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An Argument Against the Standards of Care (SOC)

A popular topic of discussion on many trans-related lists is the Harry Benjamin Standards of Care. On one list, it was recently argued that:

"That a surgeon might be reluctant to perform major elective cosmetic surgery on someone who has not been professionally evaluated as needing it and who simply states their desire for what most others would consider a disfiguring surgery is, to me, entirely understandable."

Yes, except that no one but transsexuals needs a letter to get such surgery done. Anyone with the right amount of cash can waltz into a doctor and have their face disfigured (Michael Jackson), their breasts blown up to the size of watermelons (porn star Minka), or their penis cut up (adult elective circumcision).

I do not begrudge the SOC for the positive support they have provided. They have allowed doctors and surgeons with no prior knowledge of trans issues the opportunity to educate themselves, and have allowed trans people to access services through providers who may have been reluctant to treat them otherwise.

But I do have an issue with the idea that there is a "right" way to transition. In the medical community, there is still often an assumption that every female-bodied person seeking medical intervention wants to "be a man." This, effectively, creates a timeline of sorts for a person to follow- and it may or may not suit their needs.

It also leaves the person seeking medical intervention with a ton of self-advocacy work to do. While the SOC state that a person does not need to take hormones to undergo gender-related surgery, there are many surgeons who will only provide a "complete package." In other words, if you don't want testicles added when you consult for your metoidioplasty or phalloplasty, the surgeon may choose not to perform your surgery. And god forbid if you do not want a hysterectomy or vaginectomy.

The SOC have changed over time to include more gender variance, which is great. But there are many providers out there who will use the SOC as an excuse to delay or flat out refuse treatment to a person. The same doctors who have no problem creating FFF size breasts for a patient will say to a transperson, "Oh- but you need to see a therapist for 3 more months than you already have in order to get hormones/surgery/whatever."

I'm not saying that trans people should skip therapy and jump right into taking hormones or having surgery. That would be irresponsible. But if we have to do some personal work in order to reshape our bodies, shouldn't everyone else? Everyone seeking cosmetic procedures signs consent forms and waivers, but only a small percentage of those are asked to undergo therapy before they can alter their bodies.

Bottom line is that we need to be reminding providers that the SOC are guidelines. They are reasonable steps for someone to follow if they are not comfortable in their own level of knowledge on the subject of hormone therapy or surgery for a trans person. The SOC are not written law, nor should they be used as "gatekeeping" tools. And until we all understand this, trans people will continue to be denied necessary treatment.

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