Transsexualism is one of the many
different biological variations that may occur
in human sexual formation.
The process of sexual differentiation in a
human being takes place in distinct steps:
- First the chromosomal configuration is
established (XX or XY),
- next gonadal differentiation (ovaries or
testes),
- next differentiation of the internal and
external genitalia (physical genital
formation) and
- finally the differentiation of the brain
into male or female (brain-sex).
Normally all these steps in the process of
sexual differentiation follow a predictable
pattern. The final step occurs only after
birth and up until four years of
age.
In an XY foetus (usually male) - an XY
chromosomal pattern (chromosomal configuration),
testis (gonadal development), male internal and
external genitalia and finally a male brain
differentiation being the substrate of male type
behaviour.
In an XX foetus (usually female) - an
XX chromosomal pattern (chromosomal
configuration), ovary (gonadal development),
female internal and external genitalia and
lastly a female brain differentiation being the
substrate of female-type behaviour.
Most of this physical development takes place
in the developing foetus stage before birth. The
last stages of this process of brain sexual
differentiation takes place after
birth.
These are in brain structures that only
become sex-dimorphic (differentiated) between
the ages of two and four years, well after birth
and long after legal assignment to the male
or female sex has taken place.
Transsexualism is a disorder of sexual
differentiation: the process of becoming male or
female as we conventionally understand it. It is
a condition where the sexual form and structure
(phenotype) of the appearance of a person's body
and the genetic construction (genotype) of a
person's body are opposite that of their
brain1.
There are many people for whom not all
traditional criteria of physical sex development
are in harmony. For a variety of reasons, one in
80 or so babies is born with some kind of sex or
gender identity anomaly2.
These are many intersex conditions which result
in a birth with some biological characteristics
of one sex and some of the others. Most intersex
conditions are observable at birth, others are
not observable at birth and still others are
only discovered much later at
puberty.
The predicament of transsexualism means the
sexual differentiation of the brain has not
followed the pattern predicted by their
earlier steps in the sexual differentiation
process (such as chromosomes, gonad, genitalia)
but has followed a pattern typical of the
opposite sex in the final stage of
brain differentiation process.
Like other people born with disorders in this
process of sex differentiation, men and women
with transsexualism seek medical rehabilitation
for increased harmony with that of their brain.
This decision is similar to the one made in
cases of intersexed children where legal
assignment takes place to the sex in which they
in all likelihood will function
best3.
The decision to recommend hormonal and
surgical treatment for men and women with this
condition takes place much later in life
and is based on the conclusion of a thorough
psycho-diagnostic process that concludes that a
disorder has occurred in the process of sexual
differentiation and that the man or woman
will benefit from hormonal and
surgical sex assignment.
Summary
The current medical viewpoint, based on the
most up-to-date scientific research, is that
transsexualism, is strongly associated with a
neuro-developmental condition of the
brain4 and this theory of
physical development has held over almost fifty
years5.
There is now evidence to consider that for
men and women with transsexualism, the
differentiation process of the brain which
occurs in the first years after birth has not
followed the expected course of the
preceding criteria of sex (chromosomal,
gonadal, and genital)6.
Medical professionals working in these fields
for over half a century agree that there is
not one cause for transsexualism,
but that 'genetic, prenatal (before birth)
hormonal, postnatal (after birth) social, and
post pubertal (after puberty) hormonal
determinants' are all mutually
responsible7.
Hormonal and surgical treatment for this
condition is highly successful under medical
supervision, with up to a 97% success
rate8 in the case of
individuals identified 'female' at birth.
Footnotes
1. Gooren LJ, (2000) University
Hospital, Vrije Universiteit of Amsterdam,
affidavit in Bellinger v Bellinger, TLR
22-11-2000.
2. Gender
Dysphoria, 2004, The
Gender Identity Research & Education
Society UK.
3. Gooren LJ, (2000) University
Hospital, Vrije Universiteit of Amsterdam,
affidavit in Bellinger v Bellinger, TLR
22-11-2000.
4. Benjamin, H (1953) 'Transvestism
and Transsexualism', Journal of Sex
Research, 5:2, p. 13; Hoenig, J (1985) 'The
Origin of Gender Identity' Gender Dysphoria, ed.
Steiner, B W, New York: Plenum Press; and
Docter, R F (1988) Transvestites and
Transsexuals, Towards a Theory of Cross-Gender
Behaviour, New York: Plenum Press, p. 63. Hoenig
follows Benjamin in ultimately depending on a
biological force or forces to account for
transsexualism . Summarising and commenting on
this and other medical viewpoints Docter
indicates that the overall weight of evidence is
that there is "the formation of some kind of
gender system within the brain that is
fundamental to ultimate gender identity and
gender-role development"; Reiner, WG. (1997) To
Be Male or Female - That is the Question,
Arch Pediatric Adol. Medicine 151:225
"the organ that appears to be critical to
psychosexual development and adaptation is not
the external genitalia, but the brain".
5. Playdon, ZJ, 2000, Transsexualism
as an Intersex Condition, Correspondence with
Dr Stephen Whittle, UK
6. Gooren L G J (1993) 'Biological
Aspects of Transsexualism and their relevance to
its legal aspects', Proceedings of the
XXIIIrd Colloquy on European Law:
Transsexualism, Medicine and the Law,
Strasbourg; Council of Europe.
7. Money, J (1994) 'The Concept of
Gender Identity Disorder in Childhood and
Adolescence After 39 Years', Journal of Sex
and Marital Therapy, 20 (3:163-177).
8. Green R & Fleming DT. (2000)
'Transsexual Surgery Follow-up: Status in the
1990s'. Annual Review of Sex Research,
ed. J Bancroft, 1:163-174.
