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Pallotti F, Costa D, Hirsch MN, Mercuri V, Di Chiano S, Paoli ED, Faja F, Rizzo F, Lenzi A, Paoli D, Lombardo F, Gargiulo P. Erectile function and androgen and estrogen beta receptor gene polymorphisms in acromegalic men. J Endocrinol Invest 2024; 47:141-147. [PMID: 37306894 PMCID: PMC10776471 DOI: 10.1007/s40618-023-02131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Abstract
PURPOSE Sexual dysfunctions are often experienced by male patients with acromegaly, due to a combination of hypogonadism and other comorbidities, but are a scarcely investigated complication. Erectile dysfunction is also closely related to cardiovascular diseases through endothelial dysfunction. Therefore, this project aimed to assess the prevalence of erectile dysfunction in a population of acromegalic men and evaluate its association with cardio-metabolic disorders, also exploring associations with androgen and estrogen receptor gene polymorphisms. METHODS Sexually active men aged 18-65 with previous diagnosis of acromegaly were recruited. Clinical and laboratory data were retrospectively collected. Each patient also provided a blood sample for AR and ERβ gene polymorphisms analyses and filled out the IIEF-15 questionnaire. RESULTS Twenty men with previous diagnosis of acromegaly (mean age 48.4 ± 10.0 years) were recruited. 13/20 subjects (65%) had erectile dysfunction, but only four had a concurrent biochemical hypogonadism, with no significant correlation with IIEF-15 scores. Total testosterone negatively correlated with sexual intercourse satisfaction domain (ρ = - 0.595; p = 0.019) and general satisfaction domain (ρ = - 0.651; p = 0.009). IGF-1 levels negatively correlated with biochemical hypogonadism (ρ = - 0.585; p = 0.028). The number of CAG and CA repeats in AR and ERβ receptors genes was not significantly associated with IIEF-15 scores or with GH/IGF-1 levels, but a negative correlation between CA repeats and the presence of cardiomyopathy (ρ = - 0.846; p = 0.002) was present. CONCLUSIONS Men with acromegaly have a high prevalence of erectile dysfunction, but it does not appear to be correlated with treatments, testosterone levels and AR/ER-beta signaling. Nonetheless, a shorter CA polymorphic trait (ERbeta) is associated with the presence of cardiomyopathy. If confirmed, these data may suggest an association between an incorrect hormonal balance and increased cardiovascular risk in acromegaly subjects.
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Affiliation(s)
- F Pallotti
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
- Faculty of Medicine and Surgery, University of Enna "Kore", Contrada Santa Panasia, 94100, Enna, Italy
| | - D Costa
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - M N Hirsch
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - V Mercuri
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - S Di Chiano
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - E D Paoli
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Faja
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Rizzo
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - A Lenzi
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - D Paoli
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - F Lombardo
- Laboratory of Seminology‑Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - P Gargiulo
- Department of Experimental Medicine, "Sapienza" University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Fernández R, Zubiaurre-Elorza L, Santisteban A, Ojeda N, Collet S, Kiyar M, T'Sjoen G, Mueller SC, Guillamon A, Pásaro E. CBLL1 is hypomethylated and correlates with cortical thickness in transgender men before gender affirming hormone treatment. Sci Rep 2023; 13:21609. [PMID: 38062063 PMCID: PMC10703770 DOI: 10.1038/s41598-023-48782-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
Gender identity refers to the consciousness of being a man, a woman or other condition. Although it is generally congruent with the sex assigned at birth, for some people it is not. If the incongruity is distressing, it is defined as gender dysphoria (GD). Here, we measured whole-genome DNA methylation by the Illumina © Infinium Human Methylation 850k array and reported its correlation with cortical thickness (CTh) in 22 transgender men (TM) experiencing GD versus 25 cisgender men (CM) and 28 cisgender women (CW). With respect to the methylation analysis, TM vs. CW showed significant differences in 35 CpGs, while 2155 CpGs were found when TM vs. CM were compared. With respect to correlation analysis, TM showed differences in methylation of CBLL1 and DLG1 genes that correlated with global and left hemisphere CTh. Both genes were hypomethylated in TM compared to the cisgender groups. Early onset TM showed a positive correlation between CBLL1 and several cortical regions in the frontal (left caudal middle frontal), temporal (right inferior temporal, left fusiform) and parietal cortices (left supramarginal and right paracentral). This is the first study relating CBLL1 methylation with CTh in transgender persons and supports a neurodevelopmental hypothesis of gender identity.
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Affiliation(s)
- Rosa Fernández
- Centro Interdisciplinar de Química E Bioloxía - CICA. Departamento de Psicología, Universidade da Coruña, Grupo DICOMOSA, Campus Elviña S/N, 15071, A Coruña, Spain.
- Instituto de Investigación Biomédica de A Coruña (INIBIC), 15071, Oza, A Coruña, Spain.
| | - Leire Zubiaurre-Elorza
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - Andrea Santisteban
- Centro Interdisciplinar de Química E Bioloxía - CICA. Departamento de Psicología, Universidade da Coruña, Grupo DICOMOSA, Campus Elviña S/N, 15071, A Coruña, Spain
| | - Natalia Ojeda
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad de Deusto, Bilbao, Spain
| | - Sarah Collet
- Department of Endocrinology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Meltem Kiyar
- Department of Experimental Clinical and Health Psychology, Ghent University, 9000, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Center for Sexology and Gender, Ghent University Hospital, 9000, Ghent, Belgium
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, 9000, Ghent, Belgium
| | - Antonio Guillamon
- Departamento de Psicobiología, Facultad de Psicología, Universidad Nacional de Educación a Distancia, 28040, Madrid, Spain.
| | - Eduardo Pásaro
- Centro Interdisciplinar de Química E Bioloxía - CICA. Departamento de Psicología, Universidade da Coruña, Grupo DICOMOSA, Campus Elviña S/N, 15071, A Coruña, Spain
- Instituto de Investigación Biomédica de A Coruña (INIBIC), 15071, Oza, A Coruña, Spain
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Balthazart J, Roselli CE. Hormonal, Genetic, Immunological: An Array of Mechanisms but How Do They Interact, If at All? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2963-2971. [PMID: 36376746 DOI: 10.1007/s10508-022-02469-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 10/28/2022] [Accepted: 10/30/2022] [Indexed: 05/20/2023]
Affiliation(s)
| | - Charles E Roselli
- Department of Chemical, Physiology & Biochemistry, Oregon Health & Science University, Portland, OR, USA
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Pallotti F, Senofonte G, Conflitti AC, Giancotti A, Anzuini A, Delli Paoli E, Di Chiano S, Faja F, Gatta V, Mondo A, Mosconi M, Rizzo F, Spiniello L, Lombardo F, Paoli D. Safety of gender affirming treatment in assigned female at birth transgender people and association of androgen and estrogen β receptor polymorphisms with clinical outcomes. Endocrine 2023; 81:621-630. [PMID: 37326767 DOI: 10.1007/s12020-023-03421-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Gender affirming hormone treatment (GAHT) with androgens in assigned female at birth (AFAB) people with Gender Incongruence (GI) can induce and maintain variable phenotypical changes, but individual response may be genetically determined. To clarify the role of AR and ERβ polymorphisms we prospectively evaluated AFAB subjects undergoing virilizing GAHT. METHODS Fifty-two AFAB people with confirmed GI were evaluated before (T0) and after 6 (T6) and 12 months (T12) of testosterone enanthate 250 mg i.m. every 28 days. Hormone profile (testosterone, estradiol), biochemical (blood count, glyco-metabolic profile) and clinical parameters (Ferriman-Gallwey score, pelvic organs) were evaluated at each time-point, as well as number of CAG and CA repeats for AR and ERβ, respectively. RESULTS All subjects have successfully achieved testosterone levels within normal male ranges and improved their degree of virilization, in absence of significant side effects. Hemoglobin, hematocrit and red blood cells were significantly increased after treatment, but within normal ranges. Ultrasound monitoring of pelvic organs showed their significant reduction already after 6 months of GATH, in absence of remarkable abnormalities. Furthermore, a lower number of CAG repeats was associated with a higher Ferriman-Gallwey score post treatment and a higher number of CA repeats was associated with uterine volume reduction. CONCLUSION We confirmed safety and efficacy of testosterone treatment on all measured parameters. This preliminary data hints a future role of genetic polymorphisms to tailor GAHT in GI people, but evaluation on a larger cohort is necessary as the reduced sample size could limit data generalization at this stage.
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Affiliation(s)
- Francesco Pallotti
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy.
- Faculty of Medicine and Surgery, University of Enna "Kore", 94100, Enna, Italy.
| | - Giulia Senofonte
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Anna Chiara Conflitti
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Antonella Giancotti
- Prenatal Diagnosis Centre, Department of Obstetrics, Gynaecology and Urologic Science, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Antonella Anzuini
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Enrico Delli Paoli
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Silvia Di Chiano
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Fabiana Faja
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Valentina Gatta
- Department of Psychological Health and Territorial Sciences, School of Medicine and Health Sciences, "G. d'Annunzio" University of Chieti-Pescara, 66100, Chieti, Italy
- Unit of Molecular Genetics, Center for Advanced Studies and Technology (CAST), "G. d'Annunzio" University of Chieti-Pescara, 66100, Chieti, Italy
| | - Alessandro Mondo
- Prenatal Diagnosis Centre, Department of Obstetrics, Gynaecology and Urologic Science, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Maddalena Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, 00152, Rome, Italy
| | - Flavio Rizzo
- Section of Medical Pathophysiology and Endocrinology, Department of Experimental Medicine, Sapienza University of Rome, 00161, Rome, Italy
| | - Lorenzo Spiniello
- Prenatal Diagnosis Centre, Department of Obstetrics, Gynaecology and Urologic Science, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Francesco Lombardo
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
| | - Donatella Paoli
- Laboratory of Seminology - Sperm Bank "Loredana Gandini", Department of Experimental Medicine, "Sapienza" University of Rome, 00161, Rome, Italy
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Gupta R. Gender Affirmation in India—The Current State of Knowledge, Management, Legal and Legislative Situation. Indian J Plast Surg 2022; 55:139-143. [PMID: 36017406 PMCID: PMC9398521 DOI: 10.1055/s-0041-1740528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A mismatch between the birth sex of a person and psychological recognition of self (gender) leads to a gender expression, which is at variance with the societal norms, and thus gives rise to gender incongruence (GI). In the past few years, there has been a significant change in demographics, understanding of etiology, management, laws and legislations in the field of GI. The authors, who have been performing gender affirmative surgeries (GAS) since the past 27 years, present their experience in gender affirmation together with the current state of knowledge. Recent studies report a significant rise in prevalence of GI, which is similar to the experience of author and other large volume Gender identity clinics in India and worldwide. This article endeavors to provide the medical professional with the current state of knowledge in the field of GI, so that they are better equipped to optimally manage these patients.
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Affiliation(s)
- Richie Gupta
- Department of Plastic, Aesthetic and Reconstructive Surgery, and Gender Identity Clinic, Fortis Hospital, Delhi, India
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6
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Should chromosomal analysis be performed routinely during the baseline evaluation of the gender affirmation process? The outcomes of a large cohort of gender dysphoric individuals. Int J Impot Res 2022:10.1038/s41443-022-00582-4. [PMID: 35581420 DOI: 10.1038/s41443-022-00582-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 04/28/2022] [Accepted: 05/03/2022] [Indexed: 11/08/2022]
Abstract
The role of genetics in the etiology of gender dysphoria (GD) is an important yet understudied area. Yet whether genetic analysis should be carried out during the gender affirmation process at all is a matter of debate. This study aims to evaluate the cytogenetic and molecular genetic findings of individuals with GD. We retrospectively reviewed the medical records of individuals with GD who were followed up in a tertiary clinic. After the exclusion criteria were applied, the study sample consisted of 918 individuals with GD; 691 of whom had female-to-male (FtM) and 227 male-to-female (MtF) GD. The cytogenetic analysis revealed that 223 out of 227 (98.2%) individuals with MtF GD had the 46,XY karyotype, while 683 out of 691 (98.8%) individuals with FtM GD had the 46,XX karyotype. In the Y chromosome microdeletion analysis, azospermic factor c (AZFc) deletion was detected in only two individuals with MtF GD. Our findings suggest that there are few chromosomal abnormalities in individuals with GD. Thus, this research calls into question both the role of chromosomal abnormalities in GD etiology and why the application of chromosomal analysis is in Turkey a routine part of the baseline evaluation of GD.
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Zubiaurre-Elorza L, Cerdán S, Uribe C, Pérez-Laso C, Marcos A, Rodríguez del Cerro MC, Fernandez R, Pásaro E, Guillamon A. The Effects of Testosterone on the Brain of Transgender Men. ANDROGENS: CLINICAL RESEARCH AND THERAPEUTICS 2021; 2:252-260. [PMID: 35024694 PMCID: PMC8744429 DOI: 10.1089/andro.2021.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 01/28/2023]
Abstract
Transgender men (TM) experience an incongruence between the female sex assigned when they were born and their self-perceived male identity. Some TM seek for a gender affirming hormone treatment (GAHT) to induce a somatic transition from female to male through continuous administration of testosterone. GAHT seems to be relatively safe. However, testosterone produces structural changes in the brain as detected by quantitative magnetic resonance imaging. Mainly, it induces an increase in cortical volume and thickness and subcortical structural volume probably due to the anabolic effects. Animal models, specifically developed to test the anabolic hypothesis, suggest that testosterone and estradiol, its aromatized metabolite, participate in the control of astrocyte water trafficking, thereby controlling brain volume.
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Affiliation(s)
- Leire Zubiaurre-Elorza
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Sebastian Cerdán
- Instituto de Investigaciones Biomédicas Alberto Sols, Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Carme Uribe
- Institute of Neuroscience, University of Barcelona, Barcelona, Spain
| | - Carmen Pérez-Laso
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Alberto Marcos
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | | | - Rosa Fernandez
- Departamento de Psicología, Facultade de Ciencias da Educación, Universidade da Coruña, A Coruña, Spain
| | - Eduardo Pásaro
- Departamento de Psicología, Facultade de Ciencias da Educación, Universidade da Coruña, A Coruña, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
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Ramirez K, Fernández R, Collet S, Kiyar M, Delgado-Zayas E, Gómez-Gil E, Van Den Eynde T, T'Sjoen G, Guillamon A, Mueller SC, Pásaro E. Epigenetics Is Implicated in the Basis of Gender Incongruence: An Epigenome-Wide Association Analysis. Front Neurosci 2021; 15:701017. [PMID: 34489625 PMCID: PMC8418298 DOI: 10.3389/fnins.2021.701017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction The main objective was to carry out a global DNA methylation analysis in a population with gender incongruence before gender-affirming hormone treatment (GAHT), in comparison to a cisgender population. Methods A global CpG (cytosine-phosphate-guanine) methylation analysis was performed on blood from 16 transgender people before GAHT vs. 16 cisgender people using the Illumina© Infinium Human Methylation 850k BeadChip, after bisulfite conversion. Changes in the DNA methylome in cisgender vs. transgender populations were analyzed with the Partek® Genomics Suite program by a 2-way ANOVA test comparing populations by group and their sex assigned at birth. Results The principal components analysis (PCA) showed that both populations (cis and trans) differ in the degree of global CpG methylation prior to GAHT. The 2-way ANOVA test showed 71,515 CpGs that passed the criterion FDR p < 0.05. Subsequently, in male assigned at birth population we found 87 CpGs that passed both criteria (FDR p < 0.05; fold change ≥ ± 2) of which 22 were located in islands. The most significant CpGs were related to genes: WDR45B, SLC6A20, NHLH1, PLEKHA5, UBALD1, SLC37A1, ARL6IP1, GRASP, and NCOA6. Regarding the female assigned at birth populations, we found 2 CpGs that passed both criteria (FDR p < 0.05; fold change ≥ ± 2), but none were located in islands. One of these CpGs, related to the MPPED2 gene, is shared by both, trans men and trans women. The enrichment analysis showed that these genes are involved in functions such as negative regulation of gene expression (GO:0010629), central nervous system development (GO:0007417), brain development (GO:0007420), ribonucleotide binding (GO:0032553), and RNA binding (GO:0003723), among others. Strengths and Limitations It is the first time that a global CpG methylation analysis has been carried out in a population with gender incongruence before GAHT. A prospective study before/during GAHT would provide a better understanding of the influence of epigenetics in this process. Conclusion The main finding of this study is that the cis and trans populations have different global CpG methylation profiles prior to GAHT. Therefore, our results suggest that epigenetics may be involved in the etiology of gender incongruence.
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Affiliation(s)
- Karla Ramirez
- Laboratory of Psychobiology, Department of Psychology, Institute Advanced Scientific Research Center (CICA), University of A Coruña, A Coruña, Spain.,Laboratory of Neurophysiology, Center for Biophysics and Biochemistry, Venezuelan Institute for Scientific Research (IVIC), Caracas, Venezuela
| | - Rosa Fernández
- Laboratory of Psychobiology, Department of Psychology, Institute Advanced Scientific Research Center (CICA), University of A Coruña, A Coruña, Spain
| | - Sarah Collet
- Department of Endocrinology, Ghent University, Ghent, Belgium
| | - Meltem Kiyar
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Enrique Delgado-Zayas
- Laboratory of Psychobiology, Department of Psychology, Institute Advanced Scientific Research Center (CICA), University of A Coruña, A Coruña, Spain
| | | | | | - Guy T'Sjoen
- Department of Endocrinology, Ghent University, Ghent, Belgium
| | - Antonio Guillamon
- Department of Psychobiology, Faculty of Psychology, National University of Distance Education (UNED), Madrid, Spain
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Eduardo Pásaro
- Laboratory of Psychobiology, Department of Psychology, Institute Advanced Scientific Research Center (CICA), University of A Coruña, A Coruña, Spain
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Ramírez KDV, Fernández R, Delgado-Zayas E, Gómez-Gil E, Esteva I, Guillamon A, Pásaro E. Implications of the Estrogen Receptor Coactivators SRC1 and SRC2 in the Biological Basis of Gender Incongruence. Sex Med 2021; 9:100368. [PMID: 34049263 PMCID: PMC8240342 DOI: 10.1016/j.esxm.2021.100368] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 03/30/2021] [Indexed: 12/19/2022] Open
Abstract
Introduction Brain sexual differentiation results from the effects of sex steroids on the developing brain. The presumptive route for brain masculinization is the direct induction of gene expression via activation of the estrogen receptors α and β and the androgen receptor through their binding to ligands and to coactivators, regulating the transcription of multiple genes in a cascade effect. Aim To analyze the implication of the estrogen receptor coactivators SRC-1, SRC-2, and SRC-3 in the genetic basis of gender incongruence. Main Outcome Measures Analysis of 157 polymorphisms located at the estrogen receptor coactivators SRC-1, SRC-2, and SRC-3, in 94 transgender versus 94 cisgender individuals. Method Using SNPStats software, the allele and genotype frequencies were analyzed by χ2, the strength of the association was measured by binary logistic regression, estimating the odds ratio for each genotype. Measurements of linkage disequilibrium and haplotype frequencies were also performed. Results We found significant differences at level P < .05 in 8 polymorphisms that correspond to 5.09% of the total. Three were located in SRC-1 and 5 in SRC-2. The odds ratio analysis showed significant differences at level P < .05 for multiple patterns of inheritance. The polymorphisms analyzed were in linkage disequilibrium. The SRC-1 haplotypes CGA and CGG (global haplotype association P < .009) and the SRC-2 haplotypes GGTAA and GGTAG (global haplotype association P < .005) were overrepresented in the transgender population. Conclusion The coactivators SRC-1 and SRC-2 could be considered as candidates for increasing the list of potential genes for gender incongruence. Ramírez KDV, Fernández R, Delgado-Zayas E, et al. Implications of the Estrogen Receptor Coactivators SRC1 and SRC2 in the Biological Basis of Gender Incongruence. Sex Med 2021;9:100368.
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Affiliation(s)
- Karla Del Valle Ramírez
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
| | - Rosa Fernández
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain.
| | - Enrique Delgado-Zayas
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
| | - Esther Gómez-Gil
- Unidad de Identidad de Género, Instituto de Neurociencias, Hospital Clínic, Barcelona, Spain
| | - Isabel Esteva
- Servicio de Endocrinología y Nutrición, Unidad de Identidad de Género del Hospital Regional Universitario de Málaga, Spain
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Eduardo Pásaro
- Centro de Investigaciones Científicas Avanzadas (CICA), Departamento de Psicología. Universidade da Coruña (UDC), Coruña, Spain; Instituto de Investigación Biomédica de A Coruña (INIBIC), Coruña, Spain
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10
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Guo L, Liu Y, Liu L, Shao S, Cao Y, Guo J, Niu H. The CYP19A1 (TTTA)n Repeat Polymorphism May Affect the Prostate Cancer Risk: Evidence from a Meta-Analysis. Am J Mens Health 2021; 15:15579883211017033. [PMID: 34036824 PMCID: PMC8161905 DOI: 10.1177/15579883211017033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abnormal aromatase (CYP19A1) expression may participate in prostate cancer (PCa) carcinogenesis. However, the results of studies on the CYP19A1 gene polymorphisms and PCa are conflicting. This meta-analysis aimed to systematically evaluate the associations between the CYP19A1 Arg264Cys polymorphism and the (TTTA)n repeat polymorphism and PCa. Electronic databases (PubMed, EmBase, ScienceDirect, and Cochrane Library) were comprehensively searched to identify eligible studies. The strength of the association between the Arg264Cys polymorphism and PCa was assessed by pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) in allelic, dominant, recessive, homozygous, and heterozygous genetic models. To analyze the impact of the (TTTA)n repeat polymorphism, we sequentially took the N-repeat allele (where N equals 7,8,10,11,12, and 13) as the minor allele and the sum of all the other alleles as the major allele. The ORs and 95% CIs were calculated in the allelic model; this analysis was performed individually for each repeat number. Pooled estimates of nine studies addressing the Arg264Cys polymorphism indicated that this polymorphism was not associated with PCa risk in the overall population or in the Caucasian or Asian subgroups. The 8-repeat allele in the (TTTA)n repeat polymorphism increased PCa risk in the overall population (OR = 1.34, 95% CI = 1.14-1.58, p = .001) and in the subgroup with population-based (PB) controls (OR = 1.41, 95% CI = 1.13-1.74, p = .002) as well as in the subgroup using capillary electrophoresis to identify this polymorphism (OR = 1.34, 95% CI = 1.09-1.65, p = .006).The meta-analysis indicated that the CYP19A1 (TTTA)n repeat polymorphism, but not the Arg264Cys polymorphism, may affect PCa risk.
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Affiliation(s)
- Lei Guo
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanan Liu
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Lijun Liu
- Department of Neurology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Shixiu Shao
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Yanwei Cao
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Jiaming Guo
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haitao Niu
- Department of Urology, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
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Skordis N, Kyriakou A, Dror S, Mushailov A, Nicolaides NC. Gender dysphoria in children and adolescents: an overview. Hormones (Athens) 2020; 19:267-276. [PMID: 32020566 DOI: 10.1007/s42000-020-00174-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023]
Abstract
Over the last decade, we have witnessed considerable progress in gender dysphoria (GD) terminology in an attempt to better describe the condition based on certain criteria. The ever-increasing social acceptance and destigmatization of children and adolescents with GD have resulted in an increased number of transgender individuals seeking endocrine care. In addition to terminology and diagnostic criteria, the tremendous progress of genetics and neuroimaging has enabled us to have a deeper understanding of the complex pathogenesis of GD. Although helpful guidelines for treatment with GnRH analogs and gender-affirming hormones have been proposed, several challenges and controversies still exist. In this article, the current knowledge about GD in adolescents is reviewed, with particular emphasis on terminology, clinical manifestations, and epidemiologic data. The neurobiological basis of the condition is presented, and both hormonal treatment and mental issues of transgender individuals are discussed. Undoubtedly, further research will optimize the diagnostic and therapeutic approach of children and adolescents with GD.
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Affiliation(s)
- Nicos Skordis
- Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus.
| | - Andreas Kyriakou
- Developmental Endocrinology Research Group, School of Medicine, University of Glasgow, Glasgow, UK
| | - Shai Dror
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Avital Mushailov
- St George's, University London Medical Program at the University of Nicosia Medical School, Nicosia, Cyprus
| | - Nicolas C Nicolaides
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
- Division of Endocrinology and Metabolism, Center of Clinical, Experimental Surgery and Translational Research, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Balthazart J. Sexual partner preference in animals and humans. Neurosci Biobehav Rev 2020; 115:34-47. [PMID: 32450091 PMCID: PMC7484171 DOI: 10.1016/j.neubiorev.2020.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 12/25/2022]
Abstract
Sex differences in brain and behavior of animals including humans result from an interaction between biological and environmental influences. This is also true for the differences between men and women concerning sexual orientation. Sexual differentiation is mediated by three groups of biological mechanisms: early actions of sex steroids, more direct actions of sex-specific genes not mediated by gonadal sex steroids and epigenetic mechanisms. Differential interactions with parents and conspecifics have additionally long-term influences on behavior. This presentation reviews available evidence indicating that these different mechanisms play a significant role in the control of sexual partner preference in animals and humans, in other words the homosexual versus heterosexual orientation. Clinical and epidemiological studies of phenotypically selected populations indicate that early actions of hormones and genetic factors clearly contribute to the determination of sexual orientation. The maternal embryonic environment also modifies the incidence of male homosexuality via immunological mechanisms. The relative contribution of each of these mechanisms remains however to be determined.
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Amir H, Oren A, Klochendler Frishman E, Sapir O, Shufaro Y, Segev Becker A, Azem F, Ben-Haroush A. Oocyte retrieval outcomes among adolescent transgender males. J Assist Reprod Genet 2020; 37:1737-1744. [PMID: 32430731 DOI: 10.1007/s10815-020-01815-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To compare fertility preservation (FP) outcomes among adolescent transgender males with those of cisgender females. METHODS This retrospective cohort study included nine adolescent transgender males and 39 adolescent cisgender females who underwent FP between January 2017-April 2019 and September 2013-April 2019, respectively. The transgender males were referred before initiating testosterone, and the cisgender females were referred due to cancer diagnosis before starting anticancer treatment. Statistical analyses compared assisted reproductive technology (ART) data and FP outcomes between two groups. RESULTS Basal FSH levels (5.4 ± 1.7 mIU/mL) and AFC (19.8 ± 5.6) of all transgender males were normal compared with standard references. The mean age of transgender males and cisgender females was similar (16.4 ± 1.1 vs 15.5 ± 1.3 years, respectively, P = 0.064). The amount of FSH used for stimulation was significantly lower among the former compared with the latter (2416 ± 1041 IU vs 4372 ± 1877 IU, P < 0.001), but the duration of stimulation was similar (12.6 ± 4.0 and 10.1 ± 2.8 days, P = 0.086). Peak estradiol level was significantly higher among transgender males compared with cisgender females (3073 ± 2637 pg/mL vs 1269 ± 975 pg/mL, respectively, P = 0.018), but there were no significant differences in number of retrieved oocytes between the two groups (30.6 ± 12.8 vs 22 ± 13.2, P = 0.091), number of MII oocytes (25.6 ± 12.9 vs 18.8 ± 11.2, P = 0.134), or maturity rates (81.5 ± 10.0% vs 85.4 ± 14.6%, P = 0.261). CONCLUSIONS Adolescent transgender males have an excellent response to ovulation stimulation before initiating testosterone treatment. Oocyte cryopreservation is, therefore, a feasible and effective way for them to preserve their fertility for future biological parenting.
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Affiliation(s)
- Hadar Amir
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emilie Klochendler Frishman
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Onit Sapir
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Segev Becker
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Foad Azem
- Racine IVF Unit, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Rabin Medical Center, Petach Tikva, Israel, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Analysis of Four Polymorphisms Located at the Promoter of the Estrogen Receptor Alpha ESR1 Gene in a Population With Gender Incongruence. Sex Med 2020; 8:490-500. [PMID: 32409288 PMCID: PMC7471065 DOI: 10.1016/j.esxm.2020.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/28/2020] [Accepted: 04/05/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gender incongruence defines a state in which individuals feel discrepancy between the sex assigned at birth and their gender. Some of these people make a social transition from male to female (trans women) or from female to male (trans men). By contrast, the word cisgender describes a person whose gender identity is consistent with their sex assigned at birth. AIM To analyze the implication of the estrogen receptor α gene (ESR1) in the genetic basis of gender incongruence. MAIN OUTCOME MEASURES Polymorphisms rs9478245, rs3138774, rs2234693, rs9340799. METHOD We carried out the analysis of 4 polymorphisms located at the promoter of the ESR1 gene (C1 = rs9478245, C2 = rs3138774, C3 = rs2234693, and C4 = rs9340799) in a population of 273 trans women, 226 trans men, and 537 cis gender controls. For SNP polymorphisms, the allele and genotype frequencies were analyzed by χ2 test. The strength of the SNP associations with gender incongruence was measured by binary logistic regression. For the STR polymorphism, the mean number of repeats were analyzed by the Mann-Whitney U test. Measurement of linkage disequilibrium and haplotype frequencies were also performed. RESULTS The C2 median repeats were shorter in the trans men population. Genotypes S/S and S/L for the C2 polymorphism were overrepresented in the trans men group (P = .012 and P = .003 respectively). We also found overtransmission of the A/A genotype (C4) in the trans men population (P = .017), while the A/G genotype (C4) was subrepresented (P = .009]. The analyzed polymorphisms were in linkage disequilibrium. In the trans men population, the T(C1)-L(C2)-C(C3)-A(C4) haplotype was overrepresented (P = .019) while the T(C1)-L(C2)-C(C3)-G(C4) was subrepresented (P = .005). CONCLUSION The ESR1 is associated with gender incongruence in the trans men population. Fernández R, Delgado-Zayas E,RamírezK, et al. Analysis of Four Polymorphisms Located at the Promoter of the Estrogen Receptor Alpha ESR1 Gene in a Population With Gender Incongruence. Sex Med 2020;8:490-500.
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15
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Bowers MM, Whitley CT. What Drives Support for Transgender Rights? Assessing the Effects of Biological Attribution on U.S. Public Opinion of Transgender Rights. SEX ROLES 2020. [DOI: 10.1007/s11199-019-01118-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A New Theory of Gender Dysphoria Incorporating the Distress, Social Behavioral, and Body-Ownership Networks. eNeuro 2019; 6:ENEURO.0183-19.2019. [PMID: 31792116 PMCID: PMC6911960 DOI: 10.1523/eneuro.0183-19.2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 12/16/2022] Open
Abstract
When postmortem studies related to transgender individuals were first published, little was known about the function of the various identified nuclei. Now, over 2 decades later, significant progress has been made associating function with specific brain regions, as well as in identifying networks associated with groups of behaviors. However, much of this progress has not been integrated into the general conceptualization of gender dysphoria in humans. When postmortem studies related to transgender individuals were first published, little was known about the function of the various identified nuclei. Now, over 2 decades later, significant progress has been made associating function with specific brain regions, as well as in identifying networks associated with groups of behaviors. However, much of this progress has not been integrated into the general conceptualization of gender dysphoria in humans. I hypothesize that in individuals with gender dysphoria, the aspects of chronic distress, gender atypical behavior, and incongruence between perception of gender identity and external primary sex characteristics are all directly related to functional differences in associated brain networks. I evaluated previously published neuroscience data related to these aspects and the associated functional networks, along with other relevant information. I find that the brain networks that give individuals their ownership of body parts, that influence gender typical behavior, and that are involved in chronic distress are different in individuals with and without gender dysphoria, leading to a new theory—that gender dysphoria is a sensory perception condition, an alteration in the sense of gender influenced by the reflexive behavioral responses associated with each of these networks. This theory builds upon previous work that supports the relevance of the body-ownership network and that questions the relevance of cerebral sexual dimorphism in regard to gender dysphoria. However, my theory uses a hierarchical executive function model to incorporate multiple reflexive factors (body ownership, gender typical/atypical behavior, and chronic distress) with the cognitive, reflective process of gender identity.
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Foreman M, Hare L, York K, Balakrishnan K, Sánchez FJ, Harte F, Erasmus J, Vilain E, Harley VR. Genetic Link Between Gender Dysphoria and Sex Hormone Signaling. J Clin Endocrinol Metab 2019; 104:390-396. [PMID: 30247609 DOI: 10.1210/jc.2018-01105] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
| | - Lauren Hare
- Hudson Institute of Research, Melbourne, Victoria, Australia
| | - Kate York
- Hudson Institute of Research, Melbourne, Victoria, Australia
| | | | | | - Fintan Harte
- Monash Gender Clinic, Monash Health, Melbourne, Victoria, Australia
| | | | - Eric Vilain
- Children's National Health System, Washington, DC
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Fernández R, Guillamon A, Cortés-Cortés J, Gómez-Gil E, Jácome A, Esteva I, Almaraz M, Mora M, Aranda G, Pásaro E. Molecular basis of Gender Dysphoria: androgen and estrogen receptor interaction. Psychoneuroendocrinology 2018; 98:161-167. [PMID: 30165284 DOI: 10.1016/j.psyneuen.2018.07.032] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/27/2018] [Accepted: 07/31/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Polymorphisms in sex steroid receptors have been associated with transsexualism. However, published replication studies have yielded inconsistent findings, possibly because of a limited sample size and/or the heterogeneity of the transsexual population with respect to the onset of dysphoria and sexual orientation. We assessed the role of androgen receptor (AR), estrogen receptors alpha (ERα) and beta (ERβ), and aromatase (CYP19A1) in two large and homogeneous transsexual male-to-female (MtF) and female-to-male (FtM) populations. METHODS The association of each polymorphism with transsexualism was studied with a twofold subject-control analysis: in a homogeneous population of 549 early onset androphilic MtF transsexuals versus 728 male controls, and 425 gynephilic FtMs versus 599 female controls. Associations and interactions were investigated using binary logistic regression. RESULTS Our data show that specific allele and genotype combinations of ERβ, ERα and AR are implicated in the genetic basis of transsexualism, and that MtF gender development requires AR, which must be accompanied by ERβ. An inverse allele interaction between ERβ and AR is characteristic of the MtF population: when either of these polymorphisms is short, the other is long. ERβ and ERα are also associated with transsexualism in the FtM population although there was no interaction between the polymorphisms. Our data show that ERβ plays a key role in the typical brain differentiation of humans. CONCLUSION ERβ plays a key role in human gender differentiation in males and females.
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Affiliation(s)
- Rosa Fernández
- Departamento de Psicología, Universidade da Coruña, A Coruña, Spain.
| | - Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, Madrid, Spain.
| | | | - Esther Gómez-Gil
- Unidad de Identidad de Género, Hospital Clínic, Barcelona, Spain.
| | - Amalia Jácome
- Departamento de Matemáticas, Universidade da Coruña, A Coruña, Spain.
| | - Isabel Esteva
- Unidad de Transexualidad e Identidad de Género, Hospital Carlos Haya, Málaga, Spain.
| | - MariCruz Almaraz
- Unidad de Transexualidad e Identidad de Género, Hospital Carlos Haya, Málaga, Spain.
| | - Mireia Mora
- Departmento de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain.
| | - Gloria Aranda
- Departmento de Endocrinología y Nutrición, Hospital Clínic, Barcelona, Spain.
| | - Eduardo Pásaro
- Departamento de Psicología, Universidade da Coruña, A Coruña, Spain.
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Pang KC, Feldman D, Oertel R, Telfer M. Molecular Karyotyping in Children and Adolescents with Gender Dysphoria. Transgend Health 2018; 3:147-153. [PMID: 30094339 PMCID: PMC6083207 DOI: 10.1089/trgh.2017.0051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Purpose: The presence of a disorder of sexual development (DSD) acts as a diagnostic specifier for gender dysphoria (GD) under DSM-5, while the International Classification of Diseases (ICD)-10 specifically states that its equivalent diagnosis, gender identity disorder (GID), must not be the result of a chromosomal abnormality. For these reasons, routine karyotyping has been previously advocated in the clinical work-up of children and adolescents with suspected GD or GID. However, the utility of such testing remains unclear. Methods: The results of routine molecular karyotyping were analyzed in 128 patients attending our Australian statewide pediatric gender service from 2013 to 2016. Karyotyping was performed using an Illumina BeadChip platform and provided information on both sex chromosome composition and copy number variation (CNV). Results: No sex chromosome abnormalities directly suggestive of a DSD were discovered. The rate of CNVs among our patient cohort was 8.6% (11/128), similar to that previously reported for the general population. Unexpectedly, three trans male patients shared the same CNV, involving an almost identical 400 kbp deletion on chromosome 15q11.2. The frequency of this deletion within birth-assigned females in our cohort (3/69; 4.3%) was significantly higher than that within local control populations (0.3%; Fisher's exact test p-value=0.002), suggesting a possible association between 15q11.2 deletions and trans male identity. Conclusion: Routine molecular karyotyping failed to detect any occult DSD and indicated that the rate of CNVs was similar to that of the general population. Given these findings, we suggest that molecular karyotyping has minimal clinical utility in the routine management of children and adolescents with GD.
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Affiliation(s)
- Ken C Pang
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia.,Department of Psychiatry, University of Melbourne, Parkville, Australia.,The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Debi Feldman
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia
| | - Ralph Oertel
- Victorian Clinical Genetics Service, Parkville, Australia
| | - Michelle Telfer
- Department of Adolescent Medicine, Royal Children's Hospital, Parkville, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Australia
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Mohammadi MR, Khaleghi A. Transsexualism: A Different Viewpoint to Brain Changes. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2018; 16:136-143. [PMID: 29739126 PMCID: PMC5953012 DOI: 10.9758/cpn.2018.16.2.136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 01/13/2023]
Abstract
Transsexualism refers to a condition or belief which results in gender dysphoria in individuals and makes them insist that their biological gender is different from their psychological and experienced gender. Although the etiology of gender dysphoria (or transsexualism) is still unknown, different neuroimaging studies show that structural and functional changes of the brain result from this sexual incongruence. The question here is whether these reported changes form part of the etiology of transsexualism or themselves result from transsexualism culture, behaviors and lifestyle. Responding to this question can be more precise by consideration of cultural neuroscience concepts, particularly the culture–behavior–brain (CBB) loop model and the interactions between behavior, culture and brain. In this article, we first review the studies on the brain of transgender people and then we will discuss the validity of this claim based on the CBB loop model. In summary, transgender individuals experience change in lifestyle, context of beliefs and concepts and, as a result, their culture and behaviors. Given the close relationship and interaction between culture, behavior and brain, the individual’s brain adapts itself to the new condition (culture) and concepts and starts to alter its function and structure.
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Affiliation(s)
- Mohammad Reza Mohammadi
- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Khaleghi
- Psychiatry & Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Fisher AD, Ristori J, Morelli G, Maggi M. The molecular mechanisms of sexual orientation and gender identity. Mol Cell Endocrinol 2018; 467:3-13. [PMID: 28847741 DOI: 10.1016/j.mce.2017.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/02/2017] [Accepted: 08/15/2017] [Indexed: 12/21/2022]
Abstract
Differences between males and females are widely represented in nature. There are gender differences in phenotypes, personality traits, behaviors and interests, cognitive performance, and proneness to specific diseases. The most marked difference in humans is represented by sexual orientation and core gender identity, the origins of which are still controversial and far from being understood. Debates continue on whether sexual behavior and gender identity are a result of biological (nature) or cultural (nurture) factors, with biology possibly playing a major role. The main goal of this review is to summarize the studies available to date on the biological factors involved in the development of both sexual orientation and gender identity. A systematic search of published evidence was performed using Medline (from January 1948 to June 2017). Review of the relevant literature was based on authors' expertise. Indeed, different studies have documented the possible role and interaction of neuroanatomic, hormonal and genetic factors. The sexual dimorphic brain is considered the anatomical substrate of psychosexual development, on which genes and gonadal hormones may have a shaping effect. In particular, growing evidence shows that prenatal and pubertal sex hormones permanently affect human behavior. In addition, heritability studies have demonstrated a role of genetic components. However, a convincing candidate gene has not been identified. Future studies (e.i. genome wide studies) are needed to better clarify the complex interaction between genes, anatomy and hormonal influences on psychosexual development.
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Affiliation(s)
- Alessandra D Fisher
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Jiska Ristori
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Florence, Italy
| | - Girolamo Morelli
- Department of Surgical, Medical, Molecular and of the Critical Area Pathology, University of Pisa, Pisa, Italy
| | - Mario Maggi
- Department of Experimental, Clinical and Biomedical Sciences, Careggi University Hospital, Florence, Italy.
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The Biological Contributions to Gender Identity and Gender Diversity: Bringing Data to the Table. Behav Genet 2018; 48:95-108. [DOI: 10.1007/s10519-018-9889-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 02/05/2018] [Indexed: 01/13/2023]
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23
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Fernández R, Guillamón A, Gómez-Gil E, Esteva I, Almaraz MC, Cortés-Cortés J, Lamas B, Lema E, Pásaro E. Analyses of karyotype by G-banding and high-resolution microarrays in a gender dysphoria population. Genes Genomics 2018; 40:465-473. [DOI: 10.1007/s13258-017-0646-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 12/29/2017] [Indexed: 12/31/2022]
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Maney DL. Polymorphisms in sex steroid receptors: From gene sequence to behavior. Front Neuroendocrinol 2017; 47:47-65. [PMID: 28705582 PMCID: PMC6312198 DOI: 10.1016/j.yfrne.2017.07.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/05/2017] [Accepted: 07/08/2017] [Indexed: 01/09/2023]
Abstract
Sex steroid receptors have received much interest as potential mediators of human behaviors and mental disorders. Candidate gene association studies have identified about 50 genetic variants of androgen and estrogen receptors that correlate with human behavioral phenotypes. Because most of these polymorphisms lie outside coding regions, discerning their effect on receptor function is not straightforward. Thus, although discoveries of associations improve our ability to predict risk, they have not greatly advanced our understanding of underlying mechanisms. This article is intended to serve as a starting point for psychologists and other behavioral biologists to consider potential mechanisms. Here, I review associations between polymorphisms in sex steroid receptors and human behavioral phenotypes. I then consider ways in which genetic variation can affect processes such as mRNA transcription, splicing, and stability. Finally, I suggest ways that hypotheses about mechanism can be tested, for example using in vitro assays and/or animal models.
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Affiliation(s)
- Donna L Maney
- Department of Psychology, 36 Eagle Row, Emory University, Atlanta, GA 30322, USA.
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Yang F, Zhu XH, Zhang Q, Sun NX, Ji YX, Ma JZ, Xiao B, Ding HX, Sun SH, Li W. Genomic Characteristics of Gender Dysphoria Patients and Identification of Rare Mutations in RYR3 Gene. Sci Rep 2017; 7:8339. [PMID: 28827537 PMCID: PMC5567086 DOI: 10.1038/s41598-017-08655-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/14/2017] [Indexed: 11/26/2022] Open
Abstract
Gender dysphoria (GD) is characterized by an incongruence between the gender assigned at birth and the gender with which one identifies. The biological mechanisms of GD are unclear. While common genetic variants are associated with GD, positive findings have not always been replicated. To explore the role of rare variants in GD susceptibility within the Han Chinese population, whole-genome sequencing of 9 Han female-to-male transsexuals (FtMs) and whole-exome sequencing of 4 Han male-to-female transsexuals (MtFs) were analyzed using a pathway burden analysis in which variants are first collapsed at the gene level and then by Gene Ontology terms. Novel nonsynonymous variants in ion transport genes were significantly enriched in FtMs (P- value, 2.41E-10; Fold enrichment, 2.8) and MtFs (P- value, 1.04E-04; Fold enrichment, 2.3). Gene burden analysis comparing 13 GD cases and 100 controls implicated RYR3, with three heterozygous damaging mutations in unrelated FtMs and zero in controls (P = 0.001). Importantly, protein structure modeling of the RYR3 mutations indicated that the R1518H mutation made a large structural change in the RYR3 protein. Overall, our results provide information about the genetic basis of GD.
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Affiliation(s)
- Fu Yang
- Department of Medical Genetics, Second Military Medical University, Shanghai, 200433, China.
| | - Xiao-Hai Zhu
- Department of Plastic Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, 200433, China
| | - Qing Zhang
- Center of Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Ning-Xia Sun
- Center of Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Yi-Xuan Ji
- Center of Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Jin-Zhao Ma
- Department of Medical Genetics, Second Military Medical University, Shanghai, 200433, China
| | - Bang Xiao
- Department of Medical Genetics, Second Military Medical University, Shanghai, 200433, China
| | - Hai-Xia Ding
- Center of Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China
| | - Shu-Han Sun
- Department of Medical Genetics, Second Military Medical University, Shanghai, 200433, China.
| | - Wen Li
- Center of Reproductive Medicine, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, 200003, China.
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26
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2017, Sexual Dimorphism, Sexual Pluralism, and More. Clin Ther 2017; 39:1-5. [DOI: 10.1016/j.clinthera.2016.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 12/05/2016] [Indexed: 11/20/2022]
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Abstract
The current review gives an overview of brain studies in transgender people. First, we describe studies into the aetiology of feelings of gender incongruence, primarily addressing the sexual differentiation hypothesis: does the brain of transgender individuals resemble that of their natal sex, or that of their experienced gender? Findings from neuroimaging studies focusing on brain structure suggest that the brain phenotypes of trans women (MtF) and trans men (FtM) differ in various ways from control men and women with feminine, masculine, demasculinized and defeminized features. The brain phenotypes of people with feelings of gender incongruence may help us to figure out whether sex differentiation of the brain is atypical in these individuals, and shed light on gender identity development. Task-related imaging studies may show whether brain activation and task performance in transgender people is sex-atypical. Second, we review studies that evaluate the effects of cross-sex hormone treatment on the brain. This type of research provides knowledge on how changes in sex hormone levels may affect brain structure and function.
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Affiliation(s)
- Baudewijntje P C Kreukels
- a VU University Medical Centre, Department of Medical Psychology, Centre of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research , Amsterdam , the Netherlands
| | - Antonio Guillamon
- b Universidad Nacional de Educacion a Distancia (UNED) , Departamento de Psicobiologia , Madrid , Spain
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28
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Guillamon A, Junque C, Gómez-Gil E. A Review of the Status of Brain Structure Research in Transsexualism. ARCHIVES OF SEXUAL BEHAVIOR 2016; 45:1615-48. [PMID: 27255307 PMCID: PMC4987404 DOI: 10.1007/s10508-016-0768-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/22/2015] [Accepted: 04/29/2016] [Indexed: 05/22/2023]
Abstract
The present review focuses on the brain structure of male-to-female (MtF) and female-to-male (FtM) homosexual transsexuals before and after cross-sex hormone treatment as shown by in vivo neuroimaging techniques. Cortical thickness and diffusion tensor imaging studies suggest that the brain of MtFs presents complex mixtures of masculine, feminine, and demasculinized regions, while FtMs show feminine, masculine, and defeminized regions. Consequently, the specific brain phenotypes proposed for MtFs and FtMs differ from those of both heterosexual males and females. These phenotypes have theoretical implications for brain intersexuality, asymmetry, and body perception in transsexuals as well as for Blanchard's hypothesis on sexual orientation in homosexual MtFs. Falling within the aegis of the neurohormonal theory of sex differences, we hypothesize that cortical differences between homosexual MtFs and FtMs and male and female controls are due to differently timed cortical thinning in different regions for each group. Cross-sex hormone studies have reported marked effects of the treatment on MtF and FtM brains. Their results are used to discuss the early postmortem histological studies of the MtF brain.
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Affiliation(s)
- Antonio Guillamon
- Departamento de Psicobiología, Universidad Nacional de Educación a Distancia, c/Juand del Rosal, 10, 28040, Madrid, Spain.
- Academia de Psicología de España, Madrid, Spain.
| | - Carme Junque
- Departamento de Psiquiatría y Psicobiología Clínica, Universidad de Barcelona, Barcelona, Spain
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Esther Gómez-Gil
- Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
- Unidad de Identidad de Género, Hospital Clinic, Barcelona, Spain
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30
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Abstract
Gender dysphoria (GD), a term that denotes persistent discomfort with one's biologic sex or assigned gender, replaced the diagnosis of gender identity disorder in the Diagnostic and Statistical Manual of Mental Disorders in 2013. Subtypes of GD in adults, defined by sexual orientation and age of onset, have been described; these display different developmental trajectories and prognoses. Prevalence studies conclude that fewer than 1 in 10,000 adult natal males and 1 in 30,000 adult natal females experience GD, but such estimates vary widely. GD in adults is associated with an elevated prevalence of comorbid psychopathology, especially mood disorders, anxiety disorders, and suicidality. Causal mechanisms in GD are incompletely understood, but genetic, neurodevelopmental, and psychosocial factors probably all contribute. Treatment of GD in adults, although largely standardized, is likely to evolve in response to the increasing diversity of persons seeking treatment, demands for greater client autonomy, and improved understanding of the benefits and limitations of current treatment modalities.
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Affiliation(s)
- Kenneth J Zucker
- Gender Identity Clinic, Child, Youth, and Family Services, Centre for Addiction and Mental Health and Department of Psychiatry, University of Toronto, Toronto, Ontario M5T 1R8, Canada;
| | - Anne A Lawrence
- Department of Psychology, University of Lethbridge, Lethbridge, Alberta T1K 3M4, Canada
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, VU University Medical Center and EMGO Institute for Health and Care Research, Amsterdam 1081 HV, The Netherlands
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Fernández R, Esteva I, Gómez-Gil E, Rumbo T, Almaraz MC, Roda E, Haro-Mora JJ, Guillamón A, Pásaro E. Association Study of ERβ, AR, and CYP19A1 Genes and MtF Transsexualism. J Sex Med 2014; 11:2986-94. [DOI: 10.1111/jsm.12673] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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