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Tratamento endocrinológico da disforia de género em adultos
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INTRODUÇÃO: A Disforia de género é uma condição que, apesar de ter baixa incidência, cerca de 0.6% na população estadunidense, causa grande sofrimento psíquico, com impacto negativo na qualidade de vida destas pessoas. Frequentemente, verifica-se dificuldade no acesso aos cuidados médicos para a abordagem desta condição associado ao reduzido contacto da maior parte dos médicos com a mesma. OBJETIVO: Organizar a informação recente, disponível na literatura, acerca do tratamento endocrinológico da Disforia de Género, os efeitos esperados e os potenciais riscos médicos da terapêutica endocrinológica. Analisar retrospetivamente os dados de uma amostra de 18 pacientes, seguidos em consulta de andrologia por Disforia de Género, em Portugal. MÉTODOS: A revisão da literatura foi realizada recorrendo às plataformas online da “PubMed” e “ResearchGate”, onde foram pesquisados os artigos relacionados com o tratamento endocrinológico da Disforia de Género e os seus efeitos. Foram selecionados artigos científicos, revisões sistemáticas e narrativas, e dissertações de mestrado publicados entre 2000 e 2021, em língua inglesa e portuguesa. Os termos pesquisados foram “Transgender”, “Gender Disforia”, “Endocrinology” e “Hormonal treatment”. A análise retrospetiva dos 18 pacientes, foi feita através dos registos clínicos das consultas de andrologia. RESULTADOS: Dos 18 pacientes, 17 tinham diagnostico inequívoco de Disforia de Género. Havendo 8 homens e 9 mulheres transexuais. Todos confirmaram o início das manifestações na infância, embora o diagnóstico clínico tenha sido sempre depois da puberdade. Apenas 1 ainda não tinha iniciado terapêutica hormonal e 4 tinham psicopatologia associada. CONCLUSÃO: As estratégias terapêuticas recomendadas pelas guidelines internacionais, mostram-se eficazes e seguras no processo de transição de género, com efeitos adversos clinicamente significativos muito raros. No entanto, são necessários mais estudos que englobem amostras maiores de pessoas transexuais e com seguimento após o início da terapêutica hormonal mais prolongado, de forma a identificar e caracterizar potenciais riscos a longo prazo da terapêutica da Disforia de Género.
Altough gender dysphoria is a condition with low incidence, around 0.6% in the United States population, it causes great amount of psychological distress with a negative impact in life quality of transgender individuals. It is, frequently, described some difficulty in the access of health care to address this condition, mainly because of the very low contact of medical professionals with it. GOAL: Sumarize and organize recent information, available in the literature, about the endocrinologic treatment of gender dysphoria, its expected effects and its potential health risks. Retrospectively analize data from 18 individuals, followed in andrology medical consultations for gender dysphoria in Portugal. METHODS: The review of the literature available was done by accessing online databases as PubMed and ReasearchGate, where articles related to endocrinologic treatment of gender dysphoria and its effects were researched. It was selected scientific articles, systematic and narrative reviews and masters degree’s thesis that were published between the years 2000 and 2021, either in english or portuguese. The searched terms were Transgender, Gender Dysphoria, Endocrinology and Hormonal Treatment. The retrospective analysis of 18 patients, was done via clinical records from the andrology medical consultations. RESULTS: Of the 18 patients, 17 had an unequivocal diagnosis of gender dysphoria. There was 8 transgender men and 9 transgender women. All of them reported having the first gender dysphoria manifestations during childhood, although the clinical diagnosis was effected only after puberty. There was only one patient that hadn´t started hormonal treatment yet, and 4 patients had psychopatology associated. CONCLUSION: The therapeutic strategies recomended by the international guidelines for the gender transition process, showed to be effective and safe, with very rare clinically significative adverse outcomes. Nevertheless, it remains necessary to do more studies about gender dysphoria, with larger populations and longer follow-ups, so potential long term adverse outcomes can be identified and better characterized.
Altough gender dysphoria is a condition with low incidence, around 0.6% in the United States population, it causes great amount of psychological distress with a negative impact in life quality of transgender individuals. It is, frequently, described some difficulty in the access of health care to address this condition, mainly because of the very low contact of medical professionals with it. GOAL: Sumarize and organize recent information, available in the literature, about the endocrinologic treatment of gender dysphoria, its expected effects and its potential health risks. Retrospectively analize data from 18 individuals, followed in andrology medical consultations for gender dysphoria in Portugal. METHODS: The review of the literature available was done by accessing online databases as PubMed and ReasearchGate, where articles related to endocrinologic treatment of gender dysphoria and its effects were researched. It was selected scientific articles, systematic and narrative reviews and masters degree’s thesis that were published between the years 2000 and 2021, either in english or portuguese. The searched terms were Transgender, Gender Dysphoria, Endocrinology and Hormonal Treatment. The retrospective analysis of 18 patients, was done via clinical records from the andrology medical consultations. RESULTS: Of the 18 patients, 17 had an unequivocal diagnosis of gender dysphoria. There was 8 transgender men and 9 transgender women. All of them reported having the first gender dysphoria manifestations during childhood, although the clinical diagnosis was effected only after puberty. There was only one patient that hadn´t started hormonal treatment yet, and 4 patients had psychopatology associated. CONCLUSION: The therapeutic strategies recomended by the international guidelines for the gender transition process, showed to be effective and safe, with very rare clinically significative adverse outcomes. Nevertheless, it remains necessary to do more studies about gender dysphoria, with larger populations and longer follow-ups, so potential long term adverse outcomes can be identified and better characterized.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Tratamento endocrinológico Disforia de género Transexualidade Identidade de género Efeitos adversos Endocrinologia