Transsexualism and transgender: links & articles

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This page collates links to peer-reviewed papers on the subject of transsexualism and transgender. Where non scientific papers have been included, eg Veale, it is because the author or the paper has achieved prominence in the debate.

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Many academic papers are behind paywalls and fees are astronomical, simply not viable for independent researchers. In 2011,  Alexandra Elkabyan established Sci-Hub, a resource based in Russia which gives access to tens of millions of papers for free. Of course, the USA has repeatedly tried to shut Sci-Hub down, because the exchange of knowledge and academic free speech comes a long way after profit, to the USA.

As a result of the self-appointed ‘global policeman’s actions, Sci-Hub had to move from its original URL. Google, of course, does not return useful links if you search using it. You may also find your anti-virus, or your ISP, blocks its current address. You may be able to whitelist the site in the former case. (At 22/10/20 I could access it at but only by mobile device.)


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The American Psychiatric Association’s Diagnostic and Statistical Manual (Fifth Edition) chapter on Gender Dysphoria (PDF download)The APA on Gender Dysphoria

Published Papers (alphabetically sorted by lead author)


Ainsworth TA. Quality of life of individuals with and without facial feminization surgery or gender reassignment surgery. 2010.



To determine the self-reported quality of life of male-to-female (MTF) transgendered individuals and how this quality of life is influenced by facial feminization and gender reassignment surgery.


Transwomen have diminished mental health-related quality of life compared with the general female population. However, surgical treatments (e.g. FFS, GRS, or both) are associated with improved mental health-related quality of life.

Auer M K. Transgender Transitioning and Change of Self-Reported Sexual Orientation.


Bailey, J. M. 2003. The man who would be queen: The science of gender-bending and transsexualism. Washington, DC: Joseph Henry Press.

Bailey, J. M. 2005. Academic McCarthyism. Northwestern Chron, Oct. 9.

Bailey, J. M., and K. J. Zucker. 1995. Childhoood sex-typed behavior and sexual orientation: A conceptual analysis and quantitative review. Dev Psychol 31:43–55.


Bakker A The prevalence of transsexualism in The Netherlands. 1993.


The prevalence of transsexualism in the Netherlands was estimated by counting all the subjects who were diagnosed as transsexuals by psychiatrists or psychologists and were subsequently hormonally treated and generally underwent sex-reassignment surgery. At the end of 1990, 713 Dutch-born transsexuals received treatment (507 men, 206 women). This amounts to a prevalence of 1:11,900 for male-to-female transsexualism and 1:30,400 for female-to-male transsexualism (population age 15 and above in both groups). The sex ratio was about 2.5 men to 1 woman. The most important reason for this relatively high prevalence seems to be the benevolent climate for the treatment of transsexualism in the Netherlands.

Barboza et al. Physical victimization, gender identity and suicide risk among transgender men and women. 2016.



We investigated whether being attacked physically due to one’s gender identity or expression was associated with suicide risk among trans men and women living in Virginia. The sample consisted of 350 transgender men and women who participated in the Virginia Transgender Health Initiative Survey (THIS). Multivariate multinomial logistic regression was used to explore the competing outcomes associated with suicidal risk. Thirty-seven percent of trans men and women experienced at least one physical attack since the age of 13. On average, individuals experienced 3.97 (SD = 2.86) physical attacks; among these about half were attributed to one’s gender identity or expression (mean = 2.08, SD = 1.96). In the multivariate multinomial regression, compared to those with no risk, being physically attacked increased the odds of both attempting and contemplating suicide regardless of gender attribution. Nevertheless, the relative impact of physical victimization on suicidal behavior was higher among those who were targeted on the basis of their gender identity or expression. Finally, no significant association was found between multiple measures of institutional discrimination and suicide risk once discriminatory and non-discriminatory physical victimization was taken into account. Trans men and women experience high levels of physical abuse and face multiple forms of discrimination. They are also at an increased risk for suicidal tendencies. Interventions that help transindividuals cope with discrimination and physical victimization simultaneously may be more effective in saving lives.

Beemyn & Rankin. Understanding Transgender Lives

Bentler, P. A typology of transsexualism: Gender identity theory and data.

This paper pre-dates Blanchard and in it the authors describe three types of transsexual: homosexual, asexual and heterosexual. Blanchard was able to reconcile the two latter groups into one, autogynephilic.

Blanchard, R. Heterosexual and homosexual gender dysphoria


This study investigated why more males than females complain of dissatisfaction with their anatomical sex (gender dysphoria). New referrals to a university gender identity clinic were dichotomously classified as heterosexual or homosexual. There were 73 heterosexual and 52 homosexual males; 1 heterosexual and 71 homosexual females. The average heterosexual male was 8 years older at inception than the homosexual groups. The heterosexual males reported that their first cross-gender wishes occurred around the time they first cross-dressed, whereas the homosexual groups reported that cross-gender wishes preceded cross-dressing by 3–4 years. Some history of fetishistic arousal was acknowledged by over 80% of the heterosexual males, compared to fewer than 10% of homosexual males and no homosexual females. The results suggest that males are not differentially susceptible to gender dysphoria per se, but rather that they are differentially susceptible to one of the predisposing conditions, namely, fetishistic transvestism.

Blanchard, R, The Concept of Autogynephilia and the Typology of Male Gender Dysphoria.

This is paper sets out the basis of Blanchard’s typology. The appendix contains his questionnaires. One of the most important sentences in it is this:

‘the central prediction of the present study, namely, that autogynephilic behavior will be reported more frequently by non-homosexual than by homosexual gender dysphorics.’ (My emphasis.)

It has been the consistent attempt of Western autogynephilic activists to attack Blanchard for making what they call ‘generalisations’. That is a straw man. Blanchard, in all his  papers, is careful not to go beyond the science. This is demonstrated here.

Blanchard, R The Classification and labeling of no nonhomosexual gender dysphorias. 1989 (pdf)

Perhaps the definitive paper by Blanchard on non-homosexual gender dysphoria, otherwise known as Autogynephilia.

Blanchard, R. A History of Autogynephilia (pdf) Blanchard- History of Autogynephilia

Blanchard, R. Typology of male-to-female transsexualism

Blanchard, R. The classification and labeling of nonhomosexual gender dysphorias

Blanchard R, Collins PI., “Men with sexual interest in transvestites, transsexuals, and she-males”

Blanchard R., “The she-male phenomenon and the concept of partial autogynephilia”

Blanchard R,et al. Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics.


The authors’ clinical impression that homosexual gender-dysphoric males are physically smaller than nonhomosexual gender-dysphoric males was tested. Subjects were 176 homosexual and 246 nonhomosexual male outpatients, ages 16 to 65, who complained of discontent with their biological sex. Compared with the nonhomosexual male gender dysphorics, the homosexual gender dysphorics were shorter, lighter, and lighter in proportion to their height. The homosexual gender dysphorics were also shorter than men in the general population, whereas the nonhomosexual gender dysphorics were not. The smaller physiques of homosexual gender-dysphoric men may partly explain the clinical observation that these patients are somewhat more successful in passing as women.

Blanchard, R. Fraternal Birth Order and the Maternal Immune Hypothesis of Male Homosexuality. 2001. (pdf)

Blanchard, R. Review and theory of handedness, birth order, and homosexuality in men. 2008.


Research has repeatedly shown that older brothers increase the odds of homosexuality in later-born males. This phenomenon has been called the fraternal birth order effect. The most highly developed explanation of this phenomenon is the maternal immune hypothesis, which proposes that the fraternal birth order effect reflects the progressive immunisation of some mothers to male-specific antigens by each succeeding male foetus and the concomitantly increasing effects of anti-male antibodies on the sexual differentiation of the brain in each succeeding male foetus. Recent studies indicate that older brothers increase the odds of homosexuality in right-handed males but not in non-right-handed males. The present article explores how the maternal immune hypothesis might be extended or modified to account for the apparent interaction of older brothers and handedness. Two possibilities are considered: (1) non-right-handed foetuses are insensitive to the presence of maternal anti-male antibodies, and (2) mothers of non-right-handed foetuses do not produce anti-male antibodies.

Review and theory of handedness, birth order, and homosexuality in men (PDF Download Available). Available from:

Blanchard R, et al. Sexual Attraction to Others: A Comparison of Two Models of Alloerotic Responding in Men 2010


The penile response profiles of homosexual and heterosexual pedophiles, hebephiles, and teleiophiles to laboratory stimuli depicting male and female children and adults may be conceptualized as a series of overlapping stimulus generalization gradients. This study used such profile data to compare two models of alloerotic responding (sexual responding to other people) in men. The first model was based on the notion that men respond to a potential sexual object as a compound stimulus made up of an age component and a gender component. The second model was based on the notion that men respond to a potential sexual object as a gestalt, which they evaluate in terms of global similarity to other potential sexual objects. The analytic strategy was to compare the accuracy of these models in predicting a man’s penile response to each of his less arousing (nonpreferred) stimulus categories from his response to his most arousing (preferred) stimulus category. Both models based their predictions on the degree of dissimilarity between the preferred stimulus category and a given nonpreferred stimulus category, but each model used its own measure of dissimilarity. According to the first model (“summation model”), penile response should vary inversely as the sum of stimulus differences on separate dimensions of age and gender. According to the second model (“bipolar model”), penile response should vary inversely as the distance between stimulus categories on a single, bipolar dimension of morphological similarity-a dimension on which children are located near the middle, and adult men and women are located at opposite ends. The subjects were 2,278 male patients referred to a specialty clinic for phallometric assessment of their erotic preferences. Comparisons of goodness of fit to the observed data favored the unidimensional bipolar model.

Blanchard, R. Fraternal Birth Order, Family Size, and Male Homosexuality: Meta-Analysis of Studies Spanning 25 Years. 2018. Archives of Sexual Behavior


The fraternal birth order effect is the tendency for older brothers to increase the odds of homosexuality in later-born males. This study compared the strength of the effect in subjects from small versus large families and in homosexual subjects with masculine versus feminine gender identities. Meta-analyses were conducted on 30 homosexual and 30 heterosexual groups from 26 studies, totaling 7140 homosexual and 12,837 heterosexual males. The magnitude of the fraternal birth order effect was measured with a novel variable, the Older Brothers Odds Ratio, computed as (homosexuals’ older brothers ÷ homosexuals’ other siblings) ÷ (heterosexuals’ older brothers ÷ heterosexuals’ other siblings), where other siblings = older sisters + younger brothers + younger sisters. An Older Brothers Odds Ratio of 1.00 represents no effect of sexual orientation; values over 1.00 are positive evidence for the fraternal birth order effect. Evidence for the reliability of the effect was consistent. The Older Brothers Odds Ratio was significantly >1.00 in 20 instances, >1.00 although not significantly in nine instances, and nonsignificantly <1.00 in 1 instance. The pooled Older Brothers Odds Ratio for all samples was 1.47, p < .00001. Subgroups analyses showed that the magnitude of the effect was significantly greater in the 12 feminine or transgender homosexual groups than in the other 18 homosexual groups. There was no evidence that the magnitude of the effect differs according to family size.

Dr Ray Blanchard remains one of the most interesting researchers into sex and sexuality, after a career of over 40 years.  He is generous of his time and will respond to requests for full pdf versions of papers not already available as such, for those who lack academic access to them. He can be contacted through his Researchgate page here:

Blanchard, R Early History of Autogynephilia 2005


Blanchard, R. 1985.Typology of male-to-female transsexualism. Arch Sex Behav 14(3): 247–61.

Blanchard, R. 1988. Nonhomosexual gender dysphoria. J Sex Res 24(2):188–93.

Blanchard, R. 1989a. The concept of autogynephilia and the typology of male gender dysphoria. J Nerv Ment Dis 177(10):616–23.

Blanchard, R. 1989b. The classification and labeling of nonhomosexual gender dysphorias. Arch Sex Behav 18(4):315–34.

Blanchard, R. 1990. Gender identity disorders in adult men. In Clinical management of gender identity disorders in children and adults, ed. Blanchard R. and B.W. Steiner, 47–76. Washington, DC:American Psychiatric Press.

Blanchard, R. 1991. Clinical observations and systematic studies of autogynephilia. J Sex Marital Ther 17(4):235–51.

Blanchard, R. 1993a. The she-male phenomenon and the concept of partial autogynephilia. J Sex Marital Ther 19:69–76.

Blanchard, R. 1993b. Partial versus complete autogynephilia and gender dysphoria. J Sex Marital Ther 19:301–7.

Blanchard, R. 2000. Part II: The case for publicly funded transsexual surgery. Psychiatr Rounds 4(2):4–6.

Blanchard, R. 2005. Early history of the concept of autogynephilia. Arch Sex Behav 34(8): 439–46.

Blanchard, R., L. H. Clemmensen, and B.W. Steiner. 1987. Heterosexual and homosexual gender dysphoria. Arch Sex Behav 16(2):139–52.

Blanchard R, Dickey R, Jones CL. Comparison of height and weight in homosexual versus nonhomosexual male gender dysphorics. Arch Sex Behav. 1995 Oct;24(5):543-54.

The authors’ clinical impression that homosexual gender-dysphoric males are physically smaller than nonhomosexual gender-dysphoric males was tested. Subjects were 176 homosexual and 246 nonhomosexual male outpatients, ages 16 to 65, who complained of discontent with their biological sex. Compared with the nonhomosexual male gender dysphorics, the homosexual gender dysphorics were shorter, lighter, and lighter in proportion to their height. The homosexual gender dysphorics were also shorter than men in the general population, whereas the nonhomosexual gender dysphorics were not.

Blanchard, R., and S. J. Hucker. 1991. Age, transvestism, bondage and concurrent paraphilias in 117 fatal cases of autoerotic asphyxia. Br J Psychiatry 159:371–77.

Blanchard, Ray; Racansky, I. G; Steiner, Betty W.  Phallometric detection of fetishistic arousal in heterosexual male cross-dressers. 1988


Examined whether an erotic response to cross-dressing fantasies could be detected in heterosexual male cross-dressers (HCDs) who verbally denied any erotic arousal in association with cross-dressing for at least the past year. Ss were 37 HCD patients (mean age range 29.1–36.2 yrs) and 10 heterosexual controls (mean age 23 yrs). HCDs were divided into groups according to their response to a questionnaire item asking the proportion of occasions that cross-dressing was erotically arousing during the past year. Penile blood volume was monitored while Ss listened to descriptions of cross-dressing and sexually neutral activities. All HCD groups responded significantly more to cross-dressing than to neutral narratives. It is suggested that only those causal hypotheses of heterosexual cross-dressing that also account for the presence of fetishism need to be considered.


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Bockting et al. Gay and bisexual identity development among female-to-male transsexuals in North America: emergence of a transgender sexuality.

Bogaert, Anthony F. The prevalence of male homosexuality: the effect of fraternal birth order and variations in family size 2004

Bradley, S. J., Oliver, G. D., Chernick, A. B., and Zucker, K. J. 1998. Experiment of nurture: Ablatio penis at 2 months, sex reassignment at 7 months, and a psychosexual follow- up in young adulthood. Pediatr 102(1): E9.

Bullough, Vern L. Transgenderism and the Concept of Gender

Burke, S et al. Structural connections in the brain in relation to gender identity and sexual orientation 2017


Both transgenderism and homosexuality are facets of human biology, believed to derive from different sexual differentiation of the brain. The two phenomena are, however, fundamentally unalike, despite an increased prevalence of homosexuality among transgender populations. Transgenderism is associated with strong feelings of incongruence between one’s physical sex and experienced gender, not reported in homosexual persons. The present study searches to find neural correlates for the respective conditions, using fractional anisotropy (FA) as a measure of white matter connections that has consistently shown sex differences. We compared FA in 40 transgender men (female birth-assigned sex) and 27 transgender women (male birth-assigned sex), with both homosexual (29 male, 30 female) and heterosexual (40 male, 40 female) cisgender controls. Previously reported sex differences in FA were reproduced in cis-heterosexual groups, but were not found among the cis-homosexual groups. After controlling for sexual orientation, the transgender groups showed sex-typical FA-values. The only exception was the right inferior fronto-occipital tract, connecting parietal and frontal brain areas that mediate own body perception. Our findings suggest that the neuroanatomical signature of transgenderism is related to brain areas processing the perception of self and body ownership, whereas homosexuality seems to be associated with less cerebral sexual differentiation.

Comment: On a number of parameters, this study conflicts with Rametti. The authors acknowledge this anomaly but do not explain it.


Campbell, Natalie M.  Nuclear family dynamics: Predictors of childhood crushes and adult sexual orientation 2015

Cantor, J M. New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism. 2011.

Full Article

Two independent empirical articles have recently appeared in the literature that, taken together, bear out an hypothesis Blanchard (2008) postulated in the Archives about brain development in transsexualism:

[T]he brains of both homosexual and heterosexual male-to-female transsexuals probably differ from the brains of typical heterosexual men, but in different ways. In homosexual male-to-female transsexuals, the difference does involve sex-dimorphic structures, and the nature of the difference is a shift in the female-typical direction. If there is any neuroanatomic intersexuality, it is in the homosexual group. In heterosexual male-to-female transsexuals, the difference may not involve sex-dimorphic structures at all, and the nature of the structural difference is not necessarily along the male–female dimension. (p. 437)

Blanchard’s prediction follows from studies that have repeatedly shown that the homosexual male-to-female transsexuals are “female-shifted” in multiple, sexually dimorphic characteristics, whereas the heterosexual male-to-female transsexuals are not (Blanchard, 1989a1989b). For example, homosexual male-to-female transsexuals are sexually attracted to natal males, express greater interest in female-typical activities (even in childhood), and are naturally effeminate in mannerism. In contrast, heterosexual male-to-female transsexuals are indistinguishable from nontranssexual natal males on these variables. The heterosexual transsexuals are still distinct from typical males in other ways, however, such as by manifesting “autogynephilia”—the erotic interest in or sexual arousal in response to being or seeming female. The consistent detection of cross-sex features among homosexual male-to-female transsexuals, but not among heterosexual male-to-female transsexuals, led Blanchard to predict that the cross-sex pattern would also emerge at the level of brain anatomy and be limited to the homosexual male-to-female transsexuals. That prediction now appears to be the case, with Rametti et al. (2010) supporting his prediction for the homosexual transsexuals, and Savic and Arver (2010), for the heterosexual transsexuals.

The Rametti team used an MRI technique called Diffusion Tensor Imaging to compare homosexual male-to-female transsexuals (n = 18) with nontranssexual, heterosexual control males (n = 19) and with nontranssexual, heterosexual control females (n = 19). They contrasted the male controls with the female controls to identify the sex-dimorphic portions of the brain and then contrasted the homosexual transsexuals with each of the control groups on the dimorphic brain regions so identified. The initial contrasts identified six sex-dimorphic brain regions. The homosexual transsexual sample was intermediate in volume on all six brain structures, significantly different from the male controls on five of the six (and significantly different from the female controls on all six). That is, these male-to-female transsexuals were different from the control males, shifted towards the female direction on all parameters.

Savic and Arver (2010) applied anatomical MRIs with an analogous research design, identifying the sex-dimorphic portions of the brain and contrasting the (this time) heterosexual transsexual sample (n = 24) with each control sample (n’s = 24 each) on the sex-dimorphic brain regions. Of the eight brain regions that distinguished male from female brains, the heterosexual transsexual sample differed from the male controls on none (Savic & Arver, 2010, Table 3). Of the four brain regions that distinguished these heterosexual transsexuals from the male controls, sex-dimorphism was present in none (Savic & Arver, 2010, Table 3). As Savic and Arver themselves emphasized, “Contrary to the primary hypothesis, no sex-atypical features with signs of ‘feminization’ were detected in the transsexual group….The present study does not support the dogma that [male-to-female transsexuals] have atypical sex dimorphism in the brain” although that statement should have been restricted to refer to heterosexual male-to-female transsexuals only.

Also meriting emphasis is that—although these data disconfirm that the heterosexual type has a feminized brain pattern—the data nonetheless confirm that heterosexual transsexuals have a brain structure distinct from that of typical (nontranssexual) persons. Their gender identity is not a transient or ephemeral characteristic, but a likely innate and immutable characteristic, emerging from their particular brain structure.

Clemens, B. Male‐to‐female gender dysphoria: Gender‐specific differences in resting‐state networks 2017 (full)



Recent research found gender‐related differences in resting‐state functional connectivity (rs‐FC) measured by functional magnetic resonance imaging (fMRI). To the best of our knowledge, there are no studies examining the differences in rs‐FC between men, women, and individuals who report a discrepancy between their anatomical sex and their gender identity, i.e. gender dysphoria (GD).


Our results provide first evidence that MtFs exhibit patterns of rs‐FC which are different from both their assigned and their aspired gender, indicating an intermediate position between the two sexes. We suggest that the present study constitutes a starting point for future research designed to clarify whether the brains of individuals with GD are more similar to their assigned or their aspired gender.

Chivers, M., and R. Blanchard. 1996. Prostitution advertisements suggest association of transvestism and masochism. J Sex Marital Ther 22: 97–102.

Cohen-Bendahan, C et al. Prenatal exposure to testosterone and functional cerebral lateralization: a study in same-sex and opposite-sex twin girls 2004. Psychoneuroendocrinology


De Vries et al. Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach 2012.


The Dutch approach on clinical management of both prepubertal children under the age of 12 and adolescents starting at age 12 with gender dysphoria, starts with a thorough assessment of any vulnerable aspects of the youth’s functioning or circumstances and, when necessary, appropriate intervention. In children with gender dysphoria only, the general recommendation is watchful waiting and carefully observing how gender dysphoria develops in the first stages of puberty. Gender dysphoric adolescents can be considered eligible for puberty suppression and subsequent cross-sex hormones when they reach the age of 16 years. Currently, withholding physical medical interventions in these cases seems more harmful to wellbeing in both adolescence and adulthood when compared to cases where physical medical interventions were provided.

Del Giudice, M. Joel et al.’s method systematically fails to detect large, consistent sex differences (in human brains.) 2016. (Letter)

Dhejne, C et al: Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden 2011



The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.


To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.


Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.



This study is limited in its usefulness because it does not control for the homosexual/non-homosexual variable. This results in two markedly different expressions, Homosexual transsexualism (HSTS) and Autogynephilic transvestism (AGP). The study method makes no attempt to account for this dichotomy, indeed it does not even mention it. Since the different types are so disparate, this renders it in essence useless, although it does illustrate that Gender Reconstruction Surgery is not the panacea for Gender Dysphoria that advocates claim it is. However, whether the negative effects are spread evenly across HSTS and AGP types is not analysed in the study.

This methodological failure should serve to indicate that research into Gender Dysphorias and the treatments of them must take into account and control for the four different types, male HS, male non-HS (AGP), female HS and female non-HS.

Dhejne, C. An Analysis of All Applications for Sex Reassignment Surgery in Sweden, 1960-2010: Prevalence, Incidence, and Regrets. 2014. (pdf)

Dorner, G et al Sexual differentiation of gonadotrophin secretion, sexual orientation and gender role behavior 1987

Dreger, Alice D. The Controversy Surrounding The Man Who Would Be Queen: A Case History of the Politics of Science, Identity, and Sex in the Internet Age 2008



 Fortenberry, JD Puberty and Adolescent Sexuality 2014

Freund, K.Cross-Gender Identity in a Broader Context


This chapter is a review of clinical and experimental studies that may suggest questions useful in research on the etiology of cross-gender identity (which is here conceived as an extreme form of masculine gender identity in females or feminine gender identity in males). The first section addresses itself to the typology of cross-gender identity and demonstrates that there are two main types, one occurring in homosexual, the other in heterosexual (or just nonhomosexual) persons. Next, the relationships among androphilia (an erotic preference for physically mature males), homosexual-type cross-gender identity, and feminine gender identity (in males) in general are explored. The second section investigates the feasibility of physiological hypotheses of homosexual cross-gender identity and discusses, in this context, relevant work on the development of gender identity in intersexes. The third section explores the relevance of animal studies to the problem of gender identity.

Freund K et al. Two types of cross-gender identity. 1982


A revision of the typology of male cross-gender identity was carried out by means of formalized, easily replicable methods. The results suggest (1) that there are two discrete types of cross-gender identity, one heterosexual, the other homosexual; (2) that transvestism, and closely related conditions of cross-gender identity, occur exclusively or almost exclusively in heterosexuals; (3) that of the two types of transsexualism distinguished in this study, type A is, in heterosexuals, very rare or completely nonexistent; (4) that (in the course of time) transvestites or borderline transsexuals (defined below) may develop sustained cross-gender identity, as observed by Stoller (1971); (5) that although, according to Hoenig and Kenna (1974), transsexualism by itself is not an anomalous erotic preference, it is (virtually) always either preceded by transvestism or accompanied by homosexuality or cross-gender fetishism.

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Galis, Frietson. Sexual Dimorphism in the Prenatal Digit Ratio (2D:4D)

Green et al. Specific cross-gender behaviour in boyhood and later homosexual orientation.

Green, R. Gender Identity in Childhood

Green, R. Gender Identity in Childhood and Later Sexual Orientation: Follow-Up of 78 Males (1983) (abstract)

Gooren, L. 2006. The biology of human psychosexual differentiation. Horm Behav 50: 589–601.

Green, R. 1987. The “sissy boy syndrome” and the development of homosexuality. New Haven: Yale Univ. Press.

Guillamon, A, et al. A Review of the Status of Brain Structure Research in Transsexualism

Gurven, M and Hill, K. Why Do Men Hunt? A Reevaluation of “Man the Hunter” and the Sexual Division of Labor


Hahn, al Structural Connectivity Networks of Transgender People 2015   Full paper

Hare et al. Androgen receptor repeat length polymorphism associated with male-to-female transsexualism.



There is a likely genetic component to transsexualism, and genes involved in sex steroidogenesis are good candidates. We explored the specific hypothesis that male-to-female transsexualism is associated with gene variants responsible for undermasculinization and/or feminization. Specifically, we assessed the role of disease-associated repeat length polymorphisms in the androgen receptor (AR), estrogen receptor β (ERβ), and aromatase (CYP19) genes.


A significant association was identified between transsexualism and the AR allele, with transsexuals having longer AR repeat lengths than non-transsexual male control subjects (p = .04). No associations for transsexualism were evident in repeat lengths for CYP19 or ERβ genes. Individuals were then classified as short or long for each gene polymorphism on the basis of control median polymorphism lengths in order to further elucidate possible combined effects. No interaction associations between the three genes and transsexualism were identified.

Hulshoff Pol, H. E., et al. 2006. Changing your sex changes your brain: Influences of testosterone and estrogen on adult human brain structure. Eur J Endocrinol 155(suppl. 1): S107–S114.

Herman-Jeglínska, A., A. Grabowska, and S. Dulko. 2002. Masculinity, femininity, and transsexualism. Arch Sex Behav 31:527–34.

Hilleke E Hulshoff Pol,  Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure 2006


Objective: Sex hormones are not only involved in the formation of reproductive organs, but also induce sexually-dimorphic brain development and organization. Cross-sex hormone administration to transsexuals provides a unique possibility to study the effects of sex steroids on brain morphology in young adulthood.

Methods: Magnetic resonance brain images were made prior to, and during, cross-sex hormone treatment to study the influence of anti-androgen + estrogen treatment on brain morphology in eight young adult male-to-female transsexual human subjects and of androgen treatment in six female-to-male transsexuals.

Results: Compared with controls, anti-androgen + estrogen treatment decreased brain volumes of male-to-female subjects towards female proportions, while androgen treatment in female-to-male subjects increased total brain and hypothalamus volumes towards male proportions.

Conclusions: The findings suggest that, throughout life, gonadal hormones remain essential for maintaining aspects of sex-specific differences in the human brain.

Hirschfeld M. Die Transvestiten. Berlin, Germany: Alfred Pulver Macher; 1910

Hockenberry et al. Sexual orientation and boyhood gender conformity: development of the Boyhood Gender Conformity Scale (BGCS) 1987




Two hundred twenty-five [corrected] respondents (109 [corrected] heterosexuals and 116 [corrected] homosexuals) completed a survey containing a 20-item Boyhood Gender Conformity Scale (BGCS). This scale was largely composed of edited and abridged gender items from Part A of Freund et al.’s Feminine Gender Identity Scale (FGIS-A) and Whitam’s “childhood indicators.” The combined scale was developed in an attempt to obtain a reliable, valid, and potent discriminating instrument for accurately classifying adult male respondents for sexual orientation on the basis of their reported boyhood gender conformity or nonconforming behavior and identity. In addition, 33% of these respondents were administered the original FGIS-A and Whitam inventory during a 2-week test-retest analysis conducted to determine the validity and reliability of the new instrument. All the original items significantly discriminated between heterosexual and homosexual respondents. From these a 13-item function and a 5-item function proved to be the most powerful discriminators between the two groups. Significant correlations between each of the three scales and a very high test-retest correlation coefficient supported the reliability and validity assumption for the BGCS. The conclusion was made that the five-item function (playing with boys, preferring [corrected] boys’ games, imagining self as sports figure, reading adventure and sports stories, considered a “sissy”) was the most potent and parsimonious discriminator among adult males for sexual orientation. It was similarly noted that the absence of masculine behaviors and traits appeared to be a more powerful predictor of later homosexual orientation than the traditionally feminine or cross-sexed traits and behaviors.

Hsu,  Rosenthal, Miller and Bailey, “Who are gynandromorphophilic men? Characterizing men with sexual interest in transgender women

Hsu, Rosenthal, Miller, & Bailey 2015  Who are gynandromorphophilic men? Characterizing men with sexual interest in transgender women. 2015


Italiano, M. Postsurgical Changes in the Neovagina. 1998.Transgender Treatment Bulletin.


Junger, J, et al More than Just Two Sexes: The Neural Correlates of Voice Gender Perception in Gender Dysphoria 2013


Compared to men and women, MtFs showed differences in a neural network including the medial prefrontal gyrus, the insula, and the precuneus when responding to male vs. female voices. With increased voice morphing men recruited more prefrontal areas compared to women and MtFs, while MtFs revealed a pattern more similar to women. On a behavioral and neuronal level, our results support the feeling of MtFs reporting they cannot identify with their assigned sex.

Link to full article:



Kulick, D. The Gender of Brazilian Transgender Prostitutes.1997

Note: This is an anthropological study of travestis, trans prostitutes. This, and Kulick’s other work on the subject is the most important body of information available on this subject. A great many of the observations that Kulick makes are found in other trans populations both in the West and elsewhere. Familiarity with the concepts discussed in this work will make it far easier to understand the nature of homosexuality and HSTS everywhere. (pdf download available.)

Karwowsk, Maciej Greater male variability in creativity: A latent variables approach 2016

Kruijver, F. P., et al. 2000. Male-to-female transsexuals have female neuron numbers in a limbic nucleus. J Clin Endocrinol Metab 85:2034–41.


Lagos et al. Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study. 2013.

Study of homosexual transsexuals, both MtF and FtM. Non-homosexual subjects were screened out. Results consistent with Rametti 2011.

Full text link:

Landén M, et al. Prevalence, incidence and sex ratio of transsexualism.1996.

Abstract: Frequency figures for transsexualism, concerning incidence, prevalence and sex ratio calculated in the 1960s and 1970s, were compared with recent reports. The incidence figures remained constant over time, whereas the prevalence figures tended to increase during the review period. The incidence was found to be of the same magnitude in men and women, while the corresponding ratio for prevalence figures was 3:1. It is suggested that men seeking sex reassignment represent a more heterogeneous group than women, and that the reported male predominance to date is due to a lack of categorical studies of primary/ genuine transsexualism. It would appear that genuine transsexualism is, on the whole, insensitive to societal changes. The fundamental disturbance underlying this psychosexual identity disorder is suggested to be neurobiological in origin.

Note: it is not clear what the author means by ‘primary/ genuine transsexualism‘ but we assume he means HSTS, given the subsequent comments.

Lawrence, Dr A. Anatomic Autoandrophilia in an Adult Male. 2009




Some men are sexually aroused by impersonating the individuals to whom they are sexually attracted, or by permanently changing their bodies to become facsimiles of such individuals. Blanchard (J Sex Marital Ther 17:235–251, 1991) suggested that these paraphilic sexual interests, along with fetishism, represented erotic target location errors, i.e., developmental errors in locating erotic targets in the environment. Because the desire to impersonate or become a facsimile of the kind of person to whom one is attracted can have significant implications for identity, Freund and Blanchard (Br J Psychiatry 162:558–563, 1993) coined the term erotic target identity inversion to describe this type of erotic target location error. The best-known examples of erotic target identity inversions occur in men who are sexually attracted to women and who are also sexually aroused by the idea of impersonating or becoming women; these paraphilic interests manifest as transvestic fetishism and as one type of male-to-female transsexualism. Analogous erotic target identity inversions have been described in men who are sexually attracted to children and to female amputees. In theory, erotic target identity inversions should also occur in men who are sexually attracted to men. There have been no unambiguous descriptions, however, of men who are sexually attracted to men and also sexually aroused by the idea of changing their bodies to become more sexually attractive men. This report describes such a man, whose paraphilic interest would appropriately be called anatomic autoandrophilia. The demonstration that anatomic autoandrophilia exists in men is consistent with the theory that erotic target location errors constitute an independent paraphilic dimension.

Lawrence, Dr A. Do Some Men Who Desire Sex Reassignment Have a Mental Disorder? Comment on Meyer-Bahlburg (2010) 2011

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Lawrence, A. Autogynephilia: A Paraphilic Model of Gender Identity Disorder.,_a_paraphilic_model_of_GID.pdf

Lawrence, Anne A. Autogynephilia and Heterosexuality 2012

Lawrence, A. Further Validation of Blanchard’s Typology: A Reply to Nuttbrock, Bockting, Rosenblum, Mason, and Hwahng (2010)’s_Typology_A_Reply_to_Nuttbrock_Bockting_Rosenblum_Mason_and_Hwahng_2010

Laube JS, et al. Sexual Behavior, Desire, and Psychosexual Experience in Gynephilic and Androphilic Trans Women: A Cross-Sectional Multicenter Study. J Sex Med. 2020 Jun;17(6):1182-1194. doi: 10.1016/j.jsxm.2020.01.030. Epub 2020 Mar 5. Erratum in: J Sex Med. 2020 Jun;17(6):1208. PMID: 32147311.


One of the most prominent etiological theories of gender incongruence in trans women proposes a paraphilic erotic target location error (ie, autogynephilia) as a causal factor in gynephilic (ie, exclusively gynephilic and bisexual) trans women. We hypothesized that a paraphilic erotic target location should manifest itself in various aspects of sexual behavior, solitary and dyadic sexual desire, and psychosexual experienes


This study shows flawed methodology by conflating homosexual transsexuals and pseudo-bisexual Autogyneophiles. This may have een deliberate. The result is that the study is valueless.

Lawrence, Anne A. Clinical and Theoretical Parallels Between Desire for Limb Amputation and Gender Identity Disorder 2006

Lawrence,A.A. 1998. Men trapped in men’s bodies: An introduction to the concept of autogynephilia. Transgend Tapestry 1(85):65–68.

Lawrence, A. A. 1999a. 28 narratives about autogynephilia.

Lawrence, A. A., 1999b. 31 new narratives about autogynephilia.

Lawrence,A.A. 2004. Autogynephilia: A paraphilic model of gender identity disorder. J Gay Lesbian Psychother 8(1/2):69–87

Lawrence,A.A. 2005. Sexuality before and after male-to-female sex reassignment surgery. Arch Sex Behav 34:147–66.

Lawrence,A.A. 2006. Clinical and theoretical parallels between desire for limb amputation and gender identity disorder. Arch Sex Behav 35(3):263–78.

Lawrence,A.A. 2007a. Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspect Biol Med 50(4):506–20.

Lawrence Anne A  A Critique of the Brain-Sex Theory of Transsexualism (2007) pdf download

Lawrence Anne A. Erotic Target Location Errors: An Underappreciated Paraphilic Dimension


Based on studies of heterosexual male fetishists, transvestites, and transsexuals, Blanchard (1991) proposed the existence of a hitherto unrecognized paraphilic dimension, erotic target location errors (ETLEs), involving the erroneous location of erotic targets in the environment. ETLEs can involve preferential attention to a peripheral or inessential part of an erotic target, manifesting as fetishism, or mislocation of an erotic target in one’s own body, manifesting as the desire to impersonate or become a facsimile of the erotic target (e.g., transvestism or transsexualism). Despite its potential clinical and heuristic value, the concept that ETLEs define a paraphilic dimension is underappreciated. This review summarizes the studies leading to the concept of ETLEs and describes how ETLEs are believed to manifest in men whose preferred erotic targets are women, children, men, amputees, plush animals, and real animals. This review also describes ETLEs in women; discusses possible etiologies of ETLEs; considers the implications of the ETLE concept for psychoanalytic theories of transvestism and male-to-female transsexualism, as well as for the forthcoming revision of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; suggests reasons why the concept of ETLEs has been underappreciated; and describes what might result if the concept were more widely appreciated.

Lawrence, Dr Anne A. Erotic Target Location Errors are Easy to Mischaracterize: A Reply to Moser. 2009

Lawrence, Dr Anne. Autogynephilia and the Typology of Male-to-Female Transsexualism: Concepts and Controversies. 2017.


Abstract: Sexual scientists have recognized for over a century that biologic males who seek sex reassignment – male-to-female (MtF) transsexuals – are not a homogeneous clinical population but comprise two or more distinct subtypes with different symptoms and developmental trajectories. The most widely used typologies of MtF transsexualism have been based on sexual orientation and have distinguished between persons who are androphilic (exclusively sexually attracted to males) and those who are nonandrophilic (sexually attracted to females, both males and females, or neither gender). In 1989, psychologist Ray Blanchard proposed that most nonandrophilic MtF transsexuals display a paraphilic sexual orientation called autogynephilia, defined as the propensity to be sexually aroused by the thought or image of oneself as a woman. Studies conducted by Blanchard and colleagues provided empirical support for this proposal, leading to the hypothesis that almost all nonandrophilic MtF transsexuals are autogynephilic, whereas almost all androphilic MtF transsexuals are not. Blanchard’s ideas received increased attention in 2003 after they were discussed in a book by psychologist J. Michael Bailey. The concept of autogynephilia subsequently became intensely controversial among researchers, clinicians, and MtF transsexuals themselves, causing widespread repercussions. This article reviews the theory of autogynephilia, the evidence supporting it, the objections raised by its critics, and the implications of the resulting controversy for research and clinical care.

Li et al. Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study. 2016.

Lippa, R. A. 2001. Gender-related traits in transsexuals and nontranssexuals. Arch Sex Behav 30:603–14.

Little A C. Women’s preferences for masculinity in male faces are highest during reproductive age range and lower around puberty and post-menopause 2010

Littman, L Rapid-onset gender dysphoria in adolescents and young adults: A study of parental reports 2018

Full paper available online, printable version

Rapid-onset gender dysphoria in adolesc..

Below is the GD working group’s response to Julia Serano’s ‘critique’ of the above paper. It is worth reading.

Response to Julia Serano’s critique of … Parental Reports – gdworkinggroup


Lonsdor, Elizabeth V. Sex differences in nonhuman primate behavioral development


Sex differences in behavior and developmental trajectories in human children are of great interest to researchers in a variety of fields, and a persistent topic of discussion and debate is the relative contribution of biological vs. social influences to such differences. Given the potentially large effects of cultural and social influences on human child development, nonhuman primates are important model species for investigating the biological and evolutionary roots of sex differences in human development. This Mini-Review briefly summarizes the existing literature on sex-biased behavior toward infant nonhuman primates by mothers and other social partners, followed by a review of findings on sex differences (or lack thereof) in primate behavioral development from a variety of species in wild and naturalistic settings. These include differences in physical and social development, including play, grooming, and object manipulation patterns, as well as nursing and the development of foraging behavior.


Madison, Söderlund. Objectivity and realms of explanation in academic journal articles concerning sex/gender: a comparison of Gender studies and the other social sciences (full text pdf)

Moser, C. Autogynephilia in Women. Journal of Homosexuality. 2009

Moser, C. Blanchard’s Autogynephilia Theory: A Critique

Murad, M et al. Hormonal therapy and sex reassignment: a systematic review and meta-analysis of quality of life and psychosocial outcomes. 2009.

Objective To assess the prognosis of individuals with gender identity disorder (GID) receiving hormonal therapy as a part of sex reassignment in terms of quality of life and other self-reported psychosocial outcomes.


Very low quality evidence suggests that sex reassignment that includes hormonal interventions in individuals with GID likely improves gender dysphoria, psychological functioning and comorbidities, sexual function and overall quality of life.


Newhook, JT, et al. A critical commentary on follow-up studies and “desistance” theories about transgender and gender-nonconforming children. 2018

(pdf download)

ABSTRACT Background: It has been widely suggested that over 80% of transgender children will come to identify as cisgender (i.e., desist) as they mature, with the assumption that for this 80%, the trans identity was a temporary “phase.” This statistic is used as the scientific rationale for discouraging social transition for pre-pubertal children. This article is a critical commentary on the limitations of this research and a caution against using these studies to develop care recommendations for gender-nonconforming children.

Nuttbrock et al. A Further Assessment of Blanchard’s Typology of Homosexual Versus Non-Homosexual or Autogynephilic Gender Dysphoria.


Olson-Kennedy, J et al. Health considerations for gender non-conforming children and transgender adolescents.

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Paul, JP. Childhood cross-gender behavior and adult homosexuality: the resurgence of biological models of sexuality.  1993


Research on the causes of homosexuality frequently treat it as a matter of disturbed gender identity and/or gender role. Recently, attempts have been made to link cross-gender behavior among boys with adult homosexuality. Often this research presumes a common biological determinant to both the childhood behavior patterns and homosexuality in adulthood. Authors have described such childhood cross-gender behavior in boys as part of a “prehomosexual” configuration. This paper argues that the research to date suffers from (1) a failure to differentiate such concepts as gender identity, gender role and sexual orientation, (2) a reliance upon potentially inappropriate dichotomies in describing such concepts, (3) problematic interpretations of research that makes few distinctions between human sexual behavior and sexual behavior among rodents, and (4) the contradictions implicit in seeking simple biological determinants of constructs (such as cross-gender behavior) that are culturally determined. The author argues that any potential biological factors contributing to sexual orientation must be mediated by a complex sequence of experiences and psychosocial factors. Therefore, the essentialists’ search for a simple congruence between physiological or biological traits and homosexuality may be expected to fail.


Rametti et al. White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. 2011

NOTE: This study ONLY tested homosexual transsexuals (HS). Non HS (AGP) trans were screened out. Its results DO NOT apply to these latter.


MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract.


Our results show that the white matter microstructure pattern in untreated MtF transsexuals falls halfway between the pattern of male and female controls. The nature of these differences suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during brain development.

Rekers, G A et al. Childhood gender identity change: Operant control over sex-typed play and mannerisms. 1976

Abstract: To our knowledge this case is the first successful change of childhood gender identity that is documented by pre- and post-diagnostic assessment procedures. Deviant sex-typed behaviors were modified in a 5-yr-old boy judged by an independent clinician to be a high risk for adult transsexualism. In Study 1, the child’s mother was trained to reinforce “masculine” play behaviors and to extinguish “feminine” play behaviors in the clinic. This intrasubject study introduced new procedures designed to maximize the generalization of the treatment effect to play in the alone condition. Study 2 was designed to modify the child’s cross-gender mannerisms through the use of a response-cost and verbal prompt procedure. The cross-gender mannerism “flexed elbow” decreased as a function of the treatment. At the follow-up 25 months after treatment terminated, the evaluation by an independent clinician indicated the therapeutic change to a male gender identity.

Note:  this article’s language is telling. It describes a conditioning therapy for a boy who was ‘a high risk for adult transsexualism’. This pathologisation of transsexualism persisted until the 21st century and exists even now. Being transsexual is not a disorder, any more than being homosexual is. But this paper and others like it are routinely trotted out by anti-trans groups, specifically to harm HSTS.

Further, there is no follow-up to show how the boy developed into adulthood. Perhaps he became a confused, dysphoric ‘gay male’.


Rieger G et al Sexual orientation and childhood gender nonconformity: evidence from home videos. 2008.


Homosexual adults tend to be more gender nonconforming than heterosexual adults in some of their behaviors, feelings, and interests. Retrospective studies have also shown large differences in childhood gender nonconformity, but these studies have been criticized for possible memory biases. The authors studied an indicator of childhood gender nonconformity not subject to such biases: childhood home videos. They recruited homosexual and heterosexual men and women (targets) with videos from their childhood and subsequently asked heterosexual and homosexual raters to judge the gender nonconformity of the targets from both the childhood videos and adult videos made for the study. Prehomosexual children were judged more gender nonconforming, on average, than preheterosexual children, and this pattern obtained for both men and women. This difference emerged early, carried into adulthood, and was consistent with self-report. In addition, targets who were more gender nonconforming tended to recall more childhood rejection.


Rieger G et al. Childhood gender nonconformity remains a robust and neutral correlate of sexual orientation: reply to Hegarty (2009). 2009.


In this issue, P. Hegarty (see record 2009-09998-015) comments on an article by G. Rieger, J. A. W. Linsenmeier, L. Gygax, and J. M. Bailey (see record 2007-19851-006) that compared videos of homosexual and heterosexual people from childhood and adulthood. The current authors claim it is reasonable to treat masculinity-femininity as a bipolar scale and present justification for the approach used in the earlier study. Measures used by Rieger et al. (2008) yielded large differences between homosexual and heterosexual participants, and these differences are likely to be more meaningful than the low and nonsignificant within-group correlations on which Hegarty chose to focus. The authors address his suggestion that they are working within a paradigm detrimental to the well-being of homosexual and gender-nonconforming individuals and suggest that greater openness to research such as theirs could have beneficial consequences.

Rieger et al.   Sexual Arousal and Masculinity-Femininity of Women. 2015

Studies with volunteers in sexual arousal experiments suggest that women are, on average, physiologically sexually aroused to both male and female sexual stimuli. Lesbians are the exception because they tend to be more aroused to their preferred sex than the other sex, a pattern typically seen in men. A separate research line suggests that lesbians are, on average, more masculine than straight women in their nonsexual behaviors and characteristics. Hence, a common influence could affect the expression of male-typical sexual and nonsexual traits in some women. By integrating these research programs, we tested the hypothesis that male-typical sexual arousal of lesbians relates to their nonsexual masculinity. Moreover, the most masculine-behaving lesbians, in particular, could show the most male-typical sexual responses. Across combined data, Study 1 examined these patterns in women’s genital arousal and self-reports of masculine and feminine behaviors. Study 2 examined these patterns with another measure of sexual arousal, pupil dilation to sexual stimuli, and with observer-rated masculinity-femininity in addition to self-reported masculinity-femininity. Although both studies confirmed that lesbians were more male-typical in their sexual arousal and nonsexual characteristics, on average, there were no indications that these 2 patterns were in any way connected. Thus, women’s sexual responses and nonsexual traits might be masculinized by independent factors. (PsycINFO Database Record

Sexual Arousal and Masculinity-Femininity of Women (PDF Download Available). Available from: [accessed Feb 20 2018].

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Roberts et al. The deep human prehistory of global tropical forests and its relevance for modern conservation 2017


Significant human impacts on tropical forests have been considered the preserve of recent societies, linked to large-scale deforestation, extensive and intensive agriculture, resource mining, livestock grazing and urban settlement. Cumulative archaeological evidence now demonstrates, however, that Homo sapiens has actively manipulated tropical forest ecologies for at least 45,000 years. It is clear that these millennia of impacts need to be taken into account when studying and conserving tropical forest ecosystems today. Nevertheless, archaeology has so far provided only limited practical insight into contemporary human–tropical forest interactions. Here, we review significant archaeological evidence for the impacts of past hunter-gatherers, agriculturalists and urban settlements on global tropical forests. We compare the challenges faced, as well as the solutions adopted, by these groups with those confronting present-day societies, which also rely on tropical forests for a variety of ecosystem services. We emphasize archaeology’s importance not only in promoting natural and cultural heritage in tropical forests, but also in taking an active role to inform modern conservation and policy-making.

Ross, Walinder et al. Cross-cultural approaches to transsexualism; A COMPARISON BETWEEN SWEDEN AND AUSTRALIA 1981



Several hypotheses with regard to the influence of societal factors including the rigidity of the society with regard to sex roles, sexual equality and homosexual behaviour were tested comparing prevalence, incidence and sex ratio of transsexualism between Sweden and Australia, two societies which differ with respect to these factors while otherwise remaining comparable as Western democratic societies of about the same size and level of technological development. Significant differences were found between the two countries in both frequency and sex ratio of transsexualism. These findings are discussed and it is concluded that societal influences seem to have an influence on the number of transsexuals presenting as patients. Further research is needed to assess whether these factors also influence aetiology and development of transsexualism.

Ruigrok, A et al. A meta-analysis of sex differences in human brain structure. 2014


Savic & Arver. Sex dimorphism of the brain in male-to-female transsexuals. 2011

Savic, I et al.Sexual differentiation of the human brain in relation to gender identity and sexual orientation. 2010

Abstract (extract)

A number of studies show patterns of sex atypical cerebral dimorphism in homosexual subjects. Although the crucial question, namely how such complex functions as sexual orientation and identity are processed in the brain remains unanswered, emerging data point at a key role of specific neuronal circuits involving the hypothalamus.

Sax L. How common is intersex? a response to Anne Fausto-Sterling. J Sex Res. 2002 Aug;39(3):174-8. doi: 10.1080/00224490209552139. PMID: 12476264.

Sexton, L et al Where the Margins Meet: A Demographic Assessment of Transgender Inmates in Male Prisons

Smenenyna, S et al. The Relationship between Adult Occupational Preferences and Childhood Gender Nonconformity among Samoan Women, Men, and Fa’afafine.’afafine

Smith, Y et al Transsexual subtypes: Clinical and theoretical significance 2006




The present study was designed to investigate whether transsexuals can be validly subdivided into subtypes on the basis of sexual orientation, and whether differences between subtypes of transsexuals are similar for male-to-female (MF) and female-to-male transsexuals (FMs). Within a large transsexual sample (n=187), homosexual and nonhomosexual subjects were compared on a number of characteristics before the start of treatment. Differences within MF and FM groups were also investigated. Homosexual transsexuals were found to be younger when applying for sex reassignment, reported a stronger cross-gender identity in childhood, had a more convincing cross-gender appearance, and functioned psychologically better than nonhomosexual transsexuals. Moreover, a lower percentage of the homosexual transsexuals reported being (or having been) married and sexually aroused while cross-dressing. The pattern of findings was different for MFs and FMs. No differences between homosexuals and nonhomosexuals were found in height, weight, or body mass index. A distinction between subtypes of transsexuals on the basis of sexual orientation seems theoretically and clinically meaningful. The results support the notion that in the two groups different factors influence the decision to apply for sex reassignment. The more vulnerable nonhomosexual transsexuals may particularly benefit from additional professional guidance before and/or during treatment.


Swaminathan, N. Study Says Brains of Gay Men and Women Are Similar; Brain scans provide evidence that sexual orientation is biological. Scientific American, June 16, 2008


Todd, B K et al. ‘Preferences for ‘Gender-typed’ Toys in Boys and Girls Aged 9 to 32 Months.’ 2016

Tsoi, WF. Developmental profile of 200 male and 100 female transsexuals in Singapore. 1990




Two hundred male and 100 female transsexuals compared with 100 male and 80 female heterosexuals were studied in Singapore. Transsexuals started their psychosexual development earlier than controls. Transsexual feelings started in childhood. Male transsexuals went through a homosexual phase followed by a transvestite phase, before they became transsexual. Female transsexuals did not go through distinct phases. Cross-dressing was one of the early signs of transsexualism and started earlier in females. None of the transsexuals were married, in contrast to reports showing that up to 50% of Caucasian transsexuals had been married. Cultural differences may explain the contrasts between Singapore transsexuals and patients from Western countries.


Veale, Clarke and  Lomax, “Sexuality of Male-to-Female Transsexuals”

Velasquez, S.A. 2004. Treatment recommendations for hsts transkids. recommend.html


Wallien MS, et al. Psychosexual outcome of gender-dysphoric children. 2008 J Am Acad Child Adolesc Psychiatry.


OBJECTIVE: To establish the psychosexual outcome of gender-dysphoric children at 16 years or older and to examine childhood characteristics related to psychosexual outcome.

METHOD: We studied 77 children who had been referred in childhood to our clinic because of gender dysphoria (59 boys, 18 girls; mean age 8.4 years, age range 5-12 years). In childhood, we measured the children’s cross-gender identification and discomfort with their own sex and gender roles. At follow-up 10.4 +/- 3.4 years later, 54 children (mean age 18.9 years, age range 16-28 years) agreed to participate. In this group, we assessed gender dysphoria and sexual orientation.

RESULTS: At follow-up, 30% of the 77 participants (19 boys and 4 girls) did not respond to our recruiting letter or were not traceable; 27% (12 boys and 9 girls) were still gender dysphoric (persistence group), and 43% (desistance group: 28 boys and 5 girls) were no longer gender dysphoric. Both boys and girls in the persistence group were more extremely cross-gendered in behavior and feelings and were more likely to fulfill gender identity disorder (GID) criteria in childhood than the children in the other two groups. At follow-up, nearly all male and female participants in the persistence group reported having a homosexual or bisexual sexual orientation. In the desistance group, all of the girls and half of the boys reported having a heterosexual orientation. The other half of the boys in the desistance group had a homosexual or bisexual sexual orientation.

CONCLUSIONS: Most children with gender dysphoria will not remain gender dysphoric after puberty. Children with persistent GID are characterized by more extreme gender dysphoria in childhood than children with desisting gender dysphoria. With regard to sexual orientation, the most likely outcome of childhood GID is homosexuality or bisexuality.

Watkins Christopher D. Creating beauty: creativity compensates for low physical attractiveness when individuals assess the attractiveness of social and romantic partners 2017.

Weinberg MS et al. Men sexually interested in transwomen (MSTW): gendered embodiment and the construction of sexual desire.2010

Wilson, G. D., and M. Gosselin. 1980. Personality characteristics of fetishists, transvestites and sadomasochists. Pers Individ Diff 1(3):289–95.

Winter, S. Of transgender and sin in Asia.

Winter S, Udomsak N (2002) Male, Female and Transgender : Stereotypes and Self in Thailand.

Winter S. Gender Stereotype and Self among Transgenders: Underlying Elements.

Winter S. Language and Identity in Transgender.

Winter S and King M. Well and Truly Fucked: Transwomen, Stigma, Sex Work and Sexual Health.

Winter, S. Transpeople (Khom Kham Phet) in Thailand.

Wu-jing, He Gender differences in creative thinking revisited: Findings from analysis of variability


Zhou, J. N., et al. 1995. A sex difference in the human brain and its relation to transsexuality. Nature 378:68–70.

Zuger, B. 1984. Early effeminate behavior in boys: Outcome and significance for homosexuality. J Nerv Ment Dis 172:90–97.

Zucker, K. et al. Physical attractiveness of boys with gender identity disorder

Zucker, K J, et al. Sex-typed Behavior in Cross-Gender-Identified Children: Stability and Change at a One-Year Follow-up 1986


Children referred because of concerns about their gender identity development were compared to their siblings on 4 sex-typed measures (15 variables) at both assessment and a 1-year follow-up. At assessment, the gender-referred children different from their siblings on all but one variable. At follow-up, the gender-referred children either maintained or significantly reduced their degree of cross-gender behavior; compared to their siblings, however, they continued to differ on the majority of measures. Degree of behavioral change at follow-up correlated positively with number of therapy sessions (child, parent, and total) and the child therapist’s emphasis on gender identity issues.

Zucker, K et al. Was the Gender Identity Disorder of Childhood Diagnosis Introduced into DSM-III as a Backdoor Maneuver to Replace Homosexuality? A Historical Note

Unsorted Links to published papers.


This is an UNSORTED list of links. There may be some duplication with the sorted list above.

Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. by Berglund et al Cerebral Cortex 2008 18(8):1900-1908;

…the data implicate that transsexuality may be associated with sex-atypical physiological responses in specific hypothalamic circuits, possibly as a consequence of a variant neuronal differentiation.

Male–to–female transsexuals have female neuron numbers in a limbic nucleus. Kruiver et al J Clin Endocrinol Metab (2000) 85:2034–2041

The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Swaab Gynecol Endocrinol (2004) 19:301–312.

Solid evidence for the importance of postnatal social factors is lacking. In the human brain, structural diferences have been described that seem to be related to gender identity and sexual orientation.

A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.

Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones

A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. by Garcia-Falgueras et al Brain. 2008 Dec;131(Pt 12):3132-46.

We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.

Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth by Reiner and Gearhart, N Engl J Med. 2004 January 22; 350(4): 333–341.

RESULTS Eight of the 14 subjects assigned to female sex declared themselves male during the course of this study, whereas the 2 raised as males remained male. Subjects could be grouped according to their stated sexual identity. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. Follow-up ranged from 34 to 98 months.
CONCLUSIONS Routine neonatal assignment of genetic males to female sex because of severe phallic inadequacy can result in unpredictable sexual identification. Clinical interventions in such children should be reexamined in the light of these findings.

The role of androgen receptors in the masculinization of brain and behavior: what we’ve learned from the testicular feminization mutation. Zulago et al. Horm Behav 53:613-626

The testicular feminization mutation (Tfm) in rodents, which produces a nonfunctional AR protein, provides an excellent model to probe the role of ARs in the development of brain and behavior. Tfm rodent models indicate that ARs are normally involved in the masculinization of many sexually dimorphic brain regions and a variety of behaviors, including sexual behaviors, stress response and cognitive processing. We review the role of ARs in the development of the brain and behavior, with an emphasis on what has been learned from Tfm rodents as well as from related mutations in humans causing complete androgen insensitivity.

White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. – Rametti et al, J Psychiatr Res. 2010 Jun 8.

CONCLUSIONS: Our results show that the white matter microstructure pattern in untreated FtM transsexuals is closer to the pattern of subjects who share their gender identity (males) than those who share their biological sex (females). Our results provide evidence for an inherent difference in the brain structure of FtM transsexuals.

Regional cerebral blood flow changes in female to male gender identity disorder. – Tanaka et al, Psychiatry Clin Neurosci. 2010 Apr 1;64(2):157-61.

RESULTS: GID subjects had a significant decrease in rCBF in the left anterior cingulate cortex (ACC) and a significant increase in the right insula compared to control subjects.
CONCLUSIONS: The ACC and insula are regions that have been noted as being related to human sexual behavior and consciousness. From these findings, useful insights into the biological basis of GID were suggested.

“Prenatal hormones versus postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia” Pasterski VL, Geffner ME, Brain C, Hindmarsh P, Brook C, Hines M Child Dev 76(1):264-78 2005

Data show that increased male-typical toy play by girls with CAH cannot be explained by parental encouragement of male-typical toy play. Although parents encourage sex-appropriate behavior, their encouragement appears to be insufficient to override the interest of girls with CAH in cross-sexed toys.

Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb. However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in trans-sexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation.

and also

Boys and girls behave in different ways and one of the stereotypical behavioral differences between them, that has often been said to be forced upon them by upbringing and social environment, is their behavior in play. Boys prefer to play with cars and balls, whereas girls prefer dolls. This sex difference in toy preference is present very early in life (3–8 months of age) [1]. The idea that it is not society that forces these choices upon children but a sex difference in the early development of their brains and behavior is also supported by monkey behavioral studies. Alexander and Hines [2], who offered dolls, toy cars and balls to green Vervet monkeys found the female monkeys consistently chose the dolls and examined these ano-genitally, whereas the male monkeys were more interested in playing with the toy cars and with the ball….

AMH and AMH receptor defects in persistent Müllerian duct syndrome by Josso et al Human Reproduction Update, Volume 11, Number 4, July 2005 , pp. 351-356(6)

Mutations of the AMH and AMH receptor type II (AMHR-II) genes lead to persistence of the uterus and Fallopian tubes in males. Both conditions are transmitted according to a recessive autosomal pattern and are symptomatic only in males. Affected individuals are otherwise normally virilized, undergo normal male puberty; and may be fertile if testes, tightly attached to the Fallopian tubes, can be replaced in the scrotum

Disorders of sex development expose transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in human blood leukocytes. by Holterhus et al BMC Genomics. 2009 Jul 1;10:292.

CONCLUSION: A significant fraction of gene expression differences between males and females in the human appears to have its roots in early embryogenesis and is not only caused by sex chromosomes but also by long-term sex-specific hormonal programming due to presence or absence of androgen during the time of external genital masculinization. Genetic sex and the androgen milieu during embryonic development might therefore independently modulate functional traits, phenotype and diseases associated with male or female gender as well as with DSD conditions.

Male Gender Identity in Complete Androgen Insensitivity Syndrome by T’sjoen et al. Arch Sex Behav. 2010 Apr 1.

The patient qualifies as female-to-male transsexual and was treated according to the Standards of Care by the World Professional Association for Transgender Health with good outcome. However, we do not believe that female sex of rearing as a standard procedure should be questioned in CAIS. Our case challenges the role of a functional AR pathway in the development of male gender identity.

Biological and Psychosocial Correlates of Adult GenderVariant Identities: a Review by J.F.Veale & D.E.Clarke, Personality and Individual Differences (2009) 48(4), 357-366 (PDF)

We conclude that biological factors, especially prenatal androgen levels, play a role in the development of a gender-variant identity and it is likely that psychosocial variables play a role in interaction with these factors.

True hermaphroditism with oogenesis and spermatogenesis. Shannon R, Nicolaides NJ. Aust NZ J Obstet Gynaecol. 1973 Aug;13(3):184-7

True hermaphroditism exists when both ovarian and testicular tissues are present in the same person. This condition is quite rare and it is particularly rare for the subject to exhibit oogenesis and effective spermatogenesis.

(A fertile individual who has fathered two children can have an ovary with follicles and devloping ova. This individual also has a Fallopian tube and a uterus. – M.Italiano)

Sexual differentiation of the human brain in relation to gender identity and sexual orientation D.Swaab & A.Garcia-Fulgaras Functional Neurology, Jan-Mar 2009:

One person we studied had untreated male gender dysphoria (S7), took no hormones and kept his transsexual feelings under wraps. He appeared to have a large INAH3 volume – in the male range – but a female INAH3 number of neurons (68) and a female BSTc somatostatin neuron number (95). Hence, this individual’s hypothalamic characteristics were mid-way between male and female values

Somatic Sex Reprogramming of Adult Ovaries to Testes by FOXL2 Ablation
by Uhlenhaut et al, Cell, Volume 139, Issue 6, 1130-1142, 11 December 2009:

Inducible deletion of Foxl2 in adult ovarian follicles leads to immediate upregulation of testis-specific genes including the critical SRY target gene Sox9. Concordantly, reprogramming of granulosa and theca cell lineages into Sertoli-like and Leydig-like cell lineages occurs with testosterone levels comparable to those of normal XY male littermates. Our results show that maintenance of the ovarian phenotype is an active process throughout life. They might also have important medical implications for the understanding and treatment of some disorders of sexual development in children and premature menopause in women

Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure by Pol et al, Europ Jnl Endocrinology, Vol 155, suppl_1, S107-S114 2006

Objective: Sex hormones are not only involved in the formation of reproductive organs, but also induce sexually-dimorphic brain development and organization. Cross-sex hormone administration to transsexuals provides a unique possibility to study the effects of sex steroids on brain morphology in young adulthood.

Methods: Magnetic resonance brain images were made prior to, and during, cross-sex hormone treatment to study the influence of anti-androgen + estrogen treatment on brain morphology in eight young adult male-to-female transsexual human subjects and of androgen treatment in six female-to-male transsexuals.

Results: Compared with controls, anti-androgen + estrogen treatment decreased brain volumes of male-to-female subjects towards female proportions, while androgen treatment in female-to-male subjects increased total brain and hypothalamus volumes towards male proportions.

Conclusions: The findings suggest that, throughout life, gonadal hormones remain essential for maintaining aspects of sex-specific differences in the human brain.

The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study Rametti et al Journal of Psychiatric Research, In Press, Corrected Proof, Available online 30 December 2010

MtF transsexuals differed from both male and female controls bilaterally in the superior longitudinal fasciculus, the right anterior cingulum, the right forceps minor, and the right corticospinal tract.
Our results show that the white matter microstructure pattern in untreated MtF transsexuals falls halfway between the pattern of male and female controls. The nature of these differences suggests that some fasciculi do not complete the masculinization process in MtF transsexuals during brain development.

Neuroimaging Differences in Spatial Cognition between Men and Male-to-Female Transsexuals Before and During Hormone Therapy
by Scoening et al J Sex Med. 2009 Sep 14.

Conclusions. Our results confirmed previously reported deviances of brain activation patterns in transsexual men (sic – these are MtoF) from men without GID and also corroborated these findings in a group of transsexual patients receiving cross-sex hormone therapy. The present study indicates that there are a priori differences between men and transsexual patients caused by different neurobiological processes or task-solving strategies and that these differences remain stable over the course of hormonal treatment.

Regional gray matter variation in male-to-female transsexualism. by Luders et al Neuroimage. 2009 Jul 15;46(4):904-7.

We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.

Clinical Implications of the Organizational and Activational Effects of Hormones M.Diamond Hormones and Behavior 55 (2009) 621–632

The organization-activation theory posits that the nervous system of a developing fetus responds to prenatal androgens so that, at a postnatal time, it will determine how sexual behavior is manifest. How organization-activation was or was not considered among different groups and under which circumstances it is considered is basically understood from the research and comments of different investigators and clinicians. The preponderance of evidence seems to indicate that the theory of organization-activation for the development of sexual behavior is certain for non-human mammals and almost certain for humans.

Dichotic Listening, Handedness, Brain Organization and Transsexuality
Govier et al International Journal of Transgenderism, 12:144–154, 2010

This study investigated the functional brain organization of 68 male-to-female (MtF) transwomen and 26 female-to-male (FtM) transmen by comparing their performance with 36 typical male and 28 typical female controls on two indicators of cerebral lateralization: dichotic listening and handedness. A sex-differentiating dichotic test and a handedness questionnaire were administered. It was hypothesized that the MtF participants’ dichotic performance would be significantly different from the control males and resemble the control female pattern. This hypothesis was supported. It was also hypothesized that the FtM dichotic pattern would be significantly different from the control females and would resemble the control male pattern. This hypothesis was not supported. Finally, it was hypothesized that there would be significantly more nonexclusive right-handers in both trans-groups. This hypothesis was supported. Taken together, the dichotic and handedness data reported here indicate that the MtF and FtM conditions are not mirror images in terms of the verbal-auditory aspects of their brain organization and neurobiology plays an important role, particularly in the development of the male-to-female trans-condition.

Atypical Gender Development: a review Besser et al International Journal of Transgenderism 9(1): 29-44. 2006

In sum, gender identity, whether consistent or inconsistent with other sex characteristics, may be understood to be “much less a matter of choice and much more a matter of biology” (Coolidge et al., 2000). The scientific evidence supports the paradigm that transsexualism is strongly associated with the neurodevelopment of the brain (Zhou et al., 1995; Kruijver et al., 2000). It is clear that the condition cannot necessarily be overcome by “consistent psychological socialisation as male or female from very early childhood” and it is not responsive to psychological or psychiatric treatments alone (Green, 1999). It is understood that during the fetal period the brain is potentially subject to the organising properties of sex hormones (Kruijver et al., 2000; 2001; 2002; 2003). In the case of transsexualism, these effects appear to be atypical, resulting in sex-reversal in the structure of the BSTc, and possibly other, as yet unidentified, loci (Kruijver, 2004). The etiological pathways leading to this inconsistent development almost certainly vary from individual to individual, so no single route is likely to be identified. Different genetic, hormonal and environmental factors, acting separately or in combination with each other, are likely to be involved in influencing the development of the psychological identification as male or female. Psychosocial factors and cultural mores are likely to impact on outcomes (Connolly, 2003).

Biased-Interaction Theory of Psychosexual Development: “How Does One Know if One is Male or Female?” M.Diamond Sex Roles (2006) 55:589–600

A theory of gender development is presented that incorporates early biological factors that organize predispositions in temperament and attitudes. With activation of these factors a person interacts in society and comes to identify as male or female. The predispositions establish preferences and aversions the growing child compares with those of others. All individuals compare themselves with others deciding who they are like (same) and with whom are they different. These experiences and interpretations can then be said to determine how one comes to identify as male or female, man or woman. In retrospect, one can say the person has a gendered brain since it is the brain that structures the individual’s basic personality; first with inherent tendencies then with interactions coming from experience.

Specific Cerebral Activation due to Visual Erotic Stimuli in Male-to-Female Transsexuals Compared with Male and Female Controls: An fMRI Study by Gizewski et al J Sex Med 2009;6:440–448.

Results. Significantly enhanced activation for men compared with women was revealed in brain areas involved in erotic processing, i.e., the thalamus, the amygdala, and the orbitofrontal and insular cortex, whereas no specific activation for women was found. When comparing MTF transsexuals with male volunteers, activation patterns similar to female volunteers being compared with male volunteers were revealed. Sexual arousal was assessed using standard rating scales and did not differ significantly for the three groups.

Increased Cortical Thickness in Male-to-Female Transsexualism Luders et al, Journal of Behavioral and Brain Science, 2011


Results: Results revealed thicker cortices in MTF transsexuals, both within regions of the left hemisphere (i.e., frontal and orbito-frontal cortex, central sulcus, perisylvian regions, paracentral gyrus) and right hemisphere (i.e., pre-/post-central gyrus, parietal cortex, temporal cortex, precuneus, fusiform, lingual, and orbito-frontal gyrus).
Conclusion: These findings provide further evidence that brain anatomy is associated with gender identity, where measures in MTF transsexuals appear to be shifted away from gender-congruent men.

Gender change in 46,XY persons with 5alpha-reductase-2 deficiency and 17beta-hydroxysteroid dehydrogenase-3 deficiency. Cohen-Kettenis PT. Arch Sex Behav. 2005 Aug;34(4):399-410.

Individuals with 5alpha-reductase-2 deficiency (5alpha-RD-2) and 17beta-hydroxysteroid dehydrogenase-3 deficiency (17beta-HSD-3) are often raised as girls. Over the past number of years, this policy has been challenged because many individuals with these conditions develop a male gender identity and make a gender role change after puberty. The findings also raised doubts regarding the hypothesis that children are psychosexually neutral at birth and emphasized the potential role of prenatal brain exposure to androgens in gender development. If prenatal exposure to androgens is a major contributor to gender identity development, one would expect that all, or nearly all, affected individuals, even when raised as girls, would develop a male gender identity and make a gender role switch later in life. However, an estimation of the prevalence of gender role changes, based on the current literature, shows that gender role changes occur frequently, but not invariably. Gender role changes were reported in 56-63% of cases with 5alpha-RD-2 and 39-64% of cases with 17beta-HSD-3 who were raised as girls. The changes were usually made in adolescence and early adulthood. In these two syndromes, the degree of external genital masculinization at birth does not seem to be related to gender role changes in a systematic way.

Prenatal exposure to testosterone and functional cerebral lateralization: a study in same-sex and opposite-sex twin girls. Cohen-Bendahan et al, Psychoneuroendocrinology. 2004 Aug;29(7):911-6.

In animals it has been shown that exposure to sex hormones is influenced by intrauterine position. Thus fetuses located between two male fetuses are exposed to higher levels of testosterone (T) than fetuses situated between two female fetuses or one female and one male fetus. In a group of opposite-sex (OS) twin girls and same-sex (SS) twin girls a potential effect of prenatal exposure to testosterone (T) on functional cerebral lateralization was investigated. We hypothesized that prenatal exposure to T would result in a more masculine, i.e. a more lateralized pattern of cerebral lateralization in OS twin girls than in SS twin girls. An auditory-verbal dichotic listening task (DLT) was used as an indirect method to study hemispheric specialization. Firstly, we established a sex difference on the DLT. Compared with SS girls, OS twin boys showed a more lateralized pattern of processing verbal stimuli. Secondly, as predicted OS girls had a more masculine pattern of cerebral lateralization, than SS girls. These findings support the notion of an influence of prenatal T on early brain organization in girls.

Prenatal exposure to diethylstilbestrol(DES) in males and gender-related disorders:results from a 5-year study Scott Kerlin. Proc. International Behavioral Development Symposium July 2005

More than 150 network members (out of 500) with “confirmed” or “strongly suspected” prenatal DES exposure identified as either “transsexual, pre- or post-operative,” (90 members), “transgender” (48 members), “gender dysphoric” (17 members), or “intersex” (3 members).

In this study, more than 150 individuals with confirmed or suspected prenatal DES exposure reported moderate to severe feelings of gender dysphoria across the lifespan. For most, these feelings had apparently been present since early childhood. The prevalence of a significant number of self-identified male-to-female transsexuals and transgendered individuals as well as some individuals who identify as intersex, androgynous, gay or bisexual males has inspired fresh investigation of historic theories about a possible biological/endocrine basis for psychosexual development in humans, including sexual orientation, core gender identity, and sexual identity (Benjamin, 1973; Cohen-Kettenis and Gooren, 1999; Diamond, 1965, 1996; Michel et al, 2001; Swaab, 2004).

Young, William C., Goy, Robert W., Phoenix, Charles H., “Hormones and Sexual Behavior,” Science, Vol. 143, No. 3603, January 17, 1964.

Sexual differentiation of human behavior: Effects of prenatal and pubertal organizational hormones Sheri A. Berenbaum, Adriene M. Beltz Frontiers in Neuroendocrinology 32 (2011) 183–200

A key question concerns the extent to which sexual differentiation of human behavior is influenced by sex hormones present during sensitive periods of development (organizational effects), as occurs in other mammalian species. The most important sensitive period has been considered to be prenatal, but there is increasing attention to puberty as another organizational period, with the possibility of decreasing sensitivity to sex hormones across the pubertal transition. In this paper, we review evidence that sex hormones present during the prenatal and pubertal periods produce permanent changes to behavior.
There is good evidence that exposure to high levels of androgens during prenatal development results in masculinization of activity and occupational interests, sexual orientation, and some spatial abilities; prenatal androgens have a smaller effect on gender identity, and there is insufficient information about androgen effects on sex-linked behavior problems. There is little good evidence regarding long-lasting behavioral effects of pubertal hormones, but there is some suggestion that they influence gender identity and perhaps some sex-linked forms of psychopathology, and there are many opportunities to study this issue.

The treatment of adolescent transsexuals: changing insights. Cohen-Ketternis et al, J Sex Med. 2008 Aug;5(8):1892-7.

Professionals who take responsibility for these youth and are willing to help should yet be fully aware of the impact of their interventions. In this article, the pros and cons of the various approaches to youngsters with GID are presented, hopefully inciting a sound scientific discussion of the issue.

Prenatal phthalate exposure and reduced masculine play in boys Swan et al, International Journal of Andrology, Volume 33, Issue 2, pages 259–269, April 2010

These data, although based on a small sample, suggest that prenatal exposure to antiandrogenic phthalates may be associated with less male-typical play behaviour in boys. Our findings suggest that these ubiquitous environmental chemicals have the potential to alter androgen-responsive brain development in humans.

Bigender and the Brain
ZE Brain AEBrain(2008)

Dr Veronica Drantz : Disordered or Just Different Others

The Transsexual Phenomenon H.Benjamin

Sex Reassignment. Thirty Years of International Follow-up Studies After Sex Reassignment Surgery: A Comprehensive Review, 1961-1991 Friedemann Pfäfflin, Astrid Junge (Translated from German into American English by Roberta B. Jacobson and Alf B. Meier)

Current Thinking on the Etiology of Gender Dysphoria Reprinted from The Gendered Self–Further commentary on the transsexual phenomenon by Anne Vitale PhD (2010, pp 13-16)

There is no clearly understood cause for gender variance. However, we have enough information about fetal brain development and the procedure the embryo goes through in becoming either male, female or intersexed, to implicate the complexity of the procedure itself as a cause of the spontaneous sex reversal or potential sex/gender discontinuity (1). What follows is an abbreviated sample of what we now know about what goes on relative to being gendered physiologically.

Even though the brain has both androgen and estrogen receptors, the male brain has been found to be markedly different from the female brain. Not only is the male brain larger and more capable of spatial perception, researchers studying the brains of male and female rats have found evidence that prior to being masculinized, the genetic male brain must first be defeminized,(4-7) a process by which males lose the ability to display female-type behavior.

Once in the fetal brain, testosterone is either metabolized into dihydrotestosterone by an enzyme named 5 alpha reductase or converted to estradiol by an enzyme called aromatase. Counterintuitively, increased estrogen receptor activation is responsible for defeminization while increased androgen receptor activation seems to be responsible for masculinization.(8,9) All this makes clear that there is nothing straightforward about an individual being born with a gender identity that matches their biological sex.

This leads one to consider the possibility that male hormonal surges must occur not only in sufficient amounts in the developing fetus, but must be timed to take advantage of the short time the brain is open to being defeminized/masculinized, forming a predominantly male gendermap. If there is insufficient androgen, or the surge comes too late, the gendermap may be only partially imprinted as male. These disruptions of hormonal surges may come from a variety of sources, including a disorder in the mother’s endocrine system such as a hormone-secreting tumor, common maternal stress, medications or some other toxic substance or adverse event yet to be identified.

Being the default condition, genderizing the genetic female brain is far less complex but still subject to having something stray from the norm. If nothing untoward happens, the brain remains female and the individual feels no dis-ease with her body. However, there remains the possibility of a defeminizing/masculinization event to occur for both sexes in utero.

Gender identity, far from being absolute, appears to occur on a continuum, with most people gathered at either end, the rest being somewhere in between. Feelings of discomfort or complete inappropriateness about one’s assigned sex do not mean the individual is wrong or ill. It simply means that the assignment made at birth almost universally on the shape of one’s genitals can, on occasion, differ from the unseen brain imprint.

Potential Therapeutic Errors When Using Binary Based Terminology to Explain the Gender Variant Condition Anne Vitale Ph.D. November 11, 2006

Secondly, “Dysphoria,” defined by Marriam-Webster’s Collegiate dictionary as “a state of feeling unwell or unhappy,” or in the American College Dictionary as “a state of dissatisfaction, anxiety, restlessness, or fidgeting” is simply too soft a word to describe the angst most clinicians see on intake with this population. At best it may be an apt descriptor for individuals who, despite strong evidence to the contrary, are making an extraordinary effort to convince themselves that they are sex/gender congruent. These individuals make life decisions such as getting married and having children not only because they may find it appealing to have a spouse and have children but with the added hope that this activity will ease or erase their obsessive cross gender thoughts. Although there may be instances where these special efforts succeed, (i.e. the incongruity is mild) the more likely outcome is a realization they have actually made matters worse. Typically, at time of presentation these individuals report that either their lives are in ruin, or they are very afraid that if their gender variant condition was to become known they would loose all that they cherish and be ostracized from family, friends and the ability to support themselves. High anxiety and deep depression with concurrent suicide ideation is common. One of the most extreme cases I have treated was that of a 50 year old genetic male, married and the father of 3 grown children with an international reputation as a scientist who reported to me that the reason he finally sought out treatment for his gender issues was because the number of times he found himself curled up in the corner of his office in the fetal position muffling his cry was increasing. That is not dysphoria, that is pure misery.

Gender Differences in Human Brain: A Review Z.F Zaidi The Open Anatomy Journal, 2010, 2, 37-55


The male and the female brains show anatomical, functional and biochemical differences in all stages of life. These differences begin early during development due to a combination of genetic and hormonal events and continue throughout the lifespan of an individual…


Wierckx, Katrien et al Long‐Term Evaluation of Cross‐Sex Hormone Treatment in Transsexual Persons 2012



Transsexual men did not experience important side effects such as cardiovascular events, hormonerelated cancers, or osteoporosis. In contrast, a quarter of the transsexual women had osteoporosis at the lumbar spine and radius. Moreover, 6% of transsexual women experienced a thromboembolic event and another 6% experienced other cardiovascular problems after on average 11.3 hormone treatment years. None of the transsexual women experienced a hormonerelated cancer during treatment.


Crosssex hormone treatment appears to be safe in transsexual men. On the other hand, a substantial number of transsexual women suffered from osteoporosis at the lumbar spine and distal arm. Twelve percent of transsexual women experienced thromboembolic and/or other cardiovascular events during hormone treatment, possibly related to older age, estrogen treatment, and lifestyle factors. In order to decrease cardiovascular morbidity, more attention should be paid to decrease cardiovascular risk factors during hormone therapy management.


DeLay Dawn et al The Influence of Peers During Adolescence: Does Homophobic Name Calling by Peers Change Gender Identity? 2017


Adolescents actively evaluate their identities during adolescence, and one of the most salient and central identities for youth concerns their gender identity. Experiences with peers may inform gender identity. Unfortunately, many youth experience homophobic name calling, a form of peer victimization, and it is unknown whether youth internalize these peer messages and how these messages might influence gender identity. The goal of the present study was to assess the role of homophobic name calling on changes over the course of an academic year in adolescents’ gender identity. Specifically, this study extends the literature using a new conceptualization and measure of gender identity that involves assessing how similar adolescents feel to both their own- and other-gender peers and, by employing longitudinal social network analyses, provides a rigorous analytic assessment of the impact of homophobic name calling on changes in these two dimensions of gender identity. Symbolic interaction perspectives—the “looking glass self”—suggest that peer feedback is incorporated into the self-concept. The current study tests this hypothesis by determining if adolescents respond to homophobic name calling by revising their self-view, specifically, how the self is viewed in relation to both gender groups. Participants were 299 6th grade students (53% female). Participants reported peer relationships, experiences of homophobic name calling, and gender identity (i.e., similarity to own- and other-gender peers). Longitudinal social network analyses revealed that homophobic name calling early in the school year predicted changes in gender identity over time. The results support the “looking glass self” hypothesis: experiencing homophobic name calling predicted identifying significantly less with own-gender peers and marginally more with other-gender peers over the course of an academic year. The effects held after controlling for participant characteristics (e.g., gender), social network features (e.g., norms), and peer experiences (e.g., friend influence, general victimization). Homophobic name calling emerged as a form of peer influence that changed early adolescent gender identity, such that adolescents in this study appear to have internalized the messages they received from peers and incorporated these messages into their personal views of their own gender identity.


Kruijver FP et al Male-to-female transsexuals have female neuron numbers in a limbic nucleus. 2000


Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex. A crucial question resulting from a previous brain study in male-to-female transsexuals was whether the reported difference according to gender identity in the central part of the bed nucleus of the stria terminalis (BSTc) was based on a neuronal difference in the BSTc itself or just a reflection of a difference in vasoactive intestinal polypeptide innervation from the amygdala, which was used as a marker. Therefore, we determined in 42 subjects the number of somatostatin-expressing neurons in the BSTc in relation to sex, sexual orientation, gender identity, and past or present hormonal status. Regardless of sexual orientation, men had almost twice as many somatostatin neurons as women (P < 0.006). The number of neurons in the BSTc of male-to-female transsexuals was similar to that of the females (P = 0.83). In contrast, the neuron number of a female-to-male transsexual was found to be in the male range. Hormone treatment or sex hormone level variations in adulthood did not seem to have influenced BSTc neuron numbers. The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.


Simon L et al Regional grey matter structure differences between transsexuals and healthy controls–a voxel based morphometry study. 2013


Gender identity disorder (GID) refers to transsexual individuals who feel that their assigned biological gender is incongruent with their gender identity and this cannot be explained by any physical intersex condition. There is growing scientific interest in the last decades in studying the neuroanatomy and brain functions of transsexual individuals to better understand both the neuroanatomical features of transsexualism and the background of gender identity. So far, results are inconclusive but in general, transsexualism has been associated with a distinct neuroanatomical pattern. Studies mainly focused on male to female (MTF) transsexuals and there is scarcity of data acquired on female to male (FTM) transsexuals. Thus, our aim was to analyze structural MRI data with voxel based morphometry (VBM) obtained from both FTM and MTF transsexuals (n = 17) and compare them to the data of 18 age matched healthy control subjects (both males and females). We found differences in the regional grey matter (GM) structure of transsexual compared with control subjects, independent from their biological gender, in the cerebellum, the left angular gyrus and in the left inferior parietal lobule. Additionally, our findings showed that in several brain areas, regarding their GM volume, transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender (areas in the left and right precentral gyri, the left postcentral gyrus, the left posterior cingulate, precuneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and inferior temporal gyri). These results support the notion that structural brain differences exist between transsexual and healthy control subjects and that majority of these structural differences are dependent on the biological gender.


World ranking of countries by their average IQ

Article by J M Bailey on transsexualism

Hare et al Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism 2012



There is a likely genetic component to transsexualism, and genes involved in sex steroidogenesis are good candidates. We explored the specific hypothesis that male-to-female transsexualism is associated with gene variants responsible for undermasculinization and/or feminization. Specifically, we assessed the role of disease-associated repeat length polymorphisms in the androgen receptor (AR), estrogen receptor β (ERβ), and aromatase (CYP19) genes.


This study provides evidence that male gender identity might be partly mediated through the androgen receptor.

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Akin, Deniz (2009). Bargaining with heteronormativity: elaborations of transsexual experiences in Turkey. Master’s Dissertation, Gender and Development, Faculty of Psychology, University of Bergen, Norway.

Ashbee, Olivia (2009). Tracing Erasures and Imagining Other-wise: Theorizing Toward an Intersectional Trans/Feminist Politics of Coalition. Master’s Dissertation, Department of Women’s Studies, University of Victoria. PDF Download.

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Bonifacio, Herbert Joseph (2010). Invisible persons, invisible patients: Determining the ethics of hormone-blocker therapy through an understanding of the transgender-transsexual adolescent-physician relationship. Master’s Disssertation, Bioethics Unit, Department of Experimental Medicine, McGill University. PDF Download.

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Coyle, Shannon (2010). A Mixed methods Investigation of the Needs, Experiences. and Fulfillments of Trans Persons Accessing Ontario Health Care services. Master’s Dissertation, Queen’s University. PDF Download.

Crisovan, Piper Lauren (2006). “Risky” business: Cultural conceptions of HIV/AIDS in Indonesia. PhD. Dissertation, Anthropology, University of Pittsburgh. PDF Download.

Drummond, Alexander (2008). This literature review was part of an MSc dissertation exploring the level of training counsellors and therapists have in working with issues of sexuality and gender diversity. Full Text.

Eckert, Christina Annalena (2003). The Historicisation of the Hermaphroditic/Intersexed Body: From Medicalisation to De-Medicalisation. Master’s Dissertation, Gender History, University of Essex. PDF Download.

Ehrensaft, D.  “It Takes a Gender Creative Parent” in A. Lev & A. Gottlieb (eds.),  Families in Transiton:  Parent Perspective in Raising the Gender Nonconforming or Trans Child (in press).

Ehrensaft, D. “Baby Making:  It Takes an Egg and Sperm and a Rainbow of Genders” in Katie Gentile (ed.), The Business of Being Made:  Producing Liminal Temporalities through ARTS, New York:  Routledge, 2016.

Ehrensaft, D. (07/06/2015 Wired)

Ehrensaft, D. Found in transition:  Our Littlest transgender people.  Contemporary Psychoanalysis, 50:4:  571-592, 2014.

Psychological and medical care of gender nonconforming youth.  Vance S, Ehrensaft D, Rosenthal S. M.  Pediatrics, 2014.

Gender Nonconforming/Gender Expansive and Transgender Children and Teens. Sherer I., Baum J., Ehrensaft D., Rosenthal S.M., Contemp Pediatrics, 2014.

Child and Adolescent Gender Center:  A multidisciplinary collaboration to improve the lives of gender nonconforming children and teens. Sherer I, Rosenthal SM, Ehrensaft D., Baum J., Pediatr Rev 33:273-275, 2012.

Ehrensaft, D.  “Listening and Learning from gender-nonconforming children.  The Psychoanalytic Study of the Child, Vol. 68,  28-56, 2014 .

Ehrensaft, D.  “Family complexes and Oedipal circles: mothers, fathers, babies, donors, and surrogates. In M. Mann (ed.) Psychoanalytic Aspects of Assisted Reproductive Technology.  London:  Karnac, 2014.

Ehrensaft, D. “From gender identity disorder to gender identity creativity:  The liberation of gender-nonconforming children and youth.”  In E.J. Meyer and A.P. Sansfacon (eds.), Supporting Transgender and Gender Creative Youth New York:  Peter Lang, 2014.

Ehrensaft, D.“A terrible Thing happened on the way to becoming a girl:  transgender trauma, parental loss, and recovery.” In P. Cohen, M. Sossin, & R. Ruth (eds.), Healing after Parent Loss in Childhood and Adolescence.  Lanham:  Rowman & Littlefield, 2014.

Ehrensaft, D.“The Gender affirmative model: what we know and what we aim to learn.” Hidalgo, M.A.,  Ehrensaft, D. Tishelman, A.C., Clark, L.F., Garofalo, R., Rosenthal, S.M., Spack, N.P., &  Olson, J.,  Human Development, 56: 285-290, 2013.

“Look, Mom, I’m a boy—don’t tell anyone I was a girl.” Journal of LGBT Youth, 10:928, 2013.

Ehrensaft, D.  “The ‘Birth Other’ in Assisted Reproductive Technology” In M. O’Reilly-Landry (ed.), A Psychodynamic Understanding of Modern Medicine. London:  Radcliffe, 2012.

Ehrensaft, D.  “From gender Identity disorder to gender identity creativity:  True gender self child therapy.  Journal of Homosexuality, 59:3, 337-356, 2012.

Ehrensaft, D. (2011). Boys will be girls, girls will be Boys: Children Affect Parents as Parents Affect Children in Gender Nonconformity.Psychoanalytic Psychology.

Ehrensaft, D. (2011). Gametes for Sale, Wombs for Rent, Babies to Raise. In M. O’Reilly-Landry (ed.), Relational and Psychodynamic Aspects of Medical Care. New York: Routledge
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Ehrensaft, D. (2009). One pill makes you boy, one pill makes you girl. International Journal of Applied Psychoanalytic Studies,6(1): 12–24.

Ehrensaft, D. (2008). A Child is Being Eaten: Failure, Fear, Fantasy, and Repair in the Lives of Foster Children.” Journal of Infant, Child, and Adolescent Psychotherapy, 7:2, 100-108.

Ehrensaft, D. (2008). When Baby Makes Three or Four or More. In The Psychoanalytic Study of the Child, Vol. 63, New Haven: Yale University Press.

Ehrensaft, D. (2008). Just Molly and Me, and “Donor Makes Three.   Journal of Lesbian Studies, 12: 2-3, 161-178, 2008.

Ehrensaft, D. (2007).  Raising Girlyboys: A Parent’s Perspective.” Studies in Gender and Sexuality, 8(3), 269-302, 2007.

Ehrensaft, D. (2007).  The Stork Didn’t Bring Me, I Came From a Dish: Psychological Experiences of Children Conceived through Assisted Reproductive Technology. Journal of Infant, Child, and Adolescent Psychotherapy, 6(2): 124-140.

Ehrensaft, D. (2007).  Raising Girlyboys: A Parent’s Perspective.” Studies in Gender and Sexuality, 8(3), 269-302, 2007.

Ehrensaft, D. (2007).  The Stork Didn’t Bring Me, I Came From a Dish: Psychological Experiences of Children Conceived through Assisted Reproductive Technology. Journal of Infant, Child, and Adolescent Psychotherapy, 6(2): 124-140.


Escobar, Laura Maria (2008). Progressive care : an examination of male to female transgender sex workers’ experiences within the health care and social service systems in San Francisco, California. MSW Dissertation, Smith College School for Social Work, Northampton, Mass. PDF Download. Download Page.
Evans, Richard Neil (2009). A Philosophical Exploration of Transsexuality. PhD Dissertation, The University of Birmingham. PDF Download.

Finger, Eleanor Ford (2010). Beyond the Binary: Serving the Transgender Student, Improving the College Experience. PhD Dissertation, Department of Higher Education, Washington State University. PDF Download. Download Page.

Gallacher L (2003). The psychology of intersex: Research into the experiences of individuals who have experienced abdrogen insensity syndrome or congenital adrenal hyperplasia within the UK. M.A. Thesis. University of York. PDF Download.

Germon, Jennifer E (2006). Generations of gender: past, present, potential. PhD. Dissertation, University of Sydney. PDF Download. PDF Download.
Greatheart, Marcus Skidley (2010). The Fred Study: stories of life satisfaction and wellness from post-transition transgender men. Master’s Dissertation, Social Work, University of British Columbia. PDF Download.

Greenwood Swanson, Hunter (2009). Standards of Care: Transgender/Genderqueer Clients’ Experiences with Mental Health Workers. Master’s Dissertation, Smith College School for Social Work, Northampton, Massachusetts. PDF Download.

Grey, Leslee (2009). Multiple Selves, Fractured (Un)learnings: The Pedagogical Significance of Drag Kings’ Narratives. PhD. Dissertation, Educational Policy Studies, Department of Educational Policy Studies, College of Education, Georgia State University. PDF Download.

Hill, Robert S (2007). ‘As a man I exist; as a woman I live’: Heterosexual Transvestism and the Contours of Gender and Sexuality in Postwar America. PhD. Dissertation, University of Michigan. PDF Download.

Johnson, Christine (2004). Transsexualism: An Unacknowledged Endpoint Of Developmental Endocrine Disruption? Master’s dissertation, Environmental Studies, Evergreen State College. PDF Download.

Kalterborn B (2003). The Fa’afafine, gender benders in Samoa: On cultural construction of gender and role change. PhD Dissertation, University of Oslo. PDF Download. Abstract.

Kenagy GP (1998). Exploring an Oppressed Group: A Study of the Health and Social Service Needs of Transgendered People in Philadelphia. Ph.D Dissertation. University of Pennsylvania. Full Text: Dissertations available from ProQuest. Paper AAI9913481.

Lair, Liam Oliver (2009). Beyond whiteness and ideal masculinity; expanding transgendered identity. Master’s Dissertation, Roosevelt University. PDF Download.

LeBlanc, Fred Joseph (2010). Unqueering Transgender? A Queer Geography of Transnormativity in Two Online Communities. Master’s Dissertation, Victoria University of Wellington. PDF Download.

Lepak, Jamie Lynn (2011). Gender identity: an examination of fears concerning reporting. Master’s Dissertation, College of Social Sciences & Humanities, Department of Criminology and Criminal Justice, Northeastern University. PDF Download.

Loehr K (2007). Transvestites in Buenos Aires: Prostitution, Poverty & Policy. Master’s Dissertation, Georgetown University & Universidad de San Martin. PDF Download.

MacDonald, Danielle (2009). Photography as Therapy in the Transgender Community. Senior Thesis, University of Maine, Farmington. (Related) PDF Download.

Matza, Alexis (2009). The Boston “T” Party: Masculinity, Testosterone Therapy, And Embodiment Among Aging Men And Transgender Men. PhD. Dissertation, Anthropology, The University of Iowa. PDF Download. Download Page.

McLachlan, Christine (2010). Queering gender : an exploration of the subjective experience of the development of transgender identity. Master’s Dissertation, Clinical Psychology, School of Psychology, University of KwaZulu-Natal, Pietermaritzburg. PDF Download.

Meredith, Leah (2000). The meaning of lived experience of transexual individuals. Master’s Dissertation, University of British Columbia. PDF Download.

Morland ICF (2005). Narrating Intersex: On the ethical critique of the medical management of intersexuality, 1985-2005. PHD Thesis. Royal Holloway, University of London. PDF Download N/A. Abstract.

Payne, Tina (2010). Transgender: a curriculum for inclusion. Master’s Dissertation, Social Work, California State University, Sacramento. PDF Download.

Pfeffer. Carla A (2009). Trans(Formative) Relationships: What We Learn About Identities, Bodies, Work and Families from Women Partners of Trans Men. PhD. Dissertation, Sociology, University of Michigan. PDF Download. Download Page. Note: The third chapter of this dissertation is published: Pfeffer, C. A. (2008). Bodies in relation—Bodies in transition: Lesbian partners of trans men and body image. Journal of Lesbian Studies, 12(4), 325-345.

Phillips, Amber (2011). Transgender students: a seminar for academic and personal success. Master’s Dissertation, Ball State University. Download Page. PDF Download.

Riley, Elizabeth Anne (2012). The Needs of Gender Variant Children and Their Parents. PhD. Dissertation, Faculty of Health Sciences, University of Sydney. PDF Download.

Ritchie, Laura Renee (2008). Disclosure of Sexual Orientation by Adult Children to Their Family-of-Origin: Effects Upon quality of Family Relationship. PhD Dissertation, University of North Carolina at Charlotte. PDF Download.

Ryan, Joelle Ruby (2009). Reel Gender: Examining the Politics of Trans Images in Film and Media. PhD. Dissertation, American Culture Studies/Popular Culture, Bowling Green State University. PDF Download.

Saltzburg, Nicole L (2010). Developing a Model of Transmasculine Identity. PhD. Dissertation, University of Miami. PDF Download.

Saunders, Karen (2008). Queer intercorporeality: Body Disruption of Straight Space. Master’s Dissertation, Gender Studies, University of Canterbury, Christchurch, Aotearoa/New Zealand. PDF Download.

Saunders, Sean (2007). Crossing out: transgender (in)visibility in twentieth-century culture. PhD. Dissertation, University of British Columbia. PDF Download.

Schmidt, Johanna Mary (2005). Migrating Genders: Westernisation, migration, and Samoan fa’afafine. PhD, Dissertation, Sociology, The University of Auckland.

Smith, Tones (2011). Pathology, bias and queer diagnosis : a crip queer consciousness. Master’s Dissertation, Social Work, Smith College School for Social Work, Northampton, Massachusetts. PDF Download.

Tobin, Harper Jean (2003). Sexuality in Transsexual & Transgender Individuals. BA Honors Dissertation, Department of Sociology, Oberlin College. Full Text.

Waddle, Heather M (2010). Barriers to healthcare in the transgender population. Master’s Dissertation, Social Work, California State University Sacramento. PDF Download.

Waszkiewicz, Elroi (2006). Getting by Gatekeepers: Transmen’s Dialectical Negotiations within Psychomedical Institutions. Master’s Dissertation, Sociology, Georgia State University. PDF Download. Download Page. PDF Download.

Wharton, Virginia Wyatt (2007). Gender variance and mental health : a national survey of transgender trauma history, posttraumatic stress, and disclosure in therapy. MSW Dissertation, Smith College School for Social Work, Northampton, Mass. PDF Download.

White, Caroline (2002). Re/Defining Gender and Sex: Educating for Trans, Transsexual, and Intersex Access and Inclusion to Sexual Assault Centres and Transition Houses. Master’s Dissertation, Department of Educational Studies, University of British Columbia. PDF Download.

Windsor, Elroi J (2011). Regulating Healthy Gender: Surgical Body Modification among Transgender and Cisgender Consumers. Sociology Dissertations. Paper 55. PhD Dissertation, Department of Sociology, Georgia State University. PDF Download.

Wyatt Wharton, Virginia (2007). Gender Variance and Mental Health: A National Survey of Transgender Trauma History, Posttraumatic Stress, and Disclosure in Therapy. Master’s Dissertation, Smith College School for Social Work, Northampton, Massachusetts. PDF Download.

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Lawrence AA. (1998). Men trapped in men’s bodies: an introduction to the concept of autogynephilia. Transgender Tapestry, 85, Winter 1998, 65-68. Full Text N/A.

Lawrence AA. (1998). Men trapped in men’s bodies: an introduction to the concept of autogynephilia. Transgender Tapestry, 85, Winter 1998, 65-68. (Full text N/A).

Lawrence AA. (1997). SRS after less than a one-year real-life test: absence of regrets. Presented at the 15th HBIGDA Symposium, Vancouver, BC.

Lawrence AA. (1997). Transsexual self-portraits: sublimation through photographic imaging. Presented at the Second International Congress on Sex and Gender Issues, Philadelphia.

Lawrence AA. (1997). Meeting the sexual and reproductive needs of transsexual patients. Presented at the Second International Congress on Sex and Gender Issues, Philadelphia, PA. Excerpt N/A.

Lawrence AA. (1997). Life after surgery: questions and answers from the 1996 new woman’s conference. Presented at the Second International Congress on Sex and Gender Issues, Philadelphia, PA. Full Text N/A.

Lawrence AA, et al (1996). Health care needs of transgendered patients. Journal of the American Medical Association, 276, 874. Full Text N/A.

Levitt HM, Gerrish EA, Hiestand KR (2003). The misunderstood gender: a model of modern femme identity. Sex Roles: A Journal of Research, 48(3/4): 99-113. Full Text N/A.

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Li SL (1995). Gender, cross-dressing and Chinese theatre. PH.D. Thesis, University of Massachusetts, DAI, Vol. 56-08A, p. 3131, 229 pages.

Lunsing W (1995). Japanese Gay Magazines and Marriage Advertisements. Journal of Gay and Lesbian Social Services, Vol. 3(3), 81-87. (Abstract access via BUBL Search. Must scroll down to locate abstract.)

Lynn J (1995). My Father’s Other Name is Rita. Journal of Family Social Work, Vol. 1(2), 91-99. (Abstract access via BUBL Search. Must scroll down to locate abstract.)

Mahalingam,R. (2003). Essentialism, culture, and beliefs about gender among the Aruvanis of Tamil Nadu, India. Sex Roles, 49, 9/10, 489-496. Abstract. Full Text N/A.

Mallon, Gerald P (1999). A Call for Organizational Trans-Formation. Journal of Gay & Lesbian Social Services, 10 (3/4): 131-49.

Mallon, Gerald P (1999). Knowledge for Practice with Transgendered Persons. Journal of Gay & Lesbian Social Services, 10 (3/4): 1-18.

Marks I, Green R, Mataix-Cols D (2000). Adult gender identity disorder can remit. Comprehensive Psychiatry, 41(4): 273-275. Full Text N/A: PDF Download.

May K (2002). Becoming Women: Transgendered Identities, Psychosexual Therapy and the Challenge of Metamorphosis. Sexualities, 5(4): 449-464.

Menvielle EJ, Tuerk C (2002). A support group for parents of gender-nonconforming boys. Journal of the American Academy of Child and Adolescent Psychiatry, 41(8): 1010-3. Full Text N/A.

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Miller JE (1993). Service and subjectivity: the cross-dressed woman in early modern english drama. PH.D. Thesis, The University of Utah, DAI, Vol. 54-11A, p. 4104, 230 pages.

Mumper AD (1989). Latent male gender dysphoria as measured by the GD scale of the MMPI: a prediction and construct validation study. PH.D. Thesis, The University of Akron, DAI, Vol. 50-01B, p. 349, 265 pages.

Namaste V (1999). HIV/AIDS and Female to Male Transsexuals and Transvestites: Results from a Needs Assessment in Quebec. The International Journal of Transgenderism, 3(1/2). Full Text. Full Text.

Nanda S (1985). The hijras of India: cultural and individual dimensions of an institutionalized third gender role. Journal of Homosexuality, 11(3-4), 35-54.

Navelet C, Gastambide A (1999). A study of the seduction of transsexuals by the image. Evolution Psychiatrique, 64(2): 309-322.

Nickel-Dubin, A (1998). The Effects on a Family System When One Member is Transgender: A Case Study. Progress: Family Systems Research and Therapy, 7, 163-172. Full Text. Full Text.

Niveau G, Ummel M, Harding T (1999). Human Rights Aspects of Transsexualism. Health and Human Rights, 4(1), 134-164. Download Page. PDF Download.

Norton J (1999). Transchildren and the Discipline of Children’s Literature. The Lion and the Unicorn 23(3), 415-436. Full Text. Subscription needed.

Norton J (1997). “Brain Says You’re a Girl, But I Think You’re a Sissy Boy”: Cultural Origins of Transphobia. International Journal of Sexuality and Gender Studies, 2(2): 139-164. Abstract.

Ormiston W (1996). Stone Butch Celebration: A Transgender-Inspired Revolution in Academia. Harvard Educational Review, vol. 66(2), 198-215.

Pazos, Sophia (1999). Practice with Female-to-Male Transgendered Youth. Journal of Gay & Lesbian Social Services, 10 (3/4): 65-82.

Perin, Ellen C (2003). Helping parents and children understand “Gender Identity Disorder”. The Brown University Child and Adolescent Behavior Letter. Full Text N/A. Excerpt.

Pfäfflin F (1997). Sex Reassignment, Harry Benjamin, and some European Roots. The International Journal of Transgenderism. Vol. 1(2). Full Text.

Pfäfflin F, Junge A (1998). Sex Reassignment Thirty Years of International Follow-Up Studies SRS: A Comprehensive Review, 1961-1991 (English edition). Table of Content / Full Text online. (103 files with 1,980 kb, equivalent to 370 printed pages)

Piccirillo E (1996). In Search of an Accurate Likeness: Art Therapy with Transgender Persons Living with AIDS. Art Therapy: Journal of the American Art Therapy Association, vol. 13(1), 37-46.

Piedmont O (1996). The veils of arjuna: androgyny in gay spirituality, east and west. PH.D. Thesis, California Institute of Integral Studies, DAI, Vol. 57-06B, p. 4076, 401 pages.

Powers B (1996) The Impact of Gay, Lesbian, and Bisexual Workplace Issues on Productivity. Journal of Gay and Lesbian Social Services, Vol. 4(4), 79-90. (A BUBL “abstract” link. Must scroll down to locate abstract.)

Preuss WF, Eicher R (1997). Problems of transsexual parents. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium.

Price-Spratley T (1996). Negotiating Legacies: Audre Lorde, W.E.B. Du Bois, Marlon Riggs, and Me. Harvard Educational Review, vol. 66(2), 216-30.

Prosser JD (1996). Transitional matters: the body narratives of transsexual autobiography. PH.D. Thesis, City University of New York, DAI, Vol. 57-10A, p. 4372, 00429 pages.

Prosser JD (1995. No Place Like Home: The Transgendered Narrative of Leslie Feinberg’s Stone Butch Blues. Modern Fiction Studies 41(3/4), 483-514. Full text. Subscription needed.

Rachlin, K 1999). Factors Which Influence Individual’s Decisions When Considering Female-To-Male Genital Reconstructive Surgery. The International Journal of Transgenderism, 3(3). Full text.

Reddy, Gayatri (2003). “Men” who would be kings: celibacy, emasculation, and the re-production of hijras in contemporary Indian politics. Social Research, 70(1). Full Text.

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Rosenberg, Miriam (2002). Children with gender identity issues and their parents in individual and group treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 41(5): 619-21. Full Text N/A.

Rubin HS (1996). Transformations: emerging female to male transsexual identities. PH.D. Thesis, Brandeis University, DAI, Vol. 57-04A, p. 1865, 268 pages.

Sandnabba K, Ahlberg C (1999). Parents’ attitudes and expectations about children’s cross-gender behavior. Sex Roles: A Journal of Research, February 01. Full Text.

Sax, Leonard (2002). How common is intersex? A response to Anne Fausto-Sterling. Journal of Sex Research, 39(3): 174-78. Full Text. (Journal of Sex Research: Table of Contents) (PubMed Abstract)

Schacht, Stephen (2000). Four renditions of doing female drag: feminine appearing conceptual variations of a masculine theme. Gendered Sexualities, 6: 157–180. PDF Download.

Schjelderup N (1994). Oral histories of black gay men and a black transgender person in the San Francisco bay area. M.A. Thesis, San Jose State University, MAI, Vol. 33-01, p. 66, 114 pages.

Schjelderup N (1994). Oral histories of black gay men and a black transgender person in the San Francisco bay area. M.A. Thesis, San Jose State University, MAI, Vol. 33-01, p. 66, 114 pages.

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Seshadri P, Ramakrishnan L (1999). Queering Gender: Trans Liberation and Our Lesbigay Movements. Trikone Magazine. July issue. 14(3): 6-8, 18. Full text. Full text.

Sharper, Andrew N (2001). From Functionality to Aesthetics: the Architecture of Transgender Jurisprudence. E-Law (Murdoch University Electronic Journal of Law), 8(3). Full text.

Sinnott M (2000). The semiotics of transgendered sexual identity in the Thai print media: imagery and discourse of the sexual other. Culture, Health and Sexuality, 2(4): 425-440. Excerpt.

Sherebrin H (1996). Gender Dysphoria: The Therapist’s Dilemma – The Client’s Choice. – Art Therapy: Journal of the American Art Therapy Association, vol. 13(1), 47-53.

Smith J (1995). Concerns of Gay, Lesbian, Bisexual, and Transgender Graduate Students. New Directions for Student Services, No. 72, 111-19.

Smith ME (1996). Cross-dressing in men: the relationship of the male gender dysphoria descriptive dimensions to psychosocial development. PH.D. Thesis, Indiana University, DAI, Vol. 57-12B, p. 7744, 210 pages.

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Steinmeyer SM (1986). Transsexuals in transition: the impact of a pre-surgical treatment program upon psychological adjustment and self-esteem. PH.D. Thesis, United States International University, DAI, Vol. 47-05B, p. 2216, 147 pages.

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Swann, Stephanie; Herbert, Sarah E (1999). Ethical Issues in the Mental Health Treatment of Gender Dysphoric Adolescents. Journal of Gay & Lesbian Social Services, 10 (3/4): 19-34.

Swartz L (1997). Updated Look at Legal Responses to Transsexualism: Especially Three Marriage Cases in U.K., U.S. and New Zealand. The International Journal of Transgenderism. Vol. 1(2). Full Text.

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Tomsen S, Mason G (2001). Engendering homophobia: violence, sexuality and gender conformity. Journal of Sociology, 37(3): 257-273. Excerpt.

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Tsoi WF (1990). Developmental profile of 200 male and 100 female transsexuals in Singapore. Archives of Sexual Behavior, 19(6), 595-605.

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Williams W (1997). Homophobia and Transphobia. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium.

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Wilson AN (1997). Profiles on eight consecutive HIV positive true transsexual gender dysphorics undergoing re-assignment surgery. Paper presented at the XV Harry Benjamin International Gender Dysphoria Association Symposium.

Wilson KK (1997). Gender as Illness: Issues of Psychiatric Classification. In: Taking Sides – Clashing Views on Controversial Issues in Sex and Gender, E. Paul, Ed., Dushkin McGraw-Hill, Guilford CN, 2000, pp. 31-38. First presented at the 6th Annual ICTLEP Transgender Law and Employment Policy Conference Houston, Texas, July 1997 Paper presented at the 6th Annual ICTLEP Transgender Law and Employment Policy Conference in Houston, Texas, July 1997. Full Text. Full Text.

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Wilton, Tamsin (2000). Out/Performing Our Selves: Sex, Gender and Cartesian Dualism. Sexualities, 3(2): 237-254. PDF Download. PDF Download. – Welcoming Dialogue: A Further Response to Out/Performing Our Selves (Hird, 2002).

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And The Sites – Some Searchable – Where “Free Papers” Are Available!

Search Engines & Directories: – – Google Scholar. – MSN Search.- Proteus Search. – Wikipedia Listing of Search Engines. – All GLBT Resource Directories. – Google’s GLBT Directory. – Yahoo’s Directory. – DMOZ: Open Directory. – BGLAD. – Wikipedia. – GLBTQ: The Encyclopedia of Gay, Lesbian, Bisexual, Transgender & Queer Culture.

Directories for Open Access Resources: – The Directory of Open-Access Journals. – Registry of Open Access Repositories (ROAR). – Yahoo Theses Access Directory. – Google Directory: Free Access Online Archives.
Open Access Collections From Multiple Sources: – Australian Research Online. – hal: articles en ligne (French / English Version). – Archive Ouverte INRIA. – Hispana. Directorio y recolector de recursos digitales. – Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. – Pacific Rim Library. – OAIster: a union catalog of available digital resources. – – OpenJ-Gate: Open Access. – many free full text articles and papers. –

Search for Free Papers / Book Reviews: – All Papers are free at BioMed Cental (Open Access) & PubMed Central. – HighWire Press (Numerous Free Papers). eScholarship Repository: University of California, e-books, journals and peer-reviewed documents. – DSpace Eprints: Australian National University. – DSpace@MIT. – Virginia Tech: Digital Library / Archives. – eScholarship: U of California. – University of Southampton CiteBase. – Eprints: University of Nottingham. – T-Space at The University of Toronto Libraries. – NTUR, National Taiwan University. – Allacademic: Some free papers to either read online or download as PDFs. – UNESCO: Articles, Report, Dissertations, Films, etc. – Kyoto University Research Information Repository. – Doctoral dissertations and other publications from the University of Helsinki. – E-LIS: eprints in Library & Information Services. – CogPrints: eprints. – RePEc: Research Papers in Economics. – DiVa: Scandinavian University Documents. – The International Gay & Lesbian Review (IGLR): Book Reviews & Abstracts. – InterAlia, a peer-edited scholarly journal for queer theory.

Search for Free Articles, Papers or Reports: – The Free Library. – France Queer Resources Directory. – Séminaire gai. – The QRD. – GLBTQ: The Encyclopedia of Gay, Lesbian, Bisexual, Transgender & Queer Culture. – Human Rights Campaign. – IGLHRC: The International Gay and Lesbian Human Rights Commission. – ILGA: The International Lesbian, Gay, Bisexual, Trans and Intersex Association. – ILGA-Europe: International Lesbian, Gay, Bisexual, Trans and Intersex Association of Europe. – Magnus Hirschfeld Archive for Sexology, Humboldt-Universität zu Berlin. – Kinsey Institute Staff Publications. – Sexual Policy Watch Working Papers. – NAZ Foundation International: Primary aim is to improve the sexual health and human rights of marginalised males who have sex with males, their partners and families in South Asia and elsewhere. The World Health Orgazization. – The Body: The complete HIV/AIDS Resource. – POZ Magazine: Archive dates back to 1994.
Search for Papers, with Abstract Available (Some May Be Free): The National Library of Medicine (Free papera are highlighted). Abstracts from searches are available at: ERIC: The Education Resources Information Center (Many Free Documents). – Informaworld. – Oxford Journals (Some Open Access Content). – Springer Journals (Some Open Access Content). – ScienceDirect Journals. – University of California Press Journals on Caliber. – IngentaConnect. – Project Muse. – JSTOR: The Scholarly Journal Archive. – Wiley Interscience. – Cambridge Journals Online: Follow Link. – Sage Journals. – Palgrave Macmillan Journals. – Emerald E-journals. – University of Chicago Journals. – Lippincott Williams & Wilkins Journals. – HeinOnline (Access Free Content, Law Papers). – SSRN: Social Science Research Network.

Search for Free Theses / Dissertations, May Include Papers: Library & Archives Canada, Electronic Free Theses Download. – Virginia Tech: Electronic Theses and Dissertations. – DSpace@MIT. – Electronic Theses & Dissertations BYU. – OhioLINK Electronic Theses and Dissertations (ETD) Center & Worldwide ETD Index. – Australasian Digital Theses Program (Abstracts Given & Free Downloads). – Networked Digital Library of Theses and Dissertations (Abstracts). – PQDTOpen Dissertations (Abstracts & Free Downloads: ProQuest). DART-Europe: Free Access to European Doctoral Theses. – The British Library’s EThOS service (British Doctoral Theses Abstracts). – DORAS: Free Theses, Ireland. – TEL (thèses-en-ligne). – DiVa: Scandinavian Theses / Other Documents. – BORA: Open Archive, University of Bergen, Norway. – Doctoral dissertations and other publications from the University of Helsinki. – LUP: Lund University Publications. – National Cheng Kung University Institutional Repository. – HKU Scholars Hub. – Biblioteca Digital de Teses e Dissertacoes (BDTD), Brazil. – OAIster: a union catalog of available digital resources. Free papers also available –

Full Text GLBTQ Papers / Articles by/at: – Gay & Lesbian Issues and Psychology Review. – Archive of Sexology Full Text Papers. – Hawaii AIDS Education and Training Center: AIDS Education Project. – Arlene Istar Lev. – F. Kenneth Freedman. – Margaret Nichols & IPG Staff. – Michael Shernoff. – Gary Remafedi. – Susan Cochran & Vickie Mays (and Others). – Gregory M. Herek and others. – Esther Rothblum. – First International Conference of Asian Queer Studies: Index of Papers. (Related Book) – “Queer Space: Centres and Peripheries” Conference Papers. – Sexualities: Bodies, Desires, Practices: Project Archives: 2nd Global Conference on Sex & Sexuality Papers, 2005, 3rd Conference, 2006: Probing the Problematics: Sex and Sexuality. Papers in one PDF + More Conferences. – Intersections: Gender & Sexuality in Asia and the Pacific. – The Harvard Gay & Lesbian Review – Special Issue, 1996: Lesbian, Gay, Bisexual, and Transgender People and Education (Many Authors, abstracts, articles). – The International Journal of Transgenderism (Many Authors, Official Journal of the Harry Benjamin International Gender Dysphoria Association: HBIGDA). – Lesbigay SIGnals. – Self-Help Psychology Magazine. – Australian Humanities Review: Archive Index. – Schools Out Document Resource. – All NGLTF Documents. – National Coalition for LGBT Health: Downloading Page For Full Text Papers and Reports.


The information made available on this web page does not represent all the relevant information available on the Internet, nor in professional journals and in other publications.

This web page was constructed to supply a spectrum of information for individuals seeking to understand one or more of the many gay, lesbian, bisexual, queer and transgender issues.

My thanks to the University of Calgary team for the last section

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