Reply To: Moving Beyond Psychiatric Gatekeeping for Gender-Affirming Surgery


“Gatekeeping in gender-affirming care refers to unnecessary and harmful barriers to gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS). What constitutes gatekeeping vs reasonable precautions to ensure surgical candidacy has been controversial.”

The first sentence of the article pretty much says it all. This stuff is controversial, and any opinions rendered after that statement become suspect at best.

Personally, I think a certain amount of psychological gatekeeping is necessary to protect patients from themselves. Let’s face it, there are plenty of dumb people out there. Leaving this completely up to patients isn’t the answer. But how much is too much? What’s reasonable?

Leaving this to individual doctors to decide seems reasonable, until we realize that those same doctors have a financial interest in certain outcomes. Moreover, there are plenty of doctors I wouldn’t trust to give me change for a dollar. Let’s be real, this isn’t the answer either.

So, what is the answer? Idk. Someone who makes a lot more money than me needs to decide that. I’ll just say I’m pretty certain that zero requirements would result in harm to patients, same as too many.

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