WPATH - Time for a change?

SarahEL · 2023-11-08 07:25:06

The Harry Benjamin Rules, which later became known as the Standards of Care (SoC) established by the Harry Benjamin International Gender Dysphoria Association (HBIGDA) in 1979, played a significant role in shaping transgender healthcare in the past. However, they have been subject to criticism for various reasons. These rules, like earlier versions of the DSM (Diagnostic and Statistical Manual of Mental Disorders), initially classified being transgender as a mental disorder. This pathologization perpetuated stigma and discrimination against transgender individuals, framing their gender identity as a problem to be fixed rather than a legitimate aspect of human diversity. They also imposed a strict gatekeeping model that required transgender individuals to meet specific criteria before accessing gender-affirming care, including hormone therapy or surgeries. This gatekeeping approach placed significant barriers to care and was often seen as paternalistic, reinforcing the idea that medical professionals should have the final say in an individual's gender identity and healthcare decisions. This led to many personal tragedies as people failed to cope with their dysphoria without help.

These rules showed a limited understanding of the diverse ways in which people experience gender. They predominantly focused on a binary understanding of gender and did not adequately address the needs of non-binary, genderqueer, or other gender-diverse individuals. The guidelines were often criticized for their rigidity and lack of adaptability to individual needs and preferences. Transgender healthcare is a highly personalized field, and the one-size-fits-all approach does not serve the best interests of gender diverse folk. This is something that even today needs to be addressed.

There was a huge shift away from these outdated rules in favour of more patient-centered, informed consent-based models of care. The World Professional Association for Transgender Health (WPATH, which arose from the ashes of the HBIGDA) developed standards to reflect a more contemporary and inclusive understanding of transgender healthcare (using the namechange to distance themselves from their past). These updated standards prioritized individual autonomy, respect for diverse gender identities, and a more flexible approach to care. WPATH has made significant contributions to the advancement of transgender healthcare and the understanding of gender diversity. However, like any organization, there is always room for improvement. Here are some ways in which i think WPATH could be enhanced to better serve the needs of the transgender community or maybe it is time for this organisation to step aside and we start anew?

For starters they could place a stronger emphasis on inclusivity by actively involving a more diverse range of transgender and gender-diverse individuals, especially those from underrepresented and marginalized communities. Incorporating a broader range of perspectives can help shape more inclusive guidelines. There is heavy emphasis on clinical professionals being the main persons developing their guidelines. Inclusivity could further emphasize cultural competency. Recognizing the cultural nuances and specific needs of diverse communities is crucial having representatives of these cultures present in formulating the guides can only be positive and would help incorporating cultural sensitivity training and guidance into the standards of care. This can only improve the quality of healthcare for all transgender patients.

While WPATH has made efforts to address non-binary and genderqueer individuals, there is room for further expansion and what we have still feels as if it has been 'bolted on' to binary centric care. Guidelines could be revised to be more explicitly inclusive of these gender identities, with specific recommendations for the care of non-binary and genderqueer patients embracing the diversity of gender incongruency out there across the world.

The informed consent model for gender-affirming care should be further emphasized and promoted. This model prioritizes patient autonomy and decision-making, reducing unnecessary gatekeeping. Encouraging healthcare providers to adopt informed consent practices can make care more accessible and respectful. Whilst informed consent can be a double edged sword, the removal of 'passing exams' has to be standard. Give people all the information, make them read and understand it. but do not de-power them and make their gender identity something they have to 'pass' with.. that is barbaric.

WPATH could also play a more active role in providing training and education for healthcare providers. Many providers lack the knowledge and skills necessary to provide competent transgender healthcare. Offering certification programs or courses can help ensure that more healthcare professionals are adequately trained. Imagine how much improved our healthcare would be if you could check online if your care provider has obtained training in trans-specific healthcare. Adapting the guidelines to different healthcare systems, especially in regions with limited resources is, again, vital. Ensuring that the standards of care can be implemented effectively in a global context is essential for the well-being of transgender individuals worldwide. Certification goes some way to develop this and in time enhances healthcare policies implemented by politicians globally.

WPATH has played a crucial role in advancing transgender healthcare, but there is always room for improvement. By focusing on inclusivity, cultural competency, education, and research, WPATH could evolve and better serve the needs of transgender individuals and the healthcare providers who serve them. As the field of transgender healthcare progresses, so too should the organization that guides it. Expanding WPATH's advocacy efforts can be influential in driving policy changes that benefit transgender individuals. Advocacy on both the national and international levels can help remove legal barriers and improve access to healthcare. Encouraging and supporting research in the field of transgender healthcare is essential. A more proactive role in funding and promoting research to further our understanding of the health and well-being of transgender individuals is now long overdue and could easily be funded by WPATH or a similar organisation.

So, as it stands now, I believe that WPATH and their current guidelines come up short and think, with all the history of the damage to transgender individuals over the years and the mis-information initially put into the public domain. that now is the time to call for a new global body to formulate best practices for transgender healthcare that covers all our diversities, cultures and ages. Creating a new organization to provide the best care for transgender people, similar to WPATH, would require careful planning, a commitment to inclusivity, and a strong focus on patient-centered care. It should have a transparent, inclusive leadership with close ties to the community and actively solicit feedback. Entering into discussions with the very people its policies will effect. Culturally competent with focus on evidence based, globally aware pathways. Whilst priotising the informed consent model for gender-affirming care. Make it clear that the organization supports the autonomy of transgender individuals in making decisions about their healthcare.

Certification and training for healthcare providers could generate significant funds for further research projects and also advocates our care standards globally. Information and education are key to limiting discrimination and opens the doorway to communication with policy makers on local, national and international levels.

I would love to hear any ones views on how WPATH care effected them, or how they optimised their care to their own individual circumstance, maybe going behind WPATH guidelines. Or even if you believe, like I do that it is time for a new body to take over, a body organised by people who have lived through this, people like us?

Transgender Action Online

Defending, Embracing and Supporting the Gender Spectrum.

Announcement

#1 2023-11-08 07:25:06

WPATH - Time for a change?

Board footer