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4th edition: Sherbourne’s Guidelines for gender-affirming primary care with trans and non-binary patients

4th edition: Sherbourne's Guidelines for gender-affirming primary care with trans and non-binary patients

This edition of Sherbourne’s Guidelines for gender-affirming primary care with trans and non-binary patients, like its predecessor, was authored by Dr. Amy Bourns, a family physician on Sherbourne’s LGBT2SQ Health Team. In addition to incorporating recently available evidence in both general primary care and trans health, the 2019 edition features revisions and expansions in several areas, including:

  • expanded discussion of considerations for non-binary patients;
  • unique considerations for older trans patients;
  • incorporation of changes to the International Statistical Classification of Diseases and Related Health Problems (ICD) diagnosis;
  • subtle language changes that reflect the rapid pace of cultural change;
  • an expanded discussion of fertility considerations for trans people;
  • discussion of alternate routes of hormone administration;
  • expanded discussion of HIV prevention and treatment in transfeminine and transmasculine populations;
  • an updated monitoring schedule with a reduced number of routine bloodwork parameters required;
  • an overview of the role of PCPs in supporting patients with transition-related surgeries; and
  • a review of the updated process for referrals and public funding for transition-related surgeries in Ontario.

The Trans Primary Care Guide, the online interactive tool based on the Guidelines, has also been updated to reflect the most current clinical information consistent with this new 4th edition of the Guidelines.

You may also want to access the Quick Reference Guide that was created to accompany the full Guidelines.

Please note that this publication predates the release of WPATH’s Standards of Care Version 8 (SOC-8) in September 2022, which includes significant updates regarding requirements for transition-related surgeries (TRS). At this time, the processes for accessing TRS via Ontario’s Ministry of Health remain based on the WPATH SOC-7 and are consistent with the information herein. The relevant updates to this publication will be made once the Ministry of Health revises their processes in accordance with the SOC-8.