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PubMed1984

Black female transsexuals and schizophrenia: a serendipitous finding?

While increasing numbers of individuals have identified themselves as transsexuals and requested sex reassignment surgery, the number of black female applicants is grossly underrepresented. Indeed, only 3% of the patients applying to the Case Western Reserve University (CWRU) Gender Identity Clinic (5 of 174 patients) were black females; and in one survey of nine gender identity clinics, only 1.1% of the applicants were black females. In this study, all five black female applicants who applied for transsexual evaluation to the CWRU Gender Identity Clinic served as subjects. The patients' characteristics, their psychological test results, clinical interview material, and psychological and psychiatric diagnoses are presented. All patients had severe psychopathology; three were schizophrenic, one was a schizophrenic character, and the last diagnosed as either a psychotic character or borderline personality. Among the hypotheses, it was suggested that black women may be "inoculated" against severe gender identity pathology and only exhibit such pathology as a consequence of a schizophrenic illness or severe borderline schizophrenic state. The data also suggest that more attention should be placed on investigating the family and cultural dynamics related to transsexualism. The implications of these findings for developing a comprehensive theory of transsexualism are presented.

Adult↗
PubMed1996

Psychosexual development of women with congenital adrenal hyperplasia.

Women with congenital adrenal hyperplasia (CAH) (N = 31) and their unaffected sisters or female cousins (N = 15) participated in a study of psychosexual development. All participants were > or = 18 years of age (mean age, 25 years; range, 18-40). Comparisons were also made between the CAH women with the salt-wasting (SW) form of the disorder and those with simple virilization (SV). A psychosexual assessment protocol examined six variables: (1) sex assignment at birth (probands only); (2) recalled sex-typed behavior during childhood; (3) gender identity and gender role identification in adulthood; (4) relationship status; (5) sexual orientation in fantasy; and (6) sexual orientation in behavior. Salt-wasting status and sex assignment at birth were also ascertained for the CAH women who either refused to participate in the study (N = 10) or could not be traced (N = 13). Compared to the controls, the women with CAH recalled more cross-gender role behavior and less comfort with their sense of "femininity" during childhood. The two groups did not differ in degree of gender dysphoria in adulthood, although the probands showed more cross-gender role identification. Three of the nonparticipant probands were living, as adults, in the male social role (2 reared from birth as boys and 1 who changed from the female to the male social role during adolescence). The CAH women and the controls did not differ in relationship status (married/cohabiting vs. single). The CAH women had lower rates of exclusive heterosexual fantasy and fewer sexual experiences with men than the controls; however, the CAH women did not have more sexual experiences with women than the controls. Comparisons between the SW and SV revealed several differences: the SW were less likely to be assigned to the female sex at birth, recalled more cross-gender role behavior during childhood, were less likely to be married or cohabiting, and had lower rates of sexual experiences with men. The results were discussed in relation to the effects of prenatal androgens on psychosexual differentiation.

Adrenal Hyperplasia, Congenital↗
PubMed1975

Etiology and treatment of homosexuality: a review.

The major causal theories of and treatment approaches to male and female homosexuality are critically reviewed. Neither biological, psychoanalytic, nor learning and social-learning theories are found to provide convincing evidence for the etiology of homosexuality. All of these accounts, however, are viewed as providing mixed empirical support for their predictions, with social-learning research presenting the most consistent evidence. It is argued that both social-learning research findings and results from retrospective studies suggest that homosexuality may best be linked to the early qualitative learning and development of one's gender identity and gender role. Both psychoanalytic therapy and behavior therapy are found to have minimal successes and many failures. Most therapeutic successes seem to be with bisexuals rather than with exclusive homosexuals. The combined use of psychotherapy and specific behavioral techniques is seen to offer some promise for heterosexual adaptation with certain kinds of patients. However, it is argued that better prospects for intervention in homosexuality lie in its prevention through the early identification and treatment of the potential homosexual child.

Behavior Therapy↗
PubMed2005

Sibling sex ratio and sexual orientation in men and women: new tests in two national probability samples.

One line of research on the etiology of sexual orientation has examined sibling sex ratio, the ratio of brothers to sisters collectively reported by a group of individuals, but this research has only used clinical and/or convenience samples. In the present study, homosexual men and women's sibling sex ratio was examined in two national probability samples. Results indicated that homosexual men had a sex ratio of 129.54 male live births to 100 female live births. This ratio was within the range of elevated sex ratios found in some previous studies of homosexual men, although it was only marginally significant (p = .09) relative to the known human sex ratio with regard to live births. Additional analyses indicated that this effect was likely the result of a high fraternal birth order (i.e., an elevated number of older brothers) in homosexual men. The sibling sex ratio for lesbians was 122.58 male live births to 100 female live births, which did not significantly differ from the known human sex ratio with regard to live births. The results for lesbians, however, should be interpreted with caution because the sample size (and resulting power) was low. The results in men add to research suggesting that homosexual men, unselected for gender identity or gender role behavior, do not have elevated sibling sex ratios. These results also suggest that research should concentrate on finding the cause(s) of the fraternal birth order effect, the consistent finding that homosexual men have an elevated number of older brothers.

Adult↗
PubMed1997

Women's health care: for whom and why?

Differences are investigated between female practice populations of female general practitioners providing women's health care and of women and men general practitioners providing regular health care. Women's health care in the Netherlands is provided in the general practice "Aletta" and is based on the following principles: (1) consideration of the patient's gender identity and gender roles; (2) consideration of the patient's personal and social situation; (3) treating the patient respectfully; (4) encouraging the patient to cope with health problems and stimulating self-responsibility; and (5) avoidance of medicalization. Data were derived from an extensive health interview with 253 women Aletta patients (15 years or older) about socio-demographic characteristics, gender role, attitudes, somatic and mental health status, and medical consumption. The Aletta patients were also asked about their motives in choosing women's health care. Reference groups were comprised of 391 and 628 women patients of women and men general practitioners, respectively, providing regular health care. Logistic regression analyses were performed to explain differences between the three groups. "The Aletta patient" can be characterized as a young, urban, single, highly educated, working, and childless woman, who deliberately chooses women's health care. She is more androgynous than women of other doctors, less inclined to seek help with the GP, she suffers more from psychosomatic and psychosocial problems, and she has poorer mental health. It results in a higher use of mental health care, and also of alternative health care. Women patients of women and men doctors providing regular health care hardly differ between each other in the characteristics described above. Health policy makers should take into consideration that in the future possibly more women will prefer health care in which the ideas of women's health care are being applied. The integration of some important aspects of women's health care into regular health care is recommended.

Adolescent↗
PubMed1988

Making history: the challenge of gay and lesbian studies.

This paper addresses a central problem of gay and lesbian studies: how is the subject to be defined? Current essentialist and constructionist positions are ultimately ahistorical and reductionist, reflecting the residual influence of the medical model and its sexual definition. In place of a single-dimensional and a priori sexual category, the author proposes sociosexual specialization as the appropriate focus of gay and lesbian studies and outlines a heuristic, multidimensional model for describing not only contemporary, but historical and cross-cultural evidence. Six dimensions of social and sexual variation are reviewed: sexuality, subjectivity and identity, gender, social roles, economic roles, and spirituality.

Cross-Cultural Comparison↗
PubMed1982

Androgens and sexual behavior.

Sexual behavior in humans may be classified according to gender role, gender identity, and gender orientation. Sexually dimorphic behavior in humans is generally felt to be determined by postnatal socialization. Recent work in laboratory animals shows that sexual behavior is a function of circulating steroid hormones, particularly androgens. Testosterone given during a critical period in prenatal or immediate postnatal life causes permanent organizational effects on brain structure and function in laboratory animals. Studies in human patients with testicular feminization, 5-alpha-reductase deficiency, congenital adrenal hyperplasia, or prenatal steroid hormone exposure, provide clinical examples of possible effects of prenatal hormone action in the brain as opposed to postnatal socialization. However, these studies do not permit a clear assessment of the role played by either prenatal steroid hormones or postnatal socialization factors in the ultimate expression of sexual behavior in humans.

Androgens↗
PubMed2005

Choice of gender in 5alpha-reductase deficiency: a moving target.

Steroid 5alpha-reductase deficiency is a rare, male-limited autosomal recessive disorder caused by mutation in the SRD5A2 gene resulting in a deficiency of dihydrotestosterone (DHT) during fetal development. Here we report an affected 46,XY adolescent who was born with incompletely virilized genitalia and was raised in the female gender. At 12 years of age, the patient requested feminizing genital surgery. Surgery was withheld and psychiatric counseling was instituted. At 14 years of age, the patient's gender identity and role appeared to be in transition from a female to an increasingly male gender. This case demonstrates that in patients with disorders such as 5alpha-reductase deficiency, in which significant prenatal androgen exposures are combined with postnatal virilization, adult gender identity and gender role may be a dynamic process that is not complete until well after adolescence.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed2004

Sex, gender, and identity over the years: a changing perspective.

This article attempts to put changing terms, emphases, and views on the interrelated, but separate, concepts of sex, gender, and identity into perspective. Often, these facets of a person's life are intermingled and confused. To understand individuals whose lives are touched by any aspect of sexuality that is of interest to the medical community, knowledge of how these terms have developed and changed over the years seems of particular value. The article also tries to show the relevance of certain concepts in dealing with the specific issues of intersex. Here, medical management and ethical thinking about dealing with such conditions also have undergone change. It is probable that the terms and treatment modalities that are associated with sex- and gender-related conditions will continue to evolve as we learn more about them.

Adult↗
PubMedDate not supplied

Decreased risk of alcohol dependence and/or misuse in women with high self-assertiveness and leadership abilities.

AIMS: To analyse dimensions of gender identity and its association to psychiatric disorders and alcohol consumption. METHODS: The study was performed in two stages: an initial screening (n = 8335) for alcohol consumption, followed by a structured psychiatric interview (n = 1054). The Masculinity/Femininity-Questionnaire was used as an indicator of gender identity. The final study group included 836 women. RESULTS: Leadership, caring, self-assertiveness and emotionality were dimensions of gender identity found in a factor analysis. Low self-assertiveness, high emotionality and to some extent low leadership were associated with increased odds for having bipolar disorders, severe anxiety disorders and alcohol dependence and misuse. Low self-assertiveness and high emotionality were not only associated with alcohol dependence and misuse, but also with high episodic drinking. CONCLUSIONS: There was an association between some of the dimensions of gender identity and psychiatric disorders and alcohol consumption. Further attention is needed in both clinical work and research.

Adult↗
PubMed2006

The diagnosis and care of transsexual children and adolescents: a pediatric endocrinologists' perspective.

The normally developed child whose gender identity and anatomic sex disagree is referred to as a transgendered child, or as used subsequently in this text, a transsexual. The ramifications of this disagreement include a high risk of psychiatric conflict and maladjustment, for both the individuals themselves and their families. Despite the efforts of researchers to systematically study this group of children, many fundamental questions remain. In many respects, those lingering questions are shared by patients with physical intersex who have been cared for by pediatric endocrinologists. In intersex and transsexual patients, the medical community, although sincerely interested, remains wary to intervene in ways that may lead to further inconsistency between anatomic sex and adult gender identity. A perspective on the problems of differentiating permanent from transient gender identity, some thoughts on the most appropriate management of the transsexual child/adolescent as well as remaining questions are discussed. Both the flexible and therefore potentially misleading gender identity in children and the medical communities' pledge to first do no harm (primum non nocere) have regrettably fostered disharmony between gender disordered patients, their families, and the practitioners who want to help them.

Adolescent↗
PubMed2006

Masculinity, male development, gender, and identity: modern and postmodern meanings.

Modern and postmodern scholars are addressing the crisis in masculinity by questioning the meaning of masculinity and by rethinking masculinity, male development, gender, and identity. This article explicates current modern humanist positions and postmodern positions on these topics. The first section summarizes contemporary theories advanced by scholars in the relatively new discipline of men's studies. The second section presents postmodern positions exploring sex as a biological given, the emerging critiques of differentiating sex and gender, and poststructural psychoanalytic positions on simultaneous production of individual subjectivity (sense of self), masculine identity, and society. Implications of these perspectives are identified.

Gender Identity↗
PubMed1993

Aspects of 5-alpha reductase deficiency, a review.

Two forms of 5 alpha-reductase deficiency have been described and two genes have been cloned. In view of the psychoendocrinological complexity of the primary form, the early diagnosis preferably in infancy, is crucial. Rearing up those who are assigned as females to the male gender identity could minimize the risk of gender identity and role disorders when puberty is reached.

Adolescent↗
PubMed1998

Cognitive ability and cerebral lateralisation in transsexuals.

It is still unclear to what extent cross-gender identity is due to pre- and perinatal organising effects of sex hormones on the brain. Empirical evidence for a relationship between prenatal hormonal influences and certain aspects of gender typical (cognitive) functioning comes from pre- and postpubertal clinical samples, such as women suffering from congenital adrenal hyperplasia and studies in normal children. In order to further investigate the hypothesis that cross-gender identity is influenced by prenatal exposure to (atypical) sex steroid levels we conducted a study with early onset, adult male-to-female and female-to-male transsexuals, who were not yet hormonally treated, and nontranssexual adult female and male controls. The aim of the study was to find out whether early onset transsexuals performed in congruence with their biological sex or their gender identity. The results on different tests show that gender differences were pronounced, and that the two transsexual groups occupied a position in between these two groups, thus showing a pattern of performance away from their biological sex. The findings provide evidence that organisational hormonal influences may have an effect on the development of cross-gender identity.

Adolescent↗
PubMed2002

Gender identity/role differentiation in adolescents affected by syndromes of abnormal sex differentiation.

Adolescents with abnormal sexual differentiation or intersex conditions present a unique challenge to their healthcare providers. While sex refers to the biologic considerations that specify a person as male or female, gender refers to the sex of rearing. For the child with an intersex condition, sex may differ from gender, and as that child grows into adolescence, this may lead to many concerns, questions, and decisions. Although gender is usually fixed by adolescence, there will be those adolescents with intersex conditions wishing a gender reassignment during this period. Often a physician is the best resource for information and counsel to these young adults. Although most infants with ambiguous genitalia will have a karyotype done to determine gender identity, there are occasions when a gender discrepancy is not noticed until an adolescent presents with delayed pubarche. Regardless of the age at diagnosis, at adolescence, the physician must the address the medical consequences of infertility, bone health, and hormone replacement in addition to handling the heightened psychological concerns of gender identity during puberty. It is hoped that adolescents with intersex conditions will have the support and information necessary to allow them to live as normal a life as possible.

Adolescent↗
PubMed2022

Adolescents hospitalised for suicidality: biomarkers, social and affective predictors: a cohort study.

OBJECTIVES: The present research examines genomics and in vivo dynamics of family context and experienced affect following discharge from psychiatric hospitalisation for suicidal thoughts and behaviours (STBs). The purpose of this paper is to provide an overview of a new model, description of model-guided integration of multiple methods, documentation of feasibility of recruitment and retention and a description of baseline sample characteristics. DESIGN: The research involved a longitudinal, multimethod observational investigation. SETTING: Participants were recruited from an inpatient child and adolescent psychiatric hospital. 194 participants ages 13-18 were recruited following hospitalisation for STB. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants underwent a battery of clinical interviews, self-report assessments and venipuncture. On discharge, participants were provided with a phone with (1) the electronically activated recorder (EAR), permitting acoustic capture later coded for social context, and (2) ecological momentary assessment, permitting assessment of in vivo experienced affect and STB. Participants agreed to follow-ups at 3 weeks and 6 months. RESULTS: A total of 71.1% of approached patients consented to participation. Participants reported diversity in gender identity (11.6% reported transgender or other gender identity) and sexual orientation (47.6% reported heterosexual or straight sexual orientation). Clinical interviews supported a range of diagnoses with the largest proportion of participants meeting criteria for major depressive disorder (76.9%). History of trauma/maltreatment was prevalent. Enrolment rates and participant characteristics were similar to other observational studies. CONCLUSIONS: The research protocol characterises in vivo, real-world experienced affect and observed family context as associated with STB in adolescents during the high-risk weeks post discharge, merging multiple fields of study.

Adolescent↗