[Transgender in Adolescence: State of the Art and Future Research Needs]. / Transgender im Jugendalter: Forschungsstand und zukünftiger Forschungsbedarf.

Transgender in adolescence is currently a widely discussed topic, additionally reflected by an increasing prevalence in clinical practice. The present review of the available literature on transgender, trans* , gender dysphoria or gender incongruence in youth reports results on the long-term results of medical interventions for the psychological well-being, prevalence, referral rates and sex ratio, developmental pathways, current developments and the role of the social environment. Finally, implications for clinical care and future research will be discussed.

Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study.

OBJECTIVE: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population. METHODS: This study used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt. RESULTS: Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98). CONCLUSIONS: In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.

[THE MEDICAL CARE OF TRANSGENDER PEOPLE].

INTRODUCTION: The phenomenon of the discrepancy between a person's sexual self-perception and his/her genetic sex has been known to medicine since the mid-19th century. Initially, this discrepancy was considered to be a mental disorder. Over time, advances in medical abilities in surgery, hormonal treatment and infertility, have enabled physicians to help those who are affected to fulfill their wish. The present notion is that transsexualism is a solvable problem (whether the desired wish is for a man to become a woman or vice versa). Treatment is both complicated (surgery) as well as chronic (hormones). In this review the various medical aspects of the different possible treatments are discussed, excluding the psychological part of this intriguing condition.

Sexual preferences and associated disorders: toward an extended model for description. / Preferencje seksualne i zwiazane z nimi zaburzenia: w strone rozszerzonego modelu opisu.

The notion of human sexual preferences relates to relatively stable patterns of sexual response and to directing sexual behaviors toward specific arousing stimuli, which are also important for sexual satisfaction. The preferences may pertain to the properties of the object or the sexual activity itself. Diagnosing sexual preferences, in its basic form, is conducted with the use of disorder criteria defined in diagnostic classifications (ICD-10, DSM-5). However, while employing these criteria enables the categorization of the patient's sexual preferences as normal or pathological, they seem clearly insufficient for describing complex sexual interest patterns in a comprehensive manner. The goal of this article is to present a detailed dimensional model for describing sexual preferences. This proposal assumes the description of two aspects of preference: a contentual aspect, defining the individual hierarchy of sexually attractive and aversive stimuli, and a formal aspect. The latter involves four dimensions: the diversity of stimuli falling within the pattern of the patient's sexual interest, preference changeability in time, the coherence between individual components of responding to sexual stimuli, and insight into one's own preferences. The proposed model supplements the basic description of sexual preferences conducted on the basis of diagnostic criteria. The model can be a tool useful for diagnostic practice, particularly in precise characterization of various difficulties experienced by patients in relation to the properties of their sexual interests. It can also inspire new research on features of human sexual response patterns which have been neglected in previous analyses.

Trastorno de identidad de género: Parte I. Definición, epidemiología, etiología, rol del endocrinólogo en diagnóstico y tratamiento / Gender identity disorders: definition, etiology,epidemiology and role of the endocrinologist in theirmanagement

Gender identity disorders (GID) or transsexuality have been a latent issue in Chile 20 years after the first sex reassignment treatment in 1973. Sexual minority groups have posed the problem and even present a bill for civil sexual change. Since the nineties, the number of consultants due to gender identity problems has increased steadily, including children and adolescents. The lack of medical expertise in the area, requires urgent training programs. The first part of this manuscript will deal with the definition, epidemiology, etiology and role of the endocrinologist in the process of sexual reassignment among patients with gender identity disorders. We review sexual differentiation, brain sexual dimorphism and Sexual Development Disorders (SDD) aiming to understand the neurobiological causes of GID and to perform a better differential diagnosis with Sexual Development Disorders. GID are not a psychiatric disease. However the suffering caused by stigmatization, exclusion andabuse generate emotional problems (gender dysphoria). SDD has a genetic and hormonal basis in most cases. Its clinical expression at birth can cause an erroneous civil sex assignation or a discordant civil sex with the sexual identity of the person when there is a surgical correction. GIS without gender dysphoria was excluded as a mental disease from DSM-V and it will also be excluded from the eleventh version of the international classification of diseases. It will maintained as a condition that should be differentiated from SDD and whose treatment should be financed by health systems.

Documento de posicionamiento: disforia de género en la infancia y la adolescencia. Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN) / Position statement: Gender dysphoria in childhood and adolescence. Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN)

La disforia de género (DG) en la infancia y adolescencia es una condición compleja, siendo importante la detección precoz y el tratamiento integral, ya que con ello se mejora la calidad de vida, disminuye la comorbilidad mental y la propia DG. En este documento de posicionamiento, el Grupo de Identidad y Diferenciación Sexual de la Sociedad Española de Endocrinología y Nutrición (GIDSEEN), integrado por especialistas de Endocrinología, Psicología, Psiquiatría, Pediatría y Sociología, establece unas recomendaciones sobre la evaluación y tratamiento de la DG en niños y adolescentes. El manejo interdisciplinar de la DG debe llevarse a cabo en unidades con equipos especializados (UTIG) y considerando que cualquier intervención sanitaria debe seguir los principios del rigor científico, la experiencia acumulada, los principios éticos y deontológicos y la prudencia necesaria ante tratamientos crónicos, agresivos e irreversibles

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments

Between DSM and ICD: Paraphilias and the Transformation of Sexual Norms.

The simultaneous revision of the two major international classifications of disease, the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, serves as an opportunity to observe the dynamic processes through which social norms of sexuality are constructed and are subject to change in relation to social, political, and historical context. This article argues that the classifications of sexual disorders, which define pathological aspects of "sexually arousing fantasies, sexual urges or behaviors" are representations of contemporary sexual norms, gender identifications, and gender relations. It aims to demonstrate how changes in the medical treatment of sexual perversions/paraphilias passed, over the course of the 20th century, from a model of pathologization (and sometimes criminalization) of non-reproductive sexual behaviors to a model that reflects and privileges sexual well-being and responsibility, and pathologizes the absence or the limitation of consent in sexual relations.

Diferencias de género en el trastorno delirante / Gender differences in delusional disorder

El objetivo de nuestro estudio fue explorar las diferencias de género en trastorno delirante (TD) comparando aspectos sociodemográficos, factores de riesgo, correlatos clínicos y características del curso del trastorno. La muestra se compuso de 50 pacientes con primer ingreso psiquiátrico y con diagnóstico de TD (según SCID-I para criterios DSM-IV). Los casos fueron evaluados retrospectivamente mediante la revisión de historia clínicas mediante el cuestionario OPCRIT 4.0 y un inventario diseñado por los autores que comprendió distintos aspectos clínicos no recogidos en el anterior instrumento. La proporción mujer-hombre fue de 1.27:1. La edad del primer ingreso psiquiátrico fue más alta en mujeres. Respecto a los potenciales factores de riesgo, los hombres presentaron mayor prevalencia de Trastornos por uso de sustancias premórbido mientras las mujeres más retraimiento social y síntomas depresivos previos al inicio del trastorno. En relación a la sintomatología delirante, los hombres presentaron mayor frecuencia de delirios generalizados, de grandiosidad, de celos y persecución; mientras que las mujeres presentaron mayor frecuencia de delirio erotomaniaco así como percepciones y humor delirantes. Los hombres presentaron mayor frecuencia de aumento de la estima del Self y las mujeres insomnio inicial y de media noche. No se observaron diferencias de género en otros factores sociodemográficos, potenciales factores de riesgo, correlatos clínicos y características del curso de la enfermedad (AU)

The objective of our study was to explore gender differences in Delusional Disorder (DD) comparing sociodemographic, clinical and risk factors and course ́s characteristics. The sample was compound of 50 inpatients during their first psychiatric entrance and diagnosis of DD (according to SCID-I for DSM-IV criteria). Cases were evaluated retrospectively by means of medical records revision, OPCRIT 4.0 and an inventory created by authors, about not gathered aspects. The proportion woman-man was of 1.27:1. The age of the first psychiatric entrance was higher in women. Men presented greater prevalence of Disorders for use of drugs before; while the women suffered more social retirement and previous depressive symptoms. Men presented greater frequency of generalized, megalo-maniac, and jealousy and persecution delusions; whereas women displayed greater frequency of erotomaniac delusions, as well as delusional affectivity and perceptions. Men presented greater frequency of increase of the esteem of the Self; and women displayed initial insomnia and of average night more frequently. Differences in other sociodemographic, clinical and risk factors, and course ́s characteristics were not observed (AU)

Stop Harassment Men's reactions to victims' confrontation / ¡Stop Acoso! Reacciones de los hombres a la confrontación de las víctimas

Sexual harassment is one of the most widespread forms of gender violence. Perceptions of sexual harassment depend on gender, context, the perceivers' ideology, and a host of other factors. Research has underscored the importance of coping strategies in raising a victim's self-confidence by making her feel that she plays an active role in overcoming her own problems. The aim of this study was to assess the men's perceptions of sexual harassment in relation to different victim responses. The study involved 101 men who were administered a questionnaire focusing on two of the most frequent types of harassment (gender harassment vs. unwanted sexual attention) and victim response (confrontation vs. non confrontation), both of which were manipulated. Moreover, the influences of ideological variables, ambivalent sexism, and the acceptance of myths of sexual harassment on perception were also assessed. The results highlight the complexities involved in recognizing certain behaviors as harassment and the implications of different victim responses to incidents of harassment. As the coping strategies used by women to confront harassment entail drawbacks that pose problems or hinder them, the design and implementation of prevention and/or education programs should strive to raise awareness among men and women to further their understanding of this construct (AU)

El acoso sexual es una de las formas más generalizadas de violencia de género. Las percepciones sobre el acoso sexual dependen de factores tales como el género, el contexto y la ideología del perceptor, entre otros. La investigación ha mostrado la importancia que tiene el afrontamiento de la víctima en su nivel de confianza, haciendo que sienta de esta manera que tiene un papel relevante en la solución del problema. El objetivo de este estudio fue indagar en la percepción que los hombres tienen acerca del acoso sexual y de las distintas medidas usadas como respuesta por parte de la víctima. Participaron en el estudio 101 hombres que contestaron un cuestionario en el que se manipulaban dos de los tipos de acoso más frecuentes (acoso de género vs. atención sexual no deseada) así como la respuesta de la víctima (confrontación vs. no confrontación). También se estudió la influencia en dicha percepción de variables ideológicas como el sexismo ambivalente y la aceptación de los mitos sobre el acoso sexual. Los resultados resaltan la dificultad de reconocer determinados comportamientos como acoso, así como las posibles consecuencias que puede sufrir la víctima en función de la respuesta que dé a estas situaciones de acoso. Las estrategias usadas por las mujeres para afrontar el acoso parecen presentar algún obstáculo o problema para ellas, por lo que se hace necesaria la implantación de programas preventivos y/o educativos con el fin de enseñar a hombres y mujeres a comprender mejor el constructo (AU)

[Sexual disorders in the DSM-5]. / Seksuele stoornissen in de DSM-5.

BACKGROUND: In DSM-IV-TR, the subject of 'sexual and gender identity disorders' was dealt with in one chapter; in DSM-5, however, the subject is divided into three chapters, namely sexual dysfunctions , gender dysphoria, and paraphilic disorders. AIM: To discuss the above-mentioned changes. METHOD: The one-chapter version in DSM-IV is compared with the three-chapter contribution in DSM-5 and the differing criteria are tested for their clinical utility. RESULTS: There are minor changes in the chapter 'sexual dysfunctions'. The content of the chapters on 'gender dysphoria' and 'paraphilic disorders' differs substantially from the content of the sections on these subjects in DSM-IV. In the section on gender dysphoria the term 'sex' has been replaced by 'gender' and the term 'identity disorder' has been dropped. With regard to paraphilias, a distinction is now made between a paraphilia and a paraphilic disorder. The DSM-5 makes a new distinction between pathology (paraphilic disorder) on the one hand and other unusual or unconventional non-pathological sexual behavior on the other hand. In the DSM-5 the highly relevant clinical concept 'hypersexuality' has still not been incorporated as a separate category. CONCLUSION: In the DSM-5 many parts of the chapters on sexual disorders have been substantially revised.

[A validation study of the German version of the Hypersexual Behavior Inventory (HBI)]. / Eine Validierungsstudie der deutschen Version des Hypersexual Behavior Inventory (HBI).

Hypersexuality is characterized by recurrent and intense sexual fantasies, sexual urges, or sexual behaviors resulting in clinically significant personal distress or impairment in social, occupa-tional, or other important areas of functioning. The Hypersexual Behavior Inventory (HBI, Reid et al., 2011) is a 3-factor measure (coping, control and consequences) developed to assess hypersexual behaviour. The aim of the present study was to investigate the psychometric properties of the German version of the HBI. In a sample consisting of 1 749 men and women the questionnaire was used as part of an online survey. The questionnaire showed good reliability and validity. A confirmatory factor analysis supported the 3-factor structure of the original English version. The results and potential benefit of the HBI in research and clinical practice are discussed.

Efectos de un programa multiprofesional de tratamiento de la obesidad sobre los factores de riesgo para síndrome metabólico en niños prepúberes, púberes y adolescentes: diferencias entre géneros / Effects of a multidisciplinary program of obesity treatment on risk factors for metabolic syndrome in children in prepubertal, pubertal and adolescent stages: differences between genders

Objetivo. Analizar los efectos de un programa multidisciplinar de tratamiento de la obesidad (PMTO) sobre los factores de riesgo del Síndrome Metabólico (SM) en niños prepúberes, púberes y adolescentes de acuerdo con el género. Método. Participaron en el estudio 69 niños y adolescentes obesos entre 10 y 18 años de edad divididos en dos grupos: grupo de intervención (GI) (n = 37) y grupo control (GC) (n = 32). En el GI había 23 niñas, en el GC 14. El GI fue sometido a intervención multidisciplinar, con duración de 16 semanas. Se evaluaron parámetros antropométricos, aptitud cardiorrespiratoria y factores de riesgo para SM. Resultados. Se observó que el GI obtuvo reducción en la prevalencia de SM (- 35,8 % para género masculino y - 8,7 % para femenino), entre tanto se mantuvo el valor en las niñas del grupo GC y aumentó en los niños del GC (+ 11,1 %). En relación a dislipidemias, hubo una reducción en el GI para ambos géneros (- 7,2 % para el masculino; - 17,4 % para el femenino), y para el GC se observó aumento para el masculino (+ 22,2 %) y femenino (14,3 %). Las niñas del GI tuvieron mejoras significativas para las variables índice de masa corporal, circunferencia de cintura y cadera, y sensibilidad a la insulina, que no fueron observadas en el género masculino del GI, que presentaron aumento de masa magra. Conclusión. Los resultados del estudio muestran que 16 semanas de intervención multidisciplinar, basada en una terapia cognitivo-conductual, son suficientes para promover reducción de la prevalencia de SM y dislipidemias en niños y adolescentes obesos (AU)

Objetive. To analyze the effects of a multidisciplinary program of obesity treatment (PMTO) on risk factors for metabolic syndrome (MS) in children and adolescents at prepubertal, pubertal and adolescents stages according to gender. Method. he study included 69 obese children and adolescents aged 10 to 18 years. They were allocated to the intervention group (GI) (n = 37) and control group (GC) (n = 32). There were 23 girls in GI and 14 in GC. The GI was submitted to the multidisciplinary intervention, lasting 16 weeks. It was assessed anthropometric parameters, cardiorespiratory fitness and risk factor for MS. Results. We found that the GI achieved a reduction in the prevalence of MS (7.1 % for boys and 8.7 % for girls), and in GC a maintenance for girls and increasing for boys. For dyslipidemia, a reduction in GI for both genders (boys 78.6 % to 71.4 %; girls 82.6 % to 65.2 %), and increasing in GC for both genders. GI Girls had significant improvements for the variables, body mass index, waist circumference, hip circumference and insulin sensibility which was not observed in GI boys who increased lean body mass. Conclusion. The findings show that 16 weeks of multidisciplinary intervention based on cognitive behavioral therapy are sufficient to promote decreasing in the prevalence of MS and dyslipidemia in obese children and adolescents (AU)

[The history of the concept of gender identity disorder].

The Metamorphoses Greek myth includes a story about a woman raised as a male falling in love with another woman, and being transformed into a man prior to a wedding ceremony and staying with her. It is therefore considered that people who desire to live as though they have the opposite gender have existed since ancient times. People who express a sense of discomfort with their anatomical sex and related roles have been reported in the medical literature since the middle of the 19th century. However, homosexual, fetishism, gender identity disorder, and associated conditions were mixed together and regarded as types of sexual perversion that were considered ethically objectionable until the 1950s. The first performance of sex-reassignment surgery in 1952 attracted considerable attention, and the sexologist Harry Benjamin reported a case of 'a woman kept in the body of a man', which was called transsexualism. John William Money studied the sexual consciousness about disorders of sex development and advocated the concept of gender in 1957. Thereafter the disparity between anatomical sex and gender identity was referred to as the psychopathological condition of gender identity disorder, and this was used for its diagnostic name when it was introduced into DSM-III in 1980. However, gender identity disorder encompasses a spectrum of conditions, and DSM-III -R categorized it into three types: transsexualism, nontranssexualism, and not otherwise specified. The first two types were subsequently combined and standardized into the official diagnostic name of 'gender identity disorder' in DSM-IV. In contrast, gender identity disorder was categorized into four groups (including transsexualism and dual-role transvestism) in ICD-10. A draft proposal of DSM-5 has been submitted, in which the diagnostic name of gender identity disorder has been changed to gender dysphoria. Also, it refers to 'assigned gender' rather than to 'sex', and includes disorders of sexual development. Moreover, the subclassifications regarding sexual orientation have been deleted. The proposed DSM-5 reflects an attempt to include only a medical designation of people who have suffered due to the gender disparity, thereby respecting the concept of transgender in accepting the diversity of the role of gender. This indicates that transgender issues are now at a turning point.

Surgimiento, evolución y dificultades del diagnóstico de transexualismo / Emergence, evolution and difficulties of the transsexualism diagnosis

Se realiza un recorrido histórico a través de las distintas revisiones de la Clasificación Internacional de Enfermedades (C.I.E.) y del Manual Diagnóstico y Estadístico de los Trastornos Mentales (D.S.M.). Se pretende analizar la aparición del diagnóstico de transexualismo y su evolución hasta llegar a las clasificaciones actualmente en vigor (C.I.E.-10) y ( D.S.M.-IV-TR). Por último, se expondrán algunas de las dificultades encontradas en el proceso de diagnóstico(AU)

A historical path is made through the different reviews of the International Classification of Diseases (I.C.D.) and the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.). The aim is to analyze the emergence of the transsexualism diagnosis and its evolution into the classifications currently in force (I.C.D.-10) and ( D.S.M.-IV-TR). Finally, some of the difficulties found during the diagnostic process will be presented(AU)

Children and adolescents with gender identity disorder referred to a pediatric medical center.

OBJECTIVES: To describe the patients with gender identity disorder referred to a pediatric medical center. We identify changes in patients after creation of the multidisciplinary Gender Management Service by expanding the Disorders of Sex Development clinic to include transgender patients. METHODS: Data gathered on 97 consecutive patients <21 years, with initial visits between January 1998 and February 2010, who fulfilled the following criteria: long-standing cross-gender behaviors, provided letters from current mental health professional, and parental support. Main descriptive measures included gender, age, Tanner stage, history of gender identity development, and psychiatric comorbidity. RESULTS: Genotypic male:female ratio was 43:54 (0.8:1); there was a slight preponderance of female patients but not significant from 1:1. Age of presentation was 14.8 ± 3.4 years (mean ± SD) without sex difference (P = .11). Tanner stage at presentation was 4.1 ± 1.4 for genotypic female patients and 3.6 ± 1.5 for genotypic male patients (P = .02). Age at start of medical treatment was 15.6 ± 2.8 years. Forty-three patients (44.3%) presented with significant psychiatric history, including 20 reporting self-mutilation (20.6%) and suicide attempts (9.3%). CONCLUSIONS: After establishment of a multidisciplinary gender clinic, the gender identity disorder population increased fourfold. Complex clinical presentations required additional mental health support as the patient population grew. Mean age and Tanner Stage were too advanced for pubertal suppressive therapy to be an affordable option for most patients. Two-thirds of patients were started on cross-sex hormone therapy. Greater awareness of the benefit of early medical intervention is needed. Psychological and physical effects of pubertal suppression and/or cross-sex hormones in our patients require further investigation.

Abordaje multidisciplinar de la transexualidad: desde atención primaria a la Unidad de Trastornos de Identidad de Género de Madrid (UTIG MADRID) / Multidisciplinary approach to Transsexuality: From Primary Care to the Gender Identity Disorders Unit in Madrid (GIDU-Madrid)

La transexualidad es un fenómeno emergente en nuestra sociedad, por el cual una persona de un sexo biológico se siente pertenecer al contrario. El abordaje realizado desde la Unidad de Trastornos de Identidad de Género del Hospital Ramón y Cajal parte de un enfoque multidisciplinar y se basa en que el tratamiento no debe limitarse al médico (hormonal y cirugía de reasignación de sexo) sino que es fundamental la intervención psicológica. Este proceso multidisciplinar exige varias fases de evaluación psicológica. La intervención psicológica debe ser individualizada y los objetivos terapéuticos que se plantean son, entre otros, apoyo en dificultades cognitivas o emocionales, desarrollo de estrategias de afrontamiento y adherencia al tratamiento médico (AU)

Transsexuality is an emergent phenomenon in our society. It means, that a person belonging to one biological sex feels that he/she belongs to the opposite one. The Gender Identity Disorder Unit of Madrid is achieving a cross-disciplinary approach. This approach is not just based on medical treatment, or hormonal or surgical treatments, but psychological treatment is also essential. This cross-disciplinary process requires several stages of psychological assessment. Psychological treatment must be individualized. The therapeutic goals should be: Support in cognitive and emotional difficulties, the development of coping skills, and adherence to the medical treatment (AU)