Trans — From the Moment of Birthby Loren A. Olson, MD | September 11, 2017
The moment I was born, the doctor looked at my nether regions, saw a penis, and announced to my parents, “It’s a boy”. Along with that announcement came a long list of expectations about how a boy’s life should unfold in rural Nebraska in the 1940s and ’50s. No ambiguity. No nuance. Boys will be boys—or else!
Gender reveal parties are a hot trend among today’s expectant parents.1 At about twenty weeks of gestation, an ultrasound is completed, and family and friends are called together for “the reveal,” a celebration of the newly identified biologic sex of the child. Sometimes a baby-carriage-piñata filled with candy is struck until the candy, wrapped in either pink or blue, comes rolling out—along with all the expectations about gender roles that will be established even prior to birth.
Although it could be confusing to guests, I think those parties might better be called “sex reveal parties,” but I understand that guests might come with a different set of expectations. You see, what is being revealed isn’t gender at all but the biological sex of the child. Sex and gender are not the same, although they are often confused and the terms used interchangeably.
Humans have a natural tendency to categorize, sometimes out of respect, sometimes based on stereotypes. At birth, infants are assigned a sex by a third party. It’s a binary choice based on their external genitalia or, in some cases, by chromosomes. Sex is binary: boy or girl. Gender is more of a psychological and societal concept. Gender is not binary; it may not even be linear. Enter the world of the transgender. (A discussion of intersex children who may have incomplete physical characteristics is beyond the scope of this article.)
Transgender individuals are those who identify with a gender that differs from the biological sex they were assigned at birth. They are born biologically male or female but express their gender in ways more consistent with the opposite sex.
Although it may seem like we have a wave of newly identified transgender people, the percent of trans people remains consistent at about 0.3%, and rather than a change in incidence, we are likely experiencing more visibility. While interviewing me, MJ Schwader said that he first came out as a lesbian at age nineteen and only many years later came out as a transgender man. He said:
Something wasn’t right; even without language around it, I knew from a very early age that I wasn’t going to be able to stay there. When I came to a realization that I was trans, there was this complete peace inside.2
Whether speaking of sexual orientation or gender orientation, many people live in a kind of purgatory of sexual confusion until they acquire the words to describe their individual identity.
Another layer of confusion is added when considering “drag,” that is practiced by people of all sexual orientations and gender identities. The term “drag” is used when someone wears clothing that is more conventionally worn by a person of the opposite sex, especially when a man wears women’s clothes. Drag is a performance; it does not refer to people who wish to assume a gender different from their assigned sex. Transgender women want to dress as women because they are women, transgender men are men.
One morning I heard a television pundit who opposes transgender rights say that if men can gain an advantage by saying they are women, many will do so. He was wrong on so many levels. In our patriarchal society, most would agree that not many advantages accrue to women over men. He also implied that all a man had to do was put on a dress and a wig and suddenly he is transformed into a woman. His statement ignores the complexities and pain of a trans person’s decision to transition to a different gender. Some trans people work hard to leave no doubt as to the gender they believe they are.
When a conflict exists between one’s biological sex and the gender with which one identifies, it creates gender dysphoria, a clinically significant form of distress. A report titled “Suicide Attempts among Transgender and Gender Non-Conforming Adults” states that over 40% of trans men and women have attempted suicide, with the prevalence being highest among the young, economically disadvantaged, less educated, and ethnic minorities.3
Until a recent change in the Diagnostic and Statistical Manual of the American Psychiatric Association, this condition was labeled “gender dysphoria disorder.” Although trans men and women experience dysphoria (anxiety, depression, and suicidal thoughts) at a higher rate than the general population, it is no longer considered a “disorder.” For many, their psychiatric symptoms disappear or markedly diminish once they have decided to transition to the gender with which they identify.
Why would anyone, then, choose to assume a gender different from the biological sex with which they were born? Many studies on the causes of transsexuality have been widely discredited, particularly psychological studies. A recent review of literature on the causes of gender identity concluded that a fixed, biologic basis exists for gender identity and that the best clinical outcomes are associated with hormone therapy and surgical sexual transition.4
One classic way for scientists to test whether a trait is influenced by genetics is twin studies. Identical twins have the same chromosomes; fraternal twins are raised in the same environment but share only half their genes. Several studies have shown that among twins, both identical twins are transgender more often than both fraternal twins. Studies of the brain structure have also shown that the brains of transgender males or females are more similar to the brains of the sex with which these people identify than the brains of the sex they were assigned at birth.5
Transgender identity is complex. It is not binary; it may not be linear. It is also most certainly not a capricious choice made to seek a particular advantage. It may also be more fluid than once thought. Sex and gender are most likely a matrix of identities without one precise set of causes. The most promising choices for understanding transsexualism is in epigenomics, a study that combines the effects of the environment on genetic expression.
More than one in four trans people has faced a bias-driven assault, and rates are higher for trans women and trans people of color.6 Although more than half of Americans oppose laws requiring transgender people to use bathrooms that correspond to their birth sex, the current political environment is a very difficult one for transgender men and women. “Bathroom bills” have become the focal point of anti-LGBT measures across the country. In most cases, bathroom bills have been proposed by politicians up for re-election. The bills are being used to energize these politicians’ conservative base now that the issue of same-sex marriage has been resolved, and the arguments that they are using are the same that were used against same-sex marriage—for example, to protect children.
President Trump, indebted to conservative Christians, has reversed his pre-election position and has rescinded President Obama’s rule that trans people must be allowed to use the bathroom consistent with the sex with which they identify. In an administration that so easily dismisses science, the evidence that transsexualism is biologically determined will have little impact.
We have a great deal to learn about transsexualism. For example, we know that the earlier hormonal treatment is given, the more apparent the physical transformation will be, but what are the long-term consequences of putting children on hormones with irreversible effects?
One thing we can be certain of is this: issues of sexual orientation and gender identification are complex and will not be resolved at a gender reveal party during the twentieth week of gestation.
1. Sirois M. (2017) A Word of Caution on Gender Reveal Parties. HuffPost. Available here.
2. Olson L. (2017) Finally Out: Letting Go of Living Straight with Loren Olson, MD. OMTimes Radio. Available here.
3. Haas A, Rodgers P, Herman J. (2017) Suicide Attempts Among Transgender and Gender Non-Conforming Adults – Williams Institute. Williams Institute. Available here.
4. Saraswat A, Weinland J, Shafer J. (2015) Evidence Supporting the Biologic Nature of Gender Identity, Endocrine Practice, 21(2), 199-204. doi: 10.4158/EP14351.RA.
5. Wu K. Between the (Gender) Lines: the Science of Transgender Identity – Science in the News. Harvard University – The Graduate School of Arts and Sciences. 2017. Available here.
6. (2017) Anti-Violence. National Center for Transgender Equality. Available here.
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