|
JANINE COHEN: As many as
40,000 Australians don't have standard sex
chromosomes. The scientific principle used for
decades - that all girls had XX chromosomes and all
boys, XY - isn't reliable.
Are we just on the cusp of learning what
determines gender?
PROF. ANDREW SINCLAIR: We
really are. I mean, we are just beginning to
understand this, and I think the more we go into
it, the more we understand how complex this whole
situation is. As I said, it is a very complex
network of genes that operate in space and
time.
JANINE COHEN: Christie
North has always felt female. But when she was 15
she found out she was born with male chromosomes
and internal testes.
CHRISTIE NORTH: There was
no mention during school, during human development,
that there can be mix-ups with your
chromosomes.
JANINE COHEN: The
scientific world is on the verge of discovering
what really determines gender and in many cases how
little it has to do with our environment.
ANDIE HIDER: I just sort
of grew up with scarring and things and thinking,
"Well, okay, what was this for? Why did I have
this?" But I'm being told these particular things,
I'm being told that, yes, you know, for this stage
in my life I'm a boy, therefore I must be one -
JANINE COHEN: Why did
they make you a boy?
ANDIE HIDER: Um, I have
no idea. I have absolutely no idea why they did
it.
JANINE COHEN: Australian
law, too, is grappling with the latest science on
what it means to be male or female. The federal
government tried to prove this person was a
woman.
"KEVIN": The last thing
you want to be doing is trying to prove that you
are the person you are to someone that doesn't know
you, someone that has no idea about your life,
never interacts with you at all, has never met
you.
"JENNIFER": I know what a
man is, and I know what a husband is, and I know
what a father is; and he's all of those things.
JANINE COHEN: Tonight on
Four Corners, new and challenging science on the
question of gender. What makes a boy and what makes
a girl?
If we relied on the common scientific definition
of a male - that being someone with XY chromosomes
- then Christie North would be a man. As an unborn
baby she was unable to process male hormones, so
she developed instead into a female. The Melbourne
woman has an intersex condition called Complete
Androgen Insensitivity Syndrome. This is one of
more than a dozen different types of intersex
conditions affecting thousands of Australians.
So there was nothing that made you any different
from any of the other girls?
CHRISTIE NORTH: No, not
at all. Even when I told my friends - I only told a
few friends, but they had no idea.
PROF. GARRY WARNE: My way
of thinking is that she was always intended to be a
girl but she just got there by a different path.
That, I think, is a fundamentally different way of
thinking. Instead of the negative way which says,
"This is a boy who didn't make it," This is a girl
who did make it and was meant to make it this way,
but life was just meant to be also a little
different.
JANINE COHEN: Many of
these XY women are tall and beautiful. There are
rumours that some actors and models have the
condition. It often produces women with little body
hair and clear skin.
CHRISTIE NORTH: It's
something that I have. It's not something that I
think about on a daily basis. I think about it
occasionally and I mention it - like if I mention
it to friends or a prospective boyfriend or
something like that, that's the only time it ever
gets mentioned or brought up.
JANINE COHEN: What has it
meant for Christie to have XY chromosomes?
LIZ NORTH: Oh, I think
she's happy. I think she's happy. I don't think
it's worried her at all. She's never really
complained or - she's just a normal - oh, well, a
normal girl, you know, into the hair, coloured
hair, make-up, you name it. She's into the latest
fashions.
JANINE COHEN: When
Christie North was two years old, she went into
hospital for a hernia operation. Internal testes
were discovered, and Christie was later diagnosed
with Androgen Insensitivity Syndrome.
PROF. GARRY WARNE: She
was born with testes that are capable of making the
male sex hormone, testosterone. Her body is unable
to respond, in any way, to that hormone because the
receptors in every cell in the body for
testosterone are absent, and the reason for that is
a genetic alteration.
CHRISTIE NORTH: When I
was in grade six, Professor Warne, or Dr Warne
then, sat me down with my parents and my sister,
and we discussed that I was unable to have kids and
menstruate, and that was pretty much all that was
said then.
JANINE COHEN: It wasn't
until Christie North was 15 that she was told that
she had male chromosomes and was born with
testes.
Would it have been in any way easier for you if
you had've been told everything at the
beginning?
CHRISTIE NORTH: Well,
yeah. Yeah, it would've. Sort of growing up
thinking that you had a hysterectomy or something
like that when you were younger, it's not the case
when you find out later on. So it would have been a
lot easier if you'd knew straight away.
JANINE COHEN: So you
actually didn't know why you were infertile?
CHRISTIE NORTH: No,
no.
JANINE COHEN: Every year,
Christie North receives an implant of the female
hormone oestrogen to help feminise her body.
LIZ NORTH: There's so
many people with the same problem. There's more
than what you think there is. You know, when you
knew people that didn't have children you think,
"Oh, why didn't they have children?" So now we know
why a lot of older people didn't have children.
It's because they had this problem and it was never
spoken about.
JANINE COHEN: Like
Christie, tens of thousands of Australians don't
have standard sex chromosomes. As well as girls
with XY chromosomes, one in 500 boys are born with
a double XX as well as a Y. Most have standard
genitalia and are unaware of their chromosomal
make-up until they try to father children and
discover they're infertile.
So what does a situation like yours, having XY
chromosomes, say about the gender spectrum?
CHRISTIE NORTH: Well,
it's never all one or the other. It's - one in 500
people has a chromosome variation of some sort. So
it's not uncommon.
JANINE COHEN: Most
scientists believe we're just on the verge of
learning what makes us male and female, and they
believe one way to better understand this is
through the study of those on the gender
extremes.
PROF. ANDREW SINCLAIR: I
think throughout history humans have been really
interested in what makes us male or female, and
underlying that is whether or not a testis or an
ovary develops in the embryo.
JANINE COHEN: Until the
1990s, gender was thought to be largely about
chromosomes. But this principle was challenged when
a scientific breakthrough was made during the study
of people with intersex conditions. A new gene and
its impact on the development of male genitalia was
discovered. A team of scientists, including
Associate Professor Andrew Sinclair, discovered
SRY, the gene needed to start the process of
'maleness'.
PROF. ANDREW SINCLAIR:
The rationale for finding that gene was that
we could unravel the whole process and build -
understand how you build something as complex as a
testis, and by knowing all the different component
parts - a little bit like putting a car together -
if you know all the bits, when something goes wrong
you can pinpoint that and correct that if need
be.
JANINE COHEN: It's
recently been discovered that the SRY gene is also
present in the male brain region of the
hypothalamus, the same area where gender brain
identity is developed.
ASSOC. PROF. VINCE HARLEY:
We've had some success in understanding SRY
and how it makes a testis. We're now trying to look
at what SRY might be doing in the brain. There is
some evidence from our studies that there are genes
on the Y chromosome, which males have and females
don't, that make at least rats more aggressive; and
so it could be that there are male-specific
behaviours that are carried by genes on the Y
chromosome, such as SRY.
JANINE COHEN: Associate
Professor Vincent Harley is now looking at a
further 54 genes that have been discovered since
SRY. These genes in the embryo are turned on
differently in male and female brains, even before
the organs that secrete hormones have formed. They
may help scientists to explain why some people
identify as one gender or the other, independently
of chromosomes.
ASSOC. PROF. VINCE HARLEY:
I think we're starting to understand how the
brain is hard-wired differently between males and
females.
PROF. ANDREW SINCLAIR:
Our gender - how we see ourselves - is
determined by our brains as much as anything else.
So it's quite likely, one could imagine, that
there'll be receptors in the brain which will
respond to some of those hormones. So, if the gene
or those receptors in the brain are not functioning
and are not going to receive the male hormone, then
that person may well have a feminine outlook. So
the brain will influence gender as much as the
gonads.
JANINE COHEN: Science is
starting to redefine the gender debate. For years
it was thought to be all about nurture - the way a
child was raised. Feminist theory helped the idea
along. Women limited themselves because they had
been stereotyped and socialised that way.
ARCHIVE CHEQUERBOARD
PROGRAM: It's a reality of twisted and
thwarted people, people who are twisted and
thwarted 'cause they're pushed into roles. Girls
train themselves for their future. They take
their dolls to the park.
DR LOUISE NEWMAN: Most of
the theories of the time spoke about socialisation,
spoke about the way parents train us into
particular gender roles, and that was the
prevailing model.
JANINE COHEN: In the '60s
and '70s, doctors believed the power of nurture was
so strong it could be applied to children where
their sex was ambiguous. The practice was to assign
a baby who often had both male and female genitalia
a gender. The child would then undergo genital
surgery and be raised in its assigned sex. The
theory was the child would grow up happy and well
adjusted. This philosophy was based on the work of
a famous New Zealand psychiatrist, John Money.
ARCHIVE JOHN MONEY:
When all of the problems and issues are
cleared away early, one ordinarily expects that
person to grow up, as I say sometimes for the
sake of remembering it, in the psychological sex
that agrees with the haircut.
ANNE HIDER:
Unfortunately, he was very powerful and
influential at the time and people took this theory
as gospel.
JANINE COHEN: And what do
you think of that theory now?
ANDIE HIDER: Well, I
think if - a total reliance on nurture as far as
sort of determining sex is complete rubbish. I
think it just doesn't happen.
JANINE COHEN: Andie Hider
is an example of the failure of John Money's
nurture theory. She was born with ambiguous, or
atypical, genitalia. Doctors didn't know what sex
she was, so they took a punt and decided she'd be a
boy.
ANNE HIDER: I guess we'd
always been brought up in that generation to think
that doctors were somewhat god-like. If you were
told something, you believed it.
JANINE COHEN: Andrew
Hider was a quiet, gentle little boy who always
felt not quite right about his place in the world
and didn't know why.
ANNE HIDER: He was
certainly not a typical boy, not out kicking
footballs and rough-housing. He was great at
fiddling around making things, creating things.
Very good with his hands always.
STEVE HIDER: Andie was
never really terribly male or female, always
slightly ambiguous. I guess looking back, I think
Andie probably had a really difficult
childhood.
JANINE COHEN: Andie Hider
did a lot of the things that men do. She was into
cars and mechanics. But, despite the masculine
pursuits, people often mistook Andie for female. As
a man, she started to question her gender.
ANDIE HIDER: I sort of
thought, "Well, if I'm not male, then I must be
something else," and the only other thing is
female. So, for me, that was sort of the thing that
made me realise, "Well, that's probably who I
am."
JANINE COHEN: Andie Hider
decided to do something about it. She applied for
her medical records under the Freedom of
Information Act. What she found shocked her.
She was born with a rare but extreme intersex
condition - Partial Androgen Insensitivity
Syndrome. Andie Hider has male chromosomes but her
body couldn't process enough masculine hormones,
leaving her with many feminine attributes and
ambiguous or atypical genitalia.
ANDIE HIDER: They
obviously knew at the time what they were dealing
with, but they just didn't tell my parents because
it wasn't the culture to do so.
JANINE COHEN: Your
parents had no idea?
ANDIE HIDER: No.
ANNE HIDER: I was
outraged, I suppose, that in comparatively modern
times anybody would make decisions about my child
and, you know, her future without even telling me
about it.
ANDIE HIDER: It would
have been after I got my medical records, when I
was about 30 years old, and went and told my
mother.
ANNE HIDER: I know now
that this was accepted practice that you don't tell
people about this. It's, you know, something that
must be kept quiet and out of sight and out of
mind, but -
JANINE COHEN: So Andie's
case wasn't a one-off?
ANNE HIDER: Oh, no. No,
no.
JANINE COHEN: Andie
Hider, a Federal Police officer, turned her anger
into action. In her spare time she became an
advocate for people with intersex conditions. Andie
says the culture has been not to tell parents and
particularly children of their conditions. She
wants that changed and is calling for full medical
disclosure. Andie Hider claims no amount of nurture
will make someone a boy or a girl if they aren't
one.
ANDIE HIDER: What I have
an issue with now is the fact that the medical
profession should have learned from stories like
mine and learned from stories of other people and
said, "Well, hang on, this isn't necessarily
working, and there are options. There are other
ways of treating this."
JANINE COHEN: And the
medical profession haven't learnt?
ANDIE HIDER: I don't
think they have, to be perfectly honest.
STEVE HIDER: I think
Andie's life would have been a lot easier if she
had known from the outset that, "You have a choice
here", you know, "You are this type of person - not
male, not female. You find out for yourself, rather
than having something imposed on you that may not
be the right thing."
JANINE COHEN: Professor
Garry Warne is an endocrinologist who's been
working with intersex children for almost 30
years.
PROF. GARRY WARNE: The
medical profession thought they were in a
privileged position of having the information and
that the patients didn't need to be bothered by
some of those painful facts.
ANDIE HIDER: He did
actually start the sort of movement to tell the
truth. A lot of doctors said, "No, you can't do
that," You know, "What gives you the right to turn
around and ruin these people's lives?" And, as he
said, "Well, it's not ruining their lives," and he
was quite right.
JANINE COHEN: In 2002,
Garry Warne was made an honorary life member of the
Androgen Insensitivity Support Group for his
efforts to have intersex conditions disclosed. But
he is a controversial figure. Like John Money
before him, he still believes in surgically
assigning a gender to babies with ambiguous or
atypical genitalia. He believes failure to do this
could damage the child.
PROF. GARRY WARNE: I
think that it exposes the child to the possibility
of ridicule and embarrassment. It's something that
would make them feel very different from other
children.
ANDIE HIDER: Now it's
just ludicrous to turn around and say, "Well, let's
try and alleviate some social embarrassment by
surgically altering a child at that stage of their
life."
JANINE COHEN: Many
doctors and advocates believe it's wrong to
surgically change genitalia until a child can have
its say. But Professor Warne says his policy, when
in doubt, is to make a child a boy. It provides
more choice.
PROF. GARRY WARNE: It
gives the person the greatest option when they grow
up. They can easily reverse that and go back to
female if they wish, but it's very hard to go the
other way. So preserving options I think is what
it's all about.
DR FINTAN HARTE: It's a
very difficult clinical situation to be faced with.
It's a very difficult assessment to make, and, as I
said, the current paradigm would be to wait and see
as much as possible, whereas the old paradigm would
have been to intervene, surgically re-assign and to
raise the child unambiguously.
JANINE COHEN: Some
international studies challenge Professor Warne's
view. In the US, 94 people with an intersex
condition who had atypical genitalia were surveyed.
More than half were unhappy with the sex they'd
been assigned. Despite being raised as girls and
having genital surgery, they became boys.
PROF. GARRY WARNE: It's a
hot point. But we've also recently completed our
long-term follow-up study at this hospital, and we
got it right 96 per cent of the time. In our
series, there were only two out of 50 who wanted to
be the other sex.
JANINE COHEN: So what is
the AIS Support Group going on about when they say
how badly they've been treated by doctors and how
unhappy people are with surgery? Where are they
coming from?
PROF. GARRY WARNE: Well,
I think that they're, unfortunately, a group of
people who have had bad experiences and who feel
empowered by belonging to a group and making their
presence known.
JANINE COHEN: Why doesn't
their bad experiences, then, correlate with your
study?
PROF. GARRY WARNE: I
think that - because the people that have had good
experiences don't bother joining such groups.
ANDIE HIDER: We're not a
group of malcontents. We're not a group of people
who sort of get together and grind axes about
doctors. There have been some good doctors. We give
awards to doctors who do, you know, who are forward
thinking, who do change things.
ASSOC. PROF. VINCE
HARLEY: There is a nucleus in the
hypothalamus that is differently sized in male and
females.
JANINE COHEN: Andie
Hider's story focuses attention on what can happen
when chromosomes don't match gender identity. To
better understand the biology of gender, scientists
are researching another group on the gender extreme
- transsexuals. They have the body to match their
chromosomes but believe their brain has been
hard-wired to go in the opposite direction.
ASSOC. PROF. VINCE HARLEY:
People, since the dawn of humanity, have
wondered why we feel the sex we feel, and I think
in these - nature has kind of thrown up these
variations, which are wonderful, and we should
celebrate these variations in gender identity.
JANINE COHEN: Why should
we celebrate them?
ASSOC. PROF. VINCE HARLEY:
Because I think it tells us a lot about how
we - how you and I - perceive ourselves as the sex
we are.
Here in females it's about half the size.
JANINE COHEN:
Transsexuals are particularly interesting to
scientists who want to map out the pattern of human
sexual development. They provide a unique sample
that animal studies can't replicate. There is a
small but growing body of evidence that transsexual
brains are hard-wired in utero to be either male or
female. Professor Harley hopes to prove in his
study that brain sex is responsible for the
transsexual condition.
ASSOC. PROF. VINCE
HARLEY: I think there might be a public
perception that, you know, transsexualism is a
lifestyle choice, and I think to reaffirm a
biological basis would be quite empowering for
them.
JANINE COHEN: Professor
Harley is researching a variance in the sequence of
genes thought to be found in male-to-female
transsexuals. He is studying the DNA of 50 people.
His work may also help to explain why, as males or
females, we behave the way we do.
ASSOC. PROF. VINCE HARLEY:
Well, I think ultimately it would be great
to find gender identity genes, and it might be
through the studies of transsexuals that we'll get
to those genes. In fact, I think it's the only way
we're going to get to those genes.
JANINE COHEN: The theory
of brain sex is not only challenging for science
but also for the law. It was relied on for the
first time in Australia in a landmark case in the
Family Court. 'Kevin', a transsexual, wanted to
marry his partner, 'Jennifer'. The federal
Attorney-General's Department opposed the marriage,
arguing that Kevin, in the eyes of the law, was
female. To be a man, Kevin must have been born with
male chromosomes, genitals and gonads. But,
instead, he was born into the body of a female.
Why did you decide to get married?
"KEVIN": Well, I'm a bit
of a traditionalist, first of all, and I really
wanted to marry Jennifer, and - but the absolute
crunch of the matter was to provide security for
her and any children we chose to have later.
JANINE COHEN: The Family
Court forbids the identification of parties to its
proceedings. For the purpose of a court case, the
couple were known as 'Kevin' and 'Jennifer'. This
is the first time they've ever spoken publicly.
They have been disguised.
"KEVIN": I remember going
to bed night after night, you know, wishing that
when I wake up that I'd be like all the other boys
instead of being different.
JANINE COHEN: For as long
as Kevin can remember he perceived himself to be
male. When he was very young, his mother tried to
persuade him he was a girl. She had her husband and
child stand naked in front of each other.
"KEVIN": I just continued
to say, "I'm a little boy." She kept saying,
"You're not." And I think out of desperation she
eventually made me stand in front of my father, who
was naked, and said to me, "Look, you don't look
like your father. You're not a boy," and I said,
"But I am."
JANINE COHEN: Kevin was
the oldest of four children. He had three sisters.
His adolescence was traumatic. At school he was
harassed for wearing boys' clothes. He had to learn
how to fight to protect himself.
"KEVIN": So kids used to
tease me and harass me constantly: "You're a girl,
you're not a boy. Why do you dress like that? Why
do you look like that? Why do you play soccer and
football and cricket? Why can't you be like the
rest of us?" And I'd just say, "I'm not like you.
I'm not like you. I can't be you. I'm being
myself."
JANINE COHEN: Then
puberty kicked in. He started to develop breasts
and menstruate.
"KEVIN": Oh, it was
dreadful. It was absolutely dreadful. You know, it
was like my worst nightmare. "How could this be
happening? Something's wrong. You know, everyone
kept telling me, 'You're a girl, you're a girl,'
And now my body's telling me I'm a girl when I'm
not." Like, "This is unbelievable. How could this
be happening?"
JANINE COHEN: Ten years
ago, at 29, Kevin heard for the first time about
gender re-assignment surgery.
Where would you be now if you hadn't had
surgery?
"KEVIN": Certainly not
here. Certainly not here today, certainly not
having the life - without a doubt, I would be dead.
I was getting to the point where it was becoming
more and more difficult to get up out of bed every
day and put on this facade.
JANINE COHEN: What would
you say to people who say, look, people like you
should just get some therapy and be content in the
body that you were born with?
"KEVIN": That's the
biggest joke of all. They have no understanding of
the concept of transsexualism. They have no
understanding of what it's like to have a mind
that's not in sync with your body. They have no
idea at all. And I said, "You know, come and walk
in my shoes for a day and see what it's like."
JANINE COHEN: Kevin
started hormone treatment that led to hair growth
on his face, chest and legs. Two years later, he
had chest surgery followed by a hysterectomy.
And what about when you found out about Kevin's
history? Did that make any difference to you at
all?
"JENNIFER": No, except to
say that it probably made me admire him more,
certainly not less, because I could see what a huge
journey he'd been on.
"KEVIN": I told her on
our second date, and she was just incredible,
supportive, understanding, caring and - well,
history tells us she chose to come along on the
journey because of me, who I am, not about my
gender.
"JENNIFER": I had never
had any sense of him other than that he was
completely male. His story about his transsexualism
made no difference.
JANINE COHEN: Jennifer
and Kevin started living together and not long
after decided they wanted to start a family.
Because Kevin was an infertile male, the couple
applied to join an IVF program and use donor
sperm.
"JENNIFER": I do think it
was significant that it was a public hospital
clinic which accepted us onto their fertility
program. We were the first such couple that they
had accepted onto their program ever, and so they
needed to discuss the ethics of it.
JANINE COHEN: After
Jennifer conceived with their first child, the
couple decided they should marry. Jennifer wrote to
the federal Attorney-General asking if that was
possible.
"JENNIFER": We wrote more
letters explaining thoroughly all about it, the
fact that my husband did have - had undergone the
process of transition. He'd taken all of the
available medical steps. He'd made all of the
social adjustments. He'd made the other legal
changes in terms of documentation. He had a male
birth certificate, a male passport et cetera, and
everybody whose path he crossed regarded him as
male, from the people closest to him, such as his
partner, you know, I might say, our extended
family, the people he worked with and anybody that
passed him in the street, you know.
JANINE COHEN: Jennifer
and Kevin received an email back from an officer in
the federal Attorney-General's Department. It
warned, if they went ahead and got married, Kevin
was liable for a penalty of up to two years jail.
The public servant also predicted, if the couple
took it to court, they would lose; and she
suggested the law perhaps would change one day but
not in her working life. She concluded with this:
"Believe me, as a married mother of four, marriage
is not all it's cracked up to be."
"JENNIFER": I felt very
shocked when I read that. I was actually physically
shaking when I read it. The woman that wrote the
letter, who was in quite a responsible position in
the department answering matters of family law and
so on, just made no attempt to veil her personal
bias.
JANINE COHEN: So this
public servant offered a whole lot of personal
comments?
"KEVIN": Oh, definitely,
of which I found extremely offensive, to me as an
individual, to Jennifer and myself as a couple. It
was just outrageous.
JANINE COHEN: The couple
decided to marry, despite the email, preferring
instead to have the validity of their marriage
tested in the Family Court. They hired lawyer
Rachael Wallbank, herself a transsexual and expert
on the condition. Rachael Wallbank decided to fight
the case against the Attorney-General's Department
on the basis of science.
RACHAEL WALLBANK: We were
able to take the court through a journey, really, a
scientific journey that firstly dealt with the kind
of diversity in human sexual formation, arising
from chromosomal diversity as well as bodily
formation diversity, to the point where we could
deal with evidence concerning brain sex
differentiation in the human being.
JANINE COHEN: The court
was presented with several scientific studies
suggesting a biological basis to transsexualism. A
Dutch study looking at the hypothalamus of six
male-to-female transsexuals found they had similar
features to female brains. They examined the part
of the brain essential for sexual behaviour and
found it was the same size in female transsexuals
as it was in other women. In men, this region of
the brain, known as the bed nucleus of the stria
terminalis, is much larger. The study suggested
that gender identity develops as a result of an
interaction between the developing brain and sex
hormones. Other studies supported this theory.
JUSTICE RICHARD CHISHOLM:
In view of all the evidence that I had, there's
just no reason to see how it could possibly have
been nurture. The things that characterise
transsexuals are as much biological as mental, and
that's terribly important for the law. So the point
I was trying to make in the judgment is that the
brain sex theory, the biological-based theory,
doesn't seem to have any competitors in terms of
explanation. Nobody else is saying, "Oh, there's
this other plausible explanation."
JANINE COHEN: In his
judgment, Justice Chisholm said, "It would be wrong
to suggest that a person's sex depends on any
single factor, such as chromosomes or genitalia."
"Equally", he said, "It would be wrong to say it
can be determined solely by a person's
psychological state or their brain sex."
JUSTICE RICHARD CHISHOLM:
It's not a preference but it's a sense of who they
are that for them seems to be so fundamental that
it's not an opinion and that it couldn't be
changed. It's just an absolute sense, like a sense
perhaps that life's worth living or that one is
alive or that you're sitting on a chair.
JANINE COHEN: Justice
Chisholm also considered Kevin's social standing,
the fact he'd had gender surgery and his success in
being treated as an infertile man in a Sydney
hospital's IVF program. Justice Chisholm determined
that Kevin at the time of his marriage was a man
and therefore the marriage was legal. He said in
his judgment ...
JUSTICE RICHARD CHISHOLM:
"It's difficult to imagine how there could
be a stronger case on the facts for a person with
female chromosomes born with female genitalia and
chromosomes to be treated as a man. I refer to the
extensive evidence relating to his self-perception,
appearance, medical history and functioning in
society."
JANINE COHEN: The
Attorney-General's Department appealed Justice
Chisholm's decision, and the case went to the full
bench of the Family Court. It also decided in
Kevin's favour. Kevin and Jennifer are now happily
married, living with their two children in suburban
Sydney.
"KEVIN": That's all we
want, is to blend in and get on with our lives. We
don't want to go out saying, "Hey, we're different.
Hey, look at us. Hey, treat us with a special kind
of" - I don't know what. We're just like everyone
else. We just - we work. We pay our taxes. We care
for our family. What more do you want?
JANINE COHEN: Far more
controversial than adults changing gender is the
issue of adolescents wanting to. Children seeking
medical treatment must go through the Family Court.
This follows a controversial case last year in
Melbourne where Alex, a 13-year-old born into a
girl's body, wanted to become a boy.
NEWSREADER: A
teenage girl has become the first child in
Australia to be given legal approval for a sex
change on psychiatric grounds. The teenager,
known only as 'Alex', will be allowed to start
irreversible hormone treatment when she turns
16. But the court decision has divided medical
authorities.
DR FINTAN HARTE: Alex was
a very distressed adolescent who was extremely
depressed because of his gender dysphoria, was
quite suicidal, and certainly evidence suggests
that he is much happier now having commenced
treatment.
JANINE COHEN: The court
decided the teenager could take the chosen name of
'Alex' and should be referred to as a male. It also
agreed to the contraceptive pill to suppress
menstruation.
DR LOUISE NEWMAN:
Essentially I think we saw a very
conservative judgment. This was a complex issue.
This is a young person already living in a male
role. I think what was very positive about it is
that it respected the young person's decision to do
that and supported that choice which had already
been made. In terms of biological interventions, it
was a very conservative approach, using only
reversible interventions.
JANINE COHEN: At 16,
testosterone will be considered to begin his
physical transition. The court found the teenager's
desire to be male was most likely due to biology
and psychosocial factors. The judge referred to the
expert medical evidence in Kevin's case.
CRAIG ANDREWS: Nobody
chooses to go through this route. It's not
something you would choose for yourself or you'd
wish on your worst enemy type of attitude. It's not
a walk in the park, it's not simple or easy, and it
involves a lot of medical intervention.
DR LOUISE NEWMAN: Tell me
what the good things about being a girl are. What
do you like about being a girl?
JANINE COHEN: Dr Louise
Newman specialises in child and adolescent gender
issues. She currently has four adolescents wanting
treatment to change gender. To do so, they will
have to get permission from the Family Court. A
13-year-old who says she is a girl born into a
boy's body recently went before the Family Court in
New South Wales seeking the first stage of
treatment.
DR LOUISE NEWMAN: In this
case we are seeking to use puberty-blocking
hormones which will delay pubertal change in this
young person, on the grounds that they'll be
distressed by that and probably not able to
tolerate that, and that it is very clear for them
that those changes are not going to be
acceptable.
JANINE COHEN: Lawyer
Rachael Wallbank presented medical evidence in
court that puberty-blockers were reversible and
could save the child from self-harm or, worse,
suicide. Not everyone agrees with the view that
adolescents should receive puberty-blockers for
this condition. Many religious organisations are
opposed to any form of medical intervention, and
some doctors question the long-term effects of
puberty-blockers.
PROF. GARRY WARNE: I
don't think we really know the long-term effects on
bone density of missing out on a couple of years of
the accumulation of bone density.
RACHAEL WALLBANK: All the
medical evidence, all the lived experience of
people with transsexualism, like myself, however,
and all of the post-treatment studies of children
indicate that the earlier the children with
transsexualism receive this treatment the better
their lives are, the happier they are and the more
they can actually live out a useful and fulfilling
life.
JANINE COHEN: What about
the critics who say: Adolescence is a time of
turmoil anyway, they could grow out of it, they
could change their mind, they could in fact simply
be gay? What do you say to those critics?
RACHAEL WALLBANK: The
treatment of transsexualism in childhood is a very
conservative process. Usually years go by with the
child under the microscope before the child's even
able to commence on the totally reversible stage
one treatment. What I say to those people is,
"Please keep an open mind here. It's not within
your experience. Transsexualism is not within your
experience. It's within mine. It's within the
experience of these children. If they don't have
the treatment, they're faced with years and years
of agony."
JANINE COHEN: Professor
Garry Warne recently returned from a London
workshop looking at the medical management of
transsexual children. Advocates argue that
puberty-blockers must be given to a child by 12 or
13, before puberty arrives. But Professor Warne and
some other doctors believe they shouldn't be
administered to any child under the age of 16.
PROF. GARRY WARNE:
They're worried about making the wrong
decision, and they're worried about it coming back
to bite them later on.
JANINE COHEN: And can
that happen?
PROF. GARRY WARNE: It has
happened.
JANINE COHEN: At what age
should a young person be able to take things like
hormones, for example?
CRAIG ANDREWS: It's a
dilemma because young people - it's a dilemma
because you're wondering all the time whether the
young person has a core gender of the sex they
identify themselves to be or whether they've
actually got enough life experience to make that
judgment.
JANINE COHEN: Craig
Andrews runs a support group for female-to-male
transsexuals. He has been concerned about the
increasing number of teenage girls contacting his
organisation wanting treatment because they think
their lives would be better as men.
CRAIG ANDREWS: I think
young people, for a whole range of reasons, can
grab hold of answers that might not be answers.
JANINE COHEN: Three weeks
ago, Rachael Wallbank's client received permission
to have their 13-year-old child treated with
puberty-blocking hormones. The lawyer will soon
return to court seeking an order so the parents
don't have to go through the Family Court to access
further medical treatment for their transsexual
child. The next stage would include oestrogen to
feminise the teenager. Rachael Wallbank says, if
successful, this would be a precedent-setting case,
making it no longer mandatory for children to go
before the Family Court for treatment.
RACHAEL WALLBANK: In my
view, once a court hears more complete evidence
about transsexualism, the kind of evidence that
Justice Chisholm heard in Re Kevin, then the court
will be more comfortable about allowing the
treatment of transsexualism in childhood, to follow
a medical course rather than imposing on the
parents of these children the additional burden,
financial and mental burden, of having to take the
child through a legal process to enable that child
to receive the treatment that the child needs.
JUSTICE RICHARD CHISHOLM:
The question whether procedures relating to
transsexualism require court approval I can well
imagine might be controversial, and I suppose one
might be more - the argument for having it approved
by a court would be stronger in the case of
irreversible steps, like surgery.
PROF. GARRY WARNE: We
think that there must be some compromise that can
be reached here whereby the court perhaps agrees to
certain guidelines.
JANINE COHEN: As science
discovers more about what makes a boy and what
makes a girl, these difficult decisions may be made
a little easier. But, for now, we are only just
starting to understand how complex the biology is.
It certainly isn't as simple as XX and XY.
Citation
— Cohen, J. (2005). The Gender Puzzle.
4Corners
- ABC TV,
25 July 2005
|
