Science

WPATH SOC8, a Step towards Accessible Trans Healthcare

On June 1st, 2022, the final draft of the WPATH Standards of Care 8th edition was completed after 5 years of intense work. 

“We hope the SOC8 will be a landmark in better access to inclusive trans health, for the well-being of trans people everywhere.”

Our Dr. Luis Capitán collaborated on the creation of WPATH version 8 as a member of the working group of the surgery chapter. In this latest version, facial gender-affirming surgery will finally be categorized as a medical necessity.

What is WPATH?

WPATH SOC 8 is short for the World Professional Association for Transgender Health’s “Standards of Care, 8th edition.”

Standards of care are recommendations for both patients and healthcare professionals. These recommendations inform on the rights and responsibilities in the diagnostic and treatment process.

The most known agency of best practices in medicine is the World Health Organization (WHO). The WHO publishes the International Classification of Diseases (ICD), whose 11th and most recent update included important changes for the trans community. 

In transhealth we have our own specialized version, with the 8th edition in over 40 years now pending publishing in the International Journal of Transgender Health (IJTH): WPATH’s Standards of Care.

What is New in WPATH 2022?

WPATH SOC8 consists of 20 chapters, 6 of which are entirely new and many of which have greatly expanded:

  1.  Global Applicability of the Standards of Care
  2.  Terminology – Diagnostic Criteria
  3.  Epidemiologic Considerations
  4.  Overview of Therapeutic Approaches for Gender Health
  5.  Assessment, Support and Therapeutic Approaches for Children
  6.  Assessment, Support and Therapeutic Approaches for Adolescents with Gender Variance/Dysphoria (new)
  7.  Assessment for Adults with Gender Variance/Dysphoria
  8.  Assessment, Support and Therapeutic Approaches for Non-Binary Individuals (new)
  9.  Managing Mental and Behavioral Health Conditions in Adults
  10.  The Role of Primary Care in Gender Health
  11.  Hormone Therapy for Adolescents and Adults
  12.  Sexual Health Across the Lifespan (new)
  13.  Reproductive Health for Adolescents and Adults
  14.  Voice and Communication Therapy
  15.  Surgery for Adolescents and Adults and Postoperative Care and Follow-Up
  16.  Applicability of the Standards of Care to People Living in Institutional Environments
  17.  Applicability of the Standards of Care to People with Intersex Conditions
  18.  Applicability of the Standards of Care to Eunuchs (new)
  19.  Competency, Training, Education (new)
  20.  Ethics (new)

Although the full SOC8 is still pending official release, we expect that during the 27th WPATH conference 2022 in Montreal, more details will be revealed.

The Importance of Transgender Standards of Care?

Best practices not only help move forward the quality of care and access, they are essential.

Gender diverse people historically report a lack of trans friendly healthcare. However, this is beginning to change. In the latest version of the International Classification of Diseases, WHO shows solidarity with LGBTIQ+ people: 

  • Changes in antiquated language to more affirming and inclusive terms
  • Removal from the “disorder” status to the more neutral “gender incongruence” which reduces the stigma
  • Modification as a “mental health” condition to a sexual health matter, which depathologizes the approaches and encourages early access

In general, best practices guides are living documents of regular updates as agreed upon by the corresponding medical community.  Standards of care are a unified statement on health care policy by the stakeholders they affect. 

How is WPATH Standards of Care Version 8 Developed?

As with much scientific literature of its type, it is a complex process that involves the coordination of various committees, some by vote even, and continual peer review. As is customary, a strict methodology of reviews, feedback and edits is established by the workgroups assigned to each chapter.

SOC8 Revision Committee of WPATH 2022

In 2017, WPATH started with the complex process of updating the 8th version of the WPATH Standards of Care. This began with establishing the Guideline Steering Committee and chapter members.

Together they then defined the chapters which would be included in the new edition, based on past versions. An evidence review team was created, responsible for the systematic review of all data and sources according to scientific reporting standards. 

Finally, an independent professional editor was commissioned.

WPATH SOC8 Aims to Improve Quality-of-life

WPATH version 8 clarifies details that are necessary for insurance providers of transgender people who seek a medical transition. Healthcare that is categorized as essential to your daily function is much more likely to be covered by medical insurance policies. 

Any procedure deemed to be cosmetic, however, is almost never permitted by public or private health coverage.

Effects of FFS on Quality-of-life

In 2020 Facialteam conducted research to survey the effects of FFS surgery on quality-of-life. In this, we highlight the historic lack of research in trans surgery, as facial gender surgery has largely been considered cosmetic to date.

Our Research and Development team presented evidence on why gender-affirming surgery should be defined as medically necessary in the new SOC8. All existing literature on facial feminization was also reviewed in order to consolidate conclusions.  

Researchers measured the physical and psychological health of almost 250 trans women. Part of the test group had FGCS or FFS as part of their transition, and some did not. 

This study found that trans women who had undergone facial gender confirmation surgery had significantly higher scores in psychological well-being.

Gender-affirming healthcare is vital for many women in transition or dealing with gender dysphoria. Facialteam advocates to enable greater access for women seeking trans-friendly healthcare.

Facialteam promotes WPATH’s Best Practices

Facialteam is a WPATH member, participating in modernizing the field of transgender healthcare in all its aspects. 

This is accomplished in four ways at Facialteam; 

  1. Technological innovations in imaging, surgery and patient care that improve any stage of the FFS process.
  2. Mental health around the FFS experience is core to our practice, for both patients and their supportive companions.
  3. Scientific investigation on several themes related to best practices in trans surgery.  Such as the medical article, “Facial Gender Confirmation Surgery – Review of the Literature and Recommendations for Version 8 of the WPATH Standards of Care”. The publication appeared in the International Journal of Transgender Health in 2017, an important step towards the necessary changes that were put into effective in the new SOC8.
  4. Facialteam offers education for future specialists in facial gender surgery. This results in more professionals, more access and more excellent quality of care and results.

Best practices in healthcare are essential to pioneer all areas of care. Minority groups such as trans, nonbinary and other gender queer people take most benefit of these standards.  

Facialteam stands for improving transgender health care to help make discrimination, medical malpractice and social exclusion disappear.

Patient Relations Manager Lilia Koss, presentator of Lilia's Livestreams
About the author

Hello world! I’m Lilia Koss and I use she, her, and they pronouns. What are yours? With a background in humanities and diverse professional experiences, I have been working with the Facialteam founders and directors since 2018. Involved from the ground up, so I’ve had hands in many pots: patient coordination, orientation events on 3 continents, social media, written and audiovisual content about our gender-affirming healthcare...but now life is more defined. Lately, I focus my energies on Public Relations, community management and live streaming to help raise the visibility of trans health. Life is pretty complete.