Practice Guidelines

Gender-Dysphoric/Gender-Incongruent Persons: Treatment Recommendations from the Endocrine Society


Am Fam Physician. 2018 May 1;97(9):608-609.

Author disclosure: No relevant financial affiliations.

Key Points

• Hormone treatment for prepubertal gender-dysphoric/gender-incongruent persons is not recommended.

• Adolescents meeting the diagnostic and treatment criteria should undergo initial hormone treatment to suppress pubertal development after exhibiting physical changes of puberty.

• It is important to evaluate medical conditions that can be made worse by hormone depletion and treatment.

• Clinical evaluation for adverse changes in response to treatment should be monitored every three months during the first year, then once or twice yearly.

From the AFP Editors

Gender-dysphoric/gender-incongruent persons require a safe and effective hormone regimen that will suppress sex hormone secretion determined by the person's genetic sex and maintain sex hormone levels within the normal range for the person's affirmed gender. These persons are referred to an endocrinologist for treatment to develop physical characteristics of the affirmed gender. Physicians who recommend these treatments should be appropriately trained and familiar with the diagnostic criteria and specifications for gender-affirming treatment, have training and experience in assessing psychopathology, and participate in the ongoing care throughout the endocrine transition. Hormone treatment for prepubertal gender-dysphoric/gender-incongruent persons is not recommended.

These recommendations are an update to the clinical practice guideline on endocrine treatment of transsexual persons published in 2009 by the Endocrine Society.



Only trained mental health professionals should diagnose gender dysphoria/gender incongruence in adults. They should be competent in using the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases and Related Health Problems for diagnostic purposes. They should be able to distinguish between gender dysphoria/gender incongruence and other similar conditions, and have sufficient

Author disclosure: No relevant financial affiliations.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of Practice Guidelines published in AFP is available at



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