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Gender dysphoria

Key sources
The following summarized guidelines for the evaluation and management of gender dysphoria are prepared by our editorial team based on guidelines from the American College of Obstetricians and Gynecologists (ACOG 2021), the Endocrine Society (ES 2017), and the American Psychiatric Association (APA 2015).
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Guidelines

1.Screening and diagnosis

Gender identity: recognize that:
gender is a nonbinary construct that allows for a range of gender identities and that a person's gender identity may not align with the sex assigned at birth
gender identity and sexual orientation are distinct but interrelated constructs
stigma, prejudice, discrimination, and violence affect the health and well-being of transgender and gender-nonconforming people
gender-questioning/transgender and gender-nonconforming children and adolescents have different developmental needs and not all youth will persist in a transgender and gender-nonconforming identity into adulthood
transgender and gender-nonconforming people are more likely to experience positive life outcomes when they receive social support or trans-affirmative care
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  • Diagnosis

2.Medical management

Management of prepubertal children: make decisions regarding the social transition of prepubertal youths with gender dysphoria/gender incongruence with the assistance of a mental health professional or another experienced professional.
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  • Management of adolescents

  • Management of adults (evaluation)

  • Management of adults (counseling)

  • Management of adults (surgery)

3.Follow-up and surveillance

Serial clinical and laboratory assessment: consider obtaining regular clinical evaluation for physical changes and potential adverse changes in response to sex steroid hormones and laboratory monitoring of sex steroid hormone levels every 3 months during the first year of hormone therapy in transgender males and females and then once or twice yearly.
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  • Surveillance for osteoporosis

  • Surveillance for malignancy

4.Quality improvement

Health equity and accessibility
Ensure that obstetric-gynecology offices are inclusive and invite all persons needing obstetric or gynecologic care. Ensure that obstetrician-gynecologists educate themselves and their medical teams about appropriate language and the health needs of transgender patients.
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Recognize that most medications used for gender transition are common and can be safely prescribed by a wide variety of healthcare professionals with appropriate training and education, including, but not limited to, obstetrician-gynecologists, family or internal medicine physicians, endocrinologists, advanced practice clinicians, and psychiatrists.
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