Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil.

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

Body construction and health itineraries: a survey among travestis and trans people in Rio de Janeiro, Brazil / A construção do corpo e itinerários de saúde: um estudo entre travestis e pessoas trans no Rio de Janeiro, Brasil / Construcción corporal e itinerarios de salud: una encuesta entre travestis y personas trans en Río de Janeiro, Brasil

The article examines health itineraries followed by Brazilian travestis, trans men and trans women in the affirmation of their gender, based on the survey Trans Uerj: Health and Citizenship of Trans People in Brazil. The survey's main objectives were to gauge the trans/travesti population's diversity and sociodemographic profile; and to map the various ways they access their rights as citizens, especially to healthcare services and body modification technologies. Interviewers, mainly trans people and travestis, applied 391 questionnaires in the city of Rio de Janeiro and its metropolitan region to interviewees of different social classes, schooling levels and gender identity configurations, contacted through the interviewers' social networks. For defining respondents' gender identities the survey used an original method based on self-definitions, which were then aggregated into 6 categories for data analysis purposes. This article discusses the multiple strategies used by this trans population in gender affirmation processes to gain access to regulated and/or unregulated use of hormones and surgical procedures.

O artigo examina os itinerários de saúde seguidos por travestis e mulheres e homens trans brasileiros na afirmação do seu próprio gênero, com base no inquérito Trans Uerj: Health and Citizenship of Trans People in Brazil. O inquérito teve como objetivos avaliar a diversidade e o perfil sociodemográfico da população trans/travesti e mapear as diversas maneiras pelas quais garantem seus direitos de cidadania, principalmente nos serviços saúde e em tecnologias de modificação do corpo. Os entrevistadores, majoritariamente pessoas trans e travestis, aplicaram 391 questionários na cidade e Região Metropolitana do Rio de Janeiro, com entrevistados/as de diferentes classes sociais, níveis de escolaridade e configurações de identidade de gênero, contatados através das redes sociais dos entrevistadores. A definição da identidade de gênero dos entrevistados usou um método original baseado nas autodefinições; as definições foram agregadas depois em seis categorias para fins de análise dos dados. O artigo discute as múltiplas estratégias utilizadas pela população trans nos processos de afirmação de gênero para obter acesso ao uso regulado e/ou não regulado de hormônios e procedimentos cirúrgicos.

El artículo examina los itinerarios de salud seguidos por travestis brasileños, hombres trans y mujeres trans para la afirmación de su género, está basado en la encuesta Trans Uerj: Health and Citizenship of Trans People in Brazil. Los objetivos principales de esta encuesta fueron evaluar la diversidad de la población trans/travesti y su perfil sociodemográfico; así como mapear los diferentes caminos gracias a los que consiguen tener acceso a sus derechos como ciudadanos, especialmente en lo que concierne a servicios de salud y técnicas de modificación corporales. Se entrevistaron principalmente a personas trans y travestis, de quienes se recabaron 391 cuestionarios en la ciudad de Río de Janeiro y su región metropolitana, procedentes de diferentes clases sociales, niveles educacionales y configuraciones de identidad de género, que fueron contactados a través de redes sociales por parte de los entrevistadores. Con el fin de definir las identidades de género de quienes respondieron la encuesta, se usó un método original basado en autodefiniciones, que posteriormente fueron añadidas a 6 categorías para fines de análisis de datos. Este artículo discute las múltiples estrategias utilizadas, por parte de esta población trans en procesos de afirmación de género, para conseguir acceso al uso de hormonas reguladas y/o irregulares, así como procedimientos quirúrgicos.

Gender identity disorder and its medico-legal considerations.

The general belief among behavioural scientists and physicians is that gender identity disorder or transsexualism is an identifiable and incapacitating disease which can be diagnosed and successfully treated by reassignment surgery in carefully selected patients. Although many advances have been made in the reassignment surgery techniques, phalloplasty still remains a major challenge; to date, no ideal technique has been developed. The new gender created by the reassignment surgery has, in turn, led to many legal complications for post-operative transsexuals because, in many developed and the developing countries, transsexuals are not given a legal identity, thereby adding to their agonies and miseries. This article examines the historical perspective, genesis and management of gender identity disorder, or transsexualism, and draws attention to the medico-legal considerations.

Family attitudes toward transgendered people in Turkey: experience from a secular Islamic country.

OBJECTIVE: In Turkey, an individual with gender identity disorder is stigmatized and isolated from society. The family largely reflects and reinforces these negative views because gender crossing poses a threat to the normatively sanctioned gender classification. METHODS: We examined the acceptance of gender identity differences by the families in 47 relatives of 39 transgendered individuals who applied to a psychiatry clinic for sex reassignment. RESULTS: Half of the relatives who came to the interview were mothers. While 85.1% of the families considered themselves as secular muslims, 14.9% were very religious. They first noticed the gender identity disorder during puberty (70.2%) or prepuberty (17%). In 63.8% it was remarked that it was a shocking experience. One-third of them felt responsible for it. While 65.9% tried to change the situation by coercion, only 27.7% adopted a supportive attitude. The majority of families tried to conceal the situation from their immediate environment and one-third did not even inform their closest relatives. For half of relatives the mass media was their only source of information whereas one-third received information from doctors. Most of the families were satisfied with the treatment. Family members also reported that the conformity of the transgendered relative within the family improved. Of the family members, 40.4% accepted the transgendered identity and approved the sex reassignment surgery as a final step. CONCLUSION: Involvement of family members in the process of change for the transgendered individual is important for both the family as well as the individual concerned.

Anorexia nervosa and gender identity disorder in biologic males: a report of two cases.

UNLABELLED: Gender identity disorder is a rare disorder of uncertain etiology. The emphasis on body shape in this disorder suggests that there may be an association with anorexia nervosa. METHOD: We report two cases of anorexia nervosa and gender identity disorder in biologic males who presented to an eating disorders service. RESULTS: One was treated successfully as an outpatient and subsequently underwent gender reassignment surgery. The other patient required admission and prolonged psychotherapy. DISCUSSION: Differences between the two cases are discussed. Issues of gender identity should be considered in the assessment of male patients presenting with anorexia nervosa.

Comparisons of two groups of sex-change applicants based on the MMPI.

Out of 29 men asking for a sex-change, 16 reported clinical anamnesis criteria for transsexualism according to the DSM-III-R, a more restrictive diagnosis than the DSM-IV gender dysphoria diagnosis. In addition, all the subjects had taken an MMPI which, of course, did not contribute to the transsexualism diagnosis but which served to describe their personalities. The 16 subjects diagnosed as transsexual and the 13 who did not qualify for this diagnosis were compared on the basis of personality variables measured by the MMPI. Certain differences became evident. The transsexuals systematically complied to cultural stereotypes of femininity without any uneasiness, whereas the nontranssexuals could be subdivided into two groups, those with a vague sense of ill-being linked to a pronounced feminine identity or those with only a slight feminine identity and who showed no particular difficulties.

Prenatal exposure to anticonvulsants and psychosexual development.

Animal studies have shown that prenatal exposure to the anticonvulsant drugs phenobarbital and phenytoin alters steroid hormone levels which consequently leads to disturbed sexual differentiation. In this study, possible sequelae of prenatal exposure to these anticonvulsants on gender development in humans were investigated. A follow-up study was carried out in phenobarbital- and phenytoin-exposed subjects and control subjects matched for age, sex, and the mothers' ages. Subjects were born in the Academic Medical Center between 1957 and 1972. Out of 243 exposed and 222 control subjects who were asked to volunteer, 147 exposed subjects (72 male, 75 female) and equal numbers of their matched control subjects participated in the follow-up study. They were interviewed and were asked to fill out questionnaires on gender role behavior, gender development, and sexual orientation. As a group, exposed and control subjects did not differ with respect to gender role behavior, although higher numbers of prenatally anticonvulsant-exposed subjects reported current or past cross-gender behavior and/or gender dysphoria. Three prenatally anticonvulsant-exposed subjects were transsexuals and had undergone sex reassignment surgery, a remarkably high rate given the rarity of transsexualism. In addition, two exposed males had exclusively homosexual experiences, whereas none of the control males reported exclusive homosexual behavior. The groups did not differ in attainment of pubertal psychosexual milestones.

Social desirability response set and systematic distortion in the self-report of adult male gender patients.

This study showed that the "socially desirable" presentation for a heterosexual male gender dysphoric is one that emphasizes traits and behaviors characteristic of "classic" transsexualism. Fifty-one homosexual and 64 heterosexual adult male gender patients were administered the Crowne-Marlowe (1964) Social Desirability Scale as well as eight questionnaire measures that tapped various features of the clinical history commonly given great weight in differential diagnosis. The tendency for a heterosexual subject to describe himself in terms of moral excellence or admirable personal qualities was significantly correlated with scores in the "transsexual" direction on all eight sexological measures; for the homosexual subjects, only one correlation was significant. It is argued that the patients most motivated to create a favorable impression on the examiner are likely to be those most anxious to obtain approval for sex reassignment surgery. Because, in this population, the socially desirable presentation is "feminine," it is possible that the differences in the histories produced by transvestites and heterosexual transsexuals are exaggerated to an unknown degree by the motivation of the latter to obtain approval for this operation. The findings do not diminish the important distinction between these groups, but they do suggest caution in interpreting the self-report data that have been used in comparing them.

Outcome of sex reassignment surgery.

Three independent reviews of the world literature dealing with the outcome of sex reassignment surgery in transsexualism are presented. In 10-15% of the patients who undergo sex reassignment the results end up in a failure. There are as many failures in the female to male group as in the male to female group. Optimal results from the surgical procedures are important for a successful outcome. Relatively high age when first requesting sex reassignment may be regarded as a risk factor for poor outcome. Genuine transsexuals as a group seem to have a better prognosis for successful outcome of sex reassignment than a group of secondary transsexuals (i.e. transvestites and effeminate homosexuals). On the other hand, secondary transsexuals do better than genuine transsexuals when sex reassignment is refused. It is stressed that great importance should be given to the differential diagnosis when evaluating gender dysphoric patients for sex reassignment.

Psychosocial characteristics of applicants evaluated for surgical gender reassignment.

Social, sexual, economic, familial, and psychological characteristics of 764 applicants for surgical gender reassignment, 479 males and 285 females, who completed the application questionnaire and were subsequently interviewed by the Gender Dysphoria Program in Palo Alto, California, are examined. All information except diagnosis was obtained from the applicants' responses to a standardized 100-item questionnaire. Diagnosis was determined by a psychiatrist after a 1 1/2-hour interview. A comparison of male applicants to female applicants indicated differences in five areas: (1) sexual history; (2) acting-out behavior or sociopathy; (3) work history; (4) strategies for physically passing in the desired gender, e.g., hormone therapy; and (5) diagnosis. Females had experienced more stable same-sex sexual relationships and fewer opposite-sex sexual relationships than the males had experienced. The females exhibited less acting-out behavior, indicated by few criminal convictions and little involvement in prostitution, compared to the male applicants. Twice as many males as females were unemployed and receiving welfare at the time of application. In addition, males used cosmetic surgery and hormone therapy more frequently to facilitate physically passing in the desired gender than did the females. The most frequent diagnosis for males was transvestitism, while for the females it was classic transsexualism.

The clinical syndromes of femmiphilic transvestism.

Thirty-four members of a club established for heterosexual transvestites were interviewed. They were categorized into two groups. Subjects in group I were satisfied with cross-dressing and did not desire additional feminization. Subjects in group II desired to alter their bodily appearance toward female by taking female hormones or by having surgical intervention. Group II transvestites cross-dressed more frequently and had a more intense feminine gender identity and stronger homosexual interests than did group I transvestites. A feminine gender identity appeared to be present from childhood in both groups but to be stronger in group II. Cross-dressing in subjects of both groups often occurred first during childhood and almost always prior to age 15. All subjects showed a period of fetishistic arousal to women's clothes during adolescence. With increasing age, fetishistic arousal diminished or disappeared and the frequency of cross-dressing increased. Terms in the literature used to describe the type of transvestism reported in this study are discussed. It was suggested that the term "femmiphilic transvestism" be used to describe the condition of the subjects of both groups. The term has fewer disadvantages than terms previously suggested.