Gender Dysphoric Patients Research Articles

Sexual quality of life in gender-dysphoric adults before genital sex reassignment surgery.

Although there is literature on sexuality in gender dysphoria, few studies have been done prior to genital sex reassignment surgery (SRS). To evaluate the perception of sexual QoL in gender-dysphoric patients before genital SRS and the possible factors associated to this perception. The final sample consisted of 67 male-to-female and 36 female-to-male gender-dysphoric adults consecutively attended in a gender unit who had not undergone genital SRS; 39.8% was receiving cross-sex hormonal treatment, and 30.1% had undergone breast augmentation or reduction. Sexual QoL was assessed using the sexual activity facet of the World Health Organization Quality of Life (WHOQOL)-100. Sociodemographic (age, gender, partner relationship) and clinical data (being on hormonal treatment and having undergone any breast surgery) were recorded from the clinical records. Depressive symptoms were assessed using the negative feelings facet of the WHOQOL-100. Personality was assessed using the Revised NEO-Five Factor Inventory. Sexual QoL, negative feelings, hormonal treatment, partner relationship, personality. The mean score of the sexual facet was 10.01 (standard deviation = 4.09). More than 50% of patients rated their sexual life as "poor/dissatisfied" or "very poor/very dissatisfied," around a quarter rated it as "good/satisfied" or "very good/very satisfied," and the rest had a neutral perception. Three variables were significantly associated with a better sexual QoL: less negative feelings (β = -0.356; P < 0.001), being on hormonal treatment (β = 0.216; P = 0.018), and having a partner (β = 0.206; P = 0.022). Age, sex, having undergone some breast surgery, and personality factors were not associated with their perception. This study indicates that before genital SRS, about half of gender-dysphoric subjects perceived their sexual life as "poor/dissatisfied" or "very poor/very dissatisfied." Moreover, receiving hormonal treatment, low negative feelings, and having a partner are related to a better subjective perception of sexual QoL.

Incidence of breast cancer in a cohort of 5,135 transgender veterans.

Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5,135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received >1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100,000 patient-years of VHA treatment (95 % CI 9.6-36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.

Gender Dysphoria in DSM-5: Changes and Continuities

Abstract - Gender Dysphoria is an individual’s unshakable conviction of belonging to the opposite sex, which often leads to a request for sex-reassignment surgery. New definition of Gender Dysphoria in DSM-5 has excluded the word identity, perhaps because of its philosophical difficulties in right definition. To make an accurate analyze of each Gender Dysphoric patient and to be precise on each diagnosis, patient´s receptor function, hormone basal levels and possible history of hormones changes during life including maternal gestational period, together with a careful Neuropsychological profile study, should be very important to take into account for the individual right treatment. Moreover considering this group of patients might be inside a sexual minority that is having a higher risk of maltreatment or abuse; Neuropsychological care should be provided in order to prevent them. These data are pointing out the relevance of different hormone levels in Gender Dysphoric patients to work in a whole ho-meostatic dimension during clinical treatment.

Bioethical challenges and contraversis of the interdisciplinary treatment of gender dysphoric persons

Gender dysphoria is a complex phenomenological entity in various aspects. One if them is interdisciplinary treatment approach which carries numerous bioethical questions: timing and the extend of offered therapeutic options, right of mental health professionals to offer and conduct partial treatment etc. Term 'partial' is however contraversal and in colision with elementary bioethical principles regarding patient's fundamental right to obtain complete treatment allways. Bioethical challenges proceedes in postoperative clinical experiences related to reconversions and bioethical reasonablenes as sometimes it's caused by poor differential diagnosis and unrecognised motives? De-transition case reports and long term follow-up's could contribute to clarification of clinical indicators pointing out the non/validity of reversal transition. Accepted professional ethics of mental health professionals prescribe obligation to treat gender incogruent/dysphoric children and adoelscents. Bioethical accuracy of gender dysphoric prepubertal children treatment includes necessity of clear definitions and complete diagnostic procedure reliability. Important questions are child maturity, capacity and capability to adapt to extreme transitional hormonal body changes. Prepubertal period impose question of adequate patient's informing consent fully satisissfying legal criteria of informing and competency. Expert's opinion differs from critisized considering inappropriateness of parents imposing personal standards to their children to affirmative considering parents as most appropriate reference group to give social value judgement after consultation with doctors. Health professions included in the treatment of gender dysphoric patients have equal ethical obligation to guarantee happy and productive life to children by medical or any other intreventions. Discussion on fertility preservation in some fields of clinical medicine is routine, but contraversal in gender dysphoria on expert and general public level. Such discrimination deeply undermines patient's basic bioethical rights as informing and counseling of transgender persons on contemporary opportunities of reproductive techologies is an imperative. Posttransitional parenthood has specificity in reversal parents identities and roles which makes this question much more contraversal.

Behavioral and Emotional Problems on the Teacher’s Report Form: A Cross-National, Cross-Clinic Comparative Analysis of Gender Dysphoric Children and Adolescents

For gender dysphoric children and adolescents, the school environment may be challenging due to peer social ostracism and rejection. To date, information on the psychological functioning and the quality of peer relations in gender dysphoric children and adolescents has been studied via parental report, peer sociometric methods, and social interactions in laboratory play groups. The present study was the first cross-national investigation that assessed behavior and emotional problems and the quality of peer relations, both measured by the Teacher's Report Form (TRF), in a sample of 728 gender dysphoric patients (554 children, 174 adolescents), who were referred to specialized gender identity clinics in the Netherlands and Canada. The gender dysphoric adolescents had significantly more teacher-reported emotional and behavioral problems than the gender dysphoric children. In both countries, gender dysphoric natal boys had poorer peer relations and more internalizing than externalizing problems compared to the gender dysphoric natal girls. Furthermore, there were significant between-clinic differences: both the children and the adolescents from Canada had more emotional and behavioral problems and a poorer quality of peer relations than the children and adolescents from the Netherlands. In conclusion, gender dysphoric children and adolescents showed the same pattern of emotional and behavioral problems in both countries. The extent of behavior and emotional problems was, however, higher in Canada than in the Netherlands, which appeared, in part, an effect of a poorer quality of peer relations. Per Bronfenbrenner's (American Psychologist, 32, 513-531, 1977) ecological model of human development and well-being, we consider various interpretations of the cross-national, cross-clinic differences on TRF behavior problems at the level of the family, the peer group, and the culture at large.

Gender Monitoring and Gender Reassignment of Children and Adolescents with a Somatic Disorder of Sex Development

Individuals born with a somatic disorder of sex development (DSD) have high rates of gender-atypical behavior, gender uncertainty, gender dysphoria, and patient-initiated gender change in childhood, adolescence,and adulthood. This article addresses the issues a mental health services provider has to consider in evaluating and assisting such patients and provides examples of assessment-method batteries. To date, the World Professional Association for Transgender Health's Standards of Care, 6th version, for non-DSD patients with gender dysphoria, may be cautiously used for guidance, taking into account the considerable differences in presentation and medical context between gender dysphoric patients with and without a DSD.

Potholes in the interview road with gender dysphoric patients: Contentious areas in clinical practice

Summary The mental health professional interview with a gender dysphoric patient is a unique clinical exercise. Here the patient makes the diagnosis and prescribes the treatment. The professional may be experienced as a road hazard to impede or detour the patient’s journey to sex change. London’s Charing Cross Clinic, the world’s largest, remains committed to a cautious approach. Stages in gender transformation proceed from the safest, most reversible. The duration of the Real Life Experience (RLE) is two years. This paper presents transcribed interview extracts exemplifying potentially contentious areas between professional and patient. The extensive presentation illustrates the process whereby clinician and patient engage in these pivotal areas. An effective partnership should enhance the prospect of resolving profound conflict in sexual identity.

Disclosure, risks and protective factors for children whose parents are undergoing a gender transition

SUMMARY Objective: This study attempts to delineate the effects on children within different stages of development whose parent undergoes a transition to the other sex. Methods: Questionnaires were mailed to therapists who have considerable experience working with gender dysphoric patients. These therapists were queried about their experience with individuals who had children prior to the start of their transition. Variables such as the nature and manner of disclosure to the child and the nature of the relationships between the child and each parent were evaluated. Results: Children in the preschool years were rated as adapting best to the transition, both initially and long-term. Adults also were able to adapt well, so long as the level of conflict between parents was low. Adolescents had the most difficult time adapting to a parental transition. The level of family conflict worsened the child's adaptation across all developmental levels. The therapists delineated both risk and protective factors for chi...

Split Gender Identity: Problem or Solution? Proposed Parameters for Addressing the Gender Dysphoric Patient

Working with the gender dysphoric patient is complex because of the various clinical issues that arise. One issue that has not been addressed in the psychiatric literature is whether to address the patient with the biologically congruent pronoun or name or with the patient's preferred-gender pronoun or cross-gender name. This article presents clinical examples that allow a template to be developed for pronoun use in working with such patients. Whether the clinician uses biologically congruent names and pronouns may depend upon the patient's progress in adopting the cross gender role as well whether family or friends either know or accept such changes. In certain situations, such as meetings with family members, the therapist may address the patient with gender congruent names; whereas on other occasions use cross-gender pronouns or names.

Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults.

Gender dysphoric patients of transsexual type (TS) have been considered to have severe psychopathology. However, these notions have a weak empirical documentation. TS patients (n = 86), patients with personality disorder (PD, n = 98) and adult healthy controls (HC, n = 1068) were compared by means of the Symptom Checklist 90 (SCL-90). All patients were diagnosed by structured interviews (Axis I, II and V of DSM-III-R/IV). PD patients were further characterized according to the LEAD-standard. TS patients scored significantly lower than PD patients on the Global Symptom Index and all SCL-90 subscales. Although the TS group generally scored slightly higher than the HC group, all scores were within the normal range. TS patients selected for sex reassignment showed a relatively low level of self-rated psychopathology before and after treatment. This finding casts doubt on the view that transsexualism is a severe mental disorder.

Utility of the MMPI-2 in Assessing Gender Dysphoric Patients

We compared MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) profiles of 2 groups of adult biological men requesting sex reassignment surgery; 1 group was diagnosed with Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev. [DSM-III-R]; American Psychiatric Association, 1987) transsexualism and the other with gender identity disorder of adolescence and adulthood, nontranssexual type (GIDAANT). Although the mean profiles for the transsexual group did not demonstrate any psychopathology, the GIDAANT group showed moderate psychopathology. A cluster analysis indicated that 85% of the transsexual group showed low psychopathology and 47% of the GIDAANT group showed severe psychopathology. Neither the MMPI-2 results nor the DSM-III-R clinical evaluation support the conclusion of many authors that transsexualism is associated with severe personality disorder; rather, the data indicate that transsexualism and other gender identity disorders without persistent wish for sex reassignment differ significantly in degree of psychopathology.

Twenty Years of Experience in Managing Gender Dysphoric Patients

Department of Plastic and Reconstructive Surgery Academic Hospital of the Free University P.O. Box 7057, NL-1007 MB Amsterdam The Netherlands

Twenty Years of Experience in Managing Gender Dysphoric Patients

Department of Plastic Surgery Box 376 University of Virginia Health Sciences Center Charlottesville, Va. 22908

Twenty Years of Experience in Managing Gender Dysphoric Patients

For the past 20 years, the gender treatment team formed under the auspices of the University of Texas Medical Branch Hospitals has treated 121 male individuals with gender identification disorders. The age of this group ranged between 18 and 71 years, with an average of 32.3 years. While all of them were seen regularly for 6 months after surgery, only 68 were followed for a year or longer. The regimen of surgical treatment that consisted of procedures of bilateral orchiectomy, penectomy with relocation of the urethral meatus, labial reconstruction, and neovaginoplasty was used for all patients. The castration procedure used between 1972 and 1977 included removal of both the testes and the spermatic cord. The corpora cavernosa were transected at the public symphysis. For vaginal reconstruction, a partial-thickness skin graft was used frequently, in conjunction with a skin flap fashioned from the penile skin, to line the neovaginal vault. Modifications and changes in technique were, however, introduced in 1978. Skin flaps mobilized from the inguinoperineal area instead of a partial-thickness skin graft were used to line the vaginal cavity. A proximal segment of the corpora cavernosa was retained to reconstruct a clitoris. In addition, the spermatic cord was incorporated into the reconstruction of labia majora. These technical modifications substantially reduced the incidence of vaginal stenosis and improved the external appearance of the genitalia. The experience accumulated from managing this group of patients forms the basis of this report.

Proportion of unmarried siblings of homosexual and non homosexual gender-dysphoric patients.

Among the siblings of homosexuals, a lack of sexual and romantic interest in women may be independent of erotic feelings for men. This study investigated the sexual histories of siblings of gender-dysphoric outpatients. The patients were classified into three groups: non homosexual males, homosexual males and homosexual females. Their siblings consisted of 301 brothers and 284 sisters over the age of 25. Logistic regression showed that the brothers of the homosexual male patients were significantly less likely to have been married, either legally or common-law, than the brothers of the other gender-dysphoric groups, even with age and relative birth order taken into account. This finding suggests that the low propensity for long term heterosexual relationships seen in homosexual male gender-dysphoric patients also tends to appear in their brothers.

Group therapy for gender-dysphoric heterosexual men

The treatment and clinical management of gender dysphoric heterosexual men often poses a challenge to the clinician. Gender dysphoric patients pursuing various lifestyle options may seek psychotherapy to deal with some of their conflicts. This paper describes one form of counseling--group therapy--which has been helpful to gender dysphoric heterosexual men and outlines the group psychotherapy program at the Gender Clinic of the Clarke Institute of Psychiatry.

Utility of the Gd scale for the measurement of Gender-Dysphoria in males.

Responses on the 31-item Gender Dysphoria ( Gd) scale of the MMPI of 104 primary gender-dysphoric males who had undergone or were about to undergo gender-reassignment surgery, 25 secondary gender-dysphoric patients from the same clinics, and 563 male psychiatric outpatients were tabulated and specificities and sensitivities calculated. The scale had satisfactory specificity, correctly identifying 98.1% of subjects. Sensitivity was unsatisfactory (40%) in distinguishing secondary gender-dysphorics in the Gender Clinic samples but adequate (88.4%) in the combined psychiatric outpatient and Gender Clinic samples. Factor analysis yielded 8 dimensions, but only 2 of these were easily interpretable or had sufficient items to ensure reliability, suggesting that there was little possibility of utilizing subscales. It is concluded that the Gd scale is an appropriate instrument for excluding primary gender dysphoria when used in conjunction with conventional diagnostic assessments.

Transsexualism: syndrome or symptom?

The desire to identify with and assume the role of the opposite gender has been present with us since antiquity. Unfortunately, the syndrome of transsexualism as defined by the DSM-III encompasses many individuals who are seeking a gender change perhaps allowing reassignment to take place when not indicated. This paper reviews the major classifications applied to the condition of transsexualism and a new model of classification for individuals with Gender Dysphoria is outlined. It will be shown that by subdividing the condition into those with the hypothesized syndrome (primary (true) transsexualism, or the symptom, secondary transsexualism) a better understanding of gender dysphoria is achieved. By applying this new model of classification, a management/treatment protocol is outlined which is helpful in dealing with the gender dysphoric patient.

Penile and scrotal inversion vaginoplasty for male to female transsexuals

A technique of penile and scrotal inversion vaginoplasty for the male to female transsexual has been used successfully in 11 gender-dysphoric patients. The depth of the neovagina is approximately 11 cm-a cosmetic and physiologic result that adds greatly to the patient's satisfaction with the operation. There were no complications of rectal or urethral fistulas. In 1 patient vaginal stenosis developed.

The gender identity movement: a growing surgical-psychiatric liaison.

The evaluation and treatment of individuals with gender identity problems has resulted in an interesting and productive collaboration between several specialties of medicine. In particular, the psychiatrist and surgeon have joined hands in the management of these fascinating patients who feel they are trapped in the wrong body and insist upon correcting this cruel mistake of nature by undergoing sex reassignment surgery. Over the last two decades, some 40 centers have emerged in which interdisciplinary teams cooperate in the evaluation and treatment of these gender dysphoric patients. The model for this collaboration began at The Johns Hopkins Hospital, where the Gender Identity Clinic began its operation in 1965 (Edgerton, 1983; Pauly, 1983). This "gender identity movement" has brought together such unlikely collaborators as surgeons, endocrinologists, psychologists, psychiatrists, gynecologists, and research specialists into a mutually rewarding arena. This paper deals with the background and modern era of research into gender identity disorders and their evaluation and treatment. Finally, some data are presented on the outcome of sex reassignment surgery. This interdisciplinary collaboration has resulted in the birth of a new medical subspecialty, which deals with the study of gender identification and its disorders.