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The Journal of Clinical Endocrinology... Nov 2017To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009.
OBJECTIVE
To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009.
PARTICIPANTS
The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer.
EVIDENCE
This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies.
CONSENSUS PROCESS
Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines.
CONCLUSION
Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a mental health provider for adolescents (required) and mental health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and mental health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring mental health practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, mental health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
Topics: Adolescent; Adult; Age Factors; Endocrinology; Evidence-Based Medicine; Female; Gender Dysphoria; Humans; Long-Term Care; Male; Societies, Medical; Transgender Persons; Transsexualism; Young Adult
PubMed: 28945902
DOI: 10.1210/jc.2017-01658 -
Journal of Internal Medicine May 2022In line with increasing numbers of transgender (trans) and gender nonbinary people requesting hormone treatment, the body of available research is expanding. More... (Review)
Review
In line with increasing numbers of transgender (trans) and gender nonbinary people requesting hormone treatment, the body of available research is expanding. More clinical research groups are presenting data, and the numbers of participants in these studies are rising. Many previous review papers have focused on all available data, as these were scarce, but a more recent literature review is timely. Hormonal regimens have changed over time, and older data may be less relevant for today's practice. In recent literature, we have found that even though mental health problems are more prevalent in trans people compared to cisgender people, less psychological difficulties occur, and life satisfaction increases with gender-affirming hormone treatment (GAHT) for those who feel this is a necessity. With GAHT, body composition and contours change towards the affirmed sex. Studies in bone health are reassuring, but special attention is needed for adolescent and adult trans women, aiming at adequate dosage of hormonal supplementation and stimulating therapy compliance. Existing epidemiological data suggest that the use of (certain) estrogens in trans women induces an increased risk of myocardial infarction and stroke, the reason that lifestyle management can be an integral part of trans health care. The observed cancer risk in trans people does not exceed the known cancer-risk differences between men and women. Now it is time to integrate the mostly reassuring data, to leave the overly cautious approach behind, to not copy the same research questions repeatedly, and to focus on longer follow-up data with larger cohorts.
Topics: Adolescent; Adult; Female; Gender Identity; Humans; Male; Neoplasms; Testosterone; Transgender Persons; Transsexualism
PubMed: 34982475
DOI: 10.1111/joim.13441 -
Perspectives on Psychological Science :... Mar 2022Education involving active engagement in the arts, herein called , is often believed to foster the development of desirable personality traits and skills in children and... (Review)
Review
Education involving active engagement in the arts, herein called , is often believed to foster the development of desirable personality traits and skills in children and adolescents. Yet the impact of arts education on personality development has rarely been systematically investigated. In the current article, we reviewed the literature on personality change through arts education. We identified 36 suitable experimental and quasi-experimental studies. Evidence from these studies tentatively suggests that arts-education programs can foster personality traits such as extraversion and conscientiousness but not self-esteem. In addition, the effects of arts education appeared to be stronger in early and middle childhood than in preadolescence and early adolescence. However, the evidence for the effectiveness of arts education was very limited among the few included true experiments. Furthermore, the reviewed studies were heterogenous and subject to content-related, methodological, and statistical limitations. Thus, the current evidence base is inconclusive as to the effects of arts education on personality development. By identifying potential effects of arts education and limitations of past research, our review serves as a call for more research and guidepost for future studies on arts education and personality change.
Topics: Adolescent; Child; Educational Status; Humans; Personality; Self Concept
PubMed: 34283673
DOI: 10.1177/1745691621991852 -
Acta Psychologica Feb 2023In all, 510 Europeans completed an online questionnaire rating their beliefs about personal change, including the established Dweck Mindset measure. Their ratings of 27...
In all, 510 Europeans completed an online questionnaire rating their beliefs about personal change, including the established Dweck Mindset measure. Their ratings of 27 characteristics from BMI to sexual preference factored into 5 interpretable factors labelled Personality, Beliefs and Habits, Health, Social Status and Physical. Correlation indicated beliefs about change were most related to religious beliefs but also sex and age. Dweck ratings of ability and personality growth were logically related to beliefs about change on the five factors and also to religious beliefs and self-rated optimism. Regressions indicated that being religious was the most consistent predictor about change, as well as age and education. Many beliefs about change were in direct contraction to the academic literature on the topic. Implications and limitations are acknowledged.
Topics: Humans; Personality; Religion; Sexual Behavior; Educational Status
PubMed: 36566611
DOI: 10.1016/j.actpsy.2022.103821 -
Journal of Personality and Social... May 2020The research literature on personality development is based mostly on self-report studies and on samples in younger adulthood. The present multimethod study examines...
The research literature on personality development is based mostly on self-report studies and on samples in younger adulthood. The present multimethod study examines self-other agreement on longitudinal personality change and convergence between self- and informant-reports of longitudinal and retrospective personality change in older adulthood. It provides a rare validation test of longitudinal measurements of personality change. A representative community sample of 1,630 older adults (Mage = 62.5) and their informants completed self- and informant-personality assessments across three waves that were on average 6.5 years apart. Self- and informant-reports of retrospective personality change were collected at the third wave. Latent growth modeling was used to examine longitudinal personality change, longitudinal self-other agreement on personality change, and convergence between longitudinal and retrospective personality change in each five-factor model domain. Older adults in the present study reported less change than has been found in younger samples; however, both self- and informant-reports indicated declines in extraversion. Results showed strong self-other agreement on longitudinal personality change in all 5-factor model domains, moderate correspondence between longitudinal and retrospective-reports of change within-method (i.e., within self- or informant-report), modest self-other agreement on retrospective-reports, and little association between longitudinal and retrospective change across-method (i.e., between self- and informant-reports). Findings provide validation evidence for both longitudinal and retrospective assessments of personality change, indicate that informants provide unique perspectives on personality change, and could have potentially important implications for research, assessment, and clinical settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Topics: Aged; Extraversion, Psychological; Female; Human Development; Humans; Longitudinal Studies; Male; Middle Aged; Personality; Self Report
PubMed: 30843725
DOI: 10.1037/pspp0000238 -
Journal of Personality and Social... Mar 2022Personality traits and physical health both change over the life span. Theoretical models and empirical evidence suggest that these changes are related. The current...
Personality traits and physical health both change over the life span. Theoretical models and empirical evidence suggest that these changes are related. The current study investigated the dynamic relations between personality traits and physical health at both the between-person and the within-person levels. Data were drawn from three longitudinal studies: the Veterans Affairs Normative Aging Study (NAS; N = 1,734), the Longitudinal Internet Studies for the Social Sciences (LISS; N = 13,559), and the Swedish Adoption/Twin Study of Aging (SATSA, N = 2,209). Using random intercept cross-lagged panel models (RI-CLPMs) and the continuous time (CT) models, after controlling the between-person variance, generally, evidence was found for bidirectional associations between changes in neuroticism and extraversion and changes in self-rated health and general disease level. Bidirectional associations between changes in neuroticism and change in cardiovascular diseases and central nervous system diseases were observed only when time was modeled as continuous. We also found within-person associations between changes in neuroticism and extraversion and changes in performance-based ratings of motor functioning impairment. According to the current findings, the dynamic within-person relations between personality traits and health outcomes were largely in the direction consistent with their between-person connections, although the within-person relationships were substantially smaller in strength when compared their between-person counterparts. Findings from the current study highlight the importance of distinguishing between-person and within-person effects when examining the longitudinal relationship between personality traits and health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Topics: Aging; Humans; Longitudinal Studies; Neuroticism; Personality; Personality Disorders
PubMed: 35157486
DOI: 10.1037/pspp0000399 -
Journal of the American Medical... Oct 2023Clinical observations and studies of retrospective observer ratings point to changes in personality in persons with cognitive impairment or dementia. The timing and... (Observational Study)
Observational Study
OBJECTIVES
Clinical observations and studies of retrospective observer ratings point to changes in personality in persons with cognitive impairment or dementia. The timing and magnitude of such changes, however, are unclear. This study used prospective self-reported data to examine the trajectories of personality traits before and during cognitive impairment.
DESIGN
Longitudinal observational cohort study.
SETTING AND PARTICIPANTS
Older adults from the United States in the Health and Retirement Study were assessed for cognitive impairment and completed a measure of the 5 major personality traits every 4 years from 2006 to 2020 (N = 22,611; n = 5507 with cognitive impairment; 50,786 personality and cognitive assessments).
METHODS
Multilevel modeling examined changes before and during cognitive impairment, accounting for demographic differences and normative age-related trajectories.
RESULTS
Before cognitive impairment was detected, extraversion (b = -0.10, SE = 0.02), agreeableness (b = -0.11, SE = 0.02), and conscientiousness (b = -0.12, SE = 0.02) decreased slightly; there was no significant change in neuroticism (b = 0.04, SE = 0.02) or openness (b = -0.06, SE = 0.02). During cognitive impairment, faster rates of change were found for all 5 personality traits: neuroticism (b = 0.10, SE = 0.03) increased, and extraversion (b = -0.14, SE = 0.03), openness (b = -0.15, SE = 0.03), agreeableness (b = -0.35, SE = 0.03), and conscientiousness (b = -0.34, SE = 0.03) declined.
CONCLUSIONS AND IMPLICATIONS
Cognitive impairment is associated with a pattern of detrimental personality changes across the preclinical and clinical stages. Compared with the steeper rate of change during cognitive impairment, the changes were small and inconsistent before impairment, making them unlikely to be useful predictors of incident dementia. The study findings further indicate that individuals can update their personality ratings during the early stages of cognitive impairment, providing valuable information in clinical settings. The results also suggest an acceleration of personality change with the progression to dementia, which may lead to behavioral, emotional, and other psychological symptoms commonly observed in people with cognitive impairment and dementia.
Topics: Humans; Aged; Retrospective Studies; Prospective Studies; Personality; Cognitive Dysfunction; Dementia
PubMed: 37330217
DOI: 10.1016/j.jamda.2023.05.011 -
Proceedings of the National Academy of... Feb 2021Personality traits predict important life outcomes, such as success in love and work life, well-being, health, and longevity. Given these positive relations to important... (Randomized Controlled Trial)
Randomized Controlled Trial
Personality traits predict important life outcomes, such as success in love and work life, well-being, health, and longevity. Given these positive relations to important outcomes, economists, policy makers, and scientists have proposed intervening to change personality traits to promote positive life outcomes. However, nonclinical interventions to change personality traits are lacking so far in large-scale naturalistic populations. This study ( = 1,523) examined the effects of a 3-mo digital personality change intervention using a randomized controlled trial and the smartphone application PEACH (PErsonality coACH). Participants who received the intervention showed greater self-reported changes compared to participants in the waitlist control group who had to wait 1 mo before receiving the intervention. Self-reported changes aligned with intended goals for change and were significant for those desiring to increase on a trait ( = 0.52) and for those desiring to decrease on a trait = -0.58). Observers such as friends, family members, or intimate partners also detected significant personality changes in the desired direction for those desiring to increase on a trait ( = 0.35). Observer-reported changes for those desiring to decrease on a trait were not significant ( = -0.22). Moreover, self- and observer-reported changes persisted until 3 mo after the end of the intervention. This work provides the strongest evidence to date that normal personality traits can be changed through intervention in nonclinical samples.
Topics: Female; Humans; Male; Personality; Psychotherapy; Self Report; Smartphone
PubMed: 33558417
DOI: 10.1073/pnas.2017548118 -
Social Cognitive and Affective... Oct 2020Does the tendency to adjust appraisals of ourselves in the past and future in order to maintain a favourable view of ourselves in the present require episodic memory? A...
Does the tendency to adjust appraisals of ourselves in the past and future in order to maintain a favourable view of ourselves in the present require episodic memory? A developmental amnesic person with impaired episodic memory (HC) was compared with two groups of age-matched controls on tasks assessing the Big Five personality traits and social competence in relation to the past, present and future. Consistent with previous research, controls believed that their personality had changed more in the past 5 years than it will change in the next 5 years (i.e. the end-of-history illusion), and rated their present and future selves as more socially competent than their past selves (i.e. social improvement illusion), although this was moderated by self-esteem. Despite her lifelong episodic memory impairment, HC also showed these biases of temporal self-appraisal. Together, these findings do not support the theory that the temporal extension of the self-concept requires the ability to recollect richly detailed memories of the self in the past and future.
Topics: Adult; Amnesia; Female; Humans; Memory, Episodic; Mental Recall; Personality; Self Concept
PubMed: 32734306
DOI: 10.1093/scan/nsaa105 -
Current Opinion in Psychiatry Jan 2023People and communities around the world face many crises, including increasing burdens from disease, psychopathology, burn-out, social distrust, and acts of hate and... (Review)
Review
PURPOSE OF REVIEW
People and communities around the world face many crises, including increasing burdens from disease, psychopathology, burn-out, social distrust, and acts of hate and terrorism. Personality disorder is arguably both a root cause and a consequence of these problems, creating a vicious cycle of suffering caused by fears, immoderate desires, and social distrust that are inconsistent with rational goals and prosocial values. Fortunately, recent advances in understanding the biopsychosocial basis and dynamics of development in personality and its disorders offer insights to address these problems in effective person-centered ways.
RECENT FINDINGS
Fundamental advances have been made recently in the understanding of the psychobiology and sociology of personality in relationship to health, and in basic mechanisms of personality change as a complex process of learning and memory. Promotion of self-awareness and intentional self-control releases a strong tendency for people to seek coherence of their emotions and habits with what gives their life meaning and value.
SUMMARY
People have a strong drive to cultivate personalities in which their emotions and habits are reliably in accord with reasonable goals and prosocial values. Person-centered therapeutics provide practical ways to promote a virtuous cycle of increasing well being for individuals and their communities and habitats.
Topics: Humans; Temperament; Personality Disorders; Personality; Emotions; Psychopathology
PubMed: 36449732
DOI: 10.1097/YCO.0000000000000833