Age of Onset and Sexual Orientation in Transsexual Males and Females

Department of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Journal of Sexual Medicine (Impact Factor: 3.15). 12/2010; 8(3):783-91. DOI: 10.1111/j.1743-6109.2010.02142.x
Source: PubMed


With regard to transsexual developments, onset age (OA) appears to be the starting point of different psychosexual pathways.
To explore differences between transsexual adults with an early vs. late OA.
Data were collected within the European Network for the Investigation of Gender Incongruence using the Dutch Biographic Questionnaire on Transsexualism (Biografische Vragenlijst voor Transseksuelen) and a self-constructed score sheet according to the DSM-IV-TR (Diagnostic and Statistical Manual, Fourth Edition, Text Revision) criteria of Gender Identity Disorder (GID) and Gender Identity Disorder in Childhood (GIDC). One hundred seventy participants were included in the analyses.
Transsexual adults who, in addition to their GID diagnosis, also fulfilled criteria A and B of GIDC ("a strong cross-gender identification,"persistent discomfort about her or his assigned sex") retrospectively were considered as having an early onset (EO). Those who fulfilled neither criteria A nor B of GIDC were considered as having a late onset (LO). Participants who only fulfilled criterion A or B of GIDC were considered a residual (RES) group.
The majority of female to males (FtMs) appeared to have an early OA (EO = 60 [77.9%] compared to LO = 10 [13%] and to RES = 7 [9.1%]). Within male to females (MtFs), percentages of EO and LO developments were more similar (EO = 36 [38.7%], LO = 45 [48.4%], RES = 12 [12.9%]). FtMs presented to gender clinics at an earlier age than MtFs (28.04 to 36.75). The number of EO vs. LO transsexual adults differed from country to country (Belgium, Germany, the Netherlands, Norway).
OA has a discriminative value for transsexual developments and it would appear that retrospective diagnosis of GIDC criteria is a valid method of assessment. Differences in OA and sex ratio exist between European countries.

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Available from: Timo O. Nieder, Feb 28, 2015
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    • "If both DSM-IV-TR core criteria of GID in childhood were fulfilled, individuals were categorized as EO (pre-pubertal ''strong cross-gender identification'' and ''persistent discomfort about one's assigned sex''). In case of (post-) pubertal onset of the GID (neither''strong cross-gender identification''nor''persistent discomfort about one's assigned sex'' before puberty were reported), individuals were classified as LO (Nieder et al., 2011). Individuals who fulfilled only one of the criteria in childhood were categorized in the residual group. "
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    ABSTRACT: Gender dysphoria (GD) is often accompanied by dissatisfaction with physical appearance and body image problems. The aim of this study was to compare body satisfaction with perceived appearance by others in various GD subgroups. Data collection was part of the European Network for the Investigation of Gender Incongruence. Between 2007 and 2012, 660 adults who fulfilled the criteria of the DSM-IV gender identity disorder diagnosis (1.31:1 male-to-female [MtF]:female-to-male [FtM] ratio) were included into the study. Data were collected before the start of clinical gender-confirming interventions. Sexual orientation was measured via a semi-structured interview whereas onset age was based on clinician report. Body satisfaction was assessed using the Body Image Scale. Congruence of appearance with the experienced gender was measured by means of a clinician rating. Overall, FtMs had a more positive body image than MtFs. Besides genital dissatisfaction, problem areas for MtFs included posture, face, and hair, whereas FtMs were mainly dissatisfied with hip and chest regions. Clinicians evaluated the physical appearance to be more congruent with the experienced gender in FtMs than in MtFs. Within the MtF group, those with early onset GD and an androphilic sexual orientation had appearances more in line with their gender identity. In conclusion, body image problems in GD go beyond sex characteristics only. An incongruent physical appearance may result in more difficult psychological adaptation and in more exposure to discrimination and stigmatization.
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    • "Blanchard (1994) found in a sample of non-homosexual natal males that the stronger the early cross-gender feelings were, the sooner the patient was likely to present for clinical attention, although early crossgender identity did not influence the probability of marrying or fathering children. Nieder et al. (2011) found that far more FtMs than MtFs appeared to have experienced an early onset transsexual development and that FtMs were at a younger age at clinical presentation than MtFs. In FtMs, early onset was largely overlapping with a sexual attraction towards females whereas early onset did not overlap with sexual attraction towards males to the same extent in MtFs. "
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    • "Due to the wide range of ages at which MtFs first apply for treatment, the role played by age differences especially in MtF adults is potentially significant, also in terms of body image. Whereas EO and LO developments in FtMs do not differ significantly with regard to age at clinical presentation, EO-MtFs first present at clinics at a significantly younger age than LO- MtFs (De Cuypere et al., 2005; Johansson, Sundbom, Hojerback, & Bodlund, 2010; Nieder et al., 2011). Despite finding no differences for SO subgroups with regard to body dissatisfaction , Smith, van Goozen, Kuiper, and Cohen-Kettenis (2005b) concluded that homosexual and nonhomosexual transsexuals were different subtypes with distinct characteristics. "
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    ABSTRACT: The alteration of sex-specific body features and the establishment of a satisfactory body image are known to be particularly relevant for individuals with Gender Dysphoria (GD). The aim of the study was to first develop new scales and examine the psychometric properties of the Hamburg Body Drawing Scale (Appelt & Strauß 1988). For the second part of this study, the satisfaction with different body features in young GD adults before cross-sex treatment were compared to female and male controls. Data collection took place within the context of the European Network for the Investigation of Gender Incongruence (ENIGI) including 135 female-to-male (FtMs) and 115 male-to-female (MtFs) young GD adults and 235 female and 379 male age-adjusted controls. The five female and six male body feature subscales revealed good internal consistency. The ENIGI sample reported less satisfaction with overall appearance (d = 0.30) and with all of their body features than controls, but no subgroup differences for sexual orientation (FtM and MtF) and Age of Onset (FtM) were found. Body dissatisfaction was higher with regard to sex-specific body features (largest effect sizes of d = 3.21 for Genitalia in FtMs and d = 2.85 for Androgen-responsive features and genitalia in MtFs) than with those that appeared less related to the natal sex (d = 0.64 for Facial features in FtMs and d = 0.59 for Body shape in MtFs). Not only medical body modifying interventions, but also psychosocial guidance with regard to body image might be helpful for GD individuals before transitioning.
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