Thursday, December 18, 2014

Barriers To Transition

There is an article on the Atlantic website about the barriers that we have to overcome in order transition.
Transgender People Face Outsized Barriers to Genital Surgery
People who want genital reconstructions as part of their transition are asked for not one, but two mental-health referrals. Doctors are now questioning whether that requirement is ethical.
By Rose Eveleth
December 17, 2014

Not all transgender people want surgery, nor should surgery be held up as the gold standard for someone to completely transition to their gender identity. But for those who do want to go through with procedures to alter their genitalia, they must first jump through hoops that some doctors and advocates have argued recently are unethical.

The World Professional Association for Transgender Health (WPATH) has now published seven iterations of its guidelines for doctors who treat transgender people. The guide outlines the steps health professionals should take to ensure that a patient is treated well, and cared for appropriately. The report covers all kinds of things, from hormone treatments to voice and communication therapy, but a recent study singled out one particular recommendation: Right now, WPATH suggests that any individual seeking genital reconstructive surgery should be asked for two mental-health referrals before going through with the procedure.
The article goes on to say that for most surgeries only one letter is required and questions the need for two letters. The article then goes on to say,
In light of all this, the recent paper, published in Sexual and Relationship Therapy, calls into question the two-signature suggestion. The paper, titled “Yes and yes again: are standards of care which require two referrals for genital reconstructive surgery ethical?” goes through the reasons why doctors might have asked for two referrals, and ultimately concludes that two signatures are both unnecessary and unethical. “Applying the two written qualified mental-health professionals opinion rule to all trans people, rather than those for whom it is clinically indicated, appears to be disproportionately prejudicial where the impact is delay, obstruction, and differential treatment,” they write.
But then the article cites the pro for requiring two letters,
There are a lot of reasons why asking for two signatures might be reasonable. These surgeries are irreversible and involve removing healthy tissue, so performing them on someone who might be suffering from psychiatric complications, or who might come to regret it, would certainly be bad. And not all doctors are actually qualified to perform genital reconstruction, and might take advantage of people—putting barriers between patients and bad doctors can be a good thing. (At least one such case does exist. Dr. Russel Reid, a physician working in the U.K., pushed several patients towards surgery and was later found guilty of medical misconduct in a case that was controversial in the transgender community.)
I think one letter should be all that is required for GCS, for one thing it is expensive to have to see and extra doctor and for another doctors like Dr. Reid are few and far between. But I add on caveat, healthcare providers need to be better educated on trans-healthcare. There are no guideline in the Standard of Cares on what training is required for healthcare providers, it had only a vague description of what is needed to treat gender dysphoria,
“Knowledgeable about gender-nonconforming identities and expressions, and the assessment and treatment of gender dysphoria.
In addition to the minimum credentials above, it is recommended that mental health professionals develop and maintain cultural competence to facilitate their work with transsexual, transgender, and gender-nonconforming clients. This may involve, for example, becoming knowledgeable about current community, advocacy, and public policy issues relevant to these clients and their families. Additionally, knowledge about sexuality, sexual health concerns, and the assessment and treatment of sexual disorders is preferred.
If mental health professionals are uncomfortable with, or inexperienced in, working with transsexual, transgender, and gender-nonconforming individuals and their families, they should refer clients to a competent provider or, at minimum, consult with an expert peer.
I think they need to spell out more what education is required such as an internship, or class hours, or something to better define what healthcare providers need to know.

What are your thoughts?

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