Betsy
05-11-05, 11:36 PM
I am removing all personally identifiable information in this short exchange because I swiped it off a list serv I am on and reposting is not a proper thing to do. However, I found the exchange compelling enough to and think it is okay with the personal information removed as anyone can join the list.
Dear Dr. Someone,
F to M gender change wishes or actual change in female-assigned 46,XX
with classical CAH occurs in approximately 5% of cases, based on a
review of the world lit. to be published in the August 2005 issue of the
Archives of Sexual Behavior (Dessens et al., 2005), and the team here
has documented a number of such cases in detail (Meyer-Bahlburg et al.,
1996, Hormones & Behavior 30:319-332).
Your patient's morphology suggests that glucocortiocid treatment has
been intermittent or absent; we have seen patients who deliberately
stopped taking glucocrticoids in order to virilize.
What is her CAH status in terms of Saltlosing / Simple-virilizing,
molecular genetics, Prader stage at birth?
In U.S. Psychiatry (DSM-IV), the term transsexual is typically reserved
for non-intersex individuals who change their gender. Legal gender
change is often easier to achieve for intersex individuals than for
non-intersex individuals.
Nevertheless, in our psych. evaluation for gender change, we orient
ourselves by the Standards of Care of the International Gender Dysphoria
Association (HBIGDA), which in its 6th edition also addresses gender
change issues in intersexuality.
In our experience, if one explains the problems of genital surgery in
such CAH cases, some will elect to remain unoperated or even to continue
in a lesbian role. But apart from the evaluation, our role as psychs. in
this matter is to provide information and help the person think through
pros and cons of their decision making and assist them in related
matters such as dealing with their fasmily and social environment, not
to "persuade" them one way or the other.
The average ped. psychiatrist unfortunately is not informed about gender
change issues. In many situations, someone who is not a ped. psych. but
has worked with non-intersex transsexuals is easier to find and can be
quite helpful for the psych. aspects.
As to masculinizing genital surgery, the options and outcomes depend on
how much clitorophallus tissue there is. Gerald Jordan, urologist in
Norfolk, VA, is one of the people with the most experience in these
techniques. Assistance by tissue engineering is on the horizon, but not
yet quite reality.
Some 46,XX who live in the male role without phalloplasty, manage a
mutually satisfying heterosexual sex life, but there is enormous
variability. Sexual counseling may be helpful.
With best regards,
<removed>
<original poster wrote:?
>Dear colleagues,
>
> I have a case of genetic female with male gender identification. I
>followed her for a CAH since birth. The girl is currently 18 years old. She
>is entirely decided to be a male. She is going shooting stag and flying fox.
>She has male games. Her father and her immediate family call her <removed male name> (her
>first name is <removed female name?>). Her morphology is masculine : no breast development,
>muscular distribution and facial pilosity and pelvis as a male. Pelvic US :
>small uterus and ovaries (with follicles).
>A problem is that <removed female name> had surgery of genitalia in the young age. The
>result is a clitoris not hypertrophied probably without possibility of
>sexual intercourse. However, labia majora are enlarged as a pseudo-scrotum.
>
>What are your suggestions :
>
>* to try, with the help of a pediatric psychiatrist, to persuade her to
>accept her feminine condition ?
>
>* to accept her male ³vocation² ? and then, in this hypothesis, would you
>mention for me the medical and chirurgical possibilities ?
>
>Thank you very much for your help.
>
>With my best wishes.
Dear Dr. Someone,
F to M gender change wishes or actual change in female-assigned 46,XX
with classical CAH occurs in approximately 5% of cases, based on a
review of the world lit. to be published in the August 2005 issue of the
Archives of Sexual Behavior (Dessens et al., 2005), and the team here
has documented a number of such cases in detail (Meyer-Bahlburg et al.,
1996, Hormones & Behavior 30:319-332).
Your patient's morphology suggests that glucocortiocid treatment has
been intermittent or absent; we have seen patients who deliberately
stopped taking glucocrticoids in order to virilize.
What is her CAH status in terms of Saltlosing / Simple-virilizing,
molecular genetics, Prader stage at birth?
In U.S. Psychiatry (DSM-IV), the term transsexual is typically reserved
for non-intersex individuals who change their gender. Legal gender
change is often easier to achieve for intersex individuals than for
non-intersex individuals.
Nevertheless, in our psych. evaluation for gender change, we orient
ourselves by the Standards of Care of the International Gender Dysphoria
Association (HBIGDA), which in its 6th edition also addresses gender
change issues in intersexuality.
In our experience, if one explains the problems of genital surgery in
such CAH cases, some will elect to remain unoperated or even to continue
in a lesbian role. But apart from the evaluation, our role as psychs. in
this matter is to provide information and help the person think through
pros and cons of their decision making and assist them in related
matters such as dealing with their fasmily and social environment, not
to "persuade" them one way or the other.
The average ped. psychiatrist unfortunately is not informed about gender
change issues. In many situations, someone who is not a ped. psych. but
has worked with non-intersex transsexuals is easier to find and can be
quite helpful for the psych. aspects.
As to masculinizing genital surgery, the options and outcomes depend on
how much clitorophallus tissue there is. Gerald Jordan, urologist in
Norfolk, VA, is one of the people with the most experience in these
techniques. Assistance by tissue engineering is on the horizon, but not
yet quite reality.
Some 46,XX who live in the male role without phalloplasty, manage a
mutually satisfying heterosexual sex life, but there is enormous
variability. Sexual counseling may be helpful.
With best regards,
<removed>
<original poster wrote:?
>Dear colleagues,
>
> I have a case of genetic female with male gender identification. I
>followed her for a CAH since birth. The girl is currently 18 years old. She
>is entirely decided to be a male. She is going shooting stag and flying fox.
>She has male games. Her father and her immediate family call her <removed male name> (her
>first name is <removed female name?>). Her morphology is masculine : no breast development,
>muscular distribution and facial pilosity and pelvis as a male. Pelvic US :
>small uterus and ovaries (with follicles).
>A problem is that <removed female name> had surgery of genitalia in the young age. The
>result is a clitoris not hypertrophied probably without possibility of
>sexual intercourse. However, labia majora are enlarged as a pseudo-scrotum.
>
>What are your suggestions :
>
>* to try, with the help of a pediatric psychiatrist, to persuade her to
>accept her feminine condition ?
>
>* to accept her male ³vocation² ? and then, in this hypothesis, would you
>mention for me the medical and chirurgical possibilities ?
>
>Thank you very much for your help.
>
>With my best wishes.