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PubMed2005

Gender identity disorder: general overview and surgical treatment for vaginoplasty in male-to-female transsexuals.

LEARNING OBJECTIVES: After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. BACKGROUND: Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major role in the research and treatment of gender identity disorder, publishing the Standards of Care for Gender Dysphoric Persons. METHODS: The authors performed an overview of the terminology related to male-to-female gender identity disorder; the different theories regarding cause, epidemiology, and treatment; the goals expected; and the surgical technique available for sex reassignment surgery in male-to-female transsexualism. RESULTS: Surgical techniques available for sex reassignment surgery in male-to-female transsexualism, with advantages and disadvantages offered by each technique, are reviewed. Other feminizing nongenital operative interventions are also examined. CONCLUSIONS: This review describes recent etiopathogenetic theories and actual guidelines on the treatment of the gender identity disorder in male-to-female transsexuals; the penile-scrotal skin flap technique is considered the state of the art for vaginoplasty in male-to-female transsexuals, whereas other techniques (rectosigmoid flap, local flaps, and isolated skin grafts) should be considered only in secondary cases. As techniques in vaginoplasty become more refined, more emphasis is being placed on aesthetic outcomes by both surgeons and patients.

Clitoris↗
PubMed2005

The interaction between young people with atypical gender identity organization and their peers.

This exploratory study involved the qualitative analysis of the responses of eight children with atypical gender identity organization to open-ended questions about their experiences of secondary school. The aim was to develop an understanding of these young people's interaction with their peers. It became apparent that all but one of the participants had been bullied. In this context, participants reported difficulties in developing friendships, although each participant received support from at least one of their peers. Given the hostile school environment participants did not necessarily talk to these individuals about their experiences in relation to their gender identity. The clinical implications for working with young people on a developing gender identity, and the impact on their mental health, are considered.

Adolescent↗
PubMed1992

Sex-typed responses in the Rorschach protocols of children with gender identity disorder.

A coding system was developed to measure sex-typed responses in the Rorschach protocols of children with gender identity disorder (n = 79). Their responses were compared to that of sibling (n = 25), psychiatric (n = 26), and normal (n = 28) controls. Results show that children with gender identity disorder gave significantly more cross-sex responses than same-sex responses, whereas the psychiatric and normal controls gave significantly more same-sex responses than cross-sex responses. The siblings did not differ in the number of same-sex and cross-sex responses. Results are discussed with regard to various assessment issues in the study of children with gender identity disorder.

Child↗
PubMed1977

Biochemical determinants in Gender identity.

The purpose of this communication is to report cognate studies which suggest that the nature of the peripheral metabolism of testosterone may impart gender direction to thought construction and motive. In patients with the complete testicular feminizing syndrome [4], the XO/XY syndrome [4], female trans-sexualism [4] and testicular agenesis [5] HCG-tests of 3 days duration were performed, and plasma and urinary testosterone, urinary excretion of 5 alpha-androstane, 3 alpha, 17 beta-diol (5 alpha-diol), 5 beta-androstane, 3 alpha, 17 beta-diol (5 beta-diol) and epiandrosterone before and after stimulation were measured. In addition steroid transformation was examined by incubation studies with human fetal brain tissue. The results of the latter method presented here are in agreement with published work. It seems clear therefore that the peripheral levels of androgens, oestrogens and their metabolites combine with cerebral steroid transformation, metabolism and possible also synthesis in order to establish gender identity. Exploration of the role of peripheral hormones as stimulators of both gender identity and gender function has dictated the need for a new approach to therapy for gender abnormalities in psyche and soma.

Adolescent↗
PubMed2005

Quality of life and gender identity in Parkinson's disease.

UNLABELLED: We examined the correlation between gender identity (perception of masculinity or femininity) and quality of life (QoL) of 124 Parkinson's disease (PD) patients without dementia (69 men, 55 women, mean age 65.8+/-10.2 years, mean disease duration 8.5+/-5.8 years, mean Hoehn and Yahr [H&Y] stage 2.7+/-0.8). All patients underwent clinical examinations and completed the PDQ-39 and the quality of sexual life questionnaire. Their masculine or feminine stereotypes were determined by the Bem Sex Role Inventory (BSRI) modified by Dior. QoL was significantly correlated with disease duration (r=0.262, p<0.01), H&Y staging (r=0.330, p<0.001) and disease severity (UPDRS) (r=0.432, p<0.001). The QoL of androgynous men and women (i.e., with strong feminine and masculine characteristics) was significantly (p<0.05) better than the other gender groups. A significant interaction was found between the sexes to gender identity (p<0.05). CONCLUSION: Androgynous PD patients cope better with their disease in terms of QoL parameters, especially androgynous women.

Adaptation, Psychological↗
PubMed2001

[Gender identity and eating disorders].

BACKGROUND: A possible role of the feminine gender role in the genesis of eating disorders is possible, since most patients with these disorders are women. AIM: To compare some traits of gender identity between females with eating disorders and a control group. MATERIAL AND METHODS: An structured clinical interview based on the DSM-IV diagnostic criteria for eating disorders and the Bem Sex Role Inventory (BSRI) were administered to 63 patients that fulfilled the DSM-IV criteria for anorexia nervosa or bulimia nervosa (ED group) and 63 comparison subjects (C group). RESULTS: Forty three percent of patients in contrast with 23.8% of controls were classified within the feminine category. Likewise 19% of patients and 31.7% of controls were qualified as Androgynous; 27% of patients and 43% of controls were qualified as Undifferentiated. There were significant differences between patients and controls in 22 items of the BSRI (p < 0.01). Both groups rejected and were identified with some feminine, masculine and neutral qualities. DISCUSSION: Femininity emerged as the main trait of gender identity in patients suffering of eating disorders. In contrast, Androgyny showed by the control group could result in a better adaptability and flexibility to face difficult life circumstances.

Adult↗
PubMed1998

Birth order in girls with gender identity disorder.

This study examined the birth order of girls with gender identity disorder (N = 22). Each proband was matched to 3-7 clinical control girls for age at assessment and number of siblings (the mode number of controls per proband was 7) (total N = 147). The number of older brothers, older sisters, younger brothers, and younger sisters was recorded. Slater's birth order index showed that the probands were significantly more likely to be early born than were the controls. A modified Slater's index also compared the birth order of the probands and the controls only to their brothers (when they had one or more) and only to their sisters (when they had one or more). Compared to the controls, the probands were born early compared to their sisters, but not to their brothers. These findings are the inverse of two previous studies of boys with gender identity disorder, who were later born relative to clinical control boys, an effect that appeared to be accounted for primarily by being born later relative to older brothers, but not to older sisters.

Adolescent↗
PubMed2005

The impact of family status on gender identity and on sex-typing of household tasks in Israel.

The author examined differences in sex-typing of household tasks (adult gender roles and children's chores) and differences in gender identity among adult Israelis. The author compared 2 groups of participants: single people without children (single-family participants; n = 62) and married people with children (full-family participants; n = 62). Regarding sex-typing of household tasks and direct assessments of masculine and feminine identity, there were no differences between single-family participants and full-family participants. However, family status affected self-assessments of gender identity that were based on cultural definitions of masculine and feminine attributes. Furthermore, correlations between direct assessments of gender identity and sex-typing of household tasks differed according to family status.

Adult↗
PubMed1979

Gender identity change in transsexuals. Follow-up and replications.

An apparently successful change in gender identity of an adolescent transsexual was reported several years ago. Gender-specific motor behavior, appropriate sex role social behavior, cognitive sexual activity, and finally sexual arousal patterns were defined, measured, and sequentially modified. In this report, a 6 1/2-year follow-up is presented and the application of a similar therapeutic package to two additional cases is described. In the first case, sweeping changes in gender identity, sex-role behavior, and sexual arousal patterns were observed. In the second of these cases, rigid feminine gender was given up, but the patient chose to retain homosexual arousal. Social adaptation was satisfactory. These findings and other recent developments point to the possibility of psychosocial intervention as an alternative to surgery in the treatment of transsexualism.

Adolescent↗
PubMed1987

Feminine gender identity and physical aggressiveness in heterosexual and homosexual pedophiles.

This study explored the differences among six groups of adult males in retrospective self-reports of childhood gender identity and physical aggressiveness. The three groups of homosexual men preferred prepubescent, pubescent, or physically mature sexual partners. The three groups of heterosexual men preferred prepubescent partners, normal sexual interaction with physically mature partners (controls), or anomalous interaction with physically mature partners. Childhood gender identity was measured with the Feminine Gender Identity Scale (FGIS), and boyhood aggressiveness was measured with the Physical Aggressiveness Scale (PAS). Duncan tests at the .05 level showed that the FGIS differentiated the homosexuals who preferred mature partners from the five other groups; whereas the PAS differentiated all homosexual groups from all heterosexual groups. These results suggest that male homosexuals in general tend to be unaggressive in boyhood, whereas only those who prefer mature sexual partners show significant levels of feminine identification.

Aggression↗
PubMed2004

Gender identity in XY intersexuality.

The following syndromes of XY intersexuality are reviewed: 5alpha-reductase-2 deficiency, 17beta-hydroxysteroid dehydrogenase-3 deficiency, and complete and partial androgen insensitivity with attention focused on issues of gender identity. Each syndrome, with its unique presentation, provides an opportunity to explore the relative effects of nature (androgens) versus nurture (sex of rearing) in gender identity development. The phenomenon of gender role reversal in these conditions is described and theories on the determinants of gender identity formation are proposed. Issues of importance to psychiatrists in treating patients who have these conditions also are discussed.

17-Hydroxysteroid Dehydrogenases↗
PubMed2000

Gender identity, nationalism, and social action among Jewish and Arab women in Israel: redefining the social order?

In the study this article explores, the meaning of gender identity for religious and secular Jewish and Arab women in Israeli society is examined. The study focuses on how Israeli women, rank gender identity, relative to other identities like being Jewish/Arab, being Israeli/Palestinian, religious or secular, of a certain ethnic group, and political identity. It examines the characteristics of gender identity and the attitudes that are associated with it. The analysis shows that the hierarchies of identities are different for religious and secular Jewish and Arab women, and that this is related to having different sociopolitical attitudes (e.g., Women's social and political involvement, social obedience, social influence). Thus, the hierarchy of identities and the sociopolitical attitudes of religious women indicate a more consensual acceptance of the social order than the hierarchy of identities and the sociopolitical attitudes of secular women, especially among Arab women.

Asia↗
PubMed2004

[Diagnosis and treatment of gender identity disorder].

According to DSM-IV criteria, gender identity disorder(GID) is characterized as follows: 1) Strong, persistent cross-gender identification. 2) Persistent discomfort with one's assigned sex or the Sense of inappropriateness in that gender role. 3) Not due to an intersex condition. In this chapter, symptoms, diagnosis and treatment of GID are briefly described. Possible pathogenesis of GID is also discussed.

Brain↗
PubMed2005

Gender identity and implications for recovery among men and women with schizophrenia.

The concept of gender considers masculinity and femininity as a cultural construct that varies along a continuum. Subjectively perceived, gender may affect the experience of illness among persons with schizophrenia and may have an impact on treatment and recovery. This study evaluated gender identity, according to the Bem Sex Role Inventory, among 90 men and women with schizophrenia and schizoaffective disorders. The findings indicate that persons with schizophrenia experience their gender identity in ways that vary from culturally normative standards. Both men and women scored lower on traditional masculine descriptive measures compared with persons without schizophrenia. This finding has important implications for recovery.

Adult↗
PubMedDate not supplied

Ambiguous genitalia, gender-identity problems, and sex reassignment.

This article discusses general issues with regard to gender-identity problems, sex reassignment, and clinical management in patients with ambiguous genitalia, based on a detailed case history of a patient with penile agenesis who has been followed more than 20 years. After initial uncertainty, the patient began to grow up as a boy, lived from the fourth year of life as a girl and young woman, and lived from late puberty on as a man. Over his lifetime he experienced extensive corrective surgery plus hormonal substitution therapy. Pre- and perinatal hormonal conditions, phenomenology of the genitalia, sex of rearing, timing of sex reassignment and corrective surgery, for example, appear to be important components for the development of gender-role behavior, gender identity, and sexual orientation of intersex patients. Findings and retrospective considerations for this patient suggest the need for careful differential activities in diagnostic workup, approaches to sex assignment and possible reassignment, and the clinical management of patients and families.

Adaptation, Psychological↗
PubMedDate not supplied

Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note.

Over the years, the DSM diagnosis of gender identity disorder (and its predecessors gender identity disorder of childhood [GIDC] and transsexualism) has attracted controversy as a mental disorder, for its diagnostic criteria, as a target of therapeutic intervention, and for its relationship to a homosexual sexual orientation. Another point of controversy is the claim that the diagnosis of GIDC was introduced into the DSM-III in 1980 as a kind of "backdoor maneuver" to replace homosexuality, which was deleted from the DSM-II in 1973. In this article, we challenge this historical interpretation and provide an alternative account of how the GIDC diagnosis (and transsexualism) became part of psychiatric nosology in the DSM-III. We argue that GIDC was included as a psychiatric diagnosis because it met the generally accepted criteria used by the framers of DSM-IIIfor inclusion (for example, clinical utility, acceptability to clinicians of various theoretical persuasions, and an empirical database to propose explicit diagnostic criteria that could be tested for reliability and validity). In this respect, the entry of GIDC into the psychiatric nomenclature was guided by the reliance on "expert consensus" (research clinicians)--the same mechanism that led to the introduction of many new psychiatric diagnoses, including those for which systematic field trials were not available when the DSM-III was published.

Child↗
PubMed1981

Cognitive correlates of biologic sex and gender identity in transsexualism.

Twenty-two individuals seeking sex-change surgery and diagnosed as transsexual by a Gender Identify Research Team underwent extensive neuropsychological and cognitive testing prior to surgery. On the Wechsler Adult Intelligence Scale transsexuals performed in congruence with their biologic sex rather than gender identity. In contrast, on a measure of conceptual styles, transsexuals performed in congruence with their gender identity. The MMPI did not provide evidence of a major psychopathological process.

Adult↗
PubMed2002

The heritability of gender identity disorder in a child and adolescent twin sample.

The heritability and prevalence of the gender identity disorder (GID) was examined, as well as its comorbidity with separation anxiety and depression, in a nonretrospective study of child and adolescent twins. The parents of 314 twins (ages 4-17 years; 96 monozygotic pairs [MZ] and 61 dizygotic [DZ] pairs) completed the Coolidge Personality and Neuropsychological Inventory (CPNI) containing a six-item DSM-IV-based GID scale. Prevalence of clinically significant GID symptomatology in the twin sample was estimated to be 2.3%. Univariate model fitting analyses were conducted using an ordinal transformation of the GID scale. The model that best described the data included a significant additive genetic component accounting for 62% of the variance and a nonshared environmental component accounting for the remaining 38% of the variance. Results suggested no heterogeneity in the parameter estimates resulting from age. The correlation between GID and depression was modest, but significant (r = .20; P < .05), whereas the correlation between GID and separation anxiety was nonsignificant (P > .05). Overall, the results support the hypothesis that there is a strong heritable component to GID. The findings may also imply that gender identity may be much less a matter of choice and much more a matter of biology.

Adolescent↗