Levine E M
Am J Psychiatry. 1976 Nov;133(11):1318-21. doi: 10.1176/ajp.133.11.1318.
The author describes 20 male transsexuals who differ from most discussed in professional studies and from those in media portrayals in that they live in the male homosexual subculture. Furthermore, interviews with these individuals indicated that transsexuals are no more sexually or socially homogeneous than heterosexuals or homosexuals. In general, these men entered the homosexual subculture in their teens; they knew they were not heterosexual and therefore assumed they must be homosexual. As their gender identity crystallized, homosexual activity became repugnant and they rejected and were rejected by male homosexuals. Being unable to attract heterosexual men, they sought bisexual partners in a futile effort to confirm their identity as females. The author suggests that in addition to efforts to help transsexuals shift their gender identity, psychiatrists should emphasize prevention of this psychopathologic symptom.