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."
