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PubMed2005

Transsexuals and European human rights law.

Sexual identity is a legal status, and as such it is as much dependent on public policy as on self-identification. However, because this status can be crucial to one's role in society, a conflict between the legal status and an individual's perceptions or aspirations creates a dilemma if society is committed to individual freedom. This difficulty can become particularly acute where it is technically possible for an individual to alter some of the factors used socially or legally to determine sexual identity. This paper analyses these difficulties, both from the situation of endocrine disorder and with respect to gender identity. It argues that this distinction in approach may not be a valid basis for different legal treatment. It considers four major issues: the stage at which a change of gender should be recognised; any preconditions to which a legal change of gender should be made subject; whether legal recognition should be made for all purposes or only for specific areas of the law; and the confidentiality of a person's previous sexual identity. The paper particularly analyses the law in the United Kingdom and then considers other jurisdictions before focusing on the treatment of transsexuals under the European Convention on Human Rights.

Europe↗
PubMed1993

Gender differences in identity development: an examination of longitudinal data.

Longitudinal data from 105 junior high school students were analyzed to examine the relationship between gender and identity development over time. Analysis of variance, t tests, and analysis of covariance were employed. Taken collectively, results indicated that patterns of change over time were similar for males and females; as the students aged, they grew in psychosocial maturity regardless of gender. These results are consistent with other work using Eriksonian-based assessment instruments. Gilligan, using ethnographic methodology and a framework at odds with Erikson's, has proposed a very different interpretation of development across gender. Perhaps the two methodologies and the concomitant findings should be considered in a complementary fashion in view of the complex societal forces imposed upon females as they progress in their identity development.

Adolescent↗
PubMed1996

Pathways into drug user treatment: the influence of gender and racial/ethnic identity.

Drawing on constructs from models of health behavior change, this paper examines gender and racial/ethnic influences on access to residential drug user treatment. Using a focus group methodology, data were collected from a sample of 65 in-treatment White, Black, and Hispanic men and women. Hispanics were more likely to delay treatment because of a reluctance to acknowledge their addictions and discomfort at being separated from family. Females reported more negative expectations about treatment than males and more use of drugs to bolster self-esteem. Responsibility to children represented the most powerful catalyst to treatment for women. Implications for improving access to treatment for women and minorities are discussed.

Adolescent↗
PubMedDate not supplied

Surgical therapy in transsexual patients: a multi-disciplinary approach.

A transsexual patient has the constant and persistent conviction that he or she belongs to the opposite sex, thus creating a deeply seated gender identity conflict. With psychotherapy being unsuccessful, it has been proven that in carefully selected patients, gender reassignment or adjusting the body to the mind (both with hormones and surgery) is the best way to normalize their lives. Optimal treatment of these patients requires the multidisciplinary approach of a gender team with the input of several specialties. Such a team consists of a nucleus of physicians who sees the patient more frequently: the psychiatrist, the endocrinologist, the plastic surgeon, the gynecologist and the urologist and a more peripheral group that sees the patients more incidentally: the psychologist, the otorhinolaryngologist, the dermatologist, the speech therapist, the lawyer, the nurse and the social worker. Between 1987 and 1999, a total of 71 male-to-female (MTF) and 54 female-to-male transsexuals have undergone gender confirming surgery in our hospital. This article gives a review and an update on the different surgical procedures as well as on the outcome in our patient population. The results in this series of patients clearly demonstrate that a close cooperation of the different surgical specialties, within our multidisciplinary gender team, is the key to success in treating transsexual patients.

Female↗
PubMedDate not supplied

African American female adolescent identity development: a three-dimensional perspective.

African American female adolescents have unique identity issues that structure developmental tasks. Qualitative data from a longitudinal research project are used to explicate a three-dimensional model of the identity developmental process in early-age African American female adolescents. The limitations of a gender analysis model of voice and connection are noted. It is suggested that the African American female adolescent experiences a relational crisis in both racial and gender identity development. Moreover, African American female adolescents develop skillful, unique, expressionistic, and assertive styles of relating to negotiating perceived hostile environments. Practice implications for child welfare are outlined.

Adolescent↗
PubMed1980

Steroid 5 alpha-reductase deficiency in a 65-year-old male pseudohermaphrodite: the natural history, ultrastructure of the testes, and evidence for inherited enzyme heterogeneity.

We report a 65-yr-old male pseudohermaphrodite with steroid 5 alpha-reductase deficiency in whom there was no medical intervention before, during, or after puberty, enabling us to observe the natural history of this condition. The affected subject has an android build, with more facial and body hair than in previously described affected adults. Although the subject was raised as a girl, a male gender identity evolved with the events of puberty, but social factors have delayed the complete expression of a male gender role. Plasma levels of dihydrotestosterone and the in vivo conversion of radiolabeled testosterone to dihydrotestosterone were decreased. There was an elevated urinary etiocholanolone to androsterone ratio, typical of the syndrome. Characterization of 5 alpha-reductase enzyme activity in cultured genital skin fibroblasts demonstrated a pattern of enzyme activity distinctly different from three previously described families with this condition. There was decreased enzyme affinity for testosterone and NADPH. Also, the stability of the enzyme to elevated temperature was not protected by NADPH, resulting in rapid disappearance of enzyme activity after inhibition of protein synthesis with cycloheximide. Electron microscopic evaluation of the testes was carried out.

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1974

Behavioral treatment of deviant sex-role behaviors in a male child.

This study demonstrated reinforcement control over pronounced feminine behaviors in a male child who had been psychologically evaluated as manifesting "childhood cross-gender identity". The clinical history of the subject paralleled the retrospective reports of adult transsexuals, including (a) cross-gender clothing preferences, (b) actual or imaginal use of cosmetic articles, (c) feminine behavior mannerisms, (d) aversion to masculine activities, coupled with preference for girl playmates and feminine activities, (e) preference for female role, (f) feminine voice inflection and predominantly feminine content in speech, and (g) verbal statements about the desire or preference to be a girl. The subject was treated sequentially in the clinic and home environments by his mother, trained to be his therapist. The mother was taught to reinforce masculine behaviors and to extinguish feminine behaviors, by using social reinforcement in the clinic and a token reinforcement procedure in the home. During this treatment, his feminine behaviors sharply decreased and masculine behavior increased. The treatment effects were found to be largely response-specific and stimulus-specific; consequently, it was necessary to strengthen more than one masculine behavior and weaken several feminine behaviors, in both clinic and home settings. A multiple-baseline intrasubject design was used to ensure both replication and identification of relevant treatment variables. Follow-up data three years after the treatment began suggests that the boy's sex-typed behaviors have become normalized. This study suggests a preliminary step toward correcting pathological sex-role development in boys, which may provide a basis for the primary prevention of adult transsexualism or similar adult sex-role deviation.

Attention↗
PubMed2002

The role of gender and suicide precipitant in attitudes toward nonfatal suicide behavior.

This study examined factors affecting young adults' attitudes about nonfatal suicidal behavior. It evaluated how respondent sex, respondent gender identity, the precipitant of the suicidal act (i.e., a relationship loss, an achievement failure, or a physical illness), and gender of the suicidal person influence reactions to a suicidal decision. In this study of nonfatal suicidal behavior, like in studies of suicide, attitudes were least negative when the suicidal act was in response to a physical illness. Men were more likely to agree with and accept the suicidal decision than women. Androgynous persons, on the other hand, tended to view the decision to kill oneself as foolish, independent of precipitant. They also reported less agreement, acceptance, and sympathy for such decision. The implications of these findings for the prevention of suicidal behaviors are considered. Because gender seems to play a role in the acceptability of suicidal behavior, prevention programs ought to explicitly examine gender issues in attitudes toward suicidal behavior.

Achievement↗
PubMed2005

Characteristics of non-response in the Danish Health Interview Surveys, 1987-1994.

BACKGROUND: The types and quantity of non-response in surveys influence the extent to which the results may be generalized. This study analysed trends in non-response in the Danish Health Interview Surveys from 1987 to 1994 and used the National Patient Registry to assess whether non-response biased the estimated population prevalence of morbidity when solely based on responders. METHODS: The data were for the 23,096 adults sampled for the Danish Health Interview Surveys in 1987, 1991 and 1994. All were followed using the National Patient Registry to obtain such information as hospital admissions. RESULTS: Non-response increased from 20.0% in 1987 to 22.6% in 1994. Four combinations of background variables characterized the non-response: gender and age; gender and civil status; county of residence and age; survey year and age. Non-respondents and respondents had identical gender- and age-standardized hospital admission rates for approximately 5 years before and 2 years after data collection, but non-respondents had a significantly higher rate immediately before and during data collection. Admissions rates were analysed according to reasons for non-response. Refusers had a lower admission rate than respondents before data collection but similar during and after data collection. The rate was higher during the whole period among ill or disabled non-respondents. Among people who could not be contacted during the data collection period a higher admission rate was only found immediately before and during data collection. CONCLUSIONS: Although admission rates differed between respondents and non-respondents these differences were too small to bias the estimated population prevalence of morbidity when solely based on respondents.

Adolescent↗
PubMed2001

Sex research at the borders of gender: transvestites, transsexuals, and Alfred C. Kinsey.

Sex researcher Alfred Kinsey's vision of sexual taxonomy continued to evolve after he published his first landmark volume on human sexuality, and his research into sexual subcultures went beyond his initial studies of homosexuality and prostitution. In the late 1940s and early 1950s, he developed a new interest in cross-dressing and cross-gender identification. This article outlines how and why he began to interview transvestites and transsexuals, and places his emerging vision of gendered behavior and gender identity within the scientific theories of his day. Kinsey rejected the prevailing views, preferring instead a behaviorist model of gender. He saw cross-dressing and crossgender identification as male phenomena and used them to speculate about sex differences in the capacity for psychological conditioning. In his usual style, he did not condemn transvestites or transsexuals, but he disapproved of the genital surgery requested by male-to-female transsexuals. It was here that Kinsey hit the limits of his well-known sexual liberalism in which he approved of all sexual variations that did not involve coercion.

Female↗
PubMed2005

Functional asymmetry and interhemispheric cooperation in the perception of emotions from facial expressions.

The present study used the redundant target paradigm on healthy subjects to investigate functional hemispheric asymmetries and interhemispheric cooperation in the perception of emotions from faces. In Experiment 1 participants responded to checkerboards presented either unilaterally to the left (LVF) or right visual half field (RVF), or simultaneously to both hemifields (BVF), while performing a pointing task for the control of eye movements. As previously reported (Miniussi et al. in J Cogn Neurosci 10:216-230, 1998), redundant stimulation led to shorter latencies for stimulus detection (bilateral gain or redundant target effect, RTE) that exceeded the limit for a probabilistic interpretation, thereby validating the pointing procedure and supporting interhemispheric cooperation. In Experiment 2 the same pointing procedure was used in a go/no-go task requiring subjects to respond when seeing a target emotional expression (happy or fearful, counterbalanced between blocks). Faster reaction times to unilateral LVF than RVF emotions, regardless of valence, indicate that the perception of positive and negative emotional faces is lateralized toward the right hemisphere. Simultaneous presentation of two congruent emotional faces, either happy or fearful, produced an RTE that cannot be explained by probability summation and suggests interhemispheric cooperation and neural summation. No such effect was present with BVF incongruent facial expressions. In Experiment 3 we studied whether the RTE for emotional faces depends on the physical identity between BVF stimuli, and we set a second BVF congruent condition in which there was only emotional but not physical or gender identity between stimuli (i.e. two different faces expressing the same emotion). The RTE and interhemispheric cooperation were present also in this second BVF congruent condition. This shows that emotional congruency is the sufficient condition for the RTE to take place in the intact brain and that the cerebral hemispheres can interact in spite of physical differences between stimuli.

Adult↗
PubMed2006

Opposite gender doctor-patient interactions in Iran.

BACKGROUND: The importance of physician gender in patient health outcomes has been recognized for some time in the West. For example, there is some evidence to show that female doctors use good interpersonal communication skills with their patients and that patients are satisfied with female doctors. There is little known, however, about the contribution of different configurations of gender identities to a variety of positive health outcomes in non-Western countries. In Iran, in particular, the attention given to "cross-gender dyads" in doctor-patient interactions is severely limited. DESCRIPTION: The findings were based on a well-designed questionnaire, validated and found to be reliable in Australia, which we administered to medical students in Iran. EVALUATION: Overall, there was no significant difference between the mean scores of students in relation to opposite-gender comfort. Results indicate that both male and female students were more comfortable conducting intimate physical examinations on patients of the same gender as themselves. Performing a testicular examination was significantly disagreeable for both genders, but particularly for female students. CONCLUSIONS: Both genders appeared to be comfortable talking to patients of the opposite gender about intimate matters, but same-gender dyads were viewed as preferable to cross-gender dyads in relation to physical examinations. Further qualitative research is needed to understand how these views are constituted and how they operate in practice. We make some recommendations, and we discuss the limitations of study.

Cross-Sectional Studies↗
PubMed2006

Genital lichen sclerosus in a case of male-to-female gender reassignment.

Lichen sclerosus (LS) is a chronic cutaneous disorder of uncertain aetiology seen predominantly in females. It is characterized by white atrophic macules and plaques with a predilection for involvement of the genitalia and perianal skin. Gender-identity disorder (transsexualism) is a descriptive term for individuals having the genetic, somatic and hormonal basis of one sex but who identify sexually with the opposite sex. Surgical gender reassignment is a fundamental step in the management of these complex patients and is driven by the individual's belief of being the opposite sex 'trapped' in the wrong body. We report a case of genital lichen sclerosus in hair-bearing skin originally from the scrotum, in an individual who had undergone male-to-female gender reassignment. To our knowledge, no similar cases have been reported to date.

Adult↗
PubMed1994

Treatment of gender dysphoria (transsexualism).

Gender dysphoria, or transsexualism, is a condition involving incongruity between an individual's anatomic sex and personal sense of gender identity. Only in the last 15 years have Standards of Care been established and a professional organization developed to bring definition and consistency to the field (Harry Benjamin International Gender Dysphoria Association). A typical course of treatment lasts several years and includes psychological/psychiatric evaluations, completion of the "real life" test, administration of hormone therapy to create desired secondary sex characteristics, and finally sex reassignment surgery. As the field has developed and health-care professionals and the public have become more aware, increasing numbers of individuals are coming forward to seek evaluation and treatment. Published follow-up studies documenting long-term outcome are needed now. Current intervention techniques have progressed beyond the "experimental" stage and can be regarded as accepted medical practice.

Combined Modality Therapy↗
PubMed1998

Homozygous mutation (A228T) in the 5alpha-reductase type 2 gene in a boy with 5alpha-reductase deficiency: genotype-phenotype correlations.

The molecular basis of a patient with 5alpha-reductase deficiency was investigated in this study. This disease is a rare form of male pseudohermaphroditism with virilization during puberty. The child was raised as a girl, but had a male gender identity early in life. The diagnosis was set at the age of 13 years when the virilization process began. Hypospadias repair was performed and he changed to a male gender. DNA sequence analysis disclosed a homozygous mutation in exon 4 of the 5alpha-reductase type 2 gene, alanine 228 for threonine. The heterozygous parents are first cousins of Pakistani origin.

Adolescent↗
PubMed2004

Situating gender and professional identity in American child study, 1880-1910.

The boundaries of psychological expertise in modern America were often imagined in gendered terms. Studies of child development served as one area where dominant notions of masculinity and femininity collided at a historical moment in which women were increasingly present inthe traditionally male worlds of science and higher education. Attributes that many female authors regarded as necessary qualifications for understanding child development (such as patience, sympathy, and maternal care) were routinely dismissed by male writers as contrary to an authentic scientific disposition. Thus, disputes over the meaning of child development (and the methods of studying it) indicate some of the ways that women's labor was both acknowledged and demoted during the formative years of American social science.

Child↗
PubMed2006

Need for HIV/AIDS education and intervention for MTF transgenders: responding to the challenge.

The purpose of this paper is to report on the use of qualitative and quantitative research to develop an HIV/AIDS education intervention for MTF transgenders. Findings revealed that MTF transgenders have high prevalence of adverse health outcomes such as HIV, substance use, and psychological problems. MTF transgenders of color-African American, Latina, and Asian Pacific Islanders-experience heightened risk due to multiple stigmas associated with ethnicity and gender identity. Based on this evidence of need, we developed a series of transgender- specific HIV prevention, substance use and mental health treatment, and health education programs. Future health programs for stigmatized gender minorities, such as MTF transgenders, will benefit from conducting descriptive studies to identify the health needs of the community, and by linking research scientists, health providers, and community agencies to form a collaborative network for delivering evidence based and community sensitive services.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Young people, smoking and gender--a qualitative exploration.

Smoking among young people has become increasingly gendered. In several countries, smoking among adolescent girls is now higher than among adolescent boys. However, we have only a limited understanding of the reasons behind these gender patterns. This paper reports the findings from a qualitative study which used single-sex focus groups to explore the gendered nature of the meaning and function of smoking among Scottish 15- to 16-year old smokers. The study found that young people were ambivalent about their smoking but that this was somewhat different for boys and girls. These differences related to their social worlds, pattern of social relationships, interests, activities and concerns, the meanings they attached to smoking and the role smoking played in dealing with the everyday experience of being a boy or girl in their mid-teens. For example, boys were concerned about the impact of smoking on their fitness and sport, whereas girls were more concerned about the negative aesthetic effects such as their clothes and bodies smelling of smoke. Of particular importance was how smoking related in different ways to the gendered 'identity work' that adolescents had to undertake to achieve a socially and culturally acceptable image. The implications for programmes aimed at reducing smoking among young people, particularly the need for more gender-sensitive approaches, are discussed.

Adolescent↗