WPATH

The World Professional Association for Transgender Health (WPATH) is a nonprofit, interdisciplinary medical and educational association that was organized by a small group of physicians, mental health professionals, researchers, and trans people who were concerned with the type of gender variance that, in the 1970s, was associated with the term transsexualism. Over the next 40 years, the group slowly expanded its membership, began taking public positions advocating for the health and human rights of trans people, and initiated professional continuing education aimed at increasing access to gender-affirming health care globally. Incorporated in 1979 as the Harry Benjamin International Gender Dysphoria Association (HBIGDA), the group convened biennial international meetings to share knowledge about the diagnosis and treatment of trans people. It also developed the first Standards of Care (1979), which have since evolved to become a globally powerful instrument supporting trans health and human rights.

Scholars and practitioners from fields that affected trans health—predominantly surgery, endocrinology, internal medicine, urology, gynecology, mental health, and law—who were mostly based in Western Europe and North America began holding educational meetings in 1969. These meetings were sponsored by the Reed Erickson Educational Foundation, a trans-led organization, along with different educational institutions. At the Fourth International Conference on Gender Identity in 1975, organizers named the conference after Dr. Harry Benjamin in recognition of his 90th birthday and his pioneering research on transsexuality in the United States. With the Erickson Educational Foundation ceasing operations, attendees at the Fifth International Gender Dysphoria Symposium in 1977 formed HBIGDA and named the group in his honor.

The first version of the Standards of Care (SOC), which was approved by the attendees of the Sixth International Gender Dysphoria Symposium and published in 1979, was 9 pages long and focused on hormones and gender-affirming surgeries for “gender dysphoric persons.” By establishing its own ethical and clinical guidelines, HBIGDA hoped to legitimize trans health care and bring professional respect to the field, and thus it firmly linked the standards to the diagnosis of “Transsexualism” in the American Psychiatric Association’s Diagnostic and Statistical Manual, Third Edition (DSM-III; 1980).

The second version of the SOC, published in 1980, rescinded a guideline from the first version that required candidates for hormonal therapy to have successfully lived “full-time in the social role of the genetically other sex.” This expectation, which was referred to by trans people as the “real-life test,” was a significant barrier for some people who sought to transition. However, the extent to which this and other guidelines limited access to treatment was overstated by many trans activists, as very few health care providers at the time were even aware of the standards, much less following them.

The third and fourth versions of the SOC, published in 1981 and 1990, respectively, loosened [Page 924]the qualifications needed by the mental health professionals who evaluated trans clients. Whereas previously only licensed psychologists and psychiatrists could recommend hormone therapy and gender-affirming surgery, the new criteria enabled any clinical behavioral scientist with a minimum of a master’s degree to do so in an effort to expand access to care. Nevertheless, the criteria for access to hormones and especially to surgery remained strict.

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