Sydney,
Australia — The search is on to find a
biological basis for transsexualism.
As a young child, Craig
Andrews felt certain about his future. "I always thought
I'd grow up to be a man," he recalls. 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," he says. "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. Now 35, he says
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 <http://www.ftmaustralia.org/>,
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 transsexualism develops," says
Dr Walter Bockting, a scientific editor of the
International Journal of Transgenderism
<http://www.symposion.com/ijt/>.
"We believe it is an interaction between nature and
nurture."
But 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 as family
dynamics.
Transsexual people 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 <http://www.phimr.monash.edu.au/>
in Melbourne and Professor Eric Vilain of the University
of California.
Bower claims a genetic
test of gender identity would have great benefits.
Children with disorders such as "Alex", the subject of a
controversial Family Court <http://www.familycourt.gov.au/>
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 Alex
to take a form of the contraceptive pill that will
suppress menstruation. At 16, Alex's doctors may also
prescribe male hormones, but any surgery could not be
considered until Alex was 18.
The decision
<http://www.austlii.edu.au/au/cases/cth/family_ct/2004/297.html>
was supported by Alex's doctors, teachers, aunt and two
independent psychiatrists but has been criticised 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. Victorian Health Minister, Bronwyn
Pike, last month asked an independent psychiatrist to
review procedures at the clinic following
complaints.
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. If it 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 some of the 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 was
controlled solely by hormones. But last year, Vilain, in
California, published a study that suggested sexuality
was hard-wired into the brain very early in the womb. His
team tested 15,000 genes in the brains of mice 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 that
Vilain and Harley want to study in transsexual people
from the Melbourne clinic, and work has already begun on
a couple of them. Vilain says there is little evidence
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 small
Dutch study that found a small part of the post-mortem
brain in male-to-female transsexual people was the same
size as in women, rather than men.
The gene hunt can be
justified as scientific curiosity alone, says Vilain. "We
like to understand how the brain functions and an
important function is to provide gender
identity."
But both Harley and
Vilain are also experts in intersex conditions, where
children are born with ambiguous genitalia and they say
genetic tests for sexuality 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 male-to-female transsexual
advocacy group, Australian WOMAN Network
<http://www.w-o-m-a-n.net/>.
"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 by
attacks on the Melbourne clinic - saying more, not less
services are needed for transsexual people. She believes
the clinic psychiatrists take a tough approach to
deciding who is suitable for surgery. "They put you
through the ringer."
Bower also says there
have only been a handful out of 600 patients who
regretted their surgery. "We shouldn't err at all but
this is impossible when you're dealing with
people."
Bockting, at the
University of Minnesota <http://www1.umn.edu/>,
says Dutch research on 1100 patients shows about 10 per
cent regret their decision.
He says debate continues
around the world 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
thirds of the adolescents and adults with gender identity
disorders, eventually decide to take hormones and about a
quarter have 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 accepted best practice has been followed,
says Bockting, with the initial use of a medication with
puberty-blocking, but reversible, effects, such as the
contraceptive pill, before any male hormones are
prescribed.
"Essentially it is buying
time to see a person's identity develop
further."
