Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline.
Open accessAbstract
Objective: To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. Participants: The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus Process: Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion: Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and 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. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. 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. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
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For transgender men using gender-affirming hormone therapy, the decrease in estradiol levels caused by exogenous testosterone can lead to vaginal atrophy and is associated with a high prevalence of unsatisfactory sample acquisition.
“For transgender men using gender-affirming hormone therapy, the decrease in estradiol levels caused by exogenous testosterone can lead to vaginal atrophy (367,368) and is associated with a high prevalence of unsatisfactory sample acquisition (369).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [367]
Table 12 (Evidence; page unavailable) lists vaginal atrophy as an effect of testosterone therapy in transgender males, supporting that part of the claim. The guideline does not state that a decrease in estradiol causes the atrophy. The separate claim about unsatisfactory sample acquisition is attached to citation 369, not this source. (LLM, conf=0.86)
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Trans* Pregnancy and Lactation: A Literature Review from a Nursing Perspective
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Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults
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- Authors
- Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G.
- Affiliations
- NewYork–Presbyterian Hospital (US)
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- Leiden University Medical Center (NL)
- The University of Texas Medical Branch at Galveston (US)
- Mayo Clinic (US)
- University of California, San Francisco (US)
- Boston University (US)
- Emory University (US)
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2017-09-13
- Volume
- 102
- Issue
- 11
- Pages
- 3869-3903
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2756092087
- Cited by
- 2,328
- References
- 261
- Citations by year
- 2026: 192 · 2025: 273 · 2024: 301 · 2023: 343 · 2022: 314 · 2021: 287 · 2020: 262 · 2019: 208 · 2018: 134 · 2017: 12
- FWCI
- 241.10
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Sexual Differentiation and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Keywords
- gender dysphoria, gender-affirming hormone therapy, GnRH agonist, puberty suppression, sex hormone replacement, adolescents, informed consent, multidisciplinary care, transgender health, clinical practice guideline recommendations, prepubertal children, mental health assessment
- MeSH terms
- Gender Dysphoria, Adolescent, Adult, Age Factors, Endocrinology, Female, Humans, Long-Term Care, Male, Societies, Medical, Transsexualism, Evidence-Based Medicine, Young Adult, Transgender Persons
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