Myth & Science of Sexuality

Myth and Science of Sexuality:
Disordered or Just Different?
By
Veronica Drantz, PhD

Prepared for the
Ethical Humanist Society
of Chicago
October 10, 2010

The Myth: ―The Gender Binary‖

 Gametes are binary (eggs or sperm)
 Organisms that make the gametes are not binary!

The Science:
―Organization – Activation‖
Mechanism
 ―Prenatal hormone theory‖
– Organization before birth
– Activation at puberty

Sexual
Differentiation
of
Internal
Genitalia
Figure 25-4 Embryonic
differentiation of male and
female internal genitalia
(genital ducts) from
wolffian (male) and
müllerian (female)
primordia.

Sexual
Differentiation of
External Genitalia

Figure 25-5 Differentiation of male
and female external genitalia from
indifferent primordial structures in the
embryo.

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

Male Testosterone Levels

Figure 25-8 Plasma testosterone levels at various ages in
human males.

Mechanism of Steroid
Hormone Action Brain

Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).

There Is Only One Sex!
 Mammalian body plan is inherently female
 Male is altered female !!!
 Every individual‘s body plan is a variation on the
female theme
– Default (female)
– Fully altered (male)
– Partly altered (intersex)
 Everyone falls on some point of the continuum from
female (gynemorphic) to male (andromorphic)
 This sexual body plan is organized by presence or
absence of steroid hormones during the critical
period of development
 Sexual systems are activated later by steroid
hormones during puberty

Sex Has Many Levels
Primary sex
characteristic
 Genetic Sex – Chromosomes (X & Y in mammals only)

 Gonadal Sex – Ovaries/Testis
 Hormonal Sex – Estrogen/Testosterone
 Somatic Sex – Body anatomy/physiology
 Psychological Sex - Sexual identity

and then there is
 Sexual orientation

Core Sexuality –
Nature or Nurture?
 The genitalia are obviously organized before
birth, and we obviously do not learn or choose our
genetic sex, gonadal sex, hormonal sex, or somatic
sex
 But what about sexual behavior? Sexual identity?
Sexual orientation? Innate or learned/chosen?
 Is the brain, like the body, organized by the
presence or absence of sex hormones before birth?
 Evidence for Organization-Activation Mechanism
– David Reimer story
– Intersex people (AIS, CAH, cloacal exstrophy)
– Brain work (nonhuman mammals, humans)

John Money
"Neutrality-at-Birth―
Theory
 ―Sexual behavior and orientation as Psychologist

male or female does not have an
innate, instinctive basis‖
Money, J. Hermaphroditism, gender and precocity in hyperadrenocorticism: Psychologic findings. BULLETIN OF THE JOHNS HOPKINS HOSPITAL
96:253-264 (1955)

– Postulate 1: Individuals are psychosexually neutral
at birth
– Postulate 2: Healthy psychosexual development is
intimately related to the appearance of the genitals
 No evidence to support this theory (serious
flaws in Money‘s statistical and research methods)
*Cappon D, Ezrin C, Lynes P. Psychosexual identification (psychogender) in the intersexed THE CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL 4:90-106 (1959)

Milton Diamond
―Sexuality-at-Birth"
Theory
 Prenatal genetic and hormonal Biologist

influences predispose at birth to a male or
female sexual identity
 Inherent sexuality provides built-in "bias― with
which the individual interacts with environment;
sexual behavior and thus gender role, are not
neutral and without initial direction at birth
 Organization – Activation Mechanism
 Evolutionary view

1959 – Breakthrough at
University of Kansas
 Phoenix CH, Goy RW, Gerall AA, Young WC.
Organizing action of prenatally administered
testosterone propionate on the tissues
mediating mating behavior in the female guinea
pig. ENDOCRINOLOGY 65:369-382 (1959)
 Milton Diamond
– Felt that fellow scientists were too cautious failing to
link their animal findings to human situation
– Decided to write essay challenging psychosexual
neutrality theory

Diamond Versus Money
• Diamond challenges Money - 1965
• Diamond, Milton. A critical evaluation of the ontogeny
of human sexual behavior. QUARTERLY REVIEW OF
BIOLOGY 40:147 – 175 (1965)
• Over the years, animal work accumulated showing
―determining influence‖ of prenatal hormones
• Money responds to challenge - December
28, 1972
• Symposium of American Association for the
Advancement of Science ―Sex Role Learning in
Childhood and Adolescence‖
• Man & Woman, Boy & Girl: the differentiation and
dimorphism of gender identity from conception to
maturity. Baltimore, MD: John Hopkins University
Press, 1972. 311 p. (Depts Psychiatry and Pediatrics, John Hopkins Univ. Sch. Med., Baltimore, MD)

The David Reimer Story
―Identical Twins Case‖
 ―Nature-Nurture Experiment‖
– Circumcision accident destroyed
John‘s penis; Dr. Money consulted
– John is ―assigned‖ as Joan
 Same nature: same genetics, womb
 Different nurturing: raised as different genders
 Touted as a success by John Money, this
―Nurture Over Nature‖ case report became the
foundation of standard care for treatment of
certain intersex conditions, micropenis, and
accidental penile amputation in infancy

Colapinto, John. As Nature Made Him - The Boy Who
Was Raised As A Girl HarperCollins (2000)

Joan/Brenda Becomes John/David
 ―Joan‘s turning point occurred at the age
of 14, when she, on her own
initiative, began living as a boy, John.
John recalls how soon thereafter he finally
learned the truth, ―In a tearful episode
following John‘s prodding, his father told
him of the history of what had transpired
as an infant and why. John recalls: ‗All of
a sudden everything clicked. For the first
time things made sense and I understood
who and what I was.‘‖
Beh HG, Diamond M. An Emerging Ethical and Medical Dilemma: Should Physicians Perform Sex Assignment on
Infants with Ambiguous Genitalia? MICHIGAN JOURNAL OF GENDER & LAW 7: 1-63, 2000

Colapinto, John. As Nature Made Him -
The Boy Who Was Raised As A Girl
HarperCollins (2000)

David Reimer (1965-2004)

 John Money tells medical community that Joan/Brenda is a happy
girl/woman and then claims to lose track of her
 Milton Diamond finds Joan/Brenda living as David!
 When David discovered his case was medically famous and that
thousands of intersex babies had suffered his plight, he cooperated
with Milton Diamond and ―went public‖
Milton Diamond, Ph.D. & H. Keith Sigmundson, M.D. Sex Reassignment at Birth: A Long Term Review and Clinical Implications. ARCHIVES OF PEDIATRIC &
ADOLESCENT MEDICINE 151:298-304 (1997)

 Money‘s view is now discredited!

Intersex People

Curtis Hinkle - Founder
Organization Intersex International

Brain

Androgen
Insensitivity
Syndrome
 Inherited - caused by mutations in the gene for the androgen
receptor
 Recessive X-linked single gene syndrome
 Genetic males - 46 XY
 Testes (abdominal or inguinal) secrete testosterone
 No uterus or other internal female genitalia (MIS worked)
 Male internal genitalia undeveloped (Testosterone didn‘t
work)
 Female secondary sex characteristics develop (eg, breasts)
– At puberty testosterone from testes is turned into estrogen by enzyme
(aromatase) in peripheral tissues
– Often discover their condition when they fail to menstruate (No uterus)
 Julia Child was a CAIS woman

Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL MEDICINE. England: Mosby-Wolfe (1993)
CAIS People Feel Like Women!

Partial AIS (2-5):  Grade 1:
normal masculinization in utero

Cannot Predict  Grade 2:
male phenotype with mild defect
in masculinization (eg, isolated
Sexual Identity 
hypospadias)
Grade 3:
male phenotype with severe
defect in masculinization—small
penis, perineoscrotal
hypospadias, bifid scrotum or
cryptorchidism
 Grade 4:
severe genital ambiguity—
clitoral-like phallus, labioscrotal
folds, single perineal orifice
 Grade 5: female phenotype with
posterior labial fusion and
clitoromegaly
 Grade 6/7
Numbered I through 7 in order of increasing severity female phenotype (grade 6 if
(more defective masculinization) pubic hair present in
Adapted from Quigley CA, DeBellis A, Marschke KB, El-Awady MK, Wilson EM, French FS. Androgen
Receptor Defects: Historical, Clinical, And Molecular Perspectives. ENDOCRINE REV, 1
6:282; (1995) with permission.
adulthood, grade 7 if no pubic
In: Diamond, Milton and Watson, Linda Ann. Androgen Insensitivity Syndrome And Klinefelter’s hair in adulthood)
Syndrome: Sex And Gender Considerations. CHILD ADOLESC PSYCHIATRIC CLIN N AM 13:
623—640 (2004)

Congenital Adrenal Hyperplasia (CAH)

 21 -
hydroxylase
deficiency
 11 -
hydroxylase
deficiency

Figure 22-7 Outline of hormone biosynthesis in the zona fasciculata and zona reticularis of the adrenal cortex.
The major secretory products are underlined. The enzymes for the reactions are shown on the left and at the
top of the chart. When a particular enzyme is deficient, hormone production is blocked at the points indicated
by the shaded bars.
Barrett KE, Barman SM, Boitano S, and Brooks HL. GANONG‘S REVIEW OF MEDICAL PHYSIOLOGY 23 rd ed. Lange Medical Books/McGraw-Hill (2010)

Five Degrees of Virilization Affecting
the Urogenital Sinus and
External Genitalia in Females

Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And
Recalled Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81
(2004)

Congenital Adrenal Hyperplasia
(CAH)

Luria, Z., Friedman, S., and Rose, M.D. HUMAN SEXUALITY. New York: John Wiley & Forbes, C.D. and Jackson, W.F. A COLOUR ATLAS AND TEXT OF CLINICAL
Sons (1987) MEDICINE. England: Mosby-Wolfe (1993)

Frequency of CAH

Figure 4. Frequency of nonclassical and classical 21-hydroxylase deficiency in comparison with other autosomal
recessive disease incidences

Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled
Childhood Gender Role Behavior In Women And Men With Congenital Adrenal Hyperplasiz (CAH). J SEX RES, 41: 75-81 (2004)

CAH (Adrenogenital Syndrome)

Luria, Z., Friedman, S., and Rose, M.D. HUMAN
SEXUALITY. New York: John Wiley & Sons (1987)

Sexuality of CAH Women
 More male-typical play behavior as children*
 Less satisfaction with the female sex of assignment and less
heterosexual interest*
 CAH girls who show the greatest alterations in childhood play
behavior may be the most likely to develop a bisexual or
homosexual orientation as adults and to be dissatisfied with
the female sex of assignment*
 ―The finding of greater same-sex fantasy … is consistent with
the prenatal hormonal hypothesis‖**
 ―…excess prenatal androgens predispose some women to the
development of same-gender sexual orientation‖***
 ―Dose-response relationship of androgens with sexual
orientation‖ - a study of women with various forms of CAH****
*Hines M, Brook C., Conway, G.S. Androgen And Psychosexual Development Core Gender Identity, Sexual Orientation And Recalled Childhood Gender Role Behavior In Women And Men With
Congenital Adrenal Hyperplasia (CAH). J SEX RES, 41: 75-81 (2004)
**Veniegas, Rosemary C. Biological Research on Women's Sexual Orientations: Evaluating the Scientific Evidence. J SOCIAL ISSUES, (2000)
***Pattatucci, A. M. L., & Hamer, D. H. Development And Familiality Of Sexual Orientation In Females. BEHAVIOR GENETICS, 25: 407-420 (1995)
****Meyer-Bahlburg HF, Dolezal C, Baker SE, New MI. ―Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of
Degree of Prenatal Androgen Excess‖ ARCHIVES OF SEXUAL BEHAVIOR 1: 85-99 (2008),

Cloacal Exstrophy
 Rare, complex defect
of the entire pelvis
and its contents
 Associated with
severe phallic
inadequacy or phallic
absence in genetic
males
Bladder Extrophy and absence  For about 25
of the penis years, neonatal
green arrows: everted bladder; assignment to female
blue arrows the scrotum; sex has been
yellow arrows: umbilcal cord advocated for
affected males

Prenatal Androgen - Major Factor
in Development of Sexual Identity
 Genetically and
hormonally
male-born
children may
identify as
males despite
being raised as
females and
undergoing
feminizing
genitoplasty at
birth

Reiner, William G. and Gearhart, John P. Discordant
Sexual Identity in Some Genetic Males with
Cloacal Exstrophy Assigned to Female Sex at
Birth. THE NEW ENGLAND JOURNAL OF
MEDICINE, 350:333-341 (2004)

The Sexual
Brain
 Amygdala
– Part of Limbic System
– Genesis of emotions
& emotional
expression

 Hypothalamus
– Homeostasis
– Neuroendocrine Control
– Instinctive Drives &
Behavior
Netter, Frank H. The CIBA COLLECTION OF MEDICAL
ILLUSTRATIONS. Vol I. Nervous System. Part I. Anatomy &
Physiology. New York: CIBA (1983)

The
Hypothalamus
Drives You:

-Hunger
-Thirst
-Sleep
-Body Rhythms
-Sex
Barrett KE, Barman SM, Boitano S, and Brooks HL.
GANONG‘S REVIEW OF MEDICAL PHYSIOLOGY 23rd
ed. Lange Medical Books/McGraw-Hill (2010)

Anterior Hypothalamus Governs
Sexual Behavior in Mammals

Figure 25-28 Loci where implantations of estrogen in
the hypothalamus affect ovarian weight and sexual
behavior in rats, projected on a sagittal section of
the hypothalamus. The implants that stimulate sex
behavior are located in the suprachiasmatic area
above the optic chiasm (blue area), whereas
ovarian atrophy is produced by implants in the
arcuate nucleus and surrounding ventral
hypothalamus (red). MB, mamillary body

Same Anatomy of Anterior
Hypothalamus in All Mammals

 Nucleus is grey matter
region where nerve cells
synapse
 Some of these nuclei are
sexually
dimorphic, i.e., larger in
typical males than typical
females
Paredes, Raul G., and Baum, Michael J. Role Of The Medial Preoptic Area/Anterior Hypothalamus In The Control Of Masculine Sexual Behavior ANNUAL REVIEW OF
SEX RESEARCH (1997)
Allen, L. S., Hines, M., Shryne, J. E., and Gorski, R. A. Two Sexually Dimorphic Cell Groups In The Human Brain. JOURNAL OF NEUROSCIENCE, 9: 497-506 (1989)
Byne, William. The Medial Preoptic And Anterior Hypothalamic Regions Of The Rhesus Monkey: Cytoarchitectonic Comparison With The Human And Evidence For
Sexual Dimorphism. BRAIN RESEARCH 793: 346-350 (1998)

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
Homosexuality & other sexually variant
behaviors in animals is widespread
Bruce Bagemihl, Biological Exuberance: Animal Homosexuality and Natural Diversity, New York: St. Martin's Press (1999)

Examples of same-sex behavior can be
found in almost all species in the animal
kingdom — from worms to frogs to birds —
making the practice nearly universal among
animals
Bailey N, Zuk M. Same-sex sexual behavior and evolution TRENDS IN ECOLOGY AND EVOLUTION 24:439-446 (2009)

Sexual
Orientation &
INAH3

LeVay, S. A Difference In Hypothalamic Structure Between Heterosexual And Homosexual Men. SCIENCE, 253: 1034–1037 (1991)

Confirmation of LeVay‘s Findings
 2nd human brain INAH3 study
– INAH3 volume associated with sexual
orientation.
– NEW FINDING: no difference in the number of
neurons within the INAH3 based on sexual
orientation
Byne, William, Tobel, Stuart, Mattiace, Linda A., Lasco, Mitchell S., Kemether, Eileen, Edgar, Mark A., Morgello, Susan, Buchsbaum, Monte S., and
Jones, Liesl B. The Interstitial Nuclei of the Human Anterior Hypothalamus: An Investigation of Variation with Sex, Sexual Orientation, and HIV
Status. HORMONES AND BEHAVIOR, 40: 86-92 (2001)

 Sheep brain study
– About 8% of rams are exclusively homosexual
– Volume of ovine sexually dimorphic nucleus
(oSDN) is 2X bigger in ―female-oriented‖ rams
than in ―male-oriented‖ rams
Roselli CE, Larkin K, Resko JA, Stellflug JN, Stormshak F. The volume of a sexually dimorphic nucleus in the ovine medial preoptic area/anterior hypothalamus varies with sexual partner
preference. ENDOCRINOLOGY 145:489-483 (2004)

Anterior Hypothalamus Is
Activated by Sex Pheromones
 Positron emission Activation of
Subject anterior
tomography (PET hypothalamus

scans) of anterior Heterosexual
EST
males
hypothalamus while
subjects smell sex Homosexual
males
AND

pheromones
Heterosexual
AND
females

AND = progesterone derivative 4,16-androstadien-3-one Homosexual
EST = estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol (EST) EST
females

Berglund H, Lindström P, Savic I. Brain response to putative pheromones in lesbian women. PNAS 103:8269-8274 (2006)

Genetics of Gayness in Males
 Twin studies
– Concordance rates of homosexuality
 identical twins - 52%
 non-identical twins - 22%

 non twin brothers - 9.2%
Bailey JM and Pillard RC. A genetic study of male sexual orientation. ARCH GEN PSYCHIATRY 48(12):1089-96 (1991)

 Evidence for genetic markers
– A genetic hypothesis posits that homosexuality
runs in families and that genetic markers* for
sexual orientation can be found among family
members
*Markers are regions or sections of DNA that are the same among family members, suggesting the presence of a gene

– Marker in Xq28 region of X chromosome of gay
brothers
Hamer, D. H., Hu, S., Magnuson, V. L., Hu, N., & Pattatucci, A. M. A. Linkage Between DNA Markers On The X Chromosome And Male Sexual
Orientation. SCIENCE, 261: 321-327 (1993)
Hu, S., Pattatucci, A. M., Patterson, C., Li, L., Fulker, D. W., Cherny, S. S., Kruglyak, L., & Hamer, D. H. Linkage Between Sexual Orientation And
Chromosome Xq28 In Males But Not In Females. NATURE GENETICS, 11: 248-256 (1995)

Genetics of Lesbianism
The following findings are consistent with a
genetic hypothesis:
 Lesbians had significantly higher rates of
lesbian sisters, daughters, and cousins
through a paternal uncle than did
heterosexual women
Pattatucci, A. M. L., & Hamer, D. H. Development And Familiality Of Sexual Orientation In Females. BEHAVIOR GENETICS, 25: 407-420 (1995)

 Increasing rates of concordance of
lesbianism from nonidentical twins to identical
twin pairs
Bailey, J. M., & Benishay, D. S. Familial aggregation of female sexual orientation. AMERICAN JOURNAL OF PSYCHIATRY, 150: 272-277 (1993)
Bailey, J. M., Dunne. M. P., & Martin, N. G. Genetic And Environmental Influences On Sexual Orientation And Its Correlates In An Australian Twin Sample. JOURNAL
OF PERSONALITY AND SOCIAL PSYCHOLOGY, 78: 524-536 (2000)

 But lesbianism is not associated with the
locus at Xq28
Hu, S., Pattatucci, A. M., Patterson, C., Li, L., Fulker, D. W., Cherny, S. S., Kruglyak, L., & Hamer, D. H. Linkage Between Sexual Orientation And
Chromosome Xq28 In Males But Not In Females. NATURE GENETICS, 11: 248-256 (1995)

Biology of Sexual Identity
Harry Benjamin's Syndrome (HBS)
Estimated incidence of HBS is 1 in 100.000 live births

Sexual Identity &
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)
Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)

Looking at presynaptic neurons from amygdala (emotional input) synapsing with postsynaptic
neurons of anterior hypothalamus (sexual behavior)

Bed Nucleus of the Stria Terminalis

 Figure 3
– The six transsexuals are numbered T1-T6
– The patients with abnormal sex hormone levels are numbered S1-S4
– M1 and M2: postmenopausal women
Zhou, J.N. Hofman, M.A. Gooren, L.J. and Swaab, D.F.. A Sex Difference in the Human Brain and its Relation to Transsexuality. NATURE, 378: 68-70 (1995)

2nd Study: Somatostatin Results
Parallel VIP Results
 Figure 2. Representative
immunocytochemical stainings
of the somatostatin neurons
and fibers in the BSTc
– (a) a reference man
– (b) reference woman
– (c) homosexual man
– (d) male-to-female transsexual
 Note the sex difference
regardless of sexual orientation
 The male-to-female transsexual
has a BSTc in the female range
Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris W. Hofman, Michel A.,. Gooren, Louis J. G And
Swaab, Dick F. Male-To-Female Transsexuals Have Female Neuron Numbers In A Limbic
Nucleus. J CLIN ENDOCRINOL METAB, 85: 2034-2041 (2000)

Looking at postsynaptic neurons of anterior
hypothalamus receiving input from amygdala

Figure 1. FtM Has Same Neuron
 BSTc neuron numbers.
Distribution of the BSTc
neuron numbers among
the different groups
Number in BSTc as
according to sex, sexual
orientation, and gender
identity. M, Heterosexual
male reference group;
Typical Male
HM, homosexual male
group; F, female group;
TM, male-to-female
transsexuals
 The sex hormone
disorder patients
S1, S2, S3, S5, S6, and
M2 indicate that changes
in sex hormone levels in
adulthood do not change
the neuron numbers of
the BSTc
 Note that the number
of neurons of the FMT
is fully within the male
range
Kruijver, Frank P. M., Zhou, Jiang-Ning, Pool, Chris
W. Hofman, Michel A.,. Gooren, Louis J. G
And Swaab, Dick F. Male-To-Female
Transsexuals Have Female Neuron
Numbers In A Limbic Nucleus. J CLIN
ENDOCRINOL METAB, 85: 2034-2041
(2000)

Sexual Identity &
INAH3
 INAH3 cell number may be related to sexual
identity
 Propose that the sex reversal of the INAH3 in
transsexual people is at least partly a marker
of an early atypical sexual differentiation of
the brain
 Appears to be a relationship of BSTc with
sexual identity rather than with sexual
orientation while INAH3 seems to have a
relationship with both
Garcia-Falgueras, Alicia, Swaab, Dick F. A Sex Difference In The Hypothalamic Uncinate Nucleus: Relationship To Gender Identity. BRAIN, (Nov 2, 2008)

MtF – Atypical Hypothalamic
Response to Sex Pheromones
 Data implicate that transsexuality may
be associated with sex-atypical
physiological responses in specific
hypothalamic circuits, possibly as a
consequence of a variant neuronal
differentiation

Berglund H, Lindström P. Dhejne-Helmy C, Savic I. Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids CEREB
CORTEX 0:bhm216v1-bhm216 (2007)

Genetics of Transsexuality Brain
 MtF
– Significant link with a long
version of the androgen
receptor gene and
transsexualism that may
prevent androgen effect
Hare, Lauren and Harley, Vincent. BBC News–10/26/2008

 FtM
– Gene variant for 17 -
Hydroxylase* enzyme leads
to higher than average
tissue concentrations of
androgens and estrogen
hormones that may in turn
influence early brain
development
*Also called cytochrome P17

Tempfer, Clemens et al. 2008

Homosexuality – How to Explain
in Darwinian Terms?
 Samoa - More like the setting in which humans
evolved
– South Pacific island nation
– Relatively unwesternized
– Traditional, tribally-based
cultures
– Tighter-knit families
– Fewer anti-gay biases that alienate gays
– Samoan culture characterized by a high degree of
social tolerance towards fa'afines (Males who have
sex with males)
Farran, Sue and Su‘a, Alexander. Discriminating on the grounds of status: criminal law and Fa‘afafine and Fakaleiti in the south pacific. Journal
of South Pacific 9: 1-15 (2005)

Fa'afafine
A broadly accepted social class in Samoa

Fa'afafine Do ―Kin Selection‖
 Hypothesis‘ Basic Prediction:
Androphilic (―gay‖) males should direct more
altruistic behavior toward kin than gynephilic
(―straight‖) males
 Findings:
Fa‘afafines put ―significantly‖ more effort into raising
nephews and nieces
– Childcare activities
– Babysitting
– Buying toys
– Tutoring
– Exposing the children to art and music
– Contributing to daycare, medical and education expenses
Vasey, P, Pocock, D . VanderLaan, D. Kin Selection And Male Androphilia In Samoan Fa'afafine. EVOLUTION AND HUMAN BEHAVIOR, 28: 159–167 (2007)

Gay Genes Spread Through
Kin Selection
 Gay men put extra efforts into helping raise
nephews and nieces (as compared to straight
men)
 This boosts the children‘s chances of
survival, and someday reproduction
 These youths, even if not gay, might share with
their aunt or uncle a few genes promoting
homosexuality—ensuring a clutch of ―gay genes‖
in every generation

Is Gender-atypical Identity a
Mentally Distressing Disorder?
 This Samoan study afforded the
―opportunity to examine whether
gender-atypical behavior, gender-
atypical identity, and sex-atypical
identity, in and of themselves, cause
distress in sex/gender variant
individuals
 Simultaneously controlling for the
confounding effects of extreme societal
intolerance towards such individuals‖

Transsexuality Not Distressing
 Do adult fa'afafine ―recall a strong and
persistent cross-gender identification in
childhood, a sense of inappropriateness in the
male-typical gender role, a discomfort with
their sex, or distress associated with any of
the above?‖
 Conclusion: ―the diagnostic category of GIDC
should not occur in its current form in future
editions of the DSM, as there is no compelling
evidence that cross-gender behaviors or
identities, in and of themselves, cause distress
in the individual.‖
GIDC = Gender Identity Disorder in Childhood
Vasey, P., and Bartlett, N. H. What Can the Samoan "Fa'afafine" Teach Us about the Western Concept of Gender Identity Disorder in Childhood? PERSPECTIVES IN
BIOLOGY AND MEDICINE, 50: 481-490 (2007)

Summary
 The biblical genesis story ―explains‖ only
typical men and typical women; the
scientific story explains everyone!
 ―The preponderance of evidence seems
to indicate that the theory of
organization-activation for the
development of sexual behavior is
certain for non-human mammals and
almost certain for humans"
Milton Diamond. Clinical implications of the organizational and activational effects of hormones. HORMONES AND BEHAVIOR 55:621–
632 (2009)

Organization-Activation Theory
―The fetal brain develops during the
intrauterine period in the male direction
through a direct action of testosterone on
the developing nerve cells, or in the
female direction through the absence of
this hormone surge. In this way, our
gender identity (the conviction of
belonging to the male or female gender)
and sexual orientation are programmed or
organized into our brain structures when
we are still in the womb‖
Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation PEDIATRIC
NEUROENDOCRINOLOGY 17: 22-35 (2010)

Critical Periods of Genitalia
and Brain Are Different
 ―However, 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.

Core Sexuality:
Nature - Not Nurture!
 There is no indication that social
environment after birth has an effect
on gender identity or sexual
orientation‖


Three  Somatic Morphology (X axis)
Dimensions of  Sexual Identity (Y axis)
 Sexual Orientation (Z axis)
Core Sexuality
Gynecentric

Androphilic

Gynemorphic Andromorphic

Everyone occupies a
Gynephilic point in this three-
dimensional space!
Androcentric

Sex Gender
 Sex is biological
 Gender is cultural
 Gender ―traits‖ differ
from culture to culture
and from time to time Castor Semenya
Controversy over whether this
South African eighteen-year old
should be allowed to compete as
a woman continues

The ―Gender Binary‖
 We live in a ―binary gendered‖ culture with two
genders only
– Woman
– Man

 Many cultures recognize more than two genders

NORTH AMERICA
 Two-spirits – Native American
Berdache – Illiniwek (Illinois)
Muxes – Zapotec People, Oaxaca, Mexico

Muxes

Two-spirits

Thanks to Lorelei Erisis
http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/

SOUTH AMERICA
 Travestís – Brazil
Bichas
Viados
Guevedoche – Dominican Republic
Quariwarmi – Incan

Viados
Travestís


EUROPE
 The Sworn Virgin – Balkans Sworn Virgin

Catamites – Ancient Greece
Mollies – Modern England
Tertium genus hominum (a
third human gender) ―eunuchs‖
– Ancient Eastern
Mediterranean

Catamites Sworn Virgin


AFRICA

Mashoga

 Ashtime – Maale culture of Southern Ethiopia
Mashoga – Swahili-speaking areas of the
Kenyan coast, particularly Mombasa
Mangaiko – The Mbo people, Democratic
Republic of the Congo
Sḫt (‖sekhet‖) – Middle Kingdom of Egypt
(2000-1800 BCE)

MIDDLE EAST
 The Kurgarûs – Sumer
kur.gar.ra
ur.sal
Zenanas – Arab
Xanith or Khanith – Oman


ASIA
Hijras
 lyha – Mohave
Hijras – India, Pakistan & Bangladesh
also known as: Aravani/Aruvani or Jogappa
Hijira (alt. sp.) – India
Sādhi
Kotis
Sadhin – The Gaddhi in the foothills of the
Himalayas


ASIA continued
 Basivi – Madras (area of India)
Tritiya-prakrti (third-nature) – Indic Kathoey
culture of premodern India
Ubhatobyanjanakas – Buddhist Vinaya
Pandakas
Kathoey – Thailand
Pandaka – Ancient Buddhist Societies

http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-
groups/
Kathoey

ASIA-PACIFIC
POLYNESIA
 Fa‘afafine – Samoa Polynesia
Fakaleiti – Tonga
Mahu Wahine – Hawaii
Mahu Vahine – Tahiti
Whakawahine – Māori
Akava‘ine – Cook Islands

http://transprov.wordpress.com/2009/05/21/simple-list-of-third-gender-and-gender-variant-groups/ Fa‘afafine

INDONESIA

 Waria Waria
Kwolu-aatmwol – ―Sambia‖ community in the
eastern highlands of Papua New Guinea
PHILIPPINES
bakla – Tagalog
Bayot – Cebuano
Agi – Ilonggo
Bantut – Tausug
Binabae
Bading
Lakin-on
bakla

Disordered or Just Different?
 What the medical profession has been
and is still doing to sexually-variant
peoples
– Gay, lesbian, bisexual people
– Transsexual people
– Intersex people

Medical Profession‘s Treatment of LGBT People
1952 (DSM-I) Sociopathic Personality Disorders

1968 (DSM-II) Sexual Deviation

1970 Gay rights activists storm APA annual convention

1972 APA annual meeting –first-ever panel of non-
patient homosexuals‖ and Dr. Anonymous

1973 (DSM-II Revision) Deletion of Homosexuality
Substitution of Sexual Orientation Disturbance
(Homosexuality is not illness but supposedly discomfort with being persecuted as a homosexual is
an illness)

1980 (DSM-III) Gender Identity Disorder (GID)
Ego-dystonic Homosexuality (formerly SOD)

1987 (DSM-III Revision) Homosexuality omitted entirely
(Ego-dystonic homosexuality/SOD removed. It‘s normal to not want to be persecuted & empirical
data to support diagnosis is lacking))→

2000 (APA Position Statement) Ethical psychiatrists should stop conversion or
―reparative therapies‖
Homosexuality was removed from the list of mental disorders by the World Health Organisation in 1990

The Science on Sexual Orientation
 ―There is no indication that social
environment after birth has an effect on
gender identity or sexual orientation‖

 American Psychological Association has
reported that efforts to change a person‘s
sexual orientation not only doesn‘t work but
causes harm (loss of sexual
feeling, depression, anxiety, and suicidality)
Timoshin, Natalie. ―Sexual ―conversion‖? American Psychological Association says not through psychotherapy. PSYCHIATRIC TIMES (October, 2009)

Anti-gay Quackery -
―Reparative
Therapy‖

The Science on Sexual Identity
 ―…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‖
 ―There is no indication that social

The Quackery
Against Transsexuals - GID
 Gender identity disorder is a bogus diagnosis!
 France has become the first country in the world to
declassify transsexualism as a mental illness
 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 Incongruence

The Science on Intersexuality
 ―… 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

Garcia-Falgueras A, Swaab DF. Sexual hormones and the brain: an essential alliance for sexual identity and sexual orientation
PEDIATRIC NEUROENDOCRINOLOGY 17: 22-35 (2010)

Intersex Problems
Are Socio-cultural
 ―The basic problems faced by the
intersexed are socio-cultural in nature
and not medical and are a result of the
dogmatic fundamentalism inherent in
the current binary construct of sex and
gender‖
 ―Some intersexed individuals are
subjected to genital mutilation in
childhood as a result of this
totalitarian, sexist oppression‖ Curtis Hinkle - Founder
Organization Intersex International
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html

The Quackery - Intersex People
Are Necessarily Disordered

 Genital normalization surgeries on
newborns continue!
 DSD = Disorders of Sexual Development
 OII objects to ―disorder‖ terminology
http://www.gopetition.com/petitions/solidarity-with-the-intersex-community.html

 Milton Diamond recommends Variations
of Sex Development
http://adc.bmj.com/content/91/7/554/reply#archdischild_el_2460?sid=437e97e7-049d-42c8-b60f-6d8d02dd31c1
http://adc.bmjjournals.com/cgi/eletters/91/7/554

OUTCOMES:  John Money‘s lab follows up
on some of their intersex
Ambiguous cases
Genitalia  Admit that follow-up studies
are very limited; hence, the
―Normalization‖ need for this study
Surgery  Intersex types studied
– 46, XY
– Quigley grade 2-4, average 3.5
– AIS, gonadal
dysgenesis, others
 Turns out that roughly half
were assigned/raised as
Pigeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bah
boys, half as girls
burg, HFL, Rock, JA, Brown, TR, Canella, SJ, Market
A, Ngai KM, Money J, Berkovitz GD. Ambiguous  Written questionnaire and
Genitalia With Perineoscrotal Hypospadias in 46,XY
Individuals: Long-Term Medical, Surgical, and
Psychosexual Outcome PEDIATRICS 110:10p (2002)
physical exam

Genital ―Normalization‖ Surgery - Dismal Outcomes
 23% of participants (46XY, Quigley grade 2-4, average 3.5, roughly half were assigned/raised as
boys, half as girls) were dissatisfied with sex of rearing

– Indicating ―general predictions cannot guarantee future
gender development for any single case‖
– This figure could be as high as 44%
(if all non-participating patients were also dissatisfied)
 Majority (62% men, 67% women) sought counseling
concerning condition
 Mean surgeries: men 5.8; women 2.1
 Half were dissatisfied with body image
 Two-thirds were dissatisfied to some degree with
sexual function
 Researchers never asked: What if we did nothing?
Migeon; CJ, Wisniewski, AB, Gearhart JP, Meyer-Bahlburg, HFL, Rock, JA, Brown, TR, Casella, SJ, Maret A, Ngai KM, Money J, Berkovitz GD. Ambiguous Genitalia With
Perineoscrotal Hypospadias in 46,XY Individuals: Long-Term Medical, Surgical, and Psychosexual Outcome PEDIATRICS 110:10p (2002)

NEW STANDARDS OF CARE American Academy British Association Pediatric
FOR Pediatricians Surgeons
INTERSEX PATIENTS year 2000 year 2001
Diamond, M. Sex, gender, and identity over the years: a changing
perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS
OF NORTH AMERICA 13:591-607 (2004) No surgical moratorium
#1. General moratorium on sex (In1999, AAP decided that surgical
moratorium was ―unrealistic‖ because it No surgical moratorium
assignment cosmetic surgery was hypothesized that parents would not
accept it)

#2. Moratorium should not be Recognized need for more Recognized need for more
lifted unless and until studies research and greater candor research and greater candor
show outcomes are positive and honesty and honesty

#3. Efforts should be made to No call back to families or No call back to families or
undo effects of past physician individuals that had previous individuals that had previous
deception and secrecy treatment treatment
Informed consent includes
Response to intersex birth ―Social emergency‖ ―possibility of non-operative
management‖
All virilized females (CAH or
Gender assignment on
maternal androgen) should be
Gender assignment individual basis; may include
girls (because of retained
cultural considerations
fertility)
Infants raised as girls ―will ―There is a strong case for no
Clitoral surgery usually require clitoral clitoral surgery in lesser
reduction‖ degrees of clitoromegaly‖
PAIS infants ―in whom a very
small phallus mandates a The risk of malignant testicular
Penile surgery
female sex of rearing‖ should changes in AIS is small
have testes removed

Pediatric Policy Is Reprehensible
 2006 Consensus Statement - chose term ―Disorders
of Sexual Development‖
 Dismiss ―sexual identity‖ issue: ―Structure of the brain
is not currently useful for gender assignment‖
 Factors they say influence their decision on gender
assignment
– Diagnosis
– Genital appearance
– Surgical options
– Need for lifelong replacement therapy
– Potential for fertility
– Views of family
– Circumstances relating to cultural practices
Collaboration with participants in International Consensus Conference on Intersex organized by Lawson Pediatric Endocrine Society and European Society for Paediatric Endocrinology
Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)

Pediatric Policy Must Change
 Pediatricians use parental distress & prejudice to
justify damaging surgery
Lee PA, Houk CP, Ahmed SF, Hughes IA. Consensus statement on management of intersex disorders PEDIATRICS 118:488-500 (2006)

 Clitoral reduction is ―standard clinical procedure‖
(Dr. Dix P. Poppas, Panel at Weill Cornell Medical College)
http://www.cornellsun.com/section/news/content/2010/10/05/weill-medical-college-
says-poppas%E2%80%99-surgical-procedure-standard

 Pregnant women treated with dexamethasone to
prevent ―behavioral masculinization‖ (same-sex
attraction and tom-boy behavior) in CAH girls
http://www.starobserver.com.au/news/2010/07/15/opposition-to-genital-drugs/27947
Meyer-Bahlburg HF, Dolezal C, Baker SE, New MI. ―Sexual Orientation in Women with Classical or Non-Classical Congenital Adrenal Hyperplasia as a Function of
Degree of Prenatal Androgen Excess‖ ARCHIVES OF SEXUAL BEHAVIOR 1: 85-99 (2008),

 Let‘s follow Columbia‘s example
Diamond, M. Sex, gender, and identity over the years: a changing perspective CHILD AND ADOLESCENT PSYCHIATRIC CLINICS OF NORTH AMERICA 13:591-607 (2004)

 Europe has ethical principles for intersex treatment
Wiesemann, C., Ude-Koeller, S., Sinnecker, G. H. G., & Thyen, U. Ethical principles and recommendations for the medical management of differences of sex development (DSD)/intersex
in children and adolescents EUR J PEDIATR 169:671–679 (2010)

Intersex People Now Can Also
Have ―Gender Incongruence‖!
 Special subtype of gender incongruence in
DSD is recommended by Zucker‘s
committee for the DSM-V!
 OII responds: ―We see no need to further
medicalise and stigmatize intersex people
by referring to them as necessarily
disordered (DSD) and where mistakes in
assignment have been made, we see no
value in medicalising and stigmatizing them
further by applying another form of disorder
called ‗gender incongruence‘‖
http://www.intersxualite.org/DSM5.html

Discrimination Against LGBTI
People Is a Socio-cultural Disorder
 LGBTI people are natural variations and are
different, not disordered
 Suffering of LGBTI people is not intrinsic to
their condition; rather it is imposed by the
binary-gendered society/culture
 The medical profession has been part of the
socio-cultural problem and it continues to be a
problem
 The ―scientific message about core sexuality‖
needs to reach the entire medical
community, educators, and parents

Birthright: To Be Who We Are
 Core sexuality is inborn. We do not learn
our core sexuality; we discover it
 What we learn is whether the culture will
celebrate or persecute our sexuality
 LGBTI people suffer from a socio-cultural
disorder
 The culture needs to change and make a
place for all the babies born into it
 All of us, not just the Adams and the
Eves, have the birthright to be who we
naturally and innately are

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