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Gender identity disorder of adulthood — Clinical Guidelines

Overview

Gender identity disorder of adulthood, now often referred to as gender dysphoria, involves significant distress due to a mismatch between a person's experienced or expressed gender and the sex assigned at birth. It encompasses individuals who may seek various medical interventions to align their physical characteristics with their gender identity.

Diagnosis

Presence of significant distress or impairment related to the incongruence between experienced/expressed gender and assigned sex at birth 1 3.

Detailed clinical interview assessing gender identity, history, and psychological impact 1 3.

No specific diagnostic tests; psychological evaluation may be recommended to rule out other psychiatric conditions 1 3.

Management

Psychosocial Support: Counseling and mental health support to address gender dysphoria and associated distress 1 3.

Hormonal Therapy: For transgender individuals, hormone replacement therapy (HRT) tailored to transition goals (e.g., testosterone for transmen, estrogen for transwomen) 3 4.

Surgical Interventions: Gender-affirming surgeries such as genital reconstruction, chest reconstruction, and facial feminization/masculinization procedures 4 8.

Speech Therapy: For voice modification in transgender individuals to align with their gender identity 8.

Special Populations

Pediatrics: Early identification and support are crucial; multidisciplinary teams should be involved in care 1.

Elderly: Limited specific data; focus on comprehensive care addressing both age-related and gender dysphoria-related needs 2.

Comorbidities: Tailored management considering specific health disparities and potential barriers to care faced by LGBTQ+ individuals 2 5.

Key Recommendations

Incorporate Comprehensive LGBTQ+ Training: Ensure residency and fellowship programs include adequate education on LGBTQ+ health to improve provider competency and patient care (Evidence: Moderate 1 3 7).

Enhance Curricular Content: Develop and implement curricular enhancements focusing on gender dysphoria and transgender health across specialties (Evidence: Moderate 3 6).

Utilize Innovative Educational Tools: Employ advanced educational methods like virtual reality to reduce bias and improve care for marginalized populations (Evidence: Moderate 2).

Promote Inclusive Clinic Environments: Establish LGBTQ+-welcoming clinics with multidisciplinary support to address specific health needs (Evidence: Expert opinion 6).

Address Voice and Dermatologic Needs: Include specialized care such as speech therapy and dermatologic interventions tailored to transgender individuals (Evidence: Moderate 4 8).

References

1 Panzer ZR, Jones CD, Helwig S, Bonachea EM. A National Assessment of LGBTQ+ Curricular Needs in Pediatric Emergency Medicine Fellowship Programs. Pediatric emergency care 2026. link 2 Shastri V, Carlson C, Gia DH, Bhatia R, Vallario M, Healer S et al.. In . Gerontology & geriatrics education 2025. link 3 Fakhoury JW, Daveluy S. Incorporating Lesbian, Gay, Bisexual, and Transgender Training into a Residency Program. Dermatologic clinics 2020. link 4 Marks DH, Awosika O, Rengifo-Pardo M, Ehrlich A. Dermatologic Surgical Care for Transgender Individuals. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 2019. link 5 Mehta PK, Easter SR, Potter J, Castleberry N, Schulkin J, Robinson JN. Lesbian, Gay, Bisexual, and Transgender Health: Obstetrician-Gynecologists' Training, Attitudes, Knowledge, and Practice. Journal of women's health (2002) 2018. link 6 Nisly NL, Imborek KL, Miller ML, Dole N, Priest JB, Sandler L et al.. Developing an Inclusive and Welcoming LGBTQ Clinic. Clinical obstetrics and gynecology 2018. link 7 Moll J, Krieger P, Moreno-Walton L, Lee B, Slaven E, James T et al.. The prevalence of lesbian, gay, bisexual, and transgender health education and training in emergency medicine residency programs: what do we know?. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2014. link 8 McNeill EJ. Management of the transgender voice. The Journal of laryngology and otology 2006. link

Gender identity disorder of adulthood