Ovies CG, Alonso DE, Gómez AM, Duarte CE

Language: Spanish
References: 21
Page: 1-10
PDF size: 327.92 Kb.

ABSTRACT

Introduction: Persons with gender dysphoria feel incongruity between the sex they are born with and the one they feel they belong to, therefore they need to adapt their body to the latter, and one of the pillars in achieving that purpose is the use of cross hormonal treatment.
Objective: To identify the therapeutic schemes most used in self-medication and specialized management, and their complications in patients with gender dysphoria.
Methods: Seventy eight medical records were reviewed. Seventy six of them corresponded to male-female transsexuals, assisted in the 2012-2017 period at the National Consultation of Comprehensive Care to Transgender Persons. The study team recovered information related to the therapeutic schemes used, both during self-medication and during the endocrinological management, as well as complications. Frequency distributions of the qualitative variables, mean and standard deviation of the quantitative variables were obtained for data analysis.
Results: The frequency of patients who self-administered hormones before beginning specialized care was 82.9%. The most commonly medication used in self-medication was cypress (cyproterone acetate 2 mg / ethinylestradiol 50 μg) in 90.5% of cases. Out of the treatments indicated by the endocrinologist at the beginning of the care; 50.0% were given cypress plus androcur (50 mg cyproterone acetate) of 1 to 2 tablets each, while 39.5% conjugated estrogens associated with androcur, also 1 to 2 tablets of each of these medications. Regarding the frequency of complications as a result of hormonal treatment, 40.7% of the cases had elevated prolactin levels at some time, and triglyceride levels increased to 26.3% after the start of therapy.
Conclusions: Most patients who come for the first time, are self-medicated. The most used medications are cipresta and androcur. The most frequent complication is hyperprolactinemia as a consequence of treatment.

REFERENCES

1. Fernández M, García-Vega E. Variables clínicas en el trastorno de identidad de género. Psicothema. 2012; 24:555-80.

2. Ettner S, Monstrey E. Principles of transgender medicine and surgery. New York: Haworth Press; 2007. p. 87-106.

3. Fisher A, Maggi M. Endocrine Treatment of Transexual Male-to-Female Persons. En: Management of Gender Dysphoria. A multidisciplinary approach. 2015.

4. Hadj- Moussa M, Ohl D, Kuzon W. Evaluation and Treatment of gender dysphoria to prepare for gender confirmation surgery. Sex Med Rev. 2018;43:1-11.

5. Groot L, Jamenson J. The endocrinology of sexual behaviour and gender identity En: Endocrinology. Adult and Pediatric. Capítulo 124. USA: Ed. Saunders; 2016. p. 2163-76.

6. Moreno-Pérez O, Esteva de Antonio I. Guía de práctica clínica para la valoración y tratamiento de la transexualidad. Grupo de identidad y diferenciación sexual de la SEEN. Rev Nutr. 2012;59:367-82.

7. Moreno-Pérez O. Transexualidad: control del tratamiento. En: Función androgénica en el laboratorio. Comité de Comunicación de la Sociedad Española de Bioquímica Clínica y Patología Molecular; 2010.

8. Hembree WC, Cohen-Kettenis P, Delemarre HA, Gooren LJ, Meyer WJ, Spack NP. Endocrine treatment of transsexual persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2009;94:3132-54.

9. Coleman E. Normas de atención para la salud de personas trans y con variabilidad de género. Asociación Profesional Mundial para la Salud Transgénero (WPATH). 2012 [acceso: 25 Mar 2016]. Disponible en: http://www.wpath.org

10. Ministerio de Salud Pública. Dirección General de la Salud Uruguay. Guías Clínicas para la hominización en personas trans. UNFPA. 2016 [acceso: 23 Mar 2018]. Disponible en: https://www.gub.uy/ministerio-salud-publica/

11. Good practice guidelines for the assessment and treatment of adults with gender dysphoria; Royal College of Psychiatrists. London; 2013 [acceso: 13 Feb 2019] Disponible en: http://www.rcpsych.ac.uk/publications/collegereports.aspx

12. Becerra A. Transexualismo: diagnóstico y tratamiento médico. Endocrinol Nutr. 2004; 51:26-32.

13. Alonso C. Guía clínica para la hormonización en personas trans. Hormonización MSP. Montevideo: UNFPA; 2014:31-47.

14. Levy A, Crown A, Reid R. Endocrine intervention for transsexuals. Clin Endocrinol (Oxf). 2003;59:409-18.

15. Dittrich R, Binder H, Cupisti S, Hoffmann I. Estimating HIV prevalence and risk behaviors of transgender persons in the United States: a systematic review. Endocrine treatment of male-to-female transsexuals using gonadotropin-releasing hormone agonist. Exp Clin Endocrinol Diabetes. 2005;113:586-92.

16. Asscheman H, Gooren L, Assies J, Smits J, de Slegte R. Prolactin levels and pituitary enlargement in hormonet reated male-to-female transsexuals. Clin Endocrinol (Oxf).1988;28:583-8.

17. Garcia K, Martin A, Rocha M, Gómez M, Hernández A. Prolactinoma induced by estrogen and cyproterona acetate in a male-to-female transsexual. Fertil Steril. 2010;94:1097-105.

18. Futterweit W, Deligdisch L. Histopathological effects of exogenously administered testosterone in 19 female to male transsexuals. J Clin Endocrinol Metab. 1986;62:16-21.

19. Becerra A, De Luis DA, Piédrola G. Morbilidad en pacientes transexuales con autotratamiento hormonal para cambio de sexo. Med Clin (Barc). 1999;113:484-7.

20. Elbers J, Giltay E, Teerlink T, Scheffer P, Asscheman H, Seidell J, et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (Oxf). 2003;58:562-71.

21. Coromoto Y. Receptores de estrógenos, estructura, mecanismo de acción y su relación con el desarrollo de embriones de mamíferos. Boletín Med Postg. 2009;25:1-10.