Sex reassignment requires close collaboration between a mental health professional and endocrinologist throughout the endocrine transition. The endocrinologist’s role is to confirm the diagnostic criteria that the mental health professional used to make the recommendation of sex reassignment and then collaborate with making the recommendation for surgical sex reassignment.
Transsexual people who seek sex reassignment “require a safe and effective hormone regimen that will suppress endogenous hormone secretion determined by the person’s genetic/biologic sex and maintain sex hormone levels within the normal range for the person’s gender,” the guidelines stated.
Further, “we recommend that physicians evaluate and ensure that applicants understand the reversible and irreversible effects of hormone suppression and cross-sex hormone treatment before they start hormone treatment.”
For adolescents, the guidelines recommend treating with gonadotropin-releasing hormone analogues to suppress puberty until age 16 or no earlier than Tanner stages 2to 3. After age 16, a gradually increasing dose schedule of cross-sex hormones may be given.
The task force also recommended against a complete sex change and hormone treatment in adolescents because of a high rate of remission of gender identity disorder after the onset of puberty. The guidelines suggest deferring surgery until age 18.
With regards to gender reassignment surgery, the recommendation must be made by both the mental health professional and endocrinologist. Surgery is recommended only after a year of consistent, compliant hormone treatment. Multidisciplinary collaboration is required regarding hormone use during and after surgery.
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