The Issues:
Transgender 101

Written by Dr. Dana Beyer, Equality Maryland Board Member

Transgender is an umbrella term used today to include all those who are gender variant, i.e., those persons whose sexual identity or gender expression varies from the common social forms. The group includes transsexual women and men, cross-dressers, drag queens and kings, androgynous persons, genderqueer youth and some members of the intersexed community. The common political goal today is to have human rights laws, anti-discrimination laws and hate crimes laws which include the phrase "gender identity and expression" in order to cover all of the above groups. In practice, while all gender variant persons are covered by that specific language, the laws are primarily of greatest value to those people who are most often subject to discrimination and hostility, and that translates to those transsexual persons for whom gender variance is a full-time issue. The main problems relate to identity document procurement, discrimination from employers and landlords, hostility in family court and with the police, and both physical and emotional abuse from an ill-informed and occasionally hostile population.

Why are we working to have "gender identity and expression" included? Why is this important? For several reasons. Firstly, the hodgepodge of laws in this country - municipal, state and federal - dealing with "sex" in all its forms is so variable there is no consistency under which a trans person can feel comfortable. The US Circuit Court for the 6th Circuit ruled recently that trans women are covered under Federal Title 7 protections regarding sex discrimination. Other jurisdictions have claimed that trans persons are protected under "sexual orientation" clauses, which in practice often turns out not to be the case. Ambiguity in most cases seems to put us at a disadvantage, so we are simply trying to clarify the law's intent.

Secondly, pushing for and obtaining passage of these inclusive laws is a very potent educational tool. It puts those in a position to discriminate on notice that it would be not only wrong for them to do so, but illegal as well. Most Americans are not aware of the existence of transgender individuals, except maybe from an episode of "CSI" or "The Jerry Springer Show," so these laws will encourage them to learn more. Once they understand where they need to stand to keep on the right side of the law, they can take the next step to learn that transgender persons are productive members of society who bring unique qualifications to their work and their neighborhoods.

Finally, because it is the moral thing to do. The Majority Leader of the Maryland House, during debate on passage of the gender-inclusive Hate Crimes Law, stated simply that even if there were only one transgender person in Maryland, we would be obligated as a community to stand up and protect that person's rights. We all deserve to live free and without fear in our homes, workplaces, and the streets of our neighborhoods.

Now, down to basics. What makes people transgender?

There is no one answer to that question, and, for the most part, there is still no answer at all. There have been no studies of cross-dressers or drag queens/kings since the repudiation of the Freudian paradigm. We know it's not the old "cloying mother/absent father" theory. Today's science, bolstered by the tools of molecular biology and genetics, is providing insights into the etiology of transsexualism.

What do we know at this point? Transsexualism is a subset of intersexuality, the condition of being where the different manifestations of sexuality do not line up as they do in the large majority of persons. All it takes is for one of those attributes to be of the other sex to label one as intersexed. Those attributes are as follows:

  • Chromosomal - The presence and number of X and Y chromosomes, the "sex" chromosomes.
  • Genetic - The presence and expression of various genes involved in human sexual development, i.e., SRY, DAX-1, WnT-4, Hox-10. There are at least 54 individual genes involved in complex feedback loops, both "pro-male" and "anti-male" genes.
  • Gonadal - The presence and degree of development of either testes, ovaries, both, or neither.
  • Genital - The presence and degree of development of penis/scrotum or vagina/clitoris, including variants along the spectrum between male and female (often called "ambiguous genitalia")
  • Hormonal - The relative levels and cyclicity/acyclicity of the sex (growth) hormones generally known as androgens (including testosterone) and estrogens (primarily estradiol). Also includes the presence and functioning of the cellular receptors which bind the hormones and transmit the relevant signal.
  • Morphological - The type of body one develops, including the distribution of fatty tissue, breasts development, patterns of hair growth, sweat glands, muscles and bone structure.
  • Brain Sex - The most important of all, what is often called "gender identity." The brain is sexually dimorphic, which means that there are structures in the brain that vary between males and females.

To show how this analysis works, here are a few examples:

  • Transsexuals have been found to have a region in the brain called the BSTc in the posterior hypothalamus (which is often called the "conductor" of the body's orchestra of hormones) where trans women have a female structure rather than a male structure as expected based on the chromosomes being XY.
  • Persons who were exposed to the hormone DES by their mothers to prevent miscarriage may become transsexual because of the drug's very potent estrogenic effect on the fetus.
  • Babies born with complete Androgen Insensitivity Syndrome (cAIS) have female genitals, but XY (male) chromosomes. They develop testes, produce plenty of androgens, but their cells are completely incapable of responding to the testosterone, so they develop along a female pathway. They are raised as girls, feel like girls, and often become beautiful women. They become aware of their intersexed condition at puberty when they fail to menstruate and it is then discovered they have only a shallow vagina and no other female reproductive organs along with their testes. They would be considered transsexual if one they were assigned a sex at birth based on their chromosome pattern rather than genitals. Because of cases such as these the International Olympic Committee (IOC) recently dropped sex testing using chromosomes and welcomed transpersons into competition as their reassigned sex.

So, what do we know about the causes? Very little as of this date. We know in mammals that exposure to potent estrogens (in the form of DES and other endocrine disruptors) can convert a male pup into a behaviorally female one. We have growing evidence that this happens in humans as well. There is historical evidence for the existence of transgendered persons throughout history, so the story is much more complicated. As the above description of AIS shows, there are many genetic variations which impact the developmental pathway and engender various types of intersex conditions. So the story is likely to be a complicated one. What we do know is that, like the normative categories of "male" and "female," which are far from pure in their description and categorization, intersex and transsex are normative as well.

So, if we can't do much about the causes, how about the treatments available? Based on the above discussion, many people believe they're as deserving of their lives as any other, and there should be no consideration of treatment. The psychiatric community, which after World War two took control over issues of sexual variations, is slowly coming around to acceptance. The medical community, which used to universally operate on intersexed babies with ambiguous genitalia to fit them into a distinct male or female category, now almost always will delay any surgery until the child is old enough to declare a gender and decide for herself. Medical and surgical treatment to allow transsexual persons to reconstruct their bodies to fit their minds have been used for many decades with a success rate far greater than most medical therapies, and the overwhelming majority are happy with their choice. Cross-dressers, being part-time, are still mostly in the closet and have yet to develop a political presence. Drag queens and kings generally fold into the overall gay and lesbian community politically, while the genderqueer youth are busy building their own infrastructure.

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