When we speak of gender, in a context other
than language, it is a recent concept in our culture, both lay and
professional. In 1955, John Money, Ph.D. first used the term
"gender" to discuss sexual roles, adding in 1966 the term
"gender identity" while conducting his gender research at Johns
Hopkins. In 1974, Dr. N.W. Fisk provided our now familiar diagnosis of
Gender Dysphoria. Previously, one’s sexual role was considered one of two
discrete, non-overlapping congenital attributes--male or female. These two
mutually exclusive categories allowed for no variation. Of course, we
acknowledged the cultural differences in sexual roles, but there still could
be only two modes of expression.
Now we know that one’s gender is on a
continuum, a blending, analogous to a "gray scale." But, our
distribution of gender is bimodal, that is, most people are lumped at the
two ends (see graphic) with only a minority in the middle. The great
majority will see themselves as either male or female with all that implies.
Probably more upsetting to our conventional
view of gender than this fuzziness of gender roles is that we can be a MIX
of male and female identities within the same individual. Several
researchers have developed theories of how the brain develops prenatally
along sexual lines arising from androgen mediation. Dr. Milton Diamond
concludes from his research that the brain has four stages of gender
imprinting.
The first is Basic Sexual Patterning
such as aggressiveness vs. passivity. Second comes Sexual Identity
(gender identity), third, the Mating Centers develop (sexual
orientation), and fourth, the Control Centers for sexual equipment
such as orgasm.
Gunter Dörner in Germany, using his
research with rats, sees only three stages. He believes that first the Sex
Centers develop giving typical male and female physical characteristics,
then the Mating Centers (sexual orientation) and then the Gender
Role Centers which are similar to Diamond’s "Basic Sexual
Patterning."
As a psychotherapist, I don’t presume to
enter into the discussion of what develops in what order and how. I take a
more pragmatic stance and seek to observe what behaviors are linked, or
independent from one another. From this research and observation, I have
developed the list of five semi-independent attributes of gender. Not as a
fixed dogma, but as a working theory, a map if you will, to help us
understand this complex often hotly emotional issue of gender. Consider
sexual identity/behavior springing from five semi-independent attributes.
These five attributes are:
Genetic - Our chromosomal inheritance.
Physical Appearance - Our primary
and secondary sexual characteristics.
"Brain Sex" - Functional
structure of the brain, along gender lines.
Sexual Orientation - Love/sex
object, "Love Maps."
Gender Identity - How we see ourselves:
As male, female or a combination.
It is my contention that it is possible for
an individual to view oneself and function as male or female to varying
degrees in each of the five sub-categories independent of the others. For
example, an individual may be XX female (chromosomal female), physically
female, have a "female brain," be heterosexual but see
her(him)self as male--or any other combination. One can be either male or
female in each of the five sub-categories independent of each other. If we
use "F" for female identity/function, and "M" for male
identity/function and one through five for the semi-independent attributes
listed above we could describe each individual according to their particular
breakdown:
1M ----- 2M ----- 3M ----- 4M ----- 5F
A Gender Dysphoric, Morphological Male
1M ----- 2M ----- 3M ----- 4F ----- 5M
A Homosexual Male
1F ----- 2F ----- 3M ----- 4F ----- 5F
A Dominant, But Heterosexual, Even
Feminine, Female
Since each of these independent attributes
are graded, it is easy to see the possible combinations and degrees number
in the thousands. With regard to gender, we each can be in a category of
one--ourselves.
Whether it’s gender identity, sexual
orientation, or brain sex, then expression usually remains constant from
childhood throughout one’s life.
Now, for a more detailed description and
illustration of the five sub-categories of gender:
The first sub-category, Genetics, is
only beginning to be understood. How and how much do genetic influences
effect one’s expression of gender? We do know that besides the traditional
XX chromosome of a typical female and the XY of a typical male, that there
are other combinations such as XXY, XYY, and XO.
A XXY combination results in 47 rather the
46 chromosomes. This condition is called Klinefelder’s syndrome and
occurs in one in every 500 births. Individuals with Klinefelder’s are
sterile, have enlarged breasts, small testicles and penis, and a eunuch body
shape much like the "Pat" character on "Saturday Night
Live." They show little interest in sex.
Another 47 chromosome occurrence is XYY
Syndrome. In this syndrome, the hormonal and physical appearance of the
individual are evidenced as a hormonal and physical appearance of the
individual are evidenced as a normal male, but behavior is effected.
Typically, XYY Syndrome people are bisexual or paraphilic (pedophillia,
exhibitionism, voyeurism, etc.), and show very poor impulse control.
Where Klinefelder’s and XYY Syndrome are
examples of an extra chromosome, Turner’s syndrome is a case of a missing
sex chromosome. These individuals possess 45 chromosomes (written as XO),
are unable to develop gonads, and are free of all sexual hormones, except
those crossing over from the mother during fetal life.
Turner’s Syndrome people have
external sex organs approximating a female, and their behavior is
characterized as hyper-feminine, baby care oriented, and showing very poor
spatial and math skills. The Turner’s personality, free of all influence
from testosterone, tends to be in direct opposition to the typical set of
"Tom Boy" traits.
Turner’s Syndrome relates well to our
second category of Physical Gender--that being our primary and
secondary sexual characteristics. To discuss this aspect of gender we need
to examine hormonal involvement, in particular testosterone. All sexual
differentiation, physical, mental, and emotional are produced by hormones
which may be amplified and/or specified by one’s social environment.
During fetal life, the amount present, or the absence of testosterone
determines our sexuality -- physically, mentally and emotionally. There are
key times or periods during development when the fetus will go towards the
male or the female depending on the level of testosterone. These windows of
opportunity may be only open for a few days and if the needed level of
testosterone is not present, a basic female orientation develops regardless
of the testosterone levels before or after this critical period, and the
resulting sexual imprint.
The first critical period is at conception
when the presence of the SRY gene (Sex-Determining Region of the Y
chromosome) will determine our physical gender. The SRY gene is normally
found on the short arm of the Y chromosome, but can detach making for a XY
female (the Y missing its SRY gene) or a XX male (the SRY attaching to the
X).
The SRY gene causes the fetus to release
TDF (Testes Determining Factor) which turns the undifferentiated gonad into
testes. Once testes have formed, they release androgens such as
testosterone, dihydrotestosterone, and anti-mullerian hormone.
Before the release of TDF, the developing
fetus has two tiny structures, the mullerian and wolffian ducts, and two
small undifferentiated gonads, neither testes nor ovaries. Without the
influence of TDF and testosterone, the gonads form into ovaries and the
mullerian duct forms into the female internal sex organs, the wolffian duct
disappears and the external sexual tissue becomes the labia major, clitoris,
labia minor and clitoral hood. With the influence of TDF, the gonads become
testicles and the wolffian duct forms the male internal sex organs, the
mullerian ducts dissolve and the external tissue develop into the penis,
scrotum, penile sheaths and foreskin. In other words, without testosterone
all fetuses develop into females. Adam springs from Eve, not Eve from Adam.
As the primary sexual differentiation
proceeds towards our physical gender, sometimes deviations occur. These
anomalies are sometimes called "experiments of nature." One such
"experiment" is a condition termed congenital adrenal
hyperplasia (CAH) when the female fetus releases a steroid hormone form
her adrenal glands which resembles testosterone. The resulting child often
has confusing genitals ranging from deformed female genitals to an
appearance of male genitals. If the child is raised as male, following any
"adjusting" surgery and given male hormones at puberty, the
individual develops as a "normal" but sterile male with XX
chromosomes. On the other hand, if the infant is surgically corrected to
female and given female hormones, there is a 50/50 chance of lesbian
expression.
Another revealing "experiment of
nature" is Androgen Insensitivity Syndrome. In this case, there
is normal amounts of testosterone circulating in a XY chromosome fetus, but
each cell of its body is unable to react to it. This is similar to
Turner’s Syndrome in that neither the mullerian or wolffian ducts mature
and the external genitalia develops into an approximation of normal female
genitals, but differs in that TDF stimulates the gonads into becoming
functioning testicles in a XY chromosome body. The child is raised as a girl
and is seen as a normal female until she fails to menstruate because she has
no uterus. If enough estrogen is produced by her testes, she develops into a
completely normal appearing, sterile female with XY chromosomes and internal
testicles.
Now we must leave the comfortable arena of
biology and development and enter the more rocky, emotional and even
political arena of psychology, anthropology, and sociology. An arena where
deduction, speculation and circumstantial evidence is more evident than
"hard fact."
The third, forth and fifth attributes all
reside in the brain and there is controversy on both a congenital vs.
environmental level and on a developmental one. It is still argued by some
that sexual orientation is a choice and there is no difference in the mental
abilities of men and women. Others argue that the evidence, both direct and
circumstantial, is becoming overwhelming that these stands are incorrect.
Because of the controversy over whether
significant differences in brain structure do exist between the genders, I
will confine my discussion of the "Brain Sex" attribute to
some behavioral differences that have been noted between morphological male
and female infants and children. At all times keep in mind that Physical
Gender does NOT always indicate "Brain Sex" Gender. And, while
these differences are the norm, they are not absolute. Individual children
may differ.
Even a few hours after birth, significant
behavioral differences are noted between morphologically normal boys and
girls. Newborn girls are much more sensitive to touch and sound than their
male counterparts. Several day old girls spend about twice as long looking
back at an adult face than boys, and even longer if the adult is speaking. A
girl can distinguish between the cries of another infant from other
extraneous noises long before a boy. Even before they can understand
language, girls do better at identifying the emotional context of speech.
Conversely, during the first few weeks of
infant life, boys are inattentive to the presence of an adult, whether
speaking to the infant or not. However, baby boys tend to show more activity
and wakefulness. At the age of several months, girls can usually distinguish
between the faces of strangers and people they know--boys usually do not
demonstrate this ability.
As infants grow into children, the
differences seem to intensify and polarize. Girls learn to speak earlier
than boys and do a better job of it. Boys want to explore areas, spaces and
things, girls like to talk and listen. Boys like vigorous play in a large
space where girls like more sedentary games in smaller spaces. Boys like to
build, take things apart, explore mechanical aspects of things and are
interested in other children only for their "use" (playmates,
teammates, allies, etc.). Girls see others more as individuals--and will
likely exclude a person because they're "not nice," and will more
readily include younger children and remember each other’s names. Girls
play games involving home, friendship, and emotions. Boys like rough,
competitive games full of "‘zap, pow’ and villainy." Boys will
measure success by active interference with other players, preferring games
where winning and losing is clearly defined. In contrast, girl play involves
taking turns, cooperation and indirect competition. Tag is a typical boy’s
game, hopscotch is a girl’s game.
If "Brain Sex" is controversial,
the fourth attribute of Sexual Orientation is ever more so. Although
there is public and political controversy, the overwhelming majority of
medical and psychological practitioners agree that sexual orientation may
prove to be mainly congenital, or at least firmly established in early
childhood. The term "Sexual Orientation" is a bit misleading. It
is more an erotic or love orientation in that Sexual Orientation determines
the physical gender we find attractive, with whom we fall in love, and have
romantic as well as sexual fantasies.
From experiments with animals,
"experiments of nature" in humans, and genetic and neurological
studies come a consistent, though still circumstantial, stream of evidence
that indicates one’s sexual orientation is largely hormonally determined
by the presence of testosterone at key periods in fetal development, and
possibly even beyond. As we have seen with congenital adrenal hyperplasia (CAH),
female fetuses exposed to testosterone-like agents develop a 50/50 chance of
a lesbian versus heterosexual orientation if raised as girls. Studies of
identical twins also indicate that when one twin shows homosexual or lesbian
expression, there is a 50/50 chance of homosexual or lesbian expression in
the other twin—whether raised together or apart.
The remaining 50% of determination may be
continued hormonal development, environmental considerations or a
combination. One interesting consideration with determination may be during
our early postnatal development since the fetal stage for human babies is
not completed during gestation, but continues for a year or more outside the
womb. And during this critical time after birth, we have the highest level
of testosterone present, excluding the onset of puberty--with many brain
receptors to receive this powerful hormone. At any rate, between the ages of
three and six years, one’s erotic orientation is established but may not
be acted upon for decades, if at all.
The last of our five attributes, Gender
Identity, is the last to be identified, and the least understood and
researched. When one’s Gender Identity does not match their Physical
Gender, the individual is termed Gender Dysphoric. Like Sexual
Orientation, gender dysphoria is not pathological in itself, but a natural
aberration occurring within the population. As with sexual orientation, the
percentage of the population having gender dysphoria is in dispute, with
estimates ranging between one in 39,000 individuals to three percent of the
general population.
Although it is useful for psychotherapists
and other behavioral scientists to use diagnostic nomenclature in order to
describe an individual, we must remember that these categories are often
fluid. An individual may see and express themselves for years as a
crossdresser, then change their self-identity to a more transgendered or
transsexual one. This change may be because the individual actually changes
their self-view with age, or more information and experience lead to a
clearer understanding of self.
Gender dysphoric individuals commonly, even
frequently, have a sexual orientation markedly different from their gender
identity, which suggests that the key periods of these formations occur at
differing times. While gender dysphoric individuals display a wide gamut of
incongruity and discomfort with their physical gender, three main groups
have been delineated:
Crossdresser - Those individuals
with a desire to wear the clothing of the other sex are termed crossdressers.
Most crossdressers are heterosexual men--one’s sexual preference has
nothing to do with crossdressing. Many men like to wear women’s clothing
in private or in public, and may even occasionally fantasize about becoming
a woman. Once referred to as a transvestite, crossdresser has become the
term of choice.
Transgenderist - Transgenderists are
men and women who prefer to steer away from gender role extremes and perfect
an androgynous presentation of gender. They incorporate elements of both
masculinity and femininity into their appearance. They may be seen by some
persons as male, and by others as female. They may live part of their life
as a man, and part as a woman, or they may live entirely in their new gender
role but without plans for genital surgery.
Transsexual - Men and women whose
gender identity more closely matches the other sex are termed transsexual.
These individuals desire to rid themselves of their primary and secondary
sexual characteristics and live as members of the other sex. Hormonal and
surgical techniques make this possible, but it is a difficult, disruptive,
and costly process, and must not be undertaken without psychological
counseling, careful planning, and a realistic understanding of the likely
outcome. Most transsexual people are born and first live as male.
Transsexuals are diagnostically divided
into the sub-categories of Primary or Secondary.
Primary transsexuals display an
unrelenting and high degree of gender dysphoria, usually from an early age
(four to six years of age).
Secondary transsexuals usually come
to a full realization of their condition in their twenties and thirties, and
may not act on their feelings until they are much older. Typically,
secondary transsexuals first go through phases that would be self-assessed
as being a "crossdresser or transgenderist."
The outcomes of transsexuals vary greatly.
There seems to be no significance in the outcome differences between primary
and secondary transsexuals. Those who complete this gender reassignment
process (the process of "transition") and have exercised due
diligence throughout generally do very well for themselves and lead happy
and fulfilling lives.
Unfortunately, others who go through the
process on a perfunctory basis may be unprepared to fully and comfortably
assimilate into their new gender role. In conclusion, when we think of
gender, we need to realize that many combinations in gender exist, and that
they are all natural. Although most people are morphologically male or
female, those who homogeneously fill all five gender categories as the same
gender may be in the minority. The largest minority, but still a minority.
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