Archives of Sexual Behavior

, Volume 42, Issue 3, pp 463–474 | Cite as

Measures of Clinical Health among Female-to-Male Transgender Persons as a Function of Sexual Orientation

  • S. Colton Meier
  • Seth T. Pardo
  • Christine Labuski
  • Julia Babcock
Original Paper

Abstract

The present study examined the sexual orientation classification system that was used in the DSM-IV-TR for categorizing those who met the Gender Identity Disorder diagnostic criteria in order to determine the extent to which female-to-male transgender persons (FTMs) differ on psychological variables as a function of sexual orientation. Participants were 605 self-identified FTMs from 19 different countries (83 % U.S.) who completed an internet survey assessing their sexual orientation, sexual identity, symptoms of depression and anxiety, stress (Depression Anxiety Stress Scales), social support (Multidimensional Scale of Perceived Social Support), and health related quality of life (SF-36v2 Health Survey). Over half the sample (52 %) reported sexual attractions to both men and women. The most common sexual identity label reported was “queer.” Forty percent of FTMs who had begun to transition reported a shift in sexual orientation; this shift was associated with testosterone use. Overall, FTMs ranged from normal to above average on all psychological measures. FTMs did not significantly differ by sexual attraction on any mental health variables, except for anxiety. FTMs attracted to both men and women reported more symptoms of anxiety than those attracted to men only. Results from the present study did not support a sexual orientation classification system in FTMs with regard to psychological well-being.

Keywords

Transgender Gender Identity Disorder Transsexualism Sexual orientation 

References

  1. American Psychiatric Association. (2000). Diagnostic and statistics manual of mental disorders (4th ed., text rev.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (2012). DSM-5 development: Gender dysphoria in adolescents or adults. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=482.
  3. American Psychological Association Task Force on Gender Identity and Gender Variance. (2009). Report of the Task Force on Gender Identity and Gender Variance. Washington, DC: Author.Google Scholar
  4. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  5. Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319.CrossRefGoogle Scholar
  6. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.Google Scholar
  7. Bith-Melander, P., Sheoran, B., Sheth, L., Bermudez, C., Drone, J., Wood, W., et al. (2010). Understanding sociocultural and psychological factors affecting transgender people of color in San Francisco. Journal of the Association of Nurses in AIDS Care, 21, 207–220.PubMedCrossRefGoogle Scholar
  8. Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247–261.PubMedCrossRefGoogle Scholar
  9. Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. Bodlund, O., Kullgren, G., Sundbom, E., & Höjerback, T. (1993). Personality traits and disorders among transsexuals. Acta Psychiatrica Scandinavica, 88, 322–327.PubMedCrossRefGoogle Scholar
  12. Bolin, A. (1994). Transcending and transgendering: Male-to-female transsexuals, dichotomy and diversity. In G. Herdt (Ed.), Third sex, third gender: Beyond sexual dimorphism in culture and history (pp. 447–485). New York: Zone Books.Google Scholar
  13. Bullough, B., & Bullough, V. L. (1998). Transsexualism: Historical perspectives, 1952 to present. In D. Denny (Ed.), Current concepts in transgender identity (pp. 15–34). New York: Garland Publishing.Google Scholar
  14. 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.PubMedCrossRefGoogle Scholar
  15. Clara, I., Cox, B., Enns, M., Murray, L., & Torgrud, J. (2003). Confirmatory factor analysis of the Multidimensional Scale of Perceived Social Support in clinically distressed and student samples. Journal of Personality Assessment, 81, 265–270.PubMedCrossRefGoogle Scholar
  16. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69.PubMedCrossRefGoogle Scholar
  17. Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.PubMedCrossRefGoogle Scholar
  18. Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis, and treatment. Journal of Psychosomatic Research, 46, 315–333.PubMedCrossRefGoogle Scholar
  19. Cole, C. M., O’Boyle, M., Emory, L. E., & Meyer, W. J. (1997). Comorbidity of gender dysphoria and other major psychiatric diagnoses. Archives of Sexual Behavior, 26, 13–26.PubMedCrossRefGoogle Scholar
  20. Coleman, E., & Bockting, W. O. (1988). Heterosexual prior to sex reassignment, homosexual afterwards: A case study of a female-to-male transsexual. Journal of Psychology and Human Sexuality, 1, 69–82.CrossRefGoogle Scholar
  21. Coleman, E., & Bockting, W. O. (1991). A comment on the concept of transhomosexuality, or the dissociation of the meaning. Archives of Sexual Behavior, 20, 419–421.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. Daskalos, C. T. (1998). Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.PubMedCrossRefGoogle Scholar
  24. De Cuypere, G., Janes, C., & Rubens, R. (1995). Psychosocial functioning of transsexuals in Belgium. Acta Psychiatrica Scandinavica, 91, 180–184.PubMedCrossRefGoogle Scholar
  25. de Vries, A. L., Steensma, T. D., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.PubMedCrossRefGoogle Scholar
  26. Denny, D., Green, J., & Cole, S. (2007). Gender variability. In A. F. Owens & M. S. Tepper (Eds.), Sexual health (Vol. 4, pp. 153–187). Westport, CT: Praeger.Google Scholar
  27. Devor, H. (1993a). Sexual orientation identities, attractions and practices of female-to-male transsexuals. Journal of Sex Research, 30, 303–315.CrossRefGoogle Scholar
  28. Devor, H. (1993b). Toward a taxonomy of gendered sexuality. Journal of Psychology and Human Sexuality, 6, 23–55.CrossRefGoogle Scholar
  29. Devor, A. (1997a). More than manly women: How female-to-male transsexuals reject lesbian identities. In B. Bullough, V. L. Bullough, & J. Elais (Eds.), Gender blending (pp. 146–157). Amherst, NY: Prometheus.Google Scholar
  30. Devor, A. (1997b). FTM: Female-to-male transsexuals in society. Bloomington, IN: Indiana University Press.Google Scholar
  31. Devor, A. (2004). Witnessing and mirroring: A fourteen stage model of transsexual identity formation. Journal of Gay and Lesbian Psychotherapy, 8, 41–67.Google Scholar
  32. Diamond, L. M. (2001). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 173–192.CrossRefGoogle Scholar
  33. Diamond, M. (2002). Sex and gender are different: Sexual identity and gender identity are different. Clinical Child Psychology and Psychiatry, 7, 320–334.CrossRefGoogle Scholar
  34. Diamond, L. M. (2005). A new view of lesbian subtypes: Stable versus fluid identity trajectories over an 8-year period. Psychology of Women Quarterly, 29, 119–128.CrossRefGoogle Scholar
  35. Diamond, L. M. (2008). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.Google Scholar
  36. Diamond, L. M., & Butterworth, M. (2008). Questioning gender and sexual identity: Dynamic links over time. Sex Roles, 59, 365–376.CrossRefGoogle Scholar
  37. Diamond, L. M., Pardo, S. T., & Butterworth, M. R. (2011). Transgender experience and identity. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of identity theory and research (Vol. 2, pp. 629–647). New York: Springer.CrossRefGoogle Scholar
  38. dickey, l., Burnes, T., & Singh, A. (2012). Sexual identity development of female-to-male transgender individuals: A grounded theory inquiry. Journal of LGBT Issues in Counseling, 6, 118–138.Google Scholar
  39. DiPlacidio, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation. Understanding prejudice against lesbians, gay men, and bisexuals: Psychological perspectives on lesbian and gay issues (Vol. 4, pp. 138–159). Thousand Oaks, CA: Sage.Google Scholar
  40. Dozier, R. (2005). Beards, breasts, and bodies: Doing sex in a gendered world. Gender and Society, 19, 297–316.CrossRefGoogle Scholar
  41. Dreger, A. (2008). The controversy surrounding The man who would be queen: A case history of the politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior, 37, 366–421.PubMedCrossRefGoogle Scholar
  42. Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, 39, 427–460.PubMedCrossRefGoogle Scholar
  43. Feinberg, L. (1996). Transgender warriors. Boston, MA: Beacon Press.Google Scholar
  44. Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880.PubMedCrossRefGoogle Scholar
  45. Fox, R. (2003). Bisexual identities. In L. Garnets & D. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences (pp. 86–127). New York: Columbia University Press.Google Scholar
  46. Gamson, J. (1995). Must identity movements self-destruct? A queer dilemma. Social Problems, 42, 390–407.CrossRefGoogle Scholar
  47. Gomez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godas, T., Almaraz, M. C., et al. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37, 662–670.PubMedCrossRefGoogle Scholar
  48. Green, J. (2004). Becoming a visible man. Nashville, TN: Vanderbilt University Press.Google Scholar
  49. Halberstam, J. (1998). Female masculinity. Durham, NC: Duke University Press.Google Scholar
  50. Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58, 259–261.PubMedCrossRefGoogle Scholar
  51. Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43.CrossRefGoogle Scholar
  52. Hines, S. (2007). TransForming gender: Transgender practices of identity, intimacy and care. Bristol, England: Policy Press.Google Scholar
  53. Hoshiai, M., Matsumoto, Y., Sato, T., Ohnishi, M., Okabe, N., Kishimoto, Y., et al. (2010). Psychiatric comorbidity among patients with gender identity disorder. Psychiatry and Clinical Neurosciences, 64, 514–519.PubMedCrossRefGoogle Scholar
  54. Johansson, A., Sundbom, E., Hojerback, T., & Bodlund, O. (2010). A five-year follow up study of Swedish adults with gender identity disorder. Archives of Sexual Behavior, 39, 1429–1437.PubMedCrossRefGoogle Scholar
  55. Kenagy, G. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health and Social Work, 30, 19–26.PubMedCrossRefGoogle Scholar
  56. Lawrence, A. A. (2004). Autogynephilia: A paraphilic model of gender identity disorder. Journal of Gay and Lesbian Psychotherapy, 8, 69–87.Google Scholar
  57. Lawrence, A. A. (2007). Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspectives in Biology and Medicine, 50, 506–520.PubMedCrossRefGoogle Scholar
  58. Lawrence, A. A. (2008). Gender identity disorders in adults: Diagnosis and treatment. In D. L. Rowland & L. Incrocci (Eds.), Handbook of sexual and gender identity disorders (pp. 423–456). Hoboken, NJ: John Wiley.Google Scholar
  59. Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545.PubMedCrossRefGoogle Scholar
  60. Lawrence, A. A., & Zucker, K. J. (2012). Gender identity disorders. In M. Hersen & D. C. Beidel (Eds.), Adult psychopathology and diagnosis (6th ed., pp. 601–635). Hoboken, NJ: John Wiley.Google Scholar
  61. Lev, A. I. (2004). Transgender emergence: Counseling gender-variant people and their families. Binghamton, NY: Haworth Press.Google Scholar
  62. Lev, A. I. (2005). Disordering gender identity: Gender identity disorder in the DSM-IV-TR. Journal of Psychology and Human Sexuality, 17, 35–69.CrossRefGoogle Scholar
  63. Lovibond, S. H., & Lovibond, P. F. (1995a). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation.Google Scholar
  64. Lovibond, P. F., & Lovibond, S. H. (1995b). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.PubMedCrossRefGoogle Scholar
  65. Luther, E., Sanchez, F. J., Gaser, C., Toga, A., Narr, K., Hamilton, L., et al. (2009). Regional gray matter variation in male-to-female transsexualism. Neuroimage, 46, 904–907.CrossRefGoogle Scholar
  66. McLaren, S., Jude, B., & McLachlan, A. J. (2007). Sexual orientation, sense of belonging and depression in Australian men. International Journal of Men’s Health, 6, 259–272.CrossRefGoogle Scholar
  67. Meier, S., Fitzgerald, K., Pardo, S., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay and Lesbian Mental Health, 15, 281–299.CrossRefGoogle Scholar
  68. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.PubMedCrossRefGoogle Scholar
  69. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.PubMedCrossRefGoogle Scholar
  70. Meyer, W., Bockting, W., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, A., et al. (2001). The Harry Benjamin International Gender Dysphoria Association’s Standards of Care for Gender Identity Disorders sixth version. Retrieved from http://www.wpath.org/publications_standards.cfm.
  71. Meyerowitz, J. (2002). How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard University Press.Google Scholar
  72. Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of Life Research, 15, 1447–1457.PubMedCrossRefGoogle Scholar
  73. Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M., et al. (2011). A further assessment of Blanchard’s typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. Archives of Sexual Behavior, 40, 247–257.PubMedCrossRefGoogle Scholar
  74. Pauly, I. (1974). Female transsexualism, Part I. Archives of Sexual Behavior, 3, 487–508.PubMedCrossRefGoogle Scholar
  75. Rachlin, K. (1999). Factors which influence individual’s decisions when considering female-to-male genital reconstructive surgery. International Journal of Transgenderism, 3, http://www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/ijt990302.htm.
  76. Rachlin, K., Hansbury, G., & Pardo, S. T. (2010). Hysterectomy and oophorectomy experiences of female-to-male transgender individuals. International Journal of Transgenderism, 12, 155–166.CrossRefGoogle Scholar
  77. Ross, L., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100, 496–502.PubMedCrossRefGoogle Scholar
  78. Rosser, B. R., Oakes, J. M., Bockting, W., & Miner, M. (2007). Capturing the social demographics of hidden sexual minorities: An internet study of the transgender population in the United States. Sexuality Research and Social Policy, 4, 50–64.CrossRefGoogle Scholar
  79. Rubin, N. (1975). The traffic of women: Notes on the political economy of sex. In R. R. Reiter (Ed.), Toward an anthropology of woman (pp. 157–210). New York: Monthly Review Press.Google Scholar
  80. Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.PubMedCrossRefGoogle Scholar
  81. Sandfort, T. G., de Graaf, R., Bijl, R. V., & Schanbel, P. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85–91.PubMedCrossRefGoogle Scholar
  82. Savin-Williams, R. C. (2006). Who’s gay? Does it matter? Current Directions in Psychological Science, 15, 40–44.CrossRefGoogle Scholar
  83. Schilt, K. (2009). Just one of the guys? Gender and Society, 20, 465–490.CrossRefGoogle Scholar
  84. Schleifer, D. (2006). Make me feel mighty real: Gay female-to-male transgenderists negotiating sex, gender, and sexuality. Sexualities, 9, 57–75.CrossRefGoogle Scholar
  85. Smith, Y., van Goozen, S., Kuiper, A., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160.PubMedCrossRefGoogle Scholar
  86. Sullivan, L. (1990). Information of the female to male cross-dresser and transsexual. Seattle, WA: Ingersoll Gender Center.Google Scholar
  87. Swaab, D. F. (2004). Sexual differentiation of the human brain: Relevance for gender identity, transsexualism, and sexual orientation. Gynecological Endocrinology, 19, 301–312.PubMedCrossRefGoogle Scholar
  88. Valentine, D. (2007). Imagining transgender: An ethnography of a category. Durham, NC: Duke University Press.Google Scholar
  89. Vrangalova, Z., & Savin-Williams, R. C. (2012). Mostly heterosexual and mostly gay/lesbian: Evidence for new sexual orientation identities. Archives of Sexual Behavior, 41, 85–101.PubMedCrossRefGoogle Scholar
  90. Ware, J. E. (2003). Conceptualization and measurement in health-related quality of life: Comments on an evolving field. Archives of Physical Medicine and Rehabilitation, 84, 43–51.CrossRefGoogle Scholar
  91. Ware, J., Kosinski, M., & Dewey, J. (2000). How to score version 2 of the SF-36 health survey. Lincoln, RI: QualityMetric Incorporated.Google Scholar
  92. Ware, J., Kosinski, M., & Keller, S. (1994). SF-36 ® Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: The Health Institute.Google Scholar
  93. Whisman, M. (2008). Adapting cognitive therapy for depression: Managing complexity and comorbidity. New York: Guilford Press.Google Scholar
  94. Wilson, K. K. (2000). Gender as illness: Issues of psychiatric classification. In E. Paul (Ed.), Taking sides: Clashing views on controversial issues in sex and gender (pp. 31–38). Guilford, CT: Dushkin McGraw-Hill.Google Scholar
  95. Winters, K. (2007). Issues of GID diagnosis for transsexual women and men. Retrieved online from GID Reform Advocates: http://www.gidreform.org/GID30285a.pdf.
  96. Xavier, J., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8, 31–47.CrossRefGoogle Scholar
  97. Zimet, G., Dahlem, N., Zimet, S., & Farley, G. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.CrossRefGoogle Scholar
  98. Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • S. Colton Meier
    • 1
  • Seth T. Pardo
    • 2
  • Christine Labuski
    • 3
  • Julia Babcock
    • 1
  1. 1.Department of PsychologyUniversity of HoustonHoustonUSA
  2. 2.The Rockway InstituteAlliant International UniversitySan FranciscoUSA
  3. 3.Faculty of SociologyVirginia Polytechnic Institute and State UniversityBlacksburgUSA

Personalised recommendations