Background:Gender dysphoria (GD) is a condition marked by significant distress and/or impairment in life functioning due to an incongruence between a person’s gender identity and the sex assigned at birth. Associated with GD are levels of psychopathology and psychiatric morbidity that are higher than norma-tive data or controls, but improve following gender-affirming treatment (GAT). GAT may comprise counselling and support, hormonal treatment, voice and speech therapy, surgical interventions and skin therapy. The terms and time for initiating treatment of GD in adolescence is different than those in adulthood.
Aim of guidelines: In 2012, the Swedish National Board of Health and Welfare was commissioned by the Swedish government to issue 2 sets of national guidelines targeting all aspects of GAT, 1 for adults and 1 for children/adolescents. The aim was to counteract important regional variations in care that were known to exist, to promote the use of individually tailored treatment measures based on the best-available knowledge and to ensure an up-to-date quality of treatment. The guidelines were published in 2015.
Methods:International guidelines, views of patient representatives and local priorities as expressed by professionals provided the background against which the guidelines were formed. Two separate expert groups (per set of guidelines) were involved in assessing the evidence and producing the recommenda-tions: a scientific evidence expert group and a validation group for the proposed recommendations. Patient representatives helped in focusing the scope of the guidelines and in identifying problem areas.
Scientific evidence was predominantly scarce. A multitude of recommendations was proposed and adopted in a consensus process, based on available evidence and clinical expertise and opinion.
Contents: Approximately 40 recommendations, for adults and children/adolescents respectively, cover issues such as use of multidisciplinary teams and assessment, provision of counselling, and terms for hormonal and surgical treatments.