Treatment of transsexualism
- Louis J G Gooren, MD
Louis J G Gooren, MD
- Professor Emeritus
- Vrije Universiteit Medical Center, The Netherlands
- Vin Tangpricha, MD, PhD
Vin Tangpricha, MD, PhD
- Associate Professor
- Emory University School of Medicine
- Section Editors
- Peter J Snyder, MD
Peter J Snyder, MD
- Editor-in-Chief — Endocrinology
- Section Editor — Pituitary Disease; Male Reproductive Endocrinology
- Professor of Medicine
- University of Pennsylvania School of Medicine
- Alvin M Matsumoto, MD
Alvin M Matsumoto, MD
- Section Editor — Male Reproductive Endocrinology
- Professor of Medicine
- University of Washington School of Medicine
Transsexualism is the condition in which a person with apparently normal somatic sexual differentiation of one gender is convinced that he or she is actually a member of the opposite gender. It is associated with an irresistible urge to be that gender hormonally, anatomically, and psychosocially. The treatment of transsexualism will be discussed here, while its definition and diagnosis will be discussed separately. (See "Transsexualism: Epidemiology, pathophysiology, and diagnosis".)
GENERAL PRINCIPLES OF TREATMENT
Standards of care — The international organization involved with professional help to transsexual persons, the World Professional Association for Transgender Health (WPATH), formerly known as the Harry Benjamin International Gender Dysphoria Association, has drafted Standards of Care for the diagnosis and treatment of transsexual individuals .
The mission statement of WPATH is the following: “As an international multidisciplinary professional association the mission of WPATH is to promote evidence based care, education, research, advocacy, public policy and respect in transgender health .”
WPATH publishes a Standards of Care (SOC) document, the goal of which is to “provide clinical guidance for health professionals to assist transsexual, transgender, and gender nonconforming people with safe and effective pathways to achieving lasting personal comfort with their gendered selves, in order to maximize their overall health, psychological well-being, and self-fulfillment. This assistance may include primary care, gynecologic and urologic care, reproductive options, voice and communication therapy, mental health services (eg, assessment, counseling, psychotherapy), and hormonal and surgical treatments. While this is primarily a document for health professionals, the SOC may also be used by individuals, their families, and social institutions to understand how they can assist with promoting optimal health for members of this diverse population” .
The most current version of the SOC can be found at the WPATH website.
- World Professional Association for Transgender Health. Standards of care for gender identity disorders. http://wpath.org/publications_standards.cfm (Accessed on September 13, 2011).
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- Gooren LJ, van Trotsenburg MA, Giltay EJ, van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med 2013; 10:3129.
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- Dhand A, Dhaliwal G. Examining patient conceptions: a case of metastatic breast cancer in an African American male to female transgender patient. J Gen Intern Med 2010; 25:158.
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- Slagter MH, Gooren LJ, Scorilas A, et al. Effects of long-term androgen administration on breast tissue of female-to-male transsexuals. J Histochem Cytochem 2006; 54:905.
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- GENERAL PRINCIPLES OF TREATMENT
- Standards of care
- Counseling before treatment
- Transitioning to the opposite gender
- TREATMENT OF ADOLESCENTS
- HORMONAL THERAPY FOR ADULTS
- - Suppression of androgen secretion or action
- GnRH agonists
- - Estrogen
- - Clinical outcomes
- - Long-term maintenance therapy
- - Major adverse events
- Venous thromboembolism
- Coronary heart disease
- Hyperprolactinemia/lactotroph adenoma
- - Monitoring
- - Androgen therapy
- Masculinizing effects
- Routine monitoring
- Adverse events
- - Heart disease
- - Breast and ovarian cancer
- Contraindications to hormone therapy
- SURGICAL SEX REASSIGNMENT
- Sexual function after sex reassignment
- Regrets after sex reassignment
- PSYCHOSOCIAL OUTCOMES OF TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS