Surgical sex reassignment: a comparative survey of international centers

The Harry Benjamin International Gender Dysphoria Association's Standards of Care (Walker et al., 1985) set out minimum standards for the selection of patients for sex reassignment surgery. This survey reports on the standard and policies actually used by clinics in Europe and North America, including their areas of agreement and disagreement with the Standards. To our knowledge, there has been only one prior survey of gender clinic policies, and that was restricted to European treatment facilities. The present survey is aimed at primary caregivers in the medical community; however, it may also be of use to administrators in responding to increasing demands for accountability from special interest groups and from government, with their often divergent agendas. It is our hope that this survey will begin the process of developing more uniform standards of care.