Etiological factors in female transsexualism: A first approximation

Abstract

Female-to-male transsexuals (females who are extensively identified as males and want sex-reassignment surgery) are being more frequently described. Yet discussions about etiology are almost nonexistent. Ten examples of female-to-male transsexualism are reported here in which a recurring family role constellation is noted. This constellation may indicate etiological factors. In the present series of cases, the mother is almost always psychologically removed from the family, usually by depression, early in the girl's development. The father, while a substantial person in most regards, does not support his wife in her suffering but instead sends a substitute into the breach. This surrogate husband is the transsexual-to-be, also chosen perhaps because she strikes her parents as unfeminine in appearance from birth on. Since the family needs the child to function thus, any behavior construed as masculine is encouraged, and feminine behavior discouraged, until the islands of masculine qualities coalesce into a cohesive identity. Evidence for this theory comes not only from parents but from the subjects' fantasies, which are of rescuing endangered, motherly women. That these girls' masculinity seems to originate in part from traumatic disruption of mothering suggests that the condition may be allied to some forms of female homosexuality.