A Science Mapping Analysis of Sixty-Seven Years of Scientific Evolution about the Transgender Population

TL;DR: In this paper, a bibliometric performance and network analysis (BPNA) was carried out with the existing data in the Web of Science database between 1954 and march 2021, and the results show the relation between the transgender theme and gender, identity, sexual orientation, hormone therapy and gender-affirming surgery.

Abstract: Gender and identity issues permeate society as a whole. Therefore, the matters involving transgender individuals should be analised in order to understand the difficulties experienced by this population and the social practices implemented. In this sense, the objective of this study was to investigate the strategic themes and their evolution in relation to the theme. For this, a bibliometric performance and network analysis (BPNA) was carried out with the existing data in the Web of Science database between 1954 and march 2021. Twenty-three thousand and four hundred and seventy-one (23,471) articles were identified, which were included in the SciMAT software to perform a bibliometric analysis, resulting in the graph of the thematic evolution structure and the strategic diagram, in which 8 motor themes and a cross-cutting theme of great magnitude are highlighted, which are discussed in depth. The results show the relation between the transgender theme and gender, identity, sexual orientation, hormone therapy and gender-affirming surgery. It is concluded that, despite the large number of associated researches, some areas of study are still incipient, such as the inclusion of transgender people in the formal labor market and in the prison context, thus opening field for further studies.

Summary

1. Introduction

• The sexuality theme has always been a taboo in the most distinct societies.
• Humanity processes and cultural expressions coexist that normalize, territorialize and homogenize differences [2] .
• There is an understanding of gender and sex as intrinsic, where sex is delimited by the biological constitution of the body, and gender refers to the social meanings attributed to these bodies [3] .
• The current version of the International Classification of Diseases (ICD-10), used on a large scale by the medical field, still brings transsexuality as a mental disorder [9] .
• The terms used in this study are consistent with the references used, in temporal consonance with the time they were published, and do not reflect bias or value judgement by the researchers.

2. Materials and Methods

• A Bibliometric Performance and Network Analysis (BPNA) supported by the SciMAT software was carried out to identify the strategic themes and the evolution map of the field of study.
• To achieve their goal, the Web of Science database was used to export related documents, as this indexed database has a large volume of quality research [12, 13] .

2.1. Dataset

• These terms were previous used by other authors who, despite having different goals, used similar strings [7, 14] , and others who analyzed the main terminologies used in systematic reviews of the field of study [15] .
• The terms "nonbinary", which is one of the most used since 2014, and "gender diversity", which has gained strength in recent years, have been used to give greater scope to the study [11] .
• The authors exported 23,477 documents from the Web of Science database, leaving 23,471 after deleting duplicates.
• SciMAT is a free software tool, which performs bibliometric analysis within a longitudinal map [17, 18, 19] .
• In the preprocessing step, words with the same meaning were grouped, misspelled terms have been corrected and generic words have been removed.

2.2. Discovery of strategic diagram and evolution map

• The network was extracted based on the co-occurrence of the authors keywords, to identify the units' nodes.
• In addition, the authors use the core mapper algorithm to calculate the network's co-occurrence [20, 21] .
• The thematic network structure indicates the relations of a cluster with others, and the evolution map identifies the most important themes over time.
• The lower right quadrant contains basic and transversal themes, which although co-occur with many themes have weak links.

3. Science Mapping analysis of transgender theme

• Figure 2 shows the performance analysis of scientific production related to the transgender theme from the first articles dating from 1954 until March 2021.
• It is noted that until around 1990 the number of studies was incipient, showing a slight increase from 1990 to 2000.
• Since the turn of the century, discussions have gained greater expression, but only from 2010 onwards did the theme gain notoriety and a massive number of publications, which is justified for the struggle of this population to guarantee their rights.
• The transgender cluster has the largest number of related papers (1,659).

3.1. Motor Themes and Thematic Network Structure of transgender theme

• The thematic structure of the motor themes is presented in Figure 4 , clarifying the relationships between the most relevant clusters and related themes.
• In addition, the "queer" cluster is also presented, because despite not being a motor theme, it has a significant number of associated studies.
• This structure allows us to understand the scope of discussions about the transgender population and the multiple issues that cross this field of study.

3.1.1. Transgender

• The 'TRANSGENDER' cluster is a motor theme with high density and centrality because it covers other terms related to the trans population.
• Besides, it is a generic term, which embraces all individuals whose gender identification diverges from traditional notions attributed to their biological sex [26] .
• Gender is based on the female and male categories, which are socially related to dichotomous gender divisions [26] .
• The central theme also presents relations between 'MENTAL-HEALTH' of transgender individuals and 'DISCRIMINATION', because this population has high rates of suffering and psychiatric disorders (such as personality, mood and post-traumatic stress disorders), which may be directly or indirectly related to the trauma and social discrimation experienced [28] .
• Furthermore, bullying and violence contribute to the disparities in access to health care in this population, which impacts their health, wellbeing and quality of life over time [29] .

3.1.2. Homosexuality

• The 'HOMOSEXUALITY' cluster becomes central, as it concerns sexual attraction or sexual behaviors exclusively or almost exclusively with people of the same sex [30] .
• Such theme include aspects related to 'SEXUAL-ORIENTATION', which refers to the existence or lack of sexual attraction of one person towards another [26] .
• Relating to such construction, the studies address 'NATIONALISM', which concerns the particular way each nationality sees homosexuality and different gender identities, creating norms specific to their culture [34] .
• It is noticed that these themes are crossed by the fact that the pattern discussed by transnationalism directly influences the different nations, and even so, each one of them has its particularities and norms.
• Thereby, it is explained how the themes 'HISTORY', 'MAGAZINES' and 'PERIODICAL' co-relate in this cluster.

3.1.3. Gender identity disorder

• The researches that make up the cluster 'GENDER IDENTITY DISORDER' encompass issues about 'GENDER-IDENTITY-DISORDER-OF-CHILDHOOD' and in 'ADOLESCENCE'.
• Disparities between the countries are also identified, regarding the care of these individuals and the impacts in short and medium term.
• Researches discuss this variation in children and adolescents, as these are areas of growing scientific interest after the emergence of clinics and medical centers that focus on gender identities and their variations.
• Another important relation is with the term 'AUTOGYNEPHILIA', which is a male's paraphilic tendency to feel aroused when thinking of himself as a woman.
• The fact that 'TRANSSEXUALISM' is not necessarily related to 'PSYCHIATRIC COMORBIDITY' is discussed [41] , although many transsexuals have personality disorders [42] , anxiety disorders, mood or disruptive disorders [43] .

3.1.4. Men who have sex with men

• The 'MEN WHO HAVE SEX WITH MEN' cluster refers to cisgender men who have sex with other men.
• Relating to this central theme, there is 'TRANSGENDER-WOMEN', people born male and who identify with the female gender, and 'FEMALE-SEX-WORKERS', women who have commercial sex, seeing it as their profession.
• In terms of prevention and epidemiological mapping, methodologies such as 'HIV-TESTING' and 'PREEXPOSURE PROPHYLAXIS' are included.
• For such a strategy to be effective, a care model is proposed, emphasizing and obeying the following points: definition of the population at risk, ensuring that these individuals are aware and willing to adopt such therapy, access to health care, and guaranteeing the continuity of treatment and care [47] .
• To be effective such methodology has some key elements: participants and their recruits should have a pre-existing relationship; the size of each participant's social media (the potential sampling frame) will influence; and the total number of recruitment coupons distributed to each participant is limited.

3.1.5. Corporate Governance

• The 'CORPORATE GOVERNANCE' cluster discusses 'BOARD-GENDER-DIVERSITY' in the corporate context, mainly in management and leadership positions.
• Therefore, the implementation of gender equality corporate policies favors the best financial performance of companies, produces competitive advantages regarding the labor market and generates mutual benefits for employers and employees [52] .
• It's important to take into consideration that, in some cases, women can be appointed to leadership positions under risky organizational conditions.
• Such context can lead to greater risks of failure, implying biases for evaluations [55] .
• The cluster does not present associations with themes such as 'TRANSGENDER' or 'TRANSSEXUAL', which can be explained by the incipient reaserch on the inclusion of this group in the labor market.

3.1.6. Vaginoplasty

• This cluster discusses 'SEX-REASSIGNMENT-SURGERY', 'GENDER-REASSIGNMENT-SURGERY' and 'GENDER-AFFIRMING-SURGERY', which are different names given to the surgical procedure that aims to adapt the individual's body to their perception of gender belonging.
• The theme is related to 'PHALLOPLASTY', 'PENILE-INVERSION' and 'METOIDIOPLASTY', which are different surgical methods for modification of sexual organs and adequacy of physical characteristics according to the individual's gender identity.
• The rest of the scrotum skin is used to form the labia and the urinary tract is adapted.
• As gender affirming surgeries are irreversible, it is essential that the Standards of Care (SOC) are clear and reliable.
• The sixth version of this document included national SOC, with specifications from different countries.

3.1.7. Sex change

• The cluster 'SEX CHANGE' is composed of a variety of studies that refer to both the 'ENVIRONMENTAL-SEX-DETERMINATION' and 'SEX-DIFFERENTIATION', as these occur naturally in animals, such as fishes and other marine animals [60] .
• The 'HERMAPHRODITISM' of animals that have both sexes is discussed, 'PROTOGYNY' refers to animals in which the female sexual organs reach maturity faster than male organs [61] and 'PROTANDRY' refers to the animals in which the male sexual organs are the first to reach maturity.
• Even in these species, stressors can induce sex change [63] in some subspecies.
• These studies are related to issues of 'GROWTH', because it is during this process that the progression of sexuality occurs; and 'AROMATASE', which is an enzyme responsible for a step in estrogen biosynthesis, hormone responsible for the individual's female characteristics and acts as a regulator of the reproductive cycle.
• Studies that discuss sex change in humans refer to possible procedures and treatments to achieve congruence between sex and gender [8, 65] .

3.1.8. Testosterone

• The cluster 'TESTOSTERONE' relates to 'HORMONES', 'ESTRADIOL' (an estrogen formulation), 'ESTROGEN', SEX-STEROIDS' and 'CROSS-SEX-HORMONE-THERAPY' due to the concepts of therapy/transition in transgender people.
• The need for hormonal treatment is related to the individual's dissatisfaction with their physical appearance, which is not in accordance with their gender identification.
• In female to male transsexuals, on the other hand, 'TESTOSTERONE' stimulates virilization and hair growth in a male pattern, and limits menstruation [58] .
• The term is also associated with 'TRANSGENDER-MEN', 'FEMALE-TO-MALE' and 'FEMALE-TO-MALE-TRANSSEXUALS', that portray the processe of gender readjustment.
• It is important to expand knowledge about the risks involved in these treatments, because, although the literature is limited, there are case reports of 'BREAST-CANCER' in transgender population [69] .

3.1.9. Queer

• The cluster 'QUEER' refers to a comprehensive term, considered an umbrella term, pointing out its relation with 'SEXUALITY' by including terms that refer to sexual orientation or non-binary gender identities, such as 'LGBT', 'TRANS' and 'DRAG'.
• In the beginning of the 20th century, the 'QUEER' term was used as a synonymous for 'weird' refering in a derogatory way to homosexual people.
• The term Queer, despite not having a clear definition, has been used in order to destabilize and demystify rigid identity categories, highlighting the existence of complexe sexualities, that are continually contructed [71] .
• The constitution of "identity" requires the construction of similarity with a group, with a psychological, political or sociocultural attribute or characteristic.
• The queer discussion also emcompasses the dificulties faced by this group in various everyday situations, such as in cases of 'MIGRATION' and asylum requests in other countries.

3.2. Scientific Evolution Structure Analysis

• Using SciMAT, a map of scientific evolution on transgender and associated themes was created.
• The map was divided in four analysis subperiods, in order to discuss the most important clusters and the multiple transversalities with related themes.
• The size of the clusters is proportionally related to the amount of papers associated with the theme.
• The lines represent the connections between the themes, becoming thicker as the interrelations and co-occurrence of terms increase over time.
• In the first and second subperiods (1991-2000) , the scientific production was incipient and revolved around issues of sex change and reassignment, and transsexualism.

3.2.1. Analysis and discussion of the first subperiod (1954-1990)

• The first studies on the subject date back to 1954.
• Those studies [73, 74, 75 ] cite researches from 1925, such as the book by Magnus Hirschfel, in which the term transvestism was used for the first time, and Caudwell in 1949, who used the term transsexual for the first time [76] .
• The main clusters refer to sex ratio and sex reassignment, with studies that analyze the performance of surgery [77, 78] , discuss cases of transsexualism [79, 80] , such as Christine Jorgensen, in 1950, who was the first to gain notoriety and raise discussions about gender roles [81] and the social and economical aspects of transsexualism [82] .
• Transvestism and transsexualism were understood as psychiatric disorders [74, 75, 83, 84] .
• The transsexual was the individual with an intense desire to assume the physical, mental and sexual characteristics of the opposite sex, including the modification of the anatomical structure [73, 85] .

3.2.2. Analysis and discussion of the second subperiod (1991-2000)

• During this subperiod, discussions about sex change persist, added to studies on transsexualism.
• Studies on genetic aspects of sexual orientation take place [92] , parental aspects associated to transsexualsim [93] , studies that highlight the psychological factors related to sexual orientation [94] , associated illness processes [95, 96] and the impact of heterossexist traditional culture on identity construction processes [97] .
• In 1994, with the publication of the DSM-IV, the term "gender identity disorder" started being used as a substitute for transsexualism.
• The gender identity disorder theme came to be understood as universal, raising discussions about its role in the social and cultural constructions of power and gender, exemplifying with the manifestations on the theme in religious and mythological cults.
• Discussions arise about affirmative environments for sexual minorities [101, 102] , showing concern with the inclusion and protection of these individuals.

3.2.3. Analysis and discussion of the third subperiod (2001-2010)

• In 2001 studies about policies and programs to attend the LGBT community emerged, especially because this population was considered to be in a vulnerability situation with increased risk to develop mental disorders and abuse of drugs [103, 104, 105] .
• The trans issues became focal points of the academic and popular thinking [106] , with an expressive increase in the number of publications.
• During this subperiod, sex change discussions persist.
• Furthermore, there is an important discussion about the relation between sex role and gender identity.
• To analyse the transsexual sex role, it is necessary to take into account the heteronormative social pressures to which they are subject, and that end up generating mixed roles, between the gender they identify with and the one society imposes on them.
• The researches denote greater thematic coverage and deepening of issues discussed.

3.2.4. Analysis and discussion of the fourth subperiod (2011-2021)

• The concentration of documents in this subperiod reflects the increased interest in the subject, compared to previous subperiods.
• Discussions on sex change remain constant in the four evolutional subperiods, related directly to the discussions about sex reassignment surgery.
• There is a differentiation between gender identity and gender expression.
• These discussions are relevant because, a lot of times, organizations have institutionalized cisnormativity, which makes the trans individual vulnerable to marginalization and discrimination [119] .
• During this period a large number of studies on HIV emerged, reflecting the exponential increase in the number of people infected by the virus in 2010.

4. Discussion

• No conclusive biological, social or psychological factors are identified [25] .
• Hence, discriminatory practices place trans people in a vulnerable situation, leaving them at the mercy of harassment, violence, expressions of hatred and injustice, whether in families, in the work context, in health or education institutions or in the community [8] .
• In the first subperiod described , the terms used -transvestism and transsexualism -had a connotation of disease and were conditions understood as psychiatric disorders [74, 75, 83, 84] .
• Acronyms such as LGBTTTQQIAA are also used, or even the english term LGBTQQICAPF2K+, that bring greater diversity by including transgender, two-spirit, queer, questioning, asexual, ally, no gender, pansexual, polysexual, and kink [127] .
• This process, although important, can often be long and exhausting, intensifying the suffering of the subject submitted to it.

5. Conclusions

• The issues related to non-binary gender identities, that do not fit the classic feminine or masculine, continue to oscillate between pathologization and acceptance, mainly because it is based on the patriarchal and heteronormative society.
• At the same time as the struggle for equality of rights takes place, the right to assert difference is sought.
• Thus, it is necessary to understand the uniqueness of the object of analysis and the normative and cultural dimension that mark the construction of knowledge.
• The limitations of this study refer to the fact that the first references on the transgender theme were not included in this bibliography due to the filter used, which included only articles in English from the Web of Science database.
• The incipience of research on this population in the prison context is also evident, which represents an important field for the development of new research.

Figures

Figure 2. Number of publications over time (1954 - March 13, 2021)

Figure 4. Thematic structures of the motor themes and the queer theme. (a) Transgender; (b) Homosexuality; (c) Gender Identity Disorder; (d) Men who have sex with men; (e) Corporate Governance; (f) Vaginoplasty; (g) Sex change; (h) Testosterone; (i) Queer.

Figure 1. Strategic diagram (a); thematic network structure (b); thematic evolution structure (c).

Figure 5. Thematic evolution structure.

Full text

Article
A Science Mapping Analysis of Sixty-Seven Years of Scientific
Evolution about the Transgender Population
Mariluza Sott Bender
1,3,
*, Michele Kremer Sott
2
, Vitória Merten Fernandes
3
, Mikaela Aline Bade München
3
,
Isadora Ferretti Gonçalves
3
, Silvia Virginia Coutinho Areosa
1
and Nicola Luigi Bragazzi
4,
*
1
Department of Psychology, University of Santa Cruz do Sul, Santa Cruz do Sul 96816-501, Brazil;
maribendersott@hotmail.com (M.S.B.); sareosa@unisc.br (S.V.C.A.)
2
Business School, Unisinos University, Porto Alegre 91330-002, Brazil; sott.mk@gmail.com
3
Multiprofessional Residency Program in Urgency and Emergency, Santa Cruz Hospital,
Santa Cruz do Sul, 96810-072, Brazil; vitoriafernandes@unisc.br (V.M.F.); mmunchen@unisc.br (M.A.B.M.);
isadorag@unisc.br (I.F.G.)
4 Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York
University, Toronto, ON M3J 1P3, Canada
* Correspondence: robertobragazzi@gmail.com (N.L.B); maribendersott@hotmail.com (M.S.B.)
Abstract: Gender and identity issues permeate society as a whole. Therefore, the matters involving
transgender individuals should be analised in order to understand the difficulties experienced by
this population and the social practices implemented. In this sense, the objective of this study was
to investigate the strategic themes and their evolution in relation to the theme. For this, a
bibliometric performance and network analysis (BPNA) was carried out with the existing data in
the Web of Science database between 1954 and march 2021. Twenty-three thousand and four
hundred and seventy-one (23,471) articles were identified, which were included in the SciMAT
software to perform a bibliometric analysis, resulting in the graph of the thematic evolution
structure and the strategic diagram, in which 8 motor themes and a cross-cutting theme of great
magnitude are highlighted, which are discussed in depth. The results show the relation between the
transgender theme and gender, identity, sexual orientation, hormone therapy and gender-affirming
surgery. It is concluded that, despite the large number of associated researches, some areas of study
are still incipient, such as the inclusion of transgender people in the formal labor market and in the
prison context, thus opening field for further studies.
Keywords: transgender; nonbinary; transsexual; queer; gender diversity; gender identity disorder;
bibliometrics; science mapping.
1. Introduction
The sexuality theme has always been a taboo in the most distinct societies. Adding
to that, there is the human difficulty of dealing with the difference, which is still perceived
as problematic and viewed with prejudice. This reinforces the power relation of socially
accepted groups over those considered different. What does not fit in the rigid established
heteronormative standards, may be considered as deviation from the norm or an illness
process. Prevails a definition of masculine and feminine based on sexual organs and its
embodied performance [1]. Humanity processes and cultural expressions coexist that
normalize, territorialize and homogenize differences [2].
There is an understanding of gender and sex as intrinsic, where sex is delimited by
the biological constitution of the body, and gender refers to the social meanings attributed
to these bodies [3]. This reality makes it very difficult to deconstruct the identity categories
and realize that the difference, made up of subjective experiences, crosses several trans
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 July 2021 doi:10.20944/preprints202107.0099.v1
© 2021 by the author(s). Distributed under a Creative Commons CC BY license.

subjectivities [3]. This difficulty is based on gender heteronormativity, which defends
heterossexuality and traditional gender expressions [4].
However, the dichotomous issues of male and female gender are not enough to
encompass the multiple faces of human sexuality. One of these faces is formed by the
group commonly known as LGBT (lesbians, gays, bisexuals and transsexuals). Despite the
discussions, variations and letter additions to the acronym over the years, it continues to
be used in a large number of papers, and is therefore adopted throughout this study.
Besides, the term transgender is used, to encompass all non-cisgender identities such as
transsexuals, interssexuals, transvestites, Drag Queens and Drag Kings [5].
In this context, trasngender individuals, whose gender identities are different from
their biological sex, find little to no space to live the fullness of their sexuality. Thus,
emerges the understanding that gender issues are not limited to the biological, because the
perceptions about bodies are constituted by cultural and symbolic aspects [6]. Therefore,
the theme starts to arouse great interest in the international scientific community [7].
Transsexuality, initially called transsexualism (the suffix ism identified disease), was
later included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), from
the American Psychiatric Association, as a gender identity disorder. The 5th version of this
manual, released in 2013, replaces this term with gender dysphoria, which refers to the
existence of significant suffering or prejudice in any area of the subject’s life, related to the
incongruity between the gender assigned to their sex at birth and the gender they identify
with [8]. This shows a change in perspective, that does not propose the treatment of
transsexuality, but of the suffering it can cause, and that, if not treated, can lead to
depression and suicide. However, the current version of the International Classification of
Diseases (ICD-10), used on a large scale by the medical field, still brings transsexuality as
a mental disorder [9]. On the other hand, ICD-11, expected to come into force on january
2022, seeks to overcome this issue by classifying transsexuality as a gender incongruence,
inside “conditions related to sexual health”.
However, besides the increasing number of papers about gender identity in recent
years, especially from 2010 [10], only a relatively low number has focused on non-binary
gender identities [11]. Thus, this research aimed to analyze the scientific production related
to the “transgender” theme, in order to identify the nuances it has been acquiring through
the different studies and historical contexts and give visibility to the social, cultural and
psychological challenges to which this population is subjected. The terms used in this
study are consistent with the references used, in temporal consonance with the time they
were published, and do not reflect bias or value judgement by the researchers. To achieve
our goal, a Bibliometric Performance and Network Analysis (BPNA) with the support of
the SciMAT (Science Mapping Analysis Software Tool) software was carried out to identify
the strategic themes and evolution map of the field of study.
The article is organized into sections: Section 2 demonstrates the materials and
methods. Section 3 presents the Science Mapping, the motor themes, the thematic network
structure and scientific evolution structure of the most important themes related to the
transgender field, besides pertinent discussions. Section 4 presents the conclusion,
suggestions for further research and the limitations of this paper.
2. Materials and Methods
A Bibliometric Performance and Network Analysis (BPNA) supported by the
SciMAT software was carried out to identify the strategic themes and the evolution map
of the field of study. To achieve our goal, the Web of Science database was used to export
related documents, as this indexed database has a large volume of quality research [12,
13].
2.1. Dataset
In order to identify related documents, we use a search string of terms related to
transsexuality: (“transgender” OR “transsexual” OR “transsexualism” OR
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 July 2021 doi:10.20944/preprints202107.0099.v1

“transsexuality” OR “gender dysphoria” OR “sex change” OR “sex reassignment” OR
“gender incongruence” OR “sexual reassignment” OR “gender nonconformity” OR
“sexual disorder” OR “queer” OR “non-binary” OR “nonbinary” OR “gender diversity”).
These terms were previous used by other authors who, despite having different goals,
used similar strings [7, 14], and others who analyzed the main terminologies used in
systematic reviews of the field of study [15]. The terms “nonbinary”, which is one of the
most used since 2014, and “gender diversity”, which has gained strength in recent years,
have been used to give greater scope to the study [11].
We selected articles, articles in press and reviews, in English, with the search terms
present in the title, abstract or keywords. We exported 23,477 documents from the Web of
Science database, leaving 23,471 after deleting duplicates. The documents were exported
on March 13, 2021. The SciMAT software developed in 2012 [16] was used for
preprocessing of data and generation of the strategic diagram and evolution maps.
SciMAT is a free software tool, which performs bibliometric analysis within a longitudinal
map [17, 18, 19]. In the preprocessing step, words with the same meaning were grouped,
misspelled terms have been corrected and generic words have been removed. After
preprocessing, 40,246 word clusters remained.
2.2. Discovery of strategic diagram and evolution map
In this step, the network was extracted based on the co-occurrence of the authors
keywords, to identify the units' nodes. The data were normalized with the Equivalence
Index and clustered with the Simple Center Algorithm considering a maximum 12 and
minimum 3 network. In addition, we use the core mapper algorithm to calculate the
network’s co-occurrence [20, 21]. The strategic themes were plotted on a two-dimensional
diagram composed by four quadrants where the ‘y-axis’ indicates the cluster density
(internal strength of the network), and ‘x-axis’ reflects the centrality (degree of interaction
of a cluster with others) [22]. The thematic network structure indicates the relations of a
cluster with others, and the evolution map identifies the most important themes over time.
Figure 1 presents an example of strategic diagram (a), thematic network structure and
thematic evolution structure (b).
Figure 1. Strategic diagram (a); thematic network structure (b); thematic evolution structure (c).
In this sense, the upper right quadrant contains themes with a high degree of
development (motor themes) (i.e., Figure 1 (a)). The lower right quadrant contains basic
and transversal themes, which although co-occur with many themes have weak links. The
lower left quadrant presents emerging or declining themes in the field of study, and the
upper left quadrant highlights themes with few but dense links to other themes. The
longitudinal framework (Figure 1 (c)) shows the interest of the research community and
evolution of the field over time, where the cluster size is proportional to the number of
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 July 2021 doi:10.20944/preprints202107.0099.v1

published documents and the thickness of the edges represents the strength of the
connection between themes [23, 16, 24]. For the longitudinal map, four subperiods were
defined: 1954-1990; 1991-2000; 2001-2010; and 2011-2021.The first subperiod includes a
longer time due to the low volume of publications and keywords.
3. Science Mapping analysis of transgender theme
Figure 2 shows the performance analysis of scientific production related to the
transgender theme from the first articles dating from 1954 until March 2021. It is noted
that until around 1990 the number of studies was incipient, showing a slight increase from
1990 to 2000. Since the turn of the century, discussions have gained greater expression,
but only from 2010 onwards did the theme gain notoriety and a massive number of
publications, which is justified for the struggle of this population to guarantee their rights.
Figure 2. Number of publications over time (1954 - March 13, 2021)
The strategic diagram (Figure 3) presents 35 clusters, subdivided in four quadrants.
From the clusters, 9 are motor themes (Q1), 10 basic and transversal themes (Q2), 6
emerging or declining themes (Q3) and 10 highly developed and isolated themes (Q4).
The size of the clusters is proportional to the number of associated documents. The
transgender cluster has the largest number of related papers (1,659).
Preprints (www.preprints.org) | NOT PEER-REVIEWED | Posted: 5 July 2021 doi:10.20944/preprints202107.0099.v1

Figure 3. Strategic diagram.
The most relevant clusters are the motor themes (Q1), which are basically composed
of expanded issues of transsexuality, gender, homossexuality and transgender, and the
basic and tranversal themes (Q2), that relate directly to motor themes, are composed of
dicussions about diversity, prejudice (stigma, homophobia, race, suicide) and queer,
whose discussions about gender identity and sexual orientation impact the way different
societies deal with transgender issues. The quadrant 3 (Q3) (emerging or declining
themes) contains diversified themes, permeating discussions on sexual health, sexually
transmitted infection, substance use and issues related to the police. The highly developed
and isolated themes (Q4) involve studies on fertility preservation, ovary, premature
ejaculation, Islam, aging, and issues of sexual violence and asylum for transgender
peoples.
3.1. Motor Themes and Thematic Network Structure of transgender theme
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Frequently asked questions

Q1. What have the authors contributed in "A science mapping analysis of sixty-seven years of scientific evolution about the transgender population" ?

In this sense, the objective of this study was to investigate the strategic themes and their evolution in relation to the theme. Twenty-three thousand and four hundred and seventy-one ( 23,471 ) articles were identified, which were included in the SciMAT software to perform a bibliometric analysis, resulting in the graph of the thematic evolution structure and the strategic diagram, in which 8 motor themes and a cross-cutting theme of great magnitude are highlighted, which are discussed in depth. It is concluded that, despite the large number of associated researches, some areas of study are still incipient, such as the inclusion of transgender people in the formal labor market and in the prison context, thus opening field for further studies. 

Q2. What have the authors stated for future works in "A science mapping analysis of sixty-seven years of scientific evolution about the transgender population" ?

In this perspective, as society builds masculinities and femininities aimed at a specific sex, it reinforces the construction of gender meanings, which are based on heterossexuality and the binary logic of man and woman as the only possibilities for experiencing sexuality. Furthermore, transgenderism is a broad term, and despite the large number of related articles, through the structure of thematic evolution it is possible to identify a gap in studies regarding the inclusion of transgender people in the work context and conducting future research that addresses this issues is a suggestion, so important for this population that struggles to guarantee their rights as a human being. 

Q3. Why do trans people continue to oscillate between pathologization and acceptance?

The issues related to non-binary gender identities, that do not fit the classic feminine or masculine, continue to oscillate between pathologization and acceptance, mainly because it is based on the patriarchal and heteronormative society. 

Q4. What is the role of gender in the recognition of transsexual identity?

The binary understanding of male and female interferes in political and legaldecisions related to the recognition of transsexual identity. 

Q5. What is the common treatment for transgender people?

In addition to hormonal therapies, which are also presented as fundamental means of emotional care for transgender subjects [41], there is also the possibility of surgical therapies [68]. 

Q6. What is the role of ‘PERIODICAL’ in the history of homosexuality?

It also uses stories, ideas, and insights as a resource that have implications for the conceptualization of sexuality through its own narrative. 

Q7. What is the role of the body in the creation of the identity of the subject?

The body, understood as the shell that supports the subject, in addition to showing the world who they are, participates in the creation of their identity and subjectivity [25]. 

Q8. What is the main reason for the need for sex change in humans?

The need for hormonal treatment is related to the individual’s dissatisfaction with their physical appearance, which is not in accordance with their gender identification. 

Q9. What is the importance of psychological support for parents of children and adolescents of different genders?

The importance of psychological support for parents of children and adolescents of different genders is also discussed, so they can strengthen the processes of communication and acceptance of their children [122]. 

Q10. What is the significance of the clusters analysis?

In the clusters analysis, it is noteworthy the fact that the cluster ‘CorporateGovernance’ has no relation with transgender, transsexuals, queer or its derivaties terms, highlighting that, although there is a large number of papers concerned with gender diversity in organizations, this diveristy is still conceived under the dichotomy of female and male and based on biological sex. 

Q11. What is the role of the medias in shaping queer culture?

In this perspective, these medias have played an important role in shaping queer culture from the start, putting into circulation pictures of homossexual people, most of the times transcending borders and enabling the creation of new identification processes with such representations [36]. 

Q12. What was the main reason for the increase in scientific interest on the transsexual theme?

In 1999, the increase of scientific interest on the transsexual theme was pointed out, which was understood as a phenomenon, and the change in the negative attitude of professionals towards sex reassignment surgery [93]. 

Q13. What is the first acronym used in Brazil?

In addition, the acronyms that refer to this population also varied over time, in orderto include the diversity related to human sexuality; for example, one of the first acronyms used in Brazil was LGS (lesbians, gays and supporters).