Implementing the Informed Consent Model for Gender-Affirming Care
The informed consent model is the practice of health care providers sharing enough information about treatment options and/or procedures with patients for patients to make an informed decision about their health.
This practice generally includes sharing information about the risks and benefits of any given treatment option, but the level of detail and specificity may vary depending on the provider.
Many transgender individuals experience difficulties with accessing gender-affirming care such as gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS). Several barriers to care exist such as a lack of health insurance coverage, the cost, discrimination, and often a lack of health care provider knowledge on gender-affirming care treatments.
Furthermore, past and current versions of the Standards of Care for the Health of Transgender and Gender Diverse People (SOC) state that transgender individuals seeking gender-affirming care must first complete a mental health assessment and/or provide a letter documenting their eligibility and readiness for gender-affirming care from a mental health provider.
There are certain situations in which evaluation by a mental health professional before receiving gender-affirming care may be warranted, (i.e., determining one’s capacity to seek treatment during a psychotic episode or during a mental health crisis). However, in many cases, this process may force transgender and gender diverse individuals to lie about their fundamental experience with gender and contort their histories to fit into a predetermined “top-down” idea of a patient who may be eligible for gender-affirming care.
For example, historically, recommendations and guidelines have stated that transgender people must suffer from gender dysphoria, or “clinically significant distress or impairment related to gender incongruence,” to be eligible for gender-affirming care. In reality, not all transgender people experience gender dysphoria, and some of these individuals may still want to seek gender-affirming care. Gender euphoria, or transgender joy, may be just as compelling of a reason to seek this kind of medical care, and many studies have demonstrated that transgender individuals tend to experience increased body positivity and better quality of life after receiving gender-affirming care.
As such, many experts in the field of transgender healthcare and transgender patients themselves have advocated for a shift away from the current standards-of-care model to an informed consent model. Although there would be challenges associated with the informed consent model (or any model of care,) this would allow transgender individuals the autonomy they deserve to be at the center of their healthcare decisions and make the choices that are right for them.
Simultaneously, it would address the trans-normative idea that a transgender person must experience distress to be eligible for gender-affirming treatment. In this way, the healthcare system can continue to move away from a care model that considers medical professionals to be the experts in transgender health and toward a model that views the patients themselves as the experts.
- Chiang, T., & Bachmann, G. A. (2023). The informed consent model is adequate for gender-affirming treatment: issues related with mental health assessment in the United States. The Journal of Sexual Medicine, 20(5), 584-587. https://academic.oup.com/jsm/article/20/5/584/7145730