Journal abstracts A to I inclusive.
Alderman C.
Fighting for acceptability... transsexualism.
Nursing Standard. 10(46): 22-3, 1996 Aug 7.
Fran Springfield is a passionate believer in the rights of transsexuals. She talked to Charlotte Alderman about her work and the discrimination still faced by this client group. |
Becker D, Mester R.
Further insights into transsexualism
Psychopathology. 29(1); 1-6; 1996.
Transsexualism is a challenging entity posing diagnostical, etiological, ethical and moral questions with no general consensus of opinion and a controversial management policy. The present article tries to deal with these questions by drawing a parallel with another psychiatric syndrome in which there is also a disturbance in body image, namely anorexia nervosa. The parallel is at the level of clinical presentation, psychodynamic etiology and their common socioepidemic dimension. (17 ref) |
Beemer BR.
Gender dysphoria update.
Journal of Psychosocial Nursing & Mental Health Services. 34(4): 12-9, 35-6, 1996 Apr.
Concepts of sexuality and gender identity are undergoing re-examination in society. Recent media attention has intensified interest in the area, although reliable information is sometimes lacking. Gender dysphoria, and its extreme form, transsexualism, frequently brings sufferers into contact with psychiatric, social, and mental health professionals, and surgical caregivers. Treatment of these patients often represents a challenge on many levels. Some guidelines for this care are outlined. (14 ref) |
Bodlund O, Kullgren G.
Transsexualism - general outcome and prognostic factors: a five-year follow-up study of ninteen transsexuals in the process of changing sex.
Archives of Sexual Behaviour. 25(3); 303-315; Jun 1996.
Nineteen transsexuals, approved for sex reassignment, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behaviour), and DMT (Defence Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n=13) had improved in at least two areas of functioning. In 3 cases (16%) outcome was judged as unsatisfctory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome. |
Breton J, Cordier B.
Psychiatric aspects of transsexualism. [In French].
Bulletin de l'Academie Nationale de Medecine. 180(6); 1389-1394; Jun-Jul 1996.
Transsexualism is a mental disease in which gender identity goes contrary to corporal reality. Diagnosis is purely clinical and needs a prolonged observation. The actual experience concerning about 700 cases allow us to consider that one quarter should get sexual conversion. |
Ceccarelli P.
Transsexualism, sex and gender.
International Forum of Psychoanalysis. 6(2); 141-146; Jul 1997.
How does the body into which a baby is born become a sexual body? Do the anatomical characteristics of masculine or feminine constitute a guarantee for a subject to say that he/she is a man or a woman? The passage from identifications to identity is a most complex one. To try to clarify this process the author starts by making some reflections on the notion of identity itself from the psychoanalytical point of view. This leads to a central question which is to know if one is born a boy or a girl, or if one becomes one. Working with the fundamental concept of primary identification and the distinction of sex and gender, the author shows, through a clinical vignette, that anatomy is no assurance for a construction of a feeling of gender identity according to anatomical sex. |
Cohen H, Forget H.
Auditory cerebral lateralization following cross-gender hormone therapy.
Cortex. 31(3):565-73, 1995 Sep.
In this study, 10 men, 10 women, and 13 genetic male transsexuals, all of them right-handed, were tested on two verbal (CV and nonsense polysyllables) and two nonverbal (melodies and triple tone [3T]) dichotic tasks to investigate relations between hormone therapy and auditory cerebral specialization for speech and non speech stimuli in adults. At time of testing, all transsexuals had been under hormonal treatment for at least one year and eight had had corrective surgery. ANOVA results showed a right ear advantage and similar pattern of performance for the three groups in the treatment of speech. In nonverbal tasks, interactions revealed a left ear advantage in the processing of melodies and 3T for men only; women and transsexuals exhibited similar performance in both nonverbal tasks. In accord with generalization from the animal literature, cautious interpretation of the data is some possible hormonal involvement, in adults, in the modulation of right hemispheric cognitive processing. (48 ref) |
Cole CM, O'Boyle M, Emory LE, Meyer WJ.
Comorbidity of gender dysphoria and other major psychiatric diagnoses.
Archives of Sexual Behaviour. Vol 26(1), Feb 1997, 13-26.
Examined retrospectively via an interview and a questionnaire the comorbidity between gender dysphoria (GD) and major psychopathology (PP). The charts of 318 males (mean age 32 years) and 117 females (mean age 30 years) with self-reported GD were evaluated. It was found that over two-thirds were undergoing hormone reassignment, suggesting a committment to the real-life cross-gender process. 28% reported having substance abuse problems before treatment but less than 15% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. A subgroup of 137 Ss who completed the MMPI showed profiles that were notably free of PP. Significant differences were observed only in the Mf scale, and this held true only for the male-female group. Psychological profiles as measured by the MMPI were more 'normal' in the desired sex than the anatomic sex. These support the view that GD is usually an isolated diagnosis and not part of any general PP. |
Colucciello ML.
Unveiling the mystique of gender dysphoria syndrome.
Nursing Forum. 31(2): 15-22, 1996 Apr-Jun.
There are common myths surrounding the condition of gender dysphoria and individuals seeking therapy. The diagnosis of gender dysphoria syndrome is applied to individuals who feel ill at ease with their biological body and either seek hormonal reassignment therapy or hormonal therapy and sex reassignment surgery. The author discusses standards of care, diagnostic criteria, physiological and psychological changes incurred through hormonal therapy are introduced as well as surgical techniques. By assisting individuals with gender dysphoria syndrome to enhance the integration of their new gender role into their self-identity, nurses are in an excellent position to facilitate improvements in their overall health status as well. (20 ref) |
Emerson S, Rosenfeld C.
Stages of adjustment in family members of transgender individuals.
Journal of Family Psychotherapy. Vol 7(3), 1996, 1-12.
While the clinical literature contains descriptions of the families and partners of transgender individuals, a description of the family members' processes of adjustment to a relative's transgender identity has not previously appeared in the family therapy literature. Family members experience different processes from the transgender individual. This article discusses stages that family members may experience and is directed towards therapists who work with any member of the family, as well as toward transgender individuals who may need to understand their families' experience. |
Futterweit W.
Endocrine therapy of transsexualism and potential complications of long-term treatment.
Archives of Sexual Behaviour. 27; 2; 1998; 209-26.
Physiological principles of the interrelationship of sex hormones and their regulation are the foundation of understanding appropriate treatment of the trassexual patient. While both genetic males and females have oestrogens and androgens, the quantative sex hormone production is genetically predetermined by sex hormone production both in the gonads and via peripheral conversion of hormone precursors to sex steroids. Sex hormones exert a negative feedback on the hypothalamus and pituitary gland whereby gonadotropin-releasing hormone (GnRH), pituitary luteinizing (LH) and follicle-stimulating hormone (FSH) are regulated or suppressed by the endogenous levels of these hormones. Sex hormonal therapy induces attentuated GnRH stimulation of LH and FSH causing a reduction of serum sex hormone levels. It is clear that oestrogen as well as androgen therapy have a dual role:- induction of feminisation or virilisation and
- suppression of the hypothalamic-pituitary-gonadal axis leading to a reduction of endogenous oestradiol or testosterone secretion.
Cross-sex hormonal therapy may have substantial medical side-effects. The smallest dosage of hormonal therapy compatible with the above clinical aims should be used. (67 refs.) |
Giordano G, Giusti M.
Hormones and psychosexual differentiation.
Minerva Endocrinologica. 20(3); 165-193; Sep 1995.
The male phenotype arises from the optimal concordance of chromosomal, gonadal and hormonal sex. Hormonal sex depends directly on the type of gonads that have been formed, and is linked both to the production of hormones and to their optimal effect on target tissues. The present review underlines the fact that psychosexual orientation in the male is also related to factors linked to sex hormones. Many of the experimental and clinical data available militate against the long-held belief that the development of role and gender identity in man is predominantly determined by environmental factors. This study points out the importance of hormonal factors at the CNS level. The most common abnormalities of sexual orientation are homosexuality and transsexualism. Despite their relatively high frequency in the general population, research into possible biological influences in these abnormalities is very scant. The authors of the present paper have reviewed the literature data yielded by biological and hormonal studies on homosexuality and transsexualism. These data seem to support the hypothesis that androgens may be deficient in the CNS of male homosexuals. Morphological or functional (neurotransmitter) anomalies in androgen actions at the CNS level could also favour radical dissociation between psychological sex and gonadal, hormonal and phenotypic sex in transsexualism. In conclusion, the present review seems to indicate that hormonal factors (gonadal and adrenal hormones, hormone receptors, transduction mechanism of the hormonal signal, neurosteroids, neurotransmitters etc.) play a determining role in the formation of gender identity. (228 ref). |
van Goozen SHM, Cohen-Kettenis PT, Gooren LJG, Frijda NH, et al.
Gender differences in behaviour: Activating effects of cross-sex hormones.
Psychoneuroendocrinology. 20(4); 343-363; 1995.
Examined the effects of cross-sex hormone therapy on gender behaviour differences. Tests on aggression, sexual motivation, and cognitive functioning were administered to 35 female-to-male transsexuals and 15 male-to-female transsexuals (all subjects aged 20-45 years) shortly before and 3 months after the start of cross-sex hormone treatment in a Dutch hospital. The administration of androgens to females was clearly associated with an increase in aggression proneness, sexual arousability, and spatial ability, but it had a deteriorating effect on verbal fluency tasks. Upon androgen deprivation in the male-to-female group, anger and aggression proneness, sexual arousability, and visuospatial ability decreased, whereas verbal fluency improved. Results suggest that cross-sex hormones directly and quickly affect gender-specific behaviours. |
Green R.
Transsexualism and the law.
Bulletin of the American Academy of Psychiatry & the Law. 22(4): 511-517, 1994.
Transsexuals pose dilemmas for the law in terms of defining a male or female; deciding what partners are legally acceptable for marriage; assessing the best interests of children after divorce; interpreting employment discrimination based on gender or handicap; and permitting public cross-dressing. Other dilemmas are reviewing 3rd-party reimbursement for medical procedures that may be deemed cosmetic or experimental; determining elegibility for sports competition; meeting military needs; and determining socially and medically acceptable treatment in prison. Leading law cases are reviewed in each area, with commentary on research findings. |
Green R, Fleming DT.
Transsexual surgery follow-up: Status in the 1990's.
Annual Review of Sex Research. Vol 1, 1990, 163-174.
Reviews follow-up literature from 1979-2989 on both male-to-female and female-to-male postoperative transsexuals. Preoperative factors indicating a favourable outcome included the following: reasonable degree of mental and emotional stability shown in life history with no psychosis, successful adaptation in the desired role for at least 1 year, with convincing physical appearance and behaviour, sufficient understanding of the limitations and consequences of surgery; and preoperative application of psychotherapy. Surgical adequacy was found to be a major factor in favourable outcome. The lack of reported standardized selection criteria for surgery and the infrequent use of standardized outcome instruments and rating criteria make follow-up conclusions difficult. It is suggested that follow-up measures be improved by incorporating more detailed autobiographical accounts. |
Guenzburger D.
Acoustic and perceptual implications of the transsexual voice.
Archives of Sexual Behaviour. 24(3); 339-348; Jun 1995.
Conducted two experiments concerning voice characteristics of male-to-female transsexuals. In a speech production experiment (Experiment 1), isolated words and longer utterances of six adult transsexual speakers were realized in a male and female mode. Speech samples were compared intraindividually, and the number of acoustic parameters was analyzed. Subjects appeared to realise vocal charcteristics that added to a feminine voice quality in the female speaking mode. In a perceptual task (Experiment 2), 25 male and 25 female versions of speech samples were presented pairwise to listeners (who did not know subjects were transsexuals). Listeners usually identified the intended speaker sex mode, thus corroborating the acoustic findings. Results suggest that - speech therapists should try to enhance feminine voice characteristics to further develop their effectiveness, and
- speech and voice therapy should be included in rehabilitation of transsexuals.
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Hage JJ, Karim RB.
Abdominoplastic secondary full-thickness skin graft vaginoplasty for male-to-female trannsexuals.
Plastic & Reconstructive Surgery. 101(6); 1512-1515; May 1998.
When inversion of combined penile and scrotal skin flaps for vaginoplasty in male-to-female transsexuals has become impossible or has not led to functional results, alternative vaginoplast techniques should be considered. Colocolpopoiesis involves major surgery and often leads to disappointing long-term results. An Abbe-McIndoe vaginoplasty applying split-thickness skin grafts often does not provide favourable results in the scarred area encountered after complications of skin flap inversion surgery. Because thicker skin grafts show less tendency to shrink, the use of a full-thickness skin graft has been advocated for vaginoplasty in females. In this paper, we present our technique of successful secondary vaginoplasty applying full-thickness skin grafts in six male-to-female transsexuals. In patients with sufficient groin and abdominal skin to spare, a miniabdominoplasty allows for acceptable donor site scarring with correction of the abdominal skin surplus. In flat-tummied patients, the conventional abdominoplasty will allow for sufficient skin to be harvested to ensure successful secondary vaginoplasty. Abdominoplastic vaginoplasty has been proven to provide a good alternative whenever a laparotomy is not favoured or is contraindicated in secondary cases. |
Hunt S, Main TL.
Sexual orientation confusion among spouses of transvestites and transsexuals following disclosure of spouse's gender dysphoria.
Journal of Psychology & Human Sexuality. 9(2); 39-51; 1997.
Conducted a phenomenological study of 4 women (2 wives of transvestites and 2 wives of transsexuals) to explore the event, if any, of sexual orientation confusion experienced by the nontranssexual spouse. Subjects (aged 35, 48, 36, and 38 years) were asked 40 open-ended questions in an interview with the experimenters. Sexual orientation confusion was operationally defined as the subject questioning her heterosexuality and evidenced by statements found within the text of the interview and identified as such by indepedent readers of the text. The hypothesis that sexual orientation confusion in the wives followed disclosure of the husband's cross-gendered behaviour was confirmed among wives of the transvestites. However, this was not true of the wives of the transsexuals. |
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