# RCPCH Digital Growth Charts and Transgender Patients (+/- hormonal therapy) **Category:** [Growth Charts](https://forum.rcpch.tech/c/rcpch-digital-growth-charts/6) **Created:** 2026-01-09 10:36 UTC **Views:** 23 **Replies:** 4 **URL:** https://forum.rcpch.tech/t/rcpch-digital-growth-charts-and-transgender-patients-hormonal-therapy/652 --- ## Post #1 by @pacharanero We've had inquiries about what is the correct approach for charting transgender patients or those in the process of transitioning (used here in the context of gender transition not child to adult care 'transition'). I'll give some thoughts here, from the perspective of a GP with extensive experience of digital growth charting. My colleague @eatyourpeas is a paediatric endocrinologist and will certainly be able to add more detail and more authoritative advice. I think the key clinical takeaway points are: * **A patient who is in any stage of gender transition is automatically a complex patient**, and needs timely senior input from clinicians with experience in this area. Both male **and** female growth charts may be required to guide hormonal therapy and monitor growth according to the specific needs of each patient. * **There are not yet any specialist growth chart data references for transgender patients.** Growth data references are *required* for making a growth chart. Transgender and transitioning patients (+/- additional hormonal therapies and hormone blockers) make for a widely-varying group and it would be difficult (maybe impossible) to gather meaningful data for this group of patients. As numbers of transitioning patients increase it **may** be possible to develop data references for them. We are not aware of any researchers gathering such data, but if anyone becomes aware of such research please do share it so we can make contact and (licensing permitting) incorporate it into our dGC platform in the future. In terms of implementation guidance, we advise that dGC implementations: * **DO** have a configurable 'default' sex for any given patient which should be shown initially (for safety) when the record is opened. * **DO** warn users if switching between sex on the chart, to avoid inadvertent plotting on the wrong sex chart. * **CONSIDER** the idea of a 'transgender patient view' which shows the patient on both male and female charts side by side. * **DON'T** completely prevent users switching between male and female charts, but ensure it is obvious to the user that a change has been made. * **DON'T** enforce Assigned Sex At Birth as the only type of chart that is selectable. This is just my initial advice, based on clinical common sense and an understanding of how digital growth charts are constructed. We will iterate and improve this guidance according to developments in the field and feedback from clinicians and patients. --- ## Post #2 by @susan.hansford Thanks Marcus. @eatyourpeas - did you want to add to this before I respond? --- ## Post #3 by @eatyourpeas The reference data is based on healthy UK children of known sex. If the sex of a child is not known at birth (disorders of sexual differentiation for example) the sex cannot be assigned and therefore the child cannot be plotted. Currently in the UK triptorelin etc is not licensed in children for gender dysphoria, only for central precocious puberty: that is to slow down puberty in children who have started too earlier. So my take is that chart selection should reference sex at birth, and if you use a girl's chart for a boy or vice versa the numbers will be wrong. Once you start giving puberty blockers to children to suppress puberty and then androgens or oestrogens to induce puberty for the opposite sex - well there is no growth chart for that and we can't assume that just because you do that you can just swap the chart to the opposite sex. This may work, but we do not know that it does. We don't have to make that decision in the UK at the moment, since gender transition (with hormones and so on) in not licensed for this purpose. --- ## Post #4 by @susan.hansford Thank you both (@eatyourpeas and @pacharanero ). --- ## Post #5 by @timcole Agreed that neither sex chart is appropriate. However being able to plot on both charts simultaneously, i.e. on a chart with centiles for both sexes (perhaps colour-coded), could be useful for showing how sensitive the centile is to which sex is inferred. Also marked on the chart should be the age when hormone therapy started, as its possible effect on the centile will depend on the time elapsed since the start of treatment. --- **Canonical:** https://forum.rcpch.tech/t/rcpch-digital-growth-charts-and-transgender-patients-hormonal-therapy/652 **Original content:** https://forum.rcpch.tech/t/rcpch-digital-growth-charts-and-transgender-patients-hormonal-therapy/652