Management of patients with gender dysphoria (transsexualism) is often difficult, and most patients are routinely managed outwith specialist gender identity clinics. We carried out a retrospective case-note survey of 21 patients attending a routine adult endocrine clinic (ages 2464 y; 13 male-to-female (MF) and 8 female-to-male (FM)).
All MF and 6 of 8 FM patients were on hormonal treatment. 6 of 13 MF patients took oestrogen alone, 6 used oestrogen with antiandrogen and 1 also took progestagen. First reported experience of gender dysphoria was <14 y in all patients, but FM patients started living in the preferred gender role younger than MF. Mean age for FM to live full-time in the preferred role was 22 y, for taking cross hormones, 27 y, and for first surgical intervention 29 y, compared to 37, 40 and 43 y respectively in MF.
Social disruption was commoner in MF patients. 9 of 13 were separated/single or otherwise socially isolated. 6 of 8 FM patients lacked any evidence of social disruption post-diagnosis and only one was described as socially isolated. MF patients had more evidence of past or current depression than FM but both groups had high rates of attempted suicide (MF 5 of 13, FM 2 of 8). 8 of 11 MF were attracted to females and 3 of 11 to males. 5 of 6 FM had relationships with females and one was bisexual. Divorce rates were higher in MF (5 of 13 compared with 1 of 8 FM). More FM went on to higher education than MF but unemployment rates in both groups were high.
In this small population, MF and FM transsexual patients appeared distinct. Both groups had significant social difficulties, but MF patients were worse affected. Social isolation and depression are frequently encountered but with more accepting general and medical attitudes this may improve.