What You Can Change _. And What You Can't - Martin E. Seligman [76]
In my theory, AGSs reared as males are “first cousins” of FM transsexuals. Both are 46XX fetuses who are masculinized psychologically. But the transsexual misses the next phase—the masculinization of her external organs. She is therefore born psychologically male but with a vagina, and so is declared and raised as a girl. Her life is a constant misery thereafter. It gets even worse after puberty, because unlike her AGS cousin, she sprouts breasts and has periods. Her AGS cousin is psychologically male, but was fortunate enough also to be born with the appearance of a penis and scrotum and so is declared a boy. His life works out because what everyone thinks he is (by virtue of the appearance of a penis at birth and, later, by his deep voice and facial hair) is the same as he thinks he is—a man.
The tragic difference between an AGS reared as a male and an FM transsexual is that only one phase—psychological masculinization as a fetus—goes awry for the transsexual. All the other phases go correctly, locked unfortunately to the chromosomal sex and not to sexual identity. For the AGS, all phases—fortunately—go awry, and so everything corresponds not to her chromosomal sex, but to his sexual identity.
The other disorder is AIS, the androgen-insensitivity syndrome. AISs are chromosomally male: 46XY. They are insensitive to masculinizing hormones, however. So AISs are born with male internal organs (which differentiate before the ineffective masculinizing bath) and with a vagina, though the vagina is actually a dead end. All AISs are declared girls and raised as girls. They all grow up feeling female, pursue men, and have intercourse as women. In my theory, they don’t get masculinized psychologically, and, fortunately, their external organs don’t look masculine. Like AGSs, they have an added piece of good fortune: When puberty arrives, they grow breasts under the influence of the normal male amount of estrogen secreted by the testes (which they have deep inside), and so they look like women.7
AISs are the first cousins of MF transsexuals. Both are 46XY fetuses with male internal organs who are feminized psychologically at the end of the first trimester. But the transsexual has a normal next phase—the external organs get masculinized. Therefore, though he is psychologically female, he is born with a working penis and so is declared and raised as a boy. He is miserable ever after—or until he loses his penis surgically. His AIS cousin is psychologically female, and was fortunate enough to be born with the appearance of a vagina and so is declared a girl. Her life works out because what everyone thinks she is (by virtue of her vagina and, later, her breasts) is the same as she thinks she is—a woman.
Again, the tragic difference between an AIS female and an MF transsexual is that only one phase—psychological feminization—goes awry for the transsexual. All the other phases proceed correctly, locked to the chromosomal sex and not to sexual identity. For the AIS, all phases go awry and wind up corresponding not to his chromosomal sex but to her sexual identity.
My theory speculates that sexual identity—both normal and abnormal—is so deep because it has its origin in a fundamental hormonal process that occurs around the end of the first trimester of fetal development. Fetal hormones are not the only influence on sexual identity. Rearing, pubertal hormones, sex organs, and being mocked also play a role. But at most, these later influences can reinforce—or disturb—the core identity with which we are stuck from well before