Interesting paper by Dr. Milton Diamond.  Any thoughts?

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.