The gender dysphoria (GD) refers to the distress caused by the incongruence between gender identity and biological sex. This occurs, especially in pre-treatment cross-sex hormone therapy (CHT), with a marked dissatisfaction with their body image.

The purpose of this study is to evaluate the role of perceived gender in a total of 20 subjects (9 MtFs and 11 FtMs), presented for initiation of CHT at the Psychiatric Clinic or Department of Endocrinology of University Hospital of Cagliari and deemed appropriate to take the transition path aimed at sex reassignment. On a subsample of 7 patients (2 MtFs and 5 FtMs) were then evaluated changes, in terms of improving the acceptance of body image, at 2 months after initiation of CHT, using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) (focusing on MF, Gm and Gf scale), the Bem Sex Role Inventory (BSRI), and the Body Uneasiness Test (BUT).

The MF scale shows a moderate elevation, which is reduced significantly as a result of correction for perceived gender rather than biological sex. MtFs get higher scores on the Gf scale and lower scores on the Gm scale than FtMs. This trend is confirmed by the average scores of BSRI: MtFs are more “feminine”; while the FtMs are less “masculine”. This denotes an excessive identification by MtFs with the female gender role. Before initiating the CHT, the BUT score was indicative of clinically significant distress, which decreased during the CHT.

In conclusion, CHT reduces evidently body discomfort, due to the progressive reduction of the discrepancy between biological and desired gender.