Page 40 - University of Pretoria RESEARCH REVIEW 2016
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“There is a growing commitment in public health to understand and improve the health and wellbeing of transgender people and other gender minorities, who comprise an estimated 0.3–0.5% (25 million) of the global population. The adoption of the 2030 agenda for sustainable development and its pledge to ‘leave no one behind’ has
given renewed impetus to this movement.”1
Transgenderism is a prominent socio-medical entity that has attracted wide media, social and medical discussion. The University of Pretoria Gender Reassignment Clinic at the Steve Biko Academic Hospital was started in 1992 and formalised in 1994, with team members representing the Departments of Gynaecology, Psychiatry, the Internal Medicine Division of Endocrinology, Urology, Plastic Surgery and the Institute for Molecular and Cellular Medicine.
Professor Gerhard Lindeque, Head of Obstetrics and Gynaecology, writes that transgenderism is not a psychiatric disease, as is commonly held. It can best be described as a disconnect of the assigned gender based on the physical form, and the self-realisation of gender as being what the person sees his or her gender to be. Several interventions are required to manage and support transgender individuals, and to decrease mortality.
Transgender people typically have low rates of access to health services due to a range of issues, including violence, legal barriers, severe stigmatisation and discrimination. In South Africa, the exact prevalence is unknown as many keep their condition hidden, and
1 R Thomas et al. Ensuring an inclusive global health agenda for transgender people. Bulletin of the World Health Organisation 2017; 95:154–156. doi:
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underdiagnosis is common. If untreated, the mortality of transgender people is high as a result of suicide.
Individuals are most commonly referred to the UP Clinic by a psychiatrist or psychologist, and are met by a multidisciplinary team. Once accepted into the Clinic, the time-spaced sequence of gender reassignment includes a psychiatric evaluation
to exclude psychiatric disorders; a programme to provide a continuum of support; endocrine support and hormone treatment; and finally, surgical interventions which result in the desired physical gender. There are multiple exist points which are determined by the individuals themselves based on the extent of the interventions desired.
Professor Michael Pepper, Director of the Institute for Cellular and Molecular Medicine, writes that
the interplay between nature (genes and genetics) and nurture (the environment) is at the heart of the debate about the factors responsible for gender and sexual diversity. While transgender identities have existed through much of recorded history, it is only in the past 50 years that the term transgender has been used. And it is only more recently that science, at a molecular level, has suggested that environmentally- induced variations in the expression of an individual’s genes (epigenetics) before birth, can lead to variations from perceived societal normality.
Despite advances in science, and the rights enshrined in the highest levels of the law both in South Africa and internationally, gender and sexual variation have led to immense suffering for lesbian, gay, bisexual, transgender and intersex (LGBTI) people because they do not fit the expectations of what is considered by certain sectors in society to be the ‘norm’.
          Suzy Bernstein (

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