Myth & Science of Sexuality

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This slideshow “Myth and Science of Sexuality - Disordered or Just Different?” presented to the Ethical Humanist Society of Chicago on October 10, 2010., explains the development of diverse …

This slideshow “Myth and Science of Sexuality - Disordered or Just Different?” presented to the Ethical Humanist Society of Chicago on October 10, 2010., explains the development of diverse sexualities (as natural variations of the organization-activation mechanism) and shows that LGBTI peoples suffer persecution due to a socio-cultural disorder stemming from the erroneous “gender binary” concept.

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  • 1. Myth and Science of Sexuality: Disordered or Just Different? By Veronica Drantz, PhD Prepared for the Ethical Humanist Society of Chicago October 10, 2010
  • 2. The Myth: ―The Gender Binary‖ Gametes are binary (eggs or sperm) Organisms that make the gametes are not binary!
  • 3. The Science:―Organization – Activation‖ Mechanism ―Prenatal hormone theory‖ – Organization before birth – Activation at puberty
  • 4. SexualDifferentiation of Internal GenitaliaFigure 25-4 Embryonicdifferentiation of male andfemale internal genitalia(genital ducts) fromwolffian (male) andmüllerian (female)primordia.
  • 5. SexualDifferentiation ofExternal GenitaliaFigure 25-5 Differentiation of maleand female external genitalia fromindifferent primordial structures in theembryo.
  • 6. Sexual Development in MammalsFigure 25-6 Diagrammatic summary of normal sex determination, differentiation, anddevelopment in humans. MIS, müllerian inhibiting substance; T, testosterone;DHT, Dihydrotestosterone
  • 7. Male Testosterone LevelsFigure 25-8 Plasma testosterone levels at various ages inhuman males.
  • 8. Mechanism of Steroid Hormone Action BrainFigure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
  • 9. 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
  • 10. Sex Has Many LevelsPrimary sexcharacteristic  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
  • 11. Core Sexuality – Nature or Nurture? The genitalia are obviously organized before birth, and we obviously do not learn or choose our genetic sex, gonadal sex, hormonal sex, or somatic sex But what about sexual behavior? Sexual identity? Sexual orientation? Innate or learned/chosen? Is the brain, like the body, organized by the presence or absence of sex hormones before birth? Evidence for Organization-Activation Mechanism – David Reimer story – Intersex people (AIS, CAH, cloacal exstrophy) – Brain work (nonhuman mammals, humans)
  • 12. John Money "Neutrality-at-Birth― Theory ―Sexual behavior and orientation as Psychologist 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 (serious 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)
  • 13. Milton Diamond ―Sexuality-at-Birth" Theory Prenatal genetic and hormonal Biologist 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 Organization – Activation Mechanism Evolutionary view
  • 14. 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 – Felt that fellow scientists were too cautious failing to link their animal findings to human situation – Decided to write essay challenging psychosexual neutrality theory
  • 15. 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)
  • 16. The David Reimer Story ―Identical Twins Case‖ ―Nature-Nurture Experiment‖ – Circumcision accident destroyed John‘s penis; Dr. Money consulted – John is ―assigned‖ as Joan  Same nature: same genetics, womb  Different nurturing: raised as different genders Touted as a success by John Money, 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
  • 17. Colapinto, John. As Nature Made Him - The Boy WhoWas Raised As A Girl HarperCollins (2000)
  • 18. 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 onInfants with Ambiguous Genitalia? MICHIGAN JOURNAL OF GENDER & LAW 7: 1-63, 2000
  • 19. Colapinto, John. As Nature Made Him -The Boy Who Was Raised As A GirlHarperCollins (2000)
  • 20. David Reimer (1965-2004) 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 discovered 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!
  • 21. Intersex People Curtis Hinkle - Founder Organization Intersex International
  • 22. Brain AndrogenInsensitivity Syndrome Inherited - caused by mutations in the gene for the androgen receptor Recessive X-linked single gene syndrome Genetic males - 46 XY Testes (abdominal or inguinal) secrete testosterone No uterus or other internal female genitalia (MIS worked) Male internal genitalia undeveloped (Testosterone didn‘t work) Female secondary sex characteristics develop (eg, breasts) – At puberty testosterone from testes is turned into estrogen by enzyme (aromatase) in peripheral tissues – Often discover their condition when they fail to menstruate (No uterus) Julia Child was a CAIS woman
  • 23. Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)CAIS People Feel Like Women!
  • 24. Partial AIS (2-5):  Grade 1: normal masculinization in utero Cannot Predict  Grade 2: male phenotype with mild defect in masculinization (eg, isolated Sexual Identity  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 Numbered I through 7 in order of increasing severity female phenotype (grade 6 if (more defective masculinization) pubic hair present inAdapted 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. adulthood, grade 7 if no pubic In: Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s hair in adulthood) Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13: 623—640 (2004)
  • 25. Congenital Adrenal Hyperplasia (CAH) 21 - hydroxylase deficiency 11 - hydroxylase deficiencyFigure 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 thetop of the chart. When a particular enzyme is deficient, hormone production is blocked at the points indicatedby 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)
  • 26. Five Degrees of Virilization Affecting the Urogenital Sinus and External Genitalia in FemalesHines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation AndRecalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81(2004)
  • 27. Congenital Adrenal Hyperplasia (CAH)Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICALSons (1987) MEDICINE. England: Mosby-Wolfe (1993)
  • 28. Frequency of CAHFigure 4. Frequency of nonclassical and classical 21-hydroxylase deficiency in comparison with other autosomal recessive disease incidencesHines 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)
  • 29. CAH (Adrenogenital Syndrome) Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Sons (1987)
  • 30. Sexuality of CAH Women More male-typical play behavior as children* Less satisfaction with the female sex of assignment and less heterosexual interest* CAH girls 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* ―The finding of greater same-sex fantasy … is consistent with the prenatal hormonal hypothesis‖** ―…excess prenatal androgens predispose some women to the development of same-gender sexual orientation‖*** ―Dose-response relationship of androgens with sexual orientation‖ - a study of women with various forms of CAH*****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)**Veniegas, Rosemary C. Biological Research on Womens 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)****Meyer-Bahlburg HF, Dolezal C, Baker SE, New MI. ―Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of Degree of Prenatal Androgen Excess‖ ARCHIVES OF SEXUAL BEHAVIOR 1: 85-99 (2008),
  • 31. Alex (46XX, CAH)
  • 32. Cloacal Exstrophy  Rare, complex defect of the entire pelvis and its contents  Associated with severe phallic inadequacy or phallic absence in genetic malesBladder Extrophy and absence  For about 25of the penis years, neonatalgreen arrows: everted bladder; assignment to femaleblue arrows the scrotum; sex has beenyellow arrows: umbilcal cord advocated for affected males
  • 33. Prenatal Androgen - Major Factor in Development of Sexual Identity Genetically and hormonally male-born children may identify as males despite being raised as females and undergoing feminizing genitoplasty at birthReiner, 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)
  • 34. The Sexual Brain  Amygdala – Part of Limbic System – Genesis of emotions & emotional expression  Hypothalamus – Homeostasis – Neuroendocrine Control – Instinctive Drives & BehaviorNetter, Frank H. The CIBA COLLECTION OF MEDICALILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy &Physiology. New York: CIBA (1983)
  • 35. TheHypothalamus Drives You: -Hunger -Thirst -Sleep-Body Rhythms -SexBarrett KE, Barman SM, Boitano S, and Brooks HL.GANONG‘S REVIEW OF MEDICAL PHYSIOLOGY 23rded. Lange Medical Books/McGraw-Hill (2010)
  • 36. 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
  • 37. Same Anatomy of Anterior Hypothalamus in All Mammals 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 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)
  • 38. Biology of Sexual Orientation Anthropological evidence - gay people everywhere ―Gay people have a different sensibility‖ Sandra Witelson, PhD
  • 39. Same-sex BehaviorIn Nearly All AnimalsHomosexuality & other sexually variantbehaviors in animals is widespread Bruce Bagemihl, Biological Exuberance: Animal Homosexuality and Natural Diversity, New York: St. Martins Press (1999)Examples of same-sex behavior can befound in almost all species in the animalkingdom — from worms to frogs to birds —making the practice nearly universal amonganimals Bailey N, Zuk M. Same-sex sexual behavior and evolution TRENDS IN ECOLOGY AND EVOLUTION 24:439-446 (2009)
  • 40. Sexual Orientation & INAH3LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
  • 41. Confirmation of LeVay‘s Findings 2nd human brain INAH3 study – INAH3 volume associated with sexual orientation. – NEW FINDING: no difference in the number of neurons within the INAH3 based on sexual orientationByne, 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) Sheep brain study – 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‖ ramsRoselli 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)
  • 42. Anterior Hypothalamus Is Activated by Sex Pheromones  Positron emission Activation of Subject anterior tomography (PET hypothalamus scans) of anterior Heterosexual EST males hypothalamus while subjects smell sex Homosexual males AND pheromones Heterosexual AND females AND = progesterone derivative 4,16-androstadien-3-one Homosexual EST = estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol (EST) EST femalesBerglund H, Lindström P, Savic I. Brain response to putative pheromones in lesbian women. PNAS 103:8269-8274 (2006)
  • 43. Genetics of Gayness in Males Twin studies – Concordance rates of homosexuality  identical twins - 52%  non-identical twins - 22%  non twin brothers - 9.2%Bailey JM and Pillard RC. A genetic study of male sexual orientation. ARCH GEN PSYCHIATRY 48(12):1089-96 (1991) Evidence for genetic markers – A genetic hypothesis posits that homosexuality runs in families and that genetic markers* for sexual orientation can be found among family members*Markers are regions or sections of DNA that are the same among family members, suggesting the presence of a gene – Marker in Xq28 region of X chromosome of gay brothersHamer, 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)
  • 44. Genetics of LesbianismThe 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 womenPattatucci, 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 pairsBailey, 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 Xq28Hu, 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)
  • 45. Biology of Sexual IdentityHarry Benjamins Syndrome (HBS)Estimated incidence of HBS is 1 in 100.000 live births
  • 46. Sexual Identity & 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)Looking at presynaptic neurons from amygdala (emotional input) synapsing with postsynapticneurons of anterior hypothalamus (sexual behavior)
  • 47. 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 womenZhou, 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)
  • 48. 2nd Study: Somatostatin Results Parallel VIP Results 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 rangeKruijver, 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)Looking at postsynaptic neurons of anteriorhypothalamus receiving input from amygdala
  • 49. Figure 1. FtM Has Same Neuron BSTc neuron numbers. Distribution of the BSTc neuron numbers among the different groups Number in BSTc as according to sex, sexual orientation, and gender identity. M, Heterosexual male reference group; Typical Male 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 rangeKruijver, 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)
  • 50. Sexual Identity & INAH3  INAH3 cell number may be related to 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)
  • 51. 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 differentiationBerglund H, Lindström P. Dhejne-Helmy C, Savic I. Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids CEREBCORTEX 0:bhm216v1-bhm216 (2007)
  • 52. Genetics of Transsexuality Brain MtF – Significant link with a long version of the androgen receptor gene and transsexualism that may prevent androgen effect Hare, Lauren and Harley, Vincent. BBC News–10/26/2008 FtM – Gene variant for 17 - Hydroxylase* enzyme leads to higher than average tissue concentrations of androgens and estrogen hormones that may in turn influence early brain development*Also called cytochrome P17Tempfer, Clemens et al. 2008
  • 53. Homosexuality – How to Explain in Darwinian Terms? 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 faafines (Males who have sex with males)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)
  • 54. FaafafineA broadly accepted social class in Samoa
  • 55. Faafafine Do ―Kin Selection‖ Hypothesis‘ Basic Prediction: Androphilic (―gay‖) males should direct more altruistic behavior toward kin than gynephilic (―straight‖) males Findings: 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 expensesVasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Faafafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 56. Gay Genes Spread 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 generationVasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Faafafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 57. Is Gender-atypical Identity 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 Faafafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)
  • 58. Transsexuality Not Distressing Do adult faafafine ―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?‖ Conclusion: ―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 ChildhoodVasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Faafafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)Vasey, P., and Bartlett, N. H. What Can the Samoan "Faafafine" Teach Us about the Western Concept of Gender Identity Disorder in Childhood? PERSPECTIVES IN BIOLOGY AND MEDICINE, 50: 481-490 (2007)
  • 59. Summary The biblical genesis story ―explains‖ only typical men and typical women; the scientific story explains everyone! ―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)
  • 60. 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 PEDIATRICNEUROENDOCRINOLOGY 17: 22-35 (2010)
  • 61. 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.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)
  • 62. Core Sexuality: Nature - Not Nurture! 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)
  • 63. Three  Somatic Morphology (X axis)Dimensions of  Sexual Identity (Y axis)  Sexual Orientation (Z axis)Core Sexuality Gynecentric Androphilic Gynemorphic Andromorphic Everyone occupies a Gynephilic point in this three- dimensional space! Androcentric
  • 64. Sex Gender Sex is biological 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 continues
  • 65. The ―Gender Binary‖ We live in a ―binary gendered‖ culture with two genders only – Woman – Man Many cultures recognize more than two genders
  • 66. NORTH AMERICA  Two-spirits – Native American Berdache – Illiniwek (Illinois) Muxes – Zapotec People, Oaxaca, Mexico Muxes Two-spiritsThanks to Lorelei Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 67. SOUTH AMERICA Travestís – Brazil Bichas Viados Guevedoche – Dominican Republic Quariwarmi – Incan Viados TravestísThanks to Lorelei Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 68. EUROPE The Sworn Virgin – Balkans Sworn Virgin Catamites – Ancient Greece Mollies – Modern England Tertium genus hominum (a third human gender) ―eunuchs‖ – Ancient Eastern Mediterranean Catamites Sworn Virgin Thanks to Lorelei Erisis http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 69. AFRICA Mashoga  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 Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 70. MIDDLE EAST  The Kurgarûs – Sumer kur.gar.ra ur.sal Zenanas – Arab Xanith or Khanith – OmanThanks to Lorelei Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 71. ASIA Hijras  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 HimalayasThanks to Lorelei Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 72. ASIA continued Basivi – Madras (area of India) Tritiya-prakrti (third-nature) – Indic Kathoey 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/ Kathoey
  • 73. ASIA-PACIFIC POLYNESIA Fa‘afafine – Samoa Polynesia Fakaleiti – Tonga Mahu Wahine – Hawaii Mahu Vahine – Tahiti Whakawahine – Māori Akava‘ine – Cook IslandsThanks to Lorelei Erisishttp://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Fa‘afafine
  • 74. INDONESIA Waria 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 bakla http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/
  • 75. Disordered or Just Different? What the medical profession has been and is still doing to sexually-variant peoples – Gay, lesbian, bisexual people – Transsexual people – Intersex people
  • 76. Medical Profession‘s Treatment of LGBT People1952 (DSM-I) Sociopathic Personality Disorders1968 (DSM-II) Sexual Deviation1970 Gay rights activists storm APA annual convention1972 APA annual meeting –first-ever panel of non- patient homosexuals‖ and Dr. Anonymous1973 (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) 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‖ Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990
  • 77. The Science on Sexual Orientation ―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) American Psychological Association has reported that efforts to change a person‘s sexual orientation not only doesn‘t work but causes harm (loss of sexual feeling, depression, anxiety, and suicidality)Timoshin, Natalie. ―Sexual ―conversion‖? American Psychological Association says not through psychotherapy. PSYCHIATRIC TIMES (October, 2009)
  • 78. Anti-gay Quackery - ―Reparative Therapy‖
  • 79. The Science on Sexual Identity ―…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)
  • 80. The Quackery Against Transsexuals - GID Gender identity disorder is a bogus diagnosis! 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 Reparative therapy quacks are revising the DSM! Draft of DSM-V: Gender Identity Disorder has been replaced with Gender Incongruence
  • 81. The Science on Intersexuality ―… 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)
  • 82. 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‖ ―Some intersexed individuals are subjected to genital mutilation in childhood as a result of this totalitarian, sexist oppression‖ Curtis Hinkle - Founder Organization Intersex Internationalhttp://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
  • 83. The Quackery - Intersex People Are Necessarily Disordered Genital normalization surgeries on newborns continue! DSD = Disorders of Sexual Development OII objects to ―disorder‖ terminologyhttp://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html Milton Diamond recommends Variations of Sex Developmenthttp://adc.bmj.com/content/91/7/554/reply#archdischild_el_2460?sid=437e97e7-049d-42c8-b60f-6d8d02dd31c1http://adc.bmjjournals.com/cgi/eletters/91/7/554
  • 84. OUTCOMES:  John Money‘s lab follows up on some of their intersex Ambiguous cases Genitalia  Admit that follow-up studies are very limited; hence, the ―Normalization‖ need for this study Surgery  Intersex types studied – 46, XY – Quigley grade 2-4, average 3.5 – AIS, gonadal dysgenesis, others  Turns out that roughly half were assigned/raised asPigeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bah boys, half as girlsburg, HFL, Rock, JA, Brown, TR, Canella, SJ, MarketA, Ngai KM, Money J, Berkovitz GD. Ambiguous  Written questionnaire andGenitalia With Perineoscrotal Hypospadias in 46,XYIndividuals: Long-Term Medical, Surgical, andPsychosexual Outcome PEDIATRICS 110:10p (2002) physical exam
  • 85. Genital ―Normalization‖ Surgery - Dismal Outcomes  23% of participants (46XY, Quigley grade 2-4, average 3.5, roughly half were assigned/raised as boys, half as girls) 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)  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 WithPerineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
  • 86. NEW STANDARDS OF CARE American Academy British Association Pediatric FOR Pediatricians Surgeons INTERSEX PATIENTS year 2000 year 2001Diamond, M. Sex, gender, and identity over the years: a changingperspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICSOF NORTH AMERICA 13:591-607 (2004) No surgical moratorium #1. General moratorium on sex (In1999, AAP decided that surgical moratorium was ―unrealistic‖ because it No surgical moratorium assignment cosmetic surgery was hypothesized that parents would not accept it) #2. Moratorium should not be Recognized need for more Recognized need for more lifted unless and until studies research and greater candor research and greater candor show outcomes are positive and honesty and honesty #3. Efforts should be made to No call back to families or No call back to families or undo effects of past physician individuals that had previous individuals that had previous deception and secrecy treatment treatment Informed consent includes Response to intersex birth ―Social emergency‖ ―possibility of non-operative management‖ All virilized females (CAH or Gender assignment on maternal androgen) should be Gender assignment individual basis; may include girls (because of retained cultural considerations fertility) Infants raised as girls ―will ―There is a strong case for no Clitoral surgery usually require clitoral clitoral surgery in lesser reduction‖ degrees of clitoromegaly‖ PAIS infants ―in whom a very small phallus mandates a The risk of malignant testicular Penile surgery female sex of rearing‖ should changes in AIS is small have testes removed
  • 87. Pediatric Policy Is Reprehensible  2006 Consensus Statement - chose term ―Disorders of Sexual Development‖  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 practicesCollaboration with participants in International Consensus Conference on Intersex organized by Lawson Pediatric Endocrine Society and European Society for Paediatric EndocrinologyLee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)
  • 88. Pediatric Policy Must Change Pediatricians use parental distress & prejudice to justify damaging surgeryLee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006) Clitoral reduction is ―standard clinical procedure‖ (Dr. Dix P. Poppas, Panel at Weill Cornell Medical College)http://www.cornellsun.com/section/news/content/2010/10/05/weill-medical-college- says-poppas%E2%80%99-surgical-procedure-standard Pregnant women treated with dexamethasone to prevent ―behavioral masculinization‖ (same-sex attraction and tom-boy behavior) in CAH girlshttp://www.starobserver.com.au/news/2010/07/15/opposition-to-genital-drugs/27947Meyer-Bahlburg HF, Dolezal C, Baker SE, New MI. ―Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of Degree of Prenatal Androgen Excess‖ ARCHIVES OF SEXUAL BEHAVIOR 1: 85-99 (2008), Let‘s follow Columbia‘s exampleDiamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004) Europe has ethical principles for intersex treatmentWiesemann, C., Ude-Koeller, S., Sinnecker, G. H. G., & Thyen, U. Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex in children and adolescents EUR J PEDIATR 169:671–679 (2010)
  • 89. 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
  • 90. Discrimination Against LGBTIPeople Is a Socio-cultural Disorder LGBTI people are natural variations and are different, not disordered Suffering of LGBTI people is not intrinsic to their condition; rather it is imposed by the binary-gendered society/culture The medical profession has been part of the socio-cultural problem and it continues to be a problem The ―scientific message about core sexuality‖ needs to reach the entire medical community, educators, and parents
  • 91. Birthright: To Be Who We Are Core sexuality is inborn. We do not learn our core sexuality; we discover it What we learn is whether the culture will celebrate or persecute our sexuality LGBTI people suffer from a socio-cultural disorder 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