Cross-gender Behavior Research Articles

Teachers dealing with non-conformity: Development of the attitudes toward childhood gender identity questionnaire for educational settings

Valid and reliable measures to evaluate teachers’ attitudes towards transgender and gender nonconforming students are lacking. Therefore, we developed the Attitudes toward Childhood Gender Identity Questionnaire for Teachers (ACGIQ-T). We analyzed data from 358 Spanish teachers (84.5% women). A CFA supported a 13-item version of the questionnaire with three factors (71% of the variance explained): Cross-gender roles in leisure/friendship; Cross-gender-typical behaviors and Cross-gender feelings/expressions. Cronbach´s alpha values were over 0.82. Regarding concurrent validity, women and feminine individuals were more likely to approve cross-gender behaviors. Associations of ACGIQ-T factors with other non-conformity roles were found, and the perception of cross-gender behaviors as problematic was associated with willingness to facilitate transitions of children and adolescents. Implications for the educational field are discussed.

Demographic and Clinical Characteristics of Children with Gender Dysphoria Symptoms: A Turkish Sample

Objective: In this study, we aim to describe the demographic and clinical characteristics and psychological functioning of children with gender dysphoria (GD) symptoms aged between 3-12 years. Material and Methods: The study group included 20 children (17 males, 3 females; mean age 6.63±2.43 years) with GD symptoms. A sociodemographic data form was used to collect data with regards to demographic and clinical characteristics, and pre- peri-and postnatal features. The Child Behavior Checklist (CBCL) is used to assess behavioral and emotional problems in the child. Results: The boy/girl ratio in the study group was 5.66. The mean age at onset of gender-nonconforming behaviors was 2.85±1.17 years and the mean age of admission to our clinic was 5.82±2.27 years. 20% of the mothers reported a preference for an opposite-sex child prior to conception; 20 % of the mothers reported prenatal stress, 20% of the mothers had prenatal and 25% had postnatal depressive symptoms. There was a risk of miscarriage in 10% of children and 25% were born prematurely. 55% of our study sample exceeded the clinical threshold for internalizing problems and 40% exceeded the clinical threshold for externalizing problems in CBCL ratings. Conclusion: There were more prepubertal boys than girls referred for GD symptoms and the age at referral was younger compared to western countries. In addition, findings of this study indicate that children with GD have poorer psychological functioning possibly due to social intolerance for cross-gender behaviors and/or interests alongside the GD per se.

A developmental model of gender identity course based on Hamburg sample of children with gender dysphoria

There are few data concerning first signs and developmental trajectories of people with gender variant behaviours and this paper aims to describe them in a clinical sample. Method: This paper presents a chart review of 44 children and adolescents assessed for gender dysphoria in Child and Adolescent Psychiatry and Psychotherapy, at the University Hospital Hamburg, Germany. I used information from these charts to reconstruct the course of cross-gender behaviour and identity in these patients from birth up to the time of assessment and organised it in a model. I looked into the pattern of development being representative of this sample and examined continuity/variability within individuals over time. Results: First signs at behavioural level appeared in most cases since the beginning and were consistently reported during preschool years (84%). A prior period of gender typical behaviour before onset of cross-gender behaviour was rare. Conclusion: A particular finding in this clinic based sample is that gender identity expressed around the age of 3-5 years was not reversed later in life. There was a common pattern of development in majority of cases: first signs in kindergarten age and strongly re-emergence around puberty, which might have implications in referral times of this group in the clinic.

Healing through Gender Inversion in Korean Possession Trance Rituals

Korean shamanism ( musok) considers problems of physical, social, and mental health to be a result of supernatural intervention. The unique position of male practitioners who become healers within a female-dominated sphere is especially telling as they perform cross-gender behavior that is perceived as related to homosexuality, which is stigmatized in Korea and often labeled as a “mental illness.” In contrast, musok frames these behaviors as responses to demands from the spirit world.

Links Between Autistic Traits, Feelings of Gender Dysphoria, and Mentalising Ability: Replication and Extension of Previous Findings from the General Population

Gender nonconformity is substantially elevated in the autistic population, but the reasons for this are currently unclear. In a recent study, Kallitsounaki and Williams (Kallitsounaki and Williams, Journal of Autism and Developmental Disorders, 2020; authors 1 and 2 of the current paper) found significant relations between autistic traits and both gender dysphoric feelings and recalled cross-gender behaviour, and between mentalising ability and gender dysphoric feelings. The current study successfully replicated these findings (results were supplemented with Bayesian analyses), in sample of 126 adults. Furthermore, it extended the previous finding of the role of mentalising in the relation between autistic traits and gender dysphoric feelings, by showing that mentalising fully mediated this link. Results provide a potential partial explanation for the increased rate of gender nonconformity in the autistic population.

Separation anxiety and gender variance in a community sample of children.

In clinical child and retrospective adult samples, childhood gender variance (GV; i.e., cross-gender behaviour) has been associated with separation anxiety (SA; i.e., distress related to separation from attachment figures) in males. This study examined GV and SA in a nonclinical sample of 892 boys and 933 girls aged 6-12years via parent-reports. Parental factors (i.e., parenting style, parent-child relationship, willingness to serve as an attachment figure, attitudes towards gender stereotypes in children) were examined as potential moderators. GV predicted SA in boys, even when statistically controlling for general psychopathology and demographic variables. Authoritative parenting, closeness in the parent-child relationship, willingness to serve as an attachment figure, and liberal attitudes towards gender stereotypes in children moderated the association between GV and SA in both boys and girls. Thus, SA may be a unique internalizing problem related to GV in boys in nonclinical samples and influenced by a variety of parental factors.

Social stigmatisation in late identified patients with disorders of sex development in Indonesia

ObjectivesTo assess social stigmatisation related to atypical appearance of the body, including, but not limited to the external genitalia, among Indonesian patients with a disorder of sex development (DSD). Until...

Gender Nonconformity, Homophobic Peer Victimization, and Mental Health: How Same-Sex Attraction and Biological Sex Matter

We assessed whether homophobic name-calling accounts for the relationship between gender nonconformity and mental health (social anxiety and psychological distress) in a sample of 1,026 Dutch adolescents (boys: n = 517) ages 11 to 16 (M age = 13.4). We also explored whether this hypothesized mediation differs by sexual attraction and biological sex. Data were collected by means of paper-and-pencil questionnaires at five secondary schools located in urban areas in the Netherlands. Mediation analysis indicated that gender nonconformity was related to both social anxiety and psychological distress partially via homophobic name-calling. Moderated mediation analysis further showed that the mediating role of homophobic name-calling varied according to levels of same-sex attraction (SSA) and biological sex. The mediation effects increased in magnitude when levels of SSA increased and were significant only for adolescents with mean and high levels of SSA. The mediation effects were significant for boys and girls in general, although the mediation effects were stronger for boys than for girls. Our findings emphasize the importance of research and school-level interventions to focus on factors that promote acceptance of cross-gender behavior among adolescents.

Gender change and stigmatization in late-treated Indonesian children, adolescent, and adult patients with DSD

In Indonesia clinical management of Disorders of Sex Development (DSD) is challenged by limited knowledge and limited diagnostic and treatment facilities. Prior to this study, most patients remained untreated and grew up with ambiguous bodies and doubts about their gen-der. We investigated patients’ experiences of being raised in ambiguity. 118 Indonesian patients, ages 6 – 41, with 46XX DSD (n=27), 46XY DSD (n=77) and chromosomal DSD (n=14) were compared to 118 control subjects matched for gender, age, and living area. Questionnaires for gen-der identity, gender role behavior and social stigmatiza-tion were translated or designed. The psychometric properties were satisfactory. For patient and control group comparisons, Mann-Whitney U and Fisher’s Exact tests were applied. The results showed that 7% of the children, 8% of the adolescents and 44% of the adults changed gender, parti-cularly non-diagnosed and non-treated patients with 46XY DSD (81%). 95% of the patients changed gender from female to male, including untreated patients with 46,XX CAH-SV. Compared to control groups, cross-gender role behavior was seen in young girls with 46XX CAH-SV (p=.047) and adolescent girls with different types of DSD (p=.01). In girls with DSD, confusion with gender identity was seen (young girls p=.004; adolescent girls p=.01). Adult men reported past cross-gender role behavior (p=.01) and past problems in gender identification (p=.01) prior to female-to-male gender change. Children with genital ambiguity (p<.006) and cross gender behavior (p<0.001) and adults with ambiguous 1Diponegoro University, Faculty of Psychology, Semarang, Indonesia Full list of author information is available at the end of the article bodies (p=.001) and adults who changed gender (p<0.03) suffered stigmatization. Rejection or isolation elicited depression and withdrawal from social activities in girls (p=.002), women (p=.009) and youngsters who had changed gender (p=.02). We conclude that a high percentage of our patients changed gender. The wish for gender change was parti-cularly seen in patients with progressive masculinization. Patients with DSD who had visible ambiguity in physical and behavioral appearance suffered stigmatization. Teas-ing and rejection led to strong emotional reactions. Early clinical evaluation and treatment, patient and parent edu-cation, and teaching coping strategies will improve qual-ity of life.

Birth weight and two possible types of maternal effects on male sexual orientation: A clinical study of children and adolescents referred to a Gender Identity Service

This study tested predictions regarding two hypothesized maternal immune responses influencing sexual orientation: one affecting homosexual males with high fraternal birth order and another affecting firstborn homosexual individuals whose mothers experience repeated miscarriage after the birth of the first child. Low birth weight was treated as a marker of possible exposure to a maternal immune response during gestation. Birth weight was examined relative to sibship characteristics in a clinical sample of youth (N = 1,722) classified as heterosexual or homosexual based on self-reported or probable sexual orientation. No female sexual orientation differences in birth weight were found. Homosexual, compared to heterosexual, males showed lower birth weight if they had one or more older brothers--and especially two or more older brothers--or if they were an only-child. These findings support the existence of two maternal immune responses influencing male sexual orientation and possibly also cross-gender behavior and identity.

Increased Cross-Gender Identification Independent of Gender Role Behavior in Girls with Congenital Adrenal Hyperplasia: Results from a Standardized Assessment of 4- to 11-Year-Old Children.

While reports showing a link between prenatal androgen exposure and human gender role behavior are consistent and the effects are robust, associations to gender identity or cross-gender identification are less clear. The aim of the current study was to investigate potential cross-gender identification in girls exposed prenatally to high concentrations of androgens due to classical congenital adrenal hyperplasia (CAH). Assessment included two standardized measures and a short parent interview assessing frequency of behavioral features of cross-gender identification as conceptualized in Part A of the diagnostic criteria for gender identity disorder (GID) in the DSM-IV-TR. Next, because existing measures may have conflated gender role behavior with gender identity and because the distinction is potentially informative, we factor analyzed items from the measures which included both gender identity and gender role items to establish the independence of the two constructs. Participants were 43 girls and 38 boys with CAH and 41 unaffected female and 31 unaffected male relatives, aged 4- to 11-years. Girls with CAH had more cross-gender responses than female controls on all three measures of cross-gender identification as well as on a composite measure of gender identity independent of gender role behavior. Furthermore, parent report indicated that 5/39 (12.8 %) of the girls with CAH exhibited cross-gender behavior in all five behavioral domains which comprise the cross-gender identification component of GID compared to 0/105 (0.0 %) of the children in the other three groups combined. These data suggest that girls exposed to high concentrations of androgens prenatally are more likely to show cross-gender identification than girls without CAH or boys with and without CAH. Our findings suggest that prenatal androgen exposure could play a role in gender identity development in healthy children, and may be relevant to gender assignment in cases of prenatal hormone disruption, including, in particular, cases of severely virilized 46, XX CAH.

Psychological characteristics preceding the development of homosexuality

490 gay men and 235 heterosexual men were surveyed to reveal frequency of distribution of childhood and adolescence gender non-conformity in gay men compare to similar features in straight men. Significant differences identified between two samples. The vast majority of gay men had history of various combinations of identity problems, crossgender behavior, communication problems, difficulties in adoption normative gender roles, the inability to find a common language with peers. In heterosexual sample basis were communicative problems related to particular personality features of some part of the control group. Gender-variance by itself cannot be regarded as an obvious sign indicating the development of homosexuality. In some cases it is a sign of congenital determinants that lead to the same sex sexual attraction, and in others this is only contributing personality characteristics facilitating under certain circumstances occurrence of erotic attachments to persons of the same gender.

Visibility and coping with minority stress: a gender-specific analysis among lesbians, gay men, and bisexuals in Flanders.

The role of visibility management strategies, as an extended measure of outness related to sexual orientation, has been rarely studied with the aim of explaining the experience of external stressors (i.e., experiences of everyday discrimination and perceived sanctioning of cross-gender behavior) and internal stressors (i.e., internalized homonegativity and general mental distress). In this study, we examined gender differences within these relationships. A non-representative sample of 2,378 lesbians, gay men, and bisexuals was recruited. We found that lesbian and bisexual women scored significantly higher on perceived cross-gender sanctioning and general mental distress compared to gay and bisexual men. Multivariate analysis showed that visibility management was significantly related to the experience of internalized homonegativity in both men and women. Visibility management mediated the relationship between experiences of every day discrimination on the one hand and internalized homonegativity and general mental distress on the other. Finally, we found that compared to gay and bisexual men, lesbian and bisexual women who maintained relatively closed visibility management strategies, reported lower scores on internalized homonegativity but higher scores on general mental distress. We found fewer gender differences related to visibility management than expected and those that we did find were relatively small. Flemish lesbian and bisexual women and gay and bisexual men appear to more alike than different.

EPA-1697 – Recalled gender-related play behavior and peer preferences in childhood and adolescence among adult gender-dysphoric individuals

It is frequently suggested that gender role norms influence certain expectations towards a child's gender related behavior and that deviations are perceived negatively by the social environment. Gender-dysphoric individuals experience a strong and persistent cross-gender identification and discomfort about the assigned sex and the associated gender role behaviors. The objective of this study was to investigate how adult gender dysphoric individuals recall play and peer-group preferences in childhood according to stereotypical expectations regarding the assigned sex. Differences between individuals who transition from female to male (FtMs) and those who transition from male to female (MtFs) as well as differences with regard to subgroups based on the age of onset (early onset: during childhood, EO; late onset: with begin of puberty development, LO) are tested. Data collection took place as part of the European network for the investigation of gender incongruence (ENIGI), a multicenter cooperation between European gender clinics in Amsterdam (NL), Ghent (BE), Hamburg (GER) and Oslo (NO). Play behavior and peer preferences were measured as part of the Biographic Questionnaire on Transsexualism . The total sample of N=634 participants was collected between 2006 and 2012. Participants were prescribed a diagnosis according to DSM-IV-TR criteria of Gender Identity Disorder . The results show, that cross-gender behavior was more frequently recalled in FtMS than MtFs. Within the gender-groups, individuals who were assessed as having an early onset recalled cross-gender behaviors more frequently than individuals who were assessed as having a late-onset. The results will be discussed in line with actual research findings.

Gender Identity Disorder is Not Simply Two in One

A Case Report on Gender Identity Disorder with Recurrent Depressive Disorder is presented. Individuals having this disorder often exhibit discomfort about their actual anatomic gender, and they may have wished to alter their bodies. Sex role-stereotypes adopted during childhood are the beliefs, characteristics and behaviors of individual cultures that are considered normal and appropriate for boys and girls to possess. These "norms" are influenced by one's family and friends, the mass-media, and their community. Since some cultures disapprove of cross-gender behavior, it often results in significant problems for affected individuals and those in close relationships with them. The importance of treatment is not only because of the high rate of mental-health problems, including Depression but with higher suicide rate among untreated transsexual people than in the general population. These problems are not usually related to the gender identity issues themselves, but the social and cultural responses to gender-deviated individuals. An example which classically illustrates Gender Identity Disorder is the case of a young man from Brunei Darussalam, who was seen and treated. This contribution will highlight the cultural and religious perspective of this Disorder.

Evaluation and management of children and adolescents with gender identification and transgender disorders

Gender identity development is poorly understood but impacted by central nervous system (CNS) factors, genes, gonadal hormones and receptors, genitalia, and social/environmental factors. Gender identity disorder (GID) is the diagnostic term to describe persons discontent with the sex they were assigned at birth and/or the gender roles associated with that sex. It is crucial that the diagnosis be verified as persistent, since gender confusion among those young persists among only a portion. Recent publications do not yet provide an overall perspective but involve observations regarding outcome information, unusual variables, incidence of cross-gender behavior, and CNS differences related to GID and bi-gender descriptions. Approaches to therapy for GID and task force guidelines are noted. Although the concept of gender identity is a relatively new paradigm and remains an area of active and exciting investigation, findings reported here provide items of information for understanding and treatment of GIDs and illustrate the need for further research.

New Gender Dysphoria Criteria Replace GID

New criteria for gender dysphoria will emphasize the individual’s felt sense of “incongruence” with natal gender, rather than cross-gender behavior. This article is part of a series on the differences between DSM-IV and DSM-5. The series will run through May, when the manual will be published.

Is Transgendered Male Androphilia Familial in Non-Western Populations? The Case of a Samoan Village

In Western populations, male gender atypicality (i.e., cross-gender behavior and identity) and male androphilia (i.e., sexual attraction to adult males) tend to cluster in particular families. Here, we examined whether this familial clustering effect extended to non-Western populations by examining the genealogical relationships of 17 Samoan transgendered androphilic males, known locally as fa'afafine, who were born in the same rural Samoan village. Specifically, we compared the genealogies of these 17 fa'afafine and those of 17 age-matched comparison males born in the same village. In addition to familial clustering, we examined birth order, sibship sex ratio, and sibship size. The fa'afafine were significantly later born than the comparison males and clustered into five and 16 distinct lineages, respectively, which constituted a statistically significant degree of family clustering among the 17 fa'afafine. Hence, the present study indicated that transgendered male androphilia is familial in this particular Samoan village, thus adding to a growing literature demonstrating that male androphilia and gender atypicality have consistent developmental correlates across populations. Discussion focused on the possible bases of this familial clustering effect and directions for future research.

Gender Identity Disorder: An Emerging Problem for Pediatricians

* Abbreviations: GID — : gender identity disorder PTSD — : posttraumatic stress disorder A new pediatric problem is in town. In this issue of Pediatrics there are 2 articles1,2 concerning gender identity disorder (GID). There has been an explosion of public interest in recent years and concern about children who show an interest in changing their gender. This, of course, brings more inquiries to the pediatrician about what to do. Cross-gender behavior in children has been known for many years. Even in the Child Behavior Check List3 developed by Achenbach in the 1970s there are 2 gender questions for parents to complete. Mothers reported that 2% to 4% of boys and 5% to 10% of girls of a nonclinical sample between the ages of 4 and 18 behaved as the opposite gender from time to time. Less frequently, these mothers reported that their children wished to be the opposite gender. Using the Youth Self Report,4 5% to 13% of teenage boys and 20% to 26% of teenage girls of a nonclinical sample reported cross-gender behavior. Two percent to 5% of boys and 15% to 16% of girls reported sometimes desiring to be the opposite gender. In spite of this relatively high rate of cross-gender behavior, very few patients have presented for evaluation and treatment even in countries such as the Netherlands where there is a well-established formal program for treatment.5 The prevalence there is of the order of 0.01% (1 in 10 000–30 000). Therefore, a lot of children seem to be experimenting with cross-gender behavior, but very few … Address correspondence to Walter J. Meyer III, MD, Department of Psychiatry and Behavior Sciences, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555-0193. E-mail: wmeyer{at}utmb.edu

Demographics, Behavior Problems, and Psychosexual Characteristics of Adolescents with Gender Identity Disorder or Transvestic Fetishism

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.