Medical Management of Adult Transsexual Persons

Emily L. Knezevich, Pharm.D; Laura K. Viereck, Pharm.D; Andjela T. Drincic, M.D.


Pharmacotherapy. 2012;32(1):54-66. 

In This Article

Diagnosis and Psychiatric Management

In accordance with current guidelines, diagnosis of GID should be established by a mental health provider trained in treating patients with this disorder.[1] Diagnosis should follow the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) to classify this condition as GID. Table 1 highlights criteria according to the DSM-IV-TR and International Classification of Diseases, Tenth Revision.[1,2,5] Although the term GID may be considered judgmental by some, this term is commonly used in the published literature, including the Endocrine Society guidelines and DSM-IV-TR criteria.[1,2] This review uses the term GID when making statements that are consistent with these guidelines.

Gender identification usually occurs in early childhood. The contributing factors to gender identity are still not fully understood,[1] and no biologic or psychologic evidence exists to identify a direct cause for development of GID.[6] When an individual is diagnosed with GID and desires treatment, a "real-life experience" is encouraged during which the individual lives as the gender of choice, to demonstrate full commitment to and understanding of a gender role change.[1,7] When the real-life experience is completed or adequate psychotherapy has been started, the patient's mental health is stable, and it has been determined that the patient will adhere appropriately to drug therapy, cross-sex hormone therapy may be started.[1]

Before starting therapy, patients should be educated on the risks and adverse effects of therapy as well as on anticipated temporary and permanent changes. They should receive a timeline showing when to expect the development of sex characteristics. They also should be counseled about fertility issues. Both the patient and clinician should sign an informed consent form as outlined in the standards of care before any treatment is started.[8]


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