Kelley Winters

New Standards of Care for the Health of Trans People

Filed By Kelley Winters | September 26, 2011 10:15 AM | comments

Filed in: Living, Transgender & Intersex
Tags: standards of care, trans, trans health care, transgender, transsexual, WPATH

Yesterday, the World Professional Association for Transgender Health (WPATH) released it's 7th version of Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC) in Atlanta. The previous Version 6 was published in 2001. Download
the SOC Version 7 here [pdf]
.

Overall, this newest SOC represents significant forward progress in respecting trans people and affirming the necessity of medical transition wpath_logojuni2008.jpgcare for trans and transsexual individuals who need it. Although controversies and issues of transition care access remain in the SOC7, WPATH has announced a more frequent update process that will hopefully be more responsive to emerging evidence and clinical experience in the future.

First published in 1979, the SOC has provided clinical guidance to medical and mental health providers serving trans people, with an emphasis on transsexual individuals seeking hormonal and/or surgical transition care. In many parts of the world, particularly North America and Europe, the SOC has played a role in enabling access to medical transition care and in enabling medical and surgical practitioners to provide it. However, the SOC has been controversial among trans communities and supportive care providers.

Prior versions have been critized for unreasonable barriers to medical transition care, pathologizing language of "disordered" gender identities and "gender-disturbed children," maligning pronouns and terms for transitioned individuals, and compulsory psychotherapy requirements. Fortunately, successive revisions of the SOC have trended toward greater respect for trans and transsexual people and fewer unjustified barriers to transition care. For example, mandatory urological examinations were dropped from the 4th Version in 1990, and mandatory psychotherapy requirements for those needing access to hormonal or surgical transition care were dropped from the 5th SOC in 1998.

A run-down of the changes are after the break.

Gender Conversion Psychotherapies Are Unethical

Perhaps the most historic change in the SOC7 appears in the section of ethical guidelines:

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 (Gelder & Marks, 1969; Greenson, 1964), yet without success, particularly in the long term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965). Such treatment is no longer considered ethical.

Though long overdue, this condemnation of gender-conversion or gender-reparative psychotherapies sets a new ethical standard for the mental health professions. Sexual orientation conversion therapies have been rejected by the American Psychiatric Organization, the American Psychological Association, the American Medical Association, the National Association of Social Workers and many other professional associations for over a decade. Yet the mental health and medical professions have maintained a double standard for trans, transsexual and gender nonconforming people victimized by analogous gender-reparative therapies that are equally harmful.

I commend the WPATH leadership and the SOC committees for taking this historic step and call upon the American Psychiatric Association and other professional associations to follow WPATH's leadership on this important issue.

De-psychopathologisation of Gender Difference

The 7th Version of the SOC goes further than prevous versions in employing respectful language and dispelling false myths that equate nonconformity to birth-assigned sex and gender roles with mental illness. A section entitled, "Being Transsexual, Transgender, or Gender Nonconforming Is a Matter of Diversity, Not Pathology," prominently notes:

WPATH released a statement in May 2010 urging the de-psychopathologization of gender nonconformity worldwide (WPATH Board of Directors, 2010). This statement noted that "the expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon [that] should not be judged as inherently pathological or negative."

We can only hope that the American Psychiatric Association and World Health Organizations will take guidance from this principle in future revisions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Statistical Classification of Diseases and Related Health Problems (ICD).

The de-psychopathologization principle  is underscored by statements that, "Psychotherapy is not an absolute requirement for hormone therapy and surgery," first introduced in Versions 5 and 6--

A mental health screening and/or assessment as outlined above is needed for referral to hormonal and surgical treatments for gender dysphoria. In contrast, psychotherapy - although highly recommended - is not a requirement.

The new standard clarifies gender dysphoria, from a greek root for distress, as the focus of treatment, replacing pathologizing language of "disordered" gender identity. Gender dysphoria is painful distress with one's current physical sex characteristics or assigned or ascribed social gender role. Social role transition to a congruent, affirmed gender role and hormonal and/or surgical transition treatments (for those who need them) are well proven in relieving this distress. The SOC7 notes,

...transsexual, transgender, and gender nonconforming individuals are not inherently disordered. Rather, the distress of gender dysphoria, when present, is the concern that might be diagnosable and for which various treatment options are available.

The American Psychiatric Association has already proposed to replace the defamatory diagnostic title of "gender identity disorder" with Gender Dysphoria in the pending 5th Edition of the DSM.

Other Positive Changes

The tone and language of the SOC7 are more positive than in previous versions, with more emphasis on care and less emphasis on barriers to care. Some highlights include:

  • Relaxation of the age 18 restriction for access to hormonal transition care.
  • Removal of the three month requirement for either "real life experience" (living in a congruent gender role) or psychotherapy before access to hormonal care.
  • Clarification that "the presence of co-existing mental health concerns does not necessarily preclude access to feminizing/masculinizing hormones."
  • Removal of barriers to surgical care because of family intolerance or interpersonal issues.
  • An expanded role for medical health professionals in granting access to hormonal therapies.
  • Acknowledgement of informed consent model protocols, developed at community health centers worldwide for hormonal transition care.
  • Emphasis of cultural competence and sensitivity for care providers.
  • Expanded and clarified information on puberty delaying treatment for gender dysphoric adolescents.
  • Graduated requirements for different kinds of surgical transition care.
  • Recognition of diverse non-binary gender identities and expressions.
  • Clarification on the role of the SOC as flexible clinical guidelines that may be tailored for individual needs and local cultures.

Issues for Future Revisions

Although the 7th Version of the SOC is significantly improved over previous versions, there remain issues of concern to trans communities and their allies. One issue is promotion of a widely held myth that gender dysphoria in children will persist in only a small minority by adolescence, in other words, that gender identity in children is malleable and impersistent. These statements in the SOC are based on studies that conflated mere nonconformity of gender expression in children with the distress of gender dysphoria: painful distress with born sex characteristics or assigned gender roles. Among a new generation of gender dysphoric children from supportive families, children who have actually transitioned to affirmed roles congruent with their gender identities, there is so far very little evidence of impersistence. Hopefully, future revisions of the Standards of Care will quickly incorporate research findings on these new populations of affirmed youth, as they become available.

(Crossposted at GID Reform Advocates)


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Lots of good reforms. Transitioning is hard enough without bullshit barriers.

Angela Brightfeather | September 27, 2011 12:05 AM

Great applause for these new standards. They are heading in the right direction.
Is WPATH doing anything at all to better the situation about discrimination in the DSM7 regarding crossdressing?

I wish I knew, Angela. I've not been in the loop on the WPATH response to the Blanchardian Transvestic Disorder train wreck. I only know that the only reasonable response, the only response that doesn't harm trans people, is to call for the complete removal of the Transvestic Disorder category from the DSM-5. Read More.

How about calling to remove transsexualism from the DSM?

Do you not think that would be more appropiate?

Statement from OII on the new WPATH SOC.
-------------------------------------------------------

Australia - ARROGANCE, HYPOCRISY & THE NEW WPATH STANDARDS OF CARE, VERSION 7… [2011-09-29 Organisation Intersex International Australia]

https://www.facebook.com/notes/organisation-intersex-international-australia-limited/arrogance-hypocrisy-the-new-wpath-standards-of-care-version-7/262882070418343

ARROGANCE, HYPOCRISY & THE NEW WPATH STANDARDS OF CARE, VERSION 7

by Organisation Intersex International Australia Limited on Thursday, 29 September 2011 at 09:14

Thursday 29th September 2011

Re: The World Professional Association for Transgender Health: Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th version, wpath.org

In an act of breathtaking hypocrisy the World Professional Association of Transgender Health (WPATH) has released pathologizing guidelines for the treatment of intersex children and adults who reject their birth assignments.

WPATH has for many years been considering the effects of pathologizing language on the mental health of trans individuals. The diagnosis of Gender Identity Disorder (GID) was considered especially unhelpful as it categorized their natural differences as a mental illness.

In an effort to move away from concepts that contributed to the problems rather than easing them WPATH has revised its Standards of Care (SOC) to include less pathologizing language and treatments that focus on medical needs rather than pathologizing and characterizing trans as a mental health problem.

With breathtaking arrogance and hypocrisy, WPATH then reclassifies intersex as people with Disorders of Sex Development (DSD) and see those of us who reject our birth assignments as being in need of the counsel of a mental health professional.

WPATH does this without the input or inclusion of a single intersex person. Indeed the WPATH membership requirements preclude being intersex as a reason for belonging to this organization.

Not only are intersex people excluded from membership of WPATH, we are pathologized without our contribution and without WPATH seeking any intersex input whatsoever.

WPATH would not formulate a Standards of Care for trans people without considerable trans inclusion and widespread trans consultation. That WPATH is prepared to do what they have done to intersex people shows the complete misunderstanding that trans professionals have in respect of intersex and their disregard for both our rights and for our wellbeing.

Gina Wilson
President, Organisation Intersex International Australia Limited
Sydney, Australia
oiiaustralia.com
oiiaustralia@bigpond.com
+61 (0)418 290 336

Facebook © 2011 · English (UK)


You know what? I have to agree with Suzan Cook on this one entirely even if I wish I were as far removed in time from what was often a horrible situation. Institutions built on the sort of foundation WPATH was built on are bound to fail those who they are there to ostensibly serve. WPATH is really not about serving the needs of the people whose standards of care they promote. WPATH is there to reduce liability for endocrinologists and to a lesser degree the very competent surgeons we have available but mostly WPATH is there the endocrinologists and some pediatric specialists in a lot of the same ways the Lawson Wilkens Pediatric Society is there for some of these people. Whatever reforms that are made will never be adequate.

The focus needs to be on research into the similarities in male and female physiologies, an understanding that there is a great deal of overlap between male and female, that sex change is very possible and necessary for some and that some people's physiologies are unique before people will get good enough care. There needs to be an organization of medical professionals that focuses on physical transsexual medicine. Intersex should not part of that domain and neither should people who do not need physical treatments. If people have "gender" problems they should go to charm school, join the marines or find a therapist who specializes in people who have a problem living within their assigned sex. Focusing on "gender" is what was done to David Reimer and a lot of intersex people I have come to know. We don't need that. The culprits behind WPATH are the same ones who bring non consensual "gender conforming" "health care" to intersex people and people whose bodies do not conform to standard "male" and "female". It almost happened to me. We don't need THAT

You mention:

"The focus needs to be on research into the similarities in male and female physiologies, an understanding that there is a great deal of overlap between male and female, that sex change is very possible and necessary for some and that some people's physiologies are unique before people will get good enough care."

As was mentioned at SCC, this latest SOC was able to change its focus from past SOCs due to the availability of research, which is included as References to the document. 21 pages worth of references. Something you will not find in previous SOCs. And Dr. Coleman wants more research done, to support further changes in the SOC.

You also mention "There needs to be an organization of medical professionals that focuses on physical transsexual medicine. ... If people have "gender" problems they should go to charm school, join the marines or find a therapist who specializes in people who have a problem living within their assigned sex."

Please educate me on how you determine you are transsexual. One study indicated that only a minority of child subjects continued to be gender non-conforming once they reached puberty. Isn't the definition of a transsexual someone who has a problem of living with their assigned birth sex?

I disagree with the similarities statement, or maybe I agree. How does a male suffer from maladies that are predominately female, such as growths on fatty growths on kidneys where for men, when there are growths (which is a small percentage anyway), the growths are 95% of the time precancerous, where for women, somewhere around 95% of the time they are fatty deposits? Granted, the percentages are not accurate because I am going from memory.

Or what about the few percentage of men that suffer from IBS, again, something that is predominately female.

When a male suffers from several types of these female predominant maladies, does this indicate a similarity or dissimilarity of physiologies?

Do you mean to say that physiological similarities/dissimilarities should be the overriding factor of determining if you are a transsexual? So is a small boned male with many feminine physiological traits actually a woman, ie a transsexual woman? You imply that "gender problems" are not a cause for being identified as transsexual. I thought that physiological was more the realm of intersex, while mental was the realm of transsexual.

So please educate us uninformed gender non-conforming people please.

Thanks.

Sorry I have a wash to put into the dryer and then I have to get out of here. I have a lot to do today. I scrolled about 1/8 of the way through this document to look at where the source material comes from. About half of the sources has at least one contributor who is considered outright hostile to people who are transsexual or there is someone who writes about "men" who crossdress.

You can cite statistics but people who are transsexual and intersex are exceptions to the rule. Regardless of what kind of statistics you come up with regarding "male" and "female", there are exceptions to the statistical probabilities that run into the millions. Read some Anne Fausto-Sterling. Hardly anyone is simply male and female. I know other sex based statistics, really, just statistics based on probabilities that turn into prejudice, like women are more likely to suffer or enjoy(if they are simply aural) migraines or women are more likely to develop cataracts. There is an awful lot of overlap. I am not going to cite statistics here. They are available in a lot of places but there are many, mostly greatly underreported, that demonstrate that there are numerous possibilities for male and female and various combinations of male and female that defy the statistics. Transsexualism is also evidence of this. You would have to be in denial not to accept this fact.

If you take the time to understand this, study the Chicago Consensus Statement on the Management of Intersex and then read what intersex people have to say about this you would understand how true this is or read about Dix Poppas and Maria New. The people who wrote this WPATH statement are, in large part, the same people who are involved with intersex management, Cohen-Kettinis, Meyer-Bahlburg, etc. Richard Green was involved with John Money. Sure he helped transsexual people out to some degree but he also wrote the Sissy Boy Project and defended Money in David Reimer's case against him. These people freak out over people who defy their neat statistics. They take the men are from Mars and women are from Venus approach and never the twain shall meet which is so harmful to a sizeable percentage of people and can be very harmful to the much smaller percentage that defy their sexist prejudice which is almost a religious belief.

After I wrote what I wrote, I went and tried to find as much information as I could on the formation of HBIGDA. I think Reed Erickson was involved to some degree but I also think the driving force behind its formation, in spite of others who may have had very good intentions, was Richard Green who was heavily involved with the people at Johns Hopkins who actually have quite a bit to cover up. Look at what his Archives of Sexual Behavior has spawned. I didn't have enough time to get into it but the timing of the formation of HBIGDA, I think, coincides with some other important developments. I think it coincides with the removal of transsexualism from the DSM with the replacement of "Gender Identity Disorder".

Finally to finish this off, for the time being, the assertion that Vaginoplasty is comparable to mastectomy is outrageous on the face of it. They don't stop there, however, they compare vaginoplasty to rhinoplasty. Anyone who stays with an organization like that and gives their tacit approval to their cockeyed and harmful notions cannot be trusted for very long. Transsexual healthcare for me has been entirely a matter of making the best out of a very bad situation. At times the care was so bad, it was a danger to my health. It shouldn't be this way.

citation #1Cohen-Kettenis & Pfäfflin, 2010; Knudson, De Cuypere, & Bockting, 2010b; Meyer-Bahlburg, 2010;
Zucker, 2010)
#2(Institute of Medicine, 2011;
Zucker & Lawrence, 2009).
#4(Zucker & Lawrence, 2009).
#11Zucker and colleagues (2008)
#15(Docter, 1988).
#16(Green & Fleming,
1990),
#17(1-1.5% of MtF patients and 1993).
#21(Bockting,
2008; Ekins & King, 2006; Nestle, [Wilchins], & Howell, 2002). sorry about Wilchins it's Ekins I'm pointing to here
#24(e.g., Bockting, Knudson, & Goldberg, 2006; Bolin, 1994; Rachlin, 1999;
Rachlin, Green, & Lombardi, 2008; Rachlin, Hansbury, & Pardo, 2010).
#25(Cohen-Kettenis, 2001; Zucker & Bradley, 1995).
#26(Green, 1987; Money & Russo,
1979; Zucker & Bradley, 1995; Zuger, 1984).
#27(Drummond, Bradley, Peterson-Badali, &
Zucker, 2008; Wallien & Cohen-Kettenis, 2008).

I noticed the way they lump sex reasignment surgery with cosmetic procedures. That told me a lot.

Ah, so what you are saying is that you've read the references but none of the actual content.

In these new guidelines, transition is entirely based on dysphoria, not living up to some absurd gender stereotypes, and is even available to people who don't identify with the binary at all.

Also, they explicitly state that attempts at changing kids' gender identity/expression are fucked up and evil... well, they use the word "unethical." So they may reference Zucker's research, but that does not mean they agree with his conclusions.

We agree from what you have said that there are differences between male and female beyond the genitals and what is considered intersex that can be used to describe masculine or feminine body traits. I thought I was the only one who thought my body was telling me I was woman because of something other than my sex organs.

I am an engineer, but I do believe that for something as important as this SOC, to create and maintain credibility among the scientific, medical and insurance communities, you have to include the warts along with the cream. By includind, answering and explaining the warts, justify the validity of your own conclusions as you have shown you have researched a greater volume, and not just picked and choose among the studies you approve of. This is the difference between the WPATH and the Zuckers and Camerons. What better way to fight the Zuckers but to use their own research against them.

For example, from an insurance company perspective, it would have been easy to discredit this SOC if it had neglected to include the cases of some transgender or other people (male or female) that have breast augmentation or reduction surgery for reasons to feel better about their body or make a statement with their body for reasons not of a medical necessity. In the SOC they lump both situations under the same heading, but different paragraphs, saying basically, "medical and insurance companies, we have 2 cases with some crossover, that the transsexual need for breast and other surgery is a medical necessity and we will use due dilligence to make sure the people we refer for surgery need it because of a medical necessity. We will not ask you to pay for surgery for someone that is having surgery for the same reasons a person wants a rhinoplasty or other cosmetic only reasons.

What WPATH is doing is answering the scietific and medical communities with facts and processes that give the SOC credence and authority, and yes it does mean they include the research from the Zuckers and their kind.

Sorry, only a few typos this time. Most of my verbs even match my plural and singular nouns but for those who care about these sorts of things, I meant LWPES, the Lawson Wilkins Pediatric ENDOCRINE Society

I also agree with Suzy Cooke on this one.

The new SOC is the same crap, except even more transgenderised.

The constant dragging of other groups into WPATH, is there as usual. Autistic, intersex lesbian and gay are all dragged into it, as claiming they can have gender dysphoria in some manner.

As for the TS kids. Initially it looked like an improvement until I read age of majority for hormones for TS kids. That can be 21 in some countries. It is 18 in most countries. That would prevent those kids from having an appropiate puberty and torture them by putting them through an inappropiate puberty. If that is not based in hatred of transsexual people, I don’t know what is. Hormones and gonadrelin analogues should be given from as early as 12, if the TS kid desires them so as to give an appropiate puberty.

Follow up care thoughout life, gives more away. The bastards want to pathologise our entire lives.

The section on ethical questions regarding sex reasignment surgery is sickening. The WPATH people don’t see the problem with anyone objecting to sex resignment surgery on ethical grounds. It is unethical to object to appropiate medical treatment for a patient and blatantly unethical to require a patient to declare themselves mentally ill in a letter from a paid predatory pervert before conducting sex reasignment surgery.

They also state that a person has to be out about being transsexual at work and the local community about being transsexual. That is a good way to get the number of transsexual people culled by killing and firing them.

Basically it is the same crap, pathologising everyone who is not barbie or ken and making more excuses for the transphobic bigots involved in transsexual treatment.

Reading through that, was like having someone saw me in half. It is just a hate speech document against transsexual people, nothing else.

I would hate to be going through the sex change process today.

The transgender borg are quoting the new SOC in the same manner as jehovahs witness’s quote the bible. The SOC appears to be the religious book of the transgender borg.

Which page was it that it said you have to be out about being transsexual? I could only find a part where it recommends that therapists assist patients in coming out, not that it's required of the patient to tell everyone.

Page 61.

I see you clearly have not read the document.

Before you make excuses for the authors, a lot of clinicians will take the document literally. To force an entire minority into mental healthcare purely for profit takes an abject hatred of that minority and complete lack of any empathy.

Quote:
The duration of 12 months allows for a range of different life experiences and events that may occur throughout the year (e.g., family events, holidays, vacations, season-specific work or school experiences). During this time, patients should present consistently, on a day-to-day basis and across all settings of life, in their desired gender role. This includes coming out to partners, family, friends, and community members (e.g., at school, work, other settings).

Yeah, I actually had read that. That's the section on preparation for surgery by living in and presenting as ones preferred gender role, not coming out to the world as a transsexual. How else are transsexual people supposed to transition, other than by living as their preferred sex?

If a person chooses to be stealth, that should be respected.

Your bias against transsexual people who are stealth is noted.

A persons medical condition is no one else's business.

This is geared towards the newly transitioning person... not about outing people who've socially transitioned. It's also very much referring to those who knew the transitioner 'pre' so it's pretty obviously not about being in stealth. I can pretty much bet that if you suddenly (or gradually) appear presenting as 'the other gender' you're not going to be in stealth.

You appear to want to read things into my comments that are not there.

-I- live stealth. It's no ones business that I am a transsexual, and I dont tell friends and employers. What you quoted doesn't say I'm supposed to, either. It says that in preparation for SRS the person should be openly living as their true gender, NOT that they should have to broadcast that they're transsexual. There is nothing there that says one has to publicly break stealth. "coming out" in the quoted section refers to coming out as ones true gender, not coming out as a transsexual.

Unless you're saying that people should be able to get SRS without transitioning, your objection doesn't make sense.

Or, you know, what Gina said, much more succinctly. XD

There's a section in the document, Andrea, that allows for puberty-suppressing hormones to be given as early as age 9. Section VI, pages 18-19...

"Adolescents may be eligible for puberty suppressing hormones as soon as pubertal changes have
begun. In order for adolescents and their parents to make an informed decision about pubertal
delay, it is recommended that adolescents experience the onset of puberty to at least Tanner
Stage 2. Some children may arrive at this stage at very young ages (e.g., 9 years of age)."

But not hormones until the age of majority.

Do you mean, for example, in the case of an MtF, spiro could be given at an early age, but not estrogen? I guess you mean hormones, as opposed to anti-androgens?

Which means they don't go through the wrong puberty, which you claimed they would be forced to do. That is the point of the hormone blockers. They just go through it later than most.

The appropiate puberty requires blockers and hormones.

Not giving them the appropiate hormones to go through the appropiate puberty is stopping them from going throughthe appropiate puberty, plain and simple.

No, that is not what I am saying. I would like to ask you what you mean when you use the expression "binary" and what you think other people mean when they use the expression "binary". Are you thinking of sex as a binary phenomenon or are you thinking about the "gender binary"? When the word "disorder" is used in relation to any of this how do you react to that characterization? The clinicians both psych and medical, use the term "disorder" to refer to bodies as well as so called "identities" that do not conform to ideals of male or female as disordered. I don't think you understand what I am saying about the relation between the two. It has resulted in bad medical practice for many of those concerned. As far as "dysphoria" is concerned, very often the way a "dysphoria" is characterized has little to do with the experience of the person being diagnosed. This happens not because of any kind of "nonconformance" to a "gender binary" but because sex is sometimes very less than a binary phenomenon, in one way or another.

Did you realize that one of the founding members of WPATH/HBIGDA is on the advisory board of the False Memory Syndrome Foundation? Try a web search by typing in HBIGDA LWPES. I don't know about your browser but mine comes up with http://www.endo-society.org/_MDDocReviewFiles/Transgender%20Guideline%20(1st%20Draft%2011.17.08).pdf

Do you know who founded the FMSF? Why Paul McHugh, of course. The guy who shut down the gender identity clinic at Johns Hopkins. Do you know where one of the founders of HBIGDA got his medical degree from? Do you know he also has a degree from Yale Law? Do you know who Lawson Wilkins was? I don't know too much but I've read a lot of this crap. I see a very tangled web. Throw John Money into the mix. Pedophilia . . . non consensual intersex surgeries, add "gender identity", a term which appeared around the time John Money arrived and stir slowly. Sure it's all about gender. Couldn't be about sex. Think of the paper work. It's about gender for these people because it's safer that way, false memories and gender identity disorders. It's all in your head. Complain about the lack of care or poor care, who's gonna listen. It's all in your head. That kind of help I don't need.

Sorry, been there, done that, glad I don't have to do it again. If there were anyone who really cared I would want to do it over. That's the problem. Things work out well for seven out of eight patients, I was told by one endo. I happened to be the one in eight. Too bad. Ain't got the time. That was my good experience with endos. I have a good enough primary care physician now but things should not be that way.

Edith,

Paul Mc Hugh and Martin Kafka are both advisors to the vatican on sexual disorders.

Martin Kafka has worked with Blanchard on numerous occassions. Martin Kafka has claimed he can cure transvestitism with SSRI's and he is now on the DSM revision panel.

Paul Mc Hugh has openly stated he admires the ideas of Kurt Freud which were invented to check for homosexuality amongst military recruits in the former Warsaw Pact. Paul Mc Hugh used to regularly rant about the left and communisim when he was on Fox News and when he was an advisor to George W Bush, yet admires techniques invented by communists such as Kurt Freund.

Why does Paul R. McHugh approve of the actions of Kurt Freund and Raymond Blanchard putting wires on the penis’s of pre-operative transsexual people (ie. fondling the patients penis for no scientific / medical reason), then showing them pornography?

Paul Mc Hugh claimed that he is the person responsible for stopping the sex reasignment of transsexual people in John Hopkins.

Paul Mc Hugh is a member of the Sovereign Military Order of the Knights of Malta, which puts him in the company of Reinhard Gehlen, Pinnochet, Herman Goering, Franz Von Papen, Benito Mussolini and other nazis, fascists, war criminals and genocide organisers. All knights of the order have diplomatic immunity in countries that recognise the order as an extraterritorial entity. All members of the Knights of Malta have sworn to only recognise the authority of the pope and to destroy democracy and to restore the papacy to primacy. Also as a member of the Sovereign Order of Knights of Malta, Paul R. McHugh has sworn to recognise only Vatican law and uphold Vatican law in primacy over the laws of all nations. Under Vatican law, the age of consent is set at 12 years of age and at 15 when there is a relationship of dependence, ie. teacher/student, etc.

When Maryland law was changed to require mandatory reporting of child molestation by clinician’s, the John Hopkins University School of Medicine under Paul R. McHugh, fought with everything at his disposal against that implementation of that law, in the university. In the Clinic for paedophiles in the John Hopkins University School of Medicine, Paul R. McHugh issued a memo that paedophiles should report their activities to there lawyers, who were then to inform clinical staff in John Hopkins University School of Medicine, so that client-attorney privilege could then protect the child molesters from being reported to the police. During this period at least eight men were convicted of sexually abusing children while under the care of the John Hopkins University School of Medicine run by Paul R. Mc Hugh. These men were not reported by staff at John Hopkins University School of Medicine, to the police, which they were required to do so, by law. The staff in the clinic, were in full knowledge they were protecting paedophiles from the full force of the law. They cited reason of confidentiality, by Attorney-client privilege so as to avoid reporting active paedophiles from assaulting children to the police.

Paul Mc Hugh has given evidence in defence of people accussed of paedophilia on several occassions. Paul R. McHugh once gave a court report as evidence in a court case. His testimony in that case raises real issues about what Paul R. McHugh is all about and also calls into question, if Paul R. McHugh even understands what ethical behaviour is. Paul R. Mc Hugh stated that a defendant's harassing phone calls were not obscene, including a phone call that detailed a perverted fantasy of an obscene phone caller describing a 4-year-old sex slave, locked in a dog cage and fed human waste. What sort of person gives advice to a court that a fantasy about putting a 4 year old child in a dog cage, treating the child as a sex slave and then feeding the child human waste, is not obscene?

Anyone working with Paul Mc Hugh or who has worked with him is not only an enemy of transsexual people, but an enemy of vulnerable children and adults everywhere.

I could write a book on the activities of Paul Mc Hugh.

I'm talking about the actual text of the current SOC, not shitty things that people who were related to the organization a gajillion years ago did. Planned Parenthood was originally a eugenics program. Does this mean we should ignore the good it does in the world today?

By "binary" ... well, I meant relating to gender, in that I as a genderqueer person would not have to lie and say that I'm a trans guy if my apparent femaleness got to be the cause of too much stress and I needed to take T or get a masectomy. The femme trans guy I know wouldn't have needed to dye his awesome pink hair back to brown. But it is also the case that intersex people are no longer ignored by the standards.

Basically, this model is the informed consent model, with active encouragement of therapy along the way. It is the medical industrial complex's job to facilitate transition, not the transitioner's job to pleas the MID.

The one thing they did screw up is calling intersex conditions "disorders of sexual development." IMO, they should have gone with "differences of sexual development" because that avoids both the pathologization of DisSD and the ID politics implications of intersex. But I would defer to intersex people on that issue.

@ SAS, Bingo! Let me start by saying I have issues. Anyone who violates my cardinal rule of "My mind, my body, my life" by asserting I should follow their rules is an enemy. DSM and WPATH are best ignored. Why should I care if someone wants and gets SRS without transitioning? I'm willing to give WPATH and those who write the DSM the benefit of the doubt and say they are probably sincere in wanting to help but IMHO they both fail miserably. Where both have succeeded is in convincing a large group of mostly sane people that unless you accept the tag of "insane" hormones and surgeries will be withheld. Is it any wonder that medical tourism in such places as Thailand is a thriving industry? Of course there are rules there also but less so and often relaxed.

And another thing. It all smacks of a religiosity based morality where God created people a certain way genitally speaking and if you want changes you must kiss the Pope's ring and pray for forgiveness. Poppycock!

Oh look over there. Its the elder, she who speaks of floppy discs and she says ....You're all soft (in the head). I hope I have not offended anyone too much. I'm simply expressing my way of looking at the reality of a system which sucks people into ceding control of fundamental parts of their lives to others.

Are you confusing the DSM with the latest WPATH SOC? DSM calls it a mental problem, WPATH calls it normal gender variation with a temporary psychological condition until surgery , or other means, eliminate the condition. The DSM labels you for life. The WPATH is a temporary situation.

Do you remember in the first 2 "Pirates of the Carribbean" movies the discussion "And thirdly, the code is more what you'd call "guidelines" than actual rules."

The SOC states it is "Flexible, Clinical Guidelines" and not hard fast rules. Please reread page 2 of the SOC.

The literature referred to in the latest document is telling. Are there any endocrinological studies cited? I think there might be one. I haven't had a chance to look into it but I'm not expecting much. The focus of this organization recommending medical treatments is the role of the mental health counselor. How does that make sense? The last part of the document, which focuses on DSD, is very telling, also, because of the pathologizing terminology for intersex, which does not conform to a reproductive platonic ideal. The way vaginoplasty is characterized is telling. The fact that "dysphoria" has replaced disorder doesn't impress me all that much because whenever the physical body is under discussion, it is put in a place without relation to a person's sense of self. Intersex people are very upset that their bodies are still being described as "disordered". It's not exactly like intersex people are all on board with the concerns of people who undergo transsexual treatments but in spite of the change in terminology, the disconnect between a person's body and their sense of self is very problematic for both intersex and transexxual people. That is what the consistent problem with the clinicians involved in this field has been all along. It is the point they start from, sex - male and female -- gender - possibly opening up to the fact that it isn't binary but always spoken of in a way that is disconnected from sex. xy dsd's, xx dsd's then "gender dysphoria". It is literally freaking patronizing mumbo jumbo. Sex is more complicated than a simple unalterable binary phenomenon. A lot of this results from the fact that medicine has not caught up with science and is still hung up on chromosomes in a very reductionist way.

Deanna, your comment may be literally true, but it is misleading. Indeed the WPATH SOCv7 is intentionally misleading.

To be sure it states that gender non-conformity (and elsewhere gender variance) are not mental disorders. But it also states that they can be associated with Gender Dysphoria which is DIAGNOSABLE. It then lays down treatments that may be used responsive to a documented pattern of gender dysphoria.

What this boils down to is that if you seek no medical ASSISTANCE then you should not be labelled as mentally ill and no medical ASSISTANCE beyond (time and money wasting) psychotherapy is available to you. Conversely if you seek somatic medical TREATMENT (such as pharmaceuticals or surgery) then this TREATMENT must be for a DIAGNOSED condition.

The WPATH SOCv7 states clearly that gender non-conformity is not mental illness. But it implies that gender dysphoria (the new DSM-5 name for GID) is mental illness. But it lacks the moral courage to say so (or CONVERSELY to deny that gender dysphoria is mental illness).

Transsexual people would be well served by a statement from WPATH that gender dysphoria is NOT a mental illness (aka mental disorder). They would also be served (less well served but better than the status quo) by a statement from WPATH that gender dysphoria actually IS a mental illness.

But WPATH is not going to do either one, they intentionally fudge the issue because they lack morality. WPATH is not going to do either one, they intentionally fudge the issue and as a result the harm to transfolk is greatly increased and the prospects of real improvement in human rights are greatly diminished.

I think it's important to note that the SOC7 defines distress of gender dysphoria independently of the DSM and ICD, because both documents are in flux (p. 6). This in itself is an improvement over Version 6, which was very tied up in gender-reparative terminology of "disordered" gender identity-- language which was intended in the DSM-IV to contradict rather than support transition. Most significant, by independently defining the problem requiring medical treatment, the SOC7 leaves the door open for mental diagnostic coding in the ICD to be replaced by physical somatic coding in the future. In my view this is not moral failure; it is moral leadership, preserving access to potentially lifesaving transition care (for those who need it) in the short term, under the current flawed diagnostic nomenclature in the DSM and ICD, and in the long term when or if ICD policies are reformed.

My criticism of the SOC7 is that it uses a dated definition of gender dysphoria (Fisk, 1974) that is inadequate and unclear, given the broad diversity in how gender dysphoria might be described across cultures. I and others had recommended that the SOC incorporate a more comprehensive four-cornered definition (Lev, et al., 2010) that clarifies much confusion about the term. I hope that WPATH will address this in revision 7.1.

I'm finding the back and forths here rather interesting to watch.

From cherry picking someone who was involved int he very earliest days of the WPATH and laying all manner of ills on them, to using citations that are peer reviewed to support a sociopolitical agenda (instead of a medical one), to some of the more odd things I'm seeing here, the number of strawmen and non-sequitur arguments going on here is, well, worthy of great humors.

I haven't seen any mention of the fact that Zucker was part of this, and that his and one of his colleagues work was essentially said to be unethical, and he hasn't taken to a soap box to speak out and bitch.

I find it fascinating that much of this undermines many of the arguments that many people have used here, on Bilerico.

I'm giggling because much of what was published by contributors on Bilerico over the last 18 months pretty much described all of the stuff in this, yet no one is mentioning how pretty cool it is that Bilerico contributors were more aware of this info than any other site well ahead of it actually being made into a change.

This changes the standards of care for people currently in transition. It confirms paradigms that have split the community, and cut through a large swath of the nastiest of the rhetoric, and it does so by using something totally different from all the SoC's before it -- strongly proven data.

Not suggested results, not "better safe than sorry" perspectives. It relies on evidence collected and reviewed and published and then duplicated.

Yet rather than see that, people are seeing other things in it.

The last ten years has seen more research done on trans lives than the 50 years before that, and people are bitching about how the results don't fall in line with what they think it should have shown.

Yeah, I'm gonna chuckle a bit.

Perfect? No. A hell of a lot better? Apparently that depends on your politics and who you dislike.

Chuckle, Antonia. Have a good laugh. Yeah, sure, "cherry picking", a "gajillion years ago"

http://spectrum.columbiaspectator.com/spectrum/columbia-professors-research-could-help-cure-lesbianism#more-12429

I am beginning to wonder if the "Standards of Care" shouldn't be called the "Standards of Hair Care" for all those radical hair color decisions a person might have to make throughout their lifetime.

How much clinical work is taken seriously if it doesn't appear in the International Journal of TRANSGENDERISM or, more importantly, The Archives of Sexual Behavior?

Just having a look at the Committee on "DSD" is enlightening.

Cynthya BrianKate's bibliography attached to her piece on the "Feminine Boy Project" provides a wealth of information.

1979/80 seems to have been pivotal years. I wish I had more time to connect the dots. I just do not like the idea of what I have read in the ASB and International Journal of "Transgenderism" being the basis of the of transsexual health care. I believe mine suffered because of it.

Understanding how the LWPES fits into all this with the realization they're always lurking in the shadows but never coming forth gives one perspective. People were doing SRS in Morocco and Mexico before the Johns Hopkins started and suddenly stopped. Much more is going on here than meets the eye. Biber did it all on his own, just as about all the surgeons do now. They seem to be the only competent, reliable people involved with transsexual medical care. There are no endos focused on transsexual health care. There's a lot more money in caring for diabetics and people with thyroid problems. In an ideal world there would be an alternative to WPATH that would be able to shine a light on the fact that the organization started on the wrong foot and that you just cannot build from such a poor foundation.

OK now. Pretend for a moment that women who are full blooded American natives somehow end up in a controlling position to determine who can be president of the U.S. Seems reasonable that one of the criteria should be an RLE. After all, no one should be eligible to run this great country without experience. Therefore before running for president or maybe any congress critter office the prospective candidate must migrate to Mexico, Argentina, Brazil or some other country of one's own choosing and successfully run for head of state. Yes that means sacrifice but that's necessary to prove your worthiness or the supreme self appointed native American women's council will not allow your name on the primary ballots. And, as you know, native American women are imbued with supreme authority due to the fact that they have been on this continent for centuries before Anglo s and they hold many advanced degrees in ballot science (otherwise known as BS).

So, let's put this in perspective. No President ever had to pass an RLE nor has any successful entrepreneur ever had to submit to psychiatric evaluation before pursuing their dreams. They all just went out and did it, without gatekeepers. Can you grasp the picture? It is your life. Get on with it and ignore those who would take it away from you.

Gender nonconformity or just a woman happy in her work?

http://www.kcci.com/r-video/29341050/detail.html