Abstract
Transsexualism is an emergent medical and legal problem. Discrimination, inaccessibility of medical care, lack of qualified medical specialists, high costs of services, lack of ethical skills, transphobic moods, inadequacy of existing mechanisms of medical care to transgender people with the principles of human rights, and imperfection of the legislative base among other circumstances are actual concerns nowadays. Transsexual subjects need to receive an effective and safe treatment. The purpose of those treatments is to rehabilitate a person as a member of the society in the gender area with which he or she is identified. Options for medical treatment include feminization or masculinization of the body through hormone therapy and/or surgery that are effective enough to alleviate gender dysphoria and are medically necessary for many patients. Despite the improvement in the medical care of transsexuals in countries with advanced human rights protection, there are multifactorial problems around the world that are associated with providing medical care to this group of patients, both in primary and highly specialized institutions. The lack of qualified health professionals and medical information on trans-health care is cited as one of the main reasons for the limitations for patients with gender transition seeking for medical assistance. The result of inaccessibility of qualified medical care can be self-castration, uncontrolled hormone therapy, suicidal mood, and long-term social disadaptation of transsexuals who cannot compensate for their gender discomfort. This review discusses the management of transsexuals, the types, the rationale, the effectiveness of their treatment, the recommendations of clinical centers, and the potential side effects of cross-sex hormonal treatment.
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References
Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health. 2012;102(1):118–22.
Arcelus J, Bouman WP, Van Den Noortgate W, Claes L, Witcomb G, Fernandez-Aranda F. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry. 2015;30(6):807–15.
Giblon R, Bauer GR. Health care availability, quality, and unmet need: a comparison of transgender and cisgender residents of Ontario, Canada. BMC Health Serv Res. 2017;17:283.
Dekker MJ, Wierckx K, Van Caenegem E, Klaver M, Kreukels BP, Elaut E, Fisher AD, van Trotsenburg MA, Schreiner T, den Heijer M, T’Sjoen G. A European network for the investigation of gender incongruence: endocrine part. J Sex Med. 2016;13(6):994–9.
Chevtaeva I. Why back them to the “bottom”. Novaja Gazeta. 2017;136:15.
Roberts TK, Fantz CR. Barriers to quality health care for the transgender population. Clin Biochem. 2014;47(10–11):983–7.
Sevelius JM, Patouhas E, Keatley JG, Johnson MO. Barriers and facilitators to engagement and retention in care among transgender women living with human immunodeficiency virus. Ann Behav Med. 2014;47(1):5–16.
Reisner SL, Radix A, Deutsch MB. Integrated and gender-affirming transgender clinical care and research. J Acquir Immune Defic Syndr. 2016;72(3):235–42.
Glynn TR, van den Berg JJ. A systematic review of interventions to reduce problematic substance use among transgender individuals: a call to action. Transgend Health. 2017;2(1):45–59.
Reisner SL, Hughto JMW, Dunham EE, Heflin KJ, Begenyi JBG, Coffey-Esquivel J, Cahill S. Legal protections in public accommodations settings: a critical public health issue for transgender and gender-nonconforming people. Milbank Q. 2015;93(3):484–515.
Hughto JMW, Reisner SL, Pachankis JE. Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med. 2015;147:222–31.
Ross KAE, Law MP, Bell A. Exploring healthcare experiences of transgender individuals. Transgend Health. 2016;1(1):238–49.
Edmiston EK, Donald CA, Sattler AR, Peebles JK, Ehrenfeld JM, Eckstrand KL. Opportunities and gaps in primary care preventative health services for transgender patients: a systemic review. Transgend Health. 2016;1(1):216–30.
Feldman J, Brown GR, Deutsch MB, Hembree W, Meyer W, Meyer-Bahlburg HFL, Tangpricha V, T’Sjoen G, Saferi JD. Priorities for transgender medical and health care research. Curr Opin Endocrinol Diabetes Obes. 2016;23(2):180–7.
Snelgrove JW, Jasudavisius AM, Rowe BW, Head EM, Bauer GR. “Completely out-at-sea” with “two-gender medicine”: a qualitative analysis of physician-side barriers to providing healthcare for transgender patients. BMC Health Serv Res. 2012;12:110.
Beckwith N, Reisner SL, Zaslow S, Mayer KH, Keuroghlian AS. Factors associated with gender-affirming surgery and age of hormone therapy initiation among transgender adults. Transgend Health. 2017;2(1):156–64.
Costa EM, Mendonca BВ. Clinical management of transsexual subjects. Arq Bras Endocrinol Metab. 2014;58(2):188–96.
Hughto JMW, Reisner SL. A systematic review of the effects of hormone therapy on psychological functioning and quality of life in transgender individuals. Transgend Health. 2016;1(1):21–31.
Coleman E, Bockting W, Botzer M, et al. Standards of care for the health of transsexual, transgender, and gender-nonconforming people, version 7. Int J Transgenderism. 2012;13:165–232.
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T’Sjoen GG. Endocrine treatment of gender-dysphoric/gender-incongruent persons: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869–903.
Murad MH, Elamin MB, Garcia MZ, et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol. 2010;72:214–31.
Colizzi M, Costa R, Todarello O. Transsexual patients’ psychiatric comorbidity and positive effect of cross-sex hormonal treatment on mental health: results from a longitudinal study. Psychoneuroendocrinology. 2014;39:65–73.
Heylens G, Elaut E, Kreukels BP, et al. Psychiatric characteristics in transsexual individuals: multicentre study in four European countries. Br J Psychiatry. 2014;204:151–6.
de Vries ALC, McGuire JK, Steensma TD, Wagenaar ECF, Doreleijers TAH, Cohen-Kettenis PT. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics. 2014;134(4):696–704.
Kalinichenko SJ. Transsexualism. Possibilities of hormone therapy. Moscow: Prakticheskaja medicina; 2006. p. 192.
Gooren L. Hormone treatment of the adult transsexual patient. Horm Res. 2005;64(Suppl 2):31–6.
Wierckx K, Van Caenegem E, Pennings G, Elaut E, Dedecker D, Van de Peer F, Weyers S, De Sutter P, T’Sjoen G. Reproductive wish in transsexual men. Hum Reprod. 2012;27(2):483–7.
Wierckx K, Stuyver I, Weyers S, Hamada A, Agarwal A, De Sutter P, T’Sjoen G. Sperm freezing in transsexual women. Arch Sex Behav. 2012;41(5):1069–71.
Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab. 2008;93(1):19–25.
Lapauw B, Taes Y, Simoens S, Van Caenegem E, Weyers S, Goemaere S, Toye K, Kaufman J-M, T’Sjoen GG. Body composition, volumetric and areal bone parameters in male-to-female transsexual persons. Bone. 2008;43(6):1016–21.
Wierckx K, Gooren L, T’Sjoen G. Clinical review: breast development in trans women receiving cross-sex hormones. J Sex Med. 2014;11(5):1240–7.
Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379–89.
Meriggiola MC, Gava G. Endocrine care of transpeople part I. A review of cross-sex hormonal treatments, outcomes and adverse effects in transmen. Clin Endocrinol. 2015;83(5):597–606.
Wierckx K, Elaut E, Van Hoorde B, Heylens G, De Cuypere G, Monstrey S, Weyers S, Hoebeke P, T’Sjoen G. Sexual desire in trans persons: associations with sex reassignment treatment. J Sex Med. 2014;11(1):107–18.
Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes and adverse effects. J Clin Endocrinol Metab. 2003;88:3467–73.
Castelo-Branco C, Cancelo MJ. Comprehensive clinical management of hirsutism. Gynecol Endocrinol. 2010 Jul;26(7):484–93.
Tangpricha V, Ducharme SH, Barber TW, Chipkin SR. Endocrinologic treatment of gender identity disorders. Endocr Pract. 2003;9(1):12–21.
Dittrich R, Binder H, Cupisti S, Hoffmann I, Beckmann MW, Mueller A. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2005;113(10):586–92.
Gava G, Cerpolini S, Martelli V, Battista G, Seracchioli R, Meriggiola MC. Cyproterone acetate vs leuprolide acetate in combination with transdermal oestradiol in transwomen: a comparison of safety and effectiveness. Clin Endocrinol. 2016;85(2):239–46.
Rittmaster RS. 5alpha-reductase inhibitors. J Androl. 1997 Dec;18(6):582–7.
Deutsch MB, editor. Guidelines for the primary and gender-affirming care of transgender and gender nonbinary people. 2nd ed. San Francisco, CA: Center of Excellence for Transgender Health, Department of Family and Community Medicine, University of California at San Francisco; 2017. [Internet]. [cited July 11]. Available from: http://www.transhealth.ucsf.edu.
Lehrman KJ. Pulmonary embolism in a transsexual man taking diethylstilbestrol. JAMA. 1976;235:532–3.
de Marinis M, Arnett EM. Cerebrovascular occlusion n a transsexual maintaining mestranol. Arch Intern Med. 1978;138(11):1732–3.
Vandenbroucke JP, Koster T, Briet E, Reitsma PH, Bertina RM, Rosendaal FR. Increased risk of venous thrombosis in oral contraceptive users who are carriers of factor V Leiden mutation. Lancet. 1994;344:1453–7.
Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med. 2011;364:1251–7.
Swiglo BA, Murad MH, Schünemann HJ, Kunz R, Vigersky RA, Guyatt GH, Montori VM. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab. 2008;93(3):666–73.
Toorians AWFT, Thomassen MCLGD, Zweegman S, Magdeleyns EJP, Tans G, Gooren LJG, Rosing J. Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people. J Clin Endocrinol Metab. 2003;88(12):5723–9.
Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, Battista G, Venturoli S, Meriggiola MC. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med. 2014;11(12):3002–11.
Dobs AS, Meikle AW, Arver S, Sanders SW, Caramelli KE, Mazer NA. Pharmacokinetics, efficacy, and safety of a permeation enhanced testosterone transdermal system in comparison with bi-weekly injections of testosterone enanthate for the treatment of hypogonadal men. J Clin Endocrinol Metab. 1999;84:3469–78.
Costa EMF, Mendonça BB. In: Vieira T, Paiva LAS, editors.. Identidade sexual e transexualidade Terapia hormonal no transexualismo. Cap. 11. São Paulo: Editora Roca; 2009. p. 111–23.
Dickersin K, Munro MG, Clark M, Langenberg P, Scherer R, Frick K, Zhu Q, Hallock L, Nichols J, Yalcinkaya TM, Surgical Treatments Outcomes Project for Dysfunctional Uterine Bleeding (STOP-DUB) Research Group. Hysterectomy compared with endometrial ablation for dysfunctional uterine bleeding: a randomized controlled trial. Obstet Gynecol. 2007;110(6):1279–89.
Bhasin S, Cunningham GR, Hayes FJ, Matsumoto AM, Snyder PJ, Swerdloff RS, Montori VM. Testosterone therapy in adult men with androgen deficiency syndromes: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2006;91(6):1995–2010.
Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ III, Spack NP, et al. Endocrine treatment of transexual person: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132–54.
Wierckx K, Van Caenegem E, Schreiner T, Haraldsen I, Fisher AD, Toye K, Kaufman JM, T’Sjoen G. Cross-sex hormone therapy in trans persons is safe and effective at short-time follow-up: results from the European network for the investigation of gender incongruence. J Sex Med. 2014;11(8):1999–2011.
Tugnet N, Goddard JC, Vickery RM, Khoosal D, Terry TR. Current management of male-to-female gender identity disorder in the UK. Postgrad Med J. 2007;83(984):638–42.
Costa R, Colizzi M. The effect of cross-sex hormonal treatment on gender dysphoria individuals’ mental health: a systematic review. Neuropsychiatr Dis Treat. 2016;12:1953–66.
Gupta S, Imborek KL, Krasowski MD. Сhallenges in transgender healthcare: the pathology perspective. Lab Med. 2016;47(3):180–8.
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Naumova, I., Castelo-Branco, C. (2019). Management of Transsexuality in an Outpatient Gynecologic Area. In: Berga, S., Genazzani, A., Naftolin, F., Petraglia, F. (eds) Menstrual Cycle Related Disorders. ISGE Series. Springer, Cham. https://doi.org/10.1007/978-3-030-14358-9_12
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