Betty W. Steiner

Heterosexual and homosexual gender dysphoria

This study investigated why more males than females complain of dissatisfaction with their anatomical sex (gender dysphoria). New referrals to a university gender identity clinic were dichotomously classified as heterosexual or homosexual. There were 73 heterosexual and 52 homosexual males; 1 heterosexual and 71 homosexual females. The average heterosexual male was 8 years older at inception than the homosexual groups. The heterosexual males reported that their first cross-gender wishes occurred around the time they first cross-dressed, whereas the homosexual groups reported that cross-gender wishes preceded cross-dressing by 3–4 years. Some history of fetishistic arousal was acknowledged by over 80% of the heterosexual males, compared to fewer than 10% of homosexual males and no homosexual females. The results suggest that males are not differentially susceptible to gender dysphoria per se, but rather that they are differentially susceptible to one of the predisposing conditions, namely, fetishistic transvestism.

Extension of the Gender Identity Scale for Males.

Our earlier Feminine Gender Identity Scale for males appeared to measure a strong single factor which was reliable and displayed substantial discriminant validity. However, the number of items was small and there was substantial overlap between items with respect to their meaning. In an attempt to overcome these limitations, in the present study the scale was extended and validated on subject samples corresponding to those on which the earlier scale had been validated. Each item of the new scale differentiated among the groups in an experimental sample and, subsequently, in a cross-validation sample. A secondary finding was the significantly higher feminine gender identity scores of homosexual patients over homosexual nonpatients.

Two types of cross-gender identity

A revision of the typology of male cross-gender identity was carried out by means of formalized, easily replicable methods. The results suggest (1) that there are two discrete types of cross-gender identity, one heterosexual, the other homosexual; (2) that transvestism, and closely related conditions of cross-gender identity, occur exclusively or almost exclusively in heterosexuals; (3) that of the two types of transsexualism distinguished in this study, type A is, in heterosexuals, very rare or completely nonexistent; (4) that (in the course of time) transvestites or borderline transsexuals (defined below) may develop sustained cross-gender identity, as observed by Stoller (1971); (5) that although, according to Hoenig and Kenna (1974), transsexualism by itself is not an anomalous erotic preference, it is (virtually) always either preceded by transvestism or accompanied by homosexuality or cross-gender fetishism.

Phallometric Detection of Fetishistic Arousal in Heterosexual Male Cross-Dressers

We examined whether an erotic response to cross‐dressing fantasies could be detected in heterosexual male cross‐dressers (HCDs) who verbally denied any erotic arousal in association with cross‐dressing for at least the past year. Subjects were 37 HCD patients and 10 paid heterosexual controls. HCDs were divided into groups according to their response to a questionnaire item asking the proportion of occasions that cross‐dressing was erotically arousing during the past year and offering response options from always to never. Penile blood volume was monitored while subjects listened to descriptions of cross‐dressing and sexually neutral activities. All HCD groups responded significantly more to cross‐dressing than to neutral narratives (p < .01); controls did not. Results suggest that only those causal hypotheses of heterosexual cross‐dressing need be considered that can account, also, for the presence of fetishism.

Social desirability response set and systematic distortion in the self-report of adult male gender patients.

This study showed that the “socially desirable” presentation for a heterosexual male gender dysphoric is one that emphasizes traits and behaviors characteristic of “classic” transsexualism. Fifty-one homosexual and 64 heterosexual adult male gender patients were administered the Crowne-Marlowe (1964) Social Desirability Scale as well as eight questionnaire measures that tapped various features of the clinical history commonly given great weight in differential diagnosis. The tendency for a heterosexual subject to describe himself in terms of moral excellence or admirable personal qualities was significantly correlated with scores in the “transsexual” direction on all eight sexological measures; for the homosexual subjects, only one correlation was significant. It is argued that the patients most motivated to create a favorable impression on the examiner are likely to be those most anxious to obtain approval for sex reassignment surgery. Because, in this population, the socially desirable presentation is “feminine,” it is possible that the differences in the histories produced by transvestites and heterosexual transsexuals are exaggerated to an unknown degree by the motivation of the latter to obtain approval for this operation. The findings do not diminish the important distinction between these groups, but they do suggest caution in interpreting the self-report data that have been used in comparing them.

Measuring physical aggressiveness in heterosexual, homosexual, and transsexual males

The purpose of this study was the development of a self-report measure of boyhood aggressiveness for use with adult males. Aggressiveness was defined as a generalized disposition to engage in physically combative or competitive interactions with male peers. This attribute is of sexological interest because of the reported difference in physical aggressiveness between heterosexual and homosexual boys. A physical aggressiveness scale (PAS) was constructed from items regarding boyhood athletic interest and proficiency, as well as fighting with and feelings of unease around male peers. The PAS and Part A of the Feminine Gender Identity Scale for males (FGIS(A), Freund et al.,1977) were administered to 193 adult men. The PAS was shown to be reliable and factorially pure. The PAS scores of homosexuals were significantly lower than those of heterosexuals, and the scores of male-to-female transsexuals were lower yet. No differences were found among three heterosexual groups: prison inmates and nonuniversity- and university-educated males. Precisely symmetrical results were obtained with the FGIS(A), with the male-to-female transsexuals scoring highest and the heterosexuals lowest. Group differences in FGIS(A) scores were greater than those in PAS scores; this was interpreted as possible evidence that physical aggressiveness is more sensitive than gender identity to variables uncorrelated with erotic preference, e.g., perceptual-motor ability, rate of physical maturation, etc. The main results suggest that whatever underlying factor relates homosexuality to feminine gender identity in childhood relates this erotic preference to anomalously low levels of physical aggressiveness in childhood as well.

The clinical profile of male transsexuals living as females vs. those living as males

The clinical profiles of five male groups were compared: transsexuals who live as females (FEM), those who live as males (MAL), homosexual patients (HOP), homosexual controls (HOC), and heterosexual controls (CON). The MAL group showed psychotic features on the MMPI and a greater frequency of suicide attempts than the other groups. Their sexual behavior was incongruous in that they have had substantial sexual contact with men but less often desired sexual contact with men. They also less often desired to handle the penis of an adult man or to kiss him on the lips. They were more likely to find handling anothers penis disgusting. However, they showed considerable involvement of their penis in sex relations with men. The FEM group, in contrast, had MMPI profiles suggestive of character disorders and tended to engage in antisocial behavior. Both MAL and FEM groups were similar in MMPI and 16 PF “femininity.” The HOP group showed overall similarity to MAL but was not as pathological. The HOC and CON groups were similar in being normal but their sexual behavior differed, as expected. The paradoxical behavior of MAL is discussed as well as the parallel of the FEM groups behavior to that of criminals.

Female-to-male transsexuals and their partners.

This paper reviews briefly the literature on gender disorders, that is transsexualism in fernales. Forty-one female-to-male transsexuals and twenty-one female partners of these patients were evaluated in the Gender Identity Clinic at the Clarke Institute of Psychiatry. The authors report on the type of behaviour patterns with particular reference to the kind of relationship the patients form with their partners. These seem to be stable, long-term relationships, though both the transsexual and his partner have had considerable sexual experience prior to forming this relationship. Contrary to what other workers report, these transsexuals wish to parent children and indeed frequently chose partners who already had children. The authors speculate on the reasons why a normal biological female would choose a “penis-less man” as a partner and form a long-term enduring relationship with him.

Gender reorientation, psychological adjustment, and involvement with female partners in female-to-male transsexuals

The present research examined the relationship, in a sample of female-to-male transsexuals, between psychological and social adjustment, on the one hand, and gender reorientation (approximation of the status of the opposite biological sex) on the other. This work was conducted in two stages. The quantification of the gender reorientation construct was investigated in Study 1. A gender reorientation index (GRI) was developed and subjected to standard tests of psychometric adequacy. The GRI proved to be reliable and to have a satisfactory factorial composition, and it was considered an adequate measure of gender reorientation for use in the second study. Study 2 investigated the relationship between symptomatic depression and tension, involvement with a female partner, and gender reorientation. Four stepwise multiple regression analyses were carried out, one for each of four criterion variables (depression, tension, partner-involvement, and the MMPI Lie Scale). The predictor variables, gender reorientation and age, were the same in each analysis. There was a statistically significant negative correlation between depression and gender reorientation and between tension and gender reorientation, and a significant positive correlation between involvement with a female partner and gender reorientation. The GRI did not correlate with the MMPI Lie Scale, and age was not significantly related to any of the criterion variables. Thus, the present findings support the notion that gender reorientation is accompanied by improved psychological and social adjustment.

Gender reorientation and psychosocial adjustment in male-to-female transsexuals

This study examined the relationship, in a sample of male-to-female transsexuals, between psychological and social adjustment, on the one hand, and gender reorientation (approximation of the status of the opposite biological sex), on the other. Three gender reorientation variables were studied: exogenous female hormones, vaginoplasty, and social feminization (adoption of the female gender role at home and in the transsexuals social life and the procurement of documents indicating the female sex). These three gender reorientation variables plus age were employed as predictor variables in a series of multiple regression analyses. Five stepwise regression analyses were carried out, one for each of five criterion variables (depression, tension, involvement with a male partner, cohabitation with a male partner, and the MMPI Lie Scale). There was a statistically significant negative correlation between depression and social feminization and between tension and social feminization, and a significant positive correlation between cohabitation with a male partner and vaginoplasty. Neither the MMPI Lie Scale nor the simple fact of having been “involved” with a male partner at some point during the past year correlated significantly with any of the predictor variables. These results indicate that gender reorientation is associated with better psychological and social adjustment in male-to-female transsexuals.