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Physiology

Puberty Suppression in Adolescents With Gender Identity Disorder: A Prospective Follow-Up Study

Annelou L.C. deVries, MD, et al

Dept. of Child and Adolescent Psychiatry, VU Medical Center, Amsterdam, The Netherlands


Introduction. Puberty suppression by means of gonadotropin-releasing hormone analogues (GnRHa) is used for
young transsexuals between 12 and 16 years of age. The purpose of this intervention is to relieve the suffering caused
by the development of secondary sex characteristics and to provide time to make a balanced decision regarding actual
gender reassignment.

Aim. To compare psychological functioning and gender dysphoria before and after puberty suppression in gender
dysphoric adolescents.

Methods. Of the first 70 eligible candidates who received puberty suppression between 2000 and 2008, psychological
functioning and gender dysphoria were assessed twice: at TO, when attending the gender identity clinic, before the
start of GnRHa; and at T1, shortly before the start of cross-sex hormone treatment.

Main Outcome Measures. Behavioral and emotional problems (Child Behavior Checklist and the Youth-Self
Report), depressive symptoms (Beck Depression Inventory), anxiety and anger (the Spielberger Trait Anxiety and
Utrecht Gender Dysphoria Scale), and body satisfaction (the Body Image Scale) were assessed.

Results. Behavioral and emotional problems and depressive symptoms decreased, while general functioning
improved signiflcantly during puberty suppression. Feelings of anxiety and anger did not change between TO and T1.
`VVhile changes over time were equal for both sexes, compared with natal males, natal females were older when they
started puberty suppression and showed more problem behavior at both TO and T1. Gender dysphoria and body
satisfaction did not change between TO and T1. No adolescent withdrew from puberty suppression, and all started
cross-sex hormone treatment, the flrst step of actual gender reassignment.

Conclusion. Puberty suppression may be considered a valuable contribution in the clinical management of gender
dysphoria in adolescents.


de Vries ALC, Steensma TD, Doreleijers TAH, and Cohen-Kettenis PT.

 

White matter microstructure in female to male trans-sexuals before
cross-sex hormonal treatment.

A diffusion tensor imaging study

Giuseppina Rametti,
Beatriz Carrillo,

Esther Gómez-Gil,
Carme Junque,

Santiago Segovia,
Ángel Gomez,

Antonio Guillamon

 

Background: Some gray and white matter regions of the brain are sexually dimorphic. The best MRI
technique for identifying subtle differences in white matter is diffusion tensor imaging (DTI). The purpose of this paper is to investigate whether white matter patterns in female to male (FtM )transsexuals before commencing cross-sex hormone treatment are more similar to that of their biological sex
or to that of their gender identity.

Method:  DTI was performed in 18 FtM transsexuals and 24 male and 19 female heterosexual controls
scanned with a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter fibers
of the whole brain, which was spatially analyzed using Tract-Based Spatial Statistics.

Results: In controls, males have significantly higher FA values than females in the medial and posterior
parts of the right superior longitudinal fasciculus (SLF), the forceps minor, and the corticospinal tract.
Compared to control females, FtM showed higher FA values in posterior part of the right SLF, the forceps
minor and corticospinal tract. Compared to control males, FtM showed only lower FA values in the
corticospinal tract.

Conclusions: Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gende ridentity (males) than those who share
their biological sex (females). Our results provide evidence for an inherent difference in the brain
structure of FtM transsexuals.


The microstructure of white matter in male to female transsexuals before

cross-sex hormonal treatment. A DTI study

Giuseppina Rametti,
Beatriz Carrillo,

Esther Gómez-Gil,
Carme Junque,

Santiago Segovia,
Ángel Gomez,

Antonio Guillamon

Background: Diffusion tensor imaging (DTI) has been shown to be sensitive in detecting white matter
differences between sexes. Before cross-sex hormone treatment female to male transsexuals (FtM) differ
from females but not from males in several brain fibers. The purpose of this paper is to investigate
whether white matter patterns in male to female (MtF) transsexuals before commencing cross-sex
hormone treatment are also more similar to those of their biological sex or whether they are more
similar to those of their gender identity.

Method: DTI was performed in 18 MtF transsexuals and 19 male and 19 female controls scanned with
a 3 T Trio Tim Magneton. Fractional anisotropy (FA) was performed on white matter of the whole brain,
which was spatially analyzed using Tract-Based Spatial Statistics.

Results: MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal
fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract.

Conclusions: Our results show that the white matter microstructure pattern in untreated MtF transsexuals
falls halfway between the pattern of male and female controls. The nature of these differences
suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during
brain development.


The Treatment of Adolescent Transsexuals: Changing Insights

Peggy T. Cohen-Kettenis, PhD,

Henriette A. Delemarre-van de Waal, MD, PhD,

and

Louis J. G. Gooren, MD, PhD

Introduction. Treatment of individuals with gender identity disorder (GID) has in medicine nearly always met with
a great deal of skepticism. Professionals largely follow the Standards of Care of the World Professional Association
for Transgender Health. For adolescents, specific guidelines have also been issued by the British Royal College of
Psychiatrists.

Aim. To describe the stepwise changes in treatment policy which, in recent years, have been made by the team of
the Gender Identity Clinic at the VU University Medical Center in Amsterdam, The Netherlands.

Methods. The first step taken to treat adolescents was that, after careful evaluation, (cross-sex hormone) treatment
could start between the ages of 16 and 18 years. A further step was the suppression of puberty by means of
gonadotropin-releasing hormone analogs in 12–16 year olds; the latter serves also as a diagnostic tool. Very recently,
other clinics in Europe and North America have followed this policy.

Results. The first results from the Amsterdam clinic show that this policy is promising.

Conclusions. Professionals who take responsibility for these youth and are willing to help should yet be fully aware
of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with
GID are presented, hopefully inciting a sound scientific discussion of the issue.