Journal abstracts J to Z inclusive.
Jessop N.
Occupational therapy with a male-to-female transsexual: a case study.
British Journal of Occupational Therapy. 56(9): 322-4, 1993 Sep.
A transsexuals performance in the chosen gender role can be seen in the context of functional performance of life skills, and should thus potentially be improved with appropriate occupational therapy. A detailed case study is used to illustrate the application of occupational therapy assessment and treatment with one such person, a young male-to-female transsexual in the very early stages of the lengthy pre-surgery assessment phase. (4 ref) |
Karim RB, Hage JJ, Mulder JW.
Neovaginoplasty in male transsexuals: review of surgical techniques and recommendations regarding eligibility.
Annals of Plastic surgery. 37(6); 669-675; Dec 1996.
The surgical aim of genital reassignment surgery in male-to-female transsexuals is to create a perineogenital complex as feminine in appearance and function as possible. In this paper, we present a review of the various methods to line the neovagina in male-to-female transsexuals. These methods may be classified in five categories involving, respectively, application of nongenital skin grafts, penile skin grafts, penile skin flaps, nongenital skin flaps, and pedicled intestinal transplants. Based on this review and our extensive personal experience, we come to certain recommendations regarding the eligibility of these methods. (60 ref) |
van Kesteren P, Lips P, Gooren LJ, Asscheman H, Megens J.
Long-term follow-up of bone mineral density and bone metabolism in transsexuals treated with cross-sex hormones.
Clinical Endocrinology. 48(3); 347-354; Mar 1998.
OBJECTIVE - It is unknown whether long-term cross-sex hormone treatment affects the human skeleton. We monitored bone mineral density and biochemical markers of bone turnover for 28-63 months in 20 male-to-female transsexuals (M-to-F) treated with anti-androgens and oestrogens, and 19 female-to-male transsexuals (F-to-M) treated with androgens. They underwent gonadectomy 13-35 months after the start of cross-sex hormone administration.
DESIGN - Bone mineral density (BMD) and the markers of bone turnover osteocalcin, alkaline phosphatase, fasting urinary calcium/creatinine and hydroxyproline/creatinine, were measured at baseline, after 1 year and after 28-63 months of cross-sex hormone administration.
RESULTS - In oestrogen-treated M-to-F, variables of bone turnover decreased significantly with consecutive measurements. BMD had increased significantly after 1 year, but decreased again to baseline levels after 28-63 months of cross-sex hormones. In F-to-M, alkaline phosphatase levels increased during the first year. BMD did not change during the first year but had decreased significantly after 28-63 months following ovariectomy. In both M-to-F and F-to-M, the change of BMD correlated inversely with serum LH and FSH levels. Of all biochemical variables LH levels appeared to be the best predictor of loss of BMD; in the long-term LH levels were more elevated in testosterone-treated F-to-M than in oestrogen-treated M-to-F transsexuals.
CONCLUSION - In M-to-F, oestrogen treatment prevented bone loss after testosterone deprivation. In F-to-M the testosterone dosage used, associated with a decline in serum oestradiol levels, was unable to maintain bone mass fully in all subjects in the longer term. The inverse relationship between BMD and serum LH levels suggests that the dose of hormone replacement has been too low in subjects with a decline in their BMD. Its cause might be underdosing or non-compliance in some patients. We propose that serum LH levels may be used as a measure of the adequacy of replacement with sex steroids. |
van Kesteren P, Asscheman H, Megens JA, Gooren LJ.
Mortality and morbidity in transsexual subjects treated with cross-sex hormones.
Clinical Endocrinology. 47(3); 337-342; Sep 1997.
OBJECTIVE - The optimum steroid hormone treatment regimes for transsexual subjects has not yet been established. We have investigated the mortality and morbidity figures in a large group of transsexual subjects receiving cross-sex hormone treatment.
DESIGN - A retrospective, descriptive study in a university teaching hospital.
SUBJECTS - Eight hundred and sixteen male-to-female (M-to-F) and 293 female-to-male (F-to-M) transsexuals.
INTERVENTIONS - Subjects had been treated with cross-sex hormones for a total of 10,152 patient-years.
OUTCOME MEASURES - Standardised mortality and incidence ratios were calculated from the general Dutch population (age and gender adjusted) and were also compared to side effects of cross-sex hormones in transsexuals reported in the literature.
RESULTS - In both the M-to-F and F-to-M transsexuals, total mortality was not higher than in the general population and, largely, the observed mortality could not be related to hormone treatment. Venous thromboembolism was the major complication in M-to-F transsexuals treated with oral oestrogens and anti-androgens, but fewer cases were observed since the introduction of transdermal oestradiol in the treatment of transsexuals over 40 years of age. No cases of breast carcinoma but one case of prostatic carcinoma were encountered in our population. No serious morbidity was observed which could be related to androgen treatment in the F-to-M transsexuals.
CONCLUSION - Mortality in male-to-female and female-to-male transsexuals is not increased during cross-sex hormone treatment. Transdermal oestradiol administration is recommended in male-to-female transsexuals, particularly in the population over 40 years of age in whom a high incidence of venous thromboembolism was observed with oral oestrogens. It seems that in view of the deep psychological needs of transsexuals to undergo sex reassignment our treatment schedule of cross-sex hormone administration is acceptably safe. |
Landen N, Walinder J, Hambert G, Lundstrom B.
Factors predictive of regret in sex reassignment.
Acta Psychiatracta Scandinavica. 97 (4); 248-289; Apr 1998.
The objective of this study was to evaluate the features and calculate the frequency of sex-reassigned subjects who had applied for reversal to their biological sex, and to compare these with non-regretful subjects. An inception cohort was retrospectively identified consisting of all subjects with gender identity disorder who were approved for sex reassignment in Sweden during the period 1972-1992. The period of time that elapsed between the application and this evaluation ranged from 4 to 24 years. The total cohort consisted of 218 subjects. The results showed that 3.8% of the patients who were sex reassigned during 1972-1992 regretted the measures taken. The cohort was subdivided according to the presence or absence of regret of sex reassignemnt, and the two groups were compared. The results of logistic regression analysis indicated that two factors predicted regret of sex reassignment, namely lack of support from the patient's family, and the patient belonging to the non-core group of transsexuals. In conclusion, the results show that the outcome of sex reassignment has improved over the years. However, the identified risk factors indicate the need for substantial efforts to support the families and close friends of candidates for sex reassignment. |
Landen M, Walinder J, Lundstrom B.
Prevalence, incidence and sex ratio of transsexualism.
Acta Psychiatracta Scandinavica. 93(4); 221-223; Apr 1996.
Frequency figures for transsexualism, concerning incidence, prevalence and sex ratio calculated in the 1960's and 1970's, were compared with recent reports. The incidence figures remained constant over time, whereas the prevalence figures tended to increase during the review period. The incidence was found to be of the same magnitude in men and women, while the corresponding ratio for prevalence figures was 3 : 1. It is suggested that men seeking sex reassignment represent a more heterogeneous group than women, and that the reported male predominance to date is due to a lack of categorical studies of primary/genuine transsexualism. It would appear that genuine transsexualism is, on the whole, insensitive to societal changes. The fundamental disturbance underlying this psychosexual disorder is suggested to be neurobiological in origin. (18 ref) |
Loue S.
Transsexualism in medicolegal limine: An examination and a proposal for change.
Journal of Psychiatry & Law. 24(1); 27-51; Spr 1996.
Considers transsexualism and the creation of a state of medicolegal limine for transsexuals. The article addresses transsexuality as it is currently defined annd explores the dichotomization of sex and gender. The author discusses both the social construction and the praxis of transsexuality, highlighting the medicolegal implications resulting from the current approach to transsexuality. The author argues that the creation of a medicolegal limine essentially prevents transsexuals from ever integrating fully as a member of one sex or gender, while simultaneously preventing the larger society from reconsidering its definitions of sex and gender. The article concludes with a summary of current challenges to the authors' model of transsexualism with suggestions for the resolution of this liminal medicolegal phase. |
McKain TL.
Acknowledging mixed-sex people.
Journal of Sex & Marital Therapy. Vol 22(4), 1996, 265-274.
This article calls attention to the importance of more carefully defining femaleness and maleness and more fully acknowledging the existence of mixed-sex people. Mixed-sex people are defined as people with at least one female and one male characteristic, where female or male characteristics are defined as characteristics that are possessed by no more than roughly half the population (the distribution criterion) and either play a clear role in reproduction (the reproduction criterion) or are very highly correlated across all cultures with characteristics that meet both the distribution and reproduction criteria (the correlation criterion). Among other recommendations, those who work in the field of human sexuality are urged, on the basis of these more careful definitions and on ethical grounds, to use the term sex-simplification rather than sex-change in describing surgical/hormonal treatments for transsexuals and to radically alter their use of the terms heterosexual and homosexual. |
McKeown M, McCusker B.
Unlocking the doors... transsexualism, special hospitals.
Nursing Times. 91(14): 38-9, 1995 Apr 5-11.
Nursing a male patient who decides he is really a woman presents particular challenges. When the patient is in a special hospital, there are additional obstacles. Mick McKeown and Brendan McCusker explain. (6 ref) |
Mason-Schrock D.
Transsexuals' narrative construction of the 'true self'.
Social Psychology Quarterly. 59; 3; 1996; 176-192.
The study of self-narratives thus far has sought to discern the internal structures of the stories people tell to give meaning to themselves. This approach, however, neglects the interactive processes through which self-narratives are constructed. By studying preoperative transsexuals, who are preparing for a radical identity change, one can observe the interactive processes through which stories are used to construct a new self. Based on participant observation in a transgender support group with 10 transsexuals (aged 31-47 years), in-depth interviews, and analysis of written materials, the present study shows how transsexuals collaborated, through modelling, guiding, selective affirming, and tactful blindness, to fashion biographical stories that defined into existence a differently gendered 'true self'. It also shows how dominant gender ideologies provided resources for fashioning plausible self-narratives. |
Midence K, Hargreaves I.
Psychosocial adjustment in male-to-female transsexuals: an overview of the research evidence.
Journal of Psychology. 131(6); 602-614, Nov 1997.
Transsexualism has been defined as an extreme gender dysphoria; it refers to unhappiness with one's biological sex and the desire to have the body of the opposite sex and to be regarded by others as a member of that other sex. Transsexualism is not a common condition, but its prevalence is not yet known. A large number of transsexuals receive hormonal treatment and sex reassignment surgery (SRS). In spite of years of poor quality research, due in part to methodological problems, recent research on surgical outcomes has provided important information. However, psychological research into transsexualism has ignored the cognitive style and psychological functioning of transsexuals, and very little effort has been made to incorporate research findings into the development of psychological treatments to improve the quality of life for transsexuals. (52 ref) |
Olsson SE, Jansson I, Moeller A.
Men as women: Experiences from five cases after administrative, hormonal, and surgical treatment.
Nordic Journal of Psychiatry. 50(5); 395-399; 1996.
Describes adjustments of five white biological men as women after administrative, hormonal, and surgical treatment for sex change, with emphasis on the psychologic course, and thereby provide a qualitative aspect to the treatment which traditional followup studies lack. Negative effects of the treatment comprised not only somatic, sexual, and social complications but also psychological difficulties such as indirect regret and suicidal thoughts. In light of the patients' postoperative life situations, sex change treatment appears almost counterproductive, since the definitive surgical treatment they underwent fixated the patients in a defensive position, which prevented the natural maturity and development of their own personality into a "true self". |
Parlee MB.
Situated knowledges of personal embodiment: Transgender activists' and psychological theorists' perspectives on 'sex' and 'gender'.
Theory & Psychology. 6(4); 625-645; Nov 1996.
Academic psychologists' treatment of 'sex' as an ahistorical, pretheoretical notion in theories of 'gender' is compared and constrasted with knowledge produced by persons whose own gendered embodiment is outside binary gender/sex categories and whose moral agency is erased by theories depicting them as exceptions to a binary-based scheme. This latter knowledge, emerging from an activist community's reflections on ideologies, has selectively incorporated, challenged and transformed gender/sex discourses in significant segments of medicine and academic disciplines other than psychology. Psychological theories continue to reproduce binary categories (and practices organised around them), in part because they incoporate only some of the implications of a social constructivist perspective, and in part because psychologists seem to theorise gender/sex in isolation from other knowledge-producing communities. |
Petersen ME, Dickey R.
Surgical sex reassignment: A comparative study of international centres.
Archives of Sexual Behaviour. 24(2); 135-156; Apr 1995.
Examined policies and criteria (P&Cs) currently used by European and North American gender identity clinics, using in part the Harry Benjamin International Gender Dysphoria Association's (HBIGDA) Standards of Care that set out minimum standards for the selection of patients for sex reassignment surgery. Of 19 clinics that responded to the survey, only 5 indicated that they adhere to the HBIGDA standards in their entirety. Most clinics had general P&Cs that exceed those of the HBIGDA standards. A relatively high degree of consistency exists between gender clinics in different countries regarding P&Cs for approving surgical sex reassignment for transsexual patients. Where differences occur, they tend to concern not the criteria themselves but rather how satisfaction of the criteria is actually monitored to ensure that patients are genuinely in compliance with the expectations of the treating clinic. The survey is appended. |
Sales J.
Children of a transsexual father: A successful intervention.
European Child & Adolescent Psychiatry. 4(2); 136-139; Apr 1995.
Following gender reassignment, transsexuals are often assessed in many different areas with regard to how they are functioning. However, there is little attention paid to the children they may have had prior to the operation and change in lifestyle. Children may present with problems related to the parents transsexualism, or with more generalised difficulties secondary to break-up of the family. A family of a transsexual father is described in which the children presented with difficulties and in which the intervention was successful. |
Schlatterer K, von Werder K, Stalla GK.
Multistep treatment concept of transsexual patients.
Experimental & Clinical Endocrinology & Diabetes. 104(6); 413-419, 1996.
Here we present a pragmatic multistep approach for the treatment of transsexual patients. The importance of an individually designed cross-gender hormone replacement therapy embedded in a multidisciplinary treatment concept, provided by psychiatrists, endocrinologists and surgeons, is demonstrated. Following this concept outcome of therapy has been improved in the last years. Over the last 5 years we have gained substantial experience in the cross-gender hormone treatment of transsexual patients. By continuous follow-up examinations and therapy adjustment the risk of side effects accompanying this therapy has been significantly minimised. This report is designed as a guideline to the clinical endocrinologist for the handling and treatment of transsexual patients. (63 ref) |
Sohn M, Bosinski H, Gouzoulis-Mayfrank E, Ebel H, van Saldern S, Loffler D, Jakse G.
Interdisciplinary concepts of surgical sex transformation in transsexual patients. [In German]
Urologe - Ausgabe A; 35(1); 26-34; Jan 1996.
From the introduction of the law on recognition of transsexuals (TSG) in 1980, over 1400 decisions were made by German regional district judges up to 1990. In over 90% of the cases the desired gender was accepted and attested officially. In the near future, a growing number of requests are to be expected. Generally, transsexual patients desire surgery to achieve a complete sex change. Since the foundation of an interdisciplinary gender dysphoria identity committee at our institution in 1989, we have developed criteria on indications, operative techniques and follow-up, which would over-tax a urology department, but which can be managed by an interdisciplinary team. Operative techniques may be regarded as well standardised in male-to-female transsexuals and may be performed by the urologist alone; in female-to-male transsexuals sex transformation remains a complex interdisciplinary challenge to urologists and plastic surgeons, mainly due to urethral complications. Continous psychiatric guidance and endocrinological monitoring of the patients facilitates indications for surgery and perioperative management. |
Swaab DF, Gofman MA.
Sexual differentiation of the human hypothalamus in relation to gender and sexual orientation.
Trends in Neurosciences. 18(6)(204); 264-270; Jun 1995.
Indicates that sex differences in the structures of the human hypothalamus and adjacent brain structures have been observed that seem to be related to gender, to gender problems such as transsexuality, and to sexual orientation (heterosexuality and homosexuality). Although these observations have yet to be confirmed, and their exact functional implications are not clear, they open up a whole new field of physiological structural/functional relationships in human brain research that has so far focused mainly on such relationships in pathology. Since the period of overt sexual differentiation of the human hypothalamus occurs between 4 years of age and puberty, this offers the possibility of interaction of a multitude of postnatal factors that act on sexual differentiation of the brain, not only of a genetic or hormonal, but also of a chemical and psychosocial nature. | | |
