Sex and Gender Aren’t the Same Thing: Being Transgender Isn’t a Mental Disorder

Gender and related aspects (such as stereotypical behaviors, gender roles, sexual preference, gender identity, the degree to which you identify with others, etc.) are not the same thing as sex. Neither genitals nor an individual’s chromosomes determine whether they are called a “he” or “she” in their native language; their culture’s opinions about that genitalia does, and those opinions vary. The relevant combined fields of psychology and psychiatry emphasize making this distinction between gender and sex. Psychiatrists, by the way, were MD’s before they were psychologists, and I’d suspect they are no more confused about sex and chromosomes than I.

Even saying reproduction is all that matters when deciding sex is overly simplistic; would you say reproductively sterile people are neither male nor female? No that would be silly.

Notably, it is not just mental health experts in America who make the distinction between sex and gender. The World Health organization defines gender as “the socially constructed characteristics of women and men – such as norms, roles and relationships of and between groups of women and men. It varies from society to society and can be changed. While most people are born either male or female, they are taught appropriate norms and behaviours – including how they should interact with others of the same or opposite sex within households, communities and work places.

Shankar (2015) elaborates by relating gender to the physical and emotional perception of a person; contending that restricting gender to a non-overlapping binary system of male and female is erroneous given the diversity of feelings and expressions. Sex, conversely, is described by the DSM-5 and WHO as the biological indicators related to reproductive capacities, such as sex chromosomes, gonads, and sex hormones.

Gender is not determined exclusively by chromosomes, and it did not develop uniformly throughout cultures or times. Those who would say gender has nothing to do with chromosomes are wrong. Those who would say gender has everything to do with chromosomes are wrong. These false extremes are often rooted in the false conflation of sex and gender as the same thing when they are not.

The question “how many” genders is an irrelevant question because everyone should be treated as an individual; nobody assumes every women they see will be 5′ 6″ despite knowing that to be the avg. height; same thing with personality traits, competencies, orientations, and identities. There are two reproductively viable human sexes, and this has never been in question. But reproduction is largely irrelevant to the conscious, emotional, and social experience of a person as a man, woman, or something else. This is the case regarding gender-identity. Perry, Pauletti, and Cooper (2019) define gender-identity as mental patterns concerning a person’s appraisals of their compatibility with a gender collective, and their desires to fit in with that collective. Rather than being strictly a psychosocial construct, gender-identity has been confirmed to involve a considerable level of biological factors, including genetic, neurologic, and endocrine contributors (Rosenthal, 2018).

Transgender/Transsexual a Mental Disorder?

Another important point to make is that being trans is not a mental disorder; gender dysphoria is a disorder. Gender dysphoria is the negative feelings associated with being a trans person who doesn’t (or isn’t able to for fear of reprisal from bigots) live, dress, or act in congruity with their experienced gender (what they identify as). Hence why the treatment accepted by the American Psychological Association (and American Psychiatric Association) for gender dysphoria is helping them to transition and live as their experienced gender rather than their socially assigned one.

Without criterion B, clinically significant stress or impairment, there is no mental disorder present. Similar to the fact that you have to have teeth to get a cavity, being trans is a necessary but insufficient criterion to be diagnosed with gender dysphoria.

This is not limited to the American DSM either. In their International Classification of Diseases revision 11 (ICD-11), the World Health Organisation classifies “gender incongruence” not in the mental disorders section but in that of sexual health conditions. “Evidence is now clear that it is not a mental disorder, and indeed classifying it in this can cause enormous stigma for people who are transgender, [but] there remain significant health care needs that can best be met if the condition is coded under the ICD,” and this is why it is in the ICD at all. Bigoted partisans will of course assert that these changes in diagnostic criteria occurred because of “political correctness run amok,” but they never follow up the assertion with evidence; they think it is true by virtue of them saying it. In reality, however, these changes were made for the same reason they have always been made; because the field has taken new evidence and discoveries into account.

Gender in History

Godman (2018) mentions several historic cultures that had more than one gender. Examples given included the “hijra” in Pakistan and India who are a third gender that encompassed women-like men and men-like women. Another example was the “berdache” existing in many North American native tribes. A berdache was typically a male who assumed the gender identity of a female, and was granted the accompanying social status. In the city of Madurai, in southern India, a Hindu temple called Meenkashi Amman features sculptures depicting homosexual relationships and multiple portrayals of non-binary genders (Shankar, 2015). Included was a statue of the deity Kala Samhara as a “neutrois,” an entity which changes its body from either male to female, female to male, or to something that can’t be identified as either. Also featured was a statue of Sanishwara, who is a deity known as a transgender; a statue of Shankara Narayan, who is a combination of Shiva and Vishnu, and as a result depicts male and female traits; and a stature of Arjuni, an intersex deity with a mustache and breasts. In the Byzantine Empire there was considerably more gender fluidity than in the modern West, and groups such as eunuchs were considered a gender apart from male or female (Neil & Garland, 2013). History is clearly replete with examples of cultures who recognized more than two genders or recognized a spectrum of gender possibilities.

Chromosomes make you a man or a women.”

Chromosomes make males and females, not men and women. They determine sex, but they only affect gender. Chromosomes make testes and ovaries which make androgens or estrogens, and it is those hormones and their effects on development, before and after birth, that make a person develop neurologically, psychologically, and socially into man, woman, or something else. Anatomically, all people begin as females in the womb until they are differentiated by typical development.

When a political arm-chair physician tries to make their anti-trans argument based on chromosomes, they are showing how little they actually know about biology. Having XY chromosomes is not the demarcation of being a man, it is the first domino in a cascade of biological reactions that in most occasions lead to developing as distinct a male/female with an internally experienced gender congruent with one’s anatomy. Like with abortion, however, the political opposition has anchored itself on an absolute (chromosomes in this case) and ignored all of the shades of grey. In doing this they are exercising a primitive variant of essentialism where they settle on a single event or trait, not because of a true objective value, but because they took a position a priori on the topic then tacked on whatever rationalization they though would help them maintain their existing convictions.

Are Transgender People Choosing to be Transgender: Biology and Genes

Transgender people don’t just “choose” to be transgender. Children as young as 2 often indicate they want to be the other gender and/or dislike the gender associated with their natal sex , and this is not because they are confused (Cohen-Kettenis, 2005). Children with gender dysphoria are perfectly able to label their natal sex, it is identifying with that sex that is the issue (Zucker et al.,1999). Of course there are reasons other than being transgender why a child could identify as the opposite sex, and thus stop identifying that way later. That, however, does not serve to prove that gender incongruity overall is a shallow passing phase. Many children experiment sexually with children of the same sex and grow up to be perfectly strait; that doesn’t prove that the people who grow up gay weren’t truly aware of it when they were children.

Like with sexual orientation, being transgender has an indisputable genetic component: A review of twin studies showed a 40% concordance rate between transgender monozygotic twins (Heylens et al., 2012). A substantial 62% heritability of GID was found in children and adolescents in another study (Coolidge et al., 2002). There has also been multiple genes related to genetic polymorphisms of sex steroid receptors or sex steroid metabolism implicated in gender incongruity (Ngun et al., 2011).

Regarding brain anatomy, multiple studies have shown transgender people to have brains of elevated similarity to the gender that they identify as (and in some cases, traits that differ from both genders). Studies using participants before hormone treatment found similarities when compared with controls of the same gender identity in white matter microstructure for trans men, (Rametti et al., 2011), hypothalamic activation while smelling odorous steroids in trans women (Berglund et al., 2008), sources in EEG frequencies in trans women (Flor-Henry, 2010) and brain activation patterns during the viewing erotic videos for trans women (Gizewski et al., 2009). Trans women have a white matter microstructure different from both male and female controls and similar volumes of gray matter as control men—except that the putamen in trans women were more similar to female volume—(Luders et al., 2009; Rametti et al., 2011). Putamen volume was smaller in non-androphilic trans females, in addition to smaller volumes in the thalamus and higher volumes in gray matter in the temporoparietal junction and the insular and inferofrontal cortex (Savic and Arver, 2011).

None of this discussion on neural differences is to suggest that trans individuals are just men with women’s brains and women with men’s brains, or that scanning a person’s brain alone is enough to determine whether they are cisgender, trans, or gay. Neuroimaging technology is still insufficiently advanced, and our knowledge still too incomplete to identify which of these average differences is directly related to gender incongruity and which are inconsequential. The point of discussing neurological differences is to show that they are there and that they are consistent and statistically significant differences.

One interesting relevant condition is Complete Androgen Insensitivity Syndrome (CAIS). This is where someone has XY sex-chromosomes but their body is completely unresponsive to male-hormones, and as a result, they develop from conception almost completely as a normal female; breasts, vagina, hourglass shape, smaller size, feminine voice and looks, attraction to males, and female gender identity. Gender dysphoria is extremely rare in these individuals (T’Sjoen et al., 2011). They are labeled as healthy females at birth, and nobody suspects anything until menses fails to occur and later they can’t get pregnant. This condition alone decimates the argument and slogan that chromosomes are all that matters when deciding who is a girl and who is a boy. An example of a person with this condition is musician Eden Atwood who was in a story by CNN. Atwood chromosomally male, but anatomically, neurologically, and psychologically a woman. Genes and biological processes other than those relating to sexual reproduction interfered with typical development and caused her to become what can most accurately be described as a reproductively sterile woman.

Chromosomes are associated with physical characteristics, each of which has its own bell curve. Chromosomal males and females ON AVERAGE have a different enough clusters of these traits that we evolved to recognize them. That is what our concept of male and female sprang from. We didn’t, for the vast majority of our evolution, have any concept of what a chromosome was. We responded to others based on physical characteristics and the psychologically-driven responses they reacted to us with.

Closing Discussion

What the anti-trans scientifically illiterate dullards can’t seem to understand, however, is that there are many genes throughout the genetic code (and not just on the sex chromosomes) that affect hormone production and absorption, neural development, and many other traits that under normal circumstances lead to overlapping bell-curves of traits between the average male and female. Just a few uncommon differences among these traits and a person is merely pushed modestly left or right of the average. A few more and they are now at risk if something such as prenatal hormonal issues arise (or a number of other uncontrollable factors), which could send their neurodevelopmental path in the direction of a gender identity incongruent with their sex organs and outward appearance.

This is not to say there is no room for their gender-identity trajectory to be shaped to some degree by early childhood experiences, development, and socialization; there certainly is. However, the biological factors weigh heavier in this equation. The important thing to understand is that by mid-adolescence and early adulthood, a person’s gender identity is almost completely solidified as a component of how their brains are wired, and they cannot just “choose” a different gender identity. As such, these people should be treated with compassion and understanding, not scorn and prejudice.

Possibly even more important is that trans and gay individuals are harming nobody by existing as they are, and despicable moves by the religious right and bigotry-sympathetic right-wingers to enshrine bigotry into laws against these groups of people are completely loathsome and irredeemable.


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