Abstract and Introduction

Abstract

Gender identity disorder (GID), or transsexualism, is an increasingly recognized medical condition with an expanding body of medical literature to support the use of established therapeutic guidelines. Transsexualism can be effectively managed through exogenous cross-sex hormone administration used to induce development of desired sex characteristics, as well as use of other agents, such as aldosterone antagonists, aimed at decreasing physical characteristics of the undesired sex. Many complications can arise with the use of the available therapies, and these must be considered before determining the appropriate course of action. This review describes methods, including both pharmacotherapy and surgical interventions, for effective medical management of both male and female adults with GID. In addition, specific goals of therapy as well as safety aspects with long-term use of pharmacotherapeutic agents are discussed. This review also discusses some special considerations for treating patients with significant, yet common, comorbid diseases such as human immunodeficiency virus infection, acquired immunodeficiency syndrome, and viral hepatitis, as these conditions may complicate the clinical course and preclude some patients from using certain therapies. Pharmacist involvement in the management of transsexualism can be extremely beneficial to patients and other health care providers. Pharmacists can help determine the appropriate therapy, optimize dosages, monitor for adverse effects, and educate patients on what to expect during their therapy. Pharmacists should become knowledgeable about guidelines and current literature on transsexualism, understand the monitoring parameters for safe and effective therapy, and establish themselves as partners in the collaborative management of this disorder.

Introduction

Transsexualism, also known as transgenderism, gender dysphoria, or gender identity disorder (GID), is a term coined by Magnus Hirschfeld in 1923, describing the condition in which one wishes to live as, and associates with characteristics of, the opposite sex.[1] In addition, the individual experiences ongoing discomfort in his or her genetic gender role.[2] The most widely accepted estimates on prevalence come from The Netherlands, reporting 1 in 11,900 males and 1 in 30,400 females.[3] Estimates of prevalence in the United States are considered to be similar.[4] Increasing recognition of transsexualism, as well as increased provider experience with cross-sex hormone use, has resulted in a substantial amount of literature describing optimal treatment strategies and potential adverse effects of the agents.

Despite this increasing body of evidence, many practitioners, including pharmacists, have limited experience and knowledge of current treatment strategies. The first treatment recommendations for patients with GID were published in 1979 and updated in 2001 by the World Professional Association for Transgender Health; the recommendations provide standards of care for use of psychiatric and medical management of this population.[4] In 2009, the Endocrine Society published the first U.S. clinical practice guidelines for transsexualism incorporating more recent research and clinical experience.[1]

The pharmacist's role in the treatment of patients with GID has not been published. Thus, the objective of this review is to enhance pharmacist understanding of GID guidelines and current literature, identify monitoring parameters for safe and effective therapy, and establish the pharmacist's role in assisting these individuals.