Female-to-male (FTM) transgender persons are often assumed to have been lesbian in sexual orientation prior to transition and to have maintained a primary attraction for women after transition. However, limited research and anecdotal information from clinicians who work with FTM have indicated that many identify as gay men post-transition. This article described the results of a qualitative study that employed interviews with 17 FTM in order to understand their experience of transition and sexual orientation. Of the 17 participants, seven identified as lesbian prior to transition, three as heterosexual, and seven as bisexual or queer. After transition, 10 identified as gay men and the remaining seven identified as bisexual or queer. Four patterns of sexual behavior emerged from the data and were described and discussed. These patterns were named steadfast, aligned, shifted, and fluid. These findings bring additional options to the belief that there are two distinct types of transgender: a homosexual subtype and a nonhomosexual subtype.
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Benjamin, H. (1966). The transsexual phenomenon. New York: Julian Press.
Benner, P. (1994). The tradition and skill of interpretive phenomenology in studying health, illness, and caring practices. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 99–127). Thousand Oaks, CA: Sage.
Bockting, W., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38, 688–701.
Chan, G., Brykczynski, K., Malone, R., & Benner, P. (2010). Interpretive phenomenology in health care research. Indianapolis, IN: Sigma Theta Tau International.
Chivers, M. L., & Bailey, J. M. (2000). Sexual orientation of female-to-male transsexuals: A comparison of homosexual and nonhomosexual types. Archives of Sexual Behavior, 29, 259–278.
Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health, 91, 915–921.
Coleman, E., Bockting, W. O., & Gooren, L. (1993). Homosexual and bisexual identity in sex-reassigned female-to-male transsexuals. Archives of Sexual Behavior, 22, 37–50.
Daskalos, C. T. (1998). Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.
Devor, H. (1993). Sexual orientation identities, attractions, and practices of female-to-male transsexuals. Journal of Sex Research, 30, 303–315.
Devor, H. (1994). Toward a taxonomy of gendered sexuality. Journal of Psychology and Human Sexuality, 6(1), 23–55.
Devor, H. (1997). More than manly women: How female-to-male transsexuals reject lesbian identities. In B. Bullough, V. L. Bullough, & J. Elias (Eds.), Gender blending (pp. 87–102). Amherst, NY: Prometheus Books.
Devor, H. (2004). Witnessing and mirroring: A fourteen-stage model of transsexual identity formation. Journal of Gay and Lesbian Psychotherapy, 8(1/2), 41–67.
Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann, M. S., & Crepaz, N. (2008). Estimating HIV prevalence and risk behaviors of transgender persons in the United States: A systematic review. AIDS and Behavior, 12, 1–17.
Kenagy, G. P., & Hsieh, C. M. (2005). The risk less known: Female-to-male transgender persons’ vulnerability to HIV infection. AIDS Care, 17, 195–207.
Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) for gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545.
Leonard, V. W. (1994). A Heideggerian phenomenological perspective on the concept of person. In P. Benner (Ed.), Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 43–63). Thousand Oaks, CA: Sage.
Morgan, S. W., & Stevens, P. E. (2008). Transgender identity development as represented by a group of female-to-male transgendered adults. Issues in Mental Health Nursing, 29, 585–599.
Namaste, V. K. (1999). HIV/AIDS and female to male transsexuals and transvestites: Results from a needs assessment in Quebec. International Journal of Transgenderism. Retrieved March 30, 2008, from http://www.symposion.com/ijt/ijtintro.htm.
San Francisco Department of Public Health (SFDPH). (2010). San Francisco HIV prevention plan (Harder + Company Community Research). San Francisco, CA: Author.
Sevelius, J. (2009). “There’s no pamphlet for the kind of sex I have”: HIV-related risk factors and protective behaviors among transgender men who have sex with nontransgender men. Association of Nurses in AIDS Care, 20, 398–410.
Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160.
Appendix: Interview Guide
Appendix: Interview Guide
Introduction: Thank you very much for agreeing to participate in this study. As you know, I will be asking you questions related to being transgendered and how that may have had an impact your sexual identity and behavior. I will also be asking about testosterone use.
Could you describe for me how you came to realize you were transgendered? What happened as a result of your realization? For each question, the following probes will be used to elicit greater depth from the participant: Please give me an example of that. Tell me more about that.
I’m interested in exploring sexual orientation and sexual behavior before and after transitioning. Please describe your sexual orientation and behavior prior to transitioning. Please begin with your earliest remembered feelings. Various probings depending upon participant’s response (e.g., Had you been sexually active with males prior to using testosterone? Had you ever attended gay men’s sex clubs?).
Could you describe your feelings regarding your sexual orientation when you were coming out as FTM? And what did you do about those feelings?
Could you tell me about how you began using testosterone? How was it first provided for you? And now?
Could you tell me about any changes that might have occurred with your sexual feelings and/or behavior after you started using testosterone?
How would you describe your sexual orientation and behavior now? What do you attribute that to? A variety of responses from being in a monogamous relationship to engaging in activities at gay sex clubs is expected. This area will be explored depending upon the responses.
I’d like to hear about your experience of becoming part of the gay community. Can you tell me about your experience with finding sex partners? Do you have a disclosure story? Could you tell me about how you feel that the risk of HIV impacts upon you? Has this always been the case? How has this changed?
Narrative Strategy: Questions 6 and 7 both involve eliciting narratives from the participant. The questions and probes will follow the format below: Can you tell about a time that you remember as especially meaningful with regard to: (a) practicing safe sex; (b) practicing unsafe sex; (c) managing your identity, disclosing or not disclosing. Please tell me the story of what happened. It could be a memorable story because it was a difficult situation or because you handled it very well. The following probes will be used: What happened? How the events played out. What is the setting or social context of this story? What events lead to the story? How did the situation unfold? What in this situation concerned or worried you? What did you do? What did you consider doing but rejected or were unable to do? What prevented you from doing that? What were your feelings as this was happening? Did you consider getting help or advice from others? Who? How did you get other people involved or informed? What did they do that helped the situation?
Could you tell me about any HIV prevention education that you’ve had? Do you feel it was adequate for your needs? How would you change this for other FTM?
Would you like to add anything more? Is there anything else that you think I should know? Do you have any questions for me?
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Rowniak, S., Chesla, C. Coming Out for a Third Time: Transmen, Sexual Orientation, and Identity. Arch Sex Behav 42, 449–461 (2013). https://doi.org/10.1007/s10508-012-0036-2
- Gender identity
- Sexual orientation
- Gay community