Sunday, April 27, 2008

A message of healing and hope: a holistic, person-centered approach to intersex health

Curtis E. Hinkle, Founder of Organisation Intersex International

Medical treatment of intersex people has a long history of pathologizing, stigmatizing and mutilating anyone who does not have a body which is totally “female” or totally “male” according to the definitions currently in effect for those two categories. Medical approaches to intersex variations are based on a false dichotomy, the assumption that everyone “should” be either male or female even though nature has not created such a world. The treatments are based on other false assumptions:
  • That heterosexual intercourse and reproduction are the most important contributions of an individual, despite the fact that intelligence, compassion and ability to care for others are equally, if not more, important for the evolution of humankind
  • That the sex of an intersex child is a disorder itself which MUST be treated without any input from the child at all.
  • That concealment, shame and manipulations of body parts of an intersex person will benefit the child when in fact this approach leads to trauma, a shattered sense of self and further marginalization and stigma.
The medical approach focuses on parts of a person and defines the intersex child as a disparate combination of chromosomes, genitalia, hormones, gonads and internal reproductive anatomy. This is dehumanizing. The child is not welcomed into the world as a complete, totally intact, part of the whole tapestry of nature which is constantly evolving and moving towards diversity which promotes the continued development of human potential. Welcoming diversity and respecting the wholeness of both the individual and the natural world in which we live, breathe and have our being opens human consciousness to hope, respect and finding solutions to many problems which currently face humanity, not just intersex people, but all of us.

Instead of a dehumanizing approach which focuses on body parts, we could choose to focus on the wholeness of intersex children and see this as part of their potential for development (not a disorder of sex development) and future contributions to society. This would be a radical shift from the current medicalization of sex variations but the benefits to both the intersex child and humanity itself would be enormous. This would not only promote the health of intersex children. It would promote the healing of humankind in general.

The current medical protocols based on a false dichotomy and dehumanization of intersex children are part of a wider social problem – sexism. OII has been concerned about this issue from its beginning and several years ago OII published our declaration of fundamental principles:
  • Intersex is not a medical condition: intersex refers to those individuals born of “intermediate” sex between what is considered standard for male or female in our societies.
  • Contrary to what is often asserted, the various degrees of intersex are not innately an illness or deformity. They are simply variations of the human body similar to the length of the nose, the colour of eyes, etc.
  • We reject medical categories for the various degrees of intersex, which are in fact only different reference points on a natural continuum of anatomical and genetic variations.
  • We stress the whole person from infancy through adulthood and choose not to focus on an individual's genitalia. We are people, not genitals. As people, we have a right to our own genitalia and our own identity without interference, forced treatment or other coercion from legal and/or medical authorities.
  • The basic problems faced by the intersexed are socio-cultural in nature and not medical and are a result of the dogmatic fundamentalism inherent in the current binary construct of sex and gender. Some intersexed individuals are subjected to genital mutilation in childhood as a result of this totalitarian, sexist oppression. For this reason, we denounce all forms of sexism prevalent in our societies, which is principally directed against women, the intersexed, and other communities which challenge sex and gender norms.
  • To promote visibility and the recognition of our existence as a normal and natural part of humanity will benefit not only the intersexed but all people oppressed by the sexism which prevails in our societies.
OII chooses to focus on healing, not managing body parts and defining children as disordered or sick when they are in fact not sick. The word “healing” is derived from the Old English word “whole”. Society can choose to welcome the wholeness of each intersex child and open up a place for them by making it possible for each one to affirm their own true sex and sense of self. This is a person-centered approach to healing and wholeness, one that would be of benefit to society as a whole.

The two central concepts of OII’s person-centered approach to healing are
  • wholeness
  • affirmation
We can choose to welcome children as a gift which has been entrusted to our care, as an integral part of the potential for human development as a whole, not incomplete, undeveloped beings that we control and manipulate into images and abstractions that we feel they “should” be. We can choose to accept the wholeness and oneness of life as a constantly evolving and developmental process which is to be honored and work towards harmony and mutual cooperation, not domination and manipulation. Welcoming intersex children offers hope and healing to human understanding and development towards a model based on human rights and respect for the natural world we all share as one.

The choice is ours.

Friday, April 25, 2008

OII Investigation: Introduction and Part 1

Deconstructing the Feminine Essence Narrative
Ongoing investigation by OII
by Curtis E. Hinkle
Posted April 20, 2008


In the coming weeks, OII will be working with an informant who has primary sources and e-mails from the individuals involved in an attempt to deconstruct the “feminine essence narrative”, especially those associated with the Clark/Northwestern Clique. Why is OII interested in collaborating with this informant about an issue that at first may seem tangential to intersex? OII is convinced that this issue which at first seems unrelated to intersex really has serious consequences for intersex adults and children. Current protocols for the management of intersex children require a GENDER assignment as soon as possible and the same protocols prevent the child from having any input into the ARBITRARY decision. A gender assignment is not the SEX assignment. In other words, intersex children are assigned a GENDER, which is expected to reflect their gender identity, and many are assigned a "FEMALE GENDER", which is nothing more than an expectation that their lives will reflect a "feminine essence narrative".

However, the very people who are ardent defenders of the imposition of a female gender on many intersex infants, (with the expectation that their lives will be in accord with a feminine essence narrative), are insisting that no such concept really exists, despite evidence to the contrary. The problem is, that some intersex children, may very well have a firm female gender identity (or feminine essence narrative), but others will not, despite the fact that the expectation is IMPOSED on them without consent. If the child later insists, that the imposed female gender assignment is incorrect, as it does not match their true gender identity (or feminine essence narrative), the child risks being told that there is no such thing, (and that "it is not about gender"), despite the fact that justification for the gender assignment was the belief that "gender identity" does exist.

This is strengthened by the numerous investigations of gender outcomes in various intersexed conditions (e.g., virtually the entire August 2005 issue of Archives of Sexual Behavior is devoted to gender outcomes in intersex persons with various types of intersex variations), as well as the NICHD task force on psychosexual development, and the addition of an intersex (now DSD) committee, as part of the HBIGDA/WPATH.

Part 1

In Alice Dreger’s article in defense of J. Michael Bailey, “The Controversy Surrounding The Man Who Would Be Queen”, (1) she devoted many pages to dismissing the so-called “feminine essence narrative”. After this article was published on the internet, she acted as associate editor of the Johns Hopkins publication, Perspectives in Biology and Medicine in which J Michael Bailey and Kiira Triea published another article against the feminine essence narrative. (2) Many in the intersexed community were somewhat surprised that an intersexed person, Kiira Triea, who is a “genetic female”, was speaking as if she were a homosexual transsexual. Whatever. We were confused enough trying to figure out what a homosexual transsexual was, only to find out it was a woman who is attracted to men, who was once a man. Confused? Oh, well. C’est la vie.

On a more serious note, when reading Bailey and Triea’s article in the journal with Dreger as associate editor, we noticed some serious flaws. However, there was an expert who knows much more about this than we do, Dr. Dick Swaab, who noticed some serious errors in Bailey and Triea’s article also, and tried to correct them by writing to the editor. Did Alice Dreger, the associate editor, once again protect Bailey (and this time also Triea), by using her (Dreger’s) influence in suppressing any accurate discussion of brain sex (something she has done for years now) to shield Bailey and Triea from criticism? The letter was never published.

OII has a letter that Dr. Swaab wrote to the editor of Perspectives in Biology and Medicine, in which he indicated that hypothalamus VOLUME only changed 6% in m to f's and not at all in f to m's, in a study by Hulshoff Pol et al., (3) and that such, discounts Bailey and Triea's use of the findings of this report, which they used for their assertion, that the most likely reason for the finding of a female BSTc in m to f transsexuals, was hormones which the transsexuals took.

Bailey and Triea also claimed that hormones influenced the BSTc neuron NUMBER in transsexuals. But, as Dr. Swaab’s letter pointed out, this is totally wrong, since it is basic morphometric knowledge that total neuron number in a structure of the brain is independent of either pre or post mortem changes in the structure's volume. Thus, Dr. Swaab felt that Bailey and Triea's discussion on the BSTc results in relation to hormones the transsexuals took, should receive out of hand dismissal. Dr. Swaab wondered if it was
Bailey and Triea who just didn’t want to know. Certainly that should leave us all wondering.

(1) Dreger, A. The Controversy Surrounding The Man Who Would Be Queen. 2007. Published on the internet at

(2) Bailey, J. M. & Triea, K. What many transgender activists don't want you to know: and why you should know it anyway. Perspectives in Biology and Medicine, 2007, Vol. 50, Issue 4, 521-535.

(3) Hulshoff Pol, H. E. et al. Changing your sex changes your brain: influences of testosterone and estrogen on adult human brain structure. European Journal of Endocrinology, 2006, Vol. 155, Issue suppl_1, 107-114.

OII Investigation: Part 2

Deconstructing the Feminine Essence Narrative
Ongoing investigation by OII
Part 2
by Curtis E. hinkle
Posted April 21, 2008

Anne Lawrence was already posting to Sexnet, an internet based sexuality forum, about her vast knowledge on autogynephilia as far back as mid-2000. In one of those e-mails which she forwarded to OII's informant, she wrote:

"I believe that androphilic MtF transsexuals are really a SUBSET of gay men - very FEMININE GAY MEN, who are sufficiently "SOMATICALLY COMPLIANT" that they simply do better in the world as women. They typically feel ENTITLED TO AVIDLY SEEK OUT MALE PARTNERS, and do not necessarily display a great deal of urgency about changing their bodies(especially obtaining SRS), except as NECESSARY TO ATTRACT MALE PARTNERS."

(Capitols are added here for emphasis only and for comparing these Lawrence statements with Bailey's statements in the "Queen" book, such as Bailey's statement that "homosexual transsexuals" are "especially well suited" for prostitution).

Now, consider how Lawrence on SEXNET, around mid-2000 or so, further attempted to deconstruct the "feminine essence narrative", by suggesting that all of the 6 patients in Swaab's BSTc studies were autogynephillic, and that the BSTc is a marker for autogynephilia.

"I interpret the Kruijver et al paper a bit differently than Bradley Cooke. My guess is that all six MtF TS subjects in the Kruijver et al paper, T1-T6, were *autogynephillic* transsexuals....
If the findings of Zhou et al and Kruijver et al are replicated...., then my tentative hypothesis is: small BSTc size/cell count is not a marker for feminine behavior in some global sense, or for feminine *gender* identity (WHATEVER THAT WIDELY-USED BUT POORLY DEFINED TERM MIGHT MEAN)."

(Again capitols are added for emphasis, to compare with Bailey's statement in the "Queen" book his comment: "gender identity… what the hell does that mean?" p 50.)

On SEXNET, Lawrence continued her assault on the feminine essence narrative/brain sex, to write:

"Rather, small BSTc size/cell count is a marker for either:
a. female *sex* identity -- one's sense that one's appropriate or ideal sexed body is female; OR
b. lack of a sense of "allophillic sexual entitlement" -- lack of genuine comfort with sexual behavior involving the aggressive seeking-out of partners with the body features to which one is sexually attracted (leading in some gynephillic males to displacement of "erotic target location" to one's feminized self...).... I believe that gynephilic (autogynephilic) MtF transsexuals are not-especially-feminine men who nonetheless can't quite see themselves as male, even though they often *act* like men in most ways. Perhaps they can't accept the bodies they were born with (more likely); or perhaps they can't quite accept the idea of aggressively pursuing females, and therefore tend to eroticize in themselves the femininity that most gynephilic men eroticize in female others (less likely)".

Over a year later after Anne Lawrence's post to Sexnet, OII's contact, wrote directly to Anne Lawrence and asked three short questions.

E-mail sent November 06, 2001

...I have 3 quick questions I hope you can answer.

1) Does autogynephilia occur in non-gender dysphorics?
2) Can autogynephilia cause sexual dysfunctions, e.g. inability to perform unless the fantasy is "right"?
3) How does it manifest differently after SRS?


Here was the response dated November 7, 2001 from Anne Lawrence:

I'm sorry I don't have time to reply to your questions at present. You'll just have to wait for my book.


To this day there has never been a book written by Anne Lawrence on this topic. However, the language used by Anne Lawrence as far back as around mid-2000 and her writing style, are especially similar to the style used in J. Michael Bailey's book, The Man Who Would be Queen. (1) Bailey had not really done much in the field of transsexualism before this book. He had focused on homosexuality, not transsexual issues. However, it was around this time, which Bailey had ties with Lawrence, since he was one of her PhD supervisors at The Institute for Advanced Study of Human Sexuality. We wonder, who was "educating" whom, in regards to autogynephilia. Was there a ghost-writer for this book, who did the parts dealing with autogynephilia? All of OII's informant's questions are dealt with in the book in question, although not answered scientifically.

Who really wrote this book? Anne Lawrence was intent on deconstructing the feminine essence narrative as far back as mid- 2000 and yet, the book which put those ideas forward in a popular setting, was the "Queen" book, attributed to J. Michael Bailey. Furthermore, Dreger stated in her 60p. + monograph 2007 internet publication (2) defending Bailey, that Randi Ettner's 1999 book Gender Loving Care, (3) was his impetus for writing the "Queen" book. We wonder, and encourage readers to as well, if it was Lawrence who orchestrated the parts on the "Queen" book on autogynephilia, and desconstructed the feminine essence narrative. Perhaps, she could not identify with what was written by Ettner. In any case, transgender people were cautioned against seeking her as a gender therapist in an issue of Transgender Tapestry.

And many intersexed folks started asking: “Do we need a ‘hackademic’ who compares SRS with an amputee fetish to be speaking for intersex?" With Zucker and others, she has indeed co-authored an APA bulletin on intersex. This should be an outrage and a call to action. In the next installment, we shall examine how the deconstruction of the feminine essence narrative, and surgical fetishism may seek to damage intersexed persons lives, while at the same time, seek to offer virtually unlimited immunity to intersex surgeons.

(1) Bailey, J. Michael. The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. 2003, Joesph Henry Press.

(2) Dreger, A. The Controversy Surrounding The Man Who Would Be Queen. 2007. Published on the internet at

(3) Ettner, R. Gender Loving Care: A Guide to Counseling Gender-Variant Clients. 1999, W W Norton & Co., Inc.

Response and comments on the first two parts of this investigation received from Sophia Siedlberg:
Posted April 22, 2008

After I wrote the first two parts of this investigation, I received the following commentary from Sophie Siedlberg and Prof. M. Italiano. After reading them, I decided that it would be better to post them before continuing with the subsequent installments. - Curtis E. Hinkle

Why do they hate the "Feminine Essence Narrative"

When in 1995 Zhou and Swaab published their studies on the Bed Nucleii of the Stria Terminalis (BSTc) which gave some clue as to the possibility of how hormones can affect brain sex, one of the most severe critics of this theory was Anne Lawrence. What I found curious was, that while no one would deny her right to disagree, she seemed to have thought that she and others (Kiira Treia, J Michael Bailey, the usual suspects) have a right to silence Swaab in particular, and over the years it has been the case that Swaab has faced some opposition to his work from, let's face it, especially from the Clarke Northwestern clique. The main criticism they had was based on a valid question. Basically they were interested to know whether the observed size of the BSTc in transsexual women (Being consistent with that of other women) was a result of the hormone therapy that transsexual women had been using.

The one problem with this criticism is that Swaab was describing Steroid Regulated Apoptosis which is often a developmental process that occurs before birth and probably continues soon after for a short period of time. I can say this with some confidence because it was paradoxically Eric Vilain who, when discussing the "Genetics of Brain sex", added a gene (p53) to his list of genes involved and hinted at the mechanism Swaab was describing. P53 is a gene that is involved in regulating apoptosis (Cell death) and is the "Suicide gene" most oncologists would tell you often stops working when someone has cancer. What the precise involvement of this gene is in Vilain's model remains to be seen but it is evident that Vilain did focus on apoptosis in his model. Cell death involves a pathway of events that can be regulated by the non presence of androgens (Not the introduction of 3 hydroxy steroids). Basically the process of cell death involving a peptide called NAIP (Neural Apoptosis Inhibitory Peptide) which seems to be active when androgens are present. So if NAIP is present along with a 3-oxy steroid, then the growth of the BSTc would continue, with the absence of certain 3-oxy steroids and the non activity of NAIP the BSTc shrinks. That process is more typical of pre natal cell differentiation.

The difficult part is working out why NAIP appears to be active when certain 3-oxy steroids are present. My interest in all this is that when you get steroid dependant tumors, you could look at how steroids are involved with these small apoptosis regulating peptides. In the case of NAIP it stops the caspase pathway at a given point. Could this mean that the precise form of certain steroids has an effect of the production or activity of these small peptides? That would be worthy of some research surely.

This is the essential difference between Swaab and the Clarke Northwestern Clique. Swaab has for years studied things that are generally understood to have wider implications. His interest in neuro degenerative disorders would illustrate this quite adequately. The Clarke Northwestern are interested in wobbly bits and sex. Even if their research did offer insights into brain sex and transsexualism, it would have little value outside that area; Swaab's work on the other hand does have a wider audience, among oncologists for example.

The real difference lies in the fact that up until the Clarke Northwestern had the likes of Hamer and Vilain come on board (Whose research often seems to confirm the findings of people like Swaab, albeit backhandedly), their only frames of reference were the less scientific rationalizations of psychology. Or the science of fiddling with the wobbly bits.

This is the point. Swaab got his hands dirty with the actual science. Yes, there are other criticisms such as the sample size Swaab used in his original study, but the Clarke Northwestern can hardly cry foul when at the same time another researcher looking into "Brain sex" (Imperatio Mc Ginley, in the Dominican Republic studies of 5 alpha also in 1995) not only had an equally small sample size but openly excluded people from her study that did not fit what she wanted to say. It seems odd how the Clarke Northwestern would have the implication of her "Masculine essence narrative" as being ultra valid and Swaab's similarly but better formulated "Feminine Essence Narrative" as wrong.

And yet Swaab's research methods were actually much more precise. Perhaps it is fair to say that science according to the Clarke Northwestern has to work in a given way (Promote the masculine perhaps?) in order for them to consider it valid. Which brings me back to Anne Lawrence. Given that her objections to Swaab's work are not quite as valid as she would have you believe, we have to look elsewhere to explain her objections and those of others in the Clarke Northwestern clique. The answer is perfectly simple, they are control freaks interested in wobbly bits. Hamer and Vilan are often to be found trying to spin other people's work to fit the Clarke Northwestern edict of "Only masculine counts" (Which means that surgeons with a habit of masculinizing intersex children get let of the hook of litigation and it also gives the Clarke Northwestern license to give transsexual folks a hard time etc).

Anne Lawrence herself has a fetishistic interest in genital surgery and she is trying to impose that on transsexual folks in general using this "Autogynephilia" model. You only have to stand back and think for a moment one thing that the Clarke Northwestern are noted for is complaining that any theory that competed with their "Homosexual Transsexual/Autogynephilia" model of transsexualism (And anything else they wish to apply it to, like intersex people when it is convenient for getting unethical surgeons off the hook after ripping a few children's uteruses out) is a politically correct plot to silence their sacred "Truth", a sacred "truth" which is literally a load of bollocks (I may as well say it: the HSTS/AGP theory is a load of pseudoscientific bollocks designed to serve andro-centric fetish quackery).

The problem for the Clarke Northwestern clique is simple. Swaab's work is simply more credible and more scientifically researched. Peter-meters and leading questions in surveys with pre-conceived assumptions do not come close scientifically to someone actually getting down to the nuts and bolts of the biology involved. The Clarke Northwestern may as well face the fact that what they preach is pseudoscientific claptrap and what Swaab has found is a scientific truth that does not correspond with said pseudo-science. No amount of whining about political correctness is going to change that. The truth is that it is the other way round. It has been noted that the Clarke Northwestern have actively sought to silence Swaab. From the time when Vilain made his demeaning remarks about "Hormone theories" to Anne Lawrence crying that transsexuals are "Men trapped in men's bodies and science had better agree with that or else". The whole Clarke Northwestern edifice has been responsible for stifling academic freedom, and what makes their behavior most reprehensible if the fact that Swaab's model of brain sex can offer insights into other areas of medicine such as cancer research. What does the Clarke Northwestern offer the world? Bailey in high heels doing a bit of tranny bashing. Enough said really.

Response and comments on the first two parts of this investigation received from Prof. M. Italiano:
Posted April 22, 2008


Dear Mr. Hinkle,

I am writing from the U.S., am a researcher, and will become officially registered (licensed) with the Medical Board of India, in June, as well as receive a Ph.D. in physiology. I have read, with interest, your ongoing discussion on the erosion of brain sex and its relevance, for gender essence narratives by certain individuals. I have tried to post on a forum, findings of relevance on another paper of Lawrence, on autogynephilia and romantic love. However, my post did not get on this forum. However, I have significantly expanded it, to include topics which you have been recently discussing on OII. I present it to you here. I applaud you, for bringing attention to the dangers and inaccuracies of brain sex criticism. My article shall provide further relevant discourse on the matter.

Kind Regards,
M. Italiano


The purpose of this critique, is to point out some inconsistencies, omissions, and errors, in the ongoing relegation of the theory, that transsexualism is a result of basal brain sex reversal, to that which denies this female essence, as was recently published in an article by Lawrence (1). It is ongoing relegation since an article related to this, by Ray Blanchard, is due to appear in the June 2008 issue of Archives of Sexual Behavior.

Although some individuals might attribute transsexual-like feelings, behaviors, or beliefs, to autogynephilia, romantic love, pathological narcissism and even to homosexuality, and although this may apply in persons seeking and obtaining transsexual treatment, it does NOT at all justify, the relegation of m to f transsexuality, in general, to that which would exclude those "m" to f transsexuals, who have a female gender identity, a basal brain sex reversal, and/or a gender identity specific reason for seeking sex reassignment.

The Lawrence article (1) is severely flawed. There are four studies on the brain in those classified as m to f transsexuals, which indicate a reversal of some basal brain structure or function. There are two * from Swaab's group on the central subdivision of the bed nucleus of the stria terminalis (BSTc) (2, 3), one from Berglund's group (with Savic) on the hypothalamus using PET (4), and one in German from Gizewski's group, on the hypothalamus, amygdala and insular cortex, using fMRT(5).

However, when we look at the research of Helen Fisher (with Art Aron) on romantic love/attraction (6), they found that people madly in love, when shown pictures of the person they had fallen madly in love with, "didn't show activity in either" (7) the hypothalamus or amygdala. Instead, the ventral tegmental area and caudate nucleus were activated (6). Furthermore, activity in the insular cortex was shown only after having been rejected (described as the "flip side" of romantic love) (6). We can thus be quite certain that what is described as neural correlates of transsexuality, is not what may be reduced to romantic love/attraction.

There is also a 3rd "mating system", which is found to be distinct from romantic love, and is known as attachment, also with separate brain areas from those involved in romantic love (6). Significantly, attachment (or pair-bonding) is facilitated largely through oxytocin (6), which gets us back to the hypothalamus again, and suggests that transsexuality is related to basal brain sex reversal.

The recent paper by Veale et al. (8), and the thesis by Veale (9), are both impressive, for their study of autogynephilia and romantic love in relation to transsexualism. In particular, their finding that none of the individuals with autogynephilia even reported asexuality (8), is highly significant, and provides empirical evidence, that just two classifications of transsexuality, as proposed by Blanchard (10) and Bailey (11), is not correct. Of course, this has been noted from clinical findings, such as those by Benjamin (12)#, who described his transsexual patients, who were almost universally androphillic, as often undersexed, and sometimes hyposexual. On this score, neither Blanchard's view (10) that asexual transsexuality is a type of so-called non-homosexual transsexuality, Bailey's finding of androphillic transsexuals being especially well suited for prostitution (11), Blanchard's or Lawrence's claim (1) that even decreased sexual activity is symptomatic of autogynephilia as being a representation of romantic love, deserves merit. In fact, Blanchard (10) had very little evidence to claim that asexual transsexuality, was a form of so-called non-homosexual transsexuality. In fact, he had little more than a "forcing of the data" of Bentler (13) and Person & Ovesey (14), to try to fit his theory. For instance, in the study by Bentler (13), 100% of transsexuals identified as heterosexual type, were found to be married as a male to a female, whereas 0 % of transsexuals identified as the homosexual type, were married as a male to a female, AND 0% of transsexuals identified as asexual type, were married as a male to a female (13) (Table 1, pg. 570). Another example, from Bentler (13), the number of women with whom the transsexuals had intercourse as a male, was M= 0.3 and M= 0.2, respectively, for those typed as homosexual and asexual, whereas, for those typed as heterosexual, the M= 3.3. Thus, on these two indices, the asexual transsexuals were significantly more like the homosexual type than the heterosexual type, and thus these variables do not warrant the asexual group for being categorized as so-called non-homosexual. +

Several lines of evidence, including the roughly 40% of hypogonadism found by Benjamin, of his patients (sample total= 152) (12)#, its replication (41%) by Walser (sample total= 17) (15), and comparable findings by Walinder (16), strongly suggest, that asexual transsexualism, represents a distinct type of transsexuality (seperate from androphillic, autogynephillic, erotic or romantic motives), and perhaps, represents a type of atypical sex variation or VSD (17), which is hypogonadism. It also suggests that their reasons for seeking gender reassignment are those of a reversed gender identity (and related to a feminine essence narrative), neuroendocrinological, and directly related to basal brain sex reversal (2-5).

*It has been sometimes stated that the BSTc is in or part of the hypothalamus. This is correct, to the degree that "hypo", means underneath or below, and the BSTc is certainlty part of the area which is BELOW the THALAMUS. However, the BSTc, is technically the extended amygdala, in that it is a connection which is between, and goes to and from the amygdala and hypothalamus in reciprocal fashion.

(See also the following for further reading)-

+ Non-homosexual transsexuality (10) is typically used as synonymous with Autotogynephilia (see references 10 and 11).

# In Harry Benjamin’s first transsexual patient, known as Barry, noted by Schaefer and Wheeler (Arch. Sexual Behav., Vol. 24, No. 1, 1995, page 79). It was found, that this person, denied “ever having an erection (nocturnal or otherwise) and of ever masturbating.” This is significant, as this case was seen 60 years ago, before it could be reasonably stated that patients would lie to better their chances of seeking sex reassignment surgery.

See also the following for further reading-

M. Italiano

(1) Lawrence, A.A. (2007) Becoming what we love: autogynephillic transsexualism conceptualized as an expression of romantic love. Perspectives in Biology & Medicine, 50(4):506-520.

(2) Zhou, J.N., et al. (1995) A sex difference in the human brain and its relation to transsexuality. Nature, 378:68-70.

(3) Kruijver, F.P., et al. (2000) Male-to-Female transsexuals have female neuron numbers in a limbic nucleus. Journal of Clinical Endocrinology & Metabolism, 85(5):2034-2041.

(4) Berglund, H., et al. (2007) Male-to-female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids. Cerebral Cortex. (published online December 3, 2007).

(5) Gizewski, E (2006) fMRT zur Diagnose bei Transsexualitat gepruft. (An Examination of the use of fMRT for diagnosing Transsexuality. English title transl. from German). ArzteZeitung, May 30, 2006.

(6) Fisher, H.E. et al. (2006) Romantic love: a mammalian brain system for mate choice. Philos. Trans. R. Soc. Lond. Biol. Sci. 29361(1476):2173-2176.

(7) Fisher, H.E. (2005) Posted Interview of Helen Fisher by Elizabeth Cohen, CNN Medical Correspondent,, May 2005.

(8) Veale, J.F., et al. (2008) An investigation in to the sexuality of Transsexuals. Archives of Sexual Behavior. (In press) (available on epub Feb. 26, 2008)

(9) Veale, J.F. (2005) Love of oneself as a woman: An investigation into the sexuality of transsexual and other women. Unpublished Master's thesis, Massey University, Auckland, New Zealand. (available at

(10) Blanchard, R. (1989) The Classification and Labelling of Nonhomosexual Gender Dysphorias. Archives of Sexual Behavior, 18(4);315-334.

(11) Bailey, J.M. (2003) The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism. Joseph Henry Press.

(12) Benjamin, H. (1966) The Transsexual Phenomenon. Julian Press, New York.

(13) Bentler, P. (1976) A Typology of Transsexualism: Gender Identity Theory and Data. Archives of Sexual Behavior. 5(6):567-584.

(14) Person, E. & Ovesey L. (1974) The Transsexual Syndrome in Males 1. Primary Transsexualism. American Journal of Psychotherapy. 28(1):4-20.

(15) Walser, P. (1968) Verlauf und Endzustandebe: Transvestiten und Transsexuellen. Schweiz. Arch. Neurol. Neurochir. Psychiatr. 101:417-433.

(16) Walinder, J (1967) Transsexualism: A Study of Forty Three Cases. (Doctoral Dissertation), Akademiforlaget-Gumperts, Goteborg.

(17) Diamond, M. & Beh, H.G. (2006) Variations of sex development instead of disorders of sex development. (eletter to the editor of BMJ at

DSD Guidelines: A bridge to mental disorders

Deconstructing the Feminine Essence Narrative
Ongoing investigation by OII
Part 3
by Curtis E. Hinkle
Posted April 22, 2008

DSD Guidelines: A bridge to mental disorders

It is urgent that people who are currently diagnosed as having what is now unfortunately known as a DSD (Disorder of Sex Development) be prepared for what is one of the cruelest hoaxes that people with intersex variations have ever been subjected to.

Consider the following hypothetical case which is sure to happen:

A child subjected to surgery without consent grows up and rejects the sex assigned only to find that they are diagnosed as having a paraphilia known as autogynephilia. This is one of the cruelest forms of medical abuse because the very person who has been surgically altered without consent is diagnosed as having a sexual fetish for rejecting and denouncing the very medical procedures which caused the suffering to begin with – surgery and other non-consensual normalization procedures used to assign a gender to the child.

Currently, people with intersex variations who reject their gender assignment fall under the diagnosis of GIDNOS. In reading the following from the DSM-IV, please note that intersex will be replaced by DSD (which is a much larger group of “disorders”). This will be important in understanding why the term” intersex” was changed to DSD in the first place despite an overwhelming rejection from the intersex community and the sinister motivations behind this change will become more apparent later in this analysis.

The DSM-IV provides a code for gender disorders that did not fall into these criteria. This diagnosis of Gender Identity Disorder Not Otherwise Specified (GIDNOS, 302.6) is similar to other "NOS" diagnoses, and can be given for, for example:[3]

  • 1. Intersex conditions (e.g., androgen insensitivity syndrome or congenital adrenal hyperplasia) and accompanying gender dysphoria
  • 2. Transient, stress-related cross-dressing behavior
  • 3. Persistent preoccupation with castration or penectomy without a desire to acquire the sex characteristics of the other sex, which is known as skoptic syndrome

Intersex (which will be replaced by DSD, a much larger group of “disorders”) is the only non-paraphilia currently listed under the diagnosis for GIDNOS. Several years ago, ISNA and Dreger called for mental health professionals to be involved in the evaluation and care for intersexed folks and shortly thereafter the NICHD committee was started.

The objectives of the DSD research that is being conducted by the NICHD committee, the Network on Psychosexual Differentiation at Penn State which resurrected the Disorder terminology in a psychosexual context include:

“Develop or refine animal paradigms that model and help to explain the genetic, neuroendocrine, and social processes underlying both normal sex-typed behaviors and pathological behaviors observed in individuals with intersex conditions or gender-atypical behavior.

Let’s consider the implications of this NICHD research at Penn State and in so doing, let’s analyze how the use of the new term “DSD” which is a larger class of “disorders” instead of the term “intersex” will broaden the scope of the GIDNOS diagnosis listed above.

The main objective is to link intersex with autogynephilia (often described as a fetish or paraphilia in which the person is sexually excited by the feminization process itself. In other words, some autogynephiles are sexually excited by the same procedures currently used to feminize intersex children because it is the process of becoming a “woman” that sexually excites some of them – sometimes called “forced feminization”).

Just recently the Johns Hopkins publication, Perspectives in Biology and Medicine, which was edited by Alice Dreger, included an article by J. Michael Bailey and Kiira Triea which deconstructed the feminine essence narrative with inaccurate information about Dr. Swaab’s research and he was not permitted to point out the flaws in their article. In that same publication, Anne Lawrence wrote an article which compared autogynephilia to romantic love. Was this more of a response to the upcoming assault on DSD which the NICHD is studying as a group of “psychopathologies”? That is, is there an attempt to soften the impact that autogynephilia could have on people with a DSD who reject their assigned gender, by changing the focus away from the feminization surgical process itself (the idea of sexual arousal to the surgical feminization process itself is very disturbing to many intersexed people) so as to invite less criticism about the motivations often given previously in Anne Lawrence’s writings about autogynephilia? In a previous publication, she had compared autogynephilia to an amputation fetish, a very jarring idea to many in the intersexed community, which made many of us wonder why she was so interested in intersex issues.

Presently, people with transsexualism are often said to self diagnose themselves. Many will state that they are transsexual and are gender dysphoric, that they are trapped in the wrong body and have a feminine essence. Clinicians are seen as gatekeepers and clinicians and health providers may disagree on the legitimacy of their condition. Intersexed people, in many cases, will tell the gatekeepers that they got the gender assignment wrong, that they are the other gender, neither gender, or both genders (Two Spirits) or that they are intergender. Without official recognition of this self-defining process which empowers the intersexed person to articulate their own gender identity, they will be stifled and will not feel free to do so because the only “officially recognized” diagnosis will be a paraphilia – homosexual attraction as the motivation for rejecting one’s assignment or autogynephilia, the sexual arousal associated with viewing oneself as the target of one’s sexual attraction.

It is also important to point out that the request for surgery without hormones or other treatment is becoming popular in trans circles. Requesting surgery in a vacuum makes it seem like the GIDNOS disorder of requesting penectomy or “castration” only.

I am convinced that one of the main reasons for changing intersex to DSD is because DSD will create a much larger class of people to pathologize as paraphilic (or suffering from a fetish). The researchers and other medical specialists involved will probably try to start with conditions which previously would NOT have been considered as intersex at all but which are now DSD’s, such as cloacal exstrophy, penile ablations (such as the Reimer case) and penile agenesis, cases which include children which have been forcefully assigned as female. Some will be “satisfied” with their forced assignment but others will have serious objections. However, if the objections to forced gender assignments are diagnosed as a sexual fetish or paraphilia, intersex surgeons can never be held responsible for making a wrong assignment based on the argument that the gender did not match that of the child who insists that their "gender" assignment is wrong because there will be NO diagnosis for GENDER identity as the cause. Instead, the experts will say that the person later developed a paraphilia. More so, since they will point to others who didn't have a problem with their assignment.

Next, I would think that they would classify the syndromes which they have been studying and have been frustrated about the most lately, and those are the 3 in which patients are MOST likely (more than surgeons) to request a reassignment. These categories are 5 alpha reductase 2 deficiency, NC-CAH, and 17 Beta HSD 3. There have already been studies on 5 alpha in transsexuals which found that M to F's don't have 5 alpha. Thus, those who wish to reject a male assignment will be labeled as paraphilic, and those who want to live as males will make this appear more justifiable, plus this will fuel their desire against feminizing surgeries Those who virilize at puberty and insist on masculinizing surgeries will be those whom they will seek to find grant money for in order to investigate if autoandrophilia (the counterpart in “females” of autogynephilia) exists. Then, because they have found such a high incidence of NC-CAH in F to M transsexuals, they will likely claim that CAH is similar to F to M transsexualism. Those who wish to live as males will continue to pull in more grant money because they will be more than tomboys: they will be autoandrophilics. Homosexuals would be the only other category.

Here is the progression I see in how DSD is important in reframing intersex as a sexual fetish (or paraphilia).

A) M to F TRANSSEXUALS will be the first to be classified as paraphilic. Then-

B) "DSD persons" who would not have been called intersex under the LESS inclusive category of intersex, if they reject their gender assignment, will be labeled as paraphilic. Then-

C) the conditions which PATIENT initiated gender re-assignment is requested (most common in 5 alpha, CAH, and 17 Beta) will be classified as paraphilic. Then-

D) Autoandrophilia will be created for female to male transsexuals.

E) people who were always considered intersexed, who reject their assignment, will be labeled as paraphilic.

As a conclusion, consider the fact that Anne Lawrence is on the APA committee which is responsible for gender variance and intersex (DSD) issues. Anne Lawrence is known for her writings which compare transsexualism to an amputee fetish. I personally do not dispute Anne Lawrence’s theory of autogynephilia because there most likely are people who do have a fetish for surgical feminization.

Then consider the fact that Alice Dreger, one of the architects of the new DSD terminology, recommends Anne Lawrence as a speaker on transsexualism and that she is also supporting one of the main proponents of autogynephilia, J. Michael Bailey.

The problem is not autogynephilia per se. It is the conflation of intersex issues (or people with DSD’s) with something unrelated to why many people with intersex variations reject their gender assignment which is problematic.

We in the intersexed and trans community risk ending up in a situation where:

Surgeons who perform intersex normalization surgeries without the consent of the child will always be right.
Surgeons who offer sex reassignment surgeries to adults with informed consent will always be wrong.

Many stakeholders involved in intersex treatment benefit from this, especially the surgeons and pediatric endocrinologists. Unfortunately, the main victims are the intersexed children themselves.

A call for a person-centered approach

There is a recent surge of surveying reports to find out the probability with which a person with a PARTICULAR DSD will reject their assignment. If they find in their literature searches, for example, that 94% "accept" their assignment and 6% request re-assignment, the probability is used to create a majority/minority balance, where they (the DSD proponents) then create a UNIFORM standard, which discriminates against the minority. The assignment "rejecters" then have a mental disorder, and the majority "rule" actually "rules". It is an artificial paradigm. It reduces people to mathematical formulas

Probability always involves a gamble. It occurs in medicine all the time. If you are 1 of 20 who has a side effect (a pharmacologically INDUCED illness), then you don't matter. You can't sue, and you are accused of making these side effects up, because they are "insignificant" in the population. This is what can eventually happen to the "insignificant" numbers who reject their assignment. In an era, where there is mounting discussion of pharmacology being tailored to the individual, do we really need to REGRESS with intersex treatment, and play a check/balances, game of probability (Russian roulette)? Such a bullet killed Reimer. Have the medical specialists learned anything from this?. For all of the studies in the literature of outcomes in gender assignment according to specific conditions, they have tried to guess at hormonal exposure to the brain, Prader scales, family approval ratings, timing of surgeries, amount of information given to patient/family, cultural differences in outcomes, but they have failed.

We need to have a new paradigm. Treatment needs to be PERSON centered first, and CONDITION centered, second. At present the DSD paradigm is CONDITION focused – not PERSON focused. Information about conditions are helpful, but can never be made universal. People cannot be fit into cookie cutter categories, based upon probabilities. There are too many variables (people who are unhappy with their assignment don't participate in studies, professionals like "cooperative" patients), etc. and this makes all these surveys suspect.

To pathologize someone who rejects their gender assignment is no better than to claim that pharmaceuticals don’t cause other diseases or cause side effects. Even Dreger and other DSD proponents should take a lesson from pharmaceutically-induced thalidamide effects.

Commentary from Michelle O'Brien, OII-UK:

Thinking about this, and the new Handbook of Sexual and Gender Identity Disorders, whilst DSD is included as background to GID rather than being a 'Sexual Disorder' itself (of the sort concerned about in the book), having DSD stand alongside GID and Sexual Disorders themselves opens up a possibility for the future re-establishment of homosexuality (& bisexuality) as a disorder, maybe a 'Disorder of Sexual Identity' (DSI). So, you would get Sexual Disorders, Disorders of Sexual Development, Gender Identity Disorders, and Disorders of Sexual Identity.

Sexual Disorders would presumably become 'Disorders of Sexual Function' (such as impotence, pain on intercourse, asexual tendencies), or DSF, and Disorders of Sexual Paraphilia (presumably including transsexual autogynephilia as distinct from homosexual transsexualism), or DSP; so, MtF GID would disappear, because HSTS, as a form of homosexuality, would become a type of DSI, and AGP-TS a form of DSP; no doubt FtM GID would become incorporated into either DSI (as an FtM HSTS) or DSF (based on whether there was sexual attraction to women or men - in the latter case this would be a dysfunction rather than a problematic autoandrophilia to match autogynephilia). This then would make GID a redundant category, as all instances of transsexualism would be caught within one or other form of the sexual disorders. This then would leave a neat new taxonomy of all sexual disorders, incorporating intersex and transsexuality, including homosexuality, alongside paraphilia and sexual dysfunction:

DSD (Disorders of Sexual Development) - the conditions formerly known as intersex
DSI (Disorders of Sexual Identity) - the identities formerly known as homosexuality
DSF (Disorders of Sexual Function) - problems formerly known as sexual dysfunction
DSP (Disorders of Sexual Paraphilia) - perversions formerly known as paraphilias

Nobody wins in this game, apart from those who make the rules; this scenario is partially hypothetical, although between DSD and Bailey a substantial part of this has begun to be achieved. Maybe I am being a bit paranoid, but to the man-in-the-street, they will all mean one thing - sexual disorders. What such a taxonomy would be based upon is deviation from male-female sexual reproductive norms.

Her lawsuit is an anti-surgery case that was widely publicized in Europe with articles appearing in many languages throughout the world. There was almost nothing in English except what I translated.

The reason for the silence among English-speaking experts is very simple. This is about a "feminine essence narrative." Christiane Völling was assigned MALE and her female reproductive anatomy was removed without her consent. She has proof of this and presented it in court. She won, but the surgeon is now appealing and the letters from the court still address her as "Herr Völling".

Christiane knows that she is a woman despite her assignment as male. That is the reason there is NO support from Dreger and other DSD activists of this intersex woman who has been subjected to a life of suffering.