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Sex and Gender


Robert J. Stoller, M.D.

Professor of Psychiatry

New York

Acknowledgements page vii

Part I

1 Bisexuality: The ‘Bedrock’ of Masculinity and Femininity 7

2 Extreme Femininity in boys: The Creation of Illusion 19
3 The Transsexual Boy: Mother’s Feminized Phallus 38
4 Parental Influences in Male Transsexualism: Data 56
5 The Bisexual Identity of Transsexuals 74
6 * The Oedipal Situation in Male Transsexualism 94
7 The Psychopath Quality in Male Transsexuals 109

Part II
8 The Male Transsexual as ‘Experiment’ 117
9 Tests 126
10 The Pre-Natal Hormone Theory of Transsexualism 134
11 The Term‘Transvestism’ 142
12 Transsexualism and Homosexuality 159
13 Transsexualism and Transvestism 170
14 Identical Twins 182
15 Two Male Transsexuals in One Family 187
16 The Thirteenth Case 193
17 Shaping 203
18 Etiological Factors in Female Transsexualism: A First Approximation 223

Part III
19 Male Transsexualism: Uneasiness 247
20 Follow-Up 257
21 Problems in Treatment 272
22 Conclusions: Masculinity in Males 281
References 298
Index 313
Part I


If this profound and natural-appearing femininity is already established
in the boy’s personality by his third year, what is the nature of his oedipal
experience? In other disorders of sexuality, the oedipus complex exerts a
decisive etiologic influence. And so we would expect it to be extremely
important in transsexualism also. In fact, the oedipal period is significant
in male transsexualism in that it fails to modify, alter or distort, the
already existing femininity of the boy. The oedipal situation in male
transsexualism is remarkable in that evidences of oedipal conflict—
incestuous feelings, castration anxiety and identification with the parent
of the same sex—are not seen. It is this absence of significant oedipal
conflict, we believe, that permits the feminine identity of the child to
develop thereafter in such undistorted form. We attribute the absence of
oedipal anxieties to abnormalities in the family situation, especially the
physical absence and lack of emotional involvement of the father and the
continuing symbiosis with the mother. Later we shall note how a male
therapist’s intervention during the oedipal period may alter the situation
by setting in motion reparative oedipal dynamisms.

We have been studying the phenomenon of male transsexualism in

statu nascendi by longitudinal observations of extremely feminine boys
of oedipal age, eight of whom have been in treatment in our Clinic.
These little boys manifest in behavior and fantasy the findings that
characterized the boyhoods of the adult male transsexuals we have
studied. They prefer to dress as girls, love feminine adornment, dislike
dressing as a boy or playing with boys. They are feminine in gesture and
mannerism, insist on taking a female role in fantasy games and wish
fervently that they could grow up to


* This chapter is modified from a paper by Dr. Newman and myself (1).

become not men but women. Our Clinic data indicate that adult male
transsexuals have the same childhood as these little boys (2).

The absence of signs of oedipal conflict in the boys we are studying

must not be construed to mean that we find these patients free of conflict.
On the contrary they suffer tension and sadness. But these symptoms
appear in response to pressures exerted by the outside world against the
little boy’s femininity, for example, ridicule by other boys who call the
patient a ‘sissy’ or the disapproval of teachers and neighbors. Not
infrequently these external pressures cause the child to isolate himself at
home and to continue his feminine play activities and cross-dressing in the
protected environment created and still supervised by his mother.

The Absence of Evidence of Oedipal

Conflict in the Transsexual Boy
The oedipal situation in the families of these boys is unusual. Father
absents himself from home, avoids emotional involvement with his wife or
the patient, and does not present himself as a rival for mother’s affection or
as a model for masculine identification. The mother, happy to gratify her
son’s feminine wishes and fearful of losing his love by opposing him,
makes no effort to introduce masculinity into his life. Moreover she enjoys
his femininity and uses it as a basis for common interests and
understandings. These boys are usually not brought for treatment on their
parents’ initiative (neither parent being particularly concerned about the
femininity of their son) but because of pressures exerted by others, usually
nursery-school teachers or neighbors who express their concern about the
boy’s obviously abnormal behavior.

The transsexual boy passes through the years in which in other boys,
oedipal dynamics are ordinarily active without altering his femininity or
his relationship to his parents. As he grows older and sees that other boys
his age disapprove of his feminine behavior, he begins to play only with
little girls willing to accept him as a feminine companion, sharing in
fantasy games of caring for dolls or playing ‘house’. Under the protection
of his mother at home he continues to enjoy dressing

himself up, applying make-up as if he were a beautiful woman and

walking around in her high heeled shoes. Although an enjoyable and
preferred activity, cross-dressing is not an erotic experience for these boys.
Dressing as a girl does not cause flushing, penile erections, or other
evidence of sexual excitement. (Similarly adult male transsexuals do not
respond fetishistically to female clothing.)

Of great importance is the failure of these boys to develop pleasurable

interest in their penises; they usually do not masturbate. Where other boys
enjoy directing a stream of urine while standing erect, these boys sit down
to urinate like girls. Sometimes they manifest their dislike for their male
genitals by hiding them between their thighs while they walk around at
home in a state of undress. The wish to be rid of their genitals and instead
to have those of a little girl is conscious and openly stated by the child.

For all their femininity, however, these boys are not psychodynamically
like oedipal girls. The latter are romantic, seductive or maternal with their
father (more or less). They show evidence of deep feeling for father and
are rivalrous toward mother while also increasing their identification with
her. The extremely feminine boy shows none of this. He is preoccupied
instead with outer aspects of the feminine role—especially clothing, hair
style and adornment—rather than with the object relationships
characteristic of normal boys or girls during this period.*

At this point, let us contrast the oedipal period of the transsexual boy
with that of a masculine boy. In his case report on the phobia of a 5-year-
old boy, Freud describes the development of an oedipus complex and how
oedipal conflict is resolved via symptom formation (3).

* An interesting point in this connection is that the little boys’ interest in feminine
things (beautiful dresses, jewelry, make-up, etc.) far exceeds that of their mothers.
This is also true of adult male transsexuals, who are more graceful, attractive, and
obviously feminine than were their mothers. Perhaps these mothers’ blunted
femininity can find expression only in their sons’ femininity: It is as if these mothers
are saying, ‘My son is myself, but he is more complete than I am because he
possesses a penis. He shall express the femininity I have always denied myself.’ The
pleasure these mothers take in their son’s prettiness is in contrast to their own lesser
interest in being attractive.

Little Hans, as you recall, developed a phobia of horses. This symptom

appeared with the displacement of castration anxiety, the horse
symbolically representing the feared castrator. Freud describes the
unmistakable masculinity of little Hans: ‘... he treated the girls in a most
aggressive, masculine and arrogant way, embracing them and kissing them
heartily — a process to which Berta in particular offered no objection.
When Berta was coming out of the room one evening he put his arms
around her neck and said in the fondest tones: “Berta, you are a dear!”
This, by the way, did not prevent his kissing the others as well and
assuring them of his love. He was fond, too, of the fourteen- year-old
Mariedl—another of our landlord’s daughters—who used to play with him.
One evening as he was being put to bed he said: “I want Mariedl to sleep
with me!” ’ (p. 16).

Prior to the onset of the phobia, Hans showed great curiosity about
sexual matters, especially interest in his penis and a desire to learn about
others’ ‘widdlers’. Once when she found him masturbating, his mother
threatened him with castration. Freud writes: ‘Meanwhile his interest in
widdlers was by no means a purely theoretical one; as might have been
expected, it also impelled him to touch his member. When he was three
and a half his mother found him with his hands to his penis. She threatened
him in these words: “If you do that, I shall send for Dr. A. to cut off your
widdler. And then what’ll you widdle with?”’ Hands replied: ‘“With my
bottom”.’ (pp. 7-8). Freud points out that this initial threat of castration did
not at the time it was made produce any symptoms.

Several months after this occurrence Hans first learned through his
father’s explanation, that girls did not have penises. Freud writes: ‘At the
time it [the threat of castration] was made, when he was three and a half,
this threat had no effect. He calmly replied that then he should widdle with
his bottom. It would be the most completely typical procedure if the threat
of castration were to have a deferred effect, and if he were now, a year and
a quarter later, oppressed by the fear of having to lose this precious piece
of his ego. . . . The piece of enlightenment which Hans had been given a
short time before to the effect that women really do not possess a widdler
was bound to have had a shattering effect upon his self-confidence and to
have aroused his castration complex. For this reason he resisted the

information, and for this reason it had no therapeutic results. Could it be

that living things really did exist which did not possess widdlers? If so, it
would no longer be so incredible that they could take his own widdler
away, and, as it were, make him into a woman!’ (pp. 35-36). (Our italics
this last only.)
Freud emphasizes that the threat of castration for little Hans was capable
of exerting its full effect only after he became aware of the difference
between the sexes and understood that it was his penis that signified he
was a male. Since he was masculine in personality—which is to say, very
attached to the idea of being a male—the threat of losing male status
through loss of his penis was a frightening prospect. Freud specifically
points out that he was frightened by the idea that they could ‘make him
into a woman’ by castration. It was the anxiety about castration, with the
implication of change of sex, that led to repression of his incestuous
wishes and to displacement of anxiety onto the phobic object. This
conclusion is therefore justified: Only an already existing sense of
maleness and fear of losing the masculine status can make castration a
frightening prospect and the basis of the castration complex. How
different it is for our feminine boys, who, even prior to the oedipal period
have prized femininity and found maleness abhorrent. Castration holds no
threat for them. On the contrary they wish to give up their penis and, as the
boy in the last chapter, when age 4, put it, ‘be born again as a girl’.
This boy, aged 8 at the period here reported, was feminine in his second
year, when he was already fascinated with his mother’s clothing, spent
hours draping himself in her gowns and flitting about in her shoes. He
loved to wrap himself in mother’s jewelry and dance for the amusement of
his mother, older sister and grandmother. When he first started treatment,
his mother pointed out with barely suppressed admiration, ‘He dances just
like a girl. He would make a wonderful female impersonator.’
In appearance he is a very attractive child with delicate features, large
brown eyes, long thick eyelashes, and a fine, smooth complexion. He has
always insisted on allowing his hair to grow to great length,* like a girl’s,
and his parents have

* Starting before the recent fad; now the same length in males no longer
need signify lessened masculinity.

not denied him. With his feminine postures and mannerisms and striking
physical attractiveness, he is often mistaken for a girl by strangers. When a
waiter, referring to the patient, asks his mother, ‘What would your
daughter like to eat?’ neither becomes upset. On the contrary, the boy
smiles with pleasure. His mother says that people have told her since he
was an infant that ‘He is too good looking to be a boy; he should have
been a girl.’
As with the other transsexual boys, no clear separation between his
mother’s and his body and psyche developed as infancy passed into
childhood. During his first years of life, he was held against his mother’s
body many hours each day, carried from room to room when she moved
about the house, and never purposely frustrated. When he began to walk
and talk and his fascination with feminine clothing appeared, his mother
could not bear to deny him access to these articles. Often when they were
shopping together, she would buy him a doll or feminine clothing he
His mother is efficient, energetic, and business-like. She dresses in a
mannish manner, with her hair cut short and severe, almost always wearing
slacks and her husband’s shirts. She envies men and is cutting and
condescending toward them, dominating social situations. She says her
marriage is unhappy with great distance between her and her husband. She
is unmistakeably the decision-maker in the family.
The patient’s father is a passive, hypochondriacal man who readily
admits he cannot stand a close relationship with his wife or children. He
does not play with or discipline his children. He is away from home in the
day, leaving for work before the children get up and returning after the
evening meal. He has never intervened between mother and son, and
although he now may express mild irritation at his son’s obvious
femininity, he has made no effort to end it or establish a friendly
relationship with his son. Both parents are overtly heterosexual and both
conform to our culture’s expectation of male and female roles (i.e. father
works and is the breadwinner while mother cares for the children). Yet
both betray ambivalence about their assigned gender roles.
Typically, the mother brought the patient to treatment not because she
was disturbed by his femininity but because a

neighbor woman, concerned by his appearance, urged her. During the early
months of treatment, the patient could not bear to be without his mother in
the playroom unless continuously reassured that she was just outside the
door. He avoided eye contact with his therapist and preferred to play by
himself. He spent these early hours playing with dolls and inventing
homemaking scenes in which only females were present. Another favorite
activity was drawing; an excellent artist, he spent hours drawing beautiful
and dramatic women dressed in brilliantly colored gowns, jewelry, and
high heels. He did not draw men or boys nor did he talk about them.

In conversations with the therapist the patient would talk about the
beautiful jewelry or chandeliers that belong to his grandmother, about his
sister’s dresses, about ladies’ fashion, but never about his father or other
males. He knew that his father existed, that he lived in the home, but the
boy seemed to have no emotional connection with him. On one occasion
he was asked to draw the entire family. He drew his mother, his sister, and
himself, as usual with long hair and girl’s clothes so that he seemed one
more sister. In contrast to the other figures, which were boldly outlined and
colored, the father’s figure was only lightly traced with the point of the
pencil. When asked about this, the patient replied he would like to ‘make
up a story about it’: ‘You see, Dr. Newman, that looks like a real man but it
isn’t. He’s not really a father. Actually he’s just a balloon shaped to look
exactly like a man and operated by an electronic control. He moves around
like a man but he’s not. He’s just air. But he fools everybody and nobody
knows that he’s not really the father.’ When questioned about the
whereabouts of the ‘real’ father, he replied: ‘Oh, nobody knows where he
is. They never even heard from him.’ This story represented quite well the
real situation in which the boy’s father deliberately absented himself from
the family psychologically in order to ‘avoid stress’. But the patient’s
fantasy suggested that an involved masculine personality, perhaps the
therapist, might be able to ‘fill up the balloon’ for the child and as such
was a harbinger of later stages of treatment.

When male dolls were brought into the patient’s games during this early
period, he either discarded them or else dressed them to look like women.
During this earlier part of the treatment his

personality and interests remained feminine. There was no evidence of

romantic themes in the stories he played out or drew and no
acknowledgement of heterosexual relationships or the role of a man in the
relationship. It was as if the world were peopled by women only and that
he, in fantasy, was one more little girl.
The femininity of the transsexual boy in its natural course continues
beyond the oedipal period and into adulthood unaltered, as has bqen earlier
noted. Yet we have evidence that powerful intervention during the oedipal
period may produce oedipal fantasies and conflict, changing the direction
of gender orientation toward masculinity. One might call this a
‘therapeutically induced’ oedipus complex.
Gradually the patient’s tendency to avoid contact with his therapist and
to retreat into a world of feminine fantasies was overcome.* The patient
began to feel affection for Dr. Newman and looked forward to treatment.
He no longer feared leaving his mother on entering the playroom. For the
first time, males began to appear in his stories. At first these fantasy males
were merely escorts for the dramatically beautiful women. Still, Dr.
Newman showed his unmistakable pleasure. As men appeared more,
aggression and cruelty, especially toward women, also surfaced. Usually,
however, the male was the servant of a woman.
For example, in a story told with a series of pictures, the patient first
drew an elaborately furnished ‘women’s dress and clothing store’. Next
were drawn a flamboyant woman and tiny male escort with guns in their
hands; they are holding up the store and stealing the ladies’ clothes. The
story proceeds: They had just about made good their get-away when police
arrive and shoot the male accomplice dead. The patient was told he was
afraid that becoming a real boy was dangerous and that, just like the man
in his story, he feared being hurt if assertive. But he was reassured by Dr.
Newman that he could be much more aggressive and masculine than he
had been without being in danger. The patient seemed pleased to hear this,
although he soon became anxious and changed the subject.
In the following weeks his mother reported he had begun hitting his
sister and calling her names for the first time in his

* Technique of treatment will not be reported here.


life. He also had become angry and verbally abusive toward his mother for
the first time, she said with dismay.* Aggression toward women increased
in his drawings. For instance, he drew a man with a woman lying at his
feet. He smiled as he said that the woman had made the man angry, who
had then thrown her down into the mud and beaten her.

Looking forward to pleasing his therapist by reflecting the latter’s

attitude about cross-dressing (which he was gradually incorporating), he
would announce, ‘It’s bad for a boy to dress up in girl’s clothing.’ He was
going to practice ‘being a boy’. He made up a list of ‘rules’ which he had
the therapist write down: ‘1. Don’t play with girls; 2. Don’t play with girls’
dolls; 3. Don’t dress up in girls’ clothes; 4. Don’t even look in sister’s
closets; 5. Don’t sit like a girl; 6. Don’t talk like a girl; 7. Don’t stand like
a girl; 8. Don’t tease like a girl; 9. Play like a boy; 10. Don’t wear makeup;
11. Don’t make your room look like a girl’s room; 12. Don’t pose; 13. Be a

Increased masculinity alternated with months of regression to feminine

preoccupations. These periods of regression seemed to correlate with shifts
in family dynamics. Mother and father were being seen by another
therapist, who had been encouraging the father to be closer to his son. In
response, the father had been taking the boy on walks and had introduced
him to father’s hobbies. But then father had become ill and feeling it too
great an effort to attempt to relate to his son, had given it up. Shortly
thereafter the patient said he wanted to buy a large female rubber
mannequin seen in an advertisement and to keep it in his room. This figure
was nearly life-size, and the patient would have to obtain a full set of girl’s
clothing in order to dress it. In discussions in therapy the patient indicated
by embarrassed giggles when confronted that his primary motivation for
the doll was not heterosexuality but the easy availability of girl’s clothing
for himself. When the request for this doll was refused at Dr. Newman’s
insistence, the boy became sullen and tearful and for several weeks did not
want to

* Simultaneous therapy for the mother in order to allow her to accept signs of
masculinity and aggressiveness in her son is always indicated. The loss of closeness
that she previously had with her son is painful, and therapy for her is essential if she
is to be able to accept these dynamic shifts in the relationship.

come to treatment. For a few months he made no progress in his

masculinity and seemed more feminine.
Then, he again began to move in a masculine direction, producing at this
time a series of drawings reflecting positive feelings for his therapist. In
the first drawing a boy (altogether masculine in dress and appearance) is
shown with mother (she is drawn as a normal, feminine woman in a dress).
The boy’s face is covered with red spots; he has the measles. In the second
drawing, the boy is being taken to the doctor by his mother in order to ‘get
well from his sickness’. The third drawing shows the doctor, a large,
carefully drawn, full-size smiling man. The patient says the doctor is
friendly to the boy, who in turn likes the doctor. In the next drawing the
boy is lying face down on the doctor’s examining table, and the doctor is
administering a hypodermic in his buttock. The boy’s pants are pulled
down, and his large penis is clearly seen. When asked about this, the
patient replies, ‘That’s his penis,’ in a matter-of-fact way. (This is in
contrast to earlier attempts to hide his own penis and refusal to discuss the
existence of this organ. Previously when asked about his penis, he would
become silent and sad and change the subject.) In the final drawing the boy
is dressed, the red spots are gone, and he is smiling. The patient announces
the little boy is now completely well from his illness. The patient seemed
pleased by the therapist’s comment that the little boy and the doctor, in the
story, were like the patient and the therapist and that just as in the story the
patient was happy that he was getting better. This meant that he was
becoming more pleased with the idea of being a boy.
During the second and third year of treatment, he produced themes with
men and women relating romantically. The men are drawn as carefully as
the women; they are husbands, who marry women because they want
wives. When asked if he would like to marry some day, he became
embarrassed and avoided the subject. Sometimes he would say: ‘I just
want to be a bachelor. Marriage is icky!’ But he no longer says he wants to
grow up to become a woman. When told that he once said such things, he
says, ‘That’s all baby stuff. When I was little I wanted to be a girl. I just
liked to dress as a girl and I guess maybe I thought I was one. I don’t think
that way any more.’
During the nearly four years of treatment, the patient has

moved from a totally feminine orientation and wish to become a woman

toward a considerably more masculine existence. As he began to identify
with the therapist, to become more masculine in dress and appearance,
themes of aggression, retaliation, and injury played a much larger part in
his fantasy life; he has become more aware of his penis, and his femininity
has faded. He now loves to tell the therapist ‘horror’ stories in which
violent themes are played out. For example, in a favorite theme gleaned
from movie ads and redrawn by the patient, beautiful women are tortured
and then raped by brutal men. The patient identifies himself as ‘one of the
men who tie them up and abuse them’.
So finally, we think we are beginning to see the glimmerings of an
oedipus complex. Still, while he has consciously renounced femininity, he
is feminine in gesture and appearance. The final outcome remains in doubt.
We feel that he is capable now of growing up to be a homosexual — that
is, a self-acknowledged male who wishes to remain a male and likes his
penis — rather than a transsexual.
The process of the development of oedipal concerns in the very feminine
boy during treatment has been noted by others although not underlined.
Greenson (4) described the case of another very feminine boy of our Clinic
(see Chapter 1): ‘Their main reason for seeking help for Lance was his
compulsion to wear his mother’s or sister’s clothes. This had begun when
Lance was a little over one year old and barely able to walk. He seemed to
want to put on his sister’s or mother’s shoes. He very quickly seemed to
prefer above all to walk around in his mother’s high-heeled shoes and wept
furiously when she tried to remove them (p. 396) . . . The mother reported
that he asked her at 4 years of age, “What will I be when I grow up?”
When she replied, “You will be a man”, he cried and said, “I don’t want to
be a man, I want to be a girl” ’ (p. 399).
Greenson notes the initial absence of oedipal concerns: ‘The last clinical
feature I want to note before going on to the developments arising from the
treatment is the apparent lack of active, phallic oedipal activity: for the
first half year of treatment he showed no interest in guns, shooting, knives
or fighting. (This is remarkable for an American boy.) He appeared
uninterested and without curiosity in regard to nakedness or sex.

He urinated sitting down until the age of 3½, despite his mother’s urging
that he urinate like daddy did’ (p. 399). Greenson encourages the boy to
express hostile feelings and notes, ‘Gradually he becomes more aggressive
and slams Barbie [a female doll] in the face with mud, shouting, “Shut up”
or “Take this, Barbie”, or some other girl’s name’ (p. 399). Aggressive
themes appear in the child’s fantasy life: ‘Lance wants to play murder with
Barbie, Ken [a male doll], and me. Barbie falls down and her skirts fly
over her knees. He denies any knowledge of how babies are made but
seems anxious so I explain it to him’ (p. 400). At the same time overt
aggression toward his mother appears: ‘His mother reports he hit her one
day and for the first time said “I hate you” ’ (p. 401). Greenson notes also
that the boy has begun to masturbate and for the first time seems anxious
about the possibility of injury to his penis. All this occurs simultaneously
with a slowly developing masculinity and a renunciation of his earlier
profound femininity. Identification with the male therapist, sexual
curiosity, aggression, increasing distance from mother, and castration
anxiety develop in parallel. These signs of an oedipal complex seem to us,
as in our patient, to be the product of therapy.
Sperling also described the treatment of a very feminine boy (5). His
mother is described as : ‘A sturdy woman who wore a short, straight
haircut and tailored clothes’ (p. 471). The patient’s father was hospitalized
and thus absent. The boy loved to dress up in his sister’s clothes and to
collect dolls. After a period of treatment, Sperling notes: ‘There were
noticeable changes in Tommy’s behavior after some of this material had
been worked through. He was becoming more aggressive and was
beginning to fight back with the boys’ (p. 474). In his fantasy play much
aggression appeared. There were fights between male and female puppets.
For the first time the patient said: ‘I’ll grow up and I’ll be a daddy’ (p.
477). Sperling also underlines the need to end the child’s feminine play
and especially cross-dressing outside of treatment. ‘It is essential for a
successful outcome that the treatment be carried out in an atmosphere of
instinctual deprivation. The analyst cannot be a party in the child’s
transvestite acting out in the treatment situation. The child has to know that
he is in treatment because of the transvestite behavior’ (p. 483).

Normally masculinity is established in a boy before the oedipal period.

By 2 or 3, he has begun to enjoy playing with masculine toys—cars,
trucks, soldiers—and to form some idea of the difference between males
and females. His sense of maleness is evident. For him the oedipal
situation sets in motion crucial conflicts that will result in him freeing
himself from his attachment to his mother and identifying himself with his
Mother and father are of course not passive actors in this drama but by
their behavior help create and bring the oedipus complex of the boy to a
satisfactory resolution. A mother must encourage her son’s capacity to
identify with his father by showing her appreciation of signs of
masculinity when they begin to appear in the boy. He must be aware that
she acknowledges her husband’s masculinity. Mother also must be able to
discourage some of the boy’s behavior that indicates his identification with
her feminine attributes (how much and which qualities is not our subject
but are very important in the functioning of society). By discouraging
excessive identification with her femaleness and femininity, she not only
makes it easier for him to become masculine but she also creates herself as
a person perceived as quite different from himself and as an object for his
budding romantic feelings.
This process of pushing him away from her body and psyche will, in the
happy case, lead to increasing experiences of mastery in the little boy,
though we are more familiar with the pain involved in the process of
separation. It may be that the vibrant tension so created in the space
between the mother and son is an essential quality in the pleasure of male
On the father’s side, there are contributions he will make to his son’s
developing masculinity beyond those often described. He will not only
deny his son unlimited access to mother, but he will also encourage some
access to himself, thus making it rewarding for the boy to identify with
him. A part of that identification also comes from the boy seeing his
father’s pleasure and comfort in masculinity and heterosexuality. In order
to do this, the father preferably is present, but even if he is absent, for
example in military service, his wife by lovingly describing him to his son
creates him for the boy in all but substance.
How different all this is in the families of the transsexual boys. To assess
the oedipal situation we must ask questions of our

data: does the transsexual’s mother encourage his separating from her
body? Does she encourage those activities which she considers masculine?
Does she admire his maleness? Does she encourage his heterosexual urges
toward her but at the same time sufficiently frustrate them so that he can
both appreciate their value and recognize the necessity to defer their
gratification? Does she admire her husband and keep his masculinity as a
presence in the home? Perhaps these questions can be summarized in this
one: Is she a feminine woman?
For the boy’s father: Does he encourage his son’s moves in a masculine
direction ? Does he encourage the boy’s separation from his mother? Does
he encourage the boy’s heterosexual urges for his mother and at the same
time clearly limit the possibilities? Does he encourage the boy’s other
heterosexual interests? Is he present to perform these tasks of fathering?
And, as with the boy’s mother, we may ask in summary: Is he manly?
The already very feminine boy enters an oedipal situation in which the
dynamics are so constructed that unless therapy intervenes, no interruption
in his feminine orientation is likely. Only when the therapist intrudes are
the family dynamics altered. Then certain oedipal themes not previously
present begin to appear. In brief, successful treatment creates an oedipus
The importance of early therapy cannot be stressed too strongly. As
described elsewhere (6), beyond puberty alteration of the femininity of the
transsexual male by psychotherapy does not seem possible. Treatment of
the transsexual boy may be the only way to prevent adult transsexualism.
Still, the final outcome is not yet known. Only one of the boys we have
treated has yet reached puberty. Perhaps while such therapy can succeed in
introducing enough masculinity into the personality of the very feminine
boy to abort the development of transsexualism, sufficiently strong
feminine identifications may remain that an adult masculine heterosexual
life is not possible. Perhaps homosexuality will be the outcome in such
This raises a question important for theorizing about etiology: Might
some forms of homosexuality be due to just this kind of dynamic — the
late introduction of masculinity, as a result

of life experiences, into the personality of a profoundly feminine boy, a

masculinity that is never fully integrated with the earlier more primitive
and possibly immutable feminine identifications ?

Chapter 6
1. Newman, L. E. and Stoller, R.J. (1971).‘The Oedipal Situation in Male
Transsexualism’. Brit. J. Med. Psychol. 44.
2. Stoller, R.J. (1968). Sex and Gender. New York: Science House;
London: Hogarth Press.
3. Freud, S. (1909). ‘Analysis of a Phobia in a Five-Year-Old Boy’. S.E.
4. Greenson, R. R. (1966). ‘A Transvestite Boy and a Hypothesis’. Int. J.
Psycho-Anal. 47.
5. Sperling, M. (1964). ‘The Analysis of a Boy with Transvestite
Tendencies’. Psychoanal. Study Child 19.
6. Green, R. and Money, J. (eds.) (1969). Transsexualism and Sex
Reassignment. Baltimore: The Johns Hopkins Press.