Gender Identity Problems Research Articles

Technology at the Rescue? Online Games, Adolescent Mental Health and the COVID Pandemic.

The COVID pandemic has had a major impact on the mental health of the population, especially on female adolescents. Eating disorders and gender identity problems have increased markedly. Online activities have also grown enormously during this period occupying a large portion of adolescents' time. We explore the use of social networking and online gaming by adolescent girls and boys. We discuss their possible influence on different levels of psychological distress in boys and girls in the face of the pandemic. We propose that online games, mainly used by young boys, might offer them some emotional protection through mechanisms related to the body and its experience, to the group dynamics of competition, collaboration, and hierarchy, to the possibility of expressing aggression, and to the construction of a clearer and more stable identity. An unprejudiced look at new technologies is mandatory, if we are to avoid projecting our fears and expectations onto them.

On the problem of gender and gender identity in various linguocultures

This article discusses the problems of gender and gender identity. Theoretical and practical aspects of gender identity formation are considered in particular such directions as sociolinguistic, linguoculturological, com- municative-discursive and psycholinguistic. The necessity of a detailed study of the problems of masculinity and femininity from the perspective of person and language is revealed and justified. The article provides ex- amples from various linguistic cultures that clearly demonstrate the differences and similarities in the cognitive perception of a person, taking into account his/her sex. It is revealed that the problem of gender and gender identity originates from ancient times, vividly reflected in oral folk art, in particular in proverbs and sayings. Gender identity in this perspective is a portrait of the person himself, his stereotypical ideas about his/her sex, taking into account culture, language and society. Based on the analysis carried out by the authors, it is shown that language does not just fix gender identity, characteristics or personality qualities related to gender, it constructs and creates them.

COMPARATIVE ANALYSIS OF AGE PERCEPTIONS ABOUT STEREOTYPICAL AND IDEAL GENDER QUALITIES IN MODERN SOCIETY

This article examines the problem of gender socialization and identity in modern Russian society, on the basis of an analysis of ideas about the typical and ideal gender characteristics of the personality is compared to three age groups (up to 20 years - generation q, 20-40 years - Generation Y and 40-60 years - generation X) and concludes on the main trends in the development of gender characteristics of the individual in groups of different gender and age. The study obtained new empirical data on age and sexual differences in perceptions of typical and ideal qualities of gender, in particular, found that the age of women significantly influences their ideas about the male and female gender ideal, the age of men significantly influences their perception of the male gender ideal, members of different generations of the south significantly differ in ideas about the female gender ideal, the representatives of different generations Y significantly differ in ideas about the female gender ideal , the biological sex in the age group X influences the idea of male gender ideal. At the same time, there were no statistically significant differences between gender and age in the perception of typical male and female qualities. The results can be an important material for a differentiated approach to family counselling and assistance in building harmonious inter-sex relationships.

Gender Dsyphoria and Psychiatric Disorders in Children and Adolescents with Congenital Adrenal Hyperplasia.

Gender identity, psychosexual function, psychiatric adjustment and quality of life have been investigated in congenital adrenal hyperplasia(CAH) patients. We aimed to investigate gender identity problems and the psychiatric disorders and associated factors in children and adolescents with CAH patients. Forty-five children and adolescents with CAH were included in the study. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version. Gender identity problems were investigated using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The mean age of the sample was 11.02 years (SD: 3.25, range: 6-18). 51.1% of the patients had at least one lifetime comorbid psychiatric disorder. The most common diagnoses were anxiety disorders, attention deficit hyperactivity disorder(ADHD), tic disorders and enuresis nocturna. Tic disorders and ADHD were higher in males but they were not statistically significant. Two female patients were diagnosed with gender dysphoria and 18.5% of females showed variably masculinized behaviors. The girls with gender identity problems expressed lower satisfaction with their sex than other girls and boys. Children and adolescents with CAH had many psychiatric disorders, especially neurodevelopmental disorders. ADHD and tic disorders should be kept in mind during assessment especially in male patients. Gender dysphoria and masculine behaviors seem to be common in female patients with CAH so they should be carefully investigated.

Non-binary gender identity and transgendence beyond psychiatric discourse

An analysis of the problem of non-binary gender identity and transgender shows that the professional position of psychiatrists and psychologists is often based on selfish gender when subjectivity begins to be seen in psychiatric diagnostics due to a rigid binary gender setting. Modern research proves the existence of gender diversity and a spectrum of gender identity. All this allows us to state that the phenomenon of so-called gender identity disorders goes beyond the psychopathological context. The psychiatrists use of the binary approach does not correspond to rapidly changing public ideas about the norm and pathology of human behavior.

Sexual Orientation and Gender Identity as Penalizing Criteria of Hate Speech

The article contains arguments raised in Polish discussion on the problem of sexual orientation and gender identity as penalizing criteria of hate speech. The Author points out regulations of Polish criminal law providing conditions of criminal responsibility for hate speech and binding criteria of the penalization, draft amendments in this area presented in recent years, as well as Polish legal doctrine or Supreme Court reviews referred to the issue. The background of the analyzes are provisions of international and European law as well as selected European states.

Outside the norm: Mental health, school adjustment and community engagement in non-binary youth.

Aims: The aim of this study was to explore the role of self-reported non-binary gender identity in mental health problems, school adjustment, and wish to exert influence on municipal issues in a community sample of adolescents. Methods: In a cross-sectional design, data were collected through an anonymous survey in Uppsala County, Sweden, among 8385 students (response rate 58.2%) in grades 7, 9, and 11, aged 13-17 years. The Strengths and Difficulties Questionnaire (SDQ) self-report was used to assess mental health problems. Gender identity was measured with one item and youth were categorized into those who identified as male or female (i.e. binary youth), and those who did or could not identify with either gender (i.e. non-binary youth). Logistic regressions and qualitative content analysis were used to analyse data. Results: Youth with non-binary gender identity (n = 137; 1.6%) had higher odds of having mental problems according to the SDQ total score (OR=3.05; 1.77-5.25). The association between non-binary gender identity and mental health problems remained significant after adjusting for confounders. Additionally, compared to their binary peers, the non-binary youth reported more truancy (36.5% vs 49.6%), more often failed a subject (21.5% vs 36.5%), and were more interested in exerting influence on municipal issues such as sociopolitical development, education, municipal services, and drug and alcohol policies (25.3% vs 38.0%). Conclusions: Youth with non-binary gender identity constitute a vulnerable population regarding mental health problems and school adjustment. The willingness to exert influence on municipal issues suggests a possible pathway to engagement.

Islam and Transgender (A Study of Hadith about Transgender)

One of the issues that have been considered in the public sphere today is the issue of the transgender phenomenon. Transgender is related to the problem of gender identity. It refers to the condition in which the perpetrators identify their identity and gender differently from their sex biologically. It's caused by dissatisfaction and incompatibility between their body and soul. The term transgender might not be so familiar in Indonesia. However, to indicate that phenomenon, some of the people called them "waria”, “priawan” or “tomboy". Generally, their existences were still hard to be accepted because Indonesian people considered this phenomenon as a deviation and it contradicts the moral value and religion in Indonesian society. In the teachings of Islam, the transgender phenomenon has been existed in the early days of the development of Islam, and it has been forbidden strictly. The Islamic view about this issue could be found in the prophet’s hadith explicitly. Hence, to understand this phenomenon, we need to study the hadith. The purpose is as a basis for addressing the transgender phenomenon that was prevalent in Indonesia. The understanding implementation of this hadith, in general, is not easy, because Indonesia is not a country that makes Islam as a formal state system. It has its perspective relate to the transgender phenomenon. Therefore, we have to contextualize this hadith understanding according to the Indonesian context, especially in dealing with transgender perpetrators.

MON-360 Genital Reconstruction for Ambiguous Genitalia: A Case Report on Congenital Adrenal Hyperplasia

Background: Congenital Adrenal Hyperplasia (CAH) is a group of autosomal recessive disorders characterized by impaired cortisol synthesis. Mutations in the gene CYP21A2 encoding adrenal enzyme 21-hydroxylase (P450c21) leads to blockage of corticol synthesis and diversion of its precursors to sex hormone biosynthesis. Cardinal features among females include ambiguous genitalia and progressive virilization. Clinical Case: A 16 year-old female presented with ambiguous genitalia since birth. 46XX karyotype and an elevated 17-hydroxyprogesterone (17-OHP) were noted on initial work-up. Pelvic ultrasound showed remnants of the vagina. Family history was unremarkable. She was managed as a case of congenital adrenal hyperplasia, classic virilizing form, currently maintained on prednisone 5mg/tab, 1 tablet once a day. She underwent vaginoplasty via urogenital mobilization at 1 year of age. Menarche was at 15 years old with irregular menses and scanty in volume. On physical examination, patient had a masculine voice, prominent brow ridge and jaw line, with excess hair on upper lip, chin and lower extremities (Ferriman Gallwey score of 16). Breasts were underdeveloped (Tanner Stage 2) with pubic hair extending to medial thighs (Tanner Stage 5). Clitoris was enlarged at 2.5 cm, with normal vaginal opening and perineum. There were no features of Cushing syndrome. Patient has regular follow-up with her paediatrician, endocrinologist, urologist, and school psychologist. Annual counselling regarding genital reconstruction and monitoring of serum 17-OHP were done. Latest 17-OHP result at 14 years old was 10 nmol/L (NV = 0.82-8.78 nmol/L) via radioimmunoassay. Gender preference was that of a female. She then underwent neurovascular sparing clitoroplasty. Stress doses of hydrocortisone was administered peri-operatively. No urinary incontinence, urinary tract infection nor decrease in clitoral sensitivity was noted post operatively. Recent pelvic ultrasound showed normal-sized anteverted uterus with intact endometrium. Patient is satisfied with the surgical outcome, although sexual function cannot be fully evaluated as she is sexually inactive. Feelings of anxiety and self-consciousness were subdued by sharing her thoughts to her parents and closest friends. She is currently clinically stable with no signs or symptoms of glucocorticoid deficiency or excess. Conclusion: The present case emphasized that in managing congenital adrenal hyperplasia, long-term monitoring and evaluation of multiple clinical aspects including fertility and psychological issues are of great value. Despite genital reconstruction, gender identity problems may still arise. Addition of androgen inhibitors can be considered. Addressing psychosocial issues in such patients is also a continuous process and should not be overlooked.

Становление понимания феномена расстройства половой идентификации

The aim: was to present the evolution of the views of Russian and foreign researchers on gender identity disorder, problems and controversial issues of its classification and, as such, attribution to mental disorders. Material and method keywords «gender identity disorder», «gender dysphoria» were used to find the publications in MEDLINE/PubMed. Results: this review highlights the following areas: (1) the prevalence and epidemiology of the problem at present; (2) the views of scientists throughout the entire period of studying the issue; (3) variants of classifications of gender identity disorder; (4) the current state of the problem; (5) current issues of pathogenesis.

Longitudinal course of eating disorders after transsexual treatment: a report of two cases

BackgroundSeveral reports have been published on patients with gender dysphoria and eating disorders. However, there have been few reports on the longitudinal course of eating disorders after gender reassignment surgery (GRS)/gender confirmation surgery (GCS).Case presentationWe report two Japanese cases of transsexual persons with eating disorders who underwent GRS/GCS, one male-to-female (MtF) and one female-to-male (FtM). Case 1 was a 35-year MtF person who had a 14-year-course of bulimia nervosa that developed after GRS. Case 2 was a 35-year FtM person with anorexia nervosa who underwent GCS 9 years before.ConclusionsWe found that the treatment of our transsexual patients influenced the course of their eating disorders for a long period, which could be attributable partly to the cultural situation in Japan, an East Asian country. It is possible that many gender identity problems and identity problems in general persist even after surgery and treatment; therefore, continual clinical support should be provided for patients with gender dysphoria and eating disorders even after hormonal therapy or GRS/GCS.

Transsexualisme/transgenderism : psychothérapie et transformation hormonale et chirurgicale

ObjectivesAt the end of the French evaluations and the international revision concerning the standard of care (SOC) for transsexual and transgender patients, the interest to propose psychotherapy as a supplement to the sex reassignment therapy (SRT) was unanimously recognized. But, it is clear that the works concerning this subject are rare, and that the methods of this proposal remain ill-defined. So, many questions remain unsettled such its frame, modalities, methods, objectives and its place and relation with or in the SRT, as well as on the theoretical models on which these psychotherapies base themselves. The goal of this article is therefore to present the conception and the evolution of this psychotherapy in the various versions of the standards of care, as well as the theoretical approaches on which the current model is established, then to expose the questions which according to us, still persist concerning this subject, as well as our remarks and proposals relating to the latter. MaterialsAt start, with the first SRT in the 1950s, this practice and his combination with psychotherapy suffered from a strong ethical but also partially ideological, controversy. An important number of medical practitioners met around the endocrinologist H. Benjamin to establish the first standards of care by SRT for transsexual, and defended that this treatment was the only one that could relieve the problem of gender identity of the transsexual patients. In the opposite, some psychiatrists and psychologists were in strict opposition to this treatment and postulated that transsexualism was a psychotic disorder which needed to be cured only by psychotherapy. In spite of this fist hard confrontation, it seems accepted today that the SRT can bring beneficial effects, and that an additional psychotherapy is maximizing the prognostic of this treatment. So, in the present, in the SOC, the goal of psychotherapy is “to help transsexual, transgender […] individuals achieve long-term comfort in their gender identity expression…”. However, the question of the modalities, forms and theoretical fundaments stay still not well defined. ResultsToday, the SOC recommend that psychotherapist actively collaborate and participate to the decision-making reunions of the SRT's professional team. In the same way, the role of the psychotherapist is described very near of a role of coaching and counseling, to optimize the SRT's final result. In complete consistency with these points, the theoretical models exposed are unconflict and unpathologized models which postulate that the true gender of patients could not be expressed because of social stigmatizations which can make them present a gender dysphoria. But, these points of view are more controversial that it's appearing. ConclusionsThe more controversial point concerns the narrow collaboration and the active participation of the psychotherapist with the SRT's professional team and its potential consequences. In that configuration, a collusion of the different therapeutic spaces can take place. The patients can feel unease with this particular therapeutic relation. In the same way, on the theoretical level, the conflict is a primary fundament in a psychodynamic perspective, but it also can be considered as a normal element of the therapy and the SRT's way. For all of those remarks, the question and works on the psychotherapy in complement with the SRT have to be continued.

The Prevalence of Urologic Disease in Young Men Based on a Review of Korean Military Conscription Examination Results

Purpose: We aimed to elucidate the prevalence of urologic disease in young men by reviewing the results of military conscription examinations in the Republic of Korea. Materials and Methods: The results of 615,382 conscription examinations undertaken by the military manpower administration offices in Seoul, Korea from January, 2006 to December, 2007 were reviewed. The physical examinations were conducted based on the Ministry of National Defense implementing ordinance No. 590. Results: Twenty eight hundred fifty-three (0.46%) examinees were found to have urologic diseases, among which urinary tract infection was the most frequent (0.16%) single disease entity, followed by testicular absence (0.12%), single kidney (0.05%), varicocele (0.04%), urolithiais (0.03%), and cryptorchidism (0.01%). Among the 16 examinees with penile amputation, 15 had been surgically amputated due to gender identity problems. Conclusions: With modifications of the Korean conscription examination and long-term evaluation, its results could help elucidate the prevalence of urologic diseases in young males in Korea. 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Gender Outcome in 46,XY Complete Androgen Insensitivity Syndrome: Comment on T’Sjoen et al. (2010)

The case report by T’Sjoen et al. (2010) constitutes the third published case of an originally female-assigned individual with 46,XY complete androgen insensitivity syndrome (CAIS) who appeared to have developed a male gender identity. Of the three individuals, this third one underwent the most sophisticated genetic work-up, and the social history makes a contribution of social coercion to the identity development least likely. Therefore, this report raises challenging diagnostic, phenomenologic, and etiologic questions. T’Sjoen et al. ‘‘believe this patient qualifies as female-tomale transsexual.’’ Their diagnosis was predated by the psychotherapist’s diagnosis of ‘‘childhood-onset gender identity disorder’’ made in the course of 5 years of psychotherapy that had started at age 23 years, i.e., 2 years before the initiation of androgen treatment and 4 years before mastectomy. The psychiatric nomenclature used in this case from Belgium was presumably that of the International Classification of Diseases, 10th revision (ICD-10; World Health Organization, 1992). In this context, the use of the diagnosis of F64.0 Transsexualism for a case of CAIS is puzzling, because the respective guidelines text clearly states that the ‘‘transsexual identity...must not be...associated with any intersex, genetic, or sex chromosome abnormality’’ (World Health Organization, 1992, p. 215; website p. 168). Perhaps the choice of diagnosis was influenced by the fact that this exclusion criterium has not been listed specifically for F64.2 Gender identity disorder of [prepubertal] childhood (World Health Organization, 1992, pp. 215–217; website pp. 168–170). In the Diagnostic and Statistical Manual ofMentalDisorders (DSM-IV-TR) of the American Psychiatric Association (2000), a ‘‘concurrent...physical intersex condition’’ is an exclusion criterium for Gender Identity Disorder regardless of pubertal stage. I have presented detailed arguments why the DSM-IV-TR diagnostic category of Gender Identity Disorder, as defined for persons without physical intersexuality (recently re-named ‘‘disorders of sex development’’ [DSD; Hughes et al., 2006]), should not be applied to persons with gender-identity problems in the context of a DSD (MeyerBahlburg, 1994, 2009). As T’Sjoen et al. did not discuss this issue in their report, it is unclear whether the transsexualism diagnosis was just an oversight on their part, or whether they assumed that, in this particular case, the patient-initiated gender change was distinctly different from that found in other cases of intersexuality and really more comparable to that of non-DSD transsexualism. The case history, as presented retrospectively, is much in line with what one sees clinically in many cases of DSD with patient-initiated gender change. Although assigned female at birth and undiagnosed until age 17 years, this child showed substantial cross-gender behavior since the age of 3 years, with verbal expressions of the wish to be of the other gender. However, this patient must have agreed to a short course of estrogen treatment at age 18, which was soon stopped again because of the patient’s aversive reaction to body feminization. Yet, subsequently, it took another 5 years and a revisit of her medical records for the patient to realize the potential implications of her 46,XY karyotype, which ‘‘supported the desire to make her body congruent with a long-standing male gender identity,’’ but even then there was substantial ‘‘hesitation’’ about her presentation, and another 2 years of psychotherapy before beginning androgen treatment, etc. Transient periods of gender uncertainty are experienced by many patients with DSD (Meyer-Bahlburg et al., 2004b), and the slow gradual procession to gender change in later adolescence and adulthood also appears more common among H. F. L. Meyer-Bahlburg (&) New York State Psychiatric Institute and Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 15, New York, NY 10032, USA e-mail: meyerb@childpsych.columbia.edu

Introduction: Gendering Socio Cultural Alcohol and Drug Research

The gender gap in alcohol consumption and alcohol-related harm still is considerable and largely unexplained. This paper introduces four studies performed in Sweden that explore factors influencing gender differences in levels of consumption, adverse consequences and treatment. We summarize and discuss these four studies performed within the same cultural setting, which each analyse interaction with the gender. Two studies focus on the individual level addressing criminal behaviour, alcohol problems and mortality, and gender identity and alcohol problems in women taking psychiatric co-morbidity into account. Two studies focus on the institutional and cultural levels addressing the handling of alcohol-related problems in primary healthcare and the effectiveness of using cultural analysis in identifying gender concerns for women. Future studies need to focus more on these complex associations to secure that treatment settings provide both genders with fair and adequate treatment of high quality and that prevention activities will start to test measures that take gender into consideration.

Cross-National Replication of the Gender Identity Interview for Children

We administered the Gender Identity Interview for Children, a 12-item child-informant measure, to children referred clinically for gender identity problems in Toronto, Ontario, Canada (N = 329) and Amsterdam, The Netherlands (N = 228) and 173 control children. Confirmatory factor analysis identified a Cognitive Gender Confusion factor (4 items) and an Affective Gender Confusion factor (8 items). Patients from both clinics had a significantly higher deviant total score than the controls, and the Dutch patients had a significantly higher deviant score than the Toronto patients. In this cross-national study, we are the first to report on the validity of this measure to discriminate children with gender identity disorder from controls outside of North America.

More than Murderers, Other than Men: Views of Masculinity in Modern Crime Fiction

In the crime novels The Silence of the Lambs (SL) by the American author Thomas Harris, 1 The Mermaids Singing (MS) by British Val McDermid, and Night Sister (NS) by Norwegian Unni Lindell 2 the murderers in these texts are discussed, explicitly in two cases and implicitly in one, as not being homosexual, transsexual or transvestite. The narrative technique is subtly elaborate: to propose that someone is not homosexual, for example, concurrently verbalizes homosexuality. Furthermore, considering the fact that the characters are so firmly located in a narrated environment characterized by heterosexuality and heteronormativity, they stand out as being, to say the least, and for want of a more appropriate word, non-heterosexual. This article argues that the murderers‟ non-heterosexuality is depicted as contributing to, or is even suggested as the reason for, their violent behavior; it drives them to murder and ultimately to their own death. Joseph Grixti describes Jame Gumb in The Silence of the Lambs as “the psychopathic loner who turns into a vicious beast, largely as a consequence of serious gender identity problems [...]” (91). This is true of all three killers: in the novels „gender identity problems‟ are equated with psychological problems. By providing these characterizations, masculinity as a result is represented as being „sane,‟ normal, and more or less stable.

Sexual Orientation and Gender Identity After Prenatal Exposure to the Dutch Famine

Sexual differentiation of the human brain has been suggested to take place through exposure to sex steroids during intrauterine development. Animal experiments have shown that interference in this process by underfeeding of the mother can result in feminization of the male offspring. We explored the possible effects of prenatal exposure to famine on sexual orientation and gender identity in humans. We used the Klein Sexual Orientation Grid to assess sexual orientation and also assessed gender identity in a group of 380 men and 472 women who were born as term singletons around the time of the 1944–1945 Dutch famine. Prenatal exposure to famine did not affect sexual orientation in men or in women. Three people indicated having some gender identity problems: one woman born before the famine and one man and woman exposed to famine in late gestation. In men, a later birth order was associated with a non-exclusively heterosexual identification. In conclusion, we found no evidence for a significant association between exposure to famine in utero and altered sexual orientation and gender identity. The small sample size of participants with non-exclusively heterosexual identification (possibly due to underreporting of homosexuality) may have reduced our power to detect any differences.

The Problem of Woman in Late-Medieval Hispanic Literature

What is a woman? This book questions the persistent assumption that the large corpus of medieval Hispanic texts that discuss the nature of women can be defined in terms of the cliched discourses of misogynism and defence of women, arguing instead that the problem of gender identity is vital to them all. The texts, some well-known, others which have received scant critical attention, are each discussed in their specific contexts and in relation to the ostensible reasons for their composition, such as a political, literary, religious, or didactic 'agenda'.They are also related to the literary traditions in which they are written (misogynistic denunciation, satire, humour, defence, narrative debate, among others), and the particular theoretical problems arising from them are discussed. But it is also argued that the full meaning of the texts lies at the less immediately accessible level at which they address this very problem of definition, one which arises directly from the self-perpetuating contradictions of authoritative wisdom on the nature of women. Robert Archer holds the Cervantes Chair of Spanish, King's College London.

T04-O-06 Gender identity conflicts and psychological problems in adult subjects with different forms of intersexuality (disorders of sex development, dsd): the Hamburg Intersex project

Our knowledge of the treatment options and long-term outcomes with different forms of intersexuality is insufficient. The demand for life long follow-up studies asks for more than surgical outcomes data. The objective of the Hamburg follow-up study is not only to gather information about physical development and treatment experiences of individuals with different forms of intersexuality but also about their gender identity problems, social life and especially about their psychological problems and well-being. A comprehensive questionnaire was developed that comprises standardized as well as self-constructed instruments. The instruments assessed demographic aspects, physical and sexuel development, diagnotic procedures hormonal and surgical treatment interventions, gender identity, gender role, psychological impairments. The sample includes 70 subjects with partial or complete androgen insensitivity, disturbances of androgen biosynthesis, gonadal dysgenesis (46, XY karyotype; co called XY women) and subjects with CAH (46, XX karyotype. Gender identity conflicts in intersex subjects living in the female role will be described. Optimal treatment policy demands a stable Gender identity in adulthood. This is the basic assumption for medical treatment procedures. Encouraged by the public discussion and by members of support groups many subjects ask for a more flexible view of gender identity and sexual health. From our data one can conclude that not all subjects finally want to live in a clear male or female gender role as adults. Not all of them want heterosexual relationships with the possibility of having heterosexual intercourse with penetration. The option of medical treatment procedures of sex assignment surgeries will be discussed.