Abstract
Introduction: Gender dysphoria (GD) is a disease in which the patient's gender identity does not correspond to their biological gender. Traditionally, sex is assigned accordingly to the sexual organs as male or female, however these patients do not identify with this classification. A biological male who identifies himself as a female is referred to as transgender female or male to female GD (MtF) and a biological female who identifies herself as a male is referred to as a transgender male or female to male GD (FtM). In our center there is a multidisciplinary consultation to approach and follow up patients with GD. Our work is an analysis of the patients who are currently attending this consultation. Methods: Retrospective study of patients attending the Sexual Medicine Group Consultation with diagnosis of GD. Results: 100 patients diagnosed with GD, of which 65% had GD FtM and 35% MtF. The median age is 25 years (± 9.5 years). Regarding the onset of symptoms, 76% of patients report that it occurred in childhood (before age 10); 20% from 10 to 18 years old and only 4% reported having occurred after 18 years. The median age for starting treatment is at 22 years (± 7.5 years). About 83% of the patients start therapy on medical advice, the remaining are self-medicated; 86% of FtM GD patients are currently on testosterone therapy; 85% of MtF GD patients are on estrogen therapy and 71% on anti-androgens. Concerning co-morbidities: 22% of patients have depression; 39% smoke; 6% are HIV-infected; 4% dyslipidemia and 2% hypertension. 47 (47%) patients underwent at least one surgical treatment; the average time to the first surgery was 2 years. Of the FtM GD patients, 23 (35%) patients underwent mastectomy, 10 (15%) hysterectomy and oophorectomy and 3 (5%) neophaloplasty; of the MtF GD patients 8 (23%) underwent augmentation mammoplasty; 7 (20%) neovaginoplasty. Two patients had a family history of GD. One case of Klinefelter’s syndrome and one case of congenital adrenal hyperplasia was diagnosed during the study prior to therapy initiation.
Discussion: There was a higher prevalence of FtM compared to MtF, unlike most centers reporting a higher prevalence of MtF. Regarding the proportion of patients on medical therapy, the data are in line with data from other centers already published, as well as the fact that most patients in our study are young. Conclusion: The demand for medical help from GD patients is increasing. The evaluation of these patients by endocrinology before and throughout treatment is essential, not only for the evaluation of contraindications or side effects of therapy, but also for the identification of endocrinological diseases. This is the first work, to our knowledge, to portray the case series of a consultation center dedicated to the treatment of patients with GD in Portugal.
Exogenous estrogen therapy, testicular cancer, and the male to female transgender population: a case report
