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Care of Transexual Persons

Gender identity is the sense one has of being either male or female.  Problems can occur if there is a significant incongruence between a person’s gender identity and their physical phenotype.  This difference, known as Gender Identity Disorder, can cause great psychological distress and profound isolation. 

This helpful review highlights the difficulties a person may face in living with this condition and the hurdles they have to jump in order to receive help as well as the form that help can take.

In general there has been an increasing acceptance of transsexualism amongst medical professionals, although there is still some debate about the benefits of hormonal and surgical interventions to try and match phenotype and identity.

At present, a person hoping to undergo a sex realignment programme must undergo psychological and physical assessment.  Hormones to modify secondary sexual characteristics should be started for at least a year during which the individual has to live as a person of the desired sex.  This allows the individual to gain a realistic expectation of what living as the opposite sex entails.  It’s a difficult time of adjustment and a very public statement of intent which can affect family and social dynamics.  Hormone treatment may then be followed by surgical interventions to adjust the body as desired. 

This article reminds us that long term hormone therapy and surgery may not be without risks and there is little evidence about such long term effects such as the potential risks of breast and endometrial cancer in women taking testosterone, which is aromatized to oestradiol in the body. 

The article also touches on the difficulties of diagnosing gender identity disorder in juveniles as this must be distinguished from common adolescent anxiety or simply a desire to be different.

Gender identity disorder is not something that we often encounter in clinic but with reported prevalence estimates of nearly one in 12,000 men and 1 in 30,000 women, it’s a condition we should all be aware of.

Gooren L J. Care of Transsexual Persons. N Eng J Med 2011; 364 (13):1251-1257

Filed under: Doctors Notes, View AllPosted at 21:53

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