Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care

Pravik Solanki; David Colon-Cabrera; Chris Barton; Peter Locke; Ada S Cheung; Cassandra Spanos; Julian Grace; Jaco Erasmus; Riki Lane

doi:10.1089/trgh.2021.0069

Gender-Affirming Hormone Therapy for the Trans, Gender Diverse, and Nonbinary Community: Coordinating World Professional Association for Transgender Health and Informed Consent Models of Care

Transgend Health. 2023 Mar 31;8(2):137-148. doi: 10.1089/trgh.2021.0069. eCollection 2023 Apr.

Authors

Pravik Solanki¹, David Colon-Cabrera^{2

3}, Chris Barton¹, Peter Locke⁴, Ada S Cheung⁵, Cassandra Spanos⁵, Julian Grace⁴, Jaco Erasmus³, Riki Lane^{1

3}

Affiliations

¹ Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
² Department of Anthropology, School of Social Sciences, Monash University, Clayton, Australia.
³ Monash Health Gender Clinic, Hampton East, Australia.
⁴ Equinox Clinic, Thorne Harbour Health, Fitzroy, Australia.
⁵ Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia.

Abstract

Purpose: Before commencing gender-affirming hormone therapy, people undergo assessments through the World Professional Association for Transgender Health (WPATH) model (typically with a mental health clinician), or an informed consent (IC) model (without a formal mental health assessment). Despite growing demand, these remain poorly coordinated in Australia. We aimed to compare clients attending WPATH and IC services; compare binary and nonbinary clients; and characterize clients with psychiatric diagnoses or longer assessments.

Methods: Cross-sectional audit of clients approved for gender-affirming treatment (March 2017-2019) at a specialist clinic (WPATH model, n=212) or a primary care clinic (IC model, n=265). Sociodemographic, mental health, and clinical data were collected from electronic records, and analyzed with pairwise comparisons and multivariable regression.

Results: WPATH model clients had more psychiatric diagnoses (mean 1.4 vs. 1.1, p<0.001) and longer assessments for hormones (median 5 vs. 2 sessions, p<0.001) than IC model clients. More IC model clients than WPATH model clients were nonbinary (27% vs. 15%, p=0.016). Nonbinary clients had more psychiatric diagnoses (mean 1.7 vs. 1.1, p<0.001) and longer IC assessments (median 3 vs. 2 sessions, p<0.001) than binary clients. Total psychiatric diagnoses were associated with nonbinary identities (β 0.7, p=0.001) and health care cards (β 0.4, p=0.017); depression diagnoses were associated with regional/remote residence (adjusted odds ratio [aOR] 2.2, p=0.011); and anxiety disorders were associated with nonbinary identities (aOR 2.8, p=0.012) and inversely associated with employment (aOR 0.5, p=0.016).

Conclusion: WPATH model clients are more likely to have binary identities, mental health diagnoses, and longer assessments than IC model clients. Better coordination is needed to ensure timely gender-affirming care.

Keywords: WPATH model; gender-affirming hormone therapy; informed consent model; nonbinary; transgender.