Male sexual identity disorder. It can be based on the inequalities between genetic sex and the level of sex hormones during the hypothalamic differentiation phase . A causal prophylaxis may be possible in the future and avoid such inequalities during sex-specific brain differentiation, which by morphogenesis studies , may be between the sixth and seventh month of intrauterine life.
Clinical picture
It is remarkably consistent in its fundamental features. The cases are so similar to each other that we consider the presentation of a clinical history as the most eloquent way of describing the general clinical picture.
Clinic history
This is a child of three years and three months, whose mother comes to the consultation because, according to what she tells us, the child “has feminine gestures and voice ”; he likes to play dolls , houses and little cooks.
The only child, he spends the whole day with his grandmother, his maternal aunt and his mother; has little contact with the father and almost none with male children.
Regarding the reaction to the feminine tendencies of the child, the medre tells us:
“I have never stimulated his inclinations, but I have not fought them either because I did not want to scare him and make him hide them to deceive me. I have explained to him that he is male and that he should behave as such, but he denies it and says that he is female , that he wants to be female. “
However, the examiner notes that the boy has much longer hair than what is used in his environment and at his age, it is neatly combed and the shorts are very short and tight. These details seem to contradict maternal denials of feminizing attitudes on her part. Described as a clinical picture of effeminacy in men and we proposed it as a delimited entity, with a very constant characteristic and great stability in its evolution .
The following elements of this case are common to all those we have observed and constitute the clinical picture of this entity:
Ø Early appearance of the disorder that, in many cases, is noticed by the parents during the second year of life.
Ø Global character of the Personality Disorders , with the adoption of a feminine position in toto and without observing concomitant masculine characteristics or precedents.
Ø Initial tuning of the I with the disorder, as evidenced in this case in the naive confession of wanting to be female. It tends to disappear or hide in later years due to the social pressure that is exerted on them to abandon their feminine position.
Aggressiveness
The aggression disorder in these children differs in essential respects from that in neurotic children. More than an inhibition, as occurs in the latter, it seems to be a defect. It is much more difficult to arouse the aggressiveness of the effeminate child than that of the neurotic. Nor is it observed in these children a spontaneous tendency to aggressive games ( soldiers , policemen , thieves, etc.) or competitive ( ball , running , etc.) so characteristic of normal and neurotic children.
The relationship with the mother
Ø About 60% of our cases showed signs of an early aesthetic sensitivity, which is manifested in the interest marked by the tones and combinations of colors , flowers , decoration and personal grooming in general.
Ø Marked preference for her than is observed in normal males, especially if it is contrasted with the little interest towards the father .
Ø Absence of excessive dependence on the mother , so common in neurotic children.
The relationship with the father
In about 80% of our cases, approximately the father and the effeminate child are reciprocally indifferent and emotionally estranged. This fact seems to be determined, to a large extent, by the structural differences in the sexual behavior of both. The feminine inclinations and the lack of masculine interests in the boy make it difficult for the father to approach him, since to do so he would have to treat him like a girl . Sometimes the feminine attitudes of the child and their homosexual connotations engender fear and rejection in the father.