Xavier H.M.

I've been engaging in digital self harm recently jumping into trans debates on reddit lol. I wrote out this whole wall of text and figured it was substantial enough to post on my site, too.

There was a post about the "real" definition of transsexuality and whether or not bottom surgery is a requirement. Someone quoted Harry Benjamin, the sexologist who literally pathologized transsexuality and established gender-affirming care in the US. He wrote The Transsexual Phenomenon, the first clinical text on trans people to be widely read in America; I went ahead and skimmed through it over the course of an hour (it's only a little over 100 pages).

Please note that this is in no way, shape, or form meant to constitute as a proper analysis of this text, or a finalized version of my own interpretation of either Benjamin's ideas or my personal definition of transsexuality. Detailed below are just some initial thoughts on a specific part of The Transsexual Phenomenon--specifically Benjamin's "Sex Orientation Scale", which he deployed to conceptualize transsexuality as opposed to transvestism--which I would substitute with gender non-conformity in a modern context.

I've wanted to study this text for ages now anyway; at some point in the future I'll read it in full and write up notes on everything, which I will collect into a proper blog post. For now here's...whatever this is lol.

Disclaimer: The below excerpts (and the majority of The Transsexual Phenomenon itself) only reference male "transvestites" and MTFs; there is a chapter later in the text dedicated to female transvestites and FTMs, which--of course--lacks the same amount of clinical study and documentation.¹

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this comment made me download a pdf of the transsexual phenomenon

benjamin created a table he called the SOS or "sex orientation scale". it illustrated the gradient between transvestism and transsexuality on a scale from 1-6. (in a modern context, i would replace transvestism with gender-nonconformity, i.e. non-transitioning)

the last three types fit under his definition of transsexual.

1. pseudo TV
2. fetishistic TV
3. true TV
4. nonsurgical TS
5. moderate intensity TS
6. high intensity TS

he transposed this scale onto a previous diagnostic metric:

1. group 1 for transvestites (types 1-3 on the SOS)
2. group 2 for those who may be considered either partially transvestic or partially transsexual, depending upon their symptoms and response to therapeutic treatments (cross-dressing to treat transvestism versus HRT to treat transsexuality) (types 4-5 on the SOS)
3. group 3 for transsexuals who undergo srs (types 5-6 on the SOS)

he enumerates each type of transsexual, and its corresponding location in his previous metric, as such:

A low degree of largely unconscious transsexualism can be appeased through cross-dressing and demands no other therapy for emotional comfort. These are transvestites (Group 1).

A medium degree of transsexualism makes greater demands in order to restore or maintain an emotional balance. The identification with the female cannot be satisfied by wearing her clothes alone. Some physical changes, especially breast development, are requirements for easing the emotional tension. Some of these patients waver between transvestitic indulgences and transsexual demands for transformation (Group 2).

For patients of a high degree of transsexualism (the "true and full- fledged transsexual"), a conversion operation is the all-consuming urge, as mentioned earlier and as a later chapter will show still more fully. Cross-dressing is an insufficient help, as aspirin for a brain tumor headache would be (Group 3).

benjamin admits to a gradient of transsexualism, though it is unclear how he measured each level of severity. he only really focuses on the sixth type, probably as it is the easiest to illustrate clinically.

it is obvious upon study that the "line" between transvestism (or gender non-conformity) and transsexuality lies within the transformative nature of transition.

he later talks about different case studies. "high intensity" transsexuals all transitioned to the opposite sex and had surgery, but he also places a great deal of emphasis on post-transition life and living as the opposite sex. additionally, of the case studies that were deemed to be low intensity or transvestites, none of them lived outwardly or pursued a full MTF/FTM social/legal transition.

so according to his diagnostic criteria, surgery plays a part in transsexuality and can certainly account for a large portion of its clinical justification, but living as the opposite sex legally, emotionally, and psychologically is just as important and is equally clinically relevant.

it can be assumed that HRT and the transformation of secondary sex characteristics, insofar as they enable someone to live as the opposite sex, also apply here--which is what i reckon he envisioned when speaking of group 2's "transsexual demands for transformation".

in my interpretation, i would probably divide group 2 into two subcategories: "tranvestites" or gender non-conformists who undergo HRT etc for personal, social, or cosmetic reasons, and exhibit GNC behavior on a temporary and/or conditional basis; and transsexuals who undergo medical transition to live as the opposite sex, but refrain from bottom surgery.

furthermore, he repeatedly clarifies that these typings are not set in stone, and that most patients exist between each type.

It must be emphasized again that the remaining six types are not and never can be sharply separated. The clinical pictures are approximations, schematized and idealized, so that the TV and TS who may look for himself among the types will find his own picture usually in between two recorded categories, his principal characteristics listed in both adjoining columns.

[...] It should be noted again, however, that most patients would fall in between two types and may even have this or that symptom of still another type.

with this reading in mind, i would say that transsexuality rests upon gender dysphoria and transitioning social and medically to live as the opposite sex; bottom surgery (or lack thereof) indicates either moderate/high intensity.

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✘ Originally posted on — 02-26-26
✘ Main site location — xavierhm.com/notebook/notes/benjamin-transsexuality-scale

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1. "It is probably very unfair to devote only one chapter in this volume to the female transsexual: unfair because her emotional problem is in every way as serious as that of her male counterpart. However, the frequency of female transsexualism is considerably less than that of the male. While the clinical experiences described in the preceding pages are based on 152 cases of male transsexualism, the female transsexuals here reported number only twenty (by the end of 1964). Even so, sometime in the future she may merit a book devoted to her alone." (See: FTM: Female-to-Male Transsexuals in Society by Aaron Devor.)↩