درمان با هورمون در بی قراری جنسیتی

In Italy hormonal treatment for persons with Gender Identity Dysphoria can be prescribed by endocrinologists only after a well-defined diagnosis has been formulated by trained psychologists/psychiatrists. Prescriptions must be preceded by exclusion of major comorbidities, which could physically and psychologically interfere with the sex reassignment procedure. Real life test is finalized to improve the psychosocial functioning according to the desired sex and allows also to confirm the diagnosis. For males who want to become women, treatment consists of estrogens and antiandrogens. For females who want to become men, treatment is most commonly composed of esters of testosterone. Venous thromboembolism, the most frequent complication in the past years, is nowadays far less frequent. The endocrinological follow-up is necessary, as postsurgical hypogonadism must be treated with chronic replacement therapy.

Gender identity is dramatically influenced by hormones. Macro and micro-anatomical differences in the bed nucleus of the stria terminalis (BSTc) and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder (Kruijver et al., 2000). This agrees with the evidence that gender dysphoria begins relatively early in life (around five to six years-old). The management of adult persons affected by Gender Identity Dysphoria (GID) involves endocrinologists who prescribe hormonal treatment (HT) aimed to modify physical aspect and match it with the gender identity (GI) these persons feel to belong to. Many of these persons have already undergone cross-gender hormone self-administration, frequently at high dosages, while others start treatment for the first time. These differences should not influence the endocrinologist's approach, which must comply with specific guidelines. The latter are well defined in those countries where scientific societies and/or associations deal with and provide the entire medical treatment. The universally accepted keypoints of GID treatment are: • psychological assessment of GI; • exclusion of major co-morbidities which could physically and psychologically interfere with the sex reassignment procedure; • real life test (RLT)1 during hormonal treatment, to be performed during individual or group psychological follow-up until surgical sex reassignment (SSR), in order to comply with specific laws that regulate sex change in each country (Guidelines for Transgender Care, 2006 and Gooren et al., 2008) In Italy Law 164/82 allows hormonal and surgical sex reassignment; generalities can be changed only by those subjects who have already modified their phenotype. In 1998 the Italian National Observatory on Gender Identity (O.N.I.G.) proposed specific guidelines for cross-sex hormone treatment (www.onig.it), which are currently under revision.