Table 3.

Gender-Affirming Hormone Regimens In Transgender And Gender Diverse Youth (Adapted from the Endocrine Society Guidelines; Hembree et al., 2017)

Induction of female puberty (estrogen-based regimen) with oral 17ß-estradiol Initiate at 5µg/kg/d and increase every 6 months by 5 µg/kg/d up to 20 µg/kg/d according to estradiol levels Adult dose = 2-6 mg/day

In postpubertal TGD adolescents, the dose of 17ß-estradiol can be increased more rapidly: 1 mg/d for 6 months followed by 2 mg/d and up according to estradiol levels

Induction of female puberty (estrogen-based regimen) with transdermal 17ß-estradiol Initial dose 6.25-12.5 µg/24 h (cutting 24 g patch to ¼ then ½) Titrate up by every 6 months by 12.5 µg/24 h according to estradiol levels Adult dose = 50-200 µg/24 hours For alternatives once at adult dose (Table 4)

Induction of male puberty (testosterone-based regimen) with testosterone esters 25 mg/m2/2 weeks (or alternatively half this dose weekly) Increase by 25 mg/m2/2 weeks every 6 months until adult dose and target testosterone levels are achieved. See alternatives for testosterones (Table 4)