Criteria for initiation of hormones

The criteria for initiating (starting) hormones will differ depending upon your patient’s age, and several other health factors.

For more information about the differences between the feeling and diagnosis of gender dysphoria, refer to our pages on gender dysphoria and gender diagnoses.

WPATH criteria for commencement of gender affirming hormone therapy (aged 18+) are as follows:

1. Persistent, well-documented gender incongruence (sometimes referred to as gender dysphoria);

2. Capacity to make a fully informed decision and to consent for treatment;

3. Age of majority in a given country

4. If significant medical or mental health concerns are present, they must be reasonably well-controlled.

Australian Standards of Care (SoC) criteria for adolescents to commence puberty suppression:

1. A diagnosis of Gender Dysphoria in Adolescence, made by a mental health clinician with expertise in child and adolescent development, psychopathology and experience with children and adolescents with gender dysphoria.

2. Medical assessment including fertility preservation counselling has been completed by a general practitioner, paediatrician, adolescent physician or endocrinologist. This assessment should include further fertility preservation counselling by a gynaecologist and/or andrologist as required with referral for fertility preservation when requested.

3. Tanner stage 2 pubertal status has been achieved. This can be confirmed via clinical examination with presence of breast buds or increased testicular volume (>4 mL) and elevation of luteinising hormone to ≥0.5 IU/L.

4. The treating team should agree that commencement of puberty suppression is in the best interest of the adolescent and assent from the adolescent and informed consent from their legal guardians has been obtained.

Australian SoC criteria for adolescents to commence gender affirming hormone treatment using estrogen or testosterone:

1. A diagnosis of Gender Dysphoria in Adolescence, made by a mental health clinician with expertise in child and adolescent development, psychopathology and experience with children and adolescents with gender dysphoria.

2. Medical assessment including fertility preservation counselling has been completed by a general practitioner, paediatrician, adolescent physician or endocrinologist. This assessment should include further fertility preservation counselling by a gynaecologist and/or andrologist as required with referral for fertility preservation when requested.

3. The treating team should agree that commencement of estrogen or testosterone is in the best interest of the adolescent and informed consent from the adolescent has been obtained. Although obtaining consent from parents/guardians for commencement of hormone treatment is ideal, parental consent is not required when the adolescent is considered to be competent to provide informed consent. For adolescents who are assessed as not being competent to provide informed consent, parents/legal guardians can provide informed consent on their behalf without requiring court authorisation