The Endocrine Society’s updated guidelines recommend that clinicians should educate patients receiving hormone treatment on the likely extent and time course of steroid-induced physical changes. Although the data on this is limited, and a large degree of natural variation can be expected, the guideline lists the likely masculinising effects of testosterone and the feminising effects of oestrogen and anti-androgen therapy according to the typical time to onset and time to maximum effect.
Hormonal treatment should include ongoing monitoring of hormone levels, as well as assessments of risk factors for reduced bone density. Measurement of bone mineral density is recommended for patients with risk factors for osteoporosis and, in particular, for those who stop hormone treatment following gonadectomy.
Subspecialty consultation is required for any patient with suspected or confirmed gender dysphoria. Treatment is complex and should only be undertaken as part of a package of care provided by a multidisciplinary team with extensive experience in this area.
In children and adolescents, disorders of gender identity are particularly complicated, may have higher comorbidity, and may change form as patients mature, making specialist assessment particularly important. This topic covers the management of gender dysphoria in adults only.
Gender dysphoria is not commonly pronounced enough to prompt patients to seek medical intervention. Dual role transvestism is the most common manifestation.
Most clinics treat patients with hormones only when they are adults and have already changed their social gender role (or, occasionally, have a definite and agreed time when they will do so).
Most clinics will not undertake bilateral mastectomy unless there has been a change of social gender role from female to another, demonstrably stable, social gender role, usually male.
No clinic will undertake genital surgery unless there has been agreement from 2 appropriately trained professionals and the patient has been living with demonstrated success in their new gender role for at least 1 year.
Gender non-conformity is when a person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex. 
Gender dysphoria is present when there is a distressing dissonance between a person's biological sex and associated social gender role, as assigned at birth, and that person's sense of their own gender. 
Only some gender non-conforming people experience gender dysphoria at some point in their lives. 
The term 'gender identity disorder' has been replaced by 'gender dysphoria' in the latest "Diagnostic and statistical manual of mental disorders, 5th edition" (DSM-5) after consideration by the American Psychiatric Association.  
Consultant Psychiatrist and Lead Clinician
Charing Cross Gender Identity Clinic
JB is an author of a number of references cited in this topic.
Kings Harbor Multicare Center
RG declares that he has no competing interests.
Affiliate Assistant Professor
Department of Psychiatry and Behavioral Sciences
University of Washington Medical Center
CNS declares that he has no competing interests.
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