Physical attractiveness of boys with gender identity disorder

Research Review: Gender identity in youth: treatment paradigms and controversies

BACKGROUND

Pediatric gender identity has gained increased attention over the past several years in the popular media, political arena, and medical literature. This article reviews terminology in this evolving field, traditional models of gender identity development and their limitations, epidemiology and natural history of cross-gender identification among children and adolescents, co-occurring conditions and behaviors, research into the biological and psychosocial determinants of cross-gender identification, and research into the options regarding and benefits of clinical approaches to gender incongruent youth.

METHODS

Based on a critical review of the extant literature, both theoretical and empirical, that addresses the issue of pediatric gender identity, the authors synthesized what is presently known and what is in need of further research in order to elucidate the developmental trajectory and clinical needs of gender diverse youth.

RESULTS

The field of pediatric gender identity has evolved substantially over the past several years. New research suggests that cross-gender identification is prevalent (approximately 1% of youth). These youth suffer disproportionately high rates of anxiety, depression, and suicidality. Although research into the etiology of cross-gender identification is limited, emerging data have shown that affirmative treatment protocols may improve the high rates of mental health difficulties seen among these patients.

CONCLUSIONS

The field of pediatric gender identity has evolved dramatically. Emerging data suggest that these patients' high rates of anxiety, depression, and suicidality appear to be improved with affirmative protocols, although future longitudinal data are needed.

The Roles of Self-Socialization and Parent Socialization in Toddlers' Gender-Typed Appearance

Children's gender-stereotypical dress and appearance might be one of the first representations of children's emerging sense of gender identity. Gender self-socialization theories posit that as children become more aware of gender categories, they become motivated to adhere to gender stereotypes, such as by expressing interest in dressing in feminine or masculine ways. Socialization theories predict that children's gender-typed appearance reflects parents' choices. For example, gender-traditional parents might dress their children in gender-stereotypical ways. At the same time, dressing in gender-stereotypical ways might contribute to children's growing awareness of gender categories. The current study investigated the factors associated with gender-typed appearance among 175 (87 girls, 88 boys) Mexican American, Dominican American, and African American 2-year-olds. We examined both child and parent contributions to early gender-typed appearance. To measure children's early conceptual understanding of gender categories, we assessed children's use and recognition of gender verbal labels. To examine the influence of parent socialization, we assessed mothers' gender-role attitudes. Children's gender-typed appearance was observed and coded during an assessment. Surprisingly, mothers' gender-role attitudes were not significantly associated with toddlers' gender-typed appearance. However, toddlers' gender labeling was associated with their gender-typed appearance, suggesting that self-socialization processes can be found as early as 24 months of age.

Guidance and Ethical Considerations for Undertaking Transgender Health Research and Institutional Review Boards Adjudicating this Research

The purpose of this review is to create a set of provisional criteria for Institutional Review Boards (IRBs) to refer to when assessing the ethical orientation of transgender health research proposals. We began by searching for literature on this topic using databases and the reference lists of key articles, resulting in a preliminary set of criteria. We then collaborated to develop the following nine guidelines: (1) Whenever possible, research should be grounded, from inception to dissemination, in a meaningful collaboration with community stakeholders; (2) language and framing of transgender health research should be non-stigmatizing; (3) research should be disseminated back to the community; (4) the diversity of the transgender and gender diverse (TGGD) community should be accurately reflected and sensitively reflected; (5) informed consent must be meaningful, without coercion or undue influence; (6) the protection of participant confidentiality should be paramount; (7) alternative consent procedures should be considered for TGGD minors; (8) research should align with current professional standards that refute conversion, reorientation, or reparative therapy; and (9) IRBs should guard against the temptation to avoid, limit, or delay research on this subject.

Internalized Homophobia Influences Perceptions of Men's Sexual Orientation from Photos of Their Faces

Although researchers have explored the perceiver characteristics that make people accurate at identifying others' sexual orientations, characteristics of the targets remain largely unexplored. In the current study, we examined how individual differences in internalized homophobia among gay men can affect perceptions of their sexual orientation by asking 49 individuals to judge the sexual orientations of 78 gay men from photos of their faces. We found that gay men reporting higher levels of internalized homophobia were less likely to have come out of the closet and were, in turn, less likely to be perceived as gay. Thus, internalized homophobia and the concealment of one's sexual minority status can impact perceptions of sexual orientation.

Shape differences between the faces of homosexual and heterosexual men

Previous studies have shown that homosexual men differ from heterosexual men in several somatic traits and lay people accurately attribute sexual orientation based on facial images. Thus, we may predict that morphological differences between faces of homosexual and heterosexual individuals can cue to sexual orientation. The main aim of this study was to test for possible differences in facial shape between heterosexual and homosexual men. Further, we tested whether self-reported sexual orientation correlated with sexual orientation and masculinity-femininity attributed from facial images by independent raters. In Study 1, we used geometric morphometrics to test for differences in facial shape between homosexual and heterosexual men. The analysis revealed significant shape differences in faces of heterosexual and homosexual men. Homosexual men showed relatively wider and shorter faces, smaller and shorter noses, and rather massive and more rounded jaws, resulting in a mosaic of both feminine and masculine features. In Study 2, we tested the accuracy of sexual orientation judgment from standardized facial photos which were assessed by 80 independent raters. Binary logistic regression showed no effect of attributed sexual orientation on self-reported sexual orientation. However, homosexual men were rated as more masculine than heterosexual men, which may explain the misjudgment of sexual orientation. Thus, our results showed that differences in facial morphology of homosexual and heterosexual men do not simply mirror variation in femininity, and the stereotypic association of feminine looking men as homosexual may confound judgments of sexual orientation.

Gender identity development in adolescence

This article is part of a Special Issue "Puberty and Adolescence".This article aims to provide an outline of what is currently known on trajectories, and contributing factors to gender identity development in adolescence. We give a historical overview of the concept of gender identity, and describe general identity development in adolescence, gender identity development in the general population and in gender variant youth. Possible psychosocial (such as child and parental characteristics) and biological factors (such as the effects of prenatal exposure to gonadal hormones and the role of genetics) contributing to a gender variant identity are discussed. Studies focusing on a number of psychosocial and biological factors separately, indicate that each of these factors influence gender identity formation, but little is known about the complex interplay between the factors, nor about the way individuals themselves contribute to the process. Research into normative and gender variant identity development of adolescents is clearly lagging behind. However, studies on persons with gender dysphoria and disorders of sex development, show that the period of adolescence, with its changing social environment and the onset of physical puberty, seems to be crucial for the development of a non-normative gender identity.

Same-Sex Sexuality and Adolescent Psychological Well-Being: The influence of sexual orientation, early reports of same-sex attraction, and gender

Emerging research has shown that those of sexual-minority (SM) status (i.e., those exhibiting same-sex sexuality) report lower levels of psychological well-being. This study aimed to assess whether this relation is largely in place by the onset of adolescence, as it is for other social statuses, or whether it continues to emerge over the adolescent years, a period when SM youth face numerous challenges. Moreover, the moderating influence of sexual orientation (identification), early (versus later) reports of same-sex attractions, and gender were also examined. Using data from Add Health, multiple-group latent growth curve analyses were conducted to examine growth patterns in depressive affect and self-esteem. Results suggested that psychological well-being disparities between SM and non-SM were generally in place by early adolescence. For many, the remainder of adolescence was a recovery period when disparities narrowed over time. Early and stable reporting of same-sex attractions was associated with a greater initial deficit in psychological well-being, especially among males, but it was also associated with more rapid recovery. Independent of the timing and stability of reported same-sex attractions over time, actual sexual orientation largely failed to moderate the relation between SM status and psychological well-being. Importantly, the sizable yet understudied subgroup that identified as heterosexual but reported same-sex attractions appeared to be at substantial risk.

Sex typicality and attractiveness in childhood and adulthood: assessing their relationships from videos

Prior research suggests that sex typicality (especially femininity of females, but also masculinity of males) relates to perceptions of attractiveness, for both heterosexual and homosexual individuals. Using videos from childhood and adulthood, we investigated how different components of sex typicality contributed to this effect, whether the sex of the evaluator or of the target moderated the effect, and how the relationship of attractiveness with sex typicality varied across the lifespan. In Study 1, videos of 45 female and 50 male heterosexual and homosexual adult targets (ages 18-30 years) were judged by 56 female and 65 male heterosexual and homosexual raters (ages 18-30 years). Results suggested that both heterosexual men and lesbians viewed more feminine women as more attractive. Femininity of appearance was a primary contributor to this relationship. Masculinity was not related to men's attractiveness. Study 2 used similar methodology (44 male and 46 female heterosexual and homosexual targets and 22 male and 20 female heterosexual raters). Study 2 replicated results of Study 1. In addition, Study 2 included ratings of childhood videos of targets (ages 0-15). Results suggested that childhood femininity related to attractiveness of both young girls and young boys and that the relationship became stronger for girls as they got older. The impact of femininity on attractiveness may, therefore, depend on both targets' sex and their maturity.

Accessibility of Gender Stereotype Domains: Developmental and Gender Differences in Children

The present research examined developmental and gender differences in the relative accessibility of different gender stereotype domains. A 1988 Northeastern US sample of 256 children ages 3 to 10 years old provided open-ended descriptions of girls and boys. Responses were coded by domain to examine differences by grade, gender of participant, and gender of target. Analyses revealed that girls and older children provided a higher proportion of stereotypes, and that appearance stereotypes were particularly prevalent in descriptions of girls and activity/trait stereotypes were more prevalent in descriptions of boys. Results are discussed in terms of implications for research on the stereotype knowledge-behavior link and the need for more attention to the role of appearance stereotypes in the gender stereotype literature.

Measurement of psychosexual differentiation

Since the early 1990s, there has been a surge in interest in the study of infants, children, adolescents, and adults with physical intersex conditions or other congenital conditions that affect, among other things, the configuration of the external genitalia. Regarding psychologic evaluation, an important aspect of both short-term and long-term outcome concerns gender differentiation. This article provides an overview of various measures pertaining to gender identity, gender role, and sexual orientation that have been used in assessment studies of samples of either children and adults with gender identity disorder and/or children and adults with various physical intersex conditions. All of the measures have good psychometric quality although some have been studied more systematically than others. It is hoped that this overview will provide a template for the new generation of studies that are looking at both gender development and sexual orientation in people born with physical intersex conditions.

Maxims or myths of beauty? A meta-analytic and theoretical review

Common maxims about beauty suggest that attractiveness is not important in life. In contrast, both fitness-related evolutionary theory and socialization theory suggest that attractiveness influences development and interaction. In 11 meta-analyses, the authors evaluate these contradictory claims, demonstrating that (a) raters agree about who is and is not attractive, both within and across cultures; (b) attractive children and adults are judged more positively than unattractive children and adults, even by those who know them; (c) attractive children and adults are treated more positively than unattractive children and adults, even by those who know them; and (d) attractive children and adults exhibit more positive behaviors and traits than unattractive children and adults. Results are used to evaluate social and fitness-related evolutionary theories and the veracity of maxims about beauty.

Transsexualism: a review of etiology, diagnosis and treatment

Transsexualism is considered to be the extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS). The origins of transsexualism are still largely unclear. A first indication of anatomic brain differences between transsexuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findings regarding etiology, psychopathology and success of SRS seem to be related to the fact that certain subtypes of transsexuals follow different developmental routes. The observations that psychotherapy is not helpful in altering a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignment as a treatment option. In many countries, transsexuals are now treated according to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transsexualism. Research on postoperative functioning of transsexuals does not allow for unequivocal conclusions, but there is little doubt that sex reassignment substantially alleviates the suffering of transsexuals. However, SRS is no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment.

Gender identity disorder: a review of the past 10 years

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.

Gender, racial, ethnic, sexual, and class identities

Identity is the individual's psychological relationship to particular social category systems. This chapter summarizes how people create and negotiate their gender, racial, ethnic, sexual, and class identities. Theories, methods, and priorities in each of these content areas differ. However, each systematically excludes particular research participants and thus ignores the complexity of people's multiple social identities. Research suggests that gender, racial, ethnic, sexual, and class identities are fluid, multidimensional, personalized social constructions that reflect the individual's current context and sociohistorical cohort. However, far too little empirical work captures the richly textured, theoretical conceptions of identity development, maintenance, and change. Innovative methods for assessing the content and structure of people's identities now exist. Future research should include groups other than young children or college students; should explore functions of identity other than just self-esteem, adjustment, or well-being; and should implement methodologies that are longitudinal and that assess people's many social identities.

Physical attractiveness of girls with gender identity disorder

University students, masked to group status, judged the physical attractiveness of girls with gender identity disorder and clinical and normal control girls, whose photographs were taken at the time of assessment (mean age, 6.6 years). Each student made ratings for all girls for five traits: attractive, beautiful, cute, pretty, and ugly. A multivariate analysis of variance showed a significant group effect. Multiple comparisons of the significant univariate effects showed that the girls with gender identity disorder had significantly less attractive ratings than the normal control girls for the traits attractive, beautiful, and pretty who, in turn, had less attractive ratings than the clinical control girls. Girls with gender identity disorder and the normal controls also had less attractive ratings than the clinical controls for the trait cute. Correlational analyses showed that age was substantially negatively related to the attractiveness ratings in the group of girls with gender identity disorder, but was considerably less so in the two control groups. The extent to which the group differences in attractiveness were due to objective, structural differences in facial attractiveness vs. socially created, or subjective, processes is discussed.