Wednesday, 7 May 2008

Transsexual Causation, the American Psychiatric Association, and Interpol

A sweeping from the dustbin of history, an extract from History: Interpol and the Nazi Party:
When Interpol was 1st established in 1924, Vienna was chosen as its "permanent" home by fixing in the constitution that the head of the Austrian federal police would automatically lead the organization from the capital of that nation.
Undaunted by growing Nazi participation, U.S. Attorney General Homer Cummings recommended to the Congress, a mere 2 weeks after Hitler's take-over of Austria and Interpol, that the U.S. formally join the group "as advocated by Director Hoover." Since Secretary of State Cordell Hull had no objection to the membership "from the point of view of our international relations," Congress voted the money and as of June 8, 1938, the U.S. was officially a member of Interpol. The U.S. was a member of a Nazi-run organization for only $1,500 annual dues.
Reinhard Heydrich, appointed to head the Nazi SS, became Interpol's new president, announcing that "Under its new German leadership [Interpol will] be a real center of criminal police." On December 8, 1941, Berlin was named as Interpol's new home and the move was made. Sharing a villa in Wannsee, a wealthy suburb of Berlin, with the Gestapo, Interpol was placed under Heydrich's Sicherheitdienst (SD) or Security Police.
Why have I been reminded of this recently? What faint echoes are there of an organisation with worthy aims shall we say, "misdirected" by a "fringe" group that is no doubt concerned with the issues at hand, but rather better known for other, more questionable activities? Read on, all will become clear. It's only a faint echo, and those involved aren't monsters. Just... "fringe".

But first, a talk about Transsexuality, and the causation thereof. I was recently asked what non-Freudian based theory there was about the cause of transsexuality. here's what I replied. My apologies for being repetitious in parts, but there's some novel stuff too.

The brain is a sexually dimorphic organ. The brains of men and women differ. Now just as there are flat-chested women and gynacamastic men, there's overlap, and different parts of the brain may be more or less conformal to the typically male or typically female pattern.

All sexually dimorphic organs are subject to cross-gendering, "Intersex", where a body that is mostly of one pattern can have bits more typical of the other. See any good site on Intersex to show the hundreds of different syndromes and how things can go wrong. Sometimes it's due to chromosomal causes, where the chromosomes aren't all 46xx(F) or 46xy(M), but 47xxy, or 45x, or a mixture such as 46xx/47xxy.
Sometimes it's due to other genetic causes, as when the cells aren't sensitive to the male sex hormone testosterone, so the body develops as mainly female, regardless of chromosomes. Often it's due to non-genetic causes, usually hormonal abnormalities in the womb, and sometimes it just happens for causes unknown, like many other congenital conditions.

Now since all other sexually dimorphic organs are subject to Intersex, how come the brain is uniquely immune? Or is it? In fact, there's evidence that it isn't.

Zhou J.-N, Hofman M.A, Gooren L.J, Swaab D.F (1997)
A Sex Difference in the Human Brain and its Relation to Transsexuality.
(PDF at

Kruijver F.P.M, Zhou J.-N, Pool C.W., Swaab D.F. (2000)
Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic
Nucleus (PDF at

Male and Female brains differ, both on the coarse scale (BSTc layer of the hypothalamus) and fine scale (number of neurons - brain cells - in each structure). Autopsies on transsexual women, that is, women with mostly male bodies, have shown they have female pattern brains in this respect.

Note that gay men have male pattern brains though in this respect.

The brain is a complex organ, with many different parts. It's entirely possible, even usual, to have some parts more typically feminine, and other parts more typically masculine. What really matters is what parts are what, and to what degree.

Now if this is true, then we should expect to see the differences showing up in fMRI images - "brain scans" of living people. And we do.

From ArzteZeitung, 2007
"Radiologists can now confirm what transsexuals report - that they feel “trapped in the wrong body” - on the basis of the activation of the brain when presented with erotic stimuli. There is obviously a biological correlation with the subjective feelings."

This experiment took a number of men, a number of women, and an equal number of TS women. The TS women had the same pattern of neural activity in the lymbic nucleus (part of the brain) that the other women did .

So it's all nice and neat, everything proven beyond any doubt, right?

Well, not exactly. You see, the numbers in the experiments are too small for comfort. We still don't know which parts of the brain are responsible for gender identity, though we have a good idea now. The BSTc differences between men and women only happen at puberty, yet we know gender identity is formed before then. That means the BSTc difference is a symptom, not a cause. Moreover, the brains of infants are "undifferentiated pudding", lots of neurons but few connections. In theory, there's no difference, so we should be able to grow up either way, depending on environment. Except it doesn't work that way, differences between boys and girls are measureable at 18 months in terms of attention-span and reaction to basic stimuli. We don't know why, but we can deduce that there's something going on that we haven't detected yet.

We know from the cases of surgical intervention on Intersexed infants to "normalise" them that sometimes it works, and sometimes it doesn't, so we sometimes get surgically-created transsexuals (see the infamous David Reimer case). We also know that those mothers who took the drug DES in the first trimester and have genetically male children give birth to transsexual girl babies 500 times more often than they should by random chance. If the brains of newborn infants were as plastic as psychologists theories would indicate, this would not happen. (Even the non-TS "DES sons" are usually Intersexed in other ways too BTW)

We know that those Intersexed genetic males with 5ARD or 17BHDD, so they get a "natural apparent sex change" from FtoM at puberty can be divided into three groups: those to whom it is a massive relief from transsexuality, those to whom it's just something that happens and they don't really care, and those to whom it's a nightmare, a descent into transsexuality. It appears that the three groups might broadly be the same size, but we don't know, there's too little data to be sure. We know all three groups exist, that's all.

As for the German experiment - they only looked at straight men and straight women, and it could be that they haven't found a biological basis for TS, just for sexual orientation. They didn't state whether any of the TS sample were lesbian or not. We do know that the differences detectable at autopsy aren't due to hormone treatment, as they also autopsied a number of men taking similar hormones (greater doses usually) to combat cancer, and their masculine brains were unaffected.

So all we can say is that it is "true on the balance of probabilities" rather than "proven beyond reasonable doubt". And only that assuming there isn't some more compelling evidence for another theory.

There's a lot of evidence that TS women can be divided broadly into two groups. Those that transition early, and those that transition late. The ones that transition early tend to be androphillic (attracted to men), and to have bodies that are gracile, easily transformed by hormones into pretty girls. They tend to have difficulty "passing" as boys from an early age.

The ones that transition late may be andro or gynephillic (attracted to men, women, or either), and are less gracile, and have no difficulty "passing" as men. They even sometimes have difficulty "passing" as women after treatment, and this appears independant of physical appearance, more a matter of body language and instinctive behaviour than anything else. They also tend to be good at engineering and science, with both the linear/analytic/deductive male-typical thinking and parallel/creative/intuitive female-typical thinking modes available to them. TS men follow the same broad categories (swapping boys for girls, and andro- for gynaphillia), but with one exception: they all tend to transition early.

The Neurological theory accounts for this as follows: basically, different parts of the brain are affected, and societal pressures account for the rest.

For example, until the mid 1990s, it was impossible for most TS women who were lesbian to obtain medical help in transition. It was also impossible for anyone not gracile and able to look pretty in a conventional sense. Such women were denied treatment as being "poor candidates". They transitioned as soon as they could.
In the late 50's, 60's and early 70's, there was no Internet, and no access to the data about transition we have today. Moreover, Homosexuality was punishable in many jurisdictions by prison terms of 10 years or more. The "Gay Underground" had access to data about transsexual transition, but those who had no "in" with that shadowy, furtive and underground culture (as it was then) because they didn't think of themselves as gay, had no idea that transition even existed, except as something a few freaks did at a cost of half a million dollars in today's terms in foreign locations.

Those who could do "the boy act" with some success did so, as it was their only means of survival. Those who could not mainly died, with only a handful of survivors who managed to transition despite the difficulties still alive today. Those whose neurology was less affected, so they had masculine or masculinised instincts regarding body language and mannerisms were able to cope, especially if they had typically masculine bodies. Their first opportunity to transition started less than 15 years ago. Because of their mixed neurology, they tend to be in Computer Science, the technically creative arts, the Military, or other areas where both creativity and logic are required. Many Intersexed people are the same in that area.

Now the main competing theory is AGP (AutoGynePhilia) theory, a theory based in the Freudian concept that every single human motivation is sexual in nature. In AGP theory, the early transitioners are really gay boys who want to have sex with straight men. The late transitioners have a paraphilia, a fetish, that makes them want to have female bodies based on misdirected male sexual urges (Autogynephilia). This last is associated with talents for the military, computer science, or the creative arts for reasons unknown, and the neurological evidence is swept under the carpet as an irrelevant, unexplained phenomenon based on dubious evidence. As for FtoMs, they're all inexplicable and may not even exist. Any testimony by any TS women which contradicts this is a lie, and they must all be pathological liars as so many of them contradict it.

All men are heterosexual, gay, or liars too, bisexuality doesn't exist in men, those who say they're bisexual are gay. Except in transsexuals, where those claiming to be bisexual have to actually be non-gay to make it all work. And women are all bisexual. The evidence that many late transitioning women end up being androphillic is ignored as an unexplained phenomenon, or maybe they're just lying.

If we're not careful, that last is going to be enshrined as the official position of the American Psychiatric Association.
Why do I say this? Well, the American Psychiatric Association is revising their Diagnostic Standard Manual, the DSM, from version 4 to version 5 - DSM-IV to DSM-V. This will list all the various psychiatric disorders so far identified, how to diagnose them and differentiate them from other similar disorders. This manual is something of a "Shrink's Bible", used worldwide, not just in the USA. It is capital-A Authoritative.

From a recent news release of the APA, announcing the makeup of the panel revising the DSM in the area of sexual disorders:

Sexual and Gender Identity Disorders Work Group

Kenneth J. Zucker, Ph.D. (Chair) Head, Gender Identity Service Clinic, Child, Youth, and Family Program Centre for Addiction and Mental Health Toronto, Ontario, Canada

Irving M. Binik, Ph.D. Professor Department of Psychology McGill University Montreal, Quebec, Canada

Ray Blanchard, Ph.D. Professor, Department of Psychiatry University of Toronto Head of Clinical Sexology Services Centre for Addiction and Mental Health Toronto, Ontario, Canada

Peggy T. Cohen-Kettenis, Ph.D. Head of the Department of Medical Psychology VU University Medical Center Amsterdam, The Netherlands

Jack Drescher, M.D. Clinical Assistant Professor of Psychiatry, New York Medical College Associate Attending Psychiatrist, St. Luke'sRoosevelt Hospital Center New York, NY

Cynthia Graham, Ph.D. Research Tutor Oxford Doctoral Course in Clinical Psychology Isis Education Centre Warneford Hospital Headington, Oxfordshire, United Kingdom

Richard B. Krueger, M.D. Medical Director, Sexual Behavior Clinic Department of Psychiatry New York State Psychiatric Institute and Columbia University New York, NY

Niklas Långström, M.D., Ph.D. Associate Professor Centre for Violence Prevention Karolinska Institutet Stockholm, Sweden

Heino F. L. Meyer-Bahlburg, Dr. rer. nat. Professor of Clinical Psychology Department of Psychiatry College of Physicians & Surgeons Columbia University New York, NY

Robert Taylor Segraves, M.D., Ph.D. Chairperson Department of Psychiatry MetroHealth Medical Center Cleveland, OH
One thing stands out: both the head and one of the panellists hail from the Centre for Addiction and Mental Health (CAMH) in Toronto, Canada. This was formerly known as the "Clarke Institute", and by it's detractors, "Jurassic Clarke". It, and its staff, are "controversial" to say the least. Many in the World Professional Association for Transgender Health (WPATH - formerly HBIGDA) would describe them as "fringe". This is the only institute that has two members on the panel.
Dr. Ray Blanchard resigned from the Harry Benjamin International Gender Dysphoria Association (HBIGDA) in protest to the ethics investigation of his protégé, J. Michael Bailey. Blanchard, a psychiatrist, member of a eugenics think tank, and vocal proponent of repathologizing homosexuality as a mental illness, still runs Toronto’s Clarke Institute as a maximum security processing facility, using the same procedures, locked rooms and shared space areas for pedophiles, rapists, homosexuals, and transsexuals.
From Rodkin D. Sex and Transsexuals. Chicago Reader December 12, 2003, a quote which shows the importance of the DSM even outside the USA:
Blanchard, who happens to be an American citizen, says a DSM listing has different implications in Canada than in the U.S. "This question of whether autogynephilia should be listed as a disorder is strictly an American preoccupation," he says. "In the U.S. there is no universal health insurance plan, so people will pay for their SRS out of their own pocket. But in most of the Western world, where there is government-run health insurance, in order for their sex reassignment to be paid for, it has to be a disorder, it has to be in the DSM. Health plans don't pay for surgery that is elective. They pay for surgery that is medically necessary."
Thereby completely missing the point: broken legs are not in the DSM. Surgically correctable congenital conditions are not in the DSM. If Transsexuality, like Intersex, is a biological condition, it belongs with the other biological disorders, not the psychiatric ones. The disabling distress, the GD or "Gender Dysphoria" caused by lack of treatment for the condition does though, so his job is safe, especially in determining what degree of surgical, hormonal, and supportive treatment is required to deal with the psychic damage caused by the distress. The "resultant co-morbidities" of being driven insane by decades of psychic torment.
He points out that from 1970 to '99 the Ontario Health Insurance Plan covered sex-reassignment surgery for patients who'd been approved for it by the Clarke Institute. But the conservative government that came to power in 1999 stopped paying for it. "Now a group of transsexuals have brought a human rights complaint against removal of sex-reassignment surgery as a benefit," he says. "Their argument is that this is a recognized treatment for a psychiatric disorder. It's got to remain in the DSM. The DSM has no formal jurisdiction in Canada, but in fact it's taken as the standard."
Note "autogynephilia" not "transsexuality" or "gender dysphoria". As was said at the rather polemical transgender roadmap:
Many are beginning to question whether these diagnoses are really necessary in order to receive health services. Many are even questioning whether these are diseases at all. Because Blanchard and several cronies are heavily involved in the DSM's language about these "disorders," it is likely that we will see a pitched battle about this matter when the next DSM revision is made.
Indeed, a prediction that has come to pass. And it appears they've won.

The Chair, Kenneth Zucker is best known for his "Reparative Therapy" to "cure" gender-variant children. here, I'll quote what was said about him by one of his admirers:
Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual.
First, he thinks that family dynamics play a large role in childhood GID (Gender Identity Disorder)—not necessarily in the origins of cross-gendered behavior, but in their persistence.
So the first prong of Zucker’s approach is family therapy.
The second prong is therapy for the boy, to help him adjust to the idea that he cannot become a girl, and to help teach him how to minimize social ostracism. Zucker does not teach boys how to walk in a manly fashion, but he does give them feedback about the likely consequences of taking a doll to school.
The third prong is key. Zucker says simply: “The Barbies have to go.” He has nothing against Barbie dolls, of course. He means something more general. Feminine toys and accoutrements—including Barbie dolls, girls’ shoes, dresses, purses, and princess gowns—are no longer to be tolerated at home, much less bought for the child.
Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers a bad outcome. ... Why put boys at risk for this when they can become gay men happy to be men?
Better a normal, effeminate gay boy than an icky girl! And it's all the parents' fault too. Gender Variant Kids should be terrorised into conformity.

Those quotes are from Michael Bailey, by the way, the one who so famously said that young, pretty transsexual women are "peculiarly fitted to be prostitutes" due to their sexual appetities, (which of course are entirely absent in "real women" as everyone knows). *SIGH*

Jack Drescher, also on the panel, is best known for his labelling of Reparative Therapy of the kind advocated by Zucker as Junk Science practiced only by Quacks. It doesn't take a Rocket Scientist to predict Fireworks.

Ray Blanchard I've already dealt with, but I must say a number of things to complete the picture. He's a giant in his field, he's done some excellent research and data gathering. It's only his conclusions, ones forced on him by his early training as a Freudian psych unaware of such new-fangled notions as MRI imaging, brain lesions causing psychiatric illnesses and the like that make him "beyond the fringe".

Peggy T. Cohen-Kettenis is a specialist on Neuroanatomy, and the difference between male and female brains, including transsexuals.

Heino F. L. Meyer-Bahlburg is an endocrinological specialist, who knows a lot about the role of pre-natal hormones on gender development, and is the only one who has knowledge about Intersex conditions.

Of the rest, none have any specialised knowledge about Gender.

Niklas Långström specialises in violent male sex offenders
Irving M Binik specialises in female orgasmic disorders
Robert Taylor Segraves specialises in sexual dysfunctions, impotence etc
Cynthia Graham specialises in sex therapy with respect to contraceptive use
Richard B. Krueger again specialises in sex offenders

Now Ray Blanchard, despite his unique views that all transsexuals, without exception, are gay boys or perverts, does not believe that sex reassignment should be denied them, and he believes this on strictly humanitarian grounds. He doesn't see that others in the legal and political areas, those who pass laws about this, just might not agree with his highly principled stance.

Others do though. The ones who have suffered as the result. They tend to think the worst, and are seldom disappointed. I'll quote from Organisation Intersex International. I apologise for the alphabet-soup of acronyms, they're a hazard of the profession when dealing with Intersex issues.
DSD - disorders of sexual development (Intersex by any other name)
NC-CAH NonClassical Congenital Adrenal Hyperplasia (what I'm being treated for)
17 Beta HSD 3 - 17BHDD, a cellular hormonal conversion problem leading to feminisation at birth, and masculinisation later. Similar to 5ARDS, 5 alpha reductase dediciency syndrome :
Next, I would think that they would classify the syndromes which they have been studying and have been frustrated about the most lately, and those are the 3 in which patients are MOST likely (more than surgeons) to request a reassignment. These categories are 5 alpha reductase 2 deficiency, NC-CAH, and 17 Beta HSD 3. There have already been studies on 5 alpha in transsexuals which found that M to F's don't have 5 alpha. Thus, those who wish to reject a male assignment will be labeled as paraphilic, and those who want to live as males will make this appear more justifiable, plus this will fuel their desire against feminizing surgeries Those who virilize at puberty and insist on masculinizing surgeries will be those whom they will seek to find grant money for in order to investigate if autoandrophilia (the counterpart in “females” of autogynephilia) exists. Then, because they have found such a high incidence of NC-CAH in F to M transsexuals, they will likely claim that CAH is similar to F to M transsexualism. Those who wish to live as males will continue to pull in more grant money because they will be more than tomboys: they will be autoandrophilics. Homosexuals would be the only other category.

Here is the progression I see in how DSD is important in reframing intersex as a sexual fetish (or paraphilia).

A) M to F TRANSSEXUALS will be the first to be classified as paraphilic. Then-

B) "DSD persons" who would not have been called intersex under the LESS inclusive category of intersex, if they reject their gender assignment, will be labeled as paraphilic. Then-

C) the conditions which PATIENT initiated gender re-assignment is requested (most common in 5 alpha, CAH, and 17 Beta) will be classified as paraphilic. Then-

D) Autoandrophilia will be created for female to male transsexuals.

E) people who were always considered intersexed, who reject their assignment, will be labeled as paraphilic.
The problem is not autogynephilia per se. It is the conflation of intersex issues (or people with DSD’s) with something unrelated to why many people with intersex variations reject their gender assignment which is problematic.

We in the intersexed and trans community risk ending up in a situation where:

Surgeons who perform intersex normalization surgeries without the consent of the child will always be right.
Surgeons who offer sex reassignment surgeries to adults with informed consent will always be wrong.

Many stakeholders involved in intersex treatment benefit from this, especially the surgeons and pediatric endocrinologists. Unfortunately, the main victims are the intersexed children themselves.
And that is why both Intersex and Transsexual groups are up in arms about this. The more scientifically literate, and that is a very high percentage, because of the "junk science" that will likely lead to greater persecution. The rest because of the insult such views offer us, to be mischaracterised and misrepresented in such a blatant way, our honest narratives dismissed as lies by lunatics.

Should this state of affairs be allowed to continue, should the fringe views of a few paleolithic neo-Freudians be adopted as Gospel, then an avalanche of discriminatory regulation will likely ensue. The long-standing rights to correct birth certificates, to marry in the correct gender, even to work near children, will likely be withdrawn. After all, we'll be officially "self-mutilating male perverts or gays" according to the APA, no matter what the specialists in the area might say.

Now you know why I'm reminded of those far off days in the 1930's. The echoes are faint, the people involved all well-meaning, but the consequences for people like me could be catastrophic.


Christine said...

Ignoring the oncoming tragedy to future generations... (which I am not, but I'm already going to be up all night thinking about this)...

If the DSM changes to say "reparative therapy only" does this mean no more HRT or reputable SRS options?

And...(God forbid)
Could this mean governments might retroactively change all of our information back?

Dren. And I thought AG was dying a slow death. :(


Christine said...

Also the link to the APA press release is broken.. it should be:

Zoe Brain said...

The DSM is a Diagnostic manual, which deals purely with diagnosis, not treatment. Furthermore, there is this caveat in the DSM-IV:

The purpose of DSM-IV is to provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study, and treat people with various mental disorders. It is to be understood that inclusion here, for clinical and research purposes, of a diagnostic category such as Pathological Gambling or Pedophiliadoes not imply that the condition meets legal or other nonmedical criteria for what constitutes mental disease, mental disorder, or mental disability. The clinical and scientific considerations involved in categorization of these conditions as mental disorders may not be wholly relevant to legal judgments, for example, that take into account such issues as individual responsibility, disability determination, and competency.

So they have it both ways. A condition can be a mental illness for these purposes, but can't be used in court to prove disability.
All the stigma of mental illness, with none of the legal protections.

If I had a guess, I'd say that the change would appear relatively minor. A few changes of wording, but with huge implications.

Instead of
302.6 Gender Identity Disorder in Children
302.85 Gender Identity Disorder in Adolescents or Adults

There would be 3 categories:

302.6 Gender Confusion in Children. This would be associated with faults in parental upbringing, and even could be seen as evidence of child abuse.

302.85 Gender Confusion in Adolescents. This would be associated with Homosexuality or an Intersex condition, regardless of expressed sexual preference. It would cover all FtoMs too.

302.35 Autogynephilia. This would be listed separately, along with other paraphilias such as paedophilia. The differential conditions that distinguish it from GCA above would include post-adolescent age, lack of Intersex condition, and involvement in the military, science or engineering.

Paraphilias : These mental disorders are characterized by sexual fantasies, urges, or behaviors involving non-human objects (coprophilia, Fetishism, Transvestic Fetishism), suffering or humiliation (Sexual Sadism, Masochism), children (Pedophilia) or other non-consenting person (Voyeurism, Frotteurism, Exhibitionism).

This would be a subtype of 302.3 Transvestic Fetishism : Heterosexual males with this paraphilia dress in female clothes (cross-dress) to produce or enhance sexual arousal, usually without a real partner, but with the fantasy that they are the female partner as well.

So it will be a difference in emphasis, rather than kind. The DSM-IV was a deeply flawed document, only saved by the fact that "302.3 with Gender Dysphoria" was never used, only 302.85, Gender Dysphoria in Adolescents or Adults.

The main problem would be the effect on legislation. As soon as TS people are classed as paraphiliacs like sadists or necrophiles, they're hosed.

Anonymous said...

Yep...Thanks Zoe. We're damned either way with this stuff. If the GID diagnosis goes, it will be replaced with something worse. What is truly frightening is the political game playing that have taken place to get Bailey and co onto the committee.

None of this is about science: its about egoes

Nicky said...

That's why I'm fighting to keep intersex out of the hands of Psychiatrist and the transgender community. I'm making sure that intersex stays firmly in the hands of endocrinologist instead of psychiatrist.

That's why transgender should stay in the realm of the psychology dept because transgender and GID is still a psychiatric condition. It never had a genetic or a biological cause.

That's why intersex will always stay in the hands of endocrinologist because intersex has a genetic and biological cause.

Anonymous said...

Hi Zoe,

"The main problem would be the effect on legislation. As soon as TS people are classed as paraphiliacs like sadists or necrophiles, they're hosed."

That's already been an issue in the U.S.

Just one example, from last September, before the demise of the trans-iclusive ENDA, from Andrea Lafferty of the Traditional Values Coalition ...

Keep on battlin'.


Anonymous said...

Nick said: "That's why transgender should stay in the realm of the psychology dept because transgender and GID is still a psychiatric condition. It never had a genetic or a biological cause."

But Nick, the ArzteZeitung and the Zhou studies indicate that transgender (I assume you mean Transsexualism - i.e. people that medically change their bodies from one to the other of the standard two sexes) DOES have a biological cause. It's just like other intersex conditions in that regard.

Nicky said...

Their is no proof to the study and their is zero claim to the studies to back it up because all their studies have never been duplicated by other researchers to be considered valid. All it is just a research theory that has never been duplicated or proven as a theory.

Transsexualism dose not have any proven biological cause whatsoever. It's still classified as a psychiatric condition because their is no biological or genetic cause to it.

Transsexualism is has not and is not and is never going to be proven as a form of intersex condition because their is no proven genetic DNA link or biological link in origin.

See what the transgender community it's self on is an unproven or untested theory that panned out or was proven in conclusive or had psychiatric origin.

This is why you see alot of transgender community and their trans activist pulling the HBS card as an excuse for saying that their intersex when in fact their is no such thing as a neurological intersex or a psychiatric intersex.

Zoe Brain said...

Nick, could you please adduce some evidence rather than just repeating the same old same old.

Endlessly repeating a point of view without giving any evidence to back it up doesn't make it true.

You're aware of the Swedish work that replicated the Gooren et al results?

Some URLs please.

Anonymous said...

Thank you again, Zoe, for bringing this issue so succinctly to our communities' attention.

Someone said/wrote, "the only real power a government has is to crack down on criminals. thus, if a government desires more power, they legislate more criminals." I think that's what Zucker, Blanchard, and their reich-wing transphobic friends at NARTH, FOTF and AFA (to name a few,) are hoping to do. Indeed we are hosed, and irreparable damage may already have been done.

Nick K.D Chaleunphone, your call to distance intersex (which I assume you count yourself among) from the icky GID-only trannys is ultimately self-defeating. It will not save you. As Benjamin Franklin (I think) is quoted as saying; "We must all hang together, or surely we will hang separately." Once you isolate yourself from the trans population, you will be "easy pickin's", and your defense of "but I was born this way!" will fall on mostly deaf ears.

I also resent being told by the likes of you that my being a "DES Son" isn't good enough to make my trans-ness biological, not "only psychiatric."

And please learn to spell -- I usually run from sites and comments with 'their' for 'there', 'dose' for 'does', 'it's self' for 'itself', 'alot' for 'a lot' and general ungrammaticality driven by, I suspect, rage. By the way, being a DES Son, I could claim membership with the HBS women but won't, as they are another separatist organization unto themselves yet posessing a rage similar to


Hazumu Osaragi

Nicky said...

Claiming HBS or anything dose not or will ever guarantee acceptance or legal fairness within the intersex community. The transgender community can claim all they want about being intersex, but the fact is that not every intersex is going to accept the claims that the transgender community makes because their is no hard core solid proof about their condition being intersex.

The fact is that transgender is still regarded as a psychiatric condition and that regardless what theories the transgender community or their trans activist have. They are still considered a psychiatric condition.

The Swedish study is an unproven study because it has not been duplicated by other scientist or researchers. It's just an untested theory that every transgender talks about and lives by when in reality it hasn't been proven or duplicated. It's not considered a valid proof or valid reason for entry within the intersex community.

The problem here is that the transgender community wants acceptance based on a theory that hasn't been proven or their is no scientific basis or scientific proof. It's like saying they want to be intersex without having no genetic DNA condition to back them up with solid concrete research and medical history.

That's why you have intersex people like myself who resent and don't like having transgender within intersex space, communities or groups. They have no proof of a genetic DNA condition. No karyotype to back it up and no solid medical proof or research to back up any claim.

Basically the transgender community has zero proof, zero claim and zero evidence to back their claims that their condition is biological in origin. Their's no proof and no evidence that was duplicated or tested to back up their original theory.

M Groesbeck said...

While the model of the brain as sexually dimorphic may be useful as an organizing principle for both research and activism, it's important that most neurological and psychological sexual dimorphism only appears in averages. That is, yes, male and female brain scans can be distinguished as groups, but it's not possible to reliably identify an individual as male or female by a brain scan -- or by a measure of any of the neurological and/or psychological traits generally considered sex-linked in humans. Sorting out gender identity among other traits may be important in distinguishing transgender from gender-atypical but generally cis-gendered people. While there's room for solidarity between the two groups, and while the former group is subject to more sociocultural barriers (and/or violence) in most cases, either conflating the two or denying the existence of either can only be limiting.

Zoe Brain said...

M Groesbeck - Hi!

Studies in Germany reported in the RoentgenKongress showed that in some (not all) areas, it was possible to reliably distinguish males from females on the basis of MRI scans.

Usually these things are, as you said, statistical. Certainly we should treat everyone as individuals, and not discriminate against them in any way based upon properties the majority of their cohort show. I've made some previous posts on exactly this subject.

But although it's fuzzy, it's not that fuzzy. There are some absolutes.

I'm certain that Gender Identity isn't, can't be, one of them though. I know too many IS people who just don't conform to a strict binary, as opposed to bimodal, distribution there.

Zoe Brain said...

Joanne, you have my sympathy. I know what it must have been like, though I didn't experience it that way myself. I wasn't strongly gendered as a child, and came to realise I was a girl more as a process of logical deduction than anything else. It was only after my transition, when I was amongst the other gals of the Women in Technology and Communications, that I found that I wasn't alone, that there were other people who thought exactly like me. Not quite the standard model female. It was an end, not to loneliness, but to solitude. A coming home to a place I never knew existed, and didn't realise till I got there just how very much I'd missed it.

I actually wanted to be a boy as a child, they got to do interesting things that girls didn't. But they didn't think like I did, they had different feelings and reactions. You know how it is. The differences became more apparent with every passing year too, as the evidence piled up. But again, you know how it is.

But that is all behind us now. We came through it, we survived, and I for one have a pretty good life now all things considered. I did things most women never have a chance to. You and I, we've shed enough tears in our lifetimes for ourselves. If I had a Time Machine, I'd go back to the 15 year old girl, crying softly in her room, that I was in 1973, and tell her that everything was going to be alright.

The tears we shed now are for the kids going through the same thing today. We couldn't help ourselves back then, and can't do that now, but maybe we can help those kids going through the same things we did back then. We have to try anyway.

Nicky said...

But all those studies you claim as true fact's have never been tested or duplicated by other scientist or researchers.

They have no basis for being considered intersex and they have zero proof and zero evidence. It's nothing more than pseudoscience that transgender community banks on to believe is scientific fact. When in reality their is no scientific or academic proof to back such theories.

As I said, GID and transsexualism is still a psychiatric condition regardless of facts or pseudoscience you believe is to be fact.

You can put all the facts you want, but all those fact you put up can't be validated, duplicated or tested by another scientist or researcher. Their just unproven facts and unproven theories that have never been tested or duplicated.

You will never convince the majority of the intersex population that intersex has something in common with the trans and that your theory's are valid proof for entry into the intersex community.

Zoe Brain said...

Nick, read what I said again. About the Swedish study replicating, confirming, repeating, getting the same results as, the work done in the Netherlands by Gooren et al.

You keep on saying "zero evidence" like a mantra. It would not be unreasonable to state something like "in my opinion, the evidence is insufficient", but to keep on repeating obvious mis-statements is not productive.

Can you contribute anything useful, evidence, URLs please? Constant repetition of your personal opinions doesn't help. We know what you think. You've repeated it endlessly, and we get the message as to what your opinions are on the issue. It's not that we don't know them, we just can't give them credibility when there's mistakes of fact in them, and you aren't giving us any more evidence.

Anonymous said...

Nick, what about those people that are both IS and TS (often due to being mis-assigned as infants).

You, yourself given your IS condition and your (self-admittedly) small genitalia could have been one of them. Would you be happy, growing up and living as a woman?

Christine said...

I think Nick is missing the point of the whole post. Whether you agree with the information about a biological linkage between TS & IS DSDs our political futures are linked, not because we're the same but because we are different.*

(*From what society calls "normal.")

Anonymous said...

Thank you for a well articulated,carefully thought out post that identifies the main issues. Dr.Kenneth Zucker has a standing affiliation with the APA, despite official condemnation of reparative theray. He worked on both DSM-III & DSM-IV. This alone raises some question about the ethics of his appointment in my mind. I find it even more unconscionable that a colleague from the same institute, and espousing the same questionable science should also be given an appointment to the task group. It represents a known and deliberately approved bias in those members responsible for the gender disorder sector of the group. which strikes me as being contradictory to actual scientific method itself.
Neither Zucker or Blanchard is a psychiatrist. Both are clinical psychologists, lacking the additional medical degrees.

Whether gender issues are psychiatric or medical in origin, as you point out, has not been conclusively decide. Also as you point out, the legislative aspects as repercussions and consequences of changes are the important point. I draw many of the same parellels to the noxious historical precedent you did. And it offends not only my intelligence, but my conscience to see history repeating itself so easily. My age itsel, isolates me from any serious impact either way. But I'd begun to see hope in the few indicators available that children were being given a few more precious options that I myself had been rigourously denied. It reduces the meaning I've found in my own struggle to an act of futility.

Nicky said...

Almost every intersex group is not happy with the idea of intersex being co-opted by the transgender community and one of them being the AISSG which I am a supporter of.


Intersex is not the same as a transsexual (gender dysphoria) or as a transgender state. Neither term is one that we recognise as belonging in any general discussion of intersex. We are not happy with the recent tendency of some trans groups/people/activist to promote transgender as an umbrella term to encompass, for example, transsexuality, transvestitism and intersex. We object to other organisations/individuals putting us in categories without consulting us, especially categories that imply that intersexed people, of necessity, have gender identity issues.

The problems this causes...

We are constantly trying to get away from the idea that intersex is necessarily to do with gender identity, a notion that others (including the press/media,trans activist) like to impose on us. Moreover, the prefix trans- infers a "moving across" and although a few people with intersex conditions may choose to change their gender role, the vast majority never "go" anywhere in terms of their sex or their gender, but are happy to stay in the status in which they grew up.

XY females may suffer various problems on finding out their diagnosis. Problems such as:

* confusion
* anger at secrecy and paternalism (withholding of diagnostic information)
* shame
* an existential type of identity crisis
* low self-esteem
* difficulty grasping how this biological phenomenon can come about
* grief at being denied fertility and rites of passage (e.g. lack of menstruation)
* a feeling of freakishness and isolation compared to their peers
* a fear that others might see them as 'male'
* a concern regarding their ability to function in a relationship (e.g. vaginal hypoplasia)
* the burden of keeping a secret, or uncertainty over who to tell and how
* a retreat from medical care leading to failure to take HRT with a risk of osteoporosis
* etc., etc.

These are the issues that are of major concern to most of our members; and none of these issues necessarily means that their inner sense of gender identity is compromised.

This trend towards 'muscling in' on intersex issues seems to be a initiative on the part of certain politically-minded people in the 'trans' community, to bring intersex under their banner (for whatever reason - it lends more credibility to their cause?) or even to actively interfere in clinical issues relating to intersex. See Announcements for an account of the problems we had in 2000 with a gender dysphoria/transsexual organisation trying to interfere in protocols for 'gender reinforcement' surgery in intersexed infants with so-called genital ambiguity.

Zoe Brain said...

Nick, thanks for the helpful response.

I suggest you look at the support for those with Mild AIS and a female gender identity, at

Lauren ... has Grade 1 PAIS and is willing to help people in the lower grades of PAIS who identify as female. She told us (Jan 2001):

I'm female but was raised as male until I was 18, when I transitioned to female, but haven't had any operations etc. I'm 24 now and I've been living female for the last 6 years or so - I changed over when I went to university

But she's not TS, that's completely different. Right.

From another letter:

I am involved with OII (UK)... It is intended to be inclusive, regardless of IS condition or diagnosis, and is accepting of IS people with a trans-like history as well as trans people with an IS-history.

Sorting the two apart is tricky. Especially in light of the neurological evidence.

Oh BTW the AISSG does not consider Kallmann syndrome to be an IS condition, and that those who claim it is are just trying to climb on their bandwagon. Just ask them.

I disagree with them on that, and on similar issues. As far as I'm concerned, "you're in" for whatever that's worth. Such hairsplitting doesn't interest me.

Zoe Brain said...

Again from the AISSG site:

5-alpha-reductase is an enzyme that converts the weaker testosterone into the more potent dihydrotestosterone (DHT). When this enzyme is deficient (a condition known as 5-alpha-reductase deficiency) the baby develops as a girl. However, at puberty testosterone production usually increases and is enough to cause virilization, so in such cases (where the child identifies strongly with a female role) it is advisable to perform a gonadectomy before puberty. On the other hand, there are cases where the child naturally migrates to a male role. Therefore, a conservative approach that incorporates listening to the child is imperative.

In other words, if they were TS before, they become cured by the change, and if not, they acquire TS. And some aren't bothered either way.

How do you tell? By listening to them. See any parallels here?

Nicky said...

That's why OII is pro trans and pro inclusive while most other intersex groups are against the idea in the first place.

As far as I am concerned, your just a tranny activist who thinks that intersex is the same as with the transgender and that you spin what every facts their is to suit your own needs and agenda and ignore the hard core concrete proof that is out their.

I see you as someone who wants to co-opt the intersex because you don't like the thought or idea of being a transgender and you see intersex as an escape from the stigma of being a transgenders and your are trying to find excuses or making up lies why your intersex. When in fact your just a jealous tranny who wants to ride on the intersex because intersex people are more understood and sympathized than your kind.

That's why people like you create such a hostile environment and create such hostility for the intersex.

The fact is I stand by AISSG's policy and issues and the fact is that I support their issues because I believe what AISSG dose and that AISSG is right on the issues that their are transgender groups who are trying to co-opt the intersex

Zoe Brain said...

Nick, considering I've tentatively been diagnosed with both PAIS-1 in 1986 and lately CAH as well - though there's reason to believe it's something else - I don't have a need for validation as anything other than myself.

Half my legal problems are due to being IS, not the standard model TS. People with "boy" birth certificates are not supposed to become medically female without hormones and surgery. I did.

You can call me TS. You can call me IS. Just don't call me late for dinner.

Now as for TG groups trying to "co-opt" IS, that's partially correct. In fact, it's not TG as such, it's GLBITTQ. Gay Lesbian Bisexual Intersexed Transsexual Transgender Queer. We all got co-opted without being asked, as I've blogged about before.

Anonymous said...


Kallmann Syndrome was only characterised in 1944 (wiki link), though some doctors had noticed a correlation between hypogonadism and anosmia before that.

Remember that point - that for decades before Kallmann Syndrome was actually recognised, there was some idea that hypogonadism and anosmia were often related.

So were you living before 1944, they'd have no real idea how to treat you, they may or may not believe you if you complained about your sense of smell (they might think you were making symptoms up or something). And more importantly you wouldn't have a "real disease".

Consider now the situation that TS people are in: There are some studies which have been replicated, but the sample sizes are still too small. We know that we can chemically create transsexuals (DES does it in humans about 20% of the time, other chemicals do it in mice a bit more reliably). We know we can autopsy TS people regardless of whether they have taken hormones or not and regardless of whether they had comorbid IS issues (many people have both) and their brain tissue firmly indicates that their insistence on their gender was correct (i.e. literally a male brain in a female body or vice versa).

So what if Transsexualism now, is like Kallmann Syndrome was 70 years ago, a few doctors have some kind of idea but no firm understanding and no way to firmly diagnose it.

If in say a decade time, they do find the thing that goes "wrong" in brain development in TS people, such that they can test for it and say "Yep, you definitely have the wrong body for your brain" will you accept that? Are you prepared, given enough studies and enough evidence to admit TS as a biological condition or are you just going to ignore all evidence anyone presents you and scream your head off for the rest of your life?

Anonymous said...


Just wanted to pipe in for a moment to say that i am a self-identified woman who was born pAIS and later transitioned to living life fully as a female AND had SRS.
I am the vice-president of OII in Canada and we do include anyone who id's as IS without being judgmental or the IS police. As for DSD, ewwwwww.


Christine Johnson said...

Thanks for the post Zoe. The whole Zucker/Blanchard thing has certainly raised the specter of the seriousness of this issue to a higher order. I think many transpeople are finally beginning to realize that they cannot hide and they cannot run. Those days are over. We will fight or we will be exterminated. I hate to say this, but I believe there is historical precedent for it, and current political conditions, particularly in the US, suggest that things are trending that way.

But as for the argument from Nick that there is a clear and indisputable distinction between IS and TS, I disagree.

This is based on several factors:

1) My own experience of being trans, in that my earliest memories, before any social conditioning could take effect, was that I was different in a major way from other people. I identified as female, and had every expectation that I would grow up to be female. It was only later that I realized that society had different ideas and that I would jammed into the male box whether I identified as male or not. I had physical anomalies as well, but I won’t bring them up here, since that is not the basis of my argument.

2) Evidence from the DES Sons' International Network, which has (in my mind) convincingly established that a large fraction of sons exposed to the pharmaceutical drug Diethylstilbestrol in-utero now identify as trans. See: The Presence of Gender Dysphoria, Transsexualism, and Disorders of Sexual Differentiation in Males Prenatally Exposed to Diethylstilbestrol: Initial Evidence from a 5-Year Study. A Paper Presented at 6th Annual E-Hormone Conference, New Orleans, October 27-30, 2004.

3) An abundance of evidence demonstrating that many man-made chemicals, and some naturally occurring chemicals are hormone mimics or modulate the action of hormones and/or enzymes responsible for steroid production in many species, including humans. These steroids determine, in large part, the developmental programming of genitalia and the brain. See, for example,, and for an analysis directly related to transsexualism, refer to my masters' thesis, "Transsexualism: An Unacknowledged Endpoint of Developmental Endocrine Disruption?," available at:

4) Milton Diamond's early research, summarized in the paper "A Critical Evaluation of the Ontogeny of Human Sexual Behavior," which argued against the prevailing theory put forward by John Money, the psychosexually-neutral-at-birth theory, which postulated that gender identity was determined solely by social factors related to the sex of rearing. This paper is available at:

5) A relatively recent shift in the attitude of pediatricians, who now acknowledge that determination of gender identity at birth is not currently possible based solely on the status of the genitals. They are coming to learn that reassignment of children who cannot give consent is not only ethically problematic, but in fact has frequently been in error. See:

I could go on, but I think this is enough. I am in the process of writing a book on this topic, with the aim of demonstrating that practices such as reparative therapy on children is not only misguided, it is based on outmoded beliefs on the part of psychologists like Zucker, who have religious motivations which are not grounded in science. These practices will soon be seen to be as barbaric as electroshock therapy or blood-letting.

I think you may wish to reconsider your position, since arguing that there is a clear distinction between the mind and the body is not only untenable and not scientifically demonstrable, but is politically self-defeating and divisive, which leaves intersex people isolated and weaker politically. I would recommend that you reconsider your view that transpeople are mentally ill, and instead come to the emerging viewpoint, which is that human sexual development is composed of a variety of components, each unfolding during different time periods of fetal development, and that any of these components can develop contrary to the "normal" program via genetic differences and hormonal exposures.

Anonymous said...

Wow NIck talk about not reading before you post. You're so full of hate and wanting to make your point, reminds me by the way of the stuff one could hear years ago about people of colour and not being as smart as people not of colour.

Look you don't like being included in the umbrella terms. Hate to break it to you but then your main arguement is with the large gay organisations out there. It was they who began using anyone who wasn't gay or bisexual as being transgender.

But that aside you idea that people who are transexual are mentally ill and should remain in the DSM is flawed. There is nothing to prove that community are mentally ill, just as it was eventually agreed there was nothing to really say people who were homosexual were and as such that community was removed.

What we, society, does not know is very much about the human being. We don't know really why people are gay, or why some people are bisexual just as we don't know when the world began having people with different variations in skin pigmentations.

But as I have read being posted enough times, instead of siting another's hate as evidence how about posting scientific studies to back up your theories?

"That's why intersex will always stay in the hands of endocrinologist because intersex has a genetic and biological cause."

If there is one thing society has learned about the human condition over the many generations is, just because you say it is so, doesn't make it so.

If I recall my history, once upon a time people that are intersex were left to die as infants. Later the only job they could get was in a circus.
Fortunately society has grown up some and that's no longer the case. Mind you the children are not left to die anymore but instead mutilated by some doctor who thinks they know best.

OII, which you have attacked, has learned and understand that there are many working hard inside the intersex community to keep it divided and to pathologise the community rather then working to make it stronger and prouder.

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