h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I'm always a little suspicious of research that purports to show that transexuality (or homosexuality, or...) is something you are 'born with'.

To my mind, good evidence for a strong social role in transexuality is the rapid increase in numbers in recent times. An argument could be made based on the incidence of 'gender-bending' pollutants, I guess, but that feels ad-hoc. If pollutants were the cause, we would expect to see higher rates of cancer and physical and mental deformity amongst transexuals. AFAIK, we don't.

The entry points out that 'symptoms' of transsexuality are remembered as showing themselves early: an identification with the opposite sex, a distaste for and estrangement from one's body, and so forth. But transsexuality is not the only social phenomenon with these kinds of behaviours: one could easily look at furries (A747001), otherkin [Broken link removed by Moderator], even multiple personalities (A446393), and see analogous memories.

That makes these signals an unreliable basis on which to try and assert that one has been 'born male' or 'born female'. The problems increase when one considers that memories are frequently edited in light of current knowledge. If one is transsexual, and one is informed that transsexuals are made so from birth, then one will almost inevitably emphasise certain memories in order to fit that information. Particularly if demonstrating those symptoms is necessary to obtain hormones, etc.

That'll do as a first post, anyway...
-Martin

I think there is considerable evidence that transsexualism is something you are born with. In addition to research into sexually dimorphic regions, there is the indirect evidence that a large percentage of transsexuals are left handed (determined before birth), often have a large number of older brothers (which affects hormone levels in their mother's womb). There are also many stories of intersex children who were surgically made one sex (in the belief that gender was determined by upbringing), but grew up convinced they belonged to the other. There may still not be any conclusive evidence, but all this seems to point to biological cause.

The rapid increase in numbers in recent times is clearly largely because surgery is now more widely available, transsexualism is more accepted, and information is easy to find on the internet. Transsexualism has existed throughout history and in all cultures around the world.

I think it's important to stress that transsexualism is not a lifestyle choice like furries or polygamy, but a medical condition. Of course the politics creeps into this argument. If you're campaigning for transsexual rights, it helps to have a biological cause. If you think they should be kept down, it's better to claim it's all in the mind.

> "If you're campaigning for transsexual rights, it helps to have a biological cause."

I don't believe that, but lots of people do, and that is precisely my concern. I don't think the people researching transsexuality (or homosexuality, or...) are dispassionate observers. I think they're out to prove something, for political or personal reasons, and are going on to prove that. As you say, the evidence is far from conclusive, and it would be dangerous to second-guess the outcome of further research and the scientific process.

Having older siblings has a huge effect on nurture too - an only child will statistically be more selfish than a third child, and that's nothing to do with hormone levels. Anecdotal evidence from Kate Bornstein suggests a correlation between computer jobs and transsexuality. I think it'd be foolish to trust anecdotal evidence on *either* side when there are ulterior motives involved. Anecodotal evidence is that Jesus speaks directly to millions of people throughout the world, but I'm not going to put any weight in that either, for the same reason.

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I think there's a real danger when campaigners for transsexual rights (and gay rights) go out of their way to emphasise the possibility of a pre-birth cause. That won't convince anyone that transsexuality is OK. It'll convince people that transsexuality is wrong, but those 'afflicted' can't help theirselves. It's essentially the same as a murderer's plea that sie killed because sie was genetically pre-disposed to violence: it doesn't win you acceptance - it wins you pity and treatment in a secure hospital.

And I wouldn't be surprised if that was another reason why psychiatrists love to claim that transsexuality is a medical condition. As long as this is accepted, they become the gatekeepers of hormones, and wield tremendous power over the lives of their 'patients'. You don't have to be a total cynic to see the conflict in interest there.

-Martin

martin, I think you are in a tricky position here.

The documentary evidence for arbitrary gender assignment is based (mainly) on the work of one man, who has been largely discredited due to the success of the first case of reassigning a male after a circumcision accident (don't ask) was found to be almost entirely in his head.

After many years of arbitrary assignment of sex to intersex children, the famous case was traced, and found to have been in psychiatric treatment since before puberty. Eventually, he had a sex change back into being male, and is much happier.

As most of the support for arbitrary assignment was based upon this case, on the doctor in question only mentioned that there were any problems at all after he had retired, the whole subject has been blown wide open again.

There is a difference between intersex and other children. with intersex children they have received enough sex hormones to start the change from being female, but not to complete it.

the anecdotal evidence transgender individuals is much more like that for homosexuals. Most of them seem to say that they knew what they were before starting school. most of them are happier once they don't have to lie about it.

if you are trying to say that trans people are trained to be this way by nurture, then due to the similarity with homosexuality, you are saying the same thing bout gays. not only that, but you are blaming the families for treating them exactly wrong in the first few years of their lives.

While it is possible that you could be right, I would be very dubious of your claims.

As you say, researchers on both sides have an agender, but the agender of a lot of the researchers with your position is fear and hate. while you are probably innocent in this regard, that in it self is a reason to prefer the other position in absence of evidence to the contrary.

similarly the fear by women of male to female transexuals is similar to the fear by men of homosexuals in similar circumstances.

Again I would prefer the least harmdfull conclusion as a working position until enough evidence comes in to prove it either way.

> "arbitrary gender assignment"

That's a false dichotomy. This isn't an either/or case: either gender assignment is purely pre-birth or purely post-birth. As with just about every other complex behaviour, I suggest that it is a combination of genetics, neonatal effects, a variety of social effects, random chance, and an element of free will.

> "you are blaming the families for treating them exactly wrong in the first few years of their lives."

Eh?

A) 'nurture' effects are not limited to the family. In fact, the effect of the family is pretty small (barring severe trauma) compared to the effects of wider society. There are also large quantities of random chance and free will in the mix. There is no single cause to anything.

B) I can't be 'blaming' *anyone* for doing anything wrong, because I don't consider transsexuality (and especially not homosexuality!!) wrong.

-Martin

you pick up on "arbitrary gender assignment", but this was exactly what was done to intersex children, based on the supposedly positive outcome of the one case I mentioned earlier of the person born male, and then supposedly successfully reassigned as female.

once this case was proven to be falsely reported, it discredited the idea that you can do gender reassignment arbitrarily on any children but intersex children, and often not on those.

intersex children are a special case, as they have not completed sexual differentiation, and thus don't necessarily have a full gender identity.

It would seem that I owe you an apology, as due to faults on both sides, your position did not appear too clearly.

Most of the rest of the missunderstanding would be down to having a different "null hypothosis".

My approach to all of these complex issues where the evidence is not very clear is to place the burdon of proof on the more harmfull of the options. As the current methodology of psychiatrists has a failure rate of >80% (on the last figures I saw), this is obviously the worst of the two assumptions.

Having been disbelieved by doctors myself in the past I almost always come down on believing the patient unless there is good reason not too.

As a lot of the trans people (like homosexuals) say that they have known for as long as they remember that they were in the wrong body, I see little harm in treating them as correct, and a lot of harm in psychiatrists making them jump through hoops to get an operation they can buy as simply as a boob job in certain parts of the world if they have enough money.

> "a lot of harm in psychiatrists making them jump through hoops to get an operation"

I see harm in that too - but that's a seperate issue to the nature/nurture question. Suppose it was shown that transsexuality was purely pre-birth. Then the authorities would start asking questions like:

"When did you first want to change sex?"
"What do you feel about your body?"
(etc)

And any failure to give the 'correct' answer ("for as long as I can remember, doctor"; "Oh, I hate it doctor - it's so repulsive" (etc) ), leads to denial of treatment. magine being told by a doctor - "oh, we've done a brain can on you, and the proportions of your brain don't match that of a typical transsexual, so we're not giving you the operation".

In fact, I read a book a little while ago by one Deirdre McCloskey, who said she faced precisely these sort of questions ("what do you think about your penis"), and she'd read the books and knew the 'correct' answers, and happilly lied her way through the interview.

And don't forget the rising trend in post-scanning abortions. It's easy to imagine a consultant coming in with a concerned face to an expectant mother: "Well, according to our tests, your womb has a higher than average level of oestrogen for a male birth, and we're concerned that he may be born transsexual" "Is it definate?" "Not yet, but if he's not transsexual he'll certainly be effeminate" "Oh no! Can we get an abortion?" (etc)

Yes, a position that transsexuality is a post-birth phenomenon can certainly be misused just as much - but I can't see why you think that one position is more harmful than the other. Both could be harmful, if the underlying prejudice remains intact.

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That's why I think the pre-birth/post-birth thing is essentially a red herring. The critical argument shouldn't be "I was born like this, I can't help it". It should be "My body, my choice" - to steal a slogan from the "pro-choice" campaigners. Whether that decision is one of free will, or influenced by pre-birth conditions, or whatever, should be a complete irrelevance.

The rub, of course, is that if you deal with transsexuality in those terms, it won't be paid for by the NHS. Treatment by the NHS, for anything, *has* to come with an assesment of clinical need. Maybe I misunderstood you: when you're concerned about 'jumping through hoops' are you talking about private treatment or NHS treatment?

-Martin

both, but primarily nhs, because if you can afford to go away and spend x thousand pounds, you can have it done privately out of the country anyway.

but not every transexual can afford all those thousands.

When you have psychiatrists acting as a gatekeeper to a non-psychiatric condition, and turning down 80% while leading them on to stop them going anywhere else, then that is unethical.

yet this is what was actually happening at the charring cross gender reassignment clinic.

and all the time the shrink was getting paid to lie to the patient.

The only acceptable reason to turn someone down is on valid medical reasons like alergie to anasthetic or something similarly medical.

This debate reminds me of an interesting debate I had with some of my overty enpusatic PC friends during a lecture! For the background they were outraged that the Senior Tutor had refered to me as having a psychiartic illness.
So if it isn't a psychiartic illness what is it?

It certianly isn't a physical illness in most cases.

If it isn't an illness at all then why am I seeing a doctor about it?

Yes people do see a doctor about other things such as plastic surgery but that's when either....
a) society makes them want to modfity their body such as a women who wishes to have bigger breasts because it will make her more attractive to men. Society trys to make women want to be attractive to men, not be men! So this wasn't the case.
or
b)There appearance is so badly damaged that they wish to have it corrected such a woman who has had one breast removed because of cancer.

There are cases of people who are distressed with perfectly normal bodies, Body dispmorphic disorder i think it's called. But the important difference between this and transsexuality is that when these people have had surgery they are not satisfied.

There were times when I was seeking surgery that I got angry and frustrated with what psychiartists were making me do. But now I realise that they acted entirely correctly and am even thinking of becoming one myself.

The fact is that if anyone is determined enough they can go to a psychiartrist and convince them that they want to have a sex change. iF they go to enough one will say yes. But then if you really want Tamperzan, and addictive anti depressent drug that can be injected you can quiet effectively fact depression one study is shown that it is easy to fake mania.

what is it?

it is a disorder.

it is similar to people who have big noses wanting them to be smaller, and is therefore related to body dismorphic disorder.

but then so are a lot of serious mental disorders as well.

I don't bother too much about the exact definition.

on the whole, I see it as a problem, whoch can be solved medically, and thus the medics should be in the business of facilitating a solution.

Well they should be and by and large most of them are. From what I've heard about Charing Cross these days they are getting a lot better and rejecting people out of hand. The role of the psychiartrist is to check that the patient has though things through properly and isn't doing it as an impulse descion. Surprisingly most people who are refered to a pschy for this and end up not having treatment are because they have decided themselves that they do not want it really.

You can see how someone with another mental disorder might wish that they were actually a transsexual because then they would be able to have an operation to cure it. They might then think that there other problems would go away if they had The Operation

Well, if you want the NHS to pay for something, you need to demonstrate clinical need - that spending taxpayer's money on it is a good use of funds. And that's perfectly acceptable, IMO. Equally acceptable is having some level of *advisory* counselling before any major operation, be it plastic surgery or gender reassignment. Anything beyond that seems dubious...

Does that make any sense?
-Martin

sure that makes sense.

on the question of need, there was a woman recently who developed one large breast, with the other being flat, and they insisted that she wait until she was 22 because it was a "cosmetic" procedure. I am in favour of the approach of having the medic disprove need instead.

Advisory counselling is essential, but the psychiatrist who used to be the gatekeeper at charing cross was caught more than once lying to patients about "proving their stability" when he had no intention of submitting them for the op at all. This to me seems unethical. Although there are a very few occasions where lying to a patient is ok, in just about every normal case it is a massive breach of trust.

if you can't trust your doctor, you won't tell them everything, and they will make even more bad decisions than they normally do. (that sounds a bit harsh, but you know what I mean).