It’s time to leave the Benjamin Standards behind

[Asche]

It's time to leave the Benjamin Standards behind


By s.e. smith
21 September, 2016
Meloukhia.net (Smith's blog)

http://meloukhia.net/2016/09/its_time_to_leave_the_benjamin_standards_behind/

We are in the moment of the transgender revolution, or whatever you feel like calling it: Transgender people are here, we are noisy, and we are slowly but steadily making social inroads. That's becoming especially evident in the health care field, where we now enjoy more protections when it comes to things like forcing insurance companies to cover transition care. But all isn't rosy in health care: Many transgender people around the world who are seeking some degree of medical and/or surgical transition run up against the Benjamin Standards, now called the World Professional Association for Transgender Health (WPATH) standards of care.




Admin edit: Fixed link.  Devlyn

[Michelle_P]

Yeah.  The WPATH standards are pretty good compared to what came before, but...

Like the author, I have been working through Kaiser's Oakland Multi-Specialty Transitions clinic.  They're really good, and have provided a more caring individual experience.  My gender therapist is one of the folks on staff there.  Oh, I still have issues sometimes, but they at least let me know what they need from me before they'll do something for me.  That is not always the case with care providers elsewhere.

[Georgette]

Having just come here.

The Benjamin standards, from his 1966 book, The Transsexual Phenomenon.  Was the only book to document some kinds of care. 

In 1979 the "Harry Benjamin International Gender Dysphoria Association" was formed, WPATH I think came out sometime after that.

The DSM II did not even have TS, only TV, listed in 1975-77 for me and others. 

I never had much trouble working with and against those guidelines.  Back in 1977 I was able to get reimbursed for 50 % of my medical costs from the Psychiatric part of my health insurance.

I feel that there are always times to revise older standards.

[Lady Sarah]

The part I hate, is that psych letters are required. This means you have to see a psych, and pay them. This gives them an excuse to not write the letter. Once you have the letter, you are not required to keep going back, and giving them more money.

[Laura_Squirrel]

The part I hate, is that psych letters are required. This means you have to see a psych, and pay them. This gives them an excuse to not write the letter. Once you have the letter, you are not required to keep going back, and giving them more money.

Which is why I was glad to find someone that charged on a sliding scale. I paid no more than $50 and even $5 at one point. I probably paid the equivalent of 2 and a half (maybe 3) regular priced sessions for all of the times that I saw him.

[MissGendered]

"This is an incredibly unjust system, and there's no reason it needs to be that way. Trans patients should be able to meet directly with endocrinologists and surgeons without referrals to talk about what they need — or should be given rapid referral by their primary care providers in a medical system that doesn't allow for direct appointments. Patients who want counseling, for medical or other issues, should have ready access to it, but their medical care shouldn't be contingent on counseling. And no trans person should be forced into a performative presentation of gender just to get basic health care"

The paragraph I quoted above makes sense to me.

On the other hand, the rest of it cites no evidence, instead the author references vague anectodal support for what seem to be a foregone conclusion in their mind. I'd feel better if the author had some statistics to back up such bold assertions.

"Not having experienced the WPATH standards directly, I'm in the vantage point of seeing how wrong, outdated, and dangerous they are"

This almost seems like pandering to an intended audience, not journalism, but something substantially less than journalism, an opinion not even based on actual experience...

While I have no doubt that some practitioners do not provide services tailored to all segments of the gender-variant community equally, I also know that many in the community have been served quite well, and appropriately, and safely in conjunction with the SOC 7.0.

The easy availability of low-cost, informed consent care in many places in the US seems to indicate the wave of the future, but these services do not invalidate the need for an SOC to which practitioners and clients alike can refer.

Yes, the Benjamin stuff is antiquated, and often false, but the SOC 7.0 is not the same stuff, and it is an evolving document, with plenty of wiggle room. What needs change as much, or more, are actual health care practices and insurance regulations and public education.

My opinion, and yes, it is just my opinion, is that sometimes, when we don't enjoy leaning over a hot tub, we can become tempted to throw the baby out with the bathwater.

Missy

[Lady Sarah]

Which is why I was glad to find someone that charged on a sliding scale. I paid no more than $50 and even $5 at one point. I probably paid the equivalent of 2 and a half (maybe 3) regular priced sessions for all of the times that I saw him.

I could only find one that used a sliding scale. After 3 sessions, she moved her practice. It would have required 4 hours of driving per session to continue seeing her.
I am currently hoping a psych letter written in 1994 is still valid, because I am sick and tired of wasting money on psychs.

Sent from my NS-P10A7100 using Tapatalk

[Georgette]

I guess back then, since there was NO standards I just did what had to be done.

Never heard of WPATH or SOC until lately.

I was able to send type written letters, ( NO email or Internet ), to surgeons directly for what was offered, requirements, and costs.

Prior to SRS, I had to pay out of pocket for all.
Electrolysis ( NO Laser ), HRT, Pyschs, Lawyer for Name change. SRS was later reimbursed.
NO endocrinologist, tried to get an appointment, they didn't even want to talk or had NO idea what I was asking about.

After SRS doctors and HRT was paid just like any regular health costs.

[SarahElizabeth1981]

Nothing is perfect but the standards of care are constantly evolving. They are intended to be the best approach based on latest research and approaches that can be taken.

my issue with the SOC is not so much them but the fact that my gov't healthcare system is still using version 3.. outdated much?

They are currently looking at removing the requirement for gender dysphoria from the SOC. If that happens and how long that takes who knows. but it would certainly ease the path for some.

[Lunacorn]

I definitly notice my difference in health care from when i was percieved male to when i came out ... I consider myself lucky that my main complaint is rude or transphobic staff.  Only once had some one tell me 'My organization never taught me how to deal with people like you but my religion did.'

That guy can get over himself yet the impact on care is usually only a few notches below cis people  that was my experience when i lived in MA USA at least

[Lunacorn]

also laura_squirrel your avatar is the cutest thing ive seen on this forum so far <3

[MissGendered]

I definitly notice my difference in health care from when i was percieved male to when i came out ... I consider myself lucky that my main complaint is rude or transphobic staff.  Only once had some one tell me 'My organization never taught me how to deal with people like you but my religion did.'

That guy can get over himself yet the impact on care is usually only a few notches below cis people  that was my experience when i lived in MA USA at least

When I lived in a deep southern state, even the state university hospital staff doctors assigned to my case were very supportive, but not generally well informed about intersex stuff at all, but the administration had an obviously anti-trans exclusionary approach. The endocrinology department staff was VERY rude when I asked about HRT, "we don't do THAT here", even though I am xx intersex, so, yeah, I definitely felt a blast of transphobia from that direction. None of that reflects on the SOC though, but rather the conservative zeitgeist that dominated the region. I had to get my original treatments from a very sweet doctor that did a lot of pro bono work in the community, and it wasn't until my intersex diagnosis was confirmed that my insurance began to cover my HRT and all treatments, except hair removal, vaginal reconstruction, or anything else they deemed 'cosmetic'. Had they been following the SOC, all my treatments would have been covered. I still can't get insurance to fix what doctors did to me as an infant, all because of the same transphobia seen in the south. So, in my experience, political forces have been FAR more hostile to me than doctors or therapists ever were. I now live in what used to be a very liberal northern state, that has recently gone conservative, but my doctors at this state university are well-trained and very capable and run and amazing program for gender-variant patients.

So, again, to me, the SOC is not the problem, ignorance and political wrangling are what hold us back from proper care..

Missy