What do the terms "primary transsexual" and "secondary transsexual" mean?

Primary Transsexual or Secondary Transsexual?

Hi Maddie! How are you? It's Marian and I have a question for you. I feel awkward asking you, but you had said last year to feel free to ask you questions. I T.A. for [name of clinical professor] and I teach a section. In my section on Friday, 8 students are doing a debate on an article entitled: Is sex reassignment surgery ineffective in improving the adjustment of transsexuals? However because I am rather ignorant about this topic, I was not able to answer one of my student's questions who emailed me last night. So I was hoping that you might be able to answer this question, which I have enclosed herein in my forward. Just so you know, I have not told this person that I would ask anyone...in fact, I have a an internet reference guide for the DSM-IV, which had a few web-sites on transsexualism, which I emailed to my student. But it seems like a simple question, so I thought I'd ask you. He basically would like to know what the terms "primary transsexual" and "secondary transsexual" mean? If you email me, I will pass the information along to home. Dr. C. was not able to give me an answer either, and he is curious about these terms too, so it's a learning experience for all of us! Thanks so much!, Marian

Hi Marian,

Please don't feel awkward asking me any questions. I'll try to answer your questions. I probably know *way* too much about the clinical research on transsexuals.

The distinction applies to both female-to-male (FtM) and male-to-female (MtF) transsexuals. Primary transsexuals usually behave like their target sex from childhood. They usually feel they are or should be members of the 'opposite' sex before puberty. Primary transsexuals rarely waver in their conviction that they are/should be a member of their target sex. If they do waver and try to conform to their biological sex's gender role, they don't do very well (exp: at best a primary MtF transsexual can appear not quite so feminine ... but she probably doesn't ever appear masculine). Most often primary transsexuals are sexually attracted to their biological sex (exp: a primary FtM transsexual is most likely attracted to women). Primary transsexuals are either living as their target sex (i.e. F for MtF & M for FtM) or requesting sex reassignment surgery (SRS) by roughly 25 years old. With very supportive parents they sometimes even have SRS at 18. Primary MtF transsexuals are usually *really* feminine and primary FtM transsexuals are *really* masculine. You can see a prototypical example of a primary MtF transsexual in the movie "Ma Vie en Rose" or a prototypical FtM transsexual in the recent movie "Boys Don't Cry." That movie is in English and it's amazingly well done; I think it's still playing at the movie theater by the mall!

In contrast, secondary transsexuals usually don't 'come out' until almost 40 years old or later. The most striking feature of secondary transsexuals is how, despite a deep conviction of being their target sex, their gender behavior is still quite a lot like that of their biological sex. They say they went into denial (that's why it takes until older ages to 'come out') and they often excel in the gender role of their biological sex (exp: a MtF transsexual who was captain of their high school football team, in the army, marries and has children). Even after transitioning their gender behavior still isn't all that much like their target sex. An example of a secondary transsexual is Kate Borenstein (MtF; author of gender outlaw).

This distinction might be useful for your debate because secondary transsexuals report greater rates of regret and less social adjustment than primary transsexuals do (sorry, I can't recall a good reference at the moment). You should probably also know that some researchers question if the distinction into these two categories is really appropriate. But regardless of how or if you categorize 'types' of transsexuals, almost all research on SRS shows very positive outcomes. There was once a major study saying SRS wasn't effective (Meyer and Reter, Arch. Sex. Behav. 9: 451-456) but it's *so* methodologically flawed. You can read a reply in IJT, which is available on-line: Fleming M, Steinman C, Bocknek G (1980), Methodological Problems in Assessing. Sex-Reassignment Surgery: http://www.symposion.com/ijt/ijtc0401.htm . There's also some feminist literature opposing SRS (most notably by Janice Raymond) but that line of debate probably isn't so relevant to a psychology class.

Anyway, I have lots of information and personal experiences that I can share with you if that would help. Good luck in class!