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

Some researchers such as Olsson and Moller (2006) cite the risk for transition regret as a primary rationale for strict adherence to the WPATH-SOC. On the contrary, bioethicist McQueen (2017) argues that in medical decision-making on gender-affirming medical interventions, regret is not an ethically sound reason to withhold treatment. Likewise, the risk of regret or detransitioning is not a good argument for more extensive psychosocial assessments prior to hormones or surgeries. For some trans people, being enabled to autonomously medically transition may in fact be the best way to decide if transitioning is the right treatment to relieve gender dysphoria.

There are numerous studies that provide evidence of positive outcomes from using the ICM in gender-affirming medicine. For example, in a study on the use of the ICM in the provision of cross-sex hormone therapy (csHT) across 12 U.S. clinics,10 1 17 known cases of regret were reported across all sites. No cases of malpractice claims or judgments relating to regret about the use of csHT were reported. Only 4 of 12 sites required any contact with a mental health provider prior to initiation of csHT. A minimum number of visits prior to beginning treatment was required by only 5 clinics. The literature review yielded no related legal actions.

Ehrbar and Gorton emphasize that flexibility is one of the strengths of the WPATH-SOC, allowing for customization both at the client and provider level,11 but unfortunately, many transgender clients and even some providers do not understand the WPATH-SOC’s flexibility. This misunderstanding occurs despite specific language that the standards are “flexible directions for the treatment of persons with gender identity disorders.” Ehrbar and Gorton suggest that providers have a responsibility to examine the SOC, determine their own model of care, and communicate this to clients.

  1. 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. ↩︎
  2. 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. ↩︎
  3. Canadian Medical Association (2004). Code of Ethics. Retrieved February 12 2019. ↩︎
  4. 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. ↩︎
  5. Beauchamp, T.L., & Childress, J. (1979). Principles of Biomedical Ethics, New York: Oxford University Press.; 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. ↩︎
  6. 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 ↩︎
  7. 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. ↩︎
  8. 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. ↩︎
  9. 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. ↩︎
  10. 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. ↩︎
  11. 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. ↩︎