Safety Recommendations

• The Endocrine Society: The Endocrine Society's 2017 guidelines on the endocrine treatment of gender dysphoric/gender incongruent persons establish a comprehensive framework for appropriate treatment. These guidelines standardise terminology for healthcare professionals, reaffirm the role of healthcare professionals, and emphasise the need for a broader healthcare team, including mental health services and gender-affirmation surgery. The guidelines also state that gender-dysphoric/gender-incongruent persons should receive a safe and effective hormone regimen to maintain levels of sex steroids within the normal range for the person’s affirmed gender​​.  
• The World Professional Association of Transgender Health: The World Professional Association for Transgender Health (WPATH) and its US affiliate, the United States Professional Association for Transgender Health (USPATH), have confirmed that gender-affirming healthcare is not experimental and have condemned legislation that asserts otherwise. These organisations denounce regulations halting gender-affirming healthcare for transgender and gender diverse children and adolescents as lacking scientific grounding​​.
• WPATH and USPATH vehemently oppose legislation that bans access to gender-affirming healthcare for transgender and gender diverse individuals. They emphasise that their long-standing Standards of Care for Transgender and Gender Diverse People, now in its eighth version (SOC8), detail the science- and evidence-based benefits of gender-affirming care. These organisations assert that any legislation that restricts or prohibits access to this care is against best practice medical standards and is condemned by both WPATH and USPATH​​.  
• The World Health Organisation: The World Health Organisation (WHO) is currently developing a guideline on the health of trans and gender diverse people. This new guideline is being created by WHO's Departments of Gender, Rights and Equity - Diversity, Equity and Inclusion (GRE-DEI), Global HIV, Hepatitis and Sexually Transmitted Infections Programmes (HHS), and Sexual and Reproductive Health and Research (SRH).
• The focus of the guideline will be in five key areas:
  • Provision of gender-affirming care, including hormones.
  • Health workers' education and training for the provision of gender-inclusive care.
  • Provision of health care for trans and gender diverse people who suffered interpersonal violence based on their needs.
  • Health policies that support gender-inclusive care.
  • Legal recognition of self-determined gender identity​​.
• Guidelines and Evidence:
  • Practical Guidelines for Transgender Hormone Treatment
  • Standards of Care for the Health of Transgender and Gender Diverse People, Version 8
  • Primary Care Gender Affirming Hormone Therapy Initiation Guidelines
  • WPATH, ASIAPATH, EPATH, PATHA, and USPATH Response to NHS England in the United Kingdom (UK)
  • Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People
  • Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline
  • Australian Standards of Care and Treatment Guidelines for trans and gender diverse children and adolescents
  • Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents | Pediatrics
  • Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand
  • Care for Transgender Young People

Clinical Guidelines

The provision of gender-affirming care relies on a foundation of clinical guidelines and best practices to ensure the safety and wellbeing of individuals seeking gender-affirming treatments. While guidelines may vary by region and healthcare provider, here are some of the key clinical guidelines that have been referenced in creating this Treatment Recommendation:

• World Professional Association for Transgender Health (WPATH) Standards of Care: WPATH is a leading organisation that provides guidelines for the care of transgender and gender-diverse individuals. Their Standards of Care outline the recommended steps for gender-affirming care, including hormone therapy and surgical interventions. 
• Endocrine Society Guidelines: The Endocrine Society produces clinical guidelines for hormone therapy in transgender individuals. These guidelines offer recommendations for hormone treatment regimens, monitoring, and the management of potential side effects.
• American Psychological Association (APA) Guidelines: The APA provides guidelines on psychological and mental health care for transgender individuals. These guidelines cover topics such as mental health assessments, therapy, and support.
• Center of Excellence for Transgender Health Guidelines: The Center of Excellence for Transgender Health at the University of California, San Francisco, offers comprehensive guidelines for transgender healthcare, including primary care, hormone therapy, and surgery.
• USPATH (United States Professional Association for Transgender Health) Guidelines:  USPATH provides resources and guidelines for healthcare providers in the United States, focusing on transgender and gender-diverse care.
• European Professional Association for Transgender Health (EPATH) Guidelines:  EPATH offers guidelines specific to European healthcare contexts, covering various aspects of transgender healthcare.
• Local and National Guidelines: In addition to international guidelines, many countries and regions have their own specific clinical guidelines for transgender healthcare. Healthcare providers often reference these local or national guidelines to ensure culturally competent and regionally relevant care.

It's important to note that healthcare providers should stay up-to-date with the latest research and guidelines in the field of transgender healthcare, as this field continues to evolve. These guidelines provide a framework for delivering safe and effective gender-affirming care while respecting the individual needs and preferences of each person.