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