Standards of Care for the Health of Transgender and Gender Diverse People

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The Standards of Care for the Health of Transgender and Gender Diverse People (SOC) is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition. [1] It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist –especially outside the United States –the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people. [2] [3] [4]

Contents

Version 8 of the WPATH SOC, the latest version, was released online on September 15, 2022. [1] [5]

History and development

Prior to the advent of the first SOC, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before the 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment."

The WPATH SOC are periodically updated and revised. The eighth and latest version was released on September 15, 2022. Previous versions were released in 1979 (1st), [6] 1980 (2nd), [7] 1981 (3rd), [8] [9] 1990 (4th), [10] 1998 (5th), [11] 2001 (6th), [12] [13] and 2012 (7th). [3]

Versions 1 to 4

The first four versions of the Standards of Care were titled Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons. [6] [7] [8] [9] [10] The first version was released in 1979 and revisions were made in 1980, 1981, and 1990. [6] [7] [8] [9] [10] These revisions were relatively minor, with the text staying mostly the same between versions. [14] [15] [16] These versions of the SOC followed the gatekeeping model laid out by Harry Benjamin, where clinicians set strict eligibility requirements, requiring evaluations from separate mental health professionals and compulsory psychotherapy. [15] [17] [16]

The first four versions of the Standards of Care were published as standalone documents by the Harry Benjamin International Gender Dysphoria Association. [6] [7] [8] [9] [10] However, the third version was also published as a 1985 reprint in the journal Archives of Sexual Behavior . [9] [ non-primary sources needed ]

Version 5

In the 1990's, WPATH was struggling to operate due to criticisms of their SOC in the trans community such as the requirement of the real life test, [18] where patients had to socially transition for up to a year prior to hormones. These critiques developed into a trans-led Advocacy and Liaison committee, marking the first time trans people were officially and actively consulted regarding their treatment. [19] The 5th version, [11] published in 1998, was titled the "Standards of Care for Gender Identity Disorders" to be consistent with the DSM-III. It recommended but did not require psychotherapy and stated that while GID was a mental disorder, that was not a license for stigma. [15]

Version 6

The sixth version was published in 2001 and offered more flexibility and individualized care but continued to use the phrase "gender identity disorder". At the same time transgender people increasingly complained of having to "jump through hoops". [15] SOC 6 also did not include significant changes to the tasks mental health professionals were required to take or in the general recommendations for content of the letters of readiness. [20] An important change in the eligibility criteria for GAH allowed providers to prescribe hormones even if patients had not undergone the "Real Life Test" or psychotherapy if it was for harm reduction purposes. [20] A notable change in version six separated the eligibility and readiness criteria for top and bottom surgery allowing some patients, [21] [ full citation needed ] particularly individuals assigned female at birth, to receive a mastectomy. [20] [22]

Version 7

The seventh version, titled "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People", was published in 2012 both in the International Journal of Transgenderism and as a standalone document. Included in the guidelines are sections on purpose and use of the WPATH SOC, the global applicability of the WPATH SOC, the difference between gender nonconformity and gender dysphoria, epidemiology, treatment of children, adolescents and adults, mental health, hormone replacement therapy (masculinizing or feminizing; HRT), reproductive health, voice and communication therapy, gender-affirming surgery, lifelong preventive and primary care, applicability of the WPATH SOC to people living in institutional environments, and applicability of the WPATH SOC to people with disorders of sex development.

The seventh version also includes acknowledgements of the ever-evolving language used to describe and treat transsexual, transgender, and gender non-conforming individuals. There is an emphasis placed on the idea that identifying with these labels does not inherently qualify someone as disordered, and that treatment should be focused on the alleviation of any suffering caused by gender dysphoria. They make a stance against the "deprivation of civil and human rights" on the grounds of someone's gender identity. This version, much like its predecessor requires referrals for surgical procedures based on set criteria, but notes the importance of informed consent and listening to the wishes of the patient. [3]

The seventh version includes a section distinguishing between cases of gender dysphoria and non-conformity for children and adolescents, as well as recommended treatment paths for each. [3]

A systematic review into international guidelines for management of gender dysphoria and gender incongruence in children and adolescents published as part of the Cass Review in 2024 stated WPATH SOC 7 lacked "developmental rigour and transparency". [23]

Version 8

The eighth version, titled "Standards of Care for the Health of Transgender and Gender Diverse People", was published in 2022. It gives recommendations for health professionals in eighteen chapters. [1] The guidelines were developed by a multidisciplinary committee of experts, building on previous versions and using the Delphi method. [5]

Version 8 is the first one to include a chapter on adolescent care separate from that on the care of children. [24] This version of the protocol gives no specific age limits for treatments, emphasizing the need to decide individually for each patient. [25] It was criticized for suggesting that young people may come to believe they are transgender through social influence. [24]

An earlier draft would have required several years of transgender identity before an adolescent could begin treatment. After criticism from transgender advocates, as well as from staff of Assistant Secretary for Health of the US Department of Health and Human Services (HHS), this provision was removed in the final release. Despite the criticism, transgender youths wishing to be treated are still required to undergo a "comprehensive diagnostic assessment". [26] [27] In a statement by a spokesperson for the HHS, they explained that Assistant Secretary Levine "shared her view with her staff that publishing the proposed lower ages for gender transition surgeries was not supported by science or research, and could lead to an onslaught of attacks on the transgender community." [28] In July 2024, the Biden administration said they opposed gender-affirming surgery for transgender minors, but also said they would continue to support gender-affirming care for minors and would continue to oppose bans on such treatments, including continuing to oppose bans on surgeries. [29] [27] [30] In August 2024, the Republican chairwoman Lisa McClain of the U.S. Congress Subcommittee on Health Care and Financial Services announced that it started an investigation and requested documents and information from the HHS related to its interactions with WPATH. [31]

The guidelines became a focus of controversy during the debate over the Scottish government's Gender Recognition Reform Bill in 2022. Opponents of the bill highlighted the chapter on eunuchs, which proposes eunuch be considered a gender identity, and criticised NHS Scotland's association with WPATH. [32]

NHS England commissioned the Cass Review to create guidelines for transgender people in England. A systematic review into international guidelines published as part of the review was published in 2024 and stated that WPATH SOC 8 lacked "developmental rigour and transparency". [23] NHS England in March 2024 updated their guidelines and stated that for children and adolescents they do not follow WPATH 8. [33]

Populations

Issues specific to certain demographics, including adults, children, and adolescents, are described in chapters 5–11 of version 8.

Adults

Adolescents

In a departure from previous versions, Version 8 draws a conceptual distinction between Adolescents and Children with separate chapters.

Continued care and careful assessment of cognitive maturity by qualified mental health professionals is recommended. In contrast to previous versions, there are no absolute requirements for duration of assessments or age to access gender-affirming treatments; rather, individual psychosocial and physical development should be taken into account.

Additionally, Chapter 12 and 13 and Appendix D contain further recommendations regarding hormone therapy and surgical treatments in adolescents.

Children

Pertaining to prepubescent children only, chapter 7 makes recommendations regarding the support of children and their families throughout gender exploration and potential social transitions.

Non-binary

Non-binary individuals are included for the first time in chapter 8. The guidelines recommend that medical treatment and social support be made available to non-binary people in individualized combinations, for example providing medical interventions without social transition or gender-affirming surgery without hormone therapy. The chapter additionally notes unique experiences of discrimination, minority stress, and difficulty accessing gender-affirming medical treatment among non-binary people, which healthcare providers should take into consideration.

Treatments

Recommendations for treatments, including medical and social aspects of gender transition as well as mental health, as are given in Chapters 12–18.

See also

Related Research Articles

Gender dysphoria (GD) is the distress a person experiences due to a mismatch between their gender identity—their personal sense of their own gender—and their sex assigned at birth. The term replaced the previous diagnostic label of gender identity disorder (GID) in 2013 with the release of the diagnostic manual DSM-5. The condition was renamed to remove the stigma associated with the term disorder. The International Classification of Diseases uses the term gender incongruence instead of gender dysphoria, defined as a marked and persistent mismatch between gender identity and assigned gender, regardless of distress or impairment.

Gender-affirming surgery (GAS) is a surgical procedure, or series of procedures, that alters a person's physical appearance and sexual characteristics to resemble those associated with their identified gender. The phrase is most often associated with transgender health care and intersex medical interventions, though many such treatments are also pursued by cisgender and non-intersex persons. It is also known as sex reassignment surgery (SRS), gender confirmation surgery (GCS), and several other names.

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care.

Gender dysphoria in children (GD), also known as gender incongruence of childhood, is a formal diagnosis for distress caused by incongruence between assigned sex and gender identity in some pre-pubescent transgender and gender diverse children.

Feminizing hormone therapy, also known as transfeminine hormone therapy, is hormone therapy and sex reassignment therapy to change the secondary sex characteristics of transgender people from masculine or androgynous to feminine. It is a common type of transgender hormone therapy and is used to treat transgender women and non-binary transfeminine individuals. Some, in particular intersex people, but also some non-transgender people, take this form of therapy according to their personal needs and preferences.

Stephen Barrett Levine is an American psychiatrist known for his thesis that gender dysphoria and being transgender are often caused by psychological issues that should be treated psycho-analytically as opposed to with gender-affirming care. He co-founded Case Western Reserve University School of Medicine's Gender Identity Clinic in 1974, served as the chair of the World Professional Association for Transgender Health (WPATH) drafting committee for the 5th edition of their Standards of Care (SOC-5) published 1998, and served on the American Psychiatric Association (APA) DSM-IV (1994) Subcommittee on Gender Identity Disorders.

<span class="mw-page-title-main">LGBTQ people in prison</span> Lesbian, gay, bisexual, transgender and queer people in prison

Lesbian, gay, bisexual, transgender and queer (LGBTQ) people face difficulties in prison such as increased vulnerability to sexual assault, other kinds of violence, and trouble accessing necessary medical care. While much of the available data on LGBTQ inmates comes from the United States, Amnesty International maintains records of known incidents internationally in which LGBTQ prisoners and those perceived to be lesbian, gay, bisexual or transgender have suffered torture, ill-treatment and violence at the hands of fellow inmates as well as prison officials.

<span class="mw-page-title-main">Transsexual</span> People experiencing a gender identity inconsistent with their assigned sex

A transsexual person is someone who experiences a gender identity that is inconsistent with their assigned sex, and desires to permanently transition to the sex or gender with which they identify, usually seeking medical assistance to help them align their body with their identified sex or gender.

<span class="mw-page-title-main">Transgender youth</span> Children and adolescents who are transgender

Transgender youth are children or adolescents who do not identify with the sex they were assigned at birth. Because transgender youth are usually dependent on their parents for care, shelter, financial support, and other needs, they face different challenges compared to adults. According to the World Professional Association for Transgender Health, the American Psychological Association, and the American Academy of Pediatrics, appropriate care for transgender youth may include supportive mental health care, social transition, and/or puberty blockers, which delay puberty and the development of secondary sex characteristics to allow children more time to explore their gender identity.

Johanna Olson-Kennedy is an American physician who specializes in the care of children and teenagers with gender dysphoria and youth with HIV and chronic pain. She is board-certified in pediatrics and adolescent medicine and is the medical director of the Center for Transyouth Health and Development at Children's Hospital Los Angeles.

Puberty blockers are medicines used to postpone puberty in children. The most commonly used puberty blockers are gonadotropin-releasing hormone (GnRH) agonists, which suppress the natural production of sex hormones, such as androgens and estrogens. Puberty blockers are used to delay puberty in children with precocious puberty. They are also used to delay the development of unwanted secondary sex characteristics in transgender children, so as to allow transgender youth more time to explore their gender identity. The same drugs are also used in fertility medicine and to treat some hormone-sensitive cancers in adults.

Gender-affirming hormone therapy (GAHT), also called hormone replacement therapy (HRT) or transgender hormone therapy, is a form of hormone therapy in which sex hormones and other hormonal medications are administered to transgender or gender nonconforming individuals for the purpose of more closely aligning their secondary sexual characteristics with their gender identity. This form of hormone therapy is given as one of two types, based on whether the goal of treatment is masculinization or feminization:

The real-life experience (RLE), sometimes called the real-life test (RLT), is a period of time or process in which transgender individuals live full-time in their identified gender role in order to be eligible to receive gender-affirming treatment. The purpose of the RLE has been to confirm that a given transgender person could function successfully as a member of said gender in society, as well as to confirm that they are sure they want to live as said gender for the rest of their life. A documented RLE was previously a requirement of many physicians before prescribing gender-affirming hormone therapy, and a requirement of most surgeons before performing gender-affirming surgery.

Anne Alexandra Lawrence is an American psychologist, sexologist, and physician who has published extensively on gender dysphoria, transgender people, and paraphilias. Lawrence is a transgender woman and self-identifies as autogynephilic. She is best known for her 2013 book on autogynephilia, Men Trapped in Men's Bodies: Narratives of Autogynephilic Transsexualism, which has been regarded by Ray Blanchard as the definitive text on the subject. Lawrence is one of the major researchers in the area of Blanchard's etiological typology of transgender women and has been one of the most major proponents of the theory. While Blanchard's typology and autogynephilia are highly controversial subjects and are not accepted by many transgender women and academics, some, such as Lawrence, identify with autogynephilia. Lawrence's work also extends beyond Blanchard's typology, to transgender women and to transition more generally.

Transgender health care includes the prevention, diagnosis and treatment of physical and mental health conditions for transgender individuals. A major component of transgender health care is gender-affirming care, the medical aspect of gender transition. Questions implicated in transgender health care include gender variance, sex reassignment therapy, health risks, and access to healthcare for trans people in different countries around the world. Gender affirming health care can include psychological, medical, physical, and social behavioral care. The purpose of gender affirming care is to help a transgender individual conform to their desired gender identity.

Detransition is the cessation or reversal of a transgender identification or of gender transition, temporarily or permanently, through social, legal, and/or medical means. The term is distinct from the concept of 'regret', and the decision may be based on a shift in gender identity, or other reasons, such as health concerns, social or economic pressure, discrimination, stigma, political beliefs, or religious beliefs.

Facial masculinization surgery (FMS) is a set of plastic surgery procedures that can transform the patient's face to exhibit typical masculine morphology. Cisgender men may elect to undergo these procedures, and in the context of transgender people, FMS is a type of facial gender confirmation surgery (FGCS), which also includes facial feminization surgery (FFS) for transgender women.

Rapid-onset gender dysphoria (ROGD) is a controversial, scientifically unsupported hypothesis which claims that some adolescents identify as transgender and experience gender dysphoria due to peer influence and social contagion. ROGD is not recognized as a valid mental health diagnosis by any major professional associations. The APA, WPATH and 60 other medical professional organizations have called for its elimination from clinical settings due to a lack of reputable scientific evidence for the concept, major methodological issues in existing research, and its stigmatization of gender-affirming care for transgender youth.

<span class="mw-page-title-main">Arkansas House Bill 1570 (2021)</span> 2021 Arkansas state law

Arkansas House Bill 1570, also known as the Save Adolescents From Experimentation (SAFE) Act or Act 626, is a 2021 law in the state of Arkansas that bans gender-affirming medical procedures for transgender people under 18, including puberty blockers, hormone therapy, and sex reassignment surgery. The law also bans the use of public funds for and prohibits insurance from covering gender transition procedures, while doctors who provide treatment in violation of the ban can be sued for damages or professionally sanctioned. The measure makes Arkansas the first U.S. state to make gender-affirming medical care illegal.

<span class="mw-page-title-main">Genspect</span> Organization opposing transgender rights

Genspect is an international group founded in June 2021 by psychotherapist Stella O'Malley that has been described as gender-critical. Genspect opposes gender-affirming care, as well as social and medical transition for transgender people. Genspect opposes allowing transgender people under 25 years old to transition, and opposes laws that would ban conversion therapy on the basis of gender identity. Genspect also endorses the unproven concept of rapid-onset gender dysphoria (ROGD), which proposes a subclass of gender dysphoria caused by peer influence and social contagion. ROGD has been rejected by major medical organisations due to its lack of evidence and likelihood to cause harm by stigmatizing gender-affirming care.

References

  1. 1 2 3 Coleman, E.; et al. (August 19, 2022). "Standards of Care for the Health of Transgender and Gender Diverse People, Version 8". International Journal of Transgender Health . 23 (Suppl 1): S1–S259. doi: 10.1080/26895269.2022.2100644 . ISSN   2689-5269. PMC   9553112 . PMID   36238954.
  2. ↑ Britt Colebunders; et al. (2015). "New Criteria for Sex Reassignment Surgery: WPATH Standards of Care, Version 7, Revisited". International Journal of Transgenderism . 16 (4): 222–233. doi:10.1080/15532739.2015.1081086. S2CID   74097076.
  3. 1 2 3 4 Coleman, Eli; et al. (2012). "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7" (PDF). International Journal of Transgenderism. 13 (4). World Professional Association for Transgender Health: 165–232. doi:10.1080/15532739.2011.700873. ISSN   1553-2739. Archived from the original (PDF) on March 27, 2018. Retrieved May 9, 2018.
  4. ↑ Grinberg, Emanuella (June 20, 2018). "What is medically necessary treatment for gender-affirming health care?". CNN . Archived from the original on June 27, 2023. Retrieved July 6, 2018.
  5. 1 2 World Professional Association for Transgender Health (September 15, 2022). "World Professional Association for Transgender Health (WPATH) Releases the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8" (PDF) (Press release). Archived (PDF) from the original on September 20, 2022. Retrieved September 18, 2022.
  6. 1 2 3 4 Walker, P. A.; Berger, J. C.; Green, R.; Laub, D. R.; Reynolds, C. L.; Wollman, L. (February 13, 1979), Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons (1 ed.), Palo Alto, California: The Harry Benjamin International Gender Dysphoria Association, Inc.
  7. 1 2 3 4 Walker, P. A.; Berger, J. C.; Green, R.; Laub, D. R.; Reynolds, C. L.; Wollman, L. (January 20, 1980), Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons (2 ed.), Stanford, California: The Harry Benjamin International Gender Dysphoria Association, Inc., archived from the original on September 9, 2024, retrieved May 15, 2024
  8. 1 2 3 4 Walker, P. A.; Berger, J. C.; Green, R.; Laub, D. R.; Reynolds, C. L.; Wollman, L. (March 9, 1981), Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons (3 ed.), San Francisco, California: The Harry Benjamin International Gender Dysphoria Association
  9. 1 2 3 4 5 Walker, P. A.; Berger, J. C.; Green, R.; Laub, D. R.; Reynolds, C. L.; Wollman, L. (February 1985). "Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [3rd Edition]". Archives of Sexual Behavior. 14 (1): 79–90. doi:10.1007/BF01541354. ISSN   0004-0002. PMID   3977585.
  10. 1 2 3 4 Walker, P. A.; Berger, J. C.; Green, R.; Laub, D. R.; Reynolds, C. L.; Wollman, L. (January 25, 1990), Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons (4 ed.), San Francisco, California: The Harry Benjamin International Gender Dysphoria Association, archived from the original on February 27, 2004, retrieved May 15, 2024{{citation}}: CS1 maint: bot: original URL status unknown (link)
  11. 1 2 Levine, S. B.; Brown, G.; Coleman, E.; Cohen-Kettenis, P.; Joris Hage, J.; Van Maasdam, J.; Petersen, M.; Pfaefflin, F.; Schaefer, L. C. (June 1998). "The Standards of Care for Gender Identity Disorders [5th Edition]". International Journal of Transgenderism. 2 (2). Archived from the original on December 5, 1998. Retrieved May 15, 2024. Consultants: Dallas Denny MA, Domineco DiCeglie MD, Wolf Eicher MD, Jamison Green, Richard Green MD, Louis Gooren MD, Donald Laub MD, Anne Lawrence MD, Walter Meyer III MD, C. Christine Wheeler Ph.D{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
  12. ↑ Meyer, W.; Bockting, W. O.; Cohen-Kettenis, P.; Coleman, E.; DiCeglie, D.; Devor, H.; Gooren, L.; Joris Hage, J.; Kirk, S.; Kuiper, B.; Laub, D.; Lawrence, A.; Menard, Y.; Patton, J.; Schaefer, L.; Webb, A.; Wheeler, C. C. (February 2001). "The Standards of Care for Gender Identity Disorders – Sixth Version". International Journal of Transgenderism. 5 (1). Archived from the original on July 9, 2001. Retrieved May 15, 2024.{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
  13. ↑ Meyer, W.; Bockting, W. O.; Cohen-Kettenis, P.; Coleman, E.; DiCeglie, D.; Devor, H.; Gooren, L.; Joris Hage, J.; Kirk, S.; Kuiper, B.; Laub, D.; Lawrence, A.; Menard, Y.; Patton, J.; Schaefer, L.; Webb, A.; Wheeler, C. C. (2001). "The Standards of Care for Gender Identity Disorders, Sixth Version" (PDF). Journal of Psychology & Human Sexuality. 13 (1): 1–30. doi:10.1300/J056v13n01_01. Archived from the original on March 17, 2024. Retrieved May 15, 2024.{{cite journal}}: CS1 maint: bot: original URL status unknown (link)
  14. ↑
  15. 1 2 3 4 Fraser, Lin (2015). "Gender Dysphoria: Definition and Evolution Through the Years". In Trombetta, Carlo; Liguori, Giovanni; Bertolotto, Michele (eds.). Management of Gender Dysphoria: A Multidisciplinary Approach. Springer Milan. pp. 19–31. doi:10.1007/978-88-470-5696-1_3. ISBN   978-88-470-5696-1.
  16. 1 2
  17. ↑ Fraser, Lin; Knudson, Gail (March 1, 2017). "Past and Future Challenges Associated with Standards of Care for Gender Transitioning Clients". Psychiatric Clinics of North America. Clinical Issues and Affirmative Treatment with Transgender Clients. 40 (1): 15–27. doi:10.1016/j.psc.2016.10.012. ISSN   0193-953X. PMID   28159141.
  18. ↑ Lawrence, Anne (November 4, 2001). SRS Without a One Year RLE: Still No Regrets. XVII Harry Benjamin International Symposium on Gender Dysphoria. Galveston, Texas. Archived from the original on June 23, 2018.
  19. ↑ "Trans Care within and against the Medical-Industrial Complex". manifold.umn.edu.
  20. 1 2 3 Amengual, Travis; Kunstman, Kaitlyn; Lloyd, R. Brett; Janssen, Aron; Wescott, Annie B. (October 20, 2022). "Readiness assessments for gender-affirming surgical treatments: A systematic scoping review of historical practices and changing ethical considerations". Frontiers in Psychiatry. 13. doi: 10.3389/fpsyt.2022.1006024 . ISSN   1664-0640. PMC   9630738 . PMID   36339880.
  21. ↑ Levine, Stephen; Althof, Stanley; Risen, Candace, eds. (2011). Handbook of Clinical Sexuality for Mental Health Professionals. New York, New York, United States of America: Taylor & Francis.
  22. ↑ Meyer, Walter; Bockting, Walter O.; Cohen-Kettenis, Peggy; Coleman, Eli; Diceglie, Domenico; Devor, Holly; Gooren, Louis; Hage, J. Joris; Kirk, Sheila; Kuiper, Bram; Laub, Donald; Lawrence, Anne; Menard, Yvon; Patton, Jude; Schaefer, Leah (April 11, 2002). "The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version". Journal of Psychology & Human Sexuality. 13 (1): 1–30. doi:10.1300/j056v13n01_01. ISSN   0890-7064.
  23. 1 2 Taylor, Jo; Hall, Ruth; Heathcote, Claire; Hewitt, Catherine Elizabeth; Langton, Trilby; Fraser, Lorna (April 9, 2024). "Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1)". Archives of Disease in Childhood. 109 (Suppl 2): s65–s72. doi:10.1136/archdischild-2023-326499. ISSN   0003-9888. PMID   38594049. Archived from the original on September 9, 2024. Retrieved April 26, 2024.
  24. 1 2 Yurcaba, Jo (June 17, 2022). "Trans kids and advocates blame culture war for debate over adolescent health care". NBC News . Archived from the original on September 9, 2024. Retrieved September 23, 2022.
  25. ↑ Nainggolan, Lisa (September 16, 2022). "WPATH Removes Age Limits From Transgender Treatment Guidelines". Medscape . Archived from the original on September 23, 2022. Retrieved September 23, 2022.
  26. ↑ Bazelon, Emily (June 15, 2022). "The Battle Over Gender Therapy". The New York Times Magazine . Archived from the original on July 1, 2022.
  27. 1 2 Ghorayshi, Azeen (June 25, 2024). "Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show". The New York Times. Archived from the original on September 9, 2024. Retrieved August 8, 2024.
  28. ↑ "White House says gender-affirming surgeries should be limited to adults". The Hill . July 3, 2024. Retrieved September 13, 2024.
  29. ↑ Rummler, Orion (July 2, 2024). "White House says it opposes gender-affirming surgery for minors". The 19th . Retrieved October 11, 2024.
  30. ↑ Migdon, Brooke (July 3, 2024). "White House comes out against gender-affirming surgeries for minors". The Hill. Archived from the original on September 1, 2024. Retrieved September 7, 2024.
  31. ↑ "McClain Probes Biden Administration's Influence on Removal of Age Minimums for Gender Transition Procedures". United States House Committee on Oversight and Accountability. August 27, 2024. Retrieved September 7, 2024.
  32. ↑ "NHS apologises for claiming eunuch is a gender identity". LBC. Archived from the original on September 9, 2024. Retrieved November 1, 2022.
  33. ↑ "Puberty Suppressing Hormones (PSH) for children and adolescents who have gender incongruence/dysphoria [URN 1927" (PDF). NHS England- Children and young people’s gender services. March 14, 2024. Archived (PDF) from the original on April 7, 2024. Retrieved March 25, 2024.
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