Coming out

O R I G I N A L P A P E R

Coming Out for a Third Time: Transmen, Sexual Orientation, and Identity

Stefan Rowniak • Catherine Chesla

Received: 13 September 2010 / Revised: 3 September 2012 / Accepted: 3 September 2012 / Published online: 22 November 2012

� Springer Science+Business Media New York 2012

Abstract Female-to-male (FTM) transgender persons are

often assumed to have been lesbian in sexual orientation prior

to transition and to have maintained a primary attraction for

women after transition. However, limited research and anec-

dotal information from clinicians who work with FTM have

indicated that many identify as gay men post-transition. This

article described the results of a qualitative study that employed

interviews with 17 FTM in order to understand their experience

of transition and sexual orientation. Of the 17 participants, seven

identified as lesbian prior to transition, three as heterosexual, and

seven as bisexual or queer. After transition, 10 identified as gay

men and the remaining seven identified as bisexual or queer.

Four patterns of sexual behavior emerged from the data and

were described and discussed. These patterns were named

steadfast, aligned, shifted, and fluid. These findings bring

additional options to the belief that there are two distinct

types of transgender: a homosexual subtype and a nonho-

mosexual subtype.

Keywords Transgender � Gender identity � Sexual orientation � Gay community

Introduction

Since the first sex reassignment procedures were performed

in the United States, many assumptions regarding the nature

of transgender sexual identity have been promulgated by

some members of the medical establishment and accepted by

the public at large. One underlying assumption of many of the

earliest medical gatekeepers for transgender persons was that they

desired a heterosexual life. The true transsexual, or transgen-

der person, was seen as someone who was sexually attracted to

members of their own genetic sex, yet because they had the gen-

der identity of the opposite sex, they rejected a homosexual iden-

tity (Benjamin, 1966). The notion that some transgender people

could identify as gay or lesbian after transition is at odds with this

narrative. The fact that some of these individuals may have

actually changed their orientation after transition is even more in

conflict with this paradigm. For some female-to-male (FTM)

transgender persons, or transmen, this change of orientation has

meant that they have come out three times in their lives: first as a

lesbian, then as transgendered, and finally as a gay man. This

article will examine the development of sexuality among trans-

men, including several who reported a change in their sexual

orientation after transition.

The existence of homosexually-identified transgender

persons has been recognized in medical research but this has

generally been seen as an exception to the rule, especially

among FTM. One study that documented the existence of a gay

and bisexual identity among FTM was reported by Coleman,

Bockting, and Gooren (1993). Coleman et al. described the

situation of nine FTM in the Netherlands who were sexually

attracted to men. The conclusions were that this phenomenon

may be more common than previously considered and that the

discussion of sexual orientation among transgendered people,

especially FTM, is complex and should consider both anatomy

and self-identification.

S. Rowniak

School of Nursing and Health Professions, University of San

Francisco, San Francisco, CA, USA

S. Rowniak (&) 769 14th St., San Francisco, CA 94114, USA

e-mail: [email protected]

C. Chesla

School of Nursing, University of California, San Francisco,

San Francisco, CA, USA

123

Arch Sex Behav (2013) 42:449–461

DOI 10.1007/s10508-012-0036-2

Devor (1993, 1994, 1997, 2004) has written a large body of

work devoted to the subject of FTM and their identity for-

mation, including sexuality. Of note is one study on sexuality

and identity among 45 FTM (Devor, 1997). This study exam-

ined the experience of the rejection of lesbian identities in

favor of the creation of sexual orientation identities (SOID)

that more correctly reflected the participant’s sense of their

true nature. Devor (1993) also investigated the SOID, the

sexual orientation with which one identifies, of FTM both

before and after transition. Devor found that SOID was not an

inherent characteristic but a complex process. Among De-

vor’s participants were transmen who identified as hetero-

sexual, bisexual, lesbian, and gay.

Since these studies were published, the existence of gay

FTM has been well documented. However, this has been pri-

marily in the area of HIV risk (Clements-Nolle, Marx, Guz-

man, & Katz, 2001; Sevelius, 2009). Also, FTM and MTF

have often been grouped together when examining HIV risks

(Herbst et al., 2008). In contrast, other fairly recent studies

have examined the specific risks of FTM concerning sexual

practices, perception of risk, and drug using behaviors

(Kenagy & Hsieh, 2005; Namaste, 1999; Sevelius, 2009).

These studies did not look specifically at the development of

FTM sexuality but rather examined how that sexuality placed

them at risk.

A recent qualitative study examined the trajectories of FTM

lives for the purpose of raising awareness among nurses

(Morgan & Stevens, 2008). Semi-structured interviews were

conducted with four FTM and identified four primary themes:

(1) an early sense of body-mind dissonance, (2) biding time

until medical transition was possible, (3) regret of the missed

opportunities to transition that were not pursued, and (4) the

process of transition. Even though one participant self-identi-

fied as heterosexual and another as gay, there was no explo-

ration of their sexual identity, orientation, and behavior, or how

these may have changed in the course of transition.

Several studies have examined transgendered people with

regard to a taxonomy based on sexual orientation, termed homo-

sexual or nonhomosexual with regard to the participant’s genetic

sex (Bockting, Benner, & Coleman, 2009; Chivers & Bailey,

2000; Coleman, et al., 1993; Daskalos, 1998; Lawrence, 2010;

Smith, van Goozen, Kuiper, & Cohen-Kettenis, 2005). Chivers

and Bailey (2000) questioned the notion that being a female-

born transgendered person occurred almost exclusively among

lesbian women. They recruited a convenience sample of 39

FTM who were in any stage of transition. They compared homo-

sexual and nonhomosexual FTM with regard to such variables as

gender identity, partner preferences, sexual activities, and body

modifications, including phalloplasty. Chivers and Bailey clas-

sified the participant’s sexual orientation based on their genetic

sex, not their gender identity or the sex to which they transitioned.

The findings were important for the acknowledgment that FTM

did not represent a homogenous group, as there were statistically

significant differences in the scores of the variables between the

homosexual and nonhomosexual groups. Typifying FTM sex-

uality as dichotomous instead of uniform provided an improved

understanding of the experience of sexuality within the context of

being FTM.

The same typology was used in another study that inves-

tigated whether both FTM and MTF could be divided into

these subtypes, and if there were statistically significant dif-

ferences among the groups (Smith et al., 2005). This study

recruited 187 pretreatment transgender participants from the

Netherlands. Differences among the groups were compared.

It was found that the homosexual transgender group applied

for sex reassignment at an earlier age, reported a greater child-

hood cross-gender identity, and tested better in psychological

functioning than the nonhomosexual group. When the dif-

ferences between homosexual and nonhomosexual for FTM

compared to MTF were examined, it was found that the age

difference in seeking sex reassignment was not significant for

FTM. Smith et al. stated that the data suggested that using the

homosexual and nonhomosexual subtypes for transgender

individuals had clinical and theoretical significance. It was

believed that there were only two transgender subtypes, homo-

sexual and nonhomosexual, and all who claimed bisexuality or

asexuality were placed in the nonhomosexual group. It is sig-

nificant that this division was done prior to the sex reassign-

ment procedure and there was no consideration of the possi-

bility of change in orientation post transition.

Another study that used the same categories did find a

change in sexual orientation among transgender participants

after transition (Daskalos, 1998). Daskalos used a non-ran-

dom sample of 20 FTM and MTF, half of whom were post-

operative. He divided the sample into homosexual and non-

homosexual groups based on their pre-transition biological

sex. Four postoperative and two preoperative members of the

heterosexual MTF group reported a shift in sexual orienta-

tion. This would mean a change from women to men as their

object of sexual desire. The participants saw this as being a

function of their emerging female gender identity and three of

the six attributed the shift, in part, to the female hormones they

were taking.

Lawrence (2010) reviewed transsexual typologies based

on either age of onset or sexual orientation. Lawrence found

that typologies based on sexual orientation were superior with

respect to unambiguous description and prediction of co-morbid

psychopathology and treatment outcomes. One recent study

found that sexuality among FTM required a paradigm other

than the dichotomous homosexual and nonhomosexual (Bock-

ting et al., 2009). This study was designed to improve the gen-

eralizability of Coleman et al.’s (1993) study that examined sex-

ual attraction to males among nine FTM in the Netherlands.

Twenty-five FTM from the United States who had undergone sex

reassignment and reported being attracted to men responded to

interviews regarding sexual identity, behavior, and social support.

450 Arch Sex Behav (2013) 42:449–461

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Questionnaires concerning sexual identity, self-esteem, psycho-

logical adjustment, and sexual functioning were also employed. A

comparison group of 76 nontransgender gay and bisexual men

were also given the questionnaires. The FTM group demonstrated

more bisexuality than the comparison group, but no other sig-

nificant differences were found. Bockting et al. argued for an

understanding of FTM sexual orientation that was tied to

gender identity rather than genital status and believed that it

should be seen within the emerging paradigm of transgender

sexuality. They also acknowledged the need for more quali-

tative studies to explore the development and nature of sexu-

ality among transgendered individuals.

Of note, the San Francisco Department of Public Health

recently added the acronym of TMSM to the larger group of

men who have sex with men (MSM) (SFDPH, 2010). TMSM

refers to transmen who have sex with men, the recognition of a

largely unidentified risk group within the MSM community.

While it is timely that this group has received the attention it

has, it brings to focus the limited research regarding the

ongoing development and variability in FTM sexuality. This

article will provide an insight into the life experience of 17

transmen, the majority situated within the gay or queer com-

munity in San Francisco.

Method

Participants

The participants constituted a convenience sample. The inclu-

sion criteria for this study were that the participants self-

identified as FTM, were at least 21 years of age, and had been

taking testosterone for a minimum of 1 year. The researcher

contacted TRANS:THRIVE, a community-based organi-

zation in San Francisco that provided social services and coun-

seling for transgender clients. A counselor at the program pro-

vided potential participants with contact information for the

researcher and screening was done over the telephone. Flyers

were placed at a sex club that catered to FTM and at the Les-

bian, Gay, Bisexual, and Transgender Community Center in

San Francisco. The flyers stated that the principal investigator

wanted to interview transmen who had been taking testoster-

one for a minimum of 1 year regarding sexuality and their expe-

rience of being transmen. The use of the sex club venue might

have skewed the sample in a direction of a more sexually adven-

turous group of participants. However, only two of the partici-

pants responded to the flyers at the club. The remaining partic-

ipants were introduced to the study by the counselor, were

referred by other participants in a snowball fashion, or respon-

ded to the flyer at the Community Center, a much more sex-

neutral environment.

The 17 participants ranged in age from 23 to 64 years and

the mean age was 36. The ethnicity of the participants was

predominantly White, with 10 identifying as such. The remain-

ing seven participants identified as White/Hispanic, Hispanic/

Native American, African American/Hispanic/White, White/

Basque, Jewish, and Mixed Race. Ten of the participants had a

college degree or higher, two had completed high school or its

equivalent, and five had some college short of graduation. The

number of years on testosterone was a median of 2 years with a

range from 1 to 15 years.

Procedure

This study was conducted in two phases over an 18-month

period. The initial phase was conducted in order to gain an

understanding of the population and to determine the param-

eters of the phenomena being studied. In this phase, six par-

ticipants were interviewed in a semi-structured manner for

1–2 h. In the second phase, an additional 11 participants were

engaged in in-depth interviews of 1–3 h. Each of these 11

participants also had a shorter follow-up interview several

weeks later. All of the participants were asked open-ended

questions about their experience as being FTM. Each was

asked to begin with their earliest recollections of feeling dif-

ferent with regard to their gender identity. They were asked to

discuss their sexual orientation with regard to thoughts, feel-

ings, and behaviors before and after transition (see Appendix

for question guide).

Data Analysis

Analysis of the data was guided by the methods of interpretive

phenomenology (Benner, 1994; Chan, Brykczynski, Malone,

& Benner, 2010; Leonard, 1994). Analysis began with the

first interview and was ongoing throughout the entire study.

Within 24 h of each interview, an interpretive memo was writ-

ten that addressed initial impressions with regard to the research

questions. All interviews were recorded and the initial readings

of all transcripts were compared with the recording to correct

any errors and to fully appreciate the vocal nuances that might be

lost in a printed document. The ATLAS.ti computer program

was used to code the interviews for emerging themes and cat-

egories. An extensive case summary was written for each par-

ticipant and each summary was compared with the others to note

distinctions and commonalities among the participants. The

Principle Investigator discussed the case summaries and inter-

pretations with the other investigator.

Results

Shift in Sexual Orientation

Of the 17 participants in the study, 10 identified as gay men at

the time they were interviewed. The other seven identified as

Arch Sex Behav (2013) 42:449–461 451

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queer or fluid in their sexual orientation. None identified as

heterosexual. All but two participants reported that they had

gay men as sexual partners, either as primary or casual part-

ners. The participants as a whole shifted toward having sex

with men, specifically gay men, after starting testosterone,

but this move should not be seen as a simple matter of lesbian

orientation being supplanted by a new interest in men.

Whereas the outcome at the time of the interviews indicated a

change in sexual behavior from the sexual behavior prior to tran-

sitioning, there were very distinct differences among the partic-

ipants related to their orientation and activity prior to transition

and at the time of the interviews. Four general patterns of behav-

ior were observed that were categorized as: steadfast, aligned,

shifted, and fluid. Each of these groups had its own specific con-

cerns and considerations with regard to the development of sex-

uality after transition.

Steadfast

Several of the participants identified as lesbian prior to transition

and they remained almost exclusively attracted to women after

transition. These participants included Jasper, Skip, and Vic (all

names used are pseudonyms). At 44, 64, and 51 respectively,

they were three of the oldest participants. Although after tran-

sitioning to men, their attraction to women should have meant

that they were technically heterosexual, these participants found

this a difficult label to accept after a lifetime spent outside of a

heteronormative existence. Having been part of the lesbian com-

munity was so important to their sense of self that they referred to

their current orientation as queer, a term that encompasses any

sexual orientation other than the strictly heterosexual. All three

experienced gender dysphoria throughout their lives but that did

not appear to impact their ability or desire to have sexual rela-

tionships with women who were members of the lesbian com-

munity. While all three had a history of sex with men prior to

coming out as lesbian, both Jasper and Vic had no interest in pur-

suing biological males. For Vic, there was a lack of attraction

and concern involving the risk in dating biological men:

V: Yeah. Yeah, because I think a lot of bio men are fasci-

nated now with having an extra hole to play with. And

they sometimes take advantage of the situation and go

bareback, you know. And that’s something that I didn’t

want to have to sit there and negotiate for a half an hour

before having sex, and having the whole thing just go

flop.

And I’m not, I’ve always been a top, so it’s kind of

difficult to give into a guy being my top. And usually

that’s what they’re looking for.

SR: Tell me, what are they looking for?

V: For someone that they can be an aggressor over. Instead

of being submissive.

SR: Looking for a bottom.

V: Yeah. They want a bottom, they don’t want another top.

So for them, I think, there’s very few men that you see

out there that say ‘‘I want an FTM top.’’ It’s very rare.

Skip was not as absolute, though his primary sexual interest

was women:

Well, I only played, I started playing around with guys,

because men, erotically, turned me on. But I basically,

erotically, was turned on by women, and also want a rela-

tionship with women, so it’s just more that way. And

when I was in my 20s, I was fucking everything in sight.

But I couldn’t get that many women, I was having sex

with a lot of guys, which I enjoyed, you know. And they

were all very good, they were all good relationships.

Then after I transitioned I’m much older and much more

cautious, and so I played around with some guys. But

some of the male places, they’re barebacking, and-

especially the other guy’s bi, or gay, I mean, my God, you

know. And I do know a couple guys that’s, they’ve got

HIV from that. So it’s just dangerous.

Skip was looking back on his sexual history and commented

about the fact that he was probably bisexual as a teenager, to a

great extent due to the lack of availability of other lesbians in

his social circle. It was after his 20s that he then became

almost exclusively lesbian and that is where he derived his

sense of community. After he transitioned and the testoster-

one use resulted in a greatly heightened sexual desire, Skip

wound up occasionally visiting peepshows and would involve

himself in some of the masturbatory activities that occurred

there. However, he did not get involved in the intercourse that he

knew that other transmen engaged in, primarily because he

became more cautious and careful as he grew older and he did

not want to become HIV positive which he saw happening to

other transmen.

All three in the steadfast group had been using testosterone

for over 5 years. They all reported the same initial sexual

response to testosterone use. They felt as though they were

going through a second adolescence and experienced a real

hypersexuality. Unlike some of the others in the study, the

effects of transitioning and their status of socially passing as

men did not change their life-long attraction toward women.

One dilemma for these participants was the question of

identification with the lesbian community after transition.

Many commented about the transphobia within the lesbian

community and the feeling among some that transmen had

betrayed the community. Jasper had a great personal stake in

the lesbian community and this was also the community from

which he found, and continues to find, his sexual partners.

However, after transition, he found that his status as a man

made him unwelcome in the social spaces he used to inhabit:

452 Arch Sex Behav (2013) 42:449–461

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I think some people felt that, you know, a sense of

betrayal, in the lesbian community. And the funny thing

is, is I’m a hundred percent honest, I felt that way a little

bit too before I transitioned. And, like how can you

leave our ranks, and that kind of thing. And then I just,

because, you know, I think it’s really difficult to under-

stand what it’s like to be a lesbian in the 80s and 90s.

Which was my experience, the 80s and 90s. I know it

was more difficult before then. But my experience was

that their politics can be really insular and really like,

very protected, even if you’re not like a separatist or

whatever. There’s so much oppression against women,

and so much oppression against lesbians, you know, even

more so. I mean, and it can come from such a disem-

powered place, that there’s, I don’t want to say just a

victim mentality, but there’s also just, I mean, there’s

rightly so, because of women are victims, of a lot of stuff

that goes on in the world. And that you feel like you have

to really tighten the boundaries of dyke-hood and you

don’t want to let your ranks be diminished.

Besides the question of how the lesbian community reac-

ted to transmen was the question of how the transman related

to his former life as a woman and lesbian. Jasper stated that he

understood completely the feeling of resentment and betrayal

that has now been focused on him. How could one have it both

ways, being a man and a lesbian woman at the same time? He

also appreciated the fact that, as a disempowered group, some

lesbians felt the need to close the ranks in an almost insular

manner to protect what he called the ‘‘boundaries of dyke-

hood’’. Jasper, interestingly, referred to the lesbian commu-

nity in the third person, indicating acceptance of his distance

from it.

For others, such as Vic, being shunned by the lesbian

community was a real loss and there was some bitterness

associated with it. He did, however, find a transgender group

that had affiliated itself with less separatist elements of the

lesbian community and this provided him with a connection

to the community that he felt a member of for so long. Skip, on

the other hand, labeled himself as an outcast and hadn’t yet

found a community where he felt a sense of belonging.

Aligned

The largest group consisted of the six participants who expe-

rienced gender dysphoria to such an extent at the time of ado-

lescence and later that a comfortable and natural sexual activ-

ity was impossible. They all had a life-long sexual attraction

for men but the sex itself was never right as long as they were

female-bodied and identified. The discomfort of the dys-

phoria gave them a feeling that something was wrong in the

realm of gender and sexual expression. During their pre-

transition life, most had relationships with men, these men

treated them sexually as if they were women while internally

they felt themselves men and needed to sexually relate to their

partners as such. One participant, Sam, spoke about how he

had resented being ‘‘feminized in bed’’ by men. Transition

finally allowed for a more comfortable alignment of gender

and sexuality. LeRoy described just what that sense of align-

ment was like:

Because I finally, like my gender and my sexuality were

finally in the same place at the same time, and it was

like, Ah! Finally, something is right. You know, like,

for me my gender and my sexuality have always been

very tied up in each other, and something somewhere

was always amiss. So when they finally were there,

together, I was like, Finally. I’m going to have the ado-

lescence I never had, and be super excited about sex,

because I never had it. So I wouldn’t say that I was more

interested in men, I was just acting on it more often

because I was comfortable with who I was.

Ricardo spoke about how the alignment resulted in a change

of his understanding of his own sexuality with his husband:

I started realizing that sexually, I’m male. And it came in

dreams, it came when I was with my husband, I just real-

ized that I’m male sexually. Or I want to be the male in a

sexual interaction. And that’s when I really realized,

‘‘Wow.’’ Well, this is interesting, ‘cause you know for

many-probably for most of our marriage I was the prob-

lem, sexually, in the marriage. Like I said, I was taking

testosterone, libido, you know, I was kind of the identi-

fied problem. And that was really hard to take, to live

with. And all of a sudden sex was better. Because see, not

only, I didn’t realize at the time that I was gay. But I’m,

now I’m man and I’m a gay man, and so he just saw the

sex was better. I know, I kinda knew why. But he didn’t

know, so, that went on for a while, and then I realized it

was just too dishonest, I have to tell him. But it was, the

interesting part is being sexual with him as a man, was

much better than being sexual with him as a woman, even

though the act was pretty much the same, ‘cause obvi-

ously I don’t have the parts. But it was different, ‘cause

there’s a different connect, it’s just a different connec-

tion.

Many used the same phrase of not being able to make love

to a man until they were a man. All six dated men during their

high school and college days and three of the six were married

to men. However, prior to transition, these participants felt

that something was wrong with the way they were sexually

relating with their male partners. In the search for the right

identity, all of them turned to the lesbian community for vary-

ing lengths of time. This was a social space that was accepting

of female-bodied individuals who did not fit comfortably into

a heteronormative lifestyle, though trying on a lesbian

Arch Sex Behav (2013) 42:449–461 453

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identity never felt quite right. LeRoy spent several years

identified as a lesbian, though it was primarily because he

couldn’t physically be a gay man:

I was dating a man at the time, and I had met a bunch of

women who were lesbians. And they were really nice

and they liked me a lot. And I, I don’t know, I mean I just

felt confused. Like, literally what I was thinking in my

head was, ‘‘Well I’m not, I guess I must be a gay

woman.’’I was like, well, I don’t feel comfortable being

with men. I was female-identified. And I was like, my

thought was like, ‘‘Okay, well I guess that means I’m a

gay woman.’’ So it was like this default setting. Well,

that means you’re a gay woman.

For some, like Keith, even living within the lesbian commu-

nity and having a lesbian identity did not stop a sexual desire

for men:

So I tried doing that (being lesbian), for two years. But I

was always dragging home boys. And it just, you know,

it just, I would crave, okay, I’ll be crass, I would crave

cock. And I wouldn’t really have the same cravings for

women.

In many ways, these participants did not gain a lasting sense

of identity or belonging from the lesbian community. Even within

transmale circles, some felt that they were outside the norm due

to their lack of a previous lesbian identity. Ben felt estranged

from other transmen when he first transitioned because all the

other transmen he knew had the experience of being lesbian

that he didn’t have:

When I had that first partner, I kind of dived into that

(lesbian) community, and that just wasn’t about me at

all. That was just not me. … When I started becoming part of the transgender community…at first, the guys I met were all formerly lesbian-identified females.

So, for these six participants, the nature and object of their

sexual desire did not change, but transition allowed it to

finally be realized in the way that felt right, as gay men. It is

interesting that four of the six stated that they identified as a

gay men even prior to transitioning and passing as male. Even

though it could be seen as problematic for some that their

desire for men as men forced them into a gay social milieu,

this is exactly what they felt and wanted all along. Mick

recalled the feelings he had when he started developing a

sense of his own sexuality as a teenager:

And I guess you could say I wanted to be a gay man more

than I wanted to be a lesbian woman. But at that time I

wasn’t really even thinking in that kind of language.

However, for most of the aligned group, the world of gay men

was completely new and the rules and modus operandi

apropos of sex and cruising were quite foreign. This had real

implications for vulnerability regarding the ability to nego-

tiate safe sex or even knowing how to assess and discuss risk.

For those who spent time within the lesbian or queer commu-

nities, this might not be so difficult, but for several members

of this group there was a real confusion upon entering a gay

man’s world. The difficulty was not just a matter of negoti-

ating safety but how to socially interact in a completely for-

eign milieu. This was especially true for Ricardo who was

married and had no real contact with the gay or queer com-

munities before his transition at age 44:

R: Okay. Well, first of all, the gay culture has been very

scary for me to think about, because I never knew of it.

It was… SR: So how was it, tell me how you came to contact it?

R: Well, it was, seeing my therapist, here in the city when I

identified, realized I’m gay, I-there’s places to go,

obviously. Here, for gay men. But the difficulty, and

the part I think was very scary for me, was how do I

walk into a gay bar, just even walking in a place where

there’s all men, interacting, how do I even enter that

scene? You know, I’m used to walking into places

where it’s men and women. And, how do you walk up, I

just, it was just foreign to me. I felt like a teenager first

learning to date, or, you know, what do you say, or how

do you flirt, you know, all that. Didn’t, still don’t have

much experience or clue in it.

Also LeRoy, who transitioned his early 20s, did not have

much exposure to gay culture prior to becoming a gay man.

Mick was an exception as he identified as a gay man early in

his teenage years, had gay boyfriends, and was active in the

queer and sex worker communities throughout his life. Mick

was also the only participant who reported being HIV positive.

He was infected shortly after he transitioned to being a gay

man.

Unlike the steadfast group, transition for those in the aligned

group did not mean the same loss of the lesbian community and

its social and political identity. However, like all who are trans-

gendered, they had families and friends who were impacted by

the transition and some wound up losing relationships that have

yet to be mended. The possibilities that were opened up by the

alignment brought about by transition included relief of a

lifetime of gender dysphoria and the subsequent sexuality as

gay men. As was seen, this presented the possibility of sexual

risk for which many were quite unprepared.

Shifted

There were four participants who had a rather dramatic shift

in their object of sexual desire as they transitioned from a pri-

marily lesbian orientation to that of being gay men. This was

454 Arch Sex Behav (2013) 42:449–461

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quite different from the previous participants, many of whom

knew that they were gay men prior to transitioning. All of the

men who shifted their sexual orientation stated that the change in

the object of sexual desire from women to men happened unex-

pectedly. This group included Cheyenne, Chuck, Hank, and

Thomas. Prior to transition, all were primarily lesbian, with the

exception of Hank, who was situated socially within the lesbian

community but reported equal sexual attraction to both men and

women that couldn’t be fully realized while he identified as

lesbian. However, he stated that his shift to sexually preferring

men over women came unexpectedly.

Chuck and Cheyenne both had very similar stories con-

cerning the unexpected change they experienced. Chuck had

a boyfriend for about 6 months at the time of the first inter-

view. He had been lesbian-identified since high school and

moved to San Francisco in the 1980s to be a part of the grow-

ing punk/dyke/leather community. After realizing that he was

transgender and subsequently beginning testosterone, he spent a

summer working at a traveling rock festival with his lesbian-

identified girlfriend with whom he had initially thought he

would remain. It was over that summer that Chuck noticed that

not only was his body changing but his feelings were taking

him to some very new places:

C: But I did notice, I started really looking at boys that

summer, because there were so many hot, sweaty,

shirtless guys running around. And I was sort of more

looking; it started as looking at their body type. What

body type am I gonna have when this process is over

and done with? …Then I was like, ‘‘Oh, he’s kind of cute.’’ And then it started going into, like, ‘‘Yeah, he’d

probably be cuter if he was naked,’’and it really sort of

progressed into this really kind of obsessing on guys,

and kind of looking at them more sexually.

SR: Had you ever done that before?

C: No, not really.

Shortly after getting back to San Francisco after that summer,

Chuck broke up with his girlfriend and started living as a gay

man. As his transition allowed for increasingly better passing,

he went from finding partners on heterosexual sites to using

only gay-specific web sites.

Cheyenne had lived his life prior to transition as a lesbian

and he also had planned to continue with women as sex part-

ners. He pointed out very clearly some of the aspects of being

in a gay social situation that could be extremely rewarding for

a transman:

I, well, at first, I think the first six months, I was still

kinda into women, but I was more, I was like ‘‘Whoa,’’

noticing men, and definitely gay men were cruising me.

And I felt validated by that, you know. ‘Cause ‘‘they’re

men, and they’re cruising me, so that must mean that

I’m passing really well,’’ you know. And then, it kinda

shifted to, I don’t know what happened, I stopped dating

women and I just primarily identified as a gay man, and

just started dating gay men.

Being cruised by gay men was validation that one was truly

passing. The desire for passing, for many of the participants,

became linked with a sexual desire for being with men. The

factors here appeared to be the interplay of hormonal, psy-

chological, and social forces. Cheyenne also desired to be a

recognized member of the gay community, so much so that he

also saw being HIV positive as a further validation of his gay

male status:

I was, okay, well, my partner right now is positive.

We’re non-sexual. We used to be sexual. And I think

maybe that’s another reason that we’re not sexual, I

think for him there’s a little bit of a hang-up, maybe,

about him being positive, like not wanting to infect me.

But also me not having a penis, and also, you know,

we’re not sexual. But we used to be. And there was

something that happened one time, I felt like everybody

around me was positive I felt I was already different and

already left out, and I just, you know, it sounds, what-

ever, I know I’m not the only one that felt that way. Just,

you know, and it felt like I already had a disease with my

blood that could put people at risk, you know, with

having hepatitis. But it wasn’t really giving me a sense

of belonging, or giving me free acupuncture, free mas-

sage, free reiki, free housing, free this and that. You see

other people, like, getting hooked up with benefits, and

you’re like having unprotected sex and you’re not

getting positive. I was getting off on putting myself at

risk, you know. And I was even telling people I was

positive so they wouldn’t have, you know, issues about

being with me sexually.

Cheyenne started telling HIV positive sex partners that he

was already HIV positive so that they wouldn’t feel com-

pelled to use condoms and so that he might finally become

part of the positive community. This didn’t happen as Chey-

enne eventually broke up with his boyfriend due to the com-

mon transman incompatibility for many gay men, the lack of a

penis.

Thomas, who was in his mid-40s, still lived with his female

lover from his lesbian life prior to transition, though they were

no longer having sex. Even though he had limited experience

acting upon it, he also had an unexpected shift in the object of

his sexual desire:

I am one of those guys that experienced a radical shift in

orientation during transition. Yeah, well, that’s when it

came, really came to fruition. I mean I definitely started

role-playing when I was involved in the leather scene,

prior to transition. But I definitely went from being as

Arch Sex Behav (2013) 42:449–461 455

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interested or more interested in women, to being much

more interested in men. And I mean, I can surmise that

being a little more comfortable with my own body,

freed up other things going on with how I looked at other

people, or what interested me. But I honestly don’t

know, it’s still like one of those great mysteries for me of

what happened.

When he began using testosterone 15 years ago, Thomas had

every intention of remaining with his partner until he found

that his sexual orientation shifted. Unlike Chuck, who decided

to pursue gay men when his relationship with his female partner

ended, Thomas’ situation became more complicated. His partner

developed a serious illness shortly after Thomas transitioned.

This resulted in severe mobility problems for her. Thomas chose

not to abandon his former lover and remained in the relationship

out of a sense of loyalty to her. In theory the relationship was

sexually open. However, Thomas felt quite ambivalent about seeing

men on the side. A sexual encounter could leadto a romantic involve-

ment and a possible break-up with his partner. To avoid such a

conflict, Thomas rarely acted upon his sexual desires.

Hank stated that he had been a lesbian politically and

socially. However, he was attracted to men and women

equally, though it was really his new situation of being within

a gay social environment that enabled him to change:

H: I definitely have hooked up with a lot more men since

physically transitioning and socially transitioning. And

to a large degree, that has to do with the social situation,

as far as the way I’m being read. But on the other side,

where before transitioning and even the first year, year

and a half of transition, I saw potential partners pretty

equally as far as gender goes. Was attracted to men,

attracted to women, or in between. Now, more recently,

probably in the past six months or so, it’s shifted much

further away from women and much more towards men.

You know, if somebody like threw themselves on me I

probably wouldn’t say no as far as women go, but like,

I’m actually much more… much gayer, now (laughs). SR: Which is interesting, since you did identify with the

lesbian community.

H: Yeah, and that’s been, I think that’s been part of it too,

is I don’t necessarily feel as much of a part of the

lesbian community since physically transitioning. Or

at least passing much more. I mean, a lot of people in

the community know me, so it’s not you know,

incredibly awkward, but I feel strange hanging out in a

dyke bar.

After transition, his interest shifted dramatically to the men’s

side of the equation and he was comfortably situated within

the gay community when interviewed. At that time, he stated

that he had recently broken up with a girlfriend and was in the

process of looking for a cute guy.

Fluid

The final four participants seemed to be genuinely bisexual or

fluid in their sexual orientation, and transition made sex with

gay men more of a possibility without really changing the

nature of their desire. This group included Lou, Lucas, and

Ski, who all had primary relationships with women but also

had sex with men on the side. However, even though they had

female partners, they identified themselves as bisexual or

queer men. At the time of the interview, Karl was without a

partner and was ambivalent regarding whether he wanted a

female partner or if he would continue his transitioning to

eventually become a gay man.

The attitude with which each participant approached his

sexuality was somewhat unique. Lucas stated that he really

did not like being emotionally close to men. He needed women

for his emotional needs, so he had a girlfriend and had anon-

ymous hookups with men every few months just to get the

physical need out of his system. He had arrived at this solution

after several different periods in his life where he had dated

either men or women exclusively:

I didn’t identify as a lesbian, I just didn’t want to date men

at that time. Because I had become obsessed with women.

I just had become obsessed with like, the relationship with

women. I realized that I didn’t really have much of an

emotional connection with men, when it came to dating.

So I didn’t want to further that anymore, I didn’t want to

waste my time dating men. It was more of just a sexual

thing. But with women, I had, I felt like an emotional

connection and I liked the relationship dynamics with

women. And that’s still how it is, with me, to this day, is

like, wanting to date women for emotional reasons, and

sexual. But men, I’m still interested in them sexually.

At the second interview, Lucas stated that he had begun to

rethink his view of men as being only for sexual purposes and

not for a complete emotional relationship. He had started to

date a man that he hoped would be able to fulfill both needs.

Karl tried on a lesbian identity for a brief period of time but

he found the fluid nature of his experience was problematic:

Well, I think that, one thing that’s also been a thread

through my life, is that I feel like I have a lot of fluidity in

me, that doesn’t anchor me solidly into any camp that I

can hold on to. And so, things like sexuality and gender

all seem… they all fluctuate so much that it’s a little difficult to locate myself in any one place.

Perhaps because of this difficulty in locating himself, Karl

sought out men after he started transitioning in order to help

456 Arch Sex Behav (2013) 42:449–461

123

him understand the masculinity that he was taking on for

himself:

K: I would say that I probably had an equal attraction. I

think that it was an issue of accessibility and an issue

of, like, who I wanted to be in relation to my sexual

partners.

SR: For example? What do you mean by that?

K: Sure, well, I don’t think that I ever wanted to be the

woman counterpoint to a man. So I didn’t want to have

sex with men as a woman. And then I think that, you

know, increasingly it’s become difficult to be a man to

someone’s woman, if that makes sense.

SR: To a female-identified person.

K. Right, yeah.

SR: It’s difficult to be a man to a female-identified person?

K. Mm-hm. Like that doesn’t feel right to me either.

SR: What feels right?

K. I’ll let you know when I figure it out.

Karl had a brief affair with a man 40 years older than himself

so he could be desirable and fulfill a role he understood as

somebody’s younger boy. After seeing women briefly again,

he desired more contact with and recently hooked up with

men who were closer to his own age. He was ambivalent

regarding the masculinity that he was starting to manifest and

was taking his transition at a slower pace than the other

participants. He provided a possible explanation for seeking

men as sexual partners:

I started to be more interested in trying to describe and

define to myself what masculinity might mean. And I

think that’s what led me to have these encounters with

men. So I think that the testosterone was sort of the, I

would imagine it was the impetus for the sleeping with

men, but I don’t know if it was because I was more sex-

ualized, or it was more related to my identity exploration.

Both Lou and Ski described their identity as queer or bisexual

and they spent a short amount of time in the lesbian com-

munity though they felt that the label was not appropriate for

them. They felt comfortable having a steady relationship with

a woman and having an occasional fling with a gay man. This

was very different from the gay identity that Chuck and

Thomas, of the shifted group, unexpectedly transitioned into.

For this group of sexually fluid transmen, something

occurred that opened the door of sexual possibilities that had

been previously limited. Lucas was able to describe what

happened for him:

I don’t really know. I think that I just started thinking

about sex more after I started taking hormones and also,

me being more comfortable with my own body, as I

transitioned and everything and realizing and I’ve

always identified as a fag even when I dated women.

That’s always how I just felt inside. So, you know, the

more I’m comfortable in my own body. I’m just more

comfortable with being in a gray area of sexuality, I

think. Oh, like dating everybody, you know, being really

attracted to men as well or some men and wanting to,

you know, date them as well as women.

As stated earlier, all of the transmen experienced some kind of

gender dysphoria early in life. For many, the discomfort they

felt within their own bodies created a barrier that prevented

them from being able to express their sexuality. Many had

desire for men sexually but couldn’t make love to a man while

they were female bodied and identified. Karl described how

his dysphoria led him to feel such a disconnection with his

body that he stopped taking care of himself:

K: I don’t have early memories of feeling like I was a boy,

or I, you know, I think that I grew up and felt like a pretty

little girl, and that felt fine for me. And then I think

maybe around puberty, I started to feel like, discon-

nected from my body, but not with the orientation of

feeling like I was a boy, but just feeling like I didn’t like

the physical changes in my body, I didn’t like the devel-

opment of my, like, secondary female characteristics.

And… SR: Do you know how you reacted to that at the time?

K: I just wore really baggy clothing and I stopped doing a

lot of self-care. I stopped, you know like, brushing my

hair, and I just stopped grooming basically. I think I

just stopped caring for myself because I didn’t know

how to. There was no avenue where I felt I would feel

successful as a woman or as a girl, so I just kind of

stopped trying.

He eventually started cutting and burning himself. Despite the

intervention of a school therapist, this activity did not stop until

his early 20s. It is interesting that issues of gender dysphoria

were never brought up during his therapy sessions. The major-

ity of the participants reported some kind of problem while still

in school that resulted in counseling sessions. However, only

Mick’s counseling sessions involved any discussion of gender

issues and that ended when Mick revealed his sexual orien-

tation to the counselor who balked at the notion that Mick

wanted to transition in order to become a gay man.

Discussion

Of the 17 transmen who participated in this study, all but

two stated that they had gay men as sexual partners after

Arch Sex Behav (2013) 42:449–461 457

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transitioning. All described themselves as either gay or queer.

The participants, in general, shifted toward a sexual prefer-

ence for men; however, it was primarily in the aligned and

shifted groups that the most dramatic change in sexual

activity occurred. Whereas the definitive cause of the new gay

identity among the transmen in this study is impossible to

determine, three important factors for all were the use of

testosterone, the process of transition, and the social context

in which they found themselves.

Testosterone

Even for those who had a sexual attraction to men prior to

transition, it was the testosterone that enabled them to pass as

a man, validated their male gender identification, and dimin-

ished gender dysphoria. For them, testosterone was the key

that opened the door of sexual possibilities. The extent to

which the hormone influenced the shift in sexual orientation

is probably unlikely given that the participants denied such an

effect. However, it certainly remains as a matter of further

inquiry. Of interest is the study by Daskalos (1998) where

three of the six MTF who reported a change in sexual orien-

tation toward men attributed it to the effect of the female

hormones they were taking. In contrast, while the transmen in

this study noted the increased sexual desire brought on by the

use of testosterone, none of the shifted group believed that it

was responsible for the actual change in desire.

The Process of Transition

The period when the participants first starting using testos-

terone for transition was described almost universally as a

second adolescence, better than the first. Like the first time

around, this adolescence was characterized by sexual exper-

imentation. It could be posited that the shift to men as sexual

partners was simply a factor of that experimentation. In early

transition, many did report that they sought out men as sex

partners in order to understand the male sexuality that they

were transitioning into. This concurs with the findings of

Devor (1993) who observed that some transmale participants

sought men as sex partners primarily as role models for male

sexuality.

However, in this study, this experimentation tended to

occur early in transition when participants were not passing as

convincingly as they would after more time on testosterone.

Many would present themselves as butch lesbians on online

sites that catered to heterosexual and bisexual men. The

physical changes brought on by the process of transitioning

and testosterone eventually allowed a graduation from those

sites to Internet sites specifically for gay male sexual cruising.

Over time, the experimentation with men became, for some, a

definite preference. It is also of note that the shifted group had

been taking testosterone for an average of 8� years and had, therefore, greater experience passing and living as men than

any of the fluid group, who averaged just over 2 years on

testosterone. This idea has been presented in the work of

Devor (1993) who found that those transmen who developed

a sexual attraction for men did so, on average, just over seven

years into their transition. It is conceivable that, given more

time passing as male, the sexuality of the fluid group might

move more toward gay men, such as the case of Lucas, who

expressed a marked increased interest in men in the 2 months

between interviews. However, the steadfast group, with an

average of 8 years taking testosterone, demonstrated that time

and male hormones did not necessarily result in a shift of

sexual orientation. Also two of the shifted group found that

their change in sexual orientation began as soon as 6 months

after starting testosterone. It is also important to mention that

this study represents a snapshot in time. This may not be the

final phase in their trajectory for any of the participants.

Social Context

The third factor was the social context of transition. Many of

the participants transitioned from within the gay and queer

communities in San Francisco. All of them wound up living

within them. Both socially and geographically, these are

extremely visible communities within the larger city. A queer

consciousness embraces a wide range of experience with

regard to sexual expression, economic status, and political

beliefs. In contrast to the findings of Devor (1993, 1997)

regarding the emergence of a straight or heterosexual male

identity, this was not seen in the participants and certainly the

social setting of San Francisco could have had an influence on

identity formation. Bockting et al. (2009) noted the emer-

gence of a transgender sexuality as an identity distinct from

the gay sexuality that their participants were claiming. This

was seen as an experience of sexuality that differed from a

nontransgender male or female sexuality and, in many ways,

represented a form of sexuality outside of the gender binary.

In contrast, this study found that, within the context of a

city such as San Francisco, with its wide sexual diversity and

greater tolerance relative to the rest of the country, a discrete

uniform transgender sexuality did not emerge as shared

experience for the participants. Their sexuality was a part of

the fabric of the overall queer sexuality and not necessarily a

separate entity. The participants stated that they identified

their sexuality as gay, queer, or bisexual. That identity was

not based just on themselves but also their partners and how

they identified. Instead of possessing a distinct transgender

sexuality, the presence of transmen within the gay commu-

nity can be seen as expanding gay sexuality into a more queer

realm. None of the participants could conceive of identifying

as heterosexual as it represented a community and way of

being that were both foreign and unappealing for all. While

458 Arch Sex Behav (2013) 42:449–461

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most of the participants used the terms queer and gay inter-

changeably, there were several who identified themselves as

unequivocally gay. These were transmen who did not identify

with the transgender community or with any notion of trans-

gender sexuality. They did not reject the gender binary.

Instead, they saw themselves as aligning with the male side of

the dichotomy. What was important for these transmen was

their complete integration as gay men and as part of the gay

community.

This study questions several generally accepted assump-

tions regarding the nature of transgender identity and its rela-

tionship to sexual orientation. It is intended to be a contribu-

tion to a growing body of work that examines the self-defined

sexual identities of individuals who have transitioned. One

assumption questioned is the notion that having gender dys-

phoria that results in a transgender identification is inextri-

cably linked to a person’s sexual orientation. From that idea

developed the belief that there were two distinct subtypes of

transgender who could be viewed through the lens of their

pre-transition sexual orientation, homosexual and nonho-

mosexual (Chivers & Bailey, 2000; Lawrence, 2010; Smith

et al., 2005). Devor (1994) opened up the possibilities of

different taxonomies, however, in that his transmale partici-

pants reported a heterosexual identity when they were part-

nered with women. The participants in this study were part of

the sexual/social fabric that forms the unique community of

San Francisco. As a result, even those participants who were

primarily attracted to and partnered with women could not

identity as heterosexual but as queer instead. A heteronor-

mative identity simply does not work for many people who

have become acculturated to a San Francisco mode of exis-

tence.

The participants in this study characterized their sexuality

prior to transition in a variety of ways. This ranged from a

lesbian identification to a heterosexual orientation that did not

involve any lesbian identity. The majority of the participants

were somewhere in between and did not feel comfortable

with their sexuality until they transitioned into the gender

presentation that matched their gender identity. The homo-

sexual, nonhomosexual subtype system classifies individuals

solely on a criterion of sexuality relative to genetic sex, mean-

ing that former lesbian participants are considered homo-

sexual subtypes and heterosexual and bisexual participants as

nonhomosexual. These subtypes, and thus sexual orientation,

have then been used as a means of explaining differences in

why and when transgendered people sought sex reassign-

ment. In other words, that there were distinct transgender

developmental processes for homosexuals as compared to

nonhomosexuals (Smith et al., 2005). Sexuality was, there-

fore, seen as a determinant of transgender development.

However, in this study, sexuality was found to be an unpre-

dictable outcome of transition, not a factor for transition.

The reality for the participants in this study was more

complex and was characterized by a great variability in sexual

identity and expression. In part, this variation was due to the

fact that, for the participant who had experienced gender dys-

phoria, the transition to being male opened up sexual possi-

bilities that had been previously unavailable. This was espe-

cially evident in the aligned and shifted individuals. Many

of the participants made similar statements regarding being

attracted to men from an early age but something was always

amiss because the nature of the sexual relationship was a het-

erosexual configuration requiring that they assume the female

role. This was consistent with the findings of other studies that

explored gay identity among transmen (Bockting et al., 2009;

Coleman et al., 1993). For both the aligned and fluid partici-

pants, the possibility of being gay or queer was made real.

Many participants in these groups had felt an identity as gay

men prior to transition but this did not make sense until tes-

tosterone enabled them to live as men. Thus, transition allowed

for the actualization of situated possibilities of sexuality.

However, unlike the study by Coleman et al. (1993), where

it was found that all of the participants had a sexual attraction

for men prior to transition, the four shifted participants were

essentially taken by surprise by their predominant sexual

attraction to men over women. For all four, this occurred after

they began passing as men. These individuals rendered the

subtyping of transmen into homosexual and nonhomosexual

categories as being of questionable value. Devor (1993) also

found that some transmen sought gay men as sexual partners.

He found that attraction for men tended to occur, on average,

greater than 7 years into transition and he postulated that this

might have been for the purpose of understanding male sex-

uality. While the shifted group in this study was farther, on

average, into their transition, they reported that the shift in

sexual orientation began as early as 6 months into their tran-

sition. Of significance, their shift remained stable many years

later and they had settled comfortably into their identities as

gay men.

As noted earlier, one of the fluid group, Karl, had reported

that as a child he was involved in both cutting and burning

himself. This activity was brought to the attention of a school

therapist and it stopped when he was in his early 20s. The

other participants reported that any problems they had func-

tioning were a matter of the gender dysphoria they were

experiencing and the difficulty of themselves and others to

accept and adjust to it. Transition provided the solution. It

could be posited that at least some of the participants had a

psychopathology, such as borderline personality disorder,

that organized their impaired sexual lives. However, there

was no evidence for this. The participants all felt that their sex

lives were of adequate quality and despite the routine frus-

trations of inherent in the pursuit of the right partner, they

enjoyed the sex lives they were living post transition. Two of

Arch Sex Behav (2013) 42:449–461 459

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the gay identified participants were happy with steady boy-

friends and one had moved in with his boyfriend at the time of

the second interview.

In summary, it has been demonstrated that medical sex

reassignment will, at times, result in transgendered persons

who possess a same-sex attraction toward the gender to which

they have transitioned. Further exploration is needed to under-

stand the development of sexuality among FTM that goes

beyond the typology of homosexual and nonhomosexual to

incorporate the lived experience of the development of sexual

identity in FTM as they transition.

The development of sexual identity among transmen needs to

be explored in a variety of research designs. More qualitative

data from different regions and from both rural and urban

settings would be helpful. Large quantitative studies would

help to determine the prevalence of gay transmen and where they

are.

This study has implications for all clinicians who work

with transmen. It can be beneficial to discuss sexual orien-

tation and the possibility of unanticipated change. Whereas

the participants in this study all reported their change in sex-

uality early in transition, others have found this to occur after

a number of years. Therefore, it also should not be assumed

that anyone transitioning has reached a final resting point with

regard to sexuality. This can be especially important for those

who are partnered. Even for those whose orientation was

toward men, transition could mean entering a gay community

that was previously unfamiliar. Thus, comprehensive coun-

seling regarding HIV risk and safer sex is essential.

Limitations

Limitations of this study were a result of the number and type

of participants. A small sample of 17 individuals cannot be

used to generalize to the unknown number of transmen in the

United States. Also, the criteria for this study included the

stipulation of a transition using testosterone for at least 1 year.

Not all individuals who identify as transgendered choose to

use hormones for transition or even to transition at all. It is

likely that those people who do not use hormones have a very

different experience. In addition, all of these participants

lived in an urban environment. The experience of those who

live in a rural or suburban area could also be very different. It

is also possible that those transmen who identified as gay self

selected to participate in this study, though there was no

attempt to represent them any more than other transmen.

There was also no attempt to represent such a highly educated

group of individuals; nevertheless this sample was certainly

skewed in that direction. A greater variety in racial and eco-

nomic background of the participants would provide a

broader understanding of the phenomenon.

The sexuality of the participants was assessed through

questions that asked for self-identification. Sexuality was not

separated into discrete aspects of fantasies, desires, and behav-

iors. Since the concept of sexual orientation is problematic

because behaviors and feelings are often incongruent, it is

hoped that this qualitative assessment enriches and provides

an alternative to previously specified categories.

Appendix: Interview Guide

Introduction: Thank you very much for agreeing to partici-

pate in this study. As you know, I will be asking you questions

related to being transgendered and how that may have had an

impact your sexual identity and behavior. I will also be asking

about testosterone use.

1. Could you describe for me how you came to realize you

were transgendered? What happened as a result of your

realization? For each question, the following probes will

be used to elicit greater depth from the participant: Please

give me an example of that. Tell me more about that.

2. I’m interested in exploring sexual orientation and sexual

behavior before and after transitioning. Please describe

your sexual orientation and behavior prior to transition-

ing. Please begin with your earliest remembered feel-

ings. Various probings depending upon participant’s

response (e.g., Had you been sexually active with males

prior to using testosterone? Had you ever attended gay

men’s sex clubs?).

3. Could you describe your feelings regarding your sexual

orientation when you were coming out as FTM? And

what did you do about those feelings?

4. Could you tell me about how you began using testoster-

one? How was it first provided for you? And now?

5. Could you tell me about any changes that might have

occurred with your sexual feelings and/or behavior after

you started using testosterone?

6. How would you describe your sexual orientation and

behavior now? What do you attribute that to? A variety of

responses from being in a monogamous relationship to

engaging in activities at gay sex clubs is expected. This

area will be explored depending upon the responses.

7. I’d like to hear about your experience of becoming part of

the gay community. Can you tell me about your expe-

rience with finding sex partners? Do you have a dis-

closure story? Could you tell me about how you feel that

the risk of HIV impacts upon you? Has this always been

the case? How has this changed?

Narrative Strategy: Questions 6 and 7 both involve eliciting

narratives from the participant. The questions and probes will

follow the format below: Can you tell about a time that you

remember as especially meaningful with regard to: (a) prac-

ticing safe sex; (b) practicing unsafe sex; (c) managing your

identity, disclosing or not disclosing. Please tell me the story

460 Arch Sex Behav (2013) 42:449–461

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of what happened. It could be a memorable story because it

was a difficult situation or because you handled it very well.

The following probes will be used: What happened? How the

events played out. What is the setting or social context of this

story? What events lead to the story? How did the situation

unfold? What in this situation concerned or worried you?

What did you do? What did you consider doing but rejected or

were unable to do? What prevented you from doing that?

What were your feelings as this was happening? Did you

consider getting help or advice from others? Who? How did

you get other people involved or informed? What did they do

that helped the situation?

9. Could you tell me about any HIV prevention education

that you’ve had? Do you feel it was adequate for your

needs? How would you change this for other FTM?

10. Would you like to add anything more? Is there anything

else that you think I should know? Do you have any

questions for me?

References

Benjamin, H. (1966). The transsexual phenomenon. New York: Julian Press.

Benner, P. (1994). The tradition and skill of interpretive phenomenology

in studying health, illness, and caring practices. In P. Benner (Ed.),

Interpretive phenomenology: Embodiment, caring, and ethics in health and illness (pp. 99–127). Thousand Oaks, CA: Sage.

Bockting, W., Benner, A., & Coleman, E. (2009). Gay and bisexual

identity development among female-to-male transsexuals in North

America: Emergence of a transgender sexuality. Archives of Sexual Behavior, 38, 688–701.

Chan, G., Brykczynski, K., Malone, R., & Benner, P. (2010). Interpre- tive phenomenology in health care research. Indianapolis, IN: Sigma Theta Tau International.

Chivers, M. L., & Bailey, J. M. (2000). Sexual orientation of female-to-

male transsexuals: A comparison of homosexual and nonhomo-

sexual types. Archives of Sexual Behavior, 29, 259–278. Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV

prevalence, risk behaviors, health care use, and mental health status

of transgender persons: Implications for public health intervention.

American Journal of Public Health, 91, 915–921.

Coleman, E., Bockting, W. O., & Gooren, L. (1993). Homosexual and

bisexual identity in sex-reassigned female-to-male transsexuals.

Archives of Sexual Behavior, 22, 37–50. Daskalos, C. T. (1998). Changes in the sexual orientation of six

heterosexual male-to-female transsexuals. Archives of Sexual Behavior, 27, 605–614.

Devor, H. (1993). Sexual orientation identities, attractions, and practices of

female-to-male transsexuals. Journal of Sex Research, 30, 303–315. Devor, H. (1994). Toward a taxonomy of gendered sexuality. Journal of

Psychology and Human Sexuality, 6(1), 23–55. Devor, H. (1997). More than manly women: How female-to-male

transsexuals reject lesbian identities. In B. Bullough, V. L. Bul-

lough, & J. Elias (Eds.), Gender blending (pp. 87–102). Amherst, NY: Prometheus Books.

Devor, H. (2004). Witnessing and mirroring: A fourteen-stage model

of transsexual identity formation. Journal of Gay and Lesbian Psychotherapy, 8(1/2), 41–67.

Herbst, J. H., Jacobs, E. D., Finlayson, T. J., McKleroy, V. S., Neumann,

M. S., & Crepaz, N. (2008). Estimating HIV prevalence and risk

behaviors of transgender persons in the United States: A systematic

review. AIDS and Behavior, 12, 1–17. Kenagy, G. P., & Hsieh, C. M. (2005). The risk less known: Female-to-

male transgender persons’ vulnerability to HIV infection. AIDS Care, 17, 195–207.

Lawrence, A. A. (2010). Sexual orientation versus age of onset as bases

for typologies (subtypes) for gender identity disorder in adoles-

cents and adults. Archives of Sexual Behavior, 39, 514–545. Leonard, V. W. (1994). A Heideggerian phenomenological perspective

on the concept of person. In P. Benner (Ed.), Interpretive phe- nomenology: Embodiment, caring, and ethics in health and illness (pp. 43–63). Thousand Oaks, CA: Sage.

Morgan, S. W., & Stevens, P. E. (2008). Transgender identity devel-

opment as represented by a group of female-to-male transgendered

adults. Issues in Mental Health Nursing, 29, 585–599. Namaste, V. K. (1999). HIV/AIDS and female to male transsexuals and

transvestites: Results from a needs assessment in Quebec. Inter- national Journal of Transgenderism. Retrieved March 30, 2008, from http://www.symposion.com/ijt/ijtintro.htm.

San Francisco Department of Public Health (SFDPH). (2010). San Francisco HIV prevention plan (Harder ? Company Community Research). San Francisco, CA: Author.

Sevelius, J. (2009). ‘‘There’s no pamphlet for the kind of sex I have’’:

HIV-related risk factors and protective behaviors among trans-

gender men who have sex with nontransgender men. Journal of the Association of Nurses in AIDS Care, 20, 398–410.

Smith, Y. L., van Goozen, S. H., Kuiper, A. J., & Cohen-Kettenis, P. T.

(2005). Transsexual subtypes: Clinical and theoretical signifi-

cance. Psychiatry Research, 137, 151–160.

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