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The classification and labeling of nonhomosexual gender dysphorias.

This report suggests systematic strategies for the descriptive classification of nonhomosexual gender identity disorders, based on clinical observations and research findings. The classification of biological males is considered first. A review of cross-gender taxonomies shows that previous observers have identified and labeled a homosexual type far more consistently than any other category of male gender dysphoric. It is suggested that the apparent difficulty in differentiating reliably among the nonhomosexual types results from the sharing of many overlapping characteristics by the various groups. This is supported by a review of informal, mostly clinical, observations and by the findings of three studies designed to test the hypothesis that the nonhomosexual gender dysphorias, together with transvestism, constitute a family of related disorders in men. It is concluded that the main varieties of nonhomosexual gender dysphoria are more similar to each other than any of them is to the homosexual type. Two recommendations, based on the foregoing review, are offered for the classification of male gender dysphorics in research studies. When the number of subjects is small, they may be classified simply as homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases may be classified as heterosexual, bisexual, or analloerotic (unattracted to male or female partners, but not necessarily devoid of sexual drive or activities).

Female↗

Anatomic variation of the corpus callosum in persons with gender dysphoria.

Previous postmortem anatomical studies have demonstrated differences between male and female in the size and shape of the splenium of the corpus callosum. The current study using the magnetic resonance imager compares the corpus callosum in 20 transsexuals and 40 controls to determine if the anatomic variance is related to anatomic sex or gender identity. No statistical differences were found in the cross-sectional areas of the entire corpus callosum, regardless of genetic sex or gender. However, the genetic males did have a larger whole-brain cross-sectional area. Also, even though there was a wide range of differences in shape and size in the splenium, the study found no significant differences between the sexes or between transsexual patients of either sex and the controls.

Adult↗

Men sexually assaulted as adults and sexually abused as boys.

Previous research on sexually victimized men has mainly addressed the acute symptoms seen in hospital emergency rooms and psychiatric clinics. Findings are reported on 14 men, all but 1 of whom had been sexually traumatized much earlier in life, as boys or young adults. Several problem areas are described: repression, denial, or normalization of the trauma; self-blame and shame; posttraumatic stress disorder; male gender identity fragility; sexual orientation ambiguity and internalized homophobia; sexual difficulties; mistrustfulness of adult men; and disturbances of self-esteem and body image. Gender issues in treatment are discussed.

Adaptation, Psychological↗

Gender role/identity and sibling sex ratio in homosexual men.

Previous research has suggested that homosexual men's sibling sex ratio-the ratio of brothers to sisters collectively reported by a group of individuals-is elevated but only in samples of extremely feminine (e.g., transsexual) homosexual men. I conducted an additional test of a sibling sex ratio effect in a general sample of homosexual men (N = 237), and examined the correlation between sibling sex ratio and childhood gender identity. I found no significant effects. My discussion focuses on why little evidence of a relationship between sibling sex ratio and cross-gender behavior in childhood occurs within this general sample of homosexual men when samples selected for very feminine homosexual men have detected an elevated sibling sex ratio.

Birth Order↗

Gender dysphoria update.

Concepts of sexuality and gender identity are undergoing re-examination in society. Recent media attention has intensified interest in the area, although reliable information is sometimes lacking. Gender dysphoria, and its extreme form, transsexualism, frequently brings sufferers into contact with psychiatric, social, and mental health professionals, and surgical caregivers. Treatment of these patients often represents a challenge on many levels. Some guidelines for this care are outlined.

Female↗

The resolution of a transsexual wish in a five-year-old boy.

The brief truncated psychoanalytic treatment of a transsexual boy described in this paper demonstrates the development of transference reactions and their subsequent resolution. The analytic situation allowed this young patient to live out again his relationship with his parents in his relationship with the analyst, to recover from wishing to be a member of the female sex, and to work through his conflicted symbiosis with his mother. Carlos became able to individuate and disidentify from her into a separate male child, in order to be able to identify with, and accept, his own biological and psychological maleness. It is to be hoped that our success with this patient will encourage others to treat and study children suffering from gender identity problems via the psychoanalytic approach.

Anxiety, Castration↗

Cognitive style, hemispheric specialization, and tested abilities of transsexuals and nontranssexuals.

Tests on which the 12 males and the 8 male transsexuals differed significantly and might be useful to clinicians for differentiation were the Embedded-figures Test, the Porteus Mazes, and the O'Connor Finger Dexterity Test. Sex differences emerged on the Embedded-figures Test and the first half of the dexterity test. There were no significant differences between 12 males and 14 females or males and 8 transsexuals on conjugate lateral eye movement, eye dominance, Digit Span, and Digit Symbol. Embedded-figures Test appears to tap some aspect of gender identity (males with female identities respond like females) while the first half of the O'Connor taps a biologically determined sex difference (males respond alike whether they have male or female identities).

Cognition↗

Outcome of sex reassignment surgery for transsexuals.

Fifteen years ago the author reviewed the world literature on male transsexualism (Pauly, 1965). Subsequently he summarized the results of sex reassignment surgery for male and female transsexuals (Pauly, 1968), and reviewed the literature on female transsexualism (Pauly, 1974). Very recently, Meyer and Reter (1979) concluded that 'sex reassignment surgery confers no objective advantage in terms of social rehabilitation' as compared with a group of individuals who sought sex reassignment but remained unoperated upon at follow-up. Both groups improved over time and led the Johns Hopkins Gender Identity Clinic to conclude that sex reassignment surgery would no longer be offered there. This report, and other non-surgical, psychotherapeutic approaches to gender dysphoric patients (Barlow et al., 1973; Barlow et al., 1979; Lothstein and Levine, 1980) call into question the justification for sex reassignment surgery. Therefore, it becomes important to update the results of sex reassignment surgery for transsexuals. Data on 283 male to female transsexuals and 83 female to male transsexuals are presented.

Female↗

[Cognition-correlation indices of gender schema: tests of validity].

Four-hundred and seventy-seven subjects evaluated a set of traits and behaviors in terms of how masculine and feminine they were and in terms of how well they represented their real and ideal self-images. Within-individual correlation coefficients between these evaluations were proposed as measures of psychological gender schemata, because they would represent the degree of matching between the subjects' gender-image and ideal/real self-images of gender-related attributes. The present study aims at examining the construct validity of these measures, by testing them to psychological variables that are known to reflect gender identity. The individual difference variables used as criteria were (a) satisfaction with one's own sex, (b) general happiness, (c) self-esteem (d) gender-conflict, and (e) school and occupational achievement need. Correlations between the gender-schema indices and the criteria variables supported the construct validity of those measures. Advantages of the present measurement over the conventional simple trait approach, such as BSRI, or PAQ are discussed.

Achievement↗

Puberty in disorders of somatosexual differentiation.

Despite enormous advances in the understanding of the molecular mechanisms of sexual differentiation, the medical decisions made in patients with disorders of somatosexual differentiation are mostly lacking evidence-based principles. Recent critical discussions have focused on approaches to gender assignment in infants with ambiguous genitalia. These decisions must be based on the correct diagnosis to be able to predict the development during puberty and adulthood in the affected individual. Puberty in this process plays a pivotal role not only because of the physical changes induced by endogenous or supplementary sex steroids to enhance the sex of rearing, but it is also the time for sexual orientation and promotion of gender identity. In this review we focus not only on the molecular impact of sex steroid action, but also view current opinions and studies on the gender development of the intersex patient during puberty.

Disorders of Sex Development↗

Human figure drawings of gender-problem children: a comparison to sibling, psychiatric, and normal controls.

The Draw-a-Person test was used to evaluate a number of questions regarding children referred for potential problems in their gender-identity development (N = 36). Sibling (N = 31), psychiatric (N = 23), and normal (N = 30) children served as comparison groups. The major results included the following: (1) The gender-referred children were more likely to draw an opposite-sex person when requested to "draw a person" than were the other three groups; (2) the gender-referred children who drew an opposite-sex person were more likely to play with opposite-sex toys and dress-up apparel on a free-play task than were the gender-referred children who drew a same-sex person; (3) the gender-referred children drew taller opposite-sex persons than same-sex persons; (4) using Koppitz's (1968) criteria, the normal children had a smaller proportion of emotional disturbance indicators in their same-sex drawings than did the other three groups. These findings were discussed with regard to psychometric and interpretive issues in the assessment of children with atypical gender-role behavior.

Art↗

Sex-typed play in gender-disturbed children: a comparison to sibling and psychiatric controls.

Gender-disturbed children (n = 14) were compared to their preadolescent siblings (n = 16) and psychiatric controls (n = 13) on a sex-typed free-play task previously shown to differentiate gender-disturbed boys from normal boys. On three separate trials totaling 20 minutes, the gender-disturbed children played for a significantly longer period of time with cross-sex toys and for a significantly shorter period of time with same-sex toys than did the two control groups. The gender-disturbed children also showed greater trial-to-trial consistency in their play preferences than the other two groups. The utility of this task in the assessment of childhood gender disturbance is discussed. In addition, the results are discussed in relation to a number of perspectives regarding both typical and atypical gender identity development in childhood.

Child↗

Opposite sex behaviours correlate with degree of homosexual feelings in the predominantly heterosexual.

There is extensive evidence that subjects who identify as homosexual show opposite sex-linked behaviours. However no attempt has been made to investigate whether a similar association exists between such behaviours and the presence of homosexual feelings in the predominantly heterosexual. Eighty medical students completed an anonymous questionnaire reporting the ratio of their heterosexual to homosexual feelings and the presence of sex-linked behaviours in their earlier life and currently. As in previous studies correlations between opposite sex behaviours and subjects' degree of homosexual feelings were found in the male subjects. Correlations remained present, though mainly at a weaker level, in the predominantly heterosexual students. It is suggested this evidence of a dimensional relationship between opposite sex-linked behaviours in childhood and degree of homosexual feeling in adulthood renders irrational the classification of such behaviours as a gender identity disorder of childhood when homosexuality in adults is not regarded as a disorder.

Adult↗

Androgyny and need achievement in male and female psychiatric inpatients.

An androgyny (gender identity) and a need achievement (n Ach) test were given to 28 normals, 23 schizophrenic patients, and 23 nonschizophrenic psychiatric patients. The psychiatric groups averaged a little over 3 weeks of hospitalization. There were gender differences for the androgyny and n Ach tests, but there were no significant differences among the three groups and no gender X diagnostic group interactions. There were significant correlations between age and both androgyny and n Ach scores, but no significant correlation between androgyny and n Ach scores.

Achievement↗

Male predominance among Palauan schizophrenics.

Data gathered in a three-month field study of known schizophrenics in the Palau Islands reveal a 4:1 ratio of males versus females. It si postulated that relatively rapid sociocultural changes over the last two decades have loosened traditional external restraints on behaviour, destabilised male role and gender identities, and created an environment which has been particularly schizophrenogenic for males. Statistical analysis of the age distribution of the schizophrenics is used to support the hypothesis. Evidence is also presented indicating that the gender distribution is not artifactual.

Acculturation↗

"Any decision is better than none" decision-making about sex of rearing for siblings with 17beta-hydroxysteroid-dehydrogenase-3 deficiency.

Children with 17beta-hydroxysteroid-dehydrogenase-3 (17beta-HSD-3) deficiency have a defect of testosterone biosynthesis with subsequent diminished virilization in XY individuals. Some are raised as girls and some as boys. There were two purposes of this case report: First, it analyzed the process of decision-making in a family with a pair of siblings with identical mutations leading to 17beta-HSD-3 deficiency whose parents chose to raise one child as a boy and one as a girl. This analysis was based on narrative interviews with the parents. Second, we assessed the gender role behavior and gender identity in the children to examine if the psychosexual development of these children correspond with the sex of rearing their parents chose. When participating in the study, the children were 7 (boy) and 5 (girl) years old. Parents described a difficult process of decision-making and voiced concerns about lack of appropriate and understandable information, and anticipated decision regret. However, they did not feel that the decision to "normalize" the external genitalia should have been deferred. Both children appeared to show age-typical gender-related behavior and did not show any signs of physical or mental distress.

17-Hydroxysteroid Dehydrogenases↗