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Frequently Asked Questions? FAQs

Do you think the standards of care as proposed by the World Professional Association for Trangender Health are reasonable?

Yes, in fact the SOC may be the most important development in the history of treating gender dysphoria. Prior to the SOC being written in the late 1970s by HBIGDA (now known as WPATH), surgeries were being performed on demand on kitchen tables by doctors who didn't have the slightest idea what they were doing. No hospital would allow the surgery. Hormone regimens were random and the surgery was about to be declared illegal. The SOC not only legitimized the surgery it provided a clear and workable path for thousands and thousands of others to follow. So are they reasonable? Sure, people handle the SOC with little or no difficulty.

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What do the guidelines state?

With regards to hormonal therapy, the WPATH guidelines set three criteria. Firstly, patients should be of legal age of medical maturity. This can range from 16 in most European counties to 18 here in the USA. Secondly, they should be aware of the effects and risks of taking the drugs. And thirdly, they should have documented proof that they were living in their desired gender role for at least three months or have undergone a period of psychotherapy sufficiently long enough for the gender specialist and the client to determine the time is right to make the referral. With regards to surgery, there are six eligibility criteria, the most important of which are that the patient should be a legal adult; have had 12 months of continuous hormone therapy; and have lived in their desired gender role for a year - a period known as the real life experience (RLE). There are also two readiness criteria. Patients should demonstrate that they are consolidating their gender identity, and enjoy better mental health as a result of dealing effectively with work, their family and relationships. Letters of Referral from two licensed mental health providers to the surgeon are required to check that patients meet these criteria.

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Why are the guidelines important?

Some of the procedures are irreversible, so patients need to fully understand and be prepared for treatment. Some of the side-effects of hormone therapy, such as an increased risk of blood clotting, can be life threatening to patients in poor health, for example those with heart disease. Some people with psychotic illnesses, such as schizophrenia and manic depression, may mistakenly believe they are transsexual, but a thorough psychological assessment should prevent misdiagnosis. Transgender psychiatrists also admit that the boundaries between transsexualism, transvestitism and homosexuality are not entirely clear to them. The guidelines help them to determine which patients would benifit from surgery.

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What do transsexuals make of the guidelines?

There is no consensus of opinion. Some transsexuals believe that some therapist stick too strictly to the eligibility criteria, without taking into account the circumstances and history of the individual patient; others believe they are sensible precautionary measures. Most of my clients seem to appreciate the fact that there is a well-established, medically proven system in place to aid them in this difficult task.

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What are the repercussions of sexual reassignment surgery? Are they generally positive or negative?

SRS has been performed on tens of thousands of individuals over the last 50 years. If the result was less than positive, the surgery would have been considered malpractice decades ago. To the contrary, there is plenty of empirical evidence to show that the surgery has led to positive outcomes in the lives of thousands of people who have had the surgery.

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Nothing on this site should be viewed as providing therapeutic advice. No formation of a client/therapist
relationship with Dr. Vitale is intended or to be implied or inferred. The information provided in this site is for educational
purposes only. I attempt to keep the information current but make no representation or warranties in that regard. You should
not rely upon this information as a substitute for consul with a qualified mental health professional.