Transgender identity and cryptorchidism: A case study

Tania Real Quintanar, Rebeca Robles García, María Elena Medina-Mora, Juan Carlos Jorge, Lucía Vázquez Pérez

DOI: https://doi.org/10.17711/SM.0185-3325.2019.007

Abstract


Introduction. There is a wide range of possible combinations in relation to sex at birth, gender identity, and sexual orientations. Specific medical and psychological treatment needs may also vary depending on these combinations.

Objective. In order to promote interventions that focus on the perceived needs of those directly involved, the aim of the present case study is to describe the clinical and life experiences of a 43-year old transgender woman with cryptorchidism and examine the interplay between this relative common testicular problem at birth, gender identity, and sexual orientation formation processes from her own perspective.

Method. An in-depth interview was conducted at a specialized care centre in Mexico City, Mexico. The interview was audio recorded and transcribed for a content analysis.

Results. The case under analysis was assigned to the male sex and identified herself as a transgender woman and lesbian. Although it is not possible to conclude that her gender identity or sexual orientation is related to her antecedent of cryptorchidism, as she reflected on her related negative experiences, she concluded that her gender identity and sexual orientation trajectories, as well as her life in general, would have been completely different if there were no clinical interventions in her early development.

Discussiona and conclusion. The present case could have been benefited from not receiving early treatment for her cryptorchidism. There is an urgent need for the development of standardized protocols or algorithms for physical and mental health care professionals, which focus on supportive guidance rather than adjustment to parental and medical expectations.

Keywords


Gender identity; transgender; gender; psychological intervention; case study

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References


American Academy of Pediatrics. (2000). Committee on Genetics, Section on Endocrinology, Section on Urology. 2000. Evaluation of the newborn with developmental anomalies of the external genitalia. Pediatrics, 106, 138-142.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.

American Urological Association. (2014). Evaluation and treatment of cryptorchidism: AUA guideline. American Urological Association.

Berkowitz, G., Lapinski, R., Dolgin, S., Gazella, J., Bodian, C., Holzman, I. (1993). Prevalence and natural history of cryptorchidism. Pediatrics; 92(1):44-49.

Bockting, W. O., Benner, A., and Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38 (5), 688 –701.

Bradley, S., Zucker, K. (1997). Gender Identity Disorder: A review of the past 10 years. Journal of the American Academy of Child & Adolescent Psychiatry. 36 (7): 872–80.

Brinkmann, L., Schuetzmann, K., Richter-Appelt, H. (2007). Gender assignment a medical history of individuals with different forms of intersexuality: evaluation of medical records and the patients´ perspective. International Society for Sexual Medicine, 4:946-980.

Cabral, M. (2009). Interdicciones: Escrituras de la intersexualidad en castellano. M. Cabral, Editor. Argentina: Annarés Editorial. Retrieved from: www.mulabi.org/Interdicciones2.pdf

Comité Nacional de Endocrinología. (2001). Recomendaciones para el diagnóstico y tratamiento de la criptorquidia. Archivos Argentinos de Pediatría; 99(4):372-374.

Comité Nacional de Endocrinología. (2009). Tendencias actuales en el tratamiento y seguimiento de la criptorquidia. Archivos Argentinos de Pediatría; 107(2):176-180.

Connolly, N.K. (1959). Maldescent of the testis. American Surgery 25:405-420.

Cytryn, L., Cytryn, E., Rieger, R. (1967). Psychological Implications of Cryptorchism. Journal of American Academy of Child and Adolescent Psychiatry. 6(1):131–165.

Docimo, S., Silver, R., Cromie, W. (2000). The Undescended Testicle: Diagnosis and Management. American Family Physician, 62(9):2037-2044.

Ferguson, L. and Agoulnik, A. (2013). Testicular Cancer and Cryptorchidism. Frontiers in Endocrinology (Lausanne); 4(32):1-9.

Galifer, R.B.; Kalfa, N.; Guibal, M.P. 2004. What a hidden testicule can hide?…or the clinical traps of cryptorchidism. Archives de Pédiatrie, 11(4) : 350-359.

Garnelo, L. and Caamaño B. (2005). Criptorquidia. Guías clínicas; 5 (26): 1-3.

Hughes, I., Houk, C., Ahmed, S., Lee, P., Lawson Wilkins Pediatric Endocrine Society (LWPES)/European Society for Pediatric Endocrinology (ESPE) Consensus Group. 2006. Consensus statement on management of intersex disorders. Journal of Pediatric Urology; 2, 148-162.

Hyderi, A., Angel J, Madison M, Perry LA, Hagshenas L. (2016). Transgender patients: Providing sensitive care. The Journal of Family Practice, 65 (7):450-61.

Jorge, J.C. (2010). La embriología del género y modelos moleculares emergentes para explicar la diferenciación sexual. Sexología, 15(2), 37-49. English version: Jorge J.C. 2010. “The embryology of gender”. Journal of LGBT Youth 7, 310-319.

Jorge, J.C. and Agramonte, A.(2013). Standards of care for congenital adrenal hyperplasia: a call for change in the Caribbean region. Sexuality Research and Social Policy, 10, 3, 233-241.

Kessler, S. (1997). Meanings of gender variability. Chrysalis: The Journal of Transgressive Gender Identities, 2 (5): 33-38.

Lamas, M. (2012). Transexualidad: identidad y cultura. México: Universidad Nacional Autónoma de México.

Leidolf, E.M., Curran, M., Scout-Bradford J. (2008). Intersex mental health and social support options in pediatric endocrinology training programs. Journal of Homosexuality; 54(3):233-42.

Masi, G., Millepiedi, S., Brovedani, P., Favilla, L., Mucci, M. (1999). Psychopathological aspects of cryptorchidism in children and adolescents. Child Psychiatry and Human Development; 30 (2):75-85.

Mayer, K., Bradford, J., Makadon, H., Stall, R., Goldhammer, H., Landers, S. (2008). Sexual and gender minority health: what we know and what needs to be done. American Journal of Public Health; 98(6):989-995.

Mayo Clinic. (2017) Undescended testicle. Treatment. Retrieved from: https://www.mayoclinic.org/diseases-conditions/undescended-testicle/diagnosis-treatment/drc-20352000

Nagar, H. and Haddad, R. (1997) Impact of early orchidopexy on testicular growth. British Journal of Urology, 80(2): 334-335.

Pan American Health Organiation. (2011). The Right of Young People to Health and Gender Identities: Findings, Trends, and Targets for Public Health Action. Washington: Pan American Health Organization.

Reiner, W. and Gearhart, J. (2004). Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth. New England Journal of Medicine; 350(4): 333–341.

Reisner, S., Poteat, T., Keatley, J.A., Cabral, M., Mothopeng, T., Dunham, E., Holland, C., et al. (2016). Global health burden and needs of transgender populations: a review. Lancet; 388: 412–436.

Robles, R., Fresán, A., Vega-Ramírez, H., Cruz-Islas, J., Rodríguez-Pérez, V., Domínguez-Martínez, T., Reed, GM. (2016). Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. Lancet Psychiatry, 3(9):850-859.

Secretaría de Salud. (2014). Diagnóstico y tratamiento del testículo no descendido. México: Secretaría de Salud.

Steensma, T.D., Biemond, R., de Boer, F., Cohen-Kettenis, PT. (2011). Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clinical Child Psychology and Psychiatry; 16(4):499-516.

Subhrajit, C. (2014). Problems Faced by LGBT People in the Mainstream Society: Some Recommendations. International Journal of Interdisciplinary and Multidisciplinary Studies, 1(5): 317-331.

Sumfest, J. and Kim, E.D. (2018). Cryptorchidism Treatment and Management. Drug and Diseases, Urology. Retrieved from: https://emedicine.medscape.com/article/438378-treatment

United Nations Programme on HIV/AIDS. (2014). The gap report 2014. Transgender people. Geneva: United Nations.

World Health Organization. (1992). The ICD-10 classification of mental and behavioral disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.