Toward Informed Consent: Canadian Providers' Perspectives on Presurgical Mental Health Assessments for Gender-Affirming Surgeries

• Published in: Psychology of sexual orientation and gender diversity 2024-09, Vol.11 (3), p.442-457
• Main Authors: Westmacott, Robin P., Dupasquier, Jessica, Sajtos, Adara, Mohadeb, Juan, Schwager, Aimee, Malone, Reece, Francino, Matt
• Format: Article
• Language: English
• Subjects: Female; Gender Reassignment; Health Care Services; Health Personnel Attitudes; Health Promotion; Human; Informed Consent; Male; Mental Health and Illness Assessment; Surgery
• ISSN: 2329-0382; 2329-0390
• DOI: 10.1037/sgd0000612

Previous guidelines for gender-affirming health care provided by the World Professional Association of Transgender Health (WPATH) emphasized the need for presurgical assessments; however, the field appears to be moving toward models of care based on informed consent that better support patient autonomy and depathologize gender diversity. The new WPATH guidelines (SOC8) suggest some steps toward informed consent models, while maintaining components of the existing mental health assessment model (Coleman et al., 2022). To date, little research has examined the current practices of health care providers in Canada and the degree to which practices and opinions are consistent with current guidelines. The present research aimed to examine current practices and attitudes of health care providers performing presurgical assessments for gender-affirming surgical procedures. Sixty-four providers participated in an online survey containing multiple response and open-ended questions regarding: decision-making models for surgical referral, referral roles and processes, as well as current and desired changes to assessment guidelines and practices. Results suggest that despite widespread use of WPATH guidelines, procedures for accessing gender-affirming surgeries varied widely by province, and providers who routinely conduct these assessments have different views on their utility. The majority of providers did not believe that presurgical assessments should be mandatory for all surgeries (particularly chest surgeries and hysterectomy/oophorectomy), supported informed consent models, and expressed a desire for better access to mental health services as needed. This research highlights trends in gender-affirming health care and necessary changes in health care delivery that can ensure equitable health care access for transgender people. Public Significance Statement This study suggests that most health care providers who perform presurgical assessments for gender-affirming surgeries follow the available guidelines from the World Professional Association of Transgender Health but want to see changes to these guidelines that support the autonomy of transgender people to access at least some surgeries without mental health assessment. Many health care providers wanted to see more streamlined referral processes, more selective use of mental health assessments, and greater access to and support for transgender people during and after completing gender-affirming surgeries.