Statement from the American Association of Clinical Endocrinology (AACE)
As the leading clinical endocrinology association, we at AACE are an inclusive community with thousands of endocrine-focused clinical members, affiliates, and partners from every walk of professional life. Our mission is elevating the practice of clinical endocrinology to improve global health, and our vision is achieving healthier communities through endocrine innovation, education, and care. We are committed to embracing diversity, and believe that inclusion, representation, and equal access to opportunities for all make our global community stronger and better.
Transgender and gender diverse people represent a sizable and growing segment of the U.S. and world Population. It is estimated that over 1 million people in the U.S. alone are transgender or gender diverse. Many transgender and gender diverse people seek hormone therapy under the supervision of an endocrinologist or other medically trained health care professional to better align their bodies with their gender identities. Being transgender is widely accepted to require medical treatment for those patients who seek it. Medical treatment may include behavioral assessment, hormone therapy, and surgery. These treatments are well established in the relevant established, international professional society guidelines including those from the Endocrine Society co-sponsored by the American Association of Clinical Endocrinology (AACE) and the World Professional Association for Transgender Health (WPATH).
The current Endocrine Society/AACE guidelines recommend hormone therapy for:
- Transgender and gender diverse adults with persistent gender identity (typically of which they’ve been aware for at least 6 months) that does not align with sex recorded at birth who seek treatment, who have capacity to make medical decisions, and in whom potential confounding mental health conditions are addressed.
- Transgender and gender diverse adolescents with persistent gender identity (typically of which they’ve been aware for at least 6 months) that does not align with sex recorded at birth who seek treatment, who have capacity to make medical decisions, in whom potential confounding mental health conditions are addressed, and who have been evaluated by trained mental health professionals who have expertise in gender incongruence in children/adolescents. Decisions regarding both puberty blockade and hormone therapy in adolescents should made with the input of the qualified mental health professional, the endocrinologist or clinician with experience in hormone therapy/puberty blockade in children, the child, and the family.
Endocrine patients:
Endocrine patients who are transgender or gender diverse should seek medical professionals with experience in gender affirming hormone treatment for transgender and gender diverse people. Transgender and gender diverse children with should seek specialized care which includes a multi-specialty team approach with professionals with expertise in gender incongruence in children and adolescents.
We at the American Association of Clinical Endocrinology (AACE) recommend endocrine patients who are transgender or gender diverse seek medical professionals with experience in gender affirming hormone treatment for transgender and gender diverse people.
We also strongly recommend that transgender and gender diverse adolescents seek gender affirming hormone therapy and/or puberty blockers from multi-specialty care teams that include 1. an endocrinologist or other health specialist who has medical knowledge of the advantages and disadvantages of hormone therapy and/or puberty blockers and 2. a mental health specialist with expertise in the care of children and adolescents who are transgender or gender diverse.
We strongly oppose legislation that limits access of endocrine patients to established medical therapies recommended for treatment of transgender and gender diverse youth. AACE strongly believes that decisions impacting health care of endocrine patients are best left to the health professional, the patient, and the patient’s families like for all medical care.
Endocrine care teams:
We strongly oppose legislation that criminalizes physicians and other health professionals who provide medically appropriate endocrine care as recommended by established medical guidelines.
The Endocrine Society and AACE have published peer-reviewed, evidence-based guidelines that support endocrine care of transgender and gender diverse patients. Criminalizing provision of endocrine care will further increase the health disparities of this very vulnerable population.
More information regarding endocrine care of transgender persons can be found in the November 2017 issue of Journal of Clinical Endocrinology and Metabolism and Endocrine Practice, the official journal of AACE.
Authors: Joshua Safer, MD, FACE, FACP, and Vin Tangpricha, MD, PhD, FACE, both contributed to the development of this guidance.
Listen to AACE Podcast Episode 26 featuring endocrine experts Joshua Safer, MD, FACE, FACP, and Vin Tangpricha, MD, PhD, FACE, as they discuss AACE’s Position Statement on Transgender and Gender Diverse Patients.