Homosexual transsexual

Homosexual transsexual is a controversial term used by some psychologists and sexologists to describe male-to-female transsexual women who are exclusively or predominantly attracted to males. It is less frequently used by proponents to describe female-to-male transsexual men who are exclusively attracted to females.

Proponents of the term define this category based on testing or self-report, noting that self-report is not always reliable. Previous taxonomies used the terms "classic transsexual" or "true transsexual," terms once used in differential diagnoses. Proponents have stated that many "non-homosexual" transsexuals systematically distort their life stories because "non-homosexuals" were often screened out as candidates for surgery and because some see "homosexual transsexual" as a more socially desirable diagnosis. Key characteristics include conspicuous cross-gender behavior from childhood through adulthood, and a "homosexual" sexual orientation. The term is also part of a two-type taxonomy in which non-homosexual transsexual women have a condition called autogynephilia and are aroused by the idea or image of themselves as women.

Leavitt, who has used the term in a paper notes,"Transsexuals, as a group, vehemently oppose the label and its pejorative baggage." Critics claim the term "homosexual transsexual" is "heterosexist," "archaic," and demeaning because it labels people by sex assigned at birth instead of their gender identity.

History of the term
Richard Green states that since the term "transsexual" is very new, it is necessary to examine historical specifics to identify transsexuality in history, and distinguish it from other roles that are described as "change of sex", such as homosexuality and heterosexual cross-dressing customs. Green describes the cultural roles of groups such as the Two-Spirit, Hijra, Kathoey and Khanith, stating that these people are mentally indistinguishable from modern western transsexuals. In part, because of this history, past researchers have referred to the "homosexual" category as being the "classic", "primary" or "true" transsexual. At one time due to the heteronormative bias of many psychologists, transsexual people who did not fit into this category were often screened from receiving hormones and sex reassignment surgery.

Description by western science
The concept of a taxonomy based on transsexual sexuality was first proposed by Magnus Hirschfeld in 1923, and codified by Harry Benjamin in the Benjamin Scale. Kurt Freund proposed two types of cross-gender identity, based on his observation that gender identity disorder is different for homosexual males and heterosexual males. Published reports measure a "homosexual transsexual" at a Kinsey Scale 5-6 or a Modified Androphilia Scale 9.86±2.37. Ray Blanchard saw that homosexual transsexuals were younger when applying for sex reassignment, reported a stronger cross-gender identity in childhood, had a more convincing cross-gender appearance, and functioned psychologically better than "non-homosexual" transsexuals. Blanchard found them comparatively short and light in proportion to their height than non-homosexuals. Independent research done by Smith confirmed most of Blanchards findings, except for the difference in height-weight ratio. Dorner found that when injected with Premarin (for the treatment of mild to severe vasomotor symptoms of menopause), homosexual transsexual men showed an increased luteinizing hormone and follicle stimulating hormone response compared to heterosexual or bisexual transsexual men.

Sexual activity
Leavitt and Berger further categorized homosexual transsexuals by three patterns of sexual activity, and how they used their penis. Each group showed varying levels of masculinity and emotional disturbance in development.
 * Inactive group (44%): sexually inactive.
 * Avoidant group (19%): Avoided using their male genitalia during sex.
 * Pleasure group (37%): Derived pleasure from using their male gentalia during sex.

Leavitt and Berger found that transsexuals in the avoidant group are different from those in the other two groups. They fit the description of the "nuclear transsexual". They had a strong cross gender identification, wanted female anatomy, had never married and little to no sexual activity with females. Of all the subgroups this group had the least psychopathology. The transsexuals is the pleasure group behaved sexually in ways that were classically homosexual. They were more likely than those in the avoidant group to have had sexual experience with females. They also rated higher on a test of general fetishism. Other than this transsexuals in the pleasure group were similar to the description of a "nuclear transsexual". They found that transsexuals in the inactive group had characteristics which most differed from that of the "nuclear transsexual". Characteristics such as strong heterosexual orientations (as determined from psychological test), and fetish histories. "The pattern exhibited generally conforms to that exhibited by heterosexual transsexuals." This group was found to share little with the other groups of transsexuals other than a stated sexual interest in males. Leavitt and Berger also mentioned studies by Blanchard which suggest that heterosexual transsexuals will adjust their life stories to ensure that they get sex reassignment surgery.

Prostitution
In The Man Who Would Be Queen, J. Michael Bailey saw that the homosexual transsexuals he described were comfortable with prostitution, and that they had a masculine sexual appetite and simply lusted after men. In "The Transsexual Phenomenon",Harry Benjamin, wrote that "Other transsexuals find prostitution a useful profession for emotional as well as practical reasons..." Benjamin goes on to note "How much more can his femininity be reaffirmed than by again and again attracting normal, heterosexual, and unsuspecting men and even being paid for rendering sex service as a woman?"

Frequency of Autogynephilia
Studies have variously found that between 10% and 36% of homosexual transsexuals report a history of sexual arousal to crossdressing. Bentler found 23%, while Freund reported 31%; Leavitt and Berger reported 36% among all homosexual transsexuals, and 24% of the sexually active subjects; Blanchard found significantly lower numbers than his peers: 15% in his first study on the topic, and 10% in a paper two years later. Blanchard saw autogynephilia in lower levels when comparing homosexual and non-homosexual transsexuals, with levels of anatomic autogynephilia among some of the 117 androphilic subjects. A lower percentage of the homosexual transsexuals reported being (or having been) married and sexually aroused while cross-dressing.

Socioeconomic factors
Researchers have found several demographic features that homosexual transsexuals tend to have in common. Ken Zucker found that homosexual transsexuals are of lower IQ and social class, immigrant status, non-intact family, non-Caucasian race, and childhood behavior problems D.F. MacFarlane studied transsexuals in Australia and New Zealand. MacFarlane found that in New Zealand that 90% of the homosexual transsexual prostitutes were Māori, an ethnic group who are only 9% of the overall population. In The Man Who Would Be Queen J. Michael Bailey notes that about 60% of homosexual transsexuals he studied in Chicago were Latina or black; in his studies of gay males only 20% were non-white. He saw that most homosexual transsexuals learn to live on the streets, resorting to prostitution, or shoplifting. Bailey reported the opinions of two of his subjects who attributed the difference to genetics, or inflexible gender roles in their respective cultures. MacFarlane similarly concluded that culture influenced the number of Māori homosexual transsexuals he observed.

Blanchard, Bailey, and Lawrence theory controversy
The "BBL Controversy" also known as the "Autogynephilia Controversy"  is an ongoing line of discussion in the transgendered community. The concept had not received much attention outside of sexology until sexologist Anne Lawrence, who self-identifies as an autogynephile, published a series of web articles about the concept in the late 1990s. Lynn Conway and Andrea James responded to Lawrence's essay. In 2003, J. Michael Bailey's book "The Man Who Would Be Queen" was published. Conway objected to the book's general portrayal of transsexual women and its sympathetic attitude toward Ray Blanchard's hypothesis that all male-to-female transsexuals are motivated either by feminine homosexuality or autogynephilia. Conway began an investigation that eventuated in a number of accusations against Bailey, from the scientific (that he conducted pseudo-scientific studies using poor methodology) to the ethical (that he conducted scientific research without proper ethical oversight, had sex with a transsexual prostitute who was a "research subject", wrote the book without the knowledge of his research subjects, and practiced psychology without a license). Northwestern University conducted an investigation regarding the charge that Bailey conducted scientific research without required IRB approval. Although Northwestern did not release the results of that investigation, Northwestern’s Vice President for Research, C. Bradley Moore, said, "The allegations of scientific misconduct made against Professor J. Michael Bailey do not fall under the federal definition of scientific misconduct."

In 2008 Northwestern University professor and intersex activist Alice Dreger published a historical investigation of the controversy, in the Archives of Sexual Behavior. Dreger concluded that Bailey was "essentially blameless" and that he had been subject to "harassment" in an attempt "to ruin" his career. Moreover, Dreger concluded: "the historical evidence indicates that Conway, James, and [Deirdre] McCloskey tried to destroy Bailey’s book and his reputation through these truly extraordinary measures because they didn’t like what he had to say." Conway has responded that Dreger's piece is propaganda, and that its publication in Archives of Sexual Behavior and coverage by the New York Times reflected pro-Bailey bias by the editor and reporter, respectively. Dreger's article was published alongside 23 commentaries, including some critical of Dreger.

Yolanda Smith conducted a study in 2005 in the Netherlands which verified many of Dr. Blanchard's observations. She found that Blanchards observations were replicated in her sample. Smith found that homosexual transsexuals differed from non-homosexual transsexuals in terms of reported gender non conformity and fewer had been married. She did not find the difference in height,weight, and height weight ratio that Blanchard reported. Smith concluded that categorizing transsexuals by sexual history and orientation has clinical value.