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#REDIRECT [[Blanchard's transsexualism typology]]
{{Sexual orientation}}
{{Italic title}}
'''''Homosexual transsexual''''' is a [[taxonomy (general)|taxonomic]] category of [[transsexual]] individuals used in [[sexology]], [[psychology]], and [[psychiatry]]. It categorizes [[trans women]] who are exclusively attracted to men, and less often [[trans men]] who are exclusively attracted to women, based on their [[sex assigned at birth]], rather than their current gender identity. The concept of categorizing trans women by [[sexual orientation]] originated with [[Magnus Hirschfeld]] in 1923, and was further developed by the sexologist [[Harry Benjamin]] in 1966 as a component of the [[Benjamin scale]]. The specific term ''homosexual transsexual'' was coined by [[Kurt Freund]] in 1973, and used from 1982 onward by him and others.

In the [[DSM III]], published in 1980, transsexualism was to be diagnosed and the sexual orientation of a transsexual specified using the terms ''homosexual'', ''[[Heterosexuality|heterosexual]]'', ''[[Asexuality|asexual]]'', or unspecified. This convention had its origins in the taxonomic work of researchers like Hirschfeld, Benjamin, and Freund, which found that grouping trans women by sexual orientation reveals important qualitative and statistical differences between them. These differences have been maintained by various researchers as indicative or suggestive of multiple, distinct [[etiology|etiologies]]. The term ''homosexual transsexual'' has since been used in publications by a variety of academics, including Benjamin, Freund, Blanchard, and [[Anne Lawrence]], as well as [[J. Michael Bailey]] and [[James Cantor]], among others. Sexologist [[Ray Blanchard]] uses the concept in relation to one type of male-to-female (MTF) transsexual in his [[Blanchard's transsexualism typology|transsexualism typology]] developed in the late 1980s.

The term ''homosexual transsexual'' has attracted controversy. It has been criticized from a lexical standpoint by Benjamin, [[Bruce Bagemihl]], and [[John Bancroft (sexologist)|John Bancroft]] as being confusing (though supported ''conceptually'' by the former two), as well as insensitive to the [[gender identity|gender identities]] of those whom it is intended to describe. The alternatives [[androphilia|''androphilic'']] and [[gynephilia|''gynephilic'']] have been proposed by [[Milton Diamond]] as descriptors for sexual orientation that do not make assumptions about the [[sex]] or gender identity of the person being described. Terms such as ''androphilia'' and ''gynephilia'' are sometimes used instead of, or concurrently with, ''homosexual'', ''heterosexual'', or ''non-homosexual'' in current research, such as research which has used the [[Androphilia and gynephilia#Androphilia and gynephilia scales|Modified Androphilia Scale]] to assess the attraction to men of a given trans woman.<!--In the body of the article, I have pointed out that Blanchard, as well as Leavitt and Berger, have used the so called "modified androphilia scale", a psychological test, to assess the sexual orientation of a given transsexual. Finding one homosexual or non-homosexual based on the result.--> S. J. Wahng contended in 2004 that the term ''homosexual transsexual'' is "archaic". Though the term ''transsexuality'' was removed as a mental disorder from the [[DSM-IV]] and was replaced with [[gender identity disorder]] as a diagnostic label, attraction to males, females, both, or neither was specified in the [[DSM IV-TR]].

Most of the research on homosexual transsexuality has been conducted on trans women. They are usually socioeconomically disadvantaged, born later in a series of brothers, are unlikely to display cross-gender [[Sexual fetishism|fetishism]] or [[autogynephilia]],<!--For the person who feels a citation is needed here. Please see Blanchard 1987 http://www.springerlink.com/content/q025616175225557/ Referred to as classic Blanchard in this document's ref tags. This same paper is linked in the body of the article. The style guidelines do not provide for references inside the lead which is just a summary or abstract for the article. It is also more proper for this to be linked to autogynephilia than to feminization.--> and [[Coming out|come out]] at a younger age than non-homosexual trans women. Relatively little research has been done on gender variance in assigned women, and the prevalence of [[trans men|female-to-male]] [[gender identity disorder]] (GID) is less than that of male-to-female GID.<ref>{{Cite journal|last1=Bockting|first1=Walter|last2=Coleman|first2=Eli|last3=Deutsch|first3=Madeline B.|last4=Guillamon|first4=Antonio|last5=Meyer|first5=Ilan|last6=Meyer|first6=Walter|last7=Reisner|first7=Sari|last8=Sevelius|first8=Jae|last9=Ettner|first9=Randi|date=April 2016|title=Adult Development and Quality of Life of Transgender and Gender Nonconforming People|journal=Current Opinion in Endocrinology, Diabetes and Obesity|volume=23|issue=2|pages=188–197|doi=10.1097/MED.0000000000000232|issn=1752-296X|pmc=4809047|pmid=26835800}}</ref>
==Development of the concept==
The term ''homosexual transsexual'' was defined by Kurt Freund in 1974, and is used by various sexologists and psychiatrists to describe [[Transwomen attracted to men|trans women who are attracted to men]],<ref name="freund1974">Freund K, Nagler E, Langevin R, Zajac A, Steiner B (1974). Measuring feminine gender identity in homosexual males. ''[[Archives of Sexual Behavior]]'', Volume 3, Number 3 / May, 1974, pp. 249-260.</ref><ref name="person1974">Person ES, Ovesey L (1974). The Psychodynamics of Male Transsexualism. In Friedman RC, Richart RM, and Vande Wiele LR (eds.) ''Sex Differences in Behavior, '' pp. 315-331. John Wiley & Sons, {{ISBN|9780471280538}}</ref> though occasionally they use it to describe [[Transmen attracted to women|trans men who are attracted to women]].<ref name="chivers2000">{{cite journal | last1 = Chivers | first1 = ML | last2 = Bailey | first2 = JM | year = 2000 | title = Sexual orientation of female-to-male transsexuals: A comparison of homosexual and non-homosexual types | url = http://www.elspethbrown.org/sites/default/files/imce/art3a10.10232fa3a1001915530479.pdf | journal = [[Archives of Sexual Behavior]] | volume = 29 | issue = 3| pages = 259–278 | doi = 10.1023/A:1001915530479| pmid = 10992981 }}</ref> The concept of [[Classification of transsexuals|a taxonomy based on transsexual sexuality]] was first proposed by physician [[Magnus Hirschfeld]] in 1922,<ref name="Blanchard1985b">{{cite journal | last1 = Blanchard | first1 = R | year = 1985 | title = Typology of male-to-female transsexualism | url = | journal = Archives of Sexual Behavior | volume = 14 | issue = 3| pages = 247–261 | doi=10.1007/bf01542107 | pmid=4004548}}</ref><ref name="hirschfeld1923">Hirschfeld M (1922). "Sexualpathologie", [[German language|German]]</ref> and codified by endocrinologist [[Harry Benjamin]] in the [[Benjamin Scale]] in 1966,<ref name="benjamin1966">Benjamin H (1966). ''[http://www.symposion.com/ijt/benjamin/ The Transsexual Phenomenon.]'' The Julian Press ASIN: B0007HXA76 {{webarchive |url=https://web.archive.org/web/20060821093538/http://www.symposion.com/ijt/benjamin/ |date=August 21, 2006 }}</ref><ref name="Benjamin1966b">[http://www.symposion.com/ijt/benjamin/chap_02table.htm The Transsexual Phenomenon Chapter 2 table 1] {{webarchive |url=https://web.archive.org/web/20090109132054/http://www.symposion.com/ijt/benjamin/chap_02table.htm |date=January 9, 2009 }}</ref> which was published in the influential book ''The Transsexual Phenomenon''.<ref name="benjamin1966"/> Benjamin wrote that researchers of his day thought that attraction to men while feeling that oneself is a woman was the factor that distinguished a [[transvestite]] from a transsexual.<ref name="benjamin1966"/> He wrote, "The transvestite - they say - is a man, feels himself to be one, is heterosexual, and merely wants to dress as a woman. The transsexual feels himself to be a woman ("trapped in a man’s body") and is attracted to men."<ref name="benjamin1966"/>

Homosexuality was removed as a mental disorder from the [[DSM-II]], the diagnostic manual published by the [[American Psychiatric Association]], the most widely used diagnostic manual worldwide.<ref name="Spitzer">
{{cite journal
|pmid=7457641
|title=The diagnostic status of homosexuality in DSM-III: a reformulation of the issues -- Spitzer 138 (2): 210 -- Am J Psychiatry
|journal=The American Journal of Psychiatry
|volume=138
|issue=2
|pages=210–5
|publisher=ajp.psychiatryonline.org
|last=Spitzer
|first=Robert
|year=1981
|doi=10.1176/ajp.138.2.210
}}
</ref> [[Ego-dystonic sexual orientation|Ego-dystonic homosexuality]] was retained as a diagnosis for those who are caused distress by their sexual orientation.<ref name="Spitzer"/>

In 1980 in the DSM-III, a new diagnosis was introduced, that of "302.5 Transsexualism" under "Other Psychosexual Disorders". This was an attempt to provide a diagnostic category for gender identity disorders; the others included were "302.3 Transvestism" and "302.8 Fetishism".<ref name="martin">{{cite book|last=Lothstein|first= Leslie Martin |title=Female-to-male transsexualism|publisher=Routledge |year=1983|page=[https://archive.org/details/femaletomaletran0000loth/page/60 60]|isbn=978-0-7100-9476-6|url=https://archive.org/details/femaletomaletran0000loth|url-access=registration|quote=transsexual + DSM III.|accessdate=2009-04-24}}</ref> The diagnostic category, "transsexualism", was for gender dysphoric
individuals who demonstrated at least two years of continuous interest in transforming their physical and social gender status.<ref>{{cite document
|first=Walter
|last=Meyer
|author2=Walter O. Bockting
|author3=Peggy Cohen-Kettenis
|title=The Harry Benjamin International Gender Dysphoria Association's Standards Of Care For Gender Identity Disorders, Sixth Version
|version=6th
|publisher=Harry Benjamin International Gender Dysphoria Association
|date=February 2001
|url=http://www.wpath.org/Documents2/socv6.pdf
|accessdate=2009-04-22
|display-authors=etal
|url-status=dead
|archiveurl=https://web.archive.org/web/20070610012909/http://www.wpath.org/Documents2/socv6.pdf
|archivedate=2007-06-10
|df=
}}</ref> The subtypes were 1. asexual, 2. homosexual (same anatomic sex), 3. heterosexual (other anatomic sex) and 0. unspecified.<ref name="martin"/>

Physician and sexologist [[Kurt Freund]] proposed two types of cross-gender identity in 1982, based on his observation that [[gender identity disorder]] is different for homosexual males and heterosexual males.<ref name="freund1982" /> Subsequently, this term appeared in the DSM-III-R, but not in the DSM-IV in which gender identity disorder replaced [[transsexualism]].<ref name="wahng"/> Sexologists may quantitatively measure sexual orientation using [[Psychological testing#Personality tests|psychological personality test]]s or self reports. Blanchard and Freund used the Masculine Identity in Females (MGI), and the Modified Androphilia Scale.<ref>{{cite book|last=Blanchard|first=Ray|author2=Kurt Freund|title=Gender Roles|editor=Carole A. Beere|publisher=Greenwood Publishing Group |year=1990|page=35|isbn=978-0-313-26278-4|url=https://books.google.com/books?id=5X84NFiHXcwC&pg=PA36&lpg=PA36&dq=transsexuals+homosexual#PPA35,M1|accessdate=2009-04-21}}</ref> Homosexual transsexuals averaged a [[Kinsey scale]] measurement of 5–6 or a 9.86 ± 2.37 on the [[Modified Androphilia Scale]].<ref name="lawrence2005">{{Cite journal
|last1=Lawrence
|first1=Anne
| last2 = Latty
| first2 = Elizabeth M
|title=Measurement of sexual arousal in postoperative male-to-female transsexuals using vaginal photoplethysmography.
|journal=Archives of Sexual Behavior
|volume=34
|issue=2
|pages=135–145
|date=April 2005
|doi=10.1007/s10508-005-1792-z
|id=1573-2800
|pmid=15803248
|last3=Chivers
|first3=ML
|last4=Bailey
|first4=JM
}}</ref><ref name="leavitt1990"/>

===Terminological debate===
The concept that transsexuals with homosexual and non-homosexual sexual orientations are etiologically different has a long history in this field.<ref name="wahng"/><ref name="bagemihl"/><ref name="Benjamin"/><ref name="diamond1980"/> However the terms used have not always been agreed on.<ref name="bagemihl"/><ref name="Benjamin"/> Some scientists working on the topic have criticized the practice of categorizing transsexuals by sexual orientation and sex at birth.<ref name="bagemihl"/><ref name="Benjamin">{{cite book|last=Benjamin |first=Harry |authorlink= |title=The Transsexual Phenomenon |date= |location=Chapter 2, Paragraph 16 |pages= |url=http://www.symposion.com/ijt/benjamin/chap_02.htm#Relationship%20to%20homosexuality |doi= |pmid=5233741 |isbn= |url-status=dead |archiveurl=https://web.archive.org/web/20080913065950/http://www.symposion.com/ijt/benjamin/chap_02.htm |archivedate=September 13, 2008 }}</ref><ref name="diamond2006">Diamond M (2006). Biased-Interaction theory of psychosexual development: "how does one know if one is male or female?" ''Sex Roles''</ref> In the words of Benjamin, male-to-female transsexuals can only be homosexual if anatomy alone is considered, and the psyche of MTF transsexuals is ignored. According to him, after SRS, calling a male-to-female transsexual "homosexual" is pedantic.<ref name="benjamin1966(2)">{{cite book |author=Benjamin, Harry |title=The Transsexual Phenomeonon |date=1966 |chapter-url=http://www.symposion.com/ijt/benjamin/chap_02.htm |chapter=Transvestism, Transsexualism, and Homosexuality |via=symposion.com |access-date=December 10, 2008 |archive-date=January 6, 2009 |archive-url=https://web.archive.org/web/20090106091520/http://www.symposion.com/ijt/benjamin/chap_02.htm |url-status=dead }}</ref> He opined that the question "is a transsexual homosexual?" had both "yes" and "no" answers depending on whether sexual anatomy or [[gender identity]] was prioritised, and in cases of post-operative male-to-female transsexuals, describing them as "homosexual men" was against "reason and common sense".<ref name="benjamin1966(2)"/> When Benjamin was writing, ''transsexual'' implied male-to-female, and attracted to men.<ref name="benjamin1966"/> For a time in the 1980s terms which SJ Wahng describes as ''homosexual transsexual'' were in the DSM-III-R (transsexual, homosexual subtype)<ref name="wahng"/><ref name="shefer">{{Cite book
| last1 = Shefer
| first1 = Tamara
| author-link =
| last2 = Boonzaier
| first2 = Floretta
| author2-link =
| title = The Gender of Psychology
| place =
| publisher = Juta and Company Limited
| year = 2006
| volume =
| edition = Illustrated
| url = https://books.google.com/books?id=jtiUvdDlTboC
| doi =
| isbn = 978-1-919713-92-2
}} (see pages 273-274, 282)</ref> The DSM-IV and DSM-IV-TR stipulated that the sex a transsexual is attracted to be specified as "attracted to males, females, both or neither".<ref name="shefer"/>

Others, such as biologist and linguist [[Bruce Bagemihl]], agree with what Benjamin wrote about the use of this term.<ref name="bagemihl"/> Bagemihl wrote that this terminology makes it easy to say transsexuals are really homosexual males seeking to escape from stigma.<ref name="bagemihl">Bagemihl B. Surrogate phonology and transsexual faggotry: A linguistic analogy for uncoupling sexual orientation from gender identity. In ''Queerly Phrased: Language, Gender, and Sexuality''. Anna Livia, Kira Hall (eds.) pp. 380 ff. Oxford University Press {{ISBN|0195104714}}</ref> Sexologist Jim Weinrich opined that sexologist [[Ray Blanchard]] looked for information to support his theory instead of letting the evidence guide his theorizing, by using "a series of clever questionnaires and [[Penile plethysmograph|plethysmographic]] studies."<ref name="mass1990">Mass L (1990). ‘’Dialogues of the Sexual Revolution.’’ Haworth Press, {{ISBN|9781560240464}} p. 122</ref> Weinrich said that Blanchard asserted all female-to-male transsexuals were "woman loving".<ref name="mass1990"/> Leavitt and Berger criticized the term in 1990, saying that it was "both confusing and controversial among males seeking sex reassignment."<ref name="leavitt1990"/><ref name="morgan1978">Morgan AJ Jr (1978). Psychotherapy for transsexual candidates screened out of surgery. ''[[Archives of Sexual Behavior]]''. 7: 273-282.|</ref> Critics argue that the term "homosexual transsexual" is "[[heterosexism|heterosexist]]",<ref name="bagemihl"/> "archaic",<ref name="wahng">Wahng SJ (2004). Double Cross: Transmasculinity Asian American Gendering in ''Trappings of Transhood''. in Aldama AJ (ed.) ''Violence and the Body: Race, Gender, and the State''. Indiana University Press. {{ISBN|025334171X}}</ref> and demeaning because it labels people by sex assigned at birth instead of their [[gender identity]].<ref name="leiblum2000">Leiblum SR, Rosen RC (2000). ''Principles and Practice of Sex Therapy'', Third Edition. {{ISBN|1-57230-574-6}},Guilford Press of New York, c2000.</ref> Benjamin, Leavitt, and Berger have all used the term in their own work.<ref name="benjamin1966"/><ref name="leavitt1990"/> Sexologist John Bancroft also expressed regret for having used this terminology, which was standard when he used it, to refer to transsexual women.<ref name="Bancroftcomment">{{cite journal
| last = Bancroft
| first = John
| title = Lust or Identity?
| journal = Archives of Sexual Behavior
| volume = 37
| issue = 3
| pages = 426–428
| publisher = Springer
| year = 2008
| doi = 10.1007/s10508-008-9317-1
| pmid = 18431640}}</ref> He says that he now tries to choose his words more sensitively.<ref name="Bancroftcomment"/>

====Alternative terms====
Professor of anatomy and reproductive biology [[Milton Diamond]] proposed the use of the terms androphilic and gynephilic as alternatives to homosexual and heterosexual. Diamond wrote that the terms homosexual and heterosexual are confusing as applied to transsexual persons because it is not instantly clear whether they reference the pre- or post-transition state.<ref name="diamond1980">Diamond M, Karlen A (1980). ''Sexual Decisions''. Little, Brown, {{ISBN|9780316183888}}</ref><ref name="diamond2002a">{{cite journal | last1 = Diamond | first1 = M | year = 2002a | title = Sex and gender are different: Sexual identity and gender identity are different | url = | journal = Clinical Child Psychology and Psychiatry | volume = 7 | issue = 3| pages = 320–334 | doi=10.1177/1359104502007003002}}</ref> S.J. Wahng said in 2004 that the diagnosis homosexual transsexual is archaic and conflates homosexuality with transsexuality.<ref name="wahng"/>

Sexological research has been done using these alternative terms by researchers such as Sandra L. Johnson.<ref name="Johnson1990">Johnson SL, Hunt DD (1990). The relationship of male transsexual typology to psychosocial adjustment. ''[[Archives of Sexual Behavior]]'', Volume 19, Number 4 / August, 1990 349-360.</ref> Both Blanchard and Leavitt used a psychological test called the "modified androphilia scale" to assess whether a transsexual was homosexual or not.<ref name="Blanchard1985b"/><ref name="leavitt1990"/>

===Transgender community reaction===
According to Leavitt and Berger, "transsexuals, as a group, vehemently oppose the label and its pejorative baggage."<ref name="leavitt1990">Leavitt, Frank; Berger, Jack C. (October), "Clinical patterns among male transsexual candidates with erotic interest in males", Archives of Sexual Behavior 19 (5): 491-505, doi:10.1007/BF02442350, 1573-2800</ref> Trans woman [[Andrea James]] has called the term "inaccurate and offensive,"<ref name="james2006">James A (2006). A defining moment in our history: Examining disease models of gender identity. ''Gender Medicine''. 3:56 {{ISSN|1550-8579}}</ref> and trans man [[Aaron Devor]] wrote, "If what we really mean to say is attracted to males, then say 'attracted to males' or androphilic... I see absolutely no reason to continue with language that people find offensive when there is perfectly serviceable, in fact better, language that is not offensive."<ref name="lane2008">{{cite journal | last1 = Lane | first1 = R | year = 2008 | title = Truth, Lies, and Trans Science | url = | journal = [[Archives of Sexual Behavior]] | volume = 37 | issue = 3| pages = 453–456 | doi=10.1007/s10508-008-9336-y | pmid=18431622}}</ref>

==Description==

===Androphilic male-to-female transsexuals===

====Sexual activity====
Building on work by Freund, Frank Leavitt and Jack C. Berger in 1990 further categorized homosexual transsexuals by three patterns of sexual activity in how they used their penis.<ref name="leavitt1990"/> In their study 44% were sexually inactive, 19% avoided use of the penis during sex, and 37% derived pleasure from using the penis during sex. The groups showed varying levels of masculinity and emotional disturbance in development.<ref name="leavitt1990"/> Leavitt and Berger found that transsexuals in the avoidant group are different from those in the other two groups. They fit the description of the "nuclear transsexual".<ref name="leavitt1990"/> They had a strong cross gender identification, wanted female anatomy, had never married and little to no sexual activity with females.<ref name="leavitt1990"/> Of all the subgroups this group had the least comorbid [[psychopathology]].<ref name="leavitt1990"/> The transsexuals in the pleasure group behaved sexually in ways that were "classically homosexual".<ref name="leavitt1990"/> They were more likely than those in the avoidant group to have had sexual experience with females.<ref name="leavitt1990"/> They also rated higher on a test of general [[Sexual fetishism|fetishism]].<ref name="leavitt1990"/> Other than this, transsexuals in the pleasure group were similar to the description of a "nuclear transsexual".<ref name="leavitt1990"/> They found that transsexuals in the inactive group had characteristics which most differed from that of the "nuclear transsexual",<ref name="leavitt1990"/> such as strong heterosexual orientations (as determined from psychological testing), and fetish histories. "The pattern exhibited generally conforms to that exhibited by heterosexual transsexuals."<ref name="leavitt1990"/> The inactive group was found to share little with the other groups of transsexuals other than a stated sexual interest in males.<ref name="leavitt1990"/> Leavitt and Berger also mentioned studies by Blanchard which suggest that heterosexual transsexuals will adjust their life stories to ensure that they get sex reassignment surgery.<ref name="leavitt1990"/>

[[Harry Benjamin]] writes that "Other transsexuals find prostitution a useful profession for emotional as well as practical reasons".<ref name="benjamin1966"/>{{rp|50&ndash;51}} Benjamin goes on to say, "How much more can his femininity be reaffirmed than by again and again attracting normal, heterosexual, and unsuspecting men and even being paid for rendering sex service as a woman?"<ref name="benjamin1966"/>

====Socioeconomic factors====
Researchers have recently found several [[Demography|demographic]] features that homosexual transsexuals tend to have in common.<ref name="zucker22002">{{cite journal|last=Cohen-Kettenis
|first=Peggy T.
|authorlink=
|author2=Owen A.
|author3=Kaijser V.
|author4=Bradley S.
|author5=Zucker K.
|title=Gender-Dysphoric Children and Adolescents: A Comparative Analysis of Demographic Characteristics and Behavioral Problems.
|journal=Journal of Abnormal Child Psychology
|volume=31
|issue=1
|pages=41–53
|publisher=Springer Netherlands
|location=Netherlands
|date=February 2003
|doi=10.1023/A:1021769215342
|pmid=12597698}}</ref><ref name="MacFarlane">{{cite journal
|last=MacFarlane
|first=D. F.
|authorlink=
|title=Transsexual prostitution in New Zealand: Predominance of persons of Maori extraction
|journal=Archives of Sexual Behavior
|volume=13
|issue=4
|pages=301–309
|publisher=Springer
|location=Netherlands
|date=August 1984
|doi=10.1007/BF01541903
|pmid=6487074}}</ref> Ken Zucker in 2002 and Yolanda Smith et al. in 2005 independently found that homosexual transsexuals were lower in [[IQ]],<ref name="psychology Research"/> [[social class]], and age than non-homosexual transsexuals. They were, on average, in their mid-teens to mid-20s when they reported to a gender clinic for sex reassignment.<ref name="psychology Research"/><ref name="Blanchardequation">{{cite journal | last1 = Blanchard | first1 = R | year = 1994 | title = A structural equation model for age at clinical presentation in nonhomosexual male gender dysphorics | journal = [[Archives of Sexual Behavior]] | volume = 23 | issue = 3| pages = 311–320 | doi=10.1007/bf01541566| pmid = 8024443 }}</ref>
The homosexual transsexuals are more likely to have [[immigration|recent immigrant]] status, nonintact families, non-[[Caucasian race]], and childhood [[Anti-social behaviour|behavior problems]].<ref name="zucker22002"/>

D.F. MacFarlane studied transsexuals in Australia and New Zealand.<ref name="MacFarlane"/> MacFarlane found that in New Zealand that 90% of the homosexual transsexual prostitutes were [[Māori people|Māori]],<ref name="MacFarlane"/> an ethnic group who are only 9% of the overall population.<ref name="MacFarlane"/> MacFarlane concluded that culture influenced the number of Māori homosexual transsexuals he observed.<ref name="MacFarlane"/>

====Fraternal birth order effect====
Recent research on the causes of homosexual transsexualism, transsexualism, and homosexuality overlap to a large degree.<ref name="Blanchardbrothers"/><ref name="Zuckerbrothers"/><ref name="Greenbrothers"/> The [[etiology of transsexualism]] concerns the causes of transsexuality in general, including the theory that transsexualism is caused by differences in specific areas of the brain, while relationships between [[biology and sexual orientation]] have been studied in depth as possible causes of homosexuality.<!--Look at the sources on the fraternal birth order effect. Note that in particular Blanchard's study mentions homosexual transsexuals. Further consider the other causes found in both articles on etiology of transsexualism. (G'guy: Also please don't use self references in Wikipedia articles, except as hatnotes.)-->

Blanchard and Zucker came to the general conclusion that birth order has some influence over sexual orientation in biological males in general, and homosexual male-to-female transsexuals in specific.<ref name="Blanchardbrothers">{{Cite journal
| last1 = Blanchard
| first1 = Ray
| author-link =
| last2 = Zucker
| first2 = Kenneth J.
| author2-link =
| title = Birth order and sibling sex ratio in two samples of Dutch gender-dysphoric homosexual males
| journal =Archives of Sexual Behavior
| volume = 25
| issue = 5
| pages = 495–514
| date = October 1996
| doi =10.1007/BF02437544
| pmid = 8899142
| last3 = Cohen-Kettenis
| first3 = PT
| last4 = Gooren
| first4 = LJ
| last5 = Bailey
| first5 = JM }}</ref><ref name="Zuckerbrothers">{{Cite journal
| last1 = Zucker
| first1 = Kenneth J
| author-link =
| last2 = Blanchard
| first2 = Ray
| author2-link =
| title = Birth order and sibling sex ratio in homosexual transsexual South Korean men: Effects of the male-preference stopping rule
| journal = Psychiatry and Clinical Neurosciences
| volume = 61
| issue = 5
| pages = 529–533
| date = October 2007
| doi =10.1111/j.1440-1819.2007.01703.x
| pmid=17875032
}}</ref><ref name="Greenbrothers">{{Cite journal
| last = Green
| first = Richard
| author-link =
| title = Birth order and ratio of brothers to sisters in transsexuals
| journal = Psychological Medicine
| volume = 30
| issue = 4
| pages = 789–795
| date = July 2000
| doi =10.1017/S0033291799001932
| pmid = 11037086 }}</ref> This phenomenon is called the "[[fraternal birth order]] effect".<ref name="Zuckerbrothers"/> In 2000 Richard Green wrote, "Homosexual male-to-female transsexuals have a later than expected birth order and more older brothers than other subgroups of male-to-female transsexuals. Each older brother increases the odds that a male transsexual is homosexual by 40%."<ref name="Greenbrothers"/> Green did not find a higher incidence of homosexuality in the younger brothers of homosexual transsexuals.

Zucker and Blanchard wrote that studies have consistently supported the "fraternal birth order effect" that homosexual transsexuals have more brothers than sisters and are born later in birth order. In contrast, in their study using an Asian sample they found that the transsexual men had significantly more sisters than controls.<ref name="Zuckerbrothers"/> Zucker attributes this to the preference for males in Korean society causing parents to stop having children once they have a boy.<ref name="Zuckerbrothers"/> Therefore, all male children are less likely to have older brothers and hence no fraternal birth order effect is observed.<ref name="Zuckerbrothers"/>

====Use in Blanchard's typology====
{{Main|Blanchard's transsexualism typology}}

Sexologist [[Ray Blanchard]] defined this category in his research, based on testing or self-report, and argued based on his research that self-report is not always reliable.<ref name="lawrence2005"/><ref name="leavitt1990"/><ref name="classicBlanchard">{{cite journal
|last=Blanchard
|first=Ray
|author2=Leonard H. Clemmensen
|author3=Betty W. Steiner
|title=Social desirability response set and systematic distortion in the self-report of adult male gender patients
|journal=Archives of Sexual Behavior
|volume=14
|issue=6
|pages=505–516
|publisher=Springer
|location=Netherlands
|date=December 1985
|doi=10.1007/BF01541751
|pmid=4084050
|id=1573-2800
}}</ref> Morgan, Blanchard, Lawrence, and other researchers have argued that many "non-homosexual" transsexuals systematically distort their life stories because "non-homosexuals" were often screened out as candidates for surgery,<ref name="morgan1978" /> and because some see "homosexual transsexual" as a more socially desirable diagnosis. According to Blanchard, key characteristics include conspicuous cross-gender behavior from childhood through adulthood, and a "[[homosexual]]" [[sexual orientation]]. Blanchard also says that non-homosexual transsexual women (as well as all other non-homosexual male gender dysphorics) have a condition called [[autogynephilia]] and are aroused by the idea or image of themselves as women.<ref name="blanchard1987"/> Blanchard found in his studies that homosexual transsexuals were younger when applying for sex reassignment, reported a stronger cross-gender identity in childhood, had a more convincing cross-gender appearance, and functioned psychologically better than "non-homosexual" transsexuals.<ref name="blanchard1987">Blanchard R, Clemmensen LH, Steiner BW (1987). Heterosexual and homosexual gender dysphoria. ''[[Archives of Sexual Behavior]]'', Volume 16, Number 2 / April, 1987</ref> A lower percentage of the homosexual transsexuals reported being (or having been) married, as well as sexual arousal while cross-dressing.<ref name="psychology Research"/> Studies have variously found that between 10% and 36% of homosexual transsexuals report a history of sexual arousal to cross dressing. Bentler found 23%, while Freund reported 31%.<ref name="freund1982">{{cite journal | last1 = Freund | first1 = K | last2 = Steiner | first2 = BW | last3 = Chan | first3 = S | year = 1982 | title = Two types of cross-gender identity | url = | journal = [[Archives of Sexual Behavior]] | volume = 11 | issue = 1| pages = 49–63 | doi=10.1007/bf01541365 | pmid=7073469}}</ref><ref name="leavitt1990" /><ref name="bentler1976">{{cite journal | last1 = Bentler | first1 = P M | year = 1976 | title = A typology of transsexualism: Gender identity theory and data | url = | journal = [[Archives of Sexual Behavior]] | volume = 5 | issue = 6| pages = 567–584 | doi=10.1007/bf01541220| pmid = 1008701 }}</ref><ref name="blanchard1985">{{cite journal | last1 = Blanchard | first1 = R | year = 1985 | title = Typology of male-to-female transsexualism | url = | journal = [[Archives of Sexual Behavior]] | volume = 14 | issue = 3| pages = 247–261 | doi=10.1007/bf01542107 | pmid=4004548}}</ref>

Previous taxonomies, or systems of categorization, used the terms "classic transsexual" or "true transsexual," terms once used in [[differential diagnosis|differential diagnoses]].<ref name="benjamin1966types">{{cite web|author=Benjamin H |year=1966 |url=http://www.symposion.com/ijt/benjamin/chap_04.htm#Three%20different%20types%20of%20transsexuals |title="Three different types of transsexual" ''The Transsexual Phenomenon.'' |publisher=Julian Press ASIN B0007HXA76 |url-status=dead |archiveurl=https://web.archive.org/web/20071231102831/http://www.symposion.com/ijt/benjamin/chap_04.htm |archivedate=December 31, 2007 }}</ref> Blanchard also said homosexual transsexuals were comparatively shorter and lighter in proportion to their height than non-homosexuals.<ref name="blanchard1995">{{cite journal | last1 = Blanchard | first1 = R | last2 = Dickey | first2 = R | last3 = Jones | first3 = CL | date = Oct 1995 | title = Comparison of height and weight in homosexual versus non-homosexual male gender dysphorics | url = | journal = [[Archives of Sexual Behavior]] | volume = 24 | issue = 5| pages = 543–54 | doi=10.1007/bf01541833| pmid = 8561663 }}</ref> Independent research done by Johnson and Smith concurs with most of Blanchard's observations.<ref name="Johnson1990"/><ref name="psychology Research"/> Smith did not find a significant difference in height-weight ratio.<ref name="psychology Research">{{cite journal
|last = Smith
|first = Yolanda L.S.
|authorlink =
|author2 = Stephanie Van Goozen
|author3 = Aj Kupier
|author4 = Peggy T. Cohen-Kettenis
|title = Transsexual subtypes: Clinical and theoretical significance
|journal = Psychiatry Research
|volume = 137
|issue = 3
|pages = 151–160
|date = 2005-12-15
|publisher = Elsevier
|url = http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf
|doi = 10.1016/j.psychres.2005.01.008
|accessdate = 2007-06-26
|pmid = 16298429
|url-status=dead
|archiveurl = https://web.archive.org/web/20080227130826/http://akikos-planet.cocolog-nifty.com/blog/files/psychiatry_research__transsexual_subtypes_clinical_and_theoretical_significance.pdf
|archivedate = 2008-02-27
|df =
}}</ref> Subsequent research has found only partial support of Smith's findings.<ref>{{cite journal|last=Kreukels|first=Baudewijntje |author2=Peggy Cohen-Kettenis|date=15 January 2008|title=Male-to-female transsexual subtypes: Sexual arousal with cross-dressing and physical measurements|journal=Psychiatry Research|volume=137|issue=1|page=321|doi=10.1016/j.psychres.2007.06.019}}</ref> Johnson's 1990 work used the alternative term "androphilic transsexual", Johnson wrote that there was a correlation between social adjustment to the new gender role and androphilia.<ref name="Johnson1990"/>

===Gynephilic female-to-male transsexuals===
In 2000, [[Meredith L. Chivers]] and Bailey wrote, "Transsexualism in genetic females has previously been thought to occur predominantly in homosexual (gynephilic) women." According to them, Blanchard reported in 1987 that only one in 72 female-to-male transsexuals he saw at his clinic were primarily attracted to men. They write that these individuals were so uncommon that some researchers thought that androphilic female-to-male transsexuals did not exist or misdiagnosed them as homosexual transsexuals, attracted to women. Relatively few studies have examined childhood gender variance in biological females.<ref name="chivers2000"/>

In the 2005 study by Smith and van Goozen, their findings in regards to female-to-male transsexuals were different from their findings for male-to-female transsexuals.<ref name="psychology Research"/> Smith and van Goozen's study included 52 female-to-male transsexuals, who were categorized as either homosexual or non-homosexual. Smith concluded that female-to-male transsexuals, regardless of sexual orientation, reported more GID symptoms in childhood, and a stronger sense of gender dysphoria. Smith wrote that she found some differences between homosexual and non-homosexual female-to-male transsexuals. Smith says that non-homosexual female-to-males reported more gender dysphoria than any group in her study. Smith says, "It is of interest, though, that a few female-to-male transsexuals reported to have been sexually aroused in adolescence when dressing in male clothes, as this has never been reported before."<ref name="psychology Research"/>

==MRI studies and neurological differences==
The concept that androphilic male-to-female transsexualism is related to homosexuality in masculine homosexual males has been tested by MRI studies.<ref name="Kozak">{{cite journal|last=Simon|first=Lajos|author2=Lajos R. Kozák|author3=Viktória Simon mail|author4=Pál Czobor|author5=Zsolt Unoka|author6=Ádám Szabó|author7=Gábor Csukly|title=Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study|journal=PLOS ONE|date=December 31, 2013|doi= 10.1371/journal.pone.0083947|volume=8|issue=12|pages=e83947|pmid=24391851|pmc=3877116|bibcode=2013PLoSO...883947S}}</ref><ref name=Cantor2011>{{cite journal|last=Cantor|first=James M|title=New MRI Studies Support the Blanchard Typology of Male-to-Female Transsexualism|journal=Archives of Sexual Behavior|date=July 8, 2011|volume=40|issue=5|pages=863–864|doi=10.1007/s10508-011-9805-6|pmc=3180619|pmid=21739338}}</ref> These studies have been interpreted as supporting Blanchard's transsexualism typology.<ref name=Cantor2011 /> These studies show neurological differences between homosexual transsexuals and controls as well as differences between homosexual and non-homosexual transsexuals.<ref name=Cantor2011 />

A 2013 study looked at the brains of homosexual aspiring-transsexual males and females who reported to a gender clinic who had also not had any hormonal treatments.<ref name=Kozak /> The question the research wished to address was the existence of any differences between transsexual and non-transsexual brains. Their stated reason for selecting homosexual transsexuals was to avoid clouding the issue with a sample of mixed sexual orientations, given Blanchard's typology. This study also controlled for possible influence of external hormones by looking at subjects who had not taken any yet.<ref name=Kozak /> The study found the following in its sample of homosexual transsexuals:

<blockquote> We found that transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender in their regional GM volume of several brain areas, including the left and right precentral gyri, the left postcentral gyrus (including the somatosensory cortex and the primary motor cortex), the left posterior cingulate, precueneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and [[inferior temporal gyrus|inferior temporal gyri]]. Additionally, we also found areas in the cerebellum and in the left angular gyrus and left [[inferior parietal lobule]] that showed significant structural difference between transgender subjects and controls, independent from their biological gender.<ref name=Kozak /></blockquote>

==See also==
* [[Gynephilia and androphilia]]
* [[Transgender youth]]

==References==
{{Reflist|2}}

==Further reading==
* {{cite book|author=J. Michael Bailey|title=The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism|url=https://archive.org/details/manwhowouldbeque00bail|url-access=registration|date=10 March 2003|publisher=Joseph Henry Press|isbn=978-0-309-08418-5}}

==External links==
* [http://transkids.us/ TransKids.us - Writings by Self-Identified "Homosexual Transsexuals"]
* [https://web.archive.org/web/20050306095634/http://www.autogynephilia.org/ColoredParisTalk_files/v3_document.htm "Autogynephilia and the Taxonomy of Gender Identity Disorders in Biological Males"] - Ray Blanchard, PhD 2000

{{Transgender|state=collapsed}}

[[Category:Homosexuality]]
[[Category:Transgender sexuality]]
[[Category:Transgender sexuality]]
[[Category:Transgender studies]]

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