People who don’t conform to their gender roles or cultural expectations don’t have a disorder, said the health association for professionals who treat transgender patients.
The World Association of Transgender Health Professionals, composed of doctors, psychologists and other professionals, updated their standard of care for the first time in 10 years and announced its revisions this week at its conference in Atlanta, Georgia. This international group, called WPATH, meets every two years.
“People who don’t fit cultural expectations of what it means to be a man or a woman are not inherently messy,” said Eli Coleman, who chaired a committee tasked with updating the WPATH Standard of Care. “Society stigmatizes these individuals and we have prejudice and discrimination. It causes distress to a lot of people. “
But some people have gender dysphoria, a condition in which they feel uncomfortable with their bodies because they don’t match their gender. This causes mental distress that can be relieved by changing their appearance, body or hormones, Coleman said. At other times, gender dysphoria does not need medical interventions.
“It’s not a lifelong diagnosis,” said Coleman, professor and director of human sexuality at the University of Minnesota School of Medicine. “Some people learn that they can feel comfortable if they are allowed to express their gender in a way that does not necessarily require hormonal or surgical sex demands.”
WPATH has also called restorative therapies – those that seek to change the person – “unethical”. Coleman comparing them to treatments designed to turn homosexuals into heterosexuals.
“Treatment aimed at trying to change a person’s gender identity and expression to become more conformable to the sex assigned at birth has been attempted in the past without success, especially in the long term,” indicated the directives. “Such treatment is no longer considered ethical.”
Another controversial issue regarding transgender health is when children should receive medical interventions.
Hormonal treatments prevent children from going through puberty of their gender. Girls who feel more like boys take hormone-suppressing drugs so that they don’t develop breasts and start having their period. Boys who identify as girls may take blockers to avoid developing broad shoulders, a deep voice, and facial hair. The drugs put their puberty on hold, so they can determine if they need to change their gender.
The protocol is that hormonal interventions should not be given to a child until he or she has started puberty and has a documented history of gender dysphoria, Coleman said. The guidelines do not indicate an age at which it is acceptable to start taking hormone blockers, as puberty begins at different ages for all children.
Here are the guidelines for hormone therapy for adolescents:
• The adolescent has a lasting pattern of gender nonconformity or gender dysphoria
• Gender dysphoria started or got worse with the onset of puberty. Tanner stages are predictable stretches of puberty. Children should be at least in Tanner stage 2, when boys will see their scrotum and testicles grow larger, and girls will see signs of breast development.
• Any coexisting psychological, medical, or social issues that might interfere with treatment have been resolved.
• The adolescent has given informed consent or the parents or guardians have consented to the individual’s treatment and support.
The Society of Endocrinology also has recommendations – for endocrine specialists and also advises that hormone inhibitors only start after girls and boys show signs of physical changes confirmed by estrogen and testosterone levels.
Hormone blockers are reversible, because once a child stops taking medication, natural puberty begins.
If a teenager decides to switch to the opposite sex, he or she may choose to receive either estrogen or testosterone. The use of cross hormones is partially irreversible and this decision should be made with the adolescent, the family and the treatment team.
But irreversible procedures such as sex reassignment surgery should be put on hold until adulthood, the group recommended.