Endocrine Society Issues New Gender-Affirmation Treatment Guideline

The Endocrine Society today issued a Clinical Practice Guideline (CPG) on the treatment for gender-dysphoric/gender-incongruent persons to develop the physical characteristics of the affirmed gender.

The CPG, entitled “Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline,” was published online and will appear in the November 2017 print issue of the Journal of Clinical Endocrinology & Metabolism (JCEM).

Over the last few decades, there has been a rapid expansion in the understanding of gender identity along with the implications for the care of transgender and gender incongruent individuals. The new guideline establishes a framework for the appropriate treatment of these individuals and standardizes terminology to be used by healthcare professionals.

“Diagnosing clinicians, a mental health provider for adolescents, and mental health professional for adults should be knowledgeable about the diagnostic criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition,” said Wylie Hembree, MD, of the College of Physicians and Surgeons at Columbia University and chair of the task force that authored the guideline.

The Endocrine Society recommends gender-dysphoric/gender-incongruent persons receive a safe and effective hormone regimen that will suppress endogenous sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of exogenous steroid that are within the normal range for the person’s affirmed gender.”

Other recommendations from the CPG include:

  • Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons;
  • For the care of peri-pubertal youths 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;
  • Removal of gonads may be considered when high doses of sex steroids are required to suppress endogenous secretion, 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, bone loss, and cancer risks when surgical removal is incomplete.

Because many barriers to improving the health and well-being of transgender patients remain, the Endocrine Society issued a position statement today that calls on federal and private insurers to cover medical interventions for transgender individuals as prescribed by a physician.

The position statement highlights a durable biological underpinning to gender identity that should be considered in policy determinations and furthermore calls for increased funding for national research programs to close the gaps in knowledge regarding transgender medical care.

Other members of the Endocrine Society task force that developed this CPG include: Peggy T. Cohen-Kettenis and Louis Gooren of VU University Medical Center, Amsterdam, Netherlands; Sabine E. Hannema of Leiden University Medical Centre, Leiden, Netherlands; Walter J. Meyer of the University of Texas-Medical Branch at Galveston, Galveston, Tex.; M. Hassan Murad of of the Mayo Clinic Evidence-based Practice Center, Rochester, Minn.; Stephen M. Rosenthal of the University of California San Francisco, Benioff Children’s Hospital, San Francisco, Calif.; Joshua D. Safer of Boston University School of Medicine, Boston, Mass.; Vin Tangpricha of Emory University School of Medicine, Atlanta, Ga.; and Guy G. T’Sjoen of Ghent University Hospital, Ghent, Belgium.

The Society established the CPG Program to provide endocrinologists and other clinicians with evidence-based recommendations in the diagnosis and treatment of endocrine-related conditions. Each CPG is created by a task force of topic-related experts in the field. Task forces rely on evidence-based reviews of the literature in the development of CPG recommendations. The Endocrine Society does not solicit or accept corporate support for its CPGs. All CPGs are supported entirely by Society funds.

The new guideline is co-sponsored by the American Association of Clinical Endocrinologists, American Society of Andrology, European Society for Paediatric Endocrinology, European Society of Endocrinology, Pediatric Endocrine Society, and the World Professional Association for Transgender Health.

 

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