Materiały źródłowe

• #1 Gender Dysphoria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532313/

  Gender dysphoria (previously gender identity disorder), according to the Diagnostic and Statistical Manual of Mental Disorders, is defined as a marked incongruence between their experienced or expressed gender and the one they were assigned at birth. […] Patients with this condition should be provided with psychiatric support. Hormonal therapy and surgical therapy are also available depending on the individual case and the patient’s needs. […] This activity describes the evaluation and management of gender dysphoria and reviews the role of the interprofessional team in improving care for those with this condition. […] It should also be specified according to age. Sadock et al. suggest the following. Individual, family, and group therapy are important for children to explore and counsel on gender preference. For adolescents, the added anticipation of puberty is of concern, so hormonal treatment and psychotherapy should be considered simultaneously. For adults, psychotherapy and hormonal and surgical treatments are all available options.

• #2 Gender Incongruence and Gender Dysphoria – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/gender-incongruence-and-gender-dysphoria/gender-incongruence-and-gender-dysphoria

  Gender dysphoria is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and is divided into 2 sets of diagnostic criteria, one for children and one for adolescents and adults. […] If an individual experiences or displays gender incongruity or gender nonconformity, this itself is not considered a disorder. It is considered a normal variant in human gender identity and expression. However, when the perceived mismatch between birth sex and the internal sense of gender identity causes someone significant distress or functional impairment, a clinical diagnosis of gender dysphoria may be appropriate. The diagnosis is defined by the person’s distress rather than by the presence of gender incongruity or identity. […] The distress of gender dysphoria is typically described as a combination of anxiety, depression, irritability, and the pervasive sense of not feeling comfortable in one’s body. People with severe gender dysphoria may experience severe, disturbing, and long-standing symptoms. They usually have a strong wish to change their body medically and/or surgically to make their body more closely align with their gender identity.

• #3 Gender Incongruence and Gender Dysphoria – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/gender-incongruence-and-gender-dysphoria/gender-incongruence-and-gender-dysphoria

  Gender dysphoria is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and is divided into 2 sets of diagnostic criteria, one for children and one for adolescents and adults. […] If an individual experiences or displays gender incongruity or gender nonconformity, this itself is not considered a disorder. It is considered a normal variant in human gender identity and expression. However, when the perceived mismatch between birth sex and the internal sense of gender identity causes someone significant distress or functional impairment, a clinical diagnosis of gender dysphoria may be appropriate. The diagnosis is defined by the person’s distress rather than by the presence of gender incongruity or identity. […] The distress of gender dysphoria is typically described as a combination of anxiety, depression, irritability, and the pervasive sense of not feeling comfortable in one’s body. People with severe gender dysphoria may experience severe, disturbing, and long-standing symptoms. They usually have a strong wish to change their body medically and/or surgically to make their body more closely align with their gender identity.

• #4 Gender dysphoria – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/diagnosis-treatment/drc-20475262

  A diagnosis of gender dysphoria includes distress due to gender identity differing from sex assigned at birth that lasts at least six months and involves two or more of the following: […] Gender dysphoria also includes distress that makes it hard to handle work, school, social situations and other parts of daily life. […] Our caring team of Mayo Clinic experts can help you with your gender dysphoria-related health concerns. […] The purpose of treatment is to ease gender dysphoria. Specific goals for gender dysphoria treatment depend on the person. […] If you have gender dysphoria, it’s important to find a healthcare professional who has expertise in the care of gender-diverse people. […] Treatment for gender dysphoria can include changes in gender expression, hormone therapy, surgery and supportive behavioral health therapy.

• #5 Gender Incongruence and Gender Dysphoria – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/gender-incongruence-and-gender-dysphoria/gender-incongruence-and-gender-dysphoria

  Gender dysphoria is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and is divided into 2 sets of diagnostic criteria, one for children and one for adolescents and adults. […] If an individual experiences or displays gender incongruity or gender nonconformity, this itself is not considered a disorder. It is considered a normal variant in human gender identity and expression. However, when the perceived mismatch between birth sex and the internal sense of gender identity causes someone significant distress or functional impairment, a clinical diagnosis of gender dysphoria may be appropriate. The diagnosis is defined by the person’s distress rather than by the presence of gender incongruity or identity. […] The distress of gender dysphoria is typically described as a combination of anxiety, depression, irritability, and the pervasive sense of not feeling comfortable in one’s body. People with severe gender dysphoria may experience severe, disturbing, and long-standing symptoms. They usually have a strong wish to change their body medically and/or surgically to make their body more closely align with their gender identity.

• #6 Gender Identity & Dysphoria Treatment | Charlie Health

  https://www.charliehealth.com/areas-of-care/gender-identity-dysphoria

  The main symptoms of gender dysphoria are ongoing feelings of distress or discomfort with one’s gender as assigned at birth, one’s body (specifically primary/secondary sex characteristics), and one’s expected gender roles. These symptoms can cause emotional distress, anxiety, and depression and affect a person’s ability to function in the world, highlighting the importance of providing gender-affirming care and support to those experiencing gender dysphoria.

• #7 Gender Incongruence and Gender Dysphoria – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/gender-incongruence-and-gender-dysphoria/gender-incongruence-and-gender-dysphoria

  Gender dysphoria is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), and is divided into 2 sets of diagnostic criteria, one for children and one for adolescents and adults. […] If an individual experiences or displays gender incongruity or gender nonconformity, this itself is not considered a disorder. It is considered a normal variant in human gender identity and expression. However, when the perceived mismatch between birth sex and the internal sense of gender identity causes someone significant distress or functional impairment, a clinical diagnosis of gender dysphoria may be appropriate. The diagnosis is defined by the person’s distress rather than by the presence of gender incongruity or identity. […] The distress of gender dysphoria is typically described as a combination of anxiety, depression, irritability, and the pervasive sense of not feeling comfortable in one’s body. People with severe gender dysphoria may experience severe, disturbing, and long-standing symptoms. They usually have a strong wish to change their body medically and/or surgically to make their body more closely align with their gender identity.

• #8 Gender dysphoria | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/gender-dysphoria

  Gender dysphoria is a feeling of distress that can happen when a person’s gender identity differs from the sex assigned at birth. […] A diagnosis of gender dysphoria focuses on the feeling of distress as the issue, not gender identity. […] Gender dysphoria can affect many parts of life, including daily activities. […] If gender dysphoria makes school or work very hard, the result may be dropping out of school or not being able to find a job. […] People with gender dysphoria who don’t receive the support and treatment they need are at higher risk of thinking about or attempting suicide. […] The purpose of treatment is to ease gender dysphoria. […] If you have gender dysphoria, it’s important to find a healthcare professional who has expertise in the care of gender-diverse people.

• #9 AMA to states: Stop interfering in health care of transgender children | American Medical Association

  https://www.ama-assn.org/press-center/ama-press-releases/ama-states-stop-interfering-health-care-transgender-children

  Empirical evidence has demonstrated that trans and non-binary gender identities are normal variations of human identity and expression. For gender diverse individuals, standards of care and accepted medically necessary services that affirm gender or treat gender dysphoria may include mental health counseling, non-medical social transition, gender-affirming hormone therapy, and/or gender-affirming surgeries. […] Every major medical association in the United States recognizes the medical necessity of transition-related care for improving the physical and mental health of transgender people. […] Studies suggest that improved body satisfaction and self-esteem following the receipt of gender-affirming care is protective against poorer mental health and supports healthy relationships with parents and peers.

• #10 AMA to states: Stop interfering in health care of transgender children | American Medical Association

  https://www.ama-assn.org/press-center/ama-press-releases/ama-states-stop-interfering-health-care-transgender-children

  Studies also demonstrate dramatic reductions in suicide attempts, as well as decreased rates of depression and anxiety. […] Other studies show that a majority of patients report improved mental health and function after receipt of gender-affirming care. […] It is imperative that transgender minors be given the opportunity to explore their gender identity under the safe and supportive care of a physician.

• #11 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  The nursing care plan developed for Gender Identity Disorder (GID), now more commonly referred to as Gender Dysphoria, reflects the need for sensitive, comprehensive, and affirming care for individuals navigating gender diversity. Gender Dysphoria is a complex condition characterized by a persistent and distressing misalignment between an individuals assigned gender at birth and their experienced or expressed gender identity. This incongruence often leads to significant psychological distress and impairment in social, occupational, and interpersonal functioning. The nursing care plan aims to provide a structured framework for healthcare professionals to support individuals with Gender Dysphoria in their journey towards self-acceptance, authenticity, and holistic well-being. […] By prioritizing empathy, cultural competence, and advocacy, nurses can create a safe and supportive healthcare environment where individuals feel validated, respected, and empowered to express their gender identity authentically.

• #12 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  The nursing care plan developed for Gender Identity Disorder (GID), now more commonly referred to as Gender Dysphoria, reflects the need for sensitive, comprehensive, and affirming care for individuals navigating gender diversity. Gender Dysphoria is a complex condition characterized by a persistent and distressing misalignment between an individuals assigned gender at birth and their experienced or expressed gender identity. This incongruence often leads to significant psychological distress and impairment in social, occupational, and interpersonal functioning. The nursing care plan aims to provide a structured framework for healthcare professionals to support individuals with Gender Dysphoria in their journey towards self-acceptance, authenticity, and holistic well-being. […] By prioritizing empathy, cultural competence, and advocacy, nurses can create a safe and supportive healthcare environment where individuals feel validated, respected, and empowered to express their gender identity authentically.

• #13 Sexual Dysfunctions, Paraphilias, and Gender Dysphoria – Nurseslabs

  https://nurseslabs.com/sexual-dysfunctions-paraphilias-and-gender-dysphoria/

  Nursing assessment includes: Sexual dysfunction. Sexual dysfunction is the persons experience of change in sexual dysfunction; the person views this change as unsatisfying, unrewarding, inadequate, or socially inappropriate. […] Based on the assessment data, the major nursing diagnoses are: Disturbed personal identity related to parenting patterns that encourage culturally unacceptable behaviors for assigned gender. […] The nursing interventions are: Be accepting and nonjudgmental. Sexuality is a very personal and sensitive subject; the client is more likely to share this information if he or she does not fear being judged by the nurse.

• #14 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Gender-affirming hormone therapy, which involves the use of an estrogen and antiandrogen, or of testosterone, is generally safe but partially irreversible. […] Adolescents experiencing puberty should be evaluated for reversible puberty suppression, which may make future affirmation easier and safer. […] Multidisciplinary care may be optimal but is not universally available. […] Clinicians should consider routine screening for depression, anxiety, posttraumatic stress disorder, eating disorders, substance use, intimate partner violence, self-injury, bullying, truancy, homelessness, high-risk sexual behaviors, and suicidality. […] Efforts to convert a person’s gender identity to align with their sex assigned at birth are unethical and incompatible with current guidelines and evidence.

• #15 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  The nursing care plan for Gender Dysphoria recognizes the intersecting influences of biological, psychological, social, and cultural factors on an individuals gender identity development and well-being. Through comprehensive assessment, therapeutic interventions, and ongoing evaluation, nurses strive to address the holistic needs of individuals with Gender Dysphoria, promoting resilience, self-acceptance, and quality of life. […] By advocating for inclusive healthcare policies and practices, challenging stigma and discrimination, and fostering a culture of acceptance and affirmation, nurses can contribute to creating a more equitable and inclusive healthcare system that honors the diverse spectrum of gender identities and expressions. […] By conducting a thorough nursing assessment, nurses can gain valuable insights into the unique needs and experiences of individuals with Gender Dysphoria, informing the development of holistic, person-centered care plans that support affirmation, acceptance, and well-being across the gender spectrum.

• #16 Sexual Dysfunctions, Paraphilias, and Gender Dysphoria – Nurseslabs

  https://nurseslabs.com/sexual-dysfunctions-paraphilias-and-gender-dysphoria/

  Nursing assessment includes: Sexual dysfunction. Sexual dysfunction is the persons experience of change in sexual dysfunction; the person views this change as unsatisfying, unrewarding, inadequate, or socially inappropriate. […] Based on the assessment data, the major nursing diagnoses are: Disturbed personal identity related to parenting patterns that encourage culturally unacceptable behaviors for assigned gender. […] The nursing interventions are: Be accepting and nonjudgmental. Sexuality is a very personal and sensitive subject; the client is more likely to share this information if he or she does not fear being judged by the nurse.

• #17 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  By identifying these nursing diagnoses, nurses can develop targeted interventions aimed at addressing the unique needs and challenges faced by individuals with Gender Dysphoria, promoting affirmation, acceptance, and well-being across the gender spectrum. […] By implementing these nursing interventions, nurses can play a crucial role in supporting individuals with Gender Dysphoria to navigate their gender identity journey with validation, affirmation, and holistic care. […] In conclusion, the nursing care plan developed for individuals with Gender Dysphoria reflects a commitment to providing holistic, affirming, and culturally competent care that honors the diversity of gender identities and experiences. […] Through comprehensive assessment, collaborative care planning, and evidence-based interventions, nurses play a vital role in supporting individuals with Gender Dysphoria in their journey towards self-acceptance, affirmation, and well-being.

• #18 Sexual Dysfunctions, Paraphilias, and Gender Dysphoria – Nurseslabs

  https://nurseslabs.com/sexual-dysfunctions-paraphilias-and-gender-dysphoria/

  Nursing assessment includes: Sexual dysfunction. Sexual dysfunction is the persons experience of change in sexual dysfunction; the person views this change as unsatisfying, unrewarding, inadequate, or socially inappropriate. […] Based on the assessment data, the major nursing diagnoses are: Disturbed personal identity related to parenting patterns that encourage culturally unacceptable behaviors for assigned gender. […] The nursing interventions are: Be accepting and nonjudgmental. Sexuality is a very personal and sensitive subject; the client is more likely to share this information if he or she does not fear being judged by the nurse.

• #19 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. […] Training staff in culturally sensitive terminology and transgender topics (e.g., use of chosen name and pronouns), creating welcoming and affirming clinical environments, and assessing personal biases may facilitate improved patient interactions. […] Depending on their comfort level and the availability of local subspecialty support, primary care clinicians may evaluate gender dysphoria and manage applicable hormone therapy, or monitor well-being and provide primary care and referrals. […] Clinicians should identify and treat mental health conditions but avoid the assumption that such conditions are related to gender identity.

• #20 Gender Identity & Dysphoria Treatment | Charlie Health

  https://www.charliehealth.com/areas-of-care/gender-identity-dysphoria

  Gender dysphoria is typically diagnosed through a clinical evaluation by a mental health or healthcare professional. This involves assessing a person’s experiences and feelings related to their gender identity, including any distress or discomfort associated with their gender assigned at birth. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines the complete diagnostic criteria. Diagnosis of gender dysphoria is not meant to pathologize being transgender but to make it easier for people to get the healthcare and support they need, like hormone therapy or gender-affirming surgery. […] At Charlie Health, we work with our clients experiencing gender dysphoria using multimodal approaches that include recognition, psychological support, and affirmation. […] Gender-affirming therapy is designed to support people with gender dysphoria in their gender identity exploration and transition. It supports a person’s true gender identity, helps them develop coping skills, and enables them to make informed choices about medical treatments like hormone therapy or gender-affirming surgeries. This therapy also offers a safe place to discuss challenges and discrimination faced by transgender and gender-diverse people, improving mental well-being and their connection with their gender identity.

• #21 Gender Dysphoria | Kaiser Permanente

  https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.gender-dysphoria.abs2270

  Dysphoria means feeling distressed or uneasy. Gender dysphoria is a feeling of emotional distress because your inner sense of your gender (gender identity) doesn’t match the sex that you were assigned at birth. […] Many, but not all, transgender and gender-diverse people have gender dysphoria. If someone you care about has gender dysphoria, there are ways that you can help. […] Gender dysphoria can cause great distress. Feeling loved, supported, and accepted can help. […] Usually, gender dysphoria is treated by helping someone affirm their gender identity through finding ways to express it. […] Non-medical options for expressing gender identity may include: Clothing, hairstyles, or makeup. […] Medical options may include: Gender-affirming hormones. […] If you have gender dysphoria, know that you’re not alone. Many people have gone through what you’re going through now. It can be comforting and helpful to talk to those people. You can find them through local or online groups. […] Learn all you can about gender identity. Organizations such as Parents, Families, and Friends of Lesbians and Gays (PFLAG) can help.

• #22 Psychomedical care in gender identity dysphoria during adolescence | Revista de Psiquiatría y Salud Mental (English Edition)

  https://www.elsevier.es/pt-revista-revista-psiquiatria-salud-mental-486-articulo-psychomedical-care-in-gender-identity-S2173505017300250

  The new 2012 Spanish guide for the care of individuals with GID, which updates the first version of the guide that was published in 2003, stands out for its richness of details and numerous explanations, as well as because it is written in a language aimed at the different specialists involved (psychiatrists, psychologists and plastic surgeons, etc.). […] Psychotherapy aims to help the individual to feel better in their identity and confront other different problems, clarifying and relieving conflicts. […] Patients with GID must be cared for by a multidisciplinary team (psychology, psychiatry, endocrinology and surgery). […] The responsibility for the decision to start hormone and surgical therapy is shared with the doctor who prescribes it. […] When caring for minors monitoring over time is indispensable for a reliable diagnosis, and they cannot be evaluated at a single point in time.

• #23 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  We suggest that clinicians measure hormone levels during treatment to ensure that endogenous sex steroids are suppressed and administered sex steroids are maintained in the normal physiologic range for the affirmed gender. […] We suggest 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 for transgender males and females and then once or twice yearly. […] We recommend that a patient pursue genital gender-affirming surgery only after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patients overall health and/or well-being.

• #24 Psychiatry.org – What is Gender Dysphoria?

  https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

  Family and societal rejection of gender identity are some of the strongest predictors of mental health difficulties among people who are transgender. Family and couples therapy can be important for creating a supportive environment that will allow a persons mental health to thrive. Parents of children and adolescents who are transgender may benefit from support groups. Peer support groups for transgender people themselves are often helpful for validating and sharing experiences.

• #25 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  By identifying these nursing diagnoses, nurses can develop targeted interventions aimed at addressing the unique needs and challenges faced by individuals with Gender Dysphoria, promoting affirmation, acceptance, and well-being across the gender spectrum. […] By implementing these nursing interventions, nurses can play a crucial role in supporting individuals with Gender Dysphoria to navigate their gender identity journey with validation, affirmation, and holistic care. […] In conclusion, the nursing care plan developed for individuals with Gender Dysphoria reflects a commitment to providing holistic, affirming, and culturally competent care that honors the diversity of gender identities and experiences. […] Through comprehensive assessment, collaborative care planning, and evidence-based interventions, nurses play a vital role in supporting individuals with Gender Dysphoria in their journey towards self-acceptance, affirmation, and well-being.

• #26 Framework guidelines for the process of caring for the health of adolescent transgender (T) and non-binary (NB) people experiencing gender dysphoria — the position statement of the expert panel | Gawlik-Starzyk | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/104289

  Persistent gender dysphoria often adopts the form of increased mental distress adversely affecting the health, social functioning, and development of the individual; not undertaking clinical activities is associated with some consequences, and the implementation of adequate interventions is a health-promoting approach that is lifesaving in some cases. […] The complexity of the issues related to individuals at the developmental age excludes extreme solutions, such as access to medical interventions (e.g. gender-affirming hormonal interventions) without adequate assessment and preparation as well as arbitrary and complete denial of the inclusion of these interventions. […] We understand the affirmative model of care as an approach that combines acceptance and mindfulness. […] We believe that accepting the identity experienced by an adolescent person, addressing them using the preferred personal forms and allowing medical (i.e. pharmacological and, to a limited extent, surgical) gender-affirming interventions under the age of 18 years preceded by a reliable diagnosis are among the elements of comprehensive care and do not contradict it.

• #27 Nursing Care For Transgender Patients | NurseJournal.org

  https://nursejournal.org/resources/nursing-care-for-transgender-patients/

  Transgender people face challenges in many aspects of life, including healthcare. Here’s how nurses can create welcoming spaces for and work with transgender patients. […] Nurses have an especially important role in providing an affirming space for transgender people. […] This guide aims to help nurses better understand the transgender and GNC community, the hurdles they might face in healthcare, and helpful steps on working with transgender and GNC patients. […] For many transgender patients, healthcare can be an intimidating and often inaccessible environment. […] According to Desiree Daz, Ph.D., associate professor at University of Central Florida’s College of Nursing, these distressing experiences can lead to transgender people avoiding necessary appointments and procedures. […] Greater education and training for working with transgender and GNC people is one solution to this problem.

• #28 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. […] Training staff in culturally sensitive terminology and transgender topics (e.g., use of chosen name and pronouns), creating welcoming and affirming clinical environments, and assessing personal biases may facilitate improved patient interactions. […] Depending on their comfort level and the availability of local subspecialty support, primary care clinicians may evaluate gender dysphoria and manage applicable hormone therapy, or monitor well-being and provide primary care and referrals. […] Clinicians should identify and treat mental health conditions but avoid the assumption that such conditions are related to gender identity.

• #29 Gender incongruence in primary care

  https://www.bma.org.uk/advice-and-support/gp-practices/gp-service-provision/managing-patients-with-gender-dysphoria

  Be mindful of the sensitivity of their condition and of how difficult it might have been for your patient to seek treatment. […] NHS England guidance encourages GPs to collaborate with GICs in the initiation and on-going prescribing of hormone therapy. […] The GMC advice states that GPs must co-operate with gender identity clinics and specialists to provide effective and timely treatment for trans and non-binary people. […] In our view, patients require a holistic approach; their psychological needs should be treated as well as their physical response to treatment. […] The Gender Recognition Act 2004 provides safeguards for the privacy of individuals with gender dysphoria and restricts the disclosure of certain information.

• #30 Nursing Care For Transgender Patients | NurseJournal.org

  https://nursejournal.org/resources/nursing-care-for-transgender-patients/

  Transgender people face challenges in many aspects of life, including healthcare. Here’s how nurses can create welcoming spaces for and work with transgender patients. […] Nurses have an especially important role in providing an affirming space for transgender people. […] This guide aims to help nurses better understand the transgender and GNC community, the hurdles they might face in healthcare, and helpful steps on working with transgender and GNC patients. […] For many transgender patients, healthcare can be an intimidating and often inaccessible environment. […] According to Desiree Daz, Ph.D., associate professor at University of Central Florida’s College of Nursing, these distressing experiences can lead to transgender people avoiding necessary appointments and procedures. […] Greater education and training for working with transgender and GNC people is one solution to this problem.

• #31 Nursing Care For Transgender Patients | NurseJournal.org

  https://nursejournal.org/resources/nursing-care-for-transgender-patients/

  Once nurses understand their own biases and learn more about transgender and GNC individuals, they can take steps to provide affirming healthcare spaces for people in these communities. […] As Overstreet says, A patient’s gender identity is one part of them, so be sure to care for them as a whole person and not inflate or narrow their identity. […] It is about shifting the systems and social conditioning on wider levels to include the trans and GNC experience as part of what is normal, rather than always an exception.

• #32 An affirming approach to caring for transgender and gender-diverse youth | Canadian Paediatric Society

  https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth

  Gender-affirming care refers to care provided to an individual to support their gender identity; this care may be medical, surgical, social, and/or psychological. […] Gender dysphoria refers to the distress that can arise from the incongruence between an individual’s experienced gender and their sex assigned at birth. […] When an adolescent voices concerns of gender dysphoria, care should be taken to facilitate timely access to appropriate psychosocial supports and diagnostic assessment. […] Individuals diagnosed with gender dysphoria should be reassured that this diagnosis does not indicate pathological gender identity, but rather, characterizes the distress that arises from their sex assigned at birth not aligning with their identified gender. […] Formal efforts to change a young person’s gender identity, sometimes referred to as conversion or reparative therapy, are harmful and unethical and should not be undertaken.

• #33 An affirming approach to caring for transgender and gender-diverse youth | Canadian Paediatric Society

  https://cps.ca/en/documents/position/an-affirming-approach-to-caring-for-transgender-and-gender-diverse-youth

  Gender-affirming care refers to care provided to an individual to support their gender identity; this care may be medical, surgical, social, and/or psychological. […] Gender dysphoria refers to the distress that can arise from the incongruence between an individual’s experienced gender and their sex assigned at birth. […] When an adolescent voices concerns of gender dysphoria, care should be taken to facilitate timely access to appropriate psychosocial supports and diagnostic assessment. […] Individuals diagnosed with gender dysphoria should be reassured that this diagnosis does not indicate pathological gender identity, but rather, characterizes the distress that arises from their sex assigned at birth not aligning with their identified gender. […] Formal efforts to change a young person’s gender identity, sometimes referred to as conversion or reparative therapy, are harmful and unethical and should not be undertaken.

• #34

  https://app.leg.wa.gov/wac/default.aspx?cite=182-531-1675

  WAC 182-531-1675 […] Gender affirming interventions for gender dysphoria. (1) Overview of treatment program. (a) Medicaid agency coverage. The medicaid agency covers the services listed in (b) of this subsection to treat gender dysphoria (also referred to as gender incongruence) under WAC 182-501-0050 and 182-531-0100. These services include life-changing procedures that may not be reversible. (b) Medical services covered. Medical services covered by the agency include, but are not limited to: (i) Presurgical and postsurgical hormone therapy; (ii) Puberty suppression therapy; (iii) Behavioral health services; (iv) Gender affirming hair removal services; and (v) Surgical and ancillary services including, but not limited to: (A) Anesthesia; (B) Labs; (C) Pathology; (D) Radiology; (E) Hospitalization; (F) Physician services; and (G) Hospitalizations and physician services required to treat postoperative complications of procedures performed under this section. (c) Diagnosis of gender dysphoria/gender incongruence. A diagnosis of gender dysphoria/gender incongruence is required to obtain services under this program and must be made by a provider who meets the qualifications outlined in chapter 182-502 WAC. (d) Medical necessity. The agency authorizes and pays for only medically necessary services. Medical necessity is defined in WAC 182-500-0070 and is determined under WAC 182-501-0165 and limitation extensions in accordance with WAC 182-501-0169. (e) Provider requirements. Providers should be knowledgeable of gender-nonconforming identities and expressions, and the assessment and treatment of gender dysphoria/gender incongruence, including experience utilizing standards of care that include the World Professional Association for Transgender Health (WPATH) Standards of Care. (f) Clients age 20 and younger. The agency evaluates requests for clients age 20 and younger according to the early and periodic screening, diagnosis, and treatment (EPSDT) program described in chapter 182-534 WAC. Under the EPSDT program, the agency pays for a service if it is medically necessary, safe, effective, and not experimental. (g) Transportation services. The agency covers transportation services under the provisions of chapter 182-546 WAC. (h) Out-of-state care. Any out-of-state care, including a presurgical consultation, must be prior authorized as an out-of-state service under WAC 182-501-0182. (i) Corrective surgeries for intersex traits. The agency covers corrective or reparative surgeries for people with intersex traits who received surgeries that were performed without the person’s consent. (2) Prior authorization. (a) Prior authorization requirements for surgical services. As a condition of payment, the agency requires prior authorization for all surgical services to treat gender dysphoria/gender incongruence, except as provided in subsection (3) of this section. This includes modifications or revisions to, or correcting complications from, a previous surgery related to infections or impairment of a function. (b) Required documentation. The provider must include the following documentation with the prior authorization request: (i) Behavioral health assessment. Documentation of a behavioral health assessment performed within 18 months preceding surgery by a qualified behavioral health professional as defined in WAC 182-531-1400. This provider must be a licensed health care professional who is eligible under chapter 182-502 WAC, as follows: (A) Psychiatrist; (B) Psychologist; (C) Psychiatric advanced practice registered nurse (APRN); (D) Psychiatric mental health nurse practitioner-board certified (PMHNP-BC); (E) Mental health counselor (LMHC); (F) Independent clinical social worker (LICSW); (G) Advanced social worker (LASW); or (H) Marriage and family therapist (LMFT). (ii) Evaluation requirements. The comprehensive behavioral health assessment must: (A) Confirm the diagnosis of gender dysphoria, or gender incongruence, or both, as defined by the Diagnostic Statistical Manual of Mental Disorders; (B) Document that: (I) The client’s experience of gender incongruence is marked and sustained; (II) The client has the desire to make their body as congruent as possible with a desired gender through surgery, hormone treatment, or other medical therapies; (III) Gender incongruence causes clinically significant distress or impairment in social, occupational, or other important areas of functioning; and (IV) The client has no contraindicating behavioral health conditions that would impair the ability to give informed consent, as described in (c) of this subsection. If a client has a behavioral health condition that interferes with their ability to give informed consent and the client understands the risks, benefits, and alternatives to gender affirming treatment, the provider must facilitate treatment of the underlying behavioral health condition to support the client’s ability to provide informed consent. (iii) Hormone therapy. Documentation from the primary care provider or the provider prescribing hormone therapy that the client has: (A) As appropriate to the client’s gender goal for the following procedures: (I) Had six continuous months of hormone therapy immediately preceding a request for genital surgery; or (II) Twelve continuous months of continuous hormone therapy immediately preceding a request for breast augmentation surgery, unless: Hormones are not clinically indicated for the client or hormones are not aligned with the client’s gender health care plan, or both; or The client has requested a mastectomy or reduction mammoplasty; or The client has a medical contraindication to hormone therapy; and The client has a medical necessity for surgery and the client is adherent with current gender dysphoria treatment. (B) Gender dysphoria/gender incongruence that is not a symptom of another medical condition; and (C) Had no medical conditions that would impair the client’s ability to give informed consent. (iv) Surgical. Documentation from the surgeon of the client’s: (A) Medical history and physical examination(s) performed within the 12 months preceding surgery; (B) Medical necessity for surgery and surgical plan; and (C) For hysterectomies, a completed agency hysterectomy consent form must be submitted. (c) Informed consent. The surgeon must provide documentation showing that they informed the client of: (i) The nature of the proposed care, treatment, services, medications, and procedures; (ii) Potential benefits, risks, or side effects, including potential problems that might occur during recuperation; (iii) The likelihood of achieving the client’s treatment goals; (iv) Reasonable alternatives; (v) Relevant risks, benefits, and side effects related to alternatives, including the possible results of not receiving care, treatment, and services; (vi) Any limitations on the confidentiality of information learned from or about the patient; (vii) The effect of gender-affirming treatment on reproduction; and (viii) Reproductive options before having gender-affirming surgeries that have the potential to create iatrogenic infertility. (d) Requirements for hair removal. For facial or body hair removal, a client must submit: (i) A letter written within the past 18 months from the provider managing the client’s gender-affirming hormone therapy describing the client’s attempted hair removal techniques that failed, for each affected part of the body. (ii) A letter of medical necessity from the client’s dermatologist or primary care provider written within the past 18 months that includes: (A) The size and location of the area to be treated; and (B) For each area of the body, the number of expected units needed to complete treatment. (iii) Photographs of the areas to be treated, if requested by the agency. (e) Other requirements. If the client fails to complete all of the requirements in (b) of this subsection, the agency will not authorize gender affirming surgery unless: (i) The clinical decision-making process is provided in the referral letter and attachments described in (b) of this subsection; and (ii) The agency has determined that the request is medically necessary in accordance with WAC 182-501-0165 based on review of all submitted information. (f) Behavioral health provider requirements. The behavioral health provider who performs the behavioral health assessment described in (b)(i) of this subsection must: (i) Meet the provisions of WAC 182-531-1400; (ii) Be competent in using the Diagnostic Statistical Manual of Mental Disorders, and the International Classification of Diseases for diagnostic purposes; (iii) Be able to recognize and diagnose coexisting behavioral health conditions and to distinguish these from gender dysphoria/gender incongruence; (iv) Be knowledgeable of gender-nonconforming identities and expressions, and the assessment and treatment of gender dysphoria; and (v) Have completed continuing education in the assessment and treatment of gender dysphoria. This may include attending relevant professional meetings, workshops, or seminars; obtaining supervision from a behavioral health professional with relevant experience; or participating in research related to gender nonconformity and gender dysphoria. (g) Clients age 17 and younger. Clients age 17 and younger must meet the requirements for prior authorization identified in (a) through (d) of this subsection, except that the comprehensive behavioral health assessment required in (b)(i) of this subsection must be a biopsychosocial behavioral health assessment performed by a behavioral health provider who specializes in adolescent transgender care and meets the qualifications outlined in WAC 182-531-1400. (3) Expedited prior authorization (EPA). (a) Approved EPA procedures. The agency allows a provider to use the EPA process for clients age 17 and older for the following medically necessary procedures: (i) Bilateral mastectomy or reduction mammoplasty with or without chest reconstruction; and (ii) Genital or donor skin graft site hair removal when medically necessary to prepare for genital reassignment. (b) Clinical criteria and documentation. To use the EPA process for procedures identified in (a) of this subsection, the following clinical criteria and documentation must be kept in the client’s record and made available to the agency upon request: (i) One comprehensive biopsychosocial behavioral health assessment performed by a licensed behavioral health provider within the 18 months preceding surgery that meets the requirements identified in subsection (2) of this section; (ii) Documentation from the primary care provider or the provider prescribing hormone therapy of the medical necessity for surgery and confirmation that the client is adherent with current gender dysphoria treatment; and (iii) Documentation from the surgeon of the client’s: (A) Medical history and physical examinations performed within the 12 months preceding surgery; and (B) Medical necessity for surgery and surgical plan. (c) Documentation exception. When the requested procedure is for genital or donor skin graft site hair removal to prepare for bottom surgery, there is an exception to the requirements in (b) of this subsection. The only documentation required is either a: (i) Letter of medical necessity from the treating surgeon that includes the size and location of the area to be treated, and expected date of planned genital surgery; or (ii) Letter of medical necessity from the provider who will perform the hair removal that includes the surgical consult for bottom surgery and addresses the need for hair removal prior to gender affirming surgery. (d) Prior authorization required for other surgeries. All other surgeries to treat gender dysphoria, including modifications to, or complications from a previous surgery require prior authorization to determine medical necessity. (e) Recoupment. The agency may recoup any payment made to a provider for procedures listed in this subsection if the provider does not follow the EPA process outlined in WAC 182-501-0163 or if the provider does not maintain the documentation required by this subsection.

• #35 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  The 2017 guideline on endocrine treatment of gender dysphoric/gender incongruent persons: […] Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the bodys sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the persons affirmed gender. […] Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons; […] For the care of youths during puberty and older adolescents, an expert multi-disciplinary team comprised of medical professionals and mental health professionals should manage treatment; […] For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient;

• #36 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  The 2017 guideline on endocrine treatment of gender dysphoric/gender incongruent persons: […] Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the bodys sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the persons affirmed gender. […] Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons; […] For the care of youths during puberty and older adolescents, an expert multi-disciplinary team comprised of medical professionals and mental health professionals should manage treatment; […] For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient;

• #37 A narrative review of gender dysphoria in childhood and adolescence: definition, epidemiology, and clinical recognition – Clemente – Pediatric Medicine

  https://pm.amegroups.org/article/view/7265/html

  It is considered unethical for health care providers managing individuals with gender dysphoria to deliver care that aims to make them congruent with their sex assigned at birth. Instead, they should be a part of multidisciplinary team to facilitate the transgender care. […] The goal of the multidisciplinary team is to provide support and individual expertise during the physical and psychosocial interventions, while ensuring continued communication and discussion of treatment recommendations and ongoing management. […] Hormonal therapy can be provided by an endocrinologist to either halt the progression, change, assist in acquiring with secondary physical characteristic of desired gender or both. […] The role of gender-affirmation surgery (GAS) usually comes after hormonal therapy. GAS is a group of surgical procedure that aims to affirm an individuals body with their gender identity. These include subcutaneous mastectomy, breast augmentation, vaginoplasty, metoidioplasty, phalloplasty and facial feminization/masculinization surgery. […] The care for transgender and gender diverse youth has evolved significantly throughout the years, but there remains a significant gap in knowledge related to medical care, and how the medical community can further support these individuals.

• #38 Gender Services | Boston Children’s Hospital

  https://www.childrenshospital.org/programs/gender-services

  At Boston Childrens Hospital, we specialize in providing comprehensive care to gender non-conforming children, adolescents, and young adults. […] Our Gender Multispecialty Service (GeMS) includes specialists from endocrinology, psychology and social work who help children and teens cope with the disconnect they may feel between the body in which they were born and the gender with which they identify. We provide comprehensive psychological assessment, mental health support and medical care to these patients and their families, as well as collaboration with schools, therapists in the community, pediatricians and other providers. […] The Behavioral Health, Endocrinology, Urology (BE-U) program at Boston Childrens is dedicated to providing care and support to infants, children, adolescents, and young adults with differences/disorders of sex development. […] The Transgender Reproductive Health Service at Boston Childrens Hospital provides inclusive reproductive health care for people of all gender identities and anatomies.

• #39 Gender Dysphoria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532313/

  The World Professional Association for Transgender Health (WPATH) currently publishes the Standards of Care (SOC) to provide clinical guidelines for the health care of transsexual, transgender, and gender non-conforming persons in order to maximize the health and well-being of patients with gender dysphoria. […] The criterion is needed, in addition to those listed above, for initiating hormonal treatment before opting for surgical treatment. The individual should be on one year of continuous hormone therapy and living in the desired gender role. […] In the end, constant and continued support from family, community, and peers predict favorable outcomes, even after seeking medical and mental health treatment. Individual and group therapies should be continued. Confounding substance use problems should be addressed.

• #40 Course Content – #91923: Clinical Care of the Transgender Patient – NetCE

  https://www.netce.com/coursecontent.php?courseid=2849

  The WPATH Standards of Care recommend that the diagnosis of gender dysphoria be made by a mental health professional with a minimum of a Master’s degree, with knowledge about gender variation, competence in using the DSM, and the ability to diagnose co-existing mental health concerns. […] The goal of hormone therapy is to reduce the unwanted secondary sex characteristics of the original gender and to induce the development of secondary sex characteristics of the desired gender. Hormone therapy has also been found to enhance the person’s sense of self and well-being. […] The WPATH is composed of diverse professionals with the mission to promote evidence-based care, education, research advocacy, public policy, and respect in transgender health. Since 1979, the group has published Standards of Care for the Health of Transsexual, Transgender, and Gender Non-Conforming People, with eight editions published as of 2024.

• #41 Gender dysphoria – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/diagnosis-treatment/drc-20475262

  A diagnosis of gender dysphoria includes distress due to gender identity differing from sex assigned at birth that lasts at least six months and involves two or more of the following: […] Gender dysphoria also includes distress that makes it hard to handle work, school, social situations and other parts of daily life. […] Our caring team of Mayo Clinic experts can help you with your gender dysphoria-related health concerns. […] The purpose of treatment is to ease gender dysphoria. Specific goals for gender dysphoria treatment depend on the person. […] If you have gender dysphoria, it’s important to find a healthcare professional who has expertise in the care of gender-diverse people. […] Treatment for gender dysphoria can include changes in gender expression, hormone therapy, surgery and supportive behavioral health therapy.

• #42 Gender dysphoria – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gender-dysphoria/diagnosis-treatment/drc-20475262

  Changes in gender expression to ease gender dysphoria can involve dressing, speaking and behaving in ways that are more consistent with a person’s gender identity. […] Medical treatment of gender dysphoria might include: […] Specific medical treatment is based on a person’s goals, along with an evaluation of the risks and benefits. […] A behavioral health evaluation also may be done by a healthcare professional with expertise in transgender health. […] The goal of behavioral health therapy is to improve mental well-being and quality of life. It isn’t intended to change gender identity. […] Behavioral health therapy often can help people with gender dysphoria feel comfortable with the way they express gender identity. […] Other ways to ease gender dysphoria might include use of:

• #43 Gender Dysphoria | ColumbiaDoctors

  https://www.columbiadoctors.org/treatments-conditions/gender-dysphoria

  Gender-affirming psychotherapy provides a safe environment in which children, adolescents, and adults can safely explore their gender identity and find a comfortable gender expression. […] A family based approach is also highly recommended for children and adolescents with gender dysphoria. […] Gender affirming medical interventions are available that may help alleviate gender dysphoria. […] The decision to pursue medical interventions is highly personal, and is best evaluated in the context of overall identity development and wellbeing. […] Consultation with an interdisciplinary team of healthcare professionals specializing in transgender care may be helpful in making a fully informed decision that meets the individuals needs. […] Puberty suppression can be used to delay puberty in children with gender dysphoria.

• #44 Course Content – #91923: Clinical Care of the Transgender Patient – NetCE

  https://www.netce.com/coursecontent.php?courseid=2849

  The WPATH Standards of Care recommend that the diagnosis of gender dysphoria be made by a mental health professional with a minimum of a Master’s degree, with knowledge about gender variation, competence in using the DSM, and the ability to diagnose co-existing mental health concerns. […] The goal of hormone therapy is to reduce the unwanted secondary sex characteristics of the original gender and to induce the development of secondary sex characteristics of the desired gender. Hormone therapy has also been found to enhance the person’s sense of self and well-being. […] The WPATH is composed of diverse professionals with the mission to promote evidence-based care, education, research advocacy, public policy, and respect in transgender health. Since 1979, the group has published Standards of Care for the Health of Transsexual, Transgender, and Gender Non-Conforming People, with eight editions published as of 2024.

• #45

  https://abcnews.go.com/US/gender-dysphoria-transgender-youth-care-consist/story?id=97940191

  Gender-affirming care is about supporting someone’s identity, said Dr. Goodman. It helps align their physical appearance with their gender identity, and can include puberty blockers, hormone medications, and surgery. […] Puberty blockers are used in people who have not started or completed puberty. […] Pausing puberty allows children to explore their gender identity without the growth of permanent sex characteristics, Dr. Abdul-Latif explained. […] The World Professional Association for Transgender Health guidelines recommend a thorough biopsychosocial evaluation prior to initiation of hormone therapy, including a letter from a mental health professional, informed consent from the parents in accordance with national laws, and a thorough discussion of the risks and benefits with both patients and parents.

• #46

  https://abcnews.go.com/US/gender-dysphoria-transgender-youth-care-consist/story?id=97940191

  Gender-affirming care is about supporting someone’s identity, said Dr. Goodman. It helps align their physical appearance with their gender identity, and can include puberty blockers, hormone medications, and surgery. […] Puberty blockers are used in people who have not started or completed puberty. […] Pausing puberty allows children to explore their gender identity without the growth of permanent sex characteristics, Dr. Abdul-Latif explained. […] The World Professional Association for Transgender Health guidelines recommend a thorough biopsychosocial evaluation prior to initiation of hormone therapy, including a letter from a mental health professional, informed consent from the parents in accordance with national laws, and a thorough discussion of the risks and benefits with both patients and parents.

• #47 Gender-affirming Care Saves Lives | Columbia University Department of Psychiatry

  https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives

  Research demonstrates that gender-affirming care, a medical and psychosocial health care designed to affirm individuals’ gender identities, greatly improves the mental health and overall well-being of gender diverse, transgender, and nonbinary children and adolescents. […] Measures to restrict this critical care not only run counter to scientific evidence but also threaten the mental health of TGNB youth, many of whom experience gender dysphoria—clinically significant distress or impairment caused by a discrepancy between a person’s sex assigned at birth and their gender identity. […] Gender-affirming hormone therapy, which involves the use of feminizing or masculinizing hormones to allow the body to develop physical changes that align with a person’s gender identity, also significantly decreases gender dysphoria.

• #48

  https://www.nhs.uk/conditions/gender-dysphoria/treatment/

  Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary. […] Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty. […] The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. […] It’s important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. […] There is some uncertainty about the risks of long-term cross-sex hormone treatment. […] Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

• #49 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  We suggest that clinicians measure hormone levels during treatment to ensure that endogenous sex steroids are suppressed and administered sex steroids are maintained in the normal physiologic range for the affirmed gender. […] We suggest 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 for transgender males and females and then once or twice yearly. […] We recommend that a patient pursue genital gender-affirming surgery only after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patients overall health and/or well-being.

• #50 Gender Incongruence and Gender Dysphoria – Psychiatric Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/psychiatric-disorders/gender-incongruence-and-gender-dysphoria/gender-incongruence-and-gender-dysphoria

  For most persons with gender dysphoria, the primary objective in seeking medical help is not to obtain mental health treatment, but to obtain gender-affirming treatments in the form of hormone therapy and/or gender-affirming surgery to make their physical appearance consistent with their gender identity. […] Studies have found that gender-affirming surgery is associated with improved mental health outcomes in people with gender dysphoria. […] The treatment of prepubertal children diagnosed with gender dysphoria remains controversial but does not include the use of hormonal medications or surgeries.

• #51 Gender-affirming Care Saves Lives | Columbia University Department of Psychiatry

  https://www.columbiapsychiatry.org/news/gender-affirming-care-saves-lives

  In particular, according to a recent study in JAMA Pediatrics, transmasculine adolescents who have undergone chest surgery report significant relief in dysphoria and very rare regret. […] It is clear that these proposed laws have a drastically negative impact on TGNB youth and their families, compounding the prejudice, discrimination, violence, and other forms of stigma they continue to face in their daily lives.

• #52 HRC | Get the Facts on Gender-Affirming Care

  https://www.hrc.org/resources/get-the-facts-on-gender-affirming-care

  Every single major medical organization, including the American Academy of Pediatrics, the American Medical Association, and the American Psychiatric Association, supports the provision of age-appropriate, gender-affirming care for transgender and non-binary people. […] Gender-affirming care for transgender people is best-practice, medically necessary health care. […] A recent study from the Trevor Project shows that transgender youth with access to hormone replacement therapy medications have lower rates of depression and are at a lower risk for suicide. […] Previous research has found that transgender youth who are able to socially transition and simply have their gender identity, name, and pronouns affirmed report higher levels of resilience and positive well-being and lower levels of depression, anxiety, gender dysphoria, and suicidality, relative to transgender youth who are not affirmed. […] The simple existence of legislation to ban gender-affirming care can also have substantial negative consequences.

• #53

  https://www.nhs.uk/conditions/gender-dysphoria/treatment/

  Treatment for gender dysphoria aims to help people live the way they want to, in their preferred gender identity or as non-binary. […] Most treatments offered at this stage are psychological rather than medical. This is because in many cases gender variant behaviour or feelings disappear as children reach puberty. […] The aim of hormone therapy is to make you more comfortable with yourself, both in terms of physical appearance and how you feel. […] It’s important to remember that hormone therapy is only one of the treatments for gender dysphoria. Others include voice therapy and psychological support. […] There is some uncertainty about the risks of long-term cross-sex hormone treatment. […] Long-term cross-sex hormone treatment may also lead, eventually, to infertility, even if treatment is stopped.

• #54 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  The 2017 guideline on endocrine treatment of gender dysphoric/gender incongruent persons: […] Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the bodys sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the persons affirmed gender. […] Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons; […] For the care of youths during puberty and older adolescents, an expert multi-disciplinary team comprised of medical professionals and mental health professionals should manage treatment; […] For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient;

• #55 Gender Dysphoria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532313/

  Gender dysphoria (previously gender identity disorder), according to the Diagnostic and Statistical Manual of Mental Disorders, is defined as a marked incongruence between their experienced or expressed gender and the one they were assigned at birth. […] Patients with this condition should be provided with psychiatric support. Hormonal therapy and surgical therapy are also available depending on the individual case and the patient’s needs. […] This activity describes the evaluation and management of gender dysphoria and reviews the role of the interprofessional team in improving care for those with this condition. […] It should also be specified according to age. Sadock et al. suggest the following. Individual, family, and group therapy are important for children to explore and counsel on gender preference. For adolescents, the added anticipation of puberty is of concern, so hormonal treatment and psychotherapy should be considered simultaneously. For adults, psychotherapy and hormonal and surgical treatments are all available options.

• #56 Gender Dysphoria – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK532313/

  Gender dysphoria (previously gender identity disorder), according to the Diagnostic and Statistical Manual of Mental Disorders, is defined as a marked incongruence between their experienced or expressed gender and the one they were assigned at birth. […] Patients with this condition should be provided with psychiatric support. Hormonal therapy and surgical therapy are also available depending on the individual case and the patient’s needs. […] This activity describes the evaluation and management of gender dysphoria and reviews the role of the interprofessional team in improving care for those with this condition. […] It should also be specified according to age. Sadock et al. suggest the following. Individual, family, and group therapy are important for children to explore and counsel on gender preference. For adolescents, the added anticipation of puberty is of concern, so hormonal treatment and psychotherapy should be considered simultaneously. For adults, psychotherapy and hormonal and surgical treatments are all available options.

• #57 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Gender-affirming hormone therapy, which involves the use of an estrogen and antiandrogen, or of testosterone, is generally safe but partially irreversible. […] Adolescents experiencing puberty should be evaluated for reversible puberty suppression, which may make future affirmation easier and safer. […] Multidisciplinary care may be optimal but is not universally available. […] Clinicians should consider routine screening for depression, anxiety, posttraumatic stress disorder, eating disorders, substance use, intimate partner violence, self-injury, bullying, truancy, homelessness, high-risk sexual behaviors, and suicidality. […] Efforts to convert a person’s gender identity to align with their sex assigned at birth are unethical and incompatible with current guidelines and evidence.

• #58 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  The 2017 guideline on endocrine treatment of gender dysphoric/gender incongruent persons: […] Gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen that will suppress the bodys sex hormone secretion, determined at birth and manifested at puberty, and maintain levels of sex steroids within the normal range for the persons affirmed gender. […] Hormone treatment is not recommended for pre-pubertal gender-dysphoric /gender-incongruent persons; […] For the care of youths during puberty and older adolescents, an expert multi-disciplinary team comprised of medical professionals and mental health professionals should manage treatment; […] For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient;

• #59 Psychiatry.org – What is Gender Dysphoria?

  https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

  Family and societal rejection of gender identity are some of the strongest predictors of mental health difficulties among people who are transgender. Family and couples therapy can be important for creating a supportive environment that will allow a persons mental health to thrive. Parents of children and adolescents who are transgender may benefit from support groups. Peer support groups for transgender people themselves are often helpful for validating and sharing experiences.

• #60 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Gender-affirming hormone therapy, which involves the use of an estrogen and antiandrogen, or of testosterone, is generally safe but partially irreversible. […] Adolescents experiencing puberty should be evaluated for reversible puberty suppression, which may make future affirmation easier and safer. […] Multidisciplinary care may be optimal but is not universally available. […] Clinicians should consider routine screening for depression, anxiety, posttraumatic stress disorder, eating disorders, substance use, intimate partner violence, self-injury, bullying, truancy, homelessness, high-risk sexual behaviors, and suicidality. […] Efforts to convert a person’s gender identity to align with their sex assigned at birth are unethical and incompatible with current guidelines and evidence.

• #61 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Transgender patients typically have high rates of mental health diagnoses. […] However, it is important not to assume that a patient’s mental health concerns are secondary to being transgender. […] Because of the higher prevalence of traumatic life experiences in transgender persons, care should be trauma-informed (i.e., focused on safety, empowerment, and trustworthiness) and guided by the patient’s life experiences as they relate to their care and resilience. […] Gender-affirming surgical treatments may not be required to minimize gender dysphoria, and care should be individualized. […] Transgender adolescents should have access to psychological therapy for support and a safe means to explore their gender identity, adjust to socioemotional aspects of gender incongruence, and discuss realistic expectations for potential therapy. […] Multiple studies report improved psychosocial outcomes after puberty suppression and subsequent gender-affirming hormone therapy.

• #62 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Transgender patients typically have high rates of mental health diagnoses. […] However, it is important not to assume that a patient’s mental health concerns are secondary to being transgender. […] Because of the higher prevalence of traumatic life experiences in transgender persons, care should be trauma-informed (i.e., focused on safety, empowerment, and trustworthiness) and guided by the patient’s life experiences as they relate to their care and resilience. […] Gender-affirming surgical treatments may not be required to minimize gender dysphoria, and care should be individualized. […] Transgender adolescents should have access to psychological therapy for support and a safe means to explore their gender identity, adjust to socioemotional aspects of gender incongruence, and discuss realistic expectations for potential therapy. […] Multiple studies report improved psychosocial outcomes after puberty suppression and subsequent gender-affirming hormone therapy.

• #63 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Transgender patients typically have high rates of mental health diagnoses. […] However, it is important not to assume that a patient’s mental health concerns are secondary to being transgender. […] Because of the higher prevalence of traumatic life experiences in transgender persons, care should be trauma-informed (i.e., focused on safety, empowerment, and trustworthiness) and guided by the patient’s life experiences as they relate to their care and resilience. […] Gender-affirming surgical treatments may not be required to minimize gender dysphoria, and care should be individualized. […] Transgender adolescents should have access to psychological therapy for support and a safe means to explore their gender identity, adjust to socioemotional aspects of gender incongruence, and discuss realistic expectations for potential therapy. […] Multiple studies report improved psychosocial outcomes after puberty suppression and subsequent gender-affirming hormone therapy.

• #64 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. […] Training staff in culturally sensitive terminology and transgender topics (e.g., use of chosen name and pronouns), creating welcoming and affirming clinical environments, and assessing personal biases may facilitate improved patient interactions. […] Depending on their comfort level and the availability of local subspecialty support, primary care clinicians may evaluate gender dysphoria and manage applicable hormone therapy, or monitor well-being and provide primary care and referrals. […] Clinicians should identify and treat mental health conditions but avoid the assumption that such conditions are related to gender identity.

• #65 Gender Dysphoria/Gender Incongruence Guideline Resources | Endocrine Society

  https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence

  We suggest that clinicians measure hormone levels during treatment to ensure that endogenous sex steroids are suppressed and administered sex steroids are maintained in the normal physiologic range for the affirmed gender. […] We suggest 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 for transgender males and females and then once or twice yearly. […] We recommend that a patient pursue genital gender-affirming surgery only after the MHP and the clinician responsible for endocrine transition therapy both agree that surgery is medically necessary and would benefit the patients overall health and/or well-being.

• #66 Transgender care

  https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care

  With the right investment and action, including the establishment of regional specialist gender identity services across the UK, there is significant potential to positively impact waiting lists and improve care and health outcomes. […] As expert generalists, the specialist skills required to assess and provide care to address specific needs related to gender incongruence do not fall within the remit of a GPs education and training. […] The RCGP curriculum does, however, include the need to provide high-quality, holistic and comprehensive care to transgender people. […] GPs should be aware that a patient may find the process of approaching a healthcare professional to discuss their gender identity to be difficult or distressing. […] The RCGP considers that the core role of the GP includes the following: To provide a holistic approach, contextualising a persons presentation of gender incongruence alongside an individuals physical, psychological and social health status within the broader environment.

• #67 Transgender care

  https://www.rcgp.org.uk/representing-you/policy-areas/transgender-care

  With the right investment and action, including the establishment of regional specialist gender identity services across the UK, there is significant potential to positively impact waiting lists and improve care and health outcomes. […] As expert generalists, the specialist skills required to assess and provide care to address specific needs related to gender incongruence do not fall within the remit of a GPs education and training. […] The RCGP curriculum does, however, include the need to provide high-quality, holistic and comprehensive care to transgender people. […] GPs should be aware that a patient may find the process of approaching a healthcare professional to discuss their gender identity to be difficult or distressing. […] The RCGP considers that the core role of the GP includes the following: To provide a holistic approach, contextualising a persons presentation of gender incongruence alongside an individuals physical, psychological and social health status within the broader environment.

• #68 Gender dysphoria Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/gender-dysphoria

  Gender dysphoria is the term for a deep sense of unease and distress that may occur when your biological sex does not match your gender identity. […] It is very important for people with gender dysphoria to receive psychological and social support and understanding from medical professionals. When choosing a health care provider, look for individuals who are trained to identify and work with people with gender dysphoria. […] The main goal of treatment is to help you overcome the distress you may feel. You can choose the level of treatment that helps you feel most comfortable. This may include helping you transition to the gender you identify with. […] Societal and family pressures and lack of acceptance can cause anxiety and depression and other mental health issues. This is why it’s important that you receive counseling and support throughout and even after your transition.

• #69 Nursing Care For Transgender Patients | NurseJournal.org

  https://nursejournal.org/resources/nursing-care-for-transgender-patients/

  Transgender people face challenges in many aspects of life, including healthcare. Here’s how nurses can create welcoming spaces for and work with transgender patients. […] Nurses have an especially important role in providing an affirming space for transgender people. […] This guide aims to help nurses better understand the transgender and GNC community, the hurdles they might face in healthcare, and helpful steps on working with transgender and GNC patients. […] For many transgender patients, healthcare can be an intimidating and often inaccessible environment. […] According to Desiree Daz, Ph.D., associate professor at University of Central Florida’s College of Nursing, these distressing experiences can lead to transgender people avoiding necessary appointments and procedures. […] Greater education and training for working with transgender and GNC people is one solution to this problem.

• #70 Course Content – #91923: Clinical Care of the Transgender Patient – NetCE

  https://www.netce.com/coursecontent.php?courseid=2849

  The critical point for transgender individuals is that there is incongruence between their gender identity and their birth sex. The intensity of this incongruence can vary, and transgender individuals may choose varying degrees of transition. […] Transgender individuals experience significant challenges whether or not they choose to disclose their transgender identity. Individuals who „come out” as transgender risk becoming victims of violence, losing relationships, or losing employment. Other challenges include anxiety and depression related to transition issues. […] The Institute of Medicine (IOM) has noted that there is a paucity of research on the unique healthcare needs of transgender individuals, and most existing research consists of small nonprobability samples. The IOM calls for an evidence base for providing transgender-specific health care to address gender dysphoria and a more rigorous research program to understand the health implications of hormone use and other transgender-specific issues.

• #71 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Not all transgender or gender-diverse persons require or seek hormone therapy. However, those who receive treatment generally report improved quality of life, self-esteem, and anxiety. […] Clinicians should consider initiation of or timely referral for a gonadotropin-releasing hormone analogue to suppress puberty when the patient has reached stage 2 or 3 of sexual maturity. […] When assessing transgender patients for gender-affirming care, the clinician should evaluate the magnitude, duration, and stability of any gender dysphoria or incongruence. […] The support and safety of the patient’s social environment also warrants evaluation as it pertains to gender affirmation. […] Clinicians should not consider themselves gatekeepers of hormone therapy; rather, they should assist patients in making reasonable and educated decisions about their health care using an informed consent model with parental consent as indicated.

• #72 Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/1201/p645.html

  Not all transgender or gender-diverse persons require or seek hormone therapy. However, those who receive treatment generally report improved quality of life, self-esteem, and anxiety. […] Clinicians should consider initiation of or timely referral for a gonadotropin-releasing hormone analogue to suppress puberty when the patient has reached stage 2 or 3 of sexual maturity. […] When assessing transgender patients for gender-affirming care, the clinician should evaluate the magnitude, duration, and stability of any gender dysphoria or incongruence. […] The support and safety of the patient’s social environment also warrants evaluation as it pertains to gender affirmation. […] Clinicians should not consider themselves gatekeepers of hormone therapy; rather, they should assist patients in making reasonable and educated decisions about their health care using an informed consent model with parental consent as indicated.

• #73 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  By identifying these nursing diagnoses, nurses can develop targeted interventions aimed at addressing the unique needs and challenges faced by individuals with Gender Dysphoria, promoting affirmation, acceptance, and well-being across the gender spectrum. […] By implementing these nursing interventions, nurses can play a crucial role in supporting individuals with Gender Dysphoria to navigate their gender identity journey with validation, affirmation, and holistic care. […] In conclusion, the nursing care plan developed for individuals with Gender Dysphoria reflects a commitment to providing holistic, affirming, and culturally competent care that honors the diversity of gender identities and experiences. […] Through comprehensive assessment, collaborative care planning, and evidence-based interventions, nurses play a vital role in supporting individuals with Gender Dysphoria in their journey towards self-acceptance, affirmation, and well-being.

• #74 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  By fostering a safe and supportive healthcare environment where individuals feel respected, validated, and empowered to express their gender identity authentically, nurses can facilitate healing, resilience, and self-acceptance across the gender spectrum. […] By advocating for inclusive healthcare policies and practices, challenging stigma and discrimination, and promoting cultural competence and sensitivity, nurses can contribute to creating a healthcare system that affirms and supports individuals of all gender identities.

• #75 Course Content – #91923: Clinical Care of the Transgender Patient – NetCE

  https://www.netce.com/coursecontent.php?courseid=2849

  The American Academy of Child and Adolescent Psychiatry recommends that clinicians should be aware of current evidence on the natural course of gender discordance and associated psychopathology in children and adolescents in choosing the treatment goals and modality. It is important to distinguish those who display only variation in gender role behavior (gender nonconformity, which is not a DSM diagnosis) from those who also display a gender identity discordant from their socially assigned birth gender and biologic sex.

• #76 Nursing Care Plan For Gender Identity Disorder – Made For Medical

  https://www.madeformedical.com/nursing-care-plan-for-gender-identity-disorder/

  By fostering a safe and supportive healthcare environment where individuals feel respected, validated, and empowered to express their gender identity authentically, nurses can facilitate healing, resilience, and self-acceptance across the gender spectrum. […] By advocating for inclusive healthcare policies and practices, challenging stigma and discrimination, and promoting cultural competence and sensitivity, nurses can contribute to creating a healthcare system that affirms and supports individuals of all gender identities.

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