Características sociodemográficas, psicológicas y clínicas de una cohorte de personas transgénero de mediana y avanzada edad: importancia de la atención primaria en la asistencia a la transexualidad y diversidad de género / Socio-demographic, psychological and clinical characteristics of a cohort of middle-aged and older transgender persons: the importance of primary health care in supporting transsexuality and gender diversity. Characteristics of a cohort of older transgen

Objetivo: describir la proporción de las personas transgénero mayores de 45 años que solicitan acompañamiento médico o psicológico, así como sus características sociales, historia identitaria, presencia de factores de riesgo cardiovascular, tratamiento hormonal o quirúrgico afirmativo y comorbilidades psiquiátricas.Métodos: estudio transversal descriptivo. Se incluyeron 567 pacientes con incongruencia de género que demandaron atención por la Unidad de Identidad de Género (UIG) del Hospital Universitario Doctor Peset de Valencia en el entre 2012 y 2019 (inclusive).Resultados: un 4,2% de la muestra correspondía a personas mayores de 45 años con una mediana de edad de 52 (RIQ: 50,25-60,25) años. La gran mayoría había experimentado un sentimiento de incongruencia identitaria en la etapa prepuberal o adolescente e hizo el tránsito social durante la edad adulta. Un 25% de las mujeres transgénero se automedicaban antes de acudir a la UIG. Un 29,1% tenía antecedentes de ideación suicida y el 25% había llevado a cabo intentos suicidas. Más de la mitad presentaban al menos dos factores de riesgo cardiovascular y no recibían tratamiento farmacológico específico.Conclusiones: en nuestra muestra, existió una baja proporción de personas trans mayores de 45 años que consultaban en la UIG en comparación con el resto de las franjas etarias más jóvenes. Dicho colectivo se caracterizó por presentar altas tasas de factores de riesgo cardiovascular y comorbilidades psicológicas.(AU)

Aim: to report the proportion of transgender persons aged over 45 who requested medical or psychological care, as well as social characteristics, identity history, cardiovascular risk factors, hormonal or affirmative surgical treatment and psychiatric comorbidities.Methods: cross-sectional, descriptive study. We included 567 patients with gender incongruence who requested care at the Gender Identity Unit (UIG), at Doctor Peset University Hospital (Valencia), from 2012 to 2019.Results: a total of 4.2% of sample corresponded to persons aged over 45, with a median age of 52 [IQR 50.25-60.25]. The vast majority had experienced a feeling of identity incongruity in the prepubertal or adolescent stage and made the social transition during adulthood. A total of 25% of transgender women self-medicated before visiting the UIG; 29.1% had a history of suicidal ideation (IS) and 25% had attempted suicide. More than half presented at least two cardiovascular risk factors and did not receive specific pharmacological treatment.Conclusions: In our sample, there was a low proportion of transgender individuals over the age of 45 who sought care at the IUG compared to younger age groups. This particular group was characterized by high rates of cardiovascular risk factors and psychological comorbidities.(AU)

Evolution and trends in referrals to a specialist gender identity unit in Spain over 10 years (2012-2021).

BACKGROUND: International studies have reported an increase in referrals to gender identity units, a shift in the assigned sex ratio of adolescents, a decrease in the age at first visit, and a growing presence of individuals with nonbinary gender identities. AIM: To investigate whether these trends are present in a Spanish sample of individuals referred to a gender identity unit over the last 10 years. METHODS: We conducted a retrospective chart review of 913 consecutive referrals to a gender identity unit between 2012 and 2021 and retrieved information regarding sex assigned at birth, age at first visit, and expressed gender identity. We stratified the patients into 5 age categories: children (<12 years), adolescents (12-17 years), young adults (18-25 years), adults (26-45 years), and older adults (>45 years). The data were analyzed via descriptive and regression analyses. OUTCOMES: Outcomes included the number of annual referrals, age at first visit, assigned sex ratio, and individuals with nonbinary gender identities. RESULTS: The number of referrals increased 10-fold, from 18 in 2012 to 189 in 2021. The rates of increase over time were significantly more pronounced for adolescents and young adults and significantly greater for those assigned female at birth (AFAB). The age of referrals at first visit decreased, and AFAB individuals were, on average, younger than individuals assigned male at birth. The assigned sex ratio favored AFAB patients among adolescents (2.4:1) and young adults (1.75:1). Logistic regression showed that the odds of a new referral being AFAB increased by 9% per calendar year and that adolescent and young adult new referrals were significantly more likely to be AFAB. There were 21 referrals of nonbinary individuals starting in 2017, making up 6.4% of applications in 2021 and 2.9% during the last 5 years. CLINICAL IMPLICATIONS: The evolution and trends observed in this study highlight the need for expanded resources, competent care, and careful reflection about implications for best practice. STRENGTHS AND LIMITATIONS: This investigation involves a large sample of patients and is the first in our country to include people of all ages. However, the findings might not be generalizable to other gender identity units or the broader population of gender-diverse individuals. CONCLUSION: Overall, our findings were consistent with previous international reports. We observed a marked increase in referrals, particularly among AFAB adolescents and young adults, a decreased age at first visit, and a growing presence of nonbinary individuals.

Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium.

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks.

Incongruencia de género en infancia y pubertad: un análisis de la persistencia identitaria / Gender incongruence in childhood and puberty: an analysis of identity persistence

Introducción: Diferentes estudios señalan una gran variación en las tasas de persistencia identitaria en niños, niñas y adolescentes con incongruencia de género. Objetivo: Describir el porcentaje de persistencia y de desistencia identitaria de niñas, niños y púberes atendidos/as, por manifestación de expresiones y sentimientos de género no congruente en la Unidad de Identidad de Género (UIG). Material y Métodos: Estudio transversal en una cohorte de niñas, niños y púberes que han sido atendidos entre los años 2012 y 2020, con edades comprendidas entre 3 y los 11 años. La recogida de datos se hizo mediante la información registrada en las historias clínicas y se completó con entrevistas telefónicas a menores y progenitores que no habían sido atendidos en los últimos seis meses. Resultados: La muestra final fue de 71 sujetos, 15 (21,1%) chicos trans, 45 (63,4%) chicas trans y 11 (15,5%) no binarios/variantes de género. Vinieron 39 (54,9%) en la primera infancia (0-6 años) y 32 (45,1%) en la segunda infancia-pubertad (7-11 años). El tiempo medio de seguimiento entre la primera visita a la última fue de 2,55 años. En 65 casos (91,5%) se mantuvo persistente la incongruencia de género y en seis (8,5%) hubo desistencia. 22 (30,9%) casos habían manifestado disforia corporal, 12 (16,9%) habían comenzado tratamiento hormonal para bloquear la pubertad y de estos, la mitad, habían iniciado tratamiento hormonal cruzado. Conclusiones: La persistencia de la incongruencia de género en el grupo de infancia-pubertad es mayoritaria (91,5%). La ratio sexo-género va a favor de las niñas trans (niño a niña) y hay un incremento de sujetos no binarios/variantes de género.(AU)

Introduction: Different studies indicate a great variation in the rates of identity persistence in boys, girls and adolescents with gender incongruity. Objective: To describe the percentage of identity persistence and desistance of girls, boys and adolescents attended to, due to expressions and feelings of non-congruent gender in the Gender Identity Unit (GIU). Material and methods: Cross-sectional study in a cohort of girls, boys and pubescents who have been attended between 2012 and 2020, aged between 3 and 11 years. The data collection was done through the information recorded in the medical records and was completed with telephone interviews with minors and parents who had not received care in the last six months. Results: The final sample consisted of 71 subjects, 15 (21.1%) trans boys, 45 (63.4%) trans girls, and 11 (15.5%) gender variants. 39 (54.9%) came in early childhood (0-6 years) and 32 (45.1%) in middle childhood-puberty (7-11 years). The mean follow-up time between the first visit and the last was 2.55 years. In 65 cases (91.5%) the gender inconsistency remained persistent and in six (8.5%) there was desistance. 22 cases (30.9%) had manifested body dysphoria, 12 (16.9%) had started hormonal treatment to block puberty and of these, half had started cross-hormonal treatment. Conclusions: The persistence of gender incongruity in the childhood-puberty group is the majority (91.5%). The sex-gender ratio is in favor of trans girls and there is an increase in gender variants.(AU)

Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review.

BACKGROUND: Persistent genital arousal disorder (PGAD) is characterized by elevated discomfort associated with persistent genital arousal in the absence of sexual desire. AIM: To perform a scoping review of the proposed treatments for PGAD and their efficacy. METHODS: A scoping review was carried out (PRISMA-Scr) that included articles on PGAD as the main disorder, only in women, which explained, in detail, the treatment and its efficacy, was empirical, was written in English and Spanish. No prior filtering by years was performed. OUTCOMES: Three different effective treatments were found (Physical therapies, pharmacological therapies, and psychotherapeutics in combination with other therapies). RESULTS: Thirty-eight articles were selected. From physical therapies, treatments using neuromodulation, transcutaneous electrical stimulation, Botox, surgery, electroconvulsive therapy, manual therapy, pelvic floor therapy, dietary changes, and transcranial magnetic stimulation showed effectiveness. Using the pharmacological approach, paroxetine, duloxetine, pramipexole, ropinirole, and clonazepam treatments were effective. Psychotherapy treatments showed effectiveness only in combination with other types of treatments, specifically a combination of cognitive-behavioral strategies with pharmacological treatment. CLINICAL IMPLICATIONS: Pharmacological treatment, specifically SSRIs, have proven to be the therapy of choice for different subtypes of patients. STRENGTHS AND LIMITATIONS: This study analyzed treatment effectiveness with different approaches and took into consideration those articles where psychotherapy was used as a combination treatment with pharmacological and physical therapy. The main limitation is that it was focused exclusively on women, and the results cannot be generalized to include men. CONCLUSIONS: To date, a combination of pharmacological interventions with physical therapy and, in some occasions, with psychological therapy is main strategy followed to accomplish effective treatment of PGAD. Martín-Vivar M, Villena-Moya A, Mestre-Bach G, et al. Treatments for Persistent Genital Arousal Disorder in Women: A Scoping Review. J Sex Med 2022;19:961-974.

Medical detransition following transgender identity reaffirmation: two case reports.

Background Recently, increased social and scientific attention has been paid to gender detransition, a phenomenon in which individuals discontinue gender-affirming medical interventions (GAMI) aimed at alleviating gender dysphoria (GD). Yet, clinical knowledge of detransitioners and their experiences is still scarce. Case reports published in the literature suggest that both internal and external factors may influence this decision. Methods Two transgender individuals treated for GD at a gender identity unit presented with a desire to discontinue GAMI. A description of their clinical evolution is presented. Results Increased body satisfaction, self-esteem, self-acceptance, and self-empowerment with respect to their transgender identity were mentioned by the patients as reasons for discontinuing gender-affirming treatments. Coinciding factors included reduced GD, positive changes in social environments, better interpersonal functioning, and higher levels of psychological well-being in general. Conclusions Gender detransition is an under-researched phenomenon. These cases highlight the need for a more nuanced approach to gender-related clinical presentations, which involves providing individuals the opportunity to work on their social ecosystems and explore alternative options to manage GD before initiating GAMI.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

Testosterone administration increases leukocyte-endothelium interactions and inflammation in transgender men.

OBJECTIVE: To evaluate the effect of testosterone treatment on metabolic and inflammation parameters and leukocyte-endothelium interactions in transgender men (TGM). DESIGN: Prospective observational study. SETTING: University hospital. PATIENT(S): One hundred fifty-seven TGM. INTERVENTION(S): Administration of testosterone undecanoate (1,000 mg, intramuscular) every 12 weeks. MAIN OUTCOME MEASURE(S): Endocrine parameters, adhesion molecules (vascular cell adhesion molecule-1, intercellular cell adhesion molecule-1, and E-selectin), proinflammatory cytokines interleukin-6, and tumor necrosis factor alpha were evaluated in serum before and after treatment using Luminex's xMAP technology. In addition, interactions between human umbilical vein endothelial cells and polymorphonuclear leukocytes were assessed by flow chamber microscopy. RESULT(S): Testosterone treatment led to an increase in leukocyte-endothelium interactions due to an increase in polymorphonuclear leukocytes rolling and adhesion and decreased rolling velocity. It also boosted levels of vascular cell adhesion molecule-1, E-selectin, interleukin-6, and tumor necrosis factor alpha. As expected, testosterone also produced a significant increase in free androgenic index, androstenedione, total testosterone, and atherogenic index of plasma and a decrease in sex hormone-binding globulin and high-density lipoprotein cholesterol. CONCLUSION(S): Treatment of TGM with testosterone induces an increase in leukocyte-endothelium interactions and adhesion molecules and proinflammatory cytokines. These effects are a reason to monitor cardiovascular risk in these patients.

Self-injurious and suicidal behaviour in a transsexual adolescent and young adult population, treated at a specialised gender identity unit in Spain. / Antecedentes de comportamientos autolesivos y autolíticos en población adolescente y adulta joven transexual, atendida en una unidad especializada en identidad de género en España.

INTRODUCTION: Nonsuicidal self-injury (NSSI) and suicidal behavior (SB) have a significant prevalence in transsexual people. The published data is confusing as it does not distinguish between ideation and realization, age groups, gender, or the degree of medical intervention. Their actual prevalence in Spain is unknown. OBJECTIVE: Our objective was to investigate the prevalence of NSSI behavior and SB in adolescents and young transsexual adults, differentiating between ideation and consummated behavior, prior to their receiving any type of gender-affirming medical treatment. MATERIAL AND METHODS: We retrospectively reviewed the medical history of a cohort of transsexual people aged between 10 and 35 years, treated at the Gender Identity Unit of the Valencian Community. We analyzed the data collected regarding the presence of four variables: NSSI ideation, NSSI behavior, ideas of suicide and suicide attempts, as well as differences according to age group and gender. RESULTS: The final sample consisted of 110 transsexual men and 90 transsexual women. Of these, 21% had made a suicide attempt, 50% had had suicidal ideas, 31% had a history of NSSI behavior and 35% had had NSSI ideas. No differences were found based on gender. Regarding age, subjects under 20 years of age presented a significantly higher prevalence regarding suicidal ideas compared to young adults (43% vs. 25%), while in the remaining variables, no statistically significant differences were found. CONCLUSIONS: The prevalence of a history of suicidal ideas and behavior in the Spanish adolescent and young transsexual population is significant and does not differ according to gender or age range. The prevalence of NSSI ideas and behavior differs and is more frequent in adolescent transsexuals.

[New care models for transgender people in the Spanish Health System: demands, controversies and reflections.] / Nuevos modelos de atención sanitaria para las personas transgénero en el Sistema Sanitario Español: demandas, controversias y reflexiones.

Health care for transgender people in Spain has been progressively established since 1999 when the first multidisciplinary unit for the treatment of sex reassignment was created in Andalusia. In this document, the social changes, the demands and debates of users and professionals, the new models of health care for trans people, and reflections on the current situation, have been analysed. The social openness in Spain regarding sexual and gender diversity has evolved quite positively. The health demands of the transgender users are not uniform and do not always match with the criteria of the professionals. In some Spanish regions, health care is distancing itself from the internationally recommended multidisciplinary model. The new healthcare models have been established under the aegis of primary care and/or endocrinologist in the area, without a required psychological assessment. The main contributing factors for this change of model have been the pressure from some associations with demands for "depathologization" and "decentralization". The professionals of gender units, while recognizing the need for a broader vision of trans reality, warn of the risk of treating trans people without the involvement of mental health specialists or by professionals in proximity with little experience. Moreover, the decentralization would not allow acting on large cohorts, which hinders the advance of knowledge and contrasted evaluations with neighbouring countries. In summary, the new health models, although intended to facilitate care through proximity, do not guarantee improvements in quality and difficult to make a comparative evaluation of the results.

La atención sanitaria a las personas transgénero en España se ha establecido de manera progresiva desde 1999, año en que Andalucía crea la primera unidad multidisciplinar para el tratamiento integral de la reasignación de sexo. Este documento analiza los cambios sociales, las demandas y debates entre usuarios y profesionales y los nuevos modelos de atención sanitaria, y también plantea reflexiones sobre la situación actual. La apertura social en España en la concepción de la diversidad sexual y de género es bastante favorable. Las demandas de los usuarios no son uniformes y no siempre coinciden con los criterios de los profesionales. En algunas comunidades autónomas la asistencia sanitaria se está distanciando del modelo recomendado internacionalmente, que basa la atención en equipos especializados o Unidades de Identidad de Género (UIG). Estos nuevos modelos centran la asistencia en la Atención Primaria, además de en endocrinólogos y pediatras de área sin una evaluación coordinada con Salud Mental. Los principales factores contribuyentes al cambio reciente han sido las demandas desde algunas asociaciones de "despatologización" y "descentralización". Estos nuevos modelos centran la asistencia en la Atención Primaria, además de en endocrinólogos y pediatras de área sin una evaluación coordinada con Salud Mental. Los profesionales que integran las unidades de género, si bien reconocen la necesidad de una visión amplia de la realidad transgénero, alertan del riesgo que supone tratar a personas trans sin una colaboración de especialistas en Salud Mental o por profesionales de área con escasa experiencia. Además, anticipan que la descentralización no facilita el estudio de grandes cohortes, dificultando el avance del conocimiento y la evaluación contrastada con países del entorno. En resumen, los nuevos modelos sanitarios, aunque ofrecen la atención en proximidad, no garantizan mejoras en la calidad ni promueven el análisis comparado de los resultados.

Transexualidad: transiciones, detransiciones y arrepentimientos en España / Transsexuality: Transitions, detransitions, and regrets in Spain

INTRODUCCIÓN: La demanda de atención sanitaria a personas transexuales o con incongruencia de género ha aumentado en los últimos años, sobre todo a expensas de jóvenes y adolescentes. También en paralelo ha aumentado el número de personas que refieren una pérdida o modificación en el sentimiento de género inicialmente expresado. Aunque siguen siendo minoría, nos enfrentamos cada vez más a casos complejos de personas transexuales que solicitan detransicionar y revertir los cambios conseguidos por arrepentimientos. OBJETIVO: Relatar nuestra experiencia con un grupo de personas transexuales en fase de detransición. Analizar su experiencia personal y los conflictos generados y reflexionar sobre estos procesos nunca antes descritos en España. MATERIAL Y MÉTODOS: Cohorte de 796 personas con incongruencia de género atendidas desde enero de 2008 hasta diciembre de 2018 en la Unidad de Identidad de Género del departamento Valencia Doctor Peset. De los 8 casos documentados de detransición y/o desistencia se relatan los 4 más representativos y que consideramos más ilustrativos de esta realidad. RESULTADOS: Las causas observadas que motivaron su detransición fueron la desistencia identitaria, las variantes de género no binarias, la psicomorbilidad asociada y la confusión entre identidad y orientación sexual. CONCLUSIÓN: La detransición es un fenómeno de presentación creciente que conlleva problemas clínicos, psicológicos y sociales. Una incorrecta evaluación y recurrir a la medicalización como única vía de mejora de la disforia en algunos jóvenes puede conducir a posteriores detransiciones. Es fundamental una atención integral dentro de un equipo multidisciplinar con experiencia. A falta de más estudios que determinen posibles factores predictivos de detransición, es recomendable proceder con prudencia en casos de historias identitarias atípicas

INTRODUCTION: Health care demand by transsexual people has recently increased, mostly at the expense of young and adolescents. The number of people who report a loss of or change in the former identity feeling (identity desistance) has also increased. While these are still a minority, we face more and more cases of transsexual people who ask for detransition and reversal of the changes achieved due to regret. OBJECTIVE: To report our experience with a group of transsexual people in detransition phase, and to analyze their personal experience and their associated conflicts. MATERIAL AND METHODS: A cohort of 796 people with gender incongruence attending the Identity Gender Unit of Doctor Peset University Hospital from January 2008 to December 2018 was studied. Four of the eight documented cases of detransition and/or regret are reported as the most representative. RESULTS: Causes of detransition included identity desistance, non-binary gender variants, associated psicomorbidities, and confusion between sexual identity and sexual orientation. CONCLUSION: Detransition is a growing phenomenon that implies clinical, psychological, and social issues. Inadequate evaluation and use of medicalization as the only means to improve gender dysphoria may lead to later detransition in some teenagers. Comprehensive care by a multidisciplinary and experienced team is essential. As there are no studies reporting the factors predictive of detransition, caution is recommended in cases of atypical identity courses

Transsexuality: Transitions, detransitions, and regrets in Spain. / Transexualidad: transiciones, detransiciones y arrepentimientos en España.

INTRODUCTION: Health care demand by transsexual people has recently increased, mostly at the expense of young and adolescents. The number of people who report a loss of or change in the former identity feeling (identity desistance) has also increased. While these are still a minority, we face more and more cases of transsexual people who ask for detransition and reversal of the changes achieved due to regret. OBJECTIVE: To report our experience with a group of transsexual people in detransition phase, and to analyze their personal experience and their associated conflicts. MATERIAL AND METHODS: A cohort of 796 people with gender incongruence attending the Identity Gender Unit of Doctor Peset University Hospital from January 2008 to December 2018 was studied. Four of the eight documented cases of detransition and/or regret are reported as the most representative. RESULTS: Causes of detransition included identity desistance, non-binary gender variants, associated psicomorbidities, and confusion between sexual identity and sexual orientation. CONCLUSION: Detransition is a growing phenomenon that implies clinical, psychological, and social issues. Inadequate evaluation and use of medicalization as the only means to improve gender dysphoria may lead to later detransition in some teenagers. Comprehensive care by a multidisciplinary and experienced team is essential. As there are no studies reporting the factors predictive of detransition, caution is recommended in cases of atypical identity courses.

Demanda, psicopatología, calidad de vida, autoestima y personalidad en personas transexuales adolescentes y adultas jóvenes atendidas en una Unidad de Referencia en Identidad de Género en España / Demand, psychopathology, quality of life, self-esteem and personality in adolescents and young adult transsexuals attended in a Reference Unit in Gender Identity in Spain

OBJETIVO: Evaluar en personas transexuales adolescentes y adultas jóvenes atendidas en una Unidad especializada de Identidad de Género, la evolución de la demanda, la presencia de psicopatología, autoestima, calidad de vida y personalidad. METODOLOGÍA: Estudio transversal en una cohorte de personas transexuales adolescentes y adultas jóvenes sin tratamientos previos de afirmación de género, obtenida mediante muestreo consecutivo que solicitaron atención sanitaria desde 2014 hasta 2017. La medición de las variables fue realizada mediante siete test validados: Inventario para la depresión de Beck-BDI, Cuestionario de Ansiedad Estado-Rasgo-STAI-R/E, Escala de Miedo a la Evaluación Negativa-FNE, Escala de Estrés y Evitación Social-SAD, Índice de calidad de vida-QLI-Sp, versión española, Escala de Autoestima-EAE, versión española y Cuestionario de Personalidad de Eysenck-EPI. RESULTADOS: Se analizan las variables recogidas de 190 personas, 110 hombres transexuales (Mujer-Hombre) y 80 mujeres transexuales (Hombre-Mujer), referentes a la evaluación previa al inicio de los tratamientos médicos de afirmación de género. La demanda en los últimos años ha tenido un incremento notable sobre todo en menores de edad, suponiendo el 43,45% de la misma. La ratio en hombres transexuales ha ido aumentado frente a las mujeres transexuales llegando a ser 1,3 frente a 1. El 18% presentaba depresión moderada y el 3% grave. La ansiedad estado estaba presente en el 48% de la muestra de forma moderada y en el 23% de forma severa, con distribución similar a la ansiedad rasgo (43 y 31% respectivamente). El miedo a la evaluación negativa estaba presente en el 5% de los sujetos y el 7% presentaba conductas de evitación social. La mitad de la muestra tenía baja autoestima. El 10% valoraban su calidad de vida como mala o muy mala y el 28% como regular. Un 20% puntúan alto en rasgo de neuroticismo y 21% puntuó en baja extroversión. No se encontraron diferencias significativas en ninguna de las variables estudiadas en función del género, ni cuando se compararon adolescentes (10 a 19 años) con personas adultas jóvenes (20-35 años). CONCLUSIONES: Existe un porcentaje importante de personas transexuales adolescentes y adultas jóvenes, qué al iniciar la demanda de tratamientos médicos de afirmación de género, manifiestan clínica depresiva y ansiosa y en menor medida ansiedad social. La mitad de ellas tienen baja autoestima, el 40% considera que su calidad de vida es regular o mala y la quinta parte muestra inestabilidad emocional e introversión. BREVE DESCRIPCIÓN DEL CONTENIDO: Hemos analizado la evolución de la demanda asistencial y diferentes variables de salud mental, autoestima, calidad de vida y personalidad, recogidas en los cuestionarios administrados en la evaluación inicial, previa al inicio de tratamientos médicos de afirmación de género, con el fin de detectar las necesidades de apoyo psicoterapéutico que precisa esta población para afrontar con éxito el protocolo de tratamiento médico y la adaptación social en género sentido

OBJECTIVE: To evaluate the evolution of demand, the presence of psychopathology, self-esteem, quality of life and personality in transgender adolescents and young adults attended in a specialized Unit of Gender Identity. METHODOLOGY: Cross-sectional study in a cohort of adolescent and young adult transsexuals without prior gender affirmation treatments, obtained through consecutive sampling that requested health care from 2014 to 2017. The variables were measured using seven validated tests: Inventory of Beck-BDI depression, State-Trait Anxiety Questionnaire-STAI-R / E, Scale of Fear of Negative Evaluation-FNE, Stress Scale and Avoidance Social-SAD, Quality of Life Index-QLI-Sp, Spanish version, Self-Esteem Scale-EAE, Spanish version and Eysenck-EPI Personality Questionnaire. RESULTS: The data collected from 190 people (110 female-to-male (F-M) and 80 male-to-female (M-F) are analyzed, referring to the evaluation prior to the start of medical gender affirmation treatments. Demand in recent years has had a notable increase, especially in minors, representing 43.45% of it. The ratio in transsexual men has been increasing compared to transsexual women, reaching 1.3 compared to 1. 18% had moderate depression and 3% severe. The anxiety state was present in 48% of the sample moderately and in 23% severely, with distribution similar to trait anxiety (43 and 31% respectively). The fear of negative evaluation was present in 5% of the subjects and 7% had social avoidance behaviors. Half of the sample had low self-esteem. 10% valued their quality of life as bad or very bad and 28% as regular. 20% scored high on neuroticism trait and 21% scored low extroversion. No significant differences were found in any of the variables studied according to gender, nor when adolescents (10 to 19 years old) were compared with young adults (20-35 years old). CONCLUSIONS: There is a significant percentage of adolescents and young adult transsexuals, which when they start the demand for medical gender affirmation treatments, manifest depressive and anxious clinic and to a lesser extent social anxiety. Half of them have low self-esteem, 40% consider their quality of life to be regular or bad, and a fifth show emotional instability and introversion

Nuevos modelos de atención sanitaria para las personas transgénero en el sistema sanitario español: demandas, controversias y reflexiones / New care models for transgender people in the Spanish Health System: demands, controversies and reflections

La atención sanitaria a las personas transgénero en España se ha establecido de manera progresiva desde 1999, año en que Andalucía crea la primera unidad multidisciplinar para el tratamiento integral de la reasignación de sexo. Este documento analiza los cambios sociales, las demandas y debates entre usuarios y profesionales y los nuevos modelos de atención sanitaria, y también plantea reflexiones sobre la situación actual. La apertura social en España en la concepción de la diversidad sexual y de género es bastante favorable. Las demandas de los usuarios no son uniformes y no siempre coinciden con los criterios de los profesionales. En algunas comunidades autónomas la asistencia sanitaria se está distanciando del modelo recomendado internacionalmente, que basa la atención en equipos especializados o Unidades de Identidad de Género (UIG). Estos nuevos modelos centran la asistencia en la Atención Primaria, además de en endocrinólogos y pediatras de área sin una evaluación coordinada con Salud Mental. Los principales factores contribuyentes al cambio reciente han sido las demandas desde algunas asociaciones de "despatologización" y "descentralización". Estos nuevos modelos centran la asistencia en la Atención Primaria, además de en endocrinólogos y pediatras de área sin una evaluación coordinada con Salud Mental. Los profesionales que integran las unidades de género, si bien reconocen la necesidad de una visión amplia de la realidad transgénero, alertan del riesgo que supone tratar a personas trans sin una colaboración de especialistas en Salud Mental o por profesionales de área con escasa experiencia. Además, anticipan que la descentralización no facilita el estudio de grandes cohortes, dificultando el avance del conocimiento y la evaluación contrastada con países del entorno. En resumen, los nuevos modelos sanitarios, aunque ofrecen la atención en proximidad, no garantizan mejoras en la calidad ni promueven el análisis comparado de los resultados

Health care for transgender people in Spain has been progressively established since 1999 when the first multidisciplinary unit for the treatment of sex reassignment was created in Andalusia. In this document, the social changes, the demands and debates of users and professionals, the new models of health care for trans people, and reflections on the current situation, have been analysed. The social openness in Spain regarding sexual and gender diversity has evolved quite positively. The health demands of the transgender users are not uniform and do not always match with the criteria of the professionals. In some Spanish regions, health care is distancing itself from the internationally recommended multidisciplinary model. The new healthcare models have been established under the aegis of primary care and/or endocrinologist in the area, without a required psychological assessment. The main contributing factors for this change of model have been the pressure from some associations with demands for "depathologization" and "decentralization". The professionals of gender units, while recognizing the need for a broader vision of trans reality, warn of the risk of treating trans people without the involvement of mental health specialists or by professionals in proximity with little experience. Moreover, the decentralization would not allow acting on large cohorts, which hinders the advance of knowledge and contrasted evaluations with neighbouring countries. In summary, the new health models, although intended to facilitate care through proximity, do not guarantee improvements in quality and difficult to make a comparative evaluation of the results

Impacto de la pandemia por coronavirus COVID-19 en la salud sexual y reproductiva / No disponible

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Documento de posicionamiento: disforia de género en la infancia y la adolescencia. Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN) / Position statement: Gender dysphoria in childhood and adolescence. Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN)

La disforia de género (DG) en la infancia y adolescencia es una condición compleja, siendo importante la detección precoz y el tratamiento integral, ya que con ello se mejora la calidad de vida, disminuye la comorbilidad mental y la propia DG. En este documento de posicionamiento, el Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN), integrado por especialistas de Endocrinología, Psicología, Psiquiatría, Pediatría y Sociología, establece unas recomendaciones sobre la evaluación y tratamiento de la DG en niños y adolescentes. El manejo interdisciplinar de la DG debe llevarse a cabo en unidades con equipos especializados (UTIG) y considerando que cualquier intervención sanitaria debe seguir los principios del rigor científico, la experiencia acumulada, los principios éticos y deontológicos y la prudencia necesaria ante tratamientos crónicos, agresivos e irreversibles

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments