Doctors should ditch the requirement for a mental health assessment of transgender teens and adults before prescribing them hormone treatment, argues an activist and bioethicist, drawing on their own personal experience in the Journal of Medical Ethics, MedicalXPress reports. 

The practice is dehumanizing, unjustified and turns the process of transformation into the treatment of a mental illness, says Florence Ashley of McGill University, Montreal, Canada.

It should instead be replaced with informed consent, which respects a patient’s lived experience and autonomy, they insist, MedicalXPress reports. 

The informed consent approach is becoming more common, they acknowledge. But many doctors still require an assessment and referral letter from a mental health professional in compliance with the World Professional Association of Transgender Health (WPATH) Standards of Care, MedicalXPress reports. 

The author says that their decision to take hormones was not made in haste, and they had socially transitioned months before opting for hormone treatment. Their university health clinic had adopted informed consent for transgender care, which allowed them to get a prescription for hormones without a referral letter, MedicalXPress reports. 

But “many others are not so lucky,” they point out, adding that their own luck ran out when they had to get two referral letters for genital surgery.

The assessment of gender dysphoria — discomfort or distress caused by the mismatch between a person’s gender identity and his/her sex assigned at birth — left them “feeling exposed, naked and dehumanized,” because it was viewed as a mental flaw that needed fixing, MedicalXPress reports. 

“Referral requirements for [hormone treatment] treat self-reports of gender dysphoria not as one would treat reports of normal mental experiences, but as one would treat reports of mental illnesses,” they write.

By requiring a mental health assessment instead of taking the transgender person’s word, doctors “deny the authority trans people have over their own mental health experiences,” they say.

“As being transgender is not a mental illness, treating gender dysphoria in this way is pathologizing and, because it pathologizes normal human variance, dehumanizing.”