Dean Kotula
[Abstract] Full Text [PDF]
Milton Diamond, Ph.D. is a
sexologist who has published numerous articles pertaining to his long
interest and research on sexual identity formation and sexuality.
From early on in his career,
Dr. Diamond has investigated claims about the malleability of sexual
identity and along with H. Keith Sigmundson, MD, Dr. Diamond successfully
challenged the conclusions of an important case study conducted by the
renowned medical psychologist, Dr. John Money. The so-called John/Joan case
was originally presented as proof that altering the infant’s upbringing
and genitals could easily change a child’s sexual identity. Thousands of
“sex reassignments,” with accompanying surgeries were performed based on
conclusions erroneously extracted from this example. Doctor’s Diamond and
Sigmundson discovered that Dr. Money, who was touted as “one of the
greatest sex researchers of the century” for this celebrated case, had
misinterpreted or misrepresented his data to support his theory that nurture
(social factors), rather than nature, had the greatest influence over
one’s sexual identity.
The Diamond and Sigmundson
discovery was published in a scientific journal, and the information was
broadcast to the public in the New York Times, Time, and Newsweek magazines
and other media around the world. This case, referred to as the John/Joan
case, is one in which a boy had his penis accidentally burned off during
circumcision using a cautery. On the advice of John Money, the boy’s
parents began to raise him as a girl and then send him for first stage sex
reassignment surgery that included castration. When the child was a
pre-teenager the child’s physicians started him on female hormones. The
parents were told that under no circumstances were they to tell the child
its sex at birth. For twenty-five years, the public and medical communities
were led to believe that the child had adapted to the change. In truth,
there was resistance to the sex reassignment from the very start. What was
once a landmark case to prove the influence of nurturing is now regarded as
significant to the theory of a biological premise in the formation of sexual
identity. John somehow knew being a girl didn’t feel right, despite his
female name, the absence of a penis, having a feminine body with breasts,
and being reared as a girl. This supports the transsexuals’ assertions of
“knowing” they are the opposite sex despite their bodies and what they
are told. Current brain research is further elucidating and giving
credibility to these assertions.
The John/Joan case was
outlined in a Dec 11, 1997 issue of Rolling Stone magazine, and in a best
selling book “As Nature Made Him: The boy that was raised as a girl.”
Dr. Milton Diamond teaches and
does research at the Department of Anatomy and Reproductive Biology, Pacific
Center for Sex and Society, John A. Burns School of Medicine, University of
Hawai’i-Manoa, Honolulu.
Dr. Diamond’s research is
supported in part by the Eugene Garfield Foundation of Philadelphia,
Pennsylvania and the Sabra Stiehl Foundation of Atlanta, Georgia.
DK: When you were a graduate
student at the University of Kansas, did something occur which motivated you
to have questions about the primacy of nature over nurture?
MD: I don’t think
there was any single thing. As a graduate student I was studying behavior
from both biological and psychological perspectives and was repeatedly
considering the factors that influenced behavior. But since I was working in
a laboratory that specialized in research on sexual behavior it was
questions within that realm that took most of my attention. Within that lab
[of Dr. William C. (Bill) Young] were many working on questions of sexual
development so, as a graduate student, it was easy for me to slip into
similar research. I was fortunate that my mentors at the time were, in
addition to Bill Young, Bob Goy and Charles Phoenix. The most salient
question being studied at the time was “What factors were most crucial in
determining adult sexual behaviors and how did they develop?” In the
laboratory the work was mainly with guinea pigs and rats. I was also curious
as to those factors in humans that structured sexual behavior. The zeitgeist
at the time held that it was rearing that most determined basic sexual
behaviors such as whether individuals would act as males or females and
toward which others they would be sexually attracted. It is within that
framework that we asked if the factors that determined behavior were more in
the upbringing or in the biology with which the individual was born.
DK: I’d like you to talk
about intersexuality as it relates to transsexuality and to elaborate on the
concept of “brain sex” if you would.
MD: To best answer that
question I think it worthwhile to first define some terms. To put it as
simply as possible a transsexual is a male or female
individual who thinks he or she is more suited or “meant” to live as a
member of the opposite sex. Thus a male might believe, “I should really be
a woman” or even “I am a man trapped in a male body and I should be in a
female body.” On the opposite side of the coin, a female would think
analogously. These are individuals that see the world as having two basic
“flavors,” male and female, man or woman. These convictions are strong
enough that the individual goes to great efforts to change sex. An
intersexual, in distinction, has recognized combinations of male and female
biological characteristics. Often the person with an intersex condition has
genitalia that are ambiguously male or female. An intersexed individual
might have the sex chromosomes of a male and the body characteristics of a
female or vice versa. Or an intersexed person can have male and female
gonads, both a testis and an ovary. Recognizing both male and female
features in body they may also manifest it in their behavioral preferences.
Such persons typically don’t see male and female as opposites. They can
accept, with more or less ease, that they are male and female combinations
in body and mind. However, the social situation in which they find
themselves will determine how they react to their condition. Some will live
and identify socially as men, others as women and yet others as intersexed
individuals. The term, years ago, for an intersexed person would have been a
hermaphrodite. Some accept this condition with relative ease while others
meet it only with difficulty.
Since the brain is the organ
determining or scripting male or female behaviors, the term brain sex
is a short hand to reflect on how an individual thinks and organizes the
world; whether in stereotypical male or female ways. It is certainly true
that the brain is the most sexual organ of the body and the term brain sex
reflects its male or female disposition. It directs the individual to think
and act more like a stereotypic male or more like a female.
For transsexuals, since there
is little evidence that they have been brought up in anything but typical
circumstances, and there is no obvious ambiguity in their biology, the
question arises “How do the feelings of being of the opposite sex
develop?” The simple answer is “In the brain. Transsexuals have the
mind-set of a person of the opposite sex.”
Since individuals with
different intersex conditions must also come to terms with their situations
and live in our society as men or women the analogous question arises “How
do they decide how it is best to live?” Again, the simplistic answer given
is “ It is determined by their brain-sex.” And of course this may all be
done at an unconscious level. I must add here that this is not without
awareness of the person’s position in and reaction to society. The brain
is integrating the individual’s personal history with his or her social,
familial, and religious milieu.
Transsexuals make this major
change in their lives, often at great sacrifice socially, financially and
otherwise, and without apparent provocation. Transsexuals have no apparent
anatomical traits that are of the opposite sex, they have typical genitalia
appropriate for their natal sex but, I think, their brain is somehow
predisposed to code for the opposite sex and they are thus, by our previous
definition, intersexed.
Currently there are only a few
pieces of evidence of actual structural differences between male and female
brains and fewer of the differences between the brains of transsexuals and
intersexuals and others. But this may be because we don’t yet know where
to look for such differences. The differences are unlikely to be of major
size and might even be in the way different thought patterns are generated
or organized. We might have to look for differences in physiological or
biochemical brain processes rather than differences in anatomical structural
differences. For instance we know that females use both sides of their
brains in language processing while males typically only use the left
hemisphere.
The bottom line is that any
behavioral differences in how one sees self and others, and how one
interprets ways of living in society, must lie within the nervous system.
And the organ most involved with such analyses is the brain. Even if it is
something about gender that we learn from a figurative blue room upbringing
or a pink room upbringing, it’s got to be encoded differently in the brain
somewhere. And we don’t as yet, know how to recognize such differences.
Let me use an analogy. All people are born with a disposition to speak, to
communicate with voice. When one learns to speak, there must be a change in
their nervous system. If a person learns to speak English rather than
Chinese, that too must be encoded in the nervous system. Now, English and
Chinese may be encoded in the same place, but each would have a unique code.
We could, by extension, say there is a Chinese and an English brain. With
the learning of a language there generally is no or little thought given to
why we learn Chinese or English. We learn the language of our parents and
those around us. The learning of gender is more complicated but is similar
in that we learn the gender differences of our parents and those around us.
For the transsexual, I think their brain sex tells them the gender they are
learning doesn’t fit.
DK: How does this concept of
brain-sex effect development?
MD: Sex and gender, and all
the things that we learn associated with them, are encoded in our nervous
system. This is manifest by a person’s predisposition to learn and do
certain things and avoid doing other things. Some kids like to play with
frilly dolls and other kids avoid them. And with this predisposition, comes
a somewhat innate feeling of belonging to a social group of either boys or
girls. What I think happens is that as kids grow they are keenly aware of
differences and similarities. I don’t think there is a brain template that
simply says male or female, boy or girl, but I do think we have a template
that basically says “same or different” and built-in predispositions
which encourage and discourage certain behaviors over others. When these
predispositions are sex or gender related we could say they are tied to
brain-sex.
With growth I believe the
child categorizes his or her interests and proclivities as “same” or
“different” in comparison with those around. When the great majority of
those with whom the child feels similar in interests and behaviors are boys,
that is how he or she comes to identify. When the great majority of those
with whom the child feels similar are girls, that is how he or she
identifies.
As every child develops,
whether he or she will eventually end up as a typical male or female, a
transsexual, an intersexual, or whatever, he or she looks around and
unconsciously sees “I’m like my playmates” or “I’m different”
from others that are called by my “category.” If the person is a male
and called and treated as a boy, and he feels he’s like the other boys
around town, or in his family or neighborhood, everything seems fine and he
doesn’t question his gender situation. But problems develop when he feels
he is not like the others or when he feels a greater affinity to those
called girls or thinks he is one of them. Depending on how strongly and
clearly the child feels these differences will determine how he or she
reacts. If the boy strongly enough sees himself more as a girl he can
envision himself becoming a girl and woman. If a girl strongly enough sees
herself more as a boy she can envision herself becoming a boy and man. These
self revelations are not necessarily clear cut nor rapid in appearance, nor
do they always occur very early in life or in the same way for all
transsexuals.
Often there is a period of
confusion. The boy might say to himself something like “Mommy and Daddy
call me a boy and yet I am not at all like any of the others that I know who
are called boy.” While the only other category the child knows is
“girl” the thought runs through his mind that he might be one of those.
But that thought can be too great a conceptual leap to be easily accepted.
There often is a period of doubt as to how to reconcile these awkward
feelings. The boy might imagine he is, if not a boy, than possibly an
“it,” an “alien,” or some sort of a freak. Eventually he might say,
since he knows of no other options, that he is a girl or should be a girl.
With a child’s way of believing in the Tooth Fairy or Santa Clause he
might even come to expect he will grow up to be a woman. When the
realization develops that such won’t happen, the child than begins to seek
ways to effect the desired change. Of course the same sort of situation
might hold for a girl. Mary might say to herself “They’re calling me
girl, but judging from what I prefer to do and how I prefer to act, I think
I’m more like those kids across the street that they’re calling boys.
I’m different from all the girls I know.” But, Mary doesn’t
necessarily go running to mommy with these thoughts. She might even think
“Mommy, I’m not a little girl, I’m really a little boy.” It isn’t
necessarily put in those words but might be expressed behaviorally.
These gender doubts can last
for years and the individual might live with the discomfort. Eventually,
however, they may be resolved by the person saying something like “Despite
my male body I am a girl and want to live as such.” Or he will live as
some sort of inbetween person accommodating as best he can. This is not an
easy decision nor change but neither is the uncomfortable feeling of not
fitting in as “assigned” and reared. With maturity and understanding and
awareness of the implications of the terms and recognition of
medical-anatomical realities, the male or female might say: “I must effect
a transition so that my body matches my mind.” For many persons, while the
feeling and desire to switch occurs early in life, they don’t effect the
change until a major life event comes to pass. A parent might die that they
didn’t want to offend or disappoint while alive, a marriage and children
might have become part of their life in an attempt to adjust to a typical
existence and they didn’t want to jeopardize these relationships. A
traumatic divorce might trigger the long sought after change. There are many
life conditions that are considered in making such a life-altering change.
The individuals that switch gender without any apparent medical basis for
their decision are called transsexuals. Intersexuals too might switch from
the gender in which they were raised but do so with more obvious medical
conditions associated with their decisions.
DK: It fits. I like the way
you’re talking about this, because it’s not like I was always cognizant
of the male-female thing, it took time to really figure it out. I was
distressed because I couldn’t identify with girls and felt alienated
because of that.
MD: I don’t know your
background, but my guess is that your parents were calling you girl and
calling you by a girl name, and you were looking around and saying to
yourself “Somehow this doesn’t fit.” If you have a brother, you might
say, “Hey, I’m more like my brother than I am like my sister.”
DK: Right, I grew up having
both sisters and a brother and felt I had much more in common with my
brother. I was thought of as a tomboy and with reservation I accepted that
identification because it separated me out from my sisters and gave me more
freedom. I felt that I could operate under different perimeters. Even so,
being called a tomboy gave me a queasy feeling and it didn’t really fit
and I learned to resent it - it meant I was acting inappropriate somehow and
I didn’t believe I was. Later I took on the label “lesbian”, but that
didn’t fit either since I never felt myself to be female. I had to try on
all these different things to see what did fit.
MD: That follows. If you’re
different you also want to find if there are any others like you. You
wonder: “Who am I the same as?” It’s a great revelation when you first
find out there is somebody else who had similar feelings and that you’re
not the only one in the world like you. That is usually a great day. This
also points to the importance of positive role models.
DK: Yes. I first met another
FTM 25 years ago and believe me, it was my moment of truth!
Mickey, in your intriguing
article Self-testing among transsexuals: a check on sexual identity,
that appeared in the Journal of Psychology and Human Sexuality in
1996, you make clear distinctions between the terms sexual identity and
gender identity. Whereby, gender identity refers to how people see
themselves relative to societal expectations and sexual identity is the
private, internal feeling of self that says, “I am a male” or “I am a
female.” These are the definitions and terms I am most familiar with but I
am becoming increasingly aware that these terms are sometimes being used
interchangeably, possibly incorrectly, and that the term gender is used not
only in referring to one’s masculinity or femininity but also in referring
to morphology, whether someone is male or female. The use of the term sex as
a noun also seems to be outmoded outside of scientific circles and the word
gender appears to have come into favor just as the term transgender has been
popularized and applied to transsexuals. These inconsistencies further
complicate an already complicated issue. Could you help to shed some light
on this?
MD: What you are referring to
really is a commentary on the fluidity of language and the different ways
scientists and laypersons use terms. Several of us in the sexology field
have tried to standardize the use of many terms but others prefer their own
usage. I place myself with those that prefer to standardize terms. Basically
I consider gender to refer to social and societal contexts and sex to refer
to medical and biological contexts. For instance male and female are
biological (sex) terms while boy and girl or man and woman refer to social
(gender) terms. It is thus obvious that a male can act like a girl or woman
and a female can act like a boy or man. Following from that, as I see
things, the distinctions I make between sexual identity and gender identity,
as concepts are crucial in the understanding of many aspects of
transsexuality and intersexuality.
For the typical individual,
sexual identity and gender identity are concordant. He or she is viewed in
society as a boy or girl, man or woman. That is their gender identity. They
also see themselves as biological males or females respectively. That is
their sexual identity. To the typical person there is no conflict between
sexual and gender identity although the terms involved refer to different
things. Now consider the transsexual. The transsexual sees how he or she is
viewed in society, either as a man or woman and recognizes that as his or
her gender identity. It conforms to the individual’s sex as male or
female. But, the female individual who thinks she should live as a man
recognizes male as her sexual identity. For her, gender identity and sexual
identity are in conflict.
To reconcile the differences
the transsexual says: “Change my body not my mind.”
Knowing that society interacts
with her as a woman because that is the way she looks, and she prefers it
interact with her as a man, she chooses to have surgery make the body
conform to mind. A male body type will comfort her feeling of being the male
she desires to be and assist the world in treating her as a man, the gender
identity she prefers. Her gender identity, how she is viewed by society,
will then match her sexual identity. Some people, it should be clear, use
the term gender to replace the term sex because they are sex phobics. To
such persons gender seems “clean” while sex is viewed as “dirty.”
The term transgender
was popularized by Virginia Prince in the 1970s to describe people like
herself who prefer to live as the opposite gender without undergoing
surgery. Typically the only thing the transgenderist wants to change are
features of their gender, not their sex. However, the term has become
popular particularly to describe individuals that manifest social and
behavioral characteristics and preferences typically associated with both
males and females and has become more inclusive. The transgender category
now-a-days might be used as an inclusive term to describe transsexuals,
transvestites, drag queens, so called gender benders and others.
It might be useful here to
introduce the term sexual orientation. This refers to the type of
person with whom one wants to have erotic and love relations. Most males are
oriented toward females and vice versa, most females are oriented toward
males. When discussing transsexual and intersexed persons I prefer to use
the terms androphilic (male loving) and gynecophilic (female
loving) to describe the preferred erotic or love interest. This gets away
from the confusion and social taboos when terms like heterosexual and
homosexual are used. For instance, what would be homosexual or heterosexual
for an intersexed person who has both male and female biology? And whose
view of things should prevail, the transsexual’s or the onlooker’s, when
considering the individual’s partner before and after sex-reassignment
surgery? Ambiphilic (both loving) would replace the term bisexual.
DK: The term transgender is
often used as an umbrella term meant to include all sexual minorities but I
think there are important distinctions between the various groups that are
being glossed over. Transsexuals are attempting to undergo sex reassignment
or have done so and want to be medically and legally recognized as their
“chosen” sex. Without a medical diagnosis these surgeries would not be
performed. The medical condition now referred to as Gender Identity
Disorder (GID), strikes me as a misnomer since one can have a gender
identity disorder without being transsexual. As you pointed out, there are
different elements to one’s identity and if there is nonconformity in any
of these aspects, one could be considered to have a gender identity
disorder. The term or “condition” could address all sexual minorities.
For example: In my case, I consider myself male, always had a masculine
identification, and I consider myself heterosexual in that I prefer to have
sex with women. I fit the male norm on all accounts except for the fact that
my morphology at birth was female. In using the transvestite Virginia Prince
as an example, this is someone who would likely be considered to have a
gender identity disorder along with being a transvestite. My point is that
there is no longer a medical diagnosis ascribed solely to the transsexual.
MD: Your comment relates to
several issues. One issue is how a gender identity disorder, small letters,
is viewed as a general term in popular language. Another issue is how Gender
Identity Disorder, capital letters, is seen as a medical condition. GID is a
constellation of thoughts and behaviors that is still used by the scientific
and medical communities to identify and label transsexuals only. One major
component of the diagnosis that separates this GID and transsexuals from all
the other groups subsumed under the term transgenderd is that only the
transsexual feels he or she is rightly a member of the opposite sex and
persistently wants surgery and hormones to effect a sex reassignment. And
while Drag Queens, transvestites and others might have some aspects of
gender confusion or dis-ease or dis-order, they don’t fit the medical
definition of GID. One problem you may be reacting to is that the word
“disorder” has negative connotations. In the medical definition the term
reflects the psychological distress which the transsexual usually shows.
Certainly transvestites and
others can have some gender conflicts and disputes with societies’
strictures but their condition usually don’t reach the level of intensity
seen among transsexuals. They also don’t need the medical communities
assistance in affecting their life roles and behaviors.
Lastly, we must admit that the
general public and many persons from different disciplines interchange the
terms sex and gender without any concern for a precise definition of each
term.
DK: Could you please discuss
the issue of “passing.” I think that in some instances it is cruel to
expect someone to live as the opposite sex for one year prior to going on
hormones. This is particularly true if the person can’t easily pass when
cross-dressed. I understand the need for safeguards, but there are many
individuals who aren’t fortunate enough to start out with the physical
features of their self proclaimed sex or even have an androgynous
presentation. Such persons are subjected to endless ridicule. By the time a
person approaches a professional he or she has done years of soul searching
to finally come to the decision to transition - waiting yet another year is
still no guarantee that the decision will be the right one. I can better
understand that there be a rigid criteria set up for surgeries. I believe
that as transsexualism is better understood and more accepted and as more
professionals are trained and qualified to evaluate whether or not someone
is truly transsexual and to separate them out from persons who are either
psychotic or delusional, we will find removed some of the current obstacles
to transitioning.
MD: Your concerns are well
understood and a frequent topic of discussion among professionals that try
to adhere to the standards of care proposed by the Harry Benjamin
International Gender Dysphoria Association (HBIGDA). As you know, this
professional society, named for the physician who first extensively studied
transsexuality, recommends a standard-of-care (SOC) for transsexuals which
includes a “real life test.” This test requires living for up to two
years in the gender to which the individual wishes to transition. The
problem is how to protect the individual and the professional in this
interaction and decision making process. First off, these recommendations
are not written in stone so different therapists interpret them differently
and some are more permissive than others. Thus, in actuality, a therapist
might be more liberal with one who can not pass easily and might consider
hormones early on. Also, as you well know, there is a great difference
between a male wishing he were living as a woman or a female wishing she
were living as a man, than actually living the life. The real life test
allows the individual to “try the life” out before too many irreversible
changes occur. The administration of hormones can induce changes, which
would be difficult to reverse so they are frequently given after the
individual has at least some real life experience and feels comfortable in
the chosen gender. There are also instances where hormones are given early
on or even before the switch just to ease the transition and passing.
But I do think caution is
warranted and would not feel comfortable if all the safe guards of the
standards-of-care were removed. Yes, doing away with them would make it
easier to transition but that is not always a good thing. I’ve probably
seen several hundred transsexuals who have satisfactorily made the change.
And they are no doubt happier and more satisfied with their lives now than
they were before the sex reassignment.
However, I’ve also seen two
that were very unhappy. And they couldn’t easily go back to living as they
had been. These two both had money enough to be able to bypass all the
rigmarole of evaluation, counseling and the real-life test. One went to
Casablanca and the other to Mexico. They paid their money, got the hormones
and surgeries they wanted and too late found out that their lives hadn’t
changed as they had hoped. They are two very unhappy campers. I have to
admit, these are only two out of several hundred but I think it offers a
warning not to bypass the test and evaluation.
DK: That is certainly a low
percentage. They may have forgone an evaluation knowing they wouldn’t fit
the criteria set in place. Their regret may also have been due to poor
surgical results. At any rate, with such an important life decision I think
it is extremely important to confer with professional counsel. Numerous
studies have been conducted to determine who are the best candidates for sex
reassignment surgery. Those that were least satisfied were typically those
who transitioned late in life. The reasons for delaying the process, as you
mentioned earlier, are varied - some people simply didn’t know how to
proceed, the information wasn’t available to them or they couldn’t
locate professionals in their area that were familiar with the condition.
Others had doubts yet their lives weren’t interrupted by debilitating
feelings of unease about their bodies until they were well into adulthood.
Their choices were affected by their feelings of unease, yet they went on to
establish careers, raise families and so on as opposed to the transsexual
whose early survival hinged on transition.
In your article, Self-Testing
Among Transsexuals: A Check on Sexual Identity, you offer some keen
observations that begin to explain behaviors that are atypical to the
transsexual population as a whole. Your paper documents “a phenomenon
which more than a few transsexuals undergo in trying to reconcile their
disparity of sexual and gender identities. These are the behaviors of
persons who, for an extended duration, overindulge in rather than shun
behaviors typical of their birth sex. I label this a process of self-testing.”
You go on to describe transsexuals who are self-tested and those who
are not: “With convinced transsexuals, repeated normal encounters
with living, from early on, seem an affirmation that they are of the other
sex. Failure in gender stereotypic behaviors, being accepted or rejected
without fanfare or concern by nontranssexuals, is cause for internal
reification by convinced transsexuals that they are ‘in the body of
the wrong sex.’ They do not need nor seek any self-test; their living-test
convinces them early on. Unconvinced transsexuals, while also
harboring doubts from early on, nevertheless, continue to question this
disparity between inner and outer sex and eventually only decide they are
transsexuals after a period of direct and usually prolonged arduous
self-examination. This process is often quite deliberate. It may, however,
become apparent only in retrospect. Individuals of this second group of
transsexuals are self-tested transsexuals.” Later in the article
you cite specific case examples of self-tested transsexuals, a
female-to-male transsexual who, by all outward appearances was living
successfully as a woman. You say, “Although eminently successful and
reinforced as a professional stripper and domestic wife and mother, B.B.
felt, nevertheless, she had to live her life as a man. Her inner voice was
stronger than any external reinforcement. Her self-test convinced her
that although she could easily pass any test of female (social) gender
identity, she could not pass her own self-test of internal sexual
identity.” B.B. first felt herself strongly to be male at age seven,
but it wasn’t until much later that “she” would transition to male. I
was particularly struck by this example since I myself never lived any part
of my life in the female role, nor do I personally know of any FTMs with the
experience you describe, although I do know of FTMs who married and bore
children. In effect, you are pointing out examples of transsexuals who have
compensated in a very dramatic way for the feelings they had early on with
hyper-feminine or hyper-masculine (in the case of male-to-female
transsexuals) behavior.
I have seen this phenomenon in
practice, on more than one occasion, in the case of male-to-female
transsexuals. These categorical differences between transsexuals were
recognized early on and transsexuals were either classed as primary
or secondary transsexuals. Your paper is the first I have read
addressing this issue and not only do you address it, you explain how it
works and offer explanations. I am curious about the two transsexuals you
mentioned earlier who came to regret having had sex reassignment surgery.
Was either of these individuals self-tested transsexuals?
MD: It is not clear. It might
have been so with the first one. She had been in the marines, came out of
the military service with a satisfactory record, and decided that while he
could make their standards for masculinity felt he would be happier as a
she. He had the money and family connections to get the surgery and went and
did it. She is now quite unhappy about it. The second individual also had
money and apparently just went and had it done. I have to be somewhat vague
about these two since I saw them when they came to me after all was said and
done and wanted to know how to go back. They wanted from me a simple
solution as they had sought for their originally gender conflicts. When I
couldn’t offer them one, they left.
But there are people who make
every type of decision—there are female-to-males (FtM) who only have a
hysterectomy and their breasts removed and don’t have penile
reconstruction, for example, and they are happy. Others want the penis
reconstructed. Some male-to-females (MtF) have their penis and testicles
removed, most all have extensive depilitation and some go on to have their
Adams’ apple shaved or jaw reconstructed. Each one makes a decision for
him or herself as to how much surgery he or she wants or can afford.
Virginia Prince, the well known transvestite is convinced that many—I
don’t believe this, by the way—transsexuals would be happy if they were
simply allowed to live in their chosen sex without changing their genitals.
She believes this because she’s done it herself. On the other hand, I’ve
heard some surgeons say that some of their TS patients never seem to be
satisfied and always want more surgery.
DK: So, Virginia Prince is
basically projecting her own experience onto everyone else.
MD: Exactly ... it’s like,
“Hey, I did it, why can’t you do it?” By the way I think that many
homosexuals have some similar thoughts. They think of transsexuals “If you
want to sleep with someone of the same sex, just do it. You don’t have to
be a transsexual to achieve your goal.” Of course not all transsexuals are
oriented toward those of their original sex.
DK: While I accept that there
are varying levels of discomfort one may have with their body’s sex, I
think it is also important to look at why many individuals, who define
themselves as FtM, choose not to have surgery. If pushed for an explanation,
a vast majority of FtMs say they would have genital surgery performed if
they could be guaranteed a positive outcome; an aesthetically pleasing and
sensate penis from which they could urinate and perform sexual intercourse.
Aside from the enormous costs and risks involved, the likelihood of having
all of these objectives met is extremely rare.
MD: Yes, all these aspects
need to be looked at and there is a lot of variety among the population of
transsexuals. But, in comparison, it should be said that most MtFs want a
vagina constructed even if it doesn’t work well.
DK: In recognizing this range
of diversity, would you suggest that the criteria set for sex reassignment
surgery be restated or reconsidered to include a broader range of people
requesting surgery whose experience may not fit the current requirements?
MD: I’m not sure of your
question. I think that people ought to be allowed to live however they want.
If they want to live with chickens I think they ought to live with chickens.
If someone wants to wear green hair, I think that is OK too. So, that’s
one thing. Now the law is generally not that liberal nor is society. The law
wants most things to go in very neat lines. For example, in Hawaii the
legislature is discussing the issue of whether we should allow individuals
of the same sex to marry. They don’t even want to think about what
considering transsexuals might mean in this because then they might have to
consider people that are “same-sex” married already. In regard to new
looser criteria for allowing sex reassignment surgery, all I can say is that
the standards or requirements for such are always under review. And there
are post op transsexuals on the HBIGDA review committee. Until we have more
information and know better, I think it is appropriate to follow their
guidelines.
DK: Of course. I know a number
of transsexuals who, once their appearance changed solely from the use of
hormones, managed to get the sex designation on their driver’s license
changed simply by saying a mistake was made. As I see it, the true deception
was the original designation, the assigned sex at birth. What would your
perception be about these rigid legal distinctions and the motivation behind
it?
MD: I think some of the gender
distinctions have value and others not. Most of the motivation behind the
legal distinctions goes back to our religious and cultural values. In
Judaism, Christianity, Islam and in other religions and in secular culture
as well, people are very concerned with male/female difference. This
background sets the stage for seeing the male have very different functions
in the religious world or in society than does the female. With these
beliefs come certain privileges and certain restrictions and
responsibilities associated with the different genders. The distinctions
also facilitate matters of expectation; stereotypes are sometimes helpful
but admittedly, they can be detrimental. I see many benefits were our gender
and sexual expectations much less rigid.
DK: I can certainly believe
that. That brings something interesting to mind .. In my experience and in
the experience of others advocating for transsexual rights, I’ve learned
that some of our strongest supporters, ironically, are right wing
fundamentalist Christians. They seem to be more sympathetic with our goals
than a lot of leftist politicians. I believe this is because they find
homosexuality so abhorrent and they see transsexuality as the perfect
solution to eradicating the behavior. If gays and lesbians would just have
“sex changes,” there would be no more same sex relationships. You know,
[laughter] when it works for us, why not, but...
MD: You’re just telling me
your political agenda, that’s all. But I wouldn’t put too much stock in
Right-wing religious support for transsexuals.
DK: [laughter] Yeah. Right.
Obviously, I would never support anti-gay legislation or anything of the
sort. I do find it laughable that the conservatives believe they’ve found
a purpose for us. The thing they don’t seem to realize is that not all
transsexuals are heterosexual.
MD: Right. You know, another
interesting thing that comes to mind when I think of religious
fundamentalists is that many early artists depicted Adam and Eve as
hermaphroditic. In some early paintings both Adam and Eve were depicted with
both a vaginal cleft and a penis. This comes from the Bible. In Genesis it
speaks of God creating the first human with words something like “male and
female created he them.”
DK: That’s very true.
Mickey, I’d like to
introduce the reader to the John/Joan case because of it’s significance to
the topic of transsexuality and because of your involvement in bringing to
bear the true findings in this aspect of John Money’s research. This case
serves as an excellent example to confirm the hypothesis of nature over
nurture; that we know what sex we are at an early age and any amount of
social conditioning won’t deter us from our innate conviction. Would you
please describe and elaborate on this case?
MD: Well I think you did a
good job in your introduction. The John/Joan case was the unfortunate story
of a set of normal identical male twins. They developed a penile condition
called phimosis, which is a closing of the foreskin, so it becomes difficult
to project the head of the penis. It can make it difficult to urinate and
the closed foreskin can accumulate dirt and gunk. To correct this condition
the boys were sent for circumcision. Instead of the circumcision being done
with a knife and bell clamp as is typically done, it was done with a cautery,
a device that basically uses a hot wire to cut. Surgeons often like to use
such an instrument in surgery because the heat also closes off any cut blood
vessels. In any case, there was an accident and the penis of the first twin
was burnt off. For privacy sake, in our publication, we called him John when
living as a boy and Joan when living as a girl. The parents anguished about
the decision of “What to do now with John?” What could be done for a boy
without a penis? The local physicians they consulted recommended he have
later cosmetic surgery to fashion a penis.
However, they saw Dr. John
Money on television telling how a male (transsexual) can have surgery to
live as a contented female. He was then consulted. His solution, with the
basic idea that males and females were psychosexually neutral at birth, and
any male without a penis would be better off living as a girl and then as a
woman, led him to recommend that the child be given appropriate sex
reassignment surgery and raised as a girl.
The parents followed Dr.
Money’s advice. This sex reassignment included removal of the child’s
testicles and scrotum, and preparing him, to have a vagina. The parents did
the best they could to raise the child as a girl we called Joan. As the
child grew up, however, Joan began to look around and say, “Well,
they’re calling me ‘girl’ yet I’m more like my brother than I am
like the girls around here.” “My parents are calling me girl and I have
a girl’s name but I’m not like any girl I know. I think more like a boy
and prefer to do boy things.” But there was a long transition stage before
Joan would come to refuse to live any longer as a girl. First off, not only
did Joan realize something was amiss, so did her school mates. They teased
her for the incongruities between her male-like behaviors and her
female-dress and appearance. They called her Gorilla since they saw the male
in her behavior and demeanor. Finally, despite the absence of typical male
genitalia and the administration of female hormones to induce breast growth
and feminine hips and fat deposits, Joan decided she could no longer live as
a girl. She had to live as a boy. After the switch she was called John
instead of Joan. After the switch Joan was eventually received better as
John than as the girl she had been led to believe she was.
With psychiatric help and
hormone therapy in addition to the surgical removal of his breasts and
construction of a penis, John developed into a mature man, married in his
twenties and adopted his wife’s children. He now lives as a
self-respecting husband and father.
DK: Now, was John Money
following up on these twins the entire time?
MD: As far as I know he was
aware of how the twins were developing.
DK: OK, and during this time
he was writing all these reports saying that his theories were correct and
the outcome was what he expected?
MD: That appears to be so.
DK: So you’re the one
that’s responsible for following up on the reports and finding out what
actually happened to John; you along with Dr. Sigmundson?
MD: Correct.
DK: You’re quoted in this
article from the Journal of Sex and Marital Therapy: “Zucker and I
agree that the significance of the original twin reports has been over
played. This is certainly true for the credit the twins’ story of female
conversion received as supposed proof of the power of a gender conditioning.
The actual failure of this sex reassignment has not been as widely
recognized. Possibly, since it was not a surprise, nor as noteworthy or as
newsworthy or not a ‘politically correct’ finding.” I understand that
there is a lot of resistance against this type of research given current
politics. Certainly feminists are opposed to the idea of identifying
biological determinants that rule behavior and illuminate the differences
between men and women since they attribute social conditioning as the cause
of sexism and use the concept of nurturing as their platform to discuss it.
There are also a lot of sex reassignment surgeries still being performed on
intersexed infants without their consent. Could you address how politics
affect or enter into research?
MD: I think you are addressing
several separate things. Intersexed infants with ambiguous genitalia are
often given cosmetic surgery because the physicians and or their parents
think this is better for them. If you think this is in response to the
politics of gender that everyone has to be clearly male or female, I guess
your comment fits. I think, however, this treatment is wrong on ethical
grounds and because there is to date no published evidence that it is either
necessary or warranted.
But you are certainly correct
in referring to the politics of gender when it comes to many Feminists. It
definitely helps the Feminist cause politically to argue that the only
difference between men and women is how they were raised. And if only
child-rearing practices were equal, the differences between the sexes would
disappear. Certainly we want a level playing field to offer equal
opportunities to both men and women. But we have to recognize that often men
and women come to the field with different abilities that are linked to
their sex or gender. And sometimes recognizing these differences is actually
helpful. If it is a disadvantage to be short, society can offer a ladder or
stool. By the way, I consider myself a Feminist, if we use that term to mean
somebody who wants equal opportunities for men and women.
A last thought is that getting
funding for sex or gender research is often handicapped by political
considerations.
DK: I certainly ascribe to
general feminist principles as well. At the same time, when I’m looked at
as a traitor of the female sex, or when Feminists attempt to subvert
research that might better explain the existence of transsexuals, why I feel
the way I do, I’ve got to object. Transsexuals simply don’t suit
Feminist objectives; they see our existence strictly as a social phenomenon.
MD: Yes. They’re saying as
transvestites or some lesbians might say: “Hey, look, I solved my problem
my way, you ought to solve your problem the same way I solved it. Some
feminists would think by transitioning you are joining the enemy rather than
fighting for your right to be a masculine female.
DK: Absolutely.
MD: You may know that several
years ago there was a feminist music festival in Michigan that some
transsexuals wanted to attend. Many feminists got up in arms; they said
“Hey, these are cheats, they’re phonies, we don’t want ‘em.” That,
to me, is crazy.
DK: You know, I was at that
music festival as a lesbian when the first male-to-female transsexual showed
up. I think I was in agreement with the lesbians. It just goes to show how I
resisted being transsexual! I hope I’m making amends for it now.
[Laughter]
MD: You ought to write a piece
on how your views of the world changed from when you considered yourself a
lesbian to now when you consider yourself a transsexual.
DK: I intend to; reflecting
how one’s perspective changes in accord with various stages of personal
realization is not only interesting to think about but an area I always find
interesting to read about. When I first read about the John/Joan case in
John Colapinto’s Rolling Stone article, I was stunned and moved to tears.
At the same time, the story was full of hope at the conclusion when John
reclaimed his true identity. The story reads like a major event when you
finally came in contact with Doctor Sigmundson and intervened in the
situation. It’s a very dramatic example of what ignorance or even
innocence can do in relation to the alteration of an anomalous or unexpected
identity. It also points out to me the importance of a case study like that.
I have to ask, not withstanding your own research, what would you consider
the most significant dimensions of related research today?
MD: Many different people are
looking at different things. But, I have to mention that there is little
money for sex identity research so all such work is often difficult and from
funds allotted for other things or financed out-of-pocket as much of mine
is.
Nevertheless, there has begun
a good deal of research into different intersex conditions both here and
overseas. For instance I think work at Johns Hopkins University by Dr.
William Reiner and in London at the Great Ormand Street Hospital by Mr.
Philip Ransley on children born with a condition called cloacal exstrophy
will be very informative. Here are male children born essentially without
any genitals but they do have testes. They are typically castrated and
raised as girls and given female hormones to induce a female-like puberty.
The question is “How will they identify as they get older?” Several of
these children already have expressed themselves to be boys. Work is
progressing by following up cases of intersexed individuals that have had
surgery to find out how they have adapted. Did they remain in the gender to
which they had been assigned or did they switch to another gender? These
studies should shed light on identity development.
Among transsexuals research is
developing from large population and we should soon have good data on the
long-term satisfaction and functioning of post-operative FtMs and MtFs. Much
of this comes from Charing Cross Hospital in London and the work of Dr.
Richard Green.
Work, particularly among Dutch
investigators Drs. D. F. Swaab and Louis Gooren and collaborators Frank
Kruijver and Jiang-ning Zhou, is looking at the brains of transsexuals in an
attempt to document additional clues as to which areas of the brain might be
associated with sexual identity development. Dr. Peggy Cohen-Kittenis, also
from the Netherlands, is doing some interesting work with very young and
adolescent transsexuals which I think will be revealing and the work at the
Clarke Institute in Canada with Drs. Ken Zucker and Ray Blanchard is also
exciting. I myself am trying to finish a long-term study of people with a
condition called the androgen insensitivity syndrome. These are individuals
who have XY chromosomes and have varying degrees of refractoriness to
testosterone. Most appear as females, are reared as females, and live as
females. Others are reared as males and live accordingly. Surprisingly, many
of these persons switch from their gender of rearing to the opposite gender.
We are trying to understand how and why those that remain do so and we are
trying to understand how and why those that change do so. How do they
reconcile their gender and sexual identities?
DK: An important aspect of
research is that the methodologies recognize differences appropriate to the
particular question asked. And that the results might vary according to the
research techniques used.
MD: Exactly. And here too the
law sometimes comes into play. We certainly must insure that studies are
done with the welfare of the subjects in mind and we are sometimes limited
in what we can ask or require of the research subjects.
DK: Right. Does research show
any major differences between MtFs and FtMs?
MD: Well, the most obvious
finding is that the large majority of transsexuals seem to be male-to-female
types. And among them about half are androphilic and half gynecophilic.
Among the female-to-male transsexuals most seem to be gynecophilic. That’s
just two basic group differences. There are also often other differences in
what each group expects from the transformation.
DK: Yes, there is still a lot
to be understood.
In your self-testing paper you
offer a lot of promise when you say, “the details of this process of
sexual identity formation are still to be elucidated. Nevertheless, it seems
fairly certain that this inner voice can develop without external
reinforcement and social approval for the desired sex and with ample
reinforcement in the non-desired sex. And it can occur in the face of a
socially adverse future, yet provide an inner personal calm more important
than any external rewards.” This statement and the concluding statements
in the article seem to suggest that, specifically in reference to the
transsexual or intersexed person, there needs to be a period of time and
other ameliorative efforts made that might well determine whether surgical
intervention is necessary. You offer hope that there will be an audience to
listen to these inner voices. The opportunity to publish this book with
people making very strong personal testaments, about their identity, about
their travails, and even selectivity, speaking from a multiplicity of
perspectives, also lends hope that someone may listen to this; as an
individual problem and not just something that’s legalistic or whether an
HMO or insurance company is going to approve an operation.
MD: I fully agree with that.
People have to realize that these changes are not done easily or without a
great deal of thought and often anguish. When people talk about a religious
conversion, going say from Catholicism to Judaism, or whatever, they think
of the mental workings that occur. I think going from female-to-male, or
male-to-female, is a much bigger conversion and requires much more psychic
effort.
DK: True, probably the most
manifest imaginable. Let me ask this...you mentioned research dollars. If
someone wanted to donate money for sex research, what institutions would you
suggest they contact and how can they designate that money go specifically
into a particular area of interest?
MD: If they want it to go to
gender research or sexual identity research there are a few specific
organizations to which one can donate. The Harry Benjamin International
Gender Dysphoria Association, for instance, is interested specifically in
supporting research on transsexualism. In the United Kingdom there is the
GIRES (Gender Information, Research and Education Society) which sponsors
research on transsexualism and intersex conditions. Some organizations are
slanted more toward political activity and education rather than research.
The Intersex Society of North America is one such organization. There is
also an organization that I head at the University of Hawaii called the
Pacific Center for Sex and Society (PCSS). People can send money to the
University of Hawaii Research Foundation for use by PCSS and I’d be happy
to put it toward identity and gender research. All contributions are tax
deductible, by the way. Another way is for individuals to select researchers
they admire and support their research via their host institutions. That way
the money is accounted for and everyone gets a tax break.
DK: Great. Why do you suppose
the National Institutes of Health (NIH) has done so little to address these
issues?
MD: Candidly, I really don’t
know how much they have or have not addressed. But often sex related issues
are a problem for government agencies to deal with. They’re going to say
“Look, we need money for AIDS research, or breast cancer and prostate
cancer research and identity research has a lower priority.” Or, on the
other hand, they can say, “We are supporting research in sex. Just look at
our efforts in AIDS, breast and prostate cancer, and so forth.” When you
talk to NIH about something like sexual identity, they think they’re
dealing with a much smaller need and the issue is less politically viable.
DK: I understand there has
always been a lot of competition for research dollars, particularly on the
university level...it appears as though the bulk of research is now being
done in private corporations with a profit motive in mind.
I’d like to switch gears and
talk about the article in the November 1995 issue of Nature, titled, “Sex
difference in the human brain and its relation to transsexuality.” The
article talks about an area of the brain, known as the bed nucleus in the
stria terminalis (BSTc).
Referring to an illustration
in the article, it says, “Here we show that the volume of the central
subdivision of the bed nucleus in the stria terminalis, the BSTc, a brain
area that is essential for sexual behavior, is larger in men than in women.
A female size BSTc was found in male-to-female transsexuals.” It says,
“this supports the hypothesis that gender identity develops as a result of
an interaction between the developing brain and sex hormones.” Afterward,
the article goes on to say, “This led to the hypothesis that sexual
differentiation of the brain might not have followed the line of sexual
differentiation of the body as a whole.” Sexual orientation was ruled out
as a factor affecting the size of the BSTc with further studies on both
heterosexual and homosexual men and “In addition, there is no difference
in BSTc size between early-onset and late-onset transsexuals, indicating
that the decreased size is related to the gender identity alteration per se
rather than to the age at which it becomes apparent. The use of feminizing
hormones was also ruled out as the cause.” So, what they are saying here
is that the size of the BSTc in male-to-female transsexuals, an area of the
brain responsible for sexual behaviors, corresponds with that of biological
females. As these post-mortem studies were done only on male-to-female
transsexuals, would it be supposition to suggest that the BSTc size of
female-to-male transsexuals resembles that of biological males?
MD: Yes, that would be the
supposition. Research data on FtMs would be needed to substantiate the
thesis.
DK: Your own research seems to
follow along the lines of what is contained in the article.
MD: In many ways, yes. We
know, for example, in many of the intersex people with whom we have worked,
that what happens to their genitals is different than what seems to have
happened in their brains. Keep in mind we have not done any actual
anatomical studies of the brain. But we attempt to evaluate brain
differences by people’s thinking processes and behavior patterns. Some
years ago, in monkeys, Drs. Robert Goy, Fred Bercovitch, and Mary McBrair
showed that they could induce changes in the genitals that were not followed
by brain (behavioral) changes, and vice versa, they could induce behavioral
changes in the brain that were not followed by changes in the genitals. The
brain and the genitals can be differentiated and develop independently.
DK: That sounds quite
conclusive, with some very interesting ramifications.
MD: Well, it’s conclusive
for monkeys. And I happen to think, with this matter, that we can
extrapolate from monkeys to humans. There are others that still have to be
convinced.
DK: I didn’t realize that
... So, there are still to come a few surprises in brain and identity
development research.
MD: Absolutely! I’m sure
there are interesting results yet to be gotten. As we started this
discussion, I said that people like to find anatomical differences between
male and female brains—they’re easier to see and understand than
thinking differences. The biggest differences may not be in big structures,
like an interstitial nucleus, or a BSTc. It may be in the dendrites, or the
connections the nerves make. It may be in brain biochemistry. I’m reminded
of a joke. A guy sees his friend looking under a lamppost and the
conversation goes something like this:
“What are you doing?”
“I’m looking for the watch
I lost.”
“Where’d you lose it?”
“
“I lost it down the
street.”
“Well, why are you looking
here?”
“There’s better light
here.”
[Laughter]
MD: That’s what happens—we
look for big things “where the light is better.” But the crucial answers
we are looking for may require techniques not yet available or understand.
We may have to look at some different hormones combinations, we may have to
look at some biochemical reactions, some genetic thing that we don’t know
yet.
We’re just beginning to peel
back the layers of the onion, as it were. And each time we come to a mole on
the onion we say “Hey, look at this mole.” Well, it may just be a mole;
we still have to get down to the core of the onion and understand the
contribution of all its layers. I do believe there are differences yet to be
discovered in the hypothalamus and in the stria terminalis, and in basal
ganglia, in the amygdala in the forebrain and the cortex. Unfortunately we
don’t yet know how to measure them. When we first came up with x-rays or
hologrames, people began to use those as images and analogies for how the
brain works; now people make analogies between the brain and the computer.
We might even have to find new ways to conceptualize these complicated
workings of the brain. We’re still learning... we know a lot about the
brain, but we’re also ignorant of many things about it.
DK: Again, I’d like to ask,
do you know of any research currently being conducted around the issue of
sexual identity?
MD: Well. I mentioned several
studies before. Other studies that come to mind are those of Dr. Dean Hamer
who is studying the gene structure, trying to map out areas of the genes
that may be associated with sexual orientation, heterosexuality and
homosexuality. This is a question associated with transsexuality as it is
with non-transsexuals. Other studies that should probably be mentioned are
the works of Drs. Simon LeVay, Roger Gorski, Mark Breedlove and others. Much
of the crucial work is also coming from the studies of intersexed
individuals. Here we have people that, due to endocrine or genetic or other
developmental situations, allow a peek into how behavior patterns, sexual
orientation and sexual identity might come together. In addition to those
I’ve mentioned before, the work of Drs. Julianne Imperato-McGinley, Ariel
Rosler and Ronny Schtarkshall, Melvin Grumbach and Justine Schober or Heino
Meyer-Bahlburg is important. I think that there are many projects going on.
Most of this work doesn’t have a direct commercial value so doesn’t get
as strong a measure of support as does something like Viagra. The ethical,
scientific and social issues, however, are very important.
DK: Right. I’d like to think
lives are viable enough and valuable enough without an economic inducement.
Let me ask you to respond to a
question that I imagine one of our readers might ask. We’ve been
discussing the biological implications of transsexuality... Do you think
there are individuals --transsexuals if you will-- who have simply chosen to
change their sex for social reasons or any reason not linked to biology?
MD: That’s not an unusual
question; and it’s a good one. I guess anything is possible but, no, I
don’t think an individual would go through sex reassignment surgery and
switch gender just for social reasons unless the stakes were extremely high.
And off hand I can not imagine how high that might have to be. Certainly a
male might think, if he were homosexually oriented, that it could be easier
to attract a male if he were attired or built like a woman, but he would
have to be willing to accept all the other things that go with being a woman
and that go with transitioning; he must accept the surgery, the stigma and
other social and medical features of transsexualism. And the real-life test
should convince him that the anticipated benefits did not come about. Also,
the typical male homosexual or lesbian appreciates his or her genitals and
doesn’t want to give them up. I don’t think anyone wakes up in the
morning and decides they’re going to be a transsexual just to attract a
certain type partner or live a certain life style. Individuals, I believe,
change their gender to have it conform to their “brain sex.” Making the
decision to live the life of a transsexual is not a flippant decision.
DK: Mickey, in a recent series
of programs called “Brain Sex,” aired on the Discovery Channel,
they talked about the research you mentioned with monkeys and the parallel
with humans. It is very intriguing that this is getting into the mainstream.
It doesn’t mean that the general population is suddenly turning on the Discovery
Channel, but I think it’s an important indicator that some of these
issues will become more conscious among the larger populace. I am also
impressed with a book by Gary Kelly called Sexuality Today: The Human
Perspective, which is being used as a college textbook.
These contributions are
obviously dependent on the serious efforts of researchers and I would like
to personally thank you for the brilliant work you’ve done and are
continuing to do. As a transsexual, I wish to extend my gratitude, as I
believe we are in your debt.
MD: Thank you for those kind
words.
Citation:
Interviewed by Dean Kotula, in the Realm of the "Phallus Palace":
the female to male transsexual. 2002 Pages 35-56, Alyson Books, Los Angeles.
