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Orientador : Irani Quagio-Grassiotto Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia Resumo: Os peixes teleósteos exibem vários padrões sexuais durante sua ontogenia, nos quais as gõnadas se transformam em ovários ou testículos funcionais. Nas distintas Ordens podem ser encontradas espécies gonocóricas, assim como hermafroditas, tanto simultâneas quanto seqüenciais ou consecutivas. No hermafroditismo seqüencial (protândrico ou protogínico), a mudança de sexo nos indivíduos adultos envolve a degeneração do tecido gonadal do primeiro sexo e o crescimento e maturação do tecido do sexo oposto, passando por uma fase de intersexo. Nas espécies hermafroditas protogínicas, mais frequentemente observada nos teleósteos, os individuos desenvolvem-se como fêmeas e, posteriormente, na vida adulta, seus ovários funcionais são substituídos por testículos, transformando-as em machos reprodutivamente ativos. Fatores internos e externos (ambientais) parecem controlar a mudança de sexo nas espécies hermafroditas seqüenciais. Nos vertebrados, o funcionamento do sistema reprodutor envolve o sistema nervoso e complexas vias de feedback hormonais, ambos integrados no chamado eixo hipotalâmico-hipofisário-gonadal. Nos peixes teleósteos, os esteróides sexuais, assim como os hormônios hipotalâmicos e adenohipofisários são considerados os principais fatores que controlam o desenvolvimento sexual gonadal, e podem estar envolvidos na inversão de sexo em espécies hermafroditas. Synbranchus marmoratus é um peixe hermafrodita protogínico diândrico e, na busca das possíveis correlações entre as alterações morfológicas gonadais e variações plasmáticas dos esteróides sexuais, observou-se que, na dependência do grau de decréscimo da oogênese e aumento da atividade do tecido masculino, o processo de inversão de sexo foi dividido em três fases: inicial, intermediária e final. A gõnada transicional de S. marmoratusfoi caracterizada pela a) desorganização da estrutura típica ovariana; b) massiva degeneração de células germinativas femininas; c) surgimento das células germinativas masculinas iniciais nas bordas das lamelas ovigeras, em associação com prováveis células de Sertoli; d) intensa proliferação e migração de células mióides; e) intensa atividade macrofágica, com a presença de melanomacrófagos e centros melanomacrofágicos; e f) aparecimento de grupos de células de Leydig no compartimento intersticial. As células de Leydig constituíram estruturas masculinas pioneiras a surgirem no ovário, então considerada gônada transicional inicial. Assim, estas células foram consideradas marcadores mortológicos e funcionais do processo de inversão sexual nesta espécie. As células de Leydig apresentaram as típicas características ultraestruturais associadas à esteroidogênese, bem como alta atividade esteroidogênica (3j3-HSD),provavelmente, produzindo andrógenos necessários ao desenvolvimento do tecido masculino gonadal e à espermatogênese. Na fase intermediária, a arquitetura masculina gonadal começa a ser definida, com a proliferação de numerosos cistos com células germinativas em diferentes fases de desenvolvimento. Nas gônadas transicionais finais, apenas poucos oócitos em degeneração e centros melanomacrofágicos permanecem. A mortologia da gônada transicional nesta fase é caracterizada pela completa formação das "lamelas testiculares" e dos túbulos seminíferos, os quais podem ser classificados como do tipo lobular irrestrito. Em nível hormonal, o início da transição sexual está associado à diminuição dos níveis plasmáticos de 17'beta'-estradiol, e o aumento da testosterona circulante, sugerindo a implicação destas circunstâncias para dar início à inversão de sexo natural em S. marmoratus. Os níveis plasmáticos de 11-cetotestosterona apenas sofrem baixas variações durante o início e progresso do referido processo, indicando um papel secundário deste andrógeno na inversão de sexo em S. marmoratus. A identificação das células adenohípofisárias de S. marmoratus durante a inversão de sexo não mostra qualquer alteração no padrão de imunomarcação das células produtoras dos diferentes hormônios ao longo do processo, excetuando-se as células gonadotrópicas, cuja atividade de síntese foi bastante alta nos intersexos iniciais. Provavelmente, estas células ofereçam suporte hormonal para a inversão de sexo nessa espécie. Assim, a inversão de sexo em S. marmoratus parece ocorrer sob controle do eixo hipotalâmico-hipofisário-gonadal. Por sua vez, as alterações morto lógicas necessárias à efetivação do processo propriamente dito - desestruturação do tecido gonadal feminino e desenvolvimento do tecido do sexo oposto - são gradualmente promovidas, seja pela falta ou escassez de estrógenos, e/ou pelo aumento dos níveis de andrógenos. Por conseguinte, S. marmoratus constitui um excelente modelo para o estudo dos eventos morto-funcionais da inversão de sexo Abstract: Teleost fishes exhibit several sexual patterns during their ontogeny, in which the gonads change into functional ovaries or testes. In distinct Orders, both gonochoristic and hermaphrodite species, simultaneous as well as sequential or consecutive, can be found. In sequential hermaphroditism (protandrous or protogynous), sex change in adult individuais involves the degeneration of the primary sex gonadal tissue and the growth and maturation of the opposite sex, passing through an intersex phase. In protogynous hermaphrodite species, most frequently observed in teleosts, individuais first develop into females and later, at adulthood, their functional ovaries are gradually replaced by testes, becoming them into active reproductively males. Internal and external (environmenta) factors seem to control the sex change in sequential hermaphrodite species. In vertebrates, the dynamic of reproductive system involves the nervous system and complex hormonal biosynthetic pathways, all of them integrated in the called brain-pituitary-gonad axis. In teleost fish, sex steroids, as well as brain and pituitary hormones, are considered to be the main factors controlling gonadal sex development, and may be involved in sex reversal in hermaphrodite species. Synbranchus marmoratus is a protogynous diandric fish. Depending on the degree of female gametogenesis decrease and male tissue activity increase, the sex reversal process was divided into three phases: early, intermediate, and final. S. marmoratus transitional gonad was characterized by the: a) disorganization of the typical ovarian structure; b) massive degeneration of the female germ cells; c) appearance of initial male germ cells . at the border of ovigerous lamellae in association with putative Sertoli cells; d) intense proliferation and migration of myoid cells; e) intense macrophage activity with the presence of melanomacrophages and melanomacrophage centers; and f) appearance of clusters of Leydig cells in the interstitial compartment. Leydig cells constitute the pioneer male structures to arise in the ovary, considered the early transitional gonad at this point. Thus, these cells were considered morphological and functional markers of the sex reversal process in this species. Leydig cells presented the typical fine structures associated to steroidogenesis, such as high steroidogenic activity (3'beta'-HSD), probably, producing androgens necessary to development of gonadal male tissue, and spermatogenesis. In the intermediate phase, the male gonadal architecture begins to be defined, with the proliferation of numerous spermatocysts containing germ cells at different developmental stages. In final transitional gonads, only few degenerating oocytes and melanomacrophage centers remain. The morphology of transitional gonad at this phase is characterized by the complete formation of the testicular lamellae and the seminiferous lobules, which can be classified as unrestricted lobular type. At hormonal level, the beginning of the sexual transition is associated with the decrease of plasma estradiol-17 'beta' levels and the increase of circulating testosterone, suggesting the implication of such circumstances to trigger the natural sex change in S. marmoratus. Plasma 11-ketotestosterone levels onlysuffered weak variations during the initiation and progress of such process, which may indicate the secondary role of this androgen in S. marmoratus sex reversal. The identification of the adenohypophyseal cells of Synbranchus marmoratus during sex reversal does not show any alteration in the immunomarcation pattern of secretory cells of different hormones during the process, except for gonadotropin-producing oolls, which synthesis activity was very high in the initial intersexes. Probably, these cells offer hormonal support for sex reversal in this species. Therefore, sex reversal in S. marmoratus seems to occur under hypothalamic-hypophyseal-gonadal axis control. Morphological alterations necessary to sex reversal process accomplishment - disorganization of female gonadal tissue and development of the tissue of opposite sex - are gradually promoted by the estrogens privation, and/or by the androgens levels increase. Therefore, S. marmoratus constitutes an excellent model for the studying of morpho-functional eventsof sex change Doutorado Biologia Celular Doutor em Biologia Celular e Estrutural

The objective is to analyse the Brazilian scientific production about the access to health services by transsexual women in primary care of the SUS. This integrative review was conducted from January 2020 to January 2021, in the database Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature and Banco de Dados em Enfermagem, for the period from 2013 to 2020 and selected from the guide question: How does access to health services be given in primary care of the SUS by women transsexuals? The review was composed by eleven articles. The publications found barriers in the implementation of politics for trans population, as the social name disrespect in the health unities. Moreover, the concentration of most studies in the Southest makes harder to make an overview of access in Brazil. The scientific production analysed showed the problems in the access and the need to educate SUS primary care health professionals about the needs of trans women. El objetivo es analizar la producción científica brasileña sobre el acceso a los servicios de salud por parte de mujeres transexuales en la atención primaria del SUS. Se trata de una revisión integradora, realizada de enero de 2020 a enero de 2021, en las bases de datos Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature y Banco de Dados em Enfermagem, con un plazo de 2013 a 2020 y seleccionado de la pregunta de la guía: ¿Cómo se da el acceso a los servicios de salud en la atención primaria del SUS por las mujeres transexuales? La muestra consistió en once artículos. Los estudios señalaron barreras en la aplicación de políticas dirigidas a la población trans, como la falta de respeto por los nombres sociales dentro de las unidades de salud. Además, la concentración de la mayoría de los estudios en la región sureste perjudica una visión general del acceso en Brasil. La producción analizada eviidenció las brechas de acceso existentes y la necesidad de instruir a los profesionales de la salud de la atención primaria del SUS sobre las necessidades de las mujeres trans. O objetivo do estudo foi analisar a produção científica brasileira sobre o acesso aos serviços de saúde por mulheres transexuais na atenção primária do SUS. Trata-se de uma revisão integrativa da literatura, realizada no período de janeiro de 2020 a janeiro de 2021, nas bases de dados Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulative Index to Nursing and Allied Health Literature e Banco de Dados em Enfermagem, com recorte temporal de 2013 a 2020 e selecionados a partir da questão norteadora: Como se dá o acesso aos serviços de saúde na atenção primária do SUS por mulheres transexuais? A amostra foi composta por onze artigos. Os estudos apontaram barreiras na implementação das políticas voltadas para a população trans, como, dentre outros entraves, o desrespeito ao nome social dentro das unidades de saúde. Além disso, a concentração da maior parte dos estudos na região Sudeste, prejudica uma visão geral do acesso no Brasil. A produção científica analisada evidenciou as lacunas existentes no acesso e a necessidade de instruir os profissionais de saúde da atenção primária do SUS acerca das necessidades das mulheres trans.

El presente artículo es fruto de una investigación centrada en la percepción que las per-sonas trans de Andalucía tienen sobre lo que se articula en la Ley integral 2/2014, de 8 de julio, integral para la no discriminación por motivos de identidad de género y recono-cimiento de los derechos de las personas transexuales de Andalucía. El objetivo de este estudio es analizar el nivel de importancia que las personas trans conceden a las medidas propuestas en esta ley. Han participado un total de 100 personas trans de todas las provincias andaluzas a través de un cuestionario de valoración tipo Likert . Los resultados muestran que las personas participantes consideran de gran importancia todos los aspectos que se regulan en esta ley, aunque pese a ello, aparece un porcentaje significativo de personas que consideran que aún no están representadas en las leyes au-tonómicas. Estos resultados y sus implicaciones son analizados., This work is based on transgender´s people perception that lives in Andalusia about the law number 2 of 8 July 2014, for non-discrimination and protection of transgender people from Andalusia. The aim of the study is to analyze the importance that individuals give to the measures proposed in this law. A total of 100 individuals participated in all Andalusia through a Likert scale. Results show that participants have attached great importance to the measures listed in this law but there are people that still feel unrepresented in the regional law. These re-search findings and their implications are discussed.

Transexualism constitutes a difficult psychiatric and social theme. Psychoanalyst as well as countless other specialists concern themselves with the treatment of this disturbance trying to investigate andand to understand the subjacent psychopathology. The psychoanalytical literature is not extensive and there are few contributions, or even up-to-date, on this subject. This present work aims atproviding na attempt at a psychoanalytical understanding of transexualism correlating psychoanalytical data already described. The author intend to verify if there is a consensus of opinion between the authors and if it is possible to identify a psychoanalytical theorization of transexualism by approaching the question of identity. The autor concludes with theoretical observation related the matter presented, joining them whith four clinical vignetes.

Resumo: Neste trabalho, interpreto comparativamente os itinerários agenciados por homens trans para lidar com a questão da espera, quando confrontados por desafios relacionados ao acesso a serviços de saúde no Brasil na Argentina. O texto, fruto de pesquisa antropológica nas regiões metropolitanas de Goiânia e de Buenos Aires, visa a contribuir para as discussões em torno do acesso à saúde para homens trans nesses dois contextos, buscando apontar para as ambivalências relacionadas a seus itinerários terapêuticos em busca de cuidados biomédicos. Resumen: En este trabajo, se interpretaron comparativamente los itinerarios organizados por hombres trans para enfrentarse a la cuestión de las esperas, cuando se enfrentan a desafíos relacionados con el acceso a servicios de salud en Brasil y Argentina. El texto, fruto de una investigación antropológica en las regiones metropolitanas de Goiânia y Buenos Aires, tiene como objetivo contribuir a discusiones sobre el acceso a la salud para hombres trans en esos dos contextos, buscando apuntar las ambivalencias relacionadas con sus itinerarios terapéuticos, en búsqueda de cuidados biomédicos. Abstract: In this article I provide a comparative interpretation of the itineraries used by trans men to deal with the issue of waiting, when confronted with challenges related to access to health services in Brazil and Argentina. The article was the result of anthropological research in the greater metropolitan areas of Goiânia and Buenos Aires, aimed at contributing to discussions on access to health for trans men in these two contexts, seeking to identify ambivalences related to their treatment itineraries in search of biomedical care.

Aim of the Study: To describe our surgical technique highliting several steps we experienced differently from the traditional Petrovich technique. Materials and Methods: Surgical equipe consists of two couples of surgeons working toghether at the beginning and at the end of surgery, separately at the central time. Patient position is lithotomic: two surgeons stand at the hips facing eachother, other two sit in front of perineum. Preoperative skin marking and penile lenght measuring is performed to obtain satisfacting results in terms of depth of neovagina and external genitalia reconstruction. Perifunicular fat is saved during orchifuniculectomy to add volume in labia majora construction. Spongious tissue of bulbar urethra and erectile tissue of corpora cavernosa is totally removed. Mucosa of neourethral meatus is everted using 3/0 resorbable suture. Neovaginal cavity is created by smooth dissection of Denovillier fascia. Anterior neovaginal wall consists of penile skin flap, posterior wall of scrotal skin flap. Scrotal and penile flaps are sutured along lateral borders forming a unique tubular flap, apex of neovaginal tubular flap is not sutured. Neoclitoris is proceeded from a piece of dorsal glans toghether with neurovascular penile bundle that is fixed above the symphysis by 4/0 suture. Neoclitoris/neourethral complex is lodged in a mucosal environment by a two-layered suture to connect both mucosal and spongiosal tissue. Lateral suture of labia majora is done with intradermal self-lock suture thread. Results: Contemporary surgical working allows shortening of operative time until 4 hours. Preoperative skin marking and measuring of penis lenght ensures simmetry and gives a preliminar aesthethic and function outcome. Perifunicular fat conferes natural aspect to labia majora. Total removal of erectile tissue prevents from dispareunia. Mucosal eversion of neourethral meatus prevents from stenosis. Leaving the apex of tubular neovaginal flap open allows the gain of lenght after surgery protecting from scar retraction. Adequate isolation of neurovascular bundle permits to reach orgasm by tactile stimulation and prevents from neoclitoral necrosis. Mucosal environment of neoclitoris/neourethral complex is fundamental for natural aesthetic outcome and lubrication. Intradermal lateral suture guarantees good wound healing and less infections. Discussion: The challenging of male-to-female sexual reassignment surgery requires good surgical technique and well-trained surgeons. The technique we reported has been developed after 30 years of experience and after more than 400 patients treated.

Dissertação de Mestrado apresentada no ISPA - Instituto Universitário para obtenção do grau de Mestre na especialidade de Psicologia Clínica O presente estudo visa contribuir para a compreensão da vivência subjetiva (intra e interpsíquica) do sujeito transexual e avaliar o impacto das alterações corporais inerentes ao Processo de Redesignação Sexual. Foram realizadas duas entrevistas, com o espaçamento de um ano entre elas, seguindo o Método de Narrativas de Associação Livre (Hollway & Jefferson, 2000), a um participante do género masculino em processo de redesignação para o género feminino. A análise das narrativas, orientada pelos postulados teóricos da metodologia proposta, revela que a transformação corporal consiste numa solução defensiva e radical face a um ataque e depreciação da masculinidade do sujeito, levando-o a constituir uma identidade de superfície feminina que recobre a identidade e permite a continuidade psíquica. A transformação corporal ganha sentido na fantasia de um “renascer”, com o propósito de varrer da consciência um passado doloroso e remeter as suas experiências ao esquecimento. A nova “etapa”, retratada e marcada no corpo, inspirada na fuga e no desespero, constitui a derradeira tentativa de proteger um território psíquico na iminência de desaparecer. O corpo torna-se palco de transformações sucessivas que parecem intensificar a estranheza da experiência corporal e gerar uma maior e perigosa desorganização psíquica. ABSTRACT: The present study aims to contribute to the understanding of the subjective experience (intra and interpsychic) of the transsexual subject and to evaluate the impact of the corporal changes inherent in the Sexual Reassignment Process. Two interviews were carried out, with the spacing of one year between them, following the Free Association Narratives Method (Hollway & Jefferson, 2000), to a participant of the masculine gender in the process of redesignation to the feminine gender. The analysis of the narratives, guided by the theoretical postulates of the proposed methodology, reveals that the corporal transformation consists in a defensive and radical solution to an attack and depreciation of the masculinity of the subject, leading him to constitute a feminine surface identity that encases the identity and allows for psychic continuity. Corporal transformation makes sense in the fantasy of a "rebirth", with the purpose of wiping from consciousness a painful past and remitting its experiences to oblivion. The new "stage," portrayed and marked in the body, inspired by escape and despair, is the ultimate attempt to protect a psychic territory in the imminence of disappearing. The body becomes the stage of successive transformations that seem to intensify the strangeness of bodily experience and generate a greater and dangerous psychic disorganization.

El presente trabajo de investigación, tuvo el objetivo de comprender los impactos que se generaron en los sistemas (microsistema, mesosistema, exosistema, macrosistema, cronosistema) durante el Tránsito/Transición de identidad de género, por medio de los operadores temporo espaciales: ritos, mitos y epistemes, los cuales reestructuraron los vínculos consigo mismo y con los demás, permitiendo así la Construcción Identitaria del individuo. Lo anterior estuvo fundamentado desde el Marcos Epistemológicos y Paradigmáticos logrando comprender a los individuos por medio de la Eco-Eto-Antropología, el Constructivismo, el Pensamiento Sistémico y Pensamiento complejo. Donde se utilizó una metodología cualitativa, lo cual permitió analizar los resultados obtenidos en cada una de las Historias de Vida. Se encontró que cada una de las participantes construye su identidad a partir de las experiencias propias y los cambios corporales, los cuales impactan en los diferentes sistemas en los que ellas se desenvuelven. De acuerdo con las participantes de esta investigación, la primera de ellas construyó su identidad como mujer Travesti, a los 30 años de edad y la segunda participante construyo su identidad como mujer Transexual, a los 20 años de edad. The present research work had the objective of understanding the impacts that were generated in the systems (microsystem, mesosystem, exosystem, macrosystem, chronosystem) during the transit of gender identity, through the temporo space operators: rites, myths and epistemes, which restructured the links with itself and with others, thus allowing the Identity Construction of the individual. This was based on the Epistemological and Paradigmatic Frameworks, achieving understanding of individuals through Eco-Eto-Anthropology, Constructivism, Systemic Thought and Complex Thought. Where a qualitative methodology was used, which allowed analyzing the results obtained in each of the Life Stories. It was found that each of the participants builds their identity from their own experiences and body changes, which impact on the different systems in which they operate. According to the participants of this research, the first of them built their identity as a transvestite woman, at 30 years of age and the second participant built her identity as a transsexual woman, at 20 years of age. Psicólogo Pregrado

Objectives: To provide a valid guideline for an effective dilatation in MtF patients who underwent vaginal reconstructive surgery. Materials and Methods: Dilatation Informative Leaflet is composed by 5 parts: description of dilatators (with photos), setting, performance, behavioral aspects, psychosexual aspects. Figures show three positions suggested to perform a correct dilatation. Vaginal dilatators have different sizes (lenght cm x diameter cm): 9x2cm, 11x2.5cm, 14x3cm,16x3,5cm. We submit the Dilatation Informative Leaflet to all patients at first medical examination in order to give them the adequate time to read it toghether with the surgeon and understand it completely before surgery. Patients are partnered by the surgeon and the dedicate nurse for the first dilatation (3th-4th Day after surgery), then they are usually able to do it individually. For the first 6 months after surgery we suggest to do 3-4 dilatations daily, then almost twice daily lifetime. Results: Pre-operative knowledge of dilatation management allows patients to learn the best technique briefly and start functional rehabilitation of neovagina shortly after surgery. Conclusion: Dilatation of neovagina has crucial role after sex reassignment surgery in MtF patients. A proper dilatation technique guarantees an adequate depth and diameter of neovagina and prevents from scar stenosis. Understanding the importance of correct management of dilatations plays a central role in sexual health for subjects who underwent sex reassignment surgery.

Transgender or gender dysphoria has been defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), as distress resulting from the incongruence between one's experienced gender and one's assigned gender, along with a persistent and strong desire to be of another gender, and accompanied by clinically significant distress. Adolescents referred for evaluation often want hormonal therapy and several among them also express a desire for gender reassignment surgery. Furthermore, evidence shows that adolescents and adults with gender dysphoria without a sex development disorder, before gender reassignments, are at increased risk for suicide. For this review, a search of the English language scientific literature was conducted using the PubMed database. This summary discusses the associations and comorbidities of gender dysphoria and reiterates the evidence that its etiology is multifactorial. Transsexualism involves prenatal neuroanatomical changes, has a psychiatric association, and is found to be more prevalent in conjunction with schizophrenia and autism spectrum disorders. Childhood adversities and neglect are also linked to having a transgender identity. Moreover, the evidence favors a genetic predisposition. Likewise, there seems to be a growing concern with regards to the relationship between endocrine disruptors and transsexuals as well as other gender minority populations. More research needs to be done to understand the exact pathways.

Introduction Male-to-female (MtF) and female-to-male (FtM) individuals with transsexualism (International Classification of Diseases-10) may differ in core clinical and sociodemographic variables such as age, sexual orientation, marriage and parenthood, school, educational level, and employment. Assessing and understanding the implication of such differences may be a key to developing appropriate and effective treatment and intervention strategies for this group. However, research in the area remains sparse and is often on small populations, making the generalization of results from current studies on individuals diagnosed with transsexualism difficult. Aims (i) To describe and assess key sociodemographic and treatment-related differences between MtF and FtM individuals in a Danish population of individuals diagnosed with transsexualism; (ii) to assess possible implications of such difference, if any, for clinical treatment initiatives for individuals diagnosed with transsexualism. Methods Follow-up of 108 individuals who had permission to undergo sex reassignment surgery (SRS, meaning castration and genital plastic surgery) over a 30-year period from 1978 to 2008 through the Gender Identity Unit in Copenhagen, Denmark. The individuals were identified through Social Security numbers. Clinical and sociodemographic data from medical records were collected. Results The sex ratio was 1.16:1 (MtF : FtM). Mean age at first referral was 26.9 (standard deviation [SD] 8.8) years for FtM and 30.2 (SD 9.7) for MtF individuals. Compared with MtF, FtM had a significantly lower onset age (before 12 years of age) and lower age when permission for SRS was granted. Further, FtM individuals were significantly more often gynephilic (sexually attracted to females) during research period and less likely to start self-initiated hormonal sex reassignment (SR) (treatment with cross-sex hormones). The MtF and FtM groups did not differ in years of school, educational level, employment, or engagement in marriage and cohabitation. Conclusions As approximately half of MtF started cross-sex hormonal SR without attending a gender unit, future treatment needs to focus on this group of MtF individuals in order to accommodate the medical risks of self-initiated hormonal treatment.Earlier intervention with adolescents appears necessary since three-quarters of FtM individuals before age 12 had problems with their assigned sex. For both MtF and FtM, we found problems in areas of school, education, and employment and recommend further help in these core areas.

The sexed binarity is a truth which seemed, until now uncontested and undeniable. So that, put except for designations genrées present in the Civil code, this last considered to be useful to specify only the sexes which were to be registered on the acts of the civil status, were to be exclusively female or male. However, in practice, the exclusive membership of the one of the two devoted sexes is not a universal rule.Thus the states of intersexuation came to tarnish the table, by affirming that the sex was not a single entity but a block of various components, objective and subjective, which are not necessarily concordant between them. On the one hand, the physical intersexuation, being characterized by a variation of the genital development (V. G. D.) is analyzed like nonan agreement of the objective components of the sex, i.e., all those which depend on a biological determinism. In addition, the psychic intersexuation, otherwise called transsexualism, or dysphorie of kind, implies only one discordance between the objective components and the subjective component, the psychosocial sex. In other words, the person is biologically of a determined sex, but it feels to belong to the other sex.These two states have authority to call into question the place of the sex in the acts of the civil status on two levels. On a side, the people known as “intersexes” will make us wonder about the true value of the civil status if this last does not take into account the variation in its statings. This interrogation seems to be countered by certain practices medical, which, under the constraint at the same time of the parents and the binary company, assigns young people intersexes in the days which follow the birth, while at the same time any medical need does not come to justify this act. Other side, the people transsexuals call into question the bases of the state of the people and in particular the principle of immutability.Moreover, the certainty on the sex in Right are upset by the development of the basic rights resulting from an interpretation increasingly broader of article 8 of the C.E.D.H. Thus, rises from the right to the respect of the private life, the right to the personal blooming, which itself made possible the emergence of the rights relating to the identity, of which gender identity. They are divided into two entities with on the one hand, the right to construction of the gender identity and other, the right to its recognition.All these considerations made transfer the mission of the civil status, which does not fulfill only any more one identifying mission and of civil police for the benefit of the State and the general interest, but which becomes the privileged place of the identity claims, for the benefit of individuals. Consequently, the kind becomes allowed in Right, more especially as the C.E.D.H. positions in favour of the development of this second mission.Taking into consideration these element, we can affirm that a reform of the mention of the sex to the civil status is convenient, would be this only to avoid the probable judgments of the European Court. This reform should ensure the respect due to the private life of the people in a state of intersexuation so much by limiting the stigmatizing situations of which they could be victims. It could in addition, to take two forms according to whether it would be placed in favour of an abandonment or installation of a new mention. On the first assumption, a neutralization of the sex would be considered and could take two forms. The first is analyzed in a total neutralization, i.e., that no mention of the sex appears on the acts of the civil status. The second partial insofar as the sex would be a hidden mention, or would be rationalized, with the assistance of novel methods of identification, like biometrics.; La binarité sexuée est une vérité qui semblait, jusqu’à aujourd’hui incontestée et incontestable. Si bien que, mises à part les désignations genrées présentes dans le Code civil, ce dernier n’a pas jugé utile de préciser que les sexes qui devaient être inscrits sur les actes de l’état civil, devaient être exclusivement féminin ou masculin. Cependant, en pratique, l’appartenance exclusive à l’un des deux sexes consacrés n’est pas une règle universelle.C’est ainsi que les états d’intersexuation sont venus ternir le tableau, en affirmant que le sexe n’était pas une entité unique mais un bloc de différentes composantes, objectives et subjective, qui ne sont pas nécessairement concordantes entre elles. D’une part, l’intersexuation physique, se caractérisant par une variation du développement génital (V.D.G.) s’analyse comme une non concordance des composantes objectives du sexe, c'est-à-dire, toutes celles qui dépendent d’un déterminisme biologique. D’autre part, l’intersexuation psychique, autrement appelée transsexualisme, ou dysphorie de genre, ne sous-entend qu’une discordance entre les composantes objectives et la composante subjective, le sexe psychosocial. En d’autres termes, la personne est biologiquement d’un sexe déterminé, mais elle se sent appartenir à l’autre sexe.Ces deux états ont vocation à remettre en cause la place du sexe dans les actes de l’état civil à deux niveaux. D’un côté, les personnes dites « intersexes » vont nous faire nous interroger sur la véritable valeur de l’état civil si ce dernier ne prend pas en compte la variation dans ses énonciations. Seulement, cette interrogation semble être contrée par certaines pratiques médicales, qui, sous la contrainte à la fois des parents et de la société binaire, assignent des jeunes intersexes dans les jours qui suivent la naissance, alors même qu’aucune nécessité médicale ne vient justifier cet acte. De l’autre côté, les personnes transsexuelles remettent en cause les fondements de l’état des personnes et notamment le principe de l’immutabilité.De plus, les certitudes sur le sexe en Droit sont bouleversées par le développement des droits fondamentaux issus d’une interprétation toujours plus large de l’article 8 de la C.E.D.H. Ainsi, découle du droit au respect de la vie privée, le droit à l’épanouissement personnel, qui lui-même a rendu possible l’émergence des droits relatifs à l’identité, dont l’identité de genre. Ils se divisent en deux entités avec d’une part, le droit à la construction de l’identité de genre et d’autre, le droit à sa reconnaissance.Toutes ces considérations ont fait muter la mission de l’état civil, qui ne remplit plus uniquement une mission identifiante et de police civile au bénéfice de l’État et de l’intérêt général, mais qui devient le lieu privilégié des revendications identitaires, au bénéfice des individus. Dès lors, le genre devient admis en Droit, d’autant plus que la C.E.D.H. se positionne en faveur du développement de cette seconde mission.Au regard de ces éléments, nous pouvons affirmer qu’une réforme de la mention du sexe à l’état civil est opportune, ne serait-ce que pour éviter les probables condamnations de la Cour européenne. Cette réforme devrait assurer le respect dû à la vie privée des personnes en état d’intersexuation tant en limitant les situations stigmatisantes dont elles pourraient être victimes. Elle pourrait par ailleurs, prendre deux formes selon qu’elle se placerait en faveur d’un abandon ou de la mise en place d’une nouvelle mention. Dans la première hypothèse, une neutralisation du sexe serait envisagée et pourrait prendre deux formes. La première s’analyse en une neutralisation totale, c'est-à-dire, qu’aucune mention du sexe n’apparaitrait sur les actes de l’état civil. La seconde serait partielle dans la mesure où le sexe serait une mention cachée, ou rationnalisée, avec l’aide de nouvelles techniques d’identification, comme la biométrie.

El objetivo de este trabajo es analizary reflexionar sobre los cambios introducidos en losEstandares Asistenciales (EA) de la 7a version dela Asociacion Mundial de Profesionales para la saludTransgenero (World Profesional Association forTransgender Health, WPATH, 2011). Intenta despatologizarsustituyendo el diagnostico “trastorno deidentidad de genero” por “disforia de genero” y seamplia la poblacion objeto de atencion y las opcionesde tratamiento. No es un prerrequisito realizar laexperiencia de la vida real y/o psicoterapia para eltratamiento hormonal, elimina la obligatoriedad deltratamiento hormonal para la cirugia de mamas y lacomorbilidad psiquiatrica no excluye necesariamenteel acceso a las terapias hormonal y quirurgica. Unode los apartados mas controvertidos es el dedicado aninos y adolescentes. Los nuevos estandares asistencialessuponen una superacion del modelo dicotomicotradicional, estableciendo que el genero sentido yexpresado no tiene porque ir indisolublemente ligadoal sexo biologico. Palabras clave: Estandares asistenciales;disforia de genero; trastorno de la identidad de genero;transexualismo. ABSTRACT:The aim of this presentation is toanalyse and reflect on the changes brought inthe Care Standards of the 7th version of WPATH(World Professional for Transgender Health).It attempts to depathologize replacing the Diagnostic“Gender Identity Disorders” by “GenderDysphoria” and extends the target population andtreatment options. It is not a prerequisite to carryout the real life experience and/or psychotherapyfor the hormonal treatment, the obligation to carryout the hormonal treatment for breast surgery isremoved and the psychiatric comorbidity does notneccesarily exclude the access to the hormonaland surgical therapy. One of the most controversialsections is the one dedicated to children andteenager treatment. The new standards involve anovercoming of the traditional dycotomic model,setting that gender, felt and expressed, does notneed to be inextricably linked to biological sex.Key words: Standard of Care; gender dysphoria;gender identity disorder; transexualism

Este trabajo realiza un recorrido historiográfico destacando aquellas películas que ofrecido un espacio para la representación del colectivo transexual en la ficción española. El objetivo de este estudio es identificar, analizar y comparar esta representación con el contexto en la que fue estrenada, así como destacar la labor de los profesionales de la industria del cine en la visibilidad del colectivo. El texto se centra en la representación de las mujeres transexuales debido a la inexistencia de representación de hombres transexuales en la ficción española. This study makes a historiographical tour highlighting films that offered a space for the representation of the transsexual colective in Spanish fiction. The aim of this study is to identify, analyze and compare this representation with the context in which it was released, and highlight the work of the professionals in the film industry on the visibility of the group . The text focuses on the representation of transgender women because of the lack of representation of transgender men in the Spanish fiction. Universidad de Sevilla. Grado en Comunicación Audiovisual

Con el presente estudio se busca mostrar la problemática que enfrentan las mujeres transgénero a la hora de definir su situación militar en Colombia a la luz delos Derechos Humanos, la Constitución Política, la Ley 48 de 1993, y la jurisprudencia desarrollada por la Corte Constitucional, en concordancia con instrumentos internacionales como la Convención Americana de DDHH y lo establecido por informes de la Defensoría del Pueblo y la Comisión Interamericana de Derechos Humanos. El estudio busca generar una reflexión sobre si las mujeres transgénero son objeto de violación a sus derechos humanos en un proceso del cual solo son receptores los hombres. De igual manera, analizar si es necesaria la creación de una norma específica para personas transgeneristas, que regule la situación militar en Colombia. The present study seeks to make visible the problematic that transgendered women confront in regards to the definition of their military situation in Colombia, in the light of the Human Right’s, the national constitution of this country, Law 48 of 1993, and the legal framework developed by the Constitutional Court, in accordance with international instruments such as the Human Right’s American Court, an the stated by the ombudsman’s informs, as well as the Inter American Commission for Human. The study seeks to generate in the reader a reflection upon if transgendered women are or are not object of human rights’ violations, when in a recruiting process of which only men are receptors. It also pretends to analize the necessity of a regulatory and specific norm for transgendered people, that regulates the military situation in Colombia. Magister en Defensa de los Derechos Humanos y el DIH ante Organismos, Tribunales y Cortes Internacionales Maestría

O artigo discute o atendimento a pacientes transexuais na rede pública de saúde, a partir de uma pesquisa exploratória realizada no Hospital Universitário Clementino Fraga Filho, da Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), com transexuais que procuraram atendimento com o objetivo de realização de cirurgia de transgenitalização. Observa-se que a transexualidade se caracteriza por uma condição de intenso sofrimento. Esta experiência se dá não apenas por uma percepção de não pertencimento ao sexo dito biológico, mas, sobretudo, pela precariedade social proveniente da não aceitação desta condição por parte da normatividade cultural vigente. Para além das questões subjetivas mais singulares, esta problemática revela fundamentalmente a insuficiência da nossa categorização sexual, e demonstra como os sistemas classificatórios de sexo e gênero utilizados pelos especialistas se constituem através de uma operação de exclusão. Sendo assim, considera-se que mesmo que, conjunturalmente, o diagnóstico de transtorno de identidade de gênero possibilite o acesso ao tratamento público, não se pode deixar de questionar os efeitos desta normalização. The article discusses health assistance given to transexual patients at public hospitals, based on in-house research carried out at the Hospital Universitário Clementino Fraga Filho of the Universidade Federal do Rio de Janeiro (HUCFF/UFRJ), where these patients seek medical assistance with the purpose of having transgenital surgery performed. Observations demonstrate that transexuality is characterized by a condition of severe suffering. This is an experience that comes from the individual's awareness of not pertaining to its biological gender, but, above all, by the social unsafeness that comes from society not accepting this condition due to current cultural norms. Beyond the boundaries of the more singular and subjective issues, this situation reveals, in profound detail, the insufficiency of our sexual categorization, and illustrates how the categorization system of sex and gender utilized by specialists is based on exclusion. Hence it is argued that even within the context, the diagnosis of gender identification disorder permitting the access to public treatment, one ought not to cease questioning the effects of this normalization.

El objetivo de este trabajo es analizar y reflexionar sobre los cambios introducidos en los Estándares Asistenciales (EA) de la 7ª versión de la Asociación Mundial de Profesionales para la salud Transgénero (World Profesional Association for Transgender Health, WPATH, 2011). Intenta despatologizar sustituyendo el diagnóstico "trastorno de identidad de género" por "disforia de género" y se amplía la población objeto de atención y las opciones de tratamiento. No es un prerrequisito realizar la experiencia de la vida real y/o psicoterapia para el tratamiento hormonal, elimina la obligatoriedad del tratamiento hormonal para la cirugía de mamas y la comorbilidad psiquiátrica no excluye necesariamente el acceso a las terapias hormonal y quirúrgica. Uno de los apartados más controvertidos es el dedicado a niños y adolescentes. Los nuevos estándares asistenciales suponen una superación del modelo dicotómico tradicional, estableciendo que el género sentido y expresado no tiene porqué ir indisolublemente ligado al sexo biológico. The aim of this presentation is to analyse and reflect on the changes brought in the Care Standards of the 7th version of WPATH (World Professional for Transgender Health). It attempts to depathologize replacing the Diagnostic "Gender Identity Disorders" by "Gender Dysphoria" and extends the target population and treatment options. It is not a prerequisite to carry out the real life experience and/or psychotherapy for the hormonal treatment, the obligation to carry out the hormonal treatment for breast surgery is removed and the psychiatric comorbidity does not neccesarily exclude the access to the hormonal and surgical therapy. One of the most controversial sections is the one dedicated to children and teenager treatment. The new standards involve an overcoming of the traditional dycotomic model, setting that gender, felt and expressed, does not need to be inextricably linked to biological sex.

Transexuality as practice and medical category is a phenomenon crossed by bioethical questions since its very beginnings. Pathologising medical categories, such as “transexualism” or “transvestism”, work as mechanisms producing and regulating the ‘truth’ of gender. On the basis of a sociological study, I will examine few aspects of the social and legal frameworks of transgenderism that reveal the circularity of identification and diagnostic process, as well as the interaction of medical discourse and folk notions of masculinity and femininity. In contrast with the binary frame that locates transgender people in a marginal “third” gender space, the comparative empirical studies them as a source of data about gender norms ruling all society members, and locates them in its ideological, social and political contexts. My aim is to better understand the cultural milieu in which the legal and the medical frames operate, and de-pathologising demands take place. I conclude with some thoughts about a possible interdiscursive framework that considers the ethical challenges in order to generate a new social set up more inclusive and respectful with gender fluidity., La transexualidad como práctica y categoría médica es un fenómeno atravesado por cuestiones de bioética. Categorías médicas patologizantes, como “transexualismo” o “transvestismo”, operan como productoras y reguladoras de la ‘verdad’ del género. A continuación, en base a un estudio sociológico, examinaré aspectos del marco social y legal del transgenerismo que ponen de relieve la circularidad de los procesos de identificación y diagnóstico, así como la interacción del discurso médico con las nociones folk de masculinidad y feminidad. A diferencia del marco binario que contempla al colectivo transgénero como un espacio “tercero” marginal, el estudio empírico comparativo se aproxima a él como fuente de datos acerca del género normativo que gobierna a todos los miembros de la sociedad y lo sitúa en sus contextos ideológico y socio-políticos, con el fin de comprender mejor el panorama cultural en el que se desarrollan las actuaciones legales y médicas, así como las demandas por la despatologización. A modo de conclusión ofrezco algunas reflexiones acerca de un posible marco interdiscursivo que considere los retos éticos con el fin de generar un nuevo marco social más inclusivo y respetuoso con la fluidez del género.

From women to men transexualism is a rare clinical condition in Turkey. However, in our clinic we face these kind of cases rarely. Most prominent wishes of these patients are genital sexual reconstruction. Mastectomy operations and contour correction operations will follow it. In this case a 32 year-old female(male) patient whose genital and breast surgery reconstructions have been completed, was examined. In our clinic attempts were made to repair the facial contour, and a conclusion was reached based on the patient’s request. To create a masculine face , there are some dots to be considered. A non- arc nasal dorsum, distinctive chin and mandibular corner, prominent supraorbital region are some of them. In this study we rewieved facial region contour applications for female to male tran-sxual cases.

This paper analyzes the films of José Jara (also known as José Royo Jara and John O´Hara). This research describes the thematic and aesthetic originality of his early works: Las cuatro novias de Augusto Pérez (1976), the only one film adaptation of “Niebla” (Miguel de Unamuno) to cinema theater; And El transsexual (1977), which is the first Spanish film that mixes documentary (non fiction) and fiction film about the transsexualism. Also this paper reviews the last works of José Jara: an erotic film, industrial shorts movies, his novel and his activity as Film Directing professor. Este artículo es un análisis de la obra cinematográfica de José Jara (también conocido como José Royo Jara y John O´Hara). Se presenta la originalidad temática y estética de sus primeras obras: Las cuatro novias de Augusto Pérez (1976), la única adaptación cinematográfica para sala de cine de “Niebla”, la novela de Miguel de Unamuno, y El transexual (1977), que es la primera película que mezcla el documental y la ficción sobre el tema de la transexualidad en el cine español. También se estudian su última etapa en el cine erótico, en el cine industrial así como su trabajo como escritor y docente de dirección cinematográfica.

Esta investigación buscó identificar las formas más representativas para representar e imaginar la sexualidad dentro de la comunidad transgénero en Colombia. Desarrollamos un estudio descriptivo exploratorio utilizando encuestas, entrevistas a profundidad, grupos focales y estrategias etnográficas con 18 personas transgénero. La información recolectada fue analizada teniendo en cuenta las siguientes dimensiones de interpretación: 1. Amor, erotismo y relaciones sexuales. 2. Género e identidades sexuales. 3. Prácticas y comportamiento sexual. 4. Autocuidado, percepción de riesgo frente al Virus de Inmunodeficiencia Humana (VIH) y proyectos de vida. Las personas transgénero abordadas en esta investigación expresaron la creencia de que el adoptar una identidad femenina involucra tomar riesgos en sexualidad debido a que el espacio socialmente asignado para ellas es el de la prostitución callejera en condiciones de vulnerabilidad. Proponemos intervenciones con personas transgénero para favorecer la autonomía, el goce y el autocuidado como elementos centrales de calidad de vida y equidad ciudadana para, de esta manera, reducir el estigma. This investigation sought to identify the most significant ways in which sexuality is represented and imagined within the culture of transgender women in Colombia. We performed an exploratory descriptive study using surveys, in-depth interviews, focus groups and ethnographic strategies with 18 transgender women. The collected information was analyzed, taking into account the following dimensions of interpretation: 1. Love, erotic, and sexual relations. 2. Gender and sexual identities. 3. Sexual behavior and practices. 4. Self-care, Human Inmunodeficiency Virus (HIV) risk perception and life goals. The transgender women reached in this investigation expressed the belief that adopting a feminine identity involved taking sexual risks because the space socially assigned for them is that of street prostitution in conditions of vulnerability. We propose interventions with transgender women that favor autonomy, joy, and self-care as the central elements of a quality life and equal citizenship focused on reducing stigma. Esta pesquisa procurou identificar as formas mais representativas para representar e imaginar a sexualidade dentro da comunidade transgênero na Colômbia. Desenvolvemos um estudo descritivo exploratório utilizando pesquisas, entrevistas a profundidade, grupos focais e estratégias etnográficas com 18 pessoas transgênero. A informação coletada foi analisada levando em consideração as seguintes dimensões de interpretação: 1. Amor, erotismo e relações sexuais. 2. Gênero e identidades sexuais. 3. Práticas e comportamento sexual. 4. Autocuidado, percepção de risco diante do Virus da Inmunodeficiência Humana (VIH) e projetos de vida. As pessoas transgênero abordadas nesta pesquisa expressaram a crença de que adotar uma identidade feminina envolve assumir riscos em sexualidade devido a que o espaço socialmente designado para elas é o da prostituição de rua em condições de vulnerabilidade. Propomos intervenções com pessoas transgênero para favorecer a autonomia, o gozo e o autocuidado como elementos centrais de qualidade de vida e equidade cidadã para, desta maneira, reduzir o estigma.