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Methodological Issues

Literature to date on sexuality among transgenders and transsexuals includes clinical, epidemiological, anthropological and sociological studies, as well as many autobiographical and anecdotal texts. The study of trans sexuality has been fraught with methodological problems, the most important of which I will detail here.

The first problem has to do with scope. Until perhaps a decade ago, most researchers accepted Harry Benjamin's (1966) typology of transsexualism and transvestism, which held that gender dysphoric individuals a) were almost exclusively genetic males, and b) could be separated neatly into the categories of transvestite and transsexual. Transvestites cross-dressed for sexual thrills, whereas transsexuals desired a total change of sex and a life lived as female. As documented extensively by Jason Cromwell (1999), gender diversity among genetic females was virtually invisible in the literature until the late 1990s. Furthermore, for those who sought to change their physical sex characteristics and not live in their assigned gender, "transsexual" was the only identity category open to them, and a fairly narrow one at that. The emergence of a multiplicity of trans identities, and the greater visibility of FTMs and transmen is only beginning to be reflected in the research literature (and the popular literature).

Another clear problem with sociological and anthropological as well as clinical and non-clinical psychological studies addressing trans people's sexual lives has been the small sizes of their samples. The majority of studies I encountered in all fields had sample sizes of less than fifty, and several had sample sizes of fewer than thirty; Anne Bolin's oft-quoted book In Search of Eve is based on interviews with fewer than twenty transsexuals (Bolin 1998, Rehman et al 1998, Daskalos 1999, Devor 1997, Fleming, MacGowan, & Salt 1984, Fleming, MacGowan, & Costos 1985, Griggs 1998, Lawrence 1997).

The first to write about trans people in this century, of course, were those doctors who saw to their hormonal and surgical treatment (e.g. Cauldwell 1949, Benjamin 1966, Walinder 1967), and to date the bulk of published studies on transgender and transsexual people have been clinical psychology studies, which has a number of consequences for the pictures of trans experience available to us. As Jason Cromwell points out, "these studies have been limited by the clinical environment and a focus on individuals who see their identity as problematic" (Cromwell 1999:15). Clinical subjects are likely to see their gender variance as problematic and be less emotionally and psychologically stable in general than the average person, and the approaches of clinical studies are primarily concerned with (what researchers construe as) pathology. Brian Tully's 1992 study, conducted at Britain's leading gender clinic, spends many pages on the prevalence of psychosis, dissociative experiences, alcohol and drug problems and criminal activity among 204 transsexuals -- findings which are not corroborated by any nonclinical research to date. Likewise, one could expect clinical studies to exaggerate the prevalence of sexual dysfunction, dissatisfaction and anxiety among trans people.

The clinical environment itself affects the reliability of data collected about sexual behavior. Many trans people distrust those who treat them, and with good reason; at least one study reports sexual harassment, attempts to impose rigid gender stereotypes in matters ranging from sexual behavior to choosing a new name, discrimination against sex workers and the unemployed, and failure to provide adequate information about treatment options and impacts among transpeople's common complaints (Namaste 2000). Perhaps more significantly, individuals seeking to obtain hormone treatments and/or surgery may have a vested instrumental interest in appearing to conform to antiquated clinical stereotypes about transsexuals, most specifically that "true transsexuals" only want to lead "normal" heterosexual lives. Anne Bolin noted this in her anthropological study of MTF transsexuals:

The preoperative individual recognizes the importance of fulfilling caretaker expectations in order to achieve a favorable recommendation for surgery, and this may be the single most important factor responsible for the prevalent medical-mental health conceptions of transsexualism. Transsexuals feel that they cannot reveal information at odds with caretaker impressions without suffering adverse consequences. They freely admit to lying to their caretakers about sexual orientation and other issues. (Bolin 1998:62-3)

Frank Lewins, studying MTFs at a Sydney gender clinic, found that "in response to a question [on a clinic questionnaire] about their fantasized sexual goal, almost all responded that they fantasized being a woman with a vagina and having sex with a heterosexual man." From his own, private conversations with them, however, he classified 47% as heterosexual, 31% as "clearly lesbian" and 22% as "asexual, although admittedly, [this] designation is difficult to apply" (Lewins 1995:95).

Similar behavior was apparent in Devor's study of FTMs:

When we went to the clinic, they found out [that another FTM and I] were lovers, together, so they asked us about it. So, I knew I couldn't lie, 'cause they...must have heard it from somebody. So, I said, 'We were for a while but we're no longer now.' Of course, we were.... I don't like lying, but if you gotta lie, you gotta lie. You just have to know how to do it right. Tell them what they want to hear. There's no way they would accept that [we were lovers]. (Devor 1997:404)

Though it is impossible to say for sure whether the following passage is truly an example of client deception, the possibility certainly leaps to mind:

In his marriage as with all other girlfriends he has had inadequate capabilities to have erections and has never had intercourse. Although his marriage was not consummated, he masturbated on occasions, and on one of those times, semen ran into the vagina of his wife and consequently his daughter was conceived. (Medical report on a male-to-female transsexual, cited in Tully 1995:93)

It is not only self-reports about sexual orientation or sexual behaviors that may be unreliable in the clinical setting, but also satisfaction with hormonal and surgical results. Since the goal of surgery is to markedly improve quality of life, and since some medical professionals and cultural critics still believe transpeople should be given psychotherapy rather than allowed to "mutilate" their bodies, the continuing availability of surgeries depends on positive results in follow-up studies. "Transsexuals who have survived the medical and psychiatric system's sex-changing authorization process," argues Pat Califia, "are quite sophisticated about how that system works. They know that negative answers to surveys about their postsurgical quality of life will hurt the transsexuals who come after them. Until there are excellent alternatives to the current treatment modality, among which transsexuals are truly free to pick and choose, follow-up studies will be hopelessly skewed" (Califia 1996:270). It was precisely this kind of skewing that motivated Anne Lawrence to conduct her own unscientific survey of transsexual women about their experiences at the 1996 New Woman Conference (Lawrence 1997). She found that "nearly half the women said their transitions had involved some deception of their therapists or healthcare providers."

A recent study concerning HIV prevalence and risk behaviors deserves special attention for its methodological thoroughness. Clements-Nolle et al (2001) recruited an impressive 392 MTF and 123 FTM participants in the San Francisco area from street settings, bars, social gatherings and agencies and respondent-driven sampling. Three MTF and three FTM staff of diverse ethnic backgrounds were hired and trained to conduct interviews. Respondents were given HIV antibody tests and surveyed about their sexual orientation and a range of unprotected and unprotected sexual behaviors. I know of no other study to date with so large a non-clinical sample of trans-people, nor of any other study conducted by non-trans researchers who went to the trouble of hiring trans interviewers.

Devor's book FTM: Female-to-Male Transsexuals in Society (1997) also deserves special attention for the breadth and depth of its inquiry. (See Footenote 2) If you're going to study a group of less than fifty people, particularly members of an understudied group such as FTMs, you ought to do it right; Devor managed to explore nearly every relevant area of participants' lives from childhood to the present, including copious attention to masturbation, intimate relationships, specific sexual practices, and experiences of sexual violence. Unfortunately, Devor's work is so thorough (and at times repetitive) that, at well over 600 pages, it tends to intimidate would-be readers.

2 - Since the publication of the work discussed here, Devor has made a gender transition and now writes under the name Aaron H. Devor (personal communication).

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Part II: My Study

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