In a JAMA Clinical Guidelines Synopsis, authors examine the Standards of Care for the Health of Transgender and Gender Diverse People, Version 8 (SOC-8), released in Sept. 2022 and containing recommendations for primary care, assessment of transgender and gender-diverse persons, mental health, medication, surgery, and education. “Clinicians must weigh the potential risks of [gender-affirming medical and/or surgical treatment (GAMST)] alongside the known reductions in mental health and substance use morbidity seen with social support and institution of GAMST in transgender and gender diverse people,” write the authors. “Expected benefits and potential adverse effects should be reviewed with the patient and for adolescents their parent(s)/guardian(s) in almost all situations. Voice lowering is generally irreversible, and gender-affirming hormone therapy may impair fertility. Gender-affirming hormone therapy for those assigned female at birth (testosterone) or assigned male at birth (estrogens, progestins, and androgen blockers) may be associated with increased risk of cardiovascular events such as stroke, venous thromboembolism, and myocardial infarction.”
For medications, the SOC-8 recommends “at least 6 months of exogenous hormone therapy before gender-affirming surgery is optimal, but not mandatory,” the article states. “Measures to address stigma, discrimination, and human rights violations may be equally important in improving the health for transgender and gender diverse people worldwide, and also improve access to the essential care outlined in the SOC-8 guideline.”
The authors add: “The expanded depth and scope of SOC-8 reflect the increase in transgender and gender diverse health research over the past decade. If written documentation or a letter is required to recommend GAMST in an adult, only one letter of assessment from a health care professional who has competencies in the assessment of transgender and gender diverse people is needed, due to the limited clinical value of a second letter. In adolescents, a letter of assessment from a member of a multidisciplinary team is needed and should reflect the assessment and opinion of a team that involves both medical and mental health professionals.”