Prevalence of gender nonconformity in Flanders, Belgium

Gender nonconformity refers to the extent to which a person’s gender identity, gender role and/or gender expression differs from the cultural norms prescribed for people of a particular sex, within a certain society and era. Most data on gender nonconformity focus on the prevalence of gender dysphoria (which also includes a distress factor) or on the number of legal sex changes. However, not every gender nonconforming individual experiences distress or applies for treatment. Population-based research on the broad spectrum of gender nonconformity is scarce and more information on the variance outside the gender binary is needed. This study aimed to examine the prevalence of gender incongruence (identifying stronger with the other sex than with the sex assigned at birth) and gender ambivalence (identifying equally with the other sex as with the sex assigned at birth) based on two population-based surveys, one of 1,832 Flemish persons and one of 2,472 sexual minority individuals in Flanders. In the general population, gender ambivalence was present in 2.2% of male and 1.9% of female participants, whereas gender incongruence was found in 0.7% of men and 0.6% of women. In sexual minority individuals, the prevalence of gender ambivalence and gender incongruence was 1.8% and 0.9% in men and 4.1% and 2.1% in women, respectively. With a current Flemish population of about 6 million, our results indicate a total of between 17,150 and 17,665 gender incongruent men and between 14,473 and 15,221 gender incongruent women in Flanders

Gender incongruence of childhood: clinical utility and stakeholder agreement with the World Health Organization’s proposed ICD-11 criteria

The World Health Organization (WHO) is revising the tenth version of the International Classification of Diseases and Related Health Problems (ICD-10; WHO, 1992). This includes a reconceptualization of the definition and positioning of Gender Incongruence of Childhood (GIC). This study aimed to: 1) collect the views of transgender individuals and professionals regarding the retention of the diagnosis; 2) see if the proposed GIC criteria were acceptable to transgender individuals and health care providers 3) compare results between two countries with two different healthcare systems to see if these differences influence opinions regarding the GIC diagnosis; and 4) determine whether healthcare providers from high-income countries feel that the proposed criteria are clinically useful and easy to use. A total of 628 participants were included in the study: 284 from the Netherlands (NL; 45.2 %), 8 from Flanders (Belgium; 1.3 %), and 336 (53.5%) from the United Kingdom (UK). Most participants were transgender people (or their partners/relatives; TG) (n = 522), 89 participants were healthcare providers (HCPs) and 17 were both healthcare providers and (partners/relatives of) transgender people. Participants completed an online survey developed for this study. Overall, the majority response from transgender participants (42.9%) was that if the diagnosis would be removed from the mental health chapter it should also be removed from the ICD-11 completely, while 33.6% thought it should remain in the ICD-11. Participants were generally satisfied with other aspects of the proposed ICD-11 GIC diagnosis: most TG participants (58.4%) thought the term Gender Identity Disorder should change, and most thought Gender Incongruence was an improvement (63.0%). Furthermore, most participants (76.1%) did not consider GIC to be a psychiatric disorder and placement in a separate chapter dealing with Gender and Sexual Health (the majority response in the NL and selected by 37.5% of the TG participants overall) or as a Z-code (the majority response in the UK and selected by 26.7% of the TG participants overall) would be preferable. In the UK, the majority response (35.8%) was that narrowing the diagnosis for children was an improvement, while in the NL the majority response (49.5%) was that this was not an improvement. Although generally the results from healthcare providers were in line with the results from the transgender participants (and stakeholders) some differences were found. This study suggests that, in an ideal world, a diagnosis is not welcomed. However, realistically - due to healthcare funding - including a GIC diagnosis in ICD-11 is seen as a requirement. The choice for positioning of a diagnosis of GIC within the ICD-11 is as a separate chapter dealing with symptoms and/or disorders regarding sexual and gender health. This was the overall first choice for NL participants and second choice for UK participants, after the use of a Z-code. The difference reflects the fact that in the UK, Z-codes carry no negative implications for reimbursement of treatment costs. These findings highlight the challenges faced by the WHO in their attempt to integrate research findings from different countries, with different cultures and healthcare systems in their quest to create a manual that is globally applicable

Feminine after cricothyroid approximation?

A number of studies have evaluated the effectiveness of a cricothyroid approximation (CA) in creating a more female voice in male-to-female transsexuals (MFTs) from an acoustic perspective. An increase in pitch is of little value, however, unless it accurately indicates listeners' perceptions of gender. The purpose of this study was to further investigate the effectiveness of a CA in feminizing the voice from a perceptual perspective. Video recordings of nine MFTs, nine nontranssexual males (NTMs), and nine nontranssexual females (NTFs) were presented twice to the panel of judges in a randomized order: first auditory only (only hearing a subject's speech) and subsequently audiovisual (hearing and seeing a subject's speech). The panel of judges, 42 students (21 female, 21 male) from different disciplines, rated the participants' voices on a 100-mm visual analog scale with "very male" and "very female" as left and right extremes, respectively. The group of MFT obtained scores that were situated in between those of the NTM and the NTF, both for the auditory only and the audiovisual mode of presentation. Perception of femaleness significantly correlated with average fundamental frequency for both modes of presentation. It can be concluded that a CA approximation is a viable option to raise the voice pitch in MFTs but that this surgery alone may not be sufficient to create a voice that is perceived as a totally female

Laparoscopic hysterectomy as the method of choice for hysterectomy in female-to-male gender dysphoric individuals

The objective of this paper was to report on a large series of laparoscopic hysterectomy in female-to-male (FTM) transsexual patients. A retrospective study was carried out by the gender team of Ghent University Hospital, Ghent, Belgium. The patient files of 83 consecutive cases of laparoscopic hysterectomy between April 2003 and August 2007 were reviewed and analyzed. The average operating time for the laparoscopic hysterectomy was 64 (30–150) min. The estimated blood loss for the laparoscopic hysterectomy averaged 86 (25–600) ml. We encountered two bladder perforations, which were immediately repaired, and one hematoma of the vaginal dome, which necessitated a second intervention. The serious complication rate of our series is 3.6%. Sex reassignment surgery (SRS) has proven to be the most effective treatment for patients with gender dysphoria. In FTM transsexual individuals, hysterectomy is an essential part of SRS. Since 2003, we have performed laparoscopic hysterectomy in conjunction with a subcutaneous mastectomy as a first step in SRS in FTM transsexual patients, thus, facilitating the transition for the patient and improving the operative planning for the different surgical teams. Laparoscopic hysterectomy has undoubtedly proven to be superior to abdominal hysterectomy regarding postoperative pain and recuperation, while it is as safe as the vaginal or abdominal route. We think that laparoscopic hysterectomy is the most appropriate method for hysterectomy in FTM transsexual patients