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Herrmann L, Fahrenkrug S, Bindt C, Becker-Hebly I. [Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved?]. Z Kinder Jugendpsychiatr Psychother 2024; 52:12-29. [PMID: 37947191 DOI: 10.1024/1422-4917/a000957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Gender Experiences of Transgender Youth: How Changeable is the Gender Experience of Binary vs. Nonbinary Identifying Transgender Youth and What Factors Are Involved? Abstract: Objectives: Nonbinary gender identities are becoming increasingly visible in transgender healthcare and research. However, little is known about the various gender identities of transgender adolescents - whether they are stable or fluid and which factors influence their gender experience. The present study investigates these different aspects of gender in transgender adolescents with various gender identities. Method: The sample comprised a recent cohort of 114 adolescents diagnosed with gender dysphoria (GD) attending the Hamburg Gender Identity Service for Children and Adolescents (Hamburg GIS). We used the Gender Diversity Questionnaire to assess the different aspects of gender. Results: In total, 83 % of the sample reported a binary (BI) and 17 % a nonbinary gender identity or were still questioning their gender identity (NBGQ). 15-18 % of the transgender adolescents reported gender fluidity. The NBGQ group reported significantly higher levels of gender fluidity or more often that their gender identity was still open to change, respectively, than the BI group. Puberty (79 %), physical distress (70 %), and social media (36 %) were the most frequently mentioned factors influencing their gender experience. Conclusions: The present study underscores that gender experience is not binary and fixed for all transgender adolescents, but that, in some cases, it may be nonbinary or fluid. This heterogeneity, the possible fluidity, and the puberty-related physical distress may challenge treatment decisions in transgender adolescents diagnosed with GD. This situation highlights the importance of developing individualized treatment plans.
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Affiliation(s)
- Lena Herrmann
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Saskia Fahrenkrug
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Carola Bindt
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Inga Becker-Hebly
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf, Deutschland
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2
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Canale D, Martino E, Trimarchi F. The "Ensign Nun" Catalina de Erauso: a clinical endocrinology enigma. J Endocrinol Invest 2021; 44:2527-2528. [PMID: 33675532 DOI: 10.1007/s40618-021-01536-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/11/2021] [Indexed: 11/28/2022]
Affiliation(s)
- D Canale
- Unità di Endocrinologia 2, AOU Pisana, Pisa, Italy.
| | | | - F Trimarchi
- Dept of Medicina Clinica E Sperimentale, University of Messina, Messina, Italy
- Accademia Peloritana Dei Pericolanti at the University of Messina, Messina, Italy
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3
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Cheung AS, Lim HY, Cook T, Zwickl S, Ginger A, Chiang C, Zajac JD. Approach to Interpreting Common Laboratory Pathology Tests in Transgender Individuals. J Clin Endocrinol Metab 2021; 106:893-901. [PMID: 32810277 PMCID: PMC7947878 DOI: 10.1210/clinem/dgaa546] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/11/2020] [Indexed: 12/30/2022]
Abstract
CONTEXT As the number of transgender (trans) people (including those who are binary and/or nonbinary identified) seeking gender-affirming hormone therapy rises, endocrinologists are increasingly asked to assist with interpretation of laboratory tests. Many common laboratory tests such as hemoglobin, iron studies, cardiac troponin, and creatinine are affected by sex steroids or body size. We seek to provide a summary of the impact of feminizing and masculinizing hormone therapy on common laboratory tests and an approach to interpretation. CASES Case scenarios discussed include 1) hemoglobin and hematocrit in a nonbinary person undergoing masculinizing hormone therapy; 2) estimation of glomerular filtration rate in a trans woman at risk of contrast-induced nephropathy; 3) prostate-specific antigen (PSA) in a trans woman; and 4) chest pain in a trans man with a cardiac troponin concentration between the reported male and female reference ranges. CONCLUSIONS The influence of exogenous gender-affirming hormone therapy on fat and muscle distribution and other physiological changes determines interpretation of laboratory tests that have sex-specific differences. In addition to affirmative practice to ensure a patient's name, gender, and pronoun are used appropriately, we propose that once individuals have commenced gender-affirming hormone therapy, the reference range of the affirmed gender be reported (and specified by treating clinicians) except for PSA or cardiac troponin, which are dependent on organ size. While suggestions may be challenging to implement, they also represent an opportunity to lead best practice to improve the quality of care and experiences of healthcare for all trans people.
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Affiliation(s)
- Ada S Cheung
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Correspondence and Reprint Requests: Dr Ada Cheung, Austin Health 145 Studley Road, Heidelberg, Victoria 3084, Australia. E-mail:
| | - Hui Yin Lim
- Diagnostics Haematology, Northern Pathology Victoria, Northern Health, Victoria, Australia
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Sav Zwickl
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Ariel Ginger
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
| | - Cherie Chiang
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Victoria, Australia
- Department of Pathology, Royal Melbourne Hospital, Victoria, Australia
| | - Jeffrey D Zajac
- Trans Health Research group, Department of Medicine (Austin Health), The University of Melbourne, Victoria, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
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4
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Abstract
The medical care of transgender patients relies on the use of sex hormones to develop and maintain the physical characteristics consistent with gender identity as the first step in transitioning. Hormonal therapy is usually continued indefinitely, even following gender-affirming surgeries. The use of hormonal treatments is associated with a multitude of positive effects as well as complications and side effects. The risk of venous thromboembolism (VTE) is a major concern. Transgender patients are often referred to coagulation specialists for advice regarding an individual patient's risk for VTE, especially if there is a personal or family history of VTE. Coagulation specialists need to be familiar with endocrine therapy including the goals of treatment and the VTE risks associated with currently used hormone regimens. We will review common referral questions and the available data and their limitations for the use of hormonal therapy in transgender patients focusing on the risk of VTE.
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Affiliation(s)
- Jean M Connors
- Hematology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Saskia Middeldorp
- Department of Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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5
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Rydelius PA, Frisén L, Halldin-Stenlid M, Söder O, Dhejne C, Arver S. [Not Available]. Lakartidningen 2019; 116:FR6P. [PMID: 31613371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Per-Anders Rydelius
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden -
| | - Louise Frisén
- Karolinska Institutet - Institutionen för klinisk neurovetenskap Stockholm, Sweden - Department of Clinical Neuroscience Stockholm, Sweden
| | - Maria Halldin-Stenlid
- Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden
| | - Olle Söder
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden - Stockholm, Sweden
| | - Cecilia Dhejne
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden - , Sweden
| | - Stefan Arver
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden
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6
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Rydelius PA, Frisén L, Söder O, Halldin-Stenlid M, Dhejne C, Arver S. [Not Available]. Lakartidningen 2019; 116:FR6M. [PMID: 31613370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Per-Anders Rydelius
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden -
| | - Louise Frisén
- Karolinska Institutet - Institutionen för klinisk neurovetenskap Stockholm, Sweden - Department of Clinical Neuroscience Stockholm, Sweden
| | - Olle Söder
- Karolinska Institutet - Institutionen för kvinnors och barns hälsa Stockholm, Sweden - Stockholm, Sweden
| | - Maria Halldin-Stenlid
- Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden Karolinska Institutet - Womens' and Children's Health Stockholm, Sweden
| | - Cecilia Dhejne
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden - , Sweden
| | - Stefan Arver
- Karolinska Universitetssjukhuset - ANOVA Stockholm, Sweden
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7
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Latasa Zamalloa P, Velasco Muñoz C, Iniesta Mármol C, de Beltrán Gutierrez P, Curto Ramos J, Gil-Borrelli CC. [Approach to the causes of discharge and health needs of transgender people through the National Hospital Discharge Survey in Spain during the period 2001 to 2013]. Rev Esp Salud Publica 2019; 93:e201905031. [PMID: 31155609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/27/2019] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVE The health of transgender people is a little studied topic and hospital records can be an opportunity to make an approach. The aim of this study was to describe the cause for admission and the associated comorbidities of transgender people in Spain between 2001 and 2013. METHODS Retrospective observational study with population-based administrative records (Minimum Basic Data Set). The discharges generated by the transgender in Spanish public and private hospitals were selected using one of the following ICD-9-CM codes in any diagnostic field: Trans-sexualism (302.5), Disorders of psychosexual identity (302.6) and Gender identity disorder in adolescents or adults (302.85). The causes of admission and comorbidity according were described. The qualitative variables were described in their frequency distribution according to their number(n) and proportion(%) and the quantitative variables according to their mean and standard deviation (SD) or median (MD) and interquartile range (RIQ) according to their distribution. RESULTS A total of 2,010 highs were recorded corresponding to 1,878 patients. The mean age was 33 years (SD = 10). 51% were male, 46% female and 3% undetermined or unspecified. The discharges were motivated in 59% by the process of body modification, followed by HIV (4%) and personality disorders (3%). The most common comorbidities were those associated with body modification (49%), mental health problems (40%) and infectious diseases (15%). CONCLUSIONS It is necessary to address the health of transgender people in a comprehensive way that takes into account their specific health needs, including bodily modification, mental health, HIV and other infections, through strategies that include improve research, tailor health information systems and develop guidelines and training of healthcare providers in this transgender health.
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Affiliation(s)
- Pello Latasa Zamalloa
- Iniciativa Sociosanitaria para la Cooperación y Equidad LGBT en España (ISOSCELES). Madrid. España
- Subdirección General de Epidemiología. Dirección General de Salud Pública de la Comunidad de Madrid. Madrid. España
| | - César Velasco Muñoz
- Iniciativa Sociosanitaria para la Cooperación y Equidad LGBT en España (ISOSCELES). Madrid. España
- Dirección de Gestión Integral e Innovación. Hospital Vall d`Hebron. Barcelona. España
| | - Carlos Iniesta Mármol
- Iniciativa Sociosanitaria para la Cooperación y Equidad LGBT en España (ISOSCELES). Madrid. España
- Centro nacional de Epidemiología. Instituto de Salud Carlos III. Madrid. España
| | | | - Javier Curto Ramos
- Iniciativa Sociosanitaria para la Cooperación y Equidad LGBT en España (ISOSCELES). Madrid. España
- Servicio de Psiquiatría. Hospital Universitario La Paz. Madrid. España
| | - Christian-Carlo Gil-Borrelli
- Iniciativa Sociosanitaria para la Cooperación y Equidad LGBT en España (ISOSCELES). Madrid. España
- Proyecto Sistema de Vigilancia de Violencia de Odio. Escuela Nacional de Sanidad del Instituto de Salud Carlos III. Madrid. España
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8
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Abstract
Human rights discourse on the rights of transgender people has to a large extent focused on access to correction of legal gender and medical preconditions for this change. Jurisdictions across the world are now beginning to free legal gender recognition from medical interventions and examinations. State bodies have, however, done little to realise the rights of transgender people to adequate healthcare. A key issue is whether international law obliges states to ensure access to trans-specific healthcare. This article examines the right to healthcare appropriate to transgender persons' needs. Drawing on in-depth interviews with transgender people living in Norway, it investigates how individuals explain their needs for trans-specific healthcare. It shows that Norwegian healthcare practice uses the diagnosis of 'transsexualism' to determine a person's needs for trans-specific healthcare and as such excludes many from receiving the healthcare they need. The article analyses whether trans-specific healthcare falls within the ambit of the right to health under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the right to necessary healthcare under the Norwegian Patients' Rights Act. It concludes that the Norwegian authorities are obliged to provide equal access to adequate trans-specific healthcare to those who need it.
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Affiliation(s)
- Anniken Sørlie
- Department of Public and International Law, Faculty of Law, University of Oslo, Oslo, Norway
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9
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Vargas-Huicochea I, Robles R, Real T, Fresán A, Cruz-Islas J, Vega-Ramírez H, Medina-Mora ME. A Qualitative Study of the Acceptability of the Proposed ICD-11 Gender Incongruence of Childhood Diagnosis Among Transgender Adults Who Were Labeled Due to Their Gender Identity Since Childhood. Arch Sex Behav 2018; 47:2363-2374. [PMID: 29971651 DOI: 10.1007/s10508-018-1241-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 04/07/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
For the forthcoming ICD-11, the ICD-10 category of Gender Identity Disorder of Childhood has been reformulated as Gender Incongruence of Childhood (GIC) and moved out of the mental disorders chapter. Proponents of eliminating the GIC diagnosis altogether claim that it is unnecessary and inherently harmful, although they do not eschew the diagnosis for adolescents and adults. Using a qualitative methodology, this study examined the impact of receiving a diagnosis related to gender identity as a child among transgender people who had had this experience, and evaluated participants' views of the acceptability and usefulness of the ICD-11 GIC proposal. Participants receiving health services at a specialized public clinic for transgender health in Mexico City who had received some form of diagnosis in childhood were referred to participate in a semistructured interview. A sample of 12 transgender people (eight transgender women and four transgender men; ages 18-49) was necessary to reach saturation. Diagnoses received were non-specific rather than formal gender identity diagnoses, were experienced by participants as negative, and were used to justify potentially harmful interventions. However, when participants reviewed the ICD-11 proposals for GIC, all indicated that the category was necessary and important and could have a range of personal, familial, and social benefits. They agreed with its placement in a new chapter on Conditions Related to Sexual Health and endorsed the proposed definition and name of the category. Although this study involved a small and specific sample, the results raise questions about the claim that the diagnosis is inherently harmful and universally deplored by transgender people.
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Affiliation(s)
- Ingrid Vargas-Huicochea
- Department of Psychiatry and Mental Health, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rebeca Robles
- Epidemiological and Psychosocial Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, D.F., Mexico.
| | - Tania Real
- Epidemiological and Psychosocial Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, 14370, México, D.F., Mexico
| | - Ana Fresán
- Clinical Research Directorate, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jeremy Cruz-Islas
- Mental Health Service, "Condesa" Specialized Clinic, Mexico City, Mexico
| | - Hamid Vega-Ramírez
- Mental Health Service, "Condesa" Specialized Clinic, Mexico City, Mexico
| | - María Elena Medina-Mora
- Office of the Director General, National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
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10
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López Guzmán J, González Vázquez C. [Assessment of the suppression of puberty in children with gender identity problems]. Cuad Bioet 2018; 29:247-256. [PMID: 30380899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 09/11/2018] [Indexed: 06/08/2023]
Abstract
The objective of this article is to reflect on the opportunity and risk of the proposed treatments to address gender identity problems in that sector of the population. In most of the protocols for the care of minors with gender identity problems, the abolition of puberty is proposed as a method of choice. This technique consists in the administration of reversible agonists of GnRH to provoke a suppression of the hormonal expression of the minor and, thus, the development of the sexual characters of their gender. The opportunity or adequacy of the systematic use of reversible GnRH agonists may be questioned for several reasons. The first, because the diagnosis of transsexualism in minors carries a great complexity and difficulty, so there is a wide margin of error. The second, because the suppression of puberty has direct consequences in the development of the child. Thirdly, because the aforementioned treatments have some risks and side effects in minors, some of them not studied and unknown, which, without a doubt, should be weighted. Finally, because the drugs used are neither designed nor experienced, for the care of minors with gender identity problems. Therefore, they are used without being approved by the regulatory agencies of the medicinal product for that purpose. These issues need to be addressed and also transmitted in the information provided to the stakeholders.
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Affiliation(s)
- José López Guzmán
- Área de Humanidades Farmacéuticas. Departamento de Farmacología. Facultad de Farmacia. Universidad de Navarra.
| | - Carmen González Vázquez
- Área de Humanidades Farmacéuticas. Departamento de Farmacología. Facultad de Farmacia. Universidad de Navarra
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11
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Campochiaro C, Host LV, Ong VH, Denton CP. Development of systemic sclerosis in transgender females: a case series and review of the literature. Clin Exp Rheumatol 2018; 36 Suppl 113:50-52. [PMID: 29465362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/22/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Systemic sclerosis (SSc) is a chronic, autoimmune connective tissue disease with a female predominance. The reason for the female predilection in SSc may relate to the difference in hormones between the genders. There are no current data on the influence male-to-female sex transition may have in the development of SSc. We report three patients who developed SSc after initiating the transgender process, and review current literature in regards to transgender patients with connective tissue disease (CTD). METHODS We describe the clinical features and disease course of three transgender patients who developed SSc after their transition from male-to-female, who presented to our centre. Two additional transgender cases de- scribed in the literature with CTD were included in this review. RESULTS All three patients developed SSc after having started the hormonal therapy required to transition. Two patients had surgical procedures preceding their diagnosis of SSc. Antibody profile, time of onset and disease features differed among our patients. Hormonal therapies were continued in all patients and they received the standard therapy for SSc. One patient died from complications of her disease. Only two cases describing the development of CTD in transgender patients were identified in the literature and both of these patients were diagnosed with systemic lupus erythematosus (SLE). CONCLUSIONS This case series suggests that the hormonal modification as part of gender transition may be relevant in development of SSc. No further conclusions can be drawn on the continuation or not of HT.
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Affiliation(s)
- Corrado Campochiaro
- Centre for Rheumatology and Connective Tissue Diseases, University College London, UK
| | - Lauren V Host
- Centre for Rheumatology and Connective Tissue Diseases, University College London, UK
| | - Voon H Ong
- Centre for Rheumatology and Connective Tissue Diseases, University College London, UK
| | - Christopher P Denton
- Centre for Rheumatology and Connective Tissue Diseases, University College London, UK.
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12
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Maraka S, Singh Ospina N, Rodriguez-Gutierrez R, Davidge-Pitts CJ, Nippoldt TB, Prokop LJ, Murad MH. Sex Steroids and Cardiovascular Outcomes in Transgender Individuals: A Systematic Review and Meta-Analysis. J Clin Endocrinol Metab 2017; 102:3914-3923. [PMID: 28945852 DOI: 10.1210/jc.2017-01643] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 08/24/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Transgender individuals receive cross-sex hormonal therapy to induce desired secondary sexual characteristics despite limited data regarding its effects on cardiovascular health. METHODS A comprehensive search of several databases up to 7 April 2015 was conducted for studies evaluating the effect of sex steroid use on lipids, myocardial infarction, stroke, venous thromboembolism (VTE), and mortality in transgender individuals. Pairs of reviewers selected and appraised the studies. A random-effects model was used to pool weighted mean differences and 95% confidence intervals (CIs). RESULTS We found 29 eligible studies with moderate risk of bias. In female-to-male (FTM) individuals, sex steroid therapy was associated with statistically significant increases in serum triglyceride (TG) levels at 3 to 6 months and at ≥24 months (21.4 mg/dL; 95% CI: 0.14 to 42.6) and in low-density lipoprotein cholesterol (LDL-C) levels at 12 months and ≥24 months (17.8 mg/dL; 95% CI: 3.5 to 32.1). High-density lipoprotein cholesterol (HDL-C) levels decreased significantly across all follow-up periods (highest at ≥24 months, -8.5 mg/dL; 95% CI: -13.0 to -3.9). In male-to-female (MTF) individuals, serum TG levels were significantly higher at ≥24 months (31.9 mg/dL; 95% CI: 3.9 to 59.9) without any changes in other parameters. Few myocardial infarction, stroke, VTE, and death events were reported (more frequently in MTF individuals). CONCLUSIONS Low-quality evidence suggests that sex steroid therapy may increase LDL-C and TG levels and decrease HDL-C level in FTM individuals, whereas oral estrogens may increase TG levels in MTF individuals. Data about important patient outcomes remain sparse.
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Affiliation(s)
- Spyridoula Maraka
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology and Metabolism, Center for Osteoporosis and Metabolic Bone Diseases, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205
- Central Arkansas Veterans Health Care System, Little Rock, Arkansas 72205
| | - Naykky Singh Ospina
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, Florida 32610
| | - Rene Rodriguez-Gutierrez
- Division of Endocrinology, Department of Internal Medicine, University Hospital "Dr. Jose E. Gonzalez," Autonomous University of Nuevo León, Monterrey, Mexico 64460
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, Minnesota 55905
| | - Larry J Prokop
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota 55905
| | - M Hassan Murad
- Evidence-Based Practice Research Program, Mayo Clinic, Rochester, Minnesota 55905
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13
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Abstract
BACKGROUND Gender confirming surgery (GCS) represents a new and interdisciplinary urological field of activity. OBJECTIVES Based on more than 20 years of experience, the development of interdisciplinary strategies in the surgical management of male-to-female (MtF) and female-to-male (FtM) transgenders is summarized. MATERIALS AND METHODS The current national and international literature, as well as the surgical experience of the authors in the field of GCS, were evaluated, and aspects relevant for urologists are presented in a comprehensive review. RESULTS Since 1990 more than 1200 primary GCS in MtF transgenders and more than 230 primary GCS in FtM transgenders have been performed in the authors' institutions. Presuming an incidence of at least 1:20,000 for patients with gender dysphoria (GD) in the general population, the overall number of patients is limited. The complex surgical procedures should be realized in an interdisciplinary team, trained and specialized in this field of surgery, given the high rate of complications and secondary procedures with MtF GCS. CONCLUSION Postoperative satisfaction rates of FtM and MtF transgenders at over 80% are satisfactory. During the last few decades, surgical procedures have been widely standardized. In the field of penile reconstruction, the free forearm lap represents the preferred method, while several surgical alternatives arise from the current literature in this field.
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Affiliation(s)
- M Sohn
- Klinik für Urologie, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Deutschland
| | - U M Rieger
- Klinik für Plastische Chirurgie, Wiederherstellungs- und Handchirurgie, Agaplesion Markus-Krankenhaus, Frankfurt am Main, Deutschland
| | - J Heß
- Klinik und Poliklinik für Urologie, Uroonkologie und Kinderurologie, Universitätsklinik Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
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14
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Abstract
As sex reassignment surgeries become more common and advanced, health professionals are more likely to see patients with gender identity disorders (GID) in their clinics. This can be challenging in many ways, and the challenges continue even after gender reassignment surgery as each case may present with unique anatomy. This article reviews the definition and treatment of GID, service provision in National Health Service and post-transition care of such patients.
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Affiliation(s)
- A Jain
- Department of Genito-Urinary Medicine, 2nd Floor Lambeth Wing, St Thomas Hospital, Lambeth Palace Road, London SE1 7EH, UK
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15
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Winter S, De Cuypere G, Green J, Kane R, Knudson G. The Proposed ICD-11 Gender Incongruence of Childhood Diagnosis: A World Professional Association for Transgender Health Membership Survey. Arch Sex Behav 2016; 45:1605-1614. [PMID: 27492343 DOI: 10.1007/s10508-016-0811-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 04/25/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Abstract
ICD-11 (the eleventh edition of the World Health Organization International Statistical Classification of Diseases and Related Health Problems) is due for approval in 2018. For transgender health care, the most important proposals for ICD-11 are as follows: (1) the five ICD-10 diagnoses (most notably Transsexualism and Gender Identity Disorder of Childhood) currently in Chapter 5 (Mental and Behavioural Disorders) will be replaced by two Gender Incongruence diagnoses, one of Adolescence and Adulthood and the other of Childhood (GIC), and (2) these two diagnoses will be located in a new chapter provisionally named Conditions Related to Sexual Health. Debate on the GIC proposal has focused on whether there should be a diagnosis for young children exploring their identity and has drawn on a number of arguments for and against the proposal. The World Professional Association for Transgender Health conducted a survey to examine members' views concerning the GIC proposal, as well as an alternative framework employing non-pathologizing Z Codes. The survey was completed by 241 (32.6 %) out of 740 members. Findings indicated an even split among members regarding the GIC proposal (51.0 % [n = 123] opposing and 47.7 % [n = 115] supporting the proposal). However, non-US members were overall opposed to the proposal (63.9 % [n = 46] opposing, 36.1 % [n = 26] supporting). Across the sample as a whole, and among those expressing a view about Z Codes, there was substantial support for their use in healthcare provision for children with gender issues (35.7 % [n = 86] of the sample supporting vs. 8.3 % [n = 20] rejecting).
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Affiliation(s)
- Sam Winter
- Faculty of Health Science, School of Public Health, Curtin University, Bentley, Perth, WA, 6102, Australia
| | - Griet De Cuypere
- Center of Sexology and Gender, University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
| | - Jamison Green
- Human Sexuality PhD Program, California Institute of Integral Studies, 1453 Mission Street, San Francisco, CA, 94103, USA
| | - Robert Kane
- Faculty of Health Science, School of Psychology and Speech Pathology, Curtin University, Bentley, Perth, WA, 6102, Australia
| | - Gail Knudson
- Faculty of Medicine, University of British Columbia, #201 - 1770 Fort Street, Victoria, BC, V8R 1J5, Canada
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Fernández Rodríguez M, Guerra Mora P, Martín Sánchez E. [Reflections on the epistemological framework of gender dysphoria]. Rev Esp Salud Publica 2016; 90:e1-e4. [PMID: 27530424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 06/06/2023] Open
Affiliation(s)
- María Fernández Rodríguez
- Unidad de Tratamiento de Identidad de Género del Principado de Asturias (UTIGPA). Hospital San Agustín de Avilés y Centro de Salud Mental I (CSMI) "La Magdalena". Área sanitaria III..
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Roblin D, Barzilay J, Tolsma D, Robinson B, Schild L, Cromwell L, Braun H, Nash R, Gerth J, Hunkeler E, Quinn VP, Tangpricha V, Goodman M. A novel method for estimating transgender status using electronic medical records. Ann Epidemiol 2016; 26:198-203. [PMID: 26907539 PMCID: PMC4772142 DOI: 10.1016/j.annepidem.2016.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 12/30/2015] [Accepted: 01/06/2016] [Indexed: 01/27/2023]
Abstract
PURPOSE We describe a novel algorithm for identifying transgender people and determining their male-to-female (MTF) or female-to-male (FTM) identity in electronic medical records of an integrated health system. METHODS A computer program scanned Kaiser Permanente Georgia electronic medical records from January 2006 through December 2014 for relevant diagnostic codes, and presence of specific keywords (e.g., "transgender" or "transsexual") in clinical notes. Eligibility was verified by review of de-identified text strings containing targeted keywords, and if needed, by an additional in-depth review of records. Once transgender status was confirmed, FTM or MTF identity was assessed using a second program and another round of text string reviews. RESULTS Of 813,737 members, 271 were identified as possibly transgender: 137 through keywords only, 25 through diagnostic codes only, and 109 through both codes and keywords. Of these individuals, 185 (68%, 95% confidence interval [CI]: 62%-74%) were confirmed as definitely transgender. The proportions (95% CIs) of definite transgender status among persons identified via keywords, diagnostic codes, and both were 45% (37%-54%), 56% (35%-75%), and 100% (96%-100%). Of the 185 definitely transgender people, 99 (54%, 95% CI: 46%-61%) were MTF, 84 (45%, 95% CI: 38%-53%) were FTM. For two persons, gender identity remained unknown. Prevalence of transgender people (per 100,000 members) was 4.4 (95% CI: 2.6-7.4) in 2006 and 38.7 (95% CI: 32.4-46.2) in 2014. CONCLUSIONS The proposed method of identifying candidates for transgender health studies is low cost and relatively efficient. It can be applied in other similar health care systems.
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Affiliation(s)
- Douglas Roblin
- School of Public Health, Georgia State University, Atlanta; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Joshua Barzilay
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Dennis Tolsma
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Laura Schild
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta
| | - Hayley Braun
- Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rebecca Nash
- Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Enid Hunkeler
- Division of Research, Kaiser Permanente, Oakland, CA
| | | | - Vin Tangpricha
- Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, GA.
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Abstract
PURPOSE OF REVIEW Transgender individuals display incongruence between their assigned birth sex and their current gender identity, and may identify as male, female, or being elsewhere on the gender spectrum. Gender nonconformity describes an individual whose gender identity, role, or expression is not typical for individuals in a given assigned sex category. This update highlights recent literature pertaining to the psychosocial and medical care of transgender and gender nonconforming (TGN) adolescents with applications for the general practitioner. RECENT FINDINGS The psychological risks and outcomes of TGN adolescents are being more widely recognized. Moreover, there is increasing evidence that social and medical gender transition reduces gender dysphoria, defined as distress that accompanies the incongruence between one's birth sex and identified gender. Unfortunately, lack of education about TGN adolescents in medical training persists. SUMMARY Recent literature highlights increased health risks in TGN adolescents and improved outcomes following gender dysphoria treatment. It is important for clinicians to become familiar with the range of treatment options and referral resources available to TGN adolescents in order to provide optimal and welcoming care to all adolescents.
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Affiliation(s)
- Carly Guss
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
| | - Daniel Shumer
- Boston Children’s Hospital, Division of Endocrinology, Boston, MA
| | - Sabra L. Katz-Wise
- Boston Children’s Hospital, Division of Adolescent/Young Adult Medicine, Boston, MA
- Harvard Medical School, Department of Pediatrics, Boston, MA
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Abstract
The new diagnosis of Gender Dysphoria (GD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) defines intersex, renamed "Disorders of Sex Development" (DSD), as a specifier of GD. With this formulation, the status of intersex departs from prior editions, especially from the DSM-IV texts that defined intersex as an exclusion criterion for Gender Identity Disorder. Conversely, GD--with or without a DSD--can apply in the same manner to DSD and non-DSD individuals; it subsumes the physical condition under the mental "disorder." This conceptualization, I suggest, is unprecedented in the history of the DSM. In my view, it is the most significant change in the revised diagnosis, and it raises the question of the suitability of psychiatric diagnosis for individuals with intersex/DSD. Unfortunately, this fundamental question was not raised during the revision process. This article examines, historically and conceptually, the different terms provided for intersex/DSD in the DSM in order to capture the significance of the DSD specifier, and the reasons why the risk of stigma and misdiagnosis, I argue, is increased in DSM-5 compared to DSM-IV. The DSM-5 formulation is paradoxically at variance with the clinical literature, with intersex/DSD and transgender being conceived as incommensurable terms in their diagnostic and treatment aspects. In this light, the removal of intersex/DSD from the DSM would seem a better way to achieve the purpose behind the revised diagnosis, which was to reduce stigma and the risk of misdiagnosis, and to provide the persons concerned with healthcare that caters to their specific needs.
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Affiliation(s)
- Cynthia Kraus
- Institute of Social Sciences, Faculty of Social and Political Sciences, University of Lausanne, Quartier Mouline, Geopolis Building, Office 5132, 1015, Lausanne, Switzerland,
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Abstract
The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.
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Affiliation(s)
- Alain Giami
- Inserm, CESP Centre de recherche en Epidémiologie et Santé des Populations, U1018-Team 7: Gender, Sexuality, Health, 82 rue du Général Leclerc, 94276, Le Kremlin Bicêtre, Cedex, France,
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21
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Kaltiala-Heino R, Mattila A, Kärnä T, Joutsenneimi K. [Diagnosing gender identity]. Duodecim 2015; 131:367-371. [PMID: 26237926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Transsexualism and other variations of gender identity are based on a stable sense of identity. The aetiology of this phenomenon is not fully known. Suffering caused by gender dysphoria is alleviated with sex reassignment. The psychiatric assessment of both adolescents and adults has been centralized in Finland to two university hospitals, the Helsinki University Hospital and Tampere University Hospital. In both hospitals, multidisciplinary teams aim at differential diagnosis by using well-known psychiatric and psychological instruments. Wishes for sex reassignment that are caused by a mental health disorder are excluded. Assessment in adolescence is challenging because the identity in youth is still forming.
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22
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Petersen JK. A Changed Life: Becoming True to Who I am. Narrat Inq Bioeth 2015; 5:106-109. [PMID: 26300137 DOI: 10.1353/nib.2015.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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23
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Atienza Macías E, Armaza Armaza EJ. [Transsexuality: law and health-related aspects in the Spanish legal system]. Salud Colect 2014; 10:365-377. [PMID: 25522105 DOI: 10.1590/s1851-82652014000300007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 06/04/2014] [Indexed: 06/04/2023] Open
Abstract
The social weight of transsexual groups has been and continues to be crucial in many aspects regarding transsexuality, from the progressive elimination of discrimination to influence in the legislative branch. This paper especially discusses a classic demand of these groups, comprehensive medical treatment of transsexual people within the National Health System. Thus, progress in the development of an adequate healthcare system for these groups, their treatment in the legal systems of Spain in general and of some of its autonomous communities with more noteworthy laws (especially in Andalusia, an autonomous community that has been pioneering in this regard, as well as the Basque Country and Navarre) and remaining challenges will be observed in this work. The article will also take particular note of the substantial developments that the publication of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders has established in this area.
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Affiliation(s)
- Elena Atienza Macías
- Cátedra Interuniversitaria de Derecho y Genoma Humano, Universidad de Deusto, Bilbao, España
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24
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Affiliation(s)
- Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, AB, Canada,
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25
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Forcier M, Olson J. Transgender and Gender Nonconforming Youth. Adolesc Med State Art Rev 2014; 25:377-397. [PMID: 27132320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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26
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Haselbacher G. [Escape from the wrong gender]. MMW Fortschr Med 2014; 156:38-39. [PMID: 25369683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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27
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Wittich RM. Comments on the "Clinical practice guidelines for assessment and treatment of transsexuality" issued by the Sexual Identity and Differentiation Group of the SEEN (GIDSEEN). Endocrinol Nutr 2014; 61:116-117. [PMID: 23932267 DOI: 10.1016/j.endonu.2013.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 04/04/2013] [Accepted: 04/06/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Regina-Michaela Wittich
- Estación Experimental del Zaidín, Consejo Superior de Investigaciones Científicas, Granada, España.
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28
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Moreno-Pérez O, Esteva de Antonio I. Reply to: Comments on the "Clinical practice guidelines for assessment and treatment of transsexuality" issued by the Sexual Identity and Differentiation Group of the SEEN (GIDSEEN). Endocrinol Nutr 2014; 61:118-119. [PMID: 24388415 DOI: 10.1016/j.endonu.2013.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 11/28/2013] [Indexed: 06/03/2023]
Affiliation(s)
- Oscar Moreno-Pérez
- Sección de Endocrinología y Nutrición, Unidad de Identidad de Género (UIG), Hospital General Universitario de Alicante, Universidad Miguel Hernández, Alicante, España.
| | - Isabel Esteva de Antonio
- Unidad de Transexualidad e Identidad de Género de Andalucía (UTIG), Servicio de Endocrinología y Nutrición, Hospital Regional Universitario Carlos Haya, Málaga, España
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29
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Meyenburg B. [Gender dysphoria in adolescents: difficulties in treatment]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:510-522. [PMID: 25296511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In many children and adolescents with gender dysphoria only minor or no psychopathology is found. 43% of patients seen in the Frankfurt University Gender Identity Clinic for children and adolescents suffer from major psychopathology. To demonstrate difficulties in treatment of these patients courses of treatment in four such patients are presented. In two natal females major psychopathology made decision for reassignment very difficult. Two natal males were in addition not able to follow recommended treatment steps, in these patients diagnostic doubts arose.
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30
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Quindeau I. [The development of gender identity beyond rigid dichotomy]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:437-448. [PMID: 25296507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The conflicts individuals with ambiguous sexual characteristics suffer from are not the result of genetic features but of the rigid and dichotomous gender order, which is currently undergoing a renaissance. This also applies to individuals with an uncertain gender identity. In the best interests of the child a concept of gender seems necessary, that goes beyond a binary separation and allows gender-specific intermediary stages in the personal development of identity. Such a gender concept can be developed following psychoanalytic theories. The present discourse contains a scale of connecting factors for a differentiated and less normative conceptualization of gender development. Starting from Freud's concept of constitutional bisexuality, Robert Stoller's theory, which has been firmly rooted in the mainstream of psychoanalysis for more than 40 years, will be critically reviewed. By involving Reimut Reiche's and Jean Laplanche's arguments, a continuative psychological gender theory will be drafted, which does not normatively and reductively claim the demarcation of gender, but rather opens up a space for gender diversity.
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Korte A, Beier KM, Vukorepa J, Mersmann M, Albiez V. [About the heterogeneity in adolescents with gender identity disorder: differential importance of psychiatric comorbidity and considerations of individual psychodynamics]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:523-541. [PMID: 25296512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics--i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.
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Cerwenka S, Nieder TO, Cohen-Kettenis P, De Cuypere G, Haraldsen IRH, Kreukels BPC, Richter-Appelt H. Sexual behavior of gender-dysphoric individuals before gender-confirming interventions: a European multicenter study. J Sex Marital Ther 2014; 40:457-71. [PMID: 24846436 DOI: 10.1080/0092623x.2013.772550] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
A transsexual course of development that starts before puberty (early onset) or during or after puberty, respectively (late onset), may lead to diverse challenges in coping with sexual activity. The authors explored the sexual behavior of 380 adult male-to-female and female-to-male individuals diagnosed according to DSM-IV-TR criteria who had not yet undergone gender-confirming interventions. Data originated from the European Network for the Investigation of Gender Incongruence Initiative, conducted in Belgium, Germany, The Netherlands, and Norway. Information on outcome variables was collected using self-administered questionnaires at first clinical presentation. Compared with late-onset male-to-females, early-onset individuals tended to show sexual attraction toward males more frequently (50.5%), involve genitals less frequently in partner-related sexual activity, and consider penile sensations and orgasm as more negative. Early-onset female-to-males predominantly reported sexual attraction toward females (84.0%), whereas those with a late-onset more frequently showed other sexual attractions (41.7%). The study (a) shows that early- and late-onset male-to-females differ considerably with regard to coping strategies involving their body during sexual relations and (b) reveals initial insights into developmental pathways of late-onset female-to-males.
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Affiliation(s)
- Susanne Cerwenka
- a University Medical Center Hamburg-Eppendorf , Department of Sex Research and Forensic Psychiatry , Hamburg , Germany
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33
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Meyenburg B, Korte A, Möller B, Romer G. [Gender identity disorders in childhood and adolescence (F64)]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:542-552. [PMID: 25296513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Möller B, Nieder TO, Preuss WF, Becker I, Fahrenkrug S, Wüsthof A, Briken P, Romer G, Richter-Appelt H. [Care of children and adolescents with gender dysphoria in the context of an interdisciplinary special consultation service]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:465-485. [PMID: 25296509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.
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35
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Möller B, Georg R. [Gender dysphoria in children and adolescents]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:431-436. [PMID: 25296506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Despite rising demand for treatment, far too few specialist services for gender dysphoric children and adolescents exist. Due to complex issues related to indication of physical treatment with lifelong consequences a thorough interdisciplinary treatment service with development-related evaluation is necessary. The aim of this paper is to outline the professional and social tension, in which the practitioner works, as well as to provide insight into the diversity of developmental trajectories and difficult decisions or dilemmas.
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36
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Becker I, Gjergji-Lama V, Romer G, Möller B. [Characteristics of children and adolescents with gender dysphoria referred to the Hamburg Gender Identity Clinic]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:486-509. [PMID: 25296510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients' parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9% (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches.
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Rutzen KM, Nieder TO, Schreier H, Möller B. [Clinical treatment of children and adolescents with gender dysphoria from international experts' point of view]. Prax Kinderpsychol Kinderpsychiatr 2014; 63:449-464. [PMID: 25296508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The clinical treatment of children and adolescents with gender dysphoria is still a controversial issue. The aim of this study was to get an overview of the knowledge and experience of international experts and to highlight shared views as well as differences in theoretical convictions and treatment approaches. Half-structured, guide-line based interviews were carried out with international experts in the field. The interviews were analyzed using qualitative content analysis (Mayring, 2010).
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Abstract
PURPOSE OF REVIEW To describe the experience in Spain concerning the public healthcare for transsexual persons using a multidisciplinary approach and to review the relevant literature. Treatment includes social and psychological support, cross-hormone treatment, and sex reassignment surgeries. Although the recommendations of The World Professional Association for Transgender Health are used as guidelines, the application of these standards of care varies considerably, probably because of specific clinical and country factors. RECENT FINDINGS The sex reassignment process is complex and requires not only coordination of multiple procedures, but also lifetime follow-up of transsexual individuals. Gender units must provide high-quality services, been essential the principle of accessibility to resources together with a protocolized follow-up and anticipation of secondary effects from the clinical surgical treatment. Two recent challenges are juvenile gender dysphoria and gender variants, which increasingly consult professionals. SUMMARY Transsexualism affects all adaptive physical and psychosocial aspects of a person. As diagnosis is based only on the history and personal perceptions, a broad social debate exists about the need for treatment financed by the public health systems. Some countries restrict the care to transsexuals with private medical policies. Thus, coordination of care also requires participation of the family and associations, with continuous information to the health authorities, the judiciary, and the media of each country.
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Affiliation(s)
- Isabel Esteva de Antonio
- aDepartment of Endocrinology, Andalusian Gender Team (IBIMA), Carlos Haya Hospital, Malaga bDepartment of Psychiatry, Institute Clinic of Neurosciences, Barcelona, Spain *Gender Identity and Sexual Development Disorders Spanish Group
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Zucker KJ, Cohen-Kettenis PT, Drescher J, Meyer-Bahlburg HFL, Pfäfflin F, Womack WM. Memo outlining evidence for change for gender identity disorder in the DSM-5. Arch Sex Behav 2013; 42:901-14. [PMID: 23868018 DOI: 10.1007/s10508-013-0139-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Kenneth J Zucker
- Gender Identity Service, Child, Youth, and Family Services, Underserved Populations Program, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
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Abstract
PURPOSE OF REVIEW The approach to gender identity disorder (GID) in childhood and adolescence has been rapidly evolving and is in a state of flux. In an effort to form management recommendations on the basis of the available literature, The Endocrine Society published clinical practice guidelines in 2009. The guidelines recommend against sex role change in prepubertal children, but they recommend the use of gonadotropin-releasing hormone (GnRH) agonists to suppress puberty in adolescence, and the use of cross-sex hormones starting around age 16 for eligible patients. In actual practice, the approach to GID is quite variable due to continued lack of consensus and specific barriers to treatment that are unique to GID. RECENT FINDINGS Recent literature has focused on the mental health approach to prepubertal children with GID and short-term outcomes using pubertal suppression and cross-sex steroids in adolescents with GID. SUMMARY This review will describe the literature published since the release of The Endocrine Society guidelines regarding the management of GID in both children and adolescents.
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Affiliation(s)
- Daniel E Shumer
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts, USA.
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Nakatsuka M. [Puberty-delaying hormone therapy in adolescents with gender identity disorder]. Seishin Shinkeigaku Zasshi 2013; 115:316-322. [PMID: 23691819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The guideline for the treatment of people with gender identity disorder (GID) of the Japanese Society of Psychiatry and Neurology was revised in January 2012. The guideline eased restrictions for the endocrine treatment of transsexual adolescents. A medical specialist can start treating transsexual adolescents at the age of 15 after the diagnosis of GID. It recommends that transsexual adolescents (Tanner stage 2 [mainly 12-13 years of age]) are treated by endocrinologists to suppress puberty with gonadotropin-releasing hormone (GnRH) agonists until the age of 15 years old, after which cross-sex hormones may be given. Female-to-male transsexuals do not necessarily want to start androgen therapy before presenting female secondary sexual characteristics because androgen can easily stop menstruation, cause beard growth, and lower the voice. On the contrary, male-to-female transsexuals want to start estrogen therapy before presenting male secondary sexual characteristics because estrogen cannot alter the beard and low voice. It is important to identify children with gender dysphoria in school and help them receive medical advice. However, approximately half of school teachers think that children with gender dysphoria are very rare and they do not know of the notification from Ministry of Education, Culture, Sports, Science and Technology, JAPAN, which aims to help children with gender dysphoria. The revision of the guideline for the treatment of transsexual people and endocrine treatment of transsexual adolescents by medical specialists may prevent them from attempting suicide, being depressive, and refusing to attend school. Furthermore, the treatment may help avoid mental disorders, aid being employed with the desired sexuality, and, subsequently, getting married and having children.
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Affiliation(s)
- Mikiya Nakatsuka
- Graduate School of Health Sciences, Okayama University, Department of Obstetrics and Gynecology, Gender Clinic, Okayama University Hospital, Japanese Society of Gender Identity Disorder
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44
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De Bonnecaze G, Pessey JJ, Chaput B, Al Hawat A, Vairel B. [Transsexualism: from diagnosis to management]. Rev Laryngol Otol Rhinol (Bord) 2013; 134:225-229. [PMID: 25252579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The transsexualism or gender dysphoria is a pathology during which an individual does not recognize himself in his sexual identity and wishes to change it: in that it must be differentiated from the sexual ambiguities (hermaphrodism, pseudohermaphroditism) in which the sexual phenotype is not clearly established. In France the number of transsexuals is estimated at approximately 50,000 people. Since 2009 the transsexualism is not any more considered as a mental illness, it remains regarded as a long term illness. The objective of this article is to present the recent evolutions concerning the management of transsexual patients seeking feminization.
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Seal LJ, Franklin S, Richards C, Shishkareva A, Sinclaire C, Barrett J. Predictive markers for mammoplasty and a comparison of side effect profiles in transwomen taking various hormonal regimens. J Clin Endocrinol Metab 2012; 97:4422-8. [PMID: 23055547 DOI: 10.1210/jc.2012-2030] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
CONTEXT Breast development in transwomen is an important issue, affecting general psychological functioning. Current hormonal therapies are imperfect, with 60% of patients requesting mammoplasty. INTERVENTIONS Interventions included the following: 1) comparing the effects on transwomen's requests for mammoplasty of estrogen valerate, ethinylestradiol, and conjugated equine estrogen (CEE) hormone treatments; and 2) comparing the effects of GnRH analogs and androgen antagonists. OBJECTIVE The objective of the study was to identify which hormone regimen is associated with the greatest subsequent request for augmentation mammoplasty. DESIGN The study was a controlled, retrospective case audit. SETTING The study was conducted at a single-center National Health Service tertiary care unit. PATIENTS Patients were eligible for breast augmentation after 2 yr of estrogen treatment, were Tanner IV or higher breast development, and reported psychological distress due to small breasts. One hundred sixty-five subjects and 165 age-matched controls were identified. OUTCOME MEASURE The outcome measure was a mammoplasty request. RESULTS There were significantly more self-medicating individuals than controls in the mammoplasty group (11.5 vs. 6%, P < 0.05). The type of estrogen use did not affect the outcome. Compared with other antiandrogens, spironolactone use was significantly higher in those requesting mammoplasty (4.8 vs. 1.8%, P = 0.002). Thromboembolism occurred in 1.2% of individuals, more frequently in those treated with CEE than in those treated with either estrogen valerate or ethinylestradiol (4.4 vs. 0.6 vs. 0.7%, P = 0.026). Depression was noted in approximately 30% of individuals. CONCLUSIONS Self-medication with estrogen is significantly more likely to result in a later request for mammoplasty than is treatment prescribed by licensed practitioners. Previous spironolactone use is more common in those requesting mammoplasty. CEE treatment is associated with a higher incidence of thromboembolism than treatment with other estrogen types.
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Affiliation(s)
- L J Seal
- St. George's Hospital Medical School, London SW17 0RE, United Kingdom.
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Fernández Rodríguez M, García-Vega E. [Clinical variables in gender identity disorders]. Psicothema 2012; 24:555-560. [PMID: 23079351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this research is to analyze some clinical variables in a sample of 19 female transsexuals (FT) (male to female) and 14 male transsexuals (MT) (female to male) who have made a claim for gender dysphoria to the public health service. Subject selection was done after they were diagnosed of transsexualism according to diagnostic criteria of the ICD-10 and the DSM-IV-TR, and complies with standards of care of The Harry Benjamin International Gender Dysphoria Association. The results show that FT take more hormones and for more years and undergo a greater number of surgeries (feminizing), especially on the face, but also on the body. Most transsexuals are heterosexual. Whereas 10% of FTs are attracted to women, no MTs manifest a homosexual orientation and, lastly, a high percentage of the sample experiences real life in all the contexts of their lives, in similar proportions for FTs and MTs.
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Schagen SEE, Delemarre-van de Waal HA, Blanchard R, Cohen-Kettenis PT. Sibling sex ratio and birth order in early-onset gender dysphoric adolescents. Arch Sex Behav 2012; 41:541-9. [PMID: 21674256 PMCID: PMC3338001 DOI: 10.1007/s10508-011-9777-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 04/16/2011] [Accepted: 04/30/2011] [Indexed: 05/26/2023]
Abstract
Several sibship-related variables have been studied extensively in sexual orientation research, especially in men. Sibling sex ratio refers to the ratio of brothers to sisters in the aggregate sibships of a group of probands. Birth order refers to the probands' position (e.g., first-born, middle-born, last-born) within their sibships. Fraternal birth order refers to their position among male siblings only. Such research was extended in this study to a large group of early-onset gender dysphoric adolescents. The probands comprised 94 male-to-female and 95 female-to-male gender dysphoric adolescents. The overwhelming majority of these were homosexual or probably prehomosexual. The control group consisted of 875 boys and 914 girls from the TRAILS study. The sibling sex ratio of the gender dysphoric boys was very high (241 brothers per 100 sisters) compared with the expected ratio (106:100). The excess of brothers was more extreme among the probands' older siblings (300:100) than among their younger siblings (195:100). Between-groups comparisons showed that the gender dysphoric boys had significantly more older brothers, and significantly fewer older sisters and younger sisters, than did the control boys. In contrast, the only notable finding for the female groups was that the gender dysphoric girls had significantly fewer total siblings than did the control girls. The results for the male probands were consistent with prior speculations that a high fraternal birth order (i.e., an excess of older brothers) is found in all homosexual male groups, but an elevated sibling sex ratio (usually caused by an additional, smaller excess of younger brothers) is characteristic of gender dysphoric homosexual males. The mechanisms underlying these phenomena remain unknown.
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Affiliation(s)
- Sebastian E. E. Schagen
- Department of Pediatric Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Henriette A. Delemarre-van de Waal
- Department of Pediatric Endocrinology, VU University Medical Centre, Amsterdam, The Netherlands
- Department of Pediatrics, LUMC University Hospital Leiden, Leiden, The Netherlands
| | - Ray Blanchard
- Law and Mental Health Program, Centre for Addiction and Mental Health, Toronto, ON Canada
| | - Peggy T. Cohen-Kettenis
- Department of Medical Psychology and Medical Social Work, VU University Medical Centre, PO Box 7057, 1007 MB Amsterdam, The Netherlands
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Abstract
Child and adolescent psychiatrists are increasingly evaluating youth who present with gender-nonconforming behaviors and identities. The lack of discipline-specific guidelines has made assessment and treatment of children and adolescents presenting with these concerns more difficult. Several new guidelines have recently been published, and research efforts are advancing to broaden the scope of understanding of gender identity assessment and treatment in children and adolescents. Familiarity with the latest standards of care, recent research advances, and current knowledge gaps is important to help improve clinical competency in treating mental health issues in this population.
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Affiliation(s)
- Scott F Leibowitz
- Department of Psychiatry, Children's Hospital Boston, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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