Clinical Guidelines with Information on Transfeminine Hormone Therapy

By Aly | First published November 20, 2020 | Last modified June 26, 2024

Abstract / TL;DR

This article is a collection of clinical practice guidelines throughout the world with information on transfeminine hormone therapy. Examples of these clinical guidelines include the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People, the Endocrine Society guidelines, and the University of California, San Francisco (UCSF) Center of Excellence for Transgender Health guidelines, among many others.

Introduction

Clinicians use clinical practice guidelines (CPGs) to learn about and guide themselves in administering medical care for different indications. Clinical practice guidelines review and summarize the available scientific literature and research in a given medical area. They allow clinicians to competently administer care without necessarily having to delve into and develop their understanding via the primary scientific literature. Literature reviews can serve a similar function. However, clinical practice guidelines are generally more substantial and are more founded in evidence-based medicine. They are also regularly updated. Clinical practice guidelines are developed and maintained by clinical organizations and societies, universities, government agencies, and sometimes even large medical clinics. They may be international/locationless or oftentimes region-specific.

There are many clinical practice guidelines for transgender medicine (for review, Deutsch, Radix, & Reisner, 2016; Radix, 2019; Radix, 2019; UpToDate; Bewley et al., 2021; Dahlen et al., 2021; Ziegler, Carroll, & Charnish, 2021). These guidelines discuss topics such as psychotherapy, hormone therapy, voice therapy, and surgical management of transgender people, among others. In addition to educating and guiding clinicians, transgender clinical practice guidelines are useful materials for transgender people as they can help to inform them about their care.

This page is a maintained list of known English clinical guidelines throughout the world that include information specifically on the subject of transfeminine hormone therapy. The most major guidelines on transgender hormone therapy are the World Professional Association for Transgender Health (WPATH) Standards of Care for the Health of Transgender and Gender Diverse People (SOC) (Coleman et al., 2022), the Endocrine Society guidelines (Hembree et al., 2017), and the University of California, San Francisco (UCSF) guidelines (Deutsch, 2016). The WPATH SOC and the Endocrine Society guidelines are international, while the UCSF guidelines are based in the United States.

International

WPATH Standards of Care Previous Versions

• 1st/1979: Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1979 February 13). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [1st Edition/1979 Original Draft]. Palo Alto, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar]
• 2nd/1980: Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1980 January 20). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [2nd Edition/1980 Revised Draft]. Stanford, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar 1] [Google Scholar 2]
• 3rd/1981: Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1981 March 9). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [3rd Edition/1981 Revised Draft]. San Francisco, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [URL 1] [URL 2] [DOI:10.1007/BF01541354—1985 reprint in Archives of Sexual Behavior, 14(1), 79–90)]
• 4th/1990: Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1990 January 25). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [4th Edition/1990 Revised Draft]. Palo Alto/Sonoma, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar 1] [Google Scholar 2] [URL 1] [URL 2] [URL 3] [URL 4] [URL 5] [URL 6]
• 5th/1998: Levine, S. B., Brown, G., Coleman, E., Cohen-Kettenis, P., Joris Hage, J., Van Maasdam, J., Petersen, M., Pfaefflin, F., & Schaefer, L. C. (June 1998). [The Harry Benjamin International Gender Dysphoria Association’s] The Standards of Care for Gender Identity Disorders [5th Edition]. International Journal of Transgenderism, 2(2). [Consultants: Denny, D., DiCeglie, D., Eicher, W., Green, J., Green, R., Gooren, L., Laub, D., Lawrence, A., Meyer, W., & Wheeler, C.] [URL 1] [URL 2] [URL 3] [PDF]
• 6th/2001: Meyer, W., Bockting, W. O., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, H., Gooren, L., Joris Hage, J., Kirk, S., Kuiper, B., Laub, D., Lawrence, A., Menard, Y., Patton, J., Schaefer, L., Webb, A., & Wheeler, C. C. (February 2001). [The Harry Benjamin International Gender Dysphoria Association’s] The Standards of Care for Gender Identity Disorders – Sixth Version. International Journal of Transgenderism, 5(1). [Google Scholar 1] [Google Scholar 2] [Google Scholar 3] [URL 1] [URL 2] [DOI:10.1300/J056v13n01_01—2001/2002 reprint in Journal of Psychology & Human Sexuality, 13(1), 1–30] [PDF 1] [PDF 2]
• 7th/2012: Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … & Zucker, K. (2012). [World Professional Association for Transgender Health (WPATH)] Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism, 13(4), 165–232. [DOI:10.1080/15532739.2011.700873] [URL] [PDF]

United States

Canada

Europe

United Kingdom

Italy

Australia

New Zealand

South Africa

Elsewhere

References

• AusPATH. (2022). Australian Informed Consent Standards of Care for Gender Affirming Hormone Therapy. Australia: Australian Professional Association for Trans Health. [URL] [PDF]
• Belzer, M. E., Burnett, J., Deutsch, M., Franicevich, J., Gorton, R. N., Hastings, J., Karasic, D., Kohler, L., Vanderleest, J., Van Maasdam, J., Olson, J., Green, J., & DeVries, C. (April 2011). Primary Care Protocol for Transgender Patient Care, 1st Edition. Center of Excellence for Transgender Health, University of California, San Francisco, Department of Family and Community Medicine. [URL] [PDF]
• Bewley, S., Dahlen, S., Connolly, D., Arif, I., Junejo, M., & Catherine, M. (2021). International Clinical Practice Guidelines for Gender Minority/Trans People: Systematic Review & Quality Assessment. How Does the Endocrine Society Fare? Journal of the Endocrine Society, 5(Suppl 1), A791–A791. [DOI:10.1210/jendso/bvab048.1609]
• Bourns, A. (2019). Guidelines for Gender-Affirming Primary Care with Trans and Non-Binary Patients, 4th Edition. Toronto: Rainbow Health Ontario/Sherbourne Health. [URL] [PDF]
• Callen-Lorde Community Health Center. (2018). Protocols for the Provision of Hormone Therapy. New York City: Callen-Lorde Community Health Center. [URL] [PDF]
• Cheung, A. S., Wynne, K., Erasmus, J., Murray, S., & Zajac, J. D. (2019). Position Statement on the Hormonal Management of Adult Transgender and Gender Diverse Individuals. Medical Journal of Australia, 211(3), 127–133. [DOI:10.5694/mja2.50259]
• Coleman, E., Bockting, W., Botzer, M., Cohen-Kettenis, P., DeCuypere, G., Feldman, J., Fraser, L., Green, J., Knudson, G., Meyer, W. J., Monstrey, S., Adler, R. K., Brown, G. R., Devor, A. H., Ehrbar, R., Ettner, R., Eyler, E., Garofalo, R., Karasic, D. H., … & Zucker, K. (2012). [World Professional Association for Transgender Health (WPATH)] Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. International Journal of Transgenderism, 13(4), 165–232. [DOI:10.1080/15532739.2011.700873] [URL] [PDF]
• Coleman, E., Radix, A. E., Bouman, W. P., Brown, G. R., de Vries, A. L., Deutsch, M. B., Ettner, R., Fraser, L., Goodman, M., Green, J., Hancock, A. B., Johnson, T. W., Karasic, D. H., Knudson, G. A., Leibowitz, S. F., Meyer-Bahlburg, H. F., Monstrey, S. J., Motmans, J., Nahata, L., … & Arcelus, J. (2022). [World Professional Association for Transgender Health (WPATH)] Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. International Journal of Transgender Health, 23(Suppl 1), S1–S259. [DOI:10.1080/26895269.2022.2100644] [URL] [PDF]
• Cundill, P., Wong, P., Cheung, A., & Brownhill, A. (2020). Hormone Therapy Prescribing Guide for General Practitioners working with Trans, Gender Diverse and Non-Binary Patients [Version 3.0]. Australia: Equinox Gender Diverse Health Centre/Thorne Harbour Health. [URL] [PDF]
• Dahl, M., Feldman, J. L., Goldberg, J., & Jaberi, A. (2015). Endocrine Therapy for Transgender Adults in British Columbia: Suggested Guidelines. Physical Aspects of Transgender Endocrine Therapy. Vancouver: Vancouver Coastal Health. [Google Scholar] [PDF]
• Dahlen, S., Connolly, D., Arif, I., Junejo, M. H., Bewley, S., & Meads, C. (2021). International Clinical Practice Guidelines for Gender Minority/Trans People: Systematic Review and Quality Assessment. BMJ Open, 11(4), e048943. [DOI:10.1136/bmjopen-2021-048943]
• Davidson, A., Franicevich, J., Freeman, M., Lin, R., Martinez, L., Monihan, M., Porch, M., Samuel, L., Stukalin, R., Vormohr, J., & Zevin, B. (2013). Protocols for Hormonal Reassignment of Gender. San Francisco: San Francisco Department of Public Health/Tom Waddell Health Center. [Google Scholar] [PDF]
• Deutsch, M. B. (Ed.). (2016). Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People, 2nd Edition. San Francisco: University of California, San Francisco/UCSF Transgender Care. [URL] [PDF]
• Deutsch, M. B., Radix, A., & Reisner, S. (2016). What’s in a Guideline? Developing Collaborative and Sound Research Designs that Substantiate Best Practice Recommendations for Transgender Health Care. AMA Journal of Ethics, 18(11), 1098–1106. [DOI:10.1001/journalofethics.2016.18.11.stas1-1611]
• Feldman, J., & Safer, J. (2009). Hormone Therapy in Adults: Suggested Revisions to the Sixth Version of the Standards of Care. International Journal of Transgenderism, 11(3), 146–182. [DOI:10.1080/15532730903383757]
• Fisher, A. D., Senofonte, G., Cocchetti, C., Guercio, G., Lingiardi, V., Meriggiola, M. C., Mosconi, M., Motta, G., Ristori, J., Speranza, A. M., Pierdominici, M., Maggi, M., Corona, G., & Lombardo, F. (2021). SIGIS–SIAMS–SIE position statement of gender affirming hormonal treatment in transgender and non-binary people. Journal of Endocrinological Investigation, 45(3), 657–673. [DOI:10.1007/s40618-021-01694-2]
• Godano, A., Maggi, M., Jannini, E., Meriggiola, M. C., Ghigo, E., Todarello, O., Lenzi, A., & Manieri, C. (2009). SIAMS-ONIG Consensus on Hormonal Treatment in Gender Identity Disorders. Journal of Endocrinological Investigation, 32(10), 857–864. [DOI:10.1007/BF03345758]
• Gorton, N., Jaffe, J. M., Thompson, J., Menkin, D., Nesteby, A., Dunn, D., Baker, K. K., Harbatkin, D., Do, T., Radix, A., Meacher, P., Goldstein, Z., Carpenter, W., Caine, M., Henn, S., Murayama, R., Feldmann, J., & Zayas, S. (2019). TransLine Gender Affirming Hormone Therapy Prescriber Guidelines. San Francisco: Lyon-Martin Health Services/TransLine. [URL] [PDF]
• Health Policy Project, Asia Pacific Transgender Network, United Nations Development Programme. (2015). Blueprint for the Provision of Comprehensive Care for Trans People and Trans Communities. Washington, DC: Futures Group, Health Policy Project. [URL] [PDF]
• Hembree, W. C., Cohen-Kettenis, P., Delemarre-Van De Waal, H. A., Gooren, L. J., Meyer III, W. J., Spack, N. P., Tangpricha, V., & Montori, V. M. (2009). Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 94(9), 3132–3154. [DOI:10.1210/jc.2009-0345]
• Hembree, W. C., Cohen-Kettenis, P. T., Gooren, L., Hannema, S. E., Meyer, W. J., Murad, M. H., Rosenthal, S. M., Safer, J. D., Tangpricha, V., & T’Sjoen, G. G. (2017). Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism, 102(11), 3869–3903. [DOI:10.1210/jc.2017-01658] [PDF]
• International Planned Parenthood Federation (IPPF). (2015). IMAP Statement on Hormone Therapy for Transgender People. International Medical Advisory Panel/International Planned Parenthood Federation. [URL] [PDF]
• Latkin, S., & Coakley, G. (2017). [Transgender Women] Prescribing Guidelines. Doncaster/Bassetlaw: Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust. [PDF]
• Levine, S. B., Brown, G., Coleman, E., Cohen-Kettenis, P., Joris Hage, J., Van Maasdam, J., Petersen, M., Pfaefflin, F., & Schaefer, L. C. (June 1998). [The Harry Benjamin International Gender Dysphoria Association’s] The Standards of Care for Gender Identity Disorders [5th Edition]. International Journal of Transgenderism, 2(2). [Consultants: Denny, D., DiCeglie, D., Eicher, W., Green, J., Green, R., Gooren, L., Laub, D., Lawrence, A., Meyer, W., & Wheeler, C.] [URL 1] [URL 2] [URL 3] [PDF]
• Majumder, A., Chatterjee, S., Maji, D., Roychaudhuri, S., Ghosh, S., Selvan, C., George, B., Kalra, P., Maisnam, I., & Sanyal, D. (2020). IDEA Group Consensus Statement on Medical Management of Adult Gender Incongruent Individuals Seeking Gender Reaffirmation as Female. Indian Journal of Endocrinology and Metabolism, 24(2), 128–135. [DOI:10.4103/ijem.IJEM_593_19]
• Meyer, W., Bockting, W. O., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, H., Gooren, L., Joris Hage, J., Kirk, S., Kuiper, B., Laub, D., Lawrence, A., Menard, Y., Patton, J., Schaefer, L., Webb, A., & Wheeler, C. C. (February 2001). [The Harry Benjamin International Gender Dysphoria Association’s] The Standards of Care for Gender Identity Disorders – Sixth Version. International Journal of Transgenderism, 5(1). [Google Scholar 1] [Google Scholar 2] [Google Scholar 3] [URL 1] [URL 2] [DOI:10.1300/J056v13n01_01—2001/2002 reprint in Journal of Psychology & Human Sexuality, 13(1), 1–30] [PDF 1] [PDF 2]
• Oliphant, J., Veale, J., Macdonald, J., Carroll, R., Johnson, R., Harte, M., Stephenson, C. & Bullock, J. (2018). Guidelines for Gender Affirming Healthcare for Gender Diverse and Transgender Children, Young People and Adults in Aotearoa New Zealand. Waikato: Transgender Health Research Lab/University of Waikato. [URL] [PDF]
• Pan American Health Organization, John Snow, Inc., World Professional Association for Transgender Health, et al. (2014). Blueprint for the Provision of Comprehensive Care for Trans Persons and Their Communities in the Caribbean and Other Anglophone Countries. Arlington: John Snow, Inc. [Alt] [PDF]
• Radix, A. (2019). Hormone Therapy for Transgender Adults. The Urologic Clinics of North America, 46(4), 467–473. [DOI:10.1016/j.ucl.2019.07.001]
• Radix, A. (2019). Primary Care of Transgender Adults. In Poretsky, L., & Hembree, W. C. (Eds.). Transgender Medicine: A Multidisciplinary Approach (Contemporary Endocrinology) (pp. 51–67). Cham: Humana Press. [DOI:10.1007/978-3-030-05683-4_4]
• Sappho for Equality. (2019). A Good Practice Guide to Gender-Affirmative Care. Kolkata: Sappho for Equality. [PDF]
• Seal, L. J. (2016). Information About Hormonal Treatment for Trans Women. London: West London Mental Health NHS Trust/West London NHS Trust. [PDF]
• Seal, L., & Barrett, J. (2017). Shared Care Prescribing Guidance for Treatment of Gender Dysphoria in Transwomen (Male to Female Transsexuals). London: West London Mental Health NHS Trust/West London NHS Trust. [PDF]
• Sullivan, C., & Dean, J. (2015). Prescribing Guideline. Pharmacological Treatment of Gender Dysphoria. Devon: Devon Partnership NHS Trust. [PDF]
• Tangpricha, V., & Safer, J. D. (2020). Transgender Women: Evaluation and Management. UpToDate. [URL] [PDF]
• Telfer, M. M., Tollit, M. A., Pace, C. C., & Pang, K. C. (2020). Australian Standards of Care and Treatment Guidelines for Trans and Gender Diverse Children and Adolescents Version 1.2. Melbourne: The Royal Children’s Hospital. [PDF]
• Thomas, C. (2015). Guidelines for the Use of Feminising Hormone Therapy. Information for Primary Care. Sunderland: City Hospitals Sunderland NHS Trust. [PDF]
• Thompson, J., Hopwood, R. A., deNormand, S., & Cavanaugh, T. (2021). Medical Care of Trans and Gender Diverse Adults. Boston: Fenway Health. [URL] [PDF]
• Tomson, A., McLachlan, C., Wattrus, C., Adams, K., Addinall, R., Bothma, R., Jankelowitz, L., Kotze, E., Luvuno, Z., Madlala, N., Matyila, S., Padavatan, A., Pillay, M., Rakumakoe, M. D., Tomson-Myburgh, M., Venter, W., & de Vries, E. (2021). Southern African HIV Clinicians’ Society gender-affirming healthcare guideline for South Africa. Southern African Journal of HIV Medicine, 22(1), a1299. [DOI:10.4102/sajhivmed.v22i1.1299] [PDF]
• Trans Care BC. (2021). Gender-affirming Care for Trans, Two-Spirit, and Gender Diverse Patients in BC: A Primary Care Toolkit. Vancouver: Provincial Health Services Authority/Trans Care BC. [URL] [PDF]
• T’Sjoen, G., Arcelus, J., De Vries, A. L., Fisher, A. D., Nieder, T. O., Özer, M., & Motmans, J. (2020). European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction”. The Journal of Sexual Medicine, 17(4), 570–584. [DOI:10.1016/j.jsxm.2020.01.012]
• UpToDate. (2021). Society Guideline Links: Transgender Health. UpToDate. [URL]
• Vacharathit, V., Ratanalert, W., & Samitpol, K. (2021). The Thai Handbook of Transgender Healthcare Services. Thailand: Center of Excellence in Transgender Health/Chulalongkorn University. [URL] [PDF]
• Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1979 February 13). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [1st Edition/1979 Original Draft]. Palo Alto, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar]
• Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1980 January 20). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [2nd Edition/1980 Revised Draft]. Stanford, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar 1] [Google Scholar 2]
• Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1981 March 9). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [3rd Edition/1981 Revised Draft]. San Francisco, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [URL 1] [URL 2] [DOI:10.1007/BF01541354—1985 reprint in Archives of Sexual Behavior, 14(1), 79–90)]
• Walker, P. A., Berger, J. C., Green, R., Laub, D. R., Reynolds, C. L., & Wollman, L. (1990 January 25). Standards of Care: The Hormonal and Surgical Sex Reassignment of Gender Dysphoric Persons [4th Edition/1990 Revised Draft]. Palo Alto/Sonoma, California: The Harry Benjamin International Gender Dysphoria Association, Inc. [Google Scholar 1] [Google Scholar 2] [URL 1] [URL 2] [URL 3] [URL 4] [URL 5] [URL 6]
• Wilczynski, C., & Emanuele, M. A. (2014). Treating a transgender patient: overview of the guidelines. Postgraduate Medicine, 126(7), 121–128. [DOI:10.3810/pgm.2014.11.2840]
• Wylie, K., Barrett, J., Besser, M., Bouman, W. P., Bridgman, M., Clayton, A., Green, R., Hamilton, M., Hines, M., Ivbijaro, G., Khoosal, D., Lawrence, A., Lenihan, P., Loewenthal, D., Ralph, D., Reed, T., Stevens, J., Terry, T., Thom, B., Thornton, J., Walsh, D., & Ward, D. (2014). Good Practice Guidelines for the Assessment and Treatment of Adults with Gender Dysphoria. Sexual and Relationship Therapy, 29(2), 154–214. [DOI:10.1080/14681994.2014.883353]
• Ziegler, E., Carroll, B., & Charnish, E. (2021). Review and Analysis of International Transgender Adult Primary Care Guidelines. Transgender Health, 6(3), 139–147. [DOI:10.1089/trgh.2020.0043]