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Cotaina M, Peraire M, Boscá M, Echeverria I, Benito A, Haro G. Substance Use in the Transgender Population: A Meta-Analysis. Brain Sci 2022; 12:brainsci12030366. [PMID: 35326322 PMCID: PMC8945921 DOI: 10.3390/brainsci12030366] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
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Affiliation(s)
- Miriam Cotaina
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Marc Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Mireia Boscá
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Iván Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Ana Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain
- Correspondence:
| | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
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Yu P, Fang R, Xue C, Jiang J. Anterior glottoplasty: the effect of inclusion of the vocal fold lamina propria to frequency elevation. Acta Otolaryngol 2022; 142:89-93. [PMID: 34962436 DOI: 10.1080/00016489.2021.2016953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anterior glottoplasty is a commonly used treatment for voice feminization. But it remains in dispute over whether to suture of the ligament as part of the procedure. OBJECTIVES This study aimed to explore the effect of inclusion of the vocal lamina propia. MATERIAL AND METHODS Anterior webs were created in 8 excised canine larynges by sutures placed at 10%, 20%, and 30% of the vocal fold length, respectively. The suture depth was divided into two groups: epithelium layer (Shallow Suture, SS group) and deep layers of vocal fold lamina propia (Deep Suture, DS group). RESULTS For anterior webs between 0% and 30%, the frequency elevation ranged from 3% to 151% of the pre-web fundamental frequency (fo) in SS group and from 13% to 222% in DS group. No significance was found between two groups at three different sutures (p = .486 for suture at 10% of vocal fold length, 0.686 for 20%, 0.886 for 30%, respectively). CONCLUSIONS AND SIGNIFICANCE The frequency in excised canine larynx increased continuously as the anterior glottic webs ranged from 0% to 30%. The inclusion of the vocal fold lamina propia does not affect the frequency elevation.
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Affiliation(s)
- Pengcheng Yu
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Rui Fang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Chao Xue
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
| | - Jack Jiang
- Department of Otolaryngology-Head and Neck Surgery, Eye, Ear, Nose, and Throat Hospital of Fudan University, Shanghai, China
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Goodman M, Adams N, Corneil T, Kreukels B, Motmans J, Coleman E. Size and Distribution of Transgender and Gender Nonconforming Populations: A Narrative Review. Endocrinol Metab Clin North Am 2019; 48:303-321. [PMID: 31027541 DOI: 10.1016/j.ecl.2019.01.001] [Citation(s) in RCA: 100] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Accurate estimates of the number and proportion of transgender and gender nonconforming people in a population are necessary for developing data-based policy and for planning and funding of health care delivery and research. The wide range of estimates reported in the literature is attributable primarily to differences in definitions. Other sources of variability include diverse cultural and geographic settings and important secular trends. The transgender and gender nonconforming population is undergoing rapid changes in size and demographic characteristics. More accurate and precise estimates will be available when population censuses collect data on sex assigned at birth and gender identity.
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Affiliation(s)
- Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Road, Northeast, CNR 3021, Atlanta, GA 30322, USA.
| | | | - Trevor Corneil
- University of British Columbia, School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada
| | - Baudewijntje Kreukels
- Department of Medical Psychology, VU University Medical Center, MF-H243, Van der Boechorststraat 7, 1007 MB Amsterdam, Netherlands
| | - Joz Motmans
- Ghent University Hospital, Blandijnberg 2, 9000 Ghent, Belgium
| | - Eli Coleman
- University of Minnesota, 180 West Bank Office Building, 1300 S Second Street, Minneapolis, MN 55454, USA
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Gender affirmative care of transgender people: a single center's experience in Korea. Obstet Gynecol Sci 2018; 62:46-55. [PMID: 30671393 PMCID: PMC6333764 DOI: 10.5468/ogs.2019.62.1.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/04/2018] [Accepted: 10/10/2018] [Indexed: 11/08/2022] Open
Abstract
Objective To investigate the clinical characteristics and medical management of transgender people in South Korea. Methods The electronic medical records of 54 transgender persons who had visited Soonchunhyang University Hospital from January 2016 to December 2017 for medical care were retrospectively reviewed. We identified patient demographics and gender identity-related characteristics. Moreover, we compared our hospital protocol with official guidelines. Results At the time of the medical record search, the average age of these 52 transgender persons was 27 years, and 46 (88.5%) were Korean. Ten (19.2%) persons had a mental disorder other than gender dysphoria. Gonadotropin-releasing hormone agonist, estrogen, antiandrogen agents, and testosterone were used according to the guidelines issued by the World Professional Association for Transgender Health and the Endocrine Society. Ten (19.2%) transgender persons, including 6 (22.2%) male-to-females (MTFs) and 4 (16.0%) female-to-males (FTMs), had a mental disorder other than gender dysphoria. Among persons who were administered testosterone, 3 had high triglyceride and lipoprotein cholesterol levels. Nine patients, including 6 (66.7%) MTFs and 3 (33.3%) FTMs, underwent both gonadectomy and gender affirmative surgery. Seven (43.8%) persons, including 1 (14.3%) MTF and 6 (85.7%) FTMs, underwent only gonadectomy. There was a significant difference (P=0.040) between MTFs and FTMs. Conclusion Medical providers should have adequate knowledge of and experience in managing transgender persons and be familiar with the relevant guidelines and literature. Long-term follow-up examinations should also be performed.
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Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, De Cuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfäfflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K. Normas de Atención para la salud de personas trans y con variabilidad de género. INT J TRANSGENDERISM 2018. [DOI: 10.1080/15532739.2018.1503902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
SummaryThe role of the mental health professional, and of the psychiatrist in particular, is evolving and changing. As the recognition of transsexualism and gender identity disorder expands across the transgender spectrum, it has been recommended that gender dysphoria should replace existing diagnostic terminology. Patient-focused care is evolving and this article considers the limitations of current healthcare settings and how the mental health professional can support patients undergoing the real-life experience. Differentiation from other mental health conditions that may present as gender dysphoria is outlined, as well as specific clinical situations.
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Bizic MR, Stojanovic B, Djordjevic ML. Genital reconstruction for the transgendered individual. J Pediatr Urol 2017; 13:446-452. [PMID: 28943352 DOI: 10.1016/j.jpurol.2017.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 07/12/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Gender dysphoria is defined as one's belief that his/her body does not reflect his/her true "inner" identification of physical sex and requires medical and/or surgical treatment that will alter his/her body to better reflect what he/she believes is his/her true gender. OBJECTIVE The aim was to describe current surgical techniques available in genital reconstruction for female-to-male (FTM) and male-to-female (MTF) transgender patients. STUDY DESIGN We reviewed recently published papers concerning the most common procedures in genital reconstruction in FTM transgenders and in MTF transgenders. RESULTS There is a wealth of available surgical procedures for FTM transgenders that will adjust their body and genitals toward the male gender. Chest masculinization combined with either metoidioplasty or phalloplasty are the most common procedures resulting in high patient satisfaction. Standardization of the procedures for vaginoplasty in MTF transgenders led to the penile inversion skin technique becoming a "gold standard" for vaginal lining in MTF patients, providing satisfying functional and esthetical outcome of the surgery. In extreme cases of shortage of skin, or when a vaginoplasty has failed, a vaginal lining can be created from hairless skin grafts, or a section of intestine may be used (bowel vaginoplasty). CONCLUSION A multidisciplinary approach including psychiatrists, psychologists, plastic surgeons, urologists, and gynecologists is the only effective treatment in transgenders. The surgeons' familiarity with the surgical procedure and the patients' desired body images should meet at the same level to guarantee a successful outcome.
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Affiliation(s)
- Marta R Bizic
- School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia
| | | | - Miroslav L Djordjevic
- School of Medicine, University of Belgrade, Belgrade, Serbia; University Children's Hospital, Belgrade, Serbia.
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Becerra-Fernández A, Rodríguez-Molina JM, Asenjo-Araque N, Lucio-Pérez MJ, Cuchí-Alfaro M, García-Camba E, Pérez-López G, Menacho-Román M, Berrocal-Sertucha MC, Ly-Pen D, Aguilar-Vilas MV. Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:1307-1312. [PMID: 28224311 DOI: 10.1007/s10508-017-0955-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 06/06/2023]
Abstract
In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.
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Affiliation(s)
- Antonio Becerra-Fernández
- Gender Identity Unit, University Hospital Ramón y Cajal, Madrid, Spain
- Department of Biomedic Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain
| | - José Miguel Rodríguez-Molina
- Gender Identity Unit, University Hospital Ramón y Cajal, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | | | | | | | | | | | - Miriam Menacho-Román
- Department of Clinic Biochemistry, University Hospital Ramón y Cajal, Madrid, Spain
| | | | - Domingo Ly-Pen
- Emergency Department, University Hospital Ramón y Cajal, Madrid, Spain.
- Croydon UCC, Croydon University Hospital, London, CR7 7YE, UK.
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Page S, Burgess J, Davies-Abbott I, Roberts D, Molderson J. Transgender, Mental Health, and Older People: An Appreciative Approach Towards Working Together. Issues Ment Health Nurs 2016; 37:903-911. [PMID: 27740877 DOI: 10.1080/01612840.2016.1233594] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
It cannot be assumed by healthcare providers that transgender people routinely receive care and treatment that is of the quality and sensitivity that should be expected. In particular there are concerns from within the transgender community that they experience discrimination and disrespect from both individual practitioners and the healthcare system as a whole. This causes an avoidance of contact that is undesirable for both users and providers of healthcare services. Older transgender people are vulnerable to a range of mental health problems and, like all elderly, increasingly to dementia; failure to access specialist services in a timely manner may result in unnecessary distress and potentially to crisis. This paper reports on the use of an appreciative inquiry approach towards identifying the opportunities for one health board in North Wales to work more closely with older members of the transgender community it serves.
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Affiliation(s)
- Sean Page
- a Betsi Cadwaladr University Health Board , Bangor , UK Bangor University, Mental Health Division , Bodelwyddan , North Wales, Bangor , United Kingdom
| | - Jenny Burgess
- b Unique Transgender Network, North Wales Partnership Board for Mental Health and the National Forum for Mental Health , Rhyl, North Wales , United Kingdom
| | - Ian Davies-Abbott
- c Betsi Cadwaladr University Health Board, Mental Health Division , Bodelwyddan, North Wales, Bangor , United Kingdom
| | - Debbie Roberts
- d Unique Transgender Network, Sparkle National Transgender Sparkle Manchester Limited Manchester , United Kingdom
| | - Jaanika Molderson
- c Betsi Cadwaladr University Health Board, Mental Health Division , Bodelwyddan, North Wales, Bangor , United Kingdom
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Making It Count: Improving Estimates of the Size of Transgender and Gender Nonconforming Populations. LGBT Health 2016; 3:181-5. [DOI: 10.1089/lgbt.2016.0013] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Guzmán-Parra J, Sánchez-Álvarez N, de Diego-Otero Y, Pérez-Costillas L, Esteva de Antonio I, Navais-Barranco M, Castro-Zamudio S, Bergero-Miguel T. Sociodemographic Characteristics and Psychological Adjustment Among Transsexuals in Spain. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:587-596. [PMID: 25994499 DOI: 10.1007/s10508-015-0557-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 04/07/2015] [Accepted: 04/13/2015] [Indexed: 06/04/2023]
Abstract
This study examined the sociodemographic characteristics and the psychological adjustment of transsexuals in Andalusia (Spain), and also analyzed the differences between female-to-male (FtM) and male-to-female (MtF) transsexuals. The sample included 197 transsexuals (101 MtF and 96 FtM) selected from those who visited the Transsexual and Gender Identity Unit at the Carlos Haya Hospital in Malaga between 2011 and 2012. Our analyses indicated that MtF transsexuals were more likely to have lower educational levels, live alone, have worked less frequently throughout their lifetime, and have engaged in prostitution. For FtM transsexuals, there were more frequent references to the mother's psychiatric history and more social avoidance and distress. Multivariate analysis showed that the number of personality dysfunctional traits and unemployment status were associated with depression in the entire sample. The following three conclusions can be made: there are significant differences between MtF and FtM transsexuals (mainly related to sociodemographic variables), depression was high in both groups, and a remarkable percentage of transsexuals have attempted suicide (22.8 %) or have had suicidal thoughts (52.3 %).
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Affiliation(s)
- José Guzmán-Parra
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain.
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain.
- Grupo Andaluz de Investigación Psicosocial, Málaga, Spain.
| | - Nicolás Sánchez-Álvarez
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain
| | - Yolanda de Diego-Otero
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain
| | - Lucía Pérez-Costillas
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain
| | | | - Miriam Navais-Barranco
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain
| | - Serafina Castro-Zamudio
- Department of Personality, Assessment and Psychological Treatment, University of Malaga, Málaga, Spain
| | - Trinidad Bergero-Miguel
- Mental Health Department, Málaga Plaza Hospital, University Regional Hospital of Málaga, Civil s/n, 29009, Málaga, Spain
- Transsexual and Gender Identity Unit, Málaga, Spain
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Collin L, Reisner SL, Tangpricha V, Goodman M. Prevalence of Transgender Depends on the "Case" Definition: A Systematic Review. J Sex Med 2016; 13:613-26. [PMID: 27045261 DOI: 10.1016/j.jsxm.2016.02.001] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/28/2016] [Accepted: 02/01/2016] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A systematic review and meta-analysis was conducted to evaluate how various definitions of transgender affect prevalence estimates. AIMS To evaluate the epidemiology of transgender and examine how various definitions of transgender affect prevalence estimates and to compare findings across studies that used different methodologies, in different countries, and over different periods. METHODS PubMed, EMBASE, and Medline were searched to identify studies reporting prevalence estimates of transgender in a population. All studies were grouped based on the case definition applied to the numerator. Summary estimates were derived using a random-effects model for total prevalence of transgender and for male-to-female and female-to-male subgroups. Overall and stratum-specific meta-prevalence estimates (mPs) and 95% confidence intervals (CIs) were accompanied by tests for heterogeneity and meta-regressions to assess sources of heterogeneity. MAIN OUTCOME MEASURES The main outcome measure was population prevalence of transgender. Secondary outcomes included gender-specific prevalence estimates for male-to-female and female to male subgroups. RESULTS Thirty-two studies met the inclusion criteria for systematic review. Of those, 27 studies provided necessary data for a meta-analysis. Overall mP estimates per 100,000 population were 9.2 (95% CI = 4.9-13.6) for surgical or hormonal gender affirmation therapy and 6.8 (95% CI = 4.6-9.1) for transgender-related diagnoses. Of studies assessing self-reported transgender identity, the mP was 871 (95% CI = 519-1,224); however, this result was influenced by a single outlier study. After removal of that study, the mP changed to 355 (95% CI = 144-566). Significant heterogeneity was observed in most analyses. CONCLUSION The empirical literature on the prevalence of transgender highlights the importance of adhering to specific case definitions because the results can range by orders of magnitude. Standardized and routine collection of data on transgender status and gender identity is recommended.
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Affiliation(s)
- Lindsay Collin
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Hess J, Hess-Busch Y, Kronier J, Rübben H, Rossi Neto R. Modified Preparation of the Neurovascular Bundle in Male to Female Transgender Patients. Urol Int 2016; 96:354-9. [DOI: 10.1159/000443281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/09/2015] [Indexed: 01/09/2023]
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Glidden D, Bouman WP, Jones BA, Arcelus J. Gender Dysphoria and Autism Spectrum Disorder: A Systematic Review of the Literature. Sex Med Rev 2016; 4:3-14. [DOI: 10.1016/j.sxmr.2015.10.003] [Citation(s) in RCA: 134] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/01/2015] [Indexed: 11/25/2022]
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Raigosa M, Avvedimento S, Yoon TS, Cruz‐Gimeno J, Rodriguez G, Fontdevila J. Male‐to‐Female Genital Reassignment Surgery: A Retrospective Review of Surgical Technique and Complications in 60 Patients. J Sex Med 2015; 12:1837-45. [DOI: 10.1111/jsm.12936] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Systematic Review and Meta-Analysis of Prevalence Studies in Transsexualism. Eur Psychiatry 2015; 30:807-15. [DOI: 10.1016/j.eurpsy.2015.04.005] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 04/22/2015] [Accepted: 04/26/2015] [Indexed: 11/20/2022] Open
Abstract
AbstractBackgroundOver the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data.MethodsDatabases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed.ResultsThe overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years.ConclusionsThe overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.
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Witcomb GL, Bouman WP, Brewin N, Richards C, Fernandez-Aranda F, Arcelus J. Body Image Dissatisfaction and Eating-Related Psychopathology in Trans Individuals: A Matched Control Study. EUROPEAN EATING DISORDERS REVIEW 2015; 23:287-93. [DOI: 10.1002/erv.2362] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/24/2015] [Accepted: 03/27/2015] [Indexed: 12/25/2022]
Affiliation(s)
- Gemma L. Witcomb
- School of Sport, Exercise and Health Sciences; Loughborough University; Loughborough UK
| | - Walter Pierre Bouman
- Nottingham Centre for Gender Dysphoria; Nottinghamshire Healthcare NHS Foundation Trust; Nottingham UK
| | - Nicola Brewin
- Leicestershire Adult Eating Disorder Service; Glenfield Hospital; Leicester UK
| | - Christina Richards
- Nottingham Centre for Gender Dysphoria; Nottinghamshire Healthcare NHS Foundation Trust; Nottingham UK
- Charing Cross Gender Identity Clinic; London UK
| | - Fernando Fernandez-Aranda
- Department of Psychiatry; University Hospital of Bellvitge-IDIBELL and CIBER Fisiopatología de la Obesidad y Nutrición CIBERObn; Barcelona Spain
| | - Jon Arcelus
- School of Sport, Exercise and Health Sciences; Loughborough University; Loughborough UK
- Nottingham Centre for Gender Dysphoria; Nottinghamshire Healthcare NHS Foundation Trust; Nottingham UK
- Leicestershire Adult Eating Disorder Service; Glenfield Hospital; Leicester UK
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Sawyer J, Perry JL, Dobbins-Scaramelli A. A Survey of the Awareness of Speech Services Among Transgender and Transsexual Individuals and Speech-Language Pathologists. Int J Transgend 2015. [DOI: 10.1080/15532739.2014.995260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hess J, Neto RR, Panic L, Rübben H, Senf W. Satisfaction with male-to-female gender reassignment surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:795-801. [PMID: 25487762 PMCID: PMC4261554 DOI: 10.3238/arztebl.2014.0795] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/25/2014] [Accepted: 08/25/2014] [Indexed: 01/28/2023]
Abstract
BACKGROUND The frequency of gender identity disorder is hard to determine; the number of gender reassignment operations and of court proceedings in accordance with the German Law on Transsexuality almost certainly do not fully reflect the underlying reality. There have been only a few studies on patient satisfaction with male-to-female gender reassignment surgery. METHODS 254 consecutive patients who had undergone male-to-female gender reassignment surgery at Essen University Hospital's Department of Urology retrospectively filled out a questionnaire about their subjective postoperative satisfaction. RESULTS 119 (46.9% ) of the patients filled out and returned the questionnaires, at a mean of 5.05 years after surgery (standard deviation 1.61 years, range 1-7 years). 90.2% said their expectations for life as a woman were fulfilled postoperatively. 85.4% saw themselves as women. 61.2% were satisfied, and 26.2% very satisfied, with their outward appearance as a woman; 37.6% were satisfied, and 34.4% very satisfied, with the functional outcome. 65.7% said they were satisfied with their life as it is now. CONCLUSION The very high rates of subjective satisfaction and the surgical outcomes indicate that gender reassignment surgery is beneficial. These findings must be interpreted with caution, however, because fewer than half of the questionnaires were returned.
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Affiliation(s)
- Jochen Hess
- Department of Urology at the University Hospital Essen
| | - Roberto Rossi Neto
- Department of Urology at the University Hospital Essen
- Clinica Urologia, General Hospital Ernesto Simoes Filho, Salvador, Brasilien
| | - Leo Panic
- Department of Urology at the University Hospital Essen
| | | | - Wolfgang Senf
- Department of Psychosomatic Medicine and Psychotherapy, University of Essen
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Dhejne C, Öberg K, Arver S, Landén M. An analysis of all applications for sex reassignment surgery in Sweden, 1960-2010: prevalence, incidence, and regrets. ARCHIVES OF SEXUAL BEHAVIOR 2014; 43:1535-45. [PMID: 24872188 DOI: 10.1007/s10508-014-0300-8] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 12/11/2013] [Accepted: 12/14/2013] [Indexed: 05/10/2023]
Abstract
Incidence and prevalence of applications in Sweden for legal and surgical sex reassignment were examined over a 50-year period (1960-2010), including the legal and surgical reversal applications. A total of 767 people (289 natal females and 478 natal males) applied for legal and surgical sex reassignment. Out of these, 89% (252 female-to-males [FM] and 429 male-to-females [MF]) received a new legal gender and underwent sex reassignment surgery (SRS). A total of 25 individuals (7 natal females and 18 natal males), equaling 3.3%, were denied a new legal gender and SRS. The remaining withdrew their application, were on a waiting list for surgery, or were granted partial treatment. The incidence of applications was calculated and stratified over four periods between 1972 and 2010. The incidence increased significantly from 0.16 to 0.42/100,000/year (FM) and from 0.23 to 0.73/100,000/year (MF). The most pronounced increase occurred after 2000. The proportion of FM individuals 30 years or older at the time of application remained stable around 30%. In contrast, the proportion of MF individuals 30 years or older increased from 37% in the first decade to 60% in the latter three decades. The point prevalence at December 2010 for individuals who applied for a new legal gender was for FM 1:13,120 and for MF 1:7,750. The FM:MF sex ratio fluctuated but was 1:1.66 for the whole study period. There were 15 (5 MF and 10 MF) regret applications corresponding to a 2.2% regret rate for both sexes. There was a significant decline of regrets over the time period.
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Affiliation(s)
- Cecilia Dhejne
- Center for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden,
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Hamada A, Kingsberg S, Wierckx K, T'Sjoen G, De Sutter P, Knudson G, Agarwal A. Semen characteristics of transwomen referred for sperm banking before sex transition: a case series. Andrologia 2014; 47:832-8. [DOI: 10.1111/and.12330] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2014] [Indexed: 11/29/2022] Open
Affiliation(s)
- A. Hamada
- Columbia University; Mount Sinai Medical Center; Miami Beach FL USA
- Cleveland Clinic; Cleveland OH USA
| | - S. Kingsberg
- Case Western Reserve University; Cleveland OH USA
| | | | | | | | - G. Knudson
- University of British Columbia; Vancouver BC Canada
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The development of sex reassignment surgery in Thailand: a social perspective. ScientificWorldJournal 2014; 2014:182981. [PMID: 24772010 PMCID: PMC3977439 DOI: 10.1155/2014/182981] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 03/04/2014] [Indexed: 11/17/2022] Open
Abstract
This paper reviews the development of gender reassignment in Thailand during the period of 1975-2012, in terms of social attitude, epidemiology, surgical patients' profile, law and regulation, religion, and patients' path from psychiatric assessment to surgery. Thailand healthcare for transsexual patients is described. Figures related to the number of sex reassignment surgeries performed in Thailand over the past 30 years are reported. Transsexual individuals are only apparently integrated within the Thail society: the law system of Thailand in fact, does not guarantee to transsexuals the same rights as in other Western countries; the governmental healthcare does not offer free treatments for transsexual patients. In favor of the transsexual healthcare, instead, the Medical Council of Thailand recently published a policy entitled "Criteria for the treatment of sex change, Census 2009." The goal of this policy was to improve the care of transsexual patients in Thailand, by implementing the Standards of Care of the World Professional Association of Transgender Health. Currently, in Thailand, there are 6 major private groups performing sex reassignment surgery, and mostly performing surgery to patients coming from abroad. Particularly, the largest of these (Preecha's group) has performed nearly 3000 vaginoplasties for male-to-female transsexuals in the last 30 years.
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Boada M, Atance M, Joda L, Montanuy H, Oller G, Rocafort E, Vendrell JM, Coroleu B. Transexualidad y reproducción: situación actual desde el punto de vista clínico y legal. Rev Int Androl 2014. [DOI: 10.1016/j.androl.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hedjazi A, Zarenezhad M, Hoseinzadeh A, Hassanzadeh R, Hosseini SMV. Socio-demographic Characteristics of Transsexuals Referred to the Forensic Medicine Center in Southwest of Iran. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2013; 5:224-7. [PMID: 23626960 PMCID: PMC3632028 DOI: 10.4103/1947-2714.109198] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background: Transsexualism or gender identity disorder affects person's gender identity. Aim: This study was to describe socio-demographic characteristics in a population of transsexuals. Materials and Methods: We studied 44 persons of both sexes with diagnostic criteria of gender identity disorder who were referred to the Legal Medicine Organization of Fars, southwest of Iran during the time period 2005-2010. The general practitioners examined the following socio-demographic characteristics and then recorded them in a semi-structured questionnaire, which was developed by the Forensic Medicine Center in Shiraz: Sex, age, educational level, place of residence, marital status, duration of treatment, and employment status. Results: A total of 44 persons (18 (40.9%) males versus 26 (59.1%) females) were referred for sex change during the study period. The sex ratio was 0.69:1. The mean age was 27.6 ± 2.9 years. The majority of patients were diploma and higher diploma education (77.3%), lived in urban areas (81.8%), were employed (56.9%), were single (93.1%), and were under six months of hormonal treatment (61.4%). Conclusions: It seems that social acceptance is lower for male to female transsexuals, since these patients have lower employment and literacy statuses. Further studies should be designed to evaluate and deeper analyze more socio-demographic, clinical, and psychiatric variables about transsexual patients.
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Affiliation(s)
- A Hedjazi
- Department of Forensic Sciences, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
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Meier SC, Labuski CM. The Demographics of the Transgender Population. INTERNATIONAL HANDBOOK ON THE DEMOGRAPHY OF SEXUALITY 2013. [DOI: 10.1007/978-94-007-5512-3_16] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Coleman E, Bockting W, Botzer M, Cohen-Kettenis P, DeCuypere G, Feldman J, Fraser L, Green J, Knudson G, Meyer WJ, Monstrey S, Adler RK, Brown GR, Devor AH, Ehrbar R, Ettner R, Eyler E, Garofalo R, Karasic DH, Lev AI, Mayer G, Meyer-Bahlburg H, Hall BP, Pfaefflin F, Rachlin K, Robinson B, Schechter LS, Tangpricha V, van Trotsenburg M, Vitale A, Winter S, Whittle S, Wylie KR, Zucker K. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend 2012. [DOI: 10.1080/15532739.2011.700873] [Citation(s) in RCA: 993] [Impact Index Per Article: 82.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Berry MG, Curtis R, Davies D. Female-to-male transgender chest reconstruction: a large consecutive, single-surgeon experience. J Plast Reconstr Aesthet Surg 2011; 65:711-9. [PMID: 22189204 DOI: 10.1016/j.bjps.2011.11.053] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 11/07/2011] [Accepted: 11/26/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Chest reconstruction in the female-to-male transgender individual is not a common procedure due to the low prevalence of intractable gender dysphoria. It means that few surgeons acquire sufficient expertise and many UK patients find themselves travelling abroad to centres such as Singapore, Amsterdam and the United States. PATIENTS AND METHODS This study retrospectively evaluated 100 consecutive patients of a single surgeon over a 3-year period with prime outcome measures including surgical technique, complications, surgical revision and patient-reported satisfaction, using a simple, 1-5 linear analogue scoring system. RESULTS The median age was 28 years with a median excision of 345 g per breast. Complications occurred in 11 patients, five of which required surgical haematoma evacuation. Chi(2) analysis failed to show a correlation between testosterone supplementation and haemorrhagic sequelae (p>0.1). To date, 16 patients have undergone supplementary surgery, predominantly axillary dog-ear revision. Overall patient-reported satisfaction was 4.25. CONCLUSIONS Whilst only a part of the process in gender transitioning, chest reconstruction is important as it is frequently the initial surgical procedure and enables the large-breasted to live in their chosen role much more easily. Historically associated with high rates of both complication and revision surgery, this study demonstrates that both may be appreciably lower and associated with high levels of patient satisfaction so that there is a realistic, high-quality option for British patients who might otherwise feel the need to travel abroad for their surgery.
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Affiliation(s)
- M G Berry
- The Institute of Cosmetic & Reconstructive Surgery, London W1 8GR, UK.
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Nuttbrock L, Bockting W, Mason M, Hwahng S, Rosenblum A, Macri M, Becker J. A further assessment of Blanchard's typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. ARCHIVES OF SEXUAL BEHAVIOR 2011; 40:247-57. [PMID: 20039113 PMCID: PMC2894986 DOI: 10.1007/s10508-009-9579-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 09/26/2009] [Accepted: 10/23/2009] [Indexed: 05/11/2023]
Abstract
In a series of important but now highly controversial articles, Blanchard examined associations of sexual orientation and transvestic fetishism among male-to-female (MTF) transgender persons in Toronto, Canada. Transvestic fetishism was rare among the homosexuals but prevalent among the non-homosexuals. Subtypes of non-homosexual MTFs (heterosexual, bisexual, and asexual) were consistently high with regard to transvestic fetishism. Non-linear associations of a continuous measurement of sexual attraction to women (gynephilia) and transvestic fetishism were interpreted in terms of an etiological hypothesis in which transvestic fetishism interferes with the early development of heterosexuality. Blanchard concluded that homosexual versus non-homosexual sexual orientation is a dominant and etiologically significant axis for evaluating and understanding this population. We further assessed these findings among 571 MTFs from the New York City metropolitan area. Using the Life Chart Interview, multiple measurements of transvestic fetishism were obtained and classified as lifetime, lifecourse persistent, adolescent limited, and adult onset. Large (but not deterministic) differences in lifetime, lifecourse persistent, and adolescent limited transvestic fetishism were found between the homosexuals and non-homosexuals. Contrary to Blanchard, differences in transvestic fetishism were observed across subtypes of the non-homosexuals, and linear (not curvilinear) associations were found along a continuous measurement of gynephilia and transvestic fetishism. Age and ethnicity, in addition to sexual orientation, were found to be statistically significant predictors of transvestic fetishism. The clinical, etiological, and sociopolitical implications of these findings are discussed.
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Affiliation(s)
- Larry Nuttbrock
- National Development and Research Institutes, 71 West 23rd Street, New York, NY 10010, USA.
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Lai MC, Chiu YN, Gadow KD, Gau SSF, Hwu HG. Correlates of gender dysphoria in Taiwanese university students. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:1415-28. [PMID: 19937374 DOI: 10.1007/s10508-009-9570-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Revised: 04/24/2009] [Accepted: 09/19/2009] [Indexed: 05/21/2023]
Abstract
There have been no published reports regarding the epidemiological and psychiatric features of gender dysphoria in non-clinical young adults. The current study aimed to investigate the demographics, co-occurring psychiatric symptoms, and perceived parenting style and family support in Taiwanese young adults with gender dysphoria. The sample consisted of 5010 university freshmen (male, 51.6%) with a mean age of 19.6 years (SD = 2.7) from a national university in Taiwan. The questionnaires used for this university-based survey included the Adult Self Report Inventory-4 for psychopathology (including gender dysphoria), the Parental Bonding Instrument for parenting style, and the Family APGAR for perceived family support. Results showed that gender dysphoria was more prevalent in females (7.3%) than males (1.9%). Young adults with gender dysphoria were more likely to meet a wide but specific range of co-occurring psychiatric symptoms. The most significantly associated symptoms for males were agoraphobia, hypochondriasis, manic episode, and pathological gambling, and for females dissociative disorder, hypochondriasis, and body dysmorphic disorder. Both males and females with gender dysphoria perceived significantly less support from their families and less affection/care from both parents. Findings suggest that gender dysphoria, associated with a specific range of psychopathology and family/parenting dissatisfaction (with both similar and dissimilar patterns between sexes), is not uncommon in Taiwanese university students, particularly in females. This implies the importance of attention and specific measures to offset psychiatric conditions and to promote mental well-being of this population.
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Affiliation(s)
- Meng-Chuan Lai
- Department of Psychiatry, National Taiwan University Hospital, No. 7, Chung-Shan South Road, 10002, Taipei, Taiwan
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Lawrence AA. Societal individualism predicts prevalence of nonhomosexual orientation in male-to-female transsexualism. ARCHIVES OF SEXUAL BEHAVIOR 2010; 39:573-583. [PMID: 19067152 DOI: 10.1007/s10508-008-9420-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 07/03/2008] [Accepted: 09/05/2008] [Indexed: 05/25/2023]
Abstract
There are two distinct subtypes of male-to-female (MtF) transsexuals: homosexual and nonhomosexual. The relative prevalence of these two subtypes varies dramatically between countries, but no explanation of this variability has yet been proposed. This study examined the hypothesis that the prevalence of nonhomosexual MtF transsexualism, relative to homosexual MtF transsexualism, would be higher in individualistic countries than in collectivistic countries. I analyzed data from 22 studies of MtF transsexualism, conducted in 16 countries, examining the association between percentage of nonhomosexual participants and Hofstede's (Culture's consequences: Comparing values, behaviors, institutions, and organizations across nations, 2001) Individualism Index (IDV). IDV accounted for 77% of observed variance in the percentage of nonhomosexual MtF participants (r = 0.88, p < .0001). Controlling for differences in national wealth and in Hofstede's other indices of societal values (Power Distance, Uncertainty Avoidance, and Masculinity) did not significantly change the ability of IDV to account for variance in the percentage of nonhomosexual participants. The factors that contribute to the observed association between societal individualism and the relative prevalence of nonhomosexual MtF transsexualism remain to be determined, but a greater tolerance within individualistic countries for socially disruptive gender transitions by nonhomosexual gender dysphoric men, and the availability within many collectivistic countries of socially approved transgender roles for pervasively feminine homosexual gender dysphoric men, are plausible contributors.
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Affiliation(s)
- Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, AB, Canada.
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Biological and psychosocial correlates of adult gender-variant identities: A review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2010. [DOI: 10.1016/j.paid.2009.09.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Novel Technique for Proximal Anchoring of Penile Prostheses in Female-to-male Transsexual. Urology 2009; 74:419-21. [DOI: 10.1016/j.urology.2009.01.044] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 01/22/2009] [Accepted: 01/26/2009] [Indexed: 11/20/2022]
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Winter S. Cultural Considerations for the World Professional Association for Transgender Health'sStandards of Care: The Asian Perspective. Int J Transgend 2009. [DOI: 10.1080/15532730902799938] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Zucker KJ, Lawrence AA. Epidemiology of Gender Identity Disorder: Recommendations for theStandards of Careof the World Professional Association for Transgender Health. Int J Transgend 2009. [DOI: 10.1080/15532730902799946] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Möller B, Schreier H, Li A, Romer G. Gender identity disorder in children and adolescents. Curr Probl Pediatr Adolesc Health Care 2009; 39:117-43. [PMID: 19380105 DOI: 10.1016/j.cppeds.2009.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Birgit Möller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Clinical Center Hamburg, Hamburg, Germany
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Vujovic S, Popovic S, Sbutega-Milosevic G, Djordjevic M, Gooren L. Transsexualism in Serbia: A Twenty-Year Follow-Up Study. J Sex Med 2009; 6:1018-1023. [DOI: 10.1111/j.1743-6109.2008.00799.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sutcliffe P, Dixon S, Akehurst R, Wilkinson A, Shippam A, White S, Richards R, Caddy C. Evaluation of surgical procedures for sex reassignment: a systematic review. J Plast Reconstr Aesthet Surg 2009; 62:294-306; discussion 306-8. [DOI: 10.1016/j.bjps.2007.12.009] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2006] [Revised: 08/06/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE Most previous studies of the prevalence of transsexualism have used data from individuals seeking sex reassignment surgery. New Zealand is unique in that transsexual people can apply to have an 'X' for the sex on their passport if they have a name on their birth certificate that is congruent with the sex opposite to their birth assigned sex, and provide a statutory declaration stating they have lived as a member of that sex. METHOD From information provided by the New Zealand Passports Office, it was ascertained that the prevalence of transsexualism among New Zealand passport holders was at least 1:6364. RESULTS The prevalence of male-to-female transsexualism was estimated at 1:3639, and the corresponding figure for female-to-male transsexualism was 1:22,714. CONCLUSIONS These estimates were higher than most previous estimates of transsexualism prevalence. There was also a larger than expected ratio of male-to-female transsexual people to female-to-male transsexual people (6:1), which could in part be due to female-to-male transsexual people being relatively overrepresented among those transsexual people for whom we did not have data on the direction of sex change, or this may be indicative of the demography of transsexualism in Australasia.
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Affiliation(s)
- Jaimie F Veale
- School of Psychology, Massey University, Auckland, New Zealand.
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Gooren LJ, Giltay EJ. Review of Studies of Androgen Treatment of Female-to-Male Transsexuals: Effects and Risks of Administration of Androgens to Females. J Sex Med 2008; 5:765-776. [DOI: 10.1111/j.1743-6109.2007.00646.x] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kraemer B, Delsignore A, Schnyder U, Hepp U. Body image and transsexualism. Psychopathology 2008; 41:96-100. [PMID: 18033979 DOI: 10.1159/000111554] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2006] [Accepted: 01/25/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND To achieve a detailed view of the body image of transsexual patients, an assessment of perception, attitudes and experiences about one's own body is necessary. To date, research on the body image of transsexual patients has mostly covered body dissatisfaction with respect to body perception. SAMPLING AND METHODS We investigated 23 preoperative (16 male-to-female and 7 female-to-male transsexual patients) and 22 postoperative (14 male-to-female and 8 female-to-male) transsexual patients using a validated psychological measure for body image variables. RESULTS We found that preoperative transsexual patients were insecure and felt unattractive because of concerns about their body image. However, postoperative transsexual patients scored high on attractiveness and self-confidence. Furthermore, postoperative transsexual patients showed low scores for insecurity and concerns about their body. CONCLUSIONS Our results indicate an improvement of body image concerns for transsexual patients following standards of care for gender identity disorder. Follow-up studies are recommended to confirm the assumed positive outcome of standards of care on body image.
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Affiliation(s)
- Bernd Kraemer
- Department of Psychiatry, University Hospital, Zurich, Switzerland.
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Sohn M, Bosinski HAG. Continuing Medical Education: Gender Identity Disorders: Diagnostic and Surgical Aspects (CME). J Sex Med 2007; 4:1193-207; quiz 1208. [PMID: 17727344 DOI: 10.1111/j.1743-6109.2007.00580.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Transsexualism is defined as a strong and persistent cross-gender identification with the patient's persistent discomfort with his or her sex and a sense of inappropriateness in the gender role of that sex (Diagnostic and Statistical Manual of Mental Disorders, fourth revision, text revision [DSM-IV-TR]). The disturbance is not concurrent with a physical intersex condition and causes clinical distress or impairment in social, occupational, or other important areas of functioning. The trained mental health professional is obliged to find out if the patient fulfills the criteria of an irreversible gender transposition and if he or she will benefit from medical (hormonal and surgical) sex-reassignment treatment. If a patient has absolved 12 months of real-life experience and at least 6 months of continuous hormonal treatment, the indication for surgical sex reassignment may be given. Genital sex-reassignment in male-to-female transsexuals includes vaginoplasty, preferably by inversion of penoscrotal skin flaps, clitoroplasty, and vulvoplasty. The operation may be performed in one or two sessions. In contrast to genital reassignment in male-to-female patients, no operative standards are available in female-to-male subjects. Recently, neophallus creation from sensate free forearm flaps has emerged as the most promising approach for those patients who want to have a neophallus. Other alternatives such as metoidoioplasty or neophallus reconstruction from regional flaps exist, but are also accompanied by multiple possible complications and re-interventions. Best results are to be expected when using multidisciplinary teams of plastic surgeons, urologists, gynecologists, and experts in sexual medicine in large volume centers.
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Affiliation(s)
- Michael Sohn
- Department of Urology, Markus-Hospital, Frankfurt, Germany.
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De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R, Hoebeke P, Monstrey S. Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 2006; 22:137-41. [PMID: 17188846 DOI: 10.1016/j.eurpsy.2006.10.002] [Citation(s) in RCA: 154] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2006] [Revised: 10/12/2006] [Accepted: 10/12/2006] [Indexed: 11/20/2022] Open
Abstract
AIM The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. METHODS All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients. RESULTS The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other. DISCUSSION AND CONCLUSION While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.
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Affiliation(s)
- G De Cuypere
- Department of Sexology and Gender Problems, University Hospital Gent, De Pintelaan 185, B-9000 Gent, Belgium.
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Kim TS, Cheon YH, Pae CU, Kim JJ, Lee CU, Lee SJ, Paik IH, Lee C. Psychological burdens are associated with young male transsexuals in Korea. Psychiatry Clin Neurosci 2006; 60:417-21. [PMID: 16884441 DOI: 10.1111/j.1440-1819.2006.01525.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to compare differences of the psychological burdens between young male transsexuals and age-gender matched non-transsexuals with standardized psychiatric rating scales in Korea. A total of 43 biologically unrelated young male transsexuals and 49 age-gender matched non-transsexuals participated in the study. All subjects completed Beck's Depression Inventory (BDI), Social Avoidance and Distress Scale (SADS), Self-Esteem Scale (SES) and Family Adaptability and Cohesion Evaluation Scale (FACES-III). The transsexuals showed significantly higher scores on the BDI (P < 0.0001) and SADS (P = 0.002) and lower scores on the SES (P < 0.0001) and Adaptability and Cohesion subscales (P = 0.016 and P < 0.0001, respectively) of the FACES-III than those of the non-transsexuals. The present study found young male transsexuals may be potentially vulnerable to develop psychiatric and familial problems in comparison with non-transsexuals, at least in Korea, although methodological limitations exist. Further well-designed researches should be launched to confirm this preliminary study.
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Affiliation(s)
- Tae-Suk Kim
- Department of Psychiatry, Kangnam St. Mary's Hospital, Catholic University of Korea College of Medicine, Seoul, Korea
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Parkes G, Hall I. Gender Dysphoria and Cross-Dressing in People With Intellectual Disability: A Literature Review. ACTA ACUST UNITED AC 2006; 44:260-71. [PMID: 16834463 DOI: 10.1352/0047-6765(2006)44[260:gdacip]2.0.co;2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In clinical practice, we have come across people with intellectual disability who have gender dysphoria and cross-dress. Here, we review the literature on this subject and present an illustrative case example. We searched databases, followed-up references from relevant articles, and contacted colleagues in the field. We found nine papers with case examples and one survey. Gender identity problems certainly occur in people with intellectual disabilities, and developmental perspectives are important in assessing and treating them. In some cases autistic spectrum disorder was co-morbid, for individuals with and those without intellectual disability. Aggression was also common. Documented treatments were primarily psychological and social and did not include hormones and sex reassignment surgery. Capacity to consent is a factor that determines treatment.
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Affiliation(s)
- Georgina Parkes
- Department of Mental Health-Learning Disability, St. George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 ORE.
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Sex, Drugs, Violence, and HIV Status Among Male-to-Female Transgender Persons in Houston, Texas. Int J Transgend 2005. [DOI: 10.1300/j485v08n02_07] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Kersting A, Reutemann M, Gast U, Ohrmann P, Suslow T, Michael N, Arolt V. Dissociative disorders and traumatic childhood experiences in transsexuals. J Nerv Ment Dis 2003; 191:182-9. [PMID: 12637845 DOI: 10.1097/01.nmd.0000054932.22929.5d] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this first prevalence study of dissociative symptoms and different forms of childhood experiences among transsexuals, 41 transsexuals and 115 psychiatric inpatients were compared by means of the Interview for Dissociative Disorders (SCID-D-R), the Dissociative Experiences Scale (DES), and the Childhood Trauma Questionnaire (CTQ). The total score for the dissociative symptoms revealed no significant differences between the transsexuals and the psychiatric inpatients. However, the higher DES score among transsexuals compared with a normal population was found to be due largely to one item. A surprisingly high prevalence of emotional maltreatment was recorded. The results suggest that both the DES and the SCID-D-R have limited validity as instruments for screening and diagnosing dissociative disorders in transsexuals. Psychiatrists should be mindful of the possible existence of dissociative disorders in transsexual patients. Further investigations are needed to clarify the effects of traumatic childhood experiences on sexual identity in transsexuals and to throw more light on the phenomenological correlation between transsexualism and dissociative identity, using taxometric analyses.
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Affiliation(s)
- Anette Kersting
- Department of Psychiatry, University of Muenster, D-48129 Muenster, Germany
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