European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction”

T'Sjoen, Guy; Arcelus, Jon; De Vries, Annelou L. C.; Fisher, Alessandra D.; Nieder, Timo O.; Motmans, Joz; Ozer, Mujde

Abstract

Background

There is a general lack of recommendations for and basic information tailored at sexologists and other health-care professionals for when they encounter trans people in their practice.
Aim

We present to clinicians an up-to-date overview of clinical consensus statements on trans health care with attention for sexual function and satisfaction.
Methods

The task force consisted of 7 clinicians experienced in trans health care, selected among European Society for Sexual Medicine (ESSM) scientific committee. The consensus was guided by clinical experience and a review of the available literature and by interactive discussions on trans health, with attention for sexual function and satisfaction where available.
Outcomes

The foci of the study are assessment and hormonal aspects of trans health care.
Results

As the available literature for direct recommendations was limited, most of the literature was used as background or indirect evidence. Clinical consensus statements were developed based on clinical experiences and the available literature. With the multiple barriers to care that many trans people experience, basic care principles still need to be stressed. We recommend that health-care professionals (HCPs) working with trans people recognize the diversity of genders, including male, female, and nonbinary individuals. In addition, HCPs assessing gender diverse children and adolescents should take a developmental approach that acknowledges the difference between prepubescent gender diverse children and pubescent gender diverse adolescents and trans adults. Furthermore, trans people seeking gender-affirming medical interventions should be assessed by HCPs with expertise in trans health care and gender-affirming psychological practice. If masculinization is desired, testosterone therapy with monitoring of serum sex steroid levels and signs of virilization is recommended. Similarly, if feminization is desired, we recommend estrogens and/or antiandrogen therapy with monitoring of serum sex steroid levels and signs of feminization. HCPs should be aware of the influence of hormonal therapy on sexual functioning and satisfaction. We recommend HCPs be aware of potential sexual problems during all surgical phases of treatment.
Clinical Implications

This is an up-to-date ESSM position statement.
Strengths & Limitations

These statements are based on the data that are currently available; however, it is vital to recognize that this is a rapidly changing field and that the literature, particularly in the field of sexual functioning and satisfaction, is limited.
Conclusion

This ESSM position statement provides relevant information and references to existing clinical guidelines with the aim of informing relevant HCPs on best practices when working with transgender people.

Citation

T'Sjoen, G., Arcelus, J., De Vries, A. L. C., Fisher, A. D., Nieder, T. O., Motmans, J., & Ozer, M. (2020). European Society for Sexual Medicine Position Statement “Assessment and Hormonal Management in Adolescent and Adult Trans People, With Attention for Sexual Function and Satisfaction”. Journal of Sexual Medicine, 17(4), 570-584. https://doi.org/10.1016/j.jsxm.2020.01.012

• Journal Article Type: Article
• Acceptance Date: Jan 15, 2020
• Online Publication Date: Feb 26, 2020
• Publication Date: 2020-04
• Deposit Date: Jan 21, 2020
• Publicly Available Date: Feb 27, 2021
• Journal: The Journal of Sexual Medicine
• Print ISSN: 1743-6095
• Electronic ISSN: 1743-6109
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 4
• Pages: 570-584
• DOI: https://doi.org/10.1016/j.jsxm.2020.01.012
• Keywords: Obstetrics and Gynaecology; Urology; Reproductive Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/3776968
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S174360952030045X