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Posts tagged ‘gender identity disorder’

Confusion around changing sexual orientation for trans people

I’ve been working on an article (hence the lack of posts lately) and midway through I went on a little tangent (OK, it was a rant) about this issue of confusion around changing sexual orientation for trans people, so I thought I would excerpt it here:

There is a commonly heard idea in the transgender literature and community asserting that the transgender individual will sometimes change sexual orientation after transitioning.  I have found that many patients come in with this belief.  Arlene Istar Lev (2004), a family therapist, clinical social worker and gender expert notes that “gender transition can have a tremendous impact on sexual orientation, sometimes affecting one’s sexual interests…” and in the next paragraph “Sexual orientation is not malleable and cannot be changed through force or will” (p. 301).  There seems to be a good deal of confusion and disagreement on the topic in the transgender community.

Putting aside for a moment the fact that transitioning is a long process with no particular end point (where a change in sexual orientation could be assessed) and can often mean different things to different people and that most transsexuals do not have surgeries; perhaps what is really happening in these cases is that individuals are choosing partners more for the complex array of factors that help the individual feel confirmed in their authentically felt gender rather than for their desirability based on their maleness or femaleness.

Just thinking about this logically for a minute one sees that claims of so called “reparative therapies” on non-trans homosexuals have been thoroughly debunked over the past few decades (for summaries see Haldeman, 1994; Drescher, 1998  and Bright 2004).  What bit of alchemy would then achieve this momentous transformation on the transsexual?  Hormone replacement therapy?  By this same logic, scores of menopausal lesbians taking feminizing hormones would have suddenly switched to becoming attracted to men.

A 1998 research paper titled “Changes in the Sexual Orientation of Six Heterosexual Male-to-Female Transsexuals” by Christopher Daskalos of the Department of Sociology, Arizona State University asserts that

“These respondents stated that before transitioning they had been sexually orientated towards females. After transitioning, these same respondents reported that they were sexually orientated towards males. Five of the six respondents reported having various sexual encounters with males since transitioning. The respondents explained the changes in their sexual orientation as part of their emerging female gender identities. Three of the respondents claimed that the use of female hormones played a role in changing their sexual orientation” (from the abstract p. 605).”

 

The paper was challenged in the same journal in a letter to the editor by Anne A. Lawrence (an arguably controversial figure in her own right due to her advocating the concept of  ‘autogynephilia’) who noted that “Daskalos purports to document dramatic changes in the sexual orientation of six of his transsexual informants – changes that seem to have occurred almost effortlessly.  However, a careful reading of Daskalos’ paper reveals that he has demonstrated no such thing” (p. 581). Her reasons include that sexual behavior is not the same as sexual orientation, that (a somewhat dated idea) “Sometimes such self-reports may be conscious deceptions, designed to increase the likelihood that the transsexual will qualify for sex reassignment surgery” and that “In other cases, such self-reports by transsexuals may reflect the autogynephilic fantasy of sex with a male partner” (p. 581).

However none of these refutations shed light on the reasons behind changes in behavior.  I believe Dozier’s (2005) comments from her cohort of 18 trans men to be most in keeping with what I have seen with trans people in my practice:

Respondents also challenge traditional notions of sexual orientation by focusing less on the sex of the partner and more on the gender organization of the relationship. The relationship’s ability to validate the interviewee’s masculinity or maleness often takes precedence over the sex of the partner, helping to explain changing sexual orientation as female-to-male transsexual and transgendered people transition into men (2005, p. 297).”

I’m interested in hearing your thoughts.

References:

Bright, C. (2004). Deconstructing Reparative Therapy: An Examination of the Processes Invovled When Attempting to Change Sexual Orientation. In Clinical Social Work Journal, Vol. 32, No. 4, Winter 2004 (_ 2004)

Daskalos, C. (1998).  Changes in the Sexual Orientation of Six Heterosexual Male-to-Female Transsexuals. Archives of Sexual Behavior, Vol. 27, No. 6, 1998

Dozier, R. (2005) Beards, Breasts, and Bodies: Doing Sex in a Gendered World. In Gender & Society, Vol. 19 No. 3, June 2005. 297-316

Drescher, J. (1998).  I’m Your Handyman: A History of Reparative Therapies in Journal of Homosexuality,Vol. 36(1) 1998

Haldeman, D.C.  (1994) The Practice and Ethics of Sexual Orientation Conversion Therapy. In Journal of Consulting and Clinical Psychology, Vol. 62, No. 2, 221-227

Lawrence, A. (1999) Letter to the Editor. Archives of Sexual Behavior, Vol. 28, No. 6, 1999

Lev, A. (2004). Transgender Emergence. Binghamton, NY: HaworthPress.


Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.


WPATH Releases De-Psychopathologisation Statement on Gender Variance

This is the statement from WPATH:

“FOR IMMEDIATE RELEASE

May 26, 2010

The World Professional Association for Transgender Health has prepared and released a statement urging the de-psychopathologisation of gender variance worldwide.  The statement can be found on the WPATH website www.wpath.org and is as follows:

The WPATH Board of Directors strongly urges the de-psychopathologisation of gender variance worldwide.  The expression of gender characteristics, including identities, that are not stereotypically associated with one’s assigned sex at birth is a common and culturally-diverse human phenomenon which should not be judged as inherently pathological or negative.  The psychopathologlisation of gender characteristics and identities reinforces or can prompt stigma, making prejudice and discrimination more likely, rendering transgender and transsexual people more vulnerable to social and legal marginalisation and exclusion, and increasing risks to mental and physical well-being.  WPATH urges governmental and medical professional organizations to review their policies and practices to eliminate stigma toward gender-variant people.”

Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.


The Prevalence of Transgenderism

Someone asked me recently “what is the prevalence of transgenderism”, so I thought I’d take a stab at finding out.

An article on questions of prevalence and epidemiology of GID appears in the International Journal of Transgenderism in its special issue: “Toward Version 7 of the World Professional Association for Transgender Health’s Standards of Care” (Volume 11, number 1, 2009).  The article was written by Kenneth Zucker and Anne Lawrence, and was summarized by Eli Coleman in his introduction to the special issue:

Formal epidemiological studies on gender identity disorder in children, adolescents, and adults are still lacking and no strong conclusion about its prevalence or incidence can be drawn. The current prevalence estimates that are cited in the DSM-IV and the WPATH SOC(1) are based upon data over 20 years old.  They [Zucker and Lawrence] note, however, that between the 1960’s and 1990’s, there appears to be at least a threefold increase (and as high as eightfold increase) in patients presenting to clinics in Western Europe.  This could be due to increased awareness and seeking of transgender services.  There is also the problem of whom to count.  Individuals who undergo surgical sex reassignment are only an extreme end-point of a continuum of cross-gender identification. We are more and more aware of the myriad of individuals who identify as transgender or gender queer and who represent individuals along the broad spectrum of cross-gender identification.”(p. 5)

This is from the Zucker, Lawrence article itself:

“As is the case with children and adolescents, there are also no formal epidemiological studies on GID in adults. The most common indirect method that has been used to gauge the prevalence of GID in adults has been to rely on the number of persons who attend specialty hospital and university-based clinics serving as gateways for surgical and hormonal sex reassignment.”  (p. 13)

They then present a table of data from 25 such clinics and try and estimate prevalence.   I’m listing 7 lines from their table (of 25) where the period reported falls somewhere between the year 1990 and the present and where prevalence estimates where made:

Author Period Reported Country Incusion Criteria N MtF :  FtM Prevalence
Weitze & Osburg (1996) 1981-1990 Germany Granted legal change of name or gender status 1047 2.3  :1 MtF:1 : 42,000 FtM:1 : 104,000
De Cuypere et al. (2007) 1985-2003 Belgium Completed sex reassignment surgery 412 2.4  :1 MtF:1  : 12,900 FtM:1  : 33,800
Bakker, van Kesteren, Gooren, & Bezemer (1993) 1986-1990 Netherlands Receiving hormone therapy 713 2.5  :1 MtF:1 : 11,900 FtM:1 : 30,400
Gomez Gil et al. (2006) 1996-2004 Spain Diagnosis of Transsexualsism 161 2.6  :1 MtF:  1 : 21,000 FtM:  1:  48,100
Wilson, Sharp, & Carr (1999) circa 1998 Scotland Gender Dysphoria 273 4  :  1 MtF:1  :  7,400 FtM:1  :  31,200
Wilson, Sharp, & Carr (1999) circa 1998 Scotland Receiving Hormone therapy or post-surgery 160 3.8  :1 MtF:1  :  12,800 FtM:1  :  52,100

To summarize

  • There are some estimates based on indirect methods and counting those seeking treatment specifically some form of surgery & we know that this is a small percentage of overall people with gender variance.
  • no direct studies on prevalence of GID have been done
  • doing an accurate count is complicated by the fact that those counted are those who are “out” as being transgender and seeking some form of treatment, and also those who have transitioned may not wish to be counted.

Also – this is a subject very much on the minds of researches in the field now (its been a lively topic of conversation on the WPATH email list for several months).

(1)    – prevalence cited in DSM-IV:  “Data from smaller countries in Europe with access to total population statistics and referrals suggest that roughly 1 per 30,000 adult males and 1 per  100,000 adult females seek sex-reassignment surgery.” (p. 535).  This data was probably drawn from Hoenig and Kenna (1974) “The prevalence of transsexualism in England and Wales, British Journal of Psychiatry, 124, 181-190.  And we know that only a fraction of transgendered individuals actually seek sexual reassignment surgery.”
 

an update to this post can be found here
Find out about Psychotherapy when dealing with Gender variance in yourself or someone close to you.

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