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Endocrine Treatment of Transsexual Persons:An Endocrine Society Clinical Practice Guideline

Columbia University and New York Presbyterian Hospital (W.C.H.), New York, New York 10032; VU Medical Center (P.C-K., H.A.D.-v.d.W.), 1007 MB Amsterdam, The Netherlands; Leiden University Medical Center (H.A.D.-v.d.W.), 2300 RC Leiden, The Netherlands; Andro-consult (L.J.G.) ChaingMai 50220, Thailand; University of Texas Medical Branch (W.J.M.), Galveston, Texas 77555; Harvard Medical School (N.P.S.), Boston, Massachusetts 02115; Emory University School of Medicine (V.T.), Atlanta, Georgia 30322; and Mayo Clinic (V.M.M.), Rochester, Minnesota 55905

Address all correspondences and requests for reprints to: The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, Maryland. E-mail: govt-prof{at}endo.society.org. Telephone: 301-941-0200.

Objective: The aim was to formulate practice guidelines for endocrine treatment oftranssexual persons.

Evidence: This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system to describe the strength of recommendations and the quality of evidence, which was low or very low.

Consensus Process: Committees and members of The Endocrine Society, European Society of Endocrinology, European Society for Paediatric Endocrinology, Lawson Wilkins Pediatric Endocrine Society, and World Professional Association for Transgender Health commented on preliminary drafts of these guidelines.

Conclusions: Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe, effective hormone regimen that will 1) suppress endogenous hormone secretion determined by the person’s genetic/biologic sex and 2) maintain sex hormone levels within the normal range for the person’s desired gender. A mental health professional (MHP) must recommend endocrine treatment and participate in ongoing care throughout the endocrine transition and decision for surgical sex reassignment. The endocrinologist must confirm the diagnostic criteria the MHP used to make these recommendations. Because a diagnosis of transsexualism in a prepubertal child cannot be made with certainty, we do not recommend endocrine treatment of prepubertal children. We recommend treating transsexual adolescents (Tanner stage 2) by suppressing puberty with GnRH analogues until age 16 years old, after which cross-sex hormones may be given. We suggest suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks in adult transsexual persons.

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