Transgender healthcare is much like the state of bug handling at Mozilla in 2015. Before we developed standards for making decisions on bugs in Firefox, every team had their own folkways on how to treat bug reports. How a bug was handled depended on which component of Firefox it was filed against.

Every practice has different processes for aftercare. Private, fee-for-service, practices don’t have incentives to measure outcomes. Knowledge is shared informally, or at conferences. There are no board certifications in transgender surgery practice, so learning the techniques depends on who you know.

It’s hard for us to know how people are doing, post-surgery, as a population. It’s confusing to people to see conflicting and inconsistent aftercare instructions. There’s not a clear route to how to do transgender surgical practice.

Gatekeepers inconsistently keep people from HRT and surgeries. Rates of rejection from HRT and other medical transitions vary across regions, despite cross-regional similarities between people seeking medical transition.

What is needed:

• Audits of how gatekeepers apply WPATH guidelines
• Consistent aftercare techniques
• Consistent tracking of outcomes
• Board specializations for surgical care
• Documentation of techniques and care