J Youth Adolescence
DOI 10.1007/s10964-017-0782-5
BOOK REVIEW
Thomas E. Bevan: The Psychobiology of Transsexualism and
Transgenderism: A New View Based on Scientific Evidence
Santa Barbara, CA: Praeger, 2015, 257 pp, ISBN-13: 978-1440831263
1
Alexandria E. McGlone
Received: 18 October 2017 / Accepted: 19 October 2017
© Springer Science+Business Media, LLC 2017
The Psychobiology of Transsexualism seeks to answer the
question that so many transsexual people ask themselves:
why do some people transition and live as the opposite sex?
Essentially, Bevan is attempting to identify the root cause of
transsexualism. The central thesis is that, because the first
signs of transsexualism emerge early (usually around age 4
or 5), there is little room for casual factors other than
genetics and epigenetic factors that alter DNA expression.
Bevan argues that his two factor genetic-epigenetic theory
of transsexualism is the only explanation that makes sense
in light of the studies that have been done on transsexual
people. In his two factor theory, the genetic factors include
inherited genes from parents and novel genetic mutations at
the time of conception. Epigenetic factors present during
pregnancy also account for some causality, including
exposure to environmental toxins, certain drugs, or simply
maternal stress and/or trauma during the pregnancy. Epi-
genetics is a new field. When the phrase “epigenetic factors”
is used it includes endogenous and exogenous chemical
compounds interacting with genes to alter DNA expression.
Bevan’s case is compelling, but further research will need to
be done, particularly with epigenetics, in order to confirm
his two factor theory of transsexualism.
The author also aims to provide a comprehensive review
of the subject of transsexuality in the scientific literature,
and to dispel oft-repeated misinformation and outright lies
in the public discourse about transsexual people. The author
explicitly states that he hopes that transsexual people will
* Alexandria E. McGlone
alexm@indiana.edu
1
Indiana University, Bloomington, IN, USA
read this book to understand themselves better, so that when
trans people advocate for their rights and dignity, they will
be armed with scientific facts to support their claims. It is
true that there are few books written about the empirical
research that has been done on transsexualism. Many books
and online articles that discuss transgender issues focus on
gender theory, the “social construction of gender,” and third-
wave feminist talking points about gender being “perfor-
mative.” This book challenges left-wing feminist ideas that
gender is absolutely (or at least mostly) socially constructed.
If the gender predisposition of transsexuals is biologically
determined, it logically follows that the gender predisposi-
tion of everyone is biologically determined. The most
radical feminists (think Germaine Greer) consider gender an
oppressive social construct imposed on the sexes by the
patriarchy, and that femininity and masculinity are essen-
tially learned behavior schemes. The scientific evidence in
this book alone is enough to demonstrate that those claims
are patently false (along with reams of studies about bio-
logical sex differences). The author succeeds in presenting a
fresh, yet comprehensive view of transsexualism based on
scientific evidence, and challenges many ideas that are
popular in the current public discourse surrounding trans-
gender people.
The book is organized into roughly three sections. First,
there is an introduction to the concept of transsexualism,
and an overview of the phenomenon and history of trans-
sexualism across time and culture. Then, the second section
of the book delineates the two-factor theory of transsexu-
alism, including discussion of the presence of transgender-
ism and transsexualism in children and adolescents, and
finishing off with neuroanatomical differences between
transsexuals and nontranssexual males and females. The
third and final section essentially debunks all of the other

theories that have been put forward to try to explain
transsexualism as a form of psychopathology, or as a con-
scious choice.
Before going any further, readers should take note that
the vocabulary and lexicon used to describe transgender and
transsexual people in this book have different definitions
than the definitions used by LGBT activists and individuals,
as well as the public at large. For example, in popular
culture, there has been a movement among trans activists
and celebrities to eliminate the use of transsexual in public
discourse, replacing it instead with transgender. There are
several justifications these activists have used, including
that “transsexual” is an old, out-moded word coined by cis-
heterosexual white men used to describe trans women in a
“pathologizing” or “medicalizing” fashion. There are many
trans women who still self-identify as transsexual, but the
dominant word in the public discourse is “transgender.”
There are often discussions and arguments about the dif-
ferences between the terms transsexual and transgender, and
many trans people will say that the two words are roughly
equivalent. However, this book separates transgender peo-
ple from transsexual people by the intensity and frequency
of their engagement in gender roles and behavior of the
opposite sex, and the degree to which the person undergoes
medical transsexual transition. So, using the definitions in
this book, a transgender person is often partially still in the
closet, and cross-dresses part time for relaxation and well-
being, but has not publicly transitioned. People who engage
in cross-dressing on a constant basis, undergo hormone
therapy (HT), as well as facial, breast or genital plastic
surgery would be classified as transsexual.
It should be noted that transsexual genital plastic surgery
(TS GPS, often referred to as sex reassignment surgery
(SRS), “bottom surgery,” or simply a “sex change surgery”)
is relatively rare among MTF transsexuals, with only 1/3 of
trans women undergoing TS GPS. It is even rarer for FTM
transsexuals to undergo “bottom surgery” because the sur-
gical techniques and outcomes are far inferior to the MTF
surgery. Therefore, it would seem that if a trans woman is
living “full time” as a female and is undergoing at least
hormone therapy, she would be classified as transsexual.
This is important to note, because many, if not most of the
people described above will self-identify as a “trans
woman,” a “transgender woman,” or simply as “trans.”
The introduction of the book begins with a section titled
“A Typical Transgender Story” that describes the archetypal
transsexual growing up experience through the narrative of
a boy named William. The conclusion of the book picks up
William’s story and uses theories identified in the book to
identify the causes of William’s transsexual transition from
male to female. Transsexualism/transgenderism (TSTG) is
defined as “the result of a mismatch between biological
gender predisposition and a person’s culturally assigned
J Youth Adolescence
gender behavior category.” Most cultures have two “gender
behavior categories”—i.e. masculine and feminine. The
author notes that this is not universal, and there have been
cultures in the past and present that have anywhere from 3-5
“gender behavior categories.” The theory is then that there is
a biological gender predisposition, and that for most people,
it is congruent with their natal sex. However, TSTG occurs
when genetic and epigenetic factors have altered the gender
behavior predisposition, creating a gender predisposition
that is incongruent with natal sex. This theory is compelling
because children who later come out as transsexual start
exhibiting cross-gender behaviors as early as age 3, but
usually around age 4, 5 or 6. Because the onset of TSTG is
so early, there is little room for socialization or other factors
to be involved and therefore, TSTG is primarily a naturally
occurring, biological phenomenon.
The typical timeline for an MTF transsexual is sketched
out in the introduction. Around age 4 or 5, the child starts
engaging in cross-gender play, behavior, and/or manner-
isms. The child may express a desire to wear dresses or
other female-typical clothing. However, the child also
learns male-typical behaviors, especially when that is the
only choice afforded to him by his parents. Eventually, the
violation of gender norms creates a disruption in the family
and the child learns that he has to keep his feelings and
cross-gender behavior secret. Secrecy develops as children
approach puberty and once puberty has begun, secrecy
intensifies. TSTG youth are often bullied and abused and
many rigorously study gender behavior categories in order
to conform to the male gender culturally assigned to them.
Many may play athletic sports in order to “become a man”
and overcompensate for their feminine feelings. As TSTG
people get older and enter young adulthood, there is gen-
erally a fork in the road. Especially in the last few years,
many TSTG people in their late teens and early twenties use
this newfound freedom to come out and begin transsexual
transition. But until recently, the vast majority would cross-
dress part time, in the newfound absolute secrecy of their
apartment the first time they move out of their parents’
house.
As TSTG individuals age, there is a trend for “flight to
marriage and risky occupations.” Transsexuals are twice as
likely as the general population to join the military. They
are also disproportionately represented in risky manual
labor work. The reason for this is that many may seek to
“cure themselves” of their biological gender predisposition
by entering very masculine-centric fields. The discipline
and rigorous training in the military is attractive to many
TSTG people that wish to keep themselves in denial and
attempt to live up to their culturally assigned gender
behavior category. Other TSTG individuals, especially
MTF transsexuals, end up marrying heterosexual women
and have children, hoping that regular sex with a woman
J Youth Adolescence
will satiate and suppress their cross-gender desires. They
stay in the closet, sometimes for decades. Very recently,
there has been an increase in mainstream TSTG acceptance,
and many older MTF individuals married to women are
beginning their medical transition while staying together
with their spouses. This is very new, because in the past,
psychologists and endocrinologists required MTF trans-
sexuals to get a divorce before they could begin hormone
therapy or undergo plastic surgery. Interestingly, multiple
studies cited in this book found that “homosexual trans-
sexuals” that is, a trans woman who is attracted to men,
tended to be “early bloomers” and start their transition ear-
lier, and “heterosexual transsexuals” (trans women attracted
to women) are more likely to be “late bloomers” in coming
out and beginning medical transition.
Chapter 2 of the book details all of the human and
societal costs of rejecting TSTG individuals, including lost
productivity because of alienation, isolation and gender
dysphoria, as well as a public health crisis due to the high
rate of homelessness, prostitution and drug use in trans-
sexual women. The suicide attempt rate among TSTG
people is believed to be anywhere from 31% to 43%,
compared to the national average of 1.6%. This is attributed
to widespread societal rejection. Not only do employers
discriminate against trans people, but even homeless shel-
ters and public aid reject trans individuals. The chapter
makes an objective case for accepting trans people and
affirming their equal rights, because the overall costs of
rejecting trans people on human society are significant.
Chapter 3 has some interesting data. Besides defining many
of the technical terms found in the book, chapter 3 presents
some mathematical modeling studies designed to estimate
the size of the TSTG population. Previous estimates have
been based on clinical presentation of trans people. Many
trans people stay in the closet and never seek medical
attention. Several studies ran mathematical models to
account for this. According to these studies, TSTG is more
common than once believed. The author estimates that 1%
of the male population is transgender, and 0.1% of the male
population is transsexual. The incidence of transgenderism
in females is 0.5 and 0.05% of the female population is
transsexual. If these figures are true, then the TSTG popu-
lation is an order of magnitude larger than previously
thought.
The two-factor theory of transsexualism is presented via
an overview of the available literature on the subject of
genetic and epigenetic causes of transsexualism. Chapter 5
covers the genetic causal factor. There is compelling evi-
dence that indicates DNA genetics is a casual factor in
TSTG. First, there are heritability studies of twins and
families which indicate that there is moderate to strong
heritability for TSTG, but there is still “room” for involve-
ment by an epigenetic factor. Second, “chromosome
anomalies and marker genes” have been found to correlate
with TSTG. Third, the genetic marker for MTF transsexu-
alism involves the androgen receptor (AR) gene. Allele
variations and mutations of the AR gene are also associated
with androgen insensitivity syndrome (AIS). People with
AIS have XY chromosomes but female sex characteristics,
including female external genetalia, but no uterus or ovar-
ies. People with AIS and XY chromosomes do not exhibit
increased masculine behavior when compared to XX
chromosome natal women. This is interesting because one
would expect a person with XY chromosomes to find the
masculine gender category more congruent. “In the case of
AIS, it appears that AR mutations create a feminine gender
predisposition as well as preventing the effects of androgens
on development” (Bevan 2015, p. 79). Therefore, mutations
in the allele of the AR gene create a feminine gender pre-
disposition in XY chromosome individuals. This is true
both for people with AIS and for MTF transsexuals. Lastly,
FTM transsexuals have biometrics that differ from non-
FTM females, including teeth and pelvic shape, which are
attributed to genetics.
According to the many twin studies that have been done,
“a medium strength correlation is apparent for transsexual
heritability,” e.g. 40–50% (Bevan 2015, p. 83). The corre-
lation is not as high as body height, for example, which is in
the 60–80% heritability range. So, directly inherited genes
account for about 50% of the causality of transsexualism.
This means that the remaining causality is found in novel
genetic mutations at the time of conception and epigenetic
factors.
Epigenetics is a new field of study and the understanding
of the role of epigenetics has dramatically changed even in
the two years since this title’s publication. However, given
the nascent field of epigenetic study as it relates to trans-
sexuals, the author gives an impressive overview of the
potential epigenetic phenomenon that should be investi-
gated further.
One interesting study that Bevan reports found that MTF
transsexuals had more maternal aunts than uncles given a
sample size of 417 MTF transsexuals. However, the effect
was not found on the paternal side of MTF. The effect was
not observed at all in 96 FTM transsexuals. The study,
conducted by Green and Keverne, concluded that the
“mother of the aunts and uncles had inherited an imprinting
chemical on one of her X chromosomes that selectively
reduced survival of prenatal males but not females. Only
those males who were feminized survived. This imprint
continued into the next generation on the maternal side”
(Bevan 2015, p. 105). The study is impressive because of its
large sample size, which is rare in studies of TSTG. How-
ever, it has never been replicated or followed up. This study
is a prime candidate for further research into epigenetic
causal factors in transsexualism.

Another epigenetic factor is prenatal drug exposure,
mainly to antiepileptic drugs (AEDs) and diethylstilbestrol
(DES). Note that DES has been banned for a few decades
now. After a long discussion, the ultimate verdict is that
interpretation of AED and DES studies are inconclusive
because there is no control group and there is no way of
knowing which fetuses were exposed and the extent of that
exposure. Finally, maternal stress seems to play an impor-
tant role, as “psychological stress can cause DNA mutations
and changes in DNA expression” (Bevan 2015, p. 110).
There is some evidence to suggest that this may play an
important epigenetic role in transsexualism, but more
research would need to be conducted.
The two factor theory of transsexualism is explained by
combining these genetic and epigenetic factors. There is
strong evidence that indicates handedness and transsexual-
ism are somehow linked. Handedness is a trait that has a
heritability rate of 24–26%, so epigenetic factors, including
epigenetic mutations of DNA genes or epigenetic influences
on DNA expression are involved. Handedness and trans-
sexualism are both determined by a two-factor genetic-
epigenetic theory. Additionally, the two seem to be related,
as there are several studies that indicate transsexuals are
more likely to be left handed. There are also studies that
show transsexuals to be more “non-right-handed” than
nontranssexuals. This means that even though many trans
people will be, on balance, right-hand dominant, that
dominance is not as strong. Right-handed transsexual peo-
ple are more likely to use their left hands for things that
most right-hand-dominant people would not. There is cer-
tainly more research that needs to be done to confirm this
two factor genetic-epigenetic theory. There could be more
alleles than just the AR receptor that correlate strongly with
transsexualism. Chapter 7 is most effective as a guidepost
and framework for further research to be done on the matter.
The author cannot say that his theory is absolutely correct,
however, he deftly disproves and debunks every other
theory that has been proposed to explain transsexualism.
Starting with the prenatal testosterone theory of trans-
sexualism (PTTT), the rest of the book tears down mis-
conceptions about the causes of transsexualism. The PTTT
essentially says that MTF transsexuals did not have enough
testosterone in the prenatal womb, and that FTM transsex-
uals had too much. Somehow the theory still enjoys serious
consideration by medical professionals and journalists, long
after it has been shown to be absolutely false in several
studies. (Not to mention PTTT’s links with the eugenics
movement in California at the turn of the 20th century).
Over the years, there have been hypotheses that trans-
sexualism occurs because of disturbances in childhood. The
most famous is that MTF transsexuals have distant fathers
and abnormal emotional relationships with their mothers.
The numerous studies on this have found no such link, but
J Youth Adolescence
they have found that transsexual children are often abused
by their parents because they exhibit cross-gender behavior.
Another famous theory is that transsexualism is a fetish for
either emasculation or for “autogenephylia” defined as the
love of oneself as a woman. Sexual arousal is learned
through classical conditioning, and almost any object can be
conditioned to produce a sexual arousal response. Although
cross-gender dressing may initially sexually arouse an
exploring young transsexual, the arousal goes away rela-
tively quickly, but the cross-gender behavior persists for the
entirety of the person’s life. This indicates that transsexu-
alism is not a fetish, because transsexuals quickly cease to
become aroused by their cross-gender behavior and dres-
sing once they start transsexual medical transition. There
have been many psychodynamic theories of transsexualism,
reminiscent of Freudian analysis, but each of these theories
has been found to have too many interdependent variables
and no empirical means of scientifically testing them.
Chapter 12 debunks all of the psychopathology theories of
transsexualism by demonstrating how the theories are
inherently unscientific and untestable.
The main thrust of Bevan’s work is thus: the two-factor
theory is the only working, reliable theory of transsexualism
that has been hypothesized. And if it is true, it has big
implications, especially for children, which are dealt with in
Chapters 8 and 9. If this book is correct, then transsexualism
is innate and begins to manifest when people are young
children. Childhood transition is a controversial and new
practice. This book promotes social transition of young,
prepubescent children, and advocates for the use of puberty
blockers in adolescents. This book fails to provide any well-
reasoned skepticism of the practice of childhood transition.
To be sure, the opponents of childhood transition are mainly
right-wing religious hate groups teamed up with radical
feminists that spout ideological nonsense. But that doesn’t
mean no valid criticism of the practice exists. There has
been a movement in the last two years, especially in the
United States and the United Kingdom, where increasingly
LGBT activist groups are teaming up with schools to offer
sexuality and gender “education.” They have produced
Sesame Street-esque videos explaining the concept of
gender dysphoria and gender identity, as well as ideological
constructs such as the “gender spectrum” and “nonbinary
gender identities.” These films are aimed at kindergarteners
and 1st grade students. If transsexualism is a natural pre-
disposition, children should be able to figure it out for
themselves. Children this age are not old enough to
understand abstract concepts like a “gender identity.”
Overzealous parents could mistake a simple preference for
playing with dolls as “my child is trans!” While fostering an
open environment for transgender children is important,
running straight ahead into early transition may have
unforeseen effects. The most famous transgender teenager is
J Youth Adolescence

Jazz Jennings, who has her own reality show on TLC. The transsexuality is a complex and individualized phenom-
latest episodes of the show have been concerned with how enon. It is a life changing decision and society should make
the puberty blockers and cross-sex hormones affected Jen- sure that transsexual kids are aware of and can consent to
nings’s sexual development. Because Jennings never went the changes they are undergoing. We will know more about
through male puberty, her genitals are essentially that of a the outcomes of childhood transitioners as time goes on,
child’s and she has a micropenis. Jennings has been seeking and hopefully, they will be positive.
“bottom surgery” but has been turned away by many sur-
geons because they do not believe there is enough genital
Compliance with Ethical Standards
material to perform the surgery and create a functioning
neovagina. Making transsexual children go through a pub-
erty that is incongruent with their internal gender predis- Conflict of Interest The author declares that she has no competing
interests.
position could be considered cruel. A few years of male
puberty could destroy whatever chance a trans woman had
of “passing” in the world as female. However, if she tran-
sitions early, she could be left with non-functioning genitals
that are inconsistent with her gender identity. The only
Reference
major weakness of this work is its unflinching embrace of
Bevan, T. E. (2015). The psychobiology of transsexualism and
childhood social and medical transition. Even if it is ulti- transgenderism: A new view based on scientific evidence. Santa
mately the best decision to make in any given case, Barbara, CA: Praeger.