Tangential to the main discussion here but for the record, the wider trans community has known Streeting is a transphobe for some time now. It's one reason many of us voted Green at the General Election. Labour aren't trusted.
Did you feel a conservative government would be less transphobic ?
For those discussing gender and what it is, sometimes gender feels like a cis concept to me. For instance, society says I am a woman. I say no, I do not feel like a woman, I do not think so. "But you look so soft and feminine." They are wrong. If I am soft, that has nothing to do with being feminine. Who I am is not defined by how I look. If I look honest does that mean they will trust me? No, it's just my gender I'm not allowed to decide... Pardon the rant.
I've always felt that about being a man. I'm not interested in biological and psychological descriptions, that's not who I am. I don't exist in the third person.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
That sounds like a distinction without a difference to me.
I think quite a lot of the argument derives from different understandings of what truth means. In a social constructionist understanding of the world the idea of gender identity is unremarkable. (wiki gives this.)
In this way of seeing the world, things like childhood, money and justice are also social constructs and of course also real.
That’s kind of what I mean—some things I can see as being “social constructs” (we agree on pieces of paper as money) and others not (justice as a transcendent reality). But I wouldn’t describe myself as a social constructionist.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
That sounds like a distinction without a difference to me.
I think it makes all the difference in the world. Or beyond the world. Or transcending it, technically. And my question is still relevant, I believe—if one does not believe in existentialism, how does one approach the notion that “gender identity is by definition a mental construct”?
(But people who consider themselves to be a different gender than their apparent biological sex have been around for thousands of years longer than the philosophy of existentialism. If reality is already there, with intrinsic, pre-existing meaning to be perceived by us, rather than to have meaning stamped on it by us, then in trans ontology, one could argue that a trans person’s true, intrinsic gender is the gender they perceive themselves to be, like a man’s soul in a woman’s body or vice versa, not just a human construct at all, but a metaphysical reality.)
I would not argue that the mental construct creates a reality - is that Existentialism? I don't know; I never did philosophy. I would argue it is a reality in its own terms.
I really don't see "souls" as anything other than a collection of mental constructs, inasmuch as when people ascribe attributes to souls they look like mental attributes to me. So I'm really struggling to see any real difference between having a soul with gender X and having gender X as a mental construct.
I would be very wary of tying gender identity to a religious concept of metaphysical souls.
I wonder if, in time, we will discover that gender identity (both the strength of it and, as it were, the direction of it) are biological in origin and hence that the trans experience forms part of the intersex continuum. It seems to me that atypicality in the alignment of brain and the rest of the body is not so different from a similar atypicality between e.g. gonads and external genitalia.
I don't think I've read trans perspectives on this so would be interested if anyone has and could highlight them.
I would not argue that the mental construct creates a reality - is that Existentialism? I don't know; I never did philosophy. I would argue it is a reality in its own terms.
I really don't see "souls" as anything other than a collection of mental constructs, inasmuch as when people ascribe attributes to souls they look like mental attributes to me. So I'm really struggling to see any real difference between having a soul with gender X and having gender X as a mental construct.
I would be very wary of tying gender identity to a religious concept of metaphysical souls.
Well, as I said, one could argue this—not that one must—and like a man’s soul in a woman’s body, not exclusively as a man’s soul in a woman’s body. And of course this is predicated on the idea that reality, external reality, reality whose intrinsic meaning simply *is*, is the way things work, rather than existentialism.
As I understand it, existentialism is the notion that existence precedes essence—that things in general are just “stuff” without intrinsic meaning, without an intrinsic essence—and that we as humans stamp it with our ideas of “meaning” or “essence.” Essentialism (philosophical essentialism) is the reverse, and was generally held by most western societies before existentialism came about—that, whether any humans are or were around to perceive the essence or meaning of things, those things already have intrinsic “meaning” or “essence,” and it’s ours to perceive as best we can, rather than to make up and imprint on things.
If one believes in metaphysical souls (whatever one’s religion may be), then one may certainly believe (or not) that those souls have gender. That could be one way (not necessarily the only way) that one could hold to philosophical essentialism, rather than existentialism, and believe in trans ontology.
(Er, for anyone out there who cares, ontology has to do with “what things are,” their essence and (usually intrinsic) nature.)
Another way of describing existentialism is like this: We take pieces of paper, without any real value in themselves, and put marks on them to make them “money,” which we all as a society “imprint” with meaning—some bills are 1 $ or £ or €, some are 5, etc. With existentialism, everything is like that—we as individuals and/or society “imprint” things with meaning. Without that, or in our absence, there’s no real meaning to anything—it’s all made up, by us. Philosophical essentialism holds that things have that meaning already, without humans to make it up—or even if there had never been any humans to see that meaning at all.
The gender-deniers are not in fact denying the existence of gender identity. They require it to exist for their position to make any sense at all, and they then assert that it is 100% correlated with biological sex.
And from there it's a short step to asserting that any cisgender woman who does not conform to your idea of how a woman should look and behave cannot be a 'real' woman, as was recently demonstrated by the furore over Olympic boxing. All this speculation over male and female souls is fascinating, but doesn't help my (cisgender) friend, who would quite like to use the women's loos without being challenged to prove that she's female despite having short hair, no makeup and a penchant for wearing cargo trousers and stompy boots.
The real threat to women's safety is violence from men, fuelled by misogyny. And the TERFs have allied themselves with the misogynists.
The best evidence for gender identity (roles, behaviours etc) is that gender is performed differently in different societies. I remember my father being asked, in an Arab country when I was a child, why he dressed like a woman. In that context, the questioner meant why was he wearing trousers rather than a futah or a thobe.
So we know that doing gender means more than just looking at your body in a mirror.
I was always taught that there’s no such thing as “male” or “female” clothes, and it’s sexist to say otherwise.
Gender identity by definition is a mental construct so the only evidence you really have for it - by definition - is what is in a person's mind.
This is true, of course, but I can't help wondering if the only reason it's true is because it was defined as such precisely in order to avoid any difficult questions raised by a person's physical reality.
Doesn’t “Gender identity by definition is a mental construct” rely on existentialism? I.e., that meaning is something we impose on reality rather than derive from reality? What if one doesn’t believe that?
Sounds like another way to attempt to logic trans people out of existence.
Far from it, because physical reality can be changed. Medical procedures exist that can physically transform a body from male to female (or vice versa). I’ll grant you that it changes the point at which you consider the change of gender (as opposed to the desire for such a change) to apply.
The best evidence for gender identity (roles, behaviours etc) is that gender is performed differently in different societies. I remember my father being asked, in an Arab country when I was a child, why he dressed like a woman. In that context, the questioner meant why was he wearing trousers rather than a futah or a thobe.
So we know that doing gender means more than just looking at your body in a mirror.
I was always taught that there’s no such thing as “male” or “female” clothes, and it’s sexist to say otherwise.
In the society in which we live if you turn up to work in a shirt dress to work as an estate agent, or in some other fairly conventional setting, and you identify as male - the focus of your day will become other people’s reactions to the dress.
It should not be that way - and that is why many people would say fuck the gender binary - but currently in UK society it is.
(If you don’t believe me, buy one that fits you - try it and see.)
...
For those discussing gender and what it is, sometimes gender feels like a cis concept to me. For instance, society says I am a woman. I say no, I do not feel like a woman, I do not think so. "But you look so soft and feminine." They are wrong. If I am soft, that has nothing to do with being feminine. Who I am is not defined by how I look. If I look honest does that mean they will trust me? No, it's just my gender I'm not allowed to decide... Pardon the rant.
Absolutely! Society (here predominantly Western) assigns us all behavioural roles according primarily to our appearance. We don't get a lot of say in this. As long as we are reasonably comfortable with those roles, we can take those roles on and internalise them. Otherwise, we can yearn for a role that is a better fit. But if we push for a role that is too far beyond the boundary of our assigned role, society will push back. And our predominantly Western societies are traditionally cis-societies (or cisnormative societies), with a pretty limited range of roles on offer.
Tangential to the main discussion here but for the record, the wider trans community has known Streeting is a transphobe for some time now. It's one reason many of us voted Green at the General Election. Labour aren't trusted.
Did you feel a conservative government would be less transphobic ?
I think in general a socially liberal Tory government would be somewhat more likely to enact trans-friendly legislation than a government led by the Labour Right.
The former would come at it from a individualistic perspective of personal choice rather than one of equality, of course, but it accounts for May's inherited position around GRCs - which was similar to the policy seen as highly problematic when the SNP ran with it several years later.
The latter is not only hemmed-in by their fear of the press, but having gone with 'reasonable concerns' it now runs counter to the conception they have of their own voting coalition. Lisa Nandy is a good illustration of this, primarily because she's a weathervane and will twist her politics to fit the moment. Sometime in the weeks around the election she deleted all the mildly trans-supportive tweets that she made.
Of course, the type of Tory party that would run a liberal social platform is also likely to be a distant memory.
[For similar reasons if cannabis were ever legalised in the UK it would be unlikely that a purely Labour-led government would do it]
We all define each other - this is how society works. Being a tall, fairly solid white man seems to create all sorts of expectations at odds with the person I feel myself to be. Seems to be an inevitable part of being human. The issue arises if/when any of us is punished for not fulfilling other people's expectations, as it seems to many are. Including, but not limited to, trans people, but also non-cishet and neurodivergent people.
christiles, very interesting points about liberal Tories and right wing Labour. I guess that Labour are always looking over their shoulder at working class voters, who they imagine are reactionary on race, gender, etc. So better not frighten them. Strange, that it was Cameron who brought in equal marriage. Well, not strange. So any hints of support for trans people is being redacted!
No, definitely not, but it shows the reactionary nature of some Labour policies. Amuse bouche, I joined Labour 60 years ago, and I remember the fights with the Labour Right. But they did enact some liberal policies, under Roy Jenkins. Will this lot?
No, definitely not, but it shows the reactionary nature of some Labour policies. Amuse bouche, I joined Labour 60 years ago, and I remember the fights with the Labour Right. But they did enact some liberal policies, under Roy Jenkins. Will this lot?
Jenkins was an exception, on this and many other issues Labour are only going to change policy by being subject to political pressure.
I don’t think that a Tory victory this time around would have given us a liberal Tory government.
No but we got a Labour government with transphobes in key roles like health who immediately doubled down on what the far-right Tories were doing to trans people.
There's a limit to how far you can ask people to vote for that sort of thing without utterly extracting the urine. Look at how badly they fared in some seats with a large Muslim population which returned independents when they decided they weren't going to take it anymore. People have limits on being expected to vote for those who treat them and those they care about like trash.
What do you do if you don't want to be ruled (effectively) by the Murdoch press, Mail and Express and our nasty Scottish press and their scapegoating campaigns? Who do you vote for? Starmer appears to have made a deal with the Devil for his part
Ultimately no minority is safe when parties of government take their cue from irresponsible people who've a business interest in driving moral panics. That needs to be dealt with. It would require discussing in detail on its own thread - but in passing - a lot this week has been said about social media and not nearly enough about what legacy media has done to drive panic about immigration. There's been some convenient amnesia from politicians who courted those same papers and media and attacked the minorities they told them to attack.
Transphobia is bad because it hurts trans people and, in addition, it comes with a whole package of other prejudices being ladled out by the same press - prejudice against immigrants, racism, prejudice against disabled people, attacks on bodily autonomy, attacks on anyone seen as gender non-conforming or non heterosexual and Labour is not rooting that stuff out - it's decided to play pick and mix. Labour thinks its voters can have a bit of scapegoating as a treat, so long as it brings in enough right wing voters to make up for those being thrown under the bus.
I don't blame people for voting Green, independent and Lib Dem instead (and instead of the SNP too), it's the only way they will learn it has a cost and we don't all read The Sun and Daily Record.
Labour did their electoral calculus and decided that they would throw trans people under a bus for right wing and TERF votes, they don't now get to demand trans people's votes 'because Tories'. They decided they didn't want those votes and they don't deserve them.
Labour are always trying to second guess the papers and their own voters (and they’re in hock to ‘Old Labour’ being in the words of my Labour-member grandfather ‘the British Empire, but with the British worker in the driving seat’) - I’ve been looking for this without success for a couple of days, but there’s an old take that goes something like ‘what the fascists demand today, the Tories will argue about tomorrow, and Labour will legislate on next week.’
Labour are always trying to second guess the papers and their own voters (and they’re in hock to ‘Old Labour’ being in the words of my Labour-
member grandfather ‘the British Empire, but with the British worker in the driving seat’) -
I'm pretty sure it's mostly just the press at this point, or rather they are impressing the press by appealing to a mostly imaginary conception of the working class shared by themselves but mostly used to push policies appealing to the right (you can find the clip of Douglas Murray that was circulating this week for an example). In that, I agree with what Louise said above, specifically:
Ultimately no minority is safe when parties of government take their cue from irresponsible people who've a business interest in driving moral panics. That needs to be dealt with. It would require discussing in detail on its own thread - but in passing - a lot this week has been said about social media and not nearly enough about what legacy media has done to drive panic about immigration.
I’ve been looking for this without success for a couple of days, but there’s an old take that goes something like ‘what the fascists demand today, the Tories will argue about tomorrow, and Labour will legislate on next week.’
"What Enoch Powell says today, the Tories say tomorrow and Labour legislates on the day after" - Sivanandan"
I wonder if, in time, we will discover that gender identity (both the strength of it and, as it were, the direction of it) are biological in origin and hence that the trans experience forms part of the intersex continuum. It seems to me that atypicality in the alignment of brain and the rest of the body is not so different from a similar atypicality between e.g. gonads and external genitalia.
I don't think I've read trans perspectives on this so would be interested if anyone has and could highlight them.
This is where I am at scientifically at the moment with one significant caveat. The caveat is that I have no lived experience and have no wish to pigeon-hole anyone. Some trans people may feel that talk of biological constructs or explanations might not relate to who they are as a person. I do not pretend to be remotely qualified to speak to who they are. However, I think the biology is interesting and relevant to the discussion. This has very much been my way in to this as I get very angry with bigots and transphobes abusing the science to persecute people. When you hear statements like "You can't deny biology," I can guarantee it is coming from a place of ignorance.
So the following is a little bit of human embryology followed by some speculation. I will make clear which is which. This will inevitably be a simplified description. Partly because it's a very complex topic but also because it is not fully understood. There remain important gaps in the data.
OK, Human sex differentiation. DSD is the correct terminology. "Intersex" is problematic, sadly. "DSD" is "Differences in sex differentiation" and is a whole spectrum of phenomena.
Like all mammals, we have two sex chromosomes. Women have two X chromosomes and men have an X and a Y. If you look at them closely, Y is very small and looks like a fragment of X. It has a handful of genes which are also on the X chromosome. It also has one gene which is what makes a human become male. This gene is known as either SRY "Sex-determining region of Y" or TDF "Testis determining Factor" - two names but the same thing. TDF switches on a whole host of other processes which make an embryo/foetus become male. In the absence of TDF, by default the individual becomes female.
Molecular biology is a mechanistic science. each step requires a number of biological processes and each of them can 'go wrong' in some way resulting in some form of DSD. The other important concept is how molecules interact with each other. Hormones are molecules that are released in one part of the body and have an effect in another. Typically they fail in their function if the hormone is not produced (or is dysfunctional) or if there is a problem with the receptor. Diabetes is a classic example of this. Insulin is released by the pancreas and acts on multiple cells in the body - especially in the liver - to trigger the uptake of glucose into cells. Insulin is released by the pancreas in response to glucose to regulate the level. Type I diabetes results in high blood sugar because the pancreas does not produce insulin. Type II diabetes results in high blood sugar because the receptors for insulin don't work properly. In Type II, the pancreas is pumping out plenty of insulin but it has no effect because the receptors aren't working. Biochemical pathways inside the cell work on the same principle. A molecule has to interact with the next one in the pathway to have an effect. Sex differentiation is a whole series of pathways but the big ones are driven by hormones. There are two that are important: Testosterone and AMH. We will come back to those.
The gonads are one of the first structures to form in the embryo. Until 6 weeks from conception they are 'undifferentiated' and indistinguishable between male and female embryos. This is where TDF comes in. TDF is a protein that binds to DNA and switches on a whole series of genes. The name gives away what's going on here: TDF makes undifferentiated gonads become testes. In the absence of TDF, gonads will become ovaries.
Once this switch has occurred, these embryonic testes produce Testosterone and AMH. Ovaries do not produce either. These two hormones then drive the rest of the process of making an embryo become male rather than female.
The next thing we need to talk about are the Wolffian ducts and the Mullerian Ducts. Mullerian ducts give rise to female reproductive organs; the fallopian tubes, the uterus and the upper part of the vagina. The Wolffian ducts have two purposes. In both males and females they form the ureters which connect the kidneys to the bladder. In males they also give rise to internal structures including the vas deferans (the tubes that take sperm from the testis to the urethra) and the prostate. In terms of internal development it works like this: The default is that the Wolffian duct only forms ureters and the Mullerian ducts forms the female reproductive organs. In the male embryo, the testes produce testosterone and AMH. Testosterone acts on the Wolffian ducts to form the male reproductive structures as well as the ureters. AMH stands for "Anti Mullerian Hormone." Again, the name gives away it's function, it causes the Mullerian ducts to regress and essentially disappear.
Externally is a separate process. It is relatively easy to understand once you appreciate there are two structures: The labial-scrotal folds and the phallus. Again, the default is to become female. In the female, the labial scrotal folds separate to form the vulva and give rise to the lower part of the vagina. The phallus becomes the clitoris. In males, testosterone acts on both these structures. It causes the labial-scrotal folds to become wrinkled and remain as one structure with no gap in the middle. It causes the phallus to grow. When it does it brings the urethra with it so that the opening of the urethra is at the tip of the penis. (In females the urethral opening is just below the clitoris). There is a condition called hypospadias. It is not usually considered to be part of DSD but it is where the penis develops normally except the urethral opening is not at the end of the penis but somewhere on the underside.
OK, that's the embryology. DSD occurs when one or more of these processes does not follow this course. Simplistically, testosterone determines external structures and AMH determines internal. In the absence of both (or if there is a problem with the receptor pathway), one becomes female. In the presence of both, one becomes male. One additional piece of information that's relevant here is that the adrenal glands produce testosterone. Usually in very low levels but the most common form of DSD is CAH - congenital adrenal hyperplasia - where the adrenal glands produce lots of testosterone. This can result in a girl being born with genitalia with a normal male appearance (until you examine them very closely).
Things can go awry in many different ways - as biology is rarely truly binary - but in essence all conditions included in DSD reflect some problem with the pathways I've just described. In the UK a child must be assigned to one sex by law. That is not true everywhere but it is how we work in the UK. We talk about 'virilisation.' Virilisation is the effect of testosterone on external structures so with ambiguous genitalia we have to decide if the baby is an undervirilised male or and overvirilised female.
OK. I want to introduce two groups of DSD conditions which are the Androgen Insensitivity Syndromes. There is Complete Androgen Insensitivity Syndrome and Partial Androgen Insensitivity Syndrome. For our purposes here "Androgen" = "Testosterone."
What is going on here is that you have a baby with XY chromosomes. The gonads became testicles and testicles produce testosterone and AMH. Because of the AMH, the internal female structures do not develop. However, whilst they have normal levels of testosterone the development does not happen normally because the receptors (or their pathways) are defective.
In complete androgen insensitivity syndrome these babies have a normal female external appearance. Many of them are not diagnosed until they are teenagers because they don't start menstruating. PAIS is much more complex because the pattern is very variable and often these children have truly ambiguous genitalia. Sometimes they are boys with a micropenis. In both cases, we are talking about an individual with XY chromosomes and gonads that became testes but the down-stream effects are incredibly variable. Some boys with PAIS have a very normal appearance. Some individuals are designated female and many CAIS patients have no discomfort about their gender, they are simply female but not fertile.
That's all science so far. Nothing I have described here is controversial. We also know that testosterone affects the developing brain. This is where it gets a little speculative because we do not understand very much about how the brain develops and we do not know very much with any certainty about the differences (if any) between male and female brains. And most importantly, even if you can map differences in brains they will be Venn diagrams with a lot of overlap. However, we do know that Testosterone has very profound effects on the brain and behaviour very early in life. There are very rare adrenal tumours that produce a lot of testosterone. I have looked after a couple of such patients. Imagine a two year old with adult-levels - i.e. post-pubertal levels - of testosterone. They tend to be very aggressive and have significant behavioural issues (as well as physical changes). The two year old is not mentally or emotionally able to cope with adult levels of testosterone. They get a lot better when you remove the tumour.
So, to summerise:
1. Sex differentiation is hormone-driven
2. The hormones that drive physical changes also act on the developing brain. We know there are effects in utero but they are very poorly understood.
3. The comparison between the various conditions (Especially PAIS / CAIS) shows how an individual who has normal levels of testosterone (for a male) may not develop male physical characteristics. Conversely, a female may develop male characteristics if they have abnormally high testosterone.
Here's the speculative bit:
Now, this is far too simplistic but imagine for a moment that there are receptors in the brain for testosterone. (There are). Now imagine that there is something wrong with these receptors in the brain whilst the receptors in all other parts of the body are unaffected. This would mean that either the brain would be in-effect under-exposed to testosterone and tend towards a more female profile in a boy. Conversely, in a girl the receptors could be 'hyperactive' and thus despite low levels of testosterone (normal for a girl), the brain tends towards a more male profile.
There is no direct evidence of what I just described but from a embryological and molecular-biology perspective, it is a virtual certainty that these processes can happen. It's a little bit like how mathematicians used Newton's laws to find Neptune and Pluto. They knew they must be there because the orbital paths of other planets indicated an effect of the gravitational force of these bodies. We know that sex hormones effect brain development. We know many ways in which the pathways go wrong in terms of driving physical development, some of which are quite subtle. Therefore there must be some effect on the brain.
Now, I do not want to take that model much further because it is all a bit too neat and boxed off for human persons. I do not think we are just our brains but our biology affects our minds. We all know this when hunger and tiredness makes us grumpy or alcohol makes us silly. However, all of that was by means of saying it is incredibly plausible that there is a biological explanation for being trans-sexual. If we want to be crude about it we are talking about a male brain in a female body or vice versa. Again, this is definitely overly simplistic for a lot of reasons but that does not stop it being part of the truth.
Finally, gender is unquestionably partly a social construct. However, it is not totally a social construct and there is an effect of biological sex independent on socialisation. This is best illustrated by a horrible story of medical negligence and appalling ethics.
David was born a boy but following a botched circumcision as a baby, had an unrecoverable penile injury. The doctors decided to raise him as a girl and performed gender reassignment surgery. He was raised as female until he was 14. He always 'felt' male and having learnt the truth detransitioned and lived as an adult man. Intriguingly for the biological story is that at 22 months he had both testicles removed and thus had normal female levels of testosterone throughout most of his childhood. Of course, he had been exposed to male levels of testosterone in utero and until he was 22 months old.
One final comment. If you look at adults born with DSD. Most of them are not transgender. Most of them identify as the sex they are assigned at birth. Most of them are heterosexual. However, among people with DSD, more than the average are homosexual and more than the average identify as non-cis genders.
I do not by any means have all the answers. However, I hope the above explains why I have zero tolerance with ignorant people who deny the existence of Trans people by stating biology sex is a fact.
Labour are always trying to second guess the papers and their own voters (and they’re in hock to ‘Old Labour’ being in the words of my Labour-
member grandfather ‘the British Empire, but with the British worker in the driving seat’) -
I'm pretty sure it's mostly just the press at this point, or rather they are impressing the press by appealing to a mostly imaginary conception of the working class shared by themselves but mostly used to push policies appealing to the right (you can find the clip of Douglas Murray that was circulating this week for an example). In that, I agree with what Louise said above, specifically:
Ultimately no minority is safe when parties of government take their cue from irresponsible people who've a business interest in driving moral panics. That needs to be dealt with. It would require discussing in detail on its own thread - but in passing - a lot this week has been said about social media and not nearly enough about what legacy media has done to drive panic about immigration.
I’ve been looking for this without success for a couple of days, but there’s an old take that goes something like ‘what the fascists demand today, the Tories will argue about tomorrow, and Labour will legislate on next week.’
"What Enoch Powell says today, the Tories say tomorrow and Labour legislates on the day after" - Sivanandan"
That’s the one - no wonder I couldn’t find it! Though my memory wasn’t too far off. Thanks
While its good to explain and demystify some of the biology stuff. I think it's a helpful thing to remember that what people with lived experience prefer and how they identify may differ a lot.
I've done training with people who have lived experience and the DSD terminology even with 'difference' was something that those people described to me first hand as pathologizing, used by doctors and they didn't like it.
Your mileage may vary but this, for example, is someone I've interviewed on the subject who speaks from lived experience
Speaking openly about being intersex is scary because there's tremendous social stigma attached to it. I'm not going to repeat the language used, but it's ugly, and it often comes from endosex (non-intersex) people talking over us to tell us what they think we need.
Not everybody with a variation of sex characteristics (VSC) identifies as intersex. Some view their differences as simple medical issues which are nobody else’s business, as they have every right to do. Yet they may still face discrimination because of them, or find themselves the subject of public speculation if, for instance, they turn out to be good at sport. To identify as intersex is to assert that such differences have had a significant impact on one’s life experience, and to say – whether publicly or just to a few friends – that they should not need to be hidden, that they should be accepted as a natural part of human variation
When it comes down to it what matters to me is what a person with lived experience wants people to use - the people I spoke to were adults with a history of horrendous medical experiences at the hands of doctors. As a paediatrician you may be speaking to children, parents and caregivers with entirely different perspectives for lots of different reasons and the preferred language may be very different.
Looking at Wikipedia for a quick survey there seems to be substantial disagreement on terms - some groups prefer DSD and some intersex.
I think it's a good thing to ask people with lived experience what terminology they prefer and to follow that. Certainly some people identify as intersex and their choice needs to be respected, just as those who prefer the more medical term should have their preferences respected too.
A few years ago, the medical terminology was 'disorders of sex differentiation.' It was then changed to 'differences.'
I can only go with what I have been taught.
Having said that, I, of course, fully respect people's lived experience and their choices of terminology.
I hope you can see that I have been very careful with my choice of words and am being as sensitive as possible to all positions. I may not always be successful, of course.
It's quite long, and being 5 years old may reflect language and ideas that have been subject to re-thinking, the latter half of the interview focuses on intersex medical issues.
Maybe I'm missing something, but I don't understand why trans and intersex are in the same conversation.
Plenty of trans people are not intersex. As far as I understand, intersex people don't necessarily see themselves as part of the trans community. Medically the issues are likely different.
Philosophically I don't see how assigning people with unusual genetics has any relation whatsoever to a discussion about medication for trans children.
Maybe I'm missing something, but I don't understand why trans and intersex are in the same conversation.
Plenty of trans people are not intersex. As far as I understand, intersex people don't necessarily see themselves as part of the trans community. Medically the issues are likely different.
Philosophically I don't see how assigning people with unusual genetics has any relation whatsoever to a discussion about medication for trans children.
I think I introduced intersex/DSD/VSC into the conversation. My point was speculative - wondering if there is a biological determinant (remembering that the brain is biological and and mind/body dichotomy is somewhat illusory) for some or all instances of being trans and whether such a determinant would logically group transness(!) with intersex/DSD/VSC experiences.
It's certainly not obvious right now that this is the case, but given the historical treatment of intersex/DSD/VSC kids in terms of surgery to force conformity to assigned sex there is at least some commonality of issues.
It seems to me that one of the things we've learnt from the Olympics fiasco is that public figures including Richard Dawkins not only have an overblown egotistic faith in their own powers of observation, they also seem to see absolutely no difference between trans, genetic intersex and masculinity.
I don't think we should join in with this conflating of issues and (in my opinion) inaccurate scapegoating.
I'd be interested to read something on the topic of trangender medical ethics written by a trans person. There exists academic literature, although I've no idea if it has been written specifically by people with direct and personal experience.
Allen et al. (2024) sets out the "four nonhierarchical principles" in bioethics as respect for autonomy, beneficence, nonmaleficence, and justice.
On the topic of puberty blockers they conclude:
There is no clear inherent violation of the four principles of biomedical ethics in offering puberty blockers to youths who request them, are able to provide meaningful assent, and can either consent on their own or obtain the permission of a substitute legal decision-maker. Further restricting access to puberty blockers for transgender and gender-questioning youths may be contrary to the principle of justice since puberty blockers are widely available for central precocious puberty without an evaluation of gender identity
I think this framework for understanding the bioethics is quite helpful, specifically in that it highlights that the principles are a balance, so that even if there was shown to be some negative impacts on the health of trans people given any specific medical intervention, this has to be balanced against the benefits.
From an earlier section of that paper:
For instance, concerns over bone density loss associated with puberty blockers must be weighed against respect for gender self-determination, potential mental health benefits, the possibility of avoiding future surgical interventions, and the potential harms of not providing treatment. (my bold)
In my opinion there is too much weight given in many of the discussions about trans healthcare which downplay the individual, in a way that would be unacceptable in other medical ethics contexts. Cass to me seems to have fallen into a hole of promoting poorly argued bioethics and the British government seems to have decided that it is authoritative.
Also see this recent letter to Scientific American from Horton and Pearce
Since its 2020 inception, the Cass Review’s anti-trans credentials have been clear. It explicitly excluded trans people from key roles in research, analysis and oversight of the project, while sidelining most practitioners with experience in trans health care. The project centered and sympathized with anti-trans voices, including professionals who deny the very existence of trans children. Former U.K. minister for women and equalities Kemi Badenoch, who has a history of hostility toward trans people even though her role was to promote equality within the government, boasted that the Cass Review was only possible because of her active involvement.
Maybe I'm missing something, but I don't understand why trans and intersex are in the same conversation.
Plenty of trans people are not intersex. As far as I understand, intersex people don't necessarily see themselves as part of the trans community. Medically the issues are likely different.
Philosophically I don't see how assigning people with unusual genetics has any relation whatsoever to a discussion about medication for trans children.
It is true that most recently it was @Arethosemyfeet who brought DSD/intersex into the conversation but on previous pages I have so we can share the blame.
No one is suggesting that the two should be conflated. In fact, I've been very clear about the boundary lines. However the conversation is instructive and can help here. Many anti-trans bigots resort to 'biology' as their main line of attack. My very long posts above show how ridiculous this argument is in its own terms
From a medical perspective there's also a model of care for DSD that has been adapted for gender dysphoria. The main difference is thar DSD is a tertiary service with about 20 centres in the UK,whilst gender dysphoria is quarterniary with one or two places
Many trans / non-binary people may want to discuss their lives and experiences far beyond the medical paradigm. I mean, obviously! But the kick off point for this particular discussion is nation policy on medical care for trans youths. And obviously, this is my expertise. (Although limited in the ways I have indicated, I think I am the only one on the ship who can bring this knowledge and perspective).
Additionally there is a huge cross over in the legal frameworks. Some jurisdictions have more than one legal sex. Most, including the UK, do not.
I accept that we need to be careful about lumping together groups with different lived experience and I believe we have done so. But the topic is relevant to the conversation.
Moreover, the story of David Reiner, I linked to demonstrates the fact that gender is not just a social construct, there is something intinsic as well. Which is what Trans people have been telling us. I am listening and I'm saying they have science on their side.
It is true that most recently it was @Arethosemyfeet who brought DSD/intersex into the conversation but on previous pages I have so we can share the blame.
No one is suggesting that the two should be conflated. In fact, I've been very clear about the boundary lines. However the conversation is instructive and can help here. Many anti-trans bigots resort to 'biology' as their main line of attack. My very long posts above show how ridiculous this argument is in its own terms
From a medical perspective there's also a model of care for DSD that has been adapted for gender dysphoria. The main difference is thar DSD is a tertiary service with about 20 centres in the UK,whilst gender dysphoria is quarterniary with one or two places
I wasn't intending to 'blame' anyone, I simply didn't understand the relevance. I still don't.
The part about the model of care seems to me to be problematic in that it appears to be transfering bioethics developed in the medical treatment of one group of patients to another, essentially unrelated, group of patients.
I'm not a medic so perhaps I'm wrong, but I don't think that there is evidence that many teens experiencing gender dysphoria have (for example) genetic issues like extra chromosomes. If that's correct, why would you want to import a model for the majority of trans which was developed for intersex (or whatever other term is better) people?
The whole thing makes no sense to me. I don't even really understand what similarities there could possibly be.
Well, it’s been over two decades since I got my bachelors degree in biochemistry but I have certainly found AFZ’s contribution helpful and enlightening. Especially the idea - unevidenced of course but eminently plausible - that there may be a biochemical explanation for the transgender experience. I don’t think such an explanation would detract from the lived experience or treatment of transgender people in the least, quite the reverse in fact, I think it would provide firm evidence to confirm and legitimise it. Perhaps that evidence shouldn’t be needed in an ideal world, but that’s not the world in which we live.
Moreover, the story of David Reiner, I linked to demonstrates the fact that gender is not just a social construct, there is something intinsic as well.
I'm not sure it does - a lot hangs on the sentence, "he always 'felt' male". Unless you examine how he acquired his understanding of "maleness", you can't say whether or not the concept of gender is itself intrinsic.
But that story is rather disturbing, to the extent that the psychologist involved used the case, in effect, to test his theory that gender identity is malleable. (And it gets deeply disturbing.)
What the story demonstrates to me is that trying to deny our inner sense of who and what we are can be really harmful.
Well, it’s been over two decades since I got my bachelors degree in biochemistry but I have certainly found AFZ’s contribution helpful and enlightening. Especially the idea - unevidenced of course but eminently plausible - that there may be a biochemical explanation for the transgender experience. I don’t think such an explanation would detract from the lived experience or treatment of transgender people in the least, quite the reverse in fact, I think it would provide firm evidence to confirm and legitimise it. Perhaps that evidence shouldn’t be needed in an ideal world, but that’s not the world in which we live.
Thanks Marvin. I especially agree with your last two sentences. I am being careful because I know that as a medical professional with genuine specialist experience* I know quite a lot but as a cis-hetro-male, I am incredibly ignorant of so much.
I simply didn't understand the relevance. I still don't.
The part about the model of care seems to me to be problematic in that it appears to be transfering bioethics developed in the medical treatment of one group of patients to another, essentially unrelated, group of patients.
I'm not a medic so perhaps I'm wrong, but I don't think that there is evidence that many teens experiencing gender dysphoria have (for example) genetic issues like extra chromosomes. If that's correct, why would you want to import a model for the majority of trans which was developed for intersex (or whatever other term is better) people?
The whole thing makes no sense to me. I don't even really understand what similarities there could possibly be.
1. Bioethics are universal. In fact, there's a lot of agreement about the principles we should use. The real challenge is how they apply to individual situations. The so called four-principles approach comes from work by Tom Beauchamp and James Childress in the 1970s. I will come back to that in a separate post.
2 . The model of healthcare for DSD is that patients are seen in a multidisciplinary clinic. In the room is at least one of each of the following: A paediatric surgeon (with a special interest in urology)
A paediatric endocrinologist
A psychologist
A youth worker
A Specialist Nurse
(And some trainees like what I used to be).
Children with DSD often need surgery quite apart from genital surgery and I'll leave the debate about which procedures and when to do them there for now.
These clinics will discuss all the patients together and each patient will see the clinical professionals they need to see.
(In a half day, such a clinic will see 4-6 patients which makes this a very expensive clinic to run).
Now, I have no direct experience withgender dysphoria clinics but if you remove the surgeons from the list (as rightly (IMV) surgery in childhood is not part of gender dysphoria care) and you have a pretty good starting point for how you would want to run such a clinic. These are the professionals you need. That's what I mean by 'model of care.'
Treatment of all rare conditions uses similar models where you substitute in the relevant sub-specialist expertise.
When you look at the medical needs of both groups they are quite similar. The main difference will be that trans kids need to see a paediatric endocrinologist with a special interest in gender dysphoria whilst a child with DSD will need a paediatric endocrinologist with a special interest in DSD. That may well be the same person, in some cases and this doctor would definitely also look after children with thyroid problems, adrenal disease and diabetes.
3. The majority of teens with gender dysphoria do not have chromosomal, genetic or demonstrable biochemical anomalies. Which is why they need and deserve their own service. That does not mean there is not a cross over in the needs of both groups. There is. There is also cross over in the medical knowledge and the legal framework. Hence my view that we can enhance the conversation by considering the similarities and the differences carefully.
Ok but how does that relate to the ethics of the issue we are discussing here, which is about puberty blockers? Given that trans children are not receiving surgery, which from what you've said intersex children might, how is the care similar? How is the model similar? Surely if there is some kind of ban on aspects of trans healthcare for teens, it must therefore be necessity because different.
I'm obviously aware of the four-principles (I brought them up!), I'm also aware that they're a balance to be considered by the professional team.
Of course. But other than (some of) the medics being the same, I'm still not understanding how there is necessarily the same care for trans children and intersex children.
We've obviously got historical examples where different groups of patients in the same clinic got different standards of care.
Furthermore, if the bioethics were universal (which to me is a nonsense phrase) wouldn't Cass have come to the same conclusions as other medics working in the field? Indeed doesn't the existence of the Cass report suggest that it is possible to be medic with experience in the field using the accepted framework of medical bioethics and ome to different conclusions about the puberty blockers than others?
Or are you saying that puberty blockers are commonly a part of the care for intersex children? Maybe that's the point I'm missing.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
Trans people include those who identify their gender as non-binary, agender, and various other descriptors. Observation says that whatever gender is, it's significantly less binary than biological sex. A lot of older ways of thinking about transgender issues are very binary, and those don't seem to fit the data.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
Trans people include those who identify their gender as non-binary, agender, and various other descriptors. Observation says that whatever gender is, it's significantly less binary than biological sex. A lot of older ways of thinking about transgender issues are very binary, and those don't seem to fit the data.
Again, one could believe this ("that one’s true, inner gender is A, while one’s body is sex B," etc.). One is not constrained to believe this. It's one way among others that someone who believes in philosophical essentialism (vs existentialism) might believe about such matters. The question of whether gender is or is not ultimately, on a metaphysical level, binary or not is still a philosophical question. (One could (note the word "could"--not "must") also argue that gender is ultimately binary, but that within Creation, all things (including humans) experience gender as a polarity rather than being absolutely one or the other. Or possibly multiple genders of different aspects of any given entity/object within creation, so for example the acetaminophen bottle on the desk next to me could be masculine in one aspect, feminine in another, etc., while the tablets inside it could have other aspects, the label on the bottle, etc. Ditto for rocks, trees, animals, angels, and humans. But this again is on a philosophical and metaphysical level.)
On the etiological issues AFZ discusses some may find this paper from 2006 of interest. (If it looks familiar it’s because I’m pretty sure I’ve linked to it at least twice since we started taking about these issues in 2018.) I gather the research that is cited here is no longer state of the art but AFZ mentioned he was interested in reading something with trans input which this paper has:
Julia Serano’s book Whipping Girl (a horrible title for what is in many ways an excellent book) has some helpful discussions of how gender is and is not a social construct - or at least, discussions I remember agreeing with. The book also has some less excellent moments (I remember thinking she should not take quit her day job to take up movie criticism) but on the whole I think a very helpful perspective on gender theory from a trans woman’s perspective.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
Trans people include those who identify their gender as non-binary, agender, and various other descriptors. Observation says that whatever gender is, it's significantly less binary than biological sex. A lot of older ways of thinking about transgender issues are very binary, and those don't seem to fit the data.
Which isn't too surprising, given the primacy, in Western cultures, of binary ways of thinking about the world ("binary opposition").
Again, one could believe this ("that one’s true, inner gender is A, while one’s body is sex B," etc.). One is not constrained to believe this. It's one way among others that someone who believes in philosophical essentialism (vs existentialism) might believe about such matters. The question of whether gender is or is not ultimately, on a metaphysical level, binary or not is still a philosophical question. (One could (note the word "could"--not "must") also argue that gender is ultimately binary, but that within Creation, all things (including humans) experience gender as a polarity rather than being absolutely one or the other. Or possibly multiple genders of different aspects of any given entity/object within creation, so for example the acetaminophen bottle on the desk next to me could be masculine in one aspect, feminine in another, etc., while the tablets inside it could have other aspects, the label on the bottle, etc. Ditto for rocks, trees, animals, angels, and humans. But this again is on a philosophical and metaphysical level.)
I see in the above a tendency towards conceiving the issue in binary terms - do you think this reflects the general extent to which our thinking is (predominantly) Western, or maybe that it emerges (more specifically) from an essentialist perspective?
Comments
Did you feel a conservative government would be less transphobic ?
I've always felt that about being a man. I'm not interested in biological and psychological descriptions, that's not who I am. I don't exist in the third person.
No, I’m asking exactly what I asked. I don’t think that trans ontology need rely on the notion that “gender identity is by definition a mental construct.” One could believe that one’s true, inner gender is A, while one’s body is sex B, and also believe that their gender A is objectively real, gleaned from reality rather than imposed on it, without any existentialism at all—say for instance that one’s soul/spirit is gender A in a sex B body.
That sounds like a distinction without a difference to me.
That’s kind of what I mean—some things I can see as being “social constructs” (we agree on pieces of paper as money) and others not (justice as a transcendent reality). But I wouldn’t describe myself as a social constructionist.
I think it makes all the difference in the world. Or beyond the world. Or transcending it, technically. And my question is still relevant, I believe—if one does not believe in existentialism, how does one approach the notion that “gender identity is by definition a mental construct”?
(But people who consider themselves to be a different gender than their apparent biological sex have been around for thousands of years longer than the philosophy of existentialism. If reality is already there, with intrinsic, pre-existing meaning to be perceived by us, rather than to have meaning stamped on it by us, then in trans ontology, one could argue that a trans person’s true, intrinsic gender is the gender they perceive themselves to be, like a man’s soul in a woman’s body or vice versa, not just a human construct at all, but a metaphysical reality.)
I really don't see "souls" as anything other than a collection of mental constructs, inasmuch as when people ascribe attributes to souls they look like mental attributes to me. So I'm really struggling to see any real difference between having a soul with gender X and having gender X as a mental construct.
I would be very wary of tying gender identity to a religious concept of metaphysical souls.
I don't think I've read trans perspectives on this so would be interested if anyone has and could highlight them.
Well, as I said, one could argue this—not that one must—and like a man’s soul in a woman’s body, not exclusively as a man’s soul in a woman’s body. And of course this is predicated on the idea that reality, external reality, reality whose intrinsic meaning simply *is*, is the way things work, rather than existentialism.
As I understand it, existentialism is the notion that existence precedes essence—that things in general are just “stuff” without intrinsic meaning, without an intrinsic essence—and that we as humans stamp it with our ideas of “meaning” or “essence.” Essentialism (philosophical essentialism) is the reverse, and was generally held by most western societies before existentialism came about—that, whether any humans are or were around to perceive the essence or meaning of things, those things already have intrinsic “meaning” or “essence,” and it’s ours to perceive as best we can, rather than to make up and imprint on things.
If one believes in metaphysical souls (whatever one’s religion may be), then one may certainly believe (or not) that those souls have gender. That could be one way (not necessarily the only way) that one could hold to philosophical essentialism, rather than existentialism, and believe in trans ontology.
(Er, for anyone out there who cares, ontology has to do with “what things are,” their essence and (usually intrinsic) nature.)
And from there it's a short step to asserting that any cisgender woman who does not conform to your idea of how a woman should look and behave cannot be a 'real' woman, as was recently demonstrated by the furore over Olympic boxing. All this speculation over male and female souls is fascinating, but doesn't help my (cisgender) friend, who would quite like to use the women's loos without being challenged to prove that she's female despite having short hair, no makeup and a penchant for wearing cargo trousers and stompy boots.
The real threat to women's safety is violence from men, fuelled by misogyny. And the TERFs have allied themselves with the misogynists.
I was always taught that there’s no such thing as “male” or “female” clothes, and it’s sexist to say otherwise.
Far from it, because physical reality can be changed. Medical procedures exist that can physically transform a body from male to female (or vice versa). I’ll grant you that it changes the point at which you consider the change of gender (as opposed to the desire for such a change) to apply.
In the society in which we live if you turn up to work in a shirt dress to work as an estate agent, or in some other fairly conventional setting, and you identify as male - the focus of your day will become other people’s reactions to the dress.
It should not be that way - and that is why many people would say fuck the gender binary - but currently in UK society it is.
(If you don’t believe me, buy one that fits you - try it and see.)
I think in general a socially liberal Tory government would be somewhat more likely to enact trans-friendly legislation than a government led by the Labour Right.
The former would come at it from a individualistic perspective of personal choice rather than one of equality, of course, but it accounts for May's inherited position around GRCs - which was similar to the policy seen as highly problematic when the SNP ran with it several years later.
The latter is not only hemmed-in by their fear of the press, but having gone with 'reasonable concerns' it now runs counter to the conception they have of their own voting coalition. Lisa Nandy is a good illustration of this, primarily because she's a weathervane and will twist her politics to fit the moment. Sometime in the weeks around the election she deleted all the mildly trans-supportive tweets that she made.
Of course, the type of Tory party that would run a liberal social platform is also likely to be a distant memory.
[For similar reasons if cannabis were ever legalised in the UK it would be unlikely that a purely Labour-led government would do it]
Jenkins was an exception, on this and many other issues Labour are only going to change policy by being subject to political pressure.
No but we got a Labour government with transphobes in key roles like health who immediately doubled down on what the far-right Tories were doing to trans people.
There's a limit to how far you can ask people to vote for that sort of thing without utterly extracting the urine. Look at how badly they fared in some seats with a large Muslim population which returned independents when they decided they weren't going to take it anymore. People have limits on being expected to vote for those who treat them and those they care about like trash.
What do you do if you don't want to be ruled (effectively) by the Murdoch press, Mail and Express and our nasty Scottish press and their scapegoating campaigns? Who do you vote for? Starmer appears to have made a deal with the Devil for his part
https://inews.co.uk/news/leveson-inquiry-part-two-wont-ahead-3182097
Ultimately no minority is safe when parties of government take their cue from irresponsible people who've a business interest in driving moral panics. That needs to be dealt with. It would require discussing in detail on its own thread - but in passing - a lot this week has been said about social media and not nearly enough about what legacy media has done to drive panic about immigration. There's been some convenient amnesia from politicians who courted those same papers and media and attacked the minorities they told them to attack.
Transphobia is bad because it hurts trans people and, in addition, it comes with a whole package of other prejudices being ladled out by the same press - prejudice against immigrants, racism, prejudice against disabled people, attacks on bodily autonomy, attacks on anyone seen as gender non-conforming or non heterosexual and Labour is not rooting that stuff out - it's decided to play pick and mix. Labour thinks its voters can have a bit of scapegoating as a treat, so long as it brings in enough right wing voters to make up for those being thrown under the bus.
I don't blame people for voting Green, independent and Lib Dem instead (and instead of the SNP too), it's the only way they will learn it has a cost and we don't all read The Sun and Daily Record.
Labour did their electoral calculus and decided that they would throw trans people under a bus for right wing and TERF votes, they don't now get to demand trans people's votes 'because Tories'. They decided they didn't want those votes and they don't deserve them.
And apart from anything else this is the Jenkins who concluded he couldn’t/shouldn’t stay in the Labour Party.
Yeah, but the reason he split from Labour were somewhat separate - he wasn't leaving for the cause of social liberalism.
I'm pretty sure it's mostly just the press at this point, or rather they are impressing the press by appealing to a mostly imaginary conception of the working class shared by themselves but mostly used to push policies appealing to the right (you can find the clip of Douglas Murray that was circulating this week for an example). In that, I agree with what Louise said above, specifically:
"What Enoch Powell says today, the Tories say tomorrow and Labour legislates on the day after" - Sivanandan"
This is where I am at scientifically at the moment with one significant caveat. The caveat is that I have no lived experience and have no wish to pigeon-hole anyone. Some trans people may feel that talk of biological constructs or explanations might not relate to who they are as a person. I do not pretend to be remotely qualified to speak to who they are. However, I think the biology is interesting and relevant to the discussion. This has very much been my way in to this as I get very angry with bigots and transphobes abusing the science to persecute people. When you hear statements like "You can't deny biology," I can guarantee it is coming from a place of ignorance.
So the following is a little bit of human embryology followed by some speculation. I will make clear which is which. This will inevitably be a simplified description. Partly because it's a very complex topic but also because it is not fully understood. There remain important gaps in the data.
OK, Human sex differentiation. DSD is the correct terminology. "Intersex" is problematic, sadly. "DSD" is "Differences in sex differentiation" and is a whole spectrum of phenomena.
Like all mammals, we have two sex chromosomes. Women have two X chromosomes and men have an X and a Y. If you look at them closely, Y is very small and looks like a fragment of X. It has a handful of genes which are also on the X chromosome. It also has one gene which is what makes a human become male. This gene is known as either SRY "Sex-determining region of Y" or TDF "Testis determining Factor" - two names but the same thing. TDF switches on a whole host of other processes which make an embryo/foetus become male. In the absence of TDF, by default the individual becomes female.
Molecular biology is a mechanistic science. each step requires a number of biological processes and each of them can 'go wrong' in some way resulting in some form of DSD. The other important concept is how molecules interact with each other. Hormones are molecules that are released in one part of the body and have an effect in another. Typically they fail in their function if the hormone is not produced (or is dysfunctional) or if there is a problem with the receptor. Diabetes is a classic example of this. Insulin is released by the pancreas and acts on multiple cells in the body - especially in the liver - to trigger the uptake of glucose into cells. Insulin is released by the pancreas in response to glucose to regulate the level. Type I diabetes results in high blood sugar because the pancreas does not produce insulin. Type II diabetes results in high blood sugar because the receptors for insulin don't work properly. In Type II, the pancreas is pumping out plenty of insulin but it has no effect because the receptors aren't working. Biochemical pathways inside the cell work on the same principle. A molecule has to interact with the next one in the pathway to have an effect. Sex differentiation is a whole series of pathways but the big ones are driven by hormones. There are two that are important: Testosterone and AMH. We will come back to those.
The gonads are one of the first structures to form in the embryo. Until 6 weeks from conception they are 'undifferentiated' and indistinguishable between male and female embryos. This is where TDF comes in. TDF is a protein that binds to DNA and switches on a whole series of genes. The name gives away what's going on here: TDF makes undifferentiated gonads become testes. In the absence of TDF, gonads will become ovaries.
Once this switch has occurred, these embryonic testes produce Testosterone and AMH. Ovaries do not produce either. These two hormones then drive the rest of the process of making an embryo become male rather than female.
The next thing we need to talk about are the Wolffian ducts and the Mullerian Ducts. Mullerian ducts give rise to female reproductive organs; the fallopian tubes, the uterus and the upper part of the vagina. The Wolffian ducts have two purposes. In both males and females they form the ureters which connect the kidneys to the bladder. In males they also give rise to internal structures including the vas deferans (the tubes that take sperm from the testis to the urethra) and the prostate. In terms of internal development it works like this: The default is that the Wolffian duct only forms ureters and the Mullerian ducts forms the female reproductive organs. In the male embryo, the testes produce testosterone and AMH. Testosterone acts on the Wolffian ducts to form the male reproductive structures as well as the ureters. AMH stands for "Anti Mullerian Hormone." Again, the name gives away it's function, it causes the Mullerian ducts to regress and essentially disappear.
Externally is a separate process. It is relatively easy to understand once you appreciate there are two structures: The labial-scrotal folds and the phallus. Again, the default is to become female. In the female, the labial scrotal folds separate to form the vulva and give rise to the lower part of the vagina. The phallus becomes the clitoris. In males, testosterone acts on both these structures. It causes the labial-scrotal folds to become wrinkled and remain as one structure with no gap in the middle. It causes the phallus to grow. When it does it brings the urethra with it so that the opening of the urethra is at the tip of the penis. (In females the urethral opening is just below the clitoris). There is a condition called hypospadias. It is not usually considered to be part of DSD but it is where the penis develops normally except the urethral opening is not at the end of the penis but somewhere on the underside.
OK, that's the embryology. DSD occurs when one or more of these processes does not follow this course. Simplistically, testosterone determines external structures and AMH determines internal. In the absence of both (or if there is a problem with the receptor pathway), one becomes female. In the presence of both, one becomes male. One additional piece of information that's relevant here is that the adrenal glands produce testosterone. Usually in very low levels but the most common form of DSD is CAH - congenital adrenal hyperplasia - where the adrenal glands produce lots of testosterone. This can result in a girl being born with genitalia with a normal male appearance (until you examine them very closely).
Things can go awry in many different ways - as biology is rarely truly binary - but in essence all conditions included in DSD reflect some problem with the pathways I've just described. In the UK a child must be assigned to one sex by law. That is not true everywhere but it is how we work in the UK. We talk about 'virilisation.' Virilisation is the effect of testosterone on external structures so with ambiguous genitalia we have to decide if the baby is an undervirilised male or and overvirilised female.
<cont>
What is going on here is that you have a baby with XY chromosomes. The gonads became testicles and testicles produce testosterone and AMH. Because of the AMH, the internal female structures do not develop. However, whilst they have normal levels of testosterone the development does not happen normally because the receptors (or their pathways) are defective.
In complete androgen insensitivity syndrome these babies have a normal female external appearance. Many of them are not diagnosed until they are teenagers because they don't start menstruating. PAIS is much more complex because the pattern is very variable and often these children have truly ambiguous genitalia. Sometimes they are boys with a micropenis. In both cases, we are talking about an individual with XY chromosomes and gonads that became testes but the down-stream effects are incredibly variable. Some boys with PAIS have a very normal appearance. Some individuals are designated female and many CAIS patients have no discomfort about their gender, they are simply female but not fertile.
That's all science so far. Nothing I have described here is controversial. We also know that testosterone affects the developing brain. This is where it gets a little speculative because we do not understand very much about how the brain develops and we do not know very much with any certainty about the differences (if any) between male and female brains. And most importantly, even if you can map differences in brains they will be Venn diagrams with a lot of overlap. However, we do know that Testosterone has very profound effects on the brain and behaviour very early in life. There are very rare adrenal tumours that produce a lot of testosterone. I have looked after a couple of such patients. Imagine a two year old with adult-levels - i.e. post-pubertal levels - of testosterone. They tend to be very aggressive and have significant behavioural issues (as well as physical changes). The two year old is not mentally or emotionally able to cope with adult levels of testosterone. They get a lot better when you remove the tumour.
So, to summerise:
1. Sex differentiation is hormone-driven
2. The hormones that drive physical changes also act on the developing brain. We know there are effects in utero but they are very poorly understood.
3. The comparison between the various conditions (Especially PAIS / CAIS) shows how an individual who has normal levels of testosterone (for a male) may not develop male physical characteristics. Conversely, a female may develop male characteristics if they have abnormally high testosterone.
Here's the speculative bit:
Now, this is far too simplistic but imagine for a moment that there are receptors in the brain for testosterone. (There are). Now imagine that there is something wrong with these receptors in the brain whilst the receptors in all other parts of the body are unaffected. This would mean that either the brain would be in-effect under-exposed to testosterone and tend towards a more female profile in a boy. Conversely, in a girl the receptors could be 'hyperactive' and thus despite low levels of testosterone (normal for a girl), the brain tends towards a more male profile.
There is no direct evidence of what I just described but from a embryological and molecular-biology perspective, it is a virtual certainty that these processes can happen. It's a little bit like how mathematicians used Newton's laws to find Neptune and Pluto. They knew they must be there because the orbital paths of other planets indicated an effect of the gravitational force of these bodies. We know that sex hormones effect brain development. We know many ways in which the pathways go wrong in terms of driving physical development, some of which are quite subtle. Therefore there must be some effect on the brain.
Now, I do not want to take that model much further because it is all a bit too neat and boxed off for human persons. I do not think we are just our brains but our biology affects our minds. We all know this when hunger and tiredness makes us grumpy or alcohol makes us silly. However, all of that was by means of saying it is incredibly plausible that there is a biological explanation for being trans-sexual. If we want to be crude about it we are talking about a male brain in a female body or vice versa. Again, this is definitely overly simplistic for a lot of reasons but that does not stop it being part of the truth.
Finally, gender is unquestionably partly a social construct. However, it is not totally a social construct and there is an effect of biological sex independent on socialisation. This is best illustrated by a horrible story of medical negligence and appalling ethics.
The Story of David Reimer
David was born a boy but following a botched circumcision as a baby, had an unrecoverable penile injury. The doctors decided to raise him as a girl and performed gender reassignment surgery. He was raised as female until he was 14. He always 'felt' male and having learnt the truth detransitioned and lived as an adult man. Intriguingly for the biological story is that at 22 months he had both testicles removed and thus had normal female levels of testosterone throughout most of his childhood. Of course, he had been exposed to male levels of testosterone in utero and until he was 22 months old.
One final comment. If you look at adults born with DSD. Most of them are not transgender. Most of them identify as the sex they are assigned at birth. Most of them are heterosexual. However, among people with DSD, more than the average are homosexual and more than the average identify as non-cis genders.
I do not by any means have all the answers. However, I hope the above explains why I have zero tolerance with ignorant people who deny the existence of Trans people by stating biology sex is a fact.
AFZ
That’s the one - no wonder I couldn’t find it! Though my memory wasn’t too far off. Thanks
I've done training with people who have lived experience and the DSD terminology even with 'difference' was something that those people described to me first hand as pathologizing, used by doctors and they didn't like it.
Your mileage may vary but this, for example, is someone I've interviewed on the subject who speaks from lived experience
https://x.com/jennie_kermode/status/1585212881879957504?t=f1Wpr-v3tp9htGufUPb_hQ&s=09
Some articles by Jennie on the subject
https://bylines.scot/rights-and-freedoms/when-the-body-doesnt-fit-the-story/ And another article here:
https://bylines.scot/rights-and-freedoms/why-is-scotland-still-failing-intersex-vsc-children/
When it comes down to it what matters to me is what a person with lived experience wants people to use - the people I spoke to were adults with a history of horrendous medical experiences at the hands of doctors. As a paediatrician you may be speaking to children, parents and caregivers with entirely different perspectives for lots of different reasons and the preferred language may be very different.
Looking at Wikipedia for a quick survey there seems to be substantial disagreement on terms - some groups prefer DSD and some intersex.
https://en.m.wikipedia.org/wiki/Intersex
I think it's a good thing to ask people with lived experience what terminology they prefer and to follow that. Certainly some people identify as intersex and their choice needs to be respected, just as those who prefer the more medical term should have their preferences respected too.
A few years ago, the medical terminology was 'disorders of sex differentiation.' It was then changed to 'differences.'
I can only go with what I have been taught.
Having said that, I, of course, fully respect people's lived experience and their choices of terminology.
I hope you can see that I have been very careful with my choice of words and am being as sensitive as possible to all positions. I may not always be successful, of course.
https://www.patheos.com/editorial/podcasts/theology-in-the-raw/2019/760--life-as-an-intersex-christian-lianne-simon
It's quite long, and being 5 years old may reflect language and ideas that have been subject to re-thinking, the latter half of the interview focuses on intersex medical issues.
Plenty of trans people are not intersex. As far as I understand, intersex people don't necessarily see themselves as part of the trans community. Medically the issues are likely different.
Philosophically I don't see how assigning people with unusual genetics has any relation whatsoever to a discussion about medication for trans children.
I think I introduced intersex/DSD/VSC into the conversation. My point was speculative - wondering if there is a biological determinant (remembering that the brain is biological and and mind/body dichotomy is somewhat illusory) for some or all instances of being trans and whether such a determinant would logically group transness(!) with intersex/DSD/VSC experiences.
It's certainly not obvious right now that this is the case, but given the historical treatment of intersex/DSD/VSC kids in terms of surgery to force conformity to assigned sex there is at least some commonality of issues.
I don't think we should join in with this conflating of issues and (in my opinion) inaccurate scapegoating.
Allen et al. (2024) sets out the "four nonhierarchical principles" in bioethics as respect for autonomy, beneficence, nonmaleficence, and justice.
On the topic of puberty blockers they conclude:
I think this framework for understanding the bioethics is quite helpful, specifically in that it highlights that the principles are a balance, so that even if there was shown to be some negative impacts on the health of trans people given any specific medical intervention, this has to be balanced against the benefits.
From an earlier section of that paper:
https://www.tandfonline.com/doi/full/10.1080/26895269.2024.2303462#infos-holder
In my opinion there is too much weight given in many of the discussions about trans healthcare which downplay the individual, in a way that would be unacceptable in other medical ethics contexts. Cass to me seems to have fallen into a hole of promoting poorly argued bioethics and the British government seems to have decided that it is authoritative.
Also see this recent letter to Scientific American from Horton and Pearce
https://www.scientificamerican.com/article/the-u-k-s-cass-review-badly-fails-trans-children/
It is true that most recently it was @Arethosemyfeet who brought DSD/intersex into the conversation but on previous pages I have so we can share the blame.
No one is suggesting that the two should be conflated. In fact, I've been very clear about the boundary lines. However the conversation is instructive and can help here. Many anti-trans bigots resort to 'biology' as their main line of attack. My very long posts above show how ridiculous this argument is in its own terms
From a medical perspective there's also a model of care for DSD that has been adapted for gender dysphoria. The main difference is thar DSD is a tertiary service with about 20 centres in the UK,whilst gender dysphoria is quarterniary with one or two places
Many trans / non-binary people may want to discuss their lives and experiences far beyond the medical paradigm. I mean, obviously! But the kick off point for this particular discussion is nation policy on medical care for trans youths. And obviously, this is my expertise. (Although limited in the ways I have indicated, I think I am the only one on the ship who can bring this knowledge and perspective).
Additionally there is a huge cross over in the legal frameworks. Some jurisdictions have more than one legal sex. Most, including the UK, do not.
I accept that we need to be careful about lumping together groups with different lived experience and I believe we have done so. But the topic is relevant to the conversation.
Moreover, the story of David Reiner, I linked to demonstrates the fact that gender is not just a social construct, there is something intinsic as well. Which is what Trans people have been telling us. I am listening and I'm saying they have science on their side.
I'll come back to the medical ethics part.
AFZ
I wasn't intending to 'blame' anyone, I simply didn't understand the relevance. I still don't.
The part about the model of care seems to me to be problematic in that it appears to be transfering bioethics developed in the medical treatment of one group of patients to another, essentially unrelated, group of patients.
I'm not a medic so perhaps I'm wrong, but I don't think that there is evidence that many teens experiencing gender dysphoria have (for example) genetic issues like extra chromosomes. If that's correct, why would you want to import a model for the majority of trans which was developed for intersex (or whatever other term is better) people?
The whole thing makes no sense to me. I don't even really understand what similarities there could possibly be.
But that story is rather disturbing, to the extent that the psychologist involved used the case, in effect, to test his theory that gender identity is malleable. (And it gets deeply disturbing.)
What the story demonstrates to me is that trying to deny our inner sense of who and what we are can be really harmful.
Thanks Marvin. I especially agree with your last two sentences. I am being careful because I know that as a medical professional with genuine specialist experience* I know quite a lot but as a cis-hetro-male, I am incredibly ignorant of so much.
1. Bioethics are universal. In fact, there's a lot of agreement about the principles we should use. The real challenge is how they apply to individual situations. The so called four-principles approach comes from work by Tom Beauchamp and James Childress in the 1970s. I will come back to that in a separate post.
2 . The model of healthcare for DSD is that patients are seen in a multidisciplinary clinic. In the room is at least one of each of the following: A paediatric surgeon (with a special interest in urology)
A paediatric endocrinologist
A psychologist
A youth worker
A Specialist Nurse
(And some trainees like what I used to be).
Children with DSD often need surgery quite apart from genital surgery and I'll leave the debate about which procedures and when to do them there for now.
These clinics will discuss all the patients together and each patient will see the clinical professionals they need to see.
(In a half day, such a clinic will see 4-6 patients which makes this a very expensive clinic to run).
Now, I have no direct experience withgender dysphoria clinics but if you remove the surgeons from the list (as rightly (IMV) surgery in childhood is not part of gender dysphoria care) and you have a pretty good starting point for how you would want to run such a clinic. These are the professionals you need. That's what I mean by 'model of care.'
Treatment of all rare conditions uses similar models where you substitute in the relevant sub-specialist expertise.
When you look at the medical needs of both groups they are quite similar. The main difference will be that trans kids need to see a paediatric endocrinologist with a special interest in gender dysphoria whilst a child with DSD will need a paediatric endocrinologist with a special interest in DSD. That may well be the same person, in some cases and this doctor would definitely also look after children with thyroid problems, adrenal disease and diabetes.
3. The majority of teens with gender dysphoria do not have chromosomal, genetic or demonstrable biochemical anomalies. Which is why they need and deserve their own service. That does not mean there is not a cross over in the needs of both groups. There is. There is also cross over in the medical knowledge and the legal framework. Hence my view that we can enhance the conversation by considering the similarities and the differences carefully.
AFZ
*but not subspecialist experience.
I'm obviously aware of the four-principles (I brought them up!), I'm also aware that they're a balance to be considered by the professional team.
We've obviously got historical examples where different groups of patients in the same clinic got different standards of care.
Furthermore, if the bioethics were universal (which to me is a nonsense phrase) wouldn't Cass have come to the same conclusions as other medics working in the field? Indeed doesn't the existence of the Cass report suggest that it is possible to be medic with experience in the field using the accepted framework of medical bioethics and ome to different conclusions about the puberty blockers than others?
Or are you saying that puberty blockers are commonly a part of the care for intersex children? Maybe that's the point I'm missing.
Trans people include those who identify their gender as non-binary, agender, and various other descriptors. Observation says that whatever gender is, it's significantly less binary than biological sex. A lot of older ways of thinking about transgender issues are very binary, and those don't seem to fit the data.
Again, one could believe this ("that one’s true, inner gender is A, while one’s body is sex B," etc.). One is not constrained to believe this. It's one way among others that someone who believes in philosophical essentialism (vs existentialism) might believe about such matters. The question of whether gender is or is not ultimately, on a metaphysical level, binary or not is still a philosophical question. (One could (note the word "could"--not "must") also argue that gender is ultimately binary, but that within Creation, all things (including humans) experience gender as a polarity rather than being absolutely one or the other. Or possibly multiple genders of different aspects of any given entity/object within creation, so for example the acetaminophen bottle on the desk next to me could be masculine in one aspect, feminine in another, etc., while the tablets inside it could have other aspects, the label on the bottle, etc. Ditto for rocks, trees, animals, angels, and humans. But this again is on a philosophical and metaphysical level.)
https://www.gires.org.uk/wp-content/uploads/2014/09/Atypical-Gender-Development.pdf
Julia Serano’s book Whipping Girl (a horrible title for what is in many ways an excellent book) has some helpful discussions of how gender is and is not a social construct - or at least, discussions I remember agreeing with.
I see in the above a tendency towards conceiving the issue in binary terms - do you think this reflects the general extent to which our thinking is (predominantly) Western, or maybe that it emerges (more specifically) from an essentialist perspective?