What are the guideline sources, guidelines and references for Gender dysphoria ?
Guideline 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). 1 2 3 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. E https://web.pathway.md/diseases/recaYQMG48XRcfBeX 1/4 6/24/23, 3:16 AM Gender dysphoria Pathway Diagnosis: Ensure that only trained mental health professionals meeting the following criteria diagnose gender dysphoria/gender incongruence in adults: competence in using the DSM and/or the International Classification of Diseases for diagnostic purposes ability to diagnose gender dysphoria/gender incongruence and make a distinction between gender dysphoria/gender incongruence and conditions having similar features (such as body dysmorphic disorder) training in diagnosing psychiatric conditions ability to undertake or refer for appropriate treatment ability to psychosocially assess the person's understanding, mental health, and social conditions that can impact gender-affirming hormone therapy practice of regularly attending relevant professional meetings. E Ensure that only trained mental health professionals meeting the following criteria diagnose gender dysphoria/gender incongruence in children and adolescents: training in child and adolescent developmental psychology and psychopathology competence in using the DSM and/or the International Classification of Diseases for diagnostic purposes ability to make a distinction between gender dysphoria/gender incongruence and conditions having similar features (such as body dysmorphic disorder) training in diagnosing psychiatric conditions ability to undertake or refer for appropriate treatment ability to psychosocially assess the person's understanding and social conditions that can impact gender-affirming hormone therapy practice of regularly attending relevant professional meetings knowledge of the criteria for puberty blocking and gender-affirming hormone treatment in adolescents. E 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. E Show 2 more Management of adolescents: initiate treatment to suppress pubertal development in adolescents meeting diagnostic criteria for gender dysphoria/gender incongruence, fulfilling criteria for treatment, and requesting treatment. B Show 5 more Management of adults (evaluation): confirm the diagnostic criteria of gender dysphoria/gender incongruence and the criteria for the endocrine phase of gender transition before initiating https://web.pathway.md/diseases/recaYQMG48XRcfBeX 2/4 6/24/23, 3:16 AM Gender dysphoria Pathway treatment. B Show 2 more Management of adults, counseling: As per ACOG 2021 guidelines: Discuss fertility and parenting desires early in the process of transition before the initiation of hormone therapy or gender affirmation surgery. E Recognize that gender-affirming hormone therapy is not effective contraception. Counsel sexually active individuals with retained gonads not wishing to become pregnant or cause pregnancy in others about the possibility of pregnancy if thet have a sexual activity involving sperm and oocytes. E As per ES 2017 guidelines, consider educating transgender individuals undergoing treatment about the onset and course of physical changes induced by sex hormone treatment. C Management of adults, surgery: As per ACOG 2021 guidelines, perform hysterectomy with or without bilateral salpingo- oophorectomy in patients with gender dysphoria desiring this procedure. E As per ES 2017 guidelines, consider determining the necessity of including a total hysterectomy and oophorectomy as part of gender-affirming surgery. E Show 6 more 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. C Show 2 more Surveillance for osteoporosis: obtain bone mineral density measurements when risk factors for osteoporosis exist, specifically in persons discontinuing sex hormone therapy after gonadectomy. B Surveillance for malignancy: As per ACOG 2021 guidelines, screen any anatomical structure warranting screening, regardless of gender identity, to guide preventive medical care. E As per ES 2017 guidelines: Consider following breast-screening guidelines recommended for non-transgender females for transgender females with no known increased risk of breast cancer. C Consider obtaining individualized screening according to personal risk for prostatic disease and prostate cancer in transgender females treated with estrogens. C 4. Quality improvement https://web.pathway.md/diseases/recaYQMG48XRcfBeX 3/4 6/24/23, 3:16 AM Gender dysphoria Pathway 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. E 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. E References 1. Wylie C Hembree, Peggy T Cohen-Kettenis, Louis Gooren et al. Endocrine Treatment of Gender- Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017 Nov 1;102 11 3869 3903. Open 2. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice, American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Health Care for Transgender and Gender Diverse Individuals: ACOG Committee Opinion, Number 823. Obstet Gynecol. 2021 Mar 1;137 3):e75-e88. Open 3. American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Am Psychol. 2015 Dec;70 9 832 64. Open https://web.pathway.md/diseases/recaYQMG48XRcfBeX 4/4