The prime minister of Canada, Justin Trudeau has once again shown his progressivism by promising to protect transgender people from hate speech with a new bill. This represents another step in the creation of gender identity as a legal, psychological, and moral reality. However, neurosciences were unable to substantiate the claim that transgender people are women in men’s bodies, and vice versa. The emergence of gender identity as reality justifies irreversible surgery and hormonal treatment, too often in pre-pubertal individuals, who are too young to take such major decisions. Even in older patients, hormonal replacement therapy can cause serious physical and emotional problems. In short, although the neurosciences have not been able to confirm the hypothesis that transgenders have a brain of the opposite sex, this assumption continues to legitimize laws and ambitious medical procedures.
(Essay published on Huffington Post in French)
Researchers have shown that transgender people have a brain that corresponds to their sex, and not their gender identity (1, 2, 3). Naturally, some have found a small difference, and it has encouraged some to believe that – wow – we discovered the area of gender identity! Sex was previously defined by biological criteria: the type of primary and secondary sexual characteristics, and a sex-differentiated brain. Suddenly, according to some, sexual identity would be defined simply by only one of many regions of a tiny nucleus, on one side of the brain, showing a partial (fem-)masculinization, based on a group of eight transgenders. Even if we would find a persistent differences in the transgender brain, that wouldn’t mean that this difference would be linked to gender identity.
Since there are hundreds of measures that can be compared in the brain, it is not surprising that there is at least one that differs on average when comparing groups. In addition, the differences differed in each study! It would therefore be premature to conclude anything about one study. One of the articles mentioned cautions that it would be “very speculative” to say that the answer to gender identity lies in the small difference found. That the difference is causally linked to gender identity, assuming that such a thing exists and can be seen, is a speculation. It could be the area of any other trait unrelated to gender identity. For instance, MtF transgenders could have neuroticism in the female range. Or, the difference would mean nothing at all. Yet those who seek to justify their beliefs see it as an unambiguous sign that the transgender hypothesis holds. That does not mean we will never find anything, but for now, after decades of research, it was only established that the transgender brain corresponds to their sex, all the rest being pure speculation. What is not speculative, is the adverse effects of hormone treatments.
Transgender people report feeling like the other sex. This is intriguing. How can we know how others feel? As a man, I personally have no idea how other men feel. In addition, even if the researchers had found that transgenders had a brain of the opposite sex, it would still be speculative to say that they feel like the opposite sex. Men and women have gonads that produce sex hormones that influence cognition, mood, and even brain anatomy (4). I personally have no idea how it feels to live with such high and variable estrogen levels. Nobody knows how someone with a different personality or brain structure feels. It is impossible not to make a parallel with those who identify as another ethnicity or animal species. I have no doubt that transgender people believe themselves, but what is this belief based on?
Human beings have an incredible ability to feel anxiety, which leads them to investigate the possible reasons behind this feeling. However, people do not have such an ease to determine the cause of this distress (5). Transgender people have extremely high rates of psychiatric disorders (6) and other difficulties, like a troubled childhood (7). Most claim that this is because they are transgender, or stigmatized, but no one has established that being transgender corresponds to any observable reality. The treatment does not improve their life drastically either. You could say “Well why not, if it helps,” but that would be a lie. People with high levels of estrogen, such as girls with borderline personality disorder, have extremely volatile moods. So it’s not a brilliant idea to give estrogen to people that already suffer from psychiatric disorders. The attempted suicide rate after treatment is from 32% (8) to 41% (9). In another study, the suicide rate after treatment is 19 times higher than the rest of the population (10). According to a recent article published in the International Journal of Psychiatry, the most rigorous study showed that the condition of transgender worsens after treatment (11). Many studies that have found improvements have serious methodological problems, such as a study on Danish transgenders that lost 10% of its group due to death, at an average age of 53 years (12). Worrisome.
Throughout the ages, there were various attributions to explain anxiety. After the publication of the book Sybil in 1973, following the example of the protagonist, many women reported having developed multiple personalities. Many psychologists then used hypnosis to recover repressed memories of sexual abuse. The number of cases went from 200, before publication, to 1.5% of the US population in 2013, so a few millions. The average number of reported personalities rose from 2 to 13 within a decade. Similarly, people with anorexia are convinced that their distress is caused by their obesity, although they are by definition below an adequate weight. The explanation of their distress is not based on an accurate observation.
In short, historically, there have been a myriad of explanations for distress, which were not supported by objective data. People have very little insight to understand the origins of their behavior. They are also influenced by the suggestions of professionals. In a classic study, researchers modified photos and convinced the participants that they had been taken in the youth of the participants. Half of the participants spontaneously recounted memories about this photo, believing it themselves (13). So the fact that transgender people think of themselves as the opposite sex does not mean they are right.
There could also be other reasons for being transgender, apart from a misinterpreted anxiety. Some men feel sexual excitement when personalizing a woman (14) and thus transform into a woman. Even those who oppose the most to this theory concede that this is true in some cases (15). Feeling “good” when personifying a woman does not necessarily mean that one is a woman.
In conclusion, while it does not matter to me personally how people identify themselves, the phenomenon of legitimation of transgenderism leads to dangerous and simply false solutions. If an anorexic girl thinks she is obese, doctors do not prescribe her substances to make her lose weight. If the same girl claims to have multiple personalities, she is not given multiple passports. Before making transgenderism a legal reality, as suggested Justin Trudeau, or treating people with hormones that have many adverse effects, one is entitled to question the objectivity of the phenomenon. I wish the best to transgenders, but I also think about the thousands of people with psychiatric problems who will be encouraged to take hormones that present a danger to their physical and psychological health. After all, it is the role of science to test potentially dangerous assumptions.
1. Hoekzema, E., Schagen, S. E., Kreukels, B. P., Veltman, D. J., Cohen-Kettenis, P. T., Delemarre-van de Waal, H., & Bakker, J. (2015). Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology, 55, 59-71.
2. Savic, I., & Arver, S. (2011). Sex dimorphism of the brain in male-to-female transsexuals. Cerebral Cortex, 21(11), 2525-2533.
3. Luders, E., Sánchez, F. J., Gaser, C., Toga, A. W., Narr, K. L., Hamilton, L. S., & Vilain, E. (2009). Regional gray matter variation in male-to-female transsexualism. Neuroimage, 46(4), 904-907.
4. Zubiaurre-Elorza, L., Junque, C., Gómez-Gil, E., & Guillamon, A. (2014). Effects of cross-sex hormone treatment on cortical thickness in transsexual individuals. The Journal of Sexual Medicine, 11(5), 1248-1261.
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7. Veale, J. F., Clarke, D. E., & Lomax, T. C. (2010). Biological and psychosocial correlates of adult gender-variant identities: A review. Personality and Individual Differences, 48(4), 357-366.
8. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of homosexuality, 51(3), 53-69.
9. Haas, A. P., Rodgers, P. L., & Herman, J. L. (2014). Suicide attempts among transgender and gender non-conforming adults. work, 50, 59.
10. Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: cohort study in Sweden. PloS one, 6(2), e16885.
11. Dhejne, C., Van Vlerken, R., Heylens, G., & Arcelus, J. (2016). Mental health and gender dysphoria: A review of the literature. International Review of Psychiatry, 28(1), 44-57.
12. Simonsen, R. K., Giraldi, A., Kristensen, E., & Hald, G. M. (2016). Long-term follow-up of individuals undergoing sex reassignment surgery: psychiatric morbidity and mortality. Nordic journal of psychiatry, 70(4), 241-247.
13. Wade, K. A., Garry, M., Read, J. D., & Lindsay, D. S. (2002). A picture is worth a thousand lies: Using false photographs to create false childhood memories. Psychonomic Bulletin & Review, 9(3), 597-603.
14. Blanchard, R. (1989). The concept of autogynephilia and the typology of male gender dysphoria. The Journal of nervous and mental disease, 177(10), 616-623.
15. Moser, C. (2010). Blanchard’s autogynephilia theory : A critique. Journal of Homosexuality, 57(6), 790-809.