Gender incongruence

• Gender dysphoria is a disassociation with birth gender and identification with the opposite gender. • The diagnosis needs to be made by an experienced mental health practitioner in accord with the Endocrine Society and World Professional Association for Transgender Health guidelines. • Most presenting in childhood are less likely to go onto physical treatment, whereas the majority of adolescents may wish to socially and physically transition. • Appropriate help and support should only be provided by an integrated medical and psychological/mental health team working in collaboration, with a psychosocial assessment preceding the medical review. • Initial medical assessment should be supportive only. A physical diagnostic approach is not required, and it is not considered similar to a disorder of sex development. • Counselling about fertility loss is required. • Endocrine supportive treatment is with gonadotropin-releasing hormone analogues initially. • Cross-sex hormone/gender-affirming hormone therapy may be considered after further counselling. • Surgical gender reassignment is carried out in adulthood only after additional detailed counselling.