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. 2023 Mar 31;8(2):137-148.
doi: 10.1089/trgh.2021.0069. eCollection 2023 Apr.

Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care

Pravik Solanki  1 , David Colon-Cabrera  2   3 , Chris Barton  1 , Peter Locke  4 , Ada S Cheung  5 , Cassandra Spanos  5 , Julian Grace  4 , Jaco Erasmus  3 , Riki Lane  1   3
Affiliations

Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care

Pravik Solanki et al. Transgend Health. .

Abstract

Purpose: Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments.

Methods: Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression.

Results: WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016).

Conclusion: WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.

Keywords: WPATH model; gender-affirming hormone therapy; informed consent model; nonbinary; transgender.

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Conflict of interest statement

J.E. is the head of MHGC. R.L. and D.C.-C. are researchers at MHGC. P.L. is the manager of Equinox Gender Diverse Health Centre. Other authors have no interests to disclose.

Figures

FIG. 1.
FIG. 1.
Gender identities of MHGC and Equinox clients. Not shown are 12 Equinox clients and 1 MHGC client who did not articulate a gender identity. AFAB, assigned female at birth; AMAB, assigned male at birth; MHGC, Monash Health Gender Clinic.
FIG. 2.
FIG. 2.
Number of sessions taken to complete assessments for HT at MHGC and Equinox. The maximum number of sessions (at both clinics) was 16 sessions. HT, hormone therapy.
FIG. 3.
FIG. 3.
Number of sessions taken to complete assessments for binary and nonbinary clients at Equinox.
See this image and copyright information in PMC

References

    1. Winter S, Diamond M, Green J, et al. . Transgender people: health at the margins of society. Lancet. 2016;388:390–400. - PubMed
    1. The World Professional Association for Transgender Health. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7th ed. 2012, pp. 21–64.
    1. Schulz SL. The informed consent model of transgender care: an alternative to the diagnosis of gender dysphoria. J Humanist Psychol. 2018;58:72–92.
    1. Cheung AS, Ooi O, Leemaqz S, et al. . Sociodemographic and clinical characteristics of transgender adults in Australia. Transgend Health. 2018;3:229–238. - PMC - PubMed
    1. Department of Health and Human Services. Development of Trans and Gender Diverse Services in Victoria: Final Report. Melbourne, Australia: Australian Healthcare Associates, 2018.

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