Endocrine Abstracts

Gender dysphoria is a relatively common and incurable condition associated with infertility, social isolation, divorce and a high risk of substance abuse, mental disorder and suicide. Treatment involves often uncomfortable psychiatric interventions, lifelong medication and mutilating surgery.

If we, as endocrinologists and advocates for this unfortunate group of people, hide behind the strictly pharmacotherapeutic dictate to 'first do no harm', we may well put these people at increased risk of harming themselves. If hormone doses are based on arbitrary measurement of circulating hormone levels and extrapolations of risk from unrelated patient groups rather than how our patients feel, the risk/benefit ratio of cross sex hormones may become infinite and our interventions, worse than useless.

Male to female transsexual people require estrogen treatment (often with anti-androgens and sometimes progestogens) and females to males, testosterone supplements at levels that bring about and maintain appropriate physical and mental changes life-long. Neither are difficult, if it is accepted that there is no 'magic combination' to suit all, and both, if the little available data are to be believed, seem to be relatively safe.