Dana Writes About Gender Variance

The MCPS citizens advisory committee is considering the 10th grade sexual-orientation curriculum. It's tough, arduous work, but we're plowing through it.

Last week I posted essays, I guess you'd call them, by two committee members, discussing homosexuality from two extremely differing perspectives. First, Matthew, who is gay, wrote in anticipation of some of the issues that would be coming up in the committee's discussion -- whether sexual orientation is a choice, whether being gay is "dangerous for your health," things like that. Then Peter wrote a piece expressing his conservative point of view, responding to Matthew. I posted both of those here, mostly without comment; you can scroll down to find them.

The committee also received an essay this week written by Dr. Dana Beyer about gender variance. It is important for the group to have this information as we decide what should be said in tenth grade about matters related to gender identity, and, face it, most people (like me, for instance) really don't know anything about the topic.

Dana has given us permission to publish her article here. We can use this as a kind of reference as we discuss these topics in the comments section, as well as in the citizens committee.

As an adjunct to Matt's very informative letter to the CAC, and with his support, I have written a similar essay dealing with gender variance. I have noticed at the meetings that on occasion the concepts of sex and gender are a bit confusing to some, though overall the concepts are being considered very wisely. I also personally believe that it is important that 14 year olds have at least a minimal familiarity with the concept of gender variance/transgender and gender identity. And since no one on the committee has experience with these issues I am sharing this in an effort to be of some assistance.

The definitions for your consideration are very important to prevent ongoing confusion. Generally speaking, "sex" refers to biology, while "gender" refers to psychology. When scientists and physicians speak of "sex" with respect to human sexuality, they are referring to its many aspects, both genotypic (related to genes) and phenotypic (related to physicality). So a person's sex includes:
o Chromosomes (XX, XY, XO, XXY . . .)
o Genes (SRY and over 50 regulatory genes)
o Gonads and other reproductive organs
o Genitalia
o Body habitus - size, shape, secondary sex characteristics
o Hormone levels - ratio of testosterone to estrogen
o Hormone receptor functioning
o Brain sex

Commonly all the above aspects of our sexuality line up in a seamless web and yield a male or female. When the system is working well an individual never remembers becoming aware of her sex. When any of the above manifestations are not in line with the others or are ambiguous, we have a condition called intersex, or a variation of sexual development. Hundreds of variations are known, and those of you who take in the occasional episode of House, Grey's Anatomy, or ER, are familiar with some of the more common examples. A specific example would be transsexualism, a subgroup of the umbrella transgender. In those cases brain sex is different from all the other aspects.

There are many causes for variations in sexual development, with different causes underlying different syndromes. In my personal case I am both intersex and transsexual, due to exposure in utero to the toxic drug DES, or diethylstilbestrol. This drug was given to 5 million American women between 1948-1971 in a futile attempt to prevent miscarriages, and has led to the development of cancer, infertility, urinary tract abnormalities, and gender variance. The mechanism of action is via interference with the regulatory signaling system (the WnT system) which is crucial for sexual development.

A person's "gender" is the inner sense of her sex and its social and behavioral manifestation. Brain sex underlies gender identity, one's sense of being male or female. This is a brain function; it has nothing to do with one's genitals. Individuals without genitals have gender identities, just as those with penises may identify as women and those with vaginas as men.

Gender expression is the manner in which one dresses, behaves, lives in society and expresses the entire continuum of sexuality. A person who identifies as a female and has all female sex characteristics may nevertheless be more comfortable presenting in a masculine manner, and vice versa. No one is perfectly masculine or feminine; all cultures define these terms differently, and within a culture there is a very wide spectrum. Few people are ever completely comfortable with their gender expression and attribution, and often question just how they are fitting in. This sense of discomfort is most acute with adolescents.

"Transgender" is a widely accepted umbrella term encompassing a range of gender variance. It simply refers to all those who do not fit into a given society's definition of a match between sex and gender, and choose to identify as such. Tomboys are transgender in their behavior in a very general sense, though those girls do not identify as transgender because society allows them that leeway. Feminine boys, however, are not given nearly the same space and are often teased and bullied about their behavior.

I want to add that in spite of the best efforts of the psychiatric profession for over half a century, there is absolutely no evidence that intersex or transsex conditions are related to any kind of social, familial or experiential cause, including sexual abuse, absent fathers, overweening mothers, etc.

Also, I want to repeat that "gender identity and expression" is completely separate from sexual orientation. The former is "who you are." The latter is "whom you love." A trans man, for instance, can be gay, straight, bi or asexual, just like any non-trans person.

I hope this short essay has been of value, and I'm available to answer any questions you might have.

Dana Beyer, M.D.