Dear Zeeshan!

You have asked me two significant questions. You are curious about my views about homosexuality and you also want to know how gays and lesbians are different than transsexuals and hermaphrodites. After reading your questions, I tried to remember my professional experiences and also the literature I read on this topic. In this letter I will share with you some of the highlights of my recollections and readings.

I remember the cold night of December 1977 when I was a resident in psychiatry in Memorial University, Newfoundland. I had arrived in the country a few weeks earlier and was living close to the hospital. That night I was on call. When I was called from the emergency department to come and see a patient who had just walked in and wanted to see a psychiatrist, I got dressed in my overcoat, hat and mittens and started walking towards the hospital. On my way I wondered, ‘There must be something terrible for the young man to come to the hospital in this bitter cold’.

When I entered the emergency department, the nurse guided me to the waiting room where the young man was waiting for me. He looked in his thirties. He was wearing blue jeans. He looked sad.

‘I am Dr. Sohail’ I introduced myself.

‘I am Charles’ He responded.

I extended my hand but he did not shake it. I felt a bit awkward. I took him to the interview room and when we both sat down I asked, ‘ What made you come to the hospital at this time of the night?’

‘I am experiencing an emotional crisis’.

‘Please share it with me. I am all ears’. And I picked up the clipboard to take notes.

‘I am gay and I am carrying this cross for the last fifteen years.’ He started sharing his story openly and honestly. ‘I never shared my sexual orientation with my family because they are very conservative and religious. I knew if they found out they would disown me.

For the last ten years I had been living with my partner Jonathan, who is a schoolteacher. Nobody knew that we were lovers; everybody believed we were roommates and good friends. A few weeks ago when the school authorities found out that Jonathan is gay, he was asked to resign. He was told that if he did not resign, he would be fired.

Jonathan tried to tell the authorities that he was an excellent teacher, well liked by students and their parents, but nobody listened to him.

After Jonathan was fired from the school, he protested. In response to his protest Jonathan was emotionally blackmailed and his story was published in the local newspaper. It was also mentioned that he was living in sin with Charles for the last ten years. When my parents read the news they decided to disown me. For the last few days, I have been feeling depressed and tonight I could not sleep. When I started feeling suicidal, I decided to come to the hospital to get professional help.’

After listening to his story I felt very sympathetic, but I did not know how could I help him. I had never met a gay person before and I had no idea what to suggest. When I asked him how could I help him, he told me he just wanted to talk to someone. He felt quite connected to me and wanted to see me on a regular basis to get supportive therapy. I gave him a prescription of sleeping pills for a few weeks and gave him an appointment for the next week. Charles kept on coming once a week for a few weeks. He kept on sharing his story and I kept on listening. After a couple of months when I asked him if he found those counseling sessions helpful, he said, ‘I am so grateful that you are seeing me. I do not have a single person in my family or neighborhood who is compassionate towards me. They are all prejudiced. I know you are from a different culture but I can trust you more than my own folks.’ After a few weeks I heard that Jonathan committed suicide and I never met Charles again. The nurse felt he might have left town. I was bewildered by the whole situation. Since I had not dealt with such situations before, I was not sure what was the best way to handle it.

After that incident, I developed a special incident about the plight of gay and lesbian people and couples.



I also remember the day when my friend Zahid and I were visiting San Francisco to attend the annual meeting of American Poetry Association. After I finished reciting my poem, Zahid and I left the conference to see the town. After wandering around for a while we found ourselves in the gay town, a town where nearly 100, 000 gay men and women reside.

I was quite impressed by their lifestyle. It looked a very peaceful town. Everybody looked contented and relaxed. They had their own homes, shops, schools and churches. I was impressed to see gay couples walking hand in hand. Many of them were working in their gardens helping each other.

Zahid and I entered a restaurant to have lunch. We saw gay couples sitting on other tables eating and joking around. Some were holding hands while others were affectionately whispering to each other. When the waiter came he looked at us as if we were also a gay couple. At that moment I realized I was wearing a pink shirt. I chuckled to myself. We were treated with regard and respect in that town.

After lunch we went to a book -store. I was pleasantly surprised to see hundreds of books on gay and lesbian issues. I bought a few books about gay rights, gay poetry and AIDS.



I can also recall the conference of Asian writers I attended in Sweden. My dear friend Sain Sucha was the host and fourteen writers from all over the world were visiting Stockholm for a week. The title of the workshop was Search for Identity. The first day every writer was asked to share how he or she had changed after immigrating to the Western world. When my turn came I shared with my writer friends that after living in Canada for a few years and dating Western women I realized that my fantasy life had changed. I no longer fantasized about brown skinned, long dark haired women, I rather fantasized about white short haired blondes or brunettes. I shared with the group that most people are very reluctant to openly discuss their sexual lives especially sexual fantasies but I felt it was very important in understanding people’s sexual identity and orientation. After I finished my story, our friend Iftikhar Nasim said, ‘ I am sitting here wondering that if Sohail can share his sexual fantasies openly and honestly, then I should also confess publicly that I am gay. I have stayed in the closet for a long time but living in the Western world and doing a lot of soul-searching I feel comfortable now to come out and acknowledge my sexual orientation with my friends without feeling ashamed and guilty.’ I was pleased to see that the group of writers and artists accepted Iftikhar Nasim as a gay person and gay writer. People were impressed by his openness. He shared his gay poems in that conference. Iftikhar Nasim was the first Urdu poet who had publicly acknowledged that he was gay. Later on when I published a book on gay and lesbian literature I dedicated a special section to Iftikhar Nasim.



There was an evening when Iftikhar Nasim came to Canada and stayed with me and Zahid for a few days. He took us to meet his gay friends in South Asian Gay Community. We visited a home where two gay couples lived. That home was neatly decorated. Those friends welcomed us warmly and served us drinks and dinner. We were impressed by the generosity of their spirit. When they found out that I was a psychiatrist they asked questions about the prevailing attitudes in the mental health community. I shared with them that more and more mental health professionals are accepting people with alternate lifestyles, rather than judging them and labeling them as abnormal or perverted. Those friends showed us a South Asian Gay magazine and presented us a copy. On my inquiry they told me where I could get gay and lesbian literature in Toronto.


One evening when I was buying a book in the Gay Bookstore in Toronto, I was surprised that someone touched my shoulder and said, ‘How are you Dr. Sohail?’

When I looked around it was Charles. Spontaneously we hugged each other.

‘What a pleasant surprise’ I said. ‘What are you doing here?’

‘It is a long story. But if you want to hear we can go to Tim Horton’s and I can share over a cup of coffee’

So we went to a café and he told me that he was living in San Francisco. He had bought a house and was living with his partner for the last eight years. At that time I realized that I had not seen him for fourteen years. Since his lover was from Toronto, they had come to visit his family.

‘What do you do there?’ I was curious.

‘I am a therapist. I help gay couples who have emotional and relationship problems’.

‘So you are my colleague now.’

‘Yes, I am. And I always remembered you. I always hoped to meet you one day and thank you for all the help you offered and apologize for not saying goodbye before I disappeared mysteriously.’

When I told him that he had inspired me to learn more about gay and lesbian issues and I was translating gay poems in Urdu he was quite impressed.




The terms homosexuality and heterosexuality became popular in the twentieth century. The term homosexuality is used for those men and women who have sexual relationships with the members of the same gender (men with men and women with women). On the other hand the term heterosexual is used for those men and women who have sexual relationships with the opposite gender (men with women and women with men). Homosexual people are also known as gay. Homosexual women are also called lesbians. These terms also became popular in twentieth century. The term lesbian was introduced by the poet Sappo who described the sexual relationship between women on the island of Lesbos.

Those men and women who are now known as gays and lesbians were called

Sapphists, Tribades, Pederasts, Catamites, Sissies, Uraniads, Androgynes, Contrasexuals, Inverts, Perverts, Queers, Fairies, Faggots, Dykes, Lesbics, Pansies, Devients, Hemophlies and many other names in 17th, 18th and 19th centuries.

The term homosexual appeared in New York Times for the first time in 1926 and the term heterosexual in 1930. The terms gays and lesbians took even longer to be widely accepted. The New York Times did not allow their writers to use those expressions till 1963.

When we study North American culture from a historical point of view we become aware that for centuries homosexual and heterosexual lifestyles were equally acceptable untill Spanish and French people dominated North America in 16th and 17th centuries. Europeans brought their religion and philosophy and imposed them on tribal people. They judged the tribal lifestyle with Christian moral standards and declared homosexual activities and lifestyle as unnatural and immoral. Europeans introduced their religious concepts of good and bad, right and wrong, sin and guilt and judged tribal people for their variations of human existence. Europeans considered tribal men and women as primitive people and wanted to make them civilized with their own euro-centric values.

When we study history books we find:

Carbeza De Vaca in 1530 wrote about those Indian men who were married to each other.

Torque Mada in 1609 mentioned those men who dressed like women in Florida and lived with other men as their spouses.

Pareja in his book Confessional published in 1613 focused on women who had sexual relationships with other women.

European writers were quite judgementel while describing such homosexual encounters. They considered them sinful.

Christian church gave blessings to only those sexual relationships that took place inside the institution on marriage and only for reproductive reasons. According to such moral code alongside pre-marital and extra-marital sex, even oral and anal intercourse between spouses was also considered a sin. Church was against all those sexual acts where the main aim was pleasure not reproduction. Christian priests frequently quoted the following verses of Bible during their sermons.

‘Go out and multiply

‘For this cause God gave them up unto vile affections. For even their women did change the natural use into that which is against nature and likewise also the men, leaving the natural use of women, burned in their lust one toward another, men with men working that which is unseemly and receiving in themselves that recompense of their error which was meet’.

(New Testament …St Paul’s epistle to the Romans 1:26-27 King James Translation)

Homosexuality was considered such a major sin that Father John Rayner suggested death penalty in 1642.

In 1646 when William Plaine was given death sentence, Father John Winthrop mentioned in his verdict that Plaine as a married man was indulging in homosexual acts that did not enhance the holy cause of reproduction.

In 1674 Father Danforth in his famous sermon Cry of Sodom warned American citizens that if they did not repent from homosexual relationships they might be cursed.

In the sixteenth century when Church separated from the State, homosexuality was also declared an illegal act for the first time. The same homosexual act that was called Sodomy and considered a sin in the eyes of the Church was named Buggery and considered illegal in the eyes of the State. In England as well as America Buggery was considered a major crime.

When we review the legal records of many States we find:

In 1642 Elizabeth Johnson was ordered 100 lashes in a court of Massachusette because she had sexual relationship with her maid.

In 1734 the court of Georgia ordered 300 lashes to a man who was found having sexual relationship with another man.

In Pennsylvania in 1683 homosexual act was declared an unnatural act as it did not serve reproductive purposes.

For the next hundred years hundreds of men and women were penalized, persecuted, whipped, jailed and even executed because of their homosexual lifestyle.

As time passed more and more men and women protested against such laws and punishments. Finally in 1796 in New York State the death penalty for homosexual acts was abolished. In South Carolina the law was not changed till 1873. Gradually in North America social and legal institutions started to adopt liberal policies. In the last two cwnturies there has been a gradual acceptance of alternative lifestyles. The transformation is encouraging but still quite slow.

The first change was that homosexual men and women were considered mentally ill or emotionally disturbed rather than criminals and sinners. Dr. Kierman in his scholarly essays and Kraft-Ebbing in his famous book Psychopathia Sexualis declared homosexuality as a mental aberration and suggested a sympathetic rather than a punitive attitude. He suggested that homosexual men and women should receive emotional help and psychiatric treatment.

In 1869 in Germany Dr. Bankert who was a homosexual himself protested against Sodomy Laws. He believed that sexual relationship between two men and women was a private affair and the state need not get involved in people’s personal lives. Dr. Bankert had introduced the term Homosexual for the first time which was later accepted by the public in Europe and North America.

At the end of nineteenth century when Oscar Wilde was sent to jail because of his homosexual lifestyle and Havelock Ellis’s book Sexual Inversion was banned, there was a public outcry challenging the prevailing laws and moral codes.

In twentieth century a number of writers, psychologists and intellectuals published a number of books supporting the human rights of gays and lesbians. Some of the books that changed people’s attitudes towards human sexuality in general and homosexuality in particular are as follows:

Radcliff Hall’s novel The Well of Loneliness in 1928.

James’s Baldwin’s book Studies of a New Morality in 1949.

Kinsey’s book The Human Male in 1948 and The Human Female in 1953.

Masters and Johnson’s book Human Sexual Response in 1966.

Foucault’s book The History of Sexuality in 1978.

These and many more books paved the way for sexual liberation. Kinsey highlighted that 40-50 % of people at some stage in their life got involved in homosexual fantasies, behaviours or lifestyles.

In psychiatric circles there was a heated debate for decades whether homosexuality should be included in abnormal sexual behaviour or not. Finally when the issue was put to vote in American Psychiatric Association most psychiatrists voted that homosexuality should be removed from the psychiatric classification. (It is interesting that while voting was being done inside the building there were thousands of human rights activists in favour of gay and lesbain rights  who were protesting outside the building. The results were seen a major milestone in their struggle).

Although we have come a long way in North America but still we have to go a long way. Even in most Western countries legal definition of marriage and family is from a heterosexual point of view. Gay couples do not have the same legal, social and immigration rights as heterosexuals have. Human rights groups all over the world trying their best to get the gay and lesbian couple the same rights and privileges as heterosexual couples have. It seems like an uphill struggle. In most third world countries homosexuality is still considered unnatural, immoral and illegal and the laws and traditions are very punitive. Their laws are similar to the laws of eighteenth century in the West.




To study Homosexuality from a scientific point of view and develop insights into human sexology, we need help from the disciplines of human anatomy, physiology and psychology.

From childhood to adulthood human beings pass through different stages of sexual development. We can focus on each stage to have a better understanding of the process of human growth and maturity.


Human embryo comes into being by the union of human sperm and ovum. Each one of them has 23 pairs of chromosomes, out of which 22 pairs are autonomies and the last one is the pair of sex chromosomes. The pair inherited through mother’s ovum has XX chromosomes while the pair inherited from father’s sperm is XY chromosomes. So the fetus inherits X chromosome from the mother. If fetus inherits X from father’s sperm then we have a baby girl and if fetus inherits Y chromosome from the father then we have a baby boy. That is why to hold mothers responsible for the baby’s gender is neither morally nor scientifically right.

Instead of normal number of 46 (23 pairs) if the fetus has 45 or 47 chromosomes then we see certain abnormalities in the baby. Babies with 45 chromosomes (XO) suffer from Turner’’ syndrome and babies who have 47 chromosomes are called Suerfemale if they have XXX of Supermale if they have XYY. In spite of the name ‘Super’ such children are unfortunate to suffer from a number of physical and emotional abnormalities in their lives. Normal and healthy boys and girls have 46 chromosomes.


When we study human embryology and focus on the week to week development of human fetus we discover that all fetuses start being female fetuses. If the fetus has Y chromosome then after a few weeks of development male hormones kicjk in and the fetus is gradually transformed into a male fetus.

When the fetus has XX chromosomes then the baby develops ovaries, uterus and vagina and when the fetus has XY chromosomes then the baby develops testicles and penis.

Those children in which the sexual development and differentiation is arrested, they do not fully develop sexual organs of either sex. Since they can neither be called boys nor girls they are known as Intersex or Hermaphrodites. Many such children face a number of emotional and social problems as they grow older. In Pakistan they are called HIJRAS and are socially ostracized. It is very hard for them to lead a normal, healthy and respectable life as they are victims of prejudice and ridicule.



A number of serologists believe that by the time children reach the age of 3 or 4 they have developed an identity of being a boy or a girl and that identity does not necessarily depend upon the genetic and anatomic sex. How that identity is developed is still a mystery for scientists.

Most children who have XX chromosomes and have female sexual organs have the gender identity of a female and most children who have XY chromosomes and have male sexual organs have the gender identity of a male but there are exceptions. Those children who have chromosomes and organs of one sex but identity of the other are called Transsexuals.

Male transsexuals have XY chromosomes and have penis and testicles but they believe they are females trapped in wrong bodies. As children they want to dress in female clothes and as adults want to have sex change operation to get castrated and live like a female.

On the other hand female transsexuals have XX chromosomes and have ovaries and uterus but believe they are males trapped in the wrong body. They want to wear male clothes as a child and want to have an operation to have penis and live like a male.

Gender Identity problems remain a mystery for clinicians as well as research workers.


Superficially transvestites appear as transsexuals but they are very different. Transvestites have the same identity as their sex chromosomes and sexual organs, they just like to wear clothes of the opposite sex. They enjoy cross dressing. Men like to wear women’s clothes and the other way around. Transvestism is that as serious and profound problem as transsexuals.



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