"Why Should Other People Be the Judge": The Codification of Assessment Criteria for Gender-Affirming Care, 1970s-1990s

In order to access gender-affirming care, transgender individuals were historically required by international guidelines to undergo mental health provider assessment (Coleman et al., 2012). This requirement for universal mental health provider involvement, initially formulated via professional expert opinion, has not been retained in the most recent World Professional Association for Transgender Health Standards of Care (WPATH SOC 8; Coleman et al., 2022). In the present analysis, I sought to examine the historical and cultural contexts of these expert opinions codified in the first version of the WPATH SOC released in 1979. Foucauldian genealogy and qualitative thematic analysis guided data collection and analysis. Study themes of debate, codification, and change outline the codification of early gender identity research criteria in SOC. These themes examine the historical context of the codification of mental health assessment for access to gender-affirming care. Historical perspectives from trans individuals themselves on assessment criteria are represented in the analysis, including the notable impacts of an individual's race, class, and sexual orientation on attitudes towards assessment practices.