Bruce Jenner’s recent interview with Diane Sawyer was essentially a public service to endocrinology, but it may have unintended consequences for Jenner and his family. The interview can be accessed here:

In 2009, The Endocrine Society published the first clinical practice guidelines for hormone therapy in these patients:

Long before the Jenner case became well-known, there have been concerns that endocrinologists are not being properly educated about treatment for transgender patients, as this 2014 press release for a transgender session indicates:

The Jenner case raises several sensitive ethical issues for patients and providers:

  • Confidentiality in transgender patients is often not possible after hormone therapy begins, as the transformation can be dramatic — long before the patient is ready to disclose. In high-profile patients, such as Jenner, patients may be forced to announce their treatments before they are psychosocially prepared. Discussions about confidentiality, and its limitations after treatment begins, should be part of the consent process.
  • There are concerns that media coverage of the Jenner case, or other cases, needs to be respectful, as the Center for Journalism Ethics has noted here:
  • Endocrinologists who are treating this patient population may need to work with journalists to ensure accurate information is being reported.
  • Personhood and pronouns. At what point in transition does the He become a She, or vice versa? It may be important to put together a treatment plan that includes “personhood planning”.

Ultimately, what used to be an occult practice in endocrinology is becoming part of mainstream practice. It’s time to create specific ethical standards for this unique subspecialty in endocrinology.