One of the British gender identity clinics has stated in response to a Freedom of Information request:
“Specifically, our Care Pathway follows the stages laid down within The Harry Benjamin International Standards of Care (this differs from the WPATH guidance), as we believe that hormone treatment is best undertaken after real life experience has begun.”
The clinic is using an out of date document to justify its questionable practice. WPATH has therefore made it clear in a recent letter that the new Standards of Care take precedence over all earlier versions.
http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf
The links not working.
Try this: http://www.wpath.org/documents/Standards%20of%20Care%20V7%20-%202011%20WPATH.pdf
OK Cristine
So I have a few thoughts but I am a little busy just now.
I will get back to you in the short term. Promise.
CB
Right now!
Firstly, the issue you raise is a bit obscure because I can't see a description of it. But if I second guess you correctly, you seem to be objecting to the "British Gender Clinic" claiming that hormone treatment is best undertaken after the Real Life Experience (RLE) has begun. I agree with your objection and their view is problematic for two reasons; for one, denying the transsexual person access to hormones is a neglect of his/her physical/pyschological development and for the other, the Real Life Experience lacks adequate definition.
From what I have been able to ascertain from the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th Ed., this new Standards of Care (SOC) also advocates a belief that "hormone treatment is best undertaken after real life experience has begun," and therefore corresponds to, and aligns itself with, The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version February, 2001.
It is not that the two documents equally contradict themselves but that the colloquial understanding of the SOC guidelines from those less qualified is flawed. It is also the case the RLE is inadequately defined and so the common advice often given is based on a misconstrued interpretation. Because of this, I would argue that many well intentioned recommendations lack authority or professional sanction.
Personally, I have completed 5 years of psychological study (equivalent to professional training) and was employed in the psychiatric industry for three years. While I do not have professional expertise in Transsexual Issues I believe I am qualified to speak to some of the impacts of the current SOCs.
My first concern, as you know, is the RLE.
The act of fully adopting a new or evolving gender role or gender presentation in everyday life is known as the real-life experience. ... The real-life experience tests the person's resolve, the capacity to function in the preferred gender, and the adequacy of social, economic, and psychological supports. Harry Benjamin SOC
I object to the requirement to embrace the RLE 'cold turkey' (in order to aquire hormones or Sexual Reassignment Surgery (SRS)) on the basis that it is simply not a natural practise. A transsexual feels first and foremost that their gender difference is real and therefore it is something that is growing and developing progessively. There is no 'punctuated equilibrium' that must be addressed with a sudden and traumatic assault on their personal or social status.
Nevertheless, while neglecting to adequately define the RLE or to delineate examples of practices and processes that illustrate the way of transition, the Harry Benjamin SOC and WPATH both identify some social factors that have a bearing on clinical practice.
Clinical departures from these guidelines may come about because of a patient's unique anatomic, social, or psychological situation, an experienced professional’s evolving method of handling a common situation, or a research protocol. ... Even if epidemiological studies established that a similar base rate of gender identity disorders existed all over the world, it is likely that cultural differences from one country to another would alter the behavioral expressions of these conditions. Harry Benjamin SOC
Clinical departures from the SOC may come about because of a patient’s unique anatomic, social, or psychological situation; an experienced health professional’s evolving method of handling a common situation; a research protocol; lack of resources in various parts of the world; or the need for specific harm reduction strategies. WPATH
Well this does nothing for the interests of the transsexual person. The problems I have with the RLE stem from the conflict between the Professional Carers overriding avoidance of neglect or incompetance and the individual transsexual's own real lived life experience. Not enough consideration is given to the current philosophical paradigm of the 3rd millenium, that is a post modern existentialist standpoint, or the ethnocentric understandings of the persons for whom the most concern should be held, the transsexuals. We are not here to serve the doctors. Neither should we be their laboratory rats.
Notwithstanding, I don't fully believe that the professionals take the colloquial view of those less qualified that persons should go into transition 'cold turkey.' In fact, the Harry Benjamin SOC and WPATH make these disclaimers respectfully:
The Overarching Treatment Goal.
The general goal of psychotherapeutic, endocrine, or surgical therapy for persons with gender identity disorders is lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment. Harry Benjamin SOC
WPATH recognizes that health is dependent upon not only good clinical care but also social and political climates that provide and ensure social tolerance, equality, and the full rights of citizenship. Health is promoted through public policies and legal reforms that promote tolerance and equity for gender and sexual diversity and that eliminate prejudice, discrimination, and stigma. WPATH is committed to advocacy for these changes in public policies and legal reforms. WPATH
I believe the professionals charged with our care are much more astute and understand the nuances of the interactions between the patient and their community much better than what they are often given credit for.
The Purpose of the Standards of Care.
Persons with gender identity disorders, their families, and social institutions may use the SOC to understand the current thinking of professionals. All readers should be aware of the limitations of knowledge in this area and of the hope that some of the clinical uncertainties will be resolved in the future through scientific investigation.
To conclude, indeed the SOC's have served their purpose, they have illuminated the current thinking of professionals, and in the final analysis I have found them wanting. I have not addressed the issue of hormone use but I have similar liberal views about their access by transsexuals.
Chalice
You can see that there are concerns. typically we have MEN on here who want to remain MEN, they just want to grow boobs, so a line has to be drawn, its innapropriate for any clinician, doctor or surgeon to recommend treatment of any type without establishing a need, especially in the new age of litigation, as in ''You gave me hormones, but now my willy does'nt work.'' Someone wants a leg cut of, be very foolish and expensive to cut it off without first establishing there is something wrong to warrant such drastic practice. Mainly, the laid down procedures are to protect and ratify the need for the cost of free treatment. As far as scientific discoveries go, there is the Eitiology of Gender varience thread in the general forum, I do hope it does not get to the point that people are refused treatment because their DNA, brain scan whatever shows they are not transgendered. That's why people here in the UK are referred to specialist gender clinics,in turn the care has to be controlled and adminstered to a standard. In the private sector, several people have been rushed through with disterous results.