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Psychological Characteristics and Sexuality of Natal Males with Gender Dysphoria

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Management of Gender Dysphoria

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Abstract

The psychological characteristics of individuals with gender dysphoria have recently been under scrutiny in the discussions regarding the latest Standards of Care (SOC7) of the World Professional Association for Transgender Health, the new version of the classification system Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association, and the preparations for the International Classification of Diseases (ICD-11) of the World Health Organization. In the central discussion, whether gender dysphoria is a mental disorder or not, reference is often made to the level of psychopathology in individuals presenting for treatment. This chapter provides an overview of the current literature on the psychological functioning and problems in natal male individuals with gender dysphoria. In the context of an increasing acceptance of gender dysphoria, information on the sexuality of these individuals is also slowly becoming more available. Since this information can help to further increase our knowledge on the phenomenon of gender dysphoria, this chapter also includes an overview on the evolving ideas concerning sexual orientation and a brief overview of the literature concerning the sexual functioning of natal male individuals with gender dysphoria before treatment.

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References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (Fifth edition, DSM-5). American Psychiatric Association, Washington, DC

    Book  Google Scholar 

  2. World Professional Association for Transgender Health (2011) Standards of care for the health of transsexual, transgender and gender non-conforming people, 7th version. http://www.wpath.org

  3. Cohen-Kettenis PT, Pfäfflin F (2010) The DSM diagnostic criteria for gender identity disorder in adolescents and adults. Arch Sex Behav 39:499–513

    Article  PubMed  Google Scholar 

  4. Socarides C (1969) The desire for sexual transformation: a psychiatric evaluation of transsexualism. Am J Psychiatry 125:1419–1425

    Article  CAS  PubMed  Google Scholar 

  5. Socarides C (1970) A psychoanalytic study of the desire for sexual transformation (‘transsexualism’): the plaster-of-paris man. Int J Psychoanal 51:341–349

    CAS  PubMed  Google Scholar 

  6. Socarides C (1988) The preoedipal origin and psychoanalytic therapy of sexual perversions. International Universities Press, Madison

    Google Scholar 

  7. Volkan V, Greer W (1996) True transsexualism. In: Rosen I (ed) Sexual deviation, 3rd edn. Oxford University Press, Oxford, pp 158–173

    Google Scholar 

  8. World Health Organization (1975) ICD-9, international classification of diseases. World Health Organization, Geneva

    Google Scholar 

  9. American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders (Third edition, DSM-III). American Psychiatric Association, Washington, DC

    Google Scholar 

  10. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (Forth edition, DSM-IV). American Psychiatric Association, Washington, DC

    Google Scholar 

  11. Drescher J, Cohen-Kettenis P, Winter S (2012) Minding the body: situating gender diagnoses in the ICD-11. Int Rev Psychiatry 24:568–577

    Article  PubMed  Google Scholar 

  12. Stein DJ, Philips KA, Bolton D, Fulford KWM, Sadler JZ, Kendler KS (2010) What is a mental/psychiatric disorder? From DSM-IV to DSM-V. Psychol Med 40:1759–1765

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Person E, Ovesey L (1974) The transsexual syndrome in males. Part I. Primary transsexualism. Am J Psychother 28:4–20

    CAS  PubMed  Google Scholar 

  14. Person E, Ovesey L (1974) The transsexual syndrome in males. Part II. Secondary transsexualism. Am J Psychother 28:174–193

    CAS  PubMed  Google Scholar 

  15. Pomeroy WB (1969) Transsexualism and sexuality: sexual behaviour of pre- and postoperative male transsexuals. In: Green R, Money J (eds) Transsexualism and sex reassignment. John Hopkins Press, Baltimore, pp 183–188

    Google Scholar 

  16. Cole C, O’Boyle M, Emory L, Meyer W (1997) Comorbidity of gender dysphoria and other major psychiatric diagnoses. Arch Sex Behav 26:13–26

    Article  CAS  PubMed  Google Scholar 

  17. à Campo J, Nijman H, Merckelback H, Evers C (2003) Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists. Am J Psychiatry 160:1332–1336

    Article  PubMed  Google Scholar 

  18. Lawrence A, Zucker K (2012) Gender identity disorders. In: Hersen M, Beidel D (eds) Adult psychopathology and diagnosis, 6th edn. Wiley, London, pp 601–635

    Google Scholar 

  19. Heylens G, Elaut E, Kreukels BPC, Paap MSC, Cerwenka S, Richter-Appelt H, Cohen-Kettenis PT, Haraldsen I, De Cuypere G (2013) Psychiatric characteristics in transsexual individuals: multicentre study in four European Countries. Br J Psychiatry. doi:10.1192/bjp.bp.112.121954

    PubMed  Google Scholar 

  20. Hoshiai M, Matsumoto Y, Sato T, Ohnishi M, Okabe N, Kishimoto Y, Terada S, Kuroda S (2010) Psychiatric comorbidity among patients with gender identity disorder. Psychiatry Clin Neurosci 64:514–519

    Article  PubMed  Google Scholar 

  21. Hepp U, Kraemer B, Schnyder U, Miller N, Delsignore A (2005) Psychiatric comorbidity in gender identity disorder. J Psychosom Res 58:259–261

    Article  CAS  PubMed  Google Scholar 

  22. Gómez-Gil E, Vidal-Hagemeijer A, Salamero M (2008) MMPI-2 characteristics of transsexuals requesting sex reassignment: comparison of patients in prehormonal and presurgical phases. J Pers Assess 90:368–374

    Article  PubMed  Google Scholar 

  23. Haraldsen I, Dahl A (2000) Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorder and healthy adults. Acta Psychiatr Scand 102:276–281

    Article  CAS  PubMed  Google Scholar 

  24. Miach PP, Berah EF, Butcher JN, Rouse S (2000) Utility of the MMPI-2 in assessing gender dysphoric patients. J Pers Assess 75:268–279

    Article  CAS  PubMed  Google Scholar 

  25. de Vries ALC, Kreukels BPC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT (2011) Comparing adult and adolescent transsexuals: an MMPI-2 and MMPI-A study. Psychiatry Res 186:414–418

    Article  PubMed  Google Scholar 

  26. Shiah I, Yang S, Shen L, Chang A, Gau Y, Chen Y, Chen C (2004) Psychopathology and dissociative experiences of male Taiwanese patients with gender identity disorder. J Med Sci 24:135–140

    Google Scholar 

  27. De Cuypere G, Jannes C, Rubens R (1995) Psychosocial functioning of transsexuals in Belgium. Acta Psychiatr Scand 91:180–184

    Article  PubMed  Google Scholar 

  28. Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H et al (2004) Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Acta Psychiatr Scand Suppl 420:21–27

    PubMed  Google Scholar 

  29. Murad M, Elamin M, Garcia M, Mullan R, Murad A, Erwin P et al (2010) Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. Clin Endocrinol (Oxf) 72:214–231

    Article  Google Scholar 

  30. Gallucci G, Hackerman F, Schmidt CW (2005) Gender identity disorder in an adult male with Asperger’s syndrome. Sex Disabil 23:35–40

    Article  Google Scholar 

  31. De Vries A, Noens I, Cohen-Kettenis P, van Berckelaer-Onnes I, Doreleijers T (2010) Autism spectrum disorders in gender dysphoric children and adolescents. J Autism Dev Disord 40:930–936

    Article  PubMed Central  PubMed  Google Scholar 

  32. Pasterski V, Gilligan L, Curtis R (2014) Traits of autism spectrum disorders in adults with gender dysphoria. Arch Sex Behav. doi:10.1007/s10508-013-0154-5

    Google Scholar 

  33. Madeddu F, Prunas A, Hartmann D (2009) Prevalence of Axis II disorders in a sample of clients undertaking psychiatric evaluation for sex reassignment surgery. Psychiatr Q 80:261–267

    Article  PubMed  Google Scholar 

  34. Torgersen S (2012) Epidemiology. In: Widiger T (ed) The Oxford handbook of personality disorders. Oxford University Press, Oxford, pp 186–205

    Google Scholar 

  35. Smith Y, van Goozen S, Kuiper A, Cohen-Kettenis P (2005) Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals. Psychol Med 35:89–99

    Article  PubMed  Google Scholar 

  36. Smith Y, van Goozen S, Kuiper A, Cohen-Kettenis P (2005) Transsexual subtypes: clinical and theoretical significance. Psychiatry Res 137:151–160

    Article  PubMed  Google Scholar 

  37. Lawrence AA (2010) Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Arch Sex Behav 39:514–545

    Article  PubMed  Google Scholar 

  38. Landén M, Walinder J, Hambert G, Lundstrom B (1998) Factors predictive of regret in sex reassignment. Acta Psychiatr Scand 97:284–289

    Article  PubMed  Google Scholar 

  39. Cohen-Kettenis PT, van Goozen SHM (1997) Sex reassignment of adolescent transsexuals: a follow-up study. J Am Acad Child Adolesc Psychiatry 36:263–271

    Article  CAS  PubMed  Google Scholar 

  40. Smith YLS, van Goozen SHM, Cohen-Kettenis PT (2001) Adolescents with gender identity disorder who were accepted or rejected for Sex reassignment surgery: a prospective follow-up study. J Am Acad Child Adolesc Psychiatry 40:472–481

    Article  CAS  PubMed  Google Scholar 

  41. Dhejne C, Lichtenstein P, Boman M, Johansson A, Langstrom N, Landen M (2011) Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study Sweden. PLoS One. doi:10.1371/journal.pone.0016885

    PubMed Central  PubMed  Google Scholar 

  42. Haas A, Eliason M, Mays V, Mathy R, Cochran S, D’Augelli A et al (2011) Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: review and recommendations. J Homosex 58:10–51

    Article  PubMed Central  PubMed  Google Scholar 

  43. Terada S, Matsumoto Y, Sato T, Okabe N, Kishimoto Y, Uchitomi Y (2012) Suicidal ideation among patients with gender identity disorder. Psychiatry Res 200:469–474

    Article  PubMed  Google Scholar 

  44. Hirschfeld M (1991) Transvestites: the erotic drive to cross dress (trans: Lombardi-Nash MA). Prometheus Books, Buffalo (Original work published in 1910)

    Google Scholar 

  45. Lukianowicz N (1959) Survey of various aspects of transvestism in the light of our present knowledge. J Nerv Ment Dis 128:36–64

    Article  CAS  PubMed  Google Scholar 

  46. Randell JB (1959) Transvestism and transsexualism: a study of 50 cases. Br Med J 2:1448–1452

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  47. Benjamin H (1966) The transsexual phenomenon. Julian Press, New York

    Google Scholar 

  48. Bentler PM (1976) A typology of transsexualism: gender identity theory and data. Arch Sex Behav 5:567–584

    Article  CAS  PubMed  Google Scholar 

  49. Zucker KJ, Cohen-Kettenis PT, Drescher J, Meyer-Bahlburg HFL, Pfäfflin F, Womack WM (2013) Memo outlining evidence for change for gender identity disorder in the DSM-5. Arch Sex Behav 42:901–914

    Article  PubMed  Google Scholar 

  50. Blanchard R (1985) Typology of male-to-female transsexualism. Arch Sex Behav 14:247–261

    Article  CAS  PubMed  Google Scholar 

  51. Blanchard R (1988) Nonhomosexual gender dysphoria. J Sex Res 24:188–193

    Article  CAS  PubMed  Google Scholar 

  52. Blanchard R (1989) The classification and labeling of nonhomosexual gender dysphorias. Arch Sex Behav 18:315–334

    Article  CAS  PubMed  Google Scholar 

  53. Blanchard R (1994) A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics. Arch Sex Behav 23:311–320

    Article  CAS  PubMed  Google Scholar 

  54. Johansson A, Sundbom E, Höjerback T, Bodlund O (2009) A five-year follow-up study of Swedish adults with gender identity disorder. Arch Sex Behav 39:1429–1437

    Article  PubMed  Google Scholar 

  55. Nieder TO, Herff M, Cerwenka S, Preuss WF, Cohen-Kettenis PT, De Cuypere G, Haraldsen IRH, Richter-Appelt H (2011) Age of onset and sexual orientation in transsexual males and females. J Sex Med 8:783–791

    Article  PubMed  Google Scholar 

  56. Cerwenka S, Nieder TO, Briken P, Cohen-Kettenis PT, De Cuypere G, Haraldsen IRH, Kreukels BPC, Richter-Appelt H (2014) Intimate partnerships and sexual health in gender dysphoric individuals before the start of medical treatments. Int J Sex Health 26:52–65

    Article  Google Scholar 

  57. Lawrence AA (2003) Factors associated with satisfaction or regret following male-to-female sex reassignment surgery. Arch Sex Behav 32:299–315

    Article  PubMed  Google Scholar 

  58. Money J, Gaskin RJ (1970–1971) Sex reassignment. Int J Psychiatry 9:249–269

    CAS  Google Scholar 

  59. Hastings DW (1974) Postsurgical adjustment of male transsexual patients. Clin Plast Surg 1:335–344

    CAS  PubMed  Google Scholar 

  60. Lief HI, Hubschmann L (1993) Orgasm in the postoperative transsexual. Arch Sex Behav 22:145–155

    Article  CAS  PubMed  Google Scholar 

  61. Soli M, Brunocilla E, Bertacinni A, Palmieri F, Barbieri B, Martorana G (2008) Male to female gender reassignment: modified surgical technique for creating the neoclitoris and mons veneris. J Sex Med 5:2010–2216

    Article  Google Scholar 

  62. Klein C, Gorzalka BB (2009) Sexual functioning in transsexuals following hormone therapy and genital surgery: a review (CMD). J Sex Med 6:2922–2939

    Article  PubMed  Google Scholar 

  63. Lawrence AA (2005) Sexuality before and after male-to-female sex reassignment surgery. Arch Sex Behav 35:147–166

    Article  Google Scholar 

  64. Laumann EO, Gagnon JH, Michael RT, Michaels S (1994) The social organization of sexuality: sexual practices in the United States. University of Chicago Press, Chicago

    Google Scholar 

  65. Cerwenka S, Nieder TO, Cohen-Kettenis PT, De Cuypere G, Haraldsen IRH, Kreukels BPC, Richter-Appelt H (2013) Sexual behavior of gender dysphoric individuals before gender-confirming interventions: a European multi-center perspective. J Sex Marital Ther. doi:10.1080/0092623X.2013.772550

    Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medical Psychology, VU University Medical Center, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands

    Peggy T. Cohen-Kettenis & Baudewijntje P. C. Kreukels

  2. Center of Sexology and Gender Problems, De Pintelaan 185, Ghent, 9000, Belgium

    Els Elaut

Authors
  1. Peggy T. Cohen-Kettenis
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  2. Els Elaut
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  3. Baudewijntje P. C. Kreukels
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Corresponding author

Correspondence to Peggy T. Cohen-Kettenis .

Editor information

Editors and Affiliations

  1. Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy

    Carlo Trombetta

  2. Department of Urology, University of Trieste, Cattinara Hospital, Trieste, Italy

    Giovanni Liguori

  3. Department of Radiology, University of Trieste, Cattinara Hospital, Trieste, Italy

    Michele Bertolotto

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Cohen-Kettenis, P.T., Elaut, E., Kreukels, B.P.C. (2015). Psychological Characteristics and Sexuality of Natal Males with Gender Dysphoria. In: Trombetta, C., Liguori, G., Bertolotto, M. (eds) Management of Gender Dysphoria. Springer, Milano. https://doi.org/10.1007/978-88-470-5696-1_9

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  • DOI: https://doi.org/10.1007/978-88-470-5696-1_9

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