Friday, April 25, 2008

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


GENDER IDENTITY, THE BRAIN, GENDER ESSENCE NARRATIVES AND ATTEMPTED ERASURE - A CRITIQUE OF THE ANNE LAWRENCE AUTOGYNEPHILIC/ROMANTIC LOVE-"LINE" ARTICLE

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, CNN.com, 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 jaimieveale.com)

(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 http://adc.bmj.com/cgi/eletters/91/7/554#2460)

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.

Sunday, March 9, 2008

DSD: Sexism, Classism and Eugenics

DSD (Disorders of sex development): a sexist, classist ideology based on eugenics

A brief exposé by Curtis E. Hinkle
March 9, 2008
© 2008

1) What is sexism?
2) What is eugenics?
3) Who controls the definitions?
4) Who is fit to be born?
5) Is our sex a disorder?

1) What is sexism?

Sexism can be considered from different perspectives, both intricately related one to the other, one based on discrimination itself and the other on the division of all humans into legal sex categories which is the fundamental tool used to perpetuate and justify the discrimination.

Discrimination against people which is based on their sex assignment as male or female, instead of their individual merits, is sexist. This discrimination is so prevalent in our societies that it appears natural because we assume that the underlying binary division of all people into male and female is also natural, but it is not. Intersex people prove that it is not and it can be argued rather convincingly that the erasure of intersex as a natural sex variation is a result of the basic sexism which is considered normal in our society. Unfortunately, sexism is "normal" because there are medical and legal norms which justify this sexism. However, the fact that it is "normal" does not mean it is natural.

The most basic form of sexism is the biological essentialism (1) which is used to divide all humanity into just two legal categories - male and female with all deviations defined as pathological and in need of medical intervention to "correct" their sex. There would be no reason to justify this division of all humanity legally and medically into just two categories (2) if we felt there were no fundamental differences between these two categories and there would be no need to pathologize all intersex people as disorders of sex development if this unnatural division of all humanity as male or female were not politically motivated. (3)

2) What is eugenics?

"Eugenics is the study of or belief in the possibility of improving the qualities of the human species or a human population, esp. by such means as discouraging reproduction by persons having genetic defects or presumed to have inheritable undesirable traits (negative eugenics) or encouraging reproduction by persons presumed to have inheritable desirable traits (positive eugenics)."
Based on the Random House Unabridged Dictionary, (c) Random House, Inc. 2006.

Eugenics has a very tragic, racist, classist history. (4) The nature of eugenics makes it a political ideology based on definitions of people which divide humanity into those who are fit and those who are unfit. The basic problem is that those who control the definitions are those who have political supremacy over disenfranchised populations. Denying the racist, sexist and classist history of eugenics is dangerous if one honestly wants to understand the political motivations behind eugenic movements.

In the 20th Century, abortion has been introduced as a tool for eugenic movements. This is very problematic because the conflation of women's rights with eugenics often obscures the underlying racism, sexism and classism involved in the justification of abortion as a eugenic tool. Both sides of this debate overlook the serious dangers and inequalities of women as a class. The pro-choice debate does not emphasize the lack of most women in the world to make a real choice because they are deprived of that power even when abortion is provided and this can often lead to the elimination of female fetuses. The pro-life debate fails to recognize the need for women to control their own bodies and have the right over reproductive decisions concerning their bodies.

Instead of dealing with the serious oppression of people based on race, sex and class, upper middle-class pro-choice models of abortion as the model for feminism assumes that women who are lacking almost all control of their reproductive rights can benefit from such a model. What can often happen is the choice to eliminate females and all deviations from male and female with only male births being favored. (5)

3) Who controls the definitions?

Those in charge of the definitions which determine who are male and female and whose sex is a genetic defect is a group of predominantly, Euro-centric male medical experts: the Lawson Wilkins Pediatrics Endocrine Society along with Eric Vilain and Alice Dreger both associated with the Intersex Society of North America (ISNA). This is the group which is responsible for the Chicago Consensus Statement on Management of Intersex Disorders which redefined intersex as a genetic defect and recommended the new "disorder" terminology with "intersex" being replaced by "disorders of sex development". (6)

This same group published the following consensus statement on CAH which recommends surgery on intersex infants between 2 and 6 months of age:
Consensus Statement on 21-Hydroxylase Deficiency from The Lawson Wilkins Pediatric Endocrine Society and The European Society for Paediatric Endocrinology (Joint LWPES/ESPE CAH Working Group)

4) Who is fit to be born?

Those who are closest to the ones who control the definitions. Let's be honest and stop trying to justify racism, sexism and this abuse of power over us just because those in charge of the definitions are powerful and have great influence around the world. We are not fit to be born because we do not look like them; we do not act like them and we are a threat to their two-sex system which keeps them in a privileged position. They are "fit" simply because they control the definitions of who is fit.

5) Is our sex, that is intersex, a disorder?

We in OII firmly reject the idea that our sex is a disorder and we therefore reject the pathological definition of our sex as a "disorder of sex development" or DSD. The real danger and disorders are the racism and sexism which are developing eugenic ideologies and technologies to deal with what are social problems. Instead of empowering and valuing sex variations, the solution is to eliminate us.

Open discussions about the abuse of power by those who control the definitions is one important way to confront the real problem - eugenics, Euro-centric racism and male patriarchal models of power which are at risk of collapse if the current binary male/female dichotomies are not firmly held as sacrosanct.

We in OII do not accept the current male/female binary categories imposed on all people in most countries as sacrosanct and hope that others will help us confront the political agenda of those who would eliminate us.


Footnotes:
(1) "Biological Essentialism: Biological essentialism refers to the idea that men and women are intrinsically different due to some internal essence. Biological essentialists argue that men and women are distinct from one another and that they are opposites. They claim that gender differences aren’t really differences in gender but that they reflect a biologically based difference that is consistent across cultures. Furthermore, biological essentialists stipulate that there is no variation in the expression of biologically essential characteristics."

(2) Project 1-0-1 intersex

(3) RACISM and SEXISM: A COLLECTIVE STRUGGLE: A MINORITY WOMAN'S POINT OF VIEW By Valerie Russell

(4) Brief history of eugenics: http://en.wikipedia.org/wiki/Eugenics#History

(5) What Is Gendercide? http://www.gendercide.org/

(6) Alice Dreger and some other women who have great privilege within the two-sex system have played a prominent role in pathologizing sex variations. For more information: click here

Friday, February 29, 2008

Alice Dreger: The unethical ethicist?

By Curtis E. Hinkle
© 2008
February 29, 2008

Alice Dreger, the DSD activist, who bills herself as a bioethicist has over the past few years become mired by one ethical scandal after another. Just to mention a few of her scandals, let me start with what will be one of the major setbacks in intersex history. It was Alice Dreger who was one of the prime movers of the shift from “intersex” to DSD, “disorders of sex development”. She did this by consulting with doctors and determining what worked for them and consulted the intersex community after the change had been made. Quite unethical for an ethicist because there is practically no support for this replacement of the term “intersex” with “disorders of sex development” and the ensuing Consensus Statement (1) which approved this change of terminology which elaborated a set of protocols that are a major setback for intersex people with surgery being recommended between two and six months of age. (2) This was a scandal of historical proportions.

After controlling intersex activism for over a decade and leaving it in shambles, she decided to move on to transgender activism. And already she is becoming the same divisive “activist” in the transgender movement that she was in the intersex movement. She has begun by taking sides with the gatekeepers of the trans movement, just as she placed herself with the gatekeepers of the intersex community and then left us with a more pathological terminology and set of protocols based on intersex being a genetic defect. (3)

As she started her trans activism, many of us in the intersex movement saw the same pattern slowly emerge that had been her hallmark within the intersex movement – siding with proponents of a highly problematic, pathological definition of transsexualism and attacking any opponents who resisted the academic and discursive control she was usurping over their own right to self definition and in determining their own sociopolitical agenda without having to contend with another interloper who had no experiential understanding of trans issues.

All of a sudden she picked a fight with Andrea James and tried to prevent Ms. James from being allowed to speak at the university where Alice Dreger works and alleged she was afraid of Andrea James. It was quite odd that the organization which invited Ms. James to speak at Northwestern University where Dreger works was evidently not frightened by Andrea James. Dreger decided to use the Bush foreign policy model of a pre-emptive strike against anyone who might possibly be viewed as a threat and published “The blog I write in fear” (4) in which she brought up an unfortunate event that had happened a few years ago between her colleague J Michael Bailey and Andrea James. She alleged she was frightened of Andrea and that she should not be allowed to speak at the University. This is the strawman that has been used for years now to silence any discussion of the unethical behavior that Bailey and Dreger have been involved in. Instead of dealing with the facts of their own behavior, anyone who dares discuss the facts is automatically smeared with ad hominem attacks linking them to the serious mistake that Andrea James made a few years ago. Dreger even did this to me when I openly questioned her DSD model as a replacement for intersex. (5) Instead of dealing with what she was doing, Dreger sent out an e-mail alleging that I had teamed up with Andrea James, someone I didn’t know at the time, and warned intersex people that if they were not vigilant, the intersex movement would be destroyed. Well, that was already a fait accompli and it was Dreger who was instrumental in its destruction. Many of us are trying to rebuild and move on.

We later found out why Dreger was alleging she was so afraid of Andrea James. She was working at the same University as J Michael Bailey and she was writing an article in defense of his unethical behavior and she was going to include Andrea James in that article. It certainly would be good fodder for the article if she could have provoked Andrea to get more dirt on her to include in her upcoming “exposé” of the “facts” to suit her employer, Northwestern University.

Dreger then published a 60-page tome in defense of her colleague, J Michael Bailey and in that article she once again threw ethics out the window and simply gives Bailey another platform to justify having sex with research subjects: “there is nothing intrinsically wrong or forbidden about having sex with a research subject[….] Some of my colleagues have had sex with their research subjects, because it is not unusual to ask one’s romantic partner to be a subject” (Bailey, 2005).” Rather disturbing ethical standards that Dreger is disseminating in this tome in defense of her colleague. (6)

Finally, someone is challenging Dreger on her ethics and many of us in the intersex community feel it is high time. Robin Mathy has filed ethics complaints with the American Psychological Association against Dreger and Bailey. One of the allegations in the complaint centers on Dreger and Bailey having both expressed that having sex with a research subject is not inherently wrong. Robin Mathy has also filed a complaint with the Illinois Board of Examiners of Psychology against Bailey for allegedly misrepresenting himself as a psychologist. (7)

It does appear that Robin Mathy has a lot of facts to substantiate these allegations along with many others. Ethics? Alice Dreger’s ethics seem to be focused on what is best for her career and gaining access to more power, not helping the powerless which she now has a history of dismissing, silencing and abusing.

Notes:
(1) Consensus Statement on Management of Intersex Disorders

(2) This is a quote from the Same group that gave us the Consensus Statement on DSD's.

Consensus Statement on 21-Hydroxylase Deficiency from The Lawson Wilkins Pediatric Endocrine Society and The European Society for Paediatric Endocrinology Joint LWPES/ESPE CAH Working Group

Surgery is recommended at age 2-6 months:
----------------------------------------------------------------------
"Once a decision has been made to raise a newborn as female, surgery for those with virilized genitalia caused by CAH is recommended when the patient has a high proximal junction between the vagina and urethra (12, 13). Surgery on infants with ambiguous genitalia requires a high degree of expertise and should only be performed in centers with significant experience. Based on recent clinical experience, the recommended time for surgery is at age 2–6 months; although, at present, this is not universal practice. It is important to note that surgery at this stage is technically easier than at later stages."

You can download the complete Consensus Statement on CAH at:

(3) Alice Dreger: Disorders of Sex Development

(4) “The Blog I Write in Fear”. May 13, 2006.

(5) Email from Alice Dreger to some intersex activists

(6) “In his online self-defense piece, “Academic McCarthyism,” published in October 2005, Bailey countered with this: “her ‘complaint’ is not true. The alleged event never happened. If I ever needed to do so, I could prove this, but there is no reason why I should” (Bailey, 2005). Bailey’s reasoning for why he should not have to prove he didn’t have sex with Juanita was twofold: first, he “insist[ed] that Juanita was not a research subject” when she claimed they had sex; second, “there is nothing intrinsically wrong or forbidden about having sex with a research subject[….] Some of my colleagues have had sex with their research subjects, because it is not unusual to ask one’s romantic partner to be a subject” (Bailey, 2005).”
Dreger, Alice. 2007. The Controversy Surrounding The Man Who Would Be Queen: A
Case History of the Politics of Science, Identity, and Sex in the Internet Age. p. 43

(7) Debate resumes on methods of psych professor's research by Michael Gsovski
Issue date: 2/27/08
http://www.dailynorthwestern.com/home/index.cfm?event=displayArticle&ustory_id=c6222fa5-96dd-47ee-b912-c58a9874fbdf