First on CNN: Major medical society re-examines clinical guidelines for gender-affirming care

By Jen Christensen, CNN

(CNN) — The major global medical association for endocrinologists will review its clinical guidelines for gender-affirming care, the Endocrine Society told CNN on Monday. Despite recent moves by some US states to restrict or ban such care, the society said it’s a routine update that was not prompted by politics.

The society’s guidelines help the organization’s 18,000 members – doctors, nurses, educators and students who focus on hormone-related health – determine the best practices to provide appropriate care for people who are transgender and gender-diverse. The organization said it will take about three years for the guidelines to come together.

Gender-affirming care is medically necessary, evidence-based individualized care that uses a multidisciplinary approach to help a person transition from their assigned gender – the one the person was designated at birth – to their affirmed gender – the gender by which one wants to be known.

The society’s current guidelines lay out the appropriate treatment for transgender or gender-diverse people, both children and adults. They describe when hormone treatment should be used and how the treatment should be managed. They standardize the terminology that professionals should use with patients and reaffirms the role that an endocrinologist should play in the patient’s broader individualized care.

Gender-affirming care is customized to each person’s needs and can include giving advice for the person or for their parents if they are younger; providing mental health support; and, when a person reaches the appropriate age, prescribing hormones when appropriate. Most trans youth do not get hormone therapy, according to the Trevor Project, an LGBTQ youth-focused nonprofit, but some do. Some adults may also consider surgery, but surgery is not recommended for children.

The committee revising the guidelines has had its first meeting, said chairperson Dr. Joshua Safer. The last time the committee updated its gender-affirming care guidelines was in 2017; it previously revised them in 2009.

“To be clear, we’ve been following our usual guideline process that we apply to anything that we do, whether it’s diabetes or thyroid etc., to transgender medical care,” said Safer, a member of the Endocrine Society who also serves as executive director of the Mount Sinai Center for Transgender Medicine and Surgery in New York. “Being the doctors in the room, we look at current data to give appropriate recommendations.”

When the society updated its guidelines in 2017, the organization said there had been more than 3,000 publications since 2009, when it had done its last revisions, that clarified issues around gender and gender incongruence.

The current committee — made up of Endocrine Society members and non-members who are a multidisciplinary group of gender-affirming care experts — will go through the latest science to determine the best specific approaches to provide appropriate care to patients. Safer said it will take about two years to examine the material and about another year for the revised guidelines to come together.

Other guidelines under the society’s review include treatment for vitamin D deficiency, how to handle diabetes in pregnancy and management of primary aldosteronism, a condition in which the adrenal glands produce too much of the hormone aldosterone, which can have symptoms such as high blood pressure.

Although gender-affirming care has been restricted or banned outright in more than a dozen states, with some conservative state officials labeling the practice as a form of child abuse, such care is considered the medical gold standard treatment.

Every major US medical association – including the American Medical Association, the American Psychiatric Association and the American Academy of Child & Adolescent Psychiatry – agrees that gender-affirming care is clinically appropriate for children and adults.

When the American Academy of Pediatrics called for a systematic review of the evidence last fall, some people were initially concerned that association was backing away from the practice, but instead it affirmed its support.

Several European countries have adopted more cautious approaches, restricting the use of puberty blockers, cross-sex hormones and transition-related surgeries.

More than 1.6 million adults and teens identify as transgender in the US, according to the Williams Institute – about 0.6% of the population.

Safer said he understands that there is some political sensitivity surrounding the practice and that some gender-affirming care specialists have received threats because of their work. But he said he can’t understand why this standard kind of care is seen as political.

“The whole political conversation bewilders me,” he added. “Being a doctor in a field that I think of is not political. I’m just trying to deliver care to all folks.

“Do we call it diabetes-affirming care when we treat people for diabetes? No, it’s not like that.”

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