As promised, in this installment of Illuminations, I will give a glimpse into some of the suggested changes to the World Professional Association for Transgender Health (WPATH) Standards of Care – version 8 (SOC8). SOC 8 is likely to be at least eighteen chapters and over 350 pages. One of the substantial changes is that SOC8 will remove language requiring psychological assessment for transgender adults, moving more to an informed consent model for access to hormones.
There will be some incredibly positive changes within the Adolescent chapter as well. I would like to outline some of what has been proposed that is not controversial, and then talk about the topics for which there may be some disagreement among WPATH membership.
One of the best suggestions is that SOC8 make explicit the requirement of additional training on autism spectrum disorders and neurodiversity. This is needed given the co-occurrence of these differences in many transgender teens. I do believe that this additional expectation will be a requirement for those desiring to be a Certified Provider.
There is a proposed change to guidelines so that the expectation is that a child reaches at least Tanner 2 before starting blockers. This is less stringent than SOC7 guidelines which suggested Tanner 2 or 3 (T2/T3) depending on biological sex. I think this simpler generalization will not meet resistance because everyone knows that T2/T3 was a guideline and providers make decisions on a case-by-case basis anyways.
A proposed new recommendation is that therapists engage in discussion of the health implications and safe ways to bind and tuck. This should be happening already in all provider’s offices (mental health and medical). It is important, and it will be included in SOC8, even if therapists are made obsolete (more about this later).
For medical providers there is explicit encouragement to consider the use of prescription menstrual suppression agents, especially when puberty blockers are not an option or when other interventions don’t adequately address this distressing occurrence. Again, this should already be happening and is a non-offensive suggestion that should be kept.
Lastly, there is the addition of a statement about the cognitive and emotional maturity required for informed consent, with suggestions for how to assess that. This is a CYA (cover your ass) move on the part of WPATH, in response to the Bell-Tavistock case. This will be stay and it would be wise for all providers to document this moving forward in letters of referral and medical notes.
The number of suggestions that are in conflict is minor compared to the magnitude of the content which has spurned dissent. As an insider, I expect this. The SOC is two-dimensional, and members are seen as one unified voice. Every WPATH conference I have attended is full of adolescent cliques, whispers about who is seen with whom, and ends with an (unplanned) several hour open-mike verbal attack on leadership and the status quo.
Antonia Caretto, Ph.D. is a fully licensed Clinical Psychologist and a graduate of the University of Michigan and the Alliant International University California School of Professional Psychology. Dr. Caretto’s 1991 doctoral dissertation research was on “Familial Homosexuality Among Women and It’s Relationship to Childhood Gender Role Non-Conformity and Adult Sex Role.”
Dr. Caretto has a solo private practice in Farmington Hills, MI, and gender identity development continues to the focus of much of her work.