© Christian Medical Fellowship 2004 Number 25 …

1 Christian Medical Fellowship 2004 CMF Files Number 25. Gender identity disorder Files By Andrew Sims A postmodern view of the world suggests that we can be anything we want to be and that no one should interfere with our decisions. Deciding which sex we would like to be, however, takes this concept to a new extreme. Changes in European and UK law now enable people with gender identity disorder (transsexualism) to change the sex recorded on their birth certificates, but do surgical, hormonal and legal fixes deal with the real problem? Do transsexual people have the wrong bodies, or the wrong beliefs? On 11th July 2002, the European Court respect the human rights of people who include dysmorphophobia (grossly of Human Rights ruled that the UK had feel marginalised, and to create a society disturbed notions about body shape or infringed Christine Goodwin's right to in which no one is discriminated against.)

2 Bodily organs) and morbid jealousy (a privacy under Article 8 of the European This is leading to a fundamental shift delusional belief that his/her partner is Convention on Human Rights. In away from previously held basic being unfaithful). In these cases, no one refusing her the right to marry her principles in the way we view and value would expect the State to modify the law partner, the UK government had human life. In summing up the Goodwin to accommodate these people's beliefs, additionally broken Article The case, Lord Nicholls of Birkenhead asked, although medicine may well attempt to court also handed down a similar ruling Can a person change the sex with which relieve the patient eg. with cosmetic in the case of I' v the UK he or she is born?' The answer that surgery for the nose or breasts, or by The issue was that Christine society decides to accept will reveal a means of counselling (psychotherapy).

3 Goodwin and I' claimed to be lot about its underlying philosophy of transsexual. Transsexual people are born human nature, and how best to treat Scientific objectivity with the anatomy and physiology of one people who are in some way different sex but have an unshakeable belief that from the majority. they belong to the opposite sex. There is a need to assess the best Since the middle of the seventeenth Government estimates suggest that available data on the causes and century Western societies have there are around 5,000 transsexual treatment of transsexualism before embraced a scientific understanding of people in the UK, and NHS figures show forming opinions about which policies the world, based on physical that the health service performed 89 will most benefit these people. observations. This process applies to operations to reassign a person's gender determining a child's sex at birth, which in the year 2001-2002, all of which were in most cases means simply looking for on There are claims that 10,000.

4 Such operations have been performed Medical description the presence of a penis or vulva. If in doubt, doctors look for other around the In Medical literature, transsexualism is gender specific characteristics. Males In response to the European ruling, poorly defined, but most psychiatrists have XY chromosomes, while females the UK government set about altering studying people with the symptoms say have two X chromosomes; males have UK law so that transsexual people can that their beliefs can be described as testes, while females have ovaries. protect their privacy' by changing the over-valued ideas'.5 People with over- Additional differences exist in other sex registered on their birth certificates. valued ideas believe something to be internal sex organs, so for instance, This change in legal status would also true beyond any bounds of reason; they males have sperm ducts, while females open the way for them to marry a partner firmly believe they are one sex even have a uterus and fallopian tubes.

5 Of their own sex. though all physical evidence suggests Looking at biochemical markers there are Currently lawmakers around the that they are the other. measurable differences in levels of world are looking to create policies that Similar psychiatric conditions hormones such as testosterone and 1. CMF Files Christian Medical Fellowship 2004 . oestrogen. These trigger secondary sexual characteristics such as facial hair and body shape. Intersex This fits with the biblical description A person with an intersex condition is born with sex chromosomes, external genitalia, or of humanity that says humans are male an internal reproductive system that is not considered standard for either male or female. or female. Genesis 1:27 states So God The exact frequency of these conditions is difficult to determine because of the confidentiality created man in his own image, in the that surrounds affected individuals.

6 One survey that reviewed literature between 1955. image of God he created him; male and and 1998 assessed the frequency of some of the more common intersex female he created them.'. In most people these sexual Not XX and not XY one in 1,666 births characteristics run together, although Poorly developed or absent vagina one in 6,000 births there are a few intersex people in whom Androgen insensitivity syndrome one in 13,000 births there is genuine confusion (see box), Classical congenital adrenal hyperplasia one in 13,000 births and it may be very difficult to determine Ovotestes one in 83,000 births the person's sex. Unlike intersex people, No discernable Medical cause one in 110,000 births there is no evidence that transsexual Partial androgen insensitivity syndrome one in 130,000 births people are physiologically other than the Complete gonadal dysgenesis one in 150,000 births sex they were registered as at birth.

7 Sex and gender larger in men than in women, male-to- but the European Court treated them as female transsexuals had female-sized if they identify definite physical Many commentators point to a need to This raises the question of disorders that can be solved by physical distinguish sex and gender, where sex whether the brain areas develop and treatments. refers to the person's biological make- then dictate behaviour, or whether their In an attempt to prevent just this sort up, and gender applies to a person's size changes in response to altered of misunderstanding, DSM-IV begins roles and behaviour. And for gender behaviour? Other research has cited with a cautionary statement emphasising roles, the situation is less fixed. For excessive numbers of maternal aunts, that its purpose is to provide clear example, a man who enjoys looking after birth order and left handedness as descriptions of diagnostic categories in children could be said to have good indicators of ,10 The order to enable clinicians and mothering' skills.

8 Research on this has been very limited, investigators to diagnose, communicate Transsexual people, however, move and at its strongest, the suggestions can about, study, and treat people with the debate further, claiming that not only only be seen as highly speculative. various mental disorders. It is to be do they perform some of the gender Indeed the European Court's understood that inclusion here does roles of the opposite sex, but that they assessment of the Medical and scientific not imply that the condition meets legal are' the opposite sex. data concluded that there is no scientific or other non- Medical criteria for what evidence to suggest any biological constitutes mental disease, mental causal disorder, or mental disability.'. Causes Instead, the Court considered that it is more significant [that] transsexualism For some time there has been a debate as to whether this perception is purely has wide international recognition as a Medical condition'.

9 After all, said the Treatment psychological, or whether there is any Court, doctors have recently relabelled The big question here is whether to treat physical influence such as some form transsexualism as Gender identity the person's body so that it conforms of structural alteration within the Disorder' in a key psychiatric handbook, to their self-image; to give individual's brain that might account for the Diagnostic and Statistical manual psychological treatment that aims to a man's conviction that he is a woman. (4th edition) (DSM-IV). On top of this alter the person's self-image to conform There are some claims that variants in the Court pointed to the inclusion of to their body, or to support them as they pre-natal exposure to hormones or Gender identity Disorder in the live in their contradictory state.

10 Pesticides like DDT can influence a International Classification of Diseases In the case of transsexualism, there person's sexual orientation and may play (10th Edition) of the World Health is no consensus amongst clinicians a role in establishing Organisation, although the Court did about the effectiveness of In another report, published in not mention that the term transsexualism psychological treatments, but there is Nature, researchers measured the is also retained in that book. evidence that, in a proportion at least, volume of an area in the red nucleus (part The problem here is that psychiatric transsexual people's perceived quality of the brainstem) in different people. This diagnostic classifications say nothing of life may be improved by hormonal region is essential for sexual behaviour. about underlying causes.