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| HBIGDA STANDARDS OF CARE - 1998 (version 5) |
SECTIONS |
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X.
Requirements for Genital Reconstructive and Breast Surgery
Eligibility
Criteria. These minimum eligibility criteria for various surgeries
equally apply to biological males seeking genital reconstruction and
biological females seeking mastectomy and phalloplasty. They are:
1. legal
age of majority in the patient's nation
2. 12
months of continuous hormonal therapy for those without a medical
contraindication
3. 12
months of successful continuous full time real-life experience. Periods
of returning to the original gender may indicate ambivalence about
proceeding and should not be used to fulfill this criterion
4. if
required by the mental health professional, regular responsible
participation in a psychotherapy throughout the real life experience at
a frequency determined by the mental health professional. Psychotherapy,
per se, is not an absolute eligibility criterion for surgery.
5.
demonstrable knowledge of the cost, required lengths of
hospitalizations, likely complications, and post surgical rehabilitation
requirements of various surgical approaches.
6.
awareness of different competent surgeons.
Readiness
Criteria. The readiness criteria include:
1.
demonstrable progress in consolidating the evolving gender identity
2.
demonstrable progress in dealing with work, family, and interpersonal
issues resulting in a significantly better state of mental health (this
implies an absence of problems such as sociopathy, substance abuse,
psychosis, suicidality, for instance).
Can
Surgery Be Provided Without Hormones and the Real Life Experience? Individuals who
"just" want mastectomy, penectomy, or genital reconstructive
therapy without meeting the eligibility criteria can not be provided
bodily alterations because they are "special cases." Organ
removal or remodeling is a surgical treatment for a gender disorder. The
surgery occurs after many careful steps. Such surgery is not a patient
right that once demanded has to be granted. The SOC contains provisions
for an individual approach for every patient, but this does not mean
that the general guidelines for the sequence of psychiatric evaluation,
possible psychotherapy, hormones, and real life experience can be
ignored because a person desires just one surgical procedure.
If a
person has lived convincingly as a member of the opposite sex for a long
period of time and is assessed to be a psychologically healthy person
after a requisite period of psychotherapy, there is no inherent reason
that he or she must take hormones prior to having a desired breast or
genital surgery.
| Some
of the resources in this section contain differing viewpoints comprising
a variety of authors, committees, and interest groups. Additionally,
some of these materials are delivered in an advisory context, covering
legal, ethical, medical and social issues. These materials do not
necessarily represent the guidelines of TransGenderCare or
the philosophies of our staff. |
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