The World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) are the documents that compiles evidence-based research to provide guidelines for the care of Trans and Gender Diverse (TGD) individuals. WPATH SOC Version 8 is now expected to be published Spring 2022. I think it will be released to coincide with the next major conference which will be in September 2022 in Montreal.
Version 7 was published in 2011 but Version 8 is the result of a process that began nearly 60 years ago with the 1966 publication of “The Transsexual Phenomenon” by Harry Benjamin, and the introduction of the concept of “Gender Identity” by John Money. I find it fascinating to look at the progression of TGD validation.
The mid-sixties discussions of Gender as distinct from Sex culminated in the First International Symposia on Gender Identity sponsored by the Erikson Educational Fund (1969). This organization was instrumental in the 1972 decision by the American Medical Association to sanction Sex Reassignment Surgery as the treatment of choice for transsexualism, eliminating the idea of a “cure” in the typical sense of the word.
On the heels of Gay Liberation (literally on the “heels” of transgender women of color) in 1979, the Harry Benjamin International Gender Dysphoria Association (HBIGDA) was founded. That same year, they published what would become the first Standards of Care. Just a year later, Gender Identity Disorder appeared in the Diagnostic and Statistical Manual of Mental Disorders (DSM III) and SOC version 2 was published. And a year after that (1981), SOC version 3 was published.
It wasn’t until 1990 that SOC version 4 was published. Another 8 years later (1998), SOC version 5 was released. For the first time, the SOC included a chapter on the treatment of children. It was about a dozen years (2001) until SOC version 6 was released.
Version 6 was moving away from gatekeeping and was progressive for its time. HBIGDA grew a lot and in 2007, HBIGDA became the World Professional Association for Transgender Health. This was the same year that the USA opened its first gender clinic specifically for youth. During this time (2001-2007), there was an unprecedented increase and visibility of transgender people seeking support and gender-affirming medical treatment.
Version 7 was published in 2011 and in step with the increase in visibility, the document went from 30 pages, small format to 120 pages, large format! The SOC were translated into nearly 20 languages. Gender Clinics opened all over the USA. Version 7 moved away from concepts like “eligibility and readiness” and “staged approach” to less rigidity about the sequence of and requirements for interventions. The move toward affirmative care blossomed.
Version 7 also eliminated the requirement of three months of psychotherapy before hormones and moved to an approach in which psychotherapy was not mandatory for hormones or surgery. Furthermore, there was a greater focus on the international aspect of the organization which resulted in conferences NOT in North America after Atlanta 2011.
SOC version 8 was supposed to be released for WPATH 25th symposium in 2018. There has been a lot of tension and dissent within WPATH. After a period of review and critique by membership, SOC 8 will finally be released in Spring 2022. The Chapter Titles have not been finalized but, in general, will cover the following topics: Global; Terminology; Epidemiology; Child; Adolescent; Assessment; Nonbinary; Mental Health; Primary Care; Hormone Therapy; Sexual Health; Reproductive Health; Voice; Surgery; Institutions; Intersex; Eunuch; Education; and Ethics.
Reading the proposed standards and comments I can summarize a few themes:
- In general, there has been critique that the language needs to be more inclusive of cultural diversity, neurodivergence, and nonbinary identities. Also, there still needs to be more of a global perspective.
- There is a push toward harm reduction, assessment by physicians (non-mental health providers) and informed consent. Readers would also like more emphasis on the medical necessity of care.
- There is a lot of critique about the idea that gender exploration is positive for everyone yet a continued sub-text which may value cisgender identities over other outcomes.
- Interestingly, there is a push to remove the chapter on Intersex because it is presented as distinct and not well integrated, when the fact is there are intersex transgender people.
- There are various specific medication recommendations and more discussion of fertility preservation and chest/breastfeeding. There are also some suggestions about age guidelines for various medical procedures (such as hysterectomy).
Overall, WPATH is urged to promote cultural humility among providers and to champion the autonomy of trasngender individuals with a sensitivity to issues such as access to care.
Next month I hope to be able to disclose some of the more specific changes that are likely to be noticeable, especially as it relates to children and adolescents.
Antonia Caretto, Ph.D. is a fully licensed Clinical Psychologist and a graduate of the University of Michigan and the Alliant International University California School of Professional Psychology. Dr. Caretto’s 1991 doctoral dissertation research was on “Familial Homosexuality Among Women and It’s Relationship to Childhood Gender Role Non-Conformity and Adult Sex Role.”
Dr. Caretto has a solo private practice in Farmington Hills, MI, and gender identity development continues to the focus of much of her work.