Last reviewed: June 2018
Last updated: March  2018

Updated Endocrine Society guidelines on hormonal treatment of gender dysphoria

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.

Original source of update



History and exam

Key diagnostic factors

  • gender dysphoria
  • altered appearance or affect

Other diagnostic factors

  • diminished sexual function or homosexuality
  • atypical speech and vocal quality

Risk factors

  • congenital adrenal hyperplasia
  • partial androgen insensitivity syndromes
  • Klinefelter's syndrome

Diagnostic investigations

1st investigations to order

  • serum testosterone
  • serum dihydrotestosterone
  • serum FSH and LH
  • serum prolactin
  • serum LFTs
  • serum lipid screen
  • FBC
Full details

Treatment algorithm


Authors VIEW ALL

Consultant Psychiatrist and Lead Clinician

Charing Cross Gender Identity Clinic




JB is an author of a number of references cited in this topic.

Peer reviewers VIEW ALL

Medical Director

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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