1 Introduction

2   Standards of Care

A set of 'Standards of Care' for the hormonal and surgical gender reassignment of gender dysphoric persons was laid down some years ago by a conference of medical professionals, and is widely used as a set of guidelines within the medical profession in many countries including the UK [The Harry Benjamin International Gender Dysphoria Association Inc., PO Box 1719, Sonoma CA 95476, USA] .

These standards lay down a set of 'rules' governing gender reassignment treatment. Central among these rules is a requirement for a 'real-life test' (RLT) of at least one year lived in the new gender role, along with two psychiatric referrals, before surgery is permitted. There are also guidelines regarding hormone treatment.

It must be emphasised that the Standards do not have the force of law, and are now considered overly rigid by many patients and professionals alike. In particular, the Standards call for a minimum of three months of psychotherapy before hormone treatment is initiated, but most authorities on the condition agree that this is unnecessary in the majority of patients. Likewise, the Standards call for a minimum 1 year RLT before permitting orchidectomy; many surgeons and psychiatrists in Britain recognise the value of earlier orchidectomy in appropriate patients.

There are at least two 'alternative' sets of Standards of Care, promulgated by groups with a greater input from the client group, which seek to provide adequate guidance and cover against allegations of malpractice for the professionals, while being less of an 'obstacle course' to the patient. Both are based on the principle of 'informed consent' by the patient.

3 Diagnosis



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