Background
In 1984 Dr. Elsie Shore published a case study on a 24-year-old male-to-female transsexual, who after living in the female role for two-and-a-half years reverted back to living as a male. Unlike a number of transsexual subjects, who reverted back to the male role after undergoing a gender reassignment surgical (GRS) procedure, Shore's subject, Michael a.k.a., Mickey, did not undergo a GRS procedure. At age 22 Mickey enrolled in a gender identity program for sex reassignment. Shore first met Mickey when Mickey agreed to participate in a research project. At that time Mickey had been undergoing hormone replacement therapy (HRT) for 21 months and had been living exclusively in the female gender role for 14 months. Mickey presented as a 'passable' female. Mickey was reportedly shy, lonely, and wanting to be loved and cared for.
Mickey was one of fraternal twins, the other a sister. Mickey also had a older brother. Mickey grew up in a Midwestern suburb. His father was a truck driver; his mother a housewife. Mickey reported that he often slept in the same bed as his older brother. Mickey said he wanted to marry a man, who is otherwise kind and non-domineering like his brother.
Mickey reported wanting to be like other girls, starting in the second grade. He began to cross-dress at that time, starting with the clothes of his twin sister. Mickey's proclivities towards cross-dressing waned in Junior High School, due reportedly to privacy issues. Mickey was active in sports and elevated to being captain of the football team as well as class president. Although the girls in his class found him attractive, he never took on a girlfriend.
Although Mickey cited an interest towards transsexualism as the reason for turning away female advances, he reported being shy his entire adolescence. Mickey first identified as a transsexual after watching a program on the subject. After watching the program Mickey reportedly masturbated for the first time. His masturbation thoughts involved changing genders and living as a female. Mickey's entire sexual history involves only two incidents; one with a male; and one with a female. In each case the other party made the advances.
After High School Mickey went to College and earned a College degree.
Mickey reportedly suffered from depression while in school after learning he had been called up for military service. Mickey's depressive episode reportedly lasted two years. Mickey did not seek any medical intervention for his depression. The military gave Mickey a 4F, based on his transvestism-that meant he didn't have to serve.
After graduating from College Mickey immediately applied for a sex reassignment. The gender identity clinic thought Mickey was a good candidate to go through the gender transition and authorized him to undergo HRT. The gender identity clinic that Mickey went to comprised a psychologist, psychiatrist, obstetrician-gynecologist, and endocrinology and surgery consultants. The team followed the harry Benjamin Foundation's Standards of Care. Specifically, the psychological test battery that Mickey went through had included the MMPI, 16 PF, Rotter Sentence Completion Test, House-Tree_person Technique, and the Gender Identity Checklist.
To qualify for a GRS procedure, which Mickey sought, Mickey had to live in the female role for one to two years. After acceptance into the program Mickey began to undergo HRT. He also protracted his facial hair through electrolysis. Mickey had little trouble adjusting to his new role as 'Mickey'. He found employment at a dairy store and made friends with other women and with men.
Finally, the day before Mickey was to undergo the GRS procedure, he was notified that the governing body of the hospital had decided to discontinue such procedures. Although he felt frustrated by the news, he was somewhat relieved. When asked what he thought would have happened if he had had the surgery, Mickey said that he would have continued living as a woman. However, Mickey also reported that he did not think that he would have been as happy as he now feels he can be as a man.
Mickey attributes part of his decision to revert to his original gender role to his vocational plans. Training in nursing had been a goal for some time, and he was scheduled to begin his studies after the surgery. The school that had accepted him as Mickey-the female-did not know of his transsexuality. Earlier, a different nursing school had made completion of surgical reassignment a prerequisite for acceptance. Mickey reported that he did not feel the drive to undergo the GRS procedure as strongly after the news of the unconditional acceptance by the second school. Shore noted the flaw in this reasoning on Mickey's part as the second school was in fact ignorant of Mickey's physical state.
Shore noted that the more realistic explanation of Mickey's change in attitude regarding the GRS procedure is that Mickey had had doubts about the surgery before it was canceled. Mickey's attitude towards the surgery, however, was at the least laissez faire.
Outside of Mickey's vocational ambitions Mickey, while still living in the female role, joined a charismatic religious movement. In addition to the resurgence of religion in his life, Mickey reported that he found a different kind of man among the church members. Mickey saw the men in the church more like him-gentle and passive without the loss of masculinity. Mickey also became involved with a woman at work. Given his so-called Gender Identity Disorder, Mickey did not view his attractions to the woman as homosexual but rather as the need to return to the male role. Approximately two months after Mickey's surgery had been cancelled, Mickey reportedly began to discuss the possibility that he may revert back to living as a man to the woman, he felt enamored with. Mickey stopped taking female hormones at that time, although he had not been taking the medication regularly for a while.
Analysis
Michael, a.k.a., Mickey, reported to Dr. Shore that he began to cross-dress in second grade at age 8 or thereabouts. The sexual identity of an 8-year-old child is fully developed and immutable. Michael cannot have a gender identity disorder and any diagnosis to that effect is fundamentally flawed.
Michael reported notable High School accomplishments as a male, including being selected as the captain of the football team. Playing football is a masculine interest. Michael also reported a indifferent sexual history. Michael's interest in men as marriage partners had little to do with any one particular man and more to do with functioning as a female in a working relationship, which is asexual and not homosexual. Michael reported that after watching a show about transsexualism, he masturbated to the thought of affecting a gender transition. Masturbating to the thought of affecting a gender transition is autogynephilic in nature and not indigenous to females. Michael perfectly fits the profile of an asexual autogynephile.
Michael suffered from a considerably long episode of depression which began in his final year of College. Michael reportedly took nothing for the depression. In the absence of an anti-depressant medication or Selective Seratonin Reuptake Inhibitors (SSRIs), the body relies on its own natural mechanisms to bring itself back into balance.
50% of all the people, who suffer from clinical depression, produce excess levels of cortisol, a hormone found in the blood system. In fact, the hypothalamus kicks off the process by producing corticotrophic-releasing hormone (CRH), which in turn stimulates the adrenal glands, located near the kidneys, to produce the cortisol and release the chemical into the blood system. The pituitary gland in turn produces adrenocorticotrophic hormone (ACTH). ACTH has anticonvulsant effects on the human brain, forcing the nucleus accumbens of the brain back into balance. [1]
The nucleus accumbens of the brain is the heart of the brain's reward system. That is one reason depressive episodes have cycles with definitive beginnings and ends. As Michael's own body produced ACTH-a natural anticonvulsant-to counteract the symptoms of depression, the ACTH had the tertiary effect of ameliorating a faulty reward system in his brain, bringing it back into balance.
By the time Michael's scheduled surgery date arrived, his interests in a gender transition had effectively evaporated whereas most candidates for GRS procedures, who otherwise do not suffer from a protracted episode of depression, would be livid. On the event of meeting a woman he felt enamored with he stopped the medication protocol and reverted to living as Michael.
On reading Shore's case study of the former transsexual, a number of the centralized gender identity clinics, including the Centre for Addiction and Mental Health (CAMH), began to dispense SSRIs as an alternative treatment to GRS procedures. However, they were off the mark as SSRIs are largely ineffective at treating behavioral addictions, including the behavioral addiction, underlying transsexualism. Ultimately, the centralized gender clinics returned to aversion techniques and nothing of value came out of Shore's case study.
References
[1] BURNHAM, LONSDALE, SHAHZAMANI, PEREZ-CRUZ, EDWARDS: DEVELOPMENT OF NEW ANTICONVULSANTS USING THE KINDLING MODEL