Gender Dysphoria

You should see a mental health specialist—a psychiatrist or a trained psychologist—and once the diagnosis is confirmed, you should contact the office of Dr Reena Thomas for an appointment.

Dr Reena Thomas will do a comprehensive medical evaluation and review your mental health professional’s consultation document. She will go through the different hormone options for gender dysphoria, explaining the benefits and side effects.

Once she confirms that you can make a well-informed decision and that all the relevant medical or mental health issues are well-controlled, she will arrange for you to undergo blood tests to evaluate your hormone levels, blood counts, kidney function, and liver function tests. The impact of the different treatments on future fertility will also be discussed.

Dr Thomas will review your medical evaluation and the results of the blood tests and then prescribe the appropriate hormone therapy. The goal of therapy in gender dysphoria is to induce physical changes to match your gender identity. She will adjust the doses of the hormones to maintain hormone levels to match the physiological range of the target gender.

Medications

Dr Thomas will discuss the different formulations of testosterone preparations, including doses and side effects. The goal is to achieve normal male levels. Testosterone causes male-pattern hair growth, an increase in lean body mass, muscle mass, and fat mass, and deepening of the voice.

Gender-affirming surgery

Dr Thomas will advise you that gender-affirming surgery may be done only after one year of continuous hormone therapy and living in the desired gender role.

The surgeries include chest (top) surgery and genital reconstruction surgeries.

Monitoring of therapy

Dr Thomas will monitor your weight, blood pressure, bone density, and the impact of testosterone on hair growth and menstrual cycles. She will arrange for you to undergo blood tests to monitor your blood testosterone levels, hematocrit levels, kidney and liver function, and cholesterol levels at regular intervals. Dr Thomas will advise you on age-appropriate cancer screening.

Medications

Dr Thomas will discuss the different medications, including doses and side effects.  The goal is to achieve a normal female physiological range. The medications will cause a decrease in facial hair growth, induce breast formation, change in voice, and a female pattern of fat/muscle distribution at different time intervals.

The different medications administered are:

1. Androgen suppression – Medications like Spironolactone will be started before genital reconstruction surgery is done.
2. Gonadotrophin-releasing hormone agonists – are medications that suppress gonadotrophins and testosterone secretion.
3. Estrogen therapy – there are different formulations, including transdermal estrogen, oral estradiol, or parenteral estrogen.

Gender affirming surgery

Dr Thomas will advise you that gender-affirming surgery may be done only after one year of continuous hormone therapy and living in the desired gender role.

The surgeries include chest (top) surgery and genital reconstruction surgeries.

Monitoring of therapy

Dr Thomas will perform a comprehensive medical evaluation at regular intervals, along with blood tests to monitor the metabolic panel, testosterone level, and estradiol level. He will also advise you on age-appropriate cancer screening and bone density monitoring.