Ask the Expert: Gender Identity Disorder

M, a 36-year-old genetic male serving in the military, was ordered by his commander to see a psychiatrist. A neighbor, a fellow military man, had reported seeing M leave his house dressed as a woman, and the commander felt she had no other choice than to find out if M was mentally ill. M had been a moderately effeminate boy who had preferred female playmates and knew he wanted to be “one of the girls.” He had chosen dolls over trucks and playing house over roughhousing. Until puberty M had selectively chosen “girlish” activities and had known that he was somehow “different” from other boys, but, berated and humiliated by his father, he had embarked on a hypermasculine adolescence that culminated in his military enlistment. He adorned his triceps with a four-inch tattoo and volunteered for the most arduous assignments, including a year in a combat zone. His military record was impeccable until he was reported for his cross-dressing behavior. Neither the psychiatric evaluation nor psychological testing revealed any overt psychopathology. He reported that he had started dressing as a woman several years earlier with his then-wife when they were having marital problems. He found it remarkably calming, and they got along better “woman-to-woman” than they ever had as husband and wife. “We could relate to each other so much more easily,” he said. M had been married and divorced twice. Both his wives agreed that he was more maternal than they, and he had become the custodial parent to all three children, one from his first marriage and two from his second. He had increased the time that he was presenting as a woman from occasionally dressing up to donning female garb immediately on arriving home from work and staying in it until he left the next morning. His children now called him “Mom,” and he was an officer in his son’s Parent-Teacher Association as a woman. He said that he had always known he felt “different” but had no words to describe it until well into his second marriage, when he began to explore his gender identity on the Internet. He had never had a homosexual experience and had no interest in being a man with a man. His intent was to retire from the military at the first opportunity that preserved his pension, to spend a year on female hormones while living the Real-Life Test, and to undergo sexual reassignment surgery. He intended to blend into the civilian community as a woman, and he hoped to find a husband and function as a wife. He had absolutely no qualms about making the transition to being female. “It’s who I am inside.”