Psychiatric Assessment of Transgender Adults for Sex Reassignment Surgery

Abstract

While pre-surgical assessments by an internist are relatively common, those by psychiatrists are much more rare. With the exception of bariatric surgery and live donor organ transplantation, sex reassignment surgery (SRS) is the only category of surgeries for which a mental health assessment is routinely done as part of the standard of care. This presentation will outline the assessment process as performed at the Gender Identity Clinic at the Centre for Addiction and Mental Health in Toronto, Canada, which sees and approves individuals in the Canadian province of Ontario seeking to have sex reassignment surgery through the provincial health care insurance plan. There are three main tasks of the assessment, diagnosis / differential diagnosis, eligibility assessment, and readiness assessment. Diagnosis, while controversial among some in the transgender community, is generally required by most medical professionals and insurance plans that might cover surgical transition procedures. In Ontario diagnosis is a regulated professional activity and can only be done formally by physicians and clinical psychologists. Eligibility relates to certain specific requirements broadly applied to those seeking surgery that are outlined in international standards of care. For genital surgery, this includes one year of living a full time, continuous gender role experience (GRE) in the chosen gender role. Readiness is the part of the assessment that most resembles a general psychiatric assessment, in which a full biopsychosocial formulation of the client's current status leads to recommendations for improving readiness for SRS.