WPATH Standards of Care Version 8 published

96
u/HiddenStill
Thu Sep 15 22:59:40 2022 UTC
*
WPATH SOC 8
(17 comments)

I saw a post on another sub that WPATH SOC 8 has been published.

The WPATH Standards of Care are the guidelines the medical profession use in our treatment. I'm not sure whats in it yet, but its important.

There's a length analysis on twitter

A lot of the gatekeeping for surgery seems to have gone. Here's some extracts, and some of the highlighting is mine.

Page S31

CHAPTER 5 Assessment of Adults

Page S40

Statement 5.5

We recommend transgender and gender diverse adults who fulfill the criteria for gender-affirming medical and surgical treatment require a single opinion for the initiation of this treatment from a professional who has competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.

CHAPTER 8 Nonbinary

CHAPTER 9 Eunuchs

Page S90

Statement 9.2.

We recommend health care professionals consider medical intervention, surgical intervention, or both for eunuch individuals when there is a high risk that withholding treatment will cause individuals harm through self-surgery, surgery by unqualified practitioners, or unsupervised use of medications that affect hormones.

CHAPTER 10 Intersex

No need to stop HRT for surgery (VTE means Venous Thromboembolism, or blood clots).

Page S125

Statement 12.19

After careful examination, investigators have found no perioperative increase in the rate of VTE among transgender individuals undergoing surgery, while being maintained on sex steroid treatment throughout when compared with that among patients whose sex steroid treatment was discontinued preoperatively

Page S128

CHAPTER 13 Surgery and Postoperative Care

Statement 13.6

We suggest health care professionals consider gender-affirming genital procedures in eligible* transgender and gender diverse adults seeking these interventions when there is evidence the individual has been stable on their current treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result unless hormone therapy is either not desired or is medically contraindicated).

Statement 13.8

We recommend surgeons consult a comprehensive, multidisciplinary team of professionals in the field of transgender health when eligible* transgender and gender diverse people request individually customized (previously termed “non-standard”) surgeries as part of a gender-affirming surgical intervention.

Page S256

Appendix D SUMMARY CRITERIA FOR HORMONAL AND SURGICAL TREATMENTS FOR ADULTS AND ADOLESCENTS

Related to the assessment process

  • Health care professionals assessing transgender and gender diverse adults seeking gender-affirming treatment should liaise with professionals from different disciplines within the field of trans health for consultation and referral, if required*

  • If written documentation or a letter is required to recommend gender affirming medical and surgical treatment (GAMST), only one letter of assessment from a health care professional who has competencies in the assessment of transgender and gender diverse people is needed.

Criteria for surgery

a. Gender incongruence is marked and sustained;

b. Meets diagnostic criteria for gender incongruence prior to gender-affirming surgical intervention in regions where a diagnosis is necessary to access health care;

c. Demonstrates capacity to consent for the specific gender-affirming surgical intervention;

d. Understands the effect of gender-affirming surgical intervention on reproduction and they have explored reproductive options;

e. Other possible causes of apparent gender incongruence have been identified and excluded;

f. Mental health and physical conditions that could negatively impact the outcome of gender-affirming surgical intervention have been assessed, with risks and benefits have been discussed;

g. Stable on their gender affirming hormonal treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).*

*These were graded as suggested criteria

all 17 comments


20
u/D0esANyoneREadTHese
Thu Sep 15 23:30:40 2022 UTC
(7 children)

There's also a Eunuch exemption buried in a later chapter, 9.2 allows for surgical intervention WITHOUT any of the gatekeeping IF the doctor thinks/is told there's a risk of self-surgery or illegal surgery being done.

It's only for orchiectomies, but it really opens up the door for a LOT of girls who want it done RIGHT NOW instead of waiting around for 6 months which'll be 9 months to a year before they go under the knife with waiting lists, there's still gonna be a wait but it's basically "get on the list as soon as you know what you want" as long as you're either willing to buy a $20 veterinary tool on Ebay or lie to a doctor about knowing a bodymod artist.

3
OP
Thu Sep 15 23:48:30 2022 UTC
(2 children)

Thanks, I edited it in. Strange how a DIY exception only applies to eunuchs and no one else, because there's a lot of trans people doing DIY HRT and a few doing DIY surgery. I would guess the person in charge of that chapter has a different opinion to the others.

6
Fri Sep 16 00:05:56 2022 UTC
(1 child)

Yeah, the person who wrote that chapter actually has a VERY interesting story and has been basically THE medically-accredited eunuch since like 2007. Richard Wassersug ended up getting an orchi for cancer and decided to enjoy it, and has really been at the forefront of advocating the "messy" or "weird" nonbinary identities nobody else wants to touch ever since, especially ones like eunuchs with interesting historical contexts. Honestly really glad he got a chapter, a lotta the other ones were definitely still written by gatekeepy cis doctors.

3
Mon Sep 26 10:41:50 2022 UTC
(2 children)

I would be interested to hear any stories from anyone who cited this to a urologist and got a gatekeeping-free orchi, especially in the Dallas area. Can anyone who does this ping me when they get their orchi and let me know how it went?

I'm thinking of buying said veterinary tool on eBay, taking a selfie of myself holding it, and then going to every urologist in Dallas County with a printout of the new guidelines with the relevant section highlighted, show off my selfie at the consult, and say "well if you don't want to operate on me I've got the tools to do it myself at home".

(it's a bluff of course, I wouldn't actually use the tool, just hoping the threat of it will spur someone to action)

1
Mon Sep 26 23:02:22 2022 UTC
(0 children)

If you wanna save a couple bucks I have one I tried to use on myself before I managed to get in WPATH v7 compliance and get neutered by an actual doctor, I don't exactly have the anatomy to do anything with it anymore so it's kinda just taking up space right now...

2
Thu Oct 6 15:15:03 2022 UTC
(0 children)

There is also an HRT exemption qor medical reasons and non-binary people.

15
u/Who_Am_I_I_Dont_Know
Sat Sep 17 14:36:09 2022 UTC
(1 child)

12.19 Snippet:

After careful examination, investigators have found no perioperative increase in the rate of VTE among transgender individuals undergoing surgery, while being maintained on sex steroid treatment throughout when compared with that among patients whose sex steroid treatment was discontinued preoperatively (Gaither et al., 2018; Hembree et al., 2009; Kozato et al., 2021; Prince & Safer, 2020). Sex steroid treatment is especially important after gonadectomy to avoid the sequelae of hypogonadism, the risk of developing osteo- porosis, and for the maintenance of mental health and quality of life (Fisher, Castellini et al., 2016; Rosen et al., 2019). Thus, hormone providers and surgeons should educate patients about the neces- sity for continuous exogenous hormone therapy after gonadectomy

Going to finally be able to talk to my surgeon about not having to stop a month of HRT before the surgery. Will be great to have it backed by the authority they used and referred to multiple times.

4
OP
Sat Sep 17 15:23:09 2022 UTC
(0 children)

Thanks, I’ll add this bit to the summary.

I think surgeons concerns are probably more about legal liability than anything else at this point. Ie if something goes wrong they don’t want to be blamed for doing something other surgeons do, and no one wants to go first. Now it’s in WPATH that concern should disappear. If they end up in court they can just point to best practice and get off.

u/[deleted]
Fri Sep 16 15:12:54 2022 UTC
(5 children)

[deleted]

3
Fri Sep 16 15:40:34 2022 UTC
(2 children)

You'll still need a full regiment of hair removal for full depth vaginoplasty, but yeah, vulvoplasty will be on the table at 6 months.

Fri Sep 16 15:49:07 2022 UTC
(1 child)

[deleted]

2
Wed Nov 23 17:45:08 2022 UTC
(0 children)

To the best of my knowledge, it is not optional for del Corral.

3
OP
Fri Sep 16 16:01:31 2022 UTC
(0 children)

Assuming the surgeon agrees, but that's always been the case. There are people who have done both already.

The difference now will be in the number of surgeons who will accept it.

2
u/mld53a
Sun Sep 18 18:33:56 2022 UTC
(0 children)

I have been on hart for nine years but the insurance company required two letters for FFS - not the doctor.

1
u/PricklyMuffin92
Sat Sep 17 18:03:27 2022 UTC
(0 children)

Oh my! Time to read! :)

1
u/Just_Tana
Sun Oct 2 18:43:53 2022 UTC
(1 child)

Is it true that recommendations were updated about not stopping hormones for surgery?

3
Sun Oct 2 20:32:21 2022 UTC
(0 children)

That's in statement 12.18, basically saying there's no evidence that stopping is needed.

1
u/EnBumblebee
Fri Oct 7 12:38:33 2022 UTC
(0 children)

Statement 15.14 (and other places in the guidelines), talk about genital hair removal as a gender affirming "procedure", and not just necessary as preparation for GRS.

I think this is particularly worth mentioning because:

A. This is gender affirming in its own right

B. This may reduce barriers to GRS by making it easier to get hair removal before picking/consulting a surgeon