psychoanalysis-couch

The Endocrine Society has recently updated their recommendations for caring for transgender individuals. Previous guidelines recommended that hormone treatments not begin before sixteen years of age, but the Society notes there are now compelling reasons to beginning hormone treatment earlier.

Joshua D. Safer, MD, one of the task force members who authored the guidelines, said:

“Sixteen is the typical age cutoff in many areas of the world for some decision-making capacity from a legal perspective, but when you think about hormones and puberty, 16 is pretty late. If we’re going to use biology for guidance, then hormone interventions for transgender kids should begin occurring earlier, when puberty really happens, like around age 12, 13, or 14. However, we’re in a situation where we lack a test. We can’t diagnose anybody as transgender with excellent confidence, outside of talking to those kids. When we start talking about hormone therapies, we talk about some things that will be irreversible. That’s a fraught place to go, but we recognize that people are going to treat kids under 16 in many instances.”

The new guidelines do not set a specific minimum age for hormone treatment, and this represents one of the more notable changes from the Society’s 2009 published guidelines. Dr. Safer explains:

“Although there is a ‘much better understanding’ of gender identity and care for transgender individuals since the first guideline appeared, “there remains a paucity of data. It remains a concern how little research has been supported up until now. We’re stuck with those gaps.”

The task force members worked hard to establish the new guidelines for the appropriate treatment of transgender people. Their efforts were “framed around a durable biological underpinning to gender identity.” Says Dr. Safer:

“That’s state of the art right now. People think there’s debate about whether there’s a substantial biological component. I think that the data are pretty strong, so I don’t think there’s a lot of debate about that in the scientific world. The debate is more about what that biology might be. That’s all over the map.”

It’s interesting to note that the belief of a biological basis for gender identity contributed to a second major change to the guidelines. Previously, The Endocrine Society’s guidelines recommended that the diagnosis of gender identity disorder be made by a mental health professional. Now the guidelines for the care of peripubertal youths and older adolescents state:

“We recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents.”

And the guidelines for adult gender-dysphoric/gender-incongruent people state:

“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.”

I’m so pleased to see the inclusion of various health-care professionals in the care of transgender individuals. Caring for those who are transgender is certainly one of the newer challenges faced by those in the health-care community, and it’s exciting to see how guidelines are evolving to give people the care they deserve. You can read more about additional new guidelines here.