Research on differences in sexual orientation and identity.

Both biological and psychosocial factors influence psychosexual development. High levels of pre- and postnatal androgens lead to more male-typical behavior. So far, the influence of androgens on gender identity and sexual orientation is unclear. Disorders of sex development (DSDs) are heterogeneous genetic conditions with different levels of prenatal androgens resulting in variations of genital development. Through DSD, the role of the different factors, especially androgen exposure, on psychosexual development can be evaluated. The purpose of the study was to assess psychosexual development in adolescents and adults with different forms of DSD. For the examination of psychosexual development of 66 adolescents and 110 adults with DSD, the authors used the Utrecht Gender Dysphoria Scale for adolescents, the Questionnaire of Gender Identity for adults, and a condition-specific DSD study questionnaire. Individuals were analyzed in four subgroups reflecting the karyotype, absence/presence of androgen effects, and gender of rearing. Main outcome measures used were gender identity, friendships, love and sexual relationships, and sexual orientation in adolescents and adults with DSD. Individuals with DSD did not show increased gender dysphoria. However, partnership and sexuality were identified to be difficult areas of life. Both adolescents and adults with DSD reported fewer experiences regarding love or sexual relationships compared with unaffected individuals. Especially men with DSD and undervirilization and women with DSD and androgen effects less often had a love relationship. Adult women with DSD and androgen effects more frequently engaged in love and sexual relationships with individuals of the same gender compared with women without DSD. Individuals with DSD experience atypical hormonal influences (higher levels of androgens in girls/women and lower levels in androgens in boys/men); however, they did not show increased gender dysphoria in this study. However, partnership and sexual relationships are difficult areas of life for adolescents and adults with DSD. We recommend that individuals with DSD should get support from a multiprofessional team with competency in assessing and counseling issues regarding relationships and sexuality. Contact to other individuals with DSD can be helpful for nonprofessional support and exchange of experiences.

Gender Expression and Sexual Orientation Differences in Diet Quality and Eating Habits from Adolescence to Young Adulthood

Background: There is some community survey evidence for a cohort difference in female sexual orientation. Objective: To determine whether there is a cohort difference in sexual orientation in Australia. Methods: A community survey was carried out with a sample of 7,447 adults from the age groups 20–24, 40–44 and 60–64 years. As part of this survey respondents were asked a question on sexual orientation which was answered privately. Results: A strong age cohort difference was found for women, with younger women more frequently reporting a homosexual or bisexual orientation. By contrast, no age cohort difference was found for men. Conclusion: These findings suggest that a heterosexual orientation may have become less common in younger cohorts of Australian women. This finding is consistent with data from other recent studies.

Disorders of Sex Development.

Sexual orientation and gender identity disparities in co-occurring depressive symptoms and probable substance use disorders in a national cohort of young adults

Opening the door to transgender care.

Gender Dysphoria and Gender Change in Disorders of Sex Development/Intersex Conditions: Results From the dsd-LIFE Study

Recent controversies in many countries suggest a need for clarity on same-sex orientation, attraction and behaviour (formerly referred to as homosexuality). Along with other international organizations, the WPA considers sexual orientation to be innate and determined by biological, psychological, developmental and social factors. Over 50 years ago, Kinsey et al1 documented a diversity of sexual behaviours among people. Surprisingly for the time, he described that for over 10% of individuals this included same-sex sexual behaviours. Subsequent population research has demonstrated that approximately 4% of people identify with a same-sex sexual orientation (e.g., gay, lesbian and bisexual orientations). Another 0.5% identify with a gender identity other than the gender assigned at birth (e.g., transgender)2. Globally, this equates to over 250 million individuals. There is a recognized need for moving towards a non-binary gender identity. Psychiatrists have a social responsibility to advocate for a reduction in social inequalities for all individuals, including inequalities related to gender identity and sexual orientation. Despite an unfortunate history of perpetuating stigma and discrimination, it has been decades since modern medicine abandoned pathologizing same-sex orientation and behaviour3. The World Health Organization (WHO) accepts same-sex orientation as a normal variant of human sexuality4. The United Nations Human Rights Council5 values lesbian, gay, bisexual and transgender (LGBT) rights. In two major diagnostic and classification systems (ICD-10 and DSM-5), same-sex sexual orientation, attraction and behaviour are not seen as pathologies. There is considerable research evidence to suggest that sexual behaviours and sexual fluidity depend upon a number of factors6. Furthermore, it has been shown conclusively that LGBT individuals have higher than expected rates of psychiatric disorders7, 8, and once their rights and equality are recognized these rates start to drop9-12. People with diverse sexual orientations and gender identities may have grounds for exploring therapeutic options to help them live more comfortably, reduce distress, cope with structural discrimination, and develop a greater degree of acceptance of their sexual orientation or gender identity. Such principles apply to any individual who experiences distress relating to an aspect of their identity, including heterosexual individuals. Dinesh Bhugra1, Kristen Eckstrand2, Petros Levounis3, Anindya Kar4, Kenneth R. Javate5 1Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; 2Vanderbilt University School of Medicine, Nashville, TN, USA; 3Addiction Institute of New York, New York, NY, USA; 4Calcutta National Medical College & Hospital, Calcutta, India; 5The Medical City, Manila, Philippines

Sex-related variation in human behavior and the brain

Sexual minority identity had far-reaching influences on psychological outcomes among lesbian women, gay men, and bisexual people. Previous studies conducted in Western nations revealed significant gender and sexual orientation differences in experiences of sexual minority stress. However, few studies have focused on the identity of asexual people. Confucian culture has exerted important influences on the formulation of sexual minority identity in China, but less is known about sexual minority identity among Chinese sexual minorities. This study, using Chinese sexual minority samples, aimed to test whether it is consistent with the findings in Western culture that males and bisexual minorities had more negative sexual identities than females and lesbian/gay individuals; asexual people were also included to extend the lesbian, gay and bisexual (LGB) identity to sexual minority identity. We further tested whether asexual people, similar to bisexual people, have more of a negative identity compared with lesbian/gay individuals. Eight hundred seventy-three participants (464 lesbian and gay men, 200 bisexual and 209 asexual people) completed the Lesbian and Gay Identity Scale (LGIS) or the Lesbian, Gay, and Bisexual Identity Scale (LGBIS). The results showed that bisexual people had a more negative identity than the lesbian and gay male people. Asexual people showed similar patterns to bisexual people in terms of sexual minority identity when compared with lesbian and gay male people, but they reported less Difficulty Process than did the bisexual people. The findings of this study indicate the cross-cultural consistency of sexual minority identity in terms of gender and sexual orientation.

Gender identity disorder (GID) in adolescents and adults with differences of sex development (DSD): A systematic review and meta-analysis

Federal initiatives have encouraged collection of sexual orientation, gender identity, and differences of sex development data in national health surveys. Researchers use these data sets to identify health disparities faced by marginalized populations and shape primary care practices. We summarized the current state of sexual orientation, gender identity, and differences of sex development measures in federal health surveys to inform primary care researchers, outline gaps in data, and discussed their research implications. We examined 10 large federal population-based health surveys and, using content analysis, summarized the composition and continuity of their sexual orientation, gender identity, and differences of sex development measures. Federal health surveys have longstanding measures of sexual orientation, with 4 having more than 10 years of data. Several surveys introduced gender identity questions over the last 2 years. Only 1 survey measured differences of sex development. Federal surveys have robust sexual orientation measures, but more surveys including gender identity and differences of sex development (DSD)s are needed. The presence of sexual orientation and gender identity measures in these surveys could help identify primary care disparities among sexual and gender minority populations. Research using sexual orientation data benefits from standardization and continuity that has not yet been achieved for gender identity measures across these surveys. New federal restrictions may hamper further collection of sexual orientation and gender identity data. The absence of differences of sex development data places this population at risk of having their needs go unaddressed in primary care settings.

LGBTQ cultural competence for pharmacists

Teaching and Learning Guide for: Transgender and Transsexual Studies: Sociology's Influence and Future Steps

Disorders of Sex Development (DSD) are a group of congenital medical conditions defined as atypical development of chromosomal, gonadal, and anatomical sex. Psychiatric, behavioral, and gender-associated problems could arise in both male and female adult with DSD. Structured assessments for each variable are needed to properly measure psychiatric and sexual issues and overall quality of life in adults with DSD. This study aims to review structured questionnaire instruments that had been used to assess psychiatric, behavioral, sexual problems, and quality of life in adults with DSD.For psychiatric or behavioral problems, adults with DSD can be assessed with GHQ-28, Brief Symptoms Inventory, Achenbach and Rescorla’s Adult Behavior Checklist, Rosenberg Self-esteem Scale, Mini International Neuropsychiatric Interview plus, Hospital anxiety and depression scale, Body image scale, Adult ADHD self-report scale screener, Short Autism Spectrum Quotient, and coping with DSD questionnaire. For quality of life, assessment could be done with WHOQOL and Short Form-36. Gender role assessment in adults with DSD can be done using Core Gender Identity, Sexual Orientation, and Gender Role Behavior and Utrecht Gender Dysphoria Scale. Both of the apparent male and female DSD patients can be assessed using the instruments available. Recommendations are made based on its function, compliance, validity, reliability, and avaibility of an Indonesian version of the questionnaire.There are a plethora of structured questionnaire tools that have been used to measure psychiatric or behavioral problems, quality of life, and gender roles in adult with DSD, each with its own advantages and disadvantages