Through Science, Justice…
This FAQ is on the science of transsexuality and transgender sexuality. There are many myths and misunderstandings about transsexuality and transgender people. Our scientific understanding of the transsexual phenomena has increased and dramatically improved over the past fifty years, yet much of what is available in popular literature is misinformation from the middle of the last century. Much of what the public, including transsexuals themselves, believe about the etiology and treatment of transsexuality is based on such outdated, non-scientific, ideas. Worse, many cherry-pick among the scienific papers, choosing those that, in isolation, appear to support a given thesis. Many transsexual and transgendered people have read misinformation, often in emotionally inflammatory language, that makes its rounds in the echo chamber of the web and social media. This FAQ and associated blog is an attempt to correct this situation.
Learning an uncomfortable truth is better than believing a comforting lie. –Kay Brown
All information found in this FAQ and blog is supported by peer reviewed science, which is referenced (cited) in the longer essay posts covering a given topic found on this site. Many topics are interwoven with other topics, as they are interlocking issues. Please explore the entire site for a full explanation of each topic.
Remember as you read this site; Transsexuals and transgendered people are good people, worthy of our respect, and even of our admiration. Nothing in this material is meant to imply otherwise. If you are a transsexual or transgendered person: You have value as a human being. You have the right to be respected, valued, and even celebrated as the gender to which you identify and aspire.
The FAQ questions are based on real questions I’ve received and/or search strings from Google. You may wish to review the Glossary if a word is unfamiliar. If you have questions that I haven’t addressed, I can be reached at email@example.com
What causes transsexuality and how many types of transsexuals are there?
Short answer: Two types/causes (taxons/etiologies) for each natal sex, extreme lifelong gender atypicality vs. erotic target identity inversion.
Full answer: There are two basic biological taxons (types) with their own unique etiologies (causes / conditions) that are found in transsexuals / transgendered people. They are mutually exclusive and distinct. That is to say, one and only one of these two conditions can be found in any one person. The conditions, and those people with them, only superficially resemble each other but are often confused and conflated with each other in the media and by the general public. That is to say, that there are two, and only two, separate “transgender spectrums”.
Think of these two types as being separate species, perhaps like dogs and cats. They both run on four legs, are covered in fur, have the same number of claws, prefer to eat meat, make good pets, love being petted, both deserve to be treated well, etc. Yet, for all of their similarities, they are NOT the same animal. Think: Laverne Cox vs. Caitlin (nee Bruce) Jenner.
One, often thought of as the “classic” pattern, is extremely gender atypical from early childhood, often gender dysphoric from preschool age onward, and universally and exclusively attracted to their same natal sex (opposite of their gender identity). They have unstudied mannerisms and social behavior that more closely hews to those found in the other sex. They find their sexed body deeply repugnant and embarrassing from an early age, but increasingly so at puberty. Unlike the other type, they do not experience sexual arousal with cross-dressing or to the thought of being or becoming the opposite sex. Transsexuals with this etiology are most often called, “early onset” or “homosexual transsexuals” (HSTS) in the scientific literature. (This does not imply that they act like, nor identify, as gay or lesbian. It only means that they are sexually and affectionally attracted to gender typical members of the same natal sex. This term is very often considered offensive by the very people it describes and should only be used in scientific papers and discussions, if at all.) They are sometimes called “transkids” or “transgendered youth” (transyouth) in common parlance. As adults they may be called “former transkids”. There are some differences in life arcs of Female-to-Male (FtM) and Male-To-Female (MTF) transkids. The median age of transition for MTF of this type is 20 years old, with a range of early puberty to mid 20’s. More than 95% transition full time before the age of 25 and it is unheard of to find one who transitions full time after age 30. The median age of transition for FtMs is slightly older, with a moderate number transitioning in their 30’s and later, usually after having lived as very butch lesbians. Thinking about transkids as individuals who are so like the opposite sex that they might as well be that sex offers a straight forward and insightful way of viewing these kids.
The other type is generally gender typical in behavior as a child and adolescent, but may experience transient gender dysphoria, none the less, usually kept secret, due to shame. (Note: These children and teenagers are hiding their desire to be, or be like, the other sex, not gender atypical behavior, which they don’t naturally have.) They are mostly attracted to the opposite natal sex, but may be behaviorally bisexual or asexual. They exhibit an unusual sexual arousal pattern, a particular sexual orientation, an Erotic Target Location Error, in which they map their prefered sexual object, the opposite sex, onto their own bodies and actions, and thus find the thought of being or becoming the opposite sex to be arousing and emotionally rewarding, leading to an Erotic Target Identity Inversion, in which they come to identify as a member of the class of people to which they are attracted, specifically, the opposite sex. They may also find altering their appearance to approximate the opposite sex, by cross-dressing, to also be sexually arousing. In Female-to-Male (FtM) transsexuals, it is called “autoandrophilia” (AAP) and in Male-To-Female (MTF) transsexuals this arousal pattern is called “autogynephilia” (AGP). Transsexuals with this etiology are most often called, “non-homosexual transsexuals” or “late onset” in the scientific literature.
Before transition, the natural behavior of non-homosexual / autogynephilic MTF transsexuals is gender typical, easily passing as typical straight men, often marrying women, fathering children, and successful in stereotypically masculine and even hyper-masculine (e.g. Navy Seal) careers. The modal age for transition is 35 to 40 years old, the mean is between 40 to 45, with a range of early 20’s to very old age. They are far more likely to transition in individualistic cultures than socially interdependent cultures. After transition, they may identify as lesbian, asexual, bisexual, or even straight women, including marrying men. Thinking about autogynephilic MTF transsexuals as “male bodied people who love women and (romantically) want to become what they love” offers a more accurate and more richly informative way to understand them.
Before transition, the natural behavior of non-homosexual / autoandrophilic FtM may be quite variable, but is usually less “butch” than exclusively gynephilic FtM transsexuals. Their families would likely describe them as having been very typical girls, with some tomboyish interests, comfortable being feminine (dresses, make-up, nail polish, etc.). Their sexuality is most likely to be also variable over time, where they may find men or women more attractive as partners at different times in their lives. Overt erotic cross-dressing occurs only rarely, but other aspects of autoandrophilia may be found in their fantasy life (e.g. erotic interest in Yaoi Manga). We know less about such transmen as we do transwomen, but that is changing rapidly. For more information see my essay on FtM androphilia.
For more information on the typical life arcs of each type of MTF transsexual, see my essay describing them.
Because of the difference in mean age at transition, the first type is often called, “early” or “young transitioner” and the second type “older” or “late transitioner”. However, the range of age at transition of the two types overlaps and this nomenclature may thus be misleading, especially for a “late transitioner” who transitions “early”. It is important to remember that the key difference between the two is that the first type is exclusively, or primarily, “homosexual” with regard to natal sex and gender atypical in natural behavior and manner, making it difficult to fit in as their natal sex, while the second type is defined by their atypical sexuality, being aroused by the thought of being or becoming the opposite sex. Think: Laverne Cox vs. Caitlin (nee Bruce) Jenner.
Historically, a number of terms have been applied to the two types:
Homosexual Non-Homosexual / Autogynephilic or Autoandrophilic
nuclear non-nuclear / marginal
core non-core / marginal
Androphilic Gynephilic (for MTF only, the reverse is used for FtM)
True- Pseudo- (now considered archaic and needlessly offensive & judgmental)
Primary Secondary (now considered archaic and inaccurate)
Group One Group Three (Anne Vitale 2001) (For MTF only, “Group Two” for FtM that are like Group One)
Early Onset Late Onset (Preferred terminology in Europe and the American Psychiatric Association)
It is important to understand that these are NOT different theoretical catagories, but different names that focus on different aspects of the distinct differences between the two types (taxa). These terms all refer to the same two types. For example “Early Onset” refers to those whose gender atypicality and dysphoria are evident to observers as pre-adolescents while “Late Onset” refers to those whose gender dysphoria and associated behavior (cross-dressing, etc.) begin at or after adolescence.
This taxonomy is fully recognized by the scientific community and the American Psychiatric Association. Both types benefit from and need social transition, HRT, and SRS. Both types deserve full legal, medical, family recognition, and respect.
How many people are transsexual or transgendered?
Short answer: It varies by type
Full answer: The relative incidence rates between MTF and FtM is tilted toward MTF, there being far more MTF transsexuals than FtM. However, since most of the MTF transsexuals are AGP, the relative ratio of FtM to MTF transkids favors the FtM population. MTF transkid population is the smaller group in the Western World, explaining why this group is less understood. However, the smallest group is the androphilic FtM. In the FtM population, the first type, transkid, is by far the most common, the second being quite rare, with perhaps one in 72 FtM transsexuals.
In the MTF population in Western (Northern European derived) societies, the incidence rate is reversed, with the second type (non-HSTS) being the majority (70% to 90%). In many other parts of the world, the first type predominates.
Mildly gender atypical child likely to “grow out of it” and be gay, lesbian or bisexual: eight out of 100 births of both sexes.
Extremely gender atypical and dysphoric child likely to “desist” before puberty: One in 10,000 births of both sexes.
AGP/CD ‘transgenders”: two or three in 1,000 male births (estimates go as high as three in 100 births for mild AGP)
AGP MTF transsexuals: One in 10,000 male births
MTF transkid transsexuals: Three in 100,000 male births
FtM transkid transsexuals: Three in 100,000 female births
AAP FtM transssexuals: Less than one in 100,000 female births (estimated one in 72 FtM transsexuals in one study… and possibly one in four in another… though this may be unusually high.)
The US Census, correlating name changes on Social Security cards, estimates that there are ~90,000 post-transition transgendered people in the United States today. For more information see my essay on the US Census estimates.
Short answer: Statistics
Full answer: Studies, going back to the 1970’s, looking at the correlation between sexual orientation, age of transition, childhood gender atypicality, and autogynephilia consistently find two statistically significant groupings.
One group is primarily attracted to men, transitions quite young, passed as girls/women with relative ease, were noted to be feminine (sissy boys) by parents and teachers as children, preferred female playmates, avoided rough’n’tumble play, and were unlikely to report finding wearing women’s clothing to be sexually arousing (less than 15% of self identified androphilic MTF report erotic arousal to cross-dressing).
The other grouping was sexually attracted to women, as evidenced by extensive sexual experience with women, but may identify as bisexual or asexual, transitioned later in life, rarely passed successfully as women, were considered to have been typical boys (“boyish”) by their parents and teachers, and were very likely to report finding wearing women’s clothes to be, or once had been, sexually arousing (85% of self identified gynephilic MTF report erotic arousal to cross-dressing).
No other groupings had such strong statistical signals.
Attempts to find a third group fail, as every possible third group, based on MTF transsexual narratives, claims that they represent such a third group, show that they are in fact simply a subgroup of the second group, with nearly the same level of autogynephilia, the same age of transition, the same level (lack) of gender atypicality in childhood, etc.
When using statistics with people, one always expects “noise”: false positives and false negatives: People misunderstand the questions, misinterprete their own feelings and behavior, prefer not to provide definite answers, wish to appear to better advantage, or simply like to introduce bogus answers to cause mischief… so the statistics can never be 0% vs. 100% in any study; but 15% vs. 85% is a very, very strong statistical signal in psychology studies. In fact, this statistic says that even with the false response rate, “late transitioning” transwomen are over five and a half times (5.5X) as likely to report being sexually aroused by cross-dressing as those “early transitioners” who transition in their teens. But, had these numbers been closer to 0% vs. 100%, knowledgeable scientists / psychometricians / statisticians would have flagged the data in peer review of these papers as being “too good to be true”, given well known real world difficulties in psychology research.
Science depends upon repeatability, and these results have been replicated by Buhrich (1977), Freund (1982), Blanchard (1985), Doorn (1994), Smith (2005), Lawrence (2005), and Nuttbrock (2009), in separate studies spanning four decades, collectively involving over a thousand transsexuals to date. In fact, this is one of the most repeated and reconfirmed scientific finding regarding transsexuality. This is not the only statistic that shows that there are two and only two types, of course, but is the single most important.
The second most important statistical evidence is biodemographics. One of these is that transgender leanings tend to run in families, but not the same families. That is to say, that the two types are almost never found in the same family, but it is common for several transkid siblings to transition together, while it is common to find two autogynephilic males in the same family. Another biodemographic is that transkids, as a group, have more older brothers, and more brothers than sisters, than the general population, while AGP TS do not. This means that for both types, the condition has in-born heritable factors, but not the same factors. There is no overlap between the two. This alone is powerful, and likely conclusive, evidence that the two taxons have differing etiologies.
The third statistical finding is that transkids are extremely unlikely to have paraphilic sexual interests, while non-homosexual transsexuals are very likely to have such paraphilic sexual interests such as Bondage&Discipline, latex clothing, auto-erotic asphyxiation, etc.
An additional statistical finding is that the percentage of non-homosexual transsexuals in a country highly correlates with that country’s Hofstede Index for Individualism vs. Collectivism. That is to say, that non-homosexual transsexuals are far less likely to transition in countries that place higher value on collective family responsibility, while transkids are still likely to transition.
Although not often discussed, there is data showing that transkids are genitally “avoidant”, that is to say, that though they will joyfully have sexual relations with their boyfriends, they assiduously avoid contact, and often even visual exposure, of their own pre-op genitalia. Non-homosexual transsexuals however usually have no such reservations, including active participation in vaginal and oral sex, often siring children, with their wives / girlfriends.
Further, there is the curious statistic that while transkids have as a group, average IQ=100, non-homosexual transsexuals exhibit, as a group, significantly higher IQ (127.9 in one clinical study), very unlikely to have happened by chance.
Although still tentative, there is growing evidence that transkids have cross-sex brain features and non-homosexual transsexuals do not, but may have other features, not found in controls, that are not sexually dimorphic.
Non-homosexual transsexuals have the same level of autistic traits as men, which is higher than women, while transkids have the same level of autistic traits as women.
Finally, exclusively feminine androphilic MTF transwomen, transkids, all have a distinctive hormonal (Lutinizing Hormone) response to acute introduction and withdrawal of estrogen which is the same as natal females, while non-exclusively androphilic MTF transwomen do not.
For more information click on the category Confirming Two Type Taxonomy.
Isn’t this “theory” just transphobic propaganda?
Short answer: Not even close
Full answer: Science, and the truth it describes, cannot in and of itself be transphobic. Science is a means of learning about reality. If someone attempts to use science to cast a group in a false light, the attempt itself is self-defeating, in that the science will lead only to truth, by and by. And the truth can never be transphobic.
However, when most people use the word “theory” they typically mean an untested hypothesis, such as a “theory of who really killed JFK”. This is NOT the case here. It is a “theory” in the same sense that we have a “theory of gravity”. A scientific theory is a well-substantiated explanation of some aspect of the natural world that is acquired through the scientific method and repeatedly tested and confirmed through observation and experimentation. As with most (if not all) forms of scientific knowledge, scientific theories are inductive in nature and aim for predictive power and explanatory force. The two type transsexual taxonomy is the result of many already fully tested and retested hypotheses and observations that are actively guiding additional research.
There have been efforts by various members of the transgender and transsexual communities, especially “late transitioning” transwomen, to “discredit” this research, often by false characterizations of the research, researchers, and educators involved. They often mislabel the theory, “pseudo-science” and the people “transphobic”, “crackpots”, “quacks”, and “fringe”, all without a shred of evidence to support their claims other than dislike for the theory. Rather than the science being transphobic, the denial of the taxonomy is itself part of an internalized transphobia, call it “autogynephobia” that leads many transgender people, especially AGP transwomen and cross-dressers, to deny their own autogynephilic sexuality and experiences. Autogynephobic denial also is the root cause of “identity politics” that seeks to disparage transwomen who acknowledge autogynephilia, and to disparage cross-dressers, from whom they wish to distance themselves. This has in turn, led to the coinage of derogatory terms, (e.g. “transcum”), to disparage in their turn those AGP transwomen who don’t acknowledge their kinship with non-gender-dysphoric autogynephiles: cross-dressers, bi-gendered, gender-fluid, etc.
This term and others may also be applied to transkids who publicly acknowledge and celebrate the differences between themselves and AGP transwomen. In fact, special venom is exhibited toward MTF transkids who speak or write about the science, or even just the obvious differences between themselves and AGP transwomen. One can speculate that this is because the example transkids provide so starkly points out the two type taxonomy by their striking contrast.
A common myth that is often stated by members of the transgender community is that, usually unnamed, “scientists” have “disproved” this theory. Nothing can be further from the truth. The scientific consensus is that the two type taxonomy is supported by the evidence and that the two types need different case management, as was detailed by a position paper published by the American Psychiatric Association.
Given that four out of five autogynephilic transwomen readily acknowledge autogynephilic sexual arousal in anonymous studies, a common question that non-AGP people ask is why do autogynephilic transwomen get so upset about the science being publically discussed or written about? Noted science historian, bio-ethicist, and author, Alice Dreger answered this best:
“To understand the vehemence of the backlash against [the two type taxonomy], you have to understand one more thing. There’s a critical difference between autogynephilia and most other sexual orientations; Most other orientations aren’t erotically disrupted simply by being labeled. When you call a typical gay man homosexual, you’re not disturbing his sexual hopes and desires. By contrast, autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name. The ultimate eroticism of autogynephilia lies in the idea of really becoming or being a woman, not in being a natal male who desires to be a woman. … The erotic fantasy is to really be a woman. Indeed, according to a vision of transsexualism common among those transitioning from lives as privileged straight men to trans women, sex reassignment procedures are restorative rather than transformative… to call someone with armour de soi en femme an autogynephile or even a transgender woman – rather than simply a woman – is at some level to interfere with her core sexual desire. Such naming also risks questioning her core self-identity … That’s what talking openly about autogynephilia necessarily does.”
Interestingly, there have been two camps of thought among the opposition of the two type taxonomy in the AGP transsexual community: 1) Outright denial of autogynephila in themselves and other “non-homosexual” transsexuals who may then disparage transwomen who admit to experiencing autogynephilia as “not transsexual = transvestite / cross-dresser “. One of the tactics is to ban all discussion or posts on transgender discussion forums that support the science, leaving most readers to conclude that there is no support. Some of these denialists may recognize autogynephilia exists in transwomen, but insist that they are representatives of a “third type” of transsexual. 2) Admit experiencing autogynephilia, but rationalize it in a number of obviously implausible explanations (e.g. claim it is “normal female sexuality”, projecting their autogynephilic arousal patterns onto natal female individuals, that it was just a coping mechanism for their gender dysphoria, or claim that their autogynephilia went away after SRS). It should be noted that both groups are porous, one may start out in one camp, and shift to another, often because of the pressure of local social norms. — Both groups are wrong, as explained further below.
Less understandable is why some FtM transmen who are mostly transkids, also deny the science. The likely answer is two fold; one is projecting their own experiences onto AGP transwomen uncritically; the other is a sincere wish to be good allies to MTF transwomen, again uncritically. I would invite such FtM transmen to be TRUE allies by studying the science and not uncritically accepting the propaganda from the AGP denialists.
For more information see my essay on this science denialism.
How does “Harry Benjamin Syndrome” fit into this?
Short answer: It doesn’t.
Full Answer: The so called “Harry Benjamin Syndrome” has no scientific basis and is not recognized by the scientific and medical communities. It was made up for political reasons within the AGP transsexual community, largely in an attempt to disassociate themselves from the larger transvestite/cross-dressing community to which they are etiologically and socially related.
Harry Benjamin himself failed to clearly, explicitly, differentiate autogynephilic transsexuals from transkids, though he did know about the difference; In his case histories one can clearly see and recognize both. He correctly describes differences between “young” and “later” transitioning transsexuals as having different sexual orientations, life arcs, and motivations, but chose not to expand on the etiological differences. For example, from his description of his “high intensity” category in his 1966 book, “The Transsexual Phenomena“:
“Intensely desires relations with normal male as “female,” if young. Later, libido low. May have been married and have children, by using fantasies in intercourse.”
Note that he describes “young” as exclusively androphilic, while “later”, meaning older transitioners, being gynephilic, as evidenced by marriage to women and fathering children, accompanied by “fantasies”. He carefully avoids mentioning which sort of fantasies, which he actually knew were autogynephilic. As a physician, he was primarily concerned with alleviating distress. Thus, Benjamin’s typology was based on severity of gender dysphoria, not on etiology. He describes each, but lumps the two types together at each intensity level.
Its also important to remember that Harry Benjamin wrote his book at a time when many, if not most, clinicians were queasy enough about the idea that either type should be provided with HRT and SRS, insisting instead on psychotherapy to dissuade and cure them of their “delusion”. Benjamin knew that psychotherapy had proved itself totally incapable of reducing either type’s gender dysphoria. I believe that he fully recognized the two as separate and distinct, but realized that had he written clearly about the two types as such, the “later” transitioning type might have been denied services, as indeed many clinics in the two decades that followed did so. We should also remember that Benjamin was a very close friend and colleague of Magnus Hirschfeld, a pioneering sexologist, LGBT rights activist, and openly gay man, who clearly differentiated the two types in the early 20th Century, long before HRT and SRS was available, describing what he labeled as “heterosexual transvestite” type as “loving the woman inside”, a clear description of autogynephilia.
What is the connection between transgender and intersex?
Short answer: Very little.
Full answer: Intersex refers to reproductive organs not being fully differentiated, thus the modern term “Disorders of Sexual Development” (DSD). Although transgendered people can have a DSD, most do not. Some very mild DSDs are common enough that a number of male individuals with a mild DSD may also be autogynephilic and subsequently become gender dysphoric; however, in such cases there is no causal relationship. Only a small number of particular rare DSDs have a causal connection with increased likelihood of gender atypicality and gender dysphoria. When it does occur, they are much more like transkids.
What age do MTF transsexuals transition?
Short answer: It depends on which type.
Full answer: The median age of transition for androphilic MTF transkids is 20 years old, with a range of early puberty to mid 20’s. That is to say, that half will have transitioned by age 20, and is nearly unheard of to find one who transitioned after the age of 25.
30% of transkids express severe gender dysphoria before kindergarten, but 75-85% do so by or in middle-school and 100% before they become 18 years old. Remember, all of them will have been gender atypical from birth, but the level of dysphoria grows as they get older, with peaks at pre-school (when they start to realize that boys and girls are treated differently and find it uncomfortable) and in middle-school (when they realize that their bodies are starting to, or soon will, betray them and also that their dreams of family and romance can only be realized if they transition). While the median age for social transition is 20 years old, it would likely be younger if more families were supportive of their transkids.
Given that transkids are transitioning as teenagers and pre-teens (with a small minority at even younger ages), these teens are beginning HRT as young as 12 years old. However, the majority of them are transitioning between the ages of 15 and 22. It is important to understand that transition for these youngsters is that that is the age when they last appeared in public as boys, not when they first appeared in public as girls. The majority of transkids were frequently appearing in public, with their friends, on social outings, at a younger age, the vast majority while still in high school. For example, a transkid that “transitioned” at age 23 is likely to have been going to parties and dates for several years, presenting, and being accepted, as a girl, but presenting as a (feminine gay) young man at school or work. This slow transition is usually a result of parental / familial pressure / obligation until one is able to be economically self-sufficient. It’s also important to note that due to youth and lack of capital, most transkids remain “pre-op” for years before SRS, having socially transitioned, but unable to afford SRS until much later, typically five or more years later.
The mean age for transition for autogynephilic MTF transwomen is 40 to 45 years old, with a range of early 20’s to very old age. It is not uncommon to meet AGP transwomen who transitioned in their 50’s, 60’s, or 70’s, after decades of successful masculine careers, heterosexual marriages, and raising families. But it is extremely rare to meet an AGP who socially transitioned full time before her 20th birthday, though not unheard of. There is a tendency for some AGP males to have a passing, secret, wish to transition in their mid to late teens, which fades for a time as they mature and begin dating and marrying women. This wish then tends to grow stronger again as they reach their early 30s. At some point this desire transforms into gender dysphoria, discontent with their social identity and somatic embodiment as men, leading to transition. The modal (peak numbers ) age of transition is 35 to 40 years of age. In contrast to transkids, AGP transsexuals usually have access to capital which allows them to move very quickly from social transition to SRS, often times pushing the WPATH SOC required “real life test” period of one year to it’s minimum, or even faster.
Given that in Western nations, 70 to 90% of transsexuals are the AGP type, the majority will be transitioning in mid-adult life.
Aren’t transpeople of all types transitioning at younger ages in recent years?
Short answer: No.
Full answer: No. We can see this in studies in Europe that show that the average age of social transition has not changed in over thirty years. If anything, the average age has increased. For example, the percentage that was over age 30 in one study (Sweden) increased from 37% during the 1960s, to 60% in the following three decades. In the United States, we can see that AGP transwomen still transition in mid-life in the Nuttbrock and Lawrence studies from 2009 and 2005 respectively. What is happening is that more young people are visible through social and conventional media, giving the casual observer the false impression of a shift in age of transition. Further, recent changes in law and custom have allowed for greater visibility in schools and other venues, where once such young people had to hide / pass for personal safety.
Aren’t “Early” and “Late” transitioning MTF transsexuals the same, but just transitioned at different ages?
Short answer: No.
Full answer: There is no unifying medical condition (etiology) or overlap and the two types (MTF transkid vs. AGP) are not defined by their age at transition, and can both transition “early”, say 22 years old. They are still very different in clinical presentation: sexual orientation, autogynephilia, natural gendered mannerisms, etc. Age of transition and age of first awareness of gender dysphoria are not the key clinical differences. The two types have distinctly different etiologies and motivations, but may both experience gender dysphoria when young.
Autogynephilic transsexuals can potentially transition at any age, from teenager to old age, but the median age is 35, while the average age is 40. Of the literally hundreds I’ve personally met, the youngest was 21 years old at transition and the oldest was in her 70’s.
However, there is no such thing as a “Late” transitioning MTF “Homosexual” Transsexual (transkid). The average and median age is 20 years old. That is to say, that by age 20, half have already transitioned. Nearly all will have transitioned by age 25 and it is totally unheard of to transition after age 30. If a potentially transkid individual is over 25 years old, they are extremely unlikely to transition. Such an individual will simply continue to live as a gay man. Of the many dozens I’ve met and conversed with the oldest MTF transkid transition age that I’ve personally known was 23 years old, while the youngest was just shy of three years old.
Family support is often the primary deciding factor on age of transition for transkids. Unsupportive parents will resist their child’s desire and need for transition, delaying full time social transition until that child can support themselves.
Again, if you are a transperson or active Ally… Ask yourself this question: Have you ever met a transwoman who was EXCLUSIVELY attracted to men before transition, never had sexual intercourse with a woman, but was sexually active with men, who transitioned in mid-life? That is to say, that they lived as a feminine gay (not bisexual) man until they were 35 years or older?
Further, these statistics have not changed for at least four to five decades, in spite of the misperception that the ages have been coming down, likely due to greater social visibility of transfolk in general. Both personal observation and data from clinics, most notably those in Europe, demonstrate that the mean ages and the percentage of the population that transition have not changed in over three decades of data gathering.
For more information, see my Transgender Field Guide.
Am I too old to transition?
Short answer: No.
Full answer: One is never too old.
How many transgender children grow up to be transgender adults?
Short answer: We’re not sure.
Full Answer: We’re not sure. Simply put, we don’t have enough data yet… there simply isn’t a central data base nor any proper studies that have looked at enough children to follow them as they grow up. However, what we do know is that 99% of gender atypical children do NOT grow up to be transsexual. Most grow up to be bisexual or gay adults. If we narrow down our definition and look at both gender atypical and gender dysphoric, such that they verbally inform their parents and teachers that they wish to be the opposite sex, and are taken to gender therapy, we see once again that not all such children “persist” into their teen years, many “desist” being gender dysphoric. However, we know that most children are never taken to therapist for being gender atypical, so we really don’t know as much as we would like. There is one study that followed a number of children who had been diagnosed as having Gender Identity Disorder (prior to the most recent DSM change to Gender Dysphoria) that only 16% of such children persisted and became transsexual as adults. (It should be noted that under the old GID diagnoses, extreme gender atypicality would be so diagnosed, even in the absence of significant gender dysphoria.)
Note however that the “desistors” will have “desisted” by the time that they are teens. Teenaged transkids will nearly all grow up to be transsexual adults. One of the criticisms leveled at “the transgender movement” is the idea that labeling gender atypical and dysphoric children as “transgender” is abusive and tracking them toward an undesirable outcome (the unstated bias / value judgement being that being transsexual / transgender is undesirable in any and all cases). However, in a ‘harm reduction’ model, being able to identify desisters from persistors is desirable and further, even if we accept the 16% (one in seven) persistence figure as accurate of truly being undifferentiable from desistors, this is still an amazing improvent over random identification as only three in 100,000 children.
For more information see my essay on “persisting” vs. “desisting” transkids.
What is causing the increase in the number of transkids?
Short answer: Nothing, it only seems like there are more.
Full answer: There is NO increase in the number of gender atypical nor the number of gender dysphoric pre-teens or transkid teens. But there has been a very noticeable recent increase in the visibility of these kids due to increased traditional media interest and the echo chamber effect of social media on the web. There also have been advantageous changes to law and public policy in recent years that make it possible for transkids to transition in greater safety and acceptance. However, even with greater public visibility, many transkids still face very unaccepting home and/or school environments, leading to emotional distress, homelessness, or self-harm, up to and including suicide.
It is important to understand, in previous decades, transkids transitioned at the same rates as today. But they did so in secret, as social and legal discrimination made it difficult to do so openly. Prior to the ’70s, many municipalities had laws that criminalized being transgendered and states/countries had laws criminalizing their “homosexuality”. In addition, the standard medical treatment for transkids was “reparitive” therapy, abusive and ineffective attempts to force them to be gender typical and heterosexual. Even now, most transkids will at some point choose to live “stealth”, passing as non-transgendered members of the opposite sex of birth as adults, so as to live fulfilling lives without constantly having to explain their existence. This leads to less visibily of now older (former) transkids.
Another factor is the sad history of the LGBT community’s experience of HIV/AIDS. Many MTF transkids, who being “avoidant” and “bottoms” and far too often forced by parental and social rejection leading to poverty and homelessness, turned to “survival sex” in order to secure food and shelter, were at significant risk of becoming HIV+ and subsequently dying of AIDS. This means that when observing and taking a current census of now older MTF (former) transkids, it appears that there are fewer who transitioned in the decades during and just before the HIV/AIDS epidemic.
Do parents cause children to be transgender by encouraging it, or conversely, by over-reacting to it? Do homophobic parents push their child to transition so that they can have a “normal” child?
Short answer: No.
Full Answer: This is one of those myths from the “blame the mother” movement of the mid-20th century, when just about every psychiatric or behavioral issue was blamed on poor mothering, from schizophrenia to autism. Gender atypicality and/or gender dysphoria is in-born and cannot be caused by how parents nurture their children. Further, there has never been ANY properly controlled study that shows that it is possible to “make” someone be transgendered, or the reverse, to keep someone from becoming transgendered. There have however, been studies that have shown that parental constellations and attitudes do NOT correlate with either gender atypicality or dysphoria.
For more on this topic, see my essay on etiological conjectures.
Can low testosterone make a teen boy feel transgender?
Short answer: No.
Full Answer: The opposite is true.
For autogynephilic boys, increasing testosterone means increasing libido, and thus increasing autogynephilic sexual desire and arousal, which in turn can lead to nascent gender dysphoria in some AGP boys.
On the other hand, for MTF transkids, increasing testosterone brings on very distressing changes in one’s body that intensify somatic gender dysphoria, while simultaneously increasing libido, desires to be with handsome, masculine, straight boys, which is frustrated by daily becoming less like a girl and more like a man.
So, no, low testosterone is never the cause of feeling transgender.
Can therapy “cure” my transgendered child?
Short answer: No.
Full Answer: There has never been ANY properly controlled study that shows that it is possible to make someone be non-transgendered, or to keep someone from becoming transgendered. There have been some therapists who have made claims regarding their successes of “curing” transgender children, but given that most gender atypical young children naturally “grow out of it” by the time they are ten, these therapists are wrongly claiming credit for what is a naturally occurring process. In a few cases, these therapists claimed “cures” which were later shown to have been merely the children telling the therapist what they wanted to hear.
Because attempts to “cure” transkids only causes distress, low self-esteem, and even leads to suicidal ideation, a few states have or are considering outlawing such “conversion” or “reparative” therapies.
Do transgender (transkid) teens ever “grow out of it”?
Short answer: Only Rarely. This is not a “phase”.
Full Answer: While most gender atypical and dysphoric seven-year-olds do desist, “grow out of it”, by the time that they are ten years old, transgendered teens, transkids usually do not. Researchers are still trying to find a means of identifying which seven-year-olds are destined to persist being gender dysphoric into their teens. One sign in MTF transgendered persisters appears to be their extreme distaste and embarrassment of their genitalia, while desisters have less such embarrassment. In FtM transgendered children, persisters are universally attracted to girls, while desisters are universally attracted to boys.
Some teenagers may experiment or attempt to transition but find that they have trouble passing or have other social issues. Since a major goal for transkids is to increase their chances for social success, both generally and romantically, if their experience during these early experiments is less comfortable than pre-transition, they may abandon the attempt. However, for the majority of transkids, they find that they are far more comfortable and socially successful post transition due to their naturally cross-gendered behavior and personality.
There have been a few sensationalized news stories about individuals who transitioned as teens who later de-transitioned as adults, they are exceedingly rare. Being rare examples of individuals who have emotionally unstable personalities they often crave and garner more publicity and news coverage than successful transkids who as a general rule prefer to live quiet lives out of the public’s eye. Also, being rare and “emotional trainwrecks”, the press grants excessive press, in much the same way that the very rare aviation accident has proportionally greater coverage than the tens of thousands of safe flights conducted daily.
If you are a parent or relative of a transgendered teen, you may wish to read my advice to parents.
For more information see my essay on Persisting vs. Desisting
Would a transgender child (transkid) who goes through puberty without a blocker end up not wanting to be transgender?
Short answer: No.
Full answer: While many gender atypical and gender dysphoric children desist in their desire for transition before the age of 10, puberty which is at age 12 to 14 does not affect gender atypical behavior nor gender dysphoria. If anything, it increases it, as the changes that occur are very distressing to transkids.
Should transgender teens (transkids) be treated with HRT and SRS?
Short answer: Absolutely.
Full Answer: Research has shown that “early onset” trankids do very well when they can transition in their early teens and obtain Hormone Replacement Therapy before endogenous hormones have had to time to make adverse somatic changes. Consider that not being on HRT or Lupron is the same as being on HRT, but in the opposite sense, as puberty will determine the direction of somatic changes rather than the controlled (and desireable) changes from exogenous HRT. Teens as young as 12 have been getting hormones on their own, from the street. In fact the first MTF transkid to have had surgery in the US was originally thought to have been intersexed, but was in fact stealing her mother’s birth control pills since the age of 12. These teens have demonstrated very good functioning as adults. Transkids in official clinics and programs often have to wait until they are older to switch from puberty blockers to HRT, which is both unnecessary and cruel, keeping transkids looking prepubescent and “in between sexes” while their peers develop naturally. Further, requiring transkids who have socially transitioned to wait years as ‘pre-op’ is doubly cruel and dangerous, potentially exposing teenagers to transphobic violence.
Do transgender people make good parents?
Short answer: Yes.
Full Answer: There is excellent data in a study by Dr. R. Green that AGP MTF transfolk make excellent parents both before and after they transition and that their children are emotionally and psychologically healthy. FtM transmen have been shown to be excellent fathers to their wives natural children. There is very little data on MTF transkids, since they rarely (if ever) become natural parents and must adopt or become step-parents. Children who are adopted usually come from homes where their natural parents were unable to properly care for them, so they usually come with problems before they are adopted, so care must be exercised when evaluating such adopted children of MTF transkids, lest erroneous negative conclusions are reached. Its a sad fact that since very few successful young transitioning transwomen are publicly visible, preferring to live very quiet lives, has meant that there are no published papers on MTF transkids who have adopted children. This author can say from personal experience, if she must say so herself, that at least one such adoptive mom is a great parent(!).
What is the difference between early transitioning transsexuals and feminine male and masculine female homosexuals?
Short answer: We don’t fully know.
Full Answer: It would appear that transsexuals of this type and Gays/Lesbians may have a very similar biological etiology, showing similar biodemographics, being on the same “taxonomic spectrum”. They are nearly behaviorally indistinguishable from one another before the age of ten. But starting around the age of seven to ten, gay men become less feminine in some respects, while MTF transkids become more feminine. This process seems to be finished around 25 years of age for both populations. This striking uniformity of development in each group suggests a biological underpinning to the difference between transkids and gender atypical homosexuals. In FtM a similar thing appears to happen regarding masculinity. Unfortunately, we have less data on FtM differences, largely because the funding for the research was cut off during the middle of the longitudinal study by Richard Green M.D. that began in the 1960’s following a cohort of “tomboys”.
Thus, the evidence suggests that MTF transkids and feminine gay men are on the same etiological continuum, but with a divergence in development around age 7-10 or so. As with the age old “nurture vs. nature” argument found for many behavioral differences in human populations, there appears to be contributions from both intrinsic differences and cultural factors in the difference between transkids and conventional homosexual persons.
For more information see my essay on Persisting vs. Desisting and my essay on the biological similarity between MTF HSTS and gay men. You may also be interested in my speculations on the etiological difference.
Aren’t “homosexual” transsexuals just “conflicted” or “self-hating” homosexuals who transitioned so that they can say that they aren’t homosexual?
Short answer: No.
Full Answer: This is one of those myths that has persisted from the mid-20th century when being gay was far more stigmatized (even criminalized) than today. Today, no serious sexologist believes this. Transkids, both FtM and MTF are never “conflicted” about their sexuality, have never felt guilt about it, nor feared that others may perceive them as homosexual. In fact, many have lived as openly “lesbian” or “gay” (respectively) before transition and continue to be active in the LGBT community afterwards, though certainly not all. Further, most (75%) transkids experience severe gender dysphoria as pre-adolescent children, BEFORE they become aware of their sexuality, which persists past their growing awareness of same natal sex attraction.
Let’s apply some common sense, which is more likely to be the result of internalized homophobia?
A) Changing Sex?
B) Hiding in the Closet?
Some autogynephilic transsexuals sometimes do make the claim that transkids are “homophobic homosexuals” or else try to sarcastically claim that supporters, researchers and educators, of the two type taxonomy are the ones who characterizes transkids as “homophobic homosexuals”or “ego dystonic homosexuals”. There is a variant of this, in which those autogynphilic transsexuals who oppose the scientific evidence for the two type taxonomy, sarcastically characterize the theory as describing transkids as “failed homosexuals”. As per above, neither is true.
Well, I read that homosexuals in Iran are transitioning so that they can say that they aren’t homosexual; what about that?
Short answer: Not true
Full Answer: This is a misconception from the gay community which justifiably is horrified at the horrendous mistreatment of gays and lesbians in Iran and indeed many other parts of the Middle East and Africa. However, Iran has the SAME rate of transition and SRS as Thailand, where gays/lesbians are just as accepted as transkids. Interestingly, the typical range of transition in Iran is exactly the same as for transkids in the West. Further, if you understand that gay men and lesbian women out number transkids by approximately 1000:1, if Iran’s rate of SRS was due to attempts to escape homophobic discrimination, we would expect that Iran would have tens to hundreds of times more people transitioning than Thailand. That simply is not happening. So why is the gay community perpetuating this myth? Simple, because, in spite of a lot of recent progress toward acceptance of transsexuals in Western Society, there is still a bone deep prejudice against transpeople, even in the LGB community… and the idea that gay people have to undergo, well, you know, that stuff… is a powerful image that invokes revulsion, disgust, and even horror. Thus it makes good propaganda copy… even as it belittles the transkids who live in Iran.
Let’s apply some common sense, which is more likely to be the result of wishing to escape homophobia in Iran?
A) Changing Sex?
B) Emigrating to nearby Turkey?
I also read that “homosexual” MTF transsexuals are just gay men who transition so that they can have sex with straight men, is that true?
Short answer: No.
Full Answer: This is one of those myths about MTF transkids that is a misinterpretation, sometimes deliberately and sarcastically, of the Freund / Blanchard two type taxonomy. MTF transkids do want to have sex with straight men, so that part is true. It helps to be like straight women, of course. But that is not the only reason. Other reasons include being valued, as feminine women are far more valued than feminine men. But a big reason is to be more successful in social settings, being comfortable and spontaneous, fitting in better with the rest of society, as people expect men and women to behave in certain common, typical ways. But, as feminine “men” / “boys”, transkids simply don’t fit the mold, which constantly leads to personal discomfort, embarrassment, and misunderstandings. It also leads to reduced social cooperation, opportunities, etc. It can even lead to homophobic harassment and violence. Simply stated, transkids, of both natal sexes, fit into society with less confusion as the opposite social gender. Transkids usually come to this conclusion fairly young, as pre-adolescent children, as toddlers even, BEFORE they become aware of their sexuality. As well as social motivations, transkids also have a deep seated somatic gender dysphoria, an embarrassment and hatred for their sexed body which feels alien. (But yes, it’s also more satisfying for a feminine MTF transkid to be in the arms of a loving straight boyfriend/husband, who wants a feminine girlfriend/wife, rather than a gay man who wants a masculine partner.)
Let’s apply some common sense here, which is more likely for a gay man who wants a boyfriend/husband?
A) Changing Sex?
B) Signing up for a Grindr account?
So this means that if transkids could live in a social environment, family, society that is accepting of male femininity that they would rather live as gay men?
Short answer: No.
Full Answer: Again, gay men want masculine partners! MTF transkids are too feminine for gay men to be attracted, which prefer the “straight looking / straight acting” ideal. Also, while several societies are far more accepting of feminine males, MTF transkids in these societies are still likely to live as closely as possible as women. In fact, one nation, which is one of the most accepting, Thailand, has perhaps the highest rate of Sex Reassignment Surgery (SRS) in the world.
Why do some early transitioning transsexuals become prostitutes?
Short answer: Because they have little other viable choice.
Full Answer: Research shows that about one out of three MTF transkids is either disowned by or is emotionally and/or physically abused by their families as teenagers such that they become street kids. All street teens, not just transkids, are at risk of turning to “survival sex” to find food and shelter. MTF transkids who are cared for and valued by their families do not become “prostitutes”.
For more information, see my essay on Stereotypes of Transwomen.
What is autogynephilia?
Short answer: The propensity for some natal males to find the thought of becoming or being feminine/female to be sexually arousing.
Full answer: The word comes from “auto”, meaning ‘self’, “gyne”, meaning ‘female’, and “philia” meaning ‘love’. In other words, the “love of oneself as a woman”. This is a sexual orientation in which the preferred erotic target, femaleness / femininity is sought after on oneself. Thus it is one of many possible Erotic Target Location Errors. It can take many forms, from being aroused by temporarily simulating the appearance of a woman, that is cross-dressing in clothing that is culturally prescribed for women only, to living as a woman in society, full time, to “changing sex”. Over time, the overt level of sexual arousal may diminish, but the “love” of being feminine/female remains. Think of this as analogous to the way that men often find their wives less sexually arousing over time, but still very much love them. Autogynephilia is not only about sexual arousal, it also includes aspects of desire and romantic love. In a very real sense, autogynephilic transsexuals “fall in love” with their idealized feminine image / persona, wishing to give her greater life and expression.
For more information see my essay Autogynephilia
Can gay (homosexual) men be autogynephilic?
Short answer: No.
Full answer: Autogynephilia which is a form of Erotic Target Location Error, depends upon and simultaneously competes with gynephilia, the sexual and affectional attraction to women. Gay men aren’t attracted to women and thus don’t experience autogynephilia. Only straight or bisexual men can be autogynephilic.
Is there a quiz or test for autogynephilia?
Short answer: Yes.
Full answer: This simplest test/quiz is, “Do you, or did you once, find the thought of being or becoming female/feminine sexually arousing?” and “Do you, or did you once, find wearing wearing women’s clothing to be sexually arousing?” If the honest answer to either question is “yes”, then that individual is, by definition, autogynephilic. 85% of of both gynephilic MTF transsexuals and cross-dressers readily answer “yes” to one or both of these questions.
Another test is to detect sexual arousal directly using a device to measure penile volume (pre-op) or neo-vaginal blood flow (post-op) while the subject is listening to cross-dressing erotic narratives; All non-homosexual MTF transsexuals and cross-dressers show sexual arousal to such narratives, even those who verbally deny such arousal, while heterosexual male controls (known non-autogynephilic) do not.
For more information read my essay on a recently developed instrument to study autogynephilia.
What is partial autogynephilia?
Short answer: The propensity for some natal males to find the thought of becoming or being partially feminine/female to be sexually arousing.
Full answer: Partial autogynephilia refers to the sexuality of males who are sexually aroused at the idea of becoming partially feminized, usually by having female breasts and while retaining male genitalia. Men who experience partial autogynephilia are most often also sexually attracted to pre-operative MTF transsexuals, especially MTF transkids. They may also find cross-dressing and “accidentally discovering” their own male genitalia hidden by feminine clothing to be sexually arousing.
For more information see my essay on Partial Autogynephilia
What is an Erotic Target Location Error?
Short answer: The propensity for some individuals to find the thought of becoming or being their preferred erotic object to be sexually arousing.
Full answer: For every erotic target / sexual orientation there are also a minority of people who map that erotic object onto themselves. For example, a heterosexual pedophile will also find the thought of being or becoming a young girl to be sexually arousing. Autogynephilia is an erotic target location error in that they map their adult gynephilic sexual attraction onto themselves.
Can autogynephilia lead to gender dysphoria?
Short answer: Yes.
Full answer: Yes, but not always. Most men who experience autogynephilia do not become gender dysphoric. They remain cross-dressers / transvestites. However, the need for cross-dressing is very often progressive and leads to gender dysphoria, which in turn may lead to AGP transsexuality.
Does a “female gender identity” or “gender dysphoria” cause autogynephilia?
Short answer: No.
Full answer: Not all autogynephilic males identify as women. Even in those who later transition, female self-identification often occurs only years after intense erotic cross-dressing or other autogynephilic ideation surfaces in childhood or adolescence. The case histories, though not necessarily their narratives, of AGP transsexuals strongly suggests that autogynephilia causes gender dysphoria and subsequent female self-identification, not the other way around.
One of the best documentations that autogynephilia is the root cause of non-homosexual transsexuality was done by Doctor and Prince (an MTF transgendered individual herself) , who showed that cross-gender identification was most commonly preceded by years of autogynephilic cross-dressing, that transvestism and non-homosexual transsexuality are both a continuum and a progression.
Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity.
Note the congruence between the average number of years cross-dressing before adoption of a feminine name of 21, added to the average age of puberty at 14, (14+21=35) and the modal age of transition for non-homosexual transsexuals at age 35.
For more information on the likelihood of autogynephilia as the cause of gender dysphoria see my essay on applying Hills’s criteria of causality.
Further, consider that those MTF transsexuals who transition earliest, who are the most innately and spontaneously feminine, who one would expect would have the greatest gender dysphoria and strongest “female gender identity” from early childhood, MTF transkids, never develop autogynephilia.
For more information, see my essay on The Origins of Cross-Gender Identity in Transsexuals.
Aren’t natal female women also autogynephilic?
Short answer: No.
Full answer: While it may be comforting to autogynephilic individuals to imagine that their very unusual and intense sexuality is the same as, or at least similar to, natal women, it is not. Most women are sexually attracted to their sexual partners. They are aroused by sexual ideation in which their partner is the significant figure, not themselves, their own appearance, nor their mode of dress, which, if present, is of a supporting, rather than leading role.
This notion is popular among autogynephilies because it both reduces shame for experiencing autogynephilia and feeds (if incorrectly) their own autogynephilia by imagining that their sexuality is like women’s. It is common to point to behaviors such as wearing “sexy” undergarments as “proof” that women have autogynephilia, incorrectly projecting their own autogynephilic arousal to wearing such articles onto natal females. Women wear such garments for various reasons, to increase their appeal to their lovers and or to bolster self-esteem as being desirable… but do not find being female, nor wearing garments socially prescribed for women, to be sexually arousing in and of itself the way that autogynephilic males do.
Although there is a single paper, by C. Moser, which purported to have found autogynephilia in women, it in fact did not. The test instrument (questionnaire) he devised was cleverly written to obtain positive answers to ambiguous questions that only superficially resembled questions used in instruments that are only valid for gender dysphoric males. For example, one question asked if one fantasized about having a “sexier” body? (One would hardly expect that women would fantasize about having an uglier one!) Another question asked about becoming aroused while preparing for a sexual encounter with a lover. (Such arousal would arise due to anticipation, not the mere fact of getting dressed in women’s clothing!) The construction of the test instrument cannot measure autogynephilia in natal females.
Thus, the paper is of no scientific value in exploring the nature of women’s sexuality; but that was likely not the goal of the author. The likely goal was casting doubt on the existence and role of autogynephilia in transwomen, which looking at the popularity of this paper among “late transitioning” transwomen, it acheived.
For more information about this study, see my essay on the lack of validity of Moser’s paper.
Aren’t some exclusively androphilic MTF transsexuals also autogynephilic?
Short answer: No.
Full answer: Research has shown that autogynephilia only occurs in the presence of gynephilia, since it is a form of Erotic Target Location Error. Exclusively androphilic transsexuals don’t have autogynephilia because they aren’t gynephilic, just as heterosexual natal female women are not autogynephilic because they aren’t gynephilic.
Using questionnaires and single item questions regarding sexual orientation of transsexuals only statistically (partially) separates etiologically exclusively “homosexual” transsexuals from non-homosexual transsexuals. The confusion occurs largely because of the phenomena of pseudo-androphilic autogynephilia, in which an individual’s behavioral and interpersonal autogynephilic sexual ideation includes sexual acts, as a female, of sex with men, show up in the studies in the “androphilic” study group by mistake. But such individuals are not originally, nor predominantly attracted to men; their attraction is to taking the female role in sex with men. Scientists, using statistics, can accept and account for this as “noise” in the signal. One can reduce the number of such individuals by using interviews to obtain more of the actual sexual history, most particularly, their history of sexual experiences with women, as exclusively androphilic transsexuals will not have had genital sex with women. However, due to social desirability bias, many autogynephilic transsexuals down play their sexual history with women. The most reliable indicators are their history of marriage to women, pre-transition, and fathering children, as these are a matter of public record. Using such reliable indicators, two studies both showed that 38% of previously gynephilic transwomen reported a change to androphilic during transition. However, this was not true androphilia and their sexual behavior did not match that of life-long exclusive androphilic transwomen.
For more information, see my essay on Pseudo-Androphilia.
Aren’t there gynephilic and bisexual MTF transsexuals that aren’t autogynephilic?
Short answer: No.
Full Answer: Although studies nearly all indicate that only 85% of exclusively gynephilically identified transsexuals self report that they experienced autogynephilic arousal to cross-dressing, this isn’t the only form of autogynephilia. Further, even studies of self-identified transvestite / Cross Dressing (TV/CD) men show that only 85% report such arousal, though we know that 100% of them do experience such arousal; One study showed that gynephilic gender dysphoric MTF candidates for SRS who stated that they did not experience sexual arousal to cross-dressing, did in fact have measurable penile erections when listening to cross-dressing stories. So, it appears that 85% is the maximum percentage of individuals from either group that will recognize and admit to such arousal, even though it has been demonstrated that they do experience such arousal. This is likely to be the result of Social Desirability Bias in responding to the question in both groups. For many, in a sex negative / ‘phobic society, to admit to such arousal would be admitting to a very negative personal trait. This applies even more so today for transsexuals, given the negative position such admission puts them into with regards to other transsexuals (who are themselves likely to be autogynephilic) who stigmatize those who publicly admit to being autogynephilic.
Denial of autogynephilia at 15% is eerily similar to the percentage (12.3%) of individuals living in California who use cigarettes, but do not admit that they are “smokers”, again likely to Social Desirability Bias as smoking has become a very socially undesirable habit in that state. (Reference: http://tobaccocontrol.bmj.com/content/early/2014/02/05/tobaccocontrol-2013-051400)
For more information see my essay on Social Desirability Bias in transsexuals.
In bisexual identified MTF transsexuals, their interest in men is a function of their autogynephilic sexuality, not a genuine independent sexual interest. That is to say, that they are not attracted to men per se, but to autogynephilic role playing, taking the female role in sex with men. Further, many AGP transwomen feel that being “heterosexual”, attracted to men, is the proper role for women, so will focus their social impression management efforts on finding, attracting, and maintaining a relationship with a man. Often, the men who they find are themselves, also AGP and gynandromorphilic (See below).
If CrossDressers and CrossDreamers are also autogynephilic, what is the difference between them and autogynephilic transsexuals?
Short answer: The type, intensity, and years of experience of autogynephilic ideation.
Full answer: The difference between crossdressers and AGP transsexuals is not a matter of kind, but of degree. Classic crossdressers are typically satisfied with temporarily modifying their appearance. But, when one’s autogynephilic ideation includes anatomic features, especially female genitalia, that can’t be done temporarily. Research has shown that there is a very strong correlation between such ideation and later decision to transition. In addition, there is tentative evidence that interpersonal autogynephilia plays a role in the desire to transition. The majority of those that later transition experienced erotic arousal during crossdressing for years before they transitioned. Thus, crossdressing and AGP transsexuality is both a continuum and a progression.
A classic joke in the transgendered community is, “What’s the difference between a transvestite and a transsexual?: Two years!”
What is Gender Fluid, BiGender, Gender Transient, or Dual-Gender?
Short answer: An identity accommodation of autogynephilia (or autoandrophilia).
Full answer: BiGender identity is an accommodation / resolution of the cognitive dissonance between the socially formed natal sex congruous core identity and the internal autogynephilic (or autoandrophilic) image in sexual fantasy. It reduces the need to reconcile one’s social identity as one sex, and one’s erotic ideal as the other. BiGendered individuals may have an active social life as both genders, usually in separate social circles. In other words, this takes crossdressers out of the closet and into the public realm in a socially acceptable manner. It may also be understood as a half-way transition for autogynephilic transsexual individuals who for familial or career reasons, do not wish to transition full time.
Sometimes gender atypical teens or young adults are labeled as “gender fluid” when they have not yet fully established themselves over the gender line in an unambiguous and permanent transition.
For more information see my essay on the development of crossgender identity in transgendered people.
What causes autogynephilia?
Short answer: We don’t know.
Full answer: Seriously, we don’t know. But we do know what doesn’t cause autogynephilia.
It is not caused by being forced to wear girls clothes as a child or teen (though that is a common autogynephilic sexual fantasy and occasional rationalization).
It isn’t caused by sexual curiosity. Autogynephilia drives the cross-dressing, not the other way around.
It isn’t associated with being gender atypical as a child. (Most autogynephilic males were considered to be very typical boys growing up, by parents and teachers.)
It isn’t caused by an overly smothering mother or distant father, emasculinization (castration) anxiety and emotional trauma, or a defense mechanism against Oedipal conflicts (debunked psychodynamic formulations by Freudian pseudo-scientists).
It is not caused by accidental cross-dressing and finding it “exotic” (a misapplication of Bem’s “exotic becomes erotic” theory of sexual orientation, which itself is a nonsense that depends upon the anti-evolutionary idea of human exceptionalism, since “homosexual” animals wouldn’t fit the theory.)
It is not caused by erotization (fetishizing) of misogyny (a popular misconception held by a minority of women).
It is not caused by sublimating homosexual tendencies (debunked psychodynamic formulation).
It is not caused by a “coping mechanism” for dealing with gender dysphoria or being feminine in a male body (a common rationalization).
It isn’t caused by estrogen or lack of androgens, either in utero or post-natally.
And it most certainly is not caused by having a female gender identity (see above).
Our best guess is that it is a form of Erotic Target Location Error, in which the erotic target, femininity / femaleness, is sought on / within oneself, rather than sought after in other people. It is thought that there is an evolutionarily “designed” function in the brain that serves to ensure that one doesn’t seek one’s preferred erotic target on oneself, a sort of “look elsewhere” circuit. One item of evidence that this exists is the fact that homosexual individuals seek out same sex partners, other people. If such an individual, say a gay man, were merely looking for a male body, he could simply look down or in the mirror and be self-sufficient. But this simply doesn’t happen (at least not often). There are hints that part of the brain responsible for seeking out the erotic target in the environment is somehow different, likely from birth, in people with Erotic Target Locations Errors. These brain differences appear to be inheritable, and thus not of psychogenic origin. The inheritable factor can effect both natal male and female siblings, but is far more likely to effect natal male children.
For more information see my essay on Erotic Target Location Errors
We have strong evidence that autogynephilia is a form of Erotic Target Location Error because researching amputation “wannabees”, people who wish to, or have had, voluntary, non-medically necessary, amputations scientists find that not only are they sexually attracted to women who are already amputees, but roughly 50% of them also want to change sex to that of their sexual target, exhibiting autogynephilia and gender dysphoria. This high correlation demonstrates that autogynephilia and “wannabee-ism” are both erotic target location errors. Although there are homosexual amputation “wannabees”, they never exhibit gender dysphoria, since their erotic target is other men.
For more information see my essay on the high co-morbidity of “wannabee” and autogynephilia
The result of living with and attempting to accommodate and integrate an Erotic Target Location Error into one’s self concept causes an Erotic Target Identity Inversion. In the case of autogynephilia, that Erotic Target Identity Inversion is to identify oneself as a woman.
Is there a “cure” for autogynephilia?
Short answer: No.
Full answer: Autogynephilia is not like a fear of flying… it is an innate, likely genetic or epigenetic, functional trait that runs in families. Through much of the 20th Century, a number of psychiatrists, psychoanalysts, and reparative therapy quacks tried to “cure” autogynephilia with no effect other than to make their clients miserable. Autogynephilic sexuality cannot be changed, only accommodated. One of those potential useful accommodations is social transition and HRT + SRS.
However, it has been often clinically noted that an AGP transsexual will drop out of a course of treatment leading to transition or “de-transition” (return to male social role), even after SRS, when they fall in love with a woman (or another MTF transsexual). This is because autogynephilia depends upon and simultaneously competes with heterosexuality. The sexual and emotional pair-bond with a woman can reduce autogynephilic desire and gender dysphoria in at least some individuals.
Paradoxically, HRT, the very thing that many AGP individuals seek, and especially anti-androgens, including MPA, sometimes reduces the libido sufficiently to reduce and occasionally, at least in some individuals, to eliminate the desire to cross-dress, pursue transition, and SRS. However, for most individuals, HRT may blunt overt autogynephilic sexual arousal, but not associated desires.
Do all transsexuals transition?
Short answer: No.
Full answer: In one sense, this could be seen as a tautology, since if we define “transsexual” as someone who has transitioned and had SRS, then by definition they would have had to have transitioned. But, the question really asks, “do all people who are gender dysphoric transition”? And the answer is most definitely “no”. For what ever personal reasons, all of the potential transsexual types do make decisions about their lives, for or against transition.
It is very clear from the data, that AGP individuals are far more likely to transition if they live in societies that are individualistic, that is, that they are more free to follow their own needs, rather than their extended family’s, and if they also have greater financial and social resources. Even in individualistic societies, family concerns may delay, perhaps indefinitely, plans for transition. Further, studies show that bonding with a female partner, or another MTF transsexual, often suppresses the need/desire for transition. AGP individuals may transition at any age from late teens to very old age. Obviously, some must not transition at all. If they don’t transition, they may continue to live simply as crossdressers or crossdreamers.
For more information see my essay on the correlation between society individualism and AGP transsexual incidence.
The data is far less clear regarding MTF transkids. But, there is some suggestion that if they are not physically feminine enough to successfully pass as female, they may elect to live as feminine gay men, perhaps as drag queens. But in any event, if they have not transitioned full time by age 25, they are extremely unlikely to transition later.
For more information, see my essay on transkids passing and transition decisions.
Which type of transsexual does best after transition?
Short answer: It depends.
Full answer: In many ways, FtM transkids who transition as teens or early 20’s do the best overall, for a variety of reasons. First, FtM transsexuals simply pass better after a few years of masculinizing HRT than either of the MTF types, as a group. Second, it is easier for them to find female partners who are understanding and accepting, given that both straight and lesbian women in general are more likely to have fluid, less rigid, sexualities and less prone to sexual orientation identity anxiety than men.
The autoandrophilic FtMs also seem to do well, but there is very little solid data on which to base this upon.
Autogynephilic transsexuals who successfully adjust to their nominally female role, tend to have very emotionally satisfactory lives. Due to a self-selection effect, most AGP transwomen start out with higher socio-economic status and very often retain the benefits of earlier straight male privilege. Divorce is a common problem, though many maintain marriages to their wives, or find new lesbian or bisexually identified female partners. Or, they may find another AGP transwomen or Cross-Dresser as a partner. However, perhaps due to difficulties passing, with attendant transphobic discrimination, they also have the highest incidence of de-transitioning, returning to public identities as men, both before and after SRS, of all of the types. They also have far, far higher reported rates of post-operative regret. This is why the WPATH Standards of Care for transgendered people were instituted, in the hopes that such rates of post-op regret may be kept to a minimum.
MTF transkids are often more physically feminine than their AGP peers, possibly due to self selection, innate hypomasculinity (i.e. what ever caused their brains to be less masculine, also caused their bodies to be less masculine), and simply starting HRT at a younger age. Further, they have naturally feminine mannerisms and motor skills. This allows them to pass better than AGP transsexuals.
However, MTF Transkids have significantly higher likely-hood of becoming homeless, unemployed, or underemployed, than the other types due to parental abuse and/or rejection, both before, and most especially after, transition. These kids are at high risk for substance abuse and transphobic violence. Due to family rejection, lack of support, transkids, both MTF and FtM, are less likely to attend college, and thus, as a group, have significantly lower socio-economic status.
Moreover, given that MTF transkids are exclusively androphilic (attracted to masculine straight men), they have the greatest difficulty finding partners due to the greater sexual orientation identity anxiety of straight men. This leads to MTF transkids often having a long series of short term relationships, as these straight male potential partners find their early infatuation phase gives way to growing fear of discovery of their transsexual lover’s medical history by friends and family, if she is not rejected outright upon learning of her transsexual status.
This problem of finding long term partners has led to a misunderstanding by both the public and the health care community, that has led to a false stereotype that MTF transkids (homosexual transsexuals) are innately promiscuous and emotionally unstable. In fact, the reverse is true. When MTF transkids find understanding partners, they tend to bond very tightly to them, even if these men are otherwise less than ideal partners. Sadly, the lack of monogamous long term partners, in combination with turning to sordid means of survival when homeless as teens, also means that MTF transkids have higher rates of sexually transmitted diseases, including HIV/AIDS.
Although there have been a few high profile examples of successful MTF transkids, as a group, they are the least successful post-transition. However, those whose families helped them to transition in their early teens, and continue their education into college/university may do better than those unfortunates who lack familial support.
What is Gynandromorphophilia or Gynemimetophilia?
Short answer: Sexual and affectional attraction to MTF transsexuals, especially pre-operative.
Full answer: The first word comes from “gyne”, meaning “female”; “andro”, meaning “male”; “morpho meaning “body shape”, and “philia”, meaning “love”. Thus the word means the “love of males with a female body shape”. The second word comes from “gyne”, meaning “female”; “mime” meaning “mimic” or copy, and “philia”, meaning “love”. Thus, the love of those who mimic females. This is the sexual attraction to MTF transsexuals, most especially pre-operative transsexuals. The two words are nearly interchangable, though some authors have given each more restricted definitions, which are often contradictory with other authors.
It is well recognized that autogynephilic individuals, both AGP transsexuals, and transvestites/cross-dressers, are also likely to be gynandromorphophilic. However, not all gynandromorphophilic individuals are autogynephilic. Such individuals are most likely male, as gynandromorphophilia is commonly found alongside simple gynephilia, and men are more likely to be gynephilic than women. But some women who are primarily androphilic, or bisexual, occasionally also experience gynandromorphilia if they are attracted to feminine behaving males (e.g. ‘fag hag’ as well as ‘transfan’). Gay men are the least likely to be gynandromorphophilic, in spite of media stereotyping to the contrary.
For more information see my essay on Gynandromorphophilia.
Are MTF transsexuals taller or shorter than non-transsexuals?
Short answer: It’s complicated.
Full answer: Non-homosexual (AGP) transsexuals are, as a group, exactly average height compared to non-transsexual men, as a group. But since in everyday situations we usually compare transwomen to non-transsexual women, not men, they seem far, far taller than average, as a group.
However, many clinical observers have noted that MTF transkids are shorter and slighter than non-transsexual men, but taller and huskier, than non-transsexual women. One Canadian study tested this observation and found very robust evidence that this was true. But another study in a Netherlands clinic failed to replicate the finding. So, at the present time, we are still waiting for definitive answers. (From personal observation in the USA, I do believe it is true, MTF transkids are indeed shorter than AGP transsexuals, as a group.)
It should be noted that HRT after having reached full adult age, will not affect height, but starting HRT in very early teens might. Although this might account for some of the height difference between these two populations, there are also studies that show that gay men in general are also shorter than male average. Meaning, that androphilic males, whether transkid or gay man, are both shorter than average.
For more information see my essay Searching High and Low
Is there a map of the brain showing where one’s gender identity is located?
Short answer: No.
Full answer: No, seriously, no. There is no part of the brain which defines or tells an individual what sex/gender one is. Further, in spite of the trope of having a woman’s brain in a man’s body, etc. There is no direct way that one’s conscious mind can interrogate the brain to determine this, even if one’s brain has failed to be masculinized (MTF) or been masculinized (FtM). Humans are animals, mammals, primates, etc. We evolved a large and “intelligent” brain. But evolution never was required to develop such a “gender identity” neural circuit. Instead, the brain evolved to facilitate and reinforce sexually dimorphic behaviors. To the degree one can compare one’s own such sexually dimorphic behaviors to others, one can learn of their gender typicality vs. atypicality. This may influence one’s sense of where one fits into the social schema we call social gender and from that develop one’s personal “gender identity”.
For more information see my essay on the Origins of Cross-Gender Identity in Transsexuals.
There is a popular notion, a myth, that transsexuals’ somatosensory body map are cross-sexed. We have NO evidence of this. There was one paper purporting to have shown this in MTF transwomen, but that study lacked proper controls or enough subjects. Further, there are some serious theoretical objections to this idea that would have to be addressed.
For more information see my essay on somatosensory body maps.
Do FtM transsexuals have “male brains”?
Short answer: Sort of.
Full answer: MRI imaging suggests that the majority of FtM transsexuals have masculinized brains, likely due to organizational effects of androgens in utero. However, they are not fully masculinized until they begin testosterone, since there are activational effects of HRT.
Do MTF Transsexuals have “female brains”?
Short answer: It’s complicated.
Full answer: The evidence for feminine, exclusively androphilic transsexuals is that they share certain neurologically feminized features, since birth. These features are believed likely to have been influenced by a lack of androgens (“male” hormones) in utero at specific times in the development process. There have also been suggestions that a genetic or epigenetic difference in the genes that code for androgen receptors may also play a role. Further, there is evidence that immunological factors in mothers contribute to perhaps 15% of the MTF transkid population, as each successive male born to a given woman is more likely to be homosexual or transkid. The extent of such feminization is likely to vary from individual to individual, so it is unlikely that most exclusively androphilic transsexuals are completely feminized, though a few may be close.
In AGP transsexuals, there is no evidence that they have feminized brains prior to HRT, quite the contrary. But, there are papers that suggests that autogynephilic transsexuals have several neurological features, (e.g. high levels of grey matter in the right putamen) that is different than both men and women before beginning hormone replacement therapy. We simply don’t know what these differences mean yet.
However, there is strong evidence that taking female hormones alters other neurological features (e.g. BSTc) toward the feminine morphology. This is likely due to the absence of androgens, as castrated men show the same shift. Thus, both types have more feminized brains, due to taking hormones, than non-transsexual males. Thus, one could say, with all honesty, that after years of taking female hormones, anti-androgens, and SRS, that AGP transsexuals do, in a certain sense and limited extent, have “female like” brains.
For more information, select the blog category, Brain Sex.
Can scientists identify who is transsexual from brain scans?
Short answer: No.
Full answer: While there is increasing evidence that the two types of transsexuals each have different neurologically identifiable features, this is still only discernible statistically. That is to say, that on average these features are different than controls, on average. But any given individual’s brain is too variable from that average to determine if they are transsexual or not. In point of fact, we can’t determine from their brains, if any given individual is male or female. The brains of men and women are not sufficiently sexually dimorphic for such a determination.
Didn’t a study find that the BSTc proved that all MTF transsexuals have female brains?
Short answer: No.
Full answer: For a short while, many thought that the BSTc, a sexually dimorphic feature in the brain, was female-like in older transitioning transsexuals. This would only have been interesting if it had been that way since birth, or at least since before HRT. However, it was later found, by the very same researchers, that the BSTc was only sexually dimorphic after puberty, that the amount and time of exposure to testosterone as teenager and adult, changed the size of the BSTc. Hormone Replacement Therapy (HRT) was entirely responsible for the change in BSTc found in transsexuals, as HRT and SRS reduces the size and neuron count of the BSTc and other features. The same is true of the INAH3, another sexually dimorphic brain structure that has been put forward as showing that transsexual have feminized brains, but this too has been shown to have been caused by HRT.
For more information, select the blog category, Brain Sex.
Does transsexuality or transgender run in families?
Short answer: Yes.
Full answer: The two types do tend to run in families, but not the same families. That is, autogynephilia (and autoandrophilia) tend to run in a given family while homosexual transsexuality and conventional male homosexuality tend to be found in their own families. The likelihood that an exclusively androphilic MTF transsexual will have an exclusively androphilic MTF transsexual sister or homosexual brother is higher than expected by random chance. While it is also been noted that father and son often share an erotic cross-dressing habit. There is even a famous FtM transsexual, who is primarily androphilic (identifies as a gay man) and (in my own opinion) is strongly autoandrophilic, who has an autogynephilic MTF transsexual sister. But, I know of only one case history where the two types may have been found in the same family, and that was of a autogynephilic father with lesbian daughter. This example does not break the rule, since homosexuality in males and females do not share etiological roots, that is, while male homosexuality runs in families, female homosexuality does not run in the same families.
It is important to note that while it is common to find more than one trans-person in a given family, this is not guarantied to happen.
For more information see my essay on transsexual consanguinity.
Does taking cross-sex hormones change one’s sexual orientation?
Short answer: No.
Full Answer: If hormones taken in adulthood changed one’s sexual orientation, it would have been used to “treat” homosexuals to make them stop being homosexual. This was tried, and found not to work, in either direction. One’s sexual orientation is not effected by HRT (Hormone Replacement Therapy). Further, HRT will not change one’s basic sexually dimorphic motor movements and mannerisms. These are all organizational effects of sex hormones that are “locked-in” during prenatal development. They cannot be affected in adulthood.
This is to say, that HRT will not, and cannot, affect how masculine or feminine one behaves, only how one looks.
Contrary to hopeful expectations, HRT will not change the nature of one’s sexual arousal patterns nor the nature of one’s orgasms. That is to say, taking female hormones will not give one “female orgasms” nor “female sex drive”. An effect in MTF of HRT and anti-androgens is the reduction of spermatogenesis and seminal fluid. This may change the subjective experience of orgasm as less or even no ejaculate is emitted. This may be misconstrued, interpreted, as having a “female orgasm” by autogynephilic individuals.
However, HRT can affect the libido, the level of sexual appetite, as well as aggressiveness and risk taking. For FtM transmen, taking testosterone often increases one’s libido dramatically. For MTF transwomen, taking anti-androgens can reduce libido. There is both anecdotal and limited statistical data indicating that HSTS and AGP transwomen experience different levels of libido changes when initiating HRT, with AGPs experiencing a greater drop. This may be mediated by differences in the level of sex hormone organizational effects upon the brain in utero, in which AGPs develop greater sensitivity to levels of testosterone. In addition, the type of HRT can affect libido post-operatively. Anecdotal evidence suggests that estradiol increases libido in MTF transkids, but not AGP transwomen, when compared to conjugated estrogens (Premarin) and estinyl estradiol. Additionally, bio-identical progesterone (micronized) seems to have less libido reducing effects, and may even increase libido, in transkids, while medroxyprogesterone acetate (MPA, a synthetic progestin) reduces libido in both AGP and MTF transkids.
These changes in libido have given rise to the myth that HRT causes MTF transwomen to become impotent, unable to have erections. This simply is NOT the case. MTF transwomen can and do continue to be able to have erections, but may experience fewer of them due to their lowered libido. This effect may be stronger in older individuals, following the general trend for increasing erectile dysfunction in older men. Use of medications for erectile dysfunction has been shown to reverse this effect.
For more information see my essay on bio-identical vs. other forms of HRT.
Again, none of these HRT protocols affect one’s sexual orientation, only one’s libido. Because autogynephilia is a form of sexual orientation, HRT can effect the level of overt autogynephilic arousal and desire in AGP transsexuals.
For more information see my essay on testosterone’s affect on autogynephilic arousal.
While, a number of MTF AGP transsexuals have reported that their perceived sexual orientation changed after transition, it has been shown that this is because of autogynephilic pseudo-androphilia, in which an individual’s behavioral and/or interpersonal autogynephilic sexual ideation includes sexual acts, as a female, of sex with men. Since such autogynephilic ideation depends upon being anatomically female, or at least dressed as female, such perceived orientation changes occur as a consequence of being able to actualize the fantasy during transition or post-operatively.
For more information, see my essay on Pseudo-Androphilia.
Is HRT Dangerous?
Short answer: No.
Full answer: You may have read on some forum that taking HRT is dangerous, with a number of serious potential side effects, so that one must be especially careful to have a physician monitor hormone usage, lest dire things happen. These risks seem to loom especially large when “older transitioners” caution “early transitioners” who are getting their HRT without extensive medical supervision (i.e. transkids getting their HRT ‘on the street’). This should be taken with a very large grain of salt (skepticism), especially for “bioidentical” HRT. First, there simply is no large central database, nor have there been any large studies, of transsexuals taking HRT from which one could judge such potential risks. All of our data comes from extrapolating from HRT use in non-transsexuals. From such studies, there are very small statistical risks associated with birth control, some HRT protocols for post-menopausal women, etc. But these risks are VERY small and may not apply to transwomen. The risks for transmen is even less knowable, save to extrapolate to the actuarial data that say that men in general have lower life expectancy. Quite simply, for many transfolk, the risks of not taking them may be the same as taking.
Many of the studies that show that there are risks associated with HRT have shown that using progestins, especially MPA, may have risks. Given that these progestins are less effective and have the effect of reducing libido, this may not be the best choice for HRT. For more information see my essay on MPA.
For bioidentical HRT for transwomen, consider that billions of natal women are awash with endogenous female hormones, yet it is never suggested that these hormones are a major risk factor that must be carefully monitored. A similar argument can be made for men. While each sex has certain risk factors for which endogenous hormones play a role, removing one sex type hormone and replacing it with another has a complex effect of lowering some risks and increasing others. Further, these risk factors are from decades of such hormone exposure, not from a sudden change.
I suspect that much of the concern that is posted about HRT by transfolk is from uncertainty and anxiety about transition that is externalized by exaggerating the potential risks of HRT, which are usually begun at the same time. The act of taking HRT looms especially large in their lives and may take on correspondingly large effects in their imagination, both positive and negative.
Does HRT change sex pheromones?
Short answer: No.
Full answer: You may have seen advertisements for human sex pheromones in the back of popular magazines; These claims are fraudulent. Although it is true that HRT will cause changes to body and urine odors, sometimes dramatic changes, these are not pheromones. Humans don’t use pheromones. (In spite of what you may have seen in pop-science articles, only arthropods have been shown to use pheromones.) Some of these odor changes are not detectable by everyone, as the ability to detect the metabolites of sex hormones varies considerably from individual to individual.
People who can detect and have learned to associate these hormonally influenced odors on men and women may be able to identify men and women by their smell. Thus, HRT may influence the ability to pass people’s “sniff test”. But again, these are NOT pheromones!
For more information, see my essay on Pheromones.
How long does HRT take to make changes?
Short answer: One’s whole life.
Full answer: Seriously, one’s whole life. “Sex” hormones are actually “growth” hormones and have effects one’s entire life. For example, testosterone causes the cartilage of the nose and pinna (outer ear) to grow at a slow but steady rate one’s entire life. Head hair loss (baldness) is similarly effected during one’s entire lifetime, but may have plateaus. On the other hand, some changes can be quite rapid, such as lowering of the voice on testosterone, or breast development on estrogen and progesterone, in just a few months to years.
Does increasing the dosage of HRT increase the speed of the changes?
Short answer: No.
Full answer: Estradiol, Testosterone, and Progesterone are all very chemically similar. If one takes ever increasing amounts, it becomes counter productive since there are only so many receptors (places that recognize and respond to hormones) in the body. Too much will simply saturate the receptors that one wants to stimulate, and start/continue stimulating the ones one doesn’t want, since the receptors are not perfect at differentiating which chemical is actually present. This is why too much testosterone won’t give bigger muscles, but will start to give a body-builder women’s breasts. Further, some testosterone will be converted to estrogen in the body. Similarly, too much estrogen or progesterone will actually cause an MTF to be more masculine, rather than less.
That said, it is common for physicians to be overly cautious in prescribing HRT. A little research and experimentation may be needed to find the right dosage. The desired blood level is on the high normal range for the target sex, and no more.
Do transsexuals have to continue HRT after SRS?
Short answer: Definitely.
Full answer: While one may stop taking anti-androgens after SRS, both FtM and MTF transfolk should continue on HRT for the rest of their lives. If one stops taking them, the risk of osteoporosis dramatically increases. Recent research in natal females suggest that HRT is needed to combat urinary tract infections. Besides, one may also experience uncomfortable hot flashes as well.
How old is one “too old” or “too late” for HRT ?
Short answer: It depends.
Full answer: This question comes up a lot. In one sense, “too old” is meaningless, since HRT will cause some changes no matter how old one is. But in another sense, there are changes during adolescence that are influenced by endogenous hormones that cannot be reversed once they have occurred, especially for MTF. One’s bones cannot be changed much as an adult, save by very intensive surgery, if at all. This means that face, height, hips, shoulders, hands, and feet will be fixed, unable to be influenced by exogenous HRT. Further, the vocal cords are permanently lengthened, giving one a deeper, masculine voice, under the influence of testosterone. Similarly, facial hair, a male beard, is permanent, once it has developed, as is head hair loss (baldness). Body hair, skin texture, mammary tissue, muscle tone, and subcutaneous fat are somewhat malleable, but is never as it would be had one been on the desired HRT since early adolescence. These permanent changes, especially those of the bones, are one of the reasons why “late transitioning” MTF transwomen have so much difficulty passing, even after years of HRT.
For FtM transmen, breast development and bones are also permanent after adolescence. Mastectomy will remove the breasts, but wide hips, narrow shoulders, and short stature are permanent features. Fortunately, one is never too old for testosterone to lower the voice, increase body and facial hair, increase musculature, and thicken the skin.
Thus, for best results, the best age to begin cross-gender HRT is 12 to 14 years of age.
Can surgery feminize my face, hands, shoulders, hips, height, etc. ?
Short answer: It depends.
Full answer: This question comes up a lot. Facial feminization is available but expensive. But nothing can be done for big hands or feet, broad shoulders, etc.. These bones are simply too complex and important for daily function to warrant extensive surgery that is far more likely to leave an individual crippled for life. However, some MTF transsexuals have had silicone injections into their hips, though this is not a recommended practice, as death and other serious medical complications may occur. Some transsexuals have also had lower ribs removed to effect a narrower waist, though this too is not recommended. Surgery is available to increase the natural pitch (f0) of one’s voice, but with very uncertain results that often do not exceed what may be accomplished with conventional vocal training.
What is the average intelligence (IQ) of MTF transsexuals?
Short answer: It’s complicated.
Full answer: For exclusively androphilic transsexuals (HSTS), the data suggests that they have, on average, the same IQ spread as is found in the general population: Average IQ=100 That is to say, that one will find the same number of dull witted as bright individuals, with most just being average.
For AGP transsexuals, the data from one study showed that only the more intelligent individuals transition. So, as a group, they are well above average intelligence (IQ=121.7 in one study). This is likely because of a socio-economic selection pressure such that only those non-HSTS / Autogynephilic gender dysphoric individuals who feel that they can “afford” to transition, follow through and do. Further, such AGP transsexuals are more likely to transition in societies that are individualistically oriented, as opposed to interdependent. That is to say, that AGP individuals transition more often when they are already socially and financially successful and living in a society that grants more social latitude to such successful individuals. Highly intelligent individuals living in individualist societies tend to rise to the top, where, if they are gender dysphoric, have greater socio-economic status that allows them to successfully transition.
Note that AGP transgendered persons are not natively more intelligent than average. Its just that the more intelligent among them are more likely to transition than those who are below average intelligence.
Hormone Replacement Therapy (HRT) does not effect IQ.
What is the average intelligence (IQ) of FtM transsexuals?
Short answer: Average IQ=100.
Full answer: Seriously, the same as non-transfolk.
What is the average intelligence (IQ) of gay people?
Short answer: The same as straight people.
Full answer: Although this question is not about transsexuals, we get asked this question quite often. The fact that this question keeps getting asked suggests that there is much ignorance about human sexuality. For the record: Gay people, both men and women ( and bisexuals for that matter ), have exactly the same average and range of intelligence as straight people, period.