research is needed to elucidate the relationship between sexual orientation and eating disorders.

Transgender-Specific Mental Health Status

To alleviate gender dysphoria, some transgender individuals change gender roles (either part time or full time), take feminizing or masculinizing hormones, or have surgery (breast/chest, facial, or genital reconstructive surgery). The aim of these interventions is to affirm gender identity and find a gender role and expression that are consistent with that identity.

The clinical management of gender dysphoria has been guided largely by the Standards of Care for Gender Identity Disorders set forth by the World Professional Association for Transgender Health, now in its sixth revision (Meyer et al., 2001). Within the context of a holistic, flexible approach to helping individuals explore their identity and make informed decisions about available treatment options, the Standards of Care include minimal criteria for access to medical interventions to alleviate dysphoria. For adults, these include the following:

  • For hormone therapy—Evaluation and recommendation by a mental health professional with competency in the assessment and treatment of sexual and gender identity disorders; a period of psychotherapy of a duration specified by the mental health professional (usually a minimum of 3 months) or 3 months of living full time in the preferred gender role (referred to as real life experience); and demonstrable knowledge of what hormones medically can or cannot do and their social benefits and risks.

  • For breast/chest surgery—For female-to-males, the criteria are the same as for hormone therapy. For male-to-females desiring breast surgery, there is an additional requirement for documentation by both the physician prescribing hormones and the surgeon. The documentation must confirm that after undergoing at least 18 months of hormone therapy, the patient has not achieved sufficient breast enlargement to alleviate dysphoria.

  • For genital reconstructive surgery—Evaluation and recommendation by two mental health professionals with competency in the assessment and treatment of sexual and gender identity disorders; 12 months of continuous hormone therapy (if applicable); 12 months of living full time in the preferred gender role (referred to as real life experience); if required by the mental health professional, regular participation in psychotherapy; demonstrable knowledge of the cost, required lengths of hospitalizations, likely complications, and



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