"Published transgender-specific level 1 evidence is essentially non-existent. [...] Long-term, prospective studies for most transgender-specific health issues are lacking, thus resulting in variable preventive care recommendations based primarily on expert opinion. However, by utilizing an increasing body of peer-reviewed, scientific research on transgender health, along with relevant data from the general population, one can develop an evidence-based approach to preventive care for patients who are transgendered or transsexual." -- Jamie Feldman, M.D. (Feldman, J [2007])So it's not great, but it's the best we've got, and as good (or bad) as many other medical protocols.
Very good in the main, but the hormone dosage of Oestrodiol Valerate is too low by a factor of 2, and should be maintained even after gonadectomy. Otherwise, very good, even if lacking in detail regarding the different options for genital reconstruction procedures, and with nowhere near enough emphasis on checking for Intersex conditions first. An Intersex condition disqualifies a diagnosis of Transsexuality in the ICD-10, and is a significant clinical modifier in the (draft) DSM 5. Doctors should be prepared to deal with the consequences of involuntary genital surgery on Intersexed infants, and cannot rely on the patient to tell them of those. They may not know themselves.
Hmmm.. maybe I should write to them on this...
I have had a very hard time finding doctors who are interested in checking for possible intersexed conditions. It seems that just about the only way anyone ever finds out they are IS is if it's obvious at birth or if it accidentally gets found out later on when some other physical issue is being investigated.
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