Is 40 To Late To Change Gender

• Journal List
• Sex Med
• 5.vii(ane); 2019 Mar
• PMC6377379

Sexual practice Med. 2019 Mar; vii(1): 86–93.

Age-Related Differences for Male-to-Female person Transgender Patients Undergoing Gender-Affirming Surgery

Dmitry Zavlin, Physician,^{1, 2, ∗} Richard J. Wassersug, PhD,^{3, 4} Vishwanath Chegireddy, Dr.,^five Jürgen Schaff, MD,² and Nikolaos A. Papadopulos, MD, PhD, FACS^{2, vi}

Dmitry Zavlin

^aneDepartment of Surgery, Easton Hospital, Drexel University College of Medicine, Easton, PA, Us

^twoDepartment of Plastic and Hand Surgery, University Infirmary Rechts der Isar, Technical University Munich, Munich, Federal republic of germany

Richard J. Wassersug

³Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada

⁴Australian Research Heart in Sex, Health and Society, Latrobe University, Melbourne, Australia

Vishwanath Chegireddy

^vInstitute for Reconstructive Surgery, Houston Methodist Hospital, Weill Cornell Medicine, Houston, TX, U.s.a.

Jürgen Schaff

ⁱⁱDepartment of Plastic and Hand Surgery, University Infirmary Rechts der Isar, Technical University Munich, Munich, Frg

Nikolaos A. Papadopulos

^twoDepartment of Plastic and Hand Surgery, Academy Hospital Rechts der Isar, Technical University Munich, Munich, Federal republic of germany

⁶Department of Plastic Surgery and Burns, Alexandroupoli Academy Infirmary, Democritus Academy of Thrace, Alexandroupoli, Greece

Received 2018 May 17; Accepted 2018 Nov 25.

Abstruse

Introduction

It has been theorized that in that location are 2 subgroups within the male-to-female (MtF) transgender population: individuals who are predominantly androphilic and those who are predominantly gynephylic or interested in both male person and female person partners.

Aim

To explore the role of a dichotomous distribution of age at dysphoria onset in individuals diagnosed with MtF gender dysphoria.

Methods

forty patients who presented to a surgical dispensary in Germany for gender-affirming surgery (GAS) were included in this study. Their age distribution was plotted every bit a histogram and the population was and so divided at the median self-reported historic period of onset of gender dysphoria—that is, those 17 years and younger and those 18 years and older. The ii groups were then compared with regard to demographic information, partnership history, various quality of life parameters, as well equally sexual orientation and sexual history.

Main Outcome Mensurate

Self-designed questionnaires for demographics and sexuality, Questions on Life Satisfaction and Body Image (FLZ^Thousand), Freiburg Personality Inventory, Rosenberg Self-Esteem Scale, and Patient Health Questionnaire were used.

Results

Early-onset, gender-dysphoric MtF patients underwent GAS at a much younger age (mean 32.vii vs 43.8 years, P = .004), merely had like characteristics regarding weight, peak, body mass index, marital status, and living situation to individuals who reported later onset of gender dysphoria. Preoperatively, they showed greater depressive symptoms (4.6 vs 3.three points, P = .045), which disappeared after GAS. Following surgery, the younger MtFs were predominantly attracted to men (52.6%), whereas individuals who were diagnosed with late-onset of gender dysphoria preferred women or both men and women (85.vii%) as sexual partners (P = .010). Younger trans individuals were more than frequently sexually active (73.vii% vs 42.ix%, P = .049).

Conclusion

Our findings propose that at that place are 2 MtF populations that differ in age of dysphoria onset, sexual history, and multiple personal details including sexual orientation. These data may be used to improve care to transgender individuals by providing handling reflecting their sexual interests.

Zavlin D, Wassersug RJ, Chegireddy V, et al. Age-Related Differences for Male-to-Female person Transgender Patients Undergoing Gender-Affirming Surgery. Sexual practice Med 2019;7:86–93.

Key Words: Transgender, Male person-to-Female, Gender-Affirming Surgery, Sexuality, Age, Quality of Life

Introduction

Co-ordinate to the 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the classification of gender dysphoria characterizes persons that have meaning distress and the desire to alive in another gender.1 The World Professional Clan for Transgender Health regularly publishes treatment guidelines and recommendations for transgender individuals that include mental health counseling, hormonal therapy, and surgical interventions.2 To provide the all-time healthcare for male-to-female (MtF) individuals, the professionals treating them need to be enlightened of the diversity in that population in terms of desires, expectations, and comorbidities. Offering the aforementioned treatment arroyo for every individual diagnosed with MtF gender dysphoria may not be the best standard of care.3, 4, 5

Blanchard was one of the first scientists to suggest the existence of subgroups in the accomplice of MtF trans persons based on demographic and sexual characteristics.half dozen, 7 He reported that some were sexually interested in men (classified as homosexual or androphilic), whereas others were more attracted to women (gynephilic) or both men and women. Blanchard subsequently suggested that individuals who first sought medical attention for MtF gender dysphoria at an older historic period more than often had children and were commonly married to females. Furthermore, those individuals were more likely to fit in the latter category.8

Blanchard's hypothesis was built upon data suggesting that ane motivating gene for tardily-transitioning gynophilic MtFs was autogynophila—that is, that the individuals were non only sexually attracted to females but were aroused by envisioning themselves as females. Lawrence supported Blanchard'southward theory in her review of various typologies for MtF transgender individuals related to age and sexual orientation.9, ten The crusade of these subtypes is not uncontested, and currently the subject of various discussions and investigations.10, 11, 12, 13

In a large retrospective chart review, Jackowich et al14 were the first to demonstrate a bimodal age distribution for MtF patients presenting for gender-affirming surgery (GAS). Their brief communication was based on a sample from Canada that did not include details regarding the patients' personal characteristics, sexual orientation, or sexual history.

Aim

Afterward Papadopulos et al15 reported on an independent clinical sample of MtFs seeking GAS in Europe, nosotros hypothesized that in that location would be a similarly bimodal age distribution in their raw data. We made use of the fact that they had independently collected self-reported personality, quality of life (QOL) outcomes, and sexual behavior data that could be used to assess whether there were ii distinct populations of MtFs distinguishable on their age of onset for gender dysphoria and sexual orientation. Given that the idea of two populations is a controversial topic,x we decided to investigate this from a unlike perspective. Hither, we used the self-reported age of onset of gender dysphoria in our surgical patients as the independent variable.

In this study, we test the hypothesis that there is an association between age at gender dysphoria onset and sexual orientation. We also investigate secondary upshot measures, such as QOL, depression/anxiety, and operative satisfaction between early on- and late-onset MtF patients.

Methods

Participants

All adult transgender patients who underwent their first GAS for MtF gender dysphoria with penectomy, orchiectomy, and creation of a neovagina performed by the senior plastic surgeon (J.S.) betwixt 2012 and 2014 were contacted preoperatively for written report enrollment by the outset writer (D.Z.). Exclusion criteria were patients who had previous genital surgery and were thus presenting for revision, too equally patients not fluent in German. A baseline questionnaire was start filled out at that fourth dimension. 6 months subsequently, the vast bulk of participating patients received their 2nd procedure to accost any cosmetic or functional issues, such as scar revisions, removal of domestic dog-ears, and breast augmentations. 12 months following the initial GAS, patients were contacted once again by the beginning author (D.Z.) to consummate a second set of questionnaires.

Of the 47 patients who initially consented to participate and completed the baseline questionnaires, 40 completed the 12-calendar month postoperative questionnaires (response rate, 85.i%) and were included in our last data analysis. For more details about the operative technique, please encounter our previous article.16

Questionnaires

The patients' demographic details and information nigh their personal life were collected via a set of non-validated questions specifically designed for this study (Tables i, ​ 2, and ​ 3). We asked questions about their marital status, whether they cohabit with others, children, cocky-assessed health, prior psychotherapy, and feeling of femininity. Sexual history including preferred gender of partners and details on frequency of intercourse were obtained both before and later on GAS. This part of our survey largely followed the closed-question pattern with multiple-pick options for answers, or used 0–10 or 1–5 Likert scales.

Table 1

Demographic details of the patients

Demographic	Dysphoria onset ≤17 years (N = 19)	Dysphoria onset ≥18 years (Due north = 21)	P value
Age at onset of gender dysphoria, y (mean ± SD)	12.three ± 3.9	34.8 ± 13.1	<.001∗
Age at surgery, y (mean ± SD)	32.7 ± 10.9	43.viii ± 11.9	.004∗
Weight, kg (mean ± SD)	76.6 ± 10.iv	78.8 ± 16.six	.635
Height, cm (mean ± SD)	178.six ± 4.8	179.3 ± five.9	.705
BMI, kg/thoutwo (hateful ± SD)	24.0 ± three.iii	24.5 ± five.0	.744
Marital condition† (%)			.380
Unmarried	fourteen (73.7)	x (47.6)
Married	1 (5.3)	3 (14.three)
Separated	ane (5.3)	3 (xiv.3)
Divorced	3 (fifteen.8)	5 (23.8)
Living situation (%)			.426
Lonely	6 (31.6)	11 (52.4)
With partner	7 (36.viii)	5 (23.8)
With children, no partner	ane (5.three)	0 (0.0)
With parents	3 (15.eight)	i (4.viii)
With relatives	0 (0.0)	one (iv.viii)
With roommates	2 (ten.five)	3 (xiv.8)
Children (%)	v (26.three)	ten (47.6)	.165

Table 2

Personal cocky-designed questions

Personal details	Dysphoria onset ≤17 years (N = nineteen)	Dysphoria onset ≥18 years (N = 21)	P value
Subjective impression of ain wellness (%)			.504
Very proficient	6 (31.half-dozen)	viii (38.1)
Good	10 (52.6)	12 (57.one)
Mediocre	3 (15.8)	1 (4.8)
Bad	0 (0.0)	0 (0.0)
Very bad	0 (0.0)	0 (0.0)
Length of preoperative psychotherapy, mo (hateful ± SD)	31.ii ± 14.iii	25.6 ± 11.4	.174
"Was the psychotherapy useful to y'all?"∗ (%)			.054
Yes	11 (57.nine)	xix (90.5)
Unsure	1 (v.iii)	0 (0.0)
No	7 (37.eight)	2 (9.5)
"How feminine do you feel?"∗ † (mean ± SD)
Baseline	7.ix ± 1.4	7.3 ± 2.1	.333
12 mo later	8.7 ± 1.ii	9.3 ± 1.0	.103
"How feminine practise you appear to others?"∗ † (hateful ± SD)
Baseline	7.vi ± ane.7	6.ix ± one.6	.183
12 mo after	8.ane ± one.four	7.iv ± 2.2	.267

Table 3

Sexuality

Sexual details	Dysphoria onset ≤17 years (N = xix)	Dysphoria onset ≥18 years (N = 21)	P value
At baseline and before surgery			.026∗
Interest in … (%)
Male	10 (52.half-dozen)	4 (19.0)
Female/Both/Neither	9 (47.four)	17 (81.0)
Sexually active (%)	4 (21.1)	three (14.3)	.574
12 mo later, afterward surgery
Involvement in … (%)			.010∗
Male	10 (52.half dozen)	3 (xiv.iii)
Female person/Both/Neither	9 (47.4)	18 (85.7)
Sexually active (%)	fourteen (73.seven)	9 (42.nine)	.049∗
Satisfaction with intercourse (hateful ± SD)†	6.6 ± 2.two	6.8 ± 1.9	.881

In improver, we used the German language versions of standardized and validated QOL questionnaires during both time points in our study (Table 4). These included the High german Questions on Life Satisfaction questionnaire (FLZ^Grand, Fragebogen zur Lebenszufriedenheit Module), which has 3 modules: General, Wellness, and Body Image.17, 18 The patients likewise answered the Patient Health Questionnaire 4 (PHQ-iv)nineteen assessing symptoms of depression or anxiety, the Freiburg Personality Inventory—Revised Version20 used to evaluate emotional condition, equally well equally the Rosenberg Self-Esteem Scale (RSES)21 for estimates of patients' self-esteem.

Table 4

Validated questionnaires

Psychometric findings	Dysphoria onset ≤17 years (N = 19)	Dysphoria onset ≥eighteen years (North = 21)	P value
At baseline and earlier surgery
FLZM: sum scores (hateful ± SD)
Full general module	44.0 ± xxx.eight	38.4 ± 23.8	.520
Health module	61.8 ± 49.1	63.ii ± 31.ii	.911
Torso paradigm module	94.7 ± 89.8	79.5 ± 67.5	.546
PHQ-4 (mean ± SD)	4.half-dozen ± 2.7	iii.3 ± ii.2	.045∗
PHQ-4 score over two (%)	sixteen (84.2)	12 (57.1)	.062
FPI-R (mean ± SD)	vii.0 ± 4.1	6.0 ± 3.8	.429
RSES (mean ± SD)	32.ii ± 5.seven	33.1 ± half-dozen.0	.635
12 mo later, after surgery
FLZ1000: sum scores (mean ± SD)
Full general module	64.4 ± 33.iii	53.9 ± 26.vii	.278
Wellness module	80.3 ± 43.2	79.3 ± 32.3	.932
Body image module	167.five ± 76.2	141.3 ± 80.vii	.108
PHQ-4 (mean ± SD)	2.0 ± 1.9	1.7 ± 2.i	.659
PHQ-iv score over 2 (%)	half-dozen (31.6)	5 (23.viii)	.583
FPI-R (mean ± SD)	4.8 ± 3.three	4.nine ± 3.4	.954
RSES (mean ± SD)	35.three ± three.8	34.6 ± v.nine	.552

Statistics and Ethics

The age distribution of our 40 MtF transgender patients is shown in Figure 1 in 2 forms. The patients' age at the time of surgery ranged from 19 to 66 years (greenish). Meanwhile, their self-reported onset of gender dysphoria was between iv and 63 years (orange). This 2d historic period variable was used to stratify the patients into 2 cohorts, dividing the population into those age 17 years and younger and age 18 years and older. The split up was based on the overall median age of onset of gender dysphoria, which was 18.5 years. For the statistical assessment of our data we used SPSS software (IBM SPSS Statistics for Windows, Version 24.0., IBM Corp, Armonk, NY, USA). The level of significance was set at 5% or less (P < .05) using the 2-sided t-test for continuous and the chi-foursquare test for chiselled variables. This written report had written approval from the institutional ethics committee where the GAS procedures took identify. Informed consent was obtained from all patients. Non-participation in this purely observational cohort study did non touch on the treatment of any patient. The piece of work described here has been carried out in accordance with the Proclamation of Helsinki.

Historic period distribution for male person-to-female person patients when they offset experienced gender dysphoria (orange bars) and the historic period when they underwent gender-affirming surgery (GAS) (light-green bars). Total N = xl. The vertical dotted line to the left represents the median age when the patients reported kickoff experiencing gender dysphoria. The vertical line to the right represents the depression indicate betwixt the 2 peaks for the bimodal distribution in age at the time of GAS. Our data support the hypothesis that individuals who had an early onset of gender dysphoria and GAS before the age of 35 years are significantly more than likely to be androphylic than the late-onset individuals, who had GAS after 35 years (refer to Tabular array 3).

Results

The histogram in Figure ane clearly shows bimodal age distributions for the MtF population undergoing GAS, both for their age at surgery and their age of onset for gender dysphoria. The average age at onset of transgender symptomatology was naturally earlier in the early-onset than the late-onset cohort (12.3 vs 34.8 years, P < .001). Early MtF patients also underwent GAS at an earlier historic period in their life (32.seven vs 43.viii years, P = .004).

With regard to the preoperatively nerveless demographic details, our younger and older groups had similar mean body weight (76.6 vs 78.8 kg, P = .635), height (178.6 vs 179.three cm, P = .705), and body mass index, which were within normal range (24.0 vs 24.five, P = .744). No differences were observed with regard to marital status, living state of affairs, or the presence of children when the study population was divided by the self-declared historic period of onset of gender dysphoria. All marriages were established with female partners before gender transitioning because same-sex marriage was not still legal in Deutschland at the time of the study (Table one). Only when the sample was divided by the age at surgery (with a low signal between xxx and 39, Figure 1), those patients who had GAS past the historic period of 35 years were significantly more than frequently married and had fathered children.

Both cohorts displayed a similar subjective impression of their own concrete health and reported similar lengths of pre-GAS psychotherapy. All the same, patients in the younger cohort accounted these therapy sessions less useful (57.ix%) than our older cohort (90.5%, P = .054). No differences were detected between the 2 cohorts concerning their subjective feeling of femininity on a 0–10 Likert calibration either before or later GAS. These findings are summarized in Table two.

Preoperatively, our younger MtF participants were more often sexually attracted to men (52.vi%), whereas the older group showed more interest in women or rated themselves as bisexual or rather asexual (81.0%). These preoperative differences were statistically significant (P = .026). Moreover, this trend was amplified after GAS when assessed at the later time indicate (P = .010). In other words, patients who developed gender dysphoria before the age of 17 years were mostly attracted to men (52.half dozen%), whereas patients who developed dysphoria every bit adults favored women, both men and women, or neither gender (85.seven%) as their targets of sexual interest. Patients in the younger group were as well more than often sexually agile with others at 12 months later on GAS (P = .049) than those in the older group (Tabular array 3).

The two cohorts did not score statistically differ on the General, Health, and Body Paradigm modules of the German language FLZ^M, either preoperatively nor postoperatively. However, individuals in the younger grouping appeared to have higher scores on the Body Image module at 12 months later GAS (167.5 vs 141.3), indicating a slightly higher satisfaction with their overall appearance, although these data did not reach significance (P = .108).

Before surgery, younger patients had significantly higher values of anxiety/low on the PHQ-four (4.6 vs 3.3, P = .045). These differences, even so, disappeared when assessed 12 months after GAS. Additionally, the cocky-esteem evaluated through the RSES questionnaire showed no difference between the 2 groups at both time points (Table 4).

Give-and-take

There is an ongoing fence nearly whether individuals with MtF gender dysphoria can be realistically sorted into 2 subcategories based on their targets of sexual interest—that is, into androphilic and gynephilic groups.22 Advocates of this ii-population model suggest that the 2 groups tin can be further distinguished on demographic criteria and clinical presentation.9, 23 Those who endorse this taxonomy have suggested, for case, that androphilic MtF individuals generally seek GAS earlier than those in the gynephilia group.24 They have as well suggested that individuals in the androphilic group are less probable to have a history of being married to women and to have fathered children.

Opponents to the two-population model claim that dichotomizing MtF transgender persons forth the lines of sexual orientation is too generalized and inaccurate for many MtF individuals with gender dysphoria. Nuttbrock et al,25 for example, suggested that there are more than these 2 subcategories of MtFs and more research is necessary to define those additional subgroups. Yet, Lawrence rebutted this, arguing that further categorization tended to cause confusion and distract from the validity of the basic dichotomy.26

The DSM-five itself does not dissever transgender women into 2 groups based on sexual orientation. It does depict differences in the characteristics of early on vs tardily individuals with clinically significant MtF gender dysphoria. In our study, we aimed to investigate whether there was a correlation between the age of dysphoric onset and sexual orientation within an MtF-but transgender accomplice. Given the controversies around distinguishing MtF individuals on sexual orientation,ten we specified historic period as the independent and sexual orientation as the primary dependent variable in our statistical analyses.

Our data overall back up such a 2-population model. Although our sample size is smaller, Figure i confirms the observation of Jackowich et al14 that in that location is indeed a bimodal historic period distribution for when MtF transsexuals undergo GAS.

2 subpopulations emerged from our histogram with the lowest indicate betwixt the two age peaks occurring effectually age 35 years (light-green). The reason for this trough in Figure i is not known, only various factors may account for this depression bespeak in both our and Jackowich et al's14 age distribution graphs. Transgender individuals in their 30s may exist focused on career advancement, unable to take time off from work to transition, or fear discrimination at their job. Such factors may account for the underrepresentation of individuals in their 30s having GAS. It should exist pointed out that this pattern results solely from when the individuals came frontward seeking surgical intervention and not from any exclusion from the age range shown in Figure 1.

This incidental finding is also concordant with our chief finding that at that place are 2 cohorts of MtFs based on whether a patient's onset of gender dysphoria occurred during childhood (ie, 17 years and younger) or every bit adults (ie, 18 years and older). Splitting the population at eighteen years has not only statistical significance, but also clinical implications. In Germany, surgical treatment is prohibited for transgender persons who take not nevertheless reached the legal historic period of 18 years. Yet, psychological and endocrine counseling are oft offered in pediatric cases. As shown in Table 1, those who develop transgender symptoms earlier likewise tend to undergo GAS at a significantly younger age.

In addition to showing a bimodal historic period distribution amidst MtF seeking GAS, we take further identified other characteristics that distinguish the ii populations and are in accord with recognizing 2 populations of MtFs. These are drawn from demographic details, sexual history obtained through our self-designed questionnaire, as well every bit QOL determined via standardized and previously validated survey instruments.

We demonstrated, for example, that our patients were more frequently sexually attracted to women or bisexual, if they belonged to the older cohort (Table 3). These findings are consequent with those of Gaither et al,24 who reported that gynephilic MtFs presenting for GAS were significantly older than heterosexual or bisexual controls. A study reporting on a consecutive series of predominantly immature MtF patients in Spain with a mean historic period of 29.4 years at their day of surgery showed that 89.9% were sexually interested in men.27 In dissimilarity, the population of Docter and Fleming28 with an boilerplate age of 44 years—similar to our older cohort—was preferably interested in females (47%), with few individuals interested only in males (19%), or both males and females (17%). These differences in sexual orientation persisted when the variable of age of onset of gender dysphoria was used every bit a basis for calculations,ix which are hereby replicated by our prospective study. Using the 2010 National Transgender Bigotry Survey with more than half dozen,000 participants, Kattari and Hasche29 discovered a plurality of pregnant distinctions between younger and older transgender individuals regarding their sexual characteristics. Regrettably though, they did non separately analyze MtFs from female-to-male person information. Although the sexual orientation of our forty surgical patients did not modify between baseline and the 1-year follow-up, further fourth dimension and acclimatization to the new anatomy could potentially impact the sexual orientation during longer follow-up periods and improve the power of our electric current study.

Our data also statistically distinguish younger and older MtFs populations in terms of improvements in their sexual life (regardless of sexual practices) subsequent to GAS, likewise equally other factors that contribute to QOL. Not but did we identify differences between the 2 age cohorts of MtFs, but nosotros were also able to assess the bear upon of GAS because the data were collected at 2 dissimilar time points: preoperatively and postoperatively.

Some new findings are that the younger patients showed higher symptoms of depression and anxiety on the PHQ-4 (iv.6 vs iii.3, P = .045) earlier GAS. Concordant with another contempo written report,30 our preoperative data demonstrated that the majority of our patients, both young and onetime, had high rates of mild to major depressive symptoms, with over 2 points on the PHQ-4 questionnaire, 84.2% and 57.1%, respectively. After surgery, withal, this discrepancy disappeared (Tabular array 4). This suggests that despite the differences in psychological assessment between the two subgroups of MtFs before surgery, both groups benefited from the surgical intervention when measured a year later treatment.

Last, our information suggest that, although younger patients were just as dissatisfied with their external appearance as the older MtF patients before surgery, they tend to be happier with their body image postoperatively (Table 4). This change was not statistically significant, but was consistent with some previously reported data.31 The differences in satisfaction with their self-image and their sex activity between the MtF in the 2 populations suggest that younger individuals may accept an advantage in passing as females, perhaps in facial structures, although nosotros did not considerately assess that. However, they would take an endocrinologic advantage with before hormonal therapy. Just because of their younger age, they were less likely to have experienced the androgenic alopecia that commonly leads to cranial hair loss as males age.

The differences in satisfaction with postoperative advent and sexual activity between the ii populations suggest that the postsurgical psychological support needs may differ between individuals in the younger vs older cohorts. Our findings may also exist important for reconstructive surgeons performing GAS. Younger MtF patients, who tend to be more attracted to men, may desire beingness the receptive partner in penetrative intercourse, and would thus require larger neovaginal depth. Notwithstanding, in our surgical feel, those MtF patients desiring sex with females, volition be more than interested in clitoral stimulation. As such, careful dissection of the neovascular packet supplying the glans penis is crucial to reach a sensitive neoclitoris. A detailed sexual history is thus of utmost importance during the preoperative assessment and physical exam of new patients presenting for GAS. An interdisciplinary approach with psychiatrists and endocrinologists is non merely recommended just—in Germany—even mandated to obtain treatment coverage by public and private insurers.32

To the best of our noesis, this is the get-go study to describe a statistically meaning association between age, on the ane mitt, and sexual orientation and QOL, on the other mitt, for individuals treated surgically for MtF gender dysphoria. Our findings are concordant with descriptions in the DSM-v regarding certain common differences between early and late MtF transgender persons.1 Although our data are consistent with hypotheses nearly the origin of gynophilic MtF transsexuals,6, vii, 8, ix, ten they cannot be said to validate those hypotheses. That is because all of our information on the age of onset of gender dysphoria is retrospective and prone to recollect bias.

This study is thus non without certain limitations. Owing to the retrospective pattern of our study, all significant findings have associative and non causative character; that is, we cannot make up one's mind whether historic period or sexual orientation is the antecedent variable. The age of onset of gender dysphoria, which was used equally the independent variable, was obtained by briefly questioning the patient at the time of access to our surgical section and was non based on a psychiatric evaluation. Further, our sample size was minor and included individuals treated only in 1 plastic surgery department, which admittedly treats the largest number of transgender patients in Germany. Thus these information may not be representative of all MtF individuals. Indeed, a significant portion of individuals with MtF gender dysphoria may never undergo operative procedures or be recruited for research.33 Furthermore, the data here originate from Frg with all German-speaking patients and may not apply to other countries, nationalities, or indigenous groups, especially whatsoever with vast cultural differences.34 Larger international studies will hopefully follow to reproduce these results.

Decision

Our study strengthens the theory that there are 2 singled-out age-related subgroups within the MtF transgender population undergoing GAS. Patients who study experiencing gender dysphoria at a younger age (ie, every bit children), tend to exist more androphilic and are probable to have GAS earlier the historic period of 35 years. Older patients, who report first experiencing gender dysphoria equally adults, are more frequently gynophilic and ofttimes undergo GAS after the age of 35 years. Meanwhile, younger patients are in general significantly more than sexually agile. These findings may have implications on the outcomes of psychotherapeutic, endocrinologic, and operative treatment and could ultimately influence therapeutic strategies.

Statement of authorship

Category 1

• (a)

  Conception and Design

  • Dmitry Zavlin; Nikolaos A. Papadopulos

• (b)

  Acquisition of Data

  • Dmitry Zavlin; Jürgen Schaff

• (c)

  Analysis and Interpretation of Data

  • Richard J. Wassersug; Vishwanath Chegireddy

Category 2

• (a)

  Drafting the Article

  • Dmitry Zavlin

• (b)

  Revising It for Intellectual Content

  • Richard J. Wassersug; Vishwanath Chegireddy; Jürgen Schaff; Nikolaos A. Papadopulos

Category 3

• (a)

  Final Approval of the Completed Article

  • Dmitry Zavlin; Richard J. Wassersug; Vishwanath Chegireddy; Jürgen Schaff; Nikolaos A. Papadopulos

Footnotes

Conflict of Interest: The authors report no conflicts of involvement.

Funding: None.

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Articles from Sexual Medicine are provided hither courtesy of Elsevier

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377379/

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