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Trans Models of Care

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  • September 12th 2012
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  • 3:16pm
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By Dr Fiona Bisshop

By Dr Fiona Bisshop

I recently attended the very first Transgender, Sistergirl and Gender Diverse conference in Cairns.  It was a fantastic opportunity for health professionals and members of the trans community to come together and share ideas about care.

One topic that was discussed was the idea of different models of medical care for trans patients.

For transgendered people, accessing hormones and surgery has traditionally been a long and difficult path, starting with that first challenging revelation to their doctor, and then often enduring many months or years of psychiatric assessment before they are finally allowed to start hormones and have surgery.  This is often referred to as the “gatekeeper” model of care, where doctors are seen as gatekeepers to accessing hormones and surgery.

Unsurprisingly, patients are not attracted to this model, seeing it as having to jump through hoops in order to justify themselves to the medical profession.  It is not a model that encourages a good relationship between doctor and patient.

A different model based on informed consent is gaining growing support amongst doctors both here and overseas.  In this model, trans people receive detailed information regarding the risks and benefits of hormone therapy from their doctor, and so long as they are able to understand these risks, they can consent to therapy without having to go through such an arduous assessment process.  This model is empowering for patients, and removes the requirement that they be labelled “disordered” in order to access treatment.  It’s also empowering for doctors, as they no longer have to feel like gatekeepers and can become more involved in starting and managing hormone therapy. 

Of course, many people still need and want supportive psychological counselling, but in the informed consent model, patients are not forced to see a psychiatrist to be able to start hormones.  However for those people wanting gender reassignment surgery including top surgery, a letter from a psychiatrist is still required.



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