Esalba Silveira

Clinical Characteristics, Psychiatric Comorbidities and Sociodemographic Profile of Transsexual Patients from an Outpatient Clinic in Brazil

ABSTRACT Objective: To provide a description of our transsexual population. Method: This descriptive observational study included 138 patients with a diagnosis of Trans-sexualism in Brazil, between March 1998 and September 2005. Demographic, clinical and psychiatry data were collected. Results: Age ranged from 16 to 54 years; 88.4% were male. The prevalence of sexually transmitted diseases was 19.5%, and 17.6% were HIV-positive. Hormone therapy was reported by 91.2%, and 47.4% referred drug and alcohol use; 14.2%, attempted suicide; and 12.5%, history of sexual abuse. Self-mutilation was reported by 5.2%s. Fifty-nine patients (42.7%) had at least one currently psychiatric comorbidity (axis I or II). Conclusions: Mental health professionals have a central role in coordinating the multidisciplinary care of transsexuals.

Serum concentrations of brain-derived neurotrophic factor in patients with gender identity disorder

Gender Identity Disorder (GID) is characterized by a strong and persistent cross-gender identification that affects different aspects of behavior. Brain-derived neurotrophic factor (BDNF) plays a critical role in neurodevelopment and neuroplasticity. Altered BDNF-signaling is thought to contribute to the pathogenesis of psychiatric disordersand is related to traumatic life events. To examine serum BDNF levels, we compared one group of DSM-IV GID patients (n = 45) and one healthy control group (n = 66). Serum BDNF levels were significantly decreased in GID patients (p = 0.013). This data support the hypothesis that the reduction found in serum BDNF levels in GID patients may be related to the psychological abuse that transsexuals are exposed during their life.

Minimum 2-year follow up of sex reassignment surgery in Brazilian male-to-female transsexuals.

general fatigue were resolved after a switch to blonanserin. Hypoglycemia was not detected on Day 167 following a 75-g OGTT. Her auditory hallucinations and persecutory delusions were improved (BPRS score: 21), therefore she was discharged on Day 180. Because complaints of hypoglycemia are similar to the sedative effect of SGA, clinicians may overlook hypoglycemia in patients with schizophrenia. We previously reported another case of hypoglycemia induced by quetiapine. In that case, replacement of quetiapine with perospirone improved the symptoms of hypoglycemia but asymptomatic hypoglycemia was still present upon repeat OGTT. In the current case, a switch to blonanserin improved not only the symptoms of hypoglycemia but also hypoglycemia itself upon repeat OGTT. Because blonanserin is a new antipsychotic, its effect on glucose metabolism has not been established. However, this report suggests that a switch to blonanserin may be useful when hypoglycemia induced by SGA occurs.

WHOQOL-100 Before and After Sex Reassignment Surgery in Brazilian Male-to-Female Transsexual Individuals

INTRODUCTION The 100-item World Health Organization Quality of Life Assessment (WHOQOL-100) evaluates quality of life as a subjective and multidimensional construct. Currently, particularly in Brazil, there are controversies concerning quality of life after sex reassignment surgery (SRS). AIM To assess the impact of surgical interventions on quality of life of 47 Brazilian male-to-female transsexual individuals using the WHOQOL-100. METHODS This was a prospective cohort study using the WHOQOL-100 and sociodemographic questions for individuals diagnosed with gender identity disorder according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The protocol was used when a transsexual person entered the ambulatory clinic and at least 12 months after SRS. MAIN OUTCOME MEASURES Initially, improvement or worsening of quality of life was assessed using 6 domains and 24 facets. Subsequently, quality of life was assessed for individuals who underwent new surgical interventions and those who did not undergo these procedures 1 year after SRS. RESULTS The participants showed significant improvement after SRS in domains II (psychological) and IV (social relationships) of the WHOQOL-100. In contrast, domains I (physical health) and III (level of independence) were significantly worse after SRS. Individuals who underwent additional surgery had a decrease in quality of life reflected in domains II and IV. During statistical analysis, all results were controlled for variations in demographic characteristics, without significant results. CONCLUSION The WHOQOL-100 is an important instrument to evaluate the quality of life of male-to-female transsexuals during different stages of treatment. SRS promotes the improvement of psychological aspects and social relationships. However, even 1 year after SRS, male-to-female transsexuals continue to report problems in physical health and difficulty in recovering their independence.

Using the Defensive Style Questionnaire to evaluate the impact of sex reassignment surgery on defensive mechanisms in transsexual patients

OBJECTIVE To evaluate the impact of sex reassignment surgery on the defense mechanisms of 32 transsexual patients at two different points in time using the Defensive Style Questionnaire. METHOD The Defensive Style Questionnaire was applied to 32 patients upon their admission to the Gender Identity Disorder Program, and 12 months after they had undergone sex reassignment surgery. RESULTS There were changes in two defense mechanisms: anticipation and idealization. However, no significant differences were observed in terms of the mature, neurotic and immature categories. DISCUSSION One possible explanation for this result is the fact that the procedure does not resolve gender dysphoria, which is a core symptom in such patients. Another aspect is related to the early onset of the gender identity disorder, which determines a more regressive defensive structure in these patients. CONCLUSION Sex reassignment surgery did not improve the defensive profile as measured by the Defensive Style Questionnaire.

BDNF: a biomarker for social vulnerability in individuals diagnosed with gender dysphoria.

Fuss and colleagues discussed in a review the role of brainderived neurotrophic factor (BDNF) in gender identity disorder, now gender dysphoria (GD) (Fuss et al., 2013). In this work, the authors highlighted some aspects of our article (Fontanari et al., 2013) stating that we conclude that BDNF might be a biomarker for GD. We thank Fuss and colleagues for emphasizing important topics of our article. However, we do not agree with some of their assessments. By comparing a group of GD patients (n 1⁄4 45) with a control group (n 1⁄4 66), our study found that the serum BDNF levels were significantly decreased in individuals diagnosed with GD (Fontanari et al., 2013). Decreased serum BDNF levels were also associatedwith childhood traumatic events in patients with bipolar disorder (BD) (Kauer-Sant’Anna et al., 2007). In this study, Kauer-

Discordant Transsexualism in Male Monozygotic Twins: Neuroanatomical and Psychological Differences

One monozygotic male twin pair discordant for transsexualism is described. Both twins were interviewed and tested with the Wechsler Adult Intelligence Scale battery for cognitive functions and they underwent magnetic resonance imaging to measure the volumes of specific cerebral structures. Interviews with the twins and their mother indicated no unusual medical or life history events that could have had a causal role in the emergence of the disorder. Both cognitive function testing and neuroimaging detected differences between the twins that could be related to unexplained epigenetic effects and exogenous hormone usage.