What causes transsexualism?

[Jessica Merriman]

Being realistic though, the thing that swung it was probably something far more mundane: pharmaceutical companies greasing the right palms to ensure that the gender bending properties of progestins were overlooked, so that progestins could seamlessly take the place of DES for miscarriage treatment. That way, everyone was happy. The pharmaceutical companies simply replaced one product with another so they didn't lose any revenue, and doctors continued to have treatments they could offer to women experiencing difficulties with their pregnancies.

No matter what continent we all live on it always seems to be this way. Money and bonus's over health and integrity. There is no way any of us will ever know the true causes of Transexualism, ever.

[HughE]

No matter what continent we all live on it always seems to be this way. Money and bonus's over health and integrity. There is no way any of us will ever know the true causes of Transexualism, ever.

We're such socially complex creatures that you can't say anything to do with our psychology is 100 percent due to one thing, however there's plenty of evidence that a male gender identity later in life is largely the result of the action of testosterone during your prenatal brain development (and if there isn't testosterone present during that time, or it's unable to do its job, you end up with a female gender identity instead).

There are two medical conditions in which genetically male people are raised as female, that have wildy different outcomes as far as satisfaction with assigned gender is concerned: Complete Androgen Insensitivity Syndrome (CAIS), and Cloacal Exstrophy.

CAIS women have Complete Androgen Insensitivity Syndrome, a condition that means the cells throughout their body are completely unable to detect or react to testosterone, so their prenatal development (including brain development) takes place as if there was no testosterone present.

Cloacal extrophy patients are actually normal baby boys, apart from a developmental abnormality which means they were born without a penis. They have functioning testicles though, so their prenatal brain development took place under the influence of normal male levels of testosterone. It's much easier to surgically construct a vagina rather than a penis for these patients, so the general practice for many years has been to castrate them shortly after birth, construct a vagina for them as part of the surgical repair for their condition, and raise them as girls.

Once their testicles are removed, these people are no longer able to produce testosterone, so are in basically the same situation as CAIS women as far as all their postnatal development is concerned - both groups are genetically male, however they look like and are raised as girls. The only difference is that for the cloacal extrophy patients, their brain development took place under the influence of male-typical testosterone levels, whereas prenatal development in CAIS patients takes place as if there was no testosterone present.

CAIS patients seem to be almost universally happy with a female identity, whereas assignment to female in cloacal exstrophy cases has turned out to be an unmitigated disaster:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1421517/
"Discordant Sexual Identity in Some Genetic Males with Cloacal Exstrophy Assigned to Female Sex at Birth", N Engl J Med. 2004 January 22; 350(4): 333–341.

The paper studied 14 patients who were reassigned as female and two whose parents refused the reassignment.

Subjects 1 to 5 are, according to the paper, living as female:
"None had dated. None discussed sexual activity or sexual attractions (whereas three adolescent genetic females with cloacal exstrophy did). Parents noted in follow-up interviews that these subjects were generally content. However, the parents did not want these children to participate in follow-up interviews and answered all follow-up questions themselves."

Subjects 6 to 8 had an "unclear" sexual identity:
"Identifying herself as a female at the initial assessment at the age of 10 years, Subject 6 subsequently angrily refused to discuss her sexual identity with anyone after learning, at the age of 12, that her birth status was male. After 2½ years of suggestions from her physician, she recently began taking estrogen but continues to refuse to discuss sex. Subjects 7 and 8 have persistently and spontaneously declared their sexual identity as males since the age of nine years, before the initial assessment. They live as females because their parents have rejected their declarations."

The remaining 8 out of 14 reassigned patients had completely rejected a female identity and were living as males, as were the 2 whose parents had refused to allow their reassignment to female.

[Eva Marie]

I was 100% convinced that I was a DES son. I have many clues that seem to line up with DES exposure, like a varicocele on my testes, infertility, and female like structures on my body like very long eyelashes, femme legs, small wrists, the "female" elbow, and a femme face. I was born in 1962 which was a prime time to be exposed to DES. My mom had a very difficult pregnancy and DES would have been a natural choice by her doctor back then. Oh, and I'm trans too 

And there are other oddities - I was a physically small boy until I got to about 27 and then I filled out. Why the delay?

There is only one problem with my being exposed to DES theory - my mother swears that she never took it.

So that leaves me with no clue as to what happened, but something clearly happened to me in utero.

Ultimately I guess that it doesn't matter that much.

[HughE]

I was 100% convinced that I was a DES son. I have many clues that seem to line up with DES exposure, like a varicocele on my testes, infertility, and female like structures on my body like very long eyelashes, femme legs, small wrists, the "female" elbow, and a femme face. I was born in 1962 which was a prime time to be exposed to DES. My mom had a very difficult pregnancy and DES would have been a natural choice by her doctor back then. Oh, and I'm trans too 

And there are other oddities - I was a physically small boy until I got to about 27 and then I filled out. Why the delay?

There is only one problem with my being exposed to DES theory - my mother swears that she never took it.

If you go to this website,
http://autismepigenetics.org/

about 2/3 of the way down, there's a video of a presentation by Dr June Reinisch,
"Prenatal exposures: An unrecognized multigenerational epidemic".

One of the things Dr Reinisch talks about in that video is just how poor mothers' recollection can be, of what medication they were given during their pregnancies. Apparently, in the course of her research, she's had mothers swear blind that they weren't given any medication, when their medical records show that they were being given tablets every day or injections every week. For whatever reason, women seem to forget all the bad things about their pregnancies, and that can quite often include any medication they were given!

Another thing about DES is that, during the 1950s and 60s, it became an ingredient in many pregnancy vitamin formulations, in doses that appear to have been sufficient to cause transsexuality. Maybe your mother was given pregnancy vitamins and not told that they contained DES?

Another possibility is that you were exposed to a different hormone, such as ethinyl estradiol or a progestin. A whole range of synthetic hormones began to be used alongside DES from about 1950 onwards, some of which I think are very likely to have similar effects on male development to DES.

One other possibility is that you have an actual genetic intersex condition of some kind, although seeing as your mother had a difficult pregnancy with you, my guess is that she was given DES or another hormone treatment, and has either forgotten about it or didn't realise what it was.

[Colleen♡Callie]

I've had a theory that it is caused by getting higher doses of the opposite hormone during various crucial stages of fetal brain development. So a spike in estrogen during crucial points in a male fetus' development can produce brain that is more in tune with that of a female brain, and vice versa.  And depending on how many crucial points get higher doses of the opposite gender's hormones, or how high a dose at the right time creating the range we see.  Identifying somewhere in between or fully identifying as the opposite gender you were assigned at a birth.

I remember reading about a test they did with lab rats, introducing levels of estrogen into the fetal development of  male rats at various points and testosterone into the fetal development of female rats during various points of development, and then once grown noted the behavior of the rats.  The males that received female hormones during fetal development tended to act according to female rats, and the female rats that received male hormones during development behaved characteristically as male rats. 

Another theory I've thought about is based off of XX males.  Where translocation between the X and Y chromosomes results in an X chromosome carrying the SRY gene, which then prompts the chromosomally female fetus to develop as a male fetus.  Considering this happens, it wouldn't be too improbable to believe that happens more often between the x and y chromosomes of the father.  Except with areas that blueprint for brain development.  Any number of variations between gender as well as sex can result based on which sections get translocated and how much.  This could result in any number of gender variation but physically and mentally.

I also definitely think that often times the causes of autism also carries the causes of transsexualism.  I've seen plenty of autistics, myself included, that also identify as transsexual or transgender.  The mentioned idea that being transgender can simulate Asperger's is an interesting one and something to thing about.  It is likely it has happened, but to what extent I'm not sure.  I don't think the connection and frequency of the two are all or most of the time be caused by that.  But perhaps a percentage of cases might be?

There is high number of frequency though, and not just with Asperger's but also with Kanner's autism (classic autism).  Asperger's is diagnostically just Kanner's Autism with normal undelayed (and sometimes early or above-normal) speech development.  I was diagnosed Kanner's autism because I did have a delay in speech and for a bit had developed my own language.  My first word was "Da" which was how I referred to my sister, whose name is Karen.  I apparently invented my own words for things for a bit before finally saying real words.  I was told though that I came off more asperger's than kanner's.  There are a number of psychologists and psychiatrists that seem to diagnose any high functioning autistic as asperger's over kanner's.  As such, as well as not seeing how gender dysphoria would really result in a delay of speech development or many other diagnostically relevant characteristics in very early childhood, I chose to believe that its a lot more a case of frequently being co-issues rather than heavily misdiagnosed. 

Interestingly enough, they are now starting to distinguish how asperger's and autism differs in women, and that list was a much, much, much, much more my set of symptomology than the traditional lists of symptoms common in men.   Symptom-wise I am extremely on par with how asperger's and autism in women than I am with how it presents in men.

Anyhow, those are my thoughts on the subject.  Just thought I'd share.

[tawnisofia]

I was exposed to Diethylstilbestrol Hormone both in utero and I.V. post delivery. Informal studies have shown a high percentage of Transexualism, Homosexuality and other findings. I would vote "Yes" on exposure to hormones at critical formative events. 

Well I was as well , DES exposed. 100% certain.

[Jo-is-amazing]

I know my Mum had a hormonal disorder that wasn't diagnosed until she was 6 months pregnant with me.I always assumed that might have something to do with it

[Ltl89]

I wish I knew.  To be honest, I doubt there is one single reason.  People are probably trans for different reasons.  It would seem weird for such a diverse group with different ways of experiencing gender dysphoria of some sort to have one single path that causes our feelings.  I can't say that I was born this way, but it does feel like something I didn't have much say or control over.  Why that was and is the case is something I'll probably never know.

[FrancisAnn]

This is very interesting. I have not thought about it in years. A little of my life. My mother was very healthly & I was her second child. She was married. Her first child was a boy & she wanted a girl & daughter. My father was not around much. She owned a beauty shop & as a young child I was always around women having their hair done & talking, doing their nails, etc....I loved it & it felt so normal. I played dress up as a little girl all the time. My mother was neutral to supportive of me being a little girl. It felt good to me to be her daughter. I thought I was a pretty happy little girl until first grade when my teacher told me I was a boy & needed to sit with the boys. I was so upset......................................

In my early teens my mother tried her best to find a doctor to help me with HRT however in those days it was impossible. I was forced to play football/male stuff by my father while every day I knew I should have been a girl cheerleader. So I grew up with T stuff going into my body & hated every minute of it!!!! I've never had a minute of peace & only now with a year of HRT does my body feel kind of normal & it is finally improving & changing some.

So my little story & I have never had any detail tests.

   

[kelly_aus]

I firmly believe there is a biological cause for transsexualism. Based on my reading and other research, I'm inclined to believe a major factor is hormone levels during foetal development. Now, the question then becomes, 'What causes the variance in hormone levels?'.. And that's where it gets curly. Because, given what we now know about DES, it would seem that an external source is a reasonable assumption for a cause. But that's not a complete answer, it doesn't cover those for whom there was no obvious external modifiers to hormones. I know my mother took nothing of the sort when she was pregnant with me, the joys of being a medical family, she has a complete copy of her medical records, so I know she took nothing - not relying on her memory. So we still need to track down why the variance happens in those with no obvious external sources.. Now, environmental factors could play a part, but like DES et al I don't think it's a complete answer.

And there's the problem for me. There seems to be a bunch of half answers. I call them half answers because no one of them seems to answer the question for all - or even a clear majority. I suspect it will end up being a combo of things, starting with a seemingly innocuous DNA mutation..

[Wynternight]

The use of DES in pregnancy ended in 1971 so thems as came after those of us born during its period of use should be sans DES exposure. It's a seemingly good explanation for transfolks whose mothers were given it in its time frame (1940-1971) but after? It just goes to show that the cause of GID are possibly many and varied and not likely to known in our lifetime.

That said, I'm calling my mother today and asking if she recalls getting it when she was pregnant with me.

[Wynternight]

Wow...just wow. I spoke to my mother today and she was put on DES when she was pregnant with me. I did more research on it and I can check every box on the list: I'm intersexed with hypogonadism, transgendered, and the only left-handed one in the family. What a mindf**k.

[FrancisAnn]

This is very interesting. I had no idea of this DES drug or hormone. If anyone knows, was it widely used in the US, during the 50's or 60's?? My mother has passed away so I do not have any means to find out about her treatment. I was born in the southeast USA. Also did it really have an affect to cause transsexualism?

[Wynternight]

This is very interesting. I had no idea of this DES drug or hormone. If anyone knows, was it widely used in the US, during the 50's or 60's?? My mother has passed away so I do not have any means to find out about her treatment. I was born in the southeast USA. Also did it really have an affect to cause transsexualism?

http://en.wikipedia.org/wiki/Diethylstilbestrol

[FrancisAnn]

Thanks. I do not believe my mother was exposed to this drug. She was in very good health & used a first rate doctor & hospital with her pregnancy.

[peky]

There is no doubt that transsexuality is caused by an interplay of an specific hormone deficiency, deficiency on specific hormone receptors, which at the end are due to genetic malfunctions. Although we do not have the smoking gun or the whole story complete, much progress has been made in neuro-genetics and development.  Here below is an abstract on a recent publication by tow of the foremost expert on the causes of GID

Front Neuroendocrinol. 2011 Apr;32(2):214-26. doi: 10.1016/j.yfrne.2011.02.007. Epub 2011 Feb 18.

Sexual differentiation of the human brain: relation to gender identity, sexual orientation and neuropsychiatric disorders.

Bao AM1, Swaab DF.

Abstract

During the intrauterine period a testosterone surge masculinizes the fetal brain, whereas the absence of such a surge results in a feminine brain. As sexual differentiation of the brain takes place at a much later stage in development than sexual differentiation of the genitals, these two processes can be influenced independently of each other. Sex differences in cognition, gender identity (an individual's perception of their own sexual identity), sexual orientation (heterosexuality, homosexuality or bisexuality), and the risks of developing neuropsychiatric disorders are programmed into our brain during early development. There is no evidence that one's postnatal social environment plays a crucial role in gender identity or sexual orientation. We discuss the relationships between structural and functional sex differences of various brain areas and the way they change along with any changes in the supply of sex hormones on the one hand and sex differences in behavior in health and disease on the other.

Copyright © 2011 Elsevier Inc. All rights reserved.

[Wynternight]

There is no doubt that transsexuality is caused by an interplay of an specific hormone deficiency, deficiency on specific hormone receptors, which at the end are due to genetic malfunctions. Although we do not have the smoking gun or the whole story complete, much progress has been made in neuro-genetics and development.  Here below is an abstract on a recent publication by tow of the foremost expert on the causes of GID

I've been following these studies and several other. Very interesting.

[FrancisAnn]

It is very interesting & thank you for researching the possible causes. In my specific case from my earliest memories as a child I thought I was a normal happy little girl. I felt good & just felt like any little girl would feel I guess. It was only until age 6 entering grammar school I was told point blank that I was a boy & that I had to sit & do things with the boys. The teacher was upset that I wanted to sit & play with my group, the girls. Life never felt right for me from that day forward. My mother has passed away so there is no way to find out about any drugs or hormones she might have taken during her pregnancy. 

Good luck on your reasearch & also good luck with your transition.

[anjaq]

I find it very interesting to see that now harry benjamins original hypothesis is increasingly supported. Back then he called transsexuality basically an intersex condition affecting the brain.
I think however some care has to be put on the likelyhood that this cannot by far explain everything under the transgender umbrella. It can explain some forms of what is called transsexuality, but it probably is not the best for people who mainly have gender role issues or people who just like to 'dress'.

[Eris]

I'm not certain whether this is related to my gender identity, but I was suffocated as a newborn and suffered a cerebral infarction.
My parents were told that a small part of my brain had died as a consequence of oxygen deprivation and that it would develop differently as a response.