Response to

March 15, 2017
Responding to this article in which my father wanted my professional opinion and gut reaction.
I think to give my professional opinion adequately, I need to define some important terms for the discussion.
First, there is gender identity. This is how one identifies oneself based on the definitions of gender in their society. In modern America, for instance, when going to church women wear dresses and men wear pants, but in other countries, say Saudi Arabia, men and women both wear robes, but the distinction is in the headwear. In some indigenous cultures, it is defined by body markings, paint, piercing, or various behaviors. Gender identity is usually fully formed by the time someone becomes a teenager, but it starts to be defined and formed between ages 7 and 11, what is sometimes called the Concrete Operational Stage of childhood. At this age, kids’ brains need pretty clear, simple definitions of the things they experience. Milk goes on cereal, sugar goes on fruit, salt goes on vegetables, girls wear dresses, and boys wear blue. As they go into the teenage years, they start to add complexity to the definitions. Girls wear dresses, unless it’s a kilt, then boys can wear a kilt. Boys can sometimes wear pink and purple. Girls can have short hair, boys can have long hair, etc. So as the child compares him or herself to the definitions they have learned, they start to think, “Okay, well, I have a penis, I like sports, I don’t wear skirts, I don’t have a vagina or long hair, so I must be a boy.” 99% of the time, it doesn’t go much beyond that because the kid isn’t exposed to much more variation in gender, so the identity is solidified and they go on to live their lives without giving it much more thought. Even if the culture changes around them and boys and girls start acting differently, it would be rare for someone to experience a major identity change after reaching adulthood.
Gender expression is separate from gender identity because you don’t necessarily show the world what you identify as. Think of that time when I dressed up in Tara’s clothes when I was 6 years old: My gender expression at the time was that of a woman because I was following the cultural standards of womanhood–shoulder pads and all. But inside, I thought, “I’m a boy wearing girls’ clothes!”
Biological sex is the simplest idea to define except when it isn’t. Two X chromosomes makes a woman and an XY pair makes a man. But then we’re left without an easily identifiable sex for XXY, XYY, and X individuals (Klinefelter syndrome, XYY syndrome, and Turner’s syndrome, respectively). What gender do we assign to the people who don’t fit the mold on a genetic level? Then we find out that the reason the X and Y genes make sex differences in our cells is due to testosterone and estrogen production and sensitivity, where XY is sensitive to estrogen but produces a lot of testosterone, and XX is sensitive to testosterone but produces a lot of estrogen. What happens when mutations occur where a person with XX genes becomes desensitized to testosterone and begins producing a lot of it? Or for an XY person to overproduce estrogen? Biological sex may be easy to identify for most people, but that still leaves (0.1% of “male births” have Klinefelter syndrome, 0.1% of “male births” have XYY syndrome, and 0.03% of “females” have Turner syndrome. Total, 0.23% of the ~4 million kids born in 2015 means) over 9000 American kids every year have no easily identifiable biological sex–and that’s just from three genetic abnormalities.
Sexual preference seems to be suffering from an identity crisis of its own right now. Does sexual preference refer to biological characteristics or gender identities? For instance, do two people who identify as women (one dresses as a man and one dresses as a woman) consider themselves homosexual if they are attracted to one another? Would it matter if the one who dresses as a man has a vagina and the one who dresses as a woman has a penis? Or do they consider themselves heterosexual because they have different genitals? In a lot of ways, I think sexual preference is the least important thing to define because it can get super complicated and the end result always comes down to, “Well, I think my partner is attractive.”
So with these definitions, let’s look at what it means to be transgendered. In a nutshell, it’s when your gender identity conflicts with your biological sex. It is independent of your sexual preference, so you may have a penis, identify as a woman, and have attraction to other women (and you might also consider yourself homosexual).
My problems with this article usually come down to semantics. “Sex-change surgery” is no longer the term for “gender reassignment surgery” because the sex isn’t being changed. The person has the same genetic code before and after the surgery, so only the physical expression of gender (e.g. a penis being turned into a vagina) has changed.
The random, nonsense paragraph about conversion therapy really has nothing to do with the article. I don’t know why it’s even in there. Conversion therapy rarely “works,” and when it does, it comes with a range of side effects like anxiety, depression, obsessive-compulsive tendencies, and suicide. The trade-off might be worth it to some people, but I think that should be the patient’s choice after they’ve turned 18 and lived away from home for a while.
When it comes to “gender dysphoria” the author of the article straight up lies. I’m holding the book with the official psychiatric definition, and it reads, “Gender dysphoria refers to the distress that may accompany the incongruence between one’s experienced or expressed gender and one’s assigned gender” (Diagnostic and Statistical Manual of Mental Disorders Fifth Ed., 2013, p. 451). “Transgender” is the feeling of being the opposite sex, but even that is not specific enough for the psychiatric community, which defines transgender as, “the broad spectrum of individuals who transiently or persistently identify with a gender different from their natal gender” (p. 451).
Finally, he talked about the suicide rate of those who had undergone “sex-reassignment” surgery skyrocketing in Sweden. I couldn’t find the study he was referring to, but from what I’ve learned in my studies a lot can depend on the destination gender assignment. Men who reassign to female tend to have lower life satisfaction, and one hypothesis is that they have gone through life as male with all of the advantages of being male, and then they are suddenly thrown into a woman’s world and are given fewer advantages because of general sexism. On the other hand, women who transition to men end up very happy and satisfied in part because testosterone makes you feel great, and they get to reap the benefits of being male in a male dominated society.
So that’s what I have to say in direct response to the article. In more general terms, and as someone with an interest in the subject, I think teens and young adults will always find something to be confused and dissatisfied about, so if it’s not their gender or sexual preference, it’s their career or education or personal drama. Anything can become the center of someone’s dysphoric mood. Most people get over the thing that causes them grief by the time they hit 30–some of them do it on their own, some with the help of friends, and others with the help of doctors and therapists.
I think it’s good that we’re talking about it and I think it’s good that we don’t generally murder people en masse for defying cultural gender norms. I think everyone deserves to use the restroom. I also think that an individual’s life experience is more interesting than the collective experience of a group, so I try not to think of all transgendered people as being one way or the other just as I wouldn’t think of all South Africans or all Koreans as the same.
I also think that people are reaching limits of understanding. Not everyone has the capacity to know and understand 30,000 words (Shakespeare’s written vocabulary) and it can get downright exhausting to keep up with changing social standards. When you get enough small groups of people demanding respect and the use of a whole new vocabulary, it can be frustrating, and when you add in financial stress, school, new research, the economy, the government, international relations, ethical conundrums, and religion–research also shows that these kinds of pressures can reduce language ability among other cognitive skills. The world is in an unprecedented state, both in terms of actual population, but also in terms of diversity. The solution to that building complication and stress, in my opinion (which is based as much as I can make it on research and science) is to start with positive regard for our fellow humans, to be a little more laid back about things, and to keep an open mind about new ideas.
Edit: A friend pointed out that I had the age range of the Concrete Operational Stage incorrectly identified as 3 to 7 which is actually the Preoperational Stage. The article has been edited to reflect what I intended.