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Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

E. Coleman1 Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

A. E. Radix2 Callen-Lorde Community Health Center, New York, NY, USA;3 Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA

W. P. Bouman4 Nottingham Centre for Transgender Health, Nottingham, UK;5 School of Medicine, University of Nottingham, Nottingham, UK

G. R. Brown6 James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA;7 James H. Quillen VAMC, Johnson City, TN, USA

A. L. C. de Vries8 Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands;9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

M. B. Deutsch10 Department of Family & Community Medicine, University of California—San Francisco, San Francisco, CA, USA;11 UCSF Gender Affirming Health Program, San Francisco, CA, USA

R. Ettner12 New Health Foundation Worldwide, Evanston, IL, USA;13 Weiss Memorial Hospital, Chicago, IL, USA

L. Fraser14 Independent Practice, San Francisco, CA, USA

M. Goodman15 Emory University Rollins School of Public Health, Atlanta, GA, USA

J. Green16 Independent Scholar, Vancouver, WA, USA

A. B. Hancock17 The George Washington University, Washington, DC, USA

T. W. Johnson18 Department of Anthropology, California State University, Chico, CA, USA

D. H. Karasic19 University of California San Francisco, San Francisco, CA, USA;20 Independent Practice at dankarasic.com

G. A. Knudson21 University of British Columbia, Vancouver, Canada;22 Vancouver Coastal Health, Vancouver, Canada

S. F. Leibowitz23 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

H. F. L. Meyer-Bahlburg24 New York State Psychiatric Institute, New York, NY, USA;25 Department of Psychiatry, Columbia University, New York, NY, USA

S. J. Monstrey26 Ghent University Hospital, Gent, Belgium

J. Motmans27 Transgender Infopunt, Ghent University Hospital, Gent, Belgium;28 Centre for Research on Culture and Gender, Ghent University, Gent, Belgium

L. Nahata29 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA;30 Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

T. O. Nieder31 University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany

S. L. Reisner32 Harvard Medical School, Boston, MA, USA;33 Harvard T. H. Chan School of Public Health, Boston, MA, USA

C. Richards34 Regents University London, UK;35 Tavistock and Portman NHS Foundation Trust, London, UK

L. S. Schechter36 Rush University Medical Center, Chicago, IL, USA

V. Tangpricha37 Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA;38 Atlanta VA Medical Center, Decatur, GA, USA

A. C. Tishelman39 Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA

M. A. A. Van Trotsenburg40 Bureau GenderPRO, Vienna, Austria;41 University Hospital Lilienfeld—St. Pölten, St. Pölten, Austria

S. Winter42 School of Population Health, Curtin University, Perth, WA, Australia

K. Ducheny43 Howard Brown Health, Chicago, IL, USA

N. J. Adams44 University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada;45 Transgender Professional Association for Transgender Health (TPATH)

T. M. Adrián46 Asamblea Nacional de Venezuela, Caracas, Venezuela;47 Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela

L. R. Allen48 University of Nevada, Las Vegas, NV, USA

D. Azul49 La Trobe Rural Health School, La Trobe University, Bendigo, Australia

H. Bagga50 Monash Health Gender Clinic, Melbourne, Victoria, Australia;51 Monash University, Melbourne, Victoria, Australia

K. Başar52 Department of Psychiatry, Hacettepe University, Ankara, Turkey

D. S. Bathory53 Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA

J. J. Belinky54 Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina

D. R. Berg55 National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

J. U. Berli56 Oregon Health & Science University, Portland, OR, USA

R. O. Bluebond-Langner57 NYU Langone Health, New York, NY, USA;58 Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA

M.-B. Bouman9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;59 Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands

M. L. Bowers60 Icahn School of Medicine at Mount Sinai, New York, NY, USA;61 Mills-Peninsula Medical Center, Burlingame, CA, USA

P. J. Brassard62 GrS Montreal, Complexe CMC, Montreal, Quebec, Canada;63 Université de Montreal, Quebec, Canada

J. Byrne64 University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa

L. Capitán65 The Facialteam Group, Marbella International Hospital, Marbella, Spain

C. J. Cargill66 Independent Scholar

J. M. Carswell32 Harvard Medical School, Boston, MA, USA;67 Boston’s Children’s Hospital, Boston, MA, USA

S. C. Chang68 Independent Practice, Oakland, CA, USA

G. Chelvakumar69 Nationwide Children’s Hospital, Columbus, OH, USA;70 The Ohio State University, College of Medicine, Columbus, OH, USA

T. Corneil71 School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada

K. B. Dalke72 Penn State Health, PA, USA;73 Penn State College of Medicine, Hershey, PA, USA

G. De Cuypere74 Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium

E. de Vries75 Nelson Mandela University, Gqeberha, South Africa;76 University of Cape Town, Cape Town, South Africa

M. Den Heijer9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;77 Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands

A. H. Devor78 University of Victoria, Victoria, BC, Canada

C. Dhejne79 ANOVA, Karolinska University Hospital, Stockholm, Sweden;80 Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden

A. D’Marco81 UCTRANS—United Caribbean Trans Network, Nassau, The Bahamas;82 D M A R C O Organization, Nassau, The Bahamas

E. K. Edmiston83 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

L. Edwards-Leeper84 Pacific University, Hillsboro, OR, USA;85 Independent Practice, Beaverton, OR, USA

R. Ehrbar86 Whitman Walker Health, Washington, DC, USA;87 Independent Practice, Maryland, USA

D. Ehrensaft19 University of California San Francisco, San Francisco, CA, USA

J. Eisfeld88 Transvisie, Utrecht, The Netherlands

E. Elaut74 Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium;89 Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium

L. Erickson-Schroth90 The Jed Foundation, New York, NY, USA;91 Hetrick-Martin Institute, New York, NY, USA

J. L. Feldman92 Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

A. D. Fisher93 Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy

M. M. Garcia94 Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA;95 Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA

L. Gijs96 Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium

S. E. Green97 Mermaids, London/Leeds, UK

B. P. Hall98 Duke University Medical Center, Durham, NC, USA;99 Duke Adult Gender Medicine Clinic, Durham, NC, USA

T. L. D. Hardy100 Alberta Health Services, Edmonton, Alberta, Canada;101 MacEwan University, Edmonton, Alberta, Canada

M. S. Irwig32 Harvard Medical School, Boston, MA, USA;102 Beth Israel Deaconess Medical Center, Boston, MA, USA

L. A. Jacobs103 Independent Practice, New York, NY, USA

A. C. Janssen23 Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA;104 Northwestern Feinberg School of Medicine, Chicago, IL, USA

K. Johnson105 RMIT University, Melbourne, Australia;106 University of Brighton, Brighton, UK

D. T. Klink107 Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium;108 Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children’s Hospital, Antwerp, Belgium

B. P. C. Kreukels9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;109 Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands

L. E. Kuper110 Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA;111 Department of Endocrinology, Children’s Health, Dallas, TX, USA

E. J. Kvach112 Denver Health, Denver, CO, USA;113 University of Colorado School of Medicine, Aurora, CO, USA;

M. A. Malouf114 Malouf Counseling and Consulting, Baltimore, MD, USA

R. Massey115 WPATH Global Education Institute;116 Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA

T. Mazur117 Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA;118 John R. Oishei Children’s Hospital, Buffalo, NY, USA

C. McLachlan119 Professional Association for Transgender Health, South Africa;120 Gender DynamiX, Cape Town, South Africa

S. D. Morrison121 Division of Plastic Surgery, Seattle Children’s Hospital, Seattle, WA, USA;122 Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA

S. W. Mosser123 Gender Confirmation Center, San Francisco, CA, USA;124 Saint Francis Memorial Hospital, San Francisco, CA, USA

P. M. Neira125 Johns Hopkins Center for Transgender Health, Baltimore, MD, USA;126 Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA

U. Nygren127 Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden;128 Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden

J. M. Oates129 La Trobe University, Melbourne, Australia;130 Melbourne Voice Analysis Centre, East Melbourne, Australia

J. Obedin-Maliver131 Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA;132 Department of Epidemiology and Population Health, Stanford, CA, USA

G. Pagkalos133 Independent PracticeThessaloniki, Greece;134 Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece

J. Patton135 Talkspace, New York, NY, USA;136 CytiPsychological LLC, San Diego, CA, USA

N. Phanuphak137 Institute of HIV Research and Innovation, Bangkok, Thailand

K. Rachlin103 Independent Practice, New York, NY, USA

T. Reed138 Gender Identity Research and Education Society, Leatherhead, UK

G. N. Rider55 National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

J. Ristori93 Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy

S. Robbins-Cherry4 Nottingham Centre for Transgender Health, Nottingham, UK

S. A. Roberts32 Harvard Medical School, Boston, MA, USA;139 Division of Endocrinology, Boston’s Children’s Hospital, Boston, MA, USA

K. A. Rodriguez-Wallberg140 Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden;141 Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden

S. M. Rosenthal142 Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA;143 UCSF Child and Adolescent Gender Center

K. Sabir144 FtM Phoenix Group, Krasnodar Krai, Russia

J. D. Safer60 Icahn School of Medicine at Mount Sinai, New York, NY, USA;145 Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA

A. I. Scheim146 Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA;147 Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada

L. J. Seal35 Tavistock and Portman NHS Foundation Trust, London, UK;148 St George’s University Hospitals NHS Foundation Trust, London, UK

T. J. Sehoole149 Iranti, Johannesburg, South Africa

K. Spencer55 National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA

C. St. Amand150 University of Houston, Houston, TX, USA;151 Mayo Clinic, Rochester, MN, USA

T. D. Steensma9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;109 Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands

J. F. Strang152 Children’s National Hospital, Washington, DC, USA;153 George Washington University School of Medicine, Washington, DC, USA

G. B. Taylor154 Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA

K. Tilleman155 Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium

G. G. T’Sjoen74 Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium;156 Department of Endocrinology, Ghent University Hospital, Gent, Belgium

L. N. Vala157 Independent Practice, Campbell, CA, USA

N. M. Van Mello9 Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;158 Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands

J. F. Veale159 School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa

J. A. Vencill160 Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA;161 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

B. Vincent162 Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK

L. M. Wesp163 College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA;164 Health Connections Inc., Glendale, WI, USA

M. A. West165 North Memorial Health Hospital, Robbinsdale, MN, USA;166 University of Minnesota, Minneapolis, MN, USA

J. Arcelus5 School of Medicine, University of Nottingham, Nottingham, UK;167 Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain.

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Figures & data

Table 1. Expected time course of physical changes in response to gender-affirming hormone therapy

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Table 2. Risks associated with gender affirming hormone therapy (bolded items are clinically significant) (Updated from SOC-7)

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Table 3. Gender-Affirming Hormone Regimens In Transgender And Gender Diverse Youth (Adapted from the Endocrine Society Guidelines; Hembree et al., Citation2017)

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Table 4. Hormone regimens in transgender and gender diverse adults*

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Table 5. Hormone monitoring of transgender and gender diverse people receiving gender-affirming hormone therapy (Adapted from the Endocrine Society Guidelines)

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Table 1. Expected time course of physical changes in response to gender-affirming hormone therapy

Table 2. Risks associated with gender affirming hormone therapy (bolded items are clinically significant) (Updated from SOC-7)

Table 3. Gender-Affirming Hormone Regimens In Transgender And Gender Diverse Youth (Adapted from the Endocrine Society Guidelines; Hembree et al., Citation2017)

Table 4. Hormone regimens in transgender and gender diverse adults*

Table 5. Hormone monitoring of transgender and gender diverse people receiving gender-affirming hormone therapy (Adapted from the Endocrine Society Guidelines)

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Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Figures & data

Table 1. Expected time course of physical changes in response to gender-affirming hormone therapy

Table 2. Risks associated with gender affirming hormone therapy (bolded items are clinically significant) (Updated from SOC-7)

Table 3. Gender-Affirming Hormone Regimens In Transgender And Gender Diverse Youth (Adapted from the Endocrine Society Guidelines; Hembree et al., Citation2017)

Table 4. Hormone regimens in transgender and gender diverse adults*

Table 5. Hormone monitoring of transgender and gender diverse people receiving gender-affirming hormone therapy (Adapted from the Endocrine Society Guidelines)

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