WPATH – Standards of Care

WPATH – Standards of Care 

Gender reassignment surgery is not an “on demand” procedure. In other words, individuals cannot simply request sex change surgery without demonstrating readiness for this irreversible, life changing procedure.

Responsible surgeons worldwide adhere to a set of prerequisite steps to ensure that individuals are committed to living as a transgender person who is physically, emotionally, and psychologically prepared for sex reassignment surgery. While surgeons do exercise a certain amount of discretion to determine the readiness of an individual for gender reassignment surgery, there is a widely accepted set of standards following by qualified surgeons around the world. Those standards are reviewed and published by the World Professional Association for Transgender Health Inc., known as WPATH.


The World Professional Association for Transgender Health Inc. (WPATH) is “an international, inter-disciplinary non-profit organization devoted to promoting evidence based care, education, research, advocacy, public policy and respect in transgender health”. ( www.WPATH.org). The organization brings together professionals and experts in many disciplines to understand and explore issues pertaining to gender identity.

As part of the services WPATH provides is the creation and publication of a document that provides general guidelines that help decide when treatment is medically necessary and appropriate for transition-related treatment. This document called the “World Professional Association for Transgender Health Standards of Care”, WPATH SOC, offer guidance to:

  • Physicians in the form of medical consensus about the treatment of individuals presenting with gender dysphoria (transsexualism),
  • Providers to develop and implement protocols for the diagnosis and assessment of suitability for GRS; and
  • Healthcare providers to establish clinical decisions to determine and offer medically necessary patient treatments.

These guidelines provide the safe parameters within which healthcare providers can offer treatment to individuals who, among other services, want to undergo sex change surgery. The WPATH SOC is available in many languages for free on the WPATH website ( www.wpath.org).

Prerequisites to GRS

The following requirements apply to Gender Reassignment Surgery only – other procedures such as facial feminization, top surgery, and similar procedures do not carry these requirements.

While surgeons do have some discretion in applying the WPATH SOC requirements when working with patients who desire gender reassignment surgery, in general, the following requirements should be satisfied before the surgery will be scheduled:

  1. Two letters of recommendation must be provided, one letter from a PhD or MD therapist/psychiatrist following the WPATH SOC format and content, and a second letter from a licensed therapist often located in the country where the procedure will be performed.
  2. Be between the ages of 18 and 65;
  3. Have had twelve months of continuous hormonal therapy for those without a medical contraindication;
  4. One year of continuous , successful, full time real-life experience living as the true gender without experiencing periods of returning to the original gender;
  5. Compliance with recommendations, if any, from a medical or mental health professional;
  6. Knowledge and understanding of the cost, lengths of stay in hospital, possible risks and complications of surgery, and post-surgical requirements including rehabilitation.

In addition to these WPATH SOC requirements, individual surgeons often have additional conditions that may include:

  • No smoking. Smoking reduces the amount of oxygen in the blood stream and has a negative impact on healing. Surgeons will require patients to quit smoking before and after surgery, usually a minimum of four weeks before and four weeks after.
  • Weight requirements. The surgeon will assess whether you are a reasonable weight for surgery or if surgery should be postponed until certain weight goals are met. Heavy patients pose a greater risk during surgery, especially those with medical conditions, and their surgeries often last longer increasing the possibility of complications. Your physician will discuss your medical history with you, make recommendations about weight, and review possible risks and complications with you in advance of your surgery.

Please note that HIV does NOT disqualify individuals from surgery. HIV status must be disclosed, pre-surgical testing will be required, and providers usually assess an additional charge to HIV positive patients because of the extra precautions that must be taken during surgery.

Remember that all of your personal and medical information is maintained according to strict standards of privacy and confidentiality. It is only shared with the providers of your choice. Your communications with us and with providers are confidential and respected by our staff.

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