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Pang KC, Feldman D, Oertel R, Telfer M. Molecular Karyotyping in Children and Adolescents with Gender Dysphoria. Transgend Health 2018; 3:147-153. [PMID: 30094339 PMCID: PMC6083207 DOI: 10.1089/trgh.2017.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose: The presence of a disorder of sexual development (DSD) acts as a diagnostic specifier for gender dysphoria (GD) under DSM-5, while the International Classification of Diseases (ICD)-10 specifically states that its equivalent diagnosis, gender identity disorder (GID), must not be the result of a chromosomal abnormality. For these reasons, routine karyotyping has been previously advocated in the clinical work-up of children and adolescents with suspected GD or GID. However, the utility of such testing remains unclear. Methods: The results of routine molecular karyotyping were analyzed in 128 patients attending our Australian statewide pediatric gender service from 2013 to 2016. Karyotyping was performed using an Illumina BeadChip platform and provided information on both sex chromosome composition and copy number variation (CNV). Results: No sex chromosome abnormalities directly suggestive of a DSD were discovered. The rate of CNVs among our patient cohort was 8.6% (11/128), similar to that previously reported for the general population. Unexpectedly, three trans male patients shared the same CNV, involving an almost identical 400 kbp deletion on chromosome 15q11.2. The frequency of this deletion within birth-assigned females in our cohort (3/69; 4.3%) was significantly higher than that within local control populations (0.3%; Fisher's exact test p-value=0.002), suggesting a possible association between 15q11.2 deletions and trans male identity. Conclusion: Routine molecular karyotyping failed to detect any occult DSD and indicated that the rate of CNVs was similar to that of the general population. Given these findings, we suggest that molecular karyotyping has minimal clinical utility in the routine management of children and adolescents with GD.
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Affiliation(s)
- Ken C Pang
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Debi Feldman
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Service, Parkville, Australia
| | - Michelle Telfer
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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Abstract
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.
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Affiliation(s)
- Kenneth J Zucker
- Gender Identity Clinic, Child, Youth, and Family Services, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada;
| | - Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam 1081 HV, The Netherlands
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Meyer-Bahlburg HFL. Commentary on Kraus' (2015) "classifying intersex in DSM-5: critical reflections on gender dysphoria". ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1737-1740. [PMID: 26168979 DOI: 10.1007/s10508-015-0586-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Heino F L Meyer-Bahlburg
- Division of Gender, Sexuality, and Health, Department of Psychiatry, New York State Psychiatric Institute, College of Physicians & Surgeons of Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA,
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Kraus C. Classifying Intersex in DSM-5: Critical Reflections on Gender Dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:1147-1163. [PMID: 25944182 DOI: 10.1007/s10508-015-0550-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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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Affiliation(s)
- Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, AB, Canada,
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A Noncategorical Approach to the Psychosocial Care of Persons with DSD and Their Families. GENDER DYSPHORIA AND DISORDERS OF SEX DEVELOPMENT 2014. [DOI: 10.1007/978-1-4614-7441-8_5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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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. ARCHIVES OF SEXUAL BEHAVIOR 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] [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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Auer MK, Fuss J, Stalla GK, Athanasoulia AP. Twenty years of endocrinologic treatment in transsexualism: analyzing the role of chromosomal analysis and hormonal profiling in the diagnostic work-up. Fertil Steril 2013; 100:1103-10. [PMID: 23809495 DOI: 10.1016/j.fertnstert.2013.05.047] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 05/30/2013] [Accepted: 05/30/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate that adequate pubertal history, physical examination, and a basal hormone profile is sufficient to exclude disorders of sexual development (DSD) in adult transsexuals and that chromosomal analysis could be omitted in cases of unremarkable hormonal profile and pubertal history. DESIGN Retrospective chart analysis. SETTING Endocrine outpatient clinic of a psychiatric research institute. PATIENT(S) A total of 475 subjects (302 male-to-female transsexuals [MtF], 173 female-to-male transsexuals [FtM]). Data from 323 (192 MtF/131 FtM) were collected for hormonal and pubertal abnormalities. Information regarding chromosomal analysis was available for 270 patients (165 MtF/105 FtM). INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Pubertal abnormalities, menstrual cycle, and hormonal irregularities in relation to chromosomal analysis conducted by karyotype or hair root analysis. RESULT(S) In the MtF group, 5.2% of the patients reported pubertal irregularities and 5.7% hormonal abnormalities, and in the FtM group 3.8% and 19.1%, respectively. Overall chromosomal abnormality in both groups was 1.5% (2.9% in the FtM and 0.6% in the MtF group). The aneuploidies found included one gonosomal aneuploidy (45,X[10]/47,XXX[6]/46,XX[98]), two Robertsonian translocations (45,XXder(14;22)(q10;q10)), and one Klinefelter syndrome (47,XXY) that had already been diagnosed in puberty. CONCLUSION(S) Our data show a low incidence of chromosomal abnormalities and thus question routine chromosomal analysis at the baseline evaluation of transsexualism, and suggest that it be considered only in cases of abnormal history or hormonal examination.
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Affiliation(s)
- Matthias K Auer
- Department of Internal Medicine, Endocrinology, and Clinical Chemistry, Max Planck Institute of Psychiatry, Munich, Germany.
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Abstract
This article focuses on the assessment of children who display gender-atypical behavior and, perhaps, identity. The aim is to provide an overview of assessment techniques that can be used clinically with children who show this behavioral pattern and that complement the routine use of DSM-IV criteria for the diagnosis of gender identity disorder in clinical practice. It will also provide an overview of some common approaches to the assessment of other types of behavioral and socioemotional issues that may require clinical attention in these youngsters.
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Affiliation(s)
- Kenneth J Zucker
- Gender Identity Service, Child, Youth, and Family Program, Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario, Canada.
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Meyer-Bahlburg HFL. Gender outcome in 46,XY complete androgen insensitivity syndrome: comment on T'Sjoen et al. (2010). ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1221-1224. [PMID: 20552263 DOI: 10.1007/s10508-010-9640-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Lawrence AA. Proposed revisions to gender identity disorder diagnoses in the DSM-5. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1253-1260. [PMID: 20725853 DOI: 10.1007/s10508-010-9660-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Richter-Appelt H, Sandberg DE. Should Disorders of Sex Development be an Exclusion Criterion for Gender Identity Disorder inDSM 5? Int J Transgend 2010. [DOI: 10.1080/15532739.2010.515181] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Rachlin K, Dhejne C, Brown GR. The Future of GID NOS in theDSM 5: Report of the GID NOS Working Group of a Consensus Process Conducted by the World Professional Association for Transgender Health. Int J Transgend 2010. [DOI: 10.1080/15532739.2010.509209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Cohen-Kettenis PT, Pfäfflin F. The DSM diagnostic criteria for gender identity disorder in adolescents and adults. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:499-513. [PMID: 19838784 DOI: 10.1007/s10508-009-9562-y] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Apart from some general issues related to the Gender Identity Disorder (GID) diagnosis, such as whether it should stay in the DSM-V or not, a number of problems specifically relate to the current criteria of the GID diagnosis for adolescents and adults. These problems concern the confusion caused by similarities and differences of the terms transsexualism and GID, the inability of the current criteria to capture the whole spectrum of gender variance phenomena, the potential risk of unnecessary physically invasive examinations to rule out intersex conditions (disorders of sex development), the necessity of the D criterion (distress and impairment), and the fact that the diagnosis still applies to those who already had hormonal and surgical treatment. If the diagnosis should not be deleted from the DSM, most of the criticism could be addressed in the DSM-V if the diagnosis would be renamed, the criteria would be adjusted in wording, and made more stringent. However, this would imply that the diagnosis would still be dichotomous and similar to earlier DSM versions. Another option is to follow a more dimensional approach, allowing for different degrees of gender dysphoria depending on the number of indicators. Considering the strong resistance against sexuality related specifiers, and the relative difficulty assessing sexual orientation in individuals pursuing hormonal and surgical interventions to change physical sex characteristics, it should be investigated whether other potentially relevant specifiers (e.g., onset age) are more appropriate.
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Affiliation(s)
- Peggy T Cohen-Kettenis
- Department of Medical Psychology, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Meyer-Bahlburg HF. Variants of Gender Differentiation in Somatic Disorders of Sex Development: Recommendations for Version 7 of the World Professional Association for Transgender Health'sStandards of Care. Int J Transgend 2009. [DOI: 10.1080/15532730903439476] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Abstract
The term disorders of sex development (DSD) includes congenital conditions in which development of chromosomal, gonadal or anatomical sex is atypical. Mutations in genes present in X, Y or autosomal chromosomes can cause abnormalities of testis determination or disorders of sex differentiation leading to 46,XY DSD. Detailed clinical phenotypes allow the identification of new factors that can alter the expression or function of mutated proteins helping to understand new undisclosed biochemical pathways. In this review we present an update on 46,XY DSD aetiology, diagnosis and treatment based on extensive review of the literature and our three decades of experience with these patients.
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MESH Headings
- Chromosomes, Human, X/genetics
- Chromosomes, Human, Y/genetics
- Disorders of Sex Development/diagnosis
- Disorders of Sex Development/genetics
- Disorders of Sex Development/therapy
- Female
- Gonadal Dysgenesis, 46,XY/diagnosis
- Gonadal Dysgenesis, 46,XY/genetics
- Gonadal Dysgenesis, 46,XY/therapy
- Humans
- Male
- Mutation/genetics
- Testis/abnormalities
- Testosterone/metabolism
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Affiliation(s)
- Berenice Bilharinho Mendonca
- Unidade de Endocrinologia do Desenvolvimento, Laboratorio de Hormonios e Genetica Molecular, LIM 42, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, São Paulo, Brazil.
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Meyer-Bahlburg H. Lignes de conduite pour le traitement des enfants ayant des troubles du développement du sexe. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.neurenf.2008.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jorge JC, Echeverri C, Medina Y, Acevedo P. ORIGINAL RESEARCH–INTERSEX AND GENDER IDENTITY DISORDERS: Male Gender Identity in an XX Individual with Congenital Adrenal Hyperplasia. J Sex Med 2008; 5:122-31. [PMID: 17655659 DOI: 10.1111/j.1743-6109.2007.00558.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION In spite of significant changes in the management policies of intersexuality, clinical evidence show that not all pubertal or adult individuals live according to the assigned sex during infancy. AIM The purpose of this study was to analyze the clinical management of an individual diagnosed as a female pseudohermaphrodite with congenital adrenal hyperplasia (CAH) simple virilizing form four decades ago but who currently lives as a monogamous heterosexual male. METHODS We studied the clinical files spanning from 1965 to 1991 of an intersex individual. In addition, we conducted a magnetic resonance imaging (MRI) study of the abdominoplevic cavity and a series of interviews using the oral history method. MAIN OUTCOME MEASURES Our analysis is based on the clinical evidence that led to the CAH diagnosis in the 1960s in light of recent clinical testing to confirm such diagnosis. RESULTS Analysis of reported values for 17-ketosteroids, 17-hydroxycorticosteroids, from 24-hour urine samples during an 8-year period showed poor adrenal suppression in spite of adherence to treatment. A recent MRI study confirmed the presence of hyperplastic adrenal glands as well as the presence of a prepubertal uterus. Semistructured interviews with the individual confirmed a life history consistent with a male gender identity. CONCLUSIONS Although the American Academy of Pediatrics recommends that XX intersex individuals with CAH should be assigned to the female sex, this practice harms some individuals as they may self-identify as males. In the absence of comorbid psychiatric factors, the discrepancy between infant sex assignment and gender identity later in life underlines the need for a reexamination of current standards of care for individuals diagnosed with CAH.
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Affiliation(s)
- Juan Carlos Jorge
- Department of Anatomy and Neurobiology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico.
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Szarras-Czapnik M, Lew-Starowicz Z, Zucker KJ. A psychosexual follow-up study of patients with mixed or partial gonadal dysgenesis. J Pediatr Adolesc Gynecol 2007; 20:333-8. [PMID: 18082854 DOI: 10.1016/j.jpag.2007.03.096] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 03/18/2007] [Indexed: 10/22/2022]
Abstract
STUDY OBJECTIVE To provide late adolescent and young adult psychosexual follow-up information on a consecutive series of patients with either mixed or partial gonadal dysgenesis. SETTING Children's Memorial Health Institute (Warsaw, Poland). PARTICIPANTS 19 patients (age range, 17-26 years), 9 raised as females and 10 raised as males. MEASURES Clinical interview and psychologic tests were used to evaluate gender identity, gender role, and sexual behavior. RESULTS All patients raised as male had a normal male gender identity, displayed masculine gender role behavior in childhood, and had a heterosexual sexual orientation. Seven of the 10 male patients had experienced heterosexual intercourse. Two out of nine women did not identify with the female gender. The majority had masculine gender role interests in childhood. The female patients were significantly less likely to have experienced sexual activity with a partner than the male patients. CONCLUSION Although gender identity differentiated largely in accordance with sex assignment or sex of rearing in our sample, the patients reared as female appeared to have poorer sexual adjustment than the males. Cultural factors may have impacted on this latter outcome.
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Affiliation(s)
- Maria Szarras-Czapnik
- Department of Endocrinology, The Children's Memorial Health Institute, Warsaw, Poland
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Meyer-Bahlburg HFL. Introduction: gender dysphoria and gender change in persons with intersexuality. ARCHIVES OF SEXUAL BEHAVIOR 2005; 34:371-3. [PMID: 16010460 DOI: 10.1007/s10508-005-4335-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Vidal-Ortiz S. Queering sexuality and doing gender: Transgender men's identification with gender and sexuality. ADVANCES IN GENDER RESEARCH 2004. [DOI: 10.1016/s1529-2126(02)80008-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Hird M. Considerations for a Psychoanalytic Theory of Gender Identity and Sexual Desire: The Case of Intersex. SIGNS 2003. [DOI: 10.1086/343131] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Studies of genetic males with single gene mutations that impair testosterone formation or action and consequently prevent development of the normal male phenotype provide unique insight into the control of gender role behavior. 46,XY individuals with either of two autosomal recessive mutations [17 beta-hydroxysteroid dehydrogenase 3 (17 beta-HSD3) deficiency or steroid 5 alpha-reductase 2 (5 alpha-R2) deficiency] have a female phenotype at birth and are raised as females but frequently change gender role behavior to male after the expected time of puberty. In contrast, genetic males with mutations that impair profoundly the function of the androgen receptor are also raised as females and have consistent female behavior as adults. Furthermore, the rare men with mutations that impair estrogen synthesis or the estrogen receptor have male gender role behavior. These findings indicate that androgens are important determinants of gender role behavior (and probably of gender identity) and that this action is mediated by the androgen receptor and not the result of conversion of androgen to estrogen. The fact that all genetic males with 17 beta-HSD3 or 5 alpha-R2 deficiency do not change gender role behavior indicates that other factors are also important determinants of this process.
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Affiliation(s)
- J D Wilson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, Texas 75390-8857, USA.
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Affiliation(s)
- J D Wilson
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-8857, USA.
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Howe EG. Intersexuality: What Should Careproviders Do Now. THE JOURNAL OF CLINICAL ETHICS 1998. [DOI: 10.1086/jce199809401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Dittmann RW. Ambiguous genitalia, gender-identity problems, and sex reassignment. JOURNAL OF SEX & MARITAL THERAPY 1998; 24:255-271. [PMID: 9805286 DOI: 10.1080/00926239808403961] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.
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Affiliation(s)
- R W Dittmann
- Psychosomatic Department, Children's Hospital, University of Hamburg, Germany
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Abstract
OBJECTIVE To review the clinically relevant literature on gender identity disorder (GID) in children and adolescents over the past 10 years. METHOD All literature referring to gender identity and children or adolescents from 1985 on was reviewed. RESULTS Changes in the DSM-IV nomenclature include (1) adoption of the single diagnosis of GID to apply to children, adolescents, and adults; (2) changes in the format of the criteria; and (3) placement in the section "Sexual and Gender Identity Disorders." Rates of associated psychopathology in children with GID are comparable with those in children with other psychiatric disorders, particularly disorders that are internalizing in form. Biological and psychosocial factors thought to be relevant in the development of GID are reviewed. CONCLUSIONS Research is required to elucidate the complicated interaction between biological and psychosocial factors in the development of GID and to evaluate treatment efficacy.
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Affiliation(s)
- S J Bradley
- Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
The etiology of gender identity is explored through the case history of a teenager with intersex raised without stigmatization as a girl but who declared himself male at age 14 years. Psychological ramifications of such complex medical anomalies as ambiguous genitalia demand a role for child psychiatry.
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Affiliation(s)
- W G Reiner
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Warne GL. Congenital adrenal hyperplasia. Med J Aust 1994; 161:516-7. [PMID: 7968748 DOI: 10.5694/j.1326-5377.1994.tb127592.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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