WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age

WPATH and USPATH Joint Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age

Published: January 28, 2020.

Yesterday, WPATH and USPATH released a joint statement about a recent and troubling trend across various states in the US. The Gender Dysphoria Affirmative Working Group fully endorses what is written here.

A web link to the statement can be found here: https://listloop.com/wpath/mail.cgi/archive/adhoc/20200128125839/

Statement in Response to Proposed Legislation Denying Evidence-Based Care for Transgender People Under 18 Years of Age and to Penalize Professionals who Provide that Medical Care

The World Professional Association for Transgender Health (WPATH) and its US chapter, the United States Professional Association for Transgender Health (USPATH), vehemently oppose the legislation being proposed in Florida (HB 1365), South Carolina (HB 4716), South Dakota (HB 1057), Colorado (HB 20-1114), and similar legislation in other states.  These bills seek to deny evidence-based care for transgender people under 18 years of age and to penalize professionals who provide that medical care.  These bills will punish practitioners of gender affirming care with revocation of their medical license, or up to 15 years in prison in some states.  These bills will treat health care providers as if they committed manslaughter or arson.  

Many of the procedures mentioned by these bills are not even offered to transgender youth, revealing these bills to be alarmist expressions of ill-informed opinion. Guidance for the provision of medical care for transgender youth is outlined within the 7th edition of Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender-Nonconforming People created by the World Professional Association for Transgender Health (Coleman et al. 2012). The guidelines differentiate between children and adolescents with regard to the provision of care. 

Under the SOC, children do not receive any of the medical care identified within these bills, but mental health and social supports are provided to them along with their families.  Surgeries on genitals and reproductive systems are considered for people who are typically over 18 years of age (depending on the age of consent and other relevant factors in the pertinent jurisdiction) and have been living in their affirmed gender for at least 12 months. Medical treatments that might be recommend for certain adolescents include puberty-blocking medication and – in carefully selected cases – hormone replacement therapies and surgery, most often non-genital. These treatments are not offered without conscientious medical attention and informed clinical evaluation.

Puberty suppression has been found to be very beneficial for transgender adolescents, and it is reversible (Mahfouda et al. 2017; Olson-Kennedy et al. 2018; Hodax et al. 2019; Salas-Humara et al. 2019).  Further, a recently published study has concluded that transgender adults who had access to pubertal blockers had a lower risk of suicidal ideation compared to those transgender adults who did not have access to pubertal blockers (Turban et al. 2020).

We are disturbed by these attempts to legislate medical treatment without expert guidance from the relevant national medical organizations or even testimony from experienced, qualified local or regional providers and patients for whom these treatments have been beneficial, if not lifesaving. Given the climate in which these bills are presented, however, we can imagine that few young patients or their parents would be willing to present themselves for the scrutiny of potentially hostile legislators and the activists who are promoting these damaging bills. 

All medical treatment is a crucial and very personal service that virtually everyone depends upon at some point in their lives, and it should not be delivered or restricted according to the whims of distant lawmakers who know little or nothing about the circumstances of an individual’s life. Proper medical care for any condition is a matter best negotiated between patients and their trained and qualified medical providers who are relying on clinical evidence and experience. 

These bills attempt to criminalize treatments or at best restrict medical professionals from helping their patients and their families. Since transgender children, adolescents, or adults cannot be legislated out of existence, these bills seem to be a misguided attempt to prevent transgender people from coming forward for services they need in order to live healthy lives. 

We urge you to reject these harmful bills and assure your transgender constituents and their families that their health and well-being is just as important as your own.

Click here for an additional WPATH Statement in Response to Calls for Banning Evidence-Based Supportive Health Interventions for Transgender and Gender-Diverse Youth.

References

Coleman E, Bockting W, Botzer M, et al (2012) Standards of care for the health of transsexual,

transgender, and gender-nonconforming people, version 7. Int J Transgenderism 13:165–232

Hodax JK, Wagner J, Sackett-Taylor AC, et al (2019) Medical options for care of gender diverse and

Transgender youth. J Pediatr Adolesc Gynecol S1083-3188(19)30206–2.

https://doi.org/10.1016/j.jpag.2019.05.010

Mahfouda S, Moore JK, Siafarikas A, et al (2017) Puberty suppression in transgender children and

adolescents. Lancet Diabetes Endocrinol 5:816–826. https://doi.org/10.1016/S2213-8587(17)30099-2

Olson-Kennedy J, Okonta V, Clark LF, Belzer M (2018) Physiologic Response to Gender-Affirming

Hormones Among Transgender Youth. J Adolesc Health 62:397–401.

https://doi.org/10.1016/j.jadohealth.2017.08.005

Salas-Humara C, Sequeira GM, Rossi W, Dhar CP (2019) Gender affirming medical care of transgender

youth. Curr Probl Pediatr Adolesc Health Care 49:100683.

https://doi.org/10.1016/j.cppeds.2019.100683

Turban JL, King D, Carswell JM, Keuroghlian AS. Pubertal Suppression for Transgender Youth and Risk of

Suicidal Ideation. Pediatrics. 2020 Jan 23. pii: e20191725

Yadegarfard M, Meinhold-Bergmann ME, Ho R (2014) Family rejection, social isolation, and loneliness as

predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behavior) among

Thai male-to-female transgender adolescents. J LGBT Youth 11:347–363

CLICK HERE TO DOWNLOAD FULL POLICY STATEMENT

WPATH Board of Directors

USPATH Board of Directors

STAFF

President

Vin Tangpricha, MD, PhD

President

Erica Anderson, PhD

Executive Director

Sue O’Sullivan; sue@wpath.org

President-Elect

Walter Pierre Bouman, MD, PhD

President-Elect

Madeline Deutsch, MD, MPH

Executive Director of Global Education & Development

Donna Kelly; donna@wpath.org

Secretary

Randi Ettner, PhD

Secretary/Treasurer

Emilia Lombardi, PhD

Deputy Executive Director

Blaine Vella; blaine@wpath.org

Treasurer

Baudewijntje Kreukels, PhD

Immediate Past-President

Gail Knudson, MD, MEd, FRCPC

BOARD OF DIRECTORS

Tamara Adrian, JD Marci Bowers, MD

Tone Maria Hansen, MSN Ren Massey, PhD

Asa Radix, MD, PhD, MPH

Loren Schechter, MD Jaimie Veale, PhD

Immediate Past-President Joshua Safer, MD, FACP BOARD OF DIRECTORS

Dana (Thomas) Bevan, PhD John Capozuca, PhD

Lisa Griffin, PhD

Johanna Olson-Kennedy, MD, MS

Asa Radix, MD, PhD, MPH

Student Representative

Nova Bradford, BA

Communications Director

Jamison Green; jamison@veritasmeetingsolutions.com

EPATH Representative

Walter Pierre Bouman, MD, PhD

USPATH Representative

Erica Anderson, PhD

GEI Representative (Ex-Officio)

Lin Fraser, EdD

Student Representative (Ex-Officio)

Penelope Strauss, BA, MPH

The AusPATH [Australian Professional Association for Trans Health] Position Statement on "Rapid Onset Gender Dysphoria" (ROGD)

Published September 30, 2019. Shared here in its’ entirety.

“The Australian Professional Association for Trans Health (AusPATH) was established in 2009 and is Australia’s peak body for professionals involved in the health, rights and well-being of trans, including gender diverse and non-binary (TGDNB), people. The AusPATH membership comprises approximately 250 experienced professionals working across Australia.

“The term “Rapid Onset Gender Dysphoria (ROGD)” is not a diagnosis or health condition recognised by any major professional association, nor is it listed as a subtype or classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD). Therefore, “ROGD” is an acronym describing a proposed phenomenon, with insufficient peer-reviewed scientific evidence to support its implementation and/or use within clinical, community, social and legal settings1.

“AusPATH affirms the rigorous processes by which diagnoses are developed and applied. These academic and clinical processes operate within professional medical organisations, and are developed by expert working groups of  scientists, clinicians, and stakeholders over long periods of time, with high levels of scientific scrutiny of the evidence-based literature. “ROGD” does not meet this standard, and therefore is not recognised by AusPATH.

“Whilst many have a clear picture of their gender from a very early age, for others the journey towards understanding their gender is more prolonged. The timing of when an individual discloses their gender to others is a separate consideration and does not necessarily reflect the development of their experienced gender. Many do not disclose their identity, rather hiding it for fear of negative reactions from others, including family rejection, discrimination, stigmatisation and social exclusion. The term “Rapid Onset Gender Dysphoria” is not, and has never been, a diagnosis or health condition but has been used in a single report describing parental perception of their adolescent’s gender identity without exploration of the gender identity and experiences of the adolescents themselves.

“AusPATH encourages continued scientific exploration within a culture of academic freedom, not censorship. All TGDNB people are deserving of gender-affirmative, evidence-based care that is underpinned by contemporary, adequately endorsed and community engaged standards of care and clinical guidelines.

“AusPATH recognises the harms caused by conversion, reparative and aversion treatments and opposes any such efforts to invalidate an individual’s experienced gender. AusPATH supports affirmative responses to young people whereby self-reported gender is respected, and young people are able to safely explore their gender and expression without judgment, pathologisation or predetermined outcome. AusPATH urges caution in the use of any term that has the potential to invalidate a person’s gender.

1. WPATH (World Professional Association for Transgender Health) position on “Rapid-Onset Gender Dysphoria (ROGD)”4 September 2018

https://auspath.org/advocacy/?fbclid=IwAR3GN9E6NmvTyZNx-LcCIgW1mg5zpkE8UgpUaFYweTFBawgMS023DFTgtfI

Presentation by the WPATH Standards of Care 8 Child Chapter Working Group

On September 7, 2019, members of the Standards of Care Version 8 - Child Chapter Working Group delivered a presentation at the US Professional Association of Transgender Health conference in Washington DC. This presentation outlined a significant move toward far more affirming philosophies of care, which will appear in the upcoming SOC V8.

Find more information on Affirmative Care for transgender and gender noxnbinary youth and adolescents at our website: www.gdaworkinggroup.com

And follow us on Facebook for regular updates: @gdaffirmative

As reported by community rapporteur Lotus Đào, and Dr. Asa Radix, Co-Chair of the SOC8 Review Committee, member of the Board of Directors of the World Professional Association of Transgender Health and the US Professional Association of Transgender Health:

On September 7th, 2019, members of the WPATH Standards of Care 8.0 Child Chapter Working Group presented on "Prepubescent Gender Diversity: Complexities and Recommendations." Presenters opened by sharing the working group's process and naming the complexity of working within a global context in an specialty with few expertise. Following a brief research summary, presenters established a foundation of child gender diversity as an expected aspect of general human diversity, rather than a pathology.

Furthermore, gender identity should not be conflated with gender expression. In fact, research indicates that many young children exhibiting extensive gender expansive behavior while feeling cohesive with their gender identity are likely to evolve to be gay or queer by adolescence, not transgender. In addition, gender identity is sometimes static, and sometimes fluid. Some children know from a very young age who they are and their gender identity is static throughout their lifetime. For other children, their gender identity may change over time. Presenters encouraged providers and community members to practice respect and sensitivity in honoring children where they are at and releasing the cultured need to predict a child's gender identity and presentation. In regards to the mental health provider's role in working with gender expansive children, presenters emphasized that gender expansive children should not be required to be in therapy. However, guidance from mental health providers are often helpful, especially if there are external stressors (family, school, region) or the child is interested in medical treatment.

The presenters provided recommendations for providers around advocacy, including educating and supporting gender diversity is expected and not pathological; acknowledging and addressing privilege and frequent intentional and/or unintentional negating of gender diverse experience; working in partnership with schools and childcare programs to sensitive educational providers to importance of gender affirmative practices to promote curricula; and more.

Presenters shared a much anticipated report of the SOC 8 Core Competency Recommendations, which are not finalized, including compenents on Training/Credentials, Gender Development, Child/Family Mental Health, Assessment, Therapuetic Interventions, Autism and Gender, Research Knowledge and Continuing Education. Ultimately, presenters urged attendees to promote gender literacy with gender expansive children, including identifying oppressive and violent environmental messaging around gender and critically examine whether or not it is authentic. Furthermore, presenters recommended providers to not fixate on pathology or force "transgender" onto gender expansive children, but to incorporate "play" and "fun" as important aspects of working with children.