Management of Transgender Problems

The feeling that we’re either male or female and the concordance of gender identity with our physical gender is something innate that almost all of us take for granted. ‘A little boy’, according to Purnell1 ‘will know he's a boy before he knows his address, surname, nationality or religion’. But for about 1 in 12-15,000 males and 1 in 30-35,000 females across North and South America, Europe, India, South East Asia and Russia, unshakable gender identity is at odds with phenotypic sex. The result, gender identity disorder, is an incurable condition associated with infertility, social discrimination, divorce and a high risk of substance abuse, mental disorder and suicide. The characteristic feature of gender dysphoria or gender identity disorder is discomfort with one’s phenotypic sex of sufficient magnitude to provoke a desire to have treatment to make one’s body correspond to that of the preferred sex. Medical care for transsexual people is remedial and consists for many of long term cross-sex hormone treatment and physical interventions designed to help them re-establish themselves in society in their chosen gender role. Understanding and emotional support are crucial, after which the extent of treatment - sometimes no more than wearing appropriate underwear or unisex outer garments, applying a touch of make-up or treating hirsutism - and the timing of interventions, are tailed to suit the individual.