On the Science of Changing Sex

Baby Hunger…

Posted in Editorial, Transsexual Theory by Kay Brown on July 9, 2017

female_scientistOr, Rubbing Salt Into the Wound

A couple days ago, a young androphilic transwoman from Portugal, who has been a correspondent for several years, since her late teens, wrote to me asking my opinion of androphilic transwomen’s desire for children.  She, like me, definitely has always desired to be around and to mother children.  She had recently been employed as a caregiver at a children’s group home and had loved it.  She recently entered nursing school and looks forward to someday marrying a loving man and adopting children, preferably babies.  She thought it was be a good idea for me to write an essay on this topic.  So, here it is.

Stoller, in his 1968 book, Sex And Gender, described androphilic transwomen as ardently wanting children including mothering, indeed bearing, infants,

sex-and-gender-the-development-of-masculinity-and-femininityThe ultimate progression for the transsexual … has not yet been reached in our society: he would not only like to have is body appear completely female but he would like to have his internal organs so changed (for example, by transplants) that he would now have is own functioning ovaries and uterus, ultimately to bear a child truly his own.

Stoller described a typical androphilic transwoman and concluded with “The patient is now married and hopes to adopt children.”

When I was first interviewed by Norman Fisk at the Stanford Gender Dysphoria Clinic as a 17 year old in early 1975, I told him of my hopes and dreams of finding a husband and adopting children.  I recall telling him about how much I enjoyed the two summers I had spent as a swimming instructor teaching very young children and of the then previous summer employed as a nanny taking care of two boys, aged four and ten, from early morning to dinner-time.  I had of course, actively sought out babysitting jobs all through Jr. and Sr. high school, with a promise to all of my regular families that I would break any previous engagement for a job.  I don’t remember him making fun of me.

I achieved both of these goals, though it took a lot longer that I had anticipated.  There were many things that had to be achieved first and many pit-falls to avoid along the way.

There are many obstacles for androphilic transwomen to overcome before becoming an adoptive parent.  First, one must have the social stability, an excellent support network, and sufficient family income to afford to raise a child.  Many never reach that goal.  Having a husband with a good income is a dream that is often out of reach.  Second, one has to navigate a system that would much rather find a home for a child with non-LGBT parents, especially for newborns.  Adopting a newborn, even for middle-class non-LGBT families, is difficult as there are always far more prospective families looking to adopt a baby than there are babies available for adoption.  It is becoming easier in some locales for LGBT people to foster-adopt older hard-to-place children, but it still requires surviving an extensive vetting process.  That process will black-ball any who have even the most minor of criminal records.  One also has to have the temperament and above average parenting skills to take in a child who will come with emotional challenges and maladaptive behaviors from early life experiences in a chaotic birth home.  In many locales, in spite of recent legal and social advances for LGBT people, being transsexual will mean not being seriously considered as an ‘appropriate’ placement.

Candice2

Kay Brown with her adopted daughter Liz

I first became a licenced foster parent in California in 1984, almost by happenstance when Cassandra, a 14-year-old lesbian, needed a supportive home of the sort that I could provide.  Now, 33 years later, she still calls me her Mom.  In the early ’90s while living in Oregon, I sought to become a foster, hopefully adoptive mom of a younger child and carefully researched the possibility.  I put out on the transgender social networks looking for any who had been able to do so.  I found exactly one androphilic transwoman on the east coast who was fostering her sister’s children while her sister was in prison.  (Children’s Services gives priority to relatives for placement whenever possible.)  That was it.  One family.  Special case.  I was breaking new ground when seven-year old Liz was placed in my household.  (There were several women living there.)  Liz was adopted on her ninth birthday.  I have since found one other androphilic transwoman who foster-adopted three siblings sometime after me.

There is always the possibility of surrogacy.  But that takes even more socio-economic status.  I have only one reference that may qualify as surrogacy.  Dawn Langley Simmons, who was white, married a black man then apparently faked pregnancy timed to the delivery of a mixed race baby.  The sire may have been her husband or the baby may have simply been unwanted.  We don’t have the details.

There have also been tales and hints that some androphilic transwomen have been aided by close relatives or friends volunteering to be gestational surrogates.  But those stories are kept very private for good and sufficient reasons.

There was a private effort in the transsexual community to develop ethical  biotechnology that would allow transwomen to carry a child to term in ways not too different from that prophesied by Robert Stoller… but that research did not reach our final goal.  Now, there are new developments regarding uterine transplants that may offer the final key.  Sadly, I’m too old now to participate, but I most certainly would if I were younger.

We have enough evidence here to show that at least some androphilic transwomen do have an intense interest in being mothers of both infants and small children.  But actualizing that desire is extremely difficult for most.

So, we see that though it is difficult for an androphilic transwoman to find a loving husband and build a family through adoption, it is not impossible.  But one wouldn’t know that from reading the literature on transsexuality when they discuss whether transwomen are interested in children, have maternal feelings.

In the 1974 paper describing psychiatric grand rounds at UCSD, “Gloria”, a 20-year-old androphilic pre-op transwoman already in a stable relationship with a straight man reported that she too hoped to adopt a new-born, to which an oh so ‘kindly and understanding’ physician throws shade on her coping skills, her character, and her motives for wanting to raise a child,

No matter which way this goes, Gloria is going to have trouble adjusting. A normal woman has trouble when she bears a child or adopts one; this new woman is going to have many more troubles.  At this point she wants a baby because that is part of her image of being a woman. And yet I do not know whether she really wants a baby or whether this is just the image, just as she stated that she doesn’t feel sexy if she doesn’t have a vagina.

But then we come to the most ugly of all comments coming from John Money in an abstract of a case series paper from 1968 in which we can easily discern that he is lumping together androphilic and autogynephilic transwomen together when he writes,

“All 14 patients desired adoptive motherhood, with a preference for small children, though not newborn babies. In general, the group appeared to possess a feminine gender identity, except for a masculine threshold of erotic arousal in response to visual imagery and an unmotherly disengagement from the helplessness of the newborn.”

Remember how hard it is for a post-transtion transwoman to become a mother, especially of newborns?  Remember how the clinicians made fun of “Gloria” for wanting to be such a mother?  Now, do you think it is possible that transwomen can pick up on that negative attitude, perhaps realize that if they state a desire for what is clearly unlikely to happen that it might be interpreted as having unreasonable life goals?  (One of the selection criteria that clinics used in the ’60s was whether their clients had reasonable expectations for their lives post-op.)  Further, is it in fact a good idea to pine for what can never be?  So… calling them “unmotherly” for looking to adopt hard-to-place children rather than hoping for that one-in-a-million chance to adopt a healthy baby was just rubbing salt into the wound.

So ingrained is our view that interest in children is a measure of womanly virtue it effects how autogynephilic transwomen attempt to portray themselves.  A few years ago, continuing my search for transwomen’s experiences regarding adopting children, I chanced upon an online forum where a number of transwomen were discussing how one could tell the difference between a “transsexual” and a “wannabe” [sic] by whether they noticed small children or not.  Of course, they all congratulated themselves on their interest in small children, telling stories of how they had noticed children in social settings, as did the women, while the men in their company, or even other (presumably “wannabe”) transwomen, had not.  Curious, I traced down each of these transwomen’s identities (people leave a lot of breadcrumbs behind them) and discovered that every one of them was in fact a late transitioner and more than one of them had very masculine occupations and interests.  They had not evinced any notable efforts to pursue being motherly, indeed, some had barely maintained contact with their own children from marriages prior to transition.  Their participation in this discussion was more in line with social desirability bias, impression management, and self-enhancement than in honest self-evaluation.  It fits with the well-known (to cognizant clinicians at least) phenomena of autogynephilic transwomen editing their history, experiences, and desires to more closely approximate those of “classic transsexuals”.

We need to conduct research on whether transsexuals and transgender people of all kinds are interested in being parents.  Interestingly Michael Bailey suggested a great instrument for this task in his book the Man Who Would Be Queen:

TMWWBQ CoverINTEREST IN CHILDREN
1. I greatly enjoy spending time with young children.
2. I get a lot of pleasure from holding babies.
3. I would enjoy taking care of a baby for a friend or relative.
4. I daydream about having a baby of my own.
5. Often when I see babies, I experience warm, positive feelings.
6. When I think about it hard, I have strong doubts whether the
rewards of raising an infant are worth the work and responsibility. (reverse scored)

This could be seven value Likert scored from “Definitely Do NOT Agree” to “Definitely Agree”.  Any interested in conducting the survey?

Further Reading:

Essay on Robert Stoller’s description of a “typical” androphilic transsexual.

New York Times Obituary for Dawn Simmons

Scientific American: How a transgender women could get pregnant

References:

Judd, et al., “Male Transsexualism”, (1974) Western Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130141/

MONEY, JOHN Ph.D.; PRIMROSE, CLAY, “SEXUAL DIMORPHISM AND DISSOCIATION IN THE PSYCHOLOGY OF MALE TRANSSEXUALS” (1968) The Journal of Mental and Nervous Disease
http://journals.lww.com/jonmd/Abstract/1968/11000/SEXUAL_DIMORPHISM_AND_DISSOCIATION_IN_THE.4.aspx

 

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It was the best of times…

Posted in Transsexual Field Studies by Kay Brown on June 21, 2017

Kay Brown 2010…It was the worst of times   Or, That ’70s Show

In the May 1974 issue of the Western Journal of Medicine, two back to back articles appeared, one from a number of doctors reporting on a grand rounds at UCSD hospital that included Robert J. Stoller and one from Norman M. Fisk.  Reading them both now is not only a window on the past, but explains where we are now and how we got here.

I can’t write about this period without flashing back on my own life and what was happening at the time.  In May of ’74, I was just about to turn 17, finishing my Junior year in high school.  My favorite class was “Individual Voice”, solo singing but I was also really enjoying one other class, “Cosmology; Stellar and Galactic Evolution” I was taking at a local college, taught by a NASA astronomer.  I got an “A” in the class, of course.  I was also summer job hunting and landed my dream job as a nanny taking care of two boys for a local family for $50 a week (~$250 in today’s money).  I was also desperately searching at the library for any and all information I could find on transsexuality and how I could get HRT and SRS.  That search led me to the Stanford Gender Dysphoria Clinic and Dr. Fisk.

In early ’75, after much drama with my parents, who were separated and soon to be divorced, I finally convinced them to let me go to the clinic (but failed to mention that they performed SRS, etc.), which meant first being evaluated by Dr. Fisk.  During the first interview, I got the very distinct impression that he didn’t believe a word I said, though it was all the absolute truth.  From his article, we can see why,

“The concept of gender dysphoria syndrome grew out of clinical necessity very much in an organic, naturalistic fashion.  This occurred because virtually all patients who initially presented for screening provided us with a totally pat psychobiography which seemed almost to be well rehearsed or prepared, particularly in the salients pertaining to differential diagnoses. It would be accurate to say that of the initial 30 to 40 non-psychotic patients screened, all presented as virtual textbook cases of classical transsexualism.  Remembering the old medical saw that “the last time one sees a textbook case is when one closes the textbook,” it was apparent that this group of patients were so intent upon obtaining sex conversion operations that they had availed themselves of the germane literature and had successfully prepared themselves to pass initial screening.  In some instances they had rehearsed friends, spouses and family members in a similar fashion.”

During a later interview, in the company of my mother, who with obvious disapprobation and the mistaken notion that the clinic was to “cure” me, answered his questions about my early childhood saying,

“He was very different than his brothers.  All of their friends were boys, his were all girls. … He was very prissy.  I could dress him in clean clothes on Monday and they would still be clean on Friday. … I’ve known he wanted to live as a girl for years.  I just felt that was wrong.”

In the next interview, in company with my father, who tried to argue with him about what should be done about me after learning that I had been diagnosed as transsexual, Dr. Fisk replied,

“Denial will not serve.  You will win some battles but lose the war.”

That made Dr. Fisk my hero for life!  And he should be a hero to every transsexual who has come after, since it is Dr. Fisk who changed the way transgender people are treated that continues today,

Within the first two to three years of our investigation, it became apparent that when non-fabricated or, more precisely, honest and candid psychobiographies were obtained from our patient population, there was indeed a great deal of diversity and deviance from what had been defined as the symptoms of “classical transsexualism.”  Moreover, the overtly present common denominator was the high level of dysphoria concerning the individual’s gender of assignment or rearing  … employing the diagnostic term gender dysphoria syndrome, our indications for surgical sex conversion therapy have been broadened. Patients now clearly understand that had they been interviewed five or ten or twenty years ago, they would have been diagnosed as not being classical transsexuals. These patients are informed that a diagnosis of transsexualism is not in our view the only valid criterion for deciding who receives surgical sex conversion. Moreover, we practice the rather pragmatic dictum that nothing succeeds quite like success and therefore our criteria for surgical sex reassignment or conversion are more phenomenologically oriented. … Obviously, by liberalizing the indications for sex conversion through conceptualizing patients as having gender dysphoria, we also are committed to provide a program for patients encompassing many factors related to a total overall rehabilitative experience. These include vocational counseling and guidance, psychological and psychiatric supportive therapy, grooming clinics where role-appropriate behaviors are taught, explained and practiced, legal assistance, and, probably of most benefit, an opportunity is afforded to meet and interact with other patients who have successfully negotiated gender reorientation or who are in various phases of reorientation. This program employs some former patients as counselors to persons with gender disorders.

But that’s not to say that my experiences with the clinic were all good.  In fact, personal repercussions of some of what Fisk describes in glowing self-congratulatory fashion were severe.  I’m not alone in experiencing these issues.  While Fisk’s liberalization had eliminated the absolute need for a differential diagnoses for purposes of determining who was to receive services, it has led to a false belief within the trans* communities that there are no differences on the one hand and to the harmful homogenization of treatment protocols on the other.  It is important to note that the Stanford clinic did know that there were in fact two types and organized their services around helping those most in need of “gender reorientation”.

Having seen the best of times… we now turn to the worst of times.

During psychiatric grand rounds at a UCSD hospital, a 20 year old androphilic transwoman is paraded in front of a large group.  The author of the article describing the event uses masculine pronouns to introduce her to his readers and give a bit of her history, then switches to feminine pronouns.  Here’s an excerpt,

“She was told that this interview would be part of a training session on transsexualism so that people in the Department of Psychiatry could learn more about it. She was also told that this session will have no bearing on her treatment, continuing evaluation, or the decision regarding her operation. She understands that coming here is entirely voluntary.  (The patient, whom we shall call Gloria, was escorted into the room. She wore women’s clothing, was heavily made up, and quite attractive.  She was introduced to Dr. Parzen, who interviewed her before a group of approximately 100 staff members and residents. The following are selected excerpts from that interview.)”

Does anyone today believe that “Gloria” didn’t fully understand that her voluntary cooperation was actually mandatory if she was to successfully navigate this clinic’s hoops?  Certainly she did given the times, as Dr. Parzen says,

“These patients become good actors and tend to be paranoid toward anyone who might push them to betray themselves in a way that might jeopardize their surgical treatment.  Gloria had already established a personal relationship with Dr. Millman, and his feelings about her will ultimately determine what will happen to her.”

The doctors had ultimate power of granting or denying services and transfolk knew it!  What’s interesting is that the doctors knew that the they knew it, but saw nothing wrong with this imbalance of power save for complaining about what transsexuals do in the face of such asymmetric power,

Certainly she is quite protective about herself at this point. She is awfully close to getting what she wants, and she isn’t going to tell me anything that might interfere with that. She does not know my orientation, and she isn’t crazy, and therefore isn’t going to present material that might be interpreted wrongly from her point of view.  Transsexual patients classically tend to be very manipulative and very secretive. They tell you what they want you to know, and they have learned through much experience to read and to manipulate medical staff.

I could go on with the odd ideation that these physicians have that relied on classical Freudian psychoanalysis, not to mention the incredibly disrespectful things these doctors said about “Gloria” and transgender people in general, but I don’t need to as the articles have been scanned and available for all to read.

Further Reading:

Essay on differential diagnoses and transsexual taxonomy use in the 1970s.

References:

Fisk, N., “Editorial: Gender dysphoria syndrome–the conceptualization that liberalizes indications for total gender reorientation and implies a broadly based multi-dimensional rehabilitative regimen.” (1974) Western Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130142/

Judd, et al., “Male Transsexualism”, (1974) Western Journal of Medicine
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1130141/

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Coming of (r)age in Samoa…

Posted in Science Criticism, Transsexual Field Studies, Transsexual Theory by Kay Brown on June 20, 2017

critical-thinkingOr, The Fa’afafine in Context

It seems to me that research focused on the fa’afafine of Samoa has become all the rage of late, at least for those interested in feminine androphilic males / “homosexual MTF transgender” folk.  The interest has at its heart, the hope that it represents a culture that is closer to what we might have had before large-scale civilizations began, one closer to what humans may have evolved within.

First, Samoan culture is very collectivist.  Although we don’t have a formal Hofstede Individualism Index value for Samoa, most commentators I can find all agree that it would be very low, perhaps lower than just about any other on the planet.  They do everything in groups, traditionally even living together under one roof without walls.  Family and extended family are everything.  Thus, if we were to predict the ratio of androphilic vs. non-androphilic transwomen based upon the relationship between the Hofstede Individualism Index and the percentage of non-androphilic transwomen found by Lawrence, we would expect almost no non-androphilic transwomen.  And indeed, one never sees them mentioned in connection with Samoa.

In Samoa, there is almost no stigma attached to being a feminine male.  Feminine male children are not bullied.  Fa’afafine adults are not discriminated against in employment.  There is little to no stigma attached to masculine men finding Fa’afafine sexually attractive.  This is not to say that there isn’t any problems for them.  Christian missionaries and Western colonization has brought homophobic laws and attitudes.  But because there is little to no stigma attached, androphilic males are free to express as much or as little femininity as they find in themselves with little incentive to attempt to suppress it as occurs in many other cultures.

However, before anyone lauds the Samoan culture as being the transgender (or gay) paradise, consider one other factoid.  I can’t find any reference to any fa’afafine who is in a long-term relationship with a lover.  I’ve never seen any reference to their families celebrating a marriage to a man.  The fa’afafine may be called “in the manner of a woman” (as the term loosely translates), but they aren’t given that social status.  They are granted a status as what many anthropologists would call a “third gender”.  But that gender is not seen as equal to women in status and marital desirability.

fafafineFa’afafine are universally androphilic and have sex with masculine men.  They don’t have sex with each other because they are attracted to masculinity which is not especially abundant in fa’afafine.  But those episodes with masculine men are typically “one night stands”.  I can’t believe that they wouldn’t choose to have long-term romance in a committed relationship.  Although not well publicized, and not nearly as common as we might like, such long term relationships do exist between masculine men and androphilic transwomen in Western cultures.  So I must conclude that it is the Samoan culture that in effect prohibits or discourages such relationships.  I would like to be proven wrong on this… I really would.

An educated reader will perhaps recognize my quip of a title from Margaret Mead’s 1928 book.  They may also know of how she was attacked by Derek Freeman.  Maybe I’m just biased by my friendship with Alice Dreger, since I don’t believe a word Freeman says… but the episode does offer a cautionary tale regarding the potential changes that Christian missionaries have already brought to Samoa.  I’ll leave it at that, since those who are better acquainted with the controversy will know what I mean.

One of the interesting aspects of androphilia in males is the question of evolution, to wit, if genetics play a role, and there is strong evidence it does, than why hasn’t it been selected out of the human population?  How can a trait that confers a significant reproductive disadvantage be maintained in the gene pool, should that allele(s) be under very high anti-selection pressure?  One hypothesis is the “Kin Selection” effect in which androphilic males are indirectly “fit”, reproductively successful, because they increase the resources available for their near relatives.  Paul Vasey has been testing this idea in both Western gay men and fa’afafine.  Interestingly, it doesn’t appear to be true among Western gay men, but does appear to be true among fa’afafine who exhibit strong materterally supportive behaviors toward the children of their siblings.  The speculation is that something about the suppression, the crushing, of the natural femininity of androphilic males in Western nations also suppresses this materteral behavior.  I would suggest that we also look at Western androphilic transwomen, being careful to sort by the quality of familial relationships.

Since the culture is presupposed to be closer to that of our pre-civilization ancestors, the question of who the fa’afafine are sexually attracting may offer other insights into the early evolutionary selection pressures on masculine men, specifically the notion of competition for mating opportunities between women and feminine androphilic males.  Lanna Petterson explored this in a study published as her thesis (also published in journals) in which she presented images of faces, men, women, and very plain emojis on a computer screen, asking her subjects to evaluate and report how sexually attractive they found them.  The images were limited only to the faces.  They were composites that had been digitally modified to enhance their sexual dimorphism.  (Frankly, of the two images she included in the appendix of her thesis, I personally found them disturbing, seeming to be slipping over a cliff into the uncanny valley below.  I can’t but help thinking that the results may have been influenced in part by this.)  Unknown to her subjects, the response time latency was also recorded by the computer.  Earlier studies have shown that people tend to linger over images that they find erotically rewarding.  From this data, she comes to the conclusion that the men who are having sex with fa’afafine are “bisexual”.

Sigh… Looking at the data, as well as what we know from other studies of men who seek out transwomen (chasers), I have to seriously question this conclusion.  First, very much like what androphilic transwomen experience in the West, 65% of the men had never had a sexual encounter with a man and 75% had not within the past year.  As Dr. Richard Green wrote about the men who dated Western androphilic transwomen,

“The men who fall in love with and perhaps marry women who are themselves former males, by and large, have known their partners only as women.  Their prior sexual experiences have been only with females.  They consider themselves heterosexual and their relationships heterosexual.  To varying degrees they are consciously and unconsciously aware of the biologic status of their partners, but it would be simplistic and would furthermore blur generally accepted definitions to call these men homosexual.  Rather they are men who respond to the considerable femininity of male-to-female transsexuals, ignoring the dissonant cues of masculinity.”

For many of the masculine Samoan men in Petterson’s study, I believe would fit this description as well.  Another portion of the men I believe would likely fall into the category of gynandromorphophilic (GAMP).  From a wonderful study by Hsu, we know that such men tend to be autogynephilic as well.  Although Samoan autogynephilic men are not likely to transition to presenting as women, that does not mean that they won’t seek out their prefered external sexual partners, women and feminine males, to wit fa’afafine.

From personal experience and hints from clinician and sexologist comments (e.g. Stoller and Bailey, separately), Western androphilic transwomen avoid gynandromorphophiles. One of the hallmarks of gynandromorphophiles is that they prefer pre-op and “functional”, that is, willing to allow these men to touch their penis, as Stoller remarked, “… she considered anyone who was not interested in her penis as normal…”

From reading between the lines of Petterson’s thesis, it appears that she made the assumption that sexual role “flexibility” denoted greater bisexuality.  I would argue just the opposite, that it is a signifier of potential gynandromorphophilia.  Also, I would predict that such men would have a different and “disturbed” response time when presented with faces to evaluate due to their underlying erotic target location error proneness.  While it is true that people tend to linger over images that they find erotically rewarding, they also tend to have trouble responding quickly to associations that reside further away from each other in their personal experience (e.g. implicit bias testing).  Indeed, this issue is shown in the data… that those who are willing to perform fellatio on fa’afafine had longer response latency, even to the crude emojis.

A minority of the masculine men having sex with fa’afafine are also only having sex with other masculine men, but not women.  This would suggest masculine presentation / identity exclusive androphilia, not bisexuality.  Not all fa’afafine present as extremely feminine as adults – some are fairly conventionally masculine, as average gay men would be in the West.  It would appear to me that not all androphilic males in Samoa developed an identity as fa’afafine as a child and that they are having sex with each other and to at least some of the fa’afafine, perhaps those who are less hypomasculine?

Although Petterson rejected the hypothesis that her masculine male subjects included both primarily androphilic and gynephilic subjects based on statistical tests of her response time data for normal distribution.  I believe that the effect of there being three different populations masked this fact.

Although Samoa and the fa’afafine culture seem so different than that of the West, I believe that the feminine androphilic subcultures in the West, that of feminine gay men, drag, and feminine androphilic transsexuals and our experiences very much parallel each other in important ways and future research will bear this out.

Further Reading:

Essay on relationship between Hofstede Individualism Index and non-androphilic MTF transsexual transitions

Essay on cultural influence on androphilic male presenation

Essay on Gynandromorphophilia

References:

Vasey, P. et al., “What can the Samoan Fa’afafine Teach Us About the Western Concept of Gender Identity Disorder in Childhood?”, (2007) Perspectives on Biology and Medicine,  http://muse.jhu.edu/article/222247

Vasey, P. “The Evolution of Male Androphilia” Personal Website:  http://people.uleth.ca/~paul.vasey/PLV/Evolution_Androphilia.html

Petterson, L. “Male Bisexuality In Samoa” (2012) University of Lethbridge Thesis  https://www.uleth.ca/dspace/bitstream/handle/10133/3745/PETTERSON_LANNA_MSC2015_THESIS.pdf

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Personality, My Dear…

Posted in Science Criticism by Kay Brown on October 6, 2016

phrenology…I Don’t Give a Damn!

or What is the Rate of Co-morbid Personality Disorders in Transsexuals?

I recently came upon a blog that made much of a single paper out of Iran which purported to show that about 80% of transsexuals had a serious personality disorder.  I was shocked at such a result and had to dig deeper.  Well… this paper seems to be an outlier and its use by this blogger (who fits the profile of an angry ex-wife of an autogynephilic transgender-woman turned transphobic crusader) is an example of cherry picking.  Another paper I found was only 24% of the transsexuals had “subthreshold” potential personality disorders compared to 17% of the controls.  (Note, “subthreshold” does NOT mean that they actually had the disorder.)  But why did this first paper get this outrageous percentage of actual disorders when other studies didn’t?

Because they did NOT diagnose anyone, period.  Instead Meybodi used the Millon Clinical Multiaxial Inventory II (MCMI- II), a self-scored inventory and assumed that if they got a high score on any particular scale that they must then have that clinical diagnoses.  This alone is a gross misuse of any instrument; a test score alone is NOT a diagnoses of a disorder.  From the paper, all we know is that their subjects scored higher than a non-reported cut-off, likely the one used by the publishers to indicate the “presence” of a trait.  The researchers fully admit that they did NOT actually interview and determine if the score had any bearing on actual dysfunction.  It is important to note that to have a diagnoses of a disorder, the personality trait must cause significant dysfunction to their lives.  This study failed to evaluate this dimension.  The most common of the purported personality disorders was Narcissistic Personality Disorder at nearly 60%, which given that this paper was from Iran, surprised me greatly.

As Lawrence has shown, the percentage of non-androphilic MTF transfolk is correlated with a given society’s Hofstede Individualism Index, which for Iran is 41, and thus we would expect a very low percentage.  And indeed, anecdotal reports regarding Iran’s MTF population agree.  But we know that from a number of studies and clinical surveys, that exclusively androphilic MTF transsexuals have a LOWER co-morbidity rate.   So what gives?

The answer seems to be that this study failed several basic tenets of science.  First, they failed to provide controls, which had they done so, might have flagged another issue with their methodology, namely that the MCMI-II was written and only validated in ENGLISH and is only valid for those who have at least a 5th Grade literacy level IN ENGLISH.  One assumes that the researchers simply translated the inventory items from English to Farsi and did not conduct a proper re-validation study given the very divergent cultural meanings potentially introduced by this translation?  If so, as Rogers points out, this is a gross abuse,

“Multiscale inventories can be translated into different languages with relatively little effort. The critical issue is that linguistic equivalence (i.e., similar sentences) cannot be equated to clinical equivalence (i.e., similar diagnostic relevance).  Clinical equivalence cannot be assumed, but must be objectively tested. Simple comparisons of vocabulary and syntax (e.g., from English to Spanish) are insufficient to establish clinical validity for translated versions.  An approach to translation validation in which a mere lack of significant group differences between two language or ethnic groups is assumed to mean the tests “work the same way” makes little sense. With depressed patients, for example, the clinician needs to know whether or not depressed persons of different cultures and languages have the appropriate elevations on multiscale inventories. Given our dearth of knowledge regarding translated versions and their cultural differences, psychiatrists and their consultants should be very cautious about using and interpreting translated tests.”

Even if the translation into Farsi was validated, there is the problem of interpretation; a high score on a given scale does NOT necessarily mean that one has a personality disorder.  In fact, emotionally healthy people often have high scores on scales that correlate to Narrissistic Personality Disorder as Stephen Strack explains in his book, Essentials of the Millon Inventories,

“Scale 5 has a research base that suggests that elevated scores indicate either a clinical personality disorder or a healthy adaptional personality style associated with with nonclinical people.  In factor analysis studies, Scale 5 loads positively on items dealing with extroverted traits and behaviors and negatively on items pertaining to maladjustment. … Elevations on Scale 5 are rare in psychiatric samples.  Many nonclinical populations attain elevated scores on Scale 5 including air force pilots in basic training. … Thus the clinical task is to determine whether clinically elevated scales represent a Narcissist Personality Disorder or a narcissistic personality style.  … versions of this scale have not correlated well with structured psychiatric interview schedules.”

Anyone who is familiar with either the literature on, or knows “early onset” / transkids in person knows that they can be quite extroverted, even flamboyantly so, without developing Narcissistic Personality Disorder.  Finally, a study that used structured interviews showed significantly lower co-morbid issues than those studies that used translated personality inventories, from the abstract of the Haraldsen paper,

“Transsexual patients scored significantly lower than Personality Disordered patients on the Global Symptom Index and all SCL-90 subscales. Although the transsexual group generally scored slightly higher than the healthy control group, all scores were within the normal range.  Transsexual patients selected for sex reassignment showed a relatively low level of self-rated psychopathology before and after treatment. This finding casts doubt on the view that transsexualism is a severe mental disorder.”

The conclusion here can only be that we must evaluate the literature on transsexuals and co-morbidity very carefully and critically, not accepting them at face value unless we can determine that they have been conducted with proper methodologies, including proper interview based psychiatric diagnoses, compared against valid controls from both clinically relevant disordered and healthy populations, and shown to be reproducible.  Anything else is just junk science.  {And cherry-picking the worst data you can find to defame transfolk is despicable.}

References:

Maybodi, et Al., “The Frequency of Personality Disorders in Patients with Gender Identity Disorder”
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4301205/

Bodlund, et Al., “Personality Traits and Disorders in Transsexual” (1993)
https://www.ncbi.nlm.nih.gov/pubmed/8296575

Rogers, R., “Forensic Use and Abuse of Psychological Tests: Multiscale Inventories”
http://www.reidpsychiatry.com/columns/15%20Rogers%2007-03%20pp316-320.pdf

Haraldsen, et. Al., “Symptom profiles of gender dysphoric patients of transsexual type compared to patients with personality disorders and healthy adults”
https://www.ncbi.nlm.nih.gov/pubmed/11089727

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Four Out of Five…

Posted in Transsexual Theory by Kay Brown on February 2, 2016

female_scientist… Gynephilic Transwomen Openly Acknowledge Autogynephilia

Or, Which Came First?  Chicken Or Egg?

Not too long ago, I got an email from a transwoman, and ‘older transitioner’ who acknowledged without reservation that there was a “correlation” between later transition / gynephilia (non-exclusive androphilic) transwomen and autogynephilia, while tacitly acknowleging that exclusively androphilic early transitioners do not.  This was great, but not too surprising, since four out of five such transwomen acknowledge experiencing autogynephilia either currently, or in the past.  But she asked, does it mean causation?  That is to say, is autogynephilia the prime mover in causing gynephilic (and bisexual / asexual) transwomen to become gender dysphoric and develop a ‘female identity’?

I would have thought it was obvious that it does, and that we don’t need to explicate why.  But, no, Sillyolme, nothing in science is self-evident.  One really does need to explore the question fairly, making the assumption, the null hypothesis, that it does not, then look to see if the evidence supports that null hypothesis.  Only if the data fails to support the null hypothesis should we state that it does.

17147170605_370e11393b_bLet’s start at the begining shall we?  First, does autogynephilia exist?  Yes, we need to ask this first, as it can’t be a cause of gender dysphoria if it doesn’t exist.  And, indeed, many ‘older transitioners’ insist that autogynephilia does not exist.  Well, that one is easily answered, because we have at least 100 years of sexologist observations of a minority of males who definately become sexually aroused when wearing women’s clothing and/or when thinking of themselves being or becoming female.  Consider this typical description of a teenaged male experiencing an autogynephilic episode from Richard Ekins book Male Femaling – A grounded theory approach to cross-dressing and sex-changing,

“… I was 13 when I stepped, quivering with excitement into a pair of French knickers belonging to my sister.  I ejaculated almost immediately… The feeling was glorious and yet quite alarming and I felt as though I was leaking urine. … Some three days after this first ‘event’ I got home from school to find my mother out.  I went upstairs to do my homework and through the half-opened door of my mother’s bedroom I saw, hanging over a chair, a pair of her pink directoire knickers, obviously discarded in a hurry as she changed before going out.  That soft gleaming bundle turned my whole body and senses into a jelly-like state of desire and longing.  I had to wear them, to try and see if I was all right.  Would it happen again?  My answer was there almost immediately in my swift gathering erection as I struggled out of my clothes.  …”

We can find hundreds of such examples, very often showing that this behavior is most noted in early adolescence, but continues into adulthood. In fact, we have an entire genre of erotic fiction and images (still and motion picture porn) dedicated to the tastes of autogynephilic adult male individuals.  These examples and the males that experience it are common enough that they also form organizations to join together to support each other emotionally and even politically.  So, no, we can’t say that autogynephilia does not exist.  The null hypothesis is easily proven wrong.  Autogynephilia in some males exists.

OK, now that we know that autogynephilia exists in some males, we can take a known group of autogynphilic males, conduct in depth interviews into just what sorts of things they erotically respond to that the majority non-autogynephilic males don’t.  From that we can construct trial psychometric inventories, test items (questions), for an autogynephilia scale, so that we can measure the degree of and autogynephilic factors (types) present in, autogynephilic males.  Then carefully test and validate it against known autogynephilic males and a set of control males.

However, some transwomen insist that autogynephilia can’t be the cause of their trans identity, because autogynephilia is common, perhaps near universal, in females.  Thus, that would demonstrate that autogynephilia is just part of normal female sexuality.

Does autogynephilia exist in females?  Now, remember, we START with the null hypthesis.  So, assuming it does NOT exist, can we find (credible) evidence that would disprove the null hypothesis?  First, how many sexologists have observed, documented, and remarked on autogynephilic sexual arousal in females?

Wow… I’m hearing an empty, hollow echo in that department.  Not one observation, study, or anything… oh wait, I hear some tiny voices outside the hall?  Could it be?  Why there ARE some folks saying that females do experience autogynephilia… but… what?  Oh, yeah… that… ALL of them are autogynephilic males who are claiming that their autogynephilia is the same as what women feel when they wear women’s clothing… after all, wearing “sexy” panties gets them all going, so it must get women going too?  Right?  Ummmm no.

Seriously, where in the many thousands of diaries, autobiographies, and now online social media blogs published, is there ANY (credible, not catphishing by an AGP male) female individual accounts of anything remotely like the autogynephilia so easily found in a minority of males?  Seriously?  Where are the copious accounts of how, when they were pre and early teens, that they became intensely sexually aroused upon trying on their big sister’s bra and panties?  Or looking in the mirror at their blossoming breasts and become intensely sexually aroused?  Or examining their genitals and finding them so arousing that that they masturbate while examining them… cause being female is just so sexy?  No?  Again that hollow echo.

phrenologyOh, but wait, I hear a rising chorus (of autogynephilic males) saying that a Dr. Charles Moser created an autogynphilic inventory for females and tested a group of women.  So we ask, as we must assume the null hypothesis, where did he find the known autogynephilic females to interview to create a valid test?  How did he validate it? What are the psychometric properties of the instrument?  What?  No?  He did none of that?  Well, then what did he do?  He carefully rewrote questions from an instrument intended for and validated only for males in a gender clinic setting?  Well, looking carefully at the rewrite, they don’t seem to have even a passing bearing on what autogynephilia would theoretically look like in women, or even in androphilic transsexuals. The questions were very carefully written to get positive answers from heterosexual females, as that was the intended (political) goal, to “prove” that straight women were also autogynphilic… but they have no meaning.  They don’t measure autogynephilia, they measure mostly anticipatory arousal before dates with men.  Well that was dissappointing.  One and only one demonstrably invalid study.  We still have no evidence to disprove the null hypothesis.  So, for now, we must accept that females do NOT experience autogynephilia.

OK, so now we know that autogynephilia exists in males, but there’s no (credible) evidence that it exists in females.  But are there really two types of MTF transsexual?  Does autogynephilia exist equally as much in exclusively androphilic transwomen?  Let’s assume the null hypothesis, that there is only one type, not two.  We can use the previously developed and validated, instruments to measure any putative autogynphilia in both exclusively androphilic and non-exclusively-androphilic transwomen and see if there is a difference.  Here, we have a number of studies done over the years, Buhrich (1977), Freund (1982), Blanchard (1985), Doorn (1994), Smith (2005),  Lawrence (2005), and Nuttbrock (2009).

female_scientistThese studies all clearly indicate a strong correlation with non-exclusively androphilic reporting a high, nearly universal, percentage of individuals acknowleging autogynephilic arousal, either currently, or in early adolescence, and a strong anti-correlation with exclusive androphilia.  Diving deeper, consider that in the largest and most recent of these studies by Nuttbrock (N=571), the grouping that had the highest percentage reporting sexual arousal to crossdressing was the gynephilic at 82%, while the group with the least non-exclusively androphilic was those who had begun Hormone Replacement Therapy (HRT) as teenagers, who had the lowest percentage reporting sexual arousal to cross-dressing at 14%.

To support the null hypothesis, there should have been no correlation with sexual orientation.  The null hypothesis is NOT supported, there is NOT one group, but two.  Futher, the null hypothesis regarding autogynphilia not being correlated with gynephilic/bisexual/asexual transwomen, and only these transwomen, is not supported.  Androphilic transwomen and natal female women do not experience autogynephilia.

But this only brings us back to where we started, with my correspondent fully conceding to the above.  But she still has a valid question, does this mean causation?  After all, we all know that correlation does not imply causation.  But here we need to bring up a point, actually, it doesn’t imply it… but causation does require correlation.  So, we have our first step toward answering the question.  With correlation, we may have causation.  But we need to explore further.

One of the most accepted methods of deducing whether there is a cause and effect relationship in medicine, including psychiatric epidemiology, is found in Bradford Hill’s Criteria.

The list of the criteria is as follows:

  1. Strength (effect size): A small association does not mean that there is not a causal effect, though the larger the association, the more likely that it is causal.
  2. Consistency (reproducibility): Consistent findings observed by different persons in different places with different samples strengthens the likelihood of an effect.
  3. Specificity: Causation is likely if there is a very specific population at a specific site and disease with no other likely explanation. The more specific an association between a factor and an effect is, the bigger the probability of a causal relationship.
  4. Temporality: The effect has to occur after the cause (and if there is an expected delay between the cause and expected effect, then the effect must occur after that delay).
  5. Biological gradient: Greater exposure (dosage or intensity of cause) should generally lead to greater incidence of the effect. However, in some cases, the mere presence of the factor can trigger the effect. In other cases, an inverse proportion is observed: greater exposure leads to lower incidence (as found in vitamin deficiencies).
  6. Plausibility: A plausible mechanism between cause and effect is helpful (but Hill noted that knowledge of the mechanism is limited by current knowledge).
  7. Coherence: Coherence between epidemiological and laboratory findings increases the likelihood of an effect. However, Hill noted that “… lack of such [laboratory] evidence cannot nullify the epidemiological effect on associations”.
  8. Experiment: “Occasionally it is possible to appeal to experimental evidence”.
  9. Analogy: The effect of similar factors may be considered.

Taking each in turn:

  1. Strength of the correlation is very high.  Four out of five gynephilic transwomen acknowlege experiencing, currently or in the past, autogynephilia.  Considering that autogynphilia is very rare in the general male population and non-existent in the female population, this correlation is very, very high.  But it gets even higher when considering the experimental results of phallometry of those cross-dressers experiencing gender dysphoria who claim that they did not experience sexual arousal to cross-dressing, did in fact demonstrate mild sexual arousal to cross-dressing narration (autogynephilic erotic fiction) compared to control males.
  2. Consistency of the correlation is easily shown by looking at the literature referenced above, in which study after study, over four decades, involving around a thousand transwomen, consistently shows the same data, even using different measures of sexual orientation and autogynephilia.
  3. Specificity is shown in that it is only non-exclusively-androphilic males who experience autogynephilia and that a subset of those males develop gender dysphoria.
  4. Temporality is demonstrated in that the majority of non-exclusively-androphilic males who become gender dysphoric and come to identify as women report autogynephilia in adolescence which seems to mellow even as their need to cross-dress and their gender dysphoria increases, reaching a threshold, a crisis point, most commonly in their mid-30’s.  As Prince (herself an autogynephile) and Doctor documented, “Among our subjects, 79% did not appear in public cross dressed prior to age 20; at that time, most of the subjects had already had several years of experience with cross dressing. The average number of years of practice with cross dressing prior to owning a full feminine outfit was 15. The average number of years of practice with cross dressing prior to adoption of a feminine name was 21. Again, we have factual evidence indicative of the considerable time required for the development of the cross-gender identity.”
  5. A gradient effect is easily found in autogynephilia in that men who have only very mild autogynephilia typically are content to cross-dress in private, never developing severe gender dysphoria or a female gender identity.  There are individuals with partial autogynephilia who only wish to have breasts, who are content with mildly feminizing HRT, cross-dressing in public only occasionally.  There are those who come to identify as “Bi-Gendered” or “Gender Fluid” who go back and forth.  And finally, there are those whose autogynephilic ideation was intensely focused on being completely female and develop intense and all consuming gender dysphoria who go on to live full time as women, obtain HRT, and SRS.  A number of studies have found that intensity and the specific nature of their autogynephilia correlates with these differential outcomes.  Further, these effects seem to indicate both a continuum and a progression (criterion #4).  There is another dosage effect that though subtle, is of high importance to the question of causation and the nature of autogynephilia itself found by Blanchard in “Nonmonotonic relation of autogynephilia and heterosexual attraction”, from the abstract, “the highest levels of autogynephilia were observed at intermediate rather than high levels of heterosexual interest; that is, the function relating these variables took the form of an inverted U. This finding supports the hypothesis that autogynephilia is a misdirected type of heterosexual impulse, which arises in association with normal heterosexuality but also competes with it”.  This non-monotonic relationship was questioned in the Nuttbrock study, as they hypothosized that autogynephilia was a classic conditioned sexual fetish that had arisen as a consequence of cross-dressing and gender dysphoria, and not the cause.  But Lawrence easily demonstrated that Nutbrook missed the relationship due to improper mathmatical treatment of the data… and thus the dosage relationship evidence remains valid.
  6. Plausability.  This is almost self-evident.  If one’s sexual ideation is exclusively autogynephilic, if each time such an individual sees herself as obligatorially female during sex, that would be strong drive towards gender dysphoria and an incentive to adopt a female gender identity, over time.
  7. Coherence with laboratory tests are found by looking at brain sex research which shows that non-exclusively-androphilic transwomen are different than exclusively androphilic transwomen AND females, as expected by the theory that autogynephilia is the cause, not the result, of gender dysphoria and a female gender identity.
  8. Experiments with animals are not possible as we have no animal models of autogynephilia.
  9. Analogy is found in the amazing similarity of autogynephilia and its effects are found in males with apotemnophilia, the sexual desire for limb amputation, and autopedophilia, the sexual desire to be a child.  In fact, a very high percentage of heterosexual apotemnophiliacs are also autogynephilic, experiencing an Erotic Target Location Error in which they wish to become female amputees.

So, we can see that we meet nearly all, saving only experimental evidence, to support the conclusion that autogynephilia is the cause, and not the result or merely a co-occuring factor, of gender dysporia and female gender identity in non-exclusively-androphilic transwomen.

Additional Reading:

Essay on the development of an Autogynphilia Instrument in Males

Essay on the Non-Validity of Moser’s “Autogynephilia in Women”

Essays on evidence to support the two type taxonomy of MTF transsexuality

Essay on the Origins of Cross-Gender Identity in Transsexuals

Essays on Brain Sex in Transsexuals

Essay on analogy between autogynphilia and apotemnophilia

References:

Textbook of Psychiatric Epidemiology, 3rd Edition, Wiley Press

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Brain Power…

Posted in Brain Sex, Confirming Two Type Taxonomy by Kay Brown on December 28, 2015

Teenage-brain

…I would while away the hours, confir’in with the flowers…. if I only had a brain…”  — Scarecrow, in the Wizard of Oz musical film.

After years of trying to explain the differences between the two types and the statistical evidence for the two type taxonomy of MTF transwomen, I’m now posting what should be the final clincher; solid biomedical laboratory evidence, “proof” even.

Decades ago, as I was researching our collective history and science (the two often go hand in hand), I came across a reference to studies that showed that gay men had feminized brains while MTF transsexuals did not.  SAY WHAT!?!?

Turns out, the study referenced made the false assumption that all MTF transsexuals are the same and had only included gynephilic older transitioners.  Other studies, being aware of, and accounting for the differences between the two MTF transsexual types found something quite interesting, as for example, from the Dörner (1983) abstract:

“In male rats, androgen deficiency during a critical period of sexual brain differentiation was shown to give rise to a predominantly female-differentiated brain. Such animals displayed “homosexual behaviour”, i.e., they were sexually attracted preferentially to partners of the same sex. In addition, they exhibited a sex-specific evocability of a positive oestrogen feedback effect. A positive oestrogen feedback effect on LH secretion was also induced in homosexual transsexual men, in contrast to hetero- or bisexual transsexual men. Thus in homosexual transsexual men, an intravenous injection of 20 mg Presomen (Premarin) produced a significant decrease of serum LH levels followed by a significant increase above the initial LH values. In hetero- or bisexual transsexual men, by contrast, intravenous oestrogen administration, while producing a significant decrease of serum LH levels, was not followed by an increase above the initial LH values. A positive oestrogen feedback effect on LH secretion was also found in homosexual non-transsexual men, in contrast to heterosexual men. These findings suggest that transsexual as well as non-transsexual homosexual men possess a predominantly female-differentiated brain which may be based, at least in part, on androgen deficiency during sexual differentiation of the central nervous system. Homosexual transsexual men also showed an increased LH and FSH response to LH-RH as compared to hetero- or bisexual transsexual men.”

Note that non-exclusively-androphilic (“heterosexual or bisexual”) transwomen did NOT have the female like positive estrogen feedback effect on LH serum levels.  Of course, according the Blanchard’s work, all “non-homosexual” MTF transsexuals should also be in the same taxon, so we would predict that so-called, asexual transsexuals should also show the lack of this positive feedback, and indeed, this too was found, as discribed in the Dörner’s (1976) earlier paper,

“In transsexual men with homosexual behaviour and intact testicular function, as well as in homosexual men with normal gender identity, following a negative oestrogen feedback effect a delayed positive oestrogen feedback action on LH secretion was evoked. By contrast, in transsexual men with hypo- or asexuality and intact testes or hypergonadotrophic hypo- or agonadism, as well as in heterosexual men with normal gender identity, a negative oestrogen feedback effect was not followed by a positive feedback action on LH release. In transsexual women with homosexual behaviour and oligo- and/or hypomenorrhoea, only a weak or at best moderate positive oestrogen feedback action on LH release was evocable, similarly as in castrated and oestrogen-primed heterosexual men. By contrast, in a transsexual woman with bisexual behaviour and eumenorrhoea, a strong positive oestrogen feedback action on LH secretion was evocable, as well as in heterosexual women with normal gender identity.”

Note that in this paper we see a mirror like difference between FtM “homosexual transsexuals” (gynephilic transmen) who respond more like heterosexual men and bisexual FtM transmen who respond more like heterosexual women.  Thus, this data would lend support for there being a taxonic difference between exclusively gynephilic and non-exclusively gynephilic transmen, mirroring the taxonic difference between the two types of transwomen.

Conclusion:

These papers, detailing a specific, repeatable, laboratory based test that can differentiate the two types of transsexuals described by Blanchard, “Homosexual” and “Non-Homosexual”, offers both supporting evidence for the two type taxonomy but potentially also a way of independently sorting the two types in future studies.  This difference is a classic medical biomarker for the two types.  Should anyone one doubt the weight of statistical evidence, we can also point to the biomedical evidence via laboratory tests.

References:

Dörner G, Rohde W, Schott G, Schnabl C., “On the LH response to oestrogen and LH-RH in transsexual men.” Experimental Clinical Endrocrinology (1983)
http://www.ncbi.nlm.nih.gov/pubmed/6317420

Dörner G., “Neuroendocrine response to estrogen and brain differentiation in heterosexuals, homosexuals, and transsexuals.” Archives of Sexual Behavior (1988)
http://www.ncbi.nlm.nih.gov/pubmed/3282489?dopt=Abstract

Dörner G, Rohde W, Seidel K, Haas W, Schott GS.”On the evocability of a positive oestrogen feedback action on LH secretion in transsexual men and women.” Endokrinology (1976)
http://www.ncbi.nlm.nih.gov/pubmed/1244197

 

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Raising Children is a Sacred Trust…

Posted in Editorial, Transgender Youth by Kay Brown on December 8, 2015

Kay BrownParental Attitudes Towards Transgender Children

Every now and then, I check the stats on this site.  I am gratified by the growing number of readers over the past six years.  I also check the search strings that are used to find this site.  I am happy that parents of transkids find my site and this much needed information.  But I am usually saddened by the search strings.  These are the most common, in order of frequency:

“How to cope with transgender children”

“How to deal with a transgender child”

“How to manage a transgender kid”

“My child is transgender”

Do you see the problem?  The terms ‘cope’, ‘deal’, and ‘manage’ indicate that these parents see their child as a dissappointent, a burden, a problem.  One ‘copes’ with emotional loss and dissappointment.  One ‘deals’ with a burden.  One ‘manages’ a problem.

I’ve known dozens of other transkids (and former transkids / adults who were transkids).  Nearly every one of them spoke of how their parents had been dissappointed by them.  Even those whose parents eventually came to support them went through a period where their parents tried to deny that they were transkids.  Many were disowned by their parents.

But every now and then, but not nearly as often as I would like, I see this search string:

“How to help a transgender child”

Today, among several like the first three, I saw this gem:

“How to protect a transgender child”

Several years ago, my husband and I hosted a lovely young couple and their two children.  Their children were around three years old, fraternal twins.  One was ‘all boy’.  He wore his favorite T-shirt sporting an image of a bulldozer that read, “I like dirt”.  The other child was a sweet natured, feminine girl wearing a yellow flowered sundress.  She gave us an impromptu ballet recital in our front parlor.  Can you see where this is going?  That sweet mannered girl is male.

This young couple loved and celebrated their children.  Both of them.  They told me that they didn’t like attending support groups for parents of gender atypical / transgender children because the other parents saw their children as dissappointments, problem children, burdens.  The other parents would spend most of the time trying to convince everyone, including themselves, that they had done everything they could to cope, deal, and manage their children.  They were apolegetic about their child’s behavior and even of their own eventual acceptance of their child’s atypicality, having done everything they could to prevent it.

Which brings me back to the search string that I never see, but would dearly love to:

“How to celebrate my transgender child”

(Addendum 2/4/2016:  Banner Day!  Today someone used this search string, “loving your transgender child”)

(3/26/2016:  UGLY DAY!  Today someone used this search string, “things to say to comfort parents of a transgender”, as though having a trans-child were a terrible tragedy.

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Flipping the Bird

Posted in Book Reviews by Kay Brown on March 22, 2015

Flip_the_birdBook Review:  Galileo’s Middle Finger – Heretics, Activists, And The Search For Justice In Science, by Alice Dreger

Dr. Dreger’s latest book could be described as a coming of age story as it chronicles her journey from naive graduate student to a world class activist historian, seeker of Truth, Justice, and the American Way.  She truly is a super-hero, if any real, live human being can be.  Hers is a journey into social justice activism, only to find that many of the self-styled activists were searching for anything but social justice.

Dreger’s introduction to activism was the result of meeting modern examples of the very injustice that she had previously documented had occurred to people in the 19th Century when their bodies didn’t conform to the expected norms for males and females, the so called “Hermaphrodites”, which today we called “intersexed” or “people with Disorders of Sexual Development” (DSD).  Writing about her academic work on 19th Century treatment of intersexed people,

“…It ended up pushing me into two unfamiliar and intense worlds: contemporary sex politics and contemporary medical activism.  That’s because, thanks to the Internet, by the time I came to this topic, in the mid-1990s, something was going on that the Victorian doctors would never have imagined: People who had been born with various sex anomoalies had started to find each other, and they had started to organize as an identity movement.  Labeling themselves intersex, many gather under the leadership of Bo Laurent, the founder of the Intersex Society of North America, and after reading my Victorian Studies article, some of these intersex activists, including Bo, contacted me.  A couple wrote me simply to complain that they found some of my language offensive, apparently not realizing I was relaying Victorian rhetoric in my article.  By contrast, Bo got my work.  And she asked for my help in changing the way children born intersex were treated in modern medicine. … I hastened to tell Bo, “I’m a historian; I study dead people.”  However, once I understood what was really going on at pediatric hospitals all over the nation – once I understood that Bo’s clitoris had been amputated in the name of sex “normalcy” and that this practice was still going on – I felt I had to assist in her efforts.”

Dreger rose to that challenge, taking on a leadership role in the fight to end medically unnecessary surgeries on children with ambigous genitalia.  This entailed taking on the medical establishment, confronting them, insisting that they re-examine their protocols in the light of real damage to real people.  It took a while, years, but the work of these activists with whom Dreger worked, began to seriously effect the desired change.  While the work is not truly complete, it is well on the way.  In her book, she details the long hours, the difficulties encountered, but most importantly, the need for such evidence based activism, that the work of these activists was based on demonstrating the real outcomes of these surgeries, which diverged greatly from the view previously held, that these surgeries helped.  If the book went no further, it would be worth buying it.

But Dreger’s work, and her life, as she took a new position at Northwestern University would take another turn,

“It was shortly after this time that I took on a new scholarly project, one that without warning forced me to question my politics and my political loyalties … This was a project that suddenly changed me from an activist going after establishment scientists into an aide-de-camp to scientists who found themselves the target of activists like me.  Indeed, this project soon put me in a position I would never have imagined for myself; vilified by gender activists at the National Women’s Studies Association meeting and then celebrated at the Human Behavior and Evolution Society by the enemies of my childhood hero, Stephen Jay Gould.”

In 2003, J. Michael Bailey had published his book on femininity in males, The Man Who Would Be Queen.   This had set off a firestorm among a group of autogyenphilic transwomen who took exception to Bailey’s effort to popularize Ray Blanchard’s research which had shown that there were two etiologies leading to gender dysphoria, that there were two (and only two) types of transwomen, as different as night and day, one that was gynephilic, autogynephilic, and gender typical until they announced their intention to transition –  and the other that was exclusively androphilic and gender atypical since birth.  This led to a number of serious accusations of wrongdoing by Bailey, to which Dreger was asked by her friend Paul Vasey to investigate.  As Dreger expresses her initial reluctance,

“Still, I thought I knew from my background in science studies and a decade of intersex work how to navigate an identity politics minefield, so I wasn’t that worried when in 2006 I set out to investigate the history of what had really happened with Bailey and his critics.  My investigation ballooned into a year of intensive research and a fifty-thousand word peer-reviewed scholarly account of the controversy.  And the results shocked me.  Letting the data lead me, I uncovered a story that upended the simple narrative of power and oppression to which we leftist science studies scholars had become accustomed. – I found that, in the Bailey case, a small group had tried to bury a politically challenging scientific theory by killing the messenger.  In the process of doing so, these critics, rather than restrict themselves to argument over the ideas, had charged Bailey with a whole host of serious crimes, including abusing the rights of subjects, having sex with a transsexual research subject, and making up data.  The individuals making these charges – a trio of powerful transgender women, two of them situated in the safe house of liberal academia – had nearly ruined Bailey’s reputation and his life.  To do so, they had used some of the tactics we had used in the intersex rights movement. … but there was one crucial difference: What they claimed about Bailey simply wasn’t true.”

Here, I have to break from the usual traditional book review to share my own experiences in this story.  I personally know most of the players.  I was an active participant in Bo Laurent’s work, meeting with her on several occasions, donating money, and helping her in a minor way to raise funds from the transsexual community.  One of those transwomen who donated was at the time, also a friendly acquaintance of mine, Lynn Conway, one of the “trio of powerful transsexual women”.  The other two were Andrea James, who I had never heard of before, and Deirdre McCloskey, who my good friend (and college roommate) Dr. Joy Shaffer, had spoken of highly.  It was reading Dreger’s lengthy paper on the Bailey affair that upended MY life, led me to become friends with Kiira Trea and eventually to write this blog at her encouragement.  This blog is the direct result of Dreger’s history of the Bailey affair.  I can think of no greater testament to the power of a scholar’s work, than that it should inspire others to action.

But Dreger’s story is only just beginning,

“You can probably guess what happens when you expose the unseemly deeds of the people who fight dirty … Certainly I should have known what was coming – after all, I had literally written what amounted to a book on what this small group of activists had done to Bailey.  But it was still pretty uncomfortable when I became the new target of their precise and unrelenting attacks.  The online story soon morphed into “Alice Dreger versus the rights of sexual minorities,”  and no matter how hard I tried to point people back to documentation of the truth, facts just didn’t seem to matter.”

I must share, that I too was vilified by these same transwomen, when I openly supported Dreger, Bailey, Blanchard, and Lawrence.

Because of her experiences, Dreger set out on a new scholarly journey,

“Troubled and confused by this ordeal, in 2008 I purposefully set out on a journey – or rather a series of journeys – that ended up lasting six years.  During this time, I moved back and forth between camps of activists and camps of scientists, to try to understand what happens – and to figure out what should happen – when activists and scholars find themselves in conflict over critical matters of human identity.”

The result of those journeys is her new book.  It explores intersex, transgender, indigenous peoples of the South American rainforest, back to intersexed people again.  Its quite a journey, of which I can only barely touch upon in this review.  While I read the entire book with great pleasure, here I chose to focus on the section dealing with transgender and Bailey’s book and its aftermath.

In delving further into the book, one finds gems like this,

“When people ask me how transgender is different from intersex, I usually start by saying that intersex and transgender people have historically suffered from opposite problems for the same reason.  Whereas intersex people have historically been subjected to sex “normalizing” hormones and surgeries they have not wanted, transgender people have had a hard time getting the sex-changing hormones and surgeries they have wanted.  Both problems arise from a single cause: a heterosexist medical establishment determined to retain control over who gets to be what sex.”

She even has a very insightful explanation of why the “trio”, and many others in the autogynephilic transwomen’s community, went to war against Bailey,

“To understand the vehemence of the backlash against Bailey’s book, you have to understand one more thing.  There’s a critical difference between autogynephilia and most other sexual orientations; Most other orientations aren’t erotically disrupted simply by being labeled.  When you call a typical gay man homosexual, you’re not disturbing his sexual hopes and desires.  By contrast, autogynephilia is perhaps best understood as a love that would really rather we didn’t speak its name.  The ultimate eroticism of autogynephilia lies in the idea of really becoming or being a woman, not in being a natal male who desires to be a woman. … The erotic fantasy is to really be a woman.  Indeed, according to a vision of transsexualism common among those transitioning from lives as privileged straight men to trans women, sex reassignment procedures are restorative rather than transformative… For Bailey or anyone else to call someone with armour de soi en femme an autogynephile or even a transgender woman – rather than simply a woman – is at some level to interfere with her core sexual desire.  Such naming also risks questioning her core self-identity … When they felt that Bailey was fundamentally threatening their selves and their social identities as women – well, it’s because he was.  That’s what talking openly about autogynephilia necessarily does.”

There’s a wonderful bon mot moment in the movie, Desert Hearts, when a lesbian scholar vows that she will have her revenge on a homophobe when she writes her memoirs.  In this book, one could say that Dreger takes her revenge on McCloskey, Conway, and especially James by revealing evidence that they are not only autogynephilic, but knowingly so, as Dreger reprints text from an email from Andrea James to Anne Lawrence in 1998,

“A definition is inherently inclusive or exclusive, and there’s always going to be someone who doesn’t feel they belong in or out of a definition.  I got body slammed by the usual suspects in 1996 for recommending a Blanchard book.  Sure, he’s pretty much the Antichrist to the surgery-on-demand folks, and I’ve heard some horror stories about the institute he runs that justify the nickname “Jurassic Clarke.”  However, I found many of his observations to be quite valid, even brilliant, especially in distinguishing early and late-transitioning TS patterns of thought and behavior.  I’ve noticed in most TSs, and in “surgery addicts” especially, a certain sort of self-loathing, a drive to efface every shred of masculinity.  While I readily admit to my own autogynephilia, I would contend that my drives towards feminization seem to have a component pushing me from the opposite direction as well.”

Dreger goes on,

“OK, THIS WAS FASCINATING.  A prior admission to autogynephilia from James and what seemed to amount to the same from McCloskey – plus something very much like an ongoing tacit admission from Conway? – lying behind the attempts to bury Bailey.  All that spoke to motivation on the part of Conway et al.”

Personally, I find this damning, as James has made a special point of defaming a number of individuals in the transcommunity for supporting Anne Lawrence, Bailey, or Blanchard.  She writes scurrilous material on her website against Dreger, Bailey, Blanchard, Lawrence, and many other notable transwomen, including myself; all for writing about a phenomena of which she admits she experiences.

Dreger recounts her year of research on the Bailey affair, detailing the ways in which Conway and James attack Bailey and how she was able to discover the truth of the matter, setting the record straight.  She also recounts how these two transwomen then turned on her, attempting to blacken her name with the same tar filled brush.  In the end, it becomes clear, that though the experience was unpleasant, it lead her to connect with a number of other scholars who have wrongfully been attacked and vilified by other groups, in other fields.

At the end of the book, Dreger lays out recommendations for society and especially for social justice advocates, to follow an evidence based approach.  I would like to think that I would qualify as an exemplar of her recommendations, in my conduct of this affair and of my previous, and definitely of my future, activism.

I highly recommend purchasing and carefully reading this book:

http://www.amazon.com/Galileos-Middle-Finger-Heretics-Activists/dp/1594206082

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Triumph for Whom?

Posted in Editorial by Kay Brown on March 1, 2015

CloudyIn 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.

Reference:

http://m.weeklystandard.com/articles/transgender-triumph_859614.html?page=3

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Gender Allusions

Posted in Brain Sex, Science Criticism by Kay Brown on February 24, 2015

critical-thinkingIs “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.)

Reference:

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

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