Transgender individuals have a gender identity that does not align with their sex assignment at birth (gender incongruence). They account for about approximately 0.4% of the US population (1 million people).
Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%. Some may start to live or transition into their affirmed gender. This may include social or legal transition, such as changes to attire, name, and pronouns.
Some may request hormones, surgery, or both to diminish the secondary sex characteristics associated with their birth sex. Children diagnosed as having GD/GI may start GnRH agonists after beginning puberty to prevent permanent changes, including facial hair, deepening of the voice, and breast growth.
Thereafter, they may initiate hormones to acquire the secondary sex characteristics of their affirmed gender. Prospective studies suggest these interventions are associated with improved psychological functioning and reduction in anxiety and depression.
(1) A diagnosis of gender dysphoria/gender incongruence (GD/GI) should be confirmed before proceeding with gender-affirming hormone therapy (strong recommendation; moderate evidence).
(2) Clinicians should evaluate and address medical conditions that can be exacerbated by hormone depletion and treatment with sex hormones of the affirmed gender before beginning treatment (strong recommendation; moderate evidence).
(3) Clinicians should counsel regarding options for fertility prior to initiating puberty suppression and hormone therapy (strong recommendation; moderate evidence).
(4) Adolescents, when indicated, should be offered gonadotropin-releasing hormone (GnRH) analogs to suppress pubertal hormones (strong recommendation; low evidence).
(5) Hormone therapy can be started in adolescents after a multidisciplinary team of medical and mental health professionals (MHPs) has confirmed the persistence of GD/GI and sufficient mental capacity to give informed consent (strong recommendation; low evidence).
(6) Clinicians should refer hormone-treated transgender individuals for genital surgery when an individual
(a) has had a satisfactory social role change;
(b) is satisfied about the hormonal effects; and
(c) desires definitive surgical changes, and after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patient’s overall health and well-being (strong recommendation; very low evidence).
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society * Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic
Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%. Some may start to live or transition into their affirmed gender. This may include social or legal transition, such as changes to attire, name, and pronouns.
Some may request hormones, surgery, or both to diminish the secondary sex characteristics associated with their birth sex. Children diagnosed as having GD/GI may start GnRH agonists after beginning puberty to prevent permanent changes, including facial hair, deepening of the voice, and breast growth.
Thereafter, they may initiate hormones to acquire the secondary sex characteristics of their affirmed gender. Prospective studies suggest these interventions are associated with improved psychological functioning and reduction in anxiety and depression.
(1) A diagnosis of gender dysphoria/gender incongruence (GD/GI) should be confirmed before proceeding with gender-affirming hormone therapy (strong recommendation; moderate evidence).
(2) Clinicians should evaluate and address medical conditions that can be exacerbated by hormone depletion and treatment with sex hormones of the affirmed gender before beginning treatment (strong recommendation; moderate evidence).
(3) Clinicians should counsel regarding options for fertility prior to initiating puberty suppression and hormone therapy (strong recommendation; moderate evidence).
(4) Adolescents, when indicated, should be offered gonadotropin-releasing hormone (GnRH) analogs to suppress pubertal hormones (strong recommendation; low evidence).
(5) Hormone therapy can be started in adolescents after a multidisciplinary team of medical and mental health professionals (MHPs) has confirmed the persistence of GD/GI and sufficient mental capacity to give informed consent (strong recommendation; low evidence).
(6) Clinicians should refer hormone-treated transgender individuals for genital surgery when an individual
(a) has had a satisfactory social role change;
(b) is satisfied about the hormonal effects; and
(c) desires definitive surgical changes, and after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patient’s overall health and well-being (strong recommendation; very low evidence).
Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society * Clinical Practice Guideline | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic
