AN ENDOCRINOLOGICAL APPROACH IN INDIVIDUALS WITH GENDER DYSPHORIA

Abstract

Gender identity is defined as the acceptation and perception of an individual's body and identity within a certain gender. Individuals with gender dysphoria, as diagnosed by psychiatrists, should also be evaluated in terms of endocrinologic measures, and certain underlying conditions/diseases regarding gender dysphoria must be excluded. Prior to initiation of hormonal and irreversible therapies, it is important for an individual to live suitably with the preferred gender identity as to acquire real life experience. The individual's ability to live in the desired gender is tested in this manner, and whether there is sufficient social, economic, psychological support. Treatment can be initiated for a transgender individual after three months of real-life experience. Before initiation, the reversible and permanent effects must be informed, and the treatment should be individualized. Fertility preservation should be explained prior to hormone therapy, and in those who want to, ovarian preservation in women and sperm preservation in men should be suggested and informed consent obtained. Feminization signs, serum testosterone and estradiol levels, drug side effects, routine cancer screening for breast, colon and prostate cancer and osteoporosis risk factors should be assessed in transgender women. Transgender men, on the other hand, should be screened for virilization signs, serum testosterone levels, drug side effects, annual PAP-smear if uterus is intact and mammography if breast tissue is intact, and osteoporosis risk factors. Surgery can only be proposed to individuals over 18 years of age who have completed 1 year of real-life experience with the usage of hormone therapy for at least 3 months during this period. However, it should be punctuated that surgical procedures constitute irreversible changes and they are not obligatory. Over long-term follow-up, transgender individuals who have undergone surgical procedures are reported to have increased suicide rates and psychiatric morbidities.