Chevy Chase, MD—The Endocrine Society has released a new clinical practice guideline for endocrine treatment of transsexual persons. The guideline, “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” appears in the September 2009 issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
 
Transsexualism, or gender identity disorder (GID), is defined as a condition in which a patient experiences clinically significant distress due to strong and persistent cross-gender identification combined with a discomfort with their sex or a sense of inappropriateness in the gender role of that sex.

“Transsexual persons experiencing the confusion and stress associated with feeling ‘trapped’ in the wrong body, look to endocrinologists for treatment that can bring relief and resolution to their profound discomfort,” said Wylie Hembree, MD, of Columbia University in New York and chair of the task force that developed the guideline. “It is the purpose of this guideline to make science-based recommendations that will enable endocrinologists to provide safe and effective treatment for individuals diagnosed with GID.”  

The clinical guideline recommends:

• The diagnosis of GID be made by a mental health professional;

• Against endocrine treatment of pre-pubertal children because a diagnosis of transsexualism in a child who has not yet gone through puberty cannot be made with certainty;
  
  Note: TransActive believes this guideline should be applied on a case-by-case basis rather than as a strict guideline.

• Treating transsexual adolescents when they first exhibit signs of puberty by suppressing puberty until the age of 16 years, after which cross-sex hormones may be given;
  
  Note: TransActive supports the administration of cross-sex hormones prior to age 16 with case-by-case evaluation of such treatment.

• Treating transsexual adults by suppressing endogenous sex hormones, maintaining physiologic levels of gender-appropriate sex hormones and monitoring for known risks.

“The medical field will need further rigorous evaluation of the effectiveness and safety of all endocrine treatments of transsexual persons,” said Hembree. “Of specific concern are the effects of prolonged delay of puberty on bone growth and the long-term medical and psychological risks of sex re-assignment.”

Other members of the task force that developed this guideline include:

Peggy Cohen-Kettenis and Henriette Delemarre-van de Waal of VU Medical Center in The Netherlands
Louis Gooren
Walter Meyer of the University of Texas in Galveston, Tex.
Norman Spack of Harvard Medical School in Boston, Mass.
Vin Tangpricha of Emory University in Atlanta, Ga.
Victor Montori of the Mayo Clinic in Rochester, Minn.

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