Transgender Health Care Best Practices

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In late 2017, The Journal of Clinical Endocrinology & Metabolism published updated guidelines for the medical care of transgender adolescent youth. A summary of those best practices are are listed on this page. You can download the complete 35-page article.

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Evaluation

Trained mental health professionals who regularly attend relevant professional meeting and have knowledge regarding the criteria for puberty blocking and gender-affirming hormone treatments
Social transition of prepubertal kids with gender dysphoria and gender incongruence should be made with the help of a trained mental health professional
Recommends against puberty blocking and gender-affirming hormone treatment in pre-pubertal kids
Discuss fertility preservation options before beginning puberty suppression or hormone therapy

Treatment of Adolescents

Treatment to suppress pubertal development should happen first in adolescents who meet diagnostic criteria for gender dysphoria
Pubertal hormone suppression should begin with the first sign of physical changes of puberty
GnRH analogues should be used to suppress pubertal hormones
Sex hormone treatment should begin around age 16, using a gradually increasing dosage
Sex hormone treatment can begin before the age of 16, under the supervision of a multidisciplinary team of medical and mental health professionals
Doctor visits to monitor pubertal development every 3-6 months and lab work should be ordered every 6-12 months

Adverse Outcome Prevention and Long-Term Care

Clinical and laboratory monitoring should occur every 3 months during the first year of hormone therapy and then once or twice yearly after that
Transgender females using estrogen should monitor prolactin levels
Cardiovascular risk factors for all transgender people should be monitored with fasting lipid profiles, diabetes screening, and/or other tools
Bone mineral density measurements should be taken when osteoporosis risk factors exist
Breast screening guidelines for non-transgender females should be followed by transgender females with no known increased breast cancer risk
Prostatic cancer and disease risk for transgender females treated with estrogen should continue with individualized screening
Total hysterectomy and oophorectomy should be determined based on medical necessity and the individual”s gender-affirming treatment plan

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Surgery for Sex Reassignment and Gender Confirmation

Surgery decisions should be made jointly with the patient, their mental health provider, and their doctor
Genital gender-affirming surgery should occur after at least 1 year of consistent and compliant hormone treatment, unless hormones are medically contraindicated
A transgender patient”s medical doctors should collaborate to clear the patient for gender-affirming surgery
Gender-affirming surgery should be considered after the person
(1) has had a satisfactory social role change;
(2) is satisfied with hormonal effects; and
(3) desires definitive surgical changes
Gender-affirming surgeries such as gonadectomies and hysterectomies, should wait until the patient is of the age of majority, general 18
Breast reduction surgery for transgender males does not have a specific age requirement

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