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Gender Binary & LGBTI People - Myth and Medical Malpractice


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Medical mistreatment of lesbian, gay, bisexual, transgender, and intersex people because they are neither Adams nor Eves! An update on the science versus the medical practice concerning sexuality from a physiologist’s perspective.

An audio recording that accompanies this slideshow can be found at:

Better yet, watch the video in which I explain the slides as you look at them.

Gender Binary & LGBTI People - Myth and Medical Malpractice

  1. 1. Gender Binary & LGBTI PeopleMyth and Medical Malpractice Presented By Veronica Drantz, PhD Prepared for Freethought Festival April 27th, 2012
  2. 2. The Myth: “The Gender Binary”  Only two sexes (male, female)  Sex = Gender (male = man, female = woman)  Only one kind of sexual attraction: heterosexual
  3. 3. LGBTI People - Medical Malpractice Victims Because They Are Neither Adams Nor Eves L = Lesbian G = Gay B = Bisexual T = Transgender I = Intersex
  4. 4. Organization-Activation Mechanismof Sexual Development in Mammals  “Organization” – Sexual organization of body before birth  Genetic (XY or XX)  Hormonal (testosterone or its absence during critical periods)  “Activation” – Maturation/functioning at puberty  Hormonal from ovaries or testes
  5. 5. Sexual Development in MammalsFigure 25-6 Diagrammatic summary of normal sex determination, differentiation, anddevelopment in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT,Dihydrotestosterone
  6. 6. Sexual Differentiation in Mammals
  7. 7. Mechanism of Androgen Hormone ActionFigure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
  8. 8. Males are Altered Females! Everybody is a variation on the female theme – Default (female) – Fully altered (male) – Partly altered (intersex)
  9. 9. Intersex People Differ physically from the “standard” male or female There are many different kinds of intersex people Some kinds of intersex people have ambiguous genitalia Demonstrate that organization- activation mechanism works in humans
  10. 10. AndrogenInsensitivity Syndrome Partial AIS (2 - 5) Complete AIS
  11. 11. Congenital Adrenal Hyperplasia Classical Type
  12. 12. Sexual Identity & Orientation – Nature or Nurture? We don’t learn or choose our genitalia. What about sexual behavior? Evidence for Organization-Activation Mechanism in the brain – Nonhuman mammals – David Reimer story – Sexuality of intersex people – Human brain work (trans, gay)
  13. 13. Development Of Sexual Brain – the “Animal Work” Brain-organizing action of fetal testosterone discovered (1959) Over the years, evidence for the “determining influence” of prenatal hormones has accumulated in numerous mammals
  14. 14. Hypothalamus Instinctive Drives & Behaviors – Hunger – Thirst – Sleep – Body rhythms – Sexual function Interconnected with amygdala (emotion) Ancient - similar in all mammals Netter, Frank H. The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy & Physiology. New York: CIBA (1983)
  15. 15. Sexual Behavior Is Controlled by Anterior Hypothalamus  Sexually-dimorphic nuclei in this region
  16. 16. The Gender Binary Ethos Of Medicine Is Most Vividly Illustrated In Its Treatment Of Intersex People John Money Milton Diamond “Psychosexual “Sexuality-at-Birth Neutrality-at-Birth” Theory Theory Organization-Activation Mechanism“Optimal Gender of Rearing policy” -Evolutionary view -Requires conventional genitalia -Began challenging Money when only and patient deception about grad student sexual status at birth
  17. 17. David Reimer Story (John-Joan Case)
  18. 18. Phall-O-Meter Only an Adam or an Eve Never in-between
  19. 19. Sexuality Of Intersex People Consistent with prenatal hormonal hypothesis – CAIS: female sexual identity – PAIS: sexual identity unpredictable – CAH: majority are heterosexual women but incidence of bisexual and lesbian orientations is above controls and correlates with degree of prenatal androgenization – Cloacal exstrophy: genetically and hormonally male-born children may identify as males despite being raised as females and undergoing feminizing genitoplasty at birth
  20. 20. Biology of Sexual Identity FaafafineA broadly accepted social class in Samoa
  21. 21. Bed Nucleus of the Stria TerminalisFigure 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) In anterior hypothalamus Necessary for sexual behavior in animals Receives input from amygdala Size of BSTc - not influenced by sex hormones in adulthood
  22. 22. 2nd Study on BSTc Male-to-female transsexual has BSTc in the female range S7: male, lifelong female identity, never “treated”- within female range FMT: number of neurons is fully within the male range
  23. 23. Genetics of Transsexuality MtF– linked with longer version of gene for androgen receptor that weakens testosterone effect FtM - linked with gene variant for an enzyme that causes higher concentrations of androgens and estrogen in developing brain
  24. 24. Biology of Sexual Orientation Anthropological evidence - gay people everywhere “Gay people have a different sensibility” Sandra Witelson, PhD Same-sex behavior in nearly all animals
  25. 25. Third Interstitial NucleusOf Anterior Hypothalamus INAH3
  26. 26. More Evidence For Innate Gayness  2nd human study confirmed INAH3 finding  Gay sheep brains – About 8% of rams are exclusively homosexual – “Duplicated” human INAH3 work  Sex pheromone effects in anterior hypothalamus correlate with sexual orientation  Genetic components – gayness, lesbianism
  27. 27. Summary of the Science “…gender identity and sexual orientation are programmed or organized into our brain structures when we are still in the womb” “…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”
  28. 28. Medical Malpractice Against LGBTI People The medical profession has pathologized and stigmatized gender-variant peoples Medical policy has been to “fix” LGBTI people - attempting to make them conform to the gender binary
  29. 29. Medical “Care” of Gay/Lesbian People  Methods used in attempt to change sexual orientation – Hormonal treatments  Castration  Administration of testosterone or estrogen – Psychoanalysis – Vomiting induced in combination with homo-erotic pictures – Psychosurgery (lesions in the hypothalamus) – Electroshock treatment – Chemical induction of epileptic insults  Homosexuality has been classified as “crazy” since first version of DSM and was deleted only after political activism!
  30. 30. “Reparative Therapy”by Quacks Continues Therapy involves “…counseling to acting out scenarios to in some cases shock treatment” American Psychological Association has reported that efforts to change a person’s sexual orientation not only don’t work but cause harm (loss of sexual feeling, depression, anxiety, and suicidality)
  31. 31. Anti-Trans Quackery Continues Gender identity disorder is a bogus diagnosis! 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 Dysphoria
  32. 32. Genital Mutilation of Intersex Babies Continues Whatever happened to: informed consent? Whatever happened to: “first, do no harm?”
  33. 33. Genital “Normalization” Surgery - Dismal OutcomesResearchers never asked: What if we did nothing?
  34. 34. More Intersex Mistreatment No moratorium on genital normalization surgeries Parental distress & prejudice still used to justify damaging surgery Pediatricians voted to not inform former patients of their intersex status and previous medical treatments New pathologizing terminology: (2006) “Disorders of Sexual Development” “Gender Dysphoria in DSD” recommended for the DSM-V (Intersex people will now be crazy if unhappy with assigned gender!)
  35. 35. Reform LGBTI Medical Care! Scientific message that “core sexuality is innate” needs to reach everyone LGBTI people are natural variations - different, but not disordered! Health and happiness of LGBTI patients should be medical goal Ethical guidelines for medical treatment of LGBTI people should be established
  36. 36. Medical policy should be based onscientific evidence and ethical principles - NOT religious myth!