A case report of a 36-year old female-to-male transsexual who was attracted to males prior to and following sex reassignment is described. For many years, even before hormonal and sex reassignment, this individual considered himself to be a gay male. This represents an unusual clinical finding with import to theories of sexual development, our definition of gender identity and sexual orientation and the relationship between gender identity and sexual orientation. This case may increase awareness that terminology is flawed. Gender identity and sexual orientation are separate phenomena and theories of sexual orientation are inadequate. It also improves understanding of the special problems associated with cases such as these.
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