Table of Contents of Book |

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Table of Contents of Book

List of Tables	xiii
List of Figures	xv
Foreword by Eli Coleman	xvii
Acknowledgments	xix
Introduction	xxiii
1. Beyond Vocabulary	1
Words Are Meaningful	2
Exactly What Do We Mean by Transgender	3
Crossdressers	5
The Middle Ground	6
The Other End of the Spectrum	7
Square Pegs, Round Holes	8
Degrees of Intensity of Transgender Feelings	8
The Ability and Need to Pass	9
Being Transgender Is Only One Part of a Larger Picture	11
Everyone Has a Personality	12
Labels—Sometimes Efficient but Never Without a Cost	13
The Beginning of Gender Self-Discovery	15
Sexual Orientation and Gender Identity	18
Who Has Been Paying Attention to Sexual Orientation?	19
Asking the Experts	21
Is It a Question of Morality?	21
The Debate Goes On	22
Social Gender Role, as Opposed to Gender Identity	23
Are Transgender People Just Trying to Get Attention?	24
The Search for a Definition of Self	25
The Standards of Care	27
The Standards of Care as a Focus of Controversy	28
Transgender People Need to Have Hope	30
The Transgender Person May Be Possessive of Her Closet	32
He May Hold on to the Hope that He Will Outgrow It	32
The Meaning of the Terms Masculine and Feminine	34
Being Different Is Difficult	35
Learning From Martin Luther King Jr.	36
The Loneliness of a Transgender Child	37
When and How Does Awareness of Transgender Identity Emerge?	38
Professional Self-Monitoring	39
The SOCs Do Not Offer Guidance for Every Case	39
Knowing About Alternatives	39
Finding Creative Solutions	42
Living One Day at a Time	43
2. Sex and Gender	45
Western Culture—Too Smart for Its Own Good?	45
Sex Designation	46
Reasons for Conducting This Research Project	47
A Transition Story	49
Therapy for People Who Do Not Have a Diagnosis	51
The Effect of the Gatekeeper Role	53
The God Complex	54
The Health Insurance Portability and Accountability Act (HIPAA)	57
When People Are Too Young to Speak for Themselves	57
The Basis for Defining Sexual Orientation	58
The Importance of Genitals	59
What Does the Literature Say About Sexual Orientation in Transgender People?	60
Transgender People Prior to 1948	61
Outliers	62
Autogynephilia: A Concept That May Have Been Carried Too Far	63
Other Points of View	65
Different Is Only Different, Not Necessarily Better or Worse	67
On a Personal Note	68
The Minnesota Model	69
3. The Birth of the Research Project at Hand	71
The People Who Were Studied	71
Becoming More Objective About Transgender Clients	74
Preserving Privacy	75
Exclusions	77
Willingness to Talk About Sexual Orientation	79
Meaningful Diagnosis and Changing Sexual Orientation	80
The Cyber Revolution	81
Saying the Word Sex	81
4. Findings About Sexual Orientation in MTF Transgender People	85
The Comparisons	85
The Role of Age	85
Religion	87
Marital Status and Living Situation	91
The Implications of Marriage	93
Can Falling in Love Be the Cure?	95
Avoiding Transgender Identity in Self	95
Age at First Memory Related to Being Transgender	96
The Approach to Therapy	97
Length of Time in Therapy	99
The Uniqueness of the Transgender Path	101
New Shoes	101
Experience With Transgender Expression	103
Primary Sexual Fantasy	105
Gender Identity	106
Self-Defined Sexual Orientation	107
Puberty Revisited	109
The Outliers	111
When Is a Change Really a Change?	111
The Perceived Power of Hormones	112
Considerations Other Than Therapy	112
Genital Reconstruction Surgery	113
5. Approaches to Therapy With Transgender Clients	117
Is There Really No One or Nothing to Blame?	118
Crossdressing Among Non-crossdressers	119
Assessing for Co-existing Conditions	121
Treating Co-occurring Diagnoses	121
What Price Would a Person Be Willing to Pay for Gender Congruity?	123
The Stress of Daily Life	124
The Need to Belong	125
Current Risk for Suicide	126
Current Risk for Life Crisis	126
Pacing the Therapy	127
Determining the Current Status of the Client	129
Knowledge and Experience	129
Steps Already Taken	132
The Thorny Issue of Hormones via the Internet	133
Dealing With the Gatekeeper Role	134
6. Transgender Children and Transgender Parents	137
The Transgender Child	138
When Parents Want a Therapist to Fix Their Child	140
A Child Is Not a Free Agent	142
The Colombo Approach to Therapy	143
Is Anatomy Destiny?	144
Magical Thinking Is Like Wishing on a Star	145
Just Who Is the Opposite Sex?	146
Being Different Can Be Good	147
Choosing a New Name	159
The Role of Geographic Location	151
Children and Transgender Adults	152
Children of Divorce	154
Becoming an Expert	154
7. Wives and Partners	159
“I Don’t Know Where I’m Going, but Please Come With Me”	159
A Transgender Person May Wonder If It Is Too Late	161
Emotional Energy as a Limited Resource	162
Bargaining and Avoidance	163
Wives of Crossdressers	164
When Other People Ask, “Are You Going to Get a Divorce?”	171
8. Some Further Comments on Transgender and Findings of the Current Research	173
The Uniqueness of the Transgender Path	173
Experience With Transgender Expression	174
Feminizing the Voice	174
Do Clothes Make the Woman?	175
Defining Community	175
Taking the Risk to Explore Gender Expression	176
The Role of Hormones	177
Generational Differences	177
Disclosures That Are Withheld or That Come Belatedly	178
The Pattern of Hormone Use	180
A Brave New World	181
The Individuality of Self	182
Feminine Heart—Masculine Voice	182
Other Subtleties of Speech	183
Sexual Fantasies and Partner Preference	184
How Gender Identity Influenced Sexual Orientation	186
The Importance (or Lack Thereof) of Outward Appearance	187
Cultural Influences	188
First Awareness of Being Different	189
Sexual Orientation Begins With “Who Am I?”	191
To Enjoy One’s Own Gender Is Normal	192
The Desire to Be Pretty	194
Puberty Revisited	195
Intentions Regarding Genital Reconstruction Surgery	196
Medical Contraindications for GRS	197
Weighing the Risk Factors	197
No Immunity for Transgender People	197
Cost Versus Benefit	198
An Unanticipated Reaction to Genital Surgery	199
Cause-and-Effect Relationships	200
The Relationship to Finances	200
Which Reasons for GRS Are Valid?	201
Summing up the Beginning to Notice Attractive Men	202
9. Where Do We Go From Here	205
A New Beginning	205
Tracking When There Is No Paper Trail	207
Living in Stealth	208
The Diversity of Crossdressers	209
Discovering the Real Truth	210
More Limitations	211
Waiting Until One’s Body Is “Right”	212
Beyond Semantics	213
Avoiding Misinterpretation	214
Appendix A: Mental Health Evaluation Checklist for Transgender Clients	219
Appendix B: Basic Data Sheet	223
Appendix C: More About Methods	229
Appendix D: More About Data and Findings	235
Appendix E: Internet Resources	255
Annotated Bibliography	257