Doug P. VanderLaan

Evidence for an altered sex ratio in clinic-referred adolescents with gender dysphoria.

INTRODUCTION The number of adolescents referred to specialized gender identity clinics for gender dysphoria appears to be increasing and there also appears to be a corresponding shift in the sex ratio, from one favoring natal males to one favoring natal females. AIM We conducted two quantitative studies to ascertain whether there has been a recent inversion of the sex ratio of adolescents referred for gender dysphoria. METHODS The sex ratio of adolescents from two specialized gender identity clinics was examined as a function of two cohort periods (2006-2013 vs. prior years). Study 1 was conducted on patients from a clinic in Toronto, and Study 2 was conducted on patients from a clinic in Amsterdam. RESULTS Across both clinics, the total sample size was 748. In both clinics, there was a significant change in the sex ratio of referred adolescents between the two cohort periods: between 2006 and 2013, the sex ratio favored natal females, but in the prior years, the sex ratio favored natal males. In Study 1 from Toronto, there was no corresponding change in the sex ratio of 6,592 adolescents referred for other clinical problems. CONCLUSIONS Sociological and sociocultural explanations are offered to account for this recent inversion in the sex ratio of adolescents with gender dysphoria.

Avuncular Tendencies and the Evolution of Male Androphilia in Samoan Fa’afafine

The kin selection hypothesis for male androphilia holds that genes for male androphilia can be maintained in a population if the fitness costs of not reproducing directly are offset by enhancing indirect fitness. Kin share some proportion of genes identical by virtue of descent. Theoretically speaking, androphilic males can increase their fitness indirectly by allocating altruistic behavior toward kin, which, in turn, allows kin to increase their reproductive success. Research conducted in Independent Samoa has shown that androphilic males (known locally as fa’afafine) report significantly higher avuncular tendencies relative to gynephilic men. Here, we replicate this sexual orientation difference, using a larger, independent sample, suggesting that the documented sexual orientation difference in avuncular tendencies in Independent Samoa is genuine. We also extend previous research by showing that fa’afafine exhibit significantly higher avuncular tendencies even when compared to a more closely matched control group that also lacks direct parental care responsibilities (i.e., gynephilic men with no children). Although the greater avuncular tendencies of fa’afafine relative to gynephilic men are consistent with the predictions of the kin selection hypothesis for male androphilia, further research is needed before deeming male androphilia an adaptation for promoting elevated avuncularity. Likewise, more research is needed before deeming elevated avuncularity in fa’afafine an evolved adaptation for promoting indirect fitness. We discuss these findings in the context of alternative evolutionary explanations for male androphilia (i.e., an evolved by-product of an adaptation).

Behavioral and emotional problems on the teacher's report form: A cross-national, cross-clinic comparative analysis of gender dysphoric children and adolescents

For gender dysphoric children and adolescents, the school environment may be challenging due to peer social ostracism and rejection. To date, information on the psychological functioning and the quality of peer relations in gender dysphoric children and adolescents has been studied via parental report, peer sociometric methods, and social interactions in laboratory play groups. The present study was the first cross-national investigation that assessed behavior and emotional problems and the quality of peer relations, both measured by the Teacher’s Report Form (TRF), in a sample of 728 gender dysphoric patients (554 children, 174 adolescents), who were referred to specialized gender identity clinics in the Netherlands and Canada. The gender dysphoric adolescents had significantly more teacher-reported emotional and behavioral problems than the gender dysphoric children. In both countries, gender dysphoric natal boys had poorer peer relations and more internalizing than externalizing problems compared to the gender dysphoric natal girls. Furthermore, there were significant between-clinic differences: both the children and the adolescents from Canada had more emotional and behavioral problems and a poorer quality of peer relations than the children and adolescents from the Netherlands. In conclusion, gender dysphoric children and adolescents showed the same pattern of emotional and behavioral problems in both countries. The extent of behavior and emotional problems was, however, higher in Canada than in the Netherlands, which appeared, in part, an effect of a poorer quality of peer relations. Per Bronfenbrenner’s (American Psychologist, 32, 513–531, 1977) ecological model of human development and well-being, we consider various interpretations of the cross-national, cross-clinic differences on TRF behavior problems at the level of the family, the peer group, and the culture at large.

An Adaptive Cognitive Dissociation Between Willingness to Help Kin and Nonkin in Samoan Fa’afafine

Androphilia refers to sexual attraction and arousal to adult males, whereas gynephilia refers to sexual attraction and arousal to adult females. Previous research has demonstrated that Samoan male androphiles (known locally as fa’afafine) exhibit significantly higher altruistic tendencies toward nieces and nephews than do Samoan women and gynephilic men. The present study examined whether adaptive design features characterize the psychological mechanisms underlying fa’afafine’s elevated avuncular tendencies. The association between altruistic tendencies toward nieces and nephews and altruistic tendencies toward nonkin children was significantly weaker among fa’afafine than among Samoan women and gynephilic men. We argue that this cognitive dissociation would allow fa’afafine to allocate resources to nieces and nephews in a more economical, efficient, reliable, and precise manner. These findings are consistent with the kin selection hypothesis, which suggests that androphilic males have been selected over evolutionary time to act as “helpers-in-the-nest,” caring for nieces and nephews and thereby increasing their own indirect fitness.

Autism Spectrum Disorder Risk Factors and Autistic Traits in Gender Dysphoric Children

Gender dysphoria (GD) and autism spectrum disorder (ASD) are associated. In 49 GD children (40 natal males), we examined ASD risk factors (i.e., birth weight, parental age, sibling sex ratio) in relation to autistic traits. Data were gathered on autistic traits, birth weight, parents’ ages at birth, sibling sex ratio, gender nonconformity, age, maternal depression, general behavioral and emotional problems, and IQ. High birth weight was associated with both high gender nonconformity and autistic traits among GD children. Developmental processes associated with high birth weight are, therefore, likely to underlie the GD–ASD link either directly or indirectly. The present study is the first to provide quantitative data bearing on possible mechanisms that lead GD and ASD to co-occur.

Male Androphilia in the Ancestral Environment

The kin selection hypothesis posits that male androphilia (male sexual attraction to adult males) evolved because androphilic males invest more in kin, thereby enhancing inclusive fitness. Increased kin-directed altruism has been repeatedly documented among a population of transgendered androphilic males, but never among androphilic males in other cultures who adopt gender identities as men. Thus, the kin selection hypothesis may be viable if male androphilia was expressed in the transgendered form in the ancestral past. Using the Standard Cross-Cultural Sample (SCCS), we examined 46 societies in which male androphilia was expressed in the transgendered form (transgendered societies) and 146 comparison societies (non-transgendered societies). We analyzed SCCS variables pertaining to ancestral sociocultural conditions, access to kin, and societal reactions to homosexuality. Our results show that ancestral sociocultural conditions and bilateral and double descent systems were more common in transgendered than in non-transgendered societies. Across the entire sample, descent systems and residence patterns that would presumably facilitate increased access to kin were associated with the presence of ancestral sociocultural conditions. Among transgendered societies, negative societal attitudes toward homosexuality were unlikely. We conclude that the ancestral human sociocultural environment was likely conducive to the expression of the transgendered form of male androphilia. Descent systems, residence patterns, and societal reactions to homosexuality likely facilitated investments in kin by transgendered males. Given that contemporary transgendered male androphiles appear to exhibit elevated kin-directed altruism, these findings further indicate the viability of the kin selection hypothesis.

Male Sexual Orientation and Avuncularity in Canada: Implications for the Kin Selection Hypothesis

Androphilia refers to sexual attraction and arousal to adult males, whereas gynephilia refers to sexual attraction and arousal to adult females. The Kin Selection Hypothesis (KSH) posits that genes for male androphilia can persist if androphilic males offset the fitness costs of not reproducing directly by enhancing indirect fitness. In theory, by directing altruistic behavior toward kin, androphilic males can increase the reproduction of kin, thereby enhancing indirect fitness. Evidence supporting the KSH has been documented in Samoa. Samoan transgendered, androphilic males, known locally as fa’afafine, are socially accepted by the majority of Samoans. In contrast, no supportive evidence has been garnered from other cultures (i.e., USA, UK, Japan) that are characterized by less social tolerance toward male androphiles. Tests of the KSH in Canada might be more likely to yield findings consistent with Samoa because Canadian social and political attitudes toward male androphiles are markedly more tolerant and accepting. Here, we compared the willingness of Canadian androphilic men, gynephilic men, and androphilic women to invest in nieces and nephews as well as in non-kin children. Consistent with the KSH and findings from Samoa, androphilic men exhibited a significantly greater cognitive dissociation between altruistic tendencies directed toward kin versus non-kin children relative to gynephilic men and androphilic women. The present study, therefore, provides some tentative support for the KSH from a culture other than Samoa. Findings and future directions for research are considered within the context of the existing cross-cultural literature.

Do Children With Gender Dysphoria Have Intense/Obsessional Interests?

This study examined whether children clinically referred for gender dysphoria (GD) show increased symptoms of autism spectrum disorder (ASD). Circumscribed preoccupations or intense interests were considered as overlapping symptoms expressed in GD and ASD. In gender-referred children (n = 534; 82.2% male) and their siblings (n = 419; 57.5% male), we examined Items 9 and 66 on the Child Behavior Checklist, which measure obsessions and compulsions, respectively. Non-GD clinic-referred (n = 1,201; 48.5% male) and nonreferred (n = 1,201; 48.5% male) children were also examined. Gender-referred children were elevated compared to all other groups for Item 9, and compared to siblings and nonreferred children for Item 66. A gender-related theme was significantly more common for gender-referred boys than male siblings on Item 9 only. A gender-related theme was not significantly more common for gender-referred girls compared to their female siblings on either item. The findings for Item 9 support the idea that children with GD show an elevation in obsessional interests. For gender-referred boys in particular, gender-related themes constituted more than half of the examples provided by their mothers. Intense/obsessional interests in children with GD may be one of the factors underlying the purported link between GD and ASD.

Self-Harm and Suicidality in Children Referred for Gender Dysphoria

OBJECTIVE This study examined rates of self-harm and suicidality (ideation and behavior) in children referred clinically for gender dysphoria compared with their siblings, and referred and nonreferred children from the Child Behavior Checklist (CBCL) standardization sample. Predictors or correlates of self-harm/suicidality were also examined. METHOD The sample consisted of 572 gender-referred children, 425 siblings, 878 referred children, and 903 nonreferred children. Parent report for 2 CBCL items was used to assess self-harm and suicidality. CBCL total behavior problems and a metric of peer relationship problems were also used. RESULTS The gender-referred children and the referred children from the standardization sample had significantly higher scores than siblings and nonreferred children in terms of self-harm/suicidality, total behavior problems, and poor peer relations. Based on logistic regression analyses, gender-referred children were 5.1 times more likely than nonreferred children to talk about suicide and 8.6 times more likely to self-harm/attempt suicide, even after overall behavior problems and peer relationship problems were accounted for. In the final models, group, older age, and more total behavior problems, but not poor peer relations, were significantly associated with an increased likelihood of self-harm/suicidality. CONCLUSION By parent report, children with gender dysphoria show an increased rate of self-harm/suicidality as they get older. This risk was not simply an artifact of the presence of behavioral and emotional problems, although these problems were significant correlates of self-harm/suicidality. Clinicians should routinely screen for the presence of suicidal ideation and behavior in children with gender dysphoria, particularly during the second half of childhood.

Sexual Orientation in Men and Avuncularity in Japan: Implications for the Kin Selection Hypothesis

The kin selection hypothesis for male androphilia posits that genes for male androphilia can be maintained in the population if the fitness costs of not reproducing directly are offset by enhancing inclusive fitness. In theory, androphilic males can increase their inclusive fitness by directing altruistic behavior toward kin, which, in turn, allows kin to increase their reproductive success. Previous research conducted in Western countries (U.S., UK) has failed to find any support for this hypothesis. In contrast, research conducted in Samoa has provided repeated support for it. In light of these cross-cultural differences, we hypothesized that the development of elevated avuncular (i.e., altruistic uncle-like) tendencies in androphilic males may be contingent on a relatively collectivistic cultural context. To test this hypothesis, we compared data on the avuncular tendencies and altruistic tendencies toward non-kin children of childless androphilic and gynephilic men in Japan, a culture that is known to be relatively collectivistic. The results of this study furnished no evidence that androphilic Japanese men exhibited elevated avuncular tendencies compared to their gynephilic counterparts. Moreover, there was no evidence that androphilic men’s avuncular tendencies were more optimally designed (i.e., were more dissociated from their altruistic tendencies toward non-kin children) compared to gynephilic men. If an adaptively designed avuncular male androphilic phenotype exists and its development is contingent on a particular social environment, then the research presented here suggests that a collectivistic cultural context is insufficient, in and of itself, for the expression of such a phenotype.