Friday, August 3, 2012

On Trans Gender Identity and the "Intersex Brain"


Once upon a time, in the fairly recent past, people often asked what made a person gay or lesbian—taking the perspective that homosexuality was a pathology that needed explanation. Various theories were proposed: psychological (could a domineering mother and passive father be the cause?); moral (was it a failure to embrace “traditional Christian family values”?); and biological (was there some hormone imbalance or brain abnormality at fault?).

Today, when someone comes out as lesbian, gay, or bisexual, the question of etiology is rarely raised. Lesbian, gay and bisexual rights advocates are much less likely to spend their time tossing back at the homophobic the questions, “What made you straight? When did you realize you were straight? Could you do something to change your heterosexuality if you tried?” Sexual orientation is generally treated as a fact, something that is not pathological and that requires no etiological explanation.

Back in the 20th century, however, many advocates for “gay rights” sought to find a physical cause for homosexuality. They hoped that finding proof that there was some immutable, biological reason for homosexuality, beyond the individual's control, would lead to greater social acceptance. In fact, it was political activism, not scientific discoveries, that led to the social shift to viewing LGB people as a minority deserving of protection from bigotry. But for a while, many “gay rights” activists were focused on finding proof that there was such a thing as the “gay brain,” and research on the topic persists today. The size of the hypothalamus of gay men has been argued to be more similar to straight women's than straight men's. It's been posited that straight men and lesbians have brains with a right hemisphere slightly larger than the left, while straight women and gay men have balanced brains.

Implicit behind these arguments is a belief that gay men are in some way effeminate, and lesbians masculine. But LGB activists scoff at this belief today—the idea that gender expression relates to sexual orientation now seems offensive and ridiculous. So while scientific research continues to look for ways in which gay male brains are “feminine” and lesbian brains are “mannish,” LGB rights advocates no longer pay much attention.

We've not come to this point, however, in the struggle for trans gender rights. Trans people today are making strides, but we're now in the position LGB people were decades ago. We face a great deal of discrimination and disgust from the cis gender population, and we are constantly asked, “What made you trans? Was it psychological trauma, is it that you don't respect traditional Christian family values, or is there something wrong with you medically?”

And just like lesbian, gay and bisexual people in the 20th century, trans people today face such virulent bigotry that many trans people hope finding scientific proof that there is some immutable, physical reason for trans gender identity, beyond the individual's control, will lead to greater social acceptance. Today many trans activists are eager to trumpet neurological studies that purport to show that the brains of trans men are more like the brains of cis men than of cis women, or that the brains of trans women are more like those of cis women than cis men.

It was the philosopher Descartes who first argued that the brain contains localized areas that control the body. He declared that the soul occupied the pineal gland—a theory sounds ridiculous today, when we know that the pineal glad is more prosaically the structure that secretes melatonin. But today, many trans people (it must be clear by now that I am not one of them) are looking for a brain structure housing gender identity. They argue that people are born with a “brain sex,” and that if this “brain sex” differs from the individual's genital sex, they suffer from an intersex condition that must be treated via gender transition.

I am deeply uncomfortable with this intersex theory of gender dysphoria. While I know from personal experience that it gives some trans people great comfort, and while I worry about seeking to demolish what others feel is their life raft, I want to lay out my objections.

My first objection is a scientific one: gender identity and gendered behavior are deeply complex. They are no more located in the hypothalamic unciate nucleus than the soul is located in the pineal gland. If many of ares of the brain are involved in something as comparatively simple as speech, how many more must be involved in matters as complex as sense of self?

A second objection relates to the entire field that Cordelia Fine names “neurosexism.” Basically, the entire field of neurological study of sex differences is pervaded by sexism and flawed by a teleological approach: “We know that men are good at math, logic and sport, while women are good at nurturing and communicating, so let's pin these to some brain differences we can locate.  This will show that politically-correct resistance to the idea of eternal gender roles is pointless.” By linking claims to trans rights to this body of science, we're tying ourselves to gender stereotypes and a regressive social agenda.

A third objection is that the brain is a very “plastic” organ, meaning that it changes over time. For example, when a deaf person communicates via sign language, different areas of the brain are “recruited” to process communication than just those used for oral speech. Furthermore, early and late learners of sign have different patterns of brain activation when they observe another person signing. In other words, the brain, like other parts of the body, is affected by life experience and use--it varies greatly from individual to individual, and for one individual over time. Even if we were to find that trans men resemble cis men in their patterns of brain use, this would not mean that such a similarity is inborn. It would just mean that trans people have life experiences similar to cis people who share their identified sex, cultural norms, and gendered behavior.  This is certainly proof that we experience our gendered identities and lives in the same way cis people do.  It is not proof that trans people are born with intersex brains.

Another objection I have is to the foundational premise at hand: that trans men and cis men are uniformly masculine in their gendered behavior and style, and hence distinct from feminine trans and cis women. In fact, there are plenty of men, cis and trans, who are nurturant parents, or who like the color pink, or who are bad at sports. There are many women, cis and trans, who are dominant athletes, have bad verbal skills, are excellent at spatial relations, or who hate primping. Furthermore, plenty of trans people are genderqueer in identity, which can't be explained in the least by this dyadic, reductionist framework.

I also object as someone who is intersex by birth to the framing of trans identity as an intersex condition. The difficulties faced by intersex people can indeed relate to gender identity, since children born intersex today are forcibly assigned a dyadic sex at birth, and often subjected to sex reassignment surgery to which they cannot consent. If the child grows up not to identify with the sex to which ze was coercively assigned, gender dysphoria results. But no test has ever been developed that can determine what the eventual gender identity of an intersex person will be—not in the brain, the chromosomes, the gonads or the genitals. And the issues intersex people face center on forced sex assignment in childhood--something which advocates of the intersex brain thesis tacitly support when they argue that since trans status arises from an intersex brain, it "must" be treated medically. Like many intersex people, I boggle resentfully at the idea held by some trans people that intersex people are “lucky,” have a privileged relationship to the medical community, or are free from stigma in our lives. The belief that being categorized as intersex would lead to advantages, which causes some trans people to frame trans identity as an intersex condition, is deeply flawed.

Finally, I would argue that this entire issue is a distraction. Remember that it was not the discovery of a brain area “causing” homosexuality that led to the relative successes of the LGB community in gaining civil rights. It was activism that led to those gains. The belief that if differences could be shown to be inborn, liberation would result, seems hopelessly naïve to me. Bear in mind that for many decades, scientists argued that women should not be permitted to vote or attend college because their brains were too small. More starkly, consider the Holocaust, which was founded on a belief in inborn racial inferiority.  Some intersex conditions can be detected prenatally, but this has not led to more widespread acceptance of intersexuality.  When these conditions are detected, doctors typically offer to terminate the pregnancy.

For all these reasons, I urge people not to hitch the wagon of trans rights to the idea of inborn, dyadic, neurological differences. Brains are extraordinarily complex and shaped by culture and experience over time. Gender identities are multiple, gender roles constantly evolving, and gender expression varies widely from individual to individual. Intersex people face huge obstacles, and framing us as the lucky group to be emulated denies our suffering.

The solution to transphobia is not neurology, but political activism.

23 comments:

  1. Interesting article. I do agree that gender expression is a spectrum as opposed to a binary condition. I also believe that it is formed as a combination of environmental/ social factors as well as biological factors. I also believe that sexuality is probably the same; although I think there are people who are exclusively gay which is probably a stronger biological etiology. Bisexuality and sexual fluidity probably has more to do with social/ environmental factors such as cultural acceptance or molestation/ rape than someone who is exclusively homosexual from an early age.
    I also think cross dressers are different than transsexuals in terms of the degree of gender conflict. For many crossdressers it is a sexual fetish and not an issue of gender identity disorder. Often CDs mainly identify with their biological sex except when they are cross cressed. They have no desire to transition full time or have SRS and if they did they would be very uinhappy.
    Also hormones are a factor. As someone who has had SRS, I can tell you that my sexuality before SRS and after are quite different. I could actually experience the change in my brain within the week or two after SRS from male to female. I have always been attracted to men but before SRS it was all about meeting a hot masculine guy and having an orgasm. Now it's about romance and an emotional connection and someone who respects and appreciates me. It's much more about an emotional connection.
    I think it's a very complex subject and obviously Intersex people can show a clear biological cause that can now be proven by chromosomal testing. Just because we have not developed the scientific expertise to map personality and behavior in the brain does not mean it is not there. I think it is quite obvious by just observing gays, lesbians, and transsexuals who identify at the extreme polar end of the spectrum that there is an obvious physical / biological component. There are even changes in the voice pitch and tonality in many. Sure, not everyone fits the stereotype but to miss the obvious physical traits that LGT folks share would require putting your head in the sand. "Gaydar" works for a reason...lol.

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  2. I go where the evidence takes me. One cannot explain the observed phenomena (in particular, the behaviour of 46,XX babies with CAH) any other way.

    It's complicated by the fact that most of "gendered behaviour" is socially constructed, nothing to do with biology at all; and there's been a lot of bad science in this area in the past. But there remains a kernel that won't go away.

    What effect this has on "justifying" gender identity is another matter, and to my mind, irrelevant. Reality wins in the end, regardless of whether that has desirable or undesirable results.

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  3. An excelent article. I am unaware of studies of CAH babies that suport the "brain sex" theories. I am aware of the sexist studies used by the suporters of fetal dex treatment that justify that abhorent practice. I am especially aware of those conducted by mayer Bahlberg and others that are deeply flawed but lead to the attempted eradication of uppity women and lesbians using prenatal meidaction that might reduce a newborns mental capacity.

    None of the studies on CAH have been conducted with a reasonable cohort and none conducted using double blind or similar techniques.

    Those who persue CAH kids do so in an effort to demonstrate their preconceived sexist notions. the consequence has been the elimination of CAH kids by abotion ( in West Australia a 90% reduction in live births since testing was introduced) or the atempted chemical conversion using dexamethazone. The position put by the above paper is substantiated by events.

    If the Trans gene was discovered an outporing of sympathy would not be the outcome, rather attempted cures or early termination following genetic teasing would be the result.

    TRhere can be no doubt if a gay gene was discovered genetic testing and termination would be the outcome.

    Whats happening to CAH kids read here

    http://fetaldex.org/home.html

    The kinds of sexism dressed up as academia read here.
    http://www.ncbi.nlm.nih.gov/pubmed/12187546

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  4. A cautionary tale? An unlearned opinion of a lay person.
    Being careful of stereotypical enthropic categorizations of the the intersex and trans populations in there etiological standings vs. the current perceptions of reality in popular and scientific popular understandings is, a tricky road to navigate for sure.
    The brain is after all an organ, in some recompense not so unlike any other, to suggest that plasticity of it's adaptive nature rules out propensities for one gendered persuasion over another, and this a nother differentation does 'say an more easily measured extra genital attribute'contributes more substansivly towards gendered identity than the brain is understandable, considering the atrocities suffered by those unwilling/uninformed castrated into a gender. The intubation is not unfounded nor intended to diminish any in the suffering at discriminatory and bigotted practices of the Patriarchial Binary society we all live in.

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  5. Your underlying message is:

    1. There is a clear line dividing people who have been diagnosed with a "classic" intersex variation and "those" "trans people".

    2. You then make no distinction among those who *you define* as "trans". In fact you don't make a real distinction beyond using neologisms like "trans" and "cis" and suggest the difference is in the way one "expresses gender", only, thereby erasing the realities of countless lives lived in contradiction to what you say.

    I've read Anne Fausto-Sterling over and over again. I have gone to watch her lecture about brain plasticity and theories put forth by Adrienne Harris and Francoise Ansermet. Yes, "the neurobiology of freedom." What is your point? Transsexualism doesn't exist, that those who you define as "trans" are products of their environment? I have seen Fausto-Sterling lecture twice. She has some very repugnant opinions of people who have lived with transsexualism.

    Your message is the same as many intersex people I know, particulary intersex people whose lives are interwoven with the lesbian and gay community in which there is long standing prejudice towards people who opt for transsexual medical care. Basically, your focus on the stria terminalis is a red herring. Underlying everything you are saying is that people who are transsexual(people you implicitly suggest do not exist) are icky. Keep them away from me.

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    1. Ugh, not at all.

      -Arguing for trans rights **based on the neuroscience** is a doomed dead end. It is not a path to acceptance. Alone, it's only a path to selective abortions to try to 'prevent' a 'birth defect.'

      -Intersex trans people - PARTICULARLY people who were subjected to surgical reassignment as infants - are not in any way privileged over dyadic trans people by the medical community, and it's gross and appropriative to say so, particularly acting as if some people were 'LUCKY' for being forced to undergo mutilation at birth.

      This is not hard.

      Delete
  6. Excellent article. To support it, my partner has recently been looking at the ways brains of native speakers of English or other European languages physically change as the result of learning Japanese or Chinese, since they need to process characters to read or write by meaning and visual combination rather than as phonemes related to sound. If something as simple as learning another language can do this, the likelihood is that our brains are much more rapidly adaptable than we might think.

    However, whilst I agree with your analysis, I would like to add a further caution as to why we should concentrate on political activism rather than neurological research.

    The comparison with LGB people trying to find a neurological cause is dissimilar because misguided trans campaigners are doing this at a later point in history than LGB people. Technology has moved on since the 1970s and mapping the brain appears to be much more detailed. As such neuroscientists can make claims which they can support (conformation bias and publication bias notwithstanding) with more detailed evidence. Suppose someone does find some sort of correlation which would support the "brain intersex" theory? How far is our technology from being able to detect these brain differences in the womb?

    Some would argue, probably still a long way, but with technological advancement, I suspect few would dismiss it as science-fantasy, given how medical technology has developed in the last 30 years. I doubt that the LGB researchers of the last century would have spared a second thought for the idea that eugenics might rear its ugly head again, but as the population imbalance between males & females in some countries grows ever larger, it is clear that parents in many cultures are keen to use new technology to ensure they have sons rather than daughters.

    I suspect that, while the ideas of eugenics which existed pre 1945 (and still linger today) were tied to Orwellian visions of governments introducing genetic selection into the population, eugenics in the future will be privatised, and probably expounded by religious zealots and political homophobes and transphobes. Let's face it J Michael Bailey has already written a paper in which he calls for parents to be able to select their children's sexual orientation, and the revelations of Alice Dreger, that using steriods in the womb to prevent babies from being intersex or LGB suggests that there are a whole load of people out there waiting to employ amateur eugenics on their unborn children.

    Obviously the day is not upon us yet when such detailed observations of the brains of unborn children may be made, but given the technological changes which have occurred since the 1970s, the increasing rapidity of those changes, I doubt that anyone would argue that it is too far away to worry about.

    IMO the danger is not that people start aborting LGBTI fioetuses because of brain scans of unborn children, but that they THINK they are doing so. I suspect that after such abortions start happening, the number of LGBT! children will be the same. Meanwhile some trans poeple will have committed suicide after having been denied access to GRS because brains scans show that their brains are not trans.

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  7. I fully agree with Gina and Natacha that if a medical consensus formed that some brain structure indicated a "trans brain," the result would be the development of a prenatal test for it, and another surge in selective abortion. The experience of the intersex community makes this clear (as do the experiences of people with a wide range of physical differences that are considered "disorderd" or "defective").

    I am also aware that there is a sector of the trans community comprised by people who self-identify as "true transsexuals" and against a definition of trans gender that embraces a wider range of gender identities and transition pathways. I have no quarrel with any trans person identifying with a binary sex, or needing to have genital surgery ("sex reassignment surgery," "gender affirmation surgery") to reduce their gender dysphoria. My opposition to the "intersex brain" theory of trans identity centers pragmatically on my conviction that labeling some brain morphology trans would lead to selective abortion, rather than reducing stigma, and scientifically on the teleological nature of this branch of neurological research.

    I am saddened that I have been portrayed as an enemy of gender transition, by Edith here and by others elsewhere, for critiquing the "intersex brain" theory of trans identity. I myself have gender transitioned medically, and my transition vastly improved my life. It depresses me that because my medical transition has not involved genital surgery, I should be painted by any other trans person as not "truly transsexual." As an intersex person, I am not interested in any further alterations of my sexual organs.

    I am committed to political advocacy on behalf of the intersex and trans communities, based upon human rights, respect for persons, and bodily autonomy--not upon us being "disordered."

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  8. Hi Dr. Costello,

    It is not my intention to be rude. I am not from Australia. There are, however, groups that lobby international organizations. I may be totally wrong but I suspect the issue you are speaking of might be a little more complicated than the way you are presenting it.

    What does this imply?

    2.38 The Organisation Intersex International Australia disputed that Re Kevin has settled this issue for intersex persons who have adopted a gender, arguing that ‘irrespective of surgery or other medical interventions if [a person] is born Intersex [that person] remains intersex’…

    2.40 A number of submissions recommended that any amendments to the Marriage Act to provide for marriage equality for same-sex couples should also address the issues faced by intersex and transgender persons.

    http://oiiaustralia.com/20742/senate-committee-supports-marriage-equality/

    I think how things are defined in the law have consequences. The proposal above seems to imply an awful lot. I don't have time to point out everything that concerns me but it seems to me such a definition of intersex written into law would clearly define sex as an immutable trait determined at birth.

    Wasn't the testimony of the researchers who studied the BSTc favorably received in re: Kevin? I mention this last because I don't think this study is terribly important. It's just that your argument reduces "transgender"(if you insist on vagueness completely divorced from the physical) issues being psycho social issues of "distress" that are merely accommodated by a compassionate medical community.

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  9. Some references:

    Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. by Berglund et al Cerebral Cortex 2008 18(8):1900-1908;

    Male–to–female transsexuals have female neuron numbers in a limbic nucleus. Kruiver et al J Clin Endocrinol Metab (2000) 85:2034–2041

    Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Swaab Gynecol Endocrinol (2004) 19:301–312.

    A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.

    A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. by Garcia-Falgueras et al Brain. 2008 Dec;131(Pt 12):3132-46.

    Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth by Reiner and Gearhart, N Engl J Med. 2004 January 22; 350(4): 333–341.

    The role of androgen receptors in the masculinization of brain and behavior: what we’ve learned from the testicular feminization mutation. Zulago et al. Horm Behav 53:613-626

    White matter microstructure in female to male transsexuals before cross-sex hormonal treatment. A diffusion tensor imaging study. - Rametti et al, J Psychiatr Res. 2010 Jun 8.

    Regional cerebral blood flow changes in female to male gender identity disorder. - Tanaka et al, Psychiatry Clin Neurosci. 2010 Apr 1;64(2):157-61.

    “Prenatal hormones versus postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia” Pasterski VL, Geffner ME, Brain C, Hindmarsh P, Brook C, Hines M Child Dev 76(1):

    Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

    Biological and Psychosocial Correlates of Adult Gender‐Variant Identities: a Review by J.F.Veale & D.E.Clarke, Personality and Individual Differences (2009) 48(4), 357-366

    Sexual differentiation of the human brain in relation to gender identity and sexual orientation D.Swaab & A.Garcia-Fulgaras Functional Neurology, Jan-Mar 2009:

    Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure by Pol et al, Europ Jnl Endocrinology, Vol 155, suppl_1, S107-S114 2006

    Neuroimaging Differences in Spatial Cognition between Men and Male-to-Female Transsexuals Before and During Hormone Therapy by Scoening et al J Sex Med. 2009 Sep 14.

    Regional gray matter variation in male-to-female transsexualism. by Luders et al Neuroimage. 2009 Jul 15;46(4):904-7.

    Dichotic Listening, Handedness, Brain Organization and Transsexuality Govier et al International Journal of Transgenderism, 12:144–154, 2010

    Atypical Gender Development: a review Besser et al International Journal of Transgenderism 9(1): 29-44. 2006

    Specific Cerebral Activation due to Visual Erotic Stimuli in Male-to-Female Transsexuals Compared with Male and Female Controls: An fMRI Study by Gizewski et al J Sex Med 2009;6:440–448.

    Prenatal exposure to testosterone and functional cerebral lateralization: a study in same-sex and opposite-sex twin girls. Cohen-Bendahan et al, Psychoneuroendocrinology. 2004 Aug;29(7):911-6.

    Prenatal exposure to diethylstilbestrol(DES) in males and gender-related disorders:results from a 5-year study Scott Kerlin. Proc. International Behavioral Development Symposium July 2005

    Sexual differentiation of human behavior: Effects of prenatal and pubertal organizational hormones Sheri A. Berenbaum, Adriene M. Beltz Frontiers in Neuroendocrinology 32 (2011) 183–200

    I've only mentioned one of the thousands of papers on animal experimentation, as we know that what may be true for experimental animals may not always be true for humans too. But all mammals we've ever examined have these characteristics, so it's at least possible that humans do too, it gives us clues on where to look.

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  10. Gina wrote:
    I am unaware of studies of CAH babies that suport the "brain sex" theories.

    Prenatal hormones versus postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia Pasterski VL, Geffner ME, Brain C, Hindmarsh P, Brook C, Hines M Child Dev 76(1)

    See also
    Sexual Hormones and the Brain: An Essential Alliance for Sexual Identity and Sexual Orientation Garcia-Falgueras A, Swaab DF Endocr Dev. 2010;17:22-35

    Boys and girls behave in different ways and one of the stereotypical behavioral differences between them, that has often been said to be forced upon them by upbringing and social environment, is their behavior in play. Boys prefer to play with cars and balls, whereas girls prefer dolls. This sex difference in toy preference is present very early in life (3–8 months of age) [1]. The idea that it is not society that forces these choices upon children but a sex difference in the early development of their brains and behavior is also supported by monkey behavioral studies. Alexander and Hines [2], who offered dolls, toy cars and balls to green Vervet monkeys found the female monkeys consistently chose the dolls and examined these ano-genitally, whereas the male monkeys were more interested in playing with the toy cars and with the ball....

    What is interesting - and an area that needs more research - is what characteristics define such distinct groups of toys. We know that males tend to prefer one group, females another but the definition of those groups is far too tied up with cultural assumptions at the moment, as Cordelia Fine points out in Delusions of Gender. She does however confirm that there's too much evidence for "brain sex" here for it to be dismissed, it's just the magnitude of effects and boundaries that are under discussion, not whether the phenomenon is real.

    She adduces that in the conservative, patriarchal world-view, such differences have been greatly over-stated. I think that's incontrovertible, and I recommend her book to see exactly how this has happened.

    To state though that there's no difference is easily disproven, as her book states too - though for whatever reason, this has been glossed over by many. It's not emphasised.

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  11. "I am deeply uncomfortable with this intersex theory of gender dysphoria. While I know from personal experience that it gives some trans people great comfort, and while I worry about seeking to demolish what others feel is their life raft, I want to lay out my objections."

    Wow. Not too condescending are we?

    "My first objection is a scientific one: gender identity and gendered behavior are deeply complex. They are no more located in the hypothalamic unciate nucleus than the soul is located in the pineal gland."

    Your logical fallacies are showing. That's not what the study asserted. It merely confirmed that some Transsexual females had a brain structure similar to the brains of non-transsexual females.

    Why are you so threatened by the search for knowledge? Here you state...

    "I also object as someone who is intersex by birth to the framing of trans identity as an intersex condition."

    We know the fetal brain undergoes some manner of gender differentiation in the womb, so why can't Transsexualism be a neurological intersex condition? Why must intersex conditions be limited to specific organs? The brain is as much a part of the physical body as the genitals. I was "forcibly assigned a dyadic sex at birth" as much as you were. A doctor saw a penis and testicles and said "male." Nobody asked me how I felt, or waited to see how I'd react to an imposed male childhood.

    Brain plasticity cannot account for gender identity. Consider a scenario where one imposed transition on a person against their will. How likely is it that the person would adapt to such a situation by developing a female gender identity? I'd say the chances are just about zero. There are certain aspects of being a sexual organism that cannot be "left to chance." If nature relied on social learning - the transfer of knowledge from generation to generation - to ensure reproduction, our species could easily go extinct in the absence of elder members, or if such knowledge were transferred incorrectly. Nature is not so sloppy.

    Humans are born "pre-programmed" to feel male or female, and to feel attraction toward the sex that will result in offspring. We don't need to learn this. We are given reproductive organs that "fit" together, and they feel good while doing so. Humans who aren't taught how to reproduce can "figure it out", simply because males feel like males, and seek mounting and penetration, while females feel like females and seek lordosis and being penetrated. Obviously not ALL humans feel this way, but the standard model human is supposed to, and this knowledge MUST be intrinsic to ensure species viability.

    Brains are gendered, because they HAVE TO BE.

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  12. "I am saddened that I have been portrayed as an enemy of gender transition, by Edith here and by others elsewhere, for critiquing the "intersex brain" theory of trans identity."

    I am critiquing two things:

    1. "intersex brain theory" - what is "intersex brain theory"? I think you oversimplify questions whose answers about a sense of self interacting in a social environment may be more complex than and in conflict with explanations based on notions that "gender identity"(which is another word paring that presupposes such a thing actually exists) is formed exclusively as a result of social constructs.

    2. "trans identity" - does that mean you only acknowledge that male and female only exists for "cis" people? If it exists for "trans" people, too, how does it exist for them? How are they female or male? Does "male" and "female" even exist or is sex a social construct, too? What defines a "trans" persons sex? Do "trans" people have a sex? Is it the one assigned at birth? What are sex characteristics? If sex characteristics are changed, should they be acknowledged as sex characteristics? How does brain plasticity figure into the endocrine changes involved in gonadectomy and hormone replacement? Doesn't the plasticity of the human body imply that it is possible to alter sex?

    you wrote in reply to me:

    "I myself have gender transitioned medically, and my transition vastly improved my life"

    but in your original post you say something that seems to totally contradict the assertion you make in your reply:

    " But today, many trans people (it must be clear by now that I am not one of them)"

    If you are not one of "those trans people", what makes you so qualified to speak for them?

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  13. Edith, just to clarify, I am not one of those trans people who think that our community is well-served by pinning our claims to fair treatment on the idea that trans status is an intersex disorder. I am indeed a trans person, and advocating for bodily autonomy and respect for gender identity--and against transphobia and transmisogyn--is why I blog here.

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  14. I find it difficult to understand this post, since it seems to conflate the idea of innate gender identity / gender roles (which, as you say, is just a way of reifying patriarchy) with the idea of having an internal mental map of your body that differs from the body's outward shape.

    There are plenty of explanations for the former based on culture and socialization, so there's no need to look for biological explanations. But as for the latter, how could I have learned that my brain doesn't work unless testosterone is my primary hormone? How could someone have taught me that I can enjoy sex when I have (or think about having) a penis, but not a vulva? What incentive would there be for anyone to do that? It doesn't make sense.

    I don't need the evidence to be definitive to know that my lived experience is valid.

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  15. I think if anything, a belief that a hard-wired sex or sexual orientation must specify a corresponding femininity or masculinity is far more inherently heterosexist and cissexist than people who cite studies on DES daughters, cis or trans.

    There's nothing biologically 'wrong' with a CAMAB womon any more than there's something 'wrong' with a toxin resistant bed bug. Living things are diverse, and a little bit hard-wired to be so.

    Actually, if you want to argue that the response will be an attempt to 'cure' children, you're out of luck, since by the time you can determine the gonadal morphology of the child, gender identity seems rather set. You could pretty uniformly guarantee trans lesbians, for example, with a regime of spironolactone (to prevent testosterone, which is correlated with male gender identity and androphillic sexual orientation) and DHT (to promote wolffian gonadal morphology). To try to guarantee a straight cis kid is a lot more work for very little reward.

    Also, the midbrain? Not neuroplastic after birth.

    Understanding who we are and how we develop isn't just useful in terms of getting acceptance from cisnormative folk. It's useful in terms of knowing how and when to offer help to children who may need it, and it's useful in terms of queering gestation. If parents have the right to select for genital morphology, have the right to try to influence development, then surely they have the right to try to improve their chances of having a girl.

    And just to counter the standard forthcoming arguments: Transness, even that bit of crisis-level gender dysphoria, is not a horrible thing. Cissexism that seeks to deepen and prolong it is.

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  16. As a genderqueer person undergoing medically assisted transition into a body more comfortable for me, I'm really glad to see such an eloquently argued piece against essentialising about neurobiology.

    One of my earliest fears as a trans person hearing about scientific results for brain differences was "what if someone suddenly develops some sort of scan test for trans people, and I or someone I know falls into the perennial group of outliers in a study, and then fail to qualify for treatment, be restigmatised as trans people used to be as merely psychotic and in need of help to understand my gender delusion for my own good? What good does it do anyone to have any certainty about gender anyway, to make people dependent on such a high standard of proof in such a murky area? It serves those who want to erase us or stop us living our lives as we see fit, making choices about what we do with our bodies to suit our own needs. Coopting intersex as an explanation of transsexual or transgender identity is a danger to us all trans, intersex and both.

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  17. As the sad case of David Reimer amply demonstrated, our gender identity is, to a large extent, hardwired into our brains before birth, and can't be changed afterwards by social conditioning.

    The Y chromosome is far smaller than any of our other chromosomes, and only has a few dozen functional genes on it. Basically all it does is tell your undifferentiated gonads to turn into testicles (without it they'll turn into ovaries instead). All the actual instructions for both male and female development are held elsewhere in your genome, so everyone has the full set of instructions for both sexes.

    Something has to tell your body which set of instructions to follow, and in humans that something is testosterone. By default you develop as female, but if there's testosterone present you develop as male instead.

    Ordinarily this system works quite well and you'll develop as one sex throughout the pregnancy (which one depending on whether you have testicles churning out testosterone or not). However, if something happens to interfere with testosterone production in a male fetus (e.g. XXY karotype), or cause androgens to be overexpressed in a female fetus (e.g. CAH), then you'll end up with a period of intersexed or opposite-sexed development.

    If this happens early in the pregnancy while organogenesis is taking place, then development of the genitals and reproductive organs will be affected and you'll end up with a physically intersexed baby. If it happens later in the pregnancy then sexually dimorphic brain development will be affected instead, and you'll end up with a baby who looks like their genetic sex, but has a brain that is, to a greater or lesser extent, that of the opposite sex. Obviously that baby is going to be at risk of being gender variant later in life!

    I think that most trans people are likely to have experienced some kind of disruption to their hormones during the later stages of the pregnancy - and that in many cases, the thing that caused that disruption was actually the medical use of artificial sex hormones such as DES!

    Both estrogens (mainly DES) and progestins have been widely used for decades as treatments to prevent miscarriages, at doses often considerably higher than that required to completely suppress testosterone prouction in an adult man. Why would testosterone production in a male fetus be affected any differently by these drugs than in a man?

    Miscarriage treatment typically isn't started until after the point where it'd affect genital development, but then continues throughout the later stages of the pregnancy (when sexually dimorphic brain development is taking place). It looks like an ideal recipe for creating MTF transsexuals!

    So far I've tested this theory by looking at DES sons, and there certainly appears to be a link between middle-aged MTF transsexuality and prenatal DES exposure. The ones I've chatted to or whose life stories I've read have often mentioned that they knew from a young age that they were really a woman, but social pressures prevented them from doing anything about it until they were much older.

    DES was withdrawn 40 years ago, but progestins are still in use for prevention of miscarriage, at doses that certainly look high enough to interfere with testosterone production (e.g. Proluton Depot). If they have similar effects on male development as DES apperars to have had, it would explain why transness seems to have become exponentially more popular recently!

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  18. As m2f transgender and as cognition researcher, I can assure you there is indeed a neurobiological element in psychological predispositions and a plethora of gender archetypal cognitive functions related to hormone levels. But it's sensible to state that complex patterns emerge from this in, through, and defined by experience.

    Using myself as a quick example, I've lost part of my sense of direction (which used to be almost absolute), I've lost some focused concentration (from 3 to 2 hours, on average), I've gained some efficient disperse attention (I find the "multitasking" concept rather inadequate), I've developed a more intense response to emotional stimuli (I cry more easily, take a tad longer to rationalize sensations...), etc. As far as my self-experiment goes, yes, men and women experience the world in significantly distinct ways.

    That said, note, however, that this is what happened AFTER the start of my transition. No, I have no significant evidence that my cognitive functions were any different than those of an average testosterone infused human up to that point. Taking brain functions tests, for example, is always complicated when you know how they work and how frail their logic is, so my "female" results mean next to nothing. They were just something to amuse myself with 'what if' possibilities before I decided to transition.

    What can be assigned to neurobiological factors would be much more elusive traits, such as a family predisposition to depression, my overall lack of aggressive behavior, my forgetfulness, my talent to "read" people, my underdeveloped musical aptitude, etc. These are phenotype expressions of genetic predispositions. They define very specific traits, all of which contribute to make me... me. However, their scope is very limited, and no correlation could be sensibly made between any of them and my transgenderness.

    I could have never transitioned, even with a genetic make-up that makes it a possibility for me. Yes, a possibility, not an ontological necessity. Truth is most transgenders could live without transitioning. They just wouldn't be happy, or as happy as they could be somewhere else in the gender spectrum. Too many people live unhappy lives. Transgenders are basically people who decided to deal with one of their major sources of unhappiness: their gender identity.

    Happineess, unhappiness, gender (seen as a part of the self and a social construction, different of sex, seen as biological phenotype), identity... All of these are complex phenomena, known to result of interactions in complex open metastable and multilayered systems: ourselves. Direct cause -> effect explanations are doomed to spawn noneffective and potentially harmful policies and procedures. Studies of brain development during pregnancy help to identify possible factors in the genesis of predispositions, and should never be taken for more than that. Neurocognitive studies with transgenders try to identify the current state of their cognitive functions, a product of everything they were and experienced, and as such deemed to keep changing. They shouldn't also be taken for more than that.

    All in all my personal opinion is that to simplify the nature of scientific research to provide easy answers to troubling questions reveals ignorance or bad faith. The first can be solved with relative ease. The later is way more complicated...

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  20. Hi Dr Costello,

    I'd just like to apologise for jumping in on your post yesterday in the Facebook Transgender Alliance group. Seeing your name there reminded me of this blog entry, and I couldn't resist commenting!

    The two points I was trying to make are that, firstly, a disproportionately high proportion of MTF trans folk appear, like me, to have not fully virilized as they went through puberty. If there are physical effects on hormones and body structure, then it means that transness can't be a purely psychological condition, and there must be some physical basis to it as well.

    Secondly, there's a large hidden population of people who've ended up with intersex-related disorders of various kinds, as a result of being prenatally exposed to very high doses of artificial sex hormones (estrogens, progestins and to a lesser extent anabolic steroids) during the "wonder drug" era, from about 1940 to the mid-1970s. This was a period when newly developed drugs were routinely rolled out into general use with minimal safety testing, with disastrous consequences in several cases. Thalidomide is the one the public know about, but there's at least 3 other major drug disasters that took place during that same era in which much larger numbers of people were exposed, that have remained largely or completely off the radar as far as the public's concerned - DES, progestin induced virilization and Hormone Pregnancy Tests.

    I was talking yesterday about DES causing female development in biological males, and the fact that there appear to be very high rates of both intersex-related genital abnormalities and MTF transsexuality among DES sons. However, DES isn't the only drug with the ability to disrupt sexual development in the fetus. There's an acknowledged problem called progestin induced virilization (which even has its own wikipedia page). Although progestins are supposed to target progesterone receptors and thus mimic the action of a female hormone, the first generation of progestins were actually derivatives of the testosterone molecule and turned out to have highly androgenic effects on the female fetus. See for instance:
    http://jama.jamanetwork.com/article.aspx?articleid=327726
    MASCULINIZATION OF FEMALE FETUS DUE TO USE OF ORALLY GIVEN PROGESTINS, JAMA. 1960;172(10):1028-1032.
    "A markedly masculinized female infant is readily mistaken for a hypospadic male or for a normal male with simple cryptorchism. This congenital condition is sometimes caused by virilizing adrenal hyperplasia, but data here presented show that it has also frequently resulted from administration of progestins to mothers in treating habitual or threatened abortion."

    Despite their history of gender bending effects, progestins are still quite widely used in cases of threatened abortion and recurrent premature birth. The more recently developed progestins are given in lower doses and not started until genital development in the fetus has completed, and apparently don't have virilizing effects on baby girls' genitals. I think the doses being used could still be sufficient to suppress testosterone production in a male fetus and cause abnormalities of sexual development (mainly affecting the brain) that way. Given the past track record of medical hormones in pregnancy, and the apparent lack of investigation into effects on sexual development, do you think these substances are safe? I don't, at least not until it's openly acknowledged that there have been past incidents in which large numbers of people have ended up intersexed as a result of exposure to medical hormones, and effects on sexual development are included in their safety testing.

    There's more about high dose progestin use during the mid to late 20th century here:
    http://prenatalexposures.blogspot.co.uk/2013/05/worse-than-thalidomide-consequences-of.html

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