Gender variant (GV) children have a subjective sense of gender identity and/or preferences regarding clothing, activities, and/or playmates that are different from what is culturally normative for their biological sex. Despite increases in rates of GV children and their families presenting at clinics, there is little research on how raising a GV child affects the family as a whole or how families make decisions regarding their care. This study took an ecological-transactional framework to explore the question, “what is the experience of parents who raise a GV or transgender child?” Eight mothers and three fathers of GV male and female children (ages 5–13) referred through a GV support group participated in interviews. Transcripts were analyzed using an adaptation of grounded theory analysis. These parents attempted to pave the way to a nonstigmatized childhood for their GV child, typically through two pathways: rescuing the child from fear of stigma and hurt or accepting GV and advocating for a more tolerant world. Many participants used both pathways to different degrees or shifted paths over time, and the paths selected were related to parents' own understanding of GV and their experiences and backgrounds as well as characteristics of the children they were parenting and the communities they inhabited. Limitations, clinical implications, and future directions are discussed.

Author/-s:       Sarah A. O. Gray; Kristen K. Sweeney; Renee Randazzo; Heidi M. Levitt

Publication:     Family process, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/famp.12128/abstract

Discussion of parenting methods of gender-variant children.

While there is a growing literature in the field of gender, sexuality and sport, there is a dearth of research into the lived experiences of transgender people in sport. The present study addresses this research gap by exploring and analysing the accounts of transgender people in relation to their experiences of sport and physical activity. These are examined within the theoretical rubrics of social exclusion and minority stress theory. The findings from in-depth interviews with 10 transgender persons are detailed. Four interconnected themes emerged from the interviewee accounts: the intimidating nature of the changing/locker room environment; the impact of alienating sports experiences at school; the fear of public space and how this drastically constrained their ability to engage in sport and physical activity; and the overall effects of being denied the social, health and wellbeing aspects of sport. The findings are discussed in relation to the distinctive quality of transgender exclusion, and the related distal and proximal stressors experienced by this particular minority group.

Author/-s:       Owen D. W. Hargie; David H. Mitchell; Ian J. A. Somerville

Publication:     International Review for the Sociology of Sport, 2015

Web link:          http://irs.sagepub.com/content/early/2015/04/21/1012690215583283.abstract

Transgender exclusion in sports.

An online survey was designed to explore desire for children, parenthood and life satisfaction among transgender people in Sweden. A total of 154 responses were analysed with one way between group analysis of variance (ANOVA). Results showed that those with children of their own to a larger extent rated higher on items measuring life satisfaction, psychological well-being and the extent to which they could live in accordance to their gender identity. They also had a more positive conception of society's view of transgender people as parents. A surprising finding was that desire for children was higher for those who identified with one of the two traditional genders, in comparison to those who identified with a gender identity in between, outside or beyond the binary gender norm. The results of this study could be of use to health care professionals by providing more knowledge in how to give better treatment and care to the transgender people who wish to become parents.

Author/-s:       Klas Abrahamsson; Love Arinell

Publication:     Student paper, Lund University, Sweden, 2015

Web link:          http://lup.lub.lu.se/student-papers/record/5472314

Online survey of transgender persons in Sweden.

This review focuses on the effect that cross-gender sex steroid therapy has on metabolic and hormonal parameters. There is an emphasis on those changes that result in significant clinical effects such as the positive effects of the development of secondary sexual characteristics and negative effects such as haemostatic effects and thromboembolism in transwomen or dyslipidaemia in transmen. There is also a description of the current hormonal regimens used at the largest UK gender identity clinic. The overall safety of these treatments in the context of long-term outcome data is reviewed.

Author/-s:       Leighton J. Seal

Publication:     Annals of Clinical Biochemistry, 2015

Web link:          http://acb.sagepub.com/content/early/2015/06/02/0004563215587763

Review of effects of hormone therapy.

Young people with gender dysphoria are increasingly seen by pediatric endocrinologists. Mental health child specialists assess the adolescent and give advice about psychological or medical treatment. Provided they fulfill eligibility and readiness criteria, adolescents may receive pubertal suspension, consisting of using gonadotrophin-releasing hormone analogues, later followed by cross-sex hormones (sex steroids of the experienced sex). If they fulfill additional criteria, they may have various types of gender affirming surgery. Current issues involve safety aspects. Although generally considered safe in the short-term, the long-term effects regarding bone health and cardiovascular risks are still unknown. Therefore, vigilance is warranted during and long after completion of the last gender affirming surgeries. The timing of the various treatment steps is also under debate: instead of fixed age limits, the cognitive and emotional maturation, along with the physical development, are now often considered as more relevant.

Author/-s:       Peggy T. Cohen-Kettenis; Daniel Klink

Publication:     Best Practice & Research Clinical Endocrinology & Metabolism, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S1521690X15000160

Discussion of treatment of gender-dysphoric adolescents.

Objective: To investigate the effect of hormonal androgenic treatment on antimüllerian hormone (AMH) serum levels in female-to-male (FtM) transsexual women. Polycystic ovary syndrome (PCOS) is associated with elevated AMH levels. Some hypothesize that the high AMH level is a consequence of androgen-induced excessive development of small antral follicles. However, this role of androgens is not yet clear.

Design: Observational, prospective, cohort study.

Setting: Tertiary academic medical center.

Patient(s): Twenty-two FtM transsexual women, healthy native females receiving cross-sex hormone therapy/androgenic treatment.

Intervention(s): Androgenic treatment with testosterone (T) and an aromatase inhibitor while endogenous hormone secretion was suppressed with the use of a GnRH agonist.

Main Outcome Measure(s): Hormone concentrations were measured before and after androgenic treatment (administration of T and aromatase inhibitor). Measured hormones: AMH, inhibin B, T, androstenedione, DHEAS, E2, SHBG, LH, and FSH.

Result(s): AMH concentrations were significantly lower after androgenic treatment (4.4 ± 4.4 μg/L vs. 1.4 ± 2.1 μg/L). Androgenic treatment resulted in a strong suppression of AMH secretion over a relative short period of 16 weeks.

Conclusion(s): Our data underscore the likely important role of androgens in the dynamics of folliculogenesis. It challenges the idea that androgens induce high AMH levels, which is gaining more interest nowadays as an important particular PCOS feature. This strong decline furthermore indicates that AMH must be interpreted in the context of other reproductive endocrine conditions.

Author/-s:       Mirte R. Caanen; Remi S. Soleman; Esther A.M. Kuijper; Baudewijntje P.C. Kreukels; Chloë De Roo; Kelly Tilleman; Petra De Sutter; Mick A.A. van Trotsenburg; Frank J. Broekmans; Cornelis B. Lambalk

Publication:     Fertility and Sterility, 2015

Web link:          http://www.fertstert.org/article/S0015-0282(15)00125-9/abstract

Androgen treatment for female-to-male transsexuals decreases levels of antimüllerian hormone.

This paper explores the attitudes towards transpeople, genderism and transphobia as moderated by religious ideologies. The participants in this study were 505 students from a state university in the southeastern United States. Instruments used were the Genderism and Transphobia scale developed by Hill and Willoughby (2005), a revised Questionnaire about Transsexualism developed by Landén & Innala (2000), the Revised 12-Item Religious Fundamentalism Scale developed by Altemeyer & Hunsberger (2004), contact questions adapted from Kooy (2010), and the Marlowe-Crowne Social Desirability Scale, and basic demographic questions. It was hypothesized that religious fundamentalism might have some effect on how people scored on the genderism and transphobia scale, on their attitudes and on their attitudes towards transsexuals. Differences between the biological sexes were also hypothesized to exist. While the findings did not largely support these hypotheses, results did support a correlation between religious fundamentalism, higher scores on the genderism and transphobia scale, and more negative attitudes towards transsexuals.

Author/-s:       Sharra A. Rosichan

Publication:     Dissertaion, Middle Tennesse State University, 2015

Web link:          http://gradworks.umi.com/15/88/1588261.html

Religious people and transphobia.

Purpose: To assess the evolution of body composition and bone metabolism in trans men during the first year of cross-sex hormonal therapy.

Methods: In a prospective controlled study, we included 23 trans men (female-to-male trans persons) and 23 age-matched control women. In both groups, we examined grip strength (hand dynamometer), biochemical markers of bone turnover (C-terminal telopeptides of type 1 collagen (CTX) and procollagen 1 aminoterminal propeptide (P1NP)), total body fat and lean mass, and areal bone mineral density (aBMD) by dual-X-ray absorptiometry (DXA) and fat and muscle area at the forearm and calf, bone geometry, and volumetric bone mineral density (vBMD) by peripheral quantitative computed tomography (pQCT), before treatment and after 1 year of treatment with undecanoate (1000 mg i.m./12 weeks).

Results: Before hormonal treatment, trans men had similar bone and body composition compared with control women. Testosterone treatment induced in trans men a gain in muscle mass (+10.4%) and strength and loss of fat mass (−9.7%) (all P<0.001) and increased the levels of P1NP and CTX (both P<0.01). Areal and volumetric bone parameters remained largely unchanged apart from a small increase in trabecular vBMD at the distal radius and in BMD at the total hip in trans men (P=0.036 and P=0.001 respectively). None of these changes were observed in the control group.

Conclusions: Short-term testosterone treatment in trans men increased muscle mass and bone turnover. The latter may rather reflect an anabolic effect of testosterone treatment rather than bone loss.

Author/-s:       E. van Caenegem; K. Wierckx; Y. Taes; T. Schreiner; S. Vandewalle; K. Toye; B. Lapauw;  J.-M. Kaufman; G. T'Sjoen

Publication:     European Journal of Endocrinology, 2015

Web link:          http://www.eje-online.org/content/172/2/163.abstract

Testosterone therapy increased muscle mass and bone turnover.

High levels of body dissatisfaction have already been reported in the trans population; however, the root of this dissatisfaction, and its association with eating disordered behaviours, has not been studied in-depth. This study aims to assess eating disorder risk by comparing 200 trans people, 200 people with eating disorders and 200 control participants' scores on three subscales of the Eating Disorders Inventory-2 (EDI-2) and to further explore dissatisfaction in the trans participants using the Hamburg Body Drawing Scale (HBDS). The results showed that overall participants with eating disorders scored higher than trans or control groups on all EDI-2 measures, but that trans individuals had greater body dissatisfaction than control participants and, importantly, trans males had comparable body dissatisfaction scores to eating disordered males. Drive for thinness was greater in females (cis and trans) compared with males. In relation to HBDS body dissatisfaction, both trans males and trans females reported greatest dissatisfaction not only for gender-identifying body parts but also for body shape and weight. Overall, trans males may be at particular risk for eating disordered psychopathology and other body image-related behaviours.

Author/-s:       Gemma L. Witcomb; Walter Pierre Bouman; Nicola Brewin; Christina Richards; Fernando Fernandez-Aranda; Jon Arcelus

Publication:     European Eating Disorders Review, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/erv.2362/abstract

Transsexuals are at risk for eating disorders and other body-image-related behaviours.

Background: For subjects with gender dysphoria, body image is an important aspect of their condition. These people sometimes exhibit a strong desire to change their primary and secondary sexual characteristics. In addition, idealization of beauty has grown in importance and it may increase body dissatisfaction. The aim of this paper is to analyze whether body dissatisfaction in people with gender dysphoria is similar to that in clinical population or if it is more similar to that which may appear in general population. We also looked at gender differences in body dissatisfaction.

Methods: A set of questionnaires was administered to patients with gender dysphoria: Eating Attitudes Test (EAT-26), body dissatisfaction sub-scale of Eating disorder inventory-two (EDI-2) and IMAGEN questionnaire.

Results: In the case of body dissatisfaction subscale of Eating disorder inventory-two with a cut-off 11; body dissatisfaction in our sample was close to the level presented in clinical population. However, using cutoff points 14 and 16, they exhibited a body dissatisfaction level that was similar to the general population. The same occurred for the IMAGEN questionnaire. No gender differences were found when looking at the level of dissatisfaction.

Conclusions: The data seem to indicate that people with gender dysphoria would be at an intermediate point in relation to body dissatisfaction between general population and clinical population; in both female and male transsexuals. It seems that some level of body dissatisfaction may be perceived in relation to the ideal of beauty, but this dissatisfaction is significantly lower than in clinical populations.

Autor/-s:          María Frenzi Rabito Alcón; José Miguel Rodríguez Molina

Publication:     Medwave, 2015

Web link:          http://www.medwave.cl/medios/medwave/Mayo2015/PDF/medwave.2015.04.6138.pdf

Transsexuals suffer from body dissatisfaction, but not quite as bad as cisgender people who are being treated for body dissatisfaction.

The alteration of sex-specific body features and the establishment of a satisfactory body image are known to be particularly relevant for individuals with Gender Dysphoria (GD). The aim of the study was to first develop new scales and examine the psychometric properties of the Hamburg Body Drawing Scale (Appelt & Strauß 1988). For the second part of this study, the satisfaction with different body features in young GD adults before cross-sex treatment were compared to female and male controls. Data collection took place within the context of the European Network for the Investigation of Gender Incongruence (ENIGI) including 135 female-to-male (FtMs) and 115 male-to-female (MtFs) young GD adults and 235 female and 379 male age-adjusted controls. The five female and six male body feature subscales revealed good internal consistency. The ENIGI sample reported less satisfaction with overall appearance (d = 0.30) and with all of their body features than controls, but no subgroup differences for sexual orientation (FtM and MtF) and Age of Onset (FtM) were found. Body dissatisfaction was higher with regard to sex-specific body features (largest effect sizes of d = 3.21 for Genitalia in FtMs and d = 2.85 for Androgen-responsive features and genitalia in MtFs) than with those that appeared less related to the natal sex (d = 0.64 for Facial features in FtMs and d = 0.59 for Body shape in MtFs). Not only medical body modifying interventions, but also psychosocial guidance with regard to body image might be helpful for GD individuals before transitioning.

Author/-s:       Inga Becker; Timo O. Nieder; Susanne Cerwenka; Peer Briken; Baudewijntje P. C. Kreukels; Peggy T. Cohen-Kettenis; Griet de Cuypere; Ira R. Hebold Haraldsen; Hertha Richter-Appelt

Publication:     Archives of Sexual Behaviour, 2015

Web link:          http://link.springer.com/article/10.1007/s10508-015-0527-z

Transsexuals suffer from body image problems. Subgroup differences were not found.

This paper looks at the association between gender dysphoria (GD), scores on the Social Responsiveness Scale (SRS), and reported diagnoses of autism spectrum disorder (ASD). Parents of 166 young people presenting with GD (Mean age = 14.26; SD = 2.68) completed the SRS. Information concerning an ASD diagnosis was also extracted from the patient files. 45.8 % fell within the normal range on the SRS and of those 2.8 % had an ASD diagnosis. 27.1 % fell within the mild/moderate range and of those 15.6 % had an ASD diagnosis and 6.7 % an ASD query. 27.1 % fell within the severe range and of those 24.4 % had an ASD diagnosis and 26.7 % an ASD query. No difference was found in autistic features between the natal females and males.

Author/-s:       Elin Skagerberg; Domenico Di Ceglie; Polly Carmichael

Publication:     Journal of Autism and Developmental Disorders, 2015

Web link:          http://link.springer.com/article/10.1007/s10803-015-2413-x

Autism spectrum disorder seems in creased in transsexual children, with no difference between natal males and females.

Gender dysphoria is described as '[m]ental distress caused by unhappiness with one's own sex and the desire to be identified as the opposite sex'. Gender dysphoria is distinguished from being intersex, the subject of a recent Australian Senate Committee report, which is referable to physical characteristics. It is also distinguished from gender non-conformism, gender diversity or transsexualism as, in addition to identifying and living as one's non-natal gender, it involves 'clinically significant distress'. Unfortunately, children with gender dysphoria (and indeed many gender diverse young people) are almost by definition at a high risk of depression and anxiety, as well as social isolation, self-harm and suicide. This is unsurprisingly often connected to the discrimination and abuse suffered by these groups.

Author/-s:       Felicity Bell

Publication:     The University of New South Wales Law Journal, 2015

Web link:          http://search.informit.com.au/documentSummary;dn=191588340892543;res=IELFSC

Summing up the negative consequences of gender dysphoria in children.

Hypothalamic amenorrhoea is a diagnosis of exclusion, frequent cause of which are medications or psychiatric disorders (bulimia/anorexia). Here we present a case, when its aetiology was gender identity disorder. A 18-year-old girl presented with absence of menses during last year. Menses began at the age of 14 and were regular till age of 16, when she moved to another city. She was seen by gynaecologist because of amenorrhea, and evaluation was performed: FSH 4.6 mU/ml (1.37–9.9), LH 7.2 mU/ml (1.68–15.0), oestradiol 20 pg/ml (68–606), total testosterone 0.5 nmol/l (0.38–1.97), TSH 2 mU/l (0.4–4.0), prolactin 570 mU/l (109–557), and US, multifollicular ovaries. ‘Ovarial hypofunction’ was established, and vitaminotherapy was prescribed without any effect. She appealed to different specialists, however, definitive diagnosis wasn’t established. At the age of 17, menses were recovered spontaneously and stopped again in 6 months. Patient had not taken OC, weight remained stable. Physical examination revealed BMI 19 kg/m², hirsute number 0, breast development Tanner 5. Hormonal test results were in reference range, hCG was negative. Talking with patient, our attention was drawn by her hysterical behaviour, because she told about herself as an asexual being. Thereby, she appealed to psychiatrist, and diagnosis of gender identity disorder was established. It was interesting to note that her menses recovered at that time, when she fell in love and felt as a woman. Taking into consideration absence of pregnancy, excluded endocrine causes of amenorrhea, no history of OC, no excess or insufficient food intake, spontaneous menses recover during normal identity, there was established diagnosis of hypothalamic amenorrhoea, and psychiatric treatment was recommended. In case of amenorrhoea, body weight changes, and careful inspection are needed while suspicion of bulimia/anorexia. It is also needed to pay attention to patient’s speech, which may be a clue to diagnosis of gender identity disorder as a cause of hypothalamic amenorrhea.

Author/-s:       Natalia Volkova; Maria Porksheyan; Saida Kanaeva

Publication:     Endocrine Abstracts, 2015

Web link:          http://www.endocrine-abstracts.org/ea/0037/ea0037ep1292.htm

Gender dysphoria as a cause for interrupted menses?

Nonaccepting parents of sexual minority children typically attribute their child’s same-sex orientation to external causes (e.g., early childhood experiences, peer pressure) and perceive sexual orientation as mutable and under their child’s control. Using scientific findings to introduce the possibility that sexual orientation may be, at least to some degree, biologically influenced, not a matter of choice and not under the child’s control, can reduce blame and anger and elicit empathy among these parents. This article provides therapists with an abbreviated summary of the extant research findings on the association between biology and sexual orientation, and on the results of sexual orientation change efforts, written in easily accessible language of the type we use when working with nonaccepting parents. In addition, we discuss the clinical issues therapists must consider when deciding how and when to introduce such information. Finally, we present a case study to illustrate this therapeutic process.

Author/-s:       Maya S. Shpigel; Yael Belsky; Gary M. Diamond

Publication:     Professional Psychology: Research and Practice, 2015

Web link:          http://psycnet.apa.org/journals/pro/46/1/46/

How to work with trans-phobic parents.

Hand preference – which is related to cerebral dominance – is thought to be associated with cognitive skills; however, findings on this association are inconsistent and there is no consensus whether left- or right-handers have an advantage in either spatial or verbal abilities. In addition, it is not clear whether an interaction between sex and hand preference exists in relation to these cognitive abilities. As these matters are relevant from a neurodevelopmental perspective we performed a meta-analysis of the available literature. We searched PubMed and Embase, and included 14 studies (359 890 subjects) in the verbal ability meta-analysis and 16 studies (218 351 subjects) in the spatial ability meta-analysis. There was no difference between the full sample of left and right-handers for verbal ability, nor was there a hand preference-by-sex interaction. Subgroup analysis of children showed a small right-hand benefit. Our results further revealed a modest but significant effect favouring right-handedness for overall spatial ability, which was more pronounced when analysis was restricted to studies applying the mental rotation test. We could not identify a specific interaction with sex. Our results indicate that there is a small but significant cognitive advantage of right-handedness on spatial ability. In the verbal domain, this advantage is only significant in children. An interaction effect with sex is not confirmed.

Author/-s:       Metten Somers; Laura S. Shields; Marco P. Boks; René S. Kahn; Iris E. Sommer

Publication:     Neuroscience & Biobehavioral Reviews, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S0149763415000056

No interaction between handedness and sex (?) is identified.

In 4 complete androgen insensitivity syndrome (CAIS) members of one family, 2 presented extreme and unusual clinical features: male gender identity disorder (case 1) and female precocious central puberty (case 2). The AR gene carried the mutation c.1752C>G, p.Phe584Leu. Gender dysphoria in CAIS may be considered as a true transgender and has been described in 3 other cases. Central precocious puberty has only been described in 1 case; Müllerian ducts in case 2 permitted menarche. Despite the common CAIS phenotype, there was a familial disparity for gender identity adequacy and timing and type of puberty.

Author/-s:       J. A. Bermúdez de la Vega; M. Fernández-Cancio; S. Bernal; L. Audí

Publication:     Sexual Development, 2015

Web link:          http://www.karger.com/Article/Abstract/371617

Complete androgen insensitivity and gender dysphoria.

Objective: Several studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected.

Methods: From a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2 year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems.

Results: When treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8 % of the sample at year 1 and 17.2 % at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50 % at year 1 and 55 % at year 2 developed MetS against 8 % at year 1 and 10 % at year 2 of patients without concomitant psychiatric problems.

Conclusion: This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.

Author/-s:       Marco Colizzi; Rosalia Costa; Francesca Scaramuzzi; Claudia Palumbo; Margarita Tyropani; Valeria Pace; Luca Quagliarella; Francesco Brescia; Lilia Carmen Natilla; Giuseppe Loverro; Orlando Todarello

Publication:     Journal of psychosomatic research, 2015

Web link:          http://www.jpsychores.com/article/S0022-3999(15)00036-7/abstract

Hormone therapy is linked to metabolic syndrome.

Current advances in female-to-male gender confirming surgery allow for facial masculinization, chest masculinization, gynecologic removal of female sex organs, and genital reconstruction. With the breadth of approaches to each of these surgeries, it is important for providers as well as patients to be informed of the available options. In this review, the current state of female-to-male surgical approaches is discussed for the gender dysphoric patient who has typically initiated medical transition.

Author/-s:       Shane D. Morrison; Marcelina G. Perez; Michael Nedelman; Curtis N. Crane

Publication:     Current Sexual Health Reports, 2015

Web link:          http://link.springer.com/article/10.1007/s11930-014-0038-2

Summary of the state of surgery.

Introduction: Male-to-female sex reassignment surgery involves three main procedures, namely, clitoroplasty, new urethral meatoplasty and vaginopoiesis. Herein we describe the key steps of our surgical technique.

Methods: Male-to-female sex reassignment surgery includes the following 14 key steps which are documented in this article: (1) patient installation and draping, (2) urethral catheter placement, (3) scrotal incision and vaginal cavity formation, (4) bilateral orchidectomy, (5) penile skin inversion, (6) dismembering of the urethra from the corpora, (7) neoclitoris formation, (8) neoclitoris refinement, (9) neovaginalphallic cylinder formation, (10) fixation of the neoclitoris, (11) neovaginalphallic cylinder insertion, (12) contouring of the labia majora and positioning the neoclitoris and urethra, (13) tie-over dressing and (14) compression dressing.

Results: The size and position of the neoclitoris, position of the urethra, adequacy of the neovaginal cavity, position and tension on the triangular flap, size of the neo labia minora, size of the labia majora, symmetry and ease of intromission are important factors when considering the immediate results of the surgery. We present our learning process of graduated responsibility for optimisation of these results. We describe our postoperative care and the possible complications.

Conclusion: Herein, we have described the 14 steps of the Baudet technique for male-to-female sex reassignment surgery which include clitoroplasty, new urethral meatoplasty and vaginopoiesis. The review of each key stage of the procedure represents the first step of our global teaching process.

Author/-s:       Franck Marie Leclère; Vincent Casoli, Jacques Baudet; Romain Weigert

Publication:     Aesthetic Plastic Surgery, 2015

Web link:          http://link.springer.com/article/10.1007/s00266-015-0552-2

Description of a surgical method.

The goal of this descriptive study is to determine what is common practice for endocrine intervention with adolescents diagnosed with GD or seeking treatment related to gender identity. The study surveyed gender clinics in the United States that work with adolescent clients. Gender clinics are defined by this study to be one or more providers who work with adolescents to actualize their gender identity. Twenty gender clinics completed a mixed method survey that asked them to describe basic demographics of their clinic, what recommendations they utilize to influence their treatment protocols, if and how mental health is involved in treatment, what the most important aspects of treatment are according to their clinic, and suggestions for what helps improve treatment. The findings indicate that gender clinics are using similar protocols that are based on harm reduction and providing support to adolescents and their families. Recommendations for the development of a standard protocol for adolescents and future research of gender clinics are discussed. 

Author/-s:       Elise Lehotsky

Publication:     Project work for Master of Social work, Smith College School for Social Work, Massachusetts, USA, 2015

Web link:          https://dspace.smith.edu/bitstream/handle/11020/24670/Lehotsky%20(7).pdf

Survey of treatment protocols of US gender clinics.

Transsexualism is a persistent manifestation of personal discordance between the sex assigned at birth and sex/gender sense. The approach to treatment in this population must be made by expert multidisciplinary teams. The most accepted treatment protocol between teams is based on the standards of care proposed by the World Professional Association for Transgender Health (WPATH), which are reviewed periodically and serve as care guide. The protocol process for change of sex contemplates three phases: psychological, hormonal and surgical. Gender dysphoria can manifest itself in different degrees of intensity in each person and vital moment. A large majority of cases begin at an early age, being associated with complex conditions and intense discomfort. It is therefore important early detection and comprehensive treatment and if gender identity is perfectly established there is no reason for waiting until adulthood to begin treatment. Actually, the treatment teams prefer to start the therapeutic process during pubertal stage, having a clear diagnosis of persistence and having lived the teenager early pubertal stages in their biological sex, in order to reduce the psychological suffering, improve social acceptance and improve the aesthetic result in the appearance of the desired sex. Hormone treatment with puberty suppression is reversible and should not start having reached the II-III Tanner stage, with the presence of steroids in blood and with a minimum age of 12 years.

Author/-s:       Felipe Hurtado-Murillo

Publication:     Revista Española Endocrinología Pediátrica, 2015

Web link:          http://www.endocrinologiapediatrica.org/revistas/P1-E12/P1-E12-S510-A283.pdf

A clinical guide to the treatment of young transsexuals.

Purpose: The mental health and victimization of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth have garnered media attention with the “It Gets Better Project.” Despite this popular interest, there is an absence of empirical evidence evaluating a possible developmental trajectory in LGBTQ distress and the factors that might influence distress over time.

Methods: This study used an accelerated longitudinal design and multilevel modeling to examine a racially/ethnically diverse analytic sample of 231 LGBTQ adolescents aged 16–20 years at baseline, across six time points, and over 3.5 years.

Results: Results indicated that both psychological distress and victimization decreased across adolescence and into early adulthood. Furthermore, time-lagged analyses and mediation analyses suggested that distress was related to prior experiences of victimization, with greater victimization leading to greater distress. Support received from parents, peers, and significant others was negatively correlated with psychological distress in the cross-sectional model but did not reach significance in the time-lagged model.

Conclusions: Analyses suggest that psychological distress might “get better” when adolescents encounter less victimization and adds to a growing literature indicating that early experiences of stress impact the mental health of LGBTQ youth.

Author/-s:       Michelle Birkett; Michael E. Newcomb; Brian Mustanski

Publication:     Journal of adolescent health, 2015

Web link:          http://www.jahonline.org/article/S1054-139X(14)00710-1/abstract

Distress and victimisation fortunately decrease as LGBT-youth get older.

Background and aims: Since the onset of cross hormone therapy (CHT) in transsexual individuals, there has been concern about possible chronic side effects. Our objective was to assess baseline differences in lipid profile in individuals with gender identity disorder in relation to prior CHT, and changes in the lipid profile and other cardiovascular (CV) risk factors after 24 months of treatment.

Methods: Retrospective longitudinal study including all individuals assisted for the first time in the Gender Identity Unit of Catalonia from 2006 to 2010. Socio-demographical, anthropometric and laboratory data were collected.

Results: We evaluated 247 transsexuals, 150 male to female (MtF: 60.7%) and 97 female to male (FtM; 39.3%). At baseline, FtM transsexuals were younger and had started prior CHT less often than MtF (13.4% vs. 64.7%; p < 0.001). During follow up, in MtF weight and BMI increased significantly, as well as systolic and diastolic blood pressure, though these latter remained within normal range. No significant differences in lipid profile were observed. FtM transsexuals also presented an increase in weight and BMI, without differences in blood pressure. A general worsening in lipid profile was observed in this group, with increased total cholesterol (166.0 ± 35.1 vs. 175.6 ± 38.2 mg/dL; p = 0.001), triglycerides (70.6 ± 30.7 vs. 102.3 ± 68.5 mg/dL; p < 0.001) and LDL cholesterol (103.8 ± 28.7 vs. 112.8 ± 30.3 mg/dL; p = .013) and decreased HDL cholesterol (52.2 ± 12.2 vs. 45.4 ± 13.8 mg/dL; p = 0.001), even though final levels were all within normal range.

Conclusion: There is no detectable increase in CV risk factors in MtF transsexuals who were treated with currently prescribed estrogenic compounds, while a slight worsening in lipid profile takes place in the FtM group, though within normal limits.

Author/-s:       Carmen Quirós; Ioana Patrascioiu; Mireia Mora; Gloria Beatriz Aranda; Felicia Alexandra Hanzu; Esther Gómez-Gil, Teresa Godás, Irene Halperin

Publication:     Endocrinología y Nutrición, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S1575092215000558

Hormone treatment does not increase cardiovascular risk factors.

Background: Gender identity disorder (GID) is a rare condition which is specified by an incompatibility between gender identity and biological sex. Individuals with GID are more prone to psychological problems containing de-pression and low self-confidence.

Objectives: The aim of the present study is to evaluate the effect of life skill training on the quality of life of individuals with GID.

Methods: 30 individuals who referred to Tehran welfare center during November 2011 to August 2012 were selected by available sampling procedure and randomly divided to experimental or control groups. Pretest and posttest using WHOQOL-BREF was performed before and after training for both experimental and control groups. Data were analyzed using spss version 18. Two groups were compared using independent t-test.

Results: Values were significant at P < 0.05. Quality of life has been significantly increased in study group under the training of skills training in compare with control group (P < 0.001).

Conclusion: In conclusion life skills training can be considered to be an important component of psychosocial support programs for people with gender identity disorder and promote and improve the quality of life of individuals.

Author/-s:       Tayebeh Azizi; Yousef Karimi; Mahmoud Iravani

Publication:     International Journal of Review in Life Sciences, 2015

Web link:          https://pharmascope.org/ijrls/index.php/stage/article/246

Life skills training imporves quality of life for transsexuals.

Objective: To describe weight, body mass index (BMI), blood pressure (BP), lipids, and hormone levels in transgender women and men presenting for initiation of cross-sex hormone therapy at a community clinic in the United States.

Methods: Twenty-three transgender women (persons assigned male at birth who identify as female and want to use estrogen to develop female secondary sex characteristics) and 34 transgender men (persons assigned female at birth who identify as male and want to use testosterone to develop male secondary sex characteristics) presenting for initiation of hormone therapy at a community health center were enrolled. Body mass index, BP, lipids, and sex hormone levels were measured at baseline and 6 months. Persistence of menses at 6 months in transgender men was recorded.

Results: Sixteen transgender women and 31 transgender men completed the study. Baseline and 6-month median BPs and lipid values were within a normal clinical range. Median systolic BP in transgender women dropped from baseline 130.5 mmHg (interquartile range 11.5) to 120.5 mmHg (interquartile range 15.5) at 6 months (P = 0.006). Testosterone levels remained elevated in 33 % and estradiol (E2) levels were supratherapeutic in 19 % of transgender women at 6 months. Median BMI for transgender men was 29.1 kg/m² (interquartile range 11.2) at baseline and 30.0 kg/m² (interquartile range 11.4) at 6 months (P = 0.024). Six-month total testosterone levels were subtherapeutic in 32% and E2 levels remained elevated in 71 % of transgender men.

Conclusion: In transgender women, estrogen therapy, with or without antiandrogen therapy, was associated with lower BP. In transgender men, testosterone therapy was associated with increased BMI. The study had insufficient power to detect other associations. Monitoring of hormone levels to guide therapy appears to be useful.

Author/-s:       Madeline B. Deutsch; Vipra Bhakri; Katrina Kubicek

Publication:     Obstetrics & Gynecology, 2015

Web link: http://journals.lww.com/greenjournal/Abstract/2015/03000/Effects_of_Cross_Sex_Hormone_Treatment_on.12.aspx

Hormone therapy for transsexual women lowers blood pressure; hormone therapy for transsexual men increases weight.

Gender dysphoria (GD) is characterized by discomfort with the assigned or birth gender and the urge to live as a member of the desired sex. The goal of medical and surgical treatment is to improve the well-being and quality of life of transpeople. The acquisition of phenotypic features of the desired gender requires the use of cross-sex hormonal therapy (CHT). Adult transmen are treated with testosterone to induce virilization. In adolescents with severe and persistent GD, consideration can be given to arresting puberty at Tanner Stage II and if dysphoria persists, CHT is generally started after 16 years of age. Currently available short- and long-term safety studies suggest that CHT is reasonably safe in transmen. Monitoring of transmen should be more frequent during the first year of cross-sex hormone administration reducing to once or twice per year thereafter. Long-term monitoring after sex reassignment surgery (SRS) includes annual check-ups as are carried out for natal hypogonadal men. In elderly transmen, special attention should be paid to haematocrit in particular. Screening for breast and cervical cancer should be continued in transmen not undergoing SRS.

Author/-s:       Maria Cristina Meriggiola; Giulia Gava

Publication:     Clinical Endocrinology, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/cen.12753/abstract

Review of hormone treatment for transsexual men.

There are people who have the inner assurance that their gender identity does not match their biological sex. Due to developments in medicine over the last hundred years, it has become feasible to adapt the physical sexual characteristics to the inwardly experienced sex. The number of people seeking help in outpatient clinics and private practices has increased significantly in recent years. The procedure for the diagnosis and initiation of therapy is experiencing a clear shift towards more patient centeredness and individualization of the transition process. Sex reassignment hormone therapy is an essential pillar in the physical approximation to the opposite sex. In compliance with certain safety aspects, treatment with sex hormones is safe and easy to perform. Regular follow-ups as well as an open and transaffirmative contact with the concerned persons also contribute significantly to the safety of the treatment.

Author/-s:       Niklaus Flütsch

Publication:     Journal für Klinische Endokrinologie und Stoffwechsel, 2015

Web link:          http://www.kup.at/kup/pdf/12931.pdf

Hormone treatment for transsexuals.

Introduction: The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females.

Aim: We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria.

Methods: The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006–2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam.

Results: Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6 592 adolescents referred for other clinical problems.

Conclusions: Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

Author/-s:       Madison Aitken; Thomas D. Steensma; Ray Blanchard; Doug P. VanderLaan; Hayley Wood; Amanda Fuentes; Cathy Spegg; Lori Wasserman; Megan Ames; C. Lindsay Fitzsimmons; Jonathan H. Leef; Victoria Lishak; Elyse Reim; Anna Takagi; Julia Vinik; Julia Wreford; Peggy T. Cohen-Kettenis; Annelou L.C. de Vries; Baudewijntje P.C. Kreukels; Kenneth J. Zucker

Publication:     The Journal of Sexual Medicine, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12817/abstract

In the past, male-to-female transsexualism was more prevalent. Today, the sex ratio seems to swing towards more female-to-male transsexual persons.

Cross-sex hormone treatment of transsexual people may be associated with the induction and growth stimulation of hormone-related malignancies. We report here five cases of breast cancer, three in female-to-male (FtoM) transsexual subjects and two in male-to-female (MtoF) transsexual subjects. In the general population the incidence of breast cancer increases with age and with duration of exposure to sex hormones. This pattern was not recognised in these five transsexual subjects. Tumours occurred at a relatively young age (respectively, 48, 41, 41, 52 and 46 years old) and mostly after a relatively short span of time of cross-sex hormone treatment (9, 9–10 but in one after 30 years). Occurrence of breast cancer was rare. As has been reported earlier, breast tumours may occur in residual mammary tissue after breast ablation in FtoM transsexual people. For adequate treatment and decisions on further cross-sex hormone treatment it is important to have information on the staging and histology of the breast tumour (type, grade and receptor status), with an upcoming role for the androgen receptor status, especially in FtoM transsexual subjects with breast cancer who receive testosterone administration. This information should be taken into account when considering further cross-sex hormone treatment.

Author/-s:       L. Gooren; M. Bowers; P. Lips; I. R. Konings

Publication:     Andrologia, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/and.12399/abstract

Findings about breast cancer in transsexual persons.

Purposes: This article presents the various successive ways in which trans-sexualism has been conceptualized and categorized since its introduction in the international nomenclatures (ICD and DSM), and presents the a-categorical and differentialist viewpoints on this singular clinical subject.

Methodology: A review of the literature of the different definitions and the revisions of diagnoses in the international nosographies, and of the main works on trans-sexualism was performed.

Results: This review shows that trans-sexualism has been conceptualized and categorized in various ways since its introduction, ranging from the trans-sexual syndrome itself to the current gender dysphoria as proposed by the DSM 5. This new version based on an a-categorical approach broadens the earlier gender identity disorder in the DSM IV to the extent that trans-sexualism almost disappears.

Discussion: Gathering all gender identity disorders into a single diagnosis is controversial. If they are combined into one single clinical entity, it is more difficult to differentiate between the different types of gender identity disorder, the different subtypes of trans-sexualism and to distinguish trans-sexualism from the transgenderism, which is not the same phenomenon.

Conclusion: The proposal to use a single diagnosis of gender dysphoria diagnostic entails the risk that the assimilation will prevent the clinical precision needed to instate appropriate treatment for each individual gender identity disorder. We therefore conclude to the interest of a categorical approach of trans-sexualism and gender identity disorders.

Author/-s:       Jean-Baptiste Marchand; Elise Pelladeau; François Pommier

Publication:     L’évolution psychiatrique, 2015

Web link:          http://scholar.google.de/scholar_url?url=http://www.researchgate.net/profile/Jean-Baptiste_Marchand/publication/271601273_Du_transsexualisme__la_dysphorie_de_genre__regroupement_ou_amalgame/links/54f9deb80cf25371374ffd61.pdf&hl=de&sa=X&scisig=AAGBfm25-KBwBCM3Rl8JLLoRAJiuzI4Y9Q&nossl=1&oi=scholaralrt

Discussion on medical categorisation of transsexualism.

Transsexuals vary in the sacrifices that they make while transitioning to their cross-gender group. We suggest that one influence on the sacrifices they make is identity fusion. When people fuse with a group, a visceral and irrevocable feeling of oneness with the group develops. The personal self (the sense of “I” and “me”) remains potent and combines synergistically with the social self to motivate behavior. We hypothesized that transsexuals who felt fused with the cross-gender group would be especially willing to make sacrifices while transitioning to that group. Our sample included 22 male-to-female (MtF) and 16 female-to-male (FtM) transsexuals. Consistent with expectation, those who were fused with their cross-gender group (1) expressed more willingness to sacrifice close relationships in the process of changing sex than non-fused transsexuals and (2) actually underwent irreversible surgical change of their primary sexual characteristics (vaginoplasty for MtF transsexuals and hysterectomy for FtM transsexuals). These outcomes were not predicted by a measure of “group identification,” which occurs when membership in the group eclipses the personal self (the “I” and “me” is subsumed by the group; in the extreme case, brainwashing occurs). These findings confirm and extend earlier evidence that identity fusion is uniquely effective in tapping a propensity to make substantial sacrifices for the group. We discuss identity fusion as a social psychological determinant of the choices of transsexuals.

Author/-s:       William B. Swann Jr.; Ángel Gómez; Alexandra Vázquez; Antonio Guillamón; Santiago Segovia; Beatriz Carillo

Publication:     Archives of Sexual Behavior, 2015

Web link:          http://link.springer.com/article/10.1007/s10508-014-0470-4

A somewhat odd (in my humble opinion) study on group identity and transsexualism. As far as I can tell, the result of this study in relation to transsexualism could be that people with more severe gender dysphoria are more likely to have surgery. Which does not come as major surprise.

Aims: To describe characteristics of patients referred early (<16 yrs) medical treatment for gender dysphoria (GD). GD is a rare condition in which individuals experience clinically significant distress due to incongruence between their psychological perception of, and their natally assigned, sex.

Methods: We collected data prospectively on all patients referred from May 2010–July 2014 for early pubertal suppression using gonadotropin – releasing hormone analogue (GnRHa) therapy.

Results: 61 young people (34 natal males; 55.7%) were referred for early intervention to the national GD service endocrine liaison clinic at mean age of 13.1 years (range 9.8–15.3). All patients had a karyotype consistent with their natal sex. More natal males were in early puberty (32.4% Tanner 1/2; n = 11) than natal females (11.1 % Tanner 1/2; n = 3).

Baseline endocrinology and physical examination were normal for natal sex in all patients. All females who had standard synacthen tests to exclude adrenal dysfunction (77.8%; n = 21) had normal cortisol and 17OHP. 38.2% (n = 13) males had low bone mineral density compared with 11.1% of females (n = 3).

50 patients (81.9 %) elected to receive GnRHa following full explanation and informed consent at Tanner stage 3, following international guidelines. GnRHa could not be commenced immediately if pre-pubertal (10/61), having very low bone mineral density (3/61) or low body mass index (BMI) (2/61). All who began GnRHa achieved full gonadatropin suppression. No young people withdrew from GnRHa treatment in the first 2 years.

Many GPs were unwilling to prescribe GnRHa (56.0 %; n = 28/50) therefore local hospitals (8.0 %; n = 4) or the tertiary centre (36.0 %; n = 18) issued prescriptions.

Conclusion: Early medical intervention in GD with GnRH suppression of puberty is effective and well–tolerated. Assessment of growth, bone health and psychological outcomes will be important to assess the medium-and long-term safety and effectiveness of early intervention for GD.

Author/-s:       H. M. Gunn; C. Goedhart; G. Butler; S. N. Khadr; P. A. Carmichael; R. M. Viner

Publication:     Archives of Disease in Childhood, 2015

Web link:          http://adc.bmj.com/content/100/Suppl_3/A198.1.abstract

Using hormone blockers to stop puberty in transsexual adolescents is effective and well–tolerated.

The present study examined whether men view gender-atypical (i.e., feminine) psychological disorders as threats to their gender status. Men and women (N = 355) rated their expectations of gender status loss, feelings of distress, and help-seeking intentions in response to 10 different stereotypically masculine and feminine psychological disorders. Men as compared to women expected greater gender status loss for, and reported more distress to, gender-atypical versus gender-typical disorders. Expectations of gender status loss partially mediated the link between participant gender and distress at the thought of gender-atypical disorders. These findings suggest that feminine disorders pose more powerful gender status threats for men than masculine disorders do and that men’s expectations of gender status loss for feminine disorders drive their negative reactions to these mental illnesses. The discussion emphasizes the importance of considering the gender-typicality of disorders, and the implications of these findings for clinical interventions.

Author/-s:       Kenneth S. Michniewicz; Jennifer K. Bosson; Joshua G. Lenes; Jason I. Chen

Publication:     American Journal of men’s health, 2015

Web link:          http://jmh.sagepub.com/content/early/2015/01/13/1557988314567224.abstract

“Feminine” psychological disorders pose a higher gender status threat to men.

In Indonesia clinical management of Disorders of Sex Development (DSD) is challenged by limited knowledge and limited diagnostic and treatment facilities. Prior to this study, most patients remained untreated and grew up with ambiguous bodies and doubts about their gender. We investigated patients’ experiences of being raised in ambiguity.

118 Indonesian patients, ages 6 – 41, with 46XX DSD (n=27), 46XY DSD (n=77) and chromosomal DSD (n=14) were compared to 118 control subjects matched for gender, age, and living area. Questionnaires for gender identity, gender role behavior and social stigmatization were translated or designed. The psychometric properties were satisfactory. For patient and control group comparisons, Mann-Whitney U and Fisher’s Exact tests were applied.

The results showed that 7% of the children, 8% of the adolescents and 44% of the adults changed gender, particularly non-diagnosed and non-treated patients with 46XY DSD (81%). 95% of the patients changed gender from female to male, including untreated patients with 46,XX CAH-SV. Compared to control groups, cross-gender role behavior was seen in young girls with 46XX CAH-SV (p=.047) and adolescent girls with different types of DSD (p=.01). In girls with DSD, confusion with gender identity was seen (young girls p=.004; adolescent girls p=.01). Adult men reported past cross-gender role behavior (p=.01) and past problems in gender identification (p=.01) prior to female-to-male gender change.

Children with genital ambiguity (p<.006) and cross gender behavior (p<0.001) and adults with ambiguous bodies (p=.001) and adults who changed gender (p<0.03) suffered stigmatization. Rejection or isolation elicited depression and withdrawal from social activities in girls (p=.002), women (p=.009) and youngsters who had changed gender (p=.02).

 

We conclude that a high percentage of our patients changed gender. The wish for gender change was particularly seen in patients with progressive masculinization. Patients with DSD who had visible ambiguity in physical and behavioral appearance suffered stigmatization. Teasing and rejection led to strong emotional reactions. Early clinical evaluation and treatment, patient and parent education, and teaching coping strategies will improve quality of life.

Author/-s:       Annastasia Ediati; Achmad Zulfa Juniarto; Erwin Birnie; Jolanda Okkerse; Anne de la Croix; Amy Wisniewski; Stenvert Drop; Sultana M. H. Faradz; Arianne Dessens

Publication:     International Journal of Pediatric Endocrinology, 2015

Web link:          http://www.ijpeonline.com/content/2015/S1/O56

Gender identity issues in individuals with disorders of sex development.

Gender Dysphoria (GD) in Childhood is primary a clinical diagnosis of unknown etiology with no physical or laboratory findings. Symptoms may develop as early as age 2 years. Gender Dysphoria in Children (GDC) is characterized by a marked incongruence, of at least 6 months’ duration, between a prepubescent child's experienced/expressed gender and assigned gender or natal gender. Typically, children with GD reject the anatomical gender assignment made at birth. In children without a DSD, there is no evidence of neurobiological factors contributing to GDC. Specialty clinics for GD in Children engage with and sometimes treat the child's wider psychosocial environment. The high degree of stigma associated with cross-gender behaviors in many cultures magnifies the need for respect and sensitivity in dealing with persons with GD in adolescents and adults. As treatment requires specialized knowledge, individual practitioners who encounter these patients are strongly advised to seek expert consultation when treating them.

Author/-s:       Allan Tasman; Jerald Kay; Jeffrey A. Lieberman, Michael B. First; Michelle B. Riba

Publication:     Psychiatry, Fourth Edition (book), 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/9781118753378.ch68/summary

Review of gender dysphoria.

Objective: A case is described pointing to the biological factors in gender identity and personality structure.

Methods: The history is presented of a transsexual patient who experienced a change of gender identity and personality following an episode of status epilepticus.

Results: The patient presented as convincingly feminine and with features of Borderline Personality Disorder. She had an old brain injury. After a prolonged epileptic episode the Borderline features disappeared and the patient expressed a clearly male identity.

Conclusions: The findings are equivocal: they may be seen both as reflecting a change in a neurologically structured identity and as a resetting of psychosocially acquired characteristics.

Author/-s:       John Parkinson

Publication:     Australasian Psychiatry, 2015

Web link:          http://apy.sagepub.com/content/early/2015/02/04/1039856214568223.abstract

Single case study on the co-occurrence of brain injury, epilepsy, borderline disorder and gender dysphoria.

Introduction: Comorbidity of schizophrenia and transsexualism is still controversial. Some authors exclude diagnosis of transsexualism in patients with psychosis others report this coexistence as very rare.

Objectives: Delusions of sex change have been described by some authors in about 20–25 % of schizophrenic patients. Patient's “pseudotranssexual” beliefs are usually bizarre and do not cause diagnostic doubts. In some cases complaints of gender dysphoria are predominant and psychotic symptoms can be underestimated or even unnoticed before sex reassignment procedure.

Aims: Presentation of various clinical manifestation of gender dysphoria in patients with schizophrenia.

Methods: Three clinical cases are described.

Results: Two patients have developed “pseudotranssexual” beliefs during course of psychosis. The first of them is an example of gender identity disorders related to psychotic process. The second patient presented complex psychopathology of schizophrenia and somatic symptoms which can hinder the diagnosis. The third patient has been diagnosed as a transsexual woman after diagnosis of severe schizophrenia and has undergone sex reassignment. Next she was hospitalized several times because relapses of psychosis but also because of alcohol withdrawal. Currently this patient has symptoms of dementia and a few severe somatic diagnoses.

Conclusions: The experiences of practitioners indicate that coincidence of schizophrenia and gender identity disorder is possible. Nevertheless, the consequence of misdiagnosis and sex reassignment can be serious and unconvertible. That is why the diagnosis of transsexualism in patients with psychosis should not be made hastily. It needs time, careful observation, examination and cooperation of psychiatrist and sexologist.

Author/-s:       M. Urban-Kowalczyka

Publication:     European Psychiatry, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S0924933815313663

Case series on transsexualism and schizophrenia.

Background: CAH due to 21-hydroxylase deficiency (21OHD) is a common disorder of sex development (DSD), resulting in ambiguous external genitalia in the female. Delayed diagnosis and treatment, prompt perinatal adrenal androgen exposure to accelerate growth velocity and develop premature male sex characteristics, including male behavior, mood and sexual orientation, and a gender-identity disorder in the female.

Aim: Discuss a case of gender dysphoria in an elderly patient, raising the pros and cons of performing corrective surgery later in life.

Clinical case: A 62yo 46,XX DSD patient, was registered and reared as a girl in a rural area in Brazil. Diagnosis of CAH was only established at age 10y and hormonal treatment began in an endocrine reference center. However, replacement therapy was discontinued on several occasions and, due to poor compliance, subtotal adrenalectomy was performed at age 17y. Without proper psychological management, gender dysphoria became evident. Pretending to be and secretly living for years as a male (but no ID and no fix job or residence) in different cities, at the age of 59y he decided to apply for a legitimate male ID; 3 years later, the patient unexpectedly requested for a genital sex-reassignment surgery. Although being male-sex oriented, he has never had any sexual experience. This request was reasoned, in his own words, as: “When I die, in my funeral, I’m afraid they will know who I am!” Since no other reasons were pondered, the risks of surgery and the possibility of an unsuccessful outcome (including chances of suicide) were openly discussed with the patient and family. Decision was then reached to postpone surgery and start a centered analytical therapy. This allowed the group to evaluate the real wish for surgery, as well as to care for the issue of existence itself. Along the process, surgery was ultimately disregarded by the patient.

Conclusion: Only when the wish for a corrective surgery, justified on an odd reasoning was brought up to the doctors, the role of death urged the group to rethink the course of treatment. During the psychological process, it became clear that the patient’s will for reassignment surgery, more than a wish for simply changing the genitalia, expressed a momentum when his issues had to do with endorsement and acceptance of his male identity by the society. This case report brings interesting questions about sexuality in a social context, independently of the sexual act; it also surfaces the idea that sexuality is much broader than sex and opens new questions about the psychological risks that one faces when considering a body change after living for so many years with a DSD.

Author/-s:       Mariana Telles-Silveira; Felícia Knobloch; Carolina C. P. S. Janovsky; Claudio E. Kater

Publication:     Endocrine Society's 97th Annual Meeting and Expo, 2015

Web link:          http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.AHPAA.7.THR-411

A case report of an elderly individual with a disorder of sex development.

In this review, we briefly summarize much of the existing literature on gender-related concerns and autism spectrum disorders (ASD), drawing attention to critical shortcomings in our current understanding and potential clinical implications. Some authors have concluded that gender identity disorder (GID), or gender dysphoria (GD), is more common in individuals with ASD, providing a range of potential explanations. However, existing literature is quantitatively limited, and our capacity to draw conclusions is further complicated by conceptual challenges regarding how gender identity is best understood. Discourses that emphasize gender as a component of identity formation are gaining prominence and seem particularly salient when applied to ASD. Individuals with ASD should enjoy equal rights with regard to treatment for gender dysphoria. Clinicians may be able to assist individuals in understanding this aspect of their identity by broadening the social frame and facilitating an exploration of gender roles.

Author/-s:       Gerrit I. van Schalkwyk; Katherine Klingensmith; Fred R. Volkmar

Publication:     Yale Journal of Biology and Medicine, 2015

Web link:          http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345542/

Review on the link between autism and gender dysphoria.

Previous research has indicated that gender identity is related to children’s adjustment and well-being. In the current study, involvement in school bullying was our indicator of well-being, and we tested how gender identity and gender typing measures are related to victims, bullies and bully-victims. The relations between these variables were examined with a sample of Spanish 10–12 year-old schoolchildren (n = 445). Multinomial regression analyses examined the associations among these three roles in bullying with four measures of gender identity (gender typicality, gender contentment, felt pressure, and intergroup bias) and two measures of gender typing (masculine and feminine personality traits). The results revealed that victimization is associated with low gender typicality and also with feminine traits, while perpetration is related with felt pressure to gender conformity and masculine traits. Bully-victim involvement is associated with lack of gender contentedness and masculine traits. These findings suggest that perceiving self as being a typical member of the same sex group is a protective factor for victimization, whereas felt pressure to conform to the cultural stereotypes about gender, self-attribution of masculine traits and lack of satisfaction with one’s gender are risk factors for perpetration. Implications for practice are discussed.

Author/-s:       Raúl Navarro; Elisa Larrañaga; Santiago Yubero

Publication:     Child indicators research, 2015

Web link:          http://link.springer.com/article/10.1007/s12187-015-9300-z

Gender-variant children fall victim to bullying.

This study examined associations of gender identity and sexual orientation with self-reported eating disorder (SR-ED) diagnosis and compensatory behaviors in transgender and cisgender college students.

Data came from 289 024 students from 223 U.S. universities participating in the American College Health Association-National College Health Assessment II (median age, 20 years). Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were compared among transgender students (n = 479) and cisgender sexual minority (SM) male (n = 5 977) and female (n = 9 445), unsure male (n = 1 662) and female (n = 3 395), and heterosexual male (n = 91 599) and female (n = 176 467) students using chi-square tests. Logistic regression models were used to estimate the odds of eating-related pathology outcomes after adjusting for covariates.

Rates of past-year SR-ED diagnosis and past-month use of diet pills and vomiting or laxatives were highest among transgender students and lowest among cisgender heterosexual men. Compared to cisgender heterosexual women, transgender students had greater odds of past-year SR-ED diagnosis (odds ratio [OR], 4.62; 95 % confidence interval [CI], 3.41–6.26) and past-month use of diet pills (OR, 2.05; 95 % CI, 1.48–2.83) and vomiting or laxatives (OR, 2.46; 95 % CI, 1.83–3.30). Although cisgender SM men and unsure men and women also had elevated rates of SR-ED diagnosis than heterosexual women, the magnitudes of these associations were lower than those for transgender individuals (ORs; 1.40–1.54).

Transgender and cisgender SM young adults have elevated rates of compensatory behavior and SR-ED diagnosis. Appropriate interventions for these populations are urgently needed.

Author/-s:       Elizabeth W. Diemer; Julia D. Grant; Melissa A. Munn-Chernoff; David A. Patterson; Alexis E. Duncan

Publication:     Journal of Adolescent Health, 2015

Web link: http://www.researchgate.net/publication/275589204_Gender_Identity_Sexual_Orientation_and_Eating-Related_Pathology_in_a_National_Sample_of_College_Students

This study was widely reported in the media, see: http://www.medicaldaily.com/sexual-orientation-gender-identity-tied-eating-disorder-risk-332682, http://fusion.net/story/134204/transgender-people-eating-disorder-study/ and http://www.freemalaysiatoday.com/category/leisure/2015/05/10/sexual-orientation-gender-identity-tied-to-eating-disorder-risk/.

Background: Female-to-male transsexualism (FtMt) is a rare condition, with a prevalence of 1:30.000 to 1:400.000 females. Testosterone esters are used to induce virilization and menses cessation in these patients. The long-term effects of high doses of testosterone therapy in the female internal genital tract are not well known. Androgens involvement in the process of folliculogenesis has been demonstrated in vitro and in vivo experiments. This androgen effect has been correlated with the presence of enlarged ovaries and morphological features of polycystic ovary syndrome (PCOS) observed in some FtMt treated with androgens.

Objective: To describe the histopathological effects in the internal genital tract of FtMt after long-term of androgen therapy. Patients and Methods: Histological findings of 26 FtMt submitted to hysterectomy, bilateral salpingo-oophorectomies in the sex reassignment surgery were retrospectively reviewed. The patients’ mean age at surgery was 36.5 + 8.1 yrs. The treatment with testosterone esters (200 to 250 mg, every 15 to 28 days) ranged from 1 to 18 yrs (6 ± 5.9 yrs). Two groups were established according to the interval of treatment: Group 1 (n=17) ≤ 5 years and Group 2 (n=9) > 5 years. 28% of the FTMt patients had irregular menstrual cycles before androgen treatment, and none was diagnosed with PCOS. The resected tissues were stained with HE using standard techniques.

Results: Uterine’s volume and endometrial’s thickness in group 1 were: 121 ± 192 cm3 and 0.35 ± 0.5 cm and in group 2: 54 ± 24 cm3 (p= 0.17) and 0.28 ± 0.21cm (p=0.65), respectively. Proliferative (57.7%) and atrophic (42.3%) endometrial patterns were identified. Endometrial polyp was present in one patient and the prevalence of leiomyoma was 15.3%, which is not different from the prevalence in general population. Minimal changes in the cervical histology were observed: chronic cervicitis (38.4%) and cervical intraepithelial neoplasia (3.8%). Right and left ovarian mean size were 4.7 ± 1.9 cm3 and 5.7 ± 3.3cm3, respectively in group 1, and 2.8 ± 1.7cm3 and 3.0 ± 1.4 cm3 respectively in group 2. There was a significantly reduction of right (p=0.016) and left (p=0.008) ovarian volume in the FtMt of group 2. Multiple ovarian cysts were observed in 13 patients, the majority of them (69%) in group 1.

Conclusion: An important reduction of ovarian volume was observed in the FtMt group with longer exposure to testosterone treatment. Despite the ovarian changes, the uterine histology does not seem to be significantly modified after long-term androgen exposure in this group of FtMt.

Author/-s:       Marilena Nakaguma; Tatiana S. Pelaes; Christiane Gruetzmacher; Flávia Siqueira Cunha; Maria Helena Palma Sircili; Elaine M. F. Costa; Berenice B. Mendonca; Sorahia Domenice

Publication:     Endocrine Society's 97th Annual Meeting and Expo, 2015

Web link:          http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.RE.1.OR21-1

Effects of hormone therapy on the uterus of male transsexuals.

Highlights

• We review the relative safety of hormone treatment for transgender individuals.

• Estrogen treatment for transgender women may increase risk of thrombosis.

• Androgen treatment for transgender men may increase risk of polycythemia.

• Hormone therapy has not been shown to increase transgender individuals' cancer risk.

Abstract

Introduction: Some providers report concern for the safety of transgender hormone therapy (HT).

Methods: This is a systematic literature review of HT safety for transgender adults.

Results: Current literature suggests HT is safe when followed carefully for certain risks. The greatest health concern for HT in transgender women is venous thromboembolism. HT among transgender men appears to cause polycythemia. Both groups experienced elevated fasting glucose. There is no increase in cancer prevalence or mortality due to transgender HT.

Conclusion: Although current data support the safety of transgender HT with physician supervision, larger, long-term studies are needed in transgender medicine.

Author/-s:       Jamie D. Weinand; Joshua D. Safer

Publication:     Journal of Clinical and Translational Endocrinology, 2015

Web link:          http://www.jctejournal.com/article/S2214-6237%2815%2900049-6/abstract

Hormone therapy is safe, but may increase risks for thrombosis and polycythemia. This study was reported in some media articles, such as: http://www.healio.com/endocrinology/hormone-therapy/news/online/%7B70c26a4d-8ca3-4083-82ce-0138d9252f76%7D/hormone-therapy-in-transgender-adults-appears-safe and http://fusion.net/story/54541/once-more-with-feeling-hormone-therapy-for-transgender-adults-is-safe/.

Congenital disruptions of sex hormone production lead to wide-ranging developmental and physiological effects in individuals who have atypical chromosomal, gonadal or anatomic sex. Aberrant developmental sex hormone exposure causes disorders of genital anatomy, attainment of secondary sexual characteristics and has long-term effects on metabolism, fertility and psychological functioning. Principles in the management of disorders of sex development (DSD) aim to improve physiological health and long-term outcome, as well as development of male or female sexual anatomy. Concerns raised by DSD patient advocacy groups about beneficence and autonomy with respect to prescribed hormone treatments and avoidance of unnecessary genital and gonadal surgery have demanded greater informed consent and attention to long-term outcome. Hormone treatment is influenced by underlying clinical diagnosis and by factors such as sex of rearing and gender identity of the affected individual. We describe diagnostic criteria for different DSDs, clinical considerations in management protocols, together with current concepts and detailed practical hormone treatments for male and female individuals with DSD. Gender identity issues requiring multidisciplinary consensus, ethical consideration and informed consent or assent from the young person are also addressed.

Author/-s:       Jacqueline Hewitt; Margaret Zacharin

Publication:     Best Practice & Research Clinical Endocrinology & Metabolism, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S1521690X15000202

Hormone treatment for disorders of sex development.

This paper addresses from a theoretical point of view the issue of the development of transgender identity and the role that peer groups play in this complex process. A brief review on core identity literature is provided, principally dealing with some models on transgender identity construction. These substantially highlight how transgender people usually go through different and contrasting stages before reaching a definite and firm transgender identity. The function of the others in the definition of self is central, as possibility for being recognized and valued. In particular, major argumentations about the healthy and protective effects of peer groups’ affiliation for transgender people’s are presented. Peer groups, indeed, can foster self-disclosure, improvement of inner and social resources can provide a valid support and thus promotes general psychosocial well-being. Some clinical and intervention implications are discussed.

Author/-s:       Anna Lisa Amodeo; Simona Picariello; Cristiano Scandurra; Paolo Valerio

Publication:     Romanian journal of experimental applied psychology, 2015

Web link:          http://rjeap.ro/files/vol6no2/3_vol_6_i_2.pdf

Peer groups help.

Functional magnetic resonance imaging (fMRI) was used to study the variation of functional changes that arise in the brain in response to similar tests in healthy subjects. The approach was assumed to demonstrate diverse individual strategies of achieving the same external (behavioral) response via different brain mechanisms and to identify the factors responsible for the diversity. Hemodynamic (fMRI) responses to activation of attention while opening the eyes or performing motor (consecutively moving the fingers of the right and left hands) and speech (mentally repeating the months of the year or the days of the week in the backward order) tests were determined in 21 healthy subjects aged 21–30 years, including 14 males and 7 females. A variation in fMRI responses was observed, i.e., three or four types of reactive hemodynamic changes were seen in the same test in the group, the prevalence of each type varying from 40 to 10% in one test. The responses showed distinct gender differences, and their specifics depended on the nature of the functional test. In motor and speech tests performed with the eyes closed, the fMRI responses in the females were more specific and local than in the males. In motor tests, the fMRI responses of the males compared with the females were characterized by a greater involvement of the frontal regions, which are responsible for regulatory functions. In the activation test (eye opening), the fMRI responses were more diffuse in the females and more local in the males.

Author/-s:       E. V. Sharova; M. V. Shendyapina; G. N. Boldyreva; N. Yu. Davydova; A. S. Migalev; M. V. Chelyapina; M. A. Kulikov; L. A. Zhavoronkova; E. V. Enikolopova; L. M. Fadeeva; V. N. Kornienko

Publication:     Human Physiology, 2015

Web link:          http://link.springer.com/article/10.1134/S0362119714060097

Different brain responses by gender in healthy, cisgendered people.

Introduction: In the early 80’s Dr Zoran Rakic, from the Department of Psychiatry in Belgrade was a pioneer in transgender care in Serbia and former Yugoslavia. Occasionally he used to hospitalize transsexual patients for diagnostic assessment, treatment of comorbid and concomitant psychiatric disorders and post-surgical care. His pioneer work was continued by the Counseling Service for Sexual Disfunction and Gender Dysphoria team.

Aim: To assess frequency, indication for and results of inpatient treatment of transsexual clients.

Method: Case history review and outpatient follow-up.

Results: During last 3 years hospitalization was performed in 16 cases (50 % FtM and MtF). Mean age on admission was 23.1 for FtM and 27.5 for MtF patients. Assessment of transsexualism was performed in 3 FtM clients; 62.5 % (10) were admitted for assessment and treatment of comorbid disorder (7 MtF and 2 FtM before and 1 MtF patient after gender reassignment surgery) with only one currently not in remission; physical assessment was performed in 3 FtM clients before referral for hormone therapy (financial reasons).

Conclusion: Transsexual individuals are exposed to double stigmatization, as members of the LGBT community and as “psychiatric patients”. Therefore inpatient psychiatric assessment and treatment should be avoided. Results of our clinical work show that inpatient care can be beneficial for these patients and accelerate further treatment process especially in cases with comorbid and concomitant psychiatric disorder when adequate setting is provided and medical staff are educated and sensitized to address specific needs of this population.

Author/-s:       D. Markovic Zigic; K. Maksimovic; V. Borovnica; L.J. Kicanovic; M. Djordjevic

Publication:     European Psychiatry, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S0924933815313675

Case review for treatment of transsexuals in Belgrade, Serbia.

We study the earnings of transsexuals using Dutch administrative labor force data. First, we compare transsexuals to other women and men, and find that transsexuals earn more than women and less than men. Second, we compare transsexuals before and after transition using worker fixed effects models, and find a fall in earnings for men who become women and a smaller rise (if any) in earnings for women who become men. These earnings patterns, which hold for annual as well as hourly earnings, are consistent with a labor market model in which workers are discriminated for being female and transsexual.

Author/-s:       Lydia Geijtenbeek; Erik Plug

Publication:     IZA discussion paper series, 2015

Web link:          http://ftp.iza.org/dp9077.pdf

Women and transsexuals earn less than men.

Introduction: There are people with a gender incoherence between their biological gender (phenotype) and the self-perception gender. Differences among such condition and sexual orientation give us more subtypes of gender and sexual diversity: transsexual, travesties and transgender, homosexual, heterosexual, bisexual and asexual.

Objective: To review if there are well supported evidences about sexual and gender diversity as part of evolutionary strategies.

Method: Medical and political historical documents about the birth of the concepts of gender and sexual orientation were consulted at The National Library of Medicine. These were updated, in a review of the scientific literature of the last fifty years in SCOPUS, PubMed and Science Direct systems. The following words were used: homosexuality, transsexuality, gender and evolution.

Results: Because sexual reproduction is so indispensable and so zealously selected, the existence of homosexuality and transsexuality is a kind of paradox. One must wonder: why would not evolution quickly select against behavior, which diverts an animal from sexual reproduction? Yet despite this apparently unlikelihood homosexuality does exist. Homosexuality is also the innate sexual preference for one’s own gender or the biological urge for same-sex coitus. So despite popular non-recognition of the phenomenon, natural history observations have revealed a wide range of homosexuality throughout the animal kingdom. To account for homosexuality --or any phenomenon-- using evolution, it is necessary that it be natural, i.e. it must occur naturally without human influence. Thus, animal behavior is used to illustrate the naturalness of homosexuality. In essence: there are homosexual animals in nature; therefore homosexuality is natural. Transsexuality is a gender issue, and in psychiatry remains as a mental disease named “gender dysphoria”.

Discussion and conclusion: There is some biological basis for these particular human beings, in whom the role of high levels of hormones, antibodies against testosterone receptors, order or birth is also discussed in the present article. To understand that humans are not a dichotomist species is the main goal of this work, as homo sapiens differences in many aspects of our functions are the norm.

Author/-s:       Rafael J. Salín-Pascual

Publication:     Salud Mental, 2015

Web link:          http://www.inprf-cd.gob.mx/pdf/sm3802/sm3802147.pdf

An evolutionary view on homosexuality and transsexualism.

Gender dysphoria (GD) is a condition in which a person experiences discongruency between their assigned sex and what they feel their genderidentity is. A person with gender dysphoria experiences persistently uncomfortable feelings about their birth gender (Diagnostic and Statistical Manual of Mental Disorders, Fifth edition (DSM-V) (American Psychiatric Association).

During the ‘real life experience’ hormonal treatment usually starts and applicants are required to live socially in the desired gender role before irreversible surgical reassignment is considered. Cross sex hormonal treatment is desired by trans persons to help them successfully live as a member of their identified gender. It is clear that both in adults and adolescents the decision for starting hormonal treatment is not to be made by the endocrinologist. The mental health professionals (psychiatrists and/or psychologists), by preference working in a multidisciplinary Gender team, will guide these persons to make an informed decision about hormonal treatment. Eligibility criteria and readiness as described by WPATH’s Standards of Care-7th version, should be evaluated. The goal of treatment in female-to-male trans persons is to induce virilization and to stop menses. The prinicipal hormone treatment is a testosterone preparation. In male-to-female trans persons oestrogen and anti-androgen treatment is provided. Treatment regimens are currently not standardised and include various forms of oestrogens, progestins, and/or (anti-) androgens as reported by different clinical centres. So far, no randomized intervention trials are available so treatment is largely experience-based. Options for fertility preservation should be discussed with the clients before hormonal intervention.

Appropriate care for transgender persons will lead to better outcome and should avoid unnecessary psychological pain, health risks (e.g. secondary psychiatric conditions or suicide), or self medication with inherent greater risk of complications.

Author/-s:       Guy T’Sjoen

Publication:     Endocrine Abstracts, 2015

Web link:          http://www.endocrine-abstracts.org/ea/0037/ea0037MTE6.htm

Treatment of transsexuals.

Prior research shows that health disparities exist between sexual minority and heterosexual individuals. We extend the literature by testing if the higher prevalence of childhood victimization experienced by sexual minority individuals accounts for lifetime health disparities. Heterosexual (n = 422) and sexual minority (n = 681) participants were recruited on-line in North America. Respondents completed surveys about their childhood victimization experiences (i.e., maltreatment by adults and peer victimization) and lifetime physician-diagnosed physical health conditions. Results showed that sexual minority individuals experienced higher prevalence of childhood victimization and lifetime physical health problems than heterosexuals. Mediation analyses indicated that maltreatment by adults and peer bullying explained the health disparities between sexual minority individuals and heterosexuals. This study is the first to show that multiple childhood victimization experiences may be one pathway to explain lifetime physical health disparities. Intervention programs reducing the perpetration of violence against sexual minority individuals are critical to reduce health care needs related to victimization experiences.

Author/-s:       Judith P. Andersen; Christopher Zou; John Blosnich

Publication:     Social Science & Medicine, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S0277953615001963

This study, only indirect related to transsexual issues, shows that worse health of sexual minorities can be explained by maltreatment early in life.

Hormonal treatments have been used in adolescents with gender dysphoria in the last decade. The professionals working in gender dysphoria treatment units cannot ignore this new demand. The evolution of care for such adolescents according to the last three versions of the Standards of Care (SC) of the World Professional Association for Transgender Health is described. Starting with the fifth version of the SC, hormonal treatment of adolescents has been contemplated. Recent protocols for hormonal intervention carried out by specialized clinics are analyzed. Finally, the pros and cons of hormonal treatment are debated. These hormonal interventions have major impact on the physical, social, and psychosexual development of patients and have ethical and moral implications for professionals.

Author/-s:       M. Fernández; P. Guerra; M. Díaz; E. García-Vega; J. A. Álvarez-Diz

Publication:     Actas Espanolas de Psiquiatria, 2015

Web link:          http://europepmc.org/abstract/med/25665977

Discussion on hormone treatment for transsexual youth.

 

Transgender people are individuals whose gender identity does not match their biologic sex. An ingenious endocrinologist, by the name of Harry Benjamin, was the first to use cross-sex hormones in transsexual patients in the 1950s. Current treatment with endocrine manipulation and cross-sex hormonal administration is an effective treatment of gender dysphoria.1Transgender men are assigned female at birth, however they have a male gender identity. Treatment of these individuals involves testosterone administration, typically by intramuscular route as a biweekly injection for the remainder of their lifetime. Intramuscular injections are painful and difficult to perform independently, particularly for younger patients. Healthcare providers and patients have started administering testosterone into the subcutaneous tissues, however there is a paucity of data on effectiveness and technique description.

We hypothesize that subcutaneous testosterone administered via weekly injection will result in a serum testosterone level within the normal male range with excellent tolerability. From July 1,2013 until November 1, 2014, 26 transsexual males between the ages of 16-50 (mean 27 years), were started on subcutaneous testosterone at a dose of 50 mg per week. As of November 8, 2014, twelve subjects have reported for follow up testosterone levels. Ten of these patients were naïve to testosterone use (one subject was switched from intramuscular to subcutaneous testosterone administration, and one subject had used testosterone >2 years before being seen in our clinic). Approximately four months after starting testosterone the dose was titrated to achieve total, serum testosterone levels within the normal male range (280-800 ng/dL). The average weekly dose of testosterone was 57.9 mg (range 25-100mg), representing 0.73 mg of testosterone per kilogram of body weight resulting in an average total testosterone level of 601 ng/dL (range 187-1078 ng/dL). The average time to menstrual cessation was 3 months from testosterone initiation. One participant reported minor skin irritation at the injection site, which resolved within 1 week and has not recurred. No other adverse reactions were reported in this study population.

This case series of transsexual males demonstrates total testosterone levels within the normal male range with low-dose, subcutaneous testosterone (0.73 mg/kg) administered weekly. Subcutaneous injection is likely to be an effective delivery route for testosterone esters. More frequent, lower-dose injections may also provide a more stable serum testosterone level. there were no significant adverse reactions with subcutaneous administration in our study population. We speculate that the low rate of adverse reactions may be attributed to the low dose of testosterone used in this study (62.1 mg per week).

Author/-s:       Benjamin Boh; John H. Turco; Richard J. Comi

Publication:     Endocrine Society's 97th Annual Meeting and Expo, 2015

Web link:          http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2015.RE.1.SAT-083

Subcutaneous hormone administration is safe.

Transgenderism is an emergent phenomenon. It is necessary not only to evaluate transgenderism, but also all the variables involved in the gender transition process. The aim of the study was to present and analyze psychometric properties of two assessment tools for transgender people. One for Anxiety and the other for Depression. A qualitative construction of the two scales was carried out. Then both were content-validated, and eventually their psychometric properties were tested (Through Cronbach’s Alpha, between-halves correlation, criteria validity and a Factorial Analysis). These scales were applied to 154 people. Both validity and reliability showed good outcomes (for ESANTRA Cronbach’s Alpha 0.958 and correlation between halves 0.926 and for ESDETRA Cronbach’s Alpha 0.967 and correlation between halves 0.958). Criteria validity was high (ESANTRA 0.782 p < 0.001 and ESDETRA 0.829 p < 0.001). The Exploratory Factorial Analysis only showed one factor in each scale. They had an explanatory variance of 45.71 % ESANTRA and 51.55 % ESDETRA. ESANTRA and ESDETRA scales seem to be useful for the assessment of anxiety and depression in transgender people.

Author/-s:       José Miguel Rodríguez Molina; Nuria Asenjo Araque; Antonio Becerra Fernández; María Jesús Lucio Pérez

Publication:     Psicología desde el Caribe, 2015

Web link:          http://www.scielo.org.co/pdf/psdc/v32n1/v32n1a03.pdf

Tools for assessing anxiety and depression in transgender people.

Purpose: Inconsistent access to healthcare represents a barrier to transgender patients receiving hormone therapy through a licensed provider. Inability to access care leads many transgender people to buy hormones from unlicensed sources and transition without medical supervision. Little is known about the factors predisposing people to rely on this method of transition. It is critical to understand what leads to non-prescribed hormone use to better support safe medical transitions for transgender people.

Methods: We conducted an analysis of a study with 314 transwomen in San Francisco from August-December 2010, using Respondent Driven Sampling (RDS). The study collected information on demographics, hormone use, gender identity milestones, violence and trauma experienced due to gender identity, substance use, sexually transmitted infections, law enforcement contact and sexual behaviors. We evaluated whether these demographic and behavioral characteristics were correlated in the following outcomes: taking hormones not prescribed by providers and taking hormones consistently without interruptions.

Results: Data demonstrate that 68.7% of transwomen were currently on hormone replacement therapy (HRT) but only 41% reported being on hormones consistently. In addition, 49.1% reported taking hormones for HRT not prescribed by a clinician. Consistent hormone use was independently and positively associated with being born in the United States, having contact with a health care provider, and currently living full-time as a female. Those who reported ever being forced to have sex or having been raped had 60% lower odds of being consistently on hormones. We found greater odds of non-prescribed hormone use among participants who had gender confirmation surgery and among those who had experienced verbal abuse due to their gender identity and presentation.

Conclusion: Non-prescribed HRT in transwomen is a common and poorly characterized phenomenon. Increasing access to healthcare (with culturally-competent, affordable, and accessible providers) is crucial to assuring trans people are able to have safe, consistent access to the hormones they need.

Author/-s:       Gene de Haan; Glenn-Milo Santos; Sean Arayasirikul; Henry F. Raymond

Publication:     LGBT Health, 2015

Web link:          http://online.liebertpub.com/doi/abs/10.1089/lgbt.2014.0128

Study about non-prescribed hormone usage.

Introduction: Gender reassignment surgery is the keystone of the treatment of transgender patients. For male-to-female transgenders, this involves the creation of a neovagina. Many surgical methods for vaginoplasty have been opted. The penile skin inversion technique is the method of choice for most gender surgeons. However, the optimal surgical technique for vaginoplasty in transgender women has not yet been identified, as outcomes of the different techniques have never been compared.

Aim: With this systematic review, we aim to give a detailed overview of the published outcomes of all currently available techniques for vaginoplasty in male-to-female transgenders.

Methods: A PubMed and EMBASE search for relevant publications (1995–present), which provided data on the outcome of techniques for vaginoplasty in male-to-female transgender patients.

Main Outcome Measures: Main outcome measures are complications, neovaginal depth and width, sexual function, patient satisfaction, and improvement in quality of life (QoL).

Results: Twenty-six studies satisfied the inclusion criteria. The majority of these studies were retrospective case series of low to intermediate quality. Outcome of the penile skin inversion technique was reported in 1,461 patients, bowel vaginoplasty in 102 patients. Neovaginal stenosis was the most frequent complication in both techniques. Sexual function and patient satisfaction were overall acceptable, but many different outcome measures were used. QoL was only reported in one study. Comparison between techniques was difficult due to the lack of standardization.

Conclusions: The penile skin inversion technique is the most researched surgical procedure. Outcome of bowel vaginoplasty has been reported less frequently but does not seem to be inferior. The available literature is heterogeneous in patient groups, surgical procedure, outcome measurement tools, and follow-up. Standardized protocols and prospective study designs are mandatory for correct interpretation and comparability of data.

Author/-s:       Sophie E. R. Horbach; Mark-Bram Bouman; Jan Maerten Smit; Müjde Özer; Marlon E. Buncamper; Margriet G. Mullender

Publication:     The Journal of Sexual Medicine, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12868/abstract

The two major techniques for vaginoplasty seem comparable in their results.

Background: Ovotesticular Disorder of sex development (OT DSD) is a rare disorder of sex development characterized by presence in the same individual of both histologically proven testis and ovary. There is scant data regarding this disorder from the Indian subcontinent.

Aim: To describe clinical, biochemical, imaging, cytogenetic, surgical and histopathological findings and outcome of patients with OT DSD from Western India.

Materials and methods: The records of patients referred to our center for disorders of sex development between the years 2005–2013 were reviewed and seven patients were found to have histologically proven OT DSD.

Results: The median age at presentation was eight years (range: two months – 25 years). Clinical presentation varied from genital ambiguity and inguinal swelling at birth to gynecomastia and cyclical hematuria after puberty. Karyotype was 46, XX in six patients and 46, XY in one patient. All patients underwent pelvic ultrasonography, laparoscopy and surgery for removal of gonads not congruous with the chosen sex of rearing. Gender assignment for all the patients was done by the parents at birth which was mainly influenced by the external genitalia and socio-cultural influences with five out of the seven patients being reared as males. There was no evidence of gonadal tumours in our study.

Conclusion: OT DSD should be considered as one of the differential diagnosis in cases of ambiguous genitalia with non-palpable or asymmetrical gonads, pubertal gynecomastia and cyclical hematuria irrespective of the karyotype or internal genitalia.

Author/-s:       Kranti S. Khadilkar, Sweta R. Budyal; Rajeev Kasaliwal; Pragati A. Sathe; Bhuvaneshwari Kandalkar; Beejal V, Sanghvi; Sandesh V. Parelkar; Anurag R. Lila; Tushar Bandgar; Nalini S. Shah

Publication:     Endocrine Practice, 2015

Web link:          http://aace.metapress.com/content/1401g62h5434r057/

Disorders of sex development with both ovaries and testicles present.

Disorders of sex development (DSD) are congenital conditions in which chromosomal, gonadal, or anatomic sex development is atypical. DSD-associated stigma is purported to threaten positive psychosocial adaptation. Parental perceptions of DSD-related stigma were assessed in 154 parents of 107 children (from newborn to 17 years) who completed a questionnaire comprising five subscales: parent-focused, child-focused, and perceived stigmatization; future worries; feelings about the child’s condition. Medical chart excerpts identified diagnoses and clinical management details. Stigma scale scores were generally low. Parents of children with DSD reported less stigma than parents of children with epilepsy; however, a notable proportion rated individual items in the moderate to high range. Stigma was unrelated to child’s age or the number of DSD-related surgeries. Child-focused stigma scores exceeded parent-focused stigma and mothers reported more stigma than fathers, with a moderate level of agreement. Within 46,XY DSD, reported stigma was higher for children reared as girls. In conclusion, in this first quantitative study of on-going experiences, DSD-related stigma in childhood and adolescence, while limited in the aggregate, is reported at moderate to high levels in specific areas. Because stigma threatens positive psychosocial adaptation, systematic screening for these concerns should be considered and, when reported, targeted for psychoeducational counseling.

Author/-s:       Aimee M. Rolston; Melissa Gardner; Eric Vilain; David E. Sandberg

Publication:     International Journal of Endocrinology, 2015

Web link:          http://downloads.hindawi.com/journals/ije/aip/980121.pdf

Disorders of sexual development cause stigma.

Transgender individuals are more likely to have lower social support and a more negative self-image than their cisgender (i.e., non-transgender) counterparts. While emerging research has demonstrated a potential association between these factors and physical activity behaviour, no studies have examined this relationship in transgender individuals. Eighty (n = 33 transgender, 47 cisgender) adults completed validated questionnaires assessing leisure-time physical activity, social support and physical self-perception. Transgender individuals were less physically active and reported lower social support and physical self-perception than their cisgender peers. Social support and self-perception emerged as mediators of the difference in physical activity between transgender and cisgender individuals. Results highlight the need for inclusive leisure settings and programs as well as increased social support for transgender individuals to maximize leisure-time physical activity.

Author/-s:       Megan M. Muchicko; Andrew Lepp; Jacob E. Barkley

Publication:     Leisure/Loisir, 2015

Web link:          http://www.tandfonline.com/doi/abs/10.1080/14927713.2015.1048088

Transsexuals exercise less than cisgender people, the reasons are less social support and poor self-perception.

This study compared mental health service experiences of lesbian, gay, or bisexual (LGB), transidentified, and cisgender (nontrans) heterosexual people in Ontario. An Internet-based survey, derived from the Canadian community health survey—Mental health and well-being—Cycle 1.2 (Statistics Canada, 2003), was completed by 326 individuals (194 LGB, 71 trans-identified, 61 cisgender heterosexual). Hierarchical logistic regression models were used to examine group differences. All three groups reported high levels of satisfaction and positive experiences with the provider seen most often in the past 12 months. However, substantial proportions of LGB and trans-identified people reported unmet need for mental health services.

Author/-s:       Dorina Simeonov; Leah S. Steele; Scott Anderson; Lori E. Ross

Publication:     Canadian Journal of Community Mental Health, 2015

Web link:          http://www.cjcmh.com/doi/abs/10.7870/cjcmh-2014-037

Good mental health services in Canada for LGBT individuals.

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments.

Author/-s:       I. Esteva de Antonio; N. Asenjo Araque; F. Hurtado Murillo; M. Fernández Rodríguez; Á. Vidal Hagemeijer; O. Moreno-Pérez; M. J. Lucio Pérez; J. P. López Siguero; Grupo GIDSEEN

Publication:     Endocrinologia y Nutricion: Organo de la Sociedad Espanola de Endocrinologia y Nutricion, 2015

Web link:          http://europepmc.org/abstract/med/25935352

This position statement by a Spanish working group of experts emphasises that detection and comprehensive treatment of gender dysphoria are essential to improve quality of life and to decrease mental comorbidity.

It was also published in Endocrinología Pediátrica, 2015: http://www.endocrinologiapediatrica.org/revistas/P1-E15/P1-E15-ES.pdf#page=45

Many gender differences are thought to result from interactions between inborn factors and sociocognitive processes that occur after birth. There is controversy, however, over the causes of gender-typed preferences for the colors pink and blue, with some viewing these preferences as arising solely from sociocognitive processes of gender development. We evaluated preferences for gender-typed colors, and compared them to gender-typed toy and activity preferences in 126 toddlers on two occasions separated by 6–8 months (at Time 1, M = 29 months; range 20–40). Color preferences were assessed using color cards and neutral toys in gender-typed colors. Gender-typed toy and activity preferences were assessed using a parent-report questionnaire, the Preschool Activities Inventory. Color preferences were also assessed for the toddlers’ parents using color cards. A gender difference in color preferences was present between 2 and 3 years of age and strengthened near the third birthday, at which time it was large (d > 1). In contrast to their parents, toddlers’ gender-typed color preferences were stronger and unstable. Gender-typed color preferences also appeared to establish later and were less stable than gender-typed toy and activity preferences. Gender-typed color preferences were largely uncorrelated with gender-typed toy and activity preferences. These results suggest that the factors influencing gender-typed color preferences and gender-typed toy and activity preferences differ in some respects. Our findings suggest that sociocognitive influences and play with gender-typed toys that happen to be made in gender-typed colors contribute to toddlers’ gender-typed color preferences.

Author/-s:       Wang I. Wong; Melissa Hines

Publication:     Archives of Sexual Behavior, 2015         

Web link:          http://link.springer.com/article/10.1007/s10508-015-0489-1

Colour preferences by gender seem socially influenced; toy preferences by gender seem innate.

Gender nonconformity refers to the extent to which a person’s gender identity, gender role and/or gender expression differs from the cultural norms prescribed for people of a particular sex, within a certain society and era. Most data on gender nonconformity focus on the prevalence of gender dysphoria (which also includes a distress factor) or on the number of legal sex changes. However, not every gender nonconforming individual experiences distress or applies for treatment. Population-based research on the broad spectrum of gender nonconformity is scarce and more information on the variance outside the gender binary is needed. This study aimed to examine the prevalence of gender incongruence (identifying stronger with the other sex than with the sex assigned at birth) and gender ambivalence (identifying equally with the other sex as with the sex assigned at birth) based on two population-based surveys, one of 1 832 Flemish persons and one of 2 472 sexual minority individuals in Flanders. In the general population, gender ambivalence was present in 2.2 % of male and 1.9 % of female participants, whereas gender incongruence was found in 0.7 % of men and 0.6 % of women. In sexual minority individuals, the prevalence of gender ambivalence and gender incongruence was 1.8 and 0.9 % in men and 4.1 and 2.1 % in women, respectively. With a current Flemish population of about 6 million, our results indicate a total of between 17 150 and 17 665 gender incongruent men and between 14 473 and 15 221 gender incongruent women in Flanders.

Author/-s:       Eva van Caenegem; Katrien Wierckx; Els Elaut; Ann Buysse; Alexis Dewaele; Filip Van Nieuwerburgh; Griet De Cuypere; Guy T’Sjoen

Publication:     Archives of Sexual Behavior, 2015

Web link:          http://link.springer.com/article/10.1007/s10508-014-0452-6

The prevalence of gender dysphoria is estimated at roughly 0.7 %.

Gender variant youth and their parents represent a highly understudied group of individuals. The current study aimed to gather further information regarding parents’ experiences surrounding their child’s gender variance and transition process. Participants (N = 37) were primary caregivers of gender variant children ages 10 to 17 who were recruited online. Based on parent report, neither parents nor children were experiencing significant internalizing symptoms nor were parents experiencing significant levels of fear of negative evaluation. Parents reported moderate levels of worry regarding their child’s future functioning and high average levels of support from their general and religious communities. Parents reported a variety of positive and negative events since their child’s disclosure. Results indicate that although parents are not experiencing significant distress, they do have salient concerns about their child but are also able to identify positive changes that have occurred. Current results may inform supportive interventions for families during the transition process.

Author/-s:       Jennifer M. Birnkrant

Publication:     Master thesis, Department of Psychological Sciences, Case Western Reserve University, 2015

Web link:          https://etd.ohiolink.edu/ap/10?0::NO:10:P10_ACCESSION_NUM:case1413505086

Families of gender-variant youth seem to be doing okay.

Gender-related cognitions have been central to accounts of well-being in children and adults in the United States. Yet, the child and adult literatures are currently not aligned in how they measure these experiences, creating an asymmetry in scientific understanding. The current investigation aligns these literatures by using the short-form of the Bem Sex Role Inventory (BSRI; Bem 1981) (adult literature) and a modified version of Egan and Perry’s (2001) Gender Typicality Scale (child literature) with cisgender (i.e., those whose current gender identity is the same label as their birth-assigned category) adult participants. These measures were used to determine the relative contributions of each to self-esteem using nonprobability samples of heterosexual and queer (i.e., lesbian, gay, bisexual, pansexual, and asexual) women and men in the United States. The analyzed groups consisted of cisgender individuals: heterosexual women (N = 97), heterosexual men (N = 90), queer women (N = 83), and queer men (N = 51). All groups showed significant contributions of adult gender typicality to self-esteem, over and above the BSRI dimensions. Thus, both self-reported gender typicality and self-reported endorsement of certain BSRI dimensions are important indicators of well-being in cisgender adults in the United States.

Author/-s:       Charlotte Chucky Tate; Jay N. Bettergarcia; Lindsay M. Brent

Publication:     Sex roles, 2015

Web link:          http://link.springer.com/article/10.1007/s11199-015-0458-0

Being gender-typical leads to higher self-esteem.

Objectives: This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator.

Methods: A secondary analysis of 2 949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity groweconflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes.

Results: Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators’ relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt.

Conclusion: LGBT young adults who mature in religious contexts are at higher odds for suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict.

Author/-s:       Jeremy J. Gibbs; Jeremy Goldbach

Publication:     Archives of Suicide Research, 2015

Web link:          http://www.tandfonline.com/doi/abs/10.1080/13811118.2015.1004476#.VRa6UU10wUF

Growing up in religious households increases suicide risks for LGBT youth.

This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism (ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire – Treatment Related (SIQ-TR), Symptom Checklist 90 Revised (SCL-90-R), Rosenberg Self-Esteem Scale (RSE), Hamburg Body Drawing Scale (HBDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI.

Author/-s:       Amanda Davey; Jon Arcelus; Caroline Meyer; Walter Pierre Bouman

Publication:     Health & Social Care in the Community, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/hsc.12239/abstract

Self-injury is common among transsexuals.

Introduction: Gender dysphoria refers to the incongruence between the subject’s experienced sex on the one hand and the assigned sex on the other hand. Several studies assume a relationship between oestrogen substitution therapy and serum prolactin levels.

Aim: The aim of this study is to get more insight into the effect and time-course of changes in serum prolactin levels during cross-sex hormone therapy.

Methods: This prospective study included 82 transgender persons who completed 1 year of treatment, 45 male-to-female individuals (MtFs) (mean age±S.D. 34±13 years) and 37 female-to-male individuals (FtM’s) (mean age±S.D. 27±10 years). MtF’s were treated with cyproteronacetate (50 mg/day) and estradiol valerate (2–4 mg/day) or an estradiol patch (200 μg/week). FtM’s were treated with testosterone esters i.m. (250 mg/2 weeks), testosterone undecanoate i.m. (1000 mg/12 weeks), or testosterone gel (50 mg/day). We determined serum prolactin levels at baseline and after 3 and 12 months. Serum prolactin was measured by immunometric assay (Centaur, Siemens).

Results: In MtFs mean serum prolactin levels increased from 0.16 to 0.41 U/l (160% (132–188%)) between 0 and 3 months and from 0.41 to 0.47 U/l (15% (0.2–29%)) between 3 and 12 months (mean level in biological women 0.28 U/l). In FtM’s mean serum prolactin levels decreased from 0.27 to 0.23 U/l (−16% (−28 to −4%)) between 0 and 3 months and from 0.23 to 0.21 U/l (−9% (−30 to 13%)) between 3 and 12 months (mean level in biological men 0.16 U/l).

Conclusions: In MtFs an increase in mean serum prolactin levels was seen whereby those levels exceeded mean serum prolactin levels of biological women. In FtMs a decrease in mean serum prolactin levels was seen whereby those levels did not reach the values of biological men. In both groups the biggest change was observed during the first 3 months of treatment.

Author/-s: Nienke Nota; Maartje Klaver; Martin den Heijer; Marieke Dekker; Annemieke Heijboer

Publication:     Endocrine Abstracts, 2015

Web link:          http://www.endocrine-abstracts.org/ea/0037/ea0037EP130.htm

Prolactin levels in male-to-female transsexuals increase during hormone therapy, whereas they decrease in female-to-male individuals.

The choice of sex in newborns with genital ambiguity is challenging. Information concerning the satisfaction of subjects with disorders of sex development from childhood to adulthood is required in order to address sex attribution policies. This study focuses on the methods that enable clinicians to investigate the alignment of phenotypes with gender identity and quality of life in people with disorders of this kind. These methods are presented as tools for studying a cohort of ten subjects with 45,X/46,XY mosaicism examined between 1985 and 2014 in the Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Turin: five children and five young adults, four reared as females and six as males. Clinical outcome was assessed by means of a clinical scoring system considering height, genital appearance, gonads and pubertal development. The Gender Identity Questionnaire for Children and the World Health Organization Quality of Life assessment were adopted. The four male children strongly identified with their assigned sex: male attribution was satisfactory until pubertal age. In young adults the clinical scores ranged between 55–65 % for both genders. In the young male, the reduced sexual activity and the poor body image perception strongly affected his quality of life. The clinical scores of the two young female adults (60 % for both) were not balanced with their quality of life scores (87.5 % and 68.75 % respectively): individual traits and social-familial context should be investigated in order to explain these differences. Clinical and psychosocial assessment in people with disorders of sex development is mandatory in order to plan care procedures; a detailed analysis requires adequate tools. Clinical scoring system, Gender Identity Questionnaire for Children and World Health Organization Quality of Life assessment can be used to investigate the alignment of physical phenotype with gender identity and quality of life.

Author/-s:       Roberta Risso; Silvia Einaudi; Chiara Crespi; Angela Caldarera; Francesca Verna; Emilio Merlini; Roberto Lala

Publication:     AIMS Genetics, 2015

Web link:          http://www.aimspress.com/aimsg/ch/reader/view_abstract.aspx?file_no=Genetics2014014&flag=1

About the problems of assigned gender versus experienced gender for individuals with disorders of sex development.

Background: Transgender women often suffer from transition-related discrimination and loss of social support due to their gender transition, which may pose considerable psychological challenges and may lead to a high prevalence of depression in this population. Increased self-efficacy may combat the adverse effects of gender transition on depression. However, few available studies have investigated the protective effect of self-efficacy on depression among transgender women, and there is a scarcity of research describing the mental health of Chinese transgender women. This study aims to describe the prevalence of depression among Chinese transgender women and to explore the associated factors.

Methods: A cross-sectional study was conducted in Shenyang, Liaoning Province of China by convenience sampling from January 2014 to July 2014. Two hundred and nine Chinese transgender women were interviewed face-to-face with questionnaires that covered topics including the Zung Self-Rating Depression Scale (SDS), demographic characteristics, transition status, sex partnership, perceived transgender-related discrimination, the Multidimensional Scale of Perceived Social Support (MSPSS) and the adapted General Self-efficacy Scale (GSES). A hierarchical multiple regression analysis was performed to explore the factors associated with SDS scores.

Results: The prevalence of depression among transgender women was 45.35%. Transgender women with regular partners or casual partners exhibited higher SDS scores than those without regular partners or casual partners. Regression analyses showed that sex partnership explained most (16.6%) of the total variance in depression scores. Self-efficacy was negatively associated with depression.

Conclusions: Chinese transgender women experienced high levels of depression. Depression was best predicted by whether transgender women had a regular partner or a casual partner rather than transgender-related discrimination and transition status. Moreover, self-efficacy had positive effects on attenuating depression due to gender transition. Therefore, interventions should focus on improving the sense of self-efficacy among these women to enable them to cope with depression and to determine risky sex partnership characteristics, especially for regular and casual partners.

Author/-s:       Xiaoshi Yang; Lie Wang; Chun Hao; Yuan Gu; Wei Song; Jian Wang; Margaret M. Chang; Qun Zhao

Publication:     PLOS One, 2015

Web link:          http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136975

Depression and mitigating factors.

While genderconfirming treatment (GCT) is potentially associated with acquiring the primary and/or secondary cross-sex characteristics, congruent with the gender identity, through hormonal substitution and surgical intervention, very little clinical and research attention has been paid to the potential changes in sexuality in genderdysphoric individuals. The current presentation will focus on the relation between sexual desire and the genderconfirming treatment, and on the biopsychosocial factors that are potentially associated with sexual desire in this context. Results and clinical implications will be discussed in the context of the incentive motivation theory.

Author/-s:       Els Elaut

Publication:     Transgender health care in Europe: book of abstracts, 2015

Web link:          https://biblio.ugent.be/record/5896457

Research on sexual desire during treatment for transsexuals.

Sexual complaints in the general population are prevalent, are accompanied by a significant distress and influence the quality of life of the individual and/or couple. While population surveys have looked at sexual complaints, sexual dysfunction and distress in the general population, information on the sexuality of individuals applying for gender-confirming treatment is rare. In the past, gender dysphoria was often looked upon as a ‘hyposexual’ state and the resolution of gender dysphoria overshadowed the striving towards building sexually active and pleasureful lives after treatment. A cohort of 200 applicants who was first assessed during 2007-2009 was questioned on a broad range of potential complaints with regard to their sexual functioning, their experience of distress and their satisfaction with several sexual behaviors in a multicenter European follow-up study. These results will give clinicians working with this population the necessary input for psychoeducation offered during the diagnostic and counseling process.

Author/-s:       Els Elaut; Birgit van Hoorde; Griet de Cuypere

Publication:     Transgender health care in Europe: book of abstracts, 2015

Web link:          https://biblio.ugent.be/publication/5896397

Research on sexual desire during treatment for transsexuals.

For those identifying as transgender or gender nonconforming (TGNC), the support of others can be instrumental in mitigating the challenges associated with cross-gender transition and identification. Social support and connectedness to the TGNC community can positively impact psychological well-being, facilitate resilience, and buffer against external stigmatization, prejudice, and discrimination (Frost & Meyer, 2012; Hendricks & Testa, 2012). The present study seeks to improve understanding of relationships among general social support (GSS), trans community connectedness (TCC), depressive symptoms, and anxiety symptoms. The inclusion of 2 forms of social support allows for greater examination of the differential impact of perceived general support (i.e., from both cisgender and TGNC friends and family members) and TGNC-specific social support (i.e., feeling connected to other TGNC people). To honor the diversity within the TGNC community, the impact of social support was examined among TGNC participants differentiated by gender identity, ethnicity, and living environment. As part of the Internet-based Trans Health Survey, standardized measures of depression, generalized anxiety, and social support were administered to 865 TGNC adults. For both trans male spectrum (TMS) and trans female spectrum (TFS) participants, general social support was significantly negatively associated with symptoms of anxiety and depression. However, the negative correlation between trans community connectedness and mental health symptoms was significant only for TFS participants. Variations in perceived TCC among ethnicity and living environment groups—distinguished by gender identity—are also explored. Finally, targets for future minority stress and social support research with the TGNC population are discussed.

Author/-s:       Samantha R. Pflum; Rylan J. Testa; Kimberly F. Balsam; Peter B. Goldblum; Bruce Bongar

Publication:     Psychology of Sexual Orientation and Gender Diversity, 2015

Web link:          http://psycnet.apa.org/journals/sgd/2/3/281/

Research on social support and mental health problems.

Objective: The aim of the study was to investigate the sociodemographic and clinical characteristics of people with gender dysphoria, and to evaluate the differences between female-to-male (FtM) and male-to-female (MtF) transsexual individuals.

Method: This study retrospectively examined the sociodemographic and clinical characteristics of 139 cases with the diagnosis of gender dysphoria that were referred to the Cerrahpaşa Medical Faculty for sex reassignment surgery between 2007–2013.

Results: Among 139 patients with gender dysphoria, 102 were MtF (73.4 %), and 37 were FtM (26.6 %). Rates of unemployment, employment in jobs which do not require high school education, being a sex worker (p < 0.001), drug use (p = 0.017), and not having health insurance (p < 0.001) were significantly higher in MtF individuals than in FtM individuals. Rates of receiving psychotherapy for gender dysphoria (p = 0.001) and starting hormone therapy under the supervision of a doctor (p < 0.001) were significantly higher in FtM individuals, however rates of taking hormone therapy (p < 0.001) and undergoing surgery for sex reassignment (p < 0.001) were higher in MtF individuals.

Conclusion: There are significant differences both in sociodemographic characteristics and clinical characteristics between MtF and FtM individuals. However, further studies are needed to identify underlying causes.

Author/-s:       Şenol Turan; Cana Aksoy Poyraz; Ezgi İnce; Ayşe Sakalli Kani; Hacı Murat Emül; Alaattin Duran

Publication:     Turkish Journal of Psychiatry, 2015

Web link:          http://turkpsikiyatri.com/Data/UnpublishedArticles/hctpo9.pdf

Thus study finds differences between male-to-female and female-to-male transsexuals.

Introduction: Mental disorders constitute the most important risk factor for suicidal behaviour. Studies have found that LGBT (lesbian, gay, bisexual, and transgender) individuals are at increased risk for mental health problems, as a consequence of a hostile stressful environment.

There as been a historical pathologisation of sexual orientation and gender identity, however, lately there have been significant changes in medical understanding about this theme.

Objectives/Aims: The authors aim to determine the possibility of increased suicidal ideation/suicidal behaviour among LGBT individuals.

Methods: Review of the literature using the terms LGBT, lesbian, gay, bissexual, transgender, sexual orientation, gender identity, suicide, suicidal ideation, suicidal behaviour.

Results: Studies provide evidence that individuals in a sexual or gender minority are at greater risk for suicidal thoughts and behaviours. There is evidence of elevated rates of reported suicide attempts in LGBT compared to heterosexual adolescents and adults, worldwide. Individuals reporting a bisexual orientation had an increased risk of suicide attempts and ideation compared with their homosexual and heterosexual peers. Mental disorders do not appear to entirely explain elevated rates of suicide attempts in these individuals. Social stigma, prejudice and discrimination associated with this individual are important factors.

Conclusions: Health professionals should be alert to the higher risk of suicidal behaviour in lesbian, gay, bisexual and transgender people. Further research is needed in order to prevent suicide in these populations.

Author/-s:       A.R. Figueiredo, T. Abreu

Publication:     European Psychiatry, 2015

Web link:          http://www.europsy-journal.com/article/S0924-9338(15)31398-5/abstract

Literature review of suicide among LGBT persons.

The main goal of surgical treatment for patients with male type of transsexualism is restoration of male perineum organs with formation of genitals similar to feminine one. Functional and esthetic results often don’t satisfy patients and don’t provide psycho-social adaptation and even lead to suicidal attempts in some cases. Complications that are typical for one method or another have serious impact on results of the research. This article analyses vaginoplasty treatment of 103 patients with the use of variety of methods. 33 patients were diagnosed with complications at early and remote post operational period. All of the complications were sorted in two groups: general surgical (6 complications types) and specific (3 complications types). At early post operational period, 6 complications types were recorded in 21 clinical monitoring. At remote post operational period, 3 complications types were recorded in 25 clinical monitoring.

Analysis of results of surgical treatment of over 100 patients with masculine gender identification disorder demonstrated advantage of neovaginoplasty method with the use of modified penile inversion and corporotomy over other methods. With the use of such methods only 8 patients developed various types of disorders. 6 patients had general surgical disorders, while 2 patients had specific disorders. Authors of this research gathered significant experience in surgical treatment of patients with masculine type of transsexualism, as well as post-operational care. As a result, this allowed to significantly lower the number of early and late stage complications.

Author/-s:       N. D. Kuchba; A. L. Istranov; I. V. Gulyaev; Ye. Ye. Vasilyeva; R. T. Adamyan

Publication:     АНДРОЛОГИЯ И ГЕНИТАЛЬНАЯ ХИРУРГИЯ, 2014

Web link:          http://agx.elpub.ru/index.php/jour/article/view/97/91

Complications of male-to-female sex reassignment surgery in Russia.

Aim: In previous studies, other authors have proposed the Gender Identity Disorder as a subtype of Borderline Personality Disorder. Our research hypothesis expected that the Primary transsexuals (TSS) group would show statistically significant differences in psychological scoring as compared to the TSP group, especially in the areas of object relations and reality testing. The aim of this study is to evaluate if the clinically observed differences between the TSPs and the TSSs are psychometrically measureable using the Exner CS Rorschach.

Materials and methods: 47 subjects with the diagnosis of Gender Identity Disorder were classified as either primary (TSP) or secondary (TSS) transsexuals according to the criteria put forth by H. Benjamin.

Results: The results have demonstrated that TSSs appear to be more vulnerable in the area of stress control and showed greater difficulty in adaptation, along with a higher tendency toward disorganization, impulsivity, and behavioral disorders with respect to TSPs. TSSs suffered much more from states of situational and chronic stress with alterations in the stream of voluntary thought. Analysis of the ideational section of the test reveals a higher frequency of thought disorders in the TSS group, in particular, cognitive mismanagement, ideational disorganization, pessimistic thought, and a higher tendency toward aggression. The quality of interpersonal relationships of TSSs is qualitatively lower and less adaptive, and a greater tendency toward establishing relationships connoted by dependence is more evident.

Conclusions: It would therefore seem that classification, according to Benjamin’s criteria, could prove useful both in clinical and research settings. Moreover, the Rorschach Test appears to be a valid psychometric instrument in assisting the clinician in the differential diagnosis and evaluation of the suitability of patients for sex reassignment surgery (SRS).

Author/-s:       V. Affatati; I. Grattagliano

Publication:     Journal of Forensic Research, 2015

Web link:          http://omicsonline.org/open-access/the-contribution-of-forensic-psycodiagnostic-in-legal-medical-evaluations-regarding-the-amendment-of-sex-assignment-the-rorschach-test-2157-7145-1000276.pdf

Rorschach tests for differentiating early-onset and late-onset transsexuals?

Introduction: Cross-sex hormone therapy is part of the treatment of individuals with gender dysphoria and affects several factors such as body composition and thereby cardiovascular risk. However, little is known about the specific effects on body weight and fat percentage in the first year of treatment.

Aim: The aim of this study is to examine the effects of cross-sex hormones on body weight and total fat percentage during the first year of treatment.

Methods: This prospective study (part of the ENIGI project) included 140 patients that completed one year of treatment. 70 male-to-female individuals (MtFs) received cyproteronacetate (50 mg/day). Of them, 31 MtFs were treated with an estradiol patch (200 μg/week) and 39 MtFs received estradiol valerate (2–4 mg/day). 70 female-to-male individuals (FtMs) were treated, of which 39 FtMs got testosterone esters intramuscular (250 mg/2 weeks) and 4 FtMs received testosterone undecanoate intramuscular (1000 mg/12 weeks). 27 FtMs were treated with testosterone gel (50 mg/day). At the start and after 12 months of treatment their body weight was measured and a DEXA was obtained.

Results: At baseline the mean body weight of the MtFs was 77.5 kg (S.D.±16.8), which in one year increased to 79.7 kg (S.D.±17.0) with a mean difference of 2.2 kg (95% CI 0.7–3.8). Their mean total fat percentage increased with 4.0% (95% CI 3.0–5.0), from 25.0 to 29.0%. The mean body weight of the FtMs increased from 69.1 kg (S.D.±15.0) to 72.2 kg (S.D.±14.7) with a mean difference of 3.1 kg (95%CI 2.0-4.3). In FtMs, a 4.3% (95%CI −5.3 to −3.3) decrease in total fat percentage was seen, from 34.7 to 30.4%.

Conclusions: Despite an expected increase in fat percentage in MtFs and a decrease in FtMs, total body weight increased in both groups. Further research is needed to elucidate the mechanism of weight gain during cross-sex hormone treatment.

Author/-s:       Maartje Klaver; Mariska Vlot; Marieke Dekker; Jos Megens; Martin den Heijer

Publications:   Endocrine Abstracts, 2015

Web link:          http://www.endocrine-abstracts.org/ea/0037/ea0037gp.13.05.htm

Hormone therapy increases weight.

This article details the findings of a qualitative action research project with parents of gender-variant children in Montreal, Canada. Through a unique methodology, the project aimed at understanding the issues and challenges facing parents in the process of supporting their children, as well as offering them support and an empowering platform for effecting change around them. The article explores how parents understand their children's experiences, the various challenges they themselves cope with in supporting their children, and the solutions they believe would improve their lives and the lives of their offspring. Recommendations for practice conclude this article.

Author/-s:       Annie Pullen Sansfaçon; Marie-Joëlle Robichaud; Audrey-Anne Dumais-Michaud

Publication:     Journal of LGBT Youth, 2015

Web link:          http://www.tandfonline.com/doi/abs/10.1080/19361653.2014.935555

Parenting that supports gender-variant children.

The present paper contributes an Australian focus to the growing body of research on trans and gender diverse people's family and romantic relationships. A survey designed by the authors was completed by 160 trans or gender diverse Australians. A negative correlation was found between discrimination from families of origin and perceptions of support, and conversely a positive correlation was found between perceptions of support and emotional closeness. Analysis of open-ended responses suggested that support was primarily constituted by (1) emotional support, (2) utilising correct pronouns and names, and (3) financial support. Discrimination by families of origin was primarily constituted by (1) refusal to use correct pronouns and names, (2) exclusion from family events, and (3) pathologising responses. The findings in regard to romantic relationships suggest that trans women were more likely than trans men or gender diverse people to experience challenges in negotiating romantic relationships. A negative correlation was found between difficulties in negotiating romantic relationships and belief in the likelihood that an “ideal” romantic relationship would occur in the future. Difficulties in negotiating romantic relationships were primarily described in terms of (1) anxiety over potential responses, (2) discrimination from potential partners, and (3) lack of self-acceptance. The paper concludes by discussing the implications of these findings for clinical practice.

Author/-s:       Damien W. Riggs; Henry von Doussa; Jennifer Power

Publication:     Sexual and Relationship Therapy, 2015

Web link:          http://www.damienriggs.com/blog/wp-content/uploads/2013/09/Trans-and-Gender-Diverse-Relationships.pdf

Study on family relationships of transsexual people.

This article synthesises findings from qualitative studies which have explored the lived experiences of transgender persons, using Noblit and Hare's (1998) meta-ethnography method. Thirty-one qualitative studies related to the lived experiences of transgender individuals, published between 1998 and 2013, met the inclusion criteria. A literature search was conducted between November 2012 and September 2013 using computerized searches from nine databases as well as online manual searches of key journals. Results from these individual studies revealed five major themes: (a) crossing gender and physical problems in life, (b) experiencing psychological distress, (c) encountering discrimination and social exclusion, (d) having relationships does matter, and (e) dealing with difficulties in life. Yet, despite these negative experiences, transgender people have tried to find ways to help them deal with their difficulties. We conclude that there is a need for health care providers, social workers, and health promoters to support transgender individuals, for their health and well-being. This meta-synthesis provides a clear account of what transgender individuals experience in their lives, to support the development of sympathetic health and social care services to assist them with their difficulties, and enhance their health and well-being.

Author/-s:       Pattaraporn Moolchaem; Pranee Liamputtong; Paul O’Halloran; Rosediani Muhamad

Publication:     Journal of Gay & Lesbian Social Services, 2015

Web link:          http://www.tandfonline.com/doi/abs/10.1080/10538720.2015.1021983#.VdCGZDYVioN

Analysis of the lived experiences of transgender persons.

Transgender and gender non-conforming individuals are often the subject of blatant and covert discrimination when seeking employment and studies demonstrate the negative effects on mental health.  The research question for this study was:  How can social workers best support trans* clients who are in the process of searching for employment, build self-efficacy and overcome psychological barriers that have developed as a result of oppression and discrimination?  This qualitative study of seven trans* individuals provides examples of discrimination as experienced by the participants, examines the effects discrimination has on mental health and self-efficacy, and provides social workers with recommendations for supporting trans* clients.  The study revealed that experiences of discrimination lead to feelings of anger, frustration, and hopelessness and often transform into depression, anxiety and suicidality.  Recommendations for social workers included learning about trans*-related issues, providing clients with practical resources and adopting a client-centered approach that offers empathy, encouragement and positive reinforcement.  Emotional responses to discrimination and problems that arise in the process of looking for work are also discussed. 

Author/-s:       Matthew Meurer-Lynn

Publication:     Project work for Master of Social work, Smith College School for Social Work, Massachusetts, USA, 2015

Web link:          https://dspace.smith.edu/bitstream/handle/11020/24678/MeurerLynnRedacted.pdf

Study of employment discrimination.

Introduction: The transgender and gender-nonconforming community long has been marginalized in society. As transgender individuals become more visible, obstetrician-gynecologists should direct educational initiatives to enhancing clinical templates that ensure inclusive, competent, and sensitive health services for this population, incorporating partner, culture, and community implications. Gender-unbiased health services are necessary to eliminate real and perceived barriers to care.

Methods: A review of literature on transgender medicine on PubMed over the past 5 years was conducted.

Results: There is scant research on transgender patients in obstetric and gynecologic health care settings, especially outside of hormonal and surgical transition. There are few studies on barriers to quality transgender health care, fewer quantitative studies on transgender patients' experiences in health care settings, and still fewer studies dealing with cultural and interpersonal practices that can help improve experiences for the patient and health care team. One non-peer-reviewed survey reports that 24 % of transgender respondents were denied equal treatment in doctor's offices or hospitals, 19 % were refused treatment owing to their gender identity, 28 % were verbally harassed and 2 % physically attacked in a medical setting, and 28 % postponed or avoided necessary medical care owing to discrimination. A "gender-equal" gynecologic template of care will be presented.

Conclusion/implications: More quantitative and qualitative studies should be performed assessing the needs of the transgender and gender-nonconforming community in obstetric and gynecologic practice. Existing statistics indicate that unacceptable bias and discrimination are occurring, making transgender patients less likely to seek care. Care templates on gender-equal patient encounters should be implemented to better address global and specific health needs in this population in a nonbiased manner.

Author/-s:       Gloria A. Bachmann; Brianna Mussman; Anthony Tobia

Publication:     Obstetrics & Gynecology, 2015

Web link: http://journals.lww.com/greenjournal/Abstract/2015/05001/Transgender_and_Gender_Nonconforming_Patients_.33.aspx

Gender non-conforming patients don’t receive optimal gynecologic care.

The current study used grounded theory methods to analyze trans men’s positive emotions. The sample included 11 participants who were assigned a female sex at birth and currently identify with a binary male identity. Results yielded eight positive emotion themes emerging for trans men, which included the following: confidence, comfort, connection, feeling alive, amazement, pride, happiness, and interpersonal reactionary emotions. Participants reported specific gender experiences within these themes, including a sense of brotherhood, excitement related to taking testosterone, authentic pride in identifying as a man, and happiness connected to others using correct gender language (e.g., pronouns, family labels, greetings). A theoretical model from the eight themes and 39 higher order categories emerged, indicating the importance of initial internal emotions, confidence related to trans men’s identity processes, and the ways in which positive interpersonal interactions affect positive emotions. Implications include using emotion-focused therapy and including more positivity into trans individuals’ experiences and emotions.

Author/-s:       Stephanie L. Budge; Joe J. Orovecz; Jayden L. Thai

Publication:     The Counseling Psychologist, 2015

Web link:          http://tcp.sagepub.com/content/early/2015/02/13/0011000014565715.abstract

Transition seems to lead to some positive emotions for transsexual men.

Introduction: With the development of new ENT techniques, many male transsexuals who wish to become women usually request a surgical procedure to raise the fundamental frequency of the voice (feminization). The ENT specialist and the voice-therapist have to use an interdisciplinary approach to this growing social demand. The aim of this study was to show the results in a group of transsexual patients after Wendler’s anterior synechiae, with additional voice-therapy treatment.

Methods: Ten male transexulas who wish to become women patients who had Wendler glottoplasty and voice-therapy were assessed. The surgical procedure consisted of a de-epithelialization of the anterior third of both vocal folds; this area was sutured and the surface of both vocal folds was vaporised with laser diode. Pre- and postsurgery voice assessment consisted of measuring fundamental frequency (Fo) and maximum phonation time, administering the transgender self-assessment questionnaire (TSEQ) and obtaining perceptual voice assessment by inter-rater agreement.

Results: All the male transsexuals who wish to become women patients significantly increased their Fo (106 Hz on average) after the treatment. Furthermore, significant improvements were shown in self-reported satisfaction and in the degree of voice feminization. No improvements in the maximum phonation time were observed.

Conclusions: Wendler glottoplasty is a surgical procedure to contribute to feminising the voice, with good medium-term results and without noteworthy medical complications. The increase in vocal tone was observed using several pre- and post-surgery control measures and voice therapy.

Author/-s:       Juan C. Casado; Carlos ÓConnor; María S. Angulo; José A. Adrián

Publication:     Acta Otorrinolaringológica Española, 2015

Web link:          http://www.sciencedirect.com/science/article/pii/S0001651915000552

The results of a surgical technique to feminise voices of male-to-female transsexuals seems positive.

The prevalence, age of onset, and symptomatology of many neuropsychiatric conditions differ between males and females. To understand the causes and consequences of sex differences it is important to establish where they occur in the human brain. We report the first meta-analysis of typical sex differences on global brain volume, a descriptive account of the breakdown of studies of each compartmental volume by six age categories, and whole-brain voxel-wise meta-analyses on brain volume and density. Gaussian-process regression coordinate-based meta-analysis was used to examine sex differences in voxel-based regional volume and density. On average, males have larger total brain volumes than females. Examination of the breakdown of studies providing total volumes by age categories indicated a bias towards the 18–59 year-old category. Regional sex differences in volume and tissue density include the amygdala, hippocampus and insula, areas known to be implicated in sex-biased neuropsychiatric conditions. Together, these results suggest candidate regions for investigating the asymmetric effect that sex has on the developing brain, and for understanding sex-biased neurological and psychiatric conditions.

Author/-s:       A. N. Ruigrok; G. Salimi-Khorshidi; M. C. Lai; S. Baron-Cohen; M. V. Lombardo; R. J. Tait; J. Suckling

Publication:     Neuroscience and biobehavioral reviews, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/24374381

A meta-analysis of the brain by gender.

There have been a small number of studies reporting a higher prevalence of autistic symptomatology in people with Gender Dysphoria (GD), in particular transmen (male-to-female), when compared with the general population. This study aimed to further these findings by recruiting a sample of 26 transgender adults and administering the Autism-Spectrum Quotient (AQ), together with measures of the cognitive traits of sex-differentiated thinking associated with autism and neuropsychological measures sensitive to the deficits associated with Autistic Spectrum Disorders (ASD’s), including emotion recognition, planning and set-shifting. The transgender sample was shown to occupy an area of the autism spectrum that was intermediate between ASD and neurotypical comparators. A potential trend of higher median AQ scores in transmen was observed but non-significant (r = 0.19). Cognitive sex differences on the Systemising Quotient-Revised (SQ-R) and Empathy Quotient (EQ) showed trends in the direction of their perceived gender in selected domains. Further examinations of relationships suggested that correct identification of emotions on the Cambridge Neuropsychological Test Automated Battery (CANTAB) Emotion Recognition Task (ERT) subtest was inversely related to levels of autistic traits and positively related to empathy-traits. No significant relationships were found between number of autistic traits and performance on planning and set-shifting tasks for the entire transgender sample. The overall findings of the study indicate that the pattern of performance expected in ASD was not found in the transgender sample recruited.

Author/-s:       Andrew Smith

Publication:     Thesis, University of Glasgow, 2014

Web link:          http://theses.gla.ac.uk/5755/

The link between autism and transsexualism seems weaker than expected.

Compelling studies have demonstrated that “gender identity”—a person’s inner sense of self as male, female, or occasionally a category other than male or female—is not simply a psychosocial construct, but likely reflects a complex interplay of biologic, environmental, and cultural factors. An increasing number of pre-adolescents and adolescents, identifying as “transgender” (a transient or persistent identification with a gender different from their “natal gender”—i.e. the gender that is assumed based on the physical sex characteristics present at birth), are seeking medical services to enable the development of physical characteristics consistent with their affirmed gender. Such services, including use of agents to block endogenous puberty at Tanner stage 2 and subsequent use of cross-sex hormones, are based on longitudinal studies demonstrating that those individuals who were first identified as gender-dysphoric in early or middle childhood and still meet the mental health criteria for being transgender at early puberty are likely to be transgender as adults. Furthermore, onset of puberty in transgender youth is often accompanied by increased “gender dysphoria”–clinically significant distress related to the incongruence between one’s affirmed gender and one’s “assigned (or natal) gender”. Studies have shown that such distress may be ameliorated by a “gender-affirming” model of care. While endocrinologists are familiar with concerns surrounding gender identity in patients with disorders of sex development (DSD), many providers are unfamiliar with the approach to the evaluation and management of transgender youth without a DSD. The goals of this article are to review studies that shed light on the biologic underpinnings of gender identity, the epidemiology and natural history of transgenderism, current clinical practice guidelines for transgender youth, and limitations and challenges to optimal care. Prospective cohort studies focused on long-term safety and efficacy are needed to optimize medical and mental health care for transgender youth.

Author/-s:       Stephen M. Rosenthal

Publication:     The Journal of Clinical Endocrinology & Metabolism, 2014

Web link:          http://press.endocrine.org/doi/abs/10.1210/jc.2014-1919

Review of studies about transsexualism and treatment of transgender youth.

Introduction: The etiology of male-to-female (MtF) transsexualism is unknown. Both genetic and neurological factors may play an important role.

Aim: To investigate the possible influence of the genetic factor on the etiology of MtF transsexualism.

Methods: We carried out a cytogenetic and molecular analysis in 442 MtFs and 473 healthy, age- and geographical origin-matched XY control males. The karyotype was investigated by G-banding and by high-density array in the transsexual group. The molecular analysis involved three tandem variable regions of genes estrogen receptor β (ERβ) (CA tandem repeats in intron 5), androgen receptor (AR) (CAG tandem repeats in exon 1), and CYP19A1 (TTTA tandem repeats in intron 4). The allele and genotype frequencies, after division into short and long alleles, were obtained.

Main Outcome Measures: We investigated the association between genotype and transsexualism by performing a molecular analysis of three variable regions of genes ERβ, AR, and CYP19A1 in 915 individuals (442 MtFs and 473 control males).

Results: Most MtFs showed an unremarkable 46,XY karyotype (97.96 %). No specific chromosome aberration was associated with MtF transsexualism, and prevalence of aneuploidy (2.04 %) was slightly higher than in the general population. Molecular analyses showed no significant difference in allelic or genotypic distribution of the genes examined between MtFs and controls. Moreover, molecular findings presented no evidence of an association between the sex hormone-related genes (ERβ, AR, and CYP19A1) and MtF transsexualism.

Conclusions: The study suggests that the analysis of karyotype provides limited information in these subjects. Variable regions analyzed from ERβ, AR, and CYP19A1 are notin in 2014 associated with MtF transsexualism. Nevertheless, this does not exclude other polymorphic regions not analyzed.

Author/-s:       Rosa Fernández; Isabel Esteva; Esther Gómez-Gil; Teresa Rumbo; Mari Cruz Almaraz; Ester Roda; Juan-Jesús Haro-Mora; Antonio Guillamón; Eduardo Pásaro

Publication:     The journal of sexual medicine, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12673/abstract

No connection between certain genes and transsexualism was found.

Gender dysphoria (GD) and autism spectrum disorder (ASD) are associated. In 49 GD children (40 natal males), we examined ASD risk factors (i.e., birth weight, parental age, sibling sex ratio) in relation to autistic traits. Data were gathered on autistic traits, birth weight, parents’ ages at birth, sibling sex ratio, gender nonconformity, age, maternal depression, general behavioral and emotional problems, and IQ. High birth weight was associated with both high gender nonconformity and autistic traits among GD children. Developmental processes associated with high birth weight are, therefore, likely to underlie the GD–ASD link either directly or indirectly. The present study is the first to provide quantitative data bearing on possible mechanisms that lead GD and ASD to co-occur.

Author/-s:       Doug P. VanderLaan; Jonathan H. Leef; Hayley Wood; S. Kathleen Hughes; Kenneth J. Zucker

Publication:     Journal of Autism and Developmental Disorders, 2014

Web link:          http://link.springer.com/article/10.1007/s10803-014-2331-3

Autism and gender dysphoria seem related.

This paper is based upon a grounded theory analysis of interviews with transgender-identified people from different regions of the United States. Participants held a variety of gender identities under the transgender rubric (e.g., crossdresser, transman, transwoman, butch lesbian). Interviews explored the participants’ experiences in arriving at their gender identity. This paper presents three clusters of findings related to the common processes of transgender identity development. This process was made possible by accessibility of transgender narratives that injected hope into what was a childhood replete with criticism and scrutiny. Ultimately, participants came to their identities through balancing a desire for authenticity with demands of necessity – meaning that they weighed their internal gender experience with considerations about their available resources, coping skills and the consequences of gender transitions. The implications of these findings are considered in terms of their contribution to gender theory, research, and clinical support for transgender clients.

Author/-s:       Heidi M. Levitt; Maria R. Ippolito

Publication:     Journal of Homosexuality, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/00918369.2014.951262#.U-9LCk0cQUF

How transgender people find their identity.

In adult male samples, homosexuality is associated with a preponderance of older brothers (i.e., the fraternal birth order effect). In several studies comparing gender dysphoric youth, who are likely to be homosexual in adulthood, to clinical or non-clinical control groups, the findings have been consistent with the fraternal birth order effect in males; however, less is known about unique sibship characteristics of gender dysphoric females. The current study investigated birth order and sibling sex ratio in a large sample of children and adolescents referred to the same Gender Identity Service (N = 768). Probands were classified as heterosexual males, homosexual males, or homosexual females based on clinical diagnostic information. Groups differed significantly in age and sibship size, and homosexual females were significantly more likely to be only children. Subsequent analyses controlled for age and for sibship size. Compared to heterosexual males, homosexual males had a significant preponderance of older brothers and homosexual females had a significant preponderance of older sisters. Similarly, the older sibling sex ratio of homosexual males showed a significant excess of brothers whereas that of homosexual females showed a significant excess of sisters. Like previous studies of gender dysphoric youth and adults, these findings were consistent with the fraternal birth order effect. In addition, the greater frequency of only children and elevated numbers of older sisters among the homosexual female group adds to a small literature on sibship characteristics of potential relevance to the development of gender identity and sexual orientation in females.

Author/-s:       Doug P. VanderLaan; Ray Blanchard; Hayley Wood; Kenneth J. Zucker

Publication:     PLOS one, 2014

Web link:          http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0090257

It’s about time Blanchard and Zucker retire.

This study tested predictions regarding two hypothesized maternal immune responses influencing sexual orientation: one affecting homosexual males with high fraternal birth order and another affecting firstborn homosexual individuals whose mothers experience repeated miscarriage after the birth of the first child. Low birth weight was treated as a marker of possible exposure to a maternal immune response during gestation. Birth weight was examined relative to sibship characteristics in a clinical sample of youth (N = 1 722) classified as heterosexual or homosexual based on self-reported or probable sexual orientation. No female sexual orientation differences in birth weight were found. Homosexual, compared to heterosexual, males showed lower birth weight if they had one or more older brothers—and especially two or more older brothers—or if they were an only-child. These findings support the existence of two maternal immune responses influencing male sexual orientation and possibly also cross-gender behavior and identity.

Author/-s:       Doug P. VanderLaan; Ray Blanchard; Hayley Wood; Luisa C. Garzon; Kenneth J. Zucker

Publication:     Developmental Psychobiology, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/dev.21254/abstract

Low birth weight seems to be linked to sexual orientation and possibly cross-gender behaviour and identity.

Context: Sex steroids are important for bone mass accrual. Adolescents with gender dysphoria (GD) treated with gonadotropin releasing hormone analogue (GnRHa) therapy are temporarily sex steroid deprived until the addition of cross sex hormones (CSH). The effect of this treatment on bone mineral density (BMD) in later life is not known.

Objective: To assess BMD development during GnRHa therapy and at age 22 in young adults with GD who started sex reassignment (SR) during adolescence.

Design and setting: Longitudinal observational study at a tertiary referral center.

Patients: Young adults diagnosed with gender identity disorder of adolescence (DSM IV-TR) who started SR in puberty and had undergone gonadectomy between June 1998 and August 2012 were included. In 34 subjects BMD development until the age of 22 years was analyzed.

Intervention: GnRHa monotherapy (median duration in natal boys with GD (transwomen) and natal girls with GD (transmen) 1.3 and 1.5 years, respectively) followed by CSH (median duration in transwomen and transmen 5.8 and 5.4 years, respectively) with discontinuation of GnRHa after gonadectomy.

Major outcome measures: BMD development during SR until the age of 22.

Results: and conclusion: Between start of GnRHa and age 22 the lumbar areal BMD Z-score (for natal sex) in transwomen decreased significantly from −0.8 to −1.4 and in transmen there was a trend for decrease from 0.2 to −0.3. This indicates that the BMD was below their pre-treatment potential and either attainment of peak bone mass has been delayed or peak bone mass itself is attenuated.

Author/-s:       Daniel Klink; Martine Caris; Annemieke Heijboer; Michael van Trotsenburg; Joost Rotteveel

Publication:     The Journal of Clinical Endocrinology & Metabolism, 2014

Web link:          http://press.endocrine.org/doi/abs/10.1210/jc.2014-2439

Hormone treatment changes bone mineral density in adolescents. This study is reported at http://www.healio.com/endocrinology/hormone-therapy/news/online/%7Bababa5f7-17c6-4606-9fee-f9f207e81f30%7D/ht-may-delay-stunt-bmd-in-adolescents-with-gender-dysphoria and discussed on the “Open Minded Health” website http://openmindedhealth.com/2015/01/article-review-bone-mass-young-adulthood-following-gonadotropin-releasing-hormone-analogue-treatment-cross-sex-hormone-treatment-adolescents-gender-dysphoria/.

This study provides an in-depth understanding of the lived experiences of four prepubescent transgender children (male to female), and their families. It aims to provide a space for these children and their families’ voices to be heard, in a society with a pre-established ideology about the expectations of anatomically born males and females. Using the meshing of case study and ethnographic techniques including, observations, interviews, and journaling, this study is an exploratory-descriptive analysis illuminating the strengths and challenges that this community faces.

Author/-s:       Cecillia Barron

Publication:     Master thesis, Sociology, California State University, Northridge, 2014

Web link:          http://scholarworks.csun.edu/bitstream/handle/10211.3/125270/Barron-Cecillia-thesis-2014.pdf

Four case studies of transchildren.

We examined relationships between autistic traits in children, mothers, and fathers and gender nonconformity (GNC) in children using data from the Nurses’ Health Study II and the Growing Up Today Study 1. Autistic traits of mothers, fathers and children were measured using the Social Responsiveness Scale (SRS). GNC in children was measured using questions from the Recalled Childhood Gender Identity/Gender Role Questionnaire. In multivariable analyses increase in child’s SRS score was associated with increased odds (OR 1.35; p = 0.03) of being in a higher GNC category. Increase in maternal SRS score was also associated with increased odds (OR 1.46; p = 0.005) of the child being in a higher GNC category. Paternal SRS scores were not related to child’s GNC category.

Author/-s:       Daniel E. Shumer; Andrea L. Roberts; Sari L. Reisner; Kristen Lyall; S. Bryn Austin

Publication:     Journal of Autism and Developmental Disorders, 2014

Web link:          http://link.springer.com/article/10.1007/s10803-014-2292-6

Autism in mothers seems to be associated with gender non-conforming children.

Objective: The incidence of heart disease increases with age, but is lower in women than in men up to 75 years. A protective effect of female sex hormones or, alternatively, acceleration in male heart disease by testosterone at younger ages, could explain this sex difference. In contrast with the above, male-to-female transsexual subjects (MtoF) treated with estrogens (+anti-androgens) show more cardiovascular pathology than female-to-male transsexual subjects (FtoM) receiving testosterone. Why MtoF suffer more frequently from cardiovascular disease than females is as yet unclear. The mode of cross-sex hormone treatment may be a factor, and, if so, it may need adaptations.

Subjects and methods: Studies in transsexual people on the effects of cross-sex hormone treatment on surrogate cardiovascular risks and on clinical endpoints were reviewed. With regard to MtoF, a parallel was sought with men with prostate cancer, undergoing androgen deprivation and estrogen administration.

Results: Exposure of FtoM to testosterone was not associated with a strong increase in cardiovascular events. Aging and pre-existing cardiovascular pathology contributed to the risk of cardiovascular disease in MtoF. Use of the synthetic biopotent compound ethinyl estradiol in a dose two to four times of oral contraceptives increased cardiovascular risk substantially. The route of administration of estrogens (oral vs transdermal) may have impacted on the risks.

Conclusion: MtoF should not be treated with oral ethinyl estradiol. Transdermal estrogens are probably safer than oral estrogens. Pre-existing cardiovascular risks should be taken into consideration when prescribing and choosing the type of estrogens in cross-sex hormone administration (oral vs transdermal). In addition, risk factors, as they emerge with aging, should be addressed.

Author/-s:       Louis J. G. Gooren; Katrien Wierckx; Erik J. Giltay

Publication:     European Journal of Endocrinology, 2014

Web link:          http://europepmc.org/abstract/MED/24616414

Relationship between hormone therapy and cardiovascular disease.

Objective: To explore the rationales of mental health professionals (mainly psychiatrists and psychologists) from 8 countries for removing specific diagnostic categories from mental disorders classification systems.

Method: As part of a larger study, 505 participants indicated which of 60 major disorders should be omitted from mental disorders classification systems and provided rationales. Rationale statements were analyzed using inductive content analysis.

Results: The majority of clinicians (60.4 %) indicated that 1 or more disorders should be removed. The most common rationales were (a) problematic boundaries between normal and psychopathological conditions (45.9 % of total removal recommendations), (b) problematic boundaries among mental disorders (25.4 %), and (c) problematic boundaries between mental and physical disorders (24.0 %). The categories most frequently recommended for deletion were gender identity disorder, sexual dysfunction, and paraphilias, usually because clinicians viewed these categories as being based on stigmatization of a way of being and behaving. A range of neurocognitive disorders were described as better conceptualized as nonpsychiatric medical conditions. Results were analyzed by country and country income level. Although gender identity disorder was the category most frequently recommended for removal overall, clinicians from Spain, India, and Mexico were most likely to do so and clinicians from Nigeria and Japan least likely, probably because of social and systemic factors that vary by country. Systematic differences in removal rationales by country income level may be related to the development, structure, and functioning of health systems.

Conclusion: Implications for development and dissemination of the classification of mental and behavioral disorders in WHO's ICD-11 are discussed.

Author/-s:       Rebeca Robles; Ana Fresán; María Elena Medina-Mora; Pratap Sharan; Michael C. Roberts; Jair de Jesus Mari; Chihiro Matsumoto; Toshimasa Maruta; Oye Gureje; José Luís Ayuso-Mateos; Zeping Xiao; Geoffrey M. Reed

Publication:             Journal of Clinical Psychology, 2014

Web link:         http://onlinelibrary.wiley.com/doi/10.1002/jclp.22145/abstract

A large share of clinicians wants to remove gender identity disorder from the classification as mental disorder.

Background and objective: It is unclear whether the proportion of infants with a disorder of sex development who are raised as male or female has changed over time. The temporal trends in sex assignment of affected cases entered in the International Disorder of Sex Development (I-DSD) Registry were studied.

Methods: Cases of disorders of sex development reported as partial androgen insensitivity syndrome (PAIS; n = 118), disorder of gonadal development (DGD; n = 232), and disorder of androgen synthesis (DAS; n = 104) were divided into those who were born before 1990, 1990–1999, and after 1999. External appearance of the genitalia was described by the external masculinization score.

Results: The median (5th–95th percentile) external masculinization scores of those infants with PAIS, DGD, and DAS who were raised as boys were 6 (2–9), 6 (3–9), and 6 (1–12), respectively, and were significantly higher than in those raised as girls (2 [0–6], 2 [0–7], and 0 [0–5], respectively); this difference was maintained in the 3 temporal birth cohorts (P < .01). Of the 118 cases in the pre-1990 cohort, 41 (35%) were raised as boys; of the 148 cases in the 1990–1999 cohort, 60 (41 %) were raised as boys; and of the 188 cases in the post-1999 cohort, 128 (68 %) were raised as boys.

Conclusions: Although there is an association between the external appearance of the genitalia and the choice of sex assignment, there are clear temporal trends in this practice pointing toward an increased likelihood of affected infants being raised as boys. The impact of this change in practice on long-term health outcomes requires additional focus.

Author/-s:       Zofia Kolesinska; S. Faisal Ahmed; Marek Niedziela; Jillian Bryce; Marta Molinska-Glura; Martina Rodie; Jipu Jiang; Richard O. Sinnott; Ieuan A. Hughes; Feyza Darendeliler; Olaf Hiort; Yvonne van der Zwan; Martine Cools; Tulay Guran; Paul-Martin Holterhus; Silvano Bertelloni; Lidka Lisa; Wiebke Arlt; Nils Krone; Mona Ellaithi; Antonio Balsamo; Inas Mazen; Anna Nordenstrom; Katherine Lachlan; Mona Alkhawari; Pierre Chatelain; Naomi Weintrob

Publication:     Pediatrics, 2014

Web link:          http://pediatrics.aappublications.org/content/early/2014/07/29/peds.2014-1088.abstract

Gender assignment for DSD-affected patients changes more towards male.

Background: The recent reclassification of gender identity disorder as gender dysphoria (GD) in DSM-5 identifies those seeking to pursue gender transition via specialist services as necessarily ‘distressed’ and therefore mentally disordered. Distress in gender variant clients may arise from a variety of stressors, external and intra-psychic, many of which may have their roots in childhood experience [E. Bandini et al. (2011)].

Aims: (1) to review current thinking on gender variance and recognition and classification of GD (2) to detail the contribution of childhood adversity to distress in gender variant clients from an audit of 50 such clients (33 assigned/natal males and 17 assigned/natal females) of a mainstream NHS psychosexual service.

Methods: Current issues in classification and diagnosis of GD, and debate on the aetiology of gender variance, are reviewed briefly. Audit findings on health, treatment issues and support, and thematic analysis of childhood experiences, provide the basis for a case example of a post-transition client experiencing some common difficulties associated with GD and childhood adversity.

Conclusions: Pragmatism of diagnosis and treatment of GD contrasts with the variety of theories of causation of gender variance itself. ‘Distress’ as a precondition of treatment may reflect childhood experience as much as GD-specific symptoms, and may contribute more to persistent psychological vulnerability. While educational programmes in schools and a better knowledge base in counselling and related training curricula are indicated, gender dysphoric clients, pre- and post-transition, experience common life problems for which generic forms of counselling and therapy are appropriate.

Author/-s:       Malcolm T. Firth

Publication:     Counselling and Psychotherapy Research, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/capr.12002/abstract

Trying to separate causes for distress from gender dysphoria.

Transsexual subjects are individuals who have a desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one’s anatomic sex, and a wish to have surgery and hormonal treatment to make one’s body as congruent as possible with one’s preferred sex. They seek to develop the physical characteristics of the desired gender, and should undergo an effective and safe treatment regimen. The goal of treatment is to rehabilitate the individual as a member of society in the gender he or she identifies with. Sex reassignment procedures necessary for the treatment of transsexual patients are allowed in our country, at Medical Services that have a multidisciplinary team composed of a psychologist, a social worker, a psychiatrist, an endocrinologist and surgeons (gynecologists, plastic surgeons, and urologists). Patients must be between 21 to 75 years old and in psychological and hormonal treatment for at least 2 years. Testosterone is the principal agent used to induce male characteristics in female transsexual patients, and the estrogen is the chosen hormone used to induce the female sexual characteristics in male transsexual patients. Based on our 15 years of experience, we can conclude that testosterone and estradiol treatment in physiological doses are effective and safe in female and male transsexual patients, respectively.

Author/-s:       Elaine Maria Frade Costa; Berenice Bilharinho Mendonca

Publication:     Arquivos Brasileiros de Endocrinologia & Metabologia, 2014

Web link:          http://www.abem-sbem.org.br/media/uploads/13_ABEM582.pdf

Hormone therapy is safe.

Introduction: In trans women (male-to-female transsexual persons), cross-sex hormone therapy is administered to induce feminization. Breast development is an important part of feminization for most trans women.

Aim: The aim of this study is to assess the effect of cross-sex hormone therapy on breast development in adult trans women. Additionally, we aimed to investigate the benefit or harm of administration of progestogens on breast development.

Methods: A review of the literature in Embase, Medline, The Cochrane Library, PsycINFO databases, PubMed, and Web of Knowledge until January 2014.

Main Outcome Measures: Effects of cross-sex hormone therapy and progestogens on breast development in trans women.

Results: Only few studies with low quality of evidence addressed these topics. The available evidence suggests that breast development is insufficient for the majority of trans women and that type and dosage of hormonal therapy seem not to have an important role on final breast size.

Conclusions: Our knowledge concerning the natural history and effects of different cross-sex hormone therapies on breast development in trans women is extremely sparse and based on low quality of evidence. Current evidence does not provide evidence that progestogens enhance breast development in trans women. Neither do they prove the absence of such an effect. This prevents us from drawing any firm conclusion at this moment and demonstrates the need for further research to clarify these important clinical questions.

Author/-s:       Katrien Wierckx; Louis J. G. Gooren; Guy T’Sjoen

Publication:     The Journal of sexual medicine, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/24618412

Breast development in MtF transsexuals is insufficient, type and dosage of hormone therapy don’t play a big role.

Gender identity disorder is characterized by a strong and persistent identification with the opposite sex and discomfort with one’s own sex. Aim of present study was to compare of coping strategies in gender identity disorder patients and normal subjects. Statistical population was including 30 patients who are suffering from gender identity disorder that has medical files in department of Emergency Welfare of Sari city, Iran; and 30 subjects that are health and has normal life. Measurement tool for evaluate the coping strategies was The Multidimensional Coping Inventory (COPE). Statistical analysis was conducted using SPSS, ver 18, and comparison of coping strategies between the two groups was performed using independent sample t-tests. Results showed significance difference between patients with GID and normal subjects in problem-focused coping and avoidance coping subscales and coping strategies.

Author/-s:       Maria Honarmand; Hassan Heydari

Publication:     Journal of Social Issues & Humanities, 2014

Web link:          http://www.journalsih.com/Research%20Articles/Vol%202/Issue%203/Compare%20of%20coping%20strategies%20in%20gender%20identity%20disorder%20patients%20and%20normal%20subjects.pdf

Coping strategies of transsexuals differ from controls.

Introduction: Guidelines for cross-sex hormone treatment of transsexual people are now in place. However, little attention has been paid to the issue of treatment suitability for older people. Does existing treatment need to be adapted as subjects age, and does it make a difference if treatment is only started when the subject is already older?

Aim: To assess the necessity of adapting cross-sex hormone administration for elderly transsexual people.

Main Outcome Measures: Risks/benefits of continued use of cross-sex hormones with regard to bone health, cardiovascular risks, and malignancies.

Methods: Due to lack of data on the subject population, sex hormone treatment of other conditions in older non-transsexual people has been taken as the best available analogy to determine the extent to which these might be applicable to comparable transsexual persons. Findings in transsexual people receiving cross-sex hormone treatment sometimes modified the above approach of applying guidelines for the elderly to the aging transsexual population.

Results: Testosterone administration to female-to-male transsexual persons (FtoM) carries little risk with regard to cardiovascular disease and cancer. For those with high hematocrit or cardiac insufficiency the dose can be reduced. Administration of estrogens to male-to-female transsexual persons (MtoF), particularly when combined with progestins, does significantly increase the risk of developing cardiovascular disease (almost a twofold incidence compared with the general population). This may require dose adjustment or changing from oral to safer transdermal estrogens. Tumors of the breasts, prostate and pituitary may occur. In FtoM, breast cancer can occur even after breast ablation. Older subjects can commence cross-sex hormone treatment without disproportionate risks.

Conclusion: Cross-sex hormones may be continued into old age but monitoring for cardiovascular disease and malignancies, both of the old and new sex, is recommended. MtoF will have more health complications in old age than FtoM requiring adaptations of treatment.

Author/-s:       Louis J. G. Gooren; Paul Lips

Publication:     The Journal of Sexual Medicine, 2014

Web link:          http://europepmc.org/abstract/MED/24775178

Hormone treatment for old people is safe, but requires monitoring for male-to-female transsexuals.

Introduction: Data on the effects of cross-sex hormone therapy (CHT) are limited due to the low prevalence of gender dysphoria, small number of subjects treated at each center, lack of prospective studies, and wide variations in treatment modalities.

Aim: The aim of this study is to report the short-term effects of CHT on hormonal and clinical changes, side effects, and adverse events in trans men (female-to-male gender dysphoric persons) and trans women (male-to-female gender dysphoric persons).

Methods: This was a multicenter 1-year prospective study in 53 trans men and 53 trans women. Trans men received injections of testosterone undecanoate every 3 months. Trans women younger than 45 years received 50 mg cyproterone acetate (CA) and 4 mg estradiol valerate daily, whereas those older than 45 years received 50 mg CA daily together with 100 μg/24 hours transdermal 17-β estradiol.

Main Outcome Measures: Sex steroids, prolactin, liver enzymes, lipids, hematocrit, blood pressure, anthropometrics, Ferriman and Gallwey score, and global acne grading scale were measured. Side effects, adverse events, and desired clinical changes were examined.

Results: No deaths or severe adverse events were observed. Two trans men developed erythrocytosis, and two had transient elevation of the liver enzymes. Trans men reported an increase in sexual desire, voice instability, and clitoral pain (all P ≤ 0.01). Testosterone therapy increased acne scores, facial and body hair, and prevalence of androgenetic alopecia. Waist–hip ratio, muscle mass, triglycerides, total cholesterol (C), and LDL-C increased, whereas total body fat mass and HDL-C decreased. Three trans women experienced transient elevation of liver enzymes. A significant increase in breast tenderness, hot flashes, emotionality, and low sex drive was observed (all P ≤ 0.02). Fasting insulin, total body fat mass, and prolactin levels increased, and waist–hip ratio, lean mass, total C, and LDL-C decreased.

Conclusions: Current treatment modalities were effective and carried a low risk for side effects and adverse events at short-time follow-up.

Author/-s:       Katrien Wierckx; Eva van Caenegem; Thomas Schreiner; Ira Haraldsen; Alessandra Fisher; Kaatje Toye; Jean-Marc Kaufman; Guy T’Sjoen

Publication:     The Journal of Sexual Medicine, 2014

Web link:          http://europepmc.org/abstract/MED/24828032

Hormone therapy is safe.

Serum levels of brain-derived neurotrophic factor (BDNF) are reduced in male-to-female transsexual persons (MtF) compared to male controls. It was hypothesized before that this might reflect either an involvement of BDNF in a biomechanism of transsexualism or to be the result of persistent social stress due to the condition. Here, we demonstrate that 12 month of cross-sex hormone treatment reduces serum BDNF levels in male-to-female transsexual persons independent of anthropometric measures. Participants were acquired through the European Network for the Investigation of Gender Incongruence (ENIGI). Reduced serum BDNF in MtF thus seems to be a result of hormonal treatment rather than a consequence or risk factor of transsexualism.

Author/-s:       Johannes Fuss; Rainer Hellweg; Eva van Caenegem; Peer Briken; Günter K. Stalla; Guy T’Sjoen; Matthias K. Auer

Publication:     European Neuropsychopharmacology, 2014

Web link:          http://www.europeanneuropsychopharmacology.com/article/S0924-977X(14)00330-7/abstract

BDNF is not a marker for gender dysphoria or stress in transsexual persons.

There exists limited understanding of cross-sex hormone use and mental well-being among transgender women and, particularly, among transgender men. Moreover, most studies of transgender people have taken place in the Global North and often in the context of HIV. This exploratory study compared 60 transgender men (toms) with 60 transgender women (kathoeys) regarding their use of cross-sex hormones, mental well-being and acceptance by their family. Participants also completed a dispositional optimism scale (the Life Orientation Test Revised), the Social Functioning Questionnaire and the Short Form Health Survey 36 assessing their profile of functional health and mental well-being. Cross-sex hormones were used by 35% of toms and 73% of kathoeys and were largely unsupervised by health-related personnel. There were no differences in functional health and mental well-being among toms and kathoeys. However, toms currently using cross-sex hormones scored on average poorer on bodily pain and mental health, compared to non-users. Furthermore, compared to non-users, cross-sex hormone users were about eight times and five times more likely to be associated with poor parental acceptance among toms and kathoeys, respectively. This study was the first to compare cross-sex hormone use, functional health and mental well-being among transgender women and transgender men in Southeast Asia.

Author/-s:       Louis J. Gooren; Tanapong Sungkaew; Erik J. Giltay; Thomas E. Guadamuz

Publication:     Culture, Health & Sexuality, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/13691058.2014.950982#.VDEUnU0cQUE

Hormone use in Thailand.

Objective and problematic: The transsexualism as well as its treatment by the hormonal and surgical sex reassignment are phenomena in the crossroads of all the limits: body, subjectivity, society, psyche … In front of this complexity, running with the approaches structural and deconstructivist, this thesis has for objective to define and to propose a new "transversal" approach of the transsexualism, and in the continuity of this one of the sexed identity, with the elements of the psychoanalytical theory that are the sexual death drive, the third topical of the splited Unconscious, the impulsive realization by the perception and the clinical of the extreme and the ordinary.

Material (equipment) and method: On sample of six subjects transsexuals male to female resorting at present or having resorted to the sex reassignment for more than two years, we analyzed the results in a clinical interview inspired by the structural approach, in the projective tests of the rorschach and the TAT according to the projectivist method of Paris Descartes, as well as in the MMPI-2. Our three hypotheses are that the transsexual identity problematic would send back to the sexual death drive, to the amential Unconscious and to the clinical of the extreme, then that the sex reassignment would have the potential to act such as an impulsive realization by the perception.

Results: The results validate both first ones hypothesis on the sex drive, the amential Unconscious and the clinical of the extreme, but not that one on the impulsive realization by the perception.

Conclusion and discussion: These results show the interest of a transversal approach to dread a phenomenon borderline as are it the transsexualism and the sexed identity which see each other lit by the transversal theoretical proposed elements (sexual death drive, amential Unconscious and private hospital of the extreme). Concerning, the effects of psychic sex reassignment at the level, it seems necessary to pursue our investigation, the impulsive realization by the perception has been validated to one of our subject but excluded to the other one.

Author/-s:       Jean-Baptiste Marchand

Publication:     Doctoral thesis, Université Paris Ouest-Nanterre La Défense, 2014

Web link:          https://bdr.u-paris10.fr/theses/internet/2014PA100126_diff_1.pdf

From the English abstract, this appears to be a Sokal-type hoax on postmodernism. However, the original 582-page French document looks like there is some valid data in there. I included this for the benefit of French speakers and to remind me to try to get a good translation.

The present article discusses the DSM-IV-TR diagnosis of gender identity disorder (GID) in adolescent and adults. A brief summary of GID’s historical evolution is provided, followed by an extensive literature review. Peer reviewed articles were selected for relevance and rates of citation. It is acknowledged that high citation rates do not directly translate into article quality, and therefore some references may not meet the highest research standards. In an effort to acknowledge other relevant perspectives, additional sources included writing by individuals with GID and reports released by invested organizations. Ten topics were identified: gatekeeping, post-operative patient satisfaction and regret, theoretical criticisms, reliability and validity, criterion C (absence of an intersex condition), criterion D (presence of distress or impairment), prevalence, comorbidity, homosexuality, and specifiers. Conflicting findings were acknowledged and implications were discussed when appropriate. Although the GID diagnosis underwent several changes with the release of the DSM-V in May 2013, this article only briefly touches upon that process. Ultimately, the present article focuses on the literature’s state immediately before the DSM-V release in May 2013.

Author/-s:       Saralyn Russell

Publication:     Western Undergraduate Psychology Journal, 2014

Web link:          http://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=1000&context=wupj

Good overview on the current state of diagnosing and treating gender dysphoria.

In spite of the potential clinical utility of defense mechanisms in the assessment of gender identity disorder patients as candidates to sex reassignment surgery, there is paucity of research in this field. The aim of the present study is therefore to ascertain whether the defensive profile of MtF and FtM transsexuals seeking sex reassignment surgery can be defined more primitive, immature and maladaptive than that of the two control groups. We compared the defensive profiles as assessed through the REM-71 (Steiner et al., 2001) of 104 MtF transsexuals, 46 FtM transsexuals and two control groups of males and females. Our results show that MtF transsexuals present an overall more primitive defensive array than that of both control groups, while FtMs show a profile not dissimilar from that of both control groups. Our results support the hypothesis that MtF transsexuals are characterized by higher proneness to psychopathology than the general population and show a more immature level of psychological functioning than FtM transsexuals.

Author/-s:       Antonio Prunas; Roberto Vitelli; Filomena Agnello; Elena Curti; Paolo Fazzari; Francesca Giannini; Diamante Hartmann; Maurizio Bini

Publication:     Comprehensive Psychiatry, 2014

Web link:          http://europepmc.org/abstract/MED/24439558

MtF transsexuals have a maladaptive defensive profile.

As the idea that transgender people are individuals who suffer from a pathology is overcome with the new guidelines of the DSM–5 and the recognition of their rights with a legal framework such as the Gender Identity Law in Argentina, it is expected that this population will begin to approach health care services in general and mental health aid in particular. This article reviews what is known about the prevalence, diagnosis and treatment of bipolar disorder in transgender people. Firstly, new definitions of DSM–5 are introduced; next, studies on prevalence of psychopathology in this population are reviewed; and finally, challenges and considerations for the diagnosis and treatment of bipolar disorder are presented. Due to the high rates of depression, suicide attempts and substance abuse, it is likely that the prevalence of bipolar disorder is high in this group but is not appropriately diagnosed. This might be due to the lack of access to the health care system or due to the probable confusion between symptoms of the disorder and the lifestyle characteristics of this population. It is concluded that there is a need of conducting local studies to explore the profile and characteristics of this population as well as the need of providing training on transgender specific issues to professionals in the field of mental health.

Author/-s:       Inés Arístegui

Publication:     Psicodebate, 2015

Web link:          http://www.palermo.edu/cienciassociales/investigacion-y-publicaciones/pdf/psicodebate/14/Psicodebate_N14_T1_05.pdf

More research on bipolar disorder in transsexuals is needed.

The present study aimed to investigate differences in personality traits among male-to-female (MtF), female-to-male (FtM) gender identity disorder (GID) subjects and non-transsexual male (M) and female (F) controls. Subjects were 72 MtF and 187 FtM GID subjects without psychiatric comorbidities together with 184 male and 159 female non-transsexual controls. Personality traits were assessed using a short version of the Temperament and Character Inventory (TCI-125). Group comparisons were made by two-way ANOVA. Statistical significances were observed as follows: 1) lower novelty seeking in FtM than in M or MtF, 2) higher reward dependence in FtM than in M, 3) higher cooperativeness in FtM than in M or MtF, 4) the highest self-transcendence in MtF among all the groups. The highest self-transcendence in MtF subjects may reflect their vulnerable identity and constrained adaptation to society as the minority. Nevertheless, higher reward dependence and cooperativeness in FtM subjects can be related to more determined motivation for the treatments of GID and might promise better social functioning and adjustment than MtF subjects.

Author/-s:       Eiichi Miyajima; Naoki Taira; Munenaga Koda; Tsuyoshi Kondo

Publication:     Psychiatry Research, 2014

Web link:          http://www.psy-journal.com/article/S0165-1781(14)00648-9/abstract

Personality differences between transsexuals and cisgenders.

This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD). Circumscribed preoccupations or intense interests were considered as overlapping symptoms expressed in GD and ASD. In gender-referred children (n = 534; 82.2 % male) and their siblings (n = 419; 57.5 % male), we examined Items 9 and 66 on the Child Behavior Checklist, which measure obsessions and compulsions, respectively. Non-GD clinic-referred (n = 1,201; 48.5 % male) and nonreferred (n = 1,201; 48.5 % male) children were also examined. Gender-referred children were elevated compared to all other groups for Item 9, and compared to siblings and nonreferred children for Item 66. A gender-related theme was significantly more common for gender-referred boys than male siblings on Item 9 only. A gender-related theme was not significantly more common for gender-referred girls compared to their female siblings on either item. The findings for Item 9 support the idea that children with GD show an elevation in obsessional interests. For gender-referred boys in particular, gender-related themes constituted more than half of the examples provided by their mothers. Intense/obsessional interests in children with GD may be one of the factors underlying the purported link between GD and ASD.

Author/-s:       Doug P. VanderLaan; Lori Postema; Hayley Wood: Devita Singh; Sophia Fantus; Jessica Hyun; Jonathan Leef; Susan J. Bradley; Kenneth J. Zucker

Publication:     The Journal of Sex Research, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/00224499.2013.860073#.UxH-zE2YZhE

Gender dysphoric boys show an increased risk for obsessional interests (symptom of autism spectrum disorders).

Mammalian sex determination is the unique process whereby a single organ, the bipotential gonad, undergoes a developmental switch that promotes its differentiation into either a testis or an ovary. Disruptions of this complex genetic process during human development can manifest as disorders of sex development (DSDs). Sex development can be divided into two distinct processes: sex determination, in which the bipotential gonads form either testes or ovaries, and sex differentiation, in which the fully formed testes or ovaries secrete local and hormonal factors to drive differentiation of internal and external genitals, as well as extragonadal tissues such as the brain. DSDs can arise from a number of genetic lesions, which manifest as a spectrum of gonadal (gonadal dysgenesis to ovotestis) and genital (mild hypospadias or clitoromegaly to ambiguous genitalia) phenotypes. The physical attributes and medical implications associated with DSDs confront families of affected newborns with decisions, such as gender of rearing or genital surgery, and additional concerns, such as uncertainty over the child's psychosexual development and personal wishes later in life. In this Review, we discuss the underlying genetics of human sex determination and focus on emerging data, genetic classification of DSDs and other considerations that surround gender development and identity in individuals with DSDs.

Author/-s:       Valerie A. Arboleda; David E. Sandberg; Eric Vilain

Publication:     Nature reviews endocrinology, 2014

Web link:          http://www.nature.com/nrendo/journal/vaop/ncurrent/full/nrendo.2014.130.html

Pathology of DSDs.

Background: In 2009, The Endocrine Society published clinical practice guidelines for the treatment of children and adolescents with gender dysphoria (GD). The guidelines recommend the use of GnRH agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, there is no consensus on the use of these early medical interventions. In some countries they are part of treatment protocol. Elsewhere in the world it is not standard of care due to various ethical concerns, including fear for harms of the treatment and doubts about children’s competence to make these far-reaching decisions. The aim of our study was to gain more insight in the contexts of treatment disagreements surrounding early medical interventions and the underlying considerations of proponents and opponents.

Methods:

(1) systematic review of the literature on treatment discussions in children with gender dysphoria

(2) qualitative study (semi-structured interviews) to identify considerations of key-informants (pediatric endocrinologist, psychologist, psychiatrist, ethicist) of 10 treatment teams worldwide

Results: The literature and the interviews show 6 fundamental topics that give rise to different, and even opposing, views on treatment of adolescents: 1) the (non-)availability of an explanatory model for GD (genetic, hormonal, neurodevelopmental and social factors); 2) the nature of GD (normal variation, social construct or (mental) illness); 3) the role of physiologic puberty to form a consistent gender identity; 4) the role of comorbidity; 5) ideas about possible physical or psychological harms of early medical interventions as well as of refraining from interventions; 6) ideas about decision making authority and child competence.

Interestingly, the Endocrine Society guidelines are debated both for being too liberal and for being too limiting. Many teams using the guidelines are exploring the possibility of expanding the current age limits.

Conclusion: Judgment on GD treatment is affected by fundamental ideas on the nature of gender and GD. As long as discussion remains on the abovementioned topics, and as long as there are only limited long-term treatment data, there will be no agreement on treatment options. There is an urgent need for systematic interdisciplinary and (worldwide) multicenter research and debate, not only on long-term outcomes, but also specifically on the nature of gender (dysphoria). The guidelines will only have a sound foundation once consensus is reached on these fundamental issues.

Author/-s:       Martine Charlotte de Vries; Lieke J. J. J. Vrouenraets; Anne B Wichmann; Maartje H. N. Schermer; Miranda Fredriks; Henriette Aleida Delemarre

Publication:     Endocrine Society’s 96th Annual Meeting, 2014

Web link:          http://press.endocrine.org/doi/abs/10.1210/endo-meetings.2014.RE.19.SAT-0109

Discussion on early interventions for gender-dysphoric children.

Introduction: Untreated transsexuals have a brain cortical phenotype. Cross-sex hormone treatments are used to masculinize or feminize the bodies of female-to-male (FtMs) or male-to-female (MtFs) transsexuals, respectively.

Aim: A longitudinal design was conducted to investigate the effects of treatments on brain cortical thickness (CTh) of FtMs and MtFs.

Methods: This study investigated 15 female-to-male (FtMs) and 14 male-to-female (MtFs) transsexuals prior and during at least six months of cross-sex hormone therapy treatment. Brain MRI imaging was performed in a 3-Tesla TIM-TRIO Siemens scanner. T1-weighted images were analyzed with FreeSurfer software to obtain CTh as well as subcortical volumetric values.

Main outcome measures: Changes in brain CTh thickness and volumetry associated to changes in hormonal levels due to cross-sex hormone therapy.

Results: After testosterone treatment, FtMs showed increases of CTh bilaterally in the postcentral gyrus and unilaterally in the inferior parietal, lingual, pericalcarine, and supramarginal areas of the left hemisphere and the rostral middle frontal and the cuneus region of the right hemisphere. There was a significant positive correlation between the serum testosterone and free testosterone index changes and CTh changes in parieto-temporo-occipital regions. In contrast, MtFs, after estrogens and antiandrogens treatment, showed a general decrease in CTh and subcortical volumetric measures and an increase in the volume of the ventricles.

Conclusions: Testosterone therapy increases CTh in FtMs. Thickening in cortical regions is associated to changes in testosterone levels. Estrogens and antiandrogens therapy in MtFs is associated to a decrease in the CTh that consequently induces an enlargement of the ventricular system.

Author/-s:       Leire Zubiaurre-Elorza; Carme Junque; Esther Gómez-Gil; Antonio Guillamon

Publication:     The journal of sexual medicine, 2014

Web link:          http://europepmc.org/abstract/MED/24617977

Hormone therapy changes brain structure.

Ovarian hormones are pivotal for the physiological maintenance of the brain function as well as its response to environmental stimuli. There is mounting evidence attesting the relevance of endogenous ovarian hormones as well as exogenous estradiol and progesterone for emotional and cognitive processing.

The present review systematically summarized current knowledge on ovarian sex steroid hormonal modulation of neural substrates of emotion and cognition revealed by functional magnetic resonance imaging (fMRI). Twenty-four studies of healthy naturally cycling and combined oral contraceptives (COC) user women, or women undergoing experimental manipulations, during their reproductive age, were included. Furthermore, six studies of Premenstrual Dysphoric Disorder (PMDD), a hormonally-based mood disorder, and three of Gender Dysphoria (GD), which provides an intriguing opportunity to examine the effect of high-dose cross-sex hormone therapy (CSHT) on brain functioning, were included. Globally, low (early follicular and the entire follicular phase for estrogen and progesterone, respectively) and high (COC, CSHT, late follicular and luteal phase for estrogen; COC, mid- and late luteal phase for progesterone) hormonal milieu diversely affected the response of several brain regions including the amygdala, anterior cingulate cortex, and inferior frontal gyrus, but their functional recruitment across groups and domains was scattered.

The constellation of findings provides strong initial evidence of the influence of ovarian sex steroid hormones on cortical and subcortical regions implicated in emotional and cognitive processing. Further well-powered and multimodal neuroimaging studies will be needed to identify the neural mechanism of functional brain alterations induced by ovarian sex steroid hormones.

Author/-s:       Simone Toffoletto; Rupert Lanzenberger; Malin Gingnell; Inger Sundström-Poromaa; Erika Comasco

Publication:     Psychoneuroendocrinology, 2014

Web link:          http://www.psyneuen-journal.com/article/S0306-4530(14)00301-1/abstract

How hormones shape the brain.

Background: Recent studies have highlighted the co-occurrence of gender dysphoria (GD) in adolescence and Autistic Spectrum Conditions (ASC). Systemising and empathising are two psychological dimensions linked to ASC. People with ASC score below average on the Empathy Quotient (EQ) and average or above average on the Systemising Quotient (SQ). Based on the results of previous studies we predicted that if the young people with GD shared aspects of the ‘broader autism phenotype’, their EQ would be lower, and their SQ would be the same or higher, compared to controls of their natal gender.

Methods: This preliminary study examined systemising and empathising in adolescents with GD using parent report questionnaires. 35 parents of adolescents with GD aged 12–18 attending the Gender Identity Development Service (London) took part. Parents of 156 typically developing adolescents aged 12–18 were used as a control group. The parents were asked to complete the Adolescent EQ and SQ.

Results: The mean EQ score of both the female-to-male, and male-to-female GD group was found to be significantly lower than typically developing females, but similar to that of control males. There was no significant difference on the SQ between the gender dysphoric groups and either female or male controls.

Conclusion: This study shows that on average adolescents with GD, specifically those who are female-to-male, have lower empathy than controls. For this group of adolescents it may be helpful to offer psychological interventions that improve their communication skills and their ability to take on board other people’s views, to support their development. This may enable them to make better informed decisions regarding treatment and physical intervention options during adolescence and beyond.

Author/-s:       Domenico Di Ceglie; Elin Skagerberg; Simon Baron-Cohen; Bonnie Auyeung

Publication:     Opticon 1826, 2014

Web link:          http://www.opticon1826.com/article/view/opt.bo/300

Both MtF and FtM transsexuals have Empathy Quotient scores similar to control males.

Early in 2013, the Food and Drug Administration (FDA) ordered the makers of the well-known sleep aid Ambien (zolpidem) to cut their recommended dose in half—but only for women. In essence, the FDA was acknowledging that despite extensive testing prior to the drug’s release on the market, millions of women had been overdosing on Ambien for 20 years. On February 9, 2014, CBS’s 60 Minutes highlighted this fact—and sex differences in general—by powerfully asking two questions: Why did this happen, and are men and women treated equally in research and medicine? The answer to the first question is that the biomedical community has long operated on what is increasingly being viewed as a false assumption: that biological sex matters little, if at all, in most areas of medicine. The answer to the second question is no, today’s biomedical research establishment is not treating men and women equally. What are some of the key reasons for the biomedical community’s false assumption, and why is this situation now finally changing? What are some of the seemingly endless controversies about sex differences in the brain generated by “anti–sex difference” investigators? And what lies at the root of the resistance to sex differences research in the human brain?

Author/-s:       Larry Cahill, Ph.D.

Publication:     Cerebrum, 2014

Web link: http://www.dana.org/Cerebrum/2014/Equal_%E2%89%A0_The_Same__Sex_Differences_in_the_Human_Brain/

Very interesting write-up on brain-sex differences by gender, citing a number of studies and findings.

Transgender issues and transgender rights have become increasingly a matter of media attention and public policy debates. Reflecting changes in psychiatric perspectives, the diagnosis of “trans-sexualism” first appeared in the International Statistical Classification of Diseases and Related Health Problems in 1975 and shortly thereafter, in 1980, in the Diagnostic and Statistical Manual of Mental Disorders. Since that time, international standards of care have been developed, and today those standards are followed by clinicians across diverse cultures. In many instances, treatment of older adolescents and adults is covered by national health care systems and, in some cases, by private health insurance. Most recently, the Medicare ban on coverage for gender reassignment surgery was lifted in 2014.

In contrast to the relative lack of controversy about treating adolescents and adults, there is no expert clinical consensus regarding the treatment of prepubescent children who meet diagnostic criteria for what was referred to in both DSM-IV-TR and ICD-10 as gender identity disorder in children and now in DSM-5 as gender dysphoria. One reason for the differing attitudes has to do with the pervasive nature of gender dysphoria in older adolescents and adults: it rarely desists, and so the treatment of choice is gender or sex reassignment. On the subject of treating children, however, as the World Professional Association for Transgender Health notes in their latest Standards of Care, gender dysphoria in childhood does not inevitably continue into adulthood, and only 6 to 23 percent of boys and 12 to 27 percent of girls treated in gender clinics showed persistence of their gender dysphoria into adulthood. Further, most of the boys’ gender dysphoria desisted, and in adulthood, they identified as gay rather than as transgender.

In an effort to clarify best treatment practices for transgender individuals, a recent American Psychiatric Association Task Force on the Treatment of Gender Identity outlined three differing approaches to treating prepubescent gender dysphoric children.

Author/-s:       Jack Drescher; Jack Pula

Publication:     The Hastings Center Report, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/hast.365/abstract

Discussion on treatment for adolescents.

Previous theories and research have suggested there are two distinct types of male-to-female (MF) transsexuals and these types can be distinguished by their sexuality. Using the scales Attraction to Femininity in Males, Core Autogynephilia, Autogynephilic Interpersonal Fanasy, and Attraction to Transgender Fiction as indicator variables, taxometric analysis was applied to an online-recruited sample of 308 MF transsexuals to investigate whether such a distinction is justified. In accordance with previous research findings, MF transsexuals categorized as “nonandrophilic” scored significantly higher on Core Autogynephilia than did those categorized as “androphilic”; they also scored significantly higher on Attraction to Femininity in Males and Attraction to Transgender Fiction. Results of one of the taxometric procedures, L-Mode, gave slightly more support for a dimensional, rather than taxonic (two-type), latent structure. Results of the two other taxometric procedures, MAMBAC and MAXCOV, showed greater support for a dimensional latent structure. Although these results require replication with a more representative sample, they show little support for a taxonomy, which contradicts previous theory that has suggested MF transsexuals’ sexuality is typological.

Author/-s:       Jaimie F. Veale

Publication:     Archives of Sexual Behavior, 2014

Web link:          http://link.springer.com/article/10.1007/s10508-014-0275-5

More evidence against the autogynephilia hypothesis.

Transgender individuals experience harassment, violence, and discrimination in a number of settings. Although health care discrimination against transgender people has been documented, this issue is understudied. Using a national cross-sectional survey data set (N = 1 711), the authors sought to determine how gender identity and presentation predict health care discrimination experiences among female-to-male (FTM) transgender people after demographic and socioeconomic characteristics are controlled. Analyses were conducted using chi-square tests and a two-step logistic regression. The majority of participants were white (73.9 percent) and between 25 and 44 years old (65.2 percent). Overall, 41.8 percent of FTM participants reported verbal harassment, physical assault, or denial of equal treatment in a doctor's office or hospital. When other factors were controlled, being Native American or multiracial, identifying as queer or asexual/other, having a graduate degree, living full-time as nonbirth gender, using hormones or surgery for medical transition, and having identification documents that list one's preferred gender were associated with increased reporting of health care discrimination experiences; being 45 years or older and reporting an annual income of $ 60 000 or more were associated with decreased risk. The study's findings can be useful to social workers, who play a role in educating health care providers and advocating for policies that improve health care experiences for FTM and other transgender patients.

Author/-s:       Deirdre A. Shires; Kim Jaffee

Publication:     Health & Social Work, 2015

Web link:          http://hsw.oxfordjournals.org/content/early/2015/03/03/hsw.hlv025.abstract

Transsexuals are being discriminated against by health-care professionals.

The feminist movement purports to improve conditions for women, and yet only a minority of women in modern societies self-identify as feminists. This is known as the feminist paradox. It has been suggested that feminists exhibit both physiological and psychological characteristics associated with heightened masculinization, which may predispose women for heightened competitiveness, sex-atypical behaviors, and belief in the interchangeability of sex roles. If feminist activists, i.e., those that manufacture the public image of feminism, are indeed masculinized relative to women in general, this might explain why the views and preferences of these two groups are at variance with each other. We measured the 2D:4D digit ratios (collected from both hands) and a personality trait known as dominance (measured with the Directiveness scale) in a sample of women attending a feminist conference. The sample exhibited significantly more masculine 2D:4D and higher dominance ratings than comparison samples representative of women in general, and these variables were furthermore positively correlated for both hands. The feminist paradox might thus to some extent be explained by biological differences between women in general and the activist women who formulate the feminist agenda.

Author/-s:       G. Madison; U. Aasa; J. Wallert; W. A. Woodley

Publication:     Frontiers in psychology, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/25250010

Feminist activist women might be more masculine than women on average.

Background: The use of the penile skin for vaginoplasty is a common method in male-to-female (MTF) transsexual surgery. We aim to describe the results of a one-stage vaginoplasty in previously circumcised sex reassignment surgery using fold-back perineoscrotal flap plus penile inversion flap.

Methods: In a prospective study, 112 previously circumcised MTF subjects underwent a modification of penile inversion vaginoplasty by adding a fold-back perineoscrotal flap to form the whole posterior vaginal wall and about half of the anterior vaginal wall (the proximal part). Patients follow-up, outcomes, and complications were recorded.

Results: The mean age of the subjects was 25.8 ± 3.3 years underwent feminizing genitoplasty. The success rate was 92.86 %, and the complication-free success rate was achieved in 74.11 % of subjects in general. The need for repeated surgery (failure rate) was 7.14 % (due to vaginal shrinkage in four patients, bulging in anterior vaginal wall in one case and excessive labial skin in three cases). By adding the perineoscrotal flap to the penile skin flap, we were able to reach a mean vaginal depth of 13.1 ± 1.7 and a satisfaction level of 85.71 %.

Conclusions: Fold-back perineoscrotal flap plus penile inversion vaginoplasty is a suitable surgical approach for achieving adequate vaginal depth in cases of male-to-female (MTF) transsexual vaginoplasty when subjects have short penile skin flap because of circumcision.

Author/-s:       Kamyar Tavakkoli Tabassi; Bob Djavan; Jalil Hosseini; Alireza Ghoreifi; Mohadese Ershadi; Elahe Hosseini

Publication:     European Journal of Plastic Surgery, 2014

Web link:          http://link.springer.com/article/10.1007%2Fs00238-014-1038-1

Surgery for male-to-female transsexuals with circumcision.

Objectives: We examined the effects of gender abuse (enacted stigma), depressive symptoms, and demographic, economic, and lifestyle factors on substance use among transgender women.

Methods: We conducted a 3-year prospective study (December 2004 to September 2007) of 230 transgender women aged 19 to 59 years from the New York Metropolitan Area. Statistical techniques included generalized estimating equations with logistic and linear regression links.

Results: Six-month prevalence of any substance use at baseline was 76.2%. Across assessment points, gender abuse was associated with alcohol, cannabis, cocaine, or any substance use during the previous 6 months, the number of days these substances were used during the previous month, and the number of substances used. Additional modeling associated changes in gender abuse with changes in substance use across time. Associations of gender abuse and substance use were mediated 55% by depressive symptoms. Positive associations of employment income, sex work, transgender identity, and hormone therapy with substance use were mediated 19% to 42% by gender abuse.

Conclusions: Gender abuse, in conjunction with depressive symptoms, is a pervasive and moderately strong risk factor for substance use among transgender women. Improved substance abuse treatment is sorely needed for this population.

Author/-s:       Larry Nuttbrock; Walter Bockting; Andrew Rosenblum; Sel Hwahng; Mona Mason; Monica Macri; Jeffrey Becker

Publication:     American journal of public health, 2014

Web link:          http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302106

Substance abuse among transgender women.

Gender Dysphoria and Body Integrity Identity Disorder are sometimes together in the 19 % of the cases. Other discomfort diseases related to identity, body scheme and/or integrity are discussed in relation to Gender Dysphoria. Because persons experiencing Gender Dysphoria need a precise diagnostic that protects their access to care and will not be used against them in social, occupational or legal areas a distinction diseases is provided in this text, because a meticulous description with clear exclusion criteria is required.

Author/-s:       Alicia Garcia-Falgueras

Publication:     Psychology, 2014

Web link:          http://www.scirp.org/journal/PaperInformation.aspx?PaperID=43284

A discussion of gender dysphoria and body integrity disorders; suffers somewhat from poor editing.

Purpose: Transgender and gender nonconforming people who fulfill diagnostic criteria for autism spectrum disorders (ASDs) often present to mental health providers with concerns that are distinct from those without ASDs. Gender Dysphoria (GD) and ASDs have been proposed to share etiologic mechanisms and there is evidence that ASDs may be more common in transgender and gender nonconforming people.

We explore the impact of ASD characteristics on individual gender identity, expression, and the process of psychotherapy.

Method: The authors present two case studies of high-functioning individuals with ASD and GD diagnoses.

Results: The limited ability to articulate an inner experience, deficits in Theory of Mind (ToM), along with the intolerance of ambiguity as a manifestation of the cognitive rigidity characteristic of ASDs, may present special difficulties to gender identity formation and consolidation and create challenges in psychotherapy.

Conclusions: The authors suggest that ASDs do not preclude gender transition and that individuals with high-functioning ASDs are capable of making informed decisions regarding their medical care and life choices. The authors also consider possible challenges and suggest techniques for assisting such clients in exploring their gender identities.

Author/-s:       Laura A. Jacobs; Katherine Rachlin; Laura Erickson-Schroth; Aron Janssen

Publication:     LGBT Health, 2014

Web link:          http://online.liebertpub.com/doi/abs/10.1089/lgbt.2013.0045

Autism spectrum disorders should not be used to stop gender-dysphoric people from transitioning.

From this review we conclude that:

1- Gender dysphoria has been reported in XX individuals with CAH assigned the female gender at birth.

2- It is not clear if the cause of the gender dysphoria in the reported cases was due to exposure of the fetal brain to androgens or to poor compliance with glucocorticoid replacement therapy later in life.

3- In fact, severe gender dysphoria leading to gender change in adulthood was reported in only a few individuals diagnosed at birth and assigned the female gender, some of whom did not have glucocorticoid replacement.

4- Long term endocrine follow up of females with CAH is mandatory to prevent late virilization due to poor compliance with replacement steroid therapy.

5- The published data available cast serious doubts on the suggestion by Lee et al.(8) that severely virilized newborn females with CAH be raised as males.

6- All newborns with an apparently normal penis but non-palpable testes should be immediately evaluated for possible CAH and assigned the female gender if the diagnosis of 46,XX CAH is established.

7- We stand by the recommendations made in our earlier paper that genitoplasty should be done in 1 stage in the first year of life (1).

Author/-s:       Ricardo González; Barbara M. Ludwikowski

Publication:     Frontiers in pediatrics, 2014

Web link:          http://journal.frontiersin.org/Journal/10.3389/fped.2014.00140/full

Some persons with XX chromosomes and the disorder of sex development CAH develop a male gender identity.

Drawing from controversies between medical, legal, and associative actors about the obligation of sex reassignment surgeries (SRS) for people who intend to change their civil status, this article discusses the role that medical procedures, and particularly SRS, play in contemporary gender identifications and transition pathways in France. In 2010, the French National Institute of Health and Medical Research conducted a national survey in order to study the sociodemographic characteristics, access to medical, and psychological care, and state of health among trans individuals. After a long period of ethnographic work during which a partnership was established with trans actors to map the social, medical, and political landscape of trans communities, a questionnaire was developed and distributed between July and October 2010 in collaboration with most of the trans organizations and public and private health professionals operating in France. Overall, 381 self-identified trans individuals returned the anonymous self-administered questionnaire. The results highlighted the heterogeneity of the trans population, whose definition cannot be reduced to a group of individuals undergoing standardized hormonal treatments and SRS. Two central indicators, sex assigned at birth and gender self-identification, enabled us to describe and analyze different medical and legal pathways with a particular focus on SRS, which is often compulsory for a change of civil status in France. Although SRS remains an important factor in an individual’s subjective evaluation of the success of the transition pathway, its practice varies depending on one’s sex assigned at birth and gender identification.

Author/-s:       Alain Giami; Emmanuelle Beaubatie

Publication:     Archives of sexual behavior, 2014

Web link:          http://link.springer.com/article/10.1007/s10508-014-0382-3#page-1

Not all transgender people opt for for sexual reassignment surgery.

Several studies estimate the prevalence of gender dysphoria among adults by examining the number of individuals turning to health services. Since individuals might be hesitant to seek medical care related to gender dysphoria, these studies could underestimate the prevalence. The studies also lack information regarding the variance among different aspects of gender dysphoric conditions. Therefore, the current study estimated the prevalence by examining self-reported gender identity and dysphoria in a Dutch population sample (N = 8,064, aged 15-70 years old). Three measures assessed aspects of gender dysphoria: gender identity, dislike of the natal female/male body, and wish to obtain hormones/sex reassignment surgery. Results showed that 4.6 % of the natal men and 3.2 % of the natal women reported an ambivalent gender identity (equal identification with other sex as with sex assigned at birth) and 1.1 % of the natal men and 0.8 % of the natal women reported an incongruent gender identity (stronger identification with other sex as with sex assigned at birth). Lower percentages reported a dislike of their natal body and/or a wish for hormones/surgery. Combining these figures estimated the percentage of men reporting an ambivalent or incongruent gender identity combined with a dislike of their male body and a wish to obtain hormones/surgery at 0.6 %. For women, this was 0.2 %. These novel findings show that studies based on the number of individuals seeking medical care might underestimate the prevalence of gender dysphoria. Furthermore, the findings argue against a dichotomous approach to gender dysphoria.

Author/-s:       L. Kuyper; C. Wijsen

Publication:     Archives of sexual behaviour, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/23857516

Article on the prevalence of transsexualism, finding some very high numbers (0.6 % for natal men and 0.2 % for natal women).

Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.

Author/-s:       Ravi Philip Rajkumar

Publication:     Schizophrenia Research and Treatment, 2014

Web link:          http://www.hindawi.com/journals/schizort/2014/463757/

A possible link between gender dysphoria and schizophrenia is discussed.

Research has demonstrated associations between experiences of discrimination, relationship quality, and mental health. However, critical questions remain unanswered with regard to how stigma enacted and experienced at the dyadic-level influences relationship quality and mental health for transgender women and their cisgender (nontransgender) male partners. The present study sought to examine how experiences of transgender-related discrimination (i.e., unfair treatment, harassment) and relationship stigma (i.e., the real or anticipated fear of rejection based on one's romantic affiliation) were associated with both partners relationship quality and mental health. Couples (n = 191) were recruited to participate in cross-sectional survey. Dyadic analyses using actor-partner interdependence models were conducted to examine the influence of minority stressors on clinically significant depressive distress and relationship quality. For both partners, financial hardship, discrimination, and relationship stigma were associated with an increased odds of depressive distress. For both partners, financial hardship was associated with lower relationship quality. Among transgender women, their own and their partner's higher relationship stigma scores were associated with lower relationship quality; however, among male partners, only their partner's greater relationship stigma scores were associated with lower relationship quality. Findings provide preliminary support for dyadic crossover effects of relationship stigma on the health of partners. Findings illustrate the importance of minority stress and dyadic stress frameworks in understanding and intervening upon mental health disparities among transgender women and their male partners. Couples-based interventions and treatment approaches to help transgender women and their male partners cope with minority stressors are warranted to improve the health and well-being of both partners.

Author/-s:       Kristi E. Gamarel; S. L. Reisner; J. P. Laurenceau; T. Nemoto; D. Operario

Publication:     Journal of family psychology, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/24932942

Societal stigma reduces relationship quality for transgender women.

Whether men and women are fundamentally different or similar has been debated for more than a century. This review summarizes major theories designed to explain gender differences: evolutionary theories, cognitive social learning theory, sociocultural theory, and expectancy-value theory. The gender similarities hypothesis raises the possibility of theorizing gender similarities. Statistical methods for the analysis of gender differences and similarities are reviewed, including effect sizes, meta-analysis, taxometric analysis, and equivalence testing. Then, relying mainly on evidence from meta-analyses, gender differences are reviewed in cognitive performance (e.g., math performance), personality and social behaviors (e.g., temperament, emotions, aggression, and leadership), and psychological well-being. The evidence on gender differences in variance is summarized. The final sections explore applications of intersectionality and directions for future research.

Author/-s:       Janet Shibley Hyde

Publication:     Annual Review of Psychology, 2014

Web link:          http://www.annualreviews.org/doi/pdf/10.1146/annurev-psych-010213-115057

Follow-up on the gender similarities hypothesis.

Introduction: Transsexual populations seem to present specificities in brain structure, function and psychometrics, which may play an important role in adapting to the sex transition process.

Objectives: To find neurobiological and psychometric features determining the adjustment to gender transition.

Methods: We assessed gender identity disorder diagnosed patients of our unit clinically and through MMPI-2, and secondly, we reviewed the literature on differential brain characteristics of this population.

Results: Some aspects of brain functioning may be changed by several factors, including early development and the effect of hormones in several stages of life; psychometric features may correlate with psychological adjustment and neurobiological changes, depending on psychosocial resources of the transsexual person.

Conclusions: Clinical protocols in gender identity disorder management may benefit from longitudinal tailoring, taking into account neurobiological and psychometric aspects, as well as their interplay.

Author/-s:       F. Gomes; D. Gonçalves; M. Gonçalves; M. Nascimento; R. Novo; C. Soares

Publication:     European Psychiatry, 2014

Web link:          http://www.europsy-journal.com/article/S0924-9338(14)78866-2/abstract

Discusses brain structure and psychometrics.

For a long time, transgender experience was understood in terms of transsexual experiences, who desire to transition from one’s gender assigned at birth to the “opposite” gender. However, recent studies have shown that such binary gender models are not applicable to all transgenders. A growing group of transgenders identifies as ‘genderqueer’: they feel that their gender identity cannot be captured within the binary terminology. The current study is the first to examine the prevalence of genderqueer individuals and their wellbeing (compared to transsexuals) within a clinical setting of a gender identity clinic. We analysed data of all people who applied to the Center of Expertise on Gender Dysphoria at the VU University Medical Center during the year 2013. Furthermore, five biographical semi-structured interviews were conducted to further explore identity development in genderqueer individuals. We found that genderqueers were more likely to request partial treatment than transsexuals. Also, we found some indication that genderqueers reported lower levels of wellbeing. From the interviews, a number of important factors emerged that contributed to the current gender identity. For example, people described that when they heard about transgender people, they started to explore living in the opposite gender role, but they eventually found out that this also did not ‘fit’ them. The results of the study may help counsellors with figuring out how to provide individualized care for transgender people.

Author/-s:       Titia Beek

Publication:     Master Thesis, Psychology, 2014

Web link:          http://dare.uva.nl/cgi/arno/show.cgi?fid=546375

Being genderqueer reduces well-being: gender-queer people do not fit into transsexual categories.

To navigate a busy interpersonal landscape, people direct perceptual resources in a motivated fashion that maximizes goals and minimizes threats. While adaptive, these heuristics can also lead to noteworthy biases, including a well-documented memory advantage for ingroup members. Recent research has extended these findings to reveal other motivational biases that emerge early in social perception. When perceivers feel threatened, for example, they are vigilant to outgroup members. Although compelling, evidence for this vigilance-threat hypothesis is currently limited to feelings of physical threat and memory for racial outgroups. Here, we extended these findings to a different form of threat—gender identity threat. Four studies documented that straight men who feel insecure about their masculinity have heightened recognition of gender-atypical faces. We therefore argue that gender identity concerns play an important role in social vision, arousing perceptual biases that have implications for how men attend to and remember others in their social environments.

Author/-s:       David J. Lick; Kerri L. Johnson; Rachel G. Riskind

Publication:     Group Processes Intergroup Relations, 2014

Web link:          http://m.gpi.sagepub.com/content/early/2014/06/30/1368430214538324.abstract

Men with insecure gender identity look more closely at gender non-conforming faces.

Congenital Adrenal Hyperplasia (CAH) is an endocrine disorder characterized by enzymatic deficiency in adrenal steroidogenesis, leading to adrenal insufficiency and hyperandrogenism. Patients need continuous hormone replacement therapy, but adequate control has proven challenging, exposing patients to undesirable consequences of both disease and treatment.

Objective: To evaluate the health related quality of life (HRQoL) of children and adolescents with CAH due to 21-hydroxylase deficiency.

Methods: In an analytical study, generic questionnaires, validated and translated versions, Pediatric Quality of Life Inventory 4.0 (for self-assessment of patients) and Child Health Questionnaire - PF50 (for parents) were applied and mean scores were analyzed with Student’s t-test.

Results: We included 25 patients (19 female) with classical CAH (14 salt wasting/11 simple virilizing), mean age ± standard deviation (SD) of 11.4 ± 3.6 years (5–17.9), and their parents. Self-assessment of HRQOL showed decrease in mean scores: overall (67.8 ± 15.5 vs. 88.9 ± 7.4, p value = 0.015) and in the physical (75.2 ± 15.0 vs. 95.9 ± 5.8, p value = 0.014) and psychosocial (63.9 ± 17.8 vs. 85.0 ± 9.6, p value = 0.023) dimensions of patients, compared to healthy controls (previously published national data on children and adolescents). The assessment of the parent’s view was concordant, also showing losses in the physical (43.7 ± 8.0 vs. 55.1 ± 3.6, p value = 0.013) and psychosocial (41.9 ± 9.7 vs. 53.0 ± 7.0, p value = 0.025) dimensions. The comparison of HRQOL between subgroups 1) males versus females and 2) salt-wasting versus simple virilizing showed no significant differences.

Conclusion: There seems to be a loss of HRQOL in children and adolescents with classical CAH. The self-assessment was concordant in key areas with the assessment made by their parents. No differences were observed between genders or clinical presentation of the disease.

Author/-s:       Daniel Gilban; Paulo Alves; Izabel Beserra

Publication:     Health and Quality of Life Outcomes, 2014

Web link:          http://www.hqlo.com/content/pdf/s12955-014-0107-2.pdf

Children with the DSD CAH have a lower quality of life.

Disorders of sex development (DSD) are rare genetic conditions resulting in atypical development of the sex organs. While some evidence is available on psychosexual outcomes, much less is known about the quality of life in this population, especially in children. Health-related quality of life (HRQOL) is a widely accepted endpoint for assessment and evaluation of interventions and medical care. Within the German DSD Network study, 86 children aged 8–12 years with several subtypes of DSD were recruited from Germany, Austria and Switzerland. Demographic, medical and psychosocial variables were collected through interviews of the attending physicians, the children and the parents. HRQOL was the primary outcome. It was assessed by the KINDL-R Questionnaire [2001]. Psychosexual determinants included gender identity/gender dysphoria, gender role behaviour, the child’s knowledge about the condition and number/timing of genital surgery. A significant reduction of HRQOL was reported in children’s self-report (p < 0.001), in particular in the area of self-esteem (p < 0.001), physical well-being (p < 0.01) and school functioning (p < 0.05). Girls with congenital adrenal hyperplasia who experienced gender dysphoria reported lower HRQOL scores compared to the study group at large. Atypical gender role behaviour was not associated with HRQOL.

Conclusion: Psychosocial support of children with DSD and their families appears to be necessary in at least some cases and must be accessible for all patients.

Author/-s:       Martina Jürgensen; Anke Lux; Sebastian Benedikt Wien; Eva Kleinemeier; Olaf Hiort; Ute Thyen

Publication:     European Journal of Pediatrics, 2014

Web link:          http://link.springer.com/article/10.1007/s00431-014-2264-z

Children with disorders of sex development (DSD) have a lower quality of life. Article based on the doctoral thesis by Sebastian Benedikt Wien at the Universität Lübeck 2013: “Gesundheitsbezogene Lebensqualität von 8–12-jährigen Kindern mit Störung der Geschlechtsentwicklung”.

Background: Women are two times more likely to be diagnosed with depression than men. Sex hormones modulating serotonergic transmission are proposed to partly underlie these epidemiological findings. Here, we used the cross-sex steroid hormone treatment of transsexuals seeking sex reassignment as a model to investigate acute and chronic effects of testosterone and estradiol on serotonin transporter (SERT) binding in female-to-male (FtM) and male-to-female (MtF) transsexuals.

Methods: 33 transsexuals underwent [11C]DASB PET before start of treatment, a subset of which underwent a second scan four weeks, and a third scan four months, after treatment start. SERT BPND was quantified in 12 regions of interest. Treatment effects were analyzed using linear mixed models. Changes of hormone plasma levels were correlated with changes in regional SERT BPND.

Results: One and four months of androgen treatment in FtM increased SERT binding in amygdala, caudate, putamen and median raphe nucleus. SERT binding increases correlated with treatment induced increases in testosterone levels, suggesting that testosterone increases SERT expression on the cell surface. Conversely, four months of anti-androgen and estrogen treatment in MtF led to decreases in SERT binding in insula, anterior and mid-cingulate cortex. Increases in estradiol levels correlated negatively with decreases in regional SERT binding, indicating a protective effect of estradiol against SERT loss.

Conclusions: Given the central role of the SERT in the treatment of depression and anxiety disorders, these findings may lead to new treatment modalities and expand our understanding of the mechanism of action of antidepressant treatment properties.

Author/-s:       Georg S. Kranz; Wolfgang Wadsak; Ulrike Kaufmann; Markus Savli; Pia Baldinger; Gregor Gryglewski; Daniela Haeusler; Marie Spies; Markus Mitterhauser; Siegfried Kasper; Rupert Lanzenberger

Publication:     Biological Psychiatry, 2014

Web link:          http://www.biologicalpsychiatryjournal.com/article/S0006-3223(14)00709-4/abstract

Testosterone seems to prevent depression.

In the context of transgender health, most people are not comfortable with allowing a twelve-year-old child with gender dysphoria to elect to undergo gender reassignment surgery. The likelihood is too high that the child would be unable to fully comprehend the scope of a decision that carries significant, permanent consequences, particularly because the decision to surgically change gender is based upon a conception of gender that can fluctuate during adolescent years. Conversely, however, most people would not contend that this fluidity is reason to wholly deny certain medical care such as hormonal treatments to transgender youth, a demographic with extremely high rates of violent behavior, self-harm, and suicide. This paper will explore ethical considerations to this emerging debate of what therapeutic options should be offered to transgender children and adolescents.

Pediatric endocrinologists have been treating gender dysphoric adolescents with puberty-suppressing drugs and, to a lesser extent, with cross-sex hormone therapies for more than twenty years. Clinicians and thought leaders have mentioned ethical components of this emerging practice in the few cohort studies and clinical review articles about the subject. However, ethics have generally been a secondary consideration in the medical academic literature. In this paper, I will provide a brief overview of the practice, summarize the current research on hormone treatment for transgender minors, and provide an ethical analysis of the practice.

Author/-s:       Brendan S. Abel

Publication:     The Hastings Center Report, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/hast.366/abstract

Discussion on hormonal treatment for adolescents.

There are numerous reports of sexual dimorphism in brain structure in children and adults, but data on sex differences in infancy are extremely limited. Our primary goal was to identify sex differences in neonatal brain structure. Our secondary goal was to explore whether brain structure was related to androgen exposure or sensitivity. Two hundred and ninety-three neonates (149 males) received high-resolution structural magnetic resonance imaging scans. Sensitivity to androgen was measured using the number of cytosine, adenine, guanine (CAG) triplets in the androgen receptor gene and the ratio of the second to fourth digit, provided a proxy measure of prenatal androgen exposure. There was a significant sex difference in intracranial volume of 5.87%, which was not related to CAG triplets or digit ratios. Tensor-based morphometry identified extensive areas of local sexual dimorphism. Males had larger volumes in medial temporal cortex and rolandic operculum, and females had larger volumes in dorsolateral prefrontal, motor, and visual cortices. Androgen exposure and sensitivity had minor sex-specific effects on local gray matter volume, but did not appear to be the primary determinant of sexual dimorphism at this age. Comparing our study with the existing literature suggests that sex differences in cortical structure vary in a complex and highly dynamic way across the human lifespan.

Author/-s:       Rebecca C. Knickmeyer; Jiaping Wang; Hongtu Zhu; Xiujuan Geng; Sandra Woolson; Robert M. Hamer; Thomas Konneker; Martin Styner; John H. Gilmore

Publication:     Cerebral Cortex, 2014

Web link:          http://cercor.oxfordjournals.org/content/24/10/2721.abstract

Review of sexual dimorphic brain structure of new-borns.

Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5 135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received >1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100 000 patient-years of VHA treatment (95 % CI 9.6–36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.

Author/-s:       George R. Brown; Kenneth T. Jones

Publication:     Breast Cancer Research and Treatment, 2014

Web link:          http://link.springer.com/article/10.1007/s10549-014-3213-2

Hormone therapy does not seem to increase breast cancer risk.

Evidence suggests over-representation of autism spectrum disorders (ASDs) and behavioral difficulties among people referred for gender issues, but rates of the wish to be the other gender (gender variance) among different neurodevelopmental disorders are unknown. This chart review study explored rates of gender variance as reported by parents on the Child Behavior Checklist (CBCL) in children with different neurodevelopmental disorders: ASD (N = 147; 24 females and 123 males), attention deficit hyperactivity disorder (ADHD; N = 126; 38 females and 88 males), or a medical neurodevelopmental disorder (N = 116; 57 females and 59 males), were compared with two non-referred groups [control sample (N = 165, 61 females and 104 males) and non-referred participants in the CBCL standardization sample (N = 1 605; 754 females and 851 males)]. Significantly greater proportions of participants with ASD (5.4 %) or ADHD (4.8 %) had parent reported gender variance than in the combined medical group (1.7 %) or non-referred comparison groups (0–0.7 %). As compared to non-referred comparisons, participants with ASD were 7.59 times more likely to express gender variance; participants with ADHD were 6.64 times more likely to express gender variance. The medical neurodevelopmental disorder group did not differ from non-referred samples in likelihood to express gender variance. Gender variance was related to elevated emotional symptoms in ADHD, but not in ASD. After accounting for sex ratio differences between the neurodevelopmental disorder and non-referred comparison groups, gender variance occurred equally in females and males.

Author/-s:       John F. Strang; Lauren Kenworthy; Aleksandra Dominska; Jennifer Sokoloff; Laura E. Kenealy; Madison Berl; Karin Walsh; Edgardo Menvielle; Graciela Slesaransky-Poe; Kyung-Eun Kim; Caroline Luong-Tran; Haley Meagher; Gregory L. Wallace

Publication:     Archives of Sexual Behavior, 2014

Web link:          http://link.springer.com/article/10.1007/s10508-014-0285-3

Autism and attention deficit disorders seem to be linked to gender dysphoria.

We investigated whether gender identity influences preadolescents’ tendency to single out gender-atypical peers for abuse. Data were gathered from 195 boys and girls (M age = 10.1 years) in the fall and spring of a school year. Children self-reported multiple dimensions of gender identity (intergroup bias, felt pressure for gender differentiation, felt gender typicality, gender contentedness); peers assessed each other’s social behavior (gender nonconformity, aggression toward each classmate). Using multilevel modeling, we examined how children’s attacks on gender-nonconforming peers (relative to their attacks on other peers) changed over the school year depending on their gender identity. There was modest support for the hypothesis that overconfident, arrogant gender identity promotes abuse of gender-atypical peers but considerable support for the hypothesis that insecure, self-questioning gender identity fosters this tendency. Implications for issues central to contemporary personality theory (e.g., Person × Situation interaction) are discussed. New and somewhat surprising information about the cognitive and behavioral characteristics of gender-nonconforming preadolescents is provided.

Author/-s:       Rachel E. Pauletti; Patrick J. Cooper; David G. Perry

Publication:     Journal of Personality and Social Psychology, 2014

Web link:          http://psycnet.apa.org/journals/psp/106/5/843/

Children with an insecure, self-questioning gender identity are often bullied.

The inverted peno-scrotal flap is considered the standard technique for vaginoplasty in male-to-female transsexuals. Nowadays, great importance is also given by patients to the reconstruction of the clitoro-labial complex; this is also reconstructed with tissue coming from glans penis, penile skin envelop and scrotal skin. Since the first sex reassignment surgery for biological males performed in Thailand in 1975, Dr Preecha and his team developed the surgical technique for vaginoplasty; many refinements have been introduced during the past 40 years, with nearly 3000 patients operated on. The scope of this paper is to present the surgical technique currently in use for vaginoplasty and clitoro-labioplasty and the refinements introduced at the Chulalongkorn University and at the Preecha Aesthetic Institute, Bangkok, Thailand. These refinements consist of cavity dissection with blunt technique, the use of skin graft in addition to the penile flap, shaping of the clitoris complex from penis glans and clitoral hood, and the use of the urethral mucosa to line the anterior fourchette of the neo-vagina. With the refinements introduced, it has been possible to achieve a result that is very close to the biological female genitalia.

Author/-s:       Burin Wangjiraniran; Gennaro Selvaggi; Prayuth Chokrungvaranont; Sirachai Jindarak; Sutin Khobunsongserm; Preecha Tiewtranon

Publication:     Journal of Plastic Surgery and Hand Surgery, 2014

Web link:          http://informahealthcare.com/doi/abs/10.3109/2000656X.2014.967253

Description of the surgical technique by Dr. Preecha in Thailand.

Previous research has shown sex differences in brain morphology (De Bellis et al., 2001). However, these studies have not taken gender into account. Gender is a phenotype that describes behavior. In this study, we examined the relationship between gender, sex, and brain volumes in children. One hundred and eight children ages 7 to 17 were administered the Children's Sex Role Inventory (Boldizar, 1991) and obtained volumetric brain data via magnetic resonance imaging (MRI). We found that, in the frontal lobe, higher masculinity predicted greater volumes of white matter. Also, in the temporal lobe, higher femininity predicted greater volumes of gray matter.

Author/-s:       A. M. Belfi; A. L. Conrad; J. Dawson; P. Nopoulos

Publication:     Developmental neuropsychology, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/24405182

Brain volumes differ by gender.

Purpose: Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap.

Methods: A retrospective cohort study of electronic health record data from 180 transgender patients aged 12–29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes.

Results: The sample (N = 360) had amean age of 19.6 years (standard deviation, 3.0); 43 % white, 33 % racial/ethnic minority, and 24 % race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < 0.05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.

Conclusions: Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity

Author/-s:       Sari L. Reisner; Ralph Vetters; M. Leclerc; Shayne Zaslow, Sarah Wolfrum; Daniel Shumer; Matthew J. Mimiaga

Publication:     Journal of adolescent health, 2014

Web link:          http://www.jahonline.org/article/S1054-139X(14)00693-4/abstract

Transgender youth have mental health problems. This study is reported in a number of media articles, such as: http://www.pridesource.com/article.html?article=69705; http://www.prweb.com/releases/2015/01/prweb12429699.htm; http://www.therainbowtimesmass.com/2015/01/08/fenway-study-transgender-youth-high-risk-negative-mental-health-outcomes/.

Purpose: The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status.

Methods: The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5 117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000–2009 for 1 277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3 840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups.

Results: Approximately 9.3 % (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100 000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years.

Conclusion: The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses.

Author/-s:       John R. Blosnich; George R. Brown; Sybil Wojcio; Kenneth T. Jones; Robert M. Bossarte

Publication:     LGBT Health, 2014

Web link:          http://online.liebertpub.com/doi/abs/10.1089/lgbt.2014.0050

The suicide rate for transgender persons seems higher than in the general population.

This study compared the brain activation patterns associated with visual sexual arousal in connection with sexual hormone levels in postoperative male-to-female (MTF) transsexuals and normal premenopausal and menopausal women using 3.0 T functional MRI. A total of 30 volunteers including 10 premenopausal women, 10 menopausal women, and 10 postoperative MTF transsexuals who had undergone sex reassignment surgery participated in this study. Brain activity was measured while viewing erotic male and female nude pictures. The free testosterone and estradiol levels of the postoperative MTF transsexuals were not in the normal range seen in normal premenopausal women, but were in range seen in menopausal women. The postoperative MTF transsexuals showed significantly higher activities in the hippocampus, parahippocampal gyrus, amygdala, putamen, globus pallidus, thalamus, and head of caudate nucleus in response to erotic male nude pictures in contrast to female pictures (P<0.005). The predominant activation areas observed in the postoperative MTF transsexuals in contrast to the menopausal women when viewing male nude pictures included the insula, hippocampus, thalamus, and putamen (P<0.005). Similar to the postoperative MTF transsexuals, the premenopausal women showed significantly higher activities than menopausal women in the insula, hippocampus, thalamus, and parahippocampal gyrus (P<0.005). This study revealed that the brain activation patterns associated with visual sexual arousal in postoperative MTF transsexuals are similar to those in premenopausal women, although the sexual hormone levels in the postoperative MTF transsexuals are in the average range of those in menopausal women.

Author/-s:       G. W. Kim; G. W. Jeong

Publication:     Neuroreport, 2014

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/24800986

Some brain activation patterns in post-op male-to-female transsexuals match those of natal women.

Estrogen and related hormones have a significant role to play in the etiology and the treatment of psychotic illness. Here we present the case of a 38 year old immigrant trans woman referred for management of first onset psychotic symptoms following abrupt discontinuation of female hormonal therapy first started in adolescence. The patient's symptoms progressed to catatonia, but were eventually treated with significant success by a combination of clozapine, estradiol and medroxyprogesterone.

Author/-s:       Scott M. Summers; John Onate

Publication:     Journal of Gay & Lesbian Mental Health, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/.U2UNiU2KBO8#.U4n5402KCw4

For some transsexuals, not being on hormones can lead to a psychosis.

There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences in their genomes cause sex differences in the functions of cells. This study reviews sex differences in metabolism/cardiovascular pathology, immune mechanisms, bone (patho)physiology and brain functions and examines whether they are, maybe partially, determined by genetic mechanisms rather than by (cross-sex) hormones. There do not appear to be major genetic impacts on the changes in bone physiology. Also immune functions are rather unaffected and the evidence for an increase of autoimmune disease in MtoF is preliminary. Brain functions of transsexuals may have differed from controls before cross-sex hormones; they do undergo shifts upon cross-sex hormone treatment, but there is no evidence for changes in sex-specific brain disease. The prevalence of cardiovascular disease is higher in MtoF receiving oestrogens than in FtoM receiving androgens. While type of oestrogen and route of administration might be significant, it is reasonable to speculate that nonhormonal/genetic factors play a role.

Author/-s:       L. J. Gooren; B. Kreukels; B. Lapauw; E. J. Giltay

Publication:     Andrologia, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/and.12389/abstract

Impact of genetic differences and hormone treatment.

Introduction: There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected.

Aims: This study aims to define the prevalence of Internet-sourced sex hormone use in a population attending for initial assessment at a gender identity clinic, to compare the prevalence between gender-dysphoric men and women, and to compare knowledge of cross-sex hormone side effects between users who source cross-sex hormones from medical doctors and those who source them elsewhere.

Methods: In the first part of the study, a cross-sectional design is used to measure the overall prevalence of sex hormone use among individuals referred to a gender clinic. The second part is a questionnaire survey aiming at measuring sex hormone knowledge among individuals referred to this clinic.

Main Outcome Measures:

Main outcome measures were (i) categorical data on the prevalence and source of cross-sex hormone use and (ii) knowledge of sex hormone side effects in a population referred to a gender clinic.

Results: Cross-sex hormone use was present in 23% of gender clinic referrals, of whom 70% sourced the hormones via the Internet. Trans men using testosterone had a sex hormone usage prevalence of 6%; one-third of users sourced it from the Internet. Trans women had a sex hormone usage prevalence of 32%; approximately 70% of users sourced hormones from the Internet. Cross-sex hormone users who sourced their hormones from physicians were more aware of side effects than those who used other sources to access hormones.

Conclusion: One in four trans women self-prescribe cross-sex hormones before attending gender clinics, most commonly via the Internet. This practice is currently rare among trans men. Self-prescribing without medical advice leaves individuals without the knowledge required to minimize health risks.

Author/-s:       Nick Mepham; Walter P. Bouman; Jon Arcelus; Mark Hayter; Kevan R. Wylie

Publication:     The Journal of Sexual Medicine, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12691/abstract

Study about self-prescription of hormones.

Background: Investigations in the field of gender identity disorder (GID) have been mostly related to psychiatric comorbidity and severe psychiatric disorders, but have focused less on personality and personality disorders (PDs).

Aims: The aim of the study was to assess the presence of PDs in persons with GID as compared to cisgendered (a cisgender person is a person who is content to remain the gender they were assigned at birth) heterosexuals, as well as to biological sex.

Methods: The study sample consisted of 30 persons with GID and 30 cisgendered heterosexuals from the general population.The assessment of PDs was conducted by application of the self-administered Structured Clinical Interview for DSM-IV Axis II PDs (SCID-II).

Results: Persons with GID compared to cisgender heterosexuals have higher presence of PDs, particularly Paranoid PD, avoidant PDs, and comorbid PDs. In addition, MtF (transwomen are people assigned male at birth who identify as women) persons are characterized by a more severe psychopathological profile.

Conclusions: Assessment of PDs in persons with GID is of great importance as it comprises a key part of personalized treatment plan tailoring, as well as a prognostic factor for sex-reassignment surgery (SRS) outcome.

Author/-s:       Dragana Duišin; Borjanka Batinić; Jasmina Barišić; Miroslav L. Djordjevic; Svetlana Vujović; Marta Bizic

Publication:     The Scientific World Journal, 2014

Web link:          http://www.hindawi.com/journals/tswj/2014/809058/

Transsexuals have more personality disorders than cisgender people; MtF are worse off than FtM. Personality disorders are a prognostic factor for SRS outcome.

Abstract: Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer’s minority stress model.

Discussion: […] In other words, this finding supports the notion that transitioning/gender affirmation, although associated with some reductions in gender dysphoria,29 appears also to be associated with an increase in psychological distress—possibly because of the impact of gender identity-related discrimination experiences— which aligns well with Meyer’s minority stress model. […] Finally, and most importantly, mental health professionals can be better informed that transitioning is ultimately a health-promoting process, and that psychological distress appears more related to stressors associated with a stigmatized identity and not as a result of the identity itself.

Author/-s:       Brian A. Rood; Julia A. Puckett; David W. Pantalone; Judith B. Bradford

Publication:     LGBT Health, 2014

Web link:          http://online.liebertpub.com/doi/pdfplus/10.1089/lgbt.2013.0048?src=recsys

Suicide risk is higher for transsexuals who are discriminated agains or victimised, and also for transsexuals who transition or plan to transition (probably because of increased discrimination incidents).

Objectives: Cooccurring psychiatric disorders influence the outcome and prognosis of gender dysphoria.The aim of this study is to assess psychiatric comorbidities in a group of patients.

Methods: Eighty-three patients requesting sex reassignment surgery (SRS) were recruited and assessed through the Persian Structured Clinical Interview for DSM-IV Axis I disorders (SCID-I).

Results: Fifty-seven (62.7 %) patients had at least one psychiatric comorbidity. Major depressive disorder (33.7 %), specific phobia (20.5 %), and adjustment disorder (15.7 %) were the three most prevalent disorders.

Conclusion: Consistent with most earlier researches, the majority of patients with gender dysphoria had psychiatric Axis I comorbidity.

Author/-s:       Azadeh Mazaheri Meybodi; Ahmad Hajebi; Atefeh Ghanbari Jolfaei

Publication:     Psychiatry Journal, 2014

Web link:          http://dx.doi.org/10.1155/2014/971814

Transsexuals have more axis 1 psychiatric problems.

Gender nonconforming (GN) children and adolescents, collectively referred to as GN youth, may seek care to understand their internal gender identities, socially transition to their affirmed genders, and/or physically transition to their affirmed genders. Because general pediatricians are often the first point of contact with the health care system for GN youth, familiarity with the psychological and medical approaches to providing care for this population is crucial. The objective of this review is to provide an overview of existing clinical practice guidelines for GN youth. Such guidelines emphasize a multidisciplinary approach with collaboration of medical, mental health, and social services/advocacy providers. Appropriate training needs to be provided to promote comprehensive, culturally competent care to GN youth, a population that has traditionally been underserved and at risk for negative psychosocial outcomes.

Author/-s:       Stanley R. Vance Jr.; Diane Ehrensaft; Stephen M. Rosenthal

Publication:     Pediatrics, 2015

Web link:          https://pediatrics.aappublications.org/content/134/6/1184.abstract

Review of existing clinical guidelines.

In contemporary psychology, normal development is contingent on the establishment of a coherent, universal, stable and unitary ‘core gender identity’. The present study assessed the perception of gender identity in ‘normative’ individuals in Israel using the newly constructed Multi-Gender Identity Questionnaire (Multi-GIQ). The Multi-GIQ includes 32 items assessing gender identity (Feeling like a woman, Feeling like a man, Feeling like both a man and a woman, Feeling like neither), gender dysphoria (Contentment with affirmed gender and the wish to be the ‘other’ gender, Contentment with one’s sexed body) and gender performance (Compliance with gender norms in clothing and language). Of the Men (n = 570) and Women (n = 1585) that participated in the study, over 35 % felt to some extent as the ‘other’ gender, as both men and women and/or as neither. Although such feelings were more prevalent and on average stronger in Queers (n = 70), the range of scores for all measures of gender identity was highly similar in Queers and non-Queers. A similar pattern was obtained for measures of gender dysphoria and gender performance. Sexual orientation was not a major contributor to the perception of gender identity in both Men and Women. We discuss our results in view of the current debate around the terminology and diagnostic criteria of gender dysphoria (a substitutive category for Gender Identity Disorder) in DSM-V. We conclude that the current view of gender identity as binary and unitary does not reflect the experience of many individuals, and call for a new conceptualisation of gender, which relates to multiplicity and fluidity in the experience of gender.

 Author/-s:      Daphna Joel; Ricardo Tarrasch; Zohar Berman; Maya Mukamel; Effi Ziv

Publication:     Psychology and Sexuality, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/19419899.2013.830640

Gender identity is not binary.

It is frequently suggested that gender role norms influence certain expectations towards a child's gender related behavior and that deviations are perceived negatively by the social environment. Gender-dysphoric individuals experience a strong and persistent cross-gender identification and discomfort about the assigned sex and the associated gender role behaviors.

The objective of this study was to investigate how adult gender dysphoric individuals recall play and peer-group preferences in childhood according to stereotypical expectations regarding the assigned sex.

Differences between individuals who transition from female to male (FtMs) and those who transition from male to female (MtFs) as well as differences with regard to subgroups based on the age of onset (early onset: during childhood, EO; late onset: with begin of puberty development, LO) are tested.

Data collection took place as part of the European network for the investigation of gender incongruence (ENIGI), a multicenter cooperation between European gender clinics in Amsterdam (NL), Ghent (BE), Hamburg (GER) and Oslo (NO). Play behavior and peer preferences were measured as part of the Biographic Questionnaire on Transsexualism.

The total sample of N = 634 participants was collected between 2006 and 2012. Participants were prescribed a diagnosis according to DSM-IV-TR criteria of Gender Identity Disorder.

The results show, that cross-gender behavior was more frequently recalled in FtMS than MtFs. Within the gender-groups, individuals who were assessed as having an early onset recalled cross-gender behaviors more frequently than individuals who were assessed as having a late-onset.

Author/-s:       A. Köhler; T. O. Nieder; S. Cerwenka; P. Cohen-Kettenis; G. De Cuypere; I. Haraldsen; H. Richter-Appelt

Publication:     European Psychiatry, 2014

Web link:          http://www.europsy-journal.com/article/S0924-9338(14)78839-X/abstract

Cross-gender behaviour in childhood.

Research examining risk and resilience among transgender individuals suggests that connection to a transgender community may be protective. Utilizing archival survey data of 3 087 adult transgender participants collected in 2005 and 2006, this study further evaluated how awareness and engagement with other transgender people influences risk and resilience during early gender identity development. As hypothesized, among male-to-female and female-to-male respondents, both prior awareness and prior engagement with other transgender people were independently related to less fearfulness, less suicidality, and more comfort. These relationships were not significant among male-to-different-gender or female-to-different-gender participants. Implications of these findings are discussed.

Author/-s:       Rylan J. Testa; Crystal L. Jimenez; Susan Rankin

Publication:     Journal of Gay & Lesbian Mental Health, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/.Uw5zBkJdVmM#.U525bU2KCw4

Knowing and associating with other transsexuals benefits the psychological status of transsexuals.

This study investigates the mediating role of school victimization in the relationship between lesbian, gay, bisexual, and transgender (LGBT) young adults' feelings of high school belonging and current mental health (both depression and general psychological distress) outcomes. A total of 145 LGBT young adults were recruited from college LGBT student organizations to complete an online survey that assessed high school experiences and mental health outcomes. Bootstrapping analyses were used to test for mediation. Results indicate that school victimization mediates the relationship between high school belonging and depressive symptoms and feelings of general psychological distress in young adulthood. The results suggest that school victimization is a factor that could explain why LGBT youth report lower levels of school belonging and higher levels of depression and psychological distress, relative to heterosexual youth. Implications as they relate to school psychologists are discussed and recommendations for improving the school climate for LGBT youth are provided.

Author/-s:       Nicholas C. Heck; Lauri M. Lindquist; Greg R. Machek; Bryan N. Cochran

Publication:     School Psychology Forum, 2014

Web link:          http://web.b.ebscohost.com/abstract?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=19382243&AN=95604590&h=u3OkApN35FU%2bNlzmPo9v6weQUJphQJvLErAGbqj5i03mWPqCILEW5Cgqqz3uZ%2b3EpQUw3GHd8Eu3wTEHE4JrwQ%3d%3d&crl=c

School bullying can explain distress and depression in LGBT youth.

Objective: To explore the scientific output on transsexuality in the Spanish biomedical literature between 1973 and 2011, through bibliometric and content analyses.

Methods: We carried out a descriptive, cross-sectional study of Spanish biomedical articles on transsexuality published between 1973 and 2011. The data sources consisted of Índice Médico Español and ISOC-Ciencias Sociales y Humanidades. Bibliometric and content analyses were performed.

Results: A total of 65 papers were analyzed. Knowledge on transsexuality in Spain began to appear in medical journals between 1973 and 1984. A decade of intense productivity began in 1996 and the number of journals publishing articles on transsexuality multiplied in the following years. Until 2006, the year with the most biomedical productivity, biomedical discourses reproduced representations of transsexuality anchored in biological determinism. From 2008-2011, professionals writing on the topic incorporated feminist theories and social perspectives in their discourses.

Conclusions: In the last quarter of the twentieth century, the dominant medical discourse considered manifestations of transsexual people from a biologist perspective that conceives transsexuality as a configuration mismatch between sex and gender. The emergence of new identity categories and medical reflection from non-essentialist and non-normative gender perspectives has improved the clinical management of transsexuality.

Author/-s:       Patricia Navarro-Pérez, Teresa Ortiz-Gómez, Eugenia Gil-García

Publication:     Gaceta Sanitaria, 2014

Web link:          http://www.sciencedirect.com/science/article/pii/S0213911114002027

Review of Spanish-language literature on transsexualism.

Transwomen (TW) can now turn to cryopreserve spermatozoa before gender reassignment (GR). The objective is to assess semen quality of TW and evaluate adequacy for assisted reproduction technology (ART). Pre-freezing (PF) and post-thaw (PT) semen parameters of 2 and PF data of 27 TW who were referred for sperm banking in Cleveland Clinic/USA and Ghent Center/Belgium, before GR, were retrospectively analysed. The study period was between February, 2003 and October, 2011. We also evaluated adequacy of 24-h PT data for ART. PF data of 29 TW, mean age of 28.9 years, showed high incidence of oligozoospermia (27.58%), asthenozoospermia (31%) and teratozoospermia (31%). Mean sperm concentration was 46.9 × 106/ml, mean per cent motility was 42.9 and mean per cent sperm morphology (Kruger's) was 7.98. The 24-h PT data, for 2 TW, showed mean motility 22.4%, mean total motile sperm count 13.7 × 106 and total motile sperm concentration 8.7 × 106/ml. Single patient had used the frozen spermatozoon for intrauterine insemination (IUI) of a surrogate mother resulting in birth of healthy newborn. It is concluded that poor PF and 24-h PT semen quality is frequently seen among TW. As such, considerable proportion of TW should use more expensive method of ART, for example IVF/ICSI rather than inexpensive IUI.

Author/-s:       A. Hamada; S. Kingsberg; K. Wierckx; G. T’Sjoen; P. De Sutter; G. Knudson; A. Agarwal

Publication:     Andrologia, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/and.12330/abstract

Sperm quality of transsexual women.

Introduction: Sex steroids and genital surgery are known to affect sexual desire, but little research has focused on the effects of cross-sex hormone therapy and sex reassignment surgery on sexual desire in trans persons. AIM: This study aims to explore associations between sex reassignment therapy (SRT) and sexual desire in a large cohort of trans persons.

Methods: A cross-sectional single specialized center study including 214 trans women (male-to-female trans persons) and 138 trans men (female-to-male trans persons).

Main outcome measures: Questionnaires assessing demographics, medical history, frequency of sexual desire, hypoactive sexual desire disorder (HSDD), and treatment satisfaction.

Results: In retrospect, 62.4% of trans women reported a decrease in sexual desire after SRT. Seventy-three percent of trans women never or rarely experienced spontaneous and responsive sexual desire. A third reported associated personal or relational distress resulting in a prevalence of HSDD of 22%. Respondents who had undergone vaginoplasty experienced more spontaneous sexual desire compared with those who planned this surgery but had not yet undergone it (P = 0.03). In retrospect, the majority of trans men (71.0%) reported an increase in sexual desire after SRT. Thirty percent of trans men never or rarely felt sexual desire; 39.7% from time to time, and 30.6% often or always. Five percent of trans men met the criteria for HSDD. Trans men who were less satisfied with the phalloplasty had a higher prevalence of HSDD (P = 0.02). Trans persons who were more satisfied with the hormonal therapy had a lower prevalence of HSDD (P = 0.02).

Conclusion: HSDD was more prevalent in trans women compared with trans men. The majority of trans women reported a decrease in sexual desire after SRT, whereas the opposite was observed in trans men. Our results show a significant sexual impact of surgical interventions and both hormonal and surgical treatment satisfaction on the sexual desire in trans persons.

Author/-s:       Katrien Wierckx; E. Elaut; B. van Hoorde; Gunter Heylens; Griet de Cuypere; S. Monstrey; S. Weyers; P. Hoebeke; Guy T’Sjoen

Publication:     The Journal of Sexual Medicine, 2014

Web link:          http://europepmc.org/abstract/MED/24165564

Sexual desire changes after sex reassignment surgery.

This study examined the attitudes of Greek undergraduate students toward transgender individuals to identify specific social variables as predictors of negative attitudes. Based on previous research, it appeared that gender, political conservatism, religiosity and sexual prejudice are useful variables to examine in predicting attitudes towards transgender individuals. The sample (N = 238) consisted of undergraduates at various departments of major Universities in Athens. The Genderism and Transphobia Scale (GTS) was used along with the Attitudes Toward Lesbians and Gay Men Scale (ATLG) and a brief demographics questionnaire. Correlation Analysis showed that negative attitudes toward transgender individuals were positively associated with religiosity, frequency of attendance at religious services, political designation, gender and sexual prejudice. Regression analysis revealed mainly gender and secondly sexual prejudice (as measured by the ATLG) to be independent predictors of attitudes toward transgender individuals.

Findings shed light to the current status of undergraduate students’ attitudes toward transgender individuals and reveal important variables that affect these attitudes in a specific sociocultural environment.

Author/-s:       Grigoropoulos Iraklis; Panos Kordoutis

Publication:     International Journal of Sexual health, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/19317611.2014.974792#.VF85v010wUF

Religiosity and prejudice contributes to anti-transgender feelings.

Introduction: There is a paucity of research in the area of social support and psychological well-being among people with gender dysphoria.

Aims: The present study aimed to investigate levels of social support among individuals with gender dysphoria compared with a matched control group. It also aimed to examine the relationship between social support and psychological well-being.

Methods: Participants were 103 individuals diagnosed with gender dysphoria (according to ICD-10 criteria) attending a national gender identity clinic and an age- and gender-matched nonclinical control group recruited via social networking websites.

Main Outcome Measures: All participants completed measures of social support (Multidimensional Scale of Perceived Social Support, MSPSS), psychopathology (Symptom Checklist 90 Revised, SCL), quality of life (Short Form 36 version 2, SF), and life satisfaction (Personal Wellbeing Index, PWI).

Results: Trans women reported significantly lower MSPSS total and MSPSS family scores compared with control women, although these differences in levels of social support were no longer significant when SCL depression was controlled for. No significant differences were found between trans men and any other group. MSPSS scores did not significantly predict SCL subscales but did predict both SF subscales and PWI total scores.

Conclusions: Trans women perceived themselves to be lacking social support. Given that social support is beneficial to quality of life and life satisfaction in those with gender dysphoria, this is of great concern. Though these findings have been derived from correlational results, extended research may highlight the value of clinicians helping trans women to seek out and maintain social support. Additionally, efforts could be made to educate and challenge attitudes of nontrans people towards those with gender dysphoria.

Author/-s:       Amanda Davey; Walter P. Bouman; Jon Arcelus; Caroline Meyer

Publication:     The journal of sexual medicine, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12681/abstract

Study about social support and well-being in transsexuals.

Background: Violating societal norms for masculine and feminine appearance and behavior puts one at heightened risk of harassment and discrimination, but the impact of these adverse experiences on health-related quality of life (HRQL) is unknown.

Purpose: To examine the relationship between gender expression and HRQL in a U.S. cohort.

Methods: Using data from the Growing Up Today Study (n=4,769), a prospective cohort of young adults, we assessed socially assigned gender expression with a self-report measure on how others perceive one’s appearance and mannerisms, from very feminine to very masculine.  A gender-specific continuous summary score was created (range: 1 [most conforming] to 7 [most nonconforming]). To assess HRQL, we used the EQ-5D, a population standardized instrument recommended in health economics (range: 0 [low] to 1 [high]). We used multivariable linear models, adjusted for age, race/ethnicity, and sexual orientation, to model the relationship between socially assigned gender expression and HRQL.

Results: Among women, mean HRQL ranged from 0.881 (SD=0.097) for those reporting greatest gender nonconformity to 0.927 (SD=0.090) for those reporting greatest conformity. Disparities were similar among men. In adjusted models, greater gender nonconformity was associated with a statistically significant decrement in HRQL for both women and men (women: β=-0.016, SE=0.002, p<0.001; men: β=-0.014, SE=0.004, p<0.001).

Discussion: This is the first study to document decrements in HRQL associated with socially assigned gender nonconformity and use a measure suitable for cost-effectiveness analysis. Our findings will inform future research on the degree to which these disparities may be explained by gender-related stigma and discrimination.

Author/-s:       Allegra R. Gordon; Mihail Samnaliev; Brittany Charlton; S. Bryn Austin; Najat Ziyadeh

Publication:     Presentation, 142nd APHA Annual Meeting and Exposition, 2014

Web link:          https://apha.confex.com/apha/142am/webprogram/Paper300273.html

Gender-variant people are being harassed and discriminated against, which reduces health-related quality of life.

By performing secondary data analyses of existing medical, social, and state data, this study examined the sociodemographic profile of trans persons in Belgium and gains knowledge on those who are functionally invisible in traditional epidemiological studies or clinical samples. Based on medical interventions, post-operative transsexual persons were selected from a social survey data set, to compare their sociodemographic profile with available data on legal sex changes from the Belgian National Register and with published data on clinical samples of post-operative transsexual persons. Furthermore, based on self-chosen gender identity categories in the social survey data, transsexual participants were compared with the transgender participants (those people feeling neither female nor male, or both female and male, or otherwise). The sociodemographic data on the post-operative transsexual persons from the three datasets appeared to be very similar. Based on identity categories, the data on transsexual and transgender persons from the social survey showed differences in marital status and employment. Transsexual persons were significantly more often divorced than transgender persons. Both groups differed significantly in employment status. Information about transgender people (or the “in-between” group) is too often lacking from studies but can be obtained when identity instead of medical criteria are used in research.

Author/-s:       Joz Motmans; Koen Ponnet; Griet De Cuypere

Publication:     Archives of Sexual Behavior, 2014

Web link:          http://link.springer.com/article/10.1007/s10508-014-0411-2

Sociodemographic data from Belgium.

Purpose: Testosterone is the recommended treatment for transgender youth who desire the development of male secondary sexual characteristics. While intramuscular injection remains the most common means of delivering injectable testosterone, subcutaneous (SC) delivery has been used with clinical success. No data reporting serum levels and feasibility are available. We aimed to determine both if subcutaneous delivery of testosterone resulted in menstrual cessation, and the normal male ranges of serum testosterone in this subpopulation of female-to-male transgender youth.

Methods: Within an urban hospital-affiliated Adolescent Medicine clinic, thirty-six youth aged 13 to 24 years transitioning from female to male received testosterone cypionate via subcutaneous injections for masculinization. Participants were a subpopulation of those enrolled in a longitudinal, prospective study examining the impact of treatment for transgender youth. A titrated dose of testosterone cypionate (average dose 46.4 mg per week) via subcutaneous injection was delivered over 6 months. The main outcomes included menstrual cessation as well as raised free and total testosterone levels.

Results: Eighty-five percent of participants had ceased menstrual bleeding within 6 months after initiating testosterone. The average time to menstrual cessation was 2.9 months. Most participants (91.4%) reached total testosterone levels within the normal male range after 6 months of subcutaneous delivery (49–1138 ng/dL, 521.4 ng/dL total test). Few adverse effects were reported.

Conclusion: Subcutaneous delivery of testosterone for masculinization of transgender youth seems to be effective and well tolerated over short treatment times. Additional studies are needed to determine whether long term use of subcutaneous testosterone delivery yield similar results.

Author/-s:       Johanna Olson; Sheree M. Schrager; Leslie F. Clark; Shannon L. Dunlap; Marvin Belzer

Publication:     LGBT Health, 2014

Web link:          http://online.liebertpub.com/doi/abs/10.1089/lgbt.2014.0018

Hormone therapy is safe and effective.

Objective: We aim to study the relation between exposure to violence during childhood and adolescence and substance consumption in adulthood in a population of transsexuals.

Material and Methods: Descriptive study of 209 transsexual subjects, based on the ICD-10 diagnostic criteria (109 male-to-female, and 100 female-to-male), followed at the Transsexuality and Gender Identity Unit of the General University Hospital of Malaga (Spain). The Social-demographic structured questionnaire and Exposure to Violence Questionnaire (EVQ) were used during the psychological evaluation phase of the gender reassignment process.

Results: The highest score of direct violence experienced in childhood and adolescence was obtained from when the subjects were at school, the lowest score was obtained at home, and direct violence in the neighbourhood came second. The average score of the EVQ questionnaire (Violence in the neighbourhood) was significantly higher in those who had consumed cannabis in the past compared to those who hadn’t (p<0.05). Differences were not observed either in the total direct score of EVQ nor in the other EVQ scores for active cannabis consumers. The average of the EVQ direct score in those who had consumed cocaine in the past (p <0.05) were higher. Specifically, higher scores of violence were experienced at home, both among current and past consumers of cocaine. The differences between consumers and non-consumers of designer drugs in the past were significant within the scores of exposure to violence at home (p<0.05) but not on the total questionnaire score.

Conclusions: In accordance with the data, violence experienced during childhood and adolescence may play a role in substance abuse in adult transsexuals. In addition, some characteristic patterns are observed between exposure to violence and the type of drug consumed. In an attempt to prevent early exposure to violence and its consequences on mental health and influence the psychosocial adjustment in transsexuals, early interventions are imperative.

Author/-s:       Trinidad Bergero-Miguel; Pedro Paulino-Matos; Jose Guzmán-Parra; Yolanda de Diego-Otero; Nicolas Sánchez-Álvarez; Lucia Pérez-Costillas

Publication:     Nova Science Publishers, 2014

Web link:          http://www.researchgate.net/profile/Jose_Guzman-Parra/publication/267390028_Substance_Use_and_Exposure_to_Violence_during_Childhood_and_Adolescence_in_Transsexuals/

Drug addiction and childhood abuse seems linked in transsexual children.

Excecutive summary: The prevalence of suicide attempts among respondents to the National Transgender Discrimination Survey (NTDS), conducted by the National Gay and Lesbian Task Force and National Center for Transgender Equality, is 41 percent, which vastly exceeds the 4.6 percent of the overall U.S. population who report a lifetime suicide attempt, and is also higher than the 10 to 20 percent of lesbian, gay and bisexual adults who report ever attempting suicide. […]

Key findings of this report include the following:

Suicide attempts among trans men (46 %) and trans women (42 %) were slightly higher than the full sample (41 %). Cross-dressers assigned male at birth have the lowest reported prevalence of suicide attempts among gender identity groups (21 %). […]

Prevalence of suicide attempts is elevated among those who disclose to everyone that they are transgender or gender-non-conforming (50 %) and among those that report others can tell always (42 %) or most of the time (45 %) that they are transgender or gender non-conforming even if they don’t tell them. […]

Respondents who experienced rejection by family and friends, discrimination, victimization, or violence had elevated prevalence of suicide attempts, such as those who experienced the following:

• Family chose not to speak/spend time with them: 57 %

Discrimination, victimization, or violence at school, at work, and when accessing health care:

• Harassed or bullied at school (any level): 50–54 %

• Experienced discrimination or harassment at work: 50–59 %

• Doctor or health care provider refused to treat them: 60 %

Suffered physical or sexual violence:

• At work: 64–65 %

• At school (any level): 63–78 %

Discrimination, victimization, or violence by law enforcement

• Disrespected or harassed by law enforcement officers: 57–61 %

• Suffered physical or sexual violence: By law enforcement officers: 60–70 %

• Experienced homelessness: 69 %

Overall, the most striking finding of our analysis was the exceptionally high prevalence of lifetime suicide attempts reported by NTDS respondents across all demographics and experiences. […]

Author/-s:       Ann P. Haas; Philip L. Rodgers; Jody L. Herman

Publication:     Findings of the national transgender discrimination survey, The Williams Institute, University of California, 2014

Web link:          http://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-Williams-Suicide-Report-Final.pdf

Suicides among transgender people are extremely high, discrimination is rife.

Background: Co-morbid psychiatric disorders affect prognosis, psychosocial adjustment and post-surgery satisfaction in patients with gender identity disorder. In this paper, we assessed the frequency of personality disorders in Iranian GID patients.

Methods: Seventy- three patients requesting sex reassignment surgery (SRS) were recruited for this crosssectional study. Of the participants, 57.5% were biologically male and 42.5% were biologically female. They were assessed through the Millon Clinical Multiaxial Inventory II (MCMI- II).

Results: The frequency of personality disorders was 81.4%. The most frequent personality disorder was narcissistic personality disorder (57.1%) and the least was borderline personality disorder. The average number of diagnoses was 3.00 per patient.

Conclusion: The findings of this study revealed that the prevalence of personality disorders was higher among the participants, and the most frequent personality disorder was narcissistic personality disorder (57.1%), and borderline personality disorder was less common among the studied patients.

Author/-s:       Azadeh Mazaheri Meybodi; Ahmad Hajebi; Atefeh Ghanbari Jolfaei

Publication:     Medical Journal of the Islamic Republic of Iran, 2014

Web link:          http://mjiri.iums.ac.ir/browse.php?a_id=2444&sid=1&slc_lang=en

Transsexuals frequently have personality disorders.

Autogynephilia, or paraphilic sexual arousal in a man to the thought or image of himself as a woman, manifests in a variety of different behaviors and fantasies. We examined the psychometric structure of 22 items assessing five known types of autogynephilia by subjecting them to exploratory factor analysis in a sample of 149 autogynephilic men. Results of oblique factor analyses supported the ability to distinguish five group factors with suitable items. Results of hierarchical factor analyses suggest that the five group factors were strongly underlain by a general factor of autogynephilia. Because the general factor accounted for a much greater amount of the total variance of the 22 items than did the group factors, the types of autogynephilia that a man has seem less important than the degree to which he has autogynephilia. However, the five types of autogynephilia remain conceptually useful because meaningful distinctions were found among them, including differential rates of endorsement and differential ability to predict other relevant variables like gender dysphoria. Factor-derived scales and subscales demonstrated good internal consistency reliabilities, and validity, with large differences found between autogynephilic men and heterosexual male controls. Future research should attempt to replicate our findings, which were mostly exploratory.

Author/-s:       Kevin J. Hsu; A. M. Rosenthal; J. Michael Bailey

Publication:     Archives of Sexual Behavior, 2014

Web link:          http://link.springer.com/article/10.1007/s10508-014-0397-9

J. Michael Bailey is at it again, presenting “exploratory” findings after many years of autogynephilia research.

In “A Sociological Approach to Social Problems”, Noel Timms underscores the importance of understanding how historical and social contexts shape the framing of social problems—insights that remain true as we approach the book’s semicentennial. This article applies Timms’ concepts to the social construction of mental illness for lesbian, gay, bisexual, and transgender (LGBT) persons over time in the United States, by comparing changes in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Variations between versions reflect how mental illness diagnoses associated with LGBT persons are highly intertwined with dominant social and cultural norms of sexuality and gender at a given time.

Author/-s:       Angela K. Perone

Publication:     Qualitative social work, 2014

Web link:          http://qsw.sagepub.com/content/early/2014/07/21/1473325014543544.abstract

How transgenderism as a mental illness is constructed by society.

The literature examining the co-occurrence of gender dysphoria (GD) and autistic traits has so far been limited to a series of small case studies and two systematic studies, one looking at autistic traits in gender dysphoric children and the other set within the context of the extreme male brain hypothesis and looking at adults. The current study examined this co-occurrence of GD and autistic traits in an adult population, to see whether this heightened prevalence persisted from childhood as well as to provide further comparison of MtF versus FtM transsexuals and homosexual versus nonhomosexual individuals. Using the Autistic Spectrum Quotient (AQ), 91 GD adults (63 male-to-female [MtF] and 28 female-to-male [FtM]) undertaking treatment at a gender clinic completed the AQ. The prevalence of autistic traits consistent with a clinical diagnosis for an autism spectrum disorder (ASD) was 5.5 % (n = 3 MtF and n = 2 FtM) compared to reports of clinical diagnoses of 0.5-2.0 % in the general population. In contrast to the single previous report in adults, there was no significant difference between MtF and FtM on AQ scores; however, all of those who scored above the clinical cut-off were classified as nonhomosexual with respect to natal sex. Results were considered in the context of emerging theories for the observed co-occurrence of GD and autistic traits.

Author/-s:       Vickie Pasterski; Liam Gilligan; Richard Curtis

Publication:     Archives of Sexual Behaviour, 2014

Web link:          http://europepmc.org/abstract/MED/23864402

In a small sample, transsexuals were more likely to be affected by autism spectrum disorder.

For most adolescents, being a boy or a girl is something obvious that does not require a second thought. This is not the case for adolescents with gender dysphoria, the intense feeling of being unhappy with the sex assigned at birth. The recently published DSM-5 has specified criteria for diagnosis in adolescents.

Adolescents will typically present to clinic with a clear wish for sex reassignment treatment through hormonal intervention and surgery. For many not familiar with gender dysphoria, it remains unimaginable that adolescents express this wish. At what age can one make such a decision? Will gender dysphoria disappear, and isn't it typical that (gender) identity develops during puberty? There are few adolescents that will experience gender dysphoria to the extent of fulfilling the DSM-5 criteria. Of note, there is an important difference between gender dysphoria in children younger than 12 years old and in adolescents starting puberty. In most children, gender dysphoria will disappear before the start of puberty, with figures varying between 94 and 73% in the different studies. In a minority (6–27%), the gender dysphoria becomes more important at this time point, and the intense wish to belong to the other sex does not disappear any more. It has been about 15 years now that the possibility of puberty suppression when gender dysphoria persists during adolescence was explored. Since then, this approach is increasingly accepted, even if debated heavily among professionals and policy makers. Nevertheless, The Endocrine Society and the Standards of Care of the World Professional Association of Transgender Health (WPATH) included the “Dutch” treatment protocol in their guidelines. This model of care is often referred to by the country of its developers (The Dutch Approach).

Author/-s:       Guy G. T’Sjoen

Publication:     2014 Meet-The-Professor: Endocrine Case Management, 2014

Web link:          http://press.endocrine.org/doi/abs/10.1210/MTP3.9781936704835.ch44

Review of transgender medicine for youth.

Objective: Sexual orientation is usually considered to be determined in early life and stable in the course of adulthood. In contrast, some transgender individuals report a change in sexual orientation. A common reason for this phenomenon is not known.

Methods: We included 115 transsexual persons (70 male-to-female “MtF” and 45 female-to-male “FtM”) patients from our endocrine outpatient clinic, who completed a questionnaire, retrospectively evaluating the history of their gender transition phase. The questionnaire focused on sexual orientation and recalled time points of changes in sexual orientation in the context of transition. Participants were further asked to provide a personal concept for a potential change in sexual orientation.

Results: In total, 32.9 % (n = 23) MtF reported a change in sexual orientation in contrast to 22.2 % (n = 10) FtM transsexual persons (p = 0.132). Out of these patients, 39.1 % (MtF) and 60 % (FtM) reported a change in sexual orientation before having undergone any sex reassignment surgery. FtM that had initially been sexually oriented towards males ( = androphilic), were significantly more likely to report on a change in sexual orientation than gynephilic, analloerotic or bisexual FtM (p = 0.012). Similarly, gynephilic MtF reported a change in sexual orientation more frequently than androphilic, analloerotic or bisexual MtF transsexual persons (p = 0.05).

Conclusion: In line with earlier reports, we reveal that a change in self-reported sexual orientation is frequent and does not solely occur in the context of particular transition events. Transsexual persons that are attracted by individuals of the opposite biological sex are more likely to change sexual orientation. Qualitative reports suggest that the individual's biography, autogynephilic and autoandrophilic sexual arousal, confusion before and after transitioning, social and self-acceptance, as well as concept of sexual orientation itself may explain this phenomenon.

Author/-s:       Matthias K. Auer; Johannes Fuss; Nina Höhne; Günter K. Stalla; Caroline Sievers

Publication:     PLOS One, 2014

Web link:          http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0110016

On changing the sexual orientation after transitioning.

Background: Prenatal exposure to increased androgens has been implicated in both polycystic ovary syndrome (PCOS) and autism spectrum conditions (ASC), suggesting that PCOS may be increased among women with ASC. One study suggested elevated steroidopathic symptoms (‘steroidopathy’) in women with ASC. As the symptoms are not independent, we conducted a latent class analysis (LCA). The objectives of the current study are: (1) to test if these findings replicate in a larger sample; and (2) to use LCA to uncover affected clusters of women with ASC.

Methods: We tested two groups of women, screened using the Autism Spectrum Quotient - Group 1: n = 415 women with ASC (mean age 36.39 ± 11.98 years); and Group 2: n = 415 controls (mean age 39.96 ± 11.92 years). All participants completed the Testosterone-related Medical Questionnaire online. A multiple-group LCA was used to identify differences in latent class structure between women with ASC and controls.

Results: There were significant differences in frequency of steroid-related conditions and symptoms between women with ASC and controls. A two-class semi-constrained model best fit the data. Based on response patterns, we identified the classes as ‘Typical’ and ‘Steroidopathic’. The prevalence of the ‘Steroidopathic’ class was significantly increased within the ASC group (ΔG² = 15, df =1, P = 0.0001). In particular, we confirmed higher frequencies of epilepsy, amenorrhea, dysmenorrhea, severe acne, gender dysphoria, and transsexualism, and differences in sexual preference in women with ASC.

Conclusions: Women with ASC are at increased risk for symptoms and conditions linked to steroids. LCA revealed this steroidopathy despite the apparent underdiagnosis of PCOS.

Author/-s:       Alexa Pohl; Sarah Cassidy; Bonnie Auyeung; Simon Baron-Cohen

Publication:     Molecular Autism, 2014

Web link:          http://www.molecularautism.com/content/pdf/2040-2392-5-27.pdf

Women with autism are at risk for conditions linked to steroids, including gender dysphoria.

Gender dysphoria (GD) leading to hormonal treatment and sex reassignment surgery that spans two generations has not been reported so far.

The mother was diagnosed with GD at the age of 47. As an only child she suffered from emotional, physical, and sexual abuse by her parents. From the age of 3, she fantasized being a boy and started behaving like one. During later youth the genderdysphoric feelings were repressed. She married at the age of 18. One year later she became pregnant, but after giving birth she felt no emotional connection with the baby-girl. A diagnosis of GD was established in 2004. The client started with cross-sex hormone therapy. In 2006 he underwent bilateral subcutaneous mastectomy and endoscopic hysterectomy/ovariectomy. Metadoioplasty followed by phalloplasty were performed in 2007 and 2009 respectively. In 2012, the sex reassignment surgery was completed with the placement of an erectile device and testicular prostheses.

The daughter was diagnosed with GD at age 31. She was also an only child. She has no traumatic childhood memories. GD became obvious from the age of 8, when she started behaving like a boy and sought for male playmates. During later youth she suffered from psychological problems such as panic attacks and social phobia.

A diagnosis of GD was established in 2007. In 2008, cross-sex hormone therapy was started. Bilateral subcutaneous mastectomy and endoscopic hysterectomy/ovariectomy were performed in 2009. Because of a postoperative complication after the mastectomy genital surgery is temporarily postponed.

Both father and son are doing well since their transition. Genetic testing showed an aberrant female array CGH profile with a ~650 kb duplication in chromosome 15q26.3 both in father and son and a ~100 kb deletion in 7p14.1 in the GLI3 gene in father. Further research into the clinical relevance of this finding or its connection with GD is currently ongoing.

Author/-s:       Tatjana Sajevets; Charlotte Verroken; Gunter Heylens; Elfride De Baere; Guy T’Sjoen

Publication:     Endocrine Abstracts, 2014

Web link:          http://www.endocrine-abstracts.org/ea/0035/ea0035P277.htm

Positive transition report for a parent-child pair.

The commonly used Standards of Care for people with gender dysphoria, including those of the World Professional Association for Transgender Health and The Royal College of Psychiatrists in the United Kingdom, as well as those standards used in many other countries, usually require that two signatures of approval from qualified mental health professionals be provided before genital reconstructive surgery (GRS) – sometimes called sexual reassignment surgery or gender confirmation surgery – is undertaken. This is different from surgeries which are similarly irreversible and remove reproductive capacity carried out on cisgender people. This paper explores the trans-specific issues from a standpoint of medical ethics and argues that, provided sufficient safeguards are in place, including assessment within a multidisciplinary team, a nuanced approach utilising a single signature may instead be appropriate.

Author/-s:       W. P. Bouman; C. Richards; R. M. Addinall; I. Arango de Montis; J. Arcelus; D. Duisin; I. Esteva; A. Fisher; F. Harte; B. Khoury; Z. Lu; A. Marais; A. Mattila; D. Nayarana Reddy; T. O. Nieder; R. Robles Garcia; O. M. Rodrigues Jr.; A. Roque Guerra; D. Tereshkevich; G. T’Sjoen; D. Wilson

Publication:     Sexual and Relationship Therapy, 2014

Web link:          http://www.tandfonline.com/doi/abs/10.1080/14681994.2014.954993#.VDEW800cQUE

Discussion on the gatekeeper function of medical professionals.

This article presents the findings from a cross-sectional study on demographic variables and associated difficulties in 218 children and adolescents (Mean age = 14 years, SD = 3.08, range = 5–17 years), with features of gender dysphoria, referred to the Gender Identity Development Service (GIDS) in London during a 1-year period (1 January 2012–31 December 2012). Data were extracted from patient files (i.e. referral letters, clinical notes and clinician reports). The most commonly reported associated difficulties were bullying, low mood/depression and self-harming. There was a gender difference on some of the associated difficulties with reports of self-harm being significantly more common in the natal females and autism spectrum conditions being significantly more common in the natal males. The findings also showed that many of the difficulties increased with age. Findings regarding demographic variables, gender dysphoria, sexual orientation and family features are reported, and limitations and implications of the cross-sectional study are discussed. In conclusion, young people with gender dysphoria often present with a wide range of associated difficulties which clinicians need to take into account, and our article highlights the often complex presentations of these young people.

Author/-s:       Vicky Holt; Elin Skagerberg; Michael Dunsford

Publication:     Clinical Child Psychology and Psychiatry, 2014

Web link: http://www.researchgate.net/publication/268879198_Young_people_with_features_of_gender_dysphoria_Demographics_and_associated_difficulties

Transgender youth are bullied and suffer from depression and self-harm.