The Pocket Queerpedia is a resource Tshisimani Centre for Activist Education developed for activists, educators and the queer community generally, to assist in teaching on queerness.

It can be downloaded for free in English, Afrikaans and isiXhosa here:

https://www.tshisimani.org.za/pocket-queerpedia-download/

The SOGI universe is a graphic was created by the LGBT+ Health Division at the Desmond Tutu Health Foundation (DTHF) as a simple way to help you understand some of the SOGI terms. It can be accessed here:

https://desmondtutuhealthfoundation.org.za/the-sogi-universe/

PATHSA has been requested to write letters that clients could send to their medical aid when applying for funding of gender-affirming healthcare. There are three letters, one each for pubertal suppression, hormone treatment and surgery. The letters state the evidence in support of providing care.

The letters are available on request from secretary@pathsa.org.za

A question arose considering the difficulty in some African countries to access gender-affirming treatment, whether a South African health professional can provide treatment to a patient in another country, via online consultation.

The challenges with this possibility are:

• To provide treatment to a patient who resides in a different country, a health professional would be required to be registered with the appropriate regulatory body in that country and to abide by that country’s rules and regulations.
• Prescriptions written in South Africa may not be valid in another country.
• Should the patient need emergency assistance or reacts badly to medication prescribed, it would be very difficult to manage this patient remotely.
• Should the patient complain or institute legal action, it would be in their country of residence where legislation will be different from South Africa.
• Medicolegal support would be difficult to obtain, as malpractice insurance is usually only for practice in the country where the health professional is registered.

We propose that a patient who resides in another country, finds a local health professional willing to assist them. A South African health professional can then support and advise the local health professional to provide care, while the medicolegal responsibility remains with the local health professional.

1. NAME

The name of the Association is Professional Association for Transgender Health South Africa (PATHSA), hereinafter referred to as the Association.

2. LEGAL PERSONA

The Association is a body corporate with its own legal identity which is separate from its office-bearers and members.

The Association can perform such acts as are necessary for or incidental to the achievements of its objectives and the exercise of its powers, or the performance of its functions and duties, under this Constitution or under any statute of the Republic of South Africa.

3. OBJECTIVES

The Association is an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people.

The Association is established for the following public benefit objectives:

a) Facilitate networks and foster supportive environments for health professionals working with and for trans and gender diverse people.

b) Develop, advocate for and promote best practices and clinical resources for gender-affirming health care.

c) Encourage, promote, conduct and disseminate research, which is done in a respectful way towards the community, to expand knowledge and deepen understanding about trans and gender diversity.

d) Advocate for institutional, policy, and legislative change by utilizing our collective knowledge and expertise.

e) Provide education on holistic gender-affirming healthcare promoting the health, wellbeing, and supporting the self-actualisation of trans and gender diverse people.

f) Develop leadership skills amongst trans and gender diverse health professionals and promote indigenous perspectives.

g) To disseminate awareness around power dynamics that are typically inherent to all healthcare seeker/provider interactions involving people who are part of the trans and gender-diverse communities, to acknowledge the damage that has been done by such dynamics, and to insist that gender-affirming clinicians must take steps to dismantle these typical power hierarchies.

h) Generally, to do such other things as may be incidental or conducive to the attaining of the above objectives.

4. MEMBERSHIP

a) First and Subsequent Members: The first members of the Association shall sign Schedule A of this constitution.

b) The Board may admit persons over eighteen as members of the Association.

c) The Association shall have two categories of Members: professional membership and student membership.

d) Professional memberships are available to individuals who are members of a health professional body or association and who provide direct health care (bio-psycho-social-spiritual) or indirect care, to trans and gender diverse persons.

e) Student memberships are available to students who will be eligible for membership of a health professional body or association upon graduation and who intend to provide care, to trans and gender diverse persons.

f) After receiving an application for membership, the Board must consider the application and decide whether to admit or reject the applicant. The Board need not give any reason for rejecting the applicant.

g) Every member agrees to comply with this constitution and support the objectives laid out in 3.

h) Membership fees will be determined on an annual basis at the annual general meeting.

i) The Association has to maintain a register with the names and addresses of all the members.

5. BOARD

a) The affairs of the Association shall be managed by a Board consisting of a minimum of five and a maximum of twelve members who shall be resident in the Republic of South Africa during their term of office. Elections for filling of vacant positions shall be conducted at the annual general meeting.

b) The term of office of the Board shall be three years and shall be from the end of the annual general meeting in the first year until the end of the next annual general meeting in the third year.

c) Prior to the annual General Meeting, the Board by notice to members calls for the nomination of candidates in the manner and in the form prescribed by the Board.

d) Voting for Board members may be conducted by electronic means.

e) All members of the Board will be eligible for re-appointment.

f) A casual vacancy occurring in the membership of the Board shall be filled by the Board; a Board member so elected shall retire at the next annual general meeting.

g) The appointment of a member of the Board shall terminate ipso facto and they shall vacate their office on the happening of any of the following events:

i. they resign their office by notice in writing to the Board;

ii. they are absent for more than three consecutive meetings of the Board without acceptable reasons;

iii. they are declared unfit or incapable of managing their affairs;

iv. they are sequestrated, provisionally or finally, or surrender their estate for the benefit of their creditors or make an offer of compromise to their creditors;

v. they are convicted in the Republic of South Africa or elsewhere of any criminal offence which, in the opinion of the Board, is of a disgraceful or dishonourable nature;

vi. they lose their registration with their professional body due to misconduct;

vii. they have not contributed to the responsibilities of the Board as set out in the agreed performance expectations. The performance evaluation process will be agreed by the Board and if necessary be set out in the By-laws.

h) The appointment or removal of a member to the Board shall

i) In the case of removal be confirmed by a letter signed by a Board member, the Chairperson or Vice-Chairperson on behalf of the Board whichever is appropriate to the circumstance giving the name of the member removed and the date from which their removal took effect; and

j) In the case of appointment, take effect only on receipt by the Association of a consent to act as a member of the Board signed by the person concerned.

6. POWERS OF THE BOARD

a) In managing the affairs of the Association, the Board shall be entitled to exercise all the powers of the Association except such powers as are expressly reserved by the provisions of this Constitution to the Association in general meeting.

b) Without in any way limiting the scope of its powers as generally described in paragraph (a) hereof and in addition to powers given to it elsewhere in this Constitution or the By-laws, the Board shall have power in the name of and on behalf of the Association:

c) to receive and accept donations, grants, and other money;

d) to purchase or otherwise acquire, take on lease or hire, exchange, improve, sell, mortgage, pledge, let, dispose of, or otherwise deal in property of any description whatsoever;

e) to raise or borrow or secure any sum of money or the performance of any obligation in such manner and upon such terms and conditions as it deems fit and, in particular, by the execution of mortgage or notarial bonds or the issue of debentures or debenture stock charged upon all or any of the property of the Association;

f) to invest the funds of the Association or any portion thereof in such securities and in such manner as the Board may from time to time determine and to vary or transpose such investments in its discretion;

g) to open and operate banking accounts and savings accounts with registered banking institutions;

h) to apply and use the funds and income of the Association to promote the objectives of the Association;

i) to institute and defend legal proceedings;

j) to appoint and remove any person as an officer, contractor, administrator, supplier, or employee of the Association and to determine their designation, duties, salary, and other terms of employment;

k) to pay reasonable travelling subsistence and other expenses incurred in connection with the affairs of the Association by any members of the Association or its Board or any officer or employee of the Association;

l) to enter into contracts and to authorise the settling of the terms of and the signature of any contract or any other document;

m) to interpret any clause of the Constitution or By-laws if any dispute arises as to its meaning, such interpretations being binding on the members of the Association if accepted by not less than 75% of the members of the Board;

n) to prescribe the form of the instrument appointing a proxy;

o) generally, to do whatever the Board deems necessary to enable it to carry out the objects of the Association, to exercise the powers, to perform the functions and discharge the duties given to or imposed upon it in terms of this Constitution.

7. ELECTION OF CHAIRPERSON AND VICE-CHAIRPERSON

a) At its first meeting after taking office every year, the Board shall elect from amongst its members, a Chairperson and Vice-Chairperson of the Association, to hold office until the election of their successors. The Chairperson so elected, shall stand for an initial period of two years thereafter subject to annual election by the Board.

b) The Board upon election will appoint an Honorary Treasurer of the Association or other Officers as they consider necessary for the management and conduct of the affairs of the Association. If such Officers are not themselves members of the Board, they shall be considered as ex officio members for the purpose of attending Board meetings where required to do so but shall be eligible to vote in the meetings.

8. MEETINGS OF THE BOARD

a) The Board shall meet whenever and as often as it considers necessary but at least quarterly during its term of office at such times and places as it may determine.

b) Meetings may be held by telephonic or electronic means and Board members who establish a communications link to a meeting shall be deemed to be present at that meeting.

c) The quorum for meetings of the Board shall be not less than half its number.

d) Questions arising at a meeting of the Board shall be decided by a majority of votes of members personally present and the Chairperson shall have a casting vote in addition to their deliberative vote.

e) A resolution in writing approved via written confirmation or signed by not less than a quorum of the members of the Board shall be as valid and effective as if it had been passed at a meeting of the Board duly convened and constituted.

f) The Board shall cause proper minutes to be kept of:

i. all meetings of the Board;

ii. all general meetings of members of the Association.

9. OTHER SUB-COMMITTEES

a) The Board may appoint other sub-committees to assist it in the performance of its functions and duties and shall be guided by the Sub-Committee Terms of Reference as approved by the Board. The sub-committee may appoint such of its members and such persons who are not members of the Board or the Association as it may deem fit to be members of any such sub-committee.

b) One of the members of a sub-committee may be designated by the Board as chairperson of the committee. Should the Board not so designate a member as chairperson or should the member so designated not be present or be unable to act at any particular meeting, that sub-committee shall elect a chairperson.

c) Any sub-committee so formed shall comply with any instructions given by the Board and shall keep minutes of its meetings if so directed. All decisions made by the sub-committee shall be presented to the Board for ratification.

d) The Board may assign to a sub-committee so established such of its powers which it may deem fit, but it shall not be divested of any power which it may have assigned to a sub-committee and it may amend or revoke any decision of such sub-committee.

e) Any sub-committees to whom the foregoing powers have been assigned shall continue to act and retain the powers so assigned until its appointment is revoked by the Board.

10. CHAIRPERSON OF MEETINGS

The Chairperson of the Association, or in their absence the Vice-Chairperson, shall preside at all Board meetings. In the absence of the Chairperson and the Vice-Chairperson, the members present at the meeting shall elect from their own number a chairperson for that meeting.

11. REGISTERED OFFICE

a) The registered office of the Association shall be situated at such place as the Board may from time to time determine.

b) The Board may form branches of the Association whenever and wherever deemed by it to be desirable and on such terms and conditions as may be prescribed in the By-laws from time to time.

12. FUNDS OF THE ASSOCIATION

a) The Association shall, subject to the provisions of this Constitution, apply its funds and income solely for investment purposes or in promoting the objectives of the Association.

b) The Association shall not distribute any profits or gains by way of dividend or otherwise to its members or to any other person.

c) Members or officers of the Association shall not have rights in the property or other assets of the Association by virtue of their being members or officers.

d) Should the Association be wound up, a person who has ceased to be a member of the Association or the executors, administrators, heirs or assigns of such person, shall in no circumstances have any claim to or against the Association by reason only of such previous membership.

e) Should the Association be wound up, its funds shall be dealt with in accordance with the provisions of this Constitution.

f) The financial year of the Association ends on 31 March each year.

13. GENERAL MEETINGS

a) A General Meeting of the Association may be convened only at the insistence of the Board and shall be held at a place and on a date and at a time determined by the Board.

b) Meetings may be held by telephonic or electronic means provided that the Association ensures reasonable accessibility within South Africa for electronic participation by members. Members who establish a communications link to a meeting shall be deemed to be present at that meeting.

c) Twenty-one days' notice of a General Meeting, specifying the place, date and time of the meeting and the business to be dealt with, shall be sent by electronic mail to each member at their registered e-mail address. The accidental omission to give notice to any member shall not invalidate the proceedings at any such meeting.

d) The quorum at a General Meeting shall be 10 members of the Association personally present or by proxy who are entitled to vote. Unless that quorum are personally present within 15 minutes of the time appointed for the meeting, the meeting shall stand adjourned for a future date agreed to by those present.

e) At an adjourned meeting, the members present shall form a quorum and shall have full power to transact the business of the meeting, which could have been transacted, had the meeting been held on the date for which it was called.

f) Every member of the Association who is not in arrears in payment of their annual membership fee or any contribution or charge payable by them to the Association shall be entitled to be present in person or by proxy at a General Meeting. Each such member shall have one vote. Proxies in the form laid down by the Board shall be lodged at the head office of the Association of less than 48 hours before the time of the meeting.

g) Every motion proposed and seconded at a General Meeting of the Association shall, if so demanded at the meeting, be decided by a poll. A poll demanded on any other question shall be taken at such time as the chairperson of the meeting directs. The demand for a poll shall not prevent the continuation of a meeting for the transaction of any business other than the question upon which the poll was demanded.

h) A poll shall be taken in such manner as the chairperson directs and the result of the poll shall be deemed to be the resolution of the meeting. Scrutineers not being proposers or seconders of the resolution shall be elected to declare the result of the poll and their declaration, which shall be announced by the chairperson of the meeting, shall be deemed to be the resolution of the meeting on the motion on which the poll was demanded, and an entry to that effect in the minutes of the proceedings shall be conclusive evidence of the result.

i) An annual General Meeting shall be held each year not later than six months after the end of the previous financial year. The provisions of (a) to (e) above in respect of a General Meeting shall apply to an annual General Meeting. The business to be dealt with shall be to receive, consider and approve the annual financial statements and the annual report by the Chairperson on the state of affairs of the Association and the election of Board members. In addition, any business required to be dealt with at a general meeting may be dealt with at an annual General Meeting provided due and proper notice is given.

14. BY-LAWS

a) The Board may from time to time establish, add to, rescind, and/or amend the By-laws.

b) The Board, in making and/or rescinding and/or amending the By-laws may cover any matter, which the Board considers necessary or expedient to prescribe for the better execution of this Constitution and the furtherance of the objects of the Association.

c) A resolution for the making and/or rescinding and/or amending of the By-laws shall be deemed to have been passed if carried by at least 75% of the Board members.

15. REGISTER OF MEMBERS

The Board shall maintain a Register of Members of the Association.

16. FINANCIAL STATEMENTS AND AUDIT

The Board shall cause:

a) records to be meticulously kept of all transactions undertaken in the name of the Association;

b) annual financial statements to be prepared and circulated to members. Such statements shall be audited by a member or firm appointed by the Board. The remuneration of the auditor shall be determined by agreement between the Board and the auditor and shall be disclosed in the annual financial statements.

17. INDEMNITIES

a) Every member of the Board or of any committee appointed by it and every officer and employee of the Association shall be indemnified by the Association against claims made against them and any losses and expenses incurred by them in or about the execution of their duties, except claims, losses or expenses arising from their own fraud or wilful default.

b) No member of the Association shall have any claim against the Association, or against a member of the Board or of any committee appointed by it, or against any officer or employee of the Association, in respect of anything done bona fide by it or them or any of them in the execution of their duties.

c) No member of the Board shall be liable for any act of dishonesty or other misconduct committed by any other Board member unless they knowingly allowed it or was an accessory thereto.

18. LIMITATION OF LIABILITY

a) A member of the Association shall not have any liability for any commitments undertaken by the Association. All persons shall be deemed to contract or deal with the Association on this basis.

b) The liability of a member shall be limited to the payment to the Association of any outstanding fees, membership fees and contributions and settlement of any other debts to the Association, which they may have incurred.

19. AMENDMENT OF CONSTITUTION

The Constitution may from time to time be amended, provided that such amendments are approved by not less than seventy-five percent of the members of the Association who are present in person or by proxy at a General Meeting of which the requisite notice has been given with full particulars of the proposed amendments and the quorum for such meeting shall be not less than 10 members of the Association.

20. WINDING UP

a) The Association may be dissolved and/or wound up at any time by either:

i. a unanimous resolution to that effect taken by all the Board members then in office; and

ii. by a resolution of not less than seventy-five percent of the members who are present in person or by proxy at a duly convened and constituted General Meeting and in respect of which clause 15 (c) shall apply.

b) Members shall not have any claim in respect of any surplus there may be on winding up of the Association.

c) Upon its being wound up any funds or assets of the Association remaining after the payment of the debts and expenses of the Association and the costs of winding up shall be distributed to or amongst such kindred or related associations, bodies or institutions with objects similar to those of the Association, including educational institutions (but excluding individual members or firms or companies controlled by members) as the Board shall decide.

d) The winding up shall be carried out in accordance and in compliance with any applicable legislation.

e) Where appropriate the Association may invoke the application for business rescue provisions of the Companies Act. A unanimous resolution of the Board is required for this purpose.

The Professional Association for Transgender Health South Africa (PATHSA) is an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people.

We welcome the process of developing a new Official Identity Management Policy, and would like to make the following points:

• A solution has to be found that is inclusive of transgender, non-binary and intersex persons and that does not discriminate.

• We support the proposal of a random number that does not have certain digits as a gender marker.

• We reject the proposal of an alternate digit or letter “X” be used for non-binary, transgender and intersex persons, as it will be discriminatory and can lead to othering and victimisation, and such individuals to be “outed” by their ID number.

• The Alteration of Sex Description and Sex Status Act 49 of 2003 was revolutionary for its time but is unfortunately often misunderstood by officials and in urgent need of revision. We support the approach taken by Malta and Argentina that allows for the legal gender recognition of persons based on self-determination. We regard the current process of requiring letters from two health professionals as unnecessary and not in line with the medical ethical principle of autonomy. We definitely prefer a process of self-determination without the requirement of letters from health professionals.
• As health professionals, we are painfully aware of the struggle of our patients to change their identity documents to align with their gender identity. Currently they have to apply for a name change and gender marker change, which is very time consuming. We look forward to a more streamlined process.

Yours sincerely

Chris McLachlan

Chairperson: PATHSA

It is with great dismay that we recognise the suggestions made by a South African medical professional, advocating in favour of reparative (or, as it is more widely known, conversion) therapy, specifically with reference to transgender children and youth. 

In 2020, reparative or conversion therapy has no role in the healthcare of trans or gender diverse people regardless of age. The practice is one that has been universally denounced by professional medical bodies the world over as being not just unethical and ineffective, but barbaric, and the suggestion that these modalities should be employed in the best interests of a trans or gender diverse patient is a harmful one.

What is conversion therapy?

Conversion or reparative therapy refers to any kind of intervention that aims to alter a person’s sexual orientation, or gender identity or expression. Techniques used under this umbrella have been known to include, amongst others: ice-pick lobotomies, electric shock treatments, “nausea inducing drugs... administered simultaneously with the presentation of homoerotic stimuli”, and masturbatory reconditioning. Psychotherapeutic techniques can also be employed as conversion or reparative therapy. 

Does conversion therapy work?

Conversion or reparative therapy has been conclusively shown to be ineffective in scientific studies. Furthermore, additional studies have provided ample proof that the practice is harmful to people in the LGBTQIA+ community. Conversion therapy can lead to loss of self-esteem, anxiety, depression, social isolation, intimacy difficulty, self-hatred, shame and guilt, sexual dysfunction, suicidal ideation and suicide attempts and symptoms of post-traumatic stress disorder in those exposed to it.

Conversion therapy is founded on the idea that there is something inherently pathological about same-gender attraction and/or transgender identity - concepts that have been rejected by the medical community. 

Professional bodies and legal status of conversion therapy

Numerous professional bodies the world over have condemned conversion or reparative therapy, including: the American Academy of Child & Adolescent Psychiatry, the American Academy of Pediatrics, the American College of Physicians, the American Medical Association, the American Psychological Association, the American Psychiatric Association, the British Psychological Society, the World Psychiatric Association, the Royal Australasian College of Physicians, the Psychological Society of South Africa, the South African Society of Psychiatrists, and the World Health Organisation, amongst many others. 

Conversion and reparative therapy has been prohibited by legislature in California, Massachusetts, New York, Washington, Argentina, Brazil, Ecuador, Fiji, Germany, Malta, Taiwan, and Uruguay, amongst others. 

Affirmative treatment saves lives

Healthcare services that allow for the exploration and free development and affirmation of gender identity and/or sexual orientation should be accessible and available to all members of the LGBTQIA+ community. Affirmative models of healthcare result in improved outcomes for LGBTQIA+ patients, whilst also being ethically sound. Patients who have access to affirmative care benefit from improvement in their mental health, and a decreased risk of self-harm and suicide. 

As a group of professionals with vast experience in treating trans and gender diverse patients of all ages, we unequivocally condemn the practice of conversion or reparative therapy as unethical, scientifically unsound, and ineffective, and insist that such treatments have no role in the management of such patients, and should under no circumstances be employed. We further believe that conversion and reparative therapy should be prohibited under law, as barbaric and inhumane. 

We encourage all clinicians to employ affirmative models of care, that are both scientifically and ethically sound, with a view to improving the health and outcomes of those in this marginalised and vulnerable population group.

Issued by: Dr Anastacia Tomson, on behalf of PATHSA 

For media enquiries, please contact info@pathsa.org.za

PATHSA is greatly concerned about the recent incident and resultant controversy where a health care practitioner in an open forum challenged the validity and credibility of gender-affirming healthcare for children and adolescents.

As a result, PATHSA and its founding members deem it not only critical, but also our professional and ethical responsibility and in the interest of public good to speak out and offer our position statement with regards to gender-affirming care for transgender children and adolescents.

PATHSA’s constitution states:

• “Develop, advocate for and promote best practices and clinical resources for gender-affirming health care.”
• “To disseminate awareness around power dynamics that are typically inherent to all health care seeker/provider interactions involving people who are part of the trans and gender-diverse communities, to acknowledge the damage that has been done by such dynamics, and to insist that gender-affirming clinicians must take steps to dismantle these typical power hierarchies.”

PATHSA in concert with many international professional healthcare bodies and associations take a gender-affirming position when it comes to transgender and gender diverse children and youth (American Counselling Association 2010; British Psychological Society, 2012; WPATH SOC 7, 2011; Psychological Society of South Africa, 2013; Oliphant et al 2018; Telfer et al, 2018). PATHSA regards gender affirmation of transgender children and adolescents as evidence based, internationally recognised and in the best interest of the child and adolescent (Bonifacio et al 2019; Deutsch, 2016; Devries, Kathard & Muller, 2020; Van Breda and Addinall, 2020; McLachlan et al, 2019; Spencer, Meer & Muller, 2017). This includes being supportive of social transition of prepubertal transgender and gender diverse children and puberty suppression for the transgender adolescent (Bonifacio, 2019; Deutsch et al, 2016; de Vries ALC et al 2011 & 2014; Durwood et al, 2017).

PATHSA strongly opposes any form of so called “conversion therapy” or “reparative therapy” imposed on transgender children and adolescents where the aim is to convince the child that their gender identity experience, which does not match their gender assigned at birth, to be a pathology and the child being counselled to accept their gender assigned at birth. Outcome research on this type of intervention has already been found to do harm, to worsen the mental health status of children and adolescents exposed to it; and it significantly increases the risk for self-harm and suicide (Durwood et al, 2017; Giovanardi, 2017; Oliphant et al, 2018). PATHSA stands in solidarity with the many international professional bodies who have declared such practices to be unethical and illegal and grounds for professional sanction of health care professionals who practice this.

PATHSA takes professional, academic and scientific exception to any religious or culturally positioned individuals and entities who from their subjective, fundamental, unscientific, non-evidence based biased positions attempt to discredit and characterise gender-affirming care of children and adolescents as an ideology. This is objectively false, inaccurate and could lead to significant harm should it result in parents being dissuaded to act in the best interests of their transgender and gender diverse children in accessing gender-affirming care (Spencer et al, 2017; Olson et al, 2018; Newhook et al, 2018)

PATHSA’s firm and clear position on gender-affirming healthcare for children and adolescents is supported and substantiated by a number of outcome studies already completed since the WPATH standards of Care version 7 was released in 2011. These are the studies that have produced good evidence for the improved mental health in children who were supported and allowed to socially transition; as well as the studies that produced good evidence that puberty suppression also results in significant improvement in the mental health of transgender and gender diverse adolescents further reducing the risk of self-harm and suicide. (Bonifacio et al, 2019; Devries et al, 2014; Durwood et al 2017; Giovanardi, 2017; Newhook et al, 2018; Olson et al, 2018)

Signed by the board and founding members of PATHSA

Chris McLachlan

Ron Addinall-van Straaten

Sakhile Msweli

Jean-Ré Jones

Elma de Vries

Anastacia Tomson

Kevin Adams

Simon Pickstone-Taylor

Mershen Pillay

John Torline

Jenna Bayer

Qhawekazi Thengwa

Elliott Kotze

Dulcy Rakumakoe

Chantal Fowler

References:

American Counselling Association (2010). American Counselling Association competencies

for counselling with transgender clients. Journal of LGBT Issues in Counselling, 4, 135‐159.

Bonifacio, J.H.; Maser, C; Stadelman, K and Palmert, M. 2019. Management of Gender Dysphoria in Adolescents in Primary Care. The Canadian Medical Association Journal: CMAJ 2019 January 21;191: E69-75. doi: 10.1503/cmaj.180672

British Psychological Society (2012). Guidelines and literature review for psychologists

working therapeutically with sexual and gender minority clients.Retrieved from

http://www.bps.org.uk

Deutsch, M.B. Editor. 2016. Gender-Affirming Care of Transgender and Gender Nonbinary People. 2^nd Edition. Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California.

De Vries ALC, Steensma TD, Doreleijers TAH, and Cohen-Kettenis PT. 2011

Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine; 8:2276–2283.

De Vries, A.L.C; McGuire, J.K.; Steensma, T.D.; Wagenaar, E.C.F.; Doreleijers, T.A.H. and Cohen-Kettenis, P.T. 2014. Young Adult Psychological Outcome After Puberty Suppression and Gender Reassignment. Pediatrics; originally published online September 8, 2014; DOI: 10.1542/peds.2013-2958

De Vries, E., Kathard, H. & Müller, A. (2020). Debate: Why should gender-affirming
health care be included in health science curricula? BMC Medical Education, 20(51), 1-10, https://doi.org/10.1186/s12909-020-1963-6

Durwood, L; McLaughlin, K.A and Olson, K.R. 2017. Mental Health and Self-Worth in Socially Transitioned Transgender Youth. Journal of the American Academy of Child and Adolescent Psychiatry, 56(2): 116–123.e2. doi:10.1016/j.jaac.

Giovanardi G. Buying time or arresting development? The dilemma of administering hormone blockers in trans children and adolescents. Porto Biomed. J. 2017. http://dx.doi.org/10.1016/j.pbj.2017.06.001

McLachlan, C., Nel, J.A., Pillay, S. & Victor, C.J. (2019). The Psychological Society of South Africa’s guidelines for psychology professionals working with sexually and gender-diverse people: towards inclusive and affirmative practice. South African Journal of Psychology 1 –11, DOI: 10.1177/0081246319853423 journals.sagepub.com/home/sap

Newhook, J.T.; Pyne, J.; Winters, K.; Feder, S.; Holmes, C.; Tosh, J.; Sinnott, M.; Jamieson, A. and Pickett, S. 2018. A Critical Commentary on Follow-up Studies and “Desistance” Theories About Transgender and Gender Nonconforming Children. International Journal of Transgenderism, Vol 19 (2): 212-224. https://doi.org/10.1080/15532739.2018.1456390

Psychological Society of South Africa. (2013). Sexual and gender diversity position statement. Retrieved from http://www.psyssa.com/documents/PsySSA_sexuality_ gender_position_statement_2013.pdf

Oliphant J, Veale J, Macdonald J, Carroll R, Johnson R, Harte M, Stephenson C, Bullock J. 2018. Guidelines for gender-affirming healthcare for gender diverse and transgender children, young people and adults in Aotearoa, New Zealand. Transgender Health Research Lab, University of Waikato. ISBN: 978-0-473-45837-9

Olson, K.R.; Durwood, L.; DeMeules, M. and McLaughlin, K.A. 2018. Mental Health of Transgender Children Who Are Supported in Their Identities. Paediatrics 137 (3). http://pediatrics.aappublications.org

Spencer, S., Meer, T. & Müller, A. (2017). “The care is the best you can give at the time”: Healthcare professionals’ experiences in providing gender-affirming care in South Africa. PLoS ONE 12(7): e0181132. https://doi.org/10.1371/journal.pone.0181132

Telfer, M.M.; Tollit, M.A.; Pace, C.C. and Pang, K.C. 2018. Australian Standards of Care and Treatment Guidelines for Transgender and Gender Diverse Children and Adolescents. Medical Journal of Australia, 209 (3)

Van Breda, A. D., & Addinall, R. M. (2020). State of Clinical Social Work in South Africa. Clinical Social Work Journal. doi:10.1007/s10615-020-00761-0

Wilson, D; Marais, A; de Villiers, A; Addinall, R; and Campbell, M.M. 2014. Transgender Issues in South Africa, with Particular Reference to the Groote Schuur Hospital transgender Unit. South African Medical Journal, Vol 104, No. 6.

World Professional Association for Transgender Health. 2011. Standards of Care for the Health of Transexual, Transgender, and Nonconforming People. Version 7. www.wpath.org.za.

It is with great concern that the Professional Association for Transgender Health, South Africa (PATHSA) has become aware of claims that a health care professional has motivated for a type of conversion/reparative therapy for trans and gender diverse youth.

Accordingly, the founding members and Board of PATHSA, consider it not only important, but also our responsibility to speak out regarding our position on reparative and conversion therapy/practices.

PATHSA is “an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people.”

PATHSA’s constitution states:

• “Develop, advocate for and promote best practices and clinical resources for gender-affirming health care.”
• “To disseminate awareness around power dynamics that are typically inherent to all health care seeker/provider interactions involving people who are part of the trans and gender-diverse communities, to acknowledge the damage that has been done by such dynamics, and to insist that gender-affirming clinicians must take steps to dismantle these typical power hierarchies.”

Historically many health care professionals have played an active role in stigmatisation, marginalisation and oppression of trans and gender diverse people. Health care and mental health care practices are often influenced by the dominant hetero-cis-normative discourse which permeates our society. As PATHSA’s members we work towards affirming practices where gender diversity is seen as a normal variation within the gender spectrum (Oliphant et al., 2018; Victor, Nel, Lynch & Mbatha, 2014). “Research indicates that through accessing gender affirming care, the trans and gender diverse client is able to alleviate gender dysphoria and live a more fulfilling life.” (McLachlan, 2019, p.13).

Reparative therapy and conversion therapy interventions have been proven to be unsuccessful with trans and gender diverse people and deemed against medical ethics (American Counselling Association, 2010; British Psychological Society, 2012; PsySSA, 2017). Research has found that reparative therapy can lead to increased self-hatred and anxiety, decreased self-esteem, social isolation, depression and suicidality (ASSAF, 2015, American Counselling Association, 2010; PsySSA, 2017).

Conversion and reparative therapies are seen as unethical and contra-indicated in the treatment and/or support of trans and gender diverse people.

• The World Professional Organisation for Transgender Health (2011, p.16) states: “treatment aimed at trying to change a person’s gender identity and expression to become more congruent with sex assigned at birth has been attempted in the past without success... such treatment is no longer considered ethical.”
• The Psychological Society of South Africa (2013, p.10) position statement cautions “against interventions aimed at changing a person’s sexual orientation or gender expression, such as ‘reparative’ or conversion therapy”.
• “It is particularly harmful when offered to or forced onto children and adolescents. Children displaying any kind of gender-atypical behaviour could be subject to such therapy by parents, schools or religious organisations. Besides the harm such efforts could cause to the individual, it could also put family ties and bonds under pressure, and could lead to alienation from close relatives. For the gender-diverse adolescent, the onset of irreversible and possibly unwanted physiological changes can be a cause of much distress (Bateman, 2011; McLachlan, 2010). According to Wilson et al. (2014), non-intervention in this context could cause much harm and the possibility to delay puberty needs to be explored.” (PsySSA, 2013, p.52-53)
• World Health Organisation (2015, p.25) publication states: “Not being able to live according to one’s self-identified gender is likely to be a source of distress, exacerbating other forms of ill health.”

Although some mental health care providers do attempt to assist the gender questioning child to actualise various aspects of themselves related to their sex assigned at birth, Vanderburgh (2009) states that this is ineffective and cautions that it can be dangerous and cause harm.

Health care professionals must affirm, respect, understand, and not judge their clients/ patients (De Vries, Kathard & Müller 2020). Furthermore, the health care provider needs to uphold medical ethics (Tomson, 2018).

PATHSA strongly supports ethical and accountable ways of care and supports health care that focusses on the best interest of the trans and gender diverse person. Evidence based research does not support reparative/conversion therapy.

Many countries are now looking at banning and outlawing these therapies. As an interdisciplinary health professional organisation working to promote the health, wellbeing and self-actualisation of trans and gender diverse people, we support the call for the ban of all therapies that attempt to change a person’s inherent gender identity.

Signed by the board and founding members of PATHSA

Chris McLachlan

Ron Addinall-van Straaten

Sakhile Msweli

Jean-Ré Jones

Elma de Vries

Anastacia Tomson

Kevin Adams

Simon Pickstone-Taylor

Mershen Pillay

John Torline

Jenna Bayer

Qhawekazi Thengwa

Elliott Kotze

Dulcy Rakumakoe

Chantal Fowler

References

Academy of Science of South Africa (2015). Diversity in human sexuality: Implications for policy in Africa. Pretoria: Academy of Science of South Africa.

American Counseling Association (2010). American Counseling Association competencies for counselling with transgender clients. Journal of LGBT Issues in Counseling, 4, 135‐159.

Bateman, C. (2011). Transgender patients side-lined by attitudes and labelling. South Africa Medical Journal, 101(2), 91-93.

British Psychological Society (2012). Guidelines and literature review for psychologists working therapeutically with sexual and gender minority clients. Retrieved from http://www.bps.org.uk

De Vries, E., Kathard, H. & Müller, A. (2020). Debate: Why should gender-affirming
health care be included in health science curricula? BMC Medical Education, 20(51), 1-10, https://doi.org/10.1186/s12909-020-1963-6

McLachlan, C. (2019). Que(e)ring trans and gender diversity. South African Journal of Psychology, 49(1), 10-13.

Oliphant, J., Veale, J., MacDonald, J., Carroll, R., Johnson, R., Harte, M., … Manning, P. (2018). Guidelines for Gender-affirming Health care for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand. New Zealand Medical Journal, 131(1487), 86–96.

Psychological Society of South Africa. (2013). Sexual and gender diversity position statement. Retrieved from http://www.psyssa.com/documents/PsySSA_sexuality_ gender_position_statement_2013.pdf

Psychological Society of South Africa. (2017). Practice guidelines for psychology professionals working with sexually and gender diverse people. Johannesburg: Author.

Tomson, A. (2018). Gender-affirming care in the context of medical ethics – gatekeeping v. informed consent. South African Journal of Bioethics, 11(1), 24-28.

Vanderburgh, R. (2009). Appropriate therapeutic care for families with pre-pubescent transgender /gender-dissonant children. Child Adolesc Social Work Journal, 26, 135-154.

Victor, C.J., Nel, J.A., Lynch, I. & Mbatha, K. (2014). The Psychological Society of South Africa sexual and gender diversity position statement: contributing towards a just society.  South African Journal of Psychology, 44(3), 292-302.

Wilson, D., Marais, A., De Villiers, A., Addinall, R., & Campbell, M.M. (2014). Transgender issues in South Africa, with particular reference to the Groote Schuur Hospital Transgender Unit. South Africa Medical Journal, 104 (6), 449-451.

World Health Organization (2015b). Sexual health, human rights and the law. Geneva, Switzerland: World Health Organization.

World Professional Association for Transgender Health (2011). Standards of care for the health of transsexual, transgender and gender non-conforming people. Retrieved 8 August 2014, from http://www.wpath.org/documents/SOC%20V7%2003-17-12.pdf