Tuesday, March 18, 2003

Gender Identity Issues: Jewish Survivors of Childhood Sexual Abuse and Sexual Assault

Gender Identity Issues
Jewish Survivors of Childhood Sexual Abuse and Sexual Assault


The Awareness Center is dedicated to addressing the needs of all Jewish people, including those of the Jewish faith who have Gender Identity Issues and are Survivors of Sexual abuse and assault
Please note, except for the area of sexual abuse and recovery, The Awareness Center does not make judgments concerning individuals, groups or organizations. Our view is that - as with any Jewish survivors - survivors who have gender identity issues need to know that they are NOT alone, and that they can and are worthy of receiving effective help.

If you have information that you believe should be included on this page, please forward it to VickiPolin @ aol.com for review

Disclaimer: Inclusion in this website does not constitute a recommendation or endorsement. Individuals must decide for themselves if the resources meet their own personal needs.

Table of Contents:  
  1. Articles
    1. Childhood and Gender Identity Developmental Repressive Abuse (GIDRA) (1997)
    2. Transgender Issues & Depression (1996)
    3. The Multi-Dimensionality of Gender 
  2. Books
  3. Organizations

Childhood and Gender Identity Developmental Repressive Abuse (GIDRA)
by Gianna E. Israel
Gianna Israel Gender Library - 1997

Recently I received correspondence from a transgender woman who is studying psychology. Her letter raised several interesting issues which I have not found generally included in information about gender identity issues. These include: Is having a transgender identity or need to crossdress caused by childhood abuse? Is it better to resolve childhood abuse issues before or after beginning to live in role and transitioning permanently? Does the stigma of childhood abuse carry over and prevent transgender individuals from obtaining hormones and surgery?
Childhood abuse is not a common subject in support groups, and is very seldom addressed in transgender press. Yet, like many persons in the general population, transgender men and women faced abuse and victimization during childhood. As a result, this is an issue which needs to be addressed because it is important to our well-being as individuals and as a community. However, before addressing questions and issues associated with this topic, we need to have an easy-to-understand description of what constitutes childhood abuse. Also, our focus on abuse needs to take into account the experiences of persons who are today transgender men and women.
In the broadest sense, childhood abuse is defined as the act of inflicting or allowing infliction of physical, sexual or emotional maltreatment or injury upon a child. Childhood abuse may be carried out by a parent, relative, family friend, teacher, or other adult. Abusive activities become possible when an adult misuses the power, trust and vulnerability that characterizes child/adult relationships. In many circumstances the abusing adults may be so invested in getting their own needs met, or simply reacting to emotional situations, that they do not recognize their behavior as causing pain, neglect and trauma.
Just as parents often do not see that their behavior is abusive, large segments of adult society have difficulty acknowledging that child abuse exists. Adult "survivors" of child abuse may be unaware that they were abused during childhood, and if they are aware these individuals may prefer to ignore it and move on with their lives. Child abuse is also simply not a subject one casually discusses with family and friends. Very few people wish to take on the responsibility of addressing this issue. After all, if childhood abuse is as common as the experts say it is, then this mean that you and I, as well as any of our adult friends and neighbors, may have been abused in the past or are potentially capable of abusing a child.
Another reason the topic of childhood abuse is so often avoided is that people are unaware of it or do not believe it to be that common. This is because the majority of childhood abuse cases go undetected. Generally, if a child is emotionally abused or receives a minimal amount of physical abuse, the abuse itself can be difficult to detect and is rarely reported. However, no matter how much abuse a child receives, there are always consequences. In most circumstances children develop a variety of coping mechanisms to deal with abusive situations. Regrettably, these coping mechanisms may not continue to be effective as the individual matures. In my experience, the denial, insecurity, addictions, unhealthy relationships, poor life choices and constant search for attention, which characterize many adult lives commonly has roots in unresolved childhood abuse issues.
One specific type of childhood abuse that commonly affects transgender persons is Gender Identity Developmental Repressive Abuse (GIDRA). This is defined as abuse or actions which force children to repress healthy questions about gender identity, actual crossgendered play-acting and behavior, or from self-identifying with a transgender identification. Unlike abuse where the perpetrator randomly abuses for other reasons, GIDRA is specifically carried out in an effort to force the child to adopt socially-desirable behaviors, presentation and gender-identification. However, like other forms of abuse, the effects of GIDRA are insidious, deleteriously affecting not only gender identity development but also social and communication skills and other vital coping mechanisms.
In an informal assessment of 72 private-practice counseling clients who self-identified as having a transgender identity and having lived "in role" at least part time for two years or longer as a member of the opposite gender, 16 persons reported having received repetitive verbal as well as physical abuse during childhood because they were unable to conform to socially-acceptable, non-transgender stereotypes. Among those assessed, 41 stated that as children they expressed interest in crossdressing or actually were discovered crossdressed, and after verbal reproach made certain to never discuss crossdressing or be caught again. Finally, 15 individuals reported having been abused for reasons other than gender identity, or having not been abused at all.
As a careprovider interested in the well-being of people, I must remind my readers that behind every statistic there are human beings with real experiences. While assessing clients and reviewing documentation I have heard incredible accounts of transgender men and women who were horribly abused during childhood over crossgendered behavior; yet as adults they moved on to establish successful, stable lives. Within my assessment well-over half of the abused individuals maintain professional careers and quality personal relationships. The vast majority of transgender individuals who experienced GIDRA, were able to successfully transition despite the abuse as long as they maintained a support network, focused on building communication and presentation skills, and planned transition goals which accommodated their individual circumstances.
For every positive outcome, there are also transgender men and women who are suffering. Sometimes the abuse they suffered as children affects their arriving at stable gender presentations, However in most circumstances I have found that the person's coping mechanisms are often most affected. Coping mechanisms are the devices we use to respond to real-life situations. As an example of the effects of GIDRA, one of the individuals assessed was continually punished by an abusive father for "spending too much time preening in front of a mirror such as homosexual does." To this day, even though the individual has successfully lived in role over seven years as an attractive transgender woman, every time she looks in the mirror she still remembers the pain. Not surprisingly, until she confronted this issue and expressed her anger, she honestly believed that when people looked at her that they saw an ugly, repulsive person.. Like this individual, other transgender men and women who experience GIDRA also find themselves dealing with low self-esteem and compromised social and communication skills, both before and after transition until the issue of abuse is resolved.
Because people's social and communication skills directly affect their chances at successfully interacting with others while "in role" or transitioning, this reintroduces questions as to whether abuse issues should be resolved before or after transition. In brief, the answer depends primarily on each individual and introduces more questions. Can the person maintain a consistent emotional state in social situations requiring a consistent presentation, such as in the workplace or in the general public? Is the person capable of separating his or her feelings about the abuse from present-day circumstances? Does the person recognize that his or her coping skills may be compromised by past abuse, and such can these be redefined to meet today's needs?
No matter what type of abuse people experienced, if they can answer "yes" to the preceding questions, pursuing crossdressing and transition goals under most circumstances would seem appropriate. However, if the individual finds that memories of the abuse continually recur and become disruptive, or if they find themselves having unresolvable social, communication or relationship difficulties, I strongly advise that person to discuss these issues with a therapist or counselor familiar with both abuse and gender identity issues. Bringing crossdressing out of the closet or following through with long-term transition goals is difficult enough without having one's coping skills compromised when they are needed most.
One of the concerns I hear most frequently from transgender men and women is they do not want unnecessary interference in their lives from careproviders. As a consequence many transgender persons avoid mentioning that they were abused or that they are presently experiencing difficulties as a result of childhood abuse. They fear that primary therapists who serve in a "gatekeeping" capacity, may withhold recommendations for hormones and surgeries. Because of this situation, withholding information that may suggest psychological instability often seems the best guarantee to receiving gender conformation recommendations. I suggest that if a person is having difficulties they cannot discuss with their primary therapist they engage a second therapist for the purpose of focusing on childhood abuse. Furthermore, if a careprovider declines to provide services or approve recommendations solely because an individual was abused as a child, I strongly suggest that individual find a new careprovider.
Does Gender Identity Developmental Repressive Abuse cause a person to have a transgender identity? In the vast majority of cases I do not believe so; after all GIDRA is carried out in order to suppress and not support a child's natural question-asking and gender identity exploration. Generally speaking, well over half of transgender men and women begin "re-experiencing" crossgendered feelings after establishing productive lives as adults. If we take into account that GIDRA is repressive in nature, unless an adult actually has a transgender identity, it would seem highly unlikely that they would wish to reintroduce unnecessary social turmoil or embarrassment such as they experienced during childhood.
Does "forced" crossdressing during childhood cause gender identity issues? This causality question is a little more difficult to answer. In most circumstances the answer is "no." Often this is only wishful thinking on the part of people who are more interested in defining a cause for gender identity issues rather than taking on the responsibility of understanding transgender needs. Additionally, it should be noted that in many circumstances, children who were crossdressed by another child or a parent, often were willing participants in this common childhood "game." Over time, it only became a matter of circumstance that they wished to continue crossdressing, but found it to be socially unacceptable as they matured from being children to adults.
In my experience, there are several circumstances where "forced" crossdressing during childhood may have carried over in some form into an adult's life. This can happen when crossdressing was continuously or ritually used as a punishment to shame the child. In these circumstances these individuals develop an unpleasant compulsion to secretly crossdress as a mechanism of self-punishment. However, unlike crossdressers or other transgender persons, this type of individual gains no pleasure from the act and in no means gains any benefit from his or her behavior.
When we look at the previous questions, it is important to recognize that people ask questions about causality for a variety of reasons. Many people, transgender and non-transgender alike, accept society's stereotypes and truly believe that crossgendered behaviors and transgender identities are pathological, mentally disordered or medically diseased. As a result these individuals become driven into looking for causes and cures rather than accepting human diversity as healthy. Others may unknowingly wish to believe that their personal questions about gender identity were caused by GIDRA so that they may assign blame for difficulties they have had or are currently experiencing. However, while it is appropriate to address blame when abuse affected an individual's well-being, I do not believe the abusive parties should be held responsible for the victim's gender identity. Doing so would be attributing extraordinary powers to the abuser which is neither merited nor realistic. This is evident in noting that well over half of today's transgender men and women hid their cross gendered behavior after several confrontations or were not abused at all.
With regard to dealing with personal issues of abuse, individuals must take responsibility for their own lives as adults. In doing so an individual can become his or her own present-day parent. With self-parenting, ordinary people like you and I have the ability to heal inner wounds, and to learn or refine coping mechanisms. We also can set unhealthy abusive cycles into the past, by not repeating abusive behaviors. As adults capable of self-examination and acknowledging our power, mindfulness is called for in our interactions with those less capable of self-protection. These include our partners, children, elderly persons, pets, or a disadvantaged friends or strangers.
This article provides an introduction of Gender Identity Developmental Repressive Abuse (GIDRA). As such, this is an opportunity for abused individuals to reflect whether their experience was consistently repressive to development of their gender identification. If you believe this is so for you, you may benefit from reading about similar types of abuses and issues. Regrettably, I was unable to locate any titles which specifically address transgender-specific childhood abuses, however I found the following books presented issues that may be cross-applicated as we try to understand GIDRA and its effects.

  • Growing Up Gay in a Dysfunctional Family - Rik Isensee, LCSW / Alyson Press
  • Recovery of your Inner Child - Lucia Capaccione, Ph.D. / Simon & Schuster
  • Healing the Shame that Binds You - John Bradshaw / Health Communications, Inc, Press.


Transgender Issues & Depression
by Gianna E. Israel
Gianna Israel Gender Library - 1996

Depression is the leading mental health issue faced by transgender persons. However, unless a client or reader's depression has progressed to crisis proportions it is the subject I am least likely to receive questions about. Depression is also the leading mental health issue faced by those who do not have a transgender identity. With this knowledge it should be clearly understood that when transgender persons are depressed, it does not mean that having a transgender identity or fulfilling one's crossdressing needs is pathological, mentally disordered or medically diseased.
Both transgender and non-transgender populations are equally unlikely to receive treatment for depression. This is tragic, because depression is one of the best understood mental illnesses, with recognizable symptoms and effective interventions. People do not seek treatment for a variety of reasons. Some individuals allow themselves to suffer tremendous pain, believing that obtaining help is shameful or a sign of weakness. Typically these persons have bought into the notion that mental health issues are stigmatizing or less important than medical conditions. In other words, people are more likely to seek treatment after contracting a painful, sexually-transmitted disease than get help for depression. It does not seem to matter how much emotional turmoil the person is suffering.
Within both populations, there also exist numerous persons who recognize that they are moderately to severely depressed. Some of these individuals do not seek treatment because they believe it will be ineffective or they are suspicious of the medical and mental health professions. Because transgender persons continue to be discounted, misdiagnosed or characterized as pathological, particularly by professionals unfamiliar with gender identity issues, it is understandable that some will feel hesitant in seeking support for depression. This concern is an important dynamic in supporting transgender persons. I will address it after providing basic information about depression itself and how it is identified.
Depression is a mood disorder characterized by extended feelings of sadness, loss, restlessness, discouragement, hopelessness, self-doubt and guilt. These feelings are often accompanied by noticeable changes in a depressed individual's regular sleeping, eating and sexual habits. They are also likely to have changes in self-perception, think negative thoughts on an on-going basis, have difficulty making decisions, and sometimes, contemplate self-destructive acts. Their emotions typically swing sharply between feeling angry, sad, melancholic or moody.
Depression is not about having one or several isolated bad or low-energy days; its about feeling badly and having an emotionally poor quality of life, day after day, with no hope of relief in sight.
The preceding description reflects the state of mind that characterizes depression and lends understanding to why people do not seek treatment. The more severe the depression the more limited an individual's ability to think realistically or recognize options which might improve their quality of life. Simply stated, most depressed persons routinely discount treatment options until everything else has failed. This type of "clouded" judgment also frequently slows the resolution of gender issues. Depressed transgender persons frequently feel compelled to move ahead in their transition without seeking adequate support. Also, in order to gain acceptance and reduce emotional turmoil, they may disclose their transgender issues without having taken into account potential consequences or its effect upon others.
It is well documented within professional literature that depression can be caused by either one or a combination of medical, psychological or circumstantial factors. As a result there are a variety of treatment approaches which are designed to address this disorder. Therefore, while it is a positive step for people to acknowledge they are depressed, deciding ones' own course of treatment or self-medicating is irresponsible and dangerous. A professional familiar with the treatment of depression should be consulted. In some circumstances anti-depressant medications may be useful, particularly when an individual is in crisis or experiencing debilitating emotional pain. Most anti-depressants are designed to take the edge off of the extreme lows or sharp mood swings which accompany severe depression. They provide temporary emotional relief allowing the individual an opportunity to build coping skills. Anti-depressants vary in their recommended length of use and several also address depression-related anxiety or manic-depression.
Education within individual psychotherapy also plays an important treatment role and may be coupled with medication.. In learning about depression, people frequently feel that the tremendous pain they are suffering will never end. Being reassured that despondent feelings do resolve and that positive change is possible is an important part of treatment. It is also helpful for people to find out that they are not alone, and that there are numerous instances of successful treatment. Because depression exacerbates social isolation, peer support or group therapy can provide individuals with positive social contacts and an opportunity to hear how others combat depression.
It should be noted that in providing depression treatment to transgender persons, there exist several dynamics which frequently prevent persons from seeking help. As previously mentioned, transgender persons routinely have been characterized as mentally disordered because their crossdressing and gender identity issues seem unusual to non-transgender persons. Regrettably such attitudes still exist today within the medical and mental health professions, particularly in locations that do not have access to up-to-date professional literature on gender identity issues. Both care providers and transgender persons should understand that having a transgender identity or individual crossdressing needs does not cause depression; rather they are caused by experiencing seemingly unresolvable social and circumstantial pressures. Learning effective coping skills which concurrently resolve these pressures while preserving a person's gender identification is the correct approach in these situations.
Transgender persons also avoid treatment for depression because it is widely believed that in order for treatment to be effective, both gender identity and depression issues must be addressed at the same time. This is not always the case. In some situations it is possible to provide symptom relief without having to immediately deal with gender identity issues. Individuals may seek support for their depression, stressing that they are not interested in discussing gender identity issues until they feel safe doing so, if it should it become necessary. Those who feel that disclosing their gender issues may prove compromising or be met with negativity, may choose not to. Rather, they can utilize the break from emotional anguish which is available through traditional depressive-symptom relief to seek gender-specialized resources for their crossdressing or gender identity issues.
Having two care providers, one who dispenses depression treatment and the other who offers gender-specialized support is useful in many circumstances. This is particularly so when a transgender person does not yet have a sufficient level of communication skills and knowledge about gender identity issues to disclose to a helping professional unfamiliar with gender identity issues.
The interpersonal difficulties and social hostilities which transgender persons experience can play a large role in causing or aggravating depression. This is particularly true for individuals who are coming to terms with gender issues without the assistance or awareness of gender specialized resources. "Coming-out," disclosure concerns, balancing transition costs, social isolation, family rejection, and being single or unable to find acceptance from a significant other, are some of the recognizable sources of depression in transgender persons. Less frequently acknowledged contributors to depression include; unresolved gender identity conflicts in pre and post-operative persons, pre and post-surgical emotional adjustment, poor body image and low self-esteem.
Transgender hormone administration also may play a causal role in depression. Because hormones are powerful chemicals, an increase or decrease in dosage can bring on changes in mood. 
Transgender persons and their physicians need to recognize that routine laboratory testing of blood-based hormone levels helps insure that dosages are effective, yet not so high as to create debilitating mood swings or dangerous medical complications. Gradual changes in hormone dosages are a sensible precaution that provide an opportunity for physical and emotional adjustment. Also, individuals who are initiating hormone administration frequently are poorly prepared for the emotional changes that go with it. These persons are encouraged to adjust their thinking and seek support for their needs much as women do during menopause. This is particularly so for transgender women who choose to cycle their hormones so as to mimic the biological rhythms genetic women experience.
Lastly, careproviders need to be aware that a lack of access to hormones also produces high rates of depression, emotional mood swings, and occasionally suicidal feelings. This is particularly so when public institutions, and medical or mental health providers deny transgender persons access to hormones because it is against policy or careprovider staff are unfamiliar with gender identity issues. Transgender persons should not be denied access to hormones or cut-off from pre-existing prescriptions solely because a careprovider is disinterested or unfamiliar in supporting transgender persons. Transgender hormone administration is a routine medical procedure and transgender persons are no less entitled to informed medical care than other patients.
Transgender persons can suffer depression caused by situations or disorders that are in no way related to gender issues. Transgender persons need to recognize this, and research treatment options before things reaching a crisis. It is senseless for individuals to suffer from depression when successful treatment options exist. In many circumstances severe and long-term depression can be halted with early intervention.
If you are a person suffering from depression, start searching for help now and do not give up until you find it. Most gender-specializing care providers are familiar with treatment and available resources. If you do not have a gender specialist in your area, traditional mental health counseling and psychiatric resources are listed in the "community section" of your local telephone directory. Lastly, if you would like to read more about combating depression, most bookstores and libraries have numerous professional and self-help titles available. One I recommend is The Depression Workbook, by Mary Copeland, M.S. (New Harbinger Press).


The Multi-Dimensionality of Gender  
By Carl W. Bushong, Ph.D., LMFT

When we speak of gender, in a context other than language, it is a recent concept in our culture, both lay and professional. In 1955, John Money, Ph.D. first used the term "gender" to discuss sexual roles, adding in 1966 the term "gender identity" while conducting his gender research at Johns Hopkins. In 1974, Dr. N.W. Fisk provided our now familiar diagnosis of Gender Dysphoria. Previously, one's sexual role was considered one of two discrete, non-overlapping congenital attributes—male or female determined by one's external genitals. These two mutually exclusive categories allowed for no variation. Of course, we acknowledged the cultural differences in sexual roles, but there still could be only two modes of expression.
Now we see one's gender as a continuum, a blending, analogous to a "gray scale." But, our distribution of gender is bimodal, that is, most people are lumped at the two ends (see graphic) with only a minority in the middle. The great majority will see themselves as either male or female with all that implies.
But, my review of current research and experience with gender dysphoric, gay and traditional clients has led me to see gender not as a bimodal male or female dichotomy but as a matrix—a possible mix of male/female orientation within the same individual. Several researchers have developed theories of how the brain develops prenatally along sexual lines arising from androgen mediation. Dr. Milton Diamond concludes from his research that the brain has four stages of gender imprinting. The first is Basic Sexual Patterning such as aggressiveness vs. passivity. Second comes Sexual Identity (gender identity), third, the Mating Centers develop (sexual orientation), and fourth, the Control Centers for sexual equipment such as orgasm.
Gunter Dörner in Germany, using his research with rats, sees only three stages. He believes that first the Sex Centers develop giving typical male and female physical characteristics, then the Mating Centers (sexual orientation) and then the Gender Role Centers which are similar to Diamond's "Basic Sexual Patterning."
As a psychotherapist, I don't presume to enter into the discussion of what develops in what order and how. I take a more pragmatic stance and seek to observe what behaviors are linked, or independent from one another. From this research and observation, I have developed a list of five semi-independent attributes of gender. Not as a fixed dogma, but as a working theory, a map if you will, to help us understand this complex often hotly emotional issue of gender. Consider sexual identity/behavior springing from five semi-independent attributes.


These five attributes are:
  • Genetic Our chromosomal inheritance.
  • Physical Appearance Our primary and secondary sexual characteristics.
  • "Brain Sex" Functional structure of the brain, along gender lines.
  • Sexual Orientation Love/sex object, "Love Maps."
  • Gender Identity Our subjective gender, our sexual Self-Map, how we feel ourselves to be: male or female. 

It is my contention that it is possible for an individual to view oneself and function as male or female to varying degrees in each of the five sub-categories independent of the others. For example, an individual may be XX female (chromosomal female), physically female, have a "female brain," be heterosexual but see her(him)self as male—or any other combination. One can be either male or female in each of the five sub-categories independent of each other. If we use "F" for female identity/function, and "M" for male identity/function and one through five for the semi-independent attributes listed above we could describe each individual according to their particular breakdown:
  • 1M 2M 3M 4M 5F
  • A Gender Dysphoric, Morphological Male
  • 1M 2M 3M 4F 5M
  • A Homosexual Male
  • 1F 2F 3M 4F 5F
  • A Dominant, But Heterosexual, Even Feminine, Female

Since each of these independent attributes is graded, it is easy to see the possible combinations and degrees number in the thousands. With regard to gender, we can be in a category of one—ourselves.
Perhaps only individuals who are homogeneously male or female at the highest degree in all five attributes could convincingly describe themselves as only a single gender— the rest of us are a matrix.
Like our genetic and physical gender, our gender identity, sexual orientation, and brain sex, expression usually remains constant from childhood throughout one's life.

Distribution of Gender
The Five Sub-Categories
The first sub-category, Genetics, is only beginning to be understood. What mechanism and to what degree does genetic influences effect one's expression of gender? We do know that besides the traditional XX chromosome of a typical female and the XY of a typical male, that there are other combinations such as XXY, XYY, and XO.
A XXY combination results in 47 rather the 46 chromosomes. This condition is called Klinefelder's syndrome and occurs in one in every 500 births. Individuals with Klinefelder's are sterile, have enlarged breasts, small testicles and penis, and a eunuch body shape much like the "Pat" character on "Saturday Night Live." They show little interest in sex.
Another 47-chromosome occurrence is XYY Syndrome. In this syndrome, the hormonal and physical appearance of the individual are evidenced as a normal male, but behavior is effected. Typically, XYY Syndrome people are bisexual or paraphilic (pedophilia, exhibitionism, voyeurism, etc.), and show very poor impulse control.
Where Klinefelder's and XYY Syndrome are examples of an extra chromosome, Turner's syndrome is a case of a missing sex chromosome. These individuals possess 45 chromosomes (written as XO), are unable to develop gonads, and are free of all sexual hormones, except that crossing over from the mother during fetal life.
Turner's Syndrome people have external sex organs approximating a female, and their behavior is characterized as hyper-feminine, baby care oriented, and showing very poor spatial and math skills. The Turner's personality, free of all influence from testosterone, tends to be in direct opposition to the typical set of "Tom Boy" traits.


Physical Gender
Turner's Syndrome relates well to our second category of Physical Gender—that being our primary and secondary sexual characteristics. To discuss this aspect of gender we need to examine hormonal involvement, in particular testosterone. During fetal life, the amount present, or the absence of testosterone determines our sexuality—physically, mentally and emotionally. There are key times or periods during development when the fetus will go towards the male or the female depending on the level of testosterone. These windows of opportunity may be only open for a few days and if the needed level of testosterone is not present, a basic female orientation develops regardless of the testosterone levels before or after this critical period, and the resulting sexual imprint.
The first critical period is at conception when the presence of the SRY gene (Sex-Determining Region of the Y chromosome) will determine our physical gender. The SRY gene is normally found on the short arm of the Y chromosome, but can detach making for a XY female (the Y missing its SRY gene) or a XX male (the SRY attaching to the X).
The SRY gene causes the fetus to release TDF (Testes Determining Factor) which turns the undifferentiated gonad into testes. Once testes have formed, they release androgens such as testosterone, dehydrocorticosterone, and anti-mullerian hormone.
Before the release of TDF, the developing fetus has two tiny structures, the mullerian and wolffian ducts, and two small-undifferentiated gonads, neither testes nor ovaries. Without the influence of TDF and testosterone, the gonads form into ovaries and the mullerian duct forms into the female internal sex organs, the wolffian duct disappears and the external sexual tissue becomes the labia major, clitoris, labia minor and clitoral hood. With the influence of TDF, the gonads become testicles and the wolffian duct forms the male internal sex organs, the mullerian ducts dissolve and the external tissue develop into the penis, scrotum, penile sheaths and foreskin. In other words, without testosterone all fetuses develop into females. Adam springs from Eve, not Eve from Adam.
As the primary sexual differentiation proceeds towards our physical gender, sometimes deviations occur. These anomalies are sometimes called "experiments of nature." One such "experiment" is a condition termed congenital adrenal hyperplasia (CAH) when the female fetus releases a steroid hormone form her adrenal glands which resembles testosterone. The resulting child often has confusing genitals ranging from deformed female genitals to an appearance of male genitals. If the child is raised as male, following any "adjusting" surgery and given male hormones at puberty, the individual develops as a "normal" but sterile male with XX chromosomes. On the other hand, if the infant is surgically corrected to female and given female hormones, there is a 50/50 chance of lesbian expression.
Another revealing "experiment of nature" is Androgen Insensitivity Syndrome. In this case, there is a normal amount of testosterone circulating in a XY chromosome fetus, but each cell of its body is unable to react to it. This is similar to Turner's Syndrome in that neither the mullerian or wolffian ducts mature and the external genitalia develops into an approximation of normal female genitals, but differs in that TDF stimulates the gonads into becoming functioning testicles in a XY chromosome body. The child is raised as a girl and is seen as a normal female until she fails to menstruate because she has no uterus. If her testes produce enough estrogen, she develops into a completely normal appearing, sterile female with XY chromosomes and internal testicles.
Dr. Simon LeVay, in his book, "The Sexual Brain," argues that one's brain receptors for hormones may also play a significant role in our gender development. Dr. LeVay writes,
"There is much to recommend...that there are intrinsic, genetically determined differences in the brain's hormone receptors or in the other molecular machinery that is interposed between circulating hormones and their actions on brain development. First, this would provide a mechanism that involves hormone-induced brain differentiation but does not require there to be differences in the actual levels of hormones. Second, since there are several different receptors involved (including the androgen receptor, the estrogen receptor, and at least two " estrogen-related" receptors), there is opportunity for selective effects on different brain systems."
Now we must leave the comfortable arena of biology and development and enter the more rocky, emotional and even political arena of psychology, anthropology, and sociology. An arena where deduction, speculation and circumstantial evidence is more evident than "hard fact."
The third, forth and fifth attributes all reside in the brain and there is controversy on both a congenital vs. environmental level and on a developmental one. It is still argued by some that sexual orientation is a choice and there is no difference in the mental abilities of men and women. Others argue that the evidence, both direct and circumstantial, is becoming overwhelming that these stands are incorrect.


Brain Sex
Because of the controversy over whether significant differences in brain structure do exist between the genders, I will confine my discussion of the "Brain Sex" attribute to some behavioral differences that have been noted between morphological male and female infants and children. At all times keep in mind that Physical Gender does NOT always indicate "Brain Sex" Gender. And, while these differences are the norm, they are not absolute. Individual children may differ.
Even a few hours after birth, significant behavioral differences are noted between morphologically normal boys and girls. Newborn girls are much more sensitive to touch and sound than their male counterparts. Several day old girls spend about twice as long looking back at an adult face than boys, and even longer if the adult is speaking. A girl can distinguish between the cries of another infant from other extraneous noises long before a boy. Even before they can understand language, girls do better at identifying the emotional context of speech.
Conversely, during the first few weeks of infant life, boys are inattentive to the presence of an adult, whether speaking to the infant or not. However, baby boys tend to show more activity and wakefulness. At the age of several months, girls can usually distinguish between the faces of strangers and people they know—boys usually do not demonstrate this ability.
As infants grow into children, the differences seem to intensify and polarize. Girls learn to speak earlier than boys and do a better job of it. Boys want to explore areas, spaces and things, girls like to talk and listen. Boys like vigorous play in a large space where girls like more sedentary games in smaller spaces. Boys like to build, take things apart, explore mechanical aspects of things and are interested in other children only for their "use" (playmates, teammates, allies, etc.). Girls see others more as individuals—and will likely exclude a person because they're "not nice," and will more readily include younger children and remember each other's names. Girls play games involving home, friendship, and emotions. Boys like rough, competitive games full of "`zap, pow' and villainy." Boys will measure success by active interference with other players, preferring games where winning and losing is clearly defined. In contrast, girl play involves taking turns, cooperation and indirect competition. Tag is a typical boy's game, hopscotch is a girl's game.


Sexual Orientation
If "Brain Sex" is controversial, the fourth attribute of Sexual Orientation is ever more so. Although there is public and political controversy, the overwhelming majority of medical and psychological practitioners agree that sexual orientation may prove to be mainly congenital, or at least firmly established in early childhood. The term "Sexual Orientation" is a bit misleading. It is more an erotic or love orientation in that Sexual Orientation determines the physical gender we find attractive, with whom we fall in love, and have romantic as well as sexual fantasies.
From experiments with animals, "experiments of nature" in humans, and genetic and neurological studies come a consistent, though still circumstantial, stream of evidence that indicates one's sexual orientation is largely hormonally determined by the presence or uptake of testosterone at key periods in fetal development, and possibly even beyond. As we have seen with congenital adrenal hyperplasia (CAH), female fetuses exposed to testosterone-like agents develop a 50/50 chance of a lesbian versus heterosexual orientation if raised as girls. Studies of identical twins also indicate that when one twin shows homosexual or lesbian expression, there is a 50/50 chance of homosexual or lesbian expression in the other twin—whether raised together or apart.
The remaining 50% of determination may be continued hormonal development, environmental considerations or a combination. One interesting consideration with determination may be during our early postnatal development since the fetal stage for human babies is not completed during gestation, but continues for a year or more outside the womb. And during this critical time after birth, we have the highest level of testosterone present, excluding the onset of puberty—with many brain receptors to receive this powerful hormone. At any rate, between the ages of three and six years, one's erotic orientation is very likely established but may not be acted upon for decades, if at all.
It is also interesting that sex- atypical traits (in regards to one's physical gender) seen in children destined to become gay or lesbian, are more evident than in adults who are gay or lesbian. One possible explanation is that the increased levels of androgens and estrogens at puberty stimulate the development of more sex-typical traits in adults.


Gender Identity
The last of our five attributes, Gender Identity, is the last to be identified, and the least understood and researched. Gender identity is one's subjective sense of one's own sex. Like pain, it is unambiguously felt but one is unable to prove or display it to others. One's subjective gender is just as real and immalleable as one's physical gender but unfortunately not recognized in our culture. When one's Gender Identity does not match their Physical Gender, the individual is termed Gender Dysphoric. Like minority Sexual Orientation, Gender Dysphoria is not pathological, but a natural aberration occurring within the population. As with minority sexual orientation, the percentage of the population having gender dysphoria is in dispute, with estimates ranging between one in 39,000 individuals up to three percent of the general population. My experience leads me to feel that the higher figure (3%) is closer to the actual prevalence.
Gender dysphoric individuals have been described, either by themselves or by others, as falling into three distinct groups: crossdressers, transgenderists and transsexuals.


Those individuals with a desire to wear the clothing of the other sex but not to change their sex are termed crossdressers. Most crossdressers view themselves as heterosexual men who like to wear women's clothing in private or in public, and may even occasionally fantasize about becoming a woman. Once referred to as a transvestite, crossdresser has become the term of choice.


Transgenderists are men and women who prefer to steer away from gender role extremes and perfect an androgynous presentation of gender. They incorporate elements of both masculinity and femininity into their appearance. Some persons may see them as male, and by others as female. They may live part of their life as a man, and part as a woman, or they may live entirely in their new gender role but without plans for genital surgery.


Men and women whose gender identity more closely matches the other physical sex are termed transsexual. These individuals desire to rid themselves of their primary and secondary sexual characteristics and live as members of the other sex.
Transsexuals are diagnostically divided into the sub-categories of Primary or Secondary. Primary transsexuals display an unrelenting and high degree of gender dysphoria, usually from an early age (four to six years of age). Secondary transsexuals usually come to a full realization of their condition in their twenties and thirties, but may not act on their feel
ings until they are much older. Typically, secondary transsexuals first go through phases that would be self-assessed as being a "crossdresser or transgenderist."


A New View of Gender
While the above categories are the generally accepted classifications both within the gender community and among helping professionals, during my work with gender folk I have come to the belief that there is only one cause and one conflict—but there are many reactions and adjustments to it. I have gradually come to the conclusion that one's coming to terms with the conflict between one's subjective knowledge of their gender and one's need to be "normal" fosters the conflict in all gender folk. I also feel that for most physically male gender folk, the male persona is an artificial construction produced by the early adolescent individual (age 12 to 15) in order to fit in and be like everybody else. For the F/M person, there is a separate and different, but still consistent pattern.


Physically Male/Subjective Female
Individual (M/F)
Because a child's greatest desire is to be normal (like everybody else), the great majority of M/F individuals create an artificial self which meets this goal. They are often so successful at this that they not only fool everyone else but themselves as well — at least part of the time, in some way.
Once created, M/F gender folk live in their male role — a 3-D personality with its own goals, likes and dislikes, values, hobbies, etc. Although indistinguishable from the "real thing," it isn't themselves. It is an artificial creation for them to be able to fit in. This is achieved at the expense of denying, locking away, their natural female subjective gender. Their desire to be "normal" has denied them their natural selves. But, as the nagging reality of the deception becomes harder and harder to suppress, one has to express their true subjective gender somehow, in some way.
For most, dressing is the obvious compromise. If one cannot be female, one can at least express femininity. But the more one expresses one's true self, the desire for more becomes greater. Some individuals continue expressing themselves more and more, others panic and purge only to start again later.
One's gender identity classification (crossdresser, transgenderist, transsexual, etc.) is due to each individual's adjustment to first the conflict between one's subjective gender (Self-map) and their need to be "normal," and later to the conflict between one's subjective gender and their "male persona." There is no objective "best solution," only a subjective, personal best solution.
After years or decades of living, working and building within their male persona, it is often too "expensive" to give up the life, perks, family, etc., one has built up—in order to go back to basics and have an emotionally 12 year old girl grow up—and live in a once male 40+ year old body.
However far one is able to go toward dismantling the male persona and allowing their female subjective gender to develop, one generally seems to have the following three levels of transition:


1. Recognition that one's Self Map (subjective gender) is different from one's Physical Gender —This can take the form of seeing one's self as a "woman trapped in a man's body," a need to express one's "feminine side," etc. This stage is mainly concerned with physical/surface changes such as crossdressing, passing, makeup, wigs, etc. In this first part, many gender folk don't even venture from their own home and often have a juvenile (before age 15) and later, an adult phase. The so called "Primary Transsexual" is an individual who never constructs a male persona and therefor never accepts their male genitals or challenges their female Self Map/subjective gender.


2. Accepting one's Self-Map (Subjective Gender)—This stage is more varied than the first and consists of changing one's life to fit one's Self-Map. These changes may only involve bringing one's significant other and loved one's into their dressing behavior and expanding their activities ("crossdressers") or continuing to express their Self Map and dismantle their male persona by starting hormones, electrolysis and public dressing. One develops towards a "comfort level" with one's subjective gender and its conflict with their male persona.


3. Becoming one's True Self — This is the last but unfortunately least experienced part of transitioning. This is the stage when that little child trapped inside an artificial persona in order to fit in breaks free, grows up and has their own life — often with markedly different values, temperament and interests.

It has been my observation that the female subjective self needs little help in growing up and developing if the overpowering weight of the male persona is removed from it. The M/F individual has spent years, decades developing, reinforcing and living in their male role. Dismantling the male persona takes a great deal of time, effort and outside help. In those individuals identified as "transsexual," their subjective sense of happiness and success is directly parallel with the degree they have dismantled their male identity, not on their age, physical size, hormones, surgery, etc. Another interesting aspect of a female subjective gender with a male physical gender is the concept of Sexual Orientation. To classify a M/F individual as either homosexual or heterosexual would be equally false. If one views their gender as that established by their subjective gender, then having sex with a physical/ subjective female would make them homosexual (lesbian). But, if one viewed their actions from their physical gender, they would be committing a heterosexual act. In other words, no matter which gender they have sexual relations with, they are simultaneously committing both a homosexual and heterosexual act.
I believe this example illustrates the need for us to see our gender as a matrix of male/ female expression and not as an either/or classification based on the appearance of our physical genitalia.


Physically Female/Subjective Male
Individual (F/M)
The F/M individual is much simpler than the M/F one. With F/M, there is no conflict or confusion over sexual orientation. —They are overwelmingly attracted to physical females, but not as a female themselves, but as a male. There is little, if any attempt to create a "female persona" and "crossdressing" behavior, if it appears at all, has different goals and practice.
Unlike the long transition required with M/F's, F/M's seem to need little help beyond understanding their condition, accepting it and help in correcting their physical gender to accommodate their subjective one.
In male-subjective/physical gender and female-subjective/physical gender individuals, males are generally the simple ones and females, the most complex. It may be that one's subjective gender is a major component in this complexity or the lack of it.


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The Multi-Dimensionality of Gender  by Carl W. Bushong, Ph.D., LMFT When we speak of gender, in a context other than language, it is a recent concept in our culture, both lay and professional. In 1955, John Money, Ph.D. first used the term "gender" to discuss sexual roles, adding in 1966 the term "gender identity" while conducting his gender research at Johns Hopkins. In 1974, Dr. N.W. Fisk provided our now familiar diagnosis of Gender Dysphoria. Previously, one's sexual role was considered one of two discrete, non-overlapping congenital attributes—male or female determined by one's external genitals. These two mutually exclusive categories allowed for no variation. Of course, we acknowledged the cultural differences in sexual roles, but there still could be only two modes of expression.
Caught Between Two Worlds by Sheila Mengert, Esq.
The great English poet Matthew Arnold once described his times as, "caught between two worlds, one dead, the other powerless to be born." The phrase might be used to sum up the existence of many preoperative transsexuals in our society. Of course, for the transsexual person the world of the genetically assigned sex was never really a lived world, it was a prison of pain and denial from which she desires to escape. Nevertheless, there was a certain security in the protective coloration provided by an assigned sex role. We are only now beginning to realize how many people in our society suffer chronic mental pain. Many of these people were raised in alcoholic or otherwise dysfunctional families. Others were victims of child abuse, sexual abuse, or incest. Perhaps the least addressed of the causes of chronic mental pain is the pain caused by living according to the norms of a patriarchal and heterosexual dominant culture that refuses to recognize gay, lesbian, and transsexual people. Such people are drawn into a perpetual state of ambiguity as they attempt to deny the overpowering feelings that come from their true identity and sexual preference.
Childhood sexual abuse: A profile of 44 patients attending the gender clinic at the Centre for Sexuality, Gender Identity and Reproductive Health By Darlynne Gehring, MSW, MFT Previous research has established the prevalence of sexual abuse in the general population. Research suggests that childhood sexual abuse is associated with adverse effects on adult adjustment, with more pronounced effects resulting from more severe forms of abuse. The more severe forms of sexual abuse usually refer to genital contact or force by an adult male perpetrator, who is usually identified as the father. These adverse effects are expressed in three general areas: emotional and psychological functioning, social and interpersonal relationships, and sexual adjustment. It has been hypothesized by authors and practitioners that the etiology of transsexuals is the accumulative results of childhood abuse. Our preliminary research findings do not substantiate these claims.
Gender Identity Issues - Introduction Those who most frequently end up on the streets, are excluded from existing social services, and need a safe-place of refuge are those who have dual diagnosis, a history of sexual abuse, and who are primary male to female transsexuals. As well, it is those with chemical dependency, poor social skills, poor presentation and those who suffer racial discrimination who need this refuge.


The IJT Book Collection Links to various books.
International Journal:  TRANSGENDER on transsexualism, transvestitism, cross dressing and other transgender topics Various clinical articles on Transgender issues.


Female-to-Male (FTM) FTM stands for Female-to-Male. This site is the internet contact point for the largest, longest-running educational organization serving FTM transgendered people and transsexual men. We are a diverse group. We come from different backgrounds, including every imaginable sexual orientation, and are multicultural. We range in age from our teens to our 70s and include persons who are just beginning to examine gender issues as well as persons who have been dealing with them for many years.
The International Foundation for Gender Education (IFGE) The International Foundation for Gender Education (IFGE), founded in 1987, is a leading advocate and educational organization for promoting the self-definition and free expression of individual gender identity. IFGE is not a support group, it is an information provider and clearinghouse for referrals about all things which are transgressive of established social gender norms. IFGE maintains the most complete bookstore on the subject of transgenderism available anywhere. It also publishes the leading magazine providing reasoned discussion of issues of gender expression and identity, including crossdressing, transsexualism, FTM and MTF issues spanning health, family, medical, legal, workplace issues and more.
The Harry Benjamin International - Gender Dysphoria Association, Inc. The Harry Benjamin International Gender Dysphoria Association, Inc. (HBIGDA) is a professional organization devoted to the understanding and treatment of gender identity disorders. We have approximately 350 members from around the world, in the fields such as psychiatry, endocrinology, surgery, psychology, sexology, counseling, law, and sociology.
Support Groups This page contains group resources available for people wrestling with, or simply curious about, transgender and related issues. Has information on egroups and other support groups.


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