Leading Trans Health Care Guidance Updated—and Still Stuck in the Past

    In September, the World Professional Association for Transgender Health (WPATH) released its updated Standards of Care, the gold-standard guidelines for medical professionals providing gender-affirming care. Though SOC8 makes a few critical improvements on the seventh edition, released in 2012, it represents an incrementalism out of pace with the escalating attacks on trans rights. More than a dozen US states have made recent attempts to restrict or remove access to gender-affirming care, including Florida’s enactment of a ban on all Medicaid coverage for minors.

    The SOC is similar to the Diagnostic and Statistical Manual of Mental Disorders in that it’s a tool that facilitates, but often gatekeeps, access to care. SOC recommendations are used to demonstrate to insurance companies that a patient’s gender-affirming care is medically necessary and therefore qualifies for coverage. SOC does not, however, carry any legal weight with providers, who can withhold care if they’re inclined to and not face any particular consequence.

    Rectifying a failure of all previous editions to recognize nonbinary as a gender, SOC8 includes a new chapter on care for nonbinary patients. People navigating the landscape of gender-affirming health care are often forced to do so on extremely binary terms, which the new guidance should help to alleviate. SOC8 also supports providers discussing certain nonsurgical treatments with any patients who have reached puberty, rather than recommending a minimum age of 14.

    But these are hardly sufficient improvements. SOC8 has in many ways only deepened the distrust with which many activists and community members have long regarded WPATH.

    “Most of these recent researchers are still talking about the same issues we talked about in the ’80s.”

    Rather than removing the barrier to care of getting providers to write a letter of medical necessity, the updated guidance simply advised that patients only need to obtain one such letter rather than two. Letters of medical necessity take agency away from the patients themselves and leave providers with the power to judge someone’s psychological wellbeing and ability to consent to care.

    “Most of these recent researchers are still talking about the same issues we talked about in the ’80s,” Judith Lefebvre, a member of the trans activist collective TRAPS, told Filter. “‘Is it okay to give hormones to people? Does it better their life?’”



    On September 17, TRAPS activists protested at the conference where SOC8 was being unveiled. Before being removed by security, they demanded that WPATH collaborate appropriately with the people its clinical guidance applied to—specifically people of color, and those idenfitying as Two-Spirit—and deliver an SOC predicated in bodily autonomy and informed consent.

    Lefebvre said one particularly harmful concept perpetuated by WPATH is that the “success” of a medical transition can be determined by the stability of the patient’s gender identity.

    “In adolescent care, this kind of consideration is weird to me because [people can] live through a kind of fluidity,” Lefebvre said. WPATH “pathologizes trans identities and is detrimental to the diversity of needs of our community, [and to the] very specific needs for people living at the intersection of various systems of oppression.”



    Photograph via United States House of Representatives

    • Adryan is a journalist and writer covering drugs and policing. Their reporting has appeared in publications including Rolling Stone, Teen Vogue, Vice and Complex. They live in New Jersey.

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