The Psychobiology of Transsexualism and Transgenderism
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The Psychobiology of Transsexualism and Transgenderism This page intentionally left blank The Psychobiology of Transsexualism and Transgenderism A New View Based on Scientific Evidence • Thomas E. Bevan, PhD Copyright © 2015 by Bevan Industries, Inc. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, except for the inclusion of brief quotations in a review, without prior permission in writing from the publisher. Library of Congress Cataloging-in-Publication Data Bevan, Thomas E., author. The psychobiology of transsexualism and transgenderism : a new view based on scientific evidence / Thomas E. Bevan. p.; cm. Includes bibliographical references and index. ISBN 978-1-4408-3126-3 (alk. paper) – ISBN 978-1-4408-3127-0 (ebook) I. Title. [DNLM: 1. Transsexualism–etiology. 2. Sexuality–psychology. 3. Transgendered Persons– psychology. 4. Transsexualism–genetics. 5. Transsexualism–physiopathology. WM 611] RC560.G45 2015 616.6ʹ900867–dc23 2014024279 ISBN: 978-1-4408-3126-3 EISBN: 978-1-4408-3127-0 19 18 17 16 15 1 2 3 4 5 This book is also available on the World Wide Web as an eBook. Visit www.abc-clio.com for details. Praeger An Imprint of ABC-CLIO, LLC ABC-CLIO, LLC 130 Cremona Drive, P.O. Box 1911 Santa Barbara, California 93116-1911 This book is printed on acid-free paper Manufactured in the United States of America This book discusses treatments (including types of medication and mental health therapies), diagnostic tests for various symptoms and mental health problems, and organizations. The author has made every effort to present accurate and up-to-date information. However, the information in this book is not intended to recommend or endorse particular treatments or organizations, or substitute for the care or medical advice of a qualified health professional, or used to alter any medical therapy without a medical doctor’s advice. Specific situations may require specific therapeutic approaches not included in this book. For those reasons, we recommend that readers follow the advice of qualified health care professionals directly involved in their care. Readers who suspect they may have specific medical problems should consult a physician about any suggestions made in this book. I dedicate this book to my mentor, Julian Jaynes, to my children, and to the love of my life, my darling wife. This page intentionally left blank Contents Tables and Figures ix Preface xi Acknowledgments xiii Definitions and Acronyms xv 1. Introduction 1 2. Why Understanding Transsexualism and Transgenderism Is Important 13 3. Definitions and Population Frequencies 37 4. Historical and Contemporary Cultures 65 5. Genetic Causal Factor in Transsexualism and Transgenderism 77 6. Epigenetic Causal Factor in Transsexualism and Transgenderism 103 7. The Two-Factor Theory of Transsexualism and Transgenderism Causation 123 8. Childhood and Transsexualism–Transgenderism 137 9. Adolescence, Young Adulthood, and Transsexualism–Transgenderism 151 10. Neuroanatomy and Neurophysiology 163 11. Conscious Choice and Spirituality 177 12. Psychopathology 189 13. Transition Procedures and Outcomes 207 14. Conclusion 237 viii Contents Appendix A: Suggestions for Further Reading 245 Appendix B: Organizations Serving Transsexuals and Transgender People 249 Index 253 Tables and Figures Tables 2.1 Human and cultural costs of rejecting transsexuals and transgender people 15 3.1 Summary of population frequency studies for male-to-female transsexualism 50 3.2 Summary of population frequency studies for male-to-female transgenderism 52 3.3 Summary of population frequency studies for female-to-male transsexualism 55 3.4 Summary of population frequency studies for female-to-male transgenderism 57 5.1 Studies of transsexual heritability 82 5.2 Studies of heritability of transgenderism 85 5.3 Genetic markers for transsexualism and transgenderism 88 13.1 Drugs and nominal dosages for male-to-female hormone therapy 214 13.2 Known effects of male-to-female hormone therapy 217 13.3 Potential risks and side effects of male-to-female hormone therapy 218 13.4 Drugs used in female-to-male hormone therapy 224 13.5 Effects of female-to-male hormone therapy 225 13.6 Potential risks and side effects of female-to-male hormone therapy 226 x Tables and Figures Figures 10.1 Bed nucleus of the stria terminalis (BNST), INAH3, putamen, and surrounding brain structures 165 10.2 Bed nucleus of the stria terminalis (BNST) connection to amygdala 166 10.3 Location and views of the corpus callosum 170 10.4 Gray and white matter 171 Preface We struggle against it, we fight to deny it, but it is of course pretense, it is a lie. Beneath our poised appearance, the truth is we are completely out of control. Causality. There is no escape from it, we are forever slaves to it. Our only hope, our only peace is to understand it, to understand the “why.” “Why” is what separates us from them, you from me. “Why” is the only real power, without it you are powerless. —The Merovingian in The Matrix Reloaded There are lots of “whys” about transsexualism and transgenderism. Why should a seemingly normal person risk their career, reputation, and family by cross-dressing in secret? Why do some people permanently change their bodies to be more like another sex and thus to better assume a different gender? Why do both types of people risk bullying, physical danger, abuse, and rejection? Why do they tolerate the long-term effects of having a secret life that produce preoccupation, inauthenticity, and depression? These “whys” are only the top-level of a hierarchy of whys. As the quote that opens this preface indicates, we are all out of control at the subconscious level. We have no conscious sensation and control of many of the functions of our brains and nervous systems. If we did, we would probably need a brain many times its current size to accommodate all that processing. We would be overwhelmed in thought by our own internal pro- cesses. The quote of course is from a movie written in part by Larry, now Lana, Wachowski as influenced by the Kevin Kelly book Out of Control. Kevin Kelly is the founding editor of Wired Magazine and was interested in the similarity between biological systems and computer network systems, both having sub- ordinate widgets and functions that the whole system cannot control. xii Preface So the overall question is why do transsexuals and transgender people do what they do despite wholesale cultural rejection? As detailed in this book, these behaviors have a biological basis. The evidence for this biological basis is currently spread across some 22 scientific disciplines. Everyone has at least one biological gender predisposition. Gender behavior categories are constructed by culture and vary from culture to culture in terms of number, behaviors, and flexibility. A person’s gender behavior disposition may be incongruent with a person’s culturally assigned gender behavior category. This incongru- ency results in transsexual and transgender behavior in which a person acts in a different gender behavior category from that assigned. In most binary gender system cultures, there are only two gender behavior categories, man and woman, but in some cultures there are four or five categories. Gender predisposition is a widget or a mechanism that we cannot control. It always gets a vote on our behavior starting at 3 to 4 years old when realiza- tion of transsexual and transgender behavior begins. Understanding the biological basis and the biopsychology of transsexu- alism and transgenderism (TSTG) provides us with power. Without this understanding, we lack the stronger power to appropriately set or change governmental, medical, and cultural policies and attitudes regarding TSTG. Without this understanding, we do not have the power to fully understand the human condition. Acknowledgments I acknowledge the assistance and understanding of V. E., Genny Jacks, and Patricia Bell. This page intentionally left blank Definitions and Acronyms AIS Androgen insensitivity syndrome Amygdala Brain structure controlling emotion AR Androgen receptor gene Aromatase Enzyme that catalyzes testosterone into dihydrotestosterone Autism spectrum Group of neurodevelopmental phenomena Autogynephilia Love of oneself as a woman Bakla Gender behavior category in Philippines Binary gender system System with two gender behavior categories BNST Bed nucleus of the stria terminalis Boy/man Masculine gender terms in binary gender system Bugis Indonesian subculture with five gender behavior categories CAH Congenital adrenal hyperplasia Castrati Boys castrated in childhood to preserve a soprano/contralto singing voice Cisgender Gender category in alignment with sex Consanguinity Having children with a close relative Corpus callosum Major structure connecting brain hemispheres Cross-dresser One who dresses in clothes of nonassigned gender behavior category xvi Definitions and Acronyms Cross-dressing Dressing in clothes of nonassigned gender behavior category DES Diethylstilbestrol, a drug formerly given to prevent miscarriages suspected of causing TSTG Dizygotic twins Nonidentical in terms of DNA at conception Drag Cross-dressing for performance DSD Differences in sexual development, intersex DSM-V Diagnostic and Statistical Manual, 5th edition DTI-MRI Diffusion tensor imaging magnetic resonance imaging EEG Electroencephalogram, transduction of minute electrical signals from the scalp reflecting