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PubMed1992

Three quantitative studies of gender and identity in psychotherapy consultations.

This paper details the application of three distinctive approaches to the analysis of line-by-line scores for themes of gender and identity in recorded psychotherapy consultations conducted by three male analysts with a female patient. The first method involved commonly used statistical comparisons of the frequency with which gender subthemes and allusions to identity appeared in each consultation session. The results of this study indicate three significantly different patterns of gender material in the communications from the patient with each of the analysts who interviewed her--and from each analyst and patient/analyst system as well. Therapist dominance in this area appeared to be quite strong. The second study involved measures of overall informational complexity for various aspects of the gender/identity sequence of communications. Here too, individual differences emerged. They not only add to the evidence for therapist dominance in these protocols, but also provide indications that sessions differ in respect to the extent to which the information they contain is ordered and repetitive or redundant, as compared to disordered, complex, and varied. The third study availed itself of stochastic methods in which the Box-Jenkins models were used to define mathematically and post hoc, the deeper structure of aspects of the vicissitudes of gender/identity expressions in the course of these consultations. The main finding was that change in speaker role in respect to these themes accelerated in response to random interventional shocks to the system that occurred at the time of measurement and inversely with shocks to the system sustained the previous second. This look into the deeper structure of these sequences revealed considerable sensitivity to recent shocks to the patient/therapist system, much underlying instability, and strong tendencies toward establishing stability or equilibrium when the system destabilized. Of note is the finding that all three consultations, by and large, followed the same configuration--itself a rarely seen model. The implications and promise of these methods are discussed.

Adult↗
PubMed2004

"Social thinking" and cultural images: teenagers' notions of tobacco use.

The health hazards of tobacco use are well-known, and it is considered particularly important to prevent tobacco use among teenagers. New generations of teenagers still start using tobacco. To develop a more profound understanding of tobacco use among teenagers, the purpose of this study is to explore representations of tobacco use, smoking as well as snuffing, at the age when young people often start using tobacco. Focus-group interviews were carried out with 14-15 year olds in two schools in the Stockholm area. The analysis reveals that teenagers are well informed about the health-hazards of tobacco use. At the same time they hold complex and conflicting ideas concerning the relationship between tobacco use, risk, the body and "human nature". At the most general level of "social thinking" there is a dynamic relation between the three main representations of tobacco use related to: (1) notions of risk, (2) "human nature" and; (3) society's efforts to discipline its citizens, which together can be seen as the social representation of tobacco use. These representations of tobacco use are discussed as related to the teenagers' identity-work and gender identities.

Adolescent↗
PubMed1995

[Transsexuality--standards of care].

After the description of transsexualism as a nosological entity by Harry Benjamin standards of care emerged which are useful and protective for patients and doctors involved in treatment. The diagnosis is established by the finding of an irreversibly transposed gender identity. This has to be confirmed by an expert who is competent in counselling gender identity problems. He will give his written opinion which is the indication for the hormonal treatment to be done at least for half a year prior to operation and which leads to virilization or effeminization and which is the preparation for genital surgery. Standards of female-to-male surgery are: 1. Breast-transformation 2. Colpohysterectomy with adnexectomy, possibly by the vaginal route. Surrogates for testes and phalloplasties are only in the experimental stage and not standard. Standards of male-to-female surgery are: 1. Castration by extirpation of testes. 2. Resection of penis shaft with total resection of the spongy bodies. 3. Neovagina by inverted penis-skin technique. 4. Plasty of labia majora and minora and a clitoris. 5. In case of insufficient gynecomastia breast-augmentation. After the operation, follow-up examinations are necessary by the surgeon until complete healing. A supportive psychological care by the expert who has evaluated the transposition of gender identity would be useful. It could be done also by the gynecologist who makes the follow-up examinations in male to female transsexuals. He is also competent for the life-long hormonal substitution.

Female↗
PubMed2004

Accessing the multitude within: a psychoanalytic perspective on the transformation of masculinity at mid-life.

This paper reflects upon the essential components of male identity that commonly are reworked in middle age. The author argues that healthy masculine gender identity involves an ongoing, plastic process of destabilization and reconstruction at various pivotal developmental stages, particularly during middle adulthood. In essence, a man's mature transformation of his sense of masculinity results when finite concepts of gender identity are superseded by an awareness of the complexity of one's multiple, early and diverse gender identifications. A clinical case provides insight into how psychoanalytic treatment can contribute to a new experience of masculinity. The case illustrates how a maturing man, meeting an altered sense of identity in mid-life, relies less on gender splitting and more on reuniting previously antithetical intrapsychic elements. Why this more pluralistic, polythreaded masculinity frequently must wait until mid-life is further clarified. Specific importance is attached to the early development of male gender identity as it is founded on the boy's unique struggles in separating from his mother. The foundation for male gender identity formation is reconsidered as the author questions the 'dis-identification' model while explicating how the boy's striving for narcissistic completion shapes the gendered masculine ego ideal. Classically termed 'phallicism' is understood both to facilitate and obstruct a man's adult development, while the concept of 'genitality' is augmented by the postclassical notion of 'interiority'. At mid-life, 'phallic' ego ideals (resting on omnipotence, desires for narcissistic completion and gender splitting) are transformed into more realistic, 'genital' ego ideals (synthesizing autonomy and connection). The achievement of a mature, less sharply gendered 'masculine' ego ideal (revitalizing the foreclosed dimensions of both the early maternal and paternal imagos) occurs as the balance of forces shifts in the direction of true genitality rather than defensive phallicism.

Adult↗
PubMed1990

The relationship of male transsexual typology to psychosocial adjustment.

In a search to uncover variables predictive of psychosocial adjustment of male transsexuals, this study examined features which have been empirically linked to characteristics of male transsexual typology. Data from 25 male transsexual volunteers were examined by means of multiple regression analysis to determine whether symptoms of introversion, depression, or tension, as well as adjustment to work and gender reorientation could be linked to the typological variables of androphilia, gynephilia, cross-gender fetishism, feminine gender identity in childhood, and age of onset of transsexualism. Valid and reliable scales measuring the typological variables of erotic partner preference (androphilia and gynephilia), cross-gender fantasy in association with sexual arousal (cross-gender fetishism), and degree of feminine gender identity in childhood were used. Results indicate a significant relationship between social gender reorientation and the feature of androphilia and between work adjustment and gynephilia. This differential adaptation is explained in terms of the different course that transsexualism takes within each typological subgroup. These findings offer evidence as to why some transsexuals may more readily adopt a female gender identity than others. There was no relationship found between the typological features and those variables measuring psychological disturbance.

Adult↗
PubMed1999

Role of oestrogen in male sexual behaviour: insights from the natural model of aromatase deficiency.

OBJECTIVE: In order to evaluate the role of oestrogens on human male sexual behaviour, the gender-identity, psychosexual orientation and sexual activity of a man with a congenital lack of oestradiol resulting from an inactivating mutation of the aromatase P450 gene was investigated. The psychosexual and sexual behavioural evaluations were performed before and during testosterone treatment and before oestradiol treatment, during three phases of different dosages of oestradiol treatment. DESIGN: The study was performed before (phase A) and during (phase B) testosterone enanthate treatment (250 mg i.m. every 10 days, for 6 months), during testosterone withdrawal (phase C), and during each of the following transdermal oestradiol treatments: 50 microg twice a week for 6 months (phase D); 25 microg twice a week for 9 months (phase E), and 12.5 microg twice a week for 9 months (phase F). MEASUREMENTS: Sexual behaviour was investigated by a sexological interview and by a 2-month self-reported daily diary performed during each phase of the protocol study. Furthermore, during each oestradiol treatment (phase C, D, E and F), a study of depression, anxiety trait and sexual behaviour was performed by the Beck Depression Inventory (BDI), the Spielberger Trait Anxiety Inventory (STAI) and the Golombok-Rust Inventory of Sexual Satisfaction (GRISS), respectively. Sexual orientation and gender-identity were evaluated by the BEM Sex Role Inventory (BSRI). Serum testosterone and oestradiol were measured during each phase of the study. RESULTS: Before oestradiol treatment (phase C), serum oestradiol was undetectable, while it rose to 356.1, 88.1 and 55.1 pmol/l during phases D, E and F, respectively. Before any oestradiol treatment, during phase D, phase E and phase F serum testosterone was 18.13, 0.72, 14.3 and 18.51 nmol/l, respectively. The patient's gender-identity as assessed by BSRI and by the sexological interview was clearly male. The psychosexual orientation evaluated by BSRI, by the sexological interview and by the analysis of the self-filled diary was heterosexual. Relevant modification of the patient's sexual behaviour occurred only during oestrogen treatment. This was more evident during both phase E and phase F, and concerned the behavioural parameters with an increase of libido, frequency of sexual intercourse, masturbation and erotic fantasies. A reduction of BDI and STAI scores was detected during the oestrogen phases. CONCLUSIONS: The study of the sexual behaviour in this man with aromatase deficiency suggests that oestrogens in humans do not affect gender-identity and sexual orientation but could have a role in male sexual activity.

Adult↗
PubMed1982

Hormones and psychosexual differentiation: implications for the management of intersexuality, homosexuality and transsexuality.

During fetal development of subprimate mammals, sexual differentiation of the genitals and of specific sex-dimorphic brain systems depends on androgens; corresponding sex differences are displayed in prepubertal behaviours as well as in behaviours that depend on activation by pubertal hormones. In human beings, fetal hormones play the same role in genital differentiation. Hormone-dependent structural brain changes are also very likely but have not yet been demonstrated. The corresponding effects of fetal hormones on childhood behaviour have been found both in subhuman primates and in man, while the evidence concerning later behaviour, including sexual orientation, is not yet clear. The development of gender identity in humans is a cognitive process that has no counterpart in animal behaviour and is unlikely to be based on a specific hormone-sensitive brain system. It appears that the hormone-dependent variations of sex-dimorphic behaviour in childhood can be accommodated within either gender identity, provided that the child's physical appearance is gender adequate and the parental (or other caregivers') rearing style does not interfere with typical gender role development. In intersex individuals, changes in gender identity seem to occur primarily when genital and/or general physical appearance are in conflict with the assigned gender and/or when rearing has been ambiguous. The available descriptions of such changes do not seem compatible with a primarily neuroendocrine explanation. Thus, decisions on sex assignment and reassignment of intersex patients need to be based on expected social and sexual functioning, and the clinical management of such patients must minimize the risk of ambiguous rearing and of the development of a gender-incongruent physical appearance. The development of a sexual orientation in humans as hetero- or homosexual does not seem to depend on pubertal hormones. The evidence for a role of fetal hormones is suggestive, but the issue is not yet settled. Attempts to implicate the H-Y antigen in the aetiology of transsexuality seem to have failed; psychoendocrine research here parallels that on sexual orientation. Some recent developments in the management of transsexual patients are discussed.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1978

[Psychological treatment of transsexualism and sexual identity disorders some recent attempts].

Psychological treatments of transsexualism and sex gender Dysphoria syndroms. Recent data. There are generally two types of patients requesting sex change operations: one type is the classical but rare transsexual, the others belong to the larger more vague group of sex gender Dysphoria. These syndroms have been felt to be unresponsive to psychotherapy. We review here some recent attempts of psychological treatments which claim to improve satisfaction with biological sex gender identity and result in renonciation of the request of sex reassignment surgery (S.R.S.). These psychotherapies use various methods: Behavior therapy, psychoanalytically-oriented psychotherapy, religious exorcism and conversion. The reports reviewed suggest that sex gender identity may be more malleable than previously thought in transsexual syndrom, at least in relatively youthful subjects. Cases of recent onset of the syndrom which result from a crisis cases underline the necessity for careful evaluation and attempted psychological treatment before undertaking irreversible surgical procedures.

Adolescent↗
PubMed2006

[Transsexuals' life satisfaction after gender transformation operations].

BACKGROUND: More and more frequently, the registration of life satisfaction is being used to evaluate different medical treatments. So far, there have been only few such surveys on transsexuals (TS). Therefore, the aim of this study was to evaluate the general and the health-related life satisfaction of transsexuals after gender transformation operations. PATIENTS AND METHODS: Forty patients took part in this German cross-sectional study. The Questions on Life Satisfaction Module (FLZ) and free questions on different aspects of the new gender identity were used as measuring instruments. RESULTS: Of the TS studied, 85-95% were "very satisfied" or "satisfied" with the results of their gender transformation operation in respect to gender identity. The TS were significantly less satisfied (P>0.001) in overall "general life satisfaction" than the general population. In overall FLZ scores for "health-related life satisfaction", no differences were seen. CONCLUSION: These data indicate a discrepancy between subjective satisfaction with new gender identity and current life situation, and they identify problems with life satisfaction.

Adult↗
PubMed1980

The postsurgical transsexual: empirical and theoretical considerations.

Two groups of patients served as subjects for the study. Group I consisted of seven biological males (three whites and four blacks) who received surgery before the organization of the CWRU Gender Identity Clinic; Group II consisted of 14 postsurgical patients (eight biological males, two white, six black; and six white biological females) from the CWRU Gender Identity Clinic. A nine-page, 59-item questionnaire was constructed to collect systematic follow-up data for Group II. Data were collected up to 2 years postsurgery at varying intervals, measuring the sexual, psychological, environmental, economic, parental, family, medical, and social adjustment and functioning of each patient. While surgery provided in the context of a comprehensive Gender Identity Clinic program may lead to moderate social-sexual gains, researchers must begin to focus on the psychological problems not broached by surgery. The recommendation that psychotherapy be attempted with these patients (both pre- and postsurgery) is an important outgrowth of the study. Moreover, the need for a more systematic approach to follow-up, including the use of standardized interviews and clinical assessment tools and adequate control groups, is discussed.

Adult↗
PubMed1987

Psychological findings in early treated cases of female pseudohermaphroditism caused by virilizing congenital adrenal hyperplasia.

Nine female adolescents with female pseudohermaphroditism resulting from virilizing congenital adrenocortical hyperplasia (CAH) were studied in terms of gender identity, sex-role behavior, psychological adjustment, and psychosexual development. A group of adolescents with chronic illness was used as a control. The Draw-A-Person, the Bem Sex-Role Inventory, Rorschach, TAT, and a questionnaire reviewing peer and romantic activities were administered to both groups. The two groups were comparable on measures of general personality adjustment, with the CAH girls showing a trend toward greater bodily concerns. Sex-role identity for both groups was near the adolescent girl norms for both Femininity and Masculinity, with virilized CAH girls showing slightly higher Androgyny scores. Significant differences were found on gender identity as measured by greater differentiation of the drawn male figure as well as a trend toward drawing the male figure first. The CAH females also showed consistent patterns of psychosocial delay in dating and sexual relations as compared to the control group. Gender identity in this group appears to be mediated by body image. The resulting ambivalence may be evidence of feelings of incompetence, leading to resistance to social interactions and goals involving intimacy and nurturance.

Adolescent↗
PubMed1996

Understanding the influence of gender role identity on the assumption of family caregiving roles by men.

Previous explanations of limited participation by males as family caregivers assume that socialization to dominant gender stereotypes is a universal barrier among men. Overlooked are 1) variations in the degree of internalization of gender typed attitudes that enable intense participation in a wide variety of personal care tasks and the assumption of the chief caregiver role among some men, and 2) social psychological processes used to resolve cognitive dissonance among men considering caregiver activities and/or role enactment. The present examination of these processes is responsive to calls for enhancing our understanding of the personal meaning that caregiving has for men. The introduction of Risman's view that current experience influences socialized predispositions, allows the delineation of conditions under which husbands, sons, and other male relatives who have internalized stereotypical self images of masculinity can also assume caregiver roles in the family. Drawing on interview data from a purposive sample of thirty-two men who were chief caregivers for elderly relatives, case study material is presented to illustrate several pathways by which male respondents gained access to family caregiving roles.

Adult↗
PubMed1990

The endocrinology of transsexualism: a review and commentary.

Testicular hormones play a decisive role in the sexual differentiation of the genitalia. There is now also an impressive body of knowledge, gathered predominantly from laboratory animals, of the influence of gonadal steroid hormones on the prenatal/perinatal sexual differentiation of the brain. The well-documented mechanisms in animals have been extrapolated, sometimes dogmatically, to the development of sexual orientation and gender identity/role in humans. In principle, it is doubtful that an animal model of human gender identity can be found. Studies in humans have shown that levels of circulating sex steroids and estrogen feedback on luteinizing hormone do not differ between transsexuals and controls. The only reliable sources of information on hormonal influences on human gender identity formation are clinical syndromes in which the hormonal environment of the fetus has been atypical. Follow-up studies of such patients have provided evidence for possible effects of prenatal sex steroids on brain lateralization, sexual orientation and gender role stereotypes. However, a straightforward hormonal effect on gender identity (self-identification as male or female) has been difficult to ascertain up to the present time.

Disorders of Sex Development↗
PubMedDate not supplied

Maternal reports of pregnancy, genital, and related fantasies in preschool and kindergarten children.

OBJECTIVE: To test the hypothesis that there is no difference in the proportion of young boys with pregnancy fantasies versus young girls with penis fantasies and to explore the prevalence of pregnancy, genital, and related fantasies in 2-through 6-year-old children. METHOD: The parents of 171 preschool and kindergarten children attending two private schools in New York City received questionnaires regarding the above fantasies. They were completed by the mothers of 31 girls and 34 boys (overall response rate of 38%). RESULTS: There was no statistically significant difference in the proportion of girls reported to have penis/gender fantasies and the proportion of boys reported to have pregnancy fantasies. Reports of at least one fantasy were more common for girls (p < .006), as were reports of breast-feeding, other nurturing, and other reproductive fantasies (p < .03) and reports of wanting to urinate like a boy (p < .05). Reports of an "interest" in vaginas and breasts, as opposed to a fantasy about having them, were more common in boys (p < .03). CONCLUSION: These data support the "overinclusive phase" of Fast's differentiation model of gender identity. Developmentally appropriate androgynous fantasies must be distinguished from gender identity disorder, a psychiatric condition that can emerge in the same age group.

Age of Onset↗
PubMed2005

Psychological long-term outcome in intersex conditions.

For decades, sex assignment in children with intersex conditions has depended more on surgical possibilities than on other criteria, since it was assumed that children are psychosexually neutral at birth. Adults with intersex conditions and professionals in the field have increasingly criticized this policy after the publication of studies suggesting that prenatal brain exposure to sex hormones determines gender development. Although prenatal brain exposure to androgens plays some part in the development of gender role behaviour, the current evidence is not in line with the idea of determination of gender identity through prenatal sex steroid exposure. Recent reviews on gender dysphoria and gender change in patients with intersex conditions show that initial gender assignment still seems to be the best predictor of adult gender identity.

17-Hydroxysteroid Dehydrogenases↗
PubMed2005

Family attitudes toward transgendered people in Turkey: experience from a secular Islamic country.

OBJECTIVE: In Turkey, an individual with gender identity disorder is stigmatized and isolated from society. The family largely reflects and reinforces these negative views because gender crossing poses a threat to the normatively sanctioned gender classification. METHODS: We examined the acceptance of gender identity differences by the families in 47 relatives of 39 transgendered individuals who applied to a psychiatry clinic for sex reassignment. RESULTS: Half of the relatives who came to the interview were mothers. While 85.1% of the families considered themselves as secular muslims, 14.9% were very religious. They first noticed the gender identity disorder during puberty (70.2%) or prepuberty (17%). In 63.8% it was remarked that it was a shocking experience. One-third of them felt responsible for it. While 65.9% tried to change the situation by coercion, only 27.7% adopted a supportive attitude. The majority of families tried to conceal the situation from their immediate environment and one-third did not even inform their closest relatives. For half of relatives the mass media was their only source of information whereas one-third received information from doctors. Most of the families were satisfied with the treatment. Family members also reported that the conformity of the transgendered relative within the family improved. Of the family members, 40.4% accepted the transgendered identity and approved the sex reassignment surgery as a final step. CONCLUSION: Involvement of family members in the process of change for the transgendered individual is important for both the family as well as the individual concerned.

Adult↗
PubMed2006

Health policy considerations for our sexual minority patients.

Homosexuality and transsexuality are still widely viewed by lay individuals as morally negative and deserving of legal proscription. Peer-reviewed data confirm that experiences of legal discrimination are associated with stress-related health problems, reduced utilization of health care, and financial and legal challenges for individuals and families, especially those with children. In the last 3 years, the American Psychiatric Association, American Psychological Association, and American Psychoanalytic Association have each reviewed the research on sexual orientation and identity, and each has confirmed that sexual orientation and gender identity do not correlate with mental illness or immorality. They have each endorsed laws that confer equality to sexual minorities, including nondiscrimination in employment, medical insurance coverage, adoption, and access to civil marriage. The American College of Obstetricians and Gynecologists (ACOG), by virtue of its history of advocacy for women's health, is in a position to promote policy and make similar recommendations, recognizing that sexual minority women's health and their family issues are an integral component of taking care of all women. The College should review the policies of America's premier mental health associations and consider including sexual orientation and gender identity in its own nondiscrimination policy, and ACOG should issue a policy statement in support of laws to provide safety from violence and discrimination, equal employment opportunities, equal health insurance coverage, and equal access to civil marriage.

Evidence-Based Medicine↗