Transsexualism

ABSTRACT
This research, situated at the junction of feminist, trans and disability studies, examines the limits of intersectional feminist analyses and the difficulties faced in their consideration of gender identity and ability through an analysis of two types of body modification: transsexuality and transability (voluntary disability acquisition). In response to the question “what are the limits of intersectional analyses and how can they be addressed?”, three objectives are proposed: 1) participate in the critical examination of specific limits of intersectional feminist analyses in order to diversify their axes through the consideration of gender identity and ability; 2) question the conceptual assumptions and cisgenderist and (cis)ableist privileges informing negative discourses around these body modifications and highlight points of convergence among feminist, transactivist and anti-ableist movements in order to encourage dialogue and solidarities among them; 3) provide feminist, trans and disability studies with an enriched model of intersectionality capable of addressing new claims for justice from oppressed groups, such as those of transsexual and transabled individuals. The negative discourses of certain feminists and other scientists regarding these body modifications are mapped and critiqued through a methodology combining archeological, genealogical and critical discourse analysis. The reflections presented here, inspired by poststructuralist and queer approaches, explore neither the “origins” of transsexuality and transability nor their motivations; this is a study of the negative discourses about these phenomena and the normative systems from which they originate. The result is an important contribution to theoretical, normative and political fields of knowledge: the examination of two “extreme” cases of body modification reveals the bodily normativities of dominant regimes, specifically cisgenderism and (cis)ableism, that remain as unrecognized in our societies as in our social movements. 


KEYWORDS
Intersectionality; feminist theories; trans theories; queer theories; disability theories; social movements; body modifications; bodies; transsexuality; transability; voluntary amputation; BIID; disability; mutilation; pathologization; normality/abnormality; stigmatization; discourse; critical discourse analysis; norms; oppression; autonomy; bioethics.


RÉSUMÉ
Cette recherche se situe à la jonction des études féministes, trans et sur la production du handicap. Elle s’intéresse aux limites des analyses féministes intersectionnelles et leurs difficultés à considérer certains axes identitaires, telles l’identité de genre et les capacités, à travers l’analyse de deux cas de figure de modifications corporelles, soit la transsexualité et la transcapacité (transformation visant à acquérir un handicap). Cette thèse s’articule autour de la question suivante : quels sont les angles morts des analyses intersectionnelles et comment pouvons-nous y remédier? Pour répondre à cette question, cette thèse propose trois objectifs : 1) Participer aux questionnements critiques entourant certaines limites des analyses féministes intersectionnelles pour en diversifier les axes à partir de l’identité de genre et des capacités; 2) Remettre en question les présupposés conceptuels et les privilèges cisgenristes et (cis)capacitistes qui sous-tendent les discours négatifs entourant ces modifications corporelles et mettre en valeur les points de convergence entre les mouvements féministes, transactivistes et anticapacitistes pour instaurer des dialogues et des solidarités entre eux; 3) Fournir un modèle enrichi de l’intersectionnalité pouvant être déployé en études féministes, trans et sur la production du (trans)handicap, apte à répondre aux nouvelles revendications de justice de groupes opprimés, comme celles des personnes transsexuelles et transcapacitaires. À l’aide d’une méthodologie alliant l’analyse critique de discours, l’analyse archéologique et généalogique, les discours négatifs de certaines féministes et d’autres scientifiques sur ces transformations corporelles sont cartographiés et critiqués. Les réflexions présentées ici, s’inscrivant dans une approche poststructuraliste et queer, ne proposent pas une recherche des « origines » et des motivations de la transsexualité et de la transcapacité, mais plutôt une étude des discours négatifs vis-à-vis ces phénomènes et des systèmes normatifs qui sous-tendent ces discours. C’est sous cet angle que cette recherche constitue un apport important aux champs des savoirs, tant sur le plan théorique, normatif que politique : en se penchant sur deux cas de figure « extrêmes », elle met en lumière les normativités corporelles des régimes dominants, notamment cisgenriste et (cis)capacitiste, occultées tant dans nos sociétés que dans nos mouvements sociaux.


MOTS CLÉS
Intersectionnalité; théories féministes; théories trans; théories queers; théories sur le handicap; mouvements sociaux; modifications corporelles; corps; transsexualité; transcapacité; amputations volontaires; BIID; handicap; mutilations; pathologisation; normalité/anormalité; stigmatisation; discours; analyses critiques de discours; normes; oppressions; autonomie; bioéthique.

Operations on intersexuals indicate that the sex of a person is based on more than biology. Expectations about proper gender activities furnish the frameworks through which certain features and combinations of features are understood to be fundamental to bodies and to comprise their sex. Yet, we can ask whether this interpretation is either coherent or consistent with our fuller conceptions of ourselves. Is there a point to interpreting a person as a sex? The concept of race does not hold up as a scientifically viable way of grouping human beings. It does not identify a cluster of genes at the biological level that could serve to sever human beings into neatly separable groups. It does not help identify discrete packages of color and morphology that could separate groups. It is muddled and asymmetrical in its groupings of individuals by ancestry. Finally, while genetic predispositions to certain diseases might provide a more useful way of grouping individuals, at least for medical purposes, such groupings deviate from ordinary uses of the term "race." Yet, if race is not scientifically viable, sex would seem to be fundamental. Surely, it succeeds in separating individuals along all of the lines at which the concept of race fails: the concept of sex identifies chromosomal differences between males and females; it points to transparent packages of features such as bone structure, genitalia, and the like; and it refers usefully to predispositions to different diseases such as ovarian and prostate cancer. Finally, it lacks any asymmetry in its application. One is male if one has an X and a Y chromosome; one is female if one has twoX chromosomes. These chromosomal facts, together with appropriate hormones, cause primary and secondary physical traits that Hypatia vol. 16, no. 3 (Summer 2001) 0 by Georgia Warnke

Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain ch...

Cross-gender behavior in Myanmar (formerly Burma) is reported. Western concepts of transsexualism, gynemimesis, transvestism, and homosexuality are not distinct categories by the Burmese. Males with cross-gender behavior are referred to as acaults. Although Myanmar is a profoundly Buddhist society, the people still have strong animistic beliefs with an elaborate system of 37 nats (spirit gods). One of these nats is a female named Manguedon who may take possession of males and impart femininity on them. The cross-gender status of the acaults is sanctioned by their spiritual marriage to Manguedon. The acaults, while not envied, are respected for their roles as shamans and seers.

Men generally have an inherent performance advantage over women due to their average greater height and muscle mass and power, as the result of correspondingly different exposures to androgens. Therefore, it is considered fair that in sports men and women compete in separate categories. The question now emerging is whether reassigned transsexuals can compete in fairness with others of their new sex. The pertinent question is how far the previous effects of testosterone in male-to-female transsexuals (M-F) are reversible upon androgen deprivation so that M-F have no advantage over women, and, vice versa, what the effects are of androgen exposure in female-to-male transsexuals (F-M) on variables relevant to competition in sports. Before puberty, boys and girls do not differ in height, muscle and bone mass. Recent information shows convincingly that actual levels of circulating testosterone determine largely muscle mass and strength, though with considerable interindividual diversity. ...

After studying this article, the participant should be able to discuss: 1. The terminology related to male-to-female gender dysphoria. 2. The different theories regarding cause, epidemiology, and treatment of gender dysphoria. 3. The surgical goals of sex reassignment surgery in male-to-female transsexualism. 4. The surgical techniques available for sex reassignment surgery in male-to-female transsexualism. Gender identity disorder (previously "transsexualism") is the term used for individuals who show a strong and persistent cross-gender identification and a persistent discomfort with their anatomical sex, as manifested by a preoccupation with getting rid of one's sex characteristics, or the belief of being born in the wrong sex. Since 1978, the Harry Benjamin International Gender Dysphoria Association (in honor of Dr. Harry Benjamin, one of the first physicians who made many clinicians aware of the potential benefits of sex reassignment surgery) has played a major ro...

Medical sciences have advanced extensively during the previous century. The legal fraternity has likewise tried to keep abreast of these advances and to respond to emerging challenges. However, in the case of transsexualism (the gender dysphoria syndrome), the legal position of the patient after reassignment procedures has as yet not been resolved. In the gender dysphoria syndrome the unfortunate blend of the vital components for a balanced personality results in a deeply confused and unhappy person whose maladjustment gives rise to serious psychological problems.' The difference between physical reality of the body, and gender of the mind in these patients often leads to a lack of psychological wholeness and failure to integrate socially. 2

Purpose: The purpose of this article is to educate nurse practitioners (NPs) regarding: (a) the definition and range of transgenderism, (b) social influences on transgender persons, and (c) health care for transgender persons. Data sources: Data sources include review of the literature in the areas of gender, gender identity, marginalized populations, and gender transition. Personal communication was also utilized. Conclusions: Transgender persons remain marginalized and may remain closeted and at risk for negative psychosocial consequences. For those that do come out, other issues present, including the navigation of gender transition and psychosocial and physical changes that may be positive and/or negative. Examples of positive effects may include satisfaction of living authentically and decrease in depression. Negative effects may include social discrimination and loss of relationships. To provide holistic care, NPs need to be aware of transgender lives in social context and of their healthcare needs. Implications for practice: Suggestions for cultivating a supportive healthcare environment include the usage of sensitive language and an appropriate health history and physical examination. Further, to help rectify the knowledge deficit regarding transgender care among healthcare providers, NP educators and preceptors may utilize this article as a resource in their work with students.

The intermediate nucleus (InM) in the preoptic area of the human brain, also known as the sexually dimorphic nucleus of the preoptic area (SDN-POA) and the interstitial nucleus of the anterior hypothalamus-1 (INAH-1) is explored here. We investigated its population of galanin-immunoreactive (Gal-Ir) neurons in relation to sex, age, and gender identity in the postmortem brain of 77 subjects. First we compared the InM volume and number of Gal-Ir neurons of 22 males and 22 females in the course of aging. In a second experiment, we compared for the first time the InM volume and the total and Gal-Ir neuron number in 43 subjects with different gender identities: 14 control males (M), 11 control females (F), 10 male-to-female (MtF) transsexual people, and 5 men who were castrated because of pros-

In Germany, the situation of health care services for children and adolescents with gender dysphoria is insufficient. In 2006 a specialized multiprofessional outpatient clinic was founded at the University Medical Center Hamburg-Eppendorf. Goals were improvement of health services for gender dysphoric children, development of treatment concepts, and gain of knowledge through research. After finishing a thorough interdisciplinary assessment an individualized, case-by-case treatment starts. Besides psychotherapy an interdisciplinary treatment (e. g. puberty suppression and cross-sex hormones) is provided if indicated. During childhood a watchful waiting and carefully observing attitude is necessary. If a marked increase of gender dysphoria occurs during the first phases of puberty development, puberty suppression and later cross sex-hormones might be indicated.

Gender-related aspects of self-perception were explored for 24 anatomical males consisting of three matched groups of transsexuals, heterosexuals, and homosexuals. MacKenzie's Diagnostic Criteria Scale ratings were used to confirm group membership. Instruments used were the Repertory Grid Technique,

There has long been ambivalence in the LGBT movement and related research as to the meaning of gay identity in relation to marriage. The article explores changing homonormative discourses of marriage and married men within the Swedish gay press from the mid 1950s to the mid 1980s. Expressions of the changes are a shift in language and in views of extramarital relationships, openness, and gay male identity. As a result of the shift, "married men," including both "married homosexuals" and "bisexuals," came to be distinguished from "gays."

Our earlier Feminine Gender Identity Scale for males appeared to measure a strong single factor which was reliable and displayed substantial diseriminant validity. However, the number of items was small and there was substantial overlap between items with respect to their meaning. In an attempt to overcome these limitations, in the present study the scale was extended and validated on subject samples corresponding to those on which the earlier scale had been validated. Each item of the new scale differentiated among the groups in an experimental sample and, subsequently, in a cross-validation sample. A secondary finding was the significantly higher .feminine gender identity scores of homosexual patients over homosexual nonpatients.

Physical and psychosocial aspects of intersexuality (disorders of sex development, DSD) are described here. Differences between intersexuality and transsexuality are elaborated upon, especially in terms of coping with the diagnosis and treatment recommendations when dealing with an "ambiguous" or "false" body and with the disclosure of the physical conditions. The results of the Hamburg evaluation study, which was carried out between 2002 and 2008 on intersex adults, are summarized. These results have formed the basis of the comprehensive interdisciplinary book Intersexualität kontrovers (Controversial Intersexuality ) published in 2012. An outline of the recommendations published in February 2012 by the German National Ethics Committee (Deutscher Ethikrat) on Intersexuality is also provided. Finally, the "dangers" of sex reassignment and gender change are questioned and an opening up of the binary view of sex and gender is proposed.

This study explored the relationship between sexual attraction status (same-sex, both-sex, and opposite-sex) and suicidal behavior in a diverse sample of adolescents (N = 1,533 youth). Adolescents with attractions to both sexes reported greater suicide proneness, recent and lifetime suicidal ideation, and past suicide attempts than those with exclusively opposite-sex attractions; individuals reporting same-sex attractions generally demonstrated moderate elevations on these variables. As hypothesized, both hopelessness and depression mediated the relationship between sexual attraction status and suicide proneness. Social support moderated the mediating effect of depression but not hopelessness in the sexual attraction status–suicide proneness link. Targeting the distress that can be associated with experiencing same-sex or both-sex attractions may enhance suicide prevention efforts, particularly in U.S. youth with reduced social support.

| Disorders of sex development (DSDs) are estimated to be prevalent in 0.1-2% of the global population, although these figures are unlikely to adequately represent non-white patients as they are largely based on studies performed in Europe and the USA. Possible causes of DSDs include disruptions to gene expression and regulation-processes that are considered essential for the development of testes and ovaries in the embryo. Gender dysphoria generally affects between 8.5-20% of individuals with DSDs, depending on the type of DSD. Patients with simple virilizing congenital adrenal hyperplasia (CAH), as well as those with CAH and severe virilization, are less likely to have psychosexual disorders than patients with other types of DSD. Early surgery seems to be a safe option for most of these patients. Male sex assignment is an appropriate alternative in patients with Prader IV or V DSDs. Patients with 5α-reductase 2 (5α-RD2) and 17β-hydroxysteroid dehydrogenase 3 (17β-HSD3) deficiencies exhibit the highest rates of gender dysphoria (incidence of up to 63%). Disorders such as ovotesticular DSD and mixed gonadal dysgenesis are relatively rare and it can be difficult to conclusively evaluate patients with these conditions. For all DSDs, it is important that investigators and authors conform to the same nomenclature and definitions to ensure that data can be reliably analysed.

This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities.

Ten male-to-female transsexuals participated in five sessions of oral resonance voice therapy targeting lip spreading and forward tongue carriage. Acoustic analysis of recordings made pre-and posttherapy found that participant formant frequency values (F1, F2, and F3, from the vowels /a/, /i/, and /[/), as well as fundamental frequency (F0), underwent a general increase posttherapy. F3 values, in particular, increased significantly posttreatment. Trends in listener ratings of these recordings showed that the majority of participants were perceived to sound more feminine following treatment. Participants' self-ratings of their voices pre-and posttreatment also indicated that participants perceived their voices as sounding more feminine and that they were more satisfied with their voices following treatment. The present study supports the findings of previous studies that have demonstrated that resonance characteristics in male-to-female transsexuals can be changed to more closely approximate those of females through oral resonance therapy. This intervention study also demonstrates that a spontaneous increase in F0 is achieved during the course of therapy. Further, this study provides preliminary evidence to suggest that oral resonance therapy may be effective in increasing femininity of voice in male-to-female transsexual clients.

The alteration of sex-specific body features and the establishment of a satisfactory body image are known to be particularly relevant for individuals with Gender Dysphoria (GD). The aim of the study was to first develop new scales and examine the psychometric properties of the Hamburg Body Drawing Scale (Appelt & Strauß 1988). For the second part of this study, the satisfaction with different body features in young GD adults before cross-sex treatment were compared to female and male controls. Data collection took place within the context of the European Network for the Investigation of Gender Incongruence (ENIGI) including 135 female-to-male (FtMs) and 115 male-to-female (MtFs) young GD adults and 235 female and 379 male age-adjusted controls. The five female and six male body feature subscales revealed good internal consistency. The ENIGI sample reported less satisfaction with overall appearance (d = 0.30) and with all of their body features than controls, but no subgroup differen...

This article studies people relegated to invisibility: the LGTB (lesbians, gays, transsexuals and bisexuals) from constitutional and international law point of view. Thoughts will be focused on transsexuals and their rights to be treated according to an early internalized gender and some rights emerged from this treatment. Peruvian State role in this subject and the existing challenges will also be analyzed in the same way.

Fundamental frequency (F 0 ) of speech is used to measure the success of voice therapy in male-to-female transgender clients. This study evaluates the relationship between F 0 and patients' happiness with their voice. The study design used was a cross-sectional evaluation of client satisfaction questionnaires and voice recordings from transgender clients. This study was a comparative evaluation of voice recordings by voice professionals and lay observers. Twelve male-to-female transgender participants completed visual analogue scales (VASs), rating happiness with self-perceived femininity of their voice. Fifteen speech and language therapists (SLTs) and 40 naïve observers evaluated the anonymized recordings, using the same rating system. The correlation between mean F 0 and participant happiness was established. Relationships between participant happiness and rater opinions were explored. A significant relationship between F 0 and participant happiness could not be demonstrated (r ¼ 0.32, P ¼ 0.32). There was a moderately strong positive correlation between self-perception of vocal femininity and perception of femininity by SLTs and naïve observers (r ¼ 0.76 and 0.68, P ¼ 0.003 and P ¼ 0.01, respectively). This study demonstrates that happiness with voice in male-to-female transgender clients is not directly related to F 0 . Clients can assess femininity of their voice in the form of perceived pitch. This may not affect happiness scores. Voice satisfaction may not correlate with perceptions of supervising voice professionals. However, professionals can reliably evaluate how the voice will be received by the lay public. Subjective measures of patient satisfaction, including VASs, are reliable and valid tools in evaluating therapeutic success.

Purpose
The purpose of this research project was to obtain a global picture of osteopathic dysfunctions found in transmen who have undergone surgical gender reassignment, by studying more specifically the repercussions of mastectomy, genital reconstruction and testosterone.

Methodology
Thirty-seven participants were recruited, aged 21 to 54 years old, then divided in three groups of 12 transgender men, 12 cisgender women and 13 cisgender men. Data collection was done through a one-on-one interview with each participant, using a general health survey, as well as questions regarding the medical aspects of transition for the trans* participants. A series of 43 osteopathic tests and evaluations were performed on each of the 37 participants.

Results
Our study shows a significant number of repercussions on the superior cervical spine, cervicothoracic area, soft tissue of the neck and thorax. The pelvic mobility is also affected, whether through the bone structure or musculotendinuous elements. Visceral testing revealed changes in the mobility and motility of organs, and cranial tests showed a disturbance felt throughout the entire craniosacral axis.

Conclusion
Mastectomy, hysterectomy, testosterone and high levels of stress bring a tremendous amount of disruption in trans* subject’s homeostasis. With its holistic approach, osteopathy allows the practitioner to bring harmony between the body and soul, to care for the person while respecting their authenticity, and accompany them toward global wellness, and is therefore a treatment of choice to support trans* folks in their transition process.

This is the 5th in our series on Adolescent Health. abstract Gender nonconforming (GN) children and adolescents, collectively referred to as GN youth, may seek care to understand their internal gender identities, socially transition to their affirmed genders, and/or physically transition to their affirmed genders. Because general pediatricians are often the first point of contact with the health care system for GN youth, familiarity with the psychological and medical approaches to providing care for this population is crucial. The objective of this review is to provide an overview of existing clinical practice guidelines for GN youth. Such guidelines emphasize a multidisciplinary approach with collaboration of medical, mental health, and social services/advocacy providers. Appropriate training needs to be provided to promote comprehensive, culturally competent care to GN youth, a population that has traditionally been underserved and at risk for negative psychosocial outcomes.

There is a scarcity of research into the use of non-physician-sourced cross-sex hormones in the transgender population. However, when medication is not prescribed by health professionals, users' knowledge of such medication may be adversely affected. This study aims to define the prevalence of Internet-sourced sex hormone use in a population attending for initial assessment at a gender identity clinic, to compare the prevalence between gender-dysphoric men and women, and to compare knowledge of cross-sex hormone side effects between users who source cross-sex hormones from medical doctors and those who source them elsewhere. In the first part of the study, a cross-sectional design is used to measure the overall prevalence of sex hormone use among individuals referred to a gender clinic. The second part is a questionnaire survey aiming at measuring sex hormone knowledge among individuals referred to this clinic. Main outcome measures were (i) categorical data on the prevalence an...

The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14-18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different.

Objectives: To distinguish between three distinct groups of male and transgender sex workers in Pakistan and to demonstrate how members of these stigmatised groups need to be engaged in the research process to go beyond stated norms of behaviour.

A review ofcross-gender taxonomies shows thatprevious observers have identified and labeled a homosexual type far more consistently than any other category of male gender dysphoric. It is suggested that the apparent difficulty in differentiating reliably among the nonhomosexual types results from the sharing of many overlapping characteristics by the various groups. This is supported by a review of in formal, mostly clinical, observations and by the findings of three studies designed to test the hypothesis that the nonhomosexual gender dysphorias, together with transvestism, constitute a family of related disorders in men. It is concluded that the main varieties of nonhomosexual gender dysphoria are more similar to each other than an), of them is to the homosexual type. Two recommendations, based on the foregoing review, are offered for the classification of male gender dysphorics in research studies. When the number of subjëcts is small, they may be elassified simply as homosexual or nonhomosexual. When the number is larger, the nonhomosexual cases may be classified as heterosexual, bisexual, or analloerotic (unattracted to male or female partners, but not necessarily devoid of sexual drive or activities).

Übersicht: Das Modell der Informierten Zustimmung bietet Trans*-Men-schen einen alternativen Zugang zur gegengeschlechtlichen Hormonbehandlung. Um die gegengeschlechtliche Hormonbehandlung beginnen zu können, muss nach Maßgabe dieses Modells keine Psychotherapie durchgeführt werden. In der Folge reduzieren sich – je nach Gesundheitssystem – finanzielle Belastungen sowie Verzögerungen beim Zugang zu geschlechtsangleichenden Behandlungsmaßnahmen. Statt einer Fachkraft für psychische Gesundheit ist die primäre Gesundheitsfachkraft für das erste Erfassen der psychischen Gesundheit verantwortlich, und stellt fest, ob der_die Klient_in eine informierte Zustimmung zur angestrebten Behandlung geben kann. Das Modell der Informierten Zustimmung wird im Callen-Lorde Community Health Center seit mehr als zwanzig Jahren angewandt. Das Modell integriert die Trans*-Gesundheitsversorgung in die allgemeinmedizinische Grundversorgung und betont auf diese Weise deren ganzheitlichen Charakter. Das Modell der Informierten Zustimmung steht im Einklang mit der 7. Version der Versorgungsempfehlungen der World Professional Association for Transgender Health. Eine Überprüfung der Daten von N = 1714 Patienten für einen Zeitraum von zwei Jahren ergab weder ein Bedauern der Entscheidung noch eine Umkehr geschlechtsangleichender Operationen.

The authors evaluated emotional distress among 9th–12th grade students, and examined whether the association between being lesbian, gay, bisexual, and/or transgendered (i.e., “LGBT”) and emotional distress was mediated by perceptions of having been treated badly or discriminated against because others thought they were gay or lesbian. Data come from a school-based survey in Boston, Massachusetts (n = 1,032); 10% were LGBT, 58% were female, and ages ranged from 13 to 19 years. About 45% were Black, 31% were Hispanic, and 14% were White. LGBT youth scored significantly higher on the scale of depressive symptomatology. They were also more likely than heterosexual, non-transgendered youth to report suicidal ideation (30% vs. 6%, p < 0.0001) and self-harm (21% vs. 6%, p < 0.0001). Mediation analyses showed that perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males. Perceived discrimination is a likely contributor to emotional distress among LGBT youth.

The use of gonadotropin-releasing hormone analogs (GnRHa) to suppress puberty in adolescents with gender dysphoria is a fairly new intervention in the field of gender identity disorders or transsexualism. GnRHa are used to give adolescents time to make balanced decisions on any further treatment steps, and to obtain improved results in the physical appearance of those who opt to continue with sex reassignment. The effects of GnRHa are reversible. However, concerns have been raised about the risk of making the wrong treatment decisions, as gender identity could fluctuate during adolescence, adolescents in general might have poor decision-making abilities, and there are potential adverse effects on health and on psychological and psychosexual functioning. Proponents of puberty suppression emphasize the beneficial effects of GnRHa on the adolescents&#39; mental health, quality of life and of having a physical appearance that makes it possible for the patients to live unobtrusively in t...

Introduction.  Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual gender reassignment.Aim.  To compare psychological functioning and gender dysphoria before and after puberty suppression in gender dysphoric adolescents.Methods.  Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological functioning and gender dysphoria were assessed twice: at T0, when attending the gender identity clinic, before the start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.Main Outcome Measures.  Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and Anger Scales), general functioning (the clinician's rated Children's Global Assessment Scale), gender dysphoria (the Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.Results.  Behavioral and emotional problems and depressive symptoms decreased, while general functioning improved significantly during puberty suppression. Feelings of anxiety and anger did not change between T0 and T1. While changes over time were equal for both sexes, compared with natal males, natal females were older when they started puberty suppression and showed more problem behavior at both T0 and T1. Gender dysphoria and body satisfaction did not change between T0 and T1. No adolescent withdrew from puberty suppression, and all started cross-sex hormone treatment, the first step of actual gender reassignment.Conclusion.  Puberty suppression may be considered a valuable contribution in the clinical management of gender dysphoria in adolescents. de Vries ALC, Steensma TD, Doreleijers TAH, and Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. J Sex Med 2011;8:2276–2283.