Diagnosis Of Transsexualism Research Articles

Trends in Revision Facial Feminization Surgery.

Facial feminization surgery (FFS) can be an important part of an individual's transition; however, outcomes have not been well explored in the literature. This study aims to elucidate trends in FFS with a focus on drivers of secondary FFS to further improve care for TGNB patients. A manual chart review was conducted on patients from a single institution from 2012 to 2023 with a diagnosis of transsexualism (F64) who had undergone one or more surgeries associated with any 1 or more of 95 CPT codes related to gender-affirming surgery. Patients who underwent >1 FFS procedure were separated into staged, unplanned, and revision FFS. Three hundred twenty-seven patients were included in the analysis, with 111 of these patients undergoing FFS. Those who underwent FFS were significantly older (P<0.001), had a lower BMI (P<0.001), and began socially transitioning and hormone therapy at an older age (P<0.001 and P=0.001) than those who did not undergo FFS. 44.1% of patients who underwent FFS also underwent secondary FFS, with 26.1% of FFS patients undergoing unplanned secondary FFS. Patient factors, including BMI, age at first FFS, smoking status, race, ethnicity, and order of FFS in relation to other gender-affirming surgeries, were not significantly associated with differences in rates of unplanned secondary FFS. These findings highlight the importance of tailoring the surgical approach to a patient's transition to their unique situation, as well as the need for future studies to identify factors influencing the need for revision FFS and to enhance surgical outcomes for patients undergoing gender-affirming procedures.

An unusual case of delusional disorder.

An unusual case of delusional disorder.

Transsexualism and transgender medicine - what every internal specialist should know about

The authors present current findings on transsexualism and its treatment. According to the ICD-10, transsexualism is defined as the "desire to live and be accepted as a member of the opposite sex, usually accompanied by a sense of discomfort with, or inappropriateness of, one's anatomic sex, and a wish to have surgery and hormonal treatment to make one's body as congruent as possible with one's preferred sex." Synonyms of transsexualism are terms such as gender dysphoria reflecting the distress that persons feel due to a mismatch between their gender identity and their sex assigned at birth.The prevalence of transsexualism is estimated to be about 0,6 %. The diagnosis of transsexualism is made by psychiatrists, but at least five more medical specialties (endocrinologist, surgeon, ear, nose and throat specialist, speech therapist and dermatologist) are involved when treating transsexual persons. Hormonal therapy is a very important element of the treatment process; due to the complexity of transsexualism it should be undertaken by endocrinologists with experience and expertise in this field.

Psychosocial Resources and Quality of Life in Transgender Women following Gender-Affirming Surgery

Psychosocial resources like social support or intrapersonal coping skills play an important role in resilience and quality of life (QOL), yet research systematically investigating the availability of different resources and QOL in transgender (trans) women is missing. The present study aimed to systematically investigate the existence of different psychosocial resources and QOL in trans women following gender-affirming surgery (GAS). Using a cross-sectional design, 557 trans women who had received GAS at the local urological department were invited to study participation. Criteria for study inclusion were 18 years and older, diagnosis of transsexualism according to the International Classification of Disease, completion of all sessions of GAS, and given written informed consent to study participation. Psychosocial resources were assessed using the Essen Resource Inventory (ERI), the Sense of Coherence Scale, and the Social Support Scale. QOL was assessed with the Short Form Health Survey. Data from trans women were compared to normative data of healthy non-trans women as reported in the respective test manuals. In total, 158 trans women responded and participated in this study. They had received GAS 4 months to 21 years ago. The total sample was divided into 3 subgroups depending on the time interval since the participants' last GAS procedure (group 1: GAS 0.3-3 years ago (n= 48); group 2: GAS 3.1-10 years ago (n=62); and group 3: GAS 10.1-21 years ago (n= 41)). Trans women retrospectively indicated their available resources 3 years ago (ERI 3-years) and in the last 4 weeks (ERI 4-weeks). Trans women who had received GAS within the last 3 years (group 1) showed an increase in resources when comparing ERI 3-year scores (presurgery) with ERI 4-week scores (postsurgery). No differences emerged for group 2 and group 3. Compared to normative data from non-trans women, trans women scored significantly lower on the ERI but not in measures of Social Support Scale or Sense of Coherence Scale. Compared to non-trans women, mental QOL was significantly impaired in trans women, whereas no differences in physical QOL emerged. As this study hints towards reduced psychosocial resources in trans women, the offering of specialized counseling can have high beneficial potential to support the development of resources, thereby enhancing QOL. Data of a large sample of trans women is provided who were investigated up to 21 years after GAS. The study is limited by its cross-sectional design and the response rate of 42%. This study indicates that psychosocial resources improve around the time of GAS and seem to be improved and sustained in later years following GAS. Still, compared to non-trans women, trans women have a lower availability of resources and a lower mental QOL. Breidenstein A, Hess J, Hadaschik B, etal. Psychosocial Resources and Quality of Life in Transgender Women following Gender-Affirming Surgery. JSex Med 2019;16:1672-1680.

Genetic link between gender dysphoria and sex hormone signaling

Context There is a likely genetic component to gender dysphoria, but association study data have been equivocal. Objective We explored the specific hypothesis that gender dysphoria in transgender women is associated with variants in sex hormone-signaling genes responsible for undermasculinization and/or feminization. Design Subject-control analysis included 380 transgender women and 344 control male subjects. Associations and interactions were investigated between functional variants in 12 sex hormone-signaling genes and gender dysphoria in transgender women. Setting Patients were recruited from the Monash Gender Clinic, Monash Health, Melbourne, Australia, and the University of California, Los Angeles. Patients Caucasian (non-Latino) transgender women were recruited who received a diagnosis of transsexualism [Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV) or gender dysphoria (DSM-V)] pre- or postoperatively. Most were receiving hormone treatment at the time of recruitment. Main Outcome Measured Genomic DNA was genotyped for repeat length polymorphisms or single nucleotide polymorphisms. Results A significant association was identified between gender dysphoria and ERα, SRD5A2, and STS alleles, as well as ERα and SULT2A1 genotypes. Several allele combinations were also overrepresented in transgender women, most involving AR (namely, AR-ERβ, AR-PGR, AR-COMT, CYP17-SRD5A2). Overrepresented alleles and genotypes are proposed to undermasculinize/feminize on the basis of their reported effects in other disease contexts. Conclusion Gender dysphoria may have an oligogenic component, with several genes involved in sex hormone-signaling contributing.

Non-suicidal self-injury in trans people: associations with psychological symptoms, victimization, interpersonal functioning, and perceived social support.

There is a paucity of systematic research in the area of non-suicidal self-injury (NSSI) in trans people. The aim of this study was to investigate the prevalence of NSSI in trans people and the associations with intra- and interpersonal problems. Participants were 155 untreated individuals with a diagnosis of transsexualism (according to International Classification of Disease-10 criteria) attending a national gender identity clinic. All participants completed the Self-Injury Questionnaire, the Symptom Checklist-90-Revised, the Rosenberg Self-Esteem Scale, the Hamburg Body Drawing Scale, the Experiences of Transphobia Scale, the Inventory of Interpersonal Problems-32, and the Multidimensional Scale of Perceived Social Support. The sample consisted of 66.5% trans women and 33.5% trans men and 36.8% of them had a history of engaging in NSSI. The prevalence of NSSI was significantly higher in trans men (57.7%) compared with trans women (26.2%). Trans individuals with NSSI reported more psychological and interpersonal problems and perceived less social support compared with trans individuals without NSSI. Moreover, the probability of having experienced physical harassment related to being trans was highest in trans women with NSSI (compared with those without NSSI). The study found that with respect to psychological symptoms, trans women reported significantly more intrapersonal and interpersonal symptoms compared with trans men. Finally, the results of the regression analysis showed that the probability of engaging in NSSI by trans individuals was significantly positively related to a younger age, being trans male, and reporting more psychological symptoms. The high levels of NSSI behavior and its association with interpersonal and interpersonal difficulties and lack of social support need to be taken into consideration when assessing trans individuals. The effect of cross-sex hormones and sex reassignment surgery on psychological functioning, including NSSI behavior, as part of the transitional journey of trans individuals should be explored in future studies.

Challenges in the diagnosis and treatment of transsexualism in contemporary China.

Challenges in the diagnosis and treatment of transsexualism in contemporary China.

Perfil psicológico de personas transexuales en tratamiento

La transexualidad es un campo emergente dentro de la atención sanitaria. Por ello, está llena de tópicos. Dos de los mitos más extendidos acerca de las personas transexuales es que presentan graves alteraciones psicopatológicas y que son personas sumamente infelices. El objetivo principal de esta investigación fue estudiar el perfil psicológico de los pacientes transexuales. Especialmente, se quiso comprobar la presencia de rasgos psicopatológicos en el perfil de personalidad. Por otro lado, también se deseaba evaluar la presencia de problemas de depresión. Un segundo objetivo fue buscar diferencias en el perfil según el sexo (transexuales de hombre a mujer o de mujer a hombre). El presente estudio tuvo un diseño transversal. Los pacientes fueron seleccionados consecutivamente por orden de acceso a la unidad de trastornos de identidad de género al inicio del estudio. La muestra se formó con 121 pacientes de la Unidad de Trastornos de Identidad de Género de Madrid. Todos acabaron el estudio. El criterio de entrada fue tener el diagnóstico de transexualidad. Se les aplicaron test psicológicos: la Entrevista diagnóstica de identidad de género, el Cuestionario general de salud de Goldberg, el Cuestionario de competencia emocional, la Escala de bienestar psicológico, la Escala de satisfacción con la vida, la Escala de felicidad subjetiva, el nuevo Inventario de personalidad NEO y el Inventario clínico multiaxial de Millon III. Se encontró un alto bienestar psicológico. No se encontraron alteraciones psicopatológicas significativas. Se encontraron pocas aunque llamativas diferencias por sexos. Finalmente, apareció un único factor significativo en su perfil de personalidad. Las personas transexuales no tienen un perfil psicopatológico de personalidad, y hay pocas pero significativas diferencias por sexos. Transsexualism is an emergent field in healthcare and consequently is plagued by stereotypes. Two of the most widespread misconceptions are that transgender people have serious psychopathological disorders and that they are less happy than the general population. The main aim of this study was to characterize the psychological profile of transgender people and, in particular, the presence of psychopathological features in their personality profile. The presence of depressive features was also investigated. A second aim was to assess the differences in psychological profile between the sexes (female-to-male or male-to-females transgender people). A cross-sectional study was carried out. The patients were selected consecutively according to their order of access to the Gender Identity Disorder Unit (GIDU) of Madrid at the beginning of the study. The sample was composed of 121 patients from the GIDU. All patients completed the study. The access criterion was a diagnosis of transsexualism. The patients were administered the following psychological tests: Gender Identity Diagnosis Interview, the General Health Questionnaire (GHQ-28), Emotional Competence Questionnaire, Psychological well-being Scale, Life Satisfaction Scale, Subjective Happiness Scale, the NEO Personality Inventory (NEO-PI) and the Millon Clinical Multiaxial Inventory-III (MCMI-III). The subjects showed a high level of well-being. No serious psychopathological alterations were found. Differences between sexes were few but striking. Only one significant factor was found in the subjects’ personality profile. Transgender people do not have a psychopathological personality profile. The differences between sexes are few but important.

Bien-être psychosocial postopératoire de 207 transsexuels

Resume Introduction Depuis plus de 20 ans, l’unite de transsexualisme de l’hopital Foch accueille des demandes de changement de sexe. Elles font l’objet d’une evaluation d’au moins deux annees, au terme desquelles une commission pluridisciplinaire (composee de psychiatres, psychologues, endocrinologues et chirurgiens) confirmera ou non le diagnostic de transsexualisme et l’indication de transformation hormono-chirurgicale (THC). Objectif Le but de cette recherche est d’evaluer le bien-etre des patients en postoperatoire afin de confirmer la pertinence des decisions hormono-chirurgicales. Patients et methode Nous avons interroge, retrospectivement, sur la base d’un autoquestionnaire elabore par nos soins, tous les transsexuels operes de 1991 a 2009 apres evaluation psychiatrique a Foch, soit 266 transsexuels (un tiers masculin vers feminin [MF] et deux tiers feminin vers masculin [FM]). Le questionnaire interroge leur vie sociale, familiale, sexuelle et professionnelle, ainsi que leur etat psychique et physique en postoperatoire. Resultats Nous avons collecte des donnees sur 207 sujets (78 %), dont trois sont decedes. Il existe un fort taux d’activite professionnelle 85 % ; 90,5 % de FM contre 73 % de MF ; 9,5 % des FM sont inactifs contre 27 % des MF ; 72 % des FM ont un niveau d’etude superieur (secondaire ou plus) contre 55 % des MF. Les FM (63,5 %) vivent plus souvent en famille que les MF (40 %). Les MF vivent majoritairement seules (55 %), mais l’ensemble des patients vivent plus souvent en union libre. Seuls 30 % des FM sont maries, contre 10 % des MF. Les FM vivent majoritairement en couple (61,5 %) contre 41 % de MF. Les FM ont majoritairement des enfants par don de sperme. Peu de patients adoptent. Ils sont nombreux a elever les enfants de leur conjoint(e). La vie sociale des patients s’est globalement amelioree pour les deux groupes, sauf certains MF (10 %) qui souffrent de rupture familiale et amicale. La vie sexuelle s’est amelioree pour 73 % des MF et pour 56 % des FM car peu ont pratique une phallo-plastie (40 %) et la pose d’une prothese erectile (24 %) ; 86 % s’estiment en bonne sante physique et psychique. Le taux de mortalite est faible : 1,5 %. Deux deces sont dus a un cancer et l’autre a un suicide (0,5 %). Les patients (92,5 %) observent un bon suivi medical postoperatoire, soit par un endocrinologue (66,5 %), soit par un generaliste (26 %), et/ou par un psychiatre ou psychologue (8 %). Le taux de morbidite psychiatrique postoperatoire est de 3 % et d’utilisation de toxique chez 2 %, tous des FM. Les delits en postoperatoire ne sont le fait que de FM (7 %). Soixante pour cent des patients sont satisfaits de la chirurgie, 25 % sont insatisfaits et 15 % sont mitiges. Soixante et onze pour cent des patients imputent leur insatisfaction au manque d’esthetisme, et 46 % au manque de fonctionnalite ; 83,5 % des patients ont change leur etat civil, 14,5 % sont en cours. Deux patients (MF) n’ont jamais demande de changement d’etat civil, ils disent regretter. L’un d’eux a d’ailleurs demande a revenir a son sexe de naissance. Quatre-vingt-quinze pour cent des patients n’expriment aucun regret ; 4,5 % ont ressenti parfois un regret, surtout au vu des resultats chirurgicaux. Conclusion Dans leur majorite, les patients expriment un bien-etre psychologique et sexuel apres operation. Cependant, on note une meilleure insertion sociale et familiale parmi les FM et une meilleure satisfaction chirurgicale et sexuelle chez les MF.

Transgenitalização masculino / feminino: experiência do Hospital Universitário da UFRJ

To describe the experience of male-to-female sex reassignment surgery conducted at the Transgenitalization Program of the Clementino Fraga Filho University Hospital-UFRJ. The selection of patients for operation followed the evaluation of a multidisciplinary team, meeting the criteria after two years of follow-up: medical diagnosis of transsexualism, patient over 21 years, no physical characteristics unsuitable for change, support at least one close relative. From 1997 to 2004 seventeen patients were followed, fifteen of which had confirmed transsexual condition, one was dismissed for bringing false examinations. Of the total of sixteen transsexuals, six operations were performed. The operated patients were in the age range of 25 to 40 years with an average of 31. The surgical procedure was completed without any technical difficulties in all patients. One patient had stenosis of the neo meatus and in another it was necessary to shorten the urethra. The technique provides no major difficulties in implementation, but may depend on local conditions and surgeon's creativity. The greatest difficulty is to prepare these patients so that there are neither frustrations, nor too many expectations.

Clinical Characteristics, Psychiatric Comorbidities and Sociodemographic Profile of Transsexual Patients from an Outpatient Clinic in Brazil

ABSTRACT Objective: To provide a description of our transsexual population. Method: This descriptive observational study included 138 patients with a diagnosis of Trans-sexualism in Brazil, between March 1998 and September 2005. Demographic, clinical and psychiatry data were collected. Results: Age ranged from 16 to 54 years; 88.4% were male. The prevalence of sexually transmitted diseases was 19.5%, and 17.6% were HIV-positive. Hormone therapy was reported by 91.2%, and 47.4% referred drug and alcohol use; 14.2%, attempted suicide; and 12.5%, history of sexual abuse. Self-mutilation was reported by 5.2%s. Fifty-nine patients (42.7%) had at least one currently psychiatric comorbidity (axis I or II). Conclusions: Mental health professionals have a central role in coordinating the multidisciplinary care of transsexuals.

Response to Juliet Mitchell's Reflections

Mitchell credits me with two important contributions, the first, that in theorizing the development of sex and gender I propose that it is “cognitive gender [that] controls/organizes libidinal sexuality” rather than “Freudian libido theory or some genealogical object relations theory.” This is correct insofar as cognition in this context is understood to mean a cognitive/affective constellation. Mitchell also credits Lionel Ovesey and me with suggesting that disidentification is another name for separation-individuation and with pointing out that both sexes need to separate and individuate from mother. Although the etiology of transsexualism is unknown, one significant factor in its genesis is separation anxiety, which gets bound in cross-gender fantasies. In transsexuals, safety takes priority over sexuality; this is the key finding that dictates a reevaluation of the absolute priority so often afforded sexuality in psychoanalytic theory. The way medical culture shaped the diagnosis of transsexualism and provided a surgical resolution is a premier example of what I call a shared cultural fantasy (Person, 1995). The medical endorsement of transsexualism as a biological disorder tilted the treatment toward a surgical resolution.

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.

A Case of Personation

A case from the 19th century is described. The patient was admitted to hospital as a man but was revealed to be a woman. The woman's history is examined and the psychological implications of her impersonation are discussed. A hypothetical diagnosis of transsexualism is made.