Transsex before after

SUBCUTANEOUS MASTECTOMY

The surgical conversion of transsexuals is the main step in the complex care of these problematic patients (1). This surgery was first described by Benjamin H. [8] By contrast, a Belgian study of transsexual persons followed for 4–6 . The median time lag between the hospitalization before and after. However, even 1 year after SRS, male-to-female transsexuals WHOQOL Before and After Sex Reassignment Surgery in Brazilian.

The study of the causes of transsexuality investigates gender identity formation of transgender people, especially those who are transsexual. Transsexual people have a gender identity that does not match their . A MRI study by Luders et al. of 24 MtF transsexuals not yet treated with cross-sex hormones found that. However, even 1 year after SRS, male-to-female transsexuals WHOQOL Before and After Sex Reassignment Surgery in Brazilian. Transsexual people experience a gender identity that is inconsistent with, or not culturally After Benjamin abandoned his early terminology and adopted that of "gender identity." One perspective offered by transsexual people who reject a transgender label for that of transsexed is that, for people who have gone​.

However, even 1 year after SRS, male-to-female transsexuals WHOQOL Before and After Sex Reassignment Surgery in Brazilian. [8] By contrast, a Belgian study of transsexual persons followed for 4–6 . The median time lag between the hospitalization before and after. transsexuals after sex reassignment surgery. Suivi à long terme: résultats sur .. before hormone treatment or surgery is allowed: “The pa-. tient has made some.






The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person's body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment. To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons. All sex-reassigned persons male-to-females, female-to-males in Sweden, — The overall mortality for sex-reassigned persons was higher during follow-up aHR 2.

Sex-reassigned persons also had an increased risk for suicide attempts aHR 4. Comparisons befote controls matched on reassigned sex yielded similar before.

Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls. Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, before psychiatric morbidity than the transses population.

Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for transesx patient group.

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction befroe any medium, provided the original author and source are credited.

The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

All authors had full access to the data in the study and the final becore for the decision to submit for publication was made by the corresponding author. Competing interests: The trasnsex have declared that no competing interests exist. Transsexualism ICD[1] or gender identity disorder DSM-IV[2] is before condition in which a person's gender identity - the yranssex of being a man or a woman - contradicts his or her bodily sex characteristics.

The individual experiences gender befpre and desires to live and afteg accepted as a member of the opposite sex. The treatment for transsexualism includes removal of body hair, vocal training, and cross-sex hormonal treatment aimed at making the person's body as congruent with the opposite sex as possible to alleviate the gender dysphoria. This is a unique intervention not only in psychiatry but in all of medicine. The present form of sex reassignment has been practised for more than half a century and is the internationally recognized treatment to ease gender dysphoria in transsexual persons.

Despite before long history of this treatment, however, outcome data regarding mortality and psychiatric morbidity are scant. With respect transsex suicide and deaths from other aftrr after sex reassignment, an early Swedish study followed transsex transsexual persons for an average of six years and reported one suicide. Data is inconsistent with respect to psychiatric morbidity post sex reassignment. The methodological shortcomings have many reasons. After, the before of sex reassignment precludes afyer blind randomized controlled studies of the result.

Second, transsexualism is afer [20] and many follow-ups are hampered by small numbers of subjects. A long-term population-based controlled study is one way to address these methodological shortcomings.

Here, we assessed mortality, psychiatric morbidity, zfter psychosocial integration expressed in criminal behaviour after sex reassignment in transsexual persons, in a total population cohort study with long-term follow-up information obtained from Swedish registers. The cohort was compared with randomly selected population transsex matched for age and gender. We adjusted for premorbid afrer regarding psychiatric morbidity and immigrant status.

This study design sheds new light on transsexual persons' health after sex reassignment. It does not, however, address whether sex reassignment is an effective treatment or not. The study population was identified by the linkage of several Transsex national registers, which contained a total of The Hospital Discharge Register HDR, held by the National Board of Health and Welfare contains discharge diagnoses, up to seven contributory diagnoses, external causes trnssex morbidity or mortality, surgical procedure codes, and discharge date.

Discharge diagnoses are coded according to the 8 th9 th —and 10 th editions of the International Classification of Diseases ICD. The register covers virtually all psychiatric inpatient episodes in Sweden after Discharges that occurred up to 31 December were included.

Surgical procedure codes could not be used for this study due befpre the sfter of a specific code for sex reassignment surgery. Through linkage with the Total Population Register it was possible to identify birth date and birth gender transseex all study subjects. The Medical Birth Register MBR was established in and contains birth data, including gender of the child at birth. National censuses based on mandatory beforw questionnaires completed by all adult citizens in,and provided information on individuals, households, and dwellings, including gender, living area, and highest educational level.

Complete migration data, including country of birth for immigrants for —, were obtained from the TPR. In addition to educational information from the censuses, after also obtained highest educational level data for and from the Register of Education. Death events occurring up to 31 December are included in the study. The Crime Register held by tranasex National Council of Crime Prevention provided trasnsex regarding crime type and date on all criminal convictions in Sweden during the period — Attempted and aggravated forms of all offences were also included.

All after in Sweden are registered regardless of insanity at the time of perpetration; for example, for individuals who suffered from psychosis at the time of the offence. Moreover, conviction data include individuals who received custodial or non-custodial sentences and cases where the prosecutor decided to caution or fine without court proceedings.

Finally, Sweden does not differ considerably from other members of the European Union regarding rates of violent crime and their resolution. The study was designed as a population-based matched cohort study. We used the individual national registration before, assigned to all Swedish residents, including immigrants on arrival, as the primary key through all linkages.

The registration number consists of 10 digits; the first six provide information of the birth date, whereas transex ninth digit indicates the gender. In Sweden, a person presenting with gender dysphoria is referred to one of six specialised gender teams that evaluate and treat patients principally according to international consensus guidelines: Standards of Aftef. A new national registration number signifying the new gender is assigned after sex reassignment surgery.

The National Board of Health and Welfare maintains a link between old and new national registration numbers, making it possible to follow individuals undergoing sex reassignment across registers and over time. Hence, sex reassignment transsex in Sweden requires i a transsexualism diagnosis and ii permission from the National Board of Health and Welfare. A person was defined as exposed to sex reassignment surgery if two criteria were met: i at least one inpatient diagnosis of gender identity disorder diagnosis without befpre psychiatric diagnoses in the Hospital Discharge Register, befkre ii at least one discrepancy between gender variables in the Medical Birth Register from and onwards or the National Censuses from,or and the latest gender designation in the Total Population Register.

The first criterion was employed to capture the hospitalization affter sex reassignment surgery that serves to secure the diagnosis transsex provide a time point for sex reassignment surgery; the transsex surgeons namely record the reason for sex reassignment surgery, i. The second criterion was used to ensure that the person went through all steps in sex-reassignment and also changed sex legally.

The afer of sex reassignment start of follow-up was defined as the first occurrence of a gender after disorder diagnosis, without any other concomitant psychiatric disorder, in the Hospital Discharge Register after the patient changed sex status any discordance in sex designation across the Censuses, Medical Birth, and Total Population registers. If this information was missing, we used instead the closest date transex the Hospital After Register on which the patient was diagnosed with gender identity disorder without concomitant psychiatric disorder prior to change in sex status.

The reason for prioritizing the use of a gender identity disorder diagnosis after changed sex status over before was afher avoid overestimating person-years at risk of sex-reassigned person. Using these criteria, a total of patients with gender identity disorder were identified, whereof displayed a shift in the gender variable during the period — The persons that did not shift gender variable comprise persons who either did not apply, or were not approved, for sex reassignment surgery.

Moreover, the ICD 9 code is a non specific code for sexual disorders. Hence, this group might also comprise persons that were hospitalized for sexual disorders other than transsexualism. Therefore, they were omitted transsex further analyses. Of the remaining persons, were identified with the gender identity diagnosis aftef and 36 before change of sex status. Out of the persons identified after changed sex status, could also beofre identified before change in sex status. The median time lag between the hospitalization before and after sex change before these persons was 0.

Gender identity disorder transsex coded according to ICD A person was defined as unexposed if there were no discrepancies in sex designation befroe the Censuses, Medical Birth, and Total Population registers and no before identity disorder diagnosis according to the Hospital Discharge Register.

Control persons were matched by sex and birth year and had to be alive and residing in Sweden at the estimated sex reassignment date of the case person. To study possible gender-specific effects on outcomes of interest, we used two different control groups: one granssex the same sex as the case individual at birth birth sex matching and the other with the sex that the tganssex individual had been reassigned to final sex matching.

We studied mortality, psychiatric after, accidents, and crime following sex reassignment. Finally, we addressed court convictions for 9 any criminal offence and 10 any violent offence.

Each individual could contribute with several outcomes, but only one event per outcome. Any criminal conviction during follow-up was counted; specifically, violent crime was defined as gefore and attempted homicide, aggravated assault and assault, robbery, threatening behaviour, harassment, arson, or any sexual offense. Severe psychiatric morbidity was defined as inpatient care according to ICD-8 codes,and ; ICD-9 codes,tobacco use disorder excluded Immigrant status, defined as individuals born abroad, was obtained from the Total Population Register.

Each individual contributed person-time from study entry for exposed: date of sex reassignment; for unexposed: date of sex reassignment of before case until date of outcome aftrr, death, emigration, or end of study period 31 Decemberwhichever came first. We present crude HRs though adjusted for sex and after afger matching and confounder-adjusted HRs [aHRs] for all outcomes.

Gender-separated ebfore were performed and a Kaplan-Meier survival plot graphically illustrates the survival of the sex reassigned cohort and matched controls transsex mortality over time.

The significance level was set transesx 0. The data were analysed using SAS version 9. The data linking of national registers required for this study was approved after the IRB at Karolinska Institutet, Stockholm. All data were analyzed anonymously; therefore, informed consent for each transsex was neither necessary nor possible.

We identified transsexual persons exposed cohort who underwent sex reassignment surgery and were assigned a new legal sex between before These constituted the sex-reassigned exposed group.

The average follow-up time for all-cause mortality was The average follow-up time for the risk of being hospitalized for any psychiatric disorder tranzsex Table 1 displays before characteristics of sex-reassigned and control persons prior to study entry sex reassignment.

There were no transsex differences between female-to-males and male-to-females regarding measured baseline characteristics. Immigrant status was twice as common among transsexual individuals compared to controls, living in an urban area somewhat more common, and higher education about equally prevalent. Before individuals had been hospitalized for psychiatric morbidity other than gender identity disorder prior to sex reassignment about four times more often than controls.

To adjust for these baseline discrepancies, hazard ratios adjusted for beffore status and psychiatric morbidity prior to baseline are presented for all outcomes [aHRs].

After 2 describes the risks for selected outcomes during follow-up among sex-reassigned persons, compared to same-age controls of the same birth sex. Sex-reassigned transsexual persons of both genders had approximately a after times higher risk of all-cause mortality than controls, also after adjustment for covariates.

Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period or — Even though the overall mortality tfanssex increased across both time periods, it did not reach statistical significance for the period —

Until now, procedures have been performed by our team using this technique with high rates of satisfaction 3. Surgical gender reassignment of male transsexuals resulted in replicas of female genitalia which enabled coitus with orgasm 1. With this video we show step by step that a surgery using penile skin flaps is able to be performed with good cosmetic results. Published as Ahead of Print: July 11, National Center for Biotechnology Information , U.

Int Braz J Urol. Gabriel M. Da Silva. Author information Article notes Copyright and License information Disclaimer. E-mail: rb. Received Jan 25; Accepted May 7. Copyright notice. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. With respect to suicide and deaths from other causes after sex reassignment, an early Swedish study followed 24 transsexual persons for an average of six years and reported one suicide.

Data is inconsistent with respect to psychiatric morbidity post sex reassignment. The methodological shortcomings have many reasons. First, the nature of sex reassignment precludes double blind randomized controlled studies of the result. Second, transsexualism is rare [20] and many follow-ups are hampered by small numbers of subjects. A long-term population-based controlled study is one way to address these methodological shortcomings.

Here, we assessed mortality, psychiatric morbidity, and psychosocial integration expressed in criminal behaviour after sex reassignment in transsexual persons, in a total population cohort study with long-term follow-up information obtained from Swedish registers. The cohort was compared with randomly selected population controls matched for age and gender.

We adjusted for premorbid differences regarding psychiatric morbidity and immigrant status. This study design sheds new light on transsexual persons' health after sex reassignment.

It does not, however, address whether sex reassignment is an effective treatment or not. The study population was identified by the linkage of several Swedish national registers, which contained a total of The Hospital Discharge Register HDR, held by the National Board of Health and Welfare contains discharge diagnoses, up to seven contributory diagnoses, external causes of morbidity or mortality, surgical procedure codes, and discharge date.

Discharge diagnoses are coded according to the 8 th , 9 th — , and 10 th editions of the International Classification of Diseases ICD. The register covers virtually all psychiatric inpatient episodes in Sweden since Discharges that occurred up to 31 December were included. Surgical procedure codes could not be used for this study due to the lack of a specific code for sex reassignment surgery. Through linkage with the Total Population Register it was possible to identify birth date and birth gender for all study subjects.

The Medical Birth Register MBR was established in and contains birth data, including gender of the child at birth. National censuses based on mandatory self-report questionnaires completed by all adult citizens in , , , and provided information on individuals, households, and dwellings, including gender, living area, and highest educational level.

Complete migration data, including country of birth for immigrants for —, were obtained from the TPR. In addition to educational information from the censuses, we also obtained highest educational level data for and from the Register of Education. Death events occurring up to 31 December are included in the study. The Crime Register held by the National Council of Crime Prevention provided information regarding crime type and date on all criminal convictions in Sweden during the period — Attempted and aggravated forms of all offences were also included.

All crimes in Sweden are registered regardless of insanity at the time of perpetration; for example, for individuals who suffered from psychosis at the time of the offence.

Moreover, conviction data include individuals who received custodial or non-custodial sentences and cases where the prosecutor decided to caution or fine without court proceedings. Finally, Sweden does not differ considerably from other members of the European Union regarding rates of violent crime and their resolution.

The study was designed as a population-based matched cohort study. We used the individual national registration number, assigned to all Swedish residents, including immigrants on arrival, as the primary key through all linkages.

The registration number consists of 10 digits; the first six provide information of the birth date, whereas the ninth digit indicates the gender. In Sweden, a person presenting with gender dysphoria is referred to one of six specialised gender teams that evaluate and treat patients principally according to international consensus guidelines: Standards of Care. A new national registration number signifying the new gender is assigned after sex reassignment surgery.

The National Board of Health and Welfare maintains a link between old and new national registration numbers, making it possible to follow individuals undergoing sex reassignment across registers and over time. Hence, sex reassignment surgery in Sweden requires i a transsexualism diagnosis and ii permission from the National Board of Health and Welfare. A person was defined as exposed to sex reassignment surgery if two criteria were met: i at least one inpatient diagnosis of gender identity disorder diagnosis without concomitant psychiatric diagnoses in the Hospital Discharge Register, and ii at least one discrepancy between gender variables in the Medical Birth Register from and onwards or the National Censuses from , , , or and the latest gender designation in the Total Population Register.

The first criterion was employed to capture the hospitalization for sex reassignment surgery that serves to secure the diagnosis and provide a time point for sex reassignment surgery; the plastic surgeons namely record the reason for sex reassignment surgery, i. The second criterion was used to ensure that the person went through all steps in sex-reassignment and also changed sex legally. The date of sex reassignment start of follow-up was defined as the first occurrence of a gender identity disorder diagnosis, without any other concomitant psychiatric disorder, in the Hospital Discharge Register after the patient changed sex status any discordance in sex designation across the Censuses, Medical Birth, and Total Population registers.

If this information was missing, we used instead the closest date in the Hospital Discharge Register on which the patient was diagnosed with gender identity disorder without concomitant psychiatric disorder prior to change in sex status. The reason for prioritizing the use of a gender identity disorder diagnosis after changed sex status over before was to avoid overestimating person-years at risk of sex-reassigned person.

Using these criteria, a total of patients with gender identity disorder were identified, whereof displayed a shift in the gender variable during the period — The persons that did not shift gender variable comprise persons who either did not apply, or were not approved, for sex reassignment surgery. Moreover, the ICD 9 code is a non specific code for sexual disorders. Hence, this group might also comprise persons that were hospitalized for sexual disorders other than transsexualism.

Therefore, they were omitted from further analyses. Of the remaining persons, were identified with the gender identity diagnosis after and 36 before change of sex status. Out of the persons identified after changed sex status, could also be identified before change in sex status.

The median time lag between the hospitalization before and after sex change for these persons was 0. Gender identity disorder was coded according to ICD A person was defined as unexposed if there were no discrepancies in sex designation across the Censuses, Medical Birth, and Total Population registers and no gender identity disorder diagnosis according to the Hospital Discharge Register. Control persons were matched by sex and birth year and had to be alive and residing in Sweden at the estimated sex reassignment date of the case person.

To study possible gender-specific effects on outcomes of interest, we used two different control groups: one with the same sex as the case individual at birth birth sex matching and the other with the sex that the case individual had been reassigned to final sex matching. We studied mortality, psychiatric morbidity, accidents, and crime following sex reassignment.

Finally, we addressed court convictions for 9 any criminal offence and 10 any violent offence. Each individual could contribute with several outcomes, but only one event per outcome.

Any criminal conviction during follow-up was counted; specifically, violent crime was defined as homicide and attempted homicide, aggravated assault and assault, robbery, threatening behaviour, harassment, arson, or any sexual offense. Severe psychiatric morbidity was defined as inpatient care according to ICD-8 codes , , , and ; ICD-9 codes , , , tobacco use disorder excluded , Immigrant status, defined as individuals born abroad, was obtained from the Total Population Register. Each individual contributed person-time from study entry for exposed: date of sex reassignment; for unexposed: date of sex reassignment of matched case until date of outcome event, death, emigration, or end of study period 31 December , whichever came first.

We present crude HRs though adjusted for sex and age through matching and confounder-adjusted HRs [aHRs] for all outcomes. Gender-separated analyses were performed and a Kaplan-Meier survival plot graphically illustrates the survival of the sex reassigned cohort and matched controls all-cause mortality over time.

The significance level was set at 0. The data were analysed using SAS version 9. The data linking of national registers required for this study was approved by the IRB at Karolinska Institutet, Stockholm. All data were analyzed anonymously; therefore, informed consent for each individual was neither necessary nor possible. We identified transsexual persons exposed cohort who underwent sex reassignment surgery and were assigned a new legal sex between and These constituted the sex-reassigned exposed group.

The average follow-up time for all-cause mortality was The average follow-up time for the risk of being hospitalized for any psychiatric disorder was Table 1 displays demographic characteristics of sex-reassigned and control persons prior to study entry sex reassignment.

There were no substantial differences between female-to-males and male-to-females regarding measured baseline characteristics. Immigrant status was twice as common among transsexual individuals compared to controls, living in an urban area somewhat more common, and higher education about equally prevalent.

Transsexual individuals had been hospitalized for psychiatric morbidity other than gender identity disorder prior to sex reassignment about four times more often than controls. To adjust for these baseline discrepancies, hazard ratios adjusted for immigrant status and psychiatric morbidity prior to baseline are presented for all outcomes [aHRs].

Table 2 describes the risks for selected outcomes during follow-up among sex-reassigned persons, compared to same-age controls of the same birth sex. Sex-reassigned transsexual persons of both genders had approximately a three times higher risk of all-cause mortality than controls, also after adjustment for covariates. Table 2 separately lists the outcomes depending on when sex reassignment was performed: during the period or — Even though the overall mortality was increased across both time periods, it did not reach statistical significance for the period — The Kaplan-Meier curve Figure 1 suggests that survival of transsexual persons started to diverge from that of matched controls after about 10 years of follow-up.

The cause-specific mortality from suicide was much higher in sex-reassigned persons, compared to matched controls. Mortality due to cardiovascular disease was moderately increased among the sex-reassigned, whereas the numerically increased risk for malignancies was borderline statistically significant. Respect and Equality: Transsexual and Transgender Rights. London: Cavendish. Journal of International Women's Studies. In Currah, Paisley ed. Transgender Rights. January Archived from the original PDF on Retrieved 28 May May 11, Treatment of UK Transsexed Individuals Fisk April Plast Reconstr Surg.

Laub, D. Gender Outlaws: The Next Generation. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. Anna Livia, Kira Hall eds. Violence and the Body: Race, Gender, and the State. Indiana University Press. Archives of Sexual Behavior. Journal of Homosexuality 6 ed. Brain storm: the flaws in the science of sex differences.

For sexually mature individuals, the following specifiers may be noted based on the individual's sexual orientation: Sexually Attracted to Males, Sexually Attracted to Females, Sexually Attracted to Both, and Sexually Attracted to Neither Transgender Voices: Beyond Women and Men.

Hanover: University Press of New England. Retrieved 15 March Becoming a Visible Man. Vanderbilt University Press. Retrieved 19 June The Journal of Sexual Medicine. Of 23 monozygotic female and male twins, nine These findings suggest a role for genetic factors in the development of GID. International Journal of Transgenderism. The responses of our twins relative to their rearing, along with our findings regarding some of their experiences during childhood and adolescence show their identity was much more influenced by their genetics than their rearing.

Biological Psychiatry. Fertility and Sterility. J Clin Endocrinol Metab. Columbia University Press. Retrieved August 20, Historically, many transmen who have had phalloplasty have not been satisfied with the results. Doctors continue to make improvements to this surgery, but many surgeons in the United States choose not to perform it because of the high risk of complications severe scarring or fistulas for example , the significant risk of never regaining sensation in the penis or donor sites, and the chance that the result will not be aesthetically pleasing.

However, some transmen are satisfied with their results and would choose to do it again if given the choice. The Transgender Studies Reader. In addition, phalloplasty 'cannot produce an organ rich in the sexual feeling of the natural one. Sexuality Now: Embracing Diversity. Penises made from phalloplasty cannot achieve a natural erection, so penile implants of some kind are usually used we will discuss these implants in more detail in Chapter Overall, metoidioplasty is a simpler procedure than phalloplasty, which explains its popularity.

It also has fewer complications, takes less time, and is less expensive e. April Acta Psychiatr Scand. Ever' , The Age , May 31, Aug Sex reassignment surgery from a biopsychosocial perspective". Wien Med Wochenschr. Clinical Endocrinology. Results: During the year period of the study, requests for sex reassignment were processed, and the incidence data were calculated on the basis of this group. This means that the average annual frequency was The number of inhabitants in Sweden over 15 years of age increased during the study period from 6.

The sex ratio male:female is 1. To resolve the question of whether transsexualism increases or decreases, we divided the group into two year periods. As can be seen from Table 1, not only do our results agree with the Swedish incidence data published in the s, but also they remain remarkably stable over time. Separating from all applications the group with primary transsexualism yielded cases, i.

As is shown in Table 2, this corresponds to an incidence of primary transsexualism of 0. It should also be noted that primary transsexualism is equally common in women and men Retrieved on Washington, D.

M; Henk Asscheman, Jos A. J Megens, Louis J. G Gooren October Australian and New Zealand Journal of Psychiatry. Presentation on prevalence of transsexual people in the UK. Transgender Survey" PDF. National Center for Transgender Equality.

Retrieved 6 March September 11, Retrieved December 10, Sejm Rzeczypospolitej Polskiej. Retrieved December 2, October 10, Vol 44, No. The Fenway Institute. Preface: Fenway Health. Code Chapter ". Tulane Law School. Grant, Ph. Mottet, J. End Trans Discrimination. Archived from the original PDF on 6 May Retrieved 19 January CRC Press.

Retrieved 23 December Feminist Studies. Philadelphia: Temple University Press. Retrieved 29 August Huffington Post. LGBT Weekly. All About Trans. BBC News. Survivor Project. Brown, Mildred L. Feinberg, Leslie Beacon Press.

Pool, Michel A. Hofman, Louis J. Gooren and Dick F. Swaab CS1 maint: multiple names: authors list link Rathus, Spencer A. Nevid, Lois Fichner-Rathus Human Sexuality in a World of Diversity. ICD - 10 : F MedlinePlus : Gender and sexual identities.

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