On the Science of Changing Sex

Personality, My Dear…

Posted in Science Criticism by Kay Brown on October 6, 2016

phrenology…I Don’t Give a Damn!

or What is the Rate of Co-morbid Personality Disorders in Transsexuals?

I recently came upon a blog that made much of a single paper out of Iran which purported to show that about 80% of transsexuals had a serious personality disorder.  I was shocked at such a result and had to dig deeper.  Well… this paper seems to be an outlier and its use by this blogger (who fits the profile of an angry ex-wife of an autogynephilic transgender-woman turned transphobic crusader) is an example of cherry picking.  Another paper I found was only 24% of the transsexuals had “subthreshold” potential personality disorders compared to 17% of the controls.  (Note, “subthreshold” does NOT mean that they actually had the disorder.)  But why did this first paper get this outrageous percentage of actual disorders when other studies didn’t?

Because they did NOT diagnose anyone, period.  Instead Meybodi used the Millon Clinical Multiaxial Inventory II (MCMI- II), a self-scored inventory and assumed that if they got a high score on any particular scale that they must then have that clinical diagnoses.  This alone is a gross misuse of any instrument; a test score alone is NOT a diagnoses of a disorder.  From the paper, all we know is that their subjects scored higher than a non-reported cut-off, likely the one used by the publishers to indicate the “presence” of a trait.  The researchers fully admit that they did NOT actually interview and determine if the score had any bearing on actual dysfunction.  It is important to note that to have a diagnoses of a disorder, the personality trait must cause significant dysfunction to their lives.  This study failed to evaluate this dimension.  The most common of the purported personality disorders was Narcissistic Personality Disorder at nearly 60%, which given that this paper was from Iran, surprised me greatly.

As Lawrence has shown, the percentage of non-androphilic MTF transfolk is correlated with a given society’s Hofstede Individualism Index, which for Iran is 41, and thus we would expect a very low percentage.  And indeed, anecdotal reports regarding Iran’s MTF population agree.  But we know that from a number of studies and clinical surveys, that exclusively androphilic MTF transsexuals have a LOWER co-morbidity rate.   So what gives?

The answer seems to be that this study failed several basic tenets of science.  First, they failed to provide controls, which had they done so, might have flagged another issue with their methodology, namely that the MCMI-II was written and only validated in ENGLISH and is only valid for those who have at least a 5th Grade literacy level IN ENGLISH.  One assumes that the researchers simply translated the inventory items from English to Farsi and did not conduct a proper re-validation study given the very divergent cultural meanings potentially introduced by this translation?  If so, as Rogers points out, this is a gross abuse,

“Multiscale inventories can be translated into different languages with relatively little effort. The critical issue is that linguistic equivalence (i.e., similar sentences) cannot be equated to clinical equivalence (i.e., similar diagnostic relevance).  Clinical equivalence cannot be assumed, but must be objectively tested. Simple comparisons of vocabulary and syntax (e.g., from English to Spanish) are insufficient to establish clinical validity for translated versions.  An approach to translation validation in which a mere lack of significant group differences between two language or ethnic groups is assumed to mean the tests “work the same way” makes little sense. With depressed patients, for example, the clinician needs to know whether or not depressed persons of different cultures and languages have the appropriate elevations on multiscale inventories. Given our dearth of knowledge regarding translated versions and their cultural differences, psychiatrists and their consultants should be very cautious about using and interpreting translated tests.”

Even if the translation into Farsi was validated, there is the problem of interpretation; a high score on a given scale does NOT necessarily mean that one has a personality disorder.  In fact, emotionally healthy people often have high scores on scales that correlate to Narrissistic Personality Disorder as Stephen Strack explains in his book, Essentials of the Millon Inventories,

“Scale 5 has a research base that suggests that elevated scores indicate either a clinical personality disorder or a healthy adaptional personality style associated with with nonclinical people.  In factor analysis studies, Scale 5 loads positively on items dealing with extroverted traits and behaviors and negatively on items pertaining to maladjustment. … Elevations on Scale 5 are rare in psychiatric samples.  Many nonclinical populations attain elevated scores on Scale 5 including air force pilots in basic training. … Thus the clinical task is to determine whether clinically elevated scales represent a Narcissist Personality Disorder or a narcissistic personality style.  … versions of this scale have not correlated well with structured psychiatric interview schedules.”

Anyone who is familiar with either the literature on, or knows “early onset” / transkids in person knows that they can be quite extroverted, even flamboyantly so, without developing Narcissistic Personality Disorder.  Finally, a study that used structured interviews showed significantly lower co-morbid issues than those studies that used translated personality inventories, from the abstract of the Haraldsen paper,

“Transsexual patients scored significantly lower than Personality Disordered patients on the Global Symptom Index and all SCL-90 subscales. Although the transsexual group generally scored slightly higher than the healthy control group, all scores were within the normal range.  Transsexual patients selected for sex reassignment showed a relatively low level of self-rated psychopathology before and after treatment. This finding casts doubt on the view that transsexualism is a severe mental disorder.”

The conclusion here can only be that we must evaluate the literature on transsexuals and co-morbidity very carefully and critically, not accepting them at face value unless we can determine that they have been conducted with proper methodologies, including proper interview based psychiatric diagnoses, compared against valid controls from both clinically relevant disordered and healthy populations, and shown to be reproducible.  Anything else is just junk science.  {And cherry-picking the worst data you can find to defame transfolk is despicable.}


Maybodi, et Al., “The Frequency of Personality Disorders in Patients with Gender Identity Disorder”

Bodlund, et Al., “Personality Traits and Disorders in Transsexual” (1993)

Rogers, R., “Forensic Use and Abuse of Psychological Tests: Multiscale Inventories”

Haraldsen, et. Al., “Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults”

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A (Wither) Spoonful of Poison

Posted in Editorial by Kay Brown on June 10, 2015

CloudyWhen transwomen think of transphobic attacks, they often think of Paul McHugh.  He was the adminstrator who shut down the John Hopkins Gender Clinic.  Of course, looking back, it was just a tiny fraction of a blip in time before it would have been shut down anyways – as all of the clinics in the United States were – a victim of its own success.  Yes, success, as their involvement in what was thought to be experimental became routine palliative medicine.

McHugh has long been the darling of the so called “social conservatives”, translation:  homophobic bigots.  We can see this by how ardently he is admired by the Witherspoon Institute; the same Witherspoon Institute that funded and supported the academically fraudulent Regenerus paper which purported, but in fact did not, show that children of gay and lesbian parents were emotionally harmed.  In fact, McHugh has published yet another anti-trans editorial on their website.

In his editorial, he makes some rather amazing claims regarding transsexuality and transgender sexuality, mixing just enough scientific truth to sound credible.  But mixed in are some amazing falsehoods, not just mistaken ideas, but outright lies,

“In fact, gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it.”

McHugh correctly identified that there are two types of transwomen, autogynephilic and non-autogynephilic… but then makes the most silly comparison that those with gender dysphoria “belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder”  He KNOWS better, or at least, he should.  Autogynephilia is NOT related to these two disorders in any way, shape, or form.  By making this statement, it is clear, as his final sentence in this quote shows, that he is attempting to mislead his reader into the false understanding that psychotherapy can treat autogynephilia and gender dysphoria.  It can’t.

McHugh bemoans the recent movement to outlaw the clearly ineffective and damaging practice of “reparitive therapy”, which he would like to see used to treat transkids.  A careful reading of his editorial will show that he fails to acknowledge that transkids are (with respect to their natal sex) “homosexual”.  It doesn’t take a super sleuth to know that the reason that he doesn’t mention this is because he would also like to see reparitive therapy used to “treat” homosexual teens under the guise of treating gender atypical / dysphoric youngsters.  But he knows this is even more unlikely to be allowed if society understood that the choice for transkids is one of living as a very gender atypical gay man or lesbian, or as gender typical heterosexual transwoman or transman, respectively; but McHugh wants that to be no choice. He wants such youngsters to be “repaired” to be gender typical heterosexual adults, which he knows, but seems incapable of accepting, is an impossibility.

I’ve said it before in a previous essay, but it bears repeating.  McHugh, a conservative Catholic, seeks to substitute religious bigotry for palliative medicine… and is quite willing to bend the truth to get it.

Notes: Autogynephilia, while NOT related to anorexia nervosa and body dysmorphic disorder (BDD), is related to Body Integrity Identity Disorder, a member of the family of Erotic Target Identity Disorders.  This family is about sexuality and sexual orientations, which like heterosexuality and homosexuality have been shown to be very resistant to change, thus the move to outlaw “reparitive therapy”.  Erotic Target Identity Disorders are far more common in men than women.

Anorexia Nervosa is a member of the eating disorders and is far more common in women than men.  Interestingly, among the men, it is more common in gay men than straight, suggesting a connection with hypomasculinized brains.  Cognitive Behavior Therapy helps about 50% of clients.

Body Dysmorphic Disorder is a member of the Obsessive-Compulsive disorders.  It is equally common in men and women.  The disorder responds favorably with Cognitive Behavior Therapy in combination with SSRI’s.

Note that not only are anorexia and BDD not related to autogynephilia, they aren’t even related to each other!

For the record:  No study has EVER shown that ANY therapy can “cure” either type of gender dysphoria, autogynephilic or transkid.  One can only come to some accommodation.  Among those useful accommodations is social transition, HRT, and SRS, as was fully endorsed by the American Psychiatric Association.

Addendum 5/16/2016:  McHugh continues his anti-trans ‘crusade’.  You may wish to read another rebuttal of an earlier version of McHugh’s misleading op-eds:  http://www.transadvocate.com/worlds-experts-condemn-the-mchugh-hoax_n_13924.htm

Reference: Paul McHugh, “Transgenderism: A pathogenic Meme”

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A Show of Hands

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Brown,

Thank You for Your kind email.

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

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

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

Best wishes,

Prof.Svetlana Vujovic


Vujovic et al., “Finger Length Ratios in Serbian Transsexuals”, The Scientific World Journal

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

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