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
 8

THE MALE TRANSSEXUAL AS

‘EXPERIMENT’
The most important question for me is this: can transsexualism tell us
anything about normal development? For some people, it is an interesting
but bizarre condition, a shoddy amusement; one is easily lost in frivolous
details. But this is to miss the opportunity for an ‘experiment’ that may
help us study the unfolding of masculinity and femininity in less aberrant
people.

I shall therefore again assert the obvious, observed from the perspective
the transsexual provides: that non-conflictual forces playing upon the
infant’s body and psyche are essential for personality development and that
we should extend our use of contributions from non-analytic workers even
beyond that sanctioned by Rapaport (1) and Hartmann (2). I shall also
emphasize that the earliest ‘structures’ in identity need not be accounted
for primarily by an instinct theory and only secondarily by an object
relations (social learning) theory as Freud attempted, but vice versa. One
of the positive effects of such a demonstration would be to start linking an
array of findings from psychologists in regard to learning theory. In
addition, differentiating non-conflictual from conflictual origins of
masculinity and femininity may help us see a value in separating out
mechanisms of perversion from those of non-perverse sexual aberration.
Perversion
If one determines which gender behaviors developed non-conflictually in
earliest life, one may recognize that these are unalterable parts of identity,
part of one’s true self (being) (3). They will be unchangeable by
psychoanalysis, for analysis works on the fracture lines that separate what
one is from the defenses one has to erect that overlay one’s genuine self.
Seen

117
118 THE TRANSSEXUAL EXPERIMENT

like this, the transsexual’s femininity does not spring from the neurotic
mechanisms he created from conflict and compromise, any more than does
the core of femininity in normal women. We are, however, familiar with
disorders of gender identity that are the result of conflict and defense: the
perversions. (Rather than neurosis being the negative of perversion, as
Freud said, perversion might better be considered as a neurosis that had
reason to seize the sexual apparatus for its action. In the perversion—as in
all neuroses—both the trauma and cure are simultaneously present [9].)
Transsexualism can be compared and contrasted in this regard with related
gender disorders, transvestism (fetishistic cross-dressing) and effeminate
homosexuality, which contain cross-gender perverse elements— neurotic
compromises in the area of genital behavior.
The mothers and fathers of male transsexuals have created in their
family a set of dynamics that, I hypothesized, made their beautiful son
feminine. They have brought off an experiment in rearing that one would
never have thought of performing—much less have dared to do. The first
step in my research was to observe such an experiment—a family with a
very feminine son. The next experiment broadened the search; when other
feminine boys were examined, was it found that their families also created
similar dynamics? Finally, related conditions were compared to
transsexualism to see if variables differed in predictable ways.
In the chapters so far, we have looked at the first two of these
experiments. Now we move to the third. I shall use it for two purposes.
The first, the more concrete aim of this book, is to try to understand
transsexualism; the second serves the broader range of the research, to
understand the development—ordinary and disordered—of masculinity
and femininity.
In this chapter, I am more concerned with the disordered; while
comparing transsexualism with other gender conditions, especially
transvestism and homosexuality, I shall only contrast the dynamics of non-
neurotic sexual deviance with perversion, saving detailed comparison of
these gender disorders for later chapters.
Let us look briefly at the transvestite. For now I need only note that,
because the transvestite has had a period of masculine development in his
first few years, his penis is charged with
 ‘EXPERIMENT’ 119

importance. It both signifies his maleness and has full erotic value. Thus,
however much he is driven to put on women’s clothes, the cross-dressing
takes its intensity from the knowledge of that penis (that masculinity, that
male core gender identity, that maleness) hidden beneath. His earliest
conviction is that he is a male; in response to threats to his sense of
maleness, he hides himself in a safe disguise: women’s clothes.
The effeminate homosexual also considers himself a male and prizes his
penis. He too has had his sense of maleness threatened. He does not cross-
dress to become sexually aroused, however, but rather to mock the hated,
envied, admired women. Something comparable occurs in the etiology of
effeminate homosexuals as is seen in transvestites. The mother of the
effeminate homosexual has long been described as ‘overprotective’. On
observing her behavior, however, one sees that the word ‘over-protective’
does not conjure up this mother’s actual behavior. On occasions when she
is ‘overprotective’, her behavior is comparable to that used for training
seals. When her son does not perform as she wishes, she hurts him. The
style of hurting depends on her personality; she may do it quietly or
noisily, with threats or physical punishment or by withdrawing. However
she acts, she does whatever is necessary to frighten her son enough to
modify his behavior. But when he behaves as she wishes, then comes the
reward. So the ‘overprotection’ has two distinct forms. The first is the
forbidding of distasteful behavior, the second the lavish rewarding of
approved behavior. As we know, the forbidden behavior is that sensed by
this mother as ‘masculine’. It will be rough, penetrating, physically
assertive, ‘dirty’, heterosexual. When he is mother’s lovable little boy,
however, he is clearly demonstrating that he is not doing any of the above.
Note the difference here in the chronology of the development of gender
identity: in the transsexual, there never is any masculine behavior
observable from earliest childhood, but in the effeminate homosexual,
enough masculinity has already developed that it incites his mother to
reduce it to rubble. In brief, such a mother, unable to bear her envy of
males, is granted, by her son’s vulnerability, the safe opportunity to
damage masculinity. This is a powerful attack on his identity, and he will
no more fail to defend himself than does any other
120 THE TRANSSEXUAL EXPERIMENT

child. But, like all children as they erect character structure as a defense
against parental influences, he must do the job with exquisite care, exactly
fitted to the assault his mother may mount at any moment.*
We know that the weak, passive, unmanly, and effeminate appearance is
partly facade; his mother could damage but not wipe out aggressivity.
Even his masculinity remains, though in sad disarray. It now makes its
appearance surreptitiously, in the form of caricature. Once again, as with
transvestism, trauma is converted to triumph. Bak (4) has said, ‘Common
to all perversions is the dramatized denial of castration.’ I would add that
fear of having one’s penis castrated symbolizes an even greater fear, that
one’s self will be destroyed: ‘I shall no longer be me, a male, a boy.’
I have stressed that the transsexual is feminine; ‘her’ behavior is natural,
unaffected, as one sees in feminine women. It is also continuous, not
intermittent, just as femininity is continuous in normal women. This
contrasts with the effeminate homosexual. His behavior is not like that of
women; it is mimicry, in which he underlines his distaste (and envy) for
feminine qualities. He does to femininity rather like what his mother does
to masculinity: wherever he notes it, he disparages it. Even a dazzling
portrayal, which provokes praise for his beauty and gracefulness, he still
clearly labels as a performance. But from beginning to end, he informs
everyone he is a male.
The Oedipal Conflict as The Test
Let us now consider the concept of perversion in the light of the difference
on the one hand in the psychodynamics of the transsexual’s femininity and
on the other the fetishistic excitement of the cross-dressing transvestite or
the hostile mimicry of the effeminate homosexual. Probably all analysts
will agree that, as Freud first showed, perversion is a defense. But,
illogically, most analysts feel that all sexual deviations are perversions,
and having assumed this, they may then say that all sexual deviations are
defensive in nature. My own belief is that some aberrant sexual behavior is
statistically abnormal but not the result

* Fathers’ contributions to their sons’ effeminacy is important, but being more

variable, and because I do not know enough, these shall not be discussed here.
 ‘EXPERIMENT’ 121

of conflict and defense; and I would not call this perversion.

Transsexualism is an example.*
The oedipal conflict can be our guide. I agree with Freud that it is a
crucial dynamic in the production of perversion, though also agreeing with
those who say that the time of decision comes earlier than age 5, 6, or 7,
when the conflict reaches peak intensity in the normal. As a baseline for
comparison, let us recall the oedipal conflict necessary for the production
of normal masculinity. In this situation, an already masculine boy, having
separated himself from his mother’s body and psyche, now fully perceives
her as an external object who is sexually desired. Under these
circumstances, he finds his father an unconquerable rival and defers his
hopes until later life (5).
Now in perversions, one part of this process is not too pathological; an
early phase of the oedipal situation proceeds more or less on schedule. It
consists of the following: (1) development of a sense of maleness
(masculine core gender identity); (2) development of a masculinity
(appearance, behavior, fantasies) consonant—obviously—with the sense of
maleness; (3) this masculinity advances during and as part of separation
and individuation from mother. But now† mother or occasionally her
surrogate, such as an older sister, an aunt, or neighborhood girl, reacts
specifically to the more or less successfully developed masculinity and
tries to damage it. It is only when the boy has something essential to lose
—a piece

* Except for the identity deviation (femininity and an object choice appropriate to
that identity but ‘homosexual’ anatomically), I have never seen any of the known
perversions (e.g. fetishism, sado-masochism, exhibitionism, voyeurism, bestiality) in
a transsexual. They are found often enough in many of those requesting ‘sex
transformation’; but few such people are transsexuals.
† One should not take the above literally. It is unlikely that this early stage in the
oedipal situation occurs in an uncomplicated manner and then suddenly is disrupted.
Probably there are disruptions from birth on with such mothers interfering somewhat
with the developing masculinity; and there are severe disruptions in the separation
process (cf. 6-8), traumatically opposite to the blissful symbiosis in transsexualism.
My earlier comments are not meant to say that the earliest pre-oedipal phases may
not be disrupted but only that a sufficiently intact core gender identity develops that
the child will know he has something vital to lose when his masculinity is attacked.
My point is that whatever she does up to this stage, mother has not prevented some
sense of maleness and masculinity from developing.
122 THE TRANSSEXUAL EXPERIMENT

of his true being, his identity—that he can have castration anxiety. I have
seen no evidence of castration anxiety in transsexual boys (before
treatment).
It may be noted that I am ascribing to females the major role in
producing castration anxiety. I think this often holds in the perversions, but
in the development of normal masculinity it may be father more than
mother who threatens. A father who threatens is usually, if not too cruel,* a
wholesome force in developing masculinity, because in his very
threatening, he gives the boy a model of masculinity to emulate
(identification with the aggressor can be essential for normal
development). In the perversions in males, however, one so often
(always?) finds hatred and fear of women at the heart of the dynamics.
Think of those exclusively masculine perversions such as exhibitionism,
voyeurism, pedophilia, rape, or fetishistic crossdressing (transvestism). In
each of these, there is a fantasied triumphant attack on the formerly all-
powerful women who are imagined to have inflicted the first trauma. Bak
(8) said something like this when he suggested that the fantasy of the
phallic woman lies behind perversions in men. Perversion can be
considered as trauma surmounted and the achievement of gratifying
orgasm as triumph over threatened disaster. The perverse act may be the
re-enactment of a crucial threat to existence in early childhood; in the
perverse act itself is a reliving of the historically real disaster, this time
with the happiest possible ending (9).
In both normal male development and in perversion, in contrast to
transsexualism, masculinity appears in the first few years of life.
Especially in the more normal it is the result of two processes. The first is
the encouragement of any behavior that parents consider masculine, and
the second is encouragement of separation and individuation. While both
these processes are distorted in perversions, chiefly by regression in the
face of danger, the traumas that cause the distortion do not either stop the
development of some masculinity or quite destroy whatever exists. Of
special importance in both these types of oedipal development (normality
and perversion)†, mother is

* Too much cruelty by fathers also invites perversion.

† These are not really two different types; normality and perversion, we know, are in
many ways only degrees on a continuum.
 ‘EXPERIMENT’ 123

unquestionably a distinct person and a desired heterosexual object. She is

not seen primarily as a person to be like but rather one to have (10, 11).
Father is present, clearly defined in his maleness and masculinity and a
very real threat. None of this is true for the transsexual boy. For emphasis,
let us review how the oedipal complex in the transsexual differs from that
in which a boy becomes masculine.
First, because of failure to separate himself properly from his mother’s
body, the transsexual boy never develops a yearning to possess a person of
the opposite sex. Instead the gap the child wants to bridge is between
himself and his distant father.
Second, a sense of maleness and later, of masculinity, does not develop,
as a permanent, autonomous part of the sense of self, to be prized and
protected. Therefore, genital castration cannot be a threat, for the male
genitals are not ‘connected’ to the core identity as in other males.
Third, there is no frightening but admired father who forces a detour in
development and who is used as a model to emulate: he is not there, he is
not frightening, he is not admirable—and his son does not want to be
masculine anyway.
And so, not wanting mother as a sex object or father as an object for
identification, with no barrier to simply having mother—being like her is
even more possession than winning her—there is no oedipal conflict, no
castration anxiety, hardly the situation in normality or perversion.
That this may not be just theory appears (as was described in Chapter 6)
when one treats these boys. With the separation from mother that our
treatment demands and with increase in masculine behavior, one sees for
the first time the manifestations of oedipal conflict with which one is
familiar—anxiety, phobias, aggressive behavior, interest in his male
genitals, masturbation, masculine identifications, his own appearance in
fantasies as a male, sexual curiosity toward females, and attempts to touch
mother sexually.
There are men who seek sex transformation because of oedipal conflicts
and castration anxiety. For instance, some hate their genitals or the
demands erections make, and, as in a religious fervor, attack themselves to
extirpate guilt (12). One has no problem eliciting this motive from such
people. Such is not the case with transsexuals. While they also wish to be
rid
124 THE TRANSSEXUAL EXPERIMENT

of their genitals because of erections, the motivation expressed is not guilt

but shame that one’s physical appearance is grotesque.
It seems to me, then, that transsexualism can serve as an ‘experiment’ to
tell us more about both normal and perverse development. Not only do we
fail to find trauma overcome as in the perversions but we also fail to find
the traumatic sorts of oedipal conflicts present in the perversions.
Dehumanization: The Fetish
There is one last clinical quality to be mentioned in differentiating
transsexualism from the perversions. To the earlier claim of perversion as
trauma overcome, I would add that in perversion, but not in
transsexualism, fetishization is always present.* I consider perversion to be
one side of a continuum of fetishization of objects. The so-called normal
uses this process less; those behaviors using it more are recognized by us
as perverse. Some perversions use this device less (e.g. a permanent
homosexual liaison) and some more (e.g. fetishism). It consists of the
dehumanizing of objects out of fear, distorting them in whole or in
particular attributes from their reality and reinventing them so that they
serve to undo the trauma to which their presence in the perversion bears
witness. I can think of no perversion in which this process is not central.
Most of the perversions are found in men. Is this because men’s
masculinity is threatened in infancy by closeness to mother and because
boys, to become masculine, must separate (‘disidentify’, as Greenson calls
it) from mother’s femaleness and femininity ? I believe that this does
contribute to perverseness in males, although, when negotiated with less
trauma, it is an essential factor in producing non-perverse sexuality. But is
there such a thing as ‘non-perverse sexuality’ in men or will there not
always be some remnant of hostility because of the trauma inflicted by
mother in moving her son toward masculinity and by father in frustrating
that now developed masculinity ? What may leave the normal man with
only microscopic amounts of perversion will be a feminine mother who
appreciates hetero-

* This extends Bak’s (8) belief that fetishism is the model perversion.
 ‘EXPERIMENT’ 125

sexuality and manliness (in men) and a masculine father who appreciates
heterosexuality and femininity (in women), that is, parents who can turn
the boy’s oedipal conflict into an accomplishment.

Chapter 8
1. Rapaport, D. (1960). ‘The Structure of Psychoanalytic Theory’.
Psychol. Issues. Monograph 6. New York: Int. Univ. Press.
2. Hartmann, H. (1939). Ego Psychology and the Problem of
Adaptation. New York: Int. Univ. Press, 1958; London. Hogarth
Press.
3. Winnicott, D. W. (1965). The Maturational Process and the
Facilitating Environment. New York: Int. Univ. Press; London:
Hogarth Press.
4. Bak, R. C. (1956). ‘Aggression and Perversion’. In Perversions:
Psychodynamics and Therapy, ed. S. Lorand. New York: Random
House.
5. Freud, S. (1909). ‘Analysis of a Phobia in a Five-Year-Old Boy’.
S.E. 10.
6. Greenacre, P. (1953). ‘Certain Relationships Between Fetishism and
the Faulty Development of the Body Image’. Psychoanal. Study
Child 8.
7. — (1969). ‘The Fetish and the Transitional Object’. Psychoanal.
Study Child 24.
8. Bak, R. C. (1968). ‘The Phallic Woman: The Ubiquitous Fantasy in
Perversions’. Psychoanal. Study Child 23.
9. Stoller, R. J. (1970b). ‘Pornography and Perversion’. Arch. Gen.
Psychiat. 22.
10. Greenson, R. R. (1966). ‘A Transvestite Boy and a Hypothesis’. Int.
J. Psycho-Anal. 47.
11. — (1968). ‘Disidentifying from Mother’. Int. J. Psycho-Anal. 49.
12. Socarides, C. W. (1970). ‘A Psychoanalytic Study of the Desire for
Sexual Transformation (“Transsexualism”): The Plaster-of-Paris
Man’. Int. J. Psycho-Anal. 51.