Sex steroid-related genes and male-to-female transsexualism

Transsexualism is characterised by lifelong discomfort with the assigned sex and a strong identification with the opposite sex. The cause of transsexualism is unknown, but it has been suggested that an aberration in the early sexual differentiation of various brain structures may be involved. Animal experiments have revealed that the sexual differentiation of the brain is mainly due to an influence of testosterone, acting both via androgen receptors (ARs) and--after aromatase-catalyzed conversion to estradiol--via estrogen receptors (ERs). The present study examined the possible importance of three polymorphisms and their pairwise interactions for the development of male-to-female transsexualism: a CAG repeat sequence in the first exon of the AR gene, a tetra nucleotide repeat polymorphism in intron 4 of the aromatase gene, and a CA repeat polymorphism in intron 5 of the ERbeta gene. Subjects were 29 Caucasian male-to-female transsexuals and 229 healthy male controls. Transsexuals differed from controls with respect to the mean length of the ERbeta repeat polymorphism, but not with respect to the length of the other two studied polymorphisms. However, binary logistic regression analysis revealed significant partial effects for all three polymorphisms, as well as for the interaction between the AR and aromatase gene polymorphisms, on the risk of developing transsexualism. Given the small number of transsexuals in the study, the results should be interpreted with the utmost caution. Further study of the putative role of these and other sex steroid-related genes for the development of transsexualism may, however, be worthwhile.     

A case of female transsexualism

Summary A case of transsexualism in a female before and after surgical treatment is presented, including history, examination and results of psychological testing. A brief review of the literature is given and salient features are discussed.From the Department of Psychiatry, Institute of Psychiatry, The Mount Sinai School of Medicine of the City University of New York, this paper was submitted to theQuarterly on December 26, 1969.     

Sex reassignment surgery in Europe: a survey

Since the first publications on a sex reassignment operation in Denmark in the early fifties, the European environment in which sex reassignment surgery (SRS) takes place has changed drastically. However the possibilities differ considerably between one country and another. To get a picture of the European situation a questionnaire was sent out to gender clinics and private practitioners treating transsexuals in 15 European countries. Questions were asked about evaluation of candidates for a treatment program, details of such programs, the legal and financial situation in the different countries and attitudes and place of psychotherapy in the SRS procedure. By and large there seems to be fairly good consensus within those European SRS treatment programs we had the opportunity to evaluate.     

A case of bipolar psychosis and transsexualism

A case of bipolar disorder and transsexualism is reported and discussed. The case report shows the problematic nature of the distinction between transsexualism and psychosis-induced transsexual desires. If there is a true comorbidity of these disorders, a subtly differentiated process to guide medical expert opinion and therapy is necessary.     

Challenges in the diagnosis and treatment of transsexualism in contemporary China

##正##According to the International Classification of Diseases10th Edition(ICD-10),[1]transsexualism refers to thecondition where an individual desires to live and to beaccepted as someone of the gender which is oppositetheir biological sex.It is usually accompanied withdiscomfort or distress about their anatomic sex.In somecases,individuals with this condition modify their bodyfeatures using laser or plastic surgeries to resemble     

A case of male childhood transsexualism and its management.

The syndrome of male childhood transsexualism is described and the case history of a six year old boy is reported. Treatment strategies are explained in detail and the results of ongoing therapy over an 18 month period are presented.     

Sex differences in own and other body perception

Own body perception, and differentiating and comparing one's body to another person's body, are common cognitive functions that have relevance for self‐identity and social interactions. In several psychiatric conditions, including anorexia nervosa, body dysmorphic disorder, gender dysphoria, and autism spectrum disorder, self and own body perception, as well as aspects of social communication are disturbed. Despite most of these conditions having skewed prevalence sex ratios, little is known about whether the neural basis of own body perception differs between the sexes. We addressed this question by investigating brain activation using functional magnetic resonance imaging during a Body Perception task in 15 male and 15 female healthy participants. Participants viewed their own body, bodies of same‐sex, or opposite‐sex other people, and rated the degree that they appeared like themselves. We found that men and women did not differ in the pattern of brain activation during own body perception compared to a scrambled control image. However, when viewing images of other bodies of same‐sex or opposite‐sex, men showed significantly stronger activations in attention‐related and reward‐related brain regions, whereas women engaged stronger activations in striatal, medial‐prefrontal, and insular cortices, when viewing the own body compared to other images of the opposite sex. It is possible that other body images, particularly of the opposite sex, may be of greater salience for men, whereas images of own bodies may be more salient for women. These observations provide tentative neurobiological correlates to why women may be more vulnerable than men to conditions involving own body perception.     

Incidence and sex ratio of transsexualism in Sweden

Landén M, Wålinder J, Lundström B. Incidence and sex ratio of transsexualism in Sweden. Acta Psychiatr Scand 1996: 93: 261–263. © Munksgaard 1996. The incidence and sex ratio of transsexualism in Sweden were calculated during the period between 1 July 1972 and 30 June 1992 using a case register kept on file at the Swedish Bureau of Social Welfare. Only cases of primary/genuine transsexualism were considered. The study is unique in that it has been performed in exactly the same way as a previous study by one of the authors (JW) in the 1960s and early 1970s. The data can therefore be reliably compared. The results show that the incidence figures remain constant over time and that the incidence of primary/genuine transsexualism is equally common in men and women. A larger group consisting of all those individuals who had applied for sex reassignment revealed a preponderance of men. Analysis showed that this large group included not only primary/genuine transsexuals but also effeminate homosexuals, transvestites and diagnostically uncertain cases. The importance of describing the exact methods used when calculating epidemiological data is highlighted.     

A late sex reassignment in 5-alpha reductase deficiency: case report

The syndrome of male pseudohermaphroditism, caused by a deficiency of the enzyme 5-alpha reductase, results in a selective decrease in dihyrotestosterone. Culture is an important part of the context in which decisions are made on sex assignment of patients with abnormalities of the external genitalia. In Turkey, patients with ambiguious genitalia are diagnosed very late and corrective surgery is usually performed during or after puberty. Here we present a case with 5-alpha reductase deficiency who was diagnosed at puberty and followed-up for 10 years.     

The prevalence of transsexualism in Singapore

The prevalence of transsexualism in Singapore was estimated by counting all the patients who sought sex-reassignment surgery and were subsequently diagnosed as transsexuals by psychiatrists. Up to 1986, there were a total of 458 Singapore-born transsexuals, of which 343 were males and 115 were females. This was a prevalence of 35.2 per 100,000 population age 15 and above (or 1/2900) for male transsexualism, and 12.0 per 100,000 (or 1/8300) for female transsexualism. The sex ratio was about 3 males to 1 female. The main reason for the high prevalence was the availability of sex-reassignment surgery.     

Prevalence and demography of transsexualism in Belgium.

AIM: The Belgian medical world has acknowledged the diagnosis of transsexualism and accepted Sex Reassignment Surgery (SRS) as one of the steps in the treatment of choice since 1985. This prevalence and demographic study analyses data on all Belgian individuals who have undergone SRS since that year. METHODS: All (188) plastic surgeons as well as all gender teams (Antwerp, Bruges, Ghent, and Liège) in Belgium were sent demographic questionnaires to be completed for each of their transsexual patients. RESULTS: The results show an overall prevalence of 1:12,900 for male-to-female and 1:33,800 for female-to-male transsexuals in Belgium. In Wallonia (the French-speaking region of Belgium) the prevalence is significantly lower than in Flanders (the Dutch-speaking region) and in Brussels (the bilingual capital region). In the total Belgian population the male/female sex ratio is 2.43:1, again with a substantial difference between Wallonia on the one hand and Flanders on the other. DISCUSSION AND CONCLUSION: While in Flanders and in Brussels the prevalence is comparable to that in other Western European countries, in Wallonia it is markedly lower. Transsexualism in Wallonia appears to be socially less acceptable: persons suffering from gender dysphoria in that part of Belgium encounter more problems accessing gender clinics and receiving treatment.