# Autobiography of an Androgyne/Appendix 3

Appendix III
QUESTIONNAIRE ON HOMOSEXUALITY
[The governments of all cultured lands take from time to time censuses of the blind, the deaf, and other defective classes. None has ever taken a census of homosexualists, although the latter are fully as numerous as the two definite classes previously named, and their effect on the social body is even more marked. The Medico-Legal Journal, on the basis of the following questionnaire, makes the.first essay, in the history of culture, in lining up the defective class in question so that science may have a broader knowledge of them than that afforded by the comparatively few detached biographical and analytical notes at present extant. The reader is therefore requested to fill out the following questionnaire—or have the intelligent homosexualist do so—and mail it to the Medico-Legal Journal, New York. If unable to answer all queries, kindly give as much information as possible. Additional schedules will be furnished on request. Unpublished textual descriptions of cases would be welcome, and will be returned on request. The results of this questionnaire will be published, and the addresses of respondents will be filed for due notification.]
(1) Physical sex of homosexualist......
(2) Age at date....years (or....years at death)
(3) No. of brothers.... Sisters....
(4) Approximate age of father at subject’s birth.... Of mother....
(5) Underline applicable physical type: Brunette. Blonde. Red-haired.- Net definitely any of these.
(6) Principal occupation as adult....................
(7) Lineage (ie., from what foreign countries did forebears emigrate) ........
(8) Environment in which life principally passed (Indicate by x’s):
* Municipality 2,500 to 25,000
* Up to 10 years old
* 11 to 20 years old
* 21 to 50 years old
* After 50 years old
(9) Ever legally married..... Children, how many.....
10) Plays any musical instrument
(11) Underline interest in sport: Practically none. Slight. Extensive.
(12) Underline interest in music: Practically none. Slight. Extensive.
(13) Underline interest in other art (designate): Practically none. Slight. Extensive.
(14) Underline interest in religion: Practically none. Slight. Extensive.
(15) Underline applicable schooling: Less than 8 years. High school. Liberal-arts college. Postgraduate. Professional school.
(16) If liberal arts course, favorite subjects in order of preference............
(17) Number — if any — of foreign languages ever spoken with considerable ability..... Number studied for translation.....
(18) What—if-any.—mental diseases suffered
(19) A dipsomaniac..... Other drug addiction.....
(20) What rather serious (excluding the practically universal) bodily diseases suffered............. Particularly underline applicable: Venereal warts. Syphilis. Gonorrhea. Locality (initial) of last three..........
(21) IF dead causes of death
(22) What —if any — disease has run in the family of either parent............
(23) What other blood relatives have shown sexual abnormality:
| Definite relationship | Nature of abnormality |
(24) Are seual organs normal .... Describe any abnormalities
​(25) Underline applicable fundamental or original instinct: Fellatio (active buccal). Passive buccal. Masturbation of other. Mutual onanism. Paedicatio (anal),
indicating whether subject is active or passive, or both. Cunnilingus (corresponding to active fellatio in the male). Tribadism (corresponding to masturbation of other in the male).
(26) Approximate age when instinct first manifested itself in the feelings..... years. In actions..... years.
(27) Secondary or acquired methods of coitus............
(28) Is subject a psychical hermaphrodite (attracted toward both sexes)..........
(29) Does coitus stimulate any erogenous center (i.e., afford a pleasurable titillation of any portion of the body) or is the satisfaction entirely or almost entirely mental
(30) sStateof health day following coitus
(31) If a male, does coitus induce an emission..... If so, is sensation pleasurable or horrifying.............
(32) Is there love or adoration for the associate, or is the latter used merely to secure the stimulation of the subject's erogenous center
(33) Upper and lower age limits of individuals that attract, with indication of subject’s own age at the different periods
(34) Any quality or apparel (such as plumpness, military uniform) that constitutes a special attraction
(35) If a physical male, is he undersized..... If female, unusually large..... Muscles vigorous or feeble.........
(36) Is there a striking contrast between the real and apparent age.....
(37) Any peculiarity about the hair system, particularly the facial
(38) If a physical male, any tendency to wear the hair several inches long
(39) Describe any anatomical approach toward the psychical sex (e.g., milk glands in a male)...............
(40) Ever desired to wear apparel of psychical sex..... Ever worn such apparel since childhood. ........
(41) If a physical male, fondness for loud or fancy apparel..... If female, for plain apparel..............
(42) Ever arrested or imprisoned for following instincts of psychical sex..... If so, aggregate number of months or years mprisoned
(43) Please note, any other significant data as to particular homosexualist on separate sheets.
GENERAL QUERIES:
(44) Approximate number of homosexualists — positively known as such—have you encountered in your life-time: Passive inverts.... Active pederasts.... Male psychical hermaphrodites.... Physically female homosexualists....
(45) How many additional individuals have been under your suspicion: Passive inverts.... Active pederasts.... Male psychical hermaphrodites.... Physically female homosexualists....
(46) The author of "utobiography of an Androgyne” estimates, roughly, passive inverts as 1 out of 300 physical males. Please give your estimate: Passive inverts, 1 out of....males. Active pederasts, 1 out of....males. Male psychical hermaphrodites, 1 out of....males. Female psychical hermaphrodites, 1 out of....females. Other physically female homosexualists, 1 out of....females. (In query 46, only adults are to be considered.)
NAME AND ADDRESS OF PHYSICIAN SUBMITTING SCHEDULE. THIS INFORMATION WILL BE CONSIDERED CONFIDENTIAL, AND IS ESSENTIAL. Name Street and number Post-office State Date