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(with apologies to Professor Milton
Diamond)
David Skidmore’s article “Gender
reassignment surgery does not help in our
gender-divided society”, demonstrates that
being gay does not provide an understanding of the
complex affairs of people born with transsexualism.
There is a gulf between us that he does not, or
does not want to, comprehend.
In a recent Amicus Curiae brief it provided to
the US
Supreme Court, the Harry
Benjamin International Gender Dysphoria
Association (comprising the world’s
experts in the field of transsexualism) stated:
Transsexuals
experience themselves as being of the opposite
sex, despite having the biological
characteristics of one sex… 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.
[T]ranssexualism
is a disorder of sexual differentiation, the
process of becoming man or woman as we
conventionally understand it. Like other people
afflicted with errors in the process of sexual
differentiation, such as people with intersex
conditions, transsexual people need to be
medically rehabilitated so that they can live
normalized lives as men or women.
The only available,
successful and appropriate treatment at present
for severe gender dysphoria is gender
reassignment treatments, i.e. psychiatric
assessments followed by hormone treatment, the
real life test and in suitable cases, sex
reassignment surgery. This has been confirmed by
all long-term studies.
This paradigm is somewhat narrower than the
position under Australian common law. The Family
Court of Australia in Re
Kevin (validity of marriage of a transsexual)
[2001] Fam CA 1074 heard detailed
evidence from numerous international and domestic
medical experts on the transsexual condition. His
Honour Chisholm J came to the conclusion that the
former narrow definition of “sex”
requiring congruency of all three of genitals,
gonads and chromosomes, was no longer valid.
Finding that the phenomenon of “brain
sex” was a biological fact, he said:
In my view, the
expert evidence in this case affirms that brain
development is (at least) an important
determinant of a person's sense of being a man
or a woman [at 247] … I see no
reason why I should not accept the proposition,
on the balance of probabilities, for the purpose
of this case [at 248]… In my view,
the evidence about the experience of
transsexuals, and the strength and persistence
of their feelings, fits well with the view that
"transsexuals have a sexual brain development
contrary to their other sex characteristics such
as the nature of their chromosomes, gonads, and
genitalia" [at 269]…
I am satisfied that the
evidence now is inconsistent with the
distinction formerly drawn between biological
factors, meaning genitals, chromosomes and
gonads, and merely "psychological factors", and
on this basis distinguishing between cases of
intersex (incongruities among biological
factors) and transsexualism (incongruities
between biology and psychology) [at 270]
… In my view the evidence demonstrates (at
least on the balance of probabilities), that the
characteristics of transsexuals are as much
"biological" as those of people now thought of
as inter-sex. The difference is essentially that
we can readily observe or identify the genitals,
chromosomes and gonads, but at present we are
unable to detect or precisely identify the
equally "biological" characteristics of the
brain that are present in transsexuals [at
272].
Chisholm J held that the factors to be
considered in determining a person’s sex
included, but were not limited to, the sex of the
gonads, genitals, and chromosomes; any hormonal and
surgical rehabilitative treatment the person had
undergone; the person’s perception of their
sexual identity (a manifestation of brain sex); and
the perception of others towards them. Following a
long line of precedents in Australia, he further
held that, post-operatively, a person treated for
transsexualism is a member of their re-assigned
sex.
The
Full Court upheld the decision on appeal and,
further, established the position in Australian law
that people with transsexualism should not be
treated differently to others with intersexed
conditions: they should be allowed to choose their
sex, affirm it and be accorded full legal status as
members of that sex.
It is important here to distinguish, quite
clearly, between transsexualism, a biological
variation in sexual formation with a fixed gender,
and transgender, a psychological disorder in which
the sex is fixed but there is variable or
cross-gender presentation.
Professor
Milton Diamond has probably studied the tenuous
dichotomy between sex and gender more than any
other medical researcher. In his paper, Sex
and Gender – Same or Different?, he
wrote:
Unlike the
majority of transsexuals that "feel they were
born that way" many of those identifying
themselves as transgendered or gender-bending or
gender-blending persons are attracted to the
concept of a constructed gender and see
themselves and their lives as evidence of it.
Eschewing any strict male-female dichotomy,
transgendered persons instead reach for a wide
range of admixtures of male and female
restructured anatomies and manifest masculine
and feminine life-styles. For those most unique
in their display, to reflect the socially
bizarre nature of their expression, the term
"gender fucking" is used by outspoken
transgenderists themselves and others as well.
The term is not seen as pejorative but
apt.
Transsexuals, who I
believe are intersexed, have the body and
genitals of one sex and the brain of the other
making reconciliation of their sexual and gender
identities problematic. They solve their
problems of reconciling, their disparate sexual
identity and gender identity, by saying, in
essence, "Don't change my mind; change my
body."
Thus, transsexualism is just another of the
biological variations that occur in human sexual
formation; it is about being a particular sex, not
doing it. It is also about recognising gender
norms, not challenging them. And Alex is
consequently a boy, not a girl, albeit one with a
grossly atypical phenotype, so courtesy dictates
that masculine pronouns be used to refer to him.
Transsexualism also has nothing to do with sexual
orientation. In fact, we are predominantly
heterosexual, but are also gay, lesbian, bisexual
and asexual in numbers fairly representative of the
wider community.
Alex was plainly exhibiting classical symptoms
of severe adolescent transsexualism and was at a
very severe risk of taking his own life because of
the huge distress of living with a body
oppositely-sexed to his brain. The rejection of
people experiencing transsexualism, by their
family, friends, employers and a largely ignorant
wider society leads to them experiencing the
highest levels of depression, suicidal ideation,
discrimination and harassment of any of the
minorities with sex or gender development contrary
to heteronormative expectations. That was certainly
the outcome of the report, Enough
is Enough… (pdf, 302 KB) commissioned
by the Victorian Gay and Lesbian Rights Lobby Group
and it has been reinforced by many others.
As the former Family Court Justice, the Hon
Travis Lindenmayer, explained in a very enlightened
article in The
Herald Sun, the court examined both the
medical evidence of those professionals who were
treating Alex, and the opinions of other experts
who were called to comment on their assessment and
the prognosis. The unanimous consensus was that the
treatment regimen was correct in the
circumstances.
It also needs to be pointed out, because David
missed it, that Alex is not having sex-altering
hormone treatment at 13 years of age. He has simply
been placed on the oral contraceptive pill until he
is at least 16 years. Many Australian mothers have
done the same with their teenage daughters. At 16
years, if the assessments remain unchanged, then,
and only then, can Alex commence on still largely
reversible hormone treatment until surgery is
accessible at 18 years when he is legally an
adult.
It seems to me that David’s criticism of
the treatment authorised for Alex’s
transsexualism is more likely to arise from his
personal need to be gay and proud rather than an
insightful interpretation of the expert knowledge.
Leading domestic and international medical experts
all agreed there was only one solution yet David
would have the outcome dictated by gender-political
considerations. That David endorses the views of
Sheila Jeffreys, an ultra-essentialist feminist who
deems chromosomes more powerful than the brain in
determining the sex of intersexed men and women,
but holds it paramount in informing her own
experience of gender, says it all.
In Hon Lindenmayer’s words:
If Alex had
been refused treatment and committed suicide,
there would still be questions and criticisms,
just very different ones. And death is
absolutely irreversible.
All enquires
regarding this paper should be addressed
directly to Karen Gurney DipAppChem,
BAppSc(Biol), DipAppSc(NatResourceMngt), DTS,
DipPubSectorAdmin. Republished here with
permission.
Ms Gurney is
a final year LLB Candidate at Deakin University and
a board member of the Australian WOMAN Network
 www.w-o-m-a-n.net
and the Organisation Internationale des
Intersexués www.intersexualite.org.
She has tertiary qualifications in Chemistry,
Biology, Natural Resource Management and Public
Sector Management. She is currently employed as a
researcher in the Deakin Law School and is an
advocate and active campaigner for the human rights
of people with intersex conditions, especially
those who experience the predicament of
transsexualism.
Citation
— Gurney, K., (4 May 2004). It's important
to recognise that sex and gender must be treated
differently.
OnlineOpinion. www.onlineopinion.com.au/view.asp?article=2184
Republished here with permission.
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