Behavior Problems and Psychiatric Diagnoses in Girls with Gender Identity Disorder: A Follow-Up Study.

This study evaluated the presence of clinical range behavior problems and psychiatric diagnoses in 25 girls referred for gender identity disorder (GID) in childhood (mean age: 8.88 years) at the time of follow-up in adolescence or adulthood (mean age: 23.2 years). At follow-up, three (12%) of the girls were judged to have persistent GID based on DSM-IV criteria. With regard to behavior problems at follow-up, 39.1% of the girls had a clinical range score on either the Child Behavior Checklist or Adult Behavior Checklist as rated by their mothers, and 33.3% had a clinical range score on either the Youth Self-Report or the Adult Self-Report. On either the Diagnostic Interview for Children and Adolescents or the Diagnostic Interview Schedule, the girls had, on average, 2.67 diagnoses (range: 0-10); 46% met criteria for three or more diagnoses. From the childhood assessment, five variables were significantly associated with a composite Psychopathology Index (PI) at follow-up: a lower IQ, living in a non-two-parent or reconstituted family, a composite behavior problem index, and poor peer relations. At follow-up, degree of concurrent homoeroticism and a composite index of gender dysphoria were both associated with the composite PI. Girls with GID show a psychiatric vulnerability at the time of follow-up in late adolescence or adulthood, although there was considerable variation in their general well-being.

"I am not a friend to men": Embodiment and desire in Magnus Hirschfeld's Transvestites case studies.

This article reads sexological case studies of the fin-de siècle that contain accounts of trans women's lives in the period. It argues that these sources contradict the diagnostic criteria that doctors determine as the factors that define trans feminine identity in the period: desire for men, social isolation, and tortured bodily dissatisfaction. Chief among these contradictions is the prevalence of the expression of trans women's desire for women and easy participation in women's social and kinship networks. Therefore, this article considers these narratives to be a crucial and overlooked resource for considering the breadth of lesbian identity and sociality in the late nineteenth and early twentieth century.

Sexual Arousal Patterns of Autogynephilic Male Cross-Dressers.

Men's sexual arousal patterns have been an important window into the nature of their erotic interests. Autogynephilia is a natal male's paraphilic tendency to be sexually aroused by the thought or image of being a woman. Autogynephilic arousal per se is difficult to assess objectively, because it is inwardly focused. However, assessing sexual arousal patterns of autogynephilic males in response to external stimuli is also potentially useful. For example, there is substantial association between autogynephilia and gynandromorphophilia (GAMP), or sexual attraction to gynandromorphs (GAMs), colloquially "she-males." GAMP men's sexual arousal patterns in response to GAM, female, and male stimuli have recently been characterized. In the present study, we extended this understanding by comparing the sexual arousal patterns of autogynephilic male cross-dressers, GAMP men, heterosexual men, and homosexual men. Erotic stimuli included sexually explicit videos of men, women, and GAMs. Autogynephilic men were much more similar in their arousal patterns to heterosexual and GAMP men than to homosexual men. However, similar to GAMP men, autogynephilic men showed increased arousal by GAM stimuli relative to female stimuli compared with heterosexual men.

Proposals for Paraphilic Disorders in the International Classification of Diseases and Related Health Problems, Eleventh Revision (ICD-11).

The World Health Organization is currently developing the 11th revision of the International Classifications of Diseases and Related Health Problems (ICD-11), with approval of the ICD-11 by the World Health Assembly anticipated in 2018. The Working Group on the Classification of Sexual Disorders and Sexual Health (WGSDSH) was created and charged with reviewing and making recommendations for categories related to sexuality that are contained in the chapter of Mental and Behavioural Disorders in ICD-10 (World Health Organization 1992a). Among these categories was the ICD-10 grouping F65, Disorders of sexual preference, which describes conditions now widely referred to as Paraphilic Disorders. This article reviews the evidence base, rationale, and recommendations for the proposed revisions in this area for ICD-11 and compares them with DSM-5. The WGSDSH recommended that the grouping, Disorders of sexual preference, be renamed to Paraphilic Disorders and be limited to disorders that involve sexual arousal patterns that focus on non-consenting others or are associated with substantial distress or direct risk of injury or death. Consistent with this framework, the WGSDSH also recommended that the ICD-10 categories of Fetishism, Fetishistic Transvestism, and Sadomasochism be removed from the classification and new categories of Coercive Sexual Sadism Disorder, Frotteuristic Disorder, Other Paraphilic Disorder Involving Non-Consenting Individuals, and Other Paraphilic Disorder Involving Solitary Behaviour or Consenting Individuals be added. The WGSDSH's proposals for Paraphilic Disorders in ICD-11 are based on the WHO's role as a global public health agency and the ICD's function as a public health reporting tool.

Health, disability and quality of life among trans people in Sweden-a web-based survey.

BACKGROUND: Swedish research concerning the general health of trans people is scarce. Despite the diversity of the group, most Swedish research has focused on gender dysphoric people seeking medical help for their gender incongruence, or on outcomes after medical gender-confirming interventions. This paper examines self-rated health, self-reported disability and quality of life among a diverse group of trans people including trans feminine, trans masculine, and gender nonbinary people (identifying with a gender in between male of female, or identify with neither of these genders) as well as people self-identifying as transvestites. METHODS: Participants were self-selected anonymously to a web-based survey conducted in 2014. Univariable and multivariable regression analyses were performed. Three backward selection regression models were conducted in order to identify significant variables for the outcomes self-rated health, self-reported disability and quality of life. RESULTS: Study participants included 796 individuals, between 15 and 94 years of age who live in Sweden. Respondents represented a heterogeneous group with regards to trans experience, with the majority being gender nonbinary (44 %), followed by trans masculine (24 %), trans feminine (19 %) and transvestites (14 %). A fifth of the respondents reported poor self-rated health, 53 % reported a disability and 44 % reported quality of life scores below the median cut-off value of 6 (out of 10). Nonbinary gender identity (adjusted Odds Ratio (aOR) = 2.19; 95 % CI: 1.24, 3.84), negative health care experiences (aOR = 1.92; 95 % CI: 1.26, 2.91) and not accessing legal gender recognition (aOR = 3.06; 95 % CI: 1.64, 5.72) were significant predictors for self-rated health. Being gender nonbinary (aOR = 2.18; 95 % CI: 1.35, 3.54) and history of negative health care experiences (aOR = 2.33; 95 % CI: 1.54, 3.52) were, in addition, associated with self-reported disability. Lastly, not accessing legal gender recognition (aOR = 0.32; 95 % CI: 0.17, 0.61) and history of negative health care experiences (aOR = 0.56; 95 % CI: 0.36, 0.88) were associated with lower quality of life. CONCLUSIONS: The results of this study demonstrate that the general health of trans respondents is related to vulnerabilities that are unique for trans people in addition to other well-known health determinants.

[Profile of transvestites and transgender women: tuberculosis and HIV/AIDS in the city of São Paulo]. / Perfil de travestis e transgêneros: tuberculose e HIV/Aids na cidade de São Paulo.

OBJECTIVE: To characterize the profile of transvestites and transgender women participating in a survey regarding tuberculosis and HIV/Aids in the city of São Paulo. METHOD: This cross-sectional study employed the Knowledge, Attitudes and Practices (KAP) questionnaire adapted for data collection. Sociodemographic aspects as well as aspects related to history of imprisonment, process of gender transition, use of condoms, previous treatment of sexually transmitted diseases and tuberculosis and knowledge regarding HIV/Aids were addressed. RESULTS: The study included 58 transvestites and 66 transgender women. There were differences between the two groups regarding schooling (P = 0.008), prostitution (P < 0.001), imprisonment (P < 0.001), silicone injections (P = 0.005), and hormone therapy without medical guidance (P = 0.004). All trans women (100%) and 80% of transvestites mentioned treatment of syphilis; 25.9% of transvestites reported tuberculosis/HIV co-infection. The investigation regarding knowledge of HIV/AIDS revealed inconsistent use of condoms and mistaken beliefs related to modes of transmission. CONCLUSION: The present results show that transvestites and trans women were vulnerable to tuberculosis and HIV/AIDS. The differences observed between the two groups suggest the need for different approaches to transvestites and transgender women in future studies.

Psychiatry and the 'Gay Holocaust' - the lessons of Jill Soloway's Transparent.

OBJECTIVE: We aim to consider issues relevant to psychiatry raised by the television series, Transparent. CONCLUSIONS: Psychiatry's disturbing history regarding the lesbian, gay, bisexual, transgender and intersex (LGBTI) community shares many aspects with the group's persecution by the National Socialist regime in Germany. The medicalised 'otherness' conferred on LGBTI patients, latent homophobia and transphobia, and lack of culturally sensitive clinical services for these people represent a major ethical challenge for modern Australasian psychiatry.

Cases of violence involving transvestites and transsexuals in a northeastern Brazilian city. / Situações de violência contra travestis e transexuais em um município do nordeste brasileiro.

Objective To analyze cases of violence against transvestites and transsexuals based on their sociodemographic profile. Method Cross-sectional, descriptive research performed in Cajazeiras / Paraíba, consisting of 16 transvestites and transsexuals. Data collection took place in April 2014 and was analyzed descriptively. Results The typology of violence that victimized transvestites and transsexuals were: verbal (91.96%), psychological (58.33%) and physical (33.33%), often between 24 hours and six months preceding the survey. Regarding the spatiality: the street, school and health services were all scenarios of aggression. With respect to the offending agent, the findings point towards neighbors, family members and health professionals. All forms of violence happened between agents and spaces of aggression. Conclusions Violence among this population, silence around the situations of abuse became more pronounced as did its invisibility in the social and institutional context, reflecting the inhibition of human rights and concealment of reality.

The Psychometric Structure of Items Assessing Autogynephilia.

Autogynephilia, or paraphilic sexual arousal in a man to the thought or image of himself as a woman, manifests in a variety of different behaviors and fantasies. We examined the psychometric structure of 22 items assessing five known types of autogynephilia by subjecting them to exploratory factor analysis in a sample of 149 autogynephilic men. Results of oblique factor analyses supported the ability to distinguish five group factors with suitable items. Results of hierarchical factor analyses suggest that the five group factors were strongly underlain by a general factor of autogynephilia. Because the general factor accounted for a much greater amount of the total variance of the 22 items than did the group factors, the types of autogynephilia that a man has seem less important than the degree to which he has autogynephilia. However, the five types of autogynephilia remain conceptually useful because meaningful distinctions were found among them, including differential rates of endorsement and differential ability to predict other relevant variables like gender dysphoria. Factor-derived scales and subscales demonstrated good internal consistency reliabilities, and validity, with large differences found between autogynephilic men and heterosexual male controls. Future research should attempt to replicate our findings, which were mostly exploratory.

[Simplified indicator of socioeconomic status in short surveys: a proposal based on assets and services]. / Medición simplificada del nivel socioeconómico en encuestas breves: propuesta a partir de acceso a bienes y servicios.

OBJECTIVE: To develop a socioeconomic index for brief surveys that allows a classification in relation to a reference population with a parsimonious approach. MATERIALS AND METHODS: A socioeconomic index was created using assets and use of services indicators to predict income level within a national representative survey of income (ENIGH, National Survey of Households Income and Expenditures) and then tested with data from a survey among key populations (men who have sex with men/transvestite, transgender, transsexual/female sex workers) and compared to an already published indicator. RESULTS: The concordance for quintiles 1, 2, 3, 4, and 5 between the two indexes were 94, 94, 82, 83, and 89%, respectively. The Spearman's rank correlation coefficient was 0.85. CONCLUSIONS: The proposed parsimonious index captures the socioeconomic level heterogeneity in the MSM/TTT/FSW survey. The use of this index is suggested for short surveys because of the next advantages: a) it uses dichotomic variables; b) the variables used do not imply the fulfillment of any statistical assumption; c) it is easily calculated; d) it can be used for comparing groups.

Healthcare program for sex workers: a public health priority.

OBJECTIVE: The objective of this study was to propose a model of health care for sexual workers (SWs) and transvestites (Ts) groups who were historically excluded from health services. MATERIALS AND METHODS: A prospective descriptive/analytical study with an intervention stage was performed, focusing on the health status of SWs and Ts. Access to health system, inclusion into social programs, beneficiaries' participation, and rate of risk behaviors were variables measured before and after intervention that consist in a program based on promotion/prevention activities and complete health care service suitable to SW-T needs. RESULTS: Nine hundred and fifty SW-Ts were included. At baseline, 99.7% lacked health insurance and 90.1% had no access to the health care. These data were compared with those obtained after attention quadruplicated among SW because of the implementation of the program. Risky sexual behaviors were reduced by 25 times. SWs have their own leader of health institutions and coordinate themselves with the program's activities. CONCLUSION: Responsibility of the state's authorities on vulnerable groups must focus on their inclusion. To this end, health services must adapt themselves in order to attend those community groups with special needs. Active participation of the target population contributes to viability of this type of proposals, and it is essential for the project's success.

Men's sexual interest in children: one-year incidence and correlates in a population-based sample of Finnish male twins.

In a study of 1,310 Finnish adult male twins we found that sexual interest in children aged 12 or younger was reported by 0.2% of the sample. Sexual interest in children aged 15 or younger was reported by 3.3%. Participants reporting sexual interest in children aged 15 or younger were younger, reported stronger sexual desire, and had experienced more childhood sexual and nonsexual abuse. The present study is the first to give a population-based estimate of the incidence of sexual interest in children among adult men. The 12-month incidence of sexual interest in children below the age of 16 years is roughly comparable to the one-year incidence of major depression or the lifetime prevalence of transvestitic fetishism.

[The fake lady on trial: transvestitism in psychiatry and the sexual sciences, or the regulation of public dress-code]. / Die falsche Hofdame vor Gericht: Transvestitismus in Psychiatrie und Sexualwissenschaft oder die Regulierung der öffentlichen Kleiderordnung.

With the publication of Carl Westphal's "die conträre Sexualempfindung" or "the Contrary Sexual Feeling" (1870), non-conform sexual/gender behavior, such as wearing clothing from the opposite gender, fell within psychiatry's field of activity; psychiatrists cooperated with law enforcement to maintain the public ordering of the sexes. On the basis of the Charité's medical records of a male patient, reported to have publically appeared in women's clothing and thereby making headlines in 1910 as the 'fake lady', the positions of psychiatrist Theodor Ziehen and sexual scientist Magnus Hirschfeld stand in contrast to one another--a development, which affected their forensic argumentation. As Hirschfeld had, in the same year 1910, introduced the concept of transvestitism to describe this very phenomenon, a transfer of competing interpretations out of sexual science and into psychiatry can be studied. The circulation of Magnus Hirschfeld's questionnaire to the vita sexualis allows for an investigation of the effects of such on the collective, biographical narration of sexual minorities, as well as on diagnostic capacity in psychiatry, in reference to transvestitism. An analysis of press-reports on the case and trials of the 'fake lady' approaches the question, how non-conform sexual behavior was to be recognized or identified in public and, for the sake of prevention, how it was explained. Such an analysis also investigates the role of the press in the popularization of Hirschfield's transvestitism concept.

Ghanaian youth and festive transvestism.

'Festive transvestism' is an increasingly visible cross-dressing practice performed by young people in the Southern parts of contemporary Ghana. Based on participant observation in four cross-dressing events, 15 individual interviews and a focus-group discussion, festive cross-dressing is understood as a contemporary ritual that mainly serves the purpose of reinforcing and reproducing gender binaries as well as heteronormativity in Ghanaian society. Nevertheless cross-dressing events also provide a subjective, creative and exploratory space--although temporary and circumscribed--for the transvestites as well as for the spectators to deconstruct sex, gender and sexuality through the performativity of transvestism. The opening of this exploratory space is made possible by the liminality of the social category of youth in Ghana, which grants young people, especially young men, more liberty and (gender) flexibility. Finally, the paper challenges the widely spread Western perception that feminine men and cross-dressers are necessarily homosexual by resituating the concept of homosexuality within the context of Ghanaian society, where it has recently started to occupy the public space.

Complicated suicide versus autoeroticism?: a case involving multiple drugs and a porta-potty.

In this report, a unique and bizarre case of complicated suicide is presented. The decedent was found dead in the basin of a porta-potty, wearing women's pantyhose, jewelry, and makeup. The initial investigation was suspect for homicide. Although an autoerotic accidental death cannot be excluded, the patient's medical history and autopsy results provided evidence for suicide, including several substances positive in his serum. Tramadol was quantified to be 140 mg/L, approximately 470 times the therapeutic range. Moreover, formaldehyde was also present, presumably absorbed from the contents of the chemical toilet. An exhaustive search could not reveal similar circumstances of suicide in a porta-potty or with the levels of tramadol found in the decedent.

Systematic review on health care for transvestites and transsexuals in Brazil.

OBJECTIVE: To synthesize scientific evidence to characterize health care for transvestites and transsexuals in Brazil. METHODS: This is a systematic review, conducted from July 2020 to January 2021 and updated in September 2021, whose protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO) platform, under code CRD42020188719. The survey of evidence was carried out in four databases and eligible articles were evaluated for methodological quality, and those with a low risk of bias were included. RESULTS: Fifteen articles were selected and the findings were grouped into six categories according to their thematic approaches: Possibilities to transform health care; Transvestiphobia and transphobia: violations inside and outside the Brazilian Unified Health System (SUS); Professional unpreparedness to care for transvestites and transsexuals; Search for health care alternatives; Right to health for transvestites and transsexuals: utopia or reality?; The Transsexualization Process: advances and challenges. CONCLUSIONS: There is evidence that health care for transvestites and transsexuals in Brazil is still exclusive, fragmented, centered on specialized care and guided by curative actions, resembling the care models that preceded the SUS and which have been heavily criticized since the Brazilian Sanitary Reform.

Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism.

This study provided a descriptive and quantitative comparative analysis of data from an assessment protocol for adolescents referred clinically for gender identity disorder (n = 192; 105 boys, 87 girls) or transvestic fetishism (n = 137, all boys). The protocol included information on demographics, behavior problems, and psychosexual measures. Gender identity disorder and transvestic fetishism youth had high rates of general behavior problems and poor peer relations. On the psychosexual measures, gender identity disorder patients had considerably greater cross-gender behavior and gender dysphoria than did transvestic fetishism youth and other control youth. Male gender identity disorder patients classified as having a nonhomosexual sexual orientation (in relation to birth sex) reported more indicators of transvestic fetishism than did male gender identity disorder patients classified as having a homosexual sexual orientation (in relation to birth sex). The percentage of transvestic fetishism youth and male gender identity disorder patients with a nonhomosexual sexual orientation self-reported similar degrees of behaviors pertaining to transvestic fetishism. Last, male and female gender identity disorder patients with a homosexual sexual orientation had more recalled cross-gender behavior during childhood and more concurrent cross-gender behavior and gender dysphoria than did patients with a nonhomosexual sexual orientation. The authors discuss the clinical utility of their assessment protocol.

Facilitating access to sexual health services for men who have sex with men and male-to-female transgender persons in Guatemala City.

The purpose of this study was to identify barriers to accessing sexual health services among gay, bisexual and heterosexual-identifying men who have sex with men and male-to-female transgender persons in Guatemala City, to inform the development of high quality and population-friendly services. In-depth, semi-structured interviews were conducted with 29 purposively sampled individuals, including 8 transgender, 16 gay/bisexual and 5 heterosexual-identifying participants. Topical codes were applied to the data using software Atlas.ti™ to compare data between sub-groups. Analysis revealed that public clinics were most commonly used due to their lower cost and greater accessibility, but many participants experienced discrimination, violation of confidentiality and distrust of these services. Transgender and gay/bisexual-identifying participants preferred clinics where they felt a sense of belonging, while heterosexual-identifying participants preferred clinics unassociated with the men who have sex with men community. The most prominent barriers to sexual health services included fear of discrimination, fear of having HIV, cost and lack of social support. Findings highlight the need to strengthen existing public sexually transmitted infection clinics so that they address the multiple layers of stigma and discrimination that men who have sex with men and transgender persons experience.