||An update of
the paper, The Multi-Dimensionality of Gender.
This landmark paper on the theory of gender was first
later presented in 1997 at the
Second International Congress on Sex & Gender Issuess,
co-sponsored by the Human Sexuality Program in the Graduate
Department of Education at the University of Pennsylvania, and
Tapestry Magazine in 1995 and
Gender is more complex than the expression of maleness or
femaleness. The complex journey towards one's own personal
gender expression is explored and transsexualism and transgenderism
This article will enable the reader to answer the question,
"Am I transsexual / transgendered?"
Separate fact from mythaddress key questions regarding
transition: What is transition? Is transition for me? How and
where do I find help in my transition?
Splendor of Gender
The Splendor of Gender Conference was the first of its kind
conference that brought treating professionals and the
transgender community together in a learning workshop
What is Gender and Who is Transsexual / Transgendered?
by Carl W. Bushong, Ph.D., LMFT
speak of gender, in a context other than language, it is a recent
concept in our culture, both lay and professional. It was not until 1955
that John Money, Ph.D. first used the term "gender" to discuss
sexual roles, adding in 1966 the term "gender identity"
while conducting his gender research at Johns Hopkins. In 1974, Dr. N.W.
Fisk provided our now familiar diagnosis of Gender Dysphoria.
Previously, one's sexual role was considered one of two discrete,
non-overlapping congenital attributes—male or female determined
by one's external genitals. These two mutually exclusive categories
allowed for no variation. Of course, we acknowledged the cultural
differences in sexual roles, but there still could be only two modes of
expression - of being.
began to see one's gender as a continuum, a blending, analogous to a "gray scale." But, our distribution of gender was still
bimodal, that is, most people are lumped at the two ends (see graphic)
with only a minority in the middle. The great majority would be either
male or female with all that implies.
review of current research and experience with gender dysphoric, gay and
traditional clients has led me to see gender not as a bimodal male or
female dichotomy but as a matrix—a
possible mix of male and female development within the same
research and observation, I have developed a list of five
semi-independent attributes of gender, as a map to help you to
understand this complex often hotly emotional issue of gender. Consider
sexual identity/behavior (gender) springing from five semi-independent
Genetic Gender — Our chromosomal inheritance.
Physical Gender — Our primary and secondary sexual characteristics.
Gender" — Functional structure of the brain, along gender
Sex" — Love/sex Patterns, How we relate to others on a social
and interpersonal as well as sexual level. "Love Maps."
Gender Identity — Our subjective gender, our sexual Self-Map, how we feel ourselves to
be: male or female.
It is my
contention that it is possible for an individual to view oneself
and function as male or female to varying degrees
in each of the five sub-categories independent of the others.
few weeks after conception until two to three years of age, our brains
develop gender in at least three independent dimensions which I have
called "Brain Gender." [How the brain is wired along gender
lines.] "Brain Sex" How we perceive sex, relationships and
goals along male or female sets] and Gender Identity [how we perceive
ourselves-male or female.]
are these three dimensions independent of each other, but of one's
Physical Gender as well. That is, a person can have a male body, male
Brain Sex and Identity, but have female Brain Gender. [In fact, most
writers and artists do.] Such a person would look, act and feel male,
but have a female's sensitivity to emotions, words and sensations:
Although, they may overcompensate in public and in interpersonal
relationships [e.g., Ernest Hemingway]
Genetic and Physical Gender, our Brain Gender, Gender Identity, and
Brain Sex, expression usually remains constant from childhood throughout
each of these independent attributes is graded, it is easy to see the
possible combinations and degrees number in the thousands. With regard to
gender, we can be in a category of one—ourselves.
only individuals who are homogeneously male or female at the highest
degree in all five attributes could convincingly describe themselves as
only a single gender— the rest of us are a matrix [a mixture].
the transgendered, they appear to be uniformly one gender in all three
brain dimensions, but of the opposite gender, both physically and
sub-category, Genetics, is only beginning to be
understood. What mechanism and to what degree does genetic influences
effect one's expression of gender? We do know that besides the
traditional XX chromosome of a typical female and the XY of a typical
male, that there are other combinations such as XXY, XYY, and XO.
combination results in 47 rather the 46 chromosomes. This condition is
called Klinefelder's syndrome and occurs in one in every 500 births.
Individuals with Klinefelder's are sterile, have enlarged breasts, small
testicles and penis, and a eunuch body shape much like the "Pat" character on "Saturday Night Live." They show
little interest in sex.
47-chromosome occurrence is XYY Syndrome. In this syndrome, the hormonal
and physical appearance of the individual are evidenced as a normal
male, but behavior is effected. Typically, XYY Syndrome people are
bisexual or paraphilic (pedophilia, exhibitionism, voyeurism, etc.), and
show very poor impulse control.
Klinefelder's and XYY Syndrome are examples of an extra
chromosome, Turner's syndrome is a case of a missing sex
chromosome. These individuals possess 45 chromosomes (written as XO),
are unable to develop gonads, and are free of all sexual hormones,
except that crossing over from the mother during fetal life.
Syndrome people have external sex organs approximating a female,
and their behavior is characterized as hyper-feminine, baby care
oriented, and showing very poor spatial and math skills. The Turner's
personality, free of all influence from testosterone, tends to be in
direct opposition to the typical set of "Tom Boy" traits.
of the above conditions describes the transgendered individual.
Transgenderism is far more subtle, involving probably only a few genes
on a single chromosome.
discuss this aspect of gender we need to examine hormonal involvement,
in particular testosterone. During fetal life, the amount present, or
the absence of testosterone and other androgens determines our
sexuality — physically, mentally and emotionally. There are
key times or periods during development when the fetus will go towards
the male or the female depending on the level of testosterone. These
windows of opportunity may be only open for a few days and if the needed
level of testosterone is not present, a basic female orientation
develops regardless of the testosterone levels before or after this
critical period, and the resulting sexual imprint.
critical period is at conception when the presence of the SRY gene
(Sex-Determining Region of the Y chromosome) will determine our physical
gender. The SRY gene is normally found on the short arm of the Y
chromosome, but can detach making for a XY female (the Y missing its SRY
gene) or a XX male (the SRY attaching to the X).
gene causes the fetus to release TDF (Testes Determining Factor) which
turns the undifferentiated gonad into testes. Once testes have formed,
they release androgens
the release of TDF, the developing fetus has two tiny structures, the
mullerian and wolffian ducts, and two small-undifferentiated gonads,
neither testes nor ovaries. WithouttWith the influence of TDF, the gonads
become testicles and the wolffian duct forms the male internal sex
organs, the mullerian ducts dissolve and the external tissue develop
into the penis, scrotum, penile sheaths and foreskin. In other words,
without testosterone all fetuses develop into females. Adam
springs from Eve, not Eve from Adam.
primary sexual differentiation proceeds towards our physical gender,
sometimes deviations occur. These anomalies are sometimes called "experiments of nature." One such "experiment" is a
condition termed congenital adrenal hyperplasia (CAH) when the
female fetus releases a steroid hormone form her adrenal glands which
resembles testosterone. The resulting child often has confusing genitals
ranging from deformed female genitals to an appearance of male genitals.
If the child is raised as male, following any "adjusting"
surgery and given male hormones at puberty, the individual develops as a
"normal" but sterile male with XX chromosomes. On the other
hand, if the infant is surgically corrected to female and given female
hormones, there is a 50/50 chance of lesbian or transgender expression.
This "correction" is the source of much unhappiness, and most
"intersexed" individuals have this condition.
revealing "experiment of nature" is Androgen Insensitivity
Syndrome. In this case, there is a normal amount of testosterone
circulating in a XY chromosome fetus, but each cell of its body is
unable to react to it. This is similar to Turner's Syndrome in that
neither the mullerian or wolffian ducts (see above) mature and the
external genitalia develops into an approximation of normal female
genitals, but differs in that TDF stimulates the gonads into becoming
functioning testicles in a XY chromosome body. The child is raised as a
girl and is seen as a normal female until she fails to menstruate
because she has no uterus. If her testes produce enough estrogen (excess
testosterone is converted into estrogen), she develops into a completely
normal appearing (but lacking a uterus and upper vagina), sterile female
with XY chromosomes and internal testicles.
LeVay, in his book, "The Sexual Brain," argues that one's
brain receptors for hormones may also play a significant role in our
gender development. Dr. LeVay writes, "There is much to
recommend...that there are intrinsic, genetically determined differences
in the brain's hormone receptors. This would provide a mechanism that
involves hormone-induced brain differentiation (along gender lines) but
does not require there to be differences in the actual levels of
hormones, and there is opportunity for selective effects on different
times keep in mind that Physical Gender does not always indicate "Brain Gender," while most physical male and female infants
have Brain Gender matching their physical gender, a significant (but
unknown) percentage do not. And in transgendered individuals, the
Physical and Brain Gender are the opposite, and begin to express
themselves at birth.
few hours after birth, significant behavioral differences are noted
between morphologically "normal" boys and girls. Newborn girls
are much more sensitive to touch and sound than their male counterparts.
Several day old girls spend about twice as long looking back at an adult
face than boys, and even longer if the adult is speaking. A girl can
distinguish between the cries of another infant from other extraneous
noises long before a boy. Even before they can understand language,
girls do better at identifying the emotional context of speech.
during the first few weeks of infant life, boys are inattentive to the
presence of an adult, whether speaking to the infant or not. However,
baby boys tend to show more activity and wakefulness. At the age of
several months, girls can usually distinguish between the faces of
strangers and people they know—boys usually do not demonstrate this
infants grow into children, the differences seem to intensify and
polarize. Girls learn to speak earlier than boys and do a better job of
it. Boys want to explore areas, spaces and things, girls like to talk
and listen. Boys like vigorous play in a large space where girls
like more sedentary games in smaller spaces. Boys like to build, take
things apart, explore mechanical aspects of things and are interested in
other children only for their "use" (playmates, teammates,
allies, etc.). Girls see others more as individuals—and will likely
exclude a person because they're "not nice," and will more
readily include younger children and remember each other's names. Girls
play games involving home, friendship, and emotions. Boys like rough,
competitive games full of "'zap, pow' and villainy."
Boys will measure success by active interference with other players,
preferring games where winning and losing is clearly defined. In
contrast, girl play involves taking turns, cooperation and indirect
competition. Tag is a typical boy's game, hopscotch is a girl's game.
grow into adults, these differences become both more subtle and
brained individuals are naturally socialized, tend to prefer
cooperation, group discussions and compromise, but are rigid rule
followers. Male brained individuals need to be forced into a social
conscience, see everything as winning or losing, and are very
territorial (my idea, my place, my person, etc.). Competitive and keenly
aware of their place in the pecking order, males view rules as something
to avoid, ignore or use against others. (The legal profession is very
brained individuals are very aware of emotional states, both in
themselves and others, and have a gift for, and need to express
themselves in language. These two needs/abilities combine so that there
is a great deal of discussion and description of everyday things (food,
experiences, involvements and other people) with an emotional context
and value judgment.
brained individuals have great difficulty identifying emotional states
of any kind beyond anger, fear and lust, either in themselves or others.
Language tends to be restricted and used sparingly, and hardly ever to
describe emotional states. But male brains do have superior spatial and
non-verbal skills, such as mathematics, map reading, 3-D conceptions,
and with increasing intelligence, abstractions.
for reasons not understood (at least by this writer), gender differences
seem to decrease as our IQ points increase. One study indicated that
one-third of physical females in graduate school had brains wired more
like a typical male brain.
folk tend to be born with a female brain gender, but shortly after eight
years of age begin to forsake it for a makeshift male brain type of
response. It is like abandoning a four-lane highway and taking a little
dirt road beside it -- and making the best of their choice. Why do such
a thing? To fit in. Around eight or nine years of age, the differences
between male and female behavior become obvious. In order to fit in, the
physical male with a female brain begins to mimic and then perfect (as
much as they can) a male response, leaving their natural female self
unexpressed or underdeveloped.
transgendered physical males are very good at this subterfuge and
produce a flawless macho male persona. Others are less successful, and
some produce a "Swiss cheese" persona where glimpses or whole
chunks of their natural female thinking showing through. But, no matter
how efficient an individual is in hiding their natural gender from
others, they will always be aware (at least at times and to some degree)
of it themselves.
non-transgendered would typically be able to live with their female
gendered brain (most writers, artists, actors), forming some sort of
truce or overcompensation which even they would usually come to accept
as being true. But, alas, the transgendered also have a female gendered
Brain Sex and Identity.
appears to be a male and female pattern of psychosexual behavior. These
are modes of behavior -- one male, one female which are laid down, like
Brain Gender, in early life and seem to be independent of environment
(how, where, and by whom we are raised) and can be independent of both
Physical Gender and Brain Gender.
delve into what Brain Sex is, let me state what it is not -- it
is not sexual orientation. While sexual orientation can be an
attribute of Brain Sex, it is not a primary one. More on this later.
Brain Sex? Brain Sex is the primary hard-wired patterns which dictates
how we view and relate to others on a social, interpersonal and sexual
level. Although, like Brain Gender, most physical females will have
female Brain Sex and physical males, male Brain Sex. But, this is far
from absolute, and in the case of transgendered folk, it is the reverse.
A physical male transgendered person will have female Brain Sex as
well as female Brain Gender.
referring to female and male brained individuals in this section, I will
be referring to their Brain Sex regardless of the physical or Gender
brained individuals cannot and do not separate how they feel about a
person (good, bad, nice, boring, etc.) and how they see them sexually.
They must feel positive about a person as an individual in order to
sexually desire them. Male brained individuals have a distant
disconnect between feelings about a person as an individual and as a
sex object. Males can easily, sometimes preferably, have sex with a
person they don't know, don't like or even actively dislike. Love and
sex are two different worlds for the male brained. These two worlds can
come together, and for most this is preferred, but it is not necessary,
and for some, not even desired.
female brained individuals, environmental factors are very important
when it comes to sexual contact. Such things as lighting (candles, soft
lighting), smells, sensual bedding, music and a "romantic" ambiance are important to erotic feelings and fantasies. Males can have
sex anywhere, any time, any place with equal gusto. Sex in the bed, car
or dark room with a stranger are all equivalent.
environmental concerns are low on the male totem pole of desires,
sensual attitudes come very high. How their partner looks, feels, even
smells, is very important. Males prefer their partner young (or with
young features), smooth and "sexy." Looks and sensual
components are much less important to the female brain, with social
status and acceptance given greater weight.
importance given to the senses in males and their disconnect between
romantic feeling and sex objects, help explain male interest in
pornography and their ability to have sex to orgasm almost
indiscriminately (sex dolls) and often counter to the stated attributes
of a desired partner (sex in prison).
female brained individuals are highly influenced by what society expects
or rejects in regard to their general and erotic behavior; males are
often most influenced by what display value and "bragging
rights" their behavior and partner possesses.
sexual orientation, this is an attribute which I feel to be limited to
male brained individuals. I know this is heresy and very socially
incorrect in some circles. But, allow me to illustrate my point. While
male brained persons are capable (at least while young) of having sex
with almost anything (animal, vegetable, or mineral), they are from an
early age romantically and sexually drawn to a specific physical type,
male or female. No matter what their socially influenced sexual activity
may be, or for how long, their basic attraction (even if denied) is not
acted on, their orientation does not change.
brained individuals, on the other hand, appear to be much more fluid and
less physically restricted in their choice of sexual partners. Women
routinely become romantically attached to each other, but physical
expressions remain atypical for most. While periods of lesbian
experimentation is not rare among women, for a straight male to become
romantically involved with another male in mid-life without previous gay
feelings unexpressed is all but unknown.
brained persons are far more influenced by a person's personality and "niceness" than their body, and being great rule followers,
they are highly influenced by what "society" expects of them.
This society can be anything from the greater society to their
neighborhood, family, friends, religious or social group. If a female
brained individual meets an emotionally compatible woman in a socially
accepting or nurturing environment, a romance can take place. A male
might have sex, but never romance.
transgendered physical males have female brain sex, they lack a
hard-wired sexual orientation. Therefore, while some transgender women
retain a "lesbian orientation," the majority, in spite of
their behavior, feelings and expectations before transition, develop an
attraction to males and desire a "normal" romantic and sexual
relationship with a man. They follow the rules first as a physical male
later as a physical woman.
Those individuals with a desire to wear the clothing of
the other sex but not to change their sex are termed crossdressers. Most
crossdressers view themselves as heterosexual men who like to wear
women's clothing in private or in public, and may even occasionally
fantasize about becoming a woman. Once referred to as a transvestite,
crossdresser has become the term of choice.
Transgenderists are men and women who prefer to steer
away from gender role extremes and perfect an androgynous presentation
of gender. They incorporate elements of both masculinity and femininity
into their appearance. Some persons may see them as male, and by others
as female. They may live part of their life as a man, and part as a
woman, or they may live entirely in their new gender role but without
plans for genital surgery.
Men and women whose gender identity more closely matches
the other physical sex are termed transsexual. These individuals desire
to rid themselves of their primary and secondary sexual characteristics
and live as members of the other sex.
Transsexuals are diagnostically divided into the
sub-categories of Primary or Secondary. Primary transsexuals display an
unrelenting and high degree of gender dysphoria, usually from an early
age (four to six years of age). Secondary transsexuals usually come to a
full realization of their condition in their twenties and thirties, but
may not act on their feelings until they are much older. Typically,
secondary transsexuals first go through phases that would be
self-assessed as being a "crossdresser or transgenderist."
of our five attributes, Gender Identity, is the
last to be identified, and the least understood and researched. Gender
identity is one's subjective sense of one's own sex. Like
pain, it is unambiguously felt but one is unable to prove or display it
to others.Gender Identity does not match their Physical
Gender, the individual is termed Gender Dysphoric. Like minority
Sexual Orientation, Gender Dysphoria is not pathological, but a natural
aberration occurring within the population, like blue eyes. As with
minority sexual orientation, the percentage of the population having
gender dysphoria is in dispute, with estimates ranging between one in
39,000 individuals up to three percent of the general population. My
experience leads me to feel that the higher figure (3%) is closer to the
male gender dysphoric individuals have been described, either by
themselves or by others, as falling into three distinct groups: crossdressers,
transgenderists and transsexuals.
these categories are the generally accepted classifications both within
the gender community and among helping professionals, during my work
with gender folk I have come to the belief that there is only one cause,
one conflict, one condition — but there are many reactions and
adjustments to it. I have gradually come to the conclusion that one's
coming to terms with the conflict between one's knowledge of their true
gender and one's need to be "normal" fosters the same conflict
in all gender folk. Because a child's greatest desire is to be normal
(like everybody else), the great majority of transgendered individuals
create an artificial self which meets this goal. They are often so
successful at this that they not only fool everyone else but themselves
as well — at least part of the time, in some way.
created, physically male gender folk live in their male role — a 3-D
personality with its own goals, likes and dislikes, values, hobbies,
etc. Although indistinguishable from the "real thing," it
isn't themselves. It is an artificial creation for them to be able to fit
in. This is achieved at the expense of denying, locking away, their
natural female self. (See Brain Gender and Brain Sex.) Their desire to
be "normal" has denied them their natural selves. But, as the
nagging reality of the deception becomes harder and harder to suppress,
one has to express their true gender somehow, in some way.
dressing is the obvious compromise. If one cannot be female, one
can at least express femininity. But the more one expresses one's true
self, the desire for more becomes greater. Some individuals continue
expressing themselves more and more, others panic and purge only to
start again later.
gender identity classification (crossdresser, transgenderist,
transsexual, etc.) is due to each individual's adjustment to first the
conflict between one's natural gender and their need to be "normal," and later to the conflict between one's natural
gender and their "male persona." There is no objective
"best solution," only a subjective, personal best solution.
years or decades of living, working and building within their male
persona, it is often too "expensive" to give up the life,
perks, family, etc., one has built up—in order to go back to basics
and have an emotionally 12 year old girl grow up—and live in a once
male 40+ year old body. But no one is too old to transition. I have had
many people in their 40's and 50's transition very successfully. I have
even had some clients in their 60's and 70's.
far one is able to go toward dismantling the male persona and allowing
their female subjective gender to develop, one generally seems to have
the following three levels of transition:
that one's Brain Gender is different from one's Physical Gender —This first phase comprises the majority of transgendered persons (75
– 95%) and can take the form of seeing one's self as a "woman
trapped in a man's body," a need to express one's "feminine
side," etc. This stage is mainly concerned with physical/surface
changes such as crossdressing, passing, makeup, wigs, etc. In this first
part, many gender folk don't even venture from their own home in female
attire or restrict their expression to undergarments (bra, panties) in
public. They often have a juvenile (before age 15) and later, an adult
phase. There is often years or decades between the two phases. This
level is filled with confusion, conflict, guilt, panic, and purging. The
so called "Primary Transsexual" is an individual who never
constructs a male persona and therefore never accepts their male
genitals or challenges their female Self Map/subjective gender.
one's True Self— This stage is much more varied than the
first, and has less emotional turmoil. This is the stage where one
begins to accept their female self in some way and to make lifestyle
changes to accommodate this acceptance. One may only accept the need to
appear female, still denying their female true self (crossdresser) or
begin to accept their true female self, but concentrating on a
superficial physical level of change (transsexual, transgendered).
self-identified crossdresser may begin to bring his significant other
into his dressing, begin going to crossdresser meetings and events, or
even going out into public. Those individuals more accepting of their
true self will start to look for help in physical transitioning, such as
hormones, electrolysis, and surgery, as well as wigs, makeup and
insight lacking at this stage is that they are still under the control
of the male persona with all of its unnatural fears, drives,
expectations, and knowledge. Even their view of their "female
self" is his view, not their freed and autonomous female
self. They are still trapped in the belief that physical form alone
one's True Self — This is the last but unfortunately least
experienced part of transitioning. This is the stage when that little
girl trapped inside an artificial male persona in order to fit in,
breaks free, grows up and has her own life — often with markedly
different values, temperament and interests.
been my observation that the female self needs little help in growing up
and developing if the overpowering weight of the male persona is removed
from it. The transgender individual has spent years, decades developing,
reinforcing and living in their male role. Dismantling the male persona
takes a great deal of time, effort and outside help. But, an
individual's sense of happiness and success is directly parallel with
the degree they have dismantled their male identity, not on their
age, physical size, hormones, surgery, etc.