OBSERVATIONS ABOUT TRANSGENDER PEOPLE 

Author:                LIN FRASER, M.A./MFCC

OBSERVATIONS ABOUT TRANSGENDER PEOPLE 

PRESENTED TO ETVC SAN FRANCISCO, AUGUST 11, 1990 

LIN FRASER, M.A./MFCC 

Edited by Ronda Schneider 
COPYRIGHT (c) 1990 by Lin Fraser. 
Reproduced by ETVC with permission from the author. 

They told me to talk for about an hour, so I asked some of my
clients when they came in for sessions what  kinds of things they
would be interested in my talking about. I wrote down a list of
questions they were  interested in, and that is what I am going
to cover in this talk.  

I would like to be relatively casual, but I also have a lot of
material, so if you have questions, I feel  comfortable with your
interrupting me and interacting with me, but if it looks like
were going to get too  interactive and I can't get through the
material, then we'll stop; is everybody comfortable with that? 

How did I get involved in this work, my history? What do I get
out of helping people with gender problems?  What is my approach
in helping people with gender issues; what classifications do
I put people in and why; why  do we classify? What are the people
like in these classifications, how did they get that way, what
is their  history, what types of people are these people, and are
they the same all over the world? What is the treatment  or the
therapy within these classifications? What does a transsexual
have to do to meet the minimum criteria  in the standards of care
and why do they exist at all? What issues come up in therapy and
what doesn't in this  population? What changes have I seen in the
gender community in the last 18 years? What is the future for 
transgender people, what is happening elsewhere, and what are
gender researchers working on? The best way  to divide transgender
people to facilitate understanding them is as crossdressers and
transsexuals. With  transsexuals, their "dressed" role agrees with
their primary gender identity. With crossdressers, or transvestites,
it is opposite to their primary gender identity, which is how
they are "crossed".  

In terms of this group, are you interested more in crossdressing
issues, or gender dysphoria/transsexual, or  is it about a mix
here? Are you interested in both?  

Response: Yes.  

Response: It's predominantly transvestite.  

In this room?  

Response: In this room.  

I'm not sure, as I look around.  

Response: You can talk about both, though.  

I see both in practice and I see a lot of people who don't know.

PERSONAL HISTORY  

Many people want to know how I got involved, and why I am working
with you. I came from a family  background where my mother was
the more assertive person, and my father was very nurturing and
receptive.  That made me sensitive to the possibility of role reversal
as a relatively natural thing. As the older daughter,  I was raised
with the belief that as a woman I could do anything I wanted to
do. I was born a feminist, in a  sense. Then I graduated from college
with a degree in psychology and religion and became a flight attendant,
and that's when my consciousness was really raised. As a flight
attendant, everyone projected onto me  hyperfemininity, and I wasn't.
I liked my job, and I liked traveling, but I didn't fit the stereotype
of a flight  attendant.  

So I went back to school, and put myself through graduate school
as a flight attendant. My first job, or  internship, as a graduate
student was at a place called Fort Help, and my very first assignment
was DeeDee. I  will never forget DeeDee. I did an intake on her.
I was terrified; I had never seen a client in my life. A very 
attractive woman came in and I took her up to one of the counselling
rooms and she said "I want to work on my  anger", and I thought
'Whew, I'm so glad it's something I can relate to.' I wanted my
first client to be  someone I could identify with, and half-way
through the intake, she said, "Oh, by the way, I am a preoperative 
transsexual. I have my surgery in two months, and I like you and
I want you to work with me." I didn't know  exactly what she was
talking about, but I had heard of Christine Jorgensen. I told
her I liked her too - you know  how sometimes you just like someone
and we just sort of connected - but I felt very inadequate to
work with  the issues that I projected onto her, because I assumed
she was working on gender issues. She said, "I am not  working
on my gender. I'm having surgery in two months, but I came here
because I would like to work on  my anger, and I will teach you
anything you want to know about gender issues." Meeting her was
timely for  me because as a flight attendant, I was particularly
sensitive to stereotyped based on gender. I was fascinated.  DeeDee
took me in hand. She was my client, but she taught me. Back then
I was working at Fort Help with  alternative mental health, and
dual relationships were OK. In other words, it was fine for us
to socialize with  our clients, to go outside of the psychotherapy
space and interact. My subsequent training does not allow that,
but back then as a beginning therapist in that environment, it
was fine, which I am grateful for, because without  that I would
not know what I know today. DeeDee became my friend, and she took
me to all of the places  that existed back in 1972 for the transsexual
community. She also introduced me to her surgeon, who was with 
the Stanford program, and they were kind enough to allow me to
be present in the surgery. DeeDee felt she had  a better chance
of getting a good outcome if I was watching, even though I didn't
have a clue as to what was  going on. It was an incredibly informative
experience for me. She told all her friends about me, and her 
friends started coming to Fort Help. At the time, there were no
other providers in San Francisco who knew  much about gender, to
my knowledge anyway. Paul Walker was in Texas at the time. Millie
Brown and most  of the others you're aware of now had'nt got started.
So I saw a lot of people who taught me, and that's how  I learned.
DeeDee showed me the literature and showed me Harry Benjamin's
book, "The Transsexual  Phenomenon", which is really very interesting.
I learned a lot there, and then I started reading other literature,
and as you may be aware, the literature is a mess. It's hard
to find yourself when you're looking in the  literature. "This
doesn't describe me; it has nothing to do with who I am." And
that's where most people start.  They go to their local library,
or they go to their local therapist, and they can't find anything.
The literature  is getting better, but back then... At that time,
the Harry Benjamin International Gender Dysphoria  Association
was just forming and I joined. They didn't have standards of care.
One surgeon in San Francisco,  whom I had better not name, was
accepting anyone and everyone, and people were killing themselves
after  surgery. It was a horror show. This surgeon was getting
concerned because standards were starting to be  formulated and
surgeons were developing criteria about whom they would accept
for surgery. He called me  and asked me if I would help him screen
people, so I went over to his facility. It was a garage on Lombard
St.  I saw one of his surgeries, which was done in the garage.
It was horrible. Fortunately, soon thereafter the  Standards of
Care were set up and this particular surgeon lost his medical
license, and is now either in jail or  practising in Mexico, and
no one I know ever refers to him. So that's my early history.
I went into private  practice, and was getting a number of referrals
from the Stanford program. Then transvestites started coming  to
see me, and I didn't know anything about that, either, so I did
the same thing. Always go back to the  paraculture; that's where
you get the information. That's also what I tell people to do
if they come to see me  and haven't been exposed to the paraculture.
Get involved; you will find out more about yourself there than,
at this point in time, anywhere in the literature. I learned
nothing about this in graduate school, by the way.  And I have
completed a doctoral program, with the exception of dissertation,
so I have as much training in  graduate school as any provider
you will ever find, and I was never told anything about gender.
So make sure,  if you do see a therapist, that the therapist has
experience in gender questions.  

MOTIVE  

Why I like working in this community is that people work really
hard. There are a lot of personal rewards.  People really want
to understand themselves, and that is very rewarding for a therapist.
I've seen a lot of  change in people. People come in and don't
know who they are or if they even have a right to exist. There's 
a lot of guilt and shame, and by psychotherapy and their own efforts
outside of psychotherapy and by interacting  with the paraculture.
I see tremendous growth in terms of peace of mind, self knowledge,
and knowledge about  what they want. On an intellectual level,
it's a very big challenge to work in this field. It's pioneering.
We  don't know much. So as a therapist, I'm in a situation where
I don't have a lot of teachers above me. I have  a lot of people
whom I work with who teach me, and I am a student in the most
wonderful sense. So much  is unknown. We don't know much about
etiology in terms of gender identity, gender roles, and sexual 
orientation, so it's very challenging. There's a lot of creativity
involved and a lot of opportunity for travel,  research, and meeting
other providers around the world. So it's exciting. The only thing
I don't like about  working in the field is that as a provider
I have to wear two hats. It's very uncomfortable. Everyone in
this  room can identify with having two sets of beings: you have
a male side and a female side. When I am working  with transsexuals,
I have to be both a therapist and a gatekeeper, and that's schizophrenogenic.
That is the one  part I don't like about it, having to wear two
hats. Once that's taken care of, with most people, then I can
just  be a therapist, which I much prefer. Question: What do you
mean a gatekeeper? For people who are  transsexuals, they need
referrals for hormones and surgery, 50 some people who come in
to see me may feel  that they know their diagnosis and deserve
their letter now, and they are angry at me if I don't provide
it  immediately.  

CLINICAL ORIENTATION  

As to clinical orientation, I am trained heavily in Jungian theory
and in behavioral theory. My supervisor  for my doctoral dissertation
is a behaviourist. I have an MFCC license, which means I have
a lot of training  in systems theory and family relationships.
I am in Supervision currently with two Jungian analysts, one of 
whom you may be familiar with, Jean Shinoda Bolen, because she's
written two gender-related books:  "Goddesses in Every woman" and
"Gods in Every man". So I'm heavily oriented toward dream interpretation,
archetypal patterns, and anima issues, but a lot of people I
work with are not Jungian oriented and not interested  in delving
in that direction and that's OK. What's my approach? First order
of business when you come in  to see me is what do you want; what
is your agenda? I don't have an agenda; it's what direction you
want to  go. Each person is different. Therapy is individualized,
based on what direction you need to go. A lot of  people who come
into therapy to see me really don't have gender issues; the gender
issue has been dealt with.  They want to see me because I'm free
to put the gender issue in proper perspective and to deal instead
with  work and relationships and whatever else they want to work
on. Second order of business, though, assuming  you do want to
work on gender, is assessment. What direction do you want to go?
I see so many people who  just don't know. The most common person
who comes to see me is someone who says, "I don't know if I'm 
a TV or a TS. I thought I was a TV and now I'm wondering." That's
very typical. There are a lot of other  people who come to see
me too, but for this audience I am gearing it toward gender issues.
Crossdressers  who are not uncomfortable with crossdressing generally
don't come to see me. I think a lot of people like that  are members
of ETVC. I'm talking primarily about people who do come to therapy.
What we do is we  assess together. In other words, I'm not sitting
there telling you who you are; we work on it together. With  some
people it takes a long time. Many people who are seeing me feel
confused. One day they think they're  one way and one day another,
and it's shifting and fluid and there are a lot of variables
and a lot of things  happening in your life that can change what
direction you want to go. That's why it is usually a developing 
diagnosis.  

That's not always the case I do see people who know for sure
they're crossdressers who are not leaning toward  transsexualism
and people who know they're transsexuals and have never had any
crossdressing associated with  sexual arousal, or any crossdressing
that is a response to any kind of trigger, the way TV's do. In
terms of  complexity, the most complicated situation is when you
don't know, and that usually takes the longest, and is  very common.
Why is this so complicated? Sexual identity is broken down into
biologic sex, sexual  orientation, gender identity, and gender
or sex roles. We know almost nothing about any of those four.
We  know very little about etiology, about how they develop, and
in this community we see fluidity and change in  all these areas.
So you can see how, in each person sometimes, you can have one
gender identity or two gender  identities, one gender role or two
gender roles. Sexual orientation can be towards men, it can be
towards  women, and it can be towards your image of yourself as
a woman. And it can be changing. So it's  complicated. How do you
got static, so you can settle down, so you know who you are and
what you want?  

There's a lot of controversy, too, as to how crossgender identity
develops. Is it nature; is it nurture? Again,  nobody knows. So
we just have to start with you, and what you want and what direction
you want to go,  because I don't have the answers. Nobody does.

TRANSSEXUALISM  

What classifications do we have within transsexualism? There
are in my practice over the years essentially  three types, and
if you look in the literature, they are going to be called primary
and secondary by one author,  and primary and secondary by another
author, but they are talking about two different phenomena, so
you still  get confused. So I am going to describe the three types
and see if anything rings a bell. Some of you may  exhibit characteristics
of more than one type, so if you're confused about yourself, that's
also common. One  type is early onset crossgender identity. The
person is pretty much asexual, always. There is almost no sexual 
arousal associated with crossdressing. The person is usually a
loner as a child, somewhat inhibited, may have  tried marriage
and family. Their presentation in the male gender role is not
particularly effeminate. They are  quiet people, and their sexual
orientation seems to be changing, but really they are pretty much
asexual. A  lot of their psyche is taken up by crossgender identity.
So these people have one gender identity, and that is  female.
Two gender roles, though, with the male presentation seeming
like a guy, and the female presentation  seeming the same, like
the same person, but also seeming like a woman too, someone who
is sort of  androgynous, but not in the Michael Jackson sense -
someone who is undifferentiated. Their sexual orientation  can
change as they shift roles, as they start living in the female
gender role. Another type is someone who  appears in the male gender
as an extremely effeminate homosexual. They are the sissy boys,
who have always  had a crossgender identity at the extreme end
of effeminate homosexuality. They seem like girls, and they are 
very talkative and uninhibited and talk about sex all the time.
They have always been interested in men; there  is never a change
in their sexual orientation. The third type is a person who starts
out as a transvestite. The  crossgender identity is a late onset
one. The person for many, many years has assumed he was a garden
variety  crossdresser, whose crossdressing was associated with
sexuality, sometimes tranquility, but there were triggers  to it.
Maybe he didn't know what the pattern was, but when he undergoes
therapy he realizes there were  triggers to the crossdressing.
What happens as he gets older is that the female gender identity,
which used  to be a subordinate part, starts taking over, and
he becomes she. There were two gender identities that were  quite
split, with sexual orientation usually toward women. As the female
identity takes over, whereas he  originally thought he would be
a lesbian, she goes into the female gender role, and often, with
time, she  becomes interested in men, but never has been before.
This is the late onset. A lot of these people are at  ETVC. In
terms of outcome with these three, I can't tell any difference.
All three types do just as well  following sex reassignment surgery.
At least that is what I've seen in my clinical practice, but
many researchers  disagree. Many refuse to authorize surgery for
secondary transsexuals because they fear that the chances of  making
a mistake are too great.  

Then there's the person who comes in and says they're transsexual
and they're not, or I don't think they are,  and what I have to
do with that group is set up a therapeutic alliance with them,
otherwise they will just leave  therapy. In other words, help
them to realize that I am on their side, and that my job is to
help them even  though they might not be transsexual. What is sometimes
going on in this case is a multiple personality  disorder, which
I see infrequently but I do see. There are usually several personalities,
with at least one a male  and one a female, so the experience
is that "I might be transsexual." Another possibility is a psychotic 
experience. More common though is the crossdresser who is under
extreme stress, has a big loss in his life,  and then escapes into
the female temporarily. That's where he is used to going for comfort,
safety, and  security, and he believes then that he is transsexual,
and what happens over time with psychotherapy, and just  time
really, but the push is an internal push, is that he eventually
realizes he is still fundamentally a  crossdresser. So if you are
a crossdresser one thing to be careful with if you find yourself
moving in the  direction of the feminine is to see how much stress
you are under; see if you've had any experiences that could  be
causing you to want to escape into this other identity. Treatment
for transsexualism is supportive  psychotherapy and help with referrals
for hormones and sex reassignment surgery - if that is what you
want.  A lot of people don't; a lot of people just crosslive and
feel comfortable without changing their anatomy. Such  people are
often termed transgenderists, although the term is a relatively
new one. One of the things I can  do for clients is being a female
role model for them. I was raised as a woman and I can refer you
to image  consultants, electrologists, endocrinologists, surgeons,
speech therapists, and other providers to help you with  your
socialization into the female gender role. The Standards of Care
are essentially that you be in therapy  for three months before
getting a referral for hormones and for six months with the same
therapist prior to  surgery, and that you cross live for at least
a year, preferably two, so you can go through a transition similar 
to adolescence, the way that I did, to find out what it is like
to be a woman full time.  

Question: When I first came to you, I couldn't have called myself
a transsexual because I wasn't  contemplating surgery. I think
categories are harmful. For me it wasn't a question of defining
myself in a  category, but of finding a way of living that brought
a sense of wholeness. My experience is that one becomes  a transsexual
when one starts experiencing life as a woman.  

I agree with you 100% in that regard. Trying to simplify, it
helps to look at three types because the  therapeutic issues are
different, but what actually happens, as you know, when you come
in, is you are not  spending time in categories, but trying to
decide how you want to live and what is/best for you. It is highly 
individualized. Still, treatment tends to run according to type,
and categories are still useful, especially  academically. And
for insurance purposes, to get psychotherapy paid for, I have
to label you, and everyone  else who walks through my office.  

Question: When I began, I had no sense of options of how I want
to live; I felt I was stuck with a diagnosis.  

I never hear people say, "I am living as a transsexual because
for me it is the best way to resolve my life  issues." Instead,
they define themselves as being born into a category without
choice. The only solution  I have is in therapy. I am just working
with whomever is sitting in front of me, in an individualized
way.  

Question: I would like to hear people talk about these being
resolutions to life situations rather than this is  what you are,
because one of the things I have noticed in the years I have
done therapy is when you label  somebody, frequently they become
it.  

That is true. I have felt that, not just about gender, but the
whole DSM-  III-R. I personally am a recovering alcoholic, and
for a long time, wherever  I went, my whole sense of who I was
that, and I don't want to be just  that, so your point is well
taken.  

Question:You were saying some people think they are transsexuals
but they're really not and are merely  using that to escape, but
on the other hand, there are people who have been forced into
the male role and  primarily want to escape from that and they
really should escape from that, so the whole thing gets very  confusing.
Might it not be more productive in each case simply to focus
on where do you really want to go,  rather than where you've been? 

We do both. This is giving you an overview, but what happens
in therapy, with me anyway, and hopefully  with other people, is
we are dealing with what's going on with you. We really are.  

Question:I'm also a therapist with a similar orientation to yourself.
For insurance purposes we have to put  labels on people, but in
the actual therapeutic process, we strive toward wholeness, although
categories do help  in certain ways to give you an idea of where
you're going.  

It certainly helps. I've had so much frustration being confused
by the literature and hearing something  different on a daily basis
from my clients, and hearing a complaint all the time from my
clients that "providers  don't know anything about me." When I
went out and looked at what providers were saying, including myself,
it didn't fit, so I'm trying to make sense of this. What I've
presented to you is in terms of categories I'm  familiar with,
in an attempt to try to use some logic in a very complicated field,
but it really isn't what happens  in ongoing therapy.  

CROSSDRESSERS  

What do people who are crossdressers generally want? They usually
want to integrate crossdressing into their  lives in some comfortable
way. They want to understand it and want to control it. Everybody's
different, by  the way; these are just representative types of
things that people bring in. They may want to overcome shame  and
guilt associated with it. They may want to get rid of it, or make
sure it doesn't develop into a crossgender  identity full time.
Those are basically the type of issues that come up when crossdressers
come to see me.  

What is the therapy? First order of business for most people
if they are not already connected with the  paraculture is to refer
them here (to ETVC), because the number one concern that I see
with crossdressers who  don't have any contact with the paraculture
is the overwhelming shame and guilt, the secrets. "I have a secret 
and nobody knows about it and I'm the only one and I hate myself
and what's wrong with me?" That kind of  thing. They've been living
with it their whole lives, and don't even know that this paraculture
exists. What  generally happens once they come to ETVC is they
come back to me and say, "Those people are normal!" I  hear that
all the time. They start out terrified; there's a lot of fear
about walking in this door. "Who am I  going to see? Is anyone
going to talk to me? What are these people like?" And they invariably
come back  and say, "Gee, I found somebody just like me." And that
feels wonderful. The work that this organization  is doing, and
other organizations like it, I cannot commend enough, particularly
now that there are a lot of  outreachs going on. I have some contact
with the hotline right now, and I am very impressed with that.
The  word is getting out. There are so many people who will no
longer have to be so alone with this. The number  one thing for
a crossdresser is to get them in contact with others. One exception
is when the person is  absolutely sure that what they want is to
get rid of the crossdressing behaviour, and then it's not necessarily 
the best thing to have an exposure to other crossdressers, but
those people are a minority. For control,  understanding, and integration,
what happens in the psychotherapy itself? If the person is in
a relationship and  the secret is out, I always want to involve
the spouse, if possible. That is very helpful. Crossdressing can 
become a symbol for a lot of other issues that are going on in
the relationship, that have to do with power,  control, autonomy,
and trust. It can become much more than it actually is, and it
is a good idea to bring this  up and include the spouse, and what
the limits to the crossdressing are with the spouse, what the
issues are with  children, and so forth.  

The most important thing to the crossdresser is usually how does
this affect my relationship, or if I don't  have a relationship,
how will it affect a relationship. Because the crossdresser does
this part time, there's  not the issue around work. Were not dealing
with the same kind of issues as the transperson who is living
the  female gender role full time. So we do a lot of couples counselling.
Then if you want to get into really  understanding the crossdressing,
to understand yourself in the context of it, I have a number
of questions that  we deal with over time, and this depends on
how deep you want to go. What I just mentioned up to now is  what
a lot of people do; they just want to work with their relationship
and don't have a real need to go further.  

What we do with the crossdressing behaviour itself is assess
when, why, and under what circumstances do  you crossdress? We
look at intensity, frequency, and duration of crossdressing patterns.
Do you feel you have  a choice? Is this a part of who you are,
or is it not? Is it more a compulsive type of thing that seems
to  overwhelm you, or is it an expression of who you are? What
is going on here, let's take a look at that. What  is the function
of it in your life? How did it start? How does it develop and
change over time? Is it just  sexualized, or is it a part of your
gender identity? What happens to your crossdressing when you fall
in love?  If it goes away, which it does with a lot of people,
then you can develop an understanding of what we call in  Jungian
theory the 'anima'. The anima, in the biologic male, is the image
of the feminine, or the woman within  the man. Every man has that,
and Jung writes a lot about this, but never with respect to crossdressers.
When the non-crossdressing heterosexual male falls in love, he
projects his own anima out. With the  crossdresser, when he falls
in love, sometimes he projects his own anima out and stops crossdressing,
but other  times what he is doing is having a relationship with
his own anima. So he has a blissful, sometimes an almost  in love
relationship with an internal image of the feminine, that he needs
to concertize, he needs to put into the  world and have a relationship
with. We want to know what is the crossdressing related to in
terms of when  the overwhelming need comes. What a lot of people
talk about in therapy is that it is related to assertion and  reward.
Sometimes crossdressing is a reward for something, and sometimes
it's an avoidance response, a fear  of assertion of the male side.
That isn't always the case, but it is something I have commonly
found when  working with such people. We have to assess, for instance
with dream interpretation, whether the  unconscious is pushing
the psyche in a female or a male direction. Often the conscious
self is unaware of what  the unconscious is doing. Who is the whole
person? Who is the second self? In the crossdresser, first is
the  male and second is the female. What is the male identity like,
the female identity like? Can the male have  access to the female?
It's very important for you as a crossdresser in the masculine
to be able to tap into some  of that stuff that you can get in
the feminine. The question I always ask people is, do you want
to keep these  two separate, or do you want to integrate? If you
want to keep the male and female selves separate, then it  is important
to get them working together, cooperating rather than competing.
If the crossdresser has no  conscious awareness of this, the female
side will often try to gain control, and that is the origin of
many  problems I see in therapy. We want to find out in which direction
is the female identity going, and what is  happening to the male
identity. As a Jungian, I assess the archetypal patterns in each
gender identity. What  I find with the crossdresser is a sort of
Apollonian identity in the male and a sort of Aphrodite in the
females  and I'll explain what that is in a minute.  

A lot of people in the paraculture talk about feeling like two
different people. The guy is usually rational  and concrete; you
might say he's kind of boring. The female is spontaneous and blissful
and in the moment.  That frequently is what people report to me,
typical crossdressers. This is what the male side usually looks 
like: He's the thinking type. He might have a little obsessive-
compulsive behaviour going on. He's introverted  and quiet. He
may have been shy and inhibited growing up. He's rational. He's
future oriented, which  Jungians describe as living in Kronos time.
He's serious and responsible. He's a professional and somewhat 
conservative. Logos is what he's involved in, that's thinking.
Things are concrete to him. He could be  clinically prone to depression.
He's independent; it's difficult for him to ask for help. And
he's a heterosexual.  

What is his female side like? That's the anima. That's the soul,
by the way, in every man; the anima is the  soul. Here we have
the Aphrodite archetype, a lot of bliss; it's a highly aroused
state. The world is now in  colors rather than black and white.
Here's where the feeling is, and sensation.  

In the moment - there is no future and no past, what is called
Kairos time. It feels good; it's highly  pleasurable. He can focus
on the details of the moment. He has a desire, or maybe I should
say she, has  a desire to connect with others, a desire for relationship
out in the world. She wants to go out to connect.  And there is
a recognition of dependency needs in this state, and a feeling
of safety, security, and tranquility,  as well as excitement and
risk and a sense of spontaneity. This is Eros instead of Logos.
The sexuality is  towards the female image of self. That's why
mirrors are important. Dick Doctor did some studies on this.  His
book is fabulous. He has been testing sexuality in the crossdressed
state, and one of the things he is  finding is an attraction to
men with many crossdressers, which is surprising, because there
is so much obvious  heterosexuality; we almost talk about heterosexual
crossdresser as one word. For some crossdressers, the  female archetype
is more Persephone, who is childlike and spontaneous and fun,
and also in the moment.  When you're crossdressed, I want to find
out, do you feel different to me. Often you don't, by the way.
You  feel very different to yourself, but you don't feel different
to me. You look different, but you seem the same.  

Crossdressers are very narcissistic when they are crossdressed.
"How do I look! Tell me about what I'm  wearing. Look at my nails.
" Once you get beyond that, there can be more recognition of who
you really are.  It's easy to understand, I think, just looking
at those two sides of the psyche, why the feminine is so appealing.
A lot of the fun is there; a lot of the pleasure is there. Once
again, if you feel like you're moving toward  a crossgender identity,
take a look and see if you're under a lot of stress, because
that tends to shift people into  the feminine even if they are
not really transsexual. What a lot of people say to me is their
heart wants it even  though their head doesn't; then later they
can't believe they ever said that. What do we do in terms of  control?
A lot of people say, "I just want to control this. I don't want
to give it up, but I don't want it to take  over." Again, the bottom
line, the therapeutic issue, is what do you want? And a lot of
people don't know.  

Once the female starts taking over, it's very difficult to stop
it, because that's where the psyche wants to go.  What do you do
to stop it? You need to work on the masculine side. This is very
hard to get people interested  in. I have so many of these people
coming in looking like such slobs as men. And then they get their 
courage up to come to see me crossdressed, and I have this elegant
thing coming in with the nails they spent  four hours on. They
need to spend time on the masculine. "What a nice sweater you've
got on today," and  that kind of thing, to reinforce the masculine
image. You need to seek other ways for bliss, for the risk taking 
and spontaneity that's associated with the feminine. Being in
the moment - how else can you get that, besides  dressing? Find
out what your triggers are for crossdressing. Often it's stress
control. Take a look at other  ways you can deal with stress. I
do a lot of dream interpretation. One of the things I'm interested
in is what  your unconscious is saying. Lots of times you may feel
one way and your unconscious may be saying  something else. Where
is the ego in the dream state? Crossdressers and transsexuals
dream a lot about  themselves in the female gender, but it's very
different in terms of how they dream about themselves and where 
the ego is and what direction is it going. So I do a lot of dream
interpretation. Another way to find out what  direction you are
going, as a last resort, if you feel like you're moving toward
a female gender, is to try  crossliving for a short period of time.
What tends to happen is that a lot of people get tired of it.
Work out  some way that you can take a vacation and crosslive,
to be a woman on a daily basis. Fantasia Fair isn't  good enough.
Fantasia Fair is a fantasy. It's great for what it is, and I
encourage people to go, but I'm talking  now in terms of what it's
like in your daily life every day. A lot of people do get tired
of that, and they realize  they are not really moving in that direction.
Another thing that you can do, although I don't recommend it,
is to marry a transsexual, or take a lot of pictures of crossdressers,
because there is something called projective  identification,
a psychodynamic term. You can project and then bring it back on
to yourself in an intimate  relationship, or with an object, and
often that will take away the need for you to do it yourself.
Another  thing in the male gender is to have a lot of sex, as a
man, and to also work on masturbatory fantasies, to shift  them
away from the image of self as a woman and toward intercourse
with women. There are specific  techniques for doing this. We do
this with people in practice who do not want to proceed in a transgender 
direction, but want to go backwards.  

CAUSES  

How did you get this way? What kinds of things happened in your
childhood that may have been a  contributing factor. What I say
is based on listening to lots of life stories of lots of different
people. There are  basically two paths; well, there are three,
but two that are very different. Sissy boys One is the gender 
dysphoria secondary to homosexuality. That's the sissy boy. There's
a lot of work being done by Susan Coates  in New York now and Ken
Zucker in Canada and Pichard Green at UCLA working with crossgender
identified  boys. That's not most of you, in terms of what I see
in practice when we talk about your history, and when  I interact
with you here. There's usually been a very close family system,
very close to the mother. If you  ever read some of the psychodynamic
literature by Robert Stoller, he talks a lot about this group.
He calls this  'primary transsexualism'. This child never really
has any conflict, and the theory is that he never separates  from
Mom in the separation/individuation stages of development, which
is between ages 2 and 4. This also  may be the person who has a
biologic basis to the crossgender behaviour. We don't know. The
biologic studies  are inconclusive, but we do have some. Louis
Gooren is doing some really good work in the Netherlands, and 
Eicher and Goerner are in Germany. With these extremely effeminate
boys, there may have been some 'in  utero' effect on development
of the brain. Joe Gonzalez over here (in the audience) hopefully
is going to find  out with his PET scans and other biologic research,
and perhaps some day working on the biologic end of  gender disorders
we will know more. These boys are always very effeminate. They
are like a girl from the  word go. They are only attracted to men,
and have always been. They are apparently at a very early age 
trying to repair some kind of damage to the Mom by becoming the
Mom; Susan Coates' work on this if  absolutely fascinating. They
often come from homophobic backgrounds, a lot of Catholicism or
other religious  backgrounds. This is also the phenomenon that
we see when we look at crossgender identity in non-Western  preliterate
and cross cultural studies. Many cultures have a place for this
population, a third gender if you will.  There's the berdache in
Native American studies, the acault in Burma, the Kahunain the
South Pacific, the  hijras in India. What you tend to find there
is people who are somewhere in between the spirit and the flesh.
They are often priest-like people, or shamans. They will often
live in the female gender and marry men. The  majority of people
in our culture who start out that way develop a homosexual orientation
as adults, and seldom  take the extreme path of transsexuality.
Those with More Variable Initial Gender Identity Everyone else 
that I work with comes from a background where they are not particularly
effeminate as children. Transsexuals  in this group usually, but
not always, experience an earlier onset of crossgender identity
than crossdressers.  The early onset transsexuals seldom fetishize.
They have very little sexuality associated with crossdressing,
and  very little sexuality at all. Their relationship to their
penis is neutral or negative. Except for those things,  everything
else is similar in terms of history for both the crossdressers
and transsexuals in this group. Both  seem to come from a background
where there is very little touching. This may not apply to you,
but I have  found it commonly among most clients. They didn't
get a lot of touching and they didn't have much discussion  growing
up in their family system about sex, or sexuality. So when the
child is developing, he develops his  sexuality in private, and
then he may reinforce his crossdressing with masturbation. He
doesn't tell anybody  about his crossdressing. He never learned
anything about it, or that anyone might ever condone such a thing.
Often they come from a working class background. Lots of people
I work with are not themselves working  class, but are professionals
who have come from such a background, where male identity and
female identity  was polarized. There was a big difference between
who men were and who women were. Usually mother  was not available
all the time. She was there, but it was not the close kind of
thing I was taking about with the  sissy boys. She's not there
all the time, and she's often withholding, particularly when it
comes to touching.  The father is either inconsequential, absent,
or he is disliked. He is a negative, or at best a neutral. Even
so,  the father is sometimes perceived as more nurturing than the
mother. Women have the power in this kind  of family, or that is
what it looks like to the child. It is often an extended family
and there are a lot of women  around, so the child is often in
the company of women, and he likes that. These are mother's sons
rather than  father's sons. Possibly in this family a girl was
wanted; this happens sometimes. Somewhere along the line  the child
decided it was better to be a girl.  

Occasionally you run into sexual child abuse, and in the cases
where that happens, often the crossgender  identity is developed
as a response to that. That's when you get into dissociative states
and multiple  personalities. Once in a while I will talk to someone
who was forced to be crossdressed, but that is rare. You  see that
in the literature, but in my practice most people remember that
they crossdressed themselves. It was  something internal. Some
people recognize it was a transitional object for Mom. Mom was
gone and they put  the clothes on to be close to Mom. They felt
with the clothing there was a safety and comfort and security,
kind  of like holding, the feeling of being held. As adolescents,
most of my clients were introverted and shy, and  their social
and sexual skills were not well developed. There wasn't a lot
of dating or a history of many  different women - very little contact
with real girls. So there was a lot of opportunity to develop
the image of  the feminine in private. From a Jungian perspective,
people I see are usually introverted, thinking, sensation  types.
What that means is that a lot of the psychological material is
going on internally. It's a very rich  internal world. That's one
of the reasons I like working with this community. There's usually
a tremendous  amount of internal stuff going on. The thinking orientation
comes out in the kinds of jobs that are picked -  large numbers
of engineers, and computer people, and people who are comfortable
with things and  manipulating the environment. They are interested
in details, concreteness. Sensation types concertize  experience.
They concertize the image of the feminine to make it real. And
it feels good, and gives them  security. One of the things that
I find very interesting is that I have only found this kind of
phenomenon in  the West, and Japan. I am only aware of it in the
United States and Canada, Northern Europe, South Africa,  Australia,
New Zealand, and Japan. The other kind I was talking about earlier,
the sissy boy and the  effeminate homosexual, is what you see
more often in less technological cultures, including Southern
Europe.  What I think might be going on is that as we become industrialized,
we have a nuclear family where we don't  have much contact with
the father. The father is out in the world, and there is not much
available role  modelling there. Also, when we look at the cultures
where the non-homosexual type is prevalent, and now  I'm getting
into Jungian theory, they are cold and untouching cultures and
there is little connection with the  goddess. The cultures are
not warm and spontaneous and connected with the earth. I think
what happens  in our community is that a lot of you are in touch
with that at a very deep level. You are introverted sensation 
types and you recognize that it is missing and you need to concertize
it. The culture needs to do it. We need  a lot more female images
out there. In the Southern European cultures, at least, you do
have the Madonna  - I'm not saying that's great - and there are
a lot of cultures in the East with a wide variety of goddess images,
where the image of God is not patriarchal, not male identified.
I think you're hooking into the lack of that in  this culture
at a very early age. This ability is typical of sensation types.
That is getting off into Jungian  theory, but I think that's what's
going on.  

OTHER THERAPEUTIC ISSUES  

There are different issues for people who are going to live full
time in the female gender role versus people  who are balancing
two gender images. With the transsexual, once the gender shift
occurs, most of the work  is done and you can get on and live your
life. If you're a crossdresser, it's an ongoing issue. Your whole
life  you are dealing with balancing the two, and that's a big
challenge. What a lot of people deal with in therapy  is problems
related to having a secret, so we have intimacy and trust issues.
If your whole life is a secret, it  affects who you are and your
relationship with other people, particularly with people whom
you love. Who do  you tell, how do you tell, what is the effect
of having a secret, of feeling not completely known, feeling if
you  really knew me you might reject me? Of course, there are issues
of depression, isolation, loneliness, feeling  different, issues
of self-esteem, and a lot of guilt over who you are. One of the
things we usually need to work  on is overcoming feeling guilt
about being who we are. Other people are overwhelmed by  obsessive-
compulsive issues around crossdressing. We have a relatively new
treatment coming out of the  University of Minnesota for obsessive-
compulsive gender dysphoria and/or crossdressing which is Prozac
and/or  lithium. What that seems to do is take the edge off the
feeling of overwhelming urgency.  

It allows you to be free from that and start to deal with your
issues. Some people even give up the gender  dysphoria, but not
many. What doesn't come up with this group? I don't see much psychosis
at all. I very  rarely see paranoia, with the exception of legitimate
paranoia, in other words people who say "I'm scared to  go out
in the world crossdressed, with people reading me and rejecting
me." I see almost no clinical paranoia.  I think because I'm in
private practice, I don't see a lot of borderlines, or acting
out, except for the people who  are absolutely sure they are transsexual
and they want their hormones and I don't agree with them. I see
very  little sociopathy; most people in this community play by
the rules, so I don't see people who are breaking laws.  

I don't see people who are not serious about psychotherapy. This
population is extremely interested in self  understanding, and
that's one reason I like working with you. I tell providers who
are thinking of entering  this field that there is usually a great
sense of responsibility in this population. People pay their bills,
and they  show up for appointments, and they work hard in therapy,
which is very good for the providers. I don't  see a lot of codependency.
Occasionally I do, because it's such a common thing in this culture,
but transgender  people are not controllers; they are usually
not controlling other people. They are focused on what's going
on  with them, and you can do your own thing. Live and let live.

CHANGES IN THE COMMUNITY  

What changes have I seen in the gender community? What is the
future for the T-person? I think that's the  latest politically
correct term. What is happening elsewhere and what are gender
researchers working on?  I've been around the paraculture for l8
years, and I've seen a lot of changes, all good. The people today
are  much more knowledgeable and sophisticated, and much more organized
and political. There is a lot more pride  of being who you are,
a lot more self acceptance and self confidence. I think what
is happening is these people  are moving in the same direction
the gay community was 20 or 30 years ago. ETVC is incredible.
How many  people are members now, 500? In how many years, 8? That's
incredible. More and more people are coming  out of the closet.
I was at the gay parade at your booth and you kept running out
of literature and people kept  showing up asking questions. There
was very little hostile judgment, and people were interested.
And that's  a shift. I know it's San Francisco, but I think it's
happening elsewhere more slowly. There's even a radical  contingent,
which I found out the other night from Telzey, and I think that's
good. The "Act-Up" of the  transgender community. You meet all
types, and we need to get to know each other. The Catch 22 this 
community has that others don't is that a lot of you just want
to stay in the woodwork. When you're dressed,  you want to be like
any other woman. You can't go out and be political, because you
want to fit in with  everybody else. That will always be a problem,
I think, but some people don't feel it as strongly as others.

Another thing I see is that the image of the feminine in this
community has changed, and this I like so much.  It's much more
realistic. Eighteen years ago, what I saw when I would come in
these rooms was a real  Madonna/whore split. Of course, that has
been characteristic of our culture, too. As we as women get more 
choices, what we see in this community also reflects that, and
everybody doesn't look alike, and most tend to  look more realistic.
Eighteen years ago, you didn't do as good a job. Also, you have
a lot more options.  Eighteen years ago, unless you were a DSM-
III-R transsexual wanting to get rid of your penis, nobody knew 
what to do with you. Also, you had to be heterosexual in the gender
you were moving into or you weren't  considered a candidate for
surgery, so people were lying to us as providers because there
is so much variation  among transgender people that wasn't being
acknowledged then by the providers. People then were not  comfortable
with diversity. There's a lot more diversity and options now.
There are a lot more people who  are living as women, but not electing
sex reassignment, or even hormones. The role is what's important
to  them; being related to as a female is what's important. That's
not for everybody, but you now have that option.  

I think providers and consumers are closing the gap between them.
I was at a meeting of HBIGDA in  Cleveland recently and there
is a consumer member on the board of directors of the Harry Benjamin 
Association. I really think this is good, that were interacting.
I know for me, most of what I've learned has  been from you, not
only in my office, but from associations outside. And I see that
is happening more; there  is more exchange.  

Also I notice that providers are communicating more around the
world. There are so few of us, that it is great  that we know who
each other are and can communicate with each other. In terms of
research, there's a  person now, Louis Gooren, who is Chair of
Transsexuality, if you can believe this. At the Free University 
in Amsterdam, there is now a whole chairship for him; he was just
installed. So this is exciting, in terms of  doing research in
this area. It is getting more acceptable. In Canada they're doing
a lot of work in  classification. In the United States, work on
sissy boys, and in sexual addiction and compulsivity, and that's 
probably where the money is, unfortunately. The only area I'm
aware of where funding is potentially available  for research in
the gender field is in obsessive-compulsive behaviour using Prozac
or lithium. The drug  companies will pay for that. Otherwise, it's
hard to get funding. One negative that everyone's aware of is 
what's happening in the Supreme Court, what's happening with the
First Amendment, and that concerns me in  terms of what direction
you will be able to go because of the direction that the country
is going. This is an  on-going concern.  

QUESTIONS  

Question: Is the TV syndrome for escaping stress a more healthy
behaviour than self-destructive ones like  alcohol or drugs?  

Oh, definitely. Yes. It's definitely a more healthy response
to anxiety.  

Question: And as far as escapism, as long as you don't go into
a multiple personality or something and use  it as a tool to help
cope with real life situations...  

You can. See, this is the thing: it varies from person to person.
One of the things that you need to strive to  do is to use it
that way as opposed to using it in ways that can be destructive.
Only you can decide how that  works for you.  

Question: What criteria do you use to judge whether one is a
transsexual?  

I am not sitting there diagnosing you. We are working together
to figure out (a) would you be more  comfortable living in the
female gender role, and (b) if you would, are hormones or reassignment
surgery  appropriate. That's again something we do together, because
there are a lot of options. I don't have criteria  per se. I don't
have a list because everybody's different, although I do follow
the Standards of Care. It's not  accurate to use DSM-III-R because
DSM-III-R says that a transsexual is someone who hates their penis,
and  some people who are going to live in the female gender role,
whom the paraculture terms transgenderists but  the literature
has no category for that, don't hate their penis; they use it.

Question: In your experience, have you worked with people who
have been taking hormones for extended  periods who are not surgery
candidates who are still living on both sides of the fence and
have been talking  hormones for more than a few years?  

Yes, I have. We don't have good data on that. All I can tell
you is to the best of my knowledge, the  hormones have not harmed
them. There is a concern about someone taking high levels of hormones
for an  extended period of time, but we just don't know. There's
a fellow in Amsterdam, H. Asscheman, who did  some very good research
on the negative effects of female hormones on the genetic male,
but still it wasn't  the long term kind of thing.  

Question: Obviously "high" is going to be relative to the individual.

Yes, but someone who has surgery immediately goes down in the
dosage, so if you're not going to have  surgery, you're going to
be taking higher levels of hormones than the person who has surgery.
Once a person  has surgery, required hormone levels drop because
that person's body is no longer producing as much  testosterone.
If you don't have surgery, we don't know what the long term effect
is.  

Question: I'd like to gather information on the risk factors
of taking hormones under a doctor's supervision.  

Were trying to get data, but this is something relatively new,
so we don't have long term studies, and few  people are even trying
to collect it. The best advice I can give you is to continue interacting
with your doctor  on a regular basis and paying attention to the
possible effects. There is potential for stroke, and some really 
horrible possibilities.  

Question: If you read the warnings on the bottle, they would
scare you to death.  

Yes, they are horrible. But in terms of what I have experienced
with people, they haven't suffered many  medical side effects.
What my clients much more commonly talk about is psychological
side effects.  

Question: The other thing from my personal experience is that
I was taking the high but commonly prescribed  dose of 5 mg Premarin,
10 mg Provera, and 0.5 mg Estinyl, and I think that's dangerous.
After a few years,  I wound up with arrhythmic heart, cramps,
all the things that were on the label. On lower doses, I didn't
have  those side effects.  

Thank you. I heard a really good lecture from an endocrinologist
who works with female-to-males, and he  was essentially saying
that you have to self monitor the side effects, and you have to
judge for yourself. Like  Annie, who decreased her dosage and eliminated
the side effects. Everybody's different.  

Question: Do you inform your clients of the drawbacks and limitations
of surgery?  

To the best of my knowledge, I do. I've worked with a number
of people who have had surgery over the  years and they have reported
to me what their experience has been, and what I do is relate
that information,  and tell all the horror stories that I am aware
of. I also advise people to talk with an endocrinologist who has 
had experience with postoperative clients, because such a medical
doctor can make observations more objective  than mine, which are
anecdotal. The problem you run into outside of therapy is that
when transgender people  get together in a group and talk about
their surgeries and their vaginas, they tend to make it sound
better than  it really is. It tends to sound a lot better than
what someone might say to me in individual therapy. But on  the
whole, the majority of people I have worked with who have gone
ahead and had reassignment surgery do  not regret it and feel that
it is much better than their previous experience.  

Question: In your practice, do you find a psychic difference
between transsexuals and transvestites; do they  dream differently? 

Yes. In terms of themes. It's very helpful in terms of assessment
to look at what the themes are in your  dreams. A person who starts
out as a crossdresser and becomes a transsexual develops changes
in her dreams  and begins to dream like a transsexual.  

Question: What is a typical transsexual dream?  

I can't say that there's a typical transsexual dream in terms
of content. One difference is, transsexuals as a  group tend to
dream of themselves as women; crossdressers tend to dream of themselves
crossdressed. There  is a real difference in terms of who is the
dreamer, what is the ego state of the dreamer. Often a transsexual 
will dream of herself going back in time, but in the past they
are a little girl. For a transsexual, the dreamer  is usually female.
For the transvestite, there are a lot a dreams about risk taking
and escaping with a strong  sense of being crossdressed, and also
dreams of themselves as hurt little boys. That's the main difference,
but there are others.  

Question: What's the percentage of crossdressing that you find
related to obsessive behaviour? It seems from  what I see on TV
that Prozac changes such behaviour in a broad way.  

I don't know yet. My friends in Minneapolis who are doing the
research on that are going to be presenting  their findings in
November, and that is one of the questions I have too. The researchers
are wonderful people  and have worked extensively with this community,
and they were saying that the last thing they wanted to do  was
take away any part of anyone's identity. They started with a small
group of people who said they were  obsessing all the time, and
what they found was a tremendous sense of relief for most people.
Because in the  gender community people talk to each other, they
began getting more and more people showing up wanting  it, and
many of them began completely letting go of crossdressing. Now
this is brand new research. Joe  over here is a psychiatrist to
whom I have referred some people that he has put on Prozac. In
some it doesn't  affect the gender dysphoria at all, and in others
it does. We only have 5, so I don't have a large statistical  sample,
and I am very interested in finding out the results of such studies
myself.  

Question: You made an extreme distinction between a transsexual
and a transvestite in that a transsexual feels  herself a girl
and transvestite just dresses up as an escape.  

No, no, no. If I gave the impression that transsexuals and transvestites
are very different, I was not trying  to do that. At each end of
the continuum, and there's not exactly a continuum but ignoring
the sissy boys for  a moment, the people at the ends are very,
very different, but most people are in the middle. There is a 
tremendous amount of crossing over, and of ambiguity in classification.
Put if I'm asked specifically a  question, about differences I
see in dreams for instance, then I'll be thinking of the extremes
at the ends.  

Question: What specifically is gender dysphoria?  

Gender dysphoria was a term that Norman Fisk came up with in
the late 70's. I believe, trying to come up  with a generic term
which applied to everyone who had some kind of gender discomfort
or confusion. At that  time, he did not mean to include in it crossdressers
who had no transsexual fantasies. However, the term is  often used
in this community for everybody, and when I use it, I am talking
generically about some kind of  gender identity concern. In the
literature, though, you may find it only to refer to people who
are either  transsexuals or transgenderists.  

Question: How many crossdressers involved in relationships go
further into transgenderism?  

That is an excellent question. I don't know. I am the wrong person
to ask because I see a disproportionate  share of those. I think
a good way to find out would be to do a research project with
this community.  

Question: Now that women's roles are greatly expanded, and most
women today don't fit the old stereotype,  has there been a comparable
change in the way transsexuals see themselves, or do they still
tend to perpetuate  the old stereotypes?  

Another good question. There has indeed been a change in the
population I see. In general, transsexuals seem  to be changing
in their perception of themselves at about the same rate as women
in general in the society.  People are no longer bound, as they
used to be, by the same old stereotypes. There is much more diversity 
now, which I am very pleased to see. 

Lin Fraser is a therapist practising in San Francisco, 415-922-
9240.  

ETVC is a social and educational organization open to all crossdressers
and gender dysphoric people, P.O.  Box 6486, San Francisco, CA
94101. ETVC has periodic social meetings, provides outreach to
the gender  community and to the public, and has periodic educational
meetings for its own members. This is a transcript  from one of
those meetings.  

SOURCE: ETVC