Transgender people are individuals whose gender identity and biological sex do not align. Currently, the DSM-5 is used in medical diagnosis, requiring only 2 out of 6 criteria to be met, with symptoms persisting continuously for at least 6 months and causing distress or discomfort (GENDER DYSPHORIA), necessitating transgender services for both males wishing to transition to female and females wishing to transition to male.
Care process for transitioning to the gender identity
- Declare oneself to society
- Receive a diagnosis from a psychiatrist confirming GENDER DYSPHORIA without any mental illness or condition that may cause similar symptoms leading to misunderstanding
- Suppress puberty in younger individuals to allow time for a clear diagnosis before initiating treatment to align physical sex with the patient’s gender identity later
- Physically change the body by various methods without using hormones or surgery, such as transgender men building muscles, binding the chest, or transgender women wearing wigs, shading the chest crease, using external silicone implants, etc.
- Accurate diagnosis, consideration of hormone therapy, facial feminization surgery, chest surgery, and gender reassignment surgery for those who desire and are ready
Principles of hormone therapy for transgender people
- Provide counseling on fertility issues, sperm banking, egg freezing for the opportunity to have biological children if supported by future laws
- Suppress endogenous sex hormone production according to WPATH (World Professional Association for Transgender Health), starting from age 16 with consent from a legal guardian
- Administer new sex hormones to align with the individual’s gender identity
- Implement safety measures by screening and reducing risks from hormone use, using effective but not excessive doses, and regularly monitoring hormone levels and side effects according to standards
Criteria for gender reassignment surgery
Patients must have been on hormone therapy and lived freely in their identified gender for at least
1 year according to WPATH (World Professional Association for Transgender Health). Surgery can be performed from age 18 with consent from a legal guardian, or at age 20 with the ability to sign consent independently. Gender reassignment surgery requires certification from two psychiatrists.
Other care considerations
- Regularly assess the mental health of transgender individuals
- Provide counseling on contraception, choosing effective and suitable methods for each person
- Provide counseling on sexually transmitted infections and prevention
- Screen for various cancers such as breast cancer, cervical cancer, prostate cancer, and osteoporosis according to standard recommendations
Providers serving transgender people
Should have a positive attitude, be friendly, polite, empathetic, respect rights without discrimination, use neutral language, avoid gender-specific or abnormal terms, seek permission and explain reasons if sensitive history must be taken to avoid distress, manage emotions well regarding responses as gender diversity exists, avoid judgment, and provide useful advice if behavioral adjustments according to appropriate norms are recommended.
Dr. Puthchat Lumleerkittikul
Physician in Anti-Aging and Health Rehabilitation Medicine
Obstetrician-Gynecologist and Sexual Medicine Physician
Anti-Aging Medicine Center, Phyathai 3 Hospital
