dromlakhani Check if ≥1 year compliant hormone therapy for surgery approval
STEP 1 — Gather Information
Collect hormone therapy start date, type, dosage, adherence pattern, assess for medical contraindications, and confirm patient’s desire to continue hormones and request for genital surgery.
STEP 2 — Rule In / Rule Out
Is hormone therapy desired and not medically contraindicated? If yes, proceed to Step 3; if no, surgery may be approved without the 1‑year requirement per guideline exception.
STEP 3 — Classify or Stratify
Has the patient completed ≥1 year of consistent and compliant hormone therapy? If yes, classify as eligible; if no, classify as not eligible.
STEP 4 — Decide
If eligible, approve genital gender‑affirming surgery; if not eligible, defer surgery until ≥1 year of therapy is achieved (unless hormone therapy is not desired or medically contraindicated, already addressed in Step 2).
Clinical Guardrails / Mimics / Pitfalls
Do not approve surgery based on patient request alone without verifying therapy duration and adherence; do not overlook intermittent use or non‑compliance; do not ignore medical contraindications that make hormone therapy unsafe; do not assume compliance without documentation; remember that the 1‑year rule is waived only when hormone therapy is not desired or medically contraindicated.
Concrete Clinical Example
A 26‑year‑on trans man requests metoidioplasty. He has been on testosterone 100 mg IM weekly for 10 months with good adherence, no contraindications, and desires hormones. Duration <1 year → defer surgery until 12‑month mark.
Source: Endocrine Society Clinical Practice Guideline, Endocrine Society, 2017, https://doi.org/10.1210/jc.2017-01658
TODO: consider adding scripts/calc.py for the es-check-one-year-hormone-therapy-surgery calculator