Outcome and preferences in male–to–female subjects with gender dysphoria: Experience from Eastern India

Abstract

Context:Gender dysphoria (GD) is an increasingly recognized medical condition in India, and little scientific data on treatment outcomes are available.Aims:Our objective is to study the therapeutic options including psychotherapy, hormone, and surgical treatments used for alleviating GD in male–to–female (MTF) transgender subjects in Eastern India.Subjects and Methods:This is a retrospective study of treatment preferences and outcome in 55 MTF transgender subjects who were presented to the endocrine clinic.Statistical Analysis Used:Descriptive statistical analysis is carried out in the present study, and Microsoft Word and Excel are used to generate graphs and tables.Results:The mean follow-up was 1.9 years and 14 subjects (25.5%) were lost to follow-up after a single or 2–3 contact sessions. Rest 41 subjects (74.5%) desiring treatment had regular counseling and medical monitoring. All 41 subjects were dressing to present herself as female and all of them were receiving cross-sex hormone therapy either estrogen only (68%), or drospirenone in combination with estrogen (12%) or gonadotropin-releasing hormone agonist (GnRH) in combination with estrogens (19.5%). Most of the subjects preferred estrogen therapy as it was most affordable and only a small number of subjects preferred drospirenone or GnRH agonist because of cost and availability. 23.6% subjects underwent esthetic breast augmentation surgery and 25.5% underwent orchiectomy and/or vaginoplasty. Three subjects presented with prior breast augmentation surgery and nine subjects presented with prior orchiectomy without vaginoplasty, depicting a high prevalence of poorly supervised surgeries.Conclusions:Standards of care documents provide clinical guidance for health professionals about the optimal management of transsexual people. The lack of information among health professionals about proper and protocolwise management leads to suboptimal physical, social, and sexual results.

Mystery and realities of phalloplasty: a systematic review

“…[47][48][49] Awareness of gender dysphoria and its treatment are increasing. [50] Female-to-male transgender surgery includes some components such as hysterectomy, ovariectomy, flap preparation for urethral elongation, formation of distal urethra, metoidioplasty and phalloplasty (if the patient wants a neophallus). [5] Penile cancer is a rare malignency and the most common form is squamous cell carcinoma.…”

Endocrine Therapy of Adult Gender-Incongruent Individuals Seeking Gender Reaffirmation

“…GnRH analogs are preferred the first line of therapy but spironolactone with/without finasteride is a reasonable alternative in a resource-limited settings. 3 Spironolactone facilitates breast augmentation and benefits facial hair growth but lacks an independent effect on androgen level. 8 Many transgender women seek breast augmentation due to dissatisfaction in hormonal therapy and spironolactone use is more common in those seeking augmentation.…”

“… 2 The situation is often further complicated in India with prior breast surgery and/or prior bottom surgery in both transfeminine and transmasculine individuals without following an acceptable protocol-wise approach. 1 3 4 Educating the GI individuals undergoing GAHT about the onset and time course of physical changes induced by hormone treatment and the benefits and risks associated with hormone treatment is essential for a successful outcome. Nonspecialists might also be approached for help by GI individuals and can play an important role in counseling and referring them to a gender clinic.…”

New validated Reverse Phase Ultra Performance Liquid Chromatography method for drospirenone and estetrol in Active Pharmaceutical Ingredient and tablet form and its stress studies

“…To help reduce the risk of estrogen-induced endometrial hyperplasia (Whitehead, 2006), the drospirenone component has been included in this formulation. Drospirenone has also been used in the treatment of transgender women alongside estrogen as part of hormone therapy (Majumder and Sanyal, 2017;Majumder et al, 2020).…”