Informed Consent Model

An informed consent model of trans care is an approach to primary medical care. The primary [Page 432]use of this approach is for gender-affirming hormone treatment; gender-affirming surgeries are not typically included in an informed consent model of care. An informed consent model emphasizes the medical provider–patient collaborative process of evaluation of medical need, treatment options, and discussions on the expected effects and possible risks involved prior to starting any medications. Treatment is then provided based on the patient’s ability to understand the treatment risks and benefits (informed) and to legally agree (consent) to be treated. The main feature of this model of care is that it does not require a trans person to receive mental health therapy, get psychological testing, or have a mental health professional write them a referral letter before the person can start gender-affirming medical treatment. An informed consent model of care also incorporates a harm reduction approach to treatment, providing gender-affirming care starting where the person’s needs are, for example, by providing medical supervision of nonprescribed (e.g., do-it-yourself, DIY) hormone treatments without demanding the person stop all hormones first.

An informed consent model arose as an alternative to what is commonly known as the standard model of care and in response to the needs and demands of the trans community for greater access to gender-affirming medical care. The standard model of care derives from the international World Professional Association for Transgender Health (WPATH) Standards of Care for Transsexual, Transgender, and Gender Nonconforming People (SOC). While the SOC itself is flexible and supports both standard and informed consent models of care, it strongly favors a standard model of care that stresses the involvement of mental health professionals in gender-affirming medical treatment. This emphasis on mental health professional involvement in care underlies the objections to the standard model of care and what many trans people believe to be an underlying pathologizing bias that creates unnecessary and unwanted oversight and control of their lives, thus removing their autonomy. This oversight is called gatekeeping. Gatekeeping places mental health professionals in the position of deciding whether and when a trans person can access gender-affirming medical treatment, which has resulted in widespread distrust of mental health professionals by trans communities. Nonetheless, the standard model of care may be preferred by medical providers who seldom receive education in trans health and have limited knowledge or experience with the management of gender-affirming treatment.

An informed consent model stresses that direct work with trans patients increases provider firsthand knowledge and produces more satisfying and effective care outcomes with reduced bias in treatment. Research shows that trans people are more likely to make use of care when that care is easy to access and not based in assumptions that their gender identities are a mental illness because they differ from cultural expectations based on sex assigned at birth. Informed consent–based care is not without challenges. Because an informed consent model does not automatically involve mental health professionals, the model is misunderstood by some people in the trans community to imply getting hormones on demand, meaning receiving prescription medications from a medical provider without having any assessment of need and suitability of care options by the medical provider or anyone else. An informed consent model, nevertheless, does involve an assessment of the patient’s medical need for and ability to give consent to a specific treatment.

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