Experience of a Gender Identity Unit in Spain (2015-2023): Trends, Treatments, Surgeries, and Detransitions

The healthcare model for transgender people in Andalusia changed in 2015 with the creation of Transgender People Care Units in each province. This retrospective study based on medical files describes the characteristics and analyzes the types of clinical demand of the transgender population treated at the Cadiz unit from 2015 to 2023. A total of 771 people were assisted during the study period, of whom 338 were assigned as male at birth (43.8%) and 433 were assigned as female (56.2%). The average age at the time of the initial evaluation was 21.36 ± 8.96 years. With respect to gender identity, 422 (54.73%) were identified as transmen, 334 (43.32%) as transwomen, 13 (1.69%) as gender nonbinary, and 2 as gender fluid (0.26%). Gender-affirming hormones (GAHs) were started by 620 people (80.41%), with an average age of 20.9 ± 7.43 years, and 7% of the population received puberty blockers (exclusively or prior to GAHs). Psychological support was requested by 213 people, more frequently among teenagers. A total of 194 breast surgeries and 130 genital surgeries were performed. Only 9 individuals (1.3%) presented changes in the gender identity initially expressed, and one of them expressed regret about treatment. In conclusion, demand for transgender care has grown exponentially in recent years, especially among the adolescent population, with a trend in favor of transmen. Most people requested hormonal therapy and, to a lesser extent, gender-affirming surgeries. The rate of people who changed their initially expressed gender identity was small, although it could be underestimated due to the high loss to follow-up for unknown reasons.