Guide for Aviation Medical Examiners

Decision Considerations - Aerospace Medical Dispositions
Item 48. General Systemic - Gender Dysphoria

Gender Dysphoria - All Classes

Disease/Condition Evaluation Data Disposition
A. Completed gender reassignment surgery 5 or more years ago


Treated with hormone therapy for 5 or more years

If there is no evidence of a mental health diagnosis and the airman is doing well on current treatment: ISSUE
Annotate Block 60.
B. Treated with Hormone therapy* for less than 5 years


Gender reassignment surgery less than 5 years ago


History of a coexisting mental health concern


History of mental health treatment such as psychotherapy or medications for any condition other than Gender Dysphoria

(Information is required if the airman has ever had a mental health diagnosis [including substance use disorder] or has received treatment for a mental health condition at any time. If treatment was short-term counseling for Gender Dysphoria only, note in Block 60.)

Submit the following to the FAA for review:

☐ A completed FAA Gender Dysphoria Mental Health Status Report or an evaluation from the treating physician, using World Professional Association for Transgender Health guidelines (WPATH), which addresses items listed in the Mental Health Status Report.

☐ Updated evaluations AFTER:

  • Hormone therapy: If on hormones, a current status report describing the length of time on the medication and side effects, if any.
  • Surgery: If surgery has been performed within the last one year, a status report from the surgeon or current treating physician showing full release, off any sedation or pain medication, and any surgical complications (e.g. DVT/PE/cardiac, etc.).
Submit the information to the FAA for review.

Follow up Issuance
Will be per the airman's authorization letter


The AME may ISSUE (no further information is needed), if the airman:

  • Was evaluated for or diagnosed with Gender Dysphoria and has never undergone treatment (counseling or support group for GD does not require information);
  • Has no history of other mental health diagnoses or treatment; and
  • Is otherwise qualified

* Side effects from hormone therapy can be aeromedically significant. The airman should be warned not to fly per Title 14 CFR 61.53 if they experience medication side effects.

Last updated: Friday, March 10, 2023