Rhoda Gruen

Gender Change from Female to Male in Classical Congenital Adrenal Hyperplasia

The psychoendocrinology of the development of normal gender identity and its variations is poorly understood. Studies of gender development in individuals born with endocrinologically well-characterized intersex conditions are heuristically valuable for the disaggregation of factors that are acting in concert during normal development. Four 46,XX individuals with classical congenital adrenal hyperplasia (CAH) and atypical gender identity entered a comprehensive research protocol including systematic interviews and self-report inventories on gender role behavior and identity, sexual history, and psychiatric history. Some of the data on gender variables were compared to data from 12 CAH women with the salt-wasting variant (CAH-SW) with female gender identity. The four patients (ages 28, 35, 38, and 30 years) represented three different subtypes of classical early-onset CAH: 21-OH deficiency, simple virilizing (CAH-SV); 21-OH deficiency, salt-wasting (CAH-SW); and 11-beta-OH deficiency. Their medical histories were characterized by delay beyond infancy or lack of surgical feminization of the external genitalia and progressive virilization with inconsistent or absent glucocorticoid replacement therapy. Although three patients had undergone one or more genital surgeries, all had retained at least some orgasmic capacity. In regard to childhood gender-role behavior, the four gender-change patients tended to be more masculine or less feminine than (behaviorally masculinized) CAH-SW controls. All patients were sexually attracted to females only. The process of gender change was gradual and extended well into adulthood. The most plausible factors contributing to cross-gender identity development in these patients appeared to be neither a particular genotype or endocrinotype nor a sex-typing bias on the part of the parents but a combination of a gender-atypical behavioral self-image, a gender-atypical body image, and the development of erotic attraction to women. Implications for psychosocial management are also discussed.

The Schedule for Schizotypal Personalities (SSP): A diagnostic interview for schizotypal features

The validity and reproducibility of psychiatric diagnosis are crucial to psychiatric research. To establish confidence in assigning schizotypal features, three paradigms estimating the reliability of a new instrument, the Schedule for Schizotypal personalities (SSP), were tested. The first paradigm considered joint, but independent evaluations made by two raters simultaneously. The second paradigm assessed evaluations on different occasions, with a mean interim time of 5.9 months (test-retest procedure). Both reliability paradigms demonstrated high levels of agreement for all of the scaled items. Ninety percent of the intraclass correlation coefficients were 0.80 or better for the joint evaluations, and 70% were 0.80 or better for the test-retest evaluation. The third paradigm measured the reliability of DSM-III Schizotypal Personality Disorder. The kappa value for measuring diagnostic agreement was 0.88. The authors recommend the use of the SSP as an interview schedule and discuss the implications of their findings for genetic and biological research of schizophrenia spectrum disorders.

Prenatal Estrogens and the Development of Homosexual Orientation.

In psychobiological research on sexual orientation, the prenatal hormone theory has a central posi tion. This article examines the hypothesis that prenatal estrogens contribute to the development of human sexual orientation. Several groups of women with a history of prenatal exposure to diethyl stilbestrol (DES), a nonsteroidal synthetic estrogen, were compared with several samples of control women in the context of a comprehensive study of the psychiatric and psychologic effects of prenatal DES. Various aspects of sexual orientation were assessed by systematic interview. Consistently across samples, more DES-exposed women than controls were rated as bisexual or homosexual (scores 2-6 on Kinsey-format scales ranging from 0 to 6). The data are compatible with the hypothesis that prenatal estrogens may play a role in the development of human sexual orientation

Lifetime sexual behaviors among runaway males and females

Lifetime sexual behaviors were examined among 206 male and female runaway adolescents aged 11–18 in New York City who were predominantly Black or Hispanic. Most youths experienced oral, anal or vaginal sex with opposite‐sex partners (84%), began to engage in these heterosexual activities at a relatively young age (M = 12.9 years), and used condoms inconsistently or not at all (56%). Among sexually active youths, males initiated heterosexual activity at a significantly earlier age than females, reported more opposite‐sex partners, and had a higher prevalence rate of trading sex for money or drugs. These findings indicate specific areas for targeting AIDS prevention programs for runaway youths.

Psychopathology and social functioning in women with Turner syndrome.

Turner syndrome (TUS) in women is associated with sex chromosome abnormalities, ovarian dysgenesis with estrogen deficiency, and short stature. The goal of this study was to assess the long-term effects of these sex chromosome and hormonal anomalies on psychopathology and social functioning. We report interview and questionnaire data concerning lifetime history of mental disorders and current psychiatric symptoms. Also reported are data from questionnaires and interviews evaluating social functioning as measured by education, occupation, personal resources, and sexual behavior. Twenty-three TUS women were studied and compared with 23 closely matched women with constitutional short stature (CSS) and with 10 normal sisters of the TUS women. TUS women reported generally less mental disorder and comparable rates of psychiatric symptoms. On the other hand, they had lower overall functioning on a measure of global psychological health and had more impairment in social functioning as measured by achievement of adult milestones. We conclude that TUS women display less mental illness by positive symptom-oriented criteria but also less mental health when day-to-day functioning is considered. Our data suggest that differences in TUS women cannot be explained solely by short stature and may be related to other psychosocial, genetic, endocrine, or CNS effects of the syndrome.

Sexual functioning in HIV+ and HIV- injected drug-using women.

As part of a natural history study of HIV disease in injected drug users, 38 HIV positive (HIV+) asymptomatic or low-symptomatic women and 37 HIV negative (HIV-) women, mostly of minority inner-city background, underwent a comprehensive survey of sexual functioning. At study baseline, the sample as a whole showed a relatively high prevalence of problems in all major phases of the sexual response cycle and in vaginismus and vaginal pain. Statistically significant group differences indicate higher rates of problems in sexual functioning in HIV+ women even at an early stage of disease progression.

Assortative mating in affective disorders

Assortative mating was determined in 170 spouses of patients with major affective illness (bipolar and unipolar). An increase in affective disorders was found in both wives of affected men and husbands of affected women. The data suggest that assortative mating is present in the familial transmission of affective disorder.

High Affinity 3H-Imipramine Binding in Human Platelets: Age and Sex Effects

Age and sex effects on 3H-imipramine platelet binding sites were determined in 58 normal subjects (27 males, 31 females). The correlation of age with either the maximal imipramine binding (Bmax) or the dissociation constant (Kd) was statistically nonsignificant in both males and females. Males did not differ from females in Bmax and Kd values. The implications for psychiatric research were discussed.

Age-of-Onset in Schizophrenia and Schizotypal Disorders

Age-of-onset data were gathered on 93 chronic schizophrenic probands and 57 affected (mainly schizotypal) siblings. 55% of affected individuals were ill before age 20 and 14% had their onset before age 14. The risk period for schizophrenia and schizotypal personality disorders terminated at age 40. Age-of-onset did not distinguish paranoid from nonparanoid schizophrenics, or definite from probable schizotypal personalities. Schizophrenic and schizotypal subjects were similar in their age-of-onset patterns. Sex effect on age-of-onset was not present. A square-root normal distribution gave the best fit to the data. The implications of these findings for schizophrenia research were discussed.

Gender role development in two clinical syndromes: Turner syndrome versus constitutional short stature.

Abstract Turner syndrome (TUS) in girls causes sex chromosome abnormalities, ovarian dysgenesis with estrogen deficiency, and short stature. The goal of this study was to assess the long-term effects of sex chromosome and hormonal anomalies on female gender role development. The authors report data from an interview assessing gender role development in 23 TUS women, compared with 23 closely matched women with constitutional short stature and with 10 normal sisters of the TUS women. The results show more stereotypic feminine behavior in childhood, adolescence, and adulthood in the TUS subjects. The authors conclude that the clinical features of TUS do not impede normal female gender development. Furthermore, the data suggest that the tendency to greater femininity in TUS women cannot be explained solely by short stature and may be related to other psychosocial, endocrine, or brain effects of the syndrome.