Monday, 22 October 2018

Anatomy Does Not Determine Gender

Determine Gender

Anatomy Does Not Determine Gender, Experts Say

Defining gender as a condition determined strictly by a person’s genitals are predicated on a
the notion that doctors and scientists abandoned way back as oversimplified and sometimes
medically meaningless.
Researchers who have studied gender issues and provided health care to people that do
not fit the standard M/F pigeonholes said that the Trump administration’s latest decision to
define gender goes beyond the bounds of the knowledge domain.
“The concept a person’s sex is decided by their anatomy at birth isn't true, and
we’ve known that it’s not true for many years,” said Dr. Joshua D. Safer, an endocrinologist
and executive of the middle for Transgender Medicine and Surgery at Mount
Sinai Health System in New York. He is also president of the us Professional
Association of Transgender Health.
But exactly what does determine identity — a person’s powerful, core knowledge
of who they're — isn't so clear.
“We know that there's a big, durable biological underpinning to identity,”
Dr. Safer said. “What we don’t know are all of the biological factors at play that specify
gender identity. As far as we within the mainstream biological-medical community
understand it in 2018, it's hard-wired, it's biological, it's not entirely hormonal, and we
do not have identified genes, so we cannot specifically say it's genetic.”
Are genes a factor?
Genetics does play a role, though. In studies of twins, if one is transgender, the opposite is
far more likely to even be transgender if they're identical, instead of fraternal twins.
Identical twins are near matches, genetically; fraternal ones aren't. The findings are
similar for twins who have Type 1 diabetes, which is understood to possess a robust genetic
The Trump administration’s proposal, outlined during a memo by the Health and Human
Services Department would establish a legal definition of sex under Title IX, the federal
civil rights law that bans gender discrimination in education schemes that receive
government financial assistance. The change would eliminate protections afforded
transgender people under the Obama administration.
The agency’s proposed definition would be determined by the genitals that an individual is
born with, consistent with a draft reviewed by The NY Times. Whatever is on the birth
certificate defines gender, “unless rebutted by reliable genetic evidence,” consistent with
the memo.

But what would constitute reliable evidence?
It may be hard to find.
“We don’t know genes for everything that we’ve identified medically,” Dr. Safer said. “We
just don’t have such sophisticated understanding of the many medical processes, not even
about sex.”
How to define identity
Researchers say identity comes from the brain, not the body. Some put it more
bluntly: It originates between your ears, not between your legs. But the forces that acted
on the brain to shape that identity aren't understood, and physical or chemical
differences within the brain which may relate to gender haven't been well defined.
No one knows needless to say why body and mind sometimes don't match. But being
transgender is not a matter of choice, Dr. Safer said. It is not a fad or a whim. For
transgender people, it's generally an awesome sense that their gender isn't the
one on their birth certificate. And gender isn't about whom they’re interested in — it’s
about who they are.
Distress over the mind-body mismatch can become especially intense around puberty,
and the risk of suicide shoots up for children during this situation. Mainstream medicine
has begun to acknowledge how serious a problem it is: Last month, the American Academy of
Pediatrics issued its first-ever policy statement regarding look after transgender children
and adolescents, and people who are “gender-diverse,” or non-binary, meaning they're
neither clearly male or female.
The pediatric statement urged a “gender-affirming approach,” which translates as
respecting and supporting children, even young ones, in “their self-expressed identity.”
The society also noted that transgender children “have high rates of depression,
anxiety, eating disorders, substance use, self-harm and suicide.”
Last year, the Endocrine Society — the professional group for experts within the glands and
organs that produce hormones — issued guidelines for treating transgender people.
They said identity was biologically based and urged federal and personal insurers
to cover medical needs associated with it for transgender people.
It’s not as simple as X and Y
Apart from transgender issues, other conditions make it clear that defining male and
female is not so simple. For instance, there are people with XY chromosomes — which
makes them genetically male — who look, act and desire women because of their bodies
cannot react to male hormones.

In other cases, some women with a condition that exposed them to high levels of
testosterone before birth identify as male — but more with an equivalent condition do
Some of the foremost compelling evidence for the thought of identity being hard-wired
into the brain comes from medical reports on people that were born within the 1950s and
The 1960s with birth defects involving their genitals. Doctors thought the humane solution, to
spare such children from being ostracized were to perform surgery to form them one
sex or the other.
Since it's easier for surgeons to form a vagina than a penis, most of those babies were
made female. Their parents were advised to boost them as girls and never to inform them
about their condition at birth. The general belief was that their upbringing — a triumph
of nurture over nature — would make them truly female.
The idea was a failure. As they matured, many had a transparent sense that they were male.
According to a study of 16 of them, quite half aroused identifying as male.
“Considering the fact that you can brainwash some people about just about anything,
failing with so many is catastrophic,” Dr. Safer said in an email.
Of all the knowledge on identity, he said that to doctors, the studies on

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