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They develop an aura of deep secrecy based on shame and risk of ridicule and their secret desire to be female is protected at all costs.

Essentially creating a not-male, not-female but otherwise permanent gender variant condition.

Even though there apparently are some individuals who fall very close to or dead-center on the gender identity spectrum, most gender variant people can easily identify with being closer to one end of the spectrum then the other.

Given the probable cause, it is reasonable to assume there are many permutations of the way gender variant individuals relate to their condition.

However, people who present for treatment routinely fall into three distinct groups: Two groups of female-identified males( Group One and Group Three in this paper) and one group of male-identified females (Group Two).

These individuals typically take full advantage of the social permissiveness allowed women in many societies to wear their hair short and dress in loose, gender-neutral clothing.

These individuals rarely marry, preferring instead to partner with women who may or may not identify as lesbian. Group Three (G3) is composed of natal males who identify as female but who act and appear normally male.

As a psychotherapist I have found female identified males (G1) to be clinically similar to male-identified females (G2).

That is, individuals in both groups have little or no compunction against openly presenting themselves as the other sex.

We can hypothesize that prenatal androgenization was sufficient to allow these individuals to appear and act normally as males but insufficient to establish a firm male gender identity.

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