Why Does Typology Matter to Medical Professionals?

(Somewhat related post & another)

Or, does typology have any medical bearing on treatment? It seems the answer is a resounding no according to a litany of research on the topic.

A 2016 study of Chinese trans individuals (Yang et. al) found that sexuality has essentially no correlation with PCS (physical component summary) and MCS (mental component summary) of the measured quality of life. Table 3 indicates that the associations between orientation and PCS ranged from -0.005 to 0.098, all of which were far below statistical significance. It was the same for MCS; a range from -0.012 to -.121 that did not achieve statistical significance (the most accurate model has a correlation of -0.066). Now of course we could attribute this result to sample bias, statistical error, or using faulty statistical models, but luckily there are a host of other studies that replicate the finding.

Meier et. al 2013 found no differences in mental health variables between FtM individuals, other than a minor difference in anxiety (the only difference was between androphilic and ambiphilic individuals, all other comparisons were statistically insignificant). We should also note the interesting change in sexual orientation reported by FtM individuals during the process of transition (which I’ll eventually get around to a post on).

Nieder et. al reviewed the entire literature and found just 10 studies (which is sufficient for a literature review in the field) reporting on the association between sexuality and transition-related outcomes. Just one of these studies reported a difference;

Given the intense debate surrounding the predictive, outcome-related value of sexual orientation after transition-related interventions (Lawrence, 2014; Veale, 2014, 2015), it seems remarkable that out of 10 follow-up studies (Table 1), only one reported or found a significant association according to the outcome measures between groups based on sexual orientation at all (Wierckx et al., 2014). They found that trans women who are attracted to men (unfortunately mostly referred to as ‘homosexual male-to-females’, which pertains to the sexual orientation according to the sex assigned at birth) had higher sexual desire compared with trans women who are attracted to women


Further, sexual orientation was not associated with the prevalence of hypoactive sexual desire disorder (HSDD) (Wierckx et al., 2014). However, quality of life was not
assessed within this study.

Given the literature’s confirmation that sexual orientation is not related with transition-related outcomes, it is necessary for medical professionals to ask for sexual orientation? Perhaps, in scenarios that are directly relevant; STD prevention, sex therapy, relationship counseling/therapy. But to the majority of the health professionals that trans individuals will encounter, it seems entirely unnecessary for them to ask and inquire as to the deeply personal nature of their sexual orientation.

Even more, this casts doubt on the diagnostic value of the purported ‘autogynephilia’. If we can classify ‘autogynephilic transsexuals’ and ‘homosexual transsexuals’ into two different categories, but the outcomes don’t differ, is there any value in differentiation?

Some Other Readings

A description of historical gatekeeping which importantly mentions the factor of sexual orientation

The Harry Benjamin Society standards

His book depicting the prototypical classification scale (page 19)

Experiences of gatekeeping in Thailand, Czech Republic, Germany

Assumptions about sexuality in the trans community

All of this goes to show the gatekeeping that arose from sexual orientation classification

Update – 11/16/18

Given that I choose a poor title for this piece, I’ll clarify what I had intended to communicate with the wording & the thought process I went through went writing & publishing this piece at midnight.

I was searching for more research for another piece when I came across the Chinese study (Yang et. al), recalled the existence of Nieder et. al (the literature review) and thought that the two could work together to make a coherent article on how it isn’t necessary for one’s medical professionals to inquire about sexual orientation (and thus the false ‘typology’) in order to impact decisions on providing treatment to patients. The articles linked in the Some Other Readings section articulate the issues with medical professionals asking about sexuality and using that to deny or delay treatment, which was is my primary criticism of the use of sexuality in medicine in trans-specific contexts (which is not to say that I oppose it). The existence of gatekeeping was intended to be a theme throughout the piece (and is something that I am eventually going to get around to writing on). Even more, the piece’s even larger overarching goal (as is the blog’s) is to criticize Blanchardianist ideology & criticize autogynephilia typology.

The “re”formulation of the title as “Or, does typology have any medical bearing on treatment?” helps contextualize the original purpose of the piece (as do the links to Kay Brown’s articles), but the chosen title then influenced the irrelevant and poorly worded content of the piece.

But the language I used obscured all of this; Medical professionals is far too broad of a term to refer to the individuals I intended to refer to: psychiatrists, psychologists and therapists – those who very often make diagnoses of trans individuals; the people who’ve been reported denying letters, recommendations and treatment because of sexual orientation; the paradigmatic gatekeepers. There are plenty of valid instances to ask for sexual orientation (although there may be more prudent and sensitive methods of obtaining the necessary information): for risk assessments for STD prevention, some therapeutic contexts, and so on as commenters on the Reddit thread insightfully pointed out. Even more, my crude estimation of the makeup of medical professionals trans people encounter could be false in many instances: it could be, for instance, that a trans individual is post-transition and encounters their primary physician far more than their psychiatrist (if they even have one).

A longwinded way of saying I’m sorry for choosing such a poor title.

Editorial, TERFs

Daphna Joel and the Limits of Cis – Trans Dichotomies

Daphna Joel is one of my favorite researchers in the neuroscience field (along with Jordan-Young, Fine and a set of others – almost all of whom are implicitly supportive of trans people, the rest haven’t voiced any opinions or comment on trans people). But unknown to many is that she also does research specifically on trans and nonbinary individuals.

Queering Gender

The first paper she published in the field is Queering gender: studying gender identity in “normative” individuals. The paper develops a new “Multi-GIQ” scale for measuring gender identity in both trans and cis individuals. The scale is used in a sample of 2225 individuals contacted over the internet. Joel et. al plot the data on several charts with interesting visualization techniques, showing some interesting results. 2018-11-12 15_35_02-Sci-Hub _ Queering gender_ studying gender identity in ‘normative’ individuals _.png

Just by visual inspection we can note individuals that identify as men that feel more like men than women and vice versa. There is also some level of bigenderism among several individuals. We can easily point out that a cis-trans binary focused on identification as a gender not typically associated with the gender assigned at birth is incoherent because it obscures the reality of identification: many “cis” individuals would be classified as bigender under nearly all definitions of bigender, and many would be classified as agender. These gender identities are very commonly considered “trans”. Even more, there are several cis individuals who have feelings that contrast the gender they were assigned: a woman feeling much more like a man than a woman.

2018-11-12 15_50_00-Sci-Hub _ Queering gender_ studying gender identity in ‘normative_ individuals2

While ‘qu\r’ individuals obviously had the most non-normative identities, substantiative numbers of supposedly normative individuals wished to be that of the ‘opposite gender’. If we’re operationalizing gender dysphoria as such, which many people in the trans community do, then that begets the conclusion that cis people can be dysphoric (something I’m perfectly willing to accept despite odd pushback).

Taken together, our findings suggest that dichotomous gender categorisation does not reflect the complexity and multiplicity of gender experience. Rather, our study provides supportive evidence to non-binary theories of gender (e.g. Corbett, 2009; Dimen, 1995, 2003, 2005; Goldner, 1991, 2003; Harris, 1991, 2005) that perceive gender as fluid rather than dichotomous, and consider all human beings, not just gender nonconforming individuals, to have complex assemblages of gendered selves (Harris, 2005).


Specifically, 36.6% of our non-Queer subjects reported that they sometimes feel as the ‘other’ gender (of these, 24% received scores above 1), 63.7% reported that they sometimes wish to be the ‘other’ gender (of these, 34% received scores above 1), 49% did not always wear clothes ‘appropriate’ to their sex (of these, 26% received scores below 3) and 41.9% were sometimes discontent with their sexed body (of these, 52% received scores above 1). These findings suggest that except for discontent with one’s sexed body, which is by its very definition dysphoric, the other types of feelings should not be viewed as reflecting gender dysphoria but rather the complexity and multiplicity of ‘normal’ gender experience.

While I appreciate the concession that cis individuals can experience dysphoria via discontent with ones sexed body, the dismissal of alternative definitions of gender dysphoria is somewhat annoying: I’ve seen many individuals attempt to reconcile ‘all trans people have dysphoria’ with the acceptance of a variety of trans individuals by (re)defining dysphoria as the wish to become another gender. The research shows this method is untenable in maintaining a coherent cis-trans binary.

Thus, Coolidge et al. (2002) reported that 2.3% of children scored in the clinically significant range of a six-item DSM-IV-based GID scale. Other studies report cross-gender behaviour in 2.4–10.4% of boys and 3.3–22.5% of girls (van Beijsterveldt, Hudziak, & Boomsma, 2006; Zucker, Bradley, & Sanikhani, 1997), the wish to be the other sex in 1–13.3% of boys and 2.8–13.3% of girls (Wallien et al., 2009; Zucker et al., 1997) and feeling like the other sex or more like the other sex in 4.6–10.4% of children (Wallien et al., 2009). Lai et al. reported that 1.9% of adult males and 7.3% of adult females were gender dysphoric

Some interesting results from the literature (which confirm the results of the study) which seemingly contradict Kay Brown’s claims that gender dysphoria is more common in “male” individuals. I suspect that this is not a result of intrinsic prevalence of being trans among the populations, but rather a product of societal norms (my post about butches and ftms could be enlightening as to how identity can obscure prevalence as well as my unsupported estimate that more trans men live as butch women than trans women live as feminine men). Regardless, there needs to be a lot more research into prevalence of gender dysphoria and trans identity among various populations.

Our results also do not support the prevalent view in contemporary psychoanalytic and critical theories that individuals have a binary sense of gender and that the heterosexual– homosexual binary constitutes, stabilises and naturalises the male–female binary

And while I adore this study, Joel et. al completely misrepresent Butler’s point here. It’s to be expected given that Joel is a neuroscientist and Butler is a continental philosopher who uses some complicated language and terminology that requires copious amounts of references to comprehend completely. Correlates do not disprove Butler and co’s claims about how sexuality and gender are produced by society, the discourses that surround the identities and how closely the two are related. Even more, Sedgewick and Butler would very likely not say that individuals simply “have a binary sense of gender”, their claims have much more to do with the discourses that surround gender than introspection. Butler’s work almost specifically breaks down the idea that binary gender is universally present. Despite many ‘normative’ individuals having decidedly ‘non-normative’ identities, they continue to uphold a societal system of binarism documented time and time again. From a more logical standpoint, the binary between homosexuality and heterosexuality implicitly accepts the idea that there are two mutually exclusive and immutable genders that are universally present: homosexuality for same and heterosexual for different. Even more, Butler more specifically claims that the heterosexual matrix naturalizes the male-female binary through its application of heterosexuality to everyone until it is stated or shown otherwise. Despite my adoration for Joel, it seems she is out of her depth when she wades into the philosophical feminist literature attempting to disprove descriptive statements about culture and discourse using individual representations of internal gender identity.


Jacobson and Joel recently published two studies relevant to our inquiry into the nature of gender identity. An Exploration of the Relations Between Self-Reported Gender Identity and Sexual Orientation in an Online Sample of Cisgender Individuals. and Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender, Transgender, and Gender-Diverse Individuals: An Exploratory Study.

The first notable thing that I want to highlight is not exactly related to gender identity or gender politics, but rather feminist politics and how MRAs (men’s rights activists) portray feminism politics. Table 2 indicates that 76.2% of women say they hold feminist views, 20.6% say ‘to some extent’ and only 3.2% do not. This is mirrored among men with moderately more negative reactions: 48.5% yes, 39.6% to some extent and 11.8% no. Contrary to the MRA narrative that ‘only 16% of women are feminists’, it seems as if a much larger portion are. Admittedly, this is not a representative sample and should not be extrapolated to the population as a whole, but it’s an interesting result that bears repeated testing with the same/similar questions.

As evident in Figs. 1, 2, 3, 4, and 5, many participants had what may be termed “queer” feelings, such as feeling both as a man and as a woman (38%) or as neither (35%), wishing to be the “other” gender (38%), or wishing to have the body of the “other” sex (35%)

A cross-cultural replication of the 2013 study, Joel again shows that a view that only trans people identify as genders other that they were assigned at birth is untenable and empirically false as a basis for cis-trans distinction.

The percent of binary individuals ranged between 8.8 and 40%, depending mostly on sexual orientation, with the highest percentage of binary individuals found in the exclusively heterosexual and exclusively homosexual groups, which did not signifcantly differ (p=.80), and lower percentage in the mostly heterosexual, bisexual, and mostly homosexual groups

The results also indicate that strict gender roles marginalize a majority of the population of cishet individuals. There may be correlations between identified gender and gendered performance, but that is definitively a product of social norms that are produced and reproduced by gendered performance and there exists a large population of individuals who defy these norms.

The present findings conflict with the common postulation of direct relations between biological sex, gender identity, and sexual orientation in two major aspects, which are clearly evident in Fig. 1. First, while scientific discourse usually perceives gender identity as a clear-cut, binary personality structure, our data reveal large variability in individuals’ gender identity with about a third feeling at least to some degree as the “other” gender. Second, and out of line with the idea that an “atypical” sexual orientation would entail an “atypical” gender identity, variability in gender identity was evident throughout the sexual attraction continuum, with an almost complete overlap between heterosexuals and non-heterosexuals in the range of scores on the different measures of gender identity. Moreover, even at the group level, only some non-heterosexual groups were significantly different from the exclusively heterosexual group. In fact, the finding that the group of exclusively homosexual men was not significantly different from the group of exclusively heterosexual men on any of the measures of gender identity is particularly in conflict with views strongly linking sexual orientation and gender identity. Our findings are in agreement, however, with the view that sexual orientation and gender identity are mostly distinct constructs.

Their summary of how the findings impact discourse on gender identity are good, but the bold part needs a large asterisk. The fact that sexual orientation and gender identity are coherently separate constructs is definitely a culturally specific phenomenon. In some cultures, gender and sexuality are not exactly considered distinct (see Thailand for example with gender identities and sexualities almost being considered identical in common parlance – which could have confounds when one looks at the Individualism vs Collectivism Hofstede scale and how it relates to the proportion of ‘nonhomosexual transsexuals’ in a country). In others, they’re interrelated in complex ways. Even more, the construct of sexuality is temporally and spatially-specific: cultures like that of the ancient Greeks and Romans viewed homosexuality not as a man loving another man, but a man being penetrated by a man – the act of penetration was not denigrated or deemed the same way as being penetrated was and moreover was not part of the same category. Foucault’s History of Sexuality is especially relevant on how sexuality and power are interconnected. And while gender identity and sexuality can be considered distinct constructs in the most abstract sense, we must also take note on how closely interrelated and intertwined one’s experiences of sexuality and gender identity fit together.

This finding is important because it highlights the fact that gender identities do not conform to narrowly defined dichotomous framings and suggests that identification with the “other” gender or wish to be the “other” gender or to have the body of the “other” sex are not necessarily a sign of gender dysphoria. Thus, our findings may normalize diversity in an area usually thought of as homogeneous, and by doing so help represent queer and transgender identities as belonging on the same gender grid as cisgender identities rather than as distinct phenomena.

One of my many gripes with the trans community (unfortunately transfeminists have many) is the insistence on telling individuals who have cross-gender feelings and urges that they must be trans in some fashion, that ‘only trans people want to be the “opposite” gender’, that ‘cis people don’t obsess over looking like the “opposite” gender’. It reifies an arbitrary distinction between cis and trans and while self-validating and potentially externally affirming, problematically erases the experiences of cis individuals who do in fact experience the feelings that many claim they don’t. Here it is in writing, wanting to be the “opposite” gender/sex cannot be the operationalization of gender dysphoria. Gender dysphoria contemporarily can be considered a polysemic construct rather than a homogeneous term, perhaps best represented by a Wittgensteinian family resemblance (see my article on ftms and butches on family resemblances and how they relate to gender).

More generally, our study adds to a growing body of literature that challenges dichotomous conventions within the science of gender and sexuality (for a recent review, see Hyde, Bigler, Joel, Tate, & van Anders, in press).

Most excitingly for me is my discovery that Joel is writing a new paper that reviews the research on gender and sexuality.

2018-11-13 12_23_16-Sci-Hub _ An Exploration of the Relations Between Self-Reported Gender Identity

We can note that among many sexuality subgroups, men have higher scores on the ‘wish to be the “other” gender” item, and that both items varies non-monotonically with sexuality.


Again visual inspection yields individuals that dislike their sexed body and want to have the body of the “other” sex. Furthermore, the individuals are notably not exclusively homosexual.


The graph from the discussion on gender roles above.

There are numerous other little important results that if I were to include and discuss them would make this post much longer than would make it useful or readable.

Gender Diverse

Jacobson and Joel released another 2018 study, Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender, Transgender, and Gender-Diverse Individuals: An Exploratory Study. It used a European-American sample of individuals rather than the original Israeli sample of the pioneering study, compromising a cross-cultural replication. It also introduces terminology not used in the pioneering study; “gender diverse”. I appreciate the movement away from ‘qu\r’ and while I think it’s the best solution, more could be done to clarify that genderqueer/nonbinary people can be transgender.


Again, there are AMAB men that feel like women and AFAB women that feel like men, cis men/women who feel like men and women, and cis men/women who feel somewhat unlike men and women. Also of note is that trans women/men feel less like women/men and more like men/women than cis women/men, again rebutting the idea that only trans people ‘feel’ like their gender.


Again, we note large numbers of cis individuals that feel like neither gender or as both genders, as well as trans individuals having higher rates of this (we see all of these values are quantifiable and almost all are significant in Table 2).


While we can easily note that trans and gender diverse individuals have much higher nonbinary scores on average, the range of these scores is almost identical among the 6 groups. This precludes the idea that nonbinary scores can, in every case, discriminate trans/nonbinary individuals from cis people (without forcefully categorizing individuals to best fit preconceived notions of the categories that best fit ones’ ideology).


And yet again, cis women and cis men have higher feelings of validity about their actual gender, unsurprisingly. Unfortunately this was not broken down by sexual orientation, but it’d definitely be a great exercise to see how homophobia/lesbophobia/biphobia/etc affects conceptualization of one’s gender identity as valid or invalid.

Implications for Trans Discourse

TERF Discourse

Joel et. al 2013

  • While the studies may be dismissed on face value by TERFs for using terms like ‘gender identity’ (of which I’m personally skeptical of, but that’s aside from the point) and directly referencing trans people in a supportive manner, Joel is famed in the radical feminist community because her researchers has important implications in the field of neuroscience of sex differences, namely that there are no “male” or “female” brains. In response to any claims about trans brains, they’ll typically cite Joel’s 2015 PNAS study while ignoring the nuances of the ‘trans brain studies’ (which they tend to homogenize into a monolith) that don’t necessarily claim that ‘male’ and ‘female’ brains exist. Many are reliant upon specific non-sexually dimorphic regions of the brain where trans individuals show atypical areas, values or signals, or make claims about the similarity of trans brains to cis brains that doesn’t create constructs of male/female brains. The long story short is that she’s widely cited in TERF spaces and has some level of credibility among them.
  • A common TERF claim is that “women don’t have gender identity” or “only trans people have gender identity”, both claims that are ‘disproven’ by the study. Gender identity was found to be persistent throughout large portions of the cis population, and many individuals reported ‘feeling like a woman’ / ‘feeling like a man’, things TERFs claim that do not exist in women (despite trans people pointing out that they often don’t understand the concept and/or don’t relate to it). [I’m separately skeptical about claims of feeling like a man/woman]
  • Another TERF claim about gender identity is that women have non-normative gender identities because societal misogyny disassociates them from their femaleness (the latter clause likely being true). But the study indicated that men have slightly higher non-normative gender identification, making it dubious to claim that misogyny is the cause of non-normative gender identity.
  • Yet another claim is that linking gender identity to sexual orientation, which is a claim that the study tested and disproved. There was no significant (non-scientific meaning) association with non-normative gender identity. Overall, r values were low. Even more, sexual orientation was not related with discontent with one’s sexed body; lesbians were not more likely to hate their body that heterosexual women.
  • Figure 7 indicates that qu\\rs have higher values of discontent with ones body, indicating that assertions that ‘all women are unhappy with their body’ are misleading and ignore the extent that trans individuals are unhappy/dysphoric about their body.
  • Gender roles aren’t upheld by trans/qu\\r individuals: “Men were more compliant with dress code than Women, and both Men and Women were more compliant than Queers”

Jacobson & Joel 2018

  • The research further confirms the results laid out above: that cis people have gender identities and “feel” like men/women, that sexual orientation and gender identity are very weakly linked (and not in a monotonic manner)
  • The second 2018 study we analyzed indicates that cis women and cis men have very similar feelings of non-normative gender identity. Even more, trans men/women and gender diverse individuals have much higher rates of feeling like neither gender or both genders than cis people do. It also confirmed results from previous studies about the interaction between sexuality and gender identity.
  • Essentially everything found in the Israeli sample was replicated in the predominantly English-speaking sample, lending further validity to the results.

Some Other Readings

A few of these were from the studies themselves, but I think should be highlighted for their specificity of the topic

Martin et. al 2016 A Duel Identity Approach for Conceptualizing and Measuring Children’s Gender Identity (Warning for binarism)

Nicole Rea’s Blurred Lines*: A Critical Examination of the Trans/Cis Dichotomy

Julia Serano (who I’m somewhat critical of) has a great essay describing the complexities of cis terminology

And a Tumblr post that articulates more specific problematic results of the cis-trans dichotomy rather than my accuracy-based analysis

Intersex-specific issues with the cis-trans dichotomy can be explored here and here, with personal experiences relayed here and here

Survey results highlighting the issue of casting the cis-trans binary onto nonbinary people

sillyolme, TERFs

Gender Nonconforming

(Post in question #1)

(Post in question #2)

For years, clinicians, therapists, researchers, and transfolk alike have remarked that “younger transitioners”, transkids, “homosexual transsexuals”, “early onset” (whatever label or demarcator in fashion) MTF transsexuals simply ‘pass’ better than “older transitioners”, autogynephilic transsexuals, “late onset” MTF transsexuals. For years, I wanted to conduct a study about this. Well, now we have clinical data to test this observation.

Who would have realized that male-attracted females are more gender-typical.

The Dutch have long contended that age of onset was the salient signifier, while those in North America contend that it is sexual orientation, specifically “homosexual” vs. “non-homosexual”, which readers of my blog, and those familiar with the literature, know gives a strong signal / correlation with autogynephilia in MTF transsexuals.

‘The Dutch’ have published empirical studies showing this is the case for a number of other variables, while showing sexual orientation is a lesser factor. Furthermore, the homogenization of North American trans researchers to represent Canadian researchers and then Anne Lawrence is interesting considering that a number of clinics that Brown and Blanchard and co. criticize are also from North America. Moser, a critic of Blanchardianism, is also from North America. The clinics in my area don’t follow Blanchardianism, neither have any of my therapists or psychiatrists.

In the graphs below, a higher score means more gender incongruent appearance (i.e. ‘readable’), while a lower score means more gender congruent (i.e. ‘passable’).

Modern society has the unfortunate phenomenon of gender stereotypes and gender norms that are enforced on trans and GNC individuals. This means that people who choose to present themselves as something incongruent with their gender, they are ostracized. This effect is magnified for trans people who choose to present in this manner (feminine trans men, masculine trans women).


Interesting results, but the lack of controls for choice in presentation is problematic. I can’t tell what the lines are supposed to represent, but I’m guessing that it’s either error bars or range, either of which add some important caveats. If it’s error bars (my initial interpretation), then it seems as if the correlation is inconclusive. If it’s range, then we can’t make claims about universal ‘passability’ because there’s such a large range of results. I’d be interested to see the results for GNC cis lesbian, GNC cis straight, GC cis lesbian and GC straight women as a reference point, of course using a subgroup of post-transition trans people to ensure we aren’t comparing mid-transition trans people to cis people.

Or yet another way of putting is that the least passible androphilic is the same as the average non-androphilic transwoman

Assuming that the bars represent the range, then she’d be wrong. The least passable androphilic trans women is far higher than the average for non-androphilic trans women.

There’s one other interesting graph in the study that Brown ‘forgot’ to include. The only about BIS (Body Image Scale) that measures how satisfied an individual feels about their body.


We can clearly see that the difference between androphilic and non-androphilic trans women is negligible, visually and statistically:

With regard to overall body satisfaction (i.e., BIS scores), no significant differences between sexual orientation and onset age subgroups were found in both natal sexes.

If non-androphilic trans women and androphilic trans women are equally satisfied with their body image, then it begs the conclusion that non-androphilic trans women are (relatively) content with their gender atypicality and probably even choose this. Among cis lesbian women, there is a much higher rate of chosen gender atypicality, as in “butch lesbians”, and the phenomenon of butch lesbian trans women has been documented by Leslie Feinberg.

If we hypothesize that the salient signifier is sexual orientation and NOT age of onset, then we would expect that the relative score for early onset would be intermediate between androphilic and both non-androphilic and late-onset (which is predominately non-androphilic at 79%).

The homogenized ‘Dutch’ believe that age of onset is a more significant signifier for a number of other variables, not exclusively passability.

That is to say, variation in the data is explained completely by sexual orientation and that the variation of passability with respect to age of onset is from the correlation between sexual orientation and age of onset.

The conflating of saliency with a variable explaining all of the variation of passability is disingenuous. The fact that one variable has the most significant single variable explanation does not mean other variables do not matter, or that 100% is explained by one variable.

However, given clinical experiences with each, the meaning of age of onset is quite likely different. If 43% of non-androphilic transwomen really did have an early onset… why do they all wait so long to socially transition?

I’ve given this some thought and come to the conclusion that if the etiology of FEFs is the internalization of gender dysphoria, then of course non-straight trans women are going to socially transition later on average. Regardless, we know this isn’t universally the case: Grossman et. al 2006 found that a majority of trans youth are non-“homosexual”:

While youth used a variety of terms to describe their sexual orientation, a majority of the FTM youth (15) used the word “queer”; other terms chosen were heterosexual, bisexual, and lesbian, with four youth not wanting to label their sexual orientation. In comparison, of the MTF youth, 14 identified as heterosexual, 8 as gay, 4 as bisexual, 3 as trans, 1 as lesbian, and 1 did not to select a label.

Now this is self-evidently anecdotal, but the only adolescent trans girls (I hate the term ‘girls’ but it’s the only applicable term I can think of here) that I’ve met are lesbians. And there are some interesting result about passability in this study too, so I recommend giving it a read.

We are still left with an open question. Why do androphilic transwomen pass so much better than non-androphilic? Three possible hypotheses exist, 1) Having a truly earlier age of onset and social transition age, they experience less masculinization from endogenous androgens. 2) Self selection for passibility as they are motivated to fit into society better, being both physically and behaviorally extremely gender atypical (and not autogynephilically motivated). 3) Actually being, as a group, intrinsically more physically gender atypical. (That is to say, that the etiological cause for their behavioral gender atypicality causes physical atypicality as well.)

I think that this passage, particularly point #3, really exposes Kay Brown for her beliefs. She doesn’t believe trans women are women, otherwise she wouldn’t say “gender atypical”. Feminine trans women are gender typical, because femininity is associated with womanhood. Masculine trans women are gender atypical, because masculinity masculinity is associated with manhood. The only way you can conclude that “androphilic transwomen” are “gender atypical” is if you consider their gender to be equivalent to the sex they were assigned at birth which is almost universally male.

There have been hints from a number of studies that there is a correlation between sexual orientation and subtle gender atypical facial physiognomy. A new study just how strongly supports this observation. Using a deep-layer neural net AI trained to categorize faces as heterosexual or homosexual, can differentiate between two faces, one of a heterosexual and one of a homosexual, of the same natal sex at 91% accuracy for males and 83% for females.

Citing this incredibly controversial study without referencing any of the controversy is a c h o i c e. The study has some serious methodological and logical flaws throughout, and is entirely based on the psuedoscience of physiognomy. This Medium article articulates the points better than I could. By ignoring social signaling and how the choices of what to wear (glasses, makeup) and shaving, they base their conclusions on biology rather than the obvious conclusion: that stereotypes exist. And even more, this Calling Bullshit piece explains the scientific flaws with how the study interprets its results.

The study could alternatively support the conclusion that lesbian women (cis and trans) and straight women (cis and trans) can be grouped together based on physiognomy (not one that I believe).

Onto the second article.

There is no “standard” to which behavior should “conform”. There is only behavior, period

Her first mistake is confusing the prescriptive for the descriptive. People using gender nonconforming (very often researchers studying trans people) are not saying that people should or should not conform to anything, just that they do or do not. She also seems to have missed the point as to what standard the term refers to: societal standards. It is far more socially acceptable to be a masculine man and a feminine woman than the reverse (something that has been noted by Brown herself). Conform can alternatively be interpreted as conformation to the majority, or what is most typical of the population. Gender nonconforming is a useful term politically in the first sense because by emphasizing societal standards, we offer a way to highlight those who are harmed by them and advocate for their abolition.

However, if we look at, study in depth as scientists, a species we can say that there are behaviors that are far more commonly performed by them than other behaviors seen in other species. These we can label as “typical” for that species. If we see a behavior in a given individual of a species that is uncommon for that species, we may label it “atypical”; but we would never label it “non-conforming” since we can’t really say what standard that a given species should “conform” to.

Again, nothing about gender nonconforming terminology talks about what standard an individual should conform to (as that would be a prescriptive statement), it’s describing how conformity (a social phenomenon used everywhere in the social sciences, and sometimes in the natural sciences) functions in punishing feminine men and masculine women. This is actually something recognized later in the piece, where she uses the word conform to describe the same phenomenon, while failing to recognize the meaning of gender nonconforming:

Given the religious (or related social views of gender) prejudice, one can easily see how children who exhibit these gender atypical behaviors are placed under tremendous pressure to “conform” to gender behavior standards that tend to skew to the gender typical, or even an exageration of typical behavior.

The irony.

But even deeper, is my objection to the post-modernist idea that there are no intrinsic sexually dimorphic behaviors in humans, that there are only socially constructed roles.

The everpresent postmodern (-‘ist’ in this case) strawpersyn persists. Nothing about postmodern analysis precludes the existence of sexually dimorphic behavior and some queer theorist researchers have even incorporated that into their analysis.

This notion would state that since all differences in behavior observed between the human sexes are socially constructed and maintained, there must be a socially defined standard to which we can conform or not.

There is a socially defined standard to which we can conform or not, but that is not because of ‘differences in behavior observed between the human sexes are socially constructed and maintained’ (which is definitionally true if anti-constructionists would bother to read Ian Hacking’s The Social Construction of What?), it’s because we can observe this in society.

Thus, both of these ideas reduce any behavior that is seen in an individual that is uncommon in that person’s sex to an act of “gender non-conformity” either by accident or by will… but never by nature. I find both the notion that we stand outside of nature to be scientifically preposterous and philosophically offensive.

The assertion that gendered behavior is caused by social differences rather than nature isn’t saying that we stand “outside of nature”. Her logic is a non-sequitur. The nature-nurture dichotomy has been explicitly criticized by the so-called “post-modernists” she’s alluding to (she never names them by name, but the ‘postmodernists’ that study sex and gender usually fall into the category of queer theory). Dichotomies are constantly questioned by post-structuralists, including true-false, gay-straight, man-woman and so on. My favorite example is Judith Butler:

Lévi-Strauss’s structuralist anthropology, including the problemaic nature/culture distinction, has been appropriated by some feminist theorists to support and elucidate the sex/gender distinction: the position that there is a natural or biological female who is subsequently transformed into a socially subordinate “woman,”with the consequence that “sex” is to nature or “the raw” as gender is to culture or “the cooked.” If Lévi-Strauss’s framework were true, it would be possible to trace the transformation of sex into gender by locating that stable mechanism of cultures, the exchange rules of kinship, which effect that transformation in fairly regular ways. Within such a view, “sex” is before the law in the sense that it is culturally and political undetermined, providing the “raw material” of culture, as it were, that begins to signify only through and after its subjection to the rules of kinship.

This very concept of sex-as-matter, sex-as-instrument-of-cultural-signification, however, is a discursive formation that acts as a naturalized foundation for the nature/culture distinction and the strategies of domination  that that distinction supports. The binary relation between culture and nature promotes a relationship of hierarchy in which culture freely “imposes” meaning on nature, and, hence, renders it into an “Other” to be appropriated to its own limitless uses, safeguarding the ideality of the signifier and the structure of signification on the model of domination.

and so on. For post-structuralists, a nature-nurture, nature-culture dichotomy is as incoherent as the man-woman dichotomy. Fausto-Sterling (who is not a post-modernist, but I expect would be similarly criticized by Brown) similarly criticizes the distinction between biology and culture in Sexing the Body (another fantastic read that shows how sex isn’t a natural phenomenon).

In other pages of this blog, I’ve made reference to the single most sexually dimorphic behavior in humans: androphilia (sexual attraction to adult males). In female humans, it is extremely common to be attracted to men. Approximately 98% of women are attracted to men while only approximately 5-10% of men were attracted to men. One could object to this being a ‘natural’ phenomena and say that social expectations have defined this. But it would not fit the evidence that has been amassing that sexual orientation is neither “chosen” nor “taught”.

The entire division of behavior by sexual orientation is a social construct. We can note that sexuality is constructed differently in many societies: Latin America and ancient Rome didn’t conceptualize penetration and being penetrated as equivalent forms of sexuality that are both classified under the label ‘homosexual’ or ‘gay’. In fact, penetration was classified as

Further, why should humans be unique in the world? Most mammalian species are sexually dimorphic in their sexual attractions. (No, I’m not denying that same sex behavior occurs in non-human species… only saying it is not as common as other sex attraction.) But, this isn’t the end of the story.

I will quote Daphna Joel and Lutz Jäncke on this matter.

Joel [,] has recently suggested that such evidence may be found in animal studies reporting that the effects of sex on the brain differ even to the point of opposition under varied environmental conditions and that sex-by-environment interactions may differ for different brain features. For example, Reich et al. [] found that three weeks of mild stress reversed a sex difference in the density of CB1 receptors in rats’ dorsal hippocampus. Thus, what was typical in one sex category under some conditions (i.e. low density of CB1 receptors in non-stressed females and high density of CB1 receptors in non-stressed males) was typical in the other sex category under other conditions (i.e. following three weeks of stress). A different sex-by-environment interaction determined the density of CB1 receptors in the ventral hippocampus, as the same manipulation (three weeks of mild stress) eliminated a sex difference in the density of these receptors in the ventral hippocampus.


In contrast to humans, genetic, developmental and environmental conditions can be highly controlled in laboratory animals. Thus, the variability of factors that might interact with sex to affect the brain (such as age, stress, housing conditions, nutrition, history of drug exposure; for references and review, see [,]) is greatly reduced. Consequently, brains of laboratory animals in a specific experiment are expected to be less heterogeneous compared with brains of humans in a single study. Therefore in laboratory animals, differences between the sex categories may indeed reveal the effects of sex rather than the effects of some chance difference between the sample of females and the sample of males in the study.


Although in animals there is probably no equivalence to gender as a social system, there are still environmental variables that, in addition to physiological variables (e.g. weight), correlate with sex category (e.g. number of animals in the home cage []). Studies in laboratory animals that use sex category as a variable should take special care to either control for (physiological) and avoid (environmental) sex differences in these variables, or systematically manipulate them.


This research has also been strongly influenced by animal research, where it is much easier than it is in humans to study genetic differences in terms of sex/gender, including at the molecular, hormonal, and neurophysiological levels , . However, it is not a simple endeavor to transfer results and interpretations from animal research to explain human behavior and cognition, since there are still some substantial differences between humans and other animals. One major difference is that the brain of humans is different in many respects from the brain of most other animals, although the human brain comprises the same neurons as even simpler constructed animals. The human brain comprises the largest number of neurons compared with all other animals in absolute terms . In addition, it is characterized by extreme, and in the animal kingdom unprecedented, interconnectivity that provides the necessary basis for the computation and storage of information, which is necessary for human learning and culture . This huge neural network is also significantly plastic and can be shaped by individual experience and practice

Let’s move on.

Had the strong social construction hypothesis of all gendered behavior been true, there would have been no correlation. We can reject this hypothesis.

Specifically note that she said correlation. Without causation, we cannot reject the social construction hypotheses because we could have not controlled for enough socioenvironmental variables.

This likely also extends past adolescence to explain the rather dramatic differences in passability between androphilic transwomen and gynephilic transwomen

Interesting how she overstates the ‘passability’ difference.

Being gender atypical in brain organization, it would naturally lead to later androphilia, gender atypical motor skills (feminine walk and hand gestures), and gender atypical vocal production (feminine or “gay lisp”).

Unfortunately, brain organization theory doesn’t have enough evidence to support it, especially given the predominance of the theory in contemporary neuroscience research. Rebecca Jordan-Young’s Brain Storm is a great read on this topic.

One would, at first glance, believe that those who hold the strong social construction hypothesis as true would then have no qualms about accepting gender atypical children and adults without reservation as breaking stereotypes.

Many do. For example, Andrea Dworkin, Catharine MacKinnon, Monique Wittig, Gloria Steinem are all examples of radical feminists who are in favor of trans people’s existence.

But, as we can easily discern, they often do not, as demonstrated by the minority movement within the gay and lesbian (mostly lesbian) communities of being “gender critical”

Overwhelmingly, adherents to gender critical ideology are women and most theorists are (or at the very least profess to be) radical feminists (the followers are somewhat different).

They philosophically approve of people being gender atypical… but only to a very specified point, accepting the gender normative roles that were established during the early Gay Liberation Movement.

I spend quite a bit of time reading and contesting gender critical ideology, so I like to think that I’m “educated” on it. I can definitely say that radical feminists and gender critical feminists believe themselves to be against gender roles. Their issue with trans people is that they:

  1. Believe that gender nonconforming people are erased by ‘trans ideology’. This is because they so often see female-attracted trans men transitioning (or very often themselves) who were previously butch lesbians, and male-attracted trans women that used to be feminine gay men. From their point of view, transitioning and claiming oneself to be a man/woman erases GNC individuals and turns them into gender-conforming individuals. A butch lesbian is GNC, a masculine man is not. A feminine gay man is GNC, a feminine woman is not.
  2. Believe gender roles are reified by ‘trans ideology’. While I do have gigantic issues with certain trends within some trans subcultures and communities, they by and large misrepresent the trans community to conclude that trans people reinforce gender roles. From their POV, telling feminine men that they must be women means that femininity in men is unacceptable and treated with transition. On the /r/GenderCritical sidebar (right side), there is a diagram that helps elucidate their actual beliefs.


By erasing the lived experiences of trans people and ignoring those important things called gender dysphoria and freedom, they construct their narrative that ‘trans ideology’ reifies gender roles. Now I do agree that ‘gender critical’ feminists tend to uphold and reinforce gender roles, it’s for quite different reasons than their lack of support for transition (which has more to do with a fundamental reification of the beauty of ‘original bodies’ and narratives about mutilation). When discussing and analyzing gay men and trans people, they tend to uphold the exact stereotypes they profess to oppose.

The moment that an individual steps past that point, there will be those who will denounce them as hewing to the very stereotypes that they break, but in the opposite gendered sense, denying that underlying sexually dimorphic behavior as valid.

They are (usually, but it varies based on the topic: they are often very opposed to drag queens) completely fine with feminine men, in fact that’s exactly what they wish trans women to live as. The unnecessary mutilation of their bodies is what they oppose (but as we all know, transition is neither unnecessary or mutilation).


Biphobia: Invalidating People’s Identities Is Never OK

(Post in question)

J. Michael Bailey. Oh, he’s such a joy.

Bisexuals have lambasted him for showing that true bisexuality in men is actually quite rare.

Bisexuals have “lambasted” him for invalidating their identities. He claims to have objective knowledge of intersubjective experiences of attraction, as if phallic arousal represents all attraction. His research has a number of methodological flaws which I won’t waste my time getting into here, but the point is that he invalidates bisexual people’s identities on the basis of “raw objective science” as if science isn’t a domain of power by which minorities populations are subjugated, their experiences poked, prodded and invalidated. Science is not a neutral zone where we can find “rational truth”, it’s something created by ideology and power.

Gay people have maligned him for his philosophical stance that if it is “OK” for parents to use genetic screening or manipulation to effect a non-critical trait such as eye or hair color, then it is equality “OK” to select for the equally non-critical trait of sexual orientation  (meaning that Bailey sees gay or straight as equally valuable and acceptable outcomes in children), falsely accusing Bailey of supporting anti-gay genocide (ummmm… no… he equally supported chosing FOR being gay… as they were morally the same).

Here is where Brown misrepresents the opposition to Bailey’s position. Gay people oppose his position specifically because it enables a heterosexist homophobic society to erase gay people by eugenics. It allows society to prevent gay people from being born in the first place, to fuck with genetics, to screw up our sexualities. By equivocating the support of the choice to prevent gay sexuality from developing to the support of the choice to prevent straight sexuality from developing, Brown assumes that gay and straight are mutable and interchangeable categories with identical perspectives and histories. But we’ve seen that the socially produced power dynamics between straight and non-straight people create a privileging of heterosexual opinions that would intrinsically erase gay people. It is not possible to support “genetic screening” for sexuality without supporting the effect: religious homophobes genetically modifying children’s sexualities to prevent q\er children from being born. There is virtually nobody that would modify a fetus’ sexuality to be non-heterosexual. By allowing the non-heterosexual population to be systemically eliminated, Bailey’s position would reproduce societal cisheterosexism, and as such his position is indistinguishable from generic anti-gay positions.


Cherrypicking The Transgender Brain

(Post in question)

I won’t comment on the Daphna et. al literature, because it’s still an emerging line of research that has some more philosophical and definitional questions as to what actually constitutes dimorphism (I’ve seen contradicting meanings).

Ummm… this result is in complete agreement with another hypothesis that many transwomen find uncomfortable, one made by Ray Blanchard, in which he hypothesized that late transitioning transwomen would have brain structure differences from both men and women that would NOT be sexually dimorphic; while young (“homosexual”) transsexuals would show shifts in sexually dimorphic structures toward female morphologies.  There was an earlier review of previous studies (which I also wrote a post about) that had shown that hypothesis to be supported.

There’s also recent research that shows controlling for sexuality has absolutely no effect on trans brain structures.

From the abstract:

However, controlling for individual estradiol, testosterone, or progesterone plasma levels or for subjects’ sexual orientation did not change group differences

And then in the statistical analyses section they explain their control:

To investigate whether the three sex steroid hormones (E2, T, and P4) or sexual orientation explained group differences, the named variables were added as covariates of no interest within separate ANCOVA analyses. Finally, multiple regression analyses were performed to determine the effects of hormones and sexual orientation on diffusivity maps independent of group membership, i.e., with group in addition to TIV as factor of no interest. Separate models were calculated for each of the independent variables (E2, T, P4, and sexual orientation). Because hormone values over the entire sample were non-normally distributed, they were transformed to ordinal scales based on ranks before inclusion in the analysis. Sexual orientation was entered into analyses in three different ways of coding: (1) as raw values of the Likert scale (1 for attraction toward females; 7 for attraction toward males); (2) as a spectrum from homosexuality (e.g., 1) to heterosexuality (e.g., 7) with reference to the raters’ genetic sex; and (3) as a spectrum from homosexuality to heterosexuality with reference to the raters’ gender identity. The statistical threshold was set at p < 0.05 FWE corrected, using the threshold-free cluster enhancement method to define the clusters (). Voxels showing significant differences were assigned to white matter tracts using the DTI-81 white matter atlas of the International Consortium for Human Brain Mapping as provided by the DiffeoMap software package ( Diffusivities based on tract-specific quantification for right and left CST, Fmajor, and Fminor were compared using ANOVA in SPSS. Separate models were calculated for each tract and diffusivity parameter, followed by post hoc pairwise comparisons and correction for multiple comparisons using the Bonferroni’s procedure. Analyses were run with and without TIV as covariate of no interest. Separate correlation analyses were performed to examine the association between diffusivities and age and between volumetric data [gray matter volume (GMV), white matter volume (WMV), CSF, and TIV] and age for each group.

And their results:

Here, we investigated whether sexual orientation associates with diffusivity measures. No effects on our main findings were observed when sexual orientation was regressed out in the ANCOVA design. Moreover, there was no significant effect of sexual orientation on diffusivity parameters in the regression analysis including all subjects and using group as factor of no interest.

And furthermore:
In our study, we find robust differences between investigated groups in MD, AD, and RD indicating that biological sex and gender identity both contribute to observed group differences. Moreover, the high positive correlation with adult plasma T levels (controlling for group membership) indicates that group differences cannot be explained by peripheral sex hormone plasma levels. As expected, biological males (MCs and MtF transsexuals) had higher T levels than biological females (FCs and FtM transsexuals), whereas group differences in diffusivity values showed the transition FC > FtM > MtF > MC. Furthermore, group differences were not explained by differences in sexual orientation, narrowing potential determinants for differences in diffusivity parameters to biological sex and gender identity.
As I said, I don’t particularly care about etiological debates over neurology considering the field is new enough to warrant skepticism about replicability and usefulessness, and the extent that socialization and environmental factors affect brain neurology.
But I’ll offer an alternative interpretation of the data that lesbian trans women have ‘masculinized brains’ (taking that as an axiom for the purpose of argument).
We know from some recent on the neurology of gay men and lesbian women that sexual orientation has an effect on brain neurology independent on trans status:

diffusivities and age and between volumetric data [gray matter volume (GMV), white matter volume (WMV), CSF, and TIV] and age for each group.

A 2008 study demonstrating that homosexual men and women have sex-atypical brain structures

The connectivity pattern in homosexual subjects was almost reciprocal in relation to the same-sex controls

Second, HoM, just as HeW, displayed connections with the contralateral amygdala, the anterior cingulate, the subcallosum, and the hypothalamus

Group comparisons confirmed these findings: HeW, as well as HoM, showed a greater connectivity with the contralateral amygdala and the cingulate cortex compared with both HeM and HoW.

We also found that the hemispheric ratios, as well as the patterns of amygdala connectivity, were sex atypical in homosexual subjects, with HoM exhibiting more female patterns and HoW showing more male-like features (albeit less pronounced).

(Note that this has been replicated quite a few times)

A TERF or transphobe could easily interpret this data to show that “trans women are just gay men!” and “trans men are just lesbian women”, which is exactly why the neurological argument is intrinsically flawed. But this data yields an alternative interpretation of the (contested) result that lesbian trans women have brains more similar to that of men: they should. Just like lesbian cis women have brains “more similar to that of heterosexual men” (to paraphrase), lesbian trans women do too. My conclusion is that brain structures are not organized by sex or gender, but by who one is sexually attracted to. Male/men-attracted people and female/woman-attracted people differentiate themselves. It’s internally consistent with the data, while the “male brain” / “female brain” hypothesis is not: gay men and lesbian women provide contradicting data. The issue is not one of data, but one of the paradigms we interpret the data through.

Now, this is all moot if we take the data from the study that I cited above that showed that sexual orientation had no impact on brain structures for trans individuals, which just explicates that trans brains are neurologically distinct than cis brains categorically rather than by subgroups

But either way we look at it, her argument is incorrect in some manner: paradigmatically or scientifically.

Searcy is likely to have written her article in an attempt to discount the growing evidence from transgender brain scan research that shows that the two type taxonomy for transwomen is supported.

There’s exactly one study that has shown gynephilic trans women have ‘male brains’, and there is at least one that shows the contrary. I wouldn’t be so eager to run and shout that the two type taxonomy is supported by the research

Where once older transitioning transwomen cherry picked the brain structure research in an attempt to spin it such that all transwomen had female brains.  She is spinning the science to lead us to believe that brain structure research is unimportant and should be ignored, first by saying that there is no brain structure sexual dimorphism of any consequence and then say that what differences between transgender folk and nontransfolk is unimportant anyway.

This just gets back into the debate over dimorphism, which as I said I won’t get into those weeds today, but I’d just emphasize that it’s not a simple topic. There are fundamental philosophical disagreements over what constitutes sexual dimorphism between the two camps that can’t be ignored by saying that ‘one side is supported by the evidence’ and that the other isn’t.

I believe it represents a growing fear by autogynephilic transwomen that the brain scan science will undermine their own identity as transwomen if the public were to become aware of what the evidence means.

To me it seems Brown is alluding to her own denial of lesbian trans women’s identities and womanhood, which contradicts her stated “support” of “autogynephilic transwomen”