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Aveed — Blue Cross Blue Shield of Alabama

Gender-affirming hormone therapy (GAHT) for gender incongruence/dysphoria

Initial criteria

  • Gender incongruence is marked and sustained
  • Demonstrates capacity to consent for the specific gender-affirming hormone treatment
  • Other possible causes of apparent gender incongruence have been identified and excluded
  • Mental health and physical/medical conditions that could negatively impact the outcome of treatment have been assessed, with risks and benefits discussed
  • Understands the effects and side effects of gender-affirming hormone treatment, including effects on reproduction, and they have explored reproductive options
  • For adolescents: The HCP has conducted a comprehensive biopsychosocial assessment, and included mental health and other medical professionals when required
  • Involvement of parent(s)/guardian(s) in the assessment process, unless their involvement is determined to be harmful or not feasible
  • Gender diversity/incongruence is marked and sustained over time
  • Demonstrates the emotional and cognitive maturity required to provide informed consent/assent for treatment
  • Mental health concerns (if any), physical/medical conditions, or social problems that may interfere with diagnostic clarity, capacity to consent, and gender-affirming medical treatments have been addressed sufficiently so that gender-affirming medical treatment can be provided optimally
  • Informed of the effects (including irreversible) and side effects of treatment; including reproductive effects, potential loss of fertility, and available options to preserve fertility
  • Patient is age ≥ 16 years (except for compelling circumstances to initiate earlier, typically not before 13.5–14 years)
  • Treatment should not be started prior to the onset of endogenous puberty

Reauthorization criteria

  • Patients should be evaluated for physical changes and adverse effects, and serum testosterone levels monitored every 3 months during the first year or with dose changes
  • Once stable adult maintenance dose is attained and serum testosterone levels are in the normal physiologic male range, evaluation and monitoring should be conducted once or twice a year
  • Dosing should be adjusted to target serum levels within the normal range for the individual’s gender identity