The Evidence

In response to a request that read:

What I'm requesting from anyone and everyone that can help, to please provide me with any and all creditable medical and/or psychiatric documentation that supports our condition that are completely legitimate. I have to use facts because some will try their hardest to tear it apart. I would like to use as much as possible genetic/biological proof to go along with the DSM.

Here is my reply:

Male-to-female transsexuals show sex-atypical hypothalamus activation when smelling odorous steroids. by Berglund et al Cerebral Cortex 2008 18(8):1900-1908;

...the data implicate that transsexuality may be associated with sex-atypical physiological responses in specific hypothalamic circuits, possibly as a consequence of a variant neuronal differentiation.

Male–to–female transsexuals have female neuron numbers in a limbic nucleus. Kruiver et al J Clin Endocrinol Metab (2000) 85:2034–2041

The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder.

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation. Swaab Gynecol Endocrinol (2004) 19:301–312.

Solid evidence for the importance of postnatal social factors is lacking. In the human brain, structural diferences have been described that seem to be related to gender identity and sexual orientation.

A sex difference in the human brain and its relation to transsexuality. by Zhou et al Nature (1995) 378:68–70.

Our study is the first to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones

A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity. by Garcia-Falgueras et al Brain. 2008 Dec;131(Pt 12):3132-46.

We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity.

There's a pile more with URLs at BiGender and the Brain. See also Dr Veronica Drantz's Powerpoint presentations, and the specific quotes from Dr Harry Benjamin's The Transsexual Phenomenon at Two for the Reference Library.

Legal Findings:
Re Kevin – Significant Findings Of Justice Richard Chisholm In Respect Of The Expert Medical Evidence In That Case As To The Causation Of Transsexualism And As Strongly Affirmed By The Full Court (Australian Family Court) On Appeal. Deakin Law Review 2004 v22

At paragraph (247): 'In my view the expert evidence in this case affirms that brain development is (at least) an important determinant of a person's sense of being a man or a woman. No contrary opinion is expressed. All the experts are very well qualified. None was required for cross-examination, nor was any contrary evidence called'.

At paragraph (248): 'In my view the evidence is, in essence, that the experts believe that the brain development view is likely to be true, and they explain the basis for their beliefs. In the circumstances, I see no reason why I should not accept the proposition, on the balance of probabilities, for the purpose of this case.'

At paragraph (252): 'The traditional analysis that they are "psychologically" transsexual does not explain how this state came about. For example, there seems to be no suggestion in the evidence that their psychological state can be explained by reference to circumstances of their upbringing. In that sense, the brain sex theory does not seem to be competing with other explanations, but rather is providing a possible explanation of what is otherwise inexplicable'.

At paragraph (253): 'In other words (as I understand it) the brain of an individual may in some sense be male, for example, though the rest of the person's body is female'.

At paragraph (265): 'In my view the argument in favour of the "brain sex" view is also based on evidence about the development and experience of transsexuals and others with atypical sex-related characteristics. There is a vast literature on this, some of which is in evidence, and I can do no more than mention briefly some of the main points'.

At paragraph (268): 'It seems quite wrong to think of these people as merely wishing or preferring to be of the opposite sex, or having the opinion that they are'.

At paragraph (270): 'But I am satisfied that the evidence now is inconsistent with the distinction formerly drawn between biological factors, meaning genitals, chromosomes and gonads, and merely "psychological factors", and on this basis distinguishing between cases of inter-sex (incongruities among biological factors) and transsexualism (incongruities between biology and psychology)'.

At paragraph (272): 'In my view the evidence demonstrates (at least on the balance of probabilities) that the characteristics of transsexuals are as much "biological" as those of people thought of as inter-sex'.

Kantaras v Kantaras - some excerpts from the expert testimony.

When asked does a person choose their own gender identity? He (Doctor Bockting) replied:
"No. This is something that develops. It's believed to
develop very early on in childhood. There are some
theories that say that it is fixed at the age of two. So this is
not something we choose, this is something we become
aware of as we grow up."
...
Q. Would you say (transsexualism) is more of a
psychological problem or more of a physical
problem?
A. I think it's both. It's not physical in the sense that
they have been able to detect with certainty a
physical cause of their conflict.
Q. So you think its both, or you think its only
psychological?
A. I think its psychological distress, but there's also an
aversion - - - sense of a process that people feel
physically. I think that's part of this condition. It's
really the anatomical and the psychological really
interact in this condition ***
Well, I mean, another way of saying is that what
we have been able to establish very consistently the
emotional suffering and distress when somebody
has this conflict.
Yet, the way to alleviate that conflict it involves
physical changes because the conflict is very tied to
their body image. And, then - - - there is evidence
of studies that hormonal and sexual differentiation
of the brain is believed to play a role. So its really a
condition where all of these things come together.
Q. Right. But it's a medical condition, correct?
A: Its recognized – in the medical field, a recognized
disorder. That is, a mental health disorder - - -
where a physical intervention is providing the relief.
Q. Okay. And that's exactly my point. It's a
psychological disorder with a – what did you say?
A. Where a physical intervention - - - well, it's rather a
social role change.
Q. Okay, so it's a psychological disorder that physical
intervention medically physical intervention
relieves?
A. Correct.
...
Q. Dr. Cole, does the fact that a condition is listed in the DSM
mean that it necessarily has a purely mental or
psychological cause?
A. Absolutely not. It's listed in the DSM because it
has to do with the mind, with the brain, with
emotional suffering. I mean, you also have learning
disabilities in there.
You have, you know, people who have sexual
problems, a man with erection problems, a woman
with orgasm problems, that's listed in the DSM, but
it has nothing to do with somebody being unstable.
Q. So the fact that gender identity disorder is listed in
the DSM, does that tell us anything one way or the
other about whether the condition has a
physiological or biological cause?
A. No, it doesn't. It's very controversial even within
the Benjamin Association to have it listed in the
DSM. There are many people who argue it should
be moved over to a medical kind of diagnosis as
opposed to a psychiatric diagnosis.
...
Dr. Cole was asked about Michael Kantaras and if he is a victim of a more mental problem, there's been some suggestions in this case that because gender identity disorder is in the DSM that Michael Kantaras should therefore be viewed in a pejorative sense as sick, or unbalanced or mentally ill. He was asked some questions as an expert in this area to help sort through this issue. He was asked if he was familiar with the criteria for gender identity disorder in the DSM?
A. Yes, I am.
Q. And do those criteria refer exclusively to the
conflict between the person's gender identity and
their anatomy as well as distress that conflict
causes?
A. Yes.
Q. Is there anything in those criteria relating to having
any kind of bizarre or disordered thinking or
behavior or to any kind of emotional unbalance or
instability apart from the distress caused by having
the wrong body?
A. No.
Q. So would it be true that being diagnosed with GID
does not mean that the person is otherwise unstable
or disturbed or mentally ill?
A. Absolutely.
Q. In practice, are transsexual people who have
completed their gender transition anymore likely to
have psychological problems than non-transsexual
people?
A. No.

Mr. Minton thus asked Dr. Cole are transsexual people who have completed their gender transition any more likely to have psychological problems than people who are not transsexual? Dr. Cole answered "no" and added that in the mid-nineties he and his colleagues undertook a scientific study of over 400 charts of people they worked with at the clinic and found that this group of transsexuals had no more pathology, meaning problems with suicide attempts, depression, etc., compared to the normal American population. They took a subsample of 100 people who completed MMPIs, personality tests and they did not have significant elevations on anxiety, depression, or paranoia.
...
Q. Okay. So you don't see a gender disordered person
with gender dysphoria, you don't see that as any
psychopathology?
A. I see that as not in a typical example of the
schizophrenia or affective disorders, the
psychopathology of that nature.
Q. So you do or you don't? Maybe I didn't follow
you. You do see it as psychopathology or you
don't?
A. Oh, I don't.
Q. Well, does Harry Benjamin or the people in the
Harry Benjamin Association see it as some form of
psychopathology?
A. I don't think so. I believe it's simply seen as a
persistent misidentification in terms of that sense of
identity with anatomic self.
397
Q. Okay. Well, let me ask you something, why is it
listed as a mental disorder then?
A. Well, I think, as I said in my earlier testimony, that
is because it has to do with the mind and distress of
the mind it was listed in the DSM way, way back.
But there's still controversy even today of having it
listed in the DSM as opposed to some other type of
medical disorder.

Genes
Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism by Hare at al Biological Psychiatry Volume 65, Issue 1, Pages 93-96 (1 January 2009)

A polymorphism of the CYP17 gene related to sex steroid metabolism is associated with female-to-male but not male-to-female transsexualism by Bentz et al Fertility and Sterility , Volume 90 , Issue 1 , Pages 56 - 59

Functional MRI
fMRT zur Diagnose bei Transsexualität geprüft Ärzte Zeitung, 30.05.2006

So würden bei Männern das limbische System und dort vor allem Regionen im Hypothalamus, in den Mandelkernen und im Inselkortex wesentlich stärker aktiviert. "Diese Vorbefunde konnten wir beim Vergleich der heterosexuellen Männer und Frauen unserer Kohorte bestätigen", sagte Gizewski.

Bei den transsexuellen Männern gab es diese spezifisch männliche Aktivierung des limbischen Systems nicht. Die mit der fMRT erzeugten Bilder entsprachen vielmehr exakt denen der weiblichen Probanden.

Die Radiologen können also das, was die transsexuellen Männer angeben - daß sie sich nämlich "wie im falschen Körper" fühlen - anhand der Aktivierung des Gehirns auf erotische Stimuli bestätigen. Es gibt offenbar ein biologisches Korrelat des subjektiven Befunds.

Translation:

In men, the limbic system and upper regions of the hypothalamus, the amygdalae and the insular cortex were activated substantially more strongly. "We confirmed this finding in the comparison between the heterosexual men and women of our Cohort", said Gizewski.

This specifically male activation of the limbic system was not found in the transsexual sample. Under fMRT, the pictures corresponded rather accurately to those of the female sample.

Radiologists can now confirm what transsexuals report - that they feel "trapped in the wrong body" - on the basis of the activation of the brain when presented with erotic stimuli. There is obviously a biological correlation with the subjective feelings.

To which I'll add the Official American Medical Association policy on the subject.

Whereas, An established body of medical research demonstrates the effectiveness and medical necessity of mental health care, hormone therapy and sex reassignment surgery as forms of therapeutic treatment for many people diagnosed with GID; and
Whereas, Health experts in GID, including WPATH, have rejected the myth that such treatments are “cosmetic” or “experimental” and have recognized that these treatments can provide safe and effective treatment for a serious health condition;
...
RESOLVED, That the AMA support public and private health insurance coverage for treatment of gender identity disorder (Directive to Take Action); and be it further
RESOLVED, That the AMA oppose categorical exclusions of coverage for treatment of gender identity disorder when prescribed by a physician (Directive to Take Action).
...
7. Brown G R: A review of clinical approaches to gender dysphoria. J Clin Psychiatry. 51(2):57-64, 1990.
Newfield E, Hart S, Dibble S, Kohler L. Female-to-male transgender quality of life. Qual Life Res. 15(9):1447-57, 2006.
Best L, and Stein K.(1998) “Surgical gender reassignment for male to female transsexual people.” Wessex Institute DEC report 88;
Blanchard R, et al. “Gender dysphoria, gender reorientation, and the clinical management of transsexualism.” J Consulting and Clinical Psychology. 53(3):295-304. 1985;
Cole C, et al. “Treatment of gender dysphoria (transsexualism).” Texas Medicine. 90(5):68-72. 1994;
Gordon E. “Transsexual healing: Medicaid funding of sex reassignment surgery.” Archives of Sexual Behavior. 20(1):61-74. 1991;
Hunt D, and Hampton J. “Follow-up of 17 biologic male transsexuals after sex-reassignment surgery.” Am J Psychiatry. 137(4):432-428. 1980;
Kockett G, and Fahrner E. “Transsexuals who have not undergone surgery: A follow-up study.” Arch of Sexual Behav. 16(6):511-522. 1987;
Pfafflin F and Junge A. “Sex Reassignment. Thirty Years of International Follow-Up Studies after Sex Reassignment Surgery: A Comprehensive Review, 1961-1991.” IJT Electronic Books, available at http://web.archive.org/web/20070503090247/http://www.symposion.com/ijt/pfaefflin/1000.htm;
Selvaggi G, et al. "Gender Identity Disorder: General Overview and Surgical Treatment for Vaginoplasty in Male-to-Female Transsexuals." Plast Reconstr Surg. 2005 Nov;116(6):135e-145e;
Smith Y, et al. “Sex reassignment: outcomes and predictors of treatment for adolescent and adult transsexuals.” Psychol Med. 2005 Jan; 35(1):89-99;
Tangpricha V, et al. “Endocrinologic treatment of gender identity disorders. ” Endocr Pract. 9(1):12-21. 2003;
Tsoi W. “Follow-up study of transsexuals after sex reassignment surgery.” Singapore Med J. 34:515-517. 1993;
van Kesteren P, et al. "Mortality and morbidity in transsexual subjects treated with cross-sex hormones." Clin Endocrinol (Oxf). 1997 Sep;47(3):337-42;

How much more evidence do we have to give? How many more scientific articles, research papers, journals of neurology, reproductive science, psychology, psychiatry, endocrinology, and medicine must we quote? How many expert witnesses must we call, and how many legal cases must we lose, because even at college, people are only told about "usual" circumstances regarding sex and gender, and not exceptional ones? How many pardonably ignorant journalists must we seek to educate, because the colleges and universities have let them down?

People have been fired for being Transsexual. People have been fired for being Intersexed. But now people are being fired for even teaching that Intersexuality exists. - See important updates below and in the comments.

From Atlanta Progressive News (yes, the word "progressive" doesn't instill confidence, but the facts are the facts no matter who reports them.)

"I was basically fired for teaching about intersex people in my Introduction to Sociology course this Summer against the wishes of Stombler. Stombler said she agreed with me that sex is socially constructed-in that we, as a society, have to define how many sexes there are, who gets to fit into each category, and how to handle the anomalies-but she said that it was too advanced for 101 students," Cardinale said.

"Because we do define sex and gender in any 101 class, I felt it was important to define those terms accurately and inclusively from the beginning," Cardinale said.

Last summer, an Atlanta Police Officer, Darlene Harris, came out as intersex, as reported in Southern Voice Magazine, the Atlanta Journal-Constitution, and Atlanta Progressive News.

Cardinale had invited Harris to come in and speak to his class about her experiences as an intersex person, to help illustrate the social construction of sex. Unfortunately, afterward, Stombler took issue with Harris's guest lecture and said the Department would not support Cardinale's lesson plans.

Enough. To persecute us for existing is one thing : to deliberately conceal that we even exist, another.

The next time someone who's a product of this mis-education system starts saying "Oh, I read somewhere the treatments don't work", or "don't give me any of this brain-sex nonsense", or "but aren't they just, you know, crazy like the DSM says?" - please quote them this article. Especially the last part, which shows them why not only don't they know the facts, but what facts they were taught are often wrong.

UPDATE: Please see the comments section for a first-hand account that differs significantly from that reported by the Atlanta Progressive News. Here, I'll quote:

It's unfortunate that Matthew had a bad experience, but there is much more to this story. For a Graduate Student Instructor to get taken out of the classroom, there have to be a lot of problems in the classroom, with the course design and the instructor. Every GSI undergoes extensive pedagogical training and ongoing evaluation. It is peculiar that one would claim to get fired for featuring an intersexed speaker within a climate where we are encouraged to include intersex issues in gender, sex, and sexuality curriculums.
...
..I hope you'll take the time to consider that there are other factors involved here. Please consider my alternate viewpoint and divergent experience in teaching and studying intersex at GSU.

As always, my thanks to those who comment here, and for this comment in particular. I don't claim to be correct all the time, but do try to issue corrections, or where the situation is unclear, give all the evidence.

UPDATE II
As the result of numerous comments from people with first-hand knowledge of the situation at the University concerned, I'm now convinced that the situation has been substantially mis-reported. Rather than deleting the incorrect part of the post, and pretending I hadn't got it completely wrong, I'll just unreservedly retract my statements with apologies, and refer readers to the comments section as to why my opinion has changed. It's not just a matter of accuracy or inaccuracy though. My comments were unjust to the people concerned. I can't apologise for the initial error given the limited data, but I can and should apologise for the injustice I've done them, and in public. I so do, here, now.
“When the facts change, I change my mind. What do you do, sir?”- John Maynard Keynes