Hirschfeld noted certain shared traits in the people he studied. First, and most important, their cross-dressing began at a very young age and was generally lifelong. “In most of the cases we can trace the urge back to their early childhood. It increases during puberty; the conviction becomes even clearer in their awareness at that time, and then remains almost unchanged for their entire life.” Second, he found that far from exhibiting symptoms of general pathology or derangement, most of the transvestites he knew appeared to be socially and economically successful people, whose only deviation from the norm lay in their persistent and often compulsive desire to cross-dress. “The transvestites that we have come to know here are intelligent, conscientious people who have diverse interests and a broad education,” he writes in Die Transvestiten. “In school, almost all of them excelled in motivation, diligence, and especially in their ease of understanding (which many psychiatrists today of course look upon as a slight stigma of degeneration). At present, all of them find themselves in good financial standing and in good jobs in which they have been promoted because of their great energy and proficiency.”
To understand the curious nature of that assertion, its generally positive and complimentary tone marred only by the reference to “degeneration,” one must know something about the context in which Hirschfeld was working. To the sexologists who came before him and even to his peers, all forms of sexual nonconformity, including homosexuality, were indications of disease. “The pre-sexological era of modern sex research was almost exclusively devoted to the study of people believed to be sick. The sexual manifestations of their sickness were carefully listed, and as a rule, described to degeneration,” wrote Erwin A. Haeberle, in The Birth of Sexology. The word “degeneracy” had a very specific meaning for Hirschfeld, his predecessors, and his contemporaries. Degeneracy implied weak or damaged genes, a hereditary defect that manifested in conditions as various as alcoholism, mental retardation, promiscuity, and sexual “disorders” such as homosexuality, transvestism, and fetishism. Today, the word “degeneracy” connotes a moral failing, but to Hirschfeld and his contemporaries it referred to an organic defect that should not be passed on to future generations. Like many physicians of the time, within Germany and without, Hirschfeld was a eugenicist, concerned not just with individual patients but also with the health of society as a whole. His belief in eugenics, and more specifically in biological explanations for human behavior, provided the impetus for his scientific investigations, his medical practice, and his social activism. Biology, in particular the new science of endocrinology, promised to explain everything for Hirschfeld and for his contemporaries, including the riddle of sexual intermediaries.
Hirschfeld defined four types of sexual intermediaries. First came people born with ambiguous genitalia, neither classically male nor classically female—the clinically intersexual. Next, people with cross-gendered secondary sexual characteristics, “men with womanly mammary tissue (gynecomastia) and women without such; women with manly hair, such as manly beard or manly pubes.” Into this group Hirschfeld classed men and women whose body morphology deviated from the norm. These were the unfortunate men and women who were more often mocked, harassed, and/or stopped by police when they were actually wearing the clothes of their biological sex, rather than when they were cross-dressed. One woman mentioned by Hirschfeld was actually stopped by police more than a dozen times when dressed as a woman. Dressed as a man, she encountered no problems at all.
Next came those “persons divergent with regard to their sex drive.” This category included not only homosexuals and bisexuals, but also masochistic men and those who preferred to adopt the “female” role in sex with women, and sadistic women and those who adopted the “male” role in sex with men. So, for example, men attracted to “energetic” women or to women “who are considerably more mature, intellectual and older than themselves” were believed by Hirschfeld to be expressing a kind of femininity that placed them in the same category as homosexuals. Similarly, “women betray their manly mixture in a preference for the womanly type of man, very dependent, very youthful, unusually gentle men, in general for such ones who in their traits of behavior and character correspond more to the feminine type.”
The final category of sexual intermediary included “men whose feminine emotions and feelings are reflected in their manner of love, their direction of taste, their gestures and manners, their sensitivity, and many times their particular way of writing. Also men who more or less dress themselves as women or live totally as such; on the other side women of manly character, manly ways of dressing and thinking and writing, strong tendency towards manly passions, manly dress, naturally also such women who more or less lead the life of men.” These were the people who would eventually be called “transsexual,” though there is some dispute about the origin of the term, which some attribute to Hirschfeld and others attribute to the physician David O. Cauldwell, whose perspective on these patients was considerably less positive.