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Clinical Guidelines with Information on Transfeminine Hormone Therapy

By Aly W. | First published November 20, 2020 | Last modified September 28, 2021

Abstract / TL;DR

This article is a collection of clinical practice guidelines with information on transfeminine hormone therapy that exist throughout the world. Examples of these clinical guidelines include the Endocrine Society guidelines and the University of San Francisco (UCSF) Center of Excellence for Transgender Health guidelines, among many others.

Introduction

Clinicians use clinical practice guidelines (CPGs) to learn about and guide themselves in administering medical care for different indications. Clinical practice guidelines review and summarize the available scientific literature and research in a given medical area. They allow clinicians to competently administer care without necessarily having to delve into and develop their understanding via the primary scientific literature. Literature reviews can serve a similar function. However, clinical practice guidelines are generally more substantial and are more founded in evidence-based medicine. They are also regularly updated. Clinical practice guidelines are developed and maintained by clinical organizations and societies, universities, government agencies, and sometimes even large medical clinics. They may be international/locationless or oftentimes region-specific.

There are many clinical practice guidelines for transgender medicine (for review, Deutsch, Radix, & Reisner, 2016; Radix, 2019; Radix, 2019; UpToDate; Bewley et al., 2021; Dahlen et al., 2021; Ziegler, Carroll, & Charnish, 2021). These guidelines discuss topics such as psychotherapy, hormone therapy, voice therapy, and surgical management of transgender people, among others. In addition to educating and guiding clinicians, transgender clinical practice guidelines are useful materials for transgender people as they can help to inform them about their care.

This page is a maintained list of known English clinical guidelines throughout the world that include information specifically on the subject of transfeminine hormone therapy. The most major guidelines on transgender hormone therapy are the Endocrine Society guidelines (Hembree et al., 2017), which are international, and the University of San Francisco (UCSF) guidelines (Deutsch, 2016), which are based in the United States. The World Professional Association for Transgender Health (WPATH) Standards of Care (SoC) (Coleman et al., 2012) do not currently provide guidelines or recommendations on transgender hormone therapy. Rather, they only briefly review transgender hormone therapy and instead implicitly endorse the Endocrine Society guidelines as well as other resources. An overview of the Endocrine Society and WPATH guidelines has been published (Wilczynski & Emanuele, 2014).

International

TitleAuthor / OrganizationYearForm
Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline [PDF] [See also: 1st/2009 edition]Hembree et al. / Endocrine Society2017Published article
Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7 [Alt] [PDF]aColeman et al. / World Professional Association for Transgender Health (WPATH)2012Published article
Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of the Standards of CareFeldman & Safer2009Published article
International Medical Advisory Panel (IMAP) Statement on Hormone Therapy for Transgender People [PDF]International Planned Parenthood Federation (IPPF)2015Online document
Transgender Women: Evaluation and Management [PDF]Tangpricha & Safer / UpToDate2020Online web page

a From the WPATH Standards of Care: “WPATH does not describe or endorse a particular feminizing/masculinizing hormone regimen. Rather, the medication classes and routes of administration used in most published regimens are broadly reviewed. […] The Endocrine Society Guidelines (Hembree et al., 2009) and Feldman and Safer (2009) provide specific guidance regarding the types of hormones and suggested dosing to maintain levels within physiologic ranges for a patient’s desired gender expression (based on goals of full feminization/masculinization). It is strongly recommend[ed] that hormone providers regularly review the literature for new information and use those medications that safely meet individual patient needs with available local resources.”

United States

TitleAuthor / Organization [Place]YearForm
Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People [PDF]Deutsch / Center of Excellence for Transgender Health, University of San Francisco (UCSF) [San Francisco, California]2016Online document
Medical Care of Trans and Gender Diverse Adults [PDF]Thompson, et al. / Fenway Health [Boston, Massachusetts]2021Online document
Protocols for the Provision of Hormone Therapy [PDF]Callen-Lorde Community Health Center [New York City, New York]2018Online document
Protocols for Hormonal Reassignment of GenderDavidson et al. / Tom Waddell Health Center / San Francisco Department of Public Health [San Francisco, California]2013Online document
TransLine Gender Affirming Hormone Therapy Prescriber Guidelines [PDF]Gorton et al. / TransLine / Lyon-Martin Health Services [San Francisco, California]2019Online document

Canada

TitleAuthor / OrganizationYearForm
Gender-Affirming Care for Trans, Two-Spirit, and Gender Diverse Patients in BC: A Primary Care ToolkitTrans Care BC [Vancouver, British Columbia, Canada]2021Online document
Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines: Physical Aspects of Transgender Endocrine TherapyDahl et al. / Vancouver Coastal Health [Vancouver, British Columbia, Canada]2015Online document
Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients [PDF]Bourns / Sherbourne Health / Rainbow Health Ontario [Toronto, Ontario, Canada]2019Online document

Europe

United Kingdom

TitleAuthor / OrganizationYearForm
Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria [PDF]Wylie et al. / Royal College of Psychiatrists2014Published article
Various [PDF] [PDF] [PDF] [PDF] [PDF]Various / National Health Service (NHS) TrustsVariousOnline documents

Italy

TitleAuthor / OrganizationYearForm
SIAMS-ONIG Consensus on Hormonal Treatment in Gender Identity DisordersGodano et al. / Società Italiana di Andrologia e Medicina della Sessualità (SIAMS) [Italian Society of Andrology and Sexual Medicine] / Osservatorio Nazionale sull’Identità di Genere (ONIG) [National Observatory of Gender Identity]2009Published article

Australia

New Zealand

TitleAuthor / OrganizationYearForm
Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa, New Zealand [PDF]Oliphant et al. / Transgender Health Research Lab, University of Waikato2018Published article

Elsewhere

TitleAuthor / Organization [Place]YearForm
Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities in Asia and the Pacific [PDF]Health Policy Project / Asia Pacific Transgender Network / United Nations Development Programme [Asia and the Pacific]2015Online document
Blueprint for the Provision of Comprehensive Care for Trans Persons and their Communities in the Caribbean and Other Anglophone Countries [Alt] [PDF]John Snow, Inc. / Pan American Health Organization / World Health Organization [Latin America and the Caribbean]2014Online document
A Good Practice Guide to Gender-Affirmative CareSappho for Equality [India]2019Online document
IDEA Group Consensus Statement on Medical Management of Adult Gender Incongruent Individuals Seeking Gender Reaffirmation as FemaleMajumder et al. / Integrated Diabetes and Endocrine Academy (IDEA) [India]2020Published article
The Thai Handbook of Transgender Healthcare Services (PDF)Vacharathit et al. / Center of Excellence in Transgender Health / Chulalongkorn University [Thailand]2021Online document

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