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This version published online on June 9, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0345
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Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline

Wylie C. Hembree*, Peggy Cohen-Kettenis, Henriette A. Delemarre-van de Waal, Louis J. Gooren, Walter J. Meyer III, Norman P. Spack, Vin Tangpricha, and Victor M. Montori

Columbia University and New York Presbyterian Hospital (W.C.H.), New York, New York; Vrije University Medical Center (P.C-K.), Amsterdam, The Netherlands; Vrije University Medical Center, Amsterdam and Leiden University Medical Center (H.A.D.W.), The Netherlands; Androgen Consultant (L.J.G.), Bangkok, Thailand; University of Texas Medical Branch (W.J.M.), Galveston, Texas; Harvard Medical School (N.P.S.), Boston, Massachusetts; and Emory University School of Medicine (V.T.), Atlanta, Georgia; and Mayo Clinic (V.M.M.), Rochester, Minnesota

* To whom correspondence should be addressed. E-mail: govt-prof{at}endo-society.org.

Objective: To formulate practice guidelines for the endocrine treatment of transsexual persons.

Participants: An Endocrine Society-appointed Task Force of experts, a methodologist, and a medical writer.

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

Consensus Process: One group meeting, several conference calls, and e-mail communications enabled consensus. Committees and members of The Endocrine Society, European Society of Endocrinology, the European Society for Paediatric Endocrinology (ESPE), World Professional Association for Transgender Health (WPATH), and Lawson Wilkins Pediatric Endocrine Society reviewed and commented on preliminary drafts of these guidelines.

Conclusions: Sex reassignment is a multidisciplinary treatment in which endocrinologists play an important role. Transsexual persons seeking to develop the physical characteristics of the desired gender require a safe and 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 gender. A mental health professional (MHP) must recommend endocrine treatment and participate in the ongoing care throughout the endocrine transition. The endocrinologist must confirm the diagnostic criteria the MHP used to make this recommendation and collaborate with the MHP in making the recommendation for surgical sex reassignment. We recommend treating transsexual adolescents (Tanner stage 2) with suppression of puberty with GnRH analogues until age 16 years, after which cross-sex hormones may be given. We suggest suppression of endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and surveillance for known risks and complications in adult transsexual persons.




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J W Jacobeit, L J Gooren, and H M Schulte
Safety aspects of 36 months of administration of long-acting intramuscular testosterone undecanoate for treatment of female-to-male transgender individuals
Eur. J. Endocrinol., November 1, 2009; 161(5): 795 - 798.
[Abstract] [Full Text] [PDF]


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