Category Archives: Gender Anomalies.
In four years of medical school, three years of residency training, and nearly 30 years in practice as a family physician I have never been asked “what is the definition of a woman?”
Seems obvious that one could just look at the genitalia. You’re either a boy or a girl, right? Well, not always. Although it is rare, many people are born with ambiguous genitalia. The OB/GYN and the pediatrician are simply unable to determine the sex. Historically, in consultation with the family, a sex would be assigned. Turns out that often as not the child would ultimately identify with the sex they were not assigned.
So it must be the chromosomes. The 23rd pair in humans is designated XX in females and XY in males. The Y chromosome determines male characteristics, so you are either a boy or a girl, right? Well, not always.
In embryology the default setting is female. The Y chromosome normally triggers male development. Ever heard of testicular feminization syndrome, now more properly referred to as androgen insensitivity syndrome? A normal XY baby is born with essentially normal female external genitalia. The body simply does not respond to androgens associated with the Y chromosome. As the child grows and enters puberty there will be normal female breast development and other feminine characteristics. Unless genetic testing has been done at some point, the abnormality is not discovered until the teenage daughter presents to the doctor with concerns that menstruation has not started. Examination will reveal that the vagina ends in a blind pouch, no uterus, and undescended testes. They are often very feminine – cheerleaders, beauty pageant contestants, etc.
Nearly everybody is a normal XX or XY, has anatomy to match, and is perfectly at peace with themselves. But not everybody. Several studies have identified how the sexual diversity between men and women does not exclusively involve the genitals, but also the development of different brain areas. And just as genitals can be ambiguous, or not match what XY would predict, so can the brain in some instances develop in a different direction than the genitals. Animal studies suggest this is likely due to atypical levels of sex hormones in the womb.
Studies in the human brain have involved an area of the limbic system known as the nucleus of the terminal stria. The volume of this area appears to be influenced by the stimulation of sex hormones during brain development, and in men the volume of this area is greater than in women. Scans of this area in transgender women (genetic/anatomic men who identify as females) resemble that of non-transgender females. In this matter gender identity develops from the complex interactions between sex hormones and brain during its development; moreover, this appears to be genetically predetermined and is not influenced by hormonal stimuli during the adult phase.
Gender dysphoria often begins in childhood and can lead to severe distress, depression, and suicide. Treatment includes thorough psychological and medical evaluation and psychotherapy. Hormonal treatments in children are designed to delay puberty until decisions about appropriate gender characteristics can be made. The treatments are not permanent and are REVERSIBLE. Sex change (gender reassignment) operations are not done on children. (Rare exception might be in the case of ambiguous genitalia where surgery may be done to make genital appearance more consistent with the genetic sex).
Unfortunately, there are many people who cannot or will not understand that someone different from themselves might really be different for a real reason. I recently watched a video of a Fox News personality guffawing, in an arrogant and grotesque display of not knowing what one does not know, about how “woke liberals” were looking into the science of what makes someone a man or a woman. I hope the information provided here explains why that question is not quite as simple as it sounds.
It is also unfortunate in Texas that people with political power seem to think that trans people just want to get on the girls’ track team
to win a lot of medals or get in the girls’ rest room to watch them pee. Governor Abbott, Lt Gov Patrick, and AG Paxton have shown profound ignorance and cruelty in decreeing treatment for these kids to be child abuse. Even right-wing columnist Mona Charen called Abbott’s behavior “malice masquerading as policy making”. It is no different than lunchroom bullies knocking the food tray out of the little autistic kid’s hand and having a big laugh over it. And the American Academy of Pediatrics, American Academy of Family Physicians, AMA, American College of Obstetricians and Gynecologists, and the Endocrine Society have expressed outrage.
I would hope that someone will share this with a conservative friend. For most of us it seems ridiculous that a guy would think he is a woman, or a woman to think she is a man. The human brain and human body are complex and wondrous and get it right almost every time, but sometimes they get it different. And different should not be wrong, and different people and their families should not be attacked by their own government.
– Joe McCreight, MD