Key Hospitalist Clinical Practice Guidelines in 2017

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO

Disclosures

January 16, 2018

In This Article

Transgender Medical Care

Endocrine Society

Hormone therapy suppresses the body's sex hormones, which cause many of the physical changes seen at puberty. Treatment should be safe and effective, and sex hormone levels should be kept within the normal range for gender affirmation. 

Because gender-affirming therapy is partially irreversible, it should be provided only after confirming the persistence of gender dysphoria/gender incongruence in individuals with sufficient mental capacity to give informed consent.

Gender-affirming surgery and removal of gonads or the uterus should not be performed before age 18 years or the legal age of majority in the individual's country.

Hormone therapy is not advised for prepubertal individuals with gender dysphoria or gender incongruence.

Clinicians should inform and counsel all individuals seeking gender-affirming medical treatment about the options for fertility preservation before starting puberty suppression in adolescents and before starting hormonal therapy in both adolescents and adults.

In adolescents who meet diagnostic and treatment criteria, pubertal hormone suppression using GnRH analogues should start after girls and boys first exhibit the physical changes of puberty.

In adults, clinicians should evaluate and address medical conditions that can be exacerbated by hormone depletion and treatment before starting hormone therapy.

Surgical removal of gonads may be considered when high doses of sex steroids are needed to suppress the body's own secretion of sex steroids and/or in advanced age.

All individuals receiving hormone therapy should have regular monitoring for prolactin; bone loss; cardiovascular, lipid, and metabolic disorders; and cancer screening.

References

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