What is the Purpose of the Initial Psychiatric Evaluation of Minors with Gender Dysphoria.

The rising incidence of trans youth throughout the world and the new policy of many European countries and 25 US states that psychotherapy should be the first therapeutic response to Gender Dysphoria have made a reexamination of a comprehensive psychiatric evaluation (CPE) urgently relevant. Two conflicting views of the purpose of the CPE exist based on etiologic beliefs and convictions about the best therapeutic approach. This paper provides one clinician's synthesis of the elements, processes, goals, values, benchmarks of CPE and its usual recommendation for psychotherapy.

The Myth of "Reliable Research" in Pediatric Gender Medicine: A critical evaluation of the Dutch Studies-and research that has followed.

Two Dutch studies formed the foundation and the best available evidence for the practice of youth medical gender transition. We demonstrate that this work is methodologically flawed and should have never been used in medical settings as justification to scale this "innovative clinical practice." Three methodological biases undermine the research: (1) subject selection assured that only the most successful cases were included in the results; (2) the finding that "resolution of gender dysphoria" was due to the reversal of the questionnaire employed; (3) concomitant psychotherapy made it impossible to separate the effects of this intervention from those of hormones and surgery.

Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults.

In less than a decade, the western world has witnessed an unprecedented rise in the numbers of children and adolescents seeking gender transition. Despite the precedent of years of gender-affirmative care, the social, medical and surgical interventions are still based on very low-quality evidence. The many risks of these interventions, including medicalizing a temporary adolescent identity, have come into a clearer focus through an awareness of detransitioners.

Reflections on the Clinician's Role with Individuals Who Self-identify as Transgender.

The fact that modern patterns of the treatment of trans individuals are not based on controlled or long-term comprehensive follow-up studies has allowed many ethical tensions to persist. These have been intensifying as the numbers of adolescent girls declare themselves to be trans, have gender dysphoria, or are "boys." This essay aims to assist clinicians in their initial approach to trans patients of any age.

Informed Consent for Transgendered Patients.

The request of a transgendered-identified patient for psychiatric, medical, or surgical services creates ethical tensions in mental health professionals, primary care physicians, endocrinologists, and surgeons. These may be summarized as follows: Does the patient have a clear idea of the risks of the services that are being requested? Is the consent truly informed? While this question is starkly evident among cross-gender identified children contemplating puberty suppression and social gender transition and young adolescents with rapid-onset gender dysphoria, it is also relevant to young, middle-aged, and older adults requesting assistance. Many patients cannot tolerate detailed discussion of the risks.

Transitioning Back to Maleness.

Thirty-one years after living full time as a woman, a 53-year-old skilled machinist returned to have therapy with me, a psychiatrist, because of a decision to return to living as a man. As our work together continued, I suggested to this would-be published novelist that others might benefit from his experience. This led to his posting an extensive account of his life in September 2016 on Gender Trender.

Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria.

The increasing incidence of requests for medical services to support gender transition for children, adolescents, and adults has consequences for society, governmental institutions, schools, families, health-care professionals, and, of course, patients. The sociological momentum to recognize and accommodate to trans phenomena has posed ethical dilemmas for endocrinologists, mental health professionals, and sexual specialists as they experience within themselves the clash between respect for patient autonomy, beneficence, nonmaleficence, and informed consent. The larger ethical clashes are cultural and therefore political.

Reflections on the Legal Battles Over Prisoners with Gender Dysphoria.

Momentum has shifted in the legal battles over the provision of sex reassignment surgery (SRS) for male prisoners. In 2015, two court decisions granted the operation and were not appealed by the California Department of Corrections and Rehabilitation. The author, who has participated in some of these battles as an expert, analyzes the strengths and limitations of the medical illness, developmental, and minority rights paradigms for Gender Dysphoria that are used to reach psychiatric opinions about medical necessity.

Towards a compendium of the psychopathologies of love.

Adults are commonly preoccupied with their love lives and in psychotherapy they often express frustrations with themselves and their partners. Ironically, patients' preoccupations with the processes of love have not created many professional deliberations on the nature of love and mechanisms of its subversion. This essay describes the converging influences that may explain the professional avoidance of love.

Evolution of a remedial CME course in professionalism: addressing learner needs, developing content, and evaluating outcomes.

Introduction: Scant information is available about the nature of the professional violations resulting in referral of physicians for remedial continuing medical education (CME). The CME program at Case Western Reserve University (CWRU) School of Medicine has developed the Intensive Course in Medical Ethics, Boundaries, and Professionalism (medical ethics course) for physician referrals due to ethical breaches. In this report, the authors present 7 years of data regarding the type of behavior that resulted in course referral as well as information regarding course and outcome evaluation development and participant demographics.

Efficacy and safety of dapoxetine for the treatment of premature ejaculation: integrated analysis of results from five phase 3 trials.

Introduction: Dapoxetine has been evaluated for the on-demand treatment of premature ejaculation (PE) in five phase 3 studies in various populations worldwide and has recently been approved in several countries.

Aim: To present integrated efficacy and safety data from phase 3 trials of dapoxetine.

Methods: Data were from five randomized, multicenter, double-blind, placebo-controlled studies conducted in over 25 countries.

Sexual education for psychiatric residents.

Objective: The authors seek to promote sexuality curriculum development in departments of psychiatry.

Methods: The authors first focus on educational philosophy about what residents can be taught about sexual topics and then provide numerical and narrative resident evaluation data following a 6-month, half day per week rotation in a sexuality clinic.

Results: Curricula should begin by clarifying the dimensions of individual sexuality, conceptualizing the idea of the couple as the unit for understanding partnered sexual problems, providing opportunities to grow comfortable listening to sexual stories, and approaching etiology using the First Principle of Clinical Sexuality.

Meanings and political implications of "psychopathology" in a gender identity clinic: a report of 10 cases.

Beginning in August 2007, we committed ourselves to a clinical review the co-morbid diagnostic patterns of the last 10 patients interviewed by our Gender Identity Clinic. We found 90% of these diverse patients had at least one other significant form of psychopathology. This finding seems to be in marked contrast to the public, forensic, and professional rhetoric of many who care for transgendered adults.

Psychological and interpersonal dimensions of sexual function and dysfunction.

Introduction: There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms.

Aim: To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.

Methods: An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees.