Treatment of gender dysphoria

Transseksualnost (TS) je stanje u kojem osoba osjeća nelagodu jer se rodila u spolu za koji osjeća da mu ne pripada. Spol se odnosi na kromosomska i fenotipska obilježja osobe s kojima je rođena, a rod predstavlja individualni doživljaj pripadanja određenom spolu. Zanimljivo je kako su u drevnoj povijesti u Africi na rod gledali baš onako kako ga mi danas definiramo – a to je osjećaj pripadanja. U zemljama Europske unije i SAD-a postavljeni su standardi skrbi za osobe s poremećajem spolnog identiteta gdje se detaljno opisuje procedura kako se pravilno skrbiti za TS osobu. Sama etiologija ovog stanja nije u potpunosti razjašnjena, ali najprihvaćenije su biološka teorija te psihosocijalna teorije. U biološkoj teoriji se opisuje utjecaj hormona na razvitak mozga i tijela, a u psihosocijalnoj teoriji kako međuljudski odnosi, a pogotovo odnosi u obitelji mogu utjecati na razvitak individue. Liječenje se sastoji od više koraka. Prvi korak je potražiti pomoć, najčešće su to udruge ili obiteljski liječnik koji ih onda putu k psihijatru koji se time bavi. Psihijatar pruža savjetovanje i praćenje, a nakon toga ga on uputi endokrinologu kako bi započeli hormonsku terapiju. Naravno, prije samog početka hormonske terapije potreban je potpun pregled internista i ginekologa kako bi se utvrdilo da nema nikakvih kontraindikacija koje bi mogle narušiti zdravlje osobe koja kreće u fizičku tranziciju. Uzimaju se hormoni suprotnog spola, a to im omogućuje da sekundarne spolne karakteristike budu u skladu sa rodom s kojim se identificiraju. Nakon toga, ako osoba to želi, može se započeti kirurška tranzicija. Kod tranzicije u ženski spol izvodi se odstranjenje penisa i skrotuma, stvaranje neovagine i ostalih sekundarnih spolnih obilježja, dok kod tranzicije u muški spol od velikih i malih usana stvara se neopenis te se za to mogu koristiti i proteze, također postoje i testikularne proteze; uz to se odstranjuju dojke. U Hrvatskoj se vrlo malo stručnjaka bavi transseksualnošću, ali sve više se educira i medicinsko osoblje i šira javnost. Dio tome definitivno pridonose udruge koje se bave pravima manjina jer osiguravaju podršku ne samo za TS osobe već i njihove bližnje, a uz to svakodnevnim objavama na internetu približavaju transseksualnost te se razrješavaju ikakve nedoumice.Transsexualism (TS) is a phenomenon in which person feels discomfort because of his/her assigned sex. Sex refers to chromosome and phenotypic characteristics of the sex they were born with and gender is the sex that they identify with. It is interesting that in ancient history in Africa they viewed gender as we see it today - and that is freedom to identify as they feel and not considering the sex of the person. In the countries of European union and USA there is a document called “Standards of care for gender identity disorders” in which is described the procedure of how to take care of transgender person. Etiology of this phenomenon is still not completely clear, but the two most accepted theories are biological and psychosocial theory. In biological theory it is described the influence of hormones on development of the body and brain, and in psychosocial theory they describe how relationships with family and the rest of the society can affect the development of the person. The treatment consists of several steps. The first step is to search for help, they usually find it with associations or primary care doctor and after that they visit the psychiatrist that has many experience with gender dysphoria. The psychiatrist provides counseling and follow-up, and after that TS person is referred to the endocrinologist to begin hormone therapy. Of course, before the beginning of hormone therapy, a complete examination by internist and gynecologist is needed to establish that there are no contraindications that could disrupt the health of a person starting a physical transition. In the treatment, hormones of the opposite sex are used which allows them to have secondary sexual characteristics consistent with the gender they identify with. After that, if a person wants it, a surgical transition can begin. In the transition to female sex, removal of the penis and scrotum is performed, creating neovagine and other secondary sexual features, while in the male sex transition from the large and small labia neopenis is formed and in that procedure prostheses can be used, also there are testicular prostheses; except that, there is a procedure which enables removal of the breast. In Croatia, very few experts have their main field of interest in transsexuality, but as we progress as a society medical staff and the general public are getting more and more educated. Part of this is definitely because of associations that provide support not only to TS people but also to their family and close friends, and the put daily on the internet educational post about gender dysphoria