(Dis) Empowering Trans People: Depathologization Through Treatment Guidelines and Provider Decision-Making

To depathologize transgender (trans) healthcare, revisions have been made to two documents used in the treatment of trans people. First, the 7^th Version of the Standards of Care (SOC-7) removed a lengthy therapeutic relationship and real-life experience (RLE), replacing these with a gender assessment. The second was a shift in language from Gender Identity Disorder to Gender Dysphoria in the 5^th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as well as its removal from the chapter on ‘sexual dysfunctions and paraphilias’. Despite changes, trans healthcare remains stigmatizing and gatekept. Through qualitative interviews with 20 U.S.-based health professionals, we expand current knowledge of the shifting treatment approaches for those seeking gender-affirming medical services. Data show that despite progressive document changes, providers continue to place the burden on patients to fit within a sex/gender dichotomous system and to prove mental stability and decision-making competency to access what are increasingly considered life-saving treatments. We illuminate resultant health disparities that can emerge when providers perceive trans people in need of their education and mental health support and advocate a move away from the current medicalized process towards a healthcare model situated in trans peoples' own lived experience.