Organización de la asistencia a la transexualidad en el sistema sanitario público espa？ol

objective: recognition of transexuality as a clinical entity for which medical attention should be available is currently a well-established reality, but institutional care has not been uniformly instituted throughout spain. the aim of the present study was to determine the current situation of healthcare for transexualism in the publicly-funded health service in spain. materials and methods: a descriptive study based on data provided by the spanish society of endocrinology group on identity and sexual differentiation was performed. the resources in the regions that have created specific gender units for these disorders are described. results: nine autonomous regions (55%) have started to provide various procedures, although only four provide genitoplastic procedures. the first region to include all sex reassignment surgeries was andalusia (year 1999). at the same time, madrid and catalonia also began to provide specialized mental health care and endocrinology but did not include surgical procedures until 2007 and institutional recognition until 2008. since 2007 other regions have incorporated healthcare for transsexual patients. overall, 3,303 patients (a male-to female/female-to-male transsexual ratio of 1.9/1) and 864 surgical procedures have been registered in this study. the composition and proportion of working hours of specialists, as well as the kinds of treatments provided, differ widely in each region. conclusions: the geographical distribution of healthcare to transsexual persons and the services provided vary. few regions offer genitoplastic procedures. the number of applicants exceeds the number estimated by the national health system.