Tuesday, January 03, 2017

Is Gender Dysphoria An Intersex Condition?

I read Google News, WPATH Facebook page, Facebook posts from friends to find news stories to write about, today’s post comes from A.E. Brain’s blog where she wrote about a scientific research paper by Dr. Richard Diamond.
Title: Transsexualism as an Intersex Condition
Author: Milton Diamond Ph.D.
This paper attempts to demonstrate that there are significant natural in-born sex differences found between the brains of those called transsexual people and others. It does so by showing the differences are due to normal genetic, hormonal and environmental forces that lead eventually to differences in the transsexual person’s brain. This development brings with it feelings of dysphoria regarding one’s gender identity. It is such feelings that lead to a desire for sex/gender change. These brain differences are sufficient enough to conclude that persons with a transsexual condition are intersexed. Simultaneously it is recognized that many intersexed persons will switch from their assigned gender, yet many will not.

Transsexual people are persons now also commonly referred to as trans persons or transgender persons. Those not transgender are commonly referred to as cisgender individuals. In an attempt to explain themselves trans persons often say they are convinced that they were born “in the wrong body.” They believe they have the anatomy of one sex but identity and the emotional awareness of the opposite sex. Transsexual persons are so convinced of this feeling that they desire to forego any advantages they think associated with their birth sex and seek transition to their opposite sex. And many are willing to attain the goal of transfer even at great expense financially, emotionally and socially as evidenced by divorce, separation from friends and family, and other such losses (https://www.quora.com/topic/Gender-Dysphoria; https://www.quora.com/topic/Transsexuality-1). The natural question arises – how does this feeling come about, what causes it?

The initial factor in the development of transsexualism involves genetics. Coolidge, Theda and Young, in 2002, reported, finding a strong heritable component to the condition they called Gender Identity Disorder (GID) symptomatology (Coolidge, Theda, & Young, 2002). With this they implied that gender identity was much less a matter of choice and much more a natural matter of biology. In 2013 a large study among trans persons found one third of monozygotic (identical) male twins, and approximately one quarter of female monozygotic twins, were concordant in transitioning; essentially no dizygotic (familial) twins were concordant in transitioning (Diamond, 2013). And in 2014 it was reported that concordance in transition had occurred even among a trans twin pair that were reared and lived apart (Segal & Diamond, 2014). In sum these findings support a basic biological underpinning of the trans condition.

Another feature of transsexual development needs understanding. This too points to its natural biological nature. It is known that the genitals and brain develop at different times. The genitals develop early prenatally during the first 6 – 12th week and they may develop in masculine or feminine form. If the genitals develop under the influence of the androgen testosterone they are masculinized. If they are not, female genitals develop. In comparison, the brain, it is believed, develops during the latter period of pregnancy and also is subject to the influence of androgen. If there is significant androgen present at that time there will be brain masculinization, if not, there will be brain feminization. It thus is clear that the brain and genitals can develop independently and under different forces (Bao & Swaab, 2011; Savik, Garcia-Falguera, & Swaab, 2010). As Reiner has said “The etiology of gender identity may be neither obvious nor easily conceptualized. Yet what is obvious is that the presence of androgen is critical. It is the determining factor in the development of ... behavioral dimorphism in humans—genital structure, ... male-typical behaviors, masculinization of the brain …“ (Reiner, 2002).
It is interesting that Dr. Diamond references Dr. Reiner there was an article in the New York  Times about research that he did with intersex individuals. When I read the article it made me wonder if we are a Disorder of Sexual Development, or intersexed.

Dr. Reiner, a faculty member at the University of Oklahoma and Johns Hopkins and a leading specialist in the treatment of children with the intersexual condition said in the New York Times article “Declaring With Clarity, When Gender Is Ambiguous” by Claudia Dreifus that…

Q. How do you know what constitutes gender identity?
A. As part of a research study, I've personally seen and assessed 400 children with major anomalies of the genitals. Of those, approximately 100 might be called "intersex." Our findings have been many and complex. The most important is that about 60 percent of the genetic male children raised as female have retransitioned into males. [My emphasis]

We also found that of this group there were some genetically male children, who despite genital anomalies were raised as males, and they continued to declare themselves as male.

Q. What conclusions can you draw about the eventual sexual identity of an intersex child?
A. That you can castrate a male at birth, create a female genital structure, raise the child as a girl, and in a majority of the cases, they'll still recognize themselves as male. Now many of the children I've seen are still young. I don't know what will happen as they get older.
There is something in our brain that tells us whether we are male or female and the more that they research it the more that they find that we are really and truly different.

I met Dr. Diamond back in the 2000's at Fantasia Fair where he gave a series of talks on Gender Dysphoia and various intersex conditions.


Leann Lapine said...

I read the article. Very interesting. I would accept the assertion that I am intersex based upon my brain structure. I also thought that moving the conversation about the transgender state from an apparent mental state - dysphoria being a "state of mind" - to a physical one - my internal organs (brain or ovaries) do not match with my external organ (male genitals) might get the debate away from the choice assertion. I believe more people understand the intersex condition when someone has both sets of genitalia. If we can get them to understand that the transgender condition is parallel, we might get further.

Diana_CT said...

But we cannot not rule out other vectors causing gender dysphoria.

Leann Lapine said...

Of course we can't but misaligned brain structures and genitalia has to be a major if not the major cause. The point here is to get the debate away from the thoughts of trans people to the physical nature of their bodies since it is much more difficult to argue about the physical aspects than the "psychological". Of course, it would be great if we had more people working on techniques such as fMRI that could be used as a confirmatory tool in the diagnosis from both a medical and a social/legal basis.