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/

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 

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' 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". 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  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. 

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' 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". 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.


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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.