Check eligibility for adolescent sex hormone treatment

STEP 1 — Gather Information

Collect: qualified MHP confirmation of persistent gender dysphoria; assessment of coexisting psychological/medical/social problems and whether addressed; adolescent’s mental capacity to estimate consequences, weigh benefits/risks, give informed consent; documentation that adolescent was informed of irreversible effects (including fertility loss) and preservation options; adolescent’s informed consent and parental/guardian consent if below legal medical consent age; pediatric endocrinologist agreement on indication; absence of medical contraindications. Compile collected data to evaluate eligibility criteria.

STEP 2 — Rule In / Rule Out

Rule out if a qualified MHP has not confirmed persistent gender dysphoria; otherwise, rule in and proceed to evaluate remaining criteria.

STEP 3 — Classify or Stratify

Classify as eligible if the adolescent has sufficient mental capacity to estimate consequences, weigh benefits/risks, give informed consent; parents/guardians have consented if required; coexisting psychological/medical/social problems have been addressed; otherwise, classify as not eligible.

STEP 4 — Decide

If eligible, confirm no medical contraindications and pediatric endocrinologist agreement, then initiate sex hormone treatment; if not eligible, address identified deficiencies (e.g., mental health stabilization, consent process, fertility discussion), consider puberty suppression if appropriate, and reassess later.

Clinical Guardrails / Mimics / Pitfalls

Do not initiate sex hormones without confirmed persistent gender dysphoria; do not overlook untreated coexisting psychiatric conditions that could impair adherence; do not proceed without documented informed consent from the adolescent and, when required, parents/guardians; do not assume capacity based solely on age; do not ignore medical contraindications such as uncontrolled thrombotic risk or hormone-sensitive malignancies.

Concrete Clinical Example

A 15‑year‑old transgender male requests testosterone. MHP confirms persistent gender dysphoria, coexisting anxiety is stable after treatment, adolescent demonstrates capacity to weigh risks/benefits, has been informed of infertility risk and preservation options, provides assent with parental consent, pediatric endocrinologist agrees, and no contraindications are found → eligible, start testosterone therapy.

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