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
 15

TWO MALE TRANSSEXUALS IN

ONE FAMILY*
Although hundreds of male transsexuals have been reported in the
literature, there are no reports of more than one in a family. Benjamin tells
of hearing of two sets of identical twins but has not seen the subjects and
no data are available (2,3). A newspaper photograph of two half brothers
who had ‘sex-change’ operations appeared a few years ago, but, again, no
data are given to lead to a diagnosis. Furthermore, since the diagnosis of
transsexualism cannot be made simply because one requests, or even
receives, a ‘sex-transformation’ operation, we cannot judge whether these
people are transsexuals. We have now seen such a family in which two
males fit our criteria of transsexualism.
Case Material
The two subjects are biologically normal males,† 19 and 17, of Spanish-
American descent. When the first boy was born, his father was away from
the family in the Armed Service, and, in fact, except for an occasional
visit, was away from the family for four years subsequent to that boy’s
birth and intermittently for years after. The boy’s mother was 24 when the
first was born. An earlier child, a wanted girl, was stillborn.
N, the 19-year-old, is a pretty, well-groomed unmarried fashion design
student. She sought help because ‘I’m supposed to have a sex-change
operation. I feel like a woman inside.’ She recalls around age 6 dressing in
girls’ clothing and ladies’ jewelry, playing girls’ games such as hop-scotch,
jump rope, and house, taking a girl’s part and playing with girls, especially

187

* This chapter was published as a paper by Dr. Baker and myself (1).
† In both, physical examination reveals normally male features, including genitals,
except for the effects (e.g. breasts) produced by exogenous estrogens. Chromosomes
are male: XY. (Again the debt to Dr. Sparkes.)
188 THE TRANSSEXUAL EXPERIMENT

a female cousin of about the same age. Mother did not stop the femininity,
nor did father, who was away most of the time. However, when N was 12
or 13, her mother became concerned about the feminine behavior and so
took the child to a physician, who administered male hormones, hoping to
stimulate masculinity.
Sexual feelings have always been for males. On one occasion, she, as he,
attempted to make love to a girl, but when kissed, could only think of men,
felt repulsed, and was unable to continue. Her sexual fantasies are always
of being made love to as a woman by a man. N has been living with a man,
attracted to N initially under the impression she was a woman, for about
two years. They plan to marry if N obtains a ‘sex-transformation’
operation.
When seen initially, N was alert, oriented, pleasant, and cooperative,
soft-spoken with a delicate, feminine manner; all body movements gave
this impression although she was dressed in man’s clothing. There was no
effeminacy (mimicry). She had dressed for the interview as a male
thinking the doctor would expect this though she wants to dress only in
women’s clothes. (Affect was appropriate, thought content consistent with
the history, intelligence above average, and there was no evidence of
psychosis, psychoneurosis, or organic brain disease.)
When seen a few days later at a clinical conference, N, dressed as a
woman, had on an attractive pants suit. She was carefully and tastefully
made up. The delicacy described above appeared more prominent. She was
poised and charming before the group. She appeared a woman save for the
history.
T, age 17, was asked to see us when N revealed she had a brother who
also felt like a woman and desired ‘sex-transformation’. T says she never
felt like a male. As a little boy, she played house and knitted. She insisted
she could recall incidents as early as age 2 with boys playing with her
‘back’ (anus); penetration did not occur until she was about 8.
When 8 or 9, she says her breasts began to develop; they receded after
she was given male hormones. Every Halloween since the third grade, T
dressed as a girl; her mother never liked this but permitted it. For the past
two years, she has dressed and lived exclusively as a female at home, at
work, and socially, because she was more comfortable in women’s clothes
 TWO MALE TRANSSEXUALS IN ONE FAMILY 189

and to attract men, not for sexual excitement. (She gets no sexual pleasure
from women’s clothes, nor does her brother.) At work, she is known only
as a woman.
When seen at the clinical conference, she was poised, pretty, stylishly
made-up, and dressed in a becoming mini-dress. Like her brother, save for
the history her behavior and appearance were unmistakably womanly. (She
too was without psychosis or other psychiatric symptomatology other than
the gender aberration.)
In order to learn more of their infancy and childhood, their mother was
interviewed:
Mother: I want a girl all the time. Because I like girls better. I like the girls
better because they stay in my house with me and they help me. I wanted a
girl all the time. When I got a boy, I say O.K.; I cannot do anything, but I do
not let her [sic] go out. Just to stay with me. I do not let her go play with
nobody. Stay with me all the time. And I do the same here. [She is referring
now to T, who was present in the interview.] I do not let her go play with no
one. [As the boys grew and were so feminine] I was so scared. You know in
my country they are different; the people talked.
Dr. S: You mean when a boy is like a girl?
T [transsexual son]: Yes. They talk about them, and to avoid an embarrassment
like that she said she would rather keep us in the house. [During the
interview, this son is translating for the mother, who speaks some English,
but not well.]
Dr. S: Before, when N [the other transsexual, not present for the interview] was
very little, before a year old, you kept her with you all the time ?
Mother: Yes.
T: She slept in the bedroom with him. [Father was not there for years.]
Dr. S: Did she sleep in the bed with him?
Mother: No. Sometimes. Only when he cried sometimes.
Dr. S: When N was very little did you carry her around ?
Mother: All the time. When he grow a year or so, I put him down, but all the
time he was crying, and I hold him all the time. All day long.
Dr. S: How long did you keep N around the house? How many years ?
190 THE TRANSSEXUAL EXPERIMENT

Mother: All the time. She left the house last year in September [that is, age 17].
Dr. S: I don’t mean just leaving for good but I mean each day long, staying in
the house—how much when she was 1, 2, 3, 4 years old?
T: Four.
Dr. S: N stayed in the house with her mother all the time, almost all the time,
close to her mother until she was about four ? [Both say ‘Yes’.] Then she was
allowed to go out a little more with the other children? Then after that she
went to school? [‘Yes’.] In those first four years when your mother would go
shopping or go visit friends, that is, when she actually walked out of the
house, did N go with her ?
T: Yes.
Mother: Yes. I hold her hand, and I say, ‘Sit there and do not move.’ I said, ‘You
sit over there’, and I want to watch it all the time. Dr. S: When N was born
what did she look like?
T: Like a little girl. She [mother] thought he was a little girl all the time.
Mother: Look like a girl all the time.
Dr. S: From birth on? [Mother shakes head, ‘Yes’.] Was she pretty? [Mother
shakes head, ‘Yes’.] Did she feed like a girl?
T: Yes.
Dr. S: She looked like a girl from the day she was born ?
Mother: I have the picture; like a girl they looked.
When the two transsexuals were seen together in conference, both
looked like pretty, unremarkably feminine young women. Each was
interviewed for about one-half hour, and all members of the research team
felt N was a bit more feminine, not in looks but in style and subtleties of
response. Perhaps not coincidentally, the two had a slightly different early
childhood appropriate to the difference in feminine appearance. While T
had also looked like a girl in infancy, she did not look quite as much so to
her mother. T also emphasizes she took more pride in getting away from
mother than did N. However, this behaviour did not begin before age 4 or
5, by which time she was already feminine. When she left the house, it was
not to express masculine independence but was simply a rebellion against
mother’s demands for housekeeping and for just staying in the house. In
 TWO MALE TRANSSEXUALS IN ONE FAMILY 191

addition, T, they tell us, was a ‘blue baby’. At any rate, she was a sickly
child in the first few years, and this required constant attention and
closeness from her mother. Whatever the differences in rearing, and the
most obvious one is that mother felt closer to N and fought less with N,
both children were isolated from the world, alone inside the house with
mother for the first years of their life, with no other male present, and,
most essential, without a father there to break this total maternal contact.
At no time did either boy show masculine behavior or interests. This was
the despair of their mother, but she did not know what to do. She did not
know the femininity might be produced by her excessive need to keep
them by her side for years, nor did she know her husband’s absence might
also affect her sons’ gender development. Her only recourse against the
femininity was prayer and futile, sporadic yelling.
Mother: My friends, they told me. You know, I was so embarrassed because—I
don’t like it. I prayed all the time. I say that maybe God help me. Still I’m
praying too.
Dr. S: Do you remember a time you were not feminine ?
T: No.
Dr. S: When did you first put on girls’ clothes ?
T: I was very small I think . . . [consults mother]
Mother: Yeah. He wanted to play with dolls and everything. You know, I
spanked him when he was young.
Dr. S: 3 or 4 ? [They agree.] Playing with dolls like a girl ? Mother: Yeah, with
my niece.
Dr. S: Where did they get the clothes ?
Mother: From my niece [T’s age.]
T: We lived together for two years. I was around 3 years old. We played
together all the time.
Dr. S: She would encourage you to play girls’ games because she lent you her
clothes ?
T: No, I take the clothes away from her (laughs). And I put them on.
Dr. S: When you would buy them gifts for Christmas or birthdays, what would
you get them when they were 2 or 3 years old ? Mother: I liked to buy them
dolls. I like dolls. You know, dressing [dolls] I like. But I buy a little car.
 192 THE TRANSSEXUAL EXPERIMENT

T: Oh yeah. She used to buy us cars. She said she liked dolls. She wanted to buy
us dolls but she bought us cars.
Dr. S: Where did you get the dolls from ?
T: My cousins’s.
Dr. S: When they were little, you would buy them boys’ toys ? Mother: Yes.
Sometimes they would play, but they would play with dolls. They liked to
play with dolls, and I say, ‘No!’
In no other family seen in our program in which there is a very feminine
boy has there been more than one son beautiful at birth; we wonder then if
it is the beauty that sets off the process with parents in whom this potential
exists. In all of those families with more than one son, only one—the
beautiful one—was reported as very close to his mother, and that one
always was the feminine one. This present family, then, conforms to the
hypothesis.
[Note: Another case has been reported since the above was written. It is
compatible with the hypothesis (4).]

Chapter 15
1. Stoller, R. J. and Baker, H. (1973). ‘Two Male Transsexuals in One
Family’. Arch. Sex Behav. 2.
2. Benjamin, H. (1971). ‘Should Surgery be Performed on Transsexuals?’
Am. J. Psychother. 25.
3. — Personal communication.
4. Hove, B. D., Nicolle, F. V., and Calnan, J. S. (1973). ‘Male
Transsexualism: Two Cases in a Single Family.’ Arch. Sex. Behav. 2.