| Walter Bockting, Eli Coleman, "A comprehensive Approach to the Treatment of Gender Dysphoria", J of Psychology & Human Sexuality, 5:4 1992, pp. 131-153 |
| | Today, more clinicians recognize that gender dysphoria is far more complex than previously assumed. There is no scientific consensus about a single developmental pathway which leads to gender dysphoria. Determinants of gender dysphoria remain controversial and hypothetical. |
| | There is insufficient evidence for a biological determinant of gender dysphoria. Interactions theories of psychosexual development are more likely to represent reality. |
| Julian Godlewski, "Transsexualism and Anatomic Sex Ratio Reversal in Poland", Archives of Sexual Behavior, 17:6 1988, pp. 547-548 |
| | The aetiology of transsexualism is unknown and is the subject of various speculations. |
| Michael Ross, William Walters, "Transsexualism and Sex Reassignment", Oxford University Press, 1986 p20 |
| p20: | While at present there is no evidence to suggest a biological basis for gender dysphoria, it is premature to rule out completely either a biological-environmental interaction or the fact that there may be some cases or subgroups of transsexuals with biological involvement. The insistence by some individuals, both transsexuals and medical scientists, that gender dysphoria is biologically determined is an entirely different matter. Such a belief on the part of transsexuals themselves is often an indication that they do not want to question the origins of their condition or explore its causes and development: Such individuals are often unwilling to accept any responsibility for their gender dysphoria and will not entertain any attempts to change it. Professionals who believe that gender disorders are biological may also be attempting to justify the continuation of gender reassignment surgery without too close an examination of the basis of gender dysphoria in particular patents. It is important to separate belief and fact in such cases, and to recognize the difference between individuals having a need to believe in biological determinism, on the one hand, and on scientific support for theories of biological causation on the other. |
| | It is difficult to see primary gender dysphoria as anything other than a psychological disturbance. It is of particular interest that, of the many transsexuals presenting for treatment, primary gender dysphoria is not the most common diagnosis nor gender reassignment the most common treatment. |
| p8: | Symptoms of transsexualism are characteristically psychological in nature rather than biological. |
| p16: | It may well be that there are different types of gender dysphoria, some with biological contributors, some with familial contributors, and some with primarily psychological or social contributors. |
| p20: | While there is little if any evidence to support a biological basis for gender dysphoria, there is some evidence to support the argument that, in some cases of transsexualism, there is a degree pathology. |
| Laura Roberto, "Issues in Diagnosis and Treatment of Transsexualism", Archives of Sexual Behavior, 12:5 1983, p. 445 |
| | Transsexualism is not a homogeneous syndrome but reflects a condition that may result from multiple psychosocial and sexual histories, motivations, self-concepts and stress-coping strategies. |
| | A number of clinicians have noted that patients with cross-gender identity show accompanying psychopathology. This raises critical questions regarding transsexualism as a discrete category of psychopathology at all, as opposed to a manifestation of an underlying condition. |
| Michael Ross, "Societal Relationships and Gender Role in Homosexuals: A cross-Cultural Comparison", The Journal of Sex Research, 19:3 August 1983, pp. 273-288 |
| | Gender role is based on societal, as well as parental, models. |
| L. Lothstein, "Sex Reassignment Surgery: Historical, Bioethical and Theoretical Issues", Am J Psychiatry, 139:4 April 1982, p. 417 |
| | The disorders of gender dysphoria are primarily psychological disorders |
| Lesley Rogers, Joan Walsh, "Shortcomings of the Psychomedial Research of John Money and Co-Workers into Sex Differences in Behavior: Social and Political Implications", Sex Roles, 8:3 1982 |
| | Gender is a social construction. Male and female is assigned at birth on the basis of biologically determined genital appearance, but associated patterns of male and female behavior are the result of social construction. |
| | Both biology and environment play a totally integrated role in determining gender identity and all the other behaviors in which the sexes differ. |
| Ellen Halle, Jon Meyer, Chester Schmidt, "The Role of Grandmothers in Transsexualism", Am J Psychiatry, 137:4 April 1980 |
| | Although the aetiology of transsexualism is uncertain, studies have suggested that organic and physiological abnormalities do not play a major role in this disorder. |
| L. Lothstein, "Psychodynamics and Sociodynamics of Gender Dysphoric States", American Journal of Psychotherapy, 33:2 April 1979 |
| | Transsexualism is seen as both a psychological and social phenomenon. |
| | As more patients were evaluated, it became clearer that the phenomenon of transsexualism could not be explained by a unitary theory. |
| J Hoenig, J. Kenna, "EEG Abnormalities and transsexualism", Brit. J. Psychiat., 134 1979, pp. 293-300 |
| p298: | It is possible that transsexualism does not have a uniform aetiology. Perhaps those with abnormal EEG's are aetiologically a separate group. The significance of the abnormal EEGs in a high proportion of transsexuals remains elusive. Nevertheless, the incidence is too high to be ignored, and further theories about the nature of the disorder must take this into account. |
| Linda Friar, George Rekers, Alexander Rosen, "Theoretical and Diagnostic Issues in Child Gender Disturbances", The Journal of Sex Research, 13:2 May 1977, pp. 89-103 |
| | Unfortunately, there are no published studies that report the base rate for feminine behavior in the general population of boys that eventuates in normal vs. deviant adult adjustment. Nor are there available data to indicate what percentage of feminine boys spontaneously outgrow this phase, what percentage grow up to be adult transsexuals or transvestites, and what percentage become adult male homosexuals (remembering that not all homosexuals have cross gender identity problems). |
| Lawrence Newman, Robert Stoller, "Nontranssexual Men Who Seek Sex Reassignment", Am J Psychiatry, 131:4 April 1974 |
| | As a child psychiatrist, I favor the theory that transsexualism is a personality disorder. |
| | It was theorized that these patients had probably reached this state as a result of some biological force, not yet demonstrated, which had caused them to feel feminine in such a strong way despite the fact that they possessed what appeared to be normal male genitalia. In more recent reports, Stoller has swung more toward the etiological theory that views transsexualism as a personality disorder. |
| David Barlow, "Gender Identity Change in a Transsexual", Archives of General Psychiatry, April 1973 p576 |
| p576: | In the fuzzy area of diagnosis it may be that several types of transsexuals exist, each displaying mistaken gender identity and a reversal of sex role behavior but with different background variables. |
| John Bates, P Bentler, Spencer Thopson, "Measurement of Deviant Gender Development in Boys", Child Development, 44 1973, pp. 591-598 |
| | Early gender identity or behavior problems are implicated for a significant proportion of adult transsexuals, transvestites and homosexuals. |
| Robert Stoller, "The transsexual boy: mother's feminized phallus", Br. J. Med. Psychol, 43:117 1970, p. 117 |
| | I have never seen nor heard of two transsexuals in the same family, nor has it been reported in the several hundred cases in the literature. |