The aim of this review paper was to investigate variations in sex differentiation, andalso, examine what neurobiological underpinnings there are to gender identity andgender dysphoria. In addition, the most extreme form of gender dysphoria,transsexuality, will be described from a neurobiological perspective but also discussedin terms of the classification from DSM-5. One theory considered on how genderidentity originates is the fact that the sexual differentiation of the brain and thedifferentiation of sexual organs develop during different time periods. Alterationswere displayed in a demonstration of male-to-female (MTF) and female-to-male(FTM) transsexuals that showed reversed results in cell number in a part of thehypothalamus, acronymized INAH-3 and reversal volume results in another region,acronymized BSTc. Likewise, differences in grey matter in the right putamendepended upon their natal gender. It can be concluded that there is biologicalevidence for sex differentiation and indications that lead science into consideringbiological components for gender dysphoria. This conclusion suggests for futureresearch questions focused more on the possible genetic factors of gender identity,also, consider larger sample sizes and more replications. There is still incompleteknowledge of what exactly constitutes an individual’s gender identity.

Antalet diagnoser av könsdysfori (KD), har ökat markant i Sverige och andra delar av västvärlden sedan 2008. Merparten av denna ökning utgörs av flickor i tonåren, vilka numera utgör den största gruppen av transpersoner. Tidigare studier av denna till synes nya population baseras på rapporter från föräldrar, som kan vara icke-representativa på flera olika sätt. För att undvika en del av dessa problem rekryterades skolpersonal, som fick besvara en enkät om antalet transidentifieradeelever som de känner till, och hur många som förekommer i samma klass eller kamratgrupp. Hypoteserna var att (1) transpersoner i åldrarna 13- 20 år är födda som flickor i högre utsträckning än som pojkar, (2) att fler än en transidentifierad elev återfinns i samma klassrum eller sociala krets inom en skola är vanligare än förväntat av slumpen, och (3) detta är vanligare bland flickor än pojkar. Enkäten annonserades via Facebooksidor och via e-post till rektorer för svenska grund- och gymnasieskolor. Den besvarades av 196 personer, som rapporterade om 176 transpersoner i 103 olika skolor. Av dessa var 103 flickor (58.5%) och 73 pojkar (41.5%), vilket är en signifikant skillnad. 12 transpersoner var samtidiga i samma klass, 24 i samma kamratgrupp, och 72 i samma skola. Som mest gick fyra transpersoner i samma skola under samma tid. I inget klassrum eller kamratgrupp rapporterades fler än två transpersoner. Utifrån dessa antal kunde inga definitiva slutsatser dras men vårt sampel indikerade att KD inte är medierad inomkamratgrupper. / A significant increase of gender dysphoria (GD) diagnosis has been reported in Sweden and the rest of the West since 2008. The majority of the increase is attributed to biological girls, 13-20 years, who have superseded biological boys in the amount of GD diagnosis. Studies of this seemingly new population were based on parentreports, which can be considered as non-representative for various reasons. To avoid some of those issues school-personnel were recruited as respondents. Three hypotheses were tested; (1) transpersons 13-20 are born as girls at a higher rate than boys, (2) more than one transidentified student in a classroom or social circle in a school is more common than expected by chance, (3) if 2 differs between the sexes it ́s more common amongst those born as girls than those born as boys. The survey posed questions regarding the quantity of transpersons respondents encountered, how many of those were in the same classroom. It was posted on Facebook- pages and emailed to principals of Swedish elementary- and upper secondary schools. 196 persons responded and reported 176 transpersons in 103 different schools. Girls were overrepresented, 103 (58.5%) versus 73 boys (41.5%). Of the 176 reported transpersons, 72 attended a schoolwith at least one other transperson. 12 were part of the same classroom, 24 of the same friendgroup. No more than 4 attended the same school. No class or friendgroup consisted of more than two. No definitive conclusions were made but our sample indicated that GD was not mediated by friendshipgroups.

Bakgrund: Könsdysfori är en beskrivande term som redogör för individens känslo- eller tankemässiga missnöje med det kön som tilldelats vid födseln vilket medför ett lidande för individen. Personer med könsdysfori har hög förekomst av samtidiga psykiatriska diagnoser. Syfte: Syftet med studien var att beskriva hur personal inom psykiatrin erfar omvårdnaden av personer med könsdysfori. Metod: Kvalitativ studie med semistrukturerade intervjuer. Urvalet bestod av tio respondenter arbetandes inom psykiatrisk öppenvård och slutenvård. Materialet har analyserats med tematisk innehållsanalys. Resultat: Det framkommer att patientgruppen kan upplevas som utmanande att möta utifrån olika aspekter. Detta är delvis kopplat till personalens vilja att ge god vård och bidra till minskat lidande för patienterna samtidigt som personalen ofta känner osäkerhet i mötena. Omvårdnadshandlingar sker främst via samtal och psykiatripersonalen visar delvis förståelse för patientens livsvärld och lidande. Utöver detta framkommer det också att personalen upplever kunskapsbrist och ser ett behov av ökad kunskap. Konklusion: Att möta patienter med könsdysfori kan upplevas komplext och svårt. Inom vården finns en okunskap som sannolikt adderar till redan befintligt stigma. Dock utförs omvårdnadshandlingar som ligger i linje med aktuell forskning samt nationella och internationella riktlinjer. / Background: Gender dysphoria is a descriptive term that describes the individual's emotional or mental dissatisfaction with the gender assigned at birth, which causes suffering for the individual. People with gender dysphoria have a high incidence of concomitant psychiatric diagnosis. Aim: The purpose of the study was to describe how staff in psychiatry experience the care of people with gender dysphoria. Method: Qualitative study with semi-structured interviews. The sample consisted of ten respondents working in psychiatry. The material has been analyzed using thematic analysis. Results: The results shows that the patient group can be experienced as challenging to meet based on different aspects. This is partly linked to the staff's willingness to provide good care and contribute to reduced suffering for the patients, while the staff often feel insecurity. Nursing actions take place mainly through conversations and the psychiatric staff show a partial understanding of the patient's lifeworld and suffering. In addition to this, it also appears that the staff experience a lack of knowledge and sees a need for increased knowledge. Conclusion: Meeting patients with gender dysphoria can be experienced as complex and difficult. Healthcare services sometimes lacks knowledge that probably adds to an already existing stigma. However, to some extent nursing actions are delivered in line with current research as well as national and international guidelines.

Transgender (TG) persons often receive, or self-treat, with cross-sex hormone (CSH) treatments as part of their treatment plans, with little known about their incidence of breast cancer. This information gap can lead to disparities in the provision of transgender health care. The purpose of the study was to examine the incidence of breast cancer in the largest North American sample of TG patients studied to date to determine their exposure to CSH, incidence of breast cancer, and to compare results with European studies in transsexual populations. We used Veterans Health Administration (VHA) data from 5,135 TG veterans in the United States from 1996 to 2013 to determine the incidence of breast cancer in this population. Chart reviews were completed on all patients who developed breast cancer. Age-standardized incidences of breast cancer from the general population were used for comparison. Person-years of exposure to known CSH treatment were calculated. Ten breast cancer cases were confirmed. Seven were in female-to-male patients, two in male-to-female patients, and one in a natal male with transvestic fetishism. Average age at diagnosis was 63.8 (SD = 8.2). 52 % received >1 dose of CSH treatment from VHA clinicians. All three males presented with late-stage disease were proved fatal. The overall incidence rate was 20.0/100,000 patient-years of VHA treatment (95 % CI 9.6–36.8), irrespective of VA CSH treatment. This rate did not differ from the expected rate in an age-standardized national sample, but exceeded that reported for smaller European studies of transsexual patients that were longer in duration. Although definitive conclusions cannot be made regarding breast cancer incidence in TG veterans who did or did not receive VA CSH due to the sample size and duration of observation, it appears that TG veterans do not display an increase in breast cancer incidence. This is consistent with European studies of longer duration that conclude that CSH treatment in gender dysphoric patients of either birth sex does not result in a greater incidence than the general population.

Bakgrund  Transperson är ett begrepp som innefattar ett flertal olika könsidentiteter, många transpersoner lider av könsdysfori. En person med könsdysfori har ofta en önskan om att korrigera sin kropp, men för att kunna göra det krävs en könsidentitetsutredning, vilket är en lång och påfrestande process. Denna väntan på behandling för att få känna sig hemma i sin egen kropp, att bryta mot normen, att inte längre ha möjligheten till biologiska barn och att ständigt behöva ställas inför situationer då det är nödvändigt att ”komma ut” kan påverka hälsan, såväl psykiskt som fysiskt. Syfte Syftet var att beskriva transpersoners upplevelse av hälsa.  Metod En litteraturöversikt har genomförts. Totalt inkluderades 16 artiklar publicerade mellan år 2012 och 2019 med både kvantitativ och kvalitativ metod. Resultat Fyra kategorier identifierades; Livskvalitet, Det allmänna hälsotillståndet, Suicid och suicidala handlingar samt Kontakt med vården. Både livskvaliteten och det allmänna hälsotillståndet är sämre hos transpersoner jämfört med övriga befolkningen. Transpersoner har även en högre suicidfrekvensen och utsätts ofta för både diskriminering och våld. Det sociala nätverket är bristande vilket har en negativ effekt på den upplevda hälsan. Kontakten med vården skjuts ofta upp på grund av bristande bemötande och okunskap bland vårdpersonalen.  Slutsats Transpersoner är en utsatt grupp nationellt såväl som internationellt och hälsan är sämre än övriga befolkningens. Kunskapen om trans är generellt låg bland vårdpersonal. Ett sätt att säkerställa kompetens och förbättrat bemötande vore att utbildning om trans och HBTQ inkluderas i läkar- och sjuksköterskeutbildningarna. Det finns även ett behov av att könsidentitetsutredningens utformning ses över. / Background Trans person is a term that encompasses multiple gender identities, many transgender people suffer from gender dysphoria. They often have a desire to undergo gender reassignment surgery, but in order to do so, a gender identity investigation is required, which is a long and stressful process. The wait for treatment to feel at home in one's own body, being deprived of the possibility of biological children, breaking the norm and constantly having to face situations when it is necessary to "come out" could affect health, both mentally and physically.  Aim The aim was to describe trans people´s experiences of health. Method A literature review has been conducted with a total of 16 included articles, using quantitative as well as qualitative method, published between the years 2012 and 2019. Results Four categories were identified; Quality of life, General health, Suicide and suicidal acts and Contact with health care. The quality of life and experienced health among transgender people is poorer than in the rest of the population. Suicide rates are higher and transgender people are often subjected to both discrimination and violence. Their social network is lacking which has a negative effect on the perceived health. Contact with health care is often postponed due to bad encounters and ignorance from the health care professionals. Conclusion Transgender people are a vulnerable group nationally as well as internationally, and the experienced health in this group is poorer than in the rest of the population. The knowledge about trans is low among healthcare professionals. One way to ensure competence of healthcare staff is to include education on trans and LGBTQ in the physician- and nurse educational programs. There is also a need for the gender identity investigation to be reviewed.

Under de senaste 10 åren har gruppen som sökt hjälp för könsdysfori ökat. Personer med könsdysfori är särskilt utsatta för att utveckla psykisk ohälsa jämfört med befolkningen i övrigt. Det saknas dock kunskap om deras närståendes upplevelser. Den här studien är del av svenska könsdysforistudien, SKDS. Syftet med studien var att i en svensk kontext undersöka närståendes upplevelse av att leva nära en person som genomgår utredning och behandling för könsdysfori. Utifrån semistrukturerade intervjuer med elva närstående tolkades materialet genom induktiv tematisk analys. Analysen visade att de närstående upplevt att relationen fördjupats genom processen. Oavsett varierande reaktioner initialt har samtliga närstående landat i en vilja att genom fördjupad kunskap stå upp för den vårdsökande. För många har processen känts tung och ensam. Samsjuklighet och minoritetsstress har bidragit till ökad komplexitet och tyngd. Man har också hittat kraft i den gemensamma kampen. En slutsats är att den icke-dömande hållningen och oreserverade acceptansen hos de närstående, inte i samma grad återspeglats i internationella studier. En ytterligare slutsats är att de närstående utgör en viktig resurs i den vårdsökandes möjlighet till ett gynnsamt behandlingsutfall och att de närstående behöver uppmärksammas och erbjudas stöd för att själva kunna vara ett stöd. / Delstudie till Svenska könsdysforistudien (SKDS)

[pt] Este trabalho é fruto da conjunção de quatro escritos independentes, mas que guardam entre si o mesmo fio contudor, o mesmo leitmotiv: a psicopatologia da vida sexual, em geral, e o diagnóstico de disforia de gênero, em particular. Ele busca perfazer a genealogia da categoria diagnóstica no DSM, analisando os dispositivos de poder que a engendraram e a mantêm no rol dos transtornos psiquiátricos. Discutimos sua função como sustentáculo do tratamento transicionador, bem como os efeitos a longo prazo deste último. Por fim, propomos um prognóstico do diagnóstico baseados nas contingências contemporâneas e precedentes históricos. / [en] This work is the result of the conjunction of four independent writings, which maintain between them the same leitmotiv, the psychopathology of sexual life in general, and the diagnosis of gender dysphoria in particular. It seeks to make the genealogy of the diagnostic category in the DSM, analyzing the power strategies that produced and maintain it in the role of psychiatric disorders. We discuss its function as a supporter for the transitional treatment model, as well as the long-term effects of the latter. Finally, we propose a prognosis of gender dysphoria diagnosis based on contemporary contingencies and historical precedents.

A Ruminação tem sido um importante campo de investigação para estudar os mecanismos cognitivos e alteração dos estados emocionais associados ao processo do desenvolvimento de condições de saúde mental. A presente dissertação, cujo relatório de pesquisa deriva nessa produção, busca elucidar as relações entre ruminação e disforia de gênero. Dessa forma, a dissertação apresentará dois estudos de delineamento transversal que, no entanto, sofrem adaptações na disposição dos indivíduos da amostra para testar hipóteses específicas. Em ambos os estudos foram recrutadas 39 mulheres transexuais, no período de 2014 a 2015, que atenderam aos critérios do DSM 5 para diagnóstico de Disforia de Gênero (DG). O primeiro estudo teve como objetivo analisar os níveis de ruminação em pacientes com disforia de gênero antes e depois da Cirurgia de Redesignação Sexual (CRS), o que contribui com a literatura que investiga marcadores de desfecho positivo para CRS. O primeiro subgrupo (T0) foi constituído por participantes com diagnósticos confirmados para DG e com, no máximo, um ano de acompanhamento em grupoterapia. O T1, por pacientes que atenderam os pré-requisitos em relação à frequência aos atendimentos dos grupos psicoterapêuticos de, no mínimo, um ano, e no máximo dois anos, sem contra-indicação para realização da CRS. E o T2, constituído por pacientes pós-cirúrgicos em um período superior a seis meses. O segundo estudo teve como objetivo tanto analisar a relação entre abuso emocional na infância e ruminação em mulheres transexuais quanto identificar, entre os indivíduos da amostra, quais ruminam em nível p[baixo] = (33) ≤18 e p[alto] = (67) ≥23. Essa classificação entre dois subtipos do pensamento ruminativo pode elucidar diferenças entre os fatores protetivos e os desfechos nocivos na saúde mental e física dessa população. No primeiro estudo, a ruminação diminuiu entre os pacientes no T2 e os escores em ruminação foram ainda gradualmente menores a cada procedimento realizado nas características sexuais secundárias por pacientes deste grupo. Esse achado contribui para pesquisas do paradigma Research Domain Criteria (RDoC), que almeja demonstrar marcadores psicológicos para condições de saúde mental. Nesse caso, a ruminação parece se mostrar como um marcador importante para o desfecho positivo em pacientes com disforia de gênero pós-CRS. No segundo estudo, nosso principal achado reside na prevalência em até 15 vezes (IC95%: 2,25-99,63) de maior chance para engajamento em ruminação elevada ou comportamento disfórico entre os indivíduos que foram expostos ao abuso emocional, sobretudo, entre aqueles que o vivenciaram no intervalo da tipologia que variou de moderado – grave a grave – extremo se comparado aos indivíduos com gravidade entre mínimo a moderado na escala Childhood Trauma Questionnaire (CTQ). O abuso emocional está relacionado com engajamento em ruminação, sobretudo, ao subtipo elevada, o que contribui para aumento em comportamentos disfóricos, e ao estar associado à desregulação da emoção, que contribui para os desfechos nocivos na saúde física e mental desta população. / The Rumination has recently become an important field of study to better understand cognitive mechanisms and emotional status associated to the development of mental health conditions. The current work aims to shine a light upon the relation between rumination and gender dysphoria (GD). In this sense, this work presents two cross-sectional studies, each testing two specific hypotheses. Therefore, they have suffered adaptations in the disposition of the sample. In both studies, 39 transexual women, who fulfilled the DSM 5 diagnostic criteria for GD, were recruited within the years of 2014 and 2015. The first study aimed to analyse how much GD patients have rumination processes before and after sex reassignment surgery (SRS), which contributes to the body of literature seeking for positive outcome markers for SRS. The first group (T0) was made of participants who had a confirmed DG diagnostic and participated of group therapy for up to one year (between 0 and 12 months). The second group (T1) was composed by participants who had a confirmed DG diagnostic and attended from one up to two years of group therapy and had no contraindications for SRS. The third group (T2) was comprised of patients who have gone through SRS surgery at least six months prior to the data collection. The second study aimed to analyse the relation between emotional abuse during childhood and rumination in transexual women and to identify, amongst sample individuals, those who ruminate at a low or high levels. This classification into two subsets of ruminative thinking might clarify diferences between protective factors and poor mental and physical health outcomes in this specific population. In the first study, patients of the T2 group ruminate significantly less than their counterparts; moreover, scores of the ruminative thinking process seems to fall gradually with each alteration in the secondary sex characteristics. This finding contributes to the researches of the Research Domain Criteria (RDoC) paradigm, which seeks to find physiological markers for mental health conditions. In this case, rumination seems to be an important marker for positive outcomes in post-SRS GD patients. In the second study, the main result is the higher (up to 15 fold) prevalence for likeliness to engane in high level of ruminative thinking or dysphoric behaviour amongst the individuals who were exposed to emotional abuse. Above all, the engagement in ruminative thinking process is even higher amongst those who lived through emotional abuse in the moderated - severe and the severe - extreme categories of the Childhood Trauma Questionnaire (CTQ) scale than those in the light - moderate category. Emotional abuse is related to ruminative engagement, specially to the high level subtype of rumination. This contributes to the increase in dysphoric behaviours and to the bad health and mental outcomes in this population, probably associated with emotional dysregulation.

A presente dissertação tem o objetivo de discutir a proposta dos critérios diagnósticos da CID-11 para Incongruência de Gênero e comparar as diretrizes dos manuais diagnósticos DSM-5 e CID-10 para Disforia de Gênero e Transtorno de Identidade de Gênero, respectivamente. A Organização Mundial da Saúde (OMS) está em processo de revisão da Classificação Internacional de Doenças (CID). Diferentemente do sistema de classificação vigente (CID-10), as modificações propostas pela CID-11 no que diz respeito à condição transexual são norteadas pela compreensão de que esta não é doença mental e que o acesso à saúde desta população necessita ser ampliado. O artigo derivado desta dissertação compara os critérios nos manuais diagnósticos existentes, o DSM-5 e da CID-10, em uma amostra brasileira de pessoas transexuais que procuraram serviços de saúde especificamente para a transição física. Este é um estudo transversal multicêntrico que inclui uma amostra de 103 indivíduos que procuraram os serviços em um dos dois principais centros de referência no Brasil especializados em identidade de gênero. O método da pesquisa consiste na aplicação, por profissionais previamente treinados, de uma entrevista estruturada desenvolvida pelo WHO´s Field Study Coordination Group for ICD-11 Mental and Behavioural Disorders que contempla os critérios diagnósticos. Os resultados revelam que, embora exista desacordo teórico nos critérios há uma sobreposição entre os dois sistemas quanto à confirmação do diagnóstico, com o DSM-5 mais inclusivo. Adicionalmente, a média do tempo de espera para ter acesso a este tipo de serviço é de quase uma década. Nossos achados confirmam a ideia de que há pouco consenso quanto aos critérios diagnósticos dos comportamentos transgêneros, considerando a diversidade de contextos sociais e culturais e que seguem com pouca diferenciação tanto etiológica quanto clínica para fins diagnósticos. / The current work aims to discuss the proposed diagnostic criteria of ICD-11 for Gender Incongruence and compare the diagnostic criteria of DSM-5 and ICD-10 Gender Dysphoria and Gender Identity Disorder, respectively. The World Health Organization (WHO) is reviewing the International Classification of Diseases (ICD). Despite the existing classification system (ICD-10), changes proposed by ICD-11 concerning transgender condition are guided by the understanding that it is not a mental illness and that this population needs health service access to be expanded. The study derived from this work aim to compare the criteria in the existing diagnostic manuals, the DSM-5 and the ICD-10, among a Brazilian sample of transgender persons who sought health services specifically for physical transition. This is a multicenter cross-sectional study that includes a sample of 103 subjects who sought services for gender identity disorder in one of two main reference centers in Brazil. The research method consists of applying a structured interview, which is comprised of the diagnostic criteria from the two manuals. The results reveal that although the theoretical disagreement in the criteria, there is an overlap among the two systems as diagnosis confirmation, to the DSM-5 more inclusive. Additionally, the average waiting time to access this type of service is nearly a decade. Although there is not a consensus concerning such on transgenderism in the diversity of social and cultural contexts, the findings confirm previous impression that despite efforts to determine the diagnostic settings, they follow slightly different as to etiology and different clinical presentations of this condition.

A Disforia de Gênero (DG) caracteriza-se pela marcada incongruência entre gênero e sexo atribuído ao nascer. Trata-se de uma condição rara, cuja prevalência varia muito de acordo com o local estudado: na Nova Zelândia, há 27,48 por 100 000 habitantes, enquanto que, no Irã, são 0,68 por 100 000 habitantes. Sua etiologia depende da interação entre fatores biológicos e psicossociais, sendo a herdabilidade estimada de 62%. Indivíduos diagnosticados com DG integram populações sujeitas a maior violência, desde bullying até violência sexual. História de maus-tratos na infância (HMI) associa-se a maior prevalência de psicopatologias e de envolvimento com trabalho sexual na vida adulta. O objetivo do nosso estudo é avaliar a HMI como indicador de consequências mal adaptativas na vida adulta de transexuais homem-para-mulher (HpM). Utilizamos dados transversais coletados de 289 transexuais HpM, que compareceram a atendimentos regulares, do ano de 1998 a 2014, em ambulatório do Sul do Brasil, chamado Programa de Identidade de Gênero (PROTIG). Elas foram diagnosticadas de acordo com os critérios do DSM-IV-TR para transtorno de identidade de gênero (TIG), avaliadas para comorbidades utilizando o Mini International Neuropsychiatric Interview (MINI) e para história psiquiátrica, demográfica, psicossexual e familiar por questionários específicos. A presença de HMI foi investigada por três perguntas qualitativas, envolvendo abuso sexual, violência sexual e negligência, semelhantes ao Traumatic Events Screening Inventory – Self Report Revised (TESI-SRR). A associação entre o HMI e variáveis tanto psicossociais quanto clínicas foi realizada por análises bivariadas seguidas por modelo de regressão logística. O modelo utilizado para a regressão logística incluiu a cirurgia de redesignação sexual (CRS), tentativas de suicídio, vírus da imunodeficiência humana (HIV), doenças sexualmente transmissíveis (DSTs), desordem depressiva maior, distimia, episódios maníacos e hipomaníacos, idade de início do cross-dressing definitivo, idade de início dos jogos trocados, atuação como profissional do sexo e apresentar, pelo menos, uma comorbidade psiquiátrica. O objetivo da regressão logística foi controlar potenciais confundidores nas associações bivariadas, não estabelecer relações de causa e efeito. Verificamos que a exposição à HMI associa-se com trabalho sexual (p < 0,001), com HIV (p = 0,006), com possuir pelo menos uma comorbidade psiquiátrica (p = 0,006), com transtorno de depressão maior (p = 0,025), com risco de suicídio (p = 0,014), com abuso de álcool (p = 0,027) e com maior idade de início do cross-dressing definitivo (p = 0,041) e dos jogos trocados (p = 0,009). Após a regressão logística, apenas a atuação como profissional do sexo (p < 0,001) e apresentar, pelo menos, uma comorbidade psiquiátrica (p = 0,005) permaneceram significativamente associadas com HMI. Nosso estudo sugere que as transexuais com HMI exibem maior frequência de envolvimento com trabalho sexual e psicopatologia em sua vida adulta. A partir disso, reforça-se a importância de ações preventivas direcionadas à coibir maus-tratos durante à infância, evitando-se, por exemplo, bullying homofóbico. Além disso, indivíduos diagnosticados com DG, que sofreram maus-tratos durante a infância, deverão receber especial atenção psicológica, a fim de impedir desfechos negativos, como doenças psiquiátricas e tentativas de suicídio. / Gender Dysphoria (DG) is characterized by marked incongruence between gender and sex assigned at birth. It’s a rare condition whose prevalence varies based on geographical location: in New Zealand, there are 27.48 per 100 000 inhabitants whereas, in Iran, there are 0.68 per 100 000 inhabitants. Its etiology depends on interaction between biological and psychosocial factors, presenting an estimated heritability of 62%. Individuals diagnosed with DG are victims of greater violence, from bullying to sexual violence. Childhood history of maltreatment (CHM) is associated with a higher prevalence of psychopathology and sex work in adulthood. The aim of our study is to further characterize the role of CHM as an indicator of maladaptive consequences in adult male-to-female transsexuals (MtF). Our study used cross-sectional data from a consecutive sample of 289 MTF transsexuals, which attended, from 1998 to 2014, an outpatient clinic in Southern Brazil, called Gender Identity Program (PROTIG). They were diagnosed according to the DSM-IV-TR criteria for gender identity disorder (GID), were evaluated for comorbities using Mini International Neuropsychiatric Interview and for demographic, psychosexual and family history with specific questionnaires. The lifetime presence or absence of childhood trauma was investigated by asking three separated questions, similar to specific questions related to sexual abuse and negligence included in the Traumatic Events Screening Inventory – Self Report Revised. The association between CHM and psychosocial and clinical variables was evaluated bivariate analyses followed by stepwise backwards logistic regression models. The logistic regression model included gender redesign surgery (GRS), suicide attempt, human immunodeficiency virus (HIV), sexually transmitted diseases (DST), major depression disorder, dysthymia, manic or hypomanic episode, age of cross-dressing definitive and age of exchanged games, sex work and psychiatric comorbidities. The purpose of the logistic regression was to control potential confounding factors in the bivariate associations, not to establish cause and effect relationships. We found that being exposed to CHM is associated with sex work (p < 0.001), HIV (p = 0.006), having at least one psychiatric comorbidity (p = 0.006), major depression disorder (p = 0.025), risk of suicide (p = 0.014), alcohol abuse (p = 0.027) and age of onset of definitive cross-dressing (p = 0.041) and of exchanged games (p = 0.009). After the logistic regression, only sex work (p < 0.001) and having at least one psychiatric comorbidity (p = 0.005) remained significantly associated with CHM. Our study suggests that transsexuals with CHM present a higher frequency of sex work and psychopathology in their adult life. These findings raise the important issue that prevention actions might be indicated to avoid children maltreatment especially in risk groups, for example, homophobic bullying in children with atypical gender behavior. In addition, individuals diagnosed with DG, who suffered abuse during childhood, should receive special psychological care, in order to prevent negative outcomes, such as psychiatric disorders and suicide attempts.