Medical mistreatment of lesbian, gay, bisexual, transgender, and intersex people because they are neither Adams nor Eves! An update on the science versus the medical practice concerning sexuality from a physiologist’s perspective.
An audio recording that accompanies this slideshow can be found at:
http://freethoughtfestival.org/audio/FTF120427Drantz-ed.mp3
Better yet, watch the video in which I explain the slides as you look at them.
http://drdrantz-sciencesexuality.blogspot.com/2012/07/video-gender-binary-lgbti-people-myth.html
This PowerPoint helps students to consider the concept of infinity.
Gender Binary & LGBTI People - Myth and Medical Malpractice
1. Gender Binary
&
LGBTI People
Myth and Medical Malpractice
Presented By
Veronica Drantz, PhD
Prepared for
Freethought Festival
April 27th, 2012
2. The Myth: “The Gender Binary”
Only two sexes (male, female)
Sex = Gender (male = man, female = woman)
Only one kind of sexual attraction: heterosexual
3. LGBTI People - Medical Malpractice
Victims Because They Are
Neither Adams Nor Eves
L = Lesbian
G = Gay
B = Bisexual
T = Transgender
I = Intersex
4. Organization-Activation Mechanism
of Sexual Development in Mammals
“Organization”
– Sexual organization of body before birth
Genetic (XY or XX)
Hormonal (testosterone or its absence during
critical periods)
“Activation”
– Maturation/functioning at puberty
Hormonal from ovaries or testes
5. Sexual Development in Mammals
Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and
development in humans. MIS, müllerian inhibiting substance; T, testosterone; DHT,
Dihydrotestosterone
7. Mechanism of Androgen
Hormone Action
Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).
8. Males are Altered Females!
Everybody is a variation on
the female theme
– Default (female)
– Fully altered (male)
– Partly altered (intersex)
9. Intersex People
Differ physically from the
“standard” male or female
There are many different kinds of
intersex people
Some kinds of intersex people have
ambiguous genitalia
Demonstrate that organization-
activation mechanism works in
humans
12. Sexual Identity & Orientation –
Nature or Nurture?
We don’t learn or choose our genitalia.
What about sexual behavior?
Evidence for Organization-Activation
Mechanism in the brain
– Nonhuman mammals
– David Reimer story
– Sexuality of intersex people
– Human brain work (trans, gay)
13. Development Of Sexual Brain
– the “Animal Work”
Brain-organizing action of fetal
testosterone discovered (1959)
Over the years, evidence for the
“determining influence” of
prenatal hormones has
accumulated in numerous
mammals
14. Hypothalamus
Instinctive Drives &
Behaviors
– Hunger
– Thirst
– Sleep
– Body rhythms
– Sexual function
Interconnected with
amygdala (emotion)
Ancient - similar in
all mammals Netter, Frank H. The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS. Vol I.
Nervous System. Part I. Anatomy & Physiology. New York: CIBA (1983)
15. Sexual Behavior Is Controlled by
Anterior Hypothalamus
Sexually-dimorphic nuclei in this region
16. The Gender Binary Ethos Of Medicine
Is Most Vividly Illustrated In Its
Treatment Of Intersex People
John Money Milton Diamond
“Psychosexual “Sexuality-at-Birth
Neutrality-at-Birth” Theory
Theory Organization-Activation Mechanism
“Optimal Gender of Rearing policy” -Evolutionary view
-Requires conventional genitalia -Began challenging Money when only
and patient deception about grad student
sexual status at birth
19. Sexuality Of Intersex People
Consistent with prenatal hormonal hypothesis
– CAIS: female sexual identity
– PAIS: sexual identity unpredictable
– CAH: majority are heterosexual women but
incidence of bisexual and lesbian orientations is
above controls and correlates with degree of
prenatal androgenization
– Cloacal exstrophy: genetically and hormonally
male-born children may identify as males despite
being raised as females and undergoing
feminizing genitoplasty at birth
20. Biology of Sexual Identity
Fa'afafine
A broadly accepted social class in Samoa
21. Bed Nucleus of the Stria Terminalis
Figure 2: Representative sections of the BSTc innervated by vasoactive intestinal polypeptide
(VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female
transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and
B: small sized medial subdivision (BSTm), and large oval-sized central subdivision (BSTc)
In anterior hypothalamus
Necessary for sexual behavior in animals
Receives input from amygdala
Size of BSTc - not influenced by sex hormones in
adulthood
22. 2nd Study on BSTc
Male-to-female transsexual has
BSTc in the female range
S7: male, lifelong female
identity, never “treated”- within
female range
FMT: number of neurons is fully
within the male range
23. Genetics of Transsexuality
MtF– linked with longer version of
gene for androgen receptor that
weakens testosterone effect
FtM - linked with gene variant for
an enzyme that causes higher
concentrations of androgens and
estrogen in developing brain
24. Biology of Sexual Orientation
Anthropological
evidence - gay
people everywhere
“Gay people have a
different sensibility”
Sandra Witelson, PhD
Same-sex behavior
in nearly all animals
26. More Evidence For Innate Gayness
2nd human study confirmed INAH3 finding
Gay sheep brains
– About 8% of rams are exclusively
homosexual
– “Duplicated” human INAH3 work
Sex pheromone effects in anterior
hypothalamus correlate with sexual
orientation
Genetic components – gayness, lesbianism
27. Summary of the Science
“…gender identity and sexual orientation are
programmed or organized into our brain structures
when we are still in the womb”
“…since sexual differentiation of the genitals takes
place in the first two months of pregnancy and sexual
differentiation of the brain starts in the second half of
pregnancy, these two processes can be influenced
independently, which may result in extreme cases in
transsexuality.”
“This also means that in the event of ambiguous sex
at birth, the degree of masculinization of the genitals
may not reflect the degree of masculinization of the
brain.”
“There is no indication that social environment after
birth has an effect on gender identity or sexual
orientation”
28. Medical Malpractice Against
LGBTI People
The medical profession has pathologized
and stigmatized gender-variant peoples
Medical policy has been to “fix” LGBTI
people - attempting to make them conform
to the gender binary
29. Medical “Care” of Gay/Lesbian People
Methods used in attempt to change sexual
orientation
– Hormonal treatments
Castration
Administration of testosterone or estrogen
– Psychoanalysis
– Vomiting induced in combination with homo-erotic pictures
– Psychosurgery (lesions in the hypothalamus)
– Electroshock treatment
– Chemical induction of epileptic insults
Homosexuality has been classified as “crazy”
since first version of DSM and was deleted
only after political activism!
30. “Reparative Therapy”
by Quacks Continues
Therapy involves “…counseling to acting
out scenarios to in some cases shock
treatment”
American Psychological Association has reported that efforts
to change a person’s sexual orientation not only don’t work
but cause harm (loss of sexual feeling, depression, anxiety,
and suicidality)
31. Anti-Trans Quackery Continues
Gender identity disorder is a bogus
diagnosis!
World Health Organization and the American
Psychiatric Association continue to list the
condition as a mental illness, rather than a
medical condition
Reparative therapy quacks are revising the
DSM!
Draft of DSM-V: Gender Identity Disorder
has been replaced with Gender Dysphoria
32. Genital Mutilation
of Intersex Babies Continues
Whatever happened to: informed consent?
Whatever happened to: “first, do no harm?”
34. More Intersex Mistreatment
No moratorium on genital normalization
surgeries
Parental distress & prejudice still used to
justify damaging surgery
Pediatricians voted to not inform former
patients of their intersex status and
previous medical treatments
New pathologizing terminology: (2006)
“Disorders of Sexual Development”
“Gender Dysphoria in DSD” recommended
for the DSM-V (Intersex people will now be crazy if unhappy
with assigned gender!)
35. Reform LGBTI Medical Care!
Scientific message that “core
sexuality is innate” needs to reach
everyone
LGBTI people are natural variations
- different, but not disordered!
Health and happiness of LGBTI
patients should be medical goal
Ethical guidelines for medical
treatment of LGBTI people should
be established
36. Medical policy
should be based on
scientific evidence and
ethical principles
- NOT religious myth!