José Miguel Rodríguez-Molina

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.