The Annual General Meeting for the Professional Association for Transgender Health Aotearoa (PATHA) will be held via online video call from 2-3pm on Saturday the 22nd of July, 2023.

Agenda

1. Welcome
2. Note any apologies and appoint minute taker
3. Receiving the minutes of the previous Society Meeting
   
4. President’s Report
   
5. Financial statements
6. Election of Executive Committee members
7. General business
8. Close meeting
   

PATHA members can log in to find details of how to attend the online AGM, copies of the reports, and information about nominees for the Executive Committee.

Kia ora koutou

The abstract submissions due date for the 2023 AusPATH Conference in partnership with PATHA has been extended to 11.59pm AEST 31 May. 

We would really like to see some of the amazing mahi happening in Aotearoa and pacific regions represented in the submissions. Scholarships and online options are being finalised and will be announced soon.

Find out more about and submit your abstract at: http://auspathconference.com.au/abstract-submission/

A new vision for transgender healthcare in Aotearoa New Zealand has been outlined in an article published in the New Zealand Medical Journal today. Authored by Dr Jaimie Veale and colleagues from The Professional Association for Transgender Health Aotearoa (PATHA), the article proposes ways to improve the healthcare system to better meet the needs of transgender people.

Dr Veale, PATHA president, Rutherford Discovery Fellow and Senior Lecturer in Psychology at the University of Waikato, says the need for improvements in transgender healthcare is urgent:

"Like anyone else, transgender people want to be able to access healthcare that they need, and if possible at their local doctor or hospital” said Dr Jaimie Veale. “Currently, that’s not possible for many transgender people and leaves them and their families with their lives on hold, trying to fundraise for medically necessary care."

Dr Rona Carroll, PATHA Vice-president, GP and Senior Lecturer in Primary Health Care and General Practice at the University of Otago, emphasises the importance of collaboration and transparency in improving transgender healthcare:

“It makes such a difference to my transgender patients when they have information about the medical and surgical steps available to affirm their gender. I see the positive impact that access to gender affirming healthcare makes to transgender people’s lives”, said Dr Carroll. “The new health reforms are a chance to make access to healthcare fairer, by removing the current postcode lottery where the services you receive depend on where you live.”

The vision proposed by PATHA centres around creating a new transgender health resourcing hub that operates under a Te Tiriti o Waitangi framework. This hub would make information, mentoring, and education available to healthcare providers as well as transgender people and their families around the country. Extra funding is also needed to support GPs and other primary care providers and ensure better access to gender affirming surgeries.

The resourcing hub would also teach healthcare providers how to help transgender people better. Peer health navigators, who have gone through similar experiences would help guide and support others. The plan also includes making sure that everyone knows how to access this care, and that transgender communities are involved in making sure it all works well.

Dr Veale further explains that PATHA’s vision is that the health system reforms enable best practice to happen across Aotearoa: "Let’s learn from the good practices that are already occurring regionally and create a national resourcing hub to coordinate and share what’s working well.” 

The article can be read in full on the New Zealand Medical Journal website and is available on the PATHA website here.

PATHA members have created new Primary Care Gender Affirming Hormone Therapy Initiation Guidelines. These guidelines were authored to help GPs and other primary care providers to start gender affirming hormone therapy for adults. Many PATHA members helped write or improve these these guidelines.

These guidelines have been endorsed by The Royal New Zealand College of General Practitioners.

The PDF can be downloaded on PATHA's guidelines webpage, and they are also hosted on the University of Otago website here.

PATHA has co-signed the Darlington Statement!

What is the Darlington Statement?

It is a joint consensus statement by Australian and Aotearoa/New Zealand intersex organisations and independent advocates, in March 2017. It sets out the priorities and calls by the intersex human rights movement in our countries, under six headings: a preamble, human rights and legal reform; health and wellbeing; peer support; allies; and education, awareness and employment.

The Professional Association for Transgender Health Aotearoa (PATHA) regards the Darlington Statement as an essential document for governments and service providers to ensure that  their legislation, policies, and practices support and respect the rights of intersex people.

Read the full statement and more about the essential nature of this work here: https://darlington.org.au/statement/

Originally Published on The Spinoff by Dr Julia De Bres

Many with no experience of raising trans children seem to hold a lot of views on it. That’s why Julia de Bres interviewed parents of trans kids about their actual experiences, and pulled those stories together into a powerful resource. 

Before I started interviewing parents of trans kids, I drew a picture.

In it is my child, bright, smiling and pink.  Like the Care Bears of my childhood, she emits a rainbow beam from her tummy to fight evil, and there is a glow around her as she brings her light into the world.  I am looking at her in wonder, but also at the dark cloud behind her.  As she gazes to the future in all her courage and sparkle, my eyes are on the impending storm.

As a parent of a trans child, I am very aware of how the experiences of parents like me are depicted in public discourse.  The dominant story portrays parents reacting to their child’s gender variance with shock, then slowly moving to acceptance via a painful series of phases akin to a grief process.

Parents of trans kids are asked to perform this story on the regular to people who turn to us with a curious gaze: “When did you first know your child was trans?”

I know the story is more complex and varied, because I’ve been living it for the past ten years, and because I’ve watched other parents do the same in an online support group.  Here I see parents having a wide range of experiences, positive and negative, with one thing in common – an unwavering commitment to support their kids.

If parents of trans kids only hear negative stories, they have little reason to hope for better.  I wanted to ask them how they really feel about parenting a trans child – how they navigate the hard parts and how they live their lives with joy.

I recruited parents of different cultural and social backgrounds – Māori, Pākehā, Pacific, Asian, fathers, mothers, non-binary parents, queer and straight – and I asked them to draw their experience of parenting a trans child.

Across the drawings, one visual metaphor kept recurring, which I recognised from my own: storm clouds and rainbows.

Rainbows were a recurring motif in the illustrations by parents, including this one by Julia de Bres.

The storm clouds represented the negative attitudes towards trans people that parents encounter in politics, media, and society.  For some, these attitudes are remote, in the form of laws protecting trans people from discrimination internationally being removed, misinformation on social media, and attempts to reduce access to gender-affirming care.  Others encounter them closer to home, in their interactions with family members, medical professionals, and schools.  Even within a supportive immediate environment, these attitudes remain a foreboding presence, one parent saying she was “always waiting for the ball to drop”.

There was darkness in these stories, but a different kind of darkness than others imagine.  The problem for these parents was not their child’s gender – it was everything around them.

The rainbows represented the positive aspects of parents’ experiences.  In affirming their child’s gender, parents noticed a leap in the happiness of their child, developed improved relationships with them, and experienced personal growth of their own.  One described her child as “an effervescent soul … a beacon of light drawing people towards him”, another as a charismatic “force of nature” who “takes people with her”.

Despite the challenges they face, the parents painted an uplifting picture of their experiences, vastly different from how this is depicted from the outside.  One commented: “this is going to be a lifelong journey for me and I’m never going to be at the end of the rainbow, but to have that spectrum of colour around me – I think it’s beautiful”.

A parent’s illustration from Julia de Bres’s project.

The thing about parenting a trans child is that the weather just keeps on coming.

I have kept in touch with the parents I interviewed.  Some kids who were doing well at the time of the interviews have since faced really hard times and some who were struggling are now flourishing.

Given the prevailing social environment, trans kids will face challenges.  Parents can help kids weather the storm, forming an umbrella of protection that fosters their capacity to get through difficult periods and back into the sun.

I’ve been through my own storms with my child, but there have been a lot of rainbows too.  Sometimes it is hard to separate them.  When she shines her brightest, the light seems more brilliant against the backdrop of the darkness we’ve seen.  I think that’s why one of the parents, who drew a rainbow without clouds, observed “you can’t have a rainbow without storms”.

It’s this complexity of experience, the ultimate hopefulness, and the fierce love of the parents I spoke to, that I wanted to share.

To do so, I created an illustrated resource with a colleague, called Storm Clouds and Rainbows: The Journey of Parenting a Transgender Child.

This resource was developed in partnership with the Rainbow Support Collective, a collaboration between rainbow-led organisations across Aotearoa, and supported by The Tindall Foundation, and is available to download here.

I hope it will help parents of trans kids feel seen and supported.  I also hope that it will provide insights to anyone who wants to better understand this experience – the storm clouds, the rainbows, the fog, the snow, the gentle breeze… and everything in-between.

WPATH, ASIAPATH, EPATH, PATHA, and USPATH Response to NHS England in the United Kingdom (UK) Statement regarding the Interim Service Specification for the Specialist Service for Children and Young People with Gender Dysphoria (Phase 1 Providers) by NHS England*

Following the publication of the interim report of the Cass Review of gender identity services for children and young people in England in March 2022 NHS England has now issued an interim service specification for “Phase 1” services pending establishment of new regional services in England.

See https://www.engage.england.nhs.uk/specialised-commissioning/gender-dysphoria-services/

WPATH, ASIAPATH, EPATH, PATHA, and USPATH have major reservations about this interim service specification.

1. The document fails to state that gender diversity is a normal and healthy aspect of human diversity (Coleman et al., 2022), and that many transgender people experience gender incongruence from childhood or adolescence (James et al., 2016). Transgender and gender diverse (TGD) people have a human right to access the highest achievable standard of health care, including gender-affirming care (World Health Organization, (2017; Yogyakarta Principles.org., 2007).  WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that rather than emphasising the importance of equitable access to medically necessary support and treatment for children, adolescents and young adults experiencing gender incongruence, the service specification appears designed to place unnecessary barriers in their way. Additionally, we state that when gender affirming medical treatment is provided with a standardised multidisciplinary assessment and treatment process, thorough informed consent, and ongoing monitoring and psychosocial support, the rate of regret of gender-affirming medical treatment commenced in adolescence has been observed to be very low and the benefits of treatment in adolescence are potentially greater than the benefits of gender-affirming treatment commenced in adulthood (Coleman et al., 2022). Hence, the harms associated with obstructing or delaying access to wished-for and indicated treatment for the majority, appear greater than the risks of regret for the few (Coleman et al., 2022), when transgender and cisgender people are correctly regarded as equal.
2. The document makes assumptions about transgender children and adolescents which are outdated and untrue, which then form the basis of harmful interventions. Amongst these is the supposition that gender incongruence is transient in pre-pubertal children.  This document quotes selectively and ignores newer evidence about the persistence of gender incongruence in children (Olson et al., 2022). Many older studies regarding the stability of gender identity enlisted children who did not have gender incongruence or gender dysphoria, but rather, had culturally non-conforming gender expression. The findings of these older studies should only carefully be applied to children and young people who are presenting to gender identity clinics seeking gender-affirming treatment: it may be a different population (Temple Newhook et al., 2018). The document also makes unsupported statements about the influence of family, social, and mental health factors on the formation of gender identity. WPATH, ASIAPATH, EPATH, PATHA, and USPATH believe that children and young people can have agency and can express their gender identity, and that the best course of action is to work collaboratively with the child or young person and family to support the TGD person (Coleman et al., 2022).
3. The document highlights that there have been approximately 5000 referrals to the NHS GIDS in 2021/2022, an increase from previous years. It states that referrals are currently 8.7 young people per 100,000 population.  These figures are not put in context.  The referrals to GIDS range between age 3 and 17.  There are 10,752,647 young people aged between 3 and 17 in England and Wales, making up 18% of the total population (Office of National Statistics, 2021).  Hence, referrals to GIDS are 8.7 young people per 18,000 same age population.  This is a rate of 0.048% of this population, or fewer than 5 in 10,000 young people.  Population estimates of the proportion of people who are transgender range from 0.3% to 0.5% in adults, and 1.2% to 2.7% in adolescents (Coleman et al., 2022).  Hence, referrals to GIDS represent a very tiny fraction of the total population of young people, and only a small proportion of those who self-identify as transgender.  These referrals are likely to be made up of those young people who have the most severe gender incongruence.  WPATH, ASIAPATH, EPATH, PATHA, and USPATH strongly recommend that services should be designed that welcome these appropriate referrals, providing expedited access to expert assessment, and treatment where appropriate (Coleman et al., 2022).
4. The document underscores the expectations of the family and parent/carer around the child/young person’s gender incongruence. WPATH, ASIAPATH, EPATH, PATHA, and USPATH’s position is that while it is important for health professionals to work inclusively with the family and parent/carer to assist children and young people on their gender journey, the needs of the child/young person must be paramount (Coleman et al., 2022). Family acceptance and support is essential for wellbeing (Pariseau et al., 2019; Russell et al., 2018; Simons et al., 2013).
5. This document seems to triage treatment based on an ability of the child or young person to prove the severity of their gender dysphoria. There is a reference to “the clarity, persistence and consistency of gender incongruence…”. WPATH, ASIAPATH, EPATH, PATHA, and USPATH believe that each person has a unique gender journey. There can be many reasons why children and young people may have trouble expressing or understanding their own gender incongruence. WPATH, ASIAPATH, EPATH, PATHA, and USPATH believe that all healthcare should be patient-centered and individually tailored (Coleman et al., 2022).
6. This document discourages social transition in pre-pubertal children. This is despite recent evidence pointing to positive mental health and social well-being outcomes in children who are allowed to socially transition in supportive environments before puberty (Durwood et al., 2017; Gibson et al., 2021). The document refers to the so-called “risks of an inappropriate gender transition” but does not name these risks or provide a reference for this statement. There is a section with criteria to support social transition in adolescents; this seems to suggest that adolescents will only be supported to socially transition if they meet the criteria set by the service. This represents an unconscionable degree of medical and State intrusion into personal and family decision-making about simple everyday matters such as clothing, name, pronouns, and school arrangements. Ultimately, social transition in practice is a personal and family decision, led by the young person, and should not require medical permission.  WPATH, ASIAPATH, EPATH, PATHA, and USPATH do not support a gatekeeping approach to social transition (Coleman et al., 2022).
7. This document severely limits access to puberty suppression by only allowing treatment in the context of a formal research protocol. The eligibility criteria for enrolment in this formal research protocol are not specified, but the concern is that they will be restrictive. WPATH, ASIAPATH, EPATH, PATHA, and USPATH disagree with this approach, and emphasise the increasing evidence that access to reversible puberty blockers, and later gender-affirming hormone treatment if wished, is associated with positive mental health and social well-being in adolescents with gender incongruence, and that adolescents are satisfied with these treatments and perceive them as essential and lifesaving (Coleman et al., 2022). We are deeply concerned that the NHS is taking inappropriate approaches to evaluating the established body of evidence and is therefore drawing erroneous conclusions underestimating the effectiveness of puberty suppression.  It is ethically problematic to compel adolescents to participate in a research study to access medically necessary treatment; research participation should be voluntary and should not occur under coercive conditions and in clinical research “the safety and wellbeing of the individual prevail over the interests of science and society” (National Health Service Health Research Authority, 2022).  It is also deeply concerning that the document does not describe any process for provision of estrogen or testosterone therapies for older adolescents.
8. At several points in the document, there is an emphasis on “careful exploration” of a child or young person’s co-existing mental health, neuro-developmental and/or family or social complexities. There is also a suggestion that a “care plan should be tailored to the specific needs of the individual following careful therapeutic exploration…”  WPATH, ASIAPATH, EPATH, PATHA, and USPATH are concerned that this appears to imply that young people who have coexisting autism, other developmental differences, or mental health problems may be disqualified, or have unnecessary delay, in their access to gender-affirming treatment.  This would be inequitable, discriminatory, and misguided (Coleman et al., 2022). WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend that puberty suppression, where urgently indicated, can be commenced promptly, and proceed alongside and at the same time as any necessary diagnostic clarification of other conditions, or treatment of other conditions. Whilst careful assessment is imperative, undue delay inherent within a model of care is not a neutral option and may cause significant harm to those accessing services (Coleman et al., 2022).
9. There is an alarming statement in the summary that “the primary intervention for children and young people… is psychosocial (including psychoeducation) and psychological support and intervention.” In another section, the document goes on to state that one outcome from the screening process would be “discharge with psychoeducation…” Disturbingly, this decision might be made without speaking directly with the young person or family. Taking No 8 and 9 together, this document seems to view gender incongruence largely as a mental health disorder or a state of confusion and withholds gender-affirming treatments on this basis. WPATH, ASIAPATH, EPATH, PATHA, and USPATH call attention to the fact that this “psychotherapeutic” approach, which was used for decades before being superseded by evidence-based gender-affirming care, has not been shown to be effective (AUSPATH, 2021; Coleman et al., 2022). Indeed, the denial of gender-affirming treatment under the guise of “exploratory therapy” has caused enormous harm to the transgender and gender diverse community and is tantamount to “conversion” or “reparative” therapy under another name.
10. This document reasserts the outdated “gatekeeping model” of access to gender affirming care. There are many references within the document to patients only being able to access care and be referred to the next intervention down the line if they can meet criteria set by the service. There are clear statements that if adolescents are taking puberty suppression or gender-affirming hormones obtained elsewhere, the service will not provide any care. The purpose of this section seems to be about empowering the service to withhold treatment and health monitoring from children or young people who have obtained medication without the permission of the service. WPATH, ASIAPATH, EPATH, PATHA, and USPATH affirm the human right of self-determination in health care (World Health Organization, 2017). Moreover, such action contravenes the core aspects of the NHS Constitution (Department of Health and Social Care, 2021). Children and adolescents can contribute substantially to their health care decision making, with age-appropriate capacity to weigh the risks and benefits according to their own judgement (Amnesty International, 2020; Steinberg, 2013; Vrouenraets et al., 2021; Weithorn & Campbell, 1982). Furthermore, WPATH, ASIAPATH, EPATH, PATHA, and USPATH recommend a harm-minimisation approach, and encourages doctors to work with people who access treatment from other sources in a non-judgmental manner to help them to maximise their health status (Coleman et al., 2022).
11. The document states that general practitioners would be advised to “initiate local safeguarding protocols” if a child or young person obtains puberty blockers or hormones from another source. This recommendation, which would see families reported to child protection services, is gravely concerning.  The draft service specification makes it clear that it will be difficult to obtain prompt access to puberty suppression.  Families who are in the position of seeing their young adolescent descend into suicidal distress as they continue to experience incongruent pubertal changes, whilst being unable to access appropriate care from the NHS service, may make the difficult decision to obtain puberty suppression through non-NHS sources, as caring parents affirming their child’s identity and supporting health care according to international treatment standards.  These parents would then be at risk of being reported to child protection services, a ludicrous and dangerous situation; or a general practitioner with a better understanding of gender incongruence might be put at risk of censure for refusing to make such an inappropriate child protection referral, against the recommendations of the specialist service. WPATH, ASIAPATH, EPATH, PATHA, and USPATH believe that the appropriate interim service specification should instead be supporting GPs and families to provide the best evidence-based and compassionate care for children and young people with gender incongruence, including access to puberty suppression and gender-affirming hormones where indicated (Coleman et al., 2022; de Vries et al., 2021).

Overall, WPATH, ASIAPATH, EPATH, PATHA, and USPATH find serious flaws in this document, which sets out a plan for a service for gender diverse children and young people in England that is likely to cause enormous harm and exacerbate the higher rates of suicidality experienced by these young people in the context of ongoing pathologisation and discrimination.  WPATH, ASIAPATH, EPATH, PATHA, and USPATH urge NHS England and Wales to reconsider its approach, which is now contrary to the progress being made in many countries around the world and incongruent with statements from the World Health Organization (2017) and the Yogyakarta Principles (2007) relating to the right to the highest attainable standard of health.

*PATHA and other PATH associations thank AUSPATH for allowing the use of the content of their Statement issued on 16 November 2022 about the Interim Service Specification for the Specialist Service for Children and Young People with Gender Dysphoria (Phase 1 Providers) by NHS England.

References

Amnesty International (2020). Amnesty International UK and Liberty joint statement on puberty blockers. https://www.amnesty.org.uk/press-releases/amnesty-international-uk-and-liberty-joint-statement-puberty-blockers

AUSPATH (2021). Australian Professional Association for Trans Health Public Statement on Gender-affirming Healthcare including for Trans Youth.  https://auspath.org.au/2021/06/26/auspath-public-statement-on-gender-affirming-healthcare-including-for-trans-youth  

Coleman, E., Radix, A. E., Bouman, W.P., Brown, G.R., de Vries, A. L. C., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F.L., Monstrey, S. J., Motmans, J., Nahata, L., ... Arcelus, J. (2022). Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(S1), S1-S260. https://doi.org/10.1080/26895269.2022.2100644

de Vries, A. L. C., Richards, C., Tishelman, A. C., Motmans, J., Hannema, S. E., Green, J., & Rosenthal, S. M. (2021). Bell v Tavistock and Portman NHS Foundation Trust [2020] EWHC 3274: Weighing current knowledge and uncertainties in decisions about gender-related treatment for transgender adolescents. International Journal of Transgender Health, 22(3), 217–224. https://doi.org/10.1080/26895269.2021.1904330

Department of Health and Social Care (2021). NHS Constitution for England. https://www.gov.uk/government/publications/the-nhs-constitution-for-england

Durwood, L., McLaughlin, K. A., & Olson, K. R. (2017). Mental health and self-worth in socially transitioned transgender youth. Journal of the American Academy of Child & Adolescent Psychiatry, 56(2), 116–123. https://doi.org/10.1016/j.jaac.2016.10.016.

Gibson, D. J., Glazier, J. J., Olson, K. R. (2021). Evaluation of anxiety and depression in a community sample of transgender youth. JAMA Network Open, 4(4), e214739. https://doi.org/10.1001/jamanetworkopen.2021.4739.

James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L, & Anafi, M. (2016). The report of the 2015 U.S. Transgender Survey. https://transequality.org/sites/default/files/docs/usts/USTS-AIAN-Report-Dec17.pdf

National Health Service Health Research Authority (2022).  UK Policy Framework for Health and Social Care Research. https://www.hra.nhs.uk/planning-and-improving-research/policies-standards-legislation/uk-policy-framework-health-social-care-research/uk-policy-framework-health-and-social-care-research/#allresearch

Office of National Statistics (2021). Data and analysis from Census 2021. Population estimates. https://www.ons.gov.uk/peoplepopulationandcommunity

Olson, K. R., Durwood, L., Horton, R., Gallagher, N. M., & Devor, A. (2022). Gender identity 5 years after social transition. Pediatrics, 150(2), e2021056082. https://doi.org/10.1542/peds.2021-056082

Pariseau, E. M., Chevalier, L., Long, K. A., Clapham, R., Edwards-Leeper, L., & Tishelman, A. C. (2019). The relationship between family acceptance-rejection and transgender youth psychosocial functioning. Clinical Practice in Pediatric Psychology, 7(3), 267. https://doi.org/10.1037/cpp0000291

Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003

Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019.

Steinberg, L. (2013). Does recent research on adolescent brain development inform the mature minor doctrine? The Journal of Medicine and Philosophy, 38(3), 256–267. https://doi.org/10.1093/jmp/jht017

Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Pickett, S (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. International Journal of Transgenderism, 19(2), 212-224. https://www.tandfonline.com/doi/full/10.1080/15532739.2018.14563907.

Vrouenraets, L. J. J. J., de Vries, A. L. C., de Vries, M. C., van der Miesen, A. I. R., & Hein, I. M. (2021). Assessing medical decision-making competence in transgender youth. Pediatrics, 148(6), e2020049643. https://doi.org/10.1542/peds.2020-049643

Weithorn, L.A., & Campbell, S.B. (1982). The competency of children and adolescents to make informed treatment decisions. Child Development, 53(6), 1589-1598. https://doi.org/10.2307/1130087

World Health Organization (2017). Human rights and health. https://www.who.int/news-room/fact-sheets/detail/human-rights-and-health

Yogyakarta Principles.org. (2007). Yogyakarta principles. https://yogyakarta.org

FOR THE FULL RESPONSE IN PDF, CLICK HERE.

The World Professional Association for Transgender Health (WPATH) Standards of Care 8 are published here. You can also view them on the PATHA website here. Below is from the WPATH Press Release:

Following five-years of rigorous scientific effort by more than 120 health care clinical and academic professionals across the globe, the World Professional Association for Transgender Health (WPATH) has released the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (SOC8). Building upon the Standards of Care Version 7, which were released in 2012, the SOC8 provides clinical guidance for health care professionals to assist transgender and gender diverse (TGD) people with safe and effective pathways to achieve lasting personal comfort with their gendered selves, and to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, hormonal or surgical treatments, gynecologic and urologic care, reproductive options, voice and communication therapy, and mental health services (e.g., counseling, psychotherapy), among others.

“The Standards of Care 8 represents the most comprehensive set of guidelines ever produced to assist health care professionals around the world in support of transgender and gender diverse adults, adolescents, and children who are taking steps to live their lives authentically,” said WPATH President Walter Bouman, MD, PhD, and WPATH President Elect Marci Bowers, MD. “Health care is a human right. All trans-identified people on this planet deserve the same opportunity to be their true selves and have access to the medically necessary affirming care that allows them to do just that. The field of transgender medicine is evolving rapidly, responsive foremost to the needs of patients and their families and guided by objectivity, compassion, and consensus. We are thrilled to provide this vital resource to support transgender and gender diverse people worldwide.”

The SOC8 guidelines committee consisted of multidisciplinary subject matter experts, health care professionals, researchers and stakeholders with diverse perspectives and global geographic representation. Consensus of final recommendations were based upon extensive reviews of the literature and were attained using an iterative Delphi process, which involved multiple rounds of revisions based upon careful review by the authorship team that included all members of the guidelines committee.

In December 2021, a draft of the SOC8 was released to the public for review and comment. WPATH received thousands of comments on the guidelines. All were read and taken into consideration during the editing phase of SOC8. “Watching with great pride and respect as the entire SOC8 revision committee worked in a collaborative way to develop these robust, and revised guidelines was a phenomenal experience,” said Blaine Vella, WPATH’s Executive Director. “The authors worked tirelessly, as volunteers, to ensure that their chapters were representative, balanced, and contained the most current scientific data and clinical experience available. All this in the knowledge that the SOC8 will continue to offer access and knowledge to the health and wellbeing of all transgender and gender diverse people across the globe.”

“The Standards of Care 8 is here to help people get the care they need so they can live healthy, happy lives. We are not starting from scratch. We are building upon decades of research and clinical experience,” said SOC8 Co-Chairs, Eli Coleman, PhD, Jon Arcelus, MD, PhD, and Asa Radix, MD, PhD, MPH. “The SOC8 is the most expert, nuanced, evidenced-based and consensus-based document internationally. The authors come from a variety of disciplines working in transgender health. All have done their utmost to serve a broad public and a broad area of health care providers with guidelines they can work with in different places around the world. We hope it serves the quality of care for transgender people.” Link to full Standards of Care 8 here.

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WPATH is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. Founded in 1979, the organization currently has over 3,000 health care professionals, social scientists, and legal professionals, all of whom are engaged in clinical practice, research, and education that affects the lives of TGD people. WPATH envisions a world wherein people of all gender identities and gender expressions have access to evidence-based healthcare, social services, justice, and equality.

In response to concerns about long waiting lists and accessibility problems in the centralised gender identity service for children and young people in the United Kingdom, the interim report from the Cass Review has recently recommended “commissioning a national network of regional services across the country over the coming years”. The PATHA Executive Committee is concerned that this has led to media reports suggesting that the recommended closure of the current service is due to “safety concerns”. In fact, the UK National Health Service’s response has focused on ways to “improve and expand the support offered to children and young people who are questioning their gender identity”. This approach would increase services as well as accessibility and be more similar to how gender affirming care is provided for children and young people in Aotearoa New Zealand. 

Some media reports have mentioned the use of puberty blockers. In Aotearoa New Zealand, these are prescribed based on a carefully considered decision made by the young person and their family in partnership with the health team, where the benefits are considered to outweigh potential risks.

PATHA supports the use of a gender affirmative approach to care, which is based on listening to the individual person and working with them to achieve the outcomes that are most appropriate for their individual needs. The PATHA Executive Committee is concerned about statements in the Cass Review questioning this approach and urges the Review to consider the international evidence more widely.

The PATHA Executive Committee endorses the recent AusPATH statement on this matter, which gives further details and context. This includes a link to a British Medical Journal editorial regarding this interim Cass report, whose title reiterates the need for the review to be based solidly on existing international evidence and consensus. The full AusPATH statement is copied below:

1. There have been articles in the Australian media recently about the Cass Review. These articles have misleadingly suggested that the recommended closure of the Gender Identity Development Service by the Cass review is due to “safety fears” and “rushing children into treatment”. These articles have prompted this statement by the Board of AusPATH.

2. The Board of AusPATH notes that in the UK, all gender identity services are provided by a single specialist clinic called the Gender Identity Development Service (GIDS) through the Tavistock and Portman NHS Foundation Trust. The Review has proposed the prompt development of regional centres that will develop links and work closely with local services. A system of regional centres working with local providers would be very similar to the model that provides care for children and young people with gender incongruence in Australia. Potentially, more regional centres would mean that services are more accessible especially if there is investment to increase the amount of services provided. These regional centres could also assist in the training of the local medical workforce.

3. The Board of AusPATH is concerned about the use of language in the review that talks about causation of gender incongruence. Such language is often used as a preamble to conversion therapy, which the Board of AusPATH unequivocally opposes.

4. The Board of AusPATH is concerned about statements in the review questioning an affirmative approach to gender affirming care. An affirmative approach is about listening to the individual person and working with them to achieve the outcome that is most appropriate for each individual person and this is consistent with a person-centered approach to health care. The Board of AusPATH supports the use of an affirmative approach to gender affirming care.

5. The Review suggests putting in place standardised approaches to the assessment of children and young people with gender incongruence that also includes a full mental health and neurodevelopmental assessment. In Australia, a full psychiatric/psychological assessment which can include a neurodevelopmental assessment is done before the commencement of medical treatment. The Board of AusPATH is aware of evidence showing that children and young people with gender incongruence often have high rates of mental health concerns and neurodiversity. Identifying these early and putting in place strategies to identify these concerns and support for managing them is appropriate. The Board of AusPATH do not support“ exploratory therapy” which is often used as a euphemism for conversion therapy.

6. The Review suggests putting in place research protocols to support long-term data collection with the consent of participants and the Board of AusPATH is supportive of this proposal. This is also common practice in Australia.

7. The Board of AusPATH considers that there is significant international evidence about the use of puberty blockers and gender-affirming hormone treatment for young people with gender incongruence. There is also accumulating evidence of the harm that ensues from denying puberty blockers and gender affirming hormone treatment. We urge the Review to consider the international evidence more widely. The Review has not said what model it proposes as an alternative to gender
   affirming care nor what evidence it has for any alternative model.

8. The Board of AusPATH urges any further development of policy regarding the care of children and young people with gender incongruence to work closely with young people and their families and peer-led services as well as clinicians who have experience and expertise in working with his population. We also urge the Review to consider getting input from international experts in this area.

9. The Board of AusPATH would like to draw attention to the excellent editorial in the British Medical Journal, regarding this interim report authored by Assoc Prof Ken Pang, Mr Jeremy Wiggins and Assoc Prof Michelle Telfer. Access it here.

https://auspath.org.au/2022/08/11/auspath-statement-about-the-independent-review-of-gender-identity-services-for-children-and-young-people-interim-report-february-2022-in-the-uk-cass-review/ 

Over June-July 2022, PATHA collaborated with Te Ngākau Kahukura, Gender Minorities Aotearoa, and Counting Ourselves to deliver a series of three webinars for clinicians and other people working in primary care.

Each of the three free sessions presented a different perspective on primary care and trans health, with an overall goal to improve outcomes for trans and non-binary people seeking primary healthcare. The series continued a current and dynamic conversation about the role of primary care in trans health, models of informed consent, and how we can work together to reduce barriers and improve practice.

This conversation series was generously supported by The Rule Foundation.

The three webinar sessions are now available to watch as captioned recordings on Te Ngākau Kahukura’s website.