Aaron H. Devor

Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7

ABSTRACT The Standards of Care (SOC) for the Health of Transsexual, Transgender, and Gender Nonconforming People is a publication of the World Professional Association for Transgender Health (WPATH). The overall goal of the SOC is to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., assessment, counseling, psychotherapy), and hormonal and surgical treatments. The SOC are based on the best available science and expert professional consensus. Because most of the research and experience in this field comes from a North American and Western European perspective, adaptations of the SOC to other parts of the world are necessary. The SOC articulate standards of care while acknowledging the role of making informed choices and the value of harm reduction approaches. In addition, this version of the SOC recognizes that treatment for gender dysphoria i.e., discomfort or distress that is caused by a discrepancy between persons gender identity and that persons sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics) has become more individualized. Some individuals who present for care will have made significant self-directed progress towards gender role changes or other resolutions regarding their gender identity or gender dysphoria. Other individuals will require more intensive services. Health professionals can use the SOC to help patients consider the full range of health services open to them, in accordance with their clinical needs and goals for gender expression.

Witnessing and Mirroring: A Fourteen Stage Model of Transsexual Identity Formation

SUMMARY Coming to recognize oneself as transsexual involves a number of stages of exploration and analysis on both an interpersonal and intrapersonal level over the course of many years. A model encompassing fourteen possible stages is proposed: (1) Abiding Anxiety, (2) Identity Confusion About Originally Assigned Gender and Sex, (3) Identity Comparisons About Originally Assigned Gender and Sex, (4) Discovery of Transsexualism, (5) Identity Confusion About Transsexualism, (6) Identity Comparisons About Transsexualism, (7) Tolerance of Transsexual Identity, (8) Delay Before Acceptance of Transsexual Identity, (9) Acceptance of Transsexualism Identity, (10) Delay Before Transition, (11) Transition, (12) Acceptance of Post-Transition Gender and Sex Identities, (13) Integration, and (14) Pride.

ONE inc. and Reed Erickson: The Uneasy Collaboration of Gay and Trans Activism, 1964-2003

People who are today known as transgendered and transsexual have always been present in homosexual rights movements. Their presence and contributions, however, have not always been fully acknowledged or appreciated. As in many other social reform movements, collective activism in gay and lesbian social movements is based on a shared collective identity. Homosexual collective identity, especially in the days before queer politics, was largely framed as inborn, like an ethnicity, and based primarily on sexual desires for persons of the same sex and gender.1 However, such definitions make sense only when founded on clearly delineated distinctions between sexes and genders. It becomes considerably harder to delineate who is gay and who is lesbian when it is not clear who is a male or a man and who is a female or a woman. Like bisexual people, transgendered and transsexual people destabilize the otherwise easy division of men and women into the categories of straight and gay because they are both and/or neither. Thus there is a long-standing tension over the political terrain of queer politics between gays and lesbians, on the one hand, and transgendered and transsexual people, on the other. These boundary issues, with which recent gay and lesbian social movements have struggled, have been intrinsic to definitions of homosexuality since the concept of homosexual identity was first consolidated at the turn of the last century.2 Early sexologists and their contemporaries commonly assumed that homosexuality was epitomized by females who seemed to want to be men and by males who seemed to want to be women.3 For example, J. Allen Gilbert’s 1920 article in the Journal of Nervous and Mental Disease, which described the 1917 gender transformation of Lucille Hart into Dr. Alan Hart, was titled “Homosexuality and Its Treatment.”4 Similarly, Radclyffe Hall’s book The Well of Loneliness (1928), about a (transgendered) female who yearned to be a man, almost single-handedly