New Version of Standards of Care

[Beth-Lock]

I have just learned that there is a new version of the standards of care out just now, which represents a greater degree of flexibility and some more liberal versions of various requirements. For example, it may not be necessary in some cases to have hormone therapy before gender correction surgery now. These are however exceptions to the rule. The requirements for a real life experience living as a woman, (the RLE), have also apaprently been liberalized.

These changes may give renewed hope to some TS folk, and certainly do for me.

[Rianna Humble]

After clarification, it seems that I had misinterpreted what Beth was trying to say, for which I apologise.

I welcome the new SOC because of the shift in emphasis from what we must do to merit the treatment that we need to how health professionals should treat our health needs as a whole.

The RLE was not a requirement prior to Hormone Therapy in the previous version of the Standards of Care and still is not.

However, in the Summary of Criteria for Hormone Therapy and Surgeries they still include for vaginoplasty

12 continuous months of hormone therapy as appropriate to the patient’s gender goals (unless the patient has a medical contraindication or is otherwise unable or unwilling to take hormones);

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

They go on to say

The criterion noted above for some types of genital surgeries – i.e., that patients engage in 12 continuous months of living in a gender role that is congruent with their gender identity – is based on expert clinical consensus that this experience provides ample opportunity for patients to experience and socially adjust in their desired gender role, before undergoing irreversible surgery.

[Katesback]

There is no standards of care written for a woman. They are written to address the care of a trans person. Since I knew I was a woman I ignorred the standards of care. Never went to a therapist and did it my way because I did not need to pay people to tell me things I already knew.

To each their own but the standards of care meant nothing to me in my journey.

[Melody Moore]

Kate,

you are not the only woman here and just because you didn't follow the Standards of Care, those
of us who are going through our transition through a gender clinic ran under our public health system
have no choice but to adhere to the Standards of Care. I don't know how you got approval for SRS
without following them. So it sounds to me like someone told a few tall stories somewhere to get
approved for SRS. Personally I would rather follow the SoC than to do something stupid which may
jeopardise my whole transition and put my health at risk. So I think Kate some of your advice is very
dangerous and very misleading. Anyway, I am not here to talk about your path, I am here to talk about
the paths that others must follow.

The thing that I liked about the new Standards of Care is that they are more inclusive and highlight
the need that other gender variants also suffer from similar issues to transsexuals and that some of
the treatments may be used to help them as well. This has angered those who followed the original
Harry Benjamin Standards of Care & those people who believe that it should support only those with
transsexualism, and who are really offended now because 'gender non-conforming people' who might
have 'Transvestic Fetishism' are now managed under the same set of guidelines for gender disorders.

I had a run in a few days ago with Charlotte Goiar on Facebook over this after she added me to her group
and posted a link to the new site I am setting up for our support group which also follows the WPATH SoC.

After she posted a link to my site, there discussion was taking place about the site and the new WPATH SoC
which obviously will play a huge part in how I structure the new site and about what information I publish on it.
There was some debate starting to allude to the site's definitions of the gender variants, but it was explained that
it is only a new site & that content was still being drafted up to be added that used the same terminologies as
are outlined in the new SoC. But when I pointed out why 'inclusion' was so important to our group my comments
got a lot of support from other group members, but I got kicked from the group after I made the comment. So I
contacted Charlotte to enquire as why she did that and here is the response...

We don't feel that the WPATH speak for us nor represent us regarding HBS because we consider
it to be a very serious medical condition instead of a "gender non-conforming" state of mind.

The first comment that Charlotte Goiar makes proves that she is taking offence to terms like "gender non conforming".
Charlotte has obviously taken offence because transsexuals have been put in the same group as these other gender
types and that our needs should always remain exclusive of everyone else's is the feeling I get here. But the truth is
many gender variants are affected by Gender Dysphoria which is a mood condition that relates to gender identity issues
and this is how it has now been outlined in the new WPATH SoC. Gender Identity Disorder (GID) is a totally different
condition to Gender Dysphoria (GD), however GD can affect those who are diagnosed with GID, but GD can also affect
all other gender non-conforming (GNC) people.

Charlotte graciously "invited me to re-join again after there is more clear differentiation of the different conditions"
on my site. But I told her not to bother - my whole opinion of that woman has been changed in the blink of an eye
after her very crazy response to these new Standards of Care.

[JennyA]

There is no standards of care written for a woman. They are written to address the care of a trans person. Since I knew I was a woman I ignorred the standards of care. Never went to a therapist and did it my way because I did not need to pay people to tell me things I already knew.

To each their own but the standards of care meant nothing to me in my journey.

EXACTLY! thats how i am doing things

[Melody Moore]

Irrespective of the fact that you know you are a woman - in most places you have no choice
but to follow the SoC because they have been adopted my health services around the world.

While I no longer am affected by GD, I have been affected by it in the past, but
I know I am a woman already as well - but does that make me "Super-Woman?"

If you like taking huge risks and gambling with your own life, that's fine, but do not think
that your path is the right path when it is flawed with so many possible pitfalls - there is
no substitute for proper professional help for gender transition. And I think it is extremely
irresponsible for us to promote or to tell others not to follow the WPATH Standards of Care
regardless of what anyone says.

[Kaitlyn Michele]

Real women don't brag about how they know everything, know how to do everything, and know better than every one else.. we just don't


just sayin...

[ameliabee]

One of the nice changes, at least for those starting transition, is that SOC v7 requires only a referral from a psychologist to start HRT, versus a referral and three months of counseling/psychotherapy, three months of real life experience, or for one to have been self-medicating prior as required by SOC v6.

[Katesback]

Melody. I did not offer any advice. I offered my opinion on the standards of care.

Kate,

you are not the only woman here and just because you didn't follow the Standards of Care, those
of us who are going through our transition through a gender clinic ran under our public health system
have no choice but to adhere to the Standards of Care. I don't know how you got approval for SRS
without following them. So it sounds to me like someone told a few tall stories somewhere to get
approved for SRS. Personally I would rather follow the SoC than to do something stupid which may
jeopardise my whole transition and put my health at risk. So I think Kate some of your advice is very
dangerous and very misleading. Anyway, I am not here to talk about your path, I am here to talk about
the paths that others must follow.

The thing that I liked about the new Standards of Care is that they are more inclusive and highlight
the need that other gender variants also suffer from similar issues to transsexuals and that some of
the treatments may be used to help them as well. This has angered those who followed the original
Harry Benjamin Standards of Care & those people who believe that it should support only those with
transsexualism, and who are really offended now because 'gender non-conforming people' who might
have 'Transvestic Fetishism' are now managed under the same set of guidelines for gender disorders.

I had a run in a few days ago with Charlotte Goiar on Facebook over this after she added me to her group
and posted a link to the new site I am setting up for our support group which also follows the WPATH SoC.

After she posted a link to my site, there discussion was taking place about the site and the new WPATH SoC
which obviously will play a huge part in how I structure the new site and about what information I publish on it.
There was some debate starting to allude to the site's definitions of the gender variants, but it was explained that
it is only a new site & that content was still being drafted up to be added that used the same terminologies as
are outlined in the new SoC. But when I pointed out why 'inclusion' was so important to our group my comments
got a lot of support from other group members, but I got kicked from the group after I made the comment. So I
contacted Charlotte to enquire as why she did that and here is the response...

The first comment that Charlotte Goiar makes proves that she is taking offence to terms like "gender non conforming".
Charlotte has obviously taken offence because transsexuals have been put in the same group as these other gender
types and that our needs should always remain exclusive of everyone else's is the feeling I get here. But the truth is
many gender variants are affected by Gender Dysphoria which is a mood condition that relates to gender identity issues
and this is how it has now been outlined in the new WPATH SoC. Gender Identity Disorder (GID) is a totally different
condition to Gender Dysphoria (GD), however GD can affect those who are diagnosed with GID, but GD can also affect
all other gender non-conforming (GNC) people.

Charlotte graciously "invited me to re-join again after there is more clear differentiation of the different conditions"
on my site. But I told her not to bother - my whole opinion of that woman has been changed in the blink of an eye
after her very crazy response to these new Standards of Care.

[Frances]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

[Aprilrain]

I was and still am happy to follow the standards of care. WHY NOT? it takes years for HRT to work anyway and as Frances pointed out SRS is just the icing on the cake of a full and complete GENDER transition (not a sex transition). That being said the HBSoC are not law (at least not in the USA) and people are free to do with their bodies as they wish

I think it is great that the health care profession is recognizing what it has been teach for a while now. If gender identity is a "spectrum" then it makes sense that their would be people who have gender issues who may not want or need to transition fully but still require some type of care.

[Traci Elizabeth]

I also agree with alining oneself with the standards of care. I have always been a woman and did not need anyone else confirming what I already knew. Nevertheless, I volunteered to follow the SOC. Having a psychologist and MD help you through your transition can only be beneficial not harmful.

There are far too many of us who change our minds either before or after SRS to gamble the odds. So it makes sense to me that RLE and the rest of the SOC can only be helpful in you finding out if this is the road you truly want to follow.

Its one thing to know within you that you are a woman in a man's physical body. It is an entirely different act to commit yourself to permanently live that other gender legally, physically, chemically, and emotionally thus the SOC.

[Melody Moore]

April, while the SoC is not law anywhere medical services and support organisations like Queensland Health, our state
government funded public health service runs our Sexual Health Service here have adopted the SoC as their policies
so it might as well be law. But I just don't think this happens here. You see if a practitioner does something outside of
these guidelines then they can end up being sued - as was the case with the Monash Gender Centre in Melbourne, Australia
for their misdiagnoses with a couple of transsexuals that rejected their gender reassignment. So the threat of possible
litigation is what makes medical services & support organisations toe the line nowadays because it can be argued in court
that a doctor or a psychiatrist for example was negligent for a misdiagnosis if the SoC are not followed. This is where I also
need to be very careful myself now with my role as the coordinator and chairperson for my support group. One little bit of
mis-information could get my arse or the group sued. So everything I publish now on the website has to be in keeping with
the SoC because that is also the guidelines for transgender health care in my region. To go against that is like hanging my
arse over the line waiting for a good kicking.

I agree also with Frances, there is no need to rush into things, usually those that do fall flat on their faces because there
is so much more to being a woman than just having SRS and its a shame that some people find this out the hard way. I want
my SRS ASAP as well & was approved sometime ago and if I was really desperate there are other ways I could get the money
real quickly for my SRS. But I am not 'that' desperate. My gender dysphoria has settled down a lot now, so I don't feel the
urgency I felt in the beginning because I have also come to realise that there was so much that I had to learn & get use to.
Luckily for me all seems to be coming together for me fairly quickly & smoothly, but I see others who have been under therapy
a lot longer than I have who are nowhere near the stage I am at because of the psychological issues they are yet to overcome.

Unless you really know yourself and are sure about everything would you ever attempt gender transition on your own outside
the SoC. But having said that I am also thinking now "Having a little bit of knowledge can be very dangerous". And that is how
I see it to be undergoing transition without proper support. Because even with professional medical help things can and will go
wrong. You cannot know about all the issues that can affect you or have any idea if you are in a situation of risk. I lost my gall
bladder, but I was warned just prior to this that it was showing some signs that something was wrong via tests down on my liver.

Oh and Kaitlyn... that was very well said

[Fractured]

I respect the fact the SOC is being utilized as a treatment path for so many people. And I think Ver 7 is a large improvement compared to the 2001 release. The new document, besides changing the perspective of treatment, also provides more detailed information on the risks of treatment - the possible side effects of HRT and complications that can arise from SRS. I'm not sure if that is an effort to dissuade those treatment options or if it is trying to place more information at a physician's fingertips more easily. Regardless of the reasoning, I appreciate having that additional info in a easily located reference for both health care providers and for the public.

[HenryHall]

I am a firm believer in the RLE. I do not understand why anyone would rush to SRS. Social transition is the biggest hurdle, not whether you have a penis or a vagina. The SoC are fine. It is the DSM that needs revising.

The simple answer to "why anyone" is safety.

Perhaps not where you live, but living as a chick with a d**k will get you beaten up or murdered in many parts of the world. Surgery-first is the only physically safe route to transition. Even as some might argue that it is mentally unsafe. Following that SOC can put you in harm's way.

Surgery of course costs big money, but done first it also gets you out of having to submit to psychiatry which itself carries damaging stigma (psychiatry should not be stigmatizing but it really is stigmatized and some people (not everyone) strongly object to being stigmatized, mere water off a duck's back to other people).

Not for everyone, but I hope you understand that opinions and circumstances vary and there are some very solid reasons. For some people. Live and let live, some people are adult enough to take the responsibility personally, others definitely need help to share responsibility. Not for everyone.

[Frances]

The simple answer to "why anyone" is safety.

Perhaps not where you live, but living as a chick with a d**k will get you beaten up or murdered in many parts of the world. Surgery-first is the only physically safe route to transition. Even as some might argue that it is mentally unsafe. Following that SOC can put you in harm's way.

Surgery of course costs big money, but done first it also gets you out of having to submit to psychiatry which itself carries damaging stigma (psychiatry should not be stigmatizing but it really is stigmatized and some people (not everyone) strongly object to being stigmatized, mere water off a duck's back to other people).

Not for everyone, but I hope you understand that opinions and circumstances vary and there are some very solid reasons. For some people. Live and let live, some people are adult enough to take the responsibility personally, others definitely need help to share responsibility. Not for everyone.

I don't understand your point. Why would being a man with a vagina offer safety? What country are you refering to that people see genitals in the open? Besides, reputable surgeons follow the SoC. Are you recommending getting a hack job in a shady private clinic? The SoC are designed to maximize the chances of success and minimize the chances of regret, and they work. All the people that I personnaly know who are having a hard time with their transition went around the SoC guidelines.

The problem is not seeing a psychiatrist, but the mental disorder diagnosis itself. Some countries are doing away with it. People see therapists all the time, but trans people are considered mentally ill in a pretty universal diagnostic manual.

Since you put me to task in your last paragraph, could you please tell us a little about yourself? Your profile contains no information apart from your age, you have no photo and only two posts.

[Melody Moore]

Who the hell are you HenryHall to be coming onto this forum and
in your third post to dictating how gender transition should be?

Such an expert are we? to go against a large organisation like the World Professional Association of Transgender Health

The truth is having SRS or being pre-op makes no difference to the safety of a trans-woman.

Surgery first? You really have the cart before the horse and obviously don't have a clue PMSL

[HenryHall]

I don't understand your point. Why would being a man with a vagina offer safety?

It doesn't. A man with a vagina would be an FTM doing RLT and this is also dangerous, though life is less dangerous for sexually unusual men than sexually unusual women.

What country are you refering to that people see genitals in the open?

That is a straw man attack.
If you want an example of a person who was murdered for reason of being pre-op or non-op then Gwen Araujo would be a good example. There are lots more.
http://en.wikipedia.org/wiki/Murder_of_Gwen_Araujo

The SoC are designed to maximize the chances of success and minimize the chances of regret, and they work. All the people that I personnaly know who are having a hard time with their transition went around the SoC guidelines.

Evidence for that design?
The SOC revision committee was pretty open about the fact that the SOC must protect surgeons from professional liability lawsuits. It is designed to do exactly that.

As to a hard time, all the people I have met who regret surgery are people who went through the SOC. None of the people I have met who hopped a jet to BKK and negotiated surgery after arrival have regrets.

The problem is not seeing a psychiatrist, but the mental disorder diagnosis itself. Some countries are doing away with it.

The problems are (1) the stigma associated with having a psychiatric diagnosis and (2) The WPATH SOC requires a diagnosable condition to qualify for treatment.

As I have written elsewhere, a psychiatric diagnosis should not be stigmatizing. But that does not change the fact that it is stigmatizing.

Since you put me to task in your last paragraph, could you please tell us a little about yourself? Your profile contains no information apart from your age, you have no photo and only two posts.

I confine my comments to the issues, not the personalities. I could mention that I am a citizen of multiple countries and have lived and worked on several continents.

[Frances]

I confine my comments to the issues, not the personalities. I could mention that I am a citizen of multiple countries and have lived and worked on several continents.

I wanted to know what made you an expert on transition. Are you trans? Have you started transitioning? Have you finished your transition? You are positioning yourself as an expert over people who have lived it and done it. So... who are you?

[HenryHall]

Who the hell are you HenryHall to be coming onto this forum and in your third post to dictating how gender transition should be? ..

I'm addressing the issues, not the personalities and dictating nothing.

But since you mention personalities, you appear to have an agenda that gender transition should be a certain way, not I.

My position is that different people have different needs and WPATH fails to address that beyond a quite limited extent.

[Melody Moore]

Henry, do you have any idea how many trans people there are on this planet?

There is well over 9000 here in Australia alone and you would be very lucky to even hear about a single
attack on one trans person here in Australia today. It is very obvious you don't have a clue and seem to
have an agenda to promote fear about gender transition. the new SoC are about the depsychopatholisation
of gender identity disorder and yet you claim we should just accept being treated for a "psychiatric diagnosis".

My position is that different people have different needs and WPATH fails to address that beyond a quite limited extent.

What a load of crap Mr Expert,

that statement in itself just proved you haven't even read the Standards of Care

I am really being to think you are an Anti-trans troll now.

[Kaitlyn Michele]

henry's agenda is to argue..don't get it into it with him...

he does not understand the meaning of simple words like often, and ignore
i say sayanora henry

[Beth-Lock]

Girls! Girls! Girls! (Not to mention boys.)
Just take deep breath and try and let go of all those negative emotions!

[Traci Elizabeth]

I love it when we get feathers flying. It always show me that we take ourselves way too seriously and think that our feelings are the right feelings for everyone else!

viva la fight

[Frances]

Girls! Girls! Girls! (Not to mention boys.)
Just take deep breath and try and let go of all those negative emotions!

I love it when we get feathers flying. It always show me that we take ourselves way too seriously and think that our feelings are the right feelings for everyone else! viva la fight

That is really your reading on this particular situation? Someone with no history and no established credibility comes barging in challenging and critizing everyone (read the posts in the other thread) and we are being hysterical? I must start shopping elsewhere. Long live the trolls I guess.