The Gender Variation Clinic is a clinic providing medical services for all ages. The office normally operates on the 1st – 4th Friday of each month – the business hours are from 1:00 P.M. – 3:30 P.M. The provided services are as follows:

1. Sexuality questioning and Gender diversity.

2. Mental health issues of LGBTQIA+ patients such as stress, depression, and anxiety etc.

3. Before and after gender affirmation surgery.

4. Medication related to hormone replacement therapy and dermatology such as skin and acne treatment, and drug-induced hair loss all advised by dermatologists. Also, provide a hormone intramuscular self-injection demonstration for patients.

5. Health check-up packages for transgenders such as HIV testing, screening for hepatitis B, annual screening mammogram for breast cancer, vaginal examination (for patients who have no removal of the uterus), and bone density test (to detect osteoporosis from stopping taking the medication) The total number of patients from October 2021 – September 2022 is 451; the ratio is 285 former patients and 166 new patients. Moreover, the number of provided services is 1,115. Additionally, the gender variation clinic also conducts research to understand the patients better about their changes. “Characterizing Dermatological Conditions in the Transgender Population: A Cross-Sectional Study” is a research that was published in a journal called Transgender Health with the support and collaboration from the division of dermatology and the clinic (Ramadermatology x Gen V Clinic) of the hospital. This is the very first research in Thailand that studied and focused on the transgenders’ skin after receiving hormone replacement therapy. To highly meet the individual needs, the hormone replacement must be done accordingly to the desired physical appearance of each patient. For example; transmen will be received testosterone replacement therapy to increase the masculinity such as muscle mass and deeper pitch, and also cause oily skin, acne, hirsutism, and thinning hair. On the other hand. Transwomen will be received estrogen replacement therapy to increase femininity, causing less acne, less oily skin, less body hair, meanwhile moisturizing the skin. However, the side effects from after receiving the mentioned hormone replacement therapy may be occurred and disturbing for the transgenders, depending on the period of treatment. The study showed that after receiving testosterone replacement therapy, acne severity had increased and peaked over the first 6 months, but it reduced gradually in 1-2 years later by drugs for external use or oral medications. Furthermore, the level of cumulative testosterone did not cause acne. For transmen after receiving the therapy, hirsutism occurred in body areas dependent on androgens namely mustache, chest, abdomen, and pubis. Besides after 2 years of hormone replacement therapy, 76% of transmen faced hair loss conditions similar to androgenetic alopecia in men - the statistical significance of the symptoms and conditions are relevant to the period of the therapy. In transwomen, facial acne, back acne, and oily skin reduced since the first 6 months of receiving estrogen and anti-androgen, and visibly gone after 3 years. Additionally, hirsutism in body areas dependent on androgens also decreased, which was satisfying for transwomen. In contrast, 1 of 3 transwomen had more melasma than before. The fascinating point was that 16% of transwomen had hair loss conditions similar to androgenetic alopecia in women after receiving the hormone. These conditions in transwomen could be explained by the increasing ratio of estrogen and androgen. For more information, please go to http://doi.org/10.1089/trgh.2021.0105