Nature v. Nurture

That question will never get answered; however we are getting closer to understanding the nature of our gender identity and the New York Times article on gender dysphoria takes a look...

How Changeable Is Gender?
New York Times – Opinion
By Richard A. Friedman
August 22, 2015

In fact, recent neuroscience research suggests that gender identity may exist on a spectrum and that gender dysphoria fits well within the range of human biological variation. For example, Georg S. Kranz at the Medical University of Vienna and colleagues elsewhere reported in a 2014 study in The Journal of Neuroscience that individuals who identified as transsexuals — those who wanted sex reassignment — had structural differences in their brains that were between their desired gender and their genetic sex.

Dr. Kranz studied four different groups: female-to-male transsexuals; male-to-female transsexuals; and controls who were born female or male and identify as such. Since hormones can have a direct effect on the brain, both transsexual groups were studied before they took any sex hormones, so observed differences in brain function and structure would not be affected by the treatment. He used a high-resolution technique called diffusion tensor imaging, a special type of M.R.I., to examine the white matter microstructure of subjects’ brains.

What Dr. Kranz found was intriguing: In several brain regions, people born female with a female gender identity had the highest level of something called mean diffusivity, followed by female-to-male transsexuals. Next came male-to-female transsexuals, and then the males with a male gender identity, who had the lowest levels.

In other words, it seems that Dr. Kranz may have found a neural signature of the transgender experience: a mismatch between one’s gender identity and physical sex. Transgender people have a brain that is structurally different than the brain of a nontransgender male or female — someplace in between men and women.

This study is widely known in the trans and it has been accepted with mixed feelings. What makes the trans community leery is that there might be more than one vector that cause gender dysphoria and just because a trans person doesn’t show and difference on the MRI does mean that they are not trans. The article goes on to say,

Is it really so surprising that gender identity might, like sexual orientation, be on a spectrum? After all, one can be exclusively straight or exclusively gay — or anything in between. But variability in a behavior shouldn’t be confused with its malleability. There is little evidence, for example, that you really can change your sexual orientation. Sure, you can change your sexual behavior, but your inner sexual fantasies endure.

No surprise here, trans people knew for a long time that there is a gender spectrum and I wouldn’t have used “inner sexual fantasies” but more like “inner sexual desires.”

Then the article becomes questionable,

Dr. Cecilia Dhejne and colleagues at the Karolinska Institute in Sweden have done one of the largest follow-up studies of transsexuals, published in PLOS One in 2011. They compared a group of 324 Swedish transsexuals for an average of more than 10 years after gender reassignment with controls and found that transsexuals had 19 times the rate of suicide and about three times the mortality rate compared with controls. When the researchers controlled for baseline rates of depression and suicide, which are known to be higher in transsexuals, they still found elevated rates of depression and suicide after sex reassignment.

THIS strongly suggests that gender dysphoria in young children is highly unstable and likely to change. Whether the loss of gender dysphoria is spontaneous or the result of parental or social influence is anyone’s guess. Moreover, we can’t predict reliably which gender dysphoric children will be “persisters” and which will be “desisters.”

I would like to know is the details of the study, those who had regrets did they follow the Standard of Care (SOC)? Also how did society affect them? Did they have any resistance from their family, or their religion, or from their friends? How well did they integrate into society?

Several studies have tracked the persistence of gender dysphoria in children as they grow. For example, Dr. Richard Green’s study of young boys with gender dysphoria in the 1980s found that only one of the 44 boys was gender dysphoric by adolescence or adulthood. And a 2008 study by Madeleine S. C. Wallein, at the VU University Medical Center in the Netherlands, reported that in a group of 77 young people, ages 5 to 12, who all had gender dysphoria at the start of the study, 70 percent of the boys and 36 percent of the girls were no longer gender dysphoric after an average of 10 years’ follow-up.

In ThinkProgress today there was a rebuttal by Zack Ford,

On Sunday, the New York Times published an op-ed from Richard A. Friedman, Weill Cornell Medical College professor of clinical psychiatry, who asks, “How changeable is gender?” Though Friedman sets up his piece by discussing the biological underpinnings of gender identity and the experience of being transgender, he ultimately explains his “skepticism” about assisting transgender people to change their bodies to match their identities. “After all,” he concludes, “medical and psychological treatments should be driven by the best available scientific evidence — not political pressure or cherished beliefs.”

To justify his skepticism, Friedman distorts some studies and ignores others to arrive at conclusions that support his apparent biases against transition. Under the guise of medical opinion, he mimics the flawed talking points used by some of the biggest opponents of transgender equality

Mr. Ford goes on to explain the flaws in Mr. Friedman article,

The study, he boasts, assessed suicide rates of transsexuals who had undergone transgender surgery “against controls.” What he doesn’t mention is that the controls were not transgender people who had not undergone surgery as one would expect, but in fact, the cisgender general population. “When the researchers controlled for baseline rates of depression and suicide, which are known to be higher in transsexuals, they still found elevated rates of depression and suicide after sex reassignment.” All that the research actually shows is that surgery did not alleviate all mental health issues; it does not actually provide any information about the impact of that surgery.

Friedman also fails to mention that the mortality rate in the study was only statistically significant for people who underwent surgery before 1989. For all those who had their surgery after that (1989–2003), the increased mortality was not statistically significant. Though he briefly acknowledges the impact that stigma, discrimination, and violence might instead be playing, he brushes this possibility aside to assert, “The outcome studies suggest that gender reassignment doesn’t necessarily give everyone what they really want or make them happier.” The Swedish study, the only example he cites, suggests no such thing. In fact, the researchers say as much in a disclaimer: “No inferences can be drawn as to the effectiveness of sex reassignment as a treatment for transsexualism” because “things might have been even worse without sex reassignment.”

About Mr. Friedman assertion that only a small fraction of children actually go on to transition,

There is nothing in these studies to warrant this dangerous encouragement for parents to reject their kids’ identities. In fact, the studies suffer from major flaws that suggest otherwise. Kelley Winters, who studies and writes about transgender medical policy, explains that the criteria for diagnosing Gender Identity Disorder in Children (GIDC) are not particularly consistent. Many recent studies rely on diagnosing children “on the basis of gender nonconforming behavior, with no evidence that they identified as other than their birth-assigned gender.” Thus, children who are actually distressed about their gender identity — the “persisters” — are grouped along with larger numbers of effeminate male-identified boys and masculine female-identified girls — the “desisters.”

Thus, these studies might actually be proving the opposite of what Friedman wants them to. The fact that, in these overbroad samples of gender non-conforming kids, researchers do find persisters suggests that the benefit of the doubt ought to favor these kids who might actually be trans. After all, as this population has been studied more, researchers have learned that they actually identify as consistently and innately with their gender identity as their cisgender peers. Parents risk nothing by letting kids express themselves however they might, but could cause great harm by rejecting the identities of kids who actually feel distress over their gender. The “it’s just a phase” stereotype, as Winters calls it, “has underpinned policies that keep gender dysphoric children in the closets of their birth-assigned gender.”

And finally Mr. Ford sums up the article with,

Friedman has no research to demonstrate any benefit to attempting to suppress a child’s gender expression. Still, he bases his skepticism for affirming transgender kids on the “best available scientific evidence.” If he had actually cited that evidence in his op-ed, instead of disregarding it to support his own biases, he may have drawn a different conclusion.

It seems to me that the New York Times wants to show they are balanced in their coverage of trans issues and it that is the case they should do better research before they publish an article.