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PubMed1979

The aging gender dysphoria (transsexual) patient.

Ten aging gender dysphoria patients (eight men and two women, average age 52 years) were the subjects of this study. All had presented to the Gender Identity Clinic at Case Western Reserve University requesting sex-reassignment surgery. A psychiatric-psychological profile of the patients, their sexual functioning, problems with aging, diagnostic issues, and follow-up are discussed. The aging gender dysphoric patient presents in acute crisis, that is, exhibiting marked depression, increased suicidal ideation and behavior, and urgent perception of time. Diagnostic and treatment recommendations for aging gender dysphoria patients and their depressions are provided. Furthermore, guidelines are suggested for differentiating the aging transvestite with transsexual symptoms and the aging transsexual for whom sex-reassignment surgery may be indicated. Specific treatment strategies for an aging population, including sexual surgery, are also discussed.

Aging↗
PubMed1977

The Southeast Asian interpretation of gender dysphoria: an illustrative case report.

In the West gender dysphoria is commonly attributed to a biological abnormality, parental influences favoring assumption of a gender opposite to the subject's anatomical sex, or a combination of these factors. In Southeast Asia (among Hindus and Buddhists), numerous cases of gender dysphoria occur. They generally receive less attention than they do in the West and evoke relatively little concern on the part of the persons affected and the members of their families. The condition is attribwted to residues of a previous life as a member of the opposite sex. Some persons with gender identity confusion claim to remember details of previous lives. A case illustrating such claims (without verifiable details) is presented.

Adjustment Disorders↗
PubMed1976

Sex conversion surgery in a man with severe gender dysphoria. A tragic outcome.

Although hundreds of "sex transformation" operations have been performed, little is known about the long-term postoperative adjustment. Available outcome data suggest that sex reassignment surgery in male patients is followed by a better social as well as inner adjustment in the vast majority, at least for the first several years after surgery. Surprisingly, only a handful of cases with poor outcomes have been reported. This report concerns a 53-year-old biological male with a life-long gender dysphoria who, although subjectively pleased with the surgery, developed a paranoid psychosis five years after sex conversion surgery.

Gender Identity↗
PubMed1979

Psychotherapy of an aging transvestite.

Proper categorization of individuals with gender dysphoria allows rational psychotherapy. The treatment of an aging transvestite who requested sexual reassignment is presented to demonstrate the clinical features of the disorder and the course of the illness. The initial task was to place the patient into the proper clinical category of individuals with gender dysphorias. The clinical details of this disorder include an episoidic course with individuals who have previously had clear masculine identities. In the past they have been labeled secondary or marginal transsexuals as well as fetishtic cross-dressers. The patient, who had a long-standing history of cross-dressing, reacted to specific life stresses by the symptomatic wish for sexual reassignment. The individual psychotherapy consisted of phases of symptomatic expression, emerging depression, interpersonal awareness, symptom resolution and disavowel of the wish for sexual reassignment. The genesis of this perversion appears to be identification with a phallic maternal figure. Discussion of the descriptive and dynamic literature is reported in relation to the reported case. Identification of important losses in this patient's recent life allowed proper diagnosis and appropriate ongoing therapy to prevent the patient from irreversible surgery for a condition that was a symptom not an ingrained belief of gender dysphoria.

Adult↗
PubMed2026

Quality of life and gender identity in females with congenital adrenal hyperplasia after genital restoration surgery: A single-center experience.

BACKGROUND: Legislation restricting surgical interventions in children with differences of sex development (DSD) has intensified debate about female genital restoration surgery (FGRS) in patients with congenital adrenal hyperplasia (CAH). Long-term patient-reported outcomes are needed regarding the optimal timing of surgery. OBJECTIVE: We aimed to assess health-related quality of life (HRQoL), gender identity, and family satisfaction regarding surgical timing and outcome in females with CAH following genital restoration surgery. STUDY DESIGN: Cross-sectional survey of CAH patients who underwent surgery between January 2007 to December 2016 at our institution. Validated instruments (KINDL questionnaire for HRQoL, Utrecht Gender Dysphoria Scale, UGDS) and structured telephone interviews were employed. RESULTS: Data on HRQoL was available for 25 patients (self- and/or parent-reported) out of 56 eligible patients (45% response rate). Median age at first surgery was 6 months (range: 3-137 months). Patients' age at time of participation ranged from 2 to 28 years. All had 21-hydroxylase deficiency (92% salt-wasting form) with Prader grades ranging from II-V. Wound dehiscence requiring secondary suturing occurred in 15% of patients with primary surgery at our center, while only one (4%) patient developed vaginal stenosis after early primary vaginoplasty. Two additional patients (8%) with prior outside surgery required vaginal revision after FGRS at age 12. HRQoL scores were comparable to healthy reference populations across most age groups. Children aged 3-6 and adolescents and young adults showed no significant difference from reference values, while children aged 7-13 showed a slight elevation. None of five patients &#x2265;14 years demonstrated gender dysphoria (all UGDS scores <40, threshold &#x2265;40). 14 patients and families were also interviewed by telephone. All preferred early surgical timing. No family expressed regret about the decision or preferred delayed surgery. DISCUSSION: This study provides validated intermediate-term patient- and parent-reported outcomes after FGRS in CAH. Key limitations include the small sample size, single-center design, and young age of most patients. Selection bias may exist, though participating families included those who underwent revision surgery. The absence of a non-operated comparison group reflects current clinical reality, as nearly all CAH patients with urogenital sinus underwent surgical correction. CONCLUSIONS: Females with CAH reported normal HRQoL and a comfortable female gender identity after early FGRS. The patients and their families expressed a preference for early surgery. However, there is need for longer-term follow-up to assess sexual function and reproductive outcomes as well comparison of outcomes with a non-operated group.

Humans↗
PubMed1978

[Psychological treatment of transsexualism and sexual identity disorders some recent attempts].

Psychological treatments of transsexualism and sex gender Dysphoria syndroms. Recent data. There are generally two types of patients requesting sex change operations: one type is the classical but rare transsexual, the others belong to the larger more vague group of sex gender Dysphoria. These syndroms have been felt to be unresponsive to psychotherapy. We review here some recent attempts of psychological treatments which claim to improve satisfaction with biological sex gender identity and result in renonciation of the request of sex reassignment surgery (S.R.S.). These psychotherapies use various methods: Behavior therapy, psychoanalytically-oriented psychotherapy, religious exorcism and conversion. The reports reviewed suggest that sex gender identity may be more malleable than previously thought in transsexual syndrom, at least in relatively youthful subjects. Cases of recent onset of the syndrom which result from a crisis cases underline the necessity for careful evaluation and attempted psychological treatment before undertaking irreversible surgical procedures.

Adolescent↗
PubMed1978

[Transsexualism].

According to the literature, the transsexual phenomenon can be assessed as a distinct psychiatric illness. Transsexualism, a rare but spectacular disorder, realizes a gender identity reversal raising questions regarding systems of psychiatric diagnosis, nosology and treatment. A better clinical knowledge of this "experiment" and its follow-up allow studying processes contributory to marked deviation of gender identity and furthering concepts of development of masculinity and feminity. Current research deals with hypotheses that can be stated as testable propositions about underlying dynamics in various fields: learning factors, psychoanalytic components and psycho-biological data. Focusing on the early infantile development and the environmental influences reflects a variety of non specific psychogenetic precursors. The treatment of "gender dysphoria syndrom", i.e. hormonal treatment, sex-reassignment surgery and psychotherapic processes, aims towards réduction of psychic pain and social adjustment in the cross-gender role. Transsexual phenomenon largely overlaps the psychopathological area; beyond surgical and medical aspects, social implications and legal positions refer to an ethical problem.

Adult↗
PubMed1978

A psychological profile of the transsexual. I. The male.

The present research introduced standardized psychological measurement into the clinical assessment of the male transsexual. Thirty-one males with a presenting complaint of gender dysphoria were carefully screened as to their correspondence with current nosological conceptions of transsexualism, and administered the Derogatis Sexual Functioning Inventory (DSFI) as part of their clinical psychometric work-up. The DSFI is an omnibus self-report scale providing measurement in the primary domains of sexual information, sexual experiences, sexual drive, sexual attitudes, psychological symptoms, affects, gender role definition, and sexual fantasy. Transsexual profiles were contrasted with those of a comparison group of 57 normal heterosexual males. Results of the comparisons revealed the transsexuals to show a significant decrement in accurate sexual information, and a marked reduction in the variety of sexual experiences they have been involved in. They also revealed a reduction in drive levels; however, this was qualified by which indicator of drive was used. Significant elevations in psychological symptoms and dysphoric affect were also noted, particularly of a depressive nature. Gender role definitions were markedly polarized in the feminine direction for male transsexuals, and their fantasy endorsements revealed some of the classic transsexual themes. The ability to develop this quantified and standardized psychological profile is viewed as an important step in accurately assessing the nature of these complex individuals, and developing a more accurate understanding of their condition.

Adult↗
PubMed1977

The transsexual client: a discussion of transsexualism and issues in psychotherapy.

Transsexuals, as a client group, are increasingly coming to the attention of mental health professionals. This paper offers a general discussion of gender dysphoria and sex-reassignment, including an examination of their psychosocial aspects. The role of psychotherapy in relation to this client group is explored, and reactions of the therapist to the transsexual are considered.

Attitude of Health Personnel↗
PubMed1976

A typology of transsexualism: gender identity theory and data.

An analysis of postoperative data obtained from 42 male-to-female transsexuals showed them to fall into three distinct categories: homosexual transsexuals, asexual transsexuals, and heterosexual transsexuals. Additonal data covering the areas of gender vs. sexual dysphoria, surgical details, background characteristics, sexuality-related behaviors, and postoperative adaptation further differentiated these groups and suggest that the categorization is theoretically meaningful and relevant to understanding the causes and course of the transsexual phenomenon. An extensive developmental theory is suggested to account for both differences and commonalities among the different subgroups of transsexuals, as well as among these and related groups, such as effeminate homosexuality and transvestism. The theory is sufficiently specific for making empirical predictions.

Gender Identity↗