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The WPATH standards of care

The WPATH standards of care are guidelines which are used by clinicians to help diagnose, counsel and treat transsexual, transgender and gender non conforming people. I had never read them before and I was surprised at what I found.

I had expected a document that dealt exclusively with transitioning transsexuals but I was mistaken. It in fact deals with all types of gender dysphorics.

Early on in the document, they state the following about gender non conformity versus gender dysphoria:

“Gender nonconformity refers to the extent to which a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex (Institute of Medicine, 2011). Gender dysphoria refers to discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) (Fisk, 1974; Knudson, De Cuypere, & Bockting, 2010b). Only some gender-nonconforming people experience gender dysphoria at some point in their lives”

The treatment options are also discussed:

“What helps one person alleviate gender dysphoria might be very different from what helps another person. This process may or may not involve a change in gender expression or body modifications. Medical treatment options include, for example, feminization or masculinization of the body through hormone therapy and/or surgery, which are effective in alleviating gender dysphoria and are medically necessary for many people. Gender identities and expressions are diverse, and hormones and surgery are just two of many options available to assist people with achieving comfort with self and identity.

Gender dysphoria can in large part be alleviated through treatment (Murad et al., 2010). Hence, while transsexual, transgender, and gender-nonconforming people may experience gender dysphoria at some points in their lives, many individuals who receive treatment will find a gender role and expression that is comfortable for them, even if these differ from those associated with their sex assigned at birth, or from prevailing gender norms and expectations”

Therefore transition is an option but certainly not the only one available to a person who does not fit well into the gender binary model.

The document goes on in another section:

“As the field matured, health professionals recognized that while many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options and some need neither (Bockting & Goldberg, 2006; Bockting, 2008; Lev, 2004). Often with the help of psychotherapy, some individuals integrate their trans or cross-gender feelings into the gender role they were assigned at birth and do not feel the need to feminize or masculinize their body. For others, changes in gender role and expression are sufficient to alleviate gender dysphoria.

Some patients may need hormones, a possible change in gender role, but not surgery; others may need a change in gender role along with surgery but not hormones. In other words, treatment for gender dysphoria has become more individualized”

This is a very positive advancement in recognizing that genital reassignment surgery is only one of the approaches taken these days and the focus is now on treatment which is consummate with the degree of dysphoria or discomfort that the person feels with their birth sex.

It discusses options for those who do not opt for a surgical approach:

“In addition (or as an alternative) to the psychological- and medical-treatment options described above, other options can be considered to help alleviate gender dysphoria, for example:

• In person and online peer support resources, groups, or community organizations that provide avenues for social support and advocacy;
• In person and online support resources for families and friends;
• Voice and communication therapy to help individuals develop verbal and nonverbal communication skills that facilitate comfort with their gender identity;
• Hair removal through electrolysis, laser treatment, or waxing;
• Breast binding or padding, genital tucking or penile prostheses, padding of hips or buttocks;
• Changes in name and gender marker on identity documents”

Of the points covered above I have opted for voice therapy (my own), laser hair removal and padding of the hips and buttocks along with regular cross gender expression to help me with my dysphoria and it has worked wonders.

There is a formula that will work for you and what I take from this document is that there is no “one size fits all” approach to dealing with gender incongruity in children and adults.

Your solution may be different and it is nice to see that the professional treatment options exist that can help every type of case.


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