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Sapir L, Littman L, Biggs M. The U.S. Transgender Survey of 2015 Supports Rapid-Onset Gender Dysphoria: Revisiting the "Age of Realization and Disclosure of Gender Identity Among Transgender Adults". Arch Sex Behav 2024; 53:863-868. [PMID: 38110845 PMCID: PMC10920421 DOI: 10.1007/s10508-023-02754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/20/2023] [Accepted: 11/15/2023] [Indexed: 12/20/2023]
Affiliation(s)
- Leor Sapir
- Manhattan Institute for Policy Research, 52 Vanderbilt Ave., New York, NY, 10017, USA.
| | - Lisa Littman
- The Institute for Comprehensive Gender Dysphoria Research, Providence, RI, USA
| | - Michael Biggs
- Department of Sociology, University of Oxford, Oxford, UK
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Davies EL, Ezquerra-Romano I, Thayne B, Holloway Z, Bayliss J, O'Callaghan S, Connolly DJ. Discrimination, gender dysphoria, drinking to cope, and alcohol harms in the UK trans and non-binary community. Alcohol Alcohol 2024; 59:agad060. [PMID: 37850541 DOI: 10.1093/alcalc/agad060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 10/19/2023] Open
Abstract
Transgender (trans) and non-binary people may be at increased risk of alcohol harms, but little is known about motives for drinking in this community. This study explored the relationship between risk of alcohol dependence, experience of alcohol harms, drinking motives, dysphoria, and discrimination within a United Kingdom sample of trans and non-binary people with a lifetime history of alcohol use. A cross-sectional survey was co-produced with community stakeholders and administered to a purposive sample of trans and non-binary people from 1 February until 31 March 2022. A total of 462 respondents were included-159 identified as non-binary and/or genderqueer (identities outside the man/woman binary), 135 solely as women, 63 solely as men, 15 as another gender identity, 90 selected multiple identities. Higher levels of reported discrimination were associated with higher risk of dependence and more reported harms from drinking. Coping motives, enhancement motives, and drinking to manage dysphoria were associated with higher Alcohol Use Disorders Identification Test scores. Social, coping, and enhancement motives alongside discrimination and drinking to have sex were associated with harms. The relationship between discrimination and risk of dependence was mediated by coping motives and drinking to manage dysphoria. Further to these associations, we suggest that reducing discrimination against trans and non-binary communities might reduce alcohol harms in this population. Interventions should target enhancement motives, coping motives and gender dysphoria. Social and enhancement functions of alcohol could be replaced by alcohol free supportive social spaces.
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Affiliation(s)
- Emma L Davies
- Centre for Psychological Research, Oxford Brookes University, Headington Campus, Oxford, OX3 0PB, United Kingdom
| | - Ivan Ezquerra-Romano
- Drugs and Me, 128 City Road, London, EC1V 2NX, United Kingdom
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17-19 Queen Square, London WC1N 3AZ, United Kingdom
| | - Beth Thayne
- ClimatePartner GmbH, 59 St. -Martin-Str., Munich, Bavaria, 81669, Germany
| | - Zhi Holloway
- Adero Ltd, 71-75 Shelton St, London WC2H 9JQ, United Kingdom
| | - Jacob Bayliss
- LGBT Switchboard, 113 Queens Rd, Brighton and Hove, Brighton BN1 3XG United Kingdom
| | - Stewart O'Callaghan
- OUTpatients (formerly Live Through This), LGBTIQ+ Cancer Charity, 92-94 Wallis Road London E9 5LN, United Kingdom
| | - Dean J Connolly
- Centre for Psychological Research, Oxford Brookes University, Headington Campus, Oxford, OX3 0PB, United Kingdom
- Mortimer Market Centre, Central and North West London NHS Foundation Trust, Capper St, London WC1E 6JB, United Kingdom
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Kasten Z, Lujan S, Jakeman B, Herman A, McClain M, Winters A, Bos AJ, Aragon KG. Contraceptive use in patients with gender dysphoria who were assigned female at birth receiving care at a specialty gender-affirming clinic. J Am Pharm Assoc (2003) 2024; 64:273-277. [PMID: 37598885 DOI: 10.1016/j.japh.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/04/2023] [Accepted: 08/11/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommend that all patients, regardless of gender identity or sexual orientation, should be offered family planning and contraceptive options without assumptions of sexual behaviors and pregnancy risk. Current research on family planning services for lesbian, gay, bisexual, transgender, and queer or questioning patients is limited, but patients who are sexual or gender minorities are at increased risk for unintended pregnancy. OBJECTIVES The objective of this study was to describe contraceptive use in patients assigned female at birth with gender dysphoria at a gender-affirming primary care clinic. METHODS A retrospective descriptive study was conducted. Patients were included if they were 18 to 44 years old, received care at University of New Mexico Truman Health Services in 2019, were diagnosed with gender dysphoria, and were assigned female at birth. Patients were excluded if they had never developed female reproductive organs. Data were collected from the electronic medical records. Potential differences in contraceptive use based on demographic characteristics, having a family planning discussion, and having a contraceptive use discussion were analyzed using chi-square analyses. Potential predictors of contraceptive use were identified using exploratory forward conditional logistic regression and univariate logistic regression analyses. RESULTS A total of 163 patients were included; average age was 26.6 years; 71% identified as male, 5% identified as masculine, and 25% identified as nonbinary. Most patients (92%) were prescribed masculinizing therapy (testosterone). Forty-five (28%) patients had documented contraception use; the most common form was permanent contraception (76%). Most patients (68%) did not have any documented contraindications to contraception based on CDC US Medical Eligibility Criteria for contraceptive use. Of 113 patients with a documented sexual orientation, 45 patients (40%) reported having sex with persons who have a penis; only 13 (29%) of those patients had a documented form of contraception. Family planning discussions were documented for 82% of patients. Family planning discussions that specifically addressed contraception were documented in only 49% of patients. However, the odds of a patient having a documented use of contraception was 9.26 times higher when family planning discussions specifically addressed contraception. CONCLUSION Documented contraception use was low in people assigned female at birth of childbearing age receiving care at a gender-affirming clinic. Due to increased risks of unintended pregnancy in this population and the teratogenic nature of testosterone, family planning discussion should also include discussions related to contraception, as this was associated with increased contraception use. Additional research is needed to address potential barriers to contraception use in this population.
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López Moratalla N, Calleja Canelas A, Font Arellano M. [Brain characteristics of transgender individuals and consequences of gender assignment treatment]. Cuad Bioet 2024; 35:91-102. [PMID: 38734925 DOI: 10.30444/cb.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/19/2024] [Indexed: 05/13/2024]
Abstract
The differences between the male and female brain in cisgender individuals, those in whom there is no incongruence between the so-called biological sex and the perceived sex, are known. The genetic basis that underlies the differences observed in the brains of transgender individuals compared to cisgender individuals is also becoming known. In transgender individuals, there is a fundamental change in the connectivity of neurons in the body perception network, which may give rise to gender dysphoria. This knowledge allows for the characterization of the transgender condition and distinguishes it from transgender identities such as non-binary gender, gender fluidity, or genderqueer. Articles published assume, from the perspective of depathologization imposed by Gender Ideology, that these differences are due to a different sexual development. The societal acceptance of this perspective over the last two decades paved the way for medical interventions aimed at affirming the perceived gender, different from the genetic sex, through the continuous administration of cross-sex hormones and, in some cases, mutilating surgery. In adolescents and children, affirmation treatment of the perceived gender begins with puberty blockers, which have negative consequences for ossification and growth. The importance and irreversibility of these 'side effects' require the utmost rigor and complete information about them. Spanish law pushes the ideology to the maximum, infringing on the rights of transgender individuals. Medical ethics emphasize the necessity - the right - of a medical and psychological diagnosis, free from ideological approaches, before initiating what is being called treatment. This includes the right to information, prior to consent, about the positive and negative effects of hormonal administration. It also includes the right to the recognition of diversity among transgender individuals, especially the right to research that allows for treating the brain without altering the body. These rights must be recognized and demanded by the laws.
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Affiliation(s)
| | | | - María Font Arellano
- Facultad de Farmacia y Nutrición de la Universidad de Navarra, Irunlarrea n.1, 31008 Pamplona.
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García Jiménez A, de Las Cuevas Miguel MªP, Miguélez González M. [Understanding to care: Do we really know in primary care what gender incongruence is?]. Aten Primaria 2023; 55:102755. [PMID: 37690337 PMCID: PMC10498162 DOI: 10.1016/j.aprim.2023.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
| | | | - María Miguélez González
- Endocrinología, Unidad Identidad de Género, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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Hegde P, C N M, Hari Hara S, Narayana M, Chennaveerachari NK, Bada Math S. Gender incongruence during prodrome of schizophrenia: To diagnose or not to? Asian J Psychiatr 2023; 90:103830. [PMID: 37979489 DOI: 10.1016/j.ajp.2023.103830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/20/2023]
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Nadrowski K. A New Flight from Womanhood? The Importance of Working Through Experiences Related to Exposure to Pornographic Content in Girls Affected by Gender Dysphoria. J Sex Marital Ther 2023; 50:293-302. [PMID: 38006227 DOI: 10.1080/0092623x.2023.2276149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Parallel to the advent of social media and the easy access to online pornographic content there is a sharp increase in adolescent females expressing gender dysphoria worldwide. This paper argues that treatment of gender dysphoria in female adolescents must include explicit exploration into their use and exchange of pornographic content, as well as possible online or offline contacts with adults. Possible avenues of how pornographic content may increase the shame and fear of becoming a woman include the acquisition of misogynistic sexual scripts based on false assumptions on sexuality including the normalization of the violation of females as pleasurable for them, peer influence among female friendship groups, the susceptibility of our medical systems to "mass hysteria" phenomena, easier access of adults with sexually abusive intentions to youth through social media, sexual abuse and victim blaming on females, as well as the influence of pornography on mentalization capacities. As the influence of pornography on gender dysphoria in girls is understudied, this paper provides questions for qualitative and quantitative research, case studies and history taking. Especially the lack of an adequate other during exposure may aggravate false assumptions on gender roles and gender inequality seen in mainstream pornography. Girls affected by autism might be at higher risk because of their reduced mentalization capacities. Working through experiences associated with pornographic content and sexually abusive experiences may correct false beliefs about gender inequality and therefore might alleviate gender dysphoria.
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Smids J, Vankrunkelsven P. [Uncertainties around the current gender care: five problems with the clinical lesson 'Youth with gender incongruence']. Ned Tijdschr Geneeskd 2023; 167:D7941. [PMID: 37930172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
The clinical lesson 'Youth with gender incongruence' by Dutch gender clinicians aims to describe Dutch adolescent gender care and its dilemma's. This commentary discusses five serious objections. First, the lesson fails to draw the implications from its acknowledgement of the paucity of evidence: puberty blockers and cross-sex hormones most likely do not meet the requirements for standard care. Second, it does not make the crucial distinction between childhood and adolescent onset gender dysphoria. Third, its claim that from those children that continue from GnRHa to cross-sex hormones '98% continues to use these hormones in the long term' is unfounded. Fourth, it does not acknowledge the dilemma that puberty blockers may impede, rather than facilitate, time for reflection. Fifth, it inaccurately represents the literature on the potential detrimental effects of GnRHa on brain development. The commentary concludes with a call to reform Dutch gender care, following the examples of Sweden and Finland.
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Affiliation(s)
- Jilles Smids
- Erasmus MC, afd. Medische Ethiek, Filosofie en Geschiedenis van de geneeskunde, Rotterdam
- Contact: Jilles Smids
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10
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Ion R, Jackson L, O'Malley S, Helyar S, Watson R. Gender dysphoria: The affirmative model for children and young people, and the role of health and social care educators. Nurse Educ Pract 2023; 73:103788. [PMID: 37805383 DOI: 10.1016/j.nepr.2023.103788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Affiliation(s)
| | | | | | | | - Roger Watson
- Editor-in-Chief, Nurse Education in Practice, UK
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11
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Thompson NJ, Smith CN, Thylur DS. The Intersection of Gender Dysphoria and Psychosis: Case Report of a Patient With Schizophrenia, Gender Dysphoria, and Repeated Genital Self-Mutilation. J Acad Consult Liaison Psychiatry 2023; 64:482-483. [PMID: 37689461 DOI: 10.1016/j.jaclp.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Nicholas J Thompson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Caitlin N Smith
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - David S Thylur
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
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12
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Englert E, Haas CR. [Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings]. Z Kinder Jugendpsychiatr Psychother 2023; 51:367-374. [PMID: 37681648 DOI: 10.1024/1422-4917/a000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
Practical Guideline on Dealing with Transgender Patients in Child and Adolescent Psychiatric Inpatient Settings Abstract: The guideline provided by the Federal Association of Leading Medical Directors for Child and Adolescent Psychiatry offers a framework for dealing with transgender patients in child and adolescent psychiatric clinics. It addresses the clinical challenges arising from the significant increase in transgender patients and the paradigm shift in the medical field. The guideline includes recommendations for dealing with transgender patients in various settings. Key treatment principles comprise adopting a destigmatizing approach, using preferred names and pronouns, accommodating individual room assignments, and considering relevant comorbidities. Only experienced medical doctors and psychotherapists should carry out diagnosis and treatment. The goals for supporting adolescents with gender dysphoria include promoting self-acceptance, addressing negative emotions, facilitating social integration, and fostering identity development.
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Affiliation(s)
- Ekkehart Englert
- Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Helios Klinikum Erfurt, Erfurt, Deutschland
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McNamara M, Abdul-Latif H, Boulware SD, Kamody R, Kuper LE, Olezeski CL, Szilagyi N, Alstott A. Combating Scientific Disinformation on Gender-Affirming Care. Pediatrics 2023; 152:e2022060943. [PMID: 37605864 DOI: 10.1542/peds.2022-060943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 08/23/2023] Open
Abstract
Scientific disinformation is false and misleading information that is used intentionally by legal and political actors to sway public opinion and oppose facts. In recent years, disinformation has become a tool for authorities to limit gender-affirming health care (GAC) for transgender and gender-expansive youth who experience gender dysphoria. Existing modes of expert intervention in health policy may not be sufficient to match the pace of these quickly unfolding health care bans. A cross-disciplinary team of academics in medicine, psychology, and law assembled to challenge scientific disinformation on GAC with 2 rapid-response rebuttal reports. Reports were produced in 3 to 10 weeks after the passage of GAC bans in Texas, Alabama, and Florida in 2022. They were posted online to facilitate dissemination and engage litigators, judges, policy experts, advocates, parents, and others. The team's efforts complemented public statements by medical societies and lawsuits brought by national LGBTQ litigators. The team's reports were cited in legal challenges to GAC bans in Texas, Alabama, and Florida. The team also filed amicus briefs for direct consideration by the courts and public comments to health care agencies in Florida. The reports received coverage in local and national media outlets in broadcast and print media. This advocacy case study describes the process used to challenge disinformation about GAC with rapid-response rebuttal reports, as well as the impact of this work and associated challenges. In an increasingly polarized political climate, this process may be adapted to other areas of health policy in which scientific disinformation takes root.
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Affiliation(s)
- Meredithe McNamara
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Susan D Boulware
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Rebecca Kamody
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Laura E Kuper
- Childrens' Health Systems of Texas, University of Texas Southwestern Medical Center, Houston, Texas
| | - Christy L Olezeski
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Nathalie Szilagyi
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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Cooper K, Butler C, Russell A, Mandy W. The lived experience of gender dysphoria in autistic young people: a phenomenological study with young people and their parents. Eur Child Adolesc Psychiatry 2023; 32:1655-1666. [PMID: 35377050 PMCID: PMC8977566 DOI: 10.1007/s00787-022-01979-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
Gender dysphoria is distress in relation to incongruence between an individual's gender and sex assigned at birth. Gender clinics offer support for gender dysphoria, and there is a higher prevalence of autism in young people attending such clinics than in the general population. We aimed to investigate the lived experiences of autistic young people who have experienced gender dysphoria, and their parents, using a multi-perspectival IPA design. Young autistic people aged 13-17 years (n = 15), and their parents (n = 16), completed in-depth interviews about the young person's experience of gender dysphoria. We analysed each individual transcript to generate individual themes, and for each of the dyads, developed themes which acknowledged the similarities and differences in parent-child perspectives. The first superordinate theme was coping with distress which had two subordinate themes; understanding difficult feelings and focus on alleviating distress with external support. This theme described how young people were overwhelmed by negative feelings which they came to understand as being about gender incongruence and looked to alleviate these feelings through a gender transition. The second superordinate theme was working out who I am which had two subordinate themes: the centrality of different identities and needs and thinking about gender. This theme described how young people and their parents focused on different needs; while young people more often focused on their gender-related needs, parents focused on autism-related needs. We conclude that young people and parents may have different perspectives and priorities when it comes to meeting the needs of autistic young people who experience gender dysphoria.
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Affiliation(s)
- Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Catherine Butler
- Department of Psychology, University of Exeter, EX4 4QG, Exeter, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - William Mandy
- Department of Clinical, Educational, and Health Psychology, UCL Research, Gower Street, London, WC1E 6BT, UK
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Hadland SE, Solomon ED, Guss CE. Affirming Care for Autism and Gender Diversity. Pediatrics 2023; 152:e2023061813. [PMID: 37395081 PMCID: PMC10389768 DOI: 10.1542/peds.2023-061813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 07/04/2023] Open
Affiliation(s)
- Scott E. Hadland
- Division of Adolescent and Young Adult Medicine, Mass General Hospital for Children, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | | | - Carly E. Guss
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Block J. Gender dysphoria in young people is rising-and so is professional disagreement. BMJ 2023; 380:382. [PMID: 36822640 DOI: 10.1136/bmj.p382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Moser C. A Response to Bailey and Hsu (2022): It Helps If You Stop Confusing Gender Dysphoria and Transvestism. Arch Sex Behav 2023; 52:469-471. [PMID: 36085213 DOI: 10.1007/s10508-022-02418-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Charles Moser
- Diverse Sexualities Research and Education Institute, 4304-18th Street, #14752, San Francisco, CA, 94114, USA.
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Margolin L. The Third Backdoor: How the DSM Casebooks Pathologized Homosexuality. J Homosex 2023; 70:291-306. [PMID: 34282998 DOI: 10.1080/00918369.2021.1945340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study argues that institutional psychiatry's pathologizing stance on homosexuality persisted after 1973, when the American Psychiatric Association removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders. It persisted not only through the well-known diagnoses of "ego-dystonic homosexuality" and "gender identity disorder of childhood," but also through case studies published in four editions of the DSM Casebooks (1981, 1989, 1994, 2002), the APA publications advertised as a "learning companion to the Diagnostic and Statistical Manual." These publications contained harmful and false homosexual stereotypes, associating gay men with child abuse, violence, and sexual sadism; associating homosexuality with mental disturbance while failing to similarly mark heterosexuality or bisexuality; associating psychopathology with gay social contexts while failing to similarly mark non-gay social contexts. This study provides evidence that the DSM Casebooks portrayed homosexual women and bisexuals as invisible, and homosexual men as narcissistic, predatory, and dangerous.
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Affiliation(s)
- Leslie Margolin
- Department of Counselor Education, University of Iowa, Iowa City, Iowa, USA
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Guss C, Gordon CM. Pubertal Blockade and Subsequent Gender-Affirming Therapy. JAMA Netw Open 2022; 5:e2239763. [PMID: 36318212 PMCID: PMC9793415 DOI: 10.1001/jamanetworkopen.2022.39763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Carly Guss
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Kallitsounaki A, Williams DM. Implicit and Explicit Gender-Related Cognition, Gender Dysphoria, Autistic-Like Traits, and Mentalizing: Differences Between Autistic and Non-Autistic Cisgender and Transgender Adults. Arch Sex Behav 2022; 51:3583-3600. [PMID: 35972636 PMCID: PMC9556420 DOI: 10.1007/s10508-022-02386-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
Evidence indicates a link between autism spectrum disorder (ASD) and gender diversity, yet this intersection remains insufficiently understood. Here, we investigated whether (1) ASD affects gender-related cognition (i.e., mental processes of perceiving and interpreting one's own gender self-concept), (2) autistic people have increased gender dysphoria and recall limited gender-typed behavior from childhood, and (3) transgender individuals have increased ASD-like traits and difficulties in mentalizing. A total of 106 non-autistic cisgender (51 birth-assigned female), 107 autistic cisgender (57 birth-assigned female), 78 non-autistic transgender (41 birth-assigned female), and 56 autistic transgender adults (27 birth-assigned female) participated in the study. The mean age of participants was 31.01 years (range = 18 to 70). Using an explicit as well as an implicit measure, for the first time, we found that ASD affected gender-related cognition only in autistic cisgender people. Sex differences were also observed in this group. Whereas autistic cisgender birth-assigned males showed a stronger implicit gender-group identification than non-autistic cisgender birth-assigned males, autistic cisgender birth-assigned females showed a weaker gender-group identification than non-autistic cisgender birth-assigned females. Furthermore, autistic cisgender people reported significantly more gender dysphoric feelings and recalled significantly less gender-typed behavior from childhood than non-autistic cisgender individuals. No difference was observed between non-autistic and autistic transgender people. We also found that relative to non-autistic cisgender individuals, both non-autistic transgender and autistic transgender people reported significantly more ASD-like traits. However, mentalizing difficulties were observed only in the latter group. This research enhances our understanding of the link between ASD and gender diversity.
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Affiliation(s)
- Aimilia Kallitsounaki
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK.
| | - David M Williams
- Division of Human & Social Sciences, School of Psychology, Keynes College, University of Kent, Canterbury, CT2 7NP, UK
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Bailey JM, Hsu KJ. How Autogynephilic Are Natal Females? Arch Sex Behav 2022; 51:3311-3318. [PMID: 35759067 DOI: 10.1007/s10508-022-02359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Blanchard proposed that autogynephilia is a natal male's paraphilic sexual arousal in response to the thought or fantasy of being a woman. Furthermore, based on evidence collected from natal males with gender dysphoria, Blanchard argued that autogynephilia is the fundamental motivation among nonhomosexual males (i.e., those not exclusively attracted to men) who pursue sex reassignment surgery or live as transgender women. These ideas have been challenged by several writers who have asserted, or offered evidence, that autogynephilia is common among women. However, their evidence was weakened by problematic measures and limited comparison groups. We compared four samples of autogynephilic natal males (N = 1549), four samples of non-autogynephilic natal males (N = 1339), and two samples of natal females (N = 500), using Blanchard's original measure: the Core Autogynephilia Scale. The autogynephilic samples had much higher mean scores compared with non-autogynephilic natal males and natal females, who were similar. Our findings refute the contention that autogynephilia is common among natal females.
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Affiliation(s)
- J Michael Bailey
- Department of Psychology, Northwestern University, 2029 Sheridan Rd., Evanston, IL, 60208, USA.
| | - Kevin J Hsu
- Department of Psychological and Social Sciences, Pennsylvania State University, Abington, Abington, PA, USA
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22
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McNamara M, Lepore C, Alstott A, Kamody R, Kuper L, Szilagyi N, Boulware S, Olezeski C. Scientific Misinformation and Gender Affirming Care: Tools for Providers on the Front Lines. J Adolesc Health 2022; 71:251-253. [PMID: 35787819 DOI: 10.1016/j.jadohealth.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/05/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Anne Alstott
- Yale University School of Law, New Haven, Connecticut
| | - Rebecca Kamody
- Yale University School of Medicine, New Haven, Connecticut
| | - Laura Kuper
- University of Texas, Southwestern, Dallas, Texas
| | | | - Susan Boulware
- Yale University School of Medicine, New Haven, Connecticut
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23
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Roberts C. Persistence of Transgender Gender Identity Among Children and Adolescents. Pediatrics 2022; 150:187006. [PMID: 35538638 DOI: 10.1542/peds.2022-057693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
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24
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Scott KB, Thuman J, Jain A, Gregoski M, Herrera F. Gender-Affirming Surgeries: A National Surgical Quality Improvement Project Database Analyzing Demographics, Trends, and Outcomes. Ann Plast Surg 2022; 88:S501-S507. [PMID: 35690947 DOI: 10.1097/sap.0000000000003157] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Gender affirmation surgery is an exponentially growing field within plastic surgery. The aim of our study is to analyze demographics, procedure type, trends, and outcomes in the surgical management of gender identity disorder in the past few years. METHODS The American College of Surgeons NSQIP database was queried for the years 2015 to 2019. International Classification of Diseases codes were used to identify all gender-affirming cases. Patients were categorized by procedure type using Current Procedural Terminology codes for feminizing/masculinizing top, bottom and head/neck procedures. Patient demographics, comorbidities, and postoperative complications were analyzed using SPSS statistics software. A comparative analysis was performed among the procedure type. RESULTS From 2015 to 2019, 4114 patients underwent a gender-affirming surgery (GAS) increasing the number of surgeries by over 400%, according to the NSQIP database. Demographics include age (mean = 32 years), body mass index (mean = 28 kg/m2), race (60% White, 22% unknown, 13% African American, 4% Asian, 1% other). Female to male procedures represented the most commonly performed (n = 2647; 64%), followed by male to female (n = 1278; 31%) with head/neck procedures representing 5% (n = 189) of all procedures. Top surgeries were also the most common (n = 2347, 57%), followed by bottom surgeries (n = 1578, 38%). The overall complication rate was 6% (n = 247), 2.1% (n = 4) for head/neck procedures, 8% (n = 134) for bottom procedures, and 3.5% (n = 84) for top surgeries.A reoperation within 30 days and related to the initial GAS occurred for 52 patients. Postoperative complication rates were statistically different between bottom surgeries compared with the top and head/neck procedure groups (P < 0.001). Increasing age and body mass index showed a significantly higher odds of having a complication. CONCLUSIONS Gender-affirming procedures have significantly increased over the past 5 years. Increased exposure through literature and research, as well as an improvement in social climates, including increasing insurance coverage have contributed to the expansion of these procedures. Low serious complication rates within 30 days prove GAS to be safe.
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Affiliation(s)
- Kiandra B Scott
- From the Medical University of South Carolina, Division of Plastics and Reconstructive Surgery
| | - Jenna Thuman
- From the Medical University of South Carolina, Division of Plastics and Reconstructive Surgery
| | - Abhishek Jain
- Medical University of South Carolina, College of Medicine
| | | | - Fernando Herrera
- From the Medical University of South Carolina, Division of Plastics and Reconstructive Surgery
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25
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Mirabella M, Piras I, Fortunato A, Fisher AD, Lingiardi V, Mosconi M, Ristori J, Speranza AM, Giovanardi G. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022; 19:1035-1048. [PMID: 35370103 DOI: 10.1016/j.jsxm.2022.03.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, the variability and heterogeneity of gender presentations in transgender youths have gained significant attention worldwide. Alongside this, specialized gender services have reported an increase in referrals of youths reporting non-binary identities. In Italy, studies investigating gender identity and expression in gender non-conforming youths are lacking, as are data regarding the non-binary population. AIM The present study aimed at dimensionally exploring how transgender and non-binary Italian adolescents identify and express their gender. OUTCOMES Gender expression in trans binary youths and non-binary youths. METHODS The Gender Diversity Questionnaire (GDQ; Twist & de Graaf, 2019) was used to investigate gender identity, gender fluidity, and gender expression in a sample of 125 adolescent patients from the Gender Identity Development Service (SAIFIP) in Rome and the Gender Incongruence Unit of the Careggi Hospital in Florence, between April 2019-June 2021. RESULTS The majority of participants (74.4%) identified as trans* binary and the remaining (25.6%) participants identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity across time and contexts. Almost all participants rated external appearance as important to their gender expression, yet trans binary participants attributed more importance to the body in this respect. Body discomfort and pubertal stage emerged as the most influential factors in participants' experiences of gender. Participants who were assigned male at birth expressed significantly more desire for puberty blockers, whereas those who were assigned female at birth had a stronger desire to engage in breast/chest surgery. Non-binary participants sought different medical interventions relative to trans binary participants. CLINICAL IMPLICATIONS These results may be useful for clinicians working with transgender youths as they provide awareness regarding the features of young people who identify within and outside of binary constructions of gender. STRENGTHS & LIMITATIONS This study provides useful data in gaining insight into understanding the variety of experiences and challenges of gender non-conforming youths. However as the sample was recruited from specialized services, it may not represent the entire gender non-conforming population in Italy. CONCLUSION The results describe the range of gender identities and expressions among gender non-conforming youths attending gender specialized services in Italy, thereby improving our understanding of the variety of identities experienced and the specific medical needs of both trans binary and non-binary adolescents. Mirabella M, Piras I, Fortunato A, et al. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022;19:1035-1048.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Irene Piras
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Maddalena Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Del Can Sánchez DJ, Dueñas Disotuar S, Piñar Gutiérrez A, Japón Rodríguez MÁ, Olea Comas I, Déniz García A, Soto Moreno A, Mangas Cruz MÁ. Gender Incongruity in a Person with 46,XY and Complete Androgen Insensitivity Syndrome Raised as a Female. Arch Sex Behav 2022; 51:2353-2357. [PMID: 34786658 DOI: 10.1007/s10508-021-02183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 05/22/2021] [Accepted: 10/09/2021] [Indexed: 06/13/2023]
Abstract
We present the case of a patient with female sex assignment at birth whose parents consulted with a pediatrician when the child was 12 years old, indicating that despite female sex assignment, she felt that she (henceforth "he") had a male gender identity and was gynephilic. Medical examination revealed a 46XY karyotype, a primary amenorrhea and an appropriate testosterone increase after HCG stimulation test. The patient was diagnosed then with a 46,XY disorder of sex development with androgen insensitivity syndrome, but then he missed subsequent appointments. At the age of 24, he resumed medical follow-up to reaffirm his male gender identity through sex reassignment surgery. His physical examination showed a Tanner stage III-IV breast development, vulva, clitoris, normal-sized vagina, absence of uterus and ovaries on transvaginal ultrasound, bilateral cryptorchidism on abdominal-pelvic MRI and osteoporosis on bone densitometry. The results of the blood tests were LH 24.5 mIU/mL [normal range, 1.7-8.6 mIU/mL for men] and testosterone 8.8 nmol/L [8.7-33 nmol/L]; conversely, FSH, estradiol, progesterone, and prolactin levels were normal. The molecular genetic analysis revealed an androgen receptor gene mutation associated with complete androgen insensitivity syndrome. At present, the patient has undergone bilateral orchiectomy and has initiated treatment with topical testosterone and bisphosphonates. We have yet to evaluate the effects and decide the best therapy taking into account that he has a male gender identity but complete androgen insensitivity syndrome.
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Affiliation(s)
- Diego Jesús Del Can Sánchez
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain.
| | - Suset Dueñas Disotuar
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Ana Piñar Gutiérrez
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | | | - Isabel Olea Comas
- Department of Diagnostic Imaging of the University Hospital Virgen del Rocío, Seville, Spain
| | - Alejandro Déniz García
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Alfonso Soto Moreno
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
| | - Miguel Ángel Mangas Cruz
- Department of Endocrinology and Nutrition of the University Hospital Virgen del Rocío, Muro de los Navarros Street, Apt. 40, Door 12, 41013, Seville, Spain
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Lindley L, Anzani A, Galupo MP. Gender Dysphoria and Sexual Well-Being Among Trans Masculine and Nonbinary Individuals. Arch Sex Behav 2022; 51:2049-2063. [PMID: 35449364 DOI: 10.1007/s10508-021-02242-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
Prior qualitative research has noted that gender dysphoria impacts sexual engagement and satisfaction for many trans masculine and nonbinary individuals. As such, the current cross-sectional study aimed to investigate the exact relations between distinct aspects of gender dysphoria (i.e., genital, chest, other secondary sex characteristics, and social) and engagement in, and enjoyment of, specific sexual acts. To achieve this aim, a sample of 141 trans masculine and nonbinary participants who were assigned female at birth and whom had not undertaken a medical transition were recruited. Participants were identified as trans masculine (n = 52), nonbinary (n = 72), and agender (n = 17). Participants completed a survey rating both body and social gender dysphoria and their engagement and enjoyment of receptive and performative roles across six partnered sex act domains (i.e., insertion, oral sex, sex toys, manual stimulation, nipple stimulation, and anal stimulation), as well as masturbation and noncoital activities. The overall results demonstrated that gender dysphoria is more salient to sexual acts that involve receiving versus providing sexual pleasure. In addition, genital and chest dysphoria were often significantly related to lower ratings of engagement and enjoyment. These results support the understanding that trans masculine and nonbinary individuals are likely negotiating sexual encounters to avoid sexual acts that involve areas of their body they find most distressing and marks an important area for future interventions and research.
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Affiliation(s)
- Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI, USA
| | - Annalisa Anzani
- Department of Psychology, University of Milano, Bicocca, Italy
| | - M Paz Galupo
- Department of Psychology, Towson University, 8000 York Road, Towson, MD, 21252, USA.
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Durcan E, Turan S, Bircan BE, Yaylamaz S, Okur I, Demir AN, Sulu C, Kara Z, Sahin S, Taze SS, Mefkure Ozkaya H, Kadioglu P. Fertility Desire and Motivation Among Individuals with Gender Dysphoria: A Comparative Study. J Sex Marital Ther 2022; 48:789-803. [PMID: 35332854 DOI: 10.1080/0092623x.2022.2053617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Despite receiving Gender-Affirming Hormone Therapy or Gender-Affirming Surgery, which may adversely impact their fertility, people with Gender Dysphoria (GD) may desire to form families. In this study, we aimed to quantitatively display fertility desire from the perspective of these individuals, despite all the legal challenges they face. The single center, cross-sectional comparative study included individuals with GD and cisgender volunteers. A Sociodemographic Data Form, the Fertility Desire Data Form, the Childbearing Motivations Scale and the Fertility Desire Scale were used. Of the 414 participants, 171 were individuals with GD (110 FtM; 61 MtF) and 243 were cisgender volunteers (142 cis-males; 101 cis-females). While 22% of the people with GD stated that they had regrets about not undergoing fertility preservation, 16% stated that they would like this process if it were legal. People with GD, particularly MtF, want to have children more than cisgenders. Moreover, people with MtF exhibited less negative motivations toward becoming parents, despite having reservations regarding the socioeconomic aspect of parenthood. Our findings indicate that fertility desire in people with GD is not less in comparison to cisgender people. Healthcare professionals should not forget to offer fertility preservation options as part of clinical practice before Gender-Affirming Therapy.
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Affiliation(s)
- Emre Durcan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Senol Turan
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Basak Ecem Bircan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Selver Yaylamaz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ihsan Okur
- Department of Psychiatry, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ahmet Numan Demir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cem Sulu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Zehra Kara
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Serdar Sahin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sabriye Sibel Taze
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Hande Mefkure Ozkaya
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Pinar Kadioglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Moreton KL. A Backwards-step for Gillick: Trans Children's Inability to Consent to Treatment for Gender Dysphoria-Quincy Bell & Mrs A v The Tavistock and Portman NHS Foundation Trust and Ors [2020] EWHC 3274 (Admin). Med Law Rev 2021; 29:699-715. [PMID: 34212203 DOI: 10.1093/medlaw/fwab020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The case of Quincy Bell & Mrs A v The Tavistock and Portman NHS Foundation Trust and Ors is a judicial review into the treatment practices of the Gender Identity Development Service (GIDS) run by Tavistock and Portman NHS Foundation Trust (Tavistock). The Divisional Court considered whether children and young people with Gender Dysphoria (GD) can ever be Gillick competent to consent to treatment with Puberty Blockers (PBs), and if so whether GIDS provided sufficient information to support an informed consent. This commentary examines the six key areas of the judgment: the nature of GD and its treatment with PBs; the categorisation of PBs as experimental treatment; the high bar set to achieve Gillick competence; the convergence of information provision and competence; the role of parental consent; and finally the protective jurisdiction of the court. The conclusion of the court that transgender children aged under 16 years will find 'enormous difficulties' in reaching the Gillick threshold to be able to consent to PBs, and that even 16- to 17-year olds would benefit from a 'best interests determination' from the court, signals judicial thinking which is markedly protectionist. Considering the broad contemporary stance in healthcare of facilitating competence, valuing patient participation, and respecting rights, I argue that this judgment is out of step. It has implications not only for transgender children, but it may also be a worrying signal of a greater general retreat from Gillick and a corresponding advance in emphasis on judicially determined best interests.
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30
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Manning J. Children, Parents, Courts and Medical Treatment: Now Who Decides? J Law Med 2021; 28:931-945. [PMID: 34907677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This paper analyses three decisions by different High Courts (England and Wales) concerning the competence of children and adolescents to consent to medical treatment. In Re X (No 2) Munby J upheld two decisions from the early 1990s (Re R and Re W), in which the Court of Appeal held that a court has inherent power to override a Gillick-competent child's refusal of consent to a medical treatment. The second and third decisions concerned puberty blockers (PBs) for gender dysphoria. In Bell, the Full Court considered these "experimental" and "controversial" treatments with potentially lifelong implications, such that it was doubtful that a child under 16 could understand and weigh their long-term risks and consequences and thus be competent to give a legally valid consent to treatment with them. In AB v CD the Court held that parents nevertheless retained the ability to consent to PBs if the child could or did not do so. Bell is subject to appeal. If successful, a court could revisit the interrelationship between the respective legal decision-making powers of Gillick-competent minors, their parents, clinicians, and courts.
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Affiliation(s)
- Joanna Manning
- Professor, Faculty of Law, University of Auckland, Auckland, New Zealand
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31
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Hughes LD, Kidd KM, Gamarel KE, Operario D, Dowshen N. "These Laws Will Be Devastating": Provider Perspectives on Legislation Banning Gender-Affirming Care for Transgender Adolescents. J Adolesc Health 2021; 69:976-982. [PMID: 34627657 PMCID: PMC9131701 DOI: 10.1016/j.jadohealth.2021.08.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/14/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The standards of care for transgender and gender diverse youth (TGDY) experiencing gender dysphoria are well-established and include gender-affirming medical interventions. As of July 2021, 22 states have introduced or passed legislation that bans the provision of gender-affirming medical care to anyone under the age of 18 even with parent or guardian consent. The purpose of this study is to understand what providers who deliver gender-affirming medical care to TGDY think about this legislation. METHODS In March 2021, we recruited participants via listservs known to be frequented by providers of gender-affirming medical care. Eligible participants were over the age of 18, currently working as a physician, nurse practitioner, or physician's assistant, and providing gender-affirming care to TGDY under the age of 18 in the U.S. RESULTS We analyzed the responses of 103 providers from all 50 states and DC. Most participants identified as white (77%), cisgender women (70%), specializing in pediatric care (52%). The most salient theme, described by nearly all participants, was the fear that legislation banning gender-affirming care would lead to worsening mental health including increased risk for suicides among TGDY. Other themes included the politicization of medical care, legislation that defies the current standards of care for TGDY, worsening discrimination toward TGDY, and adverse effects on the providers. CONCLUSIONS Providers of gender-affirming care overwhelmingly opposed legislation that bans gender-affirming care for TGDY citing the severe consequences to the health and well-being of TGDY along with the need to practice evidence-based medicine without fear.
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Affiliation(s)
- Landon D Hughes
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, 1 Medical Center Dr, Morgantown, West Virginia
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Nadia Dowshen
- Colonial Penn Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Jessen RS, Wæhre A, David L, Stänicke E. Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents. Arch Sex Behav 2021; 50:3489-3503. [PMID: 34716499 PMCID: PMC8604851 DOI: 10.1007/s10508-021-02024-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 05/04/2023]
Abstract
A growing number of adolescents are seeking medical care to alleviate gender dysphoria (GD). This qualitative study explored the subjective experiences of GD among help-seeking transgender and gender nonconforming (TGNC) youth in order to develop a more nuanced conceptualization of the phenomenon. Fifteen life-mode interviews were conducted with newly referred youth between the ages of 13 and 19. All participants were assigned female at birth. The data were analyzed using thematic analysis. The participants targeted five major themes that characterize GD: (1) Bodily sensations were constant reminders of GD throughout the day, (2) emotional memories from the past of being different and outside triggered GD, (3) the process of coming out was a transformative experience that changed how the participants understood themselves, (4) GD both increased and decreased in relation to others, (5) everyday life required careful negotiation to feel whole without developing new forms of GD. Based on the results, we suggest a more conceptually nuanced model of GD, one which accounts for how bodily sensations and emotional memories from the past were sources that elicited GD. The sources were mediated through the process of coming out and relating to others, and this resulted in the negotiation of GD today. The conceptual model suggested in the present study could ideally shed light on preexisting knowledge on TGNC youth struggling with GD. In addition, an improved understanding of GD could ideally help clinicians when addressing individual treatment needs.
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Affiliation(s)
- Reidar Schei Jessen
- Division of Clinical Neuroscience, Oslo University Hospital, Kirkeveien 166, 0450, Oslo, Norway.
| | - Anne Wæhre
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Linda David
- Division of Pediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Erik Stänicke
- Department of Psychology, University of Oslo, Oslo, Norway
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Levine SB. Reflections on the Clinician's Role with Individuals Who Self-identify as Transgender. Arch Sex Behav 2021; 50:3527-3536. [PMID: 34528149 PMCID: PMC8604856 DOI: 10.1007/s10508-021-02142-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 06/13/2023]
Abstract
The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist. These have been intensifying as the numbers of adolescent girls declare themselves to be trans, have gender dysphoria, or are "boys." This essay aims to assist clinicians in their initial approach to trans patients of any age. Gender identity is only one aspect of an individual's multifaceted identity. The contributions to the passionate positions in the trans culture debate are discussed along with the controversy over the official, not falsifiable, position that all gender identities are inherently normal. The essay posits that it is relevant and ethical to investigate the forces that may have propelled an individual to create and announce a new identity. Some of these biological, social, and psychological forces are enumerated. Using the adolescent patient as an example, a model for a comprehensive evaluation process and its goals are provided. The essay is framed within a developmental perspective.
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Affiliation(s)
- Stephen B Levine
- Department of Psychiatry, Case Western Reserve University, 23425 Commerce Park, #104, Beachwood, OH, 44122, USA.
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McMillan J, Gavaghan C. Mature minors and gender dysphoria: a matter for clinicians not courts. J Med Ethics 2021; 47:717-718. [PMID: 34706929 DOI: 10.1136/medethics-2021-107924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 06/13/2023]
Affiliation(s)
- John McMillan
- Bioethics Centre, University of Otago, Dunedin, New Zealand
| | - Colin Gavaghan
- Faculty of Law, University of Otago, Dunedin, New Zealand
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Kavanaugh GL, Mohnach L, Youngblom J, Kellison JG, Sandberg DE. "Good practices" in pediatric clinical care for disorders/differences of sex development. Endocrine 2021; 73:723-733. [PMID: 34021489 PMCID: PMC8325784 DOI: 10.1007/s12020-021-02748-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/30/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE To define, benchmark, and publicize elements of quality care (i.e., "good practices") for pediatric patients with disorders/differences of sex development (DSD). METHODS Principles of quality care were identified by literature review; consensus exists for 11 good practices and adherence was evaluated through online survey of 21 North American clinical sites. RESULTS Strong uptake was observed for many practices, particularly specialty participation (n ≥ 17 of 21 sites for most core specialties); point of contact (n = 18); expertise in gender dysphoria/dissatisfaction (n = 20); and DSD-specific continuing medical education (n = 18). Greater variability was apparent for frequency of peer support referrals (n = 12 universally practiced); standardized questionnaires for routine assessment of psychosocial adaptation (n = 13) and gender development (n = 10); consistently clarifying patient/family values in decision-making (n = 15); genital exam protocols that exclude trainee education as primary reason (n = 15); and internal patient-tracking efforts (n = 5-10 of 20 sites). CONCLUSION This study employed a novel approach to designate DSD good practices and identified areas of consistency and variation in these DSD clinical practices. Good practice benchmarking facilitates quality assessment within and across sites, promotes continuous improvement, and empowers stakeholders in locating and delivering high quality care.
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Affiliation(s)
- Grace L Kavanaugh
- Department of Biology, California State University, Stanislaus, CA, USA
- Accord Alliance, Higley, AZ, USA
| | - Lauren Mohnach
- Fetal Diagnostic and Treatment Center and Differences of Sex Development Clinic, University of Michigan, Ann Arbor, MI, USA
| | - Janey Youngblom
- Department of Biology, California State University, Stanislaus, CA, USA
| | - Joshua G Kellison
- Accord Alliance, Higley, AZ, USA
- Sexual Orientation and Gender Institute of Arizona, Mesa, AZ, USA
| | - David E Sandberg
- Accord Alliance, Higley, AZ, USA.
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
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Siboni L, Rucco D, Prunas A, Anzani A. "We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners. J Sex Marital Ther 2021; 48:23-46. [PMID: 34357858 DOI: 10.1080/0092623x.2021.1957733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.
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Affiliation(s)
- Laura Siboni
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Daniele Rucco
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Antonio Prunas
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
| | - Annalisa Anzani
- Department of Psychology, University of Milano - Bicocca, Milan, Italy
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Kuehn BM. Confronting High HIV Rates Among Transgender Women With Empowerment and Gender Affirmation. JAMA 2021; 326:295-297. [PMID: 34232266 DOI: 10.1001/jama.2021.10598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Scupin C, Schnell T, Kasten E. How Defined Is Gender Identity in People with Body Integrity Dysphoria? Adv Mind Body Med 2021; 35:17-32. [PMID: 34237024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Body integrity dysphoria (BID) is an intense need/desire to live in a disabled body, particularly due to a limb amputation or paraplegia. The investigators observed that significantly more people affected by BID wish to change their gender compared with the average population. The aim of this study was to find out whether gender identity (ie, typical male or female behavior) was less pronounced in a group of participants with BID than in a parallel control group of non-BID participants. The central hypothesis was that individuals in the BID group have a weak identification with their innate gender compared with the non-BID group and act more gender-neutral or contrary to their innate gender. METHODS Study participants included 25 female and 25 male individuals with BID in the BID group and 25 female and 25 male individuals in a parallel control group. RESULTS Compared with the control group, in the Minnesota Multiphasic Personality Inventory test, males with BID leaned more towards female, and females with BID leaned more toward typical male behavior. In addition, 8% of the BID group and 0% of the control group achieved the cut-off value on a test for gender dysphoria (GD). This result supports the hypothesis that BID-affected participants showed more gender-neutral behavior than the control participants. CONCLUSIONS The results indicate that gender identity in the BID group is not as defined as in the control group. These results indicate a comprehensive disruption of identification with one's own body, which is not limited to legs or arms, but also affects the gender identity of many affected individuals.
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Garz M, Schröder J, Nieder T, Becker I, Biedermann S, Hildebrandt T, Briken P, Auer M, Fuß J. Body Image and Sexual Desire in the Context of Gender Affirming Therapy: Results of a Cross-sectional Multi-centered Transgender Study. J Sex Marital Ther 2021; 47:435-445. [PMID: 33616008 DOI: 10.1080/0092623x.2021.1888831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
It has been posited that gender-affirming treatment (GAT) can have an influence on body image and sexual desire in trans people. This study aims to examine associations between GAT and sexual desire as well as whether body image mediates the influences of gender-affirming hormone therapy (GAHT) or gender-affirming surgery (GAS) on sexual desire. A total of 210 individuals diagnosed with gender dysphoria (n = 105 of each gender) were assessed via self-assessment questionnaires in a cross-sectional study. Associations between GAT and sexual desire were investigated via multivariate analyses of variance. Mediation analyses were conducted to clarify associations between GAHT/GAS, body image, and sexual desire. GAHT was associated with increased sexual desire only in transmen. GAS had no significant effect on sexual desire in transmen and transwomen. Body image did not mediate the influence of GAHT or GAS on sexual desire in both groups. GAHT and GAS had significant direct effects on body image in both genders, whereas body image showed no significant direct effect on sexual desire. The results indicate that effects of GAT on sexual desire seem to be attributable to other factors than body image, such as the hormonal influence of testosterone in transmen.
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Affiliation(s)
- Maria Garz
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johanna Schröder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo Nieder
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Becker
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah Biedermann
- Clinic of Psychiatry and Psychotherapy, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Hildebrandt
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Erlangen, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Auer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Research Group Clinical Neuroendocrinology, Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Fuß
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Gender detransition is an emerging yet poorly understood phenomenon in our society. In the absence of research, clinicians and researchers have applied the concept of detransition differently, leading to inconsistencies in its use. The article suggests a typology of gender detransition based on the cessation or the continuation of a transgender identity to address this issue. Implications of this typology for healthcare providers are discussed, emphasizing the increasing necessity of developing clinical guidelines for detransitioners. Finally, the article reflects on the possibilities of preventing detransition, which underlines the challenges that clinicians face when treating individuals with gender dysphoria.
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Affiliation(s)
- Pablo Expósito-Campos
- Clinical and Health Psychology and Research Methods, University of the Basque Country, Donostia, Spain
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Real AG, Fontanari AMV, Costa AB, Soll BMB, Bristot G, de Oliveira LF, Kamphorst AM, Schneider MA, Lobato MIR. Gender dysphoria: prejudice from childhood to adulthood, but no impact on inflammation. A cross-sectional controlled study. Trends Psychiatry Psychother 2021; 43:37-46. [PMID: 33681906 PMCID: PMC7932037 DOI: 10.47626/2237-6089-2020-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by a marked incongruence between experienced gender and one's gender assigned at birth. Transsexual individuals present a higher prevalence of psychiatric disorders when compared to non-transsexual populations, and it has been proposed that minority stress, i.e., discrimination or prejudice, has a relevant impact on these outcomes. Transsexuals also show increased chances of having experienced maltreatment during childhood. Interleukin (IL)-1β, IL-6, IL-10 and tumor necrosis factor-alpha (TNF-α) are inflammatory cytokines that regulate our immune system. Imbalanced levels in such cytokines are linked to history of childhood maltreatment and psychiatric disorders. We compared differences in IL-1β, IL-6, IL-10 and TNF-α levels and exposure to traumatic events in childhood and adulthood in individuals with and without GD (DSM-5). METHODS Cross-sectional controlled study comparing 34 transsexual women and 31 non-transsexual men. They underwent a thorough structured interview, assessing sociodemographic information, mood and anxiety symptoms, childhood maltreatment, explicit discrimination and suicidal ideation. Inflammatory cytokine levels (IL-1β, IL-6, IL-10 and TNF-α) were measured by multiplex immunoassay. RESULTS Individuals with GD experienced more discrimination (p = 0.002) and childhood maltreatment (p = 0.046) than non-transsexual men. Higher suicidal ideation (p < 0.001) and previous suicide attempt (p = 0.001) rates were observed in transsexual women. However, no differences were observed in the levels of any cytokine. CONCLUSIONS These results suggest that transsexual women are more exposed to stressful events from childhood to adulthood than non-transsexual men and that GD per se does not play a role in inflammatory markers.
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Affiliation(s)
- André Gonzales Real
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Anna Martha Vaitses Fontanari
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Angelo Brandelli Costa
- Departamento de PsicologiaPontifícia Universidade Católica do Rio Grande do SulPorto AlegreRSBrazilDepartamento de Psicologia, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
| | - Bianca Machado Borba Soll
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Giovana Bristot
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em BioquímicaUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Bioquímica, UFRGS, Porto Alegre, RS, Brazil.
| | - Larissa Fagundes de Oliveira
- INCT Translacional em MedicinaHospital de Clinicas de Porto AlegreUFRGSPorto AlegreRSBrazil Laboratório de Psiquiatria Molecular, INCT Translacional em Medicina, Hospital de Clinicas de Porto Alegre (HCPA), UFRGS, Porto Alegre, RS, Brazil.
| | - Ana Maria Kamphorst
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Maiko Abel Schneider
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
| | - Maria Inês Rodrigues Lobato
- Programa de Identidade de GêneroHospital de Clínicas de Porto AlegreUniversidade Federal do Rio Grande do SulPorto AlegreRSBrazilPrograma de Identidade de Gênero (PROTIG), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
- Programa de Pós-Graduação em Psiquiatria e Ciências do ComportamentoUFRGSPorto AlegreRSBrazilPrograma de Pós-Graduação em Psiquiatria e Ciências do Comportamento, UFRGS, Porto Alegre, RS, Brazil.
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Nishida M, Ishii W. [A Case of Breast Cancer in a Female-to-Male Transsexual during Androgen Therapy]. Gan To Kagaku Ryoho 2021; 48:77-79. [PMID: 33468728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Gender identity disorder is defined as a condition in which physical and mental sexuality do not match. A female-to-male (FTM)has the mental sexuality of males and the physical sexuality of females. FTM transsexuals generally receive androgen therapy, mastectomy, and sex reassignment surgery to live as their desired sex. The risk of breast cancer in FTM transsexual patients remains unclear. We report a case of breast cancer in an FTM transsexual. A 44-year-old man who underwent mastectomy and sex reassignment surgery and received androgen as hormone therapy developed breast cancer. At first glance, mastectomy and sex reassignment surgery may reduce the risk of breast cancer by suppressing estrogen. However, there are reports of breast cancer in FTM transsexuals. It is important to provide sufficient information that patients may develop breast cancer from residual breast tissue and that they should therefore start hormone therapy even if they have undergone mastectomy and sex reassignment surgery. In order to decide whether to restart androgen therapy after breast surgery, it is necessary to consider not only the risk of recurrence of breast cancer but also their gender identity.
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Affiliation(s)
- Maiko Nishida
- Dept. of Surgery, Japanese Red Cross Society Kyoto Daini Hospital
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43
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Giovanardi G, Fortunato A, Mirabella M, Speranza AM, Lingiardi V. Gender Diverse Children and Adolescents in Italy: A Qualitative Study on Specialized Centers' Model of Care and Network. Int J Environ Res Public Health 2020; 17:ijerph17249536. [PMID: 33352745 PMCID: PMC7766564 DOI: 10.3390/ijerph17249536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 12/30/2022]
Abstract
In recent years, Italy, similar to many other countries, has witnessed an increase in children and adolescents presenting gender incongruence. This trend has led to the development and implementation of specialized centers providing care and support for these youths and their families. The present study aimed at investigating the functioning of agencies specialized in working with transgender and gender non-conforming youths in the Italian territory. Professionals in these agencies were interviewed about their perspectives on their agency's functioning, networks with other services, and work with trans* youths and their families. A semi-structured interview was developed and administered to professionals in specialized centers and associations dedicated to trans * youths, and deductive thematic analysis was applied to the transcripts. Eight professionals were interviewed: six working in specialized centers and two working in associations. The qualitative analyses of transcripts revealed four main themes, pertaining to service referrals, assessment protocols and intervention models, psychological support for youths and families, and agency shortcomings. The study explored the functioning of Italian agencies specialized in caring for transgender and gender non-conforming youths, from the perspective of professionals working in these agencies. While several positive aspects of the work emerged, the study highlighted a lack of uniformity across the Italian territory and the need for better networks between agencies and other medical professionals.
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Gómez-Gil E, Flo M, Fernández R, Esteva I, Gómez-Gil FJ. Spanish research in gender dysphoria: A review of more than 20 years of biomedical literature. Actas Esp Psiquiatr 2020; 48:271-286. [PMID: 33398857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
To provide a bibliometric and contents analyses of the Spanish research in the field of gender dysphoria based on a literature review.
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Affiliation(s)
- Esther Gómez-Gil
- Servicio de Psiquiatría. Instituto de Neurociencias. Unidad de Identidad de Género. Hospital Clínic. IDIBAPS. Barcelona
| | - Martí Flo
- Centre de Recursos per a l’Aprenentatge i la Investigació (C.R.A.I.). Universidad de Barcelona
| | - Rosa Fernández
- Centro de Investigaciones Científicas Avanzadas (CICA). Departamento de Psicología. Universidade da Coruña
| | - Isabel Esteva
- Servicio de Endocrinología. Unidad de Identidad de Género. Hospital Regional Universitario de Málaga
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James HA, Chang AY, Imhof RL, Sahoo A, Montenegro MM, Imhof NR, Gonzalez CA, Lteif AN, Nippoldt TB, Davidge-Pitts CJ. A community-based study of demographics, medical and psychiatric conditions, and gender dysphoria/incongruence treatment in transgender/gender diverse individuals. Biol Sex Differ 2020; 11:55. [PMID: 33023634 PMCID: PMC7539507 DOI: 10.1186/s13293-020-00332-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 09/22/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Current understanding about health care in the gender diverse population is limited by the lack of community-based, longitudinal data, especially in the USA. We sought to characterize a community-based cohort of transgender individuals including demographics, gender identities, social characteristics, psychiatric and medical conditions, and medical therapy for gender dysphoria/incongruence. PATIENTS AND METHODS We performed a retrospective chart review of gender diverse residents of Olmsted County, Minnesota, who sought gender-specific healthcare from January 1, 1974, through December 31, 2015, using an infrastructure that links medical records of Olmsted County residents from multiple institutions. RESULTS The number of patients seeking gender-specific healthcare increased from 1 to 2 per 5-year interval during the 1970s-1990s to 41 from 2011 to 2015 (n = 82). Forty-nine (59.8%) were assigned male sex at birth (AMAB), 31 (37.8%) were assigned female (AFAB), and 2 (2.4%) were intersex. Gender identities evolved over time in 16.3% and 16.1% of patients AMAB and AFAB, respectively, and at most recent follow-up, 8.2% and 12.9% of patients AMAB and AFAB, respectively, were non-binary. Depression affected 78%, followed by anxiety (62.2%), personality disorder (22%), and post-traumatic stress disorder (14.6%). 58.5% experienced suicidal ideation, 22% attempted suicide, and 36.6% were victims of abuse. The most prevalent medical conditions and cardiovascular (CV) risk factors included obesity (42.7%), tobacco use (40.2%), fracture [34.1% (86.2% traumatic)], hypertension (25.6%), hyperlipidemia (25.6%), and hypertriglyceridemia (15.9%). 67.3% of patients AMAB used feminizing and 48.4% of patients AFAB used masculinizing hormone therapy. When compared to US CDC National Health Statistics, there was a significantly greater prevalence of depression and anxiety but no difference in the prevalence of obesity, hypertension, hypercholesterolemia, type 2 diabetes, or stroke. CONCLUSION Transgender and gender diverse individuals represent a population who express various gender identities and are seeking gender-specific healthcare at increasing rates. Psychiatric illness is highly prevalent compared to the US population but there is no difference in the prevalence of CV risk factors including obesity, type 2 diabetes, hypertension, and dyslipidemia.
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Affiliation(s)
- Haleigh A James
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alice Y Chang
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Reese L Imhof
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aradhana Sahoo
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Monique M Montenegro
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Nicole R Imhof
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Cesar A Gonzalez
- Department of Psychology and Psychiatry and Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology and Metabolism, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Todd B Nippoldt
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Caroline J Davidge-Pitts
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Ernst MM, Kogan BA, Lee PA. Gender identity: A psychosocial primer for providing care to patients with a disorder/difference of sex development and their families [individualized care for patients with intersex (Disorders/differences of sex development): Part 2]. J Pediatr Urol 2020; 16:606-611. [PMID: 32819812 PMCID: PMC7890938 DOI: 10.1016/j.jpurol.2020.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/BACKGROUND Many parents of infants born with a DSD describe the process of initial sex assignment at birth as highly stressful. Parents of children with a DSD also note high distress when their children engage in behaviors that are not considered typical for their gender. OBJECTIVE The goal of this article is to provide members of the health care team a brief overview of psychosocial facets of gender and gender identity particularly relevant to DSD for the purposes of enhancing shared decision-making and optimizing support for individuals with a DSD and their families. DISCUSSION Gender identity is a multidimensional construct involving related but distinct concepts such as gender typicality, gender contentedness and felt pressure for gender differentiation, and can be assessed via standardized measures. Gender dysphoria is associated with poor psychological adjustment, and is mitigated by family and peer support. Family influences on gender identity include parental modeling of gender behavior and family composition (e.g., same-sex children vs both sons and daughters in a family). Cultural factors that may influence sex assignment include societal views on gender, and gender-related differential resource allocation within a society. In addition, religious beliefs and the presence of a "third-sex" category within a culture may also influence parental gender ideology. CLINICAL APPLICATION Health care providers who work with patients with a DSD must have a strong grasp on the construct of gender identity, and must be able to clearly and consistently communicate with patients and families about gender beliefs in order to optimize family support and gender-related decisions.
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Affiliation(s)
- Michelle M Ernst
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA; Differences of Sex Development Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA.
| | | | - Peter A Lee
- Penn State College of Medicine, Hershey, PA, 17033, USA.
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Biggs M. Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Arch Sex Behav 2020; 49:2227-2229. [PMID: 32495241 PMCID: PMC8169497 DOI: 10.1007/s10508-020-01743-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 05/10/2023]
Affiliation(s)
- Michael Biggs
- Department of Sociology, St Cross College, University of Oxford, 42 Park End Street, Oxford, OX1 1JD, UK.
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Liamputtong P, Noack-Lundberg K, Dune T, Marjadi B, Schmied V, Ussher J, Perz J, Hawkey A, Sekar J, Brook E. Embodying Transgender: An Analysis of Trans Women in Online Forums. Int J Environ Res Public Health 2020; 17:ijerph17186571. [PMID: 32916993 PMCID: PMC7559890 DOI: 10.3390/ijerph17186571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/04/2020] [Accepted: 09/07/2020] [Indexed: 01/26/2023]
Abstract
This paper discusses the way that trans women embody their transgender identity, focusing on identity questioning, gender dysphoria, clinical gatekeeping and medicalized narratives. Situated within the hermeneutics methodological approach, we adopted the unobtrusive research as our research method, where data was derived from online forums where trans women posted content about their perspectives and experiences of gender and gender transitioning. Thematic analysis method was used for data analysis. Our findings suggest that gender identity is embodied and socially negotiated. Many trans women were initially ambivalent about their transgender identity and some continued to question their desired identity throughout adulthood. When presenting to healthcare professionals many trans women reported being expected to adopt a ‘wrong body’ narrative in order to gain access to treatment and surgery for gender transitioning and affirmation. In doing so, trans women interact with significant others and health care providers, and face many challenges. These challenges must be understood so that trans women can perform self-determination practices as a way to achieve gender autonomy.
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Affiliation(s)
- Pranee Liamputtong
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Kyja Noack-Lundberg
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Tinashe Dune
- School of Health Sciences, Western Sydney University, Campbelltown, NSW 2560, Australia;
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- Correspondence:
| | - Brahmaputra Marjadi
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Virginia Schmied
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW 2150, Australia
| | - Jane Ussher
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Janette Perz
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Alexandra Hawkey
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
| | - Jessica Sekar
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia; (K.N.-L.); (B.M.); (V.S.); (J.U.); (J.P.); (A.H.); (J.S.)
| | - Eloise Brook
- Gender Centre, Annandale, Sydney, NSW 2038, Australia;
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Liu M, Murthi S, Poretsky L. Polycystic Ovary Syndrome and Gender Identity. Yale J Biol Med 2020; 93:529-537. [PMID: 33005117 PMCID: PMC7513432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrinopathy affecting 46XX individuals of reproductive age. Cardinal features of PCOS include hyperandrogenism, irregular periods, and insulin resistance. Pathogenesis is unclear but likely involves hypothalamic, pituitary, or ovarian abnormalities leading to increased androgen production. In addition, alternative insulin signaling pathways are activated to preserve ovarian sensitivity to insulin while other "classical" tissues (e.g. liver, adipose, muscle) are insulin resistant. Treatment targets specific symptoms and the most common regimens include weight loss, metformin, oral contraceptives, anti-androgen compounds, and fertility treatments. Observations of individuals with gene mutations affecting androgen metabolism suggest that androgens may influence the development of gender identity. We reviewed studies exploring the relationship between gender identity and PCOS to further elucidate this relationship. Rates of PCOS in hormone-naïve transmasculine (TM) individuals appear to be higher than in the general population as cited by small, early studies using convenience samples and inconsistent criteria for PCOS. A more recent, larger study using established guidelines for PCOS did not show this to be true. Further, other studies show that although PCOS patients are less likely to identify with a traditional feminine gender scheme compared to age-matched peers, the prevalence of gender incongruence in PCOS patients is not higher than in the general population. Larger systematic studies with control groups using modern diagnostic criteria for both PCOS and gender incongruence are needed to clarify the relationship between PCOS and gender identity.
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Affiliation(s)
- Minghao Liu
- Division of Endocrinology, Friedman Transgender Health and Wellness Program, Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY
- Donald and Barbara Zucker School of Medicine at Hofstra University, Hempstead, NY
| | - Swetha Murthi
- Division of Endocrinology, Friedman Transgender Health and Wellness Program, Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY
- Donald and Barbara Zucker School of Medicine at Hofstra University, Hempstead, NY
| | - Leonid Poretsky
- Division of Endocrinology, Friedman Transgender Health and Wellness Program, Department of Medicine, Lenox Hill Hospital, Northwell Health, New York, NY
- Donald and Barbara Zucker School of Medicine at Hofstra University, Hempstead, NY
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Ocampo-Serna S, Gutiérrez-Segura JC, Vallejo-González S. Adult Gender Dysphoria with Coronary Disease. Case Report and Literature Review. Rev Colomb Psiquiatr (Engl Ed) 2020; 49:211-215. [PMID: 32888667 DOI: 10.1016/j.rcp.2018.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 04/30/2018] [Accepted: 10/16/2018] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Gender dysphoria (GD) refers to a marked incongruity between gender identity and biological sex. GD generates a significant clinical discomfort for at least six months. METHODS Case report and non-systematic literature review. Case presentation A 56-year-old male-to-female patient, who had a history of coronary disease and a second thromboembolic event after hormone therapy (self-medicated). Once she had received acute management for the cardiovascular disease, she consulted for her GD. DISCUSSION GD requires multidisciplinary management. Cross-sex hormonal therapy is considered the main treatment. It has been documented that oral oestrogen preparations may increase the risk of thromboembolic events in patients over the age of 40, especially when they have cardiovascular risk factors. CONCLUSIONS Comprehensive treatment should be offered to everyone who has GD, to relieve psychological distress, decrease psychiatric comorbidity and improve quality of life. To date, there is little scientific evidence regarding cross-sex hormonal therapy in transgender women over the age of 40; we therefore recommend multidisciplinary, close and rigorous monitoring, in particular when they have cardiovascular risk.
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Affiliation(s)
- Sabina Ocampo-Serna
- Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Colombia.
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