A Conversation with Dr. Yedla on Gender Affirming Hormone Therapy at QMG

Gen­der-affir­ma­tion care refers to treat­ments that sup­port a trans­gen­der or non­bi­na­ry per­son in their gen­der tran­si­tion. This care involves a team of health­care pro­fes­sion­als, includ­ing an endocrinologist.

Quin­cy Med­ical Group (QMG) Endocri­nol­o­gist Nihari­ka Yed­la, MD, pro­vides gen­der-affirm­ing hor­mone ther­a­py for indi­vid­u­als who are gen­der dysphoric/​gender incon­gru­ent. Gen­der incon­gru­ence is defined as the mis­match an indi­vid­ual feels as a result of the dis­crep­an­cy expe­ri­enced between their gen­der iden­ti­ty and the gen­der they were assigned at birth. Gen­der dys­pho­ria is the feel­ing of dis­com­fort or dis­tress that might occur in peo­ple whose gen­der iden­ti­ty dif­fers from their sex assigned at birth or sex-relat­ed phys­i­cal characteristics.

“Gen­der affir­ma­tion is mul­ti­dis­ci­pli­nary treat­ment. Gen­der-dys­pho­ric/­gen­der-incon­gru­ent per­sons seek and/​or are referred to endocri­nol­o­gists to devel­op the phys­i­cal char­ac­ter­is­tics of the affirmed gen­der,” explained Dr. Yed­la. ​“They require a safe and effec­tive hor­mone reg­i­men that will (1) sup­press endoge­nous sex hor­mone secre­tion deter­mined by the person’s genetic/​gonadal sex and (2) main­tain sex hor­mone lev­els with­in the nor­mal range for the person’s affirmed gender.”

This treat­ment is just one part of an individual’s over­all care. Dr. Yed­la said those seek­ing gen­der-affirm­ing hor­mone ther­a­py work in part­ner­ship with a care team.

“A patient’s treat­ment team includes an appro­pri­ate­ly trained clin­i­cian, such as an endocri­nol­o­gist, and a men­tal health provider who has suf­fi­cient train­ing and expe­ri­ence in assess­ing psy­chopathol­o­gy, and who is will­ing to par­tic­i­pate in the ongo­ing care through­out the endocrine tran­si­tion,” she explained.

Dr. Yed­la explained the cri­te­ria for gen­der-affirm­ing ther­a­py includes the following:

1. Per­sis­tent well-doc­u­ment­ed gen­der dys­pho­ria (a con­di­tion of feel­ing one’s emo­tion­al and psy­cho­log­i­cal iden­ti­ty as male or female to be oppo­site to one’s bio­log­i­cal sex) diag­nosed by a men­tal health pro­fes­sion­al well versed in the field;
2. Capac­i­ty to make a ful­ly informed deci­sion and to con­sent for treat­ment; and,
3. Good con­trol of sig­nif­i­cant med­ical and/​or men­tal comor­bid con­di­tions. The Endocrine Soci­ety rec­om­mends against pre-puber­tal treatment.

If you are expe­ri­enc­ing signs of gen­der dys­pho­ria or gen­der incon­gru­ence, Dr. Yed­la said you should first speak to a men­tal health provider who is knowl­edge­able in both.