Revised Standards Of Care HEALTH LAW STANDARDS OF CARE FOR TRANSSEXUALISM First Issued: September 15, 1993 Revisited and Reviewed 1994, 1995, 1996 Revised: October 5, 1997 Printed below is your copy of the revised "Health Law Standards of Care for Transsexualism". These Standards of Care were developed and adopted by consensus on September 15, 1993, after a two year period by the Health Law Project of the International Conference on Transgender Law and Employment Policy (ICTLEP), Inc., a non-profit Texas corporation with an IRS 501(c)(3) tax exemption. The Health Law Project's membership included professionals in the fields of law, health care policy and gender science -- most of which are transgendered themselves. It also included all interested lay transgenders who attended the first and second ICTLEP conferences in 1992 and 1993. The International Conference on Transgender Law and Employment Policy Shall Use Its Best Efforts to Disseminate these Health Law Standards of Care to All Persons Involved in the Medical Treatment of Transsexualism. We also suggest that you give these revised Standards of Care to gender services providers in your area. The Standards of Care also include standard legal forms for consent and waiver of liability. The Health Law Standards of Care were developed in the wake of widespread dissatisfaction by many in the transgendered community with the Harry Benjamin Standards of Care. Four years later, that dissatisfaction remains. Also relevant is the pending de-listing of transsexualism per se as a mental disorder from the DSM-IV. Four years later, that de-listing is still pending. Hence many, if not most, of the transgendered patients seen for gender services may not require psychological services, as was established in 1994 after the three year, Boulton and Park survey (n=934) of non-clinical transgenders. And as a result of the growth of the female to male transgendered community, it became obvious that the Standards of Care did not address FTM issues fully. Thus the recent revision was made in Standard 3. For a full transcript of the Second ICTLEP Conference which led to the adoption of the initial Standards of Care, please send $65.00 plus $5.00 s/h and specify whether you want text, audio, or ($95.00 plus $5.00 s/h) video (plus New York Sales Tax if applicable) to the letterhead mailing address (above). Please add $30.00 for non-USA mailing. The Health Law Standards of Care for Transsexualism Shall Be (and were in 1994, 1995, 1996 and 1997) Reviewed and Amended by Consensus, As Necessary, at Each Annual International Conference on Transgender Law. Unfortunately, to date, most detractors of these Standards of Care have never bothered to attend. To participate in any future iteration of the Standards you are invited to address us at the letterhead locations. Sincerely, Phyllis Randolph Frye, Executive Director and Founder Martine Aliana Rothblatt, former Director (initial and primary author) Spencer Bergstedt, Director (revision committee chair) PRINCIPLE 1. Transsexualism is an ancient and persistent part of the human experience and is not in itself a medical illness or mental disorder. Transsexualism is a desire to change the expression of one's gender identity. PRINCIPLE 2. Persons have the right to express their gender identity through changes to their physical appearance, including the use of hormones and reconstructive surgery. PRINCIPLE 3. Persons denied the ability to exercise control over their own bodies in terms of gender expression, through informed access to medical services, may experience significant distress and suffer diminished capacity to function socially, economically and sexually. PRINCIPLE 4. Providers of health care (including surgical) services to transsexuals have a right to charge reasonable fees for their services, to be paid in advance, and to require a waiver of all tort liability except negligence. PRINCIPLE 5. It is unethical to discriminate in the provision of sex reassignment services based on the sexual orientation (actual or perceived), marital status, HIV status, or physical appearance of a patient. STANDARD 1. Physicians participating in transsexual health care shall provide hormonal sex reassignment therapy to patients requesting a change in their sexual appearance subject only to: (1) the physician's reasonable belief that the therapy will not aggravate a patient's health conditions, (2) the patient's compliance with periodic blood chemistry checks to ensure a continued healthy condition, and (3) the patient's signature of an informed consent and waiver of liability form. If the patient is married, the physician may not require divorce but may also require the spouse to sign a waiver of liability form. STANDARD 2. Physicians providing hormonal sex reassignment therapy shall collect and publish on an annual basis the number of hormone prescriptions they have issued and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex hormone therapy, to all prospective patients inquiring into the physician's hormone therapy services. STANDARD 3. MTF Standards: Surgeons participating in MTF transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to 1) the surgeons reasonable belief that the surgery will not aggravate pre-existing health conditions, 2) the surgeons reasonable determination that the patient has been under hormonal sex reassignment for at least one year, and 3) the patient's signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce but may also require the spouse to sign the waiver of liability form. STANDARD 3. FTM Standards: Surgeons participating in FTM transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to 1) the surgeons reasonable belief that the surgery will not aggravate pre-existing health conditions, 2a) IN THE CASE OF CHEST RECONSTRUCTIVE SURGERY the surgeons reasonable determination that the surgery will allow the patient to more fully and sucessfully live as a man. The patient need not have been under any hormonal treatment for this surgery. 2b) GENITAL SURGERY, the surgeons reasonable determination that the patient has been under hormonal sex reassignment for at least one year, 2c) HYSTERECTOMY the surgeons reasonable determination that the patient has been under hormonal sex reassignment for at least one year OR that the surgery is otherwise medically necessary for the health and safety of the patient, and 3) the patient's signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce but may also require the spouse to sign the waiver of liability form. STANDARD 4. Physicians providing sex reassignment surgery shall collect and publish on an annual basis the number of sex reassignment surgeries they have performed and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex reassignment surgery, to all prospective patients inquiring into the physician's sex reassignment services. STANDARD 5. Physicians and surgeons shall not devulge the name or identity of any patient requesting or receiving sex reassignment services except as explicitly directed in a notarized written request by the patient. FORM 1: Informed Concent and Waiver of Liability I, __________________________, having been fully informed in writting of the potential risks and complications of hormonal or surgical sex reassignment, do hereby choose of my own free will and consent to undertake this treatment because I want to alter my physical appearance to more closely reflect my gender identity. I hereby release Dr.______________________ of any and all liability for my decision to undertake a change of my sexual appearance and, for long-term use of hormones or for sex reassignment surgery, to affect on a permanent, irreversable basis my current sexual functioning. I promise not to sue Dr.__________________ for any of the consequences of my hormonal or surgical sex reassignment unless those consequences are the result of negligence in the conduct of my hormone therapy or in the carrying out of my surgery. Dated at ______________________, this _______ day of ____________________ Patient Signature: ______________________ Witness: _____________________________ FORM 2: Spousal Informed Consent and Waiver of Liability I, __________________________________, am presently married to ________________________________("Patient"). I understand that Patient wishes to alter his or her physical appearance to more clearly reflect his or her gender identity, and has been trying to do so for at least _________ year(s). I have been actively involved in and fully support Patient's sex change process. I have been fully informed of the nature of transsexualism and sex reassignment surgery or hormonal therapy. I fully understand that the surgery and the effects of long-term use of hormones is not reversable, and that Patient will never be able to sire or bear children after the surgery or long-term hormonal therapy. I also understand that the sex reassignment process involves dangers and risks including, but not limiter to, post-operative infection, depression, emotional changes, and other physical and psychological changes. It is with my full knowledge and consent that my spouse, the Patient, undergo sex reassignment surgery of hormonal therapy to cause a change of his/her sex to occur. I hereby release and hold harmless Dr._____________________ from any and all claims arising out of performance of sex reassignment surgery or hormonal therapy, actual negligence excepted. I fully understand that I will not be able to seed monetary damages for any loss of sexual companionship between Patient and myself, the loss of Patient's ability to sire or bear children or any similar problems which may arise from the perfomance of the sex reassignment surgery or hormonal therapy. Dated at ______________________, this _______ day of ____________________ Spouse Signature: _____________________ Witness: _____________________________ NOTARY: ___________________________
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