Transsexualism in a Klinefelter male: a case report

Clinical features and prevalence of Klinefelter syndrome in transgender individuals: A systematic review

OBJECTIVE

Previous studies have suggested a higher prevalence of Klinefelter syndrome amongst transgender individuals. We undertook a systematic review to determine the prevalence of Klinefelter syndrome amongst transgender individuals presumed male at birth and summarize the clinical features and potential treatment implications for individuals with Klinefelter syndrome commencing gender-affirming hormone therapy.

DESIGN

Using preferred reporting items for systematic review and meta-analysis guidelines, we searched EMBASE, MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL) up to 31 December 2021. All studies reporting on the prevalence or clinical features of transgender individuals with Klinefelter syndrome were included. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42021227916.

RESULTS

Our search strategy retrieved 11 cohort studies comprising 1376 transgender individuals. In all, 14 of 1376 (1.02%) individuals were diagnosed with Klinefelter syndrome. Based on the seven studies in which karyotype was undertaken in all individuals, the prevalence is 9/1013 (0.88%; 95% CI, 0.41%-1.68%). Case reports highlight unique treatment considerations in this population, including azoospermia, venous thromboembolism, and monitoring of breast cancer and bone health.

CONCLUSIONS

Compared to the general population, observational studies document a higher prevalence of Klinefelter syndrome amongst transgender individuals, though underdiagnosis in the general population limits conclusions. Routine karyotype in transgender people initiating gender-affirming hormone therapy is not supported unless clinical features of Klinefelter syndrome, such as small testicular volume, or hypergonadotropic hypogonadism are present. Transgender individuals with Klinefelter syndrome need to manage a unique risk profile if they desire feminizing gender-affirming hormone therapy.

Transsexualism in female monozygotic twins: a case report

OBJECTIVE

A case report is presented of a gender identity disorder involving a pair of female monozygotic twins who requested sex reassignment. As far as we know, this case is the first in psychiatric literature and supports a genetic aetiology of this disorder.

CLINICAL PICTURE

The patients were two 18-year-old female monozygotic twins who had showed symptoms of transsexualism since early childhood. They had no other physical or psychiatric disorder except borderline mental functioning.

TREATMENT

The patients were referred for sex reassignment.

OUTCOME

They were lost to follow up after initial evaluation.

CONCLUSION

In addition to other possible (yet not confirmed) causes of transsexualism, a genetic basis for this disorder is suggested by this case.

Psychosexual development in adolescents with chronic medical illnesses

The author provides a literature review and developmental formulation, with the goal to assist clinicians working with medically ill adolescents with psychosexual issues. MEDLINE and PsychINFO database searches of English-language medical journal articles published between 1986 and 1997 for articles related to medical illness and psychosexual development in adolescence were done. The author found that little systematic research on the psychosexual implications of medical illnesses for adolescents has been undertaken, but existing studies suggest that psychosexual development is negatively affected by medical illness. A three-phase model of adolescent psychosexual development is presented, with specific psychosexual tasks associated with each phase. Impediments to progressing through adolescent psychosexual phases due to medical conditions are identified, and case examples are provided. The author concludes that clinicians working with adolescents with medical conditions should attend to the possibility of psychosexual impediments in these adolescents and use developmentally appropriate methods for assessing and treating these difficulties when they arise.

Gender identity disorder in a girl with autism--a case report

A girl with high functioning autism who developed transsexualism is described. The literature to date has, to the authors' knowledge, not documented any similar case. The diagnosis of a coexisting psychiatric disorder in transsexualism has implications for the evaluation, prognosis, and appropriate management of the patient. The question of a possible relationship between autism and transsexualism and whether there is a predisposition to gender dysphoria in autism, is discussed.