Transsexual and other disorders of gender identity: a practical guide to management. James Barrett, editor. Oxford: Radcliffe Publishing, 2007 (298 pp). ISBN 978 185775 719 4.

This is an outstanding book, fulfilling a marked need. Barrett, principal author and editor, is a consultant psychiatrist and lead clinician at the Charing Cross Hospital Gender Identity Clinic in London. He draws on 20 years’ clinical experience; his writing and presentation are clear and most helpful.

The book concentrates on the major aspects of the health care of transgender men and women, including the role of the psychiatrist and the contributions made by other medical specialists, speech therapists, and surgeons. That the general practitioner’s role in patient care was not given emphasis surprised me. GPs are often in the best position to provide continuity of patient care and coordination of the various specialist consultations.

For the male-to-female transsexual, a masculine voice may be the major obstacle to the person being accepted in the desired sex role. Two chapters describe what can be achieved by speech training and laryngeal surgery.

Feminisation of the male body or masculinisation of the female body is one of the most urgent requests that transgender patients have at their first consultation. Once their diagnosis of transsexualisation has been established, they will require lifelong hormone therapy. The chapter on this subject is essential reading. It is a masterly dissertation on all of the principles of hormonal treatment and the various regimes and modes of administration. Side effects of such therapy and their management are also discussed.

Discussions of surgical treatments deal with breast augmentation or reduction, removal of penis and testicles, vaginoplasty, vulvoplasty, and phalloplasty. All are excellent chapters, but that on phalloplasty deserves special mention because it deals with a difficult and complex subject in an enlightening manner. In all of these chapters, postoperative care and complications are adequately discussed, along with limitations of the various surgical procedures.

The legal issues of gender change are included in a chapter that addresses marriage, the family, employment, pensions and privacy. Even transsexuals in the military services, various religious traditions and their teachings about gender change, and fertility issues affecting transsexuals are considered in the concluding chapters of the book.

The editor and authors have definitely produced a practical text on gender identity disorders for everyday clinical use. I strongly recommend it to all health care professionals involved in the care and management of patients with issues of gender identity. Educators in medicine and the health sciences should consider recommending this book for their undergraduate students. It can truly be said that this book is a clinical gem.