The Science of HSTS: The Basics

You might be forgiven, listening to the mountains of woo and pseudoscience surrounding the ‘transgender’ issue today, that there was no real science that could explain transsexualism. You’ll have been bombarded by claims of ‘born in the wrong body’ by married male individuals who look like the bloke next door in a frock. You might, quite reasonably, have found this a somewhat surprising claim, but out of politeness you quietly nod. Well, you would have been right to have been confused.

I’m going to try to explain the basic science that we do have, in simple terms. In future articles, we’ll expand on this and provide more sources and background reading.

In the first place, nobody was ever ‘born in the wrong body’. We all have our own bodies. They’re ours, not someone else’s. So how could they be wrong?

Transsexualism, transgenderism, cross-dressing, and all other expressions wherein a person of one sex wishes to appear to be of the other, are real issues. If you have read my article on the history of HSTS, then you will know that it has been recorded for many thousands of years. It’s nothing new and it occurs all over the world.

At the root of all legitimate forms of trans expression is Gender Dysphoria or GD. This is a sense of discomfort at presenting in the gender which would normally be consistent with one’s biological sex. GD is not simple; it can take many forms and it can be weak or strong. It is a symptom, rather than a condition and it has more than one possible cause. The two best-known are distinguished by the sexuality of the subject, into homosexual and non-homosexual GD. The former can become what is called Homosexual Transsexualism (HSTS). In males the latter is caused by a condition called Autogynephilia (AGP), first described and defined by clinical psychologist Ray Blanchard during the 1980s.

GD is the standard diagnostic criterion used by clinicians in the West to determine whether a subject should be treated with cross-gender therapies, irrespective of the cause. In other words, GD, rather than the underlying stimulus is the clinical deciding measure in whether or not someone is actually trans. You might compare this, bluntly, to a broken leg. The clinician only has a passing interest in how the leg got broken, his or her attention is focussed on attending to the symptom itself. Unfortunately, this reasonable and pragmatic approach is less effective in the case of GD, since, as we shall see, the dysphoria is conditioned by the cause.

HSTS

Homosexual transsexualism is a condition in which a person of one sex (the majority are male) desires to live as a woman. The individual has strong romantic and sexual desires for members of the same sex, from childhood. These feelings are exclusive to same sex; they never have them for the opposite. In addition, Homosexual transsexuals (HSTS from now) have been observed to have a distinct clustering of physical characteristics that are shifted towards the average for the opposite sex, in their ethnicity.

For males, relative to related ones, they may be small, more lightly built relative to weight and neotenous (baby-faced); boys of this type are typically ‘pretty’. Behaviourally, they will be naturally feminine in their comportment and demeanour; as children they will have hated rough-and-tumble games and sports; they are cooperative rather than competitive (except where men are involved) and markedly prefer women’s company, but do not see them as sexual targets (although they probably will see them as competitors). Of course, what sets them apart most obviously is that, beginning in childhood, they will have displayed strong gender non-conforming (GNC) behaviour, eg, cross-dressing, a preference for dolls and social play and, most of all and markedly, a romantic preference for the same sex.

Not all children who might display GNC behaviours will be HSTS by any means. Even when this is ‘persistent and insistent’, many factors will influence the decision to transition. However, any person presenting with symptoms which might appear to indicate transsexualism in late adolescence or adulthood, who has not displayed GNC behaviours as a child, is unlikely to be HSTS. One of the other causes described in the literature and below is more likely to be the provocation.

So, what is ‘biological sex’?

In some animals, and we are amongst them, reproduction requires two entirely different cells called gametes. These are produced in organs called ovaries in females and testes in males. Gametes are unlike other cells in the body because they only have one strand of DNA, while the others have two, twined in a double helix. When a gamete from a female, called an ovum, meets a gamete from a male, called a spermatozoon or sperm, the single strand of DNA carried by each joins with that in the other and a new individual is conceived.

We have 23 pairs of what are called ‘chromosomes’. DNA strands are normally invisible even under a microscope but at the point of cell division, they coil up and so become dense enough to be seen. These are chromosomes. In humans the 23rd or last pair of chromosomes is called the ‘sex chromosomes’ because, at the point they can be observed, those from a female appear different to those from a male. In fact, female ones loosely resemble two letter Xs while the male ones look like an X and something that doesn’t really look like a Y at all, but that’s what we call it anyway. So females are XX and males are XY. This is called their karotype. Since the special process of cell division that takes place to produce gametes, called meiosis, uses only one half of the donor DNA, all ova (female gametes) have an X chromosome while about half of sperm have an X and half a Y. Since both gametes are required to conceive a new individual, there is roughly an equal chance of it being XX or XY, that is, female or male.

This is determined at conception and can never be changed. So sex is permanent. Nobody was ever ‘assigned sex at birth’; an expert looked at their external genitalia and, if he noted a penis and testicles, wrote ‘M’ and if he noted a vagina, ‘F’. Apart from a few interesting and well-understood conditions that account for a tiny number of births, this method is reliable. At the same time, there is no such thing as a ‘sex change’, at least in these fundamental, chromosomal terms.

Sex, then, is a set of physical characteristics that have to do with reproduction. It’s quite simple and it is a binary. Except for a tiny number of cases, which involve genetic or other anomalies and which are well explained, everyone on the planet is XX or XY.

The terms sex and gender are not interchangeable here.

Sexuality

Sexuality is a much-misunderstood concept. It is at the core of each of us. It defines the kind f sex we want to have and with whom and how we want to have it. In nearly all cases, sexuality maps directly on to sex. Sexuality, therefore, is described in the same terms as sex, that is, male and female.

However, for some people this is not the case. Their sexuality is not aligned with their sex. Males, in this case, might have a sexuality that more closely resembles the one normally found in females. They might be sexually and romantically attracted to masculine males. A similar phenomenon occurs in females.

We call this phenomenon ‘transgender homosexuality’ after its use by Dr J Michael Bailey in his book ‘The Man Who Would Be Queen.’ This is not the same usage as yu might have heard elsewhere. Transgender homosexuality is an innate form of homosexuality which typically appears in childhood. Such individuals will be gender non-conforming (GNC). That is, their behaviours and preferences will be more like what we might expect to see in children of the opposite sex.

This can begin to be observable as early as two years of age. Crucially, at some point also in childhood, the individual will begin to have same-sex crushes. These are vague romantic feelings which most children experience, senses of longing or desire. They are usually not sexual, but they are proto-erotic in that they will crystallise into the adult sexuality over time.

Sexuality is made up of many factors, including birth sex, since, after all, it is with our sexual organs that we can enjoy the pleasure of sex. But it is also formed by desire, with whom we would like to enjoy sex and romance, and also by our sense of self. That is, how we envision ourselves in our sexual and romantic relations with the targets of our desires.

Again, for most of us, this all fits nicely with the sex we were born as. But for some of us this is simply not the case. These are the transgender homosexuals. So sexuality is quite complex but devolves, essentially, to ‘aligned to birth sex’, ‘aligned to the opposite sex’ and somewhere in between. These last are bisexual.

Now if you were a boy who desired men, and who desired to play the role of woman in sex, then you would have a female sexuality. But as we have seen, sense of self is important. If you have female sexuality and also feel more comfortable as a girl, then, in addition to childhood GNC, you might exhibit childhood Gender Dysphoria, which is a persistent and insistent identification with the opposite sex. In other words, you not only want same-sex partners, you want to be the opposite sex. Childhood GD is a reliable indicator of adult HSTS.

So what is gender?

Gender is an evolved set of characteristics and behaviours that demonstrate to others what our sexuality actually is. It follows directly from sexuality, therefore. It is as innate as sexuality is and there are two genders. Gender is therefore, a binary, but, instead of being an unmodified binary, an either/or switch like sex, gender is a sliding scale. In fact, every parameter that constitutes gender is on such a scale but to reduce complexity, for there are so many, we tend to lump them together.

We call gender ‘feminine’ or ‘masculine’ to help distinguish it from sex and sexuality, which we refer to as ‘male’ or ‘female’. We might consider that sexuality is our inner self, our personal desires and responses, and gender is how we present to the world outside ourselves. But sexuality is the most powerful driving factor in humans, indeed all animals, because it derives from our need to reproduce, which is our most fundamental urge.

You’ve probably read somewhere that ‘gender is not innate, it’s socialised’. This is at best a misunderstanding. The extent to which someone expresses their innate gender is conditioned by social pressures — that which is or is not acceptable. But the underlying gender doesn’t change, because it is formed by sexuality and that is innate. So can someone repress that in deference to social norms without consequences?

No. The consequence of being forced to exhibit gender behaviours that are not aligned with sexuality is Gender Dysphoria. This is not unique to trans people. Any time a person is asked to do something that puts them outside their innate gender comfort zone, they will experience it. GD is therefore a natural, innate mechanism that helps us to shape our behaviours in such a way that they conform to the roles we expect to play. Essentially, it tells us how not to behave. If you are a man, consider going into work tomorrow wearing a miniskirt, high-heels and a wig. How do you think you would feel? Most heterosexual men would feel pretty uncomfortable, except for a particular minority, which we’ll discuss later.

Clearly, the specific expression is not innate — there is no gene for miniskirts — but the underlying gender differences, that give rise to these expressions, are.

But what sets these differences? Sexuality does.

A brief word on selection.

Individual humans do not reproduce willy-nilly. They choose their partners. That means that they are engaging in selection, which is the motivating force in evolution.

If we take a random sample of men and women from any given ethnicity and put pictures of their faces on a wall, then almost all of us can readily identify which are the men and which are the women, even if we are completely unfamiliar with the people or their characteristics. This leads us to another parameter, which we’ll return to: facial attractiveness. Although what is found attractive in a member of the opposite sex differs from culture to culture, within each culture there is a high degree of consistency in agreeing who is most attractive.

Now how could — and why would — that be the case?

Well, being able to distinguish males from females is crucial in partner selection. Humans do not have sophisticated olfactory glands such as those that a dog has, allowing it to tell immediately what sex another dog is. We are primarily visual, so we require visual indicators. So the appearance of our bodies is important. Heterosexual males are attracted to typical feminine bodies and vice versa. Now it is quite true that women’s body shape is conditioned by such things as the need to carry babies inside themselves, to deliver them, to nurture them and so on; and we can show that men have the bodies they do to make them better at running, hunting and fighting. These sex-based differences, of course, are essential to gender.

That has nothing to do with faces, however. We could all have the same faces and it would not matter. We’d be selecting purely on the grounds of the ability of our target to be a successful sexual partner — to raise children with. Faces have nothing to do with it. But men and women are measurably different, in all ethnicities, facially. Why?

How we see ourselves and how others see us is the foundation of how we relate to each other socially, and the primary method we use to communicate our feelings is facial expression. Faces, therefore, are important in the discussion of gender. In addition, evolution did not stop when we all began wearing clothes and hiding our primary and secondary sexual organs. In fact, these developments, which had both cultural and practical roots, may represent an evolutionary impetus towards increasing facial dimorphism between men and women. In other words, faces are one way that we indicate our sex to others, and so are a part of gender itself; and this, clearly, is innate.

There are only two reasons that animals do things: survival and reproduction. After staying alive, sex is the most important impetus we know. Almost everything we do, in social terms, is conditioned by the gender we are and this is conditioned in turn by sex. As we have seen, sex cannot be changed.

Men and women select partners differently. Men are visual-target-oriented. They are the hunters. They see particular features and find them attractive, and so they tend to try to select mates that have them. Men are driven in this by female fertility. They are looking, in a long-term partner, for someone whom they think will be able to bear and rear children. So who is the primary model for the ideal mother in a man’s mind? Easy; his own. So men tend to seek out women who in some way remind them of their own mothers, or rather, as their own mothers looked when they were young. There is evidence that men are most attracted to women of 20-22, which squares with this.

But these traits were evolved over a long period of time, tens or even hundreds of thousands of years, and during that time, women gave birth early, beginning at 12 or so. So, again, the ideal ‘proto-mother’ that men seek is a young woman. This results in female neoteny — the fact that women in their childbearing years tend to retain childlike facial qualities. These are selected for by men, as part of choosing a mate and they are emphasised, by women, as part of their mate-attraction strategy. Women know that men are attracted to youthfulness and that is why they spend so much time and effort trying to retain the appearance of it.

At the same time, women are under parallel influences as regards the facial features that they prefer. In a competitive environment, successful fathers, able to defend their partners and children, will be strong, masculine males, probably somewhat older. Women select for rugged, masculine looks, as, again, any advertiser knows. If we look at the classic icons of Western cinema, these are men like John Wayne, Sean Connery, Arnold Schwarzenegger, Denzel Washington — strong men with facial features that reflect both toughness — the good defender — and yet also kindness and empathy — the caring father. So, while on one hand women try to maximise their youthful, girlish beauty, men try to appear both older and more masculine in the way they look, and more successful materially.

Women’s selectivity is conditioned by the paramount need to protect their children to adulthood. A man could fertilise hundreds of women in the hope that at least one would have a baby that survived or, he might decide to stick with one woman and help her to raise his children to adulthood. One function of gender is to make him select the latter.

Women are limited in the number of children they can bear. Unlike men, they can’t simply have sex with lots of partners, since they themselves have to raise the babies to adulthood. A child that does not survive long enough to bear her own children is a wasted effort. But human children become sexually mature around the age of 12, at which time they are incapable of looking after both themselves and a child. Even for a fully adult woman, this would be a risky adventure.

From a woman’s point of view, childbirth is dangerous. Leaving aside the risks of parturition itself, which are considerable, a woman is extremely vulnerable in her late pregnancy and the first months of motherhood. If she has more than one small child, she is even more so. Remember, too, that humans become sexually mature early, at around the age of 12.

So, humans become able to fertilise and conceive babies years before they are either physically or mentally mature. This is why most modern societies put legal barriers in the way of very young pregnancies.

Simpler human cultures do not have such constraints, so women in them typically begin having children in their mid teens or earlier. But because they are neither physically nor mentally mature, the risks attendant on becoming a mother are even higher than they would be for a mature woman. In fact, most parents will know that children of 13 or 14 are completely incapable of living independently, let alone bringing up a child alone.

Society is the solution

This conundrum would have been a recipe for extinction had we not developed a solution. We did and it has been so phenomenally successful that humans are now, by far, the dominant species on Earth.

We call this development ‘society’. In it, young mothers are not left alone to bear their children and rear them, they are supported by other humans. While this effect is most influential on closely-related individuals, it affects all of us. We act instinctively to protect vulnerable mothers and children, even when they are of completely different ethnic or racial groups. ,

Humans do not naturally eject their young from their own territory, as do other animals. Instead, humans keep their children close, forming a family. A girl of 14, say, will still be living in her mother’s family group. So if she becomes pregnant and delivers a baby, she is not alone; she is supported by her own mother. And, since humans live long lives and have children young, her mother will be supported by her mother in turn and so on. This gives us a multi-generational family unit which revolves around a community of mothers, usually led by the grandmothers. This can be seen in traditional societies across the world today.

The development of this is the extended family, which is brought about through many generations of development. We might call these extended families ‘clans’ and, if they are larger, ‘tribes’. And they are all based on one imperative: assisting mothers to have and raise children.

But how do men fit into this?

Division of tasks by sex is a marked characteristic of Homo sapiens. In general, men do the hunting, building and defending, while women tend to forage, to manage the home space (which still exists, even in completely nomadic cultures) and most importantly to nurture, protect and teach the children. This model has been extremely successful. But men have no real role within the community of mothers.

This leads to group separation and this, again, can be seen everywhere. Men tend to operate outside the home space while women operate inside it. This is therefore a binary, two-group social structure. While there is considerable crossover in detail, depending on circumstances like the availability of food and shelter, men tend to work together in hunter groups which show both cooperation and competition, while women tend to cooperate in foraging groups.

But this society is not organised communally. It is not normally the case that men have common access to all the women in the group and vice versa. Usually, men and women are bonded into separate pairs, both by affection and by social convention.

Remember that, for a male, the easiest way to ensure that his genes will be carried on is to impregnate many women. Remember too, that women are sexually receptive all the time.

The only times a healthy woman does not ovulate and so cannot conceive are after her menopause and, crucially, when she is already pregnant. But human pregnancies are long, around 38 weeks. So, even if a woman were impregnated immediately after giving birth, she would still be infertile most of the time. The period when she is actually able to conceive is only that between giving birth and becoming pregnant, which might well be the first time she has sex. That means that the male scattergun approach will cause fierce competition amongst males for access to receptive females who are able to conceive. This we see in many other species, where males fight, often to the death, for the right to impregnate females.

This does occur in human society; it is the reason behind polygamy, where one man has many wives. Men compete with each other for the right to have these and defend their sexual rights vigorously. When Mohammed said it was all right for a Muslim to have 4 wives, he was actually limiting the number a man could take. Why did he do that? To reduce violent competition for women between the men. Christianity takes this further and insists on a one woman, one man partnership.

Women are physically much weaker than men and are largely unable to resist a male’s sexual advances alone. But the imperative for women is to protect the children. In other species, dominant males will simply kill the offspring of their defeated predecessor. A woman is unable to defend herself against a male attack and even groups of women could not ensure that in the process of defence, children would not be killed. So what do humans do? We set up a system whereby each man is bound to a particular woman and cannot touch any others, and then we enforce that.

In other words, we bind each man’s strength and power to an individual woman and her children, and the glue that makes this work is sex. Since women are sexually receptive all the time, even when pregnant (though they can’t conceive) they are able to sexually reward the men they are bonded with at all times. This is a superb adaptation. The primary purpose of sex is reproduction, so pregnant women should have no need for sex. This is what happens in other species; the females, once pregnant, are no longer receptive. But in order to bind a man to her, a woman remains receptive right up until late pregnancy. This keeps the couple together by providing ongoing sexual reward even when reproduction is not the purpose.

Consider that carefully. It means that sex in humans is not just about reproduction, it is about reward. Humans have sex because they like having sex, not because of the reproductive imperative. In fact, most of us, especially in the relatively childless West, rarely have sex to make babies, mostly we do it for fun.

You can fact-check that by looking at the time taken for coitus. In humans this is long; many couples will spend several minutes actually in the act itself. For most animals, it’s a matter of seconds. We enjoy the process of having sex, not just the climax, and find it rewarding. That reaction evolved because it strengthens the bonds between partners. The fact that it is so proves its evolutionary worth: pair-bonding rewarded with sex is a successful evolutionary strategy, especially when combined with the extended family or clan social structure.

It is the unique combination of these two systems, the two-group one made up of a group of mothers and children and a group of men, with the sexual bonding of individual men to women, that has made humans so successful. On the basis of this dual system we have built civilisation itself.

Both of these systems and their interconnectivity depend on one thing: gender. Without the sex-based roles and behaviours that human society is based on, there is no human society. Gender is not just innate, it is a vital part of us.

To recap, humans form social groups that have multiple generational layers. At the same time, individual men and women bond together to help each other to raise children. Mothers are supported in looking after children by their own mothers and fathers are taught how to provide for them by their fathers. This can extend for several generations, given that humans routinely live into their 70s.

Because of this structure in which humans bond for long periods or, indeed, life, women select long-term partners on the basis of their ability to deliver the parental goods rather than their pretty faces. And who is the model, for most women, of the ideal provider? Her own father.

So, men tend to select partners on the basis of looks while women tend to select them on the basis of behaviour. Men are looking for a partner who looks fit, healthy and fecund, while women are looking for a partner who will be a reliable long-term provider. These different ways of looking at the other sex condition the way that each sex behaves and appears. In other words, the range of behaviours and appearance that we call gender has roots in mate selection.

But if gender is innate, how does homosexuality work?

There is an obvious problem though. What about homosexuals? Homosexuality is, of course, an evolutionary cul-de-sac. If it is innate and genetic, then it should select itself out of existence in a few generations. But we know it has existed since written records began. So, if it is innate, and all indications are that it is, then it must be dependent either on a non-genetic cause, or a gene mutation that keeps happening and somehow never evolves itself out of existence.

In fact, there are two forms that homosexuality can take. The first is indeed innate. In males, this is often called ‘feminine homosexuality’. These individuals begin to show same-sex attractions and GNC behaviours in childhood, typically beginning around 3-5 years old. They are never interested in sexual or romantic relations with the opposite sex. When we use the term ‘innate homosexual’ here, we mean ‘exclusively attracted to members of the same sex since childhood’, to avoid confusion.

The second is acquired and that’s what we will call it. These two forms are markedly different.

How does that work?

Both men and women are known to have convenience sex, when they cannot have the sex they would prefer, with same-sex partners. But that is not homosexuality, because we define sexuality in terms of desire. So-called ‘situational homosexuality’, as happens in prisons, boarding schools, on ships and so on, is not really homosexuality as such. It only becomes so, for an individual, if he or she begins to prefer that kind of sex to any other.

Sex is the most affirming thing a human, especially a human male, can do. It’s evolved to be that way in order to bind an individual man to a woman, rather than running off and impregnating every female in sight. The urge to do that is very powerful in men and it takes a powerful force to counter it; sex is that force. It’s meant to be rewarding, so if you have same-sex activity and enjoy it, then you will probably want more. And if you want more, you might begin to find the partners you have attractive.

Acquired homosexuality occurs when we become attracted to same-sex partners, because we enjoy the experience of sex with them. It is quite different from the innate forms. Innate sexuality acts prior to sex, and conditions whom we want to have sex with, while acquired acts after sex, even as a function of sex, and might change our desired pool of sexual partners from opposite-sex to same sex.

Acquired homosexuals are, strictly, bisexual rather than homosexual, using the narrow meaning of homosexual that we are. They did not grow up desiring same-sex relationships, but after they have had them, find they enjoy them and seek to have more. These individuals are very rarely attracted only to the same sex; far more usually their same-sex attraction is in addition to an opposite-sex one, although, for social reasons in the West today, they might well conceal this fact.

A word of warning: just because someone has and enjoys same-sex activity does not, emphatically, mean they will necessarily become homosexual. In many cultures, for example, boys are not only sexually objectified but become legitimate (in the terms of the culture) sexual targets for men. This happened across the Ancient World and still happens today; in the West it is very much clandestine, but in Islamic and many traditional cultures it is normal (cite the Java old potato). Boys will play the receptive sexual role until they are old enough to grow beards, then they will penetrate younger boys. Usually, this occurs because access to women is either restricted or taboo in the culture. Most importantly, however, these men will normally (if they can) marry and have their own children, as adults. They are certainly not homosexual, but rather see boys as a kind of woman and, by implication, lived through a period during which they themselves were ‘women’ in this sense, before maturing into ‘men’.

Conflating the two types of adult same-sex behaviour has led to enormous misunderstanding and harm. Let’s be quite clear: you cannot condition a feminine homosexual male, or a masculine lesbian, into being heterosexual. But you might be able to persuade a person who has become bisexual, through situational sex, to suppress his or her same-sex desire in favour of an opposite-sex one. What you can be conditioned into, you can be conditioned out of. This is why ‘reparative therapists’ are able to claim success; the ‘homosexuals’ they claim to have ‘cured’ were not innately homosexual in the first place.

feminine homosexual males

Our interest here, however, is not with this group but the other one, which showed childhood GNC and never has had any interest in opposite sex relationships. Males of this type have been described by Drs Bailey and Blanchard amongst others as ‘feminine homosexuals’. They sometimes describe themselves as ‘femmes’. In females, the characteristics are inverted and the subjects might be referred to as ‘butch’.

So, we are talking about a group of people whose only sexual and romantic interest is in people of the same sex as themselves, from early childhood. They do not develop these feelings as a result of sexual contact, rather the feelings pre-date that and will determine which type of sex they desire. Because these feelings appear at the same time as normative gender behaviour does, but resembles that of the opposite sex, we can be confident that this is something innate, not due to conditioning. Femme homosexual males, in other words, have feminine sexuality and gender, and butch homosexual females have the masculine forms.

At the same time, these individuals showed GNC more or less intensely through childhood and also exhibit distinct physical characteristics, of being slight, neotenous and so on (in males). So their homosexuality needs to be seen as one element in a much broader profile, in which they are naturally shifted towards the norms for the opposite sex.

So how does it come about?

If there were such a thing as a specific gene that caused innate homosexuality, then evolution should have removed it from the gene pool, since homosexuals do not reproduce. Yet feminine homosexual males and masculine homosexual females have been recorded since writing began. This is a conundrum.

One possible solution is that the issue is not to do with the genes of the individual at all, but something that happens in the mother. In this hypothesis, some anomaly in the womb causes homosexuality. One suggested solution is that the developing baby is given the wrong levels of the sex hormones, oestrogen and testosterone, by the mother while in the womb. It is suggested that this ‘miswires’ the individual in such a way that when their own endocrine system takes over, it is compromised.

Another possibility is that for some reason, innate homosexuals do not respond to normal doses of sex hormones exactly as others do. There is a precedent for this in Androgen Insensitivity Syndrome (AIS), which affects ??. It can be either Partial (PAIS) or Complete (CAIS). AIS is an X-chromosome linked recessive condition carried via the mother but it affects only male, that is, XY, babies. It prevents the Androgen Receptor gene from functioning properly. In CAIS, individuals develop a vagina, female figure and breasts. They are almost always assumed to be female until they experience difficulty becoming pregnant and blood tests show their karotype to be XY. This is, as you can imagine, devastating. PAIS subjects can have a range of symptoms and the condition varies in severity. (https://ghr.nlm.nih.gov/condition/androgen-insensitivity-syndrome#inheritance)

Please note that I am not suggesting that homosexual males are suffering from AIS! But there are parallels. Could something similar be happening with feminine homosexuality? AIS has not hit an evolutionary full stop, which makes it interesting for us. It also illustrates that in the absence of effective testosterone action, XY individuals can grow up looking completely like women and having female sexuality and so, feminine gender.

This depends on seeing innate male homosexuality as ‘having female sexuality’ and female homosexuality the inverse. If this were the result of an underlying physical condition, we might expect to see some other effects, which is exactly what we do see: gender non-conformity in children, neoteny, slight build and so on. Specifically, homosexual boys tend to start wanting to play with dolls about the same time as girls do, enjoy social play in step with girls, and seek to adopt feminine appearance (which we will return to) at the same time too. The opposite, of course, applies to homosexual girls.

So far, this all holds up. Childhood GNC is certainly not always a predictor of adult HSTS but it is an accurate predictor of homosexuality. Whether the individual in the end turns out to be femme gay/butch lesbian, openly HSTS, or indeed, is completely covert, depends on three factors: the intensity of the gender dysphoria experienced, the level of social intolerance towards male femininity or female masculinity and confidence in being able to ‘pass’ as the target sex.

(In this context note that in the West, ‘gay’ culture in particular is extremely hostile towards male femininity and feminine homosexuals can suffer greatly within that community. This is not seen, to anything like the same extent, in southeast Asia, where homosexual males are expected to appear and act like girls, even if they are not fully HSTS. At the same time, lesbians look much like boys. This can cause problems for Western LGB people who expect their standards of gender normativity to apply everywhere: they don’t. In the Philippines, homosexual males who do not transition are somewhat looked down on by trans individuals, the opposite of what happens in the West. Western ‘clone’ homosexual models are largely seen as ridiculous, because everyone accepts the underlying truth that gender reveals sexuality. This is the global model; the West is aberrant.)

This sees the difference between femme gays/butch lesbians and HSTS as a matter of degree, not as one of a difference of underlying condition. This is exactly in line with Ray Blanchard’s assessment that MtF HSTS sit on an aetiological scale of development with feminine homosexuals.

Scales within scales

Gender is a sliding scale, not an either/or switch. There are some thoroughly masculine women and rather feminine men, who are not homosexual. But homosexuals of either sex are much more likely to show cross-gender characteristics, especially childhood GNC and, of course, attraction to same sex. These are propensities, not absolutes and the fact that there are exceptions does not disprove the rule.

Since gender is a mechanism which reveals sexuality and acts in mate selection, it would follow that if a male for some reason had female sexuality, that is, was homosexual, then he should be predisposed to exhibit more feminine gender characteristics. There is no point in attracting people you are not attracted to, after all.

At the same time, a person like this is likely to show some signs of Gender Dysphoria if he or she has to suppress these characteristics, and this should get more intense as we move along the scale until such severe dysphoria is encountered that it can only be dealt with by transition. This is exactly what we find. HSTS, then, is the natural end of a scale of development. (The above in inverse applies to females.)

Again, this completely torpedoes the oft-heard trope that ‘gender and sexual orientation are unrelated’. This is at best a gross misunderstanding of both and at worst a deliberate misdirection, a lie. This lie has consequences, not least the relentless aggression towards HSTS by the ‘gay’ community, a tragic paradox indeed.

Let’s look at this another way. We know that gender is innate and is related to mate attraction, in other words, sexual orientation. If one desires to be attractive to men, let’s say, then one adopts behaviours that are known to be attractive to men. You might wear make-up, clothes that accent your figure, high-heels, wear your hair long and so on. You would use your gender to advertise your sexuality in order to attract an appropriate mate. We know that this does indeed attract men; advertisers make fortunes out of it.

These characteristics improve a woman’s competitiveness in the sexual marketplace. And this is not the function merely of modern Western fashion; while the details differ, the principle remains the same, over the world.

Internal and external gender and gender dysphoria

You might have heard the term ‘gender identity’. This indicates what gender an individual ‘feels’ himself (or herself) to be. Unfortunately, it is a loaded term. How would you know what it ‘feels like’ to be a woman, if you are actually male? Further, in some parts of the West an individual may ‘identify’ as not having a gender at all, which is an oxymoron, or any one of over 150 invented, fantastical ‘genders’ which are no more than moods and feelings.

Instead I prefer the term internal gender which describes the gender roles and behaviours you visualise yourself in. This is how you feel at home with yourself. Since there are only two genders and they are a function of sexuality, this relates directly to whom you see as potential sexual partners and how you imagine yourself connecting to them. This need not be overtly sexual, at least in terms of self-image; but the underlying drive is sexual. Imagining the autumn of your life being shared with a man you love in a halcyon country cottage, for example, doesn’t look like a terribly sexy image; but it is still a gendered representation of self that is informed by your sexuality.

So, when you preview your life trajectory, you see it in terms of this, your internal gender. This is your desire; it’s what you want to happen and, being human, you will do all that you can to make it so.

‘Gender expression’ or external gender is how you present yourself to others. External gender is an innate function of sexuality and the main part of its role is to advertise to others what your sexuality and internal gender are, in order to attract appropriate mates. Sexuality is too powerful an impetus to disregard, without consequences.

What would happen, though, if these were not the same?

Suppose your internal gender were feminine but your external gender masculine? Or vice versa? What if you were a boy who was attracted to exactly the same kind of masculine man as women find attractive? Who had been dreaming of a relationship with such a man since he was 3? Would you not adopt exactly the same techniques as the girls around you? And suppose you were forced to conform to stereotypical dress and behaviour ‘appropriate’ for your sex, would you not feel most dissatisfied?

Yes, you would. You would experience what is called ‘cognitive dissonance’ — the feeling of discomfort that occurs when something is not as you think it should be. In the case of gender, however, this cognitive dissonance has a special name: we call it Gender Dysphoria (GD).

As we mentioned before, GD is not simple. In effect, it is different in detail for everyone who experiences it, because we are all different. However, in MtF at least it can be broken down into different categories, depending on the stimulus.

This resource exists to explain HSTS, and for this type, GD tends to be somewhat social in nature, rather than physical.

HSTS, remember, lie at the extremity of a developmental scale (called an aetiology) that begins with feminine male homosexuality (in MtF, the inverse in FtM). It is not quite the case that HSTS are the ‘most homosexual’ but rather that their internal gender and life goals, especially their sexual and romantic ones, simply cannot be squared with an external gender that conflicts with that. The dysphoria this causes can be extreme.

A glance at the situation outside the West might be helpful here. In the Philippines, feminine homosexual males fall into two types: what might be called ‘femboys’ and HSTS. Both have feminised external gender, but the HSTS is fully so, the femboy only partially. It is rare to meet a homosexual male who is not obviously one or other of these. It is literally possible to observe the entire scale of variation in male, feminine-homosexual aetiology just by spending an hour or so in a popular spot in any large city, people-watching. You’ll see everything from cute boys with floppy hair and maybe an earring, to HSTS so passable they are almost invisible, and every gradation in between. (And this does not count the HSTS who are so passable you don’t recognise them as such!)

As regards lesbians/FtM transmen, the same applies. These are recognisable by their external gender, which is masculinised. In both cases, the tipping point is where the individual dresses and lives as a member of the opposite sex and, usually, takes cross-sex hormones. This is called social transitioning. At this point, any ambivalence in their external gender disappears and whether or not they completely pass in the target gender, they entirely present in it.

In MtF, many HSTS are so feminine naturally that all they really have to do is to arrest the process of masculinisation. There is evidence that they respond well to surprisingly low doses of hormones in this regard. I have certainly met HSTS with most feminine bodies and faces, including natural breast growth, who have only ever taken one or two birth control pills a day.

As we’ve said, HSTS are not ‘more homosexual’ than gender-conforming, but innate, homosexuals. Both have strong libidos and are powerfully attracted to the same sex, from childhood. What is different is another parameter, their femininity (for males) or masculinity (for females), as it is felt in their internal gender and expressed in their external. If these two are in balance, then the GD will be minimal; but if the degree of femininity or masculinity in the internal gender outstrips that of the external, then gender dysphoria is inevitable. The degree of the dysphoria depends on the degree of the mismatch.

We said before that gender is a scale that is made up of many contributing scales and this is an illustration. An individual can have a stronger or weaker sex drive and be more or less feminine; these are not directly related. While all femme homosexual males are feminine by definition in internal gender, the extent to which they express this externally depends on the severity of the GD they experience and other factors. There are many individuals who sit on the borderline between the two expressions and some will switch their external gender dependent on the social situation they are in. We are even aware of some who become noticeably more feminine as an evening progresses and alcohol removes their inhibitions. But these things have no bearing on the nature of their sexual desire itself; they are all completely committed to attracting partners of the same sex.

All feminine homosexual males who are not HSTS suffer GD to some extent, at least for part of their lives. In general terms, the most ‘passing’ will be most likely to transition, whether in Asia or the West. This is somewhat independent of the GD and subject to cultural influence. Some individuals are able to suppress, sublimate or otherwise live with their GD, although for others this is just torture. Usually, the extent to which they do so is conditioned by the level of social intolerance they experience. Across Asia, individuals will much more likely to transition than struggle with their GD, because the social intolerance is lower.

The bar, however, in the West, is far higher and traditionally only those most passable and suffering, at the same time, the highest GD, would have transitioned. This is because of the extreme hostility, in Western cultures, especially Anglo-Saxon ones, to male femininity. To escape violence and intolerance, an HSTS in the West, at least till recently, had to be able to successfully ‘pass’ as a woman or she would be unlikely to transition. In addition, she would almost certainly have had to leave her home town and move to a place where her history was not known. If she could not do these things she might have to remain a feminine homosexual male; and many of these suffer high levels of GD.

In Asia, there is far less intolerance of male femininity or female masculinity. This means that the ‘passing’ bar drops from ‘absolutely convincing as a woman’ (for MtF) to somewhere around ‘instantly recognisable as trans’. But since nobody in the wider culture cares, neither do the individuals, so they cheerfully grow their hair, don mini-dresses or shorts so tight they look like a second skin, hit the hormones and go looking for a man; this phenomenon can be observed any time after 10 pm in the appropriate areas of any major city.

While fathers are often hostile, mothers in southeast Asia are usually protective of homosexual children. Indeed, there are reports of boy children being deliberately raised as girls and we know this happens in Samoa, for example. In general, HSTS are accepted by those around them and if they encounter hostility it is from others, outside their home circle, when they visit the city, for example. GNC children may suffer bullying in school but this is generally low-level, simply because there are so many.

This illustrates just how important social factors are in HSTS transition. They are crucial.

The cultural differences between the West and elsewhere have other effects too. In Asia, HSTS transwomen and femboys often socialise together. They are never lovers (they would see that as lesbianism) but they have no difficulty recognising the things they share in common. Nearly all of them grew up in communal environments amongst other homosexual and otherwise GNC children and adolescents. In the Philippines, this extends to form an interpersonal support network, which I refer to as ‘beki culture’, because ‘beki’ is the term these individuals use for themselves, rather than one chosen by others. This has become a full subculture with its own language.

Nothing like that existed in the West. Most HSTS there are isolated, either individually or in small groups, mainly because of mainstream society’s prejudice. Also important, however, are the transphobic attitudes of modern Western ‘gay’ culture, which insists that any expression of male femininity must be condemned and suppressed. So are the harmful activities of non-homosexual trans, who simply deny the existence of HSTS as a separate phenomenon.

Unsurprisingly, any HSTS, with the determination to transition, will probably put as much clear water between herself and these people as she can. HSTS avoid LGB ‘support groups’ and other places where gays or non-homosexual trans congregate, because being seen at one of these might well ‘out’ them and literally destroy their lives.

This means that HSTS in the West have traditionally found their lives and communities as women, amongst women, often being married. This is called ‘woodworking’ and it has been major factor in the Western HSTS life experience for decades. In other words, they are women, as far as everyone around them is concerned. It is in this context that GD in HSTS should be seen. When HSTS seek Genital Reconstruction Surgery, it is not because they hate their penises. They might not have any use for them sexually, but that is not the same as suffering dysmorphia about them. But they are constantly aware of the social consequences that might follow an accidental revelation of male genitalia.

Suppose your neighbour, a woman with whom you and your partner have been socialising for years, invites you to the beach. Wearing a swimsuit, especially a bikini, presents huge problems for a pre-operative HSTS. What if ‘it’ pops out? What will that do to the network of social connections you’ve built up for years, as a woman? Or what if you’re in an accident and first responders discover your genitalia?

Then there’s sex. Few HSTS transwomen are interested in using their penises in sex; they are almost always completely receptive . That means they have to use their anuses as sex organs. For some, even if they enjoy this and many do, cognitive dissonance can be provoked by it. They want a vagina so they can have sex the way any other woman does.

Pre-operative HSTS are often plagued by doubt of their partners. Would he prefer vagina? Will he leave me for a woman who has one? Or, in many cases, she frets that the man is obsessed with her penis and is in love with that rather than her; that he fetishises a part of her body that is not feminine. What does that make him? Remember, no MtF HSTS wants a relationship with a homosexual male. She wants a conventional straight man. Even worse, what if, one day, her partner asks her to penetrate him? The cognitive dissonance suffered by an HSTS in such a circumstance is huge.

As you can see, Gender Dysphoria as experienced by an HSTS is extremely complex but is largely to do with his or her interactions with others; it is social in nature.

Other types

This site is all about HSTS, obviously, but we will quickly go over the other types and how they fit with HSTS in the general overview of trans lives.

Non-homosexual trans

These individuals may refer to themselves as ‘transgender’. The distinctive characteristic difference between them and HSTS is that they are not innately homosexual. Remember that in this context, that means ‘exclusively attracted to same sex from childhood’.

In males, Blanchard was able to describe the mechanism by which this comes about and called it ‘autogynephilia’. In papers written over 20 years beginning in the 1980s, he developed a clinical and scientific model that remains the only plausible explanation for why a non-homosexual male would wish to appear to be a woman. (refs)

For Blanchard, they were ‘Sexually aroused by the thought or image of themselves as a woman’. We will discuss this at greater length in another article, but for now, it’s enough to know that they have a paraphilia that causes them to sexually fetishise the condition of ‘being women’.

Many such individuals, especially outside the West, will seek opposite-sex partners, but this functions to affirm the pseudo-feminine character that they have invented. While some have suggested that one homosexual experience was enough to do this, others like it and persist, becoming pseudo-bisexual. They are attracted to the experience of having ‘sex as a woman’ rather than to their partners per se.

Non-homosexual trans are markedly different from HSTS on nearly all parameters. They do not show any clustering of sex-shifted characteristics and will not deviate from the norms for related individuals of the same sex on any of them. They display no GNC in childhood, nor do they have same-sex crushes. In fact, they will be stereotypical for their sex. In males, as children they will enjoy rough-and-tumble sports and games and have typically masculine hobbies and pursuits. Many will marry and have children. They typically present much later in life than HSTS. In Blanchard’s sample the median age was 43 and this is typical of the Western form, although the range is huge — from late teens even into the 70s or older. They are usually somewhat unfeminine and may have great difficulty ‘passing’, even as younger transitioners.

Autogynephilia, the cause of male non-homosexual GD, according to Blanchard, only occurs in males. If there is a female form then it has not been described.

GD therefore, is directly related to sexuality. In HSTS it is the natural endpoint in a scale of development which we call innate homosexuality. This is more than just a sexual orientation and has other symptoms, lightness of build, neoteny and so on. Innate homosexuality in this sense is a cluster of phenomena that includes sexual orientation, but the orientation is vital, since without it, there is no HSTS. They might less obviously exhibit one of the other typical characteristics, but the homosexuality is constant. GD in HSTS is caused by not being able to realise the social and sexual life that the subject desires while presenting in an external gender not consistent with the internal one.

In non-homosexual GD or AGP, the stimulus is a paraphilia which causes a male to become sexually and romantically infatuated with himself in the form of a woman; eventually the pseudo-feminine character invented to be the object of this infatuation overpowers the host, causing the GD since the internal gender is now that of a pseudo-woman while the external is resolutely masculine.

Affirming the two types.

Many have disagreed with this analysis, claiming that the HSTS/non-homosexual distinction sits on top of an innate, common, transgender. These people often claim that there is a ‘feminine essence’ that causes all forms of GD (in males) and that the distinctions by sexuality are simply the same as found in the broader society.

This is fallacious. Firstly, it takes no account of the marked clustering of physical and psychological characteristics found in typical HSTS but not in AGPs. Nor does it account for why these exact same characteristics are found in feminine (innate) but gender-conforming homosexual males.

Then there’s the neurology. Many, particularly non-homosexuals with GD, have tried to assert that there was a neurological cause for he condition, and, again, that this was the same, irrespective of orientation. Against this, Blanchard said that he believed that the differences between HSTS and AGP were so marked that, when techniques were found to measure them, they would be found to have dissimilarities in neurology such that HSTS would have ‘brains like women’.

In the last decade of the last century, a small number of dissections were carried out by a team led by Zhou. These were of 6 dead transwomen. Differences were found in a part of the brain called the BSTc, which develops early (it’s a part of the cerebellum) which made them measurably more similar to the typical for women. This was lauded as a triumph. Unfortunately, later studies showed that the BSTc was especially prone to change under the effects of cross-gender hormones. The records kept by Zhou and his team confirmed that the subjects were all older and had been long-term hormone users. Zhou’s findings have been replicated only once, in one other subject, despite many such attempts. It must be regarded as at best unreliable.

By 2010, however, MRI and other scanning techniques were sophisticated enough to accuratley measure inside the brain in a living subject. Two studies were carried out, one by Rametti et al and one by Savic and Arver. It is essential to note that Rametti, using a questionnaire, screened out all non-homosexual subjects and Savic and Arver did the opposite, testing only non-homosexual or AGP subjects. Rametti found the HSTS brains shifted markedly towards the feminine on a range of parameters, while this phenomenon was not found in the non-homosexual cohort. Rametti’s findings were replicated by a number of other subsequent studies. These were large-scale studies that involved hundreds of participants and the findings led Dr Guillamon, writing in 2016, to assert that there did appear to be evidence for a brain-restricted form of intersex in HSTS, which AGPs did not display.

That would mean that, as Bailey argued many years ago, if there is an innate ‘feminine essence’ in transsex, only HSTS have it and AGPs do not.

The brain is an extremely responsive organ and it has been claimed that the shift seen in Rametti’s cohort was the result rather than the cause of their transsexualism. However, these tests were carried out on very young candidates who did not have a long history of cross-sex living and who had not begun taking hormones. This strengthens the argument that the brain difference is causative.

We prefer to see the neurological characteristics identified by Rametti and others as a part of the distinct clustering of physical characteristics that surround HSTS. In other words, HSTS is not just homosexuality ‘taken to the extreme’ but an innate human condition involving a broad range of parameters in which the individual is shifted towards the norm for the opposite sex, one of which is sexuality.

Certainly, if one is in the company of an HSTS, it is remarkable how feminine she is. She may well put on an outrageous display of camp from time to time, usually calculated for maximum effect, but in the way that she relates to a man, she is, simply, a woman. This is rarely so for non-homosexual trans.

How much of the furore today is about protecting the Western LGB social model?

That model might not outlive the social circumstances that brought it into being; in other words, more homosexuals might transition and fewer hide their cross-gender natures behind a mask of gender conformity, simply because LGB activism has lowered social intolerance. This, as we have seen, is what might be expected if something like the southeast Asian model were adopted widely in the West.

In his book ‘Kathoey (etc)’ historian Richard Totman expressed concern that the Western form of LGB might overtake the indigenous forms across southeast Asia and particularly Thailand; that the transwomen he studied would vanish. In fact, fifteen years later, this doesn’t appear to be the case. The Western model of gender-conforming LGB is not prominent in Thailand or the Philippines. If anything, the prevalence of trans is increasing rather than decreasing.

Since feminine homosexuality is innate and affects only a small percentage of males, the more HSTS we see, the fewer gender-conforming feminine homosexuals there will be, and vice versa for female. That is simple arithmetic. HSTS therefore, can replace gender-conforming homosexuality (GCH) under favourable social conditions. This would be, if it happens, a natural response.

It is understandable that GCH individuals and groups might feel threatened by this, but that should not be seen as licence to oppose transition. Unfortunately, this has happened and continues to happen. But the Western LGB model was a response to particular social circumstances in the West, particularly the USA, in the 1960s and it may be that if those change, it might simply disappear. Given that the world model was actually the model found in the West until the 1960s, it could just be that the West is reverting to it and nothing can stop that.

Pressure groups within Western LGB do not have the right to prevent, nor justification for campaigning to prevent, people from making the choices they desire to, because their decision will conflict with a socio-political ideology. There is absolutely no evidence that either the individuals concerned, or the broader society, are harmed in low-intolerance cultures like those in southeast Asia, by the elevated prevalence of transition. Indeed, observation suggests that the individuals are happier and the society more relaxed. LGB activists in the West just have to bite the bullet and accept that the lowered social intolerance they themselves have been seeking might, indeed, marginalise their lifestyle by making trans more accepted; in fact, this largely appears to be a fait accompli.

A caveat is required here, however. In southeast Asia, Gender Reconstruction Surgery (GRS) is only rarely sought. Many HSTS individuals, who could afford it, refuse it because they don’t need it to assuage their GD; social transition is fine for them. They might enthusiastically seek breast enhancements and silicone implants in strategic areas, but these are reversible. In FtM, very few pursue the regimen, of puberty blockers followed immediately by testosterone, that is promoted in the West and has been implicated in elevated sterility. Again, GRS amongst FtM is rare indeed.

This allows for flexibility and we think that Western clinicians should look carefully at this model to see if they can import some of it into best practise. In general, we should very much like to see clinicians adopt a policy of administering the minimum intervention required to relieve the dysphoria, rather than setting subjects off on an express train that leads to irreversible surgeries and heavy hormone therapies. To us, this seems little better than the blanket attempts at ‘deconditioning’ that previously characterised the Western approach. In order to do this, however, it is imperative for clinicians to understand that HSTS and non-homosexual GD are completely different things, with subjects having different envisioned life-paths and, concomitantly, requiring different therapy strategies. Sadly, this understanding is wanting.

GD in HSTS is primarily social and can largely be dealt with on that level, in most cases. Clinicians must appreciate that HSTS are naturally shifted towards the norms for the opposite sex and that this means that hormone therapy can be much less strong and still have the desired effect. I know many transwomen in Asia who take minimal doses of hormones, by Western standards, and who are both completely passable as women and very happy with their bodies. Remember, all an HSTS is trying to do is to live comfortably in the target gender; these individuals rarely suffer body dysmorphia or the other co-morbid conditions that AGPs often do.

AGPs are far more likely to have co-morbidities like body dysmorphia as well as deep psychological anxieties, especially if they transition later, leaving a wife and children in total confusion and despair. There is developing evidence that AGPs are more prone to disorders like autism and it has even been suggested that this is an underlying provocation for the condition. They may suffer deep sexual insecurity, especially if they remain heterosexual and find that their advances on lesbian women are rebuffed; on the other hand, attempts to have sex with men will run into their natural heterosexual reluctance to be intimate with them, which can extend to outright homophobia. Many will be analloerotic simply because these issues are too much to deal with alone.

If they don’t transition, they will certainly have severe GD issues and may require drug therapy to suppress libido, but almost certainly, and in addition, lengthy psycho-analysis and therapy to help them to confront and contain the cause of their GD, Autogynephilia. Love is a powerful emotion, no less so because it is focussed on the self. These subjects frequently have erected massive psychological barriers, making them hostile and difficult to approach; they require deeply sympathetic care. In addition, AGPs are often highly intelligent and quite capable of duping an unwary therapist.

Young transition in AGP

AGP trans frequently attest that they have been concealing their condition since their teenage years and indeed, have fought it. Thus, when they do transition, they are middle-aged or older and have no hope at all of ever really passing as women. If these individuals simply, as they would in Asia, decided not to suppress their autogynephilic feelings and instead to embrace them as teenagers, then would that be a bad thing? It would certainly avert the catastrophic damage done to individuals, spouses and families when a 50-year old husband and father suddenly becomes a transwoman.

While HSTS will nearly always be easily identified because of their childhood behaviours, this does not apply for AGPs and if we accept that transition is suitable for the latter, then why subject anyone to decades of having to live a covert life? Male non-homosexual trans usually have huge difficulties in ‘passing’ and it seems a cruelty to make them endure the masculinising process and so reduce their chances of doing so, for any longer than is necessary.

Rapid Onset Gender Dysphoria (ROGD)

This is a relatively recent phenomenon that appears to affect females more than males. Many authorities, including Ray Blanchard, have identified it as distinct from the more classic forms of HSTS and non-homosexual GD and it does appear to be so, at least in females. It is less clear that this is the case in males, and I’ll explain why.

HSTS is almost always preceded by pronounced childhood GNC. It has a long development time, during which the individual’s GNC behaviour will have been noted by those around him or her. Non-homosexual trans may not display this; these individuals frequently describe their feelings of dysphoria as having set on suddenly, always after puberty. In males, it may be that their early masturbatory experiences are implicated in the miswiring which causes autogynephilia (AGP).

By definition, then, non-homosexual GD in males is rapid in its onset, even if it might not be revealed for many years. At the same time, far more non-homosexual trans males are appearing in their teens now than before, somewhat more in line with the pattern in, for example, southeast Asia. This means that deciding whether a male subject has AGP or ROGD, or indeed, whether ROGD is actually separate from AGP, in males, is difficult.

The situation in females is different.

No equivalent to AGP, that might explain non-homosexual GD in females, has been described in the literature. Indeed, until very recently, female non-homosexual GD was either rare or overlooked, with only a handful of cases being described, worldwide. However, over the last decade we have seen a massive increase in referrals to clinics specialising in trans concerns in the West, and significant numbers of the subjects are female.

There is a strong case to be made that lowering levels of social intolerance coupled with the way that social media facilitates self-help and support groups, is implicated here. We can compare this to southeast Asia, where social intolerance is already low and there is a sophisticated and widespread person-to-person support network (beki culture in the Philippines, but equivalents exist in all other south and southeast Asian countries). This is associated with a marked increase in the prevalence of transition. So we might reasonably suppose that the prevalence in the West should increase to what is seen in the rest of the world, given circumstances favourable to this. While it might upset some people, there’s no evidence that higher levels of trans, of any type, are detrimental to the broader society.

In the Philippines, the apparent levels suggest that far more HSTS transition than remain gender-conforming homosexuals, as might be the case in the West. This does not seem to have increased the total number of feminine homosexual and HSTS combined. It’s just the relative numbers that change: there are more HSTS and fewer femboys. At the same time, in this culture, the late-transitioning Western form of non-homosexual GD is rare; far more transition while in teenage and few over the age of 25, though we have no idea how many remain covert all their lives. Maybe the West is aligning itself with this.

There is, however, a glaring problem. FtM GD, while more common in Asia than the West, is still very much more rare there than MtF and there is certainly nothing similar to that which we see today in the West, with a majority of new referrals being FtM. This does tend to suggest that there is something else going on.

We don’t as yet know exactly what ROGD is or the precise way that it works. It might not exist at all in males and all we are seeing is a pattern of transitioning commonly found elsewhere, appearing in the West. Although some might find this deeply uncomfortable, the Western LGB lifestyles, in particular the ‘New Gay Man’ are the product of social circumstances in the USA in the 1950s and 60s. Although attempts, by US American activists, to export these models have been made, these have had little success outside Western Europe and the Anglo-Saxon world. Everywhere else, the axiom that ‘gender reveals sexuality’, meaning that homosexual males are innately feminine and homosexual females masculine, is both recognised as true and easily observable. Some at least of the increase in male referrals to gender clinics in the West is certainly down to more MtF HSTS, who formerly would have suppressed their femininity, in compliance with social intolerance on one hand and the gender conforming rules of the LGB community on the other, rejecting this model. Instead they allow their internal and external genders to match by transitioning.

Especially in females, there is evidence that ROGD sets on after excessive use of social media and indeed, in some cases after exposure to the idea of ‘transgender’ at school. While the evidence suggests that both HSTS and AGP, non-homosexual GD in males, are persistent and usually life-long, there are troubling indications that ROGD may vanish as quickly as it appears.

If that is the case, then no therapies at all, that cannot easily be reversed, should be employed in cases where ROGD is suspected. If it turns out that this is simply a passing phase and there is more than a little evidence for that, then it is clearly irresponsible for a clinician to advise hormone therapy or surgery that might permanently change the individual’s body.

In particular, there is evidence that testosterone, which is used as a cross-gender hormone in FtM, may cause sterility in some females. (Testosterone has never been approved by the FDA in the USA for this use.) Surgical procedures are also hazardous, since they involve double mastectomy, hysterectomy, and the reconstruction of the external parts of the vagina to form a pseudo-phallus. These interventions will, clearly, drastically impact a woman’s ability to live as a normal woman, whether lesbian or heterosexual.

There are justifiable concerns that young people are being guided towards inappropriate therapies by clinicians and the principal reason for this is that those clinicians do not understand the different forms that Gender Dysphoria can take, or that each has its own indicated therapy path. Until this understanding is more widespread, we can look forward to many young lives being ruined, especially women’s, and ultimately to a backlash against all gender therapies — and if this happens, those who suffer the most will be HSTS.

Unfortunately, the non-homosexual male activists who are pushing the ‘trans agenda’ actively suppress essential information about Gender Dysphoria and the forms that it can take, because it suits their policies. They dislike that the science defines them as having a paraphilia — a mental disorder. They prefer to promote a notion of ‘feminine essence’ for which there is absolutely no clinical or empirical supporting evidence, at least, paradoxically, as regards AGPs. They have been so successful in obscuring the facts that even prominent charities and non-profits working in this field, for example GIRES in the UK, actively deny the science and, by doing so, have made themselves complicit in an unfolding tragedy.

The situation is grave and needs to be addressed.

There is no evidence for an equivalent to the ROGD phenomenon elsewhere in the world and this must lend weight to Blanchard’s view that it is in fact a separate disorder, induced or at least influenced by excessive social media use. This is supported by the uptick in voluntary desistance (detransition) that is now being reported.

In addition, ROGD shows similarity to other psychological conditions known to impact on adolescent females in particular. These include body dysmorphia, the extreme discomfort at how one’s body appears, the desire to self-harm and others. It is rare for an HSTS to exhibit dysmorphia before GD and so the inverse should be a warning.

So far the indications are that ROGD is completely different from the classic forms of GD. At root, the question is whether it really is one, or a misdiagnosis of other conditions that commonly reveal themselves in adolescence, encouraged by a fad-like wave of identification as ‘trans’. The phenomenon has many of the characteristics of the religious cults that have plagued the USA for over a century and this should make us pull up short. Is ROGD a mass mental disorder that claims its victims from amongst the most vulnerable?

If this is the case, and research needs to be done to establish whether it is or not urgently, then to propose drastic therapies including HRT that might compromise fertility, mastectomies, hysterectomies and so on, would be irresponsible. Clinicians who do so risk not only causing harm to their patients but also severe penalties in the future, if it is found that they acted without due care. Understanding the basics of how Gender Dysphoria works and the forms that it can take would seem to be the start-point of that care.