The Causation of Gender Dysphoria
Aug 6, 2007
(Adapted from a letter I sent to a beloved Christian sister who asked me, as a doctor, to try to explain what causes people to be born with Gender Dysphoria.)
In order to understand the multiplicity of possible causes of Gender Dysphoria (GD;also known as Transsexualism) it would be helpful to again visit the analogy I have used previously regarding epilepsy. I stated that just because a boy that Jesus healed who had epileptic fits (Mat 17) was demon-possessed, that did not mean that ALL seizures have demonic causes. Same thing is true of GD- or at least those who "outwardly" manifest the behaviors that one would associate with transsexuals.
The visible manifestations of epilepsy- the grand mal seizures everyone is well aware of- may be produced by many different causes- drugs, medication overdose, extremely low blood sugar, meningitis, head trauma, tumors, et. al. But many cases are “idiopathic”- people are just “born with it”, or at least they have “faulty wiring” at birth that will ultimately manifest itself in a seizure disorder without any other specific cause. To complicate matters, there are various types of epilepsy that do not manifest the typical uncontrolled tonic-clonic “jerking”- such as Petit Mal and Temporal Lobe Epilepsy.
Differentiating the causes of (apparent) GD is not always easy. Indeed, this is one of the reasons that two letters from qualified mental health professionals are required before SRS can be performed (though some countries’ surgeons are often much less “demanding”.) Despite these professionals’ best efforts, there still are occasional mistakes made (especially early on in John Hopkins; gender clinic- transvestic gays were recommended for SRS that were terrible candidates!) Those who were abused sexually as children may also “mimic” outward behaviors and tell others of “inner thoughts” typical of GD. In fact, anyone who surfs the internet and/or reads a few biographies of TS individuals can “put on a good show” for a psychiatrist and thus fool professionals (as well as themselves) into a false diagnosis of GD.
That is one reason that names for this condition have multiplied. Many professionals were considered dropping “Transsexuality” in favor of a (supposedly) more specific term: Harry Benjamin Syndrome (HBS). [Author's Note: As of May 2013, however, the official terminology has been changed to "Gender Dysphoria".] This is used to identify a life-long, persisting self-identification of someone with a (mental) gender opposite from the physical and chromosomal sex of the body. This would exclude any “Intersexed” (other than the brain itself) conditions, childhood abuse cases and Bren’s “Failure as a Male” scenarios.
As to “verifiable” evidence/scientific tests for GD: There is one region of the brain called the BSTc nucleus which may be one of the specific sites that give us our “gender identity”. This has received notable attention in the last decade or so. Dissection of this area in M2F’s shows that the nuclei counts very closely resemble that of normal women and vice-versa for F2M’s. This also appears to be independent of these individuals being on cross-gender hormone treatment. However, since this region of the brain cannot currently be examined except on autopsy, it is a poor candidate for any sort of viable “GD test”. (However, if the resolution of imaging modalities, such as CAT and MRI scanners continues to improve, perhaps there might be a diagnostic test in the future.)
We also know by statistical studies that there was a much higher proportion [compared to the general population] of male babies born to mothers that took DES (an artificial hormone used in the 40’s and 50’s to prevent miscarriages), that were born with GD. Some factors indicate that the late first and early second trimesters are the most critical times. There appears to also be a link with other chemicals common in our environment called “endocrine disruptors”. Phthalates, an additive in some plastics, may also be linked to and increased incidence of GD.
We also have animal models. Pregnant rats that are exposed to testosterone during a short but critical time in their pregnancy will produce perfectly normal-appearing female babies. However, when these females reach maturity, they begin behaving just like male rats- fighting for territory and sexually “mounting” female rats, even though they lack the proper “equipment” to truly mate. No visible differences physically, but a very observable behavioral change seen later on in life.
So, there are some good indicators that GD is not a choice. Rather, it originates from something inherent within us that gives us an unshakable certainty that we are of a different gender than our bodies evidence to those around us. But there is still a lot of research that needs to be accomplished before we can present to the world irrefutable “proof” (as you are asking). But, you have to remember- GD is a very difficult thing to study, especially among those who successfully complete their transition. They frequently are lost to follow-up, as many desire to just “disappear” into the population of “normal” men and women.
Even this lengthy discussion does not do justice to the complexities revolving around the diagnosis/causation of GD. It is hard enough to explain GD to a “normal” individual as it is without getting into all the psychiatric nuances. Unfortunately, everything that looks like a duck and quacks like a duck is not always a duck. (It could just be a very distressed and confused chicken who surfs the internet and has access to duck clothes, makeup and duck hormones! J)
Walking Daily in His Wondrous Love and Grace,