Transgender sexuality

In the United States, transgender respondents to one 2015 survey self-identified as queer (21%), pansexual (18%), gay, lesbian, or same-gender-loving (16%), straight (15%), bisexual (14%), and asexual (10%).[8] A second study found 23% reported being gay, lesbian, or same-gender-loving, 25% bisexual, 4% asexual, 23% queer, 23% straight and 2% something else.[9]

A 2015 survey of roughly 3000 American trans women showed that at least 60% were attracted to women.[10] Of the trans women respondents 27% answered gay, lesbian, or same-gender-loving, 20% answered bisexual, 19% heterosexual, 16% pansexual, 6% answered asexual, 6% queer, and 6% did not answer.[8]

Foerster reported a 15-year successful relationship between a woman and a trans man who transitioned in the late 1960s.[11][12]

In the 20th century, trans men attracted to women struggled to demonstrate the existence and legitimacy of their identity.[13] Many trans men attracted to women, such as jazz musician Billy Tipton, kept their trans status private until their deaths.

Although the literature indicates that most trans men identify as heterosexual,[14][15] their attraction can vary. Author Henry Rubin wrote that "[i]t took the substantial efforts of Lou Sullivan, a gay FTM activist who insisted that female-to-male transgender people could be attracted to men."[13] Matt Kailey, author of Just Add Hormones: An Insider’s Guide to the Transsexual Experience,[16] recounts his transition "from 40-something straight woman to the gay man he’d always known himself to be."[17] Researchers eventually acknowledged the existence of this phenomenon, and by the end of the 20th century, psychiatrist Ira Pauly wrote, "The statement that all female-to-male transgender are homosexual [Pauly means attracted to women] in their sexual preference can no longer be made."[18]

A 2015 survey of roughly 2000 American trans men showed more variation in sexual orientation or sexual identity among trans men. 23% identified as heterosexual or straight. The vast majority (65%) identified their sexual orientation or sexual identity as queer (24%), pansexual (17%), bisexual (12%), gay/same-gender loving (12%), asexual (7%), and 5% did not answer.[19]

Gay trans men have varying levels of acceptance within other communities.[20] Upon beginning testosterone treatments, some trans men report an increase in both their libido and their desire for sex with non-trans men.[21]

Psychiatrist Richard Green, in an appendix to Harry Benjamin's 1966 The Transsexual Phenomenon, considers people assigned male at birth who have adopted a more feminine gender role.[22] In this broad overview, entitled "Transsexualism: Mythological, Historical, and Cross-Cultural Aspects", Green argues that the members of these groups are mentally indistinguishable from modern western transsexual women.[22] They have in common early effeminacy, adulthood femininity, and attraction to masculine males.[23]

The Hijra of the Indian Subcontinent are people who were assigned male at birth but occupy a female sexual and/or gender role, sometimes undergoing castration.[24] As adults, they occupy a female role, but traditionally Hijra describe themselves as neither male nor female, preferring Hijra as their gender.[24] They often express their femininity in youth; as adults, they are usually sexually-oriented towards masculine men.[24]

Mukhannathun were transgender individuals of the Muslim faith and Arab extraction who were present in Medina and Mecca during and after the time of Muhammad.[25] Ibn Abd Al-Barh Al-Tabaeen, a companion of Aisha Umm ul-Mu'min'in who knew the same mukhannath as Mohammed, stated that "If he is like this, he would have no desire for women and he would not notice anything about them. This is one of those who have no interest in women who were permitted to enter upon women."[26] That said, one of the Mukhannath of Medina during Muhammad's time had married a woman.[25]

Travesti are Brazilian male assigned people who are attracted to men.[27] Travestis' feminine identity includes hormones and/or silicone body alterations, feminine dress, language, and social and sexual roles, but rarely genital surgery.[27] However, in contrast to North American transgender women, they often don't see themselves as real women, and many describe themselves as gay or homosexual.[27] According to Don Kulick, they will describe themselves instead as "feeling like a woman".[27] In his book Travesti: Sex, Gender and Culture among Brazilian Transgendered Prostitutes, he writes that no travesti in Salvador ever claims to be mulher (a woman) except as a joke, and travestis reading or hearing about transgender people who say they feel like women regard them as disturbed.[28]

Many transgender individuals choose to not use the language that is typically used to refer to sexual body parts, instead using less gendered words. The reason for this practice, is that hearing the typical names for genitalia and other sexual body parts can cause severe gender dysphoria for some trans people.[32]

Not all transgender people choose to rename their bodies. Those that choose not to rename their body, are often less uncomfortable with their body and/or don't associate their sexual body parts with a gender that differs from the one that they identify with.[32]

Ultimately, the decision of what language a trans person chooses to use for their body, and wants others to use, is up to the individual whose body is being named.[32]

Some trans women choose to call their anus their vagina because they can use their anus in many of the same ways that cisgender women can use their vagina. Furthermore, some transgender women choose to refer to other, non-sexual, parts of their body as sexual body parts that belong to cis women, such as the vulva and the clitoris.[32]

Some trans men choose to call their vagina euphemistically as their "front hole" because they feel that it is less gendered. Furthermore, some transgender men choose to refer to other parts of their bodies using male terminology. For example, some transgender men choose to refer to their clitoris as their penis, because, like the penis, the clitoris often increases in size, when an individual is aroused.[32]

For transgender women, taking estrogen stimulates the development of breast tissue, causing them to increase in both size and sensitivity. For some, this increased sensitivity can be pleasurable, while for others it can be uncomfortable or painful. Furthermore, for those taking estrogen and who have male genitalia, estrogen can (and often does) shrink the external male genitalia and decrease the production of semen (at times bringing the sperm count to zero), and can decrease the ability for the male genitalia to become erect. In addition to these changes, some transgender women going through hormone therapy (HR) can experience changes in the way their orgasms feel. For example, some people report the ability to experience multiple orgasms.[32]

HR can cause decrease in sex drive or a change in the way arousal is experienced by trans women.[32] A study published in 2014 found that 62.4% of trans women surveyed reported a decrease in sexual desire after hormone therapy and/or vaginoplasty.[33] A 2008 study reported hypoactive sexual desire disorder (HSDD) in as many as one in three post-operative trans women on HRT.[34]

A 2009 pilot study tested the effectiveness of two treatments for HSDD in trans women: transdermal testosterone and oral dydrogesterone (a progestin).[35] After six weeks of treatment, the group treated with testosterone reported improved sexual desire, while the group treated with the progestin reported no change.[35]

For transgender men, one of the most notable physical changes that many taking testosterone experience, in terms of sexuality and the sexual body, is the stimulation of clitoral tissue and the enlargement of the clitoris.[36] This increase in size can range anywhere from just a slight increase to quadrupling in size.[6] Other effects can include vaginal atrophy, where the tissues of the vagina thin and may produce less lubrication. This can make sex with the female genitalia more painful and can, at times, result in bleeding.[6] Transgender men taking testosterone are likely at increased risk of developing urinary tract infections, especially if they have receptive vaginal intercourse.[37]

Other effects that testosterone can have on transgender men can include an increase in their sex drive/libido. At times, this increase can be very sudden and dramatic. Like transgender women, some transgender men also experience changes in the way they experience arousal.[36][6]

Trans women who have undergone vaginoplasty must dilate in order to properly shape and form the neovagina. After several months, sexual intercourse can replace dilation, but if not sexually active, dilation is required again, for the rest of the patient's life.[38]

Some trans people maintain a consistent orientation throughout their lives,[39][40] in some cases remaining with the same partner through transition.[41]

Some gynephilic trans women self-report that after transitioning, they became sexually oriented towards males, and explain this as part of their emerging female identity.[42] Kurt Freund hypothesized that such reports might reflect the desire of some trans women to portray themselves as "typically feminine" or, alternatively, might reflect their erotic interest in the validation provided by male partners, rather than representing a genuine change in preference.[43] A 2005 study which relied upon vaginal photoplethysmographies to measure blood-flow in the genitalia of postoperative trans women found they had arousal patterns which were category specific (i.e. androphilic trans women were aroused by males, gynephilic trans women were aroused by females) in a similar fashion to natal males, and argue that vaginal photoplethysmographies are a useful technology for measuring the validity of such reports. The one trans woman in the study who reported a change in sexual orientation had arousal responses consistent with her pre-reassignment sexual orientation.[43]

While undergoing hormone therapy, some trans men report experiencing increased sexual attraction to cisgender men.[36] This change can be confusing for those who experience it because it is often not a change that they expect to happen.[36]

Historically, transgender people were unable to access gender affirming care unless they would be considered heterosexual post surgery.[1][2] For much of the early 1900's, transgender persons were conflated with being either an invert or homosexual; as such, non-heterosexual sexual orientation data for transgender people is limited.[1][2][55] In the 1980's, Lou Sullivan was instrumental in allowing non-heterosexual transgender people access to surgical care and hormones.[1]

Sexologist Magnus Hirschfeld first suggested a distinction based on sexual orientation in 1923.[56] A number of two-type taxonomies based on sexuality have subsequently been proposed by clinicians, though some clinicians believe that other factors are more clinically useful categories, or that two types are insufficient.[57] Some researchers have distinguished trans men attracted to women and trans men attracted to men.[58][59]

The Benjamin Scale proposed by endocrinologist Harry Benjamin in 1966 used sexual orientation as one of several factors to distinguish between "transvestites", "non-surgical" transsexuals, and "true transsexuals".[60]

In 1974, Person and Ovesey proposed dividing transsexual women into "primary" and "secondary" transsexuals. They defined "primary transsexuals" as asexual persons with little or no interest in partnered sexual activity and with no history of sexual arousal to cross-dressing or "cross-gender fantasy".[61] They defined both homosexual and "transvestic" trans people to be "secondary transsexuals".[62]

Dr Norman Fisk noted those entering his clinic seeking reassignment surgery comprised a larger group than fit into the classical transsexual diagnosis. The article notes that effeminate gay men and heterosexual fetishistic transvestites desire surgery and could be considered good candidates for it.[63]

In the DSM-II, released in 1968, "transsexualism" was within the "paraphilias" category, and no other information was provided.[64]

In the DSM-III-R, released in 1987, the category of "gender identity disorder" was created, and "transsexualism" was divided into "asexual", "homosexual", "heterosexual" and "unspecified" sub-types.[65]

In the DSM-IV-TR, released in 2000, "transsexualism" was renamed "gender identity disorder". Attraction specifications were to male, female, both, or neither, with specific variations dependent on birth sex.[66]

In the DSM-V, released in 2013 and currently used in the United States and Canada, "gender identity disorder" is now "gender dysphoria", and attraction specifications are either gynephillic or androphillic.[7]