27 January 2016

On Russo's Is there something unique about the transgender brain? Well, yes and no.

In Scientific American Mind, journalist Francine Russo takes on a fascinating research question: “Is there something unique about the transgender brain?” She reviews some of the relevant brain research on transsexuals and concludes that transgenderism is indeed a phenomenon of the brain.  Although I agree with Russo that transgenderism is a phenomenon of the brain, I believe Russo over-focussed on gender identity, which led her away from the better explanation of the data:

These brain scans don’t reflect gender identity, they reflect sexual orientation.

The research that Russo examined she explained correctly: Biological males and females differ from each other on certain subtle, non-learned features of the brain and body, and some samples of transsexuals are in-between on these features.  That is, they were shifted away from what is typical for their sex-at-birth and towards the other sex.  Taken by itself, this would indeed seem like strong evidence that transsexuality in biological males is caused by having “feminine” or “feminized” features of the brain, and ditto for females/masculine/masculinized.

Unfortunately, Russo’s analysis excludes other, closely related research that would have led her to a different conclusion: Namely, gay men and lesbians show the same shifts! That is, the differences are not specific to transgenderism. For example, Russo pointed out (correctly) that males and females differ in “echolike sounds produced by the inner ear in response to a clicking noise” and that transgendered folks are shifted towards what the opposite sex usually shows. Missing, however, was the research showing that the same shift is present in cis-gendered homosexuality (e.g., McFadden & Pasanen, 1998). [For those interested, these echo-like responses are called “click-evoked otoacoustic emissions,” and the shift among transgendered folks was reported by Burke et al. (2014). The full reference appears below.]

The reason this matters is that, in the MRI study Russo describes (Zubiaurre-Elorza et al., 2013), all of the male-to-female transsexuals were attracted to men, but all of the control males were attracted to women, and all of the female-to-male transsexuals were attracted to women, but all the control females were attracted to men.  That is, although the subject groups differed from the control groups in their gender identity (as they must), they also differed in their sexual orientation. This is what we call a confound: We can’t know whether the brains of the male-to-female transsexuals differed from the controls because they wanted to be women while the controls wanted to be men, or because they were attracted to men while the controls were attracted to women (and ditto for female-to-male transsexuals with regard to men/women/women/men).

Although Russo attributes Zubiaurre-Elorza’s MRI findings to gender identity, those findings are better attributed to sexual orientation. This would have shown by other research that Russo excluded.  Specifically, Russo excluded other MRI studies of transsexuals, namely Rametti et al. (2010) and Savic and Arver (2010).  Rametti used a set-up very much like Zubiaurre-Elorza.  (In fact, Rametti and Zubiaurre-Elorza are from the same research team, led by Antonio Guillamon.) Rametti compared 18 male-to-female transsexuals who were attracted to men with: 19 cis-gendered control males who were attracted to women, and with 19 cis-gendered control females who were attracted to men. Guillamon contrasted the male controls with the female controls to find the features of the brain where males and females differ (there were six such features), and they found the transsexual group to be intermediate on all of them. That is, male-to-female transsexuals who were attracted to men were in between cis-gendered males who were attracted to women and cis-gendered females who were attracted to males.

Now, let us compare that with the Savic and Arver study: They also analyzed male-to-female transsexuals (24 in total), but these were male-to-female transsexuals who were attracted to women. Savic and Arver contrasted them with 24 control males who were attracted to women, and with 24 control females who were attracted to men. Like Rametti, Savic and Arver contrasted the male controls with the female controls to find the brain features where males and females differ (there were eight), but found the transsexual group to differ from the male controls on none (Savic & Arver, 2010, Table 3). In contrast with Rametti and with Savic and Arver, the transgendered bio males who were attracted to women did not differ from cis-gendered bio males who were attracted to women.  That is, what we’ve observed in the brain depends on whether the groups differ in sexual orientation, not gender identity.

Just as interestingly (if not more so!) the male-to-female transsexuals who were attracted to females did show other brain differences from the control males, but they were not features in which females differ from males. To me, this brings us to the next fascinating and unanswered question for us sexual neuroscientists: What is it about male-to-female transsexuals who are attracted to females that makes their brains different from other people’s, and is not just in between biological males and females?


Burke, S. M., Menks, W. M., Cohen-Kettenis, P. T., Klink, D. T. & Bakker, J. (2014). Click-evoked otoacoustic emissions in children and adolescents with gender identity disorder. Archives of Sexual Behavior, 43, 1515−1523. doi: 10.1007/s10508-014-0278-2.

McFadden, D., & Pasanen, E. G. (1998). Comparison of the auditory systems of heterosexuals and homosexuals: Click-evoked otoacoustic emissions. Proceedings of the National Academy of Sciences, 95, 2709–2713.

Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Zubiarre-Elorza, L., Segovia, S.,... Guillamon, A. (2010). The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment: A DTI study. Journal of Psychiatric Research. doi:10.1016/ j.jpsychires.2010.11.007.

Savic, I., & Arver, S. (2010). Sex dimorphism of the brain in male-to- female transsexuals. Cerebral Cortex. doi:10.1093/cercor/bhr032.

Zubiaurre-Elorza, L., Junque, C., Gómez-Gil, E., Segovia, S., Carrillo, B., Rametti, G., Guillamon, A. (2013). Cortical thickness in untreated transsexuals. Cerebral Cortex, 23, 2855−2862.

For professional researchers, see also:

Cantor, J. M. (2011). New MRI studies support the Blanchard typology of male-to-female transsexualism. Archives of Sexual Behavior, 40, 863864. doi: 10.1007/s10508-011-9805-6 http://link.springer.com/article/10.1007%2Fs10508-011-9805-6

11 January 2016

Do trans- kids stay trans- when they grow up?

Following the closure of the CAMH Gender Identity Clinic for children, I have been receiving requests for what the science says.  Do kids grow out of wanting to change sex, or does it continue when they are adults?

In total, there have been three large scale follow-up studies and a handful of smaller ones. I have listed all of them below, together with their results. (In the table, “cis-” means non-transsexual.) Despite the differences in country, culture, decade, and follow-up length and method, all the studies have come to a remarkably similar conclusion: Only very few trans- kids still want to transition by the time they are adults. Instead, they generally turn out to be regular gay or lesbian folks. The exact number varies by study, but roughly 6090% of trans- kids turn out no longer to be trans by adulthood.

Lebovitz, P. S. (1972). Feminine behavior in boys: Aspects of its outcome. American Journal of Psychiatry, 128, 1283–1289.
Zuger, B. (1978). Effeminate behavior present in boys from childhood: Ten additional years of follow-up. Comprehensive Psychiatry, 19, 363–369.
Money, J., & Russo, A. J. (1979). Homosexual outcome of discordant gender identity/role: Longitudinal follow-up. Journal of Pediatric Psychology, 4, 29–41.
Zuger, B. (1984). Early effeminate behavior in boys: Outcome and significance for homosexuality. Journal of Nervous and Mental Disease, 172, 90–97.
Davenport, C. W. (1986). A follow-up study of 10 feminine boys.  Archives of Sexual Behavior, 15, 511–517.
Green, R. (1987). The "sissy boy syndrome" and the development of homosexuality. New Haven, CT: Yale University Press.
Kosky, R. J. (1987). Gender-disordered children: Does inpatient treatment help? Medical Journal of Australia, 146, 565–569.


Wallien, M. S. C., & Cohen-Kettenis, P. T. (2008). Psychosexual outcome of gender-dysphoric children. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 1413–1423.

Drummond, K. D., Bradley, S. J., Badali-Peterson, M., & Zucker, K. J. (2008). A follow-up study of girls with gender identity disorder. Developmental Psychology, 44, 34–45.
Singh, D. (2012). A follow-up study of boys with gender identity disorder. Unpublished doctoral dissertation, University of Toronto.
Steensma, T. D., McGuire, J. K., Kreukels, B. P. C., Beekman, A. J., & Cohen-Kettenis, P. T. (2013). Factors associated with desistence and persistence of childhood gender dysphoria: A quantitative follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 582–590.

*For brevity, the list uses “gay” for “gay and cis-”, “straight” for “straight and cis-”, etc.

07 January 2016

How do I cure my pedophilia?

I also just ran into that question on Yahoo, and thought it too was worth repeating..:
I am 16, and for years now I have been lusting after girls much younger than me.....Recently, I started lusting after little boys, too....When I see little girls' feet in public, I go back home and masturbate while fantasizing about molesting them.... I would never molest a child, but I want to get rid of these feelings....what should I do?
First, I want to congratulate you on confronting this. It's probably the most difficult type of 'coming out' that there is.

The answer to your question, however, is that there is no known way of turning a pedophile into a nonpedophile. Although there is the occasional claim, there has never been any decent evidence of it. Rather, pedophilia appears to be like a sexual orientation: innate and immutable. 

The best that can be done, and what I recommend for anyone with atypical sexual interests, is to find ways of integrating it into your life in as healthy and safe a way as possible that poses no risks to anyone. 

The male sex drive is a very powerful motivator, and it has led very many people (not just pedophiles) to make very many bad decisions. For some people, sex drive reducing medications (testosterone blockers) can be helpful. That is, some people find that dampening their sex drives is preferable to being constantly distracting by it. For other people, having a professional therapist to debrief with is a great relief. But there is no evidence that we can change the pedophilia itself. 

To help find a therapist experienced in these issues, a referral list is maintained by the Association for the Treatment of Sexual Abusers (www.atsa.com). Although the focus of that group is on people who have committed crimes, the people on their referral list are the best qualified to work with folks who have not. 

You may also find support and great advice from the Virtuous Pedophiles group, at virped.org. They are an organization of people who acknowledge their pedophilia and support each other in never committing offences and in dealing with the extreme stigma that pedophiles face in our society. 

I wish you the best of luck. 

05 January 2016

What's the difference between autogynephilia and trans women?

I saw that question on Yahoo, and thought readers here might also be interested in the answer:

First the politics: There are extremists among trans activists who oppose the very idea of autogynephilia, despite all the scientific evidence for it. They believe that it makes their desire to live as female less genuine, and they attack (sometimes quite viciously) anyone who endorses the idea. 

Now, for the actual distinction between autogynephilia and being a transwoman: Autogynephilia is when someone born male experiences sexual arousal to the image of being female. Some people express their autogynephilia through cross-dressing, and some people express it only during sexual arousal and masturbation. Some people express it through clothes and relatively visible means, and some people want to express it permanently and opt for genital surgery in addition to whatever cosmetic changes help them be perceived as female.

Autogynephilia is not the only thing that can motivate a bio male to want to live as female. The other can be thought of as extreme homosexuality...sort of like gay men who are so gay, they are actually happier living as female. These are the folks who were very obviously feminine boys during childhood, unlike the autogynephiles, who were unremarkably masculine boys in childhood.

So, that's the difference: Autogynephilia is a desire that can motivate (some) bio males to want to live as female, and trans women are those who are living as female (regardless of what motivated them). 

Unfortunately, the internalized autogynephobia in the trans community has made it nearly impossible for people to come out as autogynephilic, even within their own communities and to other autogynephiles. As a political movement, activists do not want to be recognized as living as women; they will accept only those ideas that validate that they actually were women all along. It's understandable politically, but not accurate, scientifically.