Readiness assessments prior to gender affirming medical care: The processes and perspectives of Australian healthcare practitioners.

Abstract

Background: Many trans, gender-diverse, and non-binary individuals are required to complete a comprehensive 'readiness assessment' prior to accessing gender affirming medical care. Concerns exist regarding the equity, purpose, and negative impacts of readiness assessments, as well as potential inconsistencies in how these assessments are conducted.

Aims: We sought to understand Australian healthcare practitioners' (HCPs') (i) processes for administering, (ii) understanding of the purpose of, and (iii) concerns regarding, readiness assessments.

Methods: A mixed-methods approach was used. Fourteen HCPs completed an online survey exploring their understanding of, and processes for conducting, readiness assessments, with 10 going on to complete a 1:1 interview further exploring their beliefs regarding the purpose of, and concerns regarding, assessments.

Results: Survey results demonstrated little consistency in (i) the content HCPs believed relevant to each assessment criterion as set out by the WPATH SoC and (ii) their processes in conducting assessments. Analysis of interviews generated three themes regarding the purpose of readiness assessments: (i) informed consent/capacity to consent, (ii) supporting positive outcomes, and (iii) protecting against litigation. Four themes were generated regarding concerns with readiness assessments: (i) systemic challenges, (ii) inequity and gatekeeping, (iii) personal and professional impacts, and (iv) heterogeneity of assessments.

Discussion: This research is the first to explore Australian HCPs' processes and perspectives of readiness assessments, highlighting the inequities they recognize in mandatory assessments as well as the broad inconsistencies in how assessments are administered. Reconsideration of assessments as mandatory, improved tertiary education, as well as standardized guidelines, are indicated.