Abstract and Introduction: As you'd guess this is just some preemptive descriptions of what you'd see in the chapters to come. The big points in no particular order are that the document aims to help those seeking TGD (Transgender and Gender Diverse, a term that will pop up extremely frequently in the SOC) healthcare, that said healthcare is complicated and multifaceted in both the types of care that exist and local cultural influences that impact what's available, and that the WPATH recommends (rightfully if I might add) that TGD healthcare should be offered on an individualized approach and that there is no "one size fits all". There's also some discussion on "minority stress" which is a fun concept that deserves some time, and a quick summary of each of the 18 upcoming chapters. I'm not seeing any major differences from v7 yet.

Chapter 1: Terminology: We start out with the chapter outlining that language with transgender terms varies from language to language, occasionally without proper translation between languages, and that terms used can change over time for various reasons (like the shift from "transsexual" to "transgender". The chapter then discusses how the rest of the SOC will largely use the term "transgender and gender diverse" (TGD) as it provides the best inclusivity for the individuals the document is referring to, taking over as a new "umbrella term". It should be obvious but I'll say it out loud in case it isn't clear, but "inclusivity" here does not correlate with "wokeness" or other lgbt/transgender social-politics. It's actually being used correctly which is awesome. As for the term TGD, this is actually a change from v7, and Ive got to say that I enjoy it simply out of the fact that it means you don't have to read "transsexual, transgender, and gender non-conforming" 5 times in a single page. The last thing to note about this chapter is that it's the first chapter to start giving out "Statements of Recommendations" which are probably the single most important thing about this 260 page document if I'm being honest. Copy-pasted they are:

1.1- We recommend health care professionals use culturally relevant language (including terms to describe transgender and gender diverse people) when applying the Standards of Care in different global settings.

1.2- We recommend health care professionals use language in health care settings that uphold the principles of safety, dignity, and respect.

1.3- We recommend health care professionals discuss with transgender and gender diverse people what language or terminology they prefer.

These are all great, but I hope that there will be a section in the appendix that has all Statements of Recommendations for all chapters. I'll do one more chapter then I'm going to take break.

Chapter 2: Global Applicability: Again, a pretty basic chapter; it talks about the various pressures TGD people face, how this can isolate them and generally cause stress, and also discusses some more the differences in cultural aspects of gender that can further influence what care a TGD person either needs or has access to. Statement of reccomendations is as follows:

2.1- We recommend health care systems should provide medically necessary gender-affirming health care for transgender and gender diverse people.

2.2- We recommend health care professionals and other users of the Standards of Care, Version 8 (SOC-8) apply the recommendations in ways that meet the needs of local transgender and gender diverse communities, by providing culturally sensitive care that recognizes the realities of the countries they are practicing in.

2.3- We recommend health care providers understand the impact of social attitudes, laws, economic circumstances, and health systems on the lived experiences of transgender and gender diverse people worldwide.

2.4- We recommend translations of the SOC focus on cross-cultural, conceptual, and literal equivalence to ensure alignment with the core principles that underpin the SOC-8.

2.5- We recommend health care professionals and policymakers always apply the SOC-8 core principles to their work with transgender and gender diverse people to ensure respect for human rights and access to appropriate and competent health care, including:

General principles

Be empowering and inclusive. Work to reduce stigma and facilitate access to appropriate health care for all who seek it;

Respect diversity. Respect all clients and all gender identities. Do not pathologize differences in gender identity or expression;

Respect universal human rights including the right to bodily and mental integrity, autonomy and self-determination; freedom from discrimination, and the right to the highest attainable standard of health.

Principles around developing and implementing appropriate services and accessible health care

Involve transgender and gender diverse people in the development and implementation of services;

Become aware of social, cultural, economic, and legal factors that might impact the health (and health care needs) of transgender and gender diverse people, as well as the willingness and the capacity of the person to access services;

Provide health care (or refer to knowledgeable colleagues) that affirms gender identities and expressions, including health care that reduces the distress associated with gender dysphoria (if this is present);

Reject approaches that have the goal or effect of conversion and avoid providing any direct or indirect support for such approaches or services.

Principles around delivering competent services

Become knowledgeable (get training, where possible) about the health care needs of transgender and gender diverse people, including the benefits and risks of gender-affirming care;

Match the treatment approach to the specific needs of clients, particularly their goals for gender identity and expression;

Focus on promoting health and well-being rather than solely the reduction of gender dysphoria, which may or may not be present;

Commit to harm reduction approaches where appropriate;

Enable the full and ongoing informed participation of transgender and gender diverse people in decisions about their health and well-being;

Improve experiences of health services including those related to administrative systems and continuity of care.

Principles around working towards improved health through wider community approaches

Put people in touch with communities and peer support networks;

Support and advocate for clients within their families and communities (schools, workplaces, and other settings) where appropriate.

-----(I'm back) Yes, I had to split this into two because of how long that last one was. I've checked and unfortunately there isn't a place in the document where all of these are compiled, but regarding these recommendations, all of these are great. 2.1 in particular is interesting because as part of a "including but not limited to" list of medically necessary treatments is "hair removal for gender affirmation". I wouldn't recommend being too optimistic because of how fricked the US health system is, but we might get some more insurance coverage for laser or electrolysis, which would be nice. 2.2-2.5 basically summarize to "understand trans issues and don't be shitty to trans people" which is fine. I'm going to take a break from this and continue in an undetermined amount of time, but if you have any questions you'd like to ask me, or chapters you'd like to be reviewed sooner, don't hesitate to leave a comment! See you later!

>>11042
>As for the term TGD, this is actually a change from v7, and Ive got to say that I enjoy it simply out of the fact that it means you don't have to read "transsexual, transgender, and gender non-conforming" 5 times in a single page.
Haha. It's certainly less unwieldy. I hope no one starts saying Tijidi though.

Alright I'm back from a long nap and half a gyro sandwich so I'm ready to continue. >>11045 I think that we'll be fine from TGD becoming a mainstream term and having to deal with people using it incorrectly. Other terms like GAHT (Gender Affirming Hormone Treatment) haven't caught on outside of various scientific articles because we already have a significantly better acronym for day to day use (HRT). Granted, there have been MANY examples of cissoids completely and utterly failing to find and use "inclusive terms" without actually understanding them, but I think we'll be safe for at least 5 years (and longer unless some weird culture shift happens); considering that your average ally doesn't read scientific articles about how to biohack your body. In the worse case scenario in which someone does describe a troon as "TGD" said troon should still have the option to call out the term as pathologizing or using age-old "I am a transsexual" as a way to make the other person uncomfortable enough to consider their actions. Health care professionals probably shouldn't have this problem though due to (hopefully) reading recommendation 1.2 and 1.3.

Chapter 3: Population Estimates: This chapter acted as a short meta-analysis over research in the past decade or so focused around estimating the size of the transgender population. The overall report finds the following: (which replaces the statements of reccomendation for this chapter)

Summary of reported proportions of TGD people in the general population:

Health systems-based studies: 0.02–0.1%

Survey-based studies of adults: 0.3–0.5% (transgender), 0.3–4.5% (all TGD)

Survey-based studies of children and adolescents: 1.2–2.7% (transgender), 2.5–8.4% (all TGD)

---This seems fair, but I've got to say that I'm a bit surprised by how high the total amount of youth who identify as transgender was. I personnaly usually stuck with the total population estimate of 1 in 200 to 1 in 100, but the findings of over 1 in 50 people suprises me. I've always been rather conservative with my estimates on this, but if said 1 in 50 population begins to surface more (i.e. young people finding out their trans and becoming adults,) this provides a fairly high level of hope for getting large enough voting-bloc in the US to become significant instead of just relying on lgb allies and whatnot. This would take a couple of decades though. At this point I'd also like to point out (which I forgot to mention earlier) that the SOC v7 was published in 2012, and that the DSM-5 was published in 2013. Before DSM-5 "Gender Dysphoria" was named "Gender Identity Disorder" (GID) which (as mentioned in v7) was a stigmatizing and pathologizing term that made fewer people realize (or want to realize) that they had it. It's pretty cool being able to see the changes on how changes in language, in this case diagnostic language, and how they impact how visible the community is. (On a side note, ICD-11 was also updated at the start of this year and among it's updates were a reclassifying it from "transsexualism" or "gender identity disorder" to "gender incongruence". Overall this was a fun chapter to read, and was actually pretty interesting.

Chapter 4: Education: This chapter is a chapter new to v8, and discusses how in medical training, TGD issues are largely ignored, and that in workspaces and other institutional environments a lack of transgender education leads to transphobia and other negative effects. One thing that stuck out to me was that nursing baccalaureate programs had an average of 2.1 hours of lgbtq focused training, and you know that the "t" part will only take up a fraction of that measly time. Statements of reccomendation are as follows:
4.1- We recommend all personnel working in governmental, nongovernmental, and private agencies receive cultural-awareness training focused on treating transgender and gender diverse individuals with dignity and respect.

4.2- We recommend all members of the health care workforce receive cultural-awareness training focused on treating transgender and gender diverse individuals with dignity during orientation and as part of annual or continuing education.

4.3- We recommend institutions involved in the training of health professionals develop competencies and learning objectives for transgender and gender diverse health within each of the competency areas for their specialty.

This seems pretty good, but as partially implied when discussing transphobia in workplaces, it's unlikely for much to happen unless legislative acts force it. I'll do one more chapter (a longer one) before taking a 2 hour break. Also, thank you very much >>11049 for spinning my block of text around as I was typing, that was a very fun and unique experience!

>>11048
#spin

sorry

had to

Chapter 5: Assessment of Adults: This is arguably the first important chapter so let's dive right into the statements of recommendation because they're long and will have to be split into multiple comments:
5.1- We recommend health care professionals assessing transgender and gender diverse adults for physical treatments:

5.1.a- Are licensed by their statutory body and hold, at a minimum, a master’s degree or equivalent training in a clinical field relevant to this role and granted by a nationally accredited statutory institution.

5.1.b- For countries requiring a diagnosis for access to care, the health care professional should be competent using the latest edition of the World Health Organization's International Classification of Diseases (ICD) for diagnosis. In countries that have not implemented the latest ICD, other taxonomies may be used; efforts should be undertaken to utilize the latest ICD as soon as practicable.

5.1.c- Are able to identify co-existing mental health or other psychosocial concerns and distinguish these from gender dysphoria, incongruence, and diversity.

5.1.d- Are able to assess capacity to consent for treatment.

5.1.e- Have experience or be qualified to assess clinical aspects of gender dysphoria, incongruence, and diversity.

5.1.f- Undergo continuing education in health care relating to gender dysphoria, incongruence, and diversity.

5.2- We suggest health care professionals assessing transgender and gender diverse adults seeking gender-affirming treatment liaise with professionals from different disciplines within the field of transgender health for consultation and referral, if required.

The following recommendations are made regarding the requirements for gender-affirming medical and surgical treatment (all should be met):

5.3- We recommend health care professionals assessing transgender and gender diverse adults for gender-affirming medical and surgical treatment:

5.3.a- Only recommend gender-affirming medical treatment requested by a TGD person when the experience of gender incongruence is marked and sustained.

5.3.b- Ensure fulfillment of diagnostic criteria prior to initiating gender-affirming treatments in regions where a diagnosis is necessary to access health care.

5.3.c- Identify and exclude other possible causes of apparent gender incongruence prior to the initiation of gender-affirming treatments.

5.3.d- Ensure that any mental health conditions that could negatively impact the outcome of gender-affirming medical treatments are assessed, with risks and benefits discussed, before a decision is made regarding treatment.

5.3.e- Ensure any physical health conditions that could negatively impact the outcome of gender-affirming medical treatments are assessed, with risks and benefits discussed, before a decision is made regarding treatment.

5.3.f- Assess the capacity to consent for the specific physical treatment prior to the initiation of this treatment.

5.3.g- Assess the capacity of the gender diverse and transgender adult to understand the effect of gender-affirming treatment on reproduction and explore reproductive options with the individual prior to the initiation of gender-affirming treatment.

5.4- We suggest, as part of the assessment for gender-affirming hormonal or surgical treatment, professionals who have competencies in the assessment of transgender and gender diverse people wishing gender-related medical treatment consider the role of social transition together with the individual.

5.5- We recommend transgender and gender diverse adults who fulfill the criteria for gender-affirming medical and surgical treatment require a single opinion for the initiation of this treatment from a professional who has competencies in the assessment of transgender and gender diverse people wishing gender-related medical and surgical treatment.

5.6- We suggest health care professionals assessing transgender and gender diverse people seeking gonadectomy consider a minimum of 6 months of hormone therapy as appropriate to the TGD person’s gender goals before the TGD person undergoes irreversible surgical intervention (unless hormones are not clinically indicated for the individual).

5.7- We recommend health care professionals assessing adults who wish to detransition and seek gender-related hormone intervention, surgical intervention, or both, utilize a comprehensive multidisciplinary assessment that will include additional viewpoints from experienced health care professional in transgender health and that considers, together with the individual, the role of social transition as part of the assessment process.

----Starting with 5.1, this is just asking that health care professionals are competent, and there's nothing out of the ordinary here. 5.2 adds onto this by recommending a multi-disciplinary team for transender care. In my experience this is more of a hopeful suggestion instead of something that's very likely to happen, but it's still good to have. Getting into 5.3 is where everything gets complicated, but any concerns get explained away in the ensuing explanations. 5.3.a makes sure that care isn't gatekept through stuff like "ROGD" (or any adult equivelent), 5.3.c. points out that "other causes of gender incongruence" are actually quite rare, the rest of 5.3 still highlights that delaying GASMT (Gender Affriming Surgical/Medical Treatment) is a bad idea. 5.4 is cool because it explicitly states that social and medical transition are separate and that HCPs (Health Care Provides) should let the patient choose how they deal with social transition. Realistically this means that RLE is denounced and that becoming a boymoder is 100% WPATH certified (although luckily in the text the word "boymoder" never shows up, so any other boymoders out there can still avoid hitting the mainstream). 5.5 is SUPER GOOD NEWS for the obvious reasons, 5.6 is fine, and 5.7 works out because how how frequently it mentioned that detransers are rare. Overall this is a great chapter, and hopefully the next one (dealing with adolescents) keeps this trend up. I'd also like to congratulate the SOC on reintroducing all of the acronyms used at the start of each chapter; SOCs usually aren't read in order, so it's nice to not have to go diggging through the text again if you want to find out what a HCP or GASMT is. As I said last time, I'm going to take around a 2 hour break before returning to this, (it'll be more like 3 though taking into account the time it takes for me to write these,) but if you have any questions or comments I'll probably be able to respond to them sooner. See you in a bit!

>>11046
AMAB/AFAB have been coopted for Evil. The same might happen here. Plus, it just sounds off.
It'll probably be fine but the "danger" is real.

>>11047
>Survey-based studies of children and adolescents: 1.2–2.7% (transgender), 2.5–8.4% (all TGD)
Hmm.. I can't imagine that this many people have always quietly struggled with dysphoria. Were that so you'd expect this phenomenon to have been better documented throughout the ages. Like homosexuality. Personally, this further reinforces my belief that there might be a difference in degree between the 0.5% and the rest of the delta. It might be the case that it's not just that more people of the same sort are seeking help but that people who fall below a certain threshold of intensity vis a vis their gendered feelings are now acting on those impulses. Perhaps because they're more accepted, perhaps because they now have the information required to interpret them. Perhaps for both reasons.

Or maybe it's just the endocrine-disrupting chemicals. Who knows lol. Maybe all of the above.
I could write way more about this but I have things to attend to, unfortunately, so this will have to do for now.

>>11055
At the risk of sounding like someone who thinks ROGD exists, my personal bet is that a maximum of 1 in 50 people are trans and that the extra are just people questioning or experimenting. I think a 1 in 50 would coincide well with the ~1 in 20 that are gay. Although it isn't discussed in the SOC (at least not as far as I've read), gender dysphoria is caused by "neurological sex" developing differently from "physical sex". (Of which neuralogical sex (which is a fancy way to say natal gender) is determined at a specific time in the womb from testosterone or lack thereof. This was the main result of Dick "Ferdinand" Swaab's research into the development of gender and sexuality as part of neurological development. (Look up Dick Swaab for more info; I swear that's his real name). Although the question of what neurological development "makes someone gay" isn't as concretely defined as "what makes someone trans", I think its safe to assume that they're connected enough for the above percentages of 5% and 2% to make sense as coorelations to other hormonal developments and disorders.

Thanks for commenting too! I love reading others interpretations of this sort of data and bouncing around miscellaneous medical theories!

Chapter 6: Adolescents: This chapter was a hard one to read due to my personal thoughts and experiences with gender over the last couple of years, but if you don't have deep resentments and sadness over your childhood you should be fine reading it. The chapter starts out by talking about how TGD adolescents (of which I should mention: "Children" is before puberty, "Adolescents" is puberty until adulthood, and "Adults" is the local age of majority [which for the vast majority of areas is 18, so I'll just be using that as a cutoff]) have better mental health outcomes if they get access to gender affirming care. Who knew? We also get some more (rather obvious) information being that youngshits have better mental health than midshits and oldshits. (In nicer terms of course.) Here's this chapter's recommendations:

6.1- We recommend health care professionals working with gender diverse adolescents:

6.1.a- Are licensed by their statutory body and hold a postgraduate degree or its equivalent in a clinical field relevant to this role granted by a nationally accredited statutory institution.

6.1.b- Receive theoretical and evidenced-based training and develop expertise in general child, adolescent, and family mental health across the developmental spectrum.

6.1.c- Receive training and have expertise in gender identity development, gender diversity in children and adolescents, have the ability to assess capacity to assent/consent, and possess general knowledge of gender diversity across the life span.

6.1.d- Receive training and develop expertise in autism spectrum disorders and other neurodevelopmental presentations or collaborate with a developmental disability expert when working with autistic/neurodivergent gender diverse adolescents.

6.1.e- Continue engaging in professional development in all areas relevant to gender diverse children, adolescents, and families.

6.2- We recommend health care professionals working with gender diverse adolescents facilitate the exploration and expression of gender openly and respectfully so that no one particular identity is favored.

6.3- We recommend health care professionals working with gender diverse adolescents undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity-related concerns and seek medical/surgical transition-related care, and that this be accomplished in a collaborative and supportive manner.

6.4- We recommend health care professionals work with families, schools, and other relevant settings to promote acceptance of gender diverse expressions of behavior and identities of the adolescent.

6.5- We recommend against offering reparative and conversion therapy aimed at trying to change a person’s gender and lived gender expression to become more congruent with the sex assigned at birth.

6.6- We suggest health care professionals provide transgender and gender diverse adolescents with health education on chest binding and genital tucking, including a review of the benefits and risks.

6.7- We recommend providers consider prescribing menstrual suppression agents for adolescents experiencing gender incongruence who may not desire testosterone therapy, who desire but have not yet begun testosterone therapy, or in conjunction with testosterone therapy for breakthrough bleeding.

6.8- We recommend health care professionals maintain an ongoing relationship with the gender diverse and transgender adolescent and any relevant caregivers to support the adolescent in their decision-making throughout the duration of puberty suppression treatment, hormonal treatment, and gender- related surgery until the transition is made to adult care.

6.9- We recommend health care professionals involve relevant disciplines, including mental health and medical professionals, to reach a decision about whether puberty suppression, hormone initiation, or gender-related surgery for gender diverse and transgender adolescents are appropriate and remain indicated throughout the course of treatment until the transition is made to adult care.

6.10- We recommend health care professionals working with transgender and gender diverse adolescents requesting gender-affirming medical or surgical treatments inform them, prior to initiating treatment, of the reproductive effects including the potential loss of fertility and available options to preserve fertility within the context of the youth's stage of pubertal development.

6.11- We recommend when gender-affirming medical or surgical treatments are indicated for adolescents, health care professionals working with transgender and gender diverse adolescents involve parent(s)/guardian(s) in the assessment and treatment process, unless their involvement is determined to be harmful to the adolescent or not feasible.

The following recommendations are made regarding the requirements for gender-affirming medical and surgical treatment (All of them must be met):

6.12- We recommend health care professionals assessing transgender and gender diverse adolescents only recommend gender-affirming medical or surgical treatments requested by the patient when:

6.12.a- The adolescent meets the diagnostic criteria of gender incongruence as per the ICD-11 in situations where a diagnosis is necessary to access health care. In countries that have not implemented the latest ICD, other taxonomies may be used although efforts should be undertaken to utilize the latest ICD as soon as practicable.

6.12.b- The experience of gender diversity/incongruence is marked and sustained over time.

6.12.c- The adolescent demonstrates the emotional and cognitive maturity required to provide informed consent/assent for the treatment.

6.12.d- The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.

6.12.e- The adolescent has been informed of the reproductive effects, including the potential loss of fertility and the available options to preserve fertility, and these have been discussed in the context of the adolescent’s stage of pubertal development.

6.12.f- The adolescent has reached Tanner stage 2 of puberty for pubertal suppression to be initiated.

6.12.g- The adolescent had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired surgical result for gender-affirming procedures, including breast augmentation, orchiectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment unless hormone therapy is either not desired or is medically contraindicated.

The first couple of recommendations are pretty simple, again just boiling down to "HCPs should be competent" and that a multi-disciplinary team should be used. 6.4 is great, but, not surprisingly, means practically nothing without legislative support and actions. 6.5 is the same but tends to have more legislative support (at least in the states). One thing I found interesting about 6.5 was how they described schools forcing students to have "acceptable hairstyles" (and not gender non-conforming ones) as an example of conversion therapy, even if it's minor. I personally had never considered it as such, but I know that I will in the future. 6.6 is fine, there isn't anything major to say about it, 6.7 is good, 6.8 is neat, and although 6.9 could've been iffy, explanations on how it's best accomplished should help prevent gatekeeping. 6.10 is where have my first problem, in that I think that it puts too much emphasis on options for fertility preservation. I will admit that I have my biases with this, but I think that fertility preservation recommended too much (which can lead to delays in HRT and stuff) and that if you're a tranner, you're already screwed fertility-wise and are better off going straight to coping/seething about infertility (due to not being able to have the "fertility role" of your choice. Again, I'm biased, but I wish it was just a bit shorter. 6.11 is fine, and 6.12 works because it actively discusses the ways in which adolescents might be gatekept from treatment (e.g. explaining incongruences with a patient's "described gender experience"). The only other thing I have to say about this chapter is that I wish that it mentioned how not getting on HRT but staying on blockers could cause excessive height gain due to the way bones fuse, but this might get talked about more in chapter 12. That's it for this chapter!

Chapter 7: Children: This was a relaxing chapter to read, and it makes me think on a personal level on how to best introduce the ideas of gender and being transgender to a kid being raised. For me it's a fun way to think about what the future could look if I was in the opposite position of what I'm in now, and I think it'd be neat to watch and raise a trans kid to grow up in a supportive and well educated environment. But because I'll never be able to experience something like that, here's the next set of recommendations:

7.1- We recommend health care professionals working with gender diverse children receive training and have expertise in gender development and gender diversity in children and possess a general knowledge of gender diversity across the life span.

7.2- We recommend health care professionals working with gender diverse children receive theoretical and evidenced-based training and develop expertise in general child and family mental health across the developmental spectrum.

7.3- We recommend health care professionals working with gender diverse children receive training and develop expertise in autism spectrum disorders and other neurodiversity or collaborate with an expert with relevant expertise when working with autistic/neurodivergent, gender diverse children.

7.4- We recommend health care professionals working with gender diverse children engage in continuing education related to gender diverse children and families.

7.5- We recommend health care professionals conducting an assessment with gender diverse children access and integrate information from multiple sources as part of the assessment.

7.6- We recommend health care professionals conducting an assessment with gender diverse children consider relevant developmental factors, neurocognitive functioning, and language skills.

7.7- We recommend health care professionals conducting an assessment with gender diverse children consider factors that may constrain accurate reporting of gender identity/gender expression by the child and/or family/caregiver(s).

7.8- We recommend health care professionals consider consultation, psychotherapy, or both for a gender diverse child and family/caregivers when families and health care professionals believe this would benefit the well-being and development of a child and/or family.

7.9- We recommend health care professionals offering consultation, psychotherapy, or both to gender diverse children and families/caregivers work with other settings and individuals important to the child to promote the child's resilience and emotional well-being.

7.10- We recommend health care professionals offering consultation, psychotherapy, or both to gender diverse children and families/caregivers provide both parties with age-appropriate psychoeducation about gender development.

7.11- We recommend that health care professionals provide information to gender diverse children and their families/caregivers as the child approaches puberty about potential gender affirming medical interventions, the effects of these treatments on future fertility, and options for fertility preservation.

7.12- We recommend parents/caregivers and health care professionals respond supportively to children who desire to be acknowledged as the gender that matches their internal sense of gender identity.

7.13- We recommend health care professionals and parents/caregivers support children to continue to explore their gender throughout the pre-pubescent years, regardless of social transition.

7.14- We recommend the health care professionals discuss the potential benefits and risks of a social transition with families who are considering it.

7.15- We suggest health care professionals consider working collaboratively with other professionals and organizations to promote the well-being of gender diverse children and minimize the adversities they may face.

Practically all of these summarize to "be competent". I was a bit concerned with the fertility emphasis on 7.11, but luckily it just focuses on making sure that parents understand that their trans kid will probably need HRT eventually. I also appreciated the nuance given in regards to the importance of "gender exploration", highlighted by this quote: "Cisgender children are not expected to undertake this exploration, and therefore attempts to force this with a gender diverse child, if not indicated or welcomed, can be experienced as pathologizing, intrusive and/or cisnormative (Ansara & Hegarty, 2012; Bartholomaeus et al., 2021; Oliphant et al., 2018)." Overall a good chapter. I'll do 3 more before taking a longer break.

Chapter 7: Nonbinary: The majority of this chapter describes the existence of nonbinary people, what troubles they can face with healthcare providers in regards to treatment and assumptions, and the general need for an individually personalized and tailored approach for treatment. It also dropped off the estimate that 25-50 percent of the transgender population is nonbinary, which seems like a lot to me. This might be influenced in part though by the fact that I've never seen another trans person IRL. Heres the statements of recommendations:

8.1- We recommend health care professionals provide nonbinary people with individualized assessment and treatment that affirms their experience of gender.

8.2- We recommend health care professionals consider gender-affirming medical interventions (hormonal treatment or surgery) for nonbinary people in the absence of “social gender transition.”

8.3- We recommend health care professionals consider gender-affirming surgical interventions in the absence of hormonal treatment, unless hormone therapy is required to achieve the desired surgical result.

8.4- We recommend health care professionals provide information to nonbinary people about the effects of hormonal therapies/surgery on future fertility and discuss the options for fertility preservation prior to starting hormonal treatment or undergoing surgery.

These were all fine (to my knowledge). I myself am not nonbinary and didn't see anything wrong with this chapter. I do wish though that they discussed the options of SERMs and SARMs (Selection Estrogen/Androgen Receptor Modulators) that can be used by nonbinary people for achieving specific developments of secondary sex characteristics, but that's the only major change I'd recommend.

Chapter 9: Eunuchs: Well uh... this was a chapter. It mainly acted as an introduction to eunuchs, and, honestly if you want to know more you should just read the chapter: it's a shorter one and I'm not going to explain it any better than I have so far. Recommendations are as follows:

9.1- We recommend health care professionals and other users of the Standards of Care 8th guidelines should apply the recommendations in ways that meet the needs of eunuch individuals

9.2- We recommend health care professionals should consider medical intervention, surgical intervention, or both for eunuch individuals when there is a high risk that withholding treatment will cause individuals harm through self-surgery, surgery by unqualified practitioners, or unsupervised use of medications that affect hormones.

9.3- We recommend health care professionals who are assessing eunuch individuals for treatment have demonstrated competency in assessing them.

9.4- We suggest health care professionals providing care to eunuch individuals include sexuality education and counseling.

These should all be fine; I did enjoy 9.2 a lot though and hope that some similar recommendations pop up later in chapters 12 and 13. Regarding the this being included as a chapter in the first place, I know that a lot of people were initially upset that this was included as a chapter at all, due to the time possibly wasted on it, but I don't think it matters too much. For better or worse, eunuchs as a population have medical needs most similar to transgender people, and if recommendations of care for them weren't published here, they wouldn't be published anywhere. Unless someone comes up to me with a chart of the budget for the SOC and shows me a specific monetary value of how much this chapter cost that could've been spent elsewhere, I won't harbor any resentment to anyone for the inclusion of this as a chapter, and I advise others to do the same. Moving on though, there was one other thing that popped up in this chapter that I am concerned about in relation to chapter 12 (which is about HRT). The WPATH still recommends against Bicalutamide as an antiandrogen to "lack of peer reviewed scientific studies". I get that the WPATH wants to maintain "respectability" or whatever, but honestly bica has been around for long enough that they should just throw it in anyways. Besides, if fewer people take it then we won't have the ability to make peer reviewed studies in the first place. Decent chapter though.

>>11062
It's not zero sum, I think. Just because this chapter helps this group does not mean that it came at the cost of any other group.

Sorry, don't let me interrupt haha.

>>11063
And how do you keep seeing what I type before I post it?

>>11065
Umm.. we can all do it here lol. Aren't you seeing what I'm typing?
It's kind of this board's gimmick. This site's, rather.

I never realized that. It's really cool but now I realize that I should be careful with what I type in drafts

Haha. It's pretty neat, no?.

Hah. It can be a bit stressful, I imagine. Like, I write long effortposts on other sites but I never wrote one here yet. The editing process being public could feel kind of stressful.

It's definitely stressful when seeing others talk simultaneously to typing, but it isn't too bad. Regarding your initial comment of it not being zero-sum, I agree with you, and felt sort of like an ass hole while typing that. I just remember a year or so ago seeing controversy regarding it being introduced as a chapter that I wanted to address. Anything you want to add before I go off to read the next chapter?

>>11070
>I just remember a year or so ago seeing controversy regarding it being introduced as a chapter that I wanted to address.
Yeah, fair. I was mostly agreeing with you. There's a lot of bad Discourse around this stuff and I think that you're right to directly address it. Transmed types in specific always go on about how people who are not Trans Enough are "stealing resources" so it's fair to say that this is a silly concern. Especially here.

>Anything you want to add before I go off to read the next chapter?
Nothing urgent. I need to go and do a few things anyhow. I'll comment more later.
It's fun that you're doing this btw. Appreciated.

Sounds good! Take care!

Haha. You too.

Chapter 10: Intersex: This was a fun chapter and I learned a few new things from it. Statements of recommendation are:

10.1- We suggest a multidisciplinary team, knowledgeable in diversity of gender identity and expression as well as in intersexuality, provide care to individuals with intersexuality and their families.

10.2- We recommend health care professionals providing care for transgender youth and adults seek training and education in the aspects of intersex care relevant to their professional discipline.

10.3- We suggest health care professionals educate and counsel families of children with intersexuality from the time of diagnosis onward about the child’s specific intersex condition and its psychosocial implications.

10.4- We suggest both providers and parents engage children/individuals with intersexuality in ongoing, developmentally appropriate communications about their intersex condition and its psychosocial implications.

10.5- We suggest health care professionals and parents support children/individuals with intersexuality in exploring their gender identity throughout their life.

10.6- We suggest health care professionals promote well-being and minimize the potential stigma of having an intersex condition by working collaboratively with both medical and non-medical individuals/organizations.

10.7- We suggest health care professionals refer children/individuals with intersexuality and their families to mental-health providers as well as peer and other psychosocial supports as indicated.

10.8- We recommend health care professionals counsel individuals with intersexuality and their families about puberty suppression and/or hormonal treatment options within the context of the individual's gender identity, age, and unique medical circumstances.

10.9- We suggest health care professionals counsel parents and children with intersexuality (when cognitively sufficiently developed) to delay gender-affirming genital surgery, gonadal surgery, or both, so as to optimize the children’s self-determination and ability to participate in the decision based on informed consent.

10.10- We suggest only surgeons experienced in intersex genital or gonadal surgery operate on individuals with intersexuality.

10.11- We recommend health care professionals who are prescribing or referring for hormonal therapies/surgeries counsel individuals with intersexuality and fertility potential and their families about a) known effects of hormonal therapies/surgery on future fertility; b) potential effects of therapies that are not well studied and are of unknown reversibility; c) fertility preservation options; and d) psychosocial implications of infertility.

10.12- We suggest health care professionals caring for individuals with intersexuality and congenital infertility introduce them and their families, early and gradually, to the various alternative options of parenthood.

All of these seem fine to me, but the real moral of the story is that if you're intesex or have another DSD (Disorder of Sexual Development)[a more stigmatizing, but also more inclusive term]: you're fricked. The ways you can get fricked vary, from non-consensual "normalization surgeries" to other stresses from having abnormal sexual characteristics, but you're fricked nonetheless. DSD conditions become even more complicated by the fact that different conditions (of which there are a lot) often have different treatment protocols, some of which (such as 46,XX, CAH) even having more positive outcomes for childhood surgery, which adds even more ethical nuance. The SOC does well in pointing out that for those seeking advice over intersex related issues that other documents and medical groups should be consulted for knowledge and advice. The end of the chapter also mentioned a uterus transplant in a recent study that I think I'm going to read later(Although it probably won't have anything applicable to my own situation). Overall it was a good chapter. I'm going to be taking a break from this for now up until around 15:00 PST. I'll still answer comments every once in a while, but I need to focus on making something for my Baking Blog. See you later!

>>11059
>6.12.d- The adolescent’s mental health concerns (if any) that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed.
Do they go into more detail about this? I've heard some horror stories about people being gatekept based on the fact that they're depressed, autistic, and other things like that. It'd be great if the SoC opined on that positively.

>>11075
Let me check, that chapter was a while ago:
Okay, so they provide a list of what might interfere with "capacity to consent" and it's decently made. For active health emergencies such as suicidality, self harm, or eating disorders they need to be addressed until "there is sufficient time and stabilization for thoughtful gender-related assessment and decision-making". After that there are precautions for other mental health concerns such as "obssessions and compulsions, special interests in autism, rigid thinking, broader identity problems, parent/child interaction difficulties, severe developmental anxieties (e.g., fear of growing up and pubertal changes unrelated to gender identity), trauma, or psychotic thoughts." The last consideration are things like neurodivergent traits or mental inhibitions which shouldn't prevent access to GASMT but rather be considered during the process. (e.g. someone might have reduced communication and less self-advocacy.)

After all of this though, there's this statement: "Finally, while addressing mental health concerns is important during the course of medical treatment, it does not mean all mental health challenges can or should be resolved completely. However, it is important any mental health concerns are addressed sufficiently so that gender -affirming medical treatment can be provided optimally." This should prevent good-faith doctors from delaying care. Granted, there are plenty of bad-faith doctors out there who will actively try to screw over trans kids, but there's significantly less wiggle-room to do so. In comparison to v7 I'd say its an improvement (well of course it's an improvement v7 is a decade old) and should be satisfactory for most purposes. (Another consideration to make is that you should check to see if your HCPs are using the latest documents. Unfortunately many doctors out there still use DSM-IV for certain stuff and this new SOC is less than a week old.)

>>11076
Thank you for looking into this at my request.
While this is better than nothing it's still a bit too vague for my taste. It could be interpreted very reasonably or it could be interpreted in a harmful fashion. I wish that they took a clearer stance here, clarifying when treatment should be deferred. As is clinicians will read what they want into such guidelines.

>>11056
I don't know. Were transness always this common don't you think it would've been better documented across most societies, as opposed to just some? It seems to me that either the number of transgender people has been increased by some unknown biological factors or that there is some important difference between the majority of people who transition and the historical minority. Such a difference is not necessarily incompatible with the Swaabian view if you imagine gender as more of a spectrum.

In any case I've read that Swaab's methodology was problematic and I'm not sold on his conclusions. There is no doubt that gender is somehow related to prenatal sexual differentiation, and that transness is causally linked to this process going strangely, but the exact extent to which gender is set at birth has yet to be determined. IMO given what we know it makes more sense to think in terms of proclivities. Some so strong that they effectively can't be overcome, some weak enough to be swayed by social forces. Perhaps only during one's early life. I base this on research on research like:
https://www.nejm.org/doi/full/10.1056/nejmoa022236
which shows that while biology has an enormous influence on gender it might not be the sole factor. With that said it's always hard to tell when it comes to studies of this sort because external pressure might entirely account for the variety of outcomes.

Chapter 11: Institutional Environments: Hey everyone, sorry for the delay, but I'm back and shouldn't have any more delays longer than a day long. I'm planning to review 4 more chapters today and the last 4 (and any uncovered appendixes) tomorrow, as I have an endo appointment then. So let's start!

This chapter covers TGD healthcare/treatment in institutional environments, namely things like incarceration facilities or inpatient/long-term care facilities. Previously in v7, this was a chapter at nearly the end of the document that was only around 2 pages long, so it's nice to see a set of formal recommendations explicitly stated in the new SOC. Said recommendations are as follows:

11.1- We recommend health care professionals responsible for providing gender-affirming care to individuals residing in institutions (or associated with institutions or agencies) recognize the entire list of recommendations of the SOC-8 apply equally to people living in institutions.

11.2- We suggest institutions provide all staff with training on gender diversity.

11.3- We recommend medical professionals charged with prescribing and monitoring hormones for TGD individuals living in institutions who need gender-affirming hormone therapy do so without undue delay and in accordance with the SOC-8.

11.4- We recommend staff and professionals charged with providing health care to TGD individuals living in institutions recommend and support gender-affirming surgical treatments in accordance with the SOC-8 when sought by the individual, without undue delay.

11.5- We recommend administrators, health care professionals, and all others working in institutions charged with the responsibility of caring for TGD individuals allow those individuals who request appropriate clothing and grooming items to obtain such items concordant with their gender expression.

11.6- We recommend all institutional staff address TGD individuals by their chosen names and pronouns at all times.

11.7- We recommend institutional administrators, health care professionals, and other officials responsible for making housing decisions for TGD residents consider the individual’s housing preference, gender identity and expression, and safety considerations rather than solely their anatomy or sex assignment at birth.

11.8- We recommend institutional personnel establish housing policies that ensure the safety of TGD residents without segregating or isolating these individuals.

11.9- We recommend institutional personnel allow TGD residents the private use of shower and toilet facilities upon request.

These are all great recommendations that shouldn't need detailed explanation, and I enjoy on an overall scale how this chapter (and in ways the SOC as a whole) took something from v7 that was good but vague, and expanded it into a set of formal recommendations minimizing possible misinterpretation or misuse. Granted, like some other chapters (chapter 2 to me seems like the best example) very little of this chapter actually means anything without proper legislative enforcement. For what it tries to accomplish though in the recommendations laid, I'd say that overall this chapter does pretty good.

Chapter 12: Hormone Therapy & Appendix C: Because we're covering 2 chapters this time I should mention that Appendix C is just a set of tables that corresponds with certain data, and that Appendix D (which is frequently referenced) is primarily a quick overview of the eligibility guidelines promoted in chapters 5 and 6. I'll cover Appendix D with Chapter 13.

Chapter 12 is all about HRT and acts as an informative introduction to HRT during or after puberty and GnRH agonists as a blocker. Here's the statements of recommendations (probably) split into multiple parts:

12.1- We recommend health care professionals begin pubertal hormone suppression in eligible* transgender and gender diverse adolescents after they first exhibit physical changes of puberty (Tanner stage 2).

12.2- We recommend health care professionals use gonadotropin releasing hormone (GnRH) agonists to suppress endogenous sex hormones in eligible* transgender and gender diverse people for whom puberty blocking is indicated.

12.3- We suggest health care professionals prescribe progestins (oral or injectable depot) for pubertal suspension in eligible* transgender and gender diverse youth when GnRH agonists are either not available or are cost prohibitive.

12.4- We suggest health care professionals prescribe GnRH agonists for suppression of sex steroids without concomitant sex steroid hormone replacement in eligible* transgender and gender diverse adolescents seeking such intervention and who are well into or have completed pubertal development (past Tanner stage 3) but are either unsure about or do not want to begin sex steroid hormone therapy.

12.5- We recommend health care professionals prescribe sex hormone treatment regimens as part of gender-affirming treatment for eligible* transgender and gender diverse adolescents who are at least Tanner stage 2, with parental/guardian involvement unless their involvement is determined to be harmful or unnecessary to the adolescent.

12.6- We recommend health care professionals measure hormone levels during gender-affirming treatment to ensure endogenous sex steroids are lowered and administered sex steroids are maintained at levels appropriate for the treatment goals of transgender and gender diverse people according to the Tanner stage.

12.7- We recommend health care professionals prescribe progestogens or a GnRH agonist for eligible* transgender and gender diverse adolescents with a uterus to reduce dysphoria caused by their menstrual cycle when gender-affirming testosterone use is not yet indicated.

12.8- We recommend health care providers involve professionals from multiple disciplines who are experts in transgender health and in the management of the care required for transgender and gender diverse adolescents.

12.9- We recommend health care professionals institute regular clinical evaluations for physical changes and potential adverse reactions to sex steroid hormones, including laboratory monitoring of sex steroid hormones every 3 months during the first year of hormone therapy or with dose changes until stable adult dosing is reached followed by clinical and laboratory testing once or twice a year once an adult maintenance dose is attained.

12.10- We recommend health care professionals inform and counsel all individuals seeking gender-affirming medical treatment about the options available for fertility preservation prior to initiating puberty suppression and prior to treating with hormone therapy.

12.11- We recommend health care professionals evaluate and address medical conditions that can be exacerbated by lowered endogenous sex hormone concentrations and treatment with exogenous sex hormones before beginning treatment for transgender and gender diverse people.

12.12- We recommend health care professionals educate transgender and gender diverse people undergoing gender-affirming treatment about the onset and time course of the physical changes induced by sex hormonal treatment.

12.13- We recommend health care professionals not prescribe ethinyl estradiol for transgender and gender diverse people as part of a gender-affirming hormonal treatment.

12.14- We suggest health care professionals prescribe transdermal estrogen for eligible* transgender and gender diverse people at higher risk of developing venous thromboembolism based on age > 45 years or a previous history of venous thromboembolism, when gender-affirming estrogen treatment is recommended.

12.15- We suggest health care professionals not prescribe conjugated estrogens in transgender and gender diverse people when estradiol is available as a component of gender-affirming hormonal treatment.

12.16- We recommend health care professionals prescribe testosterone-lowering medications (either cyproterone acetate, spironolactone, or GnRH agonists) for eligible* transgender and gender diverse people with testes who are taking estrogen as part of a hormonal treatment plan if the individual’s goal is to approximate circulating sex hormone concentrations in cisgender women.

12.17- We recommend health care professionals monitor hematocrit (or hemoglobin) in transgender and gender diverse people treated with testosterone.

12.18- We suggest health care professionals collaborate with surgeons regarding hormone use before and after gender-affirmation surgery.

12.19- We suggest health care professionals counsel transgender and gender diverse people about the various options available for gender-affirmation surgery unless surgery is not indicated or is medically contraindicated.

12.20- We recommend health care professionals initiate and continue gender-affirming hormone therapy for eligible* transgender and gender diverse people who require this treatment due to demonstrated improvement in psychosocial functioning and quality of life.

12.21- We recommend health care professionals maintain existing hormone therapy if the transgender and gender diverse individual's mental health deteriorates and assess the reason for the deterioration, unless contraindicated.

* For eligibility criteria for adolescents and adults, please refer to Chapter 5—Assessment for Adults and Chapter 6—Adolescents and Appendix D.

Before I actually give my thoughts on some of this, I should give the disclaimer that I have a total of zero qualifications in anything I'm about to say, and that I am biased towards what I read and what forms of HRT I use. (With those being transdermal estradiol and bicalutamide.) With that out of the way, I'll start out by saying that although the first half was miserable to read (I say this as a midshit being eternally jealous of youngshits) it seemed mostly solid. My main issue is that it promotes "GnRH agonists" instead of "GnrH analogues" (of which "analogues also includes GnRH antagonists). For those of you that don't know, GnRH analogues work as either agonists or antagonists, with agonists essentially desensitizing the GnRH receptor and antagonists blocking it off. I know that there aren't all that many GnRH antagonists in common use (the first that comes to mind is Relugolix) but the same applies to agonists in practice, with most modern focus existing of Leuprorelin. I'll say again that I probably have no idea what I'm talking about, but to me it seems weird that the WPATH would just completely ignore GnRH antagonists without any mention on why. Moving to the second half of the chapter, it's nice to see some formal recommendations against drinking horse piss (12.15) and 12.20/12.21 are really good for securing HRT and mitigate things like trans-broken arm syndrome or similar thought habits. Now for my main complaint, which I alluded to in chapter 9, I thoroughly dislike that bicalutamide was recommended against in 12.16 due to "lack of long-term data in TGD persons". It's hard for me to take recommendations against bica seriously when it has practically no major sideeffects compared to cypro and spiro (with bica actually being designed for androgen suppression, unlike CPA or spiro)(And the reason why GnRH analogues are off the table is because they're expensive with limited insurance coverage). I just want to see recomended doses for bica given like the others in Appendix C due to it's growing popularity, but I digress. The final thing I have to mention on this chapter (and the referenced Appendix C) is that I really liked how in 12.8, the WPATH specifically states that lack of HCP or MHP (mental health professional) availability shouldn't constitute a barrier

>>11113
cont. cuz I misclicked
-to care, which is something I almost had to deal with because it took so long to find a therapist that was available. I was lucky enough to not have to deal with this, but I'm glad that measures are made in the new SOC to prevent it form happening to others.

The final thing I want to do here is give my personal recommendations on where to source your own HRT data because, in all honesty, relying on only the WPATH for it is just a bad idea. (There's a reason why some people say that it stands for "We Produced All Those Hons".)

Transfeminine HRT:
I highly recommend this site if you want to gain a better understanding of transfeminine HRT as either an introduction or to learn about a specific hormone/drug: https://transfemscience.org/

Transmasculine HRT:
I don't have a website to show or anything, but I'd recommend looking into Testosterone and its esters, Aromatase Inhibitors, and Projestins

Nonbinary HRT:
See above but also check out SERMs (Selective Estrogen Receptor Modulators) and SARMs (Selective Androgen Receptor Modulators)

Hopefully these help, but if anyone out there has any good resources on HRT that they'd like to share, please put them in the comments so others can find them! That's all I have to write for this chapter!

this is very pog ty

Hey everyone, welcome to my SOC Review! I'll admit that this project was partially abandoned, but I might finish it eventually. For now though, feel free to read through what I have and ask any questions you'd like!

Chapter 13: Surgery and Postoperative Care & Appendix E: Grouping these 2 because they're related, chapter 13 is about various gender affirming surgeries (often aconymized as GAS), while appendix E just gives a rudimentary list of some common procedures. Most of this chapter is relegated to Top surgery and SRS (although it isn't actually referred to as such), although FFS is mentioned (with a new acronym) and "uncommon" other procedures are mentioned to exist, even if they aren't elaborated on. Here's their statements of recommendation:

13.1- We recommend surgeons who perform gender-affirming surgical procedures have the following credentials:

13.1.a- Training and documented supervision in gender-affirming procedures;

13.1.b- Maintenance of an active practice in gender-affirming surgical procedures;

13.1.c- Knowledge about gender diverse identities and expressions;

13.1.d- Continuing education in the field of gender-affirmation surgery

13.1.e- Tracking of surgical outcomes.

13.2- We recommend surgeons assess transgender and gender diverse people for risk factors associated with breast cancer prior to breast augmentation or mastectomy.

13.3- We recommend surgeons inform transgender and gender diverse people undergoing gender-affirming surgical procedures about aftercare requirements, travel and accommodations, and the importance of postoperative follow-up during the preoperative process.

13.4- We recommend surgeons confirm reproductive options have been discussed prior to gonadectomy in transgender and gender diverse people.

13.5- We suggest surgeons consider offering gonadectomy to eligible* transgender and gender diverse adults when there is evidence they have tolerated a minimum of 6 months of hormone therapy (unless hormone replacement therapy or gonadal suppression is not clinically indicated or the procedure is inconsistent with the patient's desires, goals, or expressions of individual gender identity).

13.6- We suggest health care professionals consider gender-affirming genital procedures for eligible* transgender and gender diverse adults seeking these interventions when there is evidence the individual has been stable on their current treatment regime (which may include at least 6 months of hormone treatment or a longer period if required to achieve the desired surgical result, unless hormone therapy is either not desired or is medically contraindicated).

13.7- We recommend surgeons consider gender-affirming surgical interventions for eligible* transgender and gender diverse adolescents when there is evidence a multidisciplinary approach that includes mental health and medical professionals has been involved in the decision-making process.

13.8- We recommend surgeons consult a comprehensive, multidisciplinary team of professionals in the field of transgender health when eligible* transgender and gender diverse people request individually customized (previously termed “non-standard”) surgeries as part of a gender-affirming surgical intervention.

13.9- We suggest surgeons caring for transgender men and gender diverse people who have undergone metoidioplasty/phalloplasty encourage lifelong urological follow-up.

13.10- We recommend surgeons caring for transgender women and gender diverse people who have undergone vaginoplasty encourage follow-up with their primary surgeon, primary care physician, or gynecologist.

13.11- We recommend patients who regret their gender-related surgical intervention be managed by an expert multidisciplinary team.

* For eligibility criteria for adolescents and adults, please refer to the Assessment for Adults and Adolescents chapters and Appendix D.

For those of you who are curious, Appendix D was the same appendix used as a list of recommendations in chapter 12, and it still holds up as being fine. I personally don't have any qualms with this chapter's recommendations, although I do especially like some of them, namely 13.1 (keeping surgeons competent) and 13.3, which is likely going to be extremely relevant for most patients. 13.8 is also nice, as it ensures that the "multidisciplinary team" approach continues even for "non-standard" procedures. ("non-standard" here means pretty much anything that isn't facial stuff, top surgery, or regular srs; stuff like clavical reduction/expansion or genital nullification surgery would both be examples.) 13.11 is the final one to mention, namely 'cause it involves detransers. Now i hate detransers as much as anyone else, but this should (hopefully) minimize them radicallizing themselves over poor treatment if they haven't already become kierra belle already. Nothing else really needs express mentioning; my only public tip I have to give is that if there's a certain procedure you're interested in, is that you should do your own research, and be as comprehensive as feasibly possible. That's all for this chapter!

>>22766
I forgot to talk about Appendix E, so here you go:
Appendix E was sort of like the majority of chapter 13; it's not too comprehensive, but because it points itself out as being a non-exhaustive list, it should be fine. onto chapter 14!

Chapter 14: Voice and Communication: This chapter is pretty short, but does cover probably one of the more important topics when it comes to transition (at least transfeminine transition). Here are our statements of recommendation:

14.1- We recommend voice and communication specialists assess current and desired vocal and communication function of transgender and gender diverse people and develop appropriate intervention plans for those dissatisfied with their voice and communication.

14.2- We recommend voice and communication specialists working with transgender and gender diverse people receive specific education to develop expertise in supporting vocal functioning, communication, and well-being in this population.

14.3- We recommend health care professionals in transgender health working with transgender and gender diverse people who are dissatisfied with their voice or communication consider offering a referral to voice and communication specialists for voice-related support, assessment, and training.

14.4- We recommend health care professionals consider working with transgender and gender diverse people who are considering undergoing voice surgery consider offering a referral to a voice and communication specialist who can provide pre- and/or postoperative support.

14.5- We recommend health care professionals in transgender health inform transgender and gender diverse people commencing testosterone therapy of the potential and variable effects of this treatment on voice and communication.

Most of these are pretty simple, 14.1 & 14.2 are partially notable because voice-training therapists/groups are one of the few resources needed that aren't as likely to be already be "transgender-centric". The chapter does well to discuss both voice training, and vocal surgery, without showing a bias towards either. Like the last chapter, I want to finish this one off with a personal tip, being DON'T HOLD OFF ON VOICE TRAINING; GET TO IT That's all for this chapter! The final four chapters are related to healthcare in general, so I'll start working on those tomorrow. Remember, if you have any questions or comments you have for me on this SOC, I'd be happy to answer or give my personal take! See you later!

thanks a ton for this, recima, appreciate a lot! its so cool to see this stuff getting better,,!

>>22820
No problem! I hope that in the near future (~2 years) trans people get more legal protections to go along with the increased medical awareness/progress, but we'll have to see.

Chapter 15: Primary Care: This was sort of a boring chapter to read, although it is definitely one of the more important ones out there. The chapter also had a fun little quote being, "In some countries, PCPs may be required to refer TGD patients to specialist services (e.g., gender identity clinics) resulting in unacceptable delays to access GAHT." which I'm pretty sure is a direct statement about the NHS. Here are the statements of recommendations:

15.1- We recommend health care professionals obtain a detailed medical history from transgender and gender diverse people that includes past and present use of hormones, gonadal surgeries, as well as the presence of traditional cardiovascular and cerebrovascular risk factors with the aim of providing regular cardiovascular risk assessment according to established, locally used guidelines.

15.2- We recommend health care professionals assess and manage cardiovascular health in transgender and gender diverse people using a tailored risk factor assessment and cardiovascular/cerebrovascular management methods.

15.3- We recommend health care professionals tailor sex-based risk calculators used for assessing medical conditions to the needs of transgender and gender diverse people, taking into consideration the length of hormone use, dosing, serum hormone levels, current age, and the age at which hormone therapy was initiated.

15.4- We recommend health care professionals counsel transgender and gender diverse people about their tobacco use and advise tobacco/nicotine abstinence prior to gender-affirming surgery.

15.5- We recommend health care professionals discuss and address aging-related psychological, medical, and social concerns with transgender and gender diverse people.

15.6- We recommend health care professionals follow local breast cancer screening guidelines developed for cisgender women in their care of transgender and gender diverse people who have received estrogens, taking into consideration the length of time of hormone use, dosing, current age, and the age at which hormones were initiated.

15.7- We recommend health care professionals follow local breast cancer screening guidelines developed for cisgender women in their care of transgender and gender diverse people with breasts from natal puberty who have not had gender-affirming chest surgery.

15.8- We recommend health care professionals apply the same respective local screening guidelines (including the recommendation not to screen) developed for cisgender women at average and elevated risk for developing ovarian or endometrial cancer in their care of transgender and gender diverse people who have the same risks.

15.9- We recommend against routine oophorectomy or hysterectomy solely for the purpose of preventing ovarian or uterine cancer for transgender and gender diverse people undergoing testosterone treatment and who have an otherwise average risk of malignancy.

15.10- We recommend health care professionals offer cervical cancer screening to transgender and gender diverse people who currently have or previously had a cervix following local guidelines for cisgender women.

15.11- We recommend health care professionals counsel transgender and gender diverse people that the use of antiretroviral medications is not a contraindication to gender-affirming hormone therapy.

15.12- We recommend health care professionals obtain a detailed medical history from transgender and gender diverse people that includes past and present use of hormones, gonadal surgeries as well as the presence of traditional osteoporosis risk factors to assess the optimal age and necessity for osteoporosis screening.

15.13- We recommend health care professionals discuss bone health with transgender and gender diverse people including the need for active weight bearing exercise, healthy diet, calcium, and vitamin D supplementation.

15.14- We recommend health care professionals offer transgender and gender diverse people referrals for hair removal from the face, body, and genital areas for gender-affirmation or as part of a preoperative preparation process.

All of these I see as good, and I have nothing to complain about. Especially 15.4, because smoking is really cringe. Hopefully I have more to talk about for the next chapter. (Which I'll start working on after I finish this week's baking blog)

>>24947
I have no idea what this means in the context of this thread.

>>24964
they post these weird frogs in almost every thread across lots of imageboards; don't mind them