As a young child,
Craig Andrews felt certain about his future.
“I always thought I’d grow up to be a
man,” he says. At school, however, his
mates were quick to remind him that he was a
girl, and point out his differences.
In far north
Queensland, where he grew up, there was nowhere,
and no one, he could turn to in his confusion
and despair: “It was extremely difficult.
They don’t keep that kind of information in
the school library.”
It was not until he was
25 and had moved to Sydney that Andrews even
discovered there were medical treatments
available. Ten years later he had hormone
therapy and surgery – options he did not
undertake lightly – have finally brought
his body and mind into harmony. “It’s
had a profound effect on me.”
It is not only this
personal experience that has led Andrews to
believe transsexualism is a biological condition
in which the brain – “the most
powerful of all the sex organs” –
develops differently to the reproductive organs,
making the desire to live as the opposite sex
overwhelming.
Since setting up a
support and advocacy group for female-to-male
transsexual men three years ago, called FTMA, he
has talked to many people with a similar story,
who knew little about their condition.
“The startling
thing is they have never been in touch with
anyone else [like them] before, and they
all say, ‘From my very first memories I
thought I was going to be a
boy’.”
Researchers, however,
are more ambivalent. “The reality is, there
is no consensus. We do not know exactly how
transsexual develops,” says Dr Walter
Bockting, a scientific editor of the
International
Journal of
Transgenderism.
But a Melbourne
psychiatrist, Dr Herbert Bower, has so few
doubts about a strongly biological origin that
he instigated the world’s first search for
genes linked to transsexualism several years
ago.
Bower, who is almost 90
and works with Australia’s only gender
dysphoria clinic, at Monash Medical Centre,
estimates he has treated more than 1000 people
with transsexualism and gender identity issues.
He says he has searched
the literature and his own patients for decades
for psychological causes, such a family
dynamics. “I have found no evidence at all
that it has anything to do with child
rearing,” he says.
“They are
perfectly normal children – with perfectly
normal parents. But they say they are in the
wrong body and I believe them.”
Transsexuals who have
attended the Melbourne clinic have recently
begun to donate blood for an expanded gene hunt
being carried out by Associate Professor Vincent
Harley of Prince Henry’s Institute of
Medical Research in Melbourne and Professor Eric
Vilain of the University of California.
Bower says a genetic
test of gender identity would have great
benefits, including that children with disorders
like Alex, the subject of a controversial Family
Court decision this week, could confidently be
raised as the opposite sex from a young age and
given treatments to prevent puberty, which is
extremely traumatic for transsexuals.
Alex is a 13-year-old
girl who is depressed and suicidal, and who has
gone to distressing lengths to live as a boy,
including wearing nappies to avoid the
girls’ toilets. Permission
was given this week
for him to take a form of the contraceptive pill
that will suppress menstruation. At 16, his
doctors may also prescribe male hormones, but
any surgery could not be considered until he was
18.
The decision was
supported by Alex’s doctors, teachers, an
aunt and two independent experts but has been
criticized by Catholic ethicists as
experimental. The Prime Minister, John Howard,
has said he is seeking advice on the case.
The controversy has
also come at a time when the Melbourne gender
dysphoria clinic is under a cloud. The Victorian
Health Minister, Bronwyn Pike, last month asked
an independent psychiatrist to review procedures
at the clinic following complaints.
The most high-profile
case involves Alan Finch, who under went male to
female surgery at the clinic when he was 21 and
intends to sue because of later regrets. The
clinic’s director, Dr Trudy Kennedy, said
her legal advice was not to comment.
Understanding of sexual
development changed dramatically with the
discovery in the early 1990s of the gene for
maleness, known as SRY, which sits on the Y
chromosome.
If the SRY gene is
absent, a girl develops. It if is present, it
sets off a cascade of genetic events that lead
to the development of testes that then flood the
foetus with male hormones. Mutations in SRY or
other genes can lead to males who look like
females.
Until very recently, it
had also been thought that differences in the
way men and women think and how their brains are
structured were controlled solely by hormones.
But last year Vilain, in California, published a
study which suggests sexuality is hard-wired
into the brain very early in the womb.
His team tested 15,000
genes in the brains of mouse embryos and found
54 genes that had different levels of activity
in male and female brains long before SRY was
switched on and testosterone was produced.
It is these 54 genes
Vilain and Harley want to study in transsexuals
from the Melbourne clinic, and work has already
begun on a couple of them. Vilain says there is
little evidence that transsexualism is
psychological but also admits “the evidence
there is a genetic component is not very
compelling”, either. “But we have more
every day,” he adds.
It includes the fact
that transsexualism can run in some families,
and a Dutch study that found a small part of the
post-mortem brain in male-to-female transsexuals
was the same size as in women, rather than men.
The gene hunt can be
justified as scientific curiously along, says
Vilain. “We like to understand how the
brain functions and an important function is to
provide gender identity.”
But Harley and Vilain
are also experts in inter-sex conditions, where
children are born with ambiguous genitalia, and
they say genetic tests for sexual identity could
improve the difficult decisions about which sex
to raise these children.
For transsexuals, any
genetic test would be “a double-edged
sword” says Kate Clarke, a spokeswoman for
the male-to-female transsexual advocacy group
Australian
WOMAN Network.
“It could be politically and legally
advantageous”, she says.
But there is also a
risk it could be used for example, to prevent
people getting the treatment they need.
Clarke is concerned
about attacks on the Melbourne clinic and says
more, not fewer services are needed for
transsexuals. She believes the clinic
psychiatrists take a tough approach to deciding
who is suitable for surgery.
Bower also says only a
few of the 600 patients regretted their surgery.
“We shouldn’t err at all but this is
impossible when you’re dealing with
people.”
Critics have claimed
that not enough follow-up of patients had been
done for anyone to be confident this success
rate is accurate, but Clarke claims the lack of
research is due to under-funding of the clinic.
Bockting, at the
University of Minnesota, says Dutch research on
1100 patients shows about 1 percent regret their
decision. He says debate continues about the age
at which treatment should begin, because not all
adolescents with gender identity disorders go on
to become transsexuals.
At his clinic about two
out of three of the adolescents and adults with
gender identity disorders eventually decide to
take hormones and about one in four has surgery.
Doctors in Europe and Britain have been giving
hormones to teenagers with gender identity
disorders for some years.
And in Alex’s case
the internationally best accepted practice has
been followed, says Bockting, with the initial
use of a medication with puberty-blocking but
reversible effects, such as the pill, before
hormones are prescribed.
“Essentially, it
is buying time to see a person’s identity
develop further.”
— by Deborah Smith, SMH April 17/18,
2004
Used with permission.
