Stereotypes are Dangerous
Everyone knows that… yet we still develop and use them. In a 2008 letter to the editor regarding a paper purporting to compare the sexuality of autogynephilic and non-autogynephilic transsexuals by Veale, et al., Anne Lawrence and Michael Bailey challenged the conclusions of the paper,
We argue here that Veale et al. reached erroneous conclusions, as a result of significant methodological problems in their analysis. Specifically, we contend that: (1) In performing their cluster analysis, Veale et al. inappropriately employed two variables that were unrelated to autogynephilia, in addition to two variables that were genuine measures of autogynephilia; (2) consequently, both transsexual groups defined by their cluster analysis displayed substantial autogynephilia: They are best described as the ‘‘autogynephilic’’ and ‘‘even more autogynephilic’’ groups, not the ‘‘nonautogynephilic’’ and ‘‘autogynephilic’’ groups; (3) because Veale et al. failed to recognize that both transsexual groups were autogynephilic, they mistakenly concluded that their results were partly inconsistent with Blanchard’s. Despite these limitations, the Veale et al. study provided valuable confirmation of another phenomenon that is widely recognized but that until now has been poorly documented: MtF transsexuals who are active on the Internet appear overwhelmingly to be autogynephilic.
Bailey and Lawrence held forward as part of their explanation as to why all of Veale’s transsexual subjects were autogynephilic was their assertion that transsexuals that were using the internet were exclusively autogynephilic because AGP transsexuals are geeky and especially drawn to computers, while homosexual transsexuals are not.
In our opinion, the principal value of this study lies elsewhere. Specifically, the Veale et al. study provides important confirmation of a phenomenon that is widely recognized but that until now has been poorly documented: MtF transsexuals who are active on the Internet appear overwhelmingly to be autogynephilic (nonhomosexual). We have observed, based on interviews we have conducted with hundreds of MtF transgender persons, that nonhomosexual MtF transsexuals are often intensely interested in computers, tend to gravitate toward computer-related occupations and hobbies, and often spend much of their free time using the Internet (see Bailey 2003, pp. 168, 196; Lawrence 2007, p. 514). Hints concerning these tendencies appeared in the academic literature over 30 years ago, when Laub and Fisk (1974) remarked that many of their MtF patients with gender dysphoria displayed a notable ‘‘interest in mathematics and computer sciences’’ (p. 399). Some 20 years later, MtF transsexual activist and author Rachel Pollack commented matter-of-factly that the dual occupations she assigned to the MtF transsexual protagonist in one of her fiction series–prostitute and computer programmer–’’were deliberately chosen from the main occupations of [MtF] transsexual women’’ (Gabriel & Pollack, 1995, p. 48), as though this were common knowledge. But these observations have not been confirmed by formal empirical research, as far as we can determine.
One of the two references they cited, as being examples to demonstrate that Veale’s study subjects were likely to be exclusively autogynephilic included Rachel Pollack creating a character who is a prostitute and computer programmer. This was cited as evidence that computer programmer was one of the two most likely occupations of MTF transsexuals. They were citing the use of stereotypes as though that use proved that they were true, a classic tautology. Held up as true was the supposition that AGP MTF trannsexuals were geeky and especially drawn to computers, while HSTS are likely to be prostitutes, as they are especially promiscuous and drawn to sex work.
These stereotypes, for both AGP and HSTS, are just as pernicious as those involving other groups; the dumb blonde, the greedy jew, the lazy black man, the bad woman driver, the bitter and humorless dyke… all wrong and insidiously malicious.
There may be a grain of truth to the observations that many of the AGP transsexuals have been computer programmers, but is it because they are especially draw to such work, or to computers in general?
Sadly, for MTF transkids, there is also a grain of truth to the assertion that they are more likely to be or have been “prostitutes”. But this is not because they are promiscuous, etc. It is because our society leaves them few other options, just as the high unemployment found among young black men is due to fewer opportunities, especially in our present jobless economic “recovery”.
First let’s examine that other reference cited by Lawrence and Bailey that AGP transsexuals are geeky and drawn to computers and especially to computer programming, in which Laub and Fisk reported that their SRS candidates included a high number of those who were interested in “mathematics and computer programming”. Frankly, having been in the Stanford program, having grown up literally blocks away from both Laub’s and Fisk’s houses, riding my bicycle past them for years… I would be very much surprised if that had not been the case; For Stanford University is the very epicenter, the beating heart of Silicon Valley. If one were to climb to the top of Hoover Tower, one could see the garage where Hewlett and Packard, both Stanford grads, started HP. In another direction, one could possibly just make out the garage where my classmate Steve Jobs started Apple. From that tower you can literally see the headquarters of Cisco, Ebay, Google, Intel, Adobe, etc. Thus, their report that there were a high number of computer programmers in their program is easily explained as an “observer effect”.
What I can accept as true is that AGP transsexuals will have had more highly paid, traditionally masculine, jobs before transition. For a mid-life candidate, transitioning successfully is expensive, what with electrolysis, hair transplants, tracheal shave, breast implants, facial feminization, and finally SRS. Further, losing straight male privilege may entail loss of opportunities for further career advancement, and likely losing a wife and children to divorce. Thus, I believe, that there is a selection effect that occurs for AGP transsexuals in that those who feel that they can “afford” it, are more likely to transition. We can see that in the already clinically observed higher IQ in AGP transsexuals. Intelligence is highly correlated with high Socio-Economic Status (SES). Thus, we can expect to find that AGP transsexuals are more likely to have high SES… and the types of jobs that high SES men have.
Looking at one list of top paying jobs, we note that of the top jobs, Anesthesiologist (at #2; Paging Dr. Lawrence?), Lawyer, College Professor, Airline Pilot, and yes, Computer Scientist, are all very high on the list. These are all jobs that we have seen AGP transsexuals holding prior to transition. It is not that AGP transsexuals are especially drawn to “mathematics and computer programming” it is that those individuals from the larger pool of potential AGP transsexuals, who have higher SES and are in occupations that are most friendly to transsexuals, are more likely to transition. Computer programming has one of the best return on education investment ratios of all of the jobs listed above. Computer programmer is the only job that it is possible to get without either a graduate degree or extensive (and expensive) training. One can even become a computer programmer as a college drop-out (e.g. Bill Gates, Steve Jobs)! It also has the advantage of not requiring public contact, and thus one’s employer is more likely to accept an employee in transition. Thus, it should be no surprise that computer programmer is a likely job for an AGP transsexual. But I assert that autogynephilic males in general are not especially drawn to computers.
But if this is the case, why are Veale’s transsexual subjects all AGP? (I do agree with Bailey and Lawrence on this point.) This is most likely to be a sampling effect of a given social network. Veale readily admits that this is not a random sample. She reached out to the transsexual community through a limited set of venues, all of which were dominated by AGP transsexuals.
Bailey and Lawrence have asserted that interest in computers leads to heavy use of computers, and thus more likely to use the internet. But this is a non sequitur. Today, everyone is using computers on the internet, especially for social media. One such venue, facebook, is so popular that I personally tallied over 25% of my graduating high school class had a facebook page! When we add up all of the possible other venues, the percentage of the U.S. population using the internet is very, very high… 77.3% at the moment. Could there be some reason HSTS folk don’t use the internet? With SmartPhone availablity, I doubt any but the very poorest and most desperate street trannie is without some internet connection.
“Birds of a feather, flock together.” It may be a tired old saw, but contains a very powerful sociological truth. In this case, AGP and HSTS transsexuals have very little in common save HRT and SRS. We live different lives and have different concerns. Plus, a very pugnacious minority of AGP transsexuals are extremely antagonistic and even vengeful, when HSTS transwomen, truthfully, point out the difference. Thus, our social networks, in person and on the internet, are largely mutually exclusive. So, Veale failed to include very many, if any, HSTS subjects.
Turning back to transkids:
Transkids are often viewed by their families as a deep embarrassment. Their obvious gender atypical behavior and homosexual orientation (pre-transition) are viewed as culturally and religiously impermissible. Such kids may experience antipathy that may range from emotional neglect, emotional abuse, to life threatening physical abuse. In such cases, a transkid may believe, and act on that belief, that running away is the safer course of action. For other transkids, their families may ask or tell them to leave. These kids are literally thrown away. Although transkids aren’t the only kids to be so treated, the percentage of them that are is extremely high, far, far higher than average.
If a teenaged MTF becomes a runaway, or throw-away, she is faced with very limited choices to survive. She will have few job skills, and even fewer legitimate prospects. What employer is going to hire a homeless “street trannie” over a “respectable” teen from a “good” family? Under such circumstances, she will often meet up with other “street trannies” (or “transsies”, as we were called when I was a teen), who have already turned to survival sex. Survival sex is when one exchanges sex, or other erotic favors, for food, shelter, or other necessities. If she is unlucky, what begins as survival sex spirals into commercial prostitution that for a few years, becomes a way of life, a life that is very difficult to leave once caught up in it. In the U.S., studies show that about 27-43% of all street kids aged 11-23, not just street transkids, have experienced such survival sex, while 6-20% engaged in transactional sex (for money, drugs, or material possessions). My point here is, runaway and throw-away transkids are no different than other street youth in being at risk of sexual exploitation by adults. I believe that in the U.S., one out of three transkids has engaged in survival sex. The Tsoi study of Singapoorean MTF transkids shows the pattern. One third of them will be “prostitutes” at some point in their lives. Although the study did not distinguish between survival sex and street prostitution, I’d be willing to bet that they are describing a mixture of survival sex and commercial prostitution. The majority of those in the Tsoi study who became “prostitutes” did so if they transitioned as teenagers, likely after leaving their natal home, supporting my assertion that such prostitution was not sought out by young trannies, but was merely a means of survival because they had few if any other opportunities.
If transkids’ families are emotionally and financially supportive, in the normal manner as they would any other loved and valued child, transkids do not become “prostitutes” in any sense! These kids will not be visible to the public or law enforcement. They will quietly transition and live invisibly in their communities. Remember, two out of three MTF transkids do not become “prostitutes”.
Thus, we have an observation effect in that the only transkids that are visible to the public are those unfortunates who have fallen into commercial prostitution, reinforcing a false stereotype.
If I can share a personal note here? On my 18th birthday, just a week before I graduated from high school, my father came over to my mother’s house, with whom I had been living after my parents divorced a year before, and gave me a combination birthday and graduation gift of an inexpensive clock radio, the only such gift any family member proffered. He also delivered the knews that I had been expecting for months. He told me that I was not welcome at my mother’s house, nor his nearby apartment. I would have to leave home after graduation. As the family did not want me to further embarrass them, they required that I move away some distance. To enforce that distance, I would be given a small allowance, to become a “remittance man” (defined here) My father encouraged me to attend a community college, which made me even more bitter, in that six months earlier, I had been accepted to a four year college in another part of the state, but my folks had shown no inclination to support that ambition; so I had had to decline the acceptance. That allowance amount was NOT enough to live on as I soon discovered. I was in essence, a throw-away kid. But I feel I was one of the lucky ones, in that I was above average intelligence, resourcefulness, and was not without some skills. I survived.
References:
Jaimie F. Veale, Dave E. Clarke and Terri C. Lomax, “Sexuality of Male-to-Female Transsexuals”
http://www.springerlink.com/content/bp2235t8261q23u3/
Anne A. Lawrence and J. Michael Bailey
Transsexual Groups in Veale et al. (2008) are “Autogynephilic” and “Even More Autogynephilic”
http://www.springerlink.com/content/u473w370g11vx758/
Jaimie F. Veale, David E. Clarke and Terri C. Lomax
Reply to Lawrence and Bailey (2008)
http://www.springerlink.com/content/cm2531l3m3148377/
MyPlan.com, “Top Ten Lists / Highest Paying Jobs”
http://www.myplan.com/careers/top-ten/highest-paying.php
Internet World Stats
http://www.internetworldstats.com/am/us.htm
National Alliance to end Homelessness
“HOMELESS YOUTH AND SEXUAL EXPLOITATION:
Research Findings and Practice Implications”
http://graphics8.nytimes.com/packages/pdf/us/20090919_alliance_draft_report.doc
Clowns to the left of me… ♫♫
♫jokers to the right♫ ♫Here I am stuck in the middle with you.♫
Also in 1978, at the Harry Benjamin Gender Dysphoria Symposium, Richard Green, M.D., expounded on the problem of the age:
The name of the game is follow-up. The controversial question of the early 1960′s: “Should transsexual surgery be performed?” has metamorphosed into the compelling question of the 1970′s: “On whom should it be performed? ‘~ Various viewpoints exist regarding the appropriate candidate for sex-reassignment surgery. It has become increasingly clear that candidates cluster into three major groups: i) individuals who report a lifelong core-morphologic sexual identity contradictory to anatomy, an absence of effective socialization in the role expected by virtue of their anatomy, an absence of genital arousal accompanying the wearing of clothes of the other sex, and an absence of genital pleasuring with partners of the other anatomic sex (“true transsexuals”); 2) males who have vacillated in their sexual identity or have been ambivalent in their identity from childhood, who have experienced genital arousal accompanying cross-dressing and who have had sexual relationships with persons of the other sex (“transvestic transsexuals”); and 3) individuals whose core-morphologic identity has been primarily consistent with anatomy, who have manifested gender-role behavior that is culturally atypical~ who have not experienced sexually arousing cross-dressing, and who have had extensive sexual relationships with same sex partners (“feminine male and masculine female homosexual transsexuals”). Some eventually receive surgery; others do not.
Green wanted to answer this burning question, just who would and would not be helped by transition and SRS. Transfolk were notorious for dissappearing after they got what they wanted out of the surgeons, so follow-up studies tended to be skewed to those segments of the population who would be inclined to cooperate. Green proposed that transfolk be required to post a substantial bond to get service. That bond would only be returned in tranches as they came back for follow-up.
I propose the following: Each individual who is accepted into an evaluation program for sex reassignment surgery must deposit an appropriate amount of funds for the anticipated professional services into a followup, interest-bearing, escrow account. In the case of medically indigent patients, the State or some third party should deposit a comparable amount on the patient’s behalf. This money is to be returned to the patient at bi-annual visits over a ten year period, one-fifth of the total amount at each visit.
This would in effect raise the hurdle that less affluent, younger transkids would have to clear. I can tell you from personal experience that this would have had the effect of driving yet more transkids onto the streets, into sordid means, or to using the services of underground butchers like the infamous Dr. Brown in California. I could well imagine that for well-to-do older transitioning folk, the bond would represent an affront, and may even backfire, causing less cooperation rather than more. Fortunately, this proposal went nowhere.
But the question still remained… and in his opening statement, Green shows us a murky problem for the clinicians. Just who was a “transsexual”? On one side, they could clearly recognize transvestites, men who clearly were or had been sexually aroused by cross-dressing. On the other side, they could clearly recognize homosexual men who occasionally put on drag to go to clubs, or homosexual women, who presented as butch as our culture allows. And they believed that they saw a group in the middle, who requested somatic feminization or masculinization, to allow them to live as members of the opposite sex. So far, pretty straight forward. But what to make of those folks who requested such somatic changes, but could be recognized to have very strong resemblance to transvestites or homosexuals? What of those who, in their presentation and narratives, downplayed such resemblance, but hints were there anyways?
The problem some thought was to find those bright shining lines that served as a demarcator for being a “true transsexual”, to separate those who were actually either homosexual or transvestite, calling them “pseudo-transsexuals”. Some researchers already thought that they had found these bright shining lines.
Person and Oversey had simple, bright shiney lines for MTF types. If you were attracted to men, you were homosexual, period. If you were having, or ever had, sex with women and cross-dressed, you were a transvestite, period. Their “primary transsexual” was completely asexual, but had vacillated on their gender identity growing up, usually having made “one last effort to be a man” before succumbing to their disorder. They readily admitted this was a very tiny minority. (Blanchard later demonstrated that Oversey&Person’s “primary transsexual” was autogynephilic.)
Green’s description of the three types is recognizably based on Stoller’s typology of “true” or “primary” transsexual. For MTF, his bright shining lines were drawn very tightly. If you were attracted to men, but used your penis, you were a homosexual, period. If you were attracted to women, and/or experienced arousal when cross-dressed, you were a transvestite, period.
Notice that Stoller’s and Person&Oversey’s “primary transsexual” were mutually exclusive, they didn’t even overlap!
Even Fisk at Stanford, which had the most liberal policy for acceptance for SRS, used a tripartite model: homosexual, transsexual, transvestite.
Using these indicia, various clinics made decisions as to who they would deign to allow SRS. Different clinics had different criteria, ranging from strictly “true transsexuals only” to very liberal, everyone welcome, so long as you pass the “Real Life Test”. Of course, you could always go overseas or Mexico, where if you had the money, they had the knife!
Given these models in use by various programs, there was a powerful incentive to lie, to craft one’s personal narrative and history to fit the acceptance criteria, as stated by Berger, as reported by Green,
It certainly seems that we are all agreed that one of the problems that we are trying to deal with in evaluating results is determining what happens to these people postoperatively. I think that it is equally a problem in that we do not know what happens to those who are rejected. I think that these people are consummate actors in many cases, and that when they are rejected, they learn what it was that they said wrong so that they can go to the next place and say it right. Since we do not communicate with each other and have no way of doing so about our results with specific patients, there is no way that we can really followup a specific patient in their travelings from clinic to clinic.
This lying became very extensive, as Deidre (Donald) McCloskey, whose 1999 autobiography Crossing: A Memoir documents numerous episodes of auto-erotic transvestism, writes (using the third person “Dee”):
The young woman psychiatrist asked Dee the usual questions, mentally running down a checklist of the gender-crossing illness. “When did you first want to be female?” “Were you effeminate as a child?” (…) Dee started to lie. They all do it. Of course gender crossers lie. They can read the DSM just as well as the psychiatrists can. “Oh yes” Dee said to the Free University psychiatrist, “I’ve always had these desires. Oh yes Doctor ever since I can remember. Oh yes it’s just like being a woman in a man’s body. Oh yes Doctor I hate my penis. Oh yes Doctor whatever your dopey list says“.
(McCloskey 1999) (Bolded text is as originally printed)
Note that McCloskey’s interviewer is asking questions based on Stoller’s “true” transsexual profile. This lying may have distorted research, paradoxically adding weight to what we later learned was a flawed concept. But as Berger shows above, and Meyer shows below, the fact that SRS candidates lied was very well known.
It should be borne in mind that there is a degree of uncertainty in the data. This uncertainty derives, among other factors, from having seen the patients intermittently, rather than continuously, the patients’ tendency to dissimulate in order to achieve sex reassignment, and the confidentiality of the evaluations which prevented direct checking of statements. … However, since most patients are aware from the literature of the “correct” early history, a degree of common falsification, and therefore factitious similarity, must not be discounted.
In contrast to this concept of the bright shining line, was the continuum of symptomology and gender dysphoria. Harry Benjamin himself thought this was true. Meyer at Hopkins held this opinion. He clearly described a range of autogynephilic and separately homosexual individuals who requested SRS. Interestingly, he also described a group he called “Eonists”, which I recognize as transkids, both MTF and FtM. (Ironically, he used the term “Eonist” which was named after a famous historically significant cross-dresser, who by his history, is easily recognizably autogynephilic.)
So, as Meyer and Benjamin described, Freund pointed out, Blanchard powerfully demonstrated & defined, and Nuttbrock recently corroborated (if unwillingly); there are no bright shining lines dividing and creating a middle group. There is nothing between the classic extremely gender dysphoric AGP transsexual and the classic closeted transvestite. There is nothing, save possibly deep disgust and shame regarding the penis, between the classic demure “true transsexual” and more flamboyant club crawling street trannies and drag queens. There is only one line, the one separating homosexual from non-homosexual transsexuals. But that is not the line that may be used to determine who is and who is not suitable for somatic feminization.
In the end, I think Meyer summed it all up best,
One is faced, however, with more ambiguity than clarity when the differential diagnosis for applicants requesting sex reassignment is limited to homosexuality, transvestism, and transsexualism. Far too many patients fall into the gray areas between. The selection of an overall classification, with the addition of descriptive subcategories, would seem more workable.
With this in mind, I would propose recognizing the condition of sufficient gender discomfort, skew, or unease to request sex reassignment as the “gender dysphoria syndrome.” This admirable term and its application, to my knowledge, were originally suggested by Norman Fisk (1973). As mentioned previously, factors in assigning the “gender dysphoria syndrome” label would be a sense of inappropriateness or incapacity in the anatomically congruent sex role, a sense that improvement would ensue with role reversal, … …and an active desire for surgical intervention. Explicit in this definition is that the patient take some active steps to realize the interest in reassignment. … The use of “gender dysphoria syndrome” has the added advantage of emphasizing disharmony within the patient’s own gender rather than implying, as in the term “transsexualism,” the successful negotiation of a gender, even though an anatomically incongruent one.
There is still the question of how to deal with the loosely used, generic term “transsexualism.” I find that I can no longer use “transsexual” or “transsexualism” without quotation marks. The use of this term suggests that there is a single diagnostic entity “transsexual,” which in current loose usage is characterized by a request for sex reassignment. All applicants, however, are not the same, and reassignees from the various clinical categories will presumably react quite differently to their surgical modification over time. Kubie and Mackie (1968) have previously emphasized these problems of definition as they relate to follow-up. An appreciation of the presenting clinical varieties emphasizes the need for great specificity in initial patient characterization if one is to speak of improvement or deterioration over long-term follow-up. Without these preliminary distinctions, with all patients lumped together, the truly valuable information will wash out of follow-up series and any opportunity for specificity in future prognosis or selection will be lost.
I would propose that the term “transsexual” be abandoned except for one specific usage. The term should be reserved only for those patients who have actually undergone, and completed, genital reassignment. The term, therefore, would refer to an anatomical fait accompli, and would have no further meaning. It could then be used as a purely descriptive term without implications regarding etiology, psychodynamics, character structure, preoperative adjustment, postoperative course, etc. It could be used much as the term “amputee” to describe a postoperative fact, with no implication as to physiological dynamics (diabetes, arteriosclerosis), character structure (alcoholic, drug addict), or the hazards of the fates (accidental trauma).
I could not agree more!
References:
Richard Green, “Transsexualism: A research note”
http://www.springerlink.com/content/x32756q117717817/
Jean M. Dixen, Heather Maddever, Judy Van Maasdam and Patrick W. Edwards, “Psychosocial characteristics of applicants evaluated for surgical gender reassignment”
http://www.springerlink.com/content/j3478u3647875058/
Jon K. Meyer, “Clinical variants among applicants for sex reassignment”
http://www.springerlink.com/content/qx35288724j54862/
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“Sherman, set the WayBack Machine to 1978″
“Sure Mr. Peabody!”
In the late summer of 1977, at the tender age of 20, the folks at Stanford made it known to me that I was then eligible for SRS, having been living full time as a young woman for two years, etc. Those two years had been great. I was happy. I was getting along with people. Folks treated me well. I had boyfriends. But two years of dating with a proscribed, ‘no fly zone’ was growing very old. I really looked forward to being post-op. All I really needed was the money. But as a young secretary, the cost of SRS was greater than a year’s gross salary! I got a better paying job as an electronics assembler, but I was still barely making ends meet. For months I had been trying to save up money… Saving more than 10% of my take-home pay would be difficult. How could I ever afford it? It would take more than a decade! So in early 1978, I turned to my folks, hoping that they had changed their minds and were now ready to help me. My mother was totally unmoved. My Dad had another proposal.
My Dad instead proposed that I should seek psychotherapy for my “problem” from a certain Dr. Stoller in Los Angeles, for which he would pay. My Dad hadn’t liked Dr. Fisk, the shrink at Stanford, who three years previously had told him that he should be supportive, not obstructive, “You will win a few battles, but lose the war.” So, my father had asked around for someone else and Stoller had been recommended. I had also heard of Stoller, of course. I understood that he was a psychiatrist. I blew off the suggestion, with extreme prejudice.
But now, as I have been researching our history and the science for this blog, I realize I missed out on meeting a very interesting man. I have a feeling we would have got on swimmingly. That’s not to say that we would have agreed. Oh no! Stoller, along with many psychiatrists of the mid-20th Century, was suckered into Freud’s pseudo-science cult of psychoanalysis. Stoller’s works are redolent of the type of confirmation bias and untested, and often untestable, assertions built upon assertions, like sand castles on quicksand, all accepted as true, and precious little of it actually so, found in non-scientific texts. (Resolutions of Oedipal Conflicts; Seriously?) A modern reader, educated in experimental psychology, neurology, and rigorous scientific method, must wade through a morass of useless psychobabble to find the occasional gem of insight. But still Stoller had a keen mind and was very observant. When he stuck to direct observation, leaving behind for a moment any superfluous psychodynamic formulations, he was brilliant.
Green, writing of and quoting Stoller, said,
Sex research published in science journals typically reports extensive samples, assessed by questionnaire, and analyzed statistically. To this, Stoller complained, ‘‘Sex research is camouflaged by large samples, hidden in tabulated columns, and dissected beyond significance by statistical packages. Although statistical techniques may enable us to corroborate or deny a hypothesis, they do not produce one’’
I couldn’t agree more. One needs to get to know the populations one is studying to gain insights that may lead to hypotheses. Although, I trust the insight only after the statistics prove out the hypothesis.
One hypothesis from Stoller that needed (still needs?) testing is that his “true transsexuals”, which he later called “primary transsexuals”*, avoid using, or allowing their male partners to touch, their penis in sexual encounters.
*(Likely to tweek Oversey and Person who were using that term for asexual transsexuals, which they mistakenly thought were not autogynephilic, but that is a subject for another essay).
It would be instructive to read a description of Stoller’s “true” or “primary” transsexual to learn just who he meant by these terms. From his 1968 book, Sex and Gender, starting on page 190:
Let us briefly describe a typical male transsexual. The patient is twenty-five years old. She is dyed-blonde, well-rounded “woman” who in none of the ordinary mannerisms of life (smoking cigarettes, walking, crossing her legs, blowing her nose, gesticulating, etc.) in any way reaveals she was ever a male. She points out that she had the same mannerisms when living as a male, when she seemed bizarre. She recalls no time in life of not wanting to be a girl, of not feeling extremely feminine, of not having intersets and daydreams that seemed to her the same as those of normal girls. Her earliest memories, starting around the age of three, already show this very feminine attitude. As a boy, she was treated with ridicule by the other boys, despite which she maintained her same feminine behavior. … her daydreams from the start were that she was a woman being made love to by a man. … She hated to masturbate and says she did so only once a year or less, not because of conscious guilt but because it so concretely demonstrated her anatomical maleness. … She began going out with men and having sexual relations. However, she never permitted a man to touch or see her genitalia, since they were such a source of shame; she defined as normal any man who made no such attempts. … Some months before I first met her, she made contact with an operated transsexual, who suggested that they live together (not sexually, of course). She did so, and at the point for the first time she went through the preparations that were so lead to her being able to pass successfully as a female. … She was so successful that she very shortly found herself a job, being hired unsuspectingly as a woman. … The patient has now married and hopes to adopt children.
I sincerely hope that this young woman did succeed in adopting, as I did, and found it as rewarding. I hope she has grandchildren. She should be in her late sixties or early seventies by now? This description is totally in keeping with what I understand as the feminine androphilic MTF transkid “homosexual transsexual” (HSTS).
Note the characteristics that Stoller attributes to this typical “true” or “nuclear” transsexual: Atypical gendered behavior since very early childhood, consciously gender dysphoric from childhood (early onset), exclusively androphilic, interested in children and being a mother, and emotionally stable, mature, and nurturing. Stoller insisted that the “true” or “primary” transsexual universally avoided, did not allow, contact or visual notice, of her genitals. Person and Oversey flatly rejected this claim. Stoller and Person&Oversey duked it out in their respective books and papers, relying on reference to psychoanalytic theory and psychodynamic formulations, citing counter examples. Sigh…
I could regale my reader with an anecdote of my own avoidant behavior… but adding one more anecdote does not help. The plural of anecdote is not data.
Hypothesis were meant to be tested.
Fast forward to 1990 when Leavitt and Berger attempted to do just that. I wrote about this before, but let’s review. The authors used Blanchard’s Modified Androphilia Scale in an attempt to identify and segregate exclusively androphilic MTF transsexuals from the larger pool of SRS candidates. But, as the authors admit, this was inadequate. Not only did they not separate the HSTS from the bisexual group, but they also caught up heterosexual and asexual types as well. As we’ve seen, pseudo-androphila and social desirability bias both lead many AGP transsexual SRS candidates to overstate any sexual interest in men, downplay any interest in women, and strongly downplay a history of erotic arousal to cross-dressing. But, when L&B separated by actual sexual behavior, they separated the types quite well as evidenced by the data.
Type: Avoidant Pleasure Inactive
Number n=15 n=30 n=36
Age 29.9 32.8 34.5
SD 4.2 7.5 9.6
Full
time: 4.9 3.1 0.73
Transition: 25 29.7 33.7 (mean age – mean time post transition)
Married: 0% 23% 47%
Penis “OK” 6.7% 83.3% 33%
Fetishistic 6.7% 33.3% 50%
Sex w/ female: 0% 33.3% 58%
Attraction to
females: 0% 33.3% 70%
Male toys 16% 46% 50%
Male playmates 16% 37% 47%
Rorschach sex# 0.7 6.4 5.7 (high score indicates “disturbed” sexuality)
F+% 70.5 57.8 51.1 (score below 70.0 indicates poor reality testing)
MMPI Scales:
Pd 61.1 70.4 68.3 (high scores indicate anti-social tendency)
Sc 57.7 70.1 68.3 (high scores indicate “odd” thinking and social alienation)
The Avoidant group fits Stoller’s profile of the “true” transsexual to a T.
(Addendum 12/24/2011: It appears that there may be one (or two) autogynephilic individual out of the fifteen who also states that she is comfortable with her penis, who was sorted into the “avoidant” group. This may be an artifact of the rules by which the sorting was performed; To be in the avoidant group, one had to have had at least five sexual encounters with a man and no more than five of those times have allowed that man to touch ones penis. Thus, an individual with relatively few sexual encounters may have actually had a high percentage of them wherein that individual allowed penile contact, up to 5/5 = 100% in fact. In the future, if this study is replicated, I recommend using an additional rule wherein there is a low percentage cut-off as well as a fixed numerical cut-off.)
The Inactive group is clearly heterosexual, with some of them possibly being the so called asexual (actually automonosexual). While L&B remarked from the strong similarity of the MMPI and Rorschach tests that the Pleasure group was essentially the same as the Inactive. As the pleasure group includes individuals who admit to being sexually attracted to women, including some who have been married, they, as a group, represent a bisexual group. Is it possible that the pleasure group also included etiologically HSTS individuals? The data can’t be used to rule this out, but I personally don’t believe so. Why would an exclusively androphilic, non-autogynephilic male who is very comfortable with having sex using their penis want to be rid of it? The data bears out Blanchard’s typology of exclusive homosexual (non-autogynephilic) vs. non-homosexual (and thus autogynephilic) transsexual etiologies.
In Leavitt and Berger’s own words,
Transsexuals who are sexually active with males but do not allow their penis to be involved in sexual activity share a constellation of traits and experiences that generally conform to characteristics of the nuclear transsexual (Buhrich and McConaghy, 1977). The picture of the nuclear transsexual conveyed by the literature is that of sustained, nonfluctuating femininity, developmental patterns involving a preference for girls’ games and company, aversion to rough-and-tumble activity in early childhood, later patterns involving a desire to posses a woman’s body, to live in society as a woman, and to attract heterosexual male partners. The nuclear transexuals experience intense disgust and aversion for their penis and deny a history of heterosexual orientation or fetish arousal. If patients in the Avoidant group are accepted as nuclear transsexuals, then only 18.5% of our sample meet those criteria. This implies that most of our sample seeking reassigment are not nuclear transsexuals (Newman and Stoller, 1974).
Thus, Stoller’s hypothesis that HSTS transkids universally are “avoidant” has been born out by this study. We should not be surprised by this observation, because it forms a natural truism; A male bodied person who was not motivated by autogynephilia and felt comfortable with their genitalia, would not be likely to actively seek out its removal.
References:
Richard Green, “Robert Stoller’s Sex and Gender: 40 Years On”
http://www.springerlink.com/content/rr775w4408071213/
Robert Stoller, “Sex and Gender, On the development of masculinity and femininity” (1968)
Frank Leavitt and Jack C. Berger, “Clinical patterns among male transsexual candidates with erotic interest in males”
http://www.springerlink.com/content/fp15j71n57474k1l/
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Oh Brother Where Art Thou?
The consanguinity of both homosexuality and autogynephilia appears to be very high. So one would not be surprised to find that the consanguinity of transsexuality would also be very high. That is to say, that transsexuality runs in families. But not the same families.
I have to wonder about my own family.
I always wondered why I never met my paternal uncle, until the day, when I was 16 years old, he showed up at our doorstep, unannounced, with his boyfriend/partner. My father desperately, but quietly, tried to shuttle my three siblings and I to our respective bedrooms, but I obstinately refused to understand my father’s not so subtle hint. My uncle gave me a present that day of a beautiful butterfly mounted as though still alive, in a plastic cube. I never saw him again. But I asked my grandmother about him when I was 22. I simply asked if he had ever married. “He’s not gay!” was her vehement reply. “That wasn’t what I asked, but now I know, thanks.”
I also wondered about one of my brothers. One brother was very, very obviously straight. He was always mooning after some girl or other in high school. But, our younger brother? The tall, handsome blond, star athlete? No girlfriends, not even a hint of one. When our mother suggested that an appointment with a girl was a “date”, he testily replied, “Its not a date, Mother! She’s just a friend.” But, as a kid, he used to dress up in mock drag and imitate drag comedians, especially Flip Wilson, “My boyfriend’s name is Killer!”, said in grating falseto. I used to cringe and want to hide when he did that. On one particular occasion, when I was 17 and he was 15, we were driving down a back road behind Stanford University, past a known gay cruising spot, when up ahead we saw a handsome young man with cut-off jeans and his shirt off, bare chested, thumbing a ride. My brother nonchalantly rolled down the passenger side window, stuck out his head as we passed by the obviously gay young man and called out teasingly, “Sorry guy. Not cute enough!” Many of my gay friends over the years said that their gaydar went off when ever he was around… but… perhaps after seeing how our family and most of our social set disowned me as a teenager, he slammed the closet door so shut that even he didn’t recognize it? He’s now married with two children, a very successful cardiologist and hospital administrator.
There have been lots of reports of transsexuals having transsexual or transvestite siblings, fathers, or sons. The press just eats up these stories. But what of the clinical experience?
From Green’s paper on the subject:
Familial cases of gender identity disorder were reviewed by Freund (1985)
and categorized as concordant or discordant for sexual orientation. No instances of
a mixed heterosexual and homosexual pattern in the same family were found. The
interpretation was that the two groups of gender-identity disorder have different
etiologies. In the 10 family series reported here, only Case Five contains a mixed
heterosexual/homosexual family pair.
Green’s ten cases came from a pool of only 1,500. This would suggest that one in one hundred fifty transsexuals has a transsexual or transvestite sibling, but not of the other type? Is this random chance? Not likely.
References:
Richard Green, M.D., “Family Cooccurrence of “Gender Dysphoria”:Ten Sibling or Parent–Child Pairs”
http://www.springerlink.com/content/p11646013q03m755/
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Searching High and Low
The first time I met other transsexuals, (February 1976) at the Stanford Gender Clinic, the very first thing I noticed was that they all seemed to tower over me. I’m 5’7″ and a half (172cm). The other thing I noticed was that most of them were obvious in appearance and manner, in spite of being dressed in women’s clothes… and that most of them had been or still were married to women. To say that I was confused would be an understatement! It would be a while before I understood that there were two types of MTF transsexuals.
Later, when I met HSTS trankids, I noted that they were more my height. My friend Jennifer was the tallest, Marcella was about my height, while Stella was very slightly shorter. Over the years, I’ve met many MTF TS folk. It has been my observation that transkids were shorter than the AGP transsexuals.
Clinicians from Harry Benjamin to Robert Stoller have remarked on the shorter stature of transkids.
But the plural of anecdote is not data.
Which brings us to Blanchard’s observation and study of the very same phenomena. He and his colleagues used the same data set that had been used earlier to explore the issue of HSTS vs. AGP typology, along with height and weight data collected by the clinic in Canada, and found that those who had been in the ‘homosexual’ cluster were shorter and lighter than the rest. Specifically, they found that the non-homosexual group was 175.70 cm (5’9″) and that they were exactly the same average height as non-transsexual Canadian men, by age group. But the mean height of the homosexual group was 172.94 cm (5’8″), 3.23 cm shorter than the norm for their age.
The mean height of each group is only a little over an inch different, but what really interests me is the histogram of the heights of the two groups. The two groups have very skewed height distributions, as shown in Fig. 2 of the paper. It shows that 25% of the non-HSTS group is 6′+, while only 10% of the HSTS group is 6′+. (But, keep in mind that we know that perhaps 15% of the ‘homosexual’ cluster was not actually etiologically HSTS… so the real percentage may be lower.) Thus, from the data, we may draw the conclusion that a non-HSTS is two and a half times more likely to be 6′ or taller than an HSTS. Conversely, 22% of the HSTS population will be 5’5″ or shorter, while only 10% of the non-HSTS will be this short. Thus, although the means don’t look all that different, as a group, because of the very large differences in the numbers at the tall and short end, the impression one gets when exposed to groups of both types of transsexuals is that the HSTS type is significantly shorter than the non-HSTS (AGP) type.
Science depends on repeatability. An independent study should confirm a finding before it is fully trusted. The Smith study in the Netherlands tested the same hypothesis, and failed to find any difference in the mean heights of the HSTS vs. non-HSTS types. Lawrence suspected and demonstrated that the sort method was incorrectly including too many non-HSTS as HSTS in the Smith study. But, when she resorted, the data still failed to support the differential mean height hypothesis. However, is it possible that there is still a difference in the distribution? Or is there something basically different between Dutch and North American populations?
References:
Ray Blanchard, Robert Dickey, Corey L. Jones, “Comparison of Height and Weight in Homosexual Versus Nonhomosexual Male Gender Dysphorics” http://www.springerlink.com/content/w318411nq4q7387u/
Lawrence, A., “Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements”
http://akikos-planet.cocolog-nifty.com/blog/files/maletofemale_transsexual_subtypes_sexual_arousal_with_crossdressing_and_physical_measurements_319320.pdf
Yolanda L.S. Smith, Stephanie H.M. van Goozen, A.J. Kuiper, Peggy T. Cohen-Kettenis, “Transsexual subtypes: Clinical and theoretical significance”
http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf
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And the Beat Goes On…
♫…Drum keeps pounding rhythm to the brain… ♫ La di da di dee…♫
James Cantor recently published a letter to the editor in the Archives of Sexual Behavior pointing out nearly the same point that I had made earlier, that recent MRI scans of transsexual brains show clear evidence that Blanchard’s two type hypotheses is supported. One of the papers he referenced is one that I had earlier referenced; The Rametti study in Spain, which showed that MTF HSTS transkids have partially feminized brain structures. The other paper is new to me; The Savic paper clearly adds yet another confirming MRI study that when combined with the Luder MRI study, shows that gynephilic MTF transsexuals do not have feminized brains. On top of it, true to another speculative prediction that Blanchard made, the new study confirms the other paper’s finding that gynephilic (AGP) MTF transsexuals show other, non-sexually dimorphic structures, are different from both non-transsexual men and women!
These two papers both noted that the putamen of gynephilic MTF transsexual are different from both non-TS men and women. This may be the main area to research in the future?
References:
Cantor, James, “New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism”
http://www.springerlink.com/content/b52p04306u076623/
Rametti G, Carrillo B, Gómez-Gil E, Junque C, Zubiarre-Elorza L, Segovia S, Gomez A, Guillamon A., “The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study.”
http://www.ncbi.nlm.nih.gov/pubmed/21195418
Ivanka Savic, Stefan Arver, “Sex Dimorphism of the Brain in Male-to-Female Transsexuals”
http://cercor.oxfordjournals.org/content/early/2011/04/05/cercor.bhr032
Luders E, Sánchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E., “Regional gray matter variation in male-to-female transsexualism.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754583/
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The Age of Innocence
At what age should transkids start HRT?
For physicians and other health care providers, an over-riding concern is to “do no harm”. One of the fears for such care providers is that of starting a course of treatment intended to treat a condition, only to discover that they misdiagnosed the patient and gave a treatment that not only was unneeded, but potentially harmful.
In the case of trankids, both MTF and FtM, the sooner one can begin hormonal & surgical treatment and social support interventions to allow them to successfully transition into the appropriate gender/sex role so as to take advantage of the normal adolescent physical and social maturation process along side their peers, the better the long term outcome.
But, as the very recent Steensma study, as well as many before it, shows, not all gender atypical children will be gender dysphoric, and not all gender dysphoric children will persist as such into their teen years. Thus, the study was conducted in the hope of finding differences between persistors and desistors, so that clinical treatment decisions can be made as early as possible. The earlier one can separate the two, the earlier one can begin to treat the transkids, while letting non-transsexual teens grow up naturally, without potentially harmful iatrogenic trauma.
Because healthcare providers have not been able to accurately predict which gender atypical / dysphoric children will persist, a number of practitioners have begun recommending and using a puberty blocking protocol, under a harm reduction model in which the persistors are protected from the harmful effects of their endogenous hormones, while refraining from iatrogenic injury from exogenous cross-sex hormones in those who will desist from their earlier gender dysphoria. The current recommendation is that such puberty blockers be used until the individual is 16 years old, at which time, if he/she is still a persistor, they may be switched to cross-sex hormones, while the desistors may terminate the puberty blocking protocol at any time. (There is a built in bias for desistors and against persistors in that desistors can begin a prefered hormonal protocol, simply by stopping the puberty blockers, but persistors must wait and “prove” to healthcare workers that they are ready.)
The problem with this protocol is two fold. First, it is not without its own potential for iatrogenic harm in that delaying puberty reduces the eventual strength of the bones in adulthood. This may not be immediately harmful, but those children will someday be older adults, whose bones will be more prone to breaks. Second, for MTF transkids, delaying puberty means that they will continue to grow taller, potentially reducing their ability to pass successfully as female. This effect may however be welcomed by the FtM transkids, but their desisting female peers may not feel the same.
Another problem with this protocol is that it is very expensive, far more expensive than cross-sex Hormone Replacement Therapy (HRT). For those who live in countries who do not have a generous state provided health plan, this may be a deal breaker.
So, for health care providers and parents alike, it may be better if they can accurately predict who will desist and who will persist. Getting this data is the object the Steensma study. The Steensma study is short on statistics, but what they do have is remarkable:
. Total group Persisters Desisters
. (N = 53) (N = 29) (N = 24)
Natal sex
% (N) Boys 56.6 (30) 58.6 (17) 54.2 (13)
% (N) Girls 43.4 (23) 41.4 (12) 45.8 (11)
Age at childhood
assessment
M (SD) 9.41 (1.46)* 9.92 (1.26) 8.81 (1.47)
Age at follow-up
M (SD) 16.11 (1.70) 16.14 (1.84) 16.07 (1.54)
Full-scale IQ
M (SD) 100.26 (12.82) 98.83 (12.28) 102 (13.50)
* Significant difference observed between persisters and desisters in age at childhood assessment (t(51) = 2.968, p < .05).
For starters, the IQ of the persistors is 98.83, essentially average. Although this is combining FtM and MTF, the number agrees with my earlier estimate of 98.6 for the MTF HSTS population.
But, the more important data is that there is a difference between the ages of childhood assessment, the age at which their parents brought them to a clinic for evaluation. But, the study makes it very clear that there was very little difference between the two groups in their early childhood gender atypicality. So why is there this difference? Why would the parents of persistors wait longer than those of desistors?
Because they don’t! It wasn’t that parents of persistors waited longer, it was that many desistors, desisted at an earlier age, such that their parents never brought their children in for assessement. As they get older, fewer and fewer parents of desistors would bring in their children. But, the persistors would continue to be brought in at later and later ages. Indeed, the authors specifically stated that from the interviews, the desistors clearly articulated that from age 10 to 13 were critical for their change in gender dysphoric feelings. While, for persistors, that same age only confirmed and strengthened their feelings. Thus, both interview report and the statistics agree that something special seems to be happening starting at around the age of ten or even a little younger.
Starting around the age of 10, and for the subsequent years, the persisters indicated that their crossgender preferences and behaviour and their gender identity remained stable, but that their dysphoric feelings intensified. The intensification of gender dysphoria was attributed to three factors; (1) Certain changes in their social environment, (2) The anticipation of and/or actual physical changes during puberty, (3) The first experiences of falling in love and discovering their sexual orientation.
The authors, in focusing on what the teenagers said were influential, may have missed a critical factor. What’s so special about the age of ten? This is well before puberty. The authors focused on changing social factors, but could it be that biology is the important factor? McClintock and Herdt point out that sexual attraction is first noted well before our classic definition of puberty, that of the maturation of the gonads and subsequent increase in testosterone, estrogen and progesterone. Instead, other hormones start earlier, typically around ten years old. And this is the age at which one’s sexuality begins to be recognizable.
With regard to sexual attraction, all persisters reported feeling exclusively attracted to persons of the same natal sex, which confirmed their gender identity as they viewed this attraction as a heterosexual attraction. They did not consider themselves homosexual or lesbian.
For the desisting boys, some came to recognize that they were gay or bisexual, essentially confirming the results of many other studies which have shown that gender atypicality in boys is highly corralated with homosexuality. However, a number of the boys self-identified as heterosexual, even though they also recognized some same sex attraction.
For the girls, all of the desistors had become aware of the fact that they were heterosexually attracted to boys and wanted to be sexually attractive to boys. Thus, they were the classic tomboys who grow up to be straight women. But the persisting girls were all attracted to girls.
Thus, this study showed that the key difference between persistors and desistors among female bodied gender atypical / dysphoric individuals was sexual orientation, but among male bodied, it was not as clear cut, desisting boys included both gynephilic and androphilic sexual orientations. However, what is clear is that persisting boys are all clearly unambiguously androphilic (HSTS). Persistors will demonstrate same sex attraction, while desistors may or may not. Thus opposite sex attraction is a key exclusionary sign for persistors. Although we still would have some desistors who don’t show this sign, we have at least conclusively identified some.
Further, none of the study group was autogynephilic.
This last point is important. Although many autogynephilic adults report having been gender dysphoric as children, it is rare, though clearly not unheard of, for them to have been noticed as such as children. They are the “non-aparent” population as children. However, for the HSTS population, of both sexes, MTF and FtM, their gender dysphoria was accompanied by obvious gender atypicality. Since obvious gender atypicality is not found in autogynephilic boys, who are universally gynephilic, we can safely say that anyone who is obviously gender atypical and sexually attracted to the opposite sex is not going to be a persistor.
Another point can be clearly found in the Steensma study is that the developmental process, what ever it is, for desistors, is finished by age 14. If a gender atypical 14 year old is still gender dysphoric and wishes to begin hormones and transition, we can be reasonably certain that he or she will not change his/her mind later. Thus, based on the evidence, we can safely begin such interventions. The sooner the better.
Conclusion
From the evidence, we draw the conclusion that for obviously gender atypical / dysphoric children, waiting until one is 16 years old to end puberty blocking protocols and begining HRT is unwarranted and ill-advised. Instead the evidence points to the age of 14 as the latest that HRT may safely be begun with little risk of iatrogenic injury to desistors. Indeed, the evidence suggests that carefully evaluated, many of the desistors may be excluded by age ten to twelve. Thus, if delaying puberty is chosen, it should not be continued past the 14th birthday, and given proper screening, may be ended earlier, to switch to HRT. For both cost and health reasons, it may be best to start on HRT for those who clearly fit the profile of a transkid, who request and understand the consequences of HRT, as soon as would be indicated for their gender of choice. That is to say, that for MTF’s, HRT should begin at age 12, and for MtF, at around age 14, mimicking the natural maturational process for each target sex.
Addendum:
My friend, Alice Dreger, has some very thought provoking things to say about this very topic:
Pink Boys with Puppy Dog Tails
Three ways to think about little boys in pretty dresses.
References:
Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis, “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study”
http://ccp.sagepub.com/content/early/2011/01/06/1359104510378303
Vicente Gilsanz, James Chalfant, Heidi Kalkwarf,Babette Zemel, Joan Lappe, Sharon Oberfield, John Shepherd, Tishya Wren, Karen Winer, “Age at Onset of Puberty Predicts Bone Mass in Young Adulthood”
http://www.jpeds.com/article/S0022-3476%2810%2900566-4/abstract
Martha K. McClintock and Gibert Herdt, “Rethinking Puberty: The Development of Sexual Attraction”
http://homepage.univie.ac.at/Michael.Berger/lit/McClintock.pdf
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Why not take part of me?
♫…Take my arms… ♫ I’ll never use them…♫
As I had discussed earlier, autogynephilia is a phenomena, not a theory… but has been theorized to be caused by Erotic Target Location Error. If this theory is true, it predicts that men who are both gynephilically attracted to female amputees and have a deep desire to have a limb, such an arm or leg, removed to be like their erotic target, would also be likely to want to be female and have other autogynephilic arousal patterns. In one of the few studies to test this prediction, we see exactly that, as described by Lawrence:
Recently, First (2005) used semistructured telephone interviews to survey 52 persons who had expressed a wish to become an amputee or who had succeeded in doing so. About two thirds of participants were recruited from Internet discussion groups and about one third from referrals by other participants. Forty-seven (90%) participants were male, 4 (8%) were female, and 1 was intersexed and raised as a male; 32 (62%) participants reported that they were heterosexual and the remainder reported that they were homosexual or bisexual. First (2005) noted that the high proportion of nonheterosexual participants was “partly explained by the fact that nine of the subjects were referred to the study by one subject who was himself homosexual, eight of whom were also homosexual” (p. 921). Nine (17%) participants had undergone a major limb amputation. Forty-eight (92%) participants had pretended to be an amputee and 45 (87%) acknowledged sexual attraction to amputees. Fifteen (29%) participants reported other paraphilic interests, including 8 (15%) with transvestic fetishism. Ten (19%) participants reported they had sometimes wished to be the opposite sex or felt that they were in the body of the wrong sex; of these, 7 (13%) participants had crossed-dressed, not including the 8 participants who had cross-dressed in connection with transvestic fetishism. Six (12%) participants had considered sex reassignment and 1 (2%) had undergone sex reassignment.
How likely are we to find in any random group of only 52 people, a post-op transsexual and six more that have thought about it? How about finding 15% who report erotic arousal to cross-dressing? And add to 13% more that cross-dress and experience some gender dysphoria? Looking at the above description, at least 15 of the 52 showed some level of gender dysphoria. Though we can’t tell from the paragraph, I’d predict that all 15 (possibly 18) were heterosexual, which if true, would mean that 15 out of 32 people (47%) reported gender dysphoria or autogynephilic (androphilic) arousal (assuming that the women were just as likely to experience gender dysphoria as the men). But, at the very least, 15 out of 52 “wannabe” people (29%) reported such.
So, Erotic Target Location Error theory’s prediction that “wannabes” will also be more likely to be autogynephilic and gender dysphoric than would be expected by random chance, is very strongly supported. Thus, the theory of Erotic Target Location Errors explaining autogynephilia is also supported by the data.
Reference:
Lawrence, A., “Clinical and Theoretical Parallels Between Desire for Limb
Amputation and Gender Identity Disorder”
http://www.annelawrence.com/publications/amputation-GID.pdf
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Speculation…
…on a hypothesis concerning bisexual and asexual transsexuals.
In the past, I’ve tried to keep from too much speculation, trying to describe and interpret the research into transsexuality. But in this post, I wish to take a chance and speculate a bit, perhaps generate a hypothesis to test that speculation.
A bit of background: Blanchard tested a hypothesis that there were only two types of transsexuals, rather than three or four as others had proposed. The earlier researchers / commentators that had proposed that there were three basic types usually settled on Asexual, Homosexual, and Transvestite (Person and Oversey, Bentler, and even Green), though they didn’t always agree on the labels, nor on which group was the “real” or “primary” transsexual. Hirschfeld had used four types of people in general, not just for TS/TG folks; Homosexual, Bisexual, Heterosexual, and Asexual. Since this four grouping also would encompass the three grouping, it seemed prudent to start with four and see if there really were differences. From this, Blanchard tested for autogynephilia and other characteristics, such as life arc (age of transition, level and quality of childhood gender atypicality, etc.). From his study, he noted that three groups were very much alike in that the majority reported autogynephilia and had similar life arcs (statistically speaking) such as late transitioning, while one of the four was quite different, showing very, very low percentage reports of autogynephilia, greater childhood gender atypicality, and very early transitioning. One group was “Homosexual” and the other was “Non-Homosexual”. Thus, his data showed only two groups as being statistically separable, but with a non-statistically-significant (meaning, it could be noise in the sample) trend for the bisexual and asexual groups to report less autogynephilic individuals. This was the state of things in the 1980′s and ’90s.
Then came the Nuttbrock study with many more subjects (N=571) in the late 2000′s. The data exactly duplicated Blanchard’s study from twenty years previous. And having enough subjects meant that the trend of having fewer bisexual and asexual individuals reporting autogynephilia (in this case, erotic arousal to cross-dressing) was shown to be statically valid, at least for bisexuals; There were so few (N=12) asexuals, that the trend might still be random noise, but when combined with Blanchard’s subjects, which reported about the same way, it gives us some additional confidence that it is real. So, as I wrote earlier last year, we are now left with trying to generate new hypotheses to test that might explain this trend.
So, what is the trend? Let’s use the Nuttbrock data:
Self-reported Homosexual Heterosexual Bisexual Asexual
Sexuality (androphilic) (gynephilic)
Number: (n=391) (n=71) (n=96) (n=12)
Autogynephilia 23.0 81.7 67.7 66.7
And looking at age of transition:
Hormone Therapy AGP
Adolescent(n=171) 91.8 0.6 7.6 14.0
Adult (n=242) 64.5 13.2 22.2 42.6
None (n=158) 54.2 25.5 20.2 59.5
And finally, we should add, from the Doorn study (N=31), that 85% of adult cross-dressers (TV/CD) reported erotic arousal to cross-dressing. This number is vitally important, as it tells us the number that will recognize and admit to such arousal. Many researchers have looked into the issue of why less than 100% this group does report such arousal. Those that don’t report ever having had such arousal, none-the-less report feeling the same exact type of satisfaction and most importantly, compulsive need, to cross-dress as those that do report such arousal… and in fact, the same type of feelings that those who found cross-dressing erotically arousing at one time, but no longer experience it as such. For our purposes here, I think we can assume that they all experience autogynephilia in some form, in desire, if no longer such intense arousal. That being so, we can note the amazing similarity to the percentage reporting AGP arousal found in the gynephilic transsexual group, who most resemble adult cross-dressers in life arc (up to but not including transition itself).
Here is where I am going to speculate, possibly rather wildly, but such is the nature of hypothesis generation. If we assume that gynephilic transsexuals are all autogynephilic, and that we can take that 82% number as a baseline of how many autogynephilic transsexuals, regardless of self-reported sexuality, report that fact, we can use it as a means of making an estimate of how many autogynephilic transsexuals there are in a given sample:
Self-reported Homosexual Heterosexual Bisexual Asexual
Sexuality (androphilic) (gynephilic)
Number: (n=391) (n=71) (n=96) (n=12)
Autogynephilia 28.0% 100% 82.7% 81.6%
And looking at percentage at age of transition:
Hormone Therapy AGP
Adolescent(n=171) 91.8 0.6 7.6 17.1
Adult (n=242) 64.5 13.2 22.2 52.1
None (n=158) 54.2 25.5 20.2 72.8
Note that we still have an interesting anomaly in that the estimated percentage of adolescent “early” transitioners is still significantly fewer autogynephilic individuals than would be predicted controlling for sexuality from the total study. And, as expected, most of those who have not started HRT, would be autogynephilic.
So, if this estimation is correct, we are left with a question, why do fewer bisexual and asexual individuals report autogynephilia? Several possible hypotheses come to mind:
1) Fewer actual autogynphilic individuals who are bisexual and asexual recognize and admit to autogynephilia.
2) Fewer self-reported bisexual and asexual individuals are autogynephilic.
3) Some combination of the above two hypotheses will be found.
The safer bet is always to look at a combination of reasons, since real human lives are messy… but, if I had to take a guess regarding the bisexual group, I will go with more of the second hypothesis, as it fits with what we know of human sexuality in general, that many male-bodied people who self-report as bisexual do so because they honestly report that at sometime in their lives, they had some sexual experience(s) with women, but that their primary sexual orientation is androphilic. If our estimate is correct, then 17.3% of the bisexual group is primarily androphilic. I’d also bet that more of them transitioned at a younger age, than those who were autogynphilic (and experience pseudo-androphilia). The asexual group is more of a question mark, but my guess would be the same, out of the twelve individuals in this study who report being asexual, two of them are primarily androphilic, but find their libido is low at the present time, or they are afraid of being emotionally hurt.
So, how do we test this hypothesis?
Addendum 1/22/2012:
I thought of a way to test this hypothesis using the reclassification from ‘homosexual’ to ‘non-homosexual’ that Lawrence performed on the Smith data set. Originally, Smith et al. dichotomously sorted, by self-reported sexuality into “homosexual” and “heterosexual” (based on natal sex). Lawrence then reviewed that original sort and resorted based on sexual history with natal females, as indicated by prior marriage to women. That is, she looked at those who self-reported being exclusively androphilic and, in essence, assigned an implied assessment of being ‘bisexual’, based on their actual history combined with their stated sexual orientation. She noted that the original ‘heterosexual’ and her resorted group had similar self-reported levels of autogynephilic arousal to cross-dressing. However, when I look at the data, I note that though the are similar, they are not identical:
Percentage Reporting Cross-dressing Arousing
Self-Identified Heterosexual: 63%
Resorted Behavioral “Bisexual”: 52%
If we examine this as a ratio of Bisexual to Heterosexual self-report of autogynephilic arousal to cross-dressing we get 0.83. The Nuttbrock ratio of Bisexual to Heterosexual self-reported arousal is 0.83. They are identical!!! Thus, this analysis supports the first, rather than the second, hypothesis, since in the Lawrence re-designated Bisexual group, we know that they are in fact non-HSTS because of their sexual history. So, my original guess was wrong. Nuttbrock’s Bisexual Group does not include etiologically homosexual transsexuals.
If the ratio of the two groups’ percentage reporting is the same, why aren’t the raw percentages? Nuttbrock’s data was gathered in the open community, not in a clinical setting, as was the Smith data. This may have led to more honesty, less social desirability bias. The bias works equally on both self-reported heterosexual and bisexual groups, so that the ratio remains the same.
So why then do bisexual transsexuals report lower amounts of erotic arousal to cross-dressing? Perhaps they experience other forms of autogynephilic arousal, as reported by Blanchard? In any case, the Smith data set adds yet more evidence to the two type taxonomy, as already noted, but also adds to the observation that ‘bisexual’ transsexuals report slightly less arousal to cross-dressing than do ‘heterosexual’ transsexuals.
This area needs further research.
Addendum 1/23/2012
Lawrence resorted 23 out of 61 self-reported ‘homosexual’ transsexuals as not being exclusively so (23/61=38%). If this percentage is similar, minus those who already sorted themselves as ‘bisexual’, in the Nuttbrock data set, and that they reported erotic cross-dressing is the same percentage as Nuttbrock’s ‘bisexual’ group, then we can explain the reported figure of 23% of the androphilic group experiencing cross-dressing to be autogynephilically arousing. That is to say, that about 33% of the “androphilic” group are not actually exclusively so. Note that most of these started HRT as adults or are not on HRT. This exercise reinforces the need for careful sorting based on actual sexual history, not simply by self-report.
Reference:
A Further Assessment of Blanchard’s Typology of Homosexual versus Non-Homosexual or Autogynephilic Gender Dysphoria, Nuttbrock, et al. Archives of Sexual Behavior
http://www.springerlink.com/content/b48tkl425217331j/
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Seeing the world in Grey and White…
…brain matter
It is exciting to see that neuroimaging science is getting to the point where we needn’t wait until subjects are dead before we can examine their brains in better detail. Exciting recent developments include a pair of papers from Spain in which Diffusion Tensor Imaging (DTI), a form of MRI, was used to compare FtM and MTF transsexuals to control men and women. The results were that transsexual brains exhibit white matter features, that are known to be sexually dimorphic, mid-way between male and female morphologies. The studies are doubly interesting, because the subjects had not yet begun exogenous Hormone Replacement Therapy (HRT) eliminating the possibility that the features were the result of activating effects of HRT.
So, does this mean that we have proven that transsexuals have “intersexed brains”?
Yes… and at the same time… No.
First, in the case of Female-to-Male transsexuals, it has always been noted that the majority were both gynephilic and masculine behaving since early childhood. So, these results are hardly surprising. However, the exact same thing can be said for butch lesbians, who do not necessarily identify as men. So, if we were to image the brains of a population of such butch lesbians, would we see the same masculinized neurological features? Would we see that transmen were more masculinized than butch lesbians, who would in turn be more masculinized than average lesbians? Also, if we imaged the brains of a population of gay identified transmen (“transfags”), would we then see that they do not share such masculinized features? I’m betting we would, and eagerly await the results of such imaging.
Which brings us back to the Male-To-Female subjects in the Spanish DTI study. As Lawrence has pointed out, different cultures have varying prevalence of non-homosexual transsexuality. Spain is one of those cultures where very few of the MTF transsexuals are non-exclusively-androphilic, with only 9% of the MTF transsexuals being non-exclusively-androphilic. In this case, as reported in the paper, there were no such non-exclusively-androphilic subjects. All were described as “early onset” and androphilic. Thus, this study only tells us about one type of transsexual.
Sadly, there wasn’t a gay male control group. It would have been interesting to see if the MTF transsexuals exhibited the same or more feminization (non-masculinization) of these sexually dimorphic brain structures. One hypothesis regarding exclusively androphilic transsexuals is that they are the extreme end of a range of feminine (hypo-masculine) homosexual males, who find that their innate femininity sufficient that living life as women is a better rational as well as emotional choice. (That is to say, that they are so feminine, like women, that they are women at heart.) I eagerly await DTI imaging studies that can test this hypothesis.
Now that we have DTI data on the HSTS population, we must gather data on the non-HSTS population to see if they do or do not exhibit such partially feminized (hypo-masculinized) features. Once again, we have no data that would show, conclusively, one way or the other, that both types of MTF transsexuals share neurologic features that would serve as the basis of a unifying etiology.
It’s not much of a limb to go out on, given the very strong data that shows that there are two types with two separate etiologies, but I’d be willing to bet that that when we do have such DTI images of gynephilic MTF transsexuals, that they will be no different than typical straight men, at least with respect to these particular sexually dimorphic features.
Which brings us to another study (Luders) looking at grey matter instead of white sexually dimorphic brain structure differences between MTF transsexuals and control men and women, this time one that suggests that for a very localized spot, they found a feature in MTF transsexuals that is different and possibly ‘more feminine’ than male controls. However, globally, the MTF brains were shown to more like men, and if anything, perhaps more masculine than control men, as they showed less grey matter then men, who show less grey matter then women. But one spot, the right putamen, is definately different in MTF transsexuals than in control men, showing more grey matter, in fact, more grey matter than the control women.
Sadly, as the researchers themselves point out, they may have included both exclusively androphilic and non-exclusively androphilic transsexuals without analyzing them separately; Of the 24 subjects, six self-reported to be androphilic and 18 reported to be gynephilic. It is heartening that the researchers recognize that in the future, they need to make the distinction and analyze the two types separately. Further, as these TS folk are pre-HRT, their ages may be used as a statistical proxy for our purposes, as HSTS folks usually (>90%) begin transition and HRT before age 25: the mean age was 47 years old, standard deviation of 13 years, with the range from 23 to 72. We know from Lawrence’s re-sorting from the Smith data set that a fair number of MTF transsexuals who self-report being androphilic are not exclusively so, thus it is likely that less than six of the subjects are exclusively androphilic. A little math will show that that with a normal distribution, only one of the 24 subjects would have been expected to have been 25 or younger, so this 23 year old may be the only one. Therefor, as Luders et al did find a statistically significant signal, we might infer that it is more likely that it came from the non-exclusively androphilic type, and thus likely also autogynephilic.
While it may be tempting to declare that this feature found in the right putamen proves that MTF transsexuals, in-fact, that gynephilic MTF transsexuals, have a part of their brains that is femininized, this conclusion should not be drawn from this data, at this time. Although it may be a marker of transsexual neurology, it may not be from a feminization of this region, especially given that it shows more grey matter than both control men and women. It may be a marker of an unusual neurological development altogether unrelated to sexual dimorphism. It may in fact be a marker for autogynephilia, or proneness to erotic target location errors. In fact, such a marker is expected to be found. We need further studies.
First, we need to compare the two types of transsexuals to test if this is a marker of a unifying neurological feature of transsexuality. Second, we need to compare both of them to individuals who are sexually aroused at the thought of becoming amputees, to test the hypothesis that this may be a marker of proneness to erotic target location errors.
But, in the mean time, the world is not so much to be understood as black and white, but shades of grey and white.
Addendum 1/28/2011:
A good link to explore the first two papers further:
http://neurocritic.blogspot.com/2011/01/white-matter-differences-in-pre-op.html
Addendum 12/19/2011:
You may wish to read a new blog entry on an additional paper on this topic.
References:
Rametti G, Carrillo B, Gómez-Gil E, Junque C, Segovia S, Gomez A, Guillamon A., “White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study.”
http://www.ncbi.nlm.nih.gov/pubmed/20562024
Rametti G, Carrillo B, Gómez-Gil E, Junque C, Zubiarre-Elorza L, Segovia S, Gomez A, Guillamon A., “The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study.”
http://www.ncbi.nlm.nih.gov/pubmed/21195418
Luders E, Sánchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E., “Regional gray matter variation in male-to-female transsexualism.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754583/
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