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JAMA Clinical Guidelines Synopsis
October 17, 2017

Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons

Author Affiliations
  • 1Callen Lorde Community Health Center, New York, New York
  • 2University of Chicago, Section of General Internal Medicine, Chicago, Illinois
JAMA. 2017;318(15):1491-1492. doi:10.1001/jama.2017.13540

Transgender individuals have a gender identity that does not align with their sex assignment at birth (gender incongruence). They account for about approximately 0.4% of the US population (1 million people).1 Some transgender people experience gender dysphoria, distress caused by the discrepancy between gender identity and birth-assigned sex, linked to lifetime suicide attempt rates of 40%.2 Some may start to live or transition into their affirmed gender. This may include social or legal transition, such as changes to attire, name, and pronouns. Some may request hormones, surgery, or both to diminish the secondary sex characteristics associated with their birth sex. Children diagnosed as having GD/GI may start GnRH agonists after beginning puberty to prevent permanent changes, including facial hair, deepening of the voice, and breast growth. Thereafter, they may initiate hormones to acquire the secondary sex characteristics of their affirmed gender. Prospective studies suggest these interventions are associated with improved psychological functioning and reduction in anxiety and depression.3

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