XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

A Biopsychosocial Approach to Female-to-Male-Transsexualism

Bosinski, Hartmut, Dept. Sexual Medicine, Christian-Albrechts-University Kiel/Germany, Medical School

An annual sample of 16 untreated female-to-male-transsexuals (FM-TS) was investigated by means of questionnaires, psychometric testing, anthropometric measurements and functional endocrinological testing, i.e. baseline levels of testosterone [T; ng/dl], androstenedione [A4; ng/dl], dehydroepiandrosterone sulfat [DHEAS; ng/ml], luteinizing hormone [LH; IU/l], follicle stimulating hormone [FSH;IU/l], and sex-hormone binding globuline [SHBG; m g/dl] were measured and a standard single-dose ACTH stimulation test (250 m g ACTH IV) was performed. Furthermore the mothers of these patients were interviewed.

Compared to a control group of 20 females and 20 males in the same age range without gender identity disorders we found in the FMT group:

(a) In childhood:

• Greater family reserve with regard to nudity (Social effect!)
• "Asymmetric Family Structure" (i.e. higher rate of absent fathers, divorces)
• Tomboy-Behavior (Self & Mothers Report)

(b)During puberty:

• In-time, but traumatic experience of menarche and breast development
• Gynephilic Sexual Orientation

(c)In adulthood (time of investigation):

• Higher rate of hyperandrogenic disorders of adrenal and/or ovarian origin:

• T, A4 and/or DHEAS é (83,3%)
• PCOS – frequency é (77,8%)
• Dysregulation of adrenal steroid synthesis é (66,7%)

• More masculine body build.

Findings are discussed in a hypothetical model of female-to-male-transsexualism.