ACTA ENDOCRINOLOGICA (BUC)

Gender diversity is currently recognized as a natural variation of human identity rather than a pathological condition, with the term “gender identity disorder” being replaced in the eleventh revision of the International Classification of Diseases and Related Health Problems (ICD‐11) by “gender incongruence” and reclassified under “conditions related to sexual health” rather than within “mental and behavioral disorders”. Lack of access to genderaffirming care or delays in treatment are associated with poorer physical, psychological, and social outcomes. Current concepts and clinical practices in gender-affirming care focus on the multidisciplinary integration of endocrine and surgical management. This review summarizes diagnostic considerations and surgical perspectives on transgender patient care from a plastic surgery standpoint, while endocrinology specialists manage hormonal therapy. Surgical treatment for transgender women may include procedures such as breast augmentation, body contouring procedures, vaginoplasty, facial feminization, reduction of the thyroid cartilage, and surgeries intended to alter voice characteristics. The surgical options for transgender men include bilateral mastectomy, placement of pectoral implants to create a male-contoured chest, total hysterectomy and salpingooophorectomy, vaginectomy, scrotoplasty, placement of testicular prostheses, metoidioplasty or phalloplasty, and body contouring procedures. This review aims to support clinicians by synthesizing current evidence and best practices to promote safe, effective, and individualized multidisciplinary treatment for transgender and genderdiverse patients.

Acute or chronic burn injuries require hormonal responses that significantly influence patient prognosis. Elevated cortisol, catecholamines, and glucagon levels, lead to important metabolic changes, such as hyperglycaemia, insulin resistance, protein catabolism, free fatty acids oxidation, and secondary metabolic acidosis. These alterations impair immune function and wound healing and trigger a systemic inflammatory response. A multidisciplinary approach is needed in order to correctly manage the aforementioned endocrine and metabolic changes. During the acute phase, glucose monitoring, corticosteroid administration for transient or iatrogenic adrenal insufficiency and electrolyte balance maintenance are critical. Chronic phase requires hormonal replacement, nutritional optimization, and anabolic agents administration to counteract catabolic states. Despite continuous advances in burn care, understanding the complex interplay between hormonal changes and immune dysfunction remains challenging. Managing burn-associated endocrine responses could lead to the development of new therapeutic strategies, including personalised and stage- adapted treatment.