Keywords
Transgender
gender transition
How to Cite
Abstract
Purpose: At the global level, there is an increase in the incidence of gender dysphoria, and in Colombia there is no information on the general characteristics of transgender patients. The objective was to characterize the population of patients with gender dysphoria in Hospital San José de Bogotá between February 2011 and September 2017.
Methods: Case series study; Clinical records of patients older than 18 years with gender dysphoria who had attended an endocrinology consultation were reviewed. We collected demographic variables, physical and biochemical changes with therapy, affirmation procedures, and complications, to evaluate the completion of the objective of physical and biochemical changes in 2 periods (at 3 months/>12 months) through anamnesis, and physical and paraclinical exams. A descriptive analysis of the information was carried out.
Results: Forty-two patients were included, 57% being trans women, and 43% being trans men. There was an increase in patients consulting over time, a predominance of transgender women, and a high rate of medical transition with hormones that affirm gender without prescription or medical supervision (57.1%). The biochemical goal was the following: group of transgender women total with testosterone levels of <50 ng/dl with estradiol 100-200 pg/ml, and for the group of transgender men estradiol level of <50 pg/ml with total testosterone between 350-700 ng/dl. Physical and biochemical changes were achieved earlier in transgender men. After a one-year follow-up, >50% of both groups fulfilled biochemical goals and had initiated physical changes. Gender affirming surgery were
performed in 3 transgender men and 4 transgender women. The median follow-up time
was 13 months, without serious complications.
Conclusion: Our series correlate with the world’s literature on an increase in patients with gender dysphoria, even though their diagnosis is still late. There is a predominance in the MtF group, as well as a high rate of medical transition with hormones that affirm gender without medical supervision. In our current setting, there are still great limitations due to the presence of human, social and knowledge barriers. The results will favor future investigations that strengthen the care of patients with gender dysphoria in our context.
References
Health WPAfT. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People [7 th Version]. 2012.
Smith ES, Junger J, Derntl B, Habel U. The transsexual brain--A review of findings on the neural basis of transsexualism. Neurosci Biobehav Rev. 2015;59:251-66.
Ahmad S, Barrett J, Beaini AY, Bouman WP, Davies A, Greener HM, et al. Gender dysphoria services: a guide for general practitioners and other healthcare staff. Sexual and Relationship Therapy. 2013;28(3):172-85.
Monro S. Non-binary and genderqueer: An overview of the field. Int J Transgend. 2019;20(2-3):126-31.
Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA, Gooren LJ, Meyer WJ, Spack NP, et al. Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2009;94(9):3132-54.
American Psychiatric A. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
Wylie K, Barrett J, Besser M, Bouman WP, Bridgman M, Clayton A, et al. Good practice guidelines for the assessment and treatment of adults with gender dysphoria. Sexual and Relationship Therapy. 2014;29(2):154-214.
Irwig MS. Testosterone therapy for transgender men. Lancet Diabetes Endocrinol. 2017;5(4):301-11.
Tangpricha V, den Heijer M. Oestrogen and anti-androgen therapy for transgender women. Lancet Diabetes Endocrinol. 2017;5(4):291-300.
Asscheman H, Giltay EJ, Megens JA, de Ronde WP, van Trotsenburg MA, Gooren LJ. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol. 2011;164(4):635-42.
Ross MW, Wålinder J, Lundström B, Thuwe I. Cross-cultural approaches to transsexualism. A comparison between Sweden and Australia. Acta Psychiatr Scand. 1981;63(1):75-82.
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.
Aitken M, Steensma TD, Blanchard R, VanderLaan DP, Wood H, Fuentes A, et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria. J Sex Med. 2015;12(3):756-63.
Báez RAL. TRANSEXUALIDAD Y SERVICIOS DE SALUD UTILIZADOS PARA TRANSITAR POR LOS SEXOS-GÉNEROS (Transsexualism and health care services used to transit by the sexes-genders). CES Psicología. 2014;7(2):108-25.
de Bogotá AM. Balances y Perspectivas: Política Pública para la Garantía Plena de los Derechos de las Personas Lesbianas, Gays, Bisexuales y Transgeneristas-LGBT-y sobre Identidades de Género y Orientaciones Sexuales en el Distrito Capital. Bogotá[Links]. 2011.
Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(11):3869-903.
Winter S, Diamond M, Green J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet. 2016;388(10042):390-400.
Irwig MS. TRANSGENDER CARE BY ENDOCRINOLOGISTS IN THE UNITED STATES. Endocr Pract. 2016;22(7):832-6.
Mayorga Bautista MA. " En Bogotá se puede ser" o la territorialización de la política pública LGBTI en el Distrito Capital (2012-2014), un análisis desde la ética de Acción Sin Daño. 2015.
De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R, et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry. 2007;22(3):137-41.
Benjamin H. The transsexual phenomenon: Symposion Pub.; 1999.
Leinung MC, Urizar MF, Patel N, Sood SC. Endocrine treatment of transsexual persons: extensive personal experience. Endocr Pract. 2013;19(4):644-50.
Mepham N, Bouman WP, Arcelus J, Hayter M, Wylie KR. People with gender dysphoria who self-prescribe cross-sex hormones: prevalence, sources, and side effects knowledge. J Sex Med. 2014;11(12):2995-3001.
Guadamuz TE, Wimonsate W, Varangrat A, Phanuphak P, Jommaroeng R, McNicholl JM, et al. HIV prevalence, risk behavior, hormone use and surgical history among transgender persons in Thailand. AIDS Behav. 2011;15(3):650-8.
Sanchez NF, Sanchez JP, Danoff A. Health care utilization, barriers to care, and hormone usage among male-to-female transgender persons in New York City. Am J Public Health. 2009;99(4):713-9.
de Haan G, Santos GM, Arayasirikul S, Raymond HF. Non-Prescribed Hormone Use and Barriers to Care for Transgender Women in San Francisco. LGBT Health. 2015;2(4):313-23.
Connolly MD, Zervos MJ, Barone CJ, Johnson CC, Joseph CL. The Mental Health of Transgender Youth: Advances in Understanding. J Adolesc Health. 2016;59(5):489-95.
Seelman KL, Colón-Diaz MJP, LeCroix RH, Xavier-Brier M, Kattari L. Transgender Noninclusive Healthcare and Delaying Care Because of Fear: Connections to General Health and Mental Health Among Transgender Adults. Transgend Health. 2017;2(1):17-28.
Asscheman H, T'Sjoen G, Lemaire A, Mas M, Meriggiola MC, Mueller A, et al. Venous thrombo-embolism as a complication of cross-sex hormone treatment of male-to-female transsexual subjects: a review. Andrologia. 2014;46(7):791-5.
Seal LJ. A review of the physical and metabolic effects of cross-sex hormonal therapy in the treatment of gender dysphoria. Ann Clin Biochem. 2016;53(Pt 1):10-20.
Pelusi C, Costantino A, Martelli V, Lambertini M, Bazzocchi A, Ponti F, et al. Effects of three different testosterone formulations in female-to-male transsexual persons. J Sex Med. 2014;11(12):3002-11.
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