Should Mental Health Screening and Psychotherapy Be Required Prior to Body Modification for Gender Expression?

AMA J Ethics. 2016 Nov 1;18(11):1079-1085. doi: 10.1001/journalofethics.2016.18.11.ecas2-1611.


Some people want to modify their bodies through hormonal and surgical treatments in order to resolve gender dysphoria, the distress they experience when their bodies do not align with their gender identity. The World Professional Association for Transgender Health (WPATH) offers guidelines to clinicians regarding treatment of people wanting to modify their bodies for this reason. Prior to these modifications, WPATH advises that mental health screening is needed and that psychotherapy is recommended though not a requirement. In fact, these advisories allow clinicians some freedom in applying the standards to specific cases. Although some variation from the WPATH Standards of Care can be clinically acceptable, informed consent remains an essential component of clinical encounters involving body modifications.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Attitude to Health
  • Ethics, Medical
  • Female
  • Gender Dysphoria* / therapy
  • Gender Identity*
  • Guideline Adherence / ethics
  • Health Services Accessibility
  • Health Services for Transgender Persons
  • Humans
  • Informed Consent* / ethics
  • Male
  • Mental Health*
  • Practice Guidelines as Topic
  • Psychotherapy* / ethics
  • Sex Reassignment Procedures* / ethics
  • Sex Reassignment Procedures* / psychology
  • Transgender Persons*
  • Transsexualism / psychology