Part 4 of "Science & Sexuality." What exactly is a female? a male? an intersex person? Some kinds of intersex people are chromosomal variants. What can we learn about sexual identity and sexual orientation from sex chromosomal variants? Who is Milton Diamond? John Money?
Who is intersex? What are the types of intersex? Is intersexuality natural? What concerns are shared by LGBT people and intersex people? Learn why you should care about intersex people!
Part 4 of "Science & Sexuality." What exactly is a female? a male? an intersex person? Some kinds of intersex people are chromosomal variants. What can we learn about sexual identity and sexual orientation from sex chromosomal variants? Who is Milton Diamond? John Money?
Who is intersex? What are the types of intersex? Is intersexuality natural? What concerns are shared by LGBT people and intersex people? Learn why you should care about intersex people!
One of lectures presented in our Port said fifth neonatology conference, 23-24 October 2014 by Prof Mohamed El Sawy, Prof in Pediatric department , faculty of medicine, Ain Shams university
the material discuss about a medical condition that has to deal with sexual development. in different stages of development, there is a need for gender identity and role, if there is a problem with any of these 2, there will be a problem with the sex assignment which will have an effect on the external genitalia sex. if all these pathway fall apart, there will be a condition called hermaphroditism which may be true or false. the material is exclusive on the topic
Part 5 of "Science & Sexuality." What can we learn about sexual development and sexual identity from XY individuals with testes who have hormone receptor molecules that don't work at all or only partly?
DSD (Disorders of sexual development), Intersex.pptxAhmed Nasef
this presentation contain full, easy & simple description for the various disorders of sexual differentiation (DSD),
intersex
intersexuality
true hermaphroditism
false hermaphroditism
ambiguous genitalia ( causes, how to manage)
criteria for normal male development
criteria for normal female development
sweyer syndrome
testicular feminization syndrome
5 alpha reductase deficiency
testicular regression syndrome
ovotestis
this for undergraduates, postgraduates, General practitioners, doctors, obstetricians, gynecologists& nurses,
One of lectures presented in our Port said fifth neonatology conference, 23-24 October 2014 by Prof Mohamed El Sawy, Prof in Pediatric department , faculty of medicine, Ain Shams university
the material discuss about a medical condition that has to deal with sexual development. in different stages of development, there is a need for gender identity and role, if there is a problem with any of these 2, there will be a problem with the sex assignment which will have an effect on the external genitalia sex. if all these pathway fall apart, there will be a condition called hermaphroditism which may be true or false. the material is exclusive on the topic
Part 5 of "Science & Sexuality." What can we learn about sexual development and sexual identity from XY individuals with testes who have hormone receptor molecules that don't work at all or only partly?
DSD (Disorders of sexual development), Intersex.pptxAhmed Nasef
this presentation contain full, easy & simple description for the various disorders of sexual differentiation (DSD),
intersex
intersexuality
true hermaphroditism
false hermaphroditism
ambiguous genitalia ( causes, how to manage)
criteria for normal male development
criteria for normal female development
sweyer syndrome
testicular feminization syndrome
5 alpha reductase deficiency
testicular regression syndrome
ovotestis
this for undergraduates, postgraduates, General practitioners, doctors, obstetricians, gynecologists& nurses,
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.
This presentation explains the development of diverse sexualities (as natural variations of the organization-activation mechanism), and shows that LGBTI peoples suffer from a socio-cultural disorder that results from the erroneous "gender binary" concept.
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
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.
lecture 25 from a college level introduction to psychology course taught Fall 2011 by Brian J. Piper, Ph.D. (psy391@gmail.com) at Willamette University, includes Masters & Johnson, Kinsey, neuroanatomy,
The Gender Binary & LGBTI People: Religious Myth and Medical MalpracticeVeronica Drantz, PhD
Designated as disordered rather than just different, LGBTI people have been and continue to be victims of medical malpractice purely because they are neither Adams nor Eves. Psychiatrists, surgeons, endocrinologists, pediatricians, and other medical experts have subjected LGBTI people to bogus and horrific treatments with reckless disregard for patient health and well-being―all the while ignoring the basic tenets of medical ethics and the ever-growing scientific evidence showing LGBTI people to be natural variations. Beyond this, medical stigmatization of LGBTI people has contributed to their oppression in the world at large. This treatise will contrast the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth.
This presentation is from Chapter 12 of the anthology Christianity Is Not Great: How Faith Fails. John W. Loftus (editor), (Amherst NY: Prometheus Books, 2014).
Paperback or Kindle version of the book here.
http://www.amazon.com/Christianity-Is-Not-Great-Faith/dp/1616149566
Gender
*
Gender = Sex?Biological sexFemale/MaleGenetics: chromosomes, XX, XYHormones: Estrogen, TestosteroneBrain chemistry
*
Female Brain & Male Brain
*
Concept of ContinuumRe: Biological Sex – Genotype/Phenotype
*
We All Start Out FemaleMore female sperm in a man’s bodyAt conception, the fertilized egg is proto-female (sex differentiation occurs after 7-8 weeks, not visible with ultrasound until 18-20 weeks)More female babies are bornMore female babies live beyond 1 yearFemales have longer life expectancy
*
Population Figures51% of world’s population is female49% is maleWhy?
*
Gender IdentityThe gender with which a person identifiesA psychological feelingMore useful to conceptualize a continuum
*
Gender Identity Independent of Sexual OrientationAll people, regardless of their sexual orientation, deal with issues of genderGender identity does not create sexual orientationMasculine and feminine heterosexuals, homosexuals, bisexuals, transgendered people can identify w/ any sexual orientation
Selected Gender TermsGender Binary/Non-BinaryGender Identity Gender FluidGender Identity Dysphoria CisgenderGender Role PangenderGender Stereotype TransgenderGender Role Socialization IntersexGender Role Conflict
Binary vs. Non-BinaryBinary - Concept that gender identity can only be conceptualized in terms of Masculinity/Femininity (belief that there are only two genders and that one's sex or gender assigned at birth will align with traditional social constructs, expression, and sexuality)
Non-Binary - Non-binary gender identity is just one term used to describe individuals who may experience a gender identity that is neither exclusively male or female or is in between or beyond both genders (some use term Gender Queer)
jackie behn (jb)
CisgenderPeople whose gender identity matches their sex assigned at birth. For example, someone who identifies as a woman and was assigned female at birth is a cisgender woman. The term cisgender is the opposite of the word transgender.
PangenderPangender is a term for people who feel that they identify with all genders available to them.
TransgenderTerm used to describe a broad range of people who experience and/or express their gender somewhat differently from what most people expect. It is an overarching term that includes those with gender characteristics that don't correspond with those traditionally ascribed to the person's sex.
*
TransgenderMedical term describing people whose gender and sex do not line up and who can seek medical treatment to bring their bodies and gender identities into alignment
Christine Jorgensen, Had sex reassignment surgery in 1951 (Used term transexual then)
*
Renee RichardsDr. Renée Richards is an American ophthalmologist and former tennis player who had some success on the professional circuit in the 1970s, and became widely known following male-to-female sex reassignment surgery, when she fought to c ...
Introduction to PsychologyHuman Development(Image from w.docxnormanibarber20063
Introduction to Psychology
Human Development
(Image from www.psychologistworld.com)
Debates in Development
Nature or nurture?
Continuous or stages?
Stability or change?
(Image from agapeleaders.com)
2
Domains of Development
Physical
Language
Cognitive
Social/Emotional
Gender and Sexuality
(Image from thepolesworthschool.com)
3
Genetics
Chromosome
DNA
Genes
(Image from publications.nigms.nih.gov)
Prenatal Development
Zygote
(Image from stemedical.com)
(Image from soad.umich.edu)
(Image from reddit.com)
Embryo
Fetus
5
Teratogens
Alcohol
Tobacco
Other drugs – OTC, prescription, illegal
Radiation
Pollution
Infectious diseases
(Image from afairgo.com)
6
Newborns
Reflexes
Temperament differences
Early recognition of mom
Preference for human faces
http://www.youtube.com/watch?v=gyVLD0hl0XY
(Image from parenting.com)
7
Physical Development in
Infancy and Early Childhood
Rapid neural growth, then pruning
Motor development: gross and fine
http://www.cdc.gov/ncbddd/actearly/milestones/index.html
(Image from urbanchildinstitute.org)
8
Language Development
Crying and cooing
Babbling
Single words
Two-word telegraphic speech
Language Development
Universal grammar
Language acquisition device (Noam Chomsky)
Critical period
Cognitive Development:
Piaget’s Stages
Concrete Operational (7-11)
-Conservation
https://www.youtube.com/watch?v=YtLEWVu815o
-Theory of mind
https://www.youtube.com/watch?v=8hLubgpY2_w
https://www.youtube.com/watch?v=RDJ0qJTLohM
Formal Operational (12+)
-Abstract logic
-Reasoning
Sensorimotor (0-2)
-Stranger anxiety
-Object permanence https://www.youtube.com/watch?v=rVqJacvywAQ
https://www.youtube.com/watch?v=4jW668F7HdA
Preoperational (2-6)
-Egocentric thinking
-Pretend play
(Image from child-development-guide.com)
Cognitive Development:
Vygotsky’s Sociocultural Theory
(Image from teach.com)
Knowledge is socially transmitted (scaffolding, cooperative learning)
Zone of Proximal Development
Learning can lead to development
12
Social & Emotional Development:
Attachment Theory
Harry Harlow
(Image from psychology.about.com)
https://www.youtube.com/watch?v=_O60TYAIgC4
Social & Emotional Development:
Attachment Theory
John Bowlby:
Safe base
Stranger wariness and separation anxiety
Emotional referencing
(Image from www.dailymail.co.uk)
14
Attachment Theory:
Mary Ainsworth’s Strange Situation
Attachment Styles:
Secure
Insecure - Avoidant
Insecure - Anxious/ Ambivalent/Resistant
https://www.youtube.com/watch?v=QquZxJhuSg8
https://www.youtube.com/watch?v=AGRT6VjnTm8
https://www.youtube.com/watch?v=Rdrp-0GLzws
https://www.youtube.com/watch?v=uSAPfiSw_Ic
15
Parenting Styles
(Image from footnotescounselin.com)
Moral Development
(Image from momiliesandmore.wordpress.com)
Goals for Moral Education
Recognizing and regulating emotions
Developing empathy
Controlling impulses
Delaying gratification
https://www.youtube.com/watch?v=QX_oy9614HQ
Psyc.
Part 1 of "Science & Sexuality." You don't believe that "Adam and Eve" story, do you? Did Eve come from Adam? Or did Adam come from Eve? This is a physiologist's refutation of the biblical binary sexual system. Click on the next 9 slideshows in numerical order for the rest of this scientific update on human sexuality.
The ability of water to form hydrogen bonds gives it amazing properties including: ability to dissolve hydrophilic (ionic and polar) but not hydrophobic (nonionic, nonpolar) molecules so as to be the "universal solvent," liquid state over large earthly temperature range, high heats of fusion and vaporization, high specific heat, high surface tension, cohesion and adhesion, lower density as solid, low viscosity, equal ionization into proton donor and acceptor for neutral pH. These properties make life on earth possible
Part 2 of "Science & Sexuality." The most important sex organ is between your ears! The hypothalamus is an ancient brain area governing instinctive drives and behaviors. People are animals and sex is more ancient than people!
Part 6 of "Science & Sexuality." What can we learn about sexuality from XX individuals who have atypically high testosterone influence during fetal development? What can they teach us about the development of sexual identity and sexual orientation?
What can we learn about the development of sexual identity from genetic males who were castrated at birth, hormonally feminized and socialized as females? What happens to the sexuality of fetuses exposed to a synthetic hormone like DES?
Part 9 of "Science & Sexuality." What determines sexual orientation? Is it learned or inborn? How does culture affect the expression, perception, and treatment of sexually different people?
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
INTERSEX LIVES
1. INTERSEX LIVES
Presented By
Veronica Drantz, PhD
Prepared for
H.E.R. Day
at the
Center on Halsted
March 10, 2012
2. What’s the “I” in LGBTI?
I = Intersex
– I for Invisible
– I for Isolation
LGBTI
– Much in common
– All are victims of the “gender binary“
Elizabeth Reis. Bodies in Doubt: An American History of Intersex. The Johns Hopkins University
Press. (2009)
3. The Myth: “The Gender Binary”
Gametes are binary (eggs or sperm)
Organisms that make the gametes are not binary!
4. Intersex People
Curtis Hinkle - Founder
Organization Intersex International
5. Some 4% Of People Are Not
Clearly Male Or Female
Frequency depends on how you define
intersex and what conditions are included
under this umbrella term
Most intersex conditions are not life-
threatening and do not require treatment
Some people are not aware that they are
intersex
Many are never diagnosed
There are many different kinds of intersex
people
6. Intersex People Are Not
Standard Males Or Females
Intersex people
– Differ physically from the “standard” male or
female
– Difference is congenital, due to atypical sexual
development
These differences involve
– Genes/chromosomes
– Gonads
– Hormones
– Genitals
May have features of both male and
female at once or may have no clearly
defined sexual features at all
7. Intersex People - Natural Variants
Everyone, including intersex persons,
are natural variations on the human
theme
All of us are unusual in some way; we
all carry unusual genes
Diversity in a population is an biological
asset, not a liability
8. Sexual Development –
What Do We Know?
Sex has many levels in people
– Genetic Sex – Chromosomes (X & Y in mammals only)
– Gonadal Sex – Ovaries/Testis (primary sex characteristic)
– Hormonal Sex –Testosterone/Estrogen
– Somatic Sex – Body anatomy/physiology
– Psychological Sex - Sexual identity
– Sexual Attraction – Sexual orientation
9. “Organization – Activation” Mechanism
of Sexual Development
Organization - before birth
– Two kinds of sexual programming of body
Genetic: 46 XX vs. 46 XY
Hormonal: androgen or its absence
Activation – at puberty
– By steroid hormones from gonads
Milton Diamond. Clinical implications of the organizational and activational effects of hormones. HORMONES AND BEHAVIOR
55:621–632 (2009)
10. Sexual Programming
by Sex Chromosomes
Genes on sex chromosomes are
expressed in brain of embryo
(before gonads develop so hormone influence is not a factor)
Laura L. Carruth, Ingrid Reisert & Arthur P. Arnold. Sex chromosome genes directly affect brain sexual differentiation NATURE NEUROSCIENCE 5,
933 - 934 (2002)
Phoebe Dewing, Tao Shi, Steve Horvath, Eric Vilain Sexually dimorphic gene expression in mouse brain precedes gonadal Differentiation
MOLECULAR BRAIN RESEARCH 118 (2003) http://www.shb-info.org/sitebuildercontent/sitebuilderfiles/4_vilain_et_al.pdf
• Multiple genes
determine gonad
differentiation
http://quizlet.com/3597081/x-and-y-chromosomes-flash-cards
11. Sexual Programming
by Androgen
Female body plan is “default” in mammals
– No significant hormone secretion by ovaries in
developing female
Androgen (testosterone) acts during
“critical periods” of development
– Testosterone is secreted by testes of typical
developing male
Epigenetic effects of testosterone or its
absence during these critical periods are
lifelong and widespread in body
12. 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.
14. Male Is Altered Female !!!
Mammalian body plan is inherently 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)
15. Prader Scale:
Five Degrees of Virilization –
Urogenital Sinus and External Genitalia
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)
16. 4 Sexes!
Four
“transcriptional
sexes” in PBMC
– XX/no T
– XY/T
– XX/T
– XY/no T
*PBMC = peripheral blood mononuclear cells
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)
17. 4 Sexes!
157 genes
expressed
differently in
males vs. females
– Sex chromosome
programming of
11 genes
– Androgen-
dependent
programming of
146 genes (not
affected by
circulating
hormones)
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)
18. Sexual Identity & Orientation –
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 sexually before
birth?
Evidence for Organization-Activation Mechanism
– David Reimer story
– Intersex people (AIS, CAH, cloacal exstrophy)
– Brain work (nonhuman mammals, humans)
19. 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)
20. 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
21. 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
22. 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)
23. 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
“Optimal Gender of Rearing” Model
– 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
24. Colapinto, John. As Nature Made Him - The Boy Who
Was Raised As A Girl HarperCollins (2000)
25. 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
26. Colapinto, John. As Nature Made Him -
The Boy Who Was Raised As A Girl
HarperCollins (2000)
27. 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!
28. 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”
published statements from ALIAS, Agree Disagree
an AIS newsletter.
“I don’t think I am any different in 82% 18%
feeling than if I were born XX, feel
very female.”
“All my efforts over the years in 10% 90%
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.”
I have to “work at being a woman” 56% (dressing in a feminine way 44%
or using cosmetics or hair styles in
a way to signal “female”
unambiguously, altering selection
of clothes;
30% did above much of the time)
Considered suicide 62% 38%
Attempted suicide 23% 77%
Diamond, Milton and Watson, Linda Ann. “Androgen insensitivity syndrome and Klinefelter’s syndrome: sex and gender
considerations” Child Adolesc Psychiatric Clin N Am 13 (2004) 623—640
29. 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)
PARTIAL AIS
8 raised as boys 4 live as women
10 raised as girls 2 live as men*
Considered suicide 61%
Attempted suicide 17%
*Now angry about castration, vaginal reconstructions 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 (2004) 623—640
30. Sexual Identity - Cloacal Exstrophy
Genetically and
hormonally
male-born
children may
identify as
males despite
being raised as
females and
undergoing
feminizing
genitoplasty at
birth
Kayla’s story
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)
31. The Sexual
Brain
Amygdala
– Part of Limbic System
– Genesis of emotions
& emotional
expression
Hypothalamus
– Homeostasis
– Neuroendocrine Control
– Instinctive Drives &
Behavior
Hunger
Thirst
Sleep
Body Rhythms
Sex
Netter, Frank H. The CIBA COLLECTION OF MEDICAL
ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy &
Physiology. New York: CIBA (1983)
32. Sexual Behavior Is Controlled by
Anterior Hypothalamus 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
33. 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)
34. Representative
Somatostatin
immunocytochemical
stainings of the somatostatin
Results Parallel
neurons and fibers in the
BSTc
VIP Results
– (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)
35. Summary -
Core
Sexuality
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)
LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)
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)
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)
Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2,
2008)
36. 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)
37. 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)
38. 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)
39. We Don’t Learn Our Sexuality.
We Discover It!
Sexual Identity,
Sexual Orientation,
and Sexual Anatomy
Can Be In Any Combination.
40. Three Somatic Morphology (X axis)
Dimensions of Sexual Identity (Y axis)
Core Sexuality Sexual Orientation (Z axis)
Gynecentric
Androphilic
Gynemorphic Andromorphic
Everyone occupies a
Gynephilic point in this three-
dimensional space!
Androcentric
41. 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
42. The “Gender Binary”
We live in a “binary gendered” culture with two
genders only
– Woman
– Man
Many cultures recognize more than two genders
43. Disordered or Just Different?
Gender binary has permeated medicine
The medical profession has
pathologized and stigmatized gender-
variant peoples
– Lesbian, gay, bisexual people
– Transsexual people
– Intersex people
44. Medical Profession’s Treatment of LGBT People
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)
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
45. Medical Quackery Continues
Genital normalization surgeries on
newborns continue!
DSD = Disorders of Sexual Development
OII objects to “disorder” terminology
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
Milton Diamond recommends
“Differences” or “Variations” of Sex
Development
http://adc.bmj.com/content/91/7/554/reply#archdischild_el_2460?sid=437e97e7-049d-42c8-b60f-6d8d02dd31c1
http://adc.bmjjournals.com/cgi/eletters/91/7/554
46. 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 International
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html
47. Different but Not Disordered
“Around the world intersex individuals are being
subjected to inhumane and degrading altering
surgical and hormonal procedures, without
consent of the intersex person, at the discretion
of doctors and outside legal regulation.
This is done to “normalize” genitals and bodies in
order to fit intersex people within the sex binary
of men and women.
Pathologization of intersex individuals results in
gross human rights violations and abuse of
bodily integrity
and personal dignity.”
1st International Intersex Forum, Brussels, Sept. 3-5, 2011
48. Phall-O-Meter
Sharon E. Preves. INTERSEX and IDENTITY The Contested Self Rutgers University Press (2003)
Whatever happened to “informed consent?”
Whatever happened to “first, do no harm?”
49. 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 With
Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)
50. NEW STANDARDS OF CARE American Academy British Association Pediatric
FOR Pediatricians Surgeons
INTERSEX PATIENTS year 2000 year 2001
Diamond, M. Sex, gender, and identity over the years: a changing
perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS
OF 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
51. 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 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)
52. Pediatric Policy Must Change
Pediatricians use parental distress & prejudice to
justify damaging surgery
Lee 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 girls
http://www.starobserver.com.au/news/2010/07/15/opposition-to-genital-drugs/27947
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),
Let’s follow Columbia’s example
Diamond, 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 treatment
Wiesemann, 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)
53. Poor 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)
54. Intersex People Now Also Crazy!
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
55. Germany Is Leading The Way
To Ethical Medical Treatment Of
Intersex People
Historic public consultation and dialog on intersex
– Intersex people in Germany were invited to participate and observe proceedings in an
historic public consultation and dialog “on the situation of people with intersexuality
[sic] in Germany”. The event has been organized by Deutscher Ethikrat - The German
Ethics Council – and its participants include ‘experts’ in intersex, medical people,
lawyers, parents of intersex people and some intersex people themselves. June 6th,
2011
http://oiiaustralia.com/13790/intersex-people-germany-experts-deutscher-ethikrat-consultatio/
Ethical principles and recommendations for the
medical management of differences of sex
development (DSD)/intersex in children and
adolescents
– “…the psychological and social support of the child and its parents is to be
ranked higher than the creation of biological normalcy.”
– “…Whenever prognostically uncertain interventions can be delayed until the
child is old enough to make decision for themselves, this option should be
presented to parents as the preference of choice.”
Wiesemann C, Ude-Koeller S, Sinnecker GHG, 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) DOI 10.1007/s00431-009-1086-x
56. Common Concerns - LGBT and I
Not “Adams” or “Eves.” Do not fit the “gender
binary”
Stigmatized as “disordered” (rather than “different”)
Cruel and unnecessary medical “treatments” – based on
belief in “gender binary” and that sexual behavior is
learned
Real medical needs not met by medical profession
“In the closet” (secrecy & shame)
Must “come out” and find each other
Need to politically organize to obtain their human rights
Civil rights issues based on gender expression
Many intersex people share “sex reassignment” issues
with trans people
Transsexuality is a subtype of (brain) intersex
57. Discrimination Against Intersex
People Is a Socio-cultural Disorder
Intersex people are natural variations
Intersex people are different, not
disordered
The suffering of intersex people is not
intrinsic to their condition; rather it is
imposed by the binary-gendered society/
culture
58. Intersex People Forsaken by
Religion and Medicine
Organized religion and the medical
profession have been part of the socio-
cultural problem and continue to be a
problem
The scientific message that “core
sexuality is innate” needs to reach the
religious communities, medical
community, educators, and parents
59. Human Rights Issue:
To Be Who We Are
Respect diversity!
People should be able to express
themselves wherever they feel
comfortable on the feminine-masculine
continuum without having rights taken
away or medical alterations forced upon
them to maintain those rights
All of us, not just the Adams and the
Eves, have the birthright to be who we
naturally and innately are