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home > Guidance & Transition > Resources > ICTLEP Standards of Care

International Conference on Transgender Law and Employment Policy, Inc.

Health Law Standards of Care for Transsexualism

Health Law Standards of Care for Transsexualism first adopted at the 2nd International Conference on Transgender Law and Employment Policy, August 1993 in Houston, Texas, U.S.A.

Principle 1. Transsexualism is an ancient and persistent part of human experience and is not in itself a medical illness or mental disorder. Transsexualism is a desire to change the expression of one's gender identity.

Principle 2. Persons have the right to express their gender identity through changes to their physical appearance, including the use of hormones and reconstructive surgery.

Principle 3. Persons denied the ability to exercise control over their own bodies in terms of gender expression, through informed access to medical services, may experience significant distress and suffer a diminished capacity to function socially, economically and sexually.

Principle 4. Providers of health care (including surgical) services to transsexuals have a right to charge reasonable fees for their services, to be paid in advance, and to require a waiver of all tort liability except negligence.

Principle 5. It is unethical to discriminate in the provision of sex reassignment services based on the sexual orientation, marital status, or physical appearance of a patient.

Standard 1. Physicians participating in transsexual health care shall provide hormonal sex reassignment therapy to patients requesting a change in their sexual appearance subject only to (1) the physician's reasonable belief that the therapy will not aggravate a patient's health conditions, (2) the patient's compliance with periodic blood chemistry checks to ensure a continued healthy condition, and (3) patient's signature of an informed consent and waiver of liability form. If the patient is married, the physician may not require divorce but may also require the spouse to sign a waiver of liability form.

Standard 2. Physicians providing hormonal sex reassignment therapy shall collect and publish on an annual basis the number of hormone prescriptions they have issued and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex hormone therapy, to all prospective patients inquiring into the physician's hormone therapy services.

Standard 3. Surgeons participating in transsexual health care shall provide sex reassignment surgery to patients requesting a change in their sexual appearance subject only to (1) the surgeon's reasonable belief that the surgery will not aggravate pre-existing health conditions. (2) the surgeon's reasonable determination that the patient has been under hormonal sex reassignment therapy for at least one year, and (3) the patient's signature of an informed consent and waiver of liability form. If the patient is married, the surgeon may not require divorce but may also require the spouse to sign a waiver of liability form.

Standard 4. Surgeons providing sex reassignment surgery shall collect and publish on an annual basis the number of sex reassignment surgeries they performed and the number and general nature of any complications and complaints involved. The publication requirement of this Standard shall be satisfied by providing the collected statistics in writing, together with other current information on the potential risks and complications of sex reassignment surgery, to all prospective patients inquiring into the sex surgeon's sex reassignment services.

Standard 5. Physicians and surgeons shall not divulge the nature or identity of any patient requesting or receiving sex reassignment services except as explicitly directed in a notarized written request by the patient.

Proposed Legal Definitions

Faced with the wide array of definitions of sex, gender and transsexualism, ICTLEP offer some standard definitions from the standpoint of utility under health law.

Sex: A person's identity along a continuum of role types with "male" and "female" at the polar extremes.

Role Type: A set of beliefs, behaviors and appearances.

Male: A role type which a particular culture associates with individuals anatomically structured for contributing reproductive cells to another person.

Female: A role type which a particular culture associates with individuals anatomically structured for receiving reproductive cells from another person.

Gender: The characteristics of a continuum of role types ranging from male to female, with such characteristics including behaviors and sexual anatomy, and being labeled as "masculine" and "feminine" at the polar extremes.

Transsexualism = Transgenderism: The condition of wanting to change one's gender to better match one's sex.

These revised legal definitions recognize the emerging scientific reality that sex is in the brain, and not the body. Transsexuals do not really change their sex - they are born with that. Instead, transsexuals aim to change the erroneous sex labels that were assigned to them at birth. The only way to change those labels is to change the basis upon which those labels were applied, namely, the outward expressions of sex. This means that to change a sexual label, one must change their gender - from behavior to anatomy - since gender is the outward expression of one's sexual identify. Hence, transsexualism is really a misnomer and transgenderism is a more scientifically accurate term.

FORM 1: Informed Consent and Waiver of Liability

I, __________________ , having been fully informed in writing of the potential risks and complications of hormonal or surgical sex reassignment, do hereby choose of my own free will and consent to undertake this treatment because I want to alter my physical appearance to more closely reflect my gender identity.

I hereby release Dr. ________________ of any and all liability for my decision to undertake a change of my sexual appearance and, for long-term use of hormones or for sex reassignment surgery, to affect on a permanent, irreversible basis my current sexual functioning, I promise not to sue Dr. _____________ for any of the consequences of my hormonal sex reassignment or surgical sex reassignment unless those consequences are the result of negligence in the conduct of my hormone therapy or in the carrying out of my surgery.

Dated at ____________ this ______ day of ________, _________.

Patent signature:

Witness:

FORM 2: Spousal Informed Consent and Waiver of Liability

I, ______________ , am presently married to _____________________ (Patient). I understand that Patient wishes to alter his/her physical appearance to more clearly reflect his/her gender identity, and has been trying to do so for at least ____ year(s). I have been actively involved in and fully support Patient's sex change process.

I have been fully informed of the nature of transsexualism and sex reassignment surgery or hormonal therapy. I fully understand that the surgery or hormone therapy which Patient will undergo will transform Patient into the opposite sex. I fully understand that the surgery and effects of long-term use of hormones is not reversible, and that Patient will never be able to sire or bear children after the surgery or long-term hormonal therapy. I also understand that the sex reassignment process involves dangers and risks including, but not limited to, post-operative infection, depression, emotional changes and other physical and psychological changes. It is with my full knowledge and consent that my spouse, the Patient, undergo sex reassignment surgery or hormonal therapy to cause a change of his/her sex to occur.

I hereby release and hold harmless Dr. ___________________ from any and all claims arising out of performance of sex reassignment surgery or hormonal therapy, actual negligence excepted. I fully understand that I will not be able to seek monetary damages for any loss of sexual companionship between Patient and myself, the loss of Patient's ability to sire or bear children or any similar problems which may arise from the performance of the sex reassignment surgery or hormonal therapy.

Dated at ____________ this ______ day of ________, _________.

Spouse signature:

Witness:

Notary:

These Standards of Care were developed and adopted by consensus over a two-year period by the Health Law Project of the International Conference on Transgender Law and Employment Policy, Inc., and will be revised, as necessary, at subsequent conferences. The Health Law Project's membership includes professionals in the fields of law, health care policy and gender science - most of whom are transgendered themselves. We suggest you distribute these freely and widely. The Health Law Standards of Care were developed in the wake of widespread dissatisfaction by many in the transgendered community with the Harry Benjamin Standards of Care. Also relevant is the pending de-listing of transsexualism per se as a mental disorder from the DSM-IV. Many, if not most, of the patients doctors see for gender medical services (hormones; surgery) do not require any psychological services.

For more information or to provide comments on these Standards of Care, please write to: Martine Aliana Rothblatt, Esq., Director Health Law Project ICTLEP, Inc., 1718 Rhode Island Ave., NW #333, Washington, DC 20036 FAX: (301) 495-8987.

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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