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INTRODUCTION
In genetic males, transsexualism commonly occurs in both heterosexual and homosexual individuals. In genetic females, however, transsexualism in a heterosexual individual--that is, an individual sexually attracted to phenotypic males--is relatively rare. In fact, the sexual orientation of genetic female transsexuals has been so overwhelmingly homosexual (sexually attracted to phenotypic females) that the recognition of other subtypes may well have been delayed or compromised. It is only recently that a sub group of genetic female transsexuals who are attracted to phenotypic males has begun to be recognized and described (Blanchard, 1990; Blanchard et al., 1987; Clare and Tully, 1989; Coleman and Bockting, 1988; Coleman et al., 1993).
Most of the reported cases of genetic female transsexuals erotically attracted to phenotypic males appear to have an erotic preference that includes the fantasy or thought of being a gay male. Some of these individuals have specifically expressed a preference for effeminate homosexual men (Blanchard et al., 1987). There have been no reports of any of these individuals being sexually aroused by male clothing or clearly describing "autoandrophilia" (i.e., erotic arousal induced by the simple thought of being a male, apart from any fantasy of sexual interaction with another). Therefore, it does not appear that the few described cases of genetic females with heterosexual transsexualism correspond to the gender-dysphoric and transsexual heterosexual males who present with autogynephilia (Blanchard, 1989).
In our clinic we have, since the patient reported by Blanchard et al. (1987), seen two additional gender-dysphoric genetic females who described sexual attraction to phenotypic males. One has undergone sex reassignment, the other is currently receiving hormone treatment and presenting socially as a phenotypic male. Our purpose is to outline their histories and attempt to establish some possible common clinical features of this particular subtype of transsexualism.
CASE REPORTS
Case One
Andy, a biological female, first presented at our Gender Clinic at the age of 37, seeking information on chest wall surgery. Andy had been May Ann throughout childhood, adolescence, and early 20s. She described herself as timid with adults and other children. She was lonely and wished she had a friend like the child David, who slew Goliath. She developed a fantasy that he was her friend and constant companion. May Ann stated that gradually, over time,...