What Causes Transsexualism

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What Causes Transsexualism?

Many causes for transsexualism have been proposed over the years. As discussed earlier in Lynn's TG/TS/IS information, it's long been known from intersex data that the genes do not determine gender identity, and recent follow-ups on intersex infant surgeries show that consistency of "genitals and upbringing" does not determine gender identity.

Instead, current scientific results strongly suggest neurobiological origins for transsexualism: Something appears to happen during the in-utero development of the transsexual child's central nervous system (CNS) so that the child is left with innate, strongly perceived cross-gender body feelings and self-perceptions. We still don't know for sure what causes this neurological development, and more research needs to be done. But the neurobiological direction for these explorations seem clear.

However, even without any scientific evidence to back them up, many psychiatrists and psychologists over the past four decades have simply assumed that transsexualism is a "mental illness". By DEFINING this socially unpopular condition to be a mental illness, these mental health professionals have shaped much of the medical establishment's and society's views of transsexuals as psychopathological "sexual deviants".

This page is an investigative report that describes and contrasts the older "mental illness" concept of transsexualism with more recently emerging scientific evidence of neurobiological bases for innate gender identity in humans.



Behaviorist psychology was a dominent school of thought during the 1950's-80's, and has left a deep imprint on theories of gender and sexual behavior. Behaviorists "believe" that an infant's mind is a blank slate upon which social factors and conditioning act to produce all aspects of personality, including gender. This belief takes the form of an axiom in their works - a basic assumption not based in evidence but upon which they derive results. Because of this belief in the infant's "mind as a blank slate", they have long had faith in John Money's "genitalia and upbringing" theory of gender-identity formation.

Readers should carefully study the section on Gender Basics in Lynn's TG/TS/TS Information pages for background on John Money's theory, and on the recent shattering of Money's theory when it was discovered that he had fabricated many results and concealed any counterevidence. For many decades his theory was the basis for arbitrary surgical sex reassignments of intersex infants, mostly boys with tiny or missing penises who were turned into "girls". Many of these kids reassigned as infants required later re-reassignments as boys when their innate gender identities became clear during childhood. In most cases, the boys lives were shattered by the surgeries that had been forced upon them as infants (they lost what genital tissues they had, as well as the ability to have orgasm). Money never reported any follow-ups of these infant surgeries that revealed the horrors that had been going on.

As we'll see, behaviorist theory has also had horrific impact on the lives of transsexual people, by classifying them as being "mentally ill", instead of being open to the scientific possibility that they too have innate gender feelings. Denying the existance of any inborn gender identity, behaviorists (following Money's ideas) see transsexualism as a failure of a person to properly socialize into their correct gender during childhood and adolescence, leading to "sexually deviant practices" in the adult which then brings on "mental illness" including the urge to "change sex".

From this viewpoint, transsexualism is viewed as psychopathological. It is even listed as a mental illness in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, under the term "Gender Identity Disorder" (GID). This listing stigmatizes transsexualism as a mental illness, just as psychiatrists stigmatized "homosexuality" and "nymphomania" in the past (of course being gay is now seen as a natural variation in sexual-partner orientation, and being a sensual woman is now a sought-after-norm by many women).

In the absence of definitive scientific explanations for transsexualism, which await a deeper understanding of developmental biology, certain dogmatic psychologists and pyschiatrists have seized the opportunity to spout and publish unscientific behaviorist "theories" without much challenge from the public, the medical establishment or the scientific establishment. They have long defended their theories in the same manner as John Money defended his: by maintaining dominant positions in their peer networks, attacking the "credentials" of any challengers, and attempting to suppress any counter-evidence put forward by others.

Unfortunately, this sort of behavior can be effective in one's advancement in niche fields such as sexology and gender studies, fields that attract few serious scientists and that are not subjected to close outside scrutiny by serious scholars. So powerful is the impact of a domineering "leader" like a John Money in a niche fields such as sexology that many wanna-be's imitate his "dominance wins" style of behavior. When aggregated, such behaviors lead to the degeneration of such fields into non-scientific cliques of "experts" who rant about nonsense-theories not based in evidence, with each expert doing "whatever it takes" to get their pet theory accepted. Unfortunately, this "he who dominates wins" methodology is the only "scientific tradition" underlying many behaviorist psychiatrists' theories in the realm of gender studies.

Believing transsexualism to be a mental illness, behaviorist psychiatrists often try to treat transsexual people by "conditioning" and/or "aversion therapy". Many transsexuals, especially young transsexuals taken to psychiatrists by their parents, have undergone years of costly psychiatric counseling to "cure their transsexualism". There have no reports of permanent cures. After inevitably failing to cure a transsexual, and considering her to be "permanently mentally ill", these psychiatrists may sometimes approve her for SRS. Of course the years of useless therapy cost thousands of dollars and waste valuable gender-corrected living-time that can never be recovered.


In the late 80's, certain behaviorists proposed a very specific "two-type" theory of transsexualism that has since "caught on" in psychiatric circles as "explaining the cause of transsexual mental illness". Two types of sexual urges were "intuited" and then described by behaviorists to explain MtF transsexualism: (i) extreme "effeminate homosexuality", and, more recently, (ii) obsessive "autogynephilic autosexuality". These so-called "deviant adult practices" are thought of as gradually "conditioning the transsexual" to want to "change into a woman". The theorists proclaim that these are the only causes of transsexualism, and all MtF transsexual people are of either one type or the other. This theory was developed and elaborated BEFORE the collapse of John Money's theory of gender was discredited, and it promotors are scrambling now to salvage it.

The main promoters of this "two-type theory" are Ray Blanchard, Ph.D., a clinical sexologist at the notorious Gender Identity Clinic of Ontario's Clarke Institute of Psychiatry who originated the idea, and his chief protege, J. Michael Bailey, Ph.D., a psychologist at Northwestern University.

Only by reading Bailey in the original can you get some idea of how totally bogus and methodologically flawed this so-called "scientific work" is. For example, Bailey's website contains a paper entitled "Women Who Were Once Boys" that simply asserts as fact, without any basis, that there are "two categories of transsexuals: homosexual and autogynephilic", and he then uses various anecdotal evidence from "interviews" to show how TS people fit into this categorization.

Bailey's paper even goes on to include a simple twelve question "test" on how to tell the two types apart! However, it concludes with the warning: "Keep in mind that people don't always tell the truth. This interview could be invalid if the transsexual is actually autogynephilic but is either (a) worried that you will think badly of her or deny her a sex change if you know the truth, or (b) obsessed with being a "real" woman." Apparantly Bailey easily disregards any answers that don't agree with his theory by simply characterizing the responder as a "lier"!

For more insight into the shallow, speculative, pseudo-scientific theorizing of people like J. Michael Bailey, see the quote of Bailey attached below regarding "stereotypes of gay people that are real". Unfortunately, the writings and lecturings of "sexologists" like Blanchard and Bailey are taken fairly seriously in psychiatric counseling circles, where few people have the courage or the wits to challenge the ideas of these aggressive theory-promoters who publish widely in obscure sexological journals.

Let's now consider each of these "two types" ideas in turn, and learn how the sexologists/psychologists/psychiatrists went wrong in their speculations.

There have always been some gay males who are very effeminate. Some of these men will occasionally dress in drag. But such males do not want to become women - they love being men, and love other men - and they are simply signalling their homosexuality using methods that are traditional in the gay community. Such a gay male is never "conditioned by his sexual activity" to want to become a woman. The sexologists' error is to not differentiate between the effeminate homosexual male and the young transsexual girl whose cross-gender feelings developed long before puberty. The sexologists thus mistakingly jump to the conclusion that effeminate homosexuality is equivalent to transsexualism, and, conversely, that addiction to "homosexual behavior" must have been what caused the transsexualism of those young TS girls who incorrectly appear to be effeminate homosexuals to the psychiatrists.

In this theorizing, the sexologists and psychiatrists are victims of another of their errors, namely their notion that transsexualism is extremely rare. By assuming that transsexualism occurs in only 1:30,000 males, and then only looking for and sampling "transsexuals" in the gay male bar scene (where only a tiny fraction of TS girls hang out), they "confirm" their theory that most young TS girls come from among young "effeminate gay males" who have become addicted to receptive sex. After all, they find more than enough TS girls in that scene to cover the 1:30,000 prevalence number. What they do not perceive is that the young effeminate males and the young TS girls themselves know that they are two totally different kinds of people, even though they may hang out in some of the same bars. By overfocussing on the gay bar scene as a source for "transsexual research subjects", the psychiatrists miss seeing the vastly larger number of TS girls who have no contact with that scene, who've had no "homosexual conditioning", and who are strong counter-examples to their "theory".

By insisting on the validity of the theory that "young transsexuals cause their transsexualism by addiction to homosexual practices", the sexologists and psychiatrists never seemed to notice the important group of "strong counter-examples" to this theory - namely that a moderate percentage (perhaps as much as 20% to 30%) of all young TS girls are actually "lesbian" in their female gendering and prefer other girls as love-partners. Worse yet, the psychiatrists years ago made the existance of these young girls "invisible" by never writing letters of support for SRS for any TS girl who was known to be "lesbian"! In other words, since these girls didn't fit their theory of transsexualism, they were denied SRS because "they weren't transsexual" according to the psychiatrists. As a result, even to this day, many young TS girls who are lesbian try to avoid their gender counselors about their sexual preference for girls, fearing that this preference will hurt their chances for approval for SRS.

Therefore, we see that two errors in "theory", namely (i) that transsexualism is extremely rare and (ii) that transsexualism is caused by conditioning to receptive homosexual sex, are compounded and mutually support each others' apparant validity. This compound error is only recognized if one realizes that MtF transsexualism is about two orders of magnitude more common than previously recognized and that it mostly occurs in young boys who are not or were not immersed in the gay male bar scene.

Then, in recent years, a new phenomenon has appeared that has also caught the psychiatrists' attention: A number of intensely transvestic males have become aware, later in life, that the physical transformations made possible by transsexual medical and surgical technology might revitalize and enhance their solitary sexual pleasures. These are male-gendered persons who desire to live in, and enjoy sexually playing with themselves in, the body of a woman. These individuals may even seek SRS, even though they are male gendered and in many cases have no particular desire to socially transition. The appearance of this phenomenon is simply a byproduct of the availability of gender modification technology - an application of that technology for something different than it was originally designed for (correction of transsexualism).

Such men are now called "autogynephiles", although in public they usually call themselves "transsexuals" in order to present a more socially recognized and socially accepted explanation for their physical gender modifications. The recent tragic death of Ernest Hemingway's son Gregory publicly revealed him to likely be an autogynephile, and revealed insights into the autogynephilic gender trajectory. Gregory had a long history of intense addiction to transvestism, and had apparently undergone SRS at sometime during his life. However, according to news reports Gregory only occasionally dressed as a woman in public, and he was referred to by the Hemingway family as Gregory (rather than Gloria or Vanessa, which were names Gregory sometimes used when dressed as a female).

In such cases, the psychiatrists' model of sexually conditioned behavior appears to offer an explanation for the behavior, because these people often self-describe their condition to counselors as being males who want to heighten their transvestic pleasures. However, such intensely transvestic autogynephilic males retain their male gender feelings even after being transformed physically into females. Therefore, they are on a completely different gender-identity trajectory from that of transsexuals. The psychiatrists' mistake is to that they confuse autogynephilia with being equivalent to late-transitioning transsexualism.

The existance of these two visible and identifiable groups of males (effeminate "homosexual" transsexuals and autogynephiles) who "appear to be transsexual", and whose "transsexualism" appears to fit the behaviorist's model that "sexual disorders are caused by conditioning", has led many psychiatrists and psychologists to the generalization that ALL transsexualism is explained by just these TWO particular types of male sexual pleasure-seeking activity.

Although there is no scientific basis for these behaviorist ideas, many male psychiatrists just can't imagine anything except powerful male sexual urges gone awry that could cause an apparantly normal male to want to become a woman. Such psychiatrists thus try to stall-off transsexual surgeries as long as possible, even for decades in some cases, until it is obvious that a patient's "homosexual urges" or "autogynephilic urges" cannot be further contained. Operating under an incorrect model of transsexualism they can do irrevocable harm by long-delaying the gender transitions of many actual transsexuals who come under their guidance.

[By the way, these same male psychiatrists never question why an FtM transsexual would want to be a man, nor do they generate theories that FtM people want to be men because of "powerful female sexual urges gone awry". To them it seems obvious that any woman might want to be a man, and thus it is only the MtF transsexual who is considered to be "mentally ill". There is also present in their thinking a quaintly Victorian notion that only males have strong sexual drives, that only males masturbate and have orgasms, and that women are inherently passive sexually.]

This situation has been worsened by additional over-promotion of the "theory of autogynephilia as the main cause of transsexualism" by an AG person who happens to run a very visible and oft-accessed TS women's support site. This person, openly identifying as an autogynephile, projects their own experience and condition on most other transsexual women (except those who were very early transitioners and who admit having early "homosexual" activity). When doing this projection and when theorizing that most transsexual women are actually autogynephiles, this person mimics the well-known macho-dominant style of John Money - doing anything possible to promote their "theory" and to defame as "liers" those who "deny being autogynephiles".

Amazingly, the promoters of the autogynephilia theory of late-transitioners don't seem to notice that many late transitioners do not just spend their lives alone engaging in solo-sex after transition as their theory would suggest. Instead, many late transitioners go on to form wonderful loving relationships - some with women and some with men - relationships in which they are fully sexual love-partners. Sadly, the widespread promotion of the non-scientific "autogynephilia theory" has caused a lot of angst among transsexual women who correctly perceive this as yet another trigger for public stigmatization and humiliation.

Unfortunately, many decades of such speculative, non-evidence-based theorizing about the causes of transsexualism have greatly muddied the waters of thinking about this condition. To this day, the mental-illness model of the condition permeates the general medical profession and negatively impacts public stereotypes of transsexual people. All of this "theorizing" is without any scientific foundation whatsoever, being little more than the "intuitions" of the most dominant thought leaders among sexologists, starting with John Money.

Maybe we should raise the question "what causes people to become sexologists", apply the same "intuitive" methods to answer that question, and then see how sexologists react to our resulting theories!


Now let's apply some common sense here. The deep sense of being incorrectly gendered begins in childhood for intense transsexuals, long before sexual feelings develop. After puberty, many young pre-op TS girls are attracted to boys just like any other girl would be. TS girls who are feminine and attractive may find boyfriends and make love with them while pre-op, just as any other girl would do. But these are not boy-to-boy homosexual relationships. These young transsexuals are thought of as girls by their boyfriends (just as Lynn was at ages 19-22), and their boyfriends are heterosexual, not homosexual. For psychiatrists to say that the "homosexual" sexual experiences of pre-op TS girls' CAUSES their transsexualism is an incredible reversal of cause and effect. Instead it is their innate feelings of being female that cause them to seek the love of boys, and then in some cases to have sex with boys (always as "the girl") in order to find affirmation of their femaleness.

Also, many older MtF transsexuals if long untreated become obsessed with the idea of becoming women. Is that so surprising? Older pre-op transsexuals without partners may also be autosexual. But aren't most humans without partners autosexual? Masturbation itself is not a solely a "male" activity nor is it a sign of "autogynephilia", as these psychiatrists seem to suggest. Many women enjoy their bodies very much, and many women masturbate for sexual pleasure and orgasmic release. Autosexuality on the part of pre-op (and postop) transsexuals of any age is just a natural part of their human nature, whether male or female, instead of being a "male sexual fetish". (It seems likely now that the old time male behaviorist psychologists didn't even know that many women masturbate and can have orgasms).

To say that "thinking about being a woman while engaging in autosexual activity" CAUSES transsexualism is clearly another reversal of cause and effect. My goodness, do you think that a preop MtF transsexual would have masturbation fantasies in which she is a man? Common sense says she will have sexual fantasies in which she is a woman, because that is her inner identity. Therefore, to say that ALL late-transitioning transsexuals are autogynephilic is similarly a reversal of cause and effect.

Unfortunately, most male psychiatrists and psychologists, never themselves having experienced the intense gender-identity-alienation, cannot get the idea out of their heads that "sexual urges must be the cause" (their own male sexual urges being the strongest urges they themselves have ever felt).

In summary: Common sense tells us that the sexual practices of pre-op transsexuals, as they struggle during their difficult life trajectories to cope with bodies that are mis-gendered, can be far more easily explained and understood as being a natural BYPRODUCT of, rather than the CAUSE of, their transsexualism. Thus the old "mental illness" theories of transsexualism are based on a classic error in science: They have confused, reversed and conflated CAUSE and EFFECT.

A lot of damage is done by the old mental illness theories. When psychiatric authority figures subtly brainwash a transsexual patient into believing that she is causing her own transsexualism by engaging in "homosexuality" or "autogynephilic masturbation", and then attempt to delay her transition for years or decades, she can lose all chances of ever later assimilating into society as a woman. Even if she transitions, she may actually think of herself as a deviant male rather than as a woman, and may be stuck with that self-image forever. This is especially true in cases where her psychiatrists insist that she buy into and parrot their theories, forcing her to admit that she is a "mentally-ill man" as a condition for signing letters of consent for her SRS.

When a counselor uses the terms homosexual transsexual and autogynephilic transsexual to classify their clients, it's a sure tip-off they believe that ALL transsexuals are mentally ill sexual deviants who have caused their own transsexualism. Lynn advises transsexuals to avoid counselors who label transsexuals in these judgmental behaviorist categories. Transsexuals are also advised to avoid TG/TS support groups whose members identify primarily as autogynephilic, because they will not fit-in well and will not learn useful skills for assimilation as women in such groups. [On the other hand, older highly transvestic males who desire transsexual physical modifications should seek out such support groups; they should also seek counselors whose practice primarily involves autogynephiles, and who will refer such males for transsexual surgery, including SRS.]

For further discussion regarding the psychological and psychiatric profession's unscientific conception of transsexualism as a mental illness, see Gender as Illness: Issues of Psychiatric Classification by Katherine K. Wilson of the Gender Identity Clinic of Colorado (GIC). GIC has also developed a new webpage resource for the Reform of Gender Disorders in the DSM-IV-TR, located at http://gidreform.org/.

Also consider recent research by psychiatrists in Norway that has found that TS patients selected for sex reassignment showed a relatively low level of psychopathology both before and after treatment. This new research also casts doubt on the old view that transsexualism is a "severe mental disorder".

For a further indictment of the professionalism, scientific credibility, factual accuracy and veracity of the APA and the DSM-IV regarding transsexualism, see Lynn's discussion of the question "How frequently does transsexualism occur?".


Except for the behaviorists (who unfortunately are still dominant among "sexologists" and "gender theorists"), most schools of psychological thought have ruled out causes related to upbringing, social interactions and sexual practices as leading to transsexualism. As in other fundamental areas of personality, most scientific researchers now believe that the formation of gender identity most likely occurs at an innate neurobiological level. Serious scientific research on the formation of gender identity is now focused on understanding the processes of CNS neurological integration of the fetus during pregnancy.

Recent research indicates that MtF transsexualism may result from a female differentiation in a genetic male of the BSTc portion of the hypothalamus, during interactions between the developing brain and fetal sex hormones; this brain region is essential to sexual feelings and behavior. The first such research was reported in 1995: See NATURE, 378: 60-70, 1995 (this paper is also web accessible at http://www.symposion.com/ijt/ijtc0106.htm ). Significant extensions of this earlier work have just been reported, in May 2000 (see following abstract and link to the full paper) :



Support for this brain-differentiation and CNS imprinting theory of gender identity also comes from the recently reported research studies on intersex boys who had been surgically changed into girls and raised as girls, yet who grew up insisting on being boys (see the important earlier section on the intersexed). These follow-up studies demonstrate that having female genitals and being raised as girls did not make these brain-sexed boys into girls. They somehow deeply knew that they were boys, in spite of all the external evidence that they were girls - in other words, they presented just as if they were FtM transsexual boys.

The we an see how the old behaviorist "genitals plus upbringing" psychological theory has caused tremendous pain and suffering, especially amongst (i) intersexed children who've undergone unwanted genital surgery and incorrect gender reassignment during their upbringing, and (ii) transsexual children who've undergone extended psychiatric "treatment" such as shock therapy, aversion therapy and behaviorist conditioning therapy in futile efforts to "reverse" their transsexualism, and who've been forced to grow up in the wrong gender in spite of their pleas and suffering. In the case of transsexual children there is also the added social stigmatization of being declared "mentally ill" by the psychiatric profession.

Emerging scientific understanding of gender identity and the accumulating empirical evidence of successful gender transitions can help society and the medical community avoid such terrible treatments and misclassifications in the future, and better help these innocent children to find their best paths in life in each individual case. If anyone doubts that those who undergo gender transition can go on to lead full and happy lives, all they need do is study the empirical evidence at Lynn's "TS Women's Successes" and "Successful TransMen" pages.


Is gender transition a "choice" or "fate"? This question very often arises in conversations about transsexualism. The notion that transition is a lifestyle "choice" is rather prevalent in our society, and can be just as stigmatizing as the idea that it is due to a mental illness. But why do people jump to the conclusion that it is a choice? Perhaps it is because of the apparent suddenness of the onset of many transsexual transitions.

Transsexual women often appear to be completely normal males before announcing they are going to "change sex". The apparent suddenness of these transitions, and the rapid and dramatic physical changes that follow, fuels speculation among family, friends and co-workers that these "decisions" are very irrational ones. People often interpret unexpected transitions as "mental breakdowns", or as sudden "choices" to do something totally weird and prurient and probably for "sexual reasons". (These interpretations are furthered by the occasional cases of autogynephilic males who go through hormone therapy and SRS specifically for sexual reasons, and who remain rather visibly transgendered and do not "vibe" as women afterwards).

What most people cannot comprehend is the extreme gender distress these transsexuals have endured during their entire lives. Forced by extreme family and societal pressures to keep their distress a secret from everyone else and never show any signs of cross-gender feelings, they simply suffer horrifically in silence, never revealing what is wrong inside. When the gender angst becomes totally overwhelming, and transsexual people seek counseling and discover options for gender-transition, the floodgates open in their minds: Transition then becomes an intensely sought-after goal, and to others may appear to have arisen out of the blue, as if it were a sudden "choice". However, gender transition is NOT a choice. Instead it is destiny for those who are intensely transsexual.



Why is there so much fixation on "causes" anyway? The answer is simple: Transsexualism has been such a socially unpopular condition in the past that the issue of "what causes it" has always raised in discussions about what to do about it.

In the past many behaviorist psychologists and psychiatrists have inherently blamed transsexuals for causing their own "sexually deviant mental illness", giving those psychiatrists a claim to responsibility for "treatment and cure of transsexual people" and giving society a rationale for discrimination, marginalization and ghettoization of transsexual people.

However, as we've seen, transsexualism is most likely a neurological condition of as yet unknown origin and not a "mental illness". There are many other intense neurological conditions such a pain, depression and bipolar disorders for which we do not know the underlying causes but suspect biological causes. We know that these other conditions are real because we see people in distress, and we treat those people medically and with compassion to relieve their suffering.

Why should it be any different with transsexualism? We now know how to relieve the suffering of transsexual people, having many options for practical counseling, social transition and hormonal/surgical gender reassignment. Why not accept those treatments as valid, since they truly relieve suffering and enhance the quality of life, even if we aren't sure what causes the underlying condition. And why stigmatize people just because they have sought medical treatment for this condition.

Fortunately there are a rapidly growing number of compassionate non-behaviorist gender counselors who provide practical help for transitioning transsexual people. These counselors follow a model of "informed consent" for their clients, presenting options for treatments and counseling clients on pragmatic, effective ways of resolving their gender issues.

Most present-day, self-reliant transsexual people who are planning and managing their own transitions seek the advice and counsel of the modern-day pragmatic gender-counselors, and they avoid traditional psychiatrists like the plague. Modern medical treatments can resolve the transsexual condition, even in the absence of scientific understanding of the detailed biological mechanisms that determine one's innate gender identity.

The following quote of J. Michael Bailey will help readers calibrate the incredibly naive and non-scientific level of thinking common among so-called "sexological researchers" when they speculate about and characterize their "research subjects". Any intelligent reader will sense the arrogance, shallowness and lack of perceptiveness in Bailey's thinking, his lack of sound evidence upon which to base conclusions, and his total conflation of causes and effects. Ask yourself if YOU'D like to be on the receiving end of "scientific thinking" like this? Need I say more?

Changeling Aspects, In affiliation with Agender-(Aust) & Transbridge-(Townsville)

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