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Information for mental health providers of transgender patients

Patient Education
Last reviewed

WPATH Standard of Care (SOC) Version 7 recommendations for hormones or surgery for adults

  • Mental health evaluation is required, ongoing psychotherapy is not required, but is recommended
  • A person may use hormones or surgery in any combination to best treat their gender dysphoria

WPATH SOC eligibility criteria for hormones and surgery for adults

  • Gender dysphoria that is persistent and consistent for at least 6 months
  • The mental capacity to make an informed decision and provide consent for treatment
  • Well controlled medical or mental health concerns, if present

Additional WPATH SOC requirements for genital surgery

  • Hormone therapy for 12 continuous months
  • If the patient is having gonadectomy only (removal of the ovaries or testes) there is no requirement regarding living in their affirmed gender
  • 12 continuous months of living in their affirmed gender if patient desires gender affirmation surgery including phallophasty or vaginoplasty
  • Ongoing mental health counseling is not required, though it is recommended

Tasks for mental health professionals outlined in WPATH SOC

  • Assess for gender dysphoria
  • Discuss gender identity and expression and options for medical treatment
  • Assess for co-existing mental health concerns and if applicable, discuss treatment options
  • Determine eligibility for hormones and/or surgery and refer if appropriate

WPATH SOC recommendations for the letter for hormones and/or surgery

  • General identifying characteristics
  • Results and diagnoses from the psychosocial assessment
  • Duration of the therapeutic relationship including type and length of assessment and additional therapy if applicable
  • Explanation that criteria for hormones and/or surgery has been met and the clinical rationale for supporting this decision
  • Assessment of the patient's mental capacity and statement that informed consent has been obtained
  • Statement that the mental health professional is available for coordination of care and welcomes a phone call to discuss this