When I am thinking about testosterone or estrogen/progesterone for a young person, I have a few go to resources that I love. 

First stop is remembering the basic physiology of average puberty for which I appreciate the Up-to-Date article here. 

I also like to review all of the major guidelines we mentioned in last week's blog. The trifecta is good, but my favorite in clinic reference is the Fenway guideline because it has handy, easy to read charts. Seattle Children’s Gender Clinic published their protocols as well to give you a bit of a comparison. 

Dosing should be individualized to the patient’s age and stage in puberty, patient and family readiness for change, and goals of care all informed by these guidelines and protocols. I have seen a 17 year old on a quarter of a patch of estradiol which is an oddly low dose based on them being in Tanner stage 4 and very ready for change with a supportive family. I can’t help but think someone mistook the guidelines for rules. That they had to start someone on the lowest dose possible and titrate slowly. The guidelines start low and go slow because they take into account the youngest patients we may be treating. As patients get further along in puberty starting doses and titrations may become slightly more aggressive depending on the individual's goals. 

I also share the appropriate reading and videos with the families:

• QueerDoc’s All the T
• Video on T
• QueerDoc’s All the E
• Video on E

The other resource I recommend on a daily basis to patients and families is QueerDoc’s self-injections page which contains written step-by-step instructions and video guides. 

These are the tools in my tool belt when it comes to the medical components of gender affirming care for youth.