| Adolescents are eligible for GnRH agonist treatment if: |
| 1. A qualified MHP has confirmed that: |
| •the adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed), |
| •gender dysphoria worsened with the onset of puberty, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment, |
| •the adolescent has sufficient mental capacity to give informed consent to this (reversible) treatment, |
| 2. And the adolescent: |
| •has been informed of the effects and side effects of treatment (including potential loss of fertility if the individual subsequently continues with sex hormone treatment) and options to preserve fertility, |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal assessment |
| •agrees with the indication for GnRH agonist treatment, |
| •has confirmed that puberty has started in the adolescent (Tanner stage ≥G2/B2), |
| •has confirmed that there are no medical contraindications to GnRH agonist treatment. |
| Adolescents are eligible for subsequent sex hormone treatment if: |
| 1. A qualified MHP has confirmed: |
| •the persistence of gender dysphoria, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start sex hormone treatment, |
| •the adolescent has sufficient mental capacity (which most adolescents have by age 16 years) to estimate the consequences of this (partly) irreversible treatment, weigh the benefits and risks, and give informed consent to this (partly) irreversible treatment, |
| 2. And the adolescent: |
| •has been informed of the (irreversible) effects and side effects of treatment (including potential loss of fertility and options to preserve fertility), |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal induction: |
| •agrees with the indication for sex hormone treatment, |
| •has confirmed that there are no medical contraindications to sex hormone treatment. |
| Adolescents are eligible for GnRH agonist treatment if: |
| 1. A qualified MHP has confirmed that: |
| •the adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed), |
| •gender dysphoria worsened with the onset of puberty, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment, |
| •the adolescent has sufficient mental capacity to give informed consent to this (reversible) treatment, |
| 2. And the adolescent: |
| •has been informed of the effects and side effects of treatment (including potential loss of fertility if the individual subsequently continues with sex hormone treatment) and options to preserve fertility, |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal assessment |
| •agrees with the indication for GnRH agonist treatment, |
| •has confirmed that puberty has started in the adolescent (Tanner stage ≥G2/B2), |
| •has confirmed that there are no medical contraindications to GnRH agonist treatment. |
| Adolescents are eligible for subsequent sex hormone treatment if: |
| 1. A qualified MHP has confirmed: |
| •the persistence of gender dysphoria, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start sex hormone treatment, |
| •the adolescent has sufficient mental capacity (which most adolescents have by age 16 years) to estimate the consequences of this (partly) irreversible treatment, weigh the benefits and risks, and give informed consent to this (partly) irreversible treatment, |
| 2. And the adolescent: |
| •has been informed of the (irreversible) effects and side effects of treatment (including potential loss of fertility and options to preserve fertility), |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal induction: |
| •agrees with the indication for sex hormone treatment, |
| •has confirmed that there are no medical contraindications to sex hormone treatment. |
Reproduced from World Professional Association for Transgender Health (16).
| Adolescents are eligible for GnRH agonist treatment if: |
| 1. A qualified MHP has confirmed that: |
| •the adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed), |
| •gender dysphoria worsened with the onset of puberty, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment, |
| •the adolescent has sufficient mental capacity to give informed consent to this (reversible) treatment, |
| 2. And the adolescent: |
| •has been informed of the effects and side effects of treatment (including potential loss of fertility if the individual subsequently continues with sex hormone treatment) and options to preserve fertility, |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal assessment |
| •agrees with the indication for GnRH agonist treatment, |
| •has confirmed that puberty has started in the adolescent (Tanner stage ≥G2/B2), |
| •has confirmed that there are no medical contraindications to GnRH agonist treatment. |
| Adolescents are eligible for subsequent sex hormone treatment if: |
| 1. A qualified MHP has confirmed: |
| •the persistence of gender dysphoria, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start sex hormone treatment, |
| •the adolescent has sufficient mental capacity (which most adolescents have by age 16 years) to estimate the consequences of this (partly) irreversible treatment, weigh the benefits and risks, and give informed consent to this (partly) irreversible treatment, |
| 2. And the adolescent: |
| •has been informed of the (irreversible) effects and side effects of treatment (including potential loss of fertility and options to preserve fertility), |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal induction: |
| •agrees with the indication for sex hormone treatment, |
| •has confirmed that there are no medical contraindications to sex hormone treatment. |
| Adolescents are eligible for GnRH agonist treatment if: |
| 1. A qualified MHP has confirmed that: |
| •the adolescent has demonstrated a long-lasting and intense pattern of gender nonconformity or gender dysphoria (whether suppressed or expressed), |
| •gender dysphoria worsened with the onset of puberty, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start treatment, |
| •the adolescent has sufficient mental capacity to give informed consent to this (reversible) treatment, |
| 2. And the adolescent: |
| •has been informed of the effects and side effects of treatment (including potential loss of fertility if the individual subsequently continues with sex hormone treatment) and options to preserve fertility, |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal assessment |
| •agrees with the indication for GnRH agonist treatment, |
| •has confirmed that puberty has started in the adolescent (Tanner stage ≥G2/B2), |
| •has confirmed that there are no medical contraindications to GnRH agonist treatment. |
| Adolescents are eligible for subsequent sex hormone treatment if: |
| 1. A qualified MHP has confirmed: |
| •the persistence of gender dysphoria, |
| •any coexisting psychological, medical, or social problems that could interfere with treatment (e.g., that may compromise treatment adherence) have been addressed, such that the adolescent’s situation and functioning are stable enough to start sex hormone treatment, |
| •the adolescent has sufficient mental capacity (which most adolescents have by age 16 years) to estimate the consequences of this (partly) irreversible treatment, weigh the benefits and risks, and give informed consent to this (partly) irreversible treatment, |
| 2. And the adolescent: |
| •has been informed of the (irreversible) effects and side effects of treatment (including potential loss of fertility and options to preserve fertility), |
| •has given informed consent and (particularly when the adolescent has not reached the age of legal medical consent, depending on applicable legislation) the parents or other caretakers or guardians have consented to the treatment and are involved in supporting the adolescent throughout the treatment process, |
| 3. And a pediatric endocrinologist or other clinician experienced in pubertal induction: |
| •agrees with the indication for sex hormone treatment, |
| •has confirmed that there are no medical contraindications to sex hormone treatment. |
Reproduced from World Professional Association for Transgender Health (16).
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