Understanding new revisions to ‘Harry Benjamin Standards of Care’Trans Progressive Thursday, October 6th, 2011
Commentary: Trans Progressive
If you’ve ever wondered about the mechanics of “treating” transgenderism, as it were, there are specific guidelines called the Harry Benjamin Standards of Care. A newly-revised edition of the Standards of Care was released Sept. 25, at the World Professional Association for Transgender Health (WPATH) conference in Atlanta.
There are significant changes to the psychiatric and medical care of the T people of the lesbian, gay, bisexual and transgender (LGBT) community in these revised standards of care, and the National Center for Transgender Equality (NCTE) has put out a list of ten items that trans people should know about WPATH’s revised edition. Here’s that list:
• Recognition that gender nonconformity in and of itself is not a disorder.
• Strong affirmation that attempts to change a person’s gender identity through “reparative” therapy are ineffective and unethical.
• Strong affirmation that transition-related treatments such as hormone therapy and surgery are medically necessary for many individuals and should be covered by insurance.
• Continued emphasis on the individual nature of transition-related care and the flexibility of treatment guidelines.
• Additional guidance on the treatment of adolescents and children, including guidelines for puberty-delaying treatment.
• Near elimination of the “real-life experience” requirement as a prerequisite criteria for medical transition in adults, with the exception of some genital surgeries.
• Discussion of a wider range of treatment options, including voice and communication therapy.
• Discussion of the preventive care needs of transgender people.
• Clarification that the Standards of Care should be applied in their entirety to those who are incarcerated or otherwise living in an institutionalized setting.
• A call for health professionals to advocate not only for their patients – for example by helping them obtain updated identity documents – but also for larger policy and legal reform promoting tolerance and equality.
Let me expound a bit on a few of the ten listed points.
To begin with, that first point that NCTE listed – that gender nonconformity in and of itself isn’t a disorder – is significant for lesbian, gay and bisexual people. Gender Identity Disorder (GID), the current diagnosis for transsexual people found in the Diagnostic and Statistical Manual of Mental Disorders, version four, (DSM-IV), suggests that cross-gender identity is itself disordered or deficient.
Gender Identity Disorder of Children is a separate diagnosis, and it’s a diagnosis for gender nonconforming youth. The diagnostic criteria are in two parts: Part A criteria are as follows:
• Repeatedly stated desire to be, or insistence that he or she is the other sex.
• In boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing.
• Strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex.
• Intense desire to participate in the stereotypical games and pastimes of the other sex.
• Strong preferences for playmates of the other sex.
The Part B criteria are as follows:
• In boys, assertion that his penis or testes are disgusting or will disappear, or assertion that it would be better not to have a penis, or aversion toward rough-and-tumble play and rejection of male stereotypical toys, games and activities.
• In girls, rejection of urinating in a sitting position, assertion that she has or will grow a penis, or assertion that she does not want to grow breasts or menstruate, or marked aversion toward normative feminine clothing.
If a child exhibits four of five of the Part A criteria, or one of the Part B criteria, then a child is diagnosable as having Gender Identity Disorder of Children. Lots of LGBT youth fall under those diagnostic criteria.
Joseph Nicolosi, Ph.D. is a founder and past president of the National Association for Research and Therapy of Homosexuality (NARTH). In his book, A Parents Guide To Preventing Homosexuality, he states, “The odds are that a boy [with Gender Identity Disorder of Children] has a 75 percent chance of growing up homosexual, bisexual or transgender.”
Nicolosi advocates gender-norming children to prevent homosexuality and transsexuality.
Which leads us to the second point that NCTE states is important about the revision of the Harry Benjamin Standards Of Care: WPATH considers attempts to change a person’s gender identity through “reparative” therapy as ineffective and unethical.
That should be welcome news not only for all of us gender nonconforming adults, but for gender nonconforming youth – including our LGBT youth.
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