ACA Blog

Jul 22, 2014


Standards of Care (SOC) for the World Professional Association for Transgender Health is an important complication for counselors, who work with transsexual, transgender, and/or gender-nonconforming clients. Although many counselors do not specialize in trans* issues, all counselors must be aware of the document and its contents in order to advise the clients and make appropriate referrals. The main aim of the SOC is "to provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment." Although the SOC includes topics of primary care, reproductive options, voice/communication therapy, hormonal treatments, and others, I'd like to touch on mental health services section for adults.

In the past, I have heard a mistaken belief that in order to get a referral for hormone therapy and/or reconstructive surgery, one must get counseling treatment. Some said that individuals must be in counseling for three months, some said for six months, and others said that counseling should last for over a year. If counselors are not aware of the correct guidelines, it can result in harm caused to clients. For example, one of my acquaintances had to pay out of pocket for expensive counseling that lasted several months, because he was told that he had to do it before he could obtain a referral to a medical professional. He has already explored his gender identity and knew that he wanted to get hormone therapy and subsequent top surgery. Therefore, although counseling was certainly useful, it delayed his transition process and placed him in a difficult financial situation.

Whereas counseling is always highly recommended as treatment or prophylaxis, counselors must assess each case individually. Some clients have gender dysphoria without any debilitating mental health issues, other clients may have mental health issues that require attention. Some clients would benefit from an immediate exploration of options for hormone therapy and/or reconstructive surgery, other clients would benefit from a period of counseling during which time they can stabilize and obtain more clarity about how to proceed. Counselors are essential agents to help trans* and gender-nonconforming clients to (a) explore their gender identity, (b) find various resources, (c) establish support systems, (d) clarify how or whether to transition, (e) prepare physically and psychologically for hormone treatment, and more. However, please keep in mind that the ultimate decision to proceed rests on clients. Personal experience has shown me that surgeons and medical professionals often decide whether or when to perform reconstructive surgeries and prescribe hormones. For example, some surgeons (Note: also depending on the type of surgery) would ask clients to live in the society as the opposite gender, other surgeons would agree to perform a reconstructive surgery as soon as they have an available opening in their schedule. As ethical counselors, do your best to help your clients explore their identities and various options to maximize their health. However, make sure to give your clients correct information.

Refer to the document at:

If you are interested in reading the SOC in Norwegian, you can certainly do so.
Evelyn Pavlova is a counselor and an Ally, whose preferred population is LGBTQIA (lesbian, gay, bisexual, transgender, transsexual, queer, questioning, intersex, invisible minority, asexual, and ally) individuals. Her areas of interest are eating disorders, mood disorders, mindfulness, and spirituality. Read more about her new counseling journey

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1 Comment

  1. 1 Annmarie 22 Jul
    Once again I am blown away by the information provided.  I do agree that all counselors must be mindful of this population an the decision always rest upon the client.  Well done Evelyn and I will certainly view SOC. 


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