ESPE Abstracts

Background/Aim: Gender identity disorder (GID) is a condition, which is characterized by incongruence between experienced gender and the natal-sex, which also causes deterioration of functionality. After psychiatric evaluations, medical treatment for adolescents with GID consists of 3 phases. First phase is the suppression of puberty with GnRH-analogues, which may be considered to be supporting the diagnostic process. In the second phase, cross-sex steroid hormones are added to GnRH analogues treatment. And the final phase is surgical procedures after the age of 18-years and keeping sex hormone levels in normal ranges. In our study, we aimed to raise awareness for individuals with GID, by presenting the clinical features and follow-ups of cases in our clinic.

Method: Twelve cases with GID included in this study who were referred between years 2016 and 2019 to our outpatient clinic for the necessary treatments during the gender transformation process. The complaints, clinical findings and follow-ups of these cases who received treatment were evaluated.

Results: Five cases were trans-female (MTF) and the remaining cases were trans-male (FTM). At the referral, the mean age was 16.6-years (min.13.3-max.21.6). Pubertal stage of one case was Tanner4, while the rest were Tanner5. All cases were uncomfortable by their natal-sex since early ages and their discomfort had increased especially during puberty. While seven of them were referred to our clinic by pediatric psychiatrists, the remaining five were brought by their parents regarding suspicions of hormonal disorders. Three trans-female cases had obesity, and hirsutism was detected in two of them. GnRH-analogue treatment (3.75mg/month) was started in five cases (3MTF, 2FTM) at a mean age of 17.2-years (min.16.7-max.17.6). In one case (MTF), the dose of GnRH analogue was required to be increased to 7.5mg/month. The induction of puberty was started in four cases (3 MTF, 1 FTM) at a mean age of 17.4-years (min.16.8-max.17.8).The trans-male case who was receiving cross-sex hormone, underwent mastectomy at the age of 17.7-years. Except one case, in which osteoporosis was detected during puberty suppression, no serious complications were observed.

Conclusion: The process of gender transformation in trans-gender individuals is a long and challenging journey. On the other hand, with a raised awareness it will be easier for these individuals to access appropriate and necessary treatments. With our increasing experience in our clinic, we are trying to assist these individuals medically and also supporting them on the way of increasing quality and satisfaction of their lives.