Editing Gender-affirming surgery (section)

=== Standards of care ===
{{See also|Transgender rights}}

Gender-affirming surgery can be hard to obtain due to financial barriers, insurance coverage, and lack of providers. A growing number of surgeons are now training to perform such surgeries. In many regions, a person's pursuit of gender-affirming surgery is often governed, or at least guided, by documents called [[Standards of Care for the Health of Transgender and Gender Diverse People]] (SOC). The most widespread SOC in this field is published and often revised by the [[World Professional Association for Transgender Health]] (WPATH, formerly the Harry Benjamin International Gender Dysphoria Association or HBIGDA). Many jurisdictions and medical boards in the US and other countries recognize the WPATH Standards of Care for the treatment of transgender individuals. Some treatment may require a minimum duration of [[psychological evaluation]] and living as a member of the target gender full-time, sometimes called the real life experience (RLE) (sometimes mistakenly called the real life test [RLT]) before sex reassignment surgeries are covered by insurance.{{Citation needed|date=March 2019}}

Standards of Care usually give certain very specific "minimum" requirements as guidelines for progressing with treatment, causing them to be highly controversial and often maligned documents among transgender patients seeking surgery. Alternative local standards of care exist, such as in the Netherlands, Germany, and Italy. Much of the criticism surrounding the WPATH/HBIGDA-SOC applies to these as well, and some of these SOCs (mostly European SOC) are actually based on much older versions of the WPATH SOC. Other SOCs are entirely independent of the WPATH. The criteria of many of those SOCs are stricter than the latest revision of the WPATH-SOC. Many qualified surgeons in North America and many in Europe adhere almost unswervingly to the WPATH SOC or other SOCs. However, in the United States many experienced surgeons are able to apply the WPATH SOC in ways which respond to an individual's medical circumstances, as is consistent with the SOC.{{Citation needed|date=March 2019}}

Many surgeons require two letters of recommendation for gender-affirming surgery. At least one of these letters must be from a mental health professional experienced in diagnosing gender identity disorder (now recognized as [[gender dysphoria]]), who has known the patient for over a year. Letters must state that sex reassignment surgery is the correct course of treatment for the patient.<ref>{{Cite web | vauthors = Weber-Main AM |date=July 2012 | veditors = Fall H |title=Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (Version 7) |url=http://www.wpath.org/documents/SOC%20V7%2003-17-12.pdf |archive-url=https://web.archive.org/web/20120920085610/http://www.wpath.org/documents/SOC%20V7%2003-17-12.pdf |archive-date=20 September 2012 |access-date=31 October 2013 |website=wpath.org |publisher=[[World Professional Association for Transgender Health]]}}</ref><ref>{{Cite web |date=17 December 2003 |title=WPATH Standards of Care |url=http://www.tssurgeryguide.com/WPATH-standards-of-care.html |archive-url=https://web.archive.org/web/20140901020629/http://www.tssurgeryguide.com/WPATH-standards-of-care.html |archive-date=1 September 2014 |access-date=11 August 2014 |publisher=Tssurgeryguide.com}}</ref>{{update inline|date=December 2022}}<!--Previous text apparently relies on SOC7 not SOC8; the latter specifies that one 1 letter is needed if written documentation is needed at all.-->

Many medical professionals and many professional associations have stated that surgical interventions should not be required for transsexual individuals to change sex designation on identity documents.<ref name="WPATH Clarification" /><ref name="APA Policy Statement">{{Cite web |title=APA Policy Statement Transgender, Gender Identity, and Gender Expression Non-Discrimination |url=http://www.apa.org/pi/lgbc/policy/transgender.pdf |archive-url=https://web.archive.org/web/20090211231509/http://www.apa.org/pi/lgbc/policy/transgender.pdf |archive-date=11 February 2009}}</ref><ref name="NASW Policy Statment">{{Cite web |date=August 2008 |title=NASW Policy Statement on Transgender and Gender Identity Issues |url=https://www.socialworkers.org/assets/secured/documents/da/da2008/reffered/Transgender.pdf | work = National Association of Social Workers (NASW) |orig-date=2006 |access-date=2 September 2022 |archive-date=15 March 2023 |archive-url=https://web.archive.org/web/20230315223712/https://www.socialworkers.org/assets/secured/documents/da/da2008/reffered/Transgender.pdf }}</ref> However, depending on the legal requirements of many jurisdictions, transsexual and transgender people are often unable to change the listing of their sex in public records unless they can furnish a physician's letter attesting that sex reassignment surgery has been performed. In some jurisdictions legal gender change is prohibited in any circumstances, even after genital or other surgery or treatment.<ref>{{Cite web | vauthors = Wareham J |title=New Report Shows Where It's Illegal To Be Transgender In 2020 |url=https://www.forbes.com/sites/jamiewareham/2020/09/30/this-is-where-its-illegal-to-be-transgender-in-2020/ |url-status=live |archive-url=https://web.archive.org/web/20210430203254/https://www.forbes.com/sites/jamiewareham/2020/09/30/this-is-where-its-illegal-to-be-transgender-in-2020/ |archive-date=30 April 2021 |access-date=8 June 2021 | work = Forbes |language=en}}</ref>