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VOLUME II
THE TRANSSEXUAL EXPERIMENT
JASON ARONSON
New York
CONTENTS
Part II
TESTS
8 The Male Transsexual as ‘Experiment’ 117
9 Tests 126
10 The Pre-Natal Hormone Theory of Transsexualism 134
11 The Term‘Transvestism’ 142
12 Transsexualism and Homosexuality 159
13 Transsexualism and Transvestism 170
14 Identical Twins 182
15 Two Male Transsexuals in One Family 187
16 The Thirteenth Case 193
17 Shaping 203
18 Etiological Factors in Female Transsexualism: A First Approximation 223
Part III
PROBLEMS
19 Male Transsexualism: Uneasiness 247
20 Follow-Up 257
21 Problems in Treatment 272
22 Conclusions: Masculinity in Males 281
References 298
Index 313
Part I
THE HYPOTHESIS
1
BISEXUALITY:
THE ‘BEDROCK’ OF MASCULINITY
AND FEMININITY
(1, p. 7; see also Kris’ remarks, pp. 38-43; letters 52, 63, 75, 113).
From the letters to Fliess until the end of his life, Freud repeated his
conviction that bisexuality was a fundamental element in human
psychology, normal and abnormal,* considering it rather as a fracture line
predisposing humans to disorder. In many papers, sensing the absence of
new data from the biologists†, he simply noted its importance‡ (2-4, 6-14,
16, 18, 20, 21, 23, 24). In these papers, he handles the subject with little
more than a phrase: ‘bisexual constitution’, ‘bisexual disposition’,
‘bisexual organisation’, ‘innate bisexual constitution’, ‘cross inheritance’,
indicating the subject is a given almost to be taken for granted. In-other
works, it is considered in more depth (5, 15, 17, 19, 22, 25, 26-28) and
becomes a central conceptual piece.
His most extensive discussion of bisexuality occurs in Three Essays on
Sexuality, even a reading of only the footnote changes of each edition
gives one a historical view of the focal importance of bisexuality in his
theory-making. Above all, what remained constant was his belief that
biological forces, still poorly understood, underlay behavior.
Since I have become acquainted with the notion of bisexuality I regarded
it as the decisive factor, and without taking bisexuality into account I think it
would scarcely be possible to arrive at an understanding of the sexual
manifestations that are actually to be observed in men and women (5, p. 220).
[However, he adds later:] It is not possible to adopt the view that the form to
be taken by sexual life is unambiguously decided, once and for all, with the
inception of the different components of the sexual constitution. On the
contrary, the determining process continues (5, p. 237) . . . The constitutional
factor must await experiences before it can make itself felt; the accidental
factor must have a constitutional basis in order to come into operation. To
cover the majority of cases we can picture what has been described as a
‘complemental series’, in which the
fruitful concept in the sense that it led to great new insights. (This is
decidedly not to say that it was therefore unimportant to him—or to us.)
In addition, observation of children just does not reveal that ‘both sexes
seem to pass through the early phases of libidinal development in the same
manner. . . . We are now obliged to recognize that the little girl is a little
man’ (26, pp. 117-18). Instead, we all have seen girls already feminine
between 1-2 years (e.g. 34).
The New Physiology of
Masculine and Feminine Behavior
Few new physiological data have been incorporated into analytic writings
since Freud’s death, only agreements or disagreements with or
permutations on theory (e.g. 32, 33, 36-40). Especially in the last decade,
however, controlled experiments on animals and ‘natural experiments’ in
humans have suggested that we shall soon know more about biological
influences on masculinity and femininity.*
(a) Controlled Experiments on Laboratory Animals
Brain physiologists are beginning to find the central mechanisms of
behavior in animals, including those of masculinity and femininity. This, it
seems, is the breakthrough; formerly mysterious forces are found to be
made up of hierarchies from components in the brain, influenced by
hormones, internal and external perceptual inputs, other brain centers,
chains of releasing mechanisms, ‘engrams’ of previous experience, and
new—psychological—experience. Interestingly, it appears that, as with the
anlagen for the sexual organs and their related apparatuses (47)†, the
resting state for the central mechanisms of gender‡ is female. Only if the
fetal brain (hypothalamus) is organized
* The upsurge had its precursors among brain researchers (e.g. 41-43), observers of
bisexual manifestations in natural behavior (e.g. 44, 45, for review), discovery of the
chemical similarities between male and female hormones (e.g. 46), and the
endocrinologists’ knowledge that many male tissues respond to female hormones
(e.g. breasts, skin, hair, fat) and vice versa with female tissue and male hormones.
† And possibly even the chromosomes. Some suggest that the Y chromosome, the
so-called male chromosome, is simply a defective X chromosome, a late mutant in
evolutionary history (48).
‡ ‘Gender’, i.e. masculine and feminine behavior as contrasted with ‘sex’, i.e. male
and female (31).
14 THE TRANSSEXUAL EXPERIMENT
(a) Feminization
i. Chromosomal abnormality: XO (Turner's Syndrome)*
Although these individuals are missing a second chromosome and have
no gonads to produce sex hormones, anatomic development is nonetheless
in the female direction. In addition, such patients grow up feminine in
behavior and heterosexual in object choice (63, 64, 31).
ii. Androgen insensitivity (testicular feminization) syndrome*
With male (XY) chromosomes, the subject nonetheless develops to
adulthood as a normal-appearing female. It is probable that the hormonal
defect is in the target organs (the gonads and extra-gonadal tissues) which,
abnormally, fail to respond to circulating andogens (46). Subjects are
feminine and heterosexual (65).
* These two categories are not as yet highly suggestive. We need more information
before we can decide if the adult femininity in these patients is related to their
unandrogenized brains or simply to their having been raised from birth unequivocally
as girls (see p. 12 above, ‘hermaphroditic identity’).
16 THE TRANSSEXUAL EXPERIMENT
(b) Masculinization
i. Progesterone effects
Otherwise normal human females were masculinized in utero by large
doses of progesterone given to their mothers to prevent spontaneous
abortion. In addition to masculinized genitals (hermaphroditism) these
little girls have developed into tomboys (masculine in behavior but
heterosexual in object choice) more than a control series (68, 69).
ii. Adrenogenital syndrome
Fetal hyperadrenalism causes masculinization of the external genitals in
females. Money, who has always reported these girls to be normally
feminine if properly diagnosed and raised as females (29, 30) now thinks
they are ‘tomboyish’, though heterosexual (69).
These human ‘experiments’ are much less indicative of a biological
bisexuality that can guide behavior than is the animal work. They are
suggestive, but they do not yet refute the evidence that post-natal effects in
humans can quite overturn the biological (except, again, with hypogonadal
males). Similarly, a body of work on genetics has tried to link overt
homosexuality with inherited factors (e.g. 70-72). These studies cannot be
adequately evaluated (38, 73).
I believe Freud was wrong in saying that the etiology of both repudiation
of femininity and the wish for a penis was biological. But his conviction
that there were physiological mechanisms that could influence either
masculine and feminine behavior in the same person (bisexuality) has
support in hundreds of studies of animals, though the necessary studies of
humans are as yet only weakly supportive.
The details of physiology certainly make for more sophisticated
discussion now than in Freud’s time. They also suggest errors by Freud.
His insistence on taking the biological into account, has not, however, been
proven wrong. In the case of bisexuality, we can see that the brain is not
the tabula rasa that some allege it to be. While the newborn presents a
most malleable CNS upon which the environment writes, we cannot say
BISEXUALITY 17
that the CNS is neutral or neuter. Rather, we can say that the effects of
these biological systems, organized prenatally in a masculine or feminine
direction, are almost always* too gentle in humans to withstand the more
powerful forces of environment in human development, the first and most
profound of which is mothering.
Freud recognized the dangers of biologizing and his own propensities
therein: ‘I regard it as a methodological error to seize upon a phylogenetic
explanation before the ontogenetic possibilities have been exhausted.’†
Even Fliess’ excesses, however, could not quite cool his own similar
tendency (as we see in the just-quoted footnote paragraph), probably just
as much a contribution to their friendship early as to their breaking off
later. It is so often around biological words that battles in psychoanalysis
have been fought: e.g. the stages of libidinal development as the origins of
specific neuroses; the death instinct; Lamarckian inheritance; libido versus
a neutral psychic energy.
But each example is only a particular case, as is bisexuality, of one of
Freud’s main philosophic concerns: the relation between the biological and
psychological. A great pitfall, so seductive for many of us, is the premature
linkage of the two.
There not being enough facts yet, one is tempted to bridge the gap with
grand theories or words that concretize concepts into ‘facts’. Freud
recognized this and was constantly struggling against his (repudiated)
enthusiasm to be a philosopher, so as, in Kris’ words, to ‘succeed in
establishing the distance between the physiological and psychological
approaches’ (1, p. 44). Happily, unlike his colleagues-become-enemies, he
never quite succumbed to the seduction of the one grand answer. Always
after the flight, he backed off, expressed his uncertainty, softened his
syntax, and declared the necessary data were still missing. That is why he
contrasts markedly with the pyrotechnicians who have been so attracted to
him.
The last words of the Three Essays on Sexuality, still valid, reveal
Freud’s sense:
The unsatisfactory conclusion, however, that emerges from these
investigations of the disturbances of sexual life is that we know far too little
of the biological processes constituting the essence of sexuality to be able to
construct from our fragmentary information a theory adequate to the
understanding alike of normal and of pathological conditions (5, p. 243).
Chapter I