A Dialogue with Ron Gold - Part II

Following on from a previous post:

Ronald Gold wrote:

Sorry, but I think I need more clarification of all this.

No problems! Glad to get a dialogue going.

Are you saying that the neuroanatomy -- by which I think you are saying possession of what you're calling a male or female brain -- is entirely the cause of the transsexual phenomenon -- and that my guess about a societally induced cause is all wet?

Um... yes. There's two different ideas here. The first is whether the cause is neurobiological. The second is the societal cause hypothesis. That one's easier to test first.

If it were true that "it's a fair cop, but society is to blame", then trans women would universally be Doris Day stereotypes. Now while some are, many are not. About the same range of behaviours as for non-trans (cis-) women. In fact, rather more are into traditionally "masculine" pursuits, such as engineering, and especially Information Technology. You certainly wouldn't expect the observed fact that 60% of them would be involved in the military. By the "social pressure" hypothesis, that should be the last thing you'd expect, the shattering of conventional gender roles, when gender role is supposed to be why they feel the way they do.

You also wouldn't expect such phenomena as cis-women with CAH syndrome (a form of intersex that masculinises 46xx women in the womb and afterwards) to universally show "typically male" behaviour patterns when young, playing with trucks rather than dolls. By rights, they should be like other girls. The same with intersexed men with 5ARD syndrome. This feminises the body in the womb, but masculinises it at puberty. How to explain that 1/2 to 2/3 change gender roles to male despite a normal feminine upbringing - or the 1/3 to1/2 that do not, despite their body masculinising? Something other than societal pressure must be at work.

Finally, there's no way of accounting for the narratives of many trans women who consistently state that they've known they were female since very early childhood, before such societal pressures could be manifest - unless to condemn them all as deluded or fooling themselves.

Does everybody who wants or is judged qualified for sex-change surgery have neuroanatomy opposite from their physical anatomy, or only some, or only partially, as I think you said?

We don't know. We've never found a single example of someone tracked for surgery that wasn't cross-sexed neurologically, nor a single example of anyone cross-sexed neurologically that wasn't tracked for surgery. But that's due to selection bias. It's easier for the purposes of getting clear experimental results to divide the population into cis-sexual (but possibly gay) on one hand, surgery-tracked unambiguous (possibly gay) trans-sexual on the other, discarding as "too ambiguous" the great majority of trans-gendered people who have no wish for surgical change, and those who desire hormone treatment but nothing else. They have not been studied.

We have shown that treatment comparable to surgery and hormones - orchidectomy and HRT treatment for testicular prostate cancer - has no effect on the area of the brain in question in cis-sexual men. And that trans-sexual women have the cross-sexed neuroanatomy even before starting treatment. The data we have on trans men is more sparse and less certain, but appears to show the same thing.

Aren't there people who've never thought themselves to be in the wrong body who also have these differences between body and brain?

Not that we've ever found, no. Until we have sample sizes in the tens of thousands, rather than the hundreds, we can't be completely certain. But we're more certain than for many other medical conditions that are accepted as proven.

If so, what makes them content to leave their bodies alone?

As for the brain-body map, that's an area that needs more study. Most of our knowledge comes from looking at people with BDD(Body dysmorphic disorder); amputees; and those born with supernumary arms, legs, hands etc . The first are a group of people who do not have the usual map, and request amputation of perfectly healthy limbs that they feel "don't belong". The second group are people who are missing limbs, and some (not all) of whom feel terrible distress that "something is missing", quite apart from the inconvenience of a "difference of a pinion". The third group is a mixed bunch - a minority are fine with their unusual situation (even if the supernumery body parts are dysfunctional), the great majority wish to be rid of things that "don't feel right", but a substantial proportion "just want to look normal" so request amputation even if it's not necessary, for purely sociological reasons. The BDD group is particularly problematic, as there are at least two different etiologies here: one involving sexual fetishisation, the other apparently a neurological anomaly, with quite different symptoms. The number of people who have acquired BDD due to strokes or other neurological damage is too small for us to use as a tool for examining which part of the brain is involved - damage in the area we think this resides in will almost always be fatal, it's too close to the areas that regulate breathing, heartbeat etc. Which makes sense, if you think about it.

You seem to say that hormones don't make much difference outside the womb, but then go on to say, I think, that female neuroanatomy makes those with male physical anatomy intolerant of male hormones (I recall one blogger saying what a relief it was to not have testosterone in the system, or words to that effect). You talk about hormone therapy, presumably to correct this intolerance. So why doesn't this suffice in lieu of surgery?

For many people it does, and the therapists dealing with this issue always try to have the minimum intervention possible. Rather than pressuring people to have surgery, it's quite the reverse. Only the most determined can get through all the hoops, and overcome all the barriers placed in their way. Many suicide instead. Better that a hundred should die because they didn't get treatment, than one get treatment who shouldn't have - because suicides don't sue.

At least, that's the case everywhere in the world except Iran. There, they surgically create transsexuals by mutilating gay men and lesbian women, and transgendered people who do not desire surgery, in order to make them conform to their idea of societal norms. If they don't agree to this, they kill them.

I suspect your answer would have something to do with the fact that you refer to some people as "transsexual women rather than men" a phrase, I must tell you, that sticks in my craw, because I think of it as something constructed out of whole cloth, not out the biology you've discussed, even including the "internal body map" you've yet to persuade me actually exists.

The concept of the "body map" is not controversial - you can see the effects using MRI imaging, and even modify the body map to some degree in some cases:
See for example "Neuroplasticity in amputees: Main implications on bidirectional interfacing of cybernetic hand prostheses " by DiPino et al, Progress in Neurobiology Volume 88, Issue 2, June 2009, Pages 114-126 Conversely, "Phantom Limb syndrome" is well-documented, when the body map insists that a limb is still there even after amputation.

See also this:

Experts at the University of California in San Diego, USA, found that 60 per cent of interviewed heterosexual men who had their genitals surgically removed following cancer claimed to continue to experience the sensation of having a penis.

Intriguingly, the same study showed that only 30 per cent of originally male transsexuals, whose genitals had been removed as part of gender reassignment, reported the same phenomenon.

"We explain the absence or presence of phantoms in these subjects by postulating a hardwired gender-specific body image in the brain that does not match the external [birth] gender" said lead author and phantom limb expert Vilayanur Ramachandran. He argues that before birth the brain may develop an image of the body that may not necessarily match the physiological outcome.

http://www.cosmosmagazine.com/node/1648

Which is the "pop sci" version of this rather dry material:
Occurrence of phantom genitalia after gender reassignment surgery V.S. Ramachandran, Paul D. McGeoch - Medical Hypotheses (2007) 69, 1001–1003

Ok, now leaving the "body map" issue aside - let's look at the question of male and female. Do these words have any meaning at all? Are they nothing but a sociological construct? Are they meaningful only in a statistical sense when it comes to biology, and nothing else? I'll attempt to answer that further on.

Because I know that there are real differences in human personalities independent of gender, and view these differences as significantly more important than the stuff like sense of smell that can (and not always, I gather) be attributed to male and female brains, I'm quite content to define a man or woman by their external (and internal, by the way) anatomies, and start hollering, when somebody -- whether a macho straight person or a *transexual" -- tells me they're a REAL man or woman.

There's a real problem with that though. Defining "male" and "female" using any other metric than neuroanatomy. I'm content to define "man" and "woman" entirely on the basis of that, while recognising that in some cases, even that's ambiguous, and under those circumstances one should just ask the person concerned. I'm also content to allow that under those circumstances, it may be useful to consider other factors, such as genitalia, chromosomes, endocrine system, the "externals".

The problem is not some transsexual man hollering that they are a "REAL man". It's that great majority of cis-sexual people, gay and straight, who insist, volubly, and sometimes in legislation, that they are NOT.

A quick digression:
I get the distinct impression - please correct me if I'm wrong - that you have absolutely no conception of just how bizarre and inhuman the treatment of trans people is in the USA and elsewhere. It's what we call "cis-privilege", like "white privilege" or even "western privilege". You consider it abnormal, even unthinkable, that you could routinely be denied the ability to re-enter the country should you leave it. I don't. It took me a 20-month legal battle to "earn" that right. You consider it similarly abnormal if you're automatically under sentence of death should your plane land in the wrong country due to a technical malfunction. I don't. While 5 gays were killed just for being gay last year (according to FBI figures), newspaper reports showed at least 19 trans people were killed just for being trans. The FBI wasn't even allowed to keep statistics about trans people's deaths until a month ago. Think about that.

You are denied the right to marry in your state, right? - But in Australia, where I live, I can only marry a man (as same sex marriage is even more anathema here than in the US), but only marry another woman in the UK, where I was born (as same sex marriage is anathema there too), and there I'm considered legally male as I'm Intersexed rather than Transsexual. As for the situation in the US....

“Taking this situation to its logical conclusion, Mrs. Littleton, while in San Antonio, Texas, is a male and has a void marriage; as she travels to Houston, Texas, and enters federal property, she is female and a widow; upon traveling to Kentucky she is female and a widow; but, upon entering Ohio, she is once again male and prohibited from marriage; entering Connecticut, she is again female and may marry; if her travel takes her north to Vermont, she is male and may marry a female; if instead she travels south to New Jersey, she may marry a male.”

Now let's look at some comments in various publications - first, the mainstream New York Times, then the Gay site Queerty:
>
> Comments from:
> New York Times
>
> I know it’s not Politically Correct to say this, but I really
> don’t buy the whole “transgender” concept.
>
> Sex is a biological thing - either your male, or you’re female
> (with the exception of a tiny handful of folks who are born as
> intersex or hermaphrodite people).
>
> Gender and gender roles are social, they vary depending on the
> society you live in, or what community or class you occupy within
> a society.
>
> As for this idea that there are “men trapped in women’s bodies” or
> “women trapped in men’s bodies” - the Nazis invented that idea!
>
> It was the Nazis explanation for homosexuality, and the infamous
> Dr Josef Mengele, an aggressive proponent of the “transgender”
> idea, performed the world’s first (non consensual) sex
> reassignment surgery on gay men who were prisoners at the SS
> Medical Research Station at Auschwitz Concentration Camp.
>
> The modern “transgender” concept is just latter day Nazi
> pseudoscience, and it’s long past time we renounce this awful concept.
>
> Men who think they are women and women who think they are men are
> deeply delusional gays and lesbians (who’s delusion has deep roots
> in our society’s homophobia) who need psychotherapy so they can be
> rehabilitated and lead healthy lives as gay men and lesbian women.
>
> — Gregory A. Butler
>
> Queerty
>
> Terriwill:
>
> No. 6 · Kian: You are 100% incorrect, I don't dislike trans
> people. I simply do not like when persons who very clearly state
> that they are straight attempt to wedge themselves under the GLB
> umbrella. Chaz is the most famous trans person in recent memory.
> What statement did he make in one of the first interviews?? "we
> are just like any other straight couple" But in this post like
> previous you and the band of trans are gonna be all over any kind
> of post which says anything which you do not like to see. Trans
> people bring a lot of baggage with them, you expect to be welcomed
> into the GLB struggle yet many of you claim to be straight. Its
> the people who do not identify themselves as Gay that need to go away
>
> Terriwill
>
> No. 8 · spalatos: I have two major trans issues:
>
> 1- When a trans person misrepresents themselves and LIES about
> their true sex to lure someone into a sexual situation and then is
> upset if that person freaks out. This behaviour is 100%
> unacceptable. If you are not 100% comfortable in the skin you are
> going to be wearing after surgery you are not ready for said surgery.
>
> 2- When a trans person identifies themselves as "straight" I am
> sorry we catch too much shit from the haters out there who claim
> that being Gay is a choice. One of their most succesful arguments
> in denying us equal protections is that being Gay as opposed to
> being say a woman or black is a choice and therefor unlike being a
> woman or black who were born that way there is justification in
> denying us equal protections under the law. Straight Parents who
> support us are a tremendous asset to the community. However there
> is a huge difference between an ally of the Gays and someone
> claiming membership in the Gay community while stating they are in
> fact straight.
>
> I do not hate trans persons. I hate numbers 1&2 above. I find
> nothing incorrect about those positions. However the trans people
> who post here will never accept any type of criticism. Instead
> they adopt behaviours and start flingiing insults that would warm
> the cold hearts of any rightwing nut bag lunatic……….
>
> naghanenu:
>
> My favorite poster today….TERRIWILL!!!!!!!!!!!!
>
> You rock! You rock! Ive lolling all morning(wipes tears from eyes)
>
> I am uncomfortable with transfolk..period. I am sorry. I promised
> myself id try but God almighty, they freak me out.
>
> The idea that by mutilating your body and take chemicals that
> distort your body is just insane to me. There i said it…im sorry
>
> naghanenu
>
> Yes, i meant it. Im sorry but that is the truth.
>
> Transgenderism is said to be a disorder right? Ok cool. I RESPECT
> THAT. I RESPECT THEM TOO. It takes courage to live your life as u
> should without fear of condemnation and prejudice. Doesnt mean i
> cant get freaked out. I mean i see a woman everyday and i think
> wow she's tall. Just found out she was a tranny. I WAS FREAKED.
> Her face was really better than some id seen and she looked like a
> real woman. All curvy and hot. Needless to say, good hormone
> therapy for her. But i cant date her. why? she has a penis. She
> does not have a vagina..at least i don think so. I still see her
> has a man. Its so weird and wrong somehow.
>
> That said….trannies make me uncomfortable
>
My comment on the subject:
>
> Let's see... a trans man is simultaneously:
>
> A propagator of Nazi Pseudo-Science
> A straight man who doesn't belong with GLBs
> Not a "real" man, but a deceiving liar
> A lesbian who's deluded and mutilated
>
> But they don't dislike him. Good job - think what they'd say if they did!
>
> Seriously, it's the "they freak me out" aspect that comes first. People don't like to think that they're prejudiced, irrational and bigoted, so they must either
> a) confront their irrational dislikes, accept them as irrational even if they can't overcome them, and move on or;
> b) find or manufacture some justification, religious or otherwise, so they can feel good and even righteous about being uncomfortable around "these people".
>
> Hence the sometimes bizarre and contradictory "justifications" put forward for racism and homophobia. Oh yes, transphobia too.
>
Yes, that is a challenge for you. Please do some introspection. OK, end of digression.

Why do I say that there's a problem using any other metric other than neurology for determining sex? I'll confine myself to some common metrics.

First, Gender Role - "REAL Men don't eat quiche". Except they do, and it's not just Rosie the Riveter who works in factories now. I think we have common ground here that the social conventions of the past were the purest hokum, and are becoming increasingly irrelevant as any form of metric. No-one, except for possibly a few of the most antedeluvian (not even anteBellum) Dominionists thinks otherwise these days. Heck, at the ANU library there's a woman who is the purest "Diesel Dyke", tatoos and leather jacket, the works. Almost a caricature, which she admits. But it's her, the way she is. Oh yes, she's Trans too.

Second, Chromosomes. XX is for girls, XY for boys. Let's leave aside the XXYs and such like.

A 46,XY mother who developed as a normal woman underwent spontaneous puberty, reached menarche, menstruated regularly, experienced two unassisted pregnancies, and gave birth to a 46,XY daughter with complete gonadal dysgenesis.

- J Clin Endocrinol Metab. 2008 Jan;93(1):182-9.

So much for that idea.

OK, what about the third.... Genitalia!
Let's leave aside the incidents of men losing theirs due to war, or accident, or treatment for cancer. And women who have had radical hysterectomies too.

The problem there is the Intersex conditions where the genitalia changes. Dichogamy. This is usually the result of either 5alpha-reductase-2 deficiency or 17beta-hydroxysteroid dehydrogenase-3 deficiency, but can be due to a number of other causes. Do these people actually "change sex"? They don't think so.

I'm on less solid ground here, as my objectivity is questionable. I'm one of them. So while my personal narrative is that I "knew" I was female long before my teens, no matter what I looked like, and can even prove that I'd picked the name "Zoe" some time between March and August 1968... I'm too close to the situation, and could be falling into the trap of Universalising my own experience.

Much as do so many Bisexuals, who say that sexual orientation is a "moral choice", that they "choose to be gay" or (far more often) "choose to be straight", and so think everyone else does too. Ignoring the fact that some people are born straight, others born gay, unlike them.

And you seem to agree with me that surgical procedures can't and don't make people into "real" women or men; indeed, the trend these days seems to be for even post-op transsexuals to refer to themselves, to paraphrase you, as "transsexual women rather than women." What's the point, especially when it involves (yes, I still think so) mutilation of the body?

One could just as well argue that Black Americans aren't "real" Americans, because the trend these days is for them to refer to themselves as "African Americans" rather than just plain "Americans".

The point is not to turn anybody into a "REAL" man or "REAL" woman - though I can't deny the extraordinary requirements for legal recognition in some jurisdictions, where even changing one's name (let alone gender marker on a drivers license) requires documentary proof of surgery. The point is to use hormones to remedy the neurological dysfunction, and surgery to remedy the body-map problem. The rest is social behaviour, and there are many transgendered (as opposed to transsexual) people who do just that.

Looking forward to your reply. It has taken me some time to answer your latest email not only because I needed to mull it over, but beacuase my mate's two sisters and their three young children have been visiting us for the past three days. Something like living in a zoo.

Oh, you mean Real Life gets in the way for you too? "Unimportant" stuff in the Grand Scheme Of Things, like family, and friends, and love, and children. The things that make Life worth living... yes, I know. I forgive you.

All the best,
Zoe

Posts in this series:
Part VII
Part VI
Part V
Part IV
Part III
Part I