Esra KARAKILIÇ ÖZTURAN, Feyza DARENDELİLER

CİNSİYET HOŞNUTSUZLUĞU OLAN ADOLESANLARDA ENDOKRİNOLOJİK YAKLAŞIM

Cinsiyet hoşnutsuzluğu (CH), en az 6 ay süreyle kişinin hissettiği/ dışa vurduğu cinsiyetiyle doğumdaki cinsiyeti arasında belirgin uyumsuzluk olması ve bu duruma işlevsellikte bozulmanın eşlik etmesi durumudur. Psikiyatrik değerlendirmeler sonrasında CH tanısı kesinleşen adolesanlarda medikal tedaviler üç aşamalıdır. Birinci aşama GnRH analog tedavisiyle puberte baskılanması, 2. aşama tedaviye cins steroidlerin eklenmesi, 3. aşamaysa 18 yaş sonrasında cerrahi düzeltme, cins steroid tedavisinin devamı ve hormon düzeylerinin normal aralıkta tutulmasıdır. Trans bireylerde cinsiyet dönüşümü uzun ve zorlu bir süreçtir. Ancak toplumsal farkındalık arttıkça ve kliniklerin artan deneyimleri ile bu bireylerin gerekli tedavilere erişimi kolaylaşacaktır.

Anahtar Kelimeler:

Cinsiyet hoşnutsuzluğu, adolesan, medikal tedavi, cinsiyet dönüşüm

ENDOCRINOLOGICAL APPROACH IN ADOLESCENTS WITH GENDER DYSPHORIA

Gender Dysphoria (GD) is a condition which is characterized by incongruence between the experienced gender and the natal sex at least for 6-months, which also causes deterioration of functionality. After psychiatric evaluations, medical treatment for adolescents with GD consists of 3-phases. The first phase is the suppression of puberty with GnRH analogues. In the second phase, cross-sex steroid hormones are added to the GnRH analogue treatment. The final phase is surgical procedures after the age of 18-years and keeping sex hormone levels in normal ranges. Sex reassignment of the individuals with GD is a long and challenging process. However, with an increased social awareness and increased experience at medical clinics, these individuals will have easier access to the necessary treatments.

Keywords:

Gender dysphoria, adolescents, medical treatment, sex reassignment,

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1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, DC: APA; 2013. [CrossRef]
2. Cohen-Kettenis PT, Klink D. Adolescents with Gender Dysphoria, Best Practice & Research Clinical Endocrinology & Metabolism (2015). [CrossRef]
3. Bakker A., Van Kesteren PJ, Gooren LJ, et al. The prevalence of transsexualism in The Netherlands. Acta Psychiatr Scand 1993;87(4):237-8. [CrossRef]
4. De Cuypere G, Van Hemelrijck M, Michel A, et al. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2007;22(3):137-41. [CrossRef]
5. Steensma TD, Biemond R, de Boer F, et al. Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study. Clin Child Psychol Psychiatry 2011;16:499- 516. [CrossRef]
6. Dessens AB, Slijper FM, Drop SL. Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Arch Sex Behav 2005;34:389-97. [CrossRef]
7. Cohen-Kettenis PT. Gender change in 46,XY persons with 5_-reductase- 2 deficiency and 17_-hydroxysteroid dehydrogenase-3 deficiency. Arch Sex Behav 2005;34:399- 410. [CrossRef]
8. Heylens G, De Cuypere G, Zucker KJ, et al. Gender identity disorder in twins: a review of the case report literature. J Sex Med. 2012;9: 751-7. [CrossRef]
9. Henningsson S, Westberg L, Nilsson S, et al. Sex steroidrelated genes and male-to-female transsexualism. Psychoneuroendocrinology 2005;30:657-64. [CrossRef]
10. Hare L, Bernard P, Sánchez FJ, et al. Androgen receptor repeat length polymorphism associated with male-tofemale transsexualism. Biol Psychiatry 2009;65:93-6. [CrossRef]
11. Lombardo F, Toselli L, Grassetti D, et al. Hormone and genetic study in male to female transsexual patients. J Endocrinol Invest 2013; 36(8):550-7.
12. Ujike H, Otani K, Nakatsuka M, et al. Association study of gender identity disorder and sex hormone-related genes. Prog Neuropsychopharmacol Biol Psychiatry 2009;33:1241- 4. [CrossRef]
13. Rosenthal SM. Approach to the patient: transgender youth: endocrine considerations. J Clin Endocrinol Metab 2014;99(12):4379-89. [CrossRef]
14. Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: a protocol on psychological and pediatric endocrinology aspects. Eur J Endocrinol 2006;155:131-7. [CrossRef]
15. Bonifacio HJ, Rosenthal SM. Gender Variance and Dysphoria in Children and Adolescents. Pediatr Clin North Am 2015;62(4):1001-16. [CrossRef]
16. Hembree WC, Cohen-Kettenis PT, Gooren L, et al. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017;102(11):3869-903. [CrossRef]
17. Schagen SE, Cohen-Kettenis PT, Delemarre-van de Waal HA, et al. Efficacy and safety of gonadotropin-releasing hormone agonist treatment to suppress puberty in gender dysphoric adolescents. J Sex Med 2016;13(7):1125-32. [CrossRef]
18. Gennari L, Khosla S, Bilezikian JP. Estrogen and fracture risk in men. J Bone Miner Res 2008;23(10):1548-51. [CrossRef]
19. Toorians AW, Thomassen MC, Zweegman S, et al. Venous thrombosis and changes of hemostatic variables during cross-sex hormone treatment in transsexual people. J Clin Endocrinol Metab 2003;88:5723-9. [CrossRef]
20. Asscheman H, Giltay EJ, Megens JA, et al. A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. Eur J Endocrinol 2011;164:635-42. [CrossRef]
21. Ott J, Kaufmann U, Bentz EK, et al. Incidence of thrombophilia and venous thrombosis in transsexuals under cross-sex hormone therapy. Fertil Steril 2010;93(4):1267-72. [CrossRef]
22. Moore E, Wisniewski A, Dobs A. Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects. J Clin Endocrinol Metab 2003;88(8):3467-73. [CrossRef]
23. Gooren LJ, Giltay EJ, Bunck MC. Long-term treatment of transsexuals with cross-sex hormones: extensive personal experience. J Clin Endocrinol Metab 2008;93(1):19-25. [CrossRef]
24. Meyer III WJ, Webb A, Stuart CA, et al. Physical and hormonal evaluation of transsexual patients: a longitudinal study. Arch Sex Behav 1986;15(2):121-38. [CrossRef]
25. Asscheman H, Gooren LJ, Assies J, et al. Prolactin levels and pituitary enlargement in hormone-treated male-to female transsexuals. Clin Endocrinol (Oxf) 1988;28(6):583-8. [CrossRef]
26. Cosyns M, Van Borsel J, Wierckx K, et al. Voice in femaleto- male transsexual persons after long-term androgen therapy. Laryngoscope 2014;124(6):1409-14. [CrossRef]
27. Deuster D, Matulat P, Knief A, et al. Voice deepening under testosterone treatment in female-to-male gender dysphoric individuals. Eur Arch Otorhinolaryngol 2016;273(4):959-65. [CrossRef]
28. Bhasin S, Cunningham GR, Hayes FJ, et al. Testosterone therapy in adult men with androgen deficiency syndromes: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2006;91(6):1995-2010. [CrossRef]
29. Shao T, Grossbard ML, Klein P. Breast cancer in female-tomale transsexuals: two cases with a review of physiology and management. Clin Breast Cancer 2011;11(6):417-9. [CrossRef]
30. Nikolic DV, Djordjevic ML, Granic M, et al. Importance of revealing a rare case of breast cancer in a female to male transsexual after bilateral mastectomy. World J Surg Oncol 2012;10:280. [CrossRef]
31. Colebunders B, D’Arpa S, Weijers S, et al. Female-to-male gender reassignment surgery. In: Ettner R, Monstrey S, Coleman E, eds. Principles of Transgender Medicine and Surgery. 2nd ed. New York, NY: Routledge Taylor & Francis Group; 2016:279-317.
32. Monstrey S, Hoebeke P, Dhont M, et al. Surgical therapy in transsexual patients: a multi-disciplinary approach. Acta Chir Belg 2001;101(5):200-9. [CrossRef]
33. Nahata L, Tishelman AC, Caltabellotta NM, et al. Low fertility preservation utilization among transgender youth. J Adolesc Health 2017;61:40-4. [CrossRef]