Transsexuality Among Twins: Identity Concordance, Transition, Rearing, and Orientation

Withdrawn: Male-to-female and female-to-male transsexual siblings with pedophilic father: A case report

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The above article, published online on March 5, 2024 in Wiley Online Library (http://wileyonlinelibrary.com), has been withdrawn by agreement between the Journal's Editor-in-Chief, Dr Charles Young, and John Wiley & Sons, Ltd.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.

Early Female Transgender Identity after Prenatal Exposure to Diethylstilbestrol: Report from a French National Diethylstilbestrol (DES) Cohort

Diagnostic of transsexualism and gender incongruence are terms to describe individuals whose self-identity does not match their sex assignment at birth. A transgender woman is an individual assigned male at birth (AMAB) on the basis of the external or internal genitalia who identifies and lives as a woman. In recent decades, a significant increase in the number of transgender people has been reported. Although, its etiology is unknown, biological, anatomical, genetic, environmental and cultural factors have been suggested to contribute to gender variation. In XY animals, it has been shown that environmental endocrine disruptors, through their anti-androgenic activity, induce a female identity. In this work, we described four XY individuals who were exposed in utero to the xenoestrogen diethylstilbesterol (DES) and were part of the French HHORAGES cohort. They all reported a female transgender identity starting from childhood and adolescence. This high prevalence of male to female transgenderism (1.58%) in our cohort of 253 DES sons suggests that exposure to chemicals with xenoestrogen activity during fetal life may affect the male sex identity and behavior.

21st Century Neo-Androgyny: What Is Androgyny Anymore and Why We Should Still Care

The notion of psychological androgyny as a research tool loiters on in an incapacitated state. The lack of a general theory and the belief that the biological gender differences are insignificant to non-existent has been the seeds for its de-construction. Over the decades, the testing of ideas associated with androgyny has declined. Indeed, the debates over its usefulness as a construct ended long ago. The judgment nowadays is that debating the constructs of masculinity, femininity, and androgyny as behavioral traits has been long settled, and a contemporary revisiting of androgyny is not warranted. However, from another contemporary viewpoint, if androgyny is to have any future, it needs a new theory devoid of masculinity and femininity. We present a novel theory with the potential to do just that. This article details a new de-gendered theory of psychological androgyny, neo-androgyny, as a candidate to replace traditional models that are now considered outdated and irrelevant. We present five potential factors for inclusion in a de-gendered model: social efficacy, creativity, capability, eminence, and determination. We review these factors concerning the future of androgyny theory.

Exploring gender dysphoria and related outcomes in a prospective cohort study: protocol for the Swedish Gender Dysphoria Study (SKDS)

INTRODUCTION

There has been a drastic increase in the reported number of people seeking help for gender dysphoria in many countries over the last two decades. Yet, our knowledge of gender dysphoria and related outcomes is restricted due to the lack of high-quality studies employing comprehensive approaches. This longitudinal study aims to enhance our knowledge of gender dysphoria; different aspects will be scrutinised, focusing primarily on the psychosocial and mental health outcomes, prognostic markers and, secondarily, on the underlying mechanisms for its origin.

METHODS AND ANALYSIS

The Swedish Gender Dysphoria Study is an ongoing multicentre longitudinal cohort study with 501 registered participants with gender dysphoria who are 15 years old or older. Participants at different phases of their clinical evaluation process can enter the study, and the expected follow-up duration is three years. The study also includes a comparison group of 458 age- and county-matched individuals without gender dysphoria. Data on the core outcomes of the study, which are gender incongruence and experienced gender dysphoria, body satisfaction and satisfaction with gender-affirming treatments, as well as other relevant outcomes, including mental health, social functioning and life satisfaction, are collected via web surveys. Two different research visits, before and after starting on gender-affirming hormonal treatment (if applicable), are planned to collect respective biological and cognitive measures. Data analysis will be performed using appropriate biostatistical methods. A power analysis showed that the current sample size is big enough to analyse continuous and categorical outcomes, and participant recruitment will continue until December 2022.

ETHICS AND DISSEMINATION

The ethical permission for this study was obtained from the Local Ethical Review Board in Uppsala, Sweden. Results of the study will be presented at national and international conferences and published in peer-reviewed journals. Dissemination will also be implemented through the Swedish Gender Dysphoria Study network in Sweden.

Environmental contaminants, endocrine disruption, and transgender: Can "born that way" in some cases be toxicologically real?

Gender is viewed by many as strictly binary based on a collection of body traits typical of a female or male phenotype, presence of a genotype that includes at least one copy of a Y chromosome, or ability to produce either egg or sperm cells. A growing non-binary view is that these descriptors, while compelling, may nonetheless fail to accurately capture an individual's true gender. The position of the American Psychological Association (APA) agrees with this view and is that transgender people are a defendable and real part of the human population. The considerable diversity of transgender expression then argues against any unitary or simple explanations, however, prenatal hormone levels, genetic influences, and early and later life experiences have been suggested as playing roles in development of transgender identities. The present review considers existing and emerging toxicologic data that may also support an environmental chemical contribution to some transgender identities, and suggest the possibility of a growing nonbinary brain gender continuum in the human population.

Concordance for Gender Dysphoria in Genetic Female Monozygotic (Identical) Triplets

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.

Gender dysphoria in twins: a register-based population study

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.

Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults

In less than a decade, the western world has witnessed an unprecedented rise in the numbers of children and adolescents seeking gender transition. Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. The many risks of these interventions, including medicalizing a temporary adolescent identity, have come into a clearer focus through an awareness of detransitioners. The risks of gender-affirmative care are ethically managed through a properly conducted informed consent process. Its elements-deliberate sharing of the hoped-for benefits, known risks and long-term outcomes, and alternative treatments-must be delivered in a manner that promotes comprehension. The process is limited by: erroneous professional assumptions; poor quality of the initial evaluations; and inaccurate and incomplete information shared with patients and their parents. We discuss data on suicide and present the limitations of the Dutch studies that have been the basis for interventions. Beliefs about gender-affirmative care need to be separated from the established facts. A proper informed consent process can both prepare parents and patients for the difficult choices that they must make and can ease professionals' ethical tensions. Even when properly accomplished, however, some clinical circumstances exist that remain quite uncertain.

Perceptions and Motivations for Uterus Transplant in Transgender Women

IMPORTANCE

Uterus transplant has been demonstrated to be a viable fertility-restoring treatment for women categorized as female at birth with absolute uterine factor infertility. Recent advancements, as well as considerations of fairness and equality in reproductive care, have now led to the possibility of uterus transplant being undertaken in transgender women.

OBJECTIVE

To investigate the reproductive aspirations of transgender women and their perceptions of uterus transplant.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional survey study used a 27-item electronic questionnaire to investigate the reproductive aspirations of 182 transgender women older than 16 years, including their perceptions of and motivations for uterus transplant, between May 1 and November 1, 2019.

MAIN OUTCOMES AND MEASURES

Perceptions of and motivations for uterus transplant, including perceived significance of the ability to gestate, menstruate, and have a physiologically functioning vagina.

RESULTS

A total of 182 transgender women completed the questionnaire; most women (109 [60%]) were aged 20 to 29 years. Most did not have children prior to transitioning (167 [92%]) and expressed a desire to have children in the future (171 [94%]). In addition, most respondents agreed or strongly agreed that the ability to gestate and give birth to children (171 [94%]) and menstruate (161 [88%]) would enhance perceptions of their femininity. Similarly, high proportions strongly agreed or agreed that having a transplanted, functioning vagina would improve their sexual experience (163 [90%]), improve their quality of life (163 [90%]), and help them to feel like more of a woman (168 [92%]). Nearly all respondents (180 [99%]) believed that uterus transplant would lead to greater happiness in transgender women. More than three-quarters of the respondents (140 [77%]) strongly agreed or agreed that they would be more inclined to cryopreserve sperm if uterus transplant became a realistic option.

CONCLUSIONS AND RELEVANCE

This study provides insights into the reproductive aspirations of transgender women and reports on their multifaceted motivation to undergo uterus transplant. The survey responses suggest that transgender women would choose to have female physiologic experiences, such as menstruation and gestation, as well as potentially having a physiologically functioning transplanted vagina. If proven feasible and safe in this setting, uterus transplant may facilitate the achievement of reproductive aspirations, improve quality of life, and further alleviate dysphoric symptoms in transgender women.

Performing Together: Monozygotic Twin Comedians/Twin research: Mirror-Image Cleft Lip and Palate; Dental Caries; Noninvasive Prenatal testing; Capgras Syndrome with Folie à Deux/In the News: Athletic Twins; Transgendered Twins; Crib-Sharing; Common Careers

Twin studies have shown that our sense of humor has an underlying genetic component, but less investigation of the origins of stand-up comedy has been undertaken. This article briefly reviews twin research findings on humor, then describes the working partnership and social affiliation of a pair of monozygotic male twins who perform together as stand-up comedians. The abilities, personalities and temperaments of these twins suggest future avenues for research in this interesting area. Next, findings from twin studies and case reports of twins with cleft lip and palate, dental caries, noninvasive prenatal testing and Capgras syndrome (with folie à deux) are summarized. In conclusion, recent news about athletic twins, transgendered twins, crib-sharing and career choice are presented.

Genetic Link Between Gender Dysphoria and Sex Hormone Signaling

CONTEXT

There is a likely genetic component to gender dysphoria, but association study data have been equivocal.

OBJECTIVE

We explored the specific hypothesis that gender dysphoria in transgender women is associated with variants in sex hormone-signaling genes responsible for undermasculinization and/or feminization.

DESIGN

Subject-control analysis included 380 transgender women and 344 control male subjects. Associations and interactions were investigated between functional variants in 12 sex hormone-signaling genes and gender dysphoria in transgender women.

SETTING

Patients were recruited from the Monash Gender Clinic, Monash Health, Melbourne, Australia, and the University of California, Los Angeles.

PATIENTS

Caucasian (non-Latino) transgender women were recruited who received a diagnosis of transsexualism [Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV) or gender dysphoria (DSM-V)] pre- or postoperatively. Most were receiving hormone treatment at the time of recruitment.

MAIN OUTCOME MEASURED

Genomic DNA was genotyped for repeat length polymorphisms or single nucleotide polymorphisms.

RESULTS

A significant association was identified between gender dysphoria and ERα, SRD5A2, and STS alleles, as well as ERα and SULT2A1 genotypes. Several allele combinations were also overrepresented in transgender women, most involving AR (namely, AR-ERβ, AR-PGR, AR-COMT, CYP17-SRD5A2). Overrepresented alleles and genotypes are proposed to undermasculinize/feminize on the basis of their reported effects in other disease contexts.

CONCLUSION

Gender dysphoria may have an oligogenic component, with several genes involved in sex hormone-signaling contributing.

Transthesia: Comparing the Prevalence of Synesthesia in Transgender and Cisgender Individuals

Purpose: To evaluate the prevalence of synesthesia in transgender versus cisgender individuals.

Methods: A 10-question, self-administered written survey, developed to assess the prevalence of synesthesia, was distributed to transgender individuals (n=96) attending support groups as well as to cisgender participants (n=103) identified among individuals accompanying transgender attendees. Demographic data and prevalence of synesthesia were analyzed using descriptive statistics. Differences between groups were analyzed using a chi-square test.

Results: Forty-two percent of transgender participants endorsed synesthesia compared with 16% of cisgender participants. These findings persisted when analyzed by specific gender identity (i.e., male, female, and nonbinary).

Conclusion: This study suggests a correlation between synesthesia and transgender identity that may indicate a common biological cause. Limitations of this study include use of a survey that has not yet been validated. Initial findings may justify further research.

Familial Patterning and Prevalence of Male Androphilia in Samoa

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%.

Transgender people: health at the margins of society

In this paper we examine the social and legal conditions in which many transgender people (often called trans people) live, and the medical perspectives that frame the provision of health care for transgender people across much of the world. Modern research shows much higher numbers of transgender people than were apparent in earlier clinic-based studies, as well as biological factors associated with gender incongruence. We examine research showing that many transgender people live on the margins of society, facing stigma, discrimination, exclusion, violence, and poor health. They often experience difficulties accessing appropriate health care, whether specific to their gender needs or more general in nature. Some governments are taking steps to address human rights issues and provide better legal protection for transgender people, but this action is by no means universal. The mental illness perspective that currently frames health-care provision for transgender people across much of the world is under scrutiny. The WHO diagnostic manual may soon abandon its current classification of transgender people as mentally disordered. Debate exists as to whether there should be a diagnosis of any sort for transgender children below the age of puberty.

Twinsters the Movie: Reared Apart Twins in Real Time

The 2015 documentary film Twinsters, tells the story of reared-apart MZ female twins, Samantha (Sam) Futerman and Anaïs Bordier. Born in South Korea, the twins were adopted separately as babies by couples living in the United States (Sam) and France (Anaïs). Their chance discovery of one another and their subsequent reunion and relationship are beautifully captured in the 2015 documentary film, Twinsters. Recent interviews with some of their family members are presented in Twin Research and Human Genetics for the first time. This is followed by brief reviews of recent twin research on a heteropagus twin, schizophrenia liability, epigenetics and homosexuality, and transgender-discordant twins. Finally, some newsworthy items are summarized, including the passing of reared-apart MZ twin Jack Yufe, an unusual twin father; identical twin models I; identical twin models II; and a pair of twin marines.