WPATH Standards of Care 8: Applying Updated Guidelines To Inform Optimal Gender-Affirming Care
BY MICAH HOFFMAN, MD, DABPN, FAPA,
ALLMED BEHAVIORAL HEALTH MEDICAL DIRECTOR
In the rapidly evolving field of gender-affirming care, identifying medical necessity can be a challenge. Decision-making that impacts the health of transgender and gender diverse (TGD) plan members often must factor in complex considerations spanning multiple specialized disciplines. In just one example, procedures long considered elective, such as facial cosmetic surgery, may now be indicated by behavioral health research to be essential in certain circumstances for transgender members. Soon-to-be-released updated standards of care from the World Professional Association for Transgender Health (WPATH) paired with growing scientific research can help plans make informed determinations with confidence.
The Growing Need for Gender-affirming Services
Over the last decade, the number and visibility of transgender and gender diverse people have grown significantly. With this expansion has come increased need for support and gender-affirming medical treatment. Health plans and professionals are looking for evidence-based guidance to help them ensure that TGD members receive appropriate care to maximize their overall health and well-being.
Many rely on the WPATH Standards of Care (SOC), which include guidance on primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (e.g., counseling, psychotherapy), and hormonal or surgical treatments, among other topics. The most recent version, SOC 7, was issued in 2011. In the 11 years since, as the field has grown, there has been a substantial increase in the relevant scientific literature. Now health professionals who provide gender-affirming care, from primary care physicians and psychiatrists to specialists in cosmetic surgery and urology, are eagerly anticipating the 2022 release of WPATH SOC 8.
Interdisciplinary Panel Focuses on Practical Application
Recently, I had the privilege of participating in a panel discussion about issues in gender-affirming care with several of my colleagues on the AllMed Gender-affirming Care Panel—board-certified physicians from different specialized disciplines. As part of that conversation, panelists highlighted some of the changes they expect (ALT: hope) to see in WPATH SOC 8 and shared insights on how the new standards might be applied when crafting plan policy.
The physician panelists universally expressed appreciation for WPATH’s efforts to base the new standards of care on solid, evidence-based practice and to include input from transgender community members. At the same time, all emphasized the need for more longitudinal data and studies on the impacts of gender-affirming care, particularly with respect to children and adolescents.
A sampling of anticipated updates in SOC 8 that are expected to provide added clarity for both physicians and health plan policymakers includes:
- A chapter on non-binary individuals, an area of care that is growing, and one on which many providers would like supplemental education.
- An updated (since SOC 7) and more objective assessment of the medical necessity of facial gender procedures and the role mental health plays in arriving at a determination – Physicians are looking for strong supporting source data to help guide them and to help them advise plans in this area.
- Data focusing on the value, in terms of mental health, of specific procedures such as those requiring urological surgery – On this issue, panelists expressed hope that the final document will include specifics about the type and extent of experience that will be necessary for physicians to become certified to perform these procedures.
Overall, the panel’s consensus was that WPATH has laid a sturdy foundation with SOC 8, compiling evidence on a wide variety of topics specific to gender-affirming care. Yet panelists were clear that the WPATH guidelines are just one (albeit critical) consideration in ensuring optimal care for TGD members. They stressed the importance of also factoring into treatment plans future evidence-based research along with an understanding of specific state legislation. In addition, panelists noted that educating providers about the new standards will be key to providing effective gender-affirming care going forward. Because this evolving field transcends so many different medical specialties, integrating the new information into both medical school and continuing education curricula offers the surest approach to equipping all providers with consistent, up-to-date guidance.
AllMed Physicians Bring Evidence-based Guidance to Complex Healthcare Issues
Maximizing the health and well-being of TGD plan members can be a multifaceted undertaking. When developing a coherent, appropriate treatment plan calls for integrating available evidence, interdisciplinary guidance, relevant legislation, and inherent complexities, AllMed can help. Board-certified physicians from AllMed bring specialized expertise, awareness of current guidelines, regulations, and research, and sensitivity to questions of medical necessity to support plans with evidence-based guidance. Collaborate with AllMed to ensure optimal, plan-aligned care for your TGD members.