American Psychiatric Association (APA) is currently working on a revision to The Manual for Diagnosis of Mental Disorders (DSM), the principal desktop diagnostic reference for psychiatric diagnosis. The APA has named the Work Groups and membership for the next revision, DSM-V. The APA stresses there will be a greater emphasis on evidence-based medicine.

The Organization Intersex International (OII) responded to the current activities on several different fronts. One of them consist of the following submission from OII Australia and OII Aotearoa New Zealand regarding the appropriateness of including Gender Identity Disorder (GID) in the DSM.

The Diagnostic and Statistical Manual of Mental Disorders (DSM)

The DSM is a guide to what the American Psychiatric Association (APA) terms mental disorders. It is the handbook desktop reference used most often for diagnostics in the US and abroad.

The DSM contains a listing of psychiatric disorders, diagnostic codes, information on the prevalence of each disorder, and diagnostic criteria. The DSM is non-theoretical and does not offer information on causes or treatments.

Mental health professionals use the DSM for a variety of purposes, such as clinical practice, research, and educational purposes. Clinicians also use the DMS-IV to classify patients for billing purposes. The government and many insurance carriers require a specific diagnosis in order to approve payment for treatment.

The DSM has the force of law in a variety of mental health related activities, such as commitment hearings, and is a principal resource used in the development of legislation.

The DSM has gone though five major revisions, with the most recent major update published in 1994.

The current version is a minor variant published in July 2000 that adds clarifying text (DSM-IV, Text Revision). The primary goal was to maintain the currency of the DSM-IV text with the empirical literature up to 1992.

Most of the changes were in the descriptive text, with some error correction and changed diagnostic codes to reflect updates to the ICD-9-CM coding system adopted by the U.S. Government. It is available from the the DSM-IV-TR web site.

DSM-V publication is planned for 2010/11. The APA Steering Commitee says it is open to suggestions and maintains a web page, DSM-V: The Future Manual.

The Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders (SCID-I) is a semi-structured interview for making the major DSM-IV Axis I diagnoses. The SCID-II is a semi-structured interview for making DSM-IV Axis II: Personality Disorder diagnoses.

The official SCID site maintains a list of Frequently Asked Questions (FAQs).

APA DSM-v Policy Initiative:
Gender Identity Disorder — In or Out?

Introducing OII

OII is the world's largest organization representing intersex people and their issues. It is wholly created and managed by intersex people on their own behalf. OII reaches out to its members in ten languages including Chinese (Mandarin) and Arabic.

OII is represented in Australasia by two independent affiliates: OII Australia and, in New Zealand by HBS-NZ.

OII International has appointed myself (Joanne M. Proctor (BA, LLB)) as the board member responsible for issues related to 'true' transsexualism, now becoming known as Harry Benjamin Syndrome.

Preamble

It has become common place to subsume biological diversity in sex formation under the umbrella terms 'gender diversity' and/or 'transgender'. The purpose of this submission is to explain the reasons why this practice is not appropriate when applied to intersexed and true (HBS) transsexualism.

1. HBS./ Transsexualism-Changing the Nomenclature

1.1 The newer name recognizes the contribution of American Endocrinologist, Dr. Harry Benjamin, who first described the syndrome thus:

"True transsexuals feel that they belong to the other sex, they want to be and function as members of the opposite sex, not only to appear as such. For them, their sex organs, the primary (testes) as well as the secondary (penis and others) are disgusting deformities..." (Ch. 2).

— Benjamin, Harry. The Transsexual Phenomenon.

1.2 True Transsexualism or Harry Benjamin Syndrome relates to individuals who experience a life-long conflict with their anatomical sex. The condition is characterized by early childhood sensations of wrongful embodiment and a powerful, often self destructive, discomfit with their reproductive function as adults. Early childhood manifestations of inappropriate 'gender role' behavior are not necessarily a component of this condition.

1.3 There is growing body of evidence that this syndrome is an intersex-like condition involving nuerobiological sex reversal in the human hypothalamus and possessed of a genetic component.

1.4 This new evidence does not support the prevailing theories that regard the condition as psychological and behavioral in origin. According to the current paradigm the syndrome is the result of mis-identification with the opposite sex, primarily caused by inappropriate gender role conditioning during the first two years after birth. The standard diagnosis of "Gender Identity Disorder" is based on that belief. (See "the sex-gender distinction," below.)

2. The legal frame-work

2.1 Australia in particular, is fortunate to have some direction from the full bench of the Family Court in this matter:

In Re Kevin (Validity of Marriage of Transsexual) [2001] FamCA 1074 (12 October 2001).

2.2 OII invites the APA to consider the case commentary, written by the plaintiff's solicitor, Rachael Wallbank. (Wallbank, R: [2004] Deakin Law Review. 22)

2.3 It is respectfully submitted that, for the reasons discussed below and to the extent that this condition is an identity issue at all, Ms. Wallbank's use of the term "sexual identity" is more appropriate than "gender identity" when dealing with the issue of true transsexualism or Harry Benjamin's Syndrome. (HBS). For the same reasons this terminology should also be used in cases of pediatric miss-assignments, where early surgical intervention is demonstrated to be inappropriate at adolescence or adulthood.

3. The Sex-Gender Distinction

3.1 To reiterate this difference, sex refers to the biological and physiological components of human sexual embodiment. Gender refers to the varied social and cultural expressions of maleness and femaleness. Thus sex is biological whilst gender is primarily the product of an individuals social environment, is largely learned, and is demonstrated or expressed by behaviors, mannerisms, dress, etc.

3.2 Recognition of the distinction is important. Gender expression is most commonly regarded as an exhibition or display of sexual or reproductive embodiment. In most cases the two are complimentary of each other. But that is demonstrably not always the case. Males can and do adopt feminine aspects of gender expression without being female embodied. The reverse is also true for females. When an individual adopts a gender expression and role that is considered socially appropriate to the opposite sex, he or she is said to be transgender. (Transiting gender.)

3.3 Some, though not all, transgender people make physical changes to their bodies to enhance their adopted gender role and expression. These physical modifications are not necessarily an indication of true transsexualism ( HBS), or any other form of biological variation.

3.4 OII supports and upholds the rights of all individuals, including intersexed and true (HBS) transsexuals, to adopt and express their sense of 'engenderment' by whatever manner best suits their personal needs.

3.5 OII has valid reasons for concern when concepts such as gender identity and gender expression are used as a basis for attempting to manage and control biological diversity, such as that found in the intersex conditions and true (HBS) transsexualism.

3.5.1 The theory that gender role conditioning in the early post-natal years can override any innate or genetic predisposition involved with predetermining the experience of individual sexual embodiment and function was discussed briefly in Paragraph 1.4 (above).

3.5.2 Many OII members have suffered substantial harm due to the clinical application of this belief. Since the late 1960's it has been common practice to surgically modify the genitals of infant's with so-called ambiguous genitalia and raise them as if they had born with the reconstructed organs. This has been done in the belief that they would self identify with the sex they were gender role conditioned into believing they belonged to. (Hence the terms 'gender identity' and 'gender assignment'.)

3.5.3 This deception is often compounded by the deliberate withholding of information on the birth status in the belief that the individual's 'gender identity' will be unstable if they are told the truth. Many intersexed individuals grow up experiencing similar sensations of physical incongruity and confusion to that experienced by true (HBS) transsexuals as a direct result of this practice.

4. Suggestions and Conclusions

4 -1 The practice of including Intersexed and True (HBS) transsexualism under the general rubric of gender diversity and/or 'transgender' is misleading and inappropriate.

4-1.2 Changing nomenclature in the case of true (HBS) transsexuals, to reflect recent neurobiological and genetic research is desirable and would assist in the development of better understanding among health professionals, educators and youth advisers such as school counselors etc. The changed nomenclature should reflect the fact that true or HBS transsexualism is first and foremost an embodiment issue, and secondarily a gender issue.

4-1.3 This approach would allow all professionals who come in contact with the syndrome to understand the profound distress that puberty causes to adolescent and pre-adolescent children with true (HBS) transsexualism, and who are either experiencing or approaching puberty. The danger of self harm at this time cannot be overstated.

4-1.4 The possibility that children and adolescents who exhibit signs of true (HBS) transsexualism began life with an intersex condition should not be eliminated without thorough investigation. This situation can easily occur where an infant has been subjected to pediatric gender assignment without their knowledge.

4-2 Legal frameworks should reflect the Australian decision in Re Kevin. Ms Wallbank's usage of sex rather than gender identity should be adopted, where appropriate, in legal documents to reflect the focus on the biological and embodiment issues rather than gender role expression and behavior.

4-2.1 To achieve this the APA should acknowledge the fact that almost all recent legal decisions involve usage of The DSM-iv(TR) and the WPATH Standards of Care. Neither of these resources accord meaningful recognition to the neurobiological components of human psychosexual development or to the experience of anatomical incongruity that is experienced by true (HBS) transsexuals, as well as many intersexed people following pediatric gender assignment.

4 -2.2 This lack of recognition results from a 'blanket' over reliance on a paradigm constructed in the mid-1950's, and which is demonstrably inapplicable to the experiences of many intersexed and true (HBS) transsexuals. The APA should recognize and take responsibility for the influence it exerts on evolving legal frameworks.

4-3 The sex-gender distinction needs to be clearly recognized and understood by all professionals. The failure to understand this distinction can readily lead to uncertainty or misdiagnoses by health professionals, inappropriate support delivery to individuals with true (HBS) transsexualism and the perpetuation of misconceptions into the wider community.

4-3.1 The APA, through the new DSM-v, can and must accept responsibility for ensuring beyond any doubt that these issues are not confused in future editions.

Conclusion

Whilst OII fully supports the rights of all people to adopt whatever mode of self expression best meets their personal needs, it is vital that clinicians and other professionals recognize that the degree and manner to which individuals express gender should always be a personal decision.

OII is fundamentally opposed to the proposition that gender can and should be used in an attempt to exert control or influence over intersexed embodiment and other biological diversity in sex formation.

Intersex and true (HBS) transsexualism can and should be excluded before any diagnosis predicated on gender behavior and expression is considered.

Other expressions of gender role behavior contradictory of birth sex are a matter for the APA and do not fall within the ambit of this submission.

The TS-Si News Service is a collaborative effort by TS-Si.org editors, contributors, and corresponding institutions. Sources can include the cited individuals and organizations, as well as TS-Si.org staff contributions. Articles and news reports do not necessarily convey official positions of TS-Si, its partners, or affiliates. We welcome your comments. Use the form below to leave a public comment or send private correspondence via the TS-Si Contact Page. We will not divulge any personal details or place you on a mailing list without your permission.


TS-Si is dedicated to the acceptance, medical treatment, and legal protection of individuals correcting the misalignment of their brains and their anatomical sex, while supporting their transition into society as hormonally reconstituted and surgically corrected citizens.

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Some very small refinements and the reasons why, I have

06 August 2009     

I have been in communication with the original author and she thought I should post my comments here as she thought I raised some interesting points. First I think that this is only half of what is needed. Simultaneous to this effort should be a push for Recognition of the medical condition with the AMA. This may not be important anywhere but the United States, but it is here. In the US: Even though our insurance often does not cover treatment for transsexualizm, some policies do. However insurance companies always insist on a “Condition” or “Diagnosis” for any treatment. Therefore we need a MEDICAL definition of a “condition” to be able to get any help. Else we will have to pay out of pocket for EVERYTHING. It seems to be a legal / medical requirement thing. Now for a suggested refinement: In the conclusion section is the following: “Intersex and true (HBS) transsexualism can and should be excluded before any diagnosis predicated on gender behavior and expression is considered.” I suggest it be changed to something like: “Diagnosis predicated on gender behavior and expression, has proven unreliable in that it has falsely diagnosed Intersex and true (HBS) transsexualism as an identify disorder. This false diagnosis is harmful both legally and in the social stigma associated with such a diagnosis” My Reasoning for the suggested change: I was trying to think, in practical terms, what the proposed changes to the definition might mean to someone seeking transition. The APA's new definition would still use gender behavior and expression to define some "disorders" but the Intersexed and HBS would have exclusions. Would the APA still be the gatekeepers to treatment? Would I have to prove that I am a "true Transsexual"? It would be against the interest of a psychiatrist to come to that conclusion. If he “can not determine” that I meet the definition, or comes to a conclusion that I am only a type IV Transexual no-op, then he would be able to “treat” me. Thus it is in his monetary interest to deny that I am a “true transsexual”. An obvious conflict of interest. Thus my Idea of removing “gender behavior and expression” as the sole diagnostic determinate. From what I have read, “GID” is the only “disorder” in the DSM to use a simple behavior to come to a diagnosis. Other “disorders” require something in addition to a behavior to reach a diagnostic conclusion. I put in the “harmful” terminology because it has been reported that in one of the meetings of the APA that discussed the definition of “GID”, one of the members commentated on “what harm is it to be over inclusive” (or something to that effect). If that attitude is not changed, the APA will not make a change to exclude the intersexed and 'true (HBS) transsexuals” no matter what evidence is presented. I want them to KNOW how we have been harmed, and how they have broken the primary rule: “First do no harm” In the conclusion section is another paragraph that states: Other expressions of gender role behavior contradictory of birth sex are a matter for the APA and do not fall within the ambit of this submission. I suggest changing to: Other expressions of gender role behavior contradictory of birth sex are a matter for the people that exhibit them and do not fall within the gambit of this submission While there may be no evidence for a medical condition, there is also no evidence for a DSM worthy “disorder” for some of the “Other expressions of gender role behavior”. This change would not throw anyone else under the bus. Let each speak for themself. I fear that if only an exclusion is added to the definition, then everyone will be ASSUMED “disordered” until they prove otherwise. (And I do not trust the APA to be the judge)

Jennifer White

Under the bus ???????, It was not the intention of this

06 August 2009     

It was not the intention of this submission to "throw anybody under a bus." The transgenderism ideology was well represented, by Traci O'Keef at least, who got speaking rights at podium. An offer that was not advanced to an OII representative. Lynn Conway also spoke. TG people of all stripes made submissions to the APA on this issue. The OII submission was presented in an attempt to press home the point that including individuals with biological variations in sex formation in the DSM was not in the best interests of those individuals. It is anybody's guess what compromise solution will emerge from the lobbying that has taken place over the past twelve months.

Joanne

Evidence, There is plenty of evidence that intersex and

06 August 2009     

There is plenty of evidence that intersex and transsexualism are medical conditions. Let me be clear about something: I believe the DSM is way past its shelf date and should be dropped altogether. For more on this see my column, Grey Lady Down: The Wreck of the DSM. The DSM is propelled by a whole lot of professional interia and the cultivation of employment opportunities for therapists, etc. A truly useful desktop reference for physicians would have different sponsorship and scope. Having said that, the DSM will no doubt hang around in one form or other for some years. Even if the DSM-V revision is cancelled and the handbook abandoned, people would still use the old versions, selectively exploiting the contents to serve their predilections. We might as well try and make it better. Including the products of bogus history, like "type IV Transexual no-op" could only make matters worse. All they have to do is encourage that kind of ignorance and deny treatment to classic transsexuals (as not that bad, after all). It would affect both hormones and the availability of surgery. Not good.

Sharon S. Gaughan

type IV Transexual Magical no-op, WTF? I would like to b

06 August 2009     

WTF? I would like to be a type 1.25 natal woman with .8 shades of transsexualism. Transsexuality is not Baskin-Robbins. We do not come in hundreds of flavors. Either you is or you isn't. If you is, you're working towards surgery. Everything else is, in Penn and Teller's words, BS. Transsexuality is not a support group or a political action committee. It is not a twelve step program. If you don't want to be transsexual, fine. Good for you. Most people, 99.999999% of all humanity is NOT TRANSSEXUAL. Be whatever and whoever you might be -- but don't go changing the definitions so you don't feel left out. Transsexuality does not exist to make you feel better about yourself. If you are transgender, say you are transgender -- what are you ashamed of? Quit playing games and get on with your life. Life is not high school or a university campus. Make a decision and go back about living your life.

Lisa Thompson

..., Kiaora, Lisa. I have a different interpretation o

06 August 2009     

Kiaora, Lisa. I have a different interpretation of this comment - which seems to be causing concern: Would the APA still be the gatekeepers to treatment? Would I have to prove that I am a "true Transsexual"? It would be against the interest of a psychiatrist to come to that conclusion. If he “can not determine” that I meet the definition, or comes to a conclusion that I am only a type IV Transexual no-op, then he would be able to “treat” me. Thus it is in his monetary interest to deny that I am a “true transsexual”. An obvious conflict of interest. I do not read the author as claiming to be a "type iv transexual." She is simply pointing out that there could be financial advantages for therapists (In the USA) were they to reach that conclusion about her - regardless of her own personal experiences, which indicate that she is not. I think we are about at the point now where a PET scan will resolve that problem. If not that must be very close as a diagnostic tool. That should remove the 'shades of transsexualism' argument from the equation. No doubt Sharon will be more up to date with this than I.

Joanne

Indeed, Positron emission tomography (PET) is very close

06 August 2009     

Positron emission tomography (PET) is very close to having the capabiliy to produce a three-dimensional image of functional processes in anyone's brain, bringing us closer to its use as a descriptive tool. Even more important are the basic research findings that show how an individual's neural crest (the progenitor of our neurobiology) can form in a generally correct manner but be left isolated in part or whole by a malfunctions in the execution of the brain's matching body plan. This represents the true join point between intersex and transsexuality.

Sharon S. Gaughan

Lisa's remarks, were largely rhetorical. I added this be

06 August 2009     

were largely rhetorical. I added this because she is busy wih a coughing fit right now.
Sharon S. Gaughan

..., Everyone seems to ignore my first point. Define the

10 August 2009     

Everyone seems to ignore my first point. Define the medical condition. IN WORDS. Get it recognized as a medical condition by a medical organization. Get in published in their book of conditions (sorry I do not know the name of the AMA’s book). Getting this done is different than research or proof, It must be RECOGNIZED by an accredited body. Without this definition and RECOGNITION in a manual, the people filling out forms to insurance companies will not have a box to check. Thus- it will be harder to gain treatment (should the APA follow the reconditions and put in the exclusion for intersex and True Transsexuals). My second point is primarily: If you only have an exclusion, The presumption is that you have a “Psychiatric Disorder” until you prove your membership in the excluded class. How will we have to “prove” this? Also even if you get the exact wording you want in the DSM (with the Exclusions added), the Definition of the term “true (HBS) transsexualism” will control who gets what kind of treatment. Without a medically recognized definition, it will be left open to interpretation, which could be harmful to people seeking treatment. It seems a conflict of interest to let the APA define the term, so it must be defined by some other medical body. On a note on the terminology I have used: As the article uses the term “true (HBS) transsexualism” , and HBS usually stands for Harry Benjamin syndrome, I tried to use the terminology in “The TRANSSEXUAL PHENOMENON” by Harry Benjamin, M.D available at http://www.symposion.com/ijt/benjamin/index.htm . Dr. Benjamin, was the first to use the term “transexualism” (August of. 1953). In his paper “The Transsexual Phenomenon” Dr Benjamin, has a table ( http://www.symposion.com/ijt/b...2table.htm) which lists 3 Different types of Transsexuals. Type IV TRANSSEXUAL Nonsurgical, Type V TRUE TRANSSEXUAL Moderate Intensity, and Type VI TRUE TRANSSEXUAL High intensity. It should be noted that Dr. Benjamin said the following about the table: “The clinical pictures are approximations, schematized and idealized, so that the TV and TS who may look for himself among the types will find his own picture usually in between two recorded categories, his principal characteristics listed in both adjoining columns” As this was the first defining paper on the subject, it’s definitions might be the ones applied, should the proposed changes be made to the DSM. (Sorry for my substitution of “non-op” for “Nonsurgical” in my comment, My mistake.) If you have better definitions of terminology that we should use when making comments, please include a link so that we (your readers) can better communicate our thoughts in a coherent manner. Lisa: To Quote you “ ... 99.999999% of all humanity is NOT TRANSSEXUAL) What only 1 in 100,000,000? That would make only 3 Transsexuals in the US or 67 in the whole world! I think it is more common than that.

Jennifer White

Define the medical condition., Define the medical condit

10 August 2009     

Define the medical condition. In words. Get it recognized as a medical condition by a medical organization. http://www.gires.org.uk/assets...AMA122.pdf Don't think you have a 'recognition' problem here Jennifer. What does exist is a serious 'definition' problem. It would be nice if the OII submission were to offer some guidance in that regard. But you must remember that a raft of Gay and TG support groups have also offered up their, different interpretations. Many of these are perfectly aware that the imminent development of a relatively certain diagnostic test (say between 90-95% positive) will preclude access to genital surgery for those TG's who decide to access it. They want the GID diagnosis kept in the DSM for their benefit! Finally, as the writer of this submission let me say that I am not overly 'hung-up' on the 'classical (HBS) label'. I used it in the submission because it was what I had available at the time. Benjamin's book was written over 50 years ago. With all due respect to the man, he was expressing his opinions using the prevailing knowledge of his day. He didn't get everything right and it would be fallacious to regard "The Transsexual Phenomenon" as the font of all wisdom in this issue. I say this because Benjamin's attempts at constructing a hierarchical continuum, starting with transvestism and ending with his two types of transsexual, has actually helped create the problems we face in trying to find a distinct and separate 'voice'. My Australian OII counterpart (A CAH affected woman) once suggest that 'Gooren-Swabb Syndrome' would be more fitting than 'Classical (HBS) Transsexualism'. Personally, I agree with her! Hope this helps. Jo. xxx

Joanne

Medicalizing Transsexualism, There are a great many amon

10 August 2009     

There are a great many among us who seek full recognition of transsexualism as a medical condition. Jennifer White mentioned the AMA. This is a big subject with which I have direct experience. FACTS I can't cover all of it here, but here are a few facts to consider: - The American Medical Association (AMA) represents retired and practicing physicians, medical students, residents, and fellows in the United States, with only liaison to non-USA societies. The AMA does not have a "book". - The AMA cohort includes less than 20% of the potential and eligible membership. - AMA critics point to what they consider a "guild" emphasis which seeks increases in physician wages and fees while simultaneously imposing limits on the supply of competitive physicians and non-physicians. - A "medical condition" is the responsibility of professional societies around the world that may work with the AMA, but are not the same as the AMA. Certain countries with advanced medical care often have their own national medical socieities. - Other medical societies usually organize around specialties that potentially encompass a variety of physical conditions and/or diseases. The founding and development of such societies often parallel increased understanding of the associated conditions and/or diseases. - The American Psychiatric Association (APA) is the custodian of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which includes certain paraphilias and non-paraphilias (e.g., transsexualism). - The AMA cites both the DSM and the World Professional Association for Transgender Health (WPATH) as authorities for matters relating to what has evolved as a very broadly defined condition: Gender Identity Disorder (GID). This has the effect of placing the APA and WPATH as authorities on transsexualism. - The combined influence of these two organizations extends to national medical codes that are used throughout the world, all of which are moving toward the International Classification of Diseases (ICD), as promulgated by the World Health Organization (WHO). Thus, transsexualism is recognized as a medical condition, however inappropriate that representation may be (see "Opinion", below"). MEDICAL SOCIETIES & SUPPORT ORGANIZATIONS As an example of how medical societies are organized, you can navigate to MedlinePlus, a joint project of the U.S. National Library of Medicine (NLM) and the (US) National Institues of Health (NIH). It contains a large number of American medical and support (or statistical organizations). Click on the titles below to see the NLM/NIH listings. - Organizations in alphabetical order. - Organizations grouped by health topic. OPINION In my opinion, the problem with this type of recognition breaks down to a few basic issues: - APA Sponsorship: The APA, through the DSM, works at cross-purposes. It acts both as an entry point for the application of diagnostic criteria and - as a medical society - maintains its own approaches to treatment. The APA approach to most other situations only deals with cases where the affected individual is experiencing adjustment difficulties, not with the underlying condition (or disease). - WPATH Participation: The Harry Benjamin International Gender Dysphoria Association (HBIGDA) had limited support due to the relatively small patient population. It was taken over and expanded into an organization that advocates a transgender focus. This happened much to the consternation of experienced counselers and therapists who knew first-hand the difference between transgender and transsexual subjects. Moreover, WPATH has only a limited medical perspective. - Research Pardigm Change: The development of the DSM under the APA, as well as the rise of WPATH as a transgender advocacy organization occurred in parallel with - but ignorant of - substantial advances in biology (especially neurobiology) and other key sciences. They have even less knowledge of developments on the horizon. - As a result, the pronouncements of APA/WPATH on the subject of transsexualism have virtually no scientific value. SOLUTION A new medical society should be formed that serves researchers and practitioners who encounter patients with a misalignment of the innate neurobiology and external genitalia. Strange, a number of people are working on just that problem. TS-Si is just one organizational entity with this charter. We see movement within the research and professional practice communities that fuel our optimism that a better day is coming. However, there is still a lot of work to do.

Sharon S. Gaughan

Rhetoric Aside (work the math) on the number of transsex

10 August 2009     

On the statistical prevalence of transsexuals. As a working percentage, assume that 0.01% of the general population is transsexual.It's as good a figure as anyone elses. There are approximately 350,000,000 (350 MILLION) people in the United States. 0.01% of 350 Million is 35,000 transsexuals alive and well in the United States. Where are they? I suspect that estimate is high. There are approximately 7,000,000,000 (7 BILLION) people in the world as I write this. If 0.01% of 7 Billion, that makes it 700,000 transsexuals walking the earth. I find that figure highly improbable and unsupported by any scientific research. That's a hell of a lot of estradiol even if half on them are female to male -- Wyeth would be ecstatic.. If there are 700,000 transsexuals on the planet, where the hell are they? They can't all be hiding on the Chinese mainland.

Lisa Thompson

The Benjamin Scale, Much has been made of what has come

10 August 2009     

Much has been made of what has come to be called the Harry Benjamin Sex Orientation Scale (S.O.S.). The "scale" was an early attempt by Benjamin to organize data on the patients he had actually seen and only heard about. Benjamin was confronted by what was then a lot of data that made no sense to him so he constructed what was essentially a "scatter plot" of the data to evaluate whether there were any meaningful trends. He used the existing scale for sexual orientation, as developed by Dr. Alfred Kinsey, to distinguish between "true transsexualism" and "transvestism". At the time, Benjamin's own perception of homosexuality was one shared by men in general - that it involved homosexual men who adopted a female sex role. As a result, the scale conflated sexual orientation with perceived cross-dressing for homosexual purposes. We know now that sexual orientation has nothing to do with what he observed. Benjamin himself noted that the "scale" he used was a going-in attempt to classify and understand various forms and subtypes of transvestism and transsexualism in biological males. Like any such attempt, it was part of hypothesis forming. As noted, sexual orientation proved to be questionable (even to Benjamin), as well as the implied escalation from "transvestite" to "true transsexualism". Benjamin's book, the The Transsexual Phenomenon (1966), is often used to recount this history. However, such accounts selectively quote from his book and ignore his professional papers and personal communications. We must remember that Benjamin developed this scale to differentiate between transvestism and transsexualism. It had notable limitations: - The scale applies only to male-to-female transsexuals, forcing a direct comparison with cross-dressers (including performance artists and Drag Queens) and transsexuals. - The scale assumes that transsexuals are "attracted to males", ignoring transsexuals who are attracted to females. This, of course, went beyond being a limitation, but called into question the entire approach, as it imposed a bias that that created an equivalence between homosexual cross-dressers (including performance artists and Drag Queens) and transsexuals. - The scale is biased towards later-presenting transsexuals, adding value to those who had the time, money, and opportunity to work on physical presentation issues, such as such as electrolysis, full-time living as a woman, and surgery. Benjamin himself noted that "It has been the intention here to point out the possibility of several conceptions and classifications of the transvestitic and the transsexual phenomenon." That is: given the imposed limitations on the patients he had actually seen and only heard about. Tellingly, Benjamin noted that "Future studies and observations may decide which one is likely to come closest to the truth and in this way a possible understanding of the etiology may be gained." - within the limitations he set on the data reduction step in his anaysis. (Benjamin, H. (1966). The Transsexual Phenomenon. New York: Julian Press. Page 24.) In other words, Benjamin left the matter as an open question, a fact willfully ignored by those who selectively quote and assess Benjamin to fortify a transgender spectrum position.

Sharon S. Gaughan

Harry Benjamin, I would certainly be reluctant to treat

10 August 2009     

I would certainly be reluctant to treat too many of Benjamin's speculations as postulates. Initially I think he recognized that he was on to something. He also knew full well that the research techniques of his day were not sufficient to discover what that was and left the question open. Three years later he wrote the introduction to: Green, R and Money, J (eds.)1969. Transsexualism And Sex ReassignmentBaltimore. Johns Hopkins University Press. pp1-10. In the intervening three years he appears to have fully adopted Money's ideas about identity acquisition. The introduction to Green and Money actually defines transsexualism as a 'gender identity' issue. A term he did not utilize once in The Transsexual Phenomenon.

Joanne

The intersex link, This is an interesting discussion! W

11 August 2009     

This is an interesting discussion! What I'd like to know is how OII feels about the creeping transgender politics. For example, I see now on Bilerico someone has created a category for "Trangender and Intersex". I am reminded of the time when things were "Transgender and Transsexual". And of course before that, it was just "Transsexual", apart from Gay politics in any sense. Is this an attempt at colonization? And if so, how do intersex activists feel about it?

Ariablue

..., Bilerco is not known for sensitivity! http://oiiin

11 August 2009     

Bilerco is not known for sensitivity! http://oiiintersex.nz.googlepages.com/terrninologyandlanguage This is a true copy of the OII position, amended only by the insertion of the words OII-NZ, other than, say OII Australia. Cheers
Joanne

OOPS!, Sorry! - try: Terminology and Language Jo.

11 August 2009     

Sorry! - try: Terminology and Language Jo.
Joanne

Thanks for the link and, I like you suggestion of Gooren

12 August 2009     

I like you suggestion of Gooren-Swaab syndrome. You make an excellent observation about the need to get away from Harry Benjamin. Not only should we move away from his sexology perspective, but Harry is the bridge that allows the TG leadership (such as it is) to link themselves with our birth condition. We need less (read no) connection to "gender identity" and more connection with the hard sciences as studied by contemporary scientists like Gooren and Swaab. I think this would be received much better by the people who need to be convinced.

Ariablue

..., I think we should be patient and avoid falling into

13 August 2009     

I think we should be patient and avoid falling into the trap that HBS fell into. Any change to Gooren Swaab or any other such term however attractive, should not be made before medical practitioners have supported the change and have standardised a diagnosis and course of treatment. The next change that is made needs to stick and be credible.
Evangelina

Isn't that what was just said?, How do you suppose that

13 August 2009     

How do you suppose that medical practitioners are going to adopt a treatment protocol in any case? Doctors are not going to lead on this, they will only follow. Before any real change can happen, certain things need to fall into place. The first thing that needs to happen is the destruction of the transgender paradigm as a social, and legal, concept. Nothing short of a complete return to the truth is going to work. What happened to HBS was that people played the transgender name game, and got mired in ridiculous identity politics and turf wars. It was just an extension of the same BS that has been going on for 15 years. What is being suggested, if I am understanding Joanne, is a complete departure from that paradigm. Gooren-Swaab or whatever you call it must arise naturally from the science. Once it is solid, then it can be named by the scientists and medical authorities themselves. I don't think anyone is suggesting a political-type identity solution to the problem. One thing is clear; things have to change.

Ariablue

Paradigms and Naming Conventions, The paradigm change th

13 August 2009     

The paradigm change that took place between 1972 (Man and Woman, Boy and Girl published) and the end of the 1970's had the effect, IMHO, of moving scientific understandings on sex, sexuality and sexual embodiment backwards by at least 50 years. In the 1950's feminist discourse was properly questioning the existing 'biology is destiny' paradigm. But thanks to Money's theories, that was replaced with the other extreme: a wholly environmental model predicated on a behaviourist/nurture process. The paradigm change was catalysed by the so- called John/Joan case. Between 1972 and Diamond & Sigmundson's revelations of its failure in 1997, at least two and an a half generations of health professionals, psychologist, sexologist and various other, lesser, potential experts, had passed through their academic programs. All being taught that the experiment had been successful. Science philosopher, Thomas Khun, tells us why Money's theories remained in situ following those revelations. “Once an organized system of looking at things becomes established, a scientific theory is declared invalid only if an alternative candidate is available to take its place.” ( Kuhn, Thomas S. 1970. The Structure of Scientific Revolutions, 2nd edition. Chicago: University of Chicago Press.) Effectively, by 1975, Money's theories had become entrenched as the new paradigm. I think scientists of all stripes now blindly continue to recite the terminology and concepts of the identity paradigm precisely for the reasons Khun described. The unfortunate reality for transsexed and intersexed is that we have embodiment issues that the current paradigm was not developed for, and cannot comprehend. Both aspects of the human condition can and do create psychological issues. Both are caused by biological variations in sex formation. A very similar situation existed when microscopes were invented in the 16th century. Back then people believed in spontaneous generation. Build a haystack and it would spontaneously generate mice. Cockroaches were spontaneously generated by dark inaccessible corners, etc. When the first sub-microscopic images were seen, they were interpreted as the eggs, or 'seeds' of spontaneously generated creatures. Louis Pasteur put an end to that belief in the mid-1800's, but the arguments lasted for 250 years and are a powerful lesson in what happens when pseudo-science and faith is used to interpret the discoveries made by hard science. I leave it to you all to draw the parallels between spontaneous generation and Money's notions of 'gender identity. I don't understand how naming conventions work. I do know that so long as researchers continue to interpret new findings using the identity paradigm there will be no change!

Joanne

Paradigm has shifted, We can't add much to our comment e

13 August 2009     

We can't add much to our comment earlier on the science article (Coufal and Gage). For this discussion, we think the paradigm is already shifting. It is the behaviorists and social engineers that lag behind. Please remember that behaviorism pivots on the learning perspective where physical action, including our internal physiology, is a set of modifiable behaviors. It is the Voodoo idea of science, as promulgated by New Age practitioners. Speaking as scientists, it is our idea of pseudoscience. It is like saying you could have a nice outdoor vegetable garden on Pluto if only your psychiatrist could rid you of your inhibitions. Fly too close to the Sun, much? Science in the hands of mature adults will inform us all. This site proves it.

Bob and Linda Archturo

Paradigms, Naming Conventions and Memes., This is an ext

13 August 2009     

This is an extract of a letter to the APA regarding the issues raised in the above submission. It was written by a biologist with a Ph.D in the field, and an individual who I respect highly. I have personal contact with this author and will hopefully dissuade her from making such assumptions in regard to classical transsexualism in the future. The passage demonstrates the power of John Money's meme. The moment a description of the T/S experience is required the meme slips into place and is used ... over and over again. What it describes is a typical transgender scenario. I advise the American Psychiatric Association to follow the example of the American Psychological Association in encouraging legal and social recognition of all people that is consistent with their gender identity and expression. The APA should affirm in a position statement the dignity and legitimacy of individuals who have transitioned their social gender roles, regardless of their physical anatomy or assigned birth sex. The full letter can be read HERE: http://drdrantz-sciencesexuali...atric.html I'm sorry - but this could have been written by Money himself - and does not indicate anything other than an entrenched fixation with the identity paradigm!

Joanne

What's it going to take?, I mean, somebody died in a hig

13 August 2009     

I mean, somebody died in a highly publicized case and yet Money's ideas remain untouched. Somehow people, even scientists, still think that our minds exist in some netherealm, floating apart from the world yet still partly shaped by it. Not the part that is governed by chemicals and meat of course, but the thoughts and influences of people older than ourselves at the time we became aware of our own consciousness. It is some kind of neo-Freudian fetish for the childhood-based root of all things. Is this mainly an American failing, or are scientists in other countries just as enamored with these wispy musings? Irritating. Maybe it is part of that Greek tradition of believing that ideas are concrete things that live in an abstract world just out of our reach. Who knows. But what is it going to take to bring people out of their magical thinking and back to the lab?

Ariablue

..., The answer is, essentially no. Take a look at thes

14 August 2009     

The answer is, essentially no. Take a look at these three recent articles and look at the way the researchers attempt to interpret their findings in the context of Money's 'identity' paradigm. 2005 Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus The present findings of somatostatin neuronal sex differences in the BSTc and its sex reversal in the transsexual brain clearly support the paradigm that in transsexuals sexual differentiation of the brain and genitals may go into opposite directions and point to a neurobiological basis of gender identity disorder. http://jcem.endojournals.org/c.../85/5/2034 2008 A sex difference in the hypothalamic uncinate nucleus: relationship to gender identity We propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain and that the changes in INAH3 and the BSTc may belong to a complex network that may structurally and functionally be related to gender identity. http://brain.oxfordjournals.or...31/12/3132 2009 Regional gray matter variation in male-to-female transsexualism "Gender identity—one's sense of being a man or a woman—is a fundamental perception experienced by all individuals that extends beyond biological sex...MTF transsexuals show a significantly larger volume of regional gray matter in the right putamen compared to men. These findings provide new evidence that transsexualism is associated with distinct cerebral pattern, which supports the assumption that brain anatomy plays a role in gender identity." http://www.sciencedirect.com/s...29fd2565d2 Absent of the paradigm change of the 1970's these research findings would have been interpreted very differently, and almost certainly as indicators of psychosexual status. The only sense I can make of the 'identity interpretations is by falling back on Kuhn's dictum. To repeat it: “Once an organized system of looking at things becomes established, a scientific theory is declared invalid only if an alternative candidate is available to take its place.” ( Kuhn, Thomas S. 1970. The Structure of Scientific Revolutions, 2nd edition. Chicago: University of Chicago Press.) The 1970's paradigm change completely re-focused the discourse of that time. When the duplicity of Money's reportage was finally revealed, the ideas, beliefs, concepts and terminologies were entrenched: back to Kuhn! The 'spontaneous generation' arguments are also pertinent because they indicate that these kinds of misinterpretations, once entrenched, can remain so for a very long while. And interpreting TS brain sex reversals as 'gender identity' related does not signal paradigm change. These interpretations merely argue that the new research findings help, in some way or another, to explain why classical transsexuals acquire the desire to act in the opposite gender role. Money's paradigm is totally intact, except that the 'psychosexually undifferentiated at birth' theory has been worked around!

Joanne

TS brain sex reversals?, Perhaps our brain sex is establ

14 August 2009     

Perhaps our brain sex is established very early in our development, (comparatively) long before the emergence of our limbs and other structural components. It might not be a case of "brain sex reversal" reversal at all, but a poorly executed body plan. If so, statements like "... classical transsexuals acquire the desire to act in the opposite gender role" become obviated. The accumulation of evidence suggests that a "psychosexually undifferentiated" individual at birth does not exist. Some sort of differentiation takes place, no matter what value we may place on the particular configuration.

Sharon S. Gaughan

Organization - activation, The accumulation of evidence

18 August 2009     

The accumulation of evidence suggests that a "psychosexually undifferentiated" individual at birth does not exist. Some sort of differentiation takes place, no matter what value we may place on the particular configuration. Your understanding of biology is far greater than mine, Sharon. Personally, I think that individually, genetic and endocrinal organization-activation is as unique as any fingerprint - and as capable of being sex reversed as any other supposedly dimorphic aspect of mammalian biology!

Joanne

Sexual Genotype & Phenotype, Joanne, any differences you

18 August 2009     

Joanne, any differences you note are more apparent than real. I am talking about something different from - and a complement to - your position. TS-Si.org carries thousands of of articles and research abstracts that examine basic questions of first-order interest. That is, what are the mechanisms that underlie the developmental sequence, including variations, that result in, well, us. Having said that, here is some additional background. Scientists developed the classical organization-activation model of hormone action to distinguish between two types of male polymorphic systems in nature. The phentype of an organism is a consequence of a genotype's interaction with its environment. Past biologists - and present-day advocates - place a strong focus on the role of sex steroids in the translation between sexual genotype into phenotype. The natural presumption at first was that of a 1:1 relationship. A male genotype results in a phenotypical male; a female genotype results in a phenotypical fe male. But the continuing notice of plasticity in phenotypic development forced at least a partial reassessment. -- In a fixed system, individual males are characterized by a single persistent phenotype throughout their adult lives. -- In a plastic system, at least one change in phenotype is possible. This is commonly referred to as sex reversal. The plasticity hypothesis provides general predictions that the organizational influences of hormones are more important in fixed systems, while the activational influences of hormones are more important in plastic systems. This provides analogies to sexual differentiation as it was understood prior to the elucidation of development processes at the cellular level upstream from the formation of endocrine systems. There had been a great deal of attention paid to the influence of hormones on sexual differentiation, but nagging questions remained regarding the the overall process of sex differentiation. There is a state often interpreted as between fixed and plastic where sex has not been wholly reversed but somehow seems like it has been somehow interrupted or interfered with. This posed a quandry since such cases were not a good fit with existing models. Moreover, while the plasticity hypothesis provided verifiable results within its constraints, the source of even those results could not be wholly explained by endocrinal sources. After all, sex differentiation includes hormones, but also how the endocrine structures that arose to manufacture and deliver those substances. How does this happen in the first place and how do they map to genomic/genetic drivers present in our DNA at conception? In other words: even if a brain is awash in hormones contrary to the morphologically external phenotype, how did the organizational capability to do so come about in the first place - and what triggers (activates) the event. To wrap up, please remember that older biology refers to "within-sex" variation as an observation of discontinuous behavioral variation as gauged against externals. For instance, see: -- Settlement preferences and recruitment of the bryozoan Bugula neritina on drift macroalgae in Mosquito Lagoon, Florida. M. J. Abgrall, and L. J. Walters. American Zoologist 2000 40(6):925-1273. doi: 10.1093/icb/40.6.925 -- Hormonal Control and Evolution of Alternative Male Phenotypes: Generalizations of Models for Sexual Differentiation. Michael C. Moore, Diana K. Hews, and Rosemary Knapp. Integr. Comp. Biol. February 1998 38: 133 - 151. These approaches rely on external identification to determine sex and assess variations from the perceived norms as behavioral.

Sharon S. Gaughan

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