(https://lh3.googleusercontent.com/YDV_u1tITownVN1_I9UiAPPwn1UDhNzbqr5HnRmbX-kDOb5pxdIrM_IH_jyrHsq5pl4v9YZ2ZQ0GqE_zY8ornpp-5JjD92mf_ucXpX_IPhrmhblovGDWgNI82wDsq_xUuZIk_CjwefJRSdMUo2MSxGSKBDlJlsJfAn_mvJx69r2Je9bVnXw6LnMmhnco9p5JdWGqqujQ6I5n0ynQQ3X0s4kvPhkRpYZj_so1Z9WYBivUnv-zBMX92ChdouBjgzVhuivZl-cTyDJGryXrhgmxBwYj6nS9mMLwXFGIFote46igUf1Gr-8ZnCn7iEiaHIr0RrwGIrDxWuqMR6LDZpXQazOckKbez4pO9EC5_fQxhHBD0ZvrtkMAv1p8d6Hw8oprZFxhgCibEGt3tzkES563yWQkKe4aWnmALVVz2EgFzF-aERNC2ER5GcvlrzU2eNPMc96e7SDnjSzva3XPRXf5SB6EWseQyarv8BqoJmFzWvBF5NFZ1rg9CeIwUyYy6j8guzx5iVtnSijWAn4HJ1Q8PDsXnh9m2OPDz0lziPqRSo8u-Ch_PtYOKx3InRTiXn9NdE47ibJ0n7k1jNTh3AL5EI2TLOwa3Bgf9lQgmb1-5A=w1200-h954-no)
Interesting paper by Dr. Milton Diamond. Any thoughts?
https://www.hawaii.edu/PCSS/biblio/articles/2015to2019/2016-transsexualism.html (https://www.hawaii.edu/PCSS/biblio/articles/2015to2019/2016-transsexualism.html)
I agree that it is since it has a physical component in the development of the brain. The problem is that currently it cannot be physically diagnosed. When medical science is able to map the brain sufficiently to diagnose it then I think there would be more widespread support for classifying it as intersex.
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Thanks so much for posting this. I will share it with my daughter.
The blurring of definitions troubles me. Gender and sex are conflated as if they are the same thing. Sex is about genitalia (male/female) and gender (masculine/feminine). One is biological, the other a sense of being. Intersex is being born with the genitalia of both sexes or ambiguous genitalia. Transsexual is being born with the genitalia of one sex, but desiring the genitalia/needing the genitalia of the other sex. That is possibly biological in origin. Gender is a sense of being that has nothing to do with a person's genitalia. So, transgender is about a sense of being (how one moves through the world) and gives rise to gender queer, etc. as an identity. And probably does not have a definitive biological cause, but rather something closer to a combination of similarities, but not always. Lastly, I know people involved in the research and I am unaware of any current theory that would seek to co-op intersex under the transsexual term because transsexuals are born with a single sex genitalia. This distinction also accounts for why some people have to have GRS, and others are not that interested.
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Leave it to a scientist (I am one, I can say that) to come along and decide to invalidate an entire segment of the population. I am not intersex as the term is presently defined, and many intersex people don't care to be limped into the transgender basket.
Generally, yes transexuality and certainly many who would identity as transgender but not transexual have biological difference from the majority of humans due to prenatal hormonal abnormality.
Fortunately one misguided paper seems unlikely to result in any changes in DSM etc.
Intersexed has so many shades of Gray. In my case I'm T levels were always on the low end of normal and my E levels were always higher than normal. When I started E my levels shot way up quickly. My Dr was surprised how my body was swimming in E so soon.
So does that count? There's no outwardly visible characteristics, just body chemistry.
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The traditional definition of intersex concerned genitalia, and genetics. Then, it expanded into various physiological conditions. Now we are beginning to understand the biology of the sexual differentiation of the brain in utero. There can be no questioning the importance of the brain as it affects human reproductive capacity. Ignoring the brain was a matter of convenience, not science. The biological forces that produce ambiguous genitals and gonads in intersex people are fundamentally the same forces that bring about the ambiguity that transsexual people feel about their sexual identities.
There's no attempt to conflate sex and gender, as I see it. Sexual identity is neuroanatomical. It's determined by body and brain. If body and brain don't align sufficiently, one's sex is ambiguous, part male and part female, the essence of what intersex means.
Brain-body mismatch is physiological, not psychological. A female brain does not functional well in a testosterone dominant body, nor does a male brain thrive on estrogen. HRT is both a diagnostic and medical treatment for transsexual people. The need for medical treatment to resolve sexual ambiguity as experienced by transsexual people is really no different than someone seeking medical treatment to resolve other intersex conditions.
Gender identity is a related, but separate matter heavily dependent on various social and psychological factors.
This is an argument waiting to happen. I was heavily scolded by someone on Facebook for describing the fetal condition of pre-sexual differentiation as being like all of us start out hermaphroditic, as that was the best word I could think of to describe having both male and female structures. I mean heavily chastised.
My own take:
The idea of "intersex" would logically include any condition whereby the body is not fully matched in all sexual function. So being that brain neural structures are, I'm going to use the word, 'meant' to coincide with chromosome normalcy, then yes being transgender is a type of intersex condition.
I would argue that "gender identity" is very much physiological where "gender expectations" is a social construct. We may consider ourselves to be above base instincts but that is not true. Yes we can fight our instincts with logical thought but that is exactly what we do when we deny our brains gender. Those neural structures provide us with our thought processes and do very much drive our wants be it socialization desires or how we act in the bedroom. These form the basis of human behavior. It's why we trans people finally find peace at least with our being by giving in and just being what is natural for us. It's fighting this that makes us miserable. It's why we decide to transition.
In my home state of Illinois, intersex is legally defined (paraphrasing here) as someone who has sexual organs and or external genitals not formed matching assigned sex or a genetic condition relating to sexual organ formation. It does not include 'gender' based neural wiring in the brain. It focuses on sexual organs specifically.
These days the science of biology is putting the whole puzzle together. In 1970 it was known that hormones, specifically testosterone, were involved in the formation of "virilized" neural structures prenataly in mammals. Obviously as technology advanced, biology has been able to explain much of the prenatal development at the gene and hormone interaction level. The formation of sexual organs one genitals are linked in many ways with the systems that would in ideal conditions result in a fully matched brain and sexual systems. We now know with hard evidence it doesn't always go as the "prefect model" would progress. We know things interfere with the development and it can range from gene mutation/variation to external endocrine interruptions.
We here all know that the incorrect sex hormone for the hardwired neural structures causes issues. I wish there was some studies done to explain this and show again in hard proof our very validity to the cis world. Aside from HRT as a diagnostic tool, a study done by Japanese researchers claims to be able to achieve clinical diagnosis of the wiring of the brain by MRI and looking at the size and shape of the corpus collosum. This is the interconnect structure in the brain between the hemispheres. In the female wired brain it is larger and has many more neurons providing data exchange between segments of the brain. It has neural paths both across and forward and rearward and bidirectional and unidirectional pathways. So far I do not believe any other team has performed a follow up study but as MRI technology advances it's likely it will be easier for scientists to see inside a person's brain and find the brain section comparisons more reliably without needing post mortem samples to study from.
Quote from: Clara Kay on December 19, 2017, 01:37:47 AM
Brain-body mismatch is physiological, not psychological. A female brain does not functional well in a testosterone dominant body, nor does a male brain thrive on estrogen.
I love this explanation. That's what I got from the article as well.
I was born with chromosomal issues (no testosterone/ lack of receptors) and a defect in the genital region, as well as other issues internally, as such I am intersex. I was fine in my youth as I was not very girly by nature but when I hit 16 years old this was a huge issue as my friends and peers were in their puberty stages and mine had not even started :(
The fact I am transgender is up in the air as to whether it is causality or coincidence! I would like to think it is linked but specialists are reluctant to say outright if it is.
It's a decent article. Lots of good points. Perhaps one day they'll figure out that we don't need to be put into a box with a bow. Perhaps with more understanding they'll have the evidence they need to realize that people need to be who they were born to be. I don't know if Trans people deserve the genetic scrutiny... Perhaps they can go looking for the violent crime repeat offender gene and put their time to better use.
Quote from: Clara Kay on December 19, 2017, 01:37:47 AM
The traditional definition of intersex concerned genitalia, and genetics. Then, it expanded into various physiological conditions. Now we are beginning to understand the biology of the sexual differentiation of the brain in utero. There can be no questioning the importance of the brain as it affects human reproductive capacity. Ignoring the brain was a matter of convenience, not science. The biological forces that produce ambiguous genitals and gonads in intersex people are fundamentally the same forces that bring about the ambiguity that transsexual people feel about their sexual identities.
There's no attempt to conflate sex and gender, as I see it. Sexual identity is neuroanatomical. It's determined by body and brain. If body and brain don't align sufficiently, one's sex is ambiguous, part male and part female, the essence of what intersex means.
Brain-body mismatch is physiological, not psychological. A female brain does not functional well in a testosterone dominant body, nor does a male brain thrive on estrogen. HRT is both a diagnostic and medical treatment for transsexual people. The need for medical treatment to resolve sexual ambiguity as experienced by transsexual people is really no different than someone seeking medical treatment to resolve other intersex conditions.
Gender identity is a related, but separate matter heavily dependent on various social and psychological factors.
I am happy more people see it this way. It took a very long time for me to accept this line of thought. My family accepted that immediately even my dad who is a medical doctor. I know this is just family, but maybe societal acceptance is around the corner? I am so happy for younger generations of trans people, a little envious too:)
Bari Jo
Quote from: Sarah leah on December 21, 2017, 05:06:09 AM
I was born with chromosomal issues (no testosterone/ lack of receptors) and a defect in the genital region, as well as other issues internally, as such I am intersex. I was fine in my youth as I was not very girly by nature but when I hit 16 years old this was a huge issue as my friends and peers were in their puberty stages and mine had not even started :(
The fact I am transgender is up in the air as to whether it is causality or coincidence! I would like to think it is linked but specialists are reluctant to say outright if it is.
Sarah, it's almost a garentee that androgen receptor insensitivity will prevent virilization(masculinization) of the brain. So depending on the level of insensitivity it most definately affected you being transgender. Every bit of modern scientific research supports this relationship. Testosterone is needed to masculinize the gender specific regions during the second trimester.
Incorporating the term 'intersex' into the vocabulary helps me to understand my journey. Here's how I describe it today:
I was born intersex. No one was aware of it, not even me.
I experienced gender dysphoria (GD) both at a conscious and subconscious level, but was unable to articulate my experience.
I identified as a boy/man for most of my life, and treated as such. I was NOT transgender.
My GD intensified during puberty and afterward. In time I came to understand it as a consequence of having been born intersex (male-bodied but female brained).
I eventually decided to change my social gender identity from man to woman. I became a transgender woman.
HRT helped reduce mental discord, but living as woman with a male body only amplified my GD.
I decided to change my physical body (sex) to align with my female self-image. I became a transsexual woman.
As my mind and body converged, GD receded dramatically.
Technically I'm still intersex, but the sexual dichotomy I was born with has been corrected.
I am now a female woman.
I'm sorry but people should realize how offensive this can be for people who are intersex and have suffered through surgeries and more surgeries to correct other surgeries. They should realize all the pain and awfulness that comes with being intersex. Plus, there is no benefit to being intersex. Society doesn't accept you more. Society accepts trans women who are "passable," which is really screwed up.
However, what is wrong with being transgender as opposed to intersex? If we dilute all words, then eventually none of them contain meaning. I do understand the yearning people have and why people want the two to be connected, but should also realize the struggle of intersex people; thus, it is not fair to appropriate the pain of people born with DSDs.
This was not pointed at anyone and, again, I totally understand. But remember this, too: being trans is nothing to be ashamed of. Of course if you can prove you need to transition by being intersex, I do see why some would want to be so. But instead of changing definitions, maybe we should change society.
Merry X-Mas and Seasons Greeting to everyone!
Clara, let me reiterate what spunky has said.
Yes the current thinking is that dimorphisms in the brain are the cause of ->-bleeped-<- and yes that's physiological. I think you're committing to a large logical fallacy in saying that anyone credible sees being trans as a purely psychological phenomenon.
Some facts.
Not all transgender subjects in the reported research showed the dimorphisms in brain structure, as it happens in the paper I'm thinking of more ftms did show a difference visible in an fmri study than MTFs however in any case, a majority did.
The more recent research based on fmri imaging tends to get cited more, however the scientific understanding of the difference between male & female predates the existence of ability to see anything about structure, see "Brain Sex" 1989.
The functionally visible differences covered in that earlier research are to me more telling. The most prominent difference between "male" and "female" brains is that women have far greater communication between the left and right brain. This means for instance that while men isolate processing of e.g. language or spatial representation on one side of the brain, women split those functions between left and right lobes.
-----
Now the question if why a "female" brain works better in the presence of estrogen than testosterone and vise versa for "male" brains is as far as I know, entirely unanswered.
I have absolutely no idea why I failed to understand men and boys around me and envied / longed to be female all of my life, I do know it's my truth and I believe it's the experience of a lot of other trans people (both f & m identified). I also know that my mind is far quieter since changing my hormonal profile to feminine with exogenous hormone therapy. I also know that before HRT, I bridged that gap with a combination of meditation, mindfulness training and body disciplines.
For better or worse, studying "me" isn't a blind experiment and also by the way, according to the APA, there are no quality / correctly blinded studies into diagnosis of transexualism / ->-bleeped-<-. Happily they continue to diagnose us, making treatment under WPATH possible.
So if you, Clara feel better classifying yourself as intersex because that's physiological, great, however the diagnosis of trans vs intersex DSD is unlikely to be changed, the former is primarily treated with hrt. Intersex being presently defined as abnormality in the formation of genitals or the underlying chromosome are an entirely different matter.
As I said in my earlier reply, neither WPATH nor DSM seem likely to be changed anytime soon by this one paper which is simply wrapping different terminology around what we already understand.
Ref: Report of the American Psychiatric Association Task Force
on Treatment of Gender Identity Disorder authors William Byne et al
Quote from: Deborah on December 18, 2017, 10:21:16 AM
I agree that it is since it has a physical component in the development of the brain. The problem is that currently it cannot be physically diagnosed. When medical science is able to map the brain sufficiently to diagnose it then I think there would be more widespread support for classifying it as intersex.
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I am in agreeance with Deborah. Plus most doctors classify intersexuality as a condition where the genitals are ambiguous and not clearly defined. Which also stated above that it can involve hormones being off for either gender. So no transexuals are not intersex except for the brain maybe.
Quote from: Spunky Brewster on December 25, 2017, 11:55:00 PM
I'm sorry but people should realize how offensive this can be for people who are intersex and have suffered through surgeries and more surgeries to correct other surgeries. They should realize all the pain and awfulness that comes with being intersex. Plus, there is no benefit to being intersex. Society doesn't accept you more. Society accepts trans women who are "passable," which is really screwed up.
However, what is wrong with being transgender as opposed to intersex? If we dilute all words, then eventually none of them contain meaning. I do understand the yearning people have and why people want the two to be connected, but should also realize the struggle of intersex people; thus, it is not fair to appropriate the pain of people born with DSDs.
This was not pointed at anyone and, again, I totally understand. But remember this, too: being trans is nothing to be ashamed of. Of course if you can prove you need to transition by being intersex, I do see why some would want to be so. But instead of changing definitions, maybe we should change society.
Merry X-Mas and Seasons Greeting to everyone!
Thanks, Spunky. I had no intention of offending intersex people, I consider myself intersex. I'm fully aware that there is no advantage to referring to myself as being intersex. Frankly, I think it's highly stigmatizing. I would also like to remind you that I have experienced a lifetime of mental anguish and undergone multiple surgeries to correct my intersex condition, namely to eliminate the ambiguity of my inborn sexual identity.
Sex and gender terminology is being diluted, there's no question about that. The term 'transgender' is so broadly defined today as to be practically meaningless. There's a concerted effort by the larger trans community to purge the word 'transsexual' from everyday usage, as inappropriate, or, worse, offensive.
Neither 'transgender' nor 'transsexual' speak to the physical reality of being born with a
sexual identity which is ambiguous or conflicted in some way. The term 'intersex' does. Intersex describes a state of physical and physiological embodiment independent of social context.
The words transgender and transsexual describe outcomes, not causes. They don't explain the reason for gender dysphoria, they describe a behavioral reaction to it. A person is transgender because they object to the gender forced upon them the day they were born. A person is transsexual when they alter their anatomy to that of the opposite sex. Neither word speaks to the underlying reason for this behavior.
Knowing that I'm intersex explains
why I suffered gender dysphoria. It explains
why I had to be prescribed cross-sex hormones. It explains
why I transitioned genders, and
why I underwent multiple surgeries to change the outward appearance of my body. These are not things that most transgender people have to deal with. These are things that intersex people live with.
I frankly don't care that the current medical definition of intersex doesn't consider the sexual dimorphism of the brain as another aspect of the intersex condition. I'm sure it will in time. Medical knowledge is constantly being updated and corrected to account for what was previously misunderstood.
Again, I'm sorry if my post has hurt or offended you. To be honest, I feel hurt, too.
Happy New Year!
For what it is worth, in training and presentations I generally refer to a difference between the sexually dimorphic regions of the brain and the genitals as gender incongruity. That is, I have a gender-related physical incongruity between a few regions of the brain that sensitive to the endocrine system and are linked to the control of my body, and my assigned sex at birth.
I feel that gender incongruity is a broader term than intersex, which has an accepted medical meaning. I prefer not to overload existing terminology with potentially confusing new meanings or expansions, particularly when that terminology is also used as an identity by a small population. My appropriating someone's identity for my own use, particularly when that use doesn't match their usage, feels wrong to me.
By the way, the entire brain is not sexually dimorphic. The sex-related differences in the brain are pretty well limited to bits linked to the control of the body and sex-related parts of the endocrine system, and some of the wiring (the connectome) for these bits. Other variations seen in the brain across assigned sexes tend to broadly overlapping and not particularly unique sex identifiers, unlike the dimorphic regions.
Quote from: Michelle_P on December 26, 2017, 02:55:34 PM
For what it is worth, in training and presentations I generally refer to a difference between the sexually dimorphic regions of the brain and the genitals as gender incongruity. That is, I have a gender-related physical incongruity between a few regions of the brain that sensitive to the endocrine system and are linked to the control of my body, and my assigned sex at birth.
I feel that gender incongruity is a broader term than intersex, which has an accepted medical meaning. I prefer not to overload existing terminology with potentially confusing new meanings or expansions, particularly when that terminology is also used as an identity by a small population. My appropriating someone's identity for my own use, particularly when that use doesn't match their usage, feels wrong to me.
By the way, the entire brain is not sexually dimorphic. The sex-related differences in the brain are pretty well limited to bits linked to the control of the body and sex-related parts of the endocrine system, and some of the wiring (the connectome) for these bits. Other variations seen in the brain across assigned sexes tend to broadly overlapping and not particularly unique sex identifiers, unlike the dimorphic regions.
I would welcome a comprehensive restructuring of the vocabulary we use to describe the various types of sex/gender phenomena. Unfortunately, that possibility seems to be nowhere in site.
The term 'gender incongruity' itself is confusing as there is a psychological condition called 'alternating gender incongruity' which is a neuropsychiatric syndrome which relates to bigenderism.
I think it's useful to separate gender identity from sexual identity. They are different concepts. Gender identity concerns the social-psychological characterization of where one exists on the
gender spectrum. Sexual identity concerns the sexual dimorphological characterization of where one exists on the
sexual spectrum. The third spectrum is sexual orientation.
These three spectra are independent vectors that describe all people. To conflate gender with sex serves no constructive purpose. I believe it muddles the understanding of these phenomena.
I contend that the sexual dimorphism of the brain is as much a sexual development matter as the differences in sexual development of the gonads and genitals, and clearly affects where people fall on the sex spectrum. To disassociate the sexual dimorphic neuroanatomical development of the brain from the rest of the reproductive system, of which it is a part, seems arbitrary and archaic, and not consistent with the research.
Quote from: Clara Kay on December 26, 2017, 12:47:36 PM
Thanks, Spunky. I had no intention of offending intersex people, I consider myself intersex. I'm fully aware that there is no advantage to referring to myself as being intersex. Frankly, I think it's highly stigmatizing. I would also like to remind you that I have experienced a lifetime of mental anguish and undergone multiple surgeries to correct my intersex condition, namely to eliminate the ambiguity of my inborn sexual identity.
Sex and gender terminology is being diluted, there's no question about that. The term 'transgender' is so broadly defined today as to be practically meaningless. There's a concerted effort by the larger trans community to purge the word 'transsexual' from everyday usage, as inappropriate, or, worse, offensive.
Neither 'transgender' nor 'transsexual' speak to the physical reality of being born with a sexual identity which is ambiguous or conflicted in some way. The term 'intersex' does. Intersex describes a state of physical and physiological embodiment independent of social context.
The words transgender and transsexual describe outcomes, not causes. They don't explain the reason for gender dysphoria, they describe a behavioral reaction to it. A person is transgender because they object to the gender forced upon them the day they were born. A person is transsexual when they alter their anatomy to that of the opposite sex. Neither word speaks to the underlying reason for this behavior.
Knowing that I'm intersex explains why I suffered gender dysphoria. It explains why I had to be prescribed cross-sex hormones. It explains why I transitioned genders, and why I underwent multiple surgeries to change the outward appearance of my body. These are not things that most transgender people have to deal with. These are things that intersex people live with.
I frankly don't care that the current medical definition of intersex doesn't consider the sexual dimorphism of the brain as another aspect of the intersex condition. I'm sure it will in time. Medical knowledge is constantly being updated and corrected to account for what was previously misunderstood.
Again, I'm sorry if my post has hurt or offended you. To be honest, I feel hurt, too.
Happy New Year!
Being diagnosed as being Intersex is NOT the same as considering yourself Intersex. Intersex effects your genitalia, even to the point of having them violated at birth. Only a doctor, can diagnose a person Intersex!!!!
What I'm hearing in response to my topic is a strong objection from those who identify as intersex to accepting transsexualism as a type of DSD (disorder of sex development) despite ample evidence that it is exactly that.
The fact that DSM-5 includes a section for DSD (the new term for intersex) is itself objectionable to many intersex people. The implication that intersex is in anyway a mental disorder is understandably concerning, even though many intersex people suffer gender dysphoria by having been assigned the wrong sex at birth, and often require psychological therapy.
The only difference between someone diagnosed with gender dysphoria who is clinically intersex and someone whose diagnosis of gender dysphoria has not been traced to a clinical DSD, is the medical profession's inability to positively diagnose brain-body sexual incongruity. Until the technology is available to make such a diagnosis, transsexual people will continue to be seen as having a psychiatric condition by the general public, not demonstrably traceable to a biological root cause. If you don't see the difference, you haven't examined right wing Christian positions on transsexual vs intersex people. This perception is highly stigmatizing, and I'm inclined to believe this is the reason for the objections I'm reading here.
Most transsexual people's gender dysphoria is more than a conflict of social gender identity. It is a 'disorder' of sexual development readily diagnosed by prescribing cross-sex hormones. Transsexual people will attest to the rapid ameliorative effect of cross-sex hormones on the brain which was not sexualized in agreement with their bodily sex. I, personally, have experienced this effect. Transsexualism is a medical condition much like clinical intersexuality, which demarcates transsexual people from other transgender people.
Transsexualism is a disorder of sexual development with symptoms of gender dysphoria. There is no question about it.
Is this relevant? lol Because i like what is explained in this article re: "Where Transgender is no longer a diagnosis".
https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/ (https://www.scientificamerican.com/article/where-transgender-is-no-longer-a-diagnosis/)
This is probs way off the mark but I don't understand all the need for medical and scientific scrutiny. Is it because of validation? we all know that we existed yeah before all of these labels were put on us? Im speaking as an Aboriginal person who has had elders pass down cultural knowledge through generations and we know that gender and sexually diverse ppl existed before religion and before all of this scientific scrutiny. I've probs just gone completely off topic but meh lol sorry, im still learning and tbh have never considered transsexualism as an intersex condition but im about to go check out the recent article on it by (Diamond, 2017). Thanks for giving me something new to research :D
Kind regards,
B
Bubbles - I tend to agree with you. Not only do humans have trans gender, it happens across many species of animals and let's not even talk about plants. I believe this all stems from the physical fundamentally and evolution in particular.
The change in Denmark is a great step forward, removing the stigma from being transgender. We had a baby step in that direction with DSM-5, changing "gender identity disorder", a pathology, to "gender dysphoria", a classification used to diagnose distress from gender mismatch.
The big problem with removing being transgender from the realm of diagnosis is how treatment is paid for. The Danish health system can simply have a psychological workup done that refers a patient for medical care. In the USA, with our motley collection of insurance companies, claims processors, Medicare, Medicaid, and state agencies, individual health care providers, and HMOs, things are a bit different.
Insuring agencies want to see a 'diagnostic code' (http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z87-/Z87.890) before they'll pay. Diagnostic codes have to refer to medical or psychological conditions. We will have to see how the ICD-11 standards shake out, and how we can code for our condition. (Currently much treatment lands under F64.1, "Dual Role Transvestism" (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.1). YUCK! Not my name, that is precisely what in in the 2017/2018 ICD.)
This may take some time to shake out.
Quote from: Clara Kay on December 26, 2017, 07:52:52 PM
What I'm hearing in response to my topic is a strong objection from those who identify as intersex to accepting transsexualism as a type of DSD (disorder of sex development) despite ample evidence that it is exactly that.
The fact that DSM-5 includes a section for DSD (the new term for intersex) is itself objectionable to many intersex people. The implication that intersex is in anyway a mental disorder is understandably concerning, even though many intersex people suffer gender dysphoria by having been assigned the wrong sex at birth, and often require psychological therapy.
The only difference between someone diagnosed with gender dysphoria who is clinically intersex and someone whose diagnosis of gender dysphoria has not been traced to a clinical DSD, is the medical profession's inability to positively diagnose brain-body sexual incongruity. Until the technology is available to make such a diagnosis, transsexual people will continue to be seen as having a psychiatric condition by the general public, not demonstrably traceable to a biological root cause. If you don't see the difference, you haven't examined right wing Christian positions on transsexual vs intersex people. This perception is highly stigmatizing, and I'm inclined to believe this is the reason for the objections I'm reading here.
Most transsexual people's gender dysphoria is more than a conflict of social gender identity. It is a 'disorder' of sexual development readily diagnosed by prescribing cross-sex hormones. Transsexual people will attest to the rapid ameliorative effect of cross-sex hormones on the brain which was not sexualized in agreement with their bodily sex. I, personally, have experienced this effect. Transsexualism is a medical condition much like clinical intersexuality, which demarcates transsexual people from other transgender people.
Transsexualism is a disorder of sexual development with symptoms of gender dysphoria. There is no question about it.
Intersex isn't some identity, it's how we are born. Almost all of us can NEVER have children. If you included ->-bleeped-<- as a DSD, it would be so mild, as most of you have working genitals . If you created life, than most likely, you are not Intersex.
This just taught me a tiny bit about the US healthcare system. I mean i can only talk with limited knowledge of it bcz i live in Australia but what i got from your description of the US system was just a whole bunch of vultures, just profit profit profit. It angers me and im not even from the US. I remember when i first was getting my hormones from my wonderful GP, she was going through all the q's and she stopped when it came to mentioning GID, and actually apologised and said it is in no way a disorder and that there is nothing wrong with me. Best GP ever and i hope she never retires lol I will admit now that alot of this DSM talk goes over my head lol :laugh: Do you agree with Bernie's proposed changes to healthcare? You know what, our right wing gvt atm is totally trying to americanize our healthcare system, they say they aren't because that issue is a complete and utter election loser here in oz. They are doing it though, slowly slowly, bit by bit, and surely enough they are on track to lose the next federal election. ;D
Quote from: Michelle_P on December 27, 2017, 09:47:41 AM
The change in Denmark is a great step forward, removing the stigma from being transgender. We had a baby step in that direction with DSM-5, changing "gender identity disorder", a pathology, to "gender dysphoria", a classification used to diagnose distress from gender mismatch.
The big problem with removing being transgender from the realm of diagnosis is how treatment is paid for. The Danish health system can simply have a psychological workup done that refers a patient for medical care. In the USA, with our motley collection of insurance companies, claims processors, Medicare, Medicaid, and state agencies, individual health care providers, and HMOs, things are a bit different.
Insuring agencies want to see a 'diagnostic code' (http://www.icd10data.com/ICD10CM/Codes/Z00-Z99/Z77-Z99/Z87-/Z87.890) before they'll pay. Diagnostic codes have to refer to medical or psychological conditions. We will have to see how the ICD-11 standards shake out, and how we can code for our condition. (Currently much treatment lands under F64.1, "Dual Role Transvestism" (http://www.icd10data.com/ICD10CM/Codes/F01-F99/F60-F69/F64-/F64.1). YUCK! Not my name, that is precisely what in in the 2017/2018 ICD.)
This may take some time to shake out.
Quote from: AlexISAlex on December 27, 2017, 10:37:05 AM
Intersex isn't some identity, it's how we are born. Almost all of us can NEVER have children. If you included ->-bleeped-<- as a DSD, it would be so mild, as most of you have working genitals . If you created life, than most likely, you are not Intersex.
Thank you for your perspective, Alex.
Yes, intersex is how we are born. That's what distinguishes transsexualism from the broader definition of ->-bleeped-<-. Transsexualism is a consequence of biological processes that go astray in utero. The only reason we are in a debate on this issue is that the medical profession has not yet officially recognized the abnormal sexual development of the brain as a DSD. Change happens slowly.
Transsexualism is not a mild DSD. It is every bit as psychologically, physically, and socially traumatic as other types intersexuality.
Infertility is not the dividing line between intersex and non-intersex people. It's true that infertility is often the mark of an intersex condition, but not all intersex people are infertile, e.g., CAH (Congenital Adrenal Hyperplasia).
The paper by Dr. Milton Diamond (Professor Emeritus of anatomy and reproductive biology at the University of Hawaii, now retired) that I referenced in my opening post summarizes the research supporting the theory that transsexualism is the result of biological processes which produce an intersex brain suggesting that transsexualism constitutes a special type of intersex condition.
Along with Dr. Milton Diamond's view that transsexualism is a type of intersex condition, I found this quote from Dr. Eric Vilain M.D. PhD Adjunct Professor of Human Genetics, Pediatrics and Urology at UCLA, and the Institute for Society and Genetics. He is also Chief of Medical Genetics, and an attending physician in the Department of Pediatrics:
"Intersex is an intermediate sexual phenotype. This means that this is a state of being in-between what's commonly accepted as male or female at all levels; that is: an anatomical level, gonadal level, and brain level, and behavioral level."I added the bold highlighting.
Clara, I have to reiterate because I really feel you're not getting the point.
But first let me say I absolutely support your desire and choice to self identity, to choose your own preferred language etc, I think we all need that. But recognize that when you choose to use redefine language that differs from what other trans people or the medical community use and agree on you're going to get push back.
And then again, anytime someone uses the "I hurt more than you do" argument, I'm sorry, you lose me.
Ok, my framework laid out, let me try to express myself clearly.
Again, a big part of your argument here is simply already almost completely agreed within medicine. Transsexualism is recognized universally as having somatic (prenatal hormonal balance) origin and as I said before, that science goes back 40+ years. I would add -- and this cuts to bubbles' points-- this isn't new and has almost certainly evolved into natural variation in pregnancy/embryology. Transexuality probably has conferred some very real evolutionary$ benefits and so it's a common variation. (I'm not going to go into somatic / RNA genetics but that probably plays a part also).
It's more within the trans community that transgender and transexual as terms are conflated. A lot of younger people who I would absolutely identity as transexual eschew that term, preferring transgender. I see that and respect it, to me transexual is a proper subset of transgender.
I also find I have to support the idea that both some people validly transition irrespective of anything that happened in utero and also that as objective tests aren't available, many of us go into transition with a degree of uncertainty as to our specific etiology or perhaps simply don't care about those distinctions.
However in all of these cases, I find getting hung up on semantics to be a waste of time and energy. Language exists to describe reality, not fully define it and so it's necessarily imprecise.
Since few of the presenting modalities of dsd/intersexuality are treatable with hrt and because none of them (that I know of at least) have anything to do with the brain, they're correctly imo distinct from transexuality. That's not inconsistent with thinking that both are somatic. The fact is that for now at least transexuality is principally diagnosed by people practicing psychology and you can't very well tell me that's wrong because in the current context it's what works.
To be clear, I wasn't personally offended, I'm transexual and honestly I don't care so much what the terminology is
What I care about is that treatment today is available, vastly improved over what it was a decade ago and no longer a beauty contest in that those of us who can't practically or for whatever reason choose not to pass are now eligible -- albeit with a bit more hoop jumping. (And yes, I've heard post op women right here on Susan's complaining about non passable women in the same recovery areas they were in so I'm under no illusions that trans people are necessarily accepting of other trans people).
Quote from: Clara Kay on December 27, 2017, 12:03:43 PM
Thank you for your perspective, Alex.
Yes, intersex is how we are born. That's what distinguishes transsexualism from the broader definition of ->-bleeped-<-. Transsexualism is a consequence of biological processes that go astray in utero. The only reason we are in a debate on this issue is that the medical profession has not yet officially recognized the abnormal sexual development of the brain as a DSD. Change happens slowly.
Transsexualism is not a mild DSD. It is every bit as psychologically, physically, and socially traumatic as other types intersexuality.
Infertility is not the dividing line between intersex and non-intersex people. It's true that infertility is often the mark of an intersex condition, but not all intersex people are infertile, e.g., CAH (Congenital Adrenal Hyperplasia).
The paper by Dr. Milton Diamond (Professor Emeritus of anatomy and reproductive biology at the University of Hawaii, now retired) that I referenced in my opening post summarizes the research supporting the theory that transsexualism is the result of biological processes which produce an intersex brain suggesting that transsexualism constitutes a special type of intersex condition.
Along with Dr. Milton Diamond's view that transsexualism is a type of intersex condition, I found this quote from Dr. Eric Vilain M.D. PhD Adjunct Professor of Human Genetics, Pediatrics and Urology at UCLA, and the Institute for Society and Genetics. He is also Chief of Medical Genetics, and an attending physician in the Department of Pediatrics:
"Intersex is an intermediate sexual phenotype. This means that this is a state of being in-between what's commonly accepted as male or female at all levels; that is: an anatomical level, gonadal level, and brain level, and behavioral level."
I added the bold highlighting.
Transsexualism, or ->-bleeped-<-, is NOT even close to being born with both male and female genitals. Try having genital dysphoria, because you can't sex with males or females, or having someone else choosing your sex for you, and never telling your parents, and finding out years later. Being Intersex, is a failure to sexually develop correctly. Image being labeled a girl, but looking like a transgender female, or the other way around.
I would ask everyone to please, please be considerate of the feelings and identities of others.
There are a few meta-issues in this conversation I would like to point out:
1) Medical terminology may not have the exact same meaning as similar or identical words used in personal identity. In both cases, meaning may shift over time.
2) Please be respectful of personal identity. If an individual disagrees with the current medical interpretation of a word, please be so kind as to avoid applying that term in a way that inappropriately negates an individual's identity, or applies that identity to an individual that does not recognize themselves as having that identity.
For example, I am medically considered a transsexual. I generally identify as transgender, but will accept transsexual. Other transgender post-op persons object strongly to transsexual, seeing this as an obsolete term that reduces their transition to genitalia.
Folks in the Intersex community often have a similar strong attachment to the "intersex" term, with scope as an identity typically limited to external and internal reproductive organs. Using a potentially expanded medical definition not yet in wide use as the identity definition may conflict with recognized intersex identities and the recognized definition of an intersex identity.
3) "A difference which makes no difference is no difference" Redefining transsexual identities as intersex identities does not alter the unique medical treatment of persons with transgender identities persuing medical transition. It does cause a problem for persons identifying as intersex, as they see their unique medical issues and treatment subsumed within the the larger body of medical transition care.
These are different communities, with some overlap. Conflating them based on a possible expanded definition of a medical term does not alter treatment, standards of care, or drive any other significant positive move for both communities.
I do understand why a person with a transgender or transsexual identity might seek to instead persue being accepted as having an intersex identity, as intersex persons are not subject to the same ideological pressures as trans folks. Unfortunately, by conflating the two communities, one is more likely to bring those same ideological pressures to bear on the intersex community, rather than provide an escape for the transsexual community.
Michelle Your comments brought back some of the problems I had making changes at Boeing. Depending what plant I was in, certain acronyms could have up to 10 different meanings. Also there are over 106 colors of "white". Just pointing this out, as I have had some troubles keeping transition sentiment to myself and have made people unhappy with my observations. I guess what I am saying, one persons, Pearl White is someone else's ivory.
Hi, Dawn!
I think that when we are poking at things that get right to the core of our being, that taking some care is warranted. I've found that phrasing is everything.
For example, on anything sensitive, I try to voice my opinion with "I" statements, owning my opinion, rather than "you" or "they" assigning my opinion upon others.
I do find conversations poking at my own identity to be uncomfortable, particularly when others seek to redefine me, and I imagine that I am not the only one that has had this experience.
Thank goodness we don't have that many acronyms! I've run into that in the workplace, where each team effectively had their own dialect that they spoke to each other in, and cross team meetings needed designated translators who would speak a common language without buzzwords or acronyms!
I'd hate to see that in our little community.
Sent from my iPhone using Tapatalk
I was diagnosed as intersexed, and never truly identified except maybe when I just started as anything other than that. Not that there is shame in being trans. That being said it doesn't come with the complications that being intersexed truly brings. . and there are a ton. Just look up swyer syndrome, androgen insensitivity, and CAH medical complications.
Quote from: Michelle_P on December 27, 2017, 03:34:08 PM
I do understand why a person with a transgender or transsexual identity might seek to instead persue being accepted as having an intersex identity, as intersex persons are not subject to the same ideological pressures as trans folks. Unfortunately, by conflating the two communities, one is more likely to bring those same ideological pressures to bear on the intersex community, rather than provide an escape for the transsexual community.
You might be right, Michelle, and I wouldn't want anyone, least of all intersex people, to be subjected to ideological opposition tied to their sexual identities. That is, unfortunately, the situation for transsexual people, and the reason is that few people are aware of the biological underpinnings of transsexualism. Intersex people have access to medical treatment and insurance coverage that transsexual people are typically denied. Transsexual people have to convince a clinical psychologist that they are free of co-occurring mental disorders to gain access to hormone therapy and related surgeries. The conflating of transsexualism with other forms of gender nonconformity which are not related to biological sexual identity does nothing to bring about better understanding and acceptance of the special needs of transsexual people, and particularly the needs of children who are denied treatment for gender dysphoria for ideological reasons and cissexism.
I think the reason the issue gets so confused amounts to a few simplified statements.
1: intersex is traditionally referring to genital sexual organs. Later added genetic conditions medically related to sexual organs development. So androgen receptor mutations, alpha5-reductase production mutations, TDF production mutations, ext.
2: understanding of brain physiology is increasing. Overall more is known about which segments of the brain are gender dymorphic and how hormones, endocrine disruptors, and the above gene mutations can affect the brain.
3: following the understanding of the brain segments, it is known that although the brain parts are mostly effected during the second trimester, they are not all hard wired at the same moment. This leads to the possibility of partial brain virilization as some are masculinized while others are not. It should follow logically that's one people have a mix of neural wiring and a mix of gender specific instinctual drives. Much like the third trimester timing of sexual attraction can be partially viralized creating a spectrum of sexual attraction instinct.
4: even modern technology still has not fully identified all sections and how they effect human thought. What must be kept in mind, is we are all individual in our neural wiring overall. Transgender people often have a mix of neural wired segments. Cis gender people also sometimes have some mixed gender structure types. As such some cis women have typical male like subconscious thinking patterns but lack the gender dysphoria. The same goes for some cis-men although men will tend to hide these as social pressure discourages such thinking. We are all individual biological creations. No two are ever the same. No one fits the "perfect" gender / sexual pattern.