Har du opplevd hatkriminalitet eller diskriminering

Har du blitt utsatt for hatkriminalitet? Det bunner som oftest i at du tilhører eller støtter en gruppe. Det kan også skje fordi gjerningspersonen mener du tilhører eller støtter en gruppe. Hatkriminalitet er svært alvorlig. Målet er ofte å ramme hele grupper av befolkningen.

Oslo politidistrikt definerer hatkriminalitet som: «[…] straffbare handlinger som helt eller delvis er motivert av negative holdninger til en persons faktiske eller oppfattede etnisitet, religion, seksuelle orientering, kjønnsuttrykk og/eller nedsatte funksjonsevne. Likestilt er også straffbare handlinger, motivert av negative holdninger, begått mot personer hvis politiske engasjement berører de nevnte kategorier.»

Ved akutte hendelser, kan du ringe politiet på 112.

Opplever du hatprat, hatytringer eller hatkriminalitet, er det viktig at du sier ifra til noen du er trygg på for å bli tatt vare på, og få hjelp til å få slutt på ytringene. Behold meldinger og bilder som bevis for hva du har blitt utsatt for.

Send gjerne en kopi av klagen din til HBRS i: info@hbrs.no Det gir oss en bedre mulighet til å følge med og bruke klagene i kampen for et bedre rettsvern.

Ta kontakt med politiet dersom det du har blitt utsatt for bør anmeldes.

Ring 02800!

Kripos tipsmottak:

Hatfulle ytringer på nettet

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Om hatkriminalitet

Tall og fakta


Mobbing, diskriminering og trakassering


Har du opplevd diskriminering på jobb eller skole?

En handling kan være et brudd på diskrimineringsloven. Ta kontakt med Likestilling- og diskrimeringsombudet (LDO).

Du kan bruke kontaktskjemaet til Likestillings- og diskrimineringsombudet

Send gjerne en kopi av klagen din til HBRS i: info@hbrs.no Det gir oss en bedre mulighet til å følge med og bruke klagene i kampen for et bedre diskrimineringsvern.

Hvis du lurer på noe om diskriminering eller trenger råd og veiledning, kan du kontakte Likestillings- og diskrimineringsombudet på telefon: 23 15 73 00 eller e-post: post@LDO.no

Hva er diskriminering og trakassering?

«Diskriminering» er forskjellsbehandling som har som formål eller virkning at en person eller en gruppe av personer stilles dårligere enn andre. «Trakassering» er handlinger, unnlatelser eller ytringer som har som formål eller virkning å være krenkende, skremmende, fiendtlige, nedverdigende eller ydmykende.

Diskriminering og trakassering er forbudt etter diskrimineringsregelverket dersom den skjer på grunn av kjønn, graviditet, permisjon ved fødsel eller adopsjon, omsorgsoppgaver, etnisitet, religion, livssyn, funksjonsnedsettelse, seksuell orientering, kjønnsidentitet, kjønnsuttrykk, alder eller kombinasjoner av disse grunnlagene. I arbeidsforhold er diskriminering også forbudt dersom det skjer på grunn av politisk syn eller medlemskap i en arbeidstakerorganisasjon. Brudd på regelverket om universell utforming og individuell tilrettelegging for personer med funksjonsnedsettelser blir også regnet som diskriminering. Fra og med 1. januar 2020 håndhever Diskrimineringsnemnda forbudet mot seksuell trakassering. Dersom du vil vite mer, kan du lese vår artikkel om hva som er viktig informasjon til deg som vurderer å bringe inn en klage på seksuell trakassering.

Skole

Mange opplever mobbing eller trakassering på skolen. Om dette skjer på grunn av noen av diskrimineringsgrunnlagene, kan det være ulovlig etter likestillings- og diskrimineringsloven. Mobbing og trakassering er også ulovlig etter opplæringsloven.

Si fra

Du kan si fra til en voksen hjemme så dere sammen kan finne ut hvordan du kan få hjelp. Du kan også si fra til en voksen på skolen: lærer, sosiallærer, rådgiver eller helsesøster. Du kan også si fra til rektor hvis du ikke får hjelp av de andre.

Disse kan hjelpe deg

Du eller dine foreldre/foresatte kan også ta kontakt med noen av disse for å få informasjon og råd om hvordan din situasjon på skolen kan bli bedre:

Hvis dere er flere elever som opplever det samme, kan det være lurt å gå sammen for å si fra til noen voksne. Noen ting kan dere også ta opp i klassens time eller med elevrådet.

 


Ved fare for selvmord eller selvskading


Nasjonalt senter for selvmordsforskning og -forebygging har en egen side der de har samlet flere gode ressurser som kan være til hjelp når livet oppleves mørkt og vanskelig. Du kan også kontakte HBRS sin samtale linje. For mer informasjon om den les her.


Alexandras Minnefond

Ønsker du å søke om midler fra Alexandras minnefond så kan du sende den inn her.

Søk om støtte fra Alexandras Minnefond

Om Alexandras minnefond

  • Alexandras Minnefond er opprettet ved gaver.
  • Midler fra minnefondet kan tildeles personer innenfor kjønnsidentitetstematikk. Det vil si personer som opplever kjønnsidentitetsutfordringer. Søknad om støtte sendes av den enkelte til Minnefondet.
  • Det kan søkes om støtte til å delta på sosiale samlinger som blant annet sommerleir og andre aktiviteter som er viktig for å bygge nettverk for å komme ut av ensomhet.
  • Delta på selvutviklingsgrupper, samtalegrupper og andre aktiviteter som vil være viktig for å forebygge og rehabilitere psykisk helse. Det kan også gis økonomisk støtte til hjelp fra psykolog.
  • Alexandras Minnefond er basert på frivillighet. Det er ingen ansatte i Minnefondet.

Ønsker du å gi et bidrag til Alexandras Minnefond?

Ønsker du å gi en gave til Alexandras minnefond.
Det er flere måter å gi din gave. Se under.
Gaver til fondet er svært velkomne.
Gaver kan også gis til minnefondets bankkonto:1506.01.97617

Fondet har begrensede midler, og vanlig avkastning gir ikke mye rom for utbetalinger.
De pengene vi disponerer nå har kommet fra
 gaver i Alexandras begravelse
 midler etter Alexandra
 gaver fra Alexandras familie og venner
 gaver fra personer i HBRS-miljøet
 gaver og loddsalg fra deltakere på HBRS sommerleir

 

Noen få har begynt med faste, månedlige gaver, og dette er vi i styret veldig glade for. Det vil være til stor hjelp hvis flere betaler inn et lite beløp hver måned, slik at fondet får en slags «fast inntekt». Dersom 20 personer betaler inn 50 kroner hver i måneden, blir det faktisk 12000 kroner i året, som kan øke utbetalingene tilsvarende.

❤️Del gjerne vår informasjon på mail eller sosiale medier❤️

Det er også mulig å vippse et ønsket beløp


Fagpersoner


Du trenger ikke å være en «spesialist» for å hjelpe unge mennesker som utforsker deres kjønnsidentitet. Faktisk, etter vurderingsprosessen, er det meste av den terapeutiske inngangen gitt utenfor Nasjonal behandlingstjenester for transseksualisme, vanligvis i BUP eller DPS. Når det er mulig, ber NBTS lokale BUP eller DPS  å være involvert sammen med NBTS teamet. Når dette skjer, er NBTS-klinikere alltid tilgjengelige for kontakt med bestemte tilfeller. NBTS har utviklet noen primære terapeutiske mål som vi har brukt til å veilede vårt arbeid. Klinisk arbeid med unge mennesker kan ta en rekke formater, inkludert en-til-en-sesjoner eller stadig gruppearbeid der andre unge sammen med fagfolk kan yte støtte.

Les mer under for flere ideer om hvordan du arbeider med unge og kjønn.

Lytt og vis forståelse


Utforsk sammen med den unge personen der de er når det gjelder kjønnsidentitet, hør på å forstå (heller enn å tilby umiddelbare løsninger).

En del av din rolle kan være å hjelpe den unge personen til å finne sine egne løsninger, og avveie fordelene og ulempene med valg de vurdere (for eksempel i forhold til sosialt overgang).


Møt med respekt


Opprettholde en respektfull og ikke-dømmende tilnærming til å jobbe med  personen

Dette kan innebære å bruke deres foretrukne navn og pronomen, selv om andre velger å ikke gjøre det.


Kjønnsuttrykk


Hjelp dem å eksperimentere med deres kjønnsuttrykk

Er det et trygt sted personen kan prøve ut ting (når det gjelder kjole, navn, pronomen etc) uten å måtte forplikte seg til noe?


Kjønsforståelse


Diskuter kjønnsforståelse

Kjønnsidentiet er komplisert og mangfoldig, og kan forstås som et spekter i stedet for nødvendigvis å være et binært valg mellom mann eller kvinne. Hva tenker den unge personen om denne ideen? Hvilke kjønnsrollemodeller har de? Skap mer innsikt


Ikke lukke noen dører


Hjelp personen til å holde alle muligheter åpne og gi en trygg mulighet til å utforske usikkerhet og tvil.

Unges identiteter utvikler seg gjennom ungdomsår og i voksen alder, og enkelte mennesker bestemmer seg for at de ønsker å uttrykke sin kjønnsidentitet på mange forskjellige måter, noe som kan endres over tid. Å holde valgmuligheter åpne er viktig for personen skal kunne endre seg hvis de vil. Det er mange måter å være menneske på. Det finnes ingen mal eller fasit. 


Familie


Jobb med familien

Gi plass til forskjellige meninger, tanker og følelser. Det er også viktig å bli lyttet til og føle omsorg. Oppfordre til åpen kommunikasjon om kjønn, på en måte som føles trygg.


Nettverk


Tenkt nettverk

Hvem kjenner personen og hvilken støtte kan de gi, om nødvendig? Utred nettverket og gjør nytte av det.


Risiko og utfordringer


Vurder risiko og tilhørende utfordringer.

Unge som stiller spørsmål om kjønnsidentitet, kan oppleve en rekke tilknyttede psykiske problemer, inkludert selvskading og selvmordstanker. Det er viktig at dette vurderes og forvaltes lokalt. Kjønnsidentitet eksisterer ikke i vakuum og det at personen søker støtte for sin kjønnsutfordring betyr ikke nødvendigvis at alle andre vanskeligheter vil bli bedre – det er ofte andre kompleksiteter som må vurderes og det vil være viktig å diskutere med person om hvordan det er best å gjøre dette.


Felles omsorg i nettverk

Etter vår erfaring har personen og fagpersoner rundt et stort utbytte når samarbeide går på tvers og det er god kommunikasjon med NBTS, BUP, DPS og andre lokale tjenestene, også skole og arbeid.


Samlet nettverksstøtte

HBRS kan om ønskelig bli med på lokale nettverksmøter, der vi kan delta i diskusjoner mellom flere organer som kan omfatte familien, skolen og andre som er involvert. Vi kan gi råd og veiledning i forhold til å møte personen på en god måte og hvordan man kan være med på å gjøre nærmiljøet til et trygt og inkluderende sted for alle. 


Lokale ressurser

HBRS mener at det er viktig at det lokale hjelpeapparatet, slik som BUP, DPS og andre er innvolvert, slik at de kan vurdere risikoer som kan oppstå, slik som selvskading eller om det er risiko for selvmord.
Samtidig så må vi erkjenne at kunnskapen rundt kjønnsdysfori og kjønnsinkongruens er ikke alltid like god alle steder. Men vi ser at kunnskapsnivået er økende, og at NBTS stiller seg til disposisjon om det lokale hjelpeapparatet trenger råd og veiledning.


Nettverksmøte

Et typisk nettverksmøte vil bli holdt der hvor barnet og familien bor, og vil involvere det lokale hjelpeapparatet, som kan være representanter fra bup, skole, eller andre instanser som er aktuelle.  På denne måten får vi en mulighet til å få et helhetlig bilde av eventuelle utfordringer.


Hvordan går man fram?

Henvisning og vurdering

NBTS fordrer nå at du har henvisning fra 2-linjetjenesten. Det betyr at din fastlege kan henvise deg til BUP (under 18 år) og til DPS (18 år og eldre). Du kan også ta direkte kontakt med psykologer som har store kunnskaper om kjønnsinkongruens og kjønnsdysfori. Du kan kontakte HBRS om vi har kunnskap om psykologer i ditt fylke som har en slik erfaring. HBRS samarbeider med psykologspesialist Asle Offerdal som har arbeidet med denne tematikken siden 2001.
Psykolog Offerdal holder til i samme lokale som HBRS i Oslo.

Hvis du er avhengig av å komme til en psykolog eller psykiater som har refusjonsavtale med NAV så kan du gå inn på nettsiden til den helseregionen som er aktuell for deg: Les mere på helsenorge.no
Du kan også kontakte HBRS på info@hbrs.no


Hvordan gå fram?

Henvisning og vurdering

NBTS fordrer nå at du har henvisning fra 2-linjetjenesten. Det betyr at din fastlege kan henvise deg til BUP (under 18 år) og til DPS (18 år og eldre). Du kan også ta direkte kontakt med psykologer som har store kunnskaper om kjønnsinkongruens og kjønnsdysfori. Du kan kontakte HBRS om vi har kunnskap om psykologer i ditt fylke som har en slik erfaring. HBRS samarbeider med psykologspesialist Asle Offerdal som har arbeidet med denne tematikken siden 2001.
Psykolog Offerdal holder til i samme lokale som HBRS i Oslo.

Hvis du er avhengig av å komme til en psykolog eller psykiater som har refusjonsavtale med NAV så kan du gå inn på nettsiden til den helseregionen som er aktuell for deg: Les mere på helsenorge.no
Du kan også kontakte HBRS på info@hbrs.no


Hvordan skal BUP, DPS utarbeide en henvisning til NBTS?

Utarbeidelse av henvisning

For barn og unge under 18 år:

BUP skal gjennomføre en bred barne- og ungdomspsykiatrisk utredning og så henviser BUP på indikasjon til Nasjonal behandlingstjeneste for transseksualisme barn og unge, Teamet for kjønnsidentitetsutredninger av barn og unge (KID-Teamet).
Følgende utredning av barnet/ungdommen er ønskelig fra lokal BUP før henvisning: Utviklingsanamnese inklusive familieforhold

  • ASEBA (barn/ungdom, foresatte, lærer)
  • Semistrukturert intervju (Kiddie-SADS, CAS)
  • Utredning av kognitiv funksjon om aktuelt (WISC, pedagogisk utredning eventuelt andre observasjoner)

Utredning med tanke på sosialt samspill og autismespekterlidelse
Forskning viser det er overhyppighet av autismespekterlidelser hos pasienter med kjønnsinkongruens (opp mot 30%). Det er derfor viktig å screene for dette. Det finnes ikke mange screeningsverktøy som er reliable nok, men vi kan anbefale disse som anbefales fra «Retningslinje for utredning av ASD i Helse Sør Øst».

Henvisninger og brev til NBTS-barn og unge

NBTS barn og unge, Teamet for kjønnsidentitetsutredninger av barn og unge (KID-Teamet)
Avdeling for barn og unges psykiske helse på sykehus (S-BUP)
Barne- og ungdomsklinikken, Rikshospitalet
Oslo Universitetssykehus
Postboks 4950 Nydalen
0424 Oslo

Voksne 18 år og eldre:

Distriktspsykiatriske poliklinikk (DPS) skal gjennomføre en psykiatrisk utredning og henvise deg videre til Nasjonal behandlingstjeneste for transseksualisme (NBTS) ved Oslo universitetssykehus.
Følgende utredning er ønskelig fra DPS før henvisning til NBTS:

  • Anamnese
  • Semistrukturert intervju (MINI)
  • SCID II
  • Utredning med tanke på autismespekterlidelse (Asperger) ved klinisk mistanke.
  • Utredning av kognitiv funksjon om aktuelt.

Henvisninger og brev til NBTS voksne
NBTS voksne
Psykosomatisk avdeling
Rikshospitalet
Oslo Universitetssykehus
Postboks 4950 Nydalen
0424 Oslo


Svar på henvisning

Når kan pasienten forvente det?

Pasienter som henvises til NBTS er såkalt (elektiv) helsehjelp i spesialisthelsetjenesten, skal få avklart om de har behov for og dermed rett til nødvendig helsehjelp fra spesialisthelsetjenesten og få vurdert hvilken frist de i så fall skal ha. NBTS må gjøre en rettighetsvurdering innen 10 virkedager. Det betyr at du innen 10 virkedager skal få et brev fra NBTS som avklarer om du vil bli innkalt til time.

Du skal ifølge pasient- og brukerrettighetsloven ha fått svar på henvisningsbrev senest 10 virkedager etter at brevet er mottatt på NBTS. Dersom du og din lege/psykolog ikke har fått svar innen 10 virkedager kan din lege/psykolog kontakte NBTS og purre på svar. Les mere om pasient- og brukerrettighetsloven på lovdata.no


Første time på NBTS

Hva kan pasienten forvente?

Den første timen blir brukt til informasjon om videre utredning og behandling. Det må også beregnes at pasienten må fylle ut en del skjemaer.


Utredning

Hva består utredningen av og hvor lenge varer den?

Det er vanskelig å si noe sikkert om hvor ofte pasiente vil bli innkalt til time. Men man kan regne med minst 4 – 6 samtaler i løpet av det første året, diagnostiske samtaler. Disse utføres av leger, psykologer og sykepleier. Utredningen er individuell og vil derfor ta ulik tid. Men utredningen skal vanligvis ikke ta mere enn 1 år.


Tidsperspektiv

Hvor lenge varer utredningen og behandlingen?

Utredning og behandling er individuell og vil derfor kunne ta ulik tid. Det vil også være preget av hvor mange operasjoner man ønsker. Men man må påregne 3 – 5 år fra første time på NBTS. I noen tilfeller kan det også ta lengre tid før man er ferdig med alle operasjoner. Hver time hos lege, psykolog og sykepleier varer i omtrent 45 minutter, hvis ikke nærmere spesifisert i innkallingsbrevet. Hvis det er ønskelig med flere timer samme dag eller to dager vil NBTS vil informere pasienten om dette skriftlig, og tilpasse det etter behov med en pasienthotell-overnatting hvis pasienten kommer fra en annen region i Norge.

Hvis du ikke finner svar på dine spørsmål vedrørende behandlingen i dette hefte eller på HBRS sin hjemmeside, så kan du sende spørsmål til info@hbrs.no

Forskning

Forskning barn og unge kjønn kjønnsdysfori


Desisting and persisting gender dysphoria after childhood Steensma 2011

Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis

Abstract

The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14-18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different.

 

Desisting and persisting gender dysphoria after childhood Steensma 2011


A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Methods: A critical review methodology is employed to systematically interpret four frequently-cited studies that sought to document identity outcomes for gender-nonconforming children (often referred to as “desistance” research).

Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children’s gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children’s gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children’s voices seriously. Listening to children’s experiences will enable a more comprehensive understanding of the needs of gender-nonconforming children and provide guidance to scientific and lay communities.

 

A critical commentary on follow-up studies and desistance NEWHOOK.IJT.2018


A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”

Thomas D. Steensma & Peggy T. Cohen-Kettenis

Abstract

The article entitled “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Picket, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1456390.[Taylor & Francis Online][Google Scholar]) is a plea to abandon longitudinal studies on the development of gender variant children as they do not respect children’s autonomy. A few relatively recent studies are criticized and it is concluded that conducting longitudinal psychosexual outcome studies and acknowledging the children’s feelings are contradictory. We agree that the longitudinal studies currently available have their limitations. We do, however, strongly disagree with the authors that studies on gender variant children’s development should be abandoned and that our studies do not take children’s needs and voices seriously or are unethical

 

A critical commentary on A critical commentary on follow up studies and desistence theories about transgender and gender non conforming children


A FOLLOW-UP STUDY OF BOYS WITH GENDER IDENTITY DISORDER

Devita Singh

Abstract

This study provided information on the long term psychosexual and psychiatric outcomes of 139 boys with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 7.49 years; range, 3–12 years) and at follow-up (mean age, 20.58 years; range, 13–39 years) were used to evaluate gender identity and sexual orientation outcome. At follow-up, 17 participants (12.2%) were judged to have persistent gender dysphoria. Regarding sexual orientation, 82 (63.6%) participants were classified as bisexual/ homosexual in fantasy and 51 (47.2%) participants were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual. With gender identity and sexual orientation combined, the most common long-term outcome was desistence of GID with a bisexual/homosexual sexual orientation followed by desistence of GID with a heterosexual sexual orientation. The rates of persistent gender dysphoria and bisexual/homosexual sexual orientation were substantially higher than the base rates in the general male population.

Childhood assessment data were used to identify within-group predictors of variation in gender identity and sexual orientation outcome. Social class and severity of cross-gender behavior in childhood were significant predictors of gender identity outcome. Severity of childhood cross-gender behavior was a significant predictor of sexualorientation at follow-up. Regarding psychiatric functioning, the heterosexual desisters reported significantly less behavioral and psychiatric difficulties compared to the bisexual/homosexual persisters and, to a lesser extent, the bisexual/homosexual desisters. Clinical and theoretical implications of these follow-up data are discussed.


Kraftig ökning av könsdysfori bland barn och unga

Louise Frisén,  Olle Söder,  Per-Anders Rydelius,

Abstract

  • Under det senaste decenniet har antalet unga med könsdysfori som söker sjukvårdens insatser för köns­ bekräftande åtgärder ökat kraftigt.
  • En minoritet (ca 20 procent) av barn <12 år med könsdysfori kommer att ha en kvarstående önskan om könsbekräftande åtgärder.
  • Majoriteten av de barn vars könsdysfori förstärks i samband med puberteten uppfyller diagnoskriterierna för transsexualism och kan behandlas med pubertets­ stoppande hormoner i syfte att undvika utveckling av oönskade sekundära könskarakteristika.
  • Tidigt insatt behandling underlättar möjligheten att framgångsrikt passera i det önskade könet och är förknippat med betydligt bättre prognos.

 

 

Barn i Sverige 2017


Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Riittakerttu Kaltiala-Heino1,2*, Maria Sumia2 , Marja Työläjärvi2 and Nina Lindberg3,4

Abstract

Background:

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.

Methods:

Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.

Results:

The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.

Conclusion:

The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Keywords:

Transsexualism, Gender dysphoria, Sex reassignment, Adolescent development

 

 

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development


CHILDREN WITH ATYPICAL GENDER DEVELOPMENT

Louise Newman

Gender dysphoria

is the sense of discomfort with one’s biological sex and assigned gender role − may present in children from the age of 2 years. Some children may express unhappiness at their gender and often may express the desire to change sex. This can have a significant impact on child development in a broad way and also on family functioning. Families vary in their response to a child’s cross-gendered preferences or gender questions with some showing acceptance and tolerance and others expressing anxiety and a desire to resolve the issue. There are scarce data available as to the prevalence of this condition in children and there is ongoing debate about the best clinical approach to it. The evidence base about treatment in children is limited and the ethical issues are complex.

 

 

Children with atypical development


Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study

Thomas D. Steensma, Ph.D., Jenifer K. McGuire, Ph.D., M.P.H., Baudewijntje P.C. Kreukels, Ph.D., Anneke J. Beekman, B.Sc., Peggy T. Cohen-Kettenis, Ph.D.

Abstract

Objective:

To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence.

Method:

The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence.

Results:

We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls.

Conclusion:

Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD. J. Am. Acad. Child Adolesc. Psychiatry, 2013;52(6):582–590.

Key Words:

childhood gender dysphoria, desistence, persistence, sexual orientation, social role transitioning

 

 

Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study


Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach

ANNELOU L. C. DE VRIES, MD, PhD and PEGGY T. COHEN-KETTENIS, PhD VU University Medical Center, Amsterdam, the Netherlands

The Dutch Approach

The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth’s functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty. Gender dysphoric adolescents can be considered eligible for puberty suppression and subsequent crosssex hormones when they reach the age of 16 years. Currently, withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.

KEYWORDS

gender, gender identity, gender identity disorder, gender identity disorder of childhood, gender identity disorder of adolescence, gender vari

 

 

Clinical Management of Gender Dysphoria in Children and Adolescents The Dutch Approach


Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study

Thomas D. Steensma, Roeline Biemond, Fijgje de Boer, and Peggy T. Cohen-Kettenis Department of Medical Psychology, VU University Medical Centre, Amsterdam, the Netherlands

Abstract

The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14–18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different. Keywords childhood gender dysphoria, Gender Identity Disorder, gender variant, psychosexual development, sexual orientation, transgender, transsexual

 

 

Desisting and persisting gender dysphoria after childhood Steensma 2011


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

Lieke Josephina Jeanne Johanna Vrouenraets, M.Sc. a,*, A. Miranda Fredriks, M.D., Ph.D. a , Sabine E. Hannema, M.D., Ph.D. b , Peggy T. Cohen-Kettenis, Ph.D. c , and Martine C. de Vries, M.D., Ph.D. b

Abstract

Purpose:

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.

Methods:

Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.

Results:

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-) availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.

Conclusions:

As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.  2015 Society for Adolescent Health and Medicine. All rights reserved.

 

 

early treatment children enocrine society 2015


Gender dysphoria in adolescents: the need for a shared assessment protocol and proposal of the AGIR protocol

D. Dèttore1,2, J. Ristori2,3, P. Antonelli2 , E. Bandini2 , A.D. Fisher2,3, S. Villani2 , A.L.C. de Vries4 , T.D. Steensma4 , P.T. Cohen-Kettenis4

Abstract

In the Center of Expertise on Gender Dysphoria at the VU University Medical Center in Amsterdam, a structured assessment and treatment protocol for adolescents with atypical gender identities is used. This multidimensional approach includes specific phases: psychological assessment, medical evaluation, possible psychotherapy, gonadotropin-releasing hormone (GnRH) analogues and cross-sex hormone therapy, which are differentiated according to age and specific requirements of each individual case. Recently, a collaborative study called AGIR (Adolescent Gender Identity Research) has been proposed by the Dutch clinic to allow international and cross-clinic comparisons with regards to referral background and psychological functioning, and to evaluate the treatment of gender dysphoric adolescents. An extensive assessment and timely treatment of adolescents with gender dysphoria seems essential to support the process of awareness and structuring of the dimensions of sexual identity, to prevent frequent associated psychopathologies and to improve quality of life by promoting more adequate psychosocial adaptation. Currently, transgender health care in Italy is characterized by isolated practitioners. Thus, it is particularly important to create specialised services that use a common protocol and that are coordinated at both the national and international levels in order to respond to the increasing number of requests in this age group.

Key words

Gender identity • Gender Dysphoria • Assessment • Intervention • Protocol • Adolescents

 

gender dysphoria in adolesents 2015


More Than Two Developmental Pathways in Children With Gender Dysphoria?

Thomas D. Steensma, PhD Peggy T. Cohen-Kettenis, PhD Center of Expertise on Gender Dysphoria VU University Medical Center Amsterdam t.steensma@vumc.nl

LETTER TO THE EDITOR

Current prospective studies on the development of children fulfilling diagnostic criteria of gender identity disorder according to the DSM-III, DSM-III-R, DSM-IV, and DSM-IV-TR have indicated that the most common psychosexual outcome is homosexuality or heterosexuality without gender dysphoria (GD).1 Across all studies, the persistence rate of GD has been approximately 16%. What should be emphasized is that these studies did not use the fairly strict criteria of the DSM-5, and children could receive the diagnosis based only on gender-variant behavior.

 

 

More Than Two Developmental Pathways in Children Steensma 2015


‘Rapid onset’ of transgender identity ignites storm

Meredith Wadman

sciencemag.org

Artikkel

Critics charge a study is biased, but others say politics is inhibiting science.

A study describing “rapid onset gender dysphoria” (ROGD) in teens and young adults—a sudden unease with the gender they were assigned at birth—has infuriated transgender activists while sparking a debate about academic freedom. Critics of the paper, published last month in PLOS ONE by physician-scientist Lisa Littman of Brown University, call it a flawed study that reflects an antitransgender agenda, in part because it suggests some cases may be the result of “social contagion.” Brown and the journal have both distanced themselves from the paper, drawing charges that they surrendered to political pressure.


The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. (2018)

Kenneth J. Zucker

Abstract

Temple Newhook et al. (2018) provide a critique of recent follow-up studies of children referred to specialized gender identity clinics, organized around rates of persistence and desistance. The critical gaze of Temple Newhook et al. examined three primary issues:

(1) the terms persistence and desistance in their own right;

(2) methodology of the follow-up studies and interpretation of the data; and

(3) ethical matters. In this response, I interrogate the critique of Temple Newhook et al. (2018).

KEYWORDS

Desistance; developmental psychiatry; DSM-5; gender dysphoria; gender identity disorder; persistence; transgender


Young Adult Psychological Outcome After Puberty
Suppression and Gender Reassignment

Annelou L.C. de Vries, MD, PhD,a Jenifer K. McGuire, PhD, MPH,b Thomas D. Steensma, PhD,a Eva C.F. Wagenaar, MD,a Theo A.H

Abstract

BACKGROUND:

In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach.

METHODS:

A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated.

RESULTS:

After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Wellbeing was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.

CONCLUSIONS:

A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults. Pediatrics 2014;134:696–704

Hjernen kjønnsdysfori Transsexual


White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study

Giuseppina Rametti d,f , Beatriz Carrillo b , Esther Gómez-Gil c , Carme Junque b,f , Santiago Segovia a , Ángel Gomez e , Antonio Guillamon a,*

ABSTRACT

Background: Some gray and white matter regions of the brain are sexually dimorphic. The best MRI technique for identifying subtle differences in white matter is diffusion tensor imaging (DTI). The purpose of this paper is to investigate whether white matter patterns in female to male (FtM) transsexuals before commencing cross-sex hormone treatment are more similar to that of their biological sex or to that of their gender identity. Method: DTI was performed in 18 FtM transsexuals and 24 male and 19 female heterosexual controls scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter fibers of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics. Results: In controls, males have significantly higher FA values than females in the medial and posterior parts of the right superior longitudinal fasciculus (SLF), the forceps minor, and the corticospinal tract. Compared to control females, FtM showed higher FA values in posterior part of the right SLF, the forceps minor and corticospinal tract. Compared to control males, FtM showed only lower FA values in the corticospinal tract. Conclusions: Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gender identity (males) than those who share their biological sex (females). Our results provide evidence for an inherent difference in the brain structure of FtM transsexuals. 

 

White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study


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

Giuseppina Rametti d,f , Beatriz Carrillo b , Esther Gómez-Gil c , Carme Junque b,f , Leire Zubiarre-Elorza b , Santiago Segovia a , Ángel Gomez e , Antonio Guillamon a,*

ABSTRACT

Background: Diffusion tensor imaging (DTI) has been shown to be sensitive in detecting white matter differences between sexes. Before cross-sex hormone treatment female to male transsexuals (FtM) differ from females but not from males in several brain fibers. The purpose of this paper is to investigate whether white matter patterns in male to female (MtF) transsexuals before commencing cross-sex hormone treatment are also more similar to those of their biological sex or whether they are more similar to those of their gender identity. Method: DTI was performed in 18 MtF transsexuals and 19 male and 19 female controls scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics. Results: MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract. Conclusions: 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. 

 

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


Effects of androgenization on the white matter microstructure of female-to-male transsexuals. A diffusion tensor imaging study

Giuseppina Rametti d,f , Beatriz Carrillo a , Esther Go´mez-Gil c , Carme Junque b,f , Leire Zubiaurre-Elorza b,f , Santiago Segovia a , A´ngel Gomez e , Kazmer Karadi g , Antonio Guillamon a, *

ABSTRACT

Diffusion tensor imaging (DTI) can sensitively detect white matter sex differences and the effects of pharmacological treatments. Before cross-sex hormone treatment, the white matter microstructure ofseveral brain bundlesin female-to-male transsexuals (FtMs) differsfrom those in females but not from that in males. The purpose of this study was to investigate whether cross-sex hormone treatment (androgenization) affects the brain white matter microstructure. Using a Siemens 3 T Trio Tim Magneton, DTI was performed twice, before and during cross-sex hormonal treatment with testosterone in 15 FtMs scanned. Fractional anisotropy (FA) was analyzed on white matter of the whole brain, and the latter was spatially analyzed using Tract-Based Spatial Statistics. Before each scan the subjects were assessed for serum testosterone, sex hormone binding globulin level (SHBG), and their free testosterone index. After at least seven months of cross-gender hormonal treatment, FA values increased in the right superior longitudinal fasciculus (SLF) and the right corticospinal tract (CST) in FtMs compared to their pretreatment values. Hierarchical regression analyses showed that the increments in the FA values in the SLF and CST are predicted by the free testosterone index before hormonal treatment. All these observations suggest that testosterone treatment changes white matter microstructure in FtMs.

 

Effects of androgenization on the white matter microstructure of female-to-male transsexuals. A diffusion tensor imaging study


Transsexualism differences caught on brain scan

Jessica Hamzelou

ABSTRACT

Differences in the brain’s white matter that clash with a person’s genetic sex may hold the key to identifying transsexual people before puberty. Doctors could use this information to make a case for delaying puberty to improve the success of a sex change later.

 

Transsexual differences caught on brain scan fra 2011


Hormoner kjønnsdysfori Transsexual


Effects of Cross-Sex Hormone Treatment on Emotionality in Transsexuals

Ditte Slabbekoorn, Stephanie H.M. Van Goozen, Louis J.G. Gooren, Peggy T. Cohen-Kettenis

ABSTRACT

The aim of the study was to investigate whether cross-sex hormone treatment in transsexuals affected the intensity of negative and positive emotions in general, and aggressive and sexual feelings in particular. With respect to emotional behavior, changes in non-verbal expressiveness and anger readiness were examined in 47 female-to-male transsexuals (FtMs) and 54 male-to-female transsexuals (MtFs). We were also interested in finding out whether, in FtMs, the rapidly changing testosterone levels in the two-week cycle testosterone treatment had predictable effects on moods, the development of male physical characteristics and sexuality.

Keywords: sex hormones, transsexuals, emotionality, sexuality, aggression.

 

 

Effects of Cross-Sex Hormone Treatment on Emotionality in Transsexuals


Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Wylie C. Hembree,1 Peggy T. Cohen-Kettenis,2 Louis Gooren,3 Sabine E. Hannema,4 Walter J. Meyer,5 M. Hassan Murad,6 Stephen M. Rosenthal,7 Joshua D. Safer,8 Vin Tangpricha,9 and Guy G. T’Sjoen10

ABSTRACT

Objective:

To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009. Participants: The participants include an Endocrine Society–appointed task force of nine experts, a methodologist, and a medical writer.

Evidence:

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus

Process:

Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.

 

Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline


Neuronal plasticity of language-related brain regions induced by long-term testosterone treatment

Andreas Hahn1 , Georg S. Kranz1 , Ronald Sladky2 , Ulrike Kaufmann3 , Sebastian Ganger1 , Allan Hummer2 , Rene Seiger1 , Marie Spies1 , Thomas Vanicek1 , Dietmar Winkler1 , Siegfried Kasper1 , Christian Windischberger2 , Dick F. Swaab4 , Rupert Lanzenberger1

ABSTRACT

The sex steroid hormone testosterone exhibits a substantial influence on behavior and cognition via the modulation of underlying brain structures and function. Testosterone plays a particular role in language function, showing associations with vocabulary and sexually dimorphic gray matter regions [1]. However, the majority of studies are limited to cross-sectional investigations or single hormone applications due to ethical reasons. Here, we assessed the influence of continuous high-dose testosterone treatment on brain structure and function in female-to-male (FtM) transsexuals before and after start of hormone therapy.

 

 

Neuronal plasticity of language-related brain regions induced by long-term testosterone treatment


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.

Dr. Courtney Finlayson

E-bok

Offering current guidelines on the relatively new practice of puberty suppression for gender-dysphoric adolescents, Pubertal Suppression in Transgender Youth provides a succinct, easy-to-digest overview of this timely topic. This concise, clinically-focused resource by Dr. Courtney Finlayson covers all relevant topics, from a brief history of medical care of transgender youth to emerging developments in the field.

Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.


Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review.

Chew D1Anderson J2Williams K1,3,4May T1,3,4,5Pang K6,3

ABSTRACT

CONTEXT:

Hormonal interventions are being increasingly used to treat young people with gender dysphoria, but their effects in this population have not been systematically reviewed before.

OBJECTIVE:

To review evidence for the physical, psychosocial, and cognitive effects of gonadotropin-releasing hormone analogs (GnRHa), gender-affirming hormones, antiandrogens, and progestins on transgender adolescents.

DATA SOURCES:

We searched Medline, Embase, and PubMed databases from January 1, 1946, to June 10, 2017.

STUDY SELECTION:

We selected primary studies in which researchers examined the hormonal treatment of transgender adolescents and assessed their psychosocial, cognitive, and/or physical effects.

DATA EXTRACTION:

Two authors independently screened studies for inclusion and extracted data from eligible articles using a standardized recording form.

RESULTS:

Thirteen studies met our inclusion criteria, in which researchers examined GnRHas (n = 9), estrogen (n = 3), testosterone (n = 5), antiandrogen (cyproterone acetate) (n = 1), and progestin (lynestrenol) (n = 1). Most treatments successfully achieved their intended physical effects, with GnRHas and cyproterone acetate suppressing sex hormones and estrogen or testosterone causing feminization or masculinization of secondary sex characteristics. GnRHa treatment was associated with improvement across multiple measures of psychological functioning but not gender dysphoria itself, whereas the psychosocial effects of gender-affirming hormones in transgender youth have not yet been adequately assessed.

LIMITATIONS:

There are few studies in this field and they have all been observational.

CONCLUSIONS:

Low-quality evidence suggests that hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact are generally lacking. Future research to address these knowledge gaps and improve understanding of the long-term effects of these treatments is required.

Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review.


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

Lieke Josephina Jeanne Johanna Vrouenraets, M.Sc. a,*, A. Miranda Fredriks, M.D., Ph.D. a , Sabine E. Hannema, M.D., Ph.D. b , Peggy T. Cohen-Kettenis, Ph.D. c , and Martine C. de Vries, M.D., Ph.D. b

ABSTRACT

Purpose

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.

Methods

Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.

Results

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.

Conclusions

As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.

Keywords:

Gender dysphoriaPuberty suppressionAdolescentsEthicsQualitative studyInterviewsQuestionnairesWorldwide

 

 

Early Medical Treatment of Children and Adolescents With Gender Dysphoria- An Empirical Ethical Study


Long term hormonal treatment for transgender people

Martin den Heijer professor of endocrinology 1 2, Alex Bakker transgender man with 20 years of experience taking hormonal treatment, Louis Gooren emeritus professor in transgender medicine 2

ABSTRACT

The aim of hormone treatment in transgender people is to adjust their secondary sex characteristics to be more congruent with their experienced gender. Hormone treatment for transgender people is usually initiated by specialist gender clinics, but some people start hormone treatment of their own accord without a prescription. With growing numbers of transgender people presenting to healthcare services (estimated as 9.2 per 100 0001 ), general practitioners, general endocrinologists, and other doctors will become increasingly involved in their long term care, the prescription of hormones, and consideration of potential side effects. Several guidelines are available on the start of hormonal treatment2-7; the focus of this article is the long term hormonal care for transgender people who might no longer attend a specialist clinic.

 

 

Long term hormonal treatment for transgender people


Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

Noor Beckwith,1,2 Sari L. Reisner,2–5 Shayne Zaslow,3,6 Kenneth H. Mayer,2,3,7 and Alex S. Keuroghlian1–3,*

ABSTRACT

Purpose:

Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults.

Methods:

We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of genderaffirming surgery and of age of hormone therapy initiation.

Results:

Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD = 11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist.

Conclusion:

This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients. Keywords: barriers to

 

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults


Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study

Sari L. Reisner, ScD, MA,1,2 Ralph Vetters, MD, MPH,3 M Leclerc, MPH,4 Shayne Zaslow, MA, MS,2Sarah Wolfrum, MPH,2 Daniel Shumer, MD,5 and Matthew J. Mimiaga, ScD, MPH1,2,6

ABSTRACT

Purpose

Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exists to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the current study aimed to fill this gap.

Methods

A retrospective cohort study of electronic health record (EHR) data from 180 transgender patients age 12–29 years seen between 2002–2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM to MTF youth on mental health outcomes.

Results

The sample (n=360) had a mean age of 19.6 (SD=3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared to cisgender matched controls, transgender youth had a two- to three-fold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p<0.05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.

Conclusions

Transgender youth were found to have a disparity in negative mental health outcomes compared to cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.

Keywords: 

mental health, transgender, gender minority, adolescent, health disparit

 

Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study


Transgender women: Evaluation and management

ABSTRACT

The terms transgender and gender incongruence describe a situation where an individual’s gender identity differs from external sexual anatomy at birth. Health care providers should be familiar with commonly used terms (table 1). Gender identity-affirming care, for those who desire, can include hormone therapy and affirming surgeries, as well as other procedures such as hair removal or speech therapy [1].

This topic will use the term transgender in the broadest sense to include any person with incongruence between gender identity and external sexual anatomy at birth. The evaluation and management of transgender women are discussed here. The evaluation and management of transgender men, the primary care of the transgender adult, and gender diversity in children and adolescents are reviewed separately. (See «Transgender men: Evaluation and management» and «Primary care of transgender individuals» and «Gender development and clinical presentation of gender diversity in children and adolescents» and «Management of transgender and gender-diverse children and adolescents».)

Transgender women: Evaluation and management

trans kirurgi


An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.46

Jordan D. Frey, M.D. Grace Poudrier, B.A. Michael V. Chiodo, M.D. Alexes Hazen, M.D.

ABSTRACT

Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient—an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction).

However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The “ideal” neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed. (Plast. Reconstr. Surg. 139: 728, 2017.)

 

 

An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.46


Chest-Wall Contouring Surgery in Female-to-Male Transsexuals: A New Algorithm

Stan Monstrey, M.D., Ph.D. Gennaro Selvaggi, M.D. Peter Ceulemans, M.D. Koen Van Landuyt, M.D. Cameron Bowman, M.D. Phillip Blondeel, M.D., Ph.D. Moustapha Hamdi, M.D. Griet De Cuypere, M.D.

ABSTRACT

: In female-to-male transsexuals, the first surgical procedure in their reassignment surgery consists of the subcutaneous mastectomy. The goals of subcutaneous mastectomy are removal of breast tissue, removal of excess skin, reduction and proper positioning of the nipple and areola, and ideally, minimization of chest-wall scars. The authors present the largest series to date of female-to-male transsexuals who have undergone subcutaneous mastectomy.

Methods:

A total of 184 subcutaneous mastectomies were performed in 92 female-to-male transsexuals, using the following five techniques: semicircular, transareolar, concentric circular, extended concentric circular, and free nipple graft. The technique used depended on the breast size and envelope, the aspect and position of the nipple-areola complex, and the skin elasticity. To best meet the goals of creating a normal male thorax, the authors have developed an algorithm to aid in choosing the appropriate procedure.

Results:

The overall postoperative complication rate was 12.5 percent (23 of 184 subcutaneous mastectomies), and in eight of these cases (4.3 percent), an additional operative intervention was required because of hematoma, infection, and/or wound dehiscence. Despite this low complication rate, additional procedures for improving aesthetic results were performed on 59 breasts (32.1 percent). The semicircular and concentric circular techniques produced the highest rating of the overall result by patient and surgeon, whereas the extended concentric circular technique produced the lowest rating.

Conclusions:

Skin excess and skin elasticity are the key factors in choosing the appropriate technique for subcutaneous mastectomy, which is reflected in the algorithm. Although the complication rate is low and patient satisfaction is high, secondary aesthetic corrections are often indicated. (Plast. Reconstr. Surg. 121: 849, 2008.)

 

 

Chest-Wall Contouring Surgery in Female-to-Male Transsexuals: A New Algorithm


The role of colpocleisis transsexual phalloplasty with urethral lengthening in

Ralph R. Chesson, MD, c David A. Gilbert, MD, a Gerald H. Jordan, MD, b Steven M. Schlossberg, MD, b Gerald T. Ramsey, PhD, and Deborah M. Gilbert, RN ~ Norfolk, Virginia

ABSTRACT

OBJECTIVE:

Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented.

STUDY DESIGN:

Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vag!nal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment.

RESULTS;

Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible.

CONCLUSION:

Extending the urethra during colpocteisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results. (Am J Obstet Gynecol 1996;175:1443-50.)

Key words:

Transsexual surgery, colpocleisis, anterior vaginal wall extension, phalloplasty

 

 

The role of colpocleisis transsexual phalloplasty with urethral lengthening in


Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism

Albert Leriche, Marc-Olivier Timsit, Nicolas Morel-Journel, André Bouillot, Diala Dembele and Alain Ruffion Department of Urology, Henry Gabrielle Hospital, University of Lyon I, Lyon, France

ABSTRACT

OBJECTIVE

To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in femaleto-male transsexuals is a surgical challenge.

PATIENTS AND METHODS

We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our department from 1986 to 2002. The complication rate was assessed by regular examination. Patient satisfaction was evaluated by a questionnaire about cosmetic aspects, sexual life and overall satisfaction.

RESULTS

The mean follow up was 110 months; 53 of the 56 patients (95%) currently have a neophallus, after a mean of six surgical procedures. Satisfaction was assessed in 53 patients using a specific questionnaire: 51 (93%) of the patients reported that the phalloplasty allowed them to accord their physical appearance with their feeling of masculinity. There were flap complications in 14 patients (25%); three (5%) flaps were lost, with one each due to early haematoma, cellulitis and late arterial thrombosis. The other 11 flap complications were all transitory, e.g. infection, haematomas and vascular thrombosis. There were prosthesis complications in 11 of 38 patients (29%). Moreover, seven of 19 patients (37%) who had a urethroplasty presented with complex strictures and fistulae that led to perineal urethrostomy.

CONCLUSION

Our study shows that phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.

KEYWORDS transsexualism, gender identity, surgical flap, penis surgery, urethra surgery, penile prosthesis

 

 

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism


Gender Confirmation Surgery, An Issue of Clinics in Plastic Surgery, E-Book (The Clinics: Surgery)

E-bok

This issue of Clinics in Plastic Surgery, guest edited by Loren Schechter and Bauback Safa, is devoted to Gender Confirmation Surgery. Articles in this issue include: Multidisciplinary Care and The Standards of Care for Transgender and Gender Non-conforming Individuals; Primary Care of Transgender and Gender Non-conforming Individuals; Mental Health Evaluation for Transgender and Gender Non-conforming Individuals; Hormonal Management for Transfeminine Individuals; Hormonal Management for Transmasculine Individuals; Facial Feminization; Breast and Body Contouring for Transgender and Gender Non-conforming Individuals; Penile inversion; Intestinal Vaginoplasty; Vaginoplasty Complications; Chest Surgery for Transgender and Gender Non-conforming Individuals; Metoidioplasty; Introduction to Phalloplasty; Radial Forearm; AnteroLateral Thigh flap (ALT); Penile Prostheses; Flap-related Complications; Urologic Complications; and Sexual Health after Surgery.

Gender Confirmation Surgery, An Issue of Clinics in Plastic Surgery, E-Book (The Clinics: Surgery)


Penile Reconstruction with the Radial Forearm Flap: An Update

M. Doornaert 1, P. Hoebeke 2, P. Ceulemans 1, G. T ’ Sjoen 3, G. Heylens 4, S. Monstrey 1

ABSTRACT

Background:

Many methods and many free or pedicled flaps have been used in phalloplasty. None of these techniques is able to completely fulfill the well described goals in penile reconstruction. Still, the radial forearm flap is currently the most frequently used fl ap and thus universally considered the gold standard.

Patients and Methods:

Since 1992, we have performed the largest series of 316 radial forearm phalloplasties to date performed by a single surgical team. From these extensive data we critically evaluate how this current supposed gold standard can meet the requirements of an ideal penile reconstruction.

Results:

We assessed outcome parameters such as number of procedures to achieve complete functional result, aesthetic outcome, tactile and erogenous sensation, voiding, donor site morbidity, scrotoplasty and sexual intercourse.

Conclusion:

While currently no controlled randomized prospective studies are available to prove the radial forearm flap is truly the gold standard in penile reconstruction, we believe that our retrospective data support the radial forearm phalloplasty as a very reliable technique for the creation of a normal looking penis and scrotum. While full functionality is achieved through a minimum of 2 procedures, the patients are always able to void standing, and in most cases to experience sexual satisfaction. The relative disadvantages of this technique are the residual scar on the forearm donor site, the rather high number of initial urinary fistulas, the potential for long-term urological complications and the need for a stiff ener or erection prosthesis. From our experience, we strongly feel that a structured multi-disciplinary cooperation between the reconstructive-plastic surgeon and the urologist is an absolute requisite to obtain the best possible technical results.

 

 

Penile Reconstruction with the Radial Forearm Flap: An Update


Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?

Stan Monstrey, M.D., Ph.D. Piet Hoebeke, M.D., Ph.D. Gennaro Selvaggi, M.D. Peter Ceulemans, M.D. Koen Van Landuyt, M.D., Ph.D. Phillip Blondeel, M.D., Ph.D. Moustapha Hamdi, M.D., Ph.D. Nathalie Roche, M.D. Steven Weyers, M.D. Griet De Cuypere, M.D. Ghent, Belgium

ABSTRACT

Background:

The ideal goals in penile reconstruction are well described, but the multitude of flaps used for phalloplasty only demonstrates that none of these techniques is considered ideal. Still, the radial forearm flap is the most frequently used flap and universally considered as the standard technique.

Methods:

In this article, the authors describe the largest series to date of 287 radial forearm phalloplasties performed by the same surgical team. Many different outcome parameters have been described separately in previously published articles, but the main purpose of this review is to critically evaluate to what degree this supposed standard technique has been able to meet the ideal goals in penile reconstruction.

Results:

Outcome parameters such as number of procedures, complications, aesthetic outcome, tactile and erogenous sensation, voiding, donor-site morbidity, scrotoplasty, and sexual intercourse are assessed.

Conclusions:

In the absence of prospective randomized studies, it is not possible to prove whether the radial forearm flap truly is the standard technique in penile reconstruction. However, this large study demonstrates that the radial forearm phalloplasty is a very reliable technique for the creation, mostly in two stages, of a normal-appearing penis and scrotum, always allowing the patient to void while standing and in most cases also to experience sexual satisfaction. The relative disadvantages of this technique are the rather high number of initial fistulas, the residual scar on the forearm, and the potential long-term urologic complications. Despite the lack of actual data to support this statement, the authors feel strongly that a multidisciplinary approach with close cooperation between the reconstructive/plastic surgeon and the urologist is an absolute requisite for obtaining the best possible results. (Plast. Reconstr. Surg. 124: 510, 2009.)

 

 

Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?


Phalloplasty: A Review of Techniques and Outcomes

Shane D. Morrison, M.D., M.S. Afaaf Shakir, B.S. Krishna S. Vyas, M.D., M.H.S. Johanna Kirby, B.S. Curtis N. Crane, M.D. Gordon K. Lee, M.D. Seattle, Wash.; Palo Alto and San Francisco, Calif.; and Lexington, Ky.

ABSTRACT

Background:

Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes.

Methods:

A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected.

Results:

A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction.

Conclusions:

Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients. (Plast. Reconstr. Surg. 138: 594, 2016.)

 

 

Phalloplasty: A Review of Techniques and Outcomes


Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients

Gennaro Selvaggi, MD,* Stan Monstrey, MD, PhD,* Peter Ceulemans, MD,* Guy T’Sjoen, MD,‡ Griet De Cuypere, MD,§ and Piet Hoebeke, MD, PhD†

ABSTRACT

Background:

Tactile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery. Since November 1993 until April 2003, a total of 105 phalloplasties with the radial forearm free flap and 127 vaginoclitoridoplasties with the inverted penoscrotal skin flap and the dorsal glans pedicled flap have been performed at Ghent University Hospital. The specific surgical tricks used to preserve genital and tactile sensitivity are presented. In phalloplasty, the dorsal hood of the clitoris is incorporated into the neoscrotum; the clitoris is transposed, buried, and fixed directly below the reconstructed phallic shaft; and the medial and lateral antebrachial nerves are coapted to the inguinal nerve and to one of the 2 dorsal nerves of the clitoris. In vaginoplasty, the clitoris is reconstructed from a part of the glans penis inclusive of a part of the corona, the inner side of the prepuce is used to reconstruct the labia minora, and the penile shaft is inverted to line the vaginal cavity.

Material and Methods:

A long-term sensitivity evaluation (performed by the Semmes-Weinstein monofilament and the Vibration tests) of 27 reconstructed phalli and 30 clitorises has been performed.

Results:

The average pressure and vibratory thresholds values for the phallus tip were, respectively, 11.1 g/mm2 and 3 m. These values have been compared with the ones of the forearm (donor site). The average pressure and vibratory thresholds values for the clitoris were, respectively, 11.1 g/mm2 and 0.5 m. These values have been compared with the ones of the normal male glans, taken from the literature. We also asked the examined patients if they experienced orgasm after surgery, during any sexual practice (ie, we considered only patients who attempted to have orgasm): all female-to-male and 85% of the male-to-female patients reported orgasm.

Conclusion:

With our techniques, the reconstructed genitalia obtain tactile and erogenous sensitivity. To obtain a good tactile sensitivity in the reconstructed phallus, we believe that the coaptation of the cutaneous nerves of the flap with the ilioinguinalis nerve and with one of the 2 nerves of the clitoris is essential in obtaining this result. To obtain orgasm after phalloplasty, we believe that preservation of the clitoris beneath the reconstructed phallus and some preservation of the clitoris hood are essential. To obtain orgasm after a vaginoplasty, the reconstruction of the clitoris from the neurovascular pedicled glans flap is essential.

Key Words:

transsexualism, phalloplasty, vaginoplasty, sensitivity, gender dysphoria, sex reass

 

 

Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients


Nordisk forskning kjønnsdysfori


”Det er ufattelig deilig når andre oppfatter deg som den du faktisk er!”

I hvilken grad er stemmen og dens uttrykk viktig for kjønnsidentitet hos personer med kjønnsinkongruens?

John F. Strang, Haley Meagher, Lauren Kenworthy, Annelou L. C. de Vries, Edgardo Menvielle, Scott Leibowitz, Aron Janssen, Peggy Cohen-Kettenis, Daniel E. Shumer, Laura Edwards-Leeper, Richard R. Pleak, Norman Spack, Dan H. Karasic, Herbert Schreier, Anouk Balleur, Amy Tishelman, Diane Ehrensaft, Leslie Rodnan, Emily S. Kuschner, Francie Mandel, Antonia Caretto, Hal C. Lewis & Laura G. Anthony

Sammendrag

Bakgrunn for tema: For å produsere stemmelyd trengs luft fra lungene, et fungerende strupehode og resonansrom. Stemmen brukes for å uttrykke seg i kommunikasjon med andre, og vi kan oppfatte det lingvistiske budskapet til avsenderen gjennom talespråket; – men vi kan også oppfatte paralingvistisk informasjon som alder og kjønn. Oppfattelsen av kjønn, og hva som forstås som kjønn, kan sies å være både biologisk og sosialt betinget. Personer med kjønnsinkongruens opplever et manglende samsvar mellom det biologiske kjønnet de fikk tildelt ved fødsel og det sosiale kjønnet de identifiserer seg som. Prosjektet søker å finne ut av hvordan personer med kjønnsinkongruens som har gjennomgått kjønnsbekreftende behandling, tenker omkring egen stemme og stemmebruk.

 

AaseFinch-Sped4090 logoped


Kraftig ökning av könsdysfori bland barn och unga

Louise Frisén,  Olle Söder,  Per-Anders Rydelius,

Abstract

  • Under det senaste decenniet har antalet unga med könsdysfori som söker sjukvårdens insatser för köns­ bekräftande åtgärder ökat kraftigt.
  • En minoritet (ca 20 procent) av barn <12 år med könsdysfori kommer att ha en kvarstående önskan om könsbekräftande åtgärder.
  • Majoriteten av de barn vars könsdysfori förstärks i samband med puberteten uppfyller diagnoskriterierna för transsexualism och kan behandlas med pubertets­ stoppande hormoner i syfte att undvika utveckling av oönskade sekundära könskarakteristika.
  • Tidigt insatt behandling underlättar möjligheten att framgångsrikt passera i det önskade könet och är förknippat med betydligt bättre prognos.

 

 

Barn i Sverige 2017


Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Riittakerttu Kaltiala-Heino1,2*, Maria Sumia2 , Marja Työläjärvi2 and Nina Lindberg3,4

Abstract

Background:

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.

Methods:

Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.

Results:

The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.

Conclusion:

The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Keywords:

Transsexualism, Gender dysphoria, Sex reassignment, Adolescent development

 

 

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development


A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder

Annika Johansson • Elisabet Sundbom • Torvald Ho¨jerback • Owe Bodlund

ABSTRACT

This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At followup, 32 patients had completed sex reassignment surgery, five were still in process, and five—following their own decision—had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5–15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years),

 

 

Johansson 2010

 

 


Kjønnskorrigerende kirurgi
ved transseksualisme

Kim Alexander Tønseth kim.tonseth@rikshospitalet.no Therese Bjark Plastikkirurgisk avdeling Oslo universitetssykehus, Rikshospitalet 0027 Oslo Gunnar Kratz Plastikkirurgisk avdeling Universitetssjukhuset Linköping Sverige Annika Gross Rolf Kirschner Kvinneklinikken Thomas Schreiner Medisinsk klinikk Trond H. Diseth Barneklinikken Ira Haraldsen Gender identity disorder (GID) seksjonen Nevroklinikken Oslo universitetssykehus, Rikshospitalet

ABSTRACT

Bakgrunn.

Oslo universitetssykehus, Rikshospitalet har siden 1979 hatt landsfunksjon for behandling av pasienter med transseksualisme. På årsbasis henvises 50–70 pasienter til utredning, hvorav rundt 20 pasienter blir diagnostisert som transseksuelle. Årlig henvises omtrent 15 pasienter av dem som oppfyller kriterier for transseksualisme, og som er blitt endokrinologisk behandlet, til kirurgisk intervensjon. I denne artikkelen beskrives diagnose og behandling av transseksualisme, med hovedvekt på kirurgi.

Materiale og metode.

Artikkelen er basert på ikke-systematisk litteraturgjennomgang og egne kliniske og vitenskapelige erfaringer.

Resultater.

Etter minimum ett års psykiatrisk utredning og diagnostikk, og ett års påfølgende hormonell behandling, vurderes pasientene i forhold til kjønnskorrigerende kirurgi. Hos pasienter som konverteres fra mann til kvinne, vurderes brystforstørrende kirurgi hvis ikke hormonbehandling alene har gitt tilfredsstillende resultat. I tillegg er det aktuelt med genital kirurgi hvor testikler og svamplegemene fjernes, og hvor neovagina og neoklitoris konstrueres. For pasienter som konverteres fra kvinne til mann, er det aktuelt å gjøre brystreduserende inngrep, hysterektomi og salpingo-ooforektomi samt neopeniskonstruksjon. Ved god respons på hormonbehandling kan klitoris rettes ut og konstrueres til en neopenis med ereksjonsmulighet (metoidioplastikk). Alternativt gjøres falloplastikk med bruk av lokalt vev fra lysken eller frie mikrovaskulære lapper.

Fortolkning.

Kjønnskorrigerende kirurgi ved transseksualisme omfatter hovedsakelig konverterende operasjoner på bryst og genitalia.

 

 

 

Kjønnskorrigerende kirurgi Rikshospitalet 2010Pdf

 


Rett til rett kjønn – helse til alle kjønn

ABSTRACT

Ekspertgruppa ble oppnevnt av Helsedirektoratet i desember 2013 for å gjennomgå nåværende vilkår for å endre juridisk kjønnsstatus i Norge, samt vurdere behovene for og foreslå endringer i dagens pasient- og behandlingstilbud til personer som opplever kjønnsdysfori. Bakgrunnen for dette var oppdrag gitt av Helse- og omsorgsdepartementet i oktober 2013. Dagens vilkår for å få endret juridisk kjønnsstatus er at vedkommende først må gjennomgå kjønnsbekreftende medisinsk behandling som inkluderer kastrasjon. Offentlig behandlingstilbud av hormonell og/eller kirurgisk art, gis kun til personer som er gitt diagnosen F64.0 Transseksualisme ved Nasjonal behandlingstjeneste for transseksualisme (NBTS), Oslo universitetssykehus. Utover dette er det ikke i dag tilrettelagt for at det gis behandling i offentlig regi andre steder.

 

 

 

Rett til rett kjønn Ferdig rapport 090415


Barn født med uklare kjønnskarakteristika

Trond H. Diseth

trond.diseth@rikshospitalet.no

ABSTRACT

Bakgrunn.

Årlig fødes 10–12 barn i Norge med alvorlig genital misdannelse hvor kjønnet ikke kan fastsettes ved fødsel. Tilstanden betegnes Forstyrrelser i kjønnsutviklingen (DSD). Alvorlig underviriliserte gutter (46,XY DSD) representerer den største utfordringen, hvor valg av kjønn tradisjonelt har vært jente.

Materiale og metode.

Artikkelen bygger på et grundig ikke-systematisk søk i PubMed samt egen klinisk erfaring. Resultater og fortolkning. I de siste ti år er det i økende grad stilt spørsmål ved det faglige grunnlaget for kjønnsvalg ved uklart kjønn. Avgjørende for den tradisjonelle behandlingsprotokoll har vært postulatet om at barn med forstyrrelser i kjønnsutviklingen vil utvikle seg til et valgt kjønn uansett årsak, såfremt ytre genitalia ble «normalisert» før toårsalderen, svarende til det valgte kjønn. Da viktigheten av falloslegemets størrelse og funksjonalitet for senere mannlig kjønnsidentitet og kjønnsrolleatferd ble understreket, ble de fleste alvorlig underviriliserte 46,XY DSD-barn operert til jenter. Ny kunnskap om mulig prenatal genetisk og hormonell påvirkning av fosterets hjerne for senere psykoseksuell utvikling, fører til at fagmiljøet nå utvikler nye behandlingsprotokoller. Eksakt diagnose av bakenforliggende tilstand for best mulig å predikere barnets fremtidige kjønnsidentitet, bør være fundamentet for kjønnsvalg

 

 

 

Studie Trond Diset 2008


Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study

Dogu Aydin, MD, Liv Johanne Buk, MD, Søren Partoft, MD, Christian Bonde, MD, Michael Vestergaard Thomsen, MD, and Tina Tos, MD

 

ABSTRACT

Introduction:

Gender dysphoria is a mismatch between a person’s biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty).

Aims:

To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period.

Methods:

Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. Main Outcome Measures: Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery.

Results:

One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period.

Conclusion:

Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period. J Sex Med 2016;-:1e6.

Copyright  2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Key Words: Gender Dysphoria;

 

 

 

sugery in Denmark 1994 2015

Autismespekteret og kjønnsdysfori


Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in…

John F. Strang, Haley Meagher, Lauren Kenworthy, Annelou L. C. de Vries, Edgardo Menvielle, Scott Leibowitz, Aron Janssen, Peggy Cohen-Kettenis, Daniel E. Shumer, Laura Edwards-Leeper, Richard R. Pleak, Norman Spack, Dan H. Karasic, Herbert Schreier, Anouk Balleur, Amy Tishelman, Diane Ehrensaft, Leslie Rodnan, Emily S. Kuschner, Francie Mandel, Antonia Caretto, Hal C. Lewis & Laura G. Anthony

ABSTRACT

Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD.

There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements.

The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment;

guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/ blurring of treatment and assessment.

 

Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents


Gender dysphoria and autism spectrum disorder: a systematic review of the literature

Derek Glidden1 , Walter Pierre Bouman 1 , Bethany Alice Jones1,2 and Jon Arcelus 1,3

ABSTRACT

Introduction.

There is a growing clinical recognition that a significant proportion of patients with Gender Dysphoria, have concurrent Autism Spectrum Disorder (ASD). Aim. The purpose of this review is to systematically appraise the current literature regarding the co-occurrence of Gender Dysphoria and ASD.

Methods

. A systematic literature search using Medline/Pubmed, PsycINFO and Embase were conducted from 1966 to July 2015.

Main Outcome Measures.

A total of 58 articles were generated from the search. Nineteen of these publications met the inclusion criteria. Results. The literature investigating ASD in children and adolescents with Gender Dysphoria have found a higher prevalence rate of ASD compared to the general population. There is a limited amount of research in adults. Only one study showed that adults attending services for Gender Dysphoria had increased ASD scores. Another study showed a higher proportion of atypical gender identity in adults with ASD.

Conclusions.

Although the research is limited, especially with adults, there is an increasing amount of evidence that suggests a co-occurrence between Gender Dysphoria and ASD. Further research is vital for educational and clinical purposes.

 

Systematic_Review_ASD_and_GD_submission_29Sept_Final


Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

Annelou L. C. de Vries • Ilse L. J. Noens • Peggy T. Cohen-Kettenis • Ina A. van Berckelaer-Onnes • Theo A. Doreleijers

ABSTRACT

Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.

 

Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents


Vi har har en elev som vil eller har endret kjønn på skolen?


Hva gjør vi?

Som lærer så kan det være mange spørsmål og bekymringer som dukker opp når det er en elev som enten har eller skal endre kjønn eller kjønnsuttrykk.

Mange føler at de har alt for liten kunnskap om tematikken til at de skal kunne håndtere situasjonen på en slik måte så alle parter blir ivaretatt. Dette er ikke uvanlig.

HBRS kan tilby mange forskjellige tilltak for å hjelpe skolen og de ansatte til å lettere håndtere situasjonen på en god måte.  Vi tilbyr samtaler med lærer, der det er rom for å stille alle spørsmål man kan sitte inne med. Vi har hørt de fleste spørsmålene før, så det er ingen feil spørsmål.

Vi kan også være behjelpelig med informasjon til elever i klassen og eventuelt andre. Dette gjør vi i samarbeid med eleven, foreldrene og skolen. Vår erfaring er at det forskjellige behov av type presentasjon fra elev til elev. Derfor vil vi ha et kartleggings møte i forkant av et eventuelt informasjonsforedrag til klassen.


Nytt navn? Juridisk kjønn?


Endring av navn og/eller juridisk kjønn?

Etter vår erfaring har personen og fagpersoner rundt et stort utbytte når samarbeide går på tvers og det er god kommunikasjon med NBTS, BUP, DPS og andre lokale tjenestene, også skole og arbeid.


Toalett, dusj og garderober?


Hvordan løser vi det, med hensyn til alle?

Når det gjelder garderobe og dusj utfordringen, så løser de aller fleste skoler det med at eleven får tilgang til en egen garderobe. Det kan være at eleven kan få benytte lærergarderoben før læreren. Eller at eleven kan gå inn i garderoben før de andre eleven. Vi vet at det også er skoler som legger kroppsøving til siste time, slik at eleven kan dusje hjemme.

Toalettet kan være utfordrende for eleven, og det kan også by på utfordringer for de andre elevene. Vi mener det er viktig å snakke med eleven og se på de ønsker eleven har, og snakke om de utfordringene som kan dukke opp. Spesielt om det er et ønske om å  benytte seg av toalettene til det kjønnet eleven opplever seg som. Vi mener det også er viktig at skolen tar hensyn til alle elevene. Det kan bety at eleven må benytte seg av eventuelle unisex toaletter, og ikke toalettet til det kjønnet eleven opplever seg som. For å løse dette på best mulig måte for alle parter, så oppfordrer vi til åpenhet og en god dialog.

Hver skole har sine egne løsninger, basert på eleven og de muligheter/begrensinger skolebygget har.


Skjult eller åpen?


Vil eleven fortelle det til alle? Eller ingen?

Når det gjelder garderobe og dusj utfordringen, så løser de aller fleste skoler det med at eleven får tilgang til en egen garderobe. Det kan være at eleven kan få benytte lærergarderoben før læreren. Eller at eleven kan gå inn i garderoben før de andre eleven. Vi vet at det også er skoler som legger kroppsøving til siste time, slik at eleven kan dusje hjemme.

Toalettet kan være utfordrende for eleven, og det kan også by på utfordringer for de andre elevene. Vi mener det er viktig å snakke med eleven og se på de ønsker eleven har, og snakke om de utfordringene som kan dukke opp. Spesielt om det er et ønske om å  benytte seg av toalettene til det kjønnet eleven opplever seg som. Vi mener det også er viktig at skolen tar hensyn til alle elevene. Det kan bety at eleven må benytte seg av eventuelle unisex toaletter, og ikke toalettet til det kjønnet eleven opplever seg som. For å løse dette på best mulig måte for alle parter, så oppfordrer vi til åpenhet og en god dialog.

Hver skole har sine egne løsninger, basert på eleven og de muligheter/begrensinger skolebygget har.


Tilrettelegging


Hva gjør vi?

Etter vår erfaring har personen og fagpersoner rundt et stort utbytte når samarbeide går på tvers og det er god kommunikasjon med NBTS, BUP, DPS og andre lokale tjenestene, også skole og arbeid.


Loven


Hva sier den?

Når det gjelder garderobe og dusj utfordringen, så løser de aller fleste skoler det med at eleven får tilgang til en egen garderobe. Det kan være at eleven kan få benytte lærergarderoben før læreren. Eller at eleven kan gå inn i garderoben før de andre eleven. Vi vet at det også er skoler som legger kroppsøving til siste time, slik at eleven kan dusje hjemme.

Toalettet kan være utfordrende for eleven, og det kan også by på utfordringer for de andre elevene. Vi mener det er viktig å snakke med eleven og se på de ønsker eleven har, og snakke om de utfordringene som kan dukke opp. Spesielt om det er et ønske om å  benytte seg av toalettene til det kjønnet eleven opplever seg som. Vi mener det også er viktig at skolen tar hensyn til alle elevene. Det kan bety at eleven må benytte seg av eventuelle unisex toaletter, og ikke toalettet til det kjønnet eleven opplever seg som. For å løse dette på best mulig måte for alle parter, så oppfordrer vi til åpenhet og en god dialog.

Hver skole har sine egne løsninger, basert på eleven og de muligheter/begrensinger skolebygget har.


Ønsker du et hel/halvdagskurs eller et foredrag?

Sammen med en rekke fagfolk har vi utviklet et undervisningsopplegg som vi tilbyr både profesjoner, kommuner, helse- og sosial foretak og andre instanser over hele landet. Vi skreddersyr opplegget vårt slik at det passer for deg/dere.

Undervisningen er basert på kunnskapsøkning og refleksjon. Vi jobber med utgangspunkt i at det er den enkelte yrkesutøver selv som vet best hvordan han eller hun vil nærme seg tema. Vi tilbyr noen perspektiver som det så blir opp til den enkelte yrkesutøver å selv velge å bruke på den måten de kjenner seg mest komfortable med.

Foredrag/kurs er gratis, men ved lengre reiser ut av oslo, må vi få dekket reise og losji.

Arbeidsted, skole eller der dere ønsker samtale/foredrag/kurs
Her kan du legge inn ønske om tidspunkt for samtale/Kurs/foredrag. Obs! Det er ingen reservasjon. Vi vil prøve å imøtekomme ønske så godt det lar seg gjøre.
For våre foredrag trenger vil lyd og bilde. Dette gjelder ikke hvis det kun er samtale.

Arbeide terapeutisk med kjønn

Du trenger ikke å være en «spesialist» for å hjelpe unge mennesker som utforsker deres kjønnsidentitet. Faktisk, etter vurderingsprosessen, er det meste av den terapeutiske inngangen gitt utenfor Nasjonal behandlingstjenester for transseksualisme, vanligvis i BUP eller DPS. Når det er mulig, ber NBTS lokale BUP eller DPS  å være involvert sammen med NBTS teamet. Når dette skjer, er NBTS-klinikere alltid tilgjengelige for kontakt med bestemte tilfeller. NBTS har utviklet noen primære terapeutiske mål som vi har brukt til å veilede vårt arbeid. Klinisk arbeid med unge mennesker kan ta en rekke formater, inkludert en-til-en-sesjoner eller stadig gruppearbeid der andre unge sammen med fagfolk kan yte støtte.

Les mer under for flere ideer om hvordan du arbeider med unge og kjønn.


Lytt og vis forståelse

Utforsk sammen med den unge personen der de er når det gjelder kjønnsidentitet, hør på å forstå (heller enn å tilby umiddelbare løsninger).

En del av din rolle kan være å hjelpe den unge personen til å finne sine egne løsninger, og avveie fordelene og ulempene med valg de vurdere (for eksempel i forhold til sosialt overgang).


Møt med respekt

Opprettholde en respektfull og ikke-dømmende tilnærming til å jobbe med  personen

Dette kan innebære å bruke deres foretrukne navn og pronomen, selv om andre velger å ikke gjøre det.


Kjønnsuttrykk

Hjelp dem å eksperimentere med deres kjønnsuttrykk

Er det et trygt sted personen kan prøve ut ting (når det gjelder kjole, navn, pronomen etc) uten å måtte forplikte seg til noe?


Kjønsforståelse

Diskuter kjønnsforståelse

Kjønnsidentiet er komplisert og mangfoldig, og kan forstås som et spekter i stedet for nødvendigvis å være et binært valg mellom mann eller kvinne. Hva tenker den unge personen om denne ideen? Hvilke kjønnsrollemodeller har de? Skap mer innsikt


Ikke lukke noen dører

Hjelp personen til å holde alle muligheter åpne og gi en trygg mulighet til å utforske usikkerhet og tvil.

Unges identiteter utvikler seg gjennom ungdomsår og i voksen alder, og enkelte mennesker bestemmer seg for at de ønsker å uttrykke sin kjønnsidentitet på mange forskjellige måter, noe som kan endres over tid. Å holde valgmuligheter åpne er viktig for personen skal kunne endre seg hvis de vil. Det er mange måter å være menneske på. Det finnes ingen mal eller fasit. 


Familie

Jobb med familien

Gi plass til forskjellige meninger, tanker og følelser. Det er også viktig å bli lyttet til og føle omsorg. Oppfordre til åpen kommunikasjon om kjønn, på en måte som føles trygg.


Nettverk

Tenkt nettverk

Hvem kjenner personen og hvilken støtte kan de gi, om nødvendig? Utred nettverket og gjør nytte av det.


Foreldrelitteratur

My Child is Transgender: 10 Tips for Parents of Adult Trans Children

Your adult child has come out to you as transgender and is considering, or has already begun, a transition from male to female or from female to male. What do you do now? This short, accessible guide is aimed at parents of transitioning adult children, offering ten tips to help you navigate one of the most challenging, and ultimately rewarding, times in your life. It is also helpful for other family members and loved ones looking for guidance.

From «Lose the Blame» to «Learn to Let Go,» the practical tips offered in My Child is Transgender: 10 Tips for Parents of Adult Trans Children will help you learn to support your child and yourself as you both move forward into new beginnings.

Matt Kailey is an award-winning author, blogger, college instructor, and community activist who began his transition from female to male in 1997. Since that time, he has educated thousands of people about transgender and transsexual issues through his presentations, trainings, books, and popular blog and website, Tranifesto.

Se mer her .

Vi i Harry Benjamin ressurssenter jobber for personer som opplever kjønnsdyfori. Eller opplever det som veldig ofte blir omtalt på folkemunne et behov for å skifte kjønn, født i feil kropp. Noen bruker også transseksuelle, transkjønnet, trans, transperson. Dette er begreper vi ikke bruker. Disse begrepene oppleves som identitetskapende. På lik linje med andre som får en diagnose, så er ikke vi vår egen diagnose. Men vi har en diagnose.
Vi mener det er viktig at hver enkelt har en reel rett til egen definisjon. Derfor bruker vi i HBRS begreper som kjønnsdysfori, kjønnsinkongruens, kjønnsidentitetsutfordringer, kjønnsmangfold og div. andre begreper som sier hva det handler om, ikke hvem man er. Så er det opp til den enkelte hva som passer for de.


Heart parents transgender love genderdysphoria kjønnsdysfori transsexualisme

Foreldre og familie

Hvorfor føler barnet seg slik?


Hvorfor?

Det ærlige svaret er at vi ikke vet nøyaktig hvorfor barn eller en ung person utvikler kjønnsatypiske følelser eller adferd. Vi kan heller ikke finne ut hvorfor noen enkeltpersoner kan utvikle en følelse av å tilhøre et annet kjønn. For hver enkelt person er det sannsynligvis en rekke forskjellige faktorer som kommer sammen for å forme dem som en person, inkludert biologiske, sosiale og psykologiske faktorer, samt deres erfaringer når de vokser opp.

Født slik eller blitt slik

Det er imidlertid mange forskjellige ideer og teorier om hvorfor noen barn og unges interesser og identiteter ikke følger en stereotypisk vei når det gjelder kjønnsidentitetsutvikling.

Noen mennesker tror at de er «født slik». De kan se etter svar i genetiske studier, eller lurer på hvordan hormoner påvirker en utviklende baby under graviditeten. Noen av disse tankene er tatt opp i flere studier, selv om mange av de tror at det kan være en biologisk årsak, så kan man ikke konkludere med at det er det.

Noen synes det er nyttig å tenke på noen som for eksempel har «en guttes hjerne i en jentes kropp.» Andre hevder at dagens forskning ikke har funnet mange store forskjeller mellom gutter og jenters hjerner – og mange av forskjellene de har funnet kan komme fra erfaringer gutter og jenter har mer  enn deres DNA eller hormonell utvikling.

Kulturelle forskjeller

Vi vet også at hvordan folk uttrykker eller opplever sitt kjønn, og hvordan folk reagerer på personer som er kjønnsatypiske, er knyttet til kulturen og tiden de eksistere i.

Traumer og autismespekteret

Vi ser mange unge mennesker som har andre utviklingsproblemer (for eksempel autismespekteret) eller som har opplevd betydelige vanskeligheter på et eller annet tidspunkt i deres tidlige liv (for eksempel traumer eller overgrep). Vi ser imidlertid også mange unge mennesker som ikke har hatt noen av disse vanskelighetene.

Mange forklaringsmodeller

HBRS mener at det er viktig å ha et åpent sin på alle de ulike forklaringsmodellene og teoriene om hvorfor et barn eller en ung person har utviklet seg på en bestemt måte. Ofte ser vi at forskjellige medlemmer av en familie vil hver ha forskjellige forklaringer.

I stedet for å prøve å finne ut hva som er «riktig» eller «feil» årsak, opfordrer vi at alle deler tanker om hvordan man kan best kan støtte barnet.

Hva med meg/oss


Foreldrestøtte

Noen foreldre føler et behov for å prate med andre foreldre i samme situasjon, eller fagpersoner som kan vise støtte og veiledning.
HBRS  i samarbeid med Stensveen Ressurssenter arr. egne pårørende seminar.

Med pårørende mener vi: Familie eller en annen person som er nær.

På samlingen får du:
Møte andre i samme situasjon
Dele erfaringer.
Ulike informasjoner om veien videre·
Fakta og kunnskap om identitet, kjønn, lover, navnendring, juridisk kjønn mm.

For mer info kontakt oss på info@hbrs.no

Når burde vi be om profesjonell hjelp?


Fagpersoner?

Man kan henvises til NBTK i alle aldre.

De to vanligste årsakene til å henvise er – ved en sosial overgang eller rundt puberteten. Hvis en ung person på noen uttrykker lidelse, vil vi oppfordre deg til å oppsøke råd og tips fra den lokale BUP eller DPS. Der kan også kontakte oss, om dere er usikker på hvordan dere går frem. Lokale tjenester kan gi støtte og råd med tanke på en henvisning til NBTK. De kan også være en støtte til dere som foreldre hvis ting blir tøffe. HBRS har også en egne foreldre- familie forening som organiserer mange foreldre i samme situasjon.

Skal vi bruke barnets foretrukne navn og pronomen?


Navn og pronomen?

Hvis barnet ditt har et spesielt sterkt ønske om at andre skal bruke et foretrukket navn og / eller pronomen, som de har gjentatte flere ganger og eksplisitt forespurt, så er det en del foreldre som etterkommer dette ønske, spesielt for ungdom.

Mens noen foreldre opplever det vanskelig. De ønsker å på å se hvordan deres barns identitet utvikles ytterligere før de gjør store endringer. De kan også forståelig nok være knyttet til navnet de valgte og har brukt i mange år.

Barn og unger forteller oss at det er viktig at deres forespørsler blir anerkjent på en eller annen måte. Hvordan du anerkjenner det kan variere avhengig av alder eller utviklingsstadium som barnet ditt er i. For eksempel kan eldre tenåringer være på et bedre sted å ta slike avgjørende beslutninger, mens for yngre barn, må foreldre måtte veie opp og fordeler med de avgjørelsene for dem.

Skynde seg sakte

Å bruke et nytt navn eller pronomen betyr ikke at det vil være det som barnet ditt bruker for livet, og ved å prøve dette ut ved siden av dem, kan du hjelpe dem til å holde seg fleksible og nysgjerrige. Å prøve å bruke foretrukne navn eller pronomen er en måte som en forelder kan kommunisere deres aksept og kjærlighet til sitt barn, og det viser at de virkelig har hørt hva deres barn forteller dem. Andre familier finner et kjønnsnøytralt kallenavn som de kan bruke som et kompromiss.
Det kan også være lurt å øve seg hjemme først, både på navn og pronomen. Slik at barnet kan kjenne på hva som er rett.

Vanen er vond å vende

Foreldre som  bruker foretrukne navn og pronomen, sier vanligvis feil navn eller pronomen, det er ikke av vond vilje, men heller at vanen er vond å venne: Da er det viktig å snakke sammen når det skjer. Hvis du føler at du ikke kan bruke nye navn eller pronomen med barnet ditt akkurat nå, snakk med barnet og forklar årsakene, slik at de bedre kan forstå ditt perspektiv. Du kan da prøve å finn andre måter som viser at du lytter og støtter dem.

Jeg er bekymret for at barnet mitt kan skade seg selv


Hva gjør jeg

Flertallet av de barna og ungdommene vi møter, begynner ikke med selvskading, og de gjør heller ikke forsøk på å avslutte sitt eget liv. Selv om det er en høyere andel av barn og unge som begynner med selvskading når de opplever utfordringer knyttet til idenitet og kjønnsidentitet sammenlignet med andre, så ser vi at det ikke er høyere en barn som er i BUP eller DPS.

Hvis du er bekymret for at barnet ditt står i fare for å skade seg, vennligst kontakt din lege og / eller ditt lokale BUP/DPS-team. Lokale tjenester er det beste stedet å søke støtte for unge mennesker i denne situasjonen. Hvis barnet ditt allerede er i kontakt med BUP/DPS, kan de hjelpe til med å utvikle en kriseplan med deg og barnet ditt for å holde dem trygge. I nødstilfeller kan du også ta barnet ditt til akuttmottak

Vet du at barnet ditt selvskader, så kan du /dere finne mye nyttig informasjon her.

www.hjelptilhjelp.no

Hvordan takler vi å ikke å vite hva som skjer i fremtiden?


Dette er vanskelig

Hvis vi visste hva som skulle skje i fremtiden, kunne vi forberede forberede oss. Men som med alt her i livet, kan vi ikke alltid vite hva som er rundt neste hjørnet.

Noen mennesker er flinkere enn andre til å håndtere ting som kommer, uansett hva. Men alle kan håndterer det, på en eller annen måte.  Vi mener det er viktig at familien sammen prøver identifisere deres eksisterende styrker og ressurser for å håndtere hva som må ligge i fremtiden.

Vi ønsker å være en støtte i den perioden. Hvis dere trenger noen å prate med, så er det bare å ta kontakt.

Hvordan vet jeg at dette ikke er en fase?


Går det over?

Ordet «fase» kan være vanskelig å høre. Siden det kan oppleves å bli brukt til å fjerne validiteten i det som blir sagt. Likevel er det et faktum at mens mange unge beholder kjønnsidentiteten de utvikler seg i barndommen eller ungdomsårene, er det noen som ikke gjør det.

Kanskje det bedre å spørre, «vil dette vare?» De aller fleste foreldre stiller dette spørsmlet på et eller annet tidspunkt. Det er forskjellige utgangspunkt dette spørsmålet blir stilt.

Noen har sett det siden barnet var lite, og har hatt lang tid til å tenke på det. Mens for andre så kommer det som et sjokk når barnet forteller om sin identitet. De har ikke sett noen tegn tidliger.

Å tåle den usikkerhet om ditt barns fremtid, kan noen ganger føle seg ganske vanskelig, ettersom du lurer på hvordan du best kan støtte dem. Det kan være spesielt vanskelig når det gjelder å ta beslutninger om å endre kjønn sosialt eller avgjørelsen om å ta i mot medisinsk inngrep.

Vi ønsker å være der  barna og deres familier, samtidig så kan vi ikke fjerne all usikkerhet. Det er derfor viktig at dere har en åpen og undrende dialog innad i familien. Slik at dere ingen er redde for å ta opp noe de har på hjertet.

I en slik tid, der usikkerheten kan være vanskelig å håndtere, så kan det også være nyttig å ta kontakt med andre som har vært i samme situasjon. Og bruke deres lokale ressurser. Det er også viktig at man ikke glemmer at det er barnets beste vi er ute etter. Uansett hva det måtte være.

Hva om vi gjør noe feil


Hvordan vet jeg om barnet mitt kan ta de rette beslutningene?

De unge menneskene vi møter, kan slite med en rekke beslutninger, alt fra å bestemme hvorvidt de er klare for eller ønsker å fortelle om deres identitet, begynne å bruke nytt navn, endre kjønn sosialt/juridisk eller å søke en medisinsk hjelp. Som med mange avgjørelser vi gjør i livet, må du og barnet ditt vurdere all informasjon som er tilgjengelig for deg og ta beslutninger basert på det som synes best på den tiden.

Yngre barn anses vanligvis ikke for å kunne ta avgjørelser alene, og kan bare ta avgjørelser med i samspill med foresatte. Når et barn er på vei ut av ungdomstiden, kan de være bedre i stand til å ta disse avgjørelsene for seg selv, men det er vanligvis foretrukket at dette fortsatt er gjort med foreldres støtte.

NBTS vil alltid vurdere om et barn er i stand til å samtykke i deres vurderinger, og de vil gjøre dette igjen hvis det blir snakk om fysiske inngrep (for eksempel hormonblokkere eller hormoner). Det kan noen ganger være nyttig å se på hvordan barnet ditt håndterer beslutningsprosesser på andre områder av livet, for å sammenligne og se om de har modnet nok til å kunne ta en slik beslutning. Det å anerkjenne og utforske en eventuelle usikkerhet er alltid en del av en beslutningsprosess.

Hvordan kan jeg oppmuntre utforskning og samtidig holde mulighetene åpne?


Råd til foreldre/omsorgspersoner med yngre barn

Småbarn blir bevisste på de fysiske forskjellene mellom gutter og jenter og kan vanligvis identifisere seg som enten en gutt eller en jente i en alder av rundt tre. I løpet av denne tiden av livet lærer barna om kjønnsrolle og hva som forventes av hvert kjønn i samfunnet, dvs ting som gutter / jenter gjør eller liker.«I løpet av dette utviklingsstadiet kan kjønnsidentitet virke ganske stabil når det gjelder stereotypiske interesser eller etiketter barna bruker for seg selv, og likevel kan små barn fortsatt ikke fullt ut forstå de mer komplekse ideene rundt kjønn. Fram til ca. 6 årsalderen går barn gjennom ulike stadier av «ønsketenkning», der de kan oppleve forvirring mellom virkelighet og fantasi. noen ganger gjør det vanskelig å vite hvor mye et yngre barn forstår fullt ut om hva de sier eller forstår om sitt eget kjønn.

Kjønnsidentiteten styrkes

Jenter og gutter i alderen 6-12 leker som regel hver for seg. Jentene finner seg gjerne en bestevenninne, mens guttene er sammen i grupper. Det er nå kjønnsidentiteten vokser og blir styrket. Grunnlaget for kjønnsidentiteten ble lagt tidlig i livet, men er ennå ikke ferdig utviklet. Mange kan oppleve en tvilrådighet og usikkerhet på dette området før og under puberteten. For at et barn skal utvikle en sunn tilfredshet med sitt eget kjønn, er holdningen til foreldrene og reaksjonene i omgivelsene på det å være jente eller gutt viktig.

Interessen for det seksuelle blir større og større etter hvert som de nærmer seg puberteten. I ti–tolvårsalderen er de først og fremst opptatt av hvordan seksualiteten fungerer. Det er viktig at hjem og skole kan møte denne nysgjerrigheten på en åpen og naturlig måte og gi saklig informasjon.(ref.)

Fra ungdomsår og utover blir det mer mulig å snakke gjennom komplekse ideer om kjønn i deres liv ( finn ut mer om kognitiv utvikling ).

Nedenfor er noen ideer for foreldre til yngre barn å vurdere:

Påminn dem om at de er vanlige.   Våre ideer om hva «gutter gjør og liker» eller hva «jenter gjør og liker» endrer seg over tid. Mye av hva vi nå knytter til mannlighet eller femininitet, har endret seg over generasjonene eller forstås annerledes av forskjellige kulturer. Derfor er det ikke noe «galt» med at barn utforsker interesser og aktiviteter utenfor de nåværende kjønns stereotyper. Faktisk er det sannsynligvis nyttig for alle barn å bli oppfordret til å leke med en rekke leker, venner, aktiviteter og følelser for at de kan finne ut hva som passer best for dem, da dette vil trolig hjelpe dem til å vokse til avrundet og akseptere voksne.

Når et barns interesser og evner er forskjellige fra samfunnsmessige forventninger, kan han eller hun bli merket eller diskriminert av andre. Forståelig kan foreldre påvirke hvordan et barn spiller eller oppfører seg for å beskytte sitt barn mot stigma, men det er viktig at barnet ikke føler at de gjør noe galt. Sørg for at barnet ditt vet at du elsker dem, og at de er trygge å leke med og utforske kjønn med deg, selv om du bestemmer deg for å begrense ting til bestemte situasjoner eller steder for en tid. Hvert barn vil utvikle unike styrker og interesser, selv om de ikke overholder samfunnets, eller til og med egne, ideer om hva som er «normalt».

Vurder utvikling. Husk at svært små barn ikke alltid fullt ut forstår hva kjønn betyr, forskjellen mellom lek og virkelighet, eller hvordan kroppene deres vil utvikle seg og forandres etter hvert som de blir eldre. De vil lære om alle disse tingene gradvis, over tid, gjennom deres forhold til deg og andre viktige voksne. Det vil vanligvis være viktig å la dem utforske og utvikle seg selv uten lek og fantasi uten å pålegge flere voksenbegreper om «realitet» til dem for tidlig.

Kjønn er ikke alt som betyr noe. En følelse av identitet utvikler seg gjennom barndommen og ungdommen. Unge barn utforsker deres fremvoksende identitet, og kjønn er bare en del av det. Prøv å få en balanse mellom å ta hensyn til et barns kjønnsrelaterte preferanser, mens du ikke tillater at kjønn blir den eneste måten du forstår barnet på. Tillat barnet ditt tilgang til alle slags leker, venner og aktiviteter, knyttet til både gutter og jenter. Sørg for at de forblir involvert i utdanning, venner og hobbyer, og husk å feire alle deler av dem, som du ville med ethvert barn. Uavhengig av kjønnsidentitet, må de fortsatt vite at de er klare, morsomme eller snille.

Hvem er engstelig?  Det finnes mange forskjellige ideer om kjønn, som kommer fra mange forskjellige kilder (f.eks. Fra familien, fellesskap, kulturelle og religiøse sammenhenger, media etc.). Ved siden av dette er de fleste foreldre opptatt av å gjøre det rette og gjøre sitt aller beste for sine barn. Hvis du føler deg bekymret for barnets kjønnsidentitet, kan det være nyttig å vurdere hvor angsten kan komme fra. Har andre folk gjort kommentarer, for eksempel, eller har du lest noen ting om hva du burde eller burde ikke gjøre som har gjort at du tviler på din egen evne som foreldre? Det er sjelden så enkelt som «rett eller feil» når det gjelder et barn som utforsker og lærer om verden og hvordan de passer inn i den.

Det er ingen hastverk.  Som foreldre kan vi lett falle i fellen for å skrive en slags «livsplan» for våre barn, selv når de er veldig unge. Dette kan innebære våre egne drømmer, for eksempel om ekteskap eller utdanning overføres til dem på et tidspunkt i fremtiden. Noen foreldre kommer til oss og diskuterer tanker om fysiske inngrep i deres barns fremtid. Forståelig nok, så kan folk i forkant ofte bli bekymret for puberteten, og hva puberteten kan bety for barnet sitt. Med yngre barn trenger vi ikke å ta raske beslutninger om noe når det gjelder deres kjønn. Sørg for at barnet ditt har trygg tid og plass for å utforske de mange aspektene av hva som vil gjøre dem til. Det kan være viktigere å fokusere på å la dem dette rommet vokse i stedet for på andre å gjette hva som kan være nødvendig i fremtiden, og muligens også bekymre dem i prosessen.

Sosial overgang? Basert på kunnskap om barnutvikling og vår erfaring med å jobbe med familier, vet vi at noen yngre barn nyter godt av å få tid til å fritt utforske deres identitet når de ser ut til å stille spørsmål om deres tildelte kjønn. Beslutningen av å gjøre en full sosial overgang (for eksempel å endre barnets kjønnsidentitet i skolen) krever nøye gjennomtenkning og forberedelse, og må gjøres på en måte som ikke begrenser muligheter for videre utforskning av barnet.

Tenk på kjønnsidentitet og uttrykk i familien din. Du vil kanskje tenke på måter som «maskulinitet» og «femininitet» uttrykkes i din familie. Passer barnet ditt med kjønnsrollene i familien din? Hvis de ikke, kan de trenge ekstra støtte for å føle seg tilpass og akseptert. Andre familiemedlemmer, foreldre, besteforeldre, søsken mv. Kan føle seg urolige av et familiemedlem som har en annen kjønnsidentitet eller som har et annet kjønnsuttrykk enn forventet. Noen ganger trenger andre i familien hjelp for å forstå og vise aksept også.

Ta vare på deg selv. Noen foreldre opplever vanskelige følelser  i seg selv når et barn begynner å stille spørsmål til kjønnsidentiteten. Noen foreldre lurer på om de kan «klandres», andre beskriver det som en forvirring – som å miste barnet på noen måter. Mens andre foreldre synes å ta det litt som det kommer. Det er ingen «normal» eller «riktig» reaksjon, men det er ofte nyttig å ha et sted der du kan diskutere dine tanker og følelser. Involver på både profesjonell og uformell støtte til deg selv, hvis du trenger det. Hold kontakten med personer du opplever som hyggelige og medfølende. Foreldre trenger også støtte, slik at de kan fortsette å gi støtte og omsorg til barnet sitt. Dine behov bør ikke legges til side på dette tidspunktet.

Den vanskelig ungdomstiden


Råd til foreldre/omsorgspersoner med ungdommer

Ungdomstiden blir ofte sett på som en tid for å utforske identitet, gjøre noen feil og lære av dem mens de støttes av familie / omsorgspersoner ( finn ut mer om kognitiv utvikling i barndom og ungdomsår). Alle ungdommer trenger støtte når de går gjennom denne prosessen, enten de er i tvil om deres kjønn eller ikke. Noen ganger føler foreldrene seg bekymret når det kommer til  å diskutere kjønn med sitt barn, de kan være redde for at de ikke vet nok, eller at  de kan gjøre feil på en eller annen måte. Etter vår erfaring kan støttende foreldre ofte være mer hjelpsomme enn de innser. Det er nyttig å gi deg tid til å høre og prøve å forstå barnet ditt hvis de kommer til deg. Gi dem muligheten og trygghet til å snakke med deg om alt, selv om det kan være vanskelig eller opprørende. Noen ganger kan det hende du må gi barnet ditt mulighet til søke støtte utenfor familien, det kan være skolen, lege eller Barne- og ungdomspsykiatrisk poliklinikk (BUP). Her er noen flere ideer når du snakker med tenåringen din om kjønn:

Påminn dem om at de er vanlige. Dette kan innebære å diskutere hvordan det å ha en ikke-stereotype kjønnsopplevelse eller interesser i ungdomsårene er vanlig og ikke en grunn til bekymring.

Tenk på kjønnsidentitet og kjønnsuttrykk i sammenheng med bredere utvikling. Det er helt normalt å utforske og tenke på hva du ønsker for deg selv og ditt liv i ungdomsårene. Det er viktig å gi ungdommen tid og plass til å gjøre dette. En ungdoms identitet kan forbli fast fra ungdomsår og fremover, eller det kan endres etter hvert som livet deres utfolder seg.

Tenk på kjønnsidentitet og hvordan der uttrykker det i familien din. Du vil kanskje tenke på måter som «maskulinitet» og «femininitet» uttrykkes i din familie. Passer barnet ditt med kjønnsrollene i familien din? Hvis ikke, kan de trenge ekstra støtte for å føle seg akseptert. Andre familiemedlemmer, foreldre, besteforeldre, søsken med flere kan føle seg urolige av at et familiemedlem som har en annen kjønnsidentitet eller kjønnsuttrykk enn forventet. Noen ganger trenger andre i familien hjelp for å forstå og vise aksept også.

Hjelp ungdommen til å takle usikkerhet. En følelse av identitet utvikler seg gjennom barndommen og ungdommen. Unge mennesker utforsker deres fremvoksende identitet, hvorav kjønn er bare ett aspekt. Det kan være nyttig å forsøke å opprettholde en balanse mellom å tillate og være oppmerksom på et barns kjønnsrelaterte preferanser, samtidig som det ikke gjør kjønn til å bli den eneste måten å forstå dem på. Dette kan skje selv om barnet ditt ønsker å få tilgang til fysiske inngrep. Å tolerere usikkerhet om fremtiden og identitet kan være vanskelig for både foreldre og unge, men er ofte nyttig, da det holder alle muligheter og ideer åpne, noe som gir fleksibilitet og gjennomtenkt beslutningstaking.

Snakk om følelser.  Av mange grunner kan unge som stiller spørsmål om kjønn, oppleve en rekke følelser knyttet til dette. Prøv å finn ut hvordan ditt barn føler og opplever alt. Vis oppmerksomhet hvis det har vært noen endringer, for eks. når en barnet har kommet ut til noen nye, eller har gjort endret kjønn sosialt. Hvis du synes det er vanskelig å snakke om følelser, sørg for at barnet ditt har noen du er trygg på å prate med. Det kan være en fagperson eller et annet familiemedlem eller en venn. Mange unge er utrolig sterke, men hvis du noen gang føler at du eller barnet ditt trenger ekstra støtte, kan du snakke med legen din eller skolen som et første skritt. Der kan også ta kontakt med oss for å få råd og veiledning. HBRS info@hbrs.no eller 22 11 40 40

Snakk om hvilken følelser de har om kroppen deres.  Noen unge som stiller spørsmål om kjønnsidentiteten opplever betydelig dysfori om kroppen deres. Dette betyr at de føler seg urolige eller misfornøyde med det, som om kroppen ikke passer inn med sin følelse av hvem de er. Noen unge ønsker å endre kroppene så mye som mulig. Unge mennesker som ble født i en kvinnekropp, kan bruke binder på brystene deres for å skape et mer «maskulinisert» bryst, eller de kan ta prevensjonsmidler for å kontrollere sine menstruasjon. De som ble født i en mannskropp, sliter noen ganger sine kjønnsorganer eller plukker ansiktshår for å «feminisere» slik de ser ut til andre.  Noen begynner med selvskading som følge av dysfori, og hvis dette skjer, bør du ta kontakt med din. Ikke vær redd for å be om hjelp hvis du trenger det.

Hjelp barnet ditt til å bli sunn, støttet og i utdanning.  Det kan oppleves vanskelig for noen å stille spørsmål til kjønn eller identitet, noe som gjør det enda viktigere at andre deler av barnets liv forblir konsistente. Tilrettelegg så godt som mulig, slik at de starter eller fortsette sin utdanning, hjelp de til å ivareta og opprettholde sine vennskap, og pass på at de og dere ivaretar deres fysiske og følelsesmessige helse. Kjønnsidentitet er bare en del av barnet ditt, og du og barnet ditt vil  takle utfordringer hvis andre aspekter av livet ditt går bra.

Overvei å begynne i en  selvhjelpsgrupper.  HBRS arrangerer flere selvhjelpsgrupper i året. Der kan ungdommene møte og støtte hverandre. Vi har selvutviklingsgrupper som er drevet av Psykolog Asle Offerdal, og engen grupper som er drevet av brukere. Vi har også egne grupper for foreldre og pårørende.

Bruk nettverket ditt. Hvem vet hva som skjer? Hvem andre støtter deg og ditt barn, og hvilken støtte kan de gi, om nødvendig? Snakk med ditt barn om deres sosiale erfaringer når de er borte fra deg. Er det noe erting eller mobbing som må tas opp? Bygg opp under det vennskap du ser har en positiv virkning?

Ta vare på deg selv. Noen foreldre opplever vanskelige følelser  i seg selv når et barn begynner å stille spørsmål til kjønnsidentiteten. Noen foreldre lurer på om de kan «klandres», andre beskriver det som en forvirring – som å miste barnet på noen måter. Mens andre foreldre synes å ta det litt som det kommer. Det er ingen «normal» eller «riktig» reaksjon, men det er ofte nyttig å ha et sted der du kan diskutere dine tanker og følelser. Involver på både profesjonell og uformell støtte til deg selv, hvis du trenger det. Hold kontakten med personer du opplever som hyggelige og medfølende. Foreldre trenger også støtte, slik at de kan fortsette å gi støtte og omsorg til barnet sitt. Dine behov bør ikke legges til side på dette tidspunktet.

Hvordan kan jeg oppmuntre utforskning og samtidig holde mulighetene åpne?


Ingen stengte dører, ingen stengte muligheter.

Det er viktig å være støttende om ditt barn ønsker å utforske kjønnsidentiteten sin. Det er også viktig å vurdere hvordan du kan gjøre dette uten å avvise muligheten for at det kan endres i fremtiden. Dette kan virke svært lite sannsynlig for noen unge mennesker. Andre har imidlertid fortalt oss hvor vanskelig det var å utforske deres identiteten, eller tillate seg å tenke tanken om å gå tilbake, når de og andre mennesker hadde kjempet så hardt for at de kunne uttrykke seg på en bestemt måte.

Kjønn er komplisert og unge mennesker utvikler seg kontinuerlig. Prøv og opprettholde et positivt støttende forhold til barnet ditt under disse kritiske og noen ganger utfordrende år.

Finn måter å vise at du elsker barnet ditt, uavhengig kjønn eller noe annet.  Vis at forholdet ditt med dem ikke vil endre seg hvis deres kjønnsidentitet eller kjønnsuttrykk endres. Du kan gi uttrykke for det med ord, eller du kan vise at du er åpen  for at de fortsette å utforske kjønnsidentiteten ved å tillate kontinuerlig tilgang til en rekke klær eller aktiviteter, enten de velger å bruke dem eller ikke. Ha en åpenhet mellom deg og ditt barn, dette bidrar til å unngå for mye forvirring og kan gi deg mulighet til å gi følelsesmessig støtte der det er mest nødvendig.

Tips og råd til foreldre


Hvordan hjelpe barnet mitt mens vi venter på vurdering

Mange unge mennesker som vi ser er utilfredse med å måtte vente – dette kan være vanskelig å vente på timer, venter på at andre skal vurdere og snakke med dem om hvordan de føler, eller vente på et fysisk inngrep. Mange unge mennesker sliter mest når de føler at de ikke kan gjøre noe annet enn å vente. Men man kan prøve å lette frustrasjonen ved å bli med på sosiale treff i HBRS, bli med i samtalegrupper, og/eller prøve forskjellige måter å uttrykke sitt kjønn på, eller prøve ut forskjellige navn. Vi vil oppfordre dere til å sammen prøve å se om det er andre praktiske ting man kan gjøre mens man venter.  Når det ikke er noe praktisk å gjøre, så kan det være til stor nytte å bruke oppmuntring, empati og aktiv lytting, dette vil kunne medvirke til at de føler en sterke støtte og samhold, som igjen vil gjør de bedre rustet til å takle ventetiden.



Kjønnsdysfori forskning

Forskning

Forskning barn og unge kjønn kjønnsdysfori


Desisting and persisting gender dysphoria after childhood Steensma 2011

Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis

Abstract

The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14-18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different.

 

Desisting and persisting gender dysphoria after childhood Steensma 2011


A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children

Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Methods: A critical review methodology is employed to systematically interpret four frequently-cited studies that sought to document identity outcomes for gender-nonconforming children (often referred to as “desistance” research).

Results: Methodological, theoretical, ethical, and interpretive concerns regarding four “desistance” studies are presented. The authors clarify the historical and clinical contexts within which these studies were conducted to deconstruct assumptions in interpretations of the results. The discussion makes distinctions between the specific evidence provided by these studies versus the assumptions that have shaped recommendations for care. The affirmative model is presented as a way to move away from the question of, “How should children’s gender identities develop over time?” toward a more useful question: “How should children best be supported as their gender identity develops?”

Conclusion: The tethering of childhood gender diversity to the framework of “desistance” or “persistence” has stifled advancements in our understanding of children’s gender in all its complexity. These follow-up studies fall short in helping us understand what children need. As work begins on the 8th version of the Standards of Care by the World Professional Association for Transgender Health, we call for a more inclusive conceptual framework that takes children’s voices seriously. Listening to children’s experiences will enable a more comprehensive understanding of the needs of gender-nonconforming children and provide guidance to scientific and lay communities.

 

A critical commentary on follow-up studies and desistance NEWHOOK.IJT.2018


A critical commentary on “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children”

Thomas D. Steensma & Peggy T. Cohen-Kettenis

Abstract

The article entitled “A critical commentary on follow-up studies and “desistence” theories about transgender and gender non-conforming children” by Temple Newhook et al. (2018Temple Newhook, J., Pyne, J., Winters, K., Feder, S., Holmes, C., Tosh, J., Sinnott, M., Jamieson, A., & Picket, S. (2018). A critical commentary on follow-up studies and “desistance” theories about transgender and gender non-conforming children. International Journal of Transgenderism. Advance online publication. doi:10.1080/15532739.2018.1456390.[Taylor & Francis Online][Google Scholar]) is a plea to abandon longitudinal studies on the development of gender variant children as they do not respect children’s autonomy. A few relatively recent studies are criticized and it is concluded that conducting longitudinal psychosexual outcome studies and acknowledging the children’s feelings are contradictory. We agree that the longitudinal studies currently available have their limitations. We do, however, strongly disagree with the authors that studies on gender variant children’s development should be abandoned and that our studies do not take children’s needs and voices seriously or are unethical

 

A critical commentary on A critical commentary on follow up studies and desistence theories about transgender and gender non conforming children


A FOLLOW-UP STUDY OF BOYS WITH GENDER IDENTITY DISORDER

Devita Singh

Abstract

This study provided information on the long term psychosexual and psychiatric outcomes of 139 boys with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 7.49 years; range, 3–12 years) and at follow-up (mean age, 20.58 years; range, 13–39 years) were used to evaluate gender identity and sexual orientation outcome. At follow-up, 17 participants (12.2%) were judged to have persistent gender dysphoria. Regarding sexual orientation, 82 (63.6%) participants were classified as bisexual/ homosexual in fantasy and 51 (47.2%) participants were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual. With gender identity and sexual orientation combined, the most common long-term outcome was desistence of GID with a bisexual/homosexual sexual orientation followed by desistence of GID with a heterosexual sexual orientation. The rates of persistent gender dysphoria and bisexual/homosexual sexual orientation were substantially higher than the base rates in the general male population.

Childhood assessment data were used to identify within-group predictors of variation in gender identity and sexual orientation outcome. Social class and severity of cross-gender behavior in childhood were significant predictors of gender identity outcome. Severity of childhood cross-gender behavior was a significant predictor of sexualorientation at follow-up. Regarding psychiatric functioning, the heterosexual desisters reported significantly less behavioral and psychiatric difficulties compared to the bisexual/homosexual persisters and, to a lesser extent, the bisexual/homosexual desisters. Clinical and theoretical implications of these follow-up data are discussed.


Kraftig ökning av könsdysfori bland barn och unga

Louise Frisén,  Olle Söder,  Per-Anders Rydelius,

Abstract

  • Under det senaste decenniet har antalet unga med könsdysfori som söker sjukvårdens insatser för köns­ bekräftande åtgärder ökat kraftigt.
  • En minoritet (ca 20 procent) av barn <12 år med könsdysfori kommer att ha en kvarstående önskan om könsbekräftande åtgärder.
  • Majoriteten av de barn vars könsdysfori förstärks i samband med puberteten uppfyller diagnoskriterierna för transsexualism och kan behandlas med pubertets­ stoppande hormoner i syfte att undvika utveckling av oönskade sekundära könskarakteristika.
  • Tidigt insatt behandling underlättar möjligheten att framgångsrikt passera i det önskade könet och är förknippat med betydligt bättre prognos.

 

 

Barn i Sverige 2017


Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Riittakerttu Kaltiala-Heino1,2*, Maria Sumia2 , Marja Työläjärvi2 and Nina Lindberg3,4

Abstract

Background:

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.

Methods:

Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.

Results:

The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.

Conclusion:

The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Keywords:

Transsexualism, Gender dysphoria, Sex reassignment, Adolescent development

 

 

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development


CHILDREN WITH ATYPICAL GENDER DEVELOPMENT

Louise Newman

Gender dysphoria

is the sense of discomfort with one’s biological sex and assigned gender role − may present in children from the age of 2 years. Some children may express unhappiness at their gender and often may express the desire to change sex. This can have a significant impact on child development in a broad way and also on family functioning. Families vary in their response to a child’s cross-gendered preferences or gender questions with some showing acceptance and tolerance and others expressing anxiety and a desire to resolve the issue. There are scarce data available as to the prevalence of this condition in children and there is ongoing debate about the best clinical approach to it. The evidence base about treatment in children is limited and the ethical issues are complex.

 

 

Children with atypical development


Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study

Thomas D. Steensma, Ph.D., Jenifer K. McGuire, Ph.D., M.P.H., Baudewijntje P.C. Kreukels, Ph.D., Anneke J. Beekman, B.Sc., Peggy T. Cohen-Kettenis, Ph.D.

Abstract

Objective:

To examine the factors associated with the persistence of childhood gender dysphoria (GD), and to assess the feelings of GD, body image, and sexual orientation in adolescence.

Method:

The sample consisted of 127 adolescents (79 boys, 48 girls), who were referred for GD in childhood (<12 years of age) and followed up in adolescence. We examined childhood differences among persisters and desisters in demographics, psychological functioning, quality of peer relations and childhood GD, and adolescent reports of GD, body image, and sexual orientation. We examined contributions of childhood factors on the probability of persistence of GD into adolescence.

Results:

We found a link between the intensity of GD in childhood and persistence of GD, as well as a higher probability of persistence among natal girls. Psychological functioning and the quality of peer relations did not predict the persistence of childhood GD. Formerly nonsignificant (age at childhood assessment) and unstudied factors (a cognitive and/or affective cross-gender identification and a social role transition) were associated with the persistence of childhood GD, and varied among natal boys and girls.

Conclusion:

Intensity of early GD appears to be an important predictor of persistence of GD. Clinical recommendations for the support of children with GD may need to be developed independently for natal boys and for girls, as the presentation of boys and girls with GD is different, and different factors are predictive for the persistence of GD. J. Am. Acad. Child Adolesc. Psychiatry, 2013;52(6):582–590.

Key Words:

childhood gender dysphoria, desistence, persistence, sexual orientation, social role transitioning

 

 

Factors Associated With Desistence and Persistence of Childhood Gender Dysphoria: A Quantitative Follow-Up Study


Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach

ANNELOU L. C. DE VRIES, MD, PhD and PEGGY T. COHEN-KETTENIS, PhD VU University Medical Center, Amsterdam, the Netherlands

The Dutch Approach

The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth’s functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty. Gender dysphoric adolescents can be considered eligible for puberty suppression and subsequent crosssex hormones when they reach the age of 16 years. Currently, withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.

KEYWORDS

gender, gender identity, gender identity disorder, gender identity disorder of childhood, gender identity disorder of adolescence, gender vari

 

 

Clinical Management of Gender Dysphoria in Children and Adolescents The Dutch Approach


Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study

Thomas D. Steensma, Roeline Biemond, Fijgje de Boer, and Peggy T. Cohen-Kettenis Department of Medical Psychology, VU University Medical Centre, Amsterdam, the Netherlands

Abstract

The aim of this qualitative study was to obtain a better understanding of the developmental trajectories of persistence and desistence of childhood gender dysphoria and the psychosexual outcome of gender dysphoric children. Twenty five adolescents (M age 15.88, range 14–18), diagnosed with a Gender Identity Disorder (DSM-IV or DSM-IV-TR) in childhood, participated in this study. Data were collected by means of biographical interviews. Adolescents with persisting gender dysphoria (persisters) and those in whom the gender dysphoria remitted (desisters) indicated that they considered the period between 10 and 13 years of age to be crucial. They reported that in this period they became increasingly aware of the persistence or desistence of their childhood gender dysphoria. Both persisters and desisters stated that the changes in their social environment, the anticipated and actual feminization or masculinization of their bodies, and the first experiences of falling in love and sexual attraction had influenced their gender related interests and behaviour, feelings of gender discomfort and gender identification. Although, both persisters and desisters reported a desire to be the other gender during childhood years, the underlying motives of their desire seemed to be different. Keywords childhood gender dysphoria, Gender Identity Disorder, gender variant, psychosexual development, sexual orientation, transgender, transsexual

 

 

Desisting and persisting gender dysphoria after childhood Steensma 2011


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

Lieke Josephina Jeanne Johanna Vrouenraets, M.Sc. a,*, A. Miranda Fredriks, M.D., Ph.D. a , Sabine E. Hannema, M.D., Ph.D. b , Peggy T. Cohen-Kettenis, Ph.D. c , and Martine C. de Vries, M.D., Ph.D. b

Abstract

Purpose:

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.

Methods:

Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.

Results:

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-) availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.

Conclusions:

As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.  2015 Society for Adolescent Health and Medicine. All rights reserved.

 

 

early treatment children enocrine society 2015


Gender dysphoria in adolescents: the need for a shared assessment protocol and proposal of the AGIR protocol

D. Dèttore1,2, J. Ristori2,3, P. Antonelli2 , E. Bandini2 , A.D. Fisher2,3, S. Villani2 , A.L.C. de Vries4 , T.D. Steensma4 , P.T. Cohen-Kettenis4

Abstract

In the Center of Expertise on Gender Dysphoria at the VU University Medical Center in Amsterdam, a structured assessment and treatment protocol for adolescents with atypical gender identities is used. This multidimensional approach includes specific phases: psychological assessment, medical evaluation, possible psychotherapy, gonadotropin-releasing hormone (GnRH) analogues and cross-sex hormone therapy, which are differentiated according to age and specific requirements of each individual case. Recently, a collaborative study called AGIR (Adolescent Gender Identity Research) has been proposed by the Dutch clinic to allow international and cross-clinic comparisons with regards to referral background and psychological functioning, and to evaluate the treatment of gender dysphoric adolescents. An extensive assessment and timely treatment of adolescents with gender dysphoria seems essential to support the process of awareness and structuring of the dimensions of sexual identity, to prevent frequent associated psychopathologies and to improve quality of life by promoting more adequate psychosocial adaptation. Currently, transgender health care in Italy is characterized by isolated practitioners. Thus, it is particularly important to create specialised services that use a common protocol and that are coordinated at both the national and international levels in order to respond to the increasing number of requests in this age group.

Key words

Gender identity • Gender Dysphoria • Assessment • Intervention • Protocol • Adolescents

 

gender dysphoria in adolesents 2015


More Than Two Developmental Pathways in Children With Gender Dysphoria?

Thomas D. Steensma, PhD Peggy T. Cohen-Kettenis, PhD Center of Expertise on Gender Dysphoria VU University Medical Center Amsterdam t.steensma@vumc.nl

LETTER TO THE EDITOR

Current prospective studies on the development of children fulfilling diagnostic criteria of gender identity disorder according to the DSM-III, DSM-III-R, DSM-IV, and DSM-IV-TR have indicated that the most common psychosexual outcome is homosexuality or heterosexuality without gender dysphoria (GD).1 Across all studies, the persistence rate of GD has been approximately 16%. What should be emphasized is that these studies did not use the fairly strict criteria of the DSM-5, and children could receive the diagnosis based only on gender-variant behavior.

 

 

More Than Two Developmental Pathways in Children Steensma 2015


‘Rapid onset’ of transgender identity ignites storm

Meredith Wadman

sciencemag.org

Artikkel

Critics charge a study is biased, but others say politics is inhibiting science.

A study describing “rapid onset gender dysphoria” (ROGD) in teens and young adults—a sudden unease with the gender they were assigned at birth—has infuriated transgender activists while sparking a debate about academic freedom. Critics of the paper, published last month in PLOS ONE by physician-scientist Lisa Littman of Brown University, call it a flawed study that reflects an antitransgender agenda, in part because it suggests some cases may be the result of “social contagion.” Brown and the journal have both distanced themselves from the paper, drawing charges that they surrendered to political pressure.


The myth of persistence: Response to “A critical commentary on follow-up studies and ‘desistance’ theories about transgender and gender nonconforming children” by Temple Newhook et al. (2018)

Kenneth J. Zucker

Abstract

Temple Newhook et al. (2018) provide a critique of recent follow-up studies of children referred to specialized gender identity clinics, organized around rates of persistence and desistance. The critical gaze of Temple Newhook et al. examined three primary issues:

(1) the terms persistence and desistance in their own right;

(2) methodology of the follow-up studies and interpretation of the data; and

(3) ethical matters. In this response, I interrogate the critique of Temple Newhook et al. (2018).

KEYWORDS

Desistance; developmental psychiatry; DSM-5; gender dysphoria; gender identity disorder; persistence; transgender


Young Adult Psychological Outcome After Puberty
Suppression and Gender Reassignment

Annelou L.C. de Vries, MD, PhD,a Jenifer K. McGuire, PhD, MPH,b Thomas D. Steensma, PhD,a Eva C.F. Wagenaar, MD,a Theo A.H

Abstract

BACKGROUND:

In recent years, puberty suppression by means of gonadotropin-releasing hormone analogs has become accepted in clinical management of adolescents who have gender dysphoria (GD). The current study is the first longer-term longitudinal evaluation of the effectiveness of this approach.

METHODS:

A total of 55 young transgender adults (22 transwomen and 33 transmen) who had received puberty suppression during adolescence were assessed 3 times: before the start of puberty suppression (mean age, 13.6 years), when cross-sex hormones were introduced (mean age, 16.7 years), and at least 1 year after gender reassignment surgery (mean age, 20.7 years). Psychological functioning (GD, body image, global functioning, depression, anxiety, emotional and behavioral problems) and objective (social and educational/professional functioning) and subjective (quality of life, satisfaction with life and happiness) well-being were investigated.

RESULTS:

After gender reassignment, in young adulthood, the GD was alleviated and psychological functioning had steadily improved. Wellbeing was similar to or better than same-age young adults from the general population. Improvements in psychological functioning were positively correlated with postsurgical subjective well-being.

CONCLUSIONS:

A clinical protocol of a multidisciplinary team with mental health professionals, physicians, and surgeons, including puberty suppression, followed by cross-sex hormones and gender reassignment surgery, provides gender dysphoric youth who seek gender reassignment from early puberty on, the opportunity to develop into well-functioning young adults. Pediatrics 2014;134:696–704

Hjernen kjønnsdysfori Transsexual


White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study

Giuseppina Rametti d,f , Beatriz Carrillo b , Esther Gómez-Gil c , Carme Junque b,f , Santiago Segovia a , Ángel Gomez e , Antonio Guillamon a,*

ABSTRACT

Background: Some gray and white matter regions of the brain are sexually dimorphic. The best MRI technique for identifying subtle differences in white matter is diffusion tensor imaging (DTI). The purpose of this paper is to investigate whether white matter patterns in female to male (FtM) transsexuals before commencing cross-sex hormone treatment are more similar to that of their biological sex or to that of their gender identity. Method: DTI was performed in 18 FtM transsexuals and 24 male and 19 female heterosexual controls scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter fibers of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics. Results: In controls, males have significantly higher FA values than females in the medial and posterior parts of the right superior longitudinal fasciculus (SLF), the forceps minor, and the corticospinal tract. Compared to control females, FtM showed higher FA values in posterior part of the right SLF, the forceps minor and corticospinal tract. Compared to control males, FtM showed only lower FA values in the corticospinal tract. Conclusions: Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gender identity (males) than those who share their biological sex (females). Our results provide evidence for an inherent difference in the brain structure of FtM transsexuals. 

 

White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study


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

Giuseppina Rametti d,f , Beatriz Carrillo b , Esther Gómez-Gil c , Carme Junque b,f , Leire Zubiarre-Elorza b , Santiago Segovia a , Ángel Gomez e , Antonio Guillamon a,*

ABSTRACT

Background: Diffusion tensor imaging (DTI) has been shown to be sensitive in detecting white matter differences between sexes. Before cross-sex hormone treatment female to male transsexuals (FtM) differ from females but not from males in several brain fibers. The purpose of this paper is to investigate whether white matter patterns in male to female (MtF) transsexuals before commencing cross-sex hormone treatment are also more similar to those of their biological sex or whether they are more similar to those of their gender identity. Method: DTI was performed in 18 MtF transsexuals and 19 male and 19 female controls scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics. Results: MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract. Conclusions: 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. 

 

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


Effects of androgenization on the white matter microstructure of female-to-male transsexuals. A diffusion tensor imaging study

Giuseppina Rametti d,f , Beatriz Carrillo a , Esther Go´mez-Gil c , Carme Junque b,f , Leire Zubiaurre-Elorza b,f , Santiago Segovia a , A´ngel Gomez e , Kazmer Karadi g , Antonio Guillamon a, *

ABSTRACT

Diffusion tensor imaging (DTI) can sensitively detect white matter sex differences and the effects of pharmacological treatments. Before cross-sex hormone treatment, the white matter microstructure ofseveral brain bundlesin female-to-male transsexuals (FtMs) differsfrom those in females but not from that in males. The purpose of this study was to investigate whether cross-sex hormone treatment (androgenization) affects the brain white matter microstructure. Using a Siemens 3 T Trio Tim Magneton, DTI was performed twice, before and during cross-sex hormonal treatment with testosterone in 15 FtMs scanned. Fractional anisotropy (FA) was analyzed on white matter of the whole brain, and the latter was spatially analyzed using Tract-Based Spatial Statistics. Before each scan the subjects were assessed for serum testosterone, sex hormone binding globulin level (SHBG), and their free testosterone index. After at least seven months of cross-gender hormonal treatment, FA values increased in the right superior longitudinal fasciculus (SLF) and the right corticospinal tract (CST) in FtMs compared to their pretreatment values. Hierarchical regression analyses showed that the increments in the FA values in the SLF and CST are predicted by the free testosterone index before hormonal treatment. All these observations suggest that testosterone treatment changes white matter microstructure in FtMs.

 

Effects of androgenization on the white matter microstructure of female-to-male transsexuals. A diffusion tensor imaging study


Transsexualism differences caught on brain scan

Jessica Hamzelou

ABSTRACT

Differences in the brain’s white matter that clash with a person’s genetic sex may hold the key to identifying transsexual people before puberty. Doctors could use this information to make a case for delaying puberty to improve the success of a sex change later.

 

Transsexual differences caught on brain scan fra 2011


Hormoner kjønnsdysfori Transsexual


Effects of Cross-Sex Hormone Treatment on Emotionality in Transsexuals

Ditte Slabbekoorn, Stephanie H.M. Van Goozen, Louis J.G. Gooren, Peggy T. Cohen-Kettenis

ABSTRACT

The aim of the study was to investigate whether cross-sex hormone treatment in transsexuals affected the intensity of negative and positive emotions in general, and aggressive and sexual feelings in particular. With respect to emotional behavior, changes in non-verbal expressiveness and anger readiness were examined in 47 female-to-male transsexuals (FtMs) and 54 male-to-female transsexuals (MtFs). We were also interested in finding out whether, in FtMs, the rapidly changing testosterone levels in the two-week cycle testosterone treatment had predictable effects on moods, the development of male physical characteristics and sexuality.

Keywords: sex hormones, transsexuals, emotionality, sexuality, aggression.

 

 

Effects of Cross-Sex Hormone Treatment on Emotionality in Transsexuals


Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline

Wylie C. Hembree,1 Peggy T. Cohen-Kettenis,2 Louis Gooren,3 Sabine E. Hannema,4 Walter J. Meyer,5 M. Hassan Murad,6 Stephen M. Rosenthal,7 Joshua D. Safer,8 Vin Tangpricha,9 and Guy G. T’Sjoen10

ABSTRACT

Objective:

To update the “Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline,” published by the Endocrine Society in 2009. Participants: The participants include an Endocrine Society–appointed task force of nine experts, a methodologist, and a medical writer.

Evidence:

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus

Process:

Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.

 

Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society* Clinical Practice Guideline


Neuronal plasticity of language-related brain regions induced by long-term testosterone treatment

Andreas Hahn1 , Georg S. Kranz1 , Ronald Sladky2 , Ulrike Kaufmann3 , Sebastian Ganger1 , Allan Hummer2 , Rene Seiger1 , Marie Spies1 , Thomas Vanicek1 , Dietmar Winkler1 , Siegfried Kasper1 , Christian Windischberger2 , Dick F. Swaab4 , Rupert Lanzenberger1

ABSTRACT

The sex steroid hormone testosterone exhibits a substantial influence on behavior and cognition via the modulation of underlying brain structures and function. Testosterone plays a particular role in language function, showing associations with vocabulary and sexually dimorphic gray matter regions [1]. However, the majority of studies are limited to cross-sectional investigations or single hormone applications due to ethical reasons. Here, we assessed the influence of continuous high-dose testosterone treatment on brain structure and function in female-to-male (FtM) transsexuals before and after start of hormone therapy.

 

 

Neuronal plasticity of language-related brain regions induced by long-term testosterone treatment


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.

Dr. Courtney Finlayson

E-bok

Offering current guidelines on the relatively new practice of puberty suppression for gender-dysphoric adolescents, Pubertal Suppression in Transgender Youth provides a succinct, easy-to-digest overview of this timely topic. This concise, clinically-focused resource by Dr. Courtney Finlayson covers all relevant topics, from a brief history of medical care of transgender youth to emerging developments in the field.

Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study.


Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review.

Chew D1Anderson J2Williams K1,3,4May T1,3,4,5Pang K6,3

ABSTRACT

CONTEXT:

Hormonal interventions are being increasingly used to treat young people with gender dysphoria, but their effects in this population have not been systematically reviewed before.

OBJECTIVE:

To review evidence for the physical, psychosocial, and cognitive effects of gonadotropin-releasing hormone analogs (GnRHa), gender-affirming hormones, antiandrogens, and progestins on transgender adolescents.

DATA SOURCES:

We searched Medline, Embase, and PubMed databases from January 1, 1946, to June 10, 2017.

STUDY SELECTION:

We selected primary studies in which researchers examined the hormonal treatment of transgender adolescents and assessed their psychosocial, cognitive, and/or physical effects.

DATA EXTRACTION:

Two authors independently screened studies for inclusion and extracted data from eligible articles using a standardized recording form.

RESULTS:

Thirteen studies met our inclusion criteria, in which researchers examined GnRHas (n = 9), estrogen (n = 3), testosterone (n = 5), antiandrogen (cyproterone acetate) (n = 1), and progestin (lynestrenol) (n = 1). Most treatments successfully achieved their intended physical effects, with GnRHas and cyproterone acetate suppressing sex hormones and estrogen or testosterone causing feminization or masculinization of secondary sex characteristics. GnRHa treatment was associated with improvement across multiple measures of psychological functioning but not gender dysphoria itself, whereas the psychosocial effects of gender-affirming hormones in transgender youth have not yet been adequately assessed.

LIMITATIONS:

There are few studies in this field and they have all been observational.

CONCLUSIONS:

Low-quality evidence suggests that hormonal treatments for transgender adolescents can achieve their intended physical effects, but evidence regarding their psychosocial and cognitive impact are generally lacking. Future research to address these knowledge gaps and improve understanding of the long-term effects of these treatments is required.

Hormonal Treatment in Young People With Gender Dysphoria: A Systematic Review.


Early Medical Treatment of Children and Adolescents With Gender Dysphoria: An Empirical Ethical Study

Lieke Josephina Jeanne Johanna Vrouenraets, M.Sc. a,*, A. Miranda Fredriks, M.D., Ph.D. a , Sabine E. Hannema, M.D., Ph.D. b , Peggy T. Cohen-Kettenis, Ph.D. c , and Martine C. de Vries, M.D., Ph.D. b

ABSTRACT

Purpose

The Endocrine Society and the World Professional Association for Transgender Health published guidelines for the treatment of adolescents with gender dysphoria (GD). The guidelines recommend the use of gonadotropin-releasing hormone agonists in adolescence to suppress puberty. However, in actual practice, no consensus exists whether to use these early medical interventions. The aim of this study was to explicate the considerations of proponents and opponents of puberty suppression in GD to move forward the ethical debate.

Methods

Qualitative study (semi-structured interviews and open-ended questionnaires) to identify considerations of proponents and opponents of early treatment (pediatric endocrinologists, psychologists, psychiatrists, ethicists) of 17 treatment teams worldwide.

Results

Seven themes give rise to different, and even opposing, views on treatment: (1) the (non-)availability of an explanatory model for GD; (2) the nature of GD (normal variation, social construct or [mental] illness); (3) the role of physiological puberty in developing gender identity; (4) the role of comorbidity; (5) possible physical or psychological effects of (refraining from) early medical interventions; (6) child competence and decision making authority; and (7) the role of social context how GD is perceived. Strikingly, the guidelines are debated both for being too liberal and for being too limiting. Nevertheless, many treatment teams using the guidelines are exploring the possibility of lowering the current age limits.

Conclusions

As long as debate remains on these seven themes and only limited long-term data are available, there will be no consensus on treatment. Therefore, more systematic interdisciplinary and (worldwide) multicenter research is required.

Keywords:

Gender dysphoriaPuberty suppressionAdolescentsEthicsQualitative studyInterviewsQuestionnairesWorldwide

 

 

Early Medical Treatment of Children and Adolescents With Gender Dysphoria- An Empirical Ethical Study


Long term hormonal treatment for transgender people

Martin den Heijer professor of endocrinology 1 2, Alex Bakker transgender man with 20 years of experience taking hormonal treatment, Louis Gooren emeritus professor in transgender medicine 2

ABSTRACT

The aim of hormone treatment in transgender people is to adjust their secondary sex characteristics to be more congruent with their experienced gender. Hormone treatment for transgender people is usually initiated by specialist gender clinics, but some people start hormone treatment of their own accord without a prescription. With growing numbers of transgender people presenting to healthcare services (estimated as 9.2 per 100 0001 ), general practitioners, general endocrinologists, and other doctors will become increasingly involved in their long term care, the prescription of hormones, and consideration of potential side effects. Several guidelines are available on the start of hormonal treatment2-7; the focus of this article is the long term hormonal care for transgender people who might no longer attend a specialist clinic.

 

 

Long term hormonal treatment for transgender people


Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults

Noor Beckwith,1,2 Sari L. Reisner,2–5 Shayne Zaslow,3,6 Kenneth H. Mayer,2,3,7 and Alex S. Keuroghlian1–3,*

ABSTRACT

Purpose:

Gender-affirming surgeries and hormone therapy are medically necessary treatments to alleviate gender dysphoria; however, significant gaps exist in the research and clinical literature on surgery utilization and age of hormone therapy initiation among transgender adults.

Methods:

We conducted a retrospective review of electronic health record data from a random sample of 201 transgender patients of ages 18–64 years who presented for primary care between July 1, 2010 and June 30, 2015 (inclusive) at an urban community health center in Boston, MA. Fifty percent in our analyses were trans masculine (TM), 50% trans feminine, and 24% reported a genderqueer/nonbinary gender identity. Regression models were fit to assess demographic, gender identity-related, sexual history, and mental health correlates of genderaffirming surgery and of age of hormone therapy initiation.

Results:

Overall, 95% of patients were prescribed hormones by their primary care provider, and the mean age of initiation of masculinizing or feminizing hormone prescriptions was 31.8 years (SD = 11.1). Younger age of initiation of hormone prescriptions was associated with being TM, being a student, identifying as straight/heterosexual, having casual sexual partners, and not having past alcohol use disorder. Approximately one-third (32%) had a documented history of gender-affirming surgery. Factors associated with increased odds of surgery were older age, higher income levels, not identifying as bisexual, and not having a current psychotherapist.

Conclusion:

This study extends our understanding of prevalence and factors associated with gender-affirming treatments among transgender adults seeking primary care. Findings can inform future interventions to expand delivery of clinical care for transgender patients. Keywords: barriers to

 

Factors Associated with Gender-Affirming Surgery and Age of Hormone Therapy Initiation Among Transgender Adults


Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study

Sari L. Reisner, ScD, MA,1,2 Ralph Vetters, MD, MPH,3 M Leclerc, MPH,4 Shayne Zaslow, MA, MS,2Sarah Wolfrum, MPH,2 Daniel Shumer, MD,5 and Matthew J. Mimiaga, ScD, MPH1,2,6

ABSTRACT

Purpose

Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exists to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the current study aimed to fill this gap.

Methods

A retrospective cohort study of electronic health record (EHR) data from 180 transgender patients age 12–29 years seen between 2002–2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM to MTF youth on mental health outcomes.

Results

The sample (n=360) had a mean age of 19.6 (SD=3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared to cisgender matched controls, transgender youth had a two- to three-fold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p<0.05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.

Conclusions

Transgender youth were found to have a disparity in negative mental health outcomes compared to cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.

Keywords: 

mental health, transgender, gender minority, adolescent, health disparit

 

Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study


Transgender women: Evaluation and management

ABSTRACT

The terms transgender and gender incongruence describe a situation where an individual’s gender identity differs from external sexual anatomy at birth. Health care providers should be familiar with commonly used terms (table 1). Gender identity-affirming care, for those who desire, can include hormone therapy and affirming surgeries, as well as other procedures such as hair removal or speech therapy [1].

This topic will use the term transgender in the broadest sense to include any person with incongruence between gender identity and external sexual anatomy at birth. The evaluation and management of transgender women are discussed here. The evaluation and management of transgender men, the primary care of the transgender adult, and gender diversity in children and adolescents are reviewed separately. (See «Transgender men: Evaluation and management» and «Primary care of transgender individuals» and «Gender development and clinical presentation of gender diversity in children and adolescents» and «Management of transgender and gender-diverse children and adolescents».)

Transgender women: Evaluation and management

trans kirurgi


An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.46

Jordan D. Frey, M.D. Grace Poudrier, B.A. Michael V. Chiodo, M.D. Alexes Hazen, M.D.

ABSTRACT

Although many transgender individuals are able to realize their gender identity without surgical intervention, a significant and increasing portion of the trans population is seeking gender-confirming surgery (alternatively, gender reassignment surgery, sexual reassignment surgery, or gender-affirming surgery). This review presents a robust overview of genital reconstruction in the female-to-male transgender patient—an operation that, historically, was seldom performed and has remained less surgically feasible than its counterpart (male-to-female genital reconstruction).

However, as the visibility and public awareness of the trans community continues to increase, the demand for plastic surgeons equipped to perform these reconstructions is rising. The “ideal” neophallus is aesthetic, maintains tactile and erogenous sensibility, permits sexual function and standing urination, and possesses minimal donor-site and operative morbidity. This article reviews current techniques for surgical construction, including metoidioplasty and phalloplasty, with both pedicled and free flaps. Emphasis is placed on the variety of techniques available for constructing a functional neophallus and neourethra. Preparative procedures (such as vaginectomy, hysterectomy, and oophorectomy) and adjunctive reconstructive procedures (including scrotoplasty and genital prosthesis insertion) are also discussed. (Plast. Reconstr. Surg. 139: 728, 2017.)

 

 

An Update on Genital Reconstruction Options for the Female-to-Male Transgender Patient: A Review of the Literature.46


Chest-Wall Contouring Surgery in Female-to-Male Transsexuals: A New Algorithm

Stan Monstrey, M.D., Ph.D. Gennaro Selvaggi, M.D. Peter Ceulemans, M.D. Koen Van Landuyt, M.D. Cameron Bowman, M.D. Phillip Blondeel, M.D., Ph.D. Moustapha Hamdi, M.D. Griet De Cuypere, M.D.

ABSTRACT

: In female-to-male transsexuals, the first surgical procedure in their reassignment surgery consists of the subcutaneous mastectomy. The goals of subcutaneous mastectomy are removal of breast tissue, removal of excess skin, reduction and proper positioning of the nipple and areola, and ideally, minimization of chest-wall scars. The authors present the largest series to date of female-to-male transsexuals who have undergone subcutaneous mastectomy.

Methods:

A total of 184 subcutaneous mastectomies were performed in 92 female-to-male transsexuals, using the following five techniques: semicircular, transareolar, concentric circular, extended concentric circular, and free nipple graft. The technique used depended on the breast size and envelope, the aspect and position of the nipple-areola complex, and the skin elasticity. To best meet the goals of creating a normal male thorax, the authors have developed an algorithm to aid in choosing the appropriate procedure.

Results:

The overall postoperative complication rate was 12.5 percent (23 of 184 subcutaneous mastectomies), and in eight of these cases (4.3 percent), an additional operative intervention was required because of hematoma, infection, and/or wound dehiscence. Despite this low complication rate, additional procedures for improving aesthetic results were performed on 59 breasts (32.1 percent). The semicircular and concentric circular techniques produced the highest rating of the overall result by patient and surgeon, whereas the extended concentric circular technique produced the lowest rating.

Conclusions:

Skin excess and skin elasticity are the key factors in choosing the appropriate technique for subcutaneous mastectomy, which is reflected in the algorithm. Although the complication rate is low and patient satisfaction is high, secondary aesthetic corrections are often indicated. (Plast. Reconstr. Surg. 121: 849, 2008.)

 

 

Chest-Wall Contouring Surgery in Female-to-Male Transsexuals: A New Algorithm


The role of colpocleisis transsexual phalloplasty with urethral lengthening in

Ralph R. Chesson, MD, c David A. Gilbert, MD, a Gerald H. Jordan, MD, b Steven M. Schlossberg, MD, b Gerald T. Ramsey, PhD, and Deborah M. Gilbert, RN ~ Norfolk, Virginia

ABSTRACT

OBJECTIVE:

Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented.

STUDY DESIGN:

Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vag!nal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment.

RESULTS;

Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible.

CONCLUSION:

Extending the urethra during colpocteisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results. (Am J Obstet Gynecol 1996;175:1443-50.)

Key words:

Transsexual surgery, colpocleisis, anterior vaginal wall extension, phalloplasty

 

 

The role of colpocleisis transsexual phalloplasty with urethral lengthening in


Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism

Albert Leriche, Marc-Olivier Timsit, Nicolas Morel-Journel, André Bouillot, Diala Dembele and Alain Ruffion Department of Urology, Henry Gabrielle Hospital, University of Lyon I, Lyon, France

ABSTRACT

OBJECTIVE

To assess the long-term outcome of forearm free-flap phalloplasty in transsexuals, as obtaining a satisfying neophallus in femaleto-male transsexuals is a surgical challenge.

PATIENTS AND METHODS

We analysed retrospectively 56 transsexuals who had a phalloplasty using a radial forearm free-flap in our department from 1986 to 2002. The complication rate was assessed by regular examination. Patient satisfaction was evaluated by a questionnaire about cosmetic aspects, sexual life and overall satisfaction.

RESULTS

The mean follow up was 110 months; 53 of the 56 patients (95%) currently have a neophallus, after a mean of six surgical procedures. Satisfaction was assessed in 53 patients using a specific questionnaire: 51 (93%) of the patients reported that the phalloplasty allowed them to accord their physical appearance with their feeling of masculinity. There were flap complications in 14 patients (25%); three (5%) flaps were lost, with one each due to early haematoma, cellulitis and late arterial thrombosis. The other 11 flap complications were all transitory, e.g. infection, haematomas and vascular thrombosis. There were prosthesis complications in 11 of 38 patients (29%). Moreover, seven of 19 patients (37%) who had a urethroplasty presented with complex strictures and fistulae that led to perineal urethrostomy.

CONCLUSION

Our study shows that phalloplasty with a forearm free-flap leads to good results in term of flap survival and patient satisfaction. However, there was a high rate of complications. Patients must be clearly informed that the procedure can seldom be achieved in one stage.

KEYWORDS transsexualism, gender identity, surgical flap, penis surgery, urethra surgery, penile prosthesis

 

 

Long-term outcome of forearm flee-flap phalloplasty in the treatment of transsexualism


Gender Confirmation Surgery, An Issue of Clinics in Plastic Surgery, E-Book (The Clinics: Surgery)

E-bok

This issue of Clinics in Plastic Surgery, guest edited by Loren Schechter and Bauback Safa, is devoted to Gender Confirmation Surgery. Articles in this issue include: Multidisciplinary Care and The Standards of Care for Transgender and Gender Non-conforming Individuals; Primary Care of Transgender and Gender Non-conforming Individuals; Mental Health Evaluation for Transgender and Gender Non-conforming Individuals; Hormonal Management for Transfeminine Individuals; Hormonal Management for Transmasculine Individuals; Facial Feminization; Breast and Body Contouring for Transgender and Gender Non-conforming Individuals; Penile inversion; Intestinal Vaginoplasty; Vaginoplasty Complications; Chest Surgery for Transgender and Gender Non-conforming Individuals; Metoidioplasty; Introduction to Phalloplasty; Radial Forearm; AnteroLateral Thigh flap (ALT); Penile Prostheses; Flap-related Complications; Urologic Complications; and Sexual Health after Surgery.

Gender Confirmation Surgery, An Issue of Clinics in Plastic Surgery, E-Book (The Clinics: Surgery)


Penile Reconstruction with the Radial Forearm Flap: An Update

M. Doornaert 1, P. Hoebeke 2, P. Ceulemans 1, G. T ’ Sjoen 3, G. Heylens 4, S. Monstrey 1

ABSTRACT

Background:

Many methods and many free or pedicled flaps have been used in phalloplasty. None of these techniques is able to completely fulfill the well described goals in penile reconstruction. Still, the radial forearm flap is currently the most frequently used fl ap and thus universally considered the gold standard.

Patients and Methods:

Since 1992, we have performed the largest series of 316 radial forearm phalloplasties to date performed by a single surgical team. From these extensive data we critically evaluate how this current supposed gold standard can meet the requirements of an ideal penile reconstruction.

Results:

We assessed outcome parameters such as number of procedures to achieve complete functional result, aesthetic outcome, tactile and erogenous sensation, voiding, donor site morbidity, scrotoplasty and sexual intercourse.

Conclusion:

While currently no controlled randomized prospective studies are available to prove the radial forearm flap is truly the gold standard in penile reconstruction, we believe that our retrospective data support the radial forearm phalloplasty as a very reliable technique for the creation of a normal looking penis and scrotum. While full functionality is achieved through a minimum of 2 procedures, the patients are always able to void standing, and in most cases to experience sexual satisfaction. The relative disadvantages of this technique are the residual scar on the forearm donor site, the rather high number of initial urinary fistulas, the potential for long-term urological complications and the need for a stiff ener or erection prosthesis. From our experience, we strongly feel that a structured multi-disciplinary cooperation between the reconstructive-plastic surgeon and the urologist is an absolute requisite to obtain the best possible technical results.

 

 

Penile Reconstruction with the Radial Forearm Flap: An Update


Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?

Stan Monstrey, M.D., Ph.D. Piet Hoebeke, M.D., Ph.D. Gennaro Selvaggi, M.D. Peter Ceulemans, M.D. Koen Van Landuyt, M.D., Ph.D. Phillip Blondeel, M.D., Ph.D. Moustapha Hamdi, M.D., Ph.D. Nathalie Roche, M.D. Steven Weyers, M.D. Griet De Cuypere, M.D. Ghent, Belgium

ABSTRACT

Background:

The ideal goals in penile reconstruction are well described, but the multitude of flaps used for phalloplasty only demonstrates that none of these techniques is considered ideal. Still, the radial forearm flap is the most frequently used flap and universally considered as the standard technique.

Methods:

In this article, the authors describe the largest series to date of 287 radial forearm phalloplasties performed by the same surgical team. Many different outcome parameters have been described separately in previously published articles, but the main purpose of this review is to critically evaluate to what degree this supposed standard technique has been able to meet the ideal goals in penile reconstruction.

Results:

Outcome parameters such as number of procedures, complications, aesthetic outcome, tactile and erogenous sensation, voiding, donor-site morbidity, scrotoplasty, and sexual intercourse are assessed.

Conclusions:

In the absence of prospective randomized studies, it is not possible to prove whether the radial forearm flap truly is the standard technique in penile reconstruction. However, this large study demonstrates that the radial forearm phalloplasty is a very reliable technique for the creation, mostly in two stages, of a normal-appearing penis and scrotum, always allowing the patient to void while standing and in most cases also to experience sexual satisfaction. The relative disadvantages of this technique are the rather high number of initial fistulas, the residual scar on the forearm, and the potential long-term urologic complications. Despite the lack of actual data to support this statement, the authors feel strongly that a multidisciplinary approach with close cooperation between the reconstructive/plastic surgeon and the urologist is an absolute requisite for obtaining the best possible results. (Plast. Reconstr. Surg. 124: 510, 2009.)

 

 

Penile Reconstruction: Is the Radial Forearm Flap Really the Standard Technique?


Phalloplasty: A Review of Techniques and Outcomes

Shane D. Morrison, M.D., M.S. Afaaf Shakir, B.S. Krishna S. Vyas, M.D., M.H.S. Johanna Kirby, B.S. Curtis N. Crane, M.D. Gordon K. Lee, M.D. Seattle, Wash.; Palo Alto and San Francisco, Calif.; and Lexington, Ky.

ABSTRACT

Background:

Acquired or congenital absence of the penis can lead to severe physical limitations and psychological outcomes. Phallic reconstruction can restore various functional aspects of the penis and reduce psychosocial sequelae. Moreover, some female-to-male transsexuals desire creation of a phallus as part of their gender transition. Because of the complexity of phalloplasty, there is not an ideal technique for every patient. This review sets out to identify and critically appraise the current literature on phalloplasty techniques and outcomes.

Methods:

A comprehensive literature search of the MEDLINE, PubMed, and Google Scholar databases was conducted for studies published through July of 2015 with multiple search terms related to phalloplasty. Data on techniques, outcomes, complications, and patient satisfaction were collected.

Results:

A total of 248 articles were selected and reviewed from the 790 identified. Articles covered a variety of techniques on phalloplasty. Three thousand two hundred thirty-eight patients underwent phalloplasty, with a total of 1753 complications reported, although many articles did not explicitly comment on complications. One hundred four patients underwent penile replantation and two underwent penile transplantation. Satisfaction was high, although most studies did not use validated or quantified approaches to address satisfaction.

Conclusions:

Phalloplasty techniques are evolving to include a number of different flaps, and most techniques have high reported satisfaction rates. Penile replantation and transplantation are also options for amputation or loss of phallus. Further studies are required to better compare different techniques to more robustly establish best practices. However, based on these studies, it appears that phalloplasty is highly efficacious and beneficial to patients. (Plast. Reconstr. Surg. 138: 594, 2016.)

 

 

Phalloplasty: A Review of Techniques and Outcomes


Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients

Gennaro Selvaggi, MD,* Stan Monstrey, MD, PhD,* Peter Ceulemans, MD,* Guy T’Sjoen, MD,‡ Griet De Cuypere, MD,§ and Piet Hoebeke, MD, PhD†

ABSTRACT

Background:

Tactile and erogenous sensitivity in reconstructed genitals is one of the goals in sex reassignment surgery. Since November 1993 until April 2003, a total of 105 phalloplasties with the radial forearm free flap and 127 vaginoclitoridoplasties with the inverted penoscrotal skin flap and the dorsal glans pedicled flap have been performed at Ghent University Hospital. The specific surgical tricks used to preserve genital and tactile sensitivity are presented. In phalloplasty, the dorsal hood of the clitoris is incorporated into the neoscrotum; the clitoris is transposed, buried, and fixed directly below the reconstructed phallic shaft; and the medial and lateral antebrachial nerves are coapted to the inguinal nerve and to one of the 2 dorsal nerves of the clitoris. In vaginoplasty, the clitoris is reconstructed from a part of the glans penis inclusive of a part of the corona, the inner side of the prepuce is used to reconstruct the labia minora, and the penile shaft is inverted to line the vaginal cavity.

Material and Methods:

A long-term sensitivity evaluation (performed by the Semmes-Weinstein monofilament and the Vibration tests) of 27 reconstructed phalli and 30 clitorises has been performed.

Results:

The average pressure and vibratory thresholds values for the phallus tip were, respectively, 11.1 g/mm2 and 3 m. These values have been compared with the ones of the forearm (donor site). The average pressure and vibratory thresholds values for the clitoris were, respectively, 11.1 g/mm2 and 0.5 m. These values have been compared with the ones of the normal male glans, taken from the literature. We also asked the examined patients if they experienced orgasm after surgery, during any sexual practice (ie, we considered only patients who attempted to have orgasm): all female-to-male and 85% of the male-to-female patients reported orgasm.

Conclusion:

With our techniques, the reconstructed genitalia obtain tactile and erogenous sensitivity. To obtain a good tactile sensitivity in the reconstructed phallus, we believe that the coaptation of the cutaneous nerves of the flap with the ilioinguinalis nerve and with one of the 2 nerves of the clitoris is essential in obtaining this result. To obtain orgasm after phalloplasty, we believe that preservation of the clitoris beneath the reconstructed phallus and some preservation of the clitoris hood are essential. To obtain orgasm after a vaginoplasty, the reconstruction of the clitoris from the neurovascular pedicled glans flap is essential.

Key Words:

transsexualism, phalloplasty, vaginoplasty, sensitivity, gender dysphoria, sex reass

 

 

Genital Sensitivity After Sex Reassignment Surgery in Transsexual Patients


Nordisk forskning kjønnsdysfori


”Det er ufattelig deilig når andre oppfatter deg som den du faktisk er!”

I hvilken grad er stemmen og dens uttrykk viktig for kjønnsidentitet hos personer med kjønnsinkongruens?

John F. Strang, Haley Meagher, Lauren Kenworthy, Annelou L. C. de Vries, Edgardo Menvielle, Scott Leibowitz, Aron Janssen, Peggy Cohen-Kettenis, Daniel E. Shumer, Laura Edwards-Leeper, Richard R. Pleak, Norman Spack, Dan H. Karasic, Herbert Schreier, Anouk Balleur, Amy Tishelman, Diane Ehrensaft, Leslie Rodnan, Emily S. Kuschner, Francie Mandel, Antonia Caretto, Hal C. Lewis & Laura G. Anthony

Sammendrag

Bakgrunn for tema: For å produsere stemmelyd trengs luft fra lungene, et fungerende strupehode og resonansrom. Stemmen brukes for å uttrykke seg i kommunikasjon med andre, og vi kan oppfatte det lingvistiske budskapet til avsenderen gjennom talespråket; – men vi kan også oppfatte paralingvistisk informasjon som alder og kjønn. Oppfattelsen av kjønn, og hva som forstås som kjønn, kan sies å være både biologisk og sosialt betinget. Personer med kjønnsinkongruens opplever et manglende samsvar mellom det biologiske kjønnet de fikk tildelt ved fødsel og det sosiale kjønnet de identifiserer seg som. Prosjektet søker å finne ut av hvordan personer med kjønnsinkongruens som har gjennomgått kjønnsbekreftende behandling, tenker omkring egen stemme og stemmebruk.

 

AaseFinch-Sped4090 logoped


Kraftig ökning av könsdysfori bland barn och unga

Louise Frisén,  Olle Söder,  Per-Anders Rydelius,

Abstract

  • Under det senaste decenniet har antalet unga med könsdysfori som söker sjukvårdens insatser för köns­ bekräftande åtgärder ökat kraftigt.
  • En minoritet (ca 20 procent) av barn <12 år med könsdysfori kommer att ha en kvarstående önskan om könsbekräftande åtgärder.
  • Majoriteten av de barn vars könsdysfori förstärks i samband med puberteten uppfyller diagnoskriterierna för transsexualism och kan behandlas med pubertets­ stoppande hormoner i syfte att undvika utveckling av oönskade sekundära könskarakteristika.
  • Tidigt insatt behandling underlättar möjligheten att framgångsrikt passera i det önskade könet och är förknippat med betydligt bättre prognos.

 

 

Barn i Sverige 2017


Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development

Riittakerttu Kaltiala-Heino1,2*, Maria Sumia2 , Marja Työläjärvi2 and Nina Lindberg3,4

Abstract

Background:

Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development.

Methods:

Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013.

Results:

The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common.

Conclusion:

The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Keywords:

Transsexualism, Gender dysphoria, Sex reassignment, Adolescent development

 

 

Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development


A Five-Year Follow-Up Study of Swedish Adults with Gender Identity Disorder

Annika Johansson • Elisabet Sundbom • Torvald Ho¨jerback • Owe Bodlund

ABSTRACT

This follow-up study evaluated the outcome of sex reassignment as viewed by both clinicians and patients, with an additional focus on the outcome based on sex and subgroups. Of a total of 60 patients approved for sex reassignment, 42 (25 male-to-female [MF] and 17 female-to-male [FM]) transsexuals completed a follow-up assessment after 5 or more years in the process or 2 or more years after completed sex reassignment surgery. Twenty-six (62%) patients had an early onset and 16 (38%) patients had a late onset; 29 (69%) patients had a homosexual sexual orientation and 13 (31%) patients had a non-homosexual sexual orientation (relative to biological sex). At index and follow-up, a semi-structured interview was conducted. At followup, 32 patients had completed sex reassignment surgery, five were still in process, and five—following their own decision—had abstained from genital surgery. No one regretted their reassignment. The clinicians rated the global outcome as favorable in 62% of the cases, compared to 95% according to the patients themselves, with no differences between the subgroups. Based on the follow-up interview, more than 90% were stable or improved as regards work situation, partner relations, and sex life, but 5–15% were dissatisfied with the hormonal treatment, results of surgery, total sex reassignment procedure, or their present general health. Most outcome measures were rated positive and substantially equal for MF and FM. Late-onset transsexuals differed from those with early onset in some respects: these were mainly MF (88 vs. 42%), older when applying for sex reassignment (42 vs. 28 years),

 

 

Johansson 2010

 

 


Kjønnskorrigerende kirurgi
ved transseksualisme

Kim Alexander Tønseth kim.tonseth@rikshospitalet.no Therese Bjark Plastikkirurgisk avdeling Oslo universitetssykehus, Rikshospitalet 0027 Oslo Gunnar Kratz Plastikkirurgisk avdeling Universitetssjukhuset Linköping Sverige Annika Gross Rolf Kirschner Kvinneklinikken Thomas Schreiner Medisinsk klinikk Trond H. Diseth Barneklinikken Ira Haraldsen Gender identity disorder (GID) seksjonen Nevroklinikken Oslo universitetssykehus, Rikshospitalet

ABSTRACT

Bakgrunn.

Oslo universitetssykehus, Rikshospitalet har siden 1979 hatt landsfunksjon for behandling av pasienter med transseksualisme. På årsbasis henvises 50–70 pasienter til utredning, hvorav rundt 20 pasienter blir diagnostisert som transseksuelle. Årlig henvises omtrent 15 pasienter av dem som oppfyller kriterier for transseksualisme, og som er blitt endokrinologisk behandlet, til kirurgisk intervensjon. I denne artikkelen beskrives diagnose og behandling av transseksualisme, med hovedvekt på kirurgi.

Materiale og metode.

Artikkelen er basert på ikke-systematisk litteraturgjennomgang og egne kliniske og vitenskapelige erfaringer.

Resultater.

Etter minimum ett års psykiatrisk utredning og diagnostikk, og ett års påfølgende hormonell behandling, vurderes pasientene i forhold til kjønnskorrigerende kirurgi. Hos pasienter som konverteres fra mann til kvinne, vurderes brystforstørrende kirurgi hvis ikke hormonbehandling alene har gitt tilfredsstillende resultat. I tillegg er det aktuelt med genital kirurgi hvor testikler og svamplegemene fjernes, og hvor neovagina og neoklitoris konstrueres. For pasienter som konverteres fra kvinne til mann, er det aktuelt å gjøre brystreduserende inngrep, hysterektomi og salpingo-ooforektomi samt neopeniskonstruksjon. Ved god respons på hormonbehandling kan klitoris rettes ut og konstrueres til en neopenis med ereksjonsmulighet (metoidioplastikk). Alternativt gjøres falloplastikk med bruk av lokalt vev fra lysken eller frie mikrovaskulære lapper.

Fortolkning.

Kjønnskorrigerende kirurgi ved transseksualisme omfatter hovedsakelig konverterende operasjoner på bryst og genitalia.

 

 

 

Kjønnskorrigerende kirurgi Rikshospitalet 2010Pdf

 


Rett til rett kjønn - helse til alle kjønn

ABSTRACT

Ekspertgruppa ble oppnevnt av Helsedirektoratet i desember 2013 for å gjennomgå nåværende vilkår for å endre juridisk kjønnsstatus i Norge, samt vurdere behovene for og foreslå endringer i dagens pasient- og behandlingstilbud til personer som opplever kjønnsdysfori. Bakgrunnen for dette var oppdrag gitt av Helse- og omsorgsdepartementet i oktober 2013. Dagens vilkår for å få endret juridisk kjønnsstatus er at vedkommende først må gjennomgå kjønnsbekreftende medisinsk behandling som inkluderer kastrasjon. Offentlig behandlingstilbud av hormonell og/eller kirurgisk art, gis kun til personer som er gitt diagnosen F64.0 Transseksualisme ved Nasjonal behandlingstjeneste for transseksualisme (NBTS), Oslo universitetssykehus. Utover dette er det ikke i dag tilrettelagt for at det gis behandling i offentlig regi andre steder.

 

 

 

Rett til rett kjønn Ferdig rapport 090415


Barn født med uklare kjønnskarakteristika

Trond H. Diseth

trond.diseth@rikshospitalet.no

ABSTRACT

Bakgrunn.

Årlig fødes 10–12 barn i Norge med alvorlig genital misdannelse hvor kjønnet ikke kan fastsettes ved fødsel. Tilstanden betegnes Forstyrrelser i kjønnsutviklingen (DSD). Alvorlig underviriliserte gutter (46,XY DSD) representerer den største utfordringen, hvor valg av kjønn tradisjonelt har vært jente.

Materiale og metode.

Artikkelen bygger på et grundig ikke-systematisk søk i PubMed samt egen klinisk erfaring. Resultater og fortolkning. I de siste ti år er det i økende grad stilt spørsmål ved det faglige grunnlaget for kjønnsvalg ved uklart kjønn. Avgjørende for den tradisjonelle behandlingsprotokoll har vært postulatet om at barn med forstyrrelser i kjønnsutviklingen vil utvikle seg til et valgt kjønn uansett årsak, såfremt ytre genitalia ble «normalisert» før toårsalderen, svarende til det valgte kjønn. Da viktigheten av falloslegemets størrelse og funksjonalitet for senere mannlig kjønnsidentitet og kjønnsrolleatferd ble understreket, ble de fleste alvorlig underviriliserte 46,XY DSD-barn operert til jenter. Ny kunnskap om mulig prenatal genetisk og hormonell påvirkning av fosterets hjerne for senere psykoseksuell utvikling, fører til at fagmiljøet nå utvikler nye behandlingsprotokoller. Eksakt diagnose av bakenforliggende tilstand for best mulig å predikere barnets fremtidige kjønnsidentitet, bør være fundamentet for kjønnsvalg

 

 

 

Studie Trond Diset 2008


Transgender Surgery in Denmark From 1994 to 2015: 20-Year Follow-Up Study

Dogu Aydin, MD, Liv Johanne Buk, MD, Søren Partoft, MD, Christian Bonde, MD, Michael Vestergaard Thomsen, MD, and Tina Tos, MD

 

ABSTRACT

Introduction:

Gender dysphoria is a mismatch between a person’s biological sex and gender identity. The best treatment is believed to be hormonal therapy and gender-confirming surgery that will transition the individual toward the desired gender. Treatment in Denmark is covered by public health care, and gender-confirming surgery in Denmark is centralized at a single-center with few specialized plastic surgeons conducting top surgery (mastectomy or breast augmentation) and bottom surgery (vaginoplasty or phalloplasty and metoidioplasty).

Aims:

To report the first nationwide single-center review on transsexual patients in Denmark undergoing gender-confirming surgery performed by a single surgical team and to assess whether age at time of gender-confirming surgery decreased during a 20-year period.

Methods:

Electronic patient databases were used to identify patients diagnosed with gender identity disorders from January 1994 through March 2015. Patients were excluded from the study if they were pseudohermaphrodites or if their gender was not reported. Main Outcome Measures: Gender distribution, age trends, and surgeries performed for Danish patients who underwent gender-confirming surgery.

Results:

One hundred fifty-eight patients referred for gender-confirming surgery were included. Fifty-five cases (35%) were male-to-female (MtF) and 103 (65%) were female-to-male (FtM). In total, 126 gender-confirming surgeries were performed. For FtM cases, top surgery (mastectomy) was conducted in 62 patients and bottom surgery (phalloplasty and metoidioplasty) was conducted in 17 patients. For MtF cases, 45 underwent bottom surgery (vaginoplasty), 2 of whom received breast augmentation. The FtM:MtF ratio of the referred patients was 1.9:1. The median age at the time of surgery decreased from 40 to 27 years during the 20-year period.

Conclusion:

Gender-confirming surgery was performed on 65 FtM and 40 MtF cases at our hospital, and 21 transsexuals underwent surgery abroad. Mastectomy was performed in 62 FtM and bottom surgery in 17 FtM cases. Vaginoplasty was performed in 45 MtF and breast augmentation in 2 MtF cases. There was a significant decrease in age at the time of gender-confirming surgery during the course of the study period. J Sex Med 2016;-:1e6.

Copyright  2016, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Key Words: Gender Dysphoria;

 

 

 

sugery in Denmark 1994 2015

Autismespekteret og kjønnsdysfori


Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in...

John F. Strang, Haley Meagher, Lauren Kenworthy, Annelou L. C. de Vries, Edgardo Menvielle, Scott Leibowitz, Aron Janssen, Peggy Cohen-Kettenis, Daniel E. Shumer, Laura Edwards-Leeper, Richard R. Pleak, Norman Spack, Dan H. Karasic, Herbert Schreier, Anouk Balleur, Amy Tishelman, Diane Ehrensaft, Leslie Rodnan, Emily S. Kuschner, Francie Mandel, Antonia Caretto, Hal C. Lewis & Laura G. Anthony

ABSTRACT

Evidence indicates an overrepresentation of youth with co-occurring autism spectrum disorders (ASD) and gender dysphoria (GD). The clinical assessment and treatment of adolescents with this co-occurrence is often complex, related to the developmental aspects of ASD.

There are no guidelines for clinical care when ASD and GD co-occur; however, there are clinicians and researchers experienced in this co-occurrence. This study develops initial clinical consensus guidelines for the assessment and care of adolescents with co-occurring ASD and GD, from the best clinical practices of current experts in the field. Expert participants were identified through a comprehensive international search process and invited to participate in a two-stage Delphi procedure to form clinical consensus statements.

The Delphi Method is a well-studied research methodology for obtaining consensus among experts to define appropriate clinical care. Of 30 potential experts identified, 22 met criteria as expert in co-occurring ASD and GD youth and participated. Textual data divided into the following data nodes: guidelines for assessment;

guidelines for treatment; six primary clinical/psychosocial challenges: social functioning, medical treatments and medical safety, risk of victimization/safety, school, and transition to adulthood issues (i.e., employment and romantic relationships). With a cutoff of 75% consensus for inclusion, identified experts produced a set of initial guidelines for clinical care. Primary themes include the importance of assessment for GD in ASD, and vice versa, as well as an extended diagnostic period, often with overlap/ blurring of treatment and assessment.

 

Initial Clinical Guidelines for Co-Occurring Autism Spectrum Disorder and Gender Dysphoria or Incongruence in Adolescents


Gender dysphoria and autism spectrum disorder: a systematic review of the literature

Derek Glidden1 , Walter Pierre Bouman 1 , Bethany Alice Jones1,2 and Jon Arcelus 1,3

ABSTRACT

Introduction.

There is a growing clinical recognition that a significant proportion of patients with Gender Dysphoria, have concurrent Autism Spectrum Disorder (ASD). Aim. The purpose of this review is to systematically appraise the current literature regarding the co-occurrence of Gender Dysphoria and ASD.

Methods

. A systematic literature search using Medline/Pubmed, PsycINFO and Embase were conducted from 1966 to July 2015.

Main Outcome Measures.

A total of 58 articles were generated from the search. Nineteen of these publications met the inclusion criteria. Results. The literature investigating ASD in children and adolescents with Gender Dysphoria have found a higher prevalence rate of ASD compared to the general population. There is a limited amount of research in adults. Only one study showed that adults attending services for Gender Dysphoria had increased ASD scores. Another study showed a higher proportion of atypical gender identity in adults with ASD.

Conclusions.

Although the research is limited, especially with adults, there is an increasing amount of evidence that suggests a co-occurrence between Gender Dysphoria and ASD. Further research is vital for educational and clinical purposes.

 

Systematic_Review_ASD_and_GD_submission_29Sept_Final


Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents

Annelou L. C. de Vries • Ilse L. J. Noens • Peggy T. Cohen-Kettenis • Ina A. van Berckelaer-Onnes • Theo A. Doreleijers

ABSTRACT

Only case reports have described the co-occurrence of gender identity disorder (GID) and autism spectrum disorders (ASD). This study examined this co-occurrence using a systematic approach. Children and adolescents (115 boys and 89 girls, mean age 10.8, SD = 3.58) referred to a gender identity clinic received a standardized assessment during which a GID diagnosis was made and ASD suspected cases were identified. The Dutch version of the Diagnostic Interview for Social and Communication Disorders (10th rev., DISCO-10) was administered to ascertain ASD classifications. The incidence of ASD in this sample of children and adolescents was 7.8% (n = 16). Clinicians should be aware of co-occurring ASD and GID and the challenges it generates in clinical management.

 

Autism Spectrum Disorders in Gender Dysphoric Children and Adolescents



MTF litteratur

He Said, She Said: Lessons, Stories, and Mistakes from My Transgender Journey

¨Today, Gigi Gorgeous is beloved for her critically-acclaimed documentary, her outrageous sense of humor, her no-holds-barred honesty, and her glam Hollywood lifestyle. Ten years ago, she was a gawky Canadian teen named Gregory. In He Said, She Said, Gigi brings us on her personal journey from Gregory to Gigi, going deeper than ever before and exposing her vulnerability behind each struggle and triumph, with her signature humor on every page.

With stunning photography and heirloom snapshots, He Said, She Said takes us back to Gigi’s early years as an Olympic-bound diver and high school mean girl, losing her mom at a tragically young age, and her journey of opening up about her sexuality and gender identity. She walks us through her transition, baring it all about dating and heartbreak in her stories of falling in love with both men and women.

Uproarious, unconventional, and unabashedly candid, Gigi shares never-before-heard stories, inspiration, and advice about how your life can take you to incredible places once you get real with yourself.

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Det sterke kjønn.

Marianne Nordli

Min kamp for å bli kvinne
Marianne Nordli

Sommeren 1981. Karl Ole vinner nordnorsk mesterskap i spyd og får sølv i kulestøt. En veltrent, maskulin gutt, men bare utenpå. I sitt hjerte er han ikke i tvil, han er kvinne og vil leve som kvinne. Det er nok nå.

I dag er Marianne suksessrik forretningskvinne, foredragsholder og på valg til Stortinget. I denne boken forteller hun om sin kamp for å få korrigert sitt kjønn og kunne leve som den kvinnen hun alltid har vært. Marianne deler også unike erfaringer om det å være kvinne i et mannsdominert yrkesliv.

Boken kan bestilles hos Juritzen her .

She’s Not There

She’s Not There is the story of a person changing genders, the story of a person bearing and finally revealing a complex secret; above all, it is a love story. By turns hilarious and deeply moving, Jennifer Finney Boylan explores the remarkable territory that lies between men and women, examines changing friendships, and rejoices in the redeeming power of family. She’s Not There is a portrait of a loving marriage—the love of James for his wife, Grace, and, against all odds, the enduring love of Grace for the woman who becomes her “sister,” Jenny.

To this extraordinary true story, Boylan brings the humorous, fresh voice that won her accolades as one of the best comic novelists of her generation. With her distinctive and winning perspective, She’s Not There explores the dramatic outward changes and unexpected results of life as a woman: Jenny fights the urge to eat salad, while James consumed plates of ribs; gone is the stability of “one damn mood, all the damn time.”

While Boylan’s own secret was unusual, to say the least, she captures the universal sense of feeling uncomfortable, out of sorts with the world, and misunderstood by her peers. Jenny is supported on her journey by her best friend, novelist Richard Russo, who goes from begging his friend to “Be a man” (in every sense of the word) to accepting her as an attractive, buoyant woman. “The most unexpected thing,” Russo writes in his Afterword to the book, “is in how Jenny’s story we recognize our shared humanity.”

As James evolves into Jennifer in scenes that are by turns tender, startling, and witty, a marvelously human perspective emerges on issues of love, sex, and the fascinating relationship between our physical and our intuitive selves. Through the clear eyes of a truly remarkable woman, She’s Not Thereprovides a new window on the often confounding process of accepting ourselves

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Sometimes it Hurts: A Transgender Woman's Journey

Allison Whitaker was born in the wrong body. Born into a life in a world that would never be right, it was never made for her. Growing up, she never knew how to confront the fact that she was transgender and buried all of her anxiety and depression deep within, focusing her energy into, and obsessing over hobbies to get her mind off of everything she hid from the world.

When finally confident to begin coming out of the closet as a gay male at age 20, she found no support for her «choice.» Rather than live with the burden of lack of support, she went back into the closet, living the next 12 years of her life closeted, seen by the world as a typical heterosexual male, again hiding her secret.
At age 32, living with worsening anxiety and depression, Allison was faced with the decision to either end it all rather than live in the wrong body or to finally come out to the world and be herself. Luckily, she chose the latter. Along the way she met new friends, has had many new experiences, including some negative ones that have included harassment, workplace discrimination, and sexual assault.
This book is a reflection of her two-year long journey of transitioning from male to female, the joys and pains, surviving, and coming out the other side whole and happy.
Read her first person account of her transition, through coming out at work and surgeries, ups and down, in a raw, honest account of her experience.

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The Other Woman

In 2007 life was humming along quite nicely. Happily married for 28 years to the love of my life, three gorgeous children and now living in idyllic surroundings, it was like a dream. That dream was soon to turn into a nightmare. When my husband took me for a walk along the beach one March afternoon I did not expect to come back facing a completely different life and wondering what on earth I was going to do next. Like all families we had our ups and downs but we always seemed to sort ourselves out. However, my husband’s revelation as we walked along the beach together was going to be a hard thing to work through. How do you hold it all together when you husband tells you that he has always wanted to live as a woman? With no experience and very little knowledge of what transgender meant I naïvely believed that it would be possible for me to support my husband and keep our family together. This is the story of the impact on all of us of Colin’s transition from male to female and the sometimes absurd happenings as I searched for new love and romance. Our story is one that hasn’t really been explored yet but it is worth learning about as the journey applies to many people out there who are stoic and determined, sometimes to their own detriment and that of their families, who are coming to terms with the loss of their partner, father, brother or son. If there are any lessons in these pages, they are that what any of us does has a direct impact on those who love us and as hard as it may be, there are times when it just can’t be about us; try to remember that those around you deserve your support too.

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Becoming Kimberly: A Transgender's Journey

Kimberly Davis knew who she was on the inside. Despite being born a male, she was very much a woman. Unfortunately, the realities of living in a rural, redneck area forced her to dress and act as a man. She spent sixty-three years living as one. It was only when her beloved wife passed away that Kimberly decided to complete her transition. She took her wife’s death as a sign that it was time to start finally living as herself.

This poignant memoir chronicles every step of her transition, from her first feelings of gender dysphoria to the surgery that completely changed her life.

Kimberly thought long and hard about her decision to have gender-reassignment surgery, and she candidly discusses the challenges the transition entails. While the obstacles often seemed enormous, Kimberly managed to find the hope and humor in each small moment. She details the tips her coworkers gave her as she completed her transition, from clothes to makeup to everything else. Kimberly had been a woman all her life, but through the surgery, her courage, and help from her friends, she was finally able to show the world what she had seen all along.

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Becoming Myself: The True Story of Thomas Who Became Sara

The courageous story of Sara-Jane and her triumphant journey to find her true self

A story of genuine victory despite the most incredible of odds

Born into a family of twelve children in Ballyfermot, Dublin, Thomas had a childhood full of bullying and humiliation. All the time Thomas was hiding a dark secret that was buried so deep, not even he understood it.

Desperate to fit in, he looked for answers in religion, work, even marriage. But through his struggle and despair he reached rock-bottom and eventually tried to take his own life.

With the help of good friends and much soul-searching, Thomas was able to have confirmed what he had somehow always known – that he had been born in the wrong body and that he was actually a woman. The medical diagnosis of gender identity disorder – a physical and neurological condition – has allowed Thomas to step out of the shadows and to face the world at last as Sara-Jane, the person he truly was all along.

Brave, humorous and powerful, Sara-Jane’s story is one of momentous personal change set against the backdrop of a changing Ireland, an Ireland now ready to embrace the growing visibility of LGBT voices in politics and preparing for the Marriage Equality Referendum in May 2015.

In sharing her powerful story of gender identity disorder with honesty, compassion and humour, Sara-Jane Cromwell is a living example of triumph over overwhelming odds, and of a rare courage which will give hope to many, and inspiration to all.

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Vi i Harry Benjamin ressurssenter jobber for personer som opplever kjønnsdyfori. Eller opplever det som veldig ofte blir omtalt på folkemunne et behov for å skifte kjønn, født i feil kropp. Noen bruker også transseksuelle, transkjønnet, trans, transperson. Dette er begreper vi ikke bruker. Disse begrepene oppleves som identitetskapende. På lik linje med andre som får en diagnose, så er ikke vi vår egen diagnose. Men vi har en diagnose.
Vi mener det er viktig at hver enkelt har en reel rett til egen definisjon. Derfor bruker vi i HBRS begreper som kjønnsdysfori, kjønnsinkongruens, kjønnsidentitetsutfordringer, kjønnsmangfold og div. andre begreper som sier hva det handler om, ikke hvem man er. Så er det opp til den enkelte hva som passer for de.


FTM litteratur

Manning Up: Transsexual Men on Finding Brotherhood, Family and Themselves

Twenty-seven men who transitioned from female to male discuss their roles as male community members: fathers, sons, brothers, husbands, boyfriends, friends, and mentors. Not since Max Wolf Valerio’s The Testosterone Files and Jamison Green’s Becoming a Visible Man has nonfiction seen such thorough and sensitive explorations of manhood, masculinity, and male embodiment—and never in a collection with such a diversity of voices. Contributors offer an incredible range of cultural, class, ethnic, spiritual, and generational backgrounds. Their work addresses topics including birthing and raising children, gay male sexuality, facing racism, and finding solace in deeply held religious beliefs. Contributors include established writers such as Valerio, Aaron Devor (author of FTM: Female-to-Male Transsexuals in Society), and Ryan Sallans (author of Second Son), as well as exciting new authors.

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Below the Belt: Genital Talk by Men of Trans Experience

Have you ever wondered what men think about their junk? Or what they feel and say about it? Raw and revealing, this collection brings together the voices of 25 men of trans experience who openly share intimate details of how gender transitioning has changed their genitalia, gender identity, and lives. These personal stories and essays take you on an odyssey of men’s innermost thoughts and feelings about erections, orgasms, penis pumping, genital reconstruction, pregnancy, menstruation, and more. Raw, frank, and sometimes funny, these cutting-edge testimonies redefine what it means to be a man in the 21st century.

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Hung Jury: Testimonies of Genital Surgery by Transsexual Men

This pioneering anthology released by Transgress Press is the first of its kind, presenting raw, unadulterated testimonies of transsexual men’s experiences of sex reassignment surgery. The collection offers a comprehensive understanding of why transsexual men choose genital surgery and its transformative impact on their lives. Hung Jury has widespread appeal, catching the attention and interests of a wide and diverse readership looking to understand transsexuality, sex, and gender identity. Because the book breaks new ground in LGBT, Gender, and feminist studies moreover, it is also an excellent read for courses taught in these academic fields.

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Body alchemy

Body Alchemy: Transsexual Portraits

Kvalitetsbilder og litt tekst som beskriver Cameron’s oppturer og nedturer når han endrer kjønn fra kvinne til mann. Boken dokumenterer også nøye andre menn med transseksualisme. Et eget kapittel dekker de mange muligheter som er tilgjengelige for å skape et mannlig kjønnsorgan. Ler mere om boken her .

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Both Sides Now: One Man's Journey Through Womanhood

Both Sides Now: One Man's Journey Through Womanhood

San Francisco attorney Khosla contends that there is a unique door to the unknown for each person. His quest for inner peace led to opening it up to a man trapped within a woman’s body. Khosla was living as a lesbian when an ex-girlfriend shared a 1994 New Yorker article on female-to-male (FTM) sex changes, and it helped Khosla to arrange the pieces of a personal puzzle through a series of gender-reassignment surgeries. After attending FTM support meetings and undergoing continuing therapy, Khosla informed two female supervisors, who proved supportive; her European parents, who were accepting; and an uncle and an aunt, who felt only so-so about it. Hormone therapy brought mood changes and irritability, but Khosla enjoyed short hair and being called «sir» by strangers. Eventually, there were a full hysterectomy and multiple further surgical and emotional changes before Khosla arrived as the man in the dust-jacket photograph. Keen observation, warmth, and humor make Khosla’s journey most readable. Whitney Scott

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Becoming alec

Becoming alec

Alec always thought she was a lesbian. She got thrown out of her house for it as a teenager, in fact. But when she moves to Chicago she begins a journey of self- discovery that leads to a place that she never imagined possible. She discovers that she isn’

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Her kan du finne mange flere bøker. Se her 

Vi i Harry Benjamin ressurssenter jobber for personer som opplever kjønnsdyfori. Eller opplever det som veldig ofte blir omtalt på folkemunne et behov for å skifte kjønn, født i feil kropp. Noen bruker også transseksuelle, transkjønnet, trans, transperson. Dette er begreper vi ikke bruker. Disse begrepene oppleves som identitetskapende. På lik linje med andre som får en diagnose, så er ikke vi vår egen diagnose. Men vi har en diagnose.
Vi mener det er viktig at hver enkelt har en reel rett til egen definisjon. Derfor bruker vi i HBRS begreper som kjønnsdysfori, kjønnsinkongruens, kjønnsidentitetsutfordringer, kjønnsmangfold og div. andre begreper som sier hva det handler om, ikke hvem man er. Så er det opp til den enkelte hva som passer for de.


Barn og ungdoms bøker

Prinsesse Ivar

Barn går ofte med vanskelige tanker inne i seg. Denne boka handler om å tørre å prøve ut slike tanker på veien til å finne ut hvem man er. Identitet handler om hvem vi forstår oss selv som, og om hvordan vi blir forstått av andre. I boka møter vi en gutt med et stort ønske. Hva vil skje hvis han prøver det ut? Målet med historien er at det skal skape mindre fordommer og mer toleranse i samfunnet vårt, at en skal kunne tørre å være den en er

Boken kan bestilles hos Haugenbok her .

Noa har en hemlighet

Barn går ofte med vanskelige tanker inne i seg. Denne boka handler om å tørre å prøve ut slike tanker på veien til å finne ut hvem man er. Identitet handler om hvem vi forstår oss selv som, og om hvordan vi blir forstått av andre. I boka møter vi en gutt med et stort ønske. Hva vil skje hvis han prøver det ut? Målet med historien er at det skal skape mindre fordommer og mer toleranse i samfunnet vårt, at en skal kunne tørre å være den en er

Boken kan bestilles hos Haugenbok her .

Vi skulle vært løver

En ny jente i klassen! Malin er spent. Kanskje er det en ny bestevenninne? Kanskje er hun en superjente som kan hamle opp med Sarah og de andre som bestemmer i klassen? Men da den nye jenta begynner, er hun svært sjenert. Malin forsøker å bli kjent med henne, men Leona er ikke enkel å komme inn på.Det viser seg at hun skjuler en hemmelighet, en hemmelighet som blir brutalt avslørt i gymgarderoben. Leona er født i feil kropp! Da får Malin får en ny utfordring: Er hun modig nok til å forsvare den som er utstøtt av alle de andre?

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Jeg er ikke

En jente opplever en nestenulykke i New York, og brått husker hun ikke hvem hun er, hvordan og hvorfor hun har havnet der. Det eneste sporet hun har, er et sett nøkler og et krøllete brev adressert til broren som hun finner i jakkelomma.

Og så treffer hun Sam som bare gjør forvirringen enda større: “Jeg, Samuel Burns, måtte på tro og ære love at jeg aldri, aldri skulle snakke om broren din, og dette løftet har jeg tenkt å holde.”

Hva er det som er så hemmelig at hun nesten tok livet av seg?

En innsiktsfull og intens historie om det å se, om kjønnsidentitet, sannhet og løgn.

Boken kan bestilles hos Gyldendal her .

Luna

Regan’s brother Liam can’t stand the person he is during the day. Like the moon from whom Liam has chosen his female name, his true self, Luna, only reveals herself at night. In the secrecy of his basement bedroom Liam transforms himself into the beautiful girl he longs to be, with help from his sister’s clothes and makeup. Now, everything is about to change: Luna is preparing to emerge from her cocoon. But are Liam’s family and friends ready to welcome Luna into their lives?

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Parrotfish

Parrotfish

When Angela cuts off her hair, changes her name to Grady, and begins to live as a boy, her family and friends have trouble accepting the change.

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Almost perfect

Almost perfect

A small-town Missouri boy’s world is rocked when he falls for the new girl at school, and she eventually confesses that she is a biological male. Logan’s world is small, as is his mind at first, but throughout the book he grows to accept and love Sage for who—not what—she is. This remarkable book takes a hard look at the difficulties and pain experienced by young male-to-female transsexuals from an easily relatable perspective, as Julie Ann Peters did in Luna (Little, Brown, 2004). Logan is a conservative 18-year-old Everyman whose generic voice isn’t—and doesn’t need to be—anything special; although readers follow his growth, it is Sage’s story that is truly important. A remarkably «clean» book dealing with sexuality and identity, this is neither preachy nor didactic while directly challenging prejudice and intolerance. With realistic characters and situations, it is a first purchase for all high school collections, and could easily be given to middle school readers who are undaunted by its length.—Rhona Campbell, Washington, DC Public Library

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Becoming alec

Becoming alec

Alec always thought she was a lesbian. She got thrown out of her house for it as a teenager, in fact. But when she moves to Chicago she begins a journey of self- discovery that leads to a place that she never imagined possible. She discovers that she isn’

Boken kan bestilles hos Amazon her .

Be who you are

Be who you are

Who You Are,» a children’s book starring a gender non-conforming child, Chicago writer Jennifer Carr tells the story of her family’s support for her son when he announced he feels like a girl inside.

Carr prefers the term «gender nonconforming» over «transgender» to avoid labeling Hope, whose feelings about gender could change going forward.

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My princess boy

My princess boy

Dyson loves the color pink and sparkly things. Sometimes he wears dresses, and sometimes he wears jeans. He likes to wear his princess tiara, even when climbing trees. He’s a Princess Boy, and his family loves him exactly the way he is.

Inspired by the author’s son—and by the author’s own initial struggles to understand his choices—this is a story about unconditional love and one remarkable family. It is also a call for tolerance and an end to bullying and judgments, and a loving reminder that the world is a brighter place when we accept people for who they are.

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10 000 dresses

10 000 dresses

Every night, Bailey dreams about magical dresses: dresses made of crystals and rainbows, dresses made of flowers, dresses made of windows. . . . Unfortunately, when Bailey’s awake, no one wants to hear about these beautiful dreams. Quite the contrary. «You’re a BOY!» Mother and Father tell Bailey. «You shouldn’t be thinking about dresses at all.» Then Bailey meets Laurel, an older girl who is touched and inspired by Bailey’s imagination and courage. In friendship, the two of them begin making dresses together. And Bailey’s dreams come true!

This gorgeous picture book—a modern fairy tale about becoming the person you feel you are inside—will delight people of all ages.

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If you belive in mermaids

If you belive in mermaids.... don´t tell

Some things you just can’t say, even to your parents. «Dad, did you ever want to be a mermaid?» Nope. Don’t say it. Not if you’re a boy. You gotta keep it inside. Maybe thirteen-year-old Todd Winslow is the best diver at summer camp. If only diving could save him. Underwater is a much kinder world, a secret mermaid world that no one else can know about – not Dad, and definitely not Brad, the camp’s numero uno bad boy. Todd tries to fit in, playing nice with flirty model-wannabe Sylvie and shunning nature-nerd Olivia – but you can only fool people for so long. Brad is watching every move, ready to expose all that’s different about Todd. Then there’s the doll thing. And Dad finds out. How will Todd survive now? PRAISE FOR IF YOU BELIEVE IN MERMAIDS.DON’T TELL «.A welcome and courageous book that speaks out for young people to be true to who they are.» -Alex Sanchez, author of Rainbow Boys and So Hard to Say «Finally-a kid-friendly middle-grade novel that disputes the myth that there is just one way of being a boy.» -Catherine Tuerk, M.A., R.N., C.S., Nurse Psychotherapist » … A refreshing look into the heart of a great kid who views the world through a slightly different lens.» -Kathleen Jeffrie Johnson, author of Target, The Parallel Universe of Liars, and Gone After winning the kindergarten jumping-rope contest, A. A. Philips grew up to become a writer, therapist, and teacher of literature with degrees from Middlebury, Harvard, and the University of

Southern Maine.

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Vi i Harry Benjamin ressurssenter jobber for personer som opplever kjønnsdyfori. Eller opplever det som veldig ofte blir omtalt på folkemunne et behov for å skifte kjønn, født i feil kropp. Noen bruker også transseksuelle, transkjønnet, trans, transperson. Dette er begreper vi ikke bruker. Disse begrepene oppleves som identitetskapende. På lik linje med andre som får en diagnose, så er ikke vi vår egen diagnose. Men vi har en diagnose.
Vi mener det er viktig at hver enkelt har en reel rett til egen definisjon. Derfor bruker vi i HBRS begreper som kjønnsdysfori, kjønnsinkongruens, kjønnsidentitetsutfordringer, kjønnsmangfold og div. andre begreper som sier hva det handler om, ikke hvem man er. Så er det opp til den enkelte hva som passer for de.