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: http://freethoughtfestival.org/audio/FTF120427Drantz-ed.mp3 Better yet, watch the video in which I explain the slides as you look at them. http://drdrantz-sciencesexuality.blogspot.com/2012/07/video-gender-binary-lgbti-people-myth.html

1. Gender Binary
&
LGBTI People
Myth and Medical Malpractice
Presented By
Veronica Drantz, PhD
Prepared for
Freethought Festival
April 27th, 2012

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. LGBTI People - Medical Malpractice
Victims Because They Are
Neither Adams Nor Eves
L = Lesbian
G = Gay
B = Bisexual
T = Transgender
I = Intersex

4. Organization-Activation Mechanism
of 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. 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

6. Sexual Differentiation in Mammals

7. Mechanism of Androgen
Hormone Action
Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).

8. Males are Altered Females!
 Everybody is a variation on
the female theme
– Default (female)
– Fully altered (male)
– Partly altered (intersex)

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. Androgen
Insensitivity
Syndrome
Partial AIS
(2 - 5)
Complete AIS

11. Congenital Adrenal Hyperplasia
Classical Type

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. 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. 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. Sexual Behavior Is Controlled by
Anterior Hypothalamus
 Sexually-dimorphic nuclei in this region

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. David Reimer Story
(John-Joan Case)

18. Phall-O-Meter
 Only an Adam or an Eve
 Never in-between

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. Biology of Sexual Identity
Fa'afafine
A broadly accepted social class in Samoa

21. 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)
 In anterior hypothalamus
 Necessary for sexual behavior in animals
 Receives input from amygdala
 Size of BSTc - not influenced by sex hormones in
adulthood

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. 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. 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. Third Interstitial Nucleus
Of Anterior Hypothalamus
INAH3

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. 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. 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. 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. “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. 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. Genital Mutilation
of Intersex Babies Continues
 Whatever happened to: informed consent?
 Whatever happened to: “first, do no harm?”

33. Genital “Normalization” Surgery - Dismal Outcomes
Researchers never asked: What if we did nothing?

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. 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. Medical policy
should be based on
scientific evidence and
ethical principles
- NOT religious myth!