Transsexualism is based on violations of the differentiation of brain structures responsible for sexual behavior, which are the biological origin of the so-called sex center responsible for the formation of a sense of gender (sexual autoidentification).
Hormonal examinations showed that patients with transsexualism do not have gross violations in the secretion of sex hormones.
Until now, there is an opinion that transsexualism arises when trying to raise a child in another field, but this point of view has no basis, since sexual behavior is determined by sexual differentiation of the brain, which occurs even in the prenatal period.
Disruption of behavior due to the feeling of belonging to the other sex, which can be noticed already at the age of 2-3 years, comes to the fore. Such children call themselves the names of the opposite sex, seek the right to wear sexually neutral clothes, but aim at wearing clothes of the opposite sex, prefer toys of the opposite sex (girls play with cars, and boys with dolls, etc.). Interestingly, before puberty in children’s groups they are perceived in accordance with their behavior, the transgender girl is often the leader among boys, and the transgender boy is the girlfriend’s favorite girlfriend, who along with others trust all secrets.
The critical period in transsexualism falls on the pubertal period, when the development of secondary sexual characteristics is maximized, the formation of sexual desire occurs, and the sensation of life in a strange, hated body increases sharply. The development of genital organs and secondary sexual characteristics, which testify to belonging to an “alien” body, is extremely aggravated, they begin to hate this body, are embarrassed to undress in the presence of strangers, carefully try to hide the genitals: the girls fix the penis to the perineum using bandages. It is not uncommon for desperate patients with M / F-transsexualism to decide on self-incrimination: amputation of the penis or complete castration.
The formation of sexual attraction corresponds to sexual self-consciousness, that is, in women with male auto-identification, it is directed to women, and in men with female auto-identification – to men, which is perceived as homosexual attraction, however, in fact, this is not, because. Accordingly, sexual identity is directed to the opposite sex.
When examining patients with transsexualism, the karyotype corresponds to the biological sex without changing the number and structure of chromosomes (in patients with M / W-transsexualism – 46, XY; in patients with W / M – transsexualism – 46, XX).
The examination of patients with transsexualism is carried out in the following areas:
- somatic status;
- genetic screening;
- analysis of spermatogenesis (in patients with M / F-transformation); Ultrasound of the pelvic organs (in patients
with W / M-transformation);
- endocrine status.
When somatic examination pay attention to the proportions of the body, the development of the skeleton, muscular system, adipose tissue. Great attention is paid to the degree of development of secondary sexual characteristics, the nature of pubic hair growth, axillary hollows, the presence of hair on the body and limbs, the frequency of shaving.
When assessing the somatic status in patients with M / W-transformation, there is a predominance of eunuchoid physique: wide pelvis, relatively long lower limbs. We determined the index of the trochanter index (the ratio of the length of the body to the length of the lower extremities) in patients with M / J-transsexualism and found that in all patients the indicator corresponds to a weaker sexual constitution, which may indirectly indicate insufficient saturation of the body with male sex hormones during the period of intensive growth organism (late closure of growth zones).
When assessing the pubescence of pubic hair in patients with M / W-transformation, predominance of 70% of female pubic pubescence is observed, which also indirectly indicates insufficient androgen activity and may be due to pathology at the level of receptors for dihydrotestosterone or impaired 5-alpha-reductase activity .
It is promising to study androgen receptors in patients with male trans-sexualism.
In patients with G / M transformation, asthenic physique predominates: a narrow pelvis, poor development of the mammary glands. In 65% of cases, pubic hairiness of the male type is noted, in 60% – the presence of hypertrichosis, in 35% – hirsutism, which indicates a high degree of androgenic saturation of the body.