Causes of transsexuality Docter and others, but opposed by Charles Allen Moser, Larry Nuttbrock, Julia Serano, and the World Professional Association for Transgender Health.<section end="factors" /> A 2008 study compared 112 male-to-female transsexuals (both androphilic and gynephilic), mostly already undergoing hormone treatment, with 258 cisgender male controls. Male-to-female transsexuals were more likely than cisgender males to have a longer version of a receptor gene (longer repetitions of the gene) for the sex hormone androgen or testosterone, which reduced its effectiveness at binding testosterone. The androgen receptor (NR3C4) is activated by the binding of testosterone or dihydrotestosterone, where it plays a critical role in
Fraternal birth order and male sexual orientation fraternal birth order (or the underlying variable it reflects) may be the first universal factor to be identified in development of same-sex attraction in males. Bearman and Brückner (2002) argued that studies showing a fraternal birth order effect have used nonrepresentative samples and/or indirect reports on siblings' sexual orientation. Their analysis, focusing on opposite-sex twins, did not find an association "between same-sex attraction and number of older siblings, older brothers, or older sisters". A study by Francis (2008), using the same Add Health survey but with broader analysis, saw a very weak correlation of male same-sex attraction with having multiple