For most persons the typical everyday life situations of growing up provide ample test of their sexual selves. Masculinity or femininity is measured by comparing oneself with societal images provided by family, peers, media, educational and religious institutions, and other social forces. These external measures provide one with a gender identity. A gender identity is how one sees him- or herself relative to society’s expectations. To be emphasized is that gender is related to society, and many aspects of it differ from one culture to another.1

Also, for most individuals the private, internal, personal view and feeling he or she has of himself or herself, “I am a male” or “I am a female,” his or her sexual identity, is—more or less—the same as society’s gender identity. Typical XY-chromosome individuals see themselves as males and are seen as such by the surrounding society. Similarly XX individuals see themselves as females and are seen as such. But, sexual identity as a private phenomenon may be in direct conflict with gender identity. One can recognize society’s gender attribution and not see it apply personally; individuals seem to come to “know” if they are male or female by a different process. The usual processes of social reinforcement as associated with sex-typing (e.g., Huston 1983) do not appear to hold. Were it simply by accepting familial, societal, and cultural dictates, the phenomenon of transsexuality would not exist. Almost without exception, males are reared as boys and females are reared as girls, but for transsexuals this is a cruel hoax.

In considering gender identity a scale of options is available. One might consider him- or herself an appropriate or inappropriate representative of the culture’s boys or girls, e.g., a sissy or tomboy. This is true regardless if the individual considers himself or herself socially appropriate as an adequate male or female, or if questions remain: “Am I masculine enough? or “Am I feminine enough?” or even if he or she makes the decision “I am not a good male or female.” This last set of statements reflects on the individual’s gender patterns2 of behavior. Patterns of behavior are basically culturally appropriate sex-linked activities: the stereotypical playing with frilly dolls or playing house versus playing with toy soldiers, guns, or trucks (Diamond 1977, 1979, 1980, 1992). With an individual’s male and female gender patterns a whole range of maleness and femaleness is on offer. For sexual identity, however, there are only two possible, mutually exclusive, choices: male or female (Diamond 1979).3

With most people, sexual and gender identity are sufficiently concordant to satisfy ego needs and overcome any doubt as to one’s own sex and appropriate role in society. In certain cases, however, internal and external cues are not in concert or are only partially so; sex and gender are not congruent. In these uncommon cases, one’s internal sexual identity signals one sex while society signals the other. Suffice it to say that intense feelings of conflict and discomfort develop from this dichotomy. This is the case with the transsexual (TS) individual.4 How this identity supposedly comes about is debated (for reviews see, e.g., Bolin 1987; Bullough and Bullough 1993; Diamond 1965, 1993, 1995; Docter 1988; Green and Money 1969; Stoller 1969).5

Early in life, the transsexual becomes aware that society is reacting to her or him in a manner felt as inappropriate. In some subtle way transsexuals come to realize they would be more comfortable treated as are their opposite-sexed siblings or peers. The developing TS (male or female transsexual) realizes he or she is being treated not in accordance with internal feelings but rather in accordance with external anatomy; the presence of a penis and scrotum or vulva and vagina. This is usually signaled during childhood by the dependent wearing clothing that is offered by parents but is not in keeping with the sex in which the transsexual feels at peace, and by parental expectations of behaviors in accordance with the birth gender even though the child feels more appropriately associated with expectations of the opposite gender. With experience, the longing for mental calm and comfort drives the transsexual to the conviction that only by living not as reared, but as a male or female according to her or his inner dictates, only by living the “core” identity (Stoller 1968), will inner peace be obtained.

This disparity between the personal view of self (identity) and society’s view (gender) are quite unsettling. The transsexual wishes his or her external body would match the internal psychic feelings. Basically, and eventually, the transsexual says to the world: “To rectify things, my body must change, not my mind.”

The path to one’s realization that he or she is a transsexual is variable. Most transsexual individuals, at first, seem to just have an amorphous feeling of being different quite early in life. Then slowly they know they are different from others in how they view themselves. Transsexual males (MtF = male to female) brought up as boys and transsexual females (FtM = female to male) reared as girls see this as a cruel mistake of fate (Blanchard and Steiner 1990; Zucker 1990; Zucker, Bradley, and Sullivan 1992). In their own minds there is no doubt they are of the opposite sex and should be reared accordingly. They become convinced so by everyday life events that they feel do not resonate well with their own image of who they are. They want to live life transformed so their anatomy fits their conviction and mental image of self. The TS then eventually presents to a physician or other professional with the urge to have sex reassignment surgery (SRS). When doing so, such individuals recount lives in which they had manifested or recognized a disposition toward cross-gender lifestyle events and behaviors. Their day-to-day social life, an experiential living-test as it was, told them their internal signals were not synchronized with the external ones and their internal signals won out. They typically recount many incidents where sex-of-birth appropriate behaviors were felt to be or were actually impossible or difficult to manage (e.g., Bolin 1987; Green and Money 1969; Wålinder 1967). And, quite often, these feelings have existed from preschool days.

Benjamin’s (1966) original definition of transsexualism was relatively clear: “True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such” (13, emphasis in original). Since then, however, a second part has often been added. For example Ziegler in 1994 follows the practice started at least twenty years earlier (e.g., Fisk 1975; Mehl 1975) in offering a multipart definition of a transsexual. The first part is the same as offered by Benjamin. In the second part, Fisk, Mehl, and Ziegler add, in effect: the transsexual persistently engages in behaviors attempting to live as the other sex. Examples would be the male TS who cannot and would not bear to wear boy’s or men’s clothing and instead wears female garb and is a failure at sports or won’t even attempt them. The typical female TS insists on binding her breasts, dressing as a man, and engaging in masculine pursuits. These persons are often seen by themselves and others as “failures” in their birth sex. Most often these behaviors arouse the ire of parents and siblings; hardly ever is this behavior reinforced for long. Stoller essentially defined a (male) transsexual as an XY individual who is fully identified with the female role, has as many feminine mannerisms, interests, and fantasies as a little girl his age, and openly expresses wishes to have his body turn into a female’s (1968, 92).

This current paper, however, describes a phenomenon that more than a few transsexuals undergo in the process of trying to reconcile their disparity of sexual and gender identities. These are the behaviors of persons who, for an extended duration, overindulge in, rather than shun, behaviors typical of their assigned sex. I label this a process, a process of self-testing.

Self-testing is significantly challenging oneself to personally measure “Am I male or female?” The challenge may consist of a particularly crucial set of incidents or events or years of experiences. It has two interdependent components. The first component is the situation. It is subjecting oneself, consciously or unconsciously, to situations or processes personally dramatic or significant enough for them to take on the status of a sex/gender marker. The second component of the “self-test” is the analysis. For the male-to-female transsexual it is saying, to put it simplistically, something like: “Although all my male peers enjoy playing with guns, I don’t. I tried it for a year or so and, although I am good at it and can outdraw my buddies and shoot more accurately, I would rather crochet. This proves to me I am truly a female.” A nontranssexual male in the same circumstance, in contrast, might say to himself: “Although all my male peers enjoy playing with guns, I don’t. … I would rather crochet. This proves to me I am not a typical or good male.” Or, “Although all my male peers enjoy playing with guns, I don’t. … I would rather crochet. This proves to me I am probably different.” Later on, with greater age and experience this last individual might come to say “Perhaps I’m gay.” Most individuals, never having heard of transsexualism, will not know how to identify such feelings at all. Transsexuals often think themselves unique in all the world. As they go over the possibility of being gay, that too doesn’t seem to satisfy them exactly and, in fact, could repel them. For someone very young, it might be easier to contemplate, along with fictional beliefs of Santa Claus and the Tooth Fairy, growing up into the other sex or saying, without full understanding, “I am really a boy/girl [opposite sex noun].”

Self-testing calls to question the concept that an adequate self-esteem system only develops when life situations are positive vis-à-vis a developing and wanted ego (Epstein 1973). As Docter wrote: “if [for example] a male predicts, for whatever reason, that he will be likely to fail in roles requiring masculine-gender competencies and skills—then either the formation of that subsystem would be weakened (or stopped), or a feminine gender identity will develop, thereby facilitating pleasure and self-esteem” (1988, 81-82). Negative reinforcement to one’s identity will supposedly lead to transsexual ideation. Feinbloom writes: “One can see transsexualism as a career gone sour. That is, one can examine the lives of transsexuals, both preoperative and postoperative, in terms of previous failure to … [resolve] issues in a life that have made one’s particular life pattern untenable. It is not stretching the definition of career to say that transsexualism itself is a career constructed on the ruins of one that has failed” (1976, 149-50, emphasis in original). Put in other terms: getting reinforced as a male (or female) will supposedly establish and fix one’s identity as a male (or female); not getting reinforced adequately will thwart proper development of suitable sexual identity.

Concomitant with this, when conflict or doubt as to which true sex exists, the individual might follow up with the thought: “If I do such-and-such successfully [test myself] it will mean I really am a male and my thoughts of being female will pass.” With the female-to-male transsexual the opposite would hold. She says to herself: “If I do thus-and-so successfully it will really mean I am a female and my thoughts of truly being male will pass.” Certainly nontranssexual individuals might come away from their own self-testing with feelings of inadequacy as a boy or girl but the inadequacy doesn’t challenge their basic sexual identity.

Simple self-testing events and demands occur early, usually pre-school, and are interpreted and resolved rather unremarkably for most children. For atypically developing individuals, however, the testing period can be prolonged, quite involved, and dramatic. With convinced transsexuals, repeated normal encounters with living, from early on, seem an affirmation that they are of the other sex. Failure in gender-stereotypic behaviors that might be accepted or rejected without fanfare or concern by nontranssexuals, is cause for internal reification by convinced transsexuals that they are “in the body of the wrong sex.” They do not need or seek any self-test; their living-test convinces them early on.

Unconvinced transsexuals, while also harboring doubts from early on, nevertheless continue to question this disparity between inner and outer sex and eventually decide they are transsexuals only after a period of direct and usually prolonged self-examination. This process is often quite deliberate. It may, however, become apparent only in retrospect. Individuals of this second group of transsexuals are self-tested transsexuals.

Another matter might be considered for self-tested transsexuals. Kando (1973) found that typical transsexuals are highly stereotyped in accepting cultural ascriptions of gender. In their eyes, a good woman should be “comfortable in the kitchen and home,” and “a good man should be macho and the bread-winner.” Indeed, among the seventeen MtF transsexuals interviewed by Kando, almost all either considered themselves full-time housewives or worked in women-typical jobs such as secretaries, waitresses, and dancers. The self-tested transsexual is not that hide-bound. He or she feels capable in either the male or female role and can see that for others as well. But he or she, for self, believes that flexibility notwithstanding, an inner identification must be dealt with. The post surgical avocation is of minor importance as long as it can be done in the preferred sex.

For everyone, the second part of the self-test is its personal evaluation: the analysis. In this evaluation, male-to-female transsexuals inevitably conclude, to the effect, “I was tested or tested myself as a male in the most rigorous manner I can imagine and even though I was successful as far as society was concerned, it was insufficient to satisfy myself. I must therefore be the female I feel within.”

Self-testing of identity is most dramatically demonstrated by transsexuals but is seen in lesser degree among transvestites, then bisexuals and homosexuals, and least by heterosexuals. Bisexuals, homosexuals, and heterosexuals might test their masculinity or femininity, so-called self-testing gender patterns or they might test their sexual orientation, their attraction toward members of the same or opposite sex or both, but rarely question if they are male or female. And anyone might self-test their mechanisms (e.g., orgasmic ability or reproductive capacity).

Several cases of transsexual persons will exemplify the phenomenon of self-testing identity. They are presented in detail to illustrate how extensive the self-test can be.

Male-to-Female Transsexuals

Case #1: Hank*

*This is a pseudonym.

Some two decades ago a thirty-six-year-old XY individual presented himself with his wife of six years. They came to my office for advice and counseling regarding their marriage and the management of their future lives. The gist of the situation was that they had met and dated for about a year and married when he was thirty and she forty.

In general the couple seemed to be getting along well. They professed to loving each other and having few arguments or difficulties of consequence that typically beset couples. They reported themselves sexually compatible with a mutually satisfying frequency and intensity of genital play and coitus. There was a great deal of cuddling and physical warmth. There was, however, one major hurdle that had developed, and they sought help in its resolution. About a year before coming to see me, Hank had told his wife about his desires to cross-dress. She reluctantly accepted this. Following that revelation, he did occasionally cross-dress in her presence. Recently, however, he confided to her that he had always felt himself to be a female, at least since the age of four. He now desired sex-change surgery and the ability to live as a female.

The wife, a highly intelligent woman, worked in an administrative position of authority. Originally she had thought the cross-dressing and female aspirations were temporary aberrations of her husband and that they would pass. The magnitude of the present situation confused her, and she wanted answers to what was happening and suggestions on how to proceed. Both husband and wife wanted to maintain the relationship if possible.

During interviews with transgendered individuals I typically ask about self-testing identity. The questions are posed as a sort of challenge and follow the gist of “You have a penis and scrotum and total body build of a male, you were raised as a male and treated as a male in all instances that you can recall. And, you appear to be in a satisfactory marriage with a comparably satisfying sex life. Yet, you nevertheless consider yourself a female. What makes you think so? Can you give me examples of how you know you are female and not a male? How did you convince yourself of the correctness of this unusual feeling?” This series of questions is tailored to fit each individual’s history and circumstances.

Most XY individuals, in response to such questions, try to impress with occurrences documenting how “female” they had been all their lives. This is in dramatic contrast with the story that Hank told. Hank told a “hyper-male” story.

Hank was the eldest of twelve children in a poor and physically abusive dysfunctional family where the number of actual fathers involved was not known but father figures were consistently present. Routine beatings for even minor childhood infractions were common from his mother or any of the men around. Even as a child, Hank was expected to work at chores, doing much of the “man’s work” around the house. This was even considered more important than school work. His family lived with cousins and other relatives to help defray costs. Some twenty or so children of all ages lived together with the boys in the basement, the girls in the attic, and the adults in between. This was in a very small midwestern town.

From about the age of four Hank recalled feeling as if he were a girl rather than a boy. He dates this first revelation from the time he had to wear a girl cousin’s pants when his were unavailable. He remembered them having a pink bow on the side, which he felt was more in keeping with his “self.” Until that experience, Hank said, “for reasons I couldn’t explain, I didn’t believe I was in tune with the way people were treating me. This, wearing of my girl cousin’s clothes, which I took as being treated as a girl, seemed right.” In private he would take to occasional cross-dressing, choosing from the profusion of girls’ clothes that were always available in the house. With so many people around, privacy was rare. When possible he “made do” with wearing the sexually ambiguous “boys’” clothes of his sisters and girl cousins. Fearing physical abuse and ridicule he dressed in outright female clothes only rarely and always in secret.

When Hank was about ten, he dared his one-year-younger brother to dress in girl’s clothes. The brother was discovered and severely beaten and ridiculed within the family and at school; his mother made him wear a dress to school the next day. Hank vowed that would not happen to him. However, when Hank was about twelve his mother caught him cross-dressed and beat him brutally with the admonition to “act like a man.” She informed the rest of the house of his behavior and most of the household joined in the ridicule.

Academically Hank did not do well although he says he tried hard. He also felt he was a “loner.” This led to truancy and school fights when other kids teased him. He claims to have won all these fights and was soon accepted because of his strength and athletic ability. Indeed, sports and athleticism were Hank’s strong suit. At elementary, middle, and high school Hank was known as a medal-winning athlete in track and field, wrestling, and football (middle linebacker). He definitely did not shun rough-and-tumble play.

At the age of twelve, after taking his friend’s bike as a prank and riding it around town, Hank was charged as a thief—his pugnaciousness had marked him around this small town. He was placed in the local jail for two weeks to “cure him from being a problem kid.” When in jail he was sent for psychological testing and counseling. Hank was found to be dyslexic but with an IQ he claims tested at 160. Teachers vouched for his willing and bright participation in class but poor test performance. This jibed with his then-unknown reading and writing dyslexia. As a result of his test scores and the psychologist’s recommendation, Hank was advanced a grade but no treatment was available for his dyslexia. This led to further ridicule from his family and schoolmates (and more fights).

With puberty Hank started to masturbate. He did not like to masturbate touching his penis, however, since it reminded him he was male. He masturbated touching his thighs and nipples and fantasizing an erotic relationship in which he was a female with a heterosexual male.

To cover his burgeoning erotic and romantic interest in cross-dressing and boys, from about the age of fourteen Hank developed a relationship with a girl who lived in a distant town. The distance between the two towns reduced the opportunities for physical contact. During this period Hank didn’t engage in any sexual activities. As a sports star in school he had many heterosexual advances made to him but all were declined. No homosexual advances were made; Hank attributes this to the homophobia of the community.

Although he still craved the parental love and affection he was denied, to get away from the abuse and ridicule at home and obtain a modicum of freedom and privacy, Hank left home at the age of sixteen. Heedless of the winter cold, he went to live alone in a barn outside of town. He continued in school and supported himself by working after school and weekends as an airplane mechanic’s helper at a nearby airport. (Hank had, at the age of twelve, joined the Civil Air Patrol for the thrill of flying and, as a cadet, worked as an airplane mechanic’s helper.)

While Hank was alone in his crude lodgings, the sheriff came to look in on him and found him fully cross-dressed. In consultation with Hank’s mother, the sheriff offered Hank three choices: go to jail for breaking the local law against cross-dressing; go to a psychiatric facility to “get cured” of his fetish; join the military and leave town. Hank chose to enlist. He also saw this as an opportunity to prove that, indeed, he really was a man. His mother and the sheriff had, in fact, said to him: “Good decision; this will make a man of you.”

While still sixteen Hank passed the test for Navy enlistment but had to wait until his seventeenth birthday to report for service. Hank chose and was granted training in the Navy’s Aircraft Maintenance school. While in school, Hank’s physical and athletic abilities so impressed his drill instructors they recommended him for additional training that could use his physical abilities.

With Hank’s dyslexia still a problem he accepted the opportunity for further training after graduation from the Navy school. With this he learned he had been “volunteered” to become part of the Navy’s Underwater Demolition Team and then, when it was activated, part of the Navy’s first class of SEALs.6 Hank reenlisted as a SEAL team member and served two tours of duty in Vietnam under extremely hazardous and demanding conditions; many of his activities are still considered top secret today. After seven years in the Navy, five of them as a SEAL, Hank wanted to be and was seen and accepted as a man among men. Hank had a girlfriend at home as a “cover” during much of this time, but since he was overseas and she in the United States, his lack of overt sexual activity did not arouse suspicion among his shipmates. While in the military Hank had his first homosexual experience at seventeen and first heterosexual coitus at twenty. During his military career he never cross-dressed.

One night Hank got very drunk and broke into the enlisted men’s club after hours and was caught by the authorities drinking at the bar. He was charged and sentenced to the brig. While in the brig he physically fought with his cell mate to the extent that both had to be hospitalized. His injuries were such that Hank was granted a medical discharge.

Hank returned home and over the next three to four years took a series of jobs as an airplane mechanic, crewman on a tugboat, and other masculine-identified jobs: bodyguard, stud in both heterosexual and homosexual “adult” movies, commercial diver repairing ocean-going vessels, martial-arts instructor. During these years he simultaneously attended school and obtained a Master’s degree in Physical Education. He then went to work as a P.E. instructor at a high school. Out of the service and in private Hank resumed cross-dressing. During this period, at the age of twenty-six, Hank first heard of the Erickson Educational Foundation and became aware of resources of possible aid to transsexuals. This to him “offered a prayer to all the problems about what I was.”

Despite success in these demanding masculine situations, Hank could not displace his own doubts about his maleness or his belief that his true sex was female. Although he could meet the rigorous tests of masculinity required by the SEALS and the erotic demands of his wife, throughout these years, he still believed himself a female trapped into a muscular body. To his inner female convictions, passing these successful self-tests were insufficient to reinforce his male identity or dispel his female identity. He flunked all his tests. Despite meeting every possible challenge to “being a male,” Hank nevertheless ended up feeling himself a female. His wife was sympathetic to his inner feelings but confused by the external realities with which she was presented.

Subsequently Hank had depilation, went on estrogens, and planned male-to-female genital surgery. “Harriet” and her ex-wife presently live together as platonic sisters. Harriet appears as a muscular and masculine woman and presently, years later, stays at home and does the housework while her wife provides the major family support. Harriet is more content with life now than in the past when living as a man.

Case #2: Jan Morris

The life of Jan Morris, as presented in her book Conundrum (1974), further illustrates self-testing identity. After Christine Jorgensen (Hamburger, Stürup, and Dahl-Iversen 1953), Morris is perhaps the best-known male-to-female transsexual. In her book Morris offers testimony to what might be considered components of her self-testing. She writes:

  • “I was three or perhaps four years old when I realized that I had been born into the wrong body, and should really be a girl.” (15)
  • “It is true that my mother had wished me to be a daughter, but I was never treated as one. … I was not … thought effeminate.” (16)
  • “[I] volunteered for the army at 17 [The ninth Lancers; a mechanized cavalry regiment] … and [although I was successful in my position and accepted by my colleagues in arms] far from making a man of me, it made me feel profoundly feminine at heart.” (39)
  • “… [T]he insight it afforded me of life in an entirely male adult world was curiously gentle and considerate.” (40)
  • “… The army had confirmed my intuition that I was fundamentally different from my male contemporaries.” (43)
  • “ … [A]s to my sense of gender, I knew it to be as different from that of my friends .as cheese fromchalk, or thump from serenade. I could not share the urgency of the male impulse, or the unquestioning sense of manhood which bound these soldiers together. … I realized … how deeply a male sexuality lay beneath their conduct, and [although I could fake it] how profoundly I lacked it.” (43)
  • “How could I be sure of my predicament ? If I thought I felt like a woman, how could I know what a woman felt? What did I mean when I said I was feminine?Were there confusions of identity?When I left the Army I resolved to explore myself more deeply.(55)  
  • “… [W]as I sure that I was not just a suppressed homosexual, like so many others?” (60, emphasis added.)
  • Morris had heard of Harry Benjamin and went to see him. Benjamin accepted Morris’s feelings but counseled: “Stick it out [as a male]. Do your best. Try to achieve an equilibrium, that’s the best way. Take it easy!” “This advice I accepted.” (63)7
  • Bisexual in activity since college, Morris fell in love, married, and fathered five children, with a preference to have been mother rather than father. He described his marital relations thus: “We could scarcely call our sexual relationship a satisfactory one, since I would have been perfectly content without any sexual relationship at all. … But for me the actual performance of the sexual act seemed of secondary importance and interest.” (68) There was, however, a great deal of affection, hugging, and erotic intimacy.
  • Morris spent several years after his military stint traveling and working as a reporter covering wars and intrigue. In this capacity he jumped at the chance to join the first ascent of Mount Everest. Afterward Morris wrote: “The male body may be ungenerous, even uncreative in the deepest kind, but when it is working properly it is a marvelous thing to inhabit. … I think for sheer exuberance the best day of my life was my last on Everest.” (96)
  • “My sense of detachment [from the other climbers] was extreme. … I hated to think of myself as one of them. … A wayward self-consciousness … compelled me to keep up male appearances, perhaps as much for my own persuasion as for anyone else’s. I even overdid it rather. I grew a beard and when at the end of the expedition I walked into the communications room at the British Embassy in Katmandu with my tin mug jangling from the belt of my trousers, the wireless operator asked acidly if I had [sic] to look so jungly. He did not know how cruelly the jibe hurt, for in a few words it cut this way and that through several skins of self-protection.” (100)
  • “Everest taught me new meanings of maleness, and emphasized once more my own inner dichotomy.” (100)
  • “I have only lately come to see that incessant wandering as an outer expression of my inner journey.” (116, emphasis added.)

Despite success in the military, as a war correspondent, climbing Mount Everest, and as a father, despite social reinforcement as a male and the advice of Benjamin, Morris felt compelled to live life as a woman. His masculine experiences, rather than confirming his maleness, bolstered his hatred and resentment of his maleness and feelings of being female. Morris returned to Benjamin for sex-change advice and after prolonged endocrine therapy had the surgery in 1972. Although divorced, Morris, as did Hank and his spouse, maintained a loving and close relationship.

Case #3: Nancy Hunt

Nancy Hunt, another male-to-female transsexual, chronicled her life in a book Mirror Image (1978). She tells how she self-tested her identity.

  • “I know by the age of four I was already aware that I had a girl’s mind.” (40)
  • “By the day I graduated [prep school], I had achieved the status of a minor celebrity [by withstanding the physical fights and attacks of the other boys without crying]. More than that, I had survived the annealing fires of manhood. … I knew well enough that I was not a girl—had only to look at what my body had become: five feet ten inches tall, skinny as a fence post, muscles hard, beard growing, hair sprouting on chest and stomach. Secret dreams aside, I was locked in an undoubtedly male body, and like most adolescent male bodies it was bubbling with hormones and potent as a cocked pistol.” (59)
  • With puberty Hunt began to masturbate and occasionally dated. His feelings about girls he expressed thus: “I seethed with envy while at the same time becoming sexually aroused—I wanted to possess them even as I wanted to become them. In my nighttime fantasies, as I masturbated or floated toward sleep, I combined the two compulsions, dreaming of sex but with myself as the girl, my partner blanked out because I so loathed the male body, even my own.” (60)
  • With the start of World War II Hunt was determined to enlist. At the end of his basic training he was convinced he was a “tough, rugged, fighting Infantryman. … I could march twenty-two miles with a full field pack and an M-1 rifle, carry a 60-mm mortar up a mountain, chin myself fifty times with my hands the wrong way around on the bar, [and] kill a man with any of seventeen weapons, including the hand grenade, the .30-caliber light machine gun (air-cooled), and the bayonet. Now when I studied myself in the company mirror, I thought I saw a tough, dangerous, competent man. The military uniform always bolstered my masculine self-image, a fact that I suspect holds true for many men.” (61)
  • “And for two blissful years of Army service I believed I had established my credentials as a man among men. I cherished this belief even as, night after night, lying on my iron cot, I dreamed of being a girl.” (62, emphasis added.)
  • … [As] buck sergeant … those chevrons on my sleeves symbolized my membership in the community of men, my acceptance by … all the other soldiers whose self-assured virility I so much envied. To this day, I secretly celebrate the anniversary of my promotion to sergeant … though I have long since forgotten the dates of my college gradation, my two weddings, and my children’s birthdays.” (65)
  • “… [H]ere was I, a former buck sergeant, tough, profane, and determined to succeed as a man.” (39)
  • “[Following my discharge and while going to college] I associated almost exclusively with veterans, attempting to extend the manly triumph of my Army career.” (68)
  • “Never having heard of transsexualism, I supposed I must be a homosexual, and the thought sickened me. … To contemplate homosexuality, to imagine the embrace of sinewy arms and hairy legs so like my own, dismayed me.” (69)
  • “[Upon being recalled to active duty for the Korean War] military life had lost its power to assure me of my manhood. … I knew now that the military life was a delusion, but I had no other[After discharge] I turned my face resolutely in another direction and set out once more to prove myself a man.” (71-72, emphasis added.)
  • Hunt became a reporter and then a copy-editor. “Newspaper city rooms ranked then with the locker rooms of professional football teams among the great bastions of masculinity. … I drew comfort from the hearty environment of the city room and felt myself to be a man among men, much as I felt in the Army.” (76)
  • “[Later, at twenty-nine years of age and again living at home] continuing to fantasize about being a woman, I remained a male virgin. In that depressing situation, marriage seemed a likely way to gain approval as a male and as a human being. To prove my claim … I married a girl.” (77)
  • “Until I became a parent [with two daughters and a son], I assumed that sex-typed behavior is acquired, but my own children convinced me that it arises spontaneously.” (83)
  • “[My wife] saw in me those male attributes she had come to hate and fear accentuated all the more by my determination practice them and be as much of a man as I could. And to the extent that I succeeded in those efforts I failed in my marriage.” (85)
  • “I wormed my way into the sailboat-racing fraternity … crewing… in the big offshore boats … on whose sails the wind exerted terrifying forces. … And if a gale caught us with everything standing, my heart filled with cold fear. But though I was often frightened I continued to sail. It was a man’s world. … If I could survive there I could prove myself a man.” (85-86, emphasis added.)
  • “[As a newspaper writer] I specialized in the most masculine stories I could find or devise, anything that would take me into a world where I could study and enjoy the way men conduct themselves … firemen, high-tension line-men, parachute jumpers, treasure divers. … I slept in the open with the Green Berets while snow fell on my face. … I spent countless nights with policemen, breaking down doors on vice raids and accompanying them into the most perilous cesspools of the city where snipers would fire on us from the windows of public housing high rises. (87)

Many exploits to prove his manhood were undertaken, including serving as a combat reporter in Vietnam. Falling in love with and marrying two different women were also part of the self-test.

  • “I had made a fetish and a profession of manhood. (Indeed I had once written an article on what it means to be a man, and the United States Marine Corps [rewarded me for it].)” (150)
  • “And there lay the heart of my dilemma: I could no longer endure pretending to be something I was not. Deceit is a tiring occupation, and despite all biological evidence to the contrary, despite my military record and my Yale degree, despite my swearing and my mustache, I knew my masculinity was fraudulent. If I were ever to make peace with myself, I would have to confront not the hairy, balding, tweed-clad façade that I presented to the world, but the person who lived inside—myself, Nancy, a woman.” (262)

Thus, Hunt provides another example of an individual who tested himself, found social success as a male, was reinforced by his peers, family, and culture, yet goes on to transsexual surgery and life as a contented woman. Despite external clues to his masculine nature and gender identity, Nancy’s internal cues to her female sexual identity were more potent.

Female-to-Male Transsexuals

Case #1: Barbara*

*This is a pseudonym

Barbara is my example of self-testing identity in a female-to-male transsexual. Like the cases of the MtF presented above, Barbara is unusual in the extent to which this phenomenon is seen.

Barbara first appeared in my office with her husband; she was dressed in jeans with a loose shirt and her long hair up in a tight bun. They came as a couple but each had a very separate agenda. His desire was for me to convince his wife that she really was a woman and not the man she claimed to be. Barbara wanted my advice on how to proceed in her desire to live as a man. As a striking brunette Barbara was a most attractive woman in face and figure. Then in her early thirties, Barbara first became convinced she was male about the age of seven. Even at that time she recalls always being seen as a tomboy by others but as a real boy to herself.

Life events in her rearing, childhood, and adolescence were not remarkable. As she matured, the attention of the boys and men with which she came into contact continued to emphasize that indeed she was female. As a female beauty she was repeatedly the object of male attention. Barbara denied her attractiveness and explained away the focus of the males as due not to her features or reality, but just their indiscriminate lust. Men had been approaching her and, much to her dismay, touching her sexually since she was a teenager. She herself recalls being attracted to and aroused by females from her teenage years. Her first sexual encounter was with a female at twenty-three years of age.

Home conditions, in a small West Coast farming community, seemed supportive and were considered to have its “normal ups and downs.” She recalls her home life and family as nurturing and caring. She had a brother eight years her junior. Barbara, at the age of eighteen, left home after completing high school to follow a career as an actress and professional fashion model. Her success as a beautiful female was in conflict with her inner feelings that she was a male. Again she felt her appeal was dependent upon males wanting sex from her. She claims she never gave in to the male advances. As she got older and modeling positions decreased and acting situations were sparse, someone suggested, with her attributes, she try stripping.

In a classic example of self-testing reasoning, Barbara rationalized that her success as a stripper would prove to herself she really was a female and remove all doubt as to her being a male. The men in the audience, she thought, would know she was not available to them and would thus judge her on her female merits alone. To further her career and, in her own words, “leave no stone unturned in proving myself a woman, I had a ‘boob job’.” Suffice it to say she was successful enough as a stripper to achieve national stature sufficient to require a full-time manager. On a worldwide tour, she was in Honolulu when she came to see me. Her stage name was, at the time, widely recognizable to devotees of stripping.

She married her manager, her only husband, nine years prior to seeking counseling. This was his third marriage but her first. Despite the worldly success and adulation as a female, Barbara could not dispel her male feelings and had only several weeks before told her husband of her conviction she was a male despite “fighting such feelings for years” and appearances to him and the world. She thought “exotic romantic Hawaii as the appropriate location to broach the topic.”

Her only bow toward masculine habits seemed to be, she had for some time been wearing men’s jockey shorts as underwear. Her husband just thought that another sign of her “tomboy” nature. Barbara had also, several months earlier, met a female friend with whom she started a close sexual relationship.

Barbara’s satisfactory abilities as a wife were testified to by her loving and attentive husband who thought she was “crazy” with these thoughts. He felt she was “just the woman he wanted.” Before this recent revelation Barbara always wanted to be called by her real (feminine) name rather than her stage name or a male name. Her husband described her as not only beautiful and sexy but also feminine in mannerisms and attitudes. Barbara did not deny that she tried in all ways to please her husband sexually and otherwise. But now she adopted a gender-ambiguous name and wanted to be seen as the male she felt herself to be.

Barbara had a son from a previous relationship who was adopted by her present husband. Having this child was a further additional female self-test in Barbara’s eyes. It simultaneously proved her femininity in the husband’s eyes. The son, ten years old at the time, traveled with his parents and was interviewed alone and in private. Barbara had also told her son of her emotional conflicts. He saw his mother as appropriate in demeanor and, her occupation and fame aside, “just like other moms” in regard to female-ness. He was appropriately concerned with the future but wanted to stay with his mom regardless. Barbara’s female lover came to Hawaii and was also interviewed. She claimed she had no preference for Barbara to be male or female. She “loved the person, not the shell.”

Despite Barbara’s success as a female, she now felt she had to live as a male. She said she had always been severely depressed every menses. Having a slight flow, she would often leave her tampon in for prolonged periods so she “wouldn’t have to deal with them.” Everything seemed to be coming to a head at once. She now fully realized she could not feel peace as a female and, without her husband’s or female lover’s knowledge, seriously considered suicide. She had also recently informed her parents of her desires and they threatened to disown her although her mother volunteered, “I always knew you were strange in that way.” Barbara nevertheless wanted to proceed with her female-to-male transition.

After counseling over a three-week period the couple left Hawaii for scheduled performances in Japan but Barbara kept in touch by mail. Upon return to the United States, against her husband’s wishes, the couple divorced. Barbara cut off her long tresses, gave up her lucrative stripping career, and started to live as a man. He bound his breasts to minimize them and was planning to remove the implants. He now took androgens and lived with his female lover. Several months later “Bob” wrote to tell me he was working as a salesman and made plans for sex-change surgery. He retained custody of the son. Contact was lost after that.

Although eminently successful and reinforced as a professional stripper and domestic wife and mother, Barbara felt, nevertheless, she had to live her life as Bob. His inner voice was stronger than her external reinforcement. Her self-test convinced her that although she could easily pass any test of female gender identity she could not pass her own self-test of sexual identity.8


There is little doubt that the lives of transsexuals can be quite variable from each other and there is no one life that typifies all (e.g., Bentler 1976; Blanchard and Steiner 1990; Bullough and Bullough 1993; Green 1974; Meyer 1974; Pauly 1969a, 1969b; Tsoi, Kok, and Long 1977). Nevertheless, tabloid presentations of transsexuals often play up the before-and-after contrasts; the macho male becoming the feminine female, and so on. The cases presented here illustrate this to a marked degree. These cases also exemplify that even full and demonstrated success and acceptance in one’s sex of birth and rearing can be insufficient to allay a feeling of mismatch between gender identity and sexual identity. Although reinforcement and success in society and concordance with social expectations exist, an individual can nevertheless feel drawn to a sexual and gender “calling” that may lead to ridicule and social opprobrium. Indeed, many have little hope of “passing” undetected in their new life yet choose this difficult social path. In all four cases presented, the individuals were engaged in loving relationships that they had to alter. By leaving their sex of birth, they all risked a substantial decrease in income. By rejecting their sex of birth they all left successful professions. There were no indications these individuals were not fully capable, rational, and sentient.

The question arises why such histories as those presented here seem rare in comparison with those for whom life was a succession of events demonstrating attempts or actual success in living as a member of the opposite sex. Part of this is believed due to the fact that indeed unconvinced transsexuals are not as prevalent or visible as are convinced transsexuals. Also believed critical are the criteria originally established for selecting candidates for the limited surgical slots available. As Fisk (1975) recounts: “we [at Stanford] went about seeking so-called ‘ideal candidates,’ and a great emphasis was placed upon attempting to exclusively treat only classical, or ‘textbook cases’ of transsexualism.” Stoller (1971) proposed that only individuals who at no stage in their development showed masculine behavior be diagnosed as transsexual. Other centers, to reduce the likelihood of regrettable surgeries, did similarly. And once establishing such criteria of longstanding and continuous outright, gender-wished-for behavior, it is not difficult to see why such cases became dominant in practice and case reports.

The current DSM-IV criteria for “Gender Identity Disorder” also states: “there must be evidence of clinically significant distress or impairment in social, occupational, or other important areas of functioning.” (1994, 533) The individuals described in the present report were able to function well in these areas. Their distress, however, was psychic and persistent. By the criteria mentioned above and those in the DSM-IV these four would not have been considered for surgery. Future editions of the DSM and surgical criteria should take account of self-testing and the manifestations of gender identity disorder described.

The origin of dysphoric male and female feelings arises from within, from the individual’s endowment of emotions mixed with the daily living test confrontation with reality. For the majority of transsexuals this results in an early-in-life capitulation. For others, however, there is a prolonged self-test period during which the transsexual convinces him- or herself that how one can live is not necessarily how one desires or prefers to live.

It must also be mentioned that recommendations for transsexual counseling and presurgical treatment require the candidate to undergo a real-life test, usually for a period of one to two years, during which he or she lives as a member of the desired sex (e.g., Clemmensen 1990; Meyer and Hoopes 1974; Money and Wiedeking 1980). This requirement, one of several seen as crucial prior to sex change surgery by the Harry Benjamin International Gender Dysphoria Association, Inc. (Walker et al. 1985), demands a period during which the individual sees how the new life confirms or denies expectations. For the true transsexual this real-life test is much easier than the living-test or any self-test. It is seen as a relief.

Previous publications have indicated in broad terms how this inner identity is believed to come about (e.g., Diamond 1965, 1968, 1977, 1979, 1993, 1994) and other types of examples have been offered that show an innate sexual identity as a male develops despite social reinforcement as a female (Diamond 1982; Diamond and Sigmundson 1995). The details of this process of sexual identity formation are still to be elucidated. Nevertheless, it seems fairly certain that this inner voice can develop without reinforcement and social approval for the desired sex and with ample reinforcement in the nondesired sex. And it can occur in the face of a socially adverse future and provide an inner personal calm more important than any external rewards.

Lastly, while probably true that self-testing is seen most dramatically among transsexuals coming to terms with their identity, it is also seen when they have to cope with measuring themselves, before and after surgery, against their peers and social expectations on other levels. Indeed, to one degree or another self-testing is demonstrated by everyone along five levels of an individual’s sexual profile: gender Patterns, Reproduction, Identity, Mechanisms, Object choice (PRIMO) (Diamond 1977, 1979). Many of these self-tests are so ubiquitous they pass as normal, as instinctual, or are seen as examples of simple experimentation and curiosity. They can, moreover, also be arduous challenges of “Is this right/wrong for me? Does this suit me or not? How do I feel when I do such-and-so?” Such self-testing is a common accompaniment to puberty and adolescence—not wanting to be different unless it is to excel—but often continues into adulthood. Part of growing up is testing one’s limits. “Spreading wings” often infers moving in directions new and challenging. Such self-tests are brief or extended; they might be outwardly mundane or dramatic.

Everyone, male or female, transsexual or not, consciously or not, tests their “fit” with gender patterns offered by society; this is self-test gender. This is wide ranging, from the clothes one will choose to the occupations or leisure pursuits one adopts. Self-test reproduction occurs when one has a child to “prove” one’s self. One often self-tests mechanisms with experimentation with orgasm, sexual arousal, and sexual performance of one type or another; e.g., “Why can Sally have multiple orgasms and I none?” or “Can I delay my ejaculation to better please my partner?” And, often dramatically, persons self-test object choice. Experimenting with male and female partners during puberty and adolescence can be viewed as such. And dating is often a more sophisticated example of this.

Often several levels are tested simultaneously and, unfortunately, at the expense of others. For instance, not a few marriages are entered into and children conceived in order to fulfill self-tests. Then, marriages consummated and children reared, many of these individuals admit to themselves and their partners that the relationship might have been loving and fulfilling and satisfactory on the outside, but it was unfulfilling and disappointing on the inside. They then change their life to concur with their inner feelings. All four of our examples demonstrated this. Self-testing along the other four of our five levels of sexual expression needs a detailed and full exposition of its own.

The phenomenon of self-testing is thus most clearly seen with transsexuals and identity. Considered in broadest terms, however, it is a process everyone experiences on all levels. The conclusion from this returns us to the old adage: “The most important sex organ is not between the legs; it’s between the ears.”



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1 Gender has been defined in many ways . For this paper, as I’ve done in the past, I emphasize that gender identity is distinct from sexual identity and keeping this distinction is useful (Diamond 1976, 1979, 1993).

2 Five levels of sexual expression have been described that together present a distinct sexual profile for any individual. These five levels are: sexual Patterns (gender roles), Reproduction, sexual Identity, sexual Mechanisms, and sexual Orientation (Diamond 1979, 1980, 1992). The acronym PRIMO is helpful in keeping these in mind.

3 It is true that some nontechnical societies conceive of a third sex. But even such a category is a modification of male or female (see Williams 1986). True hermaphroditism, and others with ambiguous genitalia, is extremely rare and not considered here (see Fausto-Sterling 1993).

4 As this area of sex and gender has developed, so too has a diverse set of terms to describe the variations that exist. Along with the term transsexual one must define transvestite: a heterosexual individual, most usually male, who derives erotic or nonerotic personal satisfaction from dressing in the clothes of the opposite sex while not believing him- or herself to be a member of the opposite sex. A drag queen is a homosexual male preferring to live, at least a preponderance of the time, as a woman. The transgenderist is one who sees him- or herself as wanting to live at least components of the life of the opposite sex with or without sex-change surgery or other body modification. For the transvestite and the transgenderist, the desire to live as the opposite sex may be periodic and not permanent. Often, the term transgenderist is used broadly to include transsexuals, transvestites, drag queens, and others who somehow mix and match personal, social, and cultural views of what it means to be a male or female, a man or woman.

5 The term identity itself has many meanings, both technical and lay. For this paper it will be used only in the sense defined.

6 The SEALs (Sea, Air, and Land special forces) are recognized as requiring among the most demanding physical and diverse abilities of any military special forces units. More than half of those volunteering for this duty do not make the grade (Wailer 1994).

7 This being early in Benjamin’s experience with transsexuals, and with Morris so outwardly masculine, I guess Benjamin was being cautious. Had Morris been more effeminate or Benjamin seen other MtFs so masculine, perhaps he would have been more supportive of sex change.

8 Following the presentation of my talk at the conference, I was gratified to have several members of the audience come to me and relate how my presentation seemed to echo their lives. Several individuals, each in private, admitted having actually, in combat, subjected himself purposely to tests of manhood with risk of death. They emphasized the point by adding they didn’t care if they lived or died in the “experiment” since life as they knew it, with the identity confusion, was not worth living anyway. Following their heroic military experiences they were able to make the transition in their lives realizing the inner strength demonstrated by their self-tests.

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