Masculinity is an Achievement

Joseph Nicolosi

At the very heart of the homosexual condition is conflict about gender. In the boy, we usually see a gender wound that traces back to childhood. He comes to see himself as different from other boys.
Gender woundedness usually exists as a silent, secret fear - one that the boy’s parents and loved ones only vaguely suspect. The boy has felt this way for as long as he is able to remember. That differentness creates a feeling of inferiority and isolates him from other males.
For some little boys, the gender confusion is obvious. Let me begin with the stories of a few of my clients, starting with “Stevie,” whose case is unusually dramatic.
As a clinical psychologist who has treated hundreds of dissatisfied adult homosexual men, I get phone calls from all over the world. But with increasing frequency, the request concerns a child. Most of the people who call me are dedicated parents who want the best for their child, and I strive to guide, educate and support them.
The particular caller one day, my secretary informed me, was from nearby Pasadena, California, I picked up the receiver and heard a woman’s voice on the other end of the line.

“Doctor, my name is Margaret Johnson,” she began. Her voice quavered, and for one long moment, I thought we might have been disconnected.
“Are you there? Can I help you?”
“Well, I ... think I saw you a couple of weeks ago on television. That was you, wasn’t it? You were debating a psychiatrist?”
“Its possible” I said. I had been on a national TV show two weeks before, jousting with a gay activist who had become a familiar figure on the talk show circuit.1 “You probably mean the debate with Dr. Isay.”
“Yes,” she said. “You were on a show that talked about little boys who want to be little girls.”
“That’s right,” I said. “We were doing a show about gender confusion and -”
This time Mrs. Johnson spoke up with determination and urgency. “Doctor, you were describing my son Stevie. He’s a beautiful little boy, a special child. But ... “ She hesitated. “Stevie’s fascinated with little-girl things. Even more so than my daughters. In fact, he just loves the colors pink and red. He even ... well, plays with Barbie dolls and ... dances around the house on tiptoes like a ballerina.”
As I listened, Mrs. Johnson gave me a few more specifics. Her son was five. “I’ve been noticing this kind of behavior for almost two years,” she explained.
To me, that length of time was significant. It is okay if a little boy wonders what he would look like wearing long blonde curls and so he tries on a wig, simply to be silly. There is nothing particularly alarming about that. But if he keeps on doing it and has little interest in “boy” things, there likely is a problem.2
“This has been going on for two years?” I asked.
I think Mrs. Johnson misinterpreted my question as a rebuke. She sounded a little defensive. “But his teacher said not to worry, it was just a passing phase. So did my mother-in-law. She even gives Stevie her scarves and jewelry to try on. ‘Grandma,’ she tells him, ‘adores her little baby doll.’”
“And you’ve been hoping they were right, that this is just a childhood phase.”
“Yes. But I really do think there’s something wrong.“ By now, Mrs. Johnson’s voice sounded sharp and determined. “Last week,” she said, “Stevie insisted I get him a Pocahontas doll. And then I saw you on TV. You were describing my son to a T, Dr. Nicolosi. And if you’re right, then Stevie will grow up - “ Then she hesitated, as if afraid to say the word. “He’ll be gay. That’s what you said. And to be honest, that’s why I called you.” Her voice began to quaver. “Doctor, will my son grow up gay?”

I wanted to waffle on the word gay. That word is a political term that carries a lot of ideological baggage.3 A more scientific term is homosexual. But this woman was not interested in science or in gay politics; she was worried about her son.

As gently as possible, I replied, “The odds are that, without intervention, a boy like Stevie has a 75 percent chance of growing up homosexual, bisexual, or transgender. Gender nonconformity is often an early sign of - “
“So that means he’ll be a homosexual? Then there’s no hope?”
“He may, but not necessarily. There’s still time to help him feel more comfortable with his maleness.”
“Okay. Okay. But what should I do?” She paused. I could almost feel her intensity.

As the president of NARTH, the National Association for Research and Therapy of Homosexuality, I often give lectures on homosexuality. For the past fifteen years, I have treated many adult men dissatisfied with their homosexuality at my office in Encino, outside Los Angeles.
Most of my adult homosexual clients had never played with dolls - Stevie’s situation was extreme. But almost all of these clients did display a characteristic gender nonconformity from early childhood that had set them painfully apart from other boys.
Most of these men remembered themselves in boyhood as unathletic, somewhat passive, lonely (except for female friends), unaggressive, and uninterested in rough-and-tumble play, and fearful of other boys, whom they found both intimidating and attractive. Many of them also had traits that could be considered gifts: they were bright, precocious, social and relational, and artistically talented. Because most of these men had not been exactly feminine as boys, in contrast to Stevie, their parents had not suspected anything amiss. Thus they had made no efforts at seeking therapy.
But on the inside, these men had, as boys, been highly ambivalent about their own gender. Many had been born sensitive and gentle, and they just were not sure that maleness could be part of “who they were.” Some writers have aptly referred to this condition as “gender emptiness.” Gender emptiness arises from a combination of a sensitive inborn temperament and a social environment that does not meet this child’s special needs. This temperamentally at-risk boy needs (but does not get) particular affirmation from parents and peers to develop a secure masculine identity.

Such a boy will then, for reasons of both temperament and family dynamics, retreat from the challenge of identifying with his dad and the masculinity he represents. So instead of incorporating a masculine sense of self, the prehomosexual boy is doing the opposite - rejecting his emerg­ing maleness and thus developing a defensive position against it.

Later, though, he will fall in love with what he has lost by seeking out someone who seems to possess what is missing within himself. This is because what we fall in love with is not the familiar, but the “other than me.”

It’s an Identity Problem

At the root of almost every case of homosexuality is some distortion of the fundamental concept of gender. We see this distortion in the case of the lesbian activist who wants Scripture rewritten with God called “She.” Or when someone says, with obvious pride, “I don’t fall in love with any particular gender, because gender doesn’t matter. I fall in love with the person - it can be either a man or a woman.” Or when a psychologist says that bisexuality is a superior orientation because it opens up creative new possibilities for sexual expression. Or when a high school boy insists he be allowed to wear a dress and high heels to school -  and a judge orders the school to support the boy’s illusion that he is a female.

Self-deception about gender is at the heart of the homosexual condition. A child who imagines that he or she can be the opposite sex - or be both sexes - is holding on to a fantasy solution to his or her confusion. This is a revolt against reality and a rebellion against the limits built into our created human natures.
But it’s time to get back to Stevie.

Gender Identity Is Established Within the Context of a Family

Dealing with the problem of prehomosexuality is a process that must involve every family member. Continuing with our telephone conversation, I asked Mrs. Johnson to tell me a little about Stevie’s father. The father plays a pivotal role in a boy’s normal development as a male.4 The truth is, Dad is more important to the boy’s gender-identity development than is Mom.
Stevie’s mom said, “My husband, Bill, is right here. Do you want to talk to him?” She asked her husband to pick up the phone and quickly summarized for him what I had just told her. “Bill, this psychologist says Stevie could become gay.”

“So, what can we do?” asked the father, his voice gruff. He sounded like a man of action. Then he immediately answered his own question. “We’ll come to your office.”
I told him that would be a good idea. I went on to say that, with some professional guidance, the two of them could learn to do some important things and change some family patterns in order to help Stevie. But first, they had to understand what was going on.

Growing Up Secure in One’s Gender

The next day, it was not hard for me to see some typical family dynamics at work when Bill, Margaret and Stevie Johnson walked into my office on Ventura Boulevard. Five-year-old Stevie was a beautiful boy, with porcelain white skin.5He had remarkably large eyes fringed with long, black lashes. Margaret was charming and articulate. Bill, a successful banking executive, had little to say. For me, this was a familiar pattern.6

I talked to them as a family for a few minutes and then took Bill and Margaret aside. I explained to them some basics about what a boy needs in order to grow up straight. “Mothers make boys,” I said; “fathers make men.”

I told them how this happens. In infancy, both boys and girls are emotionally attached to the mother. In psychodynamic language, mother is the first love object. She meets all her child’s primary needs.7 Girls can continue to develop in their feminine identification through the relationship with their mothers. On the other hand, a boy has an additional developmental task - to disidentify from his mother and identify with his father.

While learning language (“he and she,” “his and hers”), the child discovers that the world is divided into natural opposites of boys and girls, men and women. At this point, a little boy will not only begin to observe the difference, but also he must now decide where he himself fits in this gender-divided world. The girl has the easier task, I explained to Stevie’s parents; her primary attachment is already to the mother, and thus she does not need to go through the additional developmental task of disidentifying from the person closest to her in the world - Mom - to identify with the father. But the boy is different: he must separate from the mother and grow in his differentness from his primary love object if he is ever to be a heterosexual man. This may explain why there are fewer female homosexuals than there are male homosexuals. Some studies report a 2 to 1 ratio. Others say 5 to 1 or even 11 to 1. We do not really know for sure, except that it is clear that there are more male homosexuals than there are lesbians.
“The first order of business in being a man,” according to psychoanalyst Robert Stoller, “is don’t be a woman.”8

In Search of Masculinity

Meanwhile, the boy’s father has to do his part. He needs to mirror and affirm his son’s maleness. He can play rough-and-tumble games with his son - games that are decidedly different from those he would play with a little girl. He can help his son learn to throw and catch a ball. He can teach the toddler how to pound a wooden peg into a hole in a pegboard, or he can take his son with him into the shower, where the boy cannot help noticing that Dad has a male body, just like he has.

As a result, the son will learn more of what it means to be a male. And he will accept his body as a representation of his maleness. This, he will think, is the way boys - and men - are made. And it is the way I am made. I am a boy, and that means I have a penis. Psychologists call this process “incorporating masculinity into a sense of self” (or “masculine introjection”), and it is an essential part of growing up straight.

The penis is the essential symbol of masculinity - the unmistakable difference between male and female. This undeniable anatomical difference should be emphasized to the boy in therapy. As psychoanalyst Richard Green has noted, the effeminate boy (whom he bluntly calls the “sissy boy”) views his own penis as an alien, mysterious object.9 If he does not succeed in “owning” his own penis, he will grow into an adult who will find continuing fascination in the penises of other men.

The boy who makes the unconscious decision to detach himself from his own male body is well on his way to developing a homosexual orientation. Such a boy will sometimes be obviously effeminate, but more often he - like most prehomosexual boys - is what we call “gender-nonconforming.” That is, he will be somewhat different, with no close male buddies at that developmental stage when other boys are breaking away from close friendships with little girls (about age six to eleven) in order to develop a secure masculine identity. Such a boy also usually has a poor or distant relationship with his father.

Listen to the words of Richard Wyler, who sponsors an online support group for strugglers. Wyler has assembled the stories of a group of ex-gay men and published them on his dynamic and insightful website <>. He describes their shared feeling of alienation from their own masculine natures:

“Our fear and hurt at feeling rejected by the male world often led us to disassociate ourselves from the masculine - the very thing we desired most. . . . Some of us began to distance ourselves from other males, male interests and masculinity by consciously or subconsciously taking on more feminine traits, interests or mannerisms. (We often saw this in the gay community as deliberate effeminacy and “camp,” where gays sometimes took it to such an extreme they even referred to each other as “she” or “girlfriend.”)

But where did that leave us, as males ourselves? It left us in a Never-Never Land of gender confusion, not fully masculine but not really feminine either. We had disassociated not just from individual men we feared would hurt us, but from the entire heterosexual male world. Some of us even detached from our very masculinity as something shameful and inferior.”10

This means that homosexual men, as psychiatrist Charles Socarides explains, are still searching for the masculine sense of self that should have been established in early childhood and then solidified through adolescence.11 But the dynamics involved are completely unconscious. And that is why Dr. Socarides uses psychoanalysis (and some of the tools of psychoanalysis, such as dream work) to help his adult homosexual patients understand and resolve their unconscious strivings.

I try to prevent a long and difficult therapy to change homosexuality in adulthood by encouraging early intervention in childhood. Parents, particularly fathers, can best affirm their sons’ weak masculine gender identity while it is still in the formative stage. Parental intervention can lead to an increase in gender esteem, preventing the sense of male inferiority and alienation from the world of men that so many homosexual men describe.

The idea is to prevent the boy from detaching from his normal maleness and to encourage him to claim the masculine identity for which he was designed, not to somehow mold him into the caricature of a macho man (this may not be who he is, and that is okay), but to help him develop his own maleness within the context of the personality characteristics with which he was born.

Richard Wyler explains the needs he and the other strugglers felt as children - particularly, longings and loneliness like so many other gender-disidentified boys:

“Unknowingly, unintentionally, we had constructed a psychological gulf between ourselves and the heterosexual male world. Yet, as males, we needed to belong to the world of men. To be mentored by them. To be affirmed by other men. To love and be loved by them. Although we feared men, we pined for their acceptance. We envied the confidence and masculinity that appeared to come so easily to them. And as we grew, envy turned to lust. Watching men from afar, wanting to be like them, wanting to be included, they became the objects of our desire.

From the far side of the gulf we had constructed, we could never grow out of homosexuality. Gay activists and gay-affirmative therapists would tell us that our true place was in fact on this side of the gulf, that it was a good place to be. If that is true for others, it certainly wasn’t for us. We wanted something more. We wanted to face our fears, heal our underlying problems, and become the men we felt God wanted us to be. We didn’t want to be affirmed as gay. We wanted to be affirmed as men...
We wanted to heal the hidden problems that our inner voice was calling us to heal.”12
As Wyler explains, the normal process of gender identification has gone awry. Instead of identifying with their gender, such boys have defensively detached themselves from the world of men. To protect themselves from hurt, they have closed themselves off from male bonding and identification.

Much of this detachment began with a weak relationship with the father. Some fathers find a way to get involved in everything but their sons. They lose themselves in their careers, in travel, in golf, or in any number of activities that become so all-important to them that they have no time for their boys. Or they fail to see that this particular son interprets criticism as personal rejection.

Or the problem may be rooted in a temperamental mismatch - that “one particular son” was much harder for Dad to reach because of the child’s own sensitive temperament. His father found him hard to relate to, because they did not share common interests (perhaps the activities this particular son enjoys are more social and artistic and less typically masculine). And in the busyness and rush of life, this harder-to-reach boy was somehow put aside and neglected.
A few fathers take this scenario to the extreme. I saw one father (an immature and inadequate man who warned his wife, before their son was born, that he did not want a boy) completely reject and ignore their son, while doting on their older daughter. Apparently threatened by the idea of having another “man in the house,” this man made his displeasure so clear that their son, by the age of two, was wearing dresses like his sister and playing with her Barbie doll collection. Not surprisingly, this little boy felt much safer renouncing his masculine identity.

For a variety of reasons, some mothers also have a tendency to prolong their sons’ dependence. A mother’s intimacy with her son is primal, complete, exclusive, and this powerful bond can easily deepen into what psychiatrist Robert Stoller calls a “blissful symbiosis.”13 But the mother may be inclined to hold on to her son in what becomes an unhealthy mutual dependency, especially if she does not have a satisfying, intimate relationship with the boy’s father. In such cases she can put too much energy into the boy, using him to fulfill her needs for love and companionship in a way that is not good for him.14

A “salient” (that is, strong and benevolent) father will interrupt the mother-son “blissful symbiosis,” which he instinctively senses is unhealthy. If a father wants his son to grow up straight, he has to break the mother-son bond that is proper to infancy but not in the boy’s best interest afterward. In this way, the father has to be a model, demonstrating that it is possible for his son to maintain a loving relationship with this woman, his mom, while still maintaining his own independence. In this sense, the father should function as a healthy buffer between mother and son.15

Sometimes Mom might work against the father-son bond by keeping her husband away from the boy (“It’s too cold out for him,” “That might hurt him,” “He’s busy doing things with me today”) in order to satisfy her own needs for male intimacy. Her son is a “safe” male with whom she can have an intimate emotional relationship without the conflicts she may have to confront in her relationship with her husband. She might be too quick to “rescue” her son from Dad. She may cuddle and console the boy when his father disciplines or ignores him. Her excessive sympathy can discourage the little boy from making the all-important maternal separation.

Furthermore, exaggerated maternal sympathy fosters self-pity - a feature that is often observed in both prehomosexual boys and homosexual men.16 Such exaggerated sympathy from the mother may encourage the boy to stay isolated from his male peers when he is hurt by their teasing or their excluding him. As Richard Wyler tells us:

“Almost all of us had an innate sensitivity and emotional intensity that we learned could be both a blessing and a curse. (To whatever extent biology may contribute to homosexuality, this is probably where biology most affected our homosexual struggle.)
On the one hand, our sensitivity caused us to be more loving, gentle, kind and oftentimes spiritually inclined than average. On the other hand, these were some of the very traits that caused girls to welcome us into their inner circles, Moms to hold onto us more protectively, Dads to distance themselves from us, and our rough-and-tumble peers to reject us.

Perhaps even more problematic, it created within us a thin-skinned susceptibility to feeling hurt and rejected, thus magnifying many times over whatever actual rejection and offense we might have received at the hands of others. Our perception became our reality.”

Gender Nonconformity: Just a Myth?

Could the stories of childhood gender nonconformity told us by so many ex-gay men hold true for only a small, stereotyped subgroup of homosexuals? Are such stories, in fact, not typical?

One highly regarded study of homosexuality offers some revealing answers to this question. The book Sexual Preference: Its Development in Men and Women is often cited as a reference work by gay activists. The study was funded by the National Institute of Mental Health and was designed by the Kinsey Institute for Sex Research. It found that men who became homosexual are far less likely than most men to report having “very much” enjoyed traditional boys’ activities, such as baseball and football. In fact, only 11 percent of homosexual men had enjoyed those traditional boys’ activities, in contrast to 70 percent of heterosexuals.

Twice as many homosexual men reported having enjoyed solitary activities “very much,” particularly drawing, music, and reading. Typical girl activities (such as playing house, hopscotch, and jacks) were enjoyed by about half of the homosexual men, versus only 11 percent of heterosexual men.18 More than one-third (37 percent) of the homosexual men had dressed up as girls or pretended to be a girl during their grade school years, while only 10 percent of the heterosexual men had ever done so.

The family factors associated with the boys’ gender nonconformity in this study were “mother-dominated father,” “closeness to mother,” “strong mother,” and “low level of identification with father.” The authors of the study concluded, “Childhood gender nonconformity turns out to be a very strong predictor of adult sexual preference among the males in our sample.”19

This finding of childhood gender nonconformity is not just true for people who are unhappy with their homosexuality; it has also been found to hold true in studies of other homosexuals who were not patients in psychotherapy.

A Commitment to a Healthy Future

Recalling the words of psychologist Robert Stoller, I reminded Margaret and Bill that “masculinity is an achievement.” What I meant was that growing up straight is not something that just happens. It requires good parenting. It requires family support. And it takes time.
Margaret got the idea. She said, “You mean its a process?”
“How long a process?” she asked.
I knew what she was asking. How long before she would know whether Stevie was going to be homosexual? I explained that the crucial period is from one and a half to three years old, but the optimal time is before age twelve. “If we do nothing, then with the onset of puberty, when he begins to feel deep sexual stirrings and romantic longings, this search for gender will become eroticized.”
“Eroticized?” asked the father, a worried frown creasing his brow.
“He may start experimenting with other boys,” I explained. “Or even start coming into contact with older homosexuals.”
He groaned. “That’s got to be every father’s worst nightmare.”
I heard the anxiety in his voice. Like most parents, he hoped that when his son grew up, he would marry and have children.
“The fact is,” I said to Bill, “a boy who is confused about his sexual identity may experiment with same-sex intimacy, sometimes with an older man. Of course, that is likely to reinforce a homosexual identity.”21

Bill sat back in his chair and frowned. He told me, “Doc, we’ll do whatever we gotta do. We’ll sell the farm.” In that moment, I think. Bill really meant that he would “do anything” to help Stevie, no matter how drastic the action was.
I could understand Bills fears, but I assured him, “You don’t have to sell the farm. Most of the work you can do yourself. Just be there for Stevie emotionally. Maintain a warm, loving relationship with him and don’t let him pull away.”

At that point, I recalled the many session hours I have spent listening to my adult homosexual clients telling me about their search for partners and their deep longing for male love and erotic intimacy. There was a great void in their lives, tracing back to their earliest years, for a man’s attention, affection, and affirmation - a need to be hugged and held, and later to feel special to that one “best buddy” who “must certainly be out there somewhere.” Many were still searching for the love of their fathers. “Be a salient father,” I said to Bill.
He frowned.“‘Salient’? What do you mean by that?”
“‘Salient’ means two things: strong and also benevolent. Stevie needs to see you as confident, self-assured, and decisive. But he also needs to see you as supportive, sensitive, and caring. In other words, Bill, give Stevie reasons for wanting to be like you.” I gave Bill a long, searching look.
To Margaret, I said, “And you’re going to have to back off.”
She looked shocked. “I’m not sure I understand. Of course I have to take care of him and - ”
I said, “What I mean is, don’t baby Stevie. Let him do more things for himself. Don’t try to be both Mom and Dad for him. If he has questions, tell him to ask his dad.”
“Questions about what?”
“About anything. About sex, sure. But other questions, too. Why is the sky blue? Why does the wind blow? Defer to your husband any question, any task that will give him a chance to demonstrate that he is deeply interested in Stevie, that Stevie is very special to him. He’s got to prove that Dad has something to offer him.”

Many of my homosexual patients tell me that their fathers had nothing to give them. One of my homosexual clients, who was twenty-six, told me recently, “My Dad was there but not there. I mean, he was in the house, but I can’t remember anything memorable or significant about him.”22

Bill said, “So you’re saying that Stevie doesn’t need therapy?”
I told Bill that Stevie did not really need therapy. “He needs his dad.”
He needs his dad. That was easy for me to say.

The following week, when Margaret drove in from Pasadena, this time she was alone. And, sadly, I was not the least bit surprised that Bill did not show up. This, I am sorry to say, is a familiar pattern. Moms often sense what needs to be done. And, as is often the case, many dads just don’t seem to get the importance of it. (“Your mother,” they say, “will handle it.”)
“Bill hasn’t been paying much attention to Stevie,” Margaret told me rather apologetically. “Even when we were driving home after our session with you,” she said, “Bill hardly even talked to Stevie. And, as far as I know, they haven’t had any one-on-one moments since then.” 
I asked, “What happens when Bill comes home from work?”
“He doesn’t talk to Stevie, that’s for sure. He barely talks to me. He makes himself a martini and turns on the TV.”
Uh-huh, I thought, it’s the same old story.

It had not been more than a week since Bill had said he would “sell the farm” to save his boy. I did not doubt that this father loved his son and that, in his mind, he truly wanted to do the “big” thing. But he could not do the little things - the everyday, caring, and loving things that were necessary if his son was to resolve his gender confusion. As it was, Bill could not even talk to his son. Tragically, it is an all-too-familiar pattern. In fifteen years, I have spoken with hundreds of homosexual men. Perhaps there are exceptions, but I have never met a single homosexual man who said he had a close, loving, and respectful relationship with his father.”23

I have found this to be a good test of the early father-son bond: who does the little boy run to when he is happy, proud of something he has done, looking for encouragement, or seeking fun and excitement? If it is always Mom, then something is wrong with the father-son relationship.
In our own clinical work, and from the experience of the many men we have known, it seems very rare for a man who struggles with homosexuality to feel that he was sufficiently loved, affirmed, and mentored by his father while growing up or to feel that he identified with his father as a male role model. In fact, often the son remembers the relationship as characterized by a feeling of neglect, mutual hostility, and paternal lack of interest (a form of psychological abandonment).

But like all human experience, this is not universal. Sometimes the father-son relationship does seem reasonably adequate. In such cases, there may be a problem with aggressive and hostile (usually older) brothers or other male peers or abusers who have created a deep wounding. Still, the same essential problem remains: the boy has a deep sense of gender inadequacy, of not measuring up in the company of men, of not being good enough within the world of males. Call it a problem in gender esteem.

As Richard Wyler explains, speaking for a group of ex-gay men including himself, “We have never known a single case where a man who struggles with unwanted homosexual feelings was not emotionally estranged from or wounded in his relationships with other men or the male world”24
Every boy has a deep longing to be held, to be loved by a father figure, to be mentored into the world of men, and to have his masculine nature affirmed and declared good enough by his male peers, his male elders, and mentors. If none of these relationships is strong enough to welcome the boy into the world of men, then he will yearn after other men from a distance. Like Richard Wyler, I have never known a single case of a homosexual man who was not wounded in his relationships within the male world.

I was not quite ready to give up on Stevie’s father. Still, I advised Margaret, as a stopgap, that she ought to start looking for other male role models for her son. An uncle who could take Stevie fishing. A cousin who could teach the boy baseball. Other trustworthy adult males who would spend time with this boy and make him feel special.

Of course, no intervention can guarantee that a child will grow up heterosexual. All Margaret and Bill could do was to maximize Stevie’s chances by creating the best possible environment. I trusted hat Margaret and Bill would still love their son if those efforts were not successful.
But there was a great deal that could be done to lay a healthy foundation, and it was time to get started.


1 I have been interviewed by many TV interviewers over the past ten years, including Oprah Winfrey, Larry King, and Montel Williams, and my opinion has been sought by television newsmagazines such as ABC’s 20/20 and the CNN Medical Report. I have also had an opportunity to speak with a wide spectrum of radio hosts and their callers on hundreds of talk shows.

2 L. Newman, “Treatment for Parents of Feminine Boys,” American Journal of Psychiatry 133, no. 6 (1976): 683.

3 Charles W. Socarides, Homosexuality: A Freedom Too Far (Phoenix: Adam Margrave, 1995), p. 52; Joseph Nicolosi, Reparative Therapy of Male Homosexuality: A New Clinical Approach (Jason Aronson, 1991), xv-xvi.

4 E. Abelin, “Some Further Observations and Comments on the Earliest Role of the Father,” International Journal of Psychoanalysis 56 (1975): 293-302.; R. Greenson, “Dis-Identifying from Mother: Its Special Importance for the Boy,” International Journal of Psychoanalysis 49 (1968): 370-74; I. Bieber et al., Homosexuality: A Psychoanalytic Study of Male Homosexuals (New York: BasicBooks, 1962); R. J. Stoller, “Boyhood Gender Aberrations: Treatment Issues,” Journal of the American Psychoanalytic Association 27 (1979): 837-866; C. W. Socarides, “Abdicating Fathers, Homosexual Sons: Psychoanalytic Observations on the Contribution of the Father to the Development of Male Homosexuality,” in: Father and Child: Developmental and Clinical Perspectives, ed. S. H. Cath (Boston: Little, Brown, 1982), pp. 509-21; S. M. Wolfe, “Psychopathology and Psychodynamics of Parents of Boys with a Gender Identity Disorder of Childhood” (Ph.D. diss., City University of New York, 1990); Richard Green, The “Sissy Boy Syndrome” and the Development of Homosexuality (New Haven, Conn.: Yale University Press, 1987); Lawrence Hatterer, Changing Homosexuality in the Male (New York: McGraw-Hill, 1960); J. Fischoff, “Preoedipal Influences in a Boy’s Determination to Be ‘Feminine‘ During the Oedipal Period,”Journal of the American Academy of Child Psychiatry 3 (1964): 273-86.

5 Not all gender-disturbed boys are remarkably good-looking, but Richard Green saw a connection and concluded that the more beautiful the boy, the more parents permitted and encouraged his effeminacy (Green, “Sissy Boy Syndrome,” pp. 64-68).

6 See also G. A. Rekers et al., “Family Correlates of Male Childhood Gender Disturbance,” Journal of Genetic Psychology 142 (1983): 31-42.

7 P. A. Tyson, “Developmental Line of Gender Identity, Gender Role, and Choice of Love Object,” Journal of the American Psychoanalytic Association 30 (1982): 61-68.

8 Robert Stoller, Presentations of Gender (New Haven, Conn.: Yale University Press, 1985), p. 183.

9 Richard Green, letter to author. During my research, I met Dr. Green at his office at UCLA. We disagreed on one important point: the disordered nature of the homosexual condition. But at one point I asked Dr. Green if he would want his son, then three years old, to grow up as a homosexual. “Oh, no,” he said quickly. “His life would be too difficult.”


11 Socarides, Homosexuality.


13 R. J. Stoller, The Transsexual Experiment, vol. 2 of Sex and Gender (London: Hogarth, 1975), p. 24.

14 S. Coates, “Extreme Boyhood Femininity: Overview and New Research Findings,” in: Sexuality: New Perspectives, ed. Z. DeFries, R. C. Friedman, and R. Corn (Westport, Conn.: Greenwood, 1985), pp. 101-24; S. Coates, “Ontogenesis of Boyhood Gender Identity Disorder,” Journal of the American Academy of Psychoanalysis 18 (1990): 414-38; S. Coates, “The Etiology of Boyhood Gender Identity Disorder: An Integrative Model,” in: Interface of Psychoanalysis and Psychology, eds. J. W. Barron, M. N. Eagle, and D. L. Wolitzky (Washington, D.C.: American Psychological Association, 1992), pp. 245-65; S. Coates, R. C. Friedman, and S. Wolfe, “The Etiology of Boyhood Gender Identity Disorder: A Model for Integrating Temperament, Development, and Psychodynamics,” Psychoanalytic Dialogues 1 (1991): 481-523; S. Coates and E. S. Person, “Extreme Boyhood Femininity: Isolated Behavior or Pervasive Disorder?”; Journal of the American Academy of Child Psychiatry 24 (1985): 702-9; S. Coates and S. M. Wolfe, “Gender Identity Disorder in Boys: The Interface of Constitution and Early Experience,” Psychoanalytic Inquiry 15 (1995): 6-38; S. Marantz and S. Coates, “Mothers of Boys with Gender Identity Disorder: A Comparison of Matched Controls,” Journal of the American Academy of Child and Adolescent Psychiatry 30 (1991): 310-15; B. Thacher, “A Mother’s Role in the Evolution of Gender Dysphoria: The Initial Phase of Joint Treatment in the Psychotherapy of a Four-Year-Old Boy Who Wanted to Be a Girl” (paper presented at the meeting of the Division of Psychoanalysis, American Psychological Association, New York, April 1985); Green, “Sissy Boy Syndrome.”

15 Abelin, “Some Further Observations,” 293-302; R. Greenspan, “The ‘Second Other’”: The Role of the Father in Early Personality Formation and the Dyadic-Phallic Phase of Development,” in Father and Child; Greenson, “Dis-identifying from Mother,” pp. 370-74; A. J. Horner, “The Role of the Female Therapist in the Affirmation of Gender in Male Patients,” Journal of the American Academy of Psychoanalysis 20 (winter 1992): 599-610; Socarides, Homosexuality; J. Snortum et al., “Family Dynamics and Homosexuality,” Psychological Reports 24 (1969): 763-70.

16 G. van den Aardweg, On the Origins and Treatment of Homosexuality: A Psychoanalytic Reinterpretation (Westport, Conn.: Praeger, 1986).


18 A. P. Bell, N. S. Weinberg, and S. K. Hammersmith, Sexual Preference: Its Development in Men and Women (Bloomington: Indiana University Press, 1981).

19 Ibid., p. 76.

20 Snortum et al., “Family Dynamics and Homosexuality,” pp. 763-70.

21 Finkelhor found that half of the college men in his study who were currently involved in homosexual activity reported a childhood sexual experience with an older man. He hypothesized that boys molested by older men may label the event as a homosexual experience and therefore label themselves as homosexual. These boys will then reinforce the homosexual label through further homosexual behavior (D. Finkelhor, Sexually Victimized Children [New York: Free Press, 1979]).

22 See also D. J. West, “Parental Figures in the Genesis of Male Homosexuality,” International Journal of Social Psychiatry 5 (1959): 85-97.

23 For examples of the poor father-son relationship, some in the clinical literature, some autobiographical, see W. Aaron, Straight (New York: Bantam, 1972); J. R. Ackerly, My Father and Myself (New York: Poseidon, 1968); M. Boyd, Take Off the Masks (Philadelphia: New Society, 1984); Greg Louganis, Breaking the Surface (New York: Plume, 1996); G. A. Rekers et al., “Family Correlates of Male Childhood Gender Disturbance,” Journal of Genetic Psychology 142 (1985); 31-42; Andrew Sullivan, Virtually Normal (New York: Vintage, 1996); Fischhoff, “Preoedipal Influences,” pp. 273-86.