Friday, September 18, 2009

Endocrine Society Issues Guidelines for Transgender Children

A transgender individual is someone whose gender identity or subjective sense of what sex they are differs from the legal sex that was assigned them at birth. Some transgender individuals have identifiable physical syndromes that result in ambiguous sex characteristics, while others simply live their lives feeling that they are the opposite gender from what people think they are. This sense often begins in childhood, though some individuals wait until late in adulthood to choose to make the transition to the sex that fits their experience.

Once a young person has matured physically and acquired the secondary sex characteristics of their birth sex it is much more difficult to transition. Thus a person with male anatomical features whose voice changes, whose body shape becomes that of a man, whose body is covered with hair, will have a much more difficult time if they are ever to live as a woman. It is possible to intervene medically, to administer hormones that will delay or prevent the onset of puberty, which would ease the transition. But you're talking about a kid here, and a lot of people are uneasy about interfering with what appears to be a natural process, even if intervention would make the person's life happier and more satisfying in the long run. Adults are always concerned that the child is "going through a phase" that will pass, and may be hesitant to initiate procedures that will have permanent impact. Plus, there are a lot of people who are eager to pass judgment on anyone whose sexual orientation or gender identity varies from the majority.

From the LA TImes:
The nation's oldest and largest organization of endocrinologists has recommended that physicians treating children with gender identity disorder intervene to delay puberty at its first signs and wait until a child is at least 16 before offering hormonal therapy that would begin his or her gender transition.

In a new clinical practice guideline unveiled today, the Endocrine Society tackled some of the most ethically sensitive decisions endocrinologists face in the treatment of those who are born of one gender, but identify themselves strongly with the opposite gender. Indeed, the society urges that its physicians rely on a mental health professional to render a diagnosis of transsexualism, which is termed gender identity disorder in the psychiatric profession's current diagnostic manual.

The new practice guidelines also recommend that no action be taken to intervene in the hormonal balance of a young child who identifies as the opposite gender of his or her birth. "A diagnosis of transsexualism in a child who has not gone through puberty cannot be made with certainty," the group concluded.

At the first signs of puberty, however, the new guidelines recommend that physicians use hormone therapy strictly for the purpose of suppressing pubertal changes until an adolescent has reached the age of 16. At that point, the group concluded, "cross-sex hormones may be given." Treating transsexual kids: wait for, then delay puberty to treat

Seems like these days puberty starts hitting around eleven or twelve years old, sometimes younger. Plain old puberty is confusing enough to a kid that young, your body's changing but you still feel like a kid, and then to experience yourself being swept along with a falsehood about what sex you are, who you are really, that's got to be very difficult. A kid that age may not be ready to make decisions that will affect their entire future. So it sounds like a good idea to wait until they are sixteen, they ought to have some sense of who they are by that age.
Those guidelines come at a time when many of those with "gender dysphoria"--persistent distress over one's gender at birth--are asking to begin gender reassignment hormonal therapy and/or surgery at an earlier and earlier age. While surgeons have been reluctant to do gender reassignment surgery on a patient under 18, endocrinologists often face pressure from would-be transsexuals to offer earlier, interim treatment. The new guidelines are likely to set a standard that many endocrinologists will follow in such cases.

"Transsexual persons experiencing the confusion and stress associated with feeling 'trapped' in the wrong body look to endocrinologists for treatment that can bring relief and resolution to their profound discomfort," said Dr. Wylie Hembree, a Columbia University endocrinologist who chaired the committee drafting the guidelines. The new guidelines, he added in a news release, are intended to provide "science-based recommendations" for practitioners to provide "safe and effective treatment" to those diagnosed with Gender Identity Disorder.

Oddly, some members of our community use the DSM category "Gender Identity Disorder" to argue that transgender people are sick, or mentally ill. Really the diagnosis only identifies individuals who might live better after they transition to the opposite sex. Still, some bad-hearted people will try to smear transgender individuals with the stigma of mental illness, I guess it makes them feel better about their own lives.
The transgender community has advocated for changes in the psychiatry's approach to the diagnosis of gender identity disorder, which is now being revisited in drafting sessions for the profession's diagnostic manual. Among the transgender community's concerns: that current definitions of Gender Identity Disorder lump the diagnosis under "paraphilias," contribute to stigmatization, and fail to support the goals of gender transition and access to surgical and hormonal therapies in treatment of GID.

The new practice guidelines are published in the September issue of the Endocrine Society's Journal of Clinical Endocrinology & Metabolism. For a somewhat dated discussion of the ethical issues involved, check out this article from Salon. And if you feel you were born into a body of the wrong gender, here's a place to seek help and support.

These decisions are bound to be controversial. On one hand these doctors are talking about treating a straightforward, if complex, condition; on the other hand, the treatment is nested within the norms of a society that has strict prohibitions on gender behavior, and makes harsh judgments of individuals who violate those prohibitions. While it will be impossible, and probably not even desirable, for physicians to outline treatment without acknowledging social norms, in the end the patient's best interests must be kept in mind, regardless of what others think.

18 Comments:

Blogger Hazumu Osaragi said...

"Oh. My. Gawd. Think of the damage this could have to the kid's reproductive capability"...I can hear it now. So, we stick with the tried and true, where 50% attempt suicide? At least they preserved their capacity to reproduce, and didn't disgust anyone, eh?

Seriously, I think some people have a fetish for reproductive capability, and the potential that any hetero sex act could procreate. I'd like to see a study done that compared the attractiveness of potential partners where the person doing the choosing knows the fertility status of the potential partners he or she is rating -- "Now this one has had a hysterectomy/vasectomy..."

Why do I bring this up? I think the issue of fertility has some part to play in some folks' resistance to gender transition, and specifically facilitating the gender transition of pre-pubescent children.

Better to have some of 'em commit suicide.

September 18, 2009 10:34 PM  
Anonymous svelte_brunette said...

Jim, in an excellent post wrote:

“Plain old puberty is confusing enough to a kid that young, your body's changing but you still feel like a kid, and then to experience yourself being swept along with a falsehood about what sex you are, who you are really, that's got to be very difficult.”

Puberty is a time when a lot of folks really start to figure out “who they are” in the world. It can be an exciting, embarrassing, fun, and difficult all at the same time.

For many trans teens, it’s a time of a painful growing awareness that “who they are” is simply an empty bag of skin, reacting to both positive and negative feedback in order to put up a front that “society” finds acceptable. There is little “personhood” of their own – all of their thoughts, words, and actions have to be carefully selected in order to conform to expectations that will get them harassed, shunned, or assaulted if they don’t comply with “the norm” for their genitally assigned gender. I don’t think it’s possible to really convey what it’s like growing up trans – that you have no autonomous motivations of your own – that you are merely a collection of neurons that have somehow figured out how to respond to external stimuli so as to minimize pain. Some time in the sophomore to junior year of high school I penned the following poem describing some of the feelings. Consider it “the tip of the iceberg.” It was published in my college’s annual poetry review (so it is copyrighted). Hopefully today’s teens will find themselves in a society that is more understanding.

“Castle”
Welcome to my kingdom in the sky…
Huge white cloud, a most impressive castle
bursting from the top.
of many stones the walls,
and of many walls the castle…

It is a most impressive castle indeed.

I am in control of all my grand castle;
I change its countless faces;
add more stones,
build more walls,
more walls.

Building my castle impressive.

Somewhere,
deep inside,
a dark corner,
no one will find,
I.

Waking in the morning,
I immediately set to work on my castle.
Check the outside.
all the stones in their proper place,
the ivy neat and trim.
The towers, huge, towering, impressive.
I work.
…I work.
Endlessly fixing the outside.
Endlessly making it more impressive
-- more important.

Yet even behind the first great wall,
nothing changes.
Nothing moves.
All is still
all is dark
all is dead.

Somewhere,
deep inside,
a dark corner,
no one will find,
I.

I make my castle what it is.
It is I.


… or is it?


Have a nice day,

Cynthia

September 19, 2009 9:57 AM  
Blogger Priya Lynn said...

Jim said "Still, some bad-hearted people will try to smear transgender individuals with the stigma of mental illness, I guess it makes them feel better about their own lives.".

While I have often found the motivations for the haters mysterious I was surprised to find out to what degree this is often true. I was watching a talk show about a transgendered woman, another guest opposed her transistion and when asked why she said "Her doing this is saying god made a mistake and that offends me". She actually felt she was justified in making a huge imposition on another's life just because the trans woman's life made it slightly more difficult for her to believe a perfect god exists. It really shocked me how selfish some of these haters are - they'd happily turn other people's lives upside down to make their own fantasies slightly easier to cling to.

September 19, 2009 12:58 PM  
Anonymous endo elmo said...

"Some transgender individuals have identifiable physical syndromes that result in ambiguous sex characteristics, while others simply live their lives feeling that they are the opposite gender from what people think they are."

In which case, it is a subjective experience, impervious to scientific study and, quite possibly, alterable, if even real.

"Indeed, the society urges that its physicians rely on a mental health professional to render a diagnosis of transsexualism, which is termed gender identity disorder in the psychiatric profession's current diagnostic manual."

The Endocrine Society here is not endorsing the reality of GID but punting to another group of professionals.

That group of professionals, btw, does not have a strong track record of effectiveness.

"Oddly, some members of our community use the DSM category "Gender Identity Disorder" to argue that transgender people are sick,"

A condition that necessitates medical intervention to resolve would be an illness by definition.

Except, of course, in Gayagendaland, where any thought is true just because you think it.

It's a fun country but it doesn't leave a lot of room for discussion.

September 19, 2009 2:56 PM  
Anonymous Anonymous said...

Elmo, it is not clear what you're trying to say here. Are you trying to make the point that transgender people are faking somehow?

September 19, 2009 3:20 PM  
Anonymous svelte_brunette said...

Endo Elmo retorted:

“In which case, it is a subjective experience, impervious to scientific study and, quite possibly, alterable, if even real.”

Love is an entirely subjective experience, has proven itself entirely impervious to scientific study, has clearly been altered in countless of relationships, yet I don’t hear anyone questioning its reality – unless it happens to be between to gay people who want to get married.

Is it only the subjective experiences of heterosexuals that are real? Or is that only in HomophobeAgenda land?

BTW, my endocrinologist is probably the best doctor I’ve ever visited in terms of diagnosing problems and prescribing appropriate treatment – and that is when I EXCLUDE all of the hormone treatments he’s prescribed.

Have a nice day,

Cynthia

September 19, 2009 3:54 PM  
Anonymous Anonymous said...

subjective experiences are fine but what we're talking about here is how parents should proceed when a child is making these kind of statements

we shouldn't artificially be giving them hormones based on assertions beyond empirical verification

September 19, 2009 6:21 PM  
Blogger Unknown said...

Way back when most of us were not yet born, I was diagnosed as prehomosexual, the term applied to gender dysphoric children back in the fifties. The mental health consensus then was that children like myself were somehow going through a phase. Every effort was made to change the way I felt and especially how I identified myself to others. I kept claiming to be a girl and by every effort I include many behavioral modifications, medical crucifixion, electroshock and insulin shock treatments. At one point after an electrical malfunction during an electroshock series, I had only 12 memories totaling 20 or so minutes. I had to be retrained to walk, talk and control my bodily functions. In the face of all that I never doubted that I had been mislabeled by doctors as a boy. I applaud the Endrocine Society's progressive action.

September 19, 2009 6:27 PM  
Anonymous Anonymous said...

the measures used on you weren't justified, Delta Dawn

but that's not the equivalent of simply letting nature take its course until a child is old enough to decide their own path

right?

September 20, 2009 7:46 PM  
Anonymous svelt_brunette said...

Anon asserted:

“what we're talking about here is how parents should proceed when a child is making these kind of statements
we shouldn't artificially be giving them hormones based on assertions beyond empirical verification”

Actually, if you read the post carefully, they are NOT giving the children hormones, but at the onset of puberty, hormone BLOCKERS – to delay puberty, if the case warrants intervention as indicated by a mental health professional. They are not going to give children hormones just because they want them. I recommend reviewing the Harry Benjamin Standards of Care:. ( http://www.tc.umn.edu/~colem001/hbigda/hstndrd.htm )

“VII: Children with Gender Identity Disorders
A: The initial task of the child-specialist mental health professional is to provide careful diagnostic assessments of gender-disturbed children.
1. the child's gender identity and gender role behaviors, family dynamics, past traumatic experiences, and general psychological health are separately assessed. Gender-disturbed children differ significantly along these parameters.
2. hormonal and surgical therapies should never be undertaken with this age group.
3. treatment over time may involve family therapy, marital therapy, parent guidance, individual therapy of the child, or various combinations.
4. treatment should be extended to all forms of psychopathology, not simply the gender disturbance.”

As you can see from the above, a child suspected of having GID will be monitored carefully, not given hormones or surgery, and other issues will be examined to see if they are contributing GID-like symptoms. Obviously, if other issues are found they will be treated, and this may obviate the need for any hormonal or surgical treatment.

As the child gets older, a different set of issues have to be considered. The HBSOC (as it currently stands) does not recommend hormone treatments until the age of 18. The latest Endocrine Society recommendation is 16 years. In practice I’m sure the doctors and parents involved will closely monitor the teenager’s development and decision-making abilities to determine a suitable age, whether that’s 16, 17, or 18.

September 20, 2009 10:39 PM  
Anonymous svelte_brunette said...

Again, from the HBSOC:

“VII. Treatment of Adolescents

A. In typical cases the treatment is conservative because gender identity development can rapidly and unexpectedly evolve. Teenagers should be followed, provided psychotherapeutic support, educated about gender options, and encouraged to pay attention to other aspects of their social, intellectual, vocational, and interpersonal development.

B. They may be eligible for beginning triadic therapy as early as age 18, preferably with parental consent.

1. Parental consent presumes a good working relationship between the mental health professional and the parents, so that they, too, fully understand the nature of the GID.

2. In many European countries sixteen to eighteen-year-olds are legal adults for medical decision making, and do not require parental consent. In the United States, age 18 is legal adulthood.

C. Hormonal Therapy for Adolescents. Hormonal treatment should be conducted in two phases only after puberty is well established.

1. in the initial phase biological males should be administered an antiandrogen (which neutralize testosterone effects only) or an LHRH agonist (which stops the production of testosterone only)

2. biological females should be administered sufficient androgens, progestins, or LHRH agonists (which stops the production of estradiol, estrone, and progesterone) to stop menstruation.

3. second phase treatments--after these changes have occurred and the adolescent's mental health remains stable

a. biologic males may be given estrogenic agents

b. biologic females may be given higher masculinizing doses of androgens

c. second phase medications produce irreversible changes

D. Prior to Age 18. In selected cases, the real life experience can begin at age 16, with or without first phase hormones. The administration of hormones to adolescents younger than age 18 should rarely be done.

1. first phase therapies to delay the somatic changes of puberty are best carried out in specialized treatment centers under supervision of, or in consultation with, an endocrinologist, and preferably, a pediatric endocrinologist, who is part of an interdisciplinary team.

2. two goals justify this intervention

a. to gain time to further explore the gender and other developmental issues in psychotherapy

b. to make passing easier if the adolescent continues to pursue gender change.

3. in order to provide puberty delaying hormones to a person less than age 18, the following criteria must be met

a. throughout childhood they have demonstrated an intense pattern of cross-gender identity and aversion to expected gender role behaviors

b. gender discomfort has significantly increased with the onset of puberty

c. social, intellectual, psychological, and interpersonal development are limited as a consequence of their GID

d. serious psychopathology, except as a consequence of the GID, is absent

e. the family consents and participates in the triadic therapy

E. Prior to Age 16. Second phase hormones, those which induce opposite sex characteristics should not be given prior to age 16 years.

F. Mental Health Professional Involvement is an Eligibility Requirement for Triadic Therapy During Adolescence.

1. To be eligible for the implementation of the real life experience or hormone therapy, the mental health professional should be involved with the patient and family for a minimum of six months.

2. To be eligible for the recommendation of genital reconstructive surgery or mastectomy, the mental health professional should be integrally involved with the adolescent and the family for at least eighteen months.

September 20, 2009 10:42 PM  
Anonymous svelte_brunette said...

3. School-aged adolescents with gender identity disorders often are so uncomfortable due to negative peer interactions and a felt incapacity to participate in the roles of their biologic sex that they refuse to attend school.

a. Mental health professionals should be prepared to work collaboratively with school personnel to find ways to continue the educational and social development of their patients.”



Administration of the hormone blockers gives parents and doctors more time to evaluate the teenager’s adaptation to the appropriate gender role. If the teenager does not show signs of improved social development, educational development, and a reduction in the negative side-effects of GID, the treatment will stop, and cross-sex hormones will never be administered.

It is the empirical evidence of a teenager that is far better able to cope with school, society, and possible jobs that is the indicator of whether or not hormones will be an option when they turn 16, or older.

If the teenager does NOT show sign of improved behavior and social integration, the hormone blockers will be stopped, and puberty will continue as before, just delayed. The doctors then have the task of determining another explanation for the symptoms and finding an appropriate course of treatment.

In practice, it is the Real Life Experience that will separate the “wheat from the chaff,” or those with GID from those without. Children with GID who are forced to behave in a manner that society proscribes based on their genitalia are frequently depressed, isolated, reluctant to interact with peers, and may even be suicidal. Once they are allowed to express themselves in ways that come naturally, the changes in their behavior are as if a light switch has been turned on. Despite the stigma currently attached to the condition, they find it easier to make friends, their depression frequently goes away entirely, and they interact with the world pretty much the same as any other happy child.

This really shouldn’t come as a surprise. No parent in their right mind would force a boy child to act, dress, and behave as a girl. In fact, if parents did this, neighbors would probably report them to Child Welfare Services. Unfortunately this actually has been done, and the child’s name was David Reimer. (A synopsis of his life is here: http://www.cbc.ca/news/background/reimer/ ) If you dig into his story further, you’ll find that while he was being raised as a girl, he refused to play with girl toys, preferring the boy toys of his brother, hated wearing dresses, could not interact normally with other children, and he even became suicidal. His symptoms in fact were EXACTLY the same as those seen in young trans men – i.e. those diagnosed with GID. Essentially, GID was INDUCED by his parents, based on the well intentioned, but entirely misguided treatment suggested by Dr. John Money.

For a trans child, the same process (that happened to David Reimer) is occurring. The only difference is that the parents and much of society believe that since the child has genitals of one particular type, they are justified forcing the child to behave in “genital normative” fashions. This is true even though people have known for centuries that gonads are the source of reproductive cells and hormones, and that the brain is the seat of behavior.

It should come as no surprise that when a child is allowed to express the Gender Identity that comes naturally to them, symptoms of GID do not manifest themselves. The disorder really isn’t the child’s Gender Identity, but how people try to force them to behave based on what they think the child’s gender-related behavior SHOULD be.

As the child reaches puberty and his or her teenage years, blocking hormones for a while allows parents and doctors to be as certain as they can possibly be before recommending hormones themselves, and possibly surgery later.

Have a nice day,

Cynthia

September 20, 2009 10:43 PM  
Anonymous Anonymous said...

"Actually, if you read the post carefully, they are NOT giving the children hormones, but at the onset of puberty, hormone BLOCKERS – to delay puberty"

My mistake. Point is, though, that we are discussing an artifical intervention.

September 21, 2009 8:52 AM  
Anonymous svelte_brunette said...

Anon noted:

“Point is, though, that we are discussing an artifical intervention.”

Indeed we are. Most people look for artificial intervention when they have a medical problem, whether it’s a broken arm, a bad case of flu, kidney stones, cancer, depression, or bipolar disorder. There are exceptions of course, and recently one couple received criminal charges for trying to pray their child back to health rather than seeking medical help (their child died as a result).

The endocrinal intervention is done in cases where 1: there has been a recommendation from at least one mental health professional, and 2: there is parental consent.

The triadic therapy has been used successfully on thousands of trans adults for the past 60 years. In that time, mental health professionals have learned that trans adults come from trans children. Our medical histories trace out a predictable, well worn path that is easy to spot by doctors with the right experience. Treating trans teenagers at a stage before they need surgery can save them from decades of depression and tons of expenses in ancillary medical treatments, should the parents, doctors, and teenager decide to go that way.

Have a nice day,

Cynthia

September 21, 2009 10:04 AM  
Anonymous Anonymous said...

"Most people look for artificial intervention when they have a medical problem, whether it’s a broken arm, a bad case of flu, kidney stones, cancer, depression,"

When the illness is empirically verifiable and the treatment is necessary. It's not in this case.

"The endocrinal intervention is done in cases where 1: there has been a recommendation from at least one mental health professional, and 2: there is parental consent."

In the past, mental health professionals and parents have recommended some horrendous measures. Better to let the kid wait until old enough to make their own decision. There aren't any conesequences of waiting.

September 21, 2009 12:23 PM  
Anonymous svelte_brunette said...

Anon asserted:

“When the illness is empirically verifiable and the treatment is necessary. It's not in this case.” And “There aren't any conesequences (sic) of waiting.”
Unfortunately this uniformed attitude is shared by many. Perhaps the most tangible evidence would be a careful analysis of the basal nucleus of the stria terminalis (the region of the brain shown to be related to gender identity). However, as this involves dissecting the brain, preparing dozens of small slivers of tissue for microscope slides and measuring neuron density, most parents don’t consider this a viable diagnostic tool, at least pre-mortem, anyway.

In which case we are left looking for what me might call “sufficient empirical evidence.” It is not uncommon for it to take a form as related in the following NPR interview:

“SPIEGEL: But Danielle and Robert could not, would not accept that their child was a girl trapped in a boy's body, not until early last summer, when it finally became clear just how desperate their 10-year-old son had become. Robert and Danielle's oldest child, 14-year-old Melina, tells the story.

MELINA: I just remember she came storming in the kitchen, and my mom and I were getting ready for dinner and everything. And she just took the knife from the counter. She was like, I'm going to kill myself. I'm going to kill myself. And then she was all cussing and stuff.

And she was pointing the knife towards herself, and I just remember running out of the room because I just didn't want to see that. And my mom just like, held my sister, and just like put the knife down and just like put the knife down and just like was holding him. I can't - what are you trying to do? And then it just like exploded into this huge, you know, I hate the world. I hate the world and everything. You know, it's really, it was really scary.

SPIEGEL: Danielle says the more desperate her child became, the easier it was to accept her son's identity as a girl.

DANIELLE: You know, to hear your child say, you know, I don't want to be on this earth anymore unless I can be who I am and you see the desperation in her face. It's not, okay, I'm throwing a tantrum or attention. You know, we have seen his desperation, and this child just, why can't I be this way? Why, you know, why can't you accept me? Why can't people see me for who I am? I mean, it was just became very real for us, how this child was screaming out and saying, hey, you know, listen to me. This is who I am. And I need to be me.

SPIEGEL: Finally, the family found a psychologist who had experience with gender issues. At the end of a two-month evaluation, he gave them a diagnosis, Gender Identity Disorder. That's what this kind of behavior pattern is called in the Diagnostic and Statistical Manual, the mental health diagnostic book used by psychologists and psychiatrists.”

Clearly, there is evidence of a problem, a need for treatment, and consequences if things do not change.

Earlier this year I was at a conference where one of the founders (Kim Pearson) of TYFA (Trans Youth Family Allies) related the story of one set of parents she has helped. For them the “empirical evidence” came when they busted open their locked bathroom door to find their 8-year child standing in front of the toilet with penis in one hand a pair of kitchen sheers in the other. They had been vociferously telling their child for years “you’re a boy because you have a penis.” It is not difficult to surmise the negation of this simple logic that occurred in this child’s mind, and how she was going to correct the problem.

For my 18 year old friend M., the evidence is on the underside of her right forearm. It is 6 straight red scars, each about 1.5” long and about 0.5” apart. I don’t know if her mother became the reluctant supporter of her beautiful trans daughter before or after this occurred.

Have a nice day,

Cynthia

September 22, 2009 10:13 AM  
Blogger Zoe Brain said...

Empirical evidence was presented to the American Psychiatric Association annual meeting recently in seminar S10.

As Prof Ecker wrote to me:

Hi Zoe,

Yes, we gave our presentation to 60 plus psychiatrists from the US, AU, FR, IT, EU, UK, Holland etc.

We spoke for 2 1/2 hours on why cross gender identity was a normal inherited variation of humans. We showed how Transgender Brains think, smell, and hear like the opposite sex. We presented internationally accepted guidelines for hormonal treatment of transsexuals to be published Summer 2009.

Here are my slides and with my participants' permission I shall send you theirs. We are now in print in the APA Syllabus and soon in the APA Journal this summer. I am checking if we were recorded.

My greatest personal compliment came from Frank Kruijver, from Holland, whose research of the human brain in TSs started it all. He thought we have taken his work very far in our understanding of the human brain. Hope you can do something with this.

Sid Ecker, M.D.


The empirical evidence exists. A lot of people want to deny that though, usually for religious reasons, or because they see reality as supporting an immoral "homosexual agenda". The solution is to deny reality.

Others are too committed to neo-Freudian or Leftist Gender Theory. Abandoning those long-held cherished beliefs in the face of biological proof is difficult for some.

Some of the 300 papers on the subject used as evidence, detailing experimentation on animals, and measurements of human anatomy.

References:

1.DF Swaab, WC Chung, FP Kruijver, MA Hofman, TA Ishunina
Structural and functional sex differences in the human hypothalamus
Horm Behav. Sep, 2001; 40(2): 93-8. Review

2. DF Swaab
Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation
Gynecol Endocrinol. Dec, 2004; 19(6): 301-12. Review.

3.IE Sommer, PT Cohen-Kettenis, T van Raalten, AJ Vd Veer, LE Ramsey, LJ Gooren, RS Kahn, NF Ramsey
Effects of cross-sex hormones on cerebral activation during language and mental rotation: An fMRI study in transsexuals
Eur Neuropsychopharmacol. Mar 2008; 18(3): 215-21.

4.H Berglund, P Lindstrom, C Dhejne-Helmy, I Savic
Male to female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids
Cereb Cortex. Aug 2008; 18(8): 1900-8.

September 23, 2009 8:49 PM  
Anonymous svelte_brunette said...

Thanks for the info Zoe! I was previously unaware of some of these studies. I found the Odorous Steroid study particularly interesting, ( http://cercor.oxfordjournals.org/cgi/reprint/bhm216v1 ) especially Table 1 on page 4. While the study only covers pre-operative, pre-hormone treatment MTFs (arguably transsexuals with the most male-like body and chemistry) the brain response – where it does respond is predominantly female-like. However, it is interesting to note that overall, the MTF brain compared to HeM and HeW is particularly UN-responsive. A simplistic count of the HeW and HeM columns shows a total of 12 distinct co-ordinates which respond in either the males or females, however they respond to distinctly different sets of stimuli. The MTFs only respond in 7 of the cases, and when they do, it is predominantly at a lower level in a smaller size area than either the male or female subjects – except of course where neither of those groups respond.

Assuming for the moment that these measurements are similar for MTFs regardless of surgical or hormonal status, it brings to my mind the question “would this explain the high percentages of bisexual and asexuals in the transgender population relative to the cisgender population? (Anecdotally these groups make up roughly 25% each in the trans population, while I suspect bi- and asexuals make up less than 5% of the cis population combined.)

Like any good study this ones opens up even more questions – like how do post-operative and post hormone therapy subjects respond? Are they more like their target sex? How about when compared to brain scans of cisgnedered subjects with the same sexual orientation – are they even more like those?

Any thoughts?

Cynthia

September 24, 2009 10:24 AM  

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