Public Policies and Communications


Open Letter to the Government of India re: Transgender Rights 2016 Bill

November 30th, 2017.

The World Professional Association for Transgender Health (WPATH) is the only international, interdisciplinary professional association dedicated to the scientific study of gender dysphoria and the evidence-based best practices in transgender health. We are a non-profit association with over 1500 members in the fields of medicine, mental health, law and ethics, and scientific research. Formed in 1979 for the purpose of bringing scientists and medical providers together to exchange knowledge about the field, we are the creators of the internationally accepted Standards of Care for the Health of Transsexual, Transgender, and Gender-nonconforming People, now in its 7th edition (SOC v7), and available in a Hindi translation on our website: www.wpath.org. We have also advised many sovereign states (at their request) with respect to transgender health and human and civil rights, and submitted numerous educational briefs to courts of law adjudicating cases involving transgender people in many different countries.

We, WPATH's Board of Directors, write to express our concern regarding certain provisions of the Transgender Rights Bill 2016.

We note first of all that the Bill appears to confuse the concepts of transgender and intersex. We assert that transgender people are persons who identify in a gender other than the one that matches the sex they were assigned at birth. Some transgender people are also intersex. Many are not. Intersex people are individuals who have atypical sex characteristics that do not conform to the categories of male or female. Some intersex people are also transgender. Many are not.

As the world's peak professional organization concerned with transgender health, WPATH is aware of the importance that gender recognition can play in facilitating the health and wellbeing of transgender people. We share here the official WPATH Identity Recognition Statement (available on the WPATH website at by clicking here)

WPATH Identity Recognition Statement (issued November 15th, 2017).

The World Professional Association for Transgender Health (WPATH) recognizes that, for optimal physical and mental health, persons must be able to freely express their gender identity, whether or not that identity conforms to the expectations of others. WPATH further recognizes the right of all people to identity documents consistent with their gender identity, including those documents which confer legal gender status. Such documents are essential to the ability of all people to enjoy rights and opportunities equal to those available to others; to access accommodation, education, employment, and health care; to travel; to navigate everyday transactions; and to enjoy safety. Transgender people, regardless of how they identify or appear, should enjoy the gender recognition all persons expect and deserve. 

Medical and other barriers to gender recognition for transgender individuals may harm physical and mental health. WPATH opposes all medical requirements that act as barriers to those wishing to change legal sex or gender markers on documents. These include requirements for diagnosis, counseling or therapy, puberty blockers, hormones, any form of surgery (including that which involves sterilization), or any other requirements for any form of clinical treatment or letters from doctors. WPATH argues that marital and parental status should not be barriers to recognition of gender change, and opposes requirements for persons to undergo periods living in their affirmed gender, or for enforced waiting or 'cooling off' periods after applying for a change in documents. Further, court and judicial hearings can produce psychological, as well as financial and logistical barriers to legal gender change, and may also violate personal privacy rights or needs. 

WPATH advocates that appropriate gender recognition should be available to transgender youth, including those who are under the age of majority, as well as to individuals who are incarcerated or institutionalized. WPATH recognizes that there is a spectrum of gender identities, and that choices of identity limited to Male or Female may be inadequate to reflect all gender identities. An option of X, NB (non-binary), or Other (as examples) should be available for individuals who so choose. 

WPATH urges governments to eliminate barriers to gender recognition, and to institute transparent, affordable and otherwise accessible administrative procedures affirming self-determination, when gender markers on identity documents are considered necessary. These procedures should be based in law and protect privacy.

We note that the provisions of the Transgender Rights Bill present barriers to gender recognition. The proposed District Screening Committees (comprising senior medical officers and mental health professionals) may result in medical involvement in a process that should be entirely self-determined. It will also add uncertainty and prompt anxiety in those persons applying for gender recognition.

On grounds of health and wellbeing for transgender people, we also urge the Indian Government to:

a. remove the provisions in the Bill that criminalize begging. Such provisions may have a disproportionate impact on the ability of transgender people to survive in a society in which there are relatively few employment opportunities available.

b. remove provisions that have the effect of limiting rights of transgender people to associate and live freely with each other. We note that the right to associate and live with persons able to provide emotional and practical support is key to the health and wellbeing of transgender people.

c. enact provisions ( i ) providing gender affirming healthcare on the same basis as other healthcare available to the general population, ensuring that such healthcare follows guidelines consistent with the WPATH Standards of Care current at the time in question; ( ii ) ensuring that such healthcare is available to transgender people who are incarcerated, and ( iii ) ensuring that procedures are available for transgender people to seek redress in cases of medical negligence or abuse of human rights by healthcare personnel.

d. enact provisions that can effectively protect transgender people from discrimination.

We urge the Indian Government to withdraw this Bill, and replace it with one which more closely corresponds to the terms and spirit of the Supreme Court NALSA judgement.

Signed

Gail Knudson, MD, FRCPC
WPATH President


For Immediate Release

November 15, 2017

This statement replaces WPATH’s Identity Recognition Statement of January 19, 2015. 

 

WPATH Identity Recognition Statement

 
The World Professional Association for Transgender Health (WPATH) recognizes that, for optimal physical and mental health, persons must be able to freely express their gender identity, whether or not that identity conforms to the expectations of others. WPATH further recognizes the right of all people to identity documents consistent with their gender identity, including those documents which confer legal gender status. Such documents are essential to the ability of all people to enjoy rights and opportunities equal to those available to others; to access accommodation, education, employment, and health care; to travel; to navigate everyday transactions; and to enjoy safety. Transgender people, regardless of how they identify or appear, should enjoy the gender recognition all persons expect and deserve. 
 
Medical and other barriers to gender recognition for transgender individuals may harm physical and mental health. WPATH opposes all medical requirements that act as barriers to those wishing to change legal sex or gender markers on documents. These include requirements for diagnosis, counseling or therapy, puberty blockers, hormones, any form of surgery (including that which involves sterilization), or any other requirements for any form of clinical treatment or letters from doctors. WPATH argues that marital and parental status should not be barriers to recognition of gender change, and opposes requirements for persons to undergo periods living in their affirmed gender, or for enforced waiting or 'cooling off' periods after applying for a change in documents. Further, court and judicial hearings can produce psychological, as well as financial and logistical barriers to legal gender change, and may also violate personal privacy rights or needs. 

WPATH advocates that appropriate gender recognition should be available to transgender youth, including those who are under the age of majority, as well as to individuals who are incarcerated or institutionalized. WPATH recognizes that there is a spectrum of gender identities, and that choices of identity limited to Male or Female may be inadequate to reflect all gender identities. An option of X, NB (non-binary), or Other (as examples) should be available for individuals who so choose. 

WPATH urges governments to eliminate barriers to gender recognition, and to institute transparent, affordable and otherwise accessible administrative procedures affirming self-determination, when gender markers on identity documents are considered necessary. These procedures should be based in law and protect privacy.

 

For Immediate Release CONTACT: Jamison Green, PhD
Communications Director
510-393-4785 | pr@wpath.org

WPATH Opposes Transgender Military Ban

July 26, 2017: Elgin, IL. -

The Executive Board of the World Professional Association for Transgender Health (WPATH) deplores President Trump’s tweet this morning, in which he declared that transgender people will not be allowed to serve in the U.S. military “in any capacity.” Citing “tremendous” costs of care and “disruption,” the President said he had consulted with “my Generals and military experts” in reaching his decision, but this reversal of policy is itself disruptive and wasteful.

“Many thousands of dollars have already been spent studying the matter,” said Gail Knudson, M.D., WPATH President, “and creating detailed analyses reaching the conclusion that transgender people are already serving, and have been serving in secret for decades. There’s no appreciable increase in cost associated with allowing transgender people to serve openly, which is what the current policy, as stated in Directive-Type Memorandum (DTM) 16-005, ‘Military Service of Transgender Service Members’ (issued June 30, 2016) is designed to achieve. Instead, this reversal will waste all of the previous studies and the investment in training the Armed Forces have made in the estimated up to 250 currently-serving transgender-identified soldiers and sailors who have already come forward under the assumption it was safe to do so. Thousands more who haven’t come forward will have to go back into hiding to continue serving their country.”

George Brown, M.D., a former WPATH board member and author of numerous scholarly papers focused on transgender military veterans and active duty personnel, wrote in an email to the WPATH Directors, “the policies (issued last year) are currently in effect unless and until officially rescinded by the Secretary of Defense, General Jim Mattis.  The 6-month hold on new accessions ("enlistments"), effective June 30, 2017, is the last official statement in the form of a memorandum from SecDef Mattis.”

WPATH members in the US region (and globally) are professionals who work with transgender people every day. Transgender people are not a mystery to WPATH, nor is the science concerning transgender care. As a professional and educational association, WPATH is committed to promoting health, research, education, respect, dignity, and equality for transgender people in all settings, including the U.S. Armed Services.

              Transgender troops have proven themselves to be capable and dependable soldiers. They should be judged on their performance of their duties, like any other service member, and not denied medically necessary care or otherwise discriminated against or because of their gender identity. The President’s tweet is a shameful attack on a group of our fellow citizens who are right now risking their lives to protect our society and way of life. The damage done by this morning’s tweet is an outright threat to unit cohesion and military readiness as it reinforces stigma and contributes to uncertainty, leading to depression and anxiety, undermining troop morale. Along with the American Medical Association, the American Psychological Association, the HIV Medicine Association, GLMA—Health Professionals Advancing LGBT Equality, and many other healthcare, legal advocacy, and civil rights organizations, WPATH stands in staunch opposition to this proposed policy reversal. 


FORTHCOMING ICD-11 PROPOSED DRAFT MAY CONTAIN HOPE FOR TRANSGENDER HEALTH

In an unprecedented move, the World Professional Association for Transgender Health (WPATH) has joined the World Association for Sexual Health (WAS) in delivering three joint statements to the World Health Organization (WHO) as the latter group is engaged in the ongoing revision of its International Classification of Diseases (ICD). Both Associations consider proposals for a new chapter on sexual health, and the relocation of relevant trans-related diagnoses to that chapter, as being of the utmost importance. Both Associations are aware that there has been debate around these proposals, and they have therefore issued the following three joint statements, all dated 30/6/2017:

The World Association for Sexual Health and the World Professional Association for Transgender Health urge the World Health Organisation to remain fully committed to inclusion of a chapter on Conditions Related to Sexual Health in ICD-11 in the version to be presented for approval at the World Health Assembly. We also urge WHO member states to support the proposed chapter.

The World Association for Sexual Health and the World Professional Association for Transgender Health urge the World Health Organisation to remain fully committed to locating the proposed diagnosis of Gender Incongruence of Adolescence and Adulthood within the chapter on Conditions Related to Sexual Health. We also urge member states to support the proposed placement.

The World Association for Sexual Health and the World Professional Association for Transgender Health call on WHO to consider further the proposed Gender Incongruence of Childhood diagnosis, including through comprehensive consultation with the transgender community.


August 15, 2017

Roger Severino, JD, MPP
Director, Office of Civil Rights
U.S. Department of Health and Human Services (HHS)
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201

Dear Director Severino:

Thank you for your consideration in reading this letter. The World Professional Association for Transgender Health (WPATH) is the only medical association dedicated to the study, care, and treatment of transgender and gender-nonconforming people. Founded in 1979, ours is a
non-profit, interdisciplinary association of over 1400 physicians, mental health professionals, legal professionals, and academic and clinical researchers whose work directly impacts the health of transgender people. We are based near Chicago, and while we are an international association, the majority of our members practice in the U.S. As such, we have a firm stake in the provisions of § 1557 of the Affordable Care Act, and we were grateful for the opportunity to submit our comments during the prior review of § 1557 last year. We are the source of the internationally accepted Standards of Care for the Health of Transsexual, Transgender, and
Gender-nonconforming People which is referenced extensively in medical education, research, and policy statements.

We are concerned that the Trump administration has adopted an antagonistic position with regard to transgender people. It may be helpful to HHS to know that transgender people are not a modern invention, but they have been part of the human family in every race, class, and culture since the start of recorded history. The term “transgender,” though, is relatively new, as both science and culture have struggled for centuries to define people whose gender and sex do not correspond, or may be seen as untypical. Regardless of terminology, our research and clinical experience has shown that being a transgender person does not in itself constitute
mental illness (this is confirmed by the American Psychiatric Association). However, being transgender can lead to experiences of ridicule, intolerance, adverse discrimination in workplaces and even when accessing basic medical and emergency care, and various forms of abuse, both psychological and physical. No one should have to experience adverse discrimination when they are in need of health care. Such discrimination is known to lead to worse health outcomes for anyone, not just transgender people. We unequivocally support nondiscrimination protections for transgender people, and also for others with marginalizing characteristics such as race, age, disability, national origin, etc.

We also attest to the fact that medical and mental health treatments related to gender transition have been demonstrated to be beneficial and medically necessary for many transgender patients. Treatments are cost-effective and, when averaged into a large pool of covered individuals, are typically less expensive than many common, routine procedures, such as appendectomy or childbirth. We oppose health insurance exclusions targeting transition-related care. Accordingly, we support the gender identity nondiscrimination provisions of the § 1557 final rule and oppose reopening the rule. To the extent that HHS seeks to clarify the application of § 1557 and the final rule in certain respects and to address issues raised inlitigation, we urge HHS to do so through issuing interpretive guidance. However, if HHS chooses to reopen the rule, we ask HHS to first seek input from stakeholders through a Request for Information and public comment period prior to issuing a proposed rule. This is appropriate given the importance and scope of the rule, and the fact that the rule was originally developed using this process.

Please do not hesitate to contact us should you require further information.
Sincerely,

Gail Knudson, M.D.
President, WPATH


Forthcoming icd-11 proposed draft may contain hope for transgender health

July 2017

WPATH/WAS Joint In an unprecedented move, the World Professional Association for Transgender Health (WPATH) has joined the World Association for Sexual Health (WAS) in delivering three joint statements to the World Health Organization (WHO) as the latter group is engaged in the ongoing revision of its International Classification of Diseases (ICD). Both Associations consider proposals for a new chapter on sexual health, and the relocation of relevant trans-related diagnoses to that chapter, as being of the utmost importance. Both Associations are aware that there has been debate around these proposals, and they have therefore issued the following three joint statements, all dated 30/6/2017:

The World Association for Sexual Health and the World Professional Association for Transgender Health urge the World Health Organisation to remain fully committed to inclusion of a chapter on Conditions Related to Sexual Health in ICD-11 in the version to be presented for approval at the World Health Assembly. We also urge WHO member states to support the proposed chapter.

The World Association for Sexual Health and the World Professional Association for Transgender Health urge the World Health Organisation to remain fully committed to locating the proposed diagnosis of Gender Incongruence of Adolescence and Adulthood within the chapter on Conditions Related to Sexual Health. We also urge member states to support the proposed placement.

The World Association for Sexual Health and the World Professional Association for Transgender Health call on WHO to consider further the proposed Gender Incongruence of Childhood diagnosis, including through comprehensive consultation with the transgender community.


WPATH opposes the Trump administration's effort to curtail enforcement of section 1557 of the Affordable Care Act (ACA)

May 2017

Click here to download official statement


WPATH Supports Students Health and Safety

February 2017

The World Professional Association for Transgender Health (WPATH) today affirms its commitment to the health and safety of transgender students in the U.S. and across the world. 

Click here to download official statement


WPATH Timeline Guide for United States Armed Service Members Going Through Transgender Hormonal or Surgical Transition

January 2017

This guide is intended to assist in determining relative deployability of transgender service members during hormonal and surgical transition.  Customization of the specific treatment plan should be discussed by the medical provider and the service member informed by duty requirements and the below timeline guidance.

Click here to download full document


Position Statement on Medical Necessity of Treatment, Sex Reassignment, and Insurance Coverage in the U.S.A.

December 21, 2016

Download a copy of the Medical Necessity Statement


WPATH Statement about Medical Necessity of Electrolysis

July 15, 2016

Click Here to read and print this document


 

 

WPATH Statement Against Forced Anal Exams
June 23, 2016
 
The United Nations’ "Principles of Medical Ethics Relevant to the Role of Health Personnel, Particularly Physicians, in the Protection of Prisoners and Detainees Against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment” prohibits health personnel from "participation in, complicity in, incitement to, or attempts to commit torture or other cruel, inhuman or degrading treatment or punishment.” Further, the 1975 Tokyo Declaration of the World Medical Association strictly forbids medical personnel from engaging in acts of torture or other forms of cruel, inhuman or degrading treatment and requires them to protect the confidentiality of medical information. However, since 2011, in at least eight countries, medical personnel have participated in forced anal examinations of men and transgender women who are charged with consensual same-sex conduct. The UN Special Rapporteur on Torture and other forms of Cruel, Inhuman and Degrading Treatment has described forced anal examinations as "medically worthless.”  The Independent Forensic Experts Group, composed of forensic medicine specialists from around the world, has determined that "the examination has no value in detecting abnormalities in anal sphincter tone that can be reliably attributed to consensual anal intercourse.”
 
The Board of Directors of the World Professional Association for Transgender Health (WPATH) is deeply disturbed by the complicity of medical personnel in these involuntary examinations that have absolutely no medical or scientific value, and are a violation of a person’s bodily integrity. That medical personnel would also prepare "medical reports” which are used in trials to convict men and transgender women of sexual offenses is an unethical and inhumane abuse of medical authority.
 
The WPATH Board of Directors calls on the medical profession as a whole to abstain from participation in forced anal examinations, urges WPATH members to advocate for their own National Medical Councils to officially prohibit doctors from participating in such examinations, and calls upon the World Health Organization to adopt an official stance opposing forced anal examinations as unscientific and in violation of medical ethics. 

 

FOR IMMEDIATE RELEASE

 

January 19, 2015

 

2015 WPATH Statement on Identity Recognition

 

 

 


The World Professional Association for Transgender Health (WPATH) recognizes the right of all people to legal identity recognition and to identity documents consonant with their gender identity.

 

Download the full policy statement here


FOR IMMEDIATE RELEASE
July 15, 2014
WPATH Statement Concerning Cross-dressing, Gender-Nonconformity, and Gender Dysphoria


The World Professional Association for Transgender Health (WPATH) calls for the repeal of laws criminalizing gender non-conformity and expression of transgender identity.

Download the full policy statement here


 

FOR IMMEDIATE RELEASE
June 16, 2010
WPATH Identity Recognition Statement

The Board of Directors of the World Professional Association for Transgender Health (WPATH), in the interest of the health and well-being of transgender and transsexual people world-wide, issued today, 16 June 2010, the following identity recognition statement:
No person should have to undergo surgery or accept sterilization as a condition of identity recognition. If a sex marker is required on an identity document, that marker could recognize the person's lived gender, regardless of reproductive capacity. The WPATH Board of Directors urges governments and other authoritative bodies to move to eliminate requirements for identity recognition that require surgical procedures. To download a copy of this statement, please click here.


FOR IMMEDIATE RELEASE
May 26, 2010
WPATH De-Psychopathologisation Statement

The World Professional Association for Transgender Health has prepared and released a statement urging the de-psychopathologisation of gender variance worldwide. The statement is as follows:
The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide. The expression of gender characteristics, including identities, that are not stereotypically associated with one's assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative. The psychopathologisation of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being. WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people." To download a copy of this statement, please click here.


FOR IMMEDIATE RELEASE
May 25, 2010
WPATH Reaction to DSM-V Criteria for Gender Incongruence

The WPATH Board of Directors and the Chairs of the DSM Consensus Building Process Work Group of the World Professional Association for Transgender Health, would like to thank all those who contributed their expertise to draft our formal response to the proposed DSM 5 Criteria for Gender Incongruence. To view WPATH's response, please click here.


WPATH Responds to Alberta, Canada's Decision to Delist Sexual Reassignment Surgery as a Covered Medical Benefit.
Click here to read or print this document.