Health of Transgender and Gender-Diverse People Clinical Practice Guidelines (WPATH, 2022)

World Professional Association for Transgender Health

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 02, 2022

Guidelines for the health of transgender and gender-diverse people were published in September 2022 by the World Professional Association for Transgender Health (WPATH) in the International Journal of Transgender Health. [1][2]


Healthcare professionals should involve mental health and medical professionals when determining whether puberty suppression, hormone initiation, or gender-related surgery for gender-diverse and transgender adolescents are appropriate and remain indicated throughout the course of treatment until the transition is made to adult care. 

Providers should consider prescribing menstrual suppression agents for adolescents experiencing gender incongruence who may not desire testosterone therapy, who desire but have not yet begun testosterone therapy, or in conjunction with testosterone therapy for breakthrough bleeding.

Prior to treatment, healthcare professionals working with transgender and gender-diverse adolescents requesting gender-affirming medical or surgical treatments should inform these patients of the reproductive effects including the potential loss of fertility and available options to preserve fertility within the context of the youth's stage of pubertal development. 


Healthcare professionals should consider consultation, psychotherapy, or both for a gender-diverse child and family/caregivers when families and healthcare professionals believe this would benefit the wellbeing and development of a child and/or family.

Healthcare professionals should provide information to gender-diverse children and their families/caregivers as the child approaches puberty about potential gender-affirming medical interventions, the effects of these treatments on future fertility, and options for fertility preservation.


Healthcare professionals should consider gender-affirming medical interventions (hormonal treatment or surgery) for nonbinary people in the absence of “social gender transition.”

Healthcare professionals should consider gender-affirming surgical interventions in the absence of hormonal treatment, unless hormone therapy is required to achieve the desired surgical result.

Hormone therapy

Healthcare professionals should begin pubertal hormone suppression in eligible transgender and gender-diverse adolescents only after they first exhibit physical changes of puberty (Tanner stage 2).

Gonadotropin releasing hormone (GnRH) agonists should be used to suppress endogenous sex hormones in eligible transgender and gender-diverse people for whom puberty blocking is indicated. When GnRH agonists are not available or are cost prohibitive, prescribe progestins (oral or injectable depot) for pubertal suspension.

Progestogens or a GnRH agonist should be prescribed for eligible transgender and gender-diverse adolescents with a uterus to reduce dysphoria caused by their menstrual cycle when gender-affirming testosterone use is not yet indicated.

Surgery and postoperative care

Surgeons should consider offering gonadectomy to eligible transgender and gender-diverse adults when there is evidence they have tolerated a minimum of 6 months of hormone therapy.

Surgeons should recommend lifelong followup for transgender men and gender-diverse people who have undergone metoidioplasty/phalloplasty. Transgender women and gender-diverse people who have undergone vaginoplasty should be encouraged to follow up with their primary surgeon, primary care physician, or gynecologist.


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