XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Characteristics of those Attending the Gender Identity Clinic, Charing Cross Hospital, London

Miles, Clare 1. Young, Robert 2. Green, Richard 3. 1. City University, London, UK 2. & 3. Charing Cross Hospital, London, UK.

A paper entitled ‘Clinical features of patients attending a gender-identity clinic’ (Burns, Farrell and Brown, 1990), reported characteristics of transsexual patients presenting over 8 years from a Gender Identity Clinic (GIC), at the Maudsley Hospital, London. They examined ‘core-positive’ and ‘core-negative’ symptoms in their patients. ‘Core-positive’ transsexualism is defined here as: i) Age of onset before puberty; ii) Cross gender behavior and role is without sexual arousal and; iii) Dislike for their own secondary sexual characteristics. The primary/secondary classification is also used by clinicians in diagnoses of transsexualism. It is thought that these equate to ‘core-positive’ and ‘core-negative’ symptoms respectively, although clearly defined standardised criteria of what constitutes these sub-groups have not been specified. Furthermore, it is widely documented that male to female (M-F) and female to male (F-M) transsexuals (TS) show a differing pattern of clinical features and prognosis. The 1990 study however, did not analyse all clinical features or sub-group classifications by sex. The present study aims to both replicate the 1990 paper, with additionally documenting all features and sub-group classifications accurately described those patients diagnosed as ‘primary’and ‘secondary’ transsexuals to ascertain whether these classifications are interchangeable. We examined 171 case notes of those patients attending the Gender Identity Clinic at Charing Cross Hospital, London; 28 females, 143 males. Of these patients, 3 females and 21 males were diagnosed as gender dysphoric and not transsexual. This sample represented all cases attending the clinic in a 6-month period, i.e. from January-June 1996, inclusively. We focused on three areas of clinical and theoretical importance: i) Typology and Classification ii) Co-morbidity and iii) Prognosis for surgery. Our findings emphasise the importance of sex as a variable when examining clinical features and classifications. Furthermore, we identified a tertiary group of M-F patients that showed a mixture of primary and secondary features and could be described as intermediary. Whilst this classification is not yet used in terms of clinical diagnosis, this group illustrates the overlap between existing binary classifications. Individual clinical features did not discriminate well between either primary/secondary or core-positive/core-negative in terms of referral for surgery or co-morbidity. The combined value of these features however, did discriminate well between primary/secondary, but not core-positive/core-negative, in terms of contraindications. Furthermore, those referred for surgery had fewer contraindications. We created four clusters of variables, disturbed background, sexuality, psychiatric co-morbidity and core symptoms. These appeared to discriminate between groups and particularly between females, but not males in whether referred or not for surgery.