Check eligibility for adult gender-affirming hormone therapy

STEP 1 — Gather Information

Collect patient age, documentation of persistent gender dysphoria/gender incongruence, assessment of decision‑making capacity and ability to give informed consent, and evaluation of any mental health concerns (e.g., depression, anxiety, psychosis) and their current control status.

STEP 2 — Rule In / Rule Out

Is the patient at least the age of majority in their country? If NO, do not proceed with adult hormone therapy eligibility (follow adolescent criteria). If YES, continue to next step.

STEP 3 — Classify or Stratify

Assess whether the patient has persistent, well‑documented gender dysphoria/gender incongruence, sufficient decision‑making capacity to consent, and any mental health concerns are reasonably well controlled. If ALL three are satisfied, classify as ELIGIBLE; otherwise, classify as NOT ELIGIBLE.

STEP 4 — Decide

If ELIGIBLE, proceed to initiate gender‑affirming hormone therapy after obtaining informed consent and ordering baseline labs (e.g., CBC, CMP, lipids, prolactin if estrogen‑based, testosterone if androgen‑based). If NOT ELIGIBLE, address the deficient domain(s)—such as providing mental health treatment, capacity assessment, or further documentation of gender dysphoria—and re‑evaluate after optimization.

Clinical Guardrails / Mimics / Pitfalls

Do not initiate hormones without documented persistent gender dysphoria; do not overlook untreated major mental illness (e.g., active psychosis, uncontrolled bipolar disorder); do not assume decision‑making capacity without formal assessment; do not start hormones in minors using adult criteria; do not omit fertility preservation discussion before therapy.

Concrete Clinical Example

A 22‑year‑old transgender woman presents requesting estradiol. She has a two‑year history of well‑documented gender dysphoria, demonstrates capacity to consent, and her depression is stable on sertraline. She meets all criteria, so hormone therapy is initiated after informed consent and baseline labs.

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