by Katherine J. Wu
figures by Brad Wierbowski

Think of your most noticeable feature. Maybe it’s your radiant smile, or your long, piano-playing fingers. Maybe it’s your stellar jump shot, or the way you recite Shakespearean sonnets at the drop of a hat. Or maybe it’s your penchant for scientific knowledge. But whatever it is, for better or worse, it is probably not your most salient feature to the world around you. To others, our most salient feature is one that doesn’t make any of us very salient at all – a feature in which none of us had any say in, which was assigned at, or prior to, birth: are you male or female?

Gender identity haunts every aspect of our lives, dictating the outcomes of our conversations, our workplaces, our relationships – even our bath products. Before most infants are named, they are assigned a sex based on the appearance of their external genitalia by a third party. These decisions are dolled out in a typically binary fashion, with no expectations for ambiguity. This is the norm – but has this simplicity led us astray?

In March of this year, Governor Pat McCrory of North Carolina signed into law the Public Facilities Privacy and Security Act, banning individuals from public restrooms that do not correspond to their assigned biological sex. This controversial legislation was the first of its kind– though certainly not for lack of trying. So called “bathroom bills” have been within political radar since the introduction of public restrooms in the 19th century; dozens of states within the U.S, primarily in the Midwest and South, have attempted, but failed, to bring such bills into law in the past year. The charged political climate of the summer has yielded many tense conversations about gender and LGBT rights – and it’s clear that these discussions are long overdue. But if we are to regulate gender, we must first assess the extent of our knowledge on the topic. What do we know of the “causes” the phenomenon of transgender identity – and what does this mean for the future of transgender politics?

The ABC’s (and LGBTQQIAAP+2S’s) of Gender and Sexuality

First, some (controversial) definitions. It would be remiss to claim to be able to define or categorize all variations in human sexuality and gender (hence the continually lengthening acronyms used, sometimes tongue in cheek, by the community); one of the larger acronyms, LGBTQQIAAP, still humbly accepts that it is not all-inclusive. These lists, while not exhaustive, are exhausting. The labels are useful in some respects, much like any other label denoting origin or role – they help us navigate social situations and can often be signs of respect. It is a natural human inclination to categorize, but broad assumptions can also lead to stereotyping. To limit the scope of this article, we will focus on transgender identity.

Figure 1: An incomplete and incomprehensive representation of gender identity and sexual orientation. Transgender individuals are those who identify with a gender that differs from their assigned sex. This is a facet of identity that is completely distinct from sexual orientation. These graphs do not represent the full spectrum of either facet, as they are multidimensional. For instance, there may be genders that some identify with that are neither “male” nor “female. Furthermore, there are no “lines” that divide these identities, and they may be considered malleable and overlapping.
Figure 1: An incomplete and incomprehensive representation of gender identity and sexual orientation. Transgender individuals are those who identify with a gender that differs from their assigned sex. This is a facet of identity that is completely distinct from sexual orientation. These graphs do not represent the full spectrum of either facet, as they are multidimensional. For instance, there may be genders that some identify with that are neither “male” nor “female. Furthermore, there are no “lines” that divide these identities, and they may be considered malleable and overlapping.

Those persons who identify as transgender (the “T” in many queer community acronyms) are those who identify with a gender that differs from their assigned sex (Figure 1). This juxtaposes cisgender, or those who identify with their assigned gender. Though the typical assigned sexes are “male” and “female,” often designated at birth, being transgender does not limit gender identity to these two categories, as many who identify as transgender do not feel they are exclusively masculine or feminine. Importantly, transgender identity is independent of sexual orientation. The subset of transgender individuals who choose to undergo sexual reassignment surgery are often denoted as transsexual.

The transgender identity has long been associated with poor mental health, particularly the diagnoses of “gender identity disorder” and “gender dysphoria.” However, the World Health Organization is actively working towards declassifying transgender identity as a mental disorder, a change partially prompted by a recent study uncoupling the mental and physical health problems experienced by transgender people from their gender identity. Rather, those who had suffered ailments could vastly attribute their afflictions to societal stigma, discrimination, and violence.

“It’s All in Your Head” – Except When It’s Not

Sex determination – the way we are “coded” into a biological sex – is complicated in and of itself. There are far more options than just “male” or “female,” and countless instances of species that can actually transition from one sex to another within a single lifetime. With most mammals, however, the majority of individuals are cisgender male or female; transgender individuals are estimated to comprise about 0.3% of the adult U.S. population.

Little is known about the causes of transsexuality, and many of the studies that have been conducted – particularly psychological studies – have since been widely discredited (more on that later). However, scientists do seem to have some information on the biological basis of several factors.

First and foremost, is gender identity genetic? It seems the answer is yes – though, as with most traits involving identity, there is some environmental influence. One classic way for scientists to test whether a trait (which can be any characteristic from red hair to cancer susceptibility to love of horror movies) is influenced by genetics is twin studies. Identical twins have the exact same genetic background, and are usually raised in the same environment. Fraternal (nonidentical) twins, however, share only half their genes, but tend to also be raised in the same environment. Thus, if identical twins tend to share a trait more than fraternal twins, that trait is probably influenced by genetics. Several studies have shown that identical twins are more often both transgender than fraternal twins, indicating that there is indeed a genetic influence for this identity. So, what genes might be responsible?

Figure 3: Transgender women tend to have brain structures that resemble cisgender women, rather than cisgender men. Two sexually dimorphic (differing between men and women) areas of the brain are often compared between men and women. The bed nucleus of the stria terminalus (BSTc) and sexually dimorphic nucleus of transgender women are more similar to those of cisgender woman than to those of cisgender men, suggesting that the general brain structure of these women is in keeping with their gender identity.Figure 2: Transgender women tend to have brain structures that resemble cisgender women, rather than cisgender men. Two sexually dimorphic (differing between men and women) areas of the brain are often compared between men and women. The bed nucleus of the stria terminalus (BSTc) and sexually dimorphic nucleus of transgender women are more similar to those of cisgender woman than to those of cisgender men, suggesting that the general brain structure of these women is in keeping with their gender identity.

In 1995 and 2000, two independent teams of researchers decided to examine a region of the brain called the bed nucleus of the stria terminalis (BSTc) in trans- and cisgender men and women (Figure 2). The BSTc functions in anxiety, but is, on average, twice as large and twice as densely populated with cells in men compared to women. This sexual dimorphism is pretty robust, and though scientists don’t know why it exists, it appears to be a good marker of a “male” vs. “female” brain. Thus, these two studies sought to examine the brains of transgender individuals to figure out if their brains better resembled their assigned or chosen sex.

Interestingly, both teams discovered that male-to-female transgender women had a BSTc more closely resembling that of cisgender women than men in both size and cell density, and that female-to-male transgender men had BSTcs resembling cisgender men. These differences remained even after the scientists took into account the fact that many transgender men and women in their study were taking estrogen and testosterone during their transition by including cisgender men and women who were also on hormones not corresponding to their assigned biological sex (for a variety of medical reasons). These findings have since been confirmed and corroborated in other studies and other regions of the brain, including a region of the brain called the sexually dimorphic nucleus (Figure 2) that is believed to affect sexual behavior in animals.

It has been conclusively shown that hormone treatment can vastly affect the structure and composition of the brain; thus, several teams sought to characterize the brains of transgender men and women who had not yet undergone hormone treatment. Several studies confirmed previous findings, showing once more that transgender people appear to be born with brains more similar to gender with which they identify, rather than the one to which they were assigned.

Interestingly, while the hormone treatments may have caused issues in the previous studies, they also gave scientists clues as to how these differences in brain anatomy may have arisen. Brain development is heavily influenced by the prenatal environment – what hormones the fetus is exposed to in its mother’s uterus. Some scientists believe that female-to-male transgender men, for instance, may have been exposed to inadequate levels of estrogen during development (Figure 3). This phenomenon could have two causes: 1) not enough estrogen in the fetus’s immediate environment, or 2) enough estrogen in the environment, but poor sensitivity in the fetus. Think of it like a cell phone tower controlling remote calls – the tower may not be producing enough signal (scenario 1), or the receiving phone may be unable to process the message (scenario 2). In either case, the call doesn’t make it through.

Figure 2: Possible scenarios underlying insufficient feminization. During normal feminization, sufficient estrogen is present in the fetal environment. The estrogen is recognized by fetal cells and triggers the development of a female fetus. In Scenario 1, very little estrogen is present in the fetal environment. Even though the fetal cells are capable of sensing estrogen, very little enters the fetal environment and the fetus is insufficiently feminized. In Scenario 2, there is enough estrogen in the fetal environment, but fetal cells are effectively “deaf” to the estrogen and the fetus is insufficiently feminized.Figure 3: Possible scenarios underlying insufficient feminization. During normal feminization, sufficient estrogen is present in the fetal environment. The estrogen is recognized by fetal cells and triggers the development of a female fetus. In Scenario 1, very little estrogen is present in the fetal environment. Even though the fetal cells are capable of sensing estrogen, very little enters the fetal environment and the fetus is insufficiently feminized. In Scenario 2, there is enough estrogen in the fetal environment, but fetal cells are effectively “deaf” to the estrogen and the fetus is insufficiently feminized.

The amount of estrogen in the fetal environment is a little tough to measure – but there appears to be some evidence for transgender individuals having poor hormonal sensitivity in the womb. A team of researchers found that the receptor for estrogen (that is, the cell phone receiving the signal) seems to be a little worse at receiving signal in female-to-male transgender men – think a 2001 flip phone trying to process photos from Instagram. Thus, the signal doesn’t come through as clearly, and the externally “female” fetus ends up more masculinized.

The psychological studies that have attempted to unravel the causes of transsexuality, on the other hand, have largely failed to gain traction in modern times. For many years, psychologists characterized transgender identity as a psychological disorder. Some, for instance, believed it was a coping mechanism to “rectify” latent feelings of homosexuality, or the result of environmental trauma or “poor” parenting. No studies have been able to demonstrate this, however, and these “findings” are considered outdated and have been highly criticized for their discriminatory implications. Other psychologists have attempted to differentiate groups of transsexuals based on factors such as IQ and ethnicity; similarly, these theories have been overwhelmingly rejected due to poor study design and issues with ethics.

And so, while the list of causes for transgender identity continues to grow, it has become quite clear that it is not a conscious choice – similar to what has been described for the “reasons” behind sexual orientation. Still, at least 63% of transgender individuals experience debilitating acts of discrimination on a regular basis, including incarceration, homelessness, and physical assault. When about 1.7% of the population is in some way affected by cases of ambiguous genitalia at birth, these findings seem staggering.

So, where do we stand on transgender issues? Science tells us that gender is certainly not binary; it may not even be a linear spectrum. Like many other facets of identity, it can operate on a broad range of levels and operate outside of many definitions. And it also appears that gender may not be as static as we assume. At the forefront of this, transgender identity is complex – it’s unlikely we’ll ever be able to attribute it to one neat, contained set of causes, and there is still much to be learned. But we know now that several of those causes are biological. These individuals are not suffering a mental illness, or capriciously “choosing” a different identity. The transgender identity is multi-dimensional – but it deserves no less recognition or respect than any other facet of humankind.

Katherine Wu is a third-year graduate student in the BBS program at Harvard University.

This article is part of our Special Edition: Dear Madam/Mister President.

For more information:

  1. For a previous SITN blog article discussing sex determination systems, see: http://sitn.hms.harvard.edu/flash/2016/im-xy-know-sex-determination-systems-101/
  2. For a fairly comprehensive discussion on the genetics of gender, see: http://www.who.int/genomics/gender/en/index1.html
  3. For a more complete discussion on queer acronyms, see: https://decahedronofq.wordpress.com/what-is-lgbtqqiaap/






60 thoughts on “Between the (Gender) Lines: the Science of Transgender Identity

  1. Can you send me the bibliographies for the research articles you refer to please? It all sounds very logical to me. I would like to share them with people I know who are skeptical of the research.

    1. Hi Liane, All of the studies referenced are linked throughout the article. Let us know if you have trouble accessing them.

  2. Instead of classifying brains as male or female, why not embrace the diversity of brains in a particular sex and accept that whatever brain that inhabits a body, be it a male or female body, is the brain of that corresponding sex.
    It would also be interesting to see a study of the brains of ultra-femme men and butch women to see if they are similar to the majority of brains of the opposite sex. In addition to that, compare them to the brains of transgender individuals of their corresponding biological sex.

    1. Cheryl Li, I like your ideas about the comparative studies. If you don’t mind, and if you have by now found some new articles, would you share your research on the different possible studies you mentioned thus far? Links and Article Heads would be great. It’s nice to see some similar thoughts on the topic (in addition to a few other posts here).

    1. Thanks for your comment!

      Observational studies are typically compared with randomized controlled experiments. It’s true that observational studies cannot, by themselves, allow scientists to draw definitive conclusions, but observational studies almost always form the foundation of later experiments that confirm findings. In fact, most of the studies of human behavior, nutrition, and longevity (among many other fields) are observational studies. ANY kind of study can be flawed, but we take care to only cite articles that have been peer-reviewed and use appropriate statistical tests and methods. Also, importantly, many studies of human genes rely on observational studies. This is often how genetic diseases are identified, including Huntington’s, sickle cell anemia, and cystic fibrosis. This is because we can’t do randomized controlled studies on humans – like making human “gene deletions.” These would be unethical! Thus, we have to rely on observations that yield consistent results (and if they don’t, we revise our theories and look into something else).

      It’s actually unlikely that there will be “a transgender gene” identified – but it’s an interesting thought! However, just like there isn’t “a logical gene” or “a Republican gene” or “a tall gene,” there is unlikely to be a single gene, or even a strict set of genes, that defines transgender identity (or any other form of identity). Many of the aforementioned traits or aspects of identity may have roots in certain genes that affect many parts of a person, and environment can certainly interact with genes.

      Hope that helps to clarify!

      1. Thanks for your response.
        We agree, so far there is no way to “demonstrate” with these observational studies that the transgender identity is something Biological. In this sense I agree with Marshall, some expressions in the article are just too pretentious (“Science tells us that gender is certainly not binary”).
        The studies are very interesting, but don’t serve as fundament of the conclusions alleged.

    2. Genes — there are XX and XY. These genes set up the potential in the womb for natal development (e.g. esgtrogen/testosterone exposure) which may or may not be fully received/metabolized by the fetus. Accordingly, sex expression in the fetus is “nurture” in a biological sense. The genes determine sex, but the environment in the womb (nurture) results in the expression of trans-gender.

  3. This article is highly subjective and makes false presumptions. For example, it correctly points out the scarcity and questionable legitimacy of evidence surrounding transgender and its causes, then says “Science tells us that gender is certainly not binary”. In fact, there is no scientific consensus that gender isn’t binary. What we do know is that biological gender is indeed binary (as the article correctly states), and as far as we know, biology describes the totality of our gender experience. The rest is entirely speculation, most of it politicized, based on scant, often dated or discredited studies with hypothetical conclusions that establish nothing close to a consensus.

    The article makes no mention of the numerous similarities between Gender Dysphoria and other cognitive illnesses like BDD, Anorexia, BIID, and Schizophrenia; all of which are disorders of body image or delusional perceptions and which come with the same level of “certainty” that transgender people experience. Rather than inventing a mythical “brain gender” unsupported by science, the far simpler explanation is that trans is a variant on other body image disorders that often (but not always) manifests as an identification with the opposite sex. It comes with many of the same co-morbidities of other cognitive illnesses, and it can respond to drug/therapy treatment in some people, also like other mental illnesses.

    I could go on about the reasons transgender is much better explained as an illness of illusion, like anorexia, but I’ll end here. Just don’t look to this article as an accurate representation of the science because it’s not.

    1. This article is written based on scientific studies. If you would like to claim that it’s an inaccurate representation of the science, please provide a set of scientific studies to back yourself up. We seek to always represent the science fairly.

      1. As the author, it is YOUR responsibility to provide cites and resources to justify the position that you hold or the findings your deduce from the research. You provide none. So you’re asking someone else to provide evidence to disprove what you wrote. You have that backwards.

    2. While gender dysphoria used to be classified as a mental illness, it is now widely accepted that this is not the case. It is also widely accepted among both doctors and scientists that neither biological sex (i.e. XX, XY, XO, XXY, etc.) nor biological gender (whether it is identity as addressed in this article or otherwise) is binary.

      1. I have to agree with Marshall. The Scientific Method is the process of eliminating possibilities through experiments, not designing experiments to support their hypothesis. This article has not considered many other hypothesis but cherry picked evidence to support the desired conclusion. In Neurobiology you can take any group of individuals and discover similarities in their brain composition. They’ve done this with Republicans and Democrats in the USA and many other control groups.
        While the science may be sound in this article the conclusions can be misleading. It doesn’t answer what happens if an individual shows the same neurobiological signs of a transgender individual but does not identify as such? It does not compare these neurobiological findings to those with mental illnesses mentioned above ^^ (ie schizophrenia, BDD, anorexia etc)
        Also, science has never been about consensus. The strength of a scientific claim comes from it’s infallibility and evidence supporting it and not the fact that the idea is becoming widely accepted. It’s one of the signs of someone who is trying to use science with an agenda instead of discovering truth.

        1. There are some studies (almost all human studies) for which it is not possible to design the types of empirical experiments one can do with animals. The studies presented in this article are very standard scientific studies, designed using the scientific method within ethical confines.

          Twin studies are the gold standard in determining genetic contribution in human studies. If more identical twins (who have identical genomes) than fraternal twins have something in common, then it is very likely that there is a genetic contribution. This is because it is unlikely that two identical twins are raised in more similar environments than fraternal twins. And this is exactly what was seen with the trait of being transgender!

          And science is definitively about consensus! Not consensus in the “people’s court” but consensus between scientific studies–both those that directly replicate previous studies (important to rule out researcher bias) and studies that ask similar questions from the same angle. With the genetic and brain structure evidence we have now (and is explained in this article), there is scientific consensus that gender identity has biological underpinnings.

          Since I haven’t seen any evidence from you or Marshall countering any of the claims in this article, it’s difficult to judge the scientific support of your arguments. If we are biased in our reporting, that suggests there must be a wealth of scientific literature against what we’re saying. Where is that?

          1. Yes but that consensus needs to be 100% our close to in order to hold any weight. However even with consensus, evidence behind that consensus still is the strength behind the scientific claim. It was scientists like Galileo, and Newton who did not accept general consensus of their time and decided to not accept anything they couldn’t replicate and they argued that any claim can and must be challenged, even if the claim was held to be true by general consensus.

            On the note of my own personal evidence, I am not the one making a scientific claim. This paper is the one that makes a scientific claim and attempting to use evidence to support the claim. My claim is that the evidence isn’t complete. Incomplete evidence provides incomplete conclusions.

            Maybe you don’t understand the scientific method but the scientific method is making a hypothesis, and then designing multiple experiments that would disapprove that hypothesis. If all of those experiments fail to disprove the hypothesis, then logically it can be concluded that the hypothesis is correct. If you fail to perform and/or demonstrate all experiments that might disprove your hypothesis then the scientific process was incomplete.
            All that this article does is show ONE experiment that supports the hypothesis and then published the conclusions. It’s a step in the right direction, however if you want to have a solid conclusion, they’re are still some holes that need to be filled. Isn’t that the whole point of peer review? To try and catch those holes before publishing?
            Again great, insightful article but it is incomplete and does not answer all questions related to transgenderism. In fact it raises more questions than it answers and that in it of itself tells me it is an incomplete study with an incomplete conclusion.

          2. This article is not a study. It is a summary of peer-reviewed, scientific-method-using literature on this topic. The author is not trying to make or test a hypothesis. She is just summarizing available studies. It’s actually very difficult to be comprehensive in this kind of article, but we do strive to represent the field accurately. And in fact, she also comes to the conclusion you did that we do not understand this topic 100% : “At the forefront of this, transgender identity is complex – it’s unlikely we’ll ever be able to attribute it to one neat, contained set of causes, and there is still much to be learned. But we know now that several of those causes are biological.”

            When I asked you for evidence, I was responding to the part of your comment that said you agreed with Marshall. Marshall said claimed that there was evidence that explained transgenderism as a mental illness. That’s a hypothesis, right? Doesn’t someone who makes that claim have the same responsibility to present evidence for or against it? But perhaps that’s not the part of Marshall’s comment you agreed with–sorry for making assumptions.

            This article talks about multiple experiments (she cites at least 8 studies), btw. The point of peer review is to catch holes in a single study, not holes in an entire field of research. Gender is much too complicated to be understood in a single study. The studies here asked and answered specific questions (e.g. does transgenderism happen in two identical twins more than it happens in two fraternal twins? is a specific brain region of transgender men more similar to cisgender men or cisgender women?). And these studies, according to their peer-reviewers, were able to reliably answer these questions. No one is trying to explain all of the reasons contributing to gender identity in a single study. Every field has more work to do to understand ourselves and our world more completely. As scientists, we are glad that there are always more questions to answer, for this is what keeps us employed!

          3. I understand. I believe the claim he was making referred to the high suicide rates that are comparable to those with Gender-dysphoria. In fact, the suicide rates for transgender individuals are higher than veterans (PTSD) (22%), depression (2-15%), bi-polar disorder (3-20%), and schizophrenia (6-15%). The 41% figure of transgender suicides is higher than all of those and suggests that this remains a mental condition. Studies have even determined that gender re-assignment surgery does not help with the suicide rates. The easy answer is to explain this away by saying the high suicide rate is due to high exposure to bullying. Yet even among other groups that experience intense bullying still come no where close to the same amount of suicide rates. I myself have spent two years in a situation where I was constantly rejected, spit on, robbed and even threatened at gun point. Not that I’m comparing what I went through to what a transgender individual goes through, but the stats seem to show there’s something more than bullying and social nonacceptance that accounts for such a high suicide rate. I believe that is what Marshall is referring to in the above comment and is a major flaw in the above article. If you want to prove that gender-dysphoria is not a mental condition then you have to explain why there’s so much more likelihood of suicide than virtually every other “bullied” group yet is comparable to the suicide rates with those of mental conditions.

            Also it would be important to take into account individuals who have gone through what some would call a transgender lifestyle and lived to regret it. Understanding what helped them to not commit suicide and to come at peace with themselves. Many children who believe they are a different sex tend to grow out of it as their brain and body develops. So why should we encourage a behavior that is potentially self destructive? You would encourage a bulimic individual to continue throwing up would you? Also you wouldn’t try and convince them that their condition is natural and since they were born this way there’s nothing wrong with them. I would hope you would try and get them the best help possible. In fact similar neuroscience studies have found brain developmental causes for depression. Does that mean we encourage individuals with depression because it is natural? No we help them cope with it in spite of how their body naturally developed. I see no difference in with transgenderism especially because there is no indication in studies that transgender individuals would stop killing themselves if the world just stopped bullying them.


          4. First, high suicide rates in a group =/= that group has a mental illness. White men, as a group, also have higher suicide rates than the general population. Does that mean that identifying as a white man is a sign of mental illness? (of course not) https://afsp.org/about-suicide/suicide-statistics/

            Second, the 41% number you cite is the suicide attempt rate from a survey people who are transgender (and thus did not die by suicide), whereas the other numbers you cite are suicide rates (of people who died by suicide), so it’s not really a fair comparison.

            Third, can you cite the studies that show transgender people have higher suicide rates that is not due to bullying?

            And fourth, from the APA: “having any gender identity, including a transgender identity, is not a disorder.” http://www.apa.org/news/press/releases/2015/11/psychology-transgender.aspx

        2. Glancing over the “sex change regret” page, it’s worth noting a few things.
          – In the cited Guardian article, there isn’t actually as strong a stance as the author of the sex change regret website would like us to believe. The Guardian article mentions that many therapists interviewed believe that the vast majority of their clients who have undergone sexual reassignment surgery are happy with the change. The consensus from the article (from both sides of the argument) is actually that more research needs to be done, because so many follow-up studies have sampled the population poorly. Furthermore, even if we take the statistics at face value (suicide rates of 3-18%, 1/5 of patients regretting sex changes), these statistics are remarkably lower than the one you quoted before – a 41% attempted suicide rate.
          – The Swedish cohort study cited is written by authors who believe that their results “inspire improved psychiatric and somatic care after sex reassignment for this patient group.” An immense flaw of the sexual reassignment process is poor patient care. Such a dramatic change inevitably produces psychological trauma. If you have a good health care provider, they will likely offer counseling after a skin transplant following severe burns that might alter your physical appearance (for instance). Furthermore, this cohort study was comparing individuals who had undergone sexual reassignment to the general population. Perhaps a better comparison would be to transgender individuals who had not undergone reassingnment to see if suicide rates had gone down – which would ACTUALLY comment on the effectiveness of sex reassignment. Finally, the difference in mortality rate was only statistically significant for people who had surgery before 1989; for those who had their surgery between 1989 and 2003, the increased mortality for transgender individuals wasn’t statistically significant.

          Finally, a much more recent study has actually addressed some of your concerns. It shows that while suicide attempt rates are indeed higher among transgender individuals, these rates drop dramatically if psychological and social factors (bullying, marginalization, etc.) aren’t as big an issue – http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-1867-2
          If their parents supported them, rates dropped. If the individuals themselves did not have negative views surrounding transgenderism, rates dropped.

    3. Gender is not binary.

      Sex is binary — on a genetic/biological level. That said, you really should read up on intersex and how that works — on a genetic level. Gender, on the other hand, is socio-cultural. Your reading in this field might start with Anne Fausto-Sterling “Sexing the Body” and then move into Judith Butler “Gender Trouble” etc. etc. Bibliographies on both these works are a good resource for bringing yourself up to speed in the gender studies field.

      Let me further note here that homosexuality used to be viewed by the APA and the DSM as pathological. DSM5, just recently revised, changes the terminology in gender ID from “disorder” to “dysphoria” . . . Transgender is not viewed as a pathology. It’s classed as a mood disorder in the anxiety/depression realm.

      Dysphoria — sharing the Latin root w/ “eu-phoria” is fundamentally a mood. Moods do not necessarily correlate to some sort of neuro-pathological state (e.g. like schizophrenia, psychosis).

      Gender presentation by and large is a socio-cultural function. Essentially presentation is a sort of linguistic process whereby we communicate gender through cultural “semes” — signifying cues that mark gender (e.g. skirts, beards).

      Gender-mapping, that process that goes on in our heads and tells us ontologically and existentially who we are, that process as this article explains is determined by “nurture” in the womb. There are two windows in natal development for sex differentiation: First exposure to testosterone in the womb determines physiological development, penis/testes. Second window of natal exposure determines the epistemological “gender mapping” in the natal brain which codes sexual identity. Lacunae of sufficient testosterone, or inhibition to the effects of testosterone may result in a human who is physiologically “male” but nonetheless epistemologically “female” or some other variation along the infinite continuum of the sex dyad.

      Anecdotally — I’ve been “trans whatever” since I was about four years old and able to distinguish that there are gender distinctions. It’s taken me nearly 70 yrs to come to terms with who I am and what I feel. As an academic in gender theory, I’ve been inclined to attribute “gender” to a socio-cultural, male hegemonic, hetero-normative dyadic oppression. It’s altogether existentially affirming to know that how I feel and who I am has fundamental biological underpinnings.

      It’s not just all in my head.

    4. I would dearly love you to cite the evidence that gender dysphoria responds to psychopharmacological treatment or talking therapies (as the disorders you mentioned do). There’s a reason that transition is stated as the treatment for gender dysphoria by medical authorities, despite the fact that it’s a pretty extreme and expensive thing to do.

      You’re conflating dysmorphobia with dysphoria. Trans people have a perfectly good idea as to what their bodies look like. There is no fussing over any minor or imagined defect. Trans people don’t feel that they have a defective body, they feel that their body sex is misaligned with their felt gender. Treatment (i.e. transition) in the vast majority of cases makes them feel better, is associated with staggeringly low long term regret rates (1-2% post op, 5% long term hormone therapy) and reduces suicide rates to closer to that of the gen pop.

      Conversely, psychotherapeutic interventions for anorexia *are* helpful whilst helping someone with anorexia to achieve their body image goals would be assisted suicide.

      Please reply with citations and not “sounds a bit like..” arguments.

    5. Transgenderism is not at all like anorexia or other body dysmorphic illnesses because transgender patients were treated in the same exact way medically and psychologically as people with BIID, anorexia, etc and did not respond to the therapies or medication in anyway. However, people with anorexia, BIID, etc did and do respond to those therapies and medications. You should look into the history of how transgender people were treated by the medical community because they treated exactly like people suffering from body dysmorphic illnesses. If

      transgenderism were a body dysmorphic illness like anorexia or BIID, etc, then we should have seen it respond to the treatments for it in some way, and transgenderism did not. However, transgenderism did and does respond very well to the way that it is treated today, which is first to help the person come to terms with their transgender status, and then from there to help the person decide what the next course of action should be from transitioning socially, medically, or do nothing. As for the comorbidity rate much of that is due to the very negative way in which transgender people are treated, and perceived by society. As the current treatment and standards of care for

      transgender people today are very effective at managing gender dysphoria if the transgender patient is experiencing any to alleviating it completely. As a trans person myself I grew up suffering with gender dysphoria starting around the age of 6 when I realized that I couldn’t live and be perceived as the gender and sex that I had always known myself to be from my earliest memories. However, after talking with a gender therapist, socially transitioning, and especially after being on cross sex hormone replacement therapy for a few months my gender dysphoria completely went away. The only time I feel gender dysphoric now is when I want to be intimate with my partner because I have not been able to have gender confirmation surgery yet, and so I still do experience gender dysphoria, but it’s only related to my genitals and only during certain situations. Again if transgenderism were cognitive disorder like BDD, anorexia, BIID, etc then is should have responded to the treatments used to help people with those disorders, and they had no effect at all. And certain not for lack of

      trying. The reason I believe for this is simple and that is that transgenderism in and of itself is not a mental disorder or illness. It’s another form of intersexuality that only affects the brain unlike other forms of intersexuality that affect the brain, reproductive organs, and or sex chromosomes. Down below is an excerpt from a paper that Dr.Milton Diamond wrote in 2011 as well as a link to the entire paper. If you don’t know who Dr.Milton Diamond is please google him as he has contributed probably more than anyone else to our understanding of gender, transgenderism, and interseuxality. He has been studying and publishing papers on every gender related since 1950, and is also one of the people who did a study with fraternal and identical twins looking to see if there is a genetic component to transgenderism. He located a set of identical twins who were adopted away at birth, and who were raised in different countries, spoke different languages, and both transitioned at around the same time, and both talked about experiencing their transgenderism similarly. In fact, down below is a link to a youtube video with him discussing the results. He’s also the person who brought to light the truth about the John\Joan experiment aka David Reimer story in 1997 as well.

      “Actually from my own clinical experiences, my own experimental research, and from the findings of others I conclude that transsexuality is a form of intersexuality…. I believe that transsexuals are intersexed in their brains as others are or might be more obviously so in their gonads, genitals, hormonal character, receptors, enzymatic or chromosomal constitution. And it is this brain intersexuality that biases the person to assert his or her gender identity.”


      1. As a retired RN, having researched this thoroughly, I stand with you Kristin. The AMA has confirmed this is biologic condition – with time, medical dr’s are slow – it will become biologic normal condition. They do basically consider it normal to have gender fluidity. As mentioned, at least 6 genes have been identified for gender ID. As mentioned, indigenous peoples identified and were comfortable with this, until the arrival of missionaries, who punished if not complied with male or female period. Due to their choice of beliefs.
        Society is changing thank goodness, one is either for humane treatment of humans, or not. BTW I consider “liberal” irrelevant, as I believe the above sentence. Stay strong!

    6. Agreed. It’s a little weird how suddenly there’s all these young people searching for their gender and looking for microaggressions at every turn. I feel sorry for Transgendered men and women who aren’t trying to force their identities on the public through legislation. I’m especially concerned about CA Bill SB179, which will allow ONE parent to declare their child is a different gender from their biological sex on govt forms. I remember I went through a Tomboy stage for a while and wanted everyone to call me Bobby but I grew out of it. Legislating these fake ‘phobias’ sounds like a great excuse to enact hate speech laws, that if passed, will make it a crime to criticize articles like this. This is when Anti-bullying campaigns become another form of bullying people who don’t agree with you into ‘acceptance’. The fact that the governments in Europe, Canada, and California are trying to legislate these fake ‘phobias’ so they can give special privileges to members of these disenfranchised groups is frightening. Transphobia, Islamophobia, Shmobia!

      1. lol, I don’t think you understand what most of those words mean

        all these young people searching for their gender and looking for microaggressions at every turn are to tomorrow, what the bra-burners of the 70’s were to the female CEOs of today

        you do not have a right to legislate control over what other people do with their bodies. period. there is FAR MORE in the way of ethical grounds for pro-life legislation than there is for anti-trans legislation, and I am not only pro-choice but PRO-ABORTION. we are not attempting to force our identities on the public through legislation. we are attempting to end violence against us through legislation. alternatively, we are being explicitly attacked and denied the right to exist in public space through legislation, which in turn ratifies violence against us. #Texas

        are you aware that single parents exist? I’m confused

        I know, it’s almost like if California makes it really easy to change one’s gender on government forms, people will be able to do it MORE than ONCE and maybe even get the idea that it’s OK to change one’s mind about things on the regular! the horror!

        the only fake “phobias” being legislated are the ones wherein exposure to human bodies and sexuality will somehow psychologically scar Teh Children. HB2 in North Carolina was passed not long after I came out last year, and I was told by a man in a Facebook thread, as a broad, sweeping declaration, that he was coming for us all with a can of gasoline. Teh Children never seem to come under consideration when we are discussing the suicide rates of queer youth, or the fact that some queer people, such as myself, have actual real live children of our own. if you are really more concerned about being persecuted for “criticism” than you are about the daily, constant, unending harassment of a political minority, you might literally be a Nazi.

        you sound like the sort of person who likes to quote exactly two statements ever made by the Reverend Dr. Martin Luther King Jr, and ignore all the rest

        the fact that the governments in Europe, Canada, and California… y’know, I can’t even. that is such a word salad.

        ok. deep breath. I’m’a go with this. what, exactly, is the purpose of these campaigns? you seem to think there’s something else going on. what are the agendas in play? what is the endgame? enlighten me.

        while you’re at it, I’d love to hear your definitions of “privilege” and “disenfranchised.” you do realize those concepts are like, exact polar opposites, right? they cancel each other out? no?

        I agree, it’s frightening.

        privilege (noun)
        “if it doesn’t affect me then obviously it’s not a real problem”

        I have no desire to engage with a bunch of people with armchair psych degrees all screaming about IT’S A MENTAL ILLNESS like climate-change deniers, but this free-speech concern trolling was too delicious to pass up

      2. I must respectfully disagree with your words, which “seem” to state that children or young people are “searching” for their gender, & “finding micro aggressions”. It is so backward, I might laugh, but it is a serious matter when society thinks as you do. Here is a definition of “privilege” which white “straight” sometimes “religious” society enjoys currently: Some academics highlight a pattern where those who benefit from a type of privilege are unwilling to acknowledge it. American sociologist Michael S. Kimmel describes the state of having privilege as being “like running with the wind at your back”, unaware of invisible sustenance, support and propulsion.[2] The argument may follow that such a denial constitutes a further injustice against those who do not benefit from the same form of privilege. One writer has referred to such denial as a form of “microaggression” or microinvalidation that negates the experiences of people who don’t have privilege and minimizes the impediments they face. Those who need “special rights” only “need” them due to the ignorance or belief in opinion as fact, due to their un-self aware “privilege”. These special rights protect the marginalized from the many micro and macro aggressions taken on them, in daily life. People do not “search” for their gender identity. It is inherent in their brain gender ID structure, recently scientifically/medically discovered. The reproductive organs form during the first 5-12 weeks of pregnancy. As with any early pregnancy time, all organs are fragile to outside events, genetics triggered, receptors working or not, hormones. My mother was exposed to DDT, and it did cause a defect for me. So, am I “searching” for my gender ID? NO. In the last half of pregnancy, the brain forms the gender ID structure, larger in males/transmales and smaller in females/transfemales. Legislation is necessary for all marginalized, due to the current wave of outright acted upon hatred toward those not privileged to be born white. Or straight. It is BIOLOGICAL, not theological.
        You are correct about “fake phobias”. These are actually “bigotry” and “hate”. About something that does not impact others lives with harm. The marginalized have fear every day. In the USA, our Constitution demands equality for all. Wonder why this is not true? (not really).
        You are being dramatic about not being able to criticize an article. Free speech is in our Constitution also. One’s choice of religious lifestyle is not allowed to impact other’s lives in our Constitution either.
        IF you are still reading, I would suggest using the Google to research privilege, the lives daily of marginalized persons (non-white, non-binary), medical research- use .edu, .org, not .com. I do wish you well on a journey of eye opening, and hopefully more empathy and compassion for all the humans who live on this earth.
        BTW, “transgendered” is incorrect grammar. I am not “straighted” nor “gayed”.
        Thanks, hope you can have success; usually humility is earned via suffering. I will pray you learn humility.

        McIntosh wro

  4. You say “Several studies have shown that identical twins are more often both transgender than fraternal twins, indicating that there is indeed a genetic influence for this identity.” A statement like that demonstrates just how little you understand about science and scientific studies, truth and lies and is why any reader should question everything you write.

    Anyone who exercises reason can discern that just because “several studies” (with no further qualification than the word study) have shown that it does in no way “INDICATE that there is indeed a genetic influence for this identity.” This is frankly a lie, not a reasoned conclusion. To make such a conclusion from the few words you have offered is an intended deception which cast a doubt on the veracity of everything you say.

    1. The sentence you quote links to one of the studies (which is actually a meta-study that contains a nice list of all the studies it examined). We could probably write a whole article just about twin studies, but here we were trying to cover more ground. I’m sorry that you found it confusing, but the author was making a conclusion from the cited study (not just a “few words”).

      Twin studies are actually an extremely common way to determine the relative contribution of genetic and environmental factors. If you’re interested, you can read more about it here: http://msutwinstudies.com/why-twin-studies/

  5. Great. Harvard has jumped on the lunacy bandwagon now? This is just fake science and biased garbage. Enough people. What happened to reason?? Everyone rejects facts now. You have all lost your minds. It is a mental disorder, end of.

    1. Great. Harvard has jumped on its usual scientific facts now. This is just well researched science and blessed (oops misread lol) truth. Good to know 10 yrs and more of scientific research has happened, and this is accepted by reason of medical/scientific researchers/physicians instead of churches. Only fundamentalists reject facts now. I am glad majority of all humans do not reject hard scientific work now. It is biological and genetic, end of.

    2. I happen to believe there’s some physical evidence for Transexuality but it’s certainly not cast in stone. The idea that gender is fluid because Judith Butler and articles like this say so, is ridiculous.

      1. That’s funny, I find the idea of “adding” dinosaurs to the biblical story ridiculous!
        Humans are all so different, aren’t they? I read lots of different articles. Isn’t that silly? lololol

  6. A most informative piece. I found it very helpful. I found my dysphoria completely vanished once my body matched that of my mind. My. My arms, my legs, my body, my mind… I have become My self. Science – this science has helped me to make sense of why I am . Thanks.

  7. I liked the article, and chased up a couple of references, but was disappointed by what I found. In the paragraph on estrogen receptor sensitivity, you cite two articles. The first links to an an article which discusses genetic polymorphism in ERb, not direct measurement of sensitivity (I can’t read the full paper, because it is not Open Access and we don’t have a subscription to that journal, but there is nothing in the abstract about receptor study per se, just genetic linkages) while the second links to an article that states explicitly “molecular findings presented no evidence of an association between the sex hormone-related genes (ERβ, AR, and CYP19A1) and MtF transsexualism.”, which seem to me to contradict your assertion that there is evidence to support the hypothesis. Do you have any more solid data on this?

    1. Hi! Thanks so much – you actually caught a mistake! We meant to cite another article by Fernandez et al., also published in 2014, looking at transsexuals. These two papers actually came out the same year and covered a similar topic, hence the error, which has now been corrected.

      However, I don’t want to obfuscate or hide the data that’s out there! So, I want to make sure I address your comments.

      For MtF…
      – In MtF, androgen receptors appear to be longer (and thus less sensitive). See http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0006322308010871#bib19 and https://academic.oup.com/hmg/article-abstract/4/4/523/560387/Evidence-for-a-repressive-function-of-the-long?redirectedFrom=PDF
      http://www.sciencedirect.com.ezp-prod1.hul.harvard.edu/science/article/pii/S0306453005000454 – this article, as you state, discusses genetic associations. However, that’s pretty much the extent of what we can do in humans. We can’t do a lot to manipulate estrogen levels in vitro. Still, studying ERbeta in mice, we do know that polymorphisms can have drastic effects on nervous system develop. As you can see, this can go both ways – having a poor estrogen receptor or one that’s too long can result in poor feminization in FtMs (Fernandez et al in the corrected text). With MtF, the polymorphism is different, and thus has different repercussions.

      Another interesting piece of evidence with FtM – http://www.fertstert.org/article/S0015-0282(07)01228-9/fulltext – this study looks at a CYP17 variant. CYP17 is involved in hormone metabolism, and thus may be affecting estrogen production. This study supports the idea that FtM may not have sufficient estrogen production (and thus are not sufficiently feminized).

      I also want to address the other Fernandez et al. 2014 paper that was incorrectly cited. This paper wasn’t fully investigated because it isn’t in a journal available to Harvard students, and thus it wasn’t (intended to be) included in this article, and thus I can’t fully evaluate its methods. However, the androgen receptor paper cited above was fully vetted by us and met our standards. Briefly comparing what is available between the papers, the Hare et al. paper drew from a more ethnically diverse population and had strong statistics backing it up. Still, it is absolutely worth acknowledging that we don’t have a strong consensus on mechanism yet, and we will hopefully cover more of the science behind it in the future. There is, however, medical and scientific consensus that transgender identity is NOT a mental illness: the DSM-V does not list it as a mental illness, and the vast majority of certified health professionals agree that is not a type of dysphoria.

  8. Part of my difficulty with this field is understanding what is meant by having a sense of gender.
    What does it feel like to be male / female? I have emotions, feelings, & preferences etc, but I’m not aware of those being indicative of masculinity or femininity.
    I could compare them to stereotypes, but perhaps people are talking of a different, extra thing: genderception. Is that a thing?
    I’d be very grateful for insights.

  9. Science is rapidly proving the biological nature of transgender, even fluid gender. Indigenous peoples often accepted a variety of perhaps 5-6 genders, until christian missionaries arrived insisting on M or F only, or punished. As an RN, I do know genitals are formed in the first 5-12weeks of pregnancy, when one is very susceptible to outside sources such as chemicals, also hormone levels and receptors being on or off properly, and viruses. Thus there are intersex persons, who know who they are in gender. Prior to repair, a surgeon now waits until age 3-5, when the child persistently, consistently, insistently states WHO they are. There is a book out, about repair done during infancy, female; the boy knew he was a boy, and had considerable distress. This gender dysphoria is caused by non-parental support (I know of families who chose their church & threw their child out of the house, young enough to become homeless, and prey to predators). It is caused by the constant draining requirement to be unable to be out, who they are, due to job, school, any discrimination. Who could be happy living undercover due to society’s mis-information, spread by SPLC designated “christian” anti-LGBTQ hate groups? ONE hate group was behind nation wide “bathroom bills” legislation, originating the line “Do you want a MAN in the bathroom w/your LITTLE GIRL?”, “they are confused, need help”, after slandering them viciously they chose this tactic. Liberty Councel, made up of attorneys.
    Does anyone remember the gonadal changes occurring after exposure by pregnant mom to DDT? I can tell you it affected mine. The brain forms gender structure in last half of pregnancy, and is irreversible. Children do say who they are now, age 3-5, persistently, insistently, consistently. Their eyes show their change- going from sad, shaded to alive, sparkling once transition achieved. This is no choice. Why would one choose a life of taking hormone, having a surgery, having to HIDE, being discriminated in jobs, housing, bullied terribly, hated by the very religious.
    I’ve read many scientific articles, not on .com, and have read reports more detailed even than this one. Some commenters appear a bit biased against any proof. To me? This is a huge scientific paradigm shift- one’s gender is determined by one’s BRAIN! Amazing! A discovery of this sort is usually given press, celebrated. Yet, there remains too much ignorance and hate.
    You cannot imagine being in the wrong body? That is because you are in alignment with your brain. Try to write with the opposite hand if not able to write well with both. Try really hard to imagine seeing a female in place of one’s male body if identifying as male. It’s really not THAT hard. What if you woke up tomorrow with the opposite body? Would it be illusionary? Would you have dysphoria, depression, sadness?
    In Salem, they used to burn epileptics at the stake. The disabled were kept in rooms in the attic. Or institutionalized, blaming the mother. Autistic children had “refrigerator moms”. Personally I do not understand why this is so difficult to comprehend.
    Methylation is often mentioned in this anomaly. I wonder if studies have been done on parents with MTHFR? Their bodies have difficulty in methylizing and ability to make use of some vitamins, meds, etc. I would like to see that studied.
    Thank you for this article, would like to read more on genetics, as I have prior. There is genetic component to autism also. There are higher numbers of autism kids in transgender population- genetics triggered in that first 5-12 weeks of pregnancy. I would like and be open to comments by the author. Thank you.

    1. Thank you for replying. I’m not attacking the science, or individuals who suffer add a result of being transgender. My question was a genuine one.
      I do appreciate that most societies have strong concepts of how males and females should behave, what their preferences should be, the feelings they’re allowed, and so forth. These rules have a detrimental effect on everyone, especially those who don’t fit the prescribed role.
      You give a clear example of how I might understand better: you are right that I can imagine awaking to find my body is not my own. Whether it be a different race, sex, or species. That would be upsetting and confusing, at least in part due to me being used to, and having memory of, a particular physical nature. I believe I have heard some transgender people describe their condition in those terms: a mismatch between their perception and the physical reality. I think this would sometimes be a sort of body dysphoria. (Like thin anorexic people believing they are overweight).
      More commonly, though, I’ve read people’s descriptions of how their gender does not match their sex. This seems to be a different thing.
      I do have a knowledge that my body is male (i have a penis, I don’t have a vulva), I don’t have a sense that my mind is masculine, excepting that it matches more stereotypes my culture has for men than women.
      So, the body perception thing is something I can grasp.
      Societal punishment for not maintaining gender norms, I get, and do what I can to challenge such prejudices.
      Feeling a gender, I still don’t understand. I’m not denying its existence, or criticising those who do feel it, though.
      Perhaps it’s a bit like an asexual person trying to understand sexuality.

      1. It IS hard to “feel” how another feels. I wouldn’t imagine being able to state how it feels to be in the gender fluid way in my brain, because MY brain is straight female. As I said, it has been proven there is a gender ID structure in the brain. It is like white striae. In males it is larger than in females. When compared, the transman was equal in size to a male, & had also some unique properties. Same with trans women. As there have been at least 6 genes discovered for gender ID (including agender), there is much to learn about the brain. About the brain for anything really!
        Society norms make it uncomfortable to know one is male, and then have a female body. Children are now stating who they are at 3-5. Inter-sex infants used to have reparative surgery right then. Now surgeons (if knowledgeable) wait until that child insistently, persistently, consistently states their gender. Same holds true for children who state “I am a boy”- must be insistently, persistently, consistently. There are experts in this field. They are now teaching the biology of gender ID in colleges, and med schools. Society has a hard time with this. As they did back in the day with bullying ANYone with a birth difference. So I guess I’m thinking – two groups. Children get to receive care that stops puberty until proper hormones are given, and can “pass” quite easily as the gender they are. Those who are late to it, must transition, it takes generally a year. Due to society, they need to be and look as their brain dictates to be happy. I’ve seen many a picture of before/after; the eyes are so sad, dark prior, after they are alive, sparkly. So yes the gonads are separate than the brain structure informing that person “who” they are. I can’t imagine being a soldier with his/her bits blown off. (gonadal) They remain “who” they are due to the dictates of their gender ID brain structure. I would think they’d give anything to have everything look normal again. I myself have a disabled leg. I don’t expect anyone to understand how it feels to have it, to have the chronic pain, the frustration of pacing my day, having to elevate it, etc. We cannot “feel” what another is suffering. When I say what if you woke up in female body, and you are still you! Yikes!Would you accept seeing breasts? No penis? So I understand it is very hard to understand wholly, as with anything different in others. Unless one has the capability to walk in another’s shoes. And that is a whole other thing, isn’t it? Empathy maybe? No. I cannot imagine truly what it is to be W/C bound my whole life. Or being gay, I wonder how does that “feel”? Doesn’t make it untrue does it. I wish society would stop demonizing all who are not male or female straight. Their plight is tragic enough. All birth “defect” or “anomaly” are. But then to be persecuted, is unconsciounable.
        Thank you for your response. They are human beings, just as all, trying to get through life, being persecuted due to fundamentalist religion & politicians pandering to them. It is a tragedy. Obviously I know many tho I am not.They are perfectly lovely, kind, integrity filled human beings. Perhaps from suffering. Sometimes I think society gets them mixed up with the old 70’s drag queens who entertained. Couldn’t be further from the truth. Thanks for your thoughts.

      2. Damian, I appreciate your sincere question and will attempt to relay something useful from my perspective as a trans man and a feminist.

        without a doubt we have all been socialized from birth to treat people we perceive as male and people we perceive as female in different ways, and to expect different behaviors depending on how we ourselves are perceived by others. the set of expectations which are built around conceptions of “male” and “female” vary from time to time and culture to culture, but can be universally addressed as “masculinity” and “femininity.” these sets of expectations, in all their variance of expression and severity, are obviously what people are referring to when we say that gender is a social construct.

        I’m assuming it is less than controversial to assert that femininity has historically been at a disadvantage to masculinity throughout civilization in all but the most egalitarian societies — such as those of the First Nations, which we of course exhaustively cite when pushing back against eurocentric heteronormativity, with data on two-spirits. in societies with an open power disparity, gender expression is necessarily impacted by survival pressures. the contemporary mortality rate of trans women is a microcosm (we’re talking sociology now, so, y’know) of all the ways in which the modern Western world remains closer to the second scenario than the first.

        but what are “male” and “female” upon which we are building these concepts of Masculine and Feminine? the obvious answer is the shape of one’s genitalia and reproductive organs, and of course there are secondary dimorphic characteristics ​which can be generalized but are themselves highly variant (height, bone structure, muscle mass, hair growth, etc) and that’s before we even get into the existence of intersex folk. I love how anti-trans rhetoric always dismisses an already underrepresented and marginalized population because the empirical presence of exceptions in no way proves anyone’s point about exceptions being a thing. /sarcasm. but I digress.

        you say, I get all that, I get ideas about gender conformity, I grok that reproductive equipment isn’t as binary as people like to think, but what does it mean to “feel” male or female? and this is a fascinating question, with which I have been wrestling since I finally came out as a trans man a little over a year ago, after 37 years of trying to accept myself as Female. understand, I had a lot invested, politically and emotionally, in my identity as a woman, and I continue to struggle with the personal repercussions of systemic abuse of Women in our culture.

        however, regardless of the biodevelopmental or psychosocial “reasons” for my gender identity, ignoring all the cultural and political implications of male privilege and overrepresentation, I can actually define how I know I am a man fairly easily. I belong with other men.

        for all that everyone hates being labeled, everyone loves the freedom to label themselves, and that is exactly the point of self-identification, whether we are claiming status in a group defined by gender, ethnicity, or fealty to Star Trek over Star Wars. the fact of the matter is that we are primates, pure and simple, and only survive on both individual and species levels based on our ability to cohere within groups. we are social animals and very literally and demonstrably require the acceptance and attention of other humans in order to thrive, unless of course we have an antisocial personality disorder.

        and by and large, trans people may be depressed and anxious af, but we are not generally antisocial. quite the contrary, we crave acceptance by our self-identified in-group. people who were able to identify their trans expression in childhood will often refer to “the other girls” and “the other boys” as being subject to experiences ​from which the speaker felt left out, whether social (wearing dresses) or physical (sprouting facial hair at puberty). trans adults, myself among them, often report powerful somatic cravings for physical sensations and experiences​ associated with a different body, such as the ability to menstruate or penetrate a sexual partner. but in the absence of social feedback and ingroups on which to map one’s inner reality, such feelings are excruciatingly difficult to identify and describe, let alone fulfill in any meaningful way.

        I don’t stop existing when other people aren’t around (in fact I’m quite solitary) and I fought for a great deal of body acceptance as a woman and a feminist. I do not suffer from image issues, as others have noted, of believing that there is something “wrong” with my body, and in fact I find it quite strong and beautiful. but it is not mine, in a dissociative fashion I took decades to understand as, more or less, the “trapped” narrative of mainstream media. when my body causes me distress these days, it is because I do not look/smell/sound like the other members of my self-identified ingroup, and from a lizard-brain perspective this is deadly. period.

        my distress used to be rooted in a vague but pervasive sense that I didn’t belong in my ingroup, for reasons I couldn’t identify. my relationships with women have improved dramatically since I distanced myself from them consciously, after a lifetime of never feeling fully accepted by women in the way I do by men. I submit that this is not the fault of anyone, on either a cultural or individual basis (I’ve been abused by both genders equally) but rather a naturally occurring glitch in my brain, since like, there’s data to support such a conclusion. I cannot feel accepted by women as one of their own. I’m literally incapable of it, because the sex-differentiation structures​ in my brain upon which primate heirarchies are built have determined, independent of the rest of me, that I don’t belong in that ingroup.

        I lose patience with certain arguments over socialization, as though a bunch of ignant sheep herders got together several thousand years ago and invented all the conventions of gender out of whole cloth in some sort of organized effort. the fact of the matter is that certain patterns of biological typification are not difficult to identify, nor are they universal. men are more aggressive, in aggregate. women are more sensitive, in aggregate. these traits kept us alive for hundreds of thousands of years before the dawn of agriculture and its associated imposition of gender *conformity* designed to promote breeding. they are a self fulfilling prophecy in that the sensitive people consistently wind up at the mercy of the aggressive people. they are also far from deterministic and in fact I argue that medical transition for trans folk has proven conclusively that the only practical difference between the sexes is a matter of hormones.

        my understanding is that when I begin T, I can expect my inner experience to reflect the relief inherent in a biological need being fulfilled. assuming that my brain has anomalous structures associated with being Male as described in these studies, my androgen receptors will respond to hormone therapy like a dopamine drip, and a great deal of anxiety will evaporate as my lizard brain stops screaming at me after a lifetime that I don’t properly belong and my group is gonna eat me. my presentation as Male will be more readily accepted by others cuz of pheromones, and this will fall into a nice little feedback loop of affirmation. I may very well also experience heightened dysmorphia wrt certain aspects of my body, as a man who has lost his junk in an accident might. however, this is a risk I am willing to take for the opportunity to feel I fully inhabit myself, as opposed to being isolated within a mismatched reality, unable to reconcile instinct and stimuli.

        I realize this has been less than clinical but I hope it is helpful regardless

        1. I wanted to thank you for a great explanation I’d not heard before. Thank you for your well expressed honesty. It has helped “round out” my research and knowledge. As I’ve said, no one can fully feel as another. We’re all unique “primates” or humans. Those who make flippant remarks. I just cannot “feel” as they do, cannot understand the refusal to see facts or how someone else feels, I just can’t wrap my mind around. Perhaps they too have a genetic, or hormonal issue, I believe they who are un-empathetic or aggressive, ought to also be researched in much the same ways.

  10. Interesting article. The dumbed down analogies were useful and very persuasive. Ms Wu does seem to be persuading the reader in a certain direction. The circling of wagons in the comments section, is revealing.

  11. Thanks for the article. I’ve been trying to find more where a lot of studies are in one place. You usually have to do a lot of digging.
    I’m a transgender female and agree with a lot of this. I knew at a very young age but was shamed into being a boy, guy, man, whatever and didn’t come out until my early 40’s.
    People continue to call it a mental illness and it gets tiring. You develop mental illness because of the depression, anxiety, suicidal thoughts that it leaves you with trying to hide/deny your true self. It doesn’t go away and eats at you throughout life.
    You can put studies right in front of people about how trans female brains are more like cis female brains but they don’t care. I don’t even argue with them anymore. Smh

  12. I know I have commented – but I forgot to thank you for this compilation of many years of research. It is a scientific paradigm shift in understanding one’s gender is not attached to one’s reproductive organs. To me, as scientific RN, it is amazing knowledge!!! I feel awe at the human body’s many mysteries still not known. To know there is a gender ID structure in the brain- society indeed will have a hard time accepting this. I then go back to why does society understand that a male/female harmed by being a soldier in a bombing, losing their reproductive organs, remain organized in the brain as same as prior? For if organs determined gender, they should be confused as to whom they are. I will utilize your article in a group. If you have a site that can explain in laymen’s terms, I would appreciate a link. Thank you again for publishing this.

  13. Hi. A thought occurred to me when I was reading this. The research presented in this article spoke of density of cells in an area of the brain as an indicator of gender identity. Could this mean that gender is not a binary male/female subject but rather a spectrum as there must be a great range of densities in different brains.


    1. That’s a great question! I’m not aware of any studies showing that the spectrum of brain structure correlates with how non-binary gender identity, but it is certainly possible. We know that how people identify their own gender is certainly non-binary, but we are just scratching the surface of the biology behind this.

    2. I had read in several scientific articles, that geneticists had discovered at least 6 genes for gender ID. If not more. It would make sense to me. May I ask if you are aware that during the triggering of the wrong reproductive organs, autism is genetically triggered? There is a higher percentage of ASD in the trans population, not by much, but it has been noticed by parents. Thank you

      1. I think there is some scientific literature to back this observation that there are higher rates of ASD in the trans population, but the reason for it is still unknown. Since we don’t entirely understand the biology behind ASD or gender identity, it is hard to say if/how they might be biologically linked.

  14. Hi, thank you so much for putting all of this together. Something I think that sets trans people apart(myself being one; and this is in reference to being transgender often times being compared to bdd, anorexia, among other things) is that anorexic people do not feel euphoria when allowed to have the treatments they want, whereas in trans people, when we receive hormones or surgery, it is often euphoric for us. Taking hormones is the most euphoric part of my day most days. This is usually something completely overlooked or not really even brought up. It’s the same way with the presence of my breasts, it feels very good and euphoric(and not at all in a sexual way; none of the euphoria is sexual, feels more like relaxation, as though there’s this constant anxious tension and it just gets released all of the sudden) to know they’re there. They bring me a lot of comfort and a lot of peace of mind. The fact that the science lines up overwhelmingly with my experience is so relieving. I wish that people would treat us like human beings and not as though we’re some kind of abomination or something. I will definitely be citing this and these studies in the future in defesense of myself and my choice to receive treatment.

  15. The images on here are very misleading, tending to look as if the numbers of deviants of all stripes are equal to that of normals. There should be a huge circle with a tiny area around the edges for the various types of mal-adjusted individuals.

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