On the Science of Changing Sex

An Old Essay

Posted in Editorial by Kay Brown on May 19, 2018

TransGender Theory

{Note:  I wrote this essay twenty years ago for my TransHistory class website.  I believe it is useful to look back and see where we were and note how much more we have learned.}

To understand the history of transgender people, one must also understand how both transgendered people themselves, and non-transgendered people explained the presence of such apparent misfits in the otherwise neat binary sex/gender social fabric. One can understand how law, medicine, and society in general treated transgendered people only within the context in which the transgendered person fit into a theoretic framework. If transsexuals were a medical entity, one still needs to know if it is a psychiatrically pathological entity, or a developmentally intersexed entity. If the former, one would expect that “cures” would be attempted, if the latter, then compassionate, though not always welcome, medical treatments might be applied. The law could see the transgendered person as a civil identity question, a criminal pervert, or as a medical entity. The law’s treatment very much depends on the explanatory world view surrounding the transgendered in society.

Judeo-Christian-Moslem culture, drawing on a single verse in one old testament book, Deuteronomy 22-5, held that cross-dressing was an “abomination in the sight of the Lord”. Some biblical scholars hold that this line refers to a prohibition of the Hebrew people from participating in religious practices of the neighboring cultures, which included the followers of Cybele whose priestesses were post-operative male to female transsexuals. This single edict, surrounded by edicts that are seldom if ever followed today, save for the Ultra-Orthodox Jews, is sometimes quoted as sanctioning the worst transphobic treatment of transgendered people. Other old testament laws detail the status of “eunuchs”, males whose genitals have been surgically removed. Primarily these laws prescribe a second class status to the eunuch, since they are no longer “men”, they do not have male privileges, including the right to “testify” in court… since they no longer have the required equipment, testicles. (This is not a pun, but literally the origin of the words… one needed testicles to testify… and the old testament really does refer to the story, or testimony, of patriarchy.) Thus, built into Judeo-Christian-Moslem is the assumption that MTF transgendered people are untrustworthy abominations. This explains why Judeo-Christian-Moslem cultures have mistreated transgendered people while other cultures have either tolerated, or sometimes, venerated transgendered people, why Joan d’Arc was burned at the stake for wearing men’s vestments as well as armor, while the hijra of India have houses that have been in existence for hundreds of years.

Early in this century, as the United States population moved to the cities, transgender people, though extremely rare, started finding each other, just as they had in other city cultures in more populated countries as China and India. These gatherings of transgendered people were noted by their neighbors. These good people, educated in Christian values, complained to the civil authorities, who duly passed ordinances outlawing transgender expression, society, and existence. It was the cities who passed the laws against transgendered people. It must be noted that these laws were passed in the same climate and time that produced laws prohibiting citizens of African descent from owning property in the city limits, or of Catholics to operate schools. It should be noted that while the cities passed ordinances against transgendered people, the States were concerned with criminalizing homosexual conduct. City police, when they wanted to harass homosexuals, used the ordinances against the transgendered as more visible targets. Thus, the Stonewall riots of 1969, naturally began with the standard sweeping arrests of transgendered people. The ordinances began to be repealed in the 1970s. It is perhaps fitting that the first governmental bodies to atone for past discrimination by passing anti-discrimination measures in the 1990s should be the very cities that once had laws designed to expose them to criminal sanction.

Laws criminalizing homosexuality were also used to incarcerate or force medical treatment on the transgendered. In the name of eugenics, homosexual and transgendered people were sterilized against their wills. Later, when hormones became available, various medical treatments were devised. Some sought to reduce the libido by suppressing natural hormones, others sought to replace putatively low hormones. These actions were done under the theory of enlightened criminologists that many lawbreakers were rehabilitatable using modern medicine. It was rarely questioned in law enforcement that the law itself was in need of rehabilitation. But there were movements to do just that, lead by social reforming physicians such as Magnus Hirschfeld in Germany.

There were times, when the transgendered person came to the attention of the courts through the medical establishment, rather than the police, when compassionate justice prevailed. Until the mid to late century, the prevailing mechanism for transgendered people to gain protective legal status was to seek a change of sex status through correction of birth certificates or registry in the same manner as was done in cases of intersex, where physicians provide for a ‘second opinion’ as to a person’s sex later in life. The law literally saw transsexuals as a form of intersex and helpfully corrected sex designations when asked. It was not until the popular press created the myth of “sex change” that the law began to see transsexuals as separate from intersexed people. Only after this change in perception was it necessary for specific statutes needed to secure a mechanism for transsexuals to change birth certificates and identification cards. Even then it was done as an extension of the intersex theory, a reaffirmation, to counter the “sex change” paradigm.

At the turn of the century, the concepts of sexual orientation and gender identity were conflated. One was either a normal man or woman, or one was an abnormal psychosexual invert. In some respects this concept is closer to the modern concept of the classic transsexual in that it was conceptualized as a person who both identified with and shared the same sexual object as a normal member of the opposite sex. Only through education by the homophile community and open-minded sexologists such as Evelyn Hooker and Alfred Kinsey was the homosexual person viewed as having a congruent gender identity, merely finding one’s own sex to be the chief object of amorous affections. This left the concept of gender identity separable from sexual attraction, opening the door to conceptualizing the categories of the lesbian identified male to female and the gay male identified female to male transsexual. Still, it took the work of FTM transman Lou Sullivan in the late ’70s, early ’80s, to get the medical establishment to recognize the distinction.

{Read my 2009 essay on how this perception of separability of gender identity and sexual orientation actually works against understanding transfolk:  The Invisible Transsexual}

There are three main currents of thought on the origin of gender identity in humans, Essentialism, Social Constructionism, and PsychoSocialism. In academic circles these differing theories are hotly debated. But in the lives of ordinary people, especially transgendered people, the model that is applied by the medical, educational, legal, and even parental authorities that transgendered people interact, as individuals and as a class, deeply influence the interaction and the outcomes.

PsychoSocial Theories

Though Sigmund Freud was from Austria originally, his work influenced North American thought to a greater degree than European. His thoughts on the developing sexual identity and sexuality of infants and children profoundly influenced how transgendered people would be viewed in North America. Freud felt that gender identity was mediated by the existence or absence of a penis, directly. In the case of the owner of a penis the discovery that not all humans have one occasions deep anxiety lest that delightful organ of pleasure might be removed. This “Castration Anxiety” led to a distancing of the owner of the penis from the caretaker who did not own one… presumably because that person might want to steal it. While simultaneously, the owner of the penis wishes to emulate the other caretaker who by good fortune still owns a penis. Thus the owner of a penis learns to be a boy. Meanwhile, the infant who does not own a penis discovers that there are individuals who do own one. This occasions extreme jealousy. This “Penis Envy” leads one to court, and compete for, the affections of the caretaker who owns this marvelous appendage, while simultaneously emulating the caretaker who does not own a penis, who demonstrates ways of successfully courting the affections of the owner of a penis. Thus the one who lacks a penis learns to be a girl.

The existence of transgendered people brought the theory a serious challenge. How to explain people who end up having the exact opposite reaction to the presence or absence of a penis? The first answer of any theorist to such a challenge is denial, “transgendered people are psychotic”, likening the transsexual to a delusional man who believes himself to be Napoleon. This glib answer sufficed for those who had never actually spoken at length with transgendered people. But the diagnosis of psychosis failed to hold up upon examination. The challenge remained.

For FTM transgendered people the failure to resolve “Penis Envy” was enough explanation. But MTF trangendered people were still a mystery. The psychoanalytic theorists response was to posit a family constellation involving an overly close mother, who kept her son wrapped up in her emotional world, and a distant or absent father. The son could not make the emotional and subsequent identity break with his mother. Perhaps we can call this theory “Castration Envy”? This seemed at first glance to hold up well, since such family histories were indeed present in MTF transgendered people. Except it didn’t explain all of the cases since many profoundly transsexual MTF individuals had extremely good relationships with their fathers. The theory further broke down when comparing the statistics with non transgendered people. The were many families with an absent or emotionally distant father, the vast majority of single mothers, whose sons did not show signs of being transgendered. Though it remained popular to blame mothers, especially single mothers for all sorts of society’s woes, transgenderism was not able to hold up as being caused by family dynamics when tested statistically.

Still the psychoanalytic model held for most of the 20th Century, in spite of repeated failures of psychoanalytic therapy to dissuade transgendered people to abandon their gender identity. It is probably responsible for the prevailing attitude that Gender Identity Disorder is a psychiatric illness as defined by the American Psychiatric Association’s Diagnostic and Statistic Manual.

Toward the middle of the 20th Century, as the psychoanalytic model for all mental illness began to be cast into doubt, a new model of gender identity came into vogue, “Imprinting”. One the chief proponents of the theory was John Money, Ph.D. Observing that intersex infants with the same physical features at birth who had been assigned to different sexes both seemed to adjust equally well, Money theorized that there was a critical period in the infant’s early life when the parents’ sexually dimorphic treatment imprinted upon the child a congruent gender identity. The notion of imprinting comes from observation that some animals imprint the image of a caretaker in infancy. The popular image is that of goslings first sight of a farmer’s child, who subsequently is followed around as “mother”. This lead to the standard procedure of early genital surgery for intersexed infants to unambiguously assign a sex, any sex, to child so that an unambiguous gender identity will be imprinted by parents and family who “know” the childs sex. It lead to a medical ethic of misinforming even the parents as to the intersexed nature of the child. It also resulted in sterilization of thousands of male children, who born with a phallus too small to be comfortably described as a penis were reassigned as female.

Transgender people were explained by the imprinting theory similarly to the psychoanalytic model, blaming the mother. Again, an overly emotionally close mother, and sometimes the father as well, coset and pamper a male child in a manner that the hapless male child gets the message that it is female. Sometimes it was noted that the feminine male child was “physically beautiful”, that is, like a pretty girl child, eliciting a response from adults in a manner that reinforces the mistaken identity as a female child. Similarly, a physically adventurous female child might elicit masculinizing responses.

Money’s hypothesis and recommendations lead directly to the tragedy and “experiment of opportunity” of John Theissen, a man whose penis was accidentally destroyed during circumcision. Mr. Thessien was later surgically reassigned as female. His parents then proceeded to raise him as their daughter, while his identical twin brother served as “control”. When the children we several years old the clinics declared that the reassigned child was accepting “her” gender as a girl. The case became known as that of John/Joan. Money published this case as proof of his hypothesis. Unfortunately, John Theissen as a teen refused to continue the program, insisting that he was a boy… he grew to be a man, obtained phalloplasty, married, and is raising three children from his wife’s prior relationships. It can be said that his is a case of surgically created transsexuality, as his personal gender identity was at odds with his sex assignment as an infant. Mr. Theissen’s story was published in Rolling Stone magazine in the mid ’90s after a scientific paper was published by Milton Diamond, a proponent of pre- and neonatal hormonal brain sex differentiation.

{Sadly, we later learned that “John”, actually David, committed suicide, a tragic end to an evil experiment conducted on an unwitting child.}

Social Constructionism:

As the Second Wave of Feminism grew in strength, criticism of discrimination against women led to a reaction to prescribed restrictive societal roles for the sexes. “Biology is not destiny” became a rallying cry. What started out as a criticism of socially constructed roles developed into a theory of gender which denied Essentialism in every form, stating instead that society took the biological differences of procreation, and instilled in them an artificial behavioral difference. The theory, thus expanded, denies that there is any natural basis for gender identity. Thus it denies to transgender people any rational cause… while at the same time, presenting no reason why not.

To some authors this meant that transgender people were free to express themselves in any manner they chose since all gender expression is as valid as any other. Only societal convention stands in the way of such freedom. Such conventions can be modified by the society as is deemed desirable. To some, all such restrictions are to be avoided, in a live and let live ethos.

Other authors, Janice Raymond and Germain Greer being notable examples, saw MTF transgender people as exploitive of women, aping the forms of femininity, supporting the artificial sexist forms that oppress women. It is interesting that in this regard they exhibit a hidden Essentialism, one that focusses on the genitalia as defining classes of human beings. They decried the restrictions on one class, while despising those of the other class when they break those very restrictions.

Still the existence of transgender people poses a challenge to the social constructionist theory. One must explain both why gender identity exists, how it is perpetuated, enforced, and why some rare individuals “chose” to express a gender identity at odds with societally prescribed gender expression norms.

Performance Theory has it that we are taught to Perform Gender, to act it out, in the same way that we learn to act out social roles like teacher, student, friendly store clerk, police officer, etc. One is said to “do gender” rather than “have a gender”. This is very similar in basics to the psychosocial theory of imprinting, save that there is no instinctual basis for having the ability to absorb a particular gender identity. We are taught a set of gender behaviors that become so ingrained as habit that we forget that we are merely acting them out.

Transgender people are explained by this as having been improperly instructed. Even among those inclined toward psychosocial models as one would expect physicians to be, one finds this theory in currency. It is the model used in justifying Behavioral Modification Therapy to treat Gender Identity Disorder in children. Under the assumption that even though gender identity is arbitrarily socially constructed and taught to children, one should not allow children to express gender behavior different from the norm. Some rationalize it on the basis of wanting the children to fit in, experience less rejection and bullying, a “blame the victim” mentality. Others are simply moralists that insist that God has ordained that we should all behave in a certain prescribed manner.

One Post-Modern philosophical theory, one that has a striking resemblance to the psychosocial theory that transgendered people are simply crazy, has it that transgendered people are suffering under a “false consciousness”. That they are not really experiencing a gender at all… but an alienation from their social and biological reality. This theory is perhaps the most transphobic of all theories in that it denies what is called in Post-Modern cant, “agency”, the characteristic of experiencing and expressing their existence and very real psychic pain.

Oppression Theory starts from the assumption that transgendered people are very much in command of their faculties and have made a rational decision to avoid societal restrictions on desires they experience. The usual script is that an ambitious woman noting that she is unable to succeed “in a man’s world”, dons mens clothes, assumes a fictitious identity as a man, in order to achieve career success. These “passing women” are the darlings of the feminist historian because they are revered as daring pioneers for women’s liberation, or they are held as examples, proof, of how horrible conditions were in some past epoch. To the feminist historian, modern FTM transsexuals are an embarrassing disproof of the theory. Similarly, Oppression theory is used to explain modern MTF transgendered people as being examples of internalized homophobia in gay men, too ashamed to live openly, and so have to “pretend” to be women in order to express their desire for same-sex relations. To such gay male chauvinists, the fact that half of transgendered people identify as lesbian or gay male after transition, are an equally embarrassing disproof of the theory.

Social Constructionist theories fail to note that ethnobiological studies of sexually dimorphic behavior in animals is not socially constructed for non-humans. Nor does it explain the cross cultural similarity and temporal stability of core gender identity throughout history around the world.

Essentialism:

Essentialism posits that men and woman are “made that way”. It is a deceptively self-evident fact that most everyone accepts since, for over 99% of the population, there is a clear-cut correlation between genital morphology and gender identity. It is easy to for the average person to ignore the disquieting cases of intersex that cast doubt on the simplistic assumption of binary sex assignment. The question of which sex an intersex person “really is” demonstrates the essentialist bias through much of Western Society for the past two centuries. Historically, Essentialism divided on which of two somatic characteristics was indicative of the “real sex” of an individual, genitalia or gonads. For most people the genitalia, the presence or absence of a penis was the overriding feature. As medical science grew more sophisticated in the 19th century, the gonads came to be the indicative feature. But early in the 20th Century the newly discovered chromosomes, specifically the presence or absence of the “Y” chromosome, became the newly crowned final arbiter of “real” sex. The faith in microscopic examination to “scientifically” determine one’s sex was unquestioned.

In 1968 the International Olympic Committee instituted chromosomal karyotyping for all female athletes. Any that did not have the required 46,XX chromosome karyotype were disqualified from competition, informed that, scientifically speaking, they were not women. The demonstrable fact that they had female genitalia, had lived as female all of their lives not knowing that they did not have the officially approved karyotype for women, did not enter into the unfeeling officials minds. Reductionist Essentialism had no room for intersexed people. They were counselled to fake an injury, slink away into silence to keep their shame of being “not female” from becoming known.

In 1970, the Corbet vs Corbet decision to nullify the marriage of a MTF transsexual to a non-transsexual man used karyotyping as the “scientific” marker for sex and gender that the law was henceforth to follow in the United Kingdom, throwing the legal status of transsexual and many intersexed people into limbo, neither male nor female.

Although essentialism has often been used as a philosophy to ‘prove’ that transsexuals and transgendered people do not have a valid claim to their identity, Essentialism still has explanatory power. If the locus of gender is found, not in the genitals or chromosomes, but elsewhere, transsexuals could be rationally described as “men trapped in women’s’ bodies” or “women trapped in mens’ bodies”. There are several loci that are, or have been proposed as the Essential Seat of Gender, but they come down to two main categories, “Brain Sex”, and “The Soul”.

Many religions have a concept of an essential self, separable from the body. In Judeo-Christian-Moslem belief systems one’s soul separates from the body after death. This soul retains the sense of self, including gender identity. Some religious thought includes the concept of the soul entering the body at some point in becoming a living being… and therefore must become, or always have been a gendered self. For religions that included the concept of reincarnation, the notion that a being always returns to the same-sex body suggested an explanation for transgendered identity. Once in a while, a soul finds itself in the wrong sexed body. This idea was openly discussed in newsletters published in the ’60s and ’70s by the Erickson Education Foundation, as this was the personal belief of Reed Erickson, the Foundations benefactor. The Church of latter-day Saints (Mormon) debated the issue of pre-born souls finding themselves in the wrong body with Kristi Independence Kelly in 1980 at her excommunication. The Church held that, though the pre-born souls did have a gender before birth, God did not make mistakes: “There is no such thing as a man in a woman’s body or a woman in a man’s body” was declared, ex-cathedra by the leader fo the Mormon faith. Apparently, intersexed people must have also intersexed souls?

Some non-Judeo-Christian-Moslem cultures held that transgendered people were indeed gendered souls in the wrong body. Some believed that this juxtaposition have the transgendered person a special status with the spirits of nature or the powers. In ancient times in the mediterranean culture, MTF transsexual women became priestesses, Galla, of the goddess, Cebele. The Hopi Nation held that a transgendered spirit, or katchina, sent visions to transgendered people. In India, the hijra, transgendered and intersexed people are both reviled and revered, given varying circumstances. Mystical Essentialism has played an important role in various cultures, including our own.

The early 20th Century european researchers and medical practitioners believed that gender and sexual behavior in general are the result of a sexually dimorphic brain. That is to say that the brain itself has a sex. This sex usually conforms with the chromosomal and the genital sex. However, just as there can be chromosomal and genital intersex conditions, the brain might also exhibit intersex morphology leading to behavior and that elusive personal experience, gender identity, at odds with either somatic or chromosomal sex. Magnus Hirschfeld, a leading early researcher described the entire spectrum of what today we would call Queer expression, gay, lesbian, bisexual, transgender, transsexual, as forms of “Sexual Intermediates”, or intersex. This was not a metaphor or a rationalization. Instead it was an earnest theory, based on careful observation and scientific generalization, understanding the then current lack of neurological science. Hirschfeld and his colleague, Harry Benjamin believed that as our understanding of the brain grew we would discover just where and how the brain was organized to produce sexual orientation and gender identity. For Hirschfeld, there was no major divide between non-conforming sexual orientation and gender identity, they were simply different forms that intersex could take. Thus for Hirschfeld, the late 20th century division between the concepts of gender identity and sexual orientation, the great political divide between the gay & lesbians and the transgender community would be meaningless. To Hirschfeld, we are all transgendered, gay and transsexual alike.

In the first decades of the century, experiments with cross sex gonadal implants in animals suggested that there was a connection between hormones and gender specific behavior. This lead to horrific experiments in humans during the NAZI era and beyond as hormones became available as a common pharmaceutical. Testosterone was administered to gay men and MTF transgendered people in an attempt to ‘cure’ them. The hormone treatments had no effect on the sexuality or gender identity of the experiments. No lasting harm was done to the gay men. But the supermasculinizing effects on the transgendered victims was severely traumatizing.

In the later decades of the century, neuroscientists found significant sexual dimorphism in microstructures in the brains of animals and humans. Experiments on rats indicated that hormone levels during a period in late gestation and early post-natal development to be critical to the development of these structures and subsequent behavior. Gorby was able to create what he described as a laboratory model of transsexuality in rats. He demonstrated this in both MTF and FTM cases. When he introduced them to each other, the FTM rats mounted the receptive MTF rats.

Using human children to explore gender identity and sexual orientation would be extremely unethical in the laboratory, but science often uses “experiments of opportunity”. Simon La Vey used autopsy material from straight and gay men who had died from aids to find that a small microstructure of the brain differed in the two populations, suggestive of a sexual orientation controlling microstructure. The same technique of using autopsy was performed by Swaab to discover a different structure associated with gender identity. Shaffer, in an as yet unpublished study, used MRI data from a large pool of controls, MTF and FTM transsexuals to demonstrate that the corpus collosum showed sexually dimorphic structures that, on a statistical basis, correlated with gender identity. Both Swaab’s and Shaffer’s work ruled out effects of hormones in adulthood.  {Note: We have since learned that this was simply not correct.  HRT was indeed the cause of these effects.}

The early data is tantalizing, and agrees with laboratory findings using animals. However, it is also known that experience can shape the brain. Lack of sensory stimulus and a chance to work out problems leads to dramatically less brain development in infantile rats. In humans there is a suggestion that early musical training affects the shape of the corpus callosum, building greater connectivity between the two hemispheres of the brain. These early experiences suggest that early gender experiences could also lead to sexual dimorphism in the human brain by a similar mechanism. This would agree with Dr. Money’s imprinting hypothesis… But would be at odds with Gorby’s work with rats, and the results of the case of “John/Joan”.

Science could very well demonstrate that the seat of sexual orientation and gender identity is located in the brain. How that arises developmentally is still open for further research.

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