Corman V, Legros J-J
Service d'endocrinologie, CHR Citadelle, 4000 Liège, Belgique.
Ann Endocrinol (Paris). 2007 Sep;68(4):258-64. doi: 10.1016/j.ando.2007.06.017. Epub 2007 Aug 13.
Transsexualism is a sexual identity disorder distinguished by the extreme conviction of belonging to the opposite sex with a total disharmony in the original sex. Diagnosis is established when patients respond to three criteria (DSM-IV): 1) Desire to live and to be accepted as members of opposite sex; 2) Presence of sexual identity disorder for minimal two years; 3) Lack of mental disease or chromosomal anomalies. When diagnosis is confirmed, hormonal treatment can be started and so, improve the secondary sexual characters of selected sex. For patients F-M, treatment is composed of testosterone, most commonly esters of testosterone. For patients M-F, treatment consists of estrogens. These estrogens are frequently associated to an anti-androgen (cyproterone acetate) in the pre-reassignment phase. Avoiding the hepatic way, transdermal form is recommended. Hormonal treatments are not devoid of secondary effects: the most frequent one is venous thromboembolism. Considering contraindications and potential complications, each patient must be selected carefully. The endocrinological follow-up is essential and necessary.
易性癖是一种性身份障碍，其特征是坚信自己属于异性，与原生性别完全不协调。当患者符合三项标准（《精神疾病诊断与统计手册》第四版）时即可确诊：1）渴望以异性成员的身份生活并被接受；2）存在至少两年的性身份障碍；3）没有精神疾病或染色体异常。确诊后即可开始激素治疗，从而改善所选性别的第二性征。对于女性变男性的患者，治疗药物为睾酮，最常用的是睾酮酯。对于男性变女性的患者，治疗药物为雌激素。在变性前阶段，这些雌激素常与抗雄激素药物（醋酸环丙孕酮）联合使用。为避免肝脏首过效应，推荐使用透皮剂型。激素治疗并非没有副作用：最常见的是静脉血栓栓塞。考虑到禁忌证和潜在并发症，必须仔细挑选每位患者。内分泌随访至关重要且必不可少。
