Response to Letter to the Editor on “Feminine figures: body image and physical characteristics in trans women after puberty suppression and subsequent estradiol therapy”

We thank the author of the letter for his interest in our article “Feminine figures: body image and physical characteristics in trans women after puberty suppression and subsequent estradiol therapy”.1 In his letter, the author indicates that many transgender women in Vietnam do not have access to gender affirming care during adolescence. When transgender women present in adulthood, the irreversible changes caused by testosterone have already taken place and individuals may seek surgical treatment to align their body to their gender identity. This can include facial and neck feminizing surgery and laryngeal surgery to alter voice frequency. We acknowledge that access to gender affirming care is limited in many areas around the world, particularly access to gonadotropin-releasing hormone (GnRH) analog treatment for adolescents. Even in countries where this treatment is available only a minority of transgender people presents in early puberty while the vast majority presents in late adolescence or adulthood. Thus, for many surgery is an important alternative to reduce gender dysphoria after pubertal changes have occurred.