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Richard Isay's presentation brought forward many of his ideas regarding the development and manifestation of male homosexuality. Based on his many years of conducting clinical work with homosexual men, Isay concluded that, during childhood, many experienced themselves as being “different” from other boys. He shared the reports of many of his patients, who described having gender-discordant traits as children that made them feel different. He suggested that early parental admonitions and interventions to restrict or replace gender-discordant traits with more “typically” male behaviors may be harmful to the child's growth and development and may hamper intimacy in future relationships. He described how, in many of his male homosexual patients, he has witnessed attempts to avoid situations or relationships that would tend to evoke shameful, unwanted “feminine” traits. He also reported that many homosexual adults have lost their capacity to recognize or express a wide range of affects because a very crucial part of who they are was shunned or was not allowed to be expressed in childhood.
Isay's theoretical understanding of the childhood experiences of homosexual men is at odds with traditional psychoanalytic viewpoints that tend to explain the manifestation of gender-discordant traits as being preceded by traumatic childrearing experiences. Alternatively, Isay suggested that there is a fundamentally innate, biological component that largely contributes to the formation of gender-discordant traits. These constitutional traits become suppressed and renounced in response to repeated parental admonitions. While Isay's conceptualization incorporates a strong biological component to explain the etiology of homosexuality and gender-discordant traits, he emphasizes that developmental and relational problems arise due to aversive parental responsiveness to atypical, “feminine” behaviors and attitudes. Cultural issues are also an important part of Isay's theorizing, in that societ