E XT RE ME FE MININIT Y IN B O YS 58

Sex and Gender

VOLUME II
THE TRANSSEXUAL EXPERIMENT

Robert J. Stoller, M.D.

Professor of Psychiatry
DEPARTMENT OF PSYCHIATRY,
SCHOOL OF MEDICINE
UNIVERSITY OF CALIFORNIA AT LOS ANGELES

JASON ARONSON
New York
 CONTENTS

Acknowledgements page vii

Introduction
1
Part I
THE HYPOTHESIS

1. Bisexuality: The ‘Bedrock’ of Masculinity and Femininity 7

2. Extreme Femininity in boys: The Creation of Illusion 19
3. The Transsexual Boy: Mother’s Feminized Phallus 38
4. Parental Influences in Male Transsexualism: Data 56
5. The Bisexual Identity of Transsexuals 74
6. The Oedipal Situation in Male Transsexualism 94
7. The Psychopath Quality in Male Transsexuals 109

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 II
TESTS
 13

TRANSSEXUALISM AND
TRANSVESTISM

In this discussion, ‘transvestism’ will refer only to fetishistic cross-

dressing; by ‘fetishistic’ I mean specifically that women’s clothes produce
an erection. This sharply differentiates the condition from transsexualism,
where fetishistic sexual excitement is never found. Transvestism is a
perversion in the sense that an inanimate substitute, instead of a full human
relationship, is required for maximum sexual gratification. The sexual act
of cross-dressing focuses on the genitals as the most prized and necessary
producer of pleasure; it follows that if a man gets his greatest pleasure
from his penis and spends much of his time preoccupied with methods of
gratifying his sexual needs, then—whatever appearances to the contrary—
he prizes his maleness. This is the case with the transvestite, paradoxical as
it seems, since he enjoys dressing as a woman. He does not consider
himself a female trapped in a male body; he considers himself a male and
wishes to remain so. Even when dressed in women’s clothes, his greatest
pleasure is sensing his penis hidden beneath. These are almost always
masculine-appearing and masculine-behaving men, except when seized by
their sexual impulse, who are in masculine professions, married, attracted
to women’s bodies, and heterosexual in their overt behavior (4-6). Their
cross-dressing is intermittent, not permanent.
The physical appearance of the two separates them for us, usually in a
few moments, but always over a period of time. The transsexual is
feminine; no aspect of demeanor or clothes makes one suspicious. The
transvestite, on the other hand, cannot hide for long his excitement that he
is a man dressed as a woman. He can hardly refrain from announcing his
secret, either overtly or by some garishness of style. The transvestite
enjoys having his penis, searches for sexual experiences in which he will
have orgasms, obtains sexual excitement from women’s

170
 TRANSSEXUALISM AND TRANSVESTISM 171

garments (fetishism) and thus protects himself against failure of sexual

pleasure. He searches for women as sexual objects. He has no more
conscious abhorrence of the female anatomy than is typically found in the
heterosexual.* He is not disgusted that his genitals are male; he regards
them highly and throughout his life has protected his maleness. He cross-
dresses for two reasons: for erection and orgasm, and to feel like a woman.
The need is intermittent. First, following orgasm genital desire is
momentarily satisfied. However,the desire to feel like a woman is also
intermittent. Most of his days he lives as an unremarkable man. Even when
cross-dressed, the transvestite does not wish to be a normal female; he
wishes to be a woman with a penis. To the patient this means a constant
awareness of his male genitals under the women’s clothes, and his sexual
excitement as well as his non-erotic, more quiet pleasure in feeling like a
woman is dependent on a frequently conscious but continuously
preconscious awareness of his maleness. It is from that that his quiet
pleasure and also a sense of pride in his womanliness arises—out of his
male genitals. Constant awareness (and thus reassurance) that he is a male
comes, as in non-transvestic men, from such experiences as erections,
penile sensations with urination, the proprioceptive sensations of pressure
and weight continuously though usually subliminally present in the
genitals, and from the confirmation society gives in recognizing him to be
a man. The transvestite also confirms his maleness more subtly by the
competitiveness he expresses toward women; in his fantasies, he is the best
woman in the world. He surpasses all females, stating that, if given the
opportunity, he would be able to fill that role better than any woman. First,
he believes he could surpass a female because he has had to achieve
womanhood rather than having it granted by nature; second, he has, he
says, the best of both worlds, men’s and women’s; and third, he is not
anatomically defective like a female but has a penis.
Careful observation of transvestites reveals that they wish to

* This is meant to be a thought with pseudo-meaning, in part a gibe at those who in theorizing
talk about ‘the heterosexual’ as if that person had a distinct type of personality. There are in fact,
few if any, mechanisms at work in perverse, non-heterosexual people that cannot be found in
heterosexuals (cf. 2). The range of sexual practices is so heterogeneous in heterosexuals and the
meaning of sexual objects so variable that the term ‘the heterosexual’ is vague almost to the point of
saying nothing.
172 THE TRANSSEXUAL EXPERIMENT

exude their masculinity. Transvestites dressed as women do not quite seem

women, though the most motivated may get away with the masquerade in
casual social situations. In my experience, even those few who, after years
of practice, have been able to pass as women have a sharp quality
(meaning irritation just below the surface) which, when seen in
biologically normal women, is labelled ‘masculine’. In addition, they dress
too exhibitionistically. For instance, they use very strong perfumes,
striking hairdoes, coarsely colored and applied makeup, extremely colorful
clothes, and overdone underwear manufactured to be ‘sexy’ but not the
type worn by a woman who felt comfortable as a woman. This all
challenges the onlooker: calling attention to themselves as women, these
men enhance their excitement by risking discovery. When in women’s
clothes, all transvestites I have studied give away their non-femaleness in
some detail of dress or behavior like those above. Almost pathognomonic
is their style of leg maneuvering while sitting: either their knees at times
gape apart inviting a line of vision to the crotch, or, when legs are crossed,
the skirt somehow finds itself hiked up to the buttocks, revealing (amidst
coy shuffling) a blizzard of frilly underwear and great plains of thigh. The
focus is still on the hidden penis. When, on taking these risks, they are
nonetheless accepted by the world as being women, the relief of anxiety
and the pleasure in mastery frequently lead to erections.
In brief, although the transvestite has powerful feminine identifications,
which are manifested in such activities as cross-dressing, he also has
powerful masculine identifications: a sense of maleness and pleasure
emanating from that maleness.
The overt manifestations of transvestism usually begin at puberty or
soon after, when the young man is for the first time sexually excited by
putting on women’s clothes. (Infrequently, the initial episode occurs in
childhood or well into adult life.) Usually a single type of garment, such as
shoes or underwear, is used at first for excitement. In one group of
transvestites, the single garment remains the technique of choice in
promoting the masturbation that follows; in others, the cross-dressing
desire gradually spreads, so that eventually the greatest excitement is
produced by dressing completely as a woman. The latter group of men
may also enjoy passing for hours as women
 TRANSSEXUALISM AND TRANSVESTISM 173

in open society. Those who enjoy transient passing usually have

accompanying transsexual fantasies, occasional thoughts of what it would
be like to have a female body. But the duration, depth, and extent of these
fantasies are not comparable to those of transsexuals, nor is there the
demand to become a female no matter what the risks.
How does this contrast with the transsexual ? The latter does not wish to
be male. Like the transvestite in not denying that her body is male, she
would do anything to make it cease being that; when sex transformation
partially gratifies this need, the patient typically loses neurotic symptoms
of anxiety and depression, becoming better adjusted (1, 3). Disgusted by
their genitals, transsexuals masturbate rarely and indulge less in sexual
relations with others. Many report having only a few erections and
orgasms a year (even before using estrogens). While finding their own
genitals freakish (describing their feelings as a normal female might,
should she awake one morning with male genitals affixed to her
perineum), they find male genitals most appealing on others. They do not
become sexually excited by women’s bodies and do not report fantasies or
dreams of sexual relations with women. I have never heard one report a
dream in which she had either male or bisexual genitals. They dream of
themselves as women and females. (That they do not report dreams of
maleness does not, of course, guarantee they do not have them, for it
would serve them, in order to appear in all ways like women, to deny that
the genitals appear even in their sleep.) Transvestites, however, remain
male (sex) in their dreams, though they may dream of themselves as a
woman (gender).
The transsexual does not voluntarily live intermittently as a man and as a
woman. Given the opportunity, she lives exclusively as a woman and has
no difficulty passing as a woman. Adolescent transsexuals pass on their
first try. In contrast, transvestites dress for years in secret before they feel
their appearance is womanly enough for them not be arrested in the street.
And they are right; the desire to. reveal triumphantly their secret penis is
so strong that they really are at risk. But transsexuals do not need to reveal
their maleness (their phallus) as part of the excitement of cross-dressing.
They are not sexually excited by women’s garments. They do not mimic
women.
174 THE TRANSSEXUAL EXPERIMENT

While they envy women, they are not competitive with them. Transsexuals
never state that they can be a better woman than any other woman—they
would be happy just to be ordinary females, no more or less than the
women they have known.
If a transsexual’s life depended on it, she could not successfully imitate a
masculine man. All report that during their teens, when there were
powerful forces put on them to act more like a man, they could not do so,
and as a result their lives become desperate because of the humiliations
they must sustain for being too feminine. On the other hand, transvestites
have no difficulty in being masculine, not only when the situation requires,
but at other times when they spontaneously wish to feel their own
masculinity.
When transvestites report on their daydreaming, one senses an effort to
play the part of being women; their daydreams are busy, complicated
stories, dazzling and often sexually exciting for them. The daydreams of
transsexuals are usually quiet and undramatic, in which are portrayed the
ordinary tasks of and clichés of ‘old-fashioned femininity’.
The clues to etiology in transvestism are less clear than those in male
transsexualism. Perhaps this is because no adequate studies have yet been
done of the parents of transvestites. A psychiatrist sometimes encounters
transsexuals when still children and can study their infancy through the
eyes of their parents, but these opportunities are not available with
transvestites, who are seen in late adolescence or adulthood. So we have
only an impressionistic picture of etiology.
Some theorize that fetishistic cross-dressing is biologically induced, but
again there is no direct evidence, just the conviction that such conditions
must be biologically produced because they are so fixed and difficult to
treat.
Transvestites do not give a history of the close, symbiotic mother-son
relationship, nor do the few mothers of transvestites so far studied. They
do not give a history of very early femininity but on the contrary tell of
(and photographs in family albums illustrate) a period of several years of
masculine development. Then, typically, comes the story that a female
dresses this masculine little boy in women’s clothes. This experience,
forced on an already masculine boy who can sense the humiliation aimed
at him, is not sexually exciting. But in
 TRANSSEXUALISM AND TRANSVESTISM 175

time—and here I am theorizing without data—the original traumatic

experience seems to be converted into a triumph, so that what was
originally humiliating becomes sexually exciting, a success. This theory
could account for the fact that transvestites are masculine and wish to
preserve their penis, not destroy it and be converted into females.
Father’s role is less clear than in transsexualism, and the published
descriptions of fathers and those fathers whom we have seen do not add up
to a class of men with similar features. While some are distant and passive
others are noisy, angry, cruel, disciplinarians. So far I have not heard of a
loving, respected father.
Let us take up again the subject of perversion. There are two kinds of
sexual aberrations, those that are the product of trauma, conflict, and
resolution of the conflict—these I would call perversions—and those
aberrations in which the attempt to rid oneself of conflict plays no part;
these I would call variants. Although a sexual aberration, transsexualism is
not a perversion, for it is not the product of an everlasting process of
conflict and resolution. To create a perversion, one has to suffer an inner
conflict; that is, powerful demands are in opposition inside oneself (2):
transvestism is a perversion.
That this theory is correct is suggested in the pornography of
transvestites, a kind of statistical test for a psychodynamic hypothesis (6).
In this literature, one theme is forever repeated: Part I—a masculine man is
forced to put on women’s clothes by beautiful, feminine, emotionally but
not physically powerful women; that really happened in the transvestite’s
past. Part II—all ends happily, for the women become unthreatening and
love the man so long as he, along with his penis, joins them in women’s
clothes and feminine interests; that happens only with the perversion.
Pornography is the manifest content of perversion. Perversion is a
preferred, habitual form of erotic ritual in which one acts out a fantasy,
wherein one undoes the traumatic sexual victimizations of childhood.
Now, with the perversion, the victim is triumphant and the original
victimizer has been forced to become victim.* (Such a definition does not
rely on which
* In rape, sado-masochism, transvestism, exhibitionism, voyeurism,
necrophilia, fetishism, etc.—all the perversions in males—the ejaculator is overtly the
attacker, the ‘ejaculatee’ the victim.
176 THE TRANSSEXUAL EXPERIMENT

anatomical parts are used or desired, nor the vagaries of societies’ customs,
nor whether the practice is common to a majority or minority, but rather on
the meaning—conscious and unconscious—of the sexual act for the actor,
that is, on the dynamics of hostility. That is why I call transsexualism a
variant and transvestism a perversion.
A psychodynamic area into which I cannot venture now (it will be taken
up in a subsequent work on perversion) surfaces when we consider the
emotionally powerful women, more powerful than even the fully
masculine hero portrayed in transvestite pornography. That is the concept
of the phallic woman. Certainly, the transvestite in women’s clothes is the
absolute proof of the existence of a phallic woman; he is attempting to
appear like a woman but he has the superior attribute of a penis beneath
the clothes. Even stranger, despite his knowledge of the structure of female
genitals,* he believes females also can be phallic women; for the women
drawn in the illustrations have visibly phallic attributes: dark and
dangerous beauty, whips between their legs, breasts like bombs, capacity
to capture and subdue the portrayed hero.
Perversion originates from various sorts of hostility. The first is that
someone acted threateningly to the child. A second is one’s threats against
oneself, i.e. the conscious sense of guilt and the more complicated
interplay of unconscious guilt, which lead to many of the details of the
ritual that is the perverse act. But at least as important is a third form of
hostility: that which the perverse act directs out upon others. The
perversion, I believe, enacts a revenge in which is represented the person
who originally inflicted trauma, with this person, in the perverse act, now
overcome. The victim has become the victor, and the attacker of childhood
the defeated. In transvestism, the victim is the little boy who was
humiliated with the threat of loss of masculinity; the victor is the now-
grown man who so emphatically affirms his maleness just at the point at
which he would be repeating the original trauma. When in women’s
clothes and with an erection he can achieve over the villainous women the
ultimate triumph of maleness: his penis’s orgasm. The women

* See Freud’s discussion of splitting in fetishism (7, 8).

 TRANSSEXUALISM AND TRANSVESTISM 177

have been vanquished, and the little boy, by a roundabout route that
recapitulates the details of the childhood trauma, has preserved his
maleness and his sexual capacity (6).
(For fuller, more psychodynamic discussions of perversion, especially
the mechanisms at work in homosexuality and transvestism, the reader
should turn to other workers such as Freud, Fenichel, Khan, Bak, and
McDougall.)
I have referred to transvestism and especially transsexualism as having
clear-cut clinical pictures and antecedent etiologies— a presentation that
must now be explained and softened with some uncertainty. I minimized
the fact that other feminine males and masculine females, considered
transsexuals by many, neither fit my clinical definition nor present all the
above etiological factors. In other words, the description attempts a clarity
that does not attend to cases with mixed features of transsexualism and
transvestism or effeminate homosexuality.
However, this has not been so much inaccurate as incomplete. The full
clinical picture does exist in a number of subjects, and when it does most if
not all of the etiological features are present. And the more the clinical
picture is obscured by opposite-gender manifestations (for example, a
feminine male who nonetheless has had a period of fetishistic cross-
dressing and who was married as a man for some years), the less of the
etiological features are present (5). My position, therefore, is that as one
changes the etiological factors, one changes the clinical picture. I would
underline the proposition that the male who gets sexually excited by
women’s clothes has had a period of masculinity in childhood.
There is a group of men, seen these days by our research team in much
greater numbers than we see transsexuals, who also appear quite feminine.
They all want their bodies feminized, though not all want female genitals.
All other researchers call them transsexuals. I do not, though at a quick
glance they certainly seem to be. To me they are not, for the following
reasons:
(1) History. They have not been feminine since birth but had periods of
masculinity in childhood; have the capacity to create perversions (usually
fetishism, most often transvestism); have made love to women and usually
have married; have
178 THE TRANSSEXUAL EXPERIMENT

worked in masculine professions; have appeared to the world, hidden

feminine tendencies notwithstanding, to be masculine for years on end;
and have decided to pass and then learn to pass as women only after years
of rehearsal. Perhaps a quarter to a third of those I have known have had
psychotic episodes (a very rare occurrence in those I have known whom I
would call transsexuals).
(2) Appearance. Depending on how long they have been about the work
of‘self-realization’—the creation or uncovering of their so-called feminine
self—they more or less openly show male and masculine traits. Some will
not disguise their beards; some dress with dangerous disregard for their
bizarre appearance; some move like football players; some do not bother
to manage the smaller gestures, like the business (in the theater sense) for
cigarettes, hand-shaking, nose-blowing, sitting, or hair-patting. Those who
are adept fall into masculine ways as they sink deeper into a real
relationship with the interviewer-therapist.
(3) Etiology. None reports the family constellation I have found in
transsexualism, and when I have been able to interview parents, none has
reported the parental influences of transsexualism, and none of the mothers
has been like the transsexuals’ mothers.
We are seeing increasing numbers of such people. Twenty years ago they
were unknown. From where have they come? From us, of course: from
those who have written about transsexualism. This group of subjects has
been freed by publicity and by the public’s milder attitude toward cross-
gender behavior. They dare to cross-dress and even to pass; the laws, the
police, and the courts tend to deal more benignly with them. They form
organizations; they assist researchers; they guide opinions. Guilt and fear
have been checked.
Such men are another test for the transsexual hypothesis, which in their
contrast they confirm.
Let us look briefly at such a man.
Beginning in adolescence with erotic experiences precipitated only by
women’s garments, the cross-dressing behaviour spread out as the years passed,
so that, by now, in middle age, fetishistic excitement is no longer its exclusive
aspect. While he still enjoys his sexual excitement with women’s clothes, he has
now so managed
 TRANSSEXUALISM AND TRANSVESTISM 179

his life that he lives all the time as a woman.* In the last few years, he has rid
himself of his profession as a man, has gotten rid of almost all his men’s
clothes, has had all his facial hair removed, has let his hair grow so long that he
no longer needs a wig but can set it in a woman’s fashion, passes as a woman,
and has been taking estrogens in order to get some breast growth and softening
of body build. He thinks of himself as a woman, goes into the world accepted as
a woman and supports himself as a woman. But he still loves his penis and its
erections. He does not want a ‘sex change’ operation.
Over many years of experimentation and learning, this man has laboriously
worked on creating a feminine identity (one does not see such labor in the
transsexual). This process makes use of conscious imitation, mimicry (with its
hostility), acting, as well as non-conscious techniques akin to those used by
imposters and those actors who can only play themselves.
How does he differ from a transsexual ?
(1) He enjoys his penis. He is careful to take enough estrogen to give him
some breast fullness but not enough to kill his erectile capacity. He does not
want to lose his sexual excitement induced by women’s garments.
(2) Although he no longer lives as a man whose life is interrupted by cross-
dressing, masculine qualities persist. When necessary, he can effortlessly be
masculine on the telephone and even publicly (though the long hair is an
inconvenience). He still has, and himself senses, traits that he considered
masculine when he lived as a man. He prides himself on his intellectual
competitiveness, his skill in argument, his ‘clear-stated rather than fuzzy-
minded’ thinking; and if he considers himself to be a better woman than any
woman, it is because he carries inside of himself, he feels, an understanding of
men that makes him able to be more charming as a woman with men than
biologically normal women can be.

* We find this as a typical progress. I wonder if in part it results from the lowering
of androgen levels with age. With their penis less thrust in awareness by male
hormones, the balance between fetishism and femininity shifts to the latter. It may be
that this outcome is not rare but what would often happen if there were no dangers in
society for transvestites. Perhaps the clinical picture we see now is a forme fruste, an
artifact, and that the femininity becomes a more successful piece of character
structure as the years pass and the transvestite tires of the conflict between his
masculinity and his femininity. Since also he is repeatedly rewarded when cross-
dressing, both by the sense of calmness that he begins to get in later years and by the
intense erotic gratification that has accompanied the act, the balance will tip for some
toward living more exclusively in women’s clothes if that is less dangerous.
180 THE TRANSSEXUAL EXPERIMENT

(3) And their bodies are still sexually exciting.

(4) He has occasionally imagined himself having undergone ‘sex
transformation’ surgery and having a vagina and estrogen-created breasts. He
not only looks on this as fakery, but having ‘tried on’ such changes in fantasy,
he does not wish to submit himself to these ‘mutilations’.
(5) He does not consider his body to be female; he does not believe himself
to be a genetic trick of fate; he does not believe that his body can be
legitimately transformed; neither in his conscious fantasies nor in his dreams
does he sense himself as a female psyche trapped in a male body.
(6) No day passes without ‘the trick’. This is an enactment, always different
but always the same. He fools people. They think he is a female, but he reveals
he is a male. At first such behaviour was truly dangerous—and very thrilling;
now it gives a lesser sense of danger, for he knows he will not be arrested when
he reveals himself, and in fact those to whom he does so are usually fascinated
and relieved not to feel like attacking him. But it is still fun—and still
necessary: the penis beneath the women’s clothing must somehow, indirectly,
be revealed.
The thesis in fetishistic cross-dressing is that the adult perversion is the
result of childhood trauma, often the humiliating of a masculine boy by
dressing him as a girl. This history is found frequently but not invariably.
The challenge is to determine how often it occurs in the childhood of
transvestites. Here arises a troubling problem, the question of validity of
childhood memories: Did what is remembered happen, and did what is not
remembered not happen ? Some patients have given a negative history of
being cross-dressed in childhood and then have returned later with family
photographs showing that they had indeed been cross-dressed, or have
questioned their families and been told that others recall having seen them
cross-dressed. In both cases the subject has no memory of the experience.
At any rate, this history is often given by transvestites, but interestingly not
by transsexuals.
Transvestism has been used in this chapter as one more test for the
hypothesis about the etiology of male transsexualism. It is a good test, for
the two conditions are similar enough that everyone used to consider them
the same. My insistence that it is worth separating them clinically is
confirmed when one finds that the transsexual etiology is not found in
those men
 TRANSSEXUALISM AND TRANSVESTISM 181

who get sexually excited by women’s clothes and that the transvestite, in
all his variant forms, has, unlike the transsexual, both a history of
masculinity starting in childhood and evidences of that masculinity in his
present life.

Chapter 13
1. Benjamin, H. (1966). The Transsexual Phenomenon. New York: Julian
Press.
2. Freud, S. (1905). Three Essays on the Theory of Sexuality. S.E. 7.
3. Green, R. and Money, J. (eds.) (1969). Transsexualism and Sex
Reassignment. Baltimore: The Johns Hopkins Press.
4. Prince, C. V. (1965). ‘Survey of 390 Cases of Transvestism’. Read at
Western Divisional Meeting APA, Honolulu.
5. Stoller, R. J. (1968). Sex and Gender. New York: Science House;
London: Hogarth Press.
6. — (1970). ‘Pornography and Perversion’. Arch. Gen. Psychiat. 22.
7. Freud, S. (1927). ‘Fetishism’. S.E. 21.
8. — (1938). ‘Splitting of the Ego in the Process of Defence’. S.E. 23.