GUIDELINES FOR GENDER-AFFIRMING PRIMARY CARE WITH TRANS AND NON-BINARY PATIENTS - 2023 medication updates - 4TH EDITION

Sep 30, 2026

Uploaded by dawugda

Guidelines for gender-affirming primary care with trans and non-binary patients define gender-affirming primary care as culturally competent primary care plus collaborative delivery of gender-affirming medical interventions. The publication provides clinic-level recommendations tailored to patient needs, including psychosocial supports. It addresses medication safety updates focused on cyproterone, highlighting emerging concern about prolonged high-dose use and possible meningioma risk, symptoms that warrant monitoring, and imaging when clinical suspicion arises. Supporters and authorship reviewers are also listed.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages136

Reading Time5 h 43 min

AccessFree to download

Guidelines for gender-affirming primary care

Definition and scope of gender-affirming primary care

Cyproterone and risk of meningioma

Reported cases and incidence findings

Regulatory and standards-of-care statements

Practical recommendations and monitoring

Imaging and screening guidance

guidelines FOR GENDER-AFFIRMING PRIMARY CARE WITH TRANS AND NON-BINARY PATIENTS Guidelines for gender-affirming primary care with trans and nonbinary patients Trans and non-binary is an umbrella term used to encompass all people whose gender identities and expressions do not align with norms associated with their sex assigned at birth. Gender-affirming primary care encompasses the delivery of culturally competent care to trans patients in the context of primary care and the collaborative provision of gender-affirming medical interventions. Different medical treatment plans and psychosocial supports are offered depending on the needs and goals of the individual patient. This publication was developed with financial support from the Province of Ontario. The publication and any views expressed herein are those of Rainbow Health Ontario and do not necessarily reflect those of the Province. PRIMARY AUTHOR Dr. Amy Bourns, MD, CCFP Staff Family Physician, Sherbourne Health Program Director, LGBTQ Enhanced Skills Residency Program Lecturer, Department of Family and Community Medicine, University of Toronto REVIEWERS Adrian Edgar, MD, CCFP (AM) / MCFP (AM), Clinical Assistant Professor of Family Medicine, Dalhousie and Memorial Universities Allison Lou, MD, CCFP, FCFP, Lecturer, Department of Family and Community Medicine, University of Toronto Ed Kucharski, MD, CCFP, FCFP, Lecturer, Department of Family and Community Medicine, University of Toronto Marria Townsend, MD, CCFP, Clinical Assistant Professor, Faculty of Medicine, Department of Family Practice, University of British Columbia Raymond Fung, MD, FRCPC, Lecturer, Department of Medicine, University of Toronto Sue Hranilovic, MN, NP-PHC, ACRN, Adjunct Lecturer, Faculty of Nursing, University of Toronto Thea Weisdorf, MD, CCFP, FCFP, Assistant Professor, Department of Family and Community Medicine, University of Toronto GUIDELINES FOR GENDER-AFFIRMING PRIMARY CARE WITH TRANS AND NON-BINARY PATIENTS 1 2023 medication updates to sherbourne’s guidelines FOR GENDER-AFFIRMING PRIMARY CARE WITH TRANS AND NON-BINARY PATIENTS CYPROTERONE and risk of meningioma In addition to the risks and side effects of cyproterone already covered herein, concern is emerging that prolonged use of high-dose cyproterone may be associated with the development of meningiomas. Meningiomas are rare, most-often benign, tumours of the meninges (membranes covering the brain and spinal cord) . Observations of increased incidence in cis women compared with cis men as well asthe histological presence of progesterone (and to a lesser degree estrogen) receptors suggest that these tumours are hormonesensitive. Meningiomas may present with singular or multiple lesions which are often extremely slow-growing, and as such can remain asymptomatic for many years. Due to their location they may ultimately cause clinically significant symptoms such as headaches, focal neurologic symptoms, mental status changes and seizures. Symptomatic meningiomas may require neurosurgical resection if feasible. Nine cases of meningioma(s) in transfeminine individuals have been reported in the literature, in whom eight of nine were using cyproterone and seven of nine were using a high dose (50-100 mg) for at least four years.1,2 A retrospective study of 2,555 trans women primarily using high dose (50-100 mg) cyproterone for many years following gonadectomy identified an increased standardized incidence ratio compared with the general population (4 .1 compared with cis women and 11.9 compared with cis men) .3 Based on the available data in cis populations using cyproterone, the European Medicines Agency released a statement in 2020 asserting that the risk of meningioma appears to rise with increasing cumulative doses, primarily occurring at doses >25 mg/day. They recommended that doses >10 mg be restricted to certain uses but did not make any recommendation on dose limi

FAQs

What does the guideline mean by gender-affirming primary care?

It describes culturally competent care in primary care settings for trans patients, alongside collaborative provision of gender-affirming medical interventions. Care plans and psychosocial supports are individualized to patient needs and goals.

What concern does the guideline raise about cyproterone?

It notes emerging concern that prolonged use of high-dose cyproterone may be associated with development of meningiomas. The document summarizes evidence of rare, hormone-sensitive meningiomas and increasing reported incidence in relevant populations.

What recommendations are provided for patients taking cyproterone?

Include the possibility of increased meningioma risk in informed consent, consider lower starting or compounded lower doses when feasible, and limit higher doses when response to lower doses is inadequate. Patients on higher doses for longer periods should be monitored for specific symptoms, while routine screening for asymptomatic patients is not recommended; imaging is advised when symptoms suggest meningioma.

Sep 30, 2026

Uploaded by dawugda