Last reviewed: 20 Sep 2021
Last updated: 08 Sep 2021

Summary

Definition

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 syndrome

Diagnostic investigations

1st investigations to order

  • serum testosterone
  • serum dihydrotestosterone
  • serum follicle-stimulating hormone (FSH) and luteinizing hormone (LH)
  • serum prolactin
  • serum liver function tests
  • serum lipid screen
  • CBC

Treatment algorithm

Contributors

Authors

James Barrett, FRCPsych, BSc, MSc

Consultant Psychiatrist and Lead Clinician

Charing Cross Gender Identity Clinic

London

UK

Disclosures

JB has produced educational material for the Royal College of Physicians Gender Healthcare course and is a tutor on the course. He has occasionally received payment for speaking engagements on the subject and usually gets expenses. JB is an author of a number of references cited in this topic.

Peer reviewers

Roy Goldberg, MD

Medical Director

Kings Harbor Multicare Center

Bronx

NY

Disclosures

RG declares that he has no competing interests.

Craig N. Sawchuk, PhD

Affiliate Assistant Professor

Department of Psychiatry and Behavioral Sciences

University of Washington Medical Center

Seattle

WA

Disclosures

CNS declares that he has no competing interests.

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