Nature, Nurture, and Hormonal Transition

We are all constantly flowing with a complex mix of hormones. They cycle like tides, they interrelate in fascinating ways, and they are always shifting in response to our physical and social environments. Among these are the “sex steroids,” such as estrogen, progesterone, and testosterone. All of us, whatever our sex, normally produce both the “female” and “male” sex hormones—in fact, calling them “male” or “female” is very odd, considering that a man requires estrogen to produce viable sperm, and a female relies on testosterone for healthy muscle tone. It is the relative balance of estrogen and testosterone—not the absence of one or the other—that determines our secondary sex characteristics, such as the development of breast tissue or facial hair. This balance varies from person to person, because all sex characteristics exist on a spectrum (with some of us living in the middle intersex territory).

We like to tell a simple story in which people have a biological sex, over which is laid social gender (such as the clothing we wear, what we do with the hair on our heads and bodies, or what careers our society deems appropriate for us). Our physical makeup is presented as asocial and unchanging. In fact, we are naturally social beings, born to have our biological makeup affected by our social experiences. For example, humans are born with a capacity for language, but what language we learn depends on the society into which we are born. And the language we learn, in time, affects our brains. Depending on what phonemes are used in the language(s) we learn as children, we become capable of distinguishing some sounds and not others. If we learn a language in which compass-point direction is incorporated when referring to objects, we develop a much stronger innate sense of direction. If we learn to communicate in sign language, the centers of our brain recruited to produce communication develop quite differently. The brain is a “plastic” organ, shaped by social experience.

In my last post I critiqued the argument that having a trans identity should be understood as an intersex disorder of the brain, necessitating genital sex reassignment. I critiqued this argument because (1) I'm intersex and abhor the argument that it is “necessary” to surgically alter our genitals, and (2) the experience of the intersex community cautions that if there were indeed a medical test for some morphology deemed to represent a "trans brain," the result would be eugenic abortion. I got a lot of negative feedback on that post. Interestingly, some people thought it implied an argument against medical transition, which it is most assuredly not my intent (I've transitioned hormonally). My argument was only with the idea that the way to win civil rights is to champion a biological etiology for trans identity. As for etiologies of gender identity or sexual orientation, my take is that I'm sure they're incredibly complex, but also that they are as irrelevant as the etiology of identifying as a "cat person" versus a "dog person," or, less flippantly, the etiology of identifying with a particular religion. Many people affiliate with the religion (or lack thereof) their parents expect them too, but some do not, and either way, their religious identities should be respected, without needing to look for a biological etiology of religious preference to justify respect.

In any case, in this post I'd like to discuss the interrelationship of biology and social factors in hormonal transition.

In my own life, I've lived under four different hormone balances. First, I had the standard prepubertal hormonal milieu of low sex steroids. At puberty, my gonads kicked in and I developed secondary sexual characteristics—and because I had three gonads (two ovaries and an ovotestis), I developed a lot of them. In later adulthood, my internal reproductive organs were removed, and my sex steroid levels soon fell to almost nil (with less testosterone, estrogen or progesterone than what would be expected for a 90-year-old menopausal woman). And several years later I began hormone replacement therapy with testosterone, or “T,” leading to my living with typical male levels of T, unaccompanied by the usual male levels of estrogen or progesterone. I duly note that none of the three hormonal balances I have lived under as an adult are typical ones. What I can report on is what I experienced with a high, estrogen-dominant hormone load, what it's like to live with no sex steroids, and what changed when I went from no sex steroids to T alone.

There is no doubt that hormone replacement therapy has biological effects. When a person takes estrogen, “E,” (sometimes accompanied by progesterone, “P”) to gender transition, she develops breasts, deposits fat around the hips, and develops softer skin and ligaments. When a person undergoes HRT with T to transition, his voice changes, his phalloclitoris enlarges, and he grows more facial and body hair. But we often talk about other changes. In the contemporary U.S., we think of men as aggressive and dominant, and women as empathetic and emotionally labile, and we expect these conditions will develop with HRT. Often, friends and family worry that a trans man will become violent if he undergoes hormonal transition, or that a trans woman will become irrational. It's as if people see testosterone as the Hormone of War, and estrogen as the Hormone of Overwhelming Emotion (helpfully pictured in my little graphic above). In fact, the effects they produce are much less drastic.

Changes that follow HRT are real. But this does not mean that they are only biological, not social. Consider something simple, like voice. A few months after starting HRT, my voice changed. I was very happy about this, as I was never comfortable with my voice. Clearly, T precipitated changes in my vocal cords and larynx. But a lot of the changes in my voice over the course of my transition have been socially produced. First, there's the fact that I consciously chose to “work” at my voice so that I spoke out of a lower part of my register. It's extremely likely that this has affected my physical vocal apparatus, just as a singer's vocal cords are affected by voice training. But many of the changes in my speaking voice were not conscious, while hardly being biological. They emerged from my being perceived as a guy, without my much noticing what was happening.

Consider this: have you ever noticed that you can often guess the gender of the person a guy is speaking to on the phone by how he is talking? Men in the U.S. today tend to speak with a higher pitch and to articulate more clearly when speaking to women, while speaking in a more mumbled, lower range to other guys. “Hi, Mia. Oh, sure, I can meet you at 4 instead. See you then!” vs. “Hey, bro. Uh-huh. Yeah, well. See ya.” So I found myself on the receiving end of bro-talk, and as a result, the way I speak changed. My spouse teases me about my grunted, blasé “uh-huhs.” Social interactions changed the way my voice sounds. You can't tease out the physical sex and social gender effects, because they interact to produce my voice, but they are both there, each influencing the other. And both components are equally “real.”

So: even the embodied changes during HRT that seem physical and simple are both biological and social. The social effects on the more social aspects of our masculinity/femininity are almost certainly more pronounced. Let's consider the idea that men are more aggressive, that this must be biologially caused by T, and thus that HRT with T will make a person more dominant and violent. This belief is shaped by two things: first, by a cultural ideology shared by all patriarchal societies that men's dominance of society is natural, and secondly, by media reports on the phenomenon of “roid rage” in cis men who use T illegally to build muscle mass for sport or body building.

Let me talk about “roid rage” first. This occurs in people who abuse T because they take it in large and irregular doses, causing big hormone spikes. And hormone swings do make people irritable. This is seen, for example, in cis women who experience premenstrual mood swings, because the level of P rises, then falls abruptly before the menstrual period. I can report from my own experience that swings in P level made me much more irritable than changes in T level. Note, however, that we call a woman who is hormonally irritable “bitchy” rather than “raging,” and see her as less threatening. . . In any case, my experience on T has been that since my T level remains fairly constant as I use a moderate and regular dose, I don't “rage” at all. My irritability levels are no higher than they were when I was completely empty of sex steroids, and are much lower than they were under the three-gonad-circus levels I produced naturally before gonadectomy.

What's really interesting, though, is that my behavior has become a lot less dominating and aggressive than it was before my hormonal transition. I used to be very vigorously argumentative. As an academic who was read as a woman, I had to be quite assertive in order to have authority in a classroom or at a conference. It's part of our gender culture that men interrupt women, assuming greater authority in conversation, and engage in the phenomenon of “mansplaining” (i.e., explaining to a woman something she already knows in a patronizing manner). To avoid loss of social prestige as an academic, I was therefore very assertive in conversation, so as not to allow myself to be interrupted or to appear “weak” in the presentation of my ideas to (male) students or colleagues.

After some time on HRT, I found myself taken aback by how I was being perceived. People had become more reserved around me, and somehow more hesitant in conversation. I made a couple of female students cry when critiquing their comments. My behavior had not changed at all—but my social gender had. The level of dominance I'd asserted for many years was now coming across, not as simple authority, but as intimidating. I wonder if some people thought T had made me “mean,” or that I was acting in the gender-stereotyped manner cissexism claims to be characteristic of trans people. In any case, I had to consciously modify my behavior. It took me a while to retrain myself to be more restrained and gentle in my presentation. It was kind of amusing to learn how much more intimidating the assertive comments of a person who is 5'2” would be taken once he was understood as male—but also sad proof of the greater authority granted men in our society. Such is male privilege. . .

So: my take on the idea that T biologically induces rage and dominance is that it is pretty much bullpucky. Big fluctuations in the level of T can cause irritability, as do big swings in the level of E and P, but that's about it.

I don't mean to come across as saying that none of the changes that we associate with temperament and relate to sex hormones have any biological basis. One that I can speak to is crying. For many years, with my high hormone load being dominated by E and P, I cried a lot, and I hated it. The crying stopped when my gonads were removed, and did not resume when I started taking T, to my great relief. And I see that my friends on HRT with E cry much more easily. The thing is, this does not mean I don't get sad or frustrated any less often than I did in the past, or that they used to be emotionally insensitive and now are oversensitive. One of my trans women friends sees being able to cry when upset as one of the greatest gifts of HRT, because people will finally acknowledge the depth of her feelings. I am happy that I don't tear up easily anymore because I have always enjoyed being treated as having an emotional even keel. These relate clearly to gender roles, in which being emotionally expressive is valued in women and devalued in men. Hormones may affect how often we cry, but it's society that gives that great meaning.

Consider this: like crying, hiccups are also related to higher levels of estrogen. I used to get the hiccups a lot; now I don't. However, since hiccups are not burdened by any gender meanings in our society, nobody else has noticed or gives a fig leaf how often I hiccup. Also related to estrogen are more mobile bowels—people with high E suffer from irritable bowel syndrome a lot more than people with low E. A less irritable bowel is another thing I've enjoyed about my T-only hormonal balance that is clearly biologically-induced, but given no social meaning in my transition. The fact that I don't cry much anymore, however, has been remarked upon a lot, and is treated as highly significant.

So, the relationship between nature and nurture in producing “sex difference” is complex. What is clear is that since humans are such profoundly social beings, social forces shape even those things that are usually thought of as “purely biological,” like the effects of sex hormones. It's one of the things that makes understanding humans fascinating.