ESPEYB20 4. Differences of Sexual Development (DSD) and Gender Incongruence (GI) Gender Incongruence (GI): New Guidance (1 abstracts)
4.10. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
Coleman E , Radix AE , Bouman WP , Brown GR , de Vries ALC , Deutsch MB , Ettner R , Fraser L , Goodman M , Green J , Hancock AB , Johnson TW , Karasic DH , Knudson GA , Leibowitz SF , Meyer-Bahlburg HFL , Monstrey SJ , Motmans J , Nahata L , Nieder TO , Reisner SL , Richards C , Schechter LS , Tangpricha V , Tishelman AC , Van Trotsenburg MAA , Winter S , Ducheny K , Adams NJ , Adrián TM , Allen LR , Azul D , Bagga H , Başar K , Bathory DS , Belinky JJ , Berg DR , Berli JU , Bluebond-Langner RO , Bouman MB , Bowers ML , Brassard PJ , Byrne J , Capitán L , Cargill CJ , Carswell JM , Chang SC , Chelvakumar G , Corneil T , Dalke KB , De Cuypere G , de Vries E , Den Heijer M , Devor AH , Dhejne C , D’Marco A , Edmiston EK , Edwards-Leeper L , Ehrbar R , Ehrensaft D , Eisfeld J , Elaut E , Erickson-Schroth L , Feldman JL , Fisher AD , Garcia MM , Gijs L , Green SE , Hall BP , Hardy TLD , Irwig MS , Jacobs LA , Janssen AC , Johnson K , Klink DT , Kreukels BPC , Kuper LE , Kvach EJ , Malouf MA , Massey R , Mazur T , McLachlan C , Morrison SD , Mosser SW , Neira PM , Nygren U , Oates JM , Obedin-Maliver J , Pagkalos G , Patton J , Phanuphak N , Rachlin K , Reed T , Rider GN , Ristori J , Robbins-Cherry S , Roberts SA , Rodriguez-Wallberg KA , Rosenthal SM , Sabir K , Safer JD , Scheim AI , Seal LJ , Sehoole TJ , Spencer K , St Amand C , Steensma TD , Strang JF , Taylor GB , Tilleman K , T’Sjoen GG , Vala LN , Van Mello NM , Veale JF , Vencill JA , Vincent B , Wesp LM , West MA & Arcelus J
Int J Transgend Health. 2022 Sep 6;23(Suppl 1):S1–S259. doi: 10.1080/26895269.2022.2100644. PMID: 36238954; PMCID: PMC9553112
Brief summary: The World Professional Association for Transgender Health (WPATH) has issued an updated Standards of Care version 8 which contains important guidelines on how the assessment of gender variant children and adolescents should be considered, and by whom, and provides guidance around the consideration of young people for hormonal intervention.
This long and detailed document has had considerable input from many experts involved in transgender care and has incorporated what evidence is available, and when clinical experience is available, then the Delphi concensus approach was used and this process required 75% concordance to provide recommendations. There are now separate chapters dealing with children and adolescents. Key points for paediatric endocrinologists start with a recommendation to check that the mental health professionals making the diagnosis of gender incongruence are appropriately qualified to do so, and are appropriately experienced and licensed to practise in this field in their own country.
Further recommendations state that health care professionals assessing transgender and gender diverse adolescents should ensure the young people are only referred for gender-affirming medical treatments when they meet the diagnostic criteria of gender incongruence as per the WHO ICD-11 (or other appropriate diagnostic systems) and when the experience of gender incongruence is marked and sustained over time. The adolescent must demonstrate the emotional and cognitive maturity required to provide informed consent for treatment and also that their mental health concerns (if any) that could interfere with the diagnostic clarity and capacity to consent to gender-affirming medical treatments have been addressed. These recommendations emphasise assessment of maturity rather than using age-specific cut-offs. The document also emphasises the need for ongoing psychosocial support alongside endocrine treatments.
Young people must have been informed of the reproductive effects of hormonal interventions, including the potential loss of fertility and the available options to preserve fertility, and these must have been discussed in the context of the adolescent’s stage of pubertal development. They must have reached Tanner stage 2 for pubertal suppression to be initiated. Although surgical referral is not common in paediatric and adolescent practice, the adolescent must have had at least 12 months of gender-affirming hormone therapy or longer, if required, to achieve the desired result for gender-affirming procedures, such as breast removal or augmentation, orchidectomy, vaginoplasty, hysterectomy, phalloplasty, metoidioplasty, and facial surgery as part of gender-affirming treatment.
Volume 20
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ESPE Yearbook of Paediatric Endocrinology
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