Tratamiento hormonal de reasignación de sexo en España: nuestra experiencia en 236 casos

Abstract

Introduction In recent decades, demand for gender reassignment therapy (psychological, hormonal and surgical) has significantly increased. In Spain, this type of therapy has not generally been provided in public hospitals. Consequently, endocrinologists and other health professionals have insufficient experience of this treatment and transsexuals have to resort to self therapy or to private hospitals. Patients and methods During an 8-year period (1997-2004), 236 individuals with gender identity disorder (GID) were evaluated. There were 129 male-to-female transsexuals and 107 female-tomale transsexuals, aged between 19 and 54 years (mean age 34 years), with distinct educational levels (primary education in 23%, secondary education in 41%, and higher education in 36%). All patients underwent diagnostic evaluation by a psychiatrist and received psychological support. After clinical and biochemical evaluation, 4 patients were rejected for hormone therapy due to distinct organic disorders. The remaining patients were selected for distinct hormone treatments and were followed-up every 6 months. Results During the follow-up period, hyperprolactinemia occurred in 65% of female-to-male transsexuals and liver enzyme alterations in 8%. There were no cases of thrombophlebitis. In male-to-female transsexuals, liver enzyme alterations were found in 24% and hyperprolactinemia in 13%. After 2 years of hormone therapy, 43 patients underwent complete gender reassignment surgery. There were no severe adverse effects, although 5 patients reported different degrees of sexual dissatisfaction. Conclusions GID are increasingly frequent. Consequently, to prevent the adverse effects of hormone self treatment, these disorders should be managed by the Spanish national health service, which should create specific multidisciplinary units for this purpose.