Longitudinal aspects of atypical early development

Beginning in the late 1960s, the author conducted a prospective study of several dozen boys with extensive cross-gender identification and behaviour. (633) Most of these boys would today be diagnosed with GID, although at the time the diagnosis had not yet entered into the diagnostic nomenclature. These boys were evaluated periodically and assessments continued until late adolescence or young adulthood for two-thirds of them. At that time, three-quarters of the boys were homosexual or bisexual in sexual orientation. One was transsexual. In contrast, a demographically matched group of boys with conventional boyhood behaviours was heterosexual at outcome.(22)

This prospective study is consistent with retrospective reports by adult transsexual males and homosexual males. Most transsexuals, if not all, recall extensive cross-gender identification and behaviours in childhood.(34) Often, however, these are not documentable because of the length of time from onset to description and the difficulty of corroboration. Several studies have interviewed adult gay men and lesbian women with respect to gender-typed behaviours in childhood. Typically, more extensive cross-gender behaviours are reported than by groups of heterosexual men and women. These retrospective studies of men and women are consistent cross-culturally.(4,5)

Of theoretical and practical import is the overlap in childhood gender behaviours between retrospective reports given by transsexuals and homosexuals, and in the prospective study of cross-gendered boys. Because the classic picture of transsexualism and homosexuality in the adult male is quite different, the question is: Why there should be such overlap?

One possibility is that the two groups are relatively similar in earlier years, but that different life circumstances promote more comfort for one group continuing to live as males. Treatment intervention to change cross-gender behaviour may be decisive. Transsexuals were rarely treated as children. Different prevalence rates may also be key. Whereas the incidence of transsexualism may be one in 10 000 males,(35) the incidence of homosexuality may be between 2 and 3 per cent.(3) Thus if there are overlapping behaviours between the two in early years, probability would predict that the vast majority of cross-gendered males will emerge as homosexual, rather than transsexual. However, this does not explain the behavioural overlap between prehomosexual boys and pre-transsexual boys who will later be sexually attracted only to females (the latter living as lesbian women after sex reassignment surgery).

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