Let’s Talk About Gender Transition

During the editing process for this article the LGBTQ community was devastated by the deadliest mass shooting incident in the country’s history. We were torn if we should publish this article in wake of this tragedy, but we believe that this is is valuable information that everyone should know. For ways to help the victims and their families visit this link.

Everyone is pretty fixated on the bathroom habits of
transgender people lately. The awful memes and endless Facebook arguments have made it clear that many people may not understand what it means to be transgender*.

Trans people face overwhelming social stigma, and a 2000px-A_TransGender-Symbol_Plain3.svgsurvey of LGBTQ Americans suggests that they  are the least socially accepted subpopulation of the LGBTQ community. This lack of acceptance may be a major contributing factor to the strikingly high rate of suicide among trans people. The American Foundation for Suicide Prevention and the Williams Institute released results from a survey that revealed 42% of trans women, 46% of  trans men, and 36%-38% of gender non-conforming/genderqueer (GNC) people have attempted suicide. Trans and GNC people are also the victims of violent crimes, and things are not improving; the Human Rights Campaign reported that transgender homicides hit an all time high in 2015. Since transphobia may come from a place of misunderstanding, this piece aims to explain gender transition and gender identity from a biological perspective.

Gender dysphoria is a condition defined in the Diagnostic and Statistical Manual of Mental Illness as “a marked difference between the individual’s expressed/experienced gender and the gender others would assign him or her, and it must continue for at least six months.” Individuals diagnosed with gender dysphoria are referred to as transgender or GNC. Treatment for this condition includes psychotherapy and gender transition. Details of transition are case-dependent, but generally include hormone therapy and gender immersion (where a person lives as the gender with which they identify), and, in some cases, sex reassignment surgery (SRS).

Many studies have shown improved quality of life after SRS and other health care related to transition, but not all are positive. The most recent publication indicates that 1 year after surgery mental health improves, but physical health declines. Another study of a Swedish cohort in 2011 concludes that SRS is associated with higher risk of mortality and suicidal behavior, and post-op patients need better psychiatric support. However, these authors used a cisgender (non-transgender) control group and did not account for the high risk of mortality associated with being transgender, regardless of surgery.

Despite the comparatively high volume of studies that show positive outcomes with medical support of transition, some American doctors remain skeptical and may refuse treatment. Dr. Paul McHugh, former psychiatrist in chief at Johns Hopkins Hospital, is a notable opponent of SRS. In an op-ed originally published in 2014 and republished last month by the Wall Street Journal, McHugh claims that “There are subgroups of the transgendered [sic], and for none does “reassignment” seem apt.” The only study McHugh cites is the one of the Swedish cohort previously mentioned. His misinterpretation of that data and lack of evidence for other claims have been criticized by other psychiatrists and the trans community.

One critical misconception about transgender people is that SRS is an essential part of transition, but that is not the case for all transgender people. This myth stems from the idea that sex and gender are interchangeable words with the same meaning, but there is a clear distinction. Sex (male/female) refers to a person’s anatomy (penis/vagina), sex organs (testes/ovaries), and/or chromosomes (XY/XX), while gender (man/woman) refers more to the societal and cultural aspects of masculinity and femininity. These characteristics are biologically distinct and one does not imply the other.  

Last year, researchers at Boston University School of Medicine published a review article that suggests that gender identity is biologically distinct from sexual identity. The authors analyzed multiple studies on people with sexual development disorders and concluded that gender identity is a biological condition unaffected by the gender to which one is assigned at birth. Moreover, neurological studies reveal similarities between trans people and the gender with which they identify. For example, a 1995 study examined the size and number of neurons in a specific area of the brain (the BSTc) that is known to differ between men and women. When the BSTc of trans women (individuals assigned male at birth, but identified as and transitioned to female) were analyzed they more closely resembled that of women than men. Since this finding in the mid-90s others have found similar phenomena in other areas of the brain. The sample size for these neurological studies are relatively small and should be interpreted with caution. However, together, they make a strong case that gender identity is a biological condition independent of gender assignment and sex determining characteristics.

Although there are some critics, the amount of studies that show positive outcomes with transition are overwhelmingly more abundant than those that do not, and current data suggests that gender identity is a real biological condition, not a lifestyle choice. Further understanding of gender transition and gender identity will improve healthcare and ultimately lead to a better life for those with gender dysphoria.

*I am cisgender and have no idea what it is like being transgender emotionally or mentally speaking. For that, you should ask a transgender person and/or check out this article. My piece will focus on gender identity from a purely biological perspective.

Anthony Barrasso (President)
AnthonyBarrasso_AvatarAnthony is a 3rd year graduate student studying retinal development. His career interests include cancer research, education, and politics. Outside of lab, he likes playing with his dog and eating delicious food. Follow him on twitter @barrasso67
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