The Harry Benjamin Syndrome 2: The Scientific Basis

Jack Molay's picture

In this post I continue to the discussion of Rose White's book The Harry Benjamin Syndrome Comes of Age.

Continues from part 1.
She blinded me with science
Rose White argues that crossdressers and real transwomen (who she calls HBS) have nothing in common. The origins of the two conditions are completely different. While HBS transwomen have a natural brain based femininity, the crossdressers have not, she argues.
So what about the science White is pointing to? Does science really prove that HBS transwomen belong to a different race than crossdreamers who choose to transition?
White quotes an article by Zhou, Hofman, Gooren and Swaab from Nature 1997 (my emphasis):
"HBSS Harry Benjamin Syndrome Sufferers have strong feeling, often from childhood onwards, of having been born the wrong sex. - A female-sized BSTc was found in male-to-female HBS's -- the size was not influenced by sex hormones in adulthood and was independent of sexual orientation. - Investigation of genetics, gonads, genitalia or hormone levels have so far produced any results that explain HBS."
Those of you who have followed my Crossdreamer blog know about this research already. It does indeed indicate that gender dysphoria may be connected to a biological male having a female sized BSTc - a brain region reckoned to be associated withgender identity. However, I could not remember that the four authors had mentioned the Harry Benjamin Syndrome explicitly.
I checked. This is what the paper actually says (and it is from 1995, not 1997, my emphasis):
"Transsexuals have a strong feeling, often from childhood onwards, of having been born the wrong sex. The possible psychogenetic or biological aetiology of transsexuality has been the subject of debate for many years. Here we show that the volume of the central subdivision of the bed nucleus of the stria terminalis (BSTc), a brain area that is essential for sexual behaviour, is larger in men than in women. A female-sized BSTc was found in male-to-female transsexuals. The size of the BSTc was not influenced by sex hormones in adulthood and was independent of sexual orientation. Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones."
Zhou, Hofman, Gooren, Swaab: "A sex difference in the human brain and its relation to transsexuality." Nature 378, 68-70, 1995)
White has changed the text in order to make it look like these researchers support the use of the term Harry Benjamin Syndrome instead of the problematic word "transsexual". This is interesting, given that no official medical or psychiatric organisation anywhere in the world recognize the syndrome or use the label.
This method of rewriting research to make it look like the researchers are HBS supporters is not unique. Charlotte Goiar has added her own name to an article republished on her HBS site. According to online databases the article "Sexual differentiation of the human brain in relation to gender identity and sexual orientation," was written by DF Swaab and A. Garcia-Falgueras, and them only. Goiar puts up the following copyright notice: Copyright @ 2009, HBS International, Charlotte Goiar, Dr. Swaab, Dick F, and Dr. Alicia Garcia-Falgueras, CIC Edizioni Internatzionaly 2009.
Do Swaab & Co prove White right?
I have already discussed the research of Swaab & Co thoroughly in my post on What brain science says about M2F transsexuals. The short version is that this and later papers by the same group do not actually prove that the cause of transsexuality is biological. What the researchers have found is that one small part of the brain varies statistically in size according to biological sex. They do not know what this part does exactly, or if it truly is the seat of gender identity. It is far too early to tell.
However, even if some of these papers have methodological flaws, they -- and other new reports -- strongly indicate that transwomen are born with a brain with female characteristics. They are not made women by upbringing or the surrounding society.
I therefore willingly accept White's assertion that she has been a woman trapped in a man's body. She truly is a woman. The idea that her gender identity is culturally constructed or purely psychological is bogus.
I do not accept the other part of her argument, however, i.e. that this science proves that crossdressers and crossdreamers who have transitioned are not of the same kind.
The research does not compare TS with crossdreamers
First of all none of these researchers have deliberately set out to prove that crossdressers and crossdreamers (autogynephiliacs) have a regular male brain. You must document this if you want to prove that they are different from biological males with -- let's say -- a female sized BSTc.
The six transwomen Swaab & Co autopsied for their 1995 paper were not checked for HSB. They were dead and would not have been able to answer, anyway. All you can say is that they were M2F transwomen who had had sex reassignment surgery (or "sex affirmation surgery" to use White's term).
White agrees that a majority of those who transition are not HBS women. The chances are, therefore, that a majority of these six transwomen had been crossdreamers as well. If that is the case the paper could be said to have proved that crossdreaming has a biological basis.
White does not mention a later paper by Swaab & Co, where they look a related part of the brain, the INAH3. In this study they did check for sexual orientation, and found no differences between gynephilic transwomen and androphilic transwomen:

"In male-to-female subjects the number of neurons in the INAH3 does not seem to be related to sexual orientation, nor to the onset time of transsexuality, but rather to atypical early female-biased gender."

The researchers do open up for a discussion of subtypes of transsexual people, but note that it was impossible to do this in this study as most of the subjects were "non-homosexualearly onset male-to-female transsexual people". In this context "non-homosexual" means female oriented.

"Sex-atypical brain development in transsexual people may not only be dependent on the structure studied and the marker used, as discussed earlier, but it may also depend on the subgroup of transsexual individuals studied. Our sample was, however, mostly composed of non-homosexual early onset male-to-female transsexual people (Table 2), so a comparison of the different subtypes was not possible."
("A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity" by Alicia Garcia-Falgueras and Dick F. Swaab. Brain 2008: 131.)
Given that White requires real women to be androphilic, this means that the study confirms that at least some crossdreamers have a female brain, if we are to follow her definition.
Note also that in spite of what the paper says, the subjects were not "early onset" transsexuals. With the exception for one male oriented transwoman (who was 21 at the beginning of her hormone treatment), the rest were between 35 and 64. They were late bloomers, which White considers another sign of "autogynism" (crossdreaming).
This means that if we follow White's own logic, the researchers she is referring to in order to prove her case, have proven the exact opposite: The brains of the transpeople she so clearly detests are as feminine as her own.
No final proof
But please note: This is me following her own logic to its ironic conclusion. I want to see more research before I will conclude that there is conclusive proof for there being no difference between androphilic and gynephilic transwomen, brain wise. As a matter of fact, I am pretty sure there must be some such a difference. If not, why should one group be attracted to men and the other to women?
Nor have we seen the end of the discussion on whether this research proves that MTF transwomen are different from "regular men". When I look at the results from this study, that conclusion makes only sense on an aggregate level. Both the male control group and the MTF group have readings scattered all over the place. There are quite a few regular cismen with female sized INEH3, ciswomen with a male like number of neurons and MTFs on the male average. This is more in harmony with my own mixing table narrative of sex and gender, than the binary system of White.
Classic transsexual
White is an extremist. There are other"classic transsexual" women who accept that gynephilic transwomen can be considered real women. They do not accept crossdreamers and crossdressers as part of the same family, however. Nor are "feminine gay men" considered legitimate candidates for true womanhood.
The argument I have made vis-a-vis White's position also holds true also in their case. Since there is no way we can know the motives or the fantasies of the transwomen included in these scientific studies, we cannot exclude the possibility that there have been crossdressers and crossdreamers among them. Given that a majority of MTF transwomen transition late, the chances are that many of them have been crossdreamers (autogynephiles).
This means that we have no scientific proof for there being a difference between crossdreamer MTFs and "classical transsexuals" as regards brain structures. Some CT activists admit as much.
Different, but the same
This does not mean that there is no difference between crossdreamers who live like men and transwomen who have had SRS, however. Of course there is a difference! One lives as a man, the other as a woman. One tries to combine the experience of being a man with allowing himself to live out his inner woman. The other identifies completely with the experience of being a woman. She is a woman. I am not!
From the data I have available, it seems clear that the majority of crossdressers or crossdreamers do not consider transitioning. Although they recognize that they have a strong "inner woman", they also identify as men. They are not transwomen.
But some crossdreamers do identify as women, some from early childhood on. Others gradually come to the conclusion that they are women. They have the same right to be called women as the HBS separatists. They are not "perverts" or "fetishists"!
It is the attempts of HBS activists to reduce all of these trangendered people to perverted males, that provokes me. There is nothing in the scientific papers that confirms this position. And I also find it tragic to see that transwomen, who have fought so hard to become who they truly are, spend so much time on belittling others. It is unnecessary and destructive!
Next: Did Harry Benjamin really mean what White is saying?

Images from Some Like it Hot from 1959, with Marilyn Monroe and Tony Curtis and Jack Lemmon in drag.

A slightly different version of this article was originally posted over at the Crossdreamer blog.

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I have very little interest

Quiet Riot Girl's picture

I have very little interest in the 'science' of transexual and transgender identities as I am a social constructionist when it comes to gender and sexuality, but I adore that photo of marilyn Munroe and Tony Curtis! May he rest in peace, and may we all keep dreaming of who we wish to be...

The Harry Benjamin Syndrome 2: The Scientific Basis Read more:

Dear Jack, I found your article interesting but no different to other blogs on the internet that seem to always have the same theme, usually written by individuals that have not corrected the body nor wish to, but seem to think they may speak on behalf of or for, in some instances, those that actually have, two things that I found interesting in your piece and seem to be the angle of your writing.



 "Others gradually come to the conclusion that they are women. They have the same right to be called women as the HBS separatists. They are not "perverts" or "fetishists". 

Firstly,  there seems to be a movement of bloggers on the internet since 2007 when the long version of the AR variant and its relevance to female minded individuals born with transsexualism syndrome was proven.  Most of these blogs are written by people that seem adverse to the scientific advancements currently undertaken on trying to locate the exact cause of the intersex syndrome transsexualism, which is disheartening considering this condition has the highest suicide figures than any other medical condition.  While I agree with you in that some people with transsexualism due to an absence, lack of correct information or a hostile, unproductive environment can take years to find trustworthy professionals to diagnose and correct the ailment via corrective hormone replacement treatment, the removal of certain gonads and corrective genital surgery which over a period of time alters the genetic make up of the body to match the sex of the mind creating an endocrine that secretes hormones that work in conjunction with each other same as any other individual and no longer suffering from transsexualism (HBS)

That said, it is very difficult to follow your train of thought, in that an individual that has not corrected the endocrine can say that they are the same and have the same experiences as those that have, simply put and Dr Harry Benjamin did this extraordinary well given he did not have the scientific breakthroughs that we have today, in his writing The Transsexual Phenomenon he separated individuals that crossdress and individuals with Transvestism from those suffering from what he decided to call Transsexualism, which he went on to say should this ever be found to have an endocrine basis be renamed something more appropriate and so there are those that would honor Dr Harry Benjamin and his pioneering efforts in providing medical care to those that desperately sought it to have him remembered, hence Harry Benjamin Syndrome.


"It is the attempts of HBS activists to reduce all of these trangendered people to perverted males, that provokes me. There is nothing in the scientific papers that confirms this position. And I also find it tragic to see that transwomen, who have fought so hard to become who they truly are, spend so much time on belittling others. It is unnecessary and destructive!"

HBS is not a separatist group, it is a syndrome, there are all types of people that are born with syndromes and no two people are alike.  there is no such medical condition as transgenderism, there are those that crossdress usually a male, there is a condition called transvestism, then there are those that were born with the syndrome Dr Harry Benjamin referred to as Transsexualism (HBS) those that feel they are the opposite sex to the body they were born with and with good reason.

There are no trans men and trans women, there are women and men period, to call someone a trans person suggests that a child, which is what we are talking about after all, considering this syndrome occurs before birth, is not really who they are because their body got a signal to alter from female that the mind did receive or vice versa and the mind got the signal , in the future we can only hope that fetal scanning will improve as technology and medicine does and we may be able to prevent this syndrome from ever even happening.

Now considering that if you were to take all the men that cross dress because it is currently acceptable for women to wear clothes of the opposite sex, and it you were to take transvestites, all those that like to dress for pleasure erotic or not, then throw in drag queens, stage performers and then finally throw in those that suffer from the intersex transsexualism syndrome (HBS) paint everyone of these different groups under Charles Princes word transgender and look at that as 100%.  HBS only make up 5%.

The only reason Jack, that people born with HBS have had to fight for the right to have corrective surgery is because of the non existent association with Transvestites and transgenderists.

Separation IS necessary and is only destructive to the Transvestite on hormones that is not suffering has no problems with his genitalia but having the time of his life, he is the only catagory in this artificial association that loses and to be honest, if he is not about correcting the endocrine to match the mind then what is he doing taking hormones of the opposite sex?

Bye the way what in gods name is a Crossdreamer? Is that another Transvestite word like the pictures in your article.

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