Management of Transgenderism

Gender identity disorder (transgenderism) was poorly understood mechanistically and clinically, but awareness increased due to societal acceptance and hormonal treatments. Therapeutic options included hormone and surgical treatments, though insurance coverage was often limited due to high costs. Male-to-female (MTF) treatments involved estrogens, finasteride, spironolactone, and GnRH analogs, with surgical options like feminizing genital and facial surgery, breast augmentation, and fat transplantations. Female-to-male (FTM) treatments included testosterone and GnRH analogs, with surgical options like mammoplasty and phalloplasty. Medical therapy could start in early puberty, but long-term effects were unknown, and all patients required counseling and medical monitoring.