FTM: Female-to-Male Transsexuals in Society.

FTM: Female-to-Male Transsexuals in Society. By Holly Devor. Bloomington, IL: Indiana University Press, 1997, 695 pages. Cloth, $49.95.

This publication has been long awaited in the transgender community. It is the first substantial research effort to address the life experiences of female-to-male (FTM) transsexual individuals through oral and written history interviews. While acknowledging the limited demographic composition of the respondents, the relatively small sample size, and weaknesses encountered in the interviewing process, Devor offers the most comprehensive investigation to date of FTM lifespan experiences with family, peers, school, physical health, relationships, gender issues, transsexual identity development, sex and sexuality, and transgender health care and related surgeries. This book captures much of the essence and uniqueness of the FTM journey by presenting a delicate balance of sociological analysis, social perception, facts, style, history, and feminism presented in an easy to read format. The author reveals difficult truths and inspires the need for future study and greater societal humility. Descriptions of the importance of gender sensitive language effectively reminds the reader of societal insensitivity toward language that stigmatizes. This project identifies, describes, and theorizes the life experiences of individuals who initially identify themselves as part of a social category which they perceive as socially incongruous, who then begin the process of redefining their lives in every possible way to be credible and to appear and function as though they originated in that social grouping. The reader gains a deeper appreciation of diversity and greater understanding of their own self.

Historical Perspective

Devor has a keen sense of ancient and recent historical roots pertaining to life experiences and social standards imposed on women, which necessitates the secret existence of FTM individuals. Ancient history reveals that women were thought of as less important, and they were therefore less recorded in social writings. A summary review of the social/religious values of Greek/Roman Classical history, Judaism, early Christianity, and medieval times through the twentieth century prepares the reader to understand the impact made by Christine Jorgenson in the 1950s when she entered the newsbreaking social stream as the first publicized post-surgical male-to-female transsexual.

Native cultures have always contained third gender or mixed gender individuals, largely based on polytheistic spiritual beliefs. The first contacts in America were in the seventeenth century, although written evidence did not appear until the eighteenth century. Most writings traditionally focused on those classified as "female men." Wars and industrial technology in the twentieth century placed women in the workplace, only to force them back to domesticity when men returned. During this time "inverts," women who partially crossdressed, were identified as lesbians (mannish women), a description which later included feminine women who selected other women as sexual partners. The early work of such scholars and scientists as Krafft-Ebing, Ellis, and Herschfeld mark the emergence of a transgendered presence in the culture.

Although oral and recorded history indicates that the transgender presence has always existed, only in recent history have efforts been made to diagnose and treat this condition. Science has established the differences between men and women and recognized psychological and social influences. There now seems to be an emerging and evolving struggle to discover a biological cause and to medicalize the transsexual condition.

Theories about Transsexualism 

Devor is not interested in just the cause of transsexualism, although psychological and biological origins are of great importance. The social context and environment in which transsexualism is experienced is an important focus in understanding the impact and influence that culture, mores, values, and rules of normalcy have on those trying to live their own unique lives. Describing the current structure of society in which transgendered individuals live, Devor states: "At best they represent averages and approximations; at worst they function as rigid delineations which have been forced onto the rich diversity that is human life" (pg. 37). To date, most research on these topics has focused on male-to-female transsexuals (MTF). Devor emphasizes the need to recognize and question how the experiences of FTM individuals might be the same or different from MTF individuals. Because the concept of transsexualism as a public presence has only been acknowledged in any meaningful way since the 1950s, it remains virtually unknown and misunderstood in contemporary society. However, theorists agree that persons who claim the title of transsexual have been present through all time and all cultures. The difference today is that medical and surgical technologies are now available to them. A vivid review of existing theories and differences of opinion among researchers and authors gives the reader an awareness of the complexity in understanding transsexualism.

Stage theories and theoretical models abound and are briefly described, highlighting their similarities and differences, as well as noticing that most apply in concept to MTF. Awareness, information, and comparisons of FTM experiences are fewer and not fully understood. New developments, discoveries, technologies, and social wisdom are still anticipated.

Most theories to date imply that family dynamics and experiences are casual to FTM transsexualism. The psychological theories of transsexualism are discussed in readable terms, highlighting the works of Stoller, Green, Lothstein, Bradley, and Zucker. Most theories described identify grandparents and parents as primary influences in shaping and developing the female child into transgender adulthood and towards sex reassignment surgery. Fathers who are kind to their daughters, who are strongly masculine and aggressive, and who impart the message that being female is less than optimal, together with mothers who are unavailable to nurture their daughters, who are unpleasant, vulnerable, weak, or victimized, create the final formula for transsexual transition of the FTM individual from a sociologic and psychologic perspective. A partial personality split at a time of difficulty in self-development within the family is yet another theory.

Biologic theories are also reviewed, exploring genetics, "nature/critical period/nurture," recent research on homosexuality, twin studies, H-Y antigen status, various brain structures, and hormonal differences. Recent research on developmental determinism is also examined.

Devor suggests that probably no one theory will prevail; that biological causes may be present in some; that in most cases, family dynamics play a large part in development; and most importantly that "transsexualism exists because the natural world thrives on diversity" (pg. 67). She rejects the notion that FTM transsexual individuals are pathologically ill. Reviewing the historical and contemporary perspective and knowledge of transsexualism helps facilitate the reader's sensitivity to the illustrative and anecdotal personal stories and life truths which constitute a significant part of this publication.

The Developmental Years

In a descriptive delineation of childhood, adolescent and early adult growth and maturational years, and using social theory and research findings as a basis for discussion, Devor carefully illuminates the differences between general gender identity acquisition and the real life experiences of individuals who are FTM gender transitioned. Of particular interest is the information from Devor's research data which suggests a disproportionate number of participants experienced traumatic family disruption or losses and extreme personal stresses during early years. However, Devor does not imply that these experiences create psychological illnesses, only that they may have influenced the shaping of gender identity for those individuals. This implied difference is critical to contemporary thinking.

Personal testimonies of life experiences as these individuals move through the developmental years of gender formation follow. Devor's oral histories support previous transsexual theoretical concepts of awareness in early childhood that one's biologic sex was not desired and, in fact, was not what one wanted to be. This usually coincided with a deep-seated conflict with mother and what she represented to the child. These anecdotes acknowledge feelings of being rejected by mother and turbulence in the family concurrent with awareness of gender conflict, with clear alienation from identification with femininity as the overriding theme. Men and boys in the family served as the true social and cultural role models, even relationships infused with "fear or violence or antagonism."

Acknowledging that evidence is inconclusive, Devor identifies from this research that familial socialization dynamics strongly influence gender identity dysphoria but, rather than being causal in nature, it may be that families simply respond to an innate predisposition toward masculinity in girls. This research explores and supports the fact that masculine gender behavior is a major influence in choice of friends and activities in relationships beyond the family. The challenging years of adolescence reflect the undeniable experiences of natural changes in the body through puberty and middle and late adolescence, with the combined challenge of acquiring the skills of adulthood and attaining emotional independence. It is generally recognized as a time of insecurity, risk taking, and building adult skills, while learning "to live within the contours of their new bodies."

Societal expectations of heterosexuality are keenly experienced by adolescent girls, as are increasing pressures toward femininity and away from tomboy activities. Societal pressures mount at this time for masculine-identified girls, resulting in social punishment such as ridicule, shame, and stigma for not becoming feminine, which in turn create isolation and loneliness.

Sexuality

Detailed descriptions and discussions of vital developmental and physical issues in puberty, friendships, and relationships with adult women and men poignantly reflect the further separation of masculine-identified girls/women from other girls/women and serve to heighten their gender and sex dysphoria. Of particular interest is the depiction and discussion of adolescent sexuality and sexual exploration for the FTM transsexual-identified young girl. Incest, masturbation, heterosexual exploration, homosexual attractions, and major homosexual relationship experiences are presented in the context of societal expectation and gender-identity conflict. It is significant that two thirds of the research participants were romantically and sexually involved with women, supporting their own identity as males.

Devor discusses key factors in learning about sexuality as it relates to young FTM adolescents, noting that societal homophobia greatly influences and deters many from pursuing a sexual relationship with a woman until they achieved their transitions and became men. Few find much relief from the pressures and requirements of sexual and romantic relationships in our culture.

Early Adult Years

The early adult years of these women are spent in pursuit of community and the search for their own identities, which enable them to express themselves as naturally as possible, often finding themselves in lesbian communities and relationships. Excerpts from personal stories are sensitively presented, qualifying such experiences. Many, however, marry, have children, and try to comply with societal demands. Most depart from these heterosexual efforts to seriously pursue their own journey toward manhood and their true self identity, having exhausted their possibilities as women.

Medical Implications of Transition

The long, arduous journey of the final transition is perhaps the most difficult. Personal narratives reflect the struggle to obtain reasonable and safe medical and mental healthcare, revealing the lack of consistent, comprehensive services available. Many individuals creatively try to manage their own transitions without any assistance, with varying degrees of success. Compelling personal anecdotes from research participants reveal the challenges and relief experienced by finally deciding to transition.

The physiological changes desired by most individuals who are FTM transsexuals are more complicated and complex than those of MTF transsexuals. These changes include hormone reassignment, breast binding, breast reduction or removal, hysterectomy, and possible genital reassignment with varying possibilities of developing a phallus. Again, the personal anecdotes are poignant. Enormous financial costs involved in surgical transition prevent many from achieving their personal goals. The stories reflect the frustration of the limitations of FTM surgeries (less satisfactorily developed than MTF genital surgeries) as well as the months and years it takes for surgical transformation.

Such factors create further limitations in social situations, such as locker rooms, urinals, and the doctor's offices. However, these research respondents report that most are able to achieve their personal goals of living successfully and happily as men.

Post-Transition

After transition and successful presentation as a male, including varying degrees of surgery, this study reveals the most vulnerable and challenging experiences for the men were clearly the practice of their sexuality. Positive and tender personal participant stories reflect the importance of experiencing sexual validation from women or men who desire and choose to be with them in intimate situations.

The self-reported outcomes are positive and beneficial. The journey from life as a woman to life as a man enabled them to see two sides of gender in a way that is simply unavailable to all but the rarest of individuals. They indicated a special sensitivity to interpersonal dynamics and to reading emotional cues, thus enabling them to easily present as credible men in society and, in addition, to avoid sexist behavior toward women. Once transitioned, the reflections of those in this study are wistful and further illuminate their courage and dignity through the hardships and travails that scarred, tempered, and strengthened them.

Conclusion

In her conclusion, Devor discusses the complexity and challenges of FTM transsexualism and transition in a credible and carefully presented framework. She weaves a concept which includes sociological, behavioral, historical, developmental identity and process, sexuality, cultural environment, mores, and values. She actively refrains from biologic-deterministic leanings, noting that while they have merit, our society has a distinct leaning toward scientific justification, medicalization of the human condition, and the technologies available to respond.

Acknowledging the limitations of understanding this phenomena, Devor, as a sociologist, concentrates on the human condition of transsexual individuals as products of their social condition, "a perfect fit in an imperfect world" (pg. 589), challenging society to "make room for all people to fully express the tremendous diversity of gender and sex which people experience on their own" (pg. 586). She argues that the real struggle is fitting themselves into socially known categories in which they experience "abiding anxiety, identity confusion and identity comparison" (pg. 601) from which they made decisions to further transition as female-to-male transsexuals to transsexual men.

Devor's solid and articulate recommendations for future education, training, and service delivery of professionals are relevant, poignant, and timely, if not an obligation for us to prepare ourselves professionally to better assist this underserved community. The organizational presentation of this formidable work creates a clear picture of the intricate and complex aspects of the whole life-journey of the FTM transsexuals in this small study. Uncomplicated and descriptive language clarifies abstract concepts in life development, artistically inserting oral history anecdotes of the research participants to further illuminate the objectives. Presentation of known theories and models of transsexualism are carefully described, as is the historical grounding of contemporary thinking on the subject to date. However, the book never becomes so abstract that the reader is bored or distracted. It would be of interest to learn more about religious conflict with transsexualism, especially female-to-male, as well as how families accommodated the final transitions of these individuals. Also of interest would be discussion around parenting for those who parented as women and then transitioned. These topics alone would probably constitute another book by Dr. Devor.

This is the most comprehensive, professional book to date on FTM transsexualism and the many aspects of their life journeys. For its volume, this book is clearly understandable and reads without excessive use of scientific and academic rhetoric, thus making the book available to a broad audience. It is nonjudgmental, nonsensational, and provocative in its honesty, interpretation, and challenge to the future of societal opinion regarding FTM gender identity.

Dr. Devor is recognized and highly respected by both the academic community and the transgender community. Her work consistently challenges the social structure in which we live. Because this book addresses social history, theories, cultures, identity formation, developmental stages, sexuality, transitional stages, transsexualism, stigma, shame, disenfranchisement, and oral history--topics relevant to all helping professionals, theorists and researchers--this reviewer strongly recommends it as required reading. Not only does it demythologize and depathologize the contemporary social view, but it also provides the challenge of new, plausible perspectives.

Sandra S. Cole, Ph.D., University of Michigan Health Systems, Director, Comprehensive Gender Services Program, 1H221 University Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0050; email: [e-mail]