For transgender people, access to hormones and surgery is vital.
Traditionally this has often been a long and difficult path, beginning with their first disclosure to a doctor or therapist.
This is often followed by many months or years of psychiatric assessment and counselling before they are finally allowed to start hormones and eventually have surgery.
Often referred to as the “gatekeeper” model of care this remains the standard of care in many parts of the world.
Most transgender people are unhappy with this model, seeing it as having to jump through hoops to justify themselves to the medical profession. The process can be expensive and time-consuming, and for many people simply too daunting to consider.
An alternative model which is becoming more common is based on informed consent.
In this model, trans people receive detailed information regarding the risks and benefits of hormone therapy from their doctor, and if they are able to understand these risks, and have legal capacity to consent, they can begin hormone replacement therapy (HRT) without having to go through a long period of assessment and therapy.
This model is empowering and gives people bodily autonomy. It takes away the concept of needing a “diagnosis”, and replaces it with a framework of mutual understanding and working towards a goal of gender transition, and respects an individual’s capacity to know their own gender identity, while reducing the waiting time to starting HRT.
Of course, there will still be people who need and want supportive psychological counselling, but in the informed consent model, patients are not forced to see a psychiatrist or therapist before being prescribed hormones.
As a doctor, I find the informed consent model much more satisfying to work with, as the dynamic is not about the patient having to prove themselves, but about the doctor assisting the individual to attain their goals with respect to transition, through starting and managing hormone therapy.
And for the trans person, greater control of their transition leads to improved mental health. It’s a win-win model of care.
Dr Fiona Bisshop specialises in LGBT health. Read more by Dr Bisshop on her website or contact her on Twitter. Send your health question to firstname.lastname@example.org and Dr Bisshop will answer them anonymously in QNews Magazine.
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