(Dis) Empowering Trans People: Depathologization Through Treatment Guidelines and Provider Decision-Making

Abstract

To depathologize transgender (trans) healthcare, revisions have been made to two documents used in the treatment of trans people. First, the 7th Version of the Standards of Care (SOC-7) removed a lengthy therapeutic relationship and real-life experience (RLE), replacing these with a gender assessment. The second was a shift in language from Gender Identity Disorder to Gender Dysphoria in the 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as its removal from the chapter on ‘sexual dysfunctions and paraphilias’. Despite changes, trans healthcare remains stigmatizing and gatekept. Through qualitative interviews with 20 U.S.-based health professionals, we expand current knowledge of the shifting treatment approaches for those seeking gender-affirming medical services. Data show that despite progressive document changes, providers continue to place the burden on patients to fit within a sex/gender dichotomous system and to prove mental stability and decision-making competency to access what are increasingly considered life-saving treatments. We illuminate resultant health disparities that can emerge when providers perceive trans people in need of their education and mental health support and advocate a move away from the current medicalized process towards a healthcare model situated in trans peoples' own lived experience.