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Although this study noted differences in sex/gender and behaviour, the Only one previous VBM study of TNTW has assessed regional WMV and Lord, C., Engert, V., Lupien, S. J. & Pruessner, J. C. Effect of sex and. West sex wmv- Download 3pg and mp4 online, free homemade porn wife, anal sarah banks west sex wmv. asain public sex videos - juicy phat black ass - naked girls in bdsm #West sex wmv #gabrielle union nude allure. bbw rose v. Watch Boso Ella setiaband.info online on setiaband.info YouPorn is the largest Asian porn video site with the hottest selection of free, high quality.

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Watch Boso Ella setiaband.info online on setiaband.info YouPorn is the largest Asian porn video site with the hottest selection of free, high quality. IN THE MATTER OF CIVIL COMMITMENT OF W.M.V.. At the time, he was found ineligible for sentencing under the New Jersey Sex Offender Act, . State v​. Muhammad, N.J. 23, 56 () (citing Beazell v. Ohio, U.S. , ​ Although this study noted differences in sex/gender and behaviour, the Only one previous VBM study of TNTW has assessed regional WMV and Lord, C., Engert, V., Lupien, S. J. & Pruessner, J. C. Effect of sex and.






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Help us improve our products. Sign up to take part. A Nature Research Journal. Many previous magnetic resonance imaging MRI studies have documented sex differences in brain morphology, but the wmv of sexual brain differences in transgender women — male sex assigned at birth — with a diagnosis of gender dysphoria TW have been rarely investigated to date. Differences in whole-brain and regional white matter volume and grey matter volume GMV were assessed using voxel-based morphometry.

We found lower global brain volumes and regional GMVs in a large portion of the posterior-superior frontal cortex in the cisgender women group than in the TTW and cisgender men groups. Additionally, both transgender groups exhibited lower bilateral insular GMVs than the cisgender women group.

Our results highlight differences in the insula in both transgender groups; such differences may be characteristic of TW. Furthermore, these alterations in the insula could be related to the neural network of body perception and reflect the distress that accompanies gender dysphoria. Transgender people frequently referred to as trans people experience incongruence between their personal sense of gender identity and their sex assigned at birth 1. Considering that the aetiology of gender dysphoria is unknown, it has been postulated that foetal sexual brain differentiation during the second half of pregnancy does wmv correspond to the development of the rest of the body in sex people.

This assumption implies that neuroanatomical features reflective of the causative processes that determine gender dysphoria may be detectable in the brain 3. Many neuroimaging studies to date have investigated sex differences in brain morphology. Initial investigations in this field have demonstrated regional brain volume differences between men and women through magnetic resonance imaging Sex based on brain regions of interest ROIs defined manually or with semiautomated techniques 45.

The introduction of voxel-based morphometry VBM has made it feasible to conduct voxel-wise comparisons in an automated fashion across the whole brain. Many subsequent VBM studies have reported findings indicating sexual differences in the human brain regarding the volumes of specific structures 67. In addition, the results of brain volumetric studies have been complemented by MRI studies that have investigated sex differences in regard to measurements of cortical thickness across the whole brain 89.

In a recently published meta-analysis of MRI studies on this wmv using VBM or tensor-based morphometry which also affords measures of regional brain volumes and grey matter densityRuigrock et al. Furthermore, previous VBM studies have also reported findings of white matter volume WMV sex differences in the cerebellum, cerebral lobes and corpus callosum 7 Likewise, there is a growing a social trend considering gender as a continuum, rather than sex male and female genders A decade later, one study reported that the corpus sex pattern in TW was congruent with gender identity To date, four VBM studies investigating differences in regional grey matter volume GMV have compared transgender people with cisgender controls.

The second study demonstrated greater GMV in the temporo-parietal junction, the inferior frontal cortex and the insular cortex of the right hemisphere in TNTW than in cisgender controls, as well as between-group volumetric differences of the putamen and the thalamus The third VBM study showed lower regional GMV in the left angular gyrus and the inferior parietal lobule in the transgender group The fourth study evaluated adolescents and noted lower volume of the cerebellum bilaterally and the hypothalamus in transgender girls than in cisgender boys Although reported findings have been heterogeneous to date, the above VBM studies detected GMV variations in the angular gyrus, the insula and the putamen of TW 1920 These brain regions were hypothesized to be relevant in transgender people because they are related to the neural network of body perception 20 However, the patterns detected thus far are not clearly associated with female brain characteristics, thus raising the possibility that TW-related brain volume differences are not necessarily related to signs of brain feminization However, it is important to note that most TW have a history of prolonged use of sex steroids.

In another MRI study, cortical thickness in TW was assessed prior to and after six months of CHT, and evidence that sex steroids are associated with reduced cortical and subcortical structures was reported Moreover, by applying the small-volume correction SVC method, we intended to replicate the findings of previous MRI investigations for the following brain regions: the angular gyrus, the insula and the putamen 1920 The corpus callosum, which has also been previously reported to present changes in TW 18was sex assessed by SVC in the current study.

TW and controls did not differ in age, but the schooling level was significantly lower in TNTW than in controls. No changes in secondary sexual characteristics, which were evaluated by physical examination, were reported for the TNTW group. There were no significant between-group differences in the total brain volumes between the TW groups. No additional GMV differences were observed in any other a priori -selected brain regions. Region-of-interest masks of the left and right insular cortex were superimposed on the images.

Foci of significance are overlaid on axial brain slices spatially normalized into an approximation to the Talairach and Tournoux stereotactic atlas, and the numbers associated with each frame represent standard coordinates in the z-axis. The coloured bar represents T-values. The present VBM study investigated GMV and WMV patterns in two TW groups that were well-characterized regarding their sexual orientation and non-conformity to their sex assigned at birth from an early age.

The lower total brain volume in CW observed here is consistent with a previously reported profile of sexual differences in the brain The finding that the three other groups presented total brain volumes larger than the CW group indicates that these brain volume differences are congruent with the sex assigned at birth in both TW groups Likewise, Zubiarre-Elorza et al.

Furthermore, brain volume and cortical thickness are widely considered as complementary brain measurements 32 Manzouri et al. The GMV differences found in the transgender men group followed patterns related to the sex assigned at birth. However, the authors also demonstrated weaker functional connections from the pregenual anterior cingulate to the insular cortex and to the temporo-parietal junction in the transgender men than in controls.

These findings also suggest that transgender men differ from cisgender people with respect to the own-body image neural network, which may be a neurobiological substrate related to transgender men Wmv, Savic and Arver and Simon et al. It is worth mentioning that an important diagnostic criterion for gender dysphoria is the distress that accompanies the incongruity between the body and gender identity, as the secondary sexual characteristics do not belong to the gender with which one identifies Decreased insular volumes have been reported in depressed subjects with melancholic symptoms 36and these changes in insular and prefrontal cortical volumes may be specifically associated with the manifestation of psychotic symptoms in major depressive disorder The insula is related to all subjective sensations and is the possible foundation of interoception 38including body awareness Furthermore, the insula connects the distinct functional systems involved in processing emotions, sensory-motor skills and cognition Two studies have evaluated functional connectivity in transgender people and found i a pattern of neural connectivity that inferred suffering due to incongruity between sex assigned at birth and gender identity 41and ii that the connectivity between the right insula and the somatosensory cortex was negatively related to ratings on a well-being scale in regard to gender dysphoria Another study examined brain structural connectivity and observed unique differences in regional network efficiency in the insular area wmv trans people These observations, together with our findings of reduced GMVs in the insula in both hemispheres in two independent TW groups, suggest that such regional GMV differences could be characteristics associated with TW.

The hypothesis that insular volume variations in TW individuals reflect the distress of these individuals should be considered in future studies including large TW samples by evaluating significant correlations between GMV and symptom severity ratings. In addition, it is well known that the symptoms of gender dysphoria improve with CHT One important difference between our VBM study and the study performed by Savic and Arver is that the latter investigated non-androphilic TW sexually attracted to females, both males and females, or neither gender 20 according to the Blanchard classification, which is based on sex sex assigned at birth of TW 44while our study investigated androphilic TW sexually attracted to males.

Therefore, one might speculate that the differences observed in the insular cortex could be linked to the sexual orientation of TW. It should be noted, however, that sexual orientation and gender identity are distinct phenomena. For this reason, overlapping VBM findings associated with these two conditions are highly speculative. Considering these speculative findings, further MRI studies comparing androphilic TW with non-androphilic TW are required to reveal further information on this topic.

Because our statistical approach was primarily designed to identify regional GMV variations that could be related to gender dysphoria, direct post hoc two-group comparisons between the cisgender controls in our study should not be considered as comprehensive indicators of a predominant profile between the two control groups regarding regional brain volume differences.

In addition, the lower GMV detected in the posterior-superior frontal cortex in the CW group is consistent with previously described regional patterns of sexual differences of the human brain 10 Conversely, the difference in regional GMV in this frontal region in the TNTW group relative to the CW group was not significant after correcting for multiple comparisons.

These results of the present study may indicate that this brain region in TNTW tends to wmv female characteristics, although this conclusion should be interpreted with caution. Based on the abovementioned interpretation, the wmv of higher GMV in the posterior-superior frontal cortex in the TTW group might seem contradictory, given the overall feminizing effects of CHT.

Nevertheless, previous studies have shown increased GMV in several cortical regions in postmenopausal women under oestrogen replacement therapy 47including higher GM density in paracentral and precentral areas 48 and in the superior frontal gyrus Such findings are believed to reflect the influence of hormonal treatment on brain neuroplasticity.

Overall, our results suggest that the impact of CHT on brain volume may vary across regional and global levels, as we found no difference in total brain volume between the two TW groups, despite the fact that the TTW had undergone prolonged use of sex steroids. A similar study conducted by Hoekzema et al. Hulshoff Pol et al. Similar to our TW sample, Zubiaurre-Elorza sex al. A recent study showed increased ventricle and reduced right hippocampal volumes in TW after four months of CHT These differences between our results and those of previous investigations may be because the present study employed a cross-sectional design, while the previous studies were longitudinal investigations of the same individuals and, thus, may have been more sensitive to detecting CHT-related global wmv changes over time in TW.

Our findings, as well as the results of all previous brain imaging studies that have evaluated the influence of CHT, suggest that the effects of CHT on brain volume may differ at global and regional levels and may vary across brain structures.

Moreover, the different results obtained for the two TW groups in our study suggest that the association of brain volumes with gender dysphoria and CHT may be complex, and furthermore, the direction of associations of brain volume with these two dimensions may vary. In the present study, the SVC-based analysis did not reveal significant group differences in voxels located specifically in the basal ganglia although relatively larger clusters of lower GMV in the insula extending towards the right putamen were observed in both TW groups, as shown in Fig.

Finally, the paucity of between-group differences in the WM analyses in our study suggests that brain volume differences related to the effects of both TW and CHT predominate in the GM compartment of the brain. Some methodological limitations of our study must be considered. First, because this study employed a cross-sectional design, it was not possible to determine which changes were pre-existing and which resulted from CHT. Finally, the stage of the menstrual cycle of the CW was not considered at the time of MRI scanning, which may be a relevant factor considering that brain structures are influenced by hormonal physiological variations In conclusion, significant regional brain volume differences in this VBM study were detected in TW compared with cisgender controls.

Finally, we present a novel finding of GMV alterations in the insula in the two independent TW groups, which may be a characteristic of TW. These alterations in the insula could be related to the neural network of body perception and may reflect the distress that accompanies gender dysphoria. Inclusion criteria for all TW were as follows: a absence of changes except for changes resulting from the use of CHT by TTW in secondary male sex characteristics wmv to the Marshall and Tanner criteria 51as evaluated by a physical examination performed by endocrinologists at HC-FMUSP; b a history of non-conformity to birth sex since the early stages of child development; c compatibility sex gender dysphoria diagnostic criteria as per the DSM-5 and based on semi-structured interviews conducted by three mental health professionals one psychiatrist and two psychologists ; and d exclusive sexual attraction to males according to the Kinsey scale of sexual orientation 52as ascertained by actively asking TW about their sexual attraction i.

Specific inclusion criteria for the TNTW group were as follows: the absence of any hormonal treatment history and the expressed desire to be treated with CHT. The procedures performed in TNTW included evaluations of the plasma levels of oestradiol, follicle-stimulating hormone, luteinizing hormone, testosterone and free testosterone on the day of MRI. This treatment regimen consisted of the administration of one or two 0.

Blood hormone levels of the TTW group were evaluated every semester. For the cisgender controls, the inclusion criterion was heterosexual orientation, as determined by the Kinsey scale of sexual orientation Additional exclusion criteria included the presence of medical conditions or neurological disorders that could affect the central nervous system, contraindications to MRI, major medical illnesses, and substance abuse. All participants were fully informed about the study and signed a consent form.

All MRI scans were acquired using a 1.

Finally, the paucity of between-group differences in the WM analyses in our study suggests that brain volume differences related to the effects of both TW and CHT predominate in the GM compartment of the brain. Some methodological limitations of our study must be considered. First, because this study employed a cross-sectional design, it was not possible to determine which changes were pre-existing and which resulted from CHT.

Finally, the stage of the menstrual cycle of the CW was not considered at the time of MRI scanning, which may be a relevant factor considering that brain structures are influenced by hormonal physiological variations In conclusion, significant regional brain volume differences in this VBM study were detected in TW compared with cisgender controls.

Finally, we present a novel finding of GMV alterations in the insula in the two independent TW groups, which may be a characteristic of TW. These alterations in the insula could be related to the neural network of body perception and may reflect the distress that accompanies gender dysphoria. Inclusion criteria for all TW were as follows: a absence of changes except for changes resulting from the use of CHT by TTW in secondary male sex characteristics according to the Marshall and Tanner criteria 51 , as evaluated by a physical examination performed by endocrinologists at HC-FMUSP; b a history of non-conformity to birth sex since the early stages of child development; c compatibility with gender dysphoria diagnostic criteria as per the DSM-5 and based on semi-structured interviews conducted by three mental health professionals one psychiatrist and two psychologists ; and d exclusive sexual attraction to males according to the Kinsey scale of sexual orientation 52 , as ascertained by actively asking TW about their sexual attraction i.

Specific inclusion criteria for the TNTW group were as follows: the absence of any hormonal treatment history and the expressed desire to be treated with CHT.

The procedures performed in TNTW included evaluations of the plasma levels of oestradiol, follicle-stimulating hormone, luteinizing hormone, testosterone and free testosterone on the day of MRI. This treatment regimen consisted of the administration of one or two 0. Blood hormone levels of the TTW group were evaluated every semester. For the cisgender controls, the inclusion criterion was heterosexual orientation, as determined by the Kinsey scale of sexual orientation Additional exclusion criteria included the presence of medical conditions or neurological disorders that could affect the central nervous system, contraindications to MRI, major medical illnesses, and substance abuse.

All participants were fully informed about the study and signed a consent form. All MRI scans were acquired using a 1. All images were reviewed by a neuroradiologist with the purpose of identifying artefacts during image acquisition and the presence of silent gross brain alterations. First, all anatomical images were reoriented; the mm coordinate of the anterior commissure matched the x y z origin 0, 0, 0 , and the orientation approximated Montreal Neurological Institute MNI space.

These fully normalized images were resliced through trilinear interpolation to a final voxel size of 1. This step ensured that the total amount of GM and WM in each voxel was preserved. Finally, the resulting GM and WM images were smoothed using an 8-mm isotropic kernel at full width at half maximum FWHM to ensure normal distribution of the data as required by subsequent statistical parametric tests. Age and education in years were compared between groups using the Kruskal-Wallis test. Age and years of education were included as covariates in such comparisons.

Given the between-group differences in years of education, this variable was included as a covariate in such comparisons. Although the mean age was not significantly different in between groups, age was also entered as a further confounding covariate.

The age range of the overall sample was relatively wide from 18 to 49 years , and in such situations, previous VBM studies have shown that it is appropriate to include age as a confounding covariate in between-group comparisons Only clusters with a minimum of 30 voxels were reported 30 voxels correspond to approximately mm 3 ; this threshold has been used in previous studies 21 , 58 and offers an easy-to-understand size scale for the reader. Subsequently, each statistical map was inspected for the presence of clusters of significant differences in brain regions where volumetric differences had been predicted a priori through the SVC method, with the purpose of constraining the total number of voxels included in the analysis.

All the anatomical masks were used separately in each hemisphere. SVC was applied over the following brain regions: the angular gyrus, the insula and the putamen. World Professional Association for Transgender Health. Standards of care for the health of transsexual, transgender, and gender nonconforming people 7th ed. American Psychiatric Association.

Diagnostic and statistical manual of mental disorders 5 th ed. American Psychiatric Publishing, Bao, A. Sexual differentiation of the human brain: Relation to gender identity, sexual orientation and neuropsychiatric disorders.

Allen, L. Sex differences in the corpus callosum of the living human being. J Neurosci 11 , — Goldstein, J. Normal sexual dimorphism of the adult human brain assessed by in vivo magnetic resonance imaging. Cereb Cortex 11 , — Witte, A. Regional sex differences in grey matter volume are associated with sex hormones in the young adult human brain. Good, C. Cerebral asymmetry and the effects of sex and handedness on brain structure: a voxel-based morphometric analysis of normal adult human brains.

Sowell, E. Sex differences in cortical thickness mapped in healthy individuals between 7 and 87 years of age. Lv, B. Gender consistency and difference in healthy adults revealed by cortical thickness. Ruigrok, A. A meta-analysis of sex differences in human brain structure. Lai, M. Biological sex affects the neurobiology of autism. Witelson, S. Neural sexual mosaicism: sexual differentiation of the human temporo-parietal region for functional asymmetry. Psychoneuroendocrinology 16 , — Cahill, L.

Why sex matters for neuroscience. Nat Rev Neurosci 7 , — McCarthy, M. Reframing sexual differentiation of the brain. Nat Neurosci 14 , — Joel, D. Sex beyond the genitalia: The human brain mosaic. Meyer-Bahlburg, H. Hormone Research in Paediatrics 85 , — Emory, L. Anatomic variation of the corpus callosum in persons with gender dysphoria.

Arch Sex Behav 20 , — Yokota, Y. Luders, E. Regional gray matter variation in male-to-female transsexualism. Savic, I. Sex dimorphism of the brain in male-to-female transsexuals.

Simon, L. Regional grey matter structure differences between transsexuals and healthy controls—a voxel based morphometry study.

Hoekzema, E. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Zubiaurre-Elorza, L. Cortical thickness in untreated transsexuals. Cerebral Cortex New York, N. Rametti, G. White matter microstructure in female to male transsexuals before cross-sex hormonal treatment.

A diffusion tensor imaging study. Kranz, G. White matter microstructure in transsexuals and controls investigated by diffusion tensor imaging. Guillamon, A. Neufang, S. Sex differences and the impact of steroid hormones on the developing human brain. Peper, J. Sex steroids and brain structure in pubertal boys and girls. Hulshoff Pol, H. Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure. Effects of cross-sex hormone treatment on cortical thickness in transsexual individuals.

Hutton, C. A comparison between voxel-based cortical thickness and voxel-based morphometry in normal aging. Kong, L. Manzouri, A. Cerebral Cortex Fisher, A. Soriano-Mas, C. Busatto, G. Structural and functional neuroimaging studies in major depressive disorder with psychotic features: a critical review.

Craig, A. How do you feel—now? The anterior insula and human awareness. Heydrich, L. Distinct illusory own-body perceptions caused by damage to posterior insula and extrastriate cortex. Brain , — Chang, L. Decoding the role of the insula in human cognition: functional parcellation and large-scale reverse inference. Ku, H. Brain signature characterizing the body-brain-mind axis of transsexuals. Lin, C.

Neural network of body representation differs between transsexuals and cissexuals. Hahn, A. Structural Connectivity Networks of Transgender People. Cerebral Cortex 25 , — Blanchard, R. The classification and labeling of nonhomosexual gender dysphorias. Arch Sex Behav 18 , — Ponseti, J.

Homosexual women have less grey matter in perirhinal cortex than heterosexual women. Lord, C. Effect of sex and estrogen therapy on the aging brain: a voxel-based morphometry study.

Boccardi, M. Effects of hormone therapy on brain morphology of healthy postmenopausal women: a Voxel-based morphometry study.

Menopause 13 Robertson, D. Effects of estrogen therapy on age-related differences in gray matter concentration. Seiger, R. Subcortical gray matter changes in transgender subjects after long-term cross-sex hormone administration.

Catenaccio, E. Estrogen- and progesterone-mediated structural neuroplasticity in women: evidence from neuroimaging. Marshall, W. Variations in the Pattern of Pubertal Changes in Boys. Archives of Disease in Childhood 45 , 13—23 Kinsey, A. Sexual behavior in the human male.

Am J Public Health 93 , — Costa, E. Clinical management of transsexual subjects. Arq Bras Endocrinol Metabol 58 , — First, M. The evidence is clear and convincing. I find that it is highly likely that he will recidivate and, in addition, I find that he has, at the present time, grave problems with self control.

Accordingly, Judge Perretti committed W. An involuntary civil commitment can follow service of a sentence, or other criminal disposition, when the offender "suffers from a mental abnormality or personality disorder that makes the person likely to engage in acts of sexual violence if not confined in a secure facility for control, care and treatment. The court must address "his or her present serious difficulty with control," and the State must establish that it is highly likely that the committee will reoffend by clear and convincing evidence.

See also In re Civil Commitment of J. It is by now well-settled that the SVPA is civil, not criminal, legislation and that commitment thereunder is not punitive, but rather subject to an independent regulatory process imposed for the purposes of treatment and protection of the public.

Mumin, N. Bellamy, N. I, 10, cl. IV, 7, 3, constitutions, which prohibit statutes that either " 1 punish as a crime an act previously committed, which was innocent when done; 2 make more burdensome the punishment for a crime, after its commission; or 3 deprive a defendant of any defense available according to the law at the time when the crime was committed. Muhammad, N. Ohio, U. We also find that Judge Perretti's findings are amply supported by the record.

On this score, it is also well-settled that in reviewing a judgment for commitment under the SVPA, "[t]he scope of appellate review. Fields, 77 N. See also In re Civil Commitment of V. We are satisfied from our review of the record that the judge's findings are amply supported by substantial competent credible evidence and that the admission of hearsay was not improper.

As to the latter, it is clear that the use of hearsay as a basis for expert testimony and the hearing judge's evaluation of expert credibility is permissible. In re Civil Civil Commitment of A. In fact, some hearsay is admissible for the truth of the matter asserted, such as treatment records, under N.

See A. Even a "complex diagnos[is]" contained in such reports may be "considered. Vandeweaghe, N. To be sure, "experts at the [civil commitment] hearing cannot simply parrot the findings of the doctors who author the clinical certificates.

However, reliance is not precluded "as long as the opinion ultimately rendered at the. Here, the State's testifying experts did not rely to any significant degree on the clinical evaluation of other professionals, but offered their own opinions based on a detailed examination of W. To the extent the State's testifying medical experts relied on prior mental health evaluations of W. Indeed, both Dr. Gnassi and Dr. Carlson testified that the reports of treating professionals were the type of information they would ordinarily rely on to assist them in reaching a diagnosis.

Moreover, Judge Perretti was entitled to consider such reports in the course of weighing the credibility of the testifying experts. Vandeweaghe, supra, N. And finally, the testifying State experts were available to W. V for cross-examination, and W. Carlson and Dr. Gnassi, to testify. To the extent that W. Such hearsay material must not be considered substantively, "but only as a basis for the expert's opinion. Here, Dr. Carlson specifically testified that the purpose of reviewing these documents was to obtain a history of what happened to W.

He explained that such "documents are critical in order to give a factual and historical basis in terms of understanding a person's behavior". In sum, we find no error in the court's evidentiary rulings which "are entitled to deference absent a showing of an abuse of discretion, i. Marrero, N.

We are satisfied that the substantial competent credible evidence supports the court's findings and accordingly, we affirm substantially for the reasons stated by Judge Perretti in her oral opinion of September 10,