Background and aim of study: Endocrinologists play a central role in the gender affirming process that transgender people chose to undergo, and may be ill-prepared to recognize and manage psychologic difficulties that accompany gender dysphoria. We sought to characterize the patient population currently under our care with respect to their mental health, and to address the question of possible differences between transwomen (TW) and transmen (TM).
Methods: Records of all adult transgender people treated during the last decade at our Transgender Health Clinic in our medical center were reviewed. Social, demographic, and clinical data were recorded. The mandatory psychological assessment provided at the first visit was inspected for any psychiatric diagnosis. All psychoactive medications taken, addictions, and suicidal or non suicidal self-injury attempts were noted.
Results: Altogether 405 subjects were followed for a mean duration of 2.4±0.1 y. The cohort consisted of 221 TW, and 184 TM (TW:TM=1.2:1). TM were significantly younger 26.1±7.3 vs 31.3±11, and presented at a younger age 23.6±7.2 vs 29.1±10.7 than TW (P<0.0001 for both). TW tended to be in a relationship more often than TM (35/221, vs 18/184, P=0.08), and to be parents (27/221 vs 9/184, P=0.03). There was no significant difference in the level of education, but TM were more frequently employed than TW (P=0.0002). TM had generally more family and friends support (P=0.04). Despite those differences, TW did not differ from TM in any of the psychopathologies, which were highly prevalent, and well in excess of the rates for the general population. 35% of all subjects had at least one psychiatric diagnosis, and 22% were currently medicated. Major depression was present in 85 subjects (21%), anxiety disorders in 40 (9.9%). 27 subjects had attempted suicide (6.7%), while 10 had self-inflicted non suicidal injuries (2.5%). Smoking was extremely prevalent as 164 subjects smoked (40.5%). Substance abuse and addictions, albeit underreported, were also common and coexisted with smoking in each instance. Alcohol abuse was reported by 2.5%, cannabis by 2.7%, cocaine and heroin abuse by 2.5% each. Assessing the effect of gender reaffirming hormonal therapy on the prevalence or severity of these pathologies was beyond the scope of this study.
Conclusions: Our findings highlight the need to prepare endocrinologists for the high prevalence and severity of psychopathologic conditions in transgender people. A mental health professional should be an essential part of any multidisciplinary team of clinicians treating the transgender population.
18 - 21 May 2019
European Society of Endocrinology