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Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
Disordered Or Just Different? Myth, Science, and Sexuality
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Disordered Or Just Different? Myth, Science, and Sexuality

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Learn why the biblical binary sexual system is unnatural! A physiologist’s perspective on core sexuality: sexual identity, sexual orientation, sex versus gender, anthropological observations. …

Learn why the biblical binary sexual system is unnatural! A physiologist’s perspective on core sexuality: sexual identity, sexual orientation, sex versus gender, anthropological observations. “Disordered or Just Different” culminates with a scientific indictment of the (pseudo)medical practitioners who are too quick to classify the merely different as disordered and who continue to harm gay, lesbian, transsexual, and intersex peoples.

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  • 1. Disordered or Just Different? Myth, Science and Sexuality By Veronica Drantz, PhD Prepared for The Center For Inquiry/Chicago First Annual Spring Conference Dangerous Nonsense Exploring the Gulf between Science and its Imposters April 24, 2010
  • 2. The Myth
  • 3. Gamete-makers Are Not Binary!
    • Gametes are binary (eggs or sperm)
    • Organisms that make the gametes are not binary!
  • 4. The Science
    • Development of genitalia in mammals
    • Did Eve come from Adam?
    • “ Organization – Activation” Mechanism
  • 5. 23 Pairs Human Chromosomes XX (Female), XY (Male) Figure 25-2 Karyotype of chromosomes from a normal male. The chromosomes have been stained with Giemsa's stain, which produces a characteristic banding pattern.
  • 6. Genetic Sex Determination
    • Typical male has Y chromosome
    • Typical female has no Y chromosome
    Figure 25-1 Basis of genetic sex determination. In the two-stage meiotic division in the female, only one cell survives as the mature ovum. In the male, the meiotic division results in the formation of four sperms, two containing the X and two the Y chromosome. Fertilization thus produces a male zygote with 22 pairs of autosomes plus an X and a Y or a female zygote with 22 pairs of autosomes and two X chromosomes. Note that for clarity, this figure and Figures 25–6 and 25–7 differ from the current international nomenclature for karyotypes, which lists the total number of chromosomes followed by the sex chromosome pattern. Thus, XO is 45, X; XY is 46, XY; XXY is 47, XXY, and so on.
  • 7. Y Chromosome Has Testis-determining Region (Gene)
    • Is a sex-determining gene on the Y chromosome in placental mammals and marsupials
    • Initiates male sex determination
    • Located near tip of short arm of Y chromosome
    • Codes for SRY protein
      • SRY = Sex-determining region Y
      • aka testis determining factor = TDF
      • Causes gonad to differentiate into testis
        • SRY protein is DNA-binding regulatory protein
        • Acts as transcription factor
        • Initiates transcription of cascade of genes necessary for testicular differentiation
  • 8. Sexual Differentiation of Internal Genitalia Figure 25-4 Embryonic differentiation of male and female internal genitalia (genital ducts) from wolffian (male) and müllerian (female) primordia.
  • 9. Sexual Differentiation of External Genitalia Figure 25-5 Differentiation of male and female external genitalia from indifferent primordial structures in the embryo.
  • 10. Sexual Development in Mammals Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT, Dihydrotestosterone
  • 11. Male Testosterone Levels Figure 25-8 Plasma testosterone levels at various ages in human males.
  • 12. Mechanism of Steroid Hormone Action
  • 13. There Is Only One Sex!
    • Mammalian body plan is inherently female
    • Male is altered female !!!
    • Every individual’s body plan is a variation on the female theme
      • Default (female)
      • Fully altered (male)
      • Partly altered (intersex)
    • Everyone falls on some point of the continuum from female (gynemorphic) to male (andromorphic)
    • This sexual body plan is organized by presence or absence of steroid hormones during the critical period of development
    • Sexual systems are activated later by steroid hormones during puberty
  • 14. Sex Has Many Levels
    • Genetic Sex – Chromosomes (X & Y in mammals only)
    • Gonadal Sex – Ovaries/Testis
    • Hormonal Sex – Estrogen/Testosterone
    • Somatic Sex – Body anatomy/physiology
    • Psychological Sex - Sexual identity
    • and then there is
    • Sexual orientation
    Primary sex characteristic
  • 15. Core Sexuality – Nature or Nurture?
    • Genitalia are obviously inborn but what about sexual behavior?
    • Is the brain also organized by presence or absence of hormones before birth?
  • 16. John Money Psychologist
    • Psychosexual "neutrality-at-birth“ theory
      • “ Sexual behavior and orientation as male or female does not have an innate, instinctive basis”
      • Money, J. Hermaphroditism, gender and precocity in hyperadrenocorticism: Psychologic findings. BULLETIN OF THE JOHNS HOPKINS HOSPITAL 96:253-264 (1955)
      • Postulate 1: Individuals are psychosexually neutral at birth
      • Postulate 2: Healthy psychosexual development is intimately related to the appearance of the genitals
      • No evidence to support this theory (s erious flaws in Money’s statistical and research methods
    • *Cappon D, Ezrin C, Lynes P. Psychosexual identification (psychogender) in the intersexed THE CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL 4:90-106 (1959)
  • 17. Milton Diamond B iologist
    • “ Sexuality-at-birth" theory
    • Organization – Activation Mechanism - Prenatal genetic and hormonal influences predispose at birth to a male or female sexual identity
      • Inherent sexuality provides built-in "bias“ with which the individual interacts with environment; sexual behavior and thus gender role, are not neutral and without initial direction at birth
      • Biased-interaction theory of psychosexual development (also known as biased-predisposition theory of psychosexual development and same-different theory of psychosexual development)
      • Evolutionary view
  • 18. 1959 – Breakthrough at University of Kansas
    • Phoenix CH, Goy RW, Gerall AA, Young WC. Organizing action of prenatally administered testosterone propionate on the tissues mediating mating behavior in the female guinea pig. ENDOCRINOLOGY 65:369-382 (1959)
    • Milton Diamond
      • Youngest graduate student in Young’s lab
      • Felt Young et al were too cautious failing to link their animal findings to human situation
      • Decided to write essay challenging psychosexual neutrality theory
  • 19. Diamond Versus Money
    • Diamond challenges Money - 1965
      • Diamond, Milton. A critical evaluation of the ontogeny of human sexual behavior. QUARTERLY REVIEW OF BIOLOGY 40:147 – 175 (1965)
      • Over the years, animal work accumulated showing “determining influence” of prenatal hormones
    • Money responds to challenge - December 28, 1972
      • Symposium of American Association for the Advancement of Science “Sex Role Learning in Childhood and Adolescence”
      • Man & Woman, Boy & Girl: the differentiation and dimorphism of gender identity from conception to maturity . Baltimore, MD: John Hopkins University Press, 1972. 311 p. (Depts Psychiatry and Pediatrics, John Hopkins Univ. Sch. Med., Baltimore, MD)
  • 20. The David Reimer Story
    • John/Joan “Twins Case”
    • Same nature: Identical twins from same womb (same genetics and prenatal hormonal influence)
    • Different nurturing: Raised as different sexes
    • Money reported “Joan” to be a successful girl and woman
    • Touted as a success, this “Nurture Over Nature” case report became the foundation of standard care for treatment of certain intersex conditions, micropenis, and accidental penile amputation in infancy
  • 21. How to Treat a Newborn With Ambiguous Genitalia or Mutilated Penis? Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 22. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 23. N A T U R E N U R T U R E Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 24. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 25. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 26. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 27. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 28. Joan/Brenda Becomes John/David
    • “ Joan’s turning point occurred at the age of 14, when she, on her own initiative, began living as a boy, John. John recalls how soon thereafter he finally learned the truth, “In a tearful episode following John’s prodding, his father told him of the history of what had transpired as an infant and why. John recalls: ‘All of a sudden everything clicked. For the first time things made sense and I understood who and what I was.’”
    Beh HG, Diamond M. An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on Infants with Ambiguous Genitalia? MICHIGAN JOURNAL OF GENDER & LAW 7: 1-63, 2000
  • 29. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 30. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 31. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 32. Colapinto, John. As Nature Made Him - The Boy Who Was Raised As A Girl HarperCollins (2000)
  • 33.
    • John Money tells medical community that Joan/Brenda is a happy girl/woman and then claims to lose track of her
    • Milton Diamond finds Joan/Brenda living as David!
    • When David discovers his case was medically famous and that thousands of intersex babies had suffered his plight, he cooperated with Milton Diamond and “went public”
    • Milton Diamond, Ph.D. & H. Keith Sigmundson, M.D. Sex Reassignment at Birth: A Long Term Review and Clinical Implications. ARCHIVES OF PEDIATRIC & ADOLESCENT MEDICINE 151:298-304 (1997)
    • Money’s view is now discredited!
    David Reimer (1965-2004)
  • 34. Intersex People Curtis Hinkle - Founder Organization Intersex International
  • 35. Intersexuality
    • Incidence: 1.7%*- 2.5%
    • Intersexual people are as natural as the rest of us
    • They are nature’s experiments to a physiologist – providing information about sexual development
    • Only in recent years have we been able to track intersexual people over their lifetime and find out about their sexual identity and orientation
    • They illustrate how no definition of female or male is always “satisfying”
    * Fausto-Sterling, Anne. SEXING THE BODY: GENDER POLITICS AND THE CONSTRUCTION OF SEXUALITY. Basic Books (2000)
  • 36. Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010) Disordered or Just Different?
  • 37. Chromosomal Variants of Sexes 1/500 of the population have a karyotype other than XX or XY. Intersex Support Group International 1999-2001 Barrett, Kim E. Barman, Susan M. Boitano, Scott and Brooks, Heddwen L. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010) Figure 25-1 Basis of genetic sex determination. In the two-stage meiotic division in the female, only one cell survives as the mature ovum. In the male, the meiotic division results in the formation of four sperms, two containing the X and two the Y chromosome. Fertilization thus produces a male zygote with 22 pairs of autosomes plus an X and a Y or a female zygote with 22 pairs of autosomes and two X chromosomes. Note that for clarity, this figure and Figures 25–6 and 25–7 differ from the current international nomenclature for karyotypes, which lists the total number of chromosomes followed by the sex chromosome pattern. Thus, XO is 45, X; XY is 46, XY; XXY is 47, XXY, and so on. Figure 25-7 Summary of four possible defects produced by maternal nondisjunction of the sex chromosomes at the time of meiosis. The YO combination is believed to be lethal, and the fetus dies in utero.
  • 38. Variations of Genetic Sexes
    • Nondisjunction of chromosomes
      • XO Female (Turner Female)
      • XXX Female (Superfemale)
      • XXY, XXXY etc. Male (Klinefelter Male)
      • XYY Male (Jacob’s Syndrome)
    • Translocation of SRY gene from Y to X chromosome
      • XY Female (Swyer syndrome): absence or mutation of SRY on Y produces females with gonadal dysgenesis
      • XX Male (XX Male Syndrome): SRY gene in one or both X chromosomes, produces infertile males
  • 39. What If the Androgen Receptor Doesn’t Work? Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010)
  • 40. Androgen Insensitivity Syndrome
    • AIS aka testicular feminization syndrome
    • Caused by mutations in the gene for the androgen receptor
    • X-linked recessive disorder
    • Male (46 XY) karyotype
    • Testes (abdominal or inguinal)
    • Male internal genitalia undeveloped
    • No uterus or other internal female genitalia
  • 41.  
  • 42. Complete Androgen Insensitivity Syndrome (CAIS)
    • Appear female at birth and are reared as girls
    • Unless there is known or suspected AIS in the family or inguinal testes are detected, these girls typically go undiagnosed until puberty
    • Vagina may be short and blind-ending and may or may not need elongation
    • Breast development occurs but pubic and axillary hair development is sparse or absent
    • When menses fails to occur a remedy is sought
    • Julia Child was a CAIS woman
  • 43. Complete Androgen Insensitivity Syndrome Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons, 1987. Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)
  • 44. Partial Androgen Insensitivity Syndrome (PAIS)
    • Usually noticed at, or soon after, birth
    • Depending upon the degree of masculinization of the genitals, the child may be raised as a boy or a girl
    • AIS is an inherited condition
      • Recessive X-linked single gene syndrome
      • Manifests differently in children of the same parents; one child can be raised as a boy, another as a girl
    • 59% PAIS were assigned as males (United Kingdom study, 16 years or younger)
    • Most published cases of clinical-psychiatric involvement seem to be related to subjects who were raised as females
  • 45. AIS Grading Scheme
    • Grade 1: normal masculinization in utero
    • Grade 2: male phenotype with mild defect in masculinization (eg, isolated hypospadias)
    • Grade 3: male phenotype with severe defect in masculinization—small penis, perineoscrotal hypospadias, bifid scrotum or cryptorchidism
    • Grade 4: severe genital ambiguity— clitoral-like phallus, labioscrotal folds, single perineal orifice
    • Grade 5: female phenotype with posterior labial fusion and clitoromegaly
    • Grade 6/7 female phenotype (grade 6 if pubic hair present in adulthood, grade 7 if no pubic hair in adulthood)
    Numbered I through 7 in order of increasing severity (more defective masculinization ) Adapted from Quigley CA, DeBellis A, Marschke KB, El-Awady MK, Wilson EM, French FS. Androgen Receptor Defects: Historical, Clinical, And Molecular Perspectives. ENDOCRINE REV, 1 6:282; (1995) with permission. In: Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004)
  • 46. Complete AIS & Gender Identity
    • 39 subjects:
    • 100% lived as women and believed that it was the best decision for them; however, this was not a simple solution for all
    • “ Acceptance of assignment does not mean that assignment has been correct. It just means that most are able to adapt and live with the handicap; however, they might have preferred other options”
    * Indicates to me that androgen receptor is required for “alteration” of human gender identity brain region(s). Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004) published statements from ALIAS, an AIS newsletter. Agree Disagree “ I don’t think I am any different in feeling than if I were born XX, feel very female.” 82%* 18% “ All my efforts over the years in presenting a female persona have left me completely exhausted. I might just as well have had a mastectomy, cut my hair short and lived as a celibate man. It would actually have been easier I think.” 10% 90% I have to “work at being a woman” 56% (dressing in a feminine way or using cosmetics or hair styles in a way to signal “female” unambiguously, altering selection of clothes; 30% did above much of the time) 44% Considered suicide 62% 38% Attempted suicide 23% 77%
  • 47. Partial AIS & Gender Identity
    • 18 subjects:
    • Often ambivalent about assigned gender
    • 67% believed that the gender in which they were raised was best for them, whereas the others voiced reservations
    • “ Gender switch” occurred at mean age of 33, range 18-46)
    * Now angry about castration, vaginal reconstruction surgery, and somatic feminization by estrogen treatment since puberty **Attempted before switching Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004) PARTIAL AIS 8 raised as boys 4 live as women 10 raised as girls 2 live as men* Considered suicide 61% **Attempted suicide 17%
  • 48. Simple Virilizing Congenital Adrenal Hyperplasia
    • The salient features of classical simple virilizing 21-OHD are prenatal virilization and progressive postnatal masculinization with accelerated growth and advanced bone ages but no evidence of mineralocorticoid deficiency
    • 21-hydroxylase deficiency is most common form
    • Causes build-up of certain intermediate hormones along the pathway toward cortisol
    • Causes accumulation of 17-hydroxy progesterone and other hormones with androgenic properties
  • 49. Two Types of Adrenogenital Syndrome
    • 21  -hydroxylase deficiency
    • 11  -hydroxylase deficiency
    Figure 22-7 Outline of hormone biosynthesis in the zona fasciculata and zona reticularis of the adrenal cortex. The major secretory products are underlined. The enzymes for the reactions are shown on the left and at the top of the chart. When a particular enzyme is deficient, hormone production is blocked at the points indicated by the shaded bars . Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010)
  • 50. Simple Virilizing CAH
    • Diagnosis at birth of a female with simple virilizing CAH usually is made immediately because of the apparent genital ambiguity
    • In female embryos causes androgenic stimulation that results in enlargement of the genital tubercle, fusion of the internal and external urethral folds and fusion of the labio-scrotal folds just as normal production of testosterone does in male embryos
    • Can result in a female infant having marked enlargement of the clitoris and fusion of the labioscrotal folds
    • This 'virilization' can cause an infant with a 46-XX karyotype to have the appearance of having hypospadias and cryptorchidism
  • 51. Five Degrees of Virilization Affecting the Urogenital Sinus and External Genitalia in Females Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasiz (CAH). J SEX RES, 41: 75-81 (2004)
  • 52. Congenital Adrenal Hyperplasia (CAH)   Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987) Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)
  • 53. Frequency of CAH
    • Figure 4. Frequency of nonclassical and classical 21-hydroxylase deficiency in comparison with other autosomal recessive disease incidences
    • Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasiz (CAH). J SEX RES, 41: 75-81 (2004)
  • 54. Adrenogenital Syndrome Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987)
  • 55. Sexuality of CAH Women
    • Recalled significantly more male-typical play behavior as children
    • Reported significantly less satisfaction with the female sex of assignment and less heterosexual interest
    • Results suggest those girls with CAH who show the greatest alterations in childhood play behavior may be the most likely to develop a bisexual or homosexual orientation as adults and to be dissatisfied with the female sex of assignment
    • Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81 (2004)
  • 56. Sexuality of CAH Women
    • The finding of greater same-sex fantasy among CAH women than among comparison women is consistent with the prenatal hormonal hypothesis*
    • However, most CAH women were categorized as exclusively heterosexual in fantasy and behavior*
    • "These results suggest that excess prenatal androgens predispose some women to the development of same-gender sexual orientation”**
    • “ However, because CAH is a relatively rare condition, and a majority develop a heterosexual orientation, CAH plays a minor role in the overall variability of women's sexual orientation within the general population”**
    • *Veniegas, Rosemary C. Biological Research on Women's Sexual Orientations: Evaluating the Scientific Evidence. J SOCIAL ISSUES, (2000)
    • **Pattatucci, A. M. L., & Hamer, D. H. Development And Familiality Of Sexual Orientation In Females. BEHAVIOR GENETICS, 25: 407-420 (1995)
  • 57. Cloacal Exstrophy
    • Rare, complex defect of the entire pelvis and its contents
    • Occurs during embryogenesis
    • Associated with severe phallic inadequacy or phallic absence in genetic males
    • For about 25 years, neonatal assignment to female sex has been advocated for affected males
  • 58. Cloacal Exstrophy Treatment of Genetic Males
    • Orchiectomy and construction of vulvae
    • Testes normal
    • Phallic atresia occurs despite the presence of normal prenatal androgen levels
    • At birth, female-sex assignment socially, legally, and surgically
    • Neonatal orchiectomy induces a hypogonadal endocrine disorder that precludes postnatal and pubertal androgen surges
    • Unique opportunity to assess prenatal androgen influences on sexual development in genetic males with female-sex assignment and feminized genitalia in a uniform population of patients
    Reiner, William G. and Gearhart, John P. Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth. THE NEW ENGLAND JOURNAL OF MEDICINE, 350:333-341 (2004)
  • 59. Cloacal Exstrophy Reiner, William G. and Gearhart, John P. Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth. THE NEW ENGLAND JOURNAL OF MEDICINE, 350:333-341 (2004)
  • 60. Development of Male Sexual Identity in Cloacal Exstrophy
    • Prenatal androgens appear to be a major biologic factor
    • Results suggest that children who are born genetically and hormonally male may identify themselves as males despite being raised as females and undergoing feminizing genitoplasty at birth
    • Reiner, William G. and Gearhart, John P. Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth. THE NEW ENGLAND JOURNAL OF MEDICINE, 350:333-341 (2004)
  • 61. The Sexual Brain
  • 62. The Hypothalamus Integration of Neuroendocrine Activity and Genesis of Instinctive Drives & Behavior Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010) Figure 18-1 Human hypothalamus, with a superimposed diagrammatic representation of the portal hypophysial vessels.
  • 63. Hypothalamic Functions: Homeostasis and Instinctive Drives & Behavior Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG’S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010)
  • 64. Hypothalamus & Limbic System: Genesis of Emotions & Emotional Expression Netter, Frank H. The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy & Physiology. New York: CIBA (1983)
  • 65. Anterior Hypothalamus Governs Sexual Behavior in Mammals Figure 25-28 Loci where implantations of estrogen in the hypothalamus affect ovarian weight and sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area), whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral hypothalamus (red). MB, mamillary body
  • 66.
    • Nucleus is grey matter region where nerve cells synapse
    • Some of these nuclei are sexually dimorphic, i.e., larger in typical males than typical females
    Same Anatomy of Anterior Hypothalamus in All Mammals Paredes, Raul G., and Baum, Michael J. Role Of The Medial Preoptic Area/Anterior Hypothalamus In The Control Of Masculine Sexual Behavior ANNUAL REVIEW OF SEX RESEARCH (1997) Allen, L. S., Hines, M., Shryne, J. E., and Gorski, R. A. Two Sexually Dimorphic Cell Groups In The Human Brain. JOURNAL OF NEUROSCIENCE, 9: 497-506 (1989) Byne, William. The Medial Preoptic And Anterior Hypothalamic Regions Of The Rhesus Monkey: Cytoarchitectonic Comparison With The Human And Evidence For Sexual Dimorphism. BRAIN RESEARCH 793: 346-350 (1998)
  • 67. Biology of Sexual Orientation
    • Anthropological evidence - gay people everywhere
    • “ Gay people have a different sensibility” Sandra Witelson, PhD
  • 68. Same-sex Behavior In Nearly All Animals
    • Homosexuality & other sexually variant behaviors in animals is widespread
      • Bruce Bagemihl, Biological Exuberance: Animal Homosexuality and Natural Diversity , New York: St. Martin's Press ( 1999)
    • Examples of same-sex behavior can be found in almost all species in the animal kingdom — from worms to frogs to birds — making the practice nearly universal among animals
      • Bailey N, Zuk M. Same-sex sexual behavior and evolution TRENDS IN ECOLOGY AND EVOLUTION 24:439-446 (2009)
  • 69. Brain Sexual Orientation Region
    • Simon LeVay compared anterior hypothalamus of cadavers of gay men versus straight men
      • INAH-3 = Third interstitial nucleus of anterior hypothalamus
      • Measured volume (thionin stain for nucleic acids)
      • Was 2+X larger in straight men than in gay men or women
    • Thus, INAH-3 is dimorphic with sexual orientation rather than genetically determined sex
    • Lends support to idea that sexual orientation has biological basis
    • LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
  • 70. Sexual Orientation & INAH3 LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
  • 71. 2 nd Study of INAH3 & Sexual Orientation
    • Confirmed earlier findings
      • INAH3 contained significantly more neurons and occupied a greater volume in presumed heterosexual males than females
      • No sex difference in volume was detected for any other INAH
      • Trend for INAH3 to occupy a smaller volume in homosexual men than in heterosexual men
      • AIDS does not affect INAH3
    • NEW FINDING: no difference in the number of neurons within the INAH3 based on sexual orientation
    • Byne, William, Tobel, Stuart, Mattiace, Linda A., Lasco, Mitchell S., Kemether, Eileen, Edgar, Mark A., Morgello, Susan, Buchsbaum, Monte S., and Jones, Liesl B. The Interstitial Nuclei of the Human Anterior Hypothalamus: An Investigation of Variation with Sex, Sexual Orientation, and HIV Status. HORMONES AND BEHAVIOR, 40: 86-92 (2001)
  • 72. Gay Sheep Brains
    • About 8% of rams are exclusively homosexual
    • Volume of ovine sexually dimorphic nucleus (oSDN) is 2X bigger in “female-oriented” rams than in “male-oriented” rams
    • This “duplicates” LeVay’s work on INAH3 of humans
    Roselli CE, Larkin K, Resko JA, Stellflug JN, Stormshak F. The volume of a sexually dimorphic nucleus in the ovine medial preoptic area/anterior hypothalamus varies with sexual partner preference. ENDOCRINOLOGY 145:489-483 (2004)
  • 73. Anterior Hypothalamus Is Activated by Sex Pheromones
    • Positron emission tomography (PET scans) of anterior hypothalamus while subjects smell sex pheromones
    Berglund H, Lindstr ö m P, Savic I. Brain response to putative pheromones in lesbian women. PNAS PNAS 103:8269-8274 (2006) AND = progesterone derivative 4,16-androstadien-3-one EST = estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol (EST) Subject Activation of anterior hypothalamus Heterosexual males EST Homosexual males AND Heterosexual females AND Homosexual females EST
  • 74. Is There a Genetic Basis to Sexual Orientation?
    • It has been suggested that homosexuality "runs in families," meaning that there may be a genetic underpinning to the development of sexual orientation
    • Studies have examined this issue by assessing one of following
      • Incidence of homosexuality in families
      • Similarity of sexual orientation between twins
      • Evidence for genetic markers among gay family members
  • 75. Genetics of Gayness in Males
    • A genetic hypothesis posits that homosexuality runs in families and that genetic markers* for sexual orientation can be found among family members
    • Evidence for genetic markers for gay men and their gay brothers in the Xq28 region on the X chromosome
    • *Markers are regions or sections of DNA that are the same among family members, suggesting the presence of a gene
    • Hamer, D. H., Hu, S., Magnuson, V. L., Hu, N., & Pattatucci, A. M. A. Linkage Between DNA Markers On The X Chromosome And Male Sexual Orientation. SCIENCE, 261: 321-327 (1993)
    • Hu, S., Pattatucci, A. M., Patterson, C., Li, L., Fulker, D. W., Cherny, S. S., Kruglyak, L., & Hamer, D. H. Linkage Between Sexual Orientation And Chromosome Xq28 In Males But Not In Females. NATURE GENETICS, 11: 248-256 (1995)
  • 76. Genetics of Lesbianism
    • The following findings are consistent with a genetic hypothesis:
    • Lesbians had significantly higher rates of lesbian sisters, daughters, and cousins through a paternal uncle than did heterosexual women
    • Pattatucci, A. M. L., & Hamer, D. H. Development And Familiality Of Sexual Orientation In Females. BEHAVIOR GENETICS, 25: 407-420 (1995)
    • Increasing rates of concordance of lesbianism from nonidentical twins to identical twin pairs
    • Bailey, J. M., & Benishay, D. S. Familial aggregation of female sexual orientation. AMERICAN JOURNAL OF PSYCHIATRY, 150: 272-277 (1993)
    • Bailey, J. M., Dunne. M. P., & Martin, N. G. Genetic And Environmental Influences On Sexual Orientation And Its Correlates In An Australian Twin Sample. JOURNAL OF PERSONALITY AND SOCIAL PSYCHOLOGY, 78: 524-536 (2000)
    • But lesbianism is not associated with the locus at Xq28
    • Hu, S., Pattatucci, A. M., Patterson, C., Li, L., Fulker, D. W., Cherny, S. S., Kruglyak, L., & Hamer, D. H. Linkage Between Sexual Orientation And Chromosome Xq28 In Males But Not In Females. NATURE GENETICS, 11: 248-256 (1995)
  • 77. Biology of Sexual Identity Harry Benjamin's Syndrome (HBS)   Estimated incidence of HBS is 1 in 100.000 live births
  • 78. The Transsexual Brain
    • Background:
    • Investigation of genetics, gonads, genitalia or hormone level of transsexuals does NOT explain their status
    • In experimental animals, the same gonadal hormones that prenatally determine the morphology of the genitalia also influence the morphology and function of the brain in a sexually dimorphic fashion
    • This led to the hypothesis that sexual differentiation of the brain in transsexuals might not have followed the line of sexual differentiation of the body as a whole
  • 79. MtF Brains
    • Six male-to-female transsexuals (T1-T6)
    • Searched for sexually dimorphic brain structure that was not influenced by sexual orientation (male-to-female transsexuals may be "oriented" to either sex with respect to sexual behavior)
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 80. Bed Nucleus of the Stria Terminalis
    • “ Although there is no accepted animal model for gender identity alterations, the bed nucleus of the stria terminalis (BST) turned out to be an appropriate candidate to study” because BST
      • Plays an essential part in rodent sexual behavior
      • Has estrogen and androgen receptors
      • Is major aromatization center in developing rat brain
      • Receives projections mainly from the amygdala
      • Provides a strong input in the preoptic-hypothalamic region
      • Reciprocal connections well-documented between hypothalamus, BST and amygdala
      • Sex differences in the size and cell number of the BST have been described in rodents which are influenced by gonadal steroids in development
      • In humans a particular caudal part of the BST (BNST-dspm) has been reported to be 2.5 times larger in men than in women
      • The central part of the BST (BSTc) is characterized by its somatostatin cells and vasoactive intestinal polypeptide (VIP) innervation
      • Experimental endpoint: volume of the BSTc - based on its VIP innervation
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 81. Localization of the BSTc
    • Central part of the BST (BSTc) is characterized by
      • Somatostatin-producing cells
      • vasoactive intestinal polypeptide (VIP) innervation
    • Measured the volume of the BSTc on the basis of its VIP innervation
    Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 82. Bed Nucleus of the Stria Terminalis Figure 2 : Representative sections of the BSTc innervated by vasoactive intestinal polypeptide (VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and B: small sized medial subdivision (BSTm), and large oval-sized central subdivision (BSTc) Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 83. Bed Nucleus of the Stria Terminalis
    • Figure 3
      • The six transsexuals are numbered T1-T6
      • The patients with abnormal sex hormone levels are numbered S1-S4
      • M1 and M2: postmenopausal women
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 84. BSTc Volume Is Not Affected by Varying Sex Hormone Levels in Adulthood
    • S1: BSTc volume of a 46-year-old woman who had suffered for at least 1 year from a tumor of the adrenal cortex that produced very high blood levels of androstenedione and testosterone, was within the range of that of other women
    • M1, M2: Two postmenopausal women (aged over 70 years) showed a completely normal female-sized BSTc
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 85. Small-Sized BSTc in MtF Not Due to Estrogen Treatment
    • All the transsexuals had been treated with estrogens, so could the reduced size of the BSTc be due to high estrogen levels?
      • T2 and T3: both showed a small, female-like BSTc
        • T2 stopped taking estrogen about 15 months before death (since her prolactin levels were too high)
        • T3 stopped hormone treatment since a sarcoma was found about three months before death
      • S2: 31-year-old man who suffered from a feminizing adrenal tumor which induced high blood levels of estrogen, nevertheless had a very large BSTc
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 86. Small-sized BSTc in MtF Not Due to Lack of Androgens
    • All had been orchidectomized except for T4
    • S4 and S3: orchidectomized because of prostate cancer (one and three months before death respectively) - found that their BSTc sizes were at the high end of the normal male range
    • T4: single transsexual who had not been orchidectomized - ranged in the middle of the transsexual scores (Fig. 3)
    • Not only were five of the transsexuals orchidectomized, they all used the antiandrogen cyproterone acetate (CPA)
    • T3 & T6: A CPA effect on the BSTc does not seem likely, because T6 had not taken CPA for the past 10 years, and T3 took no CPA during the two years before death and still had a female-sized BSTc
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 87. MtF Has Female-sized BSTc!
    • Verified that the volume of the central subdivision of the bed nucleus of the stria terminalis (BSTc) is larger in typical men than in typical women
    • A female-sized BSTc was found in male-to-female transsexuals
    • The size of the BSTc was not influenced by sex hormones in adulthood and was independent of sexual orientation
    • This is the first study to show a female brain structure in genetically male transsexuals and supports the hypothesis that gender identity develops as a result of an interaction between the developing brain and sex hormones
    • Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)
  • 88.
    • Figure 2. Representative immunocytochemical stainings of the somatostatin neurons and fibers in the BSTc
      • (a) a reference man
      • (b) reference woman
      • (c) homosexual man
      • (d) male-to-female transsexual
    • Note the sex difference regardless of sexual orientation
    • The male-to-female transsexual has a BSTc in the female range
    • Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G And Swaab, Dick F. Male-To-Female Transsexuals Have Female Neuron Numbers In A Limbic Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)
    2 nd Study: Somatostatin Results Parallel VIP Results
  • 89. What’s Missing in the Sexual Identity Picture?
    • FtM
      • Has male sexual identity
      • Work so far predicts that BSTc of FtM should be same size as typical male’s
  • 90. FtM Has Same Neuron Number in BSTc as Typical Male
    • Figure 1.
    • BSTc neuron numbers. Distribution of the BSTc neuron numbers among the different groups according to sex, sexual orientation, and gender identity. M, Heterosexual male reference group; HM, homosexual male group; F, female group; TM, male-to-female transsexuals
    • The sex hormone disorder patients S1, S2, S3, S5, S6, and M2 indicate that changes in sex hormone levels in adulthood do not change the neuron numbers of the BSTc
    • Note that the number of neurons of the FMT is fully within the male range
    • Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G And Swaab, Dick F. Male-To-Female Transsexuals Have Female Neuron Numbers In A Limbic Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)
  • 91. BSTc Neuron Number Is Not Related to Sexual Orientation
    • Whether the transsexuals were male oriented (T1, T6), female oriented (T2, T3, T5), or both (T4) did not have any relationship with the neuron number of the BSTc
    • The same holds true for heterosexual and homosexual men
    • This shows that the BSTc number of somatostatin neurons is not related to sexual orientation
    Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G And Swaab, Dick F. Male-To-Female Transsexuals Have Female Neuron Numbers In A Limbic Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)
  • 92. Sexual Identity & INAH3
  • 93. INAH3 & BSTc: Sexual Identity Versus Sexual Orientation
    • INAH3 volume may be related to sexual orientation
    • S LeVay A difference in hypothalamic structure between heterosexual and homosexual men S cience 30 August 1991:Vol. 253. no. 5023, pp. 1034 - 1037
    • INAH3 cell number may be related to sexual identity
    • BSTc cell number and volume both related to sexual identity
    • Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 94. INAH3 in Transsexuals
    • Method: Three different stainings throughout the nuclei in every 15th section, i.e. thionin, neuropeptide Y and synaptophysin
    • INAH3 volume and number of neurons of male-to-female transsexual people is similar to that of control females
    • The female-to-male transsexual subject had an INAH3 volume and number of neurons within the male control range ( even though the treatment with testosterone had been stopped three years before death)
      • No difference in INAH3 between pre-and post-menopausal women, so feminization of the INAH3 of male-to-female transsexuals was not due to estrogen treatment
    Garcia-Falgueras, Alicia and Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 95. Copyright restrictions may apply. Garcia-Falgueras, A. et al. Brain 2008 0:awn276v1-276; doi:10.1093/brain/awn276 INAH3 number of neurons Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 96. Copyright restrictions may apply. Garcia-Falgueras, A. et al. Brain 2008 0:awn276v1-276; doi:10.1093/brain/awn276 INAH3 volume in thionin staining in different groups, according to their gender identity and hormonal changes in adulthood Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 97. Copyright restrictions may apply. Garcia-Falgueras, A. et al. Brain 2008 0:awn276v1-276; doi:10.1093/brain/awn276 Density of neurons in INAH3 in different groups: M = control male group; F = control female group; MtF = transsexual male-to-female group; CAScastrated male group; PreM = pre-menopausal women; PostM = post-menopausal women Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 98. Adult Hormones & INAH3
    • Castrated men had values intermediate between male and female controls
    • This data and S7 cannot be fully explained by activating affect of androgens on INAH3
    • Indicates there are also organizational effects of androgens during development of INAH3 morphology
    • Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 99. INAH3 & BSTc Involved in Sexual Identity
    • Propose that the sex reversal of the INAH3 in transsexual people is at least partly a marker of an early atypical sexual differentiation of the brain
    • Appears to be a relationship of BSTc with sexual identity rather than with sexual orientation while INAH3 seems to have a relationship with both
    • Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)
  • 100. MtF – Atypical Hypothalamic Response to Sex Pheromones
    • Data implicate that transsexuality may be associated with sex-atypical physiological responses in specific hypothalamic circuits, possibly as a consequence of a variant neuronal differentiation
    Berglund H, Lindström P. Dhejne-Helmy C, Savic I. Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids CEREB CORTEX 0:bhm216v1-bhm216 (2007)
  • 101. Genetics of MtF Transsexuality
    • Looked for potential differences in three genes known to be involved in sex development
      • Gene for the androgen receptor
      • Gene for estrogen receptor
      • Aromatase enzyme which converts testosterone to estrogen
    • Comparison of the DNA from the MtF transsexual participants with controls showed a significant link with a long version of the androgen receptor gene and transsexualism
      • Hare, Lauren and Harley, Vincent. BBC News–10/26/2008
  • 102. Genetics of FtM Transsexuality
    • Gene variant for 17  -Hydroxylase*
      • Leads to higher than average tissue concentrations of androgens and estrogen hormones
      • These hormones may in turn influence early brain development
    • 44% of FtM transsexuals carried it, compared with 31% of non-transsexual women
      • Proportion of MtF transsexuals with variant was similar to that in non-transsexual men
    • *Also called cytochrome P17
    • Tempfer, Clemens et al. 2008
  • 103. Gene Variant for 17  -Hydroxylase in FtM
  • 104. Homosexuality – How to Explain in Darwinian Terms?
  • 105. Fa'afafine - Broadly Accepted Social Class in Samoa
    • Fa’afafine - males who have sex with males
    • Samoa - more like the setting in which humans evolved
      • South Pacific island nation
      • Relatively unwesternized
      • Traditional, tribally-based cultures
      • Tighter-knit families
    • Fewer anti-gay biases that alienate gays
    • Samoan culture characterized by a high degree of social tolerance towards fa'afine s
    *Farran, Sue and Su’a, Alexander. Discriminating on the grounds of status: criminal law and Fa’afafine and Fakaleiti in the south pacific. Journal of South Pacific 9: 1-15 (2005)
  • 106. Kin Selection Hypothesis’ Basic Prediction
    • Androphilic (“gay”) males should direct more altruistic behavior toward kin than gynephilic (“straight”) males
    • Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 107. Fa’afafines Put “Significantly” More Effort Into Raising Nephews and Nieces
    • Childcare activities
    • Babysitting
    • Buying toys
    • Tutoring
    • Exposing the children to art and music
    • Contributing to daycare, medical and education expenses
    • Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 108. Gay Men in Samoa Reproduce Through Kin Selection
    • Gay men put extra efforts into helping raise nephews and nieces (as compared to straight men)
    • This boosts the children’s chances of survival, and someday reproduction
    • These youths, even if not gay, might share with their aunt or uncle a few genes promoting homosexuality—ensuring a clutch of “gay genes” in every generation
    • Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 109. Is Gender-atypical Behavior a Mentally Distressing Disorder?
    • This Samoan study afforded the “opportunity to examine whether gender-atypical behavior, gender-atypical identity, and sex-atypical identity, in and of themselves, cause distress in sex/gender variant individuals
    • Simultaneously controlling for the confounding effects of extreme societal intolerance towards such individuals
    Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 110. Transsexuality Not Distressing
    • Current DSM-IV TR: Transsexual diagnosis of GIDC
    • Do adult fa'afafine “recall a strong and persistent cross-gender identification in childhood, a sense of inappropriateness in the male-typical gender role, a discomfort with their sex, or distress associated with any of the above?”
    • Vasey and Bartlett concluded that “the diagnostic category of GIDC should not occur in its current form in future editions of the DSM, as there is no compelling evidence that cross-gender behaviors or identities, in and of themselves, cause distress in the individual.”
    GIDC = Gender Identity Disorder in Childhood Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007) Vasey, P., and Bartlett, N. H. What Can the Samoan "Fa'afafine" Teach Us about the Western Concept of Gender Identity Disorder in Childhood? PERSPECTIVES IN BIOLOGY AND MEDICINE, 50: 481-490 (2007)
  • 111. Summary: What We Now Know About Core Sexuality
    • The biblical genesis story “explains” only typical men and typical women
    • The scientific story explains everyone!
  • 112. “ Organization-Activation” Theory
    • “ The preponderance of evidence seems to indicate that the theory of organization-activation for the development of sexual behavior is certain for non-human mammals and almost certain for humans"
    • Milton Diamond. Clinical implications of the organizational and activational effects of hormones. HORMONES AND BEHAVIOR 55:621–632 (2009)
  • 113. Organization-Activation Theory
    • “ The fetal brain develops during the intrauterine period in the male direction through a direct action of testosterone on the developing nerve cells, or in the female direction through the absence of this hormone surge. In this way, our gender identity (the conviction of belonging to the male or female gender) and sexual orientation are programmed or organized into our brain structures when we are still in the womb”
    Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010) Similar wording in: Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. PEDIATRIC NEUROENDOCRINOLOGY 17:22-35 (2010)
  • 114. Critical Periods of Genitalia and Brain Are Different     
    • “ However, since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in transsexuality. This also means that in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain. There is no indication that social environment after birth has an effect on gender identity or sexual orientation”
    • Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)
    • Similar wording in: Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. PEDIATRIC NEUROENDOCRINOLOGY 17:22-35 (2010)
  • 115. Three Dimensions of Sexuality
    • Somatic Morphology (X axis)
    • Sexual Identity (Y axis)
    • Sexual Orientation (Z axis)
    Everyone occupies a point in this three-dimensional space! Gynemorphic Andromorphic Gynecentric Androcentric Gynephilic Androphilic
  • 116. Sex Versus Gender
    • Sex  Gender
    • Sex is biological (gonads)
    • Gender is cultural
    • Gender “traits” differ from culture to culture and from time to time
    Castor Semenya Controversy over whether this South African eighteen-year old should be allowed to compete as a woman after her victory in the women’s’ 800m race during World Championships in Berlin is continuing
  • 117. Culture Determines How Sexual Differences Are Valued!
    • Muxe of Mexico
    • http://www.nytimes. com/slideshow/ 2008/12/07/ weekinreview/ 1207-MUXE_ index.html >
    • Five Genders of Indonesia (National Geographic)
    • http://www.youtube.com/watch?v=K9VmLJ3niVo
    • Fa'afines of Samoa (National Geographic)
    • http://www.youtube.com/watch?v=EronVtKYr0c
  • 118. The “Binary Gender”
    • We live in a “binary gendered” culture
    • Two genders only
      • Man
      • Woman
    • Many cultures recognize more than two genders
  • 119. NORTH AMERICA
    • Two-spirits – Native American Berdache – Illiniwek (Illinois) Muxes – Zapotec People, Oaxaca, Mexico
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 120. SOUTH AMERICA
    • Travestís – Brazil Bichas Viados Guevedoche – Dominican Republic Quariwarmi – Incan
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 121. EUROPE
    • The Sworn Virgin – Balkans Catamites – Ancient Greece Mollies – Modern England Tertium genus hominum (a third human gender) “eunuchs” – Ancient Eastern Mediterranean
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 122. AFRICA
    • Ashtime – Maale culture of Southern Ethiopia Mashoga – Swahili-speaking areas of the Kenyan coast, particularly Mombasa Mangaiko – The Mbo people, Democratic Republic of the Congo Sḫt (”sekhet”) – Middle Kingdom of Egypt (2000-1800 BCE)
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 123. MIDDLE EAST
    • The Kurgarûs – Sumer kur.gar.ra ur.sal Zenanas – Arab Xanith or Khanith – Oman
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 124. ASIA
    • lyha – Mohave Hijras – India, Pakistan & Bangladesh also known as: Aravani/Aruvani or Jogappa Hijira (alt. sp.) – India Sādhi Kotis Sadhin – The Gaddhi in the foothills of the Himalayas Basivi – Madras (area of India) Tritiya-prakrti (third-nature) – Indic culture of premodern India Ubhatobyanjanakas – Buddhist Vinaya Pandakas Kathoey – Thailand Pandaka – Ancient Buddhist Societies
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 125. ASIA-PACIFIC POLYNESIA
    • Fa’afafine – Samoa Polynesia Fakaleiti – Tonga Mahu Wahine – Hawaii Mahu Vahine – Tahiti Whakawahine – Māori Akava’ine – Cook Islands
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 126. INDONESIA
    • Waria Kwolu-aatmwol – “Sambia” community in the eastern highlands of Papua New Guinea PHILIPPINES bakla – Tagalog Bayot – Cebuano Agi – Ilonggo Bantut – Tausug) Binabae Bading Lakin-on
    Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 127. Dangerous Nonsense
    • What the medical profession has been and is still doing to sexually-variant peoples
      • Gay, lesbian, bisexual people
      • Intersex people
      • Transsexual people
  • 128. Science Versus Anti-gay Quackery
    • “ There is no indication that social environment after birth has an effect on gender identity or sexual orientation”
    • Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)
    • Similar wording in: Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. PEDIATRIC NEUROENDOCRINOLOGY 17:22-35 (2010)
  • 129. Medical Profession’s Treatment of GLB People Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990 1952 (DSM-I) Sociopathic Personality Disorders 1968 (DSM-II) Sexual Deviation 1970 Gay rights activists storm APA annual convention 1972 APA annual meeting –first-ever panel of non-patient homosexuals” and Dr. Anonymous 1973 (DSM-II Revision) Deletion of Homosexuality Substitution of Sexual Orientation Disturbance (Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is an illness) 1980 (DSM-III) Gender Identity Disorder (GID) and Ego-dystonic Homosexuality (formerly SOD) 1987 (DSM-III Revision) Homosexuality omitted entirely (Ego-dystonic homosexuality/SOD removed. It’s normal to not want to be persecuted & empirical data to support diagnosis is lacking) )-> 2000 (APA Position Statement) Ethical psychiatrists should stop conversion or “reparative therapies”
  • 130. Anti-gay Quacks & Supporters – for Reparative Therapy
    • The American College of Pediatricians (ACP)
    • National Association for Research & Therapy of Homosexuality (NARTH)
    • Exodus International
    • The National Catholic Bioethics Center
  • 131. Dangerous Nonsense From ACP
    • ACP is a southern anti-gay advocacy group angry at American Academy of Pediatrics (AAP) because AAP policy is against reparative therapy
    • April 2010 –launched anti-gay website and also sent letters promoting their propaganda to 10,00+ school superintendents across America
    • “… schools should not seek to develop policy which “affirms” or encourages these non-heterosexual attractions among students who may merely be experimenting or experiencing temporary sexual confusion ”
  • 132. Medical Profession’s Treatment 0f Intersex People
    • Disordered or Just Different?
    • DSD = Disorders of Sexual Development
    • OII objects to “disorder” terminology
    • http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
    • Milton Diamond sent letter to the Archives of Diseases of Childhood (7/27/2006) recommending Variations of Sex Development be used for intersex conditions instead of Disorders of Sex Development
    • http://adc.bmjjournals.com/cgi/eletters/91/7/554
  • 133. Intersex Problems Are Socio-cultural
    • “ The basic problems faced by the intersexed are socio-cultural in nature and not medical and are a result of the dogmatic fundamentalism inherent in the current binary construct of sex and gender”
    Curtis Hinkle - Founder Organization Intersex International http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
  • 134. Diamond’s Letter to Pediatricians
    • Variations of sex development inextricably involve sexual and gender identity, sexuality, and one's innate sense of self. Thus, the term disorder is far too narrow and too pathological to be accurate. We oppose its adoption in this instance. We suggest that the institution of medicine take a more humble and compassionate approach, recognizing that the institution of medicine does not act from a sphere of perfect knowledge nor hold a monopoly on classifying individuals. What medicine observes are variations in human sex development, it does not know the biological purpose of such variations , and there remains great controversy about how, whether or when to intervene. Terms such as error or disorders reveal an unwelcome arrogance in light of medicine's limited vantage. Medicine can do better. One way is to, instead, use the term Variation in Sex Development (VSD), a term that is without judgment and neither prohibits or ordains medical intervention
    http://adc.bmj.com/content/91/7/554/reply#archdischild_el_2460?sid=437e97e7-049d-42c8-b60f-6d8d02dd31c1
  • 135. Medical Profession’s Treatment of Intersex People
    • … in the event of ambiguous sex at birth, the degree of masculinization of the genitals may not reflect the degree of masculinization of the brain.”
    • Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)
    • Similar wording in: Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. PEDIATRIC NEUROENDOCRINOLOGY 17:22-35 (2010)
  • 136. OUTCOMES: Ambiguous Genitalia “Normalization” Surgery
    • John Money’s lab follows up on some of their intersex cases
    • Admit that follow-up studies are very limited; hence, the need for this study
    • Intersex types studied
      • 46, XY
      • Quigley grade 2-4, average 3.5
      • AIS, gonadal dysgenesis, others
    • Turns out that roughly half were assigned/raised as boys, half as girls
    • Written questionnaire and physical exam
    Pigeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bah burg, HFL, Rock, JA, Brown, TR, Canella, SJ, Market A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 137. OUTCOMES: Ambiguous Genitalia “Normalization” Surgery
    • 23% of participants were dissatisfied with sex of rearing – indicating “general predictions cannot guarantee future gender development for any single case”
    • This figure could be as high as 44% (if all non-participating patients were also dissatisfied)
    Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 138. OUTCOMES: Ambiguous Genitalia “Normalization” Surgery
    • Majority (62% men, 67% women) sought counseling concerning condition
    • Mean surgeries: men 5.8; women 2.1
    • Half were dissatisfied with body image
    • Two-thirds were dissatisfied to some degree with sexual function
    • Researchers never asked: What if we did nothing?
    Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 139. “ Valuable Support?”
    • “ The birth of an intersex infant is often viewed as a major crisis by parents and other family members. In these instances, pediatric endocrinologists can offer valuable support by helping the parents to understand sex differentiation and medical/surgical options that are available for their child. Specifically, physicians should inform parents about 1) long-term cosmetic and functional outcomes associated with genital reconstruction , 2) the need for long-term sex hormone replacement , and 3) possibilities for reproduction”
    Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 140. Conclusions – Not Supported by Their Own Data
    • “ For infants with markedly ambiguous genitalia, including a small phallus and perineoscrotal hypospadias, sex of rearing should be decided by parents who have been thoroughly informed about their child’s medical and surgical options and have also been informed of available outcome data. Advances in medical and surgical procedures used to treat intersex conditions, along with better education and support provided to patients and their families, may further improve the quality of life experienced by individuals who are affected by syndromes of abnormal sex differentiation”
    Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 141. Poor Quality Medical Treatment of Intersex People
    • Over 50% are misdiagnosed!
    • Minto CL, Crouch NS, Conway GS, Creighton SM. XY females: revisiting the diagnosis BJOG: an International Journal of Obstetrics and Gynaecology 112:1407–1410 (2005)
    • Intersex people have their own physiology and health concerns that are not being addressed by physicians
    • Holterhus P-M, Bebermeier J-H, Werner R, Demeter J, Richter-Unruh A, Cario G, Appari M, Siebert R, Riepe F, Brooks JD, Hiort O. Disorders of sex development expose transcriptional autonomy of genetic sex and androgen-programmed hormonal sex in human blood leukocytes BMC GENOMICS 10:292 (2009)
  • 142. OII Is Against “Genital Normalization” Surgeries on Infants
    • “ The basic problems faced by the intersexed are socio-cultural in nature and not medical and are a result of the dogmatic fundamentalism inherent in the current binary construct of sex and gender”
    • “ Some intersexed individuals are subjected to genital mutilation in childhood as a result of this totalitarian, sexist oppression”
    Curtis Hinkle - Founder Organization Intersex International http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
  • 143. 3 Recommendations at 1998 AAP National Meeting
    • General moratorium on sex assignment cosmetic surgery
    • Moratorium should not be lifted unless and until studies show outcomes are positive
    • Efforts should be made to undo effects of past physician deception and secrecy
    Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004)
  • 144. Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004) NEW STANDARDS OF CARE FOR INTERSEX PATIENTS American Academy Pediatricians year 2000 British Association Pediatric Surgeons year 2001 #1. General moratorium on sex assignment cosmetic surgery No surgical moratorium (In1999, AAP decided that surgical moratorium was “unrealistic” because it was hypothesized that parents would not accept it) No surgical moratorium #2. Moratorium should not be lifted unless and until studies show outcomes are positive Recognized need for more research and greater candor and honesty Recognized need for more research and greater candor and honesty #3. Efforts should be made to undo effects of past physician deception and secrecy No call back to families or individuals that had previous treatment No call back to families or individuals that had previous treatment Response to intersex birth “ Social emergency” Informed consent includes “possibility of non-operative management” Gender assignment All virilized females (CAH or maternal androgen) should be girls (because of retained fertility) Gender assignment on individual basis; may include cultural considerations Clitoral surgery Infants raised as girls “will usually require clitoral reduction” “ There is a strong case for no clitoral surgery in lesser degrees of clitoromegaly” Penile surgery PAIS infants “in whom a very small phallus mandates a female sex of rearing” should have testes removed The risk of malignant testicular changes in AIS is small
  • 145. Reprehensible Pediatric Policy
    • 2006 Consensus Statement replaces policy of year 2000
    • They chose term “ Disorders of Sexual Development”
    • They dismiss “sexual identity” issue: “Structure of the brain is not currently useful for gender assignment”
    • Factors they say influence their decision on gender assignment
      • Diagnosis
      • Genital appearance
      • Surgical options
      • Need for lifelong replacement therapy
      • Potential for fertility
      • Views of family
      • Circumstances relating to cultural practices
    Collaboration with participants in International Consensus Conference on Intersex organized by Lawson Pediatric Endocrine Society and European Society for Paediatric Endocrinology Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
  • 146. No Controlled Clinical Trials
    • “ Long-term data regarding sexual function and quality of life among those assigned female as well as male show great variability”
    • “ There are no controlled clinical trials of the efficacy of early (  12 months of age) versus late (in adolescence and adulthood) surgery or of the efficacy of different techniques”
    Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
  • 147. Pediatricians Use Parental Distress & Prejudice to Justify Damaging Surgery
    • “ It is generally felt that surgery that is performed for cosmetic reasons in the first year of life relieves parental distress and improves attachment between the child and the parents; the systematic evidence for this belief is lacking”
    Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
  • 148. Let’s Follow Columbia’s Example
    • “ In 1998, Constitutional Court of Colombia, South America, ruled that sex reassignment of children would no longer be legal in that country
    • Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004)
    • Parents cannot consent for children over 5 years because such children are deemed to have identified with a gender and are autonomous
    • Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
    • The Court’s purported goal was ‘forcing the parents to put the child’s best interest ahead of their own fears and concerns about sexual ambiguity’”
    • Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004)
  • 149. Medical Profession’s Treatment of TransPeople Ignores Science
    • “… since sexual differentiation of the genitals takes place in the first two months of pregnancy and sexual differentiation of the brain starts in the second half of pregnancy, these two processes can be influenced independently, which may result in extreme cases in transsexuality”
    • “ There is no indication that social environment after birth has an effect on gender identity or sexual orientation”
    • Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)
    • Similar wording in: Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation. PEDIATRIC NEUROENDOCRINOLOGY 17:22-35 (2010)
  • 150. DSM
    • DSM = Diagnostic and Statistical Manual of Mental Disorders
    • Published by the American Psychiatric Association
    • Standard classification of mental disorders used by mental health professionals in the United States
  • 151. DSM Is Widely Used
    • Psychiatrists, other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, counselors
    • Researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical companies and policy makers
    • Across clinical settings (inpatient, outpatient, private practice, etc.)
  • 152. Transsexual People Are Not Mentally Disordered!
    • Transsexual persons have atypical brain structure and atypical brain function that correspond to their felt sexual identity.
    • Transsexual people are merely different. Difference does not equal disorder!
    • Therefore, the American Psychiatric Association should remove “Gender Identity Disorder” from its new version of the Diagnostic and Statistical Manual of Mental Disorders
  • 153. Gender Identity Disorder (GID)
    • How can someone have GID or GIDC (GID in children) if sexual identity is innate?
    • How do you treat something that is not learned and cannot be changed?
  • 154. Dr. Kenneth Zucker, PhD Ignores Science and Preys on Emotions!
    • Head of the child and adolescent gender identity clinic at Toronto's Centre for Addiction and Mental Health
    • Has “treated” “children with GID” since mid-’70s
    • Explains gender dysphoria in terms of “family noise”
      • Insecure mother-child relationship
      • Neglectful parents
      • Mother who wanted a daughter
      • Domineering sisters
    • Is in charge of APA committee making recommendations about GID for DSM revision!!!
    Rosin H. “A Boy’s Life” in THE ATLANTIC November 2008 Fitzgibbons RP, Sutton PM, O’Leary D. The psychopathology of “sex reassignment” surgery: assessing its medical, psychological, and ethical appropriateness THE NATIONAL CATHOLIC BIOETHICS CENTER pp 97-125 (2009)
  • 155. Zucker Dismisses Hard Data and Neuroscience As “Dogma”!
    • When referring to a poster that read: “Gender dysphoria is increasingly understood…as having biological origins,” and describes “small parts of the brain” as “progressing along different pathways,” Dr. Zucker is quoted as saying: “In terms of empirical data, this is not true. It’s just dogma, and I’ve never liked dogma. Biology is not destiny.”
    Rosin H. “A Boy’s Life” in THE ATLANTIC November 2008
  • 156. Zucker’s Misdiagnosis Assures “a Fix”
    • Richard Green did longitudinal study on the kind of children “treated” by Dr. Zucker and found these boys, without any treatment, grow up to be gay men
    • Dr. Zucker claims success at curing these male children when they come out as gay rather than trans! But they were gay all along! And Zucker gets paid for traumatizing these boys and their frantic families
    • Green R. The “Sissy Boy Syndrome” and the Development of Homosexuality THE INSTITUTION FOR SOCIAL AND POLICY ST. (1987)
  • 157. APA Statement On GID & DSM Revision Process Is a Lie!
    • May 9, 2008 – “All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data””
    • But in draft revision there is no mention of brain work, Reimer case, intersex studies, anthropological work, Green’s work – nothing of the hard science is mentioned or considered during revision process by Dr. Zucker’s committee!
  • 158. Religious Bigots Lie by Ignoring the Science and Quoting the Quacks
    • Quacks give bigots ammunition
    • In reference to a biological origin for GID (transsexuality), the Catholic Bioethics Center says:
      • “… there is no scientific evidence to support this conclusion”
      • “ There is no evidence that gender identity confusion – a gender identity contrary to anatomical structure – is inborn” (quote attributed to psychoanalyst Charles Socarides who founded NARTH in 1992)
    Fitzgibbons RP, Sutton PM, O’Leary D. The psychopathology of “sex reassignment” surgery: assessing its medical, psychological, and ethical appropriateness THE NATIONAL CATHOLIC BIOETHICS CENTER pp 97-125 (2009)
  • 159. Transsexuals Are Still Crazy in USA but Not in France!
    • France has become the first country in the world to declassify transsexualism as a mental illness
    • World Health Organization and the American Psychiatric Association continue to list the condition as a mental illness, rather than a medical condition
    • Draft of DSM-V has been released
    • Gender Identity Disorder has been replaced with Gender Incongruence for DSM-V
  • 160. Insult to Injury - Intersex People Now Can Also Have “Gender Incongruence”!
    • Special subtype of gender incongruence in DSD is recommended by Zucker’s committee for the DSM-V!
    • OII responds: “We see no need to further medicalise and stigmatize intersex people by referring to them as necessarily disordered (DSD) and where mistakes in assignment have been made, we see no value in medicalising and stigmatizing them further by applying another form of disorder called ‘gender incongruence’”
    • http://www.intersxualite.org/DSM5.html
  • 161. The Truth Shall Set Us Free!
    • There’s plenty more “dangerous nonsense”
    • But there’s also plenty more science that will continue to happen
    • Now if we apply the scientific findings to our culture, the truth shall set us free!
  • 162. Difference  Disorder
    • Everyone is born into the world as a unique “sexual somebody”
    • We do not learn our core sexuality; we discover it as we grow up and it unfolds
    • What we do learn is whether the culture will celebrate or persecute our sexuality
    • The culture needs to change and make a place for all the babies born into it
    • All of us, not just the Adams and the Eves, have the birthright to be who we naturally and innately are
  • 163. The End

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