WPATH, the World Professional Association for Transgender Health, is a worldwide professional association devoted to promoting evidence based health care for trans people. Their Standards of Care (SoC) guide governments, medical associations, and clinics across the world in setting protocols for the psychological, medical, surgical and related care of trans people. In Ontario, the protocols and criteria used by doctors and by the Ministry of Health in funding Gender Confirmation Surgeries (GCS) are largely based on the WPATH SoC V7 (although in Ontario, informed consent access to hormones is supported).
In September, WPATH released the new Standards of Care V8 which has some very exciting changes that will increase accessibility to gender affirming care, and reduce gatekeeping. Long-term, as this version is adopted by other bodies, governments, and insurers, gender affirming care will become both easier to access, and less costly.
First, WPATH has embraced access by informed consent to Hormone Replacement Therapy (HRT). This means if a patient wants to proceed after having the effects and risks explained to them, then hormones will be prescribed. While this is already the case in Ontario, it will be a major change in many jurisdictions.
The new SoC also contains major improvements in accessibility of Gender Affirming Surgeries (GAS). All surgeries now require only 6 months on HRT, rather than the previous 1 year. Even better, the SoC now recognizes our nonbinary siblings, and exempts them from the HRT requirement for surgery if they are not pursuing HRT. Even more importantly, there are no longer requirements to be completely living in your true gender for one year, or to have referral letters from doctors/therapists. If other bodies have a referral requirement, then only one letter is required for any surgery. These changes will mean quicker access, with much less procedural hassle.
However, by far the biggest long-term changes with regard to surgery is the very long list of procedures that the WPATH now considers
medically necessary. This long list includes an extensive list of Facial Feminization Surgeries, and Facial Masculinizing Surgeries, Breast Augmentations, etc. In Ontario, and in many jurisdictions, these are currently only covered by a few private insurance plans. Even better, facial and body hair clearance for trans feminine folk and preoperative genital hair clearance for all trans people are now considered a medically necessary procedure in the SoC. That should bring more coverage in private insurance plans, and hopefully, eventually coverage in public health care. Currently, trans women who can afford to spend many thousands of dollars on laser and electrolysis facial clearance.
Finally, coverage of youth and children has been improved. There is now a separate section for children, obviously focused only on social transition. The adolescent section strongly enforces the need for gender affirming care and its ability to improve mental health, strongly recommending a multidisciplinary approach and supporting youth who are medically competent in making decisions. This is a welcome change, as the community was very scared by previous drafts that moved away from supporting gender affirming care for youth.