Executive summary: Quality standards of care units for people with sexual and gender diversity.

Comprehensive biopsychosocial care for people with gender incongruence (ICD 11) who are transgender (trans) or gender diverse is a complex process in which the quality of the medical transition can only be guaranteed after a multidisciplinary approach, through teams that integrate professionals with training and experience not only in medicine but also in diversity and gender identity. Based on this, the Gonad, Identity and Sexual Differentiation working group of the Spanish Society of Endocrinology and Nutrition (GT-GIDSEEN) has established minimum care requirements that aim to guarantee adequate health care for these people by professionals. A position paper has been produced and is available at https://www.

Evolution and trends in referrals to a specialist gender identity unit in Spain over 10 years (2012-2021).

Background: International studies have reported an increase in referrals to gender identity units, a shift in the assigned sex ratio of adolescents, a decrease in the age at first visit, and a growing presence of individuals with nonbinary gender identities.

Aim: To investigate whether these trends are present in a Spanish sample of individuals referred to a gender identity unit over the last 10 years.

Methods: We conducted a retrospective chart review of 913 consecutive referrals to a gender identity unit between 2012 and 2021 and retrieved information regarding sex assigned at birth, age at first visit, and expressed gender identity.

Initial clinical and treatment patterns of advanced differentiated thyroid cancer: ERUDIT study.

Background: Up to 30% of differentiated thyroid cancer (DTC) will develop advanced-stage disease (aDTC) with reduced overall survival (OS).

Objective: The aim of this study is to characterize initial diagnosis of aDTC, its therapeutic management, and prognosis in Spain and Portugal.

Methods: A multicentre, longitudinal, retrospective study of adult patients diagnosed with aDTC in the Iberian Peninsula was conducted between January 2007 and December 2012.

Clinical practice guidelines for transsexual, transgender and gender diverse minors.

Some people, including minors, have a gender identity that does not correspond to the sex assigned at birth. They are known as trans* people, which is an umbrella term that encompasses transgender, transsexual, and other identities not conforming to the assigned gender. Healthcare units for trans* minors require multidisciplinary working, undertaken by personnel expert in gender identity, enabling, when requested, interventions for the minor and their social-familial environment, in an individualized and flexible way during the gender affirmation path.

Medical detransition following transgender identity reaffirmation: two case reports.

Background Recently, increased social and scientific attention has been paid to gender detransition, a phenomenon in which individuals discontinue gender-affirming medical interventions (GAMI) aimed at alleviating gender dysphoria (GD). Yet, clinical knowledge of detransitioners and their experiences is still scarce. Case reports published in the literature suggest that both internal and external factors may influence this decision.

[New care models for transgender people in the Spanish Health System: demands, controversies and reflections.].

Health care for transgender people in Spain has been progressively established since 1999 when the first multidisciplinary unit for the treatment of sex reassignment was created in Andalusia. In this document, the social changes, the demands and debates of users and professionals, the new models of health care for trans people, and reflections on the current situation, have been analysed. The social openness in Spain regarding sexual and gender diversity has evolved quite positively.

Testosterone administration increases leukocyte-endothelium interactions and inflammation in transgender men.

Objective: To evaluate the effect of testosterone treatment on metabolic and inflammation parameters and leukocyte-endothelium interactions in transgender men (TGM).

Design: Prospective observational study.

Setting: University hospital.

Transsexuality: Transitions, detransitions, and regrets in Spain.

Introduction: Health care demand by transsexual people has recently increased, mostly at the expense of young and adolescents. The number of people who report a loss of or change in the former identity feeling (identity desistance) has also increased. While these are still a minority, we face more and more cases of transsexual people who ask for detransition and reversal of the changes achieved due to regret.

Influence of obesity on atherogenic dyslipidemia in women with polycystic ovary syndrome.

Background: Obesity is known to underlie, at least partially, dyslipidemia in polycystic ovary syndrome (PCOS), but it is unclear whether PCOS status per se increases the risk of alterations of lipoprotein subfractions, which differ in size and atherogenic potential. Our objective was to evaluate whether PCOS influences lipoprotein profile and LDL and HDL subfractions and to study the impact of obesity on these parameters.

Materials And Methods: This was a case-control study conducted in an academic medical centre.

Symptomatic meningioma induced by cross-sex hormone treatment in a male-to-female transsexual.

Transsexualism is defined as a strong conviction of belonging to the opposite sex in individuals without any physical intersex condition. Cross-sex hormone therapy is an important component of medical treatment of transexuals but it is not exempt from adverse effects. We report a case of a meningioma in a male-to-female transsexual patient treated with estrogens and cyproterone acetate for the past 4 years.

Prolactinoma induced by estrogen and cyproterone acetate in a male-to-female transsexual.

Objective: To report a case of a microprolactinoma in a male-to-female transsexual treated with estrogens and cyproterone acetate.

Design: Case report.

Setting: Endocrinology unit in a university hospital.

A novel mutation in DAX1 (NR0B1) causing X-linked adrenal hypoplasia congenita: clinical, hormonal and genetic analysis.

The association of primary adrenal insufficiency and hypogonadotropic hypogonadism is extremely infrequent in daily clinical practice. Differential diagnosis includes X-linked adrenal hypoplasia congenita, a genetic disease characterized by an alteration in the formation of the adrenal glands and the hypothalamus-pituitary-gonadal axis. The gene responsible is DAX1 (NR0B1).

Parameters of inflammation in morbid obesity: lack of effect of moderate weight loss.

Background: Obesity has been associated with a chronic activation of the acute-phase response. The aims of our study were to investigate whether levels of inflammatory cytokines are higher in obese patients, to evaluate their relationship with metabolic syndrome, and to analyze the effect of moderate weight loss upon their levels.

Methods: Sixty-seven severe or morbid obese patients were compared with 67 controls.

Association between diabetic ketoacidosis and thyrotoxicosis.

Three cases of diabetic ketoacidosis precipitated by thyrotoxicosis are presented. Two of them are young women with type 1 diabetes mellitus; the third case is a middle-aged woman with type 2 diabetes mellitus. All of them were diagnosed with Graves' disease.

Massive triiodothyronine intoxication: efficacy of hemoperfusion?

A case of massive accidental triiodothyronine intoxication (1000-fold the usual therapeutic dose, for 8 days) is reported with important disturbances of cardiovascular and central nervous systems that required intensive care support. Serum free triiodothyronine levels were 4789 pmol L(-1) on admittance (normal values, 3.5-6.