I attended a session today on the new WPATH Standards of Care given by the Transgender Foundation of America, and two young researchers in transgender care. "A leading researcher in FTM health, Colt Meier, and an emerging researcher in transgenderism and Autism Spectrum Disorders, Levi Herman, were in attendance of the WPATH conference in Atlanta, GA, earlier this month, when the SOC were officially released."
You can find SOC 7 online at the WPATH website (PDF) at this link.
What follows is but a small amount of the material presented, and I urge you to read the SOC for yourself if this is of interest to you. That said, I am absolutely going to give you my views. I wouldn't be me if I didn't. Follow me over the golden squiggle.
[All quotes below are directly from the SOC, and any highlighting is mine.]
SOC 7 is far more patient focused. No longer are therapists and medical professionals placed in the proverbial gatekeeper role. Instead, the decisions about care (when, where, what) are primarily up to the trans person, with the professionals involvement more advisory. "Some patients may need hormones, a possible change in gender role, but not surgery; others may need a change in gender role along with surgery, but not hormones. In other words, treatment for gender dysphoria has become more individualized."
The SOC also clearly depathologizes trans / gender non-conformance. "Being Transsexual, Transgender, or Gender Nonconforming Is a Matter of Diversity, Not Pathology" is one chapter sub-head. I think this is huge. Another significant, clear, undeniable statement: "Psychotherapy is not an absolute requirement for hormone therapy and surgery."
While gender dysphoria is discussed, it makes clear that the source of dysphoria is of a social nature, rather than a mental health issue. In other words, where we have discomfort with ourselves, it comes from external pressures and expectations. We are not to be considered mentally ill simply because we are trans. As a matter of fact, there is no requirement at all for therapy. Before irreversible actions are taken, there is a recommendation for evaluation (by one or two competent professionals, depending on what is contemplated).
There is a massive amount of information on the topic of childhood/teenage trans, and the standards of care for them. This is apparently a completely new topic for the SOC since the last revision in 2001. Obviously, treatment of children is more cautious in nature than of adults, but even there the WPATH came down in support of treatment. The idea of delaying puberty onset so that the decision can be made in an informed manner by the child as ze matures is clearly recommended, for example.
Another excellent point in the SOC is the very clear statement that so-called reparative therapy is not a valid goal. "Psychotherapy is not intended to alter a person’s gender identity; rather, psychotherapy can help an individual to explore gender concerns and find ways to alleviate gender dysphoria, if present." and "Treatment aimed at trying to change a person’s gender identity and lived gender expression to become more congruent with sex assigned at birth has been attempted in the past, yet without success, particularly in the long term. Such treatment is no longer considered ethical."
Also, there is a significant amount of guidance regarding the role of the therapists in regards to social support. Many therapists felt that it might be a violation of their ethical obligations to discuss their client with family, employer, etc, even if the client were to request such support. This version of the SOC makes it clear that the professional should consider such things as a vital part of their role. "This role may involve consultation with school counselors, teachers, and administrators, human resources staff, personnel managers and employers, and representatives from other organizations and institutions. In addition, health providers may be called upon to support changes in a client’s name and/or gender marker on identity documents such as passports, driver’s licenses, birth certificates, and diplomas. "
Another huge addition is: "Applicability of the standards of Care to People living in institutional environments" The unambiguous statement in the first paragraph of this section is “The SOC in their entirety apply to all transsexual, transgender, and gender nonconforming people, irrespective of their housing situation. People should not be discriminated against in their access to appropriate health care based on where they live, including institutional environments such as prisons or long-/intermediate-term health care facilities. Health care for transsexual, transgender, and gender nonconforming people living in an institutional environment should mirror that which would be available to them if they were living in a non-institutional setting within the same community.” No more “freeze-frame” for trans people who find themselves incarcerated or in other institutional settings. Or more technically: “A “freeze frame” approach is not considered appropriate care in most situations.”
There is also a new chapter explicitly discussing the SOC as it relates to intersex people. This is obviously a very complicated issue, and I won’t go into that here, mainly because I don’t fully understand it myself.