# World Professional Association for Transgender Health

The World Professional Association for Transgender Health (WPATH), formerly the Harry Benjamin International Gender Dysphoria Association (HBIGDA), is a professional organization devoted to the understanding and treatment of gender identity and gender dysphoria, and creating standardized treatment for transgender and gender variant people. WPATH was founded in 1979 and named HBIGDA in honor of Harry Benjamin during a period where there was no clinical consensus on how and when to provide gender-affirming care.
Founding members included Dr. Harry Benjamin, Paul A. Walker, Richard Green, Jack C. Berger, Donald R. Laub, Charles L. Reynolds Jr., Leo Wollman and Jude Patton.
WPATH is mostly known for the Standards of Care for the Health of Transgender and Gender Diverse People (SOC). Early versions of the SOC mandated strict gatekeeping of transition by psychologists and psychiatrists and framed transgender identity as a mental illness. Beginning in approximately 2010, WPATH began publicly advocating the depsychopathologization of transgender identities and the 7th and 8th versions of the SOC took an approach that was more evidence-based.

## Standards of Care

WPATH develops, publishes and reviews guidelines for persons with gender dysphoria, under the name of Standards of Care for the Health of Transgender and Gender Diverse People, the overall goal of the SOC is to provide clinical guidance for health professionals to assist 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. To keep up with increasing scientific evidence, WPATH periodically commissions an update to the Standards of Care and the WPATH Guideline Steering Committee oversees the guideline development process. The first version of the Standards of Care were published in 1979. Versions were released in 1979 (1st), 1980 (2nd), 1981 (3rd), 1990 (4th), 1998 (5th), 2001 (6th), and 2012 (7th). WPATH released Version 8, the latest edition, in 2022; it is described as being based upon a "more rigorous and methodological evidence-based approach than previous versions."
SOC is an internationally accepted and influential document outlining how to provide patients with transition related care. Early versions of the SOC focused gender transition towards psychologists and psychiatrists and framed transgender identity as a mental illness. Beginning in approximately 2010, with pushing from trans activists the WPATH began publicly advocating the depsychopathologization of transgender identities in the 7th version of the SOC.

## History
### Background

Medical treatment for gender dysphoria was publicized in the early 1950s by accounts such as those of Christine Jorgensen. During this period, the majority of literature on gender diversity was pathologizing, positing dysfunctional families as the causes of dysphoria and recommending reparative therapy and psychoanalysis, such as Robert Stoller's work. Others such as George Rekers and Ole Ivar Lovaas recommended behavioral treatments to extinguish cross-sex identification and reinforce gender-normative behaviors. Knowledge on various aspects of transition related care had existed for decades, but there was no clinical consensus on the care pathways for transgender people.
In 1966, Harry Benjamin published The Transsexual Phenomenon, arguing that since there was no cure for transsexualism, it was in the best interests of transsexuals and society to aid in sex reassignment and in the same year the Johns Hopkins Gender Clinic was opened by John Money. In 1969, Reed Erickson, a wealthy transgender man who played a large role in funding research and clinics for trans healthcare through the Erickson Educational Foundation, funded Richard Green and Money's book Transsexualism and Sex Reassignment, a multidisciplinary volume exploring instructions on medical care as well as social and clinical aspects, which was dedicated to Benjamin. The same year, he funded the 1st International Symposium on Gender Identity in London. The 4th conference, taking place in 1975, was the first to use Benjamin's name in the title.

### 1979-2000

The Harry Benjamin International Gender Dysphoria Association and Standards of Care (SOC) were conceived during the 5th International Gender Dysphoria Symposium (IGDS) in 1977. The organization was named in honor of Benjamin and supported a mixture of psychological and medical treatment. The founding committee was entirely American and consisted of Jack Berger, Richard Green, Donald R. Laub, Charles Reynolds Jr., Paul A. Walker, Leo Wollman, and transgender activist Jude Patton with Walker serving as president; The first SOC committee included all founding committee members with the exception of Patton, a vote by attendees having opposed a "consumer" board member. The Articles of Incorporation were approved in 1979 at the 6th IGDS and HBIGDA was legally incorporated 7 months later.
The initial Standards of Care, The hormonal and surgical sex reassignment of gender dysphoric persons, were published in 1979 and served both as clinical guidelines for treating patients and to protect those who provided the treatments. Versions 2, 3, and 4 of the SOC were published in 1980, 1981 and 1990 respectively under the same name with few changes. These versions of the SOC followed the gatekeeping model laid out by Benjamin, where clinicians set strict eligibility requirements, requiring evaluations from separate mental health professionals and compulsory psychotherapy. WPATH played a large role in the addition of "Gender Identity Disorder" to the DSM-III in 1980. These versions used the DSM-III's criteria for the diagnoses of "Transsexualism" and "Gender Identity Disorder of Childhood", which had largely been authored by Richard Green. This led to feedback loops in research where the diagnostic criteria were thought correct since transgender people provided the narratives expected of them to access care.
In the 1990s, WPATH was struggling to operate due to criticisms of their SOC in the trans community such as the requirement of the real life test, where patients had to socially transition for up to a year prior to hormones. These critiques developed into a trans-led Advocacy and Liaison committee, marking the first time trans people were officially and actively consulted regarding their treatment. The 5th version, published in 1998, was titled the "Standards of Care for Gender Identity Disorders" to be consistent with the DSM-III. It recommended but did not require psychotherapy and stated that while GID was a mental disorder, that was not a license for stigma.

### 2001–present

The Standards of Care (SOC) 6 was published in 2001 and offered more flexibility and individualized care but continued to use the phrase "gender identity disorder". At the same time transgender people increasingly complained of having to "jump through hoops". SOC 6 also did not include significant changes to the tasks mental health professionals were required to take or in the general recommendations for content of the letters of readiness. An important change in the eligibility criteria for GAH allowed providers to prescribe hormones even if patients had not undergone RLT or psychotherapy if it was for harm reduction purposes. A notable change in version six separated the eligibility and readiness criteria for top and bottom surgery allowing some patients, particularly individuals assigned female at birth, to receive a mastectomy.
In 2006, the organization changed its name from the Harry Benjamin International Gender Dysphoria Association (HBIGDA) to the World Professional Association for Transgender Health (WPATH). In 2007, Stephen Whittle became the first transgender president of the organization.
In 2010, WPATH published the "depath statement", urging the "depsychopathologisation of gender variance worldwide" by governments and medical bodies. Shortly afterwards it released the "Identity Recognition Statement", urging governmental and medical bodies to endorse gender self-identification and no longer require surgery or sterilization as a prerequisite.
The SOC 7, published in 2011, was more evidence-based than the previous versions and first to include an international advisory committee of transgender community leaders. It changed the name to the "Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People", began to use the phrase "gender dysphoria", and marked a shift from conceiving gender as a binary to a spectrum. Differences between the 6th and the 7th versions were significant with the 7th version of the SOC including gender affirming care in female-to-male persons. The updated SOC also had a significant departure from previous versions. Including being the first version to include references, changes in guidelines where not everyone with gender concerns requires a diagnosis, replacing the requirement of the real life test and psychotherapy prior to hormone treatment or surgery with "persistent well documented gender dysphoria", criteria for hysterectomy or orchiectomy treatment, and an expansion of the effects of hormone therapy. WPATH acknowledged the importance and changes in the 7th SOC saying that "Changes in this version are based upon significant cultural shifts, advances in clinical knowledge, and appreciation of the many health care issues that can arise for transsexual, transgender, and gender nonconforming people beyond hormone therapy and surgery".
In 2022 the current edition of the Standards of Care 8 was published. The guidelines note that the complexity of the assessment process may differ from patient to patient, based on the type of gender affirming care requested and the specific characteristics of the patient. The updates to SOC 8 shifted the ethical focus of evaluations toward one of shared decision making and informed consent by removing the requirement of a second letter from a mental health professional and the requirement that the provider must have a doctoral level degree. Changes in this edition included a shift away from requiring multiple letters from mental health professionals for surgery, introduces the term gender incongruence, and the treatment of adolescents. WPATH commissioned a series of reviews to support the development of the latest version of the Standards of Care 8 from various research organizations and retained the publishing rights to the contracted research to support the SOC 8 guidelines, which were developed by a multidisciplinary committee of experts, building on previous versions and using the Delphi method. WPATH sent an update to all SOC 8 coauthors in October 2020 stating, "It is paramount that any publication based on the WPATH SOC8 data is thoroughly scrutinized and reviewed to ensure that publication does not negatively affect the provision of transgender healthcare in the broadest sense." Karen Robinson, a researcher at Johns Hopkins University, one of the contracted research organizations said that "We had hoped to publish more of those reviews but for a few reasons have not done so".

## Organization
### Membership

Professionals include anyone working in disciplines such as medicine, psychology, law, social work, counseling, psychotherapy, family studies, sociology, anthropology, speech and voice therapy and sexology. Non-professionals may also join, paying the same membership fee, but without voting privileges. The organization is funded by its membership and by donations and grants from non-commercial sources. The current president of the organization is Asa Radix, who replaced Marci Bowers in October 2024. As of 1 October 2024 the other members of the executive committee include Marci Bowers, Loren Schechter, Chris McLachlan, Stephen Rosenthal.

### Regional organizations

WPATH is affiliated with several regional organizations to inform local guidance in their respective areas of the world.
* ASIAPATH, serving Asia.
* Australian Professional Association for Trans Health (AusPATH), serving Australia.
* European Professional Association for Transgender Health (EPATH), serving Europe.
* United States Professional Association for Transgender Health (USPATH), serving the United States.
* Professional Association for Transgender Health Aotearoa (PATHA), serving New Zealand.