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Not A Choice?  What Causes it?

This is a question still being explored by the scientific community and over past decades various theories have been proposed, however, current information is pointing toward genetics and physiology.

Throughout history the transgendered person has existed and it wasn’t until the major religions began to exert their “understanding” on the non-believers that people began to shun us.

It is basic human nature to shun what is not understood, and this often turns to fear of the unknown.  There was no definable cause for the transgender person so this fear was natural even though misplaced.

There has not been a great deal of research into transgender condition because as I pointed out earlier it is not common nor perceived to be of any significance to the scientific community.  Most of the research has been sociological rather than medical including psychological.  Often the research conducted has been done by people with vested interests in transgender and as such their conclusions have often been questioned by the scientific community or outright dismissed.  This is changing.

Dating back to the late 1950’s and 60’s the train of thought was that cause was psychological, that it was a choice and as such the “cure” was through psychiatric means that today would be abusive.  Forced behaviour modification was usually the treatment including electro shock therapy and drugged detention.  At its worst, people were lobotomized.

Dr. Harry Benjamin

Dr. Harry Benjamin who is generally regarded as the leader in transsexual research began his studies in earnest in the late 1940’s at the request of Dr. Alfred Kinsey who referred a child transsexual to Dr. Benjamin.  In contrast to the psychiatric community and its approach, Dr. Benjamin took a physiological approach.  He began by treating transsexuals with hormones; Estrogen (Premarin®) to be exact, and reported a “calming effect” on his patients. 

In 1954 he coined the term transsexualism (this obscure claim is often disputed and really is moot.) then embarked on a treatment path that included carefully selected members of the medical community.  By and large, the psychiatric community of the day considered Benjamin’s approaches as contraindicated despite his successes in “treatment”.  Even today there is an element to the psych community that will not accept current scientific evidence.

During this time the proposed causality was considered to be chromosomal, however once Benjamin’s treatments with hormones became more widely known, the thinking shifted toward hormonal release during pregnancy.  It was thought that if hormonal release was not timed correctly the X-X chromosome of the female embryo would deviate from the X-X or X-Y (to create the male), would actually add an extra chromosome.   This thinking lasted well into the late 1990’s until Genetic Researchers at UCLA discovered a genetic link.

J.-N. Zhou et al

Perhaps of all studies into transgender, one of the most important deals with neurology and was conducted by Dr. J.-N. Zhou of the Netherlands Institute for Brain Research and titled “A Sex Difference In The Human Brain And Its Relation To Transsexuality” 1995.

This research was conducted over a period of eleven years.  In order to conduct the research, the subjects gave consent for brain dissection post mortem.  Each of the subjects provided in-depth case histories in order to eliminate the variables from the focus of the study.

The importance of this research is indisputable for a couple of reasons primary being why hormone replacement therapy works for the transsexual’s mental issues, and secondly because it does provide strong clues for physiological cause.

First, the study discovered that the male and female brains differ in the size of the area for sexual functioning.  In the normal male brain this area (central subdivision of the bed nucleus of the stria terminalis (BSTc), a brain area that is essential for sexual behaviour) is approximately 62% larger than the normal female.  However, the male to female transsexual brain had a much smaller BSTc area for sexual function such as would normally be found in a normal natal female. 

This discovery was significant because any influence of drug therapies or physical alteration (Orchidectomy) were ruled out as having any effect on the BSTc portion of the brain.  The study then concluded that the only possible cause could be that this anomaly could only have occurred during brain development in-utero.

This information only adds credence to the theory of the hormone wash during the first trimester of pregnancy and when taken into consideration with the UCLA Genetics study, presents a very strong argument for physiological cause although still, far from conclusive.

More in-depth study is required to unravel the reasons for Transsexuality.  There is little impetus in the scientific community to pursue this research and so it is “underfunded”.

The information that follows is a news article outlining the findings of UCLA genetics researchers.

Sexual Identity Hard-Wired by Genetics, Study Says

Reuters News Service  10/20/2003

Refuting 30 years of scientific theory that solely credits hormones for brain development, UCLA scientists have identified 54 genes that may explain the different organization of male and female brains. Published in the October edition of the journal Molecular Brain Research, the UCLA discovery suggests that sexual identity is hard-wired into the brain before birth and may offer physicians a tool for gender assignment of babies born with ambiguous genitalia.

"Our findings may help answer an important question - why do we feel male or female?" explained Dr. Eric Vilain, assistant professor of human genetics and urology at the David Geffen School of Medicine at UCLA and a pediatrician at UCLA's Mattel Children's Hospital. "Sexual identity is rooted in every person's biology before birth and springs from a variation in our individual genome."

Since the 1970s, scientists have believed that estrogen and testosterone were wholly responsible for sexually organizing the brain. In other words, a fetal brain simply needed to produce more testosterone to become male. Recent evidence, however, indicates that hormones cannot explain everything about the sexual differences between male and female brains.

Vilain and his colleagues explored whether genetic influences could explain the variations between male and female brains. Using two genetic testing methods, they compared the production of genes in male and female brains in embryonic mice - long before the animals developed sex organs.

To their surprise, the researchers found 54 genes produced in different amounts in male and female mouse brains, prior to hormonal influence. Eighteen of the genes were produced at higher levels in the male brains; 36 were produced at higher levels in the female brains.

"We didn't expect to find genetic differences between the sexes' brains," admitted Vilain. "But we discovered that the male and female brains differed in many measurable ways, including anatomy and function."

In one intriguing example, the two hemispheres of the brain appeared more symmetrical in females than in males. According to Vilain, the symmetry may improve communication between both sides of the brain, leading to enhanced verbal expressiveness in females.

"This anatomical difference may explain why women can sometimes articulate their feelings more easily than men," he said.

Overall, the UCLA team's findings counter the theory that only hormones are responsible for organizing the brain.

"Our research implies that genes account for some of the differences between male and female brains," noted Vilain. "We believe that one's genes, hormones and environment exert a combined influence on sexual brain development."

The scientists will pursue further studies to distinguish specific roles in the brain's sexual maturation for each of the 54 different genes they identified. What their research reveals may provide insight into how the brain determines gender identity.

"Our findings may explain why we feel male or female, regardless of our actual anatomy," said Vilain. "These discoveries lend credence to the idea that being transgender --- feeling that one has been born into the body of the wrong sex -- is a state of mind.

"From previous studies, we know that transgender persons possess normal hormonal levels," he added. "Their gender identity likely will be explained by some of the genes we discovered."

Vilain's findings on the brain's sex genes may also ease the plight of parents of intersex infants, and help their physicians to assign gender with greater accuracy. Mild cases of malformed genitalia occur in 1 percent of all births - about 3 million cases. More severe cases - where doctors can't inform parents whether they had a boy or girl -- occur in one in 3,000 births.

"If physicians could predict the gender of newborns with ambiguous genitalia at birth, we would make less mistakes in gender assignment," said Vilain.

Lastly, Vilain proposes that the UCLA findings may help to explain the origin of homosexuality.

"It's quite possible that sexual identity and physical attraction is 'hard-wired' by the brain," he noted. "If we accept this concept, we must dismiss the myth that homosexuality is a 'choice' and examine our civil legal system accordingly."

The UCLA study was supported by the National Institute of Child Health and Human Development, the National Science Foundation and with start-up funds from the UCLA Department of Urology. Vilain's co-authors included Phoebe Dewing, Steve Horvath and Tao Shi, all of UCLA.

Molecular Brain Research, Oct. 21 issue, Vol. 118, pgs. 82-90.

While this information is a very strong link to cause, it is far from absolute and more research is required in order to develop the theory.  Despite this need for additional research, it would appear that to date, the genetic link would provide the most substantial clue to cause of transgenderism.  Combined with the hormonal cause there is no doubt that the typical male and female brains are “wired” differently and the transgendered brain is somewhere in the middle.

Further research by Australian researchers have conclusively confirmed the UCLA findings and expanded on it by establishing that the M2F brain is nearly identical to the natal female brain. (2007)

Dr. Eric Vilain

This is exerpted from an interview with this world renowned genetic researcher from UCLA

"But you can look at [it] with a different perspective which is the makeup of the gonads, whether they're testes or ovaries and that's a completely different perspective on it. We know there are individuals who have ovaries yet they can be XY and conversely you can have testes and be XX. So they're two independent primaries.

There is a third way of looking at this, which is what we call the "phenotypic sex" and that is probably the most common sense definition of sex and that's the appearance of the external genitalia. Penis, you're male. Vagina, you're a female. Again this definition may be discordant with the genetic makeup and the endocrine or gonad makeup.

And finally, another way of looking at it is gender identity. It's one's own perception of one's sex and that's how people feel like the way they are, either male or female. This can be completely discordant with the rest. You can have individuals who are fully masculinized, have a penis, have two testicles, they're XY, they have levels of testosterone of the majority of males, yet they feel like they belong to the [female] body and in their mind they are female. These four perspectives are very important as a whole to define what sex is."

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The current thinking within the medical community is leaning more towards physiological cause for transsexuality as more research is conducted.  While all of this is fascinating, it does nothing in the way of relieving the stresses experienced with Gender Dysphoria.  This falls squarely on the shoulders of the trans person who must necessarily learn to cope through skills acquired in therapy.  Even with the introduction of hormone therapy, some dysphoria will continue to exist although it will be much less intense.

The negative side to this is that there is a small but very influential body within the psych community who cling to disproven theories and protocols of treatment for transsexualism.  Their approaches do not do any great favours for the sufferer.  Despite the knowledge that their protocols are outdated and in fact harmful, their influential positions within the community remain and so the psych community is split as a result.  However, the World Professional Association for Transgender Health do not ascribe to these theories of transgender being rooted in psychology and they reject such notions outright.

NEXT:  Are You an Ally?

This site was last updated 09/16/15