Sexual Activity and Temperament 
   In Polish Transsexuals 
   
    Stanislaw Dulko, M.D1 

  
   Two groups of 23 female-to-male and 14 male-to-female transsexuals were 
compared to a representative sample of Polish controls along following 
dimensions: (i) temperamental features including reactivity and mobility of 
nervous processes, as measured by Strelau's Temperament Inventory; and (ii) 
patterns of sexual activity, measured with Dulko's Questionnaire for 
Measurement of Transsexualism.  Transsexuals were found to resemble respective 
controls on temperamental dimensions according to their sense of gender 
identity and not their somatic sex.  Male-to-female transsexuals were more 
similar to control females than to control males and the reverse was true for 
female-to-male subjects.  With respect to forms of sexual activity, 
transsexuals, particularly the female-to-male, were found to have a relatively 
versatile erotic life.  Both groups experienced more dreams with erotic 
content than respective controls.  However, they also manifested fewer 
successes at satisfying their erotic needs. 
   
   KEY WORDS: sexual activity; temperament; transsexualism. 
   1Department of Sexology and Pathology of Human Relations in Medical Center 
of Postgraduate Education, Al. Bieruta 40, 04-158 Warsaw, Poland.  
   
   INTRODUCTION 
   Little evidence exists concerning the interrelationships between sexual 
activity in transsexuals and their personality traits, and no studies have 
investigated relationships between sexual activity and dimensions of 
temperament in transsexuals.  It was predicted that transsexuals would 
resemble respective groups of normal males and females in their patterns of 
sexual activity and in temperamental traits (strength of excitation or 
reactivity, and mobility of nervous processes).  It was uncertain, however, 
whether the resemblance would be along somatic sex or sexual identity groups. 
   Strength of excitation of nervous processes is understood in line with 
Pavlovian tradition as the capacity of a nerve cell for work.  It is supposed 
to manifest itself in the capacity of the nervous system to withstand 
prolonged or brief but strong excitation, without passing into a state of 
retroactive inhibition.  The capacity is measured by resistance to strong, 
continuing, or recurrent stimuli. 
   Strelau (1982) modified Pavlov's theory of temperament by substituting the 
notion of excitation process by a concept of reactivity, thus emphasizing that 
the physiological mechanism of temperament is not restricted to the level of 
cortex only.  This modification stresses the psychological nature of 
temperament which may be investigated with behavioral as well as physiological 
measures.  Strength of excitation and reactivity are inversely related, i.e., 
a high score on the excitation scale is an index of low reactivity. 
   It is usually assumed that any organism is endowed with a typical optimum 
level of activation (Hebb, 1969) or stimulation (Leuba, 1965).  In low 
reactive (excitation resistant) individuals the optimum is placed relatively 
high and hence they are bound to display more intense and more frequent 
activities in order to ensure a sufficient supply of stimulation and to match 
the optimum.  The opposite, low general activity level, holds for highly 
reactive persons.  Low reactive persons are thus hypothesized to actively seek 
sources of stimulation which may include their own activity (e.g., sports and 
physical exercises), frequent changes of environment (generally high physical 
mobility), choice of stimulating professions, or risk-seeking behavior, etc. 
   In Strelau's Temperament Inventory (1982) reactivity is measured by (i) 
readiness to undertake activity in highly stimulating conditions, (ii) 
maintaining an activity despite a continuing high level of stimulation, (iii) 
lack of emotional disturbances in stressful situations, (iv) lack of visible 
changes in efficiency of action in conditions of prolonged or strong 
stimulation. 
   In the majority of studies in which the Temperament Inventory was used, the 
hypotheses relating reactivity and stimulatory value of displayed behavior 
have been confirmed.  Behaviorally, however, the trait of mobility is 
relatively easy to identity since it is manifested as an ability to produce 
fast and appropriate reactions to changing circumstances (Strelau, 1982).  The 
respective items of the Temperament Inventory, diagnostic of mobility, pertain 
to this criterion.  According to Strelau, persons with high mobility of 
nervous processes should manifest a high need for a specific kind of 
stimulation: one provided by changes or variations in situation. 
   Temperament has been defined by Strelau (1982) as a set of formal 
properties of behavior, manifested mostly in an energetic level of activity 
and temporal characteristics of reactions.  The Temperament Inventory has been 
used mainly to measure reactivity and mobility of nervous processes, since 
these two temperamental properties have been considered by Strelau to hold a 
dominant position in regulation of human relations with the environment. 
   Strelau (1969; 1972; 1974; 1978; 1982) claims that underlying temperament 
is comprised of inborn physiological mechanisms which are responsible for the 
energetic level of the organism.  Particularly important are certain 
properties of a hormonal system and nervous centers located in the brain stem. 
   Boyar and Aiman (1982) investigated diverse functions of the hypothalamus 
and pituitary gland and suggested that transsexualism may result from 
neuroendocrine deficiencies of the hypothalamus and pituitary.  According to 
Dorner (1978), a deficiency of androgens in genetic males during a critical 
period of brain development changes differentiation of the brain in the 
direction of a female brain.  Moss et al. (1979), Unger (1979), and Lipton et 
al. (1976) suggested that hypothalamic hormones may influence diverse 
properties of behavior, including sexual behavior.  According to Strelau 
(1982), some forms of behavior are manifestations of temperamental traits.  
Changes in properties of behavior may be due to a decreased frequency in 
transmission of electrical impulses in neurons responsible for secretion of 
LH-RH (Renaud et al., 1975). 
   Investigation of factors influencing gender identity and gender roles in 
humans is difficult and becomes more complex if one considers the lack of 
appropriate empirical procedures, which could cover the diversity of the human 
repertoire of behaviors, modified by social factors.  The list of factors that 
are decisive for gender identity and gender role is thus by no means closed 
and conclusive. 
   So far relatively little attention has been paid to patterns of sexual 
activity in transsexuals.  The existing data are scarce and usually relate to 
single cases.  They show considerable discrepancies.  McConahay and McConahay 
(1977) suggested that transsexual subjects have more heterosexual than 
homosexual experiences.  Randell (1959) and Roth and Ball (1964) found that 
half of male-to-female transsexuals had sexual intercourses with females.  On 
the other hand, Bentler (1976) found an almost equal distribution of 42 male-
to-female studied transsexuals between three distinct categories: homosexual, 
asexual, and heterosexual.  Hoenig and Kenna (1974) found that most 
transsexuals masturbate.  Partial evidence concerning patterns of sexual 
activities in both types of transsexuals has been provided by Sorensen and 
Hertoft (1982).  All female-to-male transsexuals included in this study were 
sexually attracted by women and engaged in sexual behavior three to four times 
a week.  In contrast to the male-to-female transsexuals, they experienced 
genital satisfaction both during intercourse and while masturbating; 
masturbation involved the clitoris.  None of the female-to-male subjects in 
this study felt sexually attracted by males although some had heterosexual 
intercourse.  Genital sexual satisfaction was absent in male-to-female 
transsexuals and, in contrast to the former group, they were found to inhibit 
their sexual drive. 
   Two specific hypotheses were formulated in the present study. 
   Hypothesis 1: Transsexuals of the female-to-male type (F/M) should manifest 
temperamental features in line with their gender identity rather than with 
their somatic sex and thus should resemble males rather than females from a 
comparative group of normals.  By the same token, male-to-female transsexuals 
would resemble normal females rather than normal males. 
   Hypothesis 2: Transsexuals of the female-to-male type would display 
patterns of sexual activity that would resemble males from a comparative, 
nontranssexual group, whereas transsexuals of the male-to-female type should 
be similar to a respective group of normal females. 
   METHODOLOGY 
   Subjects 
   Subjects were 37 transsexuals from different areas of Poland.  The group 
included 23 female-to-male transsexuals and 14 male-to-female transsexuals, 
aged 18 to 46 (mean age 27.35; y = 8.311).  The majority were single, came 
from urban areas, and had completed at least high school.  Some worked, others 
were still in school.  All transsexuals had permanent sexual partners for at 
least 6 months. 
   The comparative group of normals was studied by Stawowska (1973) It 
included 2520 subjects, 1265 male and 1255 female, aged 17 to 60, mostly 
students and teachers. 
   The comparison group for studying sexual activity was formed by Ponikiewska 
(1976) and consisted of 100 married couples, aged 19-49, in habitants of a 
large city.  The majority of women had completed high school, whereas the 
majority of men had not. 
   Method 
   Hormonal tests were performed, including levels of testosterone, estradiol, 
prolactin, LH and FSH in serum, and dynamic tests using LH-RH. 
   Temperament (reactivity and mobility of nervous processes) was measured 
with Strelau's Temperament Inventory.  The questionnaire is based on the 
typology of temperament outlined by Pavlov and modified by Strelau (1982).  
The third experimental version was used.  The questionnaire was designed by 
Strelau (1982) to measure three properties of nervous processes: strength of 
excitation and inhibition, balance, and mobility.  Subjects were asked to 
complete the questionnaire, but their scores were computed for only two 
subscales: excitation (reactivity2) and mobility of nervous processes. 
   Patterns of sexual activity were rated with the questionnaire for 
measurement of transsexualism, devised by the author.  The questionnaire 
consists of 179 items that refer to sexual experiences and are listed 
according to the order in which the experiences are usually acquired.  The 
items refer to facts rather than to the subject's opinions on these facts.  
Except for a few open questions, the remaining ones are categorized. 
   Besides demographic and clinical data pertaining to transsexualism, the 
following aspects of sexual activity in adolescence were measured: sexual 
preferences, image of oneself as a sexual partner, expected and real sex-role, 
attitude toward sexuality, first sexual experiences, sexual intercourse, 
number of partners and partnerships, present partnership and type of emotional 
relationship with the partner, strength of sexual drive, frequency of 
satisfying sexual needs, degree of satisfaction during sexual behavior, and 
patterns of sexual activity.  The latter included frequency of experiencing 
sexual needs, frequency of engaging in sexual activities and satisfaction 
derived (experience of orgasm or felt sexual pleasure), as well as 
"substitutive" compensatory patterns of sexual activity (daydreaming, 
fantasies, erotic dreams, night orgasms). 
   Dimensions of sexual activity included strength of sexual drive (how 
frequently a subject experienced sexual drive) and frequency of erotic dreams.  
Frequency of satisfying sexual needs was rated, as was frequency of 
intercourse or other forms of sexual activity.  Satisfaction derived from 
sexual activity was rated from the subject's reported experiences of orgasm, 
pleasant sensations, satisfaction, or disappointment.  Patterns of sexual 
activity included "techniques" and "positions" taken during sexual 
intercourses and other forms of sexual activity. 
   The studies were carried in the Department of Sexology and Pathology of 
Interpersonal Relationships in Warsaw.  All subjects consented to participate 
and were assured secrecy of the data.  The study was not anonymous because the 
data were used later for diagnostic and therapeutic purposes.  All subjects 
were studied individually by the author.  Data were collected during three 
consecutive sessions, between May 1982 and January 1983. 
   RESULTS 
   Means, standard deviations, and proportions of measured variables were 
computed.  Chi-square, U test, and Fisher's exact test were used for 
nonparametric data, and t tests for parametric data. 
   
   Table I.  Comparison of Reactivity in Transsexuals with their Respective 
Control Group, Accounting for Sex of Subjects According to the Biological 
Criterion of Somatic Sex 
    Groupa Age     n       x       SD      U       p 
   
   F/M     18-46   17      60.83   12.748  
                                           2.922   <.01 
   F       18-60   959     51.00   12.700 
   
   M/F     18-41   14      48.93   14.856  
                                           1.019   < .05 
   M       17-61   1265    56.00   13.100 
   
   Table II.  Comparison of Reactivity in Transsexuals with their Respective 
Control Group, Accounting for Sex of Subjects According to the Psychological 
Criterion of Sex: Gender Identity 
   Groupa  Age     n       x       SD      U       p 
   
   M/F     18-41   9       53.80   13.094 
                                           .661    >.05 
   F       18-60   959     51.00   12.700 
   
   F/M     18-46   23      60.83   11.823 
                                           1.380   >.05 
   M       17-61   1265    56.00   13.100 
   aM/F = male-to-female transsexuals; F/M = female-to-male transsexuals. 
   2A score in reactivity is an inverse value of a questionnaire score; see 
Introduction. 
   
   Results and their interpretations are presented in Tables I and II which 
compare scores in two temperamental features, reactivity and mobility of 
nervous processes, of both groups of transsexuals (female-to-male and male-to-
female) with the respective groups of normals. 
   Table I compares scores in reactivity with subjects' somatic sex, whereas 
Table II compares reactivity scores with subjects' gender identity. 
   
   Female-to-male transsexuals scored significantly lower on reactivity.  
Behaviorally, people who have lower reactivity are more resistant to highly 
stimulating situations.  A lower degree of the reactivity testifies to greater 
strength of the nervous system, readiness to undertake activity in highly 
stimulating conditions; maintaining an activity despite continuing high level 
of stimulation; a lack of emotional disturbance in stressful situations; and a 
lack of visible change in efficiency of action in conditions of prolonged or 
strong stimulation.  Male-to-female transsexuals scored significantly higher 
in reactivity than the control normal group.  Additionally, transsexuals of 
the female-to-male type scored significantly lower on reactivity than male-to-
female transsexuals, with a respective mean difference of x = 11.90; t = 
2.614; p < .02. 
   When the comparison was made with subjects' gender identity, no significant 
differences were found for reactivity scores between transsexual and control 
groups. 
   The next property studied was mobility of nervous processes.  Since in 
previous studies (Stawowska, 1973) no significant sex differences were found 
with respect to this temperamental trait, the respective control group with 
which the group of transsexuals was compared has been differentiated not with 
respect to the sex but to age. 
   No significant differences were found between the transsexuals and normals, 
x = 0.10; U = .045, ns, for subjects below 30 years of age; x = 3.10; u = 
.836, ns, for subjects between 31 and 60 years of age.  Behaviorally, the 
trait of mobility is relatively easy to identify since it is manifested as an 
ability to produce fast and appropriate reactions to changing circumstances.  
This does not differentiate the transsexual groups either (with a respective 
mean difference x = 2.36; t = 0.624, p > .05). 
   The second part of the study investigated patterns of sexual activity 
displayed by transsexuals in comparison to a group of normals.  The following 
manifestations of sexuality were measured: (i) reported variety of techniques 
and positions employed during sexual activity, (ii) frequency of experienced 
sexual need, (iii) frequency of satisfying sexual needs, (iv) amount of sexual 
satisfaction, frequency of orgasm, (v) amount of pleasant sensations 
experienced during intercourse despite lack of orgasm, (vi) frequency of 
erotic dreams. 
   Female-to-male transsexuals differed from male-to-female transsexuals in 
the reported variety of employed techniques and positions during sexual 
activity, x2(1) = 4.849, p < .05.  Female-to-male transsexuals reported 
employing more variable positions during sexual behavior than male-to-female 
transsexuals.  Additionally, it was found that female-to-male transsexuals 
preferred a typically male position, with subject above partner, whereas male-
to-female transsexuals preferred a typically female position. 
   Both types of transsexuals manifested similar frequencies of felt sexual 
need, x2(1) = 0.007, ns, whereas normals displayed considerable 
differentiation in this respect, with normal males scoring higher on 
experienced sexual desire than normal females, x2(1) = 15.125, p < .001.  No 
differences in reported frequency of experienced sexual need were found 
between the pooled group of transsexuals and the respective pooled group of 
normals, x2(1) = .018, ns.  Nor were any differences observed between the 
separate groups of transsexuals and the respective subgroups of controls. 
   The frequency of satisfying sexual needs was similar in both groups of 
transsexuals, x2(1) = 0.294, ns, whereas control males scored significantly 
higher in this respect than control females, x2(1) = 4.568, p < .05.  The 
pooled group of transsexuals was satisfying their sexual needs significantly 
less frequently than the pooled group of normals, x2(1) = 8.87, p < .001.  
   
   Comparison of separate groups of transsexuals with their respective 
controls revealed the following pattern: 
   (i) Female-to-male but not male-to-female transsexuals scored significantly 
lower than the comparison group of normal males in frequency of satisfying 
their sexual needs (respective data, F/M vs. M, x2(1) = 11.88, p < .001; M/F 
vs. M, x2(1) = 3.03, ns.). 
   (ii) Female-to-male transsexuals scored slightly lower than control females 
(the result is of borderline significance), x2(1) = 3.77, p < .07), whereas no 
differences were found between male-to-female transsexuals and the respective 
control females, x2(1) = 0.370, ns. 
   The pattern of data obtained for frequency of experienced orgasm repeats 
that for frequency in satisfying sexual needs, with one exception: not only 
female-to-male but also male-to-female transsexuals scored significantly lower 
in frequency of orgasm than a control group of males.  Respective data: F/M 
vs. M, x2(1) = 58.28, p < .001; M/F vs. M, x2(1) = 61.55, p < .001.  Similar 
to the former set of data, a pooled group of transsexuals was found to 
experience orgasm significantly less frequently than a pooled comparison group 
of normals, x2(1) = 24.676, p < .001. 
   In situations where sexual behavior was not accompanied by an experience of 
orgasm, male-to-female transsexuals experienced pleasant sexual sensations 
somewhat less frequently than female-to-male transsexuals, x2(1) = 3.615, p < 
.07.  Additionally, it was found that the control group of normal females 
scored significantly higher than any group of transsexuals in frequency of 
pleasant sexual sensations experienced despite lack of orgasm (F/M vs. F, 
x2(1) = 6.589, p < .02; M/F vs. F, x2(1) = 27.937, p < .001). 
   Both types of transsexuals experienced a similar degree of erotic dreams, 
x2(1) = 1.92, ns.  Among control subjects, males scored higher than control 
females, x2(1) = 19.168, p < .001.  The pooled group of transsexuals and each 
subgroup separately experienced significantly more erotic dreams than their 
respective controls (F/M vs. F, x2(1) = 35.06, p < .001; F/M vs. M, x2(1) = 
7.22, p < .01; M/F vs. M, x2(1) = 13.83, p < .01; M/F vs. F x2(1) = 37.31, p < 
.001). 
   CONCLUSIONS 
   1.  With regard to the temperamental trait of reactivity, transsexuals 
resembled the comparative control in line with the former's gender identity 
and not somatic sex.  Thus, female-to-male transsexuals displayed a level of 
reactivity similar to a comparative group of males with whom they identified 
and not to the corresponding group of females.  Male-to-female transsexuals 
had reactivity levels analogous to those of the comparable group of normal 
females. 
   2.  Transsexual subjects tend to carry out a relatively versatile erotic 
life.  This seems particularly true for female-to-male transsexuals.  Its 
manifestations include productive and reproductive daydreaming, erotic dreams, 
night orgasms, and variety of sexual techniques and erotic positions.  Both 
groups of transsexuals experienced significantly more dreams with erotic 
content than respective controls, however, they also manifested significantly 
fewer successes at satisfying their sexual needs.  Intensity of sexual drive 
related neither to sexual identity nor to somatic sex, and it did not differ 
from the control data. 
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