Policy: GnRH Gender Dysphoria
Policy Number: 5.30.39
Last Update: 2020-01-01

Youth Services:

Off Label Use: GnRH analogues can be used in the treatment of Gender Dysphoria (GD) and should only be started once a diagnosis of GD or transsexualism has been made per the DSM V or ICD-10 criteria (1).

For Gender Dysphoria (GD):

MUST HAVE ALL of the following:

1. Prescribed by an endocrinologist or transgender specialist
2. Patient has met the DSM V criteria for GD