Outcome and preferences in male–to–female subjects with gender dysphoria: Experience from Eastern India

CONTEXT: Gender dysphoria (GD) is an increasingly recognized medical condition in India, and little scientific data on treatment outcomes are available. AIMS: Our objective is to study the therapeutic options including psychotherapy, hormone, and surgical treatments used for alleviating GD in male–to–female (MTF) transgender subjects in Eastern India. SUBJECTS AND METHODS: This is a retrospective study of treatment preferences and outcome in 55 MTF transgender subjects who were presented to the endocrine clinic. STATISTICAL ANALYSIS USED: Descriptive statistical analysis is carried out in the present study, and Microsoft Word and Excel are used to generate graphs and tables. RESULTS: The mean follow-up was 1.9 years and 14 subjects (25.5%) were lost to follow-up after a single or 2–3 contact sessions. Rest 41 subjects (74.5%) desiring treatment had regular counseling and medical monitoring. All 41 subjects were dressing to present herself as female and all of them were receiving cross-sex hormone therapy either estrogen only (68%), or drospirenone in combination with estrogen (12%) or gonadotropin-releasing hormone agonist (GnRH) in combination with estrogens (19.5%). Most of the subjects preferred estrogen therapy as it was most affordable and only a small number of subjects preferred drospirenone or GnRH agonist because of cost and availability. 23.6% subjects underwent esthetic breast augmentation surgery and 25.5% underwent orchiectomy and/or vaginoplasty. Three subjects presented with prior breast augmentation surgery and nine subjects presented with prior orchiectomy without vaginoplasty, depicting a high prevalence of poorly supervised surgeries. CONCLUSIONS: Standards of care documents provide clinical guidance for health professionals about the optimal management of transsexual people. The lack of information among health professionals about proper and protocolwise management leads to suboptimal physical, social, and sexual results.