Standards of care for gender identity disorders are non-binding protocols outlining the usual treatment for individuals who wish to undergo hormonal or surgical transition to the other sex. Clinicians' decisions regarding patients' treatment are often influenced by such SOCs.
Prior to the advent of the first SOCs, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before the 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (HBIGDA) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment." These standards are still the most well known, however, other sets of SOCs, protocols and guidelines do exist, especially outside the USA.
WPATH Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People
- Main article: WPATH Standards of Care
The Standards of Care for Gender Identity Disorders by the Harry Benjamin International Gender Dysphoria Association (HBIGDA-SOC) are the most widespread SOC used by professionals working with transsexual , transgender , or gender variant people. The HBIGDA-SOC are periodically updated and revised. The latest revision was released February 20, 2001. This is the sixth version of the HBIGDA-SOC since the original 1979 document was drafted. Previous revisions were released in 1980, 1981, 1990, and 1998.
Included in the guidelines are sections on epidemiology, mental health professionals, treatment of children, adolescents and adults, hormone replacement therapy , the Real-Life Experience (RLE), which was formerly called the Real-Life Test, and surgery.
It requires one letter for hormone replacement therapy or either augmentation mammoplasty or male chest reconstruction. Two additional letters are needed for genital surgeries. The Eligibility Criteria and Readiness Criteria give certain very specific minimum requirements as prerequisites to HRT or SRS. For this and other reasons, the HBIGDA-SOC is a highly controversial and often maligned document among patients seeking medical intervention (hormones, and/or surgery), who claim that their legally protected right to proper medical care and treatment is unjustly and unduly withheld or even denied based on the SOC.
Other SOCs, protocols and guidelines for treatment of GID
In some countries or areas, local standards of care exist, such as in the Netherlands, Germany or Italy. Also, some health care providers have their own set of SOCs which have to be followed to have access to health care. The criticism about the HBIGDA-SOCs applies to these as well; some of these SOCs are based on much older versions of the HBIGDA-SOCs, or are entirely independent of them. A more lenient version that has been increasing in acceptance is the Health Law Standards Of Care, developed by the Health Law Project (also known as the ICTLEP guidelines), which is based on a harm-reduction model.
Treatment according to older SOCs is often reserved for transsexual people only, not for other transgender people who for example might not want to undergo the complete set of treatments, or who see themselves outside a binary gender system. Such older SOCs are often used to withhold medical interventions from transgender people altogether.
A dramatic elevation in surgical and post-surgical risks as well as an increased possibility of post-surgical dissatisfaction is often the exchange for lower costs and fewer pre-surgical requirements such as weight limits. In other regions, notably Latin America, surgeons follow no particular set standards and use their own criteria for eligibility for surgery.
In Western countries the emphasis is on psychiatry or psychology, typically in Latin America the emphasis is on the ability to "pass" and in Thailand the emphasis is on cross-living experience.