[9][non-primary sources needed] In the 1990's, WPATH was struggling to operate due to criticisms of their SOC in the trans community such as the requirement of the real life test, [18] where patients had to socially transition for up to a year prior to hormones.
These critiques developed into a trans-led Advocacy and Liaison committee, marking the first time trans people were officially and actively consulted regarding their treatment.
[20] An important change in the eligibility criteria for GAH allowed providers to prescribe hormones even if patients had not undergone the "Real Life Test" or psychotherapy if it was for harm reduction purposes.
[20] A notable change in version six separated the eligibility and readiness criteria for top and bottom surgery allowing some patients,[21][full citation needed] particularly individuals assigned female at birth, to receive a mastectomy.
[20][22] The seventh version, titled "Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People", was published in 2012 both in the International Journal of Transgenderism and as a standalone document.
There is an emphasis placed on the idea that identifying with these labels does not inherently qualify someone as disordered, and that treatment should be focused on the alleviation of any suffering caused by gender dysphoria.
This version, much like its predecessor requires referrals for surgical procedures based on set criteria, but notes the importance of informed consent and listening to the wishes of the patient.
[3] The seventh version includes a section distinguishing between cases of gender dysphoria and non-conformity for children and adolescents, as well as recommended treatment paths for each.
[24] An earlier draft was criticized by transgender advocates and healthcare providers for including requirements that adolescents evidence "several years" of gender incongruence and that they must undergo comprehensive diagnostic assessments, which was regarded as pathologizing and gatekeeping.
[27][28][29] In August 2024, the Republican chairwoman Lisa McClain of the U.S. Congress Subcommittee on Health Care and Financial Services opened a probe into alleged "political interference" with WPATH's guidelines from the HHS.
In contrast to previous versions, there are no absolute requirements for duration of assessments or age to access gender-affirming treatments; rather, individual psychosocial and physical development should be taken into account.
The chapter additionally notes unique experiences of discrimination, minority stress, and difficulty accessing gender-affirming medical treatment among non-binary people, which healthcare providers should take into consideration.