This report presents socio-demographic data of gender incongruent patients, searching for gender affirming medical care (GAMC) in Russia by retrospective medical records analysis of patients. Data of 1117 patients were included in the analysis. Over the period from 2014 to 2021, there was a significant increase in the number of applications (+123.2%). Among all transgender individuals 44.01% were trans femine (MtF) and 55.99% (n=630) were trans masculine (FtM), 1.2% was non-binary persons. The average age for GAMC application in MtF was 26 years and in FtM was 23 years. Majority of patients experienced gender incongruence (GI) since pre-pubertal age (median 11.0). Age of acceptance oneself as a "transgender " was 17.0 years, earlier in FtM, later in MtF. The first coming-out was made at 20 (22 for MtF, 19 for FtM). Depression was diagnosed in 82,4% cases,12.6% of patients have suicide attempts. 53.6%, were already taking hormonal therapy (76.7% MtF, 32.3% FtM). The Russian transgender population is big, stigmatized, ethnically and culturally heterogeneous group, that has little visibility. Further research is essentials for formation of professional attitude in the medical environment.
BACKGROUND: In recent years, the demand for feminizing and masculinizing hormone therapy has increased significantly among transgender people around the world. There are no such studies in Russia and the amount of medical information on the transgender population is limited.AIM: to assess the number of transgender patients who take hormone therapy without a doctor’s prescription and to characterize the medicines they use.MATERIALS AND METHODS: data from 1117 transgender patients were included in to analysis: 44.01% (n=515) of them were trans women, 55.99% (n=630) were trans men. Patients applied to the “Scientific Center for Personalized Medicine” in order to receive medical care.RESULTS: Half of transgender people (53.6%) are already taking hormonal drugs. More often transgender women (76.7%), less often transgender men (32.3%). In this case, only 8.6% turned to endocrinologists for the therapy prescription. Many patients used unlicensed drugs, use irrational schemes and combinations, often overdose.CONCLUSION: A significant number of transgender people start using hormone replacement therapy on their own initiative, without the doctor’s supervision. The solution to this problem could be incensement of knowledge level in doctors and patients to create a friendly environment and productive interaction between therapists, endocrinologists and transgender people, as well as the organization of consulting centers within public medical institutions.
According to foreign publications, 58% of patients with gender disorders had additional psychiatric diagnosis, 39.3% had at least one suicide attempt. The data of suicidal activity and mental comorbidity in Russian population of transgenders are absent.Purpose of the study is to assess suicidal activity and mental comorbidity in persons with gender disorders.The retrospective analysis of records of patients applied with complains on gender disorders from January 2014 to April 2021 was applied. The demographic characteristics, life anamnesis, comorbid mental pathology at time of appliance, frequency of suicidal attempts, suicidal thoughts and auto-aggressive behavior were examined. The data of 926 patients with gender disorders were included: FtM 515 (55.7%), MtF 411 (44.3%). The median age of patients applied for care appliance was 24 years (13-65 years). In group of transgender patients 75.2% had no mental illness, except gender disorders. At that, there was high prevalence of comorbid mental pathology (24.8% on average). Usually, it was background mental illnesses and reversible mental disorders, which were not causes of gender disorders. The suicide rate in transgender group was 12.5%. For 1 patient with suicidal experience, there were 1.3 suicidal attempts (from 1 to 5). The significant dependence of increased suicidal activity, depression, auto-aggressive behavior and rate of comorbid mental pathology on age of debut of gender disorders was established. The transgender patients with debut of gender dysphoria in puberty age are most vulnerable to development of any mental pathology. The suicidal activity of patients with gender disorders depends on both social causes and presence of comorbid mental pathology. A number of modifiable risk factors for suicidal behavior were identified: support of relatives, external correspondence to associated gender, early steps to “change gender”, earlier apply for medical care, background compensated mental illnesses.
In foreign literature on research into the etiopathogenesis of autism spectrum disorders (ASDs), the division of this group of diseases into two forms is getting more and more frequent. These two forms are 'syndromal' and 'non-syndromal' forms of autistic disorders. The literature review aims to cover the issues of the dichotomous classification of ASDs based on the genetic and molecular psychiatric views on the etiopathogenesis of this group of diseases. It also covers the purpose of this classification, the opportunities of its usage in routine clinical practice and the network resources, which allow classifying a form of ASD correctly. Special attention is paid to the multidisciplinary approach to dichotomous classification and its difference from the clinical view on the systematization of autism and the importance of this method for selection of target therapy.
Objective: to identify potentially reversible clinical and socio-demographic factors influencing the social adaptation of patients with gender incongruence (GI). Materials and methods: a retrospective analysis of 926 patient records with MtF and FtM GI was performed. Results: among the patients who applied, 44.38% were MtF, 55.62% were FtM. The mean age was 24.0 years (from 13 to 65 years). The educational level of patients is mainly represented by higher (44.2%) and specialized (22.3%) education, 43% of persons lived in the village, 57% - in urban areas. The majority of those who applied grew up in a complete family (82.02%). The first manifestations of GI started mainly in the prepubertal (26.4%) and parapubertal (61.6%) period (up to 13 years). The average age of accepting oneself as a transgender person was 17.0 years. Steps to reduce dysphoria and receive specialized care are usually taken after the age of 20. 83.1% of transgender patients had depressive episodes, and a third (38.5%) had autoaggression. Additional psychiatric diagnoses were present in 24.5% of patients and are represented by 3 groups of diseases: group 1 (6.2%) — potentially reversible neurotic disorders; group 2 (14.1%) — background mental illnesses that are not the cause of GI; group 3 (4.3%) — other mental states with “ideas of sex change”. Conclusions: improvement of social adaptation and prevention of emotional and psychological experiences in persons with GI, assistance is possible at several levels: family, educational institutions, medical community, patient organizations.
Significance. Gender incongruence (GI) is a poorly covered problem of the domestic healthcare. It is characterized by a distinct and persistent incongruence between gender identity of a person and gender assigned at birth. This incongruence sometimes manifests in suicidal mood and autoaggression. Purpose: To analyse mental health and suicide rates among persons with GI in the Russian population in connection with the age at which they received information about transgenderism. Material and methods: a retrospective analysis of patient records who applied for gender-affirmative care. Results: Transgender people go through a long way of realizing themselves and their problems. On average, the period from the onset of the first symptoms of GI to the time of seeking gender-affirmative care equals to more than 10 years. In the group of transgender patients, 75.2% do not have any mental disorders. However, a rather high prevalence of comorbid mental pathology (24.8%) was observed. These are generally background mental disorders and reversible mental disorders that are not the cause of GI. Frequency of suicides in the group of transgender people equals to 12.8%. On average, there are 1.3 suicide attempts (1 - 5) per patient with a suicidal experience. The frequency of suicidal activity and the burden of comorbid diseases are higher in the group with children. This group also shows a later age of obtaining information. A relationship between suicidal activity, depression, auto-aggressive behaviour, incidence and severity of comorbid mental pathology and the age at which the patient was informed about transgenderism and therefore, realized their problem has been identified. Transgender patients with the onset of gender dysphoria at puberty are most vulnerable to developing a mental pathology. A negative impact on mental health and suicidal behaviour has been demonstrated in individuals attempted to adapt to the gender registered in the passport and were forced to perform the role opposite to their gender identity. Conclusion: Timely awareness of parents and adolescents about GI is an important modifiable factor for reducing the incidence of suicide and preventing the development of comorbid mental disorder in individuals with GI. An earlier possibility of adequate information about the state, possibilities for solving problems, preventing pressure from the family, teachers and society will improve mental health in GI population and reduce social loss.
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