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Sheikhmoonesi F. Withdrawn: Male-to-female and female-to-male transsexual siblings with pedophilic father: A case report. Clin Case Rep 2024; 12:e8580. [PMID: 38449893 PMCID: PMC10915293 DOI: 10.1002/ccr3.8580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/13/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Sheikhmoonesi, F. (2024) "Male-to-female and female-to-male transsexual siblings with pedophilic father: A case report" Clinical Case Reports, 12: e8580. https://doi.org/10.1002/ccr3.8580 The above article, published online on March 5, 2024 in Wiley Online Library (http://wileyonlinelibrary.com), has been withdrawn by agreement between the Journal's Editor-in-Chief, Dr Charles Young, and John Wiley & Sons, Ltd. The article came under investigation following reports by multiple third parties who expressed concerns about the patient consent described, as well as concerns about the methodology and the inclusion of potentially stigmatizing content. Significantly, the author included potentially identifiable information about the patients and family which was not fully appreciated during peer review. Upon request, the author provided copies of consent forms for two of the individuals described. An investigation by the publisher found that the consent forms did not conform to the Journal's nor Wiley's guidelines. Additionally, the author did not provide a consent form for one research subject whose private details were disclosed. In summary, through an investigation by the publisher, it was determined that patient consent had not been properly obtained and that anonymity had not been properly maintained in the published article, which would risk the identification of the patients and necessitated withdrawal. The author disagrees with the withdrawal.
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Affiliation(s)
- Fatemeh Sheikhmoonesi
- Psychiatry and Behavioral Sciences Research CenterAddiction Institute, Mazandaran University of Medical SciencesSariIran
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2
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Kauffman RP, Guerra C, Thompson CM, Stark A. Concordance for Gender Dysphoria in Genetic Female Monozygotic (Identical) Triplets. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3647-3651. [PMID: 36044128 DOI: 10.1007/s10508-022-02409-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The biopsychosocial etiology of gender dysphoria is poorly understood, but current thought suggests a complex interaction of genetic, hormonal, environmental, and differences in brain development and physiology. Twin studies have implicated a genetic role in the formation of gender identity. Congruence for gender dysphoria is more common among monozygotic twins compared to dizygotic twins. We present a case of monozygotic (identical) triplets who have each transitioned from female to male under the care of a university transgender health service. Each triplet experienced gender dysphoria from childhood and has undergone transitional endocrine care and various aspects of gender-affirming surgery. Although a pure genetic or biological component cannot be attributed as a cause of their gender dysphoria with absolute certainty since the triplets were raised together, this unusual case of gender dysphoria among a set of monozygotic triplets adds support for a heritable role in gender identity formation.
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Affiliation(s)
- Robert P Kauffman
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center School of Medicine, 1400 S. Coulter St., Amarillo, TX, 79106, USA.
| | - Carly Guerra
- Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, USA
| | | | - Amy Stark
- Department of Psychiatry, Texas Tech University Health Sciences Center School of Medicine, Amarillo, TX, USA
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Gender dysphoria in twins: a register-based population study. Sci Rep 2022; 12:13439. [PMID: 35927439 PMCID: PMC9352732 DOI: 10.1038/s41598-022-17749-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 07/30/2022] [Indexed: 11/08/2022] Open
Abstract
Both genetic and environmental influences have been proposed to contribute to the variance of gender identity and development of gender dysphoria (GD), but the magnitude of the effect of each component remains unclear. We aimed to examine the prevalence of GD among twins and non-twin siblings of individuals with GD, using data derived from a large register-based population in Sweden over the period 2001-2016. Register data was collected from the Statistics Sweden and the National Board of Health and Welfare. The outcome of interest was defined as at least four diagnoses of GD or at least one diagnosis followed by gender-affirming treatment. A total of 2592 full siblings to GD cases were registered, of which 67 were twins; age at first GD diagnosis for the probands ranged from 11.2 to 64.2 years. No same-sex twins that both presented with GD were identified during the study period. The proportion of different-sex twins both presenting with GD (37%) was higher than that in same-sex twins (0%, Fisher's exact test p-value < 0.001) and in non-twin sibling pairs (0.16%). The present findings suggest that familial factors, mainly confined to shared environmental influences during the intrauterine period, seem to contribute to the development of GD.
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Should chromosomal analysis be performed routinely during the baseline evaluation of the gender affirmation process? The outcomes of a large cohort of gender dysphoric individuals. Int J Impot Res 2022:10.1038/s41443-022-00582-4. [PMID: 35581420 DOI: 10.1038/s41443-022-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
The role of genetics in the etiology of gender dysphoria (GD) is an important yet understudied area. Yet whether genetic analysis should be carried out during the gender affirmation process at all is a matter of debate. This study aims to evaluate the cytogenetic and molecular genetic findings of individuals with GD. We retrospectively reviewed the medical records of individuals with GD who were followed up in a tertiary clinic. After the exclusion criteria were applied, the study sample consisted of 918 individuals with GD; 691 of whom had female-to-male (FtM) and 227 male-to-female (MtF) GD. The cytogenetic analysis revealed that 223 out of 227 (98.2%) individuals with MtF GD had the 46,XY karyotype, while 683 out of 691 (98.8%) individuals with FtM GD had the 46,XX karyotype. In the Y chromosome microdeletion analysis, azospermic factor c (AZFc) deletion was detected in only two individuals with MtF GD. Our findings suggest that there are few chromosomal abnormalities in individuals with GD. Thus, this research calls into question both the role of chromosomal abnormalities in GD etiology and why the application of chromosomal analysis is in Turkey a routine part of the baseline evaluation of GD.
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Gómez Jiménez FR, Vasey PL. Facial Attractiveness of the Sisters of Istmo Zapotec Men and Muxes: Implications for the Evolution of Male Androphilia. JOURNAL OF SEX RESEARCH 2022; 59:354-359. [PMID: 34213985 DOI: 10.1080/00224499.2021.1943737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Research shows that the female relatives of androphilic (i.e., sexually attracted to adult males) males have more children than the female relatives of gynephilic (i.e., sexually attracted to adult females) males. The mechanisms by which this occurs are unclear. The hypergyny hypothesis suggests that the female relatives of androphilic males have elevated attractiveness which allows them to obtain male partners with higher socioeconomic status, which in turn, provide them with more resources to produce and sustain multiple offspring. We tested whether the female kin of male androphiles are characterized by elevated attractiveness compared to the female kin of male gynephiles. The research was conducted among the Istmo Zapotec from Oaxaca, Mexico, where androphilic males are recognized as a third gender, muxes. We recruited 115 gynephilic men who rated the facial attractiveness of 27 women with at least one muxe sibling and 27 women with only gynephilic male siblings (i.e., control sisters). The results showed that gynephilic men found the faces of control sisters more attractive than the faces of muxe sisters. This finding is inconsistent with the hypergyny hypothesis and suggests that elevated facial attractiveness is not the mechanism by which the female relatives of androphilic males achieve elevated reproduction.
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Affiliation(s)
| | - Paul L Vasey
- Department of Psychology, University of Lethbridge
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Gómez Jiménez FR, Vasey PL. Kin-directed altruism and the evolution of male androphilia among Istmo Zapotec Muxes. EVOL HUM BEHAV 2022. [DOI: 10.1016/j.evolhumbehav.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Ramírez KDV, Fernández R, Delgado-Zayas E, Gómez-Gil E, Esteva I, Guillamon A, Pásaro E. Implications of the Estrogen Receptor Coactivators SRC1 and SRC2 in the Biological Basis of Gender Incongruence. Sex Med 2021; 9:100368. [PMID: 34049263 PMCID: PMC8240342 DOI: 10.1016/j.esxm.2021.100368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Brain sexual differentiation results from the effects of sex steroids on the developing brain. The presumptive route for brain masculinization is the direct induction of gene expression via activation of the estrogen receptors α and β and the androgen receptor through their binding to ligands and to coactivators, regulating the transcription of multiple genes in a cascade effect. Aim To analyze the implication of the estrogen receptor coactivators SRC-1, SRC-2, and SRC-3 in the genetic basis of gender incongruence. Main Outcome Measures Analysis of 157 polymorphisms located at the estrogen receptor coactivators SRC-1, SRC-2, and SRC-3, in 94 transgender versus 94 cisgender individuals. Method Using SNPStats software, the allele and genotype frequencies were analyzed by χ2, the strength of the association was measured by binary logistic regression, estimating the odds ratio for each genotype. Measurements of linkage disequilibrium and haplotype frequencies were also performed. Results We found significant differences at level P < .05 in 8 polymorphisms that correspond to 5.09% of the total. Three were located in SRC-1 and 5 in SRC-2. The odds ratio analysis showed significant differences at level P < .05 for multiple patterns of inheritance. The polymorphisms analyzed were in linkage disequilibrium. The SRC-1 haplotypes CGA and CGG (global haplotype association P < .009) and the SRC-2 haplotypes GGTAA and GGTAG (global haplotype association P < .005) were overrepresented in the transgender population. Conclusion The coactivators SRC-1 and SRC-2 could be considered as candidates for increasing the list of potential genes for gender incongruence. Ramírez KDV, Fernández R, Delgado-Zayas E, et al. Implications of the Estrogen Receptor Coactivators SRC1 and SRC2 in the Biological Basis of Gender Incongruence. Sex Med 2021;9:100368.
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Affiliation(s)
- Karla Del Valle Ramírez
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
| | - Rosa Fernández
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain.
| | - Enrique Delgado-Zayas
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Instituto de Neurociencias, Hospital Clínic, Barcelona, Spain
| | - Isabel Esteva
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género del Hospital Regional Universitario de Málaga, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Eduardo Pásaro
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
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Turan Ş, Boysan M, Tarakçıoğlu MC, Sağlam T, Yassa A, Bakay H, Demirel ÖF, Tosun M. 2D:4D Digit Ratios in Adults with Gender Dysphoria: A Comparison to Their Unaffected Same-Sex Heterosexual Siblings, Cisgender Heterosexual Men, and Cisgender Heterosexual Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:885-895. [PMID: 33694048 DOI: 10.1007/s10508-021-01938-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 01/26/2021] [Accepted: 01/30/2021] [Indexed: 06/12/2023]
Abstract
We compared gender dysphoria (GD) patients and their same-sex siblings in terms of their 2D:4D ratios, which may reflect prenatal exposure to androgen, one of the possible etiological mechanisms underlying GD. Sixty-eight GD patients (46 Female-to-Male [FtM]; 22 Male-to-Female [MtF]), 68 siblings (46 sisters of FtMs; 22 brothers of MtFs), and 118 heterosexual controls (62 female; 56 male) were included in the study. FtMs were gynephilic and MtFs were androphilic. We found that 2D:4D ratios in the both right hand (p < .001) and the left hand (p = .003) were lower in male controls than in female controls. Regarding right hands, FtM GD patients had lower 2D:4D ratios than female controls (p < .001) but their ratios did not differ from those of their sisters or male controls. FtM GD patients had no significant difference in their left-hand 2D:4D ratios compared to their sisters or female and male controls. While there was no significant difference in right hands between FtM's sisters and male controls, left-hand 2D:4D ratios were significantly higher in FtM's sisters (p = .017). MtF GD patients had lower right-hand 2D:4D ratios than female controls (p <.001), but their right-hand ratios did not differ from those of their brothers and male controls. There was no significant difference in left-hand 2D:4D ratios between MtF GD patients, and their brothers, or female and male controls. FtM GD patients showed significantly masculinized right-hand 2D:4D ratios, while there was no evidence of feminization in MtF GD patients.
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Affiliation(s)
- Şenol Turan
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Social Sciences and Humanities, Ankara Social Sciences University, Ankara, Turkey
| | - Mahmut Cem Tarakçıoğlu
- Department of Child and Adolescent Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Tarık Sağlam
- Department of Psychiatry, Halil Şıvgın Çubuk State Hospital, Ankara, Turkey
| | - Ahmet Yassa
- Department of Psychiatry, Yozgat State Hospital, Yozgat, Turkey
| | - Hasan Bakay
- Department of Psychiatry, Nizip State Hospital, Gaziantep, Turkey
| | - Ömer Faruk Demirel
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
| | - Musa Tosun
- Department of Psychiatry, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa-Fatih, 34098, Istanbul, Turkey
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Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020; 19:267-276. [PMID: 32020566 DOI: 10.1007/s42000-020-00174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Fernández R, Ramírez K, Gómez-Gil E, Cortés-Cortés J, Mora M, Aranda G, Zayas ED, Esteva I, Almaraz MC, Guillamon A, Pásaro E. Gender-Affirming Hormone Therapy Modifies the CpG Methylation Pattern of the ESR1 Gene Promoter After Six Months of Treatment in Transmen. J Sex Med 2020; 17:1795-1806. [PMID: 32636163 DOI: 10.1016/j.jsxm.2020.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 04/25/2020] [Accepted: 05/27/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Brain sexual differentiation is a process that results from the effects of sex steroids on the developing brain. Evidence shows that epigenetics plays a main role in the formation of enduring brain sex differences and that the estrogen receptor α (ESR1) is one of the implicated genes. AIM To analyze whether the methylation of region III (RIII) of the ESR1 promoter is involved in the biological basis of gender dysphoria. METHODS We carried out a prospective study of the CpG methylation profile of RIII (-1,188 to -790 bp) of the ESR1 promoter using bisulfite genomic sequencing in a cisgender population (10 men and 10 women) and in a transgender population (10 trans men and 10 trans women), before and after 6 months of gender-affirming hormone treatment. Cisgender and transgender populations were matched by geographical origin, age, and sex. DNAs were treated with bisulfite, amplified, cloned, and sequenced. At least 10 clones per individual from independent polymerase chain reactions were sequenced. The analysis of 671 bisulfite sequences was carried out with the QUMA (QUantification tool for Methylation Analysis) program. OUTCOMES The main outcome of this study was RIII analysis using bisulfite genomic sequencing. RESULTS We found sex differences in RIII methylation profiles in cisgender and transgender populations. Cismen showed a higher methylation degree than ciswomen at CpG sites 297, 306, 509, and at the total fragment (P ≤ .003, P ≤ .026, P ≤ .001, P ≤ .006). Transmen showed a lower methylation level than trans women at sites 306, 372, and at the total fragment (P ≤ .0001, P ≤ .018, P ≤ .0107). Before the hormone treatment, transmen showed the lowest methylation level with respect to cisgender and transgender populations, whereas transwomen reached an intermediate methylation level between both the cisgender groups. After the hormone treatment, transmen showed a statistically significant methylation increase, whereas transwomen showed a non-significant methylation decrease. After the hormone treatment, the RIII methylation differences between transmen and transwomen disappeared, and both transgender groups reached an intermediate methylation level between both the cisgender groups. CLINICAL IMPLICATIONS Clinical implications in the hormonal treatment of trans people. STRENGTHS & LIMITATIONS Increasing the number of regions analyzed in the ESR1 promoter and increasing the number of tissues analyzed would provide a better understanding of the variation in the methylation pattern. CONCLUSIONS Our data showed sex differences in RIII methylation patterns in cisgender and transgender populations before the hormone treatment. Furthermore, before the hormone treatment, transwomen and transmen showed a characteristic methylation profile, different from both the cisgender groups. But the hormonal treatment modified RIII methylation in trans populations, which are now more similar to their gender. Therefore, our results suggest that the methylation of RIII could be involved in gender dysphoria. Fernández R, Ramírez K, Gómez-Gil E, et al. Gender-Affirming Hormone Therapy Modifies the CpG Methylation Pattern of the ESR1 Gene Promoter After Six Months of Treatment in Transmen. J Sex Med 2020;17:1795-1806.
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Affiliation(s)
- Rosa Fernández
- Departamento de Psicología, Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña (UDC), Campus de Elviña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), CHUAC, SERGAS, A Coruña, Spain.
| | - Karla Ramírez
- Departamento de Psicología, Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña (UDC), Campus de Elviña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), CHUAC, SERGAS, A Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Instituto de Neurociencias, Hospital Clínic, I.D.I.B.A.P.S., Barcelona, Spain
| | - Joselyn Cortés-Cortés
- Departamento de Psicología, Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña (UDC), Campus de Elviña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), CHUAC, SERGAS, A Coruña, Spain
| | - Mireia Mora
- Departmento de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain
| | - Gloria Aranda
- Departmento de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain
| | - Enrique Delgado Zayas
- Departamento de Psicología, Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña (UDC), Campus de Elviña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), CHUAC, SERGAS, A Coruña, Spain
| | - Isabel Esteva
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género del Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Mari Cruz Almaraz
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género del Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Centro de Investigaciones Científicas Avanzadas (CICA), Universidade da Coruña (UDC), Campus de Elviña, A Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), CHUAC, SERGAS, A Coruña, Spain
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Gómez Jiménez FR, Semenyna SW, Vasey PL. The relationship between fraternal birth order and childhood sex‐atypical behavior among the Istmo Zapotec
muxes. Dev Psychobiol 2020; 62:792-803. [DOI: 10.1002/dev.21987] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Affiliation(s)
| | - Scott W. Semenyna
- Department of Psychology University of Lethbridge Lethbridge Alberta Canada
| | - Paul L. Vasey
- Department of Psychology University of Lethbridge Lethbridge Alberta Canada
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Analysis of Four Polymorphisms Located at the Promoter of the Estrogen Receptor Alpha ESR1 Gene in a Population With Gender Incongruence. Sex Med 2020; 8:490-500. [PMID: 32409288 PMCID: PMC7471065 DOI: 10.1016/j.esxm.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/28/2020] [Accepted: 04/05/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gender incongruence defines a state in which individuals feel discrepancy between the sex assigned at birth and their gender. Some of these people make a social transition from male to female (trans women) or from female to male (trans men). By contrast, the word cisgender describes a person whose gender identity is consistent with their sex assigned at birth. AIM To analyze the implication of the estrogen receptor α gene (ESR1) in the genetic basis of gender incongruence. MAIN OUTCOME MEASURES Polymorphisms rs9478245, rs3138774, rs2234693, rs9340799. METHOD We carried out the analysis of 4 polymorphisms located at the promoter of the ESR1 gene (C1 = rs9478245, C2 = rs3138774, C3 = rs2234693, and C4 = rs9340799) in a population of 273 trans women, 226 trans men, and 537 cis gender controls. For SNP polymorphisms, the allele and genotype frequencies were analyzed by χ2 test. The strength of the SNP associations with gender incongruence was measured by binary logistic regression. For the STR polymorphism, the mean number of repeats were analyzed by the Mann-Whitney U test. Measurement of linkage disequilibrium and haplotype frequencies were also performed. RESULTS The C2 median repeats were shorter in the trans men population. Genotypes S/S and S/L for the C2 polymorphism were overrepresented in the trans men group (P = .012 and P = .003 respectively). We also found overtransmission of the A/A genotype (C4) in the trans men population (P = .017), while the A/G genotype (C4) was subrepresented (P = .009]. The analyzed polymorphisms were in linkage disequilibrium. In the trans men population, the T(C1)-L(C2)-C(C3)-A(C4) haplotype was overrepresented (P = .019) while the T(C1)-L(C2)-C(C3)-G(C4) was subrepresented (P = .005). CONCLUSION The ESR1 is associated with gender incongruence in the trans men population. Fernández R, Delgado-Zayas E,RamírezK, et al. Analysis of Four Polymorphisms Located at the Promoter of the Estrogen Receptor Alpha ESR1 Gene in a Population With Gender Incongruence. Sex Med 2020;8:490-500.
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Gómez Jiménez FR, Semenyna SW, Vasey PL. Offspring Production Among the Relatives of Istmo Zapotec Men and Muxes. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:581-594. [PMID: 31897830 DOI: 10.1007/s10508-019-01611-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
Male androphilia (i.e., sexual attraction toward adult males) is influenced by biological factors, reliably occurs across diverse cultures, and has persisted over evolutionary time despite the fact that it reduces reproduction. One possible solution to this evolutionary paradox is the sexually antagonistic gene hypothesis (SAGH), which states that genes associated with male androphilia reduce reproduction when present in males but increase reproduction when present in their female relatives. The present study tested the SAGH among the Istmo Zapotec-a non-Euro-American culture in Oaxaca, Mexico, where transgender and cisgender androphilic males are known as muxe gunaa and muxe nguiiu, respectively. To test the SAGH, we compared offspring production by the biological relatives of muxe gunaa (n = 115), muxe nguiiu (n = 112), and gynephilic men (i.e., cisgender males who are sexually attracted to adult females; n = 171). The mothers and paternal aunts of muxe gunaa had higher offspring production than those of muxe nguiiu. Additionally, the relatives of muxe gunaa had more offspring than those of gynephilic men, whereas no such differences were found between the families of gynephilic men and muxe nguiiu. Elevated reproduction by the mothers and, particularly the aunts, of muxe gunaa is consistent with the SAGH. However, the absence of group differences between gynephilic men and muxe nguiiu, and the group differences between the two types of muxes are not predicted by the SAGH. This is the first study to demonstrate reproductive differences between kin of transgender and cisgender androphilic males within the same non-Euro-American culture.
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Affiliation(s)
- Francisco R Gómez Jiménez
- Department of Psychology, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Scott W Semenyna
- Department of Psychology, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
| | - Paul L Vasey
- Department of Psychology, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
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Gómez Jiménez FR, Court L, Vasey PL. A Retrospective Study of Childhood Sex-Typed Behavior in Istmo Zapotec Men, Women, and Muxes. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:467-477. [PMID: 31529223 DOI: 10.1007/s10508-019-01544-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 06/10/2023]
Abstract
Previous research has consistently demonstrated that both transgender and cisgender androphilic males (i.e., males attracted to adult males) display and recall higher levels of childhood female-typical behavior (CFTB) and lower levels of childhood male-typical behavior (CMTB) compared to gynephilic males (i.e., males attracted to adult females). In adulthood, the recalled CFTB and CMTB scores of cisgender androphilic males tend to be intermediate to those of opposite-sex-attracted men and women, whereas transgender androphilic males tend to score similar to women. These studies have been mostly conducted in Euro-American cultures. We examined recalled childhood sex-typed behavior (CSTB) among the Istmo Zapotec-a pre-Colombian culture in the Istmo region of Oaxaca, Mexico, where cisgender and transgender androphilic males are recognized as a third gender, known locally as muxes. The present study sought to determine whether Istmo Zapotec men (n = 180), cisgender muxe nguiiu (n = 63), transgender muxe gunaa (n = 120), and women (n = 138) differ with respect to recalled CFTB and CMTB. Our results indicate that men recalled significantly less CFTB and more CMTB than women. Cisgender muxes scored in between men and women. Transgender muxes scored similar to women. These findings provide further evidence that childhood sex-atypical behavior is a cross-culturally universal and normative developmental aspect of male androphilia, regardless of whether it manifests in the cisgender or transgender form. This is the first study to present quantitative data comparing the recalled CSTB of cisgender and transgender androphilic males from within the same non-Euro-American culture.
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Affiliation(s)
- Francisco R Gómez Jiménez
- Department of Psychology, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada.
| | - Lucas Court
- GIGA Neurosciences, University of Liège, Liège, Belgium
| | - Paul L Vasey
- Department of Psychology, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada
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15
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Nguyen HB, Loughead J, Lipner E, Hantsoo L, Kornfield SL, Epperson CN. What has sex got to do with it? The role of hormones in the transgender brain. Neuropsychopharmacology 2019; 44:22-37. [PMID: 30082887 PMCID: PMC6235900 DOI: 10.1038/s41386-018-0140-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 05/23/2018] [Accepted: 06/21/2018] [Indexed: 01/04/2023]
Abstract
Sex differences and hormonal effects in presumed cisgender individuals have been well-studied and support the concept of a mosaic of both male and female "characteristics" in any given brain. Gonadal steroid increases and fluctuations during peri-puberty and across the reproductive lifespan influence the brain structure and function programmed by testosterone and estradiol exposures in utero. While it is becoming increasingly common for transgender and gender non-binary individuals to block their transition to puberty and/or use gender-affirming hormone therapy (GAHT) to obtain their desired gender phenotype, little is known about the impact of these manipulations on brain structure and function. Using sex differences and the effects of reproductive hormones in cisgender individuals as the backdrop, we summarize here the existing nascent neuroimaging and behavioral literature focusing on potential brain and cognitive differences in transgender individuals at baseline and after GAHT. Research in this area has the potential to inform our understanding of the developmental origins of gender identity and sex difference in response to gonadal steroid manipulations, but care is needed in our research questions and methods to not further stigmatize sex and gender minorities.
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Affiliation(s)
- Hillary B Nguyen
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, Philadelphia, PA, USA
| | | | - Emily Lipner
- School of Arts and Sciences, Philadelphia, PA, USA
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - C Neill Epperson
- School of Arts and Sciences, Philadelphia, PA, USA.
- Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA.
- Department of Psychiatry, Philadelphia, PA, USA.
- Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
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Martinerie L, Condat A, Bargiacchi A, Bremont-Weill C, de Vries MC, Hannema SE. MANAGEMENT OF ENDOCRINE DISEASE: Approach to the management of children and adolescents with Gender Dysphoria. Eur J Endocrinol 2018; 179:R219-R237. [PMID: 30049812 DOI: 10.1530/eje-18-0227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 07/07/2018] [Accepted: 07/25/2018] [Indexed: 02/03/2023]
Abstract
Over the past 20 years, the care for transgender adolescents has developed throughout many countries following the "Dutch Approach" initiated in the 90's in pioneer countries as the Netherlands, United States and Canada, with increasing numbers of children and adolescents seeking care in transgender clinics. This medical approach has considerable positive impacts on the psychological outcomes of these adolescents and several studies have been recently published underlining the relative safety of such treatments. This paper reviews the current standards of care for transgender children and adolescents with particular emphasis on disparities among countries and short to medium-term outcomes. Finally it highlights ethical considerations regarding categorization of gender dysphoria, timing of treatment initiation, infertility, and how to deal with the long-term consequences.
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Affiliation(s)
- L Martinerie
- Department of Pediatric Endocrinology, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Diderot University, Sorbonne Paris Cité, Paris, France
- INSERM Unit 1145, Le Kremlin-Bicêtre, France
| | - A Condat
- Department of Adolescent and Child Psychiatry, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- CESP INSERM 1018, ED3C, Université Paris Descartes, Paris, France
| | - A Bargiacchi
- Department of Adolescent and Child Psychiatry, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Bremont-Weill
- Department of Endocrinology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - M C de Vries
- Departments of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
- Departments of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - S E Hannema
- Departments of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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Smith E, Junger J, Pauly K, Kellermann T, Neulen J, Neuschaefer-Rube C, Derntl B, Habel U. Gender incongruence and the brain - Behavioral and neural correlates of voice gender perception in transgender people. Horm Behav 2018; 105:11-21. [PMID: 29981752 DOI: 10.1016/j.yhbeh.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/11/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
The phenomenon of gender incongruence is hypothesized to arise from a discrepant sexual development of the brain and the genitals, contingent on genetic and hormonal mechanisms. We aimed at visualizing transgender identity on a neurobiological level, assuming a higher functional similarity to individuals of the aspired rather than assigned sex. Implementing a gender perception paradigm featuring male and female voice stimuli, behavioral and functional imaging data of transmen were compared to men and women, and to transwomen, respectively. Men had decreased activation in response to voices of the other sex in regions across the frontoparietal and insular cortex, while the activation patterns of women and transmen were characterized by little or no differentiation between male and female voices. Further, transmen had a comparatively high discrimination performance for ambiguous male voices, possibly reflecting a high sensitivity for voices of the aspired sex. Comparing transmen and transwomen yielded only few differences in the processing of male compared to female voices. In the insula, we observed a pattern similar to that of men and women, the neural responses of the transgender group being in accordance with their gender identity rather than assigned sex. Notwithstanding the similarities found dependent on biological sex, the findings support the hypothesis of gender incongruence being a condition in which neural processing modes are partly incongruent with one's assigned sex.
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Affiliation(s)
- Elke Smith
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany.
| | - Jessica Junger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute, Brain Structure-Function Relationships, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Katharina Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute, Brain Structure-Function Relationships, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Thilo Kellermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute, Brain Structure-Function Relationships, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
| | - Joseph Neulen
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - Christiane Neuschaefer-Rube
- Department of Phoniatrics, Pedaudiology and Communication Disorders, Medical School, RWTH Aachen University, Aachen, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany; JARA-BRAIN Institute, Brain Structure-Function Relationships, Forschungszentrum Jülich GmbH and RWTH Aachen University, Aachen, Germany
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18
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Mohammadi MR, Khaleghi A. Transsexualism: A Different Viewpoint to Brain Changes. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:136-143. [PMID: 29739126 PMCID: PMC5953012 DOI: 10.9758/cpn.2018.16.2.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria (or transsexualism) is still unknown, different neuroimaging studies show that structural and functional changes of the brain result from this sexual incongruence. The question here is whether these reported changes form part of the etiology of transsexualism or themselves result from transsexualism culture, behaviors and lifestyle. Responding to this question can be more precise by consideration of cultural neuroscience concepts, particularly the culture–behavior–brain (CBB) loop model and the interactions between behavior, culture and brain. In this article, we first review the studies on the brain of transgender people and then we will discuss the validity of this claim based on the CBB loop model. In summary, transgender individuals experience change in lifestyle, context of beliefs and concepts and, as a result, their culture and behaviors. Given the close relationship and interaction between culture, behavior and brain, the individual’s brain adapts itself to the new condition (culture) and concepts and starts to alter its function and structure.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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19
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The Biological Contributions to Gender Identity and Gender Diversity: Bringing Data to the Table. Behav Genet 2018; 48:95-108. [DOI: 10.1007/s10519-018-9889-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
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20
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Fernández R, Guillamón A, Gómez-Gil E, Esteva I, Almaraz MC, Cortés-Cortés J, Lamas B, Lema E, Pásaro E. Analyses of karyotype by G-banding and high-resolution microarrays in a gender dysphoria population. Genes Genomics 2018; 40:465-473. [DOI: 10.1007/s13258-017-0646-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
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21
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Semenyna SW, VanderLaan DP, Petterson LJ, Vasey PL. Familial Patterning and Prevalence of Male Androphilia in Samoa. JOURNAL OF SEX RESEARCH 2017; 54:1077-1084. [PMID: 27593894 DOI: 10.1080/00224499.2016.1218416] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Previous research established that male androphilia (i.e., sexual arousal and attraction to adult males) clusters in families. Some studies find that male androphilia clusters in both the paternal and maternal lines, while others find that it clusters only in the latter. Most of the research investigating the familial nature of male androphilia has taken place in Western cultural contexts that are problematic for such research because they are characterized by low fertility. To address this, our previous work has examined familial patterning of male androphilia in Samoa, a high-fertility population in which androphilic males are readily identified due to their public status as fa'afafine (a third gender category). Building on this work, the present study replicated the familial nature of male androphilia in Samoa using a sample size that was ~122% larger than the one we previously employed (N = 382, M ±SD age: 29.72 years ±10.16). Samoan fa'afafine had significantly more fa'afafine relatives in their maternal and paternal lines compared to Samoan gynephilic males (p < .001). The prevalence of male androphilia was equivalent across both the paternal and maternal lines (all p > .15). The revised prevalence estimate of male androphilia in Samoa falls between 0.61% and 3.51%.
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Affiliation(s)
| | - Doug P VanderLaan
- b Department of Psychology, University of Toronto Mississauga; Underserved Populations Research Program, Child, Youth and Family Division , Centre for Addiction and Mental Health
| | | | - Paul L Vasey
- a Department of Psychology , University of Lethbridge
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22
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Funktionelle Magnetresonanztomographie bei Trans*Menschen. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-016-0111-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1615-48. [PMID: 27255307 PMCID: PMC4987404 DOI: 10.1007/s10508-016-0768-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 05/22/2023]
Abstract
The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain.
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Affiliation(s)
- Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, c/Juand del Rosal, 10, 28040, Madrid, Spain.
- Academia de Psicología de España, Madrid, Spain.
| | - Carme Junque
- Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Esther Gómez-Gil
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Unidad de Identidad de Género, Hospital Clinic, Barcelona, Spain
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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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25
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Smith ES, Junger J, Derntl B, Habel U. The transsexual brain – A review of findings on the neural basis of transsexualism. Neurosci Biobehav Rev 2015; 59:251-66. [DOI: 10.1016/j.neubiorev.2015.09.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/18/2015] [Accepted: 09/20/2015] [Indexed: 12/30/2022]
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Nakachi Y, Iseki M, Yokoo T, Mizuno Y, Okazaki Y. Gene expression profile of the neonatal female mouse brain after administration of testosterone propionate. J Sex Med 2015; 12:887-96. [PMID: 25630233 DOI: 10.1111/jsm.12802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Clinical care decisions for peripubertal adolescents with gender dysphoria (GD) should be made carefully. Furthermore, the identification of biomarkers is very important for rapid and accurate diagnosis of GD in young people. AIM The aim of this study was to investigate gene expression profiles during masculinization of the neonatal female mouse brain by testosterone and to identify biomarkers related to GD. METHODS Microarray analysis was performed using RNAs extracted from the brains of neonatal mice treated by intraperitoneal injection of testosterone propionate during the sexual determination period. Sequence motif enrichment analysis for sex hormone receptor responsive elements was performed for the flanking regions of genes that showed significant expression changes following administration of testosterone propionate. MAIN OUTCOME MEASURES We revealed a gene set with marked changes in expression during brain masculinization of neonatal female mice following administration of testosterone propionate. RESULTS We identified 334 genes that showed differential expression in the masculinized neonatal female brain after testosterone propionate treatment. Interestingly, most of these genes are not reported to be expressed in a sexually dimorphic manner. Moreover, sequence motif enrichment analysis suggested that masculinization of the neonatal female brain by testosterone was controlled more by estrogen receptors than androgen receptors. CONCLUSIONS Differences in genes that are expressed differentially following administration of testosterone injection from known sexually dimorphic genes suggest that many GD-related genes are upregulated during female brain masculinization. The gene set identified in this study provides a basis to better understand the mechanisms of GD and delineate its associated biomarkers.
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Affiliation(s)
- Yutaka Nakachi
- Division of Translational Research, Research Center for Genomic Medicine, Saitama Medical University, Hidaka, Saitama, Japan
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27
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Autism Spectrum Disorder Risk Factors and Autistic Traits in Gender Dysphoric Children. J Autism Dev Disord 2014; 45:1742-50. [DOI: 10.1007/s10803-014-2331-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Junger J, Habel U, Bröhr S, Neulen J, Neuschaefer-Rube C, Birkholz P, Kohler C, Schneider F, Derntl B, Pauly K. More than just two sexes: the neural correlates of voice gender perception in gender dysphoria. PLoS One 2014; 9:e111672. [PMID: 25375171 PMCID: PMC4222943 DOI: 10.1371/journal.pone.0111672] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/03/2014] [Indexed: 01/28/2023] Open
Abstract
Gender dysphoria (also known as “transsexualism”) is characterized as a discrepancy between anatomical sex and gender identity. Research points towards neurobiological influences. Due to the sexually dimorphic characteristics of the human voice, voice gender perception provides a biologically relevant function, e.g. in the context of mating selection. There is evidence for a better recognition of voices of the opposite sex and a differentiation of the sexes in its underlying functional cerebral correlates, namely the prefrontal and middle temporal areas. This fMRI study investigated the neural correlates of voice gender perception in 32 male-to-female gender dysphoric individuals (MtFs) compared to 20 non-gender dysphoric men and 19 non-gender dysphoric women. Participants indicated the sex of 240 voice stimuli modified in semitone steps in the direction to the other gender. Compared to men and women, MtFs showed differences in a neural network including the medial prefrontal gyrus, the insula, and the precuneus when responding to male vs. female voices. With increased voice morphing men recruited more prefrontal areas compared to women and MtFs, while MtFs revealed a pattern more similar to women. On a behavioral and neuronal level, our results support the feeling of MtFs reporting they cannot identify with their assigned sex.
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Affiliation(s)
- Jessica Junger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
- * E-mail:
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Sabine Bröhr
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Josef Neulen
- Department of Gynaecological Endocrinology and Reproductive Medicine, Medical School, RWTH Aachen University, Aachen, Germany
| | - Christiane Neuschaefer-Rube
- Department of Phoniatrics, Pedaudiology and Communication Disorders, Medical School, RWTH Aachen University, Aachen, Germany
| | - Peter Birkholz
- Department of Phoniatrics, Pedaudiology and Communication Disorders, Medical School, RWTH Aachen University, Aachen, Germany
| | - Christian Kohler
- Department of Psychiatry, Neuropsychiatry Division, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Frank Schneider
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
| | - Katharina Pauly
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- Jülich Aachen Research Alliance-Translational Brain Medicine, Jülich, Germany
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Fernández R, Esteva I, Gómez‐Gil E, Rumbo T, Almaraz MC, Roda E, Haro‐Mora J, Guillamón A, Pásaro E. The (CA)n Polymorphism of ERβ Gene is Associated with FtM Transsexualism. J Sex Med 2014; 11:720-8. [DOI: 10.1111/jsm.12398] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Esteva de Antonio I, Gómez-Gil E. Coordination of healthcare for transsexual persons: a multidisciplinary approach. Curr Opin Endocrinol Diabetes Obes 2013; 20:585-91. [PMID: 24468763 DOI: 10.1097/01.med.0000436182.42966.31] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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Abstract
This article summarizes for the practicing endocrinologist the current literature on the psychobiology of the development of gender identity and its variants in individuals with disorders of sex development (DSD) or with non-DSD transgenderism. Gender reassignment remains the treatment of choice for strong and persistent gender dysphoria in both categories, but more research is needed on the short-term and long-term effects of puberty-suppressing medications and cross-sex hormones on brain and behavior.
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Affiliation(s)
- Heino F L Meyer-Bahlburg
- New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA.
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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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Diamond M. Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation. INT J TRANSGENDERISM 2013. [DOI: 10.1080/15532739.2013.750222] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guías de práctica clínica para la valoración y tratamiento de la transexualidad. Grupo de Identidad y Diferenciación Sexual de la SEEN (GIDSEEN)*(anexo 1). ACTA ACUST UNITED AC 2012; 59:367-82. [DOI: 10.1016/j.endonu.2012.02.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 02/02/2012] [Accepted: 02/06/2012] [Indexed: 11/18/2022]
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Esteva de Antonio I, Gómez-Gil E, Almaraz MC, Martínez-Tudela J, Bergero T, Olveira G, Soriguer F. [Organization of healthcare for transsexual persons in the Spanish national health system]. GACETA SANITARIA 2012; 26:203-9. [PMID: 22402241 DOI: 10.1016/j.gaceta.2011.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 10/26/2011] [Accepted: 10/26/2011] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Recognition of transexuality as a clinical entity for which medical attention should be available is currently a well-established reality, but institutional care has not been uniformly instituted throughout Spain. The aim of the present study was to determine the current situation of healthcare for transexualism in the publicly-funded health service in Spain. MATERIALS AND METHODS A descriptive study based on data provided by the Spanish Society of Endocrinology Group on Identity and Sexual Differentiation was performed. The resources in the regions that have created specific gender units for these disorders are described. RESULTS Nine autonomous regions (55%) have started to provide various procedures, although only four provide genitoplastic procedures. The first region to include all sex reassignment surgeries was Andalusia (year 1999). At the same time, Madrid and Catalonia also began to provide specialized mental health care and endocrinology but did not include surgical procedures until 2007 and institutional recognition until 2008. Since 2007 other regions have incorporated healthcare for transsexual patients. Overall, 3,303 patients (a male-to female/female-to-male transsexual ratio of 1.9/1) and 864 surgical procedures have been registered in this study. The composition and proportion of working hours of specialists, as well as the kinds of treatments provided, differ widely in each region. CONCLUSIONS The geographical distribution of healthcare to transsexual persons and the services provided vary. Few regions offer genitoplastic procedures. The number of applicants exceeds the number estimated by the national health system.
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Affiliation(s)
- Isabel Esteva de Antonio
- Endocrinología, Unidad de Transexualidad e Identidad de Género de Andalucía, Hospital Regional Universitario Carlos Haya, Málaga, España.
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Heylens G, De Cuypere G, Zucker KJ, Schelfaut C, Elaut E, Vanden Bossche H, De Baere E, T'Sjoen G. Gender identity disorder in twins: a review of the case report literature. J Sex Med 2011; 9:751-7. [PMID: 22146048 DOI: 10.1111/j.1743-6109.2011.02567.x] [Citation(s) in RCA: 160] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The etiology of gender identity disorder (GID) remains largely unknown. In recent literature, increased attention has been attributed to possible biological factors in addition to psychological variables. AIM To review the current literature on case studies of twins concordant or discordant for GID. METHODS A systematic, comprehensive literature review. RESULTS Of 23 monozygotic female and male twins, nine (39.1%) were concordant for GID; in contrast, none of the 21 same-sex dizygotic female and male twins were concordant for GID, a statistically significant difference (P=0.005). Of the seven opposite-sex twins, all were discordant for GID. CONCLUSIONS These findings suggest a role for genetic factors in the development of GID.
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Affiliation(s)
- Gunter Heylens
- Department of Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium.
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Demanda de atención sanitaria en las unidades de identidad de género de Andalucía y Cataluña durante la década 2000 a 2009. Rev Clin Esp 2011; 211:233-9. [DOI: 10.1016/j.rce.2011.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 02/03/2011] [Accepted: 02/06/2011] [Indexed: 11/19/2022]
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Savic I, Garcia-Falgueras A, Swaab DF. Sexual differentiation of the human brain in relation to gender identity and sexual orientation. PROGRESS IN BRAIN RESEARCH 2010; 186:41-62. [DOI: 10.1016/b978-0-444-53630-3.00004-x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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