Ethical Issues in Psychosocial Assessment for Sex Reassignment Surgery in Canada

Transgender individuals often pursue sex reassignment surgery to reduce the distress that results from a mismatched physical appearance and gender identity. Depending on the specific procedure, 29%-93% of transgender individuals desire some form of surgery. Sex reassignment surgery as a therapeutic intervention is controversial, as it entails the alteration or removal of healthy tissue. Due to the many considerations regarding best practices for working with transgender individuals, the World Professional Association for Transgender Health regularly publishes standards of care. Current international standards for the receipt of sex reassignment surgery require that 1 to 2 letters of recommendation be provided by a mental health professional following a comprehensive psychosocial assessment. This document outlines ethical considerations pertaining to the psychosocial assessment of suitability for sex reassignment surgery, as they relate to the ethical principles that guide the profession of psychology in Canada. Suggestions are also made that are relevant to assessments that occur within the context of an interdisciplinary team and to practitioners within other jurisdictions.