Welcome to #TransTuesday! This week we’re talking about a horrible, terrible, no-good, very bad concept that plagues the trans community, and you might be surprised to learn where it comes from: TRANSMEDICALISM, and WPATH version 1.
Trans Day of Visibility is coming up, so this is something I wanted to talk about as it’s related to TDoV in ways you might not realize. To begin with, see the trans tuesday on THIS IS NOT FOR YOU aka TRANS DAY OF VISIBILITY (yes, you are enough).
Let me just hit you with this: the REASON so many trans people feel like we might not be trans enough is BECAUSE OF TRANSMEDICALISM. This is what I mean when I say these things are related. Actually, they’re not just related, they’re sisters who share a bedroom.
So what exactly is transmedicalism? In the most GENEROUS of terms, it’s the belief that you cannot be trans if you do not experience GENDER DYSPHORIA.
But as I said in that trans tuesday, you don’t need to have dysphoria to be trans (though perhaps broadening that term to be more inclusive, as I discussed there, would change that). But as dysphoria is presently defined by the cis people in charge of our healthcare…
No, you absolutely DO NOT need to experience dysphoria in that exact way to be transgender. You do not, you Do Not, YOU DO NOT. YOU’RE TRANS IF YOU SAY YOU ARE.
But more realistically and truthfully, you will find transmedicalists believe that you’re only trans if you medically transition, and only if you basically get ALL the medical transition.
So, for example, you’re not “really” trans if you don’t have horrid gender dysphoria, go on hormone replacement therapy, and get basically every single gender-confirming surgery that exists.
Do you see the problems with this? I don’t know how you could miss them, they’re visible from orbit. If someone doesn’t want HRT but needs a gender confirmation surgery to feel right, that’s… fine. If someone wants HRT but no surgeries to feel right, that’s… fine.
If someone CAN’T medically transition, due to cost, or an unaccepting or dangerous home life, or for medical reasons… that doesn’t make them any less trans.
If someone chooses not to transition for whatever reason, that doesn’t make them any less trans!
Transitioning is NOT what makes you trans. What makes you trans is an incongruence between your gender and your body, AND THAT IS IT. You do not have to transition to be trans!
And if you stop and think for two seconds about transmedicalist beliefs, you instantly realize there is NO PLACE within it for nonbinary people. You either go from cis man to trans woman, or cis woman to trans man, with EVERY medical intervention possible. The end.
And I’m sorry, but that’s not the way it fucking works. YOU don’t get to tell other people who they are, who they can be, or what they HAVE to do with their bodies. That is EXACTLY WHAT CIS TRANSPHOBES DO TO TRANS PEOPLE!
This is horrid gatekeeping within the trans community, and that’s the LAST thing we need when the false cis binary of society, cis politicians, cis doctors, cis friends and relatives all gatekeep our transness. We can NOT be doing it to ourselves.
And now we’re getting to the heart of the matter, and why I said you’d be surprised at where this came from. Or maybe you won’t be surprised at all, because the answer is:
Cis people.
Let’s have a little history lesson! In the past… and in the not too far off past, mind you… this was the only way to transition. It was the only way cis doctors would LET trans people transition. Because they decided that was the only thing that made us actually transgender.
In 1979, WPATH (the World Professional Association for Transgender Health) was formed to try and standardize care for trans patients. It’s still being used today, with version 8 released in 2022. It’s… getting better. It’s still not perfect. It started off… awful.
I found a copy of the WPATH standards of care version one, from 1979. It’s kinda horrific. WPATH doesn’t have it on their website. And I’d be a bit less mad about it if WPATH just had it on their site for informational and educational purposes.
Just attach a note saying “we no longer agree with the recommendations in this, which were in many ways harmful, and are working to be better.” It took a lot of time and creative digging to find it. I don’t know if it’s intentionally trying to be hidden, but it feels like it.
Anyway, let’s have a look at some choice bits from the very first WPATH standards of care from 1979.
“4.1.1. Principle 1. Hormonal and surgical sex reassignment is extensive in its effects, is invasive to the integrity of the human body, has effects and consequences which are not, or are not readily, reversible…
“and may be requested by persons experiencing short-termed delusions or beliefs which may later be changed and reversed.”
Which is basically saying, “what trans people want is a horrible mutilation, and they may be just lying or not really mean it when they say they’re trans!” When you’re starting from this mindset, things aren’t gonna go great.
“4.1.4. …Hormonal and/or surgical sex-reassignment on demand (i.e. justified simply because the patient has requested such procedures) is contraindicated. It is herein declared to be professionally improper to conduct, offer, administer or perform hormonal sex reassignment…
“and/or surgical sex-reassignment without careful evaluation of the patient’s reasons for requesting such services and evaluation of the beliefs and attitudes upon which such reasons are based.”
You can’t BELIEVE a trans person! No no no! They can only get care if a cis person deems they need it. HOLY MOLY. To wit, see the trans tuesday on TRANS KIDS AND THE INTAKE EXAM to learn how I had to prove I was trans to a cis woman to get the care I needed.
“4.3.1. …The psychiatric/psychologic recommendation for hormonal and/or surgical sex-reassignment should, in part, be based upon an evaluation of how well the patient fits the diagnostic criteria for transsexualism as listed in the DSM-III…”
The DSM referenced is the Diagnostic and Statistical Manual of Mental Disorders. That’s right! They thought we all had mental disorders, isn’t that… fun? Let’s look at some of those criteria:
“Persistent wish to be rid of one’s own genitals and to live as a member of the other sex.”
aka “If you don’t want different genitals, you’re not trans!” Do you see the roots of transmedicalism? They’re right in front of you.
“The disturbance has been continuous (not limited to periods of stress) for at least two years.”
Did you only just discover why you felt so bad your whole life? Too bad! Wait two more years to do anything about it. Again see my trans tuesday on the intake exam and how I had to find instances from my life i could use as examples to “prove” my transness.
“Absence of physical intersex or genetic abnormality.”
aka “intersex people go home, we will not help you.”
“4.3.2. …requires that the psychiatrist or psychologist have knowledge, independent of the patient’s verbal claim, that the dysphoria, discomfort, sense of inappropriateness and wish to be rid of one’s own genitals, have existed for at least two years.
“This evidence may be obtained by interview of the patient’s appointed informant (friend or relative) or it may best be obtained by the fact that the psychiatrist or psychologist has personally known the patient for an extended period of time.”
Can’t trust trans people! You can only listen to CIS people you can independently confirm their transness with! AAAUUUUUGH
“The best indicator for hormonal and surgical sex-reassignment is how successfully the patient has been in living-out, full-time, vocationally and avocationally, in all social situations…
“the social role of the genetically other sex and how successful the patient has been in being accepted by others as a member of that genetically other sex.”
How GOOD are they at making you believe they’re the gender they say they are? How well do they conform? Do they not conform to gendered stereotypes? NOT TRANS!
I’m gonna scream. You HAD to uphold the false cis binary, in that if you were assigned male at birth but were a trans woman, to transition you had to be attracted to MEN. In fact, your doctor often had to think you could make an attractive woman before they’d let you!
Much worse but entirely related is that there was a whole lot of sexual abuse happening to those trans women, at the hands of their doctors, with the threat of losing access to medical care if they refused hanging over their heads.
“Genital sex-reassignment shall be preceded by a period of at least 12 months during which time the patient lives full-time in the social role of the genetically other sex.”
You were FORCED to live as your true gender for a year before you were ALLOWED access to the healthcare you needed! Do you understand what that entails, and how difficult and impossible that was for trans people? How dangerous?
Do you realize it wasn’t even living as your true gender for a year, it was living as your cis doctor’s ***IDEA*** idea of your true gender? If you didn’t hit every damned gendered stereotype THEY wanted to see, you couldn’t be you! My blood, it boils.
Do you cis folks reading know how impossible and horrible that would be for YOU to do? Live exactly as someone else dictates you should based on your gender? And if you don’t conform to their personal biases, goodbye any chance of being yourself ever again.
And, oh god this makes me so mad… often the only way forward was to leave your entire life behind, move somewhere new, and go stealth. A stealth trans person is someone who’s not out as trans, who passes for a cis person of their gender, and lets everyone think they’re cis.
This was known as “woodworking,” meaning you “disappear into the woodwork” and aren’t seen as trans, by anyone, ever. You were forced to HIDE YOUR TRANSNESS.
See the trans tuesday on MISGENDERING AND PASSING for more on what passing as cis really means.
Here’s one trans woman’s account of doing that very thing, and how it was expected as the natural outcome, as was compulsory cisgender-passing and compulsory heterosexuality, when she transitioned in the 1980s.
As you can see right there, and as I’ve said a million times, trans visibility is SO IMPORTANT. To see trans joy, to see other trans people out there living their lives, being happy and free, makes us think we can do it too.
And we were forced to hide it. All of it. It was basically that or no transition at all.
Trans people have always existed, despite this and everything else stacked against us. We’re not a fad, we’re not new, we’re not a phase. See the trans tuesday on TRANS HISTORY 1 for more.
But this is part of WHY it can be so hard to spot trans people in history. They didn’t have the terminology, they didn’t have the ability or the safety to be out, and when they DID… so many were FORCED TO HIDE IT FROM THE WORLD.
And this is where transmedicalism stems from. It was created by those cis doctors as a method of controlling trans people, forcing us into small little boxes that upheld the false cis binary matrix of society. Because open and out trans people prove that binary is a lie.
Trans people who DON’T need every single bit of medical transition prove it’s a lie. Nobinary people prove it’s a lie. Us being out and open helps more of us come out and be free and proves the cis binary is. Not. Real.
So for many trans people who HAD to go through that just to be able to transition, they’ve internalized that transmedicalism. And yeah, that’s INTERNALIZED TRANSPHOBIA. One hundred percent.
Many trans people forced through that bought into it entirely, and told other trans people that was the ONLY way to be trans. And it spread from there, on down the line, to where it’s now a serious problem in the trans community.
It’s caused a split, where transmedicalists call those of us who know gender is more than a false binary TUCUTE, as a way of minimizing the importance of our beliefs, like we’re just some naive children who don’t understand.
And then the tucutes collectively call the transmeds TRUSCUM. But if it’s caused the kind of division where we’re making up nicknames to otherize those with opposing views… who do you think benefits from that?
Transmedicalists think passing is the goal, and if you don’t want to pass you’re either not trans or shouldn’t even bother. They think your gender expression has to conform to the rigid stereotypes of men and women, otherwise you’re not “really” a man or a woman.
And also, let me just say that transmedicalist beliefs are so OBVIOUSLY bullshit because when you boil them down you’re left with… women have vaginas and men have penises.
It’s reducing genders down to nothing more than their genitals, and WHAT ON ACTUAL GREEN EARTH has feminism been fighting against SINCE ITS INCEPTION?? Women, AND men, are MORE than just what is or isn’t between their legs!
It’s so blatantly obvious this is all just another method of control, of upholding the false binary, so that those in power can maintain their power and not have it challenged by the proof that it’s all made up nonsense, and cis men really AREN’T better at everything and more important.
It’s reductive, it’s harmful, it’s not even true! There is more than “man” and “woman”. Gender is a spectrum, with cis men at one end and cis women at the other, and the space between is filled with a million color variations.
As it was so difficult for me to find the horrific WPATH standards of care version 1, I’ve copied the entire text of it and included it at the end of this document.
We have to preserve these things, so we know our history, because it informs our present. We cannot forget what cis doctors put us through, or what it did to us as a community.
We have GOT to stop gatekeeping each other. We have GOT to stop spreading society’s transphobia and doing the work of our own oppression. We have GOT to help each other be whoever we truly are, and not what cis people OR OTHER TRANS PEOPLE want us to be.
YOU’RE TRANS IF YOU’RE OUT OR NOT.
YOU’RE TRANS IF YOU TRANSITION OR NOT.
YOU’RE TRANS IF YOU GET ALL THE MEDICAL TRANSITION, SOME, OR NONE.
YOU’RE TRANS IF YOU SAY YOU ARE.
AND YOU. ARE. ENOUGH.
Tilly Bridges, end transmission.
tillysbridges@gmail.com
PS – If you’d like to enrage yourself with the full text of WPATH soc 1, you can read it here.
To preserve this, should the site linked above get taken down, here is the full text of WPATH standards of care version 1 from 1979
(warning: it will make you want to smash stuff)
- Introduction
As of the beginning of 1979, an undocumentable estimate of the number of adult Americans hormonally and surgically sex-reassigned ranges from 3,000 to 6,000. Also undocumentable is the estimate that between 30,000 and 60,000 persons, worldwide, consider themselves to be valid candidates for sex-reassignment. As of mid-1978, approximately 460 centers in the Western hemisphere offered surgical sex-reassignment to persons having a multiplicity of behavioral diagnoses applied under a multiplicity of criteria.
In recent decades, the demand for sex-reassignment has increased as have the number and variety of possible psychologic, hormonal and surgical treatments. The rationale upon which such treatments are offered have become more and more complex. Varied philosophies of appropriate care have been suggested by various professionals identified as experts on the topic of gender identity. However, until the present, no statement on the standard of care to be offered to gender dysphoric patients (sex reassignment applicants) has received official sanction by any identifiable professional group. The present document is designed to fill that void.
- Statement of Purpose
The Harry Benjamin International Gender Dysphoria Association presents the following as its explicit statement on the appropriate standards of care to be offered to applicants for hormonal and surgical sex reassignment.
- Definitions
3.1 Standard of care. The standards of care, as listed below, are minimal requirements and are not to be construed as optimal standards of care. It is recommended that professionals involved in the management of sex-reassignment cases use the following as minimal criteria for the evaluation of their work. It should be noted that some experts on gender identity recommend that the time parameters listed below should be doubled, or tripled.
3.2 Hormonal sex-reassignment. Hormonal sex-reassignment refers to the administration of androgens to genotypic and Phenotypic females, and the administration of estrogens and/or progesterones to genotypic and phenotypic males, for the purpose of effecting somatic changes in order for the patient to more closely approximate the physical appearance of the genotypically other sex. Hormonal sex-reassignment does not refer to the administration of hormones for the purpose of medical care and/or research conducted for the treatment or study of non-gender dysphoric medical conditions (e.g., aolastic anemia, impotence, cancer, etc.).
3.3 Surgical sex-reassignment. Surgical sex-reassignment refers to surgery or the genitalia and/or breasts performed for the Purpose of altering the morphology in order to approximate the physical appearance of the genetically-other sex in persons diagnosed as gender dysphoric. Such surgical procedures as mastectomy, reduction mammoplasty, augmentation mammopiasty, castration, orchidectomy, penectomy, vaginoplasty, hysterectomy, salpingectorsy, vaginectomy, cophorectomy and phalloplasty - in the absence of any diagnosable birth defect or other medically defined pathology, except gender dysphoria, are included in this category labeled surgical sex-reassignment.
Surgical sex reassignment also refers to any and all other surgical procedures of non-genital or non-breast sites (nose, throat, chin, cheeks, hips, etc.)conducted for the purpose of effecting a more masculine appearance in a genetic female or for the purpose of effecting a more feminine appearance in a genetic male, in the absence of identifiable pathology which would warrant such surgery regardless of the patients genetic sex (facial injuries, hermaphroditism, etc… )
3.4 Gender Dysphoria. Gender Dysphoria herein refers to that psychological state whereby a person demonstrates dissatisfaction with their sex of birth and the sex role, as socially defined, which applies to that sex, and who requests ‘hormonal and surgical sex-reassignment. Gender dysphoria, herein, does not refer to cases of infant sex-reassignment or re-announcement nor does it refer to those persons who, although dissatisfied with their genetically and socially defined sex status (i.e., transvestites and transgenderists) usually do not request sex-reassignment. Gender dysphoria, therefore, is the primary working diagnosis applied to any and all persons requesting surgical and hormonal sex-reassignment.
4. Principles and standards
4.1.1. Principle 1. Hormonal and surgical sex reassignment is extensive in its effects, is invasive to the integrity of the human body, has effects and consequences which are not, or are not readily, reversible, and may be requested by persons experiencing short-termed delusions or beliefs which may later be changed and reversed.
4.1.2. Principle 2. Hormonal and surgical sex reassignment are procedures requiring medical justification and are not of such minor consequence as to be performed on an elective basis.
4.1.3. Principle 3. Published and unpublished case histories are know in which the decision to undergo hormonal and surgical sex-reassignment was, after the fact, regretted and the final result of such procedures proved to be psychologically dehabilitating to the patients.
4.1.4. Standard 1. Hormonal and/or surgical sex-reassignment on demand (i.e. justified simply because the patient has requested such procedures) is contraindicated. It is herein declared to be professionally improper to conduct, offer, administer or perform hormonal sex reassignment and/or surgical sex-reassignment without careful evaluation of the patient’s reasons for requesting such services and evaluation of the beliefs and attitudes upon which such reasons are based.
4.2.1. Principle 4. The analysis or evaluation of reasons, motives, attitudes, purposes, etc., requires skills not usually associated with the -professional training of persons other than psychiatrists and psychologists.
4.2.2. Principle 5. Hormonal and/or surgical sex reassignment is performed for the purpose of improving the quality of life as subsequently experienced and such experiences are most properly studied and evaluated by the behavioral scientist (psychiatrist or psychologist).
4.2.3. Principle 6. Hormonal and surgical sex-reassignment are usually offered to persons, in part, because a psychiatric/psychologic diagnosis of transsexualism (see DSM III, proposed, section 302.5X),lor some related diagnosis, has been made. Such diagnoses are properly made only by psychiatrists or psychologists.
4.2.4. Standard 2. Hormonal and surgical (genital and non-genital) sex-reassignment must be preceded by a firm recommendation for such procedures made by a certified and licensed psychiatrist or psychologist who can justify making such a recommendation by appeal to training or professional experience in dealing with sexual disorders, especially the disorders of gender identity and role.
4.3.1. Principle 7. The psychiatric/psychologic recommendation for hormonal and/or surgical sex-reassignment should, in part, be based upon an evaluation of how well the patient fits the diagnostic criteria for transsexualism as listed in the DSM-III (proposed) category 302.5X to wit:l
- “Persistent sense of discomfort and inappropriateness about one’s anatomic sex.
- Persistent wish to be rid of one’s own genitals and to live as a member of the other sex.
- The disturbance has been continuous (not limited to periods of stress) for at least two years.
- Absence of physical intersex or genetic abnormality.
- The disturbance is not symptomatic of another mental disorder, such as Schizophrenia.”
This definition of transsexualism is herein interpreted not to exclude persons who meet the above criteria but who otherwise may, on the basis of their past behavioral histories, be conceptualized and classified as transvestites and/or effeminate male homosexuals or masculine female homosexuals.
4.3.2. Principle 8. The diagnostic evidence for “persistent” (see 4.3.1. A and 4.3.1 B, above) requires that the psychiatrist or psychologist have knowledge, independent of the patient’s verbal claim, that the dysphoria, discomfort, sense of inappropriateness and wish to be rid of one’s own genitals, have existed for at least two years. This evidence may be obtained by interview of the patient’s appointed informant (friend or relative) or it may best be obtained by the fact that the psychiatrist or psychologist has personally known the patient for an extended period of time.
4.3.3. Standard 3. The psychiatrist or psychologist making the recommendation in favor of hormonal and non-genital (surgical) sex-reassignment shall have known the patient in a psychotherapeutic relationship, for at least 3 months prior to making said recommendation. The psychiatrist or psychologist making the recommendation in favor of genital (surgical) sex-reassignment shall have known the patient, in a psychotherapeutic relationship for at least 6 months prior to making said recommendation. That psychiatrist or psychologist should have access to the results of psychometric testing (including IQ testing of the patient) when such testing is clinically indicated.
4.4.1. Principle 9. Hormonal sex-reassignment is both therapeutic and diagnostic in that the patient requesting such therapy either reports satisfaction or dissatisfaction regarding the results of such therapy.
4.4.2. Principle 10. Hormonal sex-reassignment may have some irreversible effects (infertility, hair growth, voice deepening and clitoral enlargement in the female-to-male patient and infertility and breast growth in the male-to-female patient) and, therefore, such therapy must be offered only under the guidelines proposed in the present standards.
4.4.3. Principle 11. Hormonal sex-reassignment should precede surgical sex-reassignment as its effects (patient satisfaction or dissatisfaction) may indicate or contraindicate later surgical sex-reassignment.
4.4.4. Principle 12. The best indicator for hormonal and surgical sex-reassignment is how successfully the patient has been in living-out, full-time, vocationally and avocationally, in all social situations, the social role of the genetically other sex and how successful the patient has been in being accepted by others as a member of that genetically other sex.
4.4.5. Standard 4. The initiation of hormonal sex-reassignment shall be preceded by a period of at least 3 months during which time the patient lives full-time in the social role of the genetically other sex.
4.5.1. Standard 5. Non-genital sex-reassignment (facial, hip, limb, etc.) shall be preceded by a period of at least 6 months during which time the patient lives full-time in the social role of the genetically other sex.
4.6.1. Standard 6. Genital sex-reassignment shall be preceded by a period or at least 12 months during which time the patient lives full-time in the social role of the genetically other sex.
4.7.1. Principle 13. The intersexed patient (with a documented hormonal or genetic abnormality) should first be treated by procedures commonly accepted as appropriate for such medical conditions.
4.7.2. Principle 14. The patient having a psychiatric diagnosis (i.e. , schizophrenia) in addition to a diagnosis of transsexualism should first be treated by procedures commonly accepted as appropriate for such non-transsexual psychiatric diagnoses.
4.7.3. Standard 7. Hormonal and surgical sex-reassignment may be made available to intersexed patients and to patients having non-transsexual psychiatric/psychologic diagnoses if the patient and therapist have fulfilled the requirements of the herein listed standards; if the patient can be reasonably expected to be habilitated or rehabilitated, in part, by such hormonal and surgical sex-reassignment procedures; and if all other commonly accepted therapeutic approaches to such intersexed or non-transsexual psychiatrically/psychologically diagnosed patients have been either attempted, or considered for use prior to the decision not to use such alternative therapies. The diagnosis of schizophrenia, therefore, does not necessarily preclude surgical and hormonal sex-reassignment.
4.8.1. Principle 15. Peer review is a commonly accepted procedure in most branches of science and is used primarily to ensure maximal efficiency and correctness of scientific decisions and procedures.
4.8.2. Principle 16. Psychiatrists and psychologists must often rely on possibly unreliable or invalid sources of information (patients’ verbal reports or the verbal reports of the patients’ families and friends) in making clinical decisions and in judging whether or not a patient has fulfilled the requirements of the herein listed standards.
4.8.3. Principle 17. Psychiatrists and psychologists, given the burden of deciding who to recommend for hormonal and surgical sex-reassignment and for whom to refuse such recommendations are subject to extreme social pressure and possible manipulation as to create an atmosphere in which charges of laxity, favoritism, sexism, financial gain, etc., may be made.
4.8.4. Principle 18. Psychiatrists and psychologists, in deciding to make the recommendation in favor of hormonal and/or surgical sex-reassignment share the moral responsibility for that decision with the physician and/or surgeon who accepts that recommendation.
4.8.5. Principle 19. A plethora of theories exist regarding the etiology of gender dysphoria and the purposes or goals of hormonal and/or surgical sex-reassignment such that the psychiatrist or psychologist making the decision to recommend such reassignment for a patient does not enjoy the comfort or security of knowing that his decision would be supported by the majority of his peers.
4.8.6. Standard 8. The psychiatrist or psychologist recommending that a patient applicant receive surgical (genital) sex-reassignment must obtain peer review, in the format of a psychiatrist or psychologist peer who will personally examine the patient applicant, on at least one occasion, and who will, in writing state that he or she concurs with the decision of the original psychiatrist or psychologist. Peer review (a second opinion) is not required for hormonal sex-reassignment nor for non-genital surgical sex-reassignment. At least one of the two behavioral scientists making the favorable recommendation for surgical sex reassignment must be a psychiatrist.
4.9.1. Standard 9. The physician administering or performing surgical (genital) sex-reassignment is guilty of professional misconduct if he or she does not receive written recommendations in favor of such procedures from at least two behavioral scientists; at least one of which is a psychiatrist and one of whom has known the patient in a professional relationship for at least 6 months.
4.10.1 Principle 20. The administration of androgens to females and of estrogens and progesterones to males may lead to mild or serious health-threatening complications.
4.10.2 Principle 21. Persons who are in poor physical health, or who have identifiable abnormalities in blood chemistry, may be at above average risk to develop complications should they receive hormonal medication.
4.10.3. Standard 10. The physician prescribing hormonal medication to a person for the Purpose of effecting hormonal sex-reassignment must warn the patient of possible negative complications which may arise and that physician should also make available to the patient (or refer the patient to a facility offering) monitoring of relevant blood chemistries and routine physical examinations including, but not limited to, the measurement of SGPT in person receiving testosterone and the measurement of SGPT, Bilirubin, triglycerides and fasting glucose in persons receiving estrogens.
4.11.1. Principle 22. Genital surgical sex reassignment includes the invasion of, and the alteration of, the genitourinary tract. Undiagnosed pre-existing genitourinary disorders may complicate later genital surgical sex reassignment.
4.11.2. Standard 11. Prior to genital surgical sex reassignment a urological examination should be conducted for the purpose of identifying and perhaps treating abnormalities of the Benito-urinary tract.
4.12.1. Principle 23. The care and treatment of sex-reassignment applicants or patients often causes special problems for the professionals offering such care and treatment. These special problems include, but are not limited to, the need for the professional to cooperate with education of the public to justify his or her work, the need to document the case history perhaps more completely than is customary in general patient care, the need to respond to multiple, nonpaying, service applicants and the need to be receptive and responsive to the extra demands for services and assistance often made by sex-reassignment applicants as compared to other patient groups.
4.12.2. Principle 24. Sex reassignment applicants often have need for post-therapy (psychologic, hormonal and surgical) follow-up care for which they are unable or unwilling to pay.
4.12.3. Principle 25. Sex reassignment applicants often are in a financial status which does not permit them to pay excessive professional fees.
4.12.4. Standard 12. It is unethical for professionals to charge sex-reassignment applicants “whatever the traffic will bear” or excessive fees far beyond the normal fees charged for similar services by the professional. It is permissible to charge sex reassignment applicants for services in advance of the tendering of such services even if such an advance fee arrangement is not typical of the professional’s practice. It is permissible to charge patients, in advance, for expected services such as post-therapy follow-up care and/or counseling. It is unethical to charge patients for services which are essentially research and which services do not directly benefit the patient.
4.13.1. Principle 26. Sex-reassignment applicants often experience social, legal and financial discrimination no known, at present, to be prohibited by federal or state law.
4.13.2. Principle 27. Sex-reassignment applicants often must conduct formal or semi-formal legal proceedings (i.e. in-court appearances against insurance companies or in pursuit of having legal documents changed to reflect their new sexual and genderal status, etc.).
4.13.3. Principle 28. Sex–reassignment applicants, in pursuit of what are assumed to be their civil rights as citizens, are often in need of assistance (in the forms of copies of records, letters of endorsement, court testimony, etc.) from the professionals involved in their case.
4.13.4. Standard 13. It is permissible for a professional to charge only the normal fee for services needed by a patient in pursuit of his or her civil rights. Fees should not be charged for services for which, for other patient groups, such fees are not normally charged.
4.14.1. Principle 29. Hormonal and surgical sex-reassignment has been demonstrated to be a rehabilitative, or habilitative, experience for properly selected adult patients.
4.14.2. Principle 30. Hormonal and surgical sex-reassignment are procedures which must be requested by, and performed only with the agreement of, the patient having informed consent. Sex-reannouncement or sex-reassignment procedures conducted on infantile or early-childhood intersexed patients are common medical practices and are not included in or affected by the present discussion.
4.14.3. Principle 31. Sex–reassignment applicants often, in their pursuit of sex–reassignment, believe that hormonal and surgical sex-reassignment have fewer risks than such procedures are known to have.
4.14.4. Standard 14. Hormonal and surgical sex-reassignment may be conducted or administered only to persons obtaining their legal majority (as defined by state law) or to persons declared by the courts as legal adults (emancipated minors).
4.15.1. Standard 15. Hormor.al and surgical sex-reassignment may be conducted or administered only after the patient applicant has received full and complete explanations, preferably in writing, in words understood by the patient applicant, of all risks inherent in the requested procedures.
4.16.1. Principle 32. Gender dysphoric sex-reassignment applicants and patients enjoy the same rights to medical privacy as does any other patient group.
4.16.2. Standard 16. The privacy of the medical record of the sex-reassignment patient shall be safeguarded according to procedures in use to safeguard the privacy of any other patient group.
Explication
5.1. Prior to the initiation of hormonal sex reassignment:
5.1.1. The patient must demonstrate that the sense of discomfort with the self and the urge to rid the self of the genitalia and the wish to live in the genetically opposite sex role have existed for at least 2 years.
5.1.2. The patient must be known to a licensed psychiatrist or psychologist for at least 3 months and that psychiatrist or psychologist must endorse the patient’s request for hormone therapy.
5.1.3. The patient must have been successfully living in the genetically other sex role for at least 3 months.
5.1.4. Prospective patients should receive a complete physical examination which includes, but is not limited to, the measurement of SGPT in persons to receive testosterone and the measurement of SGPT, Billirubin, triglycerides and fasting glucose in persons to receive estrogens.
5.2. Prior to the initiation of non-genital surgical sex-reassignment.
5.2.1. See 5.1.1.
5.2.2. See 5.1.2.
5.2.3. The patient must have been successfully living in the genetically other sex role for at least 6 months.
5.3 Prior to the initiation of genital sex-reassignment (penectomy, orchidectomy, castration, vaginoplasty, mastectomy, hysterectomy, oopho.rectomy, salpingectomy, vaginectomy, phalloplasty).
5.3.1. See 5.1.1., above
5.3.2. The patient must be known to a licensed psychiatrist or psychologist for at least 6 months and that psychiatrist or psychologist must endorse the patient’s request for genital surgical sex-reassignment.
5.3.3. The patient must be evaluated at least once by a licensed psychiatrist or psychologist other than the psychiatrist or psychologist specified in 3.3.2. above and that second psychiatrist or psychologist must endorse the patient’s request for genital sex-reassignment. At least one of the behavioral scientists making the recommendation for genital sex-reassignment must be a psychiatrist.
5.3.4. The patient must have been successfully living in the genetically other sex role for at least one year.
5.3.5. An urological examination should be performed.
5.4. During and after services are provided
5.4.1. The patient’s right to privacy should be honored.
5.4.2. The patient must be charged only appropriate fees and these fees may be levied in advance of services.
1DSM III (proposed) — Diagnostic and Statistical Manual (3rd edition, proposed) Washington, D. C. The American Psychiatric Association, 2nd printing 1/15/78.
Report prepared February 12, 1979
These Standards of Care were accepted by Majority vote by those persons attending the Sixth International Gender Dysphoria Symposium, held in San Diego, California February 21 – 25, 1979.