Molecular Genetics 32
The Limited Role of Genetics 33
The Influence of Hormones 34
Sexual Orientation and the Brain 39
Misreading the Research 41
Sexual Abuse Victimization 42
Distribution of Sexual Desires and Changes Over Time 50
Conclusion 57
Part 2: Sexuality, Mental Health Outcomes, and Social Stress 59
Abstract 59
Some Preliminaries 60
Sexuality and Mental Health 60
Sexuality and Suicide 66
Sexuality and Intimate Partner Violence 70
Transgender Health Outcomes 73
Explanations for the Poor Health Outcomes: The Social Stress Model 75
Discrimination and prejudice events 77
Stigma 79
Concealment 81
Testing the model 82
Conclusion 85
Part 3: Gender Identity 86
Abstract 86
Key Concepts and Their Origins 87
Gender Dysphoria 93
Gender and Physiology 98
Transgender Identity in Children 105
Therapeutic Interventions in Children 106
Therapeutic Interventions in Adults 108
Conclusion 114
Notes 117
Lawrence S. Mayer, M.B., M.S., Ph.D. is a scholar in residence in the Department of Psychiatry at the Johns Hopkins University School of Medicine and a professor of statistics and biostatistics at Arizona State University. Paul R. McHugh, M.D. is a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and was for twenty-five years the psychiatrist-in-chief at the Johns Hopkins Hospital. He is the author or coauthor of several books, including, most recently, Try to Remember:
Psychiatry’s Clash over Meaning, Memory, and Mind (Dana Press, 2008).