A.-M. Clouet

Bio: A.-M. Clouet is an academic researcher from Necker-Enfants Malades Hospital. The author has contributed to research in topics: Transsexual. The author has an hindex of 1, co-authored 1 publications receiving 27 citations.

A new type of family: Transmen as fathers thanks to donor sperm insemination. A 12-year follow-up exploratory study of their children

Abstract: Objective In France, female-to-male transsexuals who have obtained a change of civil status have the right to request donor sperm insemination (DSI) for the woman with whom they live. Because this was met with some reluctance, a trial program with a follow-up study was devised with the agreement of the ethical committee. The aim was to check the quality of parenthood and the development and quality of life of the children. Patients and methods These couples were considered to be similar to any couple requesting medical assistance to procreate. There is always an interview with a specialist in psychology before gametes are given. In these cases, there was a second one with a professional who worked with transsexuals. Usually parents are left free to choose to disclose or not the gift of gametes; but in this situation, since everybody in the father's environment as a child was aware of his background history, these parents were advised to tell the truth about the DSI and the father's transsexual past. A follow-up was proposed every second year. Parents and children were not volunteers participating in a research program; they came for a consultation from which they expected some help in their particular situation. The parents had interviews with a psychiatrist and two psychologists, the children were observed in their playing and drawing, and one standard measure (the Brunet-Lezine Scale) was used. Results Forty-two children born to 32 couples were followed up from 2000 to 2012 and the program is still on-going. Though without a penis, the transmen are considered by their wives as men; the wives are not homosexual; the couples are stable (there have been only three separations); the children are very well cared for and have good relationships with their fathers, they seem normal, happy, without any major difficulty, without any gender identity variant. Fathers (with one exception) spoke easily of the DSI, but had some difficulty with their transsexualism – although willing to talk about it, they found it hard to put into appropriate words. They were helped by one father, who wrote and illustrated a booklet, telling of his childhood experience in simple words. The children coped well with this disclosure. Conclusion This trial program brought positive results. It may continue and others may be set up in spite of persistent prejudices. The “therapeutic alliance” with these couples is now good enough to allow for research beyond pure observation – with a protocol and standard measures to appreciate the mental health, gender identity and quality of life of these children as they become adolescents.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

Abstract: Abstract Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.

Fertility options in transgender people

Abstract: Hormonal and surgical treatments for transgender people have a devastating effect on the possibility for these patients to reproduce. Additionally, transgender people tend to start sex reassignment treatment at a young age, when reproductive wishes are not yet clearly defined nor fulfilled. The most recent Standards of Care of the World Professional Association for Transgender Health recommend clearly informing patients regarding their future reproductive options prior to initiation of treatment. This review gives an overview of the current knowledge and state-of-the-art techniques in the field of fertility preservation for transgender people. Where genital reconstructive surgery definitely results in sterility, hormone therapy on the other hand also has an important, but partially reversible impact on fertility. The current fertility preservation options for trans men are embryo cryopreservation, oocyte cryopreservation and ovarian tissue cryopreservation. For trans women, sperm cryopreservation, surgical sperm extraction and testicular tissue cryopreservation are possible. Although certain fertility preservation techniques could be applicable in a standardized manner based on clear biological criteria, the technique that eventually will be performed should be the preferred choice of the patient after extended explanation of all possible options.

ESHRE Task Force on Ethics and Law 23: medically assisted reproduction in singles, lesbian and gay couples, and transsexual people

Abstract: This Task Force document discusses ethical issues arising with requests for medically assisted reproduction from people in what may be called 'non-standard' situations and relationships. The document stresses that categorically denying access to any of these groups cannot be reconciled with a human rights perspective. If there are concerns about the implications of assisted reproduction on the wellbeing of any of the persons involved, including the future child, a surrogate mother or the applicants themselves, these concerns have to be considered in the light of the available scientific evidence. When doing so it is important to avoid the use of double standards. More research is needed into the psychosocial implications of raising children in non-standard situations, especially with regard to single women, male homosexual couples and transsexual people.

Transfamily Theory: How the Presence of Trans* Family Members Informs Gender Development in Families

Abstract: The presence of a trans* family member can challenge existing theoretical notions about the development of gender in families. Emerging knowledge about trans* identities consolidates around 5 primary challenges to existing theoretical notions of gender: (a) non-dimorphic sex, (b) nonbinary gender, (c) the biological and social construction of gender, (d) gender identity development, and (e) family meaning making about transgender identity. These challenges structure an examination of hetero- and cisnormative expectations within family theory and help unpack long-standing tensions between essentialist and social constructionist views of gender development. This can play out in family theory through a recognition of the tension between upholding and decentering cisnormativity within families. This article pinpoints locations where current family theories require reexamination and expansion to accurately conceptualize the flexibility and variability of families with trans* members.

Biotechnologies that empower transgender persons to self-actualize as individuals, partners, spouses, and parents are defining new ways to conceive a child: psychological considerations and ethical issues

Abstract: Today, thanks to biomedical technologies advances, some persons with fertility issues can conceive. Transgender persons benefit also from these advances and can not only actualize their self-identified sexual identities but also experience parenthood. Based on clinical multidisciplinary seminars that gathered child psychiatrists and psychoanalysts interested in the fields of assisted reproduction technology (ART) and gender dysphoria, philosophers interested in bioethics, biologists interested in ART, and endocrinologists interested in pubertal suppression, we explore how new biotechnical advances, whether in gender transition or procreation, could create new ways to conceive a child possible. After reviewing the various medical/surgical techniques for physical gender transition and the current ART options, we discuss how these new ways for persons to self-actualize and to experience parenthood can not only improve the condition of transgender persons (and the human condition as a whole through greater equity) but also introduce some elements of change in the habitual patterns of thinking especially in France. Finally, we discuss the ethical issues that accompany the arrival of these children and provide creative solutions to help society handle, accept, and support the advances made in this area.