Gender Identity Disorder in Twins: A Review of the Case Report Literature

Heylens, Gunter; Cuypere, Griet De; Zucker, Kenneth J.; Schelfaut, Cleo; Elaut, Els; Bossche, Heidi Vanden; Baere, Elfride De; T’Sjoen, Guy

doi:10.1111/j.1743-6109.2011.02567.x

Cited by 204 publications

(85 citation statements)

References 38 publications

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“…Leading theories on the etiology of this condition involve a sex-atypical cerebral programming that diverges from the sexual differentiation of the rest of the body, postulated to reflect the organizational effects of altered levels of sex steroid hormones during a specific period of fetal development (Bao and Swaab, 2011;CohenKettenis and Gooren, 1999;Savic et al, 2010;Swaab, 2007). Some twin studies suggest a role for genetic factors in the development of GD, potentially involving polymorphisms in genes encoding elements of the sex steroid signaling or metabolic pathways (Heylens et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Hoekzema

Schagen

Kreukels

et al. 2015

Psychoneuroendocrinology

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The sexual differentiation of the brain is primarily driven by gonadal hormones during fetal development. Leading theories on the etiology of gender dysphoria (GD) involve deviations herein. To examine whether there are signs of a sex-atypical brain development in GD, we quantified regional neural gray matter (GM) volumes in 55 female-to-male and 38 male-to-female adolescents, 44 boys and 52 girls without GD and applied both univariate and multivariate analyses. In girls, more GM volume was observed in the left superior medial frontal cortex, while boys had more volume in the bilateral superior posterior hemispheres of the cerebellum and the hypothalamus. Regarding the GD groups, at whole-brain level they differed only from individuals sharing their gender identity but not from their natal sex. Accordingly, using multivariate pattern recognition analyses, the GD groups could more accurately be automatically discriminated from individuals sharing their gender identity than those sharing their natal sex based on spatially distributed GM patterns. However, region of interest analyses indicated less GM volume in the right cerebellum and more volume in the medial frontal cortex in female-to-males in comparison to girls without GD, while male-to-females had less volume in * Corresponding author. the bilateral cerebellum and hypothalamus than natal boys. Deviations from the natal sex within sexually dimorphic structures were also observed in the untreated subsamples. Our findings thus indicate that GM distribution and regional volumes in GD adolescents are largely in accordance with their respective natal sex. However, there are subtle deviations from the natal sex in sexually dimorphic structures, which can represent signs of a partial sex-atypical differentiation of the brain.

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Section: Introductionmentioning

confidence: 99%

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Hoekzema

Schagen

Kreukels

et al. 2015

Psychoneuroendocrinology

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show abstract

“…Female-to-male transsexualism has been linked to the CYP17 gene (Bentz et al, 2008) whereas male-to-female transsexualism to a polymorphism of the CAG repeat length in the androgen receptor (Hare et al, 2009).Although these associations between certain genes and transsexualism have not yet been replicated (Ujike et al, 2009) and may not be applicable to all subtypes of transsexualism (Lawrence, 2010), there is some suggestion that genes regulating sex steroid signaling and steroid receptor functioning are implicated in the development of GID. Based on case reports of twins with GID (for a recent review, see Heylens et al, 2012), it is argued that GID may indeed have a genetic component. However, the significant numbers of monozygotic twins who are discordant for GID support the notion that other factors, such as pre-and postnatal environmental effects, also may play a role in the development of GID.…”

Section: Introductionmentioning

confidence: 99%

Click-Evoked Otoacoustic Emissions in Children and Adolescents with Gender Identity Disorder

et al. 2014

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Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds that are produced by the inner ear in response to click-stimuli. CEOAEs generally have a higher amplitude in women compared to men and neonates already show a similar sex difference in CEOAEs. Weaker responses in males are proposed to originate from elevated levels of testosterone during perinatal sexual differentiation. Therefore, CEOAEs may be usedas a retrospective indicator of someone's perinatal androgen environment. Individuals diagnosed with Gender Identity Disorder (GID), according to DSM-IV-TR, are characterized by a strong identification with the other gender and discomfort about their natal sex. Although the etiology of GID is far from established, itishypothesizedthat atypicallevels of sexsteroids during a critical period of sexual differentiation of the brain might play a role. In the present study, we compared CEOAEs in treatmentnaïve children and adolescents with early-onset GID (24 natal boys, 23 natal girls) and control subjects (65 boys, 62 girls). We replicated the sex difference in CEOAE response amplitude in the control group. This sex difference, however, was not present in the GID groups. Boys with GID showed stronger, more female-typical CEOAEs whereas girls with GID did not differ in emissionstrengthcomparedtocontrolgirls.Basedontheassumption that CEOAE amplitude can be seen as an index of relative androgen exposure,our results provide some evidence for the idea that boys with GID may have been exposed to lower amounts of androgen during early development in comparison to control boys.

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“…19 There have been data (endocrine, genetic, and neurologic) to support a biological component to gender. [20][21][22][23] The prevailing psychosocial paradigm until recently had been that parents have the greatest influence on a child' s deviation from acceptable social gender norms or a child' s refusal to accept the implied gender based on the natally assigned sex. [24][25][26] Currently, the explanation that parents are primarily responsible for their child' s gender variations is being challenged.…”

Section: Gender Developmentmentioning

confidence: 99%

Psychological and Medical Care of Gender Nonconforming Youth

Vance¹,

2014

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This is the 5th in our series on Adolescent Health. abstract Gender nonconforming (GN) children and adolescents, collectively referred to as GN youth, may seek care to understand their internal gender identities, socially transition to their affirmed genders, and/or physically transition to their affirmed genders. Because general pediatricians are often the first point of contact with the health care system for GN youth, familiarity with the psychological and medical approaches to providing care for this population is crucial. The objective of this review is to provide an overview of existing clinical practice guidelines for GN youth. Such guidelines emphasize a multidisciplinary approach with collaboration of medical, mental health, and social services/advocacy providers. Appropriate training needs to be provided to promote comprehensive, culturally competent care to GN youth, a population that has traditionally been underserved and at risk for negative psychosocial outcomes.

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Gender Identity Disorder in Twins: A Review of the Case Report Literature

Cited by 204 publications

References 38 publications

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain

Click-Evoked Otoacoustic Emissions in Children and Adolescents with Gender Identity Disorder

Psychological and Medical Care of Gender Nonconforming Youth

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