Psychological Self-Perception in
Male Transsexuals, Homosexuals, and Heterosexuals1
Candice Skrapec, MSc.,2 and
K. R. MacKenzie, M.D., F.R.C.P.(C)2,3
Gender-related aspects of self-perception were explored for 24 anatomical
males consisting of three matched groups of transsexuals, heterosexuals, and
homosexuals. MacKenzie's Diagnostic Criteria Scale ratings were used to
confirm group membership. Instruments used were the Repertory Grid Technique,
the Rosenberg Self-Esteem Scale, Bem Self Role Inventory, Maferr Inventory of
Masculine Values, and Derogatis Sexual Functioning Inventory. Results for
transsexual subjects reflected lowest self-esteem. Of the three groups, they
perceived themselves to be the most like females and the most unlike other
males. Transsexual subjects tended to describe themselves in nonmasculine
terms and valued their gender role orientation. Homosexual subjects, on the
other hand, reported the highest self-esteem. Additionally, they saw
themselves as the most similar to males and the most dissimilar to females.
As a group, homosexual subjects described themselves in comparatively strong
masculine-stereotyped fashion and valued this posture. However, they believed
that women do not value the self-orientation which these subjects endorsed for
themselves. Heterosexual subjects scored moderately high in terms of global
self-esteem. They described themselves as somewhat masculine to androgynous
and reported valuing their gender role orientation. Results on the Repertory
Grid and the Derogatis Sexual Functioning Inventory showed heterosexual
subjects to be the least polarized in their gender-related self-descriptions.
This group generally appeared to be least concerned with traditional gender
role referents. The importance of a cognitive approach to clinical assessment
of the transsexual individual is stressed.
KEY WORDS: transsexualism; identification (psychological); gender identity;
self-concept; self-perception; self-assessment; gender role; sexual identity.
1Some of the material in this article was presented at the 28th Annual
Meeting of the Canadian Psychiatric Association, Halifax, 1978 and the Sixth
International Symposium on Gender Dysphoria, San Diego, 1979.
2Department of Psychiatry, Faculty of Medicine, The University of Calgary,
Calgary, Alberta, Canada T2N IN4.
3To whom correspondence should be addressed.
INTRODUCTION
The University of Calgary has an established Gender Dysphoria Clinic with a
sizable caseload of applicants for sex reassignment surgery. The general
approach of the clinic, along with results of its assessment and treatment
procedures, has been presented elsewhere (MacKenzie, 1973; MacKenzie et al.,
1977). This investigation measures selected gender-related variables forming
part of the complex network of self-referent dimensions subsumed under the
general heading of self-concept. The theoretical orientation of this study
views self-concept as a composite of hierarchically organized interacting
subsystems (Epstein, 1973). A core of self-esteem is taken as the focus of
one primary subsystem (MacKenzie, 1979). That is, a basic sense of self-
evaluation both affects and is affected by interaction of the self with
specific others in various contexts. The outcome of this interaction, what
one observes as behavior, will depend on the particular situation. Core self-
esteem is thus a global conception providing higher order organization. With
cognitive dissonance overriding the interaction, core self-esteem tends to
have a peremptory quality in evaluation of contextual meaning. Similarly,
core gender identity is considered the focal point of another primary
subsystem (Stoller, 1968; Green, 1974; Money and Ehrhardt, 1972). It
interacts with gender-related dimensions such as gender role orientation, sex
object choice, and the sexual implications of physical characteristics and
psychological constitution. The resultant gender-related behaviors observed
are thus a product of boundary resolution between the higher order sense of
core gender identity and the lower order specific manifestations.
It is assumed that individuals who are clear about their gender
identification draw referents from an organized system of beliefs as to the
psychosexual meaning of being a male or female. That is, being a male or
female implies a set of beliefs about appropriate gender roles, sexual
preference, psychological makeup, and physical appearance. As a developmental
process, individuals incorporate the resultant composite into their sense of
self. Evaluative processes accompany this integration. The transsexual
individual perceives his or her gender identity to be incongruous with the
apparent anatomical reality, thus giving rise to boundary stress between core
gender identity and physical characteristics. The purpose of this study was
to explore how gender issues impact on several dimensions of self-perception
METHODOLOGY
Subjects
Eight male transsexuals requesting sex reassignment surgery to female were
selected from the Gender Dysphoria Clinic of the University of Calgary.
Histories and assessment summaries were reviewed in order to rule out clear
indications of psychopathology. Specifically, information was derived from
available psychological testing reports (including the MMPI and social and
psychiatric history questionnaires) and clinical interview summaries. Eight
volunteer heterosexual and eight volunteer homosexual males matched for age
and socioeconomic status with the transsexuals were also studied. Sample
characteristics are summarized in Table I.
Table I. Sample Characteristics
Transsexual Heterosexual Homosexual
Age range 22-32 21-30 25-35
Mean age 26.8 23.6 29.6
Social classa
frequencies
I 1 2 1
II 0 0 1
III 3 1 3
IV 2 4 2
V 2 1 1
aFrom Hollingshead's Two Factor Index of Social Position (Hollingshead,
1957); a brief class description is as follows:
I. High social prestige (wealth).
II. High managerial positions ("well-to-do").
III. White-collar status.
IV. Semi-skilled positions.
V. Unskilled labor (poor).
None of the 24 subjects gave a history of involvement with organizations
which might be expected to render a major selection bias to this study (e.g.,
homophile societies). Additionally, all appeared to be responsible members of
the community, maintaining stable employment without attracting political or
personal notoriety. It should be noted that data for one homosexual subject
were incomplete. Analyses were adjusted accordingly.
Instruments and Techniques
1. MacKenzie's (1978) Diagnostic Criteria Scales are based on clinical
histories. They are used to quantify aspects of sexual history along the
following dimensions: (1) childhood cross-gender behavior; (2) adult cross-
gender behavior; (3) homophile association; (4) heterophile association; (5)
genital erotic focus; and (6) transvestite behavior.
2. Repertory Grid Technique offers an intriguing approach to the
operationalization of gender identification as an aspect of self-
identification. The technique is derived from Kelly's (1955) theory of
personal constructs. The element components used are summarized in Table II.
These comprise names of actual people from the subject's life as well as 10
idealized figures. There were 25 constructs obtained in the usual fashion by
eliciting descriptors used to differentiate triads of element figures. Each
element was then rated along a 5-point scale on each construct. The resultant
grid was analyzed in terms of the interelement distances. This calculation
constitutes a measure of similarity between elements (Lederman, 1954; Giles
and Rychlak, 1965; Ryle, 1975).
Table II. Nature of Grid Elements
Element
number
1 \
2 \
(7 significant males from subject's personal life)
(7 significant females from subject's personal life)
13 /
14 /
15 ideal example of a woman
16 poor example of a woman
17 ideal example of a man
18 poor example of a man
19 actual self
20 ideal self
21 women's perception of self as female
22 men's perception of self as female
23 men's perception of self as male
24 women's perception of self as male
3. The Rosenberg Self-Esteem Scale is a 10-item Guttman scale to measure
self-evaluation in global terms (Rosenberg, 1965).
4. The Bem Sex Role Inventory was administered to determine subjects'
self-perceptions according to gender role stereotypes. This scale measures an
individual's affinity for various constellations of gender role attributes.
Masculinity and femininity are treated as independent dimensions. This
permits characterization of individuals as masculine- or feminine-gender
typed; androgynous (representing coexistence of masculine and feminine
attributes), or undifferentiated (implying gender role postures low in both
masculinity and femininity) (Bem, 1974, 1977).
5. The Maferr Inventory of Masculine Values was used as a means of
quantifying attitudes toward masculine roles (Steinmann et al., 1968).
Subjects described "self" and "ideal man" perceptions according to family-
versus self-oriented values. For the family-oriented man, family
responsibilities take precedence over personal endeavors. A self-oriented
man, on the other hand, considers personal satisfactions as more important
than those of family. The family- versus self-orientation distinction
parallels an expressive/instrumental dimension which is generally taken to
distinguish gender role stereotypes.
6. The Derogatis Sexual Functioning Inventory provides a composite
psychological profile with particular relevance for sexual behavior
(Derogatis, 1976). This instrument has specific subscales related to sexual
information, experience, drive, attitudes, psychological symptoms, affect,
gender role definition, sexual fantasy, body image, and general sexual
satisfaction.
Procedure
All subjects were seen individually on two occasions separated by
approximately three weeks. They were told at the outset that the purpose of
the study was to explore attitudes about sexuality and how these might be
incorporated into a perception of self. Confidentiality of information was
stressed. It was made clear to members of the transsexual group that results
would in no way influence gender program decisions. Except for Repertory Grid
Technique administration, which occupied both sessions, the order in which
instruments were presented across the two sessions was randomly determined.
RESULTS
Results of the Diagnostic Criteria Scale ratings are presented in Table
III. Pairwise comparisons revealed statistically significant differences
across subject groups in expected directions.
Repertory Grids for each subject were analyzed using Slater's INGRID 72
program (Slater, 1977). The output includes distances between elements in
terms of their similarity or dissimilarity to each other, according to the
elicited constructs. A comparison was made between a subject's description of
himself and mean descriptions for both males and females. That is, did he
describe himself more like "a man" or more like "a woman"? Table IV presents
these results. Heterosexual subjects saw themselves as equally similar to
males and females. According to the subjects' own descriptions of males and
females, transsexual subjects describe themselves as more like females,
whereas, homosexual subjects saw themselves most like males.
Table III. Comparison of Diagnostic Criteria Scale Ratings
across Groups: Obtained Student's t Values
Crossgender Homo- Hetero- Genital Trans-
behavior phile phile Erotic vestite
Child Adult index index focus behavior
Transsexual vs.
Heterosexual 3.97b 13.05b 3.13b 3.31b 2.15a 1.89a
Transsexual vs
Homosexual 2.71b 10.21b - 1.74a -1.06 -6.63b 1.89a
Homosexual vs.
heterosexual 2.14a 1.34 7.94b 2.05a 3.26b 0
ap < 0.05. bp < 0.01.
Table IV. Distance between Elementsa
Significance
(Student's t,
Self vs Females Self vs Males within groups)
Transsexual
subjects 0.898 1.002 -> p < 0.05
Heterosexual \
subjects 0.908 0.985 N.S. -> p < 0.05b
Homosexual /
subjects 1.012 0.910 -> p < 0.01
aResults are expressed as mean standardized element-element distances.
Values less than 1.0 imply similarity between elements, and values greater
than 1.0 reflect dissimilarity.
bBetween groups.
Table V. Self-Evaluation Indices
Mean Rosenberg Scorea Actual-ideal distanceb
Transsexual
subjects / 1.38 \ / 0.650
p < 0.01 \ N.S.
Homosexual \ \ \
subjects / 1.13 p < 0.01 /
0.683 N.S.
p < 0.01 (0.86) / N.S. (t-test)
Heterosexual \ / \
subjects 0.75 / 0.765
aLow scores reflect high global self-esteem.
bStandardized element-element distances; values less than 1.0 imply
similarity between elements.
An index of self-evaluation was obtained in two ways: (1) using the
Rosenberg Self-Esteem Scale as a global measure; (2) using the concepts of
actual versus ideal self-descriptions relative to the self-generated construct
systems of the Repertory Grid. Results are shown in Table V. Scores on the
Rosenberg Self-Esteem Scale clearly discriminated transsexual subjects from
heterosexual and homosexual ones. Homosexuals thought highest of themselves
in global terms, and transsexuals scored lowest; heterosexuals fell in the
middle. All comparisons reached statistical significance. However, sample
size was small, and one heterosexual individual scored near maximum in terms
of self-dissatisfaction on the Rosenberg Scale. If his score is removed (as
indicated in parentheses in Table V), then heterosexual and homosexual groups
are not significantly different from each other. No significant differences
were found between actual - ideal self - ratings on the Repertory Grid. Thus,
these two measures, both purporting to tap self-evaluation, appeared to give
different results. To analyze this discrepancy, Rosenberg Self-Esteem Scale
scores were correlated with actual-ideal-self grid ratings. When scores for
all three groups were collapsed, a Pearson product moment correlation
coefficient of 0.46 was obtained. This indicated that 80% of the total
variance between the two sets of scores could not be accounted for by a linear
relationship. Each subject group was then looked at through separate
comparisons. For heterosexual subjects, a significant correlation was found
between Rosenberg scores and actual-ideal-self distances (r = 0.88, p < 0.01).
This difference remained even when data for the extreme scores on the
Rosenberg Scale were omitted from analysis. No such relationship was revealed
for transsexual (r = 0.10) or homosexual (r = 0.06) subjects. That is,
transsexual and homosexual self-descriptions on the Repertory Grid tended not
to match their more global self-evaluations on the Rosenberg Self-Esteem
Scale.
Both the original t-ratio scoring and the more recently recommended median-
split procedures were used to determine Bem Sex Role Inventory results (Bem,
1974, 1977). Using t-ratio scoring, transsexual subjects described themselves
either as gender typed in a feminine direction or as androgynous (mean = 0.58,
standard deviation = 1.18). Only one of these subject's scores implied slight
masculinity. The mean of the heterosexual group was in the androgynous range
(mean = 0.65, standard deviation = 2.08). One heterosexual subject scored in
a highly feminine direction. More than half of the homosexual subjects scored
in a masculine direction, with two describing themselves in more feminine
terms (mean = 1.53, standard deviation = 3.82). Scores for homosexual
subjects revealed the greatest variability.
When the same data were analyzed using a median-split procedure,
heterosexual subjects tended to score low in both masculine and feminine
characteristics (undifferentiated) relative to the overall sample. In
contrast, five of the eight transsexual subjects scored high on both masculine
and feminine characteristics, implying androgyny. Only one transsexual
individual could be classified as undifferentiated. Homosexual subjects'
results revealed even more marked polarity, with six of the seven scoring in a
masculine-gender-typed direction and the seventh subject high in both
directions. Table VI shows the classification of subjects by gender role
endorsement according to the median-split procedure.
Subjects' attitudes toward masculine roles were examined by analyzing the
data from the Maferr Inventory of Masculine Values. The same questions based
on family- versus self-oriented values were answered for (1) self-description;
(2) subject's perception of the values held by the ideal man; and (3)
subject's perception of the values women associate with the ideal man.
Subjects were first compared on the basis of their own personal values.
Homosexuals were more self-oriented than heterosexuals, who, in turn, were
more self-oriented than transsexual subjects. Using the same instrument,
subjects described their conceptions of the ideal man. Homosexual subjects
felt that the ideal man values self-orientation more than did heterosexual or
transsexual subjects. Finally, subjects were asked how they thought women
would describe values of the ideal man. Transsexuals again presented the
ideal man in a family-oriented direction. Heterosexuals rated him as
moderately self-oriented. However, results for homosexuals were markedly
different; they perceived women's ideal man to be highly family oriented.
Group means are presented in Table VII.
Table VI. Bem Sex Role Inventory Results:
Median-Split Procedure (Number of Subjects)
Masculine Feminine Androgynous Undifferentiated
Transsexuals 0 2 5 1
Heterosexuals 3 1 0 4
Homosexuals 3 3 1 0
Table VII. Maferr Inventory of Masculine Values Results,
Mean Role-Value Scoresa
Self-description Subjects' Subjects'
ideal perception of
man women's ideal man
Transsexuals +0.13 - 0.63 - 7.00
Heterosexuals +5.25 p < 0.05 +1.38 +1.25
(t-test) p < 0.05
Homosexuals +9.43 +7.43 -10.43 (t-test)
at-Test significance probabilities for transsexual compared to homosexual
groups.
Table VIII. Derogatis Sexual Functioning Inventory:
Mean T-Scores
Subscale Transsexuals Heterosexuals Homosexuals
I. Information 48 43 47
II. Experience 42 41 47
III. Drive 42 51 64
IV. Attitude 39 48 54
V. Symptoms 64 64 69
VI. Affect balance 49 48 42
VII. Gender role definition 36 49 56
VIII. Fantasy 46 54 61
IX. Body image 29 43 38
X. Satisfaction 44 45 49
Maferr Inventory of Masculine Values self-description results were
consistent with Bem Sex Role Inventory data. The Pearson product moment
correlation coefficient for transsexual subjects was -0.65 (p < 0.05), for
heterosexual subjects, -0.50 (N.S.), and for homosexual subjects, -0.63 (p <
0.05).
Results for subject groups on the Derogatis Sexual Functioning Inventory
are presented in Table VIII. On seven of the ten subscales, heterosexual
subjects scored between transsexual and homosexual subjects. Summarizing
these data, homosexual subjects reported higher sexual drive levels than did
transsexual subjects, with heterosexuals in the middle. Homosexual subjects
were most liberal-minded, and transsexuals, least. Homosexuals most strongly
endorsed masculine traits for themselves, in contrast with transsexuals who
revealed the most femininity in terms of gender role definition. Homosexual
subjects reported entertaining the widest range of fantasy activities, and
transsexual subjects, the most limited. Body images of transsexuals were
poorest. This group also scored lowest on general sexual satisfaction.
DISCUSSION
By clinical history and the Diagnostic Criteria Scales, the three groups
appeared to be relatively uncontaminated with each other. Differences between
groups across all six scales were consistent with clinical expectations. In
particular, profiles for transsexual subjects were compatible with a classic
transsexual history. This group is therefore representative only of one
subcategory of patient presenting at gender dysphoria clinics (Bentler, 1976).
In looking at the results across instruments, it becomes apparent that
there was a considerable degree of consistency for each of the subject groups.
From Repertory Grid data, it was found that transsexual subjects saw
themselves as more like females than males. It may be that they have
incorporated a female set of attitudes regarding themselves. On the Rosenberg
Self-Esteem Scale, these individuals reported having the lowest global self-
esteem. However, there was no linear relationship between Rosenberg Scale
scores and actual-ideal-self distances on the grid. Thus, transsexuals
globally evaluated themselves more critically than would be predicted from
their self-ratings. This suggests that in seeking sex reassignment surgery,
they are responding to an abstract idea of gender, more than to actual self-
perception. The presenting problem of the transsexual is one of sexual
dysphoria more than of a particular self-description. Results suggest that
the basis for transsexualism is a higher order, abstracted sense of gender,
rather than a function of actual behavioral descriptions. This is compatible
with Stoller's conceptualization of core gender identity which goes beyond
behavioral characteristics. Such an abstract sense of maleness/femaleness may
serve as the self-evaluative determinant for the transsexual. Moreover,
Maferr instrument results reflected that transsexuals subjects valued their
chosen gender role orientation. On the Bem Sex Role Inventory, these subjects
used extremes in their endorsement of masculine and/or feminine
characteristics for themselves. On the Derogatis Sexual Functioning
Inventory, they scored as the least liberal-minded group. Their endorsement
of rather polarized conservative values is in keeping with their endorsement
of traditional gender role referents. In general, the level of involvement in
and satisfaction with sexual behavior tended to be lowest for this group. As
would be expected, transsexuals had the poorest body image.
Results for heterosexuals tended to contrast with those for transsexuals,
and homosexuals. Referring to Repertory Grid distances, these subjects saw
themselves as equally similar to male and female others. They reported
moderately high global self-esteem. Further, their global self-evaluations
were congruent with actual versus ideal self-ratings on the Grid. For these
individuals, responses to the two measures of self-evaluation would seem to
have been derived from a single cognitive impression of self. The correlation
between Rosenberg Scale scores and actual-ideal-self Grid ratings for this
group approximates that determined by Silber and Tippett (1965) for college
students. Relative to transsexual and homosexual subjects, heterosexuals
described themselves in comparatively less polarized terms according to
androgyny scores. The consistency of value ratings between self and ideal-man
perceptions would indicate that heterosexual subjects valued their own gender
role orientation. Results on the Derogatis instrument presented these
individuals as the least polarized on seven of the ten subscales. Overall,
general sexual satisfaction was highest in this group. Heterosexual subjects
appeared to be moderately liberal in attitude. Therefore, the fact that they
presented as androgynous and not "masculine" on the Bem Scale scores should
not evoke psychosexual conflict.
As a group, homosexuals sketched an interesting but puzzling picture of
themselves. In terms of self versus other grid distances, it was expected
that they would see themselves somewhat further removed from their
descriptions of other males than would heterosexual subjects, particularly
since a considerable proportion of the male elements rated by homosexual
subjects were heterosexual figures. Instead, homosexual subjects described
themselves as being more like other males than heterosexual subjects did.
Homosexual subjects reported feeling better about themselves in a global sense
than their self-ratings from the grid would suggest. They seem to have
described themselves using different referents than they used in evaluating
themselves. As for gender role orientation, homosexual androgyny scores were
the most polarized and displayed the greatest variability. They reported
valuing self- over family-orientation and felt this was also true of the ideal
man. However, they perceived women's ideal man to strongly value a family
orientation. This contrasted sharply with the self-oriented terms endorsed in
describing their own values and those of their ideal man. As such, there was
a discrepancy between the gender role behavior they acknowledged and valued
for themselves, and those they believed were valued by women. This suggests a
major incongruity in their perception of male versus female expectations
regarding male behavior. Cognitive dissonance could be evoked in situations
where social expectations challenge self-perception. In particular, such
incongruity could conceivably have negative implications for psychosexual
stability. It certainly could shape the behavior of the homosexual male as he
interacts with women. In terms of sexual functioning, homosexual subjects
presented a profile suggestive of considerable involvement and satisfaction.
They were the most liberal-minded regarding sexual attitudes. By adopting a
liberal attitudinal set, they may be able to reduce any cognitive dissonance
generated by their gender role orientation and sex object choice.
Certainly, the sample size of 24 imposes important restrictions on the
generalizability of results to other members of the three populations
represented in this study. Nonetheless, the three groups were matched for
age, sex of birth, and socioeconomic status, and statistically significant
differences were found. One might also note that groups did not differ in
terms of affect balance or psychological symptoms on the Derogatis Scales.
Moreover, patterns of obtained results were compatible with logical extensions
to psychosexual stability.
To summarize, the results indicated that transsexuals tend to describe
themselves in nonmasculine terms and value their gender role orientation. As
sex-reassigned females, it would be reasonable to expect smooth psychosexual
adjustment. Indeed, sex reassignment surgery may be viewed as a means of
enhancing the consistency of the gender component of self-concept.
Heterosexuals were least polarized in terms of gender-related measures. They
appeared least concerned with traditional frames of reference and, further,
endorsed substantial balance in their gender role. For them, integration of
gender component elements into the self-concept system is not likely to meet
with great conflict. Homosexuals described themselves in more rigidly
stereotypic fashion. One might suspect that the gender identification
component of self-concept was most fragile in this group of individuals. The
data suggests that they introduced a systematic distortion into their
perceptions of maleness and male roles. One possible explanation could be the
systematic use of denial and reaction formation. The results could be
explained by using the idea of compensatory masculine responding, where
masculinity is defensively exaggerated in the face of gender role "threat"
(Babl, 1979). Such a response would be understandable in situations where the
homosexual's wish for enduring interpersonal relationships is met by a reality
of brief, more superficial encounters. In a sense then, his global self-
evaluation is "over-determined," with some kind of compensation operating at a
cognitive level. If further research supports these results, gender dysphoria
clinics may derive additional means for discriminating between effeminate
homosexual and transsexual candidates. It should be noted that, to our
knowledge, the Repertory Grid Technique has not been systematically used to
assess gender issues. Our results, in which comparison is made with three
established instruments, may be taken as supporting the construct validity of
this approach.
To conclude, it is felt that the importance of cognitive mediating
variables in relation to the interpersonal construct system used for
describing and evaluating self and others must be stressed. In terms of a
self-concept system, the presenting problem of the transsexual may be
appreciated as a symptom of the need for boundary resolution within this
system. The theoretical framework underlying this research would suggest that
psychosexual stability is determined by the efficacy of such resolutions.
ACKNOWLEDGMENT
We thank Dr. Patrick Slater and the British Medical Research Council for
services in providing the INGRID 72 program. We are particularly grateful to
Dr. Slater for his helpful correspondence.
REFERENCES
Babl, J. D. (1979). Compensatory masculine responding as a function of sex
role. J. Consult. Clin. Psychol. 47: 252-257.
Bem, S. L. (1974). The measurement of psychological androgyny. J. Consult.
Clin. Psychol 42: 155-162.
Bem, S. L., and Watson, C. (1976). Revised Scoring Packet: Bem Sex Role
Inventory. Available from first author.
Bem, S. L. (1977). On the utility of alternative procedures for assessing
psychological androgyny. J. Consult. Clin. Psychol. (1976). 45: 196-205.
Bender, M. P. (1976). Does construing people as similar involve similar
behavior towards them?: A subjective and objective replication. Brit. J. Soc.
Clin. Psychol. 15: 93-95.
Bentler, P. M. (1976). A typology of transsexualism: gender identity theory
and data. Arch. Sex. Behav. 5: 567-584.
Derogatis, L. R. (1976). Psychological assessment of the sexual
disabilities. In Meyer, J. K. (ed.), Clinical Management of Sexual Disorders,
Baltimore, Williams & Wilkins.
Derogatis, L. R., Meyer, J. K., and Vazquez, N. (1978). A psychological
profile of the transsexual: I. The male. J. Nerv. Ment. Dis. 166: 234-254.
Epstein, S. (1973). The self-concept revised: Or a theory of a theory.
Amer. Psychol. May: 28: 404-416.
Giles, P. G., and Rychlak, J. R. (1965). The validity of the role construct
repertory test as a measure of sexual identification. J. Proj. Tech. 29: 7-11.
Green, R. (1974). Sexual Identity Conflict in Children and Adults. New
York, Basic Books. London, Gerald Duckworth.
Hollingshead, A. B. (1957). Two Factor Index of Social Position. New Haven,
Connecticut, August B. Hollingshead.
Kelly, G. A. (1955). The Psychology of Personal Constructs. New York, W. W.
Norton.
Lederman, D. G. (1954). Sexual identification on the role construct
repertory test. Unpublished doctoral dissertation. Ohio State University.
MacKenzie, K. R. (1973). The family context of a case of gender dysphoria.
Paper presented at the Third International Symposium on Gender Identity,
Dubrovnik, Yugoslavia.
MacKenzie, K. R. (1978). Gender dysphoria syndrome: Toward standardized
diagnostic criteria. Arch. Sex. Behav. 7: 251-262.
MacKenzie, K. R. (1979). The measurement of self concept in psychiatric
outpatients: A factor analytic study of the Tennessee Self Concept Scale.
Paper presented at the American Group Psychotherapy Association Conference,
New York.
MacKenzie, K. R., Bala, M., Angus, D., and Love, E. (1977). Endocrine
abnormalities in gender dysphoric patients. Paper presented at the Fifth
International Symposium on Gender Dysphoria, Norfolk.
Money, J., and Ehrhardt, A. A. (1972). Man and Woman, Boy and Girl: The
Differentiation and Dimorphism of Gender Identity from Conception to Maturity,
Baltimore, The Johns Hopkins University Press.
Rosenberg, M. (1965). Society and the Adolescent Self Image, Princeton,
Princeton University Press.
Rosenberg, M. (1979). Conceiving the Self, New York, Basic Books.
Ryle, A. (1975). Frames and Cages: The Repertory Grid Approach to Human
Under standing, New York, International Universities Press.
Silber, E., and Tippett, J. S. (1965). Self-esteem: Clinical assessment and
measurement validation. Psychol. Rep. 16: 1017-1071.
Slater, P. (ed.). (1977). The Measurement of Intrapersonal Space by Grid
Technique, Volume 2, Dimensions of Intrapersonal Space, New York, John Wiley.
Steinmann, A., Fox, D., and Farkas, R. L. (1968). Male and female
perceptions of male sex roles. Proceedings of the 76th Annual American
Psychological Association Convention, San Francisco, American Psychological
Association.
Stoller, R. J. (1968). Sex and Gender (Vol. 1), New York, Science House.
Wylie, R. C. (1974). The Self-Concept: A Review of Methodological
Considerations and Measuring Instruments (Vol. 1, rev. ed.), Lincoln,
University of Nebraska Press.