Standards
Of Care For Gender Identity Disorders - Fifth Version (June 15, 1998)
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Part One - Introductory Concepts -
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The
Purpose of the Standards of Care -
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The major purpose of the Standards
of Care (SOC) is to articulate this international organization's professional
consensus about the psychiatric, psychological, medical, and surgical management
of gender identity disorders. Professionals may use this document to understand
the parameters within which they may offer assistance to those with these
problems. Persons with gender identity disorders, their families, and social
institutions may use the SOC as a means 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. |
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The
Overarching Treatment Goal -
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The general goal of the specific
psychotherapeutic, endocrine, or surgical therapies for people with gender
identity disorders is lasting personal comfort with the gendered self in
order to maximize overall psychological well-being and self-fulfillment. |
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The
Standards of Care Are Clinical Guidelines -
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The SOC are intended to provide
flexible directions for the treatment of gender identity disorders. When
eligibility requirements are stated they are meant to be minimum requirements.
Individual professionals and organized programs may raise them. 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.
These departures should be recognized as such, explained to the patient,
documented both for legal protection and so that the short and long term
results can be retrieved to help the field to evolve. |
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The
Clinical Threshold -
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A clinical threshold is passed
when concerns, uncertainties, and questions about gender identity persist
in development, become so intense as to seem to be the most important aspect
of a person's life, or prevent the establishment of a relatively unconflicted
gender identity. The person's struggles are then variously informally referred
to as a gender identity problem, gender dysphoria, a gender problem, a
gender concern, gender distress, or transsexualism. Such struggles are
known to be manifested from the preschool years to old age and have many
alternate forms. These forms come about by various degrees of personal
dissatisfaction with sexual anatomy, gender demarcating body characteristics,
gender roles, gender identity, and perceptions of others. When dissatisfied
individuals meet specified criteria in one of two official nomenclatures--the
International Classification of Diseases-10 (ICD-10) or the Diagnostic
and Statistical Manual of Mental Disorders--Fourth Edition (DSM-IV)--they
are formally designated as suffering froma gender identity disorder (GID).
Some persons with GID exceed another threshold--they persistently possess
a wish for surgical transformation of their bodies. |
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Two
Primary Populations with GID Exist - Biological Males and Biological Females
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The sex of a patient always is
a significant factor in the management of GID. Clinicians need to separately
consider the biological, social, psychological, and economic dilemmas of
each sex. For example, when first requesting professional assistance, the
typical biological female seems to be further along in consolidating a
male gender identity than does the typical biological male in his quest
for a comfortable female gender identity. This often enables the sequences
of therapy to proceed more rapidly for male-identified persons. All patients,
however, must follow the SOC. |
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Notes
On The Standards Of Care
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The
Standards of Care are provided on this site for informational purposes
only -
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The Standards of Care are intended
for use as guidelines, designed to promote the health and welfare of persons
with gender identity disorders, and exist for the protection of both the
patient and the theraputic provider of such treatment. As such, they are
not cast in stone but rather open to interpretation on a case by case basis
between the patient and the treatment professional involved, both should
be aware of these guidelines and the treatment standards they are designed
to maintain. |
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| The
Standards of Care are created and maintained by - |
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The
Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA)
1300 South Second Street, Suite 180
Minneapolis, MN 55454 USA
(612) 625-1500
http://www.hbigda.org/ |
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These
standards are updated and revised as new scientific information becomes
available -
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The current edition of the Standards
of Care presented here was released in 1998, and is the fifth version
since the original 1979 document. Previous revisions were in 1980, 1981,
and 1990. The Standards are now undergoing another major revision, with
a new edition (Version Six) expected in early 2001. We will update this
information as soon as the new version becomes available to us. |
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Forums
Contributions
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