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PubMed2000

Body ego and the preoedipal roots of feminine gender identity.

Traditionally, visual cues (that is, seeing the difference between one's own genitals and those of the opposite sex) and the fantasies that they prompt were thought to be the central determinants in the organization of gender identity. More recently attention has been focused on mother-infant interaction patterns, on the construction of the body itself, on its kinesthetic sensations, and on the fantasies that these evoke. These matters are now thought to be equal in importance to the traditional considerations. The resulting concept of a core gender identity has suggested the possibility of various forms of preoedipal genital anxiety. This paper discusses how two experiences common to childhood as well as adulthood--the tumescence of erectile tissue and the involuntary vaginal secretions of sexual arousal--may contribute to the organization of feminine gender identity. Case material, including a close examination of an analytic hour, is presented to show how this process may manifest itself in adult neurotic conflict.

Adult↗
PubMed1983

Is the distant relationship of fathers and homosexual sons related to the sons' erotic preference for male partners, or to the sons' atypical gender identity, or to both?

Study 1 compared the retrospectively reported father-son relationships of four groups of adult males: (a) Gynephiles (males who erotically prefer physically mature females), (b) androphiles (who prefer physically mature males), (c) a combined group of heterosexual pedophiles and pedohebephiles (the latter being attracted to pubescent as well as prepubescent females), and (d) a combined group of homosexual pedophiles and pedohebephiles (the latter attracted to pubescent as well as prepubescent males). The gynephiles were paid volunteers; the latter three groups were patients. The androphiles, the only group among those compared known to exhibit a measurably greater degree of cross gender identity in childhood, were also the only group to report significantly poorer father-son relations. The homosexual pedo/pedohebephiles, who also prefer male partners but who exhibit typical male gender identity in childhood, did not differ in father-son relations from the gynephiles or the heterosexual pedo/pedohebephiles. Study 2 showed that, within a sample of nonpatient volunteer androphiles, those individuals who reported the greatest degree of cross gender behavior in childhood also tended to report the worst relationships with their fathers. This correlation was replicated within a sample of androphilic patients in Study 3. The consistent pattern of results obtained from these three studies suggests that the emotionally distant relationships of fathers and androphilic sons relate to the sons' atypical childhood gender identity (or observable gender role behavior) rather than to the sons' erotic preference for male partners per se.

Adult↗
PubMed1990

Clinical features of patients attending a gender-identity clinic.

Of 106 patients attending a gender-identity clinic, 73% satisfied DSM-III criteria for transsexualism. These DSM-III positives had a significantly younger age of onset and were less likely to experience sexual arousal with cross-dressing than those who did not satisfy DSM-III criteria. They were also significantly more likely to fulfil a definition of 'core transsexualism'. 'Core transsexualism' may represent a subgroup within DSM-III criteria for transsexualism and its defining features in this study were an early age of onset, low sexual activity, lack of sexual arousal with cross-dressing and homosexual orientation. Of the whole sample, 23% were referred for gender reassignment surgery, of whom 100% were DSM-III positive and 60% were 'core transsexuals'.

Adult↗
PubMed1982

The theory of gender identity disorders.

Experience with more than 500 patients over the last decade has led to the conclusion that the quest for sex reassignment is a symptomatic compromise formation serving defensive and expressive functions. The symptoms are the outgrowth of developmental trauma affecting body ego and archaic sense of self and caused by peculiar symbiotic and separation-individuation phase relationships. The child exists in the pathogenic (and reparative) maternal fantasy in order to repair her body image and to demonstrate the interconvertability of the sexes. Gender identity exists not as a primary phenomenon, but in a sense as a tertiary one. There is, no doubt, a tendency to gender-differentiate in a way concordant with biological endowment. Nevertheless, gender formation is seriously compromised by earlier psychological difficulty. Gender identity is a fundamental acquisition in the developing personality, but it is part of a hierarchical series beginning with archaic body ego, early body image, and primitive selfness, representing their extension into sexual and reproductive spheres. Gender identity consolidates during separation-individuation and gender pathology bears common features with other preoedipal syndromes. Transsexualism is closely linked to perversions, and the clinical syndromes may shade from one into another. However, what is kept at the symbolic level in the perversions must be made concrete in transsexualism. In this regard there is a close relation to psychosis. The clinical complaint of the transsexual is a condensation of remarkable proportions. When the transsexual says that he is a girl trapped in a man's body, he sincerely means what he says. As with other symptoms, however, it takes a long time before he begins to say what he means.

Animals↗
PubMed2000

Taxometric analyses of sexual orientation and gender identity.

Taxa are nonarbitrary classes whose existence is an empirical question and not a matter of mere semantic convenience. Taxometric procedures detect whether numerical relations between purported indicators of conjectured taxa bear the hallmarks of true taxa. On the basis of theoretical considerations, the current study tested whether taxa underlie sexual orientation and related measures of gender identity. Two taxometric procedures, maximum covariance, making hits maximum (MAXCOV) and mean above minus below a cut (MAMBAC), were applied to Kinsey Scales and measures of childhood gender nonconformity and adult gender identity in a sample of nearly 5,000 members of the Australian Twin Registry. Results suggest that latent taxa underlie these measures. About 12-15% of men and 5-10% of women belong to latent taxa associated with homosexual preference. These percentages are greater than those of individuals who report homosexual preference, however, and hence it appears that an appreciable proportion of individuals in these taxa have heterosexual preference. An understanding of the origins of these latent taxa may be important to understanding the development of sexual orientation and gender identity.

Adult↗
PubMed1995

Male pseudohermaphroditism due to primary 5 alpha-reductase deficiency: variation in gender identity reversal in seven Mexican patients from five different pedigrees.

In the present study, we describe the clinical, endocrinological, psychosexual and biochemical features of 7 Mexican male pseudohermaphrodites with primary 5 alpha-reductase deficiency in whom heterogeneity in the pattern of gender identity change at puberty was observed. The patients belonged to 5 different pedigrees from diverse locations in Mexico. Six of them were admitted to the Hospital during or after puberty. The one prepubertal subject was the sibling of a previously studied patient. Basal serum gonadotropins were determined by double antibody radioimmunoassay. Basal and choriogonadotropin (CG)-stimulated concentrations of androstenedione (A), testosterone (T) and dihydrotestosterone (DHT) were determined by radioimmunoassay after extraction and separation by celite chromatography. Urinary aetiocholanolone, androsterone and C19 and C21 5 beta/5 alpha metabolite ratios were analyzed by capillary gas chromatography. Enzyme activity and androgen receptors were studied in fibroblasts cultured from genital skin. Psychological assessment was performed using the Bender-Gestalt Wechsler Adult Intelligence Scale, the Rorschach Ink Blot and the Thematic Apperception Tests. All 7 patients were unambiguously reared as females; three spontaneously changed their gender identity and role from female to male after puberty, another one changed during psychotherapy at the end of puberty. Two patients (one prepubertal and the other pubertal) have been under therapy during 1.5 years, but due to familial and social factors a female gender has prevailed. The remaining patient consulted at age 15 because of virilization; her female gender identity did not change after more than one year of treatment and due to the fact she was depressed and had suicidal tendencies, the penis and testes were removed.(ABSTRACT TRUNCATED AT 250 WORDS)

3-Oxo-5-alpha-Steroid 4-Dehydrogenase↗
PubMed1997

Sibling sex ratio of boys with gender identity disorder.

Sibling sex ratio (the ratio of brothers to sisters) was calculated for 444 boys with gender identity disorder (or with behaviors consistent with this diagnosis). The probands were ascertained from several researchers with expertise with this disorder and from the English language case report literature between 1938 and 1995. Among the probands with at least one sibling (N = 333), the results showed that boys with gender identity disorder had a significant excess of brothers to sisters, 131.1:100, when compared with the expected secondary sex ratio of 106:100. The excess of brothers replicated a previous study by Blanchard, Zucker, Bradley, and Hume (1995), in which the sibling sex ratio was 140.6:100. Further analyses showed that the probands were born later relative to their brothers than they were relative to their sisters. These findings are amenable to several psychosocial and biological explanations, which require further investigation.

Child↗
PubMed2005

Does surgical genitoplasty affect gender identity in the intersex infant?

There is no clear-cut answer to the question of whether surgical genitoplasty affects gender identity in the intersex infant. The debate centres around which is more important for the development of gender identity: the biological sex of a child or the sex in which a child is reared. We believe that the surgical achievement of a phenotype concordant with the sex of rearing is a tremendous help to the parents of an intersex infant. We do not consider that the 'neutral' upbringing of a child with ambiguous genitalia is a feasible option, first because of the parents' distress which prevents them from raising their child normally and second because in most cultures around the world gender variants are not treated as equals. A neutral upbringing may induce psychosocial consequences that are more pernicious than carefully considered neonatal sex attribution and concordant surgical genitoplasty.

Counseling↗
PubMed1996

[Family relations and gender identity: a contribution to the care of expanding families].

It approaches the influences of family relationship in the construction of the gender identity process, through the Theory of Objectal Relationship referential, proposed by Chorodow (1979). This theoretical support, emphasizes that the gender identity is basically influenced by the primary bonds established between child and adults, through the continuous personal relationship developing mother and father role. It points out that the gender construction for the boy and for the girl happens in a different way. It concludes pointing out some lines to be adopted by the nurse in the practice with families, as well as, some limitation of the Theory of Objectal Relationship.

Adult↗
PubMed2005

Gender identity outcome in female-raised 46,XY persons with penile agenesis, cloacal exstrophy of the bladder, or penile ablation.

This review addresses the long-term gender outcome of gender assignment of persons with intersexuality and related conditions. The gender assignment to female of 46,XY newborns with severe genital abnormalities despite a presumably normal-male prenatal sex-hormone milieu is highly controversial because of variations in assumptions about the role of biological factors in gender identity formation. This article presents a literature review of gender outcome in three pertinent conditions (penile agenesis, cloacal exstrophy of the bladder, and penile ablation) in infancy or early childhood. The findings clearly indicate an increased risk of later patient-initiated gender re-assignment to male after female assignment in infancy or early childhood, but are nevertheless incompatible with the notion of a full determination of core gender identity by prenatal androgens.

Adolescent↗
PubMed1980

Questioning current definitions of gender identity: implications of the Bem Sex-Role Inventory for transsexuals.

To examine the relationship between sex role and gender identity, the Bem Sex-Role Inventory (BSRI) was given to 72 self-defined transsexuals [55 male-to-female (M-F), 17 female-to-male (F-M)]. The F-Ms scored primarily masculine sex typed (six) or androgynous (six). The modal M-F scored faminine sex typed (33). The distribution of F-Ms across the four BSRI categories did not differ significantly from Bem's normative college student male distribution [chi2(3) = 2.30, p greater than 0.50] but was marginally different from that of Bem's females [chi2(3) = 6.45, p less than 0.10]. The distribution of M-Fs was significantly different from that of both college females [chi2(3) = 19.71, p less than 0.001] and males [chi2 (3) = 88.72, p less than 0.0001], because of the very high proportion of feminine sex-typed M-Fs. Psychometric data on the BSRI are presented. The score patterns of the transsexuals are compared to those from the clinical literature, and implications of the data for the relationship between gender identity and sex role are discussed.

Adolescent↗
PubMed2001

Integrating male and female elements in a woman's gender identity.

Despite advances in female developmental theory since the 1970s, there remains a lingering tendency to stereotype and polarize gender identity. The key to this puzzle may be found in the legacy of early libido theory, which offers an unintegratable solution for women. This is because in order for a woman to claim femininity according to this early theory, her masculine trends in development must be repudiated and "overcome." A contemporary theory based on primary femininity suggests that this early theoretical "either/or" dilemma puts forward a developmentally immature solution. The analysis of a thirty-year-old woman, and a commentary contrasting "old" and "newer" ways of thinking on the part of the analyst, demonstrate that an interweaving pattern of paternal identifications and male body representations, together with the female body image and female identifications, is necessary to create a mature gender identity portrait. The female body representation and maternal identifications may indeed be enhanced by male internalizations, as happened in this particular instance.

Female↗
PubMed2006

An experience of group work with parents of children and adolescents with gender identity disorder.

This article gives an account of an experience of group work with parents and carers who had children or adolescents with gender identity disorder (GID). The history of this intervention within the context of a service for children with gender identity problems is outlined. The limited literature on the subject is reviewed. Group meetings were held monthly for 6 months, facilitated by two therapists (the authors). Selection criteria for group participants, the aims of the group and the methodology for achieving those aims are described. Some information about the group's composition is provided. The structure and content of the group sessions are outlined together with details of some group interactions. Finally, we present the results of an evaluation of the intervention through feedback questionnaires and discuss the value for the children and young people of running such groups.

Adolescent↗
PubMed1985

Gender identity in childhood and later sexual orientation: follow-up of 78 males.

Two groups of males were evaluated on parameters of gender identity, initially in boyhood and later in adolescence or young adulthood. One group was composed of 66 clinically referred boys whose behaviors were consistent with the diagnosis of gender identity disorder of childhood. The other group consisted of 56 volunteers selected on the basis of demographic matching. Two-thirds of each group were reevaluated for sexual orientation; 30 of the 44 who previously had shown extensive cross-gender behavior and none of the 34 in the comparison group were bisexually or homosexually oriented.

Adolescent↗
PubMed1997

Indicators of feminine gender identity in latency-aged boys in the Draw a Person and the Rorschach tests.

Seven diagnostic indicators were examined for their potential to identify latency aged boys who had feminine gender identity. Nineteen emotionally disturbed boys (average age 10.2) with feminine gender identity were compared on these indicators with 21 control boys. The indicators which were found to be valid were drawing the female figure with a greater value than the male figure in the DAP; difficulty in identification with the male figure in stories to the DAP; a low relative rate of male human responses and/or a high relative rate of female human responses in the Rorschach; and initial butterfly response to card V in the Rorschach. Using these indicators in combination reduced the false positive and negative rates associated with each individual indicator.

Affective Symptoms↗
PubMed2003

The cultural context of gender, identity: female genital, excision and infibulation.

Our goal is to explore the practices of female genital excision and infibulation as they relate to gender identity and the acculturation process in Canada. We examined relevant research on these issues and share the results of a nationwide project conducted in 1997-1999 among 162 Canadian immigrants from regions in Africa where practices of excision and infibulation are still in effect. Our discussion of gender identity is inextricably linked to notions about the ways in which girls, women, and virginity are socially constructed. The complexity of the acculturation process along with the integration within a host society is highlighted and the conflicting identities available to women are brought to the fore.

Acculturation↗
PubMed2005

Cross-sex hormone treatment does not change sex-sensitive cognitive performance in gender identity disorder patients.

Cognitive performance in untreated early onset gender identity disorder (GID) patients might correspond to their born sex and not to their perceived gender. As a current mode of intervention, cross-sex hormone treatment causes considerable physical changes in GID patients. We asked, as has been suggested, whether this treatment skews cognitive performance towards that of the acquired sex. Somatically healthy male and female early onset GID patients were neuropsychologically tested before, 3 and 12 months after initiating cross-sex hormone treatment, whereas untreated healthy subjects without GID served as controls (C). Performance was assessed by testing six cognitive abilities (perception, arithmetic, rotation, visualization, logic, and verbalization), and controlled for age, education, born sex, endocrine differences and treatment by means of repeated measures analysis of variance. GID patients and controls showed an identical time-dependent improvement in cognitive performance. The slopes were essentially parallel for males and females. There was no significant three-way interaction of born sex by group by time for the six investigated cognitive abilities. Only education and age significantly influenced this improvement. Despite the substantial somatic cross-sex changes in GID patients, no differential effect on cognition over time was found between C and GID participants. The cognitive performance of cross-sex hormone-treated GID patients was virtually identical to that of the control group. The documented test-retest effect should be taken into consideration when evaluating treatment effects generally in psychiatry.

Adult↗