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File: 1432065493500.jpg (16.7 KB, 300x278, 150:139, 20081026_transsexual symbo….jpg)

 No.103

After seeing people's differing view on transsexualism, I figured it would be interesting to try and explore the scientific literature concerning this phenomenon. Mainly, how it originates (possible causes) and how much is nature vs. nurture, and the current treatment options available and their effectiveness comparatively.

I've only used Google Scholar to find this literature. I also tried excluding older studies since they'll likely be references in newer literature and are likely outdated.

Also worth mentioning that I haven't looked in-depth in any of the studies presented here, so forgive me if I include some bad studies and/or interpret them wrong in the conclusion.

Origin

To start, let's find out approximately how many people are transgender.

>How many people are lesbian, gay, bisexual, and transgender?

https://escholarship.org/uc/item/09h684x2

>[…] an estimated 0.3% of adults are transgender

Now for possible causes.

>Transsexualism: A review of etiology, diagnosis and treatment

http://www.sciencedirect.com/science/article/pii/S0022399998000853

>A first indication of anatomic brain differences between transsexuals and nontranssexuals has been found. Also, certain parental (rearing) factors seem to be associated with transsexualism. Some contradictory findings regarding etiology, psychopathology and success of SRS seem to be related to the fact that certain subtypes of transsexuals follow different developmental routes. The observations that psychotherapy is not helpful in altering a crystallized cross-gender identity and that certain transsexuals do not show severe psychopathology has led clinicians to adopt sex reassignment as a treatment option. In many countries, transsexuals are now treated according to the Standards of Care of the Harry Benjamin International Gender Dysphoria Association, a professional organization in the field of transsexualism. Research on postoperative functioning of transsexuals does not allow for unequivocal conclusions, but there is little doubt that sex reassignment substantially alleviates the suffering of transsexuals. However, SRS is no panacea. Psychotherapy may be needed to help transsexuals in adapting to the new situation or in dealing with issues that could not be addressed before treatment.

>The endocrinology of transsexualism: A review and commentary

http://www.sciencedirect.com/science/article/pii/0306453090900417

>Testicular hormones play a decisive role in the sexual differentiation of the genitalia. There is now also an impressive body of knowledge, gathered predominantly from laboratory animals, of the influence of gonadal steroid hormones on the prenatal/perinatal sexual differentiation of the brain. The well-documented mechanisms in animals have been extrapolated, sometimes dogmatically, to the development of sexual orientation and gender identity/role in humans. In principle, it is doubtful that an animal model of human gender identity can be found. Studies in humans have shown that levels of circulating sex steroids and estrogen feedback on luteinizing hormone do not differ between transsexuals and controls.

>Anthropometrical Measurements and Androgen Levels in Males, Females, and Hormonally Untreated Female-To-Male Transsexuals

http://link.springer.com/article/10.1023/A:1024506427497

>Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation

http://informahealthcare.com/doi/abs/10.1080/09513590400018231

>[…] observations in human subjects with genetic and other disorders show that direct effects of testosterone on the developing fetal brain are of major importance for the development of male gender identity and male heterosexual orientation. Solid evidence for the importance of postnatal social factors is lacking. In the human brain, structural differences have been described that seem to be related to gender identity and sexual orientation.

>The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study

http://www.sciencedirect.com/science/article/pii/S0022395610003250

>Our results show that the white matter microstructure pattern in untreated MtF transsexuals falls halfway between the pattern of male and female controls. The nature of these differences suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during brain development.

 No.104

Treatment

Finally, let's take a look at some studies with regard to the effectiveness of different treatment options.

>Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009.03625.x/full

>Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.

Not sure what to take from this given it's concluding based on "very low quality evidence".

>Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0016885

>Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.

This seems to be a response to a study, but since it references that it might as well be included.

>[…] in scientific literature there are few reports on the long-term safety of different treatment protocols and on the physical and psychological outcomes of medical treatments. The safety of long-term high doses oestrogen or testosterone in subjects of the opposite sex has been debated and data on long term effects are scant at best. The Asscherman paper therefore represents a very important and reassuring reference for professionals working in this field suggesting that mortality is increased among transsexuals although due to causes unrelated to cross sex replacement therapy. These results will benefit the care and treatment of these subjects.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3720111/

>A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual & transgender people

http://www.pinktherapy.com/portals/0/ModuleResourcesX/ModuleResources/LGBT_web.pdf

This one's quite extensive, but only a small part is relevant: "The relative lack of studies into therapy for transgender people means that our conclusions can only be tentative."

>Review of Studies of Androgen Treatment of Female-to-Male Transsexuals: Effects and Risks of Administration of Androgens to Females

http://onlinelibrary.wiley.com/doi/10.1111/j.1743-6109.2007.00646.x/abstract?deniedAccessCustomisedMessage=&userIsAuthenticated=false

>Our studies demonstrated that, while some markers of cardiovascular risk factors showed a shift to a more negative risk profile, others were not affected.

>Effect of sex steroid use on cardiovascular risk in transsexual individuals: a systematic review and meta-analyses

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.2009.03632.x/full

>Very low quality evidence, downgraded due to methodological limitations of included studies, imprecision and heterogeneity, suggests that cross-sex hormone therapies increase serum triglycerides in MF and FM and have a trivial effect on HDL-cholesterol and systolic blood pressure in FM. Data about patient important outcomes are sparse and inconclusive.

>Transsexualism

http://www.karger.com/Article/Abstract/336426

>Although transsexuals have increased mortality and morbidity, especially concerning psychiatric conditions, suicide, and smoking-related cancers after gender reassignment when compared to the general population, intervention with cross-gender endocrine treatment does not cause any major health hazard and can be prescribed safely


 No.105

Extra

I wasn't going to include these, but perhaps they hold some relevance to the discussion.

>Does It Get Better? A Longitudinal Analysis of Psychological Distress and Victimization in Lesbian, Gay, Bisexual, Transgender, and Questioning Youth

http://www.sciencedirect.com/science/article/pii/S1054139X14007101

>Suicidality and Depression Disparities Between Sexual Minority and Heterosexual Youth: A Meta-Analytic Review

http://www.sciencedirect.com/science/article/pii/S1054139X11000541

>The Struggle And Strength Of Sexual Minorities And Suicidality: A Qualitative Interpretive Meta-synthesis

https://uta-ir.tdl.org/uta-ir/handle/10106/11609

These studies seem to suggest that suicidality and depression is mostly tied to victimization and discrimination.

I also found this when searching for an image to use, but it's not very worthy of inclusion so I've added it here.

http://archive.cosmosmagazine.com/news/gene-linked-transsexuality/

—————————————————————-

I focused mostly on meta/review studies to give an introduction to the subject to start discussion. Feel free to object and provide other studies I might have missed.

How much is determined by nature and nurture isn't clear it seems, with everything from rearing and hormones having an effect. The seeming inefficiency of psychotherapy alone (not a lot of literature) and unique identifiable brain structure seems to suggest at least some nature. As for treatment, hormone therapy (which doesn't have too many deleterious effects) seems to be the best option, whilst sex reassignment according to the Swedish study seems to increase mortality (which is not good), although it does appear to alleviate gender dysphoria symptoms. A question that begs answering is how much of the increased mortality rate is due to discrimination as opposed to the general well-being of the individual.


 No.108

Some questions to get things going.

Is or should transsexualism be understood as a form of mental illness, and what cost or benefit lies in such a classification? Are there better classifications for it?

Does the high mortality rate, especially after sex reassignment surgery, imply that the surgery is mostly to blame? Or is it the discrimination (possibly increased post-op)? Perhaps both (to which degree)?

And follow-up on the last one: considering risk of mortality decreases with age, how does the hormonal turmoil of teenage years affect the results here?

Given the unique brain structure of transsexuals, would it be too presumptuous to assume psychotherapy alone would be inefficient as treatment, and does that hold true for all or just some transsexuals?


 No.136

They're all degenerates who need to be disposed of.




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