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2018-11-11

Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups

Journal of Autism and Developmental Disorders
December 2018, Volume 48, Issue 12

Gender Identity in Autism: Sex Differences in Social Affiliation with Gender Groups

Kate Cooper,Laura G.E.Smith,Ailsa J.Russell

Abstract

High rates of gender variance have been reported in autistic people, with higher variance in autistic females than males. The social component of gender identity may be affected, with autistic females experiencing lower identification with and feeling less positively about their gender groups than controls. We measured gender identification, gender self-esteem, and aspects of gender expression (masculinity and femininity) in autistic natal males and females, and controls (N = 486). We found that autistic people had lower gender identification and gender self-esteem than controls, and autistic natal females had lower gender identification than autistic natal males and natal female controls. In conclusion, autistic people, particularly natal females, had lower social identification with and more negative feelings about a gender group.

Keywords
Gender Social identity Self-esteem Sex differences Autism Adults

Autistic Traits in Treatment-Seeking Transgender Adults

Journal of Autism and Developmental Disorders
December 2018, Volume 48, Issue 12

Autistic Traits in Treatment-Seeking Transgender Adults

Anna NobiliCris Glazebrook Walter Pierre Bouman,Derek Glidden,Simon Baron-Cohen,Carrie Allison,Paula Smith,Jon Arcelus

Abstract

The present study aimed to compare prevalence of autistic traits measured by the self-reported autism spectrum quotient-short (AQ-short) in a transgender clinical population (n = 656) matched by age and sex assigned at birth to a cisgender community sample. Results showed that transgender and cisgender people reported similar levels of possible autistic caseness. Transgender people assigned female were more likely to have clinically significant autistic traits compared to any other group. No difference was found between those assigned male. High AQ scores may not be indicative of the presence of an autism spectrum condition as the difference between groups mainly related to social behaviours; such scores may be a reflection of transgender people’s high social anxiety levels due to negative past experiences.

Keywords
Autism spectrum conditions Autistic traits Transgender Autism spectrum quotient (AQ) Social issues Social anxiety

At the Intersection of Neurodiversity and Gender Diversity

Journal of Autism and Developmental Disorders
December 2018, Volume 48, Issue 12, pp 3973–3973

At the Intersection of Neurodiversity and Gender Diversity

Gerrit Ian van Schalkwyk

The intersection of gender diversity and neurodiversity is a focus of considerable interest, discussion, and research. As reflected in the contents of this special issue, literature has explored this intersection both clinically and conceptually. The opinions, integrations, and new data presented in this volume support the presence of a complex relationship between gender diversity and neurodiversity, but suggest that the common framing of gender dysphoria and autism spectrum disorder being ‘comorbid’ is limited. As described in the letter by Diane Ehrensaft, individuals who are both gender and neurodiverse bring to life new conceptualizations of gender as fluid and intersectional. This articulates with the hypothesis that gender diversity is an expected outcome in individuals who are less contingent on social information for identity development. Correspondingly, Jack Turban argues as to the potential for gender diverse youth to have reversible challenges with social functioning related to their experience of minority stress, potentially limiting the value of screening and diagnostic instruments to make strict, categorical statements.

The important work by Nobili et al. is unique in this literature by its inclusion of a control group—remarkably, autism caseness based on Autism Quotient scores was found to be comparable in both the transgender and cisgender group, although the subgroup of transgender individuals assigned female at birth were twice as likely to have clinically significant scores. Consistent with the argument made by Turban, this difference was related mainly to the presence of additional social difficulties in this group, highlighting both the limitations of screening instruments, and the need for more detailed conceptualizations that better capture the complexity of these youths’ experience and identity.

Where better to start than with the individuals themselves? Strang et al. describe a remarkable study that sought to understand the experience of gender in youth with diagnoses of Autism Spectrum Disorder through an in-depth qualitative approach. The participants are given a clear voice in a study that emphasized the challenges of both defining and communicating gender identity for neurodiverse youth, and the need for clinicians to create supportive spaces in which this can occur. Participants showed discomfort at simplistic reframing of their gender as a superficial ‘obsession,’ describing an altogether different and more complex character for their gender experiences.

Additional manuscripts in this issue describe a range of related issues, including sexual orientation, gender differences and ASD symptoms, and gender preferences in friendships for children with ASD. Overall, this special issue touches on key themes at the intersection of gender and ASD and should prove to be an invaluable resources to clinicians and researchers hoping to further their understanding in this area. It is clear that gender is an important issue in understanding neurodiversity, and that individuals who are neurodiverse may place importance on gender. Further work is needed to understand how these individuals may be best supported, but enough is known to provide a clear impetus for a clinical approach rooted in the knowledge that neurodiverse youth may have complex gender narratives that warrant affirmation and support.

2018-10-10

Gender identity in patients with 5-alpha reductase deficiency raised as females.

J Pediatr Urol. 2018 Sep 5. pii: S1477-5131(18)30499-6. doi: 10.1016/j.jpurol.2018.08.021. [Epub ahead of print]

Gender identity in patients with 5-alpha reductase deficiency raised as females.

Nascimento RLP1, de Andrade Mesquita IM1, Gondim R1, Dos Apóstolos RAAC1, Toralles MB1, de Oliveira LB1, Canguçu-Campinho AK1, Barroso U Jr2.

Author information ブラジル

Abstract

BACKGROUND AND OBJECTIVE:

5-Alpha reductase type 2 deficiency (5-ARD) is a rare disorder of sex development. The lack of 5-alpha reductase, an enzyme that converts testosterone into dihydrotestosterone, results in external genitalia that may appear female, or predominantly male, albeit undervirilized, or, more often, ambiguous.

METHODS:

This study describes a series of patients with 5-ARD raised as female, focusing on aspects related to gender identity. Following a retrospective chart review, patients with 5-ARD were invited to return to the clinic to enable their gender identity to be assessed using an 11-item structured in-house questionnaire. The Golombok-Rust Inventory of Sexual Satisfaction was applied to patients who had initiated their sexual life.

RESULTS:

Six patients aged >15 years with 5-ARD and raised as female were included. Most patients were diagnosed late: two before and four after puberty. The mean length of the phallus was 2.8 cm (0.5-5.0). Reasons for seeing a doctor included genital appearance (n = 3), amenorrhea/absence of breast development (n = 2), and changes in gender role attitudes (n = 1). According to the gender identity assessment, 4 patients identified as female, 1 as male, and 1 as both genders. Only the patient identified as male requested gender re-assignment. Of the two patients who had initiated their sexual life, sexual satisfaction was found to be good in one and poor in the other due to vaginal discomfort during intercourse.

CONCLUSION:

In the present series, the majority of undervirilized patients with a diagnosis of 5-ARD raised as female were in complete conformation with being female and described themselves as heterosexual. The more virilized patients were those least in conformity with their female-assigned gender.

Copyright © 2018. Published by Elsevier Ltd.


KEYWORDS:
5-Alpha reductase deficiency; Ambiguous genitali; Disorder of sex development; Gender; Gender identity; Intersex

2018-10-08

Gender Identity and Sexual Function in 46,XX Patients with Congenital Adrenal Hyperplasia Raised as Males.

Arch Sex Behav. 2018 Oct 5. doi: 10.1007/s10508-018-1299-z. [Epub ahead of print]

Gender Identity and Sexual Function in 46,XX Patients with Congenital Adrenal Hyperplasia Raised as Males.

Apóstolos RAC1,2, Canguçu-Campinho AK1, Lago R1, Costa ACS2, Oliveira LMB1, Toralles MB1, Barroso U Jr3,4.

Author information ブラジル


Abstract

In individuals with congenital adrenal hyperplasia (CAH) and 46,XX karyotype, androgens produced by the adrenal glands during the intrauterine development promote virilization of the genitals, which may even result in the development of a well-formed penis. Some of these children with late diagnosis are registered as males after birth. After obtaining approval from the internal review board, we evaluated gender identity and sexual function in four 46,XX severely virilized patients with CAH, who were originally registered and raised as males, assisted in our Disorders of Sexual Development Clinic. The evaluation consisted of questionnaires to assess gender identity and sexual activity and interview with the multidisciplinary team that provides care for these patients. The patients underwent surgery to remove uterus, ovaries, and remaining vaginal structures, in addition to implantation of testicular prosthesis and correction of hypospadias, when necessary. All four patients have developed a clear male gender identity, and when evaluated for sexual activity, they have reported having erections, libido, orgasms, and sexual attraction to women only. Two of these 4 patients had satisfactory sexual intercourses when assessed using the International Index of Erectile Function questionnaire. The other two patients who never had sexual intercourse reported not having a partner for sexual activity; one is 18 years old, and the other is 14 years old. This study showed that this group of 46,XX severely virilized patients with CAH, registered and raised as males, adapted well to the assigned male gender, with satisfactory sexual function in patients who had sexual intercourse.


KEYWORDS:

Congenital adrenal hyperplasia; Disorders of sex development; Gender identity; Intersex

2018-09-02

Psychosocial and psychosexual aspects of disorders of sex development.

Best Pract Res Clin Endocrinol Metab. 2010 Apr;24(2):325-34. doi: 10.1016/j.beem.2009.11.005.

Psychosocial and psychosexual aspects of disorders of sex development.

Cohen-Kettenis PT

Author information
Department of Medical Psychology, VU University, PO Box 7057, 1007 MB Amsterdam, The Netherlands. pt.cohen-kettenis@vumc.nl

Abstract

Psychosocial aspects of the treatment of disorders of sex development (DSDs) concern gender assignment, information management and communication, timing of medical interventions, consequences of surgery, and sexuality. Although outcome is often satisfactory, a variety of medical and psychosocial factors may jeopardise the psychological development of children with DSDs. This sometimes results in the desire to change gender later in life. The clinical management of gender dysphoria in individuals with DSD may profit from methods and insights that have been developed for gender dysphoric individuals without DSD. In DSD care, clinical decisions are often made with long-lasting effects on quality of life and should be based on empirical evidence. Yet, such evidence (e.g., regarding gender assignment, information management and timing of surgery) is largely non-existent. DSD-specific protocols and educational materials need to be developed to standardise and evaluate interventions in order to facilitate decision making of professionals and individuals with DSD and enhance psychosocial care in this area.

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2018-08-02

How the Child's Gender Matters for Families Having a Child With Congenital Adrenal Hyperplasia.

J Fam Nurs. 2017 Nov;23(4):516-533. doi: 10.1177/1074840717735499. Epub 2017 Oct 19.

How the Child’s Gender Matters for Families Having a Child With Congenital Adrenal Hyperplasia.

Fleming L1, Knafl K1, Van Riper M1.

Author information
11 University of North Carolina at Chapel Hill School of Nursing, USA.

Abstract

Children with congenital adrenal hyperplasia (CAH) are exposed to high levels of testosterone in utero often resulting in nontypical genitalia at birth for girls. The purpose of this analysis, which draws on data from a larger study, was to examine, based on the gender of the child, the family experiences of having a child with CAH. Sixteen parents were interviewed, and comparisons were made across all categories coded in the parents' interviews to examine similarities and differences in the experiences of families based on the child's gender. Families having a daughter with CAH experienced additional challenges when compared with families having a son. These include fear of stigmatization, challenging surgical decisions, and concerns regarding disclosure of the condition. Acknowledging this and creating support programs tailored for girls that address surgical procedures and complications resulting from being born with elevated testosterone are critical to promoting a healthy family and child response.


KEYWORDS:

congenital adrenal hyperplasia; family management; nontypical genitalia