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Altabas V, Galjuf V, Žegura I, Jokić Begić N, Moravek D, Arbanas G, Begić D. Referrals For Gender-Affirming Hormone Treatment in Croatia's National Network for Transgender Healthcare. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2045-2052. [PMID: 38691268 DOI: 10.1007/s10508-024-02867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
A network of healthcare professionals specializing in transgender care was established in Croatia in 2011, and legal advancements were subsequently made in 2014. Both achievements made gender transition more transparent and thus more attainable in Croatia. This observational study was conducted to assess the number of transgender individuals initiating gender-affirming hormone treatment (GAHT) in Croatia and describes trends in age and sex assigned at birth. Between 2011 and 2022, a total of 111 transgender individuals initiated GAHT. Within the cohort, 52 were assigned male at birth (AMAB) and 59 were assigned female at birth (AFAB). The overall annual incidence rate of transgender individuals initiating GAHT was 0.52 per 100,000 age-adjusted individuals. There was a statistically significant increase (p < 0.01) in transgender individuals commencing GAHT before the COVID-19 pandemic. Furthermore, a rising trend toward masculinizing rather than feminizing treatment was identified (p < 0.05), particularly among younger transgender individuals. The COVID-19 pandemic disrupted these trends in 2020, except for the trend of initiating therapy at a younger age (p < 0.01). The annual incidence and age distribution trends of transgender individuals initiating GAHT in Croatia closely mirrored those in other European countries, with a higher prevalence of individuals assigned female at birth. The study underscores a significant rise in the number of individuals initiating gender-affirming hormone treatment, emphasizing the need for proper legal regulation and healthcare system response.
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Affiliation(s)
- Velimir Altabas
- School of Medicine, University of Zagreb, Zagreb, Croatia.
- Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre Milosrdnice UHC, Vinogradska Cesta 29, 10000, Zagreb, Croatia.
| | - Vesna Galjuf
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Iva Žegura
- Vrapče University Psychiatric Hospital Zagreb, Zagreb, Croatia
| | - Nataša Jokić Begić
- Department of Psychology, Faculty of Humanities and Social Sciences, Zagreb, Croatia
| | | | - Goran Arbanas
- Vrapče University Psychiatric Hospital Zagreb, Zagreb, Croatia
- School of Medicine, University of Rijeka, Rijeka, Croatia
| | - Dražen Begić
- School of Medicine, University of Zagreb, Zagreb, Croatia
- Department of Psychiatry and Psychological Medicine, Zagreb UHC, Zagreb, Croatia
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Gutiérrez K, Moreno M, Sierra JA, Lemus R, Apraez K, Angulo MJ. Characteristics of the pediatric population with gender incongruence attending specialized care in Cali, Colombia: an observational, descriptive and retrospective study. Child Adolesc Psychiatry Ment Health 2024; 18:1. [PMID: 38172957 PMCID: PMC10763121 DOI: 10.1186/s13034-023-00689-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Gender incongruence can often manifest itself from early childhood [Olson KR, Gülgöz S. Child Dev Perspect. 2018;12:93-7. https://doi.org/10.1111/cdep.12268 ] with a significant psychological impact, altering social and school dynamics without the appropriate care.[Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ] Early identification and gender-affirming care are essential to reduce adverse mental health outcomes, such as depression and self-harm [Tordoff DM, et al. JAMA Netw Open. 2022;5(2): e220978. https://doi.org/10.1001/jamanetworkopen.2022.0978 ]..This study aims to analyze characteristics and to estimate relative frequencies of gender incongruence in a population of children and adolescents receiving gender-affirming care at a high-complexity university hospital located in the third largest city in Colombia. METHODS This was a retrospective descriptive study of patients under 18 with gender incongruence that received gender-affirming care between January 2018 and June 2022 at Fundacion Valle del Lili in Cali, Colombia. Sociodemographic and clinical characteristics of 43 patients were assessed, as well as the relative frequencies of gender incongruence. Data analysis was performed with the statistical package STATA®. To determine significant differences between the characteristics of the patients who participated in the study, the Mann‒Whitney U test was performed for numerical variables with non-parametric distribution, while either Pearson's Chi-2 test or Fisher's exact test was performed for categorical variables. RESULTS For every ten individuals assigned female at birth, who manifested gender incongruence, there were eight assigned male at birth. The median age of onset of gender incongruence was ten years (IQR: 5-13 years), and the median time elapsed between the reported onset of gender incongruence and the first consultation with a multidisciplinary gender-affirming team was three years (IQR: 1-10 years). The frequency of transgender identity was notable in participants with ages between 15 and 17 years. Depressive symptoms, anxiety, and psychotropic drug use were significantly higher in individuals assigned female at birth. Among 25 individuals assigned female at birth who participated in this study, 60% self-recognized as transgender men.18 individuals assigned male at birth, 67% self-recognized as transgender women. The most frequent treatment was a referral to mental health services (46.51%). CONCLUSION Based on the cohort of our study, we can conclude that patients consult for gender-affirming treatment 3 years after the onset of gender incongruence. Anxiety and depression were higher in individuals assigned female at birth. Additionally, they presented at a later stage of sexual maturation, reducing the possibility of using puberty blockers.
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Affiliation(s)
- Kenny Gutiérrez
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Mabel Moreno
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia
| | - Jimena Alexandra Sierra
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Rodrigo Lemus
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia
| | - Karen Apraez
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia
| | - Mario Jr Angulo
- Servicio de Endocrinología pediátrica, Fundación Valle del Lili, Cra 98 No.18-49, 760032, Cali, Colombia.
- Universidad Icesi, Facultad de ciencias de la salud, Cl. 18 #122-135, Barrio Pance, 760032, Cali, Colombia.
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Ferreira MJ, Luís Castedo J, Mota M, Carvalho D. Characterization of a transgender population in Portugal. ANNALES D'ENDOCRINOLOGIE 2021; 83:35-39. [PMID: 34871600 DOI: 10.1016/j.ando.2021.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/30/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Gender dysphoria (GD) is a condition in which the individual's gender identity does not correspond to their biological sex, causing significant distress. Biological males who identify as females are referred to as transgender females or as showing male-to-female GD (MtF GD) and biological females who identify as males are referred to as transgender males or as showing female-to-male GD (FtM GD). In our center, there is a multidisciplinary consultation to approach and follow patients with GD. AIM We aimed to analyze the characteristics of the individuals who attend this consultation. METHODS Retrospective study of individuals attending the Sexual Medicine Group Consultation. Age, comorbidities, symptom onset, and hormonal and surgical treatment were analyzed. RESULTS 114 patients were diagnosed with GD: 68.4% FtM GD and 31.6% MtF GD. Median age was 30.2±12 years. 63.2% reported symptom onset in childhood: 14.9% between 10 and 18 years, and 4.4% later than 18 years. Median age at treatment initiation was 23.1±7.1 years. Several individuals had concomitant medical conditions, notably smoking (n=37; 32.5%) and depression (n=26; 22.3%). The majority of (92.3% FtM GD and 88.9% MtF GD) were under hormone treatment, and about one-third had undergone some sex reassignment surgery. DISCUSSION We found higher prevalence of FtM than MtF, in contrast with most other studies. The reasons for this are not clear. A high percentage of our patients were self-medicated. Other characteristics were similar to those previously reported. CONCLUSION Medical requests by individuals with GD are increasing worldwide. To our knowledge, this is the first study to portray a case series in a consultation center dedicated to the diagnosis, treatment and follow-up of individuals with GD in Portugal.
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Affiliation(s)
- Maria João Ferreira
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal.
| | - José Luís Castedo
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Márcia Mota
- Department of Psychiatry of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism of Centro Hospitalar Universitário de São João, E.P.E, Porto, Portugal; Faculty of Medicine and Instituto de Investigação e Inovação em Saúde of Universidade do Porto, Portugal
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Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and Distribution of Transgender and Gender Nonconforming Populations: A Narrative Review. Endocrinol Metab Clin North Am 2019; 48:303-321. [PMID: 31027541 DOI: 10.1016/j.ecl.2019.01.001] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Accurate estimates of the number and proportion of transgender and gender nonconforming people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research. The wide range of estimates reported in the literature is attributable primarily to differences in definitions. Other sources of variability include diverse cultural and geographic settings and important secular trends. The transgender and gender nonconforming population is undergoing rapid changes in size and demographic characteristics. More accurate and precise estimates will be available when population censuses collect data on sex assigned at birth and gender identity.
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Affiliation(s)
- Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Northeast, CNR 3021, Atlanta, GA 30322, USA.
| | | | - Trevor Corneil
- University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Baudewijntje Kreukels
- Department of Medical Psychology, VU University Medical Center, MF-H243, Van der Boechorststraat 7, 1007 MB Amsterdam, Netherlands
| | - Joz Motmans
- Ghent University Hospital, Blandijnberg 2, 9000 Ghent, Belgium
| | - Eli Coleman
- University of Minnesota, 180 West Bank Office Building, 1300 S Second Street, Minneapolis, MN 55454, USA
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East EG, Gast KM, Kuzon WM, Roberts E, Zhao L, Jorns JM. Clinicopathological findings in female-to-male gender-affirming breast surgery. Histopathology 2017; 71:859-865. [DOI: 10.1111/his.13299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/24/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ellen G East
- Department of Pathology; Michigan Medicine; Ann Arbor MI USA
| | - Katherine M Gast
- Department of Surgery; Section of Plastic Surgery; Michigan Medicine; Ann Arbor MI USA
| | - William M Kuzon
- Department of Surgery; Section of Plastic Surgery; Michigan Medicine; Ann Arbor MI USA
| | - Emily Roberts
- Department of Biostatistics; University of Michigan; Ann Arbor MI USA
| | - Lili Zhao
- Department of Biostatistics; University of Michigan; Ann Arbor MI USA
| | - Julie M Jorns
- Department of Pathology; Michigan Medicine; Ann Arbor MI USA
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Becerra-Fernández A, Rodríguez-Molina JM, Asenjo-Araque N, Lucio-Pérez MJ, Cuchí-Alfaro M, García-Camba E, Pérez-López G, Menacho-Román M, Berrocal-Sertucha MC, Ly-Pen D, Aguilar-Vilas MV. Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1307-1312. [PMID: 28224311 DOI: 10.1007/s10508-017-0955-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Abstract
In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.
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Affiliation(s)
- Antonio Becerra-Fernández
- Gender Identity Unit, University Hospital Ramón y Cajal, Madrid, Spain
- Department of Biomedic Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - José Miguel Rodríguez-Molina
- Gender Identity Unit, University Hospital Ramón y Cajal, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | | | | | | | | | | | - Miriam Menacho-Román
- Department of Clinic Biochemistry, University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Domingo Ly-Pen
- Emergency Department, University Hospital Ramón y Cajal, Madrid, Spain.
- Croydon UCC, Croydon University Hospital, London, CR7 7YE, UK.
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Cussino M, Crespi C, Mineccia V, Molo M, Motta G, Veglia F. Sociodemographic characteristics and traumatic experiences in an Italian transgender sample. Int J Transgend 2017. [DOI: 10.1080/15532739.2016.1268082] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Martina Cussino
- Department of Psychology, University of Turin, Turin, Italy
- Faculty of Communication Sciences, Institute for Public Communication, University of Lugano, Lugano, Switzerland
| | - Chiara Crespi
- Carlo Molo Onlus Foundation, Turin, Italy
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | - Valentina Mineccia
- Carlo Molo Onlus Foundation, Turin, Italy
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | | | - Giovanna Motta
- Division of Endocrinology, Diabetology and Metabolism, Centro Interdipartimentale Disturbi d'Identità di Genere Molinette, City of Health and Science, Turin, Italy
| | - Fabio Veglia
- Department of Psychology, University of Turin, Turin, Italy
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Parkinson P. Gender dysphoria and the controversy over the Safe Schools program. Sex Health 2017; 14:417-422. [DOI: 10.1071/sh17014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/11/2017] [Indexed: 11/23/2022]
Abstract
The Safe Schools program has attracted great controversy. On one end of the spectrum, it is defended as an anti-bullying program for young people who identify themselves as gay or lesbian, or have issues concerning their gender identity. On the other end of the spectrum, it is regarded as social engineering. This article seeks to promote a discussion of the way in which gender identity issues are addressed in the Safe Schools program. It is argued that the information in this program to Principals, teachers and young people is inaccurate and misleading. The program, as presently designed, may actually cause harm to children and young people who experience gender identity issues because it promotes gender transitioning without expert medical advice. The Safe Schools materials do not acknowledge that the great majority of children resolve gender dysphoria issues around the time of puberty. It may be much more difficult for a child to accept his or her gender at puberty if he or she has already changed name and gender identity in primary school. These deficits need to be addressed if the program is to continue.
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Loza O, Beltran O, Mangadu T. A qualitative exploratory study on gender identity and the health risks and barriers to care for transgender women living in a U.S.–Mexico border city. Int J Transgend 2016. [DOI: 10.1080/15532739.2016.1255868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Oralia Loza
- Department of Public Health Sciences, University of Texas at El Paso, El Paso, Texas, USA
| | - Oscar Beltran
- Women's and Gender Studies, University of Texas at El Paso, El Paso, Texas, USA
| | - Thenral Mangadu
- Department of Public Health Sciences, University of Texas at El Paso, El Paso, Texas, USA
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Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of Transgender Depends on the "Case" Definition: A Systematic Review. J Sex Med 2016; 13:613-26. [PMID: 27045261 DOI: 10.1016/j.jsxm.2016.02.001] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates. AIMS To evaluate the epidemiology of transgender and examine how various definitions of transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods. METHODS PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity. MAIN OUTCOME MEASURES The main outcome measure was population prevalence of transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups. RESULTS Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9-13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6-9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, the mP was 871 (95% CI = 519-1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144-566). Significant heterogeneity was observed in most analyses. CONCLUSION The empirical literature on the prevalence of transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on transgender status and gender identity is recommended.
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Affiliation(s)
- Lindsay Collin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Systematic Review and Meta-Analysis of Prevalence Studies in Transsexualism. Eur Psychiatry 2015; 30:807-15. [DOI: 10.1016/j.eurpsy.2015.04.005] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/20/2022] Open
Abstract
AbstractBackgroundOver the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data.MethodsDatabases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed.ResultsThe overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years.ConclusionsThe overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.
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Sawyer J, Perry JL, Dobbins-Scaramelli A. A Survey of the Awareness of Speech Services Among Transgender and Transsexual Individuals and Speech-Language Pathologists. Int J Transgend 2015. [DOI: 10.1080/15532739.2014.995260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hess J, Neto RR, Panic L, Rübben H, Senf W. Satisfaction with male-to-female gender reassignment surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:795-801. [PMID: 25487762 PMCID: PMC4261554 DOI: 10.3238/arztebl.2014.0795] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. METHODS 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital's Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. RESULTS 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. CONCLUSION The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.
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Affiliation(s)
- Jochen Hess
- Department of Urology at the University Hospital Essen
| | - Roberto Rossi Neto
- Department of Urology at the University Hospital Essen
- Clinica Urologia, General Hospital Ernesto Simoes Filho, Salvador, Brasilien
| | - Leo Panic
- Department of Urology at the University Hospital Essen
| | | | - Wolfgang Senf
- Department of Psychosomatic Medicine and Psychotherapy, University of Essen
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Dhejne C, Öberg K, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1535-45. [PMID: 24872188 DOI: 10.1007/s10508-014-0300-8] [Citation(s) in RCA: 112] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/11/2013] [Accepted: 12/14/2013] [Indexed: 05/10/2023]
Abstract
Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960-2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89% (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3%, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30%. In contrast, the proportion of MF individuals 30 years or older increased from 37% in the first decade to 60% in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2% regret rate for both sexes. There was a significant decline of regrets over the time period.
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Affiliation(s)
- Cecilia Dhejne
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
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Hedjazi A, Zarenezhad M, Hoseinzadeh A, Hassanzadeh R, Hosseini SMV. Socio-demographic Characteristics of Transsexuals Referred to the Forensic Medicine Center in Southwest of Iran. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:224-7. [PMID: 23626960 PMCID: PMC3632028 DOI: 10.4103/1947-2714.109198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Transsexualism or gender identity disorder affects person's gender identity. Aim: This study was to describe socio-demographic characteristics in a population of transsexuals. Materials and Methods: We studied 44 persons of both sexes with diagnostic criteria of gender identity disorder who were referred to the Legal Medicine Organization of Fars, southwest of Iran during the time period 2005-2010. The general practitioners examined the following socio-demographic characteristics and then recorded them in a semi-structured questionnaire, which was developed by the Forensic Medicine Center in Shiraz: Sex, age, educational level, place of residence, marital status, duration of treatment, and employment status. Results: A total of 44 persons (18 (40.9%) males versus 26 (59.1%) females) were referred for sex change during the study period. The sex ratio was 0.69:1. The mean age was 27.6 ± 2.9 years. The majority of patients were diploma and higher diploma education (77.3%), lived in urban areas (81.8%), were employed (56.9%), were single (93.1%), and were under six months of hormonal treatment (61.4%). Conclusions: It seems that social acceptance is lower for male to female transsexuals, since these patients have lower employment and literacy statuses. Further studies should be designed to evaluate and deeper analyze more socio-demographic, clinical, and psychiatric variables about transsexual patients.
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Affiliation(s)
- A Hedjazi
- Department of Forensic Sciences, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Meier SC, Labuski CM. The Demographics of the Transgender Population. INTERNATIONAL HANDBOOK ON THE DEMOGRAPHY OF SEXUALITY 2013. [DOI: 10.1007/978-94-007-5512-3_16] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Lai MC, Chiu YN, Gadow KD, Gau SSF, Hwu HG. Correlates of gender dysphoria in Taiwanese university students. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1415-28. [PMID: 19937374 DOI: 10.1007/s10508-009-9570-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 04/24/2009] [Accepted: 09/19/2009] [Indexed: 05/21/2023]
Abstract
There have been no published reports regarding the epidemiological and psychiatric features of gender dysphoria in non-clinical young adults. The current study aimed to investigate the demographics, co-occurring psychiatric symptoms, and perceived parenting style and family support in Taiwanese young adults with gender dysphoria. The sample consisted of 5010 university freshmen (male, 51.6%) with a mean age of 19.6 years (SD = 2.7) from a national university in Taiwan. The questionnaires used for this university-based survey included the Adult Self Report Inventory-4 for psychopathology (including gender dysphoria), the Parental Bonding Instrument for parenting style, and the Family APGAR for perceived family support. Results showed that gender dysphoria was more prevalent in females (7.3%) than males (1.9%). Young adults with gender dysphoria were more likely to meet a wide but specific range of co-occurring psychiatric symptoms. The most significantly associated symptoms for males were agoraphobia, hypochondriasis, manic episode, and pathological gambling, and for females dissociative disorder, hypochondriasis, and body dysmorphic disorder. Both males and females with gender dysphoria perceived significantly less support from their families and less affection/care from both parents. Findings suggest that gender dysphoria, associated with a specific range of psychopathology and family/parenting dissatisfaction (with both similar and dissimilar patterns between sexes), is not uncommon in Taiwanese university students, particularly in females. This implies the importance of attention and specific measures to offset psychiatric conditions and to promote mental well-being of this population.
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Affiliation(s)
- Meng-Chuan Lai
- Department of Psychiatry, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 10002, Taipei, Taiwan
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Gómez-Gil E, Trilla A, Salamero M, Godás T, Valdés M. Sociodemographic, clinical, and psychiatric characteristics of transsexuals from Spain. ARCHIVES OF SEXUAL BEHAVIOR 2009; 38:378-92. [PMID: 18288600 DOI: 10.1007/s10508-007-9307-8] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Revised: 06/13/2007] [Accepted: 08/04/2007] [Indexed: 05/21/2023]
Abstract
The aim of this study was to examine the characteristics of transsexuals from Spain. A total of 252 consecutive applicants for sex reassignment were evaluated using a standardized semistructured clinical interview and the Mini International Neuropsychiatric Interview (Spanish Version 5.0.0) to record demographic, clinical, and psychiatric data. Transsexualism was diagnosed in 230 patients, with a male to female (MF)/female to male (FM) ratio of 2.2:1. Transsexual patients frequently had low employment status, lived with their parents, and mainly had a sexual orientation toward same-sex partners. The most frequent psychiatric diagnoses were adjustment disorder and social phobia in both groups, and alcohol and substance-related disorders in the MF group. MF transsexuals were older than FM transsexuals when requesting sex reassignment, but did not differ in age when starting hormonal therapy (often on their own); fewer MFs were in employment requiring high educational qualification, more were non-Spanish natives, and more had previous and current histories of alcohol and substance abuse or dependence. The basic characteristics of transsexuals from Spain were similar to those of other European countries, except for the higher proportion of patients living with their parents and the higher proportion of MFs who reported same-sex sexual orientation compared with previous studies.
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Affiliation(s)
- Esther Gómez-Gil
- Department of Psychiatry, Institute of Neurosciences, Hospital Clínic, University of Barcelona, Villarroel 170, Barcelona, Spain.
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Zucker KJ, Lawrence AA. Epidemiology of Gender Identity Disorder: Recommendations for theStandards of Careof the World Professional Association for Transgender Health. Int J Transgend 2009. [DOI: 10.1080/15532730902799946] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Vujovic S, Popovic S, Sbutega-Milosevic G, Djordjevic M, Gooren L. Transsexualism in Serbia: A Twenty-Year Follow-Up Study. J Sex Med 2009; 6:1018-1023. [DOI: 10.1111/j.1743-6109.2008.00799.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
OBJECTIVE Most previous studies of the prevalence of transsexualism have used data from individuals seeking sex reassignment surgery. New Zealand is unique in that transsexual people can apply to have an 'X' for the sex on their passport if they have a name on their birth certificate that is congruent with the sex opposite to their birth assigned sex, and provide a statutory declaration stating they have lived as a member of that sex. METHOD From information provided by the New Zealand Passports Office, it was ascertained that the prevalence of transsexualism among New Zealand passport holders was at least 1:6364. RESULTS The prevalence of male-to-female transsexualism was estimated at 1:3639, and the corresponding figure for female-to-male transsexualism was 1:22,714. CONCLUSIONS These estimates were higher than most previous estimates of transsexualism prevalence. There was also a larger than expected ratio of male-to-female transsexual people to female-to-male transsexual people (6:1), which could in part be due to female-to-male transsexual people being relatively overrepresented among those transsexual people for whom we did not have data on the direction of sex change, or this may be indicative of the demography of transsexualism in Australasia.
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Affiliation(s)
- Jaimie F Veale
- School of Psychology, Massey University, Auckland, New Zealand.
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Kraemer B, Delsignore A, Schnyder U, Hepp U. Body image and transsexualism. Psychopathology 2008; 41:96-100. [PMID: 18033979 DOI: 10.1159/000111554] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 01/25/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND To achieve a detailed view of the body image of transsexual patients, an assessment of perception, attitudes and experiences about one's own body is necessary. To date, research on the body image of transsexual patients has mostly covered body dissatisfaction with respect to body perception. SAMPLING AND METHODS We investigated 23 preoperative (16 male-to-female and 7 female-to-male transsexual patients) and 22 postoperative (14 male-to-female and 8 female-to-male) transsexual patients using a validated psychological measure for body image variables. RESULTS We found that preoperative transsexual patients were insecure and felt unattractive because of concerns about their body image. However, postoperative transsexual patients scored high on attractiveness and self-confidence. Furthermore, postoperative transsexual patients showed low scores for insecurity and concerns about their body. CONCLUSIONS Our results indicate an improvement of body image concerns for transsexual patients following standards of care for gender identity disorder. Follow-up studies are recommended to confirm the assumed positive outcome of standards of care on body image.
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Affiliation(s)
- Bernd Kraemer
- Department of Psychiatry, University Hospital, Zurich, Switzerland.
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De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R, Hoebeke P, Monstrey S. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2006; 22:137-41. [PMID: 17188846 DOI: 10.1016/j.eurpsy.2006.10.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 10/12/2006] [Accepted: 10/12/2006] [Indexed: 11/20/2022] Open
Abstract
AIM The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. METHODS All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients. RESULTS The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other. DISCUSSION AND CONCLUSION While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.
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Affiliation(s)
- G De Cuypere
- Department of Sexology and Gender Problems, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgium.
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Kim TS, Cheon YH, Pae CU, Kim JJ, Lee CU, Lee SJ, Paik IH, Lee C. Psychological burdens are associated with young male transsexuals in Korea. Psychiatry Clin Neurosci 2006; 60:417-21. [PMID: 16884441 DOI: 10.1111/j.1440-1819.2006.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare differences of the psychological burdens between young male transsexuals and age-gender matched non-transsexuals with standardized psychiatric rating scales in Korea. A total of 43 biologically unrelated young male transsexuals and 49 age-gender matched non-transsexuals participated in the study. All subjects completed Beck's Depression Inventory (BDI), Social Avoidance and Distress Scale (SADS), Self-Esteem Scale (SES) and Family Adaptability and Cohesion Evaluation Scale (FACES-III). The transsexuals showed significantly higher scores on the BDI (P < 0.0001) and SADS (P = 0.002) and lower scores on the SES (P < 0.0001) and Adaptability and Cohesion subscales (P = 0.016 and P < 0.0001, respectively) of the FACES-III than those of the non-transsexuals. The present study found young male transsexuals may be potentially vulnerable to develop psychiatric and familial problems in comparison with non-transsexuals, at least in Korea, although methodological limitations exist. Further well-designed researches should be launched to confirm this preliminary study.
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Affiliation(s)
- Tae-Suk Kim
- Department of Psychiatry, Kangnam St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
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Pera-Bajo FJ, Marote-González RM, Baladía-Olmedo C, García-Andrade C. [Current aspects of transsexuality and their medicolegal implication]. Med Clin (Barc) 2006; 126:750-3. [PMID: 16759592 DOI: 10.1157/13088956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kersting A, Reutemann M, Gast U, Ohrmann P, Suslow T, Michael N, Arolt V. Dissociative disorders and traumatic childhood experiences in transsexuals. J Nerv Ment Dis 2003; 191:182-9. [PMID: 12637845 DOI: 10.1097/01.nmd.0000054932.22929.5d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this first prevalence study of dissociative symptoms and different forms of childhood experiences among transsexuals, 41 transsexuals and 115 psychiatric inpatients were compared by means of the Interview for Dissociative Disorders (SCID-D-R), the Dissociative Experiences Scale (DES), and the Childhood Trauma Questionnaire (CTQ). The total score for the dissociative symptoms revealed no significant differences between the transsexuals and the psychiatric inpatients. However, the higher DES score among transsexuals compared with a normal population was found to be due largely to one item. A surprisingly high prevalence of emotional maltreatment was recorded. The results suggest that both the DES and the SCID-D-R have limited validity as instruments for screening and diagnosing dissociative disorders in transsexuals. Psychiatrists should be mindful of the possible existence of dissociative disorders in transsexual patients. Further investigations are needed to clarify the effects of traumatic childhood experiences on sexual identity in transsexuals and to throw more light on the phenomenological correlation between transsexualism and dissociative identity, using taxometric analyses.
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Affiliation(s)
- Anette Kersting
- Department of Psychiatry, University of Muenster, D-48129 Muenster, Germany
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Abstract
Transsexualism is a condition wherein an individual's psychological gender is the opposite of his or her anatomic sex. The general belief now among behavioral scientists and physicians is that it is an identifiable and incapacitating disease, which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for postoperative transsexuals because states and the judiciary have not recognized the new gender. However, with wider acceptance of transsexuals by society, this outlook has changed for the better, with many states amending their laws in accordance with the advances in medical sciences. But in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries.
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Affiliation(s)
- Dasari Harish
- Department of Forensic Medicine, Government Medical College, Chandigarh, India
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Abstract
Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS). The origins of transsexualism are still largely unclear. A first indication of anatomic brain differences between transsexuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findings regarding etiology, psychopathology and success of SRS seem to be related to the fact that certain subtypes of transsexuals follow different developmental routes. The observations that psychotherapy is not helpful in altering a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignment as a treatment option. In many countries, transsexuals are now treated according to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transsexualism. Research on postoperative functioning of transsexuals does not allow for unequivocal conclusions, but there is little doubt that sex reassignment substantially alleviates the suffering of transsexuals. However, SRS is no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment.
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Affiliation(s)
- P T Cohen-Kettenis
- Rudolf Magnus Institute of Neuroscience, Department of Child and Adolescent Psychiatry, Utrecht University, The Netherlands.
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van Kesteren PJ, Gooren LJ, Megens JA. An epidemiological and demographic study of transsexuals in The Netherlands. ARCHIVES OF SEXUAL BEHAVIOR 1996; 25:589-600. [PMID: 8931882 DOI: 10.1007/bf02437841] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This is an epidemiological and demographic study of 1285 transsexuals in the Netherlands. The data were collected from 1975 to the end of 1992. Over 95% of the Dutch transsexuals have been treated at the study center. Between 1975 and 1984 the annual number of female-to-male transsexuals increased, stabilizing thereafter. In the male-to-female transsexuals this trend continued up to 1989, declining slightly thereafter. Over the last 5 years on average 50 (range 38-60) male-to-female transsexuals and 21 (range 14-25) female-to-male transsexuals received surgical and/or hormonal treatment yearly. The sex ratio remained stable over this period: 3 male vs. 1 female subject. The calculated prevalence of transsexualism in The Netherlands is 1:11,900 males and 1:30,400 females. Transsexuals live predominantly in urbanized areas, but those living in nonurbanized areas show an even distribution over the country. The majority of female-to-male transsexuals apply for reassignment between the ages of 20-25, seldom in middle ages. The majority of male-to-female transsexuals do so between the ages of 25-30 and middle-aged subjects are not rare. Between 77-80% of both categories receive surgical and/or hormonal treatment. Five male-to-female transsexuals regretted sex reassignment.
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Affiliation(s)
- P J van Kesteren
- Department of Internal Medicine, Free University Hospital, Amsterdam, The Netherlands
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Weitze C, Osburg S. Transsexualism in Germany: empirical data on epidemiology and application of the German Transsexuals' Act during its first ten years. ARCHIVES OF SEXUAL BEHAVIOR 1996; 25:409-425. [PMID: 8836473 DOI: 10.1007/bf02437583] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
In light of possible emulation of the German Transsexuals' Act (TSG) in discussions taking place on future legislation in other states, on the 10th anniversary of the German TSG, we review the application of this law, as well as epidemiological data arising from its use. From 1981 to 1990, 1422 judicial decisions were rendered in Germany on this basis: 683 of them related to the so-called "small solution" (change of first name), and 733 involved what is termed the "major solution" (legal change of sex status). The frequency of transsexual applications over these 10 years lay between 2.1 and 2.4 per 100,000 German adult population. The average age was 33. Only 3.6% and 10.9% of the small and major applications, respectively, were rejected by courts. The sex ratio was 2.3:1 in favor of male-to-female transsexuals. Data revealed no significant trend over the years among the prevailing practices of adjudication, but evidence does exist that the German courts apply the law differently on a regional basis. Over the 10-year period, only six persons requested to have their names changed back again and only one to be reassigned to the former legal sex classification. Those who change their first names in the sense of a tentative accustomizing process waited an average of 2 years before changing their gender. Between 20 and 30% apparently went no further than the so-called "small solution."
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Affiliation(s)
- C Weitze
- Freie Universität Berlin, Institut für forensische Psychiatrie, Germany
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Bodlund O, Kullgren G. Transsexualism--general outcome and prognostic factors: a five-year follow-up study of nineteen transsexuals in the process of changing sex. ARCHIVES OF SEXUAL BEHAVIOR 1996; 25:303-316. [PMID: 8726553 DOI: 10.1007/bf02438167] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Nineteen transsexuals, approved for sex reassignement, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.
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Affiliation(s)
- O Bodlund
- Department of Psychiatry, University of Umeå, Sweden
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Abstract
Frequency figures for transsexualism, concerning incidence, prevalence and sex ratio calculated in the 1960s and 1970s, were compared with recent reports. The incidence figures remained constant over time, whereas the prevalence figures tended to increase during the review period. The incidence was found to be of the same magnitude in men and women, while the corresponding ratio for prevalence figures was 3:1. It is suggested that men seeking sex reassignment represent a more heterogeneous group than women, and that the reported male predominance to date is due to a lack of categorical studies of primary/ genuine transsexualism. It would appear that genuine transsexualism is, on the whole, insensitive to societal changes. The fundamental disturbance underlying this psychosexual identity disorder is suggested to be neurobiological in origin.
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Affiliation(s)
- M Landén
- Department of Clinical Neuroscience, University of Göteborg, Sweden
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Abstract
The incidence and sex ratio of transsexualism in Sweden were calculated during the period between 1 July 1972 and 30 June 1992 using a case register kept on file at the Swedish Bureau of Social Welfare. Only cases of primary/genuine transsexualism were considered. The study is unique in that it has been performed in exactly the same way as a previous study by one of the authors (JW) in the 1960s and early 1970s. The data can therefore be reliably compared. The results show that the incidence figures remain constant over time and that the incidence of primary/genuine transsexualism is equally common in men and women. A larger group consisting of all those individuals who had applied for sex reassignment revealed a preponderance of men. Analysis showed that this large group included not only primary/genuine transsexuals but also effeminate homosexuals, transvestites and diagnostically uncertain cases. The importance of describing the exact methods used when calculating epidemiological data is highlighted.
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Affiliation(s)
- M Landén
- Department of Clinical Neuroscience, University of Göteborg, Sweden
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Abstract
One of the primary goals of phalloplasty on female to male transsexuals is to void while standing. However, achieving competence of the neourethra, sensation, and rigidity of the neophallus still present a challenge. Over a 5 year period (1988-1993), 56 phalloplasties using sensate free forearm flaps were performed for 56 primary female transsexuals. The urethrocutaneous fistula rate was 38/56 and one flap totally necrosed. However, when the flap was prefabricated with a tubed graft of vaginal mucosa for the 28 cases (the later part of the series), there were less complications and a lower fistula rate within this portion of the neourethra. Although the whole procedure was time consuming, it was worthwhile and patient satisfaction was high.
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Affiliation(s)
- R H Fang
- Department of Surgery, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Bodlund O, Armelius K. Self-image and personality traits in gender identity disorders: an empirical study. JOURNAL OF SEX & MARITAL THERAPY 1994; 20:303-317. [PMID: 7897678 DOI: 10.1080/00926239408404380] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Self-image and personality traits, measured by SASB and SCID screen respectively, were compared between transsexuals, patients diagnosed as Gender Identity Disorders of Adolescence and Adulthood, Non-transsexual Type (GIDAANT), and normal controls. Transsexual and GIDAANT patients differed significantly in both their self-image and personality traits. While both the transsexuals' and controls' self-images were positive with self-love, the GIDAANT patients had a negative self-image. On the SCID screen, the GIDAANT group fulfilled 39.8% of all axis II criteria; transsexuals fulfilled 28.6% versus 17.1% for the control group. Mean GAF scores (axis V) were 62, 70, and 83, respectively. For all patients a more negative self-image was significantly related to lower social functioning according to GAF and to more personality pathology according to SCID screen. The prevalence of additional clinical axis I and II disorders was about twice as high among GIDAANT patients as among transsexuals. Although the two conditions are closely related, we found more differences than similarities in the studied aspects and a clear tendency that the GIDAANT patients had more psychopathology overall. Although the transsexuals also differed significantly in some aspects from the controls, they showed less personality pathology and they had a normal self-image. Negative self-image, high degree of fulfilled axis II criteria, and low GAF scores seem to be corresponding factors and in this study clearly differentiate transsexuals from GIDAANT patients.
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Affiliation(s)
- O Bodlund
- Department of Psychiatry, University Hospital, Umeå, Sweden
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41
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Abstract
A group of transsexuals, 9 biological men and 10 women, was assessed according to clinical DSM-III-R diagnosis and a self-report instrument for Axis II diagnoses based on the Structured Clinical Interview for DSM-III-R (SCID screen). A control group of 133 individuals was assessed by the same instrument. Combined with a functional criterion according to the Global Assessment of Functioning, the SCID screen showed good agreement with clinical Axis II diagnoses. The overall proportion of Axis II criteria fulfilled, proportion of criteria fulfilled for every single personality disorder and number of personality disorders were calculated from the modified version of the SCID screen. Personality disorders, mainly within cluster B, were identified among 5 of 19 transsexuals, and a majority had multiple personality disorders. Among controls, no personality disorder was identified. Personality traits as measured by the SCID screen revealed significantly more subthreshold pathology among transsexuals than controls in 8 of 12 personality categories. The proportion of overall Axis II criteria fulfilled was 29% among transsexuals versus 17% among controls. Sex differences among transsexuals, the usefulness of the SCID screen and diagnostic problems in DSM-III-R with respect to gender identity disorders are discussed.
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Affiliation(s)
- O Bodlund
- Department of Psychiatry, University Hospital, Umeå, Sweden
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Abstract
A 22 year old female-to-male half-Aboriginal transsexual had been exposed to gross neglect and violence, separation and inconsistent cultural supports during childhood. Her mother had also been convicted of homicide in a context of alcohol and violence. Transsexual identification, antisocial behaviours, self mutilation, substance abuse and unmet dependency needs were evident from childhood or early adolescence. The killing was a confrontational peer group stabbing in a brawl under influence of alcohol--the male mode of homicide. This is the first known case in world literature of a female-to-male transsexual guilty of homicide.
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Affiliation(s)
- J M Lawrence
- Department of Psychiatry, University of Queensland
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43
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Abstract
The prevalence of transsexualism in Singapore was estimated by counting all the patients who sought sex-reassignment surgery and were subsequently diagnosed as transsexuals by psychiatrists. Up to 1986, there were a total of 458 Singapore-born transsexuals, of which 343 were males and 115 were females. This was a prevalence of 35.2 per 100,000 population age 15 and above (or 1/2900) for male transsexualism, and 12.0 per 100,000 (or 1/8300) for female transsexualism. The sex ratio was about 3 males to 1 female. The main reason for the high prevalence was the availability of sex-reassignment surgery.
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Affiliation(s)
- W F Tsoi
- Department of Psychological Medicine, National University of Singapore
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44
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45
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Dolan JD. Transsexualism: syndrome or symptom? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1987; 32:666-73. [PMID: 3319128 DOI: 10.1177/070674378703200805] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The desire to identify with and assume the role of the opposite gender has been present with us since antiquity. Unfortunately, the syndrome of transsexualism as defined by the DSM-III encompasses many individuals who are seeking a gender change perhaps allowing reassignment to take place when not indicated. This paper reviews the major classifications applied to the condition of transsexualism and a new model of classification for individuals with Gender Dysphoria is outlined. It will be shown that by subdividing the condition into those with the hypothesized syndrome (primary (true) transsexualism, or the symptom, secondary transsexualism) a better understanding of gender dysphoria is achieved. By applying this new model of classification, a management/treatment protocol is outlined which is helpful in dealing with the gender dysphoric patient.
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Affiliation(s)
- J D Dolan
- Department of Psychiatry, University of Toronto, Ontario
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Blanchard R, Clemmensen LH, Steiner BW. Heterosexual and homosexual gender dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 1987; 16:139-52. [PMID: 3592961 DOI: 10.1007/bf01542067] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
This study investigated why more males than females complain of dissatisfaction with their anatomical sex (gender dysphoria). New referrals to a university gender identity clinic were dichotomously classified as heterosexual or homosexual. There were 73 heterosexual and 52 homosexual males; 1 heterosexual and 71 homosexual females. The average heterosexual male was 8 years older at inception than the homosexual groups. The heterosexual males reported that their first cross-gender wishes occurred around the time they first cross-dressed, whereas the homosexual groups reported that cross-gender wishes preceded cross-dressing by 3-4 years. Some history of fetishistic arousal was acknowledged by over 80% of the heterosexual males, compared to fewer than 10% of homosexual males and no homosexual females. The results suggest that males are not differentially susceptible to gender dysphoria per se, but rather that they are differentially susceptible to one of the predisposing conditions, namely, fetishistic transvestism.
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47
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Meyer-Bahlburg HF. Gender identity disorder of childhood. Introduction. JOURNAL OF THE AMERICAN ACADEMY OF CHILD PSYCHIATRY 1985; 24:681-3. [PMID: 4067136 DOI: 10.1016/s0002-7138(10)60109-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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48
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Abstract
The first documented case of sisters with transsexualism is reported. Given the low incidence of female transsexualism this is a most unlikely event and suggests that familial factors may be of aetological importance.
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49
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Abstract
Particular instances of sexual deviation can not be discussed sensibly without first considering certain general issues.The first of these is the question of definition. The notion of what constitutes abnormal sexual behaviour has changed in the course of history and indeed its boundaries have expanded and contracted at different times. What emerges from the history of the concept is that it has been defined by the social and moral climate of the time and indeed sexual deviance can be seen, for the most part, as a social rather than a medical concept (Bancroft, 1974).
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