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The new WPATH Standards of Care are out!

Daniel Hardy, MSN, APRN, PMHNP-BC, PMGT-BC • September 23, 2022

The new season is a great reason to make and keep resolutions. Whether it’s eating right or cleaning out the garage, here are some tips for making and keeping resolutions.

 World Professional Association for Transgender Health (WPATH) is the organization that supports healthcare providers seeking guidelines for offering healthcare to transgender and gender nonconforming (TGNC) individuals.  This year, they have published the eighth version of their Standards of Care (SOC8), which is the guideline that is used worldwide.  In the US, this guideline is especially helpful in supporting our right to access care through insurance companies. 


Although I have not had the opportunity to fully read and compare SOC7 to SOC8, there are some significant and important changes to note:

- expanded chapters on evaluation across the lifespan (pre-puberty, post-puberty youth, and adulthood)

- expanded chapters on other identities and cultural situations (nonbinary, intersex*, eunich, and people living in congregate living situations)

-specific named procedures commonly denied are explicitly listed as "medically necessary" (body contouring, vocal surgery and training, facial surgeries, hair removal). 


You can read the entire SOC8 here: WPATH SOC8  (opens in a new tab)


*There has been formal pushback on the pathologizing language in the intersex chapter.  It was recommended by  International Transgender Health in conjunction with Intersex leaders, during the public opinion term, to withdraw and revise this chapter. "We recommend that this chapter should be removed entirely from the SOC8. The content of this draft chapter is pathologizing and in conflict with global human rights standards. This, combined with absence of mention of intersex considerations in the other SOC8 chapters, sends a message that diminishes Trans people who are also Intersex and their health needs. In the future, WPATH should consult with Intersex communities and include experts from the community in leadership roles when developing inclusive standards of care." (source)


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Teens and even children now understand that the way they feel inside is not shameful, not harmful, but a variation of normal. Parents don't attempt scientifically proven harmful "therapies" aimed at changing their children, but instead affirming their true nature. And in the face of these changes, youth are claiming their identities more than ever. In 2021, nearly 30% of LGBTQ youth aged 13-24 identified as transgender, nonbinary, or both. The Trevor Project (2021) https://www.thetrevorproject.org/wp-content/uploads/2021/07/Measuring-Youth-Sexual-Orientation-and-Gender-Identity.pdf For these same youth, 21% have sexual identities as something outside the identities of gay, lesbian or bisexual. Most people, even cisgender straight people, understand the concept of gay and lesbian. Many also have a firm grasp on the bisexual identity- attraction to two or more genders or genders that are the same and different from that of ones self. It is in this "something else" that many people who are not very familiar with the queer community begin to feel lost. Here is where we will examine these identities. The "long" acronym (LGBTQPIA2S+) includes letters for many portions of the community- but not all. Starting with these letters: T- Transgender: Transgender is an individual whose gender identity (internal gender concept) is different than their assigned gender at birth. This is an umbrella term that may include people who identify with terms such as "nonbinary" (gender identity outside of the male/female binary) "gender queer" (gender identity that is outside the traditional notions of gender- 'queering gender'), "gender fluid" (gender that fluctuates), "transsexual" (transgender person who seeks medical transition, can be seen as outdated term by some, but is preferred by others), "agender" (having no gender identity) and more. The opposite of transgender is cisgender- someone whose gender identity matches their gender assigned at birth. Q- Queer: For more information about Queer, see the asterisk (*) below. Queer is an umbrella term for the longer acronym. It is fully and totally inclusive of all of the community- all those whose gender and/or sexual identities fall outside the social standard. Questioning: This term is used to include people whose identities are not firm, "I don't know where I fall- If I'm straight or gay or something else." It's healthy to explore your identity and see what fits best. P- Pansexual: Pansexual is a term similar to Bisexual (bisexual is an umbrella term inclusive of pansexual). Pansexual is a more politicized term, with attraction being defined as "without respect to gender." I- Intersex: intersex individuals are those whose biology doesn't neatly fit into a male/female binary. This might be at the genetic level only, or expressed in a more visible way. This is a much more common condition than most people realize, 1/100- with around 1/5 of these receiving coercive surgery before they are able to consent. A- Asexual, Aromantic and Agender (agender was defined above, under transgender) Asexual- a lack of sexual attraction to any gender (not necessarily lack of libido or lack of sexual action). It's important to note that this is often mistaken for a medical or mental health concern. Aromantic- a lack of romantic attraction to any gender (lack of romantic desire) A note on "A for Ally"- A in the acronym does not and should not ever stand for "ally." While allies are an important part of advocacy and support for our community, they are not within the community. Asserting that A should stand for Ally eraces the identities that A does stand for, while simultaneously centering the feelings of cisgender, heterosexual individuals, who are claiming to be allied with us while causing us actual harm (by eracing us). 2S- Two Spirit- Many native american cultures identified a third gender, generally called by the modern Pan-Indian term Two-Spirit (or known by the appropriate term within each tribal nation's language). Although the diversity across these cultures is massive, the similarities remain- that these individuals were highly respected and afforded an important place in society until white missionary work sought to "normalize" gender identities. + The Plus stands for identities that aren't captured by the longer acronym. Polysexual Omnisexual Split attraction model: Sexual attraction- desire for sexual acts with a person or a group of people (a particular gender, for example) Romantic attraction- desire for romantic acts with a person or group of people Sensual attraction- the desire for tactile but non-sexual touch with a person (such as hugging, back rub) Aesthetic attraction- an appreciation of beauty or attractiveness of another, such as a work of art Emotional attraction- the desire to form an emotional bond with someone, to understand them better Platonic attraction- the desire to form a friendship Intellectual attraction- the desire to interact on an academic or thought-process level. "picking your brain." from https://lgbtq.unc.edu/resources/exploring-identities/asexuality-attraction-and-romantic-orientation/ *"queer" specifically used as a term of inclusion here, having been reclaimed several decades ago. the more recent (post 2000s) pushback against the reclamation began as part of an anti-transgender movement. Substitute for LGBTQPIA2S+ as preferred.
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