Standards of Care for the Health of Transgender and Gender Diverse People

{{Short description|Healthcare protocol}} {{Use mdy dates|date=September 2022}} {{Transgender sidebar|medicine}}

The '''Standards of Care for the Health of Transgender and Gender Diverse People''' ('''SOC''') is an international clinical protocol by the World Professional Association for Transgender Health (WPATH) outlining the recommended assessment and treatment for transgender and gender-diverse individuals across the lifespan including social, hormonal, or surgical transition.<ref name="wpath-soc8">{{cite journal | last1 = Coleman | first1 = E. | last2 = Radix | first2 = A. E. | last3 = Bouman | display-authors=1 | title = Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 | journal = International Journal of Transgender Health | date = 19 August 2022 | volume = 23 | issue = Suppl 1 | pages = S1–S259 | issn = 2689-5269 | doi = 10.1080/26895269.2022.2100644 | doi-access=free | pmid = 36238954 | pmc = 9553112 | url = }}</ref> It often influences clinicians' decisions regarding patients' treatment. While other standards, protocols, and guidelines exist{{snd}}especially outside the United States{{snd}}the WPATH SOC is the most widespread protocol used by professionals working with transgender or gender-variant people.<ref name="wpath-criteria-2015">{{cite journal|author1=Britt Colebunders|author2=Griet De Cuypere|author3=Stan Monstrey|title=New Criteria for Sex Reassignment Surgery: ''WPATH Standards of Care, Version 7'', Revisited|display-authors=1|journal=International Journal of Transgenderism|date=2015|volume=16|issue=4|pages=222–233|doi=10.1080/15532739.2015.1081086|s2cid=74097076}}</ref><ref name="WPATH-SOC-7-2012" /><ref>{{Cite news|url=https://www.cnn.com/2018/05/31/health/transgender-medically-necessary-procedures/index.html|title=What is medically necessary treatment for gender-affirming health care?|last=Grinberg|first=Emanuella|date=June 20, 2018|work=CNN|access-date=July 6, 2018|language=en-US|archive-date=June 27, 2023|archive-url=https://web.archive.org/web/20230627041718/https://www.cnn.com/2018/05/31/health/transgender-medically-necessary-procedures/index.html|url-status=live}}</ref>

Version 8 of the WPATH SOC, the latest version, was released online on September 15, 2022.<ref name="wpath-soc8" /><ref name="WPATH-SOC8-Release">{{cite press release |author=World Professional Association for Transgender Health |date=September 15, 2022 |title=World Professional Association for Transgender Health (WPATH) Releases the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 |url=https://www.wpath.org/media/cms/Documents/SOC%20v8/SOC%208%20Press%20Release%20FINAL.pdf |access-date=September 18, 2022 |archive-date=September 20, 2022 |archive-url=https://web.archive.org/web/20220920171115/https://www.wpath.org/media/cms/Documents/SOC%20v8/SOC%208%20Press%20Release%20FINAL.pdf |url-status=live }}</ref>

==History and development== Prior to the advent of the first SOC, there was no semblance of consensus on psychiatric, psychological, medical, and surgical requirements or procedures. Before the 1960s, few countries offered safe, legal medical options and many criminalized cross-gender behaviors or mandated unproven psychiatric treatments. In response to this problem, the Harry Benjamin International Gender Dysphoria Association (now known as the World Professional Association for Transgender Health) authored one of the earliest sets of clinical guidelines for the express purpose of ensuring "lasting personal comfort with the gendered self in order to maximize overall psychological well-being and self-fulfillment."

The WPATH SOC are periodically updated and revised. The eighth and latest version was released on September 15, 2022. Previous versions were released in 1979 (1st),<ref name="HBIGDA-SOC-1-1979">{{citation | last1 = Walker | first1 = P. A. | last2 = Berger | first2 = J. C. | last3 = Green | first3 = R. | last4 = Laub | first4 = D. R. | last5 = Reynolds | first5 = C. L. | last6 = Wollman | first6 = L. | title = Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons | edition = 1 | date = 13 February 1979 | location = Palo Alto, California | publisher = The Harry Benjamin International Gender Dysphoria Association, Inc. | url = https://scholar.google.com/scholar?cluster=3937857535576528085}}</ref> 1980 (2nd),<ref name="HBIGDA-SOC-2-1980">{{citation | last1 = Walker | first1 = P. A. | last2 = Berger | first2 = J. C. | last3 = Green | first3 = R. | last4 = Laub | first4 = D. R. | last5 = Reynolds | first5 = C. L. | last6 = Wollman | first6 = L. | title = Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons | edition = 2 | date = 20 January 1980 | location = Stanford, California | publisher = The Harry Benjamin International Gender Dysphoria Association, Inc. | url = https://scholar.google.com/scholar?cluster=4070995568726990498 | access-date = May 15, 2024 | archive-date = September 9, 2024 | archive-url = https://web.archive.org/web/20240909154709/https://scholar.google.com/scholar?cluster=4070995568726990498 | url-status = live }}</ref> 1981 (3rd),<ref name="HBIGDA-SOC-3-1981">{{citation | last1 = Walker | first1 = P. A. | last2 = Berger | first2 = J. C. | last3 = Green | first3 = R. | last4 = Laub | first4 = D. R. | last5 = Reynolds | first5 = C. L. | last6 = Wollman | first6 = L. | title = Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons | edition = 3 | date = 9 March 1981 | location = San Francisco, California | publisher=The Harry Benjamin International Gender Dysphoria Association | url = https://archive.org/details/sexgendertheolog0000unse/page/284/}}</ref><ref name="HBIGDA-SOC-3-1981-Reprint">{{cite journal | last1 = Walker | first1 = P. A. | last2 = Berger | first2 = J. C. | last3 = Green | first3 = R. | last4 = Laub | first4 = D. R. | last5 = Reynolds | first5 = C. L. | last6 = Wollman | first6 = L. | title = Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [3rd Edition] | journal = Archives of Sexual Behavior | volume = 14 | issue = 1 | date = February 1985 | issn = 0004-0002 | doi = 10.1007/BF01541354 | pages = 79–90 | pmid = 3977585 | url = }}</ref> 1990 (4th),<ref name="HBIGDA-SOC-4-1990">{{citation | last1 = Walker | first1 = P. A. | last2 = Berger | first2 = J. C. | last3 = Green | first3 = R. | last4 = Laub | first4 = D. R. | last5 = Reynolds | first5 = C. L. | last6 = Wollman | first6 = L. | title = Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons | edition = 4 | date = 25 January 1990 | location = San Francisco, California | publisher = The Harry Benjamin International Gender Dysphoria Association | url = http://www.genderpsychology.org/transsexual/hbsoc_1990.html | access-date = May 15, 2024 | archive-date = February 27, 2004 | archive-url = https://web.archive.org/web/20040227222132/http://www.genderpsychology.org/transsexual/hbsoc_1990.html | url-status = bot: unknown }}</ref> 1998 (5th),<ref name="HBIGDA-SOC-5-1998">{{cite journal | last1 = Levine | first1 = S. B. | last2 = Brown | first2 = G. | last3 = Coleman | first3 = E. | last4 = Cohen-Kettenis | first4 = P. | last5 = Joris Hage | first5 = J. | last6 = Van Maasdam | first6 = J. | last7 = Petersen | first7 = M. | last8 = Pfaefflin | first8 = F. | last9 = Schaefer | first9 = L. C. | title = The Standards of Care for Gender Identity Disorders [5th Edition] | journal = International Journal of Transgenderism | volume = 2 | issue = 2 | date = June 1998 | url = http://www.symposion.com/ijt/ijtc0405.htm | quote = "Consultants: Dallas Denny MA, Domineco DiCeglie MD, Wolf Eicher MD, Jamison Green, Richard Green MD, Louis Gooren MD, Donald Laub MD, Anne Lawrence MD, Walter Meyer III MD, C. Christine Wheeler Ph.D" | access-date = May 15, 2024 | archive-date = December 5, 1998 | archive-url = https://web.archive.org/web/19981205104251/http://www.symposion.com/ijt/ijtc0405.htm | url-status = bot: unknown }}</ref> 2001 (6th),<ref name="HBIGDA-SOC-6-2001">{{cite journal | last1 = Meyer | first1 = W. | last2 = Bockting | first2 = W. O. | last3 = Cohen-Kettenis | first3 = P. | last4 = Coleman | first4 = E. | last5 = DiCeglie | first5 = D. | last6 = Devor | first6 = H. | last7 = Gooren | first7 = L. | last8 = Joris Hage | first8 = J. | last9 = Kirk | first9 = S. | last10 = Kuiper | first10 = B. | last11 = Laub | first11 = D. | last12 = Lawrence | first12 = A. | last13 = Menard | first13 = Y. | last14 = Patton | first14 = J. | last15 = Schaefer | first15 = L. | last16 = Webb | first16 = A. | last17 = Wheeler | first17 = C. C. | title = The Standards of Care for Gender Identity Disorders – Sixth Version | journal = International Journal of Transgenderism | volume = 5 | issue = 1 | date = February 2001 | url = http://www.symposion.com/ijt/soc_2001/ | access-date = May 15, 2024 | archive-date = July 9, 2001 | archive-url = https://web.archive.org/web/20010709084442/http://www.symposion.com/ijt/soc_2001/ | url-status = bot: unknown }}</ref><ref name="HBIGDA-SOC-6-2001-Reprint">{{cite journal | last1 = Meyer | first1 = W. | last2 = Bockting | first2 = W. O. | last3 = Cohen-Kettenis | first3 = P. | last4 = Coleman | first4 = E. | last5 = DiCeglie | first5 = D. | last6 = Devor | first6 = H. | last7 = Gooren | first7 = L. | last8 = Joris Hage | first8 = J. | last9 = Kirk | first9 = S. | last10 = Kuiper | first10 = B. | last11 = Laub | first11 = D. | last12 = Lawrence | first12 = A. | last13 = Menard | first13 = Y. | last14 = Patton | first14 = J. | last15 = Schaefer | first15 = L. | last16 = Webb | first16 = A. | last17 = Wheeler | first17 = C. C. | title = The Standards of Care for Gender Identity Disorders, Sixth Version | journal = Journal of Psychology & Human Sexuality | volume = 13 | issue = 1 | date = 2001 | pages = 1–30 | doi = 10.1300/J056v13n01_01 | url = https://onlineacademiccommunity.uvic.ca/ahdevor/wp-content/uploads/sites/2247/2020/04/The-Harry-Benjamin-International-Gender-Dysphoria-Association-s-Standards-of-Care-for-Gender-Identity-Disorders-Sixth-Version.pdf | access-date = May 15, 2024 | archive-date = March 17, 2024 | archive-url = https://web.archive.org/web/20240317223231/https://onlineacademiccommunity.uvic.ca/ahdevor/wp-content/uploads/sites/2247/2020/04/The-Harry-Benjamin-International-Gender-Dysphoria-Association-s-Standards-of-Care-for-Gender-Identity-Disorders-Sixth-Version.pdf | url-status = bot: unknown }}</ref> and 2012 (7th).<ref name="WPATH-SOC-7-2012">{{cite journal | last1 = Coleman | first1 = Eli | last2 = Bockting | first2 = Walter | last3 = Botzer | first3 = Marsha | last4 = Cohen-Kettenis | first4 = Peggy | last5 = DeCuypere | first5 = Griet | last6 = Feldman | first6 = Jamie | last7 = Fraser | first7 = Lin | last8 = Green | first8 = Jamison | last9 = Knudson | first9 = Gail | last10 = Meyer | first10 = Walter J. | last11 = Monstrey | first11 = Stan | last12 = Adler | first12 = Richard K. | last13 = Brown | first13 = George R. | last14 = Devor | first14 = Aaron H. | last15 = Ehrbar | first15 = Randall | last16 = Ettner | first16 = Randi | last17 = Eyler | first17 = Evan | last18 = Garofalo | first18 = Rob | last19 = Karasic | first19 = Dan H. | last20 = Lev | first20 = Arlene Istar | last21 = Mayer | first21 = Gal | last22 = Meyer-Bahlburg | first22 = Heino | last23 = Hall | first23 = Blaine Paxton | last24 = Pfaefflin | first24 = Friedmann | last25 = Rachlin | first25 = Katherine | last26 = Robinson | first26 = Bean | last27 = Schechter | first27 = Loren S. | last28 = Tangpricha | first28 = Vin | last29 = van Trotsenburg | first29 = Mick | last30 = Vitale | first30 = Anne | last31 = Winter | first31 = Sam | last32 = Whittle | first32 = Stephen | last33 = Wylie | first33 = Kevan R. | last34 = Zucker | first34 = Ken | display-authors = 1 | title = Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 | journal = International Journal of Transgenderism | volume = 13 | issue = 4 | date = 2012 | issn = 1553-2739 | doi = 10.1080/15532739.2011.700873 | pages = 165–232 | publisher = World Professional Association for Transgender Health | access-date = May 9, 2018 | url = https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf | archive-url = https://web.archive.org/web/20180327142657/https://www.wpath.org/media/cms/Documents/SOC%20v7/SOC%20V7_English.pdf | archive-date = 2018-03-27}}</ref>

==WPATH SOC== ===Versions 1 to 4=== The first four versions of the ''Standards of Care'' were titled ''Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons''.<ref name="HBIGDA-SOC-1-1979" /><ref name="HBIGDA-SOC-2-1980" /><ref name="HBIGDA-SOC-3-1981" /><ref name="HBIGDA-SOC-3-1981-Reprint" /><ref name="HBIGDA-SOC-4-1990" /> The first version was released in 1979 and revisions were made in 1980, 1981, and 1990.<ref name="HBIGDA-SOC-1-1979" /><ref name="HBIGDA-SOC-2-1980" /><ref name="HBIGDA-SOC-3-1981" /><ref name="HBIGDA-SOC-3-1981-Reprint" /><ref name="HBIGDA-SOC-4-1990" /> These revisions were relatively minor, with the text staying mostly the same between versions.<ref name="Matte_2009">{{cite journal |last1=Matte |first1=Nicholas |last2=Devor |first2=Aaron |last3=Vladicka |first3=Theresa |date=29 Apr 2009 |title=Nomenclature in the World Professional Association for Transgender Health's Standards of Care: Background and Recommendations |url=https://www.tandfonline.com/doi/abs/10.1080/15532730902799979 |journal=International Journal of Transgenderism |volume=11 |issue=1 |publisher=Taylor and Francis |page=46 |doi=10.1080/15532730902799979 |access-date=17 Feb 2026|url-access=subscription }}</ref><ref name="Fraser_2015">{{Cite book |last=Fraser |first=Lin |title=Management of Gender Dysphoria: A Multidisciplinary Approach |date=2015 |publisher=Springer Milan |isbn=978-88-470-5696-1 |editor-last=Trombetta |editor-first=Carlo |pages=19–31 |language=en |chapter=Gender Dysphoria: Definition and Evolution Through the Years |doi=10.1007/978-88-470-5696-1_3 |editor-last2=Liguori |editor-first2=Giovanni |editor-last3=Bertolotto |editor-first3=Michele |chapter-url=https://doi.org/10.1007/978-88-470-5696-1_3}}</ref><ref name="Riggs_2019">{{cite journal |last1=Riggs |first1=Damien |last2=Pearce |first2=Ruth |last3=Pfeffer |first3=Carla |last4=Hines |first4=Sally |last5=White |first5=Francis |last6=Ruspini |first6=Elisabetta |date=Nov 2019 |title=Transnormativity in the psy disciplines: Constructing pathology in the Diagnostic and Statistical Manual of Mental Disorders and Standards of Care |url=https://psycnet.apa.org/doiLanding?doi=10.1037%2Famp0000545 |journal=American Psychologist |volume=74 |issue=8 |publisher=American Psychological Association |page=22 |doi=10.1037/amp0000545 |pmid=31697127 |access-date=17 Feb 2026}}</ref> These versions of the SOC followed the gatekeeping model laid out by Harry Benjamin, where clinicians set strict eligibility requirements, requiring evaluations from separate mental health professionals and compulsory psychotherapy.<ref name="Fraser_2015" /><ref name="Fraser_2017">{{Cite journal |last1=Fraser |first1=Lin |last2=Knudson |first2=Gail |date=2017-03-01 |title=Past and Future Challenges Associated with Standards of Care for Gender Transitioning Clients |url=https://www.sciencedirect.com/science/article/pii/S0193953X16300788 |journal=Psychiatric Clinics of North America |series=Clinical Issues and Affirmative Treatment with Transgender Clients |volume=40 |issue=1 |pages=15–27 |doi=10.1016/j.psc.2016.10.012 |issn=0193-953X |pmid=28159141|url-access=subscription }}</ref><ref name="Riggs_2019" />

The first four versions of the ''Standards of Care'' were published as standalone documents by the Harry Benjamin International Gender Dysphoria Association.<ref name="HBIGDA-SOC-1-1979" /><ref name="HBIGDA-SOC-2-1980" /><ref name="HBIGDA-SOC-3-1981" /><ref name="HBIGDA-SOC-3-1981-Reprint" /><ref name="HBIGDA-SOC-4-1990" /> However, the third version was also published as a 1985 reprint in the journal ''Archives of Sexual Behavior''.<ref name="HBIGDA-SOC-3-1981-Reprint" />{{primary-source-inline|plural=yes|date=October 2024}}

===Version 5=== In the 1990s, WPATH was struggling to operate due to criticisms of their SOC in the trans community such as the requirement of the real life test,<ref>{{Cite conference |last=Lawrence |first=Anne |date=November 4, 2001 |title=SRS Without a One Year RLE: Still No Regrets |url=http://www.annelawrence.com/hbigda2001.html |conference=XVII Harry Benjamin International Symposium on Gender Dysphoria |location=Galveston, Texas |archive-url=https://web.archive.org/web/20180623203653/http://www.annelawrence.com/hbigda2001.html |archive-date=June 23, 2018 }}</ref> where patients had to socially transition for up to a year prior to hormones. These critiques developed into a trans-led Advocacy and Liaison committee, marking the first time trans people were officially and actively consulted regarding their treatment.<ref name="Malatino">{{Cite web |title=Trans Care within and against the Medical-Industrial Complex |url=https://manifold.umn.edu/read/trans-care/section/dd523426-df6e-4897-922c-2094646b335a |website=manifold.umn.edu}}</ref> The 5th version,<ref name="HBIGDA-SOC-5-1998" /> published in 1998, was titled the "Standards of Care for Gender Identity Disorders" to be consistent with the DSM-III. It recommended but did not require psychotherapy and stated that while GID was a mental disorder, that was not a license for stigma.<ref name="Fraser_2015" />

===Version 6=== The sixth version was published in 2001 and offered more flexibility and individualized care but continued to use the phrase "gender identity disorder". At the same time, transgender people increasingly complained of having to "jump through hoops".<ref name="Fraser_2015" /> SOC 6 also did not include significant changes to the tasks mental health professionals were required to take or in the general recommendations for content of the letters of readiness.<ref name="Amengual_2022">{{Cite journal |last1=Amengual |first1=Travis |last2=Kunstman |first2=Kaitlyn |last3=Lloyd |first3=R. Brett |last4=Janssen |first4=Aron |last5=Wescott |first5=Annie B. |date=2022-10-20 |title=Readiness assessments for gender-affirming surgical treatments: A systematic scoping review of historical practices and changing ethical considerations |journal=Frontiers in Psychiatry |volume=13 |article-number=1006024 |doi=10.3389/fpsyt.2022.1006024 |issn=1664-0640 |pmc=9630738 |pmid=36339880 |doi-access=free}}</ref> An important change in the eligibility criteria for GAH allowed providers to prescribe hormones even if patients had not undergone the "Real Life Test" or psychotherapy if it was for harm reduction purposes.<ref name="Amengual_2022" /> A notable change in version six separated the eligibility and readiness criteria for top and bottom surgery allowing some patients,<ref>{{Cite book |title=Handbook of Clinical Sexuality for Mental Health Professionals |publisher=Taylor & Francis |isbn=9781315716596 |year=2011 |editor-last=Levine |editor-first=Stephen |location=New York, New York, United States of America |language=en |editor-last2=Althof |editor-first2=Stanley |editor-last3=Risen |editor-first3=Candace}}</ref> particularly individuals assigned female at birth, to receive a mastectomy.<ref name="Amengual_2022" /><ref>{{Cite journal |last1=Meyer |first1=Walter |last2=Bockting |first2=Walter O. |last3=Cohen-Kettenis |first3=Peggy |last4=Coleman |first4=Eli |last5=Diceglie |first5=Domenico |last6=Devor |first6=Holly |last7=Gooren |first7=Louis |last8=Hage |first8=J. Joris |last9=Kirk |first9=Sheila |last10=Kuiper |first10=Bram |last11=Laub |first11=Donald |last12=Lawrence |first12=Anne |last13=Menard |first13=Yvon |last14=Patton |first14=Jude |last15=Schaefer |first15=Leah |date=2002-04-11 |title=The Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version |journal=Journal of Psychology & Human Sexuality |volume=13 |issue=1 |pages=1–30 |doi=10.1300/j056v13n01_01 |issn=0890-7064}}</ref>

===Version 7=== The seventh version, titled "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People", was published in 2012 both in the ''International Journal of Transgenderism'' and as a standalone document. Included in the guidelines are sections on purpose and use of the WPATH SOC, the global applicability of the WPATH SOC, the difference between gender nonconformity and gender dysphoria, epidemiology, treatment of children, adolescents and adults, mental health, hormone replacement therapy (masculinizing or feminizing; HRT), reproductive health, voice and communication therapy, gender-affirming surgery, lifelong preventive and primary care, applicability of the WPATH SOC to people living in institutional environments, and applicability of the WPATH SOC to people with disorders of sex development.

The seventh version also includes acknowledgements of the ever-evolving language used to describe and treat transsexual, transgender, and gender non-conforming individuals. There is an emphasis placed on the idea that identifying with these labels does not inherently qualify someone as disordered, and that treatment should be focused on the alleviation of any suffering caused by gender dysphoria. They make a stance against the "deprivation of civil and human rights" on the grounds of someone's gender identity. This version, much like its predecessor requires referrals for surgical procedures based on set criteria, but notes the importance of informed consent and listening to the wishes of the patient.<ref name="WPATH-SOC-7-2012" />

The seventh version includes a section distinguishing between cases of gender dysphoria and non-conformity for children and adolescents, as well as recommended treatment paths for each.<ref name="WPATH-SOC-7-2012" />

A systematic review into international guidelines for management of gender dysphoria and gender incongruence in children and adolescents published as part of the Cass Review in 2024 stated WPATH SOC 7 lacked "developmental rigour and transparency".<ref name=":0">{{Cite journal |last1=Taylor |first1=Jo |last2=Hall |first2=Ruth |last3=Heathcote |first3=Claire |last4=Hewitt |first4=Catherine Elizabeth |last5=Langton |first5=Trilby |last6=Fraser |first6=Lorna |date=2024-04-09 |title=Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of guideline quality (part 1) |url=https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499 |journal=Archives of Disease in Childhood |volume=109 |issue=Suppl 2 |pages=s65–s72 |language=en |doi=10.1136/archdischild-2023-326499 |issn=0003-9888 |pmid=38594049 |access-date=April 26, 2024 |archive-date=September 9, 2024 |archive-url=https://web.archive.org/web/20240909154604/https://adc.bmj.com/content/early/2024/04/09/archdischild-2023-326499 |url-status=live |url-access=subscription }}</ref>

===Version 8=== The eighth version, titled "Standards of Care for the Health of Transgender and Gender Diverse People", was published in 2022. It gives recommendations for health professionals in eighteen chapters.<ref name="wpath-soc8" /> The guidelines were developed by a multidisciplinary committee of experts, building on previous versions and using the Delphi method.<ref name="WPATH-SOC8-Release" /> Version 8 is the first one to include a chapter on adolescent care separate from that on the care of children.<ref name="NBC-soc8">{{Cite news |last=Yurcaba |first=Jo |date=17 June 2022 |title=Trans kids and advocates blame culture war for debate over adolescent health care |work=NBC News |url=https://www.nbcnews.com/nbc-out/out-health-and-wellness/trans-kids-advocates-blame-culture-war-debate-adolescent-health-care-rcna33679 |access-date=September 23, 2022 |archive-date=September 9, 2024 |archive-url=https://web.archive.org/web/20240909154604/https://www.nbcnews.com/nbc-out/out-health-and-wellness/trans-kids-advocates-blame-culture-war-debate-adolescent-health-care-rcna33679 |url-status=live }}</ref> This version of the protocol gives no specific age limits for treatments, emphasizing the need to decide individually for each patient.<ref>{{Cite web |last=Nainggolan |first=Lisa |date=16 September 2022 |title=WPATH Removes Age Limits From Transgender Treatment Guidelines |url=https://www.medscape.com/viewarticle/980935?reg=1&icd=ssl_login_success_220923 |website=Medscape |access-date=September 23, 2022 |archive-date=September 23, 2022 |archive-url=https://web.archive.org/web/20220923213736/https://www.medscape.com/viewarticle/980935?reg=1&icd=ssl_login_success_220923 |url-status=live }}</ref> It was criticized for suggesting that young people may come to believe they are transgender through social influence.<ref name="NBC-soc8" />

An earlier draft was criticized by transgender advocates and healthcare providers for including requirements that adolescents evidence "several years" of gender incongruence and that they must undergo comprehensive diagnostic assessments, which was regarded as pathologizing and gatekeeping. The final draft maintained the requirement of an assessment but changed "several years" to "marked and sustained over time".<ref name="NYTMag">{{Cite news |last=Bazelon |first=Emily |author-link=Emily Bazelon |date=15 June 2022 |title=The Battle Over Gender Therapy |work=The New York Times Magazine |url=https://www.nytimes.com/2022/06/15/magazine/gender-therapy.html |archive-url=https://web.archive.org/web/20220701031318/https://www.nytimes.com/2022/06/15/magazine/gender-therapy.html |archive-date=1 July 2022 |url-status=live}}</ref> The draft also lowered recommended age minimums to 14 for hormone treatments, 15 for mastectomies, 16 for breast augmentation and facial surgeries, and 17 for genital surgeries and hysterectomies. Assistant Secretary Levine of the US Department of Health and Human Services (HHS) recommended removing the age limits, which WPATH declined. WPATH removed the age limits from the final draft after the American Academy of Pediatrics said they'd withdraw support of the guidelines if they did not.<ref name="nytimes2024">{{cite news |last1=Ghorayshi |first1=Azeen |title=Biden Officials Pushed to Remove Age Limits for Trans Surgery, Documents Show |url=https://www.nytimes.com/2024/06/25/health/transgender-minors-surgeries.html |access-date=8 August 2024 |work=The New York Times |date=25 June 2024 |archive-date=September 9, 2024 |archive-url=https://web.archive.org/web/20240909154605/https://www.nytimes.com/2024/06/25/health/transgender-minors-surgeries.html |url-status=live }}</ref><ref>{{cite news |last1=Migdon |first1=Brooke |title=White House comes out against gender-affirming surgeries for minors |url=https://thehill.com/homenews/lgbtq/4753693-white-house-gender-affirming-surgeries-limited-adults/ |access-date=7 September 2024 |work=The Hill |date=3 July 2024 |archive-date=September 1, 2024 |archive-url=https://web.archive.org/web/20240901102029/https://thehill.com/homenews/lgbtq/4753693-white-house-gender-affirming-surgeries-limited-adults/ |url-status=live }}</ref><ref>{{Cite journal |last=Block |first=Jennifer |date=2024-10-30 |title=Dispute arises over World Professional Association for Transgender Health's involvement in WHO's trans health guideline |url=https://www.bmj.com/content/387/bmj.q2227 |journal=BMJ |language=en |volume=387 |article-number=q2227 |doi=10.1136/bmj.q2227 |issn=1756-1833 |pmid=39477369}}</ref>

In August 2024, the Republican chairwoman Lisa McClain of the U.S. Congress Subcommittee on Health Care and Financial Services opened a probe into alleged "political interference" with WPATH's guidelines from the HHS.<ref>{{Cite news |last=Walker |first=Jackson |date=2024-08-27 |title=House GOP probes Biden admin over push to loosen transgender surgery guidelines for minors |url=https://mynbc15.com/news/nation-world/house-gop-probes-biden-admin-over-push-to-loosen-transgender-surgery-guidelines-for-minors-rachel-levine-sarah-boateng-xavier-becerra-lisa-mcclain-department-of-health-and-human-services-wpath |access-date=2025-02-05 |work=NBC 15 News |language=en}}</ref> The guidelines became a focus of controversy during the debate over the Scottish government's Gender Recognition Reform Bill in 2022. Opponents of the bill highlighted the chapter on eunuchs, which proposes eunuch be considered a gender identity, and criticised NHS Scotland's association with WPATH.<ref>{{Cite web |title=NHS apologises for claiming eunuch is a gender identity |url=https://www.lbc.co.uk/news/nhs-apologises-for-claiming-eunuch-is-a-gender-identity/ |access-date=2022-11-01 |website=LBC |date=June 17, 2022 |language=en |archive-date=September 9, 2024 |archive-url=https://web.archive.org/web/20240909154609/https://www.lbc.co.uk/news/nhs-apologises-for-claiming-eunuch-is-a-gender-identity/ |url-status=live }}</ref> NHS England commissioned the Cass Review to create guidelines for transgender people in England. A systematic review into international guidelines published as part of the review was published in 2024 and stated that WPATH SOC 8 lacked "developmental rigour and transparency".<ref name=":0" />

====Populations==== Issues specific to certain demographics, including adults, children, and adolescents, as described in chapters 5–11 of version 8:

=====Adults===== Version 8 (SOC8) introduced an Assessment of Adults chapter, which was the first dedicated gender-affirming clinical evaluation for adults. Chapter 5 specifically recommended that adults seeking gender-affirming care should undergo an individualized assessment rather than a standardized process; clinicians must evaluate an individual's capacity to provide informed consent, including understanding the effects of treatment on reproductive health and fertility.<ref name="wpath-soc8"/><ref name="Amengual_2022"/> The most substantial update for SOC8 guidelines was the requirement of "only one letter of referral by a mental health provider for an individual who wishes to undergo medical and surgical treatment".<ref name=Wiley>{{cite web|url=https://onlinelibrary.wiley.com/doi/full/10.1002/nau.25099|title=World professional association for transgender health guidelines: 2022 surgical treatment updates in the standards of care for transgender and gender diverse people|website=Wiley Online Library|date=December 7, 2022|author1=Andrew Lai|author2=Rachael Johnson|access-date=May 27, 2026}}</ref> SOC8 also recommends against any form of mandatory psychotherapy, including conversion therapy, prior to accessing hormonal or surgical treatment. Also clearly specified for the first time was specific guidance on detransition.<ref name="wpath-soc8"/><ref name="Amengual_2022"/>

=====Adolescents===== In a departure from previous versions, Version 8 draws a conceptual distinction between adolescents and children, with separate chapters.<ref name="wpath-soc8"/><ref name=PubMed>{{cite web|url=https://pubmed.ncbi.nlm.nih.gov/37739630/|title=Assessment of Gender Diverse Children: Incorporating the Standard of Care 8th Edition|website=PubMed|author1=Amy Tishelman|author2= G Nic Rider|access-date=May 27, 2026}}</ref> <!-- Watch for future publications commenting on this development -->

Continued care and careful assessment of cognitive maturity by qualified mental health professionals is recommended.In contrast to previous versions, there are no absolute requirements for duration of assessments or age to access gender-affirming treatments; rather, individual psychosocial and physical development should be taken into account. The chapter also acknowledges the disproportionate increase in adolescents assigned female at birth and notes that social influences may play a role in the expression of gender diversity, while stopping short of endorsing "rapid-onset gender dysphoria".<ref name="wpath-soc8"/><ref name=Wiley/><ref name=MedScape>{{cite web|url=https://www.medscape.com/viewarticle/980935?form=fpf|title=WPATH Removes Age Limits From Transgender Treatment Guidelines|website=Medscape|date=September 16, 2022|author=September 16, 2022|access-date=May 27, 2026}}</ref>

SOC8 removed all previously stated minimum age thresholds for gender-affirming surgery in adolescents, replacing those qualifications with assessments of cognitive and emotional maturity. A minimum of 12 months of hormone therapy is recommended before most gender-affirming surgeries, with the sole exception of phalloplasty. Parental consent for surgical procedures is recommended but may be dispensed with if assessed as harmful or not feasible. Puberty-suppressing medication may be initiated when an adolescent has reached Tanner Stage 2 of pubertal development, demonstrating early physical signs of puberty.<ref name="wpath-soc8"/><ref name=Wiley/><ref name=MedScape/><ref>{{cite web|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC11235884/|title=Puberty suppression in adolescents with gender dysphoria: an emerging issue with multiple implications|website=National Library of Medicine|date=June 14, 2024|author1=Grigoria Betsi|author2=Panagiota Goulia|author3=Sophia Sandhu|author4=Paraskevi Xekouki|access-date=May 27, 2026}}</ref> <!-- more... -->

=====Children===== Chapter 7 of SOC8 is the first standalone chapter pertaining exclusively to prepubescent children. It does not require gender-affirming medical interventions for prepubescent gender diverse children and instead makes recommendations regarding the psychosocial support of children and their families throughout gender exploration and potential social transitions.<ref name="wpath-soc8"/><ref name=PubMed/>

=====Non-binary===== Non-binary individuals are included for the first time in chapter 8. The chapter acknowledges that non-binary people represent a significant proportion of the gender-diverse population, with estimates between 25% and 50% of those who identify as transgender or gender diverse.<ref>{{cite web|url=https://auanews.net/issues/articles/2023/february-2023/world-professional-association-for-transgender-health-standards-of-care-8-update-for-urology|title=World Professional Association for Transgender Health Standards of Care 8: Update for Urology|website=AUA|date=February 2, 2023|author1=Liem Snyder|author2=Jeffery Lin|author3=Michele Fascelli|access-date=May 27, 2026}}</ref>

The guidelines recommend that medical treatment and social support be made available to non-binary people in individualized combinations; for example, providing medical interventions without social transition or gender-affirming surgery without hormone therapy.<ref name="wpath-soc8"/><ref>{{cite web|url=https://link.springer.com/article/10.1186/s13034-024-00822-z|title=Mental health of non-binary youth: a systematic review and meta-analysis|website=Springer Nature|date=October 9, 2024|author1=Diana Klinger|author2=Sofia-Marie Oehlke|author3=Stefan Riedl|author4=Ken Eschbaum|author5=Heidi Elisabeth Zesch|author6=Andreas Karwautz|author7=Paul L. Plener|author8=Oswald D. Kothgassner|access-date=May 27, 2026}}</ref> The chapter additionally notes unique experiences of discrimination, minority stress, and difficulty accessing gender-affirming medical treatment among non-binary people, which healthcare providers should take into consideration. WPATH recommends that healthcare providers use practical measures, such as allowing for non-legal name use at intake and providing gender-neutral facilities.<ref name="wpath-soc8"/>

==Treatments== Recommendations for treatments, including medical and social aspects of gender transition as well as mental health, as are given in Chapters 12–18.

==See also== * Transgender health care * List of transgender-related topics {{Portal bar|Medicine}}

==References== {{Reflist}}

==External links== * [https://wpath.org/publications/soc8/ Standards of Care, Version 8] * [https://web.archive.org/web/20060604060835/http://www.transgendercare.com/guidance/resources/ictlep_soc.htm Health Law Standards of Care for Transsexualism]

Category:Gender transition and medicine Category:Medical ethics Category:Transgender studies