title: [Psycho-medical care of transsexuals in Spain in the era of depathologization of transsexualism as a mental disorder. An overall review].
abstract: OBJECTIVE
  To identify the strengths and weaknesses of Spanish healthcare protocols for transsexual persons and to compare them to current international protocols. To review the current status as regards transsexuality etiology and prevalence. To suggest measures to optimize care to achieve a significant improvement, including options for saving financial resources.
  
  
  METHODS
  A comparison of the contents of texts related to transsexualism in the ICD-10, DSM-IV, and guidelines of the Spanish gender units with international standards of care for transgender persons and the last draft version of the DSM-5. Systematic revision of the literature related to the etiology and prevalence of transsexualism.
  
  
  RESULTS
  Significant discrepancies have been found as regards the minimum time period for diagnosis, access to hormone replacement therapy and to genital surgery, and the requirement of the so-called real-life experience. Impact of sex hormones on the etiology of transsexualism and underestimation of its prevalence was confirmed.
  
  
  CONCLUSIONS
  The access to hormonal and surgical treatment requires a profound review, and decentralization of transsexual care is recommended, because all university hospitals haves psychiatrists, clinical psychologists, and endocrinologists available. Although gender reassignment surgery also requires plastic surgery specialists, plastic surgeons currently receive training in this field.
authors.affiliation: Estación Experimental del Zaidín, Consejo Superior de Investigaciones Científicas, Granada, España. Electronic address: r.wittich@csic.es.
authors.forename: Regina-Michaela
authors.initials: RM
authors.lastname: Wittich
mesh_terms: D006801:Humans; D038801:International Classification of Diseases; D001523:Mental Disorders / Q000175:diagnosis; D013030:Spain; D014189:Transsexualism / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*
keywords: Borrador Diagnostic and Statistical Manual of Mental Disorders - 5; Clasificación internacional de enfermedades - 10; Diagnostic and Statistical Manual of Mental Disorders - 5 draft version; Diagnostic and Statistical Manual of Mental Disorders - IV - TR; Estándares de cuidado (World Professional Association for Transgender Health 2011); Etiology of transsexualism; Etiología de la transexualidad; Experiencia de vida real; International Classification of Diseases - 10; Real life experience; Standards of care (World Professional Association for Transgender Health 2011)