Pre-Surgical Mental Health Readiness Assessments for Gender Affirming Surgeries: A Survey of Canadian Practices

Abstract

Practitioners providing pre-surgical assessments for gender affirming surgery in Canada (N=70) were surveyed on their assessment procedures, their interpretations of the World Professional Association for Transgender Health Standards of Care (SOC7) guidelines, and perspectives on future referral strategies. Most practitioners identified the SOC7 as their main or only source of pre-surgical assessment guidelines, although many other guidelines were cited as key resources. A significant proportion of practitioners indicated they used personally developed guidelines. Practitioners demonstrated a preference for decision making models other than the SOC7, the most popular being a direct referral from a primary care provider with the option of a mental health consult in the case of complex mental health presentations. Most practitioners approved of the trend towards an informed consent model for accessing gender affirming surgery, though the importance of mental health experts™ involvement was recognized. This cross-sectional survey demonstrates the importance of updated WPATH standards of care, and the development and adherence to a standardized evidence-based approach to pre-surgical mental health assessment for gender affirming surgery across Canada.