Sex Reassignment Research Articles

Molecular screening of XY SRY-negative sex reversal cases in horses revealed anomalies in amelogenin testing.

Male-to-female sex reversal in horses is a developmental disorder in which phenotypic females have a male genetic constitution. Male-to-female sex reversal is the second most common genetic sex abnormality, after X chromosome monosomy. All male-to-female sex reversal cases studied to date have been found to be infertile. Therefore, a screening test is particularly useful in laboratories doing DNA genotyping in horses. Our laboratory has tested > 209,000 horses for parentage using a panel of microsatellite markers and the sex marker gene amelogenin (AMEL). Suspect XY sex reversal cases are reported females with a male profile by AMEL testing. After routine genotyping, 49 cases were detected and further tested using the sex-determining region Y (SRY) gene, confirming the XY SRY-negative genotype of suspect sex reversal cases. When some inconsistencies arose in the initial result, a molecular panel of X- and Y-linked markers was analyzed for these samples. Of the 49 cases, 33 were confirmed as XY SRY-negative. The remaining 16 cases were identified as false-positives as a result of anomalies of AMEL testing in horses.

Molecular and morphological sex differentiation in sablefish (Anoplopoma fimbria), a marine teleost with XX/XY sex determination.

Phenotypic sex of an organism is determined by molecular changes in the gonads, so-called molecular sex differentiation, which should precede the rise of cellular or anatomical sex-distinguishing features. This study characterized molecular and morphological sex differentiation in sablefish (Anoplopoma fimbria), a marine teleost with established XX/XY genotypic sex determination. Next generation sequencing was conducted on sablefish ovarian and testicular mRNAs to obtain sequences for transcripts associated with vertebrate sex determination and differentiation and early reproductive development. Gene-specific PCRs were developed to determine the distribution and ontogenetic gonadal expression of transcription, growth, steroidogenic and germline factors, as well as gonadotropin and steroid receptors. Molecular changes associated with sex differentiation were first apparent in both XY- and XX-genotype sablefish at~60mm in body length and prior to histological signs of sex differentiation. The earliest and most robust markers of testicular differentiation were gsdf, amh, dmrt1, cyp11b, star, sox9a, and fshr. Markedly elevated mRNA levels of several steroidogenesis-related genes and ar2 in differentiating testes suggested that androgens play a role in sablefish testicular differentiation. The earliest markers of ovarian differentiation were cyp19a1a, lhcgr, foxl2, nr0b1, and igf3. Other transcripts such as figla, zp3, and pou5f3 were expressed predominantly in XX-genotype fish and significantly increased with the first appearance and subsequent development of primary oocytes. This study provides valuable insight to the developmental sequence of events associated with gonadal sex differentiation in marine teleosts with XX/XY sex determination. It also implicates particular genes in processes of male and female development and establishes robust molecular markers for phenotypic sex in sablefish, useful for ongoing work related to sex control and reproductive sterilization.

Preoperative identification of clinicopathological prognostic factors for relapse-free survival in clinical N1 non-small cell lung cancer: a retrospective single center-based study

BackgroundGiven the difficulty in preoperatively diagnosing lymph node metastasis, patients with Stage I–III non-small cell lung cancer (NSCLC) are likely to be included in the clinical N1 (cN1) group. However, better treatment options might be selected through further stratification. This study aimed to identify preoperative clinicopathological prognostic and stratification factors for patients with cN1 NSCLC.MethodsThis retrospective study evaluated 60 patients who were diagnosed with NSCLC during 2004–2014. Clinical nodal status had been evaluated using routine chest computed tomography (CT) and/or positron emission tomography (PET). To avoid biasing the fluorodeoxyglucose uptake values based on inter-institution or inter-model differences, we used only two PET systems (one PET system and one PET/CT system). Relapse-free survival (RFS) and overall survival (OS) were the primary study outcomes. The maximum standardized uptake value (SUVmax) was calculated for each tumor and categorized as low or high based on the median value. Patient sex, age, histology, tumor size, and tumor markers were also assessed.ResultsPoor OS was associated with older age (P = 0.0159) and high SUVmax values (P = 0.0142). Poor RFS was associated with positive carcinoembryonic antigen (CEA) expression (P = 0.0035) and high SUVmax values (P = 0.015). Multivariate analyses confirmed that poor OS was independently predicted by older age (hazard ratio [HR] = 2.751, confidence interval [CI]: 1.300–5.822; P = 0.0081) and high SUVmax values (HR = 5.121, 95% CI: 1.759–14.910; P = 0.0027). Furthermore, poor RFS was independently predicted by positive CEA expression (HR = 2.376, 95% CI: 1.056–5.348; P = 0.0366) and high SUVmax values (HR = 2.789, 95% CI: 1.042–7.458; P = 0.0410). The primary tumor’s SUVmax value was also an independent prognostic factor for both OS and RFS.ConclusionsFor patients with cN1 NSCLC, preoperative prognosis and stratification might be performed based on CEA expression, age, and the primary tumor’s SUVmax value. To enhance the prognostic value of the primary tumor’s SUVmax value, minimizing bias between facilities and models could lead to a more accurate prognostication.

Novel Method for the Separation of Male and Female Gametocytes of the Malaria Parasite Plasmodium falciparum That Enables Biological and Drug Discovery.

We developed a flow-cytometry-based method to separate and collect cocultured male and female Plasmodium falciparum gametocytes responsible for malaria transmission. The purity of the collected cells was estimated at >97% using flow cytometry, and sorted cells were observed by Giemsa-stained thin-smear and live-cell fluorescence microscopy. The expression of validated sex-specific markers corroborated the sorting strategy. Collected male and female gametocytes were used to confirm three novel sex-specific markers by quantitative real-time PCR that were more enriched in sorted male and female gametocyte populations than existing sex-specific markers. We also applied the method as a proof-of-principle drug screen that allows the identification of drugs that kill gametocytes in a sex-specific manner. Since the developed method allowed for the separation of male and female parasites from the same culture, we observed for the first time a difference in development time between the sexes: females developed faster than males. Hence, the ability to separate male and female gametocytes opens the door to a new field of sex-specific P. falciparum gametocyte biology to further our understanding of malaria transmission.IMPORTANCE The protozoan Plasmodium falciparum causes the most severe form of human malaria. The development of sexual forms (so-called gametocytes) is crucial for disease transmission. However, knowledge of these forms is severely hampered by the paucity of sex-specific markers and the inability to extract single sex gametocytes in high purity. Moreover, the identification of compounds that specifically affect one sex is difficult due to the female bias of the gametocytes. We have developed a system that allows for the separation of male and female gametocytes from the same population. Applying our system, we show that male and female parasites mature at different rates, which might have implications for transmission. We also identified new sex-specific genes that can be used as sex markers or to unravel sex-specific functions. Our system will not only aid in the discovery of much needed gametocidal compounds, but it also represents a valuable tool for exploring malaria transmission biology.

A Biometric Logic of Revelation: Zach Blas’s <em>SANCTUM</em> (2018)

A Biometric Logic of Revelation: Zach Blas’s <em>SANCTUM</em> (2018)

Mapping and marker identification for sex-determining in the Pacific abalone, Haliotis discus hannai Ino

Pacific abalone (Haliotis discus hannai Ino) is an economically important mollusk. It has a male heterogametic (XX/XY) sex determination system. However, little is currently known on the molecular basis of sex determination in the species. Therefore, we identified the sex-linked genomic segment and markers with genome re-sequencing in Pacific abalone. A total of 8,473,763 high quality SNPs and 6,332,868 indels were obtained with resequencing and further processing. Among them, 2397 SNPs and 98 indels were detected as sexually dimorphic. According to distribution of sexually dimorphic SNPs, a major segment on Chr. 9 (~2.59 Mb) and a minor one on Chr. 2 (~50.02 Kb) were identified as sex-linked, consistent to the results of genome-wide association analysis (GWAS). In addition, a diagnostic marker (MSP-2) for genetic sex of Pacific abalone was developed according to the male-specific deletion rs4391834 (12 bp). These results were useful in further researches on the molecular mechanism of sex determination and sex-control breeding in Pacific abalone.

“Change can never be ‘complete’”: the legal right to self-identification and incongruous bodies

At the time of writing, New Zealand's government is considering select committee recommendations to simplify the process for changing the sex recorded on a birth certificate (Governance and Administration Committee 2018). This article argues that the inconsistent requirements for binary and non-binary transgender people to amend their documentation indicates a scepticism of the legitimacy of non-binary identities. The current process for transgender people seeking to change their sex marker is onerous and often expensive (Noonan and Liddicoat 2008). Attaining an "indeterminate" marker on a birth certificate is so difficult as to be functionally impossible. Crown Law have suggested that “social factors” (how a person’s gender is perceived by others) would be considered by the courts when deciding on the veracity of their stated gender identity, indicating that being identifiable as a binary-gendered person is a contributor to achieving legal recognition of one’s gender. The proposal presumes that recording an "official" gender is natural and necessary. Legal recognition of non-binary people signals an expanded understanding of recognisable gender identities, but requires situating oneself within a bureaucratic framework. In light of the new process being proposed, I argue that if passed this Bill implicitly raises the question of why identity documents must have a sex marker on them at all.

Analysis of the effects of legal sex markers in detention: Single-sex detention facilities, conversion therapy, and violations of human rights

<p>Conversion therapies have been classified as inhuman treatment or torture on several instances, including by the UN Special rapporteur on torture and other cruel, inhuman or degrading treatment or punishment, and are explicitly prohibited by several professional bodies around the world such as the World Medical Association and the World Professional Association for Transgender Health. They have been defined as “any treatment, practice or sustained effort that aims to change, repress and, or eliminate a person’s sexual orientation, gender identity and, or gender expression” (Malta, 2016).</p><p>However, based on its functional definition, the concept of “conversion therapy” can be successfully used as a broader analytical framework to describe carceral practices that regulate gender identity and expression and, in particular, those implemented by sex-segregated detention facilities.</p><p>This paper argues that, coupled with often restrictive and sometimes impossible means for accessing legal gender recognition to change one’s identity documents, single-sex detention acts as a form of conversion therapy for trans and gender diverse people at least in two ways by coercing detainees into adopting gender expression modes that do not align with their gender identity. In that sense, it can be said that sex-segregated detention acts to change the gender identity or expression of gender diverse detainees and, therefore, can amount to inhuman treatment or torture.</p>

The Legal Certification of Sex in Belgium over Time. Ideological Effects and Practical Implications

<p><br />Belgium has recently modified the way ‘sex’ is legally certified for trans* people following the principle of self-determination. However, like in most countries, this modification has not changed the way ‘sex’ is determined for all members of society, being limited to trans* people. How is sex legally certified for different categories of people in Belgium and what are the effects thereof? Drawing on the theoretical perspective of discursive psychology (DP), we consider sex/gender categories as something constructed in discourse – in this case, legislative discourse – and not as an essentialist and pre-discursive reality. Categories are thus an effect of discourse: what discourse accomplishes or constructs. Based on this premise, this paper aims at elucidating the ideological effects and practical implications of the legal certification of sex in Belgium. The effects of the legislative discourse are ideological in the sense that they establish social norms, in this case, regarding sex/gender, leading to practical implications in everyday life. To elucidate these effects, we first identified Belgian civil law on the legal certification of sex since the establishment of Belgium as a sovereign state. We then applied a DP-inspired analytical device comprising a qualitative content analysis and the examination of content variability. The variability of discourse is a key analytical tool to elucidate the effects of discourse since these are not directly observable. The results show that the analysed legislation constructs women and men as natural categories. This is carried out through: 1) the establishment of a distinction between the population at large (unmarked) and those ‘outside the norm’ (marked subjects: ‘transgender’, ‘intersex’); 2) the lack of legal regulation of the attribution of sex markers at birth, being taken for granted; 3) the regulation of the latter only in ‘abnormal cases’ (called ‘children suffering from sexual ambiguity’); and 4) the fact that gender identity is recognised as a criterion for the attribution of sex markers only for trans* people, presented as an exception to the norm. This variability reifies sexual dimorphism and naturalises the correspondence between ‘biological sex’ and gender identity, thereby constituting ‘normative’ and ‘deviant’ sex/gender categories. The results are discussed in light of the practical implications that this legal norm has in everyday life.</p><p> </p>

Characteristics of REPRIEVE Trial Participants Identifying Across the Transgender Spectrum.

Because persons who identify across the transgender spectrum (PATS) are a key population in human immunodeficiency virus (HIV) yet are underreported in HIV and cardiovascular research, we aimed to characterize this population within the REPRIEVE global clinical trial (n = 7770). Acceptance of gathering gender identity was high (96%). Participation by PATS was 1.7% overall, 2.4% among natal males, 0.3% among natal females, and varied across geographic regions (from 0% in sub-Saharan Africa to 2.3% in High Income Region). Thirty percent of natal male PATS identified other than transgender. Some characteristics differed by gender. Most notably, 38% of natal male PATS receiving gender-affirming treatment had waist circumference >102 cm (compared with ≤25% in other groups). Given that PATS is a key population, HIV research should routinely report trial participation and outcomes by gender in addition to natal sex, to provide the results needed to optimize medical care to PATS.

An Evaluation of Baseline Kidney Function in the REPRIEVE Trial of Pitavastatin in Human Immunodeficiency Virus.

Chronic kidney disease is a common comorbid condition among persons living with human immunodeficiency virus (PWH). We characterized baseline kidney function in the REPRIEVE (Randomized Trial to Prevent Vascular Events in HIV) trial cohort. REPRIEVE enrolled PWH with low to moderate cardiovascular risk based on traditional risk factors to evaluate the effect of statin therapy on cardiovascular events. We determined baseline estimated glomerular filtration rate (eGFR) with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), Modification of Diet in Renal Disease, and Cockcroft-Gault equations, and we evaluated baseline factors associated with eGFR <90 mL/min/1.73 m2 by logistic regression. We performed Bland-Altman plots and scatterplots to assess agreement between equations. Among 7770 participants enrolled, the median age was 50 years, 31% were female (natal sex), 43% black or African American and 15% Asian, the median body mass index (calculated as calculated as weight in kilograms divided by height in meters squared) was 25.8, and the median CD4 cell count 620/µL. The median CKD-EPI eGFR was 97 mL/min/1.73 m2, and 38% had an eGFR <90 mL/min/1.73 m2. In the adjusted model, factors associated with eGFR <90 mL/min/1.73 m2 included white race, older age, higher body mass index, high-income region of enrollment, hypertension, and tenofovir disoproxil fumarate. The CKD-EPI and Modification of Diet in Renal Disease equations demonstrated strong agreement, particularly at lower eGFR values. Overall, there was 56% concordance between the 3 equations (categories <60, 60 to <90, ≥90 mL/min), improving to 73% after accounting for individual body surface area. REPRIEVE enrolled a diverse cohort including a substantial number of PWH with reduced kidney function. Factors associated with reduced eGFR included traditional risk factors and tenofovir disoproxil fumarate exposure. Three commonly used equations have only fair agreement, with potential implications for both clinical care and epidemiologic studies. NCT02344290.

The Fontan of Youth: Adult Medical Issues for Adolescents

An 18-year-old natal female, asserted male, seen in cardiology clinic for follow up status post surgical palliation (modified Fontan in 2006) for pulmonary atresia with intact ventricular septum. He has a diminutive, hypoplastic tricuspid valve and right ventricle, complicated by a large coronary sinusoid from the anterior right ventricle that communicates with the right coronary artery, as well as one from the left coronary to the left anterior descending artery, resulting in to and fro flow within the vessel. His last cardiac catheterization in 2014 demonstrated excellent Fontan hemodynamics, with …

Gender Identity, Analogy and Virtue: A Response Newton and Watt

AbstractWilliam Newton and Helen Watt have both criticised the attempt to draw an analogy between gender recognition and adoption. Newton argues that recognition of adoptive fatherhood rests on an “analogy of proportion” whereas to use the word “woman” of someone whose natal sex is male is, at most, “a weak form of analogy”. However, the definition of woman provided by Newton excludes those who are infertile and neglects the cultural dimension of gender. The case of Casimir Pulaski shows that someone could participate in many of the cultural aspects of being male, as these were expressed in his society, irrespective of the facts of his internal anatomy. Watt thinks the analogy, if modified, shows that there is an onus against transitioning. She does not regard cross-dressing or taking cross-sex hormones or use of pronouns to express gender incongruence as being intrinsically wrong but argues that transitioning is potentially misleading and can have harmful consequences. Watt's practical arguments are weak as they do not include a broad range of considerations, especially considerations about inclusion and discrimination. On the other hand, Watt's concession is significant as it implies that, at least in some circumstances, transitioning could be virtuous.

Assigning the Sex-Specific Markers via Genotyping-by-Sequencing onto the Y Chromosome for a Torrent Frog Amolops mantzorum.

We used a genotyping-by-sequencing (GBS) approach to identify sex-linked markers in a torrent frog (Amolops mantzorum), using 21 male and 19 female wild-caught individuals from the same population. A total of 141 putatively sex-linked markers were screened from 1,015,964 GBS-tags via three approaches, respectively based on sex differences in allele frequencies, sex differences in heterozygosity, and sex-limited occurrence. With validations, 69 sex-linked markers were confirmed, all of which point to male heterogamety. The male specificity of eight sex markers was further verified by PCR amplifications, with a large number of additional individuals covering the whole geographic distribution of the species. Y chromosome (No. 5) was microdissected under a light microscope and amplified by whole-genome amplification, and a draft Y genome was assembled. Of the 69 sex-linked markers, 55 could be mapped to the Y chromosome assembly (i.e., 79.7%). Thus, chromosome 5 could be added as a candidate to the chromosomes that are particularly favored for recruitment in sex-determination in frogs. Three sex-linked markers that mapped onto the Y chromosome were aligned to three different promoter regions of the Rana rugosa CYP19A1 gene, which might be considered as a candidate gene for triggering sex-determination in A. mantzorum.

A newly developed genetic sex marker and its application to understanding chemically induced feminisation in roach (Rutilus rutilus).

Oestrogenic wastewater treatment works (WwTW) effluents discharged into UK rivers have been shown to affect sexual development, including inducing intersex, in wild roach (Rutilus rutilus). This can result in a reduced breeding capability with potential population level impacts. In the absence of a sex probe for roach it has not been possible to confirm whether intersex fish in the wild arise from genetic males or females, or whether sex reversal occurs in the wild, as this condition can be induced experimentally in controlled exposures to WwTW effluents and a steroidal oestrogen. Using restriction site-associated DNA sequencing (RAD-seq), we identified a candidate for a genetic sex marker and validated this marker as a sex probe through PCR analyses of samples from wild roach populations from nonpolluted rivers. We also applied the sex marker to samples from roach exposed experimentally to oestrogen and oestrogenic effluents to confirm suspected phenotypic sex reversal from males to females in some treatments, and also that sex-reversed males are able to breed as females. We then show, unequivocally, that intersex in wild roach populations results from feminisation of males, but find no strong evidence for complete sex reversal in wild roach at river sites contaminated with oestrogens. The discovered marker has utility for studies in roach on chemical effects, wild stock assessments, and reducing the number of fish used where only one sex is required for experimentation. Furthermore, we show that the marker can be applied nondestructively using a fin clip or skin swab, with animal welfare benefits.

Neurofibromatosis 1-associated optic pathway gliomas.

Optic Pathway Gliomas (OPG) are the most common brain tumor in Neurofibromatosis 1 patients (NF1). They are found along the optic pathway and may involve the optic nerves, chiasm, retro-chiasmatic structures, and the optic radiations. NF1 associate OPG (NF1-OPG) have variable presentation, disease course and response to treatment. The optimal management is patient-specific and should be tailored by a multidisciplinary team. Age, sex, histology, and molecular markers may be important factors in the individualized decision-making process. Chemotherapy is the first-line treatment in cases of progressive tumors, and visual preservation is the main goal of treatment. In this paper we will review the disease, practical management, and recent advances of NF1-OPG.

Digit Ratio (2D:4D), Transgendered Belief, and Transsexual Drug Therapy in the BBC Internet Study

Transgendered belief—the conviction that one is the opposite gender to one’s natal gender—may be influenced by prenatal sex steroids. We consider this possibility by examining the relationship between digit ratio (2D:4D—a suggested correlate of fetal testosterone and estrogen), natal gender, felt gender, and transsexual drug therapy in a large online survey (the BBC Internet Study). There were 209,317 participants who reported their gender, their felt gender, and whether they were taking/had taken transsexual drug therapy (male-to-female (MtF) or female-to-male (FtM)). Participants included natal males who felt male (M→M, n = 104,939) and those who felt female (M→F, n = 4760) and natal females who felt female (F→F, n = 84,904) and those who felt male (F→M, n = 4705). Transsexual drug therapy (MtF and FtM) was reported by 830 and 223 participants, respectively. Digit length was determined by direct self-measurement. Mean 2D:4D of M→F and MtF individuals was higher (more “feminized”) than for M→M and natal males, respectively. These effects were found in the total sample, the most numerous ethnic group (Whites) and the two largest national White samples (the UK and the USA). The mean 2D:4D of F→M and FtM participants did not differ from that of F→F and natal females, respectively. We conclude that M→F and MtF individuals may have experienced lower prenatal testosterone and higher estrogen than M→M and natal males, respectively. There was no evidence for an effect of prenatal sex steroids on transgendered belief or transsexualism in F→M and FtM individuals.

An Evaluation of Differentially Spliced Genes as Markers of Sex for Forensic Entomology,.

Blow flies (Calliphoridae) are important medically and economically and are commonly used in forensics as temporal markers in death investigations. While phenotypic traits in adult flies can be sexually dimorphic, sex identification in immatures is difficult. Consequently, little is known about how sex may result in developmental disparities among sexes even though there are indications that they may be important in some instances. Since genetic mechanisms for sex are well studied in model flies and species of agricultural and medical importance, we exploit the sex-specifically spliced genes transformer (tra) and doublesex (dsx) in the sex determination pathway to optimize a sex identification assay for immatures. Using known primer sets for tra and with a novel one for dsx, we develop PCR assays for identifying sex in four forensically relevant Calliphoridae species: Lucilia sericata (Meigen), Lucilia cuprina (Wiedemann), Cochliomyia macellaria (Fabricius), and Chrysomya rufifacies (Macquart) and evaluated their performance. Band detection rates were found to range from 71 to 100%, call rates ranged from 90 to 100%, and no error was found when bands could be called. Such information is informative for purposes of testimony and in preparation for development studies. The developed assays will assist in further differentiating sexually dimorphic differences in development of the Calliphoridae and aid in more accurately estimating insect age when age predictive markers (size, development time, molecular expression) are sexually dimorphic.

Urethral complications after gender reassignment surgery: a systematic review

The aim of the present systematic review is to evaluate the impact of gender reassignment surgery on the development of urethral complication. A systematic search in accordance the Preferred Reporting Items for Systematic Review and Meta-Analyses statement for original articles published up until June 2019 was performed using the Pubmed, Scopus, Embase, and Web of Science databases. Pooled analyses were done when appropriate. The bibliographic search with the included terms (("Transsexualism"[Mesh])) AND ("Sex Reassignment Surgery"[Mesh]) produced a literature of 879 articles altogether. After removing papers of not interest or articles in which the outcomes could not be deduced, 32 studies were examined for a total of 3463 patients screened. Thirty-two studies met our inclusion criteria and were evaluated, and references were manually reviewed in order to include additional relevant studies in this review. Female-to-male (FtM) surgery and male-to-female (MtF) surgery was discussed in 23 and 10 studies, respectively. One study discussed both. Varying patterns of complications were observed in FtM and MtF surgeries, with increased complications in the former because of the larger size of the neourethra. Meatal stenosis is a particular concern in MtF surgery, with complication rates ranging from 4 to 40%, and usually require meatotomy for repair. Stricture and fistulization are frequently reported complications following FtM surgery. In studies reporting on fistulae involving the urethra, 19-54% of fistulae resolved spontaneously without further surgical intervention. High rates of complications are reported in the current literature, which should be understood by patients and practitioners alike. Shared decision making with patients regarding incidence and management of urethral complications including stricture disease and fistulae, particularly after FtM surgery, is critical for setting expectations and managing postoperative outcomes.

Life after sexual reassignment surgery: significance for gender and transsexuality

The Transsexualization Process is the main service directed to trans-specific health in Brazil, which provides services such as hormone therapy and sexual reassignment surgeries to the trans population. In this article, the significance surrounding the surgical procedure, the new genitalia, gender and transsexuality among women who underwent sexual reassignment surgery at the Cassiano Antônio de Moraes University Hospital (HUCAM), located in Vitória, Espírito Santo State, Brazil, was analyzed. Qualitative research was carried out, narrative interviews were recorded, and thematic content analysis was performed. The sample was composed of 9 participants selected by snowball sampling. The conclusion drawn is that the surgeries are related to the search for the humanization of bodies. The comprehension about being a woman was not limited to a biological status for gender. Transsexuality was presented as a transitional experience between genders. The sexual reassignment surgery was seen as a strategy of corporal correction in line with expectations about social relationships in gender by participants, the success of which is evaluated from the standpoint of beauty, pleasure and passability.