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Moreno JA, Manca R, Albrechet-Souza L, Nel JA, Spantidakis I, Venter Z, Juster RP. A brief historic overview of sexual and gender diversity in neuroscience: past, present, and future. Front Hum Neurosci 2024; 18:1414396. [PMID: 39351068 PMCID: PMC11440198 DOI: 10.3389/fnhum.2024.1414396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/14/2024] [Indexed: 10/04/2024] Open
Affiliation(s)
- Jhon Alexander Moreno
- Department of Psychology, Université de Montréal, Montreal, QC, Canada
- Centre de recherche de l'institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
- Notre-Dame Hospital, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Île-de-Montréal (CCSMTL), Montreal, QC, Canada
| | - Riccardo Manca
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lucas Albrechet-Souza
- Department of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Juan A. Nel
- Department of Psychology, University of South Africa, Pretoria, South Africa
| | | | - Zindi Venter
- Department of Psychology, University of South Africa, Pretoria, South Africa
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
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Ferrin PC, Burghardt E, Peters BR. Phantom sensation in genital gender-affirming surgery: a narrative review. Curr Opin Urol 2024; 34:344-349. [PMID: 38898789 DOI: 10.1097/mou.0000000000001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery. RECENT FINDINGS There is a high prevalence of phantom genital sensations in the TGD population. The prevalence varies by body part, approaching 50% in the most frequently reported transgender phantom - the phantom penis. Unlike genital phantoms that occur after trauma or surgery which are often painful, transgender phantoms are typically neutral and often erogenous in experience. Phantom sensation in the TGD population can be an affirming experience and important part of sexual well being and embodiment. SUMMARY Recent studies have begun to characterize the prevalence and presentations of phantom genital sensations in TGD people, informing our evolving understanding of the sensory experiences of the transgender and gender diverse population. Targeting integration of these centrally-mediated phantom genital sensations with the peripherally generated sensation from genital stimulation may represent one potential avenue to improve sensation and embodiment following genital gender-affirming surgical procedures. Additionally, emerging techniques in modern peripheral nerve surgery targeting phantom pain may offer potential treatment options for painful phantom sensation seen after cases of genital surgery or trauma.
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Affiliation(s)
- Peter C Ferrin
- Oregon Health Sciences University, Department of Surgery
| | - Elliot Burghardt
- Oregon Health Sciences University, Division of Plastic & Reconstructive Surgery
| | - Blair R Peters
- Oregon Health Sciences University, Division of Plastic & Reconstructive Surgery
- Oregon Health Sciences University, Transgender Health Program, Portland, Oregon, USA
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Langer SJ, Caso TJ, Gleichman L. Examining the prevalence of trans phantoms among transgender, nonbinary and gender diverse individuals: An exploratory study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 24:225-233. [PMID: 37114107 PMCID: PMC10128397 DOI: 10.1080/26895269.2022.2164101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Background Trans phantoms are bodily sensations of gendered body parts that a person was not born with (i.e., a phantom penis experienced by a trans man, or a phantom vagina experienced by a trans woman). This is distinct from the experience of many transgender and gender diverse (TGD) people, who experience awareness of their bodies as missing a gendered body part, or configuration, which is a major characteristic of gender dysphoria. Aims Our purpose was to gain greater understanding of the prevalence and quality of trans phantoms. Methods Data was gathered through a brief, online survey on trans embodiment. Respondents who had both completed the survey, and were deemed appropriate for inclusion in the study, based on their survey responses, comprised our sample of 1,446 adults. Results Results indicated that trans phantoms are a typical embodied experience of TGD people. Almost 50% of study participants reported experiencing a trans phantom, most of whom also reported feeling erotic sensation in their phantom. Conclusions Though the phenomenon of trans phantoms is not universal, it is clearly one that warrants further study.
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Affiliation(s)
| | - Taymy Josefa Caso
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
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Thorne N, Yip AKT, Bouman WP, Marshall E, Arcelus J. The terminology of identities between, outside and beyond the gender binary - A systematic review. INT J TRANSGENDERISM 2019; 20:138-154. [PMID: 32999602 PMCID: PMC6830980 DOI: 10.1080/15532739.2019.1640654] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date. Aims: To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities. Methods: A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the International Journal of Transgenderism. The descriptions each title gives for identities outside of the binary are extracted for analysis. Results: Several terms have been used over the years to describe identities outside of the binary. "Non-binary" and "genderqueer" are currently mostly used as umbrella terms. However, "gender diverse" is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities. Discussion: Identity outside of "male" and "female" is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are "non-binary" and "genderqueer." Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary.
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Affiliation(s)
- Nat Thorne
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Kam-Tuck Yip
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Walter Pierre Bouman
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottingham, UK
| | - Ellen Marshall
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Jon Arcelus
- Institute of Mental Health, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Nottingham Centre for Transgender Health, Nottingham, UK
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Consideration of Clozapine and Gender-Affirming Medical Care for an HIV-Positive Person with Schizophrenia and Fluctuating Gender Identity. Harv Rev Psychiatry 2018; 24:406-415. [PMID: 27824636 DOI: 10.1097/hrp.0000000000000120] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hembree WC, Cohen-Kettenis PT, Gooren L, Hannema SE, Meyer WJ, Murad MH, Rosenthal SM, Safer JD, Tangpricha V, T'Sjoen GG. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102:3869-3903. [PMID: 28945902 DOI: 10.1210/jc.2017-01658] [Citation(s) in RCA: 1227] [Impact Index Per Article: 175.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. PARTICIPANTS The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. EVIDENCE This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. CONSENSUS PROCESS Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. CONCLUSION Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
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Affiliation(s)
- Wylie C Hembree
- New York Presbyterian Hospital, Columbia University Medical Center, New York, New York 10032
| | | | - Louis Gooren
- VU University Medical Center, 1007 MB Amsterdam, Netherlands
| | | | - Walter J Meyer
- University of Texas Medical Branch, Galveston, Texas 77555
| | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota 55905
| | - Stephen M Rosenthal
- University of California San Francisco, Benioff Children's Hospital, San Francisco, California 94143
| | - Joshua D Safer
- Boston University School of Medicine, Boston, Massachusetts 02118
| | - Vin Tangpricha
- Emory University School of Medicine and the Atlanta VA Medical Center, Atlanta, Georgia 30322
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Schwarz K, Fontanari AMV, Mueller A, Soll B, da Silva DC, Salvador J, Zucker KJ, Schneider MA, Lobato MIR. Neural Correlates of Psychosis and Gender Dysphoria in an Adult Male. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:761-765. [PMID: 26597648 DOI: 10.1007/s10508-015-0660-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/22/2015] [Accepted: 10/24/2015] [Indexed: 06/05/2023]
Abstract
Gender dysphoria (GD) (DSM-5) or transsexualism (ICD-10) refers to the marked incongruity between the experience of one's gender and the sex at birth. In this case report, we describe the use of LSD as a triggering factor of confusion in the gender identity of a 39-year-old male patient, with symptoms of psychosis and 25 years of substance abuse, who sought psychiatric care with the desire to undergo sex reassignment surgery. The symptoms of GD/psychosis were resolved by two therapeutic measures: withdrawal of psychoactive substances and use of a low-dose antipsychotic. We discuss the hypothesis that the superior parietal cortical area may be an important locus for body image and that symptoms of GD may be related to variations underlying this brain region. Finally, this case report shows that some presentations of GD can be created by life experience in individuals who have underlying mental or, synonymously, neurophysiological abnormalities.
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Affiliation(s)
- Karine Schwarz
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil.
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Anna Martha Vaitses Fontanari
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Andressa Mueller
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Bianca Soll
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Dhiordan Cardoso da Silva
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Jaqueline Salvador
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Kenneth J Zucker
- Gender Identity Clinic, Child, Youth, and Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Maiko Abel Schneider
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Maria Inês Rodrigues Lobato
- Graduate Program in Medical Sciences: Psychiatry, Universidade Federal do Rio Grande do Sul, Ramiro Barcelos, 2400, Porto Alegre, RS, 90035-003, Brazil
- Gender Identity Disorder Program, Hospital de Clinicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Gender identity disorder and schizophrenia: neurodevelopmental disorders with common causal mechanisms? SCHIZOPHRENIA RESEARCH AND TREATMENT 2014; 2014:463757. [PMID: 25548672 PMCID: PMC4274821 DOI: 10.1155/2014/463757] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 11/20/2014] [Indexed: 12/15/2022]
Abstract
Gender identity disorder (GID), recently renamed gender dysphoria (GD), is a rare condition characterized by an incongruity between gender identity and biological sex. Clinical evidence suggests that schizophrenia occurs in patients with GID at rates higher than in the general population and that patients with GID may have schizophrenia-like personality traits. Conversely, patients with schizophrenia may experience alterations in gender identity and gender role perception. Neurobiological research, including brain imaging and studies of finger length ratio and handedness, suggests that both these disorders are associated with altered cerebral sexual dimorphism and changes in cerebral lateralization. Various mechanisms, such as Toxoplasma infection, reduced levels of brain-derived neurotrophic factor (BDNF), early childhood adversity, and links with autism spectrum disorders, may account for some of this overlap. The implications of this association for further research are discussed.
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de Vries ALC, Kreukels BPC, Steensma TD, McGuire JK. Gender Identity Development: A Biopsychosocial Perspective. GENDER DYSPHORIA AND DISORDERS OF SEX DEVELOPMENT 2014. [DOI: 10.1007/978-1-4614-7441-8_3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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