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Gender identity disorder — Clinical Guidelines

Overview

Gender identity disorder (GID) involves incongruence between a person's experienced or expressed gender and the sex assigned at birth, often necessitating gender-affirming interventions and care across multiple specialties.

Diagnosis

Clinical Assessment: Comprehensive evaluation by mental health professionals to confirm persistent gender dysphoria 28.

Hormonal Evaluation: Initial assessment by an endocrinologist to guide hormonal therapy 28.

No Specific Diagnostic Tests: Diagnosis primarily based on clinical criteria; no specific laboratory tests required 28.

Management

Gender-Affirming Hormone Therapy (GAHT):

- Testosterone for Trans Men: Initiation and monitoring by endocrinologists 28 3. - Estrogen and Anti-Androgens for Trans Women: Similar structured approach recommended 28.

Psychosocial Support: Essential for mental health and overall well-being 2 28.

Multidisciplinary Care: Involving endocrinologists, mental health professionals, surgeons, and primary care providers 5 28.

Special Populations

Pediatrics: Increasing focus on early intervention and support, often involving pediatric endocrinologists 8.

Comorbidities: Attention to specific health risks like cardiovascular disease, bone health, and mental health issues 2 3 12.

Key Recommendations

Comprehensive Training in Transgender Health: Endocrinologists and other specialists should receive standardized training to improve care quality (Evidence: Moderate 2 12).

Multidisciplinary Team Approach: Establish multidisciplinary teams to address the complex needs of transgender patients (Evidence: Expert opinion 5).

Inclusive Curriculum Development: Integrate transgender health into medical education curricula across specialties to reduce health disparities (Evidence: Moderate 10 16).

Empathetic and Non-Judgmental Care: Providers should adopt empathetic approaches to build trust and improve patient outcomes (Evidence: Expert opinion 6 19).

Insurance Coverage Advocacy: Advocate for equitable insurance coverage for gender-affirming treatments to reduce barriers to care (Evidence: Expert opinion 20).

References

1 Marra J, Christensen D, Harper JM, Iwamoto SJ, Ryan W, Safer JD et al.. Medical Care of Transgender Athletes and Policy Implications: ACSM Contemporary Issue Statement. Medicine and science in sports and exercise 2026. link 2 Ahmad T, Schreyer L, Fung R, Yu C. Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study. PloS one 2024. link 3 Hayes-Lattin M, Krivicich LM, Bragg JT, Rogerson A, Salzler MJ. Considerations for the care of transgender patients in orthopaedics and sports medicine: a narrative review. British journal of sports medicine 2024. link 4 Swonke M, Barr J, Brissett E, Ordonez A, Syed T, Thekdi A. Perceptions and Understanding of Transgender Patient Care: A Survey of Practicing Laryngologists. The Laryngoscope 2024. link 5 Marano AA, Noyes M, Eisenbeis L, Hedian HF, Segna K, Neira PM et al.. Building an Academic Transgender Medicine Center of Excellence: The 5-Year Johns Hopkins Experience. Academic medicine : journal of the Association of American Medical Colleges 2023. link 6 Pascua BN, Dyne PL. Emergency Medicine Considerations in the Transgender Patient. Emergency medicine clinics of North America 2023. link 7 Pidgeon TE, Morley R, Rose V. Exposure of plastic surgery and urology registrars in the United Kingdom to gender affirming care of transgender patients: A cross-sectional survey of training programme directors. Journal of plastic, reconstructive & aesthetic surgery : JPRAS 2023. link 8 . Ken C. Pang. Cell reports. Medicine 2022. link 9 Sahmoud A, Hamilton D, Pope R. A Trauma-Informed and Gender-Inclusive Medical Nomenclature. Obstetrics and gynecology 2022. link 10 Schmidt CN, Stretten M, Bindman JG, Pettigrew G, Lager J. Care across the gender spectrum: A transgender health curriculum in the Obstetrics and Gynecology clerkship. BMC medical education 2022. link 11 Herzog VW, Cohen A. Sports Medicine Research Practices for Categorizing Transgender and/or Intersex Participants. Journal of sport rehabilitation 2022. link 12 Bretherton I, Grossmann M, Leemaqz SY, Zajac JD, Cheung AS. Australian endocrinologists need more training in transgender health: A national survey. Clinical endocrinology 2020. link 13 Haseen B, Kahn A, Belton A, Roth Bayer C. Health Care for Transgender Men: What Is Missing in OB/GYN Care?. Journal of lower genital tract disease 2020. link 14 Condat A, Mamou G, Lagrange C, Mendes N, Wielart J, Poirier F et al.. Transgender fathering: Children's psychological and family outcomes. PloS one 2020. link 15 Sullivan P, Trinidad J, Hamann D. Issues in transgender dermatology: A systematic review of the literature. Journal of the American Academy of Dermatology 2019. link 16 Vinekar K, Rush SK, Chiang S, Schiff MA. Educating Obstetrics and Gynecology Residents on Transgender Patients: A Survey of Program Directors. Obstetrics and gynecology 2019. link 17 Kirkpatrick DL, Stowell J, Grimstad F, Brown E, Fishback S, Lemons S. Creating a Transgender-Inclusive Interventional Radiology Department. Journal of vascular and interventional radiology : JVIR 2019. link 18 Davidge-Pitts CJ, Nippoldt TB, Natt N. ENDOCRINOLOGY FELLOWS' PERCEPTION OF THEIR CONFIDENCE AND SKILL LEVEL IN PROVIDING TRANSGENDER HEALTHCARE. Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists 2018. link 19 Chisolm-Straker M, Willging C, Daul AD, McNamara S, Sante SC, Shattuck DG et al.. Transgender and Gender-Nonconforming Patients in the Emergency Department: What Physicians Know, Think, and Do. Annals of emergency medicine 2018. link 20 Learmonth C, Viloria R, Lambert C, Goldhammer H, Keuroghlian AS. Barriers to insurance coverage for transgender patients. American journal of obstetrics and gynecology 2018. link 21 Dubon ME, Abbott K, Carl RL. Care of the Transgender Athlete. Current sports medicine reports 2018. link 22 Tollinche LE, Walters CB, Radix A, Long M, Galante L, Goldstein ZG et al.. The Perioperative Care of the Transgender Patient. Anesthesia and analgesia 2018. link 23 Davidge-Pitts C, Nippoldt TB, Danoff A, Radziejewski L, Natt N. Transgender Health in Endocrinology: Current Status of Endocrinology Fellowship Programs and Practicing Clinicians. The Journal of clinical endocrinology and metabolism 2017. link 24 . Growing recognition of transgender health. Bulletin of the World Health Organization 2016. link 25 Dy GW, Osbun NC, Morrison SD, Grant DW, Merguerian PA. Exposure to and Attitudes Regarding Transgender Education Among Urology Residents. The journal of sexual medicine 2016. link 26 Unger CA. Care of the transgender patient: a survey of gynecologists' current knowledge and practice. Journal of women's health (2002) 2015. link 27 Wierckx K, Van de Peer F, Verhaeghe E, Dedecker D, Van Caenegem E, Toye K et al.. Short- and long-term clinical skin effects of testosterone treatment in trans men. The journal of sexual medicine 2014. link 28 Medraś M, Jóźków P. Transsexualism--diagnostic and therapeutic aspects. Endokrynologia Polska 2010. link

Gender identity disorder