On the Science of Changing Sex

What the NEXT Wave of Transgender Activists Need to Know

Posted in Editorial by Kay Brown on December 9, 2014

This post marks five years of writing on the subject.  It seems a good moment to stop and reflect on the reasons I’ve been writing, and to explore what has changed in that time.  I’ve tried to keep the material mostly about the science and its implications.  It hasn’t always been easy, as there is in the background, from what I would call the “Second Wave” of transactivists, a powerful and very ugly, campaign of disinformation.  Why do I say, “Second Wave”?  Because I, and a few folks I knew from the ’70s and very early ’80s, were the “First Wave”.

Christine Jorgensen would undoubtedly have to be called the first, as she wrote and spoke about her life in the hopes that others like her would have a better life in the future. I still keep in my “memory box” a small ticket stub from the day that I attended a talk she gave at a local community college in February of ’76.  After she spoke, she welcomed the small cluster of transwomen who surrounded her, hoping to speak with their heroine.  Christine took a special interest in me, teasing me as a “Baby TS, all of eighteen years old!”

Silvia Rivera is of course oft mentioned when she spoke out from the streets of New York.  I’m sad that I never got the chance to meet Silvia before she died.  Other street warriors came forward, but their efforts were, sadly, largely symbolic, yet important none-the-less.  One of these was Angela Keyes Douglas.  I was with her the evening that she typed the infamous Sister letter that Janice Raymond would later, falsely, use as an example of transsexual misogyny, in her transphobic book, The Transsexual Empire.  She asked me to review it.  It dripped with hyperbolic sarcasm, angry as she was over the transphobic treatment of Sandy Stone over her employment at Olivia Records, the seminal Womyn’s Music publisher.  I too was angry at the treatment that Sandy was enduring, being on friendly terms with her as well, but I diplomatically reported, “It’s too full of anger to do any good.”  Angela snorted, snatched the letter back from me, and posted it.  Even then, in ’77, it was very clear that Angela’s mind was deteriorating from progressive paranoid schizophrenia.

Little known is the real hero of those very early days, transman Reed Erickson, who put his fortune to work helping both the gay and trans communities.  Through the ’60s and ’70s, he supported the Erickson Education Foundation, whose Executive Director, Zelda Suplee, an iconoclastic non-transsexual woman, was a lifeline, on the phone and through the mails, for many transsexuals who would otherwise have been all alone.  Zelda was a firm believer not only in the transsexual community, but in nudism and reincarnation.  Once, as I drove the three of us to a meeting of transactivists, my roommate, Dr. Joy Shaffer asked her, “Do you really believe in that stuff?”  Zelda quipped in reply, “It beats television!”

But in the late ’70s came the likes of Joanna Clark, Jude Patton, and Joy Shaffer, who I’m proud to say invited me to join them in founding the ACLU Transsexual Rights committee.  Joanna and Jude also worked very closely with fabulously openly gay Paul Walker to continue the educational work of the recently defunct Erickson Foundation and to eventually found the Harry Benjamin Gender Dysphora Association.  One night in the mid ’80s, Paul Walker, Joanna, Joy, and I were bar hoping in San Francisco, when we entered a bar that Paul liked to frequent, catering to mostly transwomen of color.  The patrons took one look at the towering whiteness of Joanna and informed us that “This is a private club.”  Joanna, with her typically irreverent, and oft dangerously inappropriate, sense of humor, loudly quipped, “Busted!!!”.  These would be the serious activists that pioneered efforts to work with lawmakers and the courts, physicians, surgeons, clinics and scientists… to earn legal and medical recognition, to enable the majority of transfolk to transition and receive appropriate and respectful medical and legal services.  From these early, daring days, came those that soon followed, expanding the ranks of organizations that took our early cutting edge openings, to expand it and now in most of the Western World we have nearly the legal recognitions and protections we need, with a few exceptions that we can all soon hope will be only a sad memory.

But from the very late ’90s came a Second Wave that took the previous work for granted… and started a new, and in my own personal opinion, disturbing direction.

Not content with being able to transition and obtain legal recognition, these new activists have decided that they could bend the truth to their will, to use the power of the internet to coerce our best allies, the clinicians, therapists, medical practitioners, scientists, and even other transfolk, to ignore decades of clinical and scientific evidence regarding the uninvited dilemma that is transsexuality and transgender sexuality.  To my shame as a transwoman and transactivist, transfolk I knew and respected turned from respectability toward waging a vicious propaganda and slander campaign.

CedarStar

CedarStar

I first met Dr. Anne Lawrence in ’95, when Dr. Joy Shaffer brought her to have dinner at CedarStar, my Portland communal house.  While I prepared dinner, Anne and Joy explain Blanchard’s theory.  OF course, I totally understood and agreed, since I had been first educated about the very same issue when I was but 18 years old by my world wise transwoman of color friend, Marcella, who explained “older transistioners as “They are just TVs that need a bigger fix”.  I remember being amused at the thought that the scientists were finally proving it.

I first heard of Lynn Conway in 1982 from Joy’s father, who was a professor of electrical engineering.  Prof. Shaffer had proudly informed me that Lynn was also transsexual, offering the information to strongly encourage me to finish my undergraduate degree and apply at Stanford Graduate School, urging me to study to become an engineer like Joy’s younger sister.  I finally met Lynn in the late ’90s, when she wrote to me regarding my TransHistory class I was teaching at the Harvey Milk Institute in San Francisco.  I had taken advantage of the web to post my class notes, which brought me to her attention.  I was very happy to finally meet this famous transsexual Silicon Valley pioneer.  Of course, during our conversations, during her frequent visits, over dinner, lunch, and at my house, etc.  I had a chance to explain Blanchard’s two type taxonomy.  I was under the honest impression that she understood and agreed with it.

Then, in 2003, Lynn called asking me to join her in protesting Bailey’s new book that she thought was so dangerous, The Man Who Would Be Queen.  Though I hadn’t read it, I had no interest in protesting what I personally believed was true.  Seriously, I can’t imagine what would lead Lynn to believe that I would join in a fight to deny the science I knew to be true.  But, I was not to take the steps that lead to this blog until I read Alice Dreger’s history of the horrendous behavior of these ‘Second Wave’ transactivists.

In 2008, I read Alice’s article, Bailey’s book, and corresponded with a number of the players, including Bailey and Kiira Triea, who became a friend as a result.  I was horrified.  I was also ashamed; ashamed for our community, ashamed for my earlier cowardice for not having tried to stop Lynn and the others.  These people, our community, behaved abominably.  They attacked the very people who were working hard to understand us, to help us.  They falsely vilified both non-transfolk and transfolk alike, members of our own community… and established a poisonous atmosphere of fear and intimidation that persists.

As Bailey and Kiira wrote in 2007,

“Beyond denying the role of autogynephilia in MtF transsexualism, some transsexual activists have mounted attacks on those who publicly disagree with them. In 2003, the first author published a book, The Man Who Would Be Queen, about male femininity, including MtF transsexualism. The section on transsexualism included summaries of Blanchard’s theory illustrated by transsexual women of both types whom he had met, and who agreed to let their stories be included. Upon publication, there was a firestorm of controversy among some MtF transsexuals. Most notably, the transsexual activists Lynn Conway (2006) and Andrea James (2006) led an internet “investigation” into the publication of the book. Conway (2004) likened the book to “Nazi propaganda” and said that it was “transsexual women’s worst nightmare.” As a result of Conway’s and James’s efforts, a number of very public academic, personal, and professional accusations were made against the first author. None of these accusations was true (Bailey 2005). The attacks on The Man Who Would Be Queen were precisely an attempt to punish the author for writing approvingly about Blanchard’s ideas, and to intimidate others from doing so.  The second author was also attacked by some of the same transsexuals after she helped create the Website transkids.us. This website was created by a group of homosexual transsexuals, or “transkids,” their nonclinical name for themselves, to educate the clinical and research communities in the wake of the controversy regarding The Man Who Would Be Queen. The writings on the site both endorsed Blanchard’s distinction between homosexual and autogynephilic MtF transsexuals and criticized the standard feminine essence narrative as being both false and harmful to homosexual MtF transsexuals. Subsequently, Andrea James (2007) conducted highly personal attacks on individual transkids (including the second author), urging that these transkids be exposed and asserting that they were “fakes” because they would not reveal their identities publicly”.

As an example of this attempt to intimidate those who might speak out… and “discredit” those who do, James spent a year trying to figure out who the last of the transkids.us website authors, “Cloudy” was… while simultaneously attempting to convince the trans-community that “Cloudy” was yet another “fake”.  After she discovered that I was “Cloudy” she attempted to intimidate me by email and phone, in which Conway participated in a minor way.  James, failing to intimidate me from further writing on this subject, produced a scandalously scurrilous webpage, describing me as both “fringe” and… well… you can search for it yourself.

Let my experience be an object lesson for the NEXT wave of transactivists.  It is not enough to work to change the world… we need to make sure that we ourselves maintain the values that we would wish in others: respect, cooperation, open-mindedness, kindness.  We need to stand up against bullies, even our own… NO, Especially our own.

Above all… we need to maintain and reward a search for the truth, even if it is an inconvenient truth.

 

References:
Bailey, J. Michael – Triea, Kiira. “What Many Transgender Activists Don’t Want You to Know: and why you should know it anyway” – Perspectives in Biology and Medicine, Volume 50, Number 4, Autumn 2007, pp. 521-534
DOI: 10.1353/pbm.2007.0041

Alice D. Dreger, “The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age” – Archives of Sexual Behavior, June 2008, Volume 37, pp 366-421
DOI: 10.1007/s10508-007-9301-1

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Winds of Change

Posted in Science Criticism, Transsexual Field Studies, Uncategorized by Kay Brown on November 6, 2014

In a very recently published paper (not behind a paywall, thankfully) the issue of changes in self-reported sexual orientation in transsexuals over their lifetime is explored.   The paper has some interesting data… and some very, very problematic data.  One of the problematic data points was the surprising number of self-reported, putatively, originally exclusively androphilic MTF transwomen whose sexual orientation changed to something else.  But… there seems be something… well… fishy about the data.  Take a look at this table:

Initial sexual orientation and history of transition in MtF: N= 70
Orientation               androphilic        gynephilic        bisexual        analloerotic (asexual)
N =                               18 (25.7%)           36 (51.4%)       7 (10%)         9 (12.9%)
age  (SD)                     41.6 (16.4)          51 (9.6)             36(10.8)        47.9 (15.9)
Age of onset              7.2 (3.9)             11.6 (9.9)         11.7 (7.3)       14 (5.8)
first  counseling      32 (13.8)            42.6 (11.5)        31.3(8.7)       39(17)
Transition                 36.4 (10.8)        45.2 (9.6)          33 (7.7)          40.7 (12.1)
HRT                              31.1 (13.8)        42.8 (11.8)        31.9 (9.5)       41.1 (17)
SRS                               35.3 (14.1)        47.5 (10.3)        36.2 (9.3)      34 (12.7)

Do you see it?  Hint:  Compare the ages and ages of transition for the “androphilic” and “bisexual” groups.  Ummmm… sorry guys, that data disagrees with EVERY other study ever done.  The mean age of transition for transkids is closer to age 20.  This was seen in the Nuttbrock and Tsoi studies, in which half of the androphilic MTFs who had started HRT had done so as teenagers… here the average age is 31 years old???  How is it that the “bisexual” group had begun transition, on average, three and half years before the “androphilic” group?  And somehow the “androphilic” group had SRS before beginning transition???  WTF!?  NOT!  Something appears to be very wrong with the data.  The so called “androphilic” group in this study is essentially identical with the “bisexual” group.  So what’s going on?  Can we say, “Social Desirability Bias“?  It looks like there are no actual, genuinely, exclusively androphilic transwomen in this study sample… not even one.

The study suggests that five of the eighteen putatively originally androphilic transwomen had changed their sexual orientation to bisexual, gynephilic, or “unknown”.  I have another interpretation… these five individuals simply admitted to actually having always been non-exclusively-androphilic, finally acknowledge it, as they realized they didn’t have to keep up the pretense.

The rest of the study makes more sense, as six of the 36 of the originally gynephilic identified transwomen reported a shift to bisexuality and androphilia.  This sort of shift has been widely reported before.  Of course, these shifts are generally recognized to be a result of interpersonal autogynephilia,

“Autogynephilic MtF transsexual persons often report the fantasy of sexual intercourse as a woman with a man, that was repeatedly described as faceless and abstract. Yet this pseudoandrophilia has to be distinguished from genuine androphilia or homosexuality in MtF, or as Blanchard points it: ‘‘the effective erotic stimulus, however, is not the male physique per se, as it is in true homosexual attraction, but rather the thought of being a female, which is symbolized in the fantasy of being penetrated by a male. For these persons, the imagined – occasionally real – male sexual partner serves the same function as women’s apparel or makeup, namely, to aid and intensify the fantasy of being a woman’’. Similarly, one of our participants that formally reported a change of sexual orientation from gynephilia towards androphilia stressed that ‘‘I always wanted to experience sexual intercourse as a woman but I did not know what to do with my male body before the hormone treatment. I hated male bodies in general before’’. In this case a reported change in sexual orientation from gynephilic to androphilic can be attributed to autogynephilic fantasies.”

The more interesting data in this study is all about the FtM transmen, about which we have far fewer studies.  Of six originally androphilic FtMs, four of them experience a shift to being gynephilic during transition… and of the 33 originally gynephilic six experience a shift to being androphilic or bisexual.

“In gynephilic FtM a reported change of sexual orientation was less frequent. Six gynephilic FtM reported a change of sexual orientation towards bisexuality and androphilia in the present study. This may in part be explained by the fact that androphilic sexual behavior is complicated for FtM. Sex with male partners can induce intense gender dysphoria by being penetrated as a woman although feeling as a man. One participant in the study of Rowniak and Chesla stated that he didn’t like being ‘‘feminized in bed’’ and others used the description that they were unable to have sex with men ‘‘until they were a man’’. Thus in these 6 participants androphilia may have been the original sexual orientation that became possible only after transitioning. In this case we wouldn’t expect a genuine change of sexual orientation in these gynephilic FtM transsexual persons.”

I was friends with an FtM who stated exactly the same thing… that he ‘identified’ as and participated in the lesbian community because lesbians would let him be butch, but straight men wouldn’t.  As a gay identified FtM, he could finally be both butch and express his native androphilia.  He was in fact, autoandrophilic.  (See my essay on autoandrophilila in FtMs.)

It is gratifying that the authors recognize the weaknesses of their current study and make some recommendations for future studies,

“Self-reported sexual orientation studies have further been reported to be interfered by the fact that some persons do not answer the question truthfully. Some transsexual people for example may want to present themselves as particular feminine (MtF) or masculine (FtM) and thus ‘‘classical’’ transsexual persons.  Participants in the present study might have biased their reports on purpose or unwittingly towards a more gender-typical presentation. This may also involve worries on denial of sex reassignment surgery. We feel that attempts to minimize such worries are important in future studies. We also suggest that researchers should explicitly ask for autogynephilic and autoandrophilic sexual orientation.”

Reference:

Matthias K. Auer, Johannes Fuss, Nina Hohne, Gunter K. Stalla, Caroline Sievers, “Transgender Transitioning and Change of Self-Reported Sexual Orientation”
http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0110016&representation=PDF

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The Measure of…

Posted in Science Criticism by Kay Brown on November 4, 2014

…Autogynephilia.

narcissusOver the years, certain aspects of autogynephilia and its expression have caused both confusion and consternation in the transgender world.  Some of the quirks found in the data, such as the now well documented lower level of reported erotic cross-dressing in “bi-sexual” transsexuals, suggested that perhaps some bisexuals weren’t autogynephilic, etc.  But a new paper, though VERY tentative, give some credence to the idea that there are different subsets of autogynephilia, different expressions of it, that correspond with sexual behavior, specifically, that in addition to the previously well documented four types of autogynephilic expression, a fifth expression exists, that may explain these quirks.

Hsu, et al. have created a new instrument for experimental purposes and did a validity and factorial analysis of a population of known autogynephiles against a control group of men.  The known AGP men were from an internet AGP erotic sharing group, as the authors explained,

“Participants were 149 adult men (M age=34.40 years, SD=11.20) recruited from Internet forums dedicated to sharing and discussing erotic fiction and media depicting autogynephilic fantasies, including cross-dressing, transforming into a woman, and body swapping with a woman. Most of the participants identified as heterosexual (80.54%) although a substantial minority identified as bisexual (14.77 %). Four other men identified as homosexual and one as asexual; the remaining two men selected‘‘Other’’but did not specify their sexual identity. Because participants were recruited from Internet forums catering to men with autogynephilia, all participants were included in the analyses regardless of their sexual identity.  In addition to the 149 participants considered to have autogynephilia, 112 adult heterosexual men (M age=32.63 years, SD=10.88) who reported having never cross-dressed were recruited as a control group from Amazon Mechanical Turk, a website used by people who want to earn small sums of money quickly by taking online surveys.”

However, this study was not directly meant to learn about how AGP and non-AGP men differed, as the authors explained,

“Specifically, our study did not address the issue of whether autogynephilia represents a dimensional or taxonic difference from typical male sexuality. In order to explore that issue, it would be necessary to obtain a representative (and presumably large, given the likely rarity of autogynephilia) sample from the general population (Beauchaine, 2007). Rather, we explored differences among autogynephilic men, assuming that such differences are dimensional, and we focused on describing their dimensional structure. Thus, the primary empirical question that we addressed was not ‘‘How do autogynephilic men differ from other men?’’ but ‘‘How do autogynephilic men differ among each other?’’

The study was most especially NOT about the differences between AGP transsexuals and MTF transkids.  In fact, as I will explain below, this new instrument has several items that make it invalid to such a task.  But in studying autogynephilia in AGP males in general, it is a very good start.

The most exciting thing that can happen when conducing science is to hear this phrase, “That’s odd…”  It means that something unexpected has been found in the data, something new.  In this case, we may have found something, two somethings actually.

It has always been mooted about that ‘transvestic’ autogynephilia is the most commonly found form of autogynephilia, along with ‘anatomic’, ‘behavioral’, and ‘physiological’.  Sometimes, a fifth type is discussed, ‘interpersonal’.  The usual explanation for bisexual or “pseudo-androphilia” sexual behavior is that ‘behavioral’ autogynphilic ideation includes acts of having sex with a man as a woman.  But this paper supports the notion that the fifth type, ‘interpersonal’, is responsible.  The central concept of ‘interpersonal’ autogynephilia is that of narcissistic desire to be admired by other people, as an attractive, sexually desirable woman, emphasis on being a woman.

It has also been suggested that gender dysphoria, the desire to “change sex” is most motivated by ‘anatomic’ autogynephilia and that most Cross-Dressers, who do not have such strong gender dysphoria experience less ‘anatomic’ and more ‘transvestic’ autogynephilia.  But in this study, the reverse seems to hold!

Those interested in the details should read the paper carefully, but to summarize, the authors explored four factor models and five factor models to explain the variance of the data.  They also explored the idea that a single factor underlay the whole.  The best model seemed to be the five factor model with a single factor, “autogynephilia” underlying the whole.  Thus, a generic ‘autogynephilia’ does exist, but also that there are variations on a theme, with (at least) five types identified.  The newly identified type is indeed interpersonal’ and is very strongly correlated with both identifying and being behaviorally bisexual.  The ‘behavioral’ type did NOT correlate with bisexuality / androphilia.

However, a note of caution needs to be introduced here, as two of the four items that had high loading for the ‘interpersonal’ factor specifically relate to dating and having sex with men… thus is essentially measuring the same construct.  It might be interesting in the future to redact these two items to see if the high correlation remained.  I’d even like to add another item to the ‘interpersonal’ set (see below).  Yet another caution needs to be observed… and that is finding EXACTLY who (or rather, what) these men were finding attractive and having sex with.  The “men” these individuals may be having sex with are very likely to be other Cross-Dressers!  IF so, this puts a rather different interpretation on their putative ‘androphilia’.

In looking at the correlations, both zero order and partial regression coefficients, ‘anatomic’ autogynephilia did NOT correlate with gender dysphoria, counter to previous report (Blanchard).  Instead, the highest correlation with gender dysphoria was ‘interpersonal’ !!!  While it may have made some theoretical sense to believe that ‘anatomic’ autogynephilia would be a powerful motivator for “changing sex”, given that both involve anatomic features.  This data suggesting that ‘interpersonal’ autogynphilia would be even more motivating makes sense when one considers the required “real life test” before one may obtain SRS, that social transition and the ‘real life test’ are all about interpersonal aspects of life.  But, again, we need to introduce a note of caution here.  The sample used in this study were NOT sufficiently gender dysphoric as to actually proceed to transition and SRS… only that they might have wished that they could have been born as girls, etc.  This may be more a measure, in this population, of such weaker desires.  This study needs to be repeated with a sample of AGP transwomen to confirm or disconfirm this unexpected result.

The fact that ‘interpersonal’ correlates so highly with both an interest in sex with men (even with the caution of the items I mentioned above) and gender dysphoria might explain why so MANY post-transition APG transwomen experience a “change in sexual orientation” from exclusively gynephilic to being bisexual / (pseudo)androphilic.  Lawrence showed that perhaps 38% experience such a change.  The two may go together, transition and “orientation change”.

Over all, this study suggests ‘anatomic’ autogynephilia may be just as common, if not more common than ‘transvestic’.  Most importantly of all, as the authors explain,

“The finding that a general factor of autogynephilia underlies the five types among the sample of autogynephilic men was not predestined to be true. For example, autogynephilic men may engage in or be invested in behaviors or fantasies of one type of autogynephilia at the expense of those of other types. In contrast, the general factor accounted for a much greater amount of the total variance of the 22 items than did the group factors, suggesting that there is an overall tendency for some men to be more autogynephilic than others. Indeed, scores on the GAS, a measure we constructed by adding all 22 items,were normally distributed. From these results, it appears that the types of autogynephilia that a man has are less important than the degree to which he has autogynephilia.”

To explore their new instrument’s validity as a measure of autogynephilia, they compared the scores of their putatively known autogynephilic men with heterosexual control men:
Scale/subscale                                             AGP                         Controls         Cohen’s d

General Autogynephilia Scale (SD)      3.32  (0.89)        1.16 (0.38)       3.33

The absolute range for the General Autogynephilia Scale was 1–5.   My guess is that most people would find the fact that the scale is from one to five confusing, so if we made the scale from zero to four, the numbers would be 2.32 for AGPs vs. 0.16 for the controls… being more intuitively obvious that the scale works to differentiate AGP from non-AGP males.  And, for comparison purposes, making the scale from zero to eight, like Blanchard’s Core Autogynephilia scale, would be very useful.

As to my earlier comment as to why I believe that this new instrument is not valid for exploring the differences between putatively autogynephilic transwomen and putatively “homosexual” transwomen is the construction of three of the items in the instrument:

How sexually arousing would you find each of the following activities?

9. Having a stranger mistake me for a woman.
10. Picturing myself as a woman having sex with a man.
11. Having a man take me out for a romantic evening.

Item number nine, as constructed, is very likely to be interpreted in a rather different manner than that intended by the authors.  The term “mistake”, in someone who is extremely gender dysphoric and presently identifying as a woman, would have a very negative emotional valence.  Even if that individual might find having strangers who accept / perceive her as a woman as sexual arousing, she is unlikely to endorse this item as she will not experience that act of “passing” as a “mistake”.  This item would need to be modified to have a more acceptable valence.

Items 10 and 11 are problematic in that a truly androphilic and extremely gender dysphoric transwoman would also endorse these items, even in the total absence of autogynephilia, as would any heterosexual natal female for that matter.  The context of the question is not self-evident.  In fact, the construction of 11 doesn’t even specify “as a woman” or “dressed as a woman”… and even if it did… they still would not be interpreted as describing an autogynephilic motivation.  Context is everything.

In the same vein, but on the flip side, I would, for the purposes of strengthening the measure of ‘interpersonal’ autogynephilia, suggest a companion question of,

23. Picturing myself as a woman having sex with another woman.

This, I believe, is a VERY common ‘interpersonal’ autogynephilic fantasy.

And speaking of common fantasies.  The authors also explored correlations between their factors and paraphilic sexual interests.  Not unexpected, there was a slightly increased interest in sexual masochism in the AGP sample.  The correlation was highest with ‘interpersonal’ and ‘transvestic’ autogynephilia.  To explore this better, I would add another item to the instrument:

24. Being forced to wear women’s clothing by another person.

This might answer a question regarding “forced feminization” fantasies, that of which of the two competing hypotheses is correct.  Is “forced feminization” a convolution of ‘transvestic’ autogynephilia and simple sexual masochism?  Or… Is “forced feminization” a means for reducing the guilt and shame of ‘transvestic’ autogynephilia, without experiencing masochism.

Hypothesis were meant to be tested.

 

Reference:

Kevin J. Hsu, A. M. Rosenthal, J. Michael Bailey, “The Psychometric Structure of Items Assessing Autogynephilia”
Archives of Sexual Behavior, DOI 10.1007/s10508-014-0397-9

 

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Autistic Sky

Posted in Brain Sex, Confirming Two Type Taxonomy by Kay Brown on September 21, 2014

For the past several years, evidence has been accumulating that there is a fairly high comorbitity between transsexuality / transgenderism and the autism spectrum.  Interestingly, and perhaps not totally surprisingly, among MTF transwomen, it appears to be exclusively found in the non-exclusively androphilic population.  This fits the Freund/Blanchard taxonomy and more importantly, Blanchard’s prediction that “non-homosexual” (with respect to natal sex) MTF transwomen would exhibit neurological / brain differences from control males but these differences would NOT be a shift toward female like brains.

Autism and autism spectrum disorders are found in four to five  times as many men as women.  There are a number of theories as to why this happens, including the rather intriguing “hypermasculine brain hypothesis”, in which a link between the slight differences between men and women, as groups, having different cognitive and social behaviors and the apparent similarity, or rather, exaggeration of these differences between men and women, found in those on the autism spectrum.  If autism is a form of hypermasculinization, it would not surprise us to learn that FTM transmen were more autistic-like than most women… and that is what one group of researchers found.

Using a 50 item, Likert scored, instrument called the Autism Spectrum Quotient (AQ), Jones, et Al., found that FTM transmen as a group, scored 23.2, higher than control women AND men!  This puts about half of the FTM onto the high functioning autism spectrum!!   (The lower AQ cut-off for ASD is 23.)  Non-exclusively-androphilic transwomen scored essentially the same as the control men, while exclusively androphilic transwomen scored essentially the same as the control women, and definitely (statistically significant: p<0.03 ) below both the control men and non-androphilic transwomen.

Group:               Men                  Women       FTM                 Non-Androphilic           Androphilic
.                                                                                                     MTF  N=129                   MTF N=69

Score (SD):       17.8 (6.8)        15.4 (5.7)     23.2 (9.1)        17.4 (7.4)                         15.0 (5.6)

The implication is clear, FTM’s are masculine, perhaps even hypermasculine, while the data also supports the Freund/Blanchard two type taxonomy for MTF transwomen.  In the discussion section of the paper, the authors remarked,

“Interestingly, with the 198 transwomen group, there were 6 individuals (i.e. 3%) with a diagnosis of AS. This rate is about 3 times as many as in the general population.”

These authors didn’t state what the sexuality of the six AS individuals were; but if they conform to the greater likelihood that they were non-androphilic, found in other papers, the incidence rate for such non-androphilic transwomen would be closer to five times the rate found in the general population, however, that is only about twice as high as that found in the male population.

References:

Jones, et Al, “Female-To-Male Transsexual People and Autistic Traits”, J. Autism Dev. Discord. DOI: 10.1007/s10803-011-1227-8

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Autogynephilic vs. Even More Autogynephilic

Posted in Science Criticism by Kay Brown on September 12, 2014

The $64K question about the Freund/Blanchard two type taxonomy is, “Is it, in fact, taxonic?”  That is to say, “Are there in fact two types of MTF transsexuals with each having a different etiology?”  The evidence pointing to it is formidable;  If one is to try to prove this to be incorrect the evidence to counter it would have to be even more formidable and convincing.  A recent paper by Veale attempts and claims to do just that, but fails utterly upon examination, as we shall see.  What she has done is to demonstrate that the difference between exclusively gynephilic and bisexual/pseudo androphilic transsexuals is purely dimensional and not taxonic.

But first, we need to define what is meant by taxonic, and what is not taxonic.  As Gangestad explains it,

“Meehl defined a taxon as “a nonarbitrary class whose existence is conjectured as an empirical question, not a mere semantic convenience”. A domain containing taxa is taxonic. Examples include biological sex, biological species, some disease entities (e.g., measles), and some ideological systems in politics or religion (Meehl, 1992). Many taxa are characterized by their causal simplicity. Taxonic domains are more likely than dimensional ones to have specific etiologies, including dichotomous necessary causal factors. For example, infectious diseases are taxa, and their causes consist of specific microbes. (More complex causal processes, such as thresholds and polarization effects, “may also underlie taxa” .) The existence of taxa can be supported either by the demonstration of requisite causal processes or by formal mathematical taxometric methods, which decide whether latent taxa underlie a set of candidate indicators of a conjectured taxon based on numerical relations between them. If so, the formal-numerical taxa that are thereby defined are empirical. Their causal basis must be discovered through additional research, and, thereby, taxometric findings can guide future inquiry into the causes of variation in the domain.”

Turning to the Freund/Blanchard taxonomy, as Veale explains it,

“Blanchard (1989) proposed that there are two distinct types (taxa) of male-to-female (MF) transsexuals and these distinctions are characterized by their sexuality: ‘‘autogynephilic’’ or ‘‘homosexual.’’ According to Blanchard, autogynephilic MF transsexuals are sexually attracted to females (gynephilic), both sexes (bisexual), or neither sex (analloerotic); they are not unusually feminine in childhood; and prior to transitioning often live outwardly successful lives as males, frequently marrying and having children. These MF transsexuals also experience autogynephilia—a term which Blanchard used to refer to ‘‘a male’s propensity to be sexually aroused by the thought of himself as a female’’. Homosexual MF transsexuals are exclusively sexually attracted to males (androphilic), do not experience autogynephilia, are highly feminine in their childhood, do not generally have success with attempts to live in the male role, and tend to present for treatment of their gender dysphoria at a younger age. By splitting MF transsexuals into these two groups based on their sexual orientation, Blanchard 1988,1989) and others (Freund, Steiner, & Chan,1982; Johnson &Hunt, 1990; Nuttbrock et al., 2011a; Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005) have found evidence for the average differences between these groups that Blanchard proposed. However, these differences do not necessarily imply a typology exists. These results could also have been reached if there was a nontaxonic latent structure with a correlation between the sexual orientation ofMF transsexuals and these other differences. Although Blanchard (1985a) found some evidence for a taxonic latent structure of the sexuality of MF transsexuals by obtaining cut-off scores for classifying MF transsexuals into two groups using an earlier version of the taxometric procedures described in this article, he did not specifically test whether the sexuality of MF transsexuals was taxonic or dimensional.”

Veale acknowledges that there are other data that suggest, strongly I would argue, that there are clearly two taxa within the MTF transsexual population.  (See FAQ for list of data supporting the two type taxonic structure in MTF transwomen.  Also see my blog category “Supporting the Two Type Taxonomy” for essays.)  She only directly lists the fraternal birth order effect, which exclusive androphilic transsexuals share with conventional gay men, but NOT autogynephilc transsexuals.  This is important, in that Gangestad demonstrated that sexual orientation roughly correlated with a latent taxa in the general population.  Thus, there IS a taxonic structure to be considered here… and if so, we need to ask what would a non-taxonic structure among the transsexual population look like?

What is not acknowledged in Veale’s paper, but should be, is that clinical experience shows that autogynephilia also exists in male individuals who do not exhibit gender dysphoria sufficient to motivate them to transition.  We call these men, “Cross-Dressers” (CD) or “transvestites” (TV).  From long clinical observation, it has been noted that there does not appear to be a sharp line between such autogynephilic individuals, that indeed most autogynephilic transsexuals had careers that exactly match those of CD/TV men before transition.  That is also to say, that there appears to be a smooth, dimensional (non-taxonic) spectrum from mildly autogynephilic men to autogynephilic transwomen.  Also from societal and clinical observation, we note that exclusively androphilic transwomen population appears to smoothly blend toward feminine gay male “drag queens” to “effeminate” gay men, with no obvious gaps in the populations.  That is also to say, that there appears to be a smooth, dimensional (non-taxonic) spectrum from mildly feminine gay men to exclusively androphilic transwomen.  If Veale is right, than that would imply that heterosexual cross-dressers are members of the same taxon as feminine gay men.  Although I don’t believe this to be correct, it has a certain superficial theoretical appeal in that cross-dressers and autogynephilic transwomen both claim that their behavior is related to a ‘feminine essence’.  Hypothesis were meant to be tested.  I will come back to this after further examination of Veale’s study below.

In order to test whether Blanchard’s hypothesis is correct, she used statistical procedures proposed by Meehl; MAXCOV and MAMBAC.  I’m not going to even try to explain how these work.  But there are a few points to using these techniques that should be noted as they will figure prominently in the reasons why Veale failed to demonstrate that Blanchard’s hypothesis is incorrect.  First, the bare minimum number of subjects in the study needs to be 300.  The second is that the minimum number of subjects in the smaller of the two suspected taxons must be at least 30, and that the measures used to differentiate the suspected taxons must be valid.  Veale collected the needed 300 transwomen, but she failed to reach the needed minimum of 30 exclusive androphilic transswomen; worse, she failed to differentiate between bisexual/psuedo-androphilic and exclusely androphilic transwomen, using an invalid measure, as Lawrence showed in her critique of the Veale study,

In this commentary on Veale’s article, which incorporates a reanalysis of some of her data, I will argue that her critique of Blanchard’s typology was invalid, because:
1. Veale’s measures of sexual orientation and autogynephilia were not well constructed, which probably interfered with the accurate identification of participants’ sexual orientations and artificially lowered estimates of their autogynephilic arousal.
2. In her taxometric analysis,Veale employed several measures that were unrelated to the defining features of Blanchard’s typology. This rendered her analysis invalid as a confirmation or disconfirmation of Blanchard’s typology: Whatever typology Veale was examining, it was not Blanchard’s typology.
3. Even if Veale had used well-constructed measures of sexual orientation and autogynephilia and had conducted her taxometric analysis utilizing the defining features of Blanchard’s typology, the number of genuinely androphilic participants she was able to recruit—probably 18 (5.8 %) at most, and possibly even fewer—was too small to be reliably detectable through taxometric analysis. If the structure of Veale’s data appears to be dimensional rather than taxonic, this is because her participants consisted almost exclusively of only one of the two MtF transsexual types: nonhomosexuals (or nonandrophiles).

I’m far less concerned about the construction of Veale’s novel measures of autogynephilia, as almost any measures that meet the minimum required correlations with Blanchard’s Core Autogynephilic Scale would do for a taxonometric analysis.  But the real deal killer to her study was that she incorrectly included so many clearly non-exclusively androphilic transwomen in the “exclusively androphilic” category.  How do we know this?  My suspicions were first raised by the low effect size regarding core autogynephilia and sexual orientation.  From Veale:

Sexual Orientation:   Androphilic               Nonandrophilic
.                                         (n=36)                           (n=272)
Core                                 Value (SD)
autogynephilia          14.08 (14.66)              19.00  (12.21)

The values are nearly the same, especially considering the very large range of scores (standard deviation).  These score differences strike me as being very much like the differences in reported autogynephilia found between exclusive gynephiles and bisexuals and asexuals in previous studies, rather than the larger differences between non-androphilies and androphiles.  If a large number of the putative androphiles were in fact bisexual and asexual, I would expect the scores to look exactly like this.  Lawrence also suspected this to be the case as she corresponded with Veale to obtain the raw data used to classify the subjects into sexual orientation categories.  From this, she demonstrated that at least half (and likely more) of the 36 putatively ‘androphilic’ subjects were decidedly bisexual instead,

“I have reorganized these supposedly androphilic informants into three groups, based on their self-reported gynephilia before age 16 (‘‘degree to which, until the age of 16, you felt sexually attracted to females’’; Veale, 2005, p. 129) and within each of these groups, based on their self-reported androphilia before age 16 (‘‘degree to which, until the age of 16, you felt sexually attracted to males’’; Veale, 2005, p. 129). My reasoning is that some of Veale’s purported androphiles were probably actually pseudo-androphiles or bisexuals—that is, their fundamental sexual attraction was towards females, but at some point they developed a secondary sexual interest in males as a consequence of their autogynephilic sexuality—and that the easiest way to detect these persons would be to look for informants who reported moderate or greater levels of gynephilia or very low levels of androphilia or both during adolescence.

First, consider the 12 informants with Reference numbers 1–12 in Table 1: All reported sexual attraction to females at least ‘‘occasionally’’ before age 16, even though their total Androphilia scores were high and their total Gynephilia scores were low. Not surprisingly, however, their mean Core Autogynephilia score—24.0—was also high, compared to a mean of only 19.0 in the 272 informants whom Veale categorized as nonandrophilic. Moreover, the mean Autogynephilic Interpersonal Fantasy score of these 12 informants—10.9—was also high, compared to a mean of only 8.2 in Veale’s 272 nominally nonandrophilic informants. Based on their early history of gynephilia and their high mean Core Autogynephilia and Autogynephilic Interpersonal Fantasy scores, I believe there is good reason to conclude that these 12 informants were actually pseudo-androphilic or bisexual, rather than genuinely androphilic as Veale alleged.

Next, consider the six informants with Reference numbers 13–16 and 24–25 in Table 1. Although these informants reported little sexual attraction to females before age 16, they also reported ‘‘rarely’’ or ‘‘never’’ experiencing sexual attraction to males before age 16; this suggests that they developed significant sexual attraction to males rather late in life. The mean total Androphilia score of these six informants—11.8—was also somewhat lower than that of the rest of the nominally androphilic group that reported little gynephilia (Reference numbers 17–23 and 26–36; n=18), with a mean total Androphilia score of 16.4. Again not surprisingly, the mean Core Autogynephilia score of these 6 informants was 18.3, nearly equal to that of the 272 nominally nonandrophilic informants, 19.0, and substantially higher than that of the rest of the nominally androphilic group that reported little gynephilia (n=18), 6.1. However, the mean Autogynephilic Interpersonal Fantasy score of these six informants, 6.5, was similar to that of the rest of the nominally androphilic group that reported little gynephilia (n=18), 6.9. Although the case here is not quite as strong as for the 12 informants who reported significant gynephilia before age 16, I believe that most or all of these 6 informants who rarely or never experienced sexual attraction to males before age 16 were also pseudo-androphilic or bisexual, rather than genuinely androphilic as Veale alleged.

There are also a few other specific supposed androphiles whose androphilia seems questionable. For example, consider the informant with Reference number 30,whose total Gynephilia score of 8 reflected her being aroused by females in her current sexual fantasies ‘‘almost all the time,’’ currently feeling sexually attracted to females ‘‘occasionally,’’ and having been conscious of sexual arousal to females while in physical contact with them ‘‘occasionally’’: Given her Core Autogynephilia score of 37 and Autogynephilic Interpersonal Fantasy score of 13, one might suspect that she was actually pseudo-androphilic or bisexual. Or consider the informants with Reference numbers 18 and 26, whose total Androphilia scores of 9 both reflected the identical pattern of only ‘‘occasional’’ attraction to males before age 16 and currently, sexual arousal to males in their current sexual fantasies only ‘‘sometimes,’’ and having been conscious of sexual arousal to males while in physical contact with them only ‘‘occasionally’’ : Here one might suspect mild pseudo-androphilic or bisexual ideation in fundamentally analloerotic individuals.”

From this analysis, Lawrence contents (and I whole heartedly concur) that 18 of these individuals were not exclusive androphiles, and three more were very likely not.  Personally, I would say that these additional three are definitely not.   Given that this would leave, at best, only 18, and likely less, androphilic individuals, the number is definitely too low to be detected as a taxon using the techniques in Veale’s study.  Further, given that most of the putatively androphilic individuals were in fact non-androphilic, Veale’s study does successfully demonstrate that the various non-androphilic categories are dimentional and non-taxonic, supporting Blanchard’s hypothesis.

Lawrence pointed out that Veale’s method of obtaining her subjects was prone to ascertainment bias.  Simply put, one does not find androphilic transwomen at autogynephilically dominated venues such as online forums and support groups.  Veale herself recommended that a “more representitive” sample would be needed for future studies.

Suggestions for future studies.

Hypothesis were meant to be tested.

Lawrence has criticized Veale’s use of her novel “attraction to feminine males” and to “attraction to transgender fiction” scales.  Veale has previously shown an interest in developing these as a means of exploring autogynephilic sexuality, as the former is based on the observation that many autogynephiles are gynandromorphophilic and that many autogynephiles like to write and share autogynephilically inspired erotica.  While I think these are worthy areas to explore, I have to concur with Lawrence that these are not the appropriate scales to use for future taxonometric analysis tests in MTF transwomen.  Instead I would highly recommend using Blanchard’s Autogynephilia Scale and the Childhood Gender Non-conformity (CGN) Scale from Gangestad, as I believe that these will show that the Freund/Blanchard categorization of MTF transsexuals is taxonic with the two types being autogynephilic and “homosexual”.  My prediction is that there will be a very high negative correlation between CA and CGN scales that will show a taxonic structure over sexual orientation.  Sexual orientation should be based on pre-SRS behavior, not on self-report, which has been shown repeatedly, to be unreliable and subject to social desirability bias in autogynephilic transwomen.

For a dichotomous separation of exclusively androphilic and non-androphilic transwomen, I recommend a multi-factorial sieve.  First, if they self report being gynephilic, bisexual, or asexual: believe them, they are non-androphilic.  Next, of the remainder, ask these two questions, “Are you now, or have you ever been, married to a woman?” and “Have you ever fathered a child?”; if yes, then they are non-androphilic.  (Lawrence previously used marital status to exclude bisexuals from androphiles.)  Finally, of the remainder, survey their actual sexual history with these two items, “Estimate how many times you have had sexual intercourse with a woman” and “Estimate how many times you had receptive sexual contact with a man’s penis before SRS (excluding  cross-dressed/feminized males)”.  A validation study may be needed to determine appropriate cut-offs for the first question.  I would be tempted to use “zero” (0), but that may be overly aggressive… but I would be very surprised if genuinely exclusive androphiles had more than a nominal experimental number, say three at most.  The second question supports the first, and also allows discrimination of celibate analloerotic individuals.  I expect that for androphilic transwomen, older than say 2o, the number of sexual contacts with men will be greatly higher than the number of vaginal intercourse experiences.

For a continuous androphilic scale, (moderately) free from social desirability bias, take the number of vaginal intercourse experiences and subtract it from the number of sexual entercouters with men.  This scale will be negative for sexually experienced gynephiles and positive for androphiles.

References:

Gangestad, Steven W.; Bailey, J. Michael; Martin, Nicholas G., “Taxometric analyses of sexual orientation and gender identity”
Journal of Personality and Social Psychology, Vol 78(6), Jun 2000, 1109-1121. doi: 10.1037/0022-3514.78.6.1109

Jaimie F. Veale, “Evidence Against a Typology: A Taxometric Analysis of the Sexuality of Male-to-Female Transsexuals” Archives Sexual Behavior
DOI 10.1007/s10508-014-0275-5

Anne A. Lawrence, “Veale’s (2014) Critique of Blanchard’s Typology Was Invalid” Archive Sexual Behavior
DOI 10.1007/s10508-014-0383-2

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The More Things Change…

Posted in Editorial by Kay Brown on September 7, 2014

…The More They Stay the Same

APA_logoRecently, the Diagnostic & Statistics Manual, usually called by its initials, the DSM, of the American Psychiatric Association, considered by most physicians and even researchers, to be the single most important document on psychiatric conditions, was updated.  The new DSM V has an updated section on transsexual/transgender diagnoses and description.  In several ways, it was both an improvement, and a set back, for transfolk.

First, the improvement and a bit of history.  Decades ago, during the days that in my history class I called, ‘The Clinic Years”, the days when nearly all North American and European transfolk were dependent upon organized clinics for SRS, often associated with universities such as John Hopkins and Stanford, they typically excluded people that they thought fell outside of the “classic transsexual” diagnoses.  If you were a heterosexual MTF, and especially if you admitted to being sexually aroused by cross-dressing, you were not “transsexual” you were simply a “transvestite”, period.  But one clinic dispensed with this restriction, led by Norman Fisk, M.D.  Dr. Fisk coined a new term and a description of a syndrome that he described as “liberalizing” the allowable indications for HRT and SRS, “Gender Dysphoria”.  As Anne Lawrence described it:

“Fisk (1974a, b; Laub & Fisk, 1974) distinguished several types of male patients who sought sex reassignment at the Stanford University gender program. He used the term gender dysphoria syndrome, rather than transsexualism, to refer to these patients’ diagnosis. In Fisk’s typology, the number of recognized typological categories and their exact names varied slightly from one article to another. It appears that persons in only three of Fisk’s typological categories, however, were considered appropriate candidates for SRS in the Stanford program (Laub & Fisk, 1974): classic transsexualism of Benjamin (a reference to Benjamin, 1966), effeminate homosexuality, and transvestism. Only patients in these three categories, for example, were selected for inclusion in a follow-up descriptive study of applicants to the Stanford program (Dixen, Maddever, Van Maasdam, & Edwards, 1984); consequently, only these categories are included in Table 2. Other typological categories described by Fisk included persons with psychosis, extreme sociopathy and psychopathy, and inadequate/schizoid personality (1974b; Laub & Fisk, 1974). Classic MtF transsexualism was characterized by onset in early childhood, life-long feminine behavior, exclusive androphilia, absence of sexual arousal with cross-dressing, and perhaps a disinterest in genital sexuality (Fisk, 1974a; Laub & Fisk, 1974). Effeminate homosexuality progressing to gender dysphoria syndrome was characterized by androphilia, episodic nonerotic cross-dressing, and onset of gender dysphoria in adulthood (Laub & Fisk, 1974). Transvestism progressing to gender dysphoria syndrome was characterized by erotic arousal with cross-dressing, gynephilia, and onset of gender dysphoria in adulthood (Laub & Fisk, 1974).”

Here, I get to share a bit of my personal history, in that I was diagnosed as “transsexual” by Dr. Fisk in early 1975, when I was 17 years old.  So I have cherished memories of having had a grand total of six hours talking to him… but in those six hours, I got a glimpse into the mind that cut through the confusion of the differing types of candidates for sex reassignment and sought to offer such liberalized palliative medicine.  Yet, I can also tell you from those six hours, two of which were in the company of my parents (one hour each, separately, given that they were in the process of an unhappy divorce) that Fisk was a VERY skeptical man.  He dug into my history, sexuality, and aspirations with a vengeance.  I’m betting he did so with everyone.  In fact, the very first half hour spent with him, I got the very distinct impression that he was ready to believe that every word out of my mouth would be a lie.  At the time, I couldn’t understand why that should be, given that at 17, I was very naïve about the state of the on going debate in medical and scientific circles… and especially unknowing of how autogynephilic transwomen were lying to the clinics, including to Dr. Fisk.  I think it was meeting my mother, and hearing her very bitter, angry, and even hateful confirmation of my personal history and behavior since early childhood that led him to believe me.  I share this to put some color on Fisk’s support of liberalizing the diagnoses with a new inclusive term and syndrome.  Dr. Fisk supported HRT and SRS for “older transitioners” not because he believed their narritives, but because he recognized that they were in just as much of a quandary and in pain as the younger androphilic, non-autogynephilic, MTF transkids.  He was a hero.

So, back to the DSM.  Looking at the history of changes in the DSM over the decades, one can detect an undercurrent of the tides, the ebb and flow, between pragmatic science based medicine and political / social positioning.  When trans issues were first described in the DSM, it was “Transsexualism”, from the DSM, as described by Anne Lawrence (personal communication),

“Transsexualism was characterized as a “heterogeneous disorder” (p. 261), and four subtypes were recognized:

“The disorder is subdivided according to the predominant prior sexual history, which is coded in the fifth digit [e.g., 302.53] as 1 = asexual, 2 = homosexual (same anatomic sex), 3 = heterosexual (opposite anatomic sex), and 0 = unspecified.” (p. 262)

This section goes on to explain that “In the third group, ‘heterosexual,’ the individual claims to have had an active heterosexual life.” (p. 262)

In the section “Predisposing Factors (p. 263), the DSM-III recognizes that “Some cases of Transvestism evolve into Transsexualism.” Finally, in the section on “Differential Diagnosis” (p. 263), it is noted that “In both Transvestism and Transsexualism there may be cross-dressing. However, in Transvestism that has not evolved into Transsexualism there is no wish to be rid of one’s own genitals.”

The diagnostic criteria for Transsexualism (pp. 263-264) are admirably brief and uncomplicated:

1. Sense of discomfort and inappropriateness about one’s anatomic sex.

2. Wish to be rid of one’s own genitals and to live as a member of the other sex.

3. The disturbance has been continuous (not limited to periods of stress) for at least two years.

4. Absence of physical intersex or genetic abnormality.

5. Not due to another mental disorder, such as Schizophrenia.”

But later, the DSM changed the name of the disorder to “Gender Identity Disorder” which causes a distortion in therapy for all concerned because it focuses on “identity” on not on the source of their disorder.  It is even more of a distortion of the description of the etiological processes.  This was somewhat improved in the DSM-IV-TR, in that it used sexual orientation specifiers and an explanation of autogynephilia as a phenomena and an etiological origin of late transitioning transwomen’s late developing “gender identity disorder”.

Now, four decades later, the DSM has finally caught up to Dr. Fisk by using the term Gender Dysphoria Disorder.

This is the good news, in that the diagnoses speaks directly to the actual ‘pain’ of the condition, rather than to the totally inaccurate and misleading concept of a Gender Identity Disorder.  It is also good in that the history of the term goes back to Fisk’s papers that specifically describe how it incudes autogynephilic males.  However, the bad news is that the DSM no longer adequately describes autogynephilia and how it is etiologically related to gender dysphoria… and worse, still places too much emphasis on the concept of  gender identity mismatch as the cause of gender dysphoria in autogynephilic transwomen, rather than the result of autogynephilic gender dysphora,  as the science shows.  However, this reliance on “gender identity” is now euphemistically cloaked in the term “experienced / expressed gender”.

There are other problems with it, as Lawrence explains,

“…MtF and FtM transsexuals and the clinicians who treat them have traditionally recognized that a profound sense of ‘‘wrong embodiment’’—distress related to biologic sex and sexed body characteristics—is almost always a prominent feature of transsexualism and GD, in part because such wrong embodiment usually makes it difficult or impossible to ‘‘live and be accepted as a member of the opposite sex’’ (World Health Organization, 1992, p. 365). This “trapped in the wrong body’’ metaphor is not mere poetic rhetoric but offers an authentic description of transsexuals’ subjective experience. … This understanding has been largely, if not quite completely, abandoned in the DSM-5. It has been replaced by an emphasis on ‘‘assigned gender,’’ a change that seems to have occurred entirely for political and social reasons, not for scientific or clinical ones. In the DSM-5, all the clinical indicators of GD—even those that refer to biologic sex characteristics—are now conceptualized as being clinically relevant only by virtue of their evincing an ‘‘incongruence between one’s experienced/expressed gender and assigned gender’’ (APA, 2013, p. 452; the neologism ‘‘experienced/expressed gender’’ is essentially synonymous with ‘‘gender identity’’). In this formulation, the principal thing that feels wrong in transsexualism and GD is not one’s biologic sex but one’s assigned gender. This same perspective is, as we shall see, also reflected in the Subwork group members’ implicit position that effective treatment of transsexualism and GD does not require changing sexed body characteristics but only changing nominal gender assignment, as evidenced by their contention that undergoing gender transition—the only absolute criterion for which is ‘‘full-time living in the desired gender’’ (APA, 2013, p. 453)—automatically results in loss of the GD diagnosis.”

I’m not sure that this was their intent… but taken literally, one’s GD diagnoses, and thus any medical necessity justification for performing, and certainly third-party financing of, sex reassignment surgery or much needed ongoing therapeutic support services, is eliminated the moment that one is socially living as, or perceived as being, the opposite sex!  This is a bizarre result of the latest rewrite, one that Lawrence contends was done at the behest of “late transitioning” transsexuals themselves, in an effort to rid themselves of the stigma of a psychiatric diagnoses… one that is ended the moment that they transition full time.  Hopefully, the next interim revision will correct this mistake.

(Note 9/11/2014:  This essay has been edited to correct an error with respect to the history of the DSM III, thanks Anne.)

References:

Fisk, N. (1974a). Gender dysphoria syndrome: The conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen [Editorial comment]. Western Journal of Medicine, 120, 386–391.

Fisk, N. (1974b). Gender dysphoria syndrome (the how, what, and why of a disease). In D. R Laub & P. Gandy (Eds.), Proceedings of the Second Interdisciplinary Symposium on Gender Dysphoria Syndrome (pp. 7–14). Stanford, CA: Stanford University Press.

Laub, D. R., & Fisk, N. M. (1974). A rehabilitation program for gender dysphoria syndrome by surgical sex change. Plastic and Reconstructive Surgery, 53, 388–403.

Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514-545.

Lawrence, A., “Gender Assignment Dysphoria in the DSM-5″, Archives of Sexual Behavior, DOI 10.1007/s10508-013-0249-z

 

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The Last N!gg3r…

Posted in Editorial by Kay Brown on August 15, 2014

My husband has been trying to get me to write a book by this title for 17 years.  It started when we were dating.  At some point in a courtship, there comes a time when it just seems right to stay at home and enjoy each other’s company, rather than go out.  It was just such a night, our first night simply staying at his house, when he suggested that we watch some television and cuddle together quietly.  I resisted, saying, “I’m sorry, I’d rather not… I just can’t seem to watch a single night of TV and not be exposed to tranny-trashing.”  He thought I was WAY over exaggerating… but sure enough, later that evening, during the cartoon section of Saturday Night Live, a character tells another to “take the right at the corner with the transsexual”… cut to street corner scene where we see a very burly, broad-shouldered, hairy-chested man wearing a merry-widow corset, fish-net stockings, and high heels, provocatively poised, obviously “working” the corner.  I looked at my boyfriend/future husband drolly, “Que, Laugh, Track”.

I’m minded to write this essay because for the past several days, we’ve all be subjected to numerous articles lionizing Robin Williams as a hero to the LGBT communities.  Well, he might have been a hero to the LGB, but not to the T.  All I can remember of him is his tranny-trashing.  But more on that later.

Humor has been used since time immemorial to attack, denigrate, humiliate, and dehumanize minority groups.  We have “Pollack”, Asian, “Blond”, Jewish, “women drivers”, “Fag”, and of course, “N-word” jokes.  In the United States, we have a history of an entire genre of denigrating ‘coloreds’, most especially African-Americans… with stereotypes of lazy, shiftless, clueless, careless, Black men and women.  It can be very instructive to review how ugly, and how “entertaining” for racists, it can be, so here’s a great video compilation of some of it, from the mid-20th Century.

Sometimes, the message is more subtle.  The best example of this the way that all women were denigrated in the film Tootsie.  I still recall with horror my first viewing of the film in the theater, in the company of another transwoman, at the personal invitation from a non-trans* person who thought that we should enjoy the film for its trans* theme.  Not so.  First, its not really about trans* anything.  But it is an example of subtle anti-feminist agit-prop.  The underlying message of the film is that any, random, second-rate man is better than all female people ever could be.  The plot is that a has-been ham dresses en-femme drag to pass as a woman… and very soon thereafter becomes a national sensation as a feminist heroine, a role model for all women to emulate.  The, hit-the-audience-over-the-head, message is that any random man makes a better “woman” than all females.  To add insult to injury, Dustin Hoffman has in recent years portrayed his experience as “Tootsie” as having given him insight into women’s lives, that Tootsie was an enlightening feminist film.  (No Mr. Hoffman, it wasn’t and it didn’t.  Instead, you should be apologizing for your role in the film’s production.)

While they have not truly disappeared, offensive stereotypes, images, and jokes about other groups are at least pointed out, and often removed and/or resulted in apologies in the recent decades.  But not so for such offensive stereotypes, images, and jokes portraying transgender people in a negative, often extremely derogatory, manner.  We are, “The Last N!gg3r”.

Which brings me back to Robin Williams, and the underlying messaging of his tranny-trashing jokes and gags.  While they were no doubt not limited to Mrs. Doubtfire, this is one of his most well known films in which the underlying premise of the film, augmented by very pointed jokes, is that transgendered people of all types are to be belittled and dehumanized.

For example, in Mrs. Doubtfire, he sets up a joke in which he switched the phone # in an ad… so that he was the only one calling his wife about the position of nanny to her children… then called up to pretend to be various undesirable caretakers, including a post-op transwoman… which when “she” revealed this fact, his wife is horrified and hangs up… thus, the message is that transwomen are not to be trusted with children and the audience knows and agrees. Que laugh track.

As a transwoman who, in real life, was just such a nanny as a teenager, who later was a foster-mother to two girls, adoptive mother to one of them… and who continues to have contact with children and teens, I’m deeply offended at this message and the manner in which it was delivered.  I’m also deeply concerned that this very message could be delivered and not immediately repudiated.  And even more deeply concerned that this message, though a scurrilous falsehood, is one that many people actually agree with.

Lest we think this is a one off for Williams, in the very same movie, later on, we see a scene in which “Mrs.” Doubtfire is standing up to urinate when his eldest son accidentally discovers him. His instant reaction is horror and the need to protect himself and his younger siblings from this male bodied transgendered person. The gag depends on the audience knowing who Mrs. Doubtfire really is and that it is OK for him to be doing this… after all, he’s not really transgendered, but it wouldn’t be OK for a REAL transgendered person to be working as a nanny.

But Williams (and the film’s writers, producers, actors, etc.) aren’t done educating us on the dangers of transgender people being around children.

In yet another scene, we see our putative hero having to hide the fact that he is dressing as a woman from the social worker coming over to check him out.  While it could be argued that that had he been discovered, it would blow his cover as Mrs. Doubtfire, the real subtext is that it is not OK for a parent to be transgendered in any way;  That the social worker would have, rightly, recommended against him as a parent of his own children.  Nowhere in the film was there a parenthetical comment that this discrimination against transgender natural parents is wrong or unacceptable.  In fact, given the above scenes (and others in the film) the subtext is clear:

The entire premise of Mrs. Doubtfire is that transgender people are not to be trusted with children, neither their own, nor others.  This underlying message is not funny, but is dangerous.  This false stereotype has caused many late transitioning transfolk to lose parental rights, visitation rights, etc.  It is unknown how many transkids have lost opportunities to be foster-parents or adopt.

I’m saddened by Mr. William’s untimely death.  No one should have to turn to suicide and I’m sorry to see such talent lost… But more because I will never get to hear that apology he owes to me, and others, as a transwoman who cares deeply about children.  Perhaps we can get one from Harvey Fierstein, who should have known better?

 

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One Size Fits All…

Posted in Editorial by Kay Brown on July 9, 2014

“One Size Fits All”… and other lies… Or  “Why it matters”

Beyond mere scientific curiosity, there are other compelling reasons why we need to recognize the two types of transsexuals as distinct and having separate etiologies and life arcs.  Research on appropriate treatment protocols is confounded when we don’t segregate them.  Treatment itself is less effective and potentially counter productive when using the wrong protocol, or when using a ‘one-size-fits-all’, middle of the road protocol.  Finally, we dishonor who we truly are when we don’t recognize the differences.

Consider that our present protocols for treating gender dysphoric teenagers is a muddled attempt to reconcile the experiences of autogynephilic (AGP) MTF adults and transkids, both FtM and the minority MTF feminine androphilic.  If MTF “late transitioners” did not exist at all, would we be as concerned about attempting to delay puberty as a reversible treatment, given that transkid teenagers rarely have regrets or negative outcomes when given full HRT instead?  But we do have AGP teens for whom transition and HRT are not warranted, who go on to live very satisfactory lives as heterosexual cross-dressers.  If we fully recognized and diagnosed the two populations separately as teens and young adults, we would have very different treatment protocols.

Consider also, that our present protocols for adults have a requirement that a candidate for sex reassignment surgery have been living full time as their new sex before surgery, as though that fact somehow guaranteed that post-operative regret would not occur… or that surgery is simply providing genitals that match the social gender in which the client is living.  Neither is the case!  Sex reassignment surgery may, in fact I would strongly argue, is not contra-indicated by still living as one’s birth gender.  If we didn’t have the example of transkids for whom living in their new gender and sex reassignment surgery are intimately linked, would we have this requirement?

It’s possible that without the existence and example of feminine androphilic MTF transkids, whom many AGP transwomen attempt to emulate closely, Western Society might not have developed and accepted the medical category “transsexual”.  But now that we have decades of data that show that AGP transwomen are the majority, and that that majority does find improvement (at least palliatively in most cases), should we not review the assumptions that were made in the early years that only “true” transsexuals, those who needed to both live full time and rid themselves of their unused genitalia, are the only ones who would benefit from HRT and sex reassignment surgery?

Might the original purpose of the “real life test” have been not simply to reduce post-operative regret, but was (wrongly it turned out) a means of weeding out “transvestites” (autogynephiles) who were thought to not be able to pass such tests?

I would argue strongly that there is absolutely no association with living full time and lack of post-op regret.  Further, I would argue that for many AGP individuals, the “real life test” requirement is needlessly socially and professionally destructive.  How many AGP individuals would have benefited from HRT and/or sex reassignment surgery to rid themselves of the anatomic-autogynephilically induced gender dysphoria without having needed to live as women full time?  How many of them would have found a life of integration far better?  A life of the “bi-gender” individual, one who is professionally and socially a man during the weekday, but socially and sexually a woman during the evenings and weekends?  Our present protocols discount these people.  They must make a choice between no surgery, or up-ending their professional and social lives.  How many individuals have been falsely declared to have been treatment failures because after SRS, they “de-transitioned”, having obtained their true objective and now free to live their lives without the so called “Standards of Care” dictating their lives?

In therapy, the two types have very different needs.  First, most transkids do not need therapy.  But our Standards of Care (at least as practiced, if not as written) require that one have been evaluated by a therapist or psychiatrist before any medical interventions.  Why should a feminine androphilic transkid be treated differently than any other young woman?  Why should she need to get “permission” before having breast implants and not a natal female?  Could it be because she is conflated with autogynephiles for whom many practitioners are concerned may regret such interventions?  What of FtMs?  Many natal females have breast reduction surgery, but aren’t required to obtain letters from therapists before hand.  I argue that our protocols for transgendered people have been developed with experience of autogynephilic MTFs, for whom such evaluations and therapies are recommended.

Autogynephiles suffer from severe shame and guilt.  Many cross-dressers report a cycle of purging, throwing away their feminine wardrobes in self-loathing.  Many autogynephilic transwomen have had similar histories, but rarely discuss this or other autogynphilic experiences with their therapists, rightly or wrongly, assuming that the therapist is wearing their “gate-keeper” hat and might not “OK” them for HRT or SRS if that were known.  Because both the AGP transsexual community and their therapists fail to face head on the issue of autogynephilia, this shame and guilt remains untreated.  Instead, the client is left with secret denial or other defenses.  Because she has not faced her own autogynephilia, she may stigmatize others who are processing their autogynephilic experiences, shutting down group therapy discussions on the matter and even attacking other transwomen in public forums, harming the transgendered community at large.  Worse, for the individual, is that the shame, guilt, and denial are lurking in her psyche, waiting for some dark moment to come crashing to the fore, when her defenses fail, and the reality of her autogynephilic sexuality come crashing upon her.  The result may be catastrophic, perhaps even fatal.

The suicide rate among transgendered people is well known to be high.  Medical intervention is intended to alleviate suffering; but because the two types are not fully differentiated and because autogynephilia is not openly acknowledged, AGP transsexuals remain at risk for mental heath problems, especially depression and anxiety.

The two types should never be grouped together for therapy.  The two types have completely different goals and concerns.  Further, there is a very unfortunate tendency for AGP transwomen to attempt to model themselves upon transkids, to the point where they edit and even confabulate histories to match those of transkids, interfering with the therapeutic process.  Conversely, transkids are very often uncomfortable around autogynephiles, leading them to emotionally, and even physically, to withdraw from the group.  Comparing themselves and their experiences to the other type is also very damaging to their self-images, for differing reasons for each type.

Would HRT protocols be different if the types were not conflated?  Consider MPA, a synthetic progestin.  It is well known to sharply reduce libido.  Many AGP transwomen find their autogynephilic arousal intrusive and unwelcome.  For them, MPA may be a welcome addition to estradiol… or even alone.  But for feminine androphilic MTF transkids, reduction in libido is never desired.  For them, micronized progesterone is a better addition to estradiol.

Would protocols be different for the two regarding fertility?  Many AGP transwomen are already natural parents, having sired children with their wives or girlfriends.  But what of the young AGP transwomen who have not yet sired children?  Would they not benefit from banking their sperm before beginning HRT?  Would the same be right for MTF transkids?  I would argue not.  First, it would mean that they would have to wait for spermatogenesis, which would also mean damaging exposure to endogenous testosterone.  Better to begin HRT without ever being able to generate sperm.  Further, for the slightly older (post-pubertal) transitioning transkid, consider the psychological implications for her future husband… surely if they elect to pursue surrogacy, it should be his sperm, not hers?

For these, and yet other practical reasons, it matters that the two types be officially, scientifically, medically, and socially recognized as distinct.

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I Know What Boys Like…

Posted in Transsexual Theory by Kay Brown on June 29, 2014

♫♫I know what guys want…
They want to touch me,
But I won’t let them.♫♫
-The Waitresses

A while back, I explored one of the very few studies that tested Stoller’s observation that “true” MTF transsexuals, which we now recognize as exclusively androphilic MTF transkids, are “avoidant”.  That is, that though they have intimate relations with their boyfriends before SRS, they refuse to use or allow contact with their pre-operative genitalia.  Stoller (and others) held that non-exclusive androphilic women would not be “avoidant”, but would find pleasure in the use of their male genitals prior to SRS.  Now a new study explores this behavior.  But sadly, since it comes out of Europe, where they believe that age of onset of gender dysphoria, early or late, is the most important typology, the study failed to explicitly report avoidant behavior by sexual orientation.  However, I hypothesize that Stoller is correct, and that even though we don’t have explicit data in this new study, we will see a direct correlation with the percentage of exclusively androphilic transwomen in the two onset age categories and avoidant behavior.  Data is reported in the number of transwomen for each category except for that reported as percentage:

Sexual Orientation vs. Age of Onset
Onset                                                 Early         Late
Androphilic      N=                             54               20
Non-exclusively Androphilic         53               78
Percentage Androphilic:                51%            20%

Avoidant vs. Age of Onset
Onset                                                Early           Late
Avoidant           N=                            38                15
Pleasure                                             34                47
Percentage Avoidant:                     53%             24%

Note the essentially identical percentages of exclusively androphilic transwomen in each onset category and the percentages of avoidant behavior?  Thus the data supports the hypothesis perfectly.  This of course is not definitive, since we would really like to have seen the direct comparason, but if the numbers had been wildly different between them, it would have supported the null hypothesis.  The null hypothesis still cannot be ruled out… but seriously?  Seriously?

It has been my personal observation, from talking to MTFs, during my entire lifetime, that “avoidant” behavior is near universal in transkids, but very rare in “late transitioning” transwomen.  Such late transitioning transwomen have very often been sexually active with women, married to women, and have had children.  Obviously, the easiest way to have sired children is to have had vaginal intercourse (penile penetration).

Reference:

S. Cerwenka, et al., “Sexual Behavior of Gender Dysphoric Individuals Before Gender-Confirming Interventions: A European Multicenter Study” (2014)

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Researching Parental Experiences of Transkids

Posted in Editorial by Kay Brown on April 4, 2014

Here is an opportunity for the parents of transkids to give feedback to a researcher looking into their experiences,

“Researchers at Case Western Reserve University are currently conducting an online study of the experiences of families of gender variant, transgender, or otherwise non-cisgender kids ages 10-17. The study involves completing questionnaires online about your experiences with the process of your child disclosing their gender identity to you and/or the process of your child’s transition, as well as questions regarding your emotions, attitudes, and preferences for potential psychotherapy interventions for families of gender variant children. Your child will also complete several brief questionnaires about their emotions and experiences with disclosing their gender identity. To participate, you must be the parent or primary caregiver of a child or teen ages 10-17 who identifies as gender variant, transgender, or otherwise non-cisgender and you yourself must be at least 18 years of age. You will have the option of including your contact information in order to receive a $10 gift card, although providing your contact information is not necessary to participate in the study. The information gathered from this study may help us to better understand the needs of families of gender variant children and ultimately help us to design therapies to help families better cope with the changes associated with their child’s transition.”

Please participate if you qualify, as we need as many voices and as broad range of experiences as possible:

http://psychology.case.edu/research/fear_lab/lgbtq_participation.html
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