Skip to main content

Advertisement

Log in

Measures of Clinical Health among Female-to-Male Transgender Persons as a Function of Sexual Orientation

  • Original Paper
  • Published:
Archives of Sexual Behavior Aims and scope Submit manuscript

Abstract

The present study examined the sexual orientation classification system that was used in the DSM-IV-TR for categorizing those who met the Gender Identity Disorder diagnostic criteria in order to determine the extent to which female-to-male transgender persons (FTMs) differ on psychological variables as a function of sexual orientation. Participants were 605 self-identified FTMs from 19 different countries (83 % U.S.) who completed an internet survey assessing their sexual orientation, sexual identity, symptoms of depression and anxiety, stress (Depression Anxiety Stress Scales), social support (Multidimensional Scale of Perceived Social Support), and health related quality of life (SF-36v2 Health Survey). Over half the sample (52 %) reported sexual attractions to both men and women. The most common sexual identity label reported was “queer.” Forty percent of FTMs who had begun to transition reported a shift in sexual orientation; this shift was associated with testosterone use. Overall, FTMs ranged from normal to above average on all psychological measures. FTMs did not significantly differ by sexual attraction on any mental health variables, except for anxiety. FTMs attracted to both men and women reported more symptoms of anxiety than those attracted to men only. Results from the present study did not support a sexual orientation classification system in FTMs with regard to psychological well-being.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  • American Psychiatric Association. (2000). Diagnostic and statistics manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

  • American Psychiatric Association. (2012). DSM-5 development: Gender dysphoria in adolescents or adults. Retrieved from http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=482.

  • American Psychological Association Task Force on Gender Identity and Gender Variance. (2009). Report of the Task Force on Gender Identity and Gender Variance. Washington, DC: Author.

    Google Scholar 

  • Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales (DASS) in clinical groups and a community sample. Psychological Assessment, 10, 176–181.

    Article  Google Scholar 

  • Balsam, K. F., & Mohr, J. J. (2007). Adaptation to sexual orientation stigma: A comparison of bisexual and lesbian/gay adults. Journal of Counseling Psychology, 54, 306–319.

    Article  Google Scholar 

  • Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford Press.

    Google Scholar 

  • Bith-Melander, P., Sheoran, B., Sheth, L., Bermudez, C., Drone, J., Wood, W., et al. (2010). Understanding sociocultural and psychological factors affecting transgender people of color in San Francisco. Journal of the Association of Nurses in AIDS Care, 21, 207–220.

    Article  PubMed  Google Scholar 

  • Blanchard, R. (1985). Typology of male-to-female transsexualism. Archives of Sexual Behavior, 14, 247–261.

    Article  PubMed  Google Scholar 

  • Blanchard, R. (1989). The classification and labeling of nonhomosexual gender dysphorias. Archives of Sexual Behavior, 18, 315–334.

    Article  PubMed  Google Scholar 

  • Bockting, W., Benner, A., & Coleman, E. (2009). Gay and bisexual identity development among female-to-male transsexuals in North America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38, 688–701.

    Article  PubMed  Google Scholar 

  • Bodlund, O., Kullgren, G., Sundbom, E., & Höjerback, T. (1993). Personality traits and disorders among transsexuals. Acta Psychiatrica Scandinavica, 88, 322–327.

    Article  PubMed  Google Scholar 

  • Bolin, A. (1994). Transcending and transgendering: Male-to-female transsexuals, dichotomy and diversity. In G. Herdt (Ed.), Third sex, third gender: Beyond sexual dimorphism in culture and history (pp. 447–485). New York: Zone Books.

    Google Scholar 

  • Bullough, B., & Bullough, V. L. (1998). Transsexualism: Historical perspectives, 1952 to present. In D. Denny (Ed.), Current concepts in transgender identity (pp. 15–34). New York: Garland Publishing.

    Google Scholar 

  • Chivers, M. L., & Bailey, J. M. (2000). Sexual orientation of female-to-male transsexuals: A comparison of homosexual and nonhomosexual types. Archives of Sexual Behavior, 29, 259–278.

    Article  PubMed  Google Scholar 

  • Clara, I., Cox, B., Enns, M., Murray, L., & Torgrud, J. (2003). Confirmatory factor analysis of the Multidimensional Scale of Perceived Social Support in clinically distressed and student samples. Journal of Personality Assessment, 81, 265–270.

    Article  PubMed  Google Scholar 

  • Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53–69.

    Article  PubMed  Google Scholar 

  • Cochran, S. D., Sullivan, J. G., & Mays, V. M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay and bisexual adults in the United States. Journal of Consulting and Clinical Psychology, 71, 53–61.

    Article  PubMed  Google Scholar 

  • Cohen-Kettenis, P. T., & Gooren, L. J. G. (1999). Transsexualism: A review of etiology, diagnosis, and treatment. Journal of Psychosomatic Research, 46, 315–333.

    Article  PubMed  Google Scholar 

  • Cole, C. M., O’Boyle, M., Emory, L. E., & Meyer, W. J. (1997). Comorbidity of gender dysphoria and other major psychiatric diagnoses. Archives of Sexual Behavior, 26, 13–26.

    Article  PubMed  Google Scholar 

  • Coleman, E., & Bockting, W. O. (1988). Heterosexual prior to sex reassignment, homosexual afterwards: A case study of a female-to-male transsexual. Journal of Psychology and Human Sexuality, 1, 69–82.

    Article  Google Scholar 

  • Coleman, E., & Bockting, W. O. (1991). A comment on the concept of transhomosexuality, or the dissociation of the meaning. Archives of Sexual Behavior, 20, 419–421.

    Article  PubMed  Google Scholar 

  • Coleman, E., Bockting, W. O., & Gooren, L. (1993). Homosexual and bisexual identity in sex-reassigned female-to-male transsexuals. Archives of Sexual Behavior, 22, 37–50.

    Article  PubMed  Google Scholar 

  • Daskalos, C. T. (1998). Changes in the sexual orientation of six heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.

    Article  PubMed  Google Scholar 

  • De Cuypere, G., Janes, C., & Rubens, R. (1995). Psychosocial functioning of transsexuals in Belgium. Acta Psychiatrica Scandinavica, 91, 180–184.

    Article  PubMed  Google Scholar 

  • de Vries, A. L., Steensma, T. D., Doreleijers, T. A., & Cohen-Kettenis, P. T. (2011). Puberty suppression in adolescents with gender identity disorder: A prospective follow-up study. Journal of Sexual Medicine, 8, 2276–2283.

    Article  PubMed  Google Scholar 

  • Denny, D., Green, J., & Cole, S. (2007). Gender variability. In A. F. Owens & M. S. Tepper (Eds.), Sexual health (Vol. 4, pp. 153–187). Westport, CT: Praeger.

    Google Scholar 

  • Devor, H. (1993a). Sexual orientation identities, attractions and practices of female-to-male transsexuals. Journal of Sex Research, 30, 303–315.

    Article  Google Scholar 

  • Devor, H. (1993b). Toward a taxonomy of gendered sexuality. Journal of Psychology and Human Sexuality, 6, 23–55.

    Article  Google Scholar 

  • Devor, A. (1997a). More than manly women: How female-to-male transsexuals reject lesbian identities. In B. Bullough, V. L. Bullough, & J. Elais (Eds.), Gender blending (pp. 146–157). Amherst, NY: Prometheus.

    Google Scholar 

  • Devor, A. (1997b). FTM: Female-to-male transsexuals in society. Bloomington, IN: Indiana University Press.

    Google Scholar 

  • Devor, A. (2004). Witnessing and mirroring: A fourteen stage model of transsexual identity formation. Journal of Gay and Lesbian Psychotherapy, 8, 41–67.

    Google Scholar 

  • Diamond, L. M. (2001). What does sexual orientation orient? A biobehavioral model distinguishing romantic love and sexual desire. Psychological Review, 110, 173–192.

    Article  Google Scholar 

  • Diamond, M. (2002). Sex and gender are different: Sexual identity and gender identity are different. Clinical Child Psychology and Psychiatry, 7, 320–334.

    Article  Google Scholar 

  • Diamond, L. M. (2005). A new view of lesbian subtypes: Stable versus fluid identity trajectories over an 8-year period. Psychology of Women Quarterly, 29, 119–128.

    Article  Google Scholar 

  • Diamond, L. M. (2008). Sexual fluidity: Understanding women’s love and desire. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Diamond, L. M., & Butterworth, M. (2008). Questioning gender and sexual identity: Dynamic links over time. Sex Roles, 59, 365–376.

    Article  Google Scholar 

  • Diamond, L. M., Pardo, S. T., & Butterworth, M. R. (2011). Transgender experience and identity. In S. J. Schwartz, K. Luyckx, & V. L. Vignoles (Eds.), Handbook of identity theory and research (Vol. 2, pp. 629–647). New York: Springer.

    Chapter  Google Scholar 

  • dickey, l., Burnes, T., & Singh, A. (2012). Sexual identity development of female-to-male transgender individuals: A grounded theory inquiry. Journal of LGBT Issues in Counseling, 6, 118–138.

  • DiPlacidio, J. (1998). Minority stress among lesbians, gay men, and bisexuals: A consequence of heterosexism, homophobia, and stigmatization. In G. M. Herek (Ed.), Stigma and sexual orientation. Understanding prejudice against lesbians, gay men, and bisexuals: Psychological perspectives on lesbian and gay issues (Vol. 4, pp. 138–159). Thousand Oaks, CA: Sage.

  • Dozier, R. (2005). Beards, breasts, and bodies: Doing sex in a gendered world. Gender and Society, 19, 297–316.

    Article  Google Scholar 

  • Dreger, A. (2008). The controversy surrounding The man who would be queen: A case history of the politics of science, identity, and sex in the Internet age. Archives of Sexual Behavior, 37, 366–421.

    Article  PubMed  Google Scholar 

  • Drescher, J. (2010). Queer diagnoses: Parallels and contrasts in the history of homosexuality, gender variance, and the Diagnostic and Statistical Manual. Archives of Sexual Behavior, 39, 427–460.

    Article  PubMed  Google Scholar 

  • Feinberg, L. (1996). Transgender warriors. Boston, MA: Beacon Press.

    Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Beautrais, A. L. (1999). Is sexual orientation related to mental health problems and suicidality in young people? Archives of General Psychiatry, 56, 876–880.

    Article  PubMed  Google Scholar 

  • Fox, R. (2003). Bisexual identities. In L. Garnets & D. Kimmel (Eds.), Psychological perspectives on lesbian, gay, and bisexual experiences (pp. 86–127). New York: Columbia University Press.

    Google Scholar 

  • Gamson, J. (1995). Must identity movements self-destruct? A queer dilemma. Social Problems, 42, 390–407.

    Article  Google Scholar 

  • Gomez-Gil, E., Zubiaurre-Elorza, L., Esteva, I., Guillamon, A., Godas, T., Almaraz, M. C., et al. (2012). Hormone-treated transsexuals report less social distress, anxiety and depression. Psychoneuroendocrinology, 37, 662–670.

    Article  PubMed  Google Scholar 

  • Green, J. (2004). Becoming a visible man. Nashville, TN: Vanderbilt University Press.

    Google Scholar 

  • Halberstam, J. (1998). Female masculinity. Durham, NC: Duke University Press.

    Google Scholar 

  • Hepp, U., Kraemer, B., Schnyder, U., Miller, N., & Delsignore, A. (2005). Psychiatric comorbidity in gender identity disorder. Journal of Psychosomatic Research, 58, 259–261.

    Article  PubMed  Google Scholar 

  • Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56, 32–43.

    Article  Google Scholar 

  • Hines, S. (2007). TransForming gender: Transgender practices of identity, intimacy and care. Bristol, England: Policy Press.

    Google Scholar 

  • Hoshiai, M., Matsumoto, Y., Sato, T., Ohnishi, M., Okabe, N., Kishimoto, Y., et al. (2010). Psychiatric comorbidity among patients with gender identity disorder. Psychiatry and Clinical Neurosciences, 64, 514–519.

    Article  PubMed  Google Scholar 

  • Johansson, A., Sundbom, E., Hojerback, T., & Bodlund, O. (2010). A five-year follow up study of Swedish adults with gender identity disorder. Archives of Sexual Behavior, 39, 1429–1437.

    Article  PubMed  Google Scholar 

  • Kenagy, G. (2005). Transgender health: Findings from two needs assessment studies in Philadelphia. Health and Social Work, 30, 19–26.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2004). Autogynephilia: A paraphilic model of gender identity disorder. Journal of Gay and Lesbian Psychotherapy, 8, 69–87.

    Google Scholar 

  • Lawrence, A. A. (2007). Becoming what we love: Autogynephilic transsexualism conceptualized as an expression of romantic love. Perspectives in Biology and Medicine, 50, 506–520.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A. (2008). Gender identity disorders in adults: Diagnosis and treatment. In D. L. Rowland & L. Incrocci (Eds.), Handbook of sexual and gender identity disorders (pp. 423–456). Hoboken, NJ: John Wiley.

    Google Scholar 

  • Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases for typologies (subtypes) of gender identity disorder in adolescents and adults. Archives of Sexual Behavior, 39, 514–545.

    Article  PubMed  Google Scholar 

  • Lawrence, A. A., & Zucker, K. J. (2012). Gender identity disorders. In M. Hersen & D. C. Beidel (Eds.), Adult psychopathology and diagnosis (6th ed., pp. 601–635). Hoboken, NJ: John Wiley.

    Google Scholar 

  • Lev, A. I. (2004). Transgender emergence: Counseling gender-variant people and their families. Binghamton, NY: Haworth Press.

    Google Scholar 

  • Lev, A. I. (2005). Disordering gender identity: Gender identity disorder in the DSM-IV-TR. Journal of Psychology and Human Sexuality, 17, 35–69.

    Article  Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995a). Manual for the Depression Anxiety Stress Scales (2nd ed.). Sydney, Australia: Psychology Foundation.

    Google Scholar 

  • Lovibond, P. F., & Lovibond, S. H. (1995b). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–343.

    Article  PubMed  Google Scholar 

  • Luther, E., Sanchez, F. J., Gaser, C., Toga, A., Narr, K., Hamilton, L., et al. (2009). Regional gray matter variation in male-to-female transsexualism. Neuroimage, 46, 904–907.

    Article  Google Scholar 

  • McLaren, S., Jude, B., & McLachlan, A. J. (2007). Sexual orientation, sense of belonging and depression in Australian men. International Journal of Men’s Health, 6, 259–272.

    Article  Google Scholar 

  • Meier, S., Fitzgerald, K., Pardo, S., & Babcock, J. (2011). The effects of hormonal gender affirmation treatment on mental health in female-to-male transsexuals. Journal of Gay and Lesbian Mental Health, 15, 281–299.

    Article  Google Scholar 

  • Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.

    Article  PubMed  Google Scholar 

  • Meyer, W., Bockting, W., Cohen-Kettenis, P., Coleman, E., DiCeglie, D., Devor, A., et al. (2001). The Harry Benjamin International Gender Dysphoria Association’s Standards of Care for Gender Identity Disorders sixth version. Retrieved from http://www.wpath.org/publications_standards.cfm.

  • Meyerowitz, J. (2002). How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Newfield, E., Hart, S., Dibble, S., & Kohler, L. (2006). Female-to-male transgender quality of life. Quality of Life Research, 15, 1447–1457.

    Article  PubMed  Google Scholar 

  • Nuttbrock, L., Bockting, W., Mason, M., Hwahng, S., Rosenblum, A., Macri, M., et al. (2011). A further assessment of Blanchard’s typology of homosexual versus non-homosexual or autogynephilic gender dysphoria. Archives of Sexual Behavior, 40, 247–257.

    Article  PubMed  Google Scholar 

  • Pauly, I. (1974). Female transsexualism, Part I. Archives of Sexual Behavior, 3, 487–508.

    Article  PubMed  Google Scholar 

  • Rachlin, K. (1999). Factors which influence individual’s decisions when considering female-to-male genital reconstructive surgery. International Journal of Transgenderism, 3, http://www.iiav.nl/ezines/web/IJT/97-03/numbers/symposion/ijt990302.htm.

  • Rachlin, K., Hansbury, G., & Pardo, S. T. (2010). Hysterectomy and oophorectomy experiences of female-to-male transgender individuals. International Journal of Transgenderism, 12, 155–166.

    Article  Google Scholar 

  • Ross, L., Dobinson, C., & Eady, A. (2010). Perceived determinants of mental health for bisexual people: A qualitative examination. American Journal of Public Health, 100, 496–502.

    Article  PubMed  Google Scholar 

  • Rosser, B. R., Oakes, J. M., Bockting, W., & Miner, M. (2007). Capturing the social demographics of hidden sexual minorities: An internet study of the transgender population in the United States. Sexuality Research and Social Policy, 4, 50–64.

    Article  Google Scholar 

  • Rubin, N. (1975). The traffic of women: Notes on the political economy of sex. In R. R. Reiter (Ed.), Toward an anthropology of woman (pp. 157–210). New York: Monthly Review Press.

    Google Scholar 

  • Ryan, C., Huebner, D., Diaz, R. M., & Sanchez, J. (2009). Family rejection as a predictor of negative health outcomes in White and Latino lesbian, gay, and bisexual young adults. Pediatrics, 123, 346–352.

    Article  PubMed  Google Scholar 

  • Sandfort, T. G., de Graaf, R., Bijl, R. V., & Schanbel, P. (2001). Same-sex sexual behavior and psychiatric disorders: Findings from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). Archives of General Psychiatry, 58, 85–91.

    Article  PubMed  Google Scholar 

  • Savin-Williams, R. C. (2006). Who’s gay? Does it matter? Current Directions in Psychological Science, 15, 40–44.

    Article  Google Scholar 

  • Schilt, K. (2009). Just one of the guys? Gender and Society, 20, 465–490.

    Article  Google Scholar 

  • Schleifer, D. (2006). Make me feel mighty real: Gay female-to-male transgenderists negotiating sex, gender, and sexuality. Sexualities, 9, 57–75.

    Article  Google Scholar 

  • Smith, Y., van Goozen, S., Kuiper, A., & Cohen-Kettenis, P. T. (2005). Transsexual subtypes: Clinical and theoretical significance. Psychiatry Research, 137, 151–160.

    Article  PubMed  Google Scholar 

  • Sullivan, L. (1990). Information of the female to male cross-dresser and transsexual. Seattle, WA: Ingersoll Gender Center.

    Google Scholar 

  • Swaab, D. F. (2004). Sexual differentiation of the human brain: Relevance for gender identity, transsexualism, and sexual orientation. Gynecological Endocrinology, 19, 301–312.

    Article  PubMed  Google Scholar 

  • Valentine, D. (2007). Imagining transgender: An ethnography of a category. Durham, NC: Duke University Press.

    Google Scholar 

  • Vrangalova, Z., & Savin-Williams, R. C. (2012). Mostly heterosexual and mostly gay/lesbian: Evidence for new sexual orientation identities. Archives of Sexual Behavior, 41, 85–101.

    Article  PubMed  Google Scholar 

  • Ware, J. E. (2003). Conceptualization and measurement in health-related quality of life: Comments on an evolving field. Archives of Physical Medicine and Rehabilitation, 84, 43–51.

    Article  Google Scholar 

  • Ware, J., Kosinski, M., & Dewey, J. (2000). How to score version 2 of the SF-36 health survey. Lincoln, RI: QualityMetric Incorporated.

    Google Scholar 

  • Ware, J., Kosinski, M., & Keller, S. (1994). SF-36 ® Physical and Mental Health Summary Scales: A User’s Manual. Boston, MA: The Health Institute.

    Google Scholar 

  • Whisman, M. (2008). Adapting cognitive therapy for depression: Managing complexity and comorbidity. New York: Guilford Press.

    Google Scholar 

  • Wilson, K. K. (2000). Gender as illness: Issues of psychiatric classification. In E. Paul (Ed.), Taking sides: Clashing views on controversial issues in sex and gender (pp. 31–38). Guilford, CT: Dushkin McGraw-Hill.

    Google Scholar 

  • Winters, K. (2007). Issues of GID diagnosis for transsexual women and men. Retrieved online from GID Reform Advocates: http://www.gidreform.org/GID30285a.pdf.

  • Xavier, J., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered people of color living in Washington, DC. International Journal of Transgenderism, 8, 31–47.

    Article  Google Scholar 

  • Zimet, G., Dahlem, N., Zimet, S., & Farley, G. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52, 30–41.

    Article  Google Scholar 

  • Zucker, K. J., Bradley, S. J., Owen-Anderson, A., Kibblewhite, S. J., Wood, H., Singh, D., et al. (2012). Demographics, behavior problems, and psychosexual characteristics of adolescents with gender identity disorder or transvestic fetishism. Journal of Sex and Marital Therapy, 38, 151–189.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the Graduate Student Research Proposal Award from the Texas Psychological Foundation, the Student Research Award from the LGBT Special Interest Group of the Association of Behavioral and Cognitive Therapies, and the Peggy Rudd scholarship from the Houston Transgender Unity Committee. The authors would like to thank Dr. Carla Sharp for her thoughtful comments throughout the revision process.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to S. Colton Meier.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Meier, S.C., Pardo, S.T., Labuski, C. et al. Measures of Clinical Health among Female-to-Male Transgender Persons as a Function of Sexual Orientation. Arch Sex Behav 42, 463–474 (2013). https://doi.org/10.1007/s10508-012-0052-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10508-012-0052-2

Keywords

Navigation