Socio-demographic variables, clinical features and the role of pre-assessment cross-sex hormones in older trans people

Introduction. As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. Aims. The aim of this study was to investigate the socio-demographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. Methods. Every individual over the age of 50 years old referred to a national gender identity clinic during a thirty months period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. Main Outcome Measures. Socio-demographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimisation (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and non-suicidal self-injury (Self-Injury Questionnaire). Results. The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n=3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, divorced and had children. Trans females on CHT that came out as trans and transitioned at an earlier age, were significantly less anxious, reported higher levels of self-esteem and presented with less socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem, remained. Conclusion. The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined

Comparative analysis of distinct phenotypes in gambling disorder based on gambling preferences

Background: Studies examining gambling preferences have identified the importance of the type of gambling practiced on distinct individual profiles. The objectives were to compare clinical, psychopathological and personality variables between two different groups of individuals with a gambling disorder (strategic and non-strategic gamblers) and to evaluate the statistical prediction capacity of these preferences with respect to the severity of the disorder. Method: A total sample of 2010 treatment-seeking patients with a gambling disorder participated in this stand-alone study. All were recruited from a single Pathological Gambling Unit in Spain (1709 strategic and 301 non-strategic gamblers). The design of the study was cross-sectional and data were collected at the start of treatment. Data was analysed using logistic regression for binary outcomes and analysis of variance (ANOVA) for quantitative responses. Results: There were significant differences in several socio-demographic and clinical variables, as well as in personality traits (novelty seeking and cooperativeness). Multiple regression analysis showed harm avoidance and self-directedness were the main predictors of gambling severity and psychopathology, while age at assessment and age of onset of gambling behaviour were predictive of gambling severity. Strategic gambling (as opposed to non-strategic) was significantly associated with clinical outcomes, but the effect size of the relationships was small. Conclusions: It is possible to identify distinct phenotypes depending on the preference of gambling. While these phenotypes differ in relation to the severity of the gambling disorder, psychopathology and personality traits, they can be useful from a clinical and therapeutic perspective in enabling risk factors to be identified and prevention programs targeting specific individual profiles to be developed

Prevalence rates for lifetime NSSI and comparison between diagnostic group.

<p>CI = Confidence Interval, OR = Odds Ratio, HC = Healthy Controls, AN-R = Anorexia Nervosa Restrictive Subtype, AN-BP = Anorexia Nervosa Binge-eating/Purging type, BN = Bulimia Nervosa, EDNOS = Eating Disorder Not Otherwise Specified</p><p>Prevalence rates for lifetime NSSI and comparison between diagnostic group.</p

Means (standard errors) for the UPPS-P dimensions based on the diagnostic group and the NSSI behavior adjusted for age.

<p>NSSI = Non-Suicidal Self-Injury, HC = Healthy Controls, AN-R = Anorexia Nervosa Restrictive Subtype, AN-BP = Anorexia Nervosa Binge-eating/Purging type, BN = Bulimia Nervosa, EDNOS = Eating Disorder Not Otherwise Specified</p><p>Means (standard errors) for the UPPS-P dimensions based on the diagnostic group and the NSSI behavior adjusted for age.</p

Comparison for the UPPS-P dimensions based on the NSSI behavior and the diagnostic group.

<p>ANOVA controlled for age. N×G = interaction NSSI × group.</p><p>NSSI = Non-Suicidal Self Injury, HC = Healthy Controls, AN-R = Anorexia Nervosa Restrictive Subtype, AN-BP = Anorexia Nervosa Binge-eating/Purging type, BN = Bulimia Nervosa, EDNOS = Eating Disorder Not Otherwise Specified</p><p>CI = Confidence Interval MD: mean difference.</p><p>Results include Bonferroni-Simes correction for multiple significance tests.</p><p>Comparison for the UPPS-P dimensions based on the NSSI behavior and the diagnostic group.</p

Predictive capacity of the UPPS-P Impulsivity Facets on the presence of NSSI behavior: logistic regression adjusted by the covariates age and diagnostic group.

<p>Adjusted Nagelkerke’s-<i>R</i>^<i>2</i> =. 115</p><p>OR = Odd Ratio, CI = Confidence Interval</p><p>Predictive capacity of the UPPS-P Impulsivity Facets on the presence of NSSI behavior: logistic regression adjusted by the covariates age and diagnostic group.</p

Radar chart for the UPPS-P mean scores and the lifetime prevalence of Non-Suicidal Self-Injury (NSSI), stratified by the diagnostic subtypes [Healthy Controls (HC), Anorexia Nervosa-Restrictive type (AN-R), Anorexia Nervosa-Binge-eating/Purging type (AN-BP), Bulimia Nervosa (BN) and Eating Disorder Not Otherwise Specified (EDNOS)].

<p>Radar chart for the UPPS-P mean scores and the lifetime prevalence of Non-Suicidal Self-Injury (NSSI), stratified by the diagnostic subtypes [Healthy Controls (HC), Anorexia Nervosa-Restrictive type (AN-R), Anorexia Nervosa-Binge-eating/Purging type (AN-BP), Bulimia Nervosa (BN) and Eating Disorder Not Otherwise Specified (EDNOS)].</p

Anthropometric and biochemical variables in patients included in the study according to the diagnosis.

<p>Anthropometric and biochemical variables in patients included in the study according to the diagnosis.</p

An interethnic comparison of polymorphisms of the genes encoding drug-metabolizing enzymes and drug transporters: Experience in Singapore

Much of the interindividual variability in drug response is attributable to the presence of single nucleotide polymorphisms (SNPs) in genes encoding drug-metabolizing enzymes and drug transporters. In recent years, we have investigated the polymorphisms in a number of genes encoding phase I and II drug-metabolizing enzymes including CYPIA1, CYP3A4, CYP3A5, GSTM1, NAT2, UGT1A1, and TPMT and drug transporter (MDR1) in three distinct Asian populations in Singapore, namely the Chinese, Malays, and Indians. Significant differences in the frequencies of common alleles encoding these proteins have been observed among these three ethnic groups. For example, the frequency of the variant A2455G polymorphism of CYP1A1 was 28% in Chinese and 31% in Malays, but only 18% in Indians. CYP3A4*4 was detected in two of 110 Chinese subjects, but absent in Indians and Malays. Many Chinese and Malays (61-63%) were homozygous for the GSTM1*0 null genotype compared with 33% of Indians. The frequency of the UGTIA1*28 allele was highest in the Indian population (35%) compared to similar frequencies that were found in the Chinese (16%) and Malay (19%) populations. More importantly, our experience over the years has shown that the pharmacogenetics of these drug-metabolizing enzymes and MDR1 in the Asian populations are different from these in the Caucasian and African populations. For example, the CYP3A4*1B allele, which contains an A-290G substitution in the promoter region of CYP3A4, is absent in all three Asian populations of Singapore studied, but occurs in more than 54% of Africans and 5% of Caucasians. There were no difference in genotype and allelic variant frequencies in exon 12 of MDR1 between the Chinese, Malay, and Indian populations. When compared with other ethnic groups, the distribution of the wild-type C allele in exon 12 in the Malays (34.2%) and Indians (32.8%) was relatively high and similar to the Japanese (38.55%) and Caucasians (41%) but different from African-Americans (15%). The frequency of wild-type TT genotype in Asians (43.5% to 52.1%) and Japanese (61.5%) was much higher than those found in Caucasians (13.3%). All the proteins we studied represent the primary hepatic or extrahepatic enzymes, and their polymorphic expression may be implicated in disease risk and the disposition of drugs or endogenous substances. As such, dose requirements of certain drugs may not be optimal for Asian populations, and a second look at the factors responsible for this difference is necessary

Olfactory and gustatory variables in patients included in the study according to the diagnosis.

<p>Olfactory and gustatory variables in patients included in the study according to the diagnosis.</p