Plowing Through The WPATH SOC; Thinking About Dr. Benjamin’s Words

I’ve been reading through the new Version 7 of the World Professional Association for Transgender Health Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (WPATH SOC). It’s the replacement document for the The Harry Benjamin International Gender Dysphoria Association’s Standards Of Care For Gender Identity Disorders, Sixth Version (HBSOC).

The WPATH SOC recognizes how the treatment schemas have changed from one where patients were required to comply a one-size-fits-all treatment schema for transsexuals to a more individual treatment schema — One that recognizes that treatment required to alleviate the distress of what is now referred to as gender dysphoria is different for every patient. From the section entitled Advancements in the Knowledge and Treatment of Gender Dysphoria:

In the second half of the 20th century, awareness of the phenomenon of gender dysphoria increased when health professionals began to provide assistance to alleviate gender dysphoria by supporting changes in primary and secondary sex characteristics through hormone therapy and surgery, along with a change in gender role. Although Harry Benjamin already acknowledged a spectrum of gender nonconformity (Benjamin, 1966), the initial clinical approach largely focused on identifying who was an appropriate candidate for sex reassignment to facilitate a physical change from male to female or female to male as completely as possible (e.g., Green & Fleming, 1990; Hastings, 1974). This approach was extensively evaluated and proved to be highly effective. Satisfaction rates across studies ranged from 87% of MtF patients to 97% of FtM patients (Green & Fleming, 1990), and regrets were extremely rare (1-1.5% of MtF patients and <1% of FtM patients; Pfäfflin, 1993). Indeed, hormone therapy and surgery have been found to be medically necessary to alleviate gender dysphoria in many people (American Medical Association, 2008; Anton, 2009; The World Professional Association for Transgender Health, 2008).

As the field matured, health professionals recognized that while many individuals need both hormone therapy and surgery to alleviate their gender dysphoria, others need only one of these treatment options and some need neither (Bockting & Goldberg, 2006; Bockting, 2008; Lev, 2004). Often with the help of psychotherapy, some individuals integrate their trans- or cross-gender feelings into the gender role they were assigned at birth and do not feel the need to feminize or masculinize their body. For others, changes in gender role and expression are sufficient to alleviate gender dysphoria. Some patients may need hormones, a possible change in gender role, but not surgery; others may need a change in gender role along with surgery, but not hormones. In other words, treatment for gender dysphoria has become more individualized.

As a generation of transsexual, transgender, and gender nonconforming individuals has come of age – many of whom have benefitted from different therapeutic approaches – they have become more visible as a community and demonstrated considerable diversity in their gender identities, roles, and expressions. Some individuals describe themselves not as gender nonconforming but as unambiguously cross-sexed (i.e., as a member of the other sex; Bockting, 2008). Other individuals affirm their unique gender identity and no longer consider themselves either male or female (Bornstein, 1994; Kimberly, 1997; Stone, 1991; Warren, 1993). Instead, they may describe their gender identity in specific terms such as transgender, bigender, or genderqueer, affirming their unique experience that may transcend a male/female binary understanding of gender (Bockting, 2008; Ekins & King, 2006; Nestle, Wilchins, & Howell, 2002). They may not experience their process of identity affirmation as a “transition,” because they never fully embraced the gender role they were assigned at birth or because they actualize their gender identity, role, and expression in a way that does not involve a change from one gender role to another. For example, some youth identifying as genderqueer have always experienced their gender identity and role as such (genderqueer). Greater public visibility and awareness of gender diversity (Feinberg, 1996) has further expanded options for people with gender dysphoria to actualize an identity and find a gender role and expression that is comfortable for them.

It reminds me of the how Dr. Harry Benjamin talked about what the WPATH SOC would now as the gender spectrum of transsexual, transgender, and gender nonconforming individuals has come of age in his book The Transsexual Phenomenon. From Chapter 2 of his book (published 45-ish years ago in 1967), where Dr. Benjamin used binary, outdated language to describe that less than binary spectrum:

…It must be left to further observations and investigations in greater depth to decide whether or not transvestitic desires may really be transsexual in nature and origin. Many probably are, but the frequent fetishistic transvestites may have to be excluded.

“If these attempts to define and classify the transvestite and the transsexual appear vague and unsatisfactory, it is because a sharp and scientific separation of the two syndromes is not possible. We have as yet no objective diagnostic methods at our disposal to differentiate between the two. We – often – have to take the statement of an emotionally disturbed individual, whose attitude may change like a mood or who is inclined to tell the doctor what he believes the doctor wants to hear. Furthermore, nature does not abide by rigid systems. The vicissitudes of life and love cause ebbs and flows in the emotions so that fixed boundaries cannot be drawn.

“It is true that the request for a conversion operation is typical only for the transsexual and can actually serve as definition. It is also true that the transvestite looks at his sex organ as an organ of pleasure, while the transsexual turns from it in disgust. Yet, even this is not clearly defined in every instance and no two cases are ever alike. An overlapping and blurring of types or groups is certainly frequent.

I’m also left pondering Dr. Benjamin’s statement about hate that trans people harbor between different the different sorts of transsexual, transgender, and gender nonconforming individuals, even if his statement is couched in outdated language. From chapter 6 of the same book (emphasis added):

I have even met transvestites who dislike (or pretend to dislike) transsexualism so much that they are against estrogen treatment and operation (for reasons of self-protection?). There are also transsexuals who dislike transvestites as well as homosexuals. Intolerance can be found in strange quarters.

Which, of course reminds me of two quotes from Martin Luther King Jr.:

All men are caught in an inescapable network of mutuality.


We must learn to live together as brothers or perish together as fools.

I would say it’s all people that are caught in the inescapable network of mutuality, and it we who must live who must live together as siblings or perish together as fools, but the sentiments of Martin Luther King Jr. are significant in sentiment still — as well as the observation of Dr. Benjamin on trans people’s sometime intolerance of each other.

Transsexual, transgender, and gender nonconforming individuals without doubt have differences on what is needed to alleviate the gender dysphoria that each of us experience. But that said, we also have many commonalities too. And even should we only consider the differences between we transsexual, transgender, and gender nonconforming individuals exclusive of trans commonalities, we still have our humanity in common.

We live up to our humanity best when we treat others as we wish to be treated ourselves.

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