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es-assist-social-transition-decision-prepubertal

Assists clinicians in determining whether to proceed with social transition for prepubertal youth experiencing gender dysphoria or gender incongruence. Triggers include prepubertal youth with GD/gender incongruence and discussions about initiating social transition.

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dromlakhani/MD2SKILL

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Assist in social transition decision for prepubertal youth with GD/gender incongruence

STEP 1 — Gather Information

Collect age, Tanner stage (confirm prepubertal, stage 1), duration of GD/gender incongruence, expressed desire for social transition (name, pronouns, clothing, role), parental/guardian views, any coexisting psychosocial or psychiatric concerns, and confirmation that no pubertal suppression or hormone treatment is being considered.

STEP 2 — Rule In / Rule Out

Rule in: Prepubertal youth (Tanner stage 1) with GD/gender incongruence expressing desire for social transition. Rule out: Youth who have entered puberty (Tanner stage ≥2) or those without GD/gender incongruence.

STEP 3 — Classify or Stratify

Classify as requiring MHP or experienced professional assistance for the social transition decision; no further stratification needed per guideline.

STEP 4 — Decide

Decision: Involve a mental health professional (MHP) or another experienced professional in making the social transition decision; do not proceed without their input.

Clinical Guardrails / Mimics / Pitfalls

Do not allow social transition to proceed without MHP or experienced professional involvement. Avoid basing decisions solely on youth or parental request without professional assessment. Do not confuse social transition with medical intervention; hormone therapy is not recommended for prepubertal youth.

Concrete Clinical Example

A 7-year-old assigned male at birth consistently insists on being called a girl, prefers female clothing, and expresses distress when misgendered; parents seek guidance on allowing a full social transition (name change, school presentation). Clinician confirms prepubertal status (Tanner stage 1) and GD/gender incongruence, then refers to an MHP experienced in pediatric gender identity to assist in the decision-making process.

Source: Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2017, https://doi.org/10.1210/jc.2017-01658

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