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Treatment of Gender-Dysphoric/Gender-Incongruent Persons

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Key Points 2 ➤ 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. ➤ 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. Table 1. Definitions of Terms Used in This Guideline Term Definition Biological sex, biological male or female ese terms refer to physical aspects of maleness and femaleness. As these may not be in line with each other (e.g., a person with XY chromosomes may have female- appearing genitalia), the terms biological sex and biological male or female are imprecise and should be avoided. Cisgender is means not transgender. An alternative way to describe individuals who are not transgender is "non-transgender people." Gender-affirming (hormone) treatment See "Gender reassignment."

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