Back to Journal

Journal of Sexual Medicine and Reproductive Health

Rapid-Onset Gender Dysphoria - A Topic for Debate

Abstract Citation Editorial References
Details

Received: 02-Jun-2019

Accepted: 03-Jun-2019

Published: 04-Jun-2019

María Fernández Rodríguez¹*, Guerra-Mora P², and Martínez-Menéndez N³

¹Mental Health Center “La Magdalena”, University Hospital San Agustín, Spain

²Clinical Psychologist, HUSA

³Psychologist Internal Resident (HUSA, Avilés)

Corresponding Author:

María Fernández Rodríguez, Mental Health Center “La Magdalena”, University Hospital San Agustín, Valdés Salas, 4, 33400 Avilés, Asturias, Spain, Email: maria.fernandezr@sespa.es

Abstract

Several publications from specialized units report changes in the demands of children with gender dysphoria.

Citation

Haider MN, O’Donnell K, Bezherano I, Horvath PJ, Leddy JJ,et al. (2019) Retired Professional Contact Sport Athletes are more sedentary and consume fewer brain healthy nutrients than Non-contact Sport Controls. J Sexual Med Reprod Health 2: 2.

Editorial

Several publications from specialized units report changes in the demands of children with gender dysphoria. There is an increase of requests for help from minors [1-7], as well as a change in the ratio [5,6,8]. At the beginning, in 2007, the Gender Identity Treatment Unit of Asturias (UTIGPA) received few requests from children. At that time users were older. Many of them claimed to have felt gender dysphoria since an early age. Nowadays, the demands of children have multiplied. An extensive investigation is being carried out in the unit of Asturias to find out the characteristics of the children’s demands.

Some authors [9,10] point out the emergence of the phenomenon called Rapid-Onset Gender Dysphoria (ROGD). In UTIGPA some users refer their gender dysphoria starting suddenly in adolescence. They claim no experience of gender dysphoria during childhood and their families claim not to have noticed anything in regard either. This sudden onset of gender dysphoria contrasts with the backgrounds of other users who refer life stories marked by gender dysphoria: most of them had always noticed gender dysphoria. Some new users refer to the beginning of the feeling of confusion when they became teenagers. Getting in contact with other people’s experiences, through social media or real life, they came to understand the discomfort they suffered as related with their experience of gender.

Kaltiala-Heino et al.[11], research at Tampere University Hospital with a group of adolescents with gender dysphoria with no gender nonconformity during childhood. They describe teenagers suffering from depression and anxiety, who may exhibit self-injurious, isolated behaviors and experiences of bullying (preceding dysphoria). The authors consider teenagers expect gender transition would solve problems from academic, occupational, social and personal spheres.

Marchiano points out two main factors on the phenomenon of rapid-onset gender dysphoria: an increase in the use of social networks and internet, and getting in relationship with peers identified as transgender. This author highlights the influence of “social contagion”, although she considers the etiology of gender dysphoria related to biological, social and psychological factors. She fears young people could identify themselves as trans as a way to channel feelings of discomfort with their bodies or to look for a solution for their social, academic or mental health problems. The author also fears homosexual people could identify themselves as trans due to family and social pressures and thus initiate a gender transition. To learn more about ROGD phenomenon Littman [10] conducts an internet survey for parents describing these particular adolescents with gender dysphoria as different from others described as transgender. Yet activists and authors criticized Littman analysis. Restar [12] exposes methodological limitations in the survey and she raises the need for research methodologies based on the life experience of the transgender population. In fact, Littman has recently published an article [13] recognizing failures and declaring ROGD as a non validated clinical phenomenon [14].

The seventh version of the Standards of Care [15] refers differences between children and teenagers with gender dysphoria. The 7th versión quotes several studies [16,17] noticing adolescents and adults with gender dysphoria with no childhood gender nonconformity. As well, the DSM-5 [18] considers the late-onset gender dysphoria when person do not remember any similar desire in childhood or did not tell it to anyone. Nowadays, for the WPATH [19] the knowledge of the factors that contribute to the development of gender identity in adolescence is still evolving and it is not yet fully understood. Therefore, they consider inappropiate and premature using labels (as the ROGD) that can lead to absolute conclusions about the development of gender identity.

Acording to Serano [20] prejudicies towards transgender people may be connected to ROGD phenomenon. When a daughter or a son define her or himself as trans, the family could go through an initial period of blockage and consider dysphoria as a temporary phenomenon, related to peers pressure. In Littman survey parents inform about difficulties on adaptation and parent-child relationship more than about teenager identity. It is suggested assessing this phenomenon in relation to family dynamics [20].

Although each user faces her or his own needs, desires and obstacles, we observe similar goals and challenges on people with gender dysphoria now and before: acceptance and understanding or struggle against stigma and discrimination... Nowadays LGTBIQ+ people can communicate and support each other more than before, but stigma and harassment are unfortunately still alive. But also, society is changing and the resources and mechanisms to seek for help and the understanding of gender dysphoria is also in change. Regardless of the clinical evidence of ROGD, the main issue at the identity gender units is to accompany teenagers and families in the identity process, explore their gender, strengthen own resources and help cope with difficulties.

References

1. De Vries AL, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex. 2012; 59: 301-320.

2. Hewitt JK, Paul C, Kasiannan P, Grover SR, Newman LK, Warne GL. Hormone treatment of gender identity disorder in a cohort of children and adoles cents. Med J Aust. 2012; 196: 578-581.

3. Spack NP, Edwards-Leeper L, Feldman HA, Leibowitz S, Mandel F, Diamond DA, Vance SR. Children and Adolescents With Gender Identity Disorder Referred to a Pediatric Medical Center. Pediatrics. 2012; 20: 418-425.

4. Wood H, Sasaki S, Bradley SJ, Singh D, Fantus S, Owen-Anderson A, et al. Patterns of referral to a gender identity service for children and adolescents (1976–2011): age, sex ratio, and sexual orientation. J Sex Marital Ther. 2013; 39: 1-6.

5. Aitken M, Steensma TD, Blanchard R, VanderLaan DP, Wood H, Fuentes A, et al. Evidence for an altered sex ratio in clinic-referred adolescents with gender dyspho ria. J Sex Med. 2015; 3: 756-763.

6. Chen M, Fuqua J, Eugster EA. Characteristics of Referrals for gender dysphoria Over a 13-year period. J Adolesc Health. 2016; 58: 369-371.

7. Fernández M, Guerra P, Martín E, Martínez N. Álvarez-Diz, J.A y Grupo GIDSEEN. Atención sanitaria a adolescentes con disforia de género. Rev Esp Salud Pública. 2018; 92: 1-7.

8. Costa R, Dunsford M, Skagerberg E, Holt V, Carmichael P, Colizzi M. Psychological Support, Puberty supression, and psychosocial. functioning in adolescents with gender dysphoria. J Sex Med. 2015; 12: 2.s

9. Marchiano L. Outbreak: on transgender teens and psychic epidemics.Psychol Perspect. 2017; 60: 345-366

10. Littman L. Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS One. 2018; 13: e0202330.

11. Kaltiala-Heino R, Sumia M, Työläjärvi M, Lindberg N. Two years of gender identity service for minors: overrepresentation of natal girls with severe problems in adolescent development. Child Adolesc Psychiatry Ment Health. 2015; 9: 1-9.

12. Restar AJ. Methodological Critique of Littman’s (2018) Parental-Respondents Accounts of “Rapid-Onset Gender Dysphoria”. Arch Sex Behav. 2019.

13. Littman L. Correction: Parent reports of adolescents and young adults perceived to show signs of a rapid onset of gender dysphoria. PLOS One. 2019; 14: e0214157.

14. Heber J. Correcting the scientific record on gender incongruence and an apology. PLOS Blogs. 2019.

15. The World Professional Association for Transgender Health-WPATH. Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People, 7ª version. 2011.

16. Docter RF. Transvestites and transsexuals: Toward a theory of cross gender behavior. New York: Plenum Press; 1988.

17. Landen M, Wålinder J, Lundström B. Clinical characteristics of a total cohort of female and male applicants for sex reassignment: A descriptive study. Acta Psychiatr Scand. 1998; 97: 189-194.

18. American Psychiatric Association-APA. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, DC: APA; 2013.

19. The World Professional Association for Transgender Health-WPATH. WPATH position on “Rapid-Onset Gender Dysphoria (ROGD). 2018.

20. Serano J. Everything You Need to Know About Rapid Onset Gender Dysphoria. Medium com. 2018.

Other Articles

Article Image 1

Evidence for Androgenic Influences on Self-Rated Health

Background: According to most studies, males self-report being physically and mentally healthier than females. The present study sought to determine if androgens might influence health.

Methods: Self-reports of physical and mental health were obtained from college students in Malaysia (N = 2,058) and the United States (N = 2,511). Androgen exposure was assessed based on five self-reported measures that were then factor analyzed. A clear two-factor solution resulted from the analysis: muscularity, physical strength, and athletic ability loaded onto a muscular coordination factor, while adult height and 2D:4D finger length measure loaded onto a bone growth factor.

Results: As hypothesized, for males and females in both countries, self-rated physical and mental health were both positively correlated to a significant degree with the muscular coordination androgen factor. The only significant correlation between self-rated health and the bone growth androgen factor was negative among the Malaysian sample.

Conclusions: Androgenic influences on muscular coordination appear to coincidentally alter self-rated physical and mental health. This conclusion conflicts with proposals that men and women would provide the same self-ratings of health if it were not for sex role training and discrimination.

Lee Ellis¹* and Anthony W. Hoskin²


Article Image 1

Are Male Enhancement Ultraceuticals Sold Online Safe, Natural and Compliant with their Label Claim?

Attention to ultraceuticals has become extremely prevalent. A large surge of male enhancement ultraceuticals hashit the U.S. market through online retail stores such as eBay, Amazon, GNC, and Alibaba that consist of unverified therapeutic label claims. The issue at hand is the increase in the production, marketing and sale of adulterated products from these online retail stores that falsify the safety, efficacy, and therapeutic claims on their websites. These products are further provoked to continue their false claims due to the absence of strict regulatory laws to govern label claims, manufacturing, and marketing in U.S. and global markets. The online retail stores that sponsor and advertise the sales of these ultraceuticals neglect the literature that show many of the products were discovered to be counterfeit, mislabeled, or adulterated with active pharmaceutical ingredients (API). Ultimately, regulatory authorities should instill regulations in order to monitor, examine, and test the ultraceutical market and the research community should draw public attention to the possible effects of these products on consumers.

Nadine Amine, Cindy Zheng, Harshvir Kaur, Jessica Sweeney, Mark Mikail, and Mohamed Ismail Nounou*


Article Image 1

Biomechanical Comparison of the Relationship between Variable Rear Tip Extender & Inflatable Penile Implant Cylinder Lengths with X-Ray Imaging: A Cadaveric Pilot Study

Objective: Here we present our findings assessing the biomechanical properties of IPPs with differing lengths of RTEs.

Materials and Methods: This is a biomechanical study of the interaction of penile implant cylinders and RTE as assessed by column compression and modified cantilever deflection. X-Ray (XR) photography was also used to identify the precise location of kink formation after failure. The IPPs were surgically placed into two fresh cadavers via a penoscrotal technique by a single large volume implanter. A biomechanical evaluation of the properties of the IPP and RTE inside the fibroelastic tunica albuginea was assessed in unblinded testing and analyses were based on industry standard methods for assessment.

Results: In the 20 and 24 cm phallus respectively, the maximum load before kink was shown to be highest with no RTEs. This is to say device failure was at lower force when more RTE were present versus when no RTE were present. We also see in the shorter phallus there is a higher overall resistance to kink formation, even with increasing RTE lengths. Results from the horizontal studies were mixed and no direct conclusions can be drawn.

Conclusions: Column load testing to the maximum load before kink formation increases sequentially with decreasing RTE. This suggests no RTE will translate to a higher load tolerance for patients when we consider the physiologic act of intromission. Our data also suggest that even with more RTE, shorter phalluses can resist higher loads. Surgeons should use this as a guide to maximize cylinder lengths when performing IPP surgery. Further research will be required to validate these findings.

Jared J. Wallen¹*, SriGita K. Madaraju², Enrique V. Barrera³, Liehui Ge³, Angelina Hou⁴, Alexander W. Pastuszak⁵, Rafael E. Carrion⁶, Paul E. Perito⁷, and Tariq S. Hakky⁴


Article Image 1

The Psychosocial Impact of Disorders of Sexual Development

Disorders of Sexual Development (DSD) consist of ‘congenital conditions with atypical development of chromosomal, gonadal, or anatomic sex’. They cause significant psychological impact upon patients and their families. A search of MEDLINE, EMBASE and Clinical trials USA and Australia was conducted using MESH terms ‘disorders of sexual development,’ ‘psychology’ and ‘quality of life.’ Four themes emerged from the literature search; psychological support and treatment for parents and patients, the need for holistic management, quality of life assessment and identification of sociocultural factors that impact psychological health in DSD patients. Educating medical and paramedical staff is crucial to ensure adequate early assessment, diagnosis, counselling, and where appropriate management. Caution should be exercised in early genital surgery to ease parental distress; rather this should be a team-based decision at an appropriate age where the individual can be involved in the consent process. Psychological input should be specialised to the individual and more readily accessible.

Kavita Ravendran¹,²* and Rebecca Deans¹,²


Article Image 1

Dynamics of Sexual Activity of Men and Women of Different Ages, Undergoing Cerebral Stroke

Introduction: The issues of sexual activity of representatives of different sexes who have suffered a stroke are poorly covered in the literature. However, this problem has a distinct clinical significance.

Objective: Determination of the prevalence and clinical variability of sexual disorders in people of different sex and age at different times – before and after cerebral stroke, and the need to take into account sexual history in predicting the consequences of stroke and in treatment and rehabilitation measures

Materials and Methods: In the process of a targeted survey of 111 patients (58 men and 53 women) of different ages, conducted in the acute period of stroke, their sexual activity was studied in the pre – stroke period, and then in 77 of these patients-after 3-24 months. Sexual partners of the respondents were involved in the survey. The obtained data were compared with age, stroke background pathology, and stroke variant, severity of neurological defect, cognitive and emotional disorders, and results of neuroimaging studies.

Results: The decrease in sexual activity before stroke is of clear importance along with age in the development of background pathology for stroke, the formation of the consequences of stroke in cognitive and emotional functions. At the age of 55 years the most severe functional consequences of stroke were formed in 8.3% of persons who had normal sexual relations before stroke and in 27.6% in the absence of such (p=0.09). The negative dynamics of sexual activity after stroke is associated with the presence and severity of neurological deficits, especially among women, and the presence of cerebral atrophic changes, more often in men.

Conclusion: The initial quality of intimate relationships largely determines the clinical features of stroke and its consequences, and the negative dynamics of sexual activity after stroke is associated with different causal factors in different sexes, and this must be taken into account in the process of rehabilitation treatment.

Myakotnykh VS* and Ostapchuk ES


Article Image 1

Impact of COVID-19 infection on male smoker

Background: COVID-19, a mutated virulent virus of severe acute respiratory syndrome (SARS), was declared a global pandemic by the World Health Organization, with nearly 545,226,550 confirmed cases and 6,334,728 deaths. Furthermore, this mutated COVID-19 targets the lungs’ major respiratory organs and other vital organs (heart and kidney). The mutated virus of COVID-19 primarily targets crucial human organs, and those who smoke are particularly vulnerable.

Main Body: It is estimated that 30-40% of people worldwide smoke. Compared to nonsmokers, smokers exposed to the COVID-19 virus have a lower rate of recovery from this lethal virus. ACE2 is a type of angiotensin-renin converting enzyme group 2 that affects spermatogenesis and steroidogenesis by increasing or decreasing. As a result of SARS-virulent CoV-2’s capability, ACE2 was altered, and entry into the lungs/testis caused orchitis formation in the testis. A few COVID-19-infected males aged 30-35 are said to have reported microbial itching in their private parts along with decreased testosterone levels, and testicular histopathological confirmation was suggested. Because SARS-CoV-2 affects the testis, it may impact male fertility. For proof, we need to research with many participants to prevent COVID-19 mutation from causing germ cell mutation in offspring.

Conclusion: The current review primarily concerns whether this COVID-19 of SARS CoV-2 affects human male smoker fertility by impairing testicular spermatogenesis

Parameswari Ranganathan¹*, Babujanarthanam Ranganathan¹, Ganeshamoorthy², and Sridharan TB³


Article Image 1

Some Insights into the Impact of Exposure to Synthetic Sex Hormones on the Human Central Nervous System: A Never-Ending Story

Synthetic sex hormones (estrogens such as diethylstilbestrol, 17-α-ethinyl estradiol and progestins) are copies, generally not bio identical, of natural hormones and are considered endocrine disruptors. Since 1938, they have been administered, alone or in cocktails, to millions of women worldwide to avoid miscarriage, as oral contraceptives or hormone replacement therapy, and for other gynecological indications. In this review, we retrace the history of their deleterious effects on the central nervous system of children exposed in utero (severe psychiatric disorders, such as bipolar disorder, schizophrenia, autism spectrum disorders, associated or not with somatic disorders). After the discovery of the molecular link between administration of synthetic estrogens to pregnant women and psychiatric disorders in exposed children, an epigenetic mechanism (hypermethylation of some genes that influence neurodevelopment) was proposed. Moreover, the multigenerational effects of synthetic sex hormones have been described by us (autism spectrum disorders, bipolar disorder with/ without learning disorders) and other authors (cognitive disorders). We also report men exposed in utero to diethylstilbestrol who identify as transgender women in the French HHORAGES cohort. Lastly, we describe the presence of depressive disorders, anxiety and history of suicide attempts/suicide among women who take combined oral contraceptives. These findings stress that all xenohormone types should not be prescribed to women, especially during pregnancy, and as a precautionary principle also for contraception, particularly due to the hypothetical effect of oral contraception on unborn children.

Marie-Odile Soyer-Gobillard¹²*, Laura Gaspari³ and Charles Sultan³