On the Science of Changing Sex

Stereotypes are Dangerous

Posted in Science Criticism, Transsexual Field Studies by Kay Brown on December 27, 2011

critical-thinkingEveryone knows that… yet we still develop and use them.  In a 2008 letter to the editor regarding a paper purporting to compare the sexuality of autogynephilic and non-autogynephilic transsexuals by Veale, et al., Anne Lawrence and Michael Bailey challenged the conclusions of the paper,

We argue here that Veale et al. reached erroneous conclusions, as a result of significant methodological problems in their analysis. Specifically, we contend that: (1) In performing their cluster analysis, Veale et al. inappropriately employed two variables that were unrelated to autogynephilia, in addition to two variables that were genuine measures of autogynephilia; (2) consequently, both transsexual groups defined by their cluster analysis displayed substantial autogynephilia: They are best described as the ‘‘autogynephilic’’ and ‘‘even more autogynephilic’’ groups, not the ‘‘nonautogynephilic’’ and ‘‘autogynephilic’’ groups; (3) because Veale et al. failed to recognize that both transsexual groups were autogynephilic, they mistakenly concluded that their results were partly inconsistent with Blanchard’s. Despite these limitations, the Veale et al. study provided valuable confirmation of another phenomenon that is widely recognized but that until now has been poorly documented: MtF transsexuals who are active on the Internet appear overwhelmingly to be autogynephilic.

Bailey and Lawrence held forward as part of their explanation as to why all of Veale’s transsexual subjects were autogynephilic was their assertion that transsexuals that were using the internet were exclusively autogynephilic because AGP transsexuals are geeky and especially drawn to computers, while transkids are not.

In our opinion, the principal value of this study lies elsewhere.  Specifically, the Veale et al. study provides important confirmation of a phenomenon that is widely recognized but that until now has been poorly documented: MtF transsexuals who are active on the Internet appear overwhelmingly to be autogynephilic (nonhomosexual).  We have observed, based on interviews we have conducted with hundreds of MtF transgender persons, that nonhomosexual MtF transsexuals are often intensely interested in computers, tend to gravitate toward computer-related occupations and hobbies, and often spend much of their free time using the Internet (see Bailey 2003, pp. 168, 196; Lawrence 2007, p. 514). Hints concerning these tendencies appeared in the academic literature over 30 years ago, when Laub and Fisk (1974) remarked that many of their MtF patients with gender dysphoria displayed a notable ‘‘interest in mathematics and computer sciences’’ (p. 399). Some 20 years later, MtF transsexual activist and author Rachel Pollack commented matter-of-factly that the dual occupations she assigned to the MtF transsexual protagonist in one of her fiction series–prostitute and computer programmer–’’were deliberately chosen from the main occupations of [MtF] transsexual women’’ (Gabriel & Pollack, 1995, p. 48), as though this were common knowledge. But these observations have not been confirmed by formal empirical research, as far as we can determine.

One of the two references they cited, as being examples to demonstrate that Veale’s study subjects were likely to be exclusively autogynephilic included Rachel Pollack creating a character who is a prostitute and computer programmer.  This was cited as evidence that computer programmer was one of the two most likely occupations of MTF transsexuals.  They were citing the use of stereotypes as though that use proved that they were true, a classic tautology.  Held up as true was the supposition that AGP MTF trannsexuals were geeky and especially drawn to computers, while transkids are likely to be prostitutes, as they are especially promiscuous and drawn to sex work.

These stereotypes, for both AGP and transkids, are just as pernicious as those involving other groups; the dumb blonde, the greedy jew, the lazy black man, the bad woman driver, the bitter and humorless dyke… all wrong and insidiously malicious.

There may be a grain of truth to the observations that many of the AGP transsexuals have been computer programmers, but is it because they are especially draw to such work, or to computers in general?

Sadly, for MTF transkids, there is also a grain of truth to the assertion that they are more likely to be or have been “prostitutes”.  But this is not because they are promiscuous, etc.  It is because our society leaves them few other options, just as the high unemployment found among young black men is due to fewer opportunities, especially in our present jobless economic “recovery”.

First let’s examine that other reference cited by Lawrence and Bailey that AGP transsexuals are geeky and drawn to computers and especially to computer programming, in which Laub and Fisk reported that their SRS candidates included a high number of those who were interested in “mathematics and computer programming”.  Frankly, having been in the Stanford program as a teenager, having grown up quite literally (not figuratively) blocks away from both Laub’s and Fisk’s houses, riding my bicycle past them for years… I would be very much surprised if that had not been the case; For Stanford University is the very epicenter, the beating heart of Silicon Valley.  If one were to climb to the top of Hoover Tower, one could see the garage where Hewlett and Packard, both Stanford grads, started HP.  In another direction, one could possibly just make out the garage where my high school classmate Steve Jobs started Apple.  From that tower you can literally see the headquarters of Cisco, Ebay, Google, Facebook, Intel, Adobe, etc.  Thus, their report that there were a high number of computer programmers in their program is easily explained as a “sampling error”.

What I can accept as true is that AGP transsexuals will have had more highly paid, traditionally masculine, jobs before transition.  For a mid-life candidate, transitioning successfully is expensive, what with electrolysis, hair transplants, tracheal shave, breast implants, facial feminization, and finally SRS.  Further, losing straight male privilege may entail loss of opportunities for further career advancement, and likely losing a wife and children to divorce.  Thus, I believe, that there is a selection effect that occurs for AGP transsexuals in that those who feel that they can “afford” it, are more likely to transition.  We can see that in the already clinically observed higher IQ in AGP transsexuals.  Intelligence is highly correlated with high Socio-Economic Status (SES).  Thus, we can expect to find that AGP transsexuals are more likely to have high SES… and the types of jobs that high SES men have.

Looking at one list of top paying jobs, we note that of the top jobs, Anesthesiologist (at #2; Paging Dr. Lawrence?), Lawyer, College Professor, Airline Pilot, and yes, Computer Scientist, are all very high on the list.  These are all jobs that we have seen AGP transsexuals holding prior to transition.  It is not that AGP transsexuals are especially drawn to “mathematics and computer programming” it is that those individuals from the larger pool of potential AGP transsexuals, who have higher SES and are in occupations that are most friendly to transsexuals, are more likely to transition.  Computer programming has one of the best return on education investment ratios of all of the jobs listed above.  Computer programmer is the only job that it is possible to get without either a graduate degree or extensive (and expensive) training.  One can even become a computer programmer as a college drop-out (e.g. Bill Gates, Steve Jobs)!  It also has the advantage of not requiring public contact, and thus one’s employer is more likely to accept an employee in transition.  Thus, it should be no surprise that computer programmer is a likely job for an AGP transsexual.  But I assert that autogynephilic males in general are not especially drawn to computers.

But if this is the case, why are Veale’s transsexual subjects all AGP? (I do agree with Bailey and Lawrence on this point.)  This is most likely to be a sampling effect of a given social network.  Veale readily admits that this is not a random sample.  She reached out to the transsexual community through a limited set of venues, all of which were dominated by AGP transsexuals.

Bailey and Lawrence have asserted that interest in computers leads to heavy use of computers, and thus more likely to use the internet.  But this is a non sequitur.  Today, everyone is using computers on the internet, especially for social media.  One such venue, facebook, is so popular that I personally tallied over 25% of my graduating high school class had a facebook page!  When we add up all of the possible other venues, the percentage of the U.S. population using the internet is very, very high… 77.3% at the moment.  Could there be some reason transkids don’t use the internet?  With SmartPhone availablity, I doubt any but the very poorest and most desperate street trannie is without some internet connection.

“Birds of a feather, flock together.”  It may be a tired old saw, but contains a very powerful sociological truth.  In this case, AGP and early transsexuals have very little in common save HRT and SRS.  We live different lives and have different concerns.  Plus, a very pugnacious minority of AGP transsexuals are extremely antagonistic and even vengeful, when early transitioning transwomen, truthfully, point out the difference.  Thus, our social networks, in person and on the internet, are largely mutually exclusive.  So, Veale failed to include very many, if any, early transitioned subjects.

Turning back to transkids:

Transkids are often viewed by their families as a deep embarrassment.  Their obvious gender atypical behavior and “homosexual” orientation (pre-transition) are viewed as culturally and religiously impermissible.  Such kids may experience antipathy that may range from emotional neglect, emotional abuse, to life threatening physical abuse.  In such cases, a transkid may believe, and act on that belief, that running away is the safer course of action.  For other transkids, their families may ask or tell them to leave.  These kids are literally thrown away.  Although transkids aren’t the only kids to be so treated, the percentage of them that are is extremely high, far, far higher than average.

If a teenaged MTF becomes a runaway, or throw-away, she is faced with very limited choices to survive.  She will have few job skills, and even fewer legitimate prospects.  What employer is going to hire a homeless “street trannie” over a “respectable” teen from a “good” family?  Under such circumstances, she will often meet up with other “street trannies” (or “transsies”, as we were called when I was a teen), who have already turned to survival sex.  Survival sex is when one exchanges sex, or other erotic favors, for food, shelter, or other necessities.  If she is unlucky, what begins as survival sex spirals into commercial prostitution that for a few years, becomes a way of life, a life that is very difficult to leave once caught up in it.  In the U.S., studies show that about 27-43% of all street kids aged 11-23, not just street transkids, have experienced such survival sex, while 6-20% engaged in transactional sex (for money, drugs, or material possessions).  My point here is, runaway and throw-away transkids are no different than other street youth in being at risk of sexual exploitation by adults.  I believe that in the U.S., one out of three transkids has engaged in survival sex.  The Tsoi study of Singapoorean MTF transkids shows the pattern.  One third of them will be “prostitutes” at some point in their lives.  Although the study did not distinguish between survival sex and street prostitution, I’d be willing to bet that they are describing a mixture of survival sex and commercial prostitution.  The majority of those in the Tsoi study who became “prostitutes” did so if they transitioned as teenagers, likely after leaving their natal home, supporting my assertion that such prostitution was not sought out by young transitioners, but was merely a means of survival because they had few if any other opportunities.

If transkids’ families are emotionally and financially supportive, in the normal manner as they would any other loved and valued child, transkids do not become “prostitutes” in any sense!  These kids will not be visible to the public or law enforcement.  They will quietly transition and live invisibly in their communities.  Remember, two out of three MTF transkids do not become “prostitutes”.

Thus, we have sampling error effect in that the only transkids that are visible to the public are those unfortunates who have fallen into commercial prostitution, reinforcing a false stereotype.

If I can share a personal note here?  On my 18th birthday, just a week before I graduated from high school, my father came over to my mother’s house, with whom I had been living after my parents divorced a year before, and gave me a combination birthday and graduation gift of an inexpensive clock radio, the only such gift any family member proffered.  He also delivered the news that I had been expecting for months.  He told me that I was not welcome at my mother’s house, nor his nearby apartment.  I would have to leave home after graduation.  As the family did not want me to further embarrass them, they required that I move away some distance.  To enforce that distance, I would be given a small allowance, to become a “remittance man” (defined here)  My father encouraged me to attend a community college, which made me even more bitter, in that six months earlier, I had been accepted to a four year college in another part of the state, but my folks had shown no inclination to support that ambition; so I had had to decline the acceptance.  That allowance amount was NOT enough to live on as I soon discovered.  I was in essence, a throw-away kid.  But I feel I was one of the lucky ones, in that I was above average intelligence, resourcefulness, and was not without some skills.  I survived.

References:

Jaimie F. Veale, Dave E. Clarke and Terri C. Lomax, “Sexuality of Male-to-Female Transsexuals”
http://www.springerlink.com/content/bp2235t8261q23u3/

Anne A. Lawrence and J. Michael Bailey
Transsexual Groups in Veale et al. (2008) are “Autogynephilic” and “Even More Autogynephilic”
http://www.springerlink.com/content/u473w370g11vx758/

Jaimie F. Veale, David E. Clarke and Terri C. Lomax
Reply to Lawrence and Bailey (2008)
http://www.springerlink.com/content/cm2531l3m3148377/

MyPlan.com, “Top Ten Lists / Highest Paying Jobs”
http://www.myplan.com/careers/top-ten/highest-paying.php

Internet World Stats
http://www.internetworldstats.com/am/us.htm

National Alliance to end Homelessness
“HOMELESS YOUTH AND SEXUAL EXPLOITATION:
Research Findings and Practice Implications”
http://graphics8.nytimes.com/packages/pdf/us/20090919_alliance_draft_report.doc

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Clowns to the left of me… ♫♫

Posted in Science Criticism by Kay Brown on December 24, 2011

critical-thinkingjokers to the right♫  ♫Here I am stuck in the middle with you.♫

Also in 1978, at the Harry Benjamin Gender Dysphoria Symposium, Richard Green, M.D., expounded on the problem of the age:

“The name of the game is follow-up. The controversial question of the early 1960’s: “Should transsexual surgery be performed?” has metamorphosed into the compelling question of the 1970’s: “On whom should it be performed? ‘~ Various viewpoints exist regarding the appropriate candidate for sex-reassignment surgery. It has become increasingly clear that candidates cluster into three major groups: i) individuals who report a lifelong core-morphologic sexual identity contradictory to anatomy, an absence of effective socialization in the role expected by virtue of their anatomy, an absence of genital arousal accompanying the wearing of clothes of the other sex, and an absence of genital pleasuring with partners of the other anatomic sex (“true transsexuals”); 2) males who have vacillated in their sexual identity or have been ambivalent in their identity from childhood, who have experienced genital arousal accompanying cross-dressing and who have had sexual relationships with persons of the other sex (“transvestic transsexuals”); and 3) individuals whose core-morphologic identity has been primarily consistent with anatomy, who have manifested gender-role behavior that is culturally atypical~ who have not experienced sexually arousing cross-dressing, and who have had extensive sexual relationships with same sex partners (“feminine male and masculine female homosexual transsexuals”). Some eventually receive surgery; others do not.”

Green wanted to answer this burning question, just who would and would not be helped by transition and SRS.  Transfolk were notorious for dissappearing after they got what they wanted out of the surgeons, so follow-up studies tended to be skewed to those segments of the population who would be inclined to cooperate.  Green proposed that transfolk be required to post a substantial bond to get service.  That bond would only be returned in tranches as they came back for follow-up.

“I propose the following: Each individual who is accepted into an evaluation program for sex reassignment surgery must deposit an appropriate amount of funds for the anticipated professional services into a followup, interest-bearing, escrow account. In the case of medically indigent patients, the State or some third party should deposit a comparable amount on the patient’s behalf. This money is to be returned to the patient at bi-annual visits over a ten year period, one-fifth of the total amount at each visit.”

This would in effect raise the hurdle that less affluent, younger transkids would have to clear.  I can tell you from personal experience that this would have had the effect of driving yet more transkids onto the streets, into sordid means, or to using the services of underground butchers like the infamous Dr. Brown in California.  I could well imagine that for well-to-do older transitioning folk, the bond would represent an affront, and may even backfire, causing less cooperation rather than more.  Fortunately, this proposal went nowhere.

But the question still remained… and in his opening statement, Green shows us a murky problem for the clinicians.  Just who was a “transsexual”?  On one side, they could clearly recognize transvestites, men who clearly were or had been sexually aroused by cross-dressing.  On the other side, they could clearly recognize homosexual men who occasionally put on drag to go to clubs, or homosexual women, who presented as butch as our culture allows.  And they believed that they saw a group in the middle, who requested somatic feminization or masculinization, to allow them to live as members of the opposite sex.  So far, pretty straight forward.  But what to make of those folks who requested such somatic changes, but could be recognized to have very strong resemblance to transvestites or homosexuals?  What of those who, in their presentation and narratives, downplayed such resemblance, but hints were there anyways?

The problem some thought was to find those bright shining lines that served as a demarcator for being a “true transsexual”, to separate those who were actually either homosexual or transvestite, calling them “pseudo-transsexuals”.  Some researchers already thought that they had found these bright shining lines.

Person and Oversey had simple, bright shiney lines for MTF types.  If you were attracted to men, you were homosexual, period.  If you were having, or ever had, sex with women and cross-dressed, you were a transvestite, period.  Their “primary transsexual” was completely asexual, but had vacillated on their gender identity growing up, usually having made “one last effort to be a man” before succumbing to their disorder.  They readily admitted this was a very tiny minority.  (Blanchard later demonstrated that Oversey&Person’s “primary transsexual” was autogynephilic.)

Green’s description of the three types is recognizably based on Stoller’s typology of “true” or “primary” transsexual.  For MTF, his bright shining lines were drawn very tightly.  If you were attracted to men, but used your penis, you were a homosexual, period.  If you were attracted to women, and/or experienced arousal when cross-dressed, you were a transvestite, period.

Notice that Stoller’s and Person&Oversey’s “primary transsexual” were mutually exclusive, they didn’t even overlap!

Even Fisk at Stanford, which had the most liberal policy for acceptance for SRS, used a tripartite model: homosexual, transsexual, transvestite.

Using these indicia, various clinics made decisions as to who they would deign to allow SRS.  Different clinics had different criteria, ranging from strictly “true transsexuals only” to very liberal, everyone welcome, so long as you pass the “Real Life Test”.  Of course, you could always go overseas or Mexico, where if you had the money, they had the knife!

Given these models in use by various programs, there was a powerful incentive to lie, to craft one’s personal narrative and history to fit the acceptance criteria, as stated by Berger, as reported by Green,

“It certainly seems that we are all agreed that one of the problems that we are trying to deal with in evaluating results is determining what happens to these people postoperatively. I think that it is equally a problem in that we do not know what happens to those who are rejected. I think that these people are consummate actors in many cases, and that when they are rejected, they learn what it was that they said wrong so that they can go to the next place and say it right. Since we do not communicate with each other and have no way of doing so about our results with specific patients, there is no way that we can really followup a specific patient in their travelings from clinic to clinic.”

This lying became very extensive, as Deidre (Donald) McCloskey, whose 1999 autobiography Crossing: A Memoir documents numerous episodes of auto-erotic transvestism, writes (using the third person “Dee”):

“The young woman psychiatrist asked Dee the usual questions, mentally running down a checklist of the gender-crossing illness. “When did you first want to be female?” “Were you effeminate as a child?” (…) Dee started to lie. They all do it. Of course gender crossers lie. They can read the DSM just as well as the psychiatrists can. “Oh yes” Dee said to the Free University psychiatrist, “I’ve always had these desires. Oh yes Doctor ever since I can remember. Oh yes it’s just like being a woman in a man’s body. Oh yes Doctor I hate my penis. Oh yes Doctor whatever your dopey list says“.

(McCloskey 1999) (Bolded text is as originally printed)

Note that McCloskey’s interviewer is asking questions based on Stoller’s “true” transsexual profile.  This lying may have distorted research, paradoxically adding weight to what we later learned was a flawed concept.  But as Berger shows above, and Meyer shows below, the fact that SRS candidates lied was very well known.

“It should be borne in mind that there is a degree of uncertainty in the data. This uncertainty derives, among other factors, from having seen the patients intermittently, rather than continuously, the patients’ tendency to dissimulate in order to achieve sex reassignment, and the confidentiality of the evaluations which prevented direct checking of statements. …  However, since most patients are aware from the literature of the “correct” early history, a degree of common falsification, and therefore factitious similarity, must not be discounted.”

In contrast to this concept of the bright shining line, was the continuum of symptomology and gender dysphoria.  Harry Benjamin himself thought this was true.  Meyer at Hopkins held this opinion.  He clearly described a range of autogynephilic and separately homosexual individuals who requested SRS.  Interestingly, he also described a group he called “Eonists”, which I recognize as transkids, both MTF and FtM.  (Ironically, he used the term “Eonist” which was named after a famous historically significant cross-dresser, who by his history, is easily recognizably autogynephilic.)

So, as Meyer and Benjamin described, Freund pointed out, Blanchard powerfully demonstrated & defined, and Nuttbrock recently corroborated (if unwillingly); there are no bright shining lines dividing and creating a middle group.   There is nothing between the classic extremely gender dysphoric AGP transsexual and the classic closeted transvestite.  There is nothing, save possibly deep disgust and shame regarding the penis, between the classic demure “true transsexual” and more flamboyant club crawling street trannies and drag queens.  There is only one line, the one separating homosexual from non-homosexual transsexuals.   But that is not the line that may be used to determine who is and who is not suitable for somatic feminization.

In the end, I think Meyer summed it all up best,

“One is faced, however, with more ambiguity than clarity when the differential diagnosis for applicants requesting sex reassignment is limited to homosexuality, transvestism, and transsexualism. Far too many patients fall into the gray areas between. The selection of an overall classification, with the addition of descriptive subcategories, would seem more workable.

With this in mind, I would propose recognizing the condition of sufficient gender discomfort, skew, or unease to request sex reassignment as the “gender dysphoria syndrome.” This admirable term and its application, to my knowledge, were originally suggested by Norman Fisk (1973). As mentioned previously, factors in assigning the “gender dysphoria syndrome” label would be a sense of inappropriateness or incapacity in the anatomically congruent sex role, a sense that improvement would ensue with role reversal, …  …and an active desire for surgical intervention. Explicit in this definition is that the patient take some active steps to realize the interest in reassignment.  …  The use of “gender dysphoria syndrome” has the added advantage of emphasizing disharmony within the patient’s own gender rather than implying, as in the term “transsexualism,” the successful negotiation of a gender, even though an anatomically incongruent one.

There is still the question of how to deal with the loosely used, generic term “transsexualism.” I find that I can no longer use “transsexual” or “transsexualism” without quotation marks. The use of this term suggests that there is a single diagnostic entity “transsexual,” which in current loose usage is characterized by a request for sex reassignment. All applicants, however, are not the same, and reassignees from the various clinical categories will presumably react quite differently to their surgical modification over time. Kubie and Mackie (1968) have previously emphasized these problems of definition as they relate to follow-up. An appreciation of the presenting clinical varieties emphasizes the need for great specificity in initial patient characterization if one is to speak of improvement or deterioration over long-term follow-up. Without these preliminary distinctions, with all patients lumped together, the truly valuable information will wash out of follow-up series and any opportunity for specificity in future prognosis or selection will be lost.

I would propose that the term “transsexual” be abandoned except for one specific usage. The term should be reserved only for those patients who have actually undergone, and completed, genital reassignment. The term, therefore, would refer to an anatomical fait accompli, and would have no further meaning. It could then be used as a purely descriptive term without implications regarding etiology, psychodynamics, character structure, preoperative adjustment, postoperative course, etc. It could be used much as the term “amputee” to describe a postoperative fact, with no implication as to physiological dynamics (diabetes, arteriosclerosis), character structure (alcoholic, drug addict), or the hazards of the fates (accidental trauma).”

I could not agree more!

Further Reading:

Essay on Norman Fisk coining “Gender Dysphoria” and how it allowed autogynephiles to obtain HRT & SRS without lying to clinicians

Essay on Stoller’s description of a “True Transsexual”

Essay on Evelyn Person and the creation of the “Primary” and “Secondary” Transsexual

References:

Richard Green, “Transsexualism: A research note”
http://www.springerlink.com/content/x32756q117717817/

Jean M. Dixen, Heather Maddever, Judy Van Maasdam and Patrick W. Edwards, “Psychosocial characteristics of applicants evaluated for surgical gender reassignment”
http://www.springerlink.com/content/j3478u3647875058/

Jon K. Meyer, “Clinical variants among applicants for sex reassignment”
http://www.springerlink.com/content/qx35288724j54862/

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“Sherman, set the WayBack Machine to 1978”

Posted in Transsexual Field Studies by Kay Brown on December 18, 2011

female_scientist“Sure Mr. Peabody!”

In the late summer of 1977, at the tender age of 20, the folks at Stanford made it known to me that I was then eligible for SRS, having been living full time as a young woman for two years, etc.  Those two years had been great.  I was happy.  I was getting along with people.  Folks treated me well.  I had boyfriends.  But two years of dating with a proscribed, ‘no fly zone’ was growing very old.  I really looked forward to being post-op.  All I really needed was the money.  But as a young secretary, the cost of SRS was greater than a year’s gross salary!  I got a better paying job as an electronics assembler, but I was still barely making ends meet.  For months I had been trying to save up money…  Saving more than 10% of my take-home pay would be difficult.  How could I ever afford it?  It would take more than a decade!  So in early 1978, I turned to my folks, hoping that they had changed their minds and were now ready to help me.  My mother was totally unmoved.  My Dad had another proposal.

My Dad instead proposed that I should seek psychotherapy for my “problem” from a certain Dr. Stoller in Los Angeles, for which he would pay.  My Dad hadn’t liked Dr. Fisk, the shrink at Stanford, who three years previously had told him that he should be supportive, not obstructive, “You will win a few battles, but lose the war.”  So, my father had asked around for someone else and Stoller had been recommended.  I had also heard of Stoller, of course.  I understood that he was a psychiatrist.  I blew off the suggestion, with extreme prejudice.

But now, as I have been researching our history and the science for this blog, I realize I missed out on meeting a very interesting man.  I have a feeling we would have got on swimmingly.  That’s not to say that we would have agreed.  Oh no!  Stoller, along with many psychiatrists of the mid-20th Century, was suckered into Freud’s pseudo-science cult of psychoanalysis.  Stoller’s works are redolent of the type of confirmation bias and untested, and often untestable, assertions built upon assertions, like sand castles on quicksand, all accepted as true, and precious little of it actually so, found in non-scientific texts.  (Resolutions of Oedipal Conflicts; Seriously?)  A modern reader, educated in experimental psychology, neurology, and rigorous scientific method, must wade through a morass of useless psychobabble to find the occasional gem of insight.  But still Stoller had a keen mind and was very observant.  When he stuck to direct observation, leaving behind for a moment any superfluous psychodynamic formulations, he was brilliant.

Green, writing of and quoting Stoller, said,

Sex research published in science journals typically reports extensive samples, assessed by questionnaire, and analyzed statistically. To this, Stoller complained, ‘‘Sex research is camouflaged by large samples, hidden in tabulated columns, and dissected beyond significance by statistical packages. Although statistical techniques may enable us to corroborate or deny a hypothesis, they do not produce one’’

I couldn’t agree more.  One needs to get to know the populations one is studying to gain insights that may lead to hypotheses.  Although, I trust the insight only after the statistics prove out the hypothesis.

One hypothesis from Stoller that needed (still needs?) testing is that his “true transsexuals”, which he later called “primary transsexuals”*, avoid using, or allowing their male partners to touch, their penis in sexual encounters.

*(Likely to tweek Oversey and Person who were using that term for asexual transsexuals, which they mistakenly thought were not autogynephilic, but that is a subject for another essay).

It would be instructive to read a description of Stoller’s “true” or “primary” transsexual to learn just who he meant by these terms.  From his 1968 book, Sex and Gender, starting on page 190:

sex-and-gender-the-development-of-masculinity-and-femininityLet us briefly describe a typical male transsexual.  The patient is twenty-five years old. She is dyed-blonde, well-rounded “woman” who in none of the ordinary mannerisms of life (smoking cigarettes, walking, crossing her legs, blowing her nose, gesticulating, etc.) in any way reaveals she was ever a male.  She points out that she had the same mannerisms when living as a male, when she seemed bizarre.  She recalls no time in life of not wanting to be a girl, of not feeling extremely feminine, of not having intersets and daydreams that seemed to her the same as those of normal girls.  Her earliest memories, starting around the age of three, already show this very feminine attitude.  As a boy, she was treated with ridicule by the other boys, despite which she maintained her same feminine behavior.  …  her daydreams from the start were that she was a woman being made love to by a man. … She hated to masturbate and says she did so only once a year or less, not because of conscious guilt but because it so concretely demonstrated her anatomical maleness.  …  She began going out with men and having sexual relations.  However, she never permitted a man to touch or see her genitalia, since they were such a source of shame; she defined as normal any man who made no such attempts.  …  Some months before I first met her, she made contact with an operated transsexual, who suggested that they live together (not sexually, of course).  She did so, and at the point for the first time she went through the preparations that were so lead to her being able to pass successfully as a female.  …  She was so successful that she very shortly found herself a job, being hired unsuspectingly as a woman.  …  The patient has now married and hopes to adopt children.

I sincerely hope that this young woman did succeed in adopting, as I did, and found it as rewarding.  I hope she has grandchildren.  She should be in her late sixties or early seventies by now?  This description is totally in keeping with what I understand as the feminine androphilic MTF transkid “homosexual transsexual” (HSTS).

Note the characteristics that Stoller attributes to this typical “true” or “nuclear” transsexual: Atypical gendered behavior since very early childhood, consciously gender dysphoric from childhood (early onset), exclusively androphilic, interested in children and being a mother, and emotionally stable, mature, and nurturing.  Stoller insisted that the “true” or “primary” transsexual universally avoided, did not allow, contact or visual notice, of her genitals.  Person and Oversey flatly rejected this claim.  Stoller and Person&Oversey duked it out in their respective books and papers, relying on reference to psychoanalytic theory and psychodynamic formulations, citing counter examples.  Sigh…

I could regale my reader with an anecdote of my own avoidant behavior… but adding one more anecdote does not help.  The plural of anecdote is not data.

Hypothesis were meant to be tested.

Fast forward to 1990 when Leavitt and Berger attempted to do just that.  I wrote about this before, but let’s review.  The authors used Blanchard’s Modified Androphilia Scale in an attempt to identify and segregate exclusively androphilic MTF transsexuals from the larger pool of SRS candidates.  But, as the authors admit, this was inadequate.  Not only did they not separate the HSTS from the bisexual group, but they also caught up heterosexual and asexual types as well.  As we’ve seen, pseudo-androphila and social desirability bias both lead many AGP transsexual SRS candidates to overstate any sexual interest in men, downplay any interest in women, and strongly downplay a history of erotic arousal to cross-dressing. But, when L&B separated by actual sexual behavior, they separated the types quite well as evidenced by the data.

Type:             Avoidant            Pleasure     Inactive

Number                 n=15              n=30         n=36
Age                          29.9                32.8          34.5
SD                              4.2                 7.5             9.6

Full
time:                         4.9                 3.1           0.73
Transition:             25               29.7            33.7   (mean age – mean time post transition)
Married:                    0%            23%             47%
Penis “OK”             6.7%           83.3%         33%
Fetishistic              6.7%           33.3%         50%
Sex w/ female:       0%             33.3%         58%
Attraction to
females:                     0%             33.3%        70%
Male toys               16%              46%            50%
Male playmates   16%              37%           47%

Rorschach sex#   0.7               6.4             5.7    (high score indicates “disturbed” sexuality)
F+%                          70.5             57.8          51.1   (score below 70.0  indicates poor reality testing)

MMPI Scales:
Pd                              61.1            70.4          68.3  (high scores indicate anti-social tendency)
Sc                               57.7           70.1          68.3  (high scores indicate “odd” thinking and social alienation)

The Avoidant group fits Stoller’s profile of the “true” transsexual to a T.

(Addendum 12/24/2011: It appears that there may be one (or two) autogynephilic individual out of the fifteen who also states that she is comfortable with her penis, who was sorted into the “avoidant” group.  This may be an artifact of the rules by which the sorting was performed; To be in the avoidant group, one had to have had at least five sexual encounters with a man and no more than five of those times have allowed that man to touch ones penis.  Thus, an individual with relatively few sexual encounters may have actually had a high percentage of them wherein that individual allowed penile contact, up to 5/5 = 100% in fact.  In the future, if this study is replicated, I recommend using an additional rule wherein there is a low percentage cut-off as well as a fixed numerical cut-off.)

The Inactive group is clearly heterosexual, with some of them possibly being the so called asexual (actually automonosexual). While L&B remarked from the strong similarity of the MMPI and Rorschach tests that the Pleasure group was essentially the same as the Inactive. As the pleasure group includes individuals who admit to being sexually attracted to women, including some who have been married, they, as a group, represent a bisexual group. Is it possible that the pleasure group also included etiologically HSTS individuals? The data can’t be used to rule this out, but I personally don’t believe so. Why would an exclusively androphilic, non-autogynephilic male who is very comfortable with having sex using their penis want to be rid of it? The data bears out Blanchard’s typology of exclusive homosexual (non-autogynephilic) vs. non-homosexual (and thus autogynephilic) transsexual etiologies.

(Addendum 2/21/2012:  Actually, we can use the data to rule out the possibility that etiologically HSTS individuals were in included in the pleasure group.  If the pleasure group was a mixture of HSTS and autogynephilic bisexuals, then we would expect the scores on the Rorschach and MMPI scores to be intermediate between the avoidant and inactive groups.  Instead, they are nearly the same as the inactive, if anything, these scores are further away from the avoidant group’s scores.)

In Leavitt and Berger’s own words,

Transsexuals who are sexually active with males but do not allow their penis to be involved in sexual activity share a constellation of traits and experiences that generally conform to characteristics of the nuclear transsexual (Buhrich and McConaghy, 1977). The picture of the nuclear transsexual conveyed by the literature is that of sustained, nonfluctuating femininity, developmental patterns involving a preference for girls’ games and company, aversion to rough-and-tumble activity in early childhood, later patterns involving a desire to posses a woman’s body, to live in society as a woman, and to attract heterosexual male partners. The nuclear transexuals experience intense disgust and aversion for their penis and deny a history of heterosexual orientation or fetish arousal. If patients in the Avoidant group are accepted as nuclear transsexuals, then only 18.5% of our sample meet those criteria. This implies that most of our sample seeking reassigment are not nuclear transsexuals (Newman and Stoller, 1974).

Thus, Stoller’s hypothesis that HSTS transkids universally are “avoidant” has been born out by this study. We should not be surprised by this observation, because it forms a natural truism; A male bodied person who was not motivated by autogynephilia and felt comfortable with their genitalia, would not be likely to actively seek out its removal.

Addendum 8/1/2014:  I added another essay on this topic, using a very recent paper that adds evidence to the above hypothesis.

References:

Richard Green, “Robert Stoller’s Sex and Gender: 40 Years On”
http://www.springerlink.com/content/rr775w4408071213/

Robert Stoller, “Sex and Gender, On the development of masculinity and femininity” (1968)

Frank Leavitt and Jack C. Berger, “Clinical patterns among male transsexual candidates with erotic interest in males”
http://www.springerlink.com/content/fp15j71n57474k1l/

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Oh Brother Where Art Thou?

Posted in Confirming Two Type Taxonomy, Transsexual Field Studies by Kay Brown on December 17, 2011

female_scientistThe consanguinity of both homosexuality and autogynephilia appears to be very high.  So one would not be surprised to find that the consanguinity of transsexuality would also be very high.  That is to say, that transsexuality runs in families.  But not the same families.

I have to wonder about my own family.

I always wondered why I never met my paternal uncle, until the day, when I was 16 years old, he showed up at our doorstep, unannounced, with his boyfriend/partner.  My father desperately, but quietly, tried to shuttle my three siblings and I to our respective bedrooms, but I obstinately refused to understand my father’s not so subtle hint.  My uncle gave me a present that day of a beautiful butterfly mounted as though still alive, in a plastic cube.  I never saw him again.  But I asked my grandmother about him when I was 22.  I simply asked if he had ever married.  “He’s not gay!” was her vehement reply.  “That wasn’t what I asked, but now I know, thanks.”

I also wondered about one of my brothers.  One brother was very, very obviously straight.  He was always mooning after some girl or other in high school.  But, our younger brother?  The tall, handsome blond, star athlete?  No girlfriends, not even a hint of one.  When our mother suggested that an appointment with a girl was a “date”, he testily replied, “Its not a date, Mother!  She’s just a friend.”  But, as a kid, he used to dress up in mock drag and imitate drag comedians, especially Flip Wilson, “My boyfriend’s name is Killer!”, said in grating falseto.  I used to cringe and want to hide when he did that.  When he was a ‘tween’, he had a poster of the teen-girls heart-throb of the day, Bobby Sherman, on his door.  On one particular occasion, when I was 17 and he was 15, we were driving down a back road behind Stanford University, past a known gay cruising spot, when up ahead we saw a handsome young man with cut-off jeans and his shirt off, bare chested, thumbing a ride.  My brother nonchalantly rolled down the passenger side window, stuck out his head as we passed by the obviously gay young man and called out teasingly, “Sorry guy.  Not cute enough!”  Many of my gay friends over the years said that their gaydar went off when ever he was around… but… perhaps after seeing how our family and most of our social set disowned me as a teenager, he slammed the closet door so shut that even he didn’t recognize it?  He’s now married with two children, a very successful cardiologist and hospital administrator.

There have been lots of reports of transsexuals having transsexual or transvestite siblings, fathers, or sons.  The press just eats up these stories.  But what of the clinical experience?

From Green’s paper on the subject:

Familial cases of gender identity disorder were reviewed by Freund (1985)
and categorized as concordant or discordant for sexual orientation. No instances of
a mixed heterosexual and homosexual pattern in the same family were found. The
interpretation was that the two groups of gender-identity disorder have different
etiologies. In the 10 family series reported here, only Case Five contains a mixed
heterosexual/homosexual family pair.

Green’s ten cases came from a pool of only 1,500.  This would suggest that one in one hundred fifty transsexuals has a transsexual or transvestite sibling, but not of the other type?  Is this random chance?  Not likely.

References:

Richard Green, M.D., “Family Cooccurrence of “Gender Dysphoria”:Ten Sibling or Parent–Child Pairs”
http://www.springerlink.com/content/p11646013q03m755/

Esther Go´mez-Gil et al. “Familiality of Gender Identity Disorder in Non-Twin Siblings”
http://link.springer.com/article/10.1007/s10508-009-9524-4

Robert J. Stoller and Howard J. Baker, “Two male transsexuals in one family”
http://link.springer.com/article/10.1007/BF01541006

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Searching High and Low

Posted in Transsexual Field Studies by Kay Brown on December 15, 2011

female_scientistThe first time I met other transsexuals, (February 1976) at the Stanford Gender Clinic, the very first thing I noticed was that they all seemed to tower over me.  I’m 5’7″ and a half (172cm).  The other thing I noticed was that most of them were obviously male in appearance and manner, in spite of being dressed in women’s clothes… and that most of them had been or still were married to women.  To say that I was confused would be an understatement!  It would be a while before I understood that there were two types of MTF transsexuals.

Later, when I met HSTS trankids, I noted that they were more my height.  My friend Jennifer was the tallest, Marcella was about my height, while Stella was very slightly shorter.  Over the years, I’ve met many MTF TS folk.  It has been my observation that transkids were shorter than the AGP transsexuals.

Clinicians from Harry Benjamin to Robert Stoller have remarked on the shorter stature of transkids.

But the plural of anecdote is not data.

Which brings us to Blanchard’s observation and study of the very same phenomena.  He and his colleagues used the same data set that had been used earlier to explore the issue of HSTS vs. AGP typology, along with height and weight data collected by the clinic in Canada, and found that those who had been in the ‘homosexual’ cluster were shorter and lighter than the rest.  Specifically, they found that the non-homosexual group was 175.70 cm (5’9″) and that they were exactly the same average height as non-transsexual Canadian men, by age group.  But the mean height of the homosexual group was 172.94 cm (5’8″), 3.23 cm shorter than the norm for their age.

The mean height of each group is only a little over an inch different, but what really interests me is the histogram of the heights of the two groups.  The two groups have very skewed height distributions, as shown in Fig. 2 of the paper.  It shows that 25% of the non-HSTS group is 6’+, while only 10% of the HSTS group is 6’+.  (But, keep in mind that we know that perhaps 15% of the ‘homosexual’ cluster was not actually etiologically HSTS… so the real percentage may be lower.)  Thus, from the data, we may draw the conclusion that a non-HSTS is two and a half times more likely to be 6′ or taller than an HSTS.  Conversely, 22% of the HSTS population will be 5’5″ or shorter, while only 10% of the non-HSTS will be this short.  Thus, although the means don’t look all that different, as a group, because of the very large differences in the numbers at the tall and short end, the impression one gets when exposed to groups of both types of transsexuals is that the HSTS type is significantly shorter than the non-HSTS (AGP) type.

Science depends on repeatability.  An independent study should confirm a finding before it is fully trusted.  The Smith study in the Netherlands tested the same hypothesis, and failed to find any difference in the mean heights of the HSTS vs. non-HSTS types.  Lawrence suspected and demonstrated that the sort method was incorrectly including too many non-HSTS as HSTS in the Smith study.  But, when she resorted, the data still failed to support the differential mean height hypothesis.  However, is it possible that there is still a difference in the distribution?  Or is there something basically different between Dutch and North American populations?

Further Reading:

These studies were in essence, attempts to use replicable metrics that might explain the oft clinically and community noted trend that MTF transkids (HSTS) passed better than non-homosexual transsexuals.  A more recent study from the Netherlands, using clinically scored metrics of physical gender congruity found that this observation is statistically supported, as described in my essay on passability differences between homosexual and non-homosexual transsexuals.

References:

Ray Blanchard, Robert Dickey, Corey L. Jones, “Comparison of Height and Weight in Homosexual Versus Nonhomosexual Male Gender Dysphorics” http://www.springerlink.com/content/w318411nq4q7387u/

Lawrence, A., “Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements”
http://akikos-planet.cocolog-nifty.com/blog/files/maletofemale_transsexual_subtypes_sexual_arousal_with_crossdressing_and_physical_measurements_319320.pdf

Yolanda L.S. Smith, Stephanie H.M. van Goozen, A.J. Kuiper, Peggy T. Cohen-Kettenis, “Transsexual subtypes: Clinical and theoretical significance”
http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf

Anthony F. Bogaert, Jian Liu, “Physical Size and Sexual Orientation: Analysis of the Chinese Health and Family Life Survey:
http://link.springer.com/article/10.1007/s10508-013-0110-4

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And the Beat Goes On…♫♫

Posted in Brain Sex, Confirming Two Type Taxonomy by Kay Brown on December 8, 2011

♫…Drum keeps pounding rhythm to the brain… La di da di dee…♫

shrinking brainJames Cantor recently published a letter to the editor in the Archives of Sexual Behavior pointing out nearly the same point that I had made earlier, that recent MRI scans of transsexual brains show clear evidence that Blanchard’s two type hypotheses is supported.  One of the papers he referenced is one that I had earlier referenced; The Rametti study in Spain, which showed that MTF  transkids have partially feminized brain structures.  The other paper is new to me; The Savic paper clearly adds yet another confirming MRI study that when combined with the Luders MRI study, shows that gynephilic MTF transsexuals do not have feminized brains.  On top of it, true to another speculative prediction that Blanchard made, the new study confirms the other paper’s finding that gynephilic (AGP) MTF transsexuals show other, non-sexually dimorphic structures, are different from both non-transsexual men and women!

These two papers both noted that the putamen of gynephilic MTF transsexual are different from both non-TS men and women.  This may be the main area to research in the future?

For more essays on trans-brains see Brain Sex

References:

Cantor, James, “New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism”
http://www.springerlink.com/content/b52p04306u076623/

Reply to Italiano’s (2012) Comment on Cantor (2011)
JamesM. Cantor  http://link.springer.com/content/pdf/10.1007%2Fs10508-012-0011-y

Rametti G, Carrillo B, Gómez-Gil E, Junque C, Zubiarre-Elorza L, Segovia S, Gomez A, Guillamon A., “The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study.”
http://www.ncbi.nlm.nih.gov/pubmed/21195418

Ivanka Savic, Stefan Arver, “Sex Dimorphism of the Brain in Male-to-Female Transsexuals”
http://cercor.oxfordjournals.org/content/early/2011/04/05/cercor.bhr032

Luders E, Sánchez FJ, Gaser C, Toga AW, Narr KL, Hamilton LS, Vilain E., “Regional gray matter variation in male-to-female transsexualism.”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2754583/

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