Our work with transgender patients involves any of the following:
- Diagnostic assessment
- Psychotherapy
- ELIGIBILITY and READINESS Criteria for Hormones or Surgery
- Documentation Letters for Hormones/Surgery
- Real life experience
- Requirements for Genital Reconstructive and Breast Surgery
- Post-surgical Follow-up by Professionals
BNC | ICD10-DSM-5 DIAGNOSTIC ASSESSMENT
Gender Dysphoria 302.85|F64.9
A marked in-congruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, as manifested by 2 or more of the following indicators:
- a marked in-congruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or, in young adolescents, the anticipated secondary sex characteristics)
- a strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked in-congruence with one’s experienced/expressed gender (or, in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics)
- a strong desire for the primary and/or secondary sex characteristics of the other gender
- a strong desire to be of the other gender (or some alternative gender different from one’s assigned gender)
- a strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender)
- a strong conviction that one has the typical feelings and reactions of the other gender (or some _alternative gender different from one’s assigned gender)
Dual-role Transvestism| F64.1
- The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex
- There is no sexual motivation for the cross-dressing
- The individual has no desire for a permanent change to the opposite sex
BNC | ADULT PSYCHOTHERAPY CHECK LIST
- Estimated treatment duration for Real-Life Experience: Either/or:-
- at least 3-months of psychotherapy after initial evaluation
- at least 3-months documentation of real-life experience before hormone treatment
- Estimated duration of treatment before for Hormone Therapy.
- Estimated duration of treatment before surgery.
- Has patient previously seriously considered other options?
- Address patient to be realistic about work and relationships
- Define & alleviate patient’s conflicts that hinder a stable lifestyle
- Attempt to create a long term stable life style
- Ability to live within a gender role and body
- Process likelihood that no educational, psychotherapy, medical, or surgical therapy can permanently eradicate all psychological traces of the person’s original sex assignment
NEW GENDER ROLE REAL LIFE EXPERIENCES ASSESSMENT Changing one’s gender role has an instant impact on personal & social consequences. The assessment entails reviewing:
- the impact of familial, vocational, interpersonal, educational, economic, and legality
- the ability to maintain full or part-time employment or community-based volunteer activity
- the ability to function as a student
- the ability to acquire a new (legal) first or last name
- the ability to provide documentation that others [not therapist] know that the patient functions in the new gender role
ADULT HORMONE THERAPY ELIGIBILITY & READINESS
3-ELIGIBILITY CRITERIA
Under no circumstances should a person be provided hormones who has neither fulfilled criteria #3 or #4
- age 18 years
- show knowledge of what hormones medically can and cannot do, social benefits & risks
- Either a documented real life experience for at least three months prior to the administration of hormones Or
- psychotherapy of a duration specified by the therapist after the initial evaluation (min of 3- months)
3-READINESS CRITERIA
Hormones can be given for those who do not initially want surgery or a real life experience. They must be appropriately diagnosed, however, and meet the criteria stated above for hormone administration.
- patient has consolidation gender identity during real-life experience or psychotherapy
- patient has progressed in improving or continuing stable mental health
- hormones are likely to be taken responsibly
BNC | BRIEF GUIDE TO THE STANDARDS OF CARE
Our work with transgender patients involves any of the following
THE DIFFERENCES BETWEEN ELIGIBILITY & READINESS Eligibility_ specific account of criteria prior to the triadic therapeutic sequence (real life experience, hormones & surgery)
Readiness_ the specified criteria of clinician’s judgment prior to the triadic therapeutic sequence
THE THERAPIST LETTERS FOR HORMONES/SURGERY ENTAILS:
- The patient’s general identifying characteristics
- The initial & evolving gender, sexual, and other psychiatric diagnoses
- The duration of treatment, type of psychotherapy or evaluation
- The eligibility criteria that have been met and the rationale for hormones or surgery
- The patient’s compliance to the Standards of Care to date & chances of future compliance
- If the therapist is part of a gender team or is working without an organized team approach
- The offer of receiving a phone call to verify that the documentation letter is authentic
LETTERS FOR HORMONE & SURGERY
- One-Letter Required for Instituting Hormone Treatment;
- Two-Letters Required for Surgery
- Two separate letters of recommendation from mental health professionals who work alone without colleagues experienced with gender identity disorders are required for surgery and
- If the first letter is from a person with a master’s degree, the second letter should be from a psychiatrist or a clinical psychologist–those who can be expected to adequately evaluate co-morbid psychiatric conditions.
- If the first letter is from the patient’s psychotherapist, the second letter should be from a person who has only played an evaluative role for the patient. Each letter writer, however, is expected to cover the same seven elements
- One letter with two signatures is acceptable if the mental health professionals conduct their tasks and periodically report on these processes to a team of other mental health professionals and nonpsychiatric physicians.
GENITAL RECONSTRUCTIVE & BREAST SURGERY
6-Eligibility criteria for surgeries for biological males & females
- legal age of majority in the patient’s nation
- 12 months of continuous hormonal therapy for those without a medical contraindication
- 12 months of successful continuous full time real-life experience. Periods of returning to the original gender may indicate ambivalence about proceeding and should not be used to fulfill this criterion
- regular sessions may be required by the counselor throughout the real life experience
- knowledge of the cost, lengths of hospital stay, likely complications, post surgical rehabilitation
- awareness of different competent surgeons
2-Readiness criteria
- show progress in consolidating the new gender identity
- show psychological progress dealing with work, family & interpersonal issues
POST-SURGICAL FOLLOW-UP
- Long term post-operative follow-up is associated with a good psychosocial outcome.
- Follow-up is essential to the patient’s subsequent anatomic, medical & mental health