Endocrine Abstracts

Gender dysphoria (GD) is a condition in which a person experiences discongruency between their assigned sex and what they feel their genderidentity is. A person with gender dysphoria experiences persistently uncomfortable feelings about their birth gender (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-V) (American Psychiatric Association).

During the ‘real life experience’ hormonal treatment usually starts and applicants are required to live socially in the desired gender role before irreversible surgical reassignment is considered. Cross sex hormonal treatment is desired by trans persons to help them successfully live as a member of their identified gender. It is clear that both in adults and adolescents the decision for starting hormonal treatment is not to be made by the endocrinologist. The mental health professionals (psychiatrists and/or psychologists), by preference working in a multidisciplinary Gender team, will guide these persons to make an informed decision about hormonal treatment. Eligibility criteria and readiness as described by WPATH’s Standards of Care-7th version, should be evaluated. The goal of treatment in female-to-male trans persons is to induce virilization and to stop menses. The prinicipal hormone treatment is a testosterone preparation. In male-to-female trans persons oestrogen and anti-androgen treatment is provided. Treatment regimens are currently not standardised and include various forms of oestrogens, progestins, and/or (anti-) androgens as reported by different clinical centres. So far, no randomized intervention trials are available so treatment is largely experience-based. Options for fertility preservation should be discussed with the clients before hormonal intervention.

Appropriate care for transgender persons will lead to better outcome and should avoid unnecessary psychological pain, health risks (e.g. secondary psychiatric conditions or suicide), or self medication with inherent greater risk of complications.

Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ 3rd, Spack NP, Tangpricha V & Montori VM. Endocrine Society. J Clin Endocrinol Metab 2009 Sep; 94 (9): 3132–54.

Sexual and physical health after sex reassignment surgery. De Cuypere G, T’Sjoen G, Beerten R, Selvaggi G, De Sutter P, Hoebeke P, Monstrey S, Vansteenwegen A & Rubens R. Arch Sex Behav 2005 Dec; 34 (6): 679–90.