(053) Multidisciplinary Treatment of Transgender Woman with Severe Gender Dysphoria and Comorbid Psychiatric Disorders - Case Report
Authors: Rahne Otorepec I , Simetinger G 
Published: June 2023

Abstract

Introduction
Gender dysphoria is a distress a person feels due to incongruence between their gender identity and their birth assigned sex. Transgender people have higher rates of mood disorders, suicidal ideations and suicide attempts as well as poorer general health. They often abuse psychoactive substances. There is also a correlation between perceived stigma and discrimination.

Objectives
The purpose of this case report is to show the treatment process of a transgender person born as a man using multidisciplinary approach based on the bio-psycho-social model, taking sex history, comorbid psychiatric disorders, social constraints and psychological needs into account.

Methods
A 45-year old male came to the Transgender clinic in Ljubljana, Slovenia. He wanted to transition from male to female. At that time, his appearance, sex and gender was male. He was a miner, married to a woman and lived with his wife in the countryside. His family was ashamed of him because he would go on nights out in public dressed as a woman and had a drinking problem. In the diagnostic phase we confirmed alcohol dependency and severe depression and had him join the addiction treatment programme, which proved successful as he reached stable abstinence. Having overcoming alcohol addiction he still tried very hard to repress his desire to become a woman. His wife tried to get pregnant but he avoided sexual intercourse. He had serious problems with erection and painful sex ascribed to phimosis and eventually got circumcised. He also confessed that he still dressed as a woman in secret, that he wanted to become a woman and consequently started referring to himself as ‘a she’. The wife demanded a divorce. Clinical psychological assessment showed no psychiatric contraindications to start with hormone therapy, first with antiandrogens and a year later with oestrogens, which successfully reduced her gender dysphoria. She reached emotional stability and stopped taking antidepressants. She did not need any otorhinolaryngological procedures or voice therapy. She had face laser therapy and genital epilation as well as nose operation, breast augmentation and genital reconstructive surgery. She received support from the Slovenian non- government organisations and other transgender women. She got a permanent new job in the same firm. Her family of the origin finally accepted her.

Results
Treatment, which lasted for ten year, resulted in a complete medical and social transition without any regrets. She now lives as a woman, uses dilatators and wants to have a biological male partner. She is on permanent therapy with oestradiol, aldactone, dutasteride, and vitamin D. She does not drink alcohol, has no comorbid psychiatric disorders neither gender dysphoria. She is emotionally stable with positive body image and self-esteem. She wears a wig because of hair loss.

Conclusions
Treatment, which lasted for ten year, resulted in a complete medical and social transition without any regrets. She now lives as a woman, uses dilatators and wants to have a biological male partner. She is on permanent therapy with oestradiol, aldactone, dutasteride, and vitamin D. She does not drink alcohol, has no comorbid psychiatric disorders neither gender dysphoria. She is emotionally stable with positive body image and self-esteem. She wears a wig because of hair loss.

Disclosure
No.