IDEA group consensus statement on medical management of adult gender incongruent individuals seeking gender reaffirmation as female

Abstract

Cross sex hormone therapy (CSHT) is a strongly desired medical intervention for gender incongruent individuals. The goal is to change secondary sex characteristics to facilitate gender presentation that is consistent with the desired sex. When appropriately prescribed CSHT can greatly improve mental health and quality of life for gender incongruent individuals. Appropriate care for gender incongruent individuals in India is almost absent due to lack of country specific guideline and lack of training amongst the medical professionals. This document is intended to assist endocrinologists and physicians whose adult gender incongruent client is seeking gender reaffirmation as female (transfeminine). These individuals require a safe and effective CSHT regimen that will suppress endogenous male hormone secretion and maintain physiologic levels of female sex hormone. In this document, we offer suggestions based on an in-depth review of Guidelines of Endocrine Society, The World Professional Association for Transgender Health guidelines, the Sappho Good Practice Guide of India and collegial meetings with expert Indian clinicians working in this field. Clinicians represented in our expert panel are not gender specialists by training but have developed expertise due to the volume of gender incongruent individuals they manage. This consensus statement on medical management provides protocols for the prescribing clinician relating to diagnosis, baseline evaluation and counselling, prescription planning for feminizing hormone therapy and anti-androgen therapy, targets for monitoring hormone therapy, choice of therapy, clinical and biochemical monitoring, recommending sex reaffirmation surgery and peri-operative hormone therapy. The recommendations made in this document should not be perceived as a rigid set of guidelines and the treating clinicians are encouraged to modify our suggested protocols to address emerging issues.

“The Graying Minority”: Lived Experiences and Psychosocial Challenges of Older Transgender Adults During the COVID-19 Pandemic in India, A Qualitative Exploration

“…The World Professional Association for Transgender Health (WPATH), in association with the Sappho Good Practice Guide, India, has laid down consensus guidelines for diagnosis, hormone therapy, recommendations for sex reaffirmation surgeries, and subsequent follow-ups. The guidelines stress multi-disciplinary efforts, appropriate knowledge regarding the procedures, and adequate psychological support, both pre and post-treatments ( 7 ). However, prevalent misconceptions and misinformation in India have led to unscrupulous “conversion therapies” that are unfortunately recommended to “cure” transgender and homosexual individuals.…”

Endocrine Therapy of Adult Gender-Incongruent Individuals Seeking Gender Reaffirmation

“…The biochemical targets for testosterone and estradiol in a transfeminine individual undergoing hormone therapy were laid down by the Endocrine Society 2 ( Table 4 ) and adopted in the Indian consensus statement as well. 6…”

“…Karyotype testing is optional as is the evaluation of prostate-specific antigen. 6 Endocrine Therapy of GI Individuals-Seeking Gender Reaffirmation as Female (Transfeminine)…”

“…The estrogen dose requirement is more in those who are not receiving GnRH therapy and in those with preserved testes. 6 Estrogen therapy should be started at lower doses and titrated upward over the course of a year, similar to the induction of puberty in natal girls in whom rapid estrogen exposure leads to poor breast development. 8 …”

“…5 Tailoring the currently available protocols may be done within the context of accepted safety guidelines. 2 The practical suggestions on the assessment and management in this article are largely based on the experience of the author and the few existing national 6 and international 2 guidelines. involved in the care of GI individuals should assess and evaluate the subjects before starting the GAHT.…”