Thursday, 23 July 2009

Losing my Objectivity

Maybe I've been hiding from the difficulties, burying myself in research on what the FARNARCKLE happened in 2005. Treating it objectively, dispassionately as a defence mechanism.

Or maybe it was because I had picked the name "Zoe" in 1968. Before the change, I was a transsexual woman, not that I knew that.

I had hoped that every one of us that this happened to was in a similar situation. My pollyanna-ish views got shaken by the story of Terry Wright in the UK, but maybe that was a glitch, an anomaly. Or just plain mis-reporting.

But it seems not, and that has shaken me out of my objectivity. I knew this kind of thing was very likely to be under-reported for obvious reasons, but had managed not to think about the consequences.

From a recent e-mail:
Your initial reaction was very similar to those received from anyone connected to the medical field. I was also told by the Asst. Director of Research at the University of (redacted) that she could not reccommend any course of action nor any doctor that could help

I can assure you that the one thing I am is not, is psychotic or delusional. As to acceptance of my condition, it is predicated on accepting what evidently cannot be changed. This acceptance occurred over at least two years of research, learning virtually nothing, and learning to live as a female. Believe me when I say that it is far easier to live as a male. I also have a wife of some 38 years ..... My hiding has more to do with the legal complications of staying married. and giving her a decent life.

I am in (redacted). the home of the (famous medical establishment name redacted) and I have found a doctor who may be of some help. However, since I do research for a living I have found that people talk, and that the medical field is no exception. Need I say more.


If I had been a guy... with some degree of being BiGendered... I could have written something very like that.

Now I have to help them, when all my research over 4 years has found Zip, Nada, Nothing.

Then there's this:
One day, while out on a motorcycle ride, Ted was stung several times by a bee. He was severely allergic to bee stings, so Rene rushed him to the hospital.

"They start putting me on IVs of epinephrine and different hormones, trying to counter and stop this bee sting reaction," Chloe said.

A blood test at the hospital led to an endocrinologist and a diagnosis that Chloe said explained why she had felt so different her whole life.

"They sat me down and they said, 'Are you aware of having Klinefelter's syndrome?' And I [said] 'No, what is that? Never heard of [it].'"

Klinefelter's syndrome is one of the most common chromosomal abnormalities in humans. Normally, a male is born with XY chromosomes and a female XX, but an estimated one in every 500 boys is born XXY. One of the main side effects of Klinefelter's syndrome is a much lower level of testosterone than the average male.

The news of his medical condition was a moment of clarity for Ted, who for so long had struggled with gender identity issues.

"The veil was off," said Chloe. "I was like, this is why, you know, I tap dance like a little cat on the fence of the gender line -- why I can't commit to either side. Appearance-wise, I look like every other male, but on a DNA-chromosomal scale, I was neither."

Chloe says the doctors told them that the severity of the sting had essentially reset Ted's endocrine system, according to Chloe. Gradually, his body started to change. Initially, Rene thought Ted was gaining weight, but they knew something else was going on when he started developing breasts.

"I had muscular arms, [but] all that started to change with Klinefelter's shifting the dynamics of my endocrine system. I could see that the fat density in my face and my body, the softness of my skin, my muscular features were all changing at that point," Chloe said.

With an actual medical diagnosis to help explain why he had felt different his whole life, Ted felt free to express his true identity.

"I wanted to physically align my body in appearance with how I felt inside. I wanted to be authentically myself -- which was female. I didn't feel like I needed to prove myself anymore to my father, to the world, to my mom. I didn't need to be a man."

But for Rene, it was incredibly painful to watch the man she loved disappear.
For some of us - the transsexual women - a natural transition is a wonderful miracle. But it may be something quite different to those we love. Our wives (wives??? how can I have a wife? I'm a woman!), and our children.

Chloe's transsexuality was far worse than mine. She too went to see Dr Suporn - he's good with cases of Intersex - and she got both genital reconstruction, and the full facial faminisation surgery too. She probably didn't need it, but she desperately wanted it. And she's beautiful. I.... don't need it. And my face isn't beautiful. But it's mine, and I don't think facial reconstruction would help me much anyway. Dr Suporn said as much - the things he can really improve, I was already there, and the flaws were something he couldn't do more than make marginal improvements on. An improvement, certainly - just marginal. He didn't think it was worth it.

Oh yes, there's the $25,000 cost as well. Money that could better be spent helping others, or put into my son's educational fund.

How to get the medics interested in looking at this area? I don't know. It seems that every second case has a new etiology, a different cause. Even in aggregate, there's perhaps 20 cases recorded worldwide. And every one of us has been told "er, we don't know what's happening, and we can't do anything about it". One has damage to the pituitary, causing excess prolactin. Another is 47xxy and has the endocrine system reset by massive anaphaleptic shock. Another few are 45x/45xy and feminise at puberty. Another few have late-onset complete androgen insensitivity syndrome, associated with anomalous uptake of estrogen - this may be the most common cause. And in my case... we haven't got a clue. I got a reset of my hormonal balance to female, but that can't explain the rapidity of the change, or the androgen weirdness since. I'm 46xy, not 47xxy. It appears now that some other cases are even more inexplicable, and the change more complete.

The only thing we have in common is that we all look (somewhat, mostly, or completely) male before, and (somewhat, mostly, or completely) female afterwards. And that it's those around us who are "collateral damage". Not only is my own case unique, but my family is too. My partner. My child. I've neither harmed nor lost them, or even upset them appreciably. Carmel knew, even if I managed to hide it from everyone else, especially myself. She loved me anyway. As I love her. Even though we're both straight.

I want to help those not as outrageously lucky as I was. I want to help them, and I want to help their families. I particularly want to help those to whom a female gender is not natural, not who they really are, even if they can function in that role. But I feel so helpless. My Objectivity? That's lost, I care too much.


Anonymous said...

Figure out whether you actually need it before you worry too much about not having it.

Emelye Waldherr said...

Just a thought. I have to wonder if it was the bee stings or the treatment against the anaphaleptic shock (or the combination of the two) since it is likely that others with Kleinfelter's Syndrome have been stung without experiencing the subsequent effects that Chloe described.

Ultimately though, I think the whole search for an etiology is moot when it comes to being transsexual. It's an interesting subject and all but the bottom line is, are you or are you not trans and what are you going to do about it?

immybass said...

I have Klinefelter's Syndrome. I got a karyotype done in 2005 after comments about my very strange build gradually sank into my obtuse brain. When I read the description of KS, it was like someone had written the story of my life. Did you ever have one of those moments where Suddenly The World Is Different? It was one of those.

I never had any hormonal about-face like you describe; just a very weak puberty that ended early. But I do have extensive allergies, which I gather is common among KS people.

Zoe Brain said...

Emelye - yes, but what happens if someone becomes trans due to an involuntary sex reversal?
We're in uncharted territory here.

Regarding Kleinfelter's - the vast majority of people who are 47xxy are men. Men who have a minor genetic whoopsie, but one that can be very threatening to the male ego. Oh yes, they have all sorts of interesting medical issues too. The majority are not TS, and can rightly get very offended if someone claims they are. That's the majority. Men with a pesky extra X chromosome in some or all of their cells, that can cause some distressing lack of pubertal development.

A sizeable minority though have cross-gendered neurology compared to the rest of the body. They're women with a pesky Y chromosome in some or all of their cells. Are these women TS? Technically, no, they're Intersexed. 47xxy, not 46xx or 46xy. Not Red or Blue but Purple. And that can mean that they get denied treatment, or it can mean they are fast-tracked.

And a very few of these women have a somatic appearance that matches their neurology. They are able to get pregnant and give birth.

What gets my goat is the propensity to treat all these people with arrogance, and disregard the individual circumstances.

We have those who say "47xxy? You're not really men at all! You're Freaks, and quite possibly pedophiles and perverts too, who should be exterminated!". Grrrrrrrr..... keep me away from throttling such arrogant anal sphincters... seriously, such people are nasty pieces of work, wastes of space and oxygen.

We have others who say "47xxy? You're just men, so if you think your gender identity is female, you're delusional, mentally ill, a pervert etc etc". Which is almost as bad.

We have those who say "Intersex conditions are so rare, we shouldn't change our laws to accommodate these handful of people" but then refuse to allow the laws to make any exceptions for cases where the law shouldn't apply, and won't permit any discretion or common humanity to be shown.

Then there's those who, for religious reasons, refuse to believe that Intersex conditions actually exist - that it's all a conspiracy by Atheistic Evilutionist Scientists to promote the Communist Homosexual Agenda to Destroy Our Society and pollute our precious bodily fluids. Not a problem if they're soapbox orators, but such people infest some legislatures - and rather more churches.

Most of the problems could be solved by a good healthy dose of common humanity.

In this case though - it's our medical knowledge that's lacking too. It's not so much a TS issue as an IS one.

immybass said...

Yes, as far as I can tell there's been almost no research done on KS, which leaves one in an information vacuum. I was advised not to talk about it during my transition, because it would provide a potential excuse to deny me treatment.

I can understand male-identified KS people being touchy about it; it's hard not to feel defective as a man or woman.

Anonymous said...

Zoe Brain,its Kailana again:

An gender or sex reassignment, or sex normalization of an intersexed person does not make them transsexual, no matter how much you would love to see doctors repeat it does make them transsexual. Fact I keep reminding people that those HBSoC, only applies to a normal biologically genetic man or woman with cross gender Identification. <---that is the TS guidelines and clinical definition.

A intersexed person, regardless of whatever gender we end up with through surgery are considered that sex. You can call it a Double standard with some crappy consequences. By the way, I do identity as Intersexed, but if you or others must insist on labeling me as trans then know, I am a trans man who rejects the use of repeated surgery to make me look male.

I prefered your comments Zoe, your blog bit the big one. The IS community wants nothing to do with having any one assume any of us are transexual. Mind you doctors suck bigtime, and love making the comparison to a sex reversed or surgically normalized intersexed person, which is a load of crap.

My advice to you, Zoe Brain, is stop pushing TS as a subset of intersex. They are nothing alike. Other then the fact that both are abused by people who don't know any better.

Zoe Brain said...

All transsexual people are intersexed : very few intersexed people are transsexual.

Transgendered is another issue.

Zoe Brain said...

Of course what this *does* mean is that there may be no actual cases of GID as given by the DSM-IV-TR. The condition as defined there may not actually exist, and would certainly only apply to a minority of those currently diagnosed with GID if it does.

It means that most or all cases involve some IS condition - if you define IS as a body conforming neither to male nor female stereotypes. The APA may be coming round to this view, even if Zucker and Co do not.

This leads to some difficulties of course. At the moment, those who are Intersexed and unhappy with their arbitrarily assigned gender are classed as GIDNOS, along with crossdressers who don't desire surgery. IS people diagnosed as such who require surgical treatment often keep their condition hidden so as to avoid being denied it.

Anyone who thinks IS people have it easy is, well, reality-challenged. They often have the stigma of mental illness attached to them, just because of a physical problem. People confuse IS and TS. And IS and TG. And IS and Gay. And IS and Crazy. And IS and "Gender confused".

Worse, what does a woman with CAH have in common with a Man who is 47xxy? Or either have in common with a somatically and neurologically cisgendered person who's a 46xx/46xy mosaic? Heck, what does a 46xx woman with CAH have in common with a 46xx man with CAH?

Many women with CAH don't want to be identified as IS, because of the stigma there. They're not "He/She's", "Freaks", they're just women with a minor medical issue.

There is so much misunderstanding and xenophobia that you don't know whether to laugh or cry. Transsexuals not wanting to be put in the same category as "those sexual perverts who dress up for a thrill", the Transgendered, Intersexed people quite secure with their gender thank you very much who don't want to be lumped in with those gender-confused crazies, the transsexuals, and men and women with tiny, negligible medical anomalies who don't want to be put in with those sideshow freaks, the neither-man-nor-woman Intersexed. And people who are proud that only they are "really" intersexed, and the ones with Kalman's syndrome, or Kleinfelters, or CAIS, well, they're just wannabes if they don't have both testicular AND ovarian tissue.

So much misunderstanding. So much fear of being misunderstood.

Anonymous said...

great comment again Zoe, oh and yeah its Kailana again, sorry cant remember my google id and pass. anyways your getting closer to the trueth. Intersex the word you keep using is a medical made up word to replace Hermaphroditic bodys, ie genitalia at birth. <----- I am intersexed becuase i was born with ambigous genitalia. Unfortunately i TRANS man or woman with normal Genitalia are not born with Ambigous genitalia, they had no normal genital reconstruction to appear as a boy or girl, and therefore are clearly not Intersex people and never have been. Now just cause a few incompetent researchers happened to mentioned the Intersex Brain Theory some very few within the TS community have latched onto the Intersex Bandwagon, or are trying to. I hate to say it, but I am one of the most accepting intersex activists, advocates when it comes to TS issues, however as I am fighting for my rights as an medically abused intersexed person, people like you only piss me off more and more especially when you insist that TS are intersexed. There is nothing Hermaphroditic about a TS persons body, or their genetics. Now a TS person is talking about, thinking about, feeling about their gender expression, that being opposite to their birth sex, their birth genetics their birth gender. And I do understand what that means, and accept it. Do not assume that any one who is intersexed will ever accept a Transsexual man or woman as an intersexed person. You have idiot doctors saying they are the same, and none want anything to do with accepting a transsexual diagnosis to fit some psychological requirement just to be allowed to live as we are. We do not want the TS standards of care being applied to us, none who are intersexed need that additional abuse. So please think about it some more and realize you if you are infact intersex. quit making life harder for your own intersex community.

Anonymous said...

How dare you call people with Kalman's syndrome, or Kleinfelters, or CAIS Wannabes. That's just so insulting and that's so transgender of you to call people who are Kalman's syndrome, Kleinfelters, AIS or CAIS people wannabes. Your missing the point what Kailana has has told you. Intersex people do not want anything to do with the transgender people and they find it very insulting if you class intersex people with the transgender people

Zoe Brain said...

Nicky - read the comment again please. Carefully.

I've stated many times that I consider Kalman's syndrome to be an IS condition, even though many IS people do not, and consider you to be riding on their coat-tails.

It's OK, I don't, as I've said many times.

Please sign your anonymous posts though. It's not as if it's not obvious.

Anonymous said...

I dont think Kallmann's syndrome is an intersex condition.
(If) "Intersex is about having a verifiable and proven DNA and genetic medical condition."



"In KS and HH it is not this simple. There are already 8 different genes that have been known to cause the condition and it is very likely there are more. Only about 30% of KS / HH cases have a known genetic cause."
(my bold)

Therefore about 30% of Kallmann's Syndrome cases are intersex (as they have a verifiable and proven DNA and genetic medical condition) but the other 70% are not intersex because [the genetic nature of] their condition can't be proven by medical science.


Zoe Brain said...

I prefer the definition of the UK Intersex Society, the Organisation Intersex International, and the text on Intersex, Ann Fausto-Stirling's "Sexing the Body".

A body born neither wholly male nor wholly female.

Yes, by Nick's own definition, he's not Intersexed. By mine though, he is.

I know that it's ironic that he makes such a big song and dance about how he's intersexed, and those icky transsexuals aren't, but nonetheless.

He's been treated badly by his family. He's been treated badly by the medical profession. He's been treated badly by various "More Intersex Than Thou" groups. And he treats trans people badly in return, probably in order to boost his own ego, which has taken many unfair and unjust knocks. His penchant for multiple aliasses and sock-puppets has gotten him banned from many fora. His only "friends" have been rabidly transphobic second-wave feminists, but even they shunned him in the end. His habits were too obnoxious even for them, even though his message of unalloyed hatred was music to their ears.

He's also a member of the Coast Guard, and does voluntary EMT work. Being handed one of life's bitterest lemons, he's made lemonade. I find that pretty admirable.

I've been unable to find anything concrete that he's ever done for Intersexed people though. Or for that matter, anyone else.

Anonymous said...

I prefer the DSD Guidelines that are being used in America and put out by the ISNA/Accord Alliance. I think the DSD is a step in the right direction, though not perfect, but in the right direction. Right now, the American Academy of Pediatrics follows the DSD Guidelines as well.

As for Kallmann's syndrome being intersex. I would read the latest medical research that comes out of Harvard Medical College, Harvard University, Brown University and Massachusetts General Hospital.

What I mean by verifiable and proven, is a medical term for genetic testing, blood testing and biological testing including testing of the Bone and doing CAT/MRI scans of the brain and even x-rays of the hand.

What's So sad ZOE, is that Kailana, who is a friend of mine gave you a beat down to stop using the "All transsexual people are intersexed : very few intersexed people are transsexual." and the "TS as a subset of intersex" comments and ideas.

That's because Kailana, who is heck of alot smarter than you knowns, that we Intersex people do not want the TS Standard of care applied to the intersex people. We Intersex do not even want to be associated with the trans community as well.

Me and Kailana know fully well that trans people are trying to latch on to the intersex brain theory, which in reality is an incomplete study and it really invalidated their study when they added an older person. Also, no known intersex group will accept the intersex brain theory as an intersex condition.

That's why Me and Kailana don't like the fact that your making it harder for the intersex community to survive and your not helping at all.

So If you want to see the light, I suggest you look at Kailana's site

Zoe Brain said...

The TS SOC can't apply to IS people. Because the diagnosis is not GID, but GIDNOS.

Of course, some therapists fast-track anyone obviously IS who doesn't accept their assigned gender, and others refuse all treatment. It's a lottery. And some use the TS SOC because, well, just because. Because they're scared.

I got fast-tracked.

Using a TS SOC for all IS people would be as inappropriate as treating all IS people as if they had salt-wasting CAH. For one thing, not every IS person is unhappy with their assigned sex. Most can at least live with it, and for very many, it's accurate.

Careful of the DSD nomenclature though - have a look at OII's critique of it. That really would mean all IS people would be by definition mentally disordered if they did not accept the assignment at birth, and in many cases, even if they do.

A minority of IS people look on themselves as not disordered in any way, any more than someone who is left-handed or red haired.

I feel their wishes should be respected. I look upon my own condition as a disorder, but one similar to colour-blindness. I would have preferred a slightly less interesting life, but one involving 46xx chromosomes, pregnancy etc. But you play the hand you're dealt.

Thanks for your cogent and coherent post.

Anonymous said...

hmm, its Kailana once again.

I wrote what i wrote Nicky at the time, because the statement " all transsexual's are intersex" is debatable to me. From past medical refference of the transsexual criteria a intersex person is disqualified from a TS diagnosis. That used to be written in the HBSoC. Now though you just see a biological man or women with cross gender identification. now back in 1980ish, when the DSM 4 came out they added GIDNOS under GID if a intersex condition was present, which was a way to hide the actual intersex condition. the DSM standards for labeling a mental condition due to a medical condition is suppose to label the mental first, like Suicide due to molestation. They just lumped an intersex person who did not accept the gender forced onto them under GID, ie transexual to hide the actual medical condition. there words if an intersex condition is present GIDNOS can be used for diagnostic Dx. What I contest is the assumption that surgeons ie doctors or parents can expect to make a boy or girl from someone that never was. The medical community misguided as they were, forced surgery, genital normalization and I do believe some intersex people like myself reject the surgical assignment because we are not what they say we will be. I accept Transexual men and women as men and women. I have no anger to them, but the continued use of comparing intersex to transexual is bloody annoying, because all that does is cause the idiot's in the world to mock and tease and abuse those of us who do not deserve that abuse. I would hate anyone allready hurting from a intersex diagnosis of being assumed to be a transsexual. Now there is nothing wrong with being transsexual but please understand that doing so, can cause alot of missunderstanding to people who are already struggling with being different.

Anonymous said...

Kailana with a follow-up.

the use of DSD in its own way causes additional harm as well. I also agree with Zoe on OII's statement of the missuse of DSD. Again, there are tons of idiots who make statements that those of us with intersexed conditions are now defective, not men, not women, and then there are those with a religous bent who say we are the biproduct of sin. None of that helps any of us with accepting that we are infact different. DSD was meant to be a clinical definition to state that intersex is infact different again because there has been a push of putting all gender variation, under the umbrella term intersex. But Intersex was meant to be a replacement less traumatizing word then Hermaphrodite. Hermaphroditic people are those with conditions that does cause ambigous genitalia and body development. That is my biggest issue with using intersex as an umbrella terminology for intersex conditons. It failed miserably as a replacement word. Many, not all intersex affected people hate the use of DSD. As I have written posts for many years at and written tons of slamming comments on the use of DSD, think I was one of the first to reject DSD on BLO, and many others followed. I am unaware of other people doing the same when DSD first came out. fact I had many arguements with some who accepted DSD over intersex. I even tell my doctors to never use DSD around me because I think it is a horrendous terminology that only causes additional problems. Zoe thank you for your follow-up comments I do feel they explain what you meant with this latest blog better. I actually hated reading the blog. Also becarefull as OII australia is much more accepting then other intersex groups when it comes to transexuality.

Anonymous said...

the HBSoC is older then the DSM-4 which added GIDNOS to its classifications. That is one of the big issues within the intersex community as well. it is also why most intersex reject the assumption that any of us are transexual. The HBSoC was never meant to be used on anyone with an intersex condition. We did not need to follow those guidelines. Zoe your comment about being fasttracked that is basically what intersex people were suppose to be treated like. That does not always happen however, there are doctors who will use the intersex condition to stop treatment for reassigning and also there are many of the Gender surgeons who will refuse treatment on some intersex people because of poor outcomes due to previous scar tissue and or lack of available tissue. <--which is something I may have to worry about.
Makes me wonder if the use of Bowel tissue would be available for myself as i do not have much to work with. additional issues with surgical scarring of allready reconstructed urinary track. Which transexuals do not have to worry about but as a reassigning intersex person is going to have to worry about.

oh and Zucker is an idiot he should never have been added to the DSM-5 board. Idiots like him only make people ashamed of themselves. Zucker should have his medical license revoked permanently. His teachings only cause pain and suffering.

Anonymous said...

that last comment was mine, ie its Kailana.

Zoe I am still curious to know your condition. You have made several references so far yet never made one that made any sense. Instead you compared your condition to others. like 5-ard, 17 B-HSD type 3. and lately Late Onset AIS, or was that PAIS, and that makes no sense at all. None of your information by the makes sense right now, but your older stuff from BLO, did to me. Again I was thinking perhaps late onset CAH, which does happen, and depending on what form of CAH, because some of your androgen hormone levels common to some forms of CAH, did make alot of sense, especially compared to my own. Which could be appropriate to some conditions. but those also are usually present by puberty or early adulthood, to be 45 and experience those things are really odd. I can not say that it can't happen, but I am really curious what your doctors are saying and telling you.

Anonymous said...

I know that too. When someone talks about other people's condition before their's. You gotta assume that they are transgender because No known intersex I know of will ever talk that way. Most intersex I know, will talk about their condition first before explain the others out their. That's why you have to assume someone's transgender when someone talks about other people's conditions before their's.

Zoe Brain said...

As regards my own condition - we don't know.
We're currently chasing up my genetic history.
It's none of the known conditions, it is "idiopathic".

What are my doctors telling me? That they don't know, and that the aim at this stage is to manage the symptoms.

Zoe Brain said...

Kailana - I go with what the science says, and then work to make sure that IS people are not disadvantaged by that.

I'm not doing it for political reasons, I'm going where my interpretation of the evidence takes me. When the facts change, I change my opinions, I don't try to pick and choose and cherry-pick evidence to fit pre-conceptions. I probably do a bit, being human, but I try very hard not to, and when I'm made aware of it, I backtrack.

For one thing, in the long run, Reality always wins. Suppression of inconvenient truths does not work.

My main concern with IS human rights is first, to stop TS people (or those IS people who don't accept their arbitrarily assigned gender, whatever you want to call them) from being surgically created by the mutilation of IS babies.

Secondly, to stop the creeping pathologisation and "mental illness" stigma put on IS people that seems to pervade much of WPATH these days.

Third, to increase the level of knowledge in the medical profession about IS conditions. It's currently worse than woeful, so even with the best will in the world, medics screw up. A lot.

Fourth, to ensure that those IS people who fit in the gender binary model have that fit accepted, and those who do not fit also have that accepted too. That means, inter alia, making sure that IS people have access to whatever surgery or hormone therapy they feel they require, and to do so with the best medical advice possible.

Right now, we have the worst of both worlds: children who cannot possibly give informed consent being subject to surgery to please others, and adults who can give informed consent often being denied treatment.

It's at least possible that the work on congenital Gender Identity will help, rather than hinder, these political aims. But even if it hinders, I'll still go with what the evidence says. And then try to ameliorate any consequent problems.

Anonymous said...

What I mean by verifiable and proven, is a medical term for genetic testing, blood testing and biological testing including testing of the Bone and doing CAT/MRI scans of the brain and even x-rays of the hand.

Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus
Transsexuals experience themselves as being of the opposite sex, despite having the biological characteristics of one sex. A crucial question resulting from a previous brain study in male-to-female transsexuals was whether the reported difference according to gender identity in the central part of the bed nucleus of the stria terminalis (BSTc) was based on a neuronal difference in the BSTc itself or just a reflection of a difference in vasoactive intestinal polypeptide innervation from the amygdala, which was used as a marker. Therefore, we determined in 42 subjects the number of somatostatin-expressing neurons in the BSTc in relation to sex, sexual orientation, gender identity, and past or present hormonal status. Regardless of sexual orientation, men had almost twice as many somatostatin neurons as women (P < 0.006). The number of neurons in the BSTc of male-to-female transsexuals was similar to that of the females (P = 0.83). In contrast, the neuron number of a female-to-male transsexual was found to be in the male range. Hormone treatment or sex hormone level variations in adulthood did not seem to have influenced BSTc neuron numbers. 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.

Regional gray matter variation in male-to-female transsexualism

Gender identity—one's sense of being a man or a woman—is a fundamental perception experienced by all individuals that extends beyond biological sex. Yet, what contributes to our sense of gender remains uncertain. Since individuals who identify as transsexual report strong feelings of being the opposite sex and a belief that their sexual characteristics do not reflect their true gender, they constitute an invaluable model to understand the biological underpinnings of gender identity. We analyzed MRI data of 24 male-to-female (MTF) transsexuals not yet treated with cross-sex hormones in order to determine whether gray matter volumes in MTF transsexuals more closely resemble people who share their biological sex (30 control men), or people who share their gender identity (30 control women). Results revealed that regional gray matter variation in MTF transsexuals is more similar to the pattern found in men than in women. However, MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity.

Anonymous said...

What I mean by verifiable and proven, is a medical term for genetic testing, blood testing and biological testing including testing of the Bone and doing CAT/MRI scans of the brain and even x-rays of the hand.

A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity
Transsexuality is an individual's unshakable conviction of belonging to the opposite sex, resulting in a request for sex-reassignment surgery. We have shown previously that the bed nucleus of the stria terminalis (BSTc) is female in size and neuron number in male-to-female transsexual people. In the present study we investigated the hypothalamic uncinate nucleus, which is composed of two subnuclei, namely interstitial nucleus of the anterior hypothalamus (INAH) 3 and 4. Post-mortem brain material was used from 42 subjects: 14 control males, 11 control females, 11 male-to-female transsexual people, 1 female-to-male transsexual subject and 5 non-transsexual subjects who were castrated because of prostate cancer. To identify and delineate the nuclei and determine their volume and shape we used three different stainings throughout the nuclei in every 15th section, i.e. thionin, neuropeptide Y and synaptophysin, using an image analysis system. The most pronounced differences were found in the INAH3 subnucleus. Its volume in thionin sections was 1.9 times larger in control males than in females (P < 0.013) and contained 2.3 times as many cells (P < 0.002). We showed for the first time that INAH3 volume and number of neurons of male-to-female transsexual people is similar to that of control females. The female-to-male transsexual subject had an INAH3 volume and number of neurons within the male control range, even though the treatment with testosterone had been stopped three years before death. The castrated men had an INAH3 volume and neuron number that was intermediate between males (volume and number of neurons P > 0.117) and females (volume P > 0.245 and number of neurons P > 0.341). There was no difference in INAH3 between pre-and post-menopausal women, either in the volume (P > 0.84) or in the number of neurons (P < 0.439), indicating that the feminization of the INAH3 of male-to-female transsexuals was not due to estrogen treatment. 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.

Androgen Receptor Repeat Length Polymorphism Associated with Male-to-Female Transsexualism
A significant association was identified between transsexualism and the AR allele, with transsexuals having longer AR repeat lengths than non-transsexual male control subjects (p = .04). No associations for transsexualism were evident in repeat lengths for CYP19 or ERĪ² genes. Individuals were then classified as short or long for each gene polymorphism on the basis of control median polymorphism lengths in order to further elucidate possible combined effects. No interaction associations between the three genes and transsexualism were identified.

Anonymous said...

What I mean by verifiable and proven, is a medical term for genetic testing, blood testing and biological testing including testing of the Bone and doing CAT/MRI scans of the brain and even x-rays of the hand.

Cognitive ability and cerebral lateralisation in transsexuals
It is still unclear to what extent cross-gender identity is due to pre- and perinatal organising effects of sex hormones on the brain. Empirical evidence for a relationship between prenatal hormonal influences and certain aspects of gender typical (cognitive) functioning comes from pre- and postpubertal clinical samples, such as women suffering from congenital adrenal hyperplasia and studies in normal children. In order to further investigate the hypothesis that cross-gender identity is influenced by prenatal exposure to (atypical) sex steroid levels we conducted a study with early onset, adult, male-to-female and female-to-male transsexuals, who were not yet hormonally treated, and nontranssexual adult female and male controls. The aim of the study was to find out whether early onset transsexuals performed in congruence with their biological sex or their gender identity. The results on different tests show that gender differences were pronounced, and that the two transsexual groups occupied a position in between these two groups, thus showing a pattern of performance away from their biological sex. The findings provide evidence that organisational hormonal influences may have an effect on the development of cross-gender identity.

Specific Cerebral Activation due to Visual Erotic Stimuli in Male-to-Female Transsexuals Compared with Male and Female Controls: An fMRI Study
Introduction. Transsexuals harbor the strong feeling of having been born to the wrong sex. There is a continuing controversial discussion of whether or not transsexualism has a biological representation. Differences between males and females in terms of functional imaging during erotic stimuli have been previously described, revealing gender-specific results.

Aim. Therefore, we postulated that male-to-female (MTF) transsexuals may show specific cerebral activation differing from their biological gender.

Main Outcome Measure. Cerebral activation patterns during viewing of erotic film excerpts in functional magnetic resonance imaging (fMRI).

Methods. Twelve male and 12 female heterosexual volunteers and 12 MTF transsexuals before any treatment viewed erotic film excerpts during fMRI. Additionally, subjective rating of sexual arousal was assessed. Statistics were performed using the Statistical Parametric Mapping software.

Results. Significantly enhanced activation for men compared with women was revealed in brain areas involved in erotic processing, i.e., the thalamus, the amygdala, and the orbitofrontal and insular cortex, whereas no specific activation for women was found. When comparing MTF transsexuals with male volunteers, activation patterns similar to female volunteers being compared with male volunteers were revealed. Sexual arousal was assessed using standard rating scales and did not differ significantly for the three groups.

Conclusions. We revealed a cerebral activation pattern in MTF transsexuals compared with male controls similar to female controls compared with male controls during viewing of erotic stimuli, indicating a tendency of female-like cerebral processing in transsexualism

Ghoti said...

Milton Diamond prefers that DSD be read as Difference in Sexual Development or changed to Variation in Sexual Development.

Zoe Brain said...

Fish - hopefully I'll be seeing Prof Diamond in about 3 weeks, when I go to Hawaii.

Anonymous said...

Kailana again:this is the MRI study of pre-HRT and post HRT patients and brain mass structure changes that were changed due to HRT. Prior to the introduction of HRT MtF had brain mass structure identical to other men, FtM had identical brain mass structure of women. With HRT all subjects brains mass and structure changed to resemble the target sex.

if you going to include information about studies you need to post all of it. the 2006 MRI studies are accurate and there are no assumptions made as there were in the BST studies of Post-mortem ie dead cadavers. The error introduced in that study was infact that all but 1 patient was post HRT, all were dead, and the 1 that was pre-hrt was an elderly identified MtF, which also hung herself, body was found 3 days later, and was assumed to be a good case study as she also had a similar BSTc region identical to females rather then males. The Error is in the use of her as a control. You would need to study many MtF, who hung themselves were found 3 days later just to prove if they all had similar BSTc regions, and then do the same for a whole bunch of men who hung themselves, were also found 3 days later and there BSTc regions were still normal male. <--that is how that study should of been done, without the additional studies, an assumption was made that all MtF pre-hrt will have that same female sized BSTc region. That is what I mean about the study being flawed. They also need to do more MtF, and FtM of varying age groups just to see what their BSTc region looks like before HRT. That is how scientific testing is usually done. They did not do that, and to date as far as I know they still havent done so. The MRI study is the most recent study that does share alot more of what is going on as a direct result of HRT. I cannot accept TS as Intersex, at this time because I do understand a great deal about what it means to be intersex. I do accept TS as the gender they identify as, I have no issues with seeing them as Men or women. As I do believe all of us are still people and we all do deserve respect.

Zoe I loved your last comments the problem is, your assumption that you are helping by identifying TS as intersex people. That only causes confusion of what it means to be intersex, and belittles the intersex community. your use of combining TS as intersex only makes life harder for people who are intersex.
Oh and Idiopathic lol my definition is a bad result of the idiocy of something doctors have done to screw up a patients life and they are ashamed to admit that they made a mistake and are afraid of actually acknowledging what they did to screw a person up. ie they use Idiopathic as a default for oops.

Anonymous said...

Kailana again with a followup.

your condition Zoe, as idiopathic is not very helpfull to you or me. I understand why you might have an idiopathic dx. Problem is how can you assume it is similar to 5-ard or 17b-hsd3, or late-onset AIS? I actually want to laugh at the last by the way, PAIS perhaps is appropriate and honestly those can be tested for, same with 5-ard and 17B-hsd3.

I would love to hear once you and they do figure out what is going on.
Now then I so wish you had chosen to talk to me on skype, I really am not so bad to talk too. think i prefer skype over writing comments to much hassle on hear. lol like why can't i just use my email handle or something, and have this sight remember it instead of trying to remember my google id which i cant even remember these days as i haven't used it in ages.

Grandma Nah Zee said...

ie they use Idiopathic as a default for oops

induced by a physician's words or therapy (used especially of a complication resulting from treatment) -

(of diseases) arising from an unknown cause; "idiopathic epilepsy"

Zoe Brain said...

Try contacting me on skype - zoe.ellen.brain
The addy you gave me didn't work.

PAIS was the original diagnosis in 1985. But that isn't consistent with the somatic oddities in 2005, nor the endocrinal anomalies since.

As far as I know, there still is no reliable test for PAIS, diagnosis is based on secondary effects on skeleton etc. Even CAIS tests are only 70% reliable.

Anonymous said...

Kailana again, thank you Grandma Nah Zee, for the clinical definition. That was not what i meant. I have had a idiopathic WBC disease for awhile now, had thought i might have leukemia. I just think that the use of Idiopathetic in my case was a result of different doctors not knowing what had allready been done and how I have had fairly consistent infections ever since 2002, with a steadily worsening WB count. Only thing missing was the circulating blasts for leaukemia. SO they say Idiopathic WBC disease. made me laugh actually and then more depression. And i so hate the depression but for me at least i understand why it is being used. ie a cover up for really screwing me up with previous surgery that none will now acknowledge being done.

I understand the usage and meaning of idiopathic. Just thought the oops would be funny.

Zoe I have had you on my skype contact for over a week i sent a few messages and will send again just incase you missed them.

Anonymous said...

and its Kailana once more, not sure about getting that link to work, i am not so computer techie, i had just copied it and pasted. didn't set up correctly.

Zoe i understand all the studies done so far, but i also see the flaws in them. I do think all are important. But question them as well. The BSTc region used too many assumptions that were not tested for or ruled in or out. the use of 1 pre-hrt elderly MtF as a control only makes the assumptions they made about her being a good control subject debatable. The method of death and time before found can alter any findings. ie blood pooling towards the feet from extended hanging. The question for me, is how would that alone affect the size of the BSTc region and would similar results be shown in other Men of similar age and weight, health. would it also show in women, similar method of death, ie show even smaller structural size by death by hanging and extended period before being found.
Sorry these are questions I ask as a curious layman scientist.

The MRI study does show brain structural changes to all aspects of the brain in Pre-HRT MtF and FtM, due to the use of HRT ie brain structure does change toward the target sex, when HRT is added, but before HRT is introduced the brain mass and structure is identical in MtF as other men, and FtM are identical to other women.

That is the newest study I have read on the structural changes of brains. I am still waiting for additional studies and confirmation of the first BSTc region to see if it is repeatable and hopefully larger test subjects used.

I think it is important for everyone to understand what is going on. now I am only a semi intelligent human, lol Many of the so called higly intelligent scientists and doctors question those studies because they can see the same things i can, the studies are flawed and way too many assumptions are being made that have not been proven.

I honestly think people think the way they do just because they are who they are.

mind you I am not fond of the word Trans, Transsexual or Transgender. Regardless of whether a person reassigns, and I would expect most TS people to actually feel the same way. It is why I can accept a MtF as female, and a FtM as male, I ignore the whole Trans concept.

As an intersexed person, I hate even more the assumption that anyone with an intersex condition is trans. That is the one area where me and Nicky actually agree, i do not however have his hate for you or anyone else, but you have a tendency Zoe too make some crappy comments about Intersex being TS. That does upset me.
Just as the use of some conditons like 5-ARD and 17B-HSD3, where you claim they are all men. They are not, some are men, and some are women, but here in the US, Doctors have routinely stated that all are men. In the real world it isn't so. there are plenty of 5-ARD and 17B-HSD women who are happy as women even though they are genetically XY.
See that is where i hate some of your comments on some of your other Blogs. I hope you can understand why some of my comments are so im sorry bashing you. I actually don't want to or have people assume i am bashing you. I am actually very curious about you.

Anonymous said...

That's why for me, my only reason why I don't like trans is the assumptions that trans people make, thinking that they are intersex and claiming that an incomplete and inaccurate study makes them intersex. When in reality it doesn't and no intersex group will accept that idea.

It also pisses me off that when people like you Zoe make some crappy comments about intersex being TS. That not only upsets me, but it also offends me and it's also very offensive to the entire intersex community as well. It dose no good when you make crappy comments about intersex being TS and it makes intersex people like myself and Kailana pissed off when people like you associate intersex with TS.

Gramdma Nah Zee said...

The MRI study does show brain structural changes to all aspects of the brain in Pre-HRT MtF and FtM, (my bold)

Not so fast, this study only considers total brain volume, hypothalamus volumne and the volumes of the third and lateral ventricles.

They did not specifically measure the volumes or neuron densities of any specific brain units (BSTc, INAH3 etc.) and thus does not contradict any of the other studies.

Also, I do not read Zoe as claiming that all IS are TS. Some IS folks transition, not all. OTOH, if TS is caused by variation in (parts of) the brain then there is no viable distinction between it and any other sexual variation - thus it is accurately described as a specific example of an IS condition.

Anonymous said...

Gramdma Nah Zee,
That's where your totally wrong right their. The study that kailana put up contradicted the intersex brain theory study because they put an elderly man who was MTF who hung himself and was found 3 days after. That in itself invalidated the intersex brain theory and study because to include that one elderly MTF who hing himself and was found 3 days later. He was not viable enough to study.

Grandma Nah Zee said...

That's where your totally wrong right their. The study that kailana put up contradicted the intersex brain theory study
Which "intersex brain theory" study? There are lots of them.

because they put an elderly man who was MTF who hung himself and was found 3 days after.
Oh, that one.

That in itself invalidated the intersex brain theory and study because to include that one elderly MTF who hing himself and was found 3 days later. He was not viable enough to study.
Firstly, please show some respect, and refer to "the MtF" as she. Assuming that both you and Kailana are both referring to "T1" in that study, I'm not sure how you are under the impression that she was used as a control.

At any rate, it may weaken the conclusion of that individual study, but it does not "totally invalidate" (or even slightly invalidate) the study, let alone the theory.
That study was repeated (including some new subjects and controls) and published in 2000, affirming the previous results and further indicating that HIV status, changes in sex hormone levels occuring in adulthood, sexual orientation, age when seeking treatment for TS did not change the neuron count in the BSTc.
Furthermore none of: age, brain weight, postmortem time, fixation time or storage time affected the results.

To totally invalidate the study, you would have to undertake it with better/more controls and get different results. This has NOT been done and the growing number of studies that confirm the Gooren and Swaab 1995 study indicate that this is unlikely to occur.

Anonymous said...

Kailana Sidrandi Alaniz once more.

ok, I really think some of you missed my point, being at least with this one, reading once more and reflecting, again, similar mistake, using an elderly MtF.

Where are the elderly normal sorry i said that men to validate the similarity or difference of elderly men to a elderly MtF non-treated?

Where are the younger non-treated HRT MtF, and FtM to validate that BSTc region is infact the same as women and men.

Now Zoe is a Rocket Scientist and should have enough education to understand a proper Scientific analysis on any science related testing of a hypothesis.

Now please do not get me wrong in assuming that i am perfect, what I see is a flawed study, a flawed testing of a hypothesis. There are not enough control subjects again.

I am also curious of how long each person was dead before being found? ie put into cold storage.

Again i do think this field of study is important to the world. Now I am not questioning whether or not a MtF has a female BSTc region, i am questioning the testing standards and so far I have not found the evidence credible. That is why I said the first ie the only one i thought had been done, as the only mention of other studies i recall were done on rats. ie that validated the size of the BSTc region in males and females rats, which looked promising for the 1995 study.

now this one also included a few conditions which is good, but then there were not enough and the use of some of them actualy contradicts the first in there assumptions of fetal exposure to male androgens, ie all the sex hormone disorder people studied showed no change in size of the BSTc region, unless i read that wrong. This was a assumption made in the first study. So apparently the information in this study shows that prolonged exposure to androgens of a mixed sort as some were male and some female affected by conditons, and they had no change or no relavent change which is what they said was expected in the first study iek i am unsure at this moment whether some were on HRT or not, cause that would also influence the outcome of the study, apparently some stopped treatment a few months prior to death, so they were on some form of hormone regimine, unless i read that wrong, and if that is true, then using them to validate the similarity of a Syndrome affected male on hrt to a male being identical then it would fit for a FtM being similar as well, or MtF on hrt being simliar to a turners woman on hrt as being female. I am only wondering now and rereading several times, think the one Syndrome affected person was the one with the adrenal tumour while producing more male androgens was still female<---i may have to read that again, and it may be that it was only affected her for a little over a year, i would need more information, and also need to know what kind of medications she was on, and or treatment for the Tumor, I would not believe her to be an untreated person where doctors knew a tumor was present and chose no treatment for it, might happen but would be odd i think.

Anonymous said...

Kailana Sidrandi Alaniz

ok, does that make any sense, and i am sure i will need to reread this a few times more just to make sure i have as much information correctly stated.

I will say that i did make a mistake i was or had thought the 2000 study was a reprinting of the first, that is my error. Still please remember I am notintentionally bashing anyone who is trans, except Zoe when she annoys me, Bur seriously, I actually like Zoe and am very curious about her, and is why i do remember her from several support groups, again, as a laymen who has just done way too much research on IS conditions i will remind Zoe again, advise your doctors again to concentrate on the 17 variations within cah, ie 17a, 17b, your labwork that i remmember did mimic alot of my own, and while I do not have an exact variation known to me, i do know enough about CAH to guess on my own, that it is going to be one of them. oh and if your wondering that i know of there are 15 or more variations just to 17B. and its still CAH regardless of the variation, they are rare but do exist. Now that I say only if what I recall of Zoe's blood work she shared years ago is infact correctly presented. It does match closely to my own, concerning CAH, or as i was told Adrenal Genital Syndrome in 1993, and knowing that a karyotype followed just to find out if I was XX rather then XY. as im neither i do care about all things genetically, biologically, hormonally that can be classified as intersex, and i am actually pleased to at least see them in this study use Hermaphroditic, as that is my preferred term for intersex people.

Grandma Nah Zee said...

Where are the elderly normal sorry i said that men to validate the similarity or difference of elderly men to a elderly MtF non-treated?
From the 1995 Nature study: "Brains of 42 subjects matched for age, postmortem time and duration of formalin fixation were investigated.

Now please do not get me wrong in assuming that i am perfect, what I see is a flawed study, a flawed testing of a hypothesis. There are not enough control subjects again.
25 controls, 12 trans patients, 5 cancer patients...

I am also curious of how long each person was dead before being found? ie put into cold storage.
This data is listed in Tables 1,2 and 3 of Swaab's 2000 study (A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity)

now this one also included a few conditions which is good, but then there were not enough and the use of some of them actualy contradicts the first in there assumptions of fetal exposure to male androgens, ie all the sex hormone disorder people studied showed no change in size of the BSTc region, unless i read that wrong.
Remember that the hypothesis is that it is foetal exposure to sex hormones that creates the brain structure(s) responsible for gender identity and that adult exposure to sex hormones cannot change this.
The patients that had abnormal adult sex hormone levels due to cancer, but had normal gender identities and were shown to have sex-typical BSTc regions, actually SUPPORT the hypothesis.
Put another way; a biological male who had high circulating oestrogen levels due to prostate cancer, still identified as male and had a male size BSTc layer. Whereas a biological male, who had high levels of circulating oestrogen due to MtF hormone therapy, identified as female and had a female-size BSTc layer.
Both biological males, both high levels of circulating oestrogen (and low testosterone). The male-dentified person had a male BSTc, the female-identified person had a female BSTc. It can't be the adult hormone levels that were responsible (because if so, both patients would have had the same BSTc characteristics).

Anonymous said...

Kailana again, you need to read the ages of all the patients, and as far as i can tell, no other elderly men were studied. Just the one 84 year old. While they state ages were matched it is very apparent that they weren't.

I can also say the same regarding the conditions. especially the turners woman, who was the lowest within the female category across the board, which i actually expected to see. But then i do know a great deal about Turners.

again, I like the study, but my scientific mind tells me it is incomplete and again too many assumptions are being made without enough data to draw an accurate presentation.

In all actuality, I had thought this was the first study, and the referenced previous study was done just using rats. I could be wrong, but then I am not perfect either.

See my biggest issue is the numbers, if this was reported in 2000? and I know this study has been questioned by many within the medical field, then why has not a follow-up been done, that would validate the issues over lack of more people, age and condition related. with many more normal men and women as controls. not a few, because with so few controls there is no way of knowing if what is reported are only random variation in all men and women.

Basically screw the rats, and study humans. Reporting many subjects and all variations of the many studied for a better control.

See, I actually believe the BSTc means little, as again those brainy researchers are assuming it may be responsible for female or male like root beliefs? When it could be there for an entirely different reason, lol like balance, or smell lol. oh wait, perhaps it is the root core structure responsible for picking ones nose. Or maybe a preference for liking wet sloppy kisses, ie being huggable, and the referse being distant and a loner lol.

Sorry I can't help it right now, i just see a terribly limited flawed study, and see the people being reported as the ones who fit within the hypothesis ie they threw out the other people results because they didn't fit what they were trying to prove.

annoying aint I.