Kaete Walker

* Trans Presentation Oct 2009

An evening presentation Kaete gave, held at the Gallpoli Club, Hamilton, NSW, Australia, during Rainbow Festival Week, 2009.

Click here to download notes from the presentation, in Word Doc format, and entitled: ‘Trans latest research and discussion’

‘Transsexualism – latest research and discussion’. The presentation was entitled ‘Transsexualism – latest research and opinion’

That which follows, are the references and abstracts given at the presentation

  • Bailey, J. M and Triea, K. ( 2007) What Many Transgender Activists Don’t Want You to Know: and why you should know it anyway. Perspectives in Biology and Medicine. Volume 50, Number 4, Autumn 2007, pp. 521-534
  • Baltieri DA, De Andrade AG (2009). Schizophrenia modifying the expression of gender identity disorder. Journal of Sexual Medicine. 6(4):1185-8, 2009 Apr.
  • Bess, JA and Stabb, SD. The experiences of transgendered persons in psychotherapy: voices and recommendations.Journal of Mental Health Counseling. 31.3 (July 2009): p264(19).
  • Bockting, Walter(2009)’Are Gender Identity Disorders Mental Disorders? Recommendations for Revision of the World Professional Association for Transgender Health’s Standards of Care’,International Journal of Transgenderism,11:1,53 — 62
  • Coleman, Eli(2009)’Toward Version 7 of the World Professional Association  for Transgender Health’s Standards of Care: Psychological Assessment and Approaches to Treatment’,International Journal of Transgenderism,11:2,69 —73 URL: http://dx.doi.org/10.1080/15532730903008008
  • Davis E. (2009), Situating “Fluidity”: (Trans) Gender Identification and the Regulation of Gender Diversity GLQ: A Journal of Lesbian and Gay Studies – Volume 15, Number 1, 2009, pp. 97-130
  • Garcia-Falgueras, A and Swaab, D.F (2008) A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 131, 3132-3146
  • Heath, RA.  (2006) The Praeger Handbook of Transsexuality: Changing Gender to Match Mindset. Praeger Books.

·       Kersting A, Reutemann M, Gast U, Ohrmann P, Suslow T, Michael N, Arolt V. Dissociative disorders and traumatic childhood experiences in transsexuals. J Nerv Ment Dis. 2003 Mar;191(3):182-9.

  • Lawrence AA. Becoming what we love: autogynephilic transsexualism conceptualized as an expression of romantic love. Source Perspectives in Biology & Medicine. 50(4):506-20, 2007.
  • Luders E, Sanchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E (2009| Regional gray matter variation in male-to-female transsexualism. Neuroimage. 46(4):904-7, 2009 Jul 15.
  • Manners, P. J. ( 2008) Gender Identity in Adolescence: A Review of the Literature. Child and Adolescent Mental Health. Vol14, No2, 2009, pp 62-68.
  • Matte, Nicholas, Devor, Aaron H. and Vladicka, Theresa(2009)’Nomenclature in the World Professional Association or Transgender Health’s Standards of Care: Background and Recommendations’,International Journal of Transgenderism,11:1,42 — 52
  • Morgan, S.W. and Stevens, P.E. (2008) Transgender Identity Development as Represented by a Group of Female-to-Male Transgendered Adults. Issues in Mental Health Nursing. 29 (6), 585-99.
  • Parkes, G., Hall, I., & Wilson, D. (2009). Cross dressing and gender dysphoria in  people with learning disabilities: a descriptive study. British Journal of Learning Disabilities, 37, 151-156.
  • Persson, D (2009) Unique Challenges of Transgender Aging: Implications From the Literature. Journal of Gerontological Social Work  1540-4048, Volume 52 Issue 6, 2009, Pages 633 – 646
  • Rands, KE. (2009) Considering Transgender People in Education: A Gender-Complex Approach. Journal of Teacher Education, Sep 2009; vol. 60: pp. 419 – 431.
  • Reis, E. (2004). Teaching Transgender History, Identity and Politics. Radical History Review.
  • Wallien. M, and Cohen-Kettenis, P. (2008) Psychosexual Outcome of Gender Dysphoric Children. Acad. Child Adolesc. Psychiatry, 47:12.
  • Wilson R, Spiers A, Ewan J, Johnson P, Jenkins C, Carr S ( 2009) Effects of high dose oestrogen therapy on circulating inflammatory markers. Maturitas. 62(3):281-6, 2009 Mar 20.
  • Zucker, Kenneth J. and Lawrence, Anne A.(2009)’Epidemiology of Gender Identity Disorder: Recommendations for the Standards of Care of the World Professional Association for Transgender Health’,International Journal of Transgenderism,11:1,8-18


Abstracts

Ault, A and Brzuzy, S (2009). Removing gender identity disorder from the Diagnostic and Statistical Manual of Mental Disorders: a call for action Social Work, April, 2009

In 2012, the American Psychiatric Association

(APA) plans to release the next edition of

the Diagnostic and Statistical Manual of Mental

Disorders (DSM-V). In July 2007, APA named a

27-member task force to oversee development

of the new edition, which will constitute the first

major revision of the document’s diagnostic categories

since 1994. Gender identity disorder (GID)

is probably the most widely contested diagnosis in

the current DSM; APA’s revision process provides

social workers with the opportunity to weigh in

on the debate about GID, and it is imperative that

we do so. This diagnosis, which is used to justify

“treatment” for gender-nonconforming children

and for adults seeking sex-change surgery, has

implications worldwide, given the influence ofthe

DSM on other diagnostic tools, such as the World

Health Organization s International Statistical Classification

of Diseases and Related Health Problems (2007).

Social workers should support the elimination of

GID from the DSM now, as we supported the declassification

of homosexuality as a mental illness

in the 1970s. Similar to the depathologization of

homosexuality, removing GID from the DSM will

have wide-ranging and liberatory effects for gendernonconforming

people currently labeled “gender

disordered” and for standards of gender expression

for the general population.

Bailey, J. M and Triea, K. ( 2007) What Many Transgender Activists Don’t Want You to Know: and why you should know it anyway. Perspectives in Biology and Medicine. Volume 50, Number 4, Autumn 2007, pp. 521-534

“Currently the predominant cultural understanding of male-to-female transsexualism is that all male-to-female (MtF) transsexuals are, essentially, women trapped in men’s bodies. This understanding has little scientific basis, however, and is inconsistent with clinical observations. Ray Blanchard has shown that there are two distinct subtypes of MtF transsexuals. Members of one subtype, homosexual transsexuals, are best understood as a type of homosexual male. The other subtype, autogynephilic transsexuals, are motivated by the erotic desire to become women. The persistence of the predominant cultural understanding, while explicable, is damaging to science and to many transsexuals.”

Baba T, Endo T, Honnma H, Kitajima Y, Hayashi T, Ikeda H, Masumori N, Kamiya H, Moriwaka O, Saito T. Association between polycystic ovary syndrome and female-to-male transsexuality. Hum Reprod. 2007 Apr;22(4):1011-6. (Full text: http://humrep.oxfordjournals.org/cgi/content/full/22/4/1011 Accessed October 2009)
ABSTRACT
The aim of this study is to understand the relationship between polycystic ovary syndrome (PCOS), altered hormonal characteristics and insulin resistance in female-to-male (FTM) transsexual patients. METHODS: We studied 69 Japanese FTM cases, aged 17-47 years, who were seen in the Gender Identity Disorder Clinic of Sapporo Medical University Hospital between December 2003 and May 2006. The subjects had never received hormonal treatment or sex re-assignment surgery. Prior to treatment, they received physical examinations entailing measurement of anthropometric, metabolic and endocrine parameters, after which we compared the values obtained according to the presence or absence of PCOS and/or obesity. Insulin resistance was determined using the homeostasis model assessment of insulin resistance (HOMA-IR). RESULTS: Of the 69 participating FTM cases, 40 (58.0%) were found to have PCOS. Of the 49 for whom HOMA-IR was calculated, 15 (30.6%) also showed insulin resistance, whereas of the 59 for whom adiponectin was measured, 18 (30.5%) showed hypoadiponectinaemia. Of 69 for whom androgens were measured, 29 (39.1%) showed hyperandrogenaemia. Insulin resistance was associated with obesity but not with PCOS. In contrast, hyperandrogenaemia was associated with both PCOS and obesity. CONCLUSION: FTM transsexual patients have a high prevalence of PCOS and hyperandrogenaemia.

Baltieri DA, De Andrade AG. Schizophrenia modifying the expression of gender identity disorder. Journal of Sexual Medicine. 6(4):1185-8, 2009 Apr.

Abstract: According to the Brazilian Federal Medical Association, transsexualism is recognized as a gender identity disorder if a long-term diagnostic therapeutic process has demonstrated that the transposition of gender roles is irreversible, and if only hormonal and surgical procedures are appropriate to relieve the stress associated with the gender identity. Although such treatment will only be initiated with caution and after a long phase of intense diagnostic screening, the differentiation between pure identity disorders and transsexual feelings secondary to an ongoing psychopathologic process, such as schizophrenia, can be arduous for many health professionals. AIM: To report a case of a female patient with schizophrenia and transsexualism and the risks of a potential diagnostic confusion. METHOD: A 19-year-old black woman, with an 8-year history of undifferentiated schizophrenia and intense gender dysphoria, was referred for sex reassignment surgery evaluation in the Ambulatory for the Treatment of Sexual Disorders of the ABC Medical School. RESULT: After a more adequate antipsychotic treatment, her masculine behavior has persisted, but her desire to change her own genital organs has decreased. CONCLUSION: A better acceptance of the multiplicity of possible genders should neither contribute to inadequate interpretations of the signs and symptoms of our patients nor facilitate dangerous clinical or surgical recommendations.

Berglund, Lindström, Dhejne-Helmy, and Savic
Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids. Cereb Cortex, August 2008; 18: 1900 – 1908.

Abstract: One working hypothesis behind transsexuality is that the normalsex differentiation of certain hypothalamic networks is altered.We tested this hypothesis by investigating the pattern of cerebralactivation in 12 nonhomosexual male-to-female transsexuals (MFTRs)when smelling 4,16-androstadien-3-one (AND) and estra-1,3,5(10),16-tetraen-3-ol(EST). These steroids are reported to activate the hypothalamicnetworks in a sex-differentiated way. Like in female controlsthe hypothalamus in MFTRs activated with AND, whereas smellingof EST engaged the amygdala and piriform cortex. Male controls,on the other hand, activated the hypothalamus with EST. However,when restricting the volume of interest to the hypothalamusactivation was detected in MFTR also with EST, and explorativeconjunctional analysis revealed that MFTR shared a hypothalamiccluster with women when smelling AND, and with men when smellingEST. Because the EST effect was limited, MFTR differed significantlyonly from male controls, and only for EST-AIR and EST-AND. Thesedata suggest a pattern of activation away from the biologicalsex, occupying an intermediate position with predominantly female-likefeatures. Because our MFTRs were nonhomosexual, the resultsare unlikely to be an effect of sexual practice. Instead, thedata implicate that transsexuality may be associated with sex-atypicalphysiological responses in specific hypothalamic circuits, possiblyas a consequence of a variant neuronal differentiation. ( Fulll text at http://cercor.oxfordjournals.org/cgi/content/full/18/8/1900 )

Bess, JA and Stabb, SD. The experiences of transgendered persons in

psychotherapy: voices and recommendations.Journal of Mental Health

Counseling. 31.3 (July 2009): p264(19).

This study explored the therapeutic alliance and satisfaction between

transgender clients and their therapists. The design was qualitative and

heuristically based. Seven transgendered participants who had lived

full-time as their non-natal gender for at least three months and who had

spent at least the majority of a course of therapy discussing their current

gender identity were recruited. Interviews were semi-structured, and each

was transcribed verbatim. Three levels of coding were used)or analysis:

seven individual depictions in narrative form, a single composite depiction

bringing together similarities between the experiences of the participants,

and a single exemplary depiction of critical themes. Results suggest that

the participants did not experience many of the heterosexist, sexist, and

pathologizing biases described in previous studies. Rather, they described

supportive and affirming relationships with their therapists. Some

participants had had negative experiences with previous therapists.

Participants called for further training and education for therapists and

other helping professionals. Implications for theory, research, practice,

and policy are explored.

Bockting, Walter(2009) Are Gender Identity Disorders Mental Disorders?

Recommendations for Revision of the

World Professional Association for Transgender Health’s Standards of

Care’,International Journal of Transgenderism,11:1,53 — 62

Abstract

Gender identity disorders are included as formal diagnoses in both the

Diagnostic and Statistical Manual of Mental Disorders and the International

Classification of Diseases. The fact that gender identity disorders are

classified as mental disorders is increasingly being contested, with some

critics arguing for removal (drawing a parallel with the removal of

homosexuality as a mental disorder from the DSM in 1974) and others for

reform. At the heart of the argument are concerns about a mental health

diagnosis pathologizing gender variance and perpetuating the attached social

stigma. Some critics argue for coding gender identity concerns requiring

medical intervention as physical conditions rather than mental disorders;

after all, they argue, hormonal and surgical sex reassignment aim to adapt

the body to match the patient’s gender identity. However, as of yet, gender

dysphoria cannot be detected by any physical anomaly justifying a physical

rather than a mental health diagnosis. Even though recent research points

toward the role of biology via sexual differentiation of the brain, the

etiology of gender dysphoria remains unknown. On the other hand, research

justifying the current diagnostic criteria of mental disorder is also

limited. This article summarizes the diagnostic criteria and reviews the

empirical evidence and scientific debate surrounding these diagnoses,

concluding with recommendations for revision of the Standards of Care for

Gender Identity Disorders set forth by the World Professional Association

for Transgender Health and directions for future research.

Coleman, Eli(2009)’Toward Version 7 of the World Professional Association

for Transgender Health’s Standards of Care: Psychological Assessment and

Approaches to Treatment’,International Journal of Transgenderism,11:2,69 —

73

URL: http://dx.doi.org/10.1080/15532730903008008

Abstract

In the previous issue of the International Journal of Transgenderism, I

reviewed the history of the development of the Standards of Care (SOC) of

the World Professional Association for Transgender Health (WPATH), formerly

the Harry Benjamin International Gender Dysphoria Association (Coleman,

2009). In considering the next revision of the SOC, a number of articles

were commissioned to examine various parts of the current WPATH SOC and to

review the literature pertaining to those sections. These papers were

designed to (1) review the evidence (and provide us with references), (2)

point out where research is lacking and needed, and (3) make possible

recommendations (significant and cosmetic) to the SOC based upon new

evidence. This article introduces the second set of articles pertaining to

psychological assessment and approaches to treatment.

Davis E. (2009), Situating “Fluidity”: (Trans) Gender Identification and the Regulation of Gender Diversity GLQ: A Journal of Lesbian and Gay Studies – Volume 15, Number 1, 2009, pp. 97-130

Abstract

“Drawing on Butler’s theory of gender performativity, which conceptualizes the discursive production of the gendered subject and the corresponding “constitutive instabilities” of such reiterative practices, I provide an empirical sociological examination of how individuals negotiate potentially unintelligible identities in their daily lives and the extent to which these practices call into question the conceptual dichotomization of stability and fluidity. While transsexed bodies, histories, and identities may “exceed” the limits of intelligibility, trans individuals are engaged in the process of meaning making—creating coherence both for themselves and for others. The present theorizing of (trans)gender identification has not fully explored the interaction among social expectations, individuals’ attempts to be credible, and the structural limitations on intelligible gender identifications. In addition, despite theoretical arguments resting on the compulsory, regulatory nature of gender regimes, gender fluidity is often situated as counter to such regulation. By exploring the negotiated identifications of transsexed respondents across different interactional spaces and the structural rules and norms which frame such presentation choices, this article theorizes the contextual regulation of (trans)gender diversity and the corresponding production of situated identification. Further, in examining this negotiation, the concept of fluidity is interrogated in order to complicate the analytic dualism of fluidity/stability and the corresponding dichotomous positioning of transsexed individuals as either blurring or reifying the boundaries of the gender binary.”

de Vries AL, Doreleijers TA, Cohen-Kettenis PT ( 2007). Disorders of sex development and gender identity outcome in adolescence and adulthood: understanding gender identity development and its clinical implications. Pediatr Endocrinol Rev. 2007 Jun;4(4):343-51

This article reviews studies on gender identity outcome in individuals with disorders of sex development (DSD). It appears that a high percentage of affected individuals suffer from gender dysphoria. However, these figures differ substantially among the various DSD and they never reach 100%. From the studies it also becomes clear that a distinction should be made between gender role behavior and gender identity. Put in a broader theoretical framework, there is now more evidence that biological factors influence the development of gender role behavior than gender identity. Developmental psychology studies add evidence that social and psychological factors play a role as well in gender development. Clinicians should be aware of, but not overestimate the influences of neurobiological factors in gender development.

Garcia-Falgueras, A and Swaab, D.F (2008) A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. Brain 131, 3132-3146

ABSTRACT

Transsexuality is an individual’s unshakable conviction of belonging to the opposite sex, resulting in a request for sex-reassignment surgery. We have shown previously that the bed nucleus of the stria terminalis (BSTc) is female in size and neuron number in male-to-female transsexual people. In the present study we investigated the hypothalamic uncinate nucleus, which is composed of two subnuclei, namely interstitial nucleus of the anterior hypothalamus (INAH) 3 and 4. Post-mortem brain material was used from 42 subjects: 14 control males, 11 control females, 11 male-to-female transsexual people, 1 female-to-male transsexual subject and 5 non-transsexual subjects who were castrated because of prostate cancer. To identify and delineate the nuclei and determine their volume and shape we used three different stainings throughout the nuclei in every 15th section, i.e. thionin, neuropeptide Y and synaptophysin, using an image analysis system. The most pronounced differences were found in the INAH3 subnucleus. Its volume in thionin sections was 1.9 times larger in control males than in females (P < 0.013) and contained 2.3 times as many cells (P < 0.002). We showed for the first time that INAH3 volume and number of neurons of male-to-female transsexual people is similar to that of control females. The female-to-male transsexual subject had an INAH3 volume and number of neurons within the male control range, even though the treatment with testosterone had been stopped three years before death. The castrated men had an INAH3 volume and neuron number that was intermediate between males (volume and number of neurons P > 0.117) and females (volume P > 0.245 and number of neurons P > 0.341). There was no difference in INAH3 between pre-and post-menopausal women, either in the volume (P > 0.84) or in the number of neurons (P < 0.439), indicating that the feminization of the INAH3 of male-to-female transsexuals was not due to estrogen treatment. We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.

Kersting A, Reutemann M, Gast U, Ohrmann P, Suslow T, Michael N, Arolt V. Dissociative disorders and traumatic childhood experiences in transsexuals. J Nerv Ment Dis. 2003 Mar;191(3):182-9.

In this first prevalence study of dissociative symptoms and different forms of childhood experiences among transsexuals, 41 transsexuals and 115 psychiatric inpatients were compared by means of the Interview for Dissociative Disorders (SCID-D-R), the Dissociative Experiences Scale (DES), and the Childhood Trauma Questionnaire (CTQ). The total score for the dissociative symptoms revealed no significant differences between the transsexuals and the psychiatric inpatients. However, the higher DES score among transsexuals compared with a normal population was found to be due largely to one item. A surprisingly high prevalence of emotional maltreatment was recorded. The results suggest that both the DES and the SCID-D-R have limited validity as instruments for screening and diagnosing dissociative disorders in transsexuals. Psychiatrists should be mindful of the possible existence of dissociative disorders in transsexual patients. Further investigations are needed to clarify the effects of traumatic childhood experiences on sexual identity in transsexuals and to throw more light on the phenomenological correlation between transsexualism and dissociative identity, using taxometric analyses.

Lawrence AA. Becoming what we love: autogynephilic transsexualism conceptualized as an expression of romantic love. Source Perspectives in Biology & Medicine. 50(4):506-20, 2007.

The increasing prevalence of male-to-female (MtF) transsexualism in Western countries is largely due to the growing number of MtF transsexuals who have a history of sexual arousal with cross-dressing or cross-gender fantasy. Ray Blanchard proposed that these transsexuals have a paraphilia he called autogynephilia, which is the propensity to be sexually aroused by the thought or image of oneself as female. Autogynephilia defines a transsexual typology and provides a theory of transsexual motivation, in that Blanchard proposed that MtF transsexuals are either sexually attracted exclusively to men (homosexual) or are sexually attracted primarily to the thought or image of themselves as female (autogynephilic), and that autogynephilic transsexuals seek sex reassignment to actualize their autogynephilic desires. Despite growing professional acceptance, Blanchard’s formulation is rejected by some MtF transsexuals as inconsistent with their experience. This rejection, I argue, results largely from the misconception that autogynephilia is a purely erotic phenomenon. Autogynephilia can more accurately be conceptualized as a type of sexual orientation and as a variety of romantic love, involving both erotic and affectional or attachment-based elements. This broader conception of autogynephilia addresses many of the objections to Blanchard’s theory and is consistent with a variety of clinical observations concerning autogynephilic MtF transsexualism.

Lev, A. I. ( 2009) The Ten Tasks of the Mental Health Provider: Recommendations for Revision of the World Professional Association for Transgender Health’s Standards of Care. International Journal of Transgenderism, 1434-4599, Volume 11, Issue 2, 2009, PP74– 99

Abstract This article outlines recommendations for the World Professional Association for Transgender Health’s (WPATH) Standards of Care (SOC) regarding the roles, responsibilities, and tasks of the mental health provider in assessing eligibility and readiness for medical and surgical treatment of gender nonconforming, transgender, and transsexual clients. It reflects a reconceptualization of the role of the mental health provider as a gender specialist and an advocate and educator for transgender people and their families utilizing a nonpathologizing assessment process. This article reflects a need for clinical SOC that minimize the role of “gatekeeping,” and increase the use of informed consent and harm-reduction procedures, while still providing guidelines for psychosocial evaluation. Recommendations are made for less pathologizing nomenclature, clearer definitions for the professional qualifications of those specializing in working with gender-variant people, and increased collaboration across disciplines. Suggestions are made for the SOC to recognize greater diversity in gender expression and identity, increased focus on the families and occupational environments of transgender people, and a broader view of gender issues throughout the lifecycle. Guidelines for psychosocial assessment and referral letters to physicians are outlined, including proposals to revisit the professional qualifications of letter writers and the need for two letters for surgical assessment. It is suggested that WPATH take leadership in the training and credentialing of gender specialists. These recommendations require a reorganization of the format of the SOC that will create a state-of-the-art standard of health care for transgender, transsexual, and gender nonconforming people and ensure the provision of high-quality clinical services for those individuals and their families.

Luders E, Sanchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E (2009|

Regional gray matter variation in male-to-female transsexualism. Neuroimage. 46(4):904-7, 2009 Jul 15.

Abstract Gender identity-one’s sense of being a man or a woman-is a fundamental perception experienced by all individuals that extends beyond biological sex. Yet, what contributes to our sense of gender remains uncertain. Since individuals who identify as transsexual report strong feelings of being the opposite sex and a belief that their sexual characteristics do not reflect their true gender, they constitute an invaluable model to understand the biological underpinnings of gender identity. We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.

Manners, P. J. ( 2008) Gender Identity in Adolescence: A Review of the Literature. Child and Adolescent Mental Health. Vol14, No2, 2009, pp 62-68.

This article reviews the empirical literature on gender identity disorder in Adolescents: one of the most contested diagnoses in DSM. Fourteen studies were identified, a critique is provided and the surrounding controversies explored. This article suggests recommendations for future practice and research.

Matte, Nicholas, Devor, Aaron H. and Vladicka, Theresa(2009)’Nomenclature in

the World Professional Association

for Transgender Health’s Standards of Care: Background and

Recommendations’,International Journal of Transgenderism,11:1,42 —

52

Abstract

This article looks at the history of terminology used in the Standards of

Care for Gender Identity Disorder (SOC), the document guiding much of

transgender health care today. We argue that a deeper understanding of how

terms and concepts in this set of professional guidelines have evolved over

time may foster a more positive relationship between service providers and

users by publicly acknowledging tensions that have emerged. The article

looks first at the development of the SOC in relation to the Diagnostic and

Statistical Manual of Mental Disorders (DSM) and the International

Classification of Disease and Related Health Problems (ICD) and then at the

ways that the American and Western European cultural contexts of many of its

authors may have unintentionally undermined what we assume to have been the

authors’ best efforts to produce a document international in scope. We also

discuss attempts to address the needs and views of community users and

service providers and how this might have affected the language used in

previous versions of the SOC. Designed to be valuable to service users, for

service providers, and particularly for those drafting future editions of

the SOC, we end with specific recommendations, arguing that in order to

develop better language for use in the SOC, a more thorough critical

examination of the SOC’s history and social context(s) is in order.

Morgan, S and Stevens, P. TRANSGENDER IDENTITY DEVELOPMENT AS REPRESENTED BY A GROUP OF FEMALE-TO-MALE TRANSGENDERED ADULTS Issues in Mental Health Nursing, 29:585–599, 2008

This article represents work done in the discipline of

nursing to raise awareness about the lives and experiences

of transgendered persons, who receive little coverage in our

nursing textbooks, professional journals, or student clinical

experiences. The findings presented here are from a larger

qualitative examination of the lives and experiences of a

group of 11 transgendered adults that examined four broad

areas: transgender identity recognition, acknowledgement,

and development; bodily experiences; relationships with

others; and health care experiences. The focus of this

article is the relevant findings related to four participants in

the study who identified as female-to-male (FTM), meaning

they were born female-bodied, but identify as male. The

highlight here is on the recognition, acknowledgement, and

development of transgender identity. Our intention is to

expose uninformed people to first-hand accounts by FTM

transgendered persons about their life trajectories,

particularly during childhood, adolescence, and the early

adult years.

Parkes, G., Hall, I., & Wilson, D. (2009). Cross dressing and gender dysphoria in

people with learning disabilities: a descriptive study. British Journal of

Learning Disabilities, 37, 151-156.  (Key findings reported at www.thenadd.org/pdfs/research/pr-parkes-crossdressing.pdf

We aimed to determine the characteristics of people with learning disability who cross-dress or who have gender dysphoria. Using a retrospective review of anonymised data from clinical records about people referred to a specialist service. All 13 participants cross-dressed and 12 were biological males. Only one person was in a core transsexual group which may do better from sex reassignment surgery. There was a high level of mental health problems and high levels of reported childhood abuse. Three people were unhappy about their homosexual feelings, and two people had capacity issues. People with learning disabilities experience a wide range of gender identity issues similar to those seen in the non-learning disabled population. They would benefit from a more person centred understanding. People with learning disability may need longer assessments and more psychotherapeutic exploration and intervention prior to thinking about hormone and surgical interventions. Deciding treatment in someone’s best interests for those lacking capacity presents complex ethical dilemmas.

Persson, D. I (2009) Unique Challenges of Transgender Aging: Implications

From the Literature. Journal of Gerontological Social Work  1540-4048,

Volume 52  Issue 6, 2009, Pages 633 – 646

Abstract

Transgender elders are both underserved and understudied. Neither the

etiology nor prevalence of transgender is well understood. Because sex,

gender, and sexuality are at the very core of individual identity, it is

difficult to dislodge one’s ideas and feelings about them. Unlike biological

sex and sexual orientation, gender has several aspects: gender identity,

gender expression, and gender classification. A discussion of the

terminology of transgender is presented, and the issues facing aging

transgender individuals are identified. Although the challenges of adequate

healthcare, social support, and legal obstacles are faced by many elderly

individuals, the way they are presented and managed are unique to this often

invisible group.

Rands, KE. (2009) Considering Transgender People in Education: A

Gender-Complex Approach. Journal of Teacher Education, Sep 2009; vol. 60:

pp. 419 – 431.

Schools serve as a setting in which students come to understand gender, but

transgender students (those who transgress societal gender norms) are

largely left out of discussions of education. The high level of harassment

that transgender students face poses sizable obstacles to school success. If

the field of education is committed to equity and social justice, then

teacher education programs must prepare educators to teach gender in more

complex ways that take into consideration the existence and needs of

transgender people. This article is intended to begin the discussion of

transgender issues in teacher education by providing a rationale for why

teacher educators need to care about transgender issues, presenting

definitions of basic terms and concepts related to gender and transgender,

offering a new framework for understanding gender privilege and oppression,

and examining three previously proposed or existing types of gender

education and proposing gender-complex education as an alternative, and

exploring possibilities for gender-complex teacher education.

Reis, E. (2004). Teaching Transgender History, Identity and Politics. Radical History Review.

Introduction: What’s transgender?” “Is there transgender history?” “You can teach a whole course on that?” “Transgender issues? Cool!” These responses reflect the range of reactions I get when I tell people the title of the course I teach at the University of Oregon: “Transgender History, Identity, and Politics.” Most of the students seem to know what transgender means; last term the class filled to capacity within days of the onset of registration, and I turned away as many as the forty that enrolled. Transgender issues are entering the mainstream. In movies like Some Like It Hot (dir. Billy Wilder, 1959), Tootsie (dir. Sydney Pollack, 1982), and The Crying Game (dir. Neil Jordan, 1992), Hollywood has explored gender-crossing themes, the most recent examples being Better Than Chocolate (dir. Anne Wheeler, 1999) and Boys Don’t Cry (dir. Kimberly Pierce, 1999). And the publishing industry is following suit. Recent successes include She’s Not There: A Life in Two Genders by Jennifer Finney Boylan, Crossing: A Memoir by Deirdre McCloskey, and As Nature Made Him: The Boy Who Was Raised As a Girl by John Colapinto. Transgender is out of the closet, and it should be in the classroom as well…..

Schöning S, Engelien A, Bauer C, Kugel H, Kersting A, Roestel C, Zwitserlood P, Pyka M, Dannlowski U, Lehmann W, Heindel W, Arolt V, Konrad C ( 2009) Neuroimaging Differences in Spatial Cognition between Men and Male-to-Female Transsexuals Before and During Hormone Therapy. J Sex Med. 2009

ABSTRACT . Neuropsychological abnormalities in transsexual patients have been reported in comparison with subjects without gender identity disorder (GID), suggesting differences in underlying neurobiological processes. However, these results have not consistently been confirmed. Furthermore, studies on cognitive effects of cross-sex hormone therapy also yield heterogeneous results. Aim. We hypothesized that untreated transsexual patients differ from men without GID in activation pattern associated with a mental rotation task and that these differences may further increase after commencing of hormonal treatment. Method. The present study investigated 11 male-to-female transsexual (MFTS) patients prior to cross-sex hormone therapy and 11 MFTS patients during hormone therapy in comparison with healthy men without GID. Using functional magnetic resonance imaging at 3-Tesla, a mental rotation paradigm with proven sexual dimorphism was applied to all subjects. Data were analyzed with SPM5. Main Outcome Measures. Patterns of brain activation associated with a mental rotation task. Results. The classical mental rotation network was activated in all three groups, but significant differences within this network were observed. Men without GID exhibited significantly greater activation of the left parietal cortex (BA 40), a key region for mental rotation processes. Both transsexual groups revealed stronger activation of temporo-occipital regions in comparison with men without GID. Conclusions. Our results confirmed previously reported deviances of brain activation patterns in transsexual men from men without GID and also corroborated these findings in a group of transsexual patients receiving cross-sex hormone therapy. The present study indicates that there are a priori differences between men and transsexual patients caused by different neurobiological processes or task-solving strategies and that these differences remain stable over the course of hormonal treatment.

Wallien. M, and Cohen-Kettenis, P. (2008) Psychosexual Outcome of Gender Dysphoric Children. Acad. Child Adolesc. Psychiatry, 47:12.

OBJECTIVE: To establish the psychosexual outcome of gender-dysphoric children at 16 years or older and to examine childhood characteristics related to psychosexual outcome. METHOD: We studied 77 children who had been referred in childhood to our clinic because of gender dysphoria (59 boys, 18 girls; mean age 8.4 years, age range 5-12 years). In childhood, we measured the children’s cross-gender identification and discomfort with their own sex and gender roles. At follow-up 10.4 +/- 3.4 years later, 54 children (mean age 18.9 years, age range 16-28 years) agreed to participate. In this group, we assessed gender dysphoria and sexual orientation. RESULTS: At follow-up, 30% of the 77 participants (19 boys and 4 girls) did not respond to our recruiting letter or were not traceable; 27% (12 boys and 9 girls) were still gender dysphoric (persistence group), and 43% (desistance group: 28 boys and 5 girls) were no longer gender dysphoric. Both boys and girls in the persistence group were more extremely cross-gendered in behavior and feelings and were more likely to fulfill gender identity disorder (GID) criteria in childhood than the children in the other two groups. At follow-up, nearly all male and female participants in the persistence group reported having a homosexual or bisexual sexual orientation. In the desistance group, all of the girls and half of the boys reported having a heterosexual orientation. The other half of the boys in the desistance group had a homosexual or bisexual sexual orientation. CONCLUSIONS: Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.

Wilson R, Spiers A, Ewan J, Johnson P, Jenkins C, Carr S (2009) Effects of high dose oestrogen therapy on circulating inflammatory markers. Maturitas. 62(3):281-6, 2009 Mar 20.

Abstract: Whilst initial studies suggested HRT reduced the incidence of coronary heart disease, recent studies have suggested HRT increases cardiovascular risk. The route of HRT administration appears important with oral oestrogen significantly increasing levels of inflammatory markers and transdermal oestrogen causing no such changes. As the effects of the very high levels of oestrogen taken by male to female transsexuals are poorly understood this study has compared the changes occurring in circulating inflammatory markers following 6 months oral or transdermal oestrogen therapy. MATERIALS AND METHODS: 23 patients (mean age 36+/-10 years) about to commence oral oestrogen were enrolled into Group 1. Group 2 comprised 7 patients (mean age 47+/-6 years) about to commence transdermal oestrogen. Plasma lipids (total cholesterol, triglyceride and HDL cholesterol); cytokines (IL-1, IL-6, IL-8, TNFalpha); antioxidants (superoxide dismutase, total nitric oxide, glutathione) and clotting factors (Factor V11, Factor V111, Factor 1X, fibrinogen) were measured after 0, 2, 4 and 6 months treatment. RESULTS: No significant differences were found in plasma lipid levels. Group 1 patients showed significantly raised levels of IL-6, IL-1 and IL-8 during the first 2-4 months of treatment. Thereafter levels fell. Levels of SOD, FV11 and FV1X in Group 1 also increased over the study period. Patients receiving transdermal oestrogen showed elevated levels of GSH in the second month of treatment, but no significant changes in any of the other parameters measured. The rise in levels of IL-1 and Factor IX in the second month of treatment was significantly higher in the oral group than in the transdermal group. No other significant differences between the treatment groups were found. CONCLUSION: Transsexual patients receiving oral oestrogen showed significant changes in inflammatory markers involved in the pathogenesis of vascular disease. No such changes were associated with transdermal oestrogen. Changes in two inflammatory markers were significantly greater than among patients receiving transdermal oestrogen.

Zucker, Kenneth J. and Lawrence, Anne A.(2009)’Epidemiology of Gender

Identity Disorder: Recommendations for

the Standards of Care of the World Professional Association for Transgender

Health’,International Journal of Transgenderism,11:1,8

— 18

Abstract

Formal epidemiological studies on the incidence and prevalence of gender

identity disorder (GID) or transsexualism have not been conducted.

Accordingly, crude estimates of prevalence have had to rely on indirect

methods, such as parental endorsement of behavioral items pertaining to GID

on omnibus questionnaires for children and youth or the number of adult

patients seeking contra-sex hormonal treatment or sex-transformative surgery

at hospital- or university-based gender clinics. Data from child and

adolescent parent-report questionnaires show that the frequent wish to be of

the other sex is quite low but that periodic cross-gender behavior is more

common. In the general population, cross-gender behavior is more common in

girls than it is in boys but boys are referred to gender identity clinics

more frequently than are girls. Prevalence estimates of GID in adults

indicate that it is higher in natal males than in natal females although

this may be accounted for by between-sex variation in sexual orientation

subtypes. Prevalence estimates of GID in adults based on clinic-referred

samples suggest an increase in more recent cohorts. It remains unclear

whether this represents a true increase in prevalence or simply greater

comfort in the seeking out of clinical care as professionals become more

attuned to the psychosocial and biomedical needs of transgendered people.

Written by Kaete

October 11, 2009 at 16:59

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