Clinical Practice Guideline

Gender Dysphoria/Gender Incongruence Guideline Resources

September 01, 2017

Full Guideline: Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
JCEM September 2017

Wylie C. Hembree (Chair), Peggy T. Cohen-Kettenis, Louis Gooren, Sabine E. Hannema, Walter J. Meyer, M. Hassan Murad, Stephen M. Rosenthal, Joshua D. Safer, Vin Tangpricha, Guy G. T’Sjoen

The 2017 guideline on endocrine treatment of gender dysphoric/gender incongruent persons:

  • Establishes a framework for the appropriate treatment of these individuals
  • Standardizes terminology to be used by healthcare professionals
  • Reaffirms the role of the endocrinologist
  • Emphasizes that a broader healthcare team is needed to provide mental health services and other treatments, such as gender-affirmation surgery

Endocrine Treatment of Gender Incongruent/Gender Dysphoric Persons: An Endocrine Society Clinical Practice Guideline



Essential Points

  • Diagnosing clinicians, mental health providers for adolescents, and mental health professionals for adults all should be knowledgeable about the diagnostic criteria for gender-affirming treatment, have sufficient training and experience in assessing related mental health conditions, and be willing to participate in the ongoing care throughout the endocrine transition
  • Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the body’s sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the person’s affirmed gender.
  • Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons;
  • For the care of youths during puberty and older adolescents, an expert multi-disciplinary team comprised of medical professionals and mental health professionals should manage treatment;
  • For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient;
  • All individuals seeking gender-affirming medical treatment should receive information and counsel on options for fertility preservation prior to initiating puberty suppression in adolescents and prior to treating with hormonal therapy in both adolescents and adults;
  • Removal of gonads may be considered when high doses of sex steroids are required to suppress the body’s secretion of hormones, and/or to reduce steroid levels in advanced age; and
  • During sex steroid treatment, clinicians should monitor, in both transgender males (female to male) and/or transgender females (male to female), prolactin, metabolic disorders, and bone loss, as well as cancer risks in individuals who have not undergone surgical treatment

Summary of Recommendations

+ 1.0 Evaluation of Youth and Adults

+ 2.0 Treatment of Adolescents

+ 3.0 Hormonal Therapy for Transgender Adults

+ 4.0 Adverse Outcome Prevention and Long-Term Care

+ 5.0 Surgery for Sex Reassignment and Gender Confirmation

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