Antonio Becerra-Fernández

Abordaje psicológico de la transexualidad desde una unidad multidisciplinaria: la Unidad de Trastornos de Identidad de Género de Madrid

Resumen La transexualidad es un fenomeno emergente en nuestra sociedad, por el cual una persona de un sexo biologico se siente pertenecer al contrario. El tratamiento realizado desde la Unidad de Trastornos de Identidad de Genero del Hospital Ramon y Cajal de Madrid parte de un enfoque multidisciplinario y se basa en que el tratamiento no debe limitarse al medico (hormonal y cirugia de reasignacion de sexo), sino que la intervencion psicologica es fundamental. Este proceso es multidisciplinario y exige 2 momentos de evaluacion psicologica sucesivos, que en su caso pueden dar lugar al inicio del tratamiento hormonal y del apoyo psicologico, en la fase denominada experiencia de vida real. La intervencion psicologica debe ser individualizada y los objetivos terapeuticos que se plantean son, entre otros, apoyo en dificultades cognitivas o emocionales, desarrollo de estrategias de afrontamiento y adherencia al tratamiento medico.

Prevalencia de hiperandrogenismo y síndrome de ovario poliquístico en transexuales de mujer a hombre

INTRODUCTION Prevalence of hyperandrogenism (HA), including the polycystic ovary syndrome (PCOS), in female-to-male transsexuals (FMT) is high. This has been related to metabolic syndrome (MS), which appears to increase cardiovascular morbidity and mortality throughout cross-sex hormone (CSH) therapy. OBJECTIVES To assess the prevalence of HA and PCOS in FMT patients before the start of CSH therapy, and their association to MS and its components, insulin resistance (IR) and other cardiovascular risk (CVR) factors. MATERIALS AND METHODS Seventy-seven FMTs underwent clinical and biochemical assessment for HA before the start of CSH therapy. CVR, IR, and other MS parameters were also assessed. RESULTS Prevalence of HA was 49.4% (73.7% were cases of PCOS [Rotterdam criteria]), and prevalence of PCOS in the overall sample was 36.4%. Prevalence of MS was 38.4% and 51.7% according to ATP-III and IDF criteria respectively). MS (according to ATP-III and IDF criteria respectively) was found in 36.8% and 57.9% as compared to 25.6% and 41% of patients with and without HA respectively (p<0.0001 and P<0.01 respectively). Of total patients, 54.5% had normal weight (body mass index [BMI] 18.5-24.9 kg.m(-2)), 26% were overweight (BMI 25-29.9 kg.m(-2)), and 19.5% were obese (BMI ≥ 30 kg.m(-2)). After adjusting for BMI, the comparison of hormonal, metabolic, and anthropometric parameters showed statistically significant differences in plasma glucose, HOMA-IR, and abdominal circumference (P<0.001 for all), as well as HDL cholesterol (HDL) (P=0.033), but not in total testosterone or calculated free testosterone levels. In the total sample, 27.3% had HDL levels less than 50mg/dL. CONCLUSIONS Overall HA, and PCOS in particular, are highly prevalent in FMTs. HA and PCOS are related to early development of SM, IR, and other CVR factors with unknown consequences in adulthood.

Sexualidad y reproducción, un campo importante de la endocrinología

El Grupo de Trabajo sobre Trastornos de Identidad de Genero fue creado como respuesta a la, cada vez mas frecuente, necesidad de asistencia medica del transexualismo. Despues de algunos anos, el grupo decidio extenderse hacia el campo de la sexualidad y la reproduccion, porque este tema no esta suficientemente desarrollado por los endocrinologos espanoles. La sobrecarga asistencial provocada por otras enfermedades mas prevalentes, el papel secundario adjudicado a los endocrinologos por instituciones publicas y privadas, o las dificultades diagnosticas y terapeuticas, pueden haber contribuido a la falta de endocrinologos interesados en este campo. Por ello, nuestro grupo de trabajo intenta abordar cuadros clinicos cuyo origen o consecuencia estan, directa o indirectamente, relacionados con alteraciones de la funcion gonadal (masculina o femenina). Estas alteraciones, principalmente hormonales, precipitaran diversos trastornos en multiples organos y sistemas. Estos diferentes cuadros han propiciado que otras disciplinas (ginecologia, urologia, medicina interna, cardiologia, traumatologia, dermatologia, geriatria, etc.) asuman el protagonismo, tanto a escala asistencial como en el terreno de la investigacion. Asi, nosotros creemos que el desarrollo asistencial, docente e investigador de enfermedades con un sustrato hormonal (y especificamente gonadal) tiene que contar con un punto de vista endocrinologico, y esta tarea es la razon de ser de las actividades de nuestro grupo.

Bullying victimization in variant gender children: Experience in Madrid´s gender identity unit.

It had been reported that transgender people show increased prevalence of stressful childhood experiences. Objective: We describe and analyze the probability of suffering from bullying in gender dysphoria minors, for both genders, as referred to our Gender Identity Unit, at University Hospital “Ramón y Cajal”. Patients and method: Our study has a descriptive design. We took in consideration the variable “self-reported bullying”. If positive, we also asked if they felt it was related to gender dysphoria. Fifty-three consecutive minors were included. Data were collected through a structured clinical interview, 54.7% were female and 45.3% were male. Results: Of 53 children, 52 completed the whole interview. One child was referred to a Mental Health Centre, because of severe psychopathology, and did not complete the interview. From the total of 52 children included, 13 (24.5%) stated bullying and 39 (73.5%) denied. From the 13 children reporting bullying, 12 (92.3%) felt it was related to their gender dysphoria. We found no significant differences (p=0.054) from the two sexes. Conclusions: Our data do not support the idea, reported by other authors, that minors with gender dysphoria suffer from increased bullying rates than nondysphoric minors. Correspondence to: Nuria Asenjo-Araque, Gender Identity Unit, University Hospital Ramón y Cajal, Madrid, Spain, E-mail: mailto:nasenjo@gmail.com