For years, I’ve been using this image on my blog to represent the perception of sex. I’ve long had an intense interest, both personal and professional, in the branch of psychology that deals with perception. In my professional career that area has been mostly focused (yes, pun intended) on early vision processes. But in my own time, I’ve always loved higher level perceptual processes. I’ll bet you, my reader, do too… as in the so called “optical illusions”.
For transfolk, the issue of perception can be of even more practical interest. To wit; how to “pass”. But before we can answer that question, we need to ask another, “What perceptual characteristics do people use to attribute a given sex to an individual?” The image above is one of my favorite “illusions”. Which face is that of a woman? Which face is that of a man? In fact, the two faces are identical. The only difference is the contrast adjustment that was applied by post-processing. Take a moment to view this video:
While contrast is important, so is chromatic cues. Women have greener faces overall, while men have redder (ruddy) faces, due to capillaries carrying red blood closer to the skin surface. Which underscores the use of cosmetics. Women use cosmetics to increase the contrast and color cues that our brains will interpret as gender cues, increasing the sexually dimorphoric cues into super-cues, as people find highly sexually dimorphic characteristics more attractive in both sexes.
But as thousands of transwomen who have had Facial Feminization Surgery (FFS) can confirm, cosmetics alone aren’t sufficient. Other cues feed our perception and attribution of sex. Certain facial shape / feature distances also contribute. Consider the images here. Which is more feminine? Masculine? The one on the left has lower eyebrows than that on the right. This shows why women tweeze their eyebrows from underneath, to increase the distance between the eyes and the brows. But this small difference is not as powerful as the other cues, all things being equal.
So far, science hasn’t really looked at the three dimensional aspects of the face. But given the obvious effects that FFS have on one’s ability to pass, they obviously have a very powerful effect. I look forward to further studies which will include these facial cues.
Dupuis-Roy, N. et al., “Uncovering gender discrimination cues in a realistic setting”
Journal of Vision (2009) doi:10.1167/9.2.10
When transwomen think of transphobic attacks, they often think of Paul McHugh. He was the adminstrator who shut down the John Hopkins Gender Clinic. Of course, looking back, it was just a tiny fraction of a blip in time before it would have been shut down anyways – as all of the clinics in the United States were – a victim of its own success. Yes, success, as their involvement in what was thought to be experimental became routine palliative medicine.
McHugh has long been the darling of the so called “social conservatives”, translation: homophobic bigots. We can see this by how ardently he is admired by the Witherspoon Institute; the same Witherspoon Institute that funded and supported the academically fraudulent Regenerus paper which purported, but in fact did not, show that children of gay and lesbian parents were emotionally harmed. In fact, McHugh has published yet another anti-trans editorial on their website.
In his editorial, he makes some rather amazing claims regarding transsexuality and transgender sexuality, mixing just enough scientific truth to sound credible. But mixed in are some amazing falsehoods, not just mistaken ideas, but outright lies,
“In fact, gender dysphoria—the official psychiatric term for feeling oneself to be of the opposite sex—belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder. Its treatment should not be directed at the body as with surgery and hormones any more than one treats obesity-fearing anorexic patients with liposuction. The treatment should strive to correct the false, problematic nature of the assumption and to resolve the psychosocial conflicts provoking it.”
McHugh correctly identified that there are two types of transwomen, autogynephilic and non-autogynephilic… but then makes the most silly comparison that those with gender dysphoria “belongs in the family of similarly disordered assumptions about the body, such as anorexia nervosa and body dysmorphic disorder” He KNOWS better, or at least, he should. Autogynephilia is NOT related to these two disorders in any way, shape, or form. By making this statement, it is clear, as his final sentence in this quote shows, that he is attempting to mislead his reader into the false understanding that psychotherapy can treat autogynephilia and gender dysphoria. It can’t.
McHugh bemoans the recent movement to outlaw the clearly ineffective and damaging practice of “reparitive therapy”, which he would like to see used to treat transkids. A careful reading of his editorial will show that he fails to acknowledge that transkids are (with respect to their natal sex) “homosexual”. It doesn’t take a super sleuth to know that the reason that he doesn’t mention this is because he would also like to see reparitive therapy used to “treat” homosexual teens under the guise of treating gender atypical / dysphoric youngsters. But he knows this is even more unlikely to be allowed if society understood that the choice for transkids is one of living as a very gender atypical gay man or lesbian, or as gender typical heterosexual transwoman or transman, respectively; but McHugh wants that to be no choice. He wants such youngsters to be “repaired” to be gender typical heterosexual adults, which he knows, but seems incapable of accepting, is an impossibility.
I’ve said it before in a previous essay, but it bears repeating. McHugh, a conservative Catholic, seeks to substitute religious bigotry for palliative medicine… and is quite willing to bend the truth to get it.
Notes: Autogynephilia, while NOT related to anorexia nervosa and body dysmorphic disorder (BDD), is related to Body Integrity Identity Disorder, a member of the family of Erotic Target Identity Disorders. This family is about sexuality and sexual orientations, which like heterosexuality and homosexuality have been shown to be very resistant to change, thus the move to outlaw “reparitive therapy”. Erotic Target Identity Disorders are far more common in men than women.
Anorexia Nervosa is a member of the eating disorders and is far more common in women than men. Interestingly, among the men, it is more common in gay men than straight, suggesting a connection with hypomasculinized brains.
Body Dysmorphic Disorder is a member of the Obsessive-Compulsive disorders.
Note that not only are anorexia and BDD not related to autogynephilia, they aren’t even related to each other!
For the record: No study has EVER shown that therapy can “cure” either type of gender dysphoria, autogynephilic or transkid. One can only come to some accommodation. Among those useful accommodations is social transition, HRT, and SRS, as was fully endorsed by the American Psychiatric Association.
Reference: Paul McHugh, “Transgenderism: A pathogenic Meme”
There’s a wonderful new study that uses the United States Social Security Administration and Census Bureau data to get a much better estimate of the number of post-transition transsexuals in the United States. The numbers line up pretty well with what we already knew, but we get additional data, like where we are more likely to live and when we transitioned.
Take a look at the map above. It looks like very few transfolk live in Utah, home of the very openly transphobic Mormon (LDS) Church. Quite a few transfolk call the West Coast home, while the North East is another inviting locale, not really surprising, but interesting non-the-less.
The study’s abstract says it all,
“This paper utilizes changes to individuals ’first names and sex-coding in files from the Social Security Administration (SSA) to identify people likely to be transgender. I first document trends in these transgender-consistent changes and compare them to trends in other types of changes to personal information. I find that transgender-consistent changes are present as early as 1936 and have grown with non-transgender consistent changes. Of the likely transgender individuals alive during 2010, the majority change their names but not their sex-coding. Of those who changed both their names and their sex-coding, most change both pieces of information concurrently, although over a quarter change their name first and their sex-coding 5-6 years later. Linking individuals to their 2010 Census responses shows my approach identifies more transgender members of racial and ethnic minority groups than other studies using, for example, anonymous on line surveys. Finally, states with the highest proportion of likely transgender residents have state-wide laws prohibiting discrimination on the basis of gender identity or expression. States with the lowest proportion do not.”
The data shows that as the population of the US grew, so did the number of transfolk. The two went nearly hand in hand, supporting my long held thesis that there had NOT been an increase in the percentage of transfolk in the population. The data shows that from 1936 to 2010, perhaps 30,000 post-op transsexuals changed their sex designation on SSA data. We know that from 1980 onwards, the SSA would only allow that to be done upon proof of SRS. Interestingly, the data indicates that the average age of name and sex change is around 35, consistent with other studies. The other really interesting thing is that about 25% of those who had SRS, changed their names about five or so years before. This is consistent with the experience of younger MTF transwomen and FtM transmen who often cannot afford SRS until later.
But, this author, using both SSA and Census records, looking at name changes, not just SRS, says,
“I am able to identify 135,367 individuals who are likely to be transgender. Of these, 89,667 were alive during the 2010 Census.”
The author noted than many of these individuals who had not changed their sex designation did so because they were FtM transmen who likely had not elected to get ‘bottom’ SRS that would qualify for such designation change under the SSA rules. This also means that these individuals were not included in the map above.
(Addendum 6/15/2015: For the past 13 years, many news sources, including the New York times and GLAAD, have been quoting an erroneous figure of 700,000 transgender people in the United States, from a highly speculative paper by Lynn Conway in which she included in the figure her estimate of closeted cross-dressers / cross-dreamers (i.e. non-transsexual autogynephiles). Here, we have solid numbers from the SSA and Cencus records, that show that there are perhaps 90,000 post social transition transgender people in the US today. Often taken by the press to indicate the number of post transition transgender people, the earlier conjectural estimate overstates the number by nearly ten fold. This lower figure also underscores the high anti-trans hate crimes and murders as a percentage of the transgender population.)
Benjamin Cerf Harris, “Likely Transgender Individuals in U.S. Federal Administrative Records and the 2010 Census”
Today is a very historic day, one I’ve been waiting for my entire life. Today the Supreme Court of the United States hears oral arguments regarding marriage equality. This is personal, and the personal is political. It matters to the Transsexual communities, both AGPs and Transkids, because now our marriages will either be validated or put into jeopardy.
To understand, we need to review a little history.
When transsexual surgery and post-op legal recognition in the US first began, it was only for single people. In fact, the first transsexual person to be recognized in her new gender was likely Christine Jorgensen, who as a single person was able to get her passport amended after she had SRS overseas in 1953, so that she might return as legally female. Since then, it has been State Department policy to recognize a legal sex post-operatively. But what of married people?
When SRS was first offered legally in the US, at a limited number of medical clinics, it was no secret that they struggled to understand who was a valid candidate. Most of the clinics refused to offer services to those that they knew to be heterosexual transvestites. And they used a current status of being married to the opposite biological sex as one such indicator. Further, these clinics were loath to artificially create “homosexuals” out of straight people. Some of this was because of internalized heteronormative values, some of it was genuine fear of legal liability. After all, if one performs what was then considered “experimental” SRS on a husband, would not the wife have legal grounds to sue due to estrangement and denial of conjugal rights? Since same sex marriages were not valid, would not their marriage also be adjudicated invalid if their husband was now legally female? Or would the courts refuse to recognize the change of sex and thus enforce the marriage? The clinics wanted nothing to do with this potential legal mess, so refused to perform SRS on married people. So, many candidates for SRS back in the ’70s got divorced, even when they remained on good terms with their female partners, just to secure SRS.
A bit of personal history. Back to 1976. I remember well the irony of sitting in a room full of AGP clients at the Stanford Gender Dysphoria Clinic, listening to a lecture from a lawyer telling the room about how to ensure that their future marriages, which he presumed to be with men when we became post-op, would be “valid”. Truly, I was the ONLY one in that room that cared for his advice! The rest wanted to know how to KEEP their present marriages to women valid ! Unlike many clinics, Stanford did NOT discriminate against gynephilic and admitted autogynephilic transwomen. Thus, the burning question on their minds was, would the law still recognize them as married and simultaneously female after SRS? Though Stanford didn’t discriminate against AGP transwomen, it did insist that they be unmarried at the time of SRS.
In a sense, the question was never adjudicated, to my knowledge, for transwomen married to women. But marriage and recognition of legal sex DID become an issue for a fair number of transkids married to men… sometimes with a positive outcome for both questions, and sometimes with a negative outcome for both questions, depending on the State and the court.
Here is how it gets personal. I’ve been legally married in the State of California since 1999, sixteen years. I love my husband very much, and with or without legal recognition, I would still be with him and consider myself his wife. But I wanted and still want our marriage to be valid and recognized. And therein lay the rub. I was born in the State of Texas, which in 1999, did NOT recognize either “sex change” nor post-operative transsexual persons marriages. Texas would not change a birth certificate for “sex change”… but that didn’t stop me from getting a “corrected” one, to correct the “clerical error” of the wrong name and sex, oopsie! So, in the State of Texas, should the court have discovered my subterfuge, a Texas court would likely have declared me legally male and my marriage void, (as happened to Christine Littleton around that time). I vowed never to live in Texas !
It should be noted that Texas has since changed its policy on transsexual birth certificates and a Texas court has since reversed precedent and declared that transsexual persons marriages to their spouses of the opposite (legally recognized) sex to be valid. Further, since California Prop. 8 was declared unconstitutional and same sex marriage is recognized, my marriage is just that much more protected from court challenge.
But there are still places and courts where this is not clear. But if a transkid’s marriage can’t be voided by declaring her legally male, ‘phobic judges will have less incentive to do so. And similarly for an FtM transman married to his wife. So it still matters to transkids that the SCOTUS decide that same sex marriages are the law of the land. And it matters even more to AGP transwomen still, or wishing to be, married to their female (or even other transwomen) partners. Let us all hope that the SCOTUS makes the right decision after the hearings today.
(Addendum 6/26/2015: BREAKING NEWS – Marriage Equality is now the law of the land in all 50 U.S. States !!!)
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.
(Addendum 7/7/2015: I got suspicious of this paper as it reads like a cherry-picked list of papers that support the brain sex hypothesis for all transsexuals, including “late onset” transwomen, so I checked into the background of the authors. Sure enough, one of the authors is transgendered. While that alone is NOT damning (after all, so am I), it does explain why this paper only referenced the studies it did, and did not include those studies that when considered as a whole, would show that while one subset of the larger transsexual population could possibly be explained by the brain sex hypothesis, most transwomen could not. This paper then can and should be considered part of the ongoing effort by some in the transgender community to deny the evidence of the two type taxonomy.)
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”