Background: Males and females have different temperaments. In individuals with gender dysphoria (GD) there is marked incongruence between a person׳s expressed/experienced gender and their biological sex. The present study aimed to investigate the most common affective temperaments in individuals with female-to-male (FtM) GD.

Methods: We performed a prospective and comparative study investigating affective temperaments in subjects with FtM GD. Eighty subjects with FtM GD and 68 female controls were enrolled. The Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) was completed by all participants.

Results: TEMPS-A scores were significantly higher in subjects with FtM GD for hyperthymic temperament (p ≤ 0.001), whereas depressive (p ≤ 0.001), anxious (p ≤ 0.001), and cyclothymic (p = 0.028) temperament scores were significantly higher in female controls.

Limitations: The study was limited by the lack of male-to-female subjects and male controls.

Conclusions: The results of our study indicate that individuals with FtM GD have significantly higher scores of hyperthymic temperament, measured by TEMPS-A. Biological basis underlying the development of gender identity independent from the biological sex might be related with affective temperaments.

Author/-s:       Şenol Turan; Cana Aksoy Poyraz; Tuba Öcek Baş; Ayşe Sakallı Kani; Alaattin Duran

Publication:     Journal of affective disorders, 2015

Web link:          http://www.jad-journal.com/article/S0165-0327(15)00077-4/abstract

Introduction: Gender identity disorders (GID) are heterogeneous disorders that may be influenced by culture and social norms.

Aim: The aim of this study was to determine masculine and feminine gender roles in a group of Iranian patients with GID and compare these roles with two control groups.

Methods: Twelve male-to-female (MF) and 27 female-to-male (FM) individuals with GID referred to Tehran Psychiatric Institute in Tehran, I. R. Iran were evaluated by self-report inventories and were compared with two groups of healthy controls (81 men and 89 women). Diagnoses were established based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria. Data analysis was done using analysis of variance and chi-squared test.

Main Outcome Measures: Masculine and feminine gender roles were assessed by two questionnaires: (i) Gender-Masculine (GM) and Gender-Feminine (GF) scales derived from the Minnesota Multiphasic Inventory-2 (MMPI-2); (ii) Bem Sex Role Inventory (BSRI).

Results: In the scales of masculinity, MF-GID individuals scored as male controls, but lower than female controls. FM-GID individuals scored similar to female controls and higher than male controls. In femininity scales, MF-GID individuals and control women seemed similar, and both scored higher than the other groups. FM-GID persons were considered less feminine than both controls in the GF scale of MMPI-2, but not in the BSRI. In both scales, FM-GID persons had higher scores than control women and MF-GID individuals.

Conclusion: Iranian FM-GID individuals were less feminine than normal men. However, MF-GID individuals were similar to normal women or more feminine. Cultural considerations remain to be investigated.

Author/-s:       Kaveh Alavi; Mehrdad Eftekhar; Amir Hossein Jalali

Publication:     Sexual Medicine, 2015

Web link:          http://onlinelibrary.wiley.com/doi/10.1002/sm2.79/full

A visible and growing cohort of transgender children in North America live according to their expressed gender rather than their natal sex, yet scientific research has largely ignored this population. In the current study, we adopted methodological advances from social-cognition research to investigate whether 5- to 12-year-old prepubescent transgender children (N = 32), who were presenting themselves according to their gender identity in everyday life, showed patterns of gender cognition more consistent with their expressed gender or their natal sex, or instead appeared to be confused about their gender identity. Using implicit and explicit measures, we found that transgender children showed a clear pattern: They viewed themselves in terms of their expressed gender and showed preferences for their expressed gender, with response patterns mirroring those of two cisgender (nontransgender) control groups. These results provide evidence that, early in development, transgender youth are statistically indistinguishable from cisgender children of the same gender identity.

Author/-s:       Kristina R. Olson; Aidan C. Key; Nicholas R. Eaton

Publication:     Psychological Science, 2015

Web link:          http://pss.sagepub.com/content/early/2015/03/05/0956797614568156.abstract

In general, speech language therapy for transsexual persons focuses on pitch and pitch variation and more recently also on resonance. Other communicative aspects are dealt with far less often, especially language. This study investigated to what extent conversational topics might need attention in therapy for transsexual persons. A total of 111 males, 116 females, 28 male-to-female and 18 female-to-male transsexuals were asked to indicate on a list with 34 topics how often they speak about each topic (never, sometimes, often) in conversations with males, with females and in a gender mixed group. Results showed that transsexual persons behave in accordance with the desired gender. However, they also tend to adopt a position depending on the gender of their conversational partner. It can be concluded that in general it is not necessary to pay attention to conversational topics in therapy for transsexual persons.

Author/-s:       John van Borsel; Miet Cayzeele; Eva Heirman; Guy T’Sjoen

Publication:     Clinical Linguistics & Phonetics, 2014

Web link:          http://europepmc.org/abstract/MED/24446798

Introduction: Differences in facial preferences between heterosexual men and women are well documented. It is still a matter of debate, however, how variations in sexual identity/sexual orientation may modify the facial preferences.

Aim: This study aims to investigate the facial preferences of male-to-female (MtF) individuals with gender dysphoria (GD) and the influence of short-term/long-term relationships on facial preference, in comparison with healthy subjects.

Methods: Eighteen untreated MtF subjects, 30 heterosexual males, 64 heterosexual females, and 42 homosexual males from university students/staff, at gay events, and in Gender Clinics were shown a composite male or female face. The sexual dimorphism of these pictures was stressed or reduced in a continuous fashion through an open-source morphing program with a sequence of 21 pictures of the same face warped from a feminized to a masculinized shape.

Main Outcome Measures: An open-source morphing program (gtkmorph) based on the X-Morph algorithm.

Results: MtF GD subjects and heterosexual females showed the same pattern of preferences: a clear preference for less dimorphic (more feminized) faces for both short- and long-term relationships. Conversely, both heterosexual and homosexual men selected significantly much more dimorphic faces, showing a preference for hyperfeminized and hypermasculinized faces, respectively.

Conclusions: These data show that the facial preferences of MtF GD individuals mirror those of the sex congruent with their gender identity. Conversely, heterosexual males trace the facial preferences of homosexual men, indicating that changes in sexual orientation do not substantially affect preference for the most attractive faces.

Author/-s:       Giacomo Ciocca; Erika Limoncin; Alessandro Cellerino; Alessandra D. Fisher; Giovanni Luca Gravina; Eleonora Carosa; Daniele Mollaioli; Dario R. Valenzano; Andrea Mennucci; Elisa Bandini; Savino M. Di Stasi; Mario Maggi; Andrea Lenzi; Emmanuele A. Jannini

Publication:     The Journal of Sexual Medicine, 2014

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12633/abstract

Objective: Investigating psychopathological profiles of transsexuals raises a very basic methodological question: are control groups, which represent the biological or the phenotypic sex, most suited for an optimal evaluation of psychopathology of transsexuals?

Method: Male-to-female (MtF) (n=52) and female-to-male transsexuals (FtM) (n=32), receiving cross-sex hormone treatment, were compared with age matched healthy subjects of the same genetic sex (n=178) and with the same phenotypic sex (n=178) by means of the Symptom Check List-90-Revisited instrument (SCL-90-R). We performed analyses of covariance (ANCOVA) to test for group and sex effects. Furthermore, we used a profile analysis to determine if psychopathological symptom profiles of transsexuals more closely resemble genotypic sex or phenotypic sex controls.

Results: Transsexual patients reported more symptoms of psychopathological distress than did healthy control subjects in all subscales of the SCL-90-R (all p<0.001), regardless of whether they were compared with phenotype or genotype matched controls. Depressive symptoms were more pronounced in MtF than in FtM (SCL-90-R score 0.85 vs. 0.45, p = 0.001). We could demonstrate that FtM primarily reflect the psychopathological profile of biological males rather than that of biological females (r = 0.945), while MtF showed a slightly higher profile similarity with biological females than with biological males (r = 0.698 vs. r = 0.685).

Conclusion: Our findings suggest that phenotypic sex matched controls are potentially more appropriate for comparison with the psychopathology of transsexual patients than are genetic sex matched controls.

Author/-s:       Matthias K. Auer; Nina Höhne; María Ángeles Bazarra-Castro; Hildegard Pfister; Johannes Fuss; Günter K. Stalla; Caroline Sievers; Marcus Ising

Publication:     PLoS One, 2013

Web link:          http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0078469

Introduction: In the literature, verbal fluency (VF) is generally described as a female-favoring task. Although it is conceivable that this sex difference only evolves during adolescence or adulthood under influence of sex steroids, this has never been investigated in young adolescents.

Aim: First, to assess sex differences in VF performance and regional brain activation in adolescents. Second, to determine if untreated transsexual adolescents differ from their sex of birth with regard to VF performance and regional brain activation.

Method: Twenty-five boys, 26 girls, 8 Male-to-Female transsexual adolescents (MtFs), and 14 Female-to-Male transsexual adolescents (FtMs) were tested in a cross-sectional study, while performing a phonetic and semantic VF task within an MRI scanner.

Main Outcome Measures: Functional MRI response during VF task.

Results: Boys and girls produced similar amounts of words, but the group MtFs produced significantly more words in the phonetic condition compared to control boys, girls, and FtMs. During the semantic condition, no differences were found. With regard to brain activity, control boys showed more activation in the right Rolandic operculum, a small area adjacent to Broca's area, compared to girls. No significant differences in brain activity were found comparing transsexual adolescents, although sub-threshold activation was found in the right Rolandic operculum indicating a trendwise increase in activation from control girls to FtMs to MtFs to control boys.

Conclusions: The better performance of MtFs is consistent with our expectation that MtFs perform better on female-favoring tasks. Moreover, they produced more words than girls and FtMs. Even though a trendwise linear increase in brain activity between the four groups only approached significance, it may indicate differences in individuals with gender identity disorder compared to their birth sex. Although our findings should thus be interpreted with caution, they suggest a biological basis for both transgender groups performing in-between the two sexes.

Author/-s:       Remi S. Soleman; Sebastian E. E. Schagen; Dick J. Veltman; Baudewijntje P. C. Kreukels; Peggy T. Cohen-Kettenis; Cornelis B. Lambalk; Femke Wouters; Henriette A. Delemarre-van de Waal

Publication:     The Journal of Sexual Medicine, 2013

Web link:          http://onlinelibrary.wiley.com/doi/10.1111/jsm.12083/abstract

The aim of this study was to evaluate personality in transsexuals. The Temperament and Character Inventory (TCI) profiles of 166 male-to-female (MF) and 88 female-to-male (FM) transsexuals were compared with those of a control group of males and females. MF and FM transsexuals scored significantly lower than males and females in RD4 (more independent) and C3 (more self-centeredness). MF transsexuals scored higher than males and females in HA4 (more fatigable), ST and ST3 (more spiritual acceptance), and lower in C5 (more opportunistic); moreover, they showed higher scores than males in RD1 (more sentimental) and lower than females in C (less cooperativeness). FM transsexuals scored lower than females in HA2 (more daring and confident), RD (less sentimental), and C5 (more opportunistic). Compared with FM, MF transsexuals scored higher on HA2 (more fearful), RD, RD1 (more sentimental), ST, ST2 and ST3 (more spiritual). All these differences were less than half a standard deviation except for C3. Data show that transsexuals and controls display a similar personality profile, even though there are some differential personality traits. Moreover, the personality profile of transsexuals was closer to the profile of subjects who shared their gender identity than those who shared their anatomical sex.

Author/-s:       Esther Gómez-Gil; Fernando Gutiérrez; Silvia Cañizares; Leire Zubiaurre-Elorza; Miquel Monràs; Isabel Esteva de Antonio; Manel Salamero; Antonio Guillamón

Publication:     Psychiatry Research, 2013

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/23958334/

The aim of the study is to evaluate the usefulness of the Bem Sex Role Inventory (BSRI; Bem, 1974), an overall measurement of the cultural construct of masculinity and femininity, in the psychological assessment of Spanish transsexuals. Seventy male-to-female transsexuals (MF), 51 female-to-male transsexuals (FM), 77 control men, and 79 control women completed the Spanish version of the BSRI. Statistically significant differences between groups were only found on the femininity scale, on which MF transsexuals and control women scored significantly higher than FM transsexuals and control men. The results indicate that (a) only the femininity scale of the BSRI appears to be useful today for evaluating differences in the sex-role identification in Spanish controls and transsexuals; and (b) MF and FM transsexuals score as a function of their gender identity instead of their anatomical sex on the BSRI femininity scale.

Author/-s:       Esther Gómez-Gil; Angel Gómez; Silvia Cañizares; Antonio Guillamón; Giuseppina Rametti; Isabel Esteva; Alexandra Vázquez; Manuel Salamero-Baró

Publication:     Journal of Personality Assessment, 2012

Web link:          http://europepmc.org/abstract/MED/22242861

The aim of this study is to identify the body image and personality traits of male-to-female transsexual and homosexual persons in Turkey: 36 homosexuals and 52 male-to-female transsexuals were evaluated. According to the Body Cathexis Scale (Secord & Jourard, 1953) transsexuals compared with controls are statistically more satisfied with their waist, height, eyes, hips, legs, body posture and weight; dissatisfied with their body hair distribution, shoulder width and genitals. Homosexuals compared with controls are statistically more satisfied in height, sharpness of senses, hips, legs, sexual activity and body posture; dissatisfied in body hair distribution and genitals. It may be interpreted that transsexuals are identified with female body. The Eysenck Personality Questionnaire (Eysenck & Eysenck, 1978) revealed that transsexual participants have statistically higher mean neuroticism (N) scores than do controls.

Author/-s:       Ali Bozkurt; Hasmet Isikli; Fusun Demir; K. Nahit Ozmenler; Zeynep Gulcat; Tunay Karlidere; Hamdulla Aydin

Publication:     Social Behavior and Personality, 2006

Web link:          http://www.ingentaconnect.com/content/sbp/sbp/2006/00000034/00000008/art00004

The aim of this research project was to study gender identification in male transsexuals compared to male and female controls, using the Rorschach test and the MMPI. In the international literature, many researches have shown that the nature of the human response on Rorschach card III is linked to gender identification, as is the MMPI Mf scale. Ten untreated male homosexual transsexuals and 18 treated and operated male homosexual transsexuals were compared to 10 male and 12 female controls regarding verbal IQ, human content on Rorschach card III and the MMPI Mf scale. Absence of hormonal treatment for the first group of transsexuals was checked by a blood test at the time of the psychological testing. Responses on Rorschach card III were scored according to different kinds of human contents: male (M), female (F), gender-unidentified/neutral (N), bisexual (B), feminine then masculine or the opposite (M/F), and nonhuman (NH). N, B, M/F and NH responses were rare in all Rorschach protocols. As expected, responses given by participants in the control group were significantly more consistent with their anatomical sex than with the opposite sex. Untreated transsexuals do not differ from treated and operated transsexuals on Rorschach data, and both transsexual groups give significantly more female human representations than male controls. Transsexuals’ results are similar to female controls. Untreated transsexuals' mean score on the MMPI Mf scale is significantly higher than that of treated and operated transsexuals' score, in the male profile (biological sex). Both groups of transsexuals score higher on the Mf scale in the male profile than in the female profile. The mean Mf score in the male profile is significantly higher than that of male controls, whereas, in the female profile, the mean Mf score is similar to that of female controls. This study shows that for both groups of transsexuals, results are homogenous in respect of Rorschach and MMPI, showing hyper-conformism to self-perceived gender. Results in both groups are similar to results of female controls, but tend to show even more feminine gender identification. The absence of any significant difference between untreated and treated and operated transsexuals seems surprising, suggesting that the hormonal treatment has not had a major impact on gender identification processes. It would doubtless be interesting to study gender identification using even more kinds of data: all human contents in the Rorschach protocol (not just the responses given to card III), MMPI Mf scale, Draw-A-Person Test and Animal-and-Opposite Drawing Test. This would enhance result liability and could provide useful information about how gender identification processes evolve after surgical sex reassignment.

Author/-s:       S. Coussinoux; T. Gallarda; J. Smith; M. C. Bourdel; B. Cordier; C. Brémont; M. F. Poirier; M. Haddou; J. P. Olié

Publication:     L’Encephale, 2005

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/15971637/           

Out of 29 men asking for a sex-change, 16 reported clinical anamnesis criteria for transsexualism according to the DSM-III-R, a more restrictive diagnosis than the DSM-IV gender dysphoria diagnosis. In addition, all the subjects had taken an MMPI which, of course, did not contribute to the transsexualism diagnosis but which served to describe their personalities. The 16 subjects diagnosed as transsexual and the 13 who did not qualify for this diagnosis were compared on the basis of personality variables measured by the MMPI. Certain differences became evident. The transsexuals systematically complied to cultural stereotypes of femininity without any uneasiness, whereas the nontranssexuals could be subdivided into two groups, those with a vague sense of ill-being linked to a pronounced feminine identity or those with only a slight feminine identity and who showed no particular difficulties.

Author/-s:       A. Michel; M. Ansseau; J. J. Legros; W. Pitchot; J. P. Cornet; C. Mormont

Publication:     Psychological reports, 2002

Web link:          http://www.amsciepub.com/doi/abs/10.2466/pr0.2002.91.1.233

This study examined the relationship between sex role and gender identity in a Polish transsexual population where, unlike in Western countries, male-to-female (MF) transsexualism is much less common than female-to-male (FM) transsexualism. One hundred and three FM (82 primary, 21 secondary) and 29 MF (16 primary, 13 secondary) transsexuals plus 135 control males (CM) and 303 control females (CF) completed a Sex Role Inventory, which measures sex-role identification, that is, the degree to which one self-identifies with masculine and feminine characteristics. Data obtained from primary transsexuals revealed that, on a femininity scale, MF transsexuals scores exceeded not only CM but also CF. On a masculinity scale, MF transsexuals rated themselves significantly lower than CM, but at a level comparable to CF. The comparison of FM transsexuals and controls showed that, on a masculinity scale, transsexuals scored higher than CF but were not different from CM. On the femininity scale, FM transsexuals rated themselves in between the two control groups: lower than CF but slightly higher than CM. The relations of secondary transsexuals' scores to CF and CM scores, on both masculine and feminine scales, were in the same direction as the primary transsexuals' scores. Secondary transsexuals rated themselves very similarly to their primary counterparts (the exception was a much higher score of MF-primary transsexuals than MF-secondary transsexuals on the femininity scale). Our study revealed that transsexualism does not imply a simple inversion of sex-role patterns: transsexuals differ not only from nontranssexual individuals of the same anatomical sex but also from those of the opposite sex. Moreover, MF transsexualism is not a mirror image of FM transsexualism: it constitutes a more extreme condition in the identification with feminine versus masculine personality traits. These differences seem to be universal for different countries and regions. The diagnostic value of our findings is discussed.

Author/-s:       A. Herman-Jeglińska; A. Grabowska; S. Dulko

Publication:     Archives of sexual behavior, 2002

Web link:          http://www.ncbi.nlm.nih.gov/pubmed/12462479

Thirty-eight male-to-female (M-to-F) transsexuals, 7 female-to-male (F-to-M) transsexuals, 135 nontranssexual men, and 225 nontranssexual women were assessed on the following: gender diagnosticity (GD) measures, which assessed male- vs. female-typical occupational and hobby preferences; instrumentality; expressiveness; self-ascribed masculinity; and self-ascribed femininity. M-to-F transsexuals differed strongly and significantly from nontranssexual men on GD and self-ascribed femininity (effect sizes from 1.84 to 3.40) and more weakly on instrumentality, expressiveness, and self-ascribed masculinity (effect sizes from 0.40 to 0.56). F-to-M transsexuals differed strongly and significantly from nontranssexual women on GD and on self-ascribed masculinity and femininity (effect sizes from 2.45 to 3.97), but not on instrumentality or expressiveness (effect sizes of 0.07 and 0.39). The degree to which the six assessed gender-related traits distinguished transsexual from nontranssexuals was strongly correlated with the degree to which these same traits distinguished nontranssexual men from nontranssexual women. Using comparison data from past research, M-to-F transsexuals were quite similar to gay men on all gender-related traits except self-ascribed femininity, but F-to-M transsexuals were considerably more masculine than lesbian women on all gender-related traits except for instrumentality and expressiveness.

Author/-s:       Richard A. Lippa

Publication:     Archives of Sexual Behavior, 2001

Web link:          http://link.springer.com/article/10.1023/A%3A1011962917346

Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10 % evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more “normal” in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.

Author/-s:       Collier M. Cole; Michael O’Boyle; Lee E. Emory; Walter. J. Meyer III

Publication:     Archives of Sexual Behavior, 1997

Web link:          http://www.ncbi.nlm.nih.gov/m/pubmed/9015577/