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Introduction: A transsexual (TXL) is an individual who seeks or has commenced a social transition from natal gender to desired gender. (1) This transition usually involves hormone treatment or sex reassignment surgery (SRS). Epidemiological characteristics of TXLs in Sri Lanka (SL) has not been studied to date. Objective: The aim of this study is to describe the epidemiological characteristics and management of TXL clinic attendees at a tertiary care clinic setting in SL. Method: This is a descriptive cross sectional study. Data was collected retrospectively from routine clinic notes on demographic and management characteristics of TXLs registered in the psychiatry clinics of Teaching Hospital Peradeniya from their incept to 31 st August 2018. Data were analyzed using SPSS-17. Results: Total number of TXLs were 71 with 31% male to female (MTF) TXLs and 69% female to male (FTM) TXLs. Ratio between FTM to MTF was 2:1. Majority were Sinhala Buddhists between 31-35yrs. Unemployment was seen in 23%. A comorbid psychiatric condition was diagnosed in 20% on presentation. The clinic has increasingly drained TXLs from almost all the provinces in SL over time. Hormonal treatment was received by 65% while 25% received some SRS. Majority were distressed due to deficiencies in organizing legal documents, hormone administration and SRS. Conclusions: There is an increasing trend in help seeking by TXL individuals. Many were unable to have SRS. There is a major gap in service provision. The study creates awareness on the distribution of the TXLs in SL, their epidemiological characteristics and deficiencies in management .

A pericardial effusion is a rare but very serious side effect of clozapine. We present a case of a 50-year old female, who developed fever and tachycardia during the initial period of treatment with clozapine. This case highlights the importance of having a high degree of SL J Psychiatry 2020; 11(2): 33-34