Building on work by Freund, Frank Leavitt and Jack C. Berger in 1990 further categorized homosexual transsexuals by three patterns of sexual activity in how they used their penis. In their study 44% were sexually inactive, 19% avoided use of the penis during sex, and 37% derived pleasure from using the penis during sex. The groups showed varying levels of masculinity and emotional disturbance in development. Leavitt and Berger found that transsexuals in the avoidant group are different from those in the other two groups. They fit the description of the "nuclear transsexual". They had a strong cross gender identification, wanted female anatomy, had never married and little to no sexual activity with females. Of all the subgroups this group had the least comorbid psychopathology. The transsexuals in the pleasure group behaved sexually in ways that were "classically homosexual". They were more likely than those in the avoidant group to have had sexual experience with females. They also rated higher on a test of general fetishism. Other than this, transsexuals in the pleasure group were similar to the description of a "nuclear transsexual". They found that transsexuals in the inactive group had characteristics which most differed from that of the "nuclear transsexual", such as strong heterosexual orientations (as determined from psychological testing), and fetish histories. "The pattern exhibited generally conforms to that exhibited by heterosexual transsexuals." The inactive group was found to share little with the other groups of transsexuals other than a stated sexual interest in males. Leavitt and Berger also mentioned studies by Blanchard which suggest that heterosexual transsexuals will adjust their life stories to ensure that they get sex reassignment surgery.