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Clinical Crossroads | Conferences With Patients and Doctors| February 6, 2013 Clinician's Corner

Management of Transgenderism

Norman P. Spack, MD

JAMA. 2013;309(5):478-484. doi:10.1001/jama.2012.165234.

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ABSTRACT

Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical standpoints. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. Therapeutic options include hormone and surgical treatments but may be limited by insurance coverage because costs are high. For patients seeking male-to-female (MTF) change, hormone treatment includes estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs. Surgical options include feminizing genital and facial surgery, breast augmentation, and various fat transplantations. For patients seeking a female-to-male (FTM) gender change, medical therapy includes testosterone and GnRH analogs and surgical therapy includes mammoplasty and phalloplasty. Medical therapy for both FTM and MTF can be started in early puberty, although long-term effects are not known. All patients considering treatment need counseling and medical monitoring.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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May 22, 2013

Care for Transgender Persons

Ann Danoff, MD; Demetre Daskalakis, MD, MPH; Judith A. Aberg, MD

JAMA. 2013;309(20):2092-2093. doi:10.1001/jama.2013.4662.

May 22, 2013

Care for Transgender Persons

Anne A. Lawrence, MD, PhD; Kenneth J. Zucker, PhD

JAMA. 2013;309(20):2093-2094. doi:10.1001/jama.2013.4665.

May 22, 2013

Care for Transgender Persons—Reply

Norman P. Spack, MD

JAMA. 2013;309(20):2093-2094. doi:10.1001/jama.2013.4668.

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Spack NP. Management of Transgenderism. JAMA. 2013;309(5):478-484. doi:10.1001/jama.2012.165234.

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