On the Science of Changing Sex

Somewhere, Over the Rainbow…

Posted in Transsexual Field Studies by Kay Brown on November 16, 2010

female_scientist♫…Skies are blue.

In Counting Noses, I attempted to determine the likely ratio of HSTS vs. non-HSTS transsexuals using the Smith (Netherlands) data.  This question was previously explored by Lawrence in various different cultures.  She noted that different countries presented widely different ratios, from 0% to 91% non-HSTS in various studies.  She noticed a pattern and tested a hypothesis that societal individualism corresponded with the prevalence of non-HSTS transsexuals.  Interestingly, the hypothesis was born out.  Ruggedly individualistic societies, as measured by the Hofsted Index had the highest percentage, while very socially interdependent societies had the lowest percentage of non-HSTS transsexuals.  The lowest numbers were found in Singapore, Thailand, Korea, and Brazil.  No surprise for those of us in the Anglo-American world; The United Kingdom, Canada, and the United States had the highest non-HSTS percentage.

The correlation with published measures of individualism and the percentage of non-HSTS transsexuals was 0.88, an amazingly high value for a sociological and psychosexual study.  In fact, I think this correlation could not have been higher, given that a statistical correlation can never be higher than the internal test/retest reliability of each of the measures, which are not likely to be much higher than this correlation.  Kudos to Dr. Lawrence for discovering this powerful correlation.

Personally, I was interested in determining if the HSTS populations in these cultures were similar or different than the HSTS population here in the United States.  So, I looked at the Tsoi paper from Singapore, which had the very lowest percentage of non-HSTS at zero and had near the lowest individualism index score at 20.  Thus, this was the most extreme differential in both percentage and individualism.  The question to be tested: Are Anglo-American and Singaporean HSTS transkids similar in behavior and life arcs?

Singapore HSTS Life Arcs
(Cumulative Percentages at Age Indicated)

Age:                                                             6    12   18     24 Total %
Start to feel like a girl                       27    74  99  100 100
First cross-dressing                          25    60   92    99  100
Idea of sex-change surgery             1     48   88  100 100
Sexual Experience
Love a boy (man)                                2     30   94    99  100
Petting with male                                 1     17   84    96    97
First sexual intercourse                   0     12   73    90    92
First boyfriend                                     0       8   72     92    95
Start to cohabit                                    0       3   23     54    59
Cross-dress in public                         1       4   65     90    95
Stopped wearing male clothes       1       3   41    78     87
Started HRT                                           0      0   38   80     90
Obtained SRS                                         0      0    1     21     50

Looking at the data from the Tsoi paper, we see that the HSTS transkids are essentially the same as the US HSTS transkids in every respect.  They typically transition before age 25.  In fact, looking at the percentage that had begun HRT in adolescence, we see essentially the same numbers as were found for the HSTS (androphilic) subjects in the Nuttbrock study:

New York Started HRT                 na    na    40     na     80
Singapore Started HRT                  0      0     38     80     90

Both the Nuttbrock study in New York and the Tsoi study in Singapore showed that ~38 to 40% of androphilic transsexuals had started HRT in adolescence!  The other data certainly fits my own personal observations… and of course my own life.  The earliest I can recall unambiguously being attracted to a boy was when I was 12.  I had my first serious crush on a boy at age 15.  I started cross-dressing in public in high school, in the afternoon/evening, exactly like Tsoi describes for Singaporean transkids.  I stopped dressing as a boy right after graduation, the same week I turned 18.  I started HRT that summer, started dating boys, and became sexually active that fall, as I started college.  I had SRS at age 23.  In Singapore, 21% of the transkids had had SRS by age 24 and 14% of HSTS transkids attended university.  From my experiences knowing a fair number of transkids here in the West Coast of the United States, I would say that my experience was fairly typical… and the range matches that of the HSTS in Singapore.

There was one other sad fact reported in the Tsoi paper:  That 35% of the HSTS transsexuals were prostitutes at some point in their young lives… a number that agrees with my own estimate for the West Coast of the United States.  Although higher than is found for natal females, this number is still a minority.  Consider; 65% of HSTS do not become prostitutes.  In my personal experience, and I can imagine it is similar in Singapore, the primary motivator for becoming a prostitute is to gain the extra income needed to obtain SRS, given that there is no public health coverage for SRS in these countries.

Thus, although there is a vast difference between cultures in the number of non-HSTS (and as we’ve shown ad infinitum, ad nauseum: autogynephilic) transsexuals that transition, the experiences of HSTS transkids is universal.

Addendum 12/3/2010:

Age:                                                             6    12   18   24 Total %

Stopped wearing male clothes       1       3   41    78     87
Become a prostitute                           0       1   23   32      35
% of post transition                             0    33   56   41      40

% becoming prostitute at age         0    33   58   37     33

The percentage of Singaporean transkids becoming prostitutes as a function of age of transition is highest for those transitioning as teenagers.  I believe this is an effect of family support.  One is more likely to transition earlier when parents kick them out of the home, which also necessitates becoming a prostitute for survival.  Transitioning after age 18 is often associated with having remained at home, and is associated with higher familial support.  Further, an older teen is more likely to find sufficiently remunerative employment.


Anne A. Lawrence, “Societal Individualism Predicts Prevalence of Nonhomosexual Orientation in Male-to-Female Transsexualism”

W. F. Tsoi, “Developmental profile of 200 male and 100 female transsexuals in Singapore”



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