Please explain Transgenderism to me

Great Debates
101

Martin Hyde, the big problem is that transsexuality can NOT be changed by any NON-medical means we are aware of. It’s not like people haven’t tried.

I suppose it would be possible to argue that if we could wave a magic wand and make all the transsexuals happy with their bodies and feel like they were the gender their genitals proclaim them to be, that would be the “best” solution. But whether it is or not is irrelevant - we don’t have the magic wand. It doesn’t exist.

At which point, you’re looking at damage control. What can we do to minimize the pain these people are going through? After all - it’s claimed 1/4 of them will committ suicide if we don’t do something. That’s a pretty nasty problem!

Let’s take a little detour back to the amputation issue - amputation is a horrible thing to do to someone BUT - it is justifiable if it is necessary to save a human life. Remember that guy a couple years back who went hiking by himself in Utah, wound up trapped in a canyon, and had to cut his own hand off to escape death? That wasn’t crazy - it was a logical action carried out after all other possible alternatives had been exhausted. Justifiable because it saved his life.

Now, let’s go back and look at our unhappy, unmodified transsexual. We can’t change what’s in their head. We have no treatment, no therapy, no drug that will make them happy in their natal physical gender. They are so unhappy and distressed they are at a VERY high risk of death. This is a circumstance where drastic measures can be justified.

No, we can’t truly make the bodies match the minds. But if we can reduce the distress and given them a better life… well, seems to me no one has the right to stand in their way. So, to my mind, the questions are - does the suicide rate go down in treated transexuals? If it does, the treatment is justified. Does the rate of other symptoms of distress go down in treated transexuals? If it does, the treatment is justified. Are they happier, do they function better (remain employed, pay the bills, refrain from self-destructive behavior, etc.) after treatment? If yes, the treatment is justified.

I don’t think any transsexual here is going to say our current treatment methods are perfect… they are simply the best we have at present.

And I think, after talking with transsexuals here on the Dope I think perhaps us more normal folks focus a little too much on the surgery and not enough on some of the other aspects like hormone treatments and being allowed to live without harassment and other social trauma. There clearly ARE transsexuals who take hormones and are content to live without surgery even if some of their bits don’t match other bits or what’s in their head. Maybe they’re waiting for better surgical techniques. Maybe it’s just that they don’t need surgery as much as a different hormone balance. I don’t know.

I’ll admit, I still find the idea of transsexualism freaky most of the time. No, I’m not comfortable with it, it does disturb me, and I can’t say I understand it in any but the most analytical manner - emotionally I just don’t “get it”. But, you know what? How I feel doesn’t matter. This isn’t about MY discomfort, it’s about the discomfort of these other people. It’s THEIR life, THEIR bodies, THEIR needs - not mine or yours. It’s about what eases their pain, not mine; their confusion, not mine. Because I can walk away from this problem, it’s outside me - for them, it’s not something they can ever get away from.

If the price of keeping KellyM or Eve or Lazz or these other find folks in this world is radical surgery… well, if they find it a fair trade then it is. Because it’s about them, not me or you.

102

Total removal of the prostate is a difficult and radical procedure because of the anatomy. As Eve points out, it can also lead to incontinence. I do appreciate the back-up here; I dislike being accused of harassing my patients.

103

Oh, right - sorry, forgot about that.

Not having one of my own I forget about the details.

104

Did you let the APA know? I’m sure they’ll be glad to know that homosexuality is, contrary to what has been their stated position lo these 30+ years, a mental illness.

I’m sure others will speak to transgenderism and other such things’ proper place, in or out of the DSM, better than I can. ISTM more based on a lack of scientific understanding than much of anything else.

105

Well to be an illness to my mind it does have to cause harm, and I think both transexuality and homosexuality do. But I don’t think homosexuality causes enough general harm to be something we have to seek a cure for. As an example I’m quite pale. I’m of primarily Scottish stock and I don’t coexist well with the sun at all, I burn quite easily, and my light colored eyes are extra sensitive to sunlight. These are genetic mutations, passed on throughout the millenia. Now in my particular case these are mutations that served a purpose, that is if I lived in a northern latitude and didn’t have access to multivitamins. Not all mutations are detrimental and not all are beneficial. Some mutations eventually become mainstream. At least if my biology teacher wasn’t leading me on in HS years ago. Now, as things go I tend to think transexuality is possibly a genetically caused mental illness, or perhaps it is a mental illness that arises because of other environmental factors, that I don’t know. As a mental illness/genetic disorder homosexuality tends to be like having 6 fingers, it will cause some social ostracism, and it isn’t what the majority of the population has going, but it isn’t all that bad and sans our society (which obviously is a theoretical state) it wouldn’t be a problem for the person involved whatsoever. While transexuality would always cause problems because the person would never feel that they had the right body parts.

Lot’s of people do indeed just consider these things “traits.” I’m sure someone born with a genetic disorder that has them lacking arms, legs, proper functioning kidneys et cetera may think of these things as “traits” and they are, but they are negative traits (and can be called deformaties, mutations, and genetic disorders) and the properly evolved human body doesn’t posess those traits (I am making somewhat of an opinionated judgment, in that I don’t feel the “properly formed” body is missing limbs or has greatly disfunctional organs.)

I don’t have the intention of offending anyone, but I didn’t set out to avoid offending anyone either.

It was my opinion, and I’m no psychiatrist or psychologist (or biologist/geneticist for that matter), and I don’t even have any well developed knowledge in the field, other than a wide curiosity that has lead me to read a lot of things about a lot of things. And considering the title of this forum, I think my opinion is fairly appropriate. Obviously if someone in an administrative/moderation capacity felt otherwise I’d not bring it up again here.

Anyways, I ultimately think it is a lot more likely that someone is born with a diseased male mind (or develops a disease of said mind) that leads that male to think he’s “really” a female as opposed to a male with male genes develops in the womb with a female brain.

106

I made my statements in a fairly neutral tone. There have been quite a few replies to my post as I can see from skimming the thread, and I’m going to endeavor to reply to all of them. But if you feel the need to post aggressively I won’t bother. I have no problem with aggressively arguing something, name calling et cetera, but in this particular thread and in this particular sub forum I don’t wish to engage in it, so if you wish to debate with my after this post you’ll need to temper your tongue.

I will summarily respond to your post:

  1. You are incorrect, my definition of mental illness is fairly consistent. And if you care to read the APA’s definition of mental illness it is fairly broad, or if you consult the dictionary you’ll also see a definition just about as broad. The APA has indeed taken most sexually related mental illness off the books, but that’s a matter I will discuss in my reply to another poster as I feel it’s more appropriately phrased there.

  2. Just because doctors do it doesn’t mean it is the best way. Any arguments stemming from “doctors do this” isn’t a good argument at all. Doctors themselves are always trying to find better treatments and for virtually every affliction out there most doctors will tell you they think the treatment/cure could conceivable improve in the future.

  3. This forum is “In My Humble Opinion” so I make no secret of the fact I was indeed voicing an opinion, as many others had done in this thread before me and in many threads before today in this very forum. I have openly admitted I don’t have any medical credentials, but that doesn’t mean I can’t have opinions on medical issues. Most of the medical sources I’ve read relating to homosexuality and transexuality don’t paint me a story that is solidified in rockhard empirical evidence. And furthermore the existence of evidence isn’t an argument, because anyone can explain any evidence in any way at any given time.l

107

At one time the most effective treatment for a great many disease was worse than the disease itself, so just because it is the most effective treatment doesn’t mean it is something we should be doing.

If you don’t think believing you are a different gender than you really are effects a persons emotional well being you are sadly mistaken, as we’ve all pretty much already agreed that these transexual actions (surgery, dressing up et cetera) are “necessary” to satisfy emotional health.

There are some people who have psychotic disorders in which the person only feels “right” if he’s killed someone recently (many serial killers say the only times they ever felt happy before they were captured was when they were killing and right afterwards.) Obviously feeding the delusions and feeding the illness seems to be a form for curing it, but it is one in which a person is either doomed to be living a lie or in danger of hurting himself or others.

In my opinion a psychiatrist should strive to correct any delusions as I personally wouldn’t want to believe a falsehood to the point of being mentally deranged whether or not the falsehood greatly affected my ever day life.

108

I said in my original post that transexuals should have the right to be surgically modified if they felt it was necessary, but I said that I think it should be discouraged.

Again, I just don’t see the evidence that disproves genetics. You either are a male or you aren’t a male. If I was schizophrenic and thought I was Cthulhu, I would be psychotic and sadly mistaken, and the proof of that would be my genetics and of course the obvious appearance of myself that is in vast contradiction to the real appearance of the fictional Cthulhu character.

My primary point is transexuals aren’t males/females trapped in the wrong bodies, they are males/females who have a mental disorder that so drastically affects them they truly believe they are “really” of the opposite sex.

The best treatment for these people may currently involve surgery for some, but I think the medical establishment would do better to try to find a way to cure the brain instead of damaging the body.

109

Firstly, no I did not. I don’t have any connections within the APA, they have obviously taken their stand on the issue, and since I’m not a member nor a trained professional me informing the APA would not be of any great use to anyone.

I said in my initial post that my views on homosexuality are a bit more complex, as I think homosexuality occurs due to many different factors, and I don’t think all homosexuals necessarily have the psychiatric disorder. But again, I think that homosexuality tends to be somewhat OT from this topic, and I said in the initial post I didn’t want my briefly mentioned opinion on homosexuality to detract too much from the core topic of the thread.

Transexuality on the other hand is without a doubt a mental disorder, and gender identity disorders in general are mental disorders. So people arguing to the contrary are patently incorrect, transexuals are people with a disorder, a disorder that is often treated by surgery or hormonal curatives because we have no other effective means to treat the problem.

If you don’t believe me you can check the Merck manual and it will happily show you the classification of transexuality as a gender identity disorder, right under it’s psychiatric disorders section.

Furthermore there is a gender identity disorder that is often seen in schizophrenics, and the big difference between it and transexuality is that transexuals don’t ever desist from their belief that they are of the opposite sex. I think this is because we don’t have the same drugs to treat this particular mental disorder as we do schizophrenia.

Anyways, most of the medical texts don’t seriously contend that there are genetic males with female brains or vice versa, they classify transexuality as a psychiatric disorder. Which for some reason we seem to be a bit too willing to treat by trying to satisfy people’s delusions.

110

As was stated earlier in this thread, there is a region of the brain (the BSTc) that is demonstrably smaller in women than in men. Its size in transsexuals is consistent with the subject’s preferred gender, not birth gender. So, the evidence we have suggests that we are indeed talking about female brains in male bodies and vice versa.

How would genes cause “diseases of the mind” anyway? Genes direct the expression of proteins. The brain wires itself up according to what is learned once outside the womb. Concepts like self, maleness, and femaleness are developed, and introspection eventually ties the first to one of the other two. It is actually harder to believe that genes can do this, given the extremely basic molecular influence they have and the almost macroscopic nature of the brain.

Humble opinions are fine in matters where there is no empirical evidence. However, this is a subject where there is empirical evidence, however sparse that evidence is. IOW, to the best of humankind’s knowledge, the opinion you voiced is factually incorrect. :wink:

I hope to see a scan developed within my lifetime that can measure the size of the BSTc in living persons. It would add a lot to our understanding of gender identity.

111

I also wanted to respond to this:

I think this is not the right way to go about defining an illness. A person with 6 fingers is not ill, just has more of a particular anatomical feature than what society considers “normal”. A population of 6 fingered humans could live quite well. Defining illness based on social ostracism is argumentum ad populum.

Since you bring up homosexuality, might I point out that it has been observed in nonhuman species (particularly bonobos) in which it causes no harm at all. ISTR reading somewhere that transsexualism has also been observed in non-humans. I fail to understand your reasoning here about how society’s norms manage to take a trait and define it into an illness.

112

Who do they harm and how?

113

The most important people in this discussion, transexuals. I mean the condition is so serious some people require surgery to correct it, if you don’t see that as not being a “great experience” for the patients involved then I guess you can say it doesn’t cause harm.

But to me years of pyschiatric problems and difficult surgeries = harm to me.

114
  1. As to the BSTc issue, there have been to my knowledge only 2-3 actual studies done. And all of them had extremely small sample sizes we’re takling six transexuals in one and a very small number of heterosexuals to compare to which to compare them. Furthermore no study I’ve seen relating to the matter makes the claim that the purpose and function of the BSTc itself is known at all. Of the two studies I’ve been able to find and read (there is a third I’ve heard about but cannot find any means to read it) both of them make the admission that true nature of the BSTc area of the hypothalamus is unknown, but believed to be related to sexual behavior.

Also of course when talking about these BSTc findings we can only make comments concerning Male to Female transexuals, as the findings aren’t factually related in any way to Female to Male transexuals.

A neuroscientist from the University of California at Berkely further explains that 5 of the 6 patients done in the most famous of the studies done involving the BSTc were on a battery of drugs that could very likely could have caused the effects on the BSTc seen in the study. And he also continues to explain it is impossible to know what effect BSTc size has on transexuality.

You’re going against a very old rule of thumb when proving causality, just because A is found with B doesn’t mean A is caused by B.

  1. I think you go way overboard when you take a very non-conclusive study and sit here and tell us that “the evidence we have suggests that we are indeed talking about female brains in male bodies and vice versa.” Firstly the study has made absolutely no correlation that would suggest we have females with male brains, but we do have ONE statistically irrelevant correlation on the issue of males with female brains, a correlation that has done nothing to even begin proving causality. And the BSTc is 1/8" in size, unless you know that 1) the BSTc is the only known difference between the male and female brain and 2) M-F transexuals differentiate between healthy males across all the differences, can you say we have males with female brains.

Even if I was to accept the study completey as proof that transexual males have female brains (which even the people who authored the study aren’t bold enough to claim) it still would just say that an M-F transexual’s brain is partially like that of a woman.

  1. As to how would gene’s affect diseases of the mind? First comment: I don’t know for sure. But if you care to google the matter virtually all mental illnesses (schizophrenia, bi-polar disorder et al.) have been proven to be genetic in a variable number of cases (I think for schizophrenia 10% of all cases have been in some way linked to genetics.) So it’s indeed accepted by people with far more training than us in the field that schizophrenia is related to genetics, and has been proven to be so in 10% of the known cases (again ballparking because I haven’t read up on it in awhile.)

It’s possible that the other 90% is something different or that 90% just represents cases where the data hasn’t allowed us to see the genetic root.

As to my opinion on “how” considering the medications that work to alleviate schizophrenia I think it’s safe to say it is primarily caused by chemical problems in the brain. Typically chemical imbalances, and it’s not a far leap to say that certain genes can cause the development of a brain, glands et al. that produce an inappropriate amount of certain chemicals, which in turn causes mental illness in that person.

  1. For further reading check out the topic page on transexuality/gender identity disorders in a lot of medical encylopedieas/publications, most of them list transexuality as a psychiatric disorder. So obviously a lot of very smart and intelligent people have found the evidence to support the claim that transexuality is a mental disorder.

  2. You’re trying to say that the brain wires itself up after leaving the womb, while the very study that has found the BSTc correlation says exactly the opposite, that this sort of development happens “perhaps at the fetal stage” (their usage of the word perhaps agains hows the study is a bit lacking on loads of empirical evidence.)

115

Correction: Disregard the battery of grammatical/typing mistakes I made in the above post :).

116

Nicely put. I also think this is where Martin Hyde’s definition falls apart rather dramatically.

117

Actually, no - there are a couple dozen disorders that can make a person “intersex” with ambiguous genitals. The most extreme form is the XY female, where the chromosomes and even the hormones are completely normal for male, except for one teeny region of chromosomes that code for the androgen receptors in the cells, which is non-functional. As a result, you have someone who actually looks more feminine than average - flawless skin, luxurious hair on the head, no hair anywhere else, and the external genitalia of a female human being. They don’t have a uterus, and they have testes where ovaries would be in a normal woman, but you certainly can’t see that from the outside. Regardless of what the chromosomes say, however, these aren’t men, they’re women, it would be foolish to describe them as anything else. But there are a who bunch of other disorders between that and normal - people born initially appearing female who grow a penis at puberty, bearded women, women with an enlarged clitoris. One of the major medical journals this year published a short piece, with photos, of a baby with XX/XY mosacism that was a true hermaphrodite with both male and female parts (an ovary and a testicle, among other things). There is Klinfelter’s Syndrome, where the chromosomes are XXY or XXXY or even more excessive (Tula, a rather well known transsexual who appeared as a “Bond girl” at one point, is if I recal correctly XXXY Klinefelter - although most transsexuals do not have chromosome abnormalities she does)

So no, the matter is not as cut and dried as it first appears.

If someone is of ambiguous sex at birth, would it be acceptable to you to subject this person to surgery (particularly if they ask for it later in life) to become more defined as one sex or the other?

To my mind, it’s not beyond possibility that there really IS some subtle dysfunction in response to sex hormones we just haven’t found a way to detect yet. 30 years ago we couldn’t point to the damage in a stroke victim’s brain - we diagnosed it by their behavior (or lack of such) or after death, by cutting into the brain and finding damage - even then, we couldn’t find the really small lesions. Now, we can put someone into a PET scanner or the like and SEE what parts of their brain are or are not functioning while they’re still alive. Did that mean strokes didn’t happen before we had PET? That it was a delusion? Of course not.

So why are you so adamant that transexualism is purely delusional? No, the studies aren’t conclusive, the evidence isn’t rock hard, but there is some indication this might be so, and no one has proved there isn’t a physical dysfunction of some sort.

118

Ah yes. That’s the theory of good old J. Michael Bailey- he teaches at Northwestern (actually I think he’s the chair of the psych department). His Human Sexuality class is among the most popular at the university. I never got the chance to take it, but I know a bunch of people who did. Interesting guy, kind of a jerk, seemed to teach a lot of stereotypes. Absolutely reviled by the TG community.

119

So there’s a 10% correlation between schizophrenia and some genetic mutation and that’s meaningful evidence, but a study involving 6 M2F TS women that found something consistent across them is not? :dubious:

I’m trying to say the brain wires itself up to learn these concepts after birth. The tendency to be male or female is already there waiting for the individual to recognize it in themselves.

120

Do you mean like “trans-fat”, as in “partially hydrogenated”? :slight_smile: