Therapy and frequency	Surveillance
Pubertal suppression (i.e., with a gonadotropin-releasing hormone analogue)
Every visit	History: psychosocial assessment and treatment of high-risk findings; injection-site reaction and vasomotor symptoms; adherence to medication and mental health treatment plan
3 months	History: menstruation (if applicable)
	Physical examination: height, weight, Tanner stage
	Laboratory: serum luteinizing hormone, follicle-stimulating hormone, estradiol/testosterone levels (by ultrasensitive assay)
12 months	Laboratory: serum comprehensive metabolic panel (renal and liver function, glucose level), lipid levels, A1C level, bone age, and bone density testing
Male-to-female hormone treatment*
Every visit	History: assessment for comorbid mental health conditions and treatment of high-risk findings (including suicidality); adherence to medication and mental health treatment plan; tobacco cessation if indicated
3 months	Laboratory: serum testosterone (goal: < 55 ng per dL [1.9 nmol per L]) and estradiol (goal: < 200 pg per mL [734 pmol per L]), and electrolytes if spironolactone is used (especially during first year); adjust doses if appropriate
3 months†	Physical examination: assessment for feminization, adverse reactions (e.g., hypertension, thromboembolic disease), weight assessment
Periodic	Laboratory: serum liver enzymes, prolactin, and lipid levels; diabetes mellitus screening
Female-to-male hormone treatment*
Every visit	History: assessment for comorbid mental health conditions and treatment of high-risk findings (including suicidality); adherence to medication and mental health treatment plan; tobacco cessation if indicated
2 to 3 months‡	Laboratory: serum testosterone (goal: 350 to 700 ng per dL [12.2 to 24.3 nmol per L]) midway between injections (for testosterone enanthate/cypionate); adjust dosing if appropriate, and decrease screening interval once testosterone is in normal physiologic male range; serum estradiol (goal: < 50 pg per mL [184 pmol per L]), may discontinue estradiol level measurement if no uterine bleeding for six months
3 months†	Physical examination: assessment for virilization, adverse reactions (e.g., hypertension, thromboembolic disease), weight assessment
	Laboratory: serum liver enzymes, hematocrit (goal: < 55%), lipid levels; diabetes screening