Prediction of regrets in postoperative transsexuals.

This study investigated whether heterosexual males are more likely to regret sex reassignment surgery than homosexual males or females. Subjects were 111 postoperative transsexuals who had been surgically reassigned for at least one year, representing a follow-up rate of 84.1%. Subjects' feelings about surgery were assessed with self-administered questionnaires. None of the 61 homosexual females or 36 homosexual males consciously regretted surgery, compared to 4 of the 14 heterosexual males: a significant difference. This finding suggests that heterosexual applicants for sex reassignment should be evaluated with particular caution, although a heterosexual preference is not an absolute contraindication for surgery.

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.

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.

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 transsexual's 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.

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.

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.

Female-to-male transsexuals and their partners.

This paper reviews briefly the literature on gender disorders, that is transsexualism in females. 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.

Changes in patients with gender-identity problems after parental death.

The authors studied the incidence of parental loss among 163 gender-disordered patients and an equal number of psychiatric control patients. An unusually high number of gender-disordered patients had lost their fathers, particularly during adolescence and early adulthood. Many of these patients showed shifts in gender identity in the year after loss, and during that period many requested surgical sex reassignment for the first time. Changes in the patient's relationship with the remaining parent and experiences related to loss of the father are discussed.

The crisis of middle age.

Today's emphasis on youth makes it increasingly difficult to accept growing old. The denial of ageing is reflected in society's attitudes and in the paucity of medical and psychiatric literature on the subject. In the middle years there is the greatest demand for adequate emotional adaptation during a rapidly changing period in life, which frequently involves two people, both separately and together. This paper discusses some of the problems which may be encountered from the psychosomatic, sexual and psychological aspects in the middle-aged man, woman and the couple. It emphasizes the need for the family physician to be aware of these difficulties and to be able to help the patient deal with them. The more successful the resolution of the middle-age crisis, the more contented and peaceful will be the acceptance of old age by the individual.