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The Benjamin Standards of Care (1992)

The Benjamin Standards of Care (1992)

© 1992, 2013 by Dallas Denny

Source: Denny, Dallas. (1992). To your health: The Benjamin Standards of Care. Alicia’s TV Girl Talk, 4(10), 19.






Alicia’s TV Girl Talk Pages (PDF)

The Benjamin Standards of Care

By Dallas Denny


Many transsexual persons have little idea how to go about the difficult and demanding process of changing their gender. Some go off half-cocked, doing dangerous and stupid things like buying hormones on the street or even attempting to castrate themselves. Others, not knowing what to do, do nothing, and can become overwhelmed by feelings of hopelessness and depression. Fortunately, there is an approved way to go about sex reassignment. I’m talking about the Benjamin Standards of Care.

Before 1979, there were no guidelines for the hormonal and surgical treatment of transsexual persons. Physicians and psychologists and even gender clinics were flying by the seat of their pants, for transsexualism was a new phenomenon, unheard of before Christine Jorgensen stepped off the plane in late 1952. There were no schools or universities which specialized in gender dysphoria, and even training in human sexuality was difficult to find. Those who were providing professional services often had to make their best guess about appropriate treatment.

Because there were no guidelines, some people wound up with hormonal treatment and even sex reassignment surgery when they should not have. You know, sort of like the lumberjack in Monty Python’s “I’m a lumberjack and I’m OK” song getting a surgery date and ending up still a lumberjack, a man with a vagina. There were a lot of what Geraldo calls “transsexual regrets.” “Hey, this isn’t like I thought it would be. Can you put it back?”

Unfortunately, there is no way to “put it back.” In the late seventies, those who specialized in providing services, dismayed by the chaotic state of affairs, got together and formed a professional organization named after a physician who had brought much relief to transsexual persons—Dr. Harry Benjamin. One of the first things HBIGDA, the Harry Benjamin International Gender Dysphoria Association, Inc. did was to form a committee and decide upon Standards of Care for hormonal and surgical treatment of gender dysphoric persons. Although here were several other authors, Dr. Paul Walker, whose career was cut short by his untimely death from AIDS last year, was the driving force behind the Standards, which have been regularly revised since their appearance in 1979.

The Standards of Care safeguard both the consumer and the provider of services by outlining a clearly defined series of steps for treatment of persons desiring sex reassignment. They are quite frankly the best thing ever to have come down the pike for transsexual persons, for they provide a progressive series of steps which lead to the desired surgery, at the same time leaving an escape hatch. Up until the day of the surgery, it is possible for the individual to return to their original gender. Of course, the further down the road one goes, the more compromised he or she will be, but it is possible to return. And many people do back out, for as they modify their bodies and begin assuming the social roles associated with their preferred gender, they often find out that the reality of crossliving is far removed from their former fantasies of it. By placing surgery at the end of the journey, the Standards minimize “transsexual regrets.”

The steps of the Standards of Care are simple, being in brief 1) consulting a psychologist, counselor, or psychiatrist who will provide a diagnosis and a letter of referral to an endocrinologist (hormone doctor); 2) taking this letter to a physician who will prescribe hormones; and 3) living full-time in the gender of choice for one full year before sex reassignment surgery. It’s more complicated than that, of course; for instance, the Standards require ongoing involvement of therapists, but those three things are the backbone of the Standards of Care.

Most reputable surgeons, endocrinologists, and plastic surgeons adhere to the Standards of Care, requiring letters before they will provide services. It is always possible to find someone who does not adhere to the Standards, but the chances of finding someone who knows what they’re doing in this way is very low, and the chance of locating a quack is high.

Transsexual people often look at the Standards of Care with typical masculine process-oriented, goal-driven patterns of thinking, as if they were a series of obstacles to be overcome. However, the Standards are not meant to impede the transsexual person in his or her journey towards gender congruency, but to provide safeguards and opportunities which would otherwise be lacking. For instance, the “real-life test” is just that: an opportunity to live and work in the gender of choice so that the individual will have a good idea about what life will be like in the new gender role. It’s more than just living in drag; the individual must function in the new role. The more fully socialized he or she becomes, the better the prognosis for surgery.

Sex reassignment is more than just a series of physical procedures—it is a process of psychological and social evolution with milestones marked by the Standards of Care. The more fully the spirit of the Standards are adhered to, the more likely will be the chance of a successful transition.