A Dialogue with Ron Gold - Part III

Ronald Gold wrote:

Once again I thank you for your willingness to share your vast store of information with me. You have just about persuaded me that there is such a thing as neuroanatomy and that it's the cause of transsexuality, but I think we're still far about what, if anything, should be done about it. I'll need to look over your email more thoroghly and think about it.

By all means! Exactly what I hoped for, that you'd spare your limited and valuable time to really examine the issue, and ask further questions... not take anything I say at face value, but either ask me to justify my statements, or (better) do some independent research to make sure that my subjectivity is limited. A conclusion you arrive at independently based on independently-found evidence is always more convincing than one that's spoon-fed to you.

As regards the therapy, a bit of history from my own viewpoint.

In the dim, distant past, little distinction was made between homosexuality and transsexuality. It was thought that gay men were really wannabe-women, and that transsexual women were really gay men who were taking things to the logical extreme. Various crypto-religious psychiatric theories were proposed about some form of "feminine essence" or "female soul" that all gays had to some degree, and transsexual women had to an extreme amount. Some of the very first surgeries were performed on this basis - and in 1940's Germany, in the extermination camps, not on willing volunteers.

Later on, the persistant demands by transsexual women and men, and the catastrophically high suicide rate, pursuaded some medics to try all sorts of therapies. Amongst them - lobotomy, leucotomy, "aversion therapy" involving administration of nauseating drugs and electric shocks to genitalia and eyeballs, all sorts of "gestalt" therapy, "neuro-linguistic programming", "cognitive therapy", psychoanalysis, electro-convulsive therapy with dosages far higher than would be permitted today, and often without anaesthetic, psychotropic drugs, masculinising hormones...quite literally every tool in the arsenal of psychiatry was tried. Even "spirit release therapy" and exorcism, using bell, book and candle.

See "Gender identity change in a transsexual: an exorcism" by Barlow et al, .Arch Sex Behav. 1977 Sep;6(5):387-95 for example. They got pretty desperate.

Long-term follow-ups showed temporary remission of symptoms in many cases, especially those involving the more extreme forms of aversion therapy that left 2nd degree burns, but no improvement over the long-term. Not without some unfortunate side-effects, such as the patient's IQ being lowered to the level of a cabbage due to over-enthusiastic brain surgery. And patients continued to die.

In the spirit of "what the heck, nothing else works", from the early 50's, some surgeons in Europe tried the first "production-line" (as opposed to "experimental") genital reconstruction surgeries, in conjunction with feminising hormones.... and they started getting some dramatic improvements. By the 1960's, French surgeons in Casablanca, Morocco were doing several surgeries per week, at a cost in today's terms of about a quarter of a million dollars each.

It wasn't enough to be independantly wealthy, an "exotic dancer" with an employer who would pony up the cash, or to have a "Sugar Daddy" though. Only the most gracile, prettiest and most effeminate of "boys" - no-one over 25 - were accepted into one or the other of the programs that started in the 60's. See the surgeon wearing slacks rather than skirt, high heels, makeup and perfume, and you'd be rejected. As you would be if you were too tall, too thickset, too "butch" in body language, or if there was even the slightest hint that you might be attracted to anything other than gorgeous hunks of manhood.

By the 70's, surgeons all over the US were starting treatment programs, usually in association with Universities and Clinics, and prices were lowered so they were in the reach of the "comfortably well off" rather than the "filthy rich". But if you were a banker, you'd have to become a secretary - if an engineer, a beautician, or other occupation that was deemed appropriate for your sex. And of course you'd have to sever all contact with your previous life, and not see any member of your family ever again.

The great majority of transsexual women and men were of course excluded from this treatment, though some of them managed to re-shape their lives into the caricatures required by the gatekeepers, lying through their teeth to give the answers that the gatekeepers wanted. The rest died. But those that *did* qualify for treatment ended up beautiful, utterly feminine, the very model of the ideal 1950's womanhood the very conservative medical profession required, and success rates climbed.

Genital Reconstruction was thus a purely pragmatic approach, with no theoretical justification other than that it stopped patients killing themselves. It was still viewed as mutilation of the deluded, but better that than a dead patient, as nothing else worked.

Of course the surgery did nothing to help heal any sequelae from years of misery. It solved the One Big Problem, but to expect it to also deal with the problems of alcohol or substance abuse, the mental damage from having this condition, was as ridiculous as expecting concentration-camp survivors and torture victims to be entirely free of psychiatric problems from the moment of their release. Some of the more ultra-conservative psychiatrists didn't see it that way though: if this wasn't a magic bullet, a complete cure-all, it was unacceptable on ideological grounds.

Here's Dr McHugh, writing in the Arch-Conservative Catholic religious journal "First Things" as late as 2004, on events of the late 70's:

"We saw the results as demonstrating that just as these men enjoyed cross-dressing as women before the operation so they enjoyed cross-living after it. But they were no better in their psychological integration or any easier to live with. With these facts in hand I concluded that Hopkins was fundamentally cooperating with a mental illness. We psychiatrists, I thought, would do better to concentrate on trying to fix their minds and not their genitalia."

Many psychiatrists are still trying, 60 years after the first serious attempts. They know that there *must* be a better way, they just haven't found it yet, and the patients unco-operatively keep dying before they do! Their reference books say that it's a mental illness, after all.

By the middle 1980's, the University programs were pretty much a thing of the past. The research had been done, the experiments conducted, and the surgery was farmed out to being performed by plastic and urological surgeons, many of whom had more enthusiasm than skill. Quite a few did a half-dozen operations, had an unbroken string of "poor results", and gave up. This is a specialised area, and although there are still many surgeons around who will say "I'll give it a go... I saw it done once...", now most of the surgery is being performed by a handful of surgeons with dozens, or even hundreds, of successful surgeries under their belt.

By the late 1980's, a few psychiatrists were even giving the go-ahead to women in their 30's, and even 40's. Even ones who would never look pretty. Even ones who would never "pass" as anything other than "transsexuals". Even a few who admitted that in the past they weren't exclusively attracted to men. Having ever been married was still an absolute bar though.

It wasn't until 1996 - in Australia anyway - that this absolute prohibition was lifted, and the existence of lesbians was acknowledged. These days, they'll even treat people like me - thickset, as graceful as a hippopotamus, but not as good-looking. OK, I have a classical female skull structure, and a female pattern pelvis, I'm 5' 6" rather than 6', all due to my intersex condition and never having had a normal male puberty, but I have a 45" ribcage, arms like Rosie the Riveter... meh.

It could be worse. I look much like most other women my age, and rather younger-looking than many. I look plain - but at least I no longer look male. But I digress.

The point is, that even if you regard this as "mutilation" rather than "reconstruction", and say "they should try alternative treatments", the problem is that there *is* no "alternative treatment" to try. Not that works. Religiously and Ideologically motivated mental health professionals are still attempting to turn lead into gold, leaving an unbroken line of corpses and psychic cripples to mark their 0.000000000 batting average, but they still keep trying. But while there's literally hundreds of studies showing the effectiveness of the "triadic therapy" involving hormones and surgery, and even some studies showing the effectiveness of hormones alone on less severe cases, there's none where someone who meets all (not just some) of the diagnostic criteria that have ever shown improvement in long-term follow-up.

The widely-held belief that "they don't need surgery, they need psychiatric help instead" is not borne out by any actual evidence. Not a skerric, jot or tittle.

It was this complete lack of success that led to the speculation in the late 60's about a biological cause, rather than a psychiatric one.

As the great pioneer in the field, Harry Benjamin, wrote as far back as 1966:

"The possible origin of transsexualism is not discussed in the medical literature very often or in very much detail. Most frequently, there is the simple statement that the cause is unknown.
...
The two principal theories are concerned either with possible organic, that is, biological (inborn) causes not necessarily inherited, or - much more often - with purely psychological ones.
Biologically minded authors are likely to consider TVism and TSism as "intersexual" phenomena but those are almost exclusively European scientists.
...
In this country, psychology and psychoanalysis still dominate the field of sexual deviations. Many psychologists, particularly analysts, have little biological background and training. Some seem actually contemptuous of biological facts and persistently overstate psychological data, so much so that a distorted, one-sided picture of the problem under consideration results.
Psychiatrists with biological orientation strongly disagree and even decry the exclusive psychoanalytic interpretations. But their voice is heard too rarely."

Those words are still true to a great extent today. Though less so, as the evidence is now pretty overwhelming.

I am not at all insensitive to the discrimination and hostility faced by trans people, and have tried to say from the start that, whatever one's views on the whole question of transsexuality, hatred and hostility are indefiensible. I don't think you'd be wasting your time corresponding with me, if you didn't understand that.

I'm not just writing this for you, Ron. I'm writing it for all those who hold similar views to you, yes, even the ones who engage in hostility and hatred towards transsexual people. Not even to further the "GLBT Agenda" or to argue for Human Rights, but simply to set the record straight. There are many who switched from hating because "those people" are morally corrupt (the MassResistance view) to hating because they are Mentally Ill (the FocusOnTheFamily view), to hating because these people are "freaks of nature".

"Adol T. Owen-Williams II, a Montgomery County Republican Central Committee member, ... shouted "Heil Hitler!" immediately after the vote to allow Intersexed women and men to be allowed to drink from public drinking fountains. "Wait until little girls start showing up dead all over the county because of freaks of nature."

My adducing the evidence won't stop the hatred. There are many to whom the hatred is the thing, the exact justification is unimportant to them, though there are many more who can be reached, so my efforts will diminish the hatred. But that's not why I'm doing it.

I'm doing it so that people can come to informed decisions, and not be misled by common superstitions, for want of a better term. I'm doing it because I'm a Geek Girl, a Scientist. And not least, I'm doing it because I'm a human being who is sick and tired of the utter bilge that people who should know better continually spout from positions of invincible ignorance. I may leave them no wiser, but at least they'll be better informed.

And I do wish you'd had a few unkind words to say on the blog to those who viewed me as their sworn enemy and were after my head.

Ron... I'm sorry, but I'm unable to do that. Because if I did, out of fairness, I'd have to tell you some very unpleasant home-truths about just how badly you committed canine intercourse on this one as well. I'd rather you come to that conclusion yourself. I'm a monster of arrogance and ego, but there's been far too much arrogant commanding of others as to what they should think by those in a position of privilege, be it sociological or because "(scientific) knowledge is power". I'm on my home turf here, I'm a genuine honest-to-goodness Rocket Scientist for goodness sake! This gives me a privilege and a power you don't have, "rep" and "street cred", much of which is wholly undeserved.

You're a good man. You have the "runs on the board", having done more for most people than I can ever hope to do. From your e-mails to me, I've come not just to respect you in the abstract, but to like you too. In order to criticise and restrain those whose anger has let it get the better of them, I'd also have to arrogantly tell you in no uncertain terms that their anger is justified, and some, first, and tell you just how much real damage your ill-informed views have done. I'm really averse to doing that. As I said, I'd prefer you come to such a conclusion yourself, if you think it warranted.

I do tend to share the view, however, of those who wonder whether trans people who consider themselves straight ought to embrace or be embraced as members of the gay political community, and I'm appallled by the whole notion that you're entitled to marry a man when you can say you no longer are one.

I never was one though. And not for lack of trying. But it's something you are or you aren't.

As for the political stuff... I identify as a straight woman. I feel as if I've been dragooned into the "GLB(t)" political movement. I don't regard myself as "transgendered" in any way, and yes, I uphold the "gender binary norm". I fit the binary gender model really, really well, not a trace of Butch about me. The binary gender role model, not so well, I'm in Engineering and Science, hardly traditionally "female" occupations. I'm not girlie at all. Makeup is nice sometimes, on special occasions, and is certainly no sillier than guys wearing ties, and heels make my legs look heaps better, though they're instruments of torture and completely impractical. The binary sex model on the other hand.... I'm about as far away from fitting it as it's possible to be. I'm not even in the same Galaxy, let alone the same neighbourhood of it.

So as regards Gender, I'm not a Revolutionary, I'm a Counter-Revolutionary. As regards Gender Role, I'm a confirmed Feminist, even a bit militant about it. As regards biological sex, I'm not just Revolutionary, I'm Chaos and Anarchy personified, AntiMatter whose mere existence blows the whole concept apart.

But that's me. Others differ. I'm unusual, and I realise that, and don't expect others to be the same.

I don't belong in any movement that is GLB and GLB alone. I can be an Ally, but I will always be supporting from the outside, not the inside. When I looked male, I was asexual to lesbian, hence apparently straight, and somewhat homophobic too (though I tried to overcome that disease). When my appearance changed, I had a period of strict asexuality, then started finding guys kinda cute. This came as a surprise to no-one except me. But I digress once more.

In a comment Nichole wrote:

"...Zoe, I feel that you've done this with Mr. Gold, and I thank you very much for that. Perhaps we should now be lobbying "Bilerico" to allow him to publish a more informed piece in place of the article that they allowed to be published initially, then removed once they realised how unpopular that viewpoint really was.

Which leads me to this. There has been debate in Sydney in recent times about whether the T belongs as all in the GLBT, and while it's quite apparent to most of us that literally it doesn't belong, but as we are such a minority group we occasionally need to ride on the back of, share resources and support each other in our sometimes similar other times unique endeavours.

But this article was published by a group sprouting itself as an inclusive GLBT organization and unfortunately this is quite common. It makes me wonder about the whole thing again, and even just how much the B even belongs in that acronym as they are also pretty much a misunderstood group among the Gay and lesbian community...."

Here was my reply:

"In Australia, it seems to me that TS people - by which I mean those who require hormonal and often surgical intervention - have more in common with Intersexed people than any group based on sexual orientation.

But trying to split the gender nonconformant into neat piles, transgendered here, lesbian there, transsexual over here, and the various categories of intersexed people in their own little cubicles, is impractical, even though from a philosophical and taxonomical view that would be correct. In truth they have little in common. But that little means they all get treated much the same.

I may not see myself as gay or lesbian - but others think differently, though they disagree on whether I'm gay, lesbian, or both simultaneously - consistency and logic is often not their strong suite. I may not see myself as transgendered, but I don't get a say in it.

Chassidic, Orthodox, or Reformed Jews, Ashkenazi, Mizrahi or Sepphadic, practicing or not, they all went into the ovens together, no matter how different they were from each other.

That provides a certain commonality of interest, no matter how much we may loath or just plain not comprehend each other.

I was dragooned into the GLBITQ-whatever camp (pardon the pun). But it was in some ways the best thing that could have happened to a priggish person like me.

Whether as an "ally" outsider of a strictly GLB group, or an "insider" of some grand GLBITTQXYZ conglomerate, I'd be doing the same thing. Trying to do what's right. Having experienced persecution myself, I can't ignore it just because it's not happening to me personally."

That gives my thoughts on the subject, anyway.

And it's my view that your categorical statement that some poeple are born gay and some are born straiight is pure undocumented drivel--calling into question the biological focus of your views on human psycholoogy in the areas in which you are attempting to familiarize me,.

The old "Clock that strikes 13" bit. Drivel it may be, but hardly undocumented.

Have a look at this picture:

It's a series of MRI images showing the differences between the brains of those exclusively attracted to women, and those exclusively attracted to men. Anatomical differences.
And here's a quote from a PopSci article:

Striking similarities between the brains of gay men and straight women have been discovered by neuroscientists, offering fresh evidence that sexual orientation is hardwired into our neural circuitry.

Scans reveal homosexual men and heterosexual women have symmetrical brains, with the right and left hemispheres almost exactly the same size. Conversely, lesbians and straight men have asymmetrical brains, with the right hemisphere significantly larger than the left.

Scientists at the prestigious Stockholm Brain Institute in Sweden also found certain brain circuits linked to emotional responses were the same in gay men and straight women.

The findings, published tomorrow in the US journal Proceedings of the National Academy of Sciences, suggest the biological factors that influence sexual orientation - such as exposure to testosterone in the womb - may also shape the brain's anatomy.

The study, led by the neurobiologist Ivanka Savic, builds on previous research that has identified differences in spatial and verbal abilities related to sex and sexual orientation. Tests have found gay men and straight women fare better at certain language tasks, while heterosexual men and lesbians tend to have better spatial awareness.

Savic and her colleague Per Linström took MRI brain scans of 90 volunteers who were divided into four groups of similar ages according to whether they were male, female, heterosexual or homosexual. The scans showed the right side of the brain in heterosexual men was typically 2% larger than the left. Lesbians showed a similar asymmetry, with the right hand side of the brain 1% larger than the left.

Scans on homosexual men and heterosexual women revealed both sides of the brain were the same size.

Ok, but that just proves that the brains are different, not that they were born different.

For some of the evidence of that see
"Sex Differences in Brain and Behavior: Hormones Versus Genes" by S.Bockland and E.Vilain, in Advances in Genetics Volume 59, 2007, Pages 245-266

I'm writing this at home, so can't get through the pay-per-view firewall as I can at Uni - I'll send you a follow-up quote. There's rather more than just one article though, and again we can reliably induce strict homosexuality in experimental animals by appropriate hormonal and genetic manipulation. That's not to say that all gays and lesbians are born that way - just that evidence is pretty clear that quite a few must be. A third? Half? Two thirds? That we don't know, and the evidence from other areas does more than hint that while males tend to be strongly sexually oriented to either gay or straight, women differ. I won't go so far as the unspeakable J.Michael Bailey does in "Gay, Straight or Lying" though. (see the PopSci article in the NYT)

I wasn't complaining about real life intruding on my correspondence. I share your views on that. Only saying that having 3 noisy demanding tots around was a shock to my tired old nervous system. My friend was asking where you live, so I'm glad to learn it's Australia. We've been trying to go there for quite a while, but it's been impossible for him to get a visa. Maybe we'll try again, and if successful, will loook you up, if you'd have us. What city are you in?

Canberra - and of course you'd be welcome.

One noisy demanding 8 year old boy is quite enough for me to deal with, despite my sprightly age of 51. Of course, I have him full-time, as he's my son (and boy, the odds against his existence were incalculable, as we found out 4 years after his birth when it was found out I was biologically more F than M). His Intersex condition is relatively mild too, though he did require genital reconstruction even before I did.

Did I mention I'm married? To another woman, even though same-sex marriages are illegal here. It's because I was legally male at the time. We're both straight, but everyone thinks we're one of the 2% of couples here in Canberra who are lesbian. We don't try to disabuse them of the notion, we still love each other for one thing. For another.... trying to explain would be far, far, far too difficult. The phrase "it's complicated" was made for us.

All the best, to you and your whole family,
Zoe

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