Previous legal guidelines required medical assessments to diagnose the affected person with gender dysphoria.
The drug doesn’t require as many medical controls, since a secure focus of testosterone is maintained, avoiding peaks and alterations.
On December 2, the Ministry of Health introduced the inclusion within the pharmaceutical provision of the National Health System of a brand new hormonal therapy whose lively precept is a testosterone decanoate and which is meant, amongst others, for trans folks.
“This drug, known in Spain as reandron, had already existed for a long time, but until now it was not included in the free health coverage,” explains Antonio Becerra, endocrinologist knowledgeable in transgender drugs and coordinator of the Community’s Gender Identity Unit. from Madrid. The foremost benefit of this remedy is that trans males would require fewer intramuscular punctures, often administered weekly.
“This treatment only involves an intramuscular injection every three months, which makes life much more comfortable,” explains the specialist. In addition, the drug doesn’t require so many medical controls, since a secure focus of testosterone is maintained, avoiding peaks and alterations.
Medical evaluations to begin intercourse change remedies have been a subject of debate all through this 12 months. On May 18, the admission to course of a invoice trans who, by not reaching a easy majority of votes in favor, didn’t go forward. But, a month later, the Spanish authorities accepted a invoice to permit that from the age of 14 you’ll be able to change your intercourse within the civil registry with an administrative process with out the necessity for well being studies and medical and authorized guardianship to proceed with such modification.
Until then, the earlier legislation, of 2007, required that for the change of intercourse the individual had been identified with gender dysphoria, for which it was required a medical or psychological report. In addition, she should have been medically handled for a minimum of two years to accommodate her bodily traits to these comparable to intercourse.
“From my personal point of view, the gender identity of the person is not diagnosed. Identity is a feeling of belonging and does not admit diagnosis. gender self-determination as a principle The regulator has been included in various regional laws for several years. Valencia and Madrid are a sample ”, says Marcelino Gómez Balaguer, from the Gender Identity Unit of the Dr. Peset University Hospital in Valencia and coordinator of the Sexual Identity and Differentiation group of the Spanish Society of Endocrinology and Nutrition (GIDSEEN) of the Spanish Society of Endocrinology and Nutrition (SEEN), established more than 20 years ago years as a multidisciplinary group of professionals involved in the identity issue.
“In the last Spanish National Congress of Psychiatry, the board of directors already put a headline that transsexuality is not a disease. And the World Health Organization (WHO) stopped considering it a mental disorder in 2018. That is why a psychiatric examination is no longer a mandatory requirement to start hormonal treatment ”, justifies Becerra, who attended her first case of sex change in the 92. According to a publication of the magazine Endocrinology and Metabolism Clinics of North America, the rough estimate of the trans and non-binary population ranges from 0.1% to 2% among adults.
Although in Spain there are no exact data on the prevalence of the trans population in Spain, experts are increasingly finding more cases of patients who want to transit.
Lifetime hormonal treatment
“The current profile of users we serve has changed a lot in recent years. A few years ago the percentage of transgender people requesting surgery was very high. Currently, the “corporeality” model and the very dynamics of society make transgender people request less binary and rigid models of intervention, ”explains Gómez Balaguer.
“Before there was a higher proportion of trans women, but in recent years we are observing a worldwide phenomenon: it is mainly girls between the ages of 16 and 18 who want to transition to men. The prevalence of people who are born women, but who feel they are men is growing exponentially “, says Becerra, till a month in the past coordinator and member of the Sexual Identity and Differentiation group of the Spanish Society of Endocrinology and Nutrition (GIDSEEN).
For the specialist, the seek for id is a gradual course of “that should go step-by-step. You can not begin with an irreversible intervention, comparable to an operation, however it’s important to begin with the changeable, with the change of garments, for instance.
It begins with a low dose of hormones and we transfer ahead. When a 12 months and a half or two have handed, then we suggest surgical procedure ”, particulars the endocrinologist from the Community of Madrid. “And it must be taken into account that the treatment is for life, without hormones the bones are decalcified, whether male or female. If they have had surgery they will always need hormones for their bones! ”He provides.
In Spain there are a number of facilities which have specialised models in gender and id however, besides within the case of a mastectomy, just some communities comparable to Madrid, Andalusia, the Basque Country, Valencia or Catalonia, carry out gender reassignment surgical procedures.
According to the Center for Oncological Surgery, which has a unit specialised in gynecological surgical procedure, this sort of intervention has doubled in our nation within the final 5 years. In Becerra’s phrases, “specialized surgical personnel are scarce and should be increased. Making a vagina that is physically functional and aesthetic at the same time for an expert who has done many is not complicated ”.
“Masculinizing genital surgeries do not give good results so they are still in little demand”, provides the coordinator of the GIDSEEN group, explaining that “transgender women do not necessarily reject their genitalia. The demand for this type of surgery continues to be very important, but in young people the experience of the genital has changed a lot. In the case of transgender men, mastectomy is mostly requested ”.
Vaginoplasty, whose purpose is to create a vagina in the person who was born male, consists of removing the testicles (orchiectomy) and penis (penectomy), creating a vagina with penile or colon tissue (vaginoplasty), creating a vulva ( vulvoplasty), create a clitoris (clitoroplasty) and create genital lips (labiaplasty). There are two forms of intervention.
On the one hand, it can be carried out by penile inversion, “in which the skin of the penis and scrotum are inverted to create a vagina. As if it were a sock ”, details the specialist. The other method is through the pedunculated rectosigmoidal flap, an operation in which the end of the large intestine is used to create the vagina. “This is less frequent because it is more complicated. A tissue with sapofritic bacteria placed for other functions can make them turn out to be pathogenic. “
In the opinion of the knowledgeable from the Dr. Peset University Hospital, “it isn’t an excellent technique to carry out surgical procedures on a physique that’s nonetheless creating and on folks with a gender id in coaching and in a part nonetheless of id development. It is handy to set an individualized technique in response to every life historical past and the severity of the dysphoria. We should assess the individual’s scientific state of affairs, related danger elements, smoking, pores and skin situation, surgical dangers, and so on. “
According to Becerra, “the real problem with these interventions occurs when patients come across inexperienced hands, as happened before with bariatric surgery. Now there is experience, but before there were many disasters and even deaths ”.
The expert in transgender medicine points out another problem when it comes to sex reassignment: “not all people who transition come to a specialist from scratch, they may have been self-medicating for years, without having had any medical attention. Some have been subjected by inexperienced hands, with surgeries that have to be modified, with penis mutilation or oils that have been injected for breast development, for example ”.
In addition to the genitals, sex change operations require facial and voice surgery, among other aspects. “That is why, even whether it is an endocrine subject, it’s so essential to have a disciplinary staff to hold out an entire technique of intercourse reassignment”, emphasizes the specialist. Our job is not only to administer powerful hormones or offer a scalpel, but to inform people, explore alternative routes to medication and accompany them in making their decisions “, concludes Gómez-Balaguer.