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Management of Transsexuality in an Outpatient Gynecologic Area

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Menstrual Cycle Related Disorders

Part of the book series: ISGE Series ((ISGE))

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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

  1. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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.

    Article  CAS  PubMed  Google Scholar 

  3. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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.

    Article  CAS  PubMed  Google Scholar 

  5. Chevtaeva I. Why back them to the “bottom”. Novaja Gazeta. 2017;136:15.

    Google Scholar 

  6. Roberts TK, Fantz CR. Barriers to quality health care for the transgender population. Clin Biochem. 2014;47(10–11):983–7.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. Ross KAE, Law MP, Bell A. Exploring healthcare experiences of transgender individuals. Transgend Health. 2016;1(1):238–49.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  15. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Costa EM, Mendonca BВ. Clinical management of transsexual subjects. Arq Bras Endocrinol Metab. 2014;58(2):188–96.

    Article  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

    Article  Google Scholar 

  22. 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.

    Article  CAS  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. Kalinichenko SJ. Transsexualism. Possibilities of hormone therapy. Moscow: Prakticheskaja medicina; 2006. p. 192.

    Google Scholar 

  26. Gooren L. Hormone treatment of the adult transsexual patient. Horm Res. 2005;64(Suppl 2):31–6.

    CAS  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  PubMed  Google Scholar 

  29. 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.

    Article  CAS  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  Google Scholar 

  31. 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.

    Article  PubMed  Google Scholar 

  32. Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab. 2014;99(12):4379–89.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  CAS  Google Scholar 

  34. 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.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. Castelo-Branco C, Cancelo MJ. Comprehensive clinical management of hirsutism. Gynecol Endocrinol. 2010 Jul;26(7):484–93.

    Article  CAS  PubMed  Google Scholar 

  37. Tangpricha V, Ducharme SH, Barber TW, Chipkin SR. Endocrinologic treatment of gender identity disorders. Endocr Pract. 2003;9(1):12–21.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  CAS  PubMed  Google Scholar 

  39. 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.

    Article  CAS  Google Scholar 

  40. Rittmaster RS. 5alpha-reductase inhibitors. J Androl. 1997 Dec;18(6):582–7.

    CAS  PubMed  Google Scholar 

  41. 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.

  42. Lehrman KJ. Pulmonary embolism in a transsexual man taking diethylstilbestrol. JAMA. 1976;235:532–3.

    Article  CAS  PubMed  Google Scholar 

  43. de Marinis M, Arnett EM. Cerebrovascular occlusion n a transsexual maintaining mestranol. Arch Intern Med. 1978;138(11):1732–3.

    Article  Google Scholar 

  44. 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.

    Article  CAS  PubMed  Google Scholar 

  45. Gooren LJ. Clinical practice. Care of transsexual persons. N Engl J Med. 2011;364:1251–7.

    Article  CAS  PubMed  Google Scholar 

  46. 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.

    Article  CAS  PubMed  Google Scholar 

  47. 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.

    Article  CAS  PubMed  Google Scholar 

  48. 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.

    Article  PubMed  Google Scholar 

  49. 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.

    CAS  PubMed  Google Scholar 

  50. 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.

    Google Scholar 

  51. 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.

    Article  PubMed  Google Scholar 

  52. 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.

    Article  CAS  PubMed  Google Scholar 

  53. 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.

    Article  CAS  PubMed  Google Scholar 

  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.

    Article  CAS  PubMed  Google Scholar 

  55. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  56. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Gupta S, Imborek KL, Krasowski MD. Сhallenges in transgender healthcare: the pathology perspective. Lab Med. 2016;47(3):180–8.

    Article  PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Medical Faculty, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russian Federation

    Iuliia Naumova

  2. Clinic Institute of Gynecology, Obstetrics and Neonatology, Hospital Clínic, Faculty of Medicine, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain

    Camil Castelo-Branco

Authors
  1. Iuliia Naumova
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  2. Camil Castelo-Branco
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Correspondence to Camil Castelo-Branco .

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Editors and Affiliations

  1. Wake Forest SOM/WF Baptist Medical Center, Executive Director Women’s Health Services, Winston Salem, NC, USA

    Sarah L. Berga

  2. International Society of Gynecological Endocrinology, University of Pisa, Pisa, Italy

    Andrea R. Genazzani

  3. Department of Obstetrics and Gynecology, New York University, New York, NY, USA

    Frederick Naftolin

  4. Department of Obstetrics and Gynaecology, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy

    Felice Petraglia

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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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  • DOI: https://doi.org/10.1007/978-3-030-14358-9_12

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