On the Science of Changing Sex

Etiological Conjectures, Part 3

Posted in Transsexual Theory by Kay Brown on February 14, 2013

androgynous faceAs I related in Part 1 and Part 2 of my discussion regarding etiological conjectures, there are still more questions than answers about how early onset gender atypicality and dysphoria develops.  However, there are some very intriguing clues from the biodemographics of transkids.  As I discussed in an earlier essay on how MTF transkids may be a subset population of the larger exclusively androphilic, gender atypical, but not gender dysphoric children who grow up to be conventional gay men, the biodemographics of MTF transkids seems to be very similar, if not identical, to that of at least some gay men.

Simply put, MTF transkids have more brothers than sisters, far more than one would expect comparing them to the general population.  They tend to have more older brothers than would be expected, showing that for each older brother, the likelihood that a given male would be an MTF transkid is increased by 40%.  Note that the absolute likelihood of being an MTF transkid is still very, very tiny, but the more older brothers that one’s mother had given birth to, the more likely this tiny chance is increased.  This effect is also found in conventional gay men, but only those who were feminine as children.

From this statistical anomaly, Blanchard suggested that at least some gay men and MTF transkids have an etiological cause that is effected by their mother’s prior pregnancy experiences.  His conjecture is that prior male pregnancies challenged their mother’s immune system such that they developed anti-bodies to “maleness” in some, as yet to be discovered, fashion.

I would offer a different conjecture.  It is fairly well established that placentas from each fetus a women bears releases cells that migrate to all parts of her body.  In effect, she becomes a genetic chimera, carrying the DNA of each of her children (including those who miscarried).  This means that she also carries cells in her body which are genetically “male”, that have a Y chromosome and have supposedly been epigenetically tagged as being “male” during gestastion, prior to escaping via the placenta and migrating into her own body.  I conjecture that the mother’s own epigenetic gene regulation mechanisms are invoked to bring these “male” cells in line with her female body.  If these mechanisms become especially strong, they may tag her own germ cell line prior to oogenesis with epigenetic tags that push the later born male children toward neurological femininity.

Perhaps someday, we will see which, if either, of us guessed right.

References:

Sebastian E. E. Schagen, Henriette A. Delemarre-van de Waal, Ray Blanchard, Peggy T. Cohen-Kettenis, (2012) “Sibling Sex Ratio and Birth Order in Early-Onset Gender Dysphoric Adolescents”
http://link.springer.com/article/10.1007%2Fs10508-011-9777-6

Blanchard, R., & Sheridan, P. M. (1992). Sibship size, sibling sex ratio, birth order, and parental age in homosexual and nonhomosexual gender dysphorics. Journal of Nervous and Mental Diseases, 180, 40–47.
http://www.ncbi.nlm.nih.gov/pubmed/1538206

Blanchard, Bogaert, “Homosexuality in men and number of older brothers”
http://ajp.psychiatryonline.org/cgi/content/abstract/153/1/27?ijkey=e186877631aa1c47de8fd859310668c21bcd25ef&keytype2=tf_ipsecsha

Anthony F. Bogaert, “Biological versus nonbiological older brothers and men’s sexual orientation”
http://www.pnas.org/content/103/28/10771.full

Green, R. (2000). Birth order and ratio of brothers to sisters in transsexuals. Psychological Medicine, 30, 789–795.
http://www.ncbi.nlm.nih.gov/pubmed/11037086

Blanchard, R., Zucker, K., Cohen-Kettenis, P., Gooren, L., & Bailey, J. (1996) “Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males” Archives of Sexual Behavior, 25, 495–514.
http://link.springer.com/article/10.1007%2FBF02437544?LI=true

Johannes Bohacek, Katharina Gapp, Bechara J. Saab, Isabelle M. Mansuy, “Transgenerational Epigenetic Effects on Brain Functions”
http://www.biologicalpsychiatryjournal.com/article/PIIS0006322312007299/abstract

Miranda P. Dierselhuis, Els Goulmy, “We are all born as microchimera”
https://www.landesbioscience.com/journals/chimerism/article/23348/

 

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Etiological Conjectures, Part 2

Posted in Science Criticism, Transsexual Theory by Kay Brown on December 25, 2012

androgynous faceAs I alluded in my previous post, scientists also like to speculate and generate conjectures regarding the etiology of transsexuals. In this post, I will explore and comment on some of them.

Many of the earlier conjectures were highly influenced by psychoanalysis, shoehorning observations into existing, yet completely untested, models of psycho-sexual development.  These were largely psychogenic theories, that is to say, that mental process create the condition, either transsexuality or homosexuality.  More specifically, they theorized that family constellations, usually an overly involved mother and a distant father create the conditions whereby a male child gets the erroneous idea that they must be female, as they can’t separate themselves as individuals from their mothers.  Or, the theory might be that fear of losing their precious penis causes them to overly-identify with their mother so that losing it doesn’t  seem such a bad alternative.  (Yes, I’m over simplifying, deliberately, sarcastically.)

Before we completely laugh at the idea of psychogenic illness, we should remember that there are several very real psychiatric illnesses which have been identified and shown, using modern science, to be of such psychogenic origin.  The most heart breaking is Reactive Attachment Disorder, which is common among institutionalized children who as babies and toddlers were literally not cuddled.  The lack of physical / emotional contact with caregivers literally creates a condition whereby these children have severe emotional and behavioral problems as they grow up (but not autism).  Another illness that has a psychogenic origin is post-traumatic stress disorder.  Although traumatic events as adults act as the proximate trigger, horrific events in childhood have been identified as leaving these individuals without the emotional resilience to weather such events.  A history of physical abuse as a child is one of the more commonly identified preconditions for later post-traumatic stress syndrome, likely due to down-regulation of cortisol production.

But, during the early to mid-twentieth century, psychoanalysis claimed illnesses were psychogenic that we now have clearly established as neurological defects including schizophrenia and autism spectrum disorders.  Typically, the quality of mothering was blamed.  (Sound familiar?)  Mothers were blamed for nearly every sort of bad outcome in their children, without ANY corroborating statistics or evidence.  The ugliest of these was calling the mothers of autistic children, “refrigerator mothers” and the mothers of schizophrenic young adults, “schizogenic mothers”.

So, in a similar vein, I call the theories that invoke parenting styles, especially those that blame mothers, for MTF transkids, the “smother mother” hypothesis.  Without ANY corroborating statistics or evidence, many psychoanalysts and their medical colleagues, accepted many of these theories as “true”.  Although it is true that many parents become emotionally distant from a transkid, this is far more likely a result, not a cause, of the child’s gender atypical behavior.  These theories, although largely abandoned by scientists, still seem to have currency with a number of therapists that I’ve talked to.  In one odd conversation I had about two decades ago, an elderly therapist acknowledged that it didn’t seem to be true of her “early transitioners”, but she was convinced that her “late transitioners and transvestites” had come from such families with smothering mothers and distant fathers.  During the conversation, I began to suspect that she was guilty of confirmation bias and of  subtly “coaching” her clients in what she expected them to say, so that they could obtain their “letters”.

To a modern scientifically based intellect, the creation and wide scale acceptance of psychodynamic theories about the origins of both typical and atypical gender and sexual behavior seems incomprehensible.  How could they ever even entertain such odd notions?  But, if we understand that the ideas have at their core, the pre-Darwinian notion that humans are a special creation, unlike any other species on the planet, it starts to make some sense.  While to us, the thought that gendered and sexual behavior comes from a mental process that, if we translated to our rodent cousins, would make it sound, and be, ludicrous:  Baby rat sees Daddy rat’s penis and notices she doesn’t have one… and envies Daddy rat’s penis… so she starts acting like Mommy rat to get Daddy rat’s affectional attention, etc.   But, if humans are special creation, the theory doesn’t have to work for our rodent, or even, or maybe especially (?) our primate cousins.  These notions had their genesis in Late-Victorian Europe, which was then struggling with the implications of Darwin’s theory of natural selection and evolution and spread to North America which is still struggling (!) .

Another hypothesis is that an anomalous hormonal environment causes cross-sex neurological development.  This is bolstered by experimental research in various animal models, usually rodents, in which exogenous hormonal intervention at certain critical times in neurological development induces cross-sex behaviors.  When coupled with the discovery of cross-sex neurological features in the brain, this would seem to clinch the matter.  Yet… and yet… it doesn’t explain how or why these events occur in otherwise phenotypically normal individuals.  Further, phenotypical markers of prenatal hormone exposure, such as the 2D:4D finger ratio have failed to provide consistent, reproducible, results.

(Addendum 7/7/2017:  We may have found a consistent, reproducable marker of perinatal androgen exposure!  And lo… it correlates with gender atypical play styles in four years olds.)

Thus was born the “gay gene” hypothesis.  Studies of gay men and MTF transkids consistently show evidence of consanguinity, that male homosexuality and exclusive androphilic MTF transsexuality both run in families.  However, the idea of a “gay gene” caused problems with evolutionary theory, since how could such a genetic allele continue to exist against the obvious reproductive disadvantage that being gay (or transkid) naturally presented.  Researchers have spent the past two decades searching for an evolutionary advantage that the relatives of gay men and transkids might enjoy as a “carrier” of the putative “gay gene”.  But years of searching have failed to find such a gene(s).  Perhaps that’s because, there isn’t one?

Finally, we have our new variant on the “gay gene”, the “gay epigene”.  An epigenetic model is based on the recognition that genes are controlled and regulated by other genes using chemical tags, dangling links, attached to the DNA in each and every cell in the body.  These marks are like the conditional branch points, the “flags” or variables, of a computer program.  The interesting thing about such epi-marks is that though it is believed that they should all be erased between generations, many of them are not always fully erased.  This might be a mistake… or it might even be an evolved ability for a crude form of transgenerational gene regulation “memory”.  For example, if an organism needs to adjust it’s metabolism to lean times, like not enough food, by becoming careful about not burning off fat too quickly, it might be advantageous to their progeny to have that adjustment already turned on.  Just such a behavior has been seen in humans, where grandchildren of individuals who knew starvation have slower metabolisms than individuals whose grandparents and parents never knew such lean times.

One of the earliest models to include an epigenetic explanation was from Richard Green M.D., ( a stalwart friend of the transsexual community) and E.B. Keverne, a noted geneticist.  This model suggests that the failure to erase/modify epigenetic markers on the X chromosome that are supposed to be passed down to only one generation, but when passed down past that generation, are theorized to cause severe harm:

A significant skewing in the sex ratio in favour of females has been reported for the families of homosexual men such that there are fewer maternal uncles than aunts. This finding is repeated for a large series of transsexual families in this study. Four hundred and seventeen male-to-female transsexuals and 96 female-to-male transsexuals were assessed. Male-to-female transsexuals have a significant excess of maternal aunts vs. uncles. No differences from the expected parity were found for female-to-male transsexuals or on the paternal side. A posited explanation for these findings invokes X inactivation and genes on the X chromosome that escape inactivation but may be imprinted. Our hypothesis incorporates the known familial traits in the families of homosexuals and transsexuals by way of retention of the grand parental epigenotype on the X chromosome. Generation one would be characterized by a failure to erase the paternal imprints on the paternal X chromosome. Daughters of this second generation would produce sons that are XpY and XmY. Since XpY expresses Xist, the X chromosome is silenced and half of the sons are lost at the earliest stages of pregnancy because of the normal requirement for paternal X expression in extra-embryonic tissues. Females survive by virtue of inheriting two X chromosomes, and therefore the possibility of X chromosome counting and choice during embryonic development. In generation three, sons inheriting the paternal X after its second passage through the female germline survive, but half would inherit the feminizing Xp imprinted genes. These genes could pre-dispose the sons to feminization and subsequent development of either homosexuality or transsexualism.

The latest attempt to explain the presence of homosexuality goes into greater detail of how epigenetic markers canalize (channel) the sex hormone influenced masculinization in males or protect against such masculization in females.  This model assumes that all of the epimarkers should have been erased between generations, but the ones from the cross-sex parent were not fully erased:

It is well established that fetal androgen signaling strongly influences sexual development. We show that an unappreciated feature of this process is reduced androgen sensitivity in XX fetuses and enhanced sensitivity in XY fetuses, and that this difference is most feasibly caused by numerous sex-specific epigenetic modifications (“epi-marks”) originating in embryonic stem cells. These epi-marks buffer XX fetuses from masculinization due to excess fetal androgen exposure and similarly buffer XY fetuses from androgen underexposure. Extant data indicates that individual epi-marks influence some but not other sexually dimorphic traits, vary in strength across individuals, and are produced during ontogeny and erased between generations. Those that escape erasure will steer development of the sexual phenotypes they influence in a gonad-discordant direction in opposite sex offspring, mosaically feminizing XY offspring and masculinizing XX offspring. Such sex-specific epi-marks are sexually antagonistic (SA-epi-marks) because they canalize sexual development in the parent that produced them, but contribute to gonad-trait discordances in opposite-sex offspring when unerased. In this model, homosexuality occurs when stronger-than-average SA-epi-marks (influencing sexual preference) from an opposite-sex parent escape erasure and are then paired with a weaker-than-average de novo sex-specific epi-marks produced in opposite-sex offspring. Our model predicts that homosexuality is part of a wider phenomenon in which recently evolved androgen-influenced traits commonly display gonad-trait discordances at substantial frequency, and that the molecular feature underlying most homosexuality is not DNA polymorphism(s), but epi-marks that evolved to canalize sexual dimorphic development that sometimes carryover across generations and contribute to gonad-trait discordances in opposite-sex descendants.

This model has much to recommend it.  For instance, it would fit with the conjecture I made in my last post regarding the possibility of multiple semi-independent genes controlling sexually dimorphic behavior being involved. Yet,the odd thing about this recently published paper is that the authors seem to have no understanding of the nature of homosexuality and the close relationship it has with transkids, childhood gender atypicality, childhood gender dysphoria in desisting pre-homosexuals, and persisting transkids.  Incredibly, they actually predict that such epigenetic marking will have no correspondence with “gender identity”:

We describe our hypothesis for an epigenetic cause of homosexuality as a series of statements (see Figure 3 for a graphical summary):

a) Empirical studies demonstrate that XX fetuses are canalized to blunt androgen signaling (lower sensitivity to T) and XY fetuses are canalized to boost androgen signaling (higher sensitivity to T).

b) Empirical studies demonstrate the production of XX- and XY-induced epi-marks in embryonic stem cells and extensive sex-specific differences in gene expression at this time. Epi-marks laid down during the embryonic stem cell stage are also established to influence gene expression later in development. This stem cell period is the most plausible candidate time point for the production of epi-marks influencing sensitivity to androgens later in development (canalization of fetal androgen signaling).

c) Epi-marks produced in embryonic stem cells are mitotically transmitted to cell lineages leading to both the soma and the germline, and hence can contribute to pseudo-heritability when they escape erasure across generations (nonerasure in the primordial germ cells and in the zygote and first few cell divisions of the next generation). Animal models as well as human data unambiguously demonstrate that such a multistep escape from erasure does occur at nontrivial frequency.

d) Epi-marks blunting (in XX fetuses) or boosting (in XY fetuses) androgen signaling will be sexually antagonistic (SA-epi-marks) when they have a nonzero probability of carryover across generations and are expressed in oppose sex descendants. Such carryover will contribute to discordance between the gonad and one or more sexually dimorphic traits.

e) Our modeling work shows that SA-epi-marks are favored by natural selection over a broad span of parameter space because there is a net benefit to the carrier (due to canalization of sexually dimorphic development) that is not offset sufficiently by transmission (and fitness reduction) to opposite sex descendants.

f) Genetic mutations causing SA-epi-marks are expected to fix in populations and are therefore not expected to be polymorphic except transiently during their initial spread within a population. Therefore, no association between genotype and homosexuality is predicted.

g) Because the androgen signaling pathways differ among organs and tissues (e.g., use of different AR cofactors), the same inherited SA-epi-mark can affect only a subset of sexually dimorphic traits, e.g., no effect on the genitalia, but a large effect on a sexually dimorphic region of the brain.

h) Shared, gonad-discordant SA-epi-marks that carryover across generations would contribute to the observed realized heritability of homosexuality, e.g., monozygotic twins share the same SA-epi-marks coinherited from a parent.

i) Unshared, gonad-concordant SA-epi-marks, produced during fetal development, would contribute to the low proband concordance of homosexuality observed between monozygotic twins, i.e., they need not share SA-epi-marks generated during development that occurs after the twins have separated.

j) Homosexuality occurs when an individual inherits one or more gonad-discordant SA-epi-marks that are not masked nor erased by the production of de novo gonad-concordant SA-epi-marks that accrue during ontogeny. The SA-epi-mark(s) influence androgen signaling in the part of the brain controlling sexual orientation, but not the genitalia nor the brain region(s) controlling gender identity.

Perhaps they are referring not to the existence of transkids “gender identity” but of the “gender identity” of autogynephilic transsexuals? If so, I would TOTALLY agree with them. But, somehow, I believe that they are simply basing this odd assertion on the mistaken acceptance of our late 20th Century adoption of the separation of sexual orientation and gender identity as being unrelated phenomena, without having read the scientific literature dispelling it.

Thus, we see that cultural biases have and continue to distort scientific discourse into the etiology of homosexual transsexuality.

References:

David E. Simpson, J.J. Hanley, Gordon Quinn, Documentary film: “Refrigerator Mothers”
http://www.pbs.org/pov/refrigeratormothers/#.UNntP6xLnkY

Pasterski, V., “Fetal Androgens and Human Sexual Orientation: Searching for the Elusive Link”, (2017) Archives of Sexual Behavior
https://link.springer.com/article/10.1007/s10508-017-1021-6

Pasterski, V., et al., “Postnatal penile growth concurrent with mini-puberty predicts later sex-typed play behavior: Evidence for neurobehavioral effects of the postnatal androgen surge in typically developing boys”, (2015) Hormones and Behavior
http://www.sciencedirect.com/science/article/pii/S0018506X15000033#f0005

Green, R., Keverne, EB., The disparate maternal aunt-uncle ratio in male transsexuals: an explanation invoking genomic imprinting.
http://www.ncbi.nlm.nih.gov/pubmed/10623499

Rice, et al.  “Homosexuality as a Consequence of Epigenetically Canalized Sexual Development”
http://www.jstor.org/stable/10.1086/668167

 

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Etiological Conjectures, Part 1

Posted in Transsexual Theory by Kay Brown on December 22, 2012

androgynous faceWe all love to speculate on what made us the way we are.  We all love to generate models for how the transgendered world came to be.  I’m certainly not immune to those speculations, and neither are many of the scientists who conduct research on the trans-phenomena.  About two decades ago, I formulated a model of how MTF transkids (HSTS) and conventional gay men were similar and dissimilar.  At the time, it was purely based on personal observation and conjecture.  Imagine my surprise and delight when I read a recent paper based on genetic manipulation (gene “knock-out”) on sexual dimorphic behaviors in mice that would support part of my conjecture.

Many animals who are bisexual (i.e. that come in two and only two sexes) also often have sexually dimorphic behaviors.  Typically, they involve reproductive behavior, sexual uniting of gametes, mating, and rearing or protection of their young.  The range of such behaviors found in the animal world are so diverse, that I would fill up an entire multi-volume set of books just to list them all.  However, for mammals, many of these behaviors are similar enough that we can use some animals as stand-ins for researching what is likely to be also true for humans, especially in the evolutionarily close relatives in primates and rodents.  The most useful, due to their short lifespans, small size, and ease of maintaining, are mice and rats.

My personal model has been that many sexually dimorphic behaviors are independently evolved and genetically encoded.  They are developmentally controlled by similar mechanisms such as sex hormone receptors on neurons.  This implied that masculinity and femininity (to be defined below) are not a “one shot deal” nor a simple one dimensional, nor even a two dimensional behavioral space.  That is to say, that many of the sexually dimorphic behaviors may be “switched on or off” independently.  In fact, when describing this model to others, I often asked my listener to imagine a long row of switches, which may be up or down.  Some of these switches control masculine behaviors and some feminine.  In theory, they could be in any combination, but during development, processes come into play such that the vast majority of people have all of one type, masculine or feminine in the on, while the opposite type are in the off positions.  However, in a small number of individuals some of the switches are flipped to the “wrong” state.  In an even smaller number of individuals, quite a few of the switches are flipped to the wrong state.  Some of those switches have only small effects.  But some of the switches have rather dramatic effects.

To say that a given behavior is masculine or feminine is to say that that behavior is more likely to be produced by one sex than the other.  For example, in common rabbits, a female is far more likely to pull hair from its belly to line an underground nest in preparation for caring for kits (newborn rabbits).  Thus, in rabbits, nest lining would be a “feminine” behavior.  In rodents, females are far more likely than males to exhibit lordosis, arching of the spine to tilt and raise the pelvis, than males, usually in the presence of adult male.  So we can describe lordosis as also being “feminine” behavior.  Conversely, mounting behavior is usually only seen in males, and thus may be described as a “masculine” trait.

Now, at least in mice, we have confirmation that it is possible to switch “off” individual genes that are associated with such behaviors, both masculine and feminine.  This study did not demonstrate turning “on” a cross-sex behavior, but that has been demonstrated repeatedly, if crudely, by administering cross-sex hormones to neonatal rats.   Further, in sheep, we have seen that a mix of masculine and feminine traits can coexist in that one finds male sheep who preferentially mount (masculine) other male sheep for sex (feminine).  (I needn’t provide references, given that these are well known in the literature.)

In humans, there are a range of behaviors that show varying levels of sexual dimorphism.  Simple observation would suggest that the single most sexually dimorphic trait in humans is the propensity for sexual attraction to men.  In women, approximately 98% exhibit sexual attraction to men, while in men perhaps only 5-10% are attracted to other men, and only 3% are exclusively so.  Thus, sexual attraction to men would, by our definition, be a “feminine” trait.  Interestingly, there appears to be analogs to “mounting behavior” and “lordosis” in humans.   Men who are sexually attracted to other men, also exhibit a preference for mounting (active or “top”) or lordosis (passive or “bottom”).  It is my thesis here that in gay men, independent sexually dimorphic behaviors have been feminized while others have not, and that this independent switching has occurred in varying combinations in individual men.  That is to say, that a gay man could be quite feminized in at least one behavior (androphilia) but show a range of other behaviors that may or may not also be feminine.

Which brings us to MTF transkids.

Transkids are universally attracted to men.  They are also universally obligate “bottoms”.  In fact, they are also universally “avoidant” as well.  That is to say, that they refuse to allow a partner to take notice of, or touch, their pre-op genitalia.  Transkids are also, by definition, persistors, while most gay men were at least somewhat gender atypical as young children and may or may not have also been gender dysphoric, yet they desisted being so by the time they were eleven or twelve.  Transkids remain behaviorally feminine in voice production, motor movements, etc.  I’ve often noted that many transkids are especially interested in small children and babies.  As a speculative conjecture, might the difference between conventional gay men and transkids be the number, or a key subset, of the sexually dimorphic behaviors that are possible?  That it is not so much that they are “more feminine” than most gay men, but that they are “feminine in more ways”?  So much so, that they find it far more comfortable and advantageous to transition?

Etiological Conjectures, Part 2

Etiological Conjectures, Part 3

References:

X. Xu et al. “Modular Genetic Control of Sexually Dimorphic Behaviors”
http://dx.doi.org/10.1016/j.cell.2011.12.018

 

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The Sound of Your Voice…

Posted in Transsexual Field Studies by Kay Brown on December 1, 2012

female_scientist…Oh, how I miss waking up to the sound of your voice…
-Bare Naked Ladies

Each time we utter a word, we communicate far more than just the lexical unit of speech; we also announce to the listener our native language, our hometown, our age, our gender, and possibly our sexual orientation.  In the transgender field guide videos, I asked the viewer to pay attention to the vocal inflections of each of the transwomen.  If you listened carefully, you probably noted that the HSTS transkids each were distinctly different than the AGPs.  This vocal difference that transkids have, compared to non-gender-atypical boys, is present since childhood.  It is not a recent development, not a conscious attempt to sound like women.  That voice is largely untrained.

Many gay men have a discernibly “gay voice”, but not all.  Interestingly, this voice quality corresponds to the level of gender atypicality that they exhibited as children.  That is to say, that straight sounding gay men report having been typically masculine as boys, but “gay” sounding men report having been gender atypical as boys.  Research also shows that this “gay voice”, far from being a speech defect, the stereotyped “lisp”, it is actually clearer sounding speech.  This speech is also more like how heterosexual women speak, than how straight men speak.  Given this, it shouldn’t surprise anyone that gender atypical boys should sound more like girls than gender typical boys.

A large percentage of boys who were gender atypical grow up to be gay, though some do grow up to be straight identified.  (Given that being gay is still socially stigmatized and discriminated against, I personally suspect that many of these so-called “straight” men are in fact closet homosexuals.)  A number of these gender atypical boys are also gender dysphoric.  And a subset of those that are gender dysphoric will persist being so to become transkids.

In the Crocker and Munson study, they showed that older gender atypical boys had even more feminine voices than younger atypical boys.  As I showed in my essay on persisting and desisting gender dysphoria in children, those who desist in being gender atypical and gender dysphoric seem to be doing so just before the age of 10 or so.  Thus, I believe that we can surmise that Crocker& Munson’s older boys would have a higher percentage of ‘persisters’, transkids, than their younger test group.  So, I hypothesize that the increased perceived femininity of voice production in the older group is an artifact of the desisters having dropped out of the potential pool of older boys, leaving the more naturally feminine transkids.

One working assumption is that a sizable subset of gay men have significantly feminized brain structures that influence both erotic target (sexual orientation) and vocal production.  This is supplanting the hypothesis that the “gay voice” is the result of community wide agreement upon a ‘code’, a voice that helps gay men identify each other.  The evidence supports the former, rather than the latter, as pre-adolescent boys are unlikely to have self-identified as gay, and to have deliberately learned a community code.

I hypothesize that the feminization of the brain is more extensive in ‘persisters’, transkids, and that the voice production is similarly more feminized.  This is in keeping with the conceptualization that (at least some) gay men are somewhat feminized, more like women than straight men, and that HSTS transkids are “so gay they’re women”, as James Cantor has quipped.

I think it would be interesting for researchers to compare the “gay voice” to the “transkid voice”.  From my own experience, they are similar, but not identical.  The gay voice is trending towards the transkid voice, but doesn’t reach it.  The average transkid voice is trending toward the female voice, but also doesn’t quite reach it, though, with just a tiny effort, it can allow the average transkids to pass as female to most listeners.  Some transkids have voices so like the typical female voice that no effort is needed.

Again, as I pointed out in the field guide, the untrained AGP voice is typically masculine.  A great conscious effort must be made if an AGP wishes to achieve a passably female voice.  I think it would be interesting to compare and contrast the HSTS and AGP voice.

Addendum 1/4/2013:

Lal Zimman has conducted an interesting bit of research on FtM transmen’s voice, which I now reference.  He has a couple sound clips that may be of interest.

References:

Crocker, L., & Munson, B., “Speech Patterns of Gender Non-Conforming Boys”
http://www.tc.umn.edu/~munso005/Crocker&Munson_NWAV2006_PostConference.pdf

Peter Renn, “Speech, male sexual orientation, and childhood gender nonconformity”
http://homepage.psy.utexas.edu/homepage/class/psy158h/prevhonors/z111/project.htm

Deborah Günzburger, “Acoustic and perceptual implications of the transsexual voice”
http://link.springer.com/article/10.1007/BF01541604

Lal Zimman, “Pronunciation of ‘s’ sounds impacts perception of gender, CU-Boulder researcher finds”
http://www.colorado.edu/news/releases/2013/01/03/pronunciation-%E2%80%98s%E2%80%99-sounds-impacts-perception-gender-cu-boulder-researcher

 

 

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Losing Kiira

Posted in Autobiographical, Editorial by Kay Brown on November 4, 2012

Cloudy“My heart has joined the thousand, for my friend stopped running today.”
–Richard Adams, in Watership Down

Two days ago, on the 2nd of November, my friend and collaborator on the transkids.us website, Kiira Triea (AKA Denise Magner), died of cancer.  I am not alone in mourning her loss.  Her sister will miss her most.  But our mutual friend, Alice Dreger will miss her acutely.  Alice has written a fitting tribute to Kiira on her blog, far better than anything that I will be able to write.

I first corresponded with Kiira in early 2008, as I had just discovered Alice’s article on the contretemps surrounding Bailey’s The Man Who Would Be Queen and wanted to learn as much as I could about the events for myself, as I felt an irrational personal guilt for not having paid attention to what happened in 2003.  I felt guilty for not having spoken out against the rampant ugliness at the time.   I needed to do something.  In Kiira, I found a path forward.  We corresponded at great length and had long, almost weekly phone calls.  After a year or so of these conversations, I gathered the courage to finally speak out and write an essay of my own to add to those already on the transkids.us website.  I knew full well that I was inviting down the wrath of those who opposed the science that Bailey had written about… and was not disappointed.  However, I had joined good company.

With Kiira’s encouragement, I began this blog to explore and explicate the science… to tell the truth.

Our correspondence and conversations also covered our personal lives.  Strange, that in Kiira, whose biology was so different than mine, I should find a kindred spirit.

Correspondence and long distance phone calls are all well and good, but no substitute for face to face, in person dialog, so a few years ago, I bought her tickets to travel from her home in Maryland to my home in California, as Kiira and her sister were as poor as church mice.  My daughter and I picked her up at the airport.  From her writing and her wicked, witty, dialog during our phone conversations, I had always pictured her as a strong, almost Amazon-like, warrior.  Instead, she was a frail, delicate, very feminine middle-aged woman who I felt concern for her lest the cold California winter winds whisk her away.  She spent a week at our house, during which I had the uncomfortable feeling that I was seeing in her a deep pain that could never be healed.

Though I will miss her, I sincerely hope that she can now find healing balm.

Addendum 11/25/2012:

When I began to write this blog, Kiira impressed upon me the guidelines that she and the other contributors to the Transkids.us website followed, of keeping the essays largely non-personal, only describing ourselves to the extent necessary to explain who we were as a population, not as individuals.  This had two purposes.  First, it protected the identities of the young people who were involved in creating the content of the original 2004-2005 website (whose identities and photos she DID share with me).  Second, it was an effort to be as objective as is humanly possible regarding the differences between the two types of MTF transwomen.  This effort to protect the identities of the contributors allowed a number of people who opposed publishing and exploring documentation of the differences to question whether such individuals even existed,  even to the extent of stating and/or insinuating that Kiira made up those individuals as a “hoax”, in an effort to cast doubt on the information contained on the website.  In a way, it was an unearned complement to Kiira, as it presupposed that Kiira had the literary talent to write in what even a cursory examination of the essays will show are completely different and consistent writing styles, the individual “voices” of those very real young transwomen.  The simple truth was that Kiira loved these kids, and as the website-mistress, worked hard to protect them from being “outed” and libeled, by those same opponents.  Opponents who have shown themselves to be devoid of honor and decency, having gone to great lengths to vilify and smear those who have merely said or written about the science or politics of the transcommunity.

Those in the trans-community who know, or just suspect, who I am, know that from my many years of transactivism and personally aiding transfolk of all kinds, that I would never participate in any “hoax”, and that I would never do anything I knew would harm any individual or community.  Kiira is gone.  I have inherited her mission.  I intend to maintain the existence of the transkids.us website largely untouched, as she created it, to honor her and those young transwomen who created it.  But her passing has left me to my own ideas of how I should explore the differences, both scientific and political, here on my own blog.

Further Reading:

Essay on Responsibility and Bullying in the Transgender Activist Community

Book Review of Galileo’s Middle Finger by Alice Dreger.

 

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Stereotypes are Dangerous

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Turning back to transkids:

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

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

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

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

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

References:

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

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

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

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

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

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

 

 

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“Sherman, set the WayBack Machine to 1978”

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

female_scientist“Sure Mr. Peabody!”

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

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

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

Green, writing of and quoting Stoller, said,

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

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

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

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

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

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

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

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

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

Hypothesis were meant to be tested.

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

Type:             Avoidant            Pleasure     Inactive

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

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

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

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

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

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

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

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

In Leavitt and Berger’s own words,

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

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

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

References:

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

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

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

 

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Searching High and Low

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

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

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

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

But the plural of anecdote is not data.

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

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

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

Further Reading:

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

References:

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

Lawrence, A., “Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements”

Yolanda L.S. Smith, Stephanie H.M. van Goozen, A.J. Kuiper, Peggy T. Cohen-Kettenis, “Transsexual subtypes: Clinical and theoretical significance”

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

Malvina N. Skorska & Anthony F. Bogaert, “Sexual Orientation, Objective Height, and Self-Reported Height” (2016)
http://dx.doi.org/10.1080/00224499.2015.1124831

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The Age of Innocence

Posted in Female-to-Male, Transgender Youth, Transsexual Field Studies by Kay Brown on February 28, 2011

At what age should transkids start HRT?

WISHES
OH, if you were a little boy,
.  And I was a little girl –
Why you would have some whiskers grow,
.  And then my hair would curl.
Ah! if I could have whiskers grow,
.  I’d let you have my curls;
But what’s the use of wishing it –
.  Boys never can be girls.
–Kate Greenaway, Marrigold Garden, (1885)

For physicians and other health care providers, an over-riding concern is to “do no harm”.  One of the fears for such care providers is that of starting a course of treatment intended to treat a condition, only to discover that they misdiagnosed the patient and gave a treatment that not only was unneeded, but potentially harmful.

In the case of trankids, both MTF and FtM, the sooner one can begin hormonal & surgical treatment and social support interventions to allow them to successfully transition into the appropriate gender/sex role so as to take advantage of the normal adolescent physical and social maturation process along side their peers, the better the long term outcome.

But, as the very recent Steensma study, as well as many before it, shows, not all gender atypical children will be gender dysphoric, and not all gender dysphoric children will persist as such into their teen years.  Thus, the study was conducted in the hope of finding differences between persistors and desistors, so that clinical treatment decisions can be made as early as possible.  The earlier one can separate the two, the earlier one can begin to treat the transkids, while letting non-transsexual teens grow up naturally, without potentially harmful iatrogenic trauma.

Because healthcare providers have not been able to accurately predict which gender atypical / dysphoric children will persist, a number of practitioners have begun recommending and using a puberty blocking protocol, under a harm reduction model in which the persistors are protected from the harmful effects of their endogenous hormones, while refraining from iatrogenic injury from exogenous cross-sex hormones in those who will desist from their earlier gender dysphoria.  The current recommendation is that such puberty blockers be used until the individual is 16 or even 18 years old, at which time, if he/she is still a persistor, they may be switched to cross-sex hormones, while the desistors may terminate the puberty blocking protocol at any time.  (There is a built in bias for desistors and against persistors in that desistors can begin a prefered hormonal protocol, simply by stopping the puberty blockers, but persistors must wait and “prove” to healthcare workers that they are ready.)

The problem with this protocol is two fold.  First, it is not without its own potential for iatrogenic harm in that delaying puberty reduces the eventual strength of the bones in adulthood.  This may not be immediately harmful, but those children will someday be older adults, whose bones will be more prone to breaks.  Second, for MTF transkids, delaying puberty means that they will continue to grow taller, potentially reducing their ability to pass successfully as female.  This effect may however be welcomed by the FtM transkids, but their desisting female peers may not feel the same.

Another problem with this protocol is that it is very expensive, far more expensive than cross-sex Hormone Replacement Therapy (HRT). For those who live in countries who do not have a generous state provided health plan, this may be a deal breaker.

So, for health care providers and parents alike, it may be better if they can accurately predict who will desist and who will persist.  Getting this data is the object the Steensma study.  The Steensma study is short on statistics, but what they do have is remarkable:

.                                Total group       Persisters     Desisters
.                                    (N = 53)            (N = 29)       (N = 24)

Natal sex
% (N) Boys             56.6 (30)          58.6 (17)      54.2 (13)
% (N) Girls              43.4 (23)          41.4 (12)       45.8 (11)
Age at childhood
assessment
M (SD)                   9.41 (1.46)*     9.92 (1.26)    8.81 (1.47)
Age at follow-up
M (SD)                 16.11 (1.70)     16.14 (1.84)   16.07 (1.54)
Full-scale IQ
M (SD)            100.26 (12.82)    98.83 (12.28)  102 (13.50)

* Significant difference observed between persisters and desisters in age at childhood assessment (t(51) = 2.968, p < .05), Cohens d = 0.81 .

For starters, the IQ of the persistors is 98.83, essentially average.  Although this is combining FtM and MTF, the number agrees with my earlier estimate of 98.6 for the MTF HSTS population.

But, the more important data is that there is a difference between the ages of childhood assessment, the age at which their parents brought them to a clinic for evaluation.  (The difference being on average a little over a year, or over 10% of their age, and a very large effect size of d = 0.81 )  But, the study makes it very clear that there was very little difference between the two groups in their early childhood gender atypicality.  So why is there this difference?  Why would the parents of persistors wait longer than those of desistors?

Because they don’t!  It wasn’t that parents of persistors waited longer, it was that many desistors, desisted at an earlier age, such that their parents never brought their children in for assessement.  As they get older, fewer and fewer parents of desistors would bring in their children.  But, the persistors would continue to be brought in at later and later ages.  Indeed, the authors specifically stated that from the interviews, the desistors clearly articulated that from age 10 to 13 were critical for their change in gender dysphoric feelings.  While, for persistors, that same age only confirmed and strengthened their feelings.  Thus, both interview report and the statistics agree that something special seems to be happening starting at around the age of ten or even a little younger.

Starting around the age of 10, and for the subsequent years, the persisters indicated that their crossgender preferences and behaviour and their gender identity remained stable, but that their dysphoric feelings intensified. The intensification of gender dysphoria was attributed to three factors; (1) Certain changes in their social environment, (2) The anticipation of and/or actual physical changes during puberty, (3) The first experiences of falling in love and discovering their sexual orientation.

The authors, in focusing on what the teenagers said were influential, may have missed a critical factor.  What’s so special about the age of ten?  This is well before puberty.  The authors focused on changing social factors, but could it be that biology is the important factor?  McClintock and Herdt point out that sexual attraction is first noted well before our classic definition of puberty, that of the maturation of the gonads and subsequent increase in testosterone, estrogen and progesterone.  Instead, other hormones start earlier, typically around ten years old.  And this is the age at which one’s sexuality begins to be recognizable.

With regard to sexual attraction, all persisters reported feeling exclusively attracted to persons of the same natal sex, which confirmed their gender identity as they viewed this attraction as a heterosexual attraction. They did not consider themselves homosexual or lesbian.

For the desisting boys, some came to recognize that they were gay or bisexual, essentially confirming the results of many other studies which have shown that gender atypicality in boys is highly corralated with homosexuality.  However, a number of the boys self-identified as heterosexual, even though they also recognized some same sex attraction.

For the girls, all of the desistors had become aware of the fact that they were heterosexually attracted to boys and wanted to be sexually attractive to boys.  Thus, they were the classic tomboys who grow up to be straight women.  But the persisting girls were all attracted to girls.

Thus, this study showed that the key difference between persistors and desistors among female bodied gender atypical / dysphoric individuals was sexual orientation, but among male bodied, it was not as clear cut, desisting boys included both gynephilic and androphilic sexual orientations.  However, what is clear is that persisting boys are all clearly unambiguously androphilic (HSTS).  Persistors will demonstrate same sex attraction, while desistors may or may not.  Thus opposite sex attraction is a key exclusionary sign for persistors.  Although we still would have some desistors who don’t show this sign, we have at least conclusively identified some.

Further, none of the study group was autogynephilic.

This last point is important.  Although many autogynephilic adults report having been gender dysphoric as children, it is rare, though clearly not unheard of, for them to have been noticed as such as children.  They are the “non-aparent” population as children.  However, for the HSTS population, of both sexes, MTF and FtM, their gender dysphoria was accompanied by obvious gender atypicality.  Since obvious gender atypicality is not found in autogynephilic boys, who are universally gynephilic, we can safely say that anyone who is obviously gender atypical and sexually attracted to the opposite sex is not going to be a persistor.

Another point can be clearly found in the Steensma study is that the developmental process, what ever it is, for desistors, is finished by age 14.  If a gender atypical 14 year old is still gender dysphoric and wishes to begin hormones and transition, we can be reasonably certain that he or she will not change his/her mind later.  Thus, based on the evidence, we can safely begin such interventions.  The sooner the better.

Conclusion

Transkids after transition

Transkids after transition

From the evidence, we draw the conclusion that for obviously gender atypical / dysphoric children, waiting until one is 16 or 18 years old to end puberty blocking protocols and beginning HRT is unwarranted and ill-advised.  Instead the evidence points to the age of 14 as the latest that HRT may safely be begun with little risk of iatrogenic injury to desistors.  Indeed, the evidence suggests that carefully evaluated, many of the desistors may be excluded by age ten to twelve.  Another point to come of these studies is that anatomic dysphoria (discomfort with genitalia, etc.) is correlated with persistence.  Thus, if delaying puberty is chosen, it should not be continued past the 14th birthday, and given proper screening, may be ended earlier, to switch to HRT.  For both cost and health reasons, it may be best to start on HRT for those who clearly fit the profile of a transkid, who request and understand the consequences of HRT, as soon as would be indicated for their gender of choice.  That is to say, that for MTF’s, HRT should begin at age 12, and for FtM, at around age 14, mimicking the natural maturational process for each target sex.

Addendum 2/23/2012:

If you are a young teen, finding this post:  Welcome!  To answer some questions.  Yes, you can start blockers, maybe with low dose HRT, as young as 10 years old, but should start with very low doses, gradually increasing to the recommended level for teenagers as you reach 12-14 years old.  Of course, you would need either your parents permission, or find a youth clinic that understands transkids’ issues, who would prescribe blockers & HRT on a “harm reduction model” .  (Seriously, that’s the magic words, “harm reduction”… as in… “I’m going to get hormones on the street if I don’t get them here.”)  Good luck!

Addendum 6/1/2012:

Please read my Advice to Parents of Transgender Children

Addendum 12/29/2012:

Please read my Advice to Transgendered Teens

Addendum 4/1/2021:

A newly published study, by Singh, but with individuals who had gone to a Toronto clinic years earlier (and thus evaluated with older criteria that we know are a bit loser than today’s) has data on persisting and desisting male youth.  As before, we see that most of them turned out to be primarily androphilic with the persisters being universally so.  And again, we see a difference in the age of evaluation with persisters being older at 8.85 years and the androphilic desisters being 6.96 years old (Cohen’s d = 0.84 a ‘large’ difference).  Interestingly, there were a number of gynephilic desisters in the study who were also younger in age at evaluation at 7.49 which is very similar to the desisting androphiles (d = 0.2 a ‘small’ difference).  Note that the difference, of d = 0.84 is essentially the same as the d = 0.81 found in the Steensma study.  Thus, the characteristic difference has been replicated and may be trusted.

Another difference was found in IQ.  Desisters were more intelligent than average at 110 while the persisters had the expected population average of 99 (100 is the population average, so this showed no significant difference).  Thus, there seems to be a selection effect that smarter kids are being brought in by their families at a younger age by families with higher socio-economic status (which correlates with higher IQ that runs in families).  Perhaps this is because they over-react to mild gender atypicality?  The authors of the study suggested that it was the fault of the poorer parents, “delaying” instead.  I stand by my assertion that it’s based simply on the fact that desisters desist and are no longer brought in for evaluation.

As seen in other studies, the persisters were more gender atypical and gender dysphoric at evaluation than desisters.

Further External Reading:

https://www.kqed.org/futureofyou/441784/the-controversial-research-on-desistance-in-transgender-youth

References:

Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis, “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study”
http://ccp.sagepub.com/content/early/2011/01/06/1359104510378303

Vicente Gilsanz, James Chalfant, Heidi Kalkwarf,Babette Zemel, Joan Lappe, Sharon Oberfield, John Shepherd, Tishya Wren, Karen Winer, “Age at Onset of Puberty Predicts Bone Mass in Young Adulthood”
http://www.jpeds.com/article/S0022-3476%2810%2900566-4/abstract

Martha K. McClintock and Gibert Herdt, “Rethinking Puberty: The Development of Sexual Attraction”
http://homepage.univie.ac.at/Michael.Berger/lit/McClintock.pdf

Madeleine S.C. Wallien, Peggy T. Cohen-Kettenis,”Psychosexual Outcome of Gender-Dysphoric Children” Journal of the Academy of Child and Adolescent Psychiatry (2008)
https://doi.org/10.1097/CHI.0b013e31818956b9

Annelou L.C. de Vries, Jenifer K. McGuire, Thomas D. Steensma, Eva C.F. Wagenaar, Theo A.H. Doreleijers, Peggy T. Cohen-Kettenis, “YOUNG ADULT PSYCHOLOGICAL OUTCOME AFTER PUBERTY SUPPRESSION AND GENDER REASSIGNMENT” Pediatrics (2014)
http://pediatrics.aappublications.org/content/early/2014/09/02/peds.2013-2958

Kelly Winters, “Methodological Questions In Childhood Gender Identity Desistence Research”  Blog Link

Brik, T., Vrouenraets, L.J.J.J., de Vries, M.C. et al. Trajectories of Adolescents Treated with Gonadotropin-Releasing Hormone Analogues for Gender Dysphoria. Arch Sex Behav(2020).  https://doi.org/10.1007/s10508-020-01660-8

Singh D. et al., “A Follow-Up Study of Boys with Gender Identity Disorder”, Frontiers in Psychiatry, https://doi.org/10.3389/fpsyt.2021.632784 

 

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Somewhere, Over the Rainbow…

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

female_scientist♫…Skies are blue.

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

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

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

Singapore HSTS Life Arcs
(Cumulative Percentages at Age Indicated)

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

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

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

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

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

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

Addendum 12/3/2010:

Age:                                                             6    12   18   24 Total %

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

% becoming prostitute at age         0    33   58   37     33

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

References:

Anne A. Lawrence, “Societal Individualism Predicts Prevalence of Nonhomosexual Orientation in Male-to-Female Transsexualism”
http://www.springerlink.com/content/x556338354658m3w/

W. F. Tsoi, “Developmental profile of 200 male and 100 female transsexuals in Singapore”
http://www.springerlink.com/content/u8368t3213688nn5/

 

 

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