THE ETIOLOGY OF TRANSSEXUALITY
Where does such a deep disorder come from? What sorts of events must conspire in order for a physically normal girl to be convinced that she is
really a boy or a boy to feel that he is a girl?
The answers are very speculative but there are two sets of factors that might disrupt sexual identity, and both of these occur very early in life.
Fetal Hormones
In the course of a normal pregnancy, the fetus is bathed in a variety of hormones.
These hormones modulate physical growth, bodily differentiation,
and psychological growth as well. Fetal hormones may influence the way we
think and act, and evidence for this comes from the rare, but theoretically
important, phenomenon of hermaphroditism.
Hermaphrodites who are chromosomally female (46XX), if hormonally
masculinized as a fetus, are born with ambiguous-looking genitals. Either
because of genetic defect or because of drugs taken by the mother during
pregnancy, some fetuses receive too much androgen while they are in the
uterus. Hormonal androgenization is principally responsible for the masculinized
development of the external genitals in the male. When a female is
fetally androgenized, upon birth her clitoris is enlarged and penis-like, and
her vagina may be partially sealed off. When the diagnosis is promptly
made, the vaginal opening is brought to the exterior, and the clitoris is surgically
feminized in early infancy. Such females are raised as girls. If the external
masculinization is complete, with a penis in an empty scrotum, such
a baby may be raised as a boy. Subsequently, circumstances may conspire,
and such a child may, on rare occasions, request sex reassignment.
John Money, one of America's leading sex researchers, intensively studied
thirty fetally androgenized hermaphrodites, raised in the female role, as
children and as adolescents. He found that when compared to girls matched
for IQ, race, and class, these girls differed psychologically along several stereotyped dimensions of masculinity and femininity. They expressed more
dissatisfaction with the female sex role, they had more athletic interest and
skills, they preferred male companions, and they wore slacks, rather than
dresses, more often than the controls. These findings lead us to conclude
that some stereotyped sex-role behavior may be determined in the uterus by
fetal hormones (Money and Ehrhardt, 1972; Money, Schwartz, and Lewis,
1983). None of these girls believed they were boys, but some researchers
have speculated that in the prenatal history of transsexuals a hormonal or
related biochemical error affecting sexual pathways in the brain must have
occurred. But no proof has yet been forthcoming.
Rearing Practices
How parents treat a young child affects the sexual identity ofthe child. What
would happen to a male child who was given a girl's name, dressed as a girl,
and introduced to friends, relatives, and other children as a girl? Parents ofa
pre-transsexual child are usually ambivalent about what to do. They put off
decisions and ultimately panic when the gender disorder doesn't go away.
But whether this is a cause or a consequence of the child's transsexuality is
unknown. The accidental loss of a penis by one of two identical twins in
early childhood provides some evidence that how a child is raised by his or
her parents may influence sexual identity.
The rearing of this child is described below:
Aterrible accident took place in the life of one of two identical twins when he
was seven months old. As he was being circumcised, his entire penis was burned
offby a faulty electricaldevice. After medical and psychological advice, the parents decided to rear the child as a girl, starting at seventeen months of age. But would his sexual identity change? Would he, in spite of his male internal organs, male hormones in utero, and seventeen months of being treated as a boy, ever come to feel, act, and have the sexual desires of a girl? At twenty-one in months, plastic surgery was undertaken and the appearance of a vagina constructed. The parents, in consultation with the surgeon and psychiatrists, decided to rear the child in the most female-stereotyped way:clothes and hair do were feminized,and the child was given pink shirts, frilly blouses, bracelets,and hair ribbons. Within a year the little child clearly preferred dresses over slacks, and was proud of her long hair.
She became much neater and daintier than her twin brother. Her mother
taught her to squat whileurinating, unlike her brother whostood. For the next few
years, the mother began to prepare the child to become a wife and housekeeper,
and the child began to imitate her mother in the house keeping role. The little girl
now preferred dolls and mother roles in play, while her male identical twin preferred toy cars and father roles in play.
By the time the twins were almost six,they had a different vision of their future.
"I found that my son chosevery masculine things, like a fireman or policeman, or
something like that. He wanted to do what Daddy does, work where Daddy does,
and carry a lunch kit, and drive a car. And she didn't want any of those things. I
asked her, and she said she wanted to be a doctor or a teacher. And I asked her,
'Well, did she have any plans that maybe someday she'd get married, like
Mommy?' She'll get married someday-she wasn't too worried about that.
Shedidn't think about that too much but she wants to be a doctor. But none of the
thingsthat she ever wanted to be were like a policeman or a fireman, and that sort
of thing never appealed to her." (Money and Ehrhardt, 1972)
The twins are now in adolescence and the indications are that the female twin,
in spiteof being genetically a male-but having been reared as a female-shows
some, but not all, the aspects of female role and identity. (Williams and Smith,
1979)
It is possible that rearing conditions, particularly while the child is very
young, and in individuals who are predisposed-perhaps by fetal hormones-
may influence sexual identity decisively. The future may hold a
way of identifying hormonally vulnerable children and then paying special
attention to appropriate rearing conditions. Since we know that transsexuality,
once acquired, is very difficult to reverse, the need for a preventative
technique of this sort is acute.
THERAPY OF TRANSSEXUALISM: SEX-CHANGE OPERATIONS
Transsexualism does not spontaneously change in the lifetime of the transsexual.
Also conventional therapies have only very rarely been able to reverse
it (see Barlow, Abel, and Blanchard, 1979, for the single report of
reversal oftranssexuality-by exorcism). In spite of this, there is some hope
for transsexuals today. Sex-change operations, while still imperfect, allow
transsexuals to get the genitals they desire and to marry. As we have seen,
normal sexual identity is shaped both by biological conditions, such as what
hormones we are exposed to in the womb, and by environmental conditions,
such as people reacting to us as male or female. Therapy for transsexuals
consists of changing the external reproductive organs by surgery; in addition,
this change is supported by social, vocational, domestic, and bodily
changes in an attempt to shore up the new gender status.
Therapists treating a transsexual who is a candidate for sex-change surgery
often require that the person first live for two years in the new gender
role. If after two years ofpassing for and being treated as a female or male, the
individual stillwants surgery, the psychological hazards of the surgery are
probably lessened. Those who are schizophrenic, delusional, or otherwise
emotionally disordered should probably not undertake it (Money and Ambinder,
1978).
Bodily changes are prerequisite to sex-change surgery. In male-to-female
sex changes, there is a combination of hormonal treatment to make the
breasts grow and make facial hair disappear, and surgery to remove the
penis and transform it into a vagina. Because the skin of the penis is used to
line the vagina, sexual intercourse-when the surgery is successful-is erotically
pleasurable. Orgasm is a warm, sometimes spasmodic, glow through
the body.
In female-to-male sex-change operations, the surgery is much more complicated
and extensive. It involves multiple operations that take place over
several years. First, hormonal treatment suppresses menstruation, deepens
the voice, and causes growth of facial and body hair. Then surgery is performed
to remove the breasts, the ovaries, and rarely to construct a penis.
The capacity for orgasm is always retained, but such a penis cannot become
erect, and a prosthetic device has to be used for sexual intercourse.
There has not been a massive and well-controlled follow-up of patients
who have undergone sex-change operations. In one eight-year follow-up of
seventeen male transsexuals after sex-change surgery, modest gains in working
and interpersonal relationships occurred, as well as larger gains in sexual
satisfaction. Level of psychological disturbance did not change, however
(Hunt and Hampson, 1980).
Some clinicians claim that when the two-year trial period in the role of the
desired sex precedes the operations, patients always benefit from the surgery,
both in their sense of well-being and in their ability to love. Job status
improves, sexual relationships tend to be more stable, and patients indicate
that if they had to do it over again-even though the surgical outcome may
have been disappointing-they would do so (Money and Ambinder, 1978).
But there is disagreement about this. In a follow-up of fourteen patients
operated on at UCLA, almost all ofthe patients had had surgical complications.
Urination was frequently difficult and sexual intercourse often proved
impossible. One patient committed suicide after surgery, and some of the
others became depressed and apathetic (Stoller, 1978).
On balance, sex-change operations seem to provide the best-indeed the
only-hope, at present, for transsexuals. As surgical techniques improve,
the operation is apt to become more satisfactory, although even then the
transsexual must cope with other problems of adjustment. But because
there seems to be no alternative but despair, sex-change operations seem to
be the therapy of choice.
NOTE:
For transsexuals, homosexuals or heterosexuals
who were raise in a shame or guilt based family of origin...
I suggest psychotherapy to come to terms with identity and move into acceptance.
For the treatment method I recommend click here!
http://theliberatormethod.com/Welcome.html
For transsexuals, homosexuals or heterosexuals
who were raise in a shame or guilt based family of origin...
I suggest psychotherapy to come to terms with identity and move into acceptance.
For the treatment method I recommend click here!
http://theliberatormethod.com/Welcome.html