Controversies in Sexual Medicine: Is Physical Examination Required Before Prescribing Hormones to Patients with Gender Dysphoria?


Yoram Vardi, MD, Neuro-Urology Unit, Rambam Medical Center, pob.9602, Haifa, 31096, Israel. Tel: 97-2485-42819; Fax: 97248542883; E-mail:


Introduction.  A genital examination can have psychologic effects on a patient, particularly when the source of their sexual medicine complaint is a body part. How necessary is a physical exam before prescribing hormones in cases of gender dsyphoria?

Methods.  Five people with expertise and/or interest in the area of gender dysphoria and endocrinology were asked to contribute their opinions.

Main Outcome Measure.  To provide food for thought, discussion, and possible further research in a poorly discussed area of sexual medicine.

Results.  Of the five experts writing on the topic, one believes that a physical examination should always be performed before prescribing hormones for gender dysphoria, one believes it is not a prerequisite, and three believe a physical examination is recommended, but is not necessary in cases where the patient objects despite an explanation of the purpose of the exam. As long as this was documented, it would not present a medicolegal problem.

Conclusions.  It is not clear whether or not a physical examination must be performed on all gender dsyphoric patients before prescribing hormones; however, an examination would be helpful in revealing a significant health management issue. Vardi Y, Wylie KR, Moser C, Assalian P, Dean J, and Asscheman H. Is physical examination required before prescribing hormones to patients with gender dysphoria? J Sex Med 2008;5:21–26.