Common wisdom says not to judge a book by its cover. But one can’t help but be struck by the uncanny resemblance between the cover of Ms. Heath’s 2006 Handbook and J. Michael Bailey’s 2003 The Man Who Would Be Queen. Take a moment to look at both, compare and contrast the two. Given the nasty fuss within the autogynephilic transwomen’s community regarding Bailey’s book, even deriding its cover, calling it transphobic and disrepectful, one can’t help but wonder if the editors at Praeger and perhaps even Heath herself, were making an insider’s editorial comment? Consider Heath’s own words, in fact the second paragraph of Chapter One, which states it clearly,
“When writing about a sensitive issue such as transsexuality, the temptation to right the wrongs is always present. However, it is equally important to offer readers a critical evaluation of what is known. By so doing, transsexed people will not be deluded by half-truths, and professionals and researchers will not be deterred by uninformed claims from disenchanted clients. This book treads a fine line between upholding the human rights of the downtrodden minority and ensuring that what is known about transsexuality and related conditions is presented accurately and understandably.”
Heath’s book was published before Alice Dreger’s history of the contretemps surrounding Bailey’s book, but I strongly suspect that she understood the wrongness of accusations against Bailey, given the cover and the complete coverage of the very material, the research into the true nature of transsexuality, upon which Bailey relied.
If I have any serious criticism of this book it is that although a wonderful aggregation of the research, it lacks the very “critical evaluation” that Heath states as a goal. Further, the work lacks a comprehensive synthesis of the voluminous data and accrued hypothesis, which was tested and found supported by them. It is left to the reader to perform these tasks. Given that in this absence, a critical analysis requires going back to the original papers, it is essential that a serious reader constantly refer to the many footnotes.
As an example of the failure to synthesize the information contained, consider how she covers the two type taxonomy and the evidence supporting it. In Chapter Five, Interesting Correlates of Gender Identity and Sexual Orientation, she writes in a subchapter, “Relations Between Gender Identity and Sexual Orientation,
“Young transsexed woman are more likely to be nonheterosexual than are older transsexed women. Transsexed men tend to be nonheterosexual irrespective of their age at transition. This generalization suggest that the independence of gender identity and sexual orientation is difficult to discern… A contentious idea is to associate heterosexual transsexed people with autogynephilia, the tendency to be sexually aroused by one’s own image as a woman. … According to Blanchard, there are only two fundamentally different types of transsexuality in males: homosexual and nonhomosexual. In his view, nonhomosexual transsexed women, that is those with a sexual preference for women, are characterized by their propensity towards autogynephilia.”
She goes on for several pages covering the research and evidence, but then fails to note later in the book that other researchers are referring to the exact same two populations and their characteristics, while a critical reader can’t fail to note them. Consider her Chapter Seven, Transsexualism as a Medical Condition and her subchapter Primary and Secondary Transsexualism,
“Primary transsexualism is distinguished by its early onset, with clients reporting memories of cross-dressing when they were young, as well as partaking in feminine activities such as playing with dolls from an early age. Primary transsexed women who often exhibit homosexual preferences from adolescence onwards frequently enjoy greater success in transition than do their older counterparts. Secondary transexualism develops after a period of possibly fetishistic cross-dressing when the client starts to assume a more permanent feminine self-identity around puberty. Often secondary transsexed women prefer sexual relationships with women. They seek initial assessment at an older age … The primary transsexed group tends to present earlier for assessment, show better social gender reorientation, have less erotic arousal when cross-dressing, and experience fewer postoperative regrets than does the secondary transsexed group. … Differences between primary (young) and secondary (older) transsexed people have some diagnostic value.”
Note the clear connection between age of transition, sexual orientation, and “erotic arousal when cross-dressing”, also known as autogynephilia. Later in the same chapter, Heath discusses Anne Vitale’s Group 1 vs. Group 3, while completely missing the obvious, that these are simply names for the same groups as Blanchard’s and for the classic dichotomous Primary vs. Secondary transwomen.
The book, while being somewhat encyclopedic, is very poorly indexed. For example, she frequently refers to researchers by name, but these names are not found in the index, making it difficult to find such references.
Even with its weaknesses, I recommend buying and referring to this handbook.
In a recent popular magazine article, intellectual essayist, Charlotte Allen wrote an extensive and deep exposition on the events of the past 15 years of the increase in visibility of the Transgender community. Encouragingly, it was unflinching in its exploration of not only the pop-psychology, but also the REAL psychology and politics. Of neccessity, this also means that she explained about the two type taxonomy, Blanchard’s role in researching it, Bailey’s role in popularizing it… and of the disgraceful behavior of the autogynephilic transwomen who attempted to shout down those who, in their research, came to support the scientific recognition that “late transitioning” transwomen are on the same continuum as transvestites / cross-dressers. Ms. Allen writes,
“Blanchard’s theory is that transgenders fall into two distinct categories whose sexual orientations, interests, choice of careers, and even, to a large extent, social class are violently different from each other. One of those categories he calls “homosexual” transgenders, whose sexual attraction, from childhood to death, is strictly toward members of their own genetic sex. Among males, they’re the extremely effeminate boys who identify as girls in early childhood, play with dolls and other girls’ toys, and shun the rough-and-tumble play typical of boys their age. Studies at Vanderbilt and the University of London have shown that 70 to 80 percent of those trans-children grow out of their trans-identity at puberty and become, simply, gay adolescents and, later, gay adult men. The 20 to 30 percent who do take formal steps toward transitioning, Blanchard believes, are a self-selected group who, thanks to their more delicate looks, can function fairly successfully as women. “They’re people who might be unsuccessful as men,” Blanchard said. — Homosexual transgender men transition early in adulthood, typically during their twenties, Blanchard observed. They account for the vast majority of transgenders in the non-Western world: from the “two-spirits” of indigenous North American tribes, to the fa’afafine of Samoa, to the kathoeys of Thailand who can easily fool Western sex tourists into misidentifying them as women. In those societies there is typically a recognized and thoroughly integrated social niche for men who identify and dress as women. The fa’afafine typically work as secretaries, nannies, and housekeepers—stereotypically female occupations. In that respect, they’re not unlike the flamboyant gay men of Western culture who carved out a recognized social niche for themselves in such occupations as hairdresser, dancer, makeup artist, interior decorator, couturier, and fashion consultant (Queer Eye for the Straight Guy). Boys and men in drag played women’s roles on stage from classical times to the 17th century, and they continue to be popular entertainers for both gays and heterosexuals to this day, as the demographics of the Kit Kat Lounge attest. — By contrast, Blanchard discovered that the predominant form that trangenderism takes in the West today involves men who, as men, have never identified as homosexual in their erotic attractions, but rather as heterosexual, bisexual, or asexual. Those men, his research revealed, tended to make their transitions in their mid-to-late thirties, or even later—at least a full decade on average after the homosexual transgenders did. Furthermore, many of those men were married and fathers before they came out. The paradigm might be travel writer Jan Morris, now 88, who spent the first 46 years of her life as James Morris, the journalist who covered Edmund Hillary’s ascent of Mt. Everest and who fathered five children before undergoing transition surgery in 1972. And many in this heterosexual population—in contrast to the homosexual transgenders on the drag scene—worked in stereotypically hypermasculine professions: They’d been parachutists, Navy SEALs, engineers, policemen, firemen, and high school football coaches. The billionaire philanthropist James Pritzker, who became Jennifer Natalya Pritzker in 2013, in his early sixties, is a retired much-decorated U.S. Army lieutenant colonel with three children by his former wife. “They’ll say that they chose those professions in order to suppress their feelings as females,” Blanchard said. “But no one put a gun to their heads to choose those jobs.” Many late-transitioning transgenders (Jennifer Finney Boylan, for example) insist, contra Blanchard, that they were aware from early childhood that they were born into the wrong body—but Blanchard thinks they aren’t being honest with themselves.”
Ms. Allen then goes on to explain how certain members of the autogynephilic tranwomen’s community took umbridge with Bailey’s attempt at popularizing Blanchard’s work,
“The Man Who Would Be Queen inflamed transgender activists. It did have certain inflammatory aspects. There was the jacket photo of the man in high heels. Blanchard’s coinage “autogynephilia” (extensively used by Bailey in the book), with its connotations of fetishism, deviance, and mental disorder, has never sat well with transgenders. Bailey was even more adamant than Blanchard that autogynephilic transgenders often lied about their erotic fascination with cross-dressing. Furthermore, Bailey observed, drawing on his previous studies, that homosexual transgenders tended to come from lower socioeconomic classes than autogynephiles, and that they tended to have short time-horizons that often led them into streetwalking, shoplifting, and other petty crimes. “Prostitution is the single most common occupation,” Bailey wrote. His book also, perhaps inadvertently, included details about “Cher” that made her real identity quickly discoverable to those in the know: Anjelica Kieltyka, a Chicago transgender woman who, although disagreeing with Bailey about his characterization of her as autogynephilic, had made frequent guest appearances in his classes and had introduced him to other figures in the city’s transgender scene. — Bailey’s book caught the immediate—and hostile—attention of Lynn Conway, now 77, a pioneer of computer-chip design during the 1970s, a longtime engineering professor at the University of Michigan, and a leading transgender activist who figured as one of Time’s “21 Transgender People Who Influenced American Culture” in its May 2014 cover story. Conway was close to Andrea James (both had been patients of Dr. Ousterhout and touted his facial-feminization techniques on their websites). James, best-known for counseling Felicity Huffman, the star of the film Transamerica (2005), on transgender voice and mannerisms, underwent transition surgery in 1996. She and Conway teamed up with Kieltyka, and with Deirdre McCloskey, to make sure that The Man Who Would Be Queen would not receive a respectable academic hearing. McCloskey’s participation in this enterprise seems odd. For one thing, her memoir, Crossing, describes her pre-transition self as having been “sexually aroused” as a young man by accounts of cross-dressing—a classic Blanchard-esque theme.”
She also notes that the science does not support the contention that “late transitioners” have female brains,
“The medical evidence for a mismatch between brains and bodies is ambiguous. The two studies cited most frequently by transgender activists, published in 1995 and 2000, examined the brains of a total of seven male-to-female transgenders and found that a region of the hypothalamus, an almond-shaped area of the brain that controls the release of hormones by the pituitary gland, was female-typical in those brains. But those studies have been criticized for not controlling for the estrogen—which affects the size of the hypothalamus—that most male-to-female transgenders take daily in order to maintain their feminine appearance.”
If I had any serious criticism of her essay, it would be in the way that she hews to the stereotype that transkids, “homosexual transsexuals”, are stereotyped as being prone to becoming petty criminals, prostitutes, and drag performers. I also found her take on the recent improvments in medicine and law regarding the treament of transchildren and teens to be unsympathetic. She gives one the impression that too many gender variant pre-teens are being pushed into iatrogenic trauma via puberty blockers, etc. While it may be true that autogynephiles may overvalue transition, most transkids and our caregivers are careful not to push children who are more likely to become gay and lesbian adults into wrong paths.
It may be uncomfortable reading, but I highly recommend that you do.
Is “Gender Identity” biological? For most people, the answer is intuitively obvious, “duh!”. Of course, for these people, they usually also insist that the markers for such identity is some privileged and testable characteristic, like genitalia, which is easy to observe, or karyotype (sex chromosome configuration) which requires a microscope. But for people with Disorders of Sexual Development (DSD), these markers may not be all that clear. Further, what are we to make of the gender identities of transsexual and transgendered people, people whose experienced / stated gender identity is at odds with all currently known sex markers? IS there a biological etiology? And is that etiology the same as that that gives rise to the gender identity of non-trans people? A recent review article attempts to answer these very questions. Sadly, I believe that it falls far short of a conclusive answer. In fact, as I will show, it invokes conclusions from several papers as evidence that are quite questionable. Further, the authors failed to note the very probable multiple etiologies for Gender Dysphoria and their associated gender identity resolutions suggested by the Freund/Blanchard two type taxonomy of MTF transsexuality. First, they reviewed evidence for a biological basis for the phenomenological existence of “gender identity” in non-transfolk which comes from those with certain DSDs,
A seminal study by Meyer-Bahlburg et al involving outcomes of XY individuals raised as females due to severe non-hormonal, anatomic abnormalities of sex development has provided the most convincing evidence that gender identity is fixed. These congenital abnormalities include penile agenesis, cloacal exstrophy, and penile ablation. For many years, female gender assignment along with surgical feminization was the dominant approach for these patients. In this study, it was observed that 78% of all female-assigned 46 XY patients were living as females. While the majority of these patients did not initiate a gender change to male, none of the 15 male raised 46 XY patients initiated a gender change to female. Thus, risk of questioning gender identity was higher in those patients raised as females than in those raised as males among 46 XY subjects with one of these conditions. A study by the same group that examined the degree of satisfaction with surgical intervention reported by patients with 46 XY genotype also found that those subjects raised as boys were considerably more comfortable with their gender identity. – Another seminal study relevant to this topic was by Reiner and Gearhart in their review of 16 XY genotype subjects with cloacal exstrophy who underwent female gender reassignment surgery. Out of the 14 individuals raised as girls, 4 announced they were male and 4 later chose to live as boys when they became aware of their genotype. The 2 individuals who were raised as males identified as males throughout life. The sexual behavior and attitudes of all 16 subjects ultimately reflected strong masculine characteristics regardless of gender assignment. Thus, children who were born genetically and hormonally male identified as males despite being raised as females and undergoing feminizing genitoplasty at birth. Although cohort size in these studies is small, these data provide the strongest evidence for biological underpinnings of gender identity. … In a study of affected subjects, gender role changes were reported in 56-63% of cases with 5 alpha-reductase-2 and 39-64% of cases with 17-beta-hydroxy-steroid dehydrogenase-3 who were raised as girls (6). These data support the concept that gender identity might be attributed to hormone milieu during intrauterine development on some occasions.
These studies are indeed very strong evidence. Looking at the data, we see that of those raised as girls, 22% of of these subjects in the first study and 57% in the second study, while in the third study, those with hormonal abnormalities, 56-63%, chose to socially transition from female-to-male. Compare that to the very, very small number of 46XX individuals in the general population who experience severe gender dysphoria and choose to transition. As an aside, the fact that not all chose to transition should not be taken as proof that gender identity is all that malleable, but should probably be taken as a demonstration that social transition has very high social costs and is not undertaken lightly. Strangely, this paper did not explicitly mention that the majority of these individuals, whether they experienced gender dysphoria or not, were exclusively gynephilic, but they did allude to it. Also puzzling was their failure to include the converse situation of individuals with 46XY and complete androgen insensitivity syndrome (CAIS), all raised as female, who are extremely unlikely to experience gender dysphoria or sex reassignment, and are universally exclusively androphilic. Or the even more interesting case of 46XX progestin influenced females raised as male, 50% of whom transitioned from male to female and all are exclusively androphilic.
Thus, they failed to explicitly show the very high correlation of brain sex with gender identity, gendered behavior, and sexual orientation. Having shown that there is indeed very strong evidence that “gender identity might be attributed to hormone milieu during intrauterine development on some occasions”, which supports the notion that gender identity has a basis in biology (as opposed to being purely a social construct overlain on observable sex differences), it is tempting to say that transsexuality, all transsexuality and transgender identity, is also the result of mismatched hormonal milieu. In fact, many transsexuals hold to just such a position.
But they would be dead wrong.
The logical leap that all transsexuals have such an etiology is not supported by the above evidence. In fact, given the very probable differing etiologies for Gender Dysphoria and their associated gender identity resolutions suggested by the Freund/Blanchard two type taxonomy of MTF transsexuality, at least one of these types must NOT have been caused by such. Blanchard went on to predict that this would be born out by studies of the sexually dimorphic structures in the brain, predicting that the exclusively androphilic MTF transsexual would show shifts toward the female morphology, while the other type would not. It is here that this recent paper has its biggest failings, in that not only did they not discuss this issue, but included very problematic studies by Swaab that purported to have shown female like shifts in non-exclusively androphilic transwomen. These papers did show the shifts in the BSTc and INAH3, but incorrectly concluded that they had existed prior to exogenous HRT and incorrectly concluded that these features in the brain were organization effects of endogenous hormones in utero, when the data clearly demonstrated the opposite, that these shifts were purely activational effects from exogenous estrogenic and anti-androgenic HRT. To be fair, they did mention that the BSTc was potentially questionable, but completely failed with regards to the INAH3, which demonstrably is not evidence for a biological basis of gender identity.
In reviewing the recent grey and white matter studies, they failed to note that it fits and supports Blanchard’s prediction, which had they done so, would have strengthened their argument for a biological basis for a conventional gender identity in exclusively androphilic MTF transsexuals. That is to say, that they experience the same feminine “gender identity” as females because their brains are female like. Conversely, they would also have evidence for a biological underpinning to autogynephiles sexuality, a non-sexually-dimporphic one, which lead to an epiphenomically generated “female gender identity” later in adulthood. (See my essay on the different origins of cross-gender identity in transsexuals.)
The authors reviewed the literature on possible genetic factors that could lead to transsexuality, noting that they were inconclusive. Totally absent in this paper was any mention of the papers that document the fraternal birth order effect found in exclusively androphilic MTF transsexuals. All in all, I was disappointed in this paper.
I found it shallow, lacking in both depth and breadth, and literally out of step with much of the literature on the cutting edge of the science.
Aruna Saraswat, MD, Jamie D. Weinand, BA, BS; Joshua D. Safer, MD, “Evidence Supporting the Biological Basis of Gender Identity” (2015) DOI:10.4158/EP14351.RA
We live in exciting times – At least scientifically. We can now peer into the heads of transsexuals to see if their brains exhibit sexually dimorphic features that match their natal sex or their preferred gender. Years ago, Ray Blanchard made a prediction, based on early evidence that there was a taxonic difference between “homosexual” and “non-homosexual” transwomen in sexuality, natural gendered mannerisms, age of transition, etc, that the former would show sexually dimorphic features in the brain that were shifted in the female direction while the latter would not, but would show features that were different than controls, but that they would not be sexually dimorphic features, and definitely not shifted in the female direction. We now have yet more evidence that that prediction is correct, giving more weight to the two type taxonomy of MTF transsexuality, namely exclusively androphilic vs. autogynephilic.
The best evidence would be to use two populations of transwomen, one known to be exclusively androphilic and the other not, and test them for the same features, using the same type of measurement. We now have that data for grey matter distribution in the brains of both types of transsexual.
In the earlier Savic and Arver paper, they compared grey matter distribution of 24 gynephilic transwomen, before HRT to that of heterosexual men and women. (Remember, HRT itself causes a shift in sexually dimorphic features due to activational effects of sex hormones, and the lack of such hormones.) The conclusion?
“The present data do not support the notion that brains of (gynephilic) MtF-TR are feminized.”
In the later Simon paper, they compared grey matter distribution of 10 exclusively androphilic transwomen, and 7 exclusively gynephilic FtM transmen, before HRT to that of heterosexual men and women. The conclusion?
“Our findings support the notion that structural differences exist between subjects with GID and controls from the same biological gender. We found that transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender in their regional GM volume of several brain areas, including the left and right precentral gyri, the left postcentral gyrus (including the somatosensory cortex and the primary motor cortex), the left posterior cingulate, precueneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and inferior temporal gyri. Additionaly, we also found areas in the cerebellum and in the left angular gyrus and left inferior parietal lobule that showed significant structural difference between transgender subjects and controls, independent from their biological gender.”
The choice to explore only “homosexual” transsexuals in this study was informed by the researchers’ knowledge of the Freund/Blanchard taxonomy and of Blanchard’s prediction, as they explained,
“Both MTF and FTM patients were eligible for the study, but only those with homosexual orientation. The rationale for this choice was based on the Blanchard typology which considers two fundamentally different types of transsexualism: homosexual and nonhomosexual. Homosexual transsexual individuals are sexually attracted to the same biological gender, while nonhomosexual transsexual individuals are attracted to either the opposite gender or show no sexual orientation/attraction at all. According to Blanchard, homosexual transsexuals are usually younger at initial presentation of gender identity disorder and show more pronounced and frequent childhood femininity, as well as different anthropometric data. One might argue that mixing individuals from both transsexual groups in one study targeting the neurobiological background of transsexualism might bias the results by introducing heterogeneity in the sample. Thus, in our study, only homosexual transsexual individuals were included preventing our findings from the aforementioned bias.”
This points to growing recognition within the scientific community that the two type taxonomy is correct. They went further, indirectly referring to the taxonomy and Blanchard’s prediction,
“In another study also limited to MTF transsexuals Savic and Arver, reported no “feminization” of any brain region with regard to structure. Nonetheless, certain brain areas (clusters ≥100 voxels) showed characteristic structural features in the transsexual group compared with both male and female control groups. Specifically, they found reduced thalamus and putamen volumes and increased GM volumes in the insular and inferior frontal cortex and in the right temporo-parietal junction (angular gyrus and superior temporal gyrus) in the transsexual group compared with both control groups. In our study, however only the angular gyrus (but in the left hemisphere) was affected among these areas, showing lower regional GM concentration in both FTM and MTF transgender subjects compared to controls, independent of their biological gender. When comparing the results reported by Savic and Arver to either our study or to other imaging studies in the literature of transsexualism, it has to be taken into consideration that their reported results were obtained from a solely nonhomosexual transsexual group of patients. The lack of real overlap between our and Savic and Arvers’ findings, despite the very similar methodology used, might at least in part be explained by the difference of the sexual orientation of the two samples.”
Truly, exiting times.
Ivanka Savic, Stefan Arver, “Sex Dimorphism of the Brain in Male-to-Female Transsexuals”
Lajos Simon, Lajos R. Kozák, Viktória Simon, Pál Czobor, Zsolt Unoka, Ádám Szabó, Gábor Csukly, “Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study”
For years, critics of transkids’ identities have made claims that transkids are either “confused”, “delayed”, or “pretending”. Many papers describing feminine boys from the 1960’s would describe them as being “talented mimics”, explicitely taking the position that men and women, boys and girls, do in fact have in-born differences in behavior, mannerisms, and motor-movements, but that these feminine boys were NOT exhibiting natural behavior, but were consciously, or “subconsciously”, observing girls and women, and learning to “mimic” these behaviors. Of course, those of us who were such and grew up to transition, have long begged to differ!
Today, we have a published paper that demolishes these notions. At the core of the paper is the ability to determine implicit associations between concepts. If you are not familiar with this tool, it may be useful to review the Wiki page on Implicit Association Testing . One of it strengths is that it cannot be “faked”. It is impervious to Social Desirability Bias or other impression management distortions. It is also impossible for someone to be “pretending”, as the cognitive load to evaluate the test set-up, determine the “right” answer, etc. would create an obvious delay in the test. Further, if a child were “confused” as to the meaning of sex and gender, there would be an obvious anomalous signature in the test results.
The study involved 32 transkids, ages 5-12, 12 FtM, 20 MTF, who have already transitioned full time, with the full support of their families. This would obviously include “early onset” transkids. However, and this is critical, we know, or at least suspect, that some of these kids will “desist” being gender dysphoric before puberty, if they follow the trend already seen in other studies, most especially the Steensma study from the Netherlands. Yet, for all of that, the results of the study show that these kids are completely consistent in their implicit gender identity and preferences as their opposite sex, non-trans, controls and siblings. They are NOT pretending, nor confused.
The folks who conducted this recent study are continuing their work, looking at these kids as they grow up. They are looking for additional transkids to join the study.
Study on Gender Nonconformity in Children
Hi from the TransYouth Project at the University of Washington! We are researchers interested in gender development in children and have a new research project we are currently recruiting families for. The project aims to better understand gender development in gender nonconforming and transgender children. Our new study takes 30-60 minutes and includes children ages 3-12. We are running the study all over the U.S. and Canada so please let us know if you are interested and we can let you know when we’ll be in your area. We are hoping to recruit gender nonconforming children as well as their siblings (where applicable). All data collected as part of this study are confidential. Payment is $10 per parent and $10 plus a small toy per child. There is an optional longitudinal component that we can tell you more about as well if you are interested. To sign up for the study, please visit: http://www.transyouthproject.org. If you have any questions, feel free to contact me, Dr. Kristina Olson, via email (email@example.com) or phone (206-616-1371). Thanks for considering being a part of this research or telling someone who might be!
Kristina R. Olson, Aidan C. Key, Nicholas R. Eaton, “Gender Cognition in Transgender Children“, Psychological Science
Thomas D. Steensma, Roeline Biemond, Fijgie de Boer and Peggy T. Cohen-Kettenis, “Desisting and persisting gender dysphoria after childhood: A qualitative follow-up study”
It has long been hypothesized that prenatal or perinatal hormone levels influence sexually dimorphic behavior in humans. The evidence from studies of people with Disorders of Sexual Development and in numerous animals studies lends strong evidence that this is true. So it would seem natural that we should ask if sexual orientation and gendered behavior in otherwise phenotypically normal individuals could also have been affected by hormones. The ultimate study would be one that longitudinally follows a large cohort of individuals from conception to adulthood, taking extensive hormonal assays while evaluating gendered behavior and sexual orientation. The problems of doing such a study for transsexuality is obvious… the cohort would have to be in the hundreds of thousands to ensure statistically significant numbers of transsexual individuals were included.
Thus, researchers are interested in finding sexually dimorphic markers that record historical hormone environments. That is to say, something that is an organizational and not an activational effect, preferably one that becomes fixed at the same period in prenatal development as organizational effects in the brain. It must be something that is observable at birth and remains stable long enough to allow us to use it to retrospectively determine ones hormonal environment after we have found our gender atypical population of interest.
I’ve already blogged about one such putative measure, the 2D:4D ratio, which is mildly sexually dimorphic, and in at least some population has a recognizably large enough effect size that we can hope that we can use it. Sadly, the results have been contradictory so far. But despair not, another such sexually dimorphic marker is available, though it requires specialized equipment to measure.
In individuals with normal, unimpaired hearing, a curious effect is found in which our inner ears respond to external sounds with sounds of their own, which is known to be mildly sexually dimorphic, as described in the abstract from a recent paper out of Europe, the first known to explore this effect as a potential probe of the role of androgens in gender dysphoria,
“Click-evoked otoacoustic emissions (CEOAEs) are echo-like sounds that are produced by the inner ear in response to click-stimuli. CEOAEs generally have a higher amplitude in women compared to men and neonates already show a similar sex difference in CEOAEs. Weaker responses in males are proposed to originate from elevated levels of testosterone during perinatal sexual differentiation. Therefore, CEOAEs may be used as a retrospective indicator of someone’s perinatal androgen environment.”
Before we get too excited about this marker, we need to look at the effect size, with is quite small at only d=0.30 in the left ear and was better in the right ear at d=0.60. You may recall that this is of the same order as the 2D:4D finger length ratios at d=0.63. This is large enough to be useful, but only if enough subjects are available to achieve significant statistical power. Sadly, this lack of enough subjects seems to be the case in this study. Too bad, because there is a hint at some exciting results in that looking at a group of gender atypical and gender dysphoric children and teens, the natal males seem to show a shift in the female-like direction, but oddly, the natal females do NOT,
“In the present study, we retrospectively investigated possible organizational effects of prenatal androgens on CEOAEs in relation to gender identity. We found that boyswith GID had sex-atypical (hypomasculinized) emissions. Their mean response amplitudes, though, were not significantly different from either the male or female controls. Thus, boys with GID had an intermediate position between the sexes in terms of CEOAE response amplitudes. By contrast, girls with GID showed emissions in the same range as female controls. Consistent with several earlier studies, sex differences in emission strengths were observed in the control group, with girls having significantly stronger emission amplitudes than boys. Our finding that boys with GID showed stronger, more female-typical emissions compared to control boys suggests that boys with GID might have been exposed to relatively lower amounts of androgens during early development. The effect sizes for the comparison boys with GID versus control boys were similar to those for control girls versus control boys, supporting the notion of a hypomasculinized early sexual differentiation in boys with GID. However, considering the lack of statistically significant differences between the control boys and the boys with GID and the relatively small sample size of subjects with GID, this conclusion may still be premature and our results therefore need to be interpreted with caution. Furthermore, our findings did not support the hypothesis of an increased exposure to androgens in girls with GID during prenatal development. Though speculative, this might reflect that GID in girls does not develop under the influence of prenatal androgens or at least not during the same critical time window as when androgens exert influences over OAEs.”
This result is surprising, in that previous studies involving gay men and women, researchers saw the opposite pattern, in that gay men showed no shift from control men, but lesbians showed a shift from the female to the male response. The most exciting times in science are when you hear, “That’s strange!” This is one of those times. Several possibilities exist. This result could just be spurious, with not enough subjects to have seen the real signal. It could be that there is an additional activational effect that occurs as children mature, that causes a shift for both gay men and gay women toward the masculine response. We may be seeing the effect of heterosexual “tomboys” swamping out the FtM signal. Or, we could be witnessing the first hint that there is a difference between transkids, both MTF and FtM, and conventionally gay men and lesbian women. Time and additional studies will tell.
Sarah M. Burke, Willeke M. Menks, Peggy T. Cohen-Kettenis, Daniel T. Klink, Julie Bakker, “Click-Evoked Otoacoustic Emissions in Children and Adolescents with Gender Identity Disorder” Archives of Sexual Behavior, DOI 10.1007/s10508-014-0278-2
Dennis McFadden, Edward G. Pasanen, “Spontaneous otoacoustic emissions in heterosexuals, homosexuals, and bisexuals” Journal of the Acoustic Society of America, http://dx.doi.org/10.1121/1.426845
A recent paper seemed to be lending weight to the hypothesis that prenatal androgen exposure dose may influence transsexuality. The papers concern the use of 2D:4D finger length ratio as a proxy measurement of prenatal androgen dose exposure. I’ve written about this before, but please allow me to cover the basics again.
The 2D:4D ratio is mildly sexually dimorphic based on the androgen/estrogen ratio during fetal development. The conventionally approved method of measuring the 2D:4D ratio is from the middle of the crease between the finger and the palm to the middle of the tip of the finger. When I measure mine, I find that for the left hand, they measure 67mm:62mm giving a 2D:4D ratio of 1.08. For my right hand, I measure 67mm:63mm, giving a 2D:4D ratio of 1.06. If you are wondering, this is an extremely feminine (hypomasculine) 2D:4D ratio, which would be very unusual to find in a western european male (mostly Irish descent).
When we do this measurement for a large population and graph it as a histogram, as shown on the right, we see that the average male hand has a 2D:4D ratio of 0.975, and the average female hand has a 2D:4D ratio of 0.995. One also notices that there is a range, a classic bell curve, of ratios. Note that they are highly overlapping, but still recognizably separate (effect size d=0.63). Thus, for any given individual, the ratio is essentially meaningless. It is only when we look at large numbers, can we average out the noise, the random factors that push the measurement one direction or the other, that we can see a real signal that might give us interesting clues to scientific questions. Different ethnic populations show different average and effect sizes, so it is important that when conducting a study of this type, that the controls be from the same ethnic population as the subjects.
In the Vujovic paper, they compared a group of FtM and MTF transsexuals to controls, all of whom were ethnic Serbs. The paper was very confusing in that in the text, they use the conventional 2D:4D ratio. But the accompanying bar chart, shown on the left, appear to have flipped this for some, but not all, to use 4D:2D ratios ! This kind of error should have been spotted during peer review. (I’ve seen exactly this kind of error in the papers that I’ve reviewed for journals… it is common to find mislabeling of figures, etc. due to multiple contributing authors.) So, let’s ignore the bar graph and look at the numbers?
“Our study found larger 2D : 4D for right hand in control males, compared to left hand (0.928 versus 0.935). Control female exhibited, as well, larger 2D : 4D for right hand, compared to left hand (0.921 versus 0.945). Control males left hand ratio 2D : 4D is lower (0.935) than in female left hand control (0.945) while there were no differences for the right hand (0.928 versus 0.921).”
Oh dear… if you follow that text carefully, one realizes that once again, something is messed up. The larger numbers were supposed to be for the right hands in the first two sentences, but now it appears, from the third sentence, that the opposite is true. Once again, it appears that the ratios have been flipped from 2D:4D, to 4D:2D in the numbers in the text, but that the original writer of the words had intended to use the conventional 2D:4D ratio… but someone inserted the flipped numbers at some point. (Again, this should have been caught at peer review!)
So what is going on? Clearly this paper could NOT have been peer reviewed, since if it had, these simple and inexcusable errors would not have been allowed in the final version of the paper. The answer is simple. The journal in which this paper was published is NOT peer reviewed. In fact, it is an egregious example of what many in the scientific community are calling “predatory publishing”, as Jeffrey Beall explains,
“An example of a gold open-access journal is The Scientific World Journal, currently published by Cairo-based Hindawi Publishing Corporation. This megajournal covers virtually all scientific fields and imposes an article processing charge of $1,000 for each accepted article. “
As Beall has pointed out, because this is not a peer reviewed journal, not even a subject focused journal, quite literally (not figuratively) anyone can publish ANYTHING in these journals, most especially this one, as long as you pay the publishing fee. The process of academic science depends upon peer review to keep everyone honest, to keep junk science, non-science, erroneous and, most especially, fake data out of the publications. This “journal” does none of that.
Thus, this paper is of questionable value to the scientific community… and especially to the trans-science-skeptic like me. How can I trust the data presented? How can anybody? We can’t. I don’t.
Addendum 1/16/2015: In doing a bit more research into this journal, its publisher claims that it uses a single-blinded peer review process. But, I’m still convinced that it could NOT have been properly reviewed. It took me only a few minutes to realize that the graphs, text, and numerical values were messed up. One would NOT need to be a specialist to see the error, merely scientifically literate.
Addendum 2/17/2015: I wrote to the lead author of this study asking for the correct data. She didn’t bother to read my letter, nor this blog post, with any depth, because her response was non-nonsensical, starting with misgendering me, likely not understanding that the name “Kay” in English denotes a woman’s name, not a man’s. But in any case, it means that she hadn’t bothered to look at my blog post, nor my “about” page:
Thank You for Your kind email.
Figure 1 was excluded from the paper because men created it made a mistake (incidentaly he took data from another study).
I am sorry for this mistake. All other data in the text are correct.
We followed up transsexuals since 1989. and have many interesting data. So, if You have any interest we can have further successfull cooperation.
Vujovic et al., “Finger Length Ratios in Serbian Transsexuals”, The Scientific World Journal
A new argument was presented to me just yesterday involving the well documented fact that among those who transitioned as teenagers, far fewer report having experienced autogynephilia. What made the line of argument ironic was that the proponent had started out in absolute denial of any of the science and most especially of the the notion that autogynephilia existed in some transsexuals, “autogynephilia my ass!” However as the debate developed, she presented a novel take on the Nuttbrock data that I presented, to wit that in that study, 82% of self-reported exclusive gynephiles reported sexual arousal to cross-dressing, while only 14% of those who had begun HRT as adolescents (defined in the Nuttbrock study as before one’s 20th birthday) reported such arousal.
Here’s where it gets interesting: In an effort to win ANY point she could, she took the position that I was twisting the data to suit my position… yet in so doing she had to take the position, for her arguments’ logic to work, that autogynephilia is a UNIVERSAL phenomena among MTF transsexuals. I had to laugh privately, since this reversal of her position would obviate all of her previous positions and support some (but not all) of mine. Interestingly, this argument of universal autogynephilia mirrors the argument proposed by another contingent of autogynephilic transwomen, that autogynephilia is also normal and expected in natal women. I find it doubly ironic that there is such an extreme reaction to the two type taxonomy, but from two camps, those that deny any autogynephilia in transwomen, and those who insist that their autogynephilia is just part of being a woman, and thus, all transwomen must also be autogynephilic.
Her argument also starts with several assumptions that are not supported by the data, nor by community observation. She assumed first that HRT in these teens meant “puberty blockers” and that such blockers would preclude an individual from experiencing any sexual arousal. It wasn’t made explicit, but she may also have been making the false assumption that even traditional HRT precludes any sexual arousal. (I’ve heard several “late transitioning” transwomen make this statement, likely due to their own personal experience, while real for these individuals, is neither universal nor inevitable. From casual observation, it seems to occur more frequently in more senior transwomen than younger “late transitioning” transwomen. And from personal conversations with a fair number of transkids, not one had experienced this phenomena.)
So, she explains the significant difference between these adolescents (of whom only one had identified as gynephilic and 7% as bisexual, with the remaining 93% identifying as exclusively androphilic) and the gynephilic (all but one of whom had begun HRT as adults or had never had HRT, and yes, that one individual is in both groups… I couldn’t back her out of the data), as the adolescents not experiencing sexual arousal to cross-dressing due to them not experiencing sexual arousal in general.
So, having convinced herself that she had won her point… she began to crow that I was the one who was not willing to look at reality!!!
Ummm… Not so fast.
Hypothesis were meant to be tested.
I’ve already pointed out the canard that HRT stops sexual arousal in all transwomen. If it did, would we be having sex as often as we do post HRT and SRS, especially transkids? It simply isn’t true. Second, it is extremely unlikely that these youngsters were all on puberty blockers (e.g. Lupron) as it is still a fairly rare protocol. It is typically initiated by well meaning parents bringing their extremely gender dysphoric pre-adolescent children to specialists. While I would wish that all parents were so willing to medically intervene and save their transkid from the damaging effects of endogenous hormones, it is still a rare parent who does so. Most transkids have to fight to get medical help… and many never get parental support, either waiting until they are legally of age, running away early, or getting HRT “on the street” surreptitiously.
Although the Nuttbrock study did not give us the fine detail I would have liked regarding the exact ages which folks started HRT, we know that half of those who identified as androphilic and had started HRT did so before the age of 20. That also means that half did NOT. From other studies, we know that the age of 20 is the median and the mode, that most androphilic transwomen start HRT, not right at puberty, but nearer age 20, showing a Gaussian distribution centered on age 20, with the bulk having started HRT between the ages of 17 and 23 inclusive. This is enough after puberty to have allowed them to experience that first flush of sexual awakening that accompanies the onset of puberty and adolescence.
We know from countless personal narritives of autogynephilia that those early years of adolescence are typically when sexual arousal to autogynephilic imagery, most especially to cross-dressing, stereotypically in women’s lingerie, is the most obvious and intense. Thus, IF these youngsters who began HRT as teens were universally autogynephilic, they would have had ample time to experience it in all of its intensity, before begining HRT, even if, as was argued, HRT would preclude experiencing it!
Looking further at the Nuttbrock study, only 40% of the self identified exclusively androphilic population had started HRT before age 20. If this argument that HRT in adolescence explains the reduced number reporting autogynephilic arousal to cross-dressing, we would expect that those who did NOT start HRT as an adolescent to report at the same rate as the other sexual orientations. Of those who self-identified as androphilic, all of those, including adolescent onset HRT, adult onset HRT (40%), and not on HRT (10%), the combined population had 23% report autogynephilic arousal to cross-dressing. A little algebra and a calculator will show that those who were NOT adolescent onset HRT were reporting at the rate of 29%, far lower than the 82% of gynephilic transwomen, and even lower than the bisexually identified transwomen who reported at 67%, and the asexual at 66%.
Thus, even if HRT did what my erstwhile debating partner claimed… the data STILL would NOT show that self-reported exclusive androphiles report less than half the incidence of autogynephilic arousal to cross-dressing. We would instead expect the later onset HRT androphiles to report at rates that were at least similar to the bisexual population.
OH… and a note on why I keep using the term “self-reported”: There is, unfortunately for our research purposes, a well documented phenomena of “late transitioning” transwomen misreporting their sexual orientation. It is quite possible, even probable, that the 29% rate of adult onset HRT and no HRT, is from a number of such misreporting older transitioners.
Thus, I’ve outlined my theoretical and evidence based reasons why this novel hypothesis is not supported by the data. Instead, the data supports the two type taxonomy for MTF transsexuality, namely “exclusively androphilic vs. autogynephilic”.
To those who understand the limitations and implications of sociological and psychological studies, I’m sure that the above explication of the data is sufficient. I’m equally certain that to those who are in denial of this research and of the Fruend/Blanchard transsexual taxonomy, what I’ve outlined above will only back them further into their denial.