Clinical Support Tool
Genspect does not endorse medical interventions for gender distress. Instead, we advocate for a cautious, least-invasive approach that prioritizes mental health support and addresses potential comorbidities.
There is no high-quality evidence supporting the safety or efficacy of hormonal or surgical interventions for gender dysphoria, and emerging evidence points to serious risks of permanent harm from these interventions. In this context, the CHANGE tool is an informational resource only. This tool, based on the limited existing data, cannot predict individual outcomes and should not be used as a diagnostic instrument. It aims only to raise awareness about factors potentially associated with discontinuation of gender transition, as identified in available literature.
Comprehensive, long-term studies on this topic are lacking. Therefore, healthcare providers should continuously monitor and review the growing body of evidence on detransition, desistance, and the long-term risks of medical transition to stay fully informed.
CHANGE is a clinical decision support tool designed to assist clinicians in assessing patients considering medical gender transition, while also evaluating the risk level for discontinuing the transition process.
Please select the options that best describe your patient’s current situation. A response to each question is required to generate a risk score.
HIGH (Score 3.3 and above): The patient may be at a high risk of reconsidering their decision about medical gender transition in the future. This score indicates significant factors that may warrant deeper exploration and careful support from healthcare providers before proceeding with gender transition.
ELEVATED (Score 0.1 – 3.3): The patient may be at an elevated risk of reconsidering their decision about medical gender transition in the future. This score suggests areas of concern that should be discussed thoroughly with a healthcare provider before proceeding with gender transition.
STANDARD (Score 0): The patient may be at a standard risk level for reconsidering their decision about medical gender transition. This category is not risk-free, as any gender transition procedure poses immediate and long-term risks, including potential regret, physical complications (such as infection or loss of sensation), and mental health challenges. This score should prompt careful, ongoing discussions between the healthcare provider and patient before proceeding.
FAQ- Frequently Asked Questions
Carrie D. Mendoza, MD
What is a Clinical Decision Support Tool (CDST) in medical practice?
A Clinical Decision Support Tool (CDST) is an information aid that aggregates medical data into a user-friendly algorithm, flowchart, or medical calculator. The tool is intended to help practitioners make the most informed, safe, and highest quality medical decisions in conjunction with other relevant data and physical exams. With the advent of digitization and artificial intelligence in healthcare, CDSTs continue to grow as a part of modern medical practice including integration into electronic health records (EHR) systems. Some CDSTs may be required in medical documentation as part of quality and safety metrics. CDSTs are not intended to be a substitute for clinical judgment.
What is an example of a Clinical Decision Support Tool (CDST) in medical practice?
Some of the most popular CDSTs are medical calculators providing risk assessment scores. For example, the HEART score is a risk calculator used to risk stratify chest pain patients in the Emergency Department who may have a major cardiac event within 6 weeks of discharge. Many “low risk” patients are admitted to hospitals and undergo unnecessary tests and procedures, so the HEART score emerged to help identify “low risk” chest pain patients who would likely be safe to discharge and follow-up as an outpatient for further testing. The tool is based on data from studies identifying the risk factors for coronary artery disease and major cardiac events. Once the HEART score was developed, it has been prospectively studied to test its accuracy. Some hospital systems require Emergency Medicine physicians to document the HEART Score for chest pain patients as part of quality and safety metrics.
What is the CHANGE Score for transgender identification?
The CHANGE score is a clinical decision support tool (CDST) designed to assist clinicians in assessing patients considering medical gender transition, while also evaluating the risk level for discontinuing the transition process. The tool is intended solely for qualified healthcare professionals and is not for patient self-assessment. The first version was released in September 2024.
Why is the CHANGE Score needed?
As the number of individuals who identify as transgender increases, more patients are exposed to medical interventions that may include hormonal medications. With that growing exposure, an expanding cohort of patients has emerged who report a misdiagnosis of a fixed transgender identity and who decide to stop their hormonal medications or revise surgeries. Because there is no validated diagnostic tool to identify a patient who will have a fixed transgender identification over time, medical practitioners need better tools to identify these risk factors, improve informed consent, prevent medical error and avoid patient harm.
Does the Change Score calculate the “Detransition Rate”?
No. Because there is no medical billing code for “detransition”, “desistance”, or other descriptors that describe a discontinuation in transgender identification and medical interventions, a specific number cannot be calculated from insurance claim data. Currently, estimates of a “detransition rate” are calculated from anecdotal information and retrospective studies. See Stats for Gender for more information.
Does the CHANGE Score provide certainty about a transition decision?
No. This tool is in an ongoing validation process and is intended solely for use by qualified healthcare professionals as a guide to support clinical conversations around medical gender transition and potential risk factors. It should not replace clinical judgment, diagnosis, or a comprehensive assessment. Clinicians are encouraged to consider this tool alongside their expertise, the patient’s unique history, and other clinically relevant factors. Use of this tool is at the clinician’s discretion, and patient care remains the provider’s responsibility. Always prioritize individualized patient care and conduct further evaluations as necessary.
What are the CHANGE Score ranges and what do they mean?
HIGH (Score 3.3 and above): The patient may be at a high risk of reconsidering their decision about medical gender transition in the future. This score indicates significant factors that may warrant deeper exploration and careful support from healthcare providers before proceeding with gender transition.
ELEVATED (Score 0.1 – 3.3): The patient may be at an elevated risk of reconsidering their decision about medical gender transition in the future. This score suggests areas of concern that should be discussed thoroughly with a healthcare provider before proceeding with gender transition.
STANDARD (Score 0): The patient may be at a standard risk level for reconsidering their decision about medical gender transition. This category is not risk-free, as any gender transition procedure poses immediate and long-term risks, including potential regret, physical complications (such as infection or loss of sensation), and mental health challenges. This score should prompt careful, ongoing discussions between the healthcare provider and patient before proceeding.
What data is used to create the CHANGE Score?
A comprehensive search of peer reviewed literature related to gender transition discontinuation was conducted. Peer reviewed research papers were selected if they contained statistically significant information about discontinuing gender transition. These questions were then analyzed for the degree to which they affect a patient’s decision-making in the studies. A weighted score (“influence score”) for each question (except biological sex) was calculated based on the strength of the data across the selected papers using standard statistical methods and validated by two researchers. Questions with an “influence score” of 50% or more were included in the risk calculator.
Of note, the demographic questions of biological sex did not have enough statistically significant data collected. It is included in the version 1.0 release to allow for future data collection for researchers. For age, each study broke out age ranges differently. Given the legal definition of a minor in the United States, we use the categories of “under 18” or “18 and older”. The study data was weighted based on these two buckets.
The data from the following papers were incorporated:
Kaltiala, R., Helminen, M., Holttinen, T., & et al. (2024). Discontinuing hormonal gender reassignment: A nationwide register study. BMC Psychiatry, 24, 566. https://doi.org/10.1186/s12888-024-06005-6
Kaltiala-Heino, R., Bergman, H., Työläjärvi, M., & Frisén, L. (2018). Gender dysphoria in adolescence: Current perspectives. Adolescent Health, Medicine and Therapeutics, 9, 31-41.
Littman, L. (2021). Individuals treated for gender dysphoria with medical and/or surgical transition who subsequently detransitioned: A survey of 100 detransitioners. Archives of Sexual Behavior, 50, 3353-3369.
Littman, L., O’Malley, S., Kerschner, H., & Bailey, J. M. (2023). Detransition and desistance among previously trans-identified young adults. The Institute for Comprehensive Gender Dysphoria Research.
Roberts, C. M., Klein, D. A., Adirim, T. A., Schvey, N. A., & Hisle-Gorman, E. (2022). Continuation of gender-affirming hormones among transgender adolescents and adults. Journal of Clinical Endocrinology & Metabolism, 107(9), e3937-e3943. https://doi.org/10.1210/clinem/dgac251
Can the CHANGE Score be used for research?
Yes. High quality research is needed to prevent misdiagnosis and to provide safe and high-quality care for patients involved with medical gender transition. Please contact info@genspect.org to learn more about using the CHANGE Score for your research.
Who created the CHANGE Score?
The CHANGE Score was created by Carrie Mendoza, MD, independent researchers and statisticians. If you have any questions, please email info@genspect.org.