Gender dysphoria in Saudi Arabia

Gender dysphoria is defined as a multisystemic medical condition where a person has marked discordance between their biological sex and the gender they identify with. Here we report a case of 44-year-old male who presented to the family medicine clinic as a known case of gender dysphoria. Patient was severely distressed about his life and was actively seeking a solution to his problem. The patient requested that the treating physician addresses him as a female and uses feminine proverbs while speaking with him. On examination of genitalia, testicles were smaller than normal for his age and sex. Several abnormalities were found including low levels of testosterone, luteinizing hormone, and follicle-stimulating hormone, and elevated prolactin levels. Abdominal and pelvic ultrasound showed that the internal organs were all normal size and consistency. No uterus, ovaries or rudimentary female reproductive organs were found. Testicular ultrasound revealed atrophy of both testicles and weak peripheral testicular vascularity were noted. CT scan with contrast revealed severe hepatic steatosis as well as bilateral gynecomastia. Primary care physicians need to be aware of gender-related disorders as well as the importance of early recognition of these emerging disorders. A multidisciplinary approach is needed to manage these disorders.