Es Follow Sex Hormone Induction Monitoring

---
name: es-follow-sex-hormone-induction-monitoring
description: Provides schedule for monitoring during sex hormone induction. Trigger: patient initiating gender-affirming hormone therapy (GAHT).
---

# Follow monitoring protocol during sex hormone induction

## STEP 1 — Gather Information
Confirm patient has initiated sex hormone therapy, document gender identity, sex assigned at birth, date of hormone start, baseline Tanner stage, and review prior monitoring results if any.

## STEP 2 — Rule In / Rule Out
Is the patient transgender male (assigned female at birth, identifies as male) or transgender female (assigned male at birth, identifies as female)? This determines sex-specific monitoring parameters.

## STEP 3 — Classify or Stratify
Calculate time since last monitoring visit: if ≥3 months, anthropometry due; if ≥6 months, laboratory tests due; if ≥12 months, bone mineral density (BMD) due.

## STEP 4 — Decide
Order indicated tests: for transgender males: hemoglobin/hematocrit, lipids, testosterone, 25OH vitamin D; for transgender females: prolactin, estradiol, 25OH vitamin D; plus anthropometry (height, weight, sitting height, blood pressure, Tanner stage) every visit; schedule BMD via DXA if interval met.

## Clinical Guardrails / Mimics / Pitfalls
Do not omit sex-specific labs (e.g., prolactin in transgender females, hemoglobin/hematocrit in transgender males); avoid delaying BMD monitoring beyond 2 years; ensure vitamin D assessment in all patients; recognize that missed monitoring may miss early detection of polycythemia, dyslipidemia, or prolactinoma.

## Concrete Clinical Example
A 16-year-old transgender male initiates testosterone therapy. At 4-month visit: anthropometry performed; labs not yet due (6-month interval). At 8-month visit: anthropometry and labs (hemoglobin/hematocrit, lipids, testosterone, vitamin D) ordered; BMD not due until 12 months.

**Source:** Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2017, https://doi.org/10.1210/jc.2017-01658