Crossing T's

Aug 28 2013 Published by under [Medicine&Pharma]

In case you have been living under a rock, last week Private Bradley Manning announced the decision to begin living as Chelsea Manning.

Even people I know who are quite accepting of homosexuality seemed a bit less accepting of this...change, even though we have scientific evidence that the brain's "gender" can be conditioned by early hormonal exposures (and probably other events), leading to a disconnect between genetic sex, phenotypic sex, and gender identity.

First, let's get some terminology straight (no pun intended):

  • Genetic sex: The complement of chromosomes that generally determine one's sex; in humans, XX and XY are the normal female and male genotype, respectively
  • Phenotypic sex: The secondary sexual characteristics, especially genitalia, which may or may not correspond to one's genotype
  • Gender identity: How a person identifies themselves, based on both phenotypic sex and psychosocial factors

Now, let's look at an example of how these interact in a less controversial case, that of testicular feminization. In this disorder, the embryo/fetus/child is completely unable to respond to androgens like testosterone. Even though the genotype is XY, no masculinizing events occur in the brain or external genitalia; a phenotypic female is born. The phenotype is not complete, though. These girls lack uterus and ovaries. The disorder usually gets diagnosed at puberty when menstruation fails to occur. In general, these genetic males are gendered females and live that way without societal scorn, if anyone even knows about their condition. They marry men and adopt children without the gender police getting up in arms.

So why, when something happens and the brain gets crossed signals, do we react so violently? Why is someone whose genetic and phenotypic sex a mis-match for their gender identity so much less acceptable? Is it just our horror when we think about the surgery involved?

As a pediatric nephrologist, I see some children with ambiguous genitalia at birth (the embryological development of the urinary and reproductive tracts are intimately connected). When I started training in the 1980s, virtually all of these kids underwent surgery to become phenotypic females (surgically, it is much easier to create a functional vagina than a functional penis). However, a few years later some of these kids were having problems. Some XY children refused to dress as girls and insisted on standing to urinate. Their brains were male, even though we had made them look like girls and their parents were trying to raise them female.

Sex and gender are way more complicated than dressing a baby in pink or blue.

I mean the "we" in this discussion literally; I also have trouble wrapping my brain around the idea of "changing gender," although I know all the science behind the condition. I also know that these people are not "changing" genders (their brains have always been that way), they are merely making their phenotypic sex match their gender. It is still a difficult concept to accept; no wonder those who do not follow this science react so viscerally about their tax dollars being spent for "this wierdo's hormone therapy."

I am always glad when we talk about issues in public forums; that's the only way we can learn to accept everyone, even those we do not comprehend.

NPR's On Point presented a great discussion on transsexual issues. You can find it here.

I found one recent study on heterosexuals' attitudes to transsexuality which showed the expected correlations with other characteristics (political conservatism, psychological authoritarianism, religiosity, etc), but it did not help me understand my specific questions: Norton and Herek. Sex Roles 68:738-753, 2013 (Full text here)

Finally, Jeffrey Eugenides' Middlesex provides a literary discussion of these issues (available on Amazon here).

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