Informed consent vs. talk therapy: who decides when a transgender person can... - Charlie Blotner

The National Institutes of Health recently announced that they have designated lesbian, gay, bisexual, and transgender (LGBT) people as a health disparity population. The rationale for this designation has to do with the mounting evidence that the LGBT population has less access to health care and experiences higher of burdens of diseases such as depression, cancer, and HIV/AIDS. A study by Stanford University School of Medicine itself found that when surveying 176 medical schools, the median reported time dedicated to teaching LGBT-related content over the course of the entire curriculum was 5 hours. A third of those responses reported that their schools spent zero hours on LGBT health-related content during clinical training. While the extent of the causes of health disparities for the LGBT population are not yet fully understood, we have the power to educate current and future providers on how to better improve the lives of their LGBT patients.

I intend to discuss the gatekeeper model versus the informed consent model in the context of the World Professional Association for Transgender Health (WPATH) standards for transgender (trans) individuals seeking to start hormone replacement therapy (HRT) and or gender reassignment surgeries. The benefits and dangers that these models pose are crucial for providers to be aware of when treating their trans patients. Trans patients have been expected to undergo extensive talk therapy in order to access medical interventions and start HRT in recent years. However, with a lack of finances and access to health care to begin with, this step and pillar of the gatekeeper model and WPATH as a whole is extremely dangerous for an already vulnerable population in delaying care. While medical attention to trans people is starting to increase (see: Lancelet 2016 Transgender Health series), we still can and need to do better.

Take-a-ways from my presentation would include:

- Increased knowledge of the current WPATH standards of care and problematic models of starting hormone replacement therapy and having gender affirming surgeries

- Empowerment to taking changing the standard of care

- An understanding of hormone replacement therapy and general overview of gender affirming surgeries - Acquisition of transgender health care resources

- Empathy surrounding medical transition

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