The results suggest that MHO is a dynamic concept that should be taken into account over time. As a clinical entity, it may be questionable.

Cross-sex hormonal treatment, family support, and working or studying are linked to a better self-reported QoL in transsexuals. Healthcare providers should consider these factors when planning interventions to promote the health-related QoL of transsexuals.

Recent studies have confirmed important regional differences in the prevalence of obesity, as well as a tendency for this prevalence to increase. Determination of the social factors involved in obesity may be very useful to design intervention and prevention strategies. This transverse study was undertaken in Pizarra (Malaga, Spain) from a random sample of the population between 18 and 65 years of age (n = 1226). All participants were interviewed and given a physical examination. Standardized anthropometrical measurements were made, and a baseline blood sample was taken after an oral glucose tolerance test. The overall prevalence of obesity (BMI > 30 kg/m2) was 28.8%. This figure increased continuously from 10% in the group aged 18-25 years to above 50% in the groups aged over 55 years. This prevalence is higher than that reported in most other studies in Spain. The obese persons ate differently, at least from a qualitative viewpoint, probably more saturated fats and fewer unsaturated fats, and had a different behaviour concerning alcohol and smoking. Marital status was related with the rate of obesity, and the close relation between the level of education and the risk of obesity was confirmed (OR = 3.8 for being obese and having no education compared to having university studies). The most important consequence of the study was that all these factors are potentially modifiable and preventable. An increased level of general education in the population may well contribute decisively to a reduction in the prevalence of obesity.

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Transsexualism affects all adaptive physical and psychosocial aspects of a person. As diagnosis is based only on the history and personal perceptions, a broad social debate exists about the need for treatment financed by the public health systems. Some countries restrict the care to transsexuals with private medical policies. Thus, coordination of care also requires participation of the family and associations, with continuous information to the health authorities, the judiciary, and the media of each country.