August 8, 2010

HBS 2: The science behind the Harry Benjamin Syndrome

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

Continues from part 1.

She blinded me with science

Rose White argues that crossdressers and real trans women (who she calls HBS) have nothing in common. The origins of the two conditions are completely different. While HBS trans women 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 trans women 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 this 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 trans women 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 trans women 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 trans women 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 trans women 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 trans women and androphilic trans women:

"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-homosexual
early 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 trans woman (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 trans women, 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 trans women 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 trans women 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 trans women 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 trans women 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 trans women 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 trans women.

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 trans women, who have fought so hard to become who they truly are, spend so much time on belittling others. It is unnecessary and destructive!

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


  1. I generally support the notion that what is most like a female, acts most like a female.

    That said women with conditions like CAH or too much childhood testosterone can actually evince some very masculine characteristics yet are still seen as women. I think it is unclear whether a female brain living in a male environment would behave more like an extension of a gay male or like a woman exposed to extreme amounts of testosterone.

    Ultimately, it doesn't matter.. and I probably would hold that a person's gender is the role that they are best psychologically and physically able to fulfill no matter what their genitalia.

    I do not think god works very hard to put people into male and female boxes but I think society does and I think that it is largely because most people conform well to those boxes (generally their assigned ones). Normalcy equals comfort. Perhaps some transitioners are more real women than others but if they all live happy productive lives, who really should care?

    Science should always be about trying to make people's lives better. Understanding something shouldn't be about belittling or attacking another group. If all crossdreamers were better off transitioning, they should (assuming society as a whole was not too adversely effected). Right or wrong is not a question of exactly matching a definition but of choosing the best answer.

  2. I've found this sentence on a website and I think this makes sense:

    "when anyone, male or female, says they "feel" like a woman or a man they are actually saying that what they feel corresponds with feminine or masculine sex roles."


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