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Current Concepts in Transgender Identity (1998)

Current Concepts in Transgender Identity (1998)

©1998, 2014 by Dallas Denny

Source: Denny, Dallas (Ed.). (1998). Current concepts in transgender identity: Toward a new synthesis. New York: Garland Publishers.





Current Concepts is an edited text with chapters by a wide variety of noted clinicians, researchers, and theorists in the field. It is, among other things, an homage to John Money & Richard Green’s 1969 edited text Transsexualism and Sex Reassignment and includes chapters by three of the original contributors: Money, Green, and Ira Pauley. Other authors include Anne Bolin, Holly Boswell, Richard Green, Bonnie and Vern Bullough, Ruth Hubbard, Aaron Devor, Richard Ekins and Dave King, Sandra Cole, George Brown, Collier Cole and Walter Meyer, Bill Henkin, and others.

The text is divided into two parts. In Part I: Toward a New Synthesis, authors highlight emerging methodologies and ideas about being trans* These include discussions of sex and gender, emerging transgender models, and historical treatments. In Part II: Research and Treatment Issues, the authors write about among other things, therapy, electrolysis, male-to-female and female-to-male hormonal therapy, MTF genital surgery, interpersonal relationships, and issues of sexuality.

For those unfamiliar with Green & Money’s Transsexualism and Sex Reassignment, it described the treatment protocols for sex reassignment at Johns Hopkins University. It included chapters on MTF and FTM genital surgery and hormonal therapy, office management electrolysis, psychological testing, legal issues, religion, and more. It was an influential book that was followed faithfully by clinicians. Current Concepts was, in essence, a revision and update that described new models of thinking about trans* people.

Table of Contents

Table of Contents

Chapter 1:  Mythological, Historical, and Cross-Cultural Aspects of Transsexualism / Richard Green

Chapter 2: Transsexualism: Historical Perspectives, 1952 to Present / Bonnie Bullough and Vern L. Bullough

Chapter. 3: Black Telephones, White Refrigerators: Rethinking Christine Jorgensen / Dallas Denny

Chapter 4: Gender and Genitals: Constructs of Sex and Gender / Ruth Hubbard

Chapter 5. The Transgender Paradigm Shift Toward Free Expression / Holly Boswell

Chapter 6: Transcending and Transgendering: Male-to-Female Transsexuals, Dichotomy, and Diversity / Anne Bolin

Chapter 7: Blending Genders: Contributions to the Emerging Field of Transgender Studies / Richard Ekins and Dave King

Chapter 8: Fearful Others: Medico-Psychological Constructions of Female-to-Male Transgenderism / Jason Cromwell

Chapter 9: FTM: An Emerging Voice / Jamison Green

Chapter 10: Multiple Personality Order: An Alternate Paradigm for Understanding Cross-Gender Experience / William A. Henkin

Chapter 11: On Male Femaling: A Grounded Theory Approach to Cross-Dressing and Sex-Changing / Richard Ekins

Chapter 12: A New Concept of Body-Image Syndromes and Gender Identity / John Money

Chapter 13: Therapeutic Issues in Working with Transgendered Clients / Barbara F. Anderson

Chapter 144 Transgender Behavior and DSM IV / Collier M. Cole and Walter J. Meyer III

Chapter 15: Gender Identity and Sexual Orientation / Ira B. Pauly

Chapter 16: Sexual-Orientation Identities, Attractions, and Practices of Female-to-Male Transsexuals / Holly Devor

Chapter 17: Hormonal Therapy of Gender Dysphoria: The Male-to-Female Transsexual / Rosemary Basson and Jerilynn C. Prior

Chapter 18. Hormonal Therapy of Gender Dysphoria: The Female-to-Male Transsexual / Jerilynn C. Prior and Stacy Elliott

Chapter 19: Male-to-Female Feminizing Genital Surgery / Eugene A. Schrang

Chapter 20: Electrolysis in Transsexual Women: A Retrospective Look at Frequency of Treatment in Four Cases / Dallas Denny and Ahoova Mishael

Chapter 21: Women in the Closet: Relationships with Transgendered Men / George R. Brown

Chapter 22: The Female Experience of the Femme: A Transgender Challenge / Sandra S. Cole

Chapter 23: A Process Model of Supportive Therapy for Families of Transgender Individuals / Carole Rosenfeld and Shirley Emerson

Chapter 244 Gynemimesis and Gynemimetophilia: Individual and Cross-Cultural Manifestations of a Gender-Coping Strategy Hitherto Unnamed / John Money and Margaret Lamacz

Conclusion to Transsexualism and Sex Reassignment: Reflections at 25 Years / Richard Green

Appendix. The Empowerment of a Community / Rosalyne Blumenstein, Barbara E. Warren and Lynn E. Walker.[/learn_more




I would like to thank Dr. Phyllis Korper, my editor at Garland Press, for giving me the green light on this project.   I would like to thank the authors of the various chapters for their patience when I was unable to tell them exactly what I wanted; they came through marvelously. I’m very proud of each and every one of them.   would especially like to thank Dr. Richard Green and Dr. John Money for contributing to this work. Both have remained active in the study of gender and sex issues in the more than twenty-five years since their book, Transsexualism and Sex Reassignment was published, and have made important empirical and theoretical contributions to the literature.

Author's Note

Author’s Note


I am a woman of transexual experience. That is a revelation that I did not make in my previous book for Garland Publishers, but one which I am proud to make now.

For many years, the stigma attached to transexualism would have prevented me from making such a statement, or, indeed, from being able to contribute to the transgender and transexual literature in any meaningful way, had I acknowledged my transexualism, or had my transexual status been known to others.  The stigma associated with being transexual in American society would have silenced me.

That is no longer true.  Just as it is impossible to imagine the study of Black history without the contributions of Black scholars, or the study of homosexuality devoid of the writings of gay men and lesbians, it has become impossible for there to be meaningful study of transexualism or crossdressing without input from those who have been directly affected. Walter Williams (1995) has called such people “living experts.”

I am happy and proud to claim my status as a living expert.




In 1969, seventeen years after the news of Christine Jorgensen’s “sex change” shocked the world, the first collaborative textbook on transsexualism, Transsexualism and Sex Reassignment, edited by Richard Green and John Money, was published by the Johns Hopkins University Press. Just as Dr. Harry Benjamin’s monograph, The Transsexualism Phenomenon, had been three years earlier, Transsexualism and Sex Reassignment (or T&SR, as I will call it throughout these pages), was a quantum leap forward in the study and treatment of persons who were uncomfortable with their gender of assignment.

Dr. Money, pre-eminent in his field, and Dr. Green, who was rapidly becoming so, assembled a team of authors who examined transsexualism from a variety of perspectives: historical and mythological, legal, social, psychological, and medical. Articles included not only descriptions of surgical procedures and hormonal regimens, but discussions of etiology, neurological correlates, and social adjustment after sex reassignment. Many of the chapter authors went on to publish extensively in the field, and many continue to be active today. Of those authors, both Dr. Green & Dr. Money, and Dr. Ira Pauly, have been good enough to contribute chapters to this book.

View Table of Contents, Transsexualism and Sex Reassignment

The interdisciplinary approach of T&SR has been used several times since 1969, most notably in books with a clinical focus (Steiner, 1985; Walters & Ross, 1986; Blanchard & Steiner, 1990; and Bockting & Coleman, 1993), and in conference proceedings (c.f. Laub & Gandy, 1973; Wheale, 1992), but increasingly in social critiques (Epstein & Straub, 1992) and anthropology (Herdt, 1994). All of these books have been remarkable in their own right. But what has been lacking has been a work with a larger scope—one which attempts to integrate issues of treatment into the larger perspective which has been made available by those who have worked outside the clinical setting, and by transgendered and transsexual persons themselves.

This book is an attempt to do just that. I had initially hoped to subtitle it “A New Synthesis,” but in my opinion it is yet too early for that synthesis to occur—or perhaps I should say that I am not yet able to offer such a synthesis.

Current Concepts in Transgender Identity covers a variety of topics by authors with widely varying of viewpoints. Moreover, the underlying conceptual and theoretical frameworks from which the authors write varies dramatically, ranging from medical constructions of transsexualism to the emerging transgender view, in which being transgendered is not a pathology, but a gift.

Current Concepts does not cover all of the topics of importance-—I would have really liked to have included, for instance, chapters on chest reconstruction and metadoioplasty (a masculinizing genital surgery procedure) in female-to-male persons, and chapters on religion and legal issues—but Einsteinian limitations (you know, space and time) made it impossible to do all I wanted. However, if, by putting a variety of innovative and even controversial ideas together under one cover, I will have helped to lay the groundwork for a synthesis to come about, this book will more than have served its purpose.




Benjamin, H. (1966). The transsexual phenomenon. New York: Julian Press.

Blanchard, R., & Steiner, B. (Eds.). (1990). Clinical management of gender identity disorders in children and adults. Washington, DC: American Psychiatric Press.

Bockting, W., & Coleman, E. (Eds.). (1992). Gender dysphoria: Interdisciplinary approaches in clinical management. New York: Haworth Press.

Epstein, J., & Straub, K. (Eds.). (1992). Bodyguards: The cultural politics of gender ambiguity. New York: Chapman & Hall.

Green, R., & Money, J. (Ed.). (1969). Transsexualism and sex reassignment. Baltimore: The Johns Hopkins University Press.

Herdt, G. (Ed.). (1994). Third sex, third gender. New York: Zone Books.

Laub, D.R., & Gandy, P. (Eds). (1973). Gender dysphoria syndrome: Proceedings of the Second International Symposium on Gender Dysphoria Syndrome. Berkeley: Stanford University.

Steiner, B. (Ed.). (1985). Gender dysphoria: Development, research, management. New York: Plenum Press.

Walters, W.A.W., & Ross, M.W. (Eds.). (1986). Transsexualism and sex reassignment. New York: Oxford University Press.

Wheale, J. (Ed.). (1992). Counselling gender dysphoria: Proceedings of a national conference held at the Arcade Hotel, Birmingham, 15 February 1992. Cornwall & Devon: The Accredited Training Centre for Cornwall & Devon.                    



The Changing Face of Sex Reassignment

By Dallas Denny


Although transsexualism and crossdressing have been widely viewed as mental disorders in contemporary Western society, transgendered (i.e., transgressively gendered, what we might today call transsexual or crossdressing) people in any number of cultures other than our own have filled established social roles in which they were viewed sometimes with scorn, sometimes with awe and respect, and sometimes with a mixture of emotions—but not as mentally ill or perverted. Evidence of this can be found in sources as scattered as a seventeenth-century sketch by Theodor de Vrie (reproduced in Williams, 1986), which depicts transgendered Tinemuca Indians serving as stretcher bearers; a historical study by Roscoe (1994), in which he shows that gallae (emasculated males) served as priestesses of the goddess Magna Mater throughout the Middle East and Eastern Europe; a Paleolithic cave drawing of a transgendered shaman (Dragoin, 1995); and cross-cultural Nanda, 1989, 1994) and historical (Roscoe, 1990; Williams, 1986) studies.

In Western societies, transgendered persons have not fared well since their socially accepted roles were repressed by early Christians and others (Bullough & Bullough, 1993; Roscoe, 1994). For two thousand years, crossdressing has frequently resulted in prosecution, persecution, and even execution (Bullough & Bullough, 1993). With a few notable public exceptions such as the Chevalier d’Eon (Kates, 1995), those with transgender natures either lived quietly and probably unhappily in the gender and clothing of original assignment or as “passing men and women” (Dekker & van de Pol, 1989). Only in the past several decades have transgendered persons felt free to crossdress or crosslive openly, but even in the 1990s, it can be dangerous and even fatal to do so (cf Minkowitz, 1994; Bowles, 1996).

In the nineteenth century, transgendered persons began to come under the scrutiny of Western science; they and homosexuals were initially characterized as “sexual inverts” (Uhlrichs, 1994). As Richard Ekins points out in this volume, transgendered persons were not adequately differentiated from homosexuals until early in this century (Hirschfeld, 1910), and it was not until 1953, when details of Christine Jorgensen’s case were published in The Journal of the American Medical Association, that transsexualism was defined as a clinically diagnosable “syndrome” (Hamburger, Sturup, & Dahl-Iversen, 1953); see Bullough & Bullough, this volume).

The publication of Benjamin’s book The Transsexual Phenomenon in 1966 legitimized the mid-twentieth century category and identity of transsexualism, in which individuals with a presumed mental disorder called (at least initially) transsexualism use or wish to use medical technologies in order to change their bodies to resemble those of the other sex. [1] Within this framework, sex reassignment came to be seen not as an option that a reasonable individual might choose in order to have a body and gender role more to his or her liking, but rather as a medical treatment, a way to give relief to the suffering of the individual by altering the body because he or she had a mental condition which could not be “cured” by psychotherapy or other traditional means. Even those who dissented did not argue that transsexuals did not have a mental disorder. Their disagreement was in regard to the use of medical technology to modify the body. They contended that the proper way to treat a mental illness was by altering the mind, and not the body; they considered sex reassignment “collusion with delusion” or “collaboration with psychosis,” and argued against it (cf Ostow, 1953; Socarides, 1976; and Wiedeman, 1953).

Considering that the initial center of academic interest in the United States was Johns Hopkins Hospital, where John Money had been working with intersexed persons since the 1950s (Money, 1991), it is not surprising that the treatment system which arose to meet the needs of transsexual persons and the concomitant terminology which arose to describe them followed this medical model. Under the medical model, transsexual people became not merely presumably competent individuals who sought medical intervention to change aspects of their bodies and social roles which displeased them, but, because of the clinical and general societal zeitgeists of the time, patients with a mental disorder; it was incumbent upon medical and psychological caregivers to determine who would and would not benefit from sex reassignment, in which the individual’s body, behavior, and social role were modified as much as was feasible to mimic that of the other sex. In Transsexualism and Sex Reassignment (1969), Richard Green and John Money of Johns Hopkins presented a variety of clinical perspectives on the phenomenon of sex reassignment. [2] A number of viewpoints were represented in their book, but later clinicians and researchers narrowed rather than expanded Green & Money’s focus, with the result that the literature came to consist almost solely of papers based on the medical model; other viewpoints rarely if ever made it into print.

During the 1960s and 1970s, the process of sex reassignment was viewed as fraught with peril, and was considered best done in a highly restrictive setting under the guidance of an interdisciplinary team which made treatment decisions in the supposed best interest of the patient (Lothstein, 1979a). In actuality, these teams usually actively dissuaded individuals—and especially those who did not fit the characteristics of transsexual people as depicted in the emerging literature—from pursuing sex reassignment; only those most persistent and who most closely fit the clinics’ models of what a transsexual was were offered sex reassignment (Denny, 1992). To this day, many gender clinics continue to place needless and often sexist (Bolin, 1984) requirements on their patients. In a survey of gender programs, Petersen & Dickey (1995) found that some clinics still withhold hormonal and surgical procedures for such things as the “wrong” (i.e. post-transition gay or lesbian) sexual orientation; for inability or unwillingness to pass as a nontranssexual member of the non-natal sex; and for refusal to adopt a stereotypical cross-gender role and mode of dress (i.e., those who fail the “Barbie” and “Ken” tests). Not uncommonly, all treatment is withheld if the individual does not desire (or profess to desire) surgical sex reassignment (SRS) (cf Dickey, 1990)—this despite the commonly acknowledged fact that most transsexual people who transition (i.e., permanently cross gender roles) never, for one reason or another, have surgery.

In 1979, the Harry Benjamin International Gender Dysphoria Association (HBIGDA) put into place minimal Standards of Care for hormonal and surgical sex reassignment (Walker, 1984). Standardization of treatment was in fact badly needed, but the Standards of Care placed mental health professionals in the unenviable position of having the ultimate say-so about whether the applicant for sex reassignment procedures actually obtained them. A number of writers (Bolin, 1988; Denny, 1992; Kessler & McKenna, 1978; Stone, 1991) have commented on the unfortunate effect this “gatekeeping” function has had on the therapeutic relationship. The power dynamics inherent when one party (the transsexual) is dependent upon “permission” from another (the therapist) for a highly desired commodity (medical treatment) is hardly conducive to honest communication. The therapist may use this access as a tool for motivating the transsexual client to deal with other issues, or to entice the client into continuing with therapy. The client, on the other hand, may say or do whatever he or she thinks will maximize the change of obtaining permission for hormonal therapy and surgery.

In my earlier examination of the literature (Denny, 1994), I was struck by the fact that it reflected a curious tunnel-blindness. Despite the fact that as early as 1978, studies by sociologists and anthropologists clearly indicated problems with the medical model (Kessler & McKenna, 1978), the model itself has never been never seriously questioned by clinicians. Nor have clinicians, before this decade at least, seemed to really listen to the things transsexual people have been telling them about their lives—their sexuality, their developmental histories, their views of masculinity and femininity (see Devor, in this volume, for some interesting data on transgender sexuality which arose from a sociological study). No one seriously questioned a literature which depicted transsexual people in various unflattering ways which were in actuality reflections of the power struggle which centered around access to medical technology: as untrustworthy and manipulative (Stone, 1977), as inventing their early histories (Knorr, Wolf, & Meyer, 1968), as having highly stereotyped notions of masculinity and femininity (Althof & Keller, 1980; Kando, 1973), as having various characterological and personality disorders (Levine & Lothstein, 1981; Lothstein, 1983), and even as having a propensity for violence (Lothstein, 1979b) and murder (Milliken, 1982). Baker (1969) characterized much of what was said in the literature about transsexual people as “psychiatric name-calling.” I myself have noted that the literature is “full of countertransference, which surfaces as name-calling, inaccuracy, misperceptions, opinion posing as fact, humor at the expense of transsexual people, and perhaps even some lies” (Denny, 1993). [3]

Not surprisingly, it was not until someone not directly involved in the patient/caregiver cycle took a careful look at transsexualism that this clinical microcosm was put into perspective. Anne Bolin, a cultural anthropologist, building upon the theories and observations of Kessler & McKenna (1978), studied a group of transsexual women outside the clinical setting. Her doctoral thesis, which was published in 1988 with the title In Search of Eve: Transexual Rites of Passage, was a participant-observation study of a small group of transsexual women in a city in the Midwest.

Bolin found that many of the clinical truisms did not apply to her subjects. They did not, for instance, have highly stereotyped and exaggerated feminine appearance, as had been widely reported (cf Althof & Keller, 1980; Kando, 1973). Instead, Bolin found a diversity of personal styles and sexual orientations which paralleled those of a group of nontranssexual women.

But Bolin’s most important contribution was her analysis of the client-caregiver interaction. She confirmed the findings of Kessler & McKenna (1978) that the cultural assumptions of caregivers affected the way they viewed and reacted toward their transsexual clients. Bolin charged that:

… inherent in the Standards of Care and in the policy relations of caretaker to client is an inequity in power relations such that the recommendation for surgery is completely dependent on the caretaker’s evaluation. This results in a situation in which the psychological evaluation may be, and often is, wielded like a club over the head of the transsexual who so desperately wants the surgery. Such power dynamics often breed hostility on the part of transsexual clients. (p. 51).

The imbalance of power germane to transsexual-caretaker interaction along with transsexual resentment of psychiatric classification as a mental illness has culminated in transsexual hostility and distrust towards caretakers, particularly psychiatrists. Such feelings unfortunately override, and in some ways offset, the great concern and advocacy efforts of many psychiatrists and psychologists. (p. 55).

Bolin’s work has had little direct impact on the clinical literature, which continues to rely heavily upon a pathology model. However, by placing the clinical literature in context, she has had an immense impact by pointing out that there are alternative ways to view it. Consequently, to many clinicians, researchers, and transsexual people themselves, much of the clinical literature of the sixties, seventies, and eighties is colored by unfair and untrue assumptions about the nature of transsexual people; by power dynamics in the treatment settings which generated the literature; and by selection criteria which washed out all subjects except the ones who filled the expectations of the authors (Denny, 1992).

Science lurches drunkenly onwards, often stumbling, sometimes heading in the wrong direction, but always moving forward. The literature of transsexualism and crossdressing has slowly begun to reflect changing ideas about the nature of transgendered persons. The ideas of social constructionists, who believe that transsexualism is an invention, rather than a discovery (see Birrell & Cole, 1990; Ekins & King, in this volume; Hubbard, in this volume); the criticisms of Janice Raymond (1979, 1994); and most importantly, the emerging voices of transsexual and transgendered scholars (see Boswell, Cromwell, Denny, and J. Green, in this volume) have resulted in a new zeitgeist, a paradigm shift, if you will, much as happened with homosexuality (Bayer, 1987). As gay men and lesbians have assumed prestigious roles in politics, business, and science with no objective evidence of dysfunction, it has become impossible to portray them as pathetic and mentally ill. Those, like Charles Socarides, who continue to maintain against all reason that homosexuals are seriously disturbed, begin to look seriously disturbed themselves (Socarides, 1996). Similarly, it is becoming increasingly difficult to discount or pathologize transsexuals as they—I should say we—begin the same slow climb to social equality.

In dealing with my own transsexualism, and in working with hundreds of other transexual people, it has become clear to me that transsexualism, as conceptualized by Benjamin (1966), is an invented way of looking at a much larger transgender phenomenon, and that the process of sex reassignment, as outlined in Green & Money’s 1969 Transsexualism and Sex Reassignment, is but one way of dealing with that phenomenon. Transsexualism has a set of convenient diagnostic characteristics and its treatment (sex reassignment) gives only two choices: remaining in the sex of original assignment or doing everything possible to “change one’s sex.” There is no middle ground.

Raymond (1979, 1994) and others have criticized transsexual people for perpetuating what she sees as an inherently evil bipolar man/woman-male/female gender system, but her criticism would more appropriately have been directed at the treatment system which insisted that they move from a social role as a man to a narrowly defined role as a woman, rather than taking whatever steps they found necessary to feel comfortable in their own skins.

During the 1990s, and even before, transgendered people have begun to claim this middle ground. Prince (1978) was the first to ask just why it is important for transgendered people to have or claim to want SRS in order to live productively in the desired gender role. Her 1978 talk, given at The Fourth International Conference on Gender Identity, went virtually unremarked. When Boswell (1991, and in this volume) raised the question again, Prince had been living successfully as a woman for more than 15 years, without surgery.

While many transgendered people identify as “men trapped in women’s” and “women trapped in men’s” bodies and seek sex reassignment, as classically defined, others claim an essential transgender nature, and seek a level of comfort and personal satisfaction which may or may not involve genital surgery or hormonal therapy, and in which they may or may not attempt to “pass” as members of the other sex. For the first time, post-operative transsexual men and women are not disappearing into the closet of assimilation, but being open about their transsexual status, and adopting appearances and identities which are far from the stereotypes the clinical literature has claimed that they inevitably portray.

It is time to re-examine the basic tenets of the medical model of transsexualism. Should medical technologies continue to be available only to a narrowly defined class of persons called transsexuals, with mental health professionals having the responsibility and privilege of deciding who does and does not qualify to receive it? Should the technology continue to be available only in an all-or-none fashion, with the invariable goal being to produce picture-perfect males with neophalluses and females with neovaginas? Or should it be available, as are other body-sculpting medical technologies, in piecemeal fashion to those who can give informed consent? Must the inevitable result of masculinizing or feminizing surgical and hormonal procedures be to produce a member of the “other” sex with “appropriate” genitalia who will disappear into the greater society, or is it acceptable to produce persons who identify as neither or both sexes, or as a third or fourth sex, or who function in society as men with vaginas or women with penises? Is it necessary or desirable or accurate to continue to depict those who desire the application of such technologies, or who wish to change their social roles from male to female or vice-versa as dysfunctional, pathetic, and unfortunate?

Neither I nor anyone else has definitive answers to these questions, as data are only now beginning to accumulate. But my belief is that the Benjamin model of transsexualism has had its day as the sole way to view persons with gender identity issues, and that sex reassignment will in the future be but one of many options for them.

This book is an attempt to provide a broad focus on transgender phenomena, including contemporary perspectives from a variety of disciplines, and from transgendered persons themselves. The various chapters should be considered representative, and not a comprehensive list of contemporary issues. There are unfortunately not chapters on legal and religious issues, chest reconstruction surgery or metadoioplasty for female-to-male transsexuals, or any number of other important issues. But Current Concepts does include chapters on topics which have not been broached in other edited texts, and, I believe, for the first time in such an edited text, looks at the broader transgender phenomenon.




[1] Today, transsexualism is lumped with similar “conditions” and classified in DSM-IV as “Gender Identity Disorder” (see Pauly, this volume).

[2] Sex reassignment, as it was envisioned in the 1960s, consisted of hormone replacement therapy, genital and sometimes other plastic surgeries, electrolysis (for those wishing to be rid of facial and/or body hair), and legal and social readjustment in the new gender role. It was considered “palliative,” as it reduced the unhappiness of the individual with transsexualism. This treatment was administered only to those who are “true” transsexuals (i.e., had an unambiguous gender identity as females, if male; or male, if female), for those without such clear-cut gender identities would be (it was felt) grievously harmed by sex reassignment procedures. Those who were treated become “normal” men and women, and were hopefully integrated into society to live presumably successful and uneventful heterosexual lives—although the extent to which this actually happened is unclear, since patients were typically lost to long-term follow-up because of this assimilation process.

[3] Transsexual people have been pictured in various highly negative ways which one would hardly expect in a supposedly objective literature. In many cases, this literature has crossed lines of propriety and devolved into name-calling and forums for the expression of moral (Laub & Fisk, 1974; Wiedeman, 1953) or political (Raymond, 1979) beliefs. This continues even today (Raymond, 1994; Fagan, et al., 1994, Zucker, 1995), but only from those who choose to remain ignorant for ideological reasons. There has been an increasing willingness by most researchers to study transgendered and transsexual persons outside the therapy setting, to incorporate changing perspectives on transgender phenomena, and to view transgendered persons as real, live human beings rather than solely as “human experiments” (Stoller, 1975).

To give but a few examples of pejorative language from the literature:

Stoller (1982) once referred to male-to-female transsexual people as “near-misses.”

Laub & Fisk (1974) began an article in the journal Plastic and Reconstructive Surgery with the sentence, “To change an individual’s God-given anatomic sex is a repugnant concept.”

In the very first paragraph of her book The Transsexual Empire, Janice Raymond (1979) writes sarcastically of transsexual Renee Richards, “It takes (castrated) balls to play women’s tennis” (pp. xiii).

But if the literature contains statements which could only have been chosen to be deliberately offensive, there is much hostility just below the surface, as in Janice Raymond (1979), who wrote about post-operative male-to-female transsexual Mario Martino: “Mario Martino, in ‘his’ own experience as a female-to-constructed male transsexual…” (p. xxii) (note the deliberate misuse of pronouns, stigmatization by use of quotation marks, and the invented pejorative term female-to-constructed male).

A convention which arose in the literature was the use of quotation marks around pronouns when discussing transsexual persons. Admittedly, choosing appropriate pronouns to discuss the course of treatment of an individual who moves from a female role to a male role, or vice-versa, or who appears sometimes in male guise, and sometimes as a female, is a complex task, but pronouns have often been used in highly inappropriate and even aggressively insulting manners in the literature. Lothstein, for example, in his book Female-to-Male Transsexualism (1983), consistently used feminine pronouns and long-discarded female names to describe female-to-male transsexual people who had long ago become men. Taken in context in a book which is highly patronizing, hostile, and demeaning to female-to-male people, there seems little doubt that this usage of pronouns was chosen to heighten the impression Lothstein wished to make, which is that female-to-male transsexual people have unstable lives due to high levels of psychopathology which others have not commented upon only because their powers of observation and deductive abilities are not as well-developed as those of the author.

Many transsexual and transgendered people find much of the extant terminology to be offensive. In 1993, at the IXth International Symposium on Gender Dysphoria in New York City, Barbara Warren introduced to the community of gender researchers terminology used by the Gender Identity Project at New York City’s Lesbian and Gay Community Services Center (Warren, 1993). Unlike treatment models which center on the supposed pathology of being transsexual or transgendered, the Gender Identity Project moves clients away from a self-concept based on shame and pathology to a sense of empowerment as an individual with a unique transsexual or transgendered identity. The program uses peer interaction and support, peer counseling, and community-building to do this (see Appendix A).




Althof, S.E., & Keller, A. (1980). Group therapy with gender identity patients. International Journal of Group Psychotherapy, 30(4), 481-489.

 Baker, H.J. (1969). Transsexualism—problems in treatment. American Journal of Psychiatry, 125(10), 1412-1418.

Bayer, R. (1987). Homosexuality and American psychiatry: The politics of diagnosis. Princeton, NJ: Princeton University Press.

Benjamin, H. (1966). The transsexual phenomenon: A scientific report on transsexualism and sex conversion in the human male and female. New York: Julian Press.

Birrell, S., & Cole, C.L. (1990). Double fault: Renee Richards and the construction and naturalization of difference. Sociology ofSport Journal, 7(1), 1-21.

Bolin, A.E. (1984). Sexism in the diagnosis and treatment of male-to-female transsexuals. Argoix, 5(1 and 2), 23-30.

Bolin, A. (1988). In search of Eve: Transsexual rites of passage. South Hadley, MA: Bergin & Garvey Publishers, Inc.

Boswell, H. (1991). The transgender alternative. Chrysalis Quarterly, 1(2), 29-31.

Bowles, S. (1996, 10 December). A death robbed of dignity mobilizes a community. Washington Post.

Bullough, V.L., & Bullough, B. (1993). Cross-dressing, sex, and gender. Philadelphia: University of Pennsylvania Press.

Bullough, B., & Bullough, V.L. (1996). Transsexualism: Historical Perspectives: 1952 to Present. In D. Denny, Current Concepts in Transgender Identity. New York: Garland Publishers.

Bullough, V.L., Bullough, B., & Smith, R.A. (1983). A comparative study of male transvestites, male-to-female transsexuals, and male homosexuals. Journal of Sex Research, 19(3), 238-257.

Dekker, R.J., & van de Pol, L.C. (1989). The tradition of female transvestism in early modern Europe. New York: St. Martin’s Press.

Denny, D. (1992). The politics of diagnosis and a diagnosis of politics: The university-affiliated gender clinics, and how they failed to meet the needs of transsexual people. Chrysalis Quarterly, 1(3), 9-20.

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During the several years since I wrote the foreword of this book, the genderrevolution has been happening. The political awakening of the transgender community has given me new ways of looking at transsexualism and crossdressing and caused me to reassess much of what I thought I knew.

As my thinking has evolved, the assumptions and biases of much of the existing literature has become more apparent. I find myself looking at old studies in a new way. Consider, for instance, the much-researched question of whether transsexuals are more likely to have psychiatric disturbances than nontranssexuals. Previously, such studies have tended to assume that transsexuals are inherently unstable, completely overlooking the fact that being transsexual is likely to lead to a lifetime of abuse and discrimination. The important questions then, become not “Do transsexuals exhibit significantly more psychopathology than nontranssexuals, and what is it about them that makes them so?” but “What environmental stresses do transsexuals encounter, how does this affect them, and how can we ensure that they are treated better?” The locus of the problem changes: it is externalized, no longer within the transsexual. It is not the transsexual or transsexualism that is at fault; the problem is an intolerant and violent society.

When such a shift of viewpoint takes place, much of the existing literature immediately becomes irrelevant. It no longer tells us anything very useful.

This does not mean that the existing research was unimportant or trivial. Indeed, it was essential, for without it, we would never have found ourselves in this place of changing perspectives. This is how science works. Our old models topple, and we are off on a new quest, asking new questions which will themselves one day seem quaint and limited.

Everyone doesn’t “get it” at once. Some take a while longer than others– and a few diehards will refuse to acknowledge the validity of the new order. But the paradigm shift is a juggernaut, impossible to resist. It changes things, and it changes them forever.

I’m very excited to be around while all this is happening.


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