Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

/pdf/suicide-and-suicide-risk-in-lesbian-gay-bisexual-and-271n34o75q.pdf

Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations.

Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.

/pdf/the-dsm-diagnostic-criteria-for-gender-identity-disorder-in-4ocpj25bnr.pdf

The DSM Diagnostic Criteria for Gender Identity Disorder in Adolescents and Adults

Affirmative Cognitive Behavior Therapy with Transgender and Gender Nonconforming Adults.

Transgender, transsexual, and other gender minority (trans) populations experience numerous health disparities in comparison to cisgender (non-trans) groups. Many trans and gender nonconforming people report interactions with health care providers who lack knowledge about the client's specific health care needs and in some cases discrimination from health care providers, which leads to health care avoidance behaviors and poor health outcomes. Trans-positive health care interventions are necessary in order to improve health care access and outcomes for this marginalized group. In this paper we (a) synthesize literature in the areas of trans-positive care and clinical behavior change according to predisposing, reinforcing, and enabling factors, factors to be addressed as a part of the Precede-Proceed model, a model to develop and evaluate behavior change interventions, and (b) discuss future directions for research and program development with the goal of improving access to competent and quality he...

Predisposing, reinforcing, and enabling factors of trans-positive clinical behavior change: A summary of the literature

The current nosology in the Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV TR), identifies those whose gender identities or expressions differ from their assigned birth sex as mentally ill. As the American Psychiatric Association (APA) prepares its fifth edition of the DSM, gender variant individuals face the stigma of mental disorder and sexual deviance resulting from this classification and/or worsened barriers to medical transition care that requires some form of diagnostic coding. We propose a solution following a harm reduction model in which the current Gender Identity Disorder (GID) diagnosis is replaced by one that distinguishes the normative distress of membership in a subjugated class from the distress of incongruence between anatomy and identity (historically termed gender dysphoria). We suggest renaming the diagnosis to clarify distress of gender dysphoria as the problem rather than gender identity itself. We recommend revision in the DSM-5 that woul...

Beyond Conundrum: Strategies for Diagnostic Harm Reduction

Sugerencias para la revisión de los diagnósticos relacionados con el género en el DSM y el CIE

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Beyond Conundrum: Strategies for Diagnostic Harm Reduction

Sugerencias para la revisión de los diagnósticos relacionados con el género en el DSM y el CIE