Endocrine Division, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
JAMA. 2013 Feb 6;309(5):478-84. doi: 10.1001/jama.2012.165234.
Gender identity disorder (transgenderism) is poorly understood from both mechanistic and clinical standpoints. Awareness of the condition appears to be increasing, probably because of greater societal acceptance and available hormonal treatment. Therapeutic options include hormone and surgical treatments but may be limited by insurance coverage because costs are high. For patients seeking male-to-female (MTF) change, hormone treatment includes estrogens, finasteride, spironolactone, and gonadotropin-releasing hormone (GnRH) analogs. Surgical options include feminizing genital and facial surgery, breast augmentation, and various fat transplantations. For patients seeking a female-to-male (FTM) gender change, medical therapy includes testosterone and GnRH analogs and surgical therapy includes mammoplasty and phalloplasty. Medical therapy for both FTM and MTF can be started in early puberty, although long-term effects are not known. All patients considering treatment need counseling and medical monitoring.
性别认同障碍（跨性别）从机制和临床角度来看都知之甚少。由于社会的接受程度提高和激素治疗的普及，人们对这种情况的认识似乎有所提高。治疗选择包括激素和手术治疗，但可能受到保险范围的限制，因为费用很高。对于寻求男性到女性（MTF）转变的患者，激素治疗包括雌激素、非那雄胺、螺内酯和促性腺激素释放激素（GnRH）类似物。手术选择包括女性化生殖器和面部手术、乳房增大和各种脂肪移植。对于寻求女性到男性（FTM）性别转变的患者，医学治疗包括睾酮和 GnRH 类似物，手术治疗包括乳房切除术和阴茎成形术。FTM 和 MTF 的医学治疗都可以在青春期早期开始，尽管长期效果尚不清楚。所有考虑治疗的患者都需要咨询和医学监测。
