Advertisement

Transsexualism (“Gender Identity Disorder”) – A CNS-Limited Form of Intersexuality?

  • Heino F.L. Meyer-BahlburgEmail author
Conference paper
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 707)

Abstract

In terms of their gender-related behavior, persons with (non-intersex) gender identity disorder (GID; aka transsexualism) of early onset resemble patients with somatic intersexuality who request a change of gender. However, there is currently no known intersex analog for GID of late onset. Neuroanatomy studies of somatic intersex are too few for providing any guidance on what brain effects to expect in a putative CNS-limited form of intersexuality as the basis for (non-intersex) GID. Findings in GID patients of atypical androgen levels apply only to about one-third of female-to-male transsexuals and not at all to male-to-female transsexuals. Sex steroid-related findings of genetic polymorphisms are weak, inconsistent, and largely unreplicated. Neuroanatomic findings are few and also largely unreplicated; distributions for patients with GID overlap with those of controls and are therefore of questionable utility for GID diagnosis. Given the complexity of gendered behavior and identity, the neuroanatomic basis of GID is likely to be neural networks rather than individual brain nuclei or regions. Findings on neurofunction in persons with GID are few and unreplicated. In summary, the emerging data are interesting, but at this time insufficient to constitute a firm basis for the recategorization of GID as a form of CNS-limited intersexuality.

Keywords

Gender Behavior Gender Identity Disorder Prenatal Androgen Body Integrity Identity Disorder Erotic Film 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

This work was supported, in part, by NIMH grant P30-MH-43530 (P.I.: Anke A. Ehrhardt, Ph.D.).

References

  1. 1.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th edn., text revision). Author: Washington, DCGoogle Scholar
  2. 2.
    Arnold AP (2009) The organizational-activational hypothesis as the foundation for a unified theory of sexual differentiation of all mammalian tissues. Horm Behav 55(5):570–578PubMedCrossRefGoogle Scholar
  3. 3.
    Bentz E-K, Schneeberger C, Hefler LA et al (2007) A common polymorphism of the SRD5A2 gene and transsexualism. Reprod Sci 14(7):705–709PubMedCrossRefGoogle Scholar
  4. 4.
    Bentz E-K, Hefler LA, Kaufmann U et al (2008) A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism. Fertil Steril 90:56–59PubMedCrossRefGoogle Scholar
  5. 5.
    Berglund H, Lindström P, Dhejne-Helmy C et al (2008) Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. Cereb Cortex 18:1900–1908PubMedCrossRefGoogle Scholar
  6. 6.
    Blanchard R (2008) The concept of autogynephilia and the typology of male gender dysphoria. J Nerv Ment Dis 177(10):616–623Google Scholar
  7. 7.
    Bosinski HA, Peter M, Bonatz G et al (1997) A higher rate of hyperandrogenic disorders in female-to-male transsexuals. Psychoneuroendocrinology 22:361–380PubMedCrossRefGoogle Scholar
  8. 8.
    Ciumas C, Lindén Hirschberg A, Savic I (2009) High fetal testosterone and sexually dimorphic cerebral networks in females. Cereb Cortex 19(5):1167–1174PubMedCrossRefGoogle Scholar
  9. 9.
    Cosgrove KP, Mazure CM, Staley JK (2007) Evolving knowledge of sex differences in brain structure, function, and chemistry. Biol Psychiatry 62:847–855PubMedCrossRefGoogle Scholar
  10. 10.
    Dewing P, Shi T, Horvath S et al (2003) Sexually dimorphic gene expression in mouse brain precedes gonadal differentiation. Brain Res Mol Brain Res 118(1-2):82–90PubMedCrossRefGoogle Scholar
  11. 11.
    First MB (2005) Desire for amputation of a limb: Paraphilia, psychosis, or a new type of identity disorder. Psychol Med 35:919–928PubMedCrossRefGoogle Scholar
  12. 12.
    Garcia-Falgueras A, Swaab DF (2008) A sex difference in the hypothalamic uncinate nucleus: Relationship to gender identity. Brain 131:3132–3146PubMedCrossRefGoogle Scholar
  13. 13.
    Gizewski ER, Krause E, Schlamann M et al (2009) Specific cerebral activation due to visual erotic stimuli in male-to-female transsexuals compared with male and female controls: An fMRI study. J Sex Med 6:440–448PubMedCrossRefGoogle Scholar
  14. 14.
    Grumbach MM, Hughes IA, Conte FA (2003) Disorders of sex differentiation. In: Larson PR, Kronenberg HM, Melmed S, Polonsky KS (eds) Williams Textbook of Endocrinology, 10th edn (pp 842–1002). Philadelphia: W.B. SaundersGoogle Scholar
  15. 15.
    Hare L, Bernard P, Sánchez FJ et al (2009) Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biol Psychiatry 65:93–96PubMedCrossRefGoogle Scholar
  16. 16.
    Hembree WC, Cohen-Kettenis P, Delemarre-van de Waal HA et al (2009) Endocrine treatment of transsexual persons: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 94(9):3132–3154PubMedCrossRefGoogle Scholar
  17. 17.
    Henningsson S, Westberg L, Nilsson S et al (2005) Sex steroid-related genes and male-to-female transsexualism. Psychoneuroendocrinology 30:657–664PubMedCrossRefGoogle Scholar
  18. 18.
    Hughes IA, Houk C, Ahmed SF et al (2006) Consensus statement on management of intersex disorders. Arch Dis Child 91(7):554–563PubMedCrossRefGoogle Scholar
  19. 19.
    Kruijver FP, Zhou J, Pool C et al (2000). Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocrinol Metab 85:2034–2041PubMedCrossRefGoogle Scholar
  20. 20.
    Lawrence AA (2009) Erotic target location errors: an underappreciated paraphilic dimension. J Sex Res 46:194–215PubMedCrossRefGoogle Scholar
  21. 21.
    Luders E, Sánchez FJ, Gaser C et al (2009) Regional gray matter variation in male-to-female transsexualism. Neuroimage 46:904–907PubMedCrossRefGoogle Scholar
  22. 22.
    Maheu FS, Merke DP, Schroth EA et al (2008) Steroid abnormalities and the developing brain: declarative memory for emotionally arousing and neutral material in children with congenital adrenal hyperplasia. Psychoneuroendocrinology 33(2):238–245PubMedCrossRefGoogle Scholar
  23. 23.
    Martin CL, Ruble DN (2010) Patterns of gender development. Annu Rev Psychol 61:353–381PubMedCrossRefGoogle Scholar
  24. 24.
    Merke DP, Fields JD, Keil MF et al (2003) Children with classic congenital adrenal hyperplasia have decreased amygdala volume: potential prenatal and postnatal hormonal effects. J Clin Endocrinol Metab 88(4):1760–1765PubMedCrossRefGoogle Scholar
  25. 25.
    Meyer-Bahlburg HFL, Dolezal C, Baker SW et al (2004) Prenatal androgenization affects gender-related behavior but not gender identity in 5-12 year old girls with congenital adrenal hyperplasia. Arch Sex Behav 33:97–104PubMedCrossRefGoogle Scholar
  26. 26.
    Meyer-Bahlburg HFL, Dolezal C, Baker SW et al (2006) Gender development in women with congenital adrenal hyperplasia as a function of disorder severity. Arch Sex Behav 35:667–684PubMedCrossRefGoogle Scholar
  27. 27.
    Meyer-Bahlburg HFL, Dolezal C, Baker SW et al (2008) Sexual orientation in women with classical or non-classical congenital adrenal hyperplasia as a function of degree of prenatal androgen excess. Arch Sex Behav 37:85–99PubMedCrossRefGoogle Scholar
  28. 28.
    Meyer-Bahlburg HF (2010) From mental disorder to iatrogenic hypogonadism: dilemmas in conceptualizing gender identity variants as psychiatric conditions. Arch Sex Behav 39(2):461–476PubMedCrossRefGoogle Scholar
  29. 29.
    Mueller A, Gooren LJ, Naton-Schötz S et al (2008) Prevalence of polycystic ovary syndrome and hyperandrogenemia in female-to-male transsexuals. J Clin Endocrinol Metab 93(4):1408–1411PubMedCrossRefGoogle Scholar
  30. 30.
    Pilgrim C, Reisert I (1992) Differences between male and female brains–developmental mechanisms and implications. Horm Metab Res 24(8):353–359PubMedCrossRefGoogle Scholar
  31. 31.
    Ruble DN, Martin CL, Berenbaum SA (2006) Gender development. In: Damon W, Lerner RM (series eds), and Eisenberg N, Damon W, Lerner RM (vol eds), Handbook of child psychology: Vol. 3. Social, emotional, and personality development (6th edn, pp 858–932). New York: WileyGoogle Scholar
  32. 32.
    Schöning S, Engelien A, Bauer C et al (2010) Neuroimaging differences in spatial cognition between men and male-to-female transsexuals before and during hormone therapy. J Sex Med 7(5):1858–1867Google Scholar
  33. 33.
    Ujike H, Otani K, Nakatsuka M et al (2009) Association study of gender identity disorder and sex hormone-related genes. Prog Neuropsychopharmacol Biol Psychiatry 33(7):1241–1244PubMedCrossRefGoogle Scholar
  34. 34.
    Vance SR Jr, Cohen-Kettenis PT, Drescher J et al (2010) Opinions about the DSM gender identity disorder diagnosis: results from an international survey administered to organizations concerned with the welfare of transgender people. Int J Transgenderism 12(1):1–14Google Scholar
  35. 35.
    Wallen K, Hassett JM (2009) Sexual differentiation of behaviour in monkeys: role of prenatal hormones. J Neuroendocrinol 21(4):421–426PubMedCrossRefGoogle Scholar
  36. 36.
    Yang X, Schadt EE, Wang S et al (2006) Tissue-specific expression and regulation of sexually dimorphic genes in mice. Genome Res 16(8):995–1004PubMedCrossRefGoogle Scholar
  37. 37.
    Zhou J-N, Hofman MA, Gooren LJG et al (1995) A sex difference in the human brain and its relation to transsexuality. Nature 378:68–70PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.NYS Psychiatric Institute/Department of PsychiatryColumbia UniversityNew YorkUSA

Personalised recommendations