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Principles of transgender health care

Last updated: July 5, 2021

Summarytoggle arrow icon

Transgender people have a gender identity that differs from the sex assigned at birth and sometimes choose to undergo hormone therapy and/or surgery to align their physical appearance and gender identity. Often, transgender individuals face social and institutional discrimination and stigmatization that affect their quality of life, including experiences with the health system and access to care. Clinicians should be aware of these issues and ensure a welcoming environment that allows for patients to provide the necessary information to address their health needs. Transgender patients present with the same spectrum of health problems and needs as cisgender patients, and the majority of presentations will be unrelated to gender identity. Hormone therapy and surgery are typically overseen by specialist centers; however, some patients may subsequently present to their primary care physician or local hospital with treatment side effects and complications, including long-term changes to physiology (e.g., secondary to gonadectomy and gender-affirming hormone therapy) that can increase the risk of certain diseases. Transgender people also face unique challenges in managing fertility, contraception, and pregnancy.

[1][2]

Systemic barriers and health risks disproportionately affecting transgender patients [1][2][3][4]

Transgender people often face structural barriers in society that can result in health inequities (including increased risks for specific medical conditions) and affect their quality of life and life expectancy. Consider screening for and addressing these barriers and conditions in at-risk patients if they are pertinent to the reason the patient is seeking care (see “Preventive health care”).

Avoid assuming a direct link between any medical or social risk and gender identity, as individual patient experiences vary. Unwarranted assumptions can damage the patient-provider relationship and decrease the likelihood that patients will feel comfortable divulging sensitive health information or returning to seek care. [6]

Factors affecting health care encounters [3][6][7]

Health care environments can be the source of stress, frustration, humiliation, and fear for transgender patients if systemic barriers and inappropriate health-provider behavior, biases, and incompetencies are left unaddressed. The following have been reported as factors that erode patients' trust in health care systems and personnel, and may prevent them from seeking care as a result:

  • Systemic barriers
    • Lack of adequate health insurance
    • Risk of discrimination and harassment in healthcare institutions
    • Health care institutions lacking adequate resources to ensure privacy and confidentiality
    • Insufficient accommodation and facilities for gender-diverse patients
  • Provider-related barriers: training gaps, biases, and unprofessional behavior
    • Insufficient knowledge surrounding transgender health and social issues
    • Inappropriate questioning
    • Use of culturally insensitive terminology
    • Accidental or intentional misgendering (i.e., failure and/or refusal to acknowledge transgender identity or use preferred pronouns) or outing the patient
    • Counseling that invalidates or devalues transgender experiences
    • Transphobic and disrespectful behavior of staff

Optimizing the patient experience

Best practices during health care visits

  • Respecting patient preferences
    • Ask the patient what name and pronouns they prefer and adhere to using them.
    • When pertinent to the reason for the visit, ask directly and specifically about the following :
    • Familiarize yourself with preferred terminology regarding gender identity.
  • Other recommendations [6]
    • Avoid gender-specific terminology.
    • Preferably, use last names when referring to patients in group settings.
    • Do not discuss sensitive information unless it is relevant to the reason for the visit.
    • Ensure privacy at all times (especially when discussing gender identity and other sensitive issues).

Focused history-taking [1][2]

This information should only be solicited if it is pertinent to the reason for seeking care and in a manner appropriate to the patient's gender identity.

  • History of gender transition
    • Ask about any previous gender-affirming interventions and plans to undergo future ones.
    • Be aware of potential problems, changes, and mistakes in the patient's medical records and identification documents.
  • Gynecological history: Ask about previous pregnancies, menstruation, and the most recent gynecological cancer screening.
  • Sexual history: Obtain a detailed sexual history, including information on the number and gender(s) of sexual partners and any high-risk sexual behavior.
  • Others: The rest of the clinical history should not differ from the one used for cisgender patients.
    • Family history: Ask especially about hormone-related cancers and cardiovascular disease.
    • Mental health: Screen for depression and suicidal ideation, and ask about any issues impacting quality of life.
    • Social support: Ask about the patient's financial and work situation and relationship with friends and family.

Only address aspects of gender identity that are clinically relevant. The focus should be on the reason for the patient's visit. Inappropriate questioning can erode the patient's trust in the health care system, contributing to poorer health outcomes in an already marginalized population.

Sensitive physical examination [1][2]

  • Clinicians should be aware that secondary sex characteristics might be present, partially present, or not present at all, depending on whether the patient has had gender-affirming surgery and/or hormonal therapy.
  • Ask the patient if they would like to have a chaperone in the examination room with them (this may be a person who came with the patient or a member of staff).
  • Discuss all steps of the physical examination beforehand.
  • Remind the patient to state if, at any time, they feel uncomfortable during the physical examination.

General principles

  • Gender-affirming care may include treatment with hormone therapy and/or surgery.
  • Most transgender people taking hormone therapy report an improved quality of life; however, medications can cause side effects that clinicians should be aware of. [8]
  • Transgender people facing barriers to health care sometimes access hormone therapy without a formal prescription and these individuals may be at additional risk of side effects. [9]
  • Nonbinary transgender patients may also elect to take hormone therapy for masculinization or feminization, or at partial doses to reflect their gender identity. [10]

Gender-affirming hormone therapy

Overview of hormone therapy for transgender patients [8]
Masculinizing medical therapy
Hormone type Effects Common formulations Common adverse effects
Testosterone
  • Intramuscular or subcutaneous: every 1–2 weeks
  • Implant: every 3–4 months
  • Transdermal: every day
  • Acne
  • Hair loss
  • Localized injection site reactions
Feminizing medical therapy
Hormone type Effects Common formulations Common adverse effects
Estrogen (preferred preparation: estradiol)
  • Feminization of features (e.g., breast development)
  • Suppression of androgen production (typically in conjunction with antiandrogens)
  • Oral: every day
  • Intramuscular or subcutaneous: every 2 weeks
  • Transdermal: twice weekly [11]
  • Venous thromboembolism (VTE)
  • Cardiovascular disease
  • Decreased libido
  • Loss of erectile function
  • Localized injection site reactions
Antiandrogens
  • Hepatotoxicity
  • GnRH agonists: intramuscular monthly or implant every 12 months

Puberty suppression [13][14]

Procedures [16][17][18]

Gender-affirming surgery may include genital surgery, chest surgery, and additional procedures such as facial feminization or masculinization. Up to half of transgender individuals undergo a gender-affirming surgical procedure, and demand is increasing. Several procedures are often required to achieve the desired outcome. [17][19]

Transgender individuals may choose to undergo several or none of these procedures.

Surgical procedures for transgender women

Surgical procedures for transgender men

  • Genital surgery
    • Resection
    • Reconstruction
      • Metoidioplasty: creation of a microphallus from the clitoris
      • Phalloplasty: creation of a neophallus and neourethra, commonly out of a tissue flap
      • Scrotoplasty: creation of a neoscrotum from the labia majora; may include a testicular implant
  • Chest surgery: bilateral subcutaneous mastectomy and construction of masculinized features [21]

Additional procedures [17]

  • Facial feminization or masculinization, e.g., rhinoplasty or lip augmentation
  • Body contouring, e.g., liposuction or gluteal augmentation
  • Voice modification surgery

Complications [16][18][20]

General complications

Complications of male-to-female genital surgery

Complications of female-to-male genital surgery

Urinary retention is a common complication following gender-affirming surgery. [20]

Gender-affirming treatments such as hormone medication or surgery may have a permanent impact on patients' fertility, and counseling on future family planning should be offered prior to starting treatment. Because fertility may still be possible despite treatment, clinicians should ensure that patients are fully aware of their contraceptive options.

Fertility

Fertility preservation rates in transgender individuals are low despite a high expressed desire for children; possible explanations are insufficient knowledge on the part of health care providers, high cost, and individual concerns about the invasiveness of the treatment. [25][26]

Effect of hormone therapy on fertility
Impact of hormone therapy [27] Fertility preservation options [25][27]
Transgender women
Transgender men .

Contraception [28][29]

Patients who retain their gonads may still become pregnant or impregnate a sexual partner and should, therefore, be offered counseling on contraception. Counseling is particularly important for transgender men, as testosterone therapy is teratogenic.

Contraceptive counseling is mandatory for transgender individuals and they should be advised that testosterone therapy is teratogenic. [27]

Pregnancy and lactation [26][27]

Transgender men may become pregnant. Data and clinical guidance on pregnancy (planned or unplanned) in transgender men are limited.

Considerations during pregnancy

Considerations during lactation

  • Chestfeeding may be possible following pregnancy, or it may be induced in both transgender men and women without prior gestation via hormone administration. [30]
  • The decision to continue GAHT during lactation should be made in collaboration with the patient.
    • Hormones such as testosterone may suppress lactation.
    • There is a paucity of evidence on the safety of using GAHT during lactation.
  • Infant latch may be difficult if chest surgery has been performed.

Most principles of preventive health care are the same for transgender and cisgender patients. Patients should be offered appropriate age-based screening and general preventive health advice (e.g., healthy eating, exercise, smoking cessation).

Disease risk

Risks for certain diseases can vary between transgender and cisgender persons. Risks can be influenced by whether or not individuals have undergone gender-affirming surgery or are taking hormones and at which age gender-affirming treatment was performed or started.

Altered disease risk and screening options in transgender persons
Transgender men Transgender women
Cardiovascular system [31][32][33]
  • ↑ Risk of cardiovascular disease in patients taking GAHT compared with cisgender men
  • Screening measures
    • Lipid panel: annually (triglycerides, LDL, HDL: common in patients taking GAHT)
    • Blood pressure: Consider additional screening every 1–3 months in the first year after starting testosterone.
  • ↑ Risk of cardiovascular disease and cerebrovascular events in patients taking GAHT compared with cisgender women [31]
  • Screening measures
    • Lipid panel: annually (common: triglycerides)
    • Blood pressure: routine screening
Endocrine system [33][34]
Renal system [2][36][37][38]
Hepatobiliary system [38]
  • Liver chemistries: every 3 months for the first year, then every 6–12 months for patients taking GAHT
  • Liver chemistries: every 3 months for the first year, then every 6–12 months for patients taking GAHT
Bone health [15][33][39]
Thromboembolic risk
Sexually transmitted infections [5][15][41][42]

Cancer screening

  • Do not make assumptions about what reproductive body parts patients may have or what screening should be offered.
  • Clarify the person's gender identity, sex assigned at birth, and previous gender-affirming procedures, and offer screening that is appropriate to their bodies (see also “Approach to the clinical evaluation”).
  • Bear in mind that patients may be uncomfortable with the screening of body parts that are incongruent with their gender identity.
Cancer screening for transgender persons
Transgender men Transgender women
Breast cancer [44][45]
  • Potentially lower risk compared with cisgender women
  • Follow the same screening protocols for cisgender women. [15]
Gynecological cancer [46][47]
  • In rare cases, patients develop squamous cell carcinoma of the neovagina.
  • Optimum screening intervals are unclear; annual gynecological examination has been proposed. [47][52]
Prostate cancer [53]
  • N/A
  1. Connelly PJ, Marie Freel E, Perry C, et al. Gender-Affirming Hormone Therapy, Vascular Health and Cardiovascular Disease in Transgender Adults. Hypertension. 2019; 74 (6): p.1266-1274. doi: 10.1161/hypertensionaha.119.13080 . | Open in Read by QxMD
  2. Alzahrani T, Nguyen T, Ryan A, et al. Cardiovascular Disease Risk Factors and Myocardial Infarction in the Transgender Population. Circulation. 2019; 12 (4). doi: 10.1161/circoutcomes.119.005597 . | Open in Read by QxMD
  3. Houssayni S, Nilsen K. Transgender Competent Provider: Identifying Transgender Health Needs, Health Disparities, and Health Coverage.. Kans J Med. 2018; 11 (1): p.1-18.
  4. Spanos C, Bretherton I, Zajac JD, Cheung AS. Effects of gender-affirming hormone therapy on insulin resistance and body composition in transgender individuals: A systematic review. World J Diabetes. 2020; 11 (3): p.66-77. doi: 10.4239/wjd.v11.i3.66 . | Open in Read by QxMD
  5. Shadid S, Abosi-Appeadu K, De Maertelaere A-S, et al. Effects of Gender-Affirming Hormone Therapy on Insulin Sensitivity and Incretin Responses in Transgender People. Diabetes Care. 2019; 43 (2): p.411-417. doi: 10.2337/dc19-1061 . | Open in Read by QxMD
  6. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017; 102 (11): p.3869-3903. doi: 10.1210/jc.2017-01658 . | Open in Read by QxMD
  7. Rosendale N, Goldman S, Ortiz GM, Haber LA. Acute Clinical Care for Transgender Patients. JAMA Internal Medicine. 2018; 178 (11): p.1535. doi: 10.1001/jamainternmed.2018.4179 . | Open in Read by QxMD
  8. Whitley CT, Greene DN. Transgender Man Being Evaluated for a Kidney Transplant. Clin Chem. 2017; 63 (11): p.1680-1683. doi: 10.1373/clinchem.2016.268839 . | Open in Read by QxMD
  9. Fernandez-Prado R, Ortiz A. A sudden decrease in serum creatinine and estimated glomerular filtration rate: clinical implications of administrative gender assignment in transgender persons. Clin Kidney J. 2019; 13 (6): p.1107-1108. doi: 10.1093/ckj/sfz152 . | Open in Read by QxMD
  10. Hashemi L, Weinreb J, Weimer AK, Weiss RL. Transgender Care in the Primary Care Setting: A Review of Guidelines and Literature.. Fed Pract. 2018; 35 (7): p.30-37.
  11. Stevenson MO, Tangpricha V. Osteoporosis and Bone Health in Transgender Persons.. Endocrinol Metab Clin North Am. 2019; 48 (2): p.421-427. doi: 10.1016/j.ecl.2019.02.006 . | Open in Read by QxMD
  12. Shatzel JJ, Connelly KJ, DeLoughery TG. Thrombotic issues in transgender medicine: A review. Am J Hematol. 2017; 92 (2): p.204-208. doi: 10.1002/ajh.24593 . | Open in Read by QxMD
  13. Guidelines for gender-affirming primary care with trans and non-binary patients.
  14. Neumann MS, Finlayson TJ, Pitts NL, Keatley J. Comprehensive HIV Prevention for Transgender Persons.. Am J Public Health. 2017; 107 (2): p.207-212. doi: 10.2105/AJPH.2016.303509 . | Open in Read by QxMD
  15. Van Gerwen OT, Jani A, Long DM, Austin EL, Musgrove K, Muzny CA. Prevalence of Sexually Transmitted Infections and Human Immunodeficiency Virus in Transgender Persons: A Systematic Review. Transgend Health. 2020; 5 (2): p.90-103. doi: 10.1089/trgh.2019.0053 . | Open in Read by QxMD
  16. Ropero Álvarez AM, Pérez-Vilar S, Pacis-Tirso C, et al. Progress in vaccination towards hepatitis B control and elimination in the Region of the Americas. BMC Public Health. 2017; 17 (1). doi: 10.1186/s12889-017-4227-6 . | Open in Read by QxMD
  17. Hibbert MP, Wolton A, Weeks H, et al. Psychosocial and sexual factors associated with recent sexual health clinic attendance and HIV testing among trans people in the UK. BMJ Sex Reprod Health. 2019; 46 (2): p.116-125. doi: 10.1136/bmjsrh-2019-200375 . | Open in Read by QxMD
  18. Meggetto O, Peirson L, Yakubu M, et al. Breast cancer risk and breast screening for trans people: an integration of 3 systematic reviews.. CMAJ open. undefined; 7 (3): p.E598-E609. doi: 10.9778/cmajo.20180028 . | Open in Read by QxMD
  19. De Blok CJM, Wiepjes CM, Nota NM, et al. Breast cancer risk in transgender people receiving hormone treatment: nationwide cohort study in the Netherlands. BMJ. 2019 : p.l1652. doi: 10.1136/bmj.l1652 . | Open in Read by QxMD
  20. Peitzmeier SM, Reisner SL, Harigopal P, Potter J. Female-to-male patients have high prevalence of unsatisfactory Paps compared to non-transgender females: implications for cervical cancer screening.. J Gen Intern Med. 2014; 29 (5): p.778-84. doi: 10.1007/s11606-013-2753-1 . | Open in Read by QxMD
  21. Fierz R, Ghisu GP, Fink D. Squamous Carcinoma of the Neovagina after Male-to-Female Reconstruction Surgery: A Case Report and Review of the Literature.. Case Rep Obstet Gynecol. 2019; 2019 : p.4820396. doi: 10.1155/2019/4820396 . | Open in Read by QxMD
  22. Bates CK, Carroll N, Potter J. The Challenging Pelvic Examination. Journal of General Internal Medicine. 2011; 26 (6): p.651-657. doi: 10.1007/s11606-010-1610-8 . | Open in Read by QxMD
  23. Braun H, Nash R, Tangpricha V, Brockman J, Ward K, Goodman M. Cancer in Transgender People: Evidence and Methodological Considerations. Epidemiol Rev. 2017; 39 (1): p.93-107. doi: 10.1093/epirev/mxw003 . | Open in Read by QxMD
  24. Hawkins M, Deutsch MB, Obedin-Maliver J, et al. Endometrial findings among transgender and gender nonbinary people using testosterone at the time of gender-affirming hysterectomy. Fertil Steril. 2021 . doi: 10.1016/j.fertnstert.2020.11.008 . | Open in Read by QxMD
  25. Sterling J, Garcia MM. Cancer screening in the transgender population: a review of current guidelines, best practices, and a proposed care model. Transl Androl Urol. 2020; 9 (6): p.2771-2785. doi: 10.21037/tau-20-954 . | Open in Read by QxMD
  26. Wang G, Ferguson D, Ionescu DN, et al. HPV-Related Neovaginal Squamous Cell Carcinoma Presenting as Lung Metastasis after Male-to-Female Gender Confirmation Surgery. Case Rep Oncol. 2020; 13 (1): p.17-22. doi: 10.1159/000504936 . | Open in Read by QxMD
  27. Ingham MD, Lee RJ, MacDermed D, Olumi AF. Prostate cancer in transgender women. Urol Oncol. 2018; 36 (12): p.518-525. doi: 10.1016/j.urolonc.2018.09.011 . | Open in Read by QxMD
  28. Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People. https://transcare.ucsf.edu/guidelines. Updated: June 17, 2016. Accessed: March 9, 2021.
  29. Klein DA, Paradise SL, Goodwin ET. Caring for Transgender and Gender-Diverse Persons: What Clinicians Should Know.. Am Fam Physician. 2018; 98 (11): p.645-653.
  30. von Vaupel-Klein AM, Walsh RJ. Considerations in genetic counseling of transgender patients: Cultural competencies and altered disease risk profiles.. J Genet Couns. 2021; 30 (1): p.98-109. doi: 10.1002/jgc4.1372 . | Open in Read by QxMD
  31. Chisolm-Straker M, Jardine L, Bennouna C, et al. Transgender and Gender Nonconforming in Emergency Departments: A Qualitative Report of Patient Experiences.. Transgender health. 2017; 2 (1): p.8-16. doi: 10.1089/trgh.2016.0026 . | Open in Read by QxMD
  32. Safer JD, Coleman E, Feldman J, et al. Barriers to healthcare for transgender individuals.. Curr Opin Endocrinol Diabetes Obes. 2016; 23 (2): p.168-71. doi: 10.1097/MED.0000000000000227 . | Open in Read by QxMD
  33. Coleman E et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J of Transgend. 2012; 13 (4): p.165-232. doi: 10.1080/15532739.2011.700873 . | Open in Read by QxMD
  34. Hahn M et al. Providing Patient-Centered Perinatal Care for Transgender Men and Gender-Diverse Individuals. Obstet Gynecol. 2019; 134 (5): p.959-963. doi: 10.1097/aog.0000000000003506 . | Open in Read by QxMD
  35. Patel S, Sweeney LB. Maternal Health in the Transgender Population. J Womens Health (Larchmt). 2021; 30 (2): p.253-259. doi: 10.1089/jwh.2020.8880 . | Open in Read by QxMD
  36. Jones K et al. Contraception choices for transgender males.. J Fam Plann Reprod Health Care. 2017; 43 (3): p.239-240. doi: 10.1136/jfprhc-2017-101809 . | Open in Read by QxMD
  37. Mancini I et al.. Contraception across transgender. Int J Impot Res. 2021 . doi: 10.1038/s41443-021-00412-z . | Open in Read by QxMD
  38. Reisman T, Goldstein Z. Case Report: Induced Lactation in a Transgender Woman. Transgend Health. 2018; 3 (1): p.24-26. doi: 10.1089/trgh.2017.0044 . | Open in Read by QxMD
  39. Schechter LS, D’Arpa S, Cohen MN, Kocjancic E, Claes KEY, Monstrey S. Gender Confirmation Surgery: Guiding Principles. J Sex Med. 2017; 14 (6): p.852-856. doi: 10.1016/j.jsxm.2017.04.001 . | Open in Read by QxMD
  40. Safer JD, Tangpricha V. Care of Transgender Persons. N Engl J Med. 2019; 381 (25): p.2451-2460. doi: 10.1056/nejmcp1903650 . | Open in Read by QxMD
  41. Schechter LS. Gender Confirmation Surgery: An Update for the Primary Care Provider. Transgend Health. 2016; 1 (1): p.32-40. doi: 10.1089/trgh.2015.0006 . | Open in Read by QxMD
  42. Nolan IT, Kuhner CJ, Dy GW. Demographic and temporal trends in transgender identities and gender confirming surgery. Transl Androl Urol. 2019; 8 (3): p.184-190. doi: 10.21037/tau.2019.04.09 . | Open in Read by QxMD
  43. Bryson C, Honig SC. Genitourinary Complications of Gender-Affirming Surgery. Curr Urol Rep. 2019; 20 (6). doi: 10.1007/s11934-019-0894-4 . | Open in Read by QxMD
  44. Morrison SD, Chen ML, Crane CN. An overview of female-to-male gender-confirming surgery. Nat Rev Urol. 2017; 14 (8): p.486-500. doi: 10.1038/nrurol.2017.64 . | Open in Read by QxMD
  45. Getahun D, Nash R, Flanders WD, et al. Cross-sex Hormones and Acute Cardiovascular Events in Transgender Persons. Ann Intern Med. 2018; 169 (4): p.205. doi: 10.7326/m17-2785 . | Open in Read by QxMD
  46. Safa B, Lin WC, Salim AM, Deschamps-Braly JC, Poh MM. Current Concepts in Feminizing Gender Surgery. Plast Reconstr Surg. 2019; 143 (5): p.1081e-1091e. doi: 10.1097/prs.0000000000005595 . | Open in Read by QxMD
  47. Dreher PC, Edwards D, Hager S, et al. Complications of the neovagina in male-to-female transgender surgery: A systematic review and meta-analysis with discussion of management. Clin Anat. 2017; 31 (2): p.191-199. doi: 10.1002/ca.23001 . | Open in Read by QxMD
  48. Unger CA. Hormone therapy for transgender patients. Transl Androl Urol. 2016; 5 (6): p.877-884. doi: 10.21037/tau.2016.09.04 . | Open in Read by QxMD
  49. Mepham N, Bouman WP, Arcelus J, Hayter M, Wylie KR. People with Gender Dysphoria Who Self‐Prescribe Cross‐Sex Hormones: Prevalence, Sources, and Side Effects Knowledge. J Sex Med. 2014; 11 (12): p.2995-3001. doi: 10.1111/jsm.12691 . | Open in Read by QxMD
  50. Cocchetti C, Ristori J, Romani A, Maggi M, Fisher AD. Hormonal Treatment Strategies Tailored to Non-Binary Transgender Individuals. J Clin Med. 2020; 9 (6): p.1609. doi: 10.3390/jcm9061609 . | Open in Read by QxMD
  51. Chan W, Drummond A, Kelly M. Deep vein thrombosis in a transgender woman. Can Med Assoc J. 2017; 189 (13): p.E502-E504. doi: 10.1503/cmaj.160408 . | Open in Read by QxMD
  52. Sonnenblick EB, Shah AD, Goldstein Z, Reisman T. Breast Imaging of Transgender Individuals: A Review. Curr Radiol Rep. 2018; 6 (1). doi: 10.1007/s40134-018-0260-1 . | Open in Read by QxMD
  53. Mahfouda S, Moore JK, Siafarikas A, Zepf FD, Lin A. Puberty suppression in transgender children and adolescents. Lancet Diabetes Endocrinol. 2017; 5 (10): p.816-826. doi: 10.1016/s2213-8587(17)30099-2 . | Open in Read by QxMD
  54. Carswell JM, Roberts SA. Induction and Maintenance of Amenorrhea in Transmasculine and Nonbinary Adolescents. Transgend Health. 2017; 2 (1): p.195-201. doi: 10.1089/trgh.2017.0021 . | Open in Read by QxMD