Sexual Orientation versus Age of Onset as Bases for Typologies (Subtypes) for Gender Identity Disorder in Adolescents and Adults

Abstract

The most widely used and influential typologies for transsexualism and gender identity disorder (GID) in adolescents and adults employ either sexual orientation or age of onset of GID-related symptoms as bases for categorization. This review compares these two typological approaches, with the goal of determining which one should be employed for the diagnosis of GID in Adolescents or Adults (or its successor diagnosis) in the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). Typologies based on sexual orientation and age of onset of GID-related symptoms are roughly comparable in ease and reliability of subtype assignment. Typologies based on sexual orientation, however, employ subtypes that are less ambiguous and better suited to objective confirmation and that offer more concise, comprehensive clinical description. Typologies based on sexual orientation are also superior in their ability to predict treatment-related outcomes and comorbid psychopathology and to facilitate research. Commonly expressed objections to typologies based on sexual orientation are unpersuasive when examined closely. The DSM should continue to employ subtypes based on sexual orientation for the diagnosis of GID in Adolescents or Adults or its successor diagnosis.

Male-typical visuospatial functioning in gynephilic girls with gender dysphoria — organizational and activational effects of testosterone

“…Peters and colleagues 63 and Maylor and colleagues 64 showed that performance on the MRT varied as a function of sexual orientation: homosexual men performed worse than heterosexual men, whereas lesbian women excelled in mental rotation performance compared with heterosexual women. The majority of natal women with GD are gynephilic, [65][66][67] which was also found in our group of adolescent girls with GD. However, effects of sexual orientation have been shown only for behavioural responses and have not been investigated using neuroimaging studies of visuospatial cognitive abilities.…”

To treat or not to treat: puberty suppression in childhood-onset gender dysphoria

“…These groups have been summarized in the DSM-5 8 . Some researchers and clinicians have suggested that early-onset gender-dysphoric individuals might present with more constant forms of gender dysphoria or gender variance from childhood onwards than the late-onset group and identify with homosexual sexual orientation more frequently, and could benefit from early medical intervention 24,38 . Children in the early-onset group can experience substantial distress at the physical changes of puberty and gender dysphoria can even become more intense at this time 24 .…”

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

“…The etiology and biological underpinnings of GID are still largely unknown and may be different for males and females (Cohen-Kettenis, Van Goozen, Doorn, & Gooren, 1998;Schagen,Delemarre-van de Waal, Blanchard,&Cohen-Kettenis, 2012). 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.…”