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Endocrinologists well positioned to be experts on changes in transgender care



In light of changing clinical practice guidelines and changing provider attitudes, endocrinologists have the opportunity to step up and become community experts on transgender health care, according to Joshua D. Safer, MD, executive director of the Mount Sinai Center for Transgender Medicine and Surgery, New York.

“It’s not that we have to be the experts on making diagnoses or other elements of transgender care, necessarily,” Dr. Safer said in an interview here at the annual scientific & clinical congress of the American Association of Clinical Endocrinologists.

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Dr. Joshua Safer

“But in this world, people should be free to go to their primary care providers in their community,” he continued. “We endocrinologists in those same communities need to be able to help those individuals – even if it’s just an occasional patient – do what is safe and be expert there, just like we are with other hormone treatments.”

In a meet-the-expert session at AACE, Dr. Safer talked about the “change in landscape” in transgender medical care that precipitated the Endocrine Society clinical practice guideline on endocrine treatment of gender-dysphoric/gender-incongruent individuals.

The new guidelines, published just this past fall, updated guidance published by the society back in 2009.

One big change for pediatrics in the new guidelines is the recognition that there may be “compelling reasons” to start cross-sex hormonal therapy prior to 16 years, the former age cut-off. Sixteen years is “very late if you’re thinking about it from a biological perspective,” said Dr. Safer, who was a coauthor of the new guidelines.

While there are only limited data on using gender-affirming hormones in younger adolescents, there are potential risks of waiting until age 16 years in some cases, according to the guidelines.

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