Prediction of outcome in transsexualism by means of the Defense Mechanism Test and multivariate modeling: a pilot study

To elaborate the predictive value of the projective method using the Defense Mechanism Test in a 5-yr. follow-up study of 16 transsexuals, all subjects were approved for sex reassignment surgery and had completed the baseline assessments and the 5-yr. follow-up evaluation. Furthermore, we intended to create an outcome model based on the test data for prior patients wherein new consecutive applicants for sex change could be tested to predict the outcome in individual cases. Outcomes after five years showed that 62% of the transsexuals were judged as improved in a variety of areas of psychosocial functioning, 19% were unchanged, and 19% were worsened. Firstly, the analysis of the test data confirmed differences between the improved transsexuals and those who were not. Secondly, sex differences were found, with female-to-male transsexuals having a better outcome and being more homogeneous than their male counterparts. Thirdly, there was good correspondence in prediction of outcome between the model based on the Defense Mechanism Test and a clinical judgment made by a psychiatrist for two new applicants for sex reassignment surgery. It appears the Defense Mechanism Test has a predictive ability for patients with gender-identity disorder.     

MMPI-2 characteristics of transsexuals requesting sex reassignment: comparison of patients in prehormonal and presurgical phases

To assess psychopathology in transsexuals at different phases of sex reassignment, we administered the Spanish adaptation of the MMPI-2 (Avila-Espada & Jiménez-Gómez, 1999) to 107 male-to-female and 56 female-to-male transsexuals. Except for the Mf scale, mean T scores from the Clinical scales were within the normal range and did not differ between sexes. Male-to-female transsexuals seeking sex-reassignment hormonal therapy, but not female-to-male patients, scored significantly higher on the Depression, Hysteria, Psychopathic Deviate, Schizophrenia, and Social Introversion scales than patients seeking sex-reassignment surgery. The results show that the majority of patients were free of psychopathology. Transsexuals in the initial phases of sex reassignment may experience more distress than in later phases; however, these results are unlikely to reflect clinically relevant differences.     

Borderline manifestations in the Rorschachs of male transsexuals

It was hypothesized that male transsexuals manifest a character structure consistent with Kernberg's criteria for borderline personality organization. Exploring this hypothesis, Kernberg's criteria for borderline personality organization were operationalized using Rorschach measures. The following variables were examined: aggression (Holt System Aggressive Content Section), object relations (Urist's Mutuality of Autonomy Scale), reality testing (Exner System X + %), and self/object differentiation (Exner System Special Scorings). A group of male college students, a group of male borderlines, and a group of male transsexuals were compared on the above variables. Compared to the normals, the transsexuals and borderlines displayed significantly more intense levels of aggression, a lower level of object relations, poorer reality testing, and impaired boundary differentiation. The transsexuals and borderlines did not differ significantly. The results were taken as suggesting that male gender dysphorics may be a sub-group of the wider borderline diagnostic category.     

Clinical Utility of the Bem Sex Role Inventory (BSRI) in the Spanish Transsexual and Nontranssexual Population

The aim of the study is to evaluate the usefulness of the Bem Sex Role Inventory (BSRI; Bem, 1974), an overall measurement of the cultural construct of masculinity and femininity, in the psychological assessment of Spanish transsexuals. Seventy male-to-female transsexuals (MF), 51 female-to-male transsexuals (FM), 77 control men, and 79 control women completed the Spanish version of the BSRI. Statistically significant differences between groups were only found on the femininity scale, on which MF transsexuals and control women scored significantly higher than FM transsexuals and control men. The results indicate that (a) only the femininity scale of the BSRI appears to be useful today for evaluating differences in the sex-role identification in Spanish controls and transsexuals; and (b) MF and FM transsexuals score as a function of their gender identity instead of their anatomical sex on the BSRI femininity scale.     

Clinical utility of the Bem Sex Role Inventory (BSRI) in the Spanish transsexual and nontranssexual population

The aim of the study is to evaluate the usefulness of the Bem Sex Role Inventory (BSRI; Bem, 1974), an overall measurement of the cultural construct of masculinity and femininity, in the psychological assessment of Spanish transsexuals. Seventy male-to-female transsexuals (MF), 51 female-to-male transsexuals (FM), 77 control men, and 79 control women completed the Spanish version of the BSRI. Statistically significant differences between groups were only found on the femininity scale, on which MF transsexuals and control women scored significantly higher than FM transsexuals and control men. The results indicate that (a) only the femininity scale of the BSRI appears to be useful today for evaluating differences in the sex-role identification in Spanish controls and transsexuals; and (b) MF and FM transsexuals score as a function of their gender identity instead of their anatomical sex on the BSRI femininity scale.     

EDITORS' INTRODUCTION

ABSTRACT

Transsexualism implies that an anatomically normal individual feels that he or she is actually a member of the opposite sex. Treatment usually includes real-life experience along with hormone therapy and sex reassignment surgery. Voice modification surgery may be necessary, as pass ability in general is still in a large extent dependent on the aspects of voice in transsexual people. Often male-to-female patients report being addressed in telephone conversations as their genetic gender, which is experienced as a disability. The purpose of this study was to evaluate the impact of voice on the quality of life in transsexuals.

In order to detect the disability caused by a voice disorder, the validated assessment method the Voice Handicap Inventory (VHI) was used. An additional question about the way patients were addressed in a telephone conversation was added.

As part of a study describing general health in transsexual persons, done at the Ghent University Hospital Belgium, a total of 48 patients were evaluated. In female-to-male transsexuals the median scores were very low, suggesting testosterone treatment led to an acceptable voice alteration. A higher serum LH level was significantly correlated with higher total, functional and emotional VHI scores. In male-to-female transsexuals the scores were significantly higher than those of the female-to-male transsexuals, but still there was no indication of a real disability/handicap. The extra telephone question was scored higher suggesting male-to-female transsexuals did experience a disability caused by their voice. From this study it is concluded that the VHI values did not demonstrate a handicapping effect.     

Transsexuals in Sport–Fairness and Freedom,Regulation and Law

The question of if, and under what conditions transsexuals should be allowed to participate in sports in their acquired sex is becoming increasingly relevant partly because the number of transsexuals is increasing partly because many countries now provide mechanisms for achieving legal recognition as belonging to the new acquired sex. This paper develops (1) an analysis of the justification for maintaining sex segregation in some sports and (2) an account of the rights of transsexuals to be recognised in their new sex. On the basis of these two analyses it critically evaluates two set of rules for the participation of transsexuals in elite sports: the UK guidelines issued in pursuance of the Gender Recognition Act 2004 and the International Olympic Committee's guidelines. It is argued that these guidelines are conflicting and that a modified set of criteria is more justifiable.     

Psychosocial Adjustment in Male-to-Female Transsexuals: An Overview of the Research Evidence

Transsexualism has been defined as an extreme gender dysphoria; it refers to unhappiness with one's biological sex and the desire to have the body of the opposite sex and to be regarded by others as a member of that other sex. Transsexualism is not a common condition, but its prevalence is not yet known. A large number of transsexuals receive hormonal treatment and sex reassignment surgery (SRS). In spite of years of poor quality research, due in part to methodological problems, recent research on surgical outcomes has provided important information. However, psychological research into transsexualism has ignored the cognitive style and psychological functioning of transsexuals, and very little effort has been made to incorporate research findings into the development of psychological treatments to improve the quality of life for transsexuals.     

PERCEPTIONS OF FEMALE/MALE PRESIDENTIAL CANDIDATES: Familial and Personal Situations

A factor mediating attitudes toward female/male political candidates may be the potential effect of a candidate's private life. The impact of a familial situation on attitudes towards a hypothetical presidential candidate was investigated in Study 1. Although main effects for candidate sex and familial situation were found, our data did not support differential effects by candidate sex. In Study 2 the potential impact of a candidate's personal problem was examined. A male with past psychological problems was perceived as more electable than three of four female candidates. In both studies, male candidates were perceived as more likely to win the election than were female candidates.     

The Legal Status of Transsexuals in Turkey

ABSTRACT

The development of the legal regulations concerning transsexuals in Turkey can be analysed in three phases. The first phase was prior to 1988 when there were no legal parameters at all. The second phase started in 1988 when certain changes made in the Turkish Civil Code (TCC) for the first time gave people who had already undergone sex reassignment surgery (SRS) the possibility to enter this change into the birth register. The third phase commenced in 2002 when the new Turkish Civil Code came into force.¹ Art.40 of the Code now regulates the pre-conditions for a surgery and the procedure for getting a court authorisation in order to be operated as well as the procedure for entering the sex change into the birth register after the operation. Following remarks aim at briefly explaining these historical developments in Turkish law and presenting the current legal situation in Turkey with respect to transsexuals. The deficiencies in the existing regulation and possible ways of surmounting these will also be examined.     

Perceptions of candidate strength in job recruitment: Does candidate race moderate the attractiveness bias in White women?

The attractiveness bias suggests that people who are more attractive will be positively favored across life outcomes. This study sought to test whether candidate attractiveness, sex, and race, affect perceptions of candidate strength in a job recruitment task. In total, 338 White women (M_age = 20.94 ± 5.65) were asked to make judgements of a potential candidate for an administrative job (resume with candidate photograph). The vignettes differed in terms of candidate ability (strong/weak), sex (male/female), race (Black/White), and attractiveness (attractive/less attractive). Participants rated perceived candidate strength and likelihood to invite for interview. Results showed no significant main effects for attractiveness. However, there was a significant interaction for target attractiveness and race, such that attractive/White candidates were more likely to be invited for interview than less attractive/White candidates. There was also a significant main effect for race such that Black candidates were rated as stronger and more likely to be interviewed. Sensitivity analyses (with nonheterosexual women removed from the sample) also showed a main effect for target sex such that female candidates were favored over male candidates. Overall, these findings provide evidence that attractiveness, sex, and race have important, albeit complex, effects on hiring decisions in the workplace.     

The health and well-being of prostate cancer patients and male-to-female transsexuals on androgen deprivation therapy: a qualitative study with comments on expectations and estrogen

Both male-to-female transsexuals and advanced prostate cancer (PCa) patients are treated with androgen-suppressing drugs that have emasculating effects. Additionally, transsexuals take estrogenic compounds to feminize their bodies. We explore the quality of life of these populations, based on interviews with 12 individuals from each group. Overall, the transsexuals had a better psychological response to chemical castration than the PCa patients. The transsexuals showed more enthusiasm about the changes in their life; they viewed their lives as beginning anew, accepted their reduced libido, and were more comfortable with their increased emotionality. Different responses in the two groups are not surprising given that they undergo androgen deprivation under very different medical contexts. However, the fact that the transwomen are able to conceptualize the effects as positive suggests that some androgen-deprived PCa patients may benefit from reconceptualizing their changes within a positive framework. Additionally, difference in the two populations may be attributed, in part, to the fact that the transsexuals take supplemental estrogen. Circumstantial evidence suggests that estrogen in androgen-deprived males may improve sleep quality, help retain sexual interest, and protect cognitive function. This suggests that PCa patients may benefit from using estradiol for androgen suppression.     

Sex Reassignment Technology: The Dilemma of Transsexuals in Islam and Christianity

The birth of people with confused or ambiguous sex makeup as a biological fact since the annals of history has posed the challenge of accommodating them within the binary gender of sociocultural systems. In this process, the role of religion as a defining factor in social engineering has been paramount. Major religions, such as Islam and Christianity, have addressed this issue within the frame of their God-ordained laws by devising a set of moral and legal imperatives specific to the “third gender.” Modern developments in medicine and biology, however, have made sex reassignment possible for this category of people, today called transsexuals. The question is: How do Islam and Christianity respond to it. After presenting an analytical view of both Muslim scholars and Christian religious authorities on the legitimacy of sex reassignment for transsexuals, this paper attempts to explore if such a dilemma can be resolved.     

Transsexuals and Pseudotranssexuals

SUMMARY

This article was first published in Archives of Sexual Behavior, vol. 7, no. 4, 1978, pp. 263–272. Prince admits to being attracted by the idea of sex reassignment for herself at the time of the publicity given to the case of Christine Jorgensen. However, the development of her philosophy that the central issues were to do with gender (the psycho-social) and not sex (anatomy and physiology) leads her to the view that it is perfectly possible for a male to be a woman without having sex surgery. She speaks out forcefully against sex reassignment, arguing that it is not appropriate for nine out of ten of those requesting it and writes of “so-called” or pseudo transsexuals. Susceptible transvestites are seduced by the publicity given to the topic into thinking it is the solution to their problems.     

Personality characteristics of fetishists, transvestites and sadomasochists

Many theorists have suggested that sexual deviates adopt impersonal outlets because of difficulties in social interaction, particularly with adult members of the opposite sex. In order to investigate the personality and mental health of non-clinical fetishists, transvestites and sadomasochists, the Eysenck Personality Questionnaire was distributed to the members of clubs catering to these predilections. Completed questionnaires were obtained from 125 fetishists (mainly rubber and leather), 285 transvestites and transsexuals, and 133 sadomasochists. Comparison of personality scores with male controls revealed that these groups of men are relatively introverted, neurotic and slightly higher on psychoticism. However, their levels of neuroticism and psychoticism were not so high as to be comparable with clinical samples of neurotics, psychotics or even patients with sex problems. Analysis of individual items in the EPQ showed that the deviant groups were more shy, lonely, sensitive and depressed than controls and were less likely to enjoy telling jokes, all of which suggests some difficulty with social skills. Other questions concerning their social background and upbringing revealed that the deviant groups were more likely to be without a steady partner, to have perceived their upbringing as restrictive and to have disliked their mother. However, it was not possible to implicate the experience of corporal punishment in childhood with any of these sexual preferences.     

Psychological adjustment in transvestism and transsexualism

Thirty-four transvestites who had shown fetishistic arousal in association with cross-dressing were categorized into two groups on the intensity of feminine gender identity. The two transvestite groups were compared to a group of 24 non-fetishistic transsexuals who sought a full sex change operation. Ss in all three groups reported greater current psychological stress and scored higher on neuroticism and introversion than Ss in a normal population. A large proportion of Ss in the three groups had previously sought psychiatric help. The degree of psychological maladjustment was not related to the intensity of feminine gender identity.     

Transexuals' Recognition of Emotions as Measured by the FEEL-Test

ABSTRACT

The study investigates the ability of transsexuals (TS) to recognize facially expressed basic emotions. It was hypothesized that, due to their discomfort in their gender role, this ability might be diminished in TS. In addition it was expected that emotion recognition improves during the course of transgendering, e.g., after having started the Real-life Experience (RLE) which regularly reduces stress levels. Finally it was hypothesized that TS do better in recognizing facial emotions when the person showing them has their desired sex and gender. To test these hypotheses the FEEL-test (Facially Expressed Emotion Labelling) was used. Forty-seven TS and 55 non-transsexual controls matched for age and sex were included in the study. The first hypothesis was confirmed. As regards the second hypothesis, no differences could be found between the groups at different stages in the transition between the two genders. The third hypothesis was also rejected: TS recognized facially expressed basic emotions from male and female stimuli independently of their desired sex.     

Relations between anger expression and cardiovascular reactivity: reconciling inconsistent findings through a matching hypothesis

Previous psychophysiological research has demonstrated that both anger expression and anger suppression are related to cardiovascular responses, but in an inconsistent fashion. The present study tested the following hypotheses: (a) that the influence of anger expression style on psychophysiological responses would be limited to Ss exposed to an anger instigation, and (b) that the specific pattern of psychophysiological responses would vary as a function of whether Ss were induced to use their preferred vs. nonpreferred mode of anger expression style in response to the instigation. Seventy-eight male college undergraduates were randomly assigned to work on a task with either an annoying or a pleasant confederate and subsequently to write either a negative or a positive evaluation of the confederate. Blood pressure was measured intermittently and heart rate continuously throughout task performance and a subsequent 15-min rest period. Ss' preferred method of anger expression had been previously assessed by a self-report questionnaire. Systolic blood pressure results generally were consistent with the hypotheses. Implications of the findings for the etiology of cardiovascular diseases are discussed.     

Psychophysiologic abnormalities in schizophrenia: some implications for therapy

On the basis of several studies, some psychophysiological activation abnormalities in schizophrenia are explained. These abnormalities give rise to at least three therapeutic aims: (1) As some psychophysiological systems may be under- and others overaroused in schizophrenic patients compared to normal controls, therapeutic interventions should approach the systems selectively. (2) The ability to modulate the psychophysiological activation, which is diminished in schizophrenic patients, should be improved. (3) Schizophrenic patients need a more differentiated perception of their own state of activation. These aims contrast somewhat with past therapeutic studies, which tried to change activation for the purpose of tension reduction. It seems advisable to link basic psychophysiological research more closely to the development of therapies.