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Etiology of Gender Dysphoria

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Gender Confirmation Surgery

Abstract

Several theories of the etiology of gender incongruity have been proposed to explain the origins of the condition. Historically, individuals who were uncomfortable in their birth-assigned sex were thought to suffer from severe psychopathology. As technology advanced and more individuals sought treatment, biological theories emerged and replaced psychoanalytic theories. It became evident that although people may experience distress with their birth-assigned sex, this was not, in and of itself, a pathological disorder. An assemblage of research emerged supporting a biological basis for the condition. Researchers have found evidence of several areas in the brain that differ in transgender and non-transgender individuals. Twin and familial studies suggest a genetic component, and some researchers have explored specific genes of the androgen and estrogen receptors. Early hormonal influences on the brain appear to account for different brain phenotypes and may ultimately provide answers to the origins of gender incongruence.

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References

  1. Eliot A. Myths. London: McGraw Hill; 1976.

    Google Scholar 

  2. Taylor T. The prehistory of sex: four million years of human sexual culture. New York: Bantam; 1996.

    Google Scholar 

  3. Pauly IB. Terminology and classification of gender identity disorders. In: Bockting WO, Coleman E, editors. Gender dysphoria: interdisciplinary approaches in clinical management. New York: Haworth; 1992. p. 1–11.

    Google Scholar 

  4. Ettner R. Gender loving care. New York: WWW Norton; 1999.

    Google Scholar 

  5. Schaefer L, Wheeler CC. Tribute to Harry Benjamin, 1885–1986. Paper presented at the tenth international symposium on gender dysphoria. Amsterdam: Harry Benjamin International Gender Dysphoria Association; 1987.

    Google Scholar 

  6. Belli M. Transsexual surgery: a new tort? J Am Med As. 1978;239(20):2143–8.

    CAS  Google Scholar 

  7. Shtasel TF. Behavioral treatment of transsexualism: a case report. J Sex Marital Ther. 1979;5(4):362–7.

    CAS  PubMed  Google Scholar 

  8. Lundberg PO, Sjovall A, Walinder J. Sella turcica in male-to-female transsexuals. Arch Sex Beh. 1975;4(6):657–62.

    CAS  Google Scholar 

  9. Gooren L. The neuroendocrine response of luteinizing hormone to estrogen administration in heterosexual, homosexual, and transsexual subjects. J Clin Endocr Metab. 1986;63(3):583–8.

    CAS  PubMed  Google Scholar 

  10. Kula K, Dulko S, Pawlikowski M, et al. A nonspecific disturbance of the gonadostat in women with transsexualism and isolated hypergonadotropism in the male-to-female disturbance of gender identity. Exp Clin Endocrinol. 1986;87(1):8–14.

    CAS  PubMed  Google Scholar 

  11. Eicher W, Spoljar M, Murken JD, Richter K, Cleve H, Stengel-Rutkowski S, Steindel E. Transsexuality and X-Y antigen. Geburtshilfe Frauenheilkd. 1980;40(6):529–40.

    CAS  PubMed  Google Scholar 

  12. Spoljar M, Eicher W, Eiermann W, Cleve H. H-Y antigen expression in different tissues from transsexuals. Hum Genet. 1981;57(1):52–7.

    CAS  PubMed  Google Scholar 

  13. Eicher W, Spoljar M, Murken JD, Richter K, Cleve H, Stengel-Rutkowski S. Transsexualism and the X-Y antigen. Fortschr Med. 1981;99(1–2):9–12.

    CAS  PubMed  Google Scholar 

  14. Engel W, Pfafflin F, Wiedeking C. H-Y antigen in transsexuality, and how to explain testis differentiation in H-Y antigen positive males and ovary differentiation in H-Y antigen positive females. Hum Genet. 1980;55(30):315–9.

    CAS  PubMed  Google Scholar 

  15. Gooren L. The endocrinology of transsexualism: a review and commentary. Psychoneuroendocrino. 1990;15(1):3–14.

    CAS  Google Scholar 

  16. Greenberg RP, Laurence L. A comparison of the MMPI results for psychiatric patients and male applicants for transsexual surgery. J Nerv Ment Dis. 1981;169(5):320–3.

    CAS  PubMed  Google Scholar 

  17. Tsushima WT, Wedding D. MMPI results of male candidates for transsexual surgery. J Pers Assess. 1979;43(4):385–7.

    CAS  PubMed  Google Scholar 

  18. Leavitt F, Berger JC, Hoeppner JA, Northrop G. Presurgical adjustment in male transsexuals with and without hormonal treatment. J Nerv Ment Dis. 1980;168(11):693–7.

    CAS  PubMed  Google Scholar 

  19. Cole CM, O’Boyle M, Emory LE, Meyer WJ. Comorbidity of gender dysphoria and other major psychiatric diagnoses. Arch Sex Beh. 1997;26(1):13–26.

    CAS  Google Scholar 

  20. Buhrich N, McConaghy N. Parental relationships during childhood in homosexuality, transvestism, and transsexualism. Aust N Z J Psychiatry. 1978;12(2):103–8.

    CAS  PubMed  Google Scholar 

  21. Dorner G, Poppe I, Stahl F, et al. Gene and environment-dependent neuroendocrine etiogenesis of homosexuality and transsexualism. Exp Clin Endocrinol. 1991;98(2):141–50.

    CAS  PubMed  Google Scholar 

  22. Elias AN, Valenta LJ. Are all males equal? Anatomic and functional basis for sexual orientation in males. Med Hypotheses. 1992;39(1):39–45.

    Google Scholar 

  23. Giordano G, Giusti M. Hormones and psychosocial differentiation. Minerva Endocrinol. 1995;20(3):165–93.

    CAS  PubMed  Google Scholar 

  24. Coleman E, Gooren L, Ross M. Theories of gender transpositions: a critique and suggestions for further research. J Sex Res. 1989;26(4):525–38.

    Google Scholar 

  25. Butler J. Gender trouble: feminism and the subversion of identity. New York: Routledge; 1990.

    Google Scholar 

  26. Angier, N. Size of region of brain may hold crucial clue to transsexuality, a study finds The New York Times November 2; 1995

    Google Scholar 

  27. Krujiver FPM, Zhou J, Pool CW, et al. Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocr Met. 2000;85:2034–41.

    Google Scholar 

  28. Chung W, De Vries G, Swaab D. Sexual differentiation of the bed nucleus of the stria terminalis in humans may extend into adulthood. J Neurosci. 2002;22(3):1027–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Garcia-Falgueras A, Swaab DF, et al. Brain. 2008;131:3132–46.

    Google Scholar 

  30. Taziaux M, Swaab DF, Bakker J. Sex differences in the neurokin B system in the human infundibular nucleus. J Clin Endocrin Metab. 2012;97(12):E2010–20.

    Google Scholar 

  31. Dessens AB, Cohen-Kettenis PT, Mellenbergh GJ, et al. Prenatal exposure to anticonvulsants and psychosexual development. Arch Sex Beh. 1999;28:31–44.

    CAS  Google Scholar 

  32. Swaab DF. Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Gynecol Endocrinol. 2004;19:301–12.

    CAS  PubMed  Google Scholar 

  33. Colborn T, Dumanoski D, Myers JP. Our stolen future. New York: Penguin Books; 1996.

    Google Scholar 

  34. Langston N. Toxic bodies: hormone disruptors and the legacy of DES. London: Yale Unviersity Press; 2010.

    Google Scholar 

  35. Kerlin, SP. The presence of gender dysphoria, transsexualism, and disorders of sex differentiation in males prenatally exposed to diethylstilbestrol: initial evidence from a 5-year study: DES Sons International network; 2004. TransAdvocate.org

  36. Phelps VR. Relative index finger length as a sex-influenced train in man. Am J Hum Gen. 1952;4:72–89.

    CAS  Google Scholar 

  37. Garn SM, Burdi AR, Babler WJ, et al. Early prenatal attainment of adult metacarpal-phalangeal rankings and proportions. Am J Phys Anthro. 1975;43:327–32.

    CAS  Google Scholar 

  38. Manning JT, Fink B, Neave N, et al. The ratio of 2nd to 4th digit length, a predictor of sperm numbers and concentrations of testosterone, luteinizing hormone and oestrogen. Hum Reprod. 1998;13:3000–4.

    CAS  PubMed  Google Scholar 

  39. Galis F, Ten Broek C, Van Dongen S, et al. Sexual dimorphism in the prenatal digit ratio (2D:4D). Arch Sex Beh. 2010;39(1):57–62.

    Google Scholar 

  40. Schneider HJ, Pickel J, Stalla GK. Typical female 2nd–4th finger length (2D:4D) ratios in male-to-female transsexuals-possible implications for prenatal androgen exposure. Psychoneuroendocrinol. 2006;31(2):265–9.

    CAS  Google Scholar 

  41. Green R. Family co-occurrence of “gender dysphoria”: ten siblings or parent-child pairs. Arch Sex Beh. 2000;29(5):499–507.

    CAS  Google Scholar 

  42. Gomez-Gil E, Esteva I, Almaraz MC, et al. Familiality of gender identity disorder in non-twin siblings. Arch Sex Beh. 2010;39(2):265–9.

    Google Scholar 

  43. Diamond M. Transsexuality among twins: identity concordance, transition, rearing, and orientation. Int J Trans. 2013;14:24–8.

    Google Scholar 

  44. Henningsson S, Westberg L, Nilsson S, et al. Sex steroid-related genes and male-to-female transsexualism. Psychoneuroendocrino. 2005;30(7):657–64.

    CAS  Google Scholar 

  45. Bentz EK, Hefler LA, Kaufman U, et al. 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. 2008;90(1):56–9.

    CAS  PubMed  Google Scholar 

  46. Hare L, Bernard P, Sanchez FJ, et al. Androgen receptor length polymorphism associated with male-to-female transsexualism. Biol Psychiatry. 2009;65:93–6.

    CAS  PubMed  Google Scholar 

  47. Fernandez R, Esteva I, Gomez-Gil E, Rumbo T, Almaraz MC, Roda E, Haro-Mora JJ, Guillamon A, Pasaro E. Association study of ERb, AR, and CYP19A1 genes and MtF transsexualism. J Sex Med. 2014a;11:2986–94.

    CAS  PubMed  Google Scholar 

  48. Fernandez R, Esteva I, Gomez-Gil E, Rumbo T, Almaraz MC, Roda E, Haro-Mora JJ, Guillamon A, Pasaro E. The (CA) in polymorphism of ERb gene is associated with FtM transsexualism. J Sex Med. 2014b;11:720–8.

    CAS  PubMed  Google Scholar 

  49. Luders E, Narr KL, Thompson PM, Rex DE, Woods RP, Deluca H, Toga AW. Gender effects on cortical thickness and the influence of scaling. Human Beh Mapping. 2006;27:314–32.

    CAS  Google Scholar 

  50. Shaw P, Kabani NJ, Lerch JP, Eckstrand K, Lenroot R, Gogtay N, Greenstein D, Clasen L, Evans A, Rapoport JL, Giedd JN, Wise SP. Neurodevelopmental trajectories of the human cerebral cortex. J Neurosci. 2008;28:3586–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  51. Zubiaurre-Elorza L, Junque C, Gomez-Gil E, Segovia S, Carrillo B, Rametti G, Guillamon A. Cortical thickness in untreated transsexuals. Cereb Cortex. 2013;23:2855–62.

    PubMed  Google Scholar 

  52. Savic I, Arver S. Sex dimorphism of the brain in male-to-female transsexuals. Cereb Cortex. 2011;23:2855–62.

    Google Scholar 

  53. Rametti G, Carrillo B, Gomez-Gil E, Junque C, Segovia S, Gomez A, Guillamon A. White matter microstructure in female to male transsexuals before cross-sex hormonal treatment: a diffusion tensor imaging study. J Psychiatr Res. 2011a;45:199–204.

    PubMed  Google Scholar 

  54. Rametti G, Carrillo B, Gomez-Gil E, Junque C, Zubiarre-Elorza L, Segovia S, Guillamon A. The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment: a DTI study. J Psychiatr Res. 2011b;45:949–54.

    PubMed  Google Scholar 

  55. Longo MR, Azanon E, Haggard P. More than skin deep: body representation beyond primary somatosensory cortex. Neuropsyhologia. 2010;48:655–68.

    Google Scholar 

  56. Hulshoff Pol HE, Cohen-Kettenis P, Van Haren N, et al. Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure. Eur J Endocrinol. 2006;155:S107–11.

    Google Scholar 

  57. Zubiaurre-Elorza L, Junque C, Gomez-Gil E, Guillamon A. Effects of cross-sex hormone treatment on cortical thickness in transsexual individuals. J Sex Med. 2014;11:1248–61.

    CAS  PubMed  Google Scholar 

  58. Rametti G, Carrillo B, Gomez-Gil E, Junque C, Zubiarre-Elorza L, Segovia S, Guillamon A. Effects of androgenization on the white matter microstructure of female-to-male transsexuals: a diffusion tensor imaging study. Psychoneuroendocrinology. 2012;37:1261–9.

    CAS  PubMed  Google Scholar 

  59. Guillamon, A., Junque, C. & Gomez-Gil, E., (2015). A review on the status of brain structure research in transsexualism, submitted.

    Google Scholar 

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Authors and Affiliations

  1. Clinical and Forensic Psychologist, Evanston, IL, USA

    Randi Ettner

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  1. Randi Ettner
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Editors and Affiliations

  1. Department of Plastic Surgery, The Center for Gender Confirmation Surgery Weiss Memorial Hospital, Chicago, IL, USA

    Loren S. Schechter

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Ettner, R. (2020). Etiology of Gender Dysphoria. In: Schechter, L. (eds) Gender Confirmation Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-29093-1_2

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  • DOI: https://doi.org/10.1007/978-3-030-29093-1_2

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-29092-4

  • Online ISBN: 978-3-030-29093-1

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