Policy: Gender Confirmation Surgery and Hormone Therapy
Last Update: 2021-09
Next Update: 2022-09
Issued in: North Carolina

Facial Reconstruction:

Surgical procedures

The following surgical procedures may be considered medically necessary if the above general criteria have been met AND the procedures are being performed only as a part of the overall treatment plan for gender dysphoria:

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3. Facial procedures for facial feminization or masculinization:

Blepharoplasty • Brow lift • Cheek/malar implants • Chin contouring and implants • Face lift (only if done as necessary in conjunction with other facial procedures) • Facial bone osteoplasty • Forehead reduction and contouring • Mandible reduction, contouring, augmentation • Rhinoplasty

Youth Services:

Criteria for Adolescents Entering Puberty Adolescents, having reached puberty (Tanner 2), and who have met eligibility and readiness criteria can be treated with GnRH analogues. The definition of puberty is having reached Tanner stage 2/5 and/or having LH, estradiol levels or testosterone levels, within the pubertal range. These LH, estradiol and testosterone ranges are well-known and published and are broken down by biological male vs. biological female Tanner stage, and nocturnal and diurnal levels. Adolescents are eligible for GnRH treatment, (for suppression of puberty) by these criteria: (same for adults)

1. Have an established diagnosis for GD based on DSM V or ICD-10 criteria;

2. Have experienced puberty to at least Tanner stage 2, which can be confirmed by pubertal levels of LH, estrogen or testosterone; 3. Have experienced pubertal changes that resulted in an increase of their gender dysphoria;

4. Do not suffer from psychiatric comorbidity (that interferes with the diagnostic work-up or treatment);

5. Have adequate psychological and social support during treatment, to include having parental/guardian consent;

6. Demonstrate knowledge and understanding of the expected outcomes of GnRH analogue treatment, cross-sex hormone treatment, and gender affirmation surgeries, as well as the medical and social risks and benefits of gender affirmation; and have been counseled regarding fertility options.