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Gender Identity and Bisexuality (1996)

Gender Identity and Bisexuality (1996)

©1996, 2013 by Dallas Denny and Jamison Green

Source: Dallas Denny & Jamison Green. (1996). Gender identity and bisexuality. In Beth Firestein (Ed.), Bisexuality: The psychology and politics of an invisible minority, pp. 85-102. Thousand Oaks, CA: Sage Publications.




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Related Chapter: Transgender Identities and Bisexual Expression (2007)


Gender Identity & Bisexuality

By Dallas Denny, M.A.

And Jamison Green, M.F.A.

 (Both Authors Contributed Equally to this Essay)


 Individuals are generally assumed to adopt one of the gender identities socially available to them by unequivocally defining themselves as “male” or “female” in accordance with the biological reality of their body types. Occasionally, people are born who exhibit ambiguous indicators of biological sex, whose chromosomal makeup is at variance with their external genital makeup, or who simply feel strongly that they are meant to be a different sex or gender than that which they were assigned at birth.

Many individuals making the transition from male to female or from female to male experience alterations in the definition of their sexual orientation, and some of these individuals identify as bisexual, either during the transition process or following completion of the transition. This chapter will provide an introduction to gender identity issues and review research and clinical findings pertinent to the relationships among transgenderism, transsexualism, and bisexuality.—Ed. (Beth Firestein)


If bisexuality marks the intersection between homosexuality and heterosexuality, transgender identity can be seen either as the virtual melting pot of biological and social distinctions, or as the final arbiter of the interaction between an individual’s self-concept and the object of her or his sexual desire. What we are talking about here is the confusion of sex and gender, and the role of anatomy in determining sex, gender, and sexual orientation.

Intersexed and transsexual people make for convenient focal points in social, political, and scientific debates about such issues. Transsexualism, especially, has been used to justify myriad positions. Some assert that transsexuals do not break down gender stereotypes, but only reinforce them (Raymond, 1979, 1994); while others point out that “…the transsexual currently occupies a position which is nowhere, which is outside the binary oppositions of gendered discourse” (Stone, 1991, p. 295). And there are some who believe that in actuality, “there are no transsexuals; we are all transsexuals” (Halberstam, 1994, p. 226).

The confluence of sex and gender is a confusing area of the mind and body, made all the more challenging by virtue of finding ourselves in a society which has barely cracked open the door leading to our ability to discuss these topics. What is sex? And what is gender? What is gender identity? And what does all this mean for the concept of bisexuality?



The following vignettes are composites, pastiches of the lives of the authors and the lives of others:

Michael started his life in a female body. He grew up as a girl named Deborah, and he was never attracted to women. Even though he had (then) heterosexual relationships with men, he always felt something was wrong, that he was really more male than female. Deborah married a man and gave birth to a child, and still the feelings of male gender identity did not abate. Eventually, Deborah divorced, and, after a long process of self- examination, went through hormonal and surgical sex reassignment. Deborah fully expected that as Michael, (s)he would continue to be attracted to men and would assume a homosexual identity. However, after several years of living as a man, Michael was surprised to realize that he was not attracted to gay men. Instead, he was attracted to heterosexual women (primarily) and men (occasionally). He now identifies as a bisexual man.

Charlene was pronounced a boy at birth, and given the name Charles. Until she was five, she thought she was a girl. Eventually, she realized that her body was male, and resented that fact very much. Although most of her sexual relationships as an adolescent and young adult were with women, Charlene had a number of casual encounters with men, always while crossdressed. Yet whenever she would have sex with a man, she would feel dissatisfied because her partner would treat her like another man instead of the woman she knew she really was. When she made love to a woman, she felt she was using her partner to learn about female behavior; she wanted not only to love her female partners, but to be them, and she wanted to be a woman when she had sex with men. Charlene’s desire to be a woman culminated in hormonal and surgical sex reassignment at age 34, after which she dated men exclusively for several years. One night she wound up in bed with a close female friend. Their relationship lasted several years, after which she began dating both men and women. Today, she considers herself to be bisexual.



For purposes of clarity, we will begin by defining some terms. Biological sex refers to the chromosomal makeup, external and internal genitalia, hormonal state, and gonads of an individual. Gender is a social construct which is independent of biological sex; one is male or female because of one’s biological sex, but one is a boy or girl, man or woman because of one’s gender identity and gender role. Gender identity is one’s sense of self as a boy or girl, woman or man, or, as we are increasingly realizing, as a non-gendered, bi-gendered, transgendered, intersexed, or otherwise alternatively-gendered person. Gender role is a set of expectations that one will look, dress, and behave as a man or woman, while the term sexual orientation refers to the object(s) of one’s sexual desire.

Intersexuality occurs when an individual is born with physical evidence of sexual ambiguity or duality such as a micropenis, androgen insensitivity [which results in an XY (chromosomally male) child with a vagina who is assigned as a female], enlarged clitoris, hypospadias (a congenital urinary condition in males), and/or ovotestes. Intersexed people often receive surgical intervention to assign—or reassign—their sex while they are still infants; often, this intervention is problematic physically or psychically for the individual so treated (Alvarado, 1994; Fausto-Sterling, 1993).

A transgenderist identifies with both the male and female roles, or as a member of an alternative sex. Many transgenderists live full-time as members of the non-natal sex, but with no desire for genital modification (as distinct from a transsexual individual who makes a decision not to pursue surgery because it is imperfect or disfiguring or costly). Transgenderists do sometimes modify their bodies with hormones or electrolysis or plastic surgery.

Transsexual people are those who have a longstanding desire to live as the sex opposite that of their “normal” genitalia, and who wish to have the primary and secondary sex characteristics of the other sex. Transsexual people usually—but don’t always—seek medical intervention as adults to reassign, or realign their sex to match their psyche. A transsexual woman is a biological male who has a longstanding desire to live as a woman, and a transsexual man (also called a female-to-male, or FTM) is a biological female who has a longstanding desire to live as a man. We use these terms regardless of whether the individual has actually transitioned into the other gender role. We realize that the terms “male transsexual” and “female transsexual” have been widely used in the clinical literature to refer respectively to biological males and females with transsexualism, but this terminology is offensive to many transsexual people (including us), and, we believe, fundamentally disrespectful. We do not use the word transsexual in isolation, for transsexualism is but one aspect of a human being with the condition called transsexualism; instead, we use the terms transsexual person or transsexual people and person with transsexualism.

Sex reassignment refers to the complex process of therapy, electrolysis (for transsexual women), hormonal therapy, social reorientation, and (if desired) surgery which allows an individual to live as a member of the non-natal gender (Green & Money, 1969). Transsexual men and women can be post-operative or pre-operative, depending upon whether or not they have had surgery to modify their genitals. Non-operative transsexual people have made a conscious choice not to have genital surgical procedures, but nonetheless identify totally as a member of the new gender (Schaefer & Wheeler, 1983). Many transsexual people hope to discover that they are, in fact, intersexed so that there will be a concrete, medically accepted reason for their “gender dysphoria,” and so that insurance companies might consider their necessary surgeries “corrective” as opposed to “elective,” “cosmetic” or “experimental.”

Transition begins when the transsexual individual prepares to live full time in the new gender role, and ends (usually) after genital reconstruction, or when the individual senses the transition has ended and is no longer concerned about it. Transition is characterized by profound physical changes and tremendous social stress, amplified by the constant effort which must be applied to finding one’s place in the world, and an acute awareness of how “fitting in” is distinguished from “difference” in every social encounter. The individual in transition often experiences both euphoria and depression: the first arising from the actualization of a longstanding desire; the second rooted in the often debilitating consequences of that action. Depression may set in because of the length of time the transition takes to accomplish, or the failure of the transition process to achieve the desired goal, such as when the effect of hormones is insubstantial, too extreme, or adverse (requiring cessation), or when surgical procedures go awry. Challenges arise during transition with relation to one’s family, in the workplace, among friends, with social institutions (identification, school transcripts, military records, licenses, etc.), between sexual partners or in dating, and with the expense or scheduling of medical procedures. These difficulties can also contribute to depression.

Transition ends gradually, with the individual’s recognition that he or she feels at ease with his or her self and feels fully integrated into society, whether or not he or she continues to identify as transsexual in private and/or public.

Gender-identity disorder or gender dysphoria are the terms used in the clinical literature to describe the constellation of attitudinal and behavioral indicators commonly manifested by those who wish to change their bodies and social role—but this use is unfortunate, for it needlessly pathologizes a set of behaviors which has been manifested in all cultures throughout history and appear to be natural for a certain percentage of human beings. However, when an individual is in extreme distress because of having transgender feelings, he or she can appropriately be said to be experiencing gender dysphoria. The term transgender is commonly used to describe the global community of crossdressing and transsexual persons.


Transsexualism and Bisexuality

Any discussion of transsexual sexuality is bound to be very confusing and, we would argue, ultimately very instructive about the nature of sexuality in general, and especially of bisexuality. Should homosexuality be considered in relation to the individual’s natal sex, or their new role? Is a transsexual woman who is still fulfilling the role of husband in a marriage in a lesbian relationship? Certainly, it does not seem so to the world, which sees a heterosexual relationship. And yet five years later, when the individual has transitioned into the woman’s role, the same couple, if publicly affectionate, will be perceived as lesbian. What of a post-transition nonoperative transsexual woman in a sexual relationship with a male? The public sees a heterosexual couple, and yet, in the bedroom, their genitals match. Should their sexual act be considered heterosexual or homosexual? Does it matter if the feminized partner does or does not take the active role in intercourse? And what if the same individual then has surgery and finds a female partner? Is this relationship homosexual or heterosexual? Finally, what if a nonoperative transsexual man has as a partner a post-operative transsexual man? Is this a gay relationship? A straight one? Are any of these people bisexual? And most significantly, can the term bisexuality have any meaning at all when gender is deconstructed?

Transsexual persons must make some sense of their self- identity as members of the other sex and of their sexuality in a world largely ruled by traditional gender beliefs (Garfinkel, 1967). The experience of feeling or being perceived as “transgendered”—that is, being someone who crosses or blurs gender boundaries—is different for someone who chooses to cultivate such a persona from time to time than for someone whose gender identity persistently does not match his or her body. Transsexual men are often perceived by others as transgendered, masculine, or lesbian women prior to transition, and as feminine men, gay men, or simply as men afterward. Transsexual women often are perceived as men, gay men, or feminine men prior to transition, and as women, transvestites, transsexual women, or masculine women afterward.

The feeling of being transgendered comes from the knowledge that one’s body and mind (psyche) are not in accord, or that one has adopted a manner of coping with the dominant two-gender-only system by moving across the line to a position of discord between mind and body that others might perceive is a false premise—that the individual is, in fact, more comfortable outside the stereotypical definitions of gender. When a person comes into a sexual relationship from such a position, the words defining the sexual behavior may be less important than the self-definition of the individuals involved.

While clearly their primary issue is one of gender identity and not of sexuality, transsexual persons, like all humans, are sexual beings, and must deal with their sexuality before, during, and after their transition. An orientation which is viewed as homosexual at one point in their lives may be seen as heterosexual at another point, and vice-versa.


“Natural” Attitudes Toward Gender

From Kessler & McKenna, 1978, pp. 113-114

(Following Garfinkel, 1967)


1. There are two, and only two genders (female and male).

2. One’s gender is invariant (If you are female/male, you always were female/male and you always will be female/male.)

3. Genitals are the essential sign of gender. (A female is a person with a vagina; a male is a person with a penis.)

4. Any exceptions to two genders are not to be taken seriously. (They must be jokes, pathology, etc.)

5. There are no transfers from one gender to another except ceremonial ones (masquerades).

6. Everyone must be classified as a member of one gender or another. (There are no cases where gender is not attributed.)

7. The male/female dichotomy is a “natural” one. [Males and females exist independently of scientists’ (or anyone else’s) criteria for being male or female.]

8. Membership in one gender or another is “natural.” (Being female or male is not dependent on anyone’s deciding what you are.)

Garfinkel (1967) noted that there are a number of beliefs which people traditionally hold about gender (see Table 1 for a list of these beliefs). The existence of transsexualism challenges all eight of these beliefs. Transsexual people defy categorization into one of the two gender roles, and so cast doubt on the belief that there are only two genders. Most infuriatingly, they traverse between roles, seriously challenging the view that biology is destiny. Consequently, many people find transsexualism (and transsexual people) threatening and react to them with hostility and scorn.

Those who subscribe to Garfinkel’s traditional belief system would describe a relationship between a biological male and a postoperative transsexual woman as homosexual (and would no doubt be very confused by the idea of a postoperative transsexual man with a nontranssexual man). Others, less bound to these “rules,” would describe the first relationship as heterosexual, and the second as homosexual. Many clinical settings are based on some of these traditional beliefs, with the result that transsexual people are forever categorized by their natal genitalia, so that all of their sexual behavior is classified by this “fixed” reference point, as if to delegitimize the person’s identity as well as any reconstruction that might occur.

The high visibility of transgendered male-to-female sex workers in large cities and a thriving pornography industry belie the fact that most transsexual women report reduced sexual activity and that many transsexual women are considered to be less sexually active than the general population (Benjamin, 1966). Transsexual men experience a dramatic increase in libido after administration of testosterone, but we know of no clinical studies which have examined FTM sexual behavior and physiological sexual response.

For transsexual people, at least, and perhaps for everyone, it may make more sense to describe relationships as homogenderal or heterogenderal (Pauly, 1973). That is, gender, rather than sex, is the critical component in defining their sexual behavior. A relationship between a biological female and a transsexual woman is homogenderal, regardless of whether the transsexual woman has had or plans to have genital surgery. Similarly, a relationship between a post-transition transsexual woman and a post-transition transsexual man is heterogenderal, regardless of their respective surgical states (i.e., there is a man and a woman, even if they are such by choice, and not by biology) (Pauly, 1973).

If all of this seems confusing, it is because it indeed is. Our long-established notions and vocabulary of sexuality and gender are no longer sufficient, and a new system is not yet fully in place, although “work is in progress.”


Review of the Literature on Transsexualism and Bisexuality

Much of the transgender literature is highly clinical in nature, what one of us has called elsewhere “a collection of papers by clinicians explaining to other clinicians how to deal with such troublesome people” (Denny, 1993). Unfortunately, historical, sociological, and anthropological analyses of transsexualism which accord transgender behavior a respected position within cultures tend to be overlooked or dismissed by clinicians, who have assembled a literature which is naive and full of superficiality (Bolin, 1988; Denny, 1992, 1993, 1994; Stone, 1991). [1] One of the truisms of this literature is that transsexual people must necessarily be attracted only to those of the same natal sex. With a few exceptions (c.f. Bentler, 1976), the clinical literature has only within the past ten years started to reflect what transsexual people have always known—that many are bisexual or attracted to members of their new gender (Bockting, 1987; Bockting & Coleman, 1992; Coleman & Bockting, 1988; 1989; Coleman, Bockting, & Gooren, 1993; Pauly, 1989a, 1989b, 1989c, 1990, 1992a, 1992b). Some clinicians still don’t “get it.” As recently as 1994, Fagan, Schmidt, and Wise of the Sexual Behaviors Consultation Unit at Johns Hopkins University stated their conviction, in a letter in The New Yorker, that female-to-male transsexual people are “fundamentally homophilic but cannot consciously accept their sexual orientation” (p. 15). This is both manifestly untrue and incredibly disrespectful of the ways in which transsexual people choose to live and love.

Objections to transsexualism are almost invariably made on ideological grounds and tend to be based on unverifiable assumptions by people who have never taken the trouble to become acquainted with the people to whom they are objecting. Certainly this is true of Janice Raymond, who argued that transsexualism should be “morally mandated out of existence” (Raymond, 1979, 1994). For her anti-transsexual manifesto The Transsexual Empire (1979), Raymond interviewed only 15 transsexual people.

Clinicians with the same appalling lack of knowledge of transsexual people continue to contribute to the literature. In a letter written to another professional in the summer of 1994, psychiatrist Paul McHugh expressed incredulity that a transsexual woman could be attracted to other women. McHugh has admitted that he took a position at Johns Hopkins University in order to shut down their gender identity clinic (McHugh, 1994). [2]

The first (and to date the only) clinical book written exclusively about transsexual men (Lothstein, 1983) is fortunately out of print, “but unfortunately it is still available in libraries and used bookstores, and the harm it has done [to patients and their parents seeking information] persists. Many of us have experienced serious setbacks in our quests for self- realization after being exposed to this book.” (Sullivan, 1989.)

In spite of the heterosexist and clinical bias in much of the literature (cf Denny, 1994), the balance of the literature and our respective personal experiences suggest that there is a great deal of bisexuality among transsexual persons. In his 1966 textbook, Harry Benjamin discussed bisexuality in transsexualism. Benjamin took it for granted that all transsexual women would be sexually attracted to males, and all men would be sexually attracted to females. He noted that before transition, many transsexual people function in marriages and long-term relationships with the other biological sex, but never seemed to consider that after transition the individual might wish to continue a relationship which would now be considered “homogenderal.”

Other clinicians also assumed that transsexual persons would, after transition, inevitably wind up in heterogenderal relationships. Barr, Raphael, and Hennessey (1974) were surprised to find two male applicants for sex reassignment who stated that they were not erotically attracted to men. Unfortunately, their observation was largely ignored.

Following the opening of the Gender Identity Clinic at JohnsHopkinsUniversity in 1967, applicants for sex reassignment were rigidly screened. Sex reassignment was considered at Hopkins and other centers to be highly experimental, and access to feminizing and masculinizing medical procedures was restricted to those who best fit the often stereotyped and sexist notions of what transsexual people were like (Denny, 1992). Kessler & McKenna (1978) noted:

A clinician during a panel session on transsexualism at the 1974 meeting of the American Psychological Association said that he was more convinced of the femaleness of a male-to-female transsexual if she was particularly beautiful and was capable of evoking in him those feelings that beautiful women generally do. Another clinician told us that he uses his own sexual interest as a criterion for deciding whether a transsexual is really the gender she/he claims. (p. 118)

Present-day clinicians have begun to incorporate the notion of bisexuality into their work with transsexual people. Coleman and Bockting (Bockting, 1987; Bockting & Coleman, 1993; Coleman & Bockting, 1988, 1989, 1993) have taken a lead, doing much-needed descriptive studies. Blanchard (cf Blanchard, 1989, 1990a, 1990b), Clare (1984, 1991), Clare & Tully (1989), and Money & Lamacz (1984) have taken typological approaches, inventing complicated terms like “autogynephlia” and “transhomosexuality” to refer to the sexual desires of transsexual people. But the most exciting findings have come from field studies. Bolin, an anthropologist found a high degree of bisexuality in her participant-observation study of a small group of male-to-female transsexual persons in the Midwest. Of the seventeen subjects who provided data on sexual orientation, one reported being exclusively heterosexual, one reported being heterosexual by preference, but open to bisexuality, one was bisexual but preferred males, six were bisexual, six were exclusively lesbian, one reported a lesbian preference but was open to bisexuality, and one did not know her preference. Sexual preferences were reported according to the subjects’ roles as women; thus a heterosexual relationship was a relationship with a man. Bolin (1988) wrote:

The assumption behind the conception of transsexual heterosexuality is that if one wants to be a woman then the only appropriate sexual object choice is male. One vignette of a caretaker-client interaction is illuminating in this respect. Tanya, a preoperative transsexual, saw a psychiatrist as part of an agency employment requirement. Because in this situation the psychiatrist was not going to conduct her psychological evaluation, Tanya, a bisexual, discussed a recent lesbian encounter and her openness to a lesbian relationship postoperatively. The psychiatrist was incredulous. He asked, “Why do you want to go through all the pain of surgery if you are going to be with a female lover?” (p. 62)

Clearly, those conducting much of the assessment and treatment of transsexual people have not themselves been clear on the difference between gender identity and sexual orientation. In much of the published research seeking to find correlations between sexual orientation and gender identity, the heterosexual model as “norm” is the starting point. But gender identity in general is not an indicator of sexual object choice.

Recently (1993), Devor, a sociologist with no “gatekeeping” power over her interview subjects (that is, she could not influence their access to hormones or surgery), published data on the sexual orientation identities (SOIDs) of 45 transsexual men. She found that these men were reluctant to specify their physical selves as the most important factor in selecting their SOIDs. In other words, there is more to defining one’s sexuality than the shape of one’s genitals, whether pre- or post-operatively. While all but one of the participants in Devor’s study reported having been attracted to women, more than half of them were also attracted to men at various times in their lives. Devor (1993) reports:

…an intriguing 257% increase in the number of post-transition participants who began to find gay men sexually attractive. The participants who developed an interest in sexual relations with gay men after they themselves had become men tended to be among the furthest into their changes, averaging 10.75 years since beginning their transitions. More significantly, they averaged 7.4 years into their transition before starting to find men sexually attractive. (pp. 310-311)

Devor (1993) also writes, “It is important to remember that, for many people, SOID is not stable. SOIDs are, in part, built on a foundation of sex and gender identities. These are not static for most transsexual persons” (p. 306). In other words, sexual orientation identity is not necessarily tied to the formation of one’s genitals or indelibly etched into stone upon one’s first experience of arousal. SOID is composed of a complex amalgam of feelings, beliefs, attractions, repulsions, and drives, and these not only vary between individuals, but can also change within individuals over time. [3]

Recognizing that bisexuality does exist among transsexual people makes it easier for clinicians to view their clients diagnosed with “gender identity disorder” as more than people who are homophobic concerning their primary sexual attraction to people of their natal sex, and who may be seeking to “legitimize” that attraction by changing their bodies to achieve a heterosexual effect. However, another distorted view of transsexual people is promulgated in Dual Attraction (Weinberg, et al., 1994). The chapters on transsexual bisexuals are riddled with derogatory language, and the use of quotation marks when referring to orientations and sex organs (“heterosexual,” “lesbian,” “vaginas,” etc.) reveal the authors’ lack of awareness as they delegitimize the feelings, desires, and physical realities of transsexual people. The small research sample (ten transsexual women, one transsexual man) makes the data highly questionable and far too weak to support the conclusions stated. Most offensive is the assertion: “Given too that attracting a partner, any partner, presents a problem for the transsexual, adopting a bisexual identity widens the range of potential eligibles” (page 64). Many transsexual people are secure in their gender identity, and do not have difficulty finding partners. At the same time, many transsexual people may find bisexually identified partners attractive because people who are not monogenderal in their affinities may be better able to relate to the experience and perspectives of transgendered people.

Weinberg, et al. also declare that “For some, bisexuality is a transitional stage, and they may utilize sex not so much for pleasure (as do other bisexuals), but as a way to validate their gender” (pp. 64-65). Such belittling remarks, used to marginalize transsexual people, could as easily apply to non-transsexual people of any gender or sexual orientation, and then become meaningless.

In the conclusion to their chapter on bisexual transsexual people, Weinberg et al. state that “the major difference (between transsexual and nontranssexual bisexuals) is that the nontranssexual bisexuals do not worry about their gender identity” (p. 64). We postulate that many transsexual people do not worry about their gender identity, either; they worry about their bodies. They worry about being misperceived, misinterpreted, rejected or ridiculed because of their bodies, not their gender identities: people might read the wrong signals, read the body, not the soul. And the risk of being misinterpreted is great: the more transgendered one appears, the more likely he or she is to be physically or verbally attacked. [4]

Like bisexuals, who challenge the “norm” of monosexual orientations, the highly varied transgendered, intersexed, and transsexual people who embody the concepts of fluid, changeable, or contra-physical gender identity also break down a rigid binary system that has been used for centuries to control society. Bisexuals are the most likely class of people to understand and easily embrace the concept of gender identity as separate from sexual orientation. But as marginalized groups struggle for mainstream acceptability, there is a temptation to jettison cargo that might impede progress. Transgendered people have long received a cold shoulder from the now-mainstream lesbian and gay communities. And not all bisexual people are ready to admit a connection between trans-genderal and bisexual issues.

There are still many more questions than there are answers. Recognizing each individual’s need to define him or herself with respect to gender as well as sexuality can generate provocative inquiry and may lead us to a deeper understanding of ourselves.


Suggestions for Therapists Working with Transsexual Clients

The period when the clinician is most likely to encounter the transsexual adult is just prior to and during transition. Many transsexual people, and especially those who have not reached the age of majority, are likely to first seek out therapists for other problems, such as confusion over sexual orientation; lack of self-esteem; inability to perform in school, work, and social situations; depression; substance abuse; or oppression and/or physical abuse from parents or peers because of perceived gender difference. It then becomes incumbent upon the therapist to assist in the recognition of gender identity issues.

When a client presents with issues concerning gender identity, which may or may not include questions about the client’s understanding of his or her sexual orientation, the therapist’s most important task is to assist in clarifying the issues. If this is to occur, the therapist must be able to understand the distinction between sexual orientation and gender identity, and to distinguish between biological sex, gender role, gender identity, and sexual orientation. The client’s issues may not lie in any of these concerns, specifically, but distress can manifest as a disturbance in any of these areas.

Transgendered or transsexual people may present with a variety of masking conditions which, when addressed, give way to the underlying gender issue. Therapists must be sensitive to the tremendous fear the client may have concerning his or her revelation of gender identity issues, and his or her reluctance to deal with them in a forthright manner. It is possible for an individual with bisexual attractions to have confusion or concern about his or her gender identity. They may confuse the attraction dynamic with a desire to have the body of the “opposite” sex. It is important to assist clients in distinguishing between sexual fantasies and the reality of gender identity. Not everyone who fantasizes about having “other” genitalia is transsexual, though some clients might wonder about themselves, or even convince themselves this is the case. Frank discussions about the realities of the transsexual process are necessary to ensure clients are able to make informed decisions concerning body alteration.

Transsexual people who have come to terms with their gender identity, and who have researched the topic and know what they want, are not always the most cooperative clients. Under other circumstances they would not seek therapy, but because of the Standards of Care of the Harry Benjamin International Gender Dysphoria Association (Walker, et al., 1985), they are required to be in therapy in order to obtain clearance to proceed further along the path toward physical transformation. They may be resentful that they have to pay money, especially if they feel that they know more about the condition of transsexualism than does the therapist (and this is too frequently the case). The therapeutic relationship is not facilitated by a power struggle between provider and client.

Therapists who are not trained in gender identity issues, transsexual processes, and issues of transition should be able to refer clients to others with applicable special knowledge [5].

Transgendered persons are awakening to the realization that the desire to crossdress or to modify their bodies with hormones and surgery is not in and of itself a pathology, and that transgender feelings are not something which should be “cured” or “resolved,” but accepted. Clinicians have been slower to realize this, and continue to use value-laden, pathologizing terms like “gender dysphoria,” “male transsexual,” and “deviancy,” to refer to transsexual persons. It is of obvious importance that clinicians should use the terms which transgendered persons have chosen for themselves rather than to continue to use stigmatizing jargon.

Clinicians have invented needlessly complicated terms like “transhomosexuality” (Clare, 1984, 1991; Clare & Tully, 1989) and “gynandromorphophilia” (Blanchard & Collins, 1993) to refer, respectively, to the sexual attractions of transgendered persons, and to those attracted to them. These terms are misused, unless the person has a specific attraction to that category of person, as opposed to an attraction to an individual. A man who has a sexual relationship with a transsexual woman, and who may even marry her, is more likely to do so despite her transsexualism, than because of it. Indeed, considering the quality of male-to- female genital surgery, he may never be aware of her transsexualism. Certainly, he is not a “gynandromorphophile.” On the other hand, some men specifically prefer transsexual woman, and qualify for the term.

By the same token, a post-transition transsexual woman who considers herself to be a lesbian, or a post-transition transsexual man who identifies as gay need not be considered as “transhomosexual,” (Clare, 1984, 1991; Clare & Tully, 1989) but simply as lesbian or gay. Similarly, it is not uncommon for transsexual persons to choose other transsexual persons as their sexual partners, but this is more often a matter of opportunity than of specific preference for other transsexual people.

The clinician must be prepared not only to assist the transsexual client with issues of identity, but with the complicated issues of sexual attraction in relation to gender identity. The concept of bisexuality makes no sense without the traditional binary gender system. There is no bisexuality, or for that matter, sexual orientation, without gender. Without gender there is no social dynamic to charge the relationships between people—there are only bodies, and the mechanical joining or friction between them. Human beings tend to be attracted to other human beings, regardless of labels. Perhaps that is the bottom line.




[1] In a 1993 review of Ann Bolin’s In Search of Eve, Charles Mate-Kole wrote that Bolin’s book “may offer greater assistance to the student or avid reader in sociology/anthropology than to the clinician or psychology/psychiatry student.” This is an extremely shortsighted view, for In Search of Eve offers a cogent analysis of the interactions between transsexual people and their “caregivers.” Bolin (as did Kessler & McKenna, 1978), points out that the expectations and treatment goals of transsexual people who desire hormonal and surgical treatment are often in conflict with therapists, who see themselves as “gatekeepers,” the ultimate arbiters of who will and will not be allowed access to body-changing medical technologies.

[2] McHugh and company accomplished this task in 1979, to the detriment of many transsexual people and to the study of gender identity issues in general. See Ogas, 1994, for the story of the closing of the Gender Identity Clinic at Johns Hopkins. And for a textbook example of science misused for political purposes, see Meyer & Reter, 1994, and the critique of that paper by Blanchard & Sheridan (1990).

[3] Dr. Holly Devor’s article “Sexual Orientation Identities, Attractions, and Practices of Female-to-Male Transsexuals”, Journal of Sex Research, Vol. 30, No. 4, pp. 303-315, November, 1993) gives probably the most cogent analysis done to date. It contains an excellent summary of previous theories and clinical literature. Her study includes one of the largest FTM research samples, and, while it cannot be the definitive last word on the formation of gender and sexual orientation identity, it goes a long way toward illuminating this complex subject.

[4] For documentation of the risk of transgendered identity, see the Report of the San Francisco Human Rights Commission on its Investigation into Discrimination Against Transgendered People (Jamison Green, principal author), issued September, 1994, available from the SFHRC, 25 Van Ness Avenue, Suite 800, San Francisco, CA 94102-6033, 415-252-2500.

[5] List of Resources:

American Educational Gender Information Service, Inc. (AEGIS), P.O. Box 33724, Decatur, GA 30033-0724. (404) 939-2128

business; (770) 939-0244 information & referrals; (770) 939-1770 FAX; E-Mail. AEGIS is a 501(c)(3) nonprofit membership organization which functions as a clearinghouse for gender identity issues. Publishes the respected journal Chrysalis and other materials, maintains the National Transgender Library & Archive, provides educational outreach and mail order book sales, conducts research, maintains telephone help line, makes referrals and provides information. Publishes Recommended Guidelines for Transgender Care.

FTM International, 5337 College Avenue, #142, Oakland, CA 94618. (510) 287-2646 (voice mailbox). Peer support and information for transsexual men, FTM crossdressers, and their significant others. Publishes The FTM Newsletter, an FTM Resource Guide and other informational materials, provides public speakers, educational presentations, consultation and referrals

Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA), P.O. Box 1718, Sonoma, CA95476. (707) 938-2871 voice & FAX. Membership organization for professionals who work with persons with gender dysphoria. Newsletter, bi-annual conference. Those with transgender issues should contact AEGIS and/or IFGE (see this listing).

International Foundation for Gender Education (IFGE), P.O. Box 229, Waltham, MA02254-0229. (617) 899-2212 voice; (617) 899-5703 fax. Publishes The TV-TS Tapestry Journal and other materials, has walk-in center, holds annual conference, provides educational outreach and mail order book sales, maintains telephone help line, makes referrals and provides information.




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Biographical Sketch

Jamison Green


Jamison “James” Green, is the Director of FTM International, the world’s largest information and networking group for female-to-male transgendered people and transsexual men. He is a writer of both fiction and non-fiction, and until recently served as editor of the FTM Newsletter. As a Gender Diversity Consultant, Mr. Green provides academic lectures, organizational sensitivity trainings, and transgender advocacy services to groups, institutions, and corporations. He is a member of the Board of Directors of the International Foundation for Gender Education, and his work with the San Francisco Human Rights was instrumental in the 1995 implementation of legislation to protect transgendered people in the City and County of San Francisco. He holds a Master of Fine Arts degree in English/Creative Writing, has published several short stories, one of which was nominated for the 1984 Pushcart Prize. He is also a technical communications consultant for high technology medical, electronics, and financial corporations.

Biographical Sketch

Dallas Denny


Dallas Denny is a Licensed Psychological Examiner and a member of the Harry Benjamin International Gender Dysphoria Association, Inc. and of the Society for the Scientific Study of Sex. She is founder and executive director of the American Educational Gender Information Service, Inc., a national clearinghouse for information about gender dysphoria, editor and publisher of Chrysalis Quarterly, and founder of Atlanta Gender Explorations, a support group for persons who are exploring nontraditional gender roles. She also works as a Behavior Specialist with persons with mental retardation. She has more than twenty years of experience working with persons with mental and physical disabilities. Ms. Denny has a Master of Arts degree in psychology, and is completing a doctorate in special education at Peabody College of Vanderbilt University. She has been previously published in many magazines and a number of peer-reviewed professional journals. She has written four novels, and is a songwriter as well. Her books Gender Dysphoria: A Guide to Research and Identity Management in Transsexualism were published in 1994. She currently has a new book, Current Concepts in Transgender Identity: Towards A New Synthesis, for Garland Publishers.