Tuesday, 16 September 2008

Reading Lists

Some more Transsexual, Intersexed and Transgender Information - and Misinformation.

I better add a disclaimer here. Not everything included here bears any resemblance to reality, other than the fact that some people hold beliefs of this kind.

First is a reference list by Gender Menders, an arm of the Australian Gender Identity Awareness Association (GIAA). Basically, the sole member appears to be Alan Finch, who I've blogged about before. It's an anti-surgery anti-hormones site. Part of it's Mission Statement:
To Bring awareness that there is an alternative view to that of SRS practitioners. This view, which is supported by majority of the medical profession, is that the surgical intervention for treatment of individuals whose gender identity disorders are purely of a psychological or emotional origin is unethical, illusory and become culturally driven, ineffective to the resolution of underlying causes of gender confusion and should not be promoted.
As I believe that most, if not all cross-gendering is the result of biology, not of "psychological or emotional origin", I disagree with the basic premise.

However... the list of references is a very good resource indeed.

None of the resources under "Theories of the origin of Gender Identity Disorder" are later than 1992, and most are from the 70's and 80's. The latest data is
Walter Bockting, Eli Coleman, "A comprehensive Approach to the Treatment of Gender Dysphoria", J of Psychology & Human Sexuality, 5:4 1992, pp. 131-153
Today, more clinicians recognize that gender dysphoria is far more complex than previously assumed. There is no scientific consensus about a single developmental pathway which leads to gender dysphoria. Determinants of gender dysphoria remain controversial and hypothetical.
There is insufficient evidence for a biological determinant of gender dysphoria. Interactions theories of psychosexual development are more likely to represent reality.
Compare and contrast with an earlier statement of particular interest to me:
Michael Ross, William Walters, "Transsexualism and Sex Reassignment", Oxford University Press, 1986 p20
p20: While at present there is no evidence to suggest a biological basis for gender dysphoria, it is premature to rule out completely either a biological-environmental interaction or the fact that there may be some cases or subgroups of transsexuals with biological involvement. The insistence by some individuals, both transsexuals and medical scientists, that gender dysphoria is biologically determined is an entirely different matter. Such a belief on the part of transsexuals themselves is often an indication that they do not want to question the origins of their condition or explore its causes and development: Such individuals are often unwilling to accept any responsibility for their gender dysphoria and will not entertain any attempts to change it. Professionals who believe that gender disorders are biological may also be attempting to justify the continuation of gender reassignment surgery without too close an examination of the basis of gender dysphoria in particular patents. It is important to separate belief and fact in such cases, and to recognize the difference between individuals having a need to believe in biological determinism, on the one hand, and on scientific support for theories of biological causation on the other.
It is difficult to see primary gender dysphoria as anything other than a psychological disturbance. It is of particular interest that, of the many transsexuals presenting for treatment, primary gender dysphoria is not the most common diagnosis nor gender reassignment the most common treatment.
Since then, a mountain of evidence for a biological cause has come in. Over 50% of the publications on the subject have been produced in the last 10 years, well after 1986. Much of what was thought then has been thoroughly and most comprehensively debunked.

This passage did "give me furiously to think" though. Was I fooling myself? Do I have some peculiar need for "justification"? How would I know if I did? Those were extremely good and valid questions, and deserved much introspection. Which they got.

The trouble is, there was photographic and eyewitness evidence that my body was changing. At some point in evaluating evidence, doubts about your own objectivity can become not essential tools to ensure intellectual honesty, they become irrational notions that don't pass the giggle test. When the only person still retaining any doubts at all about your thinking is you, maybe you should wake up and listen to what others say. They're objective.

Initially, part of me hoped that it was all psychological anyway. Something that therapy could fix. The prospect of the inconvenience and disruption to my life caused me stark terror. But I soon recognised from my readings that even if it was "psychological", there was no therapy that worked other than surgery.

As for the argument for biological justification, consider the following similar argument: "Broken legs are a figment of psychotic belief. Those who insist that their bones are actually broken are merely seeking justification of their mental illness. It is important to separate belief and fact in such cases, and to recognize the difference between individuals having a need to believe in biological causation, on the one hand, and on scientific support for theories of biological causation on the other." Lacking X-ray machines, and with only a crude knowledge of human anatomy, one can see how such a belief could be reasonable.

All of these articles, however flawed they appear with hindsight, were "best guesses" based on the evidence available at the time, by people genuinely trying to find out more about an intractable puzzle. I can only hope that my own opinions based on the evidence available to me now will hold up as well or better in 20 years time, when we know more.

Moreover, such views are still useful. If our current view of reality is so good, it should be able to withstand a little criticism. Or a lot, as long as it's intellectually honest. Unfortunately, not all is, but that's another issue. Anyway, I recommend looking at both the biological and psychological causation references - the latter in particular contains much that will cause some rueful chuckles amongst the cognoscenti.

Next on the list:
The ethics of surgically assigning sex for intersex infants (PDF) by Merle Spriggs and Julian Savulescu . The definitive discussion paper on the subject, IMHO.
A growing number of objectors have argued against early genital surgery on the grounds that it is not necessary, it is not reversible and it can cause harm. Some commentators argue that surgery to normalize the infant is based on parent’s fears and concerns rather than the best interests of the child and amounts to ‘the medical management of a psychological condition’ performed on the child for the sake of the parents: ‘Cosmetic surgeries are performed without the subject’s consent because of adults’ discomfort with intersexuality’.
The central questions in the management of intersex infants are:
• When, if ever, should surgery be carried out?
• Who should decide?
• On what criteria should decisions be based?
One of the criticisms of the traditional treatment model is that it fails to recognise the experience of intersexed people and to recognize that they are experts in terms of theirexperience of intersex conditions.
We have argued that the critical ethical issue is whether early surgery benefits or harms a particular individual in the sense of making that person’s overall life go better or worse. Strikingly, there is very little empirical evidence to answer this question. The management of intersex speaks to the moral imperative to conduct ethically informed scientific research. Only then will we know what we should do.
After that, we have Dorner's original research paper from 1988, which provided the first clues as to a biological basis for transsexuality, and homosexuality too. I wish I'd seen this before, it fits nicely into the unolding pattern I described in Bigender and the Brain.
In clinical studies, we induced a positive estrogen feedback luteinizing hormone secretion in most intact homosexual men, in clear-cut contrast to intact heterosexual or bisexual men. In addition, the evocability of a positive estrogen feedback was also demonstrable in most homosexual male-to-female transsexuals in significant contrast to hetero-or bisexual male-to-female transsexuals. The following relations have been found between sex hormone levels during brain differentiation and sex-specific responses in adulthood: (i) Estrogens, which are mostly converted from androgens, are responsible for the sex-specific organization of gonadotropin secretion and hence the evocability of a positive estrogen feedback in later life; (ii) both estrogens and androgens, occurring during brain differentiation, predetermine sexual orientation, and (iii) androgens, without conversion to estrogens, are responsible for the sex-specific organization of gender role behavior. Furthermore, the organization periods for sex-specific gonadotropin secretion, sexual orientation, and gender role behavior are not identical but overlapping. Thus, combinations as well as dissociations between deviation of the neuroendocrine organization of sex-specific gonadotropin secretion, sexual orientation, and gender role behavior may occur.
More work needs doing, not just with fMRI scans, but in sexually differentiated biochemical responses to hormones.

Moving on to matters legal, the Transgender Law and Policy Institute list of caselaw in the anglosphere. Some of the cases are heartbreaking - such as that of Jacob B. Nash and Erin A. Barr. Denied marriage in Ohio in 2002, and lost an appeal in 2003. And this one:
In a ruling that shocked GLBT activists, a Cook County Judge ruled last week that although he and his son “have a good and loving relationship,” a transgender father named Sterling will not be granted custody of his 10-year-old son.

Judge Gerald Bender said although the man has been a good father, his previous marriage to the child’s mother is invalid because he was a woman at birth— same-sex marriages are illegal in Illinois.

The child’s public guardian, the nationally known and respected child advocate Patrick Murphy, disagreed with the ruling and says he will appeal.
In view of these considerations, the judge in Kantaras declined to hold that phalloplasty is required for a transgender woman to be recognized as legally male, since any such requirement would be at odds with current medical knowledge and practice. In contrast, in the Chicago case, the trial court relied on the "lack" of genital reconstructive surgery to declare Sterling S. to be legally female, despite his male gender identity, extensive medical treatments, and twenty-plus years of living and being accepted as a man.
The Kantaras verdict was overturned on appeal too.

Finally, in 5 parts, we have a TG Timeline up to 2007 by Marlene A. Bomer. Parts 1, 2, 3, 4 and 5.


Anonymous said...

This is really interesting stuff - thanks for posting the reading list.


Unknown said...

> The trouble is, there was photographic and eyewitness evidence that my body was changing.

You do understand, of course, that your experience was anomalous in the extreme, and doesn't in itself support a biological model of transsexualism (against which I am not arguing)?

As far as I know, almost no "classic" transsexuals undergo spontaneous changes like your own. For most, the reality testing is quite a bit more subjective.

Zoe Brain said...

TPQ - glad to be of service.

Val - yes, I'm anomalous in terms of my metabolism. But psychologically speaking, I'm indistinguishable from the standard TS case.

It would seem to me to be quite a coincidence, one that strectches credulity. Here we have one of the dozen or so known cases of a natural MtoF change, and they all - with one recent possible exception - coincidentally happened to fit the classic TS profile exactly.

It's almost the perfect experiment - what happens when a biological female (well, more female than male) is forced to adopt a male gender role due to her appearance. What would be the consequences in how she would feel, how her mind would work.

The mapping is not exact: I never cross-dressed for example, and before the change, my gender dysphoria was under control. Enough so I would not have appeared on any Transgender survey, anyway. I has a mild case, I was and am not as strongly gendered as pure TS women who present for treatment. Or maybe I'm just more cowardly, as my female gender identity seems strong enough now!

But that would tend to reinforce the case for biological TS causation, not diminish it. And totally destroy any idea that I'm searching for some kind of "it's not my fault!" excuse. I could, in theory, after all, have taken FtoM measures. I did consider it, and even subscribed to an FtoM magazine. But I just couldn't do it. I'm good at self-deception, but I've never claimed that this wasn't something I desperately needed.

Rather than me using my unusual biology as an excuse for transitioning, I've always said that it was just the trigger, the "spur that pricked the side of my intent". Without it, I never would have transitioned. But only because I was too terrified to, not because I wasn't classically TS, like all the rest.

Unknown said...

I think I still see a difficulty with classification order. While it doesn't strike me as at all coincidental, that the (very) small population of "natural changers" are also psychologically "classical TS" doesn't necessarily imply the larger biological model. The very small subset does not define the conditions of the much larger set.

I also note that it's pretty much impossible not to invoke the psychological markers while arguing for a strictly biological condition... inevitably so, given the near-total lack of overt physical markers in most.

All of which is taxonomic quibble, as opposed to outright argument.

Your last comment, though, particularly piques my interest. Given that most transpeople do not have the benefit of that undeniable kick in the evidentiary ass that you received, how many classical TSs might remain too frightened, confused, isolated, etc., to make that step?

Zoe Brain said...

Good points, val. I need to think on them.

As for the others who don't appear on the radar screen - how can we know how many exist? I think Lynn Conway's figures might be more reliable than I'd assumed. And there are degrees of this, it's not a hard, rigid binary.

Bad hair days said...

I would describe myself as a heavy case, but I myself didn't crossdress before social change, too - well I did some experiments and I always hid my male patterned baldness under a cap or cloth even when at home. But I think that doesn't count. I never defined femaleness over clothes.
I think that was the result of a very feministic upbringing.

Anonymous said...

Many fewer than before, Val. The information and interaction available on the internet is saving a lot of lives of younger as well as older people.

I can't imagine you as an FTM, Zoe. But I do identify with the terror and confusion that hitting the wall does produce.