Gender Dysphoria Guidelines

Updated: Apr 24, 2019
  • Author: Mohammed A Memon, MD; Chief Editor: Glen L Xiong, MD  more...
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Guidelines

Guidelines Summary

Royal College of Psychiatrists

In October 2013, the Royal College of Psychiatrists in the United Kingdom issued new guidelines for the assessment and treatment of gender dysphoria, which include the following: [18, 19]

  • Gender treatment should involve a multidisciplinary team

  • People with gender dysphoria should have access to high-quality care without unnecessarily long waits

  • People with gender dysphoria have a right to psychotherapy and counseling as part of their treatment

  • Treatment should recognize the preferences, needs, and circumstances of the particular patient

  • Treatments that have been initiated for adolescents should continue into adulthood without interruption

  • More research should be encouraged, including research on patient outcome and satisfaction with interventions and transition

American Psychological Association

In 2015, the American Psychological Association adopted Guidelines for Psychological Practice with Transgender and Gender Nonconforming Clients in order to describe affirmative psychological practice with transgender and gender nonconforming (TGNC) clients. There are 16 guidelines in this document that guide TGNC-affirmative psychological practice across the lifespan, from TGNC children to older adults. The guidelines are organized into five clusters: (a) foundational knowledge and awareness; (b) stigma, discrimination, and barriers to care; (c) lifespan development; (d) assessment, therapy, and intervention; and (e) research, education, and training. [20, 21]

World Professional Association for Transgender Health

The World Professional Association for Transgender Health (WPATH) currently publishes the Standards of Care (SOC), to provide clinical guidelines for health care of transsexual, transgender and gender non-conforming persons in order to maximize health and well-being by revealing gender dysphoria. [22] The latest version of the SOC is available here.

Endocrine Society

In 2017, the Endocrine Society updated its Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline. [23]

The new guideline states that only trained mental health professionals (MHPs) should diagnose gender dysphoria (GD)/gender incongruence in adults. These MHPs should be well-versed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and/or the International Statistical Classification of Diseases and Related Health Problems (ICD) and trained in diagnosing psychiatric disorders and distinguishing between GD/gender incongruence and conditions that have similar features. MHPs working with children and adolescents should also possess training in child and adolescent developmental psychology and psychopathology.

The Society recommends against puberty blocking and gender-affirming hormone treatment in prepubertal children with GD/gender incongruence. However, it may be offered to adolescents, and GnRH analogues can be used if indicated. Sex hormone treatment should be initiated using a gradually increasing dose schedule. Treatment should include periodic monitoring of hormone levels and metabolic parameters, as well as assessments of bone density and the impact upon prostate, gonads, and uterus.

It is advised that clinicians approve genital genderaffirming surgery only after completion of at least 1 year of consistent and compliant hormone treatment. Clinicians should inform pubertal children, adolescents, and adults seeking genderconfirming treatment of their options for fertility preservation. This surgery should be delayed in cases involving gonadectomy and/or hysterectomy until the patient is at least 18 years old.