Anthem

Policy Number
CG-DRUG-60, CG-DRUG-61
Last Update
Youth Services

VI. Gender Dysphoria in Adolescents


A. GnRH analogs may be approved for adolescents (greater than or equal to 10 years of age and less than 18 years of age) with gender dysphoria when all of the following criteria are met:

1. Fulfills the DSMV criteria for gender dysphoria; and
2. Has experienced puberty to at least Tanner stage 2; and
3. Has (early) pubertal changes that have resulted in an increase of their gender dysphoria; and
4. Does not suffer from a psychiatric comorbidity that interferes with the diagnostic work-up or treatment; and
5. Has psychological and social support during treatment; and
6. Demonstrates knowledge and understanding of the expected outcomes of GnRH analog treatment.

May NOT be approved:
GnRH analogs may NOT be approved for adolescents with gender dysphoria when the criteria above are not met.