An ad hoc committee of the National Academies of Sciences, Engineering, and Medicine will review the latest published research and medical guidelines addressing the current status of sex-specific medical diagnosis, evaluation, and treatment for individuals who are transgender or who are undergoing gender affirming procedures. Based on the available evidence, the committee’s report will strive to:
1. Describe the current clinical conceptions of sex and gender accepted by the medical community, including:
a. How sex and gender are medically defined and the preferred nomenclature for transgender individuals, those who have undergone some amount of gender affirming therapy, treatments, or care, and others with intersex sex traits, expression, or identity;
b. The recognized categories of individuals with intersex sex traits, expression, or identity, and to the extent possible, identify:
i. Each category’s prevalence in the American public;
ii. How does the medical community handle decisions involving intersex, transgender, and transitioning patients and what are the particular impacts each trait, expression, or identity has on medical evaluation and care; and
iii. Any trends or potential changes in how physiological sex differences are conceptualized, measured, or accounted for in the provision of medical care and what is driving these trends;
c. How and when sex and gender identification information is collected and used in the clinical practice of medicine; and
d. How other large, national health organizations, besides SSA, collect sex and gender information, and whether and how they use that information to make healthcare decisions (e.g., VHA, Medicaid, HMOs).
2. Identify the usual physiological differences between the male and female sex and describe what is known about:
a. How differences between the sexes are measured and change in quantity or quality over the course of development, puberty, and growth;
b. Exceptions to these usual differences, their prevalence, and what can cause them;
c. The specific effect hormonal or other gender-affirming therapies, treatments, or care (or similar therapies used for other reasons) have on expected physiological sex differences such as height and weight, including how those differences change based on the onset, duration, or intensity of the employed therapy, treatment, or care; and
d. The diagnostic or evaluative testing that may be impacted by sex differences or sex transition and how to account for that impact.
3. Describe the gender-affirming therapies, treatments, and care utilized most commonly today to aid in sex affirmation and detail for each:
a. The method of action and expected physiological effect;
b. Prerequisite testing or treatment before the therapy, treatment, or care is prescribed;
c. Ways of categorizing the therapies, treatments, and care;
d. The general course of treatment, specific impacts, and potential side effects from the therapy, treatment, or care, including how progress is measured and indicators that would lead to cessation of the therapy, treatment, or care; and
e. Common comorbid impairments for those seeking, undergoing, or under the effects of the therapy, treatment, or care.
4. For the criteria in the listing of impairments that currently consider an individual’s gender* describe the evidence related to:
a. If these criteria were changed to vary based upon an individual’s birth sex, or, alternatively, to vary based upon an individual’s affirmed sex after gender affirming therapy, treatment, or care, rather than their gender, would the criteria appropriately measure the severity of the underlying medical concept?
b. Based on the current criteria, could sex assigned at birth or affirmed sex (or some other categorization) be used to measure the severity of the underlying medical concept as a medically appropriate indicator of severity?
c. What guidelines are available to maintain the specificity of these criteria for persons who have undergone some type and amount of gender-affirming therapy, treatment, or care or who have an intersex sex expression, trait, or identity?
d. Are there alternative tests, evaluations, or laboratory values that would offer similar insight into functional capability as what is revealed by the current criteria?
e. If and how other large, national health organizations, besides SSA, assess the impairments associated with these criteria and determine eligibility for individuals who have undergone some type and amount of gender-affirming therapy, treatment, or care or who have an intersex sex expression, trait, or identity, to the extent applicable?
f. If there are alternative tests that would offer similar insight into functional capability, could an individual’s sex assigned at birth or affirmed sex (or some other categorization) be applied to appropriately assess medical severity for each of those tests?
5. For the criteria or listings in the listing of impairments that currently consider conditions generally associated with only one sex, what is known about:**
a. How does the medical community diagnose and what terminology is appropriate to evaluate the considered conditions when they affect an individual that has undergone some type and amount of gender-affirming therapy, treatment, or care or who has an intersex sex expression, trait, or identity?
b. Which of SSA’s existing listing criteria could be most appropriately used to evaluate these conditions in individuals effected by some type and amount of gender-affirming therapy, treatment, or care or who have an intersex sex expression, trait, or identity?
c. What are the circumstances under which an individual with a different sex assigned at birth could appropriately be evaluated under the criteria?
d. What, if any, changes to the current criteria would be necessary for them to serve as medically appropriate indicators of severity for claimants outside of the generally associated sex?
e. Are there any screening recommendations or guidelines related to the considered conditions specific to individuals who have undergone some type and amount of gender-affirming therapy, treatment, or care or who have an intersex sex expression, trait, or identity?
f. Do other large, national health organizations, besides SSA, assess these impairments and determine eligibility for individuals who have undergone some type and amount of gender-affirming therapy, treatment, or care or who have an intersex sex expression, trait, or identity?
The report will include findings and conclusions but not recommendations.
*Adult listings with different criteria for males and females include 3.02, 3.03, 3.04, and 6.05. Child listings with different criteria for males and females include 103.02, 103.04, 105.08, and 106.05. Listings that refer to male and female growth charts under listing 105.08B include 100.05, 104.02, 106.08, and 114.11(I).
**Listings considering conditions generally associated with only one sex include 13.23, 13.24, 13.25, 13.26, and 14.11(I).