and Social Behavior 57(3), 319-332.
Shuster, S.M. (2019). Performing informed consent in transgender medicine. Social Science & Medicine 226, 190-197. DOI:10.1016/j.socscimed.2019.02.053
Tannehill, B. (2016, February 2). Myths About Transition Regrets. Retrieved from https://www.huffpost.com/entry/myths-about-transition-regrets_b_6160626.
Toivonen, K.I., & Dobson, K.S. (2017). Ethical issues in psychosocial assessment for sex reassignment surgery in Canada. Canadian Psychology 58(2), 178-186.
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.
Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v. informed consent. South African Journal of Bioethics and Law 11(1), 24-28.
World Professional Association for Transgender Health (WPATH) (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (Version 7).
