Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management

healthtransgenderwomenkapak

PSYCHOLOGICAL ASSESSMENT OF TRANSGENDER INDIVIDUALS BEFORE SURGERY

Elif Küçük

Yüksek İhtisas University, Faculty of Medicine, Department of Psychiatry, Ankara, Türkiye

Küçük E. Psychological Assessment of Transgender Individuals Before Surgery. Balsak D, Aksin Ş, eds. Health of Transgender Women: Gynecological, Hormonal, Sexual and Psychological Management. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.261-270.

ABSTRACT

Gender identity and expression are multifaceted constructs encompassing biological, psychological, and social dimensions. While traditionally defined through binary classifications, recent research highlights the dynamic and fluid nature of gender identity. Transgender individuals, whose gender identity does not correspond with their assigned sex at birth, frequently face significant psychosocial challenges. These include social exclusion, discrimination, barriers to accessing healthcare, and societal stigma. The “Gender Dysphoria” diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders -5 (DSM-5) aims to reduce stigma and foster inclusive healthcare practices for transgender individuals.

Social stressors faced by transgender individuals include misgendering, the need to conceal their gender identity, discrimination, and systemic marginalization. These factors significantly contribute to the prevalence of mental health issues such as depression, anxiety, and suicidal ideation among this population. Additionally, experiences of disrespect or mistreatment within healthcare settings can lead to healthcare avoidance and increased substance use. However, studies have demonstrated that gender-affirming medical interventions, such as hormone therapy and surgical procedures, significantly reduce gender dysphoria, improve mental health outcomes, and enhance overall quality of life.

Preoperative psychological assessments are crucial in determining an individual’s readiness for medical interventions and ensuring the safety and efficacy of these procedures. Mental health professionals are responsible for evaluating patients’ capacity to provide informed consent while addressing coexisting psychiatric conditions and substance use disorders. Such issues should not prevent access to gender-affirming care but should be managed to support successful outcomes.

During the perioperative period, addressing psychosocial needs—such as housing stability, social support systems, and economic challenges—is essential. Additionally, mitigating health risks such as smoking can enhance the success rates of medical interventions. Gender-affirming care must adopt a patient-centered approach, respecting individual autonomy and incorporating evidence-based practices to address healthcare disparities. Continuous psychotherapy can support individuals in exploring their identity, building resilience, and maintaining mental well-being before and after medical transitions.

In conclusion, healthcare services for transgender individuals should be delivered through a multidisciplinary and personalized approach. Reducing barriers to care, improving access to treatment, and fostering inclusive environments that affirm diverse gender identities are vital for enhancing the quality of life and overall health of transgender individuals. A comprehensive approach addressing the psychological, social, and medical aspects of gender-affirming care is imperative.

Keywords: Gender dysphoria; Transgender persons; Health dervices for transgender person; Sex reassignment surgery; Personality disorders

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