On the Science of Changing Sex

Triumph for Whom?

Posted in Editorial by Kay Brown on March 1, 2015

CloudyIn a recent popular magazine article, intellectual essayist, Charlotte Allen wrote an extensive and deep exposition on the events of the past 15 years of the increase in visibility of the Transgender community.  Encouragingly, it was unflinching in its exploration of not only the pop-psychology, but also the REAL psychology and politics.  Of neccessity, this also means that she explained about the two type taxonomy, Blanchard’s role in researching it, Bailey’s role in popularizing it… and of the disgraceful behavior of the autogynephilic transwomen who attempted to shout down those who, in their research, came to support the scientific recognition that “late transitioning” transwomen are on the same continuum as transvestites / cross-dressers.  Ms. Allen writes,

“Blanchard’s theory is that transgenders fall into two distinct categories whose sexual orientations, interests, choice of careers, and even, to a large extent, social class are violently different from each other. One of those categories he calls “homosexual” transgenders, whose sexual attraction, from childhood to death, is strictly toward members of their own genetic sex. Among males, they’re the extremely effeminate boys who identify as girls in early childhood, play with dolls and other girls’ toys, and shun the rough-and-tumble play typical of boys their age. Studies at Vanderbilt and the University of London have shown that 70 to 80 percent of those trans-children grow out of their trans-identity at puberty and become, simply, gay adolescents and, later, gay adult men. The 20 to 30 percent who do take formal steps toward transitioning, Blanchard believes, are a self-selected group who, thanks to their more delicate looks, can function fairly successfully as women. “They’re people who might be unsuccessful as men,” Blanchard said.  —  Homosexual transgender men transition early in adulthood, typically during their twenties, Blanchard observed. They account for the vast majority of transgenders in the non-Western world: from the “two-spirits” of indigenous North American tribes, to the fa’afafine of Samoa, to the kathoeys of Thailand who can easily fool Western sex tourists into misidentifying them as women. In those societies there is typically a recognized and thoroughly integrated social niche for men who identify and dress as women. The fa’afafine typically work as secretaries, nannies, and housekeepers​—​stereotypically female occupations. In that respect, they’re not unlike the flamboyant gay men of Western culture who carved out a recognized social niche for themselves in such occupations as hairdresser, dancer, makeup artist, interior decorator, couturier, and fashion consultant (Queer Eye for the Straight Guy). Boys and men in drag played women’s roles on stage from classical times to the 17th century, and they continue to be popular entertainers for both gays and heterosexuals to this day, as the demographics of the Kit Kat Lounge attest.  — By contrast, Blanchard discovered that the predominant form that trangenderism takes in the West today involves men who, as men, have never identified as homosexual in their erotic attractions, but rather as heterosexual, bisexual, or asexual. Those men, his research revealed, tended to make their transitions in their mid-to-late thirties, or even later​—​at least a full decade on average after the homosexual transgenders did. Furthermore, many of those men were married and fathers before they came out. The paradigm might be travel writer Jan Morris, now 88, who spent the first 46 years of her life as James Morris, the journalist who covered Edmund Hillary’s ascent of Mt. Everest and who fathered five children before undergoing transition surgery in 1972. And many in this heterosexual population​—​in contrast to the homosexual transgenders on the drag scene​—​worked in stereotypically hypermasculine professions: They’d been parachutists, Navy SEALs, engineers, policemen, firemen, and high school football coaches. The billionaire philanthropist James Pritzker, who became Jennifer Natalya Pritzker in 2013, in his early sixties, is a retired much-decorated U.S. Army lieutenant colonel with three children by his former wife. “They’ll say that they chose those professions in order to suppress their feelings as females,” Blanchard said. “But no one put a gun to their heads to choose those jobs.” Many late-transitioning transgenders (Jennifer Finney Boylan, for example) insist, contra Blanchard, that they were aware from early childhood that they were born into the wrong body—​but Blanchard thinks they aren’t being honest with themselves.”

Ms. Allen then goes on to explain how certain members of the autogynephilic tranwomen’s community took umbridge with Bailey’s attempt at popularizing Blanchard’s work,

The Man Who Would Be Queen inflamed transgender activists. It did have certain inflammatory aspects. There was the jacket photo of the man in high heels. Blanchard’s coinage “autogynephilia” (extensively used by Bailey in the book), with its connotations of fetishism, deviance, and mental disorder, has never sat well with transgenders. Bailey was even more adamant than Blanchard that autogynephilic transgenders often lied about their erotic fascination with cross-dressing. Furthermore, Bailey observed, drawing on his previous studies, that homosexual transgenders tended to come from lower socioeconomic classes than autogynephiles, and that they tended to have short time-horizons that often led them into streetwalking, shoplifting, and other petty crimes. “Prostitution is the single most common occupation,” Bailey wrote. His book also, perhaps inadvertently, included details about “Cher” that made her real identity quickly discoverable to those in the know: Anjelica Kieltyka, a Chicago transgender woman who, although disagreeing with Bailey about his characterization of her as autogynephilic, had made frequent guest appearances in his classes and had introduced him to other figures in the city’s transgender scene.  —  Bailey’s book caught the immediate​—​and hostile—​attention of Lynn Conway, now 77, a pioneer of computer-chip design during the 1970s, a longtime engineering professor at the University of Michigan, and a leading transgender activist who figured as one of Time’s “21 Transgender People Who Influenced American Culture” in its May 2014 cover story. Conway was close to Andrea James (both had been patients of Dr. Ousterhout and touted his facial-feminization techniques on their websites). James, best-known for counseling Felicity Huffman, the star of the film Transamerica (2005), on transgender voice and mannerisms, underwent transition surgery in 1996. She and Conway teamed up with Kieltyka, and with Deirdre McCloskey, to make sure that The Man Who Would Be Queen would not receive a respectable academic hearing. McCloskey’s participation in this enterprise seems odd. For one thing, her memoir, Crossing, describes her pre-transition self as having been “sexually aroused” as a young man by accounts of cross-dressing​—​a classic Blanchard-esque theme.”

She also notes that the science does not support the contention that “late transitioners” have female brains,

“The medical evidence for a mismatch between brains and bodies is ambiguous. The two studies cited most frequently by transgender activists, published in 1995 and 2000, examined the brains of a total of seven male-to-female transgenders and found that a region of the hypothalamus, an almond-shaped area of the brain that controls the release of hormones by the pituitary gland, was female-typical in those brains. But those studies have been criticized for not controlling for the estrogen​—​which affects the size of the hypothalamus​—​that most male-to-female transgenders take daily in order to maintain their feminine appearance.”

If I had any serious criticism of her essay, it would be in the way that she hews to the stereotype that transkids, “homosexual transsexuals”, are stereotyped as being prone to becoming petty criminals, prostitutes, and drag performers.  I also found her take on the recent improvments in medicine and law regarding the treament of transchildren and teens to be unsympathetic.  She gives one the impression that too many gender variant pre-teens are being pushed into iatrogenic trauma via puberty blockers, etc.  While it may be true that autogynephiles may overvalue transition, most transkids and our caregivers are careful not to push children who are more likely to become gay and lesbian adults into wrong paths.

It may be uncomfortable reading, but I highly recommend that you do.

Reference:

http://m.weeklystandard.com/articles/transgender-triumph_859614.html?page=3

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Gender Allusions

Posted in Brain Sex, Science Criticism by Kay Brown on February 24, 2015

critical-thinkingIs “Gender Identity” biological?  For most people, the answer is intuitively obvious, “duh!”.  Of course, for these people, they usually also insist that the markers for such identity is some privileged and testable characteristic, like genitalia, which is easy to observe, or karyotype (sex chromosome configuration) which requires a microscope.  But for people with Disorders of Sexual Development (DSD), these markers may not be all that clear.  Further, what are we to make of the gender identities of transsexual and transgendered people, people whose experienced / stated gender identity is at odds with all currently known sex markers?  IS there a biological etiology?  And is that etiology the same as that that gives rise to the gender identity of non-trans people? A recent review article attempts to answer these very questions.  Sadly, I believe that it falls far short of a conclusive answer.  In fact, as I will show, it invokes conclusions from several papers as evidence that are quite questionable.  Further, the authors failed to note the very probable multiple etiologies for Gender Dysphoria and their associated gender identity resolutions suggested by the Freund/Blanchard two type taxonomy of MTF transsexuality. First, they reviewed evidence for a biological basis for the phenomenological existence of “gender identity” in non-transfolk which comes from those with certain DSDs,

A seminal study by Meyer-Bahlburg et al involving outcomes of XY individuals raised as females due to severe non-hormonal, anatomic abnormalities of sex development has provided the most convincing evidence that gender identity is fixed. These congenital abnormalities include penile agenesis, cloacal exstrophy, and penile ablation. For many years, female gender assignment along with surgical feminization was the dominant approach for these patients. In this study, it was observed that 78% of all female-assigned 46 XY patients were living as females. While the majority of these patients did not initiate a gender change to male, none of the 15 male raised 46 XY patients initiated a gender change to female. Thus, risk of questioning gender identity was higher in those patients raised as females than in those raised as males among 46 XY subjects with one of these conditions. A study by the same group that examined the degree of satisfaction with surgical intervention reported by patients with 46 XY genotype also found that those subjects raised as boys were considerably more comfortable with their gender identity. – Another seminal study relevant to this topic was by Reiner and Gearhart in their review of 16 XY genotype subjects with cloacal exstrophy who underwent female gender reassignment surgery. Out of the 14 individuals raised as girls, 4 announced they were male and 4 later chose to live as boys when they became aware of their genotype. The 2 individuals who were raised as males identified as males throughout life. The sexual behavior and attitudes of all 16 subjects ultimately reflected strong masculine characteristics regardless of gender assignment. Thus, children who were born genetically and hormonally male identified as males despite being raised as females and undergoing feminizing genitoplasty at birth. Although cohort size in these studies is small, these data provide the strongest evidence for biological underpinnings of gender identity.  …  In a study of affected subjects, gender role changes were reported in 56-63% of cases with 5 alpha-reductase-2 and 39-64% of cases with 17-beta-hydroxy-steroid dehydrogenase-3 who were raised as girls (6). These data support the concept that gender identity might be attributed to hormone milieu during intrauterine development on some occasions.

These studies are indeed very strong evidence.  Looking at the data, we see that of those raised as girls, 22% of of these subjects in the first study and 57% in the second study, while in the third study, those with hormonal abnormalities, 56-63%, chose to socially transition from female-to-male.  Compare that to the very, very small number of 46XX individuals in the general population who experience severe gender dysphoria and choose to transition.  As an aside, the fact that not all chose to transition should not be taken as proof that gender identity is all that malleable, but should probably be taken as a demonstration that social transition has very high social costs and is not undertaken lightly. Strangely, this paper did not explicitly mention that the majority of these individuals, whether they experienced gender dysphoria or not, were exclusively gynephilic, but they did allude to it.  Also puzzling was their failure to include the converse situation of individuals with 46XY and complete androgen insensitivity syndrome (CAIS), all raised as female, who are extremely unlikely to experience gender dysphoria or sex reassignment, and are universally exclusively androphilic.  Or the even more interesting case of 46XX progestin influenced females raised as male, 50% of whom transitioned from male to female and all are exclusively androphilic.

Thus, they failed to explicitly show the very high correlation of brain sex with gender identity, gendered behavior, and sexual orientation. Having shown that there is indeed very strong evidence that “gender identity might be attributed to hormone milieu during intrauterine development on some occasions”, which supports the notion that gender identity has a basis in biology (as opposed to being purely a social construct overlain on observable sex differences), it is tempting to say that transsexuality, all transsexuality and transgender identity, is also the result of mismatched hormonal milieu.  In fact, many transsexuals hold to just such a position.

But they would be dead wrong.

The logical leap that all transsexuals have such an etiology is not supported by the above evidence.  In fact, given the very probable differing etiologies for Gender Dysphoria and their associated gender identity resolutions suggested by the Freund/Blanchard two type taxonomy of MTF transsexuality, at least one of these types must NOT have been caused by such.  Blanchard went on to predict that this would be born out by studies of the sexually dimorphic structures in the brain, predicting that the exclusively androphilic MTF transsexual would show shifts toward the female morphology, while the other type would not. It is here that this recent paper has its biggest failings, in that not only did they not discuss this issue, but included very problematic studies by Swaab that purported to have shown female like shifts in non-exclusively androphilic transwomen.  These papers did show the shifts in the BSTc and INAH3, but incorrectly concluded that they had existed prior to exogenous HRT and incorrectly concluded that these features in the brain were organization effects of endogenous hormones in utero, when the data clearly demonstrated the opposite, that these shifts were purely activational effects from exogenous estrogenic and anti-androgenic HRT.  To be fair, they did mention that the BSTc was potentially questionable, but completely failed with regards to the INAH3, which demonstrably is not evidence for a biological basis of gender identity.

In reviewing the recent grey and white matter studies, they failed to note that it fits and supports Blanchard’s prediction, which had they done so, would have strengthened their argument for a biological basis for a conventional gender identity in exclusively androphilic MTF transsexuals.  That is to say, that they experience the same feminine “gender identity” as females because their brains are female like.  Conversely, they would also have evidence for a biological underpinning to autogynephiles sexuality, a non-sexually-dimporphic one, which lead to an epiphenomically generated “female gender identity” later in adulthood.  (See my essay on the different origins of cross-gender identity in transsexuals.)

The authors reviewed the literature on possible genetic factors that could lead to transsexuality, noting that they were inconclusive. Totally absent in this paper was any mention of the papers that document the fraternal birth order effect found in exclusively androphilic MTF transsexuals. All in all, I was disappointed in this paper.

I found it shallow, lacking in both depth and breadth, and literally out of step with much of the literature on the cutting edge of the science.

Reference:

Aruna Saraswat, MD, Jamie D. Weinand, BA, BS; Joshua D. Safer, MD, “Evidence Supporting the Biological Basis of Gender Identity” (2015) DOI:10.4158/EP14351.RA

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Shades of Grey…

Posted in Brain Sex, Confirming Two Type Taxonomy by Kay Brown on February 23, 2015

shrinking brainShades of Grey… Matter

We live in exciting times – At least scientifically.  We can now peer into the heads of transsexuals to see if their brains exhibit sexually dimorphic features that match their natal sex or their preferred gender.  Years ago, Ray Blanchard made a prediction, based on early evidence that there was a taxonic difference between “homosexual” and “non-homosexual” transwomen in sexuality, natural gendered mannerisms, age of transition, etc, that the former would show sexually dimorphic features in the brain that were shifted in the female direction while the latter would not, but would show features that were different than controls, but that they would not be sexually dimorphic features, and definitely not shifted in the female direction.  We now have yet more evidence that that prediction is correct, giving more weight to the two type taxonomy of MTF transsexuality, namely exclusively androphilic vs. autogynephilic.

The best evidence would be to use two populations of transwomen, one known to be exclusively androphilic and the other not, and test them for the same features, using the same type of measurement.  We now have that data for grey matter distribution in the brains of both types of transsexual.

In the earlier Savic and Arver paper, they compared grey matter distribution of 24 gynephilic transwomen, before HRT to that of heterosexual men and women.  (Remember, HRT itself causes a shift in sexually dimorphic features due to activational effects of sex hormones, and the lack of such hormones.)  The conclusion?

“The present data do not support the notion that brains of (gynephilic) MtF-TR are feminized.”

In the later Simon paper, they compared grey matter distribution of 10 exclusively androphilic transwomen, and 7 exclusively gynephilic FtM transmen, before HRT to that of heterosexual men and women.  The conclusion?

“Our findings support the notion that structural differences exist between subjects with GID and controls from the same biological gender. We found that transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender in their regional GM volume of several brain areas, including the left and right precentral gyri, the left postcentral gyrus (including the somatosensory cortex and the primary motor cortex), the left posterior cingulate, precueneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and inferior temporal gyri. Additionaly, we also found areas in the cerebellum and in the left angular gyrus and left inferior parietal lobule that showed significant structural difference between transgender subjects and controls, independent from their biological gender.”

The choice to explore only “homosexual” transsexuals in this study was informed by the researchers’ knowledge of the Freund/Blanchard taxonomy and of Blanchard’s prediction, as they explained,

“Both MTF and FTM patients were eligible for the study, but only those with homosexual orientation. The rationale for this choice was based on the Blanchard typology which considers two fundamentally different types of transsexualism: homosexual and nonhomosexual. Homosexual transsexual individuals are sexually attracted to the same biological gender, while nonhomosexual transsexual individuals are attracted to either the opposite gender or show no sexual orientation/attraction at all. According to Blanchard, homosexual transsexuals are usually younger at initial presentation of gender identity disorder and show more pronounced and frequent childhood femininity, as well as different anthropometric data. One might argue that mixing individuals from both transsexual groups in one study targeting the neurobiological background of transsexualism might bias the results by introducing heterogeneity in the sample. Thus, in our study, only homosexual transsexual individuals were included preventing our findings from the aforementioned bias.”

This points to growing recognition within the scientific community that the two type taxonomy is correct.  They went further, indirectly referring to the taxonomy and Blanchard’s prediction,

“In another study also limited to MTF transsexuals Savic and Arver, reported no “feminization” of any brain region with regard to structure. Nonetheless, certain brain areas (clusters ≥100 voxels) showed characteristic structural features in the transsexual group compared with both male and female control groups. Specifically, they found reduced thalamus and putamen volumes and increased GM volumes in the insular and inferior frontal cortex and in the right temporo-parietal junction (angular gyrus and superior temporal gyrus) in the transsexual group compared with both control groups. In our study, however only the angular gyrus (but in the left hemisphere) was affected among these areas, showing lower regional GM concentration in both FTM and MTF transgender subjects compared to controls, independent of their biological gender. When comparing the results reported by Savic and Arver to either our study or to other imaging studies in the literature of transsexualism, it has to be taken into consideration that their reported results were obtained from a solely nonhomosexual transsexual group of patients. The lack of real overlap between our and Savic and Arvers’ findings, despite the very similar methodology used, might at least in part be explained by the difference of the sexual orientation of the two samples.”

Truly, exiting times.

References:

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

Lajos Simon, Lajos R. Kozák, Viktória Simon, Pál Czobor, Zsolt Unoka, Ádám Szabó, Gábor Csukly, “Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study”
10.1371/journal.pone.0083947

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Child’s Play

Posted in Science Criticism by Kay Brown on February 9, 2015

critical-thinkingFor years, critics of transkids’ identities have made claims that transkids are either “confused”, “delayed”, or “pretending”.  Many papers describing feminine boys from the 1960’s would describe them as being “talented mimics”, explicitely taking the position that men and women, boys and girls, do in fact have in-born differences in behavior, mannerisms, and motor-movements, but that these feminine boys were NOT exhibiting natural behavior, but were consciously, or “subconsciously”, observing girls and women, and learning to “mimic” these behaviors.  Of course, those of us who were such and grew up to transition, have long begged to differ!

Today, we have a published paper that demolishes these notions.  At the core of the paper is the ability to determine implicit associations between concepts.  If you are not familiar with this tool, it may be useful to review the Wiki page on Implicit Association Testing .  One of it strengths is that it cannot be “faked”.  It is impervious to Social Desirability Bias or other impression management distortions.  It is also impossible for someone to be “pretending”, as the cognitive load to evaluate the test set-up, determine the “right” answer, etc. would create an obvious delay in the test.  Further, if a child were “confused” as to the meaning of sex and gender, there would be an obvious anomalous signature in the test results.

ImplicitThe study involved 32 transkids, ages 5-12, 12 FtM, 20 MTF, who have already transitioned full time, with the full support of their families.  This would obviously include “early onset” transkids.  However, and this is critical, we know, or at least suspect, that some of these kids will “desist” being gender dysphoric before puberty, if they follow the trend already seen in other studies, most especially the Steensma study from the Netherlands.  Yet, for all of that, the results of the study show that these kids are completely consistent in their implicit gender identity and preferences as their opposite sex, non-trans, controls and siblings.  They are NOT pretending, nor confused.

The folks who conducted this recent study are continuing their work, looking at these kids as they grow up.  They are looking for additional transkids to join the study.

Study on Gender Nonconformity in Children

Hi from the TransYouth Project at the University of Washington! We are researchers interested in gender development in children and have a new research project we are currently recruiting families for. The project aims to better understand gender development in gender nonconforming and transgender children.  Our new study takes 30-60 minutes and includes children ages 3-12. We are running the study all over the U.S. and Canada so please let us know if you are interested and we can let you know when we’ll be in your area. We are hoping to recruit gender nonconforming children as well as their siblings (where applicable). All data collected as part of this study are confidential. Payment is $10 per parent and $10 plus a small toy per child. There is an optional longitudinal component that we can tell you more about as well if you are interested. To sign up for the study, please visit: http://www.transyouthproject.org. If you have any questions, feel free to contact me, Dr. Kristina Olson, via email (krolson@uw.edu) or phone (206-616-1371). Thanks for considering being a part of this research or telling someone who might be!

Reference:

Kristina R. Olson, Aidan C. Key, Nicholas R. Eaton, “Gender Cognition in Transgender Children“, Psychological Science

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

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Are Your Ears Burning?

Posted in Science Criticism by Kay Brown on January 19, 2015

critical-thinkingIt has long been hypothesized that prenatal or perinatal hormone levels influence sexually dimorphic behavior in humans.  The evidence from studies of people with Disorders of Sexual Development and in numerous animals studies lends strong evidence that this is true.  So it would seem natural that we should ask if sexual orientation and gendered behavior in otherwise phenotypically normal individuals could also have been affected by hormones.  The ultimate study would be one that longitudinally follows a large cohort of individuals from conception to adulthood, taking extensive hormonal assays while evaluating gendered behavior and sexual orientation.  The problems of doing such a study for transsexuality is obvious… the cohort would have to be in the hundreds of thousands to ensure statistically significant numbers of transsexual individuals were included.

Thus, researchers are interested in finding sexually dimorphic markers that record historical hormone environments.  That is to say, something that is an organizational and not an activational effect, preferably one that becomes fixed at the same period in prenatal development as organizational effects in the brain.  It must be something that is observable at birth and remains stable long enough to allow us to use it to retrospectively determine ones hormonal environment after we have found our gender atypical population of interest.

I’ve already blogged about one such putative measure, the 2D:4D ratio, which is mildly sexually dimorphic, and in at least some population has a recognizably large enough effect size that we can hope that we can use it.  Sadly, the results have been contradictory so far.  But despair not, another such sexually dimorphic marker is available, though it requires specialized equipment to measure.

In individuals with normal, unimpaired hearing, a curious effect is found in which our inner ears respond to external sounds with sounds of their own, which is known to be mildly sexually dimorphic, as described in the abstract from a recent paper out of Europe, the first known to explore this effect as a potential probe of the role of androgens in gender dysphoria,

“Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds that are produced by the inner ear in response to click-stimuli. CEOAEs generally have a higher amplitude in women compared to men and neonates already show a similar sex difference in CEOAEs. Weaker responses in males are proposed to originate from elevated levels of testosterone during perinatal sexual differentiation.  Therefore, CEOAEs may be used as a retrospective indicator of someone’s perinatal androgen environment.”

coeaeBefore we get too excited about this marker, we need to look at the effect size, with is quite small at only d=0.30 in the left ear and was better in the right ear at d=0.60.  You may recall that this is of the same order as the 2D:4D finger length ratios at d=0.63.  This is large enough to be useful, but only if enough subjects are available to achieve significant statistical power.  Sadly, this lack of enough subjects seems to be the case in this study.  Too bad, because there is a hint at some exciting results in that looking at a group of gender atypical and gender dysphoric children and teens, the natal males seem to show a shift in the female-like direction, but oddly, the natal females do NOT,

“In the present study, we retrospectively investigated possible organizational effects of prenatal androgens on CEOAEs in relation to gender identity. We found that boyswith GID had sex-atypical (hypomasculinized) emissions. Their mean response amplitudes, though, were not significantly different from either the male or female controls. Thus, boys with GID had an intermediate position between the sexes in terms of CEOAE response amplitudes. By contrast, girls with GID showed emissions in the same range as female controls.  Consistent with several earlier studies, sex differences in emission strengths were observed in the control group, with girls having significantly stronger emission amplitudes than boys. Our finding that boys with GID showed stronger, more female-typical emissions compared to control boys suggests that boys with GID might have been exposed to relatively lower amounts of androgens during early development. The effect sizes for the comparison boys with GID versus control boys were similar to those for control girls versus control boys, supporting the notion of a hypomasculinized early sexual differentiation in boys with GID.  However, considering the lack of statistically significant differences between the control boys and the boys with GID and the relatively small sample size of subjects with GID, this conclusion may still be premature and our results therefore need to be interpreted with caution. Furthermore, our findings did not support the hypothesis of an increased exposure to androgens in girls with GID during prenatal development. Though speculative, this might reflect that GID in girls does not develop under the influence of prenatal androgens or at least not during the same critical time window as when androgens exert influences over OAEs.”

This result is surprising, in that previous studies involving gay men and women, researchers saw the opposite pattern, in that gay men showed no shift from control men, but lesbians showed a shift from the female to the male response.  The most exciting times in science are when you hear, “That’s strange!”  This is one of those times.  Several possibilities exist.  This result could just be spurious, with not enough subjects to have seen the real signal.  It could be that there is an additional activational effect that occurs as children mature, that causes a shift for both gay men and gay women toward the masculine response.  We may be seeing the effect of heterosexual “tomboys” swamping out the FtM signal.  Or, we could be witnessing the first hint that there is a difference between transkids, both MTF and FtM, and conventionally gay men and lesbian women.  Time and additional studies will tell.

References:

Sarah M. Burke, Willeke M. Menks, Peggy T. Cohen-Kettenis, Daniel T. Klink, Julie Bakker, “Click-Evoked Otoacoustic Emissions in Children and Adolescents with Gender Identity Disorder”  Archives of Sexual Behavior, DOI 10.1007/s10508-014-0278-2

Dennis McFadden, Edward G. Pasanen, “Spontaneous otoacoustic emissions in heterosexuals, homosexuals, and bisexuals” Journal of the Acoustic Society of America, http://dx.doi.org/10.1121/1.426845

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A Show of Hands

Posted in Science Criticism by Kay Brown on January 15, 2015

A recent paper seemed to be lending weight to the hypothesis that prenatal androgen exposure dose may influence transsexuality.  The papers concern the use of 2D:4D finger length ratio as a proxy measurement of prenatal androgen dose exposure.  I’ve written about this before, but please allow me to cover the basics again.

handThe 2D:4D ratio is mildly sexually dimorphic based on the androgen/estrogen ratio during fetal development.  The conventionally approved method of measuring the 2D:4D ratio is from the middle of the crease between the finger and the palm to the middle of the tip of the finger.  When I measure mine, I find that for the left hand, they measure 67mm:62mm giving a 2D:4D ratio of 1.08.  For my right hand, I measure 67mm:63mm, giving a 2D:4D ratio of 1.06.  If you are wondering, this is an extremely feminine (hypomasculine) 2D:4D ratio, which would be very unusual to find in a western european male (mostly Irish descent).

finger vs sexWhen we do this measurement for a large population and graph it as a histogram, as shown on the right, we see that the average male hand has a 2D:4D ratio of 0.975, and the average female hand has a 2D:4D ratio  of 0.995.  One also notices that there is a range, a classic bell curve, of ratios.  Note that they are highly overlapping, but still recognizably separate (effect size d=0.63).  Thus, for any given individual, the ratio is essentially meaningless.  It is only when we look at large numbers, can we average out the noise, the random factors that push the measurement one direction or the other, that we can see a real signal that might give us interesting clues to scientific questions.  Different ethnic populations show different average and effect sizes, so it is important that when conducting a study of this type, that the controls be from the same ethnic population as the subjects.

2d4d SerbsIn the Vujovic paper, they compared a group of FtM and MTF transsexuals to controls, all of whom were ethnic Serbs.  The paper was very confusing in that in the text, they use the conventional 2D:4D ratio.  But the accompanying bar chart, shown on the left, appear to have flipped this for some, but not all, to use 4D:2D ratios !  This kind of error should have been spotted during peer review.  (I’ve seen exactly this kind of error in the papers that I’ve reviewed for journals… it is common to find mislabeling of figures, etc. due to multiple contributing authors.)  So, let’s ignore the bar graph and look at the numbers?

“Our study found larger 2D : 4D for right hand in control males, compared to left hand (0.928 versus 0.935). Control female exhibited, as well, larger 2D : 4D for right hand, compared to left hand (0.921 versus 0.945). Control males left hand ratio 2D : 4D is lower (0.935) than in female left hand control (0.945) while there were no differences for the right hand (0.928 versus 0.921).”

Oh dear… if you follow that text carefully, one realizes that once again, something is messed up.  The larger numbers were supposed to be for the right hands in the first two sentences, but now it appears, from the third sentence, that the opposite is true.  Once again, it appears that the ratios have been flipped from 2D:4D, to 4D:2D in the numbers in the text, but that the original writer of the words had intended to use the conventional 2D:4D ratio… but someone inserted the flipped numbers at some point.  (Again, this should have been caught at peer review!)

So what is going on?  Clearly this paper could NOT have been peer reviewed, since if it had, these simple and inexcusable errors would not have been allowed in the final version of the paper.  The answer is simple.  The journal in which this paper was published is NOT peer reviewed.  In fact, it is an egregious example of what many in the scientific community are calling “predatory publishing”, as Jeffrey Beall explains,

“An example of a gold open-access journal is The Scientific World Journal, currently published by Cairo-based Hindawi Publishing Corporation. This megajournal covers virtually all scientific fields and imposes an article processing charge of $1,000 for each accepted article. “

As Beall has pointed out, because this is not a peer reviewed journal, not even a subject focused journal, quite literally (not figuratively) anyone can publish ANYTHING in these journals, most especially this one, as long as you pay the publishing fee.  The process of academic science depends upon peer review to keep everyone honest, to keep junk science, non-science, erroneous and, most especially, fake data out of the publications.  This “journal” does none of that.

Thus, this paper is of questionable value to the scientific community… and especially to the trans-science-skeptic like me.  How can I trust the data presented?  How can anybody?  We can’t.  I don’t.

Addendum 1/16/2015:  In doing a bit more research into this journal, its publisher claims that it uses a single-blinded peer review process.  But, I’m still convinced that it could NOT have been properly reviewed.  It took me only a few minutes to realize that the graphs, text, and numerical values were messed up.  One would NOT need to be a specialist to see the error, merely scientifically literate.

Addendum 2/17/2015:  I wrote to the lead author of this study asking for the correct data.  She didn’t bother to read my letter, nor this blog post, with any depth, because her response was non-nonsensical, starting with misgendering me, likely not understanding that the name “Kay” in English denotes a woman’s name, not a man’s.  But in any case, it means that she hadn’t bothered to look at my blog post, nor my “about” page:

Mr. Brown,

Thank You for Your kind email.

Figure 1 was excluded from the paper because men created it made a mistake (incidentaly he took data from another study).

I am sorry for this mistake.  All other data in the text are correct.

We followed up transsexuals since 1989. and have many interesting data. So, if You have any interest we can have further successfull cooperation.

Best wishes,

Prof.Svetlana Vujovic

References:

Vujovic et al., “Finger Length Ratios in Serbian Transsexuals”, The Scientific World Journal
http://dx.doi.org/10.1155/2014/763563

Jeffrey Beall, “Predatory Publishing”, The Scientist Magazine, August 2012

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A Novel Argument

Posted in Transsexual Theory by Kay Brown on January 1, 2015

Science vs nonsenseA new argument was presented to me just yesterday involving the well documented fact that among those who transitioned as teenagers, far fewer report having experienced autogynephilia.  What made the line of argument ironic was that the proponent had started out in absolute denial of any of the science and most especially of the the notion that autogynephilia existed in some transsexuals, “autogynephilia my ass!”  However as the debate developed, she presented a novel take on the Nuttbrock data that I presented, to wit that in that study, 82% of self-reported exclusive gynephiles reported sexual arousal to cross-dressing, while only 14% of those who had begun HRT as adolescents (defined in the Nuttbrock study as before one’s 20th birthday) reported such arousal.

Here’s where it gets interesting: In an effort to win ANY point she could, she took the position that I was twisting the data to suit my position… yet in so doing she had to take the position, for her arguments’ logic to work, that autogynephilia is a UNIVERSAL phenomena among MTF transsexuals.  I had to laugh privately, since this reversal of her position would obviate all of her previous positions and support some (but not all) of mine.  Interestingly, this argument of universal autogynephilia mirrors the argument proposed by another contingent of autogynephilic transwomen, that autogynephilia is also normal and expected in natal women.  I find it doubly ironic that there is such an extreme reaction to the two type taxonomy, but from two camps, those that deny any autogynephilia in transwomen, and those who insist that their autogynephilia is just part of being a woman, and thus, all transwomen must also be autogynephilic.

Her argument also starts with several assumptions that are not supported by the data, nor by community observation.  She assumed first that HRT in these teens meant “puberty blockers” and that such blockers would preclude an individual from experiencing any sexual arousal.  It wasn’t made explicit, but she may also have been making the false assumption that even traditional HRT precludes any sexual arousal.  (I’ve heard several “late transitioning” transwomen make this statement, likely due to their own personal experience, while real for these individuals, is neither universal nor inevitable.  From casual observation, it seems to occur more frequently in more senior transwomen than younger “late transitioning” transwomen.  And from personal conversations with a fair number of transkids, not one had experienced this phenomena.)

So, she explains the significant difference between these adolescents (of whom only one had identified as gynephilic and 7% as bisexual, with the remaining 93% identifying as exclusively androphilic) and the gynephilic (all but one of whom had begun HRT as adults or had never had HRT, and yes, that one individual is in both groups… I couldn’t back her out of the data), as the adolescents not experiencing sexual arousal to cross-dressing due to them not experiencing sexual arousal in general.

So, having convinced herself that she had won her point… she began to crow that I was the one who was not willing to look at reality!!!

Ummm…  Not so fast.

Hypothesis were meant to be tested.

I’ve already pointed out the canard that HRT stops sexual arousal in all transwomen.  If it did, would we be having sex as often as we do post HRT and SRS, especially transkids?  It simply isn’t true.  Second, it is extremely unlikely that these youngsters were all on puberty blockers (e.g. Lupron) as it is still a fairly rare protocol.  It is typically initiated by well meaning parents bringing their extremely gender dysphoric pre-adolescent children to specialists.  While I would wish that all parents were so willing to medically intervene and save their transkid from the damaging effects of endogenous hormones, it is still a rare parent who does so.  Most transkids have to fight to get medical help… and many never get parental support, either waiting until they are legally of age, running away early, or getting HRT “on the street” surreptitiously.

Although the Nuttbrock study did not give us the fine detail I would have liked regarding the exact ages which folks started HRT, we know that half of those who identified as androphilic and had started HRT did so before the age of 20.  That also means that half did NOT.  From other studies, we know that the age of 20 is the median and the mode, that most androphilic transwomen start HRT, not right at puberty, but nearer age 20, showing a Gaussian distribution centered on age 20, with the bulk having started HRT between the ages of 17 and 23 inclusive.  This is enough after puberty to have allowed them to experience that first flush of sexual awakening that accompanies the onset of puberty and adolescence.

We know from countless personal narritives of autogynephilia that those early years of adolescence are typically when sexual arousal to autogynephilic imagery, most especially to cross-dressing, stereotypically in women’s lingerie, is the most obvious and intense.  Thus, IF these youngsters who began HRT as teens were universally autogynephilic, they would have had ample time to experience it in all of its intensity, before begining HRT, even if, as was argued, HRT would preclude experiencing it!

Looking further at the Nuttbrock study, only 40% of the self identified exclusively androphilic population had started HRT before age 20.  If this argument that HRT in adolescence explains the reduced number reporting autogynephilic arousal to cross-dressing, we would expect that those who did NOT start HRT as an adolescent to report at the same rate as the other sexual orientations.  Of those who self-identified as androphilic, all of those, including adolescent onset HRT, adult onset HRT (40%), and not on HRT (10%), the combined population had 23% report autogynephilic arousal to cross-dressing.  A little algebra and a calculator will show that those who were NOT adolescent onset HRT were reporting at the rate of 29%, far lower than the 82% of gynephilic transwomen, and even lower than the bisexually identified transwomen who reported at 67%, and the asexual at 66%.

Thus, even if HRT did what my erstwhile debating partner claimed… the data STILL would NOT show that self-reported exclusive androphiles report less than half the incidence of autogynephilic arousal to cross-dressing.  We would instead expect the later onset HRT androphiles to report at rates that were at least similar to the bisexual population.

OH… and a note on why I keep using the term “self-reported”:  There is, unfortunately for our research purposes, a well documented phenomena of “late transitioning” transwomen misreporting their sexual orientation.  It is quite possible, even probable, that the 29% rate of adult onset HRT and no HRT, is from a number of such misreporting older transitioners.

Thus, I’ve outlined my theoretical and evidence based reasons why this novel hypothesis is not supported by the data.  Instead, the data supports the two type taxonomy for MTF transsexuality, namely “exclusively androphilic vs. autogynephilic”.

To those who understand the limitations and implications of sociological and psychological studies, I’m sure that the above explication of the data is sufficient.  I’m equally certain that to those who are in denial of this research and of the Fruend/Blanchard transsexual taxonomy, what I’ve outlined above will only back them further into their denial.

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What the NEXT Wave of Transgender Activists Need to Know

Posted in Editorial by Kay Brown on December 9, 2014

CloudyThis 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 my lifetime.  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.  Angela angrily pulled it fresh from her typewriter and 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 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 (later renamed World Professional Association for Transgender Health (WPATH).  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.

In the early ’90s, transactivists across the Western World began actively lobbying their governments.  In late’96, transactivist lawyer, JoAnna McNamara asked me to work with her lobbying the Oregon legislature to address language in a new bill that would have stripped transfolk in that state of protections that JoAnna herself had only recently won in admistrative ‘court’.  I worked fulltime, alongside her, as we made appointments to speak to key legislators, using a deliberate one-two punch, in which she, as an older transitioner, not very “passable” would be assumed to be “the transsexual” discussed how transphobia worked to deny employment opportunities to transwomen like her.  As I sat quietly taking notes, I was assumed to be her natal female assistant… until I spoke up about what discrimination awaits transwomen like me who pass, but are later discovered by their employer… The sudden shocking realization would cause the legislator to rethink their opposition to our position.  It reached a climax in a public hearing about the bill in which the room was packed with transactivists that JoAnna and I had hurriedly put together on very short notice.  We won.  The anti-trans* languange was removed from the bill in committee.  Six months of full time lobbying paid off.

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 explained 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 “… 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 was at the time, (joining my boyfriend’s mother in chorus, who being an engineer herself, also wanted her son’s girlfriend to also be an engineer).

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 by Kay Brown on November 6, 2014

critical-thinkingIn 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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