Musings On WPATH -- The War Against Trans Children Is Over, Part 3

Traveling at high-speed through the French countryside I'm left to muse on the changes that have occurred in the trans medicine over the past five decades. From discussions about Harry Benjamin, who founded modern trans medicine in New York in the 50s and published The Transsexual Phenomenon in 1966, to President Obama's dedication of the Stonewall Inn as a national landmark for the 47th anniversary of the Uprising, and the fallout from the Orlando massacre, there is much food for thought.

I just finished reading an article on epigenetics by Pulitzer-Prize winning author, Siddhartha Mukherjee in the May 2 issue of The New Yorker. It's a short but fascinating introduction to the science of epigenetics, the changes to the functioning of the genome that imprint us throughout our lives and contribute to our distinctiveness. He mentions the description of "being" by Hindu philosophers as a web -- jaal -- and which I've long thought of in a similar vein, with our individuality marking our entanglements in the web with others. Epigenetics deals with the histone proteins which wrap the strands of DNA and regulate it (no, British racists, you cannot escape regulation, even by abandoning the EU), and the supposed "junk DNA" that composes much of our genome. We are human not because our DNA is very different from that of bonobos (it isn't), but because of the choreography of gene expression that begins just after conception and continues through each individual life.

In a way, genetics and epigenetics help explain gender identity and gender expression. Our identity is hardwired -- fixed -- in our genome, and the expression of that identity is then managed through epigenetic effects (firmware). Our gender identity is part of our overall identity, which is then expressed through the web of gene regulation, and beyond through hormonal and neural networks.

As the train pulls into Brussels and the heavy police presence becomes evident, I'm reminded of the better part of our nature and harken back to a presentation by Diane Ehrensaft I mentioned in my last column. Diane, describing the differences among gender-variant children -- trans girls, gay boys, and gender-expansive kids -- mentioned, somewhat off-handedly, that the first group is evidence primarily of biology, the second mostly of environmental inputs, and the third of culture. That's a very handy way of thinking of the different groups, but I got to thinking about the political reality of it all. My thoughts were encouraged when I passed a guy in the club car who was dressed in a bandeau, miniskirt and wearing a pink wig. One need not be an essentialist to see that is clearly not a biological state of being, so maybe there is something to this tripartite classification.

We know there are genetic variations that create a host of intersex conditions which have an LGBT component to them. Androgen Insensitivity Syndrome (AIS), as one example, includes individuals with XY sex chromosomes, undescended testes and a female gender identity. We've discovered some examples of trans women with genetic variations in the androgen receptor. We know that diethylstilbestrol (DES), an endocrine disruptor, causes an increased incidence of homosexuality and transsexualism. So we know that sexual variation has a basis in both the genome and epigenome.

Studies are showing that young trans children have natural biological variations in multiple organ systems long before they are subject to puberty blockers or cross-sex hormones (for a long time the debate was whether the biological differences in trans persons were due to hormone treatment or predated them). The accumulation of new data is implying that trans boys and girls are, indeed, "born that way." While more research will continue to be done, it seems this debate, too, is over.

Unfortunately there's been little research with gay boys, let alone genderqueer kids. I asked some of the researchers and the response was what you'd expect -- they have a hard enough time getting grant money to do the trans work; there's no chance they can branch out and answer those questions. So for the time being we're left with inferences from history and clinical work.

One type of data that leads me to believe that gay boys develop from environmental/epigenetic influences rather than genetic changes is the research data on birth order. Dean Hamer claimed there was a gay gene on the X chromosome back in 1993, and he and Michael Bailey (yes, that Michael Bailey) may have replicated that study two years ago, but the strongest, reproducible data relates to younger brothers, and it's become increasingly obvious that the effect is prenatal.

So we have, roughly speaking, trans kids who are trans from a genetic or epigenetic basis (more nature than nurture), and proto-gay kids who have been impacted by their intrauterine or post-natal environment (more nurture than nature), leaving us with the gender-expansive children. History is full of androgynous people, going back the Biblical midrash about the first human created by Yahweh. And while there may very well be biological bases for such identities, be they intersex metabolic conditions or fetal hormonal exposure, or possibly BSTc nuclei in the hypothalamus that are comprised of neurons halfway between male and female numbers (not yet found in any research), based on the stories told at the WPATH conference it seems that Dr. Ehrensaft is correct and the phenomenon is mostly cultural. Gay boys do not yet, before puberty, have a gay identity, but they may very well have a feminine style of gender expression. The genderqueer children take that a step further.

Stories were told by clinicians of non-binary patients calling themselves many colorful names, including "demi-girls" or "nano-boys," with the common feature being "I know I'm a girl (boy), but I also sometimes feel a little like a boy (girl)." I daresay most western adults have probably felt that way, maybe often, during their lifetimes, and it's only now that it is safe to say it. Girls who played and dressed like boys have been enabled and encouraged for a very long time, since at least the 16th century, and it's always been clear that the majority of them are neither trans nor gay. Today the culture has changed sufficiently that boys can say it, too, without fear. And that's a very good thing.

We should be protecting all forms of gender expression, and our laws are generally structured to do just that. However, it's important to distinguish biological and environmental conditions from purely cultural ones. Non-binary is nothing less than a social revolution if it takes off, and it will have more far-reaching consequences than the simple acceptance of trans persons who transgress while also validating binary gender norms as well as gay persons who do the same in their relationships.

A simple example of one potential problem -- legislation that prevents discrimination on the basis of gender identity often has gender identity defined as "persistent" and "consistent" presentation in the affirmed gender. There is nothing consistent in the presentation of a non-binary person other than its non-binary nature. Many laws have exceptions for employment dress codes; will we create non-binary dress codes? How about genderqueer sports teams and leagues?

Then there's the problem of language. One cannot speak a Romance or Slavic or Semitic language in a non-binary way. Changing that will be exceedingly difficult, if not impossible. And, finally, to my pet peeve -- gender-neutral pronouns. Dr. Jo Olson presented a list of over fifty pronouns used by her patients. 50! The Swedes, at least, imposed a single pronoun, and I imagine, though I haven't spoken with any Swedes, that such a change will be manageable. Fifty pronouns are not manageable, and the use of plural pronouns only confuses people and muddles the language, making communication even more difficult than it already is. Using plural pronouns is as useful as actually saying trans*, and, fortunately, that has fallen by the wayside. May plurals quickly follow.

It's wonderful to stand up on the balcony and survey how much has changed for the better. Now we have to work not only to continue along this path, but engage with the broader and more powerful geopolitical forces that are abroad in our societies to ensure they don't take control and undo all the progress we've made the past twenty years.