Frank P. Pool, Michel A. Hofman, Louis J. Gooren, Dick F. Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex.
Transgender history. Lipoprotein a : The renaissance of an enigmatic lipoprotein. Huffington Post. Twenty-six of the reference subjects were the same as used in the earlier study of Zhou et al. Permissions Icon Permissions.
Door of no return slavery. 1. Introduction
World J Urol. Creation of a male chest in female transsexuals. One forearm nerve is connected to Real male to female transsexuals ilioinguinal nerve for protective sensation and the other nerve of the arm is anastomosed to one of the dorsal clitoral nerves for erogenous sensation. A Incisions and scar; B preoperative; C postoperative. Transgender post op orchiectomy. After excision, a pelvic floor reconstruction is always performed to prevent possible diseases such as cystocele and rectocele. On January 1,aged 19, she decided to open up about her transgender identity by posting it on Facebook. Novelist Maggie Alderson reveals why after decades of fretting about the impression she made on men she finally stopped caring The royal fashion parade continues! Arch Sex Behav. Post Op Ladyboy Slutwear Creampie. In turn, the surgeons must commit to the extended care of this unique population, which, by definition, will protract well Cunt fucking clips the future. Sainsbury's has axed fireworks ahead of Guy Fawkes' Night, so: Should all mums fight to ban this noisy The recommendations of the authors are summarized in their algorithm Fig.
But women need actual safe spaces—not from intellectual challenge, of course, but from physical threat of harm from men.
- Combine Orientation.
- The next operative procedure consists of the genital transformation and includes a vaginectomy, a reconstruction of the horizontal part of the urethra, a scrotoplasty and a penile reconstruction usually with a radial forearm flap or an alternative.
I n recent years, US society has seen a sea change in the perception of transgender people, with celebrities such as Caitlyn Jenner and Laverne Cox becoming the recognizable faces of a marginalized population. Yet a biological understanding of the contrast between the natal sex and the gender identity of transgender people remains elusive.
In recent years, techniques such as functional magnetic resonance imaging fMRI have begun to yield clues to possible biological underpinnings of the condition known as gender dysphoria.
Techniques such as functional MRI have begun to yield clues to possible biological underpinnings of gender. One prominent hypothesis on the basis of gender dysphoria is that sexual differentiation of the genitals occurs separately from sexual differentiation of the brain in utero, making it possible that the body can veer in one direction and the mind in another. As recently as the s, many researchers argued that social norms in how we raised our children solely dictated the behavioral differences that developed between girls and boys.
Sex differences in the brain are now well documented, although the extent to which these arise from biological versus social factors is still hotly debated.
The developmental mismatch idea draws support from two sets of findings. Dick Swaab of the Netherlands Institute for Neuroscience is a pioneer in the neuroscience underlying gender identity. In the mids, his group examined the postmortem brains of six transgender women and reported that the size of the central subdivision of the bed nucleus of the stria terminalis BSTc or BNSTc , a sexually dimorphic area in the forebrain known to be important to sexual behavior, was closer to that of cisgender women than cisgender men.
In another study published in , Swaab and a coauthor examined the postmortem volume of the INAH3 subnucleus, an area of the hypothalamus previously linked to sexual orientation.
The researchers found that this region was about twice as big in cisgender men as in women, whether trans- or cisgender. Functional similarities between transgender people and their cisgender counterparts were apparent in a study led by Julie Bakker of VU University Medical Center and the Netherlands Institute for Neuroscience in Amsterdam that examined neural activity during a spatial-reasoning task.
Previous studies had indicated that the exercise engaged different brain areas in men and women. Bakker and colleagues found that trans boys who had not been exposed to testosterone, but had had female pubertal hormones suppressed as well as cisgender boys, displayed less activation than cisgender girls in frontal brain areas when they performed the task. Some studies have pinpointed characteristics of the transgender brain that fall in between what is typical for either sex.
In , for example, Georg Kranz , a neuroscientist at the Medical University of Vienna, used diffusion MRI data to investigate differences in white matter microstructure among trans- and cisgender subjects. In a study from the Netherlands Institute for Neuroscience, a comparison of the distribution of gray matter in 55 female-to-male and 38 male-to-female transgender adolescents with cisgender controls in the same age group found broad similarities in the hypothalami and the cerebellums of the transgender subjects and cisgender participants of the same natal sex.
The team found that in some respects, such as the level of activation of a brain area called the right superior frontal gyrus, trans and cis women were similar, while cisgender men showed higher activity, possibly reflecting greater cognitive effort on the task.
Ivanka Savic , a neuroscientist at the Karolinska Institute in Sweden, also doubts the explanatory power of the developmental mismatch hypothesis. In , for example, Savic and a colleague found that two brain regions, the thalamus and putamen, were smaller in transgender women than in cisgender controls, but overall gray matter volume was greater. Specifically, compared with cisgender individuals of both sexes, transgender men showed less connectivity among regions known as the anterior cingulate, posterior cingulate, and precuneus when they viewed images of themselves.
It is one of the pivotal points in biology, and the biology of humans. Additionally, logistical challenges confront scientists searching for a biological understanding of gender dysphoria. It is typically difficult to recruit enough transgender subjects to conduct studies with high statistical power. But some researchers are working to remedy that problem. In , for example, the ENIGMA Consortium, which promotes networking and information-sharing among researchers working to detect modest gene effects on brain structure and function, launched a new, transgender-focused working group.
And geneticist Lea Davis of Vanderbilt University is organizing a yet-to-be-funded effort to sequence and analyze the genomes of thousands of trans- and cisgender people in search of variations linked to gender identity. Apart from the big mystery regarding the roots of gender identity, researchers in the field have a number of lingering questions. Also still to be determined, adds Savic, is whether the brain differences that have been identified between cis and trans people persist after hormone treatment.
For now, as is the case for many aspects of human experience, the neural mechanisms underlying gender remain largely mysterious. But some groups are specifically exploring the effects that these treatments might have on the brain. Only a handful of studies have addressed the question of how these hormone treatments affect the brain. A Dutch study similarly concluded that the overall brain volumes of transgender women dropped as a result of treatment, while those of transgender men increased, particularly in the hypothalamus Eur J Endocrinol , S, And last year, Karolinska Institute neuroscientist Ivanka Savic found that the brains of transgender men taking testosterone showed several changes, including increases in connectivity between the temporoparietal junction involved in own-body perception and other brain areas Cereb Cortex , doi Correction March 15 : The original version of this article incorrectly stated that Lea Davis is organizing a study to look for genetic variants linked to gender dysphoria.
We have corrected the article to reflect the fact that Davis is focused on understanding the genetic contribution to gender identity, not specifically gender dysphoria.
Bao, D. Zhou et al. Garcia-Falgueras, D. Burke et al. Kranz et al. Hoekzema et al. Zubiaurre-Elorza et al. Guillamon et al. Junger et al. Savic, S. Feusner et al. Smith et al. Related Articles. Infographic: Searching for the Neural Basis of Gender. The Biggest Science News of
Figure 4. Secret: Maya, pictured aged 18 wearing extensions while alone in her own home, before she made her decision to transition public, now has a big following as a YouTuber. Christmas parties cancelled, written consent for sex and a growing hostility between men and women. Chest wall contouring for female-to-male transsexuals: Amsterdam experience. After that there are numerous photos of her in dresses, openly wearing make-up, showing off manicures and experimenting with longer hair and different styles.
Real male to female transsexuals. SUBCUTANEOUS MASTECTOMY
Frank P. Pool, Michel A. Hofman, Louis J. Gooren, Dick F. Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex. A crucial question resulting from a previous brain study in male-to-female transsexuals was whether the reported difference according to gender identity in the central part of the bed nucleus of the stria terminalis BSTc was based on a neuronal difference in the BSTc itself or just a reflection of a difference in vasoactive intestinal polypeptide innervation from the amygdala, which was used as a marker.
Therefore, we determined in 42 subjects the number of somatostatin-expressing neurons in the BSTc in relation to sex, sexual orientation, gender identity, and past or present hormonal status.
In contrast, the neuron number of a female-to-male transsexual was found to be in the male range. Hormone treatment or sex hormone level variations in adulthood did not seem to have influenced BSTc neuron numbers.
The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.
ANIMAL experiments and observations in human brains have convincingly shown that sexual differentiation not only concerns the genitalia but also the brain 1 , 2. The strongly connected and sexually differentiated hypothalamus, septum, bed nucleus of the stria terminalis BST , and amygdala are implicated in sexually dimorphic patterns of reproductive and nonreproductive behaviors 2 — Gender identity i.
Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex 19 — In line with the hypothesis that in transsexuals sexual differentiation of the brain contrasts with that of the genetic and physical characteristics of sex, our group has recently found that the size of the central subdivision of the BST BSTc was within the female range in genetically male-to-female transsexuals In that study the, BSTc was defined on the basis of its vasoactive intestinal polypeptide innervation, which is probably mainly derived from the amygdala A crucial question resulting from that study was, therefore, whether the difference according to gender in the BSTc is based on a neuronal difference in the BSTc itself or rather a reflection of a difference in innervation from the amygdala.
To see whether the BSTc itself has a neuronal organization that is opposite to that of the genetic and genitalial characteristics of transsexuals, we determined the number of somatostatin SOM -expressing neurons in the BSTc, which is the major neuronal population in this structure In the present study, 42 brains of patients were analyzed for an overview see Table 1. The brains of 34 reference subjects 9 presumed heterosexual males, 9 homosexual males, 10 presumed heterosexual females, and 6 male-to-female transsexuals ranging from 20—53 yr of age, together with six brains three males and three females of patients with sex hormone disorders were obtained at autopsy, after the required permissions had been obtained.
Twenty-six of the reference subjects were the same as used in the earlier study of Zhou et al. A nontreated individual with strong cross-gender identity feelings S7 , which were already present since his earliest childhood, was also analyzed.
In addition, we had the exceptional opportunity to be able to study the first collected brain ever of a female-to-male transsexual FMT. The brains were matched for age, postmortem time, and duration of formalin fixation. Neuropathology of all subjects was systematically performed by Dr. Subjects had no primary neurological or psychiatric diseases, unless stated otherwise.
BSTc neuron numbers. Distribution of the BSTc neuron numbers among the different groups according to sex, sexual orientation, and gender identity. Note that the number of neurons of the FMT is fully within the male range.
The same holds true for heterosexual and homosexual men. This shows that the BSTc number of somatostatin neurons is not related to sexual orientation. A, AIDS patient. P, Postmenopausal woman. The hypothalamic area was subsequently dissected, dehydrated, and embedded in paraffin. To enhance antigen retrieval [for a review see Shi et al. S to prevent the antibody from diffusing.
The light was reduced by neutral gray filters 0. In this image the BSTc was outlined manually on the basis of the distribution of the SOM immunoreactivity in neurons and fibers see Fig. In each field, SOM-positive neurons containing a nucleolus were counted manually, taking into account the exclusion lines according to Gundersen Neurons with double nucleoli were never seen.
The spectrum of neuronal sizes was equally distributed among the different groups. The image analysis procedure. Only somatostatin-positive neurons with a visible nucleolus were counted see Morphometry in Materials and Methods. The total volume of the BSTc was calculated by rostro-caudal integration of the outlined areas, taking into account the distance between the measured sections.
The neuronal density was calculated on the basis of the nucleolus counts in the sample volume. An estimation of the total number of SOM neurons was obtained by multiplying the total volume with the mean neuronal density. Differences among the groups were statistically evaluated by the nonparametric Kruskal-Wallis multiple comparison test. To further test whether the differences in the BSTc between the groups were affected by possible confounding factors, such as paraffin-embedded storage time of sections, fixation time, postmortem time, or brain weight, an analysis of covariance was carried out.
The number of neurons in the BSTc of male-to-female transsexuals was similar to that of females In addition, the neuron number of the FMT was clearly in the male range see Fig. There seemed to be no clear difference in the BSTc number of neurons between early onset T2, T5, T6 and late-onset transsexuals T1, T3 , indicating that their smaller number of neurons is related to the gender identity per se rather than to the age at which it became apparent.
No indication was found for a relationship between cause of death and BSTc neuron numbers. Analysis of the BSTc volumes showed a similar pattern of differences among the groups with heterosexual men having a BSTc volume of 4. The BSTc volume of females 3. The volumes of all males, regardless of sexual orientation, vs.
Representative immunocytochemical stainings of the somatostatin neurons and fibers in the BSTc of a reference man a , reference woman b , homosexual man c , and male-to-female transsexual d. Note the sex difference regardless of sexual orientation.
The male-to-female transsexual has a BSTc in the female range. Bar represents 0. Analysis of the total number of SOM neurons of the human BSTc in individual patients with highly different hormone levels does not give any indication that changes in sex hormone levels in adulthood change the neuron numbers.
Because the transsexuals had all been treated with estrogens, at least for some time see Table 2 , the reduced neuron numbers of the BSTc could theoretically be due to the presence of high levels of circulating estrogens. We, therefore, studied two nontranssexual men S3 and S5 who had been orchiectomized because of prostate cancer 3 months and 2 yr before death, respectively, and found that the BSTc neuron number of S3 was close to the mean of the male group and that the BSTc number of neurons of S5 was even the highest observed Fig.
Not only were five of the transsexuals orchiectomized, they all used the antiandrogen cyproterone acetate CPA. The BSTc SOM neuron numbers of two postmenopausal women [ M2 and yr-old P ] and of a yr-old woman with Turner syndrome S6: complete 45,X0, with ovarian hypoplasia were completely within the normal female range Fig. If high estrogen levels would have a reducing effect on BSTc neuron numbers, the opposite effect high neuron numbers would be expected in the postmenopausal women and the Turner syndrome patient due to their low endogenous sex hormone level status.
However, this was not the case. Noteworthy is that according to the available clinical data the two postmenopausal women did not receive any estrogen replacement therapy either.
Again, this argues against the probability of an estrogen-induced reduction effect on the number of SOM neurons. Finally, the BSTc neuron number of a yr-old woman who had suffered for at least 1 yr from a virilizing tumor of the adrenal cortex that produced very high blood levels of androstendione and testosterone was also clearly within the lower spectrum of that of other women Fig.
Thus, an increasing effect of testosterone on the BSTc neurons does not seem likely to be the case either. In addition, we had the unique opportunity to study the brain of an yr-old man S7 who also had very strong cross-gender identity feelings but was never orchiectomized, sex re-assigned, or treated with CPA or estrogens. This case provides an additional argument against the view that orchiectomy, CPA, or adult estrogen treatment of the transsexuals would be responsible for the reduced somatostatinergic neuron numbers.
This observation is also in agreement with the control SOM neuron numbers of the castrated male patients S3, S5 and testosterone-exposed S1 female patient.
Together, all these data clearly indicate that sex hormone-mediated reduction or enhancement effects on transsexual BSTc neurons in adulthood are extremely unlikely to be the underlying mechanism of the observed somatostatinergic BSTc differences. In short, our findings seem to support the hypothesis that the somatostatinergic sex differences, the female number of SOM neurons in the BSTc of the male-to-female transsexual brain and the male number of SOM neurons in the BSTc of the FMT are not the result of changes of sex hormone levels in adulthood.
Instead, the neuronal differences are likely to have been established earlier during development [see also Zhou et al.
In line with this reasoning are the developmental data on the rat BST showing that adult volumes and neuron numbers of BST subdivisions are orchestrated by androgen exposure during early brain development 31 , Such a mechanism is also in agreement with data of Breedlove 33 , 34 showing that perinatal androgens but not adult variations in androgen exposure induce differences in the total neuron number of the rat spinal nucleus bulbocavernosus.
Although our collection of male-to-female transsexual brains is small, it offers new opportunities to explore neurobiological correlates of transsexualism, as has previously been done in relation to sexual orientation 4 — 6.
The development of high resolution imaging techniques may allow in vivo volume measurements of particular brain areas in much larger groups of transsexuals, which could extend our findings in the distant future. Although brain imaging proved to be useful in visualizing [ e. It is conceivable that this dichotomy is just the tip of the iceberg and holds also true for many other sexually dimorphic brain areas.
Mariann Fodor is thanked for critically reading the manuscript. Brain material was provided by the Netherlands Brain Bank coordinator Dr. Rivka Ravid. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In.
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