UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

TALLAHASSEE DIVISION

JAMI CLAIRE, KATHRYN LANE

And AHMIR MURPHY,

Plaintiffs,

vs. Case No. 4:20-cv-00020-MW/MAF

FLORIDA DEPARTMENT OF

MANAGEMENT SERVICES et al.,

Defendants.

_______________________________/

DEFENDANTS’ RULE 26(a)(2) DISCLOSURES

Defendants, FLORIDA DEPARTMENT OF MANAGEMENT SERVICES 

(DMS), and JONATHAN SATTER in his official capacity as Secretary of the 

Florida Department of Management Services (SATTER), hereby disclose the 

following information pursuant to Rule 26(a)(2), Federal Rules of Civil Procedure 

regarding persons that may be used as expert witnesses at trial to present evidence 

under Rules 702, 703 or 705 of the Federal Rules of Civil Procedure. Defendants 

reserve the right to amend or supplement the disclosures upon discovery of 

additional information relevant to this matter, including the need to contradict or 

rebut evidence on the same subject when such opinion information is disclosed in a 

written report by Plaintiff pursuant to Rule 26(a)(2).

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1. Stephen B. Levine 

6415 Gates mills Blvd

Mayfield Heights, Ohio 44124

Dr. Levine’s report is attached hereto and includes the information 

required by Rule 26(a)(2).

2. Additional persons and witnesses that were not retained as expert 

witnesses and thus not required to prepare a report, but may be used to 

present evidence that may be considered to be testimony of an expert 

under the meaning of Federal Rules of Evidence 702, 703, or 705 (i.e. 

technical or specialized knowledge), have been previously identified in 

Defendant’s initial and supplemental Rule 26 disclosures this case, and 

include each of the following persons(s):

a. Dearline Thomas-Brown 

DMS Legal Consultant 

c/o J. Steven Carter and Miriam R. Coles

Henry Buchanan, P.A

The subject matter on which the witness is expected to 

present evidence under Federal Rule of Evidence 702, 703, or 

705; and a summary of the facts and opinions to which the 

witness is expected to testify:

The subject matter of Ms. Thomas-Brown’s testimony will be 

primarily factual but may include hybrid fact/opinion testimony 

regarding the following: The relationship between DMS and 

third party plan administrators; how coverage determinations are 

made under the State Health Plan, including the process for 

making decisions regarding level II appeals to DMS; state Health 

Plan exclusions; and treatment and services that have been 

covered historically and how such determinations were made, as 

well as categories of treatment or services that may or may not 

be covered under the State Health Plan and how such 

determinations are reached. For example, Ms. Dearline ThomasBrown will testify regarding the coverage and treatment provided 

for Gender Dysphoria as well as other psychological diagnoses 

under the State Health Plan. 

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Dated this 16th day of November 2020. 

HENRY BUCHANAN, P.A.

 s/ Miriam R. Coles 

J. STEVEN CARTER

 Florida Bar No. 896152

 scarter@henryblaw.com

 MIRIAM R. COLES

 Florida Bar No. 58402

 mcoles@henryblaw.com 

 Post Office Drawer 14079

 Tallahassee, Florida 32317-4079

 (850) 222-2920: Telephone

 (850) 224-0034: Facsimile

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the foregoing has been 

electronically filed via the CM/ECF, which automatically provides electronic 

documentation/notification of this filing to all attorneys of record on this 16th day 

of November 2020.

 s/ Miriam R. Coles 

MIRIAM R. COLES

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Expert Report of Stephen B. Levine

Claire et. a. v. DMS et. al

November 16, 2020

My Credentials:

Please refer to my curriculum vitae for a complete description of my 

qualifications, prior testimony and publications. I am Clinical Professor of 

Psychiatry at Case Western Reserve University School of Medicine, and maintain 

an active private clinical practice. I received my MD from Case Western Reserve 

University in 1967, and completed a psychiatric residency at the University 

Hospitals of Cleveland in 1973. I became an Assistant Professor of Psychiatry at 

Case Western in 1973, and became a Full Professor in 1985.

Since July 1973 my specialties have included psychological problems and 

conditions relating to sexuality and sexual relations, therapies for sexual problems, 

and the relationship between love and intimate relationships and wider mental 

health. In 2005, I received the Masters and Johnson Lifetime Achievement Award 

from the Society of Sex Therapy and Research. I am a Distinguished Life Fellow of 

the American Psychiatric Association. 

I have served as a book and manuscript reviewer for numerous professional 

publications. I have been the Senior Editor of the first (2003), second (2

2010) and third (2016) editions of the Handbook of Clinical Sexuality for Mental 

Health Professionals. In addition to five other solo-authored books, I have authored 

Psychotherapeutic Approaches to Sexual Problems, published in 2020; it has a 

chapter titled “The Gender Revolution.”

I first encountered a patient suffering what we would now call gender 

dysphoria in July 1973. In 1974, I founded the Case Western Reserve University 

Gender Identity Clinic, and have served as Co-Director of that clinic since that time. 

Across the years, our Clinic treated hundreds of patients who were experiencing a 

transgender identity. 

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I was an early member of the Harry Benjamin International Gender Dysphoria 

Association (later known as WPATH) and served as the Chairman of the Standards 

of Care Committee that developed the 5th version of its Standards of Care in 1999. 

In 1993 the Case Western Reserve University Gender Identity Clinic was 

renamed, moved to a new location, and became independent of CWRU. I continue 

to serve as Co-Director. 

In 2006, Judge Mark Wolf of the Eastern District of Massachusetts asked me 

to serve as an independent, court-appointed expert in a litigation involving the 

treatment of a transgender inmate within the Massachusetts prison system. I have 

been retained by the Massachusetts Department of Corrections as a consultant on the 

treatment of transgender inmates since 2007.

In this statement, I offer information and my own expert opinions concerning 

a number of aspects of the phenomenon of gender dysphoria and transgender 

identity, as well as the competing views among mental health professionals as to the 

appropriate therapeutic responses for patients who experience gender dysphoria.

Basis of Opinions:

In forming my opinions I reviewed the medical records of Jamie Claire, Ahmir 

Murphy and Kathryn Lane, as well as the literature cited within my report. My 

opinions are also based on my years of training and experience in the field. Any 

exhibits used to summarize or support my opinions would include the literature cited 

within my report.

Statement of Compensation:

I have been retained to review this case at a rate of $400 per hour. 

Statement of Opinions the witness will express and the based and reasons for 

them:

I. The biological baseline of sex

The sex of a human individual at its core structures the person’s biological 

reproductive capabilities—to produce ova and bear children as a mother, or to 

produce semen and beget children as a father. As physicians know, sex 

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determination occurs at the instant of conception, depending on whether a sperm’s 

X or Y chromosome fertilizes the egg. Medical technology can now be used to 

determine a fetus’s sex before birth almost as easily as after birth. It is not correct to 

assert that doctors “designate” or “assign” the sex of a child at birth. Instead, they 

simply recognize the existing fact of that child’s sex. Barring rare disorders of sexual 

development, anyone can identify the sex of an infant by genital inspection. 

Moreover, every nucleated cell of an individual’s body is chromosomally 

identifiably male or female—XY or XX.

The self-perceived gender of a child, in contrast, arises in part from how others 

label the infant and toddler, and acceptance of the designated gender occurs more 

than 99% of the time. Anomalous gender identity formation raises a few questions 

including the following: Is it biologically determined? Is it biologically shaped? Is 

it the product of how the child was privately regarded and treated? Does it stem from 

trauma-based rejection of maleness or femaleness, and if so, flowing from what 

trauma? Does it derive from a tense, chaotic interpersonal parental relationship 

without physical or sexual abuse? Is it a symptom of another, as of yet unrevealed, 

emotional disturbance or neuropsychiatric condition (autism)? The answers to these 

relevant questions are not scientifically known. 

Under the influence of hormones secreted by the testes or ovaries, numerous 

additional sex-specific differences between male and female bodies continuously 

develop postnatally, culminating in the dramatic maturation of the primary and 

secondary sex characteristics with puberty. These include differences in hormone 

levels, height, weight, bone mass, internal organ size, shape and development, 

musculature, body fat levels and distribution, and hair patterns, as well as 

physiological differences such as menstruation. These are genetically programmed 

biological consequences of sex, which also serve to influence the consolidation of 

conventional gender identity during and after puberty. 

Despite the increasing ability of hormones and various surgical procedures to 

reconfigure some male bodies to visually pass as female, or vice versa, the biology 

of the person remains as defined by his (XY) or her (XX) chromosomes, which leads 

to cellular, anatomic, and physiologic characteristics and to particular disease 

vulnerabilities associated with that chromosomally-defined sex. For instance, the 

XX (genetically female) individual who takes testosterone to stimulate male 

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secondary sex characteristics will nevertheless remain unable to produce sperm and 

father children. It is true that hormone therapy and social transition can significantly 

change a person’s physical appearance But in critical respects this change can only 

be “skin deep.” Contrary to assertions and hopes that medicine and society can fulfill 

the aspiration of the trans individual to become “a complete man” or “a complete 

woman,” this is not biologically attainable.1 Some adolescents and adults can pass 

unnoticed as the opposite gender—but with limitations, costs, and risks, as I detail 

later. 

The term “transgender” describes a person whose gender identity does not 

match their biological sex. Not all persons who identify as transgender have a 

diagnosis of gender dysphoria, discussed at length below. Not all individuals with 

gender dysphoria want or need surgical intervention. Some individuals with gender 

dysphoria may only change their name or gender designation. Others may rely on 

hormone therapy. Others may seek surgical interventions to change their sex 

characteristics. Those who have undergone surgical interventions on their genitals 

or natal females who have had their breasts surgically removed are sometimes also 

referred to transsexual persons.

II. Definition and diagnosis of gender dysphoria 

Specialists have used a variety of terms over time, with somewhat shifting 

definitions, to identify and speak about a distressing incongruence between an 

individual’s sex as determined by their chromosomes and their thousands of genes, 

and the gender with which they identify. Today’s American Psychiatric Association 

Diagnostic and Statistical Manual of Mental Disorders (“DSM-5”) employs the term 

Gender Dysphoria.

There are at least five distinct pathways to gender dysphoria: early childhood 

onset; onset near or after puberty with no prior cross gender patterns; onset after 

defining oneself as gay for several or more years and participating in a homosexual 

1 S. Levine (2018), Informed Consent for Transgendered Patients, J. OF SEX & MARITAL 

THERAPY, at 6, DOI: 10.1080/0092623X.2018.1518885 (“Informed Consent”); S. Levine 

(2016), Reflections on the Legal Battles Over Prisoners with Gender Dysphoria, J. AM. ACAD. 

PSYCHIATRY LAW 44, 236 at 238 (“Reflections”)

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life style; adult onset after years of heterosexual transvestism; and onset in later 

adulthood with few or no prior indications of cross-gender tendencies or identity.

Gender dysphoria has very different characteristics depending on age and sex 

at onset. Young children who are living a transgender identity commonly suffer 

materially fewer symptoms of concurrent mental distress than do older patients.2

The developmental and mental health patterns for each of these groups are 

sufficiently different that data developed in connection with one of these populations 

cannot be assumed to be applicable to another. 

The criteria used in DSM-5 to identify Gender Dysphoria include a number 

of signs of discomfort with one’s natal sex and vary somewhat depending on the age 

of the patient, but in all cases require “clinically significant distress or impairment 

in . . . important areas of functioning” such as social, school, or occupational settings. 

When these criteria are not met, two other diagnoses may be given. These are: Other 

Specified Gender Dysphoria and Unspecified Gender Dysphoria. 

Children and adolescents, for example, who conclude that they are 

transgender are often unaware of a vast array of adaptive possibilities for how to live 

life as a man or a woman—possibilities that become increasingly apparent over time 

to both males and females. A boy or a girl who claims or expresses interest in 

pursuing a transgender identity often does so based on stereotypical notions of 

femaleness and maleness that reflect constrictive notions of what men and women 

can be.3 A young child’s—or even an adolescent’s—understanding of this topic is 

quite limited. Certain groups of children display a greater prevalence of gender 

dysphoria: those of color, those with mental developmental disabilities, particularly 

autism. (at a rate more than 7x the general population), those residing in foster care 

homes, adopted children (at a rate more than 3x the general population), those with 

a prior history of psychiatric illness, and during the previous decade young 

2 K. Zucker (2018), The Myth of Persistence: Response to “A Critical Commentary on Follow-Up 

Studies & ‘Desistance’ Theories about Transgender & Gender Non-Conforming Children” by 

Temple Newhook et al., INT’L J. OF TRANSGENDERISM at 10, DOI: 

10.1080/15532739.2018.1468293 (“Myth of Persistence”).

3 S. Levine (2017), Ethical Concerns About Emerging Treatment Paradigms for Gender Dysphoria, 

J. OF SEX & MARITAL THERAPY at 7, DOI: 10.1080/0092623X.2017.1309482 (“Ethical 

Concerns”).

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adolescent girls (in a large recent study, at a rate more than 2x that of boys).4 The 

social transitioning, hormonal, and surgical paths that are often facilitated by gender 

clinics may lead to life-long sterility, which may only lead to despair ten or more 

years later. 

Competing conceptual models of gender dysphoria and transgender 

identity

Discussions about appropriate responses by mental health professionals 

("MHPs") to actual or sub-threshold gender dysphoria are complicated by the fact 

that various speakers and advocates (or a single speaker at different times) view 

transgenderism through at least three very different paradigms, often without being 

aware of, or at least without acknowledging, the distinctions. 

Gender dysphoria is conceptualized and described by some professionals and 

laypersons as though it were a serious, physical medical illness that causes suffering, 

comparable, for example, to prostate cancer, a disease that is curable before it 

spreads. Within this paradigm, whatever is causing distress associated with gender 

dysphoria—whether secondary sex characteristics such as facial hair, nose and jaw 

4 4 G. Rider et al. (2018), Health and Care Utilization of Transgender/Gender NonConforming 

Youth: A Population Based Study, PEDIATRICS at 4, DOI: 10.1542/peds.2017-1683. (In a large 

sample, non-white youth made up 41% of the set who claimed a transgender or gendernonconforming identity, but only 29% of the set who had a gender identity consistent with their 

sex.) 5 D. Shumer & A. Tishelman (2015), The Role of Assent in the Treatment of Transgender 

Adolescents, INT. J. TRANSGENDERISM at 1, DOI: 10.1080/15532739.2015.1075929. 6 D. 

Shumer et al. (2016), Evaluation of Asperger Syndrome in Youth Presenting to a Gender 

Dysphoria Clinic, LGBT HEALTH, 3(5) 387 at 387. 7 D. Shumer et al. (2017), Overrepresentation 

of Adopted Adolescents at a HospitalBased Gender Dysphoria Clinic, TRANSGENDER 

HEALTH Vol. 2(1) 76 at 77. 8 L. Edwards-Leeper et al. (2017), Psychological Profile of the First 

Sample of Transgender Youth Presenting for Medical Intervention in a U.S. Pediatric Gender 

Center, PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY, 4(3) 374 

at 375 (“Psychological Profile”); R. Kaltiala-Heino et al. (2015), Two Years of Gender Identity 

Service for Minors: Overrepresentation of Natal Girls with Severe Problems in Adolescent 

Development, CHILD & ADOLESCENT PSYCHIATRY & MENTAL HEALTH 9(9) 1 at 5. (In 

2015 Finland gender identity service statistics, 75% of adolescents assessed “had been or were 

currently undergoing child and adolescent psychiatric treatment for reasons other than gender 

dysphoria.”); L. Littman (2018), Parent Reports of Adolescents & Young Adults Perceived to 

Show Signs of a Rapid Onset of Gender Dysphoria, PLoS ONE 13(8): e0202330 at 13 (Parental 

survey concerning adolescents exhibiting Rapid Onset Gender Dysphoria reported that 62.5% of 

gender dysphoric adolescents had “a psychiatric disorder or neurodevelopmental disability 

preceding the onset of gender dysphoria.”

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shape, presence or absence of breasts, or the primary anatomical sex organs of testes, 

ovaries, penis, or vagina—should be removed to alleviate the illness. The promise 

of these interventions is the cure of the gender dysphoria.

It should be noted, however, that gender dysphoria is a psychiatric, not a 

medical, diagnosis. Since its inception of transsexualism in the DSM-III in 1983, it 

has always been specified in the psychiatric DSM manuals and is not specified in 

medical diagnostic manuals. Notably, gender dysphoria is the only psychiatric 

condition to be treated by surgery, even though no endocrine or surgical 

intervention package corrects any identified biological abnormality. (Levine, 

Reflections, at 240.) Prior to 1992 ses reassignment surgery was considered 

experimental. 

Gender dysphoria is alternatively conceptualized in developmental terms, as 

an adaptation to a psychological problem that was first manifested as a failure to 

establish a comfortable conventional sense of self in early childhood. This paradigm 

starts from the premise that all human lives are influenced by past processes and 

events. Trans lives are not exceptions to this axiom. (Levine, Reflections, at 238.) 

Mental Health Professionals who think of gender dysphoria through this paradigm 

may work both to identify and address causes of the basic problem of the deeply 

uncomfortable self, and also to ameliorate suffering when the underlying problem 

cannot be solved. They work with the patient and (ideally) family to inquire what 

forces may have led to the trans person repudiating the gender associated with his 

sex. The developmental paradigm is mindful of temperamental, parental bonding, 

psychological, sexual, and physical trauma influences, and the fact that young 

children work out their psychological issues through fantasy and play. 

In addition, the developmental paradigm recognizes that, with the important 

exception of genetic sex, essentially all aspects of an individual’s identity (and there 

are many) evolve—often markedly—across the individual’s lifetime. This includes 

gender. 

Some advocates assert that a transgender identity is biologically caused, fixed 

from early life, and eternally present in an unchanging manner. This assertion, 

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however, is not supported by science.5 Although numerous studies have been 

undertaken to attempt to demonstrate a distinctive physical brain structure associated 

with transgender identity, as of yet there is no evidence that these patients have any 

defining abnormality in brain structure that precedes the onset of gender dysphoria. 

The belief that gender dysphoria is the consequence of brain structure is challenged 

by the sudden increase in incidence of child and adolescent gender dysphoria and 

teen girls over the last twenty years in North America and Europe. Meanwhile, 

multiple studies have documented rapid shifts in gender ratios of patients presenting 

for care with gender-related issues, pointing to cultural influences,6 while a recent 

study documented “clustering” of new presentations in specific schools and among 

specific friend groups, pointing to social influences (Littman). Both of these findings 

strongly suggest cultural factors. From the beginning of epidemiological research 

into this arena, there have always been some countries, Poland and Australia, for 

example, where the sex ratios were reversed as compared to North America and 

Europe, again demonstrating a powerful effect of cultural influences. 

Further, as I detail later below, many studies and clinical observations confirm 

that gender identity can and does change or evolve over time for many individuals. 

And recent studies and anecdotal reports provide strong, if preliminary, evidence 

that therapeutic choices can have a powerful effect on whether and how gender 

identity does change, or gender dysphoria desists. 

The third paradigm through which gender dysphoria is alternatively 

conceptualized is from a sexual minority rights perspective. Under this paradigm, 

any response other than medical and societal affirmation and implementation of a 

patient’s claim to “be” the opposite gender is a violation of the individual’s civil 

right to self-expression. Any effort to ask “why” questions about the patient’s 

condition, or to address underlying causes, is viewed as a violation of the patient’s 

autonomy and civil rights. In the last few years, this paradigm has been successful 

in influencing public policy and the education of pediatricians, endocrinologists, and 

5 Even the advocacy organization The Human Rights Campaign asserts that a person can have “a 

fluid or unfixed gender identity.” https://www.hrc.org/resources/glossary-of-terms.

6 Levine, Ethical Concerns, at 8 (citing M. Aitken, T. D. Steensma, et al. (2015), Evidence for an 

Altered Sex Ratio in Clinic-Referred Adolescents with Gender Dysphoria, J. OF SEXUAL 

MEDICINE 12(3) 756 at 756-63)

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many mental health professionals. Obviously this is not a medical or psychiatric 

perspective. 

III. Competing models of therapy of children and adolescents

Because of the complexity of the human psyche and the difficulty of running 

controlled experiments in this area, substantial disagreements among professionals 

about the causes of psychological disorders, and about the appropriate therapeutic 

responses, are not unusual. When we add to this the very different paradigms for 

understanding transgender phenomena discussed above, it is not surprising that such 

disagreements also exist with regard to appropriate therapies for patients 

experiencing gender-related distress. I summarize below the leading approaches, and 

offer certain observations and opinions concerning them. 

(1) The “watchful waiting” therapy model

When a pre-adolescent child presents with gender dysphoria, a “watchful 

waiting” approach seeks to allow for the fluid nature of gender identity in children 

to naturally evolve— that is, take its course from forces within and surrounding the 

child. Watchful waiting has two versions: a. Treating any other psychological comorbidities—that is, other mental illnesses or problems as defined by DSM-5—that 

the child may exhibit (separation anxiety, bedwetting, eating disorder, self-harming 

behaviors, attention deficit disorder, obsessive-compulsive disorder) without a focus 

on gender (model #1); and b. No treatment at all for anything but a regular followup appointment. This is labeled a “hands off” approach. Many mental health 

professionals, me included, feel that watchful waiting with our without treatment of 

underlying or accompanying difficulties is best for children and adolescents. This is 

because pursuing gender reassignment can be a dangerous, to the person’s future. 

The early support for transition is not unproven, it is an unjustified life-changing 

intervention for a child or adolescent. Hormonal intervention of individuals at early 

puberty interferes with natural processes of psychosocial, brain and physical 

development. 

(2) The psychotherapy model: Alleviate distress by identifying and 

addressing causes 

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One of the foundational principles of psychotherapy has long been to work 

with a patient to identify the causes of observed psychological distress and then to 

address those causes as a means of alleviating the distress. The National Institute of 

Mental Health has promulgated the idea that 75% of adult psychopathology has its 

origins in childhood experience. Many experienced practitioners in the field of 

gender dysphoria, including myself, have believed that it makes sense to employ 

these long-standing tools of psychotherapy for all patients of whatever age who are 

experiencing gender dysphoria. The therapy process, which differs markedly 

between children, teenagers, and adults seeks to identify the factors in the patient’s 

life that contribute to the patient’s repudiation of his or her natal sex. (Levine, Ethical 

Concerns, at 8.) In adolescents and adults, the therapy process is an unhurried 

process of reviewing the well-known risks of trans lives. Relieving accompanying 

psychological co-morbidities leaves the patient freer to consider the pros and cons 

of transition as he or she matures. I and others have reported success in alleviating 

distress in this way for at least some patients, whether or not the patient’s discomfort 

with his or her natal sex entirely dissipated. 

Among other things, the psychotherapist who is applying traditional methods 

of psychotherapy may help—for example—the male patient appreciate the wide 

range of masculine emotional and behavioral patterns available to him as he grows 

older. The therapist may discuss with the patient that one does not have to become a 

“woman” in order to be kind, compassionate, caring, noncompetitive, and devoted 

to others’ feelings and needs.7 Many biologically male trans individuals, from 

childhood to older ages, speak of their perceptions of femaleness as enabling them 

to discuss their feelings openly, whereas they perceive boys and men to be 

constrained from emotional expression within the family and larger culture. Men, of 

course, can be emotionally expressive, just as they can wear pink. Converse 

examples can be given for girls and women. These ideas regularly arise during 

psychotherapies.

As I note above, many gender-nonconforming children and adolescents in 

recent years derive from minority and vulnerable groups who have reasons to feel 

isolated and have an uncomfortable sense of self. A trans identity may be a hopeful 

7 11 S. Levine (2017), Transitioning Back to Maleness, ARCH. OF SEXUAL BEHAVIOR at 7, 

DOI: 10.1007/s10508-017-1136-9) (“Transitioning”).

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attempt to redefine the self in a manner that increases their comfort and decreases 

their anxiety. The incongruence between the trans person’s anatomy and gender 

identity may be a product of a more basic incongruence between the idealized notion 

of one’s personhood and the disappointing experience of oneself. The clinician who 

uses traditional methods of psychotherapy may not focus on their gender identity, 

but instead work to help them to address the actual non-anatomic sources of their 

discomfort. Success in this effort may remove or reduce the desire for a redefined 

identity. Discomfort and disappointment in oneself may have their origins in 

disruptions in their attachment to parents for vulnerable children. Children in the 

foster care system may be an good example.

Because “watchful waiting” can include treatment of accompanying 

psychological co-morbidities, and the psychotherapist who hopes to relieve gender 

dysphoria may focus on potentially causal sources of psychological distress rather 

than on the gender dysphoria itself, there is no sharp line between “watchful waiting” 

and the psychotherapy model in the case of prepubescent children. 

To my knowledge, there is no evidence beyond anecdotal reports that 

psychotherapy can enable a return to male identification for genetically male boys, 

adolescents, and men, or return to female identification for genetically female girls, 

adolescents, and women. On the other hand, anecdotal evidence of such outcomes 

does exist; I and other clinicians have witnessed reinvestment in the patient’s 

biological sex in some individual patients who are undergoing psychotherapy. The 

Internet contains many such reports, and I have published a paper on a patient who 

sought my therapeutic assistance to reclaim his male gender identity after 30 years 

living as a woman and is in fact living as a man today. (Levine, Transitioning, at 1.) 

I have seen children desist even before puberty in response to thoughtful parental 

interactions and a few meetings of the child with a therapist. 

(3) The affirmation therapy model 

While it is widely agreed that the therapist should not directly challenge a 

claimed transgender identity in a child, some advocates and practitioners go much 

further by promoting and recommending that any expression of transgender identity 

should be immediately accepted as decisive, and should be thoroughly affirmed by 

means of consistent use of clothing, toys, pronouns, etc., associated with aspired to

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identity. As I understand it, this is justification for males who assert a female gender 

identity must be permitted to compete in girls’ or women’s athletic events. These 

advocates treat any question about the causes of the child’s transgender 

identification as inappropriate and irrelevant. They assume that observed 

psychological co-morbidities in the children or their families are unrelated or will 

get better with transition. Therefore, they need not be addressed by the MHP who 

is supporting the individual’s social transition..

Some advocates, indeed, assert that unquestioning affirmation of any claim of 

transgender identity, even in children is ideal. However, it should be noted that 

“almost all clinics and professional associations in the world” do not use “gender 

affirmation” for prepubescent children and instead “delay any transitions after the 

onset of puberty.”8 9 Numerous health care professionals challenged the notion that 

gender transition is safe or effective for children or adolescence10, pointing out that 

the medical literature does not support this assertion.11 Further, a disturbingly large 

proportion of children and adolescents who seek professional care in connection 

8 J. Cantor (2019), Transgender and Gender Diverse Children and Adolescents: Fact Checking of 

AAP Policy, J. OF SEX & MARITAL THERAPY at 1, DOI: 10.1080.0092623X.2019.1698481

9 It is notable that even the Standards of Care published by WPATH, an organization which in 

general leans strongly towards affirmation in the case of adults, do not specify affirmation of 

transgender identity as the indicated therapeutic response for young children. Instead, the WPATH 

Standards of Care recognize that social transition in early childhood “is a controversial issue, and 

divergent views are held by health professionals”; state that “[t]he current evidence base is 

insufficient to predict the long-term outcomes of completing a gender role transition during early 

childhood”; and acknowledge that “previously described relatively low persistence rates of 

childhood gender dysphoria” are “relevant” to the wisdom of social transition in childhood. 

(WPATH SOC p. 17.)

10 Bannerman, (2019) https://www.thetimes.co.uk/article/calls-to-endtransgender-experiment-on-children-k792rfj7d

11 Jarrett, (2018) https://digest.bps.org.uk/2018/07/23/systematic-reviewpuberty-suppressing-drugs-do-not-alleviate-gender-dysphoria/

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with gender issues have a wider history of psychiatric co-morbidities. (See supra n. 

9.)12

IV. Understanding the WPATH and its “Standards of Care” 

Plaintiffs assert that the WPATH Standards of Care are “widely accepted. 

Accordingly, I provide some context concerning that private organization and its 

Standards of Care.

I was a member of the Harry Benjamin International Gender Dysphoria 

Association from 1974 until 2001. From 1997 through 1998, I served as the 

Chairman of the eight-person International Standards of Care Committee that issued 

the fifth version of the Standards of Care. I resigned my membership in 2002 due to 

my regretful conclusion that the organization and its recommendations had become 

dominated by politics and ideology, rather than by scientific process, as it was years 

earlier. In approximately 2007, the Henry Benjamin International Gender Dysphoria 

Association changed its name to the World Professional Association for Transgender 

Health.

WPATH is a voluntary membership organization. Since at least 2002, 

attendance at its biennial meetings has been open to trans individuals who are not 

licensed professionals. While this ensures taking patients’ needs into consideration, 

it limits the ability for honest and scientific debate, and means that WPATH can no 

longer be considered a purely professional organization.

WPATH takes a decided view on issues as to which there is a wide range of 

opinion among professionals. WPATH explicitly views itself as not merely a 

scientific organization, but also as an advocacy organization. (Levine, Reflections, 

at 240.) WPATH is supportive to those who want sex reassignment surgery (“SRS”). 

Skepticism as to the benefits of SRS to patients, and strong alternate views, are not 

well tolerated in discussions within the organization or their educational outreach 

12 A 2017 study from the Boston Children’s Hospital Gender Management Service program 

reported that: “Consistent with the data reported from other sites, this investigation documented 

that 43.3% of patients presenting for services had significant psychiatric history, with 37.1% 

having been prescribed psychotropic medications, 20.6% with a history of self-injurious behavior, 

9.3% with a prior psychiatric hospitalization, and 9.3% with a history of suicide attempts.” (L. 

Edwards-Leeper, Psychological Profile, at 375.)

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programs, and particularly among the members who are not mental health 

professions.

The WPATH Standards of Care ("SOC") is the product of an enormous effort 

to be balanced, but it is not a politically neutral document. WPATH aspires to be 

both a scientific organization and an advocacy group for the transgendered. These 

aspirations sometimes conflict. The limitations of the Standards of Care, however, 

are not primarily political. They are caused by the lack of rigorous research in the 

field, which allows room for passionate convictions on how to care for the

transgendered. 

In recent years, WPATH has fully adopted some mix of the medical and civil 

rights paradigms. It has downgraded the role of counseling or psychotherapy as a 

requirement for these life-changing processes. WPATH no longer considers 

preoperative psychotherapy to be a requirement. It is important to WPATH that the 

person has gender dysphoria; the pathway to the development of this state is not. 

(Levine, Reflections, at 240.) The trans person is assumed to have thoughtfully 

considered his or her options before seeking hormones, for instance.

Most psychiatrists and psychologists who treat patients suffering sufficiently 

severe distress from gender dysphoria to seek inpatient psychiatric care are not 

members of WPATH. Many psychiatrists, psychologists, and pediatricians who treat 

some patients suffering gender dysphoria on an outpatient basis are not members of 

WPATH. WPATH represents a self-selected subset of the profession along with its 

many non-professional members; it does not capture the clinical experiences of 

others. WPATH claims to speak for the medical profession; however, it does not 

welcome skepticism and therefore, deviates from the philosophical core of medical 

science. For example, in 2010 the WPATH Board of Directors issued a statement 

advocating that incongruence between sex and felt gender identity should cease to 

be identified in the DSM as a pathology. This position was debated but not adopted 

by the (much larger) American Psychiatric Association, which maintained the 

definitions and diagnoses of gender dysphoria as a pathology in the DSM-5 manual 

issued in 2013.

In my experience most current members of WPATH have little ongoing 

experience with the mentally ill, and many trans care facilities are staffed by MHPs 

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who are not deeply experienced with recognizing and treating frequently associated 

psychiatric comorbidities. Because the 7th version of the WPATH SOC deleted the 

requirement for therapy, trans care facilities that consider these Standards sufficient 

are permitting patients to be counseled to transition by means of social presentation, 

hormones, and surgery by individuals with masters rather than medical degrees. As 

a result of the downgrading of the role of the psychiatric assessment of patients, new 

“gender affirming” clinics have quickly arisen in many urban settings.

While the WPATH standard are assumed to be scientifically established, they 

are in fact, compassionate political ideas thought to ameliorate the obviously 

troubled lives of this population rather than focusing on clinical research and 

evidence-based outcomes. The eighth version of the Standards of Care was 

originally scheduled to appear in 2019 but now is targeted for 2021. A number for 

factors may have slowed the process including: recognition that even fully treated 

individuals have significant prevalence of social and psychiatric limitations, 

increasing numbers of trans youth define themselves as non-binary and changing, 

and there is uncertainty and increasing social controversy about what to do with trans 

kids and feminine girls who respond to their early puberty by declaring themselves 

to be trans males. 

Research in Gender dysphoria has low scientific quality.

Prominent voices in the field have emphasized the severe lack of scientific 

knowledge in this field. The American Academy of Child and Adolescent Psychiatry 

has recognized that “Different clinical approaches have been advocated for 

childhood gender discordance. . . . There have been no randomized controlled trials 

of any treatment. . . . [T]he proposed benefits of treatment to eliminate gender 

discordance ... must be carefully weighed against ... possible deleterious effects.” 

(Adelson et al., Practice Parameter, at 968–69.) 

Similarly, the American Psychological Association has stated, “because no 

approach to working with [transgender and gender nonconforming] children has 

been adequately, empirically validated, consensus does not exist regarding best 

practice with pre-pubertal children.” 

Critically, “there are no randomized control trials with regard to treatment of 

children with gender dysphoria.” (Zucker, Myth of Persistence, at 8.) On numerous 

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critical questions relating to cause, developmental path if untreated, and the effect 

of alternative treatments, the knowledge-base remains primarily at the level of the 

practitioner’s exposure to individual cases, or multiple individual cases. As a result, 

claims to certainty are not justifiable. (Levine, Reflections, at 239.)

A review of 28 studies of outcomes from hormonal therapy in connection with 

sex reassignment reported that these studies provided only “very low quality 

evidence” for a variety of reasons.13 Large gaps exist in the medical community’s 

knowledge regarding the long-term effects of Sexual Reassignment Surgery (also 

now known as Gender Confirming Surgery) and other gender identity disorder

treatments in relation to their positive or negative correlation to suicidal ideation, 

attempts, and completion. What is known, however, is not encouraging.

With respect to suicide, individuals with gender dysphoria are well known to 

commit suicide or otherwise suffer increased mortality before and after not only 

social transition, but also before and after SRS. (Levine, Reflections, at 242.) 

Suicide, however, does not explain most of the premature mortality of this group 

which has more infectious, cardiovascular, and cancer deaths as well. The death rates 

of trans US veterans are comparable to those with schizophrenia and bipolar 

diagnoses—20 years earlier than expected. Similarly, researchers in Sweden and 

Denmark have reported on almost all individuals who underwent sex-reassignment 

surgery over a 30-year period.14 The Swedish follow-up study found a suicide rate 

in the post-SRS population 19.1 times greater than that of the controls; both studies 

demonstrated elevated mortality rates from medical and psychiatric conditions. 

(Levine, Ethical Concerns, at 10.) A more recent study from Sweden demonstrated 

a 3.5 fold increase in suicide compared the general population.

13 H. Murad et al., Hormonal therapy and sex reassignment: a systematic review and meta-analysis 

of quality of life and psychosocial outcomes. CLINICAL ENDOCRINOLOGY 2010; 72(2): 214-

231. See also R. D’Angelo, Psychiatry’s ethical involvement in gender-affirming care, 

AUSTRALASIAN PSYCHIATRY 2018, Vol 26(5) 460-463, noting the large number of 

nonresponders in follow-up outcome studies, and observing that “it is generally not known whether 

they are alive or dead,” and that “it is . . . pure speculation to assume that none committed suicide.”

14 C. Dhejne et al. (2011), Long-Term Follow-Up of Transsexual Persons Undergoing Sex 

Reassignment Surgery: Cohort Study in Sweden, PLOS ONE 6(2) e16885 (“Long Term”); R. K. 

Simonsen et al. (2016), Long-Term Follow-Up of Individuals Undergoing Sex Reassignment 

Surgery: Psychiatric Morbidity & Mortality, NORDIC J. OF PSYCHIATRY 70(4).

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No studies show that affirmation of children (or anyone else) reduces suicide, 

prevents suicidal ideation, or improves long-term outcomes, as compared to either a 

“watchful waiting” or a psychotherapeutic model of response, as I have described 

above.15

A number of data sets have also indicated significant concerns about wider 

indicators of physical and mental health, including ongoing functional limitations; 

substance abuse, depression, and psychiatric hospitalizations; and increased 

cardiovascular disease, cancer, asthma, and COPD.16 Worldwide estimates of HIV 

infection among transgendered individuals are up to 17-fold higher than the 

cisgender population. (Levine, Informed Consent, at 6.)

Instead, transition of any sort must be justified, if at all, as a life-enhancing 

measure, not a lifesaving measure. (Levine, Reflections, at 242.) In my opinion, this 

is an important fact that patients, parents, and even many MHPs fail to understand.

V. Physical risks associated with transition 

(1) Sterilization

There is not good scientific evidence that genital conformation surgery (better 

known historically as sex reassignment surgery [SRS]) results in better long-term 

mental health outcomes. What is certain, however, is that SRS that removes testes, 

ovaries, or the uterus is inevitably sterilizing. While by no means all transgender 

adults elect SRS, many patients do ultimately feel compelled to take this serious step 

in their effort to live fully as the opposite phenotypic sex. More immediately, 

practitioners recognize that the administration of cross-sex hormones, which is often 

15 A recent article, J. Turban et al. (2020), Puberty Suppression for Transgender Youth and Risk 

of Suicidal Ideation, PEDIATRICS 145(2), DOI: 10.1542/peds.2019-1725, has been described in 

press reports as demonstrating that administration of puberty suppressing hormones to transgender 

adolescents reduces suicide or suicidal ideation. The paper itself does not make that claim, nor 

permit that conclusion.

16 G. Zeluf, C. Dhejne et al. (2016), Health, Disability and Quality of Life Among Trans People in 

Sweden—A Web-Based Survey, BMC PUBLIC HEALTH 16(903), DOI: 10.1186/s12889- 016-

3560-5; C. Dhejne, R. Van Vlerken et al. (2016), Mental Health & Gender Dysphoria: A Review 

of the Literature, INT’L REV. OF PSYCHIATRY 28(1) 44; C. Dragon, P. Guerino, et al. (2017), 

Transgender Medicare Beneficiaries & Chronic Conditions: Exploring Fee-for-Service Claims 

Data, LGBT HEALTH 4(6) 404, DOI: 10.1089/lgbt.2016.0208.

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viewed as a less “radical” measure, and is now increasingly done to minors, creates 

at least a risk of irreversible sterility.17

(2)Loss of sexual response

In the case of males, the cross-sex administration of estrogen limits penile 

genital function. Much has been written about the negative psychological and 

relational consequences of anorgasmia among non-transgender individuals that is 

ultimately applicable to the transgendered. (Levine, Informed Consent, at 6.)

Puberty blockers prevent maturation of the sexual organs and response. Some, 

and perhaps many, transgender individuals who transitioned as children and thus did 

not go through puberty consistent with their sex face significantly diminished sexual 

response as they enter adulthood and are unable ever to experience orgasm. This and 

other sexual consequences of social, endocrine, and surgical transition have recently 

been extensively documented.18

(3) Other effects of hormone administration. 

It is well known that many effects of cross-sex hormones cannot be reversed 

should the patient later regret his transition. After puberty, the individual who wishes 

to live as the opposite sex will in most cases have to take cross-sex hormones for 

most of life.

The long-term health risks of this major alteration of hormonal levels have not 

yet been quantified in terms of exact risk.19 However, a recent study found greatly 

elevated levels of strokes and other acute cardiovascular events among male-to17 See C. Guss et al., TGN Adolescent Care at 4 (“a side effect [of cross-sex hormones] may be 

infertility”) and 5 (“cross-sex hormones . . . may have irreversible effects”); Tishelman et al., 

Serving TG Youth at 8 (Cross-sex hormones are “irreversible interventions” with “significant

ramifications for fertility”).

18 Holmberg M, Arver S, Dhejne C. (2020) Improving Sexual Function and Pleasure in Transgender Persons. In KSK 

Hall and IM Binik (editors) Principles and Practices of Sex Therapy( 6th edition). The Guilford Press. Pp432-451.

19 See Tishelman et al., Serving TG Youth at 6-7 (Long-term effect of cross-sex hormones “is an 

area where we currently have little research to guide us.”)

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female transgender individuals taking estrogen.20 Another group of authors similarly 

noted that administration of cross-sex hormones creates “an additional risk of 

thromboembolic events”—blood clots (Guss et al., TGN Adolescent Care at 5), 

which are associated with strokes, heart attacks, and lung and liver failure. 

While advocates commonly state that the effects of puberty blockers are 

reversible after cessation, a more prudent assessment is that medicine does not know 

what the long-term health effects on bone, brain, and other organs are of a “pause” 

between ages 11-16, and psychology likewise does not know the long-term effects 

on coping skills, interpersonal comfort, and intimate relationships of this “pause” 

while one’s peers are undergoing their maturational gains in these vital arenas of 

future mental health. 

(4) Health risks inherent in complex surgery. 

Complications of surgery exist for each procedure,21 and complications in 

surgery affecting the reproductive organs and urinary tract can have significant 

anatomical and functional complications for the patient’s quality of life. Genital 

surgeries reoperation rates are particularly high and invarious studies average 30%.

(5) Social risks associated with transition 

Family and friendship relationships. Gender transition routinely leads to 

isolation from at least a significant portion of one’s family in adulthood. By 

adulthood, the friendships of transgender individuals tend to be confined to other 

transgender individuals (often “virtual” friends known only online) and the generally 

limited set of others who are comfortable interacting with transgender individuals. 

(Levine, Ethical Concerns, at 5.) This is one of the factors that the group is referred 

to as a marginalized population by health services professionals.

20 5 D. Getahun et al. (2018), Cross-Sex Hormones and Acute Cardiovascular Events in 

Transgender Persons: A Cohort Study, ANNALS OF INTERNAL MEDICINE at 8, 

DOI:10.7326/M17- 2785.

21 Levine, Informed Consent, at 5 (citing T. van de Grift, G. Pigot et al. (2017), A Longitudinal 

Study of Motivations Before & Psychosexual Outcomes After Genital Gender Confirming Surgery 

in Transmen, J. SEXUAL MEDICINE 14(12) 1621.).

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Long-term psychological and social impact of sterility. The life-long negative 

emotional impact of infertility on both men and women has been well studied. While 

this impact has not been studied specifically within the transgender population, the 

opportunity to be a parent is likely a human, emotional need, and so should be 

considered an important risk factor when considering gender transition for any 

patient. It implies a greater degree of isolation as the trans person ages.

Sexual-romantic risks associated with transition. After adolescence, 

transgender individuals find a greatly diminished pool of individuals willing to 

develop a romantic and intimate relationship with them. When a trans person who 

passes well reveals his or her natal sex, many potential cisgender mates lose interest. 

When a trans person does not pass well, he discovers that the pool of those interested 

consists largely of individuals looking for exotic sexual experiences rather than 

genuinely loving relationships. (Levine, Ethical Concerns, at 5, 13.) Nor is the 

problem all on the other side; transgender individuals commonly become strongly 

narcissistic, unable to give the level of attention to the needs of another that is 

necessary to sustain a loving relationship.22

Social risks associated with delayed puberty. The social and psychological 

impacts of remaining puerile for, e.g., three-to- five years while one’s peers are 

undergoing pubertal transformations, and of undergoing puberty at a substantially 

older age, have not been systematically studied, although clinical mental health 

professionals often hear of distress and social awkwardness in those who naturally 

have a delayed onset of puberty. In my opinion, individuals in whom puberty is 

delayed multiple years are likely to suffer at least subtle negative psychosocial and 

self-confidence effects as they stand on the sidelines while their peers are developing 

the social relationships (and attendant painful social learning experiences) that come 

with adolescence. (Levine, Informed Consent, at 9.) 

(6) Mental health costs or risks

One would expect the negative physical and social impacts reviewed above to 

adversely affect the mental health of individuals who have transitioned. In addition, 

adult transitioned individuals find that living as the other (or, in a manner that is 

consistent with the stereotypes of the other as the individual perceives them) is a 

22 S. Levine, Barriers to Loving: A Clinician’s Perspective, at 40 (Routledge, New York 2013).

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continual challenge and stressor, and many find that they continue to struggle with 

a sense of inauthenticity in their transgender identity. (Levine, Informed Consent, at 

9.) In addition, individuals often pin excessive hope in transition, believing that 

transition will solve what are in fact ordinary social stresses associated with 

maturation or mental health co-morbidities. Thus, transition can result in deflection 

from mastering personal challenges at the appropriate time or addressing conditions 

that require treatment.

For many reasons, transgender individuals including transgender youth 

certainly experience greatly increased rates of mental health problems. In some adult 

patients, these reasons combine to generate chronic anxiety, depression, and 

substance dependence. It is vital for them and their mental health professionals to 

consider that the patients’ drive for further anatomic transformation is an attempt to 

eradicate their psychiatric and social problems. It is already clear that this is often 

not accomplished. Swedish researchers in a long-term study (up to 30 years since 

SRS, with a median time since SRS of > 10 years) concluded that individuals who 

have SRS should have postoperative lifelong psychiatric care. (Dhejne, Long Term, 

at 6-7.) With respect to youths a cohort study found that transgender youth had an 

elevated risk of depression (50.6% vs. 20.6%) and anxiety (26.7% vs. 10.0%); a 

higher risk of suicidal ideation (31.1% vs. 11.1%), suicide attempts (17.2% vs. 

6.1%), and self-harm without lethal intent (16.7% vs. 4.4%) relative to the matched 

controls; and a significantly greater proportion of transgender youth accessed 

inpatient mental health care (22.8% vs. 11.1%) and outpatient mental health care 

(45.6% vs. 16.1%) services.23

Gender dysphoria is not “easily managed” except when it naturally desists. A 

recent study in the American Journal of Psychiatry reported the high mental health 

utilization patterns of adults for ten years after surgery for approximately 35% of 

patients.

24

23 S. Reisner et al. (2015), Mental Health of Transgender Youth in Care at an Adolescent Urban 

Community Health Center: A Matched Retrospective Cohort Study, J. OF ADOLESCENT 

HEALTH 56(3) at 6, DOI:10.1016/j.jadohealth.2014.10.264; see also supra ¶ 21

24 Branstrom & Pachankis, (2019), Reduction in Mental Health Treatment Utilization Among 

Transgender Individuals After Gender-Affirming Surgeries, AM. J. OF PSYCHIATRY. 

4:Appiajp201919010080. Doi: 10.1176/Appi.Ajp.2019.19010080.

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VI. Regret following transition is not an infrequent phenomenon. 

The large numbers of children and young adults who have desisted as 

documented in both group and case studies each represent “regret” over the initial 

choice in some sense. The phenomenon of desistance or regret experienced later than 

adolescence or young adulthood, or among older transgender individuals, has to my 

knowledge not been quantified or well-studied. However, it is a real phenomenon. I 

myself have worked with multiple individuals who have abandoned trans female 

identity after living in that identity for years, and who would describe their 

experiences as “regret.”

I have seen several Massachusetts inmates and trans individuals in the 

community abandon their [trans] female identity after several years. (Levine, 

Reflections, at 239.) In the gender clinic which I founded in 1974 and to this day, in 

a different location, continue to direct, we have seen many instances of individuals 

who claimed a transgender identity for a time, but ultimately changed their minds 

and reclaimed the gender identity congruent with their sex. More dramatically, a 

surgical group prominently active in the SRS field has published a report on a series 

of seven male-to-female patients requesting surgery to transform their surgically 

constructed female genitalia back to their original male form.25

I noted above an increasingly visible online community of young women who 

have desisted after claiming a male gender identity at some point during their teen 

years. Given the rapid increase in the number of girls presenting to gender clinics 

within the last few years, the phenomena of regret and desistance by young women 

deserves careful attention and study by MHPs.

The low frequency of regret, often quoted as approximately 2%, is based on 

those undergoing SRS queried by one or two questions on a form after a variable 

length of time. 

25 Djordjevic et al. (2016), Reversal Surgery in Regretful Male-to-Female Transsexuals After Sex 

Reassignment Surgery, J. Sex Med. 13(6) 1000, DOI: 10.1016/j.jsxm.2016.02.173.

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Kathryn Lane

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Ahmir Murphy

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Page 1 of 21

Curriculum Vita

Stephen B. Levine, M.D.

I) Brief Introduction

 Dr. Levine is Clinical Professor of Psychiatry at Case Western Reserve University School of 

Medicine. He is the solo author of four books, Sex Is Not Simple in 1989 (translated to German 

in 1992 and reissued in English in 1997 as Solving Common Sexual Problems); Sexual Life: A 

clinician’s guide in 1992; Sexuality in Midlife in 1998 and Demystifying Love: Plain talk for the 

mental health professional in 2006; Barriers to Loving: A clinician’s perspective in 2013. He is 

the Senior Editor of the first (2003), second (2010) and third (2016) editions of the Handbook of 

Clinical Sexuality for Mental Health Professionals. Psychotherapeutic Approaches to Sexual 

Problems: An Essential Guide For Mental Health Professionals (2020). .He has been teaching, 

providing clinical care, and writing since 1973 and has generated original research, invited 

papers, commentaries, chapters, and book reviews. He has served as a journal manuscript and 

book prospectus reviewer for many years. He was co-director of the Center for Marital and 

Sexual Health/ Levine, Risen & Associates, Inc. in Beachwood, Ohio from 1992-2017. He and 

two colleagues received a lifetime achievement Masters and Johnson’s Award from the Society 

for Sex Therapy and Research in March 2005. 

II) Personal Information

A) Date of birth 1/14/42, Married 1963

B) Medical license no. Ohio 35-03-0234-L

C) Board Certification 6/76 American Board of Neurology and Psychiatry

D) Office-23425 Commerce Park, Beachwood, Ohio 44122-5402 phone 216-831-2900 

x 13 fax 216-831-4306 

E) Home-6415 Gates Mills Boulevard, Mayfield Heights, Oh 44124 440-442-2622; fax 

216-831-4306

III) Education

A) 1963 BA Washington and Jefferson College

B) 1967 MD Case Western Reserve University School of Medicine

C) 1967-68 internship in Internal Medicine University Hospitals of Cleveland

D) 1968-70 Research associate, National Institute of Arthritis and Metabolic Diseases, 

Epidemiology Field Studies Unit, Phoenix, Arizona, United States Public Health 

Service

E) 1970-73 Psychiatric Residency, University Hospitals of Cleveland

F) 1974-77 Robert Wood Johnson Foundation Clinical Scholar

IV) Appointments at Case Western Reserve University School of Medicine

A) 1973- Assistant Professor of Psychiatry

B) 1979-Associate Professor 

C) 1982-Tenure

D) 1985-Full Professor

E) 1993-Clinical Professor

V) Honors

A) Summa Cum Laude, Washington & Jefferson

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B) Teaching Excellence Award-1990 and 2010 (residency program)

C) Visiting Professorships

1) Stanford University-Pfizer Professorship program (3 days)–1995

2) St. Elizabeth’s Hospital, Washington, DC –1998

3) St. Elizabeth’s Hospital, Washington, DC--2002

D) Named to America’s Top Doctors consecutively since 2001

E) Invitations to present various Grand Rounds at Departments of Psychiatry and 

Continuing Education Lectures and Workshops

F) Masters and Johnson Lifetime Achievement Award from the Society of Sex Therapy 

and Research, April 2005 along with Candace Risen and Stanley Althof 

G) 2006 SSTAR Book Award for The Handbook of Clinical Sexuality for Mental 

Health Professionals: Exceptional Merit

H) 2018—Albert Marquis Lifetime Achievement Award from Marquis Who’s Who. 

(exceling in one’s field for at least twenty years)

VI) Professional Societies

A) 1971- American Psychiatric Association; fellow; #19909

B) 2005-American Psychiatric Association- Distinguished Life Fellow

C) 1973- Cleveland Psychiatric Society

D) 1973-Cleveland Medical Library Association

1) 1985-Life Fellow

2) 2003 Distinguished Life Fellow

E) 1974-Society for Sex Therapy and Research

1) 1987-89-President

F) 1983- International Academy of Sex Research

G) 1983- Harry Benjamin International Gender Dysphoria Association

1) 1997-8 Chairman, Standards of Care Committee

H) 1994- 1999 Society for Scientific Study of Sex

VII) Community Boards

A) 1999-2002Case Western Reserve University Medical Alumni Association

B) 1996-2001 Bellefaire Jewish Children’s Bureau

C) 1999-2001 Physicians’ Advisory Committee, The Gathering Place (cancer 

rehabilitation)

VIII) Editorial Boards

A) 1978-80 Book Review Editor Journal Sex and Marital Therapy

B) Manuscript Reviewer for

1) Archives of Sexual Behavior

2) Annals of Internal Medicine

3) British Journal of Obstetrics and Gynecology

4) JAMA

5) Diabetes Care

6) American Journal of Psychiatry

7) Maturitas

8) Psychosomatic Medicine

9) Sexuality and Disability

10) Journal of Nervous and Mental Diseases

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11) Journal of Neuropsychiatry and Clinical Neurosciences

12) Neurology

13) Journal Sex and Marital Therapy

14) Journal Sex Education and Therapy

15) Social Behavior and Personality: an international journal (New Zealand)

16) International Journal of Psychoanalysis

17) International Journal of Transgenderism

18) Journal of Urology

19) Journal of Sexual Medicine

20) Current Psychiatry

21) International Journal of Impotence Research

22) Postgraduate medical journal

23) Academic Psychiatry

24) Expert Opinion on Drug Safety

25) Clinical Psychology Reviews

26) Heliyon

27) Andrologia

28) Children and Youth Services Review

C) Prospectus Reviewer

1) Guilford

2) Oxford University Press

3) Brunner/Routledge

4) Routledge

IX) Administrative Responsibilities

A) Co-director, Center for Marital and Sexual Health/ Levine, Risen & Associates, Inc.

until June 30, 2017

B) Principal Investigator of approximately 70 separate studies involving 

pharmacological interventions for sexual dysfunction since 1989. 

C) Co-leader of case conferences at DELRLLC.com

X) Recent Expert Witness Appearances

A) US District Court, Judge Mark L.Wolf’s witness in Michelle Kosilek vs. 

Massachusetts Dept of Corrections et al. case (transsexual issue) in Boston 2007

B) Deposition in the Battista vs. Massachusetts Dept of Corrections case (transsexual 

issue) in Cleveland October 2009

C) Witness for Massachusetts Dept. of Corrections in their defense of a lawsuit brought 

by prisoner Katheena Soneeya. March 22, 2011 Deposition in Boston and October 

2018 in Cleveland

D) Witness for State of Florida vs. Reyne Keohane July 2017

XI) Consultancy

A) Massachusetts Department of Corrections—evaluation of 12 transsexual prisoners 

and the development of a Gender Identity Disorders Program for the state prison 

system. Monthly consultation with the GID treatment team since February 2009 and 

the GID policy committee since February 2010 

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B) California Department of Corrections and Rehabilitation; 2012-2015; education, 

inmate evaluation, commentary on inmate circumstances, suggestions on future 

policies

C) Virginia Department of Corrections –evaluation of an inmate

D) New Jersey Department of Corrections—evaluation of an inmate

E) Idaho Department of Corrections—workshop 2016

F) Expert Witness reports to lawsuits in Idaho, Wisconsin, and the UK in 2020

G) Testimony to Subcommittee on Health to Pennsylvania legislature in March 2020

XII) Grant Support/Research Studies

A) TAP–studies of Apomorphine sublingual in treatment of erectile dysfunction

B) Pfizer–Sertraline for premature ejaculation

C) Pfizer–Viagra and depression; Viagra and female sexual dysfunction; Viagra as a 

treatment for SSRI-induced erectile dysfunction

D) NIH- Systemic lupus erythematosis and sexuality in women

E) Sihler Mental Health Foundation

1) Program for Professionals

2) Setting up of Center for Marital and Sexual Health

3) Clomipramine and Premature ejaculation

4) Follow-up study of clergy accused of sexual impropriety

5) Establishment of services for women with breast cancer

F) Alza–controlled study of a novel SSRI for rapid ejaculation

G) Pfizer–Viagra and self-esteem 

H) Pfizer- double-blind placebo control studies of a compound for premature 

ejaculation

I) Johnson & Johnson – controlled studies of Dapoxetine for rapid ejaculation

J) Proctor and Gamble: multiple studies to test testosterone patch for post menopausal 

sexual dysfunction for women on and off estrogen replacement

K) Lilly-Icos—study of Cialis for erectile dysfunction

L) VIVUS – study for premenopausal women with FSAD

M) Palatin Technologies- studies of bremelanotide in female sexual dysfunction—first 

intranasal then subcutaneous administration

N) Medtap – interview validation questionnaire studies

O) HRA- quantitative debriefing study for Female partners os men with premature 

ejaculation, Validation of a New Distress Measure for FSD, 

P) Boehringer-Ingelheim- double blind and open label studies of a prosexual agent for 

hypoactive female sexual desire disorder

Q) Biosante- studies of testosterone gel administration for post menopausal women with 

HSDD

R) J&J a single-blind, multi-center, in home use study to evaluate sexual enhancement 

effects of a product in females.

S) UBC-Content validity study of an electronic FSEP-R and FSDS-DAO and usability 

of study PRO measures in premenopausal women with FSAD, HSDD or Mixed 

FSAD/HSDD

T) National registry trial for women with HSDD

U) Endoceutics—two studies of DHEA for vaginal atrophy and dryness in post 

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menopausal women

V) Palatin—study of SQ Bremelanotide for HSDD and FSAD

W) Trimel- a double-blind, placebo controlled study for women with acquired female 

orgasmic disorder.

X) S1 Biopharma- a phase 1-B non-blinded study of safety, tolerability and efficacy of 

Lorexys in premenopausal women with HSDD

Y) HRA – qualitative and cognitive interview study for men experiencing PE

XIII) Publications

A) Books

1) Pariser SR, Levine SB, McDowell M (eds.), Clinical Sexuality, Marcel 

Dekker, New York, 1985

2) Sex Is Not Simple, Ohio Psychological Publishing Company, 1988

(a) Translated into German as Angstfreie Sexualitat: Gluck und 

Erfullung in der Liebe, Wilhelm Heyne Verlag, Muchen, 1992

(b) Reissued in paperback as: Solving Common Sexual Problems: 

Toward a Problem Free Sexual Life, Jason Aronson, Livingston, 

NJ. 1997

3) Sexual Life: A Clinician’s Guide. Plenum Publishing Corporation. New York, 

1992

(a) See review in Archives of Sexual Behavior 28(4): 361-363,1999

4) Sexuality in Midlife. Plenum Publishing Corporation. New York, 1998

(a) See review in Am Journal of Psychiatry 156((9):1468, 1999

(b) See review in Contemporary Psychology APA Review of Books 

44(4):293-295, 1999

(c) See review J Sex Education and Therapy January, 2000

(d) See review J Sex and Marital Therapy, Winter, 2000

5) Editor. Clinical Sexuality. Psychiatric Clinics of North America, March, 1995.

6) Editor, (Candace Risen and Stanley Althof, associate editors) Handbook of 

Clinical Sexuality for Mental Health Professionals. Routledge, New York, 

2003

1. see review American Journal of Psychiatry April, 2005

2. 2006 SSTAR Book Award: Exceptional Merit

3. see review in Archives of Sexual Behavior 35(6):757-758

4. see two reviews in Journal of Sex and Marital Therapy 33(3):272-276

7) Demystifying Love: Plain Talk For The Mental Health Professional. 

Routledge, New York, 2006

(a) See review in Psychiatric Times, August 2008 by Leonore Tiefer

(b) See review in Journal of Sex and Marital Therapy 34(5)-459-460.

8) Senior editor, (Candace B. Risen and Stanley E. Althof, Associate editors), 

Handbook of Clinical Sexuality for Mental Health Professionals. 2nd edition

Routledge, New York, 2010. See review by Pega Ren, JSex&Marital Therapy

9) Barriers to Loving: A Clinician’s Perspective. Routledge, New York, 2014.

10) Senior editor Candace B. Risen and Stanley E. Althof, Associate editors),

Handbook of Clinical Sexuality for Mental Health Professionals. 3rd edition

Routledge, New York, 2016

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B) Research and Invited Papers When his name is not listed in a citation, Dr. Levine 

is either the solo or the senior author

1) Sampliner R. Parotid enlargement in Pima Indians. Annals of Internal 

Medicine 1970; 73:571-73

2) Confrontation and residency activism: A technique for assisting residency 

change: World Journal of Psychosynthesis 1974; 6: 23-26

3) Activism and confrontation: A technique to spur reform. Resident and Intern 

Consultant 173; 2

4) Medicine and Sexuality. Case Western Reserve Medical Alumni Bulletin 

1974:37:9-11.

5) Some thoughts on the pathogenesis of premature ejaculation. J. Sex & Marital 

Therapy 1975; 1:326-334

6) Marital Sexual Dysfunction: Introductory Concepts. Annals of Internal 

Medicine 1976;84:448-453

7) Marital Sexual Dysfunction: Ejaculation Disturbances . Annals of Internal

Medicine 1976; 84:575-579

8) Yost MA: Frequency of female sexual dysfunction in a gynecology clinic: An 

epidemiological approach. Archives of Sexual Behavior 1976;5:229-238

9) Engel IM, Resnick PJ, Levine SB: Use of programmed patients and videotape 

in teaching medical students to take a sexual history. Journal of Medical 

Education 1976;51:425-427

10) Marital Sexual Dysfunction: Erectile dysfunction. Annals of Internal 

Medicine 1976;85:342-350

11) Articles in Medical Aspects of Human Sexuality 

(a) Treating the single impotent male. 1976; 10:123, 137

(b) Do men enjoy being caressed during foreplay as much as women 

do? 1977; 11:9

(c) Do men like women to be sexually assertive? 1977;11:44

(d) Absence of sexual desire in women: Do some women never 

experience sexual desire? Is this possibility genetically 

determined? 1977; 11:31

(e) Barriers to the attainment of ejaculatory control. 1979; 13:32-56.

(f) Commentary on sexual revenge.1979;13:19-21

(g) Prosthesis for psychogenic impotence? 1979;13:7

(h) Habits that infuriate mates. 1980;14:8-19

(i) Greenberger-Englander, Levine SB. Is an enema an erotic 

equivalent?1981; 15:116

(j) Ford AB, Levine SB. Sexual Behavior and the Chronically Ill 

Patients. 1982; 16:138-150

(k) Preoccupation with wife’s sexual behavior in previous marriage 

1982; 16:172

(l) Co-existing organic and psychological impotence. 1985;19:187-8

(m) Althof SE, Turner LA, Kursh ED, Bodner D, Resnick MI, Risen 

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CB. Benefits and Problems with Intracavernosal injections for the 

treatment of impotence. 1989;23(4):38-40

12) Male Sexual Problems. Resident and Staff Physician 1981:2:90-5

13) Female Sexual Problems. Resident and Staff Physician 1981:3:79-92

14) How can I determine whether a recent depression in a 40 year old married 

man is due to organic loss of erectile function or whether the depression is 

the source of the dysfunction? Sexual Medicine Today 1977;1:13

15) Corradi RB, Resnick PJ Levine SB, Gold F. For chronic psychologic 

impotence: sex therapy or psychotherapy? I & II Roche Reports; 1977

16) Marital Sexual Dysfunction: Female dysfunctions 1977; 86:588-597

17) Current problems in the diagnosis and treatment of psychogenic 

impotence. Journal of Sex & Marital Therapy 1977;3:177-186

18) Resnick PJ, Engel IM. Sexuality curriculum for gynecology residents. 

Journal of Medical Education 1978; 53:510-15

19) Agle DP. Effectiveness of sex therapy for chronic secondary 

psychological impotence Journal of Sex & Marital Therapy 1978;4:235-

258

20) DePalma RG, Levine SB, Feldman S. Preservation of erectile function 

after aortoiliac reconstruction. Archives of Surgery 1978;113-958-962

21) Conceptual suggestions for outcome research in sex therapy Journal of 

Sex & Marital Therapy 1981;6:102-108

22) Lothstein LM. Transsexualism or the gender dysphoria syndrome. Journal 

of Sex & Marital Therapy 1982; 7:85-113

23) Lothstein LM, Levine SB. Expressive psychotherapy with gender 

dysphoria patients Archives General Psychiatry 1981; 38:924-929

24) Stern RG Sexual function in cystic fibrosis. Chest 1982; 81:422-8

25) Shumaker R. Increasingly Ruth: Towards understanding sex reassignment 

surgery Archives of Sexual Behavior 1983;12:247-61

26) Psychiatric diagnosis of patients requesting sex reassignment surgery. 

Journal of Sex & Marital Therapy 1980; 6:164-173

27) Problem solving in sexual medicine I. British Journal of Sexual Medicine 

1982;9:21-28

28) A modern perspective on nymphomania. Journal of Sex & Marital 

Therapy 1982;8:316-324

29) Nymphomania. Female Patient 1982;7:47-54

30) Commentary on Beverly Mead’s article: When your patient fears 

impotence. Patient Care 1982;16:135-9

31) Relation of sexual problems to sexual enlightenment. Physician and 

Patient 1983 2:62

32) Clinical overview of impotence. Physician and Patient 1983; 8:52-55.

33) An analytical approach to problem-solving in sexual medicine: a clinical 

introduction to the psychological sexual dysfunctions. II. British Journal 

of Sexual Medicine

34) Coffman CB, Levine SB, Althof SE, Stern RG Sexual Adaptation among 

single young adults with cystic fibrosis. Chest 1984;86:412-418

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35) Althof SE, Coffman CB, Levine SB. The effects of coronary bypass in 

female sexual, psychological, and vocational adaptation. Journal of Sex & 

Marital Therapy 1984;10:176-184

36) Letter to the editor: Follow-up on Increasingly Ruth. Archives of Sexual 

Behavior 1984;13:287-9

37) Essay on the nature of sexual desire Journal of Sex & Marital Therapy 

1984; 10:83-96

38) Introduction to the sexual consequences of hemophilia. Scandanavian 

Journal of Haemology 1984; 33:(supplement 40).75-

39) Agle DP, Heine P. Hemophila and Acquired Immune Deficiency 

Syndrome: Intimacy and Sexual Behavior. National Hemophilia 

Foundation; July, 1985

(a) Translated into German

(b) Translated into Spanish

40) Turner LA, Althof SE, Levine SB, Bodner DR, Kursh ED, Resnick MI. 

External vacuum devices in the treatment of erectile dysfunction: a oneyear study of sexual and psychosocial impact. Journal of Sex & Marital 

Therapy

41) Schein M, Zyzanski SJ, Levine SB, Medalie JH, Dickman RL, Alemagno 

SA. The frequency of sexual problems among family practice patients. 

Family Practice Research Journal 1988; 7:122-134

42) More on the nature of sexual desire. Journal of Sex & Marital Therapy 

1987;13:35-44

43) Waltz G, Risen CB, Levine SB. Antiandrogen treatment of male sex 

offenders. Health Matrix 1987; V.51-55.

44) Lets talk about sex. National Hemophilia Foundation January, 1988

45) Sexuality, Intimacy, and Hemophilia: questions and answers . National 

Hemophilia Foundation January, 1988

46) Prevalence of sexual problems. Journal Clinical Practice in Sexuality 

1988;4:14-16.

47) Kursh E, Bodner D, Resnick MI, Althof SE, Turner L, Risen CB, Levine 

SB. Injection Therapy for Impotence. Urologic Clinics of North America 

1988; 15(4):625-630

48) Bradley SJ, Blanchard R, Coates S, Green R, Levine S, Meyer-Bahlburg 

H, Pauly I, Zucker KJ. Interim report of the DSM-IV Subcommittee for 

Gender Identity Disorders. Archives of Sexual Behavior 

1991;;20(4):333-43. 

49) Sexual passion in mid-life. Journal of Clinical Practice in Sexuality 1991 

6(8):13-19

50) Althof SE, Turner LA, Levine SB, Risen CB, Bodner DR, Resnick MI. 

Intracavernosal injections in the treatment of impotence: A prospective 

study of sexual, psychological, and marital functioning. Journal of Sex & 

Marital Therapy 1987; 13:155-167

51) Althof SE, Turner LA, Risen CB, Bodner DR, Kursh ED, Resnick MI. 

Side effects of self-administration of intracavernosal injection of 

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papaverine and phentolamine for treatment of impotence. Journal of 

Urology 1989;141:54-7

52) Turner LA, Froman SL, Althof SE, Levine SB, Tobias TR, Kursh ED, 

Bodner DR. Intracavernous injection in the management of diabetic 

impotence. Journal of Sexual Education and Therapy 16(2):126-36, 1989

53) Is it time for sexual mental health centers? Journal of Sex & Marital

Therapy 1989;

54) Althof SE, Turner LA, Levine SB, Risen CB, Bodner D, Kursh ED, 

Resnick MI. Sexual, psychological, and marital impact of self injection of 

papaverine and phentolamine: a long-term prospective study. Journal of 

Sex & Marital Therapy

55) Althof SE, Turner LA, Levine SB, Risen CB, Bodner D, Kursh ED, 

Resnick MI. Why do so many men drop out of intracavernosal treatment? 

Journal of Sex & Marital Therapy. 1989;15:121-9

56) Turner LA, Althof SE, Levine SB, Risen CB, Bodner D, Kursh ED, 

Resnick MI. Self injection of papaverine and phentolamine in the 

treatment of psychogenic impotence. Journal of Sex & Marital Therapy. 

1989; 15(3):163-78

57) Turner LA, Althof SE, Levine SB, Risen CB, Bodner D, Kursh ED, 

Resnick MI. Treating erectile dysfunction with external vacuum devices: 

impact upon sexual, psychological, and marital functioning. Journal of 

Urology 1990;141(1):79-82

58) Risen CB, Althof SE. An essay on the diagnosis and nature of paraphilia 

Journal of Sex & Marital Therapy 1990; 16(2):89-102.

59) Althof SE, Turner LA, Levine SB, Risen CB, Bodner DB, Kursh ED, 

Resnick MI. Through the eyes of women: the sexual and psychological 

responses of women to their partners’ treatment with self-injection or 

vacuum constriction therapy. International Journal of Impotence Research 

(supplement 2)1990;346-7.

60) Althof SE, Turner LA, Levine SB, Risen CB, Bodner DB, Kursh ED, 

Resnick MI. A comparison of the effectiveness of two treatments for 

erectile dysfunction: self injection vs. external vacuum devices. . 

International Journal of Impotence Research (supplement 2)1990;289-90

61) Kursh E, Turner L, Bodner D, Althof S, Levine S. A prospective study on 

the use of the vacuum pump for the treatment of impotence.International 

Journal of Impotence Research (supplement 2)1990;340-1. 

62) Althof SE, Turner LA, Levine SB, Risen CB, Bodner DB, Kursh ED, 

Resnick MI. Long term use of intracavernous therapy in the treatment of 

erectile dysfunction in Journal of Sex & Marital Therapy 1991; 17(2):101-

112

63) Althof SE, Turner LA, Levine SB, Risen CB, Bodner DB, Kursh ED, 

Resnick MI. Long term use of vacuum pump devices in the treatment of 

erectile dsyfunction in Journal of Sex & Marital Therapy 1991;17(2):81-

93

64) Turner LA, Althof SE, Levine SB, Bodner DB, Kursh ED, Resnick MI. A 

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12-month comparison of the effectiveness of two treatments for erectile 

dysfunction: self injection vs. external vacuum devices. Urology 

1992;39(2):139-44

65) Althof SE, The pathogenesis of psychogenic impotence. J. Sex Education 

and Therapy. 1991; 17(4):251-66

66) Mehta P, Bedell WH, Cumming W, Bussing R, Warner R, Levine SB. 

Letter to the editor. Reflections on hemophilia camp. Clinical Pediatrics 

1991; 30(4):259-260

67) Successful Sexuality. Belonging/Hemophilia. (Caremark Therapeutic 

Services), Autumn, 1991

68) Psychological intimacy. Journal of Sex & Marital Therapy 1991; 

17(4):259-68

69) Male sexual problems and the general physician, Georgia State Medical 

Journal 1992; 81(5): 211-6

70) Althof SE, Turner LA, Levine SB, Bodner DB, Kursh E, Resnick MI. 

Through the eyes of women: The sexual and psychological responses of 

women to their partner’s treatment with self-injection or vacuum 

constriction devices. Journal of Urology 1992; 147(4):1024-7

71) Curry SL, Levine SB, Jones PK, Kurit DM. Medical and Psychosocial 

predictors of sexual outcome among women with systemic lupus 

erythematosis. Arthritis Care and Research 1993; 6:23-30

72) Althof SE, Levine SB. Clinical approach to sexuality of patients with 

spinal cord injury. Urological Clinics of North America 1993; 20(3):527-

34

73) Gender-disturbed males. Journal of Sex & Marital Therapy 19(2):131-141, 

1993

74) Curry SL, Levine SB, Jones PK, Kurit DM. The impact of systemic lupus 

erythematosis on women’s sexual functioning. Journal of Rheumatology 

1994; 21(12):2254-60

75) Althof SE, Levine SB, Corty E, Risen CB, Stern EB, Kurit D. 

Clomipramine as a treatment for rapid ejaculation: a double-blind 

crossover trial of 15 couples. Journal of Clinical Psychiatry 

1995;56(9):402-7

76) Risen CB, Althof SE. Professionals who sexually offend: evaluation 

procedures and preliminary findings. Journal of Sex & Marital Therapy 

1994; 20(4):288-302

77) On Love, Journal of Sex & Marital Therapy 1995; 21(3):183-191

78) What is clinical sexuality? Psychiatric Clinics of North America 1995; 

18(1):1-6

79) “Love” and the mental health professions: Towards an understanding of 

adult love. Journal of Sex & Marital Therapy 1996; 22(3)191-202

(a) Reprinted in Issues in Human Sexuality: Current & Controversial 

Readings with Links to Relevant Web Sites, 1998-9, Richard 

Blonna, Editor, Engelwood, Co. Morton Publishing Company, 

1998

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80) The role of Psychiatry in erectile dysfunction: a cautionary essay on the 

emerging treatments. Medscape Mental Health 2(8):1997 on the Internet. 

September, 1997.

81) Discussion of Dr. Derek Polonsky’s SSTAR presentation on 

Countertransference. Journal of Sex Education and Therapy 1998; 

22(3):13-17

82) Understanding the sexual consequences of the menopause. Women’s 

Health in Primary Care, 1998

(a) Reprinted in the International Menopause Newsletter

83) Fones CSL, Levine SB. Psychological aspects at the interface of diabetes 

and erectile dysfunction. Diabetes Reviews 1998; 6(1):1-8

84) Guay AT, Levine SB, Montague DK. New treatments for erectile 

dysfunction. Patient Care March 15, 1998

85) Extramarital Affairs. Journal of Sex & Marital Therapy 1998; 24(3):207-

216

86) Levine SB (chairman), Brown G, Cohen-Kettenis P, Coleman E, Hage JJ, 

Petersen M, Pfäfflin F, Shaeffer L, vanMasdam J, Standards of Care of 

the Harry Benjamin International Gender Dysphoria Association, 5th

revision, 1998. International Journal of Transgenderism at 

http://www.symposion.com/ijt

(a) Reprinted by the Harry Benjamin International Gender Dysphoria 

Association, Minneapolis, Minnesota

(b) also published in: 

87) Althof SE, Corty E, Levine SB, Levine F, Burnett A, McVary K, Stecher 

V, Seftel. The EDITS: the development of questionnaires for evaluating 

satisfaction with treatments for erectile dysfunction. Urology 

1999;53:793-799

88) Fones CSL, Levine SB, Althof SE, Risen CB. The sexual struggles of 23 

clergymen: a follow-up study. Journal of Sex & Marital Therapy 1999

89) The Newly Devised Standards of Care for Gender Identity Disorders. 

Journal of Sex Education and Therapy 24(3):1-11,1999

90) Levine, S. B. (1999). The newly revised standards of care for gender 

identity disorders. Journal of Sex Education & Therapy, 24, 117-127.

91) Melman A, Levine SB, Sachs B, Segraves RT, Van Driel MF. 

Psychological Issues in Diagnosis of Treatment (committee 11) in Erectile 

Dysfunction (A.Jarden, G.Wagner, S.Khoury, F. Guiliano, H.Padmanathan, R. Rosen, eds.) Plymbridge Distributors Limited, London, 2000

92) Pallas J, Levine SB, Althof SE, Risen CB. A study using Viagra in a 

mental health practice. J Sex&Marital Therapy.26(1):41-50, 2000

93) Levine SB, Stagno S. Informed Consent for Case Reports: the ethical 

dilemma between right to privacy and pedagogical freedom. Journal of 

Psychotherapy: Practice and Research, 2001, 10 (3): 193-201.

94) Alloggiamento T., Zipp C., Raxwal VK, Ashley E, Dey S. Levine SB, 

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Froelicher VF. Sex, the Heart, and Sildenafil. Current Problems in 

Cardiology 26 June 2001(6):381-416 

95) Re-exploring The Nature of Sexual Desire. Journal of Sex and Marital 

Therapy 28(1):39-51, 2002.

96) Understanding Male Heterosexuality and Its Disorders in Psychiatric 

Times XIX(2):13-14, February, 2002

97) Erectile Dysfunction: Why drug therapy isn’t always enough. (2003) 

Cleveland Clinic Journal of Medicine, 70(3): 241-246.

98) The Nature of Sexual Desire: A Clinician’s Perspective. Archives of 

Sexual Behavior 32(3):279-286, 2003 .

99) Laura Davis. What I Did For Love: Temporary Returns to the Male 

Gender Role. International Journal of Transgenderism, 6(4), 2002 and 

http://www.symposion.com/ijt 

100) Risen C.B., The Crisis in the Church: Dealing with the Many Faces of 

Cultural Hysteria in The International Journal of Applied Psychoanalytic 

Studies, 1(4):364-370, 2004

101) Althof SE, Leiblum SR (chairpersons), Chevert-Measson M. Hartman U., 

Levine SB, McCabe M., Plaut M, Rodrigues O, Wylie K., Psychological 

and Interpersonal Dimensions of Sexual Function and Dysfunction in 

World Health Organization Conference Proceedings on Sexual 

Dysfunctions, Paris, 2003. Published in a book issued in 2004.

102) Commentary on Ejaculatory Restrictions as a Factor in the Treatment of 

Haredi (Ultra-Orthodox) Jewish Couples: How Does Therapy Work? 

Archives of Sexual Behavior, 33(3):June 2004

103) What is love anyway? J Sex & Marital Therapy 31(2):143-152,2005.

104) A Slightly Different Idea, Commentary on Y.M.Binik’s Should 

Dyspareunia Be Retained as a Sexual Dysfunction in DSM-V? A Painful 

Classification Decision. Archives of Sexual Behavior 34(1):38-39, 2005.

http://dx.doi.org/10.1007/s10508-005-7469-3

105) Commentary. Pharmacologic Treatment of Erectile Dysfunction: Not 

always a simple matter. BJM USA; Primary Care Medicine for the 

American Physician, 4(6):325-326, July 2004 

106) Leading Comment: A Clinical Perspective on Infidelity. Journal of Sexual 

and Relationship Therapy, 20(2):143-153, May 2005.

107) Multiple authors. Efficacy and safety of sildenafil citrate (Viagra) in men 

with serotonergic antidepressant-associated erectile dysfunction: Results 

from a randomized, double-blind, placebo-controlled trial. Submitted to 

Journal of Clinical Psychiatry Feb 2005

108) Althof SE, Leiblum SR, Chevert-Measson M, Hartman U,Levine 

SB,McCabe M, Plaut M, Rodrigues O, Wylie K. Psychological and 

Interpersonal Dimensions of Sexual Function and Dysfunction. Journal of 

Sexual Medicine, 2(6): 793-800, November, 2005

109) Shifren JL, Davis SR, Moreau M, Waldbaum A, Bouchard C., DeRogatis 

L., Derzko C., Bearnson P., Kakos N., O’Neill S., Levine S., Wekselman 

K., Buch A., Rodenberg C., Kroll R. Testosterone Patch for the Treatment 

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of Hypoactive Sexual Desire Disorder in Naturally Menopausal Women: 

Results for the INTIMATE NM1 Study. Menopause: The Journal of the 

North American Menopause Society 13(5) 2006.

110) Reintroduction to Clinical Sexuality. Focus: A Journal of Lifelong 

Learning in Psychiatry Fall 2005. III (4):526-531

111) PDE-5 Inhibitors and Psychiatry in J Psychiatric Practice 12 (1): 46-49, 

2006.

112) Sexual Dysfunction: What does love have to do with it? Current 

Psychiatry 5(7):59-68, 2006.

113) How to take a Sexual History (Without Blushing), Current Psychiatry 

5(8): August, 2006.

114) Linking Depression and ED: Impact on sexual function and relationships 

in Sexual Function and Men’s Health Through the Life Cycle under the 

auspices of the Consortium for Improvement of Erectile Function 

(CIEF),12-19, November, 2006.

115) The First Principle of Clinical Sexuality. Editorial. Journal of Sexual 

Medicine,4:853-854, 2007

116) Commentary on David Rowland’s editorial, “Will Medical Solutions to 

Sexual Problems Make Sexological Care and Science Obsolete?” Journal 

of Sex and Marital Therapy, 33(5), 2007 in press

117) Real-Life Test Experience: Recommendations for Revisions to the 

Standards of Care of the World Professional Association for Transgender 

Health International Journal of Transgenderism, Volume 11 Issue 3, 186-

193, 2009

118) Sexual Disorders: Psychiatrists and Clinical Sexuality. Psychiatric Times 

XXIV (9), 42-43, August 2007

119) I am not a sex therapist! Commentary to I. Binik and M. Meana’s article 

Sex Therapy: Is there a future in this outfit? Archives of Sexual Behavior, 

Volume 38, Issue 6 (2009), 1033-1034

119) Solomon A (2009) Meanings and Political Implications of 

“Psychopathology” in a Gender Identity Clinic: Report of 10 cases. 

Journal of Sex and Marital Therapy 35(1): 40-57.

120) Perelman, MA., Levine SB, Fischkoff SA. Randomized, PlaceboControlled, Crossover Study to Evaluate the Effects of Intranasal 

Bremelanotide on Perceptions of Desire and Arousal in Postmenopausal 

Women with Sexual Arousal Disorder submitted to Journal of Sexual 

Medicine July 2009, rejected

121) What is Sexual Addiction? Journal of Sex and Marital Therapy.2010 

May;36(3):261-75

122) David Scott (2010) Sexual Education of Psychiatric Residents. 

Academic Psychiatry, 34(5) 349-352. 

 123) Chris G. McMahon, Stanley E. Althof, Joel M. Kaufman, Jacques Buvat, 

Stephen B. Levine, Joseph W. Aquilina, Fisseha Tesfaye, Margaret 

Rothman, David A. Rivas, Hartmut Porst. Efficacy and Safety of 

Dapoxetine for the Treatment of Premature Ejaculation: Integrated 

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Analysis of Results From 5 Phase 3 Trials Journal of Sexual Medicine

2011 Feb;8(2):524-39.

 124) Commentary on Consideration of Diagnostic Criteria for Erectile 

Dysfunction in DSM V. Journal of Sexual Medicine July 2010

 125) Hypoactive Sexual Desire Disorder in Men: Basic types, causes, and 

treatment. Psychiatric Times 27(6)4-34. 2010

 126) Male Sexual Dysfunctions, an audio lecture, American Physician Institute 

2013

127) Fashions in Genital Fashion: Where is the line for physicians? 

Commentary on David Veale and Joe Daniels’ Cosmetic Clitoridectomy 

in a 33-year-old woman. Archives of Sexual Behavior, epub ahead of 

print Sept 24, 2011. Arch Sex Behav (2012) 41:735–736 DOI 

10.1007/s10508-011-9849-7

 128) Review: Problematic Sexual Excess. Neuropsychiatry 2(1):1-12, 2012

 129). The Essence of Psychotherapy. Psychiatric Times 28 (2): August 2, 2012 

translated into Portuguese and republished in Revista Latinoamericana de 

Psicopatologia Fundamental (latin-American Journal of Fundamental 

Psychopathology) in press 2012. Reprinted by Psychiatric Times on July 

26, 2019 https://www.psychiatrictimes.com/articles/essencepsychotherapy

130) Parran TV, Pisman, AR, Youngner SJ, Levine SB.Evolution of 

 remedial CME course in professionalism: Addressing learner needs, 

 developing content, and evaluating outcomes. Journal of Continuing 

 Education in the Health Professions, 33(3): 174-179, 2013.

131) Love and Psychiatry. Psychiatric Times November 2013

132) Orgasmic Disorders, Sexual Pain Disorders, and Sexual Dysfunction Due 

to a Medical Condition. Board Review Psychiatry 2013-2014 Audio 

Digest CD 27. Audio recording of a one-hour lecture available October 

2013.

133) Towards a Compendium of the Psychopathologies of Love. Archives of 

Sexual Behavior Online First December 25, 2013 DOI 10.1007/s10508-

013-0242-6 43(1)213-220.

134) Flibanserin. (editorial) Archives of Sexual Behavior 44 (8), 2015 

November 2015. DOI: 10.1007/s10508-015-0617-y

135) Martel C, Labrie F, Archer DF, Ke Y, Gonthier R, Simard JN, Lavoie L, 

Vaillancourt M, Montesino M, Balser J, Moyneur É; other participating members 

of the Prasterone Clinical Research Group. (2016) Serum steroid concentrations 

remain within normal postmenopausal values in women receiving daily 6.5mg 

intravaginal prasterone for 12 weeks.J Steroid Biochem Mol Biol. 2016 

May;159:142-53. doi: 10.1016/j.jsbmb.2016.03.016

136) Reflections of an Expert on the Legal Battles Over Prisoners with Gender 

 Dysphoria. J Am Acad Psychiatry Law 44:236–45, 2016

137) Cooper E, McBride J, Levine SB. Does Flibanserin have a future? 

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Page 15 of 21

Psychiatric Times accepted October 23, 2015.

138 Levine SB, Sheridan DL, Cooper EB. The Quest for a Prosexual Medication 

for Women, Current Sexual Health Reports (2016) 8: 129. 

doi:10.1007/s11930-016-0085-y

139) Why Sex Is Important: Background for Helping Patients with Their Sexual 

Lives., British Journal of Psychiatry Advances (2017), vol. 23(5)

300-306; DOI: 10.1192/apt.bp.116.016428 

140) Flibanserin: Offene Forshungsfragen , Zeitschrift für Sexualforschung. 29: 

 170-175, 2016. This is a translation of 134).

141) Commentary on "Asexuality: Orientation, paraphilia, dysfunction, or none 

 of the above? Archives Sexual Behavior, Archives of Sexual Behavior April 2017, 

 Volume 46, Issue 3, pp 639–642 DOI: 10.1007/s10508-017-0947-z

142) Sexual Dysfunction in Clinical Psychiatry, Psychiatric Times, March 2017

143) Ethical Concerns About the Emerging Treatment of Gender Dysphoria . 

 Journal of Sex and Marital Therapy, 44(1):29-44. 2017. DOI 

 10.1080/0092623X.2017.1309482

144) The Psychiatrist’s Role in Managing Transgender Youth: Navigating 

 Today’s Politicized Terrain. CMEtoGO® Audio Lecture Series, May 2017

145) Transitioning Back to Maleness, Archives of Sexual Behavior, 2017 Dec 

 20. doi: 10.1007/s10508-017-1136-9. [Epub ahead of print]; 47(4), 1295-

1300, May 2018

146) Informed Consent for Transgender Patients, Journal of Sex and Marital 

Therapy, 2019;45(3):218-229. doi: 10.1080/0092623X.2018.1518885

.147) Life Processes are Illuminated by Sexual History. (2019) Psychiatric 

Times, December Volume XXXVI. No.12

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4. Clinical Introduction to Human Sexual Dysfunction. In Pariser SF, Levine 

SB, McDowell M (eds) Clinical Sexuality. New York, Marcel Dekker 

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5. Psychodynamically-oriented clinician’s overview of psychogenic 

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8. Psychological Sexual Dysfunction. In Sudak H (ed) Clinical 

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9. Male sexual dysfunction. In Sudak H (ed) Clinical Psychiatry. 

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10. Sexuality and Aging. In Sudak H (ed) Clinical Psychiatry. Warren H. 

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11. Homosexuality. In Sudak H (ed) Clinical Psychiatry. Warren H. Green. St. 

Louis, 1985

12. Individual and intrapsychic factors in sexual desire. In Leiblum SR, Rosen 

RC (eds). Clinical Perspectives on Sexual Desire Disorders. Guilford 

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13. Gender Identity Disorders. In Sadock B, Kaplan H(eds). Comprehensive 

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1061-9

14. Intrapsychic and Interpersonal Aspects of Impotence: Psychogenic 

Erectile Dysfunction. In Leiblum SR, Rosen RC (eds). Erectile 

Disorders: Assessment and Treatment. Guilford Press, New York, 1992

15. Psychological Factors in Impotence. In Resnick MI, Kursh ED, (eds.) 

Current Therapy in Genitourinary Surgery, 2nd edition. BC Decker, 

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16. The Vagaries of Sexual Desire. In Leiblum SR, Rosen RC (eds). In Case 

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18. Althof SE. Psychological Evaluation and Sex Therapy. In Mulcahy JJ 

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19. Althof SE, Levine SB. Psychological Aspects of Erectile Dysfunction. In 

Hellstrum WJG (ed) Male Infertility and Dysfunction. Springer-Verlag, 

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20. Paraphilias. In Comprehensive Textbook of Psychiatry/VII. Sadock BJ, 

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21. Women’s Sexual Capacities at Mid-Life in The Menopause: 

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25. What Patients Mean by Love, Psychological Intimacy, and Sexual Desire 

(2003) in SB Levine, CB Risen, SE Althof (eds) Handbook of Clinical 

Sexuality for Mental Health Professionals, Brunner-Routledge, New 

York, pp.21-36.

26. Infidelity (2003) in SB Levine, CB Risen, SE Althof (eds) Handbook of 

Clinical Sexuality for Mental Health Professionals, Brunner-Routledge, 

New York, pp57-74 

27. Preface (2003) in SB Levine, CB Risen, SE Althof (eds) Handbook of 

Clinical Sexuality for Mental Health Professionals, Brunner-Routledge, 

New York, pp xiii-xviii

28. A Psychiatric Perspective on Psychogenic Erectile Dysfunction (2004) in 

T.F. Lue (ed) Atlas of Male Sexual Dysfunction, Current Medicine, 

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of Psychiatric Disorders, 3rd edition (Gabbard GO, editor), American 

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30. Risen CB, (2009)Professionals Who Are Accused of Sexual Boundary 

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and Legal Issues edited by Fabian M. Saleh, Albert J. Grudzinskas, Jr., 

and John M. Bradford, Oxford University Press, 2009

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SB, Risen, CB, and Althof, SE, Routledge, New York, 2010

32. Infidelity in Handbook of Clinical Sexuality for Mental Health 

Professionals edited by Levine SB, Risen, CB, and Althof, SE, 

Routledge, New York, 2010

33. Scott DL, Levine, SB. Understanding Gay and Lesbian Life in Handbook 

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SB, Risen, CB, and Althof, SE, Routledge, New York, 2010

34. Levine, SB, Hasan, S., Boraz M. (2009) Male Hypoactive Sexual Desire 

Disorder (HSDD) in Clinical Manual of Sexual Disorders (R. Balon and 

RT Segraves, eds), American Psychiatric Press, Washington, DC. 

35. Levine, SB. Sexual Disorders in Fundamentals of Psychiatry (by Allan 

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editors), 5th edition, Guilford Press, New York, 2014.

37. Why is Sex Important? In Handbook of Clinical Sexuality for Mental 

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York. Routledge, 2016, Chapter 1 

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CB Risen, SE Althof, eds] New York. Routledge, 2016. Chapter 4

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Sexual Dysfunction in Men and Women [L Lipshultz, A Pastuszak, M 

Perelman, A Giraldi, J Buster, eds.] New York, Springer, 2016.

41. Sommers, B., Levine, S.B., Physician’s Attitude Towards Sexuality

Psychiatry and Sexual Medicine: A Comprehensive Guide for Clinical 

Practitioners, Springer, Heidelberg, Germany,2020

 42. Boundaries And The Ethics Of Professional Misconduct in A. Steinberg, J. L.

Alpert, C A. Courtois( Eds.) Sexual Boundary Violations In 

Psychotherapy:Therapist Indiscretions, & Transgressions, & Misconduct

American Psychological Association, In Press 2021

42. Levine, SB, Risen CB. (2020). Professionals Who Are Accused of Sexual

Boundary Violations In Sex Offenders: Identification, Risk 

Assessment,Treatment, and Legal Issues, 2nd edition. edited by Fabian 

M. Saleh, , Oxford University Press, in press

43. Foreward to Psychotherapy of Gender Dysphoria of Children and Young 

Adults, Phoenix Publication, UK in press

C) Book Reviews

1) Homosexualities: A Study of Diversity Among Men and Women by Alan P. 

Bell and Martin S. Weinberg, Simon and Schuster, New York, 1978. In 

Journal of Sex & Marital Therapy 1979; 5:

2) Marriage and Marital Therapies: Psychoanalytic, Behavioral & System Theory 

Perspectives by TJ Paolino and BS McCrady. Brunner/Mazel, New York, 

1978. In Journal of Sex & Marital Therapy 1979; 5:

3) Management of Male Impotence. Volume 5 International Perspectives in 

Urology AH Bennett, (ed) Williams and Wilkins, Baltimore, 1992. In 

American Journal of Psychiatry, 1984

4) The Sexual Relationship by DE Scharff, Routledge & Kegan Paul, 1982 in 

Family Process 1983;22:556-8

5) Phenomenology and Treatment of Psychosexual Disorders, by WE Fann, I 

Karacan, AD Pokorny, RL Williams (eds). Spectrum Publications, New 

York, 1983. In American Journal of Psychiatry 1985;142:512-6

6) The Treatment of Sexual Disorders: Concepts and Techniques of Couple 

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Therapy, G Arentewicz and G Schmidt. Basic Books, New York, 1983. In 

American Journal of Psychiatry 1985;142:983-5

7) Gender Dysphoria: Development, Research, Management. BN Steiner (ed). 

Plenum Press, 1985 in Journal of Clinical Psychiatry, 1986

8) Gender Dysphoria: Development, Research, Management. BN Steiner 

(ed). Plenum Press, 1985 in Contemporary Psychology 1986:31:421-2 

[titled, The Limitations of Science, the Limitations of Understanding]

9) Psychopharmacology of Sexual Disorders by M Segal (ed) John Libbey & 

Co Ltd, London, 1987 in American Journal of Psychiatry 1987;144:1093

10) “The Sissy Boy Syndrome” and the Development of Homosexuality by R 

Green. Yale University Press, New Haven, 1987. In American Journal of 

Psychiatry 1988;145:1028

11) Male Homosexuality: A contemporary psychoanalytic perspective by RC 

Friedman, Yale University Press, New Haven, 1988 in Journal of Clinical 

Psychiatry 1989;50:4, 149

12) Sexual Landscapes: Why we are what we are, why we love whom we 

love. By JD Weinrich, Charles Schribner’s Sons, New York, 1987 in 

Archives of Sexual Behavior 21 (3):323-26, 1991

13) How to Overcome Premature Ejaculation by HS Kaplan, Brunner/Mazel, 

New York, 1989 in Journal of Clinical Psychiatry 51(3):130, 1990

14) Clinical Management of Gender Identity Disorders in Children and Adults 

R. Blanchard, BN Steiner (eds) American Psychiatry Press, Washington, 

DC, 1990. In Journal of Clinical Psychiatry 52(6):283, 1991

15) Psychiatric Aspects of Modern Reproductive Technologies. NL Stotland 

(ed) American Psychiatric Press, Washington DC, 1990. In Journal of 

Clinical Psychiatry 1991;52(9):390

16) Homosexualities: Reality, Fantasy, and the Arts. CW Socarides, VD 

Volkan (eds). International Universities Press, Madison, Connecticut, 

1990. In Journal of Clinical Psychiatry 1992;(10)

17) Reparative Therapy of Male Homosexuality: A New Clinical Approach. J 

Nicolosi, Jason Aronson, Northvale NJ, 1992. In Contemporary 

Psychology 38(2):165-6, 1993 [entitled Is Evidence Required?]

18) Male Victims of Sexual Assault, GC Mezey, MB King (eds) Oxford 

University Press, New York, 1992. In Journal of Clinical Psychiatry 

1993;54(9):358,

19) AIDS and Sex: An Integrated Biomedical and Biobehavioral Approach. B 

Voeller, JM Reinisch, M Gottlieb, Oxford University Press, New York, 

1990. In American Journal of Psychiatry

20) Porn: Myths for the Twentieth Century by RJ Stoller, Yale University 

Press, New Haven, 1991. In Archives of Sexual Behavior 1995;24(6):663-

668

21) Sexual Dysfunction: Neurologic, Urologic, and Gynecologic Aspects. R 

Lechtenberg, DA Ohl (eds) Lea & Febiger, Philiadelphia, 1994. In 

Neurology

22) The Sexual Desire Disorders: Dysfunctional Regulation of Sexual

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 Motivation. HS Kaplan Brunner/Mazel, New York, 1995. In Neurology 

 1996; 47:316

23) Femininities, Masculinities, Sexualities: Freud and Beyond. N. Chodorow. 

The University Press of Kentucky, Lexington, 1994. Archives of Sexual 

Behavior 28(5):397-400,1999

24) Sexual Function in People with Disability and Chronic Illness:A Health 

Professional’s Guide by ML Sipski, CJ Alexander. Aspen Publishers, 

Gaitersburg, Md, 1997. In Journal of Sex Education and Therapy, 

1998;23(2):171-2

25) Sexual Aggression by J Shaw (ed). American Psychiatric Press, 

Washington, DC, 1998. In American Journal of Psychiatry, May, 1999

26) The Wounded Healer: Addiction-Sensitive Approach to the Sexually 

Exploitative Professional by Richard Irons and Jennifer P. Schneider. 

Jason Aronson, Northvale, N.J., 1999 in American Journal of Psychiatry 

157(5):8-9,2000.

27) Culture of the Internet by Sara Kiesler (editor), Lawrence Erlbaum 

Associates, Mahway, New Jersey, 1997. 463pp in Journal of Sex Research 

in press, 2001

28) Psychological Perspectives on Human Sexuality. Lenore T. Szuchman and 

Frank Muscarella (editors), Wiley and Sons, New York, American Journal 

of Psychiatry, April, 2002

29) “How Sexual Science Operates” a review of Sex, Love, and Health in 

America: Private Choices and Public Policies. EO Laumann and RT 

Michael, editors. Chicago, University of Chicago, 2001 in Second 

Opinion, The Park Ridge Center for the Study of Health, Faith, and Ethics, 

11:82-3, April, 2004.

30) Sexual Orientation and Psychoanalysis: Sexual Science and Clinical 

Practice. R.C.Friedman and J.I. Downey (eds). New York. Columbia 

University Press. in Archives of Sexual Behavior (2003) 31(5):473-474

31) Prozac on the Couch: Prescribing Gender in the Era of Wonder Drugs, 

Jonathon Michel Metzl. Duke University Press, Durham, 2003 in 

American Journal of Psychiatry, November, 2004.

32) Sex and Gender by M. Diamond and A.Yates Child Psychiatric Clinics of 

North America W. B. Saunders, Philadelphia, Pennsylvania, 2004, 268 pp in 

Archives of Sexual Behavior April 2007 on line publication in Dec.2006 

at http://dx.doi.org/10.1007/s10508-006-9114-7

33) Getting Past the Affair: A program to help you cope, heal, and move on—

together or apart by Douglas K. Snyder, Ph.D, Donald H. Baucom, Ph.D, 

and Kristina Coop Gordon, Ph.D, New York, Guilford Press, 2007 in 

Journal of Sex and Marital Therapy,34:1-3, 2007 

34) Dancing with Science, Ideology and Technique. A review of Sexual 

Desire Disorders: A casebook Sandra R. Leiblum editor, Guilford Press, 

New York, 2010. In Journal of Sex Research 2011.

35) What is more bizarre: the transsexual or transsexual politics? A review of 

Men Trapped in Men’s Bodies: Narratives of Autogynephilic 

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Transsexualism by Anne A. Lawrence, New York, Springer, 2014. In Sex 

Roles: a Journal of Research, 70, Issue 3 (2014), Page 158-160, 2014.

DOI: 10.1007/s11199-013-0341-9

36) There Are Different Ways of Knowing. A review of: How Sexual Desire 

Works: The Enigmatic Urge by Frederick Toates, Cambridge, UK, 

Cambridge University Press, in Sexuality and Cu1ture (2015) 19:407–409 

DOI 10.1007/s12119-015-9279-0

37) The Dynamics of Infidelity: Applying Relationship Science to Clinical 

Practice by Lawrence Josephs, American Psychological Association, 

Washington, DC, 2018, pp. 287, $69.95 in Journal of Sex and Marital 

Therapy10.1080/0092623X.2018.1466954, 2018. For free access:

https://www.tandfonline.com/eprint/UgiIHbWbpdedbsXWXpNf/full

38) Transgender Mental Health by Eric Yarbrough, American Psychiatric 

Association Publications, 2018, Journal and Marital & Sexual Therapy, 

https://doi.org/10.1080/0092623X.2018.1563345 .

39) Seduced into Darkness:Transcending My Psychiatrist’s Sexual Abuse by 

Carrie T. Ishee, Terra Nova Books, Santa Fe, in Journal of Sex and 

Marital Therapy, in press 2020. 

10.1080/0092623X.2020.1757847

40) Principles and Practices of Sex Therapy, 6th edition,(2020) KSK Hall, IM 

Binik (editors), Guilford Press, New York in Journal of Sex and Marital 

Therapy in press 2020.

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