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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. Int J Transgend Health 2022;23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 455] [Impact Index Per Article: 227.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]

Abstract

Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

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Affiliation(s)

E Coleman Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
A E Radix Callen-Lorde Community Health Center, New York, NY, USA Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
W P Bouman Nottingham Centre for Transgender Health, Nottingham, UK School of Medicine, University of Nottingham, Nottingham, UK
G R Brown James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA James H. Quillen VAMC, Johnson City, TN, USA
A L C de Vries Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
M B Deutsch Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA UCSF Gender Affirming Health Program, San Francisco, CA, USA
R Ettner New Health Foundation Worldwide, Evanston, IL, USA Weiss Memorial Hospital, Chicago, IL, USA
L Fraser Independent Practice, San Francisco, CA, USA
M Goodman Emory University Rollins School of Public Health, Atlanta, GA, USA
J Green Independent Scholar, Vancouver, WA, USA
A B Hancock The George Washington University, Washington, DC, USA
T W Johnson Department of Anthropology, California State University, Chico, CA, USA
D H Karasic University of California San Francisco, San Francisco, CA, USA Independent Practice at dankarasic.com
G A Knudson University of British Columbia, Vancouver, Canada Vancouver Coastal Health, Vancouver, Canada
S F Leibowitz Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
H F L Meyer-Bahlburg New York State Psychiatric Institute, New York, NY, USA Department of Psychiatry, Columbia University, New York, NY, USA
S J Monstrey Ghent University Hospital, Gent, Belgium
J Motmans Transgender Infopunt, Ghent University Hospital, Gent, Belgium Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
L Nahata Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
T O Nieder University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
S L Reisner Harvard Medical School, Boston, MA, USA Harvard T. H. Chan School of Public Health, Boston, MA, USA
C Richards Regents University London, UK Tavistock and Portman NHS Foundation Trust, London, UK
L S Schechter Rush University Medical Center, Chicago, IL, USA
V Tangpricha Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Decatur, GA, USA
A C Tishelman Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
M A A Van Trotsenburg Bureau GenderPRO, Vienna, Austria University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
S Winter School of Population Health, Curtin University, Perth, WA, Australia
K Ducheny Howard Brown Health, Chicago, IL, USA
N J Adams University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada Transgender Professional Association for Transgender Health (TPATH)
T M Adrián Asamblea Nacional de Venezuela, Caracas, Venezuela Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
L R Allen University of Nevada, Las Vegas, NV, USA
D Azul La Trobe Rural Health School, La Trobe University, Bendigo, Australia
H Bagga Monash Health Gender Clinic, Melbourne, Victoria, Australia Monash University, Melbourne, Victoria, Australia
K Başar Department of Psychiatry, Hacettepe University, Ankara, Turkey
D S Bathory Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
J J Belinky Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
D R Berg National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
J U Berli Oregon Health & Science University, Portland, OR, USA
R O Bluebond-Langner NYU Langone Health, New York, NY, USA Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
M-B Bouman Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
M L Bowers Icahn School of Medicine at Mount Sinai, New York, NY, USA Mills-Peninsula Medical Center, Burlingame, CA, USA
P J Brassard GrS Montreal, Complexe CMC, Montreal, Quebec, Canada Université de Montreal, Quebec, Canada
J Byrne University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
L Capitán The Facialteam Group, Marbella International Hospital, Marbella, Spain
C J Cargill Independent Scholar
J M Carswell Harvard Medical School, Boston, MA, USA Boston's Children's Hospital, Boston, MA, USA
S C Chang Independent Practice, Oakland, CA, USA
G Chelvakumar Nationwide Children's Hospital, Columbus, OH, USA The Ohio State University, College of Medicine, Columbus, OH, USA
T Corneil School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
K B Dalke Penn State Health, PA, USA Penn State College of Medicine, Hershey, PA, USA
G De Cuypere Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
E de Vries Nelson Mandela University, Gqeberha, South Africa University of Cape Town, Cape Town, South Africa
M Den Heijer Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
A H Devor University of Victoria, Victoria, BC, Canada
C Dhejne ANOVA, Karolinska University Hospital, Stockholm, Sweden Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
A D'Marco UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas D M A R C O Organization, Nassau, The Bahamas
E K Edmiston University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
L Edwards-Leeper Pacific University, Hillsboro, OR, USA Independent Practice, Beaverton, OR, USA
R Ehrbar Whitman Walker Health, Washington, DC, USA Independent Practice, Maryland, USA
D Ehrensaft University of California San Francisco, San Francisco, CA, USA
J Eisfeld Transvisie, Utrecht, The Netherlands
E Elaut Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
L Erickson-Schroth The Jed Foundation, New York, NY, USA Hetrick-Martin Institute, New York, NY, USA
J L Feldman Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
A D Fisher Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
M M Garcia Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
L Gijs Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
S E Green Mermaids, London/Leeds, UK
B P Hall Duke University Medical Center, Durham, NC, USA Duke Adult Gender Medicine Clinic, Durham, NC, USA
T L D Hardy Alberta Health Services, Edmonton, Alberta, Canada MacEwan University, Edmonton, Alberta, Canada
M S Irwig Harvard Medical School, Boston, MA, USA Beth Israel Deaconess Medical Center, Boston, MA, USA
L A Jacobs Independent Practice, New York, NY, USA
A C Janssen Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Northwestern Feinberg School of Medicine, Chicago, IL, USA
K Johnson RMIT University, Melbourne, Australia University of Brighton, Brighton, UK
D T Klink Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
B P C Kreukels Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
L E Kuper Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA Department of Endocrinology, Children's Health, Dallas, TX, USA
E J Kvach Denver Health, Denver, CO, USA University of Colorado School of Medicine, Aurora, CO, USA
M A Malouf Malouf Counseling and Consulting, Baltimore, MD, USA
R Massey WPATH Global Education Institute Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
T Mazur Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA John R. Oishei Children's Hospital, Buffalo, NY, USA
C McLachlan Professional Association for Transgender Health, South Africa Gender DynamiX, Cape Town, South Africa
S D Morrison Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
S W Mosser Gender Confirmation Center, San Francisco, CA, USA Saint Francis Memorial Hospital, San Francisco, CA, USA
P M Neira Johns Hopkins Center for Transgender Health, Baltimore, MD, USA Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
U Nygren Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
J M Oates La Trobe University, Melbourne, Australia Melbourne Voice Analysis Centre, East Melbourne, Australia
J Obedin-Maliver Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA Department of Epidemiology and Population Health, Stanford, CA, USA
G Pagkalos Independent PracticeThessaloniki, Greece Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
J Patton Talkspace, New York, NY, USA CytiPsychological LLC, San Diego, CA, USA
N Phanuphak Institute of HIV Research and Innovation, Bangkok, Thailand
K Rachlin Independent Practice, New York, NY, USA
T Reed Gender Identity Research and Education Society, Leatherhead, UK
G N Rider National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
J Ristori Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
S Robbins-Cherry Nottingham Centre for Transgender Health, Nottingham, UK
S A Roberts Harvard Medical School, Boston, MA, USA Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
K A Rodriguez-Wallberg Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
S M Rosenthal Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA UCSF Child and Adolescent Gender Center
K Sabir FtM Phoenix Group, Krasnodar Krai, Russia
J D Safer Icahn School of Medicine at Mount Sinai, New York, NY, USA Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
A I Scheim Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
L J Seal Tavistock and Portman NHS Foundation Trust, London, UK St George's University Hospitals NHS Foundation Trust, London, UK
T J Sehoole Iranti, Johannesburg, South Africa
K Spencer National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
C St Amand University of Houston, Houston, TX, USA Mayo Clinic, Rochester, MN, USA
T D Steensma Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
J F Strang Children's National Hospital, Washington, DC, USA George Washington University School of Medicine, Washington, DC, USA
G B Taylor Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
K Tilleman Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
G G T'Sjoen Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium Department of Endocrinology, Ghent University Hospital, Gent, Belgium
L N Vala Independent Practice, Campbell, CA, USA
N M Van Mello Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
J F Veale School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
J A Vencill Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
B Vincent Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
L M Wesp College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA Health Connections Inc., Glendale, WI, USA
M A West North Memorial Health Hospital, Robbinsdale, MN, USA University of Minnesota, Minneapolis, MN, USA
J Arcelus School of Medicine, University of Nottingham, Nottingham, UK Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain

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Rosenthal SM, Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Safer JD, Tangpricha V, T'Sjoen GG. Response to Letter to the Editor: "Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline". J Clin Endocrinol Metab 2019;104:5102-5103. [PMID: 31046093 DOI: 10.1210/jc.2019-00930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/26/2019] [Indexed: 02/13/2023]

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. ENDOCRINE TREATMENT OF GENDER-DYSPHORIC/GENDER-INCONGRUENT PERSONS: AN ENDOCRINE SOCIETY CLINICAL PRACTICE GUIDELINE. Endocr Pract 2018;23:1437. [PMID: 29320642 DOI: 10.4158/1934-2403-23.12.1437] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]

Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017. [PMID: 28945902 DOI: 10.1210/jc.2017-01658.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]

Abstract

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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Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017;102:3869-3903. [PMID: 28945902 DOI: 10.1210/jc.2017-01658] [Citation(s) in RCA: 1107] [Impact Index Per Article: 158.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]

Abstract

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

CONSENSUS PROCESS

CONCLUSION

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Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, Toye K, Kaufman JM, T'Sjoen GG. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone 2008;43:1016-21. [PMID: 18835591 DOI: 10.1016/j.bone.2008.09.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/20/2008] [Accepted: 09/02/2008] [Indexed: 12/27/2022]

Abstract

CONTEXT

Male-to-female (M-->F) transsexual persons undergo extreme changes in gonadal hormone concentrations, both by pharmacological and surgical interventions. Given the importance of sex steroids for developing and maintaining bone mass, bone health is a matter of concern in daily management of these patients.

OBJECTIVE

To provide data on bone metabolism, geometry and volumetric bone mineral density in M-->F transsexual persons.

DESIGN/SETTING/PARTICIPANTS

Twenty-three M-->F transsexual persons, recruited from our gender dysphoria clinic and at least 3 yrs after sex reassignment surgery, together with 46 healthy age- and height-matched control men were included in this cross-sectional study.

MAIN OUTCOME MEASURES

Body composition, areal and volumetric bone parameters determined using DXA and peripheral quantitative computed tomography. Hormone levels and markers of bone metabolism assessed using immunoassays. Peak torque of biceps and quadriceps muscles and grip strength assessed using an isokinetic and hand dynamometer, respectively.

RESULTS

M-->F transsexual persons presented lower total and regional muscle mass and lower muscle strength as compared to controls (all P<0.001). In addition, they had higher total and regional fat mass (P<0.010) and a lower level of sports-related activity index (P<0.010). Bone mineral content and areal density (aBMD) of the lumbar spine, total hip and distal radius, as well as trabecular vBMD of the distal radius was lower as compared to controls (P<0.010). At cortical sites, no differences in cortical vBMD were observed, whereas M-->F transsexual persons were characterized by smaller cortical bone size at both the radius and tibia (P<0.010). Lower levels of biochemical markers of bone formation and resorption (P<0.010) suggested decreased bone turnover.

CONCLUSION

M-->F transsexual persons have less lean mass and muscle strength, and higher fat mass. In addition, they present lower trabecular vBMD and aBMD at the lumbar spine, total hip and distal radius, and smaller cortical bone size as compared to matched controls. Both the lower level of sports-related physical activity as well testosterone deprivation could contribute to these findings. These results indicate that bone health should be a parameter of interest in the long-term follow-up care for M-->F transsexual persons.

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T'Sjoen GG, Giagulli VA, Delva H, Crabbe P, De Bacquer D, Kaufman JM. Comparative assessment in young and elderly men of the gonadotropin response to aromatase inhibition. J Clin Endocrinol Metab 2005;90:5717-22. [PMID: 16046582 DOI: 10.1210/jc.2005-0982] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]

T'Sjoen GG, Beguin Y, Feyen E, Rubens R, Kaufman JM, Gooren L. Influence of exogenous oestrogen or (anti-) androgen administration on soluble transferrin receptor in human plasma. J Endocrinol 2005;186:61-7. [PMID: 16002536 DOI: 10.1677/joe.1.06112] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]

T'Sjoen GG, De Vos S, Goemaere S, Van Pottelbergh I, Dierick M, Van Heeringen C, Kaufman JM. Sex Steroid Level, Androgen Receptor Polymorphism, and Depressive Symptoms in Healthy Elderly Men. J Am Geriatr Soc 2005;53:636-42. [PMID: 15817010 DOI: 10.1111/j.1532-5415.2005.53212.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]