The Transsexual Adult

Overall, data suggest an increase in transgendered-related diagnoses, possibly reflecting accelerated openness and awareness in both the lay and medical communities about health concerns specific to transsexual individuals. It is hypothesized that a combination of prenatal sex hormonal milieu, genetics, and differences in sexually dimorphic brain structures may be important in the pathophysiology of transsexualism. The diagnosis of transsexualism is generally made by a mental health professional and it is key to identify potential psychiatric comorbidities prior to consideration of hormonal or surgical therapy. Both the Endocrine Society guidelines and WPATH Standards of Care provide excellent clinical guidance on the management of transsexual adults. Gender-affirming hormone therapy for transsexual women typically includes an antiandrogen agent and estrogen and for transsexual men includes testosterone. If the decision to go forward with gender-affirming surgery is made, it is recommended that individuals live as the desired gender for at least 1 year prior. Prior to going forward with hormone or surgical therapy, it is important to address fertility preservation. Lifelong surveillance is recommended to address the unique primary care concerns of this population. There is a clear need for well-conducted research in characterizing health disparities, comorbid disease, and the effects of gender-affirming hormonal and surgical interventions on morbidity, mortality, and quality of life.