Coordination of healthcare for transsexual persons: a multidisciplinary approach.
OBJECTIVE
To describe the experience in Spain concerning the public healthcare for transsexual persons using a multidisciplinary approach and to review the relevant literature. Treatment includes social and psychological support, cross-hormone treatment, and sex reassignment surgeries. Although the recommendations of The World Professional Association for Transgender Health are used as guidelines, the application of these standards of care varies considerably, probably because of specific clinical and country factors.


RESULTS
The sex reassignment process is complex and requires not only coordination of multiple procedures, but also lifetime follow-up of transsexual individuals. Gender units must provide high-quality services, been essential the principle of accessibility to resources together with a protocolized follow-up and anticipation of secondary effects from the clinical surgical treatment. Two recent challenges are juvenile gender dysphoria and gender variants, which increasingly consult professionals.


CONCLUSIONS
Transsexualism affects all adaptive physical and psychosocial aspects of a person. As diagnosis is based only on the history and personal perceptions, a broad social debate exists about the need for treatment financed by the public health systems. Some countries restrict the care to transsexuals with private medical policies. Thus, coordination of care also requires participation of the family and associations, with continuous information to the health authorities, the judiciary, and the media of each country.
aDepartment of Endocrinology, Andalusian Gender Team (IBIMA), Carlos Haya Hospital, Malaga bDepartment of Psychiatry, Institute Clinic of Neurosciences, Barcelona, Spain *Gender Identity and Sexual Development Disorders Spanish Group.
Isabel
I
Esteva de Antonio
Esther
E
Gómez-Gil
D005260:Female; D062985:Health Services for Transgender Persons / Q000458:organization & administration / Q000592:standards / Q000639:trends; D020249:Hormone Replacement Therapy; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures; D057830:Gender-Affirming Surgery / Q000592:standards; D013030:Spain; D063106:Transgender Persons / Q000523:psychology; D014189:Transsexualism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome