Gender Identity Disorder (GID) is a condition in which a person experiences discongruency between their assigned sex and what they feel their genderidentity is. A person with gender dysphoria experiences persistently uncomfortable feelings about their birth gender (Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) (American Psychiatric Association, 1994).
During the real life experience hormonal treatment starts and applicants are required to live socially in the desired gender role before irreversible surgical reassignment is considered. Cross sex hormonal treatment is desired by transsexual persons to help them successfully live as a member of their identified gender. It is clear that both in adults and adolescents the decision for starting hormonal treatment in transssexualism is not to be made by the endocrinologist. The mental health professionals (psychiatrists and/or psychologists), by preference working in a multidisciplinary Gender team, will guide these persons to make an informed decision about hormonal treatment. Eligibility criteria and readiness as described by WPATHs Standards of Care for GID-7th version, should be evaluated. The goal of treatment in female-to-male transsexual persons is to induce virilization and to stop menses. The prinicipal hormone treatment is a testosterone preparation. In male-to-female transsexual persons oestrogen and anti-androgen treatment is provided. Treatment regimens are currently not standardised and include various forms of oestrogens, progestins, and/or (anti-) androgens as reported by different clinical centres. So far, no randomized intervention trials are available so treatment is largely experience-based.
Appropriate care for transgender persons will lead to better outcome and should avoid unnecessary psychological pain, health risks (e.g. secondary psychiatric conditions or suicide), or self medication with inherent greater risk of complications.
Declaration of interest: The author declares that there is a conflict of interest.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.