Apparent autistic traits in transgender people: a prospective study of the impact of gender-affirming hormonal treatment.

PURPOSE: We evaluated differences in Autism Spectrum Quotient (AQ) scores between a sample of hormone-naïve transgender and cisgender people and the impact of gender-affirming hormonal treatment (GAHT) on AQ scores across time. Furthermore, we assessed alexithymia and social anxiety as possible mediators of changes in AQ scores. METHODS: A cross-sectional comparison between cisgender and transgender people before GAHT and a prospective study on the effects of GAHT over time were performed. Transgender and cisgender people completed several psychometric tests. A total sample of 789 persons (n = 229 cismen; n = 172 ciswomen; n = 206 transmen; n = 182 transwomen) referring to the Florence and Rome Gender Clinics between 2018 and 2020 was enrolled. Of these, 62 participants referring to the Florence Gender Clinic were evaluated in a prospective study at baseline and 12 months after GAHT. RESULTS: Groups showed significant differences in terms of autistic traits: ciswomen showed lower scores of AQ, while cismen reported higher scores of AQ than all other groups. Transgender individuals showed significant higher levels of Gender Dysphoria (GD), body uneasiness, alexithymia and social anxiety, compared to cisgender ones. No significant differences in general psychopathology were found between groups. Across time, transmen and transwomen showed a significant reduction in AQ scores. The decrease in alexithymia and social anxiety after GAHT did not predict the change in AQ scores. CONCLUSIONS: The autistic traits in our sample may represent an epiphenomenon of GD rather than being part of an Autism Spectrum Disorder (ASD) condition, since they significantly decreased after 12 months of GAHT.

SIGIS-SIAMS-SIE position statement of gender affirming hormonal treatment in transgender and non-binary people.

PURPOSE: Gender Incongruence (GI) is a marked and persistent incongruence between an individual's experienced and the assigned gender at birth. In the recent years, there has been a considerable evolution and change in attitude as regards to gender nonconforming people. METHODS: According to the Italian Society of Gender, Identity and Health (SIGIS), the Italian Society of Andrology and Sexual Medicine (SIAMS) and the Italian Society of Endocrinology (SIE) rules, a team of experts on the topic has been nominated by a SIGIS-SIAMS-SIE Guideline Board on the basis of their recognized clinical and research expertise in the field, and coordinated by a senior author, has prepared this Position statement. Later on, the present manuscript has been submitted to the Journal of Endocrinological Investigation for the normal process of international peer reviewing after a first internal revision process made by the SIGIS-SIAMS-SIE Guideline Board. RESULTS: In the present document by the SIGIS-SIAMS-SIE group, we propose experts opinions concerning the psychological functioning, gender affirming hormonal treatment, safety concerns, emerging issues in transgender healthcare (sexual health, fertility issues, elderly trans people), and an Italian law overview aimed to improve gender non-conforming people care. CONCLUSION: In this Position statement, we propose experts opinions concerning the psychological functioning of transgender people, the gender-affirming hormonal treatment (full/partial masculinization in assigned female at birth trans people, full/partial feminization and de-masculinization in assigned male at birth trans people), the emerging issues in transgender health care aimed to improve patient care. We have also included an overview of Italian law about gender affirming surgery and registry rectification.

Transition memories: experiences of trans adult women with hormone therapy and their beliefs on the usage of hormone blockers to suppress puberty.

PURPOSE: In recent years, an increasing number of specialized gender clinics have been prescribing gonadotropin-releasing hormone (GnRH) analogs to adolescents diagnosed with gender dysphoria (GD) to suppress puberty. This paper presents qualitative research on the hormone therapy (HT) experiences of older trans-people and their views on puberty suppression. The main aim of this research was to explore the psychological aspects of hormonal treatments for gender non-conforming adults, including the controversial use of puberty suppression treatments. METHODS: Using a semi-structured interview format, ten adult trans-women were interviewed (mean age: 37.4) to explore their personal histories regarding GD onset and development, their HT experiences, and their views on the use of GnRH analogs to suppress puberty in trans-children and adolescents. RESULTS: the interview transcripts were analyzed using the consensual qualitative research method from which several themes emerged: the onset of GD, childhood experiences, experiences with puberty and HT, views on the puberty suspension procedure, and the effects of this suspension on gender identity and sexuality. CONCLUSIONS: The interviews showed that overall, the participants valued the new treatment protocol due to the opportunity to prevent the severe body dysphoria and social phobia trans-people experience with puberty. It seems that the risk of social isolation and psychological suffering is increased by the general lack of acceptance and stigma toward trans-identities in the Italian society. However, during gender transitions, they highlight the need to focus more on internal and psychological aspects, rather than over-emphasize physical appearance. This study gives a voice to an under-represented group regarding the use of GnRH analogs to suppress puberty in trans-individuals, and collected firsthand insights on this controversial treatment and its recommendations in professional international guidelines.

An fMRI study on the neural correlates of social conformity to a sexual minority.

Social conformity refers to the tendency to align one's own behaviors, beliefs and values to those of others. Little is known about social influence coming from a minority group. To test whether social pressure from sexual minorities triggers avoidance-motivated behaviors, we explored how being influenced by the preferences of gay peers modifies the behavioral and neural reactivity of individuals defined as in- vs. out- groups on the basis of sexual orientation. To this aim, we combined fMRI with a social conformity paradigm in which heterosexual and gay/bisexual (hereafter non-exclusively heterosexual, NEH) individuals provided with male body attractiveness ratings by a fictitious group of gay students may or may not alter their previous rating and may or may not conform to the mean. Behaviorally, conformity to the minority preference was found in in-group NEH more than in out-group heterosexuals. Analysis of BOLD signal showed that social pressure brought about increased brain activity in frontal and parietal regions associated with the detection of social conflict. These results show that members of a sexual majority group display a smaller level of conformity when a sexual minority group exerts social influence. However, the neural correlates of this modulation are yet to be clarified.

Challenges in assessing personality of individuals with Gender Dysphoria with the SWAP-200.

BACKGROUND: Personality assessment can be useful to better understand the complexity of transgender and transsexual people. In particular, the Shedler Westen Assessment Procedure-200 (SWAP-200) is a measure that provides an accurate dimensional evaluation of personality. When assessing gender non-conforming people, however, clinicians can encounter some difficulties in giving appropriate ratings to all the items. PURPOSE OF THE REVIEW: A brief guide to the use of SWAP-200 with transgender patients is provided, taking into account three areas of psychological functioning: identity, relationships and sexuality. The authors review, one by one, the SWAP-200 items related to these areas, and, relying on their clinical experience and on scientific literature on Gender Dysphoria, they propose recommendations for making personality diagnoses meaningful. CONCLUSION: This paper facilitates a better clinical understanding of transgender people, and help clinicians to be more knowledgeable in the assessment of this heterogeneous population.

Who has the worst attitudes toward sexual minorities? Comparison of transphobia and homophobia levels in gender dysphoric individuals, the general population and health care providers.

PURPOSE: To date, few studies have addressed attitudes toward transgender individuals. In addition, little is known about health care providers' (HCP) attitudes toward sexual minorities. The aim of the present study is to compare attitudes toward homosexual and transgender individuals between gender dysphoric individuals (GDs), general population controls (C) and HCP. METHODS: A total of 310 subjects were considered, including 122 GDs (63 transwomen and 59 transmen), 53 heterosexual HCP (26 males and 27 females) and 135 C. Participants completed the Modern Homophobia Scale (MHS) and the Attitudes Toward Transgendered Individuals Scale (ATTI) in order to assess attitudes toward gay men and lesbian women and toward transgender individuals, respectively. In addition, GDs completed the Gender Identity/Gender Dysphoria Questionnaire (GIDYQ-AA) and ATTI to measure, respectively, gender dysphoria levels and internalized transphobia. Religious attitudes were evaluated by means of the Religious Fundamentalism Scale (RFS), and Discrimination and Stigma Scale (DISC-12) was used to measure perceived discrimination. RESULTS: (1) Men showed significantly higher levels of homophobia and transphobia when compared to women (p < 0.001); (2) perceived discrimination was higher in lesbian women compared to gay men and in transwomen compared to transmen (p < 0.001 and p < 0.05, respectively); and (3) religious fundamentalism was associated with both homophobia and transphobia (both p < 0.001). CONCLUSIONS: Our results underline the need to promote awareness and acceptance of the sexual minorities, who are more at risk of discriminatory attitudes, which are strongly dependent on religious precepts and dogma.

Defense mechanisms and personality disorders.

The evaluation of defense mechanisms represents one of the most promising fields in the psychodynamic-oriented empirical research on personality disorders (PDs). This study examines the association between DSM-IV PDs and defense mechanisms. We evaluated a sample of 50 adult outpatients seeking personality assessment and psychotherapeutic treatment. PDs have been assessed using the Structured Clinical Interview for DSM-IV Personality Disorder, version 2.0. Defense mechanisms have been evaluated by a group of trained clinical psychologists and psychiatrists (interrater reliability from .61 to .95) using Perry's Defense Mechanism Rating Scale. Our results support the hypothesis that some defense mechanisms underlie PDs and that defenses call for further attention as we assess PDs.

Hermeneutics and the philosophy of medicine: Hans-Georg Gadamer's platonic metaphor.

Taking as our starting point Plato's metaphor of the doctor as philosopher we reflect on some aspects of the epistemological status of medicine. The framework to this paper is the hermeneutics of Hans-Georg Gadamer which shows the paradoxical nature of Western medicine in choosing the body-object as its investigative starting point, while in actual fact dealing with subjects. Gadamer proposes a model of medicine as the art of understanding and dialogue, which is capable of bringing together its various constituent parts, i.e. knowledge, knowing how to do and knowing how to be, in medical practice and in the physician's training. The paper concludes with a brief discussion of the dyadic figure of the physician as Platonic "master of the living totality" and wounded healer, capable of activating the patient's self-healing capacity.

[Childhood trauma and personality disorders]. / Disturbi di personalità ed eventi traumatici nell'infanzia.

The influence of the model of object relations on modern psychodynamic research has led to increased emphasis on the importance of relations and traumatic events in the genesis of some psychic disorders, especially with regard to personality disorders. The development of axis II in the DSM-III system has increased the number of empiric studies in this field. In this paper, the Authors report data relating to a sample of 49 subjects with personality disorders (DSM-III-R) in which the presence of sexual abuse, physical maltreatment and negative family atmosphere was examined using a self-administered questionnaire (CAT). The results suggest a significant presence of these events throughout the sample and reveal a correlation between some personality disorders and specific traumatic events. It may therefore be hypothesized that the presence of these events represents an important factor from the point of treatment, both in technical and in prognostic terms.

How we teach the doctor-patient relationship.

Since the reform of the Italian medical degree in 1988, fourth-year students now study the dynamics of the doctor-patient relationship as part of the compulsory 'methodology of the clinical, therapeutic, prevention and rehabilitation approach' course. This work illustrates a pilot scheme carried out at the Milan University Medical School and begun shortly before the reform of the Italian medical degree. In dealing with the teaching of the doctor-patient relationship, the authors look into a relational-psychological perspective which is supported by notions and instruments intrinsic to medical pedagogy. The work is handled along three main lines: (a) presentation of a relational teaching model and definition of teaching objectives; (b) presentation of the methods and techniques used (role-playing, videotape recordings, video simulation and group work); and (c) discussion on the evaluation criteria.

An international perspective on assessment of negative and positive symptoms in schizophrenia.

The authors used the Scale for Assessment of Negative Symptoms and the Scale for Assessment of Positive Symptoms in interviews of 96 psychiatric inpatients in Italy. They evaluated the interrater reliability and the internal consistency of these scales for the assessment of negative and positive symptoms in schizophrenia. Their findings indicate that the results of these scales are similar in Italy and the United States, countries with different languages and cultures.