The role of the family in the dynamics of female transsexualism is often obscured by the fact that either the parents are unavailable or they refuse to cooperate in their daughter's transsexual evaluation.

The brother, who was visiting family in the US, was anguished by his sister's transsexualism. At the root of his concern was his struggle between his religious orthodoxy, his love for his sister, and the fear that he would be forced to reject her formally for violating God's law. He wrote:

Dear Dr. Lothstein,

I've been doing research on gender dysphoria and came across articles you've written concerning group therapy. Of all the many books and articles I've read, I was most impressed by the questions you raise and you're approach. I am therefore writing you for advice on this subject which is new and disturbing to me. Seven months ago my father was tragically killed while riding his bicycle. My sister who was then 18 fell into depression and when she visited me a month after the funeral disclosed to me that she was a lesbian. She told me that our mother knew about it but that it was being kept secret from me for fear of my disapproval. During the visit my wife (who has a B.S. in psychology and is doing graduate work) further questioned her and my sister said that she's "been a lesbian since she's 12 years old and would have had the sex change operation if it wasn't for her weak heart." My sister doesn't have a weak heart and my wife assumed that this was my sister's form of reducing cognitive dissonance and subconsciously avoiding an operation. Also, the coupling of lesbianism with transsexualism seems to us unwarranted and atypical of true transsexuals. My parents moved to the U.S. three years ago from Europe and my sister was unwillingly uprooted from her social circle and school. Within a 2 year period she's also seen our parents divorce, our father killed, all of her personal belongings were stolen along with our family’s lift, 4 of her friends were killed in accidents this year, and she's had 2 serious knee operations. She was a striking, precocious, coquetish and willful girl, and now she is unrecognizable. Our father was a holocaust victim who's tortured life greatly affected our childhood and her experience seems to fit the classical literature. But up till my fathers death she was "in the closet" and I believe that his death awoke in her motives to become our father. She has always been compared to our father, physically, personality wise and behavior wise. Our family dynamics even before the divorce were such that my father favored me (excessively) and my mother favored my sister to compensate for this. Prior to my father's death my sister and father had many disagreements and it seems to me that her desire to change her sex is due to (1) Her subconscious wish to be posthumously accepted (as a boy) by my father (2) The death of many of her friends and pets has convinced her that she's cursed (and she killed them) and that with a sex change she will be reborn and cleansed (3) My father had a self destructive drive (why did I survive the camps?) and my sister seems to have these same self destructive traits. This may be a clue to her problem as I don't think this is typical of most cases.

Her adolescent years were of great trauma to my parents -- she ran away from home for six weeks when she was 13 and my father liked to blame her for the divorce. So you see, she has suffered great feelings of guilt and she verbally admits that she wants to be reborn. Objective facts which are also important are that she has had heterosexual affairs and was badly disappointed by a boyfriend who married her best friend 2 years after promising to wait for mysister. A year ago at my wedding she dated my best friend for 2 weeks and he said that she cooperated with him sexually until his overtures became too serious (threatening?) -- which agrees with the statement that many transsexuals choose this sexual orientation as a retreat from sex.

My sister is very secretive of the treatment she is receiving and I suspect that she's being treated illegally and seeing a psychologist (M.S.) who is used by the transsexual community for attaining documents saying they are transsexuals getting operations. She coerces people with threats and money to get her own way, and this makes it very difficult to get her into an alliance with a respectable and objective psychologist. She has only started cross dressing in the past 3 weeks and started androgen therapy very intensively since August and has secondary male characteristics. She lives with 2 male to female transsexuals who supply her with hormones and all the "right" answers and information about her case. I would like your advice on how to deal with her -- should I encourage her to travel to a gender clinic such as Case Western's -- is there a clinic in her area which would help her? Our family is willing to accept her claim of being gay, but we can't believe she's truly transsexual. What do you advise us to do? We can't force her to enter therapy, she doesn't even agree to enter family oriented therapy, which we feel due to our traumatic life experience as children of a survivor is the only correct way to deal with this.

I appreciate any advice you can give me as a clinician and human being who must come in contact with many cases such as this.

Thank you very much,

Mr. S. France

P .S. My sister wants to have the new sex change operation in March — she believes she will be capable even of reproduction so this is of immediate concern to us. (see THE ROLE OF THE FAMILY IN THE DYNAMICS OF FEMALE TRANSSEXUALISM PART II)