The Shelton Agenda — Part 2
The Transgender Agenda
During the Marriage Equality campaign, Lyle Shelton hammered away on everything but two people marrying. Instead, it was all ‘consequences.’ Disastrous consequences for Australia if we were to allow loving same-sex couples to marry. One of these disastrous consequences, made by way of his daily tweet declarations, was of radical gender theory being mandated to be taught in schools where kids would be taught that their gender is actually gender fluid. He continues on post-marriage survey to spread these untruths, for both of those statements are wrong and ignorant. They are wrong scientifically, educationally and pedagogically.
But as a result, we now know the next social issues battle front for Shelton, the Australian Christian Lobby, conservative religious politicians and conservative commentators like Miranda Devine. It is gender and specifically, transgender people. Having lost the sexual orientation battle, conservative Christian fundamentalism has now moved on to gender as their do or die, dig in the trenches battle. And Shelton is leading the troops. After all, from his point of view, didn’t Genesis 5: 2 state, “He created them male and female, and He blessed them and named them Man in the day when they were created.” No mention of transgender there. Can’t be right then. God said so.
With so much misinformation being said about transgender people, and kids in particular, from Shelton, ‘concerned’ mums, political mums , the ACL and Marriage Alliance among others, I want to offer in summary form here what the latest scholarship is saying about transgender folk, as well as how psychology views treatment so that when you read the misinformation and exaggerated statements by Shelton and others, you will be able to easily identify them. So let’s get started.
Sex and Gender
Let’s start with the basics. Sex and gender are not the same thing.
Sex can be defined as one’s maleness or femaleness. From a scientific point of view, it is identified by secondary sexual characteristics (genitalia), genotype (the genetic constitution of an individual organism), and karyotype (the number and visual appearance of the chromosomes in the cell nuclei of an organism or species). Further, there is, what might be called, a neural sexing, ie., the sexing of the brain occurring in utero during the third trimester. Usually, humans are born with, or assigned, male or female genital characteristics. The vast majority of people are in this camp, around 98%.
However, we know now that it is not a simple binary. A good number of people are born as intersex, with either ambiguous genitalia or subtler forms of variations. Sometimes they have different patterns of X and Y chromosomes eg., a female can be born with single X chromosome (Turner’s Syndrome), a male can be born with an extra X chromosome as in XXY (Klinefelter Syndrome) leading to the development of breasts, wider hips and infertility. The best data reports intersex rates at around 1.7%, similar to the incidence of red hair (1–2%) in the population; a clearly not insignificant number (1).
To complicate this even further, but we should if we want to gain the fullest understanding possible, biological sex while being a real and concrete thing, still has an element about it where human beings make decisions about what is what.
Nature presents us with sex anatomy spectrums. Breasts, penises, clitorises, scrotums, labia, gonads — all of these vary in size and shape and morphology. So-called “sex” chromosomes can vary quite a bit, too. But in human cultures, sex categories get simplified into male, female, and sometimes intersex, in order to simplify social interactions, express what we know and feel, and maintain order. So nature doesn’t decide where the category of “male” ends and the category of “intersex” begins, or where the category of “intersex” ends and the category of “female” begins. Humans decide. Humans (today, typically doctors) decide how small a penis has to be, or how unusual a combination of parts has to be, before it counts as intersex. Humans decide whether a person with XXY chromosomes or XY chromosomes and androgen insensitivity will count as intersex (2).
Gender on the other hand is less anatomical, less biological, less hormonal. Gender is what we mean when we talk about masculinity or femininity. One of the wonderful lessons learned from the explosion of gay and lesbian presence in the modern world is the idea that there is more than one way to be masculine and more than one way to be feminine.
As a gay man, I have inherited the notion that I can be masculine in my own Stuart way. I don’t have to conform to the masculinity of my late father or my three straight brothers, or to the traditional Newcastle version of masculinity, which historically has been quite working class-informed, heteronormative, fairly blokey, anti-academic, and certainly not touchy-feely. A stereotype to be sure, but one based on a certain historic truth, and thankfully changing. But I am nothing like either of those versions of masculinity. In my version, I can be attracted to other men and can present myself in and to the world as a man in my own Stuart way, which I do, and still be perfectly masculine.
In fact, these days, we talk about masculinities — plural. And femininities — plural. And it is not remotely controversial to say that everybody knows someone who doesn’t quite fit the standard model: males supposed to be strong, confident, a man’s man, in control, less emotional, the bread-winner. And women supposed to be soft, tender, compassionate, caring, emotional, the homemaker. Wretched stereotypes! Yet we all know of soft heterosexual men who don’t like football or car engines, but like reading or even ballet and are interested in fashion and dressing nicely. And we know of heterosexual women who love digging, driving machinery, contact sport, are not so emotional and don’t give a fig about fashion. We laughed at first at the metrosexual of the 1990s but understood eventually that he had something important to say.
Let me say this again. There is more than one way to be masculine or feminine.
Gender as Construct
These multivarious versions of being masculine or feminine speak to the notion of gender. And gender we understand now is both socially and culturally constructed. It is different for different individuals, it is different for different groups and it is different across different ethnicities and nations.
Public affection can be a telling cue to local gender norms. When travelling in Korea, I saw young straight men who would sit together arm in arm to watch something on television, or walk down the street sometimes arm over the friend’s shoulder. You don’t see that so much in Australia, although it is slowly changing. Touch is almost a taboo between men in Australia unless it is on the sporting field or inside a family unit or rough-housing between school boys. Historically, it’s not seen as a particularly masculine thing to do here.
Not so in other cultures. In Europe, there is still the kiss on the cheek hello and goodbye between men. Saudi men touch each other freely in the daily course of affairs as do many men in Asian societies. Our concept of what is masculine, and feminine behaviour, is very much culturally bound. You can see this easily at any University by just watching how different nationalities navigate physical touch and intimacy in the public domain.
You can also see how gender plays out in gender roles, ie., the things that different genders are supposed to do, the particular behaviours they engage in. In Australia, men do the outside work, gardens, lawns, repairs, construction etc. It is the breadwinner gender role. Women do the laundry, grocery shopping, cooking, cleaning, child-rearing, the homemaker gender role. But I am describing here the Australia of the post-war era, the era when my parents were young adults, and a gender role system that lasted decades. But things have changed in the twenty-first century. These gender roles have significantly moved on from the 1950s so that men and women swap between gender roles quite freely now and there is even an expectation in society that this is how it should be, that individuals, families and households are better off this way.
So when Shelton talks about gender being biological, he is off the mark. He is conflating sex with gender. But they are not the same thing.
Gender is a complex construction strongly influenced by personal psychology, family ecology, social mores and cultural factors and falling within a continuum.
So not biological and not binary. And as we saw above, even sex is not binary. We human beings are complex creatures. The gay pride movement from the 1970s showed us that. Reproductively, I am not supposed to be attracted to men, but I am, yet I am not sick or deviant. My brain is wired this way for sexual orientation and it trumps any other factor that might be in play, including physiology, socialisation, religion, or personal belief systems. I’ll say something more about this a little further because it is a crucial point.
Now there is a great debate about the interface between sex and gender. Because sex is objectively more concrete, though as we have seen, not totally, and gender is more subjective, does that mean that sex trumps gender? You must conform your gender to your birth assigned sex. Who gets to make that call? Somebody other than yourself? Your family, the judge, the priest? Or is a person’s subjective experience, their personal psychology, at least equal in importance to their biological sex? If a man wants to wear a dress and lipstick because he enjoys the feeling it gives him, is he breaking some elemental rule of life? Should he be prevented? The way I feel and view my life subjectively seems to be perfectly legitimate in every other area of my life, so why should it not be the same in my sense of gender? If sex is the truth of the matter, then so is gender equally. Happily, for such an attitude is more open, inclusive and compassionate, this appears to be where society is increasingly heading.
Transgender and Non-Binary People
In the same way that a minority of people (gay/lebsbian/bi) do not share the sexual orientation experience of the majority (straight), it is now clear that a minority of people do not share the gender experience that clearly most of us do. The vast majority of people have a congruence between their sex and their gender, ie., the maleness or femaleness as assigned anatomically at birth and normatively accepted by society aligns with the way they navigate the world as male or female. However, for some, there appears to be an incongruence between assigned sexual characteristics and the subjective experience of their gender.
Some of these people feel that while anatomically male, they are female in their gender. Or vice versa. While some are anatomically female, they experience their gender as male. These folk we now call transgender.
However, it is even more complex than this, for some others again, while anatomically specific, male or female, feel they do not belong to either binary gender and view themselves somewhere on a continuum, or able to move along it freely. Some, although not all folk in this camp, might use an academic term from sociology, gender fluid, to describe their subjective experience. They are the first to say this is not easy to talk about and that they sometimes struggle for the right language to describe their experience, that it is very complex and that words often fail them. So ‘gender fluid’ is but one term among a whole host that people in this minority use to describe the complexity of their situation. These folk are sometimes called gender-diverse or more often, non-binary.
To make it easier for writing and understanding, I use the common phrase cisgender to refer to non-transgender people when comparing.
So how many transgender or non-binary people are there? Does this just happen once in a million or what? The best scientific data suggests that about 1% of the population (adults and kids) is Transgender or Non-Binary (3). This is about the same as the world population of people with autism, just to give a comparison. Again, this is not an insignificant number. With Australia’s population at just under 25 million, it means there are a lot of transgender or non-binary people.
Now it is very important to understand that this phenomenon is not something that millennials have just cooked up. Or the latest fad, or another way the Left wants to subvert the dominant gender paradigm. Far from it. Transgender and non-binary people are real and have always existed. They have real everyday lives and in today’s society, they feel they can be more open about themselves now. Thus, Australia has a chance, as a modern sophisticated and educated society, to treat them well, fairly and compassionately as they undertake what is often a challenging personal journey. So, rather than listening to the falsehoods and mischaracterisations of the Sheltons and Devines, let’s be grown-up and look at the available science. I have relied heavily on a 2015 paper by Terry Reed in Gender Identity Research and Education Society to assist us here (4).
In examining the science, it is important to understand that it is still in its nascent stages. The science around transgender matters is perhaps 10–20 years behind (just my own guesstimate) the sexual orientation science. But happily, the sexual orientation science has paved the way in philosophy and methodology so that research into transgender can take much from it and learn from the earlier science and maybe as a result, go a little faster. I hope so. Historic and ongoing sexual orientation research has brought to light some remarkable things, eg., genetic predispositions to being gay, that gay and lesbian people have slightly different neural architecture than straight people, that we are ‘wired’ to be gay in our orientation, along with some fascinating biological correlates that we see being consistently associated with being gay. Are there similar findings for transgender people?
We know that sex differentiation for humans happens in utero, most significantly in the third trimester, when there is either a presence or absence of an androgen (male sex hormone) cascade, which shunts the brain, gonads and genitalia down a particular path for bringing about a male or female fetus. Thus, at birth, physically, genetically and neurologically, the baby is sexed. Researchers have for some time now landed on evidence that the neonate is also primed for sexual orientation as well, for the pre-natal androgen theory is the best biological explanation of the origins of orientation to date.
As I noted earlier, some people for various reasons (eg., genetic, congenital, birth-trauma) are born intersex. When this occurred in times past, doctors typically made the decision and suggested assertively to parents to undertake ‘corrective surgery’, usually to bring about a female appearance, despite there being in many cases an underlying karyotype of male XY chromosomes. Thus these little ones were named, dressed and socialised as little girls, and knew no better, but many, ultimately developed gender dysphoria and rejected their imposed gender, resolving it by adopting a male gender when older, against both genital appearance and the imposed gender role that socialisation brought about (5).
This extraordinary outcome supports the view that pre-natal hormonal affects on the brain trump other factors like surgery, coercion or socialisation. These days, such surgery on infants is much rarer now and in ambiguous cases, is considered unethical by many since infants cannot give consent and their future agency is removed from them. We now see the same outcome in transgender people where they are not able to suppress their subjective experience of gender, ie., what their brain is telling them, despite their assigned secondary sexual characteristics or their socialisation. It seems the transgender brain too trumps all other factors.
Further, we now believe there is a strong genetic influence in transgender phenomenology. We have seen in twin studies when observing who transitions to another gender role permanently, that male monozygotic twins (identical) have a 33% concordance rate and that female monozygotic twins have a 23% rate, compared to 0% in dizygotic twins (fraternal) for both males and females (6). So there is definitely something genetic going on here, which puts us in mind of similar powerful twin studies in the area of sexual orientation.
But there is more. Neurological functioning refers to how our brains work, how they function in a given task and how they process information. How do transgender brains function? What happens when you compare them to cisgender functioning? Cerebral lateralisation is the tendency for some cognitive functions to be specialised in one hemisphere of the brain or the other. Sexual dimorphism is the occurrence of phenomena in two distinct forms in the same species, one in the male, the other in the female, eg., size, colour, shape, structure.
Cerebral lateralisation has been shown to be sexually dimorphic in the perception of hearing in cisgender people. Selective attention is very interesting in this regard. Being able to give your attention solely to a single voice in a jumble of other voices or other noises, known as the cocktail party effect, is sexually dimorphic, ie., there are different patterns in the brain in males and females of how the information is processed. A 2010 study of a dichotic hearing test (paying attention in one ear to a voice while ignoring another voice in the other ear) showed that transgender women are significantly different from cisgender males and are in fact, more similar to the cisgender female pattern (7). So, at least in this brain function, there is evidence that the transgender brain is operating, not by way of its birth-assigned sex, but by the transgender self.
Further, a 2001 study showed a distinct pattern in transgender men and women for non-righthandedness. Some studies showed an increase of two and even three times the likelihood than the general population of non-right-handedness (8).
In earlier research on sexual orientation, researchers in post-mortem studies found differences in brain architecture between gay and straight people. Would those types of differences show up between transgender people and cisgender people? In fact, early studies are showing just that. A few post-mortem studies have been carried out on transgender people and their neural architecture was compared to cisgender brains. Small nuclei known to be sexually-dimorphic have been shown to be in opposition to the genital and gonadal characteristics of the individuals. The cisgender brains did not show this (9).
Finally, two 2011 studies by the same team showed that white matter in the brains of transgender men are masculinised and appear male in three of four levels scanned (10) while the white matter in the brains of transgender women were shown to be feminised and were significantly different from cisgender men and women controls at all four levels scanned (11).
What do we make of all this? At the very least, we can say that neurological architecture, biology and brain functionality play a role in the origin and phenomenology of being transgender. There are definitely neural phenomena in the brains of transgender people which puts to bed the false idea that people are just making things up or are sick or psychopathological. There is something elemental going on here, just as we saw there was all those years ago with the sexual orientation of gay and lesbian people. It has been recommended to the World Health Organisation in 2013 by researchers, clinicians and transgender people themselves that a pathologisation model be abandoned and a supportive model of clinical treatment based on scientific evidence and best practice be adopted. How we treat such people in society then becomes the all important question.
Many transgender folk become aware of the incongruence between their assigned sexual characteristics and their subjective experience of gender at a very young age. Of course, it typically causes some distress, what psychiatrists and psychologists call gender dysphoria, but interestingly, not all people experience this dysphoria.
Many people work through the issues on their own, while others seek professional help. I regularly see transgender people, both adults and kids, and most are not dysphoric but seem to be comfortable with their transgender identity, while any distress or confusion is more about how to navigate the school years or families with this knowledge. In fact, the only dysphoria I see regularly is that caused by others imposing a notion that they will have to suppress their gender for the rest of their lives, that they are not acceptable the way they are.
Young transgender or non-binary people who are told they must suppress their gender identity and live out their lives congruent to their assigned sex at birth go through exactly the same kinds of emotional distress as what gay people experienced when we were told we could never fall in love with someone of our own sex and express that physically and emotionally. Closets are cruel places.
The school years are hard years. Let’s face it, they were hard for most of us. If you happen to be navigating sexual orientation or transgender issues at the same time as going through puberty and heading into adolescence, these constitute yet another layer of complexity altogether and you would think that schools themselves should and could play a greater role in scaffolding you and showing some decent human care. Many schools are open to this. Religious and political conservatives are not.
Clinical treatment of transgender kids is now based on support as it is for adults. The Australian Psychological Society ‘s Position Statement on Mental Health Practices for transgender people is based on evidence alone and states:
The Australian Psychological Society recommends therapeutic responses that:
1) Affirm the person’s gender;
2) Challenge negative attitudes towards gender diversity;
3) Discuss referral options for gender-affirming treatments if desired; and
4) Advocate for the support needs of transgender people.
In session, we unpack the phenomenology of the young person’s experience with them, and sometimes with their parents too, and offer support for any dysphoria they might be experiencing while early on trying to locate the origin and focus of that dysphoria. Transitioning is the usual way that people resolve the fundamental challenge, ie., they will begin to present themselves to the world, often in a staged, careful and slow way, as the gender they feel they experience as their authentic self. This takes time.
It can amount to dressing differently at home, then publicly, adopting a different name and using pronouns consistent with that name. If this feels comfortable, and the alternate represents an aversive nightmare (which it almost always does), then puberty blockers can be prescribed in High School before the onset of puberty. Generally, by this time, the young person is seeing a GP, a psychologist, perhaps a psychiatrist as well, and an endcrinologist, so is getting expert medical and psychological support. We typically work closely with each other in these presentations. Parents of course receive education about the typical course of transitioning and assisted in their own journey. No-one is saying this is not challenging. Puberty blockers are not irreversible as some opponents ignorantly put out. They are absolutely reversible. If puberty blockers are ceased, the onset of puberty activates.
If this course continues, then typically, the young person will want to continue transitioning by ultimately taking hormone therapy. These range of medications are more lasting, yet even here, if hormones are ceased, some effects are reversible. However, by this stage, the individual has lived the transgendered life usually for years and knows beyond any shadow of doubt as to the authenticity of their transgender experience. I regularly have clients at differing stages of treatment.
I often note the palpable difference there is in terms of reduction of stress, increased personal comfort and increased confidence as individuals move along the treatment process at their own pace. Those who progress on to hormone therapy are happier, less distressed and more comfortable in themselves as they present to the world. At the end of the day, those individuals know their own mind and heart better than I ever can, and certainly better than by some fundamentalist conservative who really doesn’t know the first thing. Transgender people are the experts on themselves.
Now of course, there are some transgender people who will eventually go further and opt for sex reassignment surgery. These people must go through a rigorous screening process with medicos and psychological assessment to ensure that along with their own story, the story of the professionals matches up. Remember though, they have already been living and presenting as their transgender self for years and years. I have had a number of my clients opt for surgery. They have all been adults and it has been an enormous privilege for me to accompany them along this journey to what they consider is their final level of authenticity. More power to them.
Shelton and others have continued to promulgate a myth that most young people who explore a transgender self will toy with it for a while, then abandon it later, ie., they will desist from the transgender journey. This is now known as the desistance myth. Some very shonky work has been cited by opponents saying that 80% and even 85% of young people desist. But fundamentalist conservatives have history in quoting these kinds of dodgy studies. They did the same years ago in the sexual orientation sphere, quoting studies by partisan ‘researchers’ who always seem to come out at odds to the rest of the academic world. All were debunked. So too here.
These few studies have been thoroughly debunked. If you want to read a very informative article on this debunking, you could take a look at The End of The Desistance Myth. This article cites some Australian work from the Royal Children’s Hospital Melbourne which reports that from 2003 to 2017, they only had a 4% desistance rate among kids and that 96% of kids persisted with their transgender or gender diverse self into late adolescence. That’s fourteen years of data. So don’t believe the desistance myth. It is the argument of the desperate.
Transgender and non-binary kids in school need all the help and support that we can give them. There is no denying that their journey is a challenging one. What are we as a nation to make of these people? Is Australia sophisticated enough, compassionate enough to say, “well, we find this confronting, but hell, we’ll do our best to understand and support you.” Safe Schools was about precisely that. Bullying of the LGBTIQ youth community has long been an identified priority for action. Safe Schools was to provide Principals and teachers with professional development so they could better understand these kids and so better provide for them.
It was to look after the 1% and make sure they were safe as they crossed this difficult terrain. To include them, support them, scaffold them. But it was also to teach the other 99% respect for their mates and that such diversity, while not common statistically, is a part of life and a normal part of the human condition, as they have learned already about their gay and lesbian mates. And of course, Safe Schools was designed to look after gay and lesbian and bisexual kids too. And let’s not forget the intersex kids. Safe Schools was to encourage staff to enlist the 99% support in looking out for their transgender and gay friends, to not exclude them, not ignore them, not bully them or harm them, but to be caring companions and to stand up with them against any bullying or harm.
So, back to Shelton. His false tweets that kids are now gender fluid under rainbow fascist rule and that schools must teach kids that they are gender fluid are entirely wrong and absolutely fraudulent. Schools are not telling their kids that they are gender fluid. The notion is just ridiculous and laughable.
The figure of 1% not only tells us about transgender kids, but also tells us something about the majority. About 99% of kids, in fact most of us adults too, do not have this challenge between sex and gender. Most of us align our assigned birth sex with our gender and are comfortable in our presentation of our gender/sex mix to the world. We are not transgender, we are not non-binary and we are not gender fluid. Having Shelton out there every day running wild with theses insane tweets and statements that kids are now being compulsorily told that they are, is utterly dishonest and false.
I have not heard of one school in Australia where their kids are being told in science, PE PD Health, or any other class, that their genders are fluid. Scientifically, that is wrong and educationally, it is not happening. Allow me on this occasion to defer to the vernacular.
It is absolute bullshit and should be treated as such.
I will personally ring any Principal in the country where I am told that this is happening in order to confirm or disconfirm any plausible information I am given. In the meantime, Shelton needs to stop his misinformation campaign. I asked him recently on Twitter to give me details of where this is happening.
He never answered me. But, he never does. Answering his opponents is not his style. Shelton’s personal mission against any progress for LGBTIQ people is historic and well-known. It springs from a fundamentalist Christian worldview that many are now either reviewing or abandoning. It is a view that historically, Australians have never really taken to. Australians have always been suspicious of religion, especially the kind that Shelton espouses. But it is a free country. He is free to believe what he wants. And I am fine with that. And as long as he stays within the law, he is free to say what he wants. I do not like what he says and I understand it to be wrong, but I believe in free speech too. But he cannot expect us to buy into his hard Right religious conservatism that harms a whole group of people in our society without being challenged. And really, in the end, I feel safe, because I do not ever see a time when Australia will swallow the whole Shelton agenda.
Transgender people are just like you and I. They are youths, they are adults. They are straight, they are gay. They have families and friends. They are not sick or sinful. And yes, they have a challenging journey. Mostly, their journey is only challenging because society has such a hard time with them. It is my profound hope that as transgender and non-binary people become more present and open in our society and as people become educated further in the extraordinary diversity that is the human condition, they can have a better time of it. Part of that I think is up to us. One of the ways we can do that is to dispel the lies and misinformation that are so overtly promulgated by conservative reactionaries and stand up for these brave people privately and publicly. We can help smooth the way for them in our own small ways so they can fulfill their lives in the very best way they can.
(1) Fausto-Sterling, A. (2000). Sexing the Body: Gender Politics and the Construction of Sexuality. New York: Basic Books.
(2) Intersex Society of North America: What is intersex? http://www.isna.org/faq/what_is_intersex
(3) Olyslager, F., & Conway, L. (2007). On the calculation of the prevalence of transsexualism. World Professional Association for Transgender Health, 20th International Symposium, Chicago.
(4) Reed, T. (2015). Biological correlations in the development of atypical gender identities. Gender Identity Research and Education Society.
(5) Dessens, A.B., Froukje, M.E., Slijper, F.M.E., Stenvert, L.S., & Drop, S.L.S. (2005) Gender dysphoria and gender change in chromosomal females with congenital adrenal hyperplasia. Archives of Sexual Behavior 34(4):389–397.
(6) Diamond, M. (2013) Transsexuality among twins. International Journal of Transgenderism, 14:1, 24–48
(7) Govier, E., Diamond, M., Wolowiec, T., & Slade, C. (2010). Dichotic listening, handedness, brain organisation and Transsexuality, International Journal of Transgenderism, 12(3) 144–154.
(8) Green, R., & Young, R. (2001) Hand preference, sexual preference, and transsexualism, Archives of Sexual Behavior 30:565–574).
(9) Zhou, J-N., Swaab, D.F., Gooren, L.J., & Hofman, M.A. (1995) A sex difference in the human brain and its relation to transsexuality. Nature, 378:68–70.
(10) Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Segovia, S., Gomez, A., & Guillamon, A. (2011). White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study, Journal of Psychiatric Research 45 199–204.
(11) Rametti, G., Carrillo, B., Gómez-Gil, E., Junque, C., Zubiarre-Elorza, L., Segovia, S., Gomez, A., & Guillamon, A. (2011). The microstructure of white matter in male to female transsexuals before cross-sex hormonal treatment. A DTI study. Journal of Psychiatric Research, 1- 6.