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PubMed2006

Prenatal testosterone and gender-related behaviour.

Testosterone plays an important role in mammalian brain development. In neural regions with appropriate receptors testosterone, or its metabolites, influences patterns of cell death and survival, neural connectivity and neurochemical characterization. Consequently, testosterone exposure during critical periods of early development produces permanent behavioural changes. In humans, affected behaviours include childhood play behaviour, sexual orientation, core gender identity and other characteristics that show sex differences (i.e. differ on average between males and females). These influences have been demonstrated primarily in individuals who experienced marked prenatal hormone abnormalities and associated ambiguities of genital development (e.g. congenital adrenal hyperplasia). However, there is also evidence that testosterone works within the normal range to make some individuals within each sex more sex-typical than others. The size of testosterone-related influences, and perhaps even their existence, varies from one sex-typed characteristic to another. For instance: prenatal exposure to high levels of testosterone has a substantial influence on sex-typical play behaviour, including sex-typed toy preferences, whereas influences on core gender identify and sexual orientation are less dramatic. In addition: there appears to be little or no influence of prenatal testosterone on mental rotations ability, although mental rotations ability shows a marked sex difference. These findings have implications for basic understanding of the role of testosterone in normative gender development, as well as for the clinical management of individuals with disorders of sex development (formerly called intersex syndromes).

Adrenal Hyperplasia, Congenital↗
PubMed2002

The role of affect and reasoning in a patient with a delusion of misidentification.

INTRODUCTION: This study investigated a patient with a delusion of misidentification (DM) resembling a Capgras delusion. Instead of the typical Capgras delusion--the false belief that someone has been replaced by an almost identical impostor--patient MF misidentified his wife as his former business partner. METHOD: Detailed investigation of MF's face processing, affective response and affect perception, and ability to evaluate, and reject, implausible ideas was undertaken. RESULTS: MF's visual processing of identity, gender, and age of familiar and unknown faces was intact but he was unable to identify the facial expressions of anger, disgust, and fear, or to match faces across expressions. MF also showed a reduced affective responsiveness to his environment, and impaired reasoning ability. CONCLUSIONS: We propose that MF's delusion of misidentification resulted from a combination of affective deficits, including impairment of both affective response and affect perception, in addition to an inability to evaluate, and reject, implausible ideas. These deficits, in combination with specific life events at the time of onset of the delusion, may have contributed to the form and content of the delusion. In addition, the results raise the possibility that the processing of face identity and facial expression are not as independent as previously proposed in models of face processing.

Journal Article↗
PubMed2004

Categorizing facial identities, emotions, and genders: attention to high- and low-spatial frequencies by children and adults.

Three age groups of participants (5-6 years, 7-8 years, adults) matched faces on the basis of facial identity. The procedure involved either low- or high-pass filtered faces or hybrid faces composed from two faces associated with different spatial bandwidths. The comparison stimuli were unfiltered faces. In the three age groups, the data indicated a significant bias for processing of low-pass information in priority. In a second task, participants were asked to identify the emotion (smiling or grimacing) or gender (male or female) of hybrid high-pass/low-pass faces. Opposite results emerged in the two tasks irrespective of the age group; the gender discrimination task indicated a bias for low-pass information, and the emotion task indicated a bias for high-pass information. These differences suggest independent processing routes for functionally different types of information such as emotion, gender, and identity. These routes are already established by 5 years of age.

Adolescent↗
PubMedDate not supplied

Transsexuality: some remarks based on clinical experience.

People with severe gender identity problems have always existed. Some hope to find a solution to their deep intrapersonal conflicts in a so-called sex transformation. The term 'transsexual' was coined by Cauldwell in 1949 and since then an unknown number of people all over the world, probably more biological men than women, have undergone a hormonal and surgical sex-transformation procedure. In this chapter we discuss the impossibility of real sex change from man to woman and vice versa. We briefly touch on two classical cases of sex transformation with some connection with Denmark: the Lili Elbe case of 1930 and the famous Chris Jorgensen case from the early fifties. We discuss the incidence of transsexuality and follow-up studies of patients, and give preliminary results from a Danish study of 110 people (81 men and 29 women) who during the past 25 years have applied for a sex-change operation. Of these, 56 individuals (42 men and 14 women) have had such operations. These are minimum figures since some transsexuals are known to have had operations in other countries but have not contacted Danish hospitals or health personnel.

Denmark↗
PubMedDate not supplied

Voice change surgery in the transsexual.

Sexual reassignment surgery for individuals with gender identity confusion has been highly successful, especially in the male-to-female transformation. A troublesome problem for some of these individuals is the retention of their male voice. Although castration and estrogen therapy may produce minor elevations of pitch and the assumption of a falsetto voice produces a more typical but contrived female tone, the basic male anatomic structure of the larynx must be altered to effect a physiological transformation. In three transsexuals, an attempt was made to effect a more female tonal quality by shortening the vibrating length of the vocal folds. Through a laryngofissure, the anterior one third of each cord was denuded and the raw edges approximated. This produced an anterior web that successfully resulted in pitch elevation in all three cases.

Humans↗
PubMed2001

Structural and functional sex differences in the human hypothalamus.

Sex differences in the brain may be the basis not only for sex differences in reproduction, gender identity (the feeling of being male or female), and sexual orientation (heterosexuality vs homosexuality), but also for the sex difference in prevalence of psychiatric and neurological diseases ( Swaab and Hofman, 1995 ). In this brief article we discuss a few examples of structural and functional sex differences in the human brain.

Aging↗
PubMed1983

Feedback modality and dimension in voluntary skin temperature control.

Ten male and ten female subjects were trained in the voluntary control of peripheral skin temperature, under four different conditions of feedback. These conditions were (i) visual proportional, (ii) visual binary, (iii) auditory proportional, and (iv) auditory binary. Results were analyzed using a repeated-measures ANOVA and showed a significant effect attributable to dimension, with proportional displays promoting faster acquisition of control than binary displays. No differences were detected between the visual and the auditory modes or in gender identity. The importance of these results is discussed with reference to the present need for a taxonomy of feedback displays which would optimize the effects of feedback training in a clinical milieu.

Adult↗
PubMed1977

Can fetishism occur in transsexuals?

The literature concerning the relationships between transsexualism and transvestism and their association with fetishism is reviewed. Sexual activity, including sexual arousal to women's clothes, is frequently reported in histories of transsexuals. Characteristics are reported of 12 male subjects who have shown sexual arousal to women's clothes and who have a sustained cross-gender identity combined with a desire for a change-of-sex operation. Diagnostic categories alternative to transsexualism for subjects who cross-dress are inadequate to classify at least some of the 12 subjects reported. Restricting the definition of transsexualism so as to exclude those who have shown fetishistic features is considered premature.

Adolescent↗
PubMed1979

Female-to-male transsexuals compared to lesbians: behavioral patterns of childhood and adolescent development.

We report detailed interview data on a clinical sample (N = 15) of female-to-male transsexuals (FTs) compared to a matched research sample (N = 15) of lesbians (Ls). Both groups were relatively young, with a mean age of 21 years 10 months (FTs) and 23 years 8 months (Ls), respectively, and were of middle or lower SES. Both groups did not differ from each other in respect to frequency of tomboyish behavior or interest in doll play and other aspects of materanl rehearsal. Male peer preference was more often remembered among the FTs, but the difference between the groups was only of borderline significance. The groups differed significantly regarding childhood cross-dressing (80% for FTs, 0% for Ls), gender identity confusion in adolescence (absent among Ls), and negative reaction to breast development and menarche (approximately 70% for FTs, 10% for Ls). The similarities and differences between the two groups in childhood and adolescent development are relevant for clinical management and the differential diagnosis of transsexualism vs. lesbianism.

Adolescent↗
PubMed1985

Study of the effect of estradiol on gonadotrophin levels in untreated male-to-female transsexuals.

This project was an attempt to test Dörner's theory that aspects of gender identity and sexual behavior depend on a defect in a normal imprinting mechanism of testicular testosterone (T) on the male hypothalamus. It has been suggested that such an action by T is incomplete in male-to-female transsexuals and that in this disorder the hypothalamus retains a cyclic pattern of gonadotrophin secretion and a positive feedback response to estrogens, such as is seen in the normal female. Five untreated male-to-female transsexuals and five normal male controls were each given 2 mg IM of estradiol, and T, estradiol, LH, and FSH globulin was measured serially over the following five days. No significant differences were found in the gonadotrophin or any of the other hormone responses in the transsexuals compared to normal controls. If there is a defect in imprinting of the hypothalamus in transsexual men, it does not seem to affect the basal levels of gonadotrophins or the pattern of their response to estrogen, at least in the intact male.

Adult↗
PubMed1986

The female mid-life sex change applicant: a comparison with younger female transsexuals and older male sex change applicants.

This paper reports on a survey approach to the study of the aging (40 years of age and older) female requesting sex reassignment surgery (SRS). A profile of 13 cases presenting at a cross-section of gender identity clinics in North America is presented. The mid-life SRS applicant is also compared on selected characteristics with a younger female transsexual group and with the aging male sex change applicant. Findings suggest that the mid-life female SRS applicant is closely akin to the aging, conflicted homosexual, whereas the mid-life male SRS applicant appears more closely associated with the aging transvestite.

Adult↗
PubMed1975

A body image scale for evaluating transsexuals.

Body image has come to mean not only the way one perceives his body but also how one feels about these perceptions. It is an important part of one's total self-concept. As such, it can present a significant problem for many individuals. For individuals with gender identity problems, such as transsexuals, body image dissatisfaction and distortion are a fundamental aspect of their condition. It is possible to more fully understand this condition by appreciating the distinction between the reality of the transsexual's body and his preferred body image. The Body Image (BI-I) scale presented here representa an effort to quantify the transsexual's body attitude. It consists of 30 body features which the subject is asked to rate on a 5-point scale of satisfaction. This test, as part of a larger seven-test battery, was administered to 16 male and 16 female transsexuals. The data have been analyzed for comparisons between males and females, for the effects of endocrinological and surgical treatment on body attitude, and for the common denominators which characterize the transsexual's body attitude. This instrument is being used as an additional tool in evaluating the transsexual's request for sex-reassignment surgery and in following those individuals who have been accepted for treatment as they progress through the evaluation and treatment program.

Body Image↗
PubMed1975

Sella turcica in male-to-female transsexuals.

Roentgenological examination of the skull in 11 male-to-female transsexuals revealed considerable asymmetry (2.5-3 mm) of the sellar floor in three cases. There was no asymmetry exceeding 1.5 mm in 103 male controls. Asymmetry of the sella turcica suggests the presence of an intrasellar pituitary tumor. This finding in three patients with transsexualism is of interest in view of reports of endocrine disorders or hormonal secretion abnormalities in patients with atypical sexuality or gender identity problems.

Adolescent↗
PubMed1996

The outcome of sex reassignment surgery in Belgrade: 32 patients of both sexes.

Several aspects of the quality of life after sex reassignment surgery in 32 transsexuals of both sexes (22 men, 10 women) were examined. The Belgrade Team for Gender Identity Disorders designed a standardized questionnaire for this purpose. The follow-up period after operation was from 6 months to 4 years, and four aspects of the quality of life were examined: attitude towards the patients' own body, relationships with other people, sexual activity, and occupational functioning. In most transsexuals, the quality of life was improved after surgery inasmuch as these four aspects are concerned. Only a few transsexuals were not satisfied with their life after surgery.

Adult↗
PubMedDate not supplied

Chest wall contouring for female-to-male transsexuals.

Several techniques for treating the breasts of patients with female-to-male gender identity disorders have been reported. When the patient's breasts do not sag significantly, the authors prefer to remove the breast tissue through a crescent-shaped excision of infraareolar skin in the first operation. In the second operation, reduction of the nipple is performed. Because the periareolar incision may cause a deformity of the areola, the new small nipple should be positioned in the center of the areola. Because breast scars are visible in many Asian patients, the authors believe that the scars should be as small as possible.

Adult↗
PubMed2006

Congenital adrenal hyperplasia: long-term evaluation of feminizing genitoplasty and psychosocial aspects.

Analyzing the long-term outcome in females with congenital adrenal hyperplasia (CAH) is crucial to evaluate effectiveness of treatment strategies. The aim of the study was to evaluate the long-term results in patients with CAH after feminizing surgery from the pediatric intersex clinic. Of 163 patients of CAH being followed (1980-2005), 50 responded for review. The patients had undergone feminizing genitoplasty and hormonal therapy. Evaluation included filling a detailed questionnaire along with physical examination and a structured interview in privacy. Assessment was performed for cosmetic results (50), psychosocial adjustment (42) above 5-year age, and functional outcome in 19 cases above 14-year age. Mean age at clitoroplasty was 3.6 years (1-16 years) and at time of the study was 14.6 years (4-23 years), with a mean post-op follow up of 6 years after the final surgery (6 months-17 years). The cosmetic outcome of clitoroplasty was excellent in 37, satisfactory in 10, and poor in 3. Gender identity was female, male, and mixed in 45, 4, and 1, respectively. The attitude to self and life was positive in 36 and negative in 6. The functional outcome of vaginoplasty was satisfactory, unsatisfactory, and undetermined in 11, 4, and 4, respectively. Endocrine control was satisfactory in 36/50. A novel assessment system has been adopted for analyzing the results of clitoroplasty and vaginoplasty. Endocrine control and surgical treatment are complimentary to each other to achieve satisfactory results in majority of CAH patients.

Adolescent↗
PubMed1983

Intersex disorders in adolescents and adults.

Inasmuch as disorders of sexual development and differentiation are not all diagnosed during the neonatal period, physicians and surgeons do encounter such problems in adolescent and adult patients. Because phenotype and gender identity are usually already firmly established, complaints are likely to be functional. Current cytogenetic and hormonal techniques may clarify the cause of the abnormalities but will rarely lead to sex reversal. The therapeutic goal is, when feasible, to maintain and enhance existing sexual identity.

Adolescent↗
PubMed1982

Early barbiturate exposure: the brain, sexually dimorphic behavior and learning.

Barbiturates, one of the most widely prescribed and abused classes of drugs, reportedly have been prescribed in as many as 25% of pregnancies in the U.S. and Europe over the last 30 years. Nevertheless, there exists little if any data on long-term consequences of prenatal exposure to barbiturates in humans. Evidence from laboratory animals indicates that exposure to barbiturates during early developmental periods results in abnormal neural and biochemical differentiation of the central nervous system, deficits in learning, retarded attainment of developmental milestones, alteration of behavioral and physiological sex differences, increased activity, and decreased responsiveness to aversive and appetitive stimuli. Barbiturates appear to influence the brain via two routes: (1) by direct action on neural tissue; and (2) indirectly by altering hepatic metabolism of steroid hormones. It is concluded that prenatal exposure to barbiturates in human subjects may lead to learning disabilities, decreased IQ, performance deficits, increased incidence of psychosocial maladjustment, and demasculinization of gender identity and sex role behavior in males.

Animals↗