Approach of the transgender patient

Abstract

“Trans” is an umbrella term that covers transgender individuals, whose gender identity differs from their birth sex but who may not alter their bodies, and transsexual individuals, who pursue full physical and social transition—often through hormonal and surgical interventions—to align with their affirmed gender.

Although evidence of gender transition dates back 5,000 years, modern sex‑reassignment surgery began with French surgeon Georges Burou in 1956 and has evolved into highly specialized procedures performed by multidisciplinary teams. Transition is best viewed as a spectrum: some patients adopt only social changes (name, dress, legal documents), while others progress to hormone therapy and surgery.

Clinical management starts with a comprehensive assessment—medical history, endocrine and thyroid panels, mental‑health screening, and specialty referrals. Confirming gender dysphoria is essential to rule out conditions such as body‑dysmorphic disorder that could lead to postoperative regret.

Transfeminine surgery typically creates a sensate, hair‑free neovagina, either with inverted penile/scrotal skin or, in advanced techniques, a sigmoid‑colon segment for superior depth and lubrication. Transmasculine surgery constructs a neophalus by sculpting muscular flaps from the non‑dominant forearm, adding urethral lengthening, vascular anastomoses, and penile/testicular prostheses.

Because demand for gender‑affirming care is rising, clinicians must cultivate inclusive language, avoid stigmatizing terms, and deliver long‑term hormonal, surgical, and psychological follow‑up. Ongoing advances—such as regenerative medicine—promise even more refined options, but ethical, cultural, and legal barriers remain globally.