Gender, Sex, and Choice

An article by Hannah Rosin in The Atlantic about transgender children.

Since he could speak, Brandon, now 8, has insisted that he was meant to be a girl. This summer, his parents decided to let him grow up as one. His case, and a rising number of others like it, illuminates a heated scientific debate about the nature of gender—and raises troubling questions about whether the limits of child indulgence have stretched too far.

It’s tough reading; the stories of these kids are full of anguish and loneliness, hurt, despair and above all else, a maddening confusion that seems as bewildering as it is devastating. At the heart of the article is a discussion of treatment. In particular,

A recent medical innovation holds out the promise that this might be the first generation of transsexuals who can live inconspicuously. About three years ago, physicians in the U.S. started treating transgender children with puberty blockers, drugs originally intended to halt precocious puberty. The blockers put teens in a state of suspended development. They prevent boys from growing facial and body hair and an Adam’s apple, or developing a deep voice or any of the other physical characteristics that a male-to-female transsexual would later spend tens of thousands of dollars to reverse. They allow girls to grow taller, and prevent them from getting breasts or a period.

Of course, the practice has it’s detractors. And it’s certainly hard to cringe at the attitude of one parent,

“He’ll just basically be living life,” Jill explained about her (natal) daughter. “I already legally changed his name and called all the parents at the school. Then, when he’s in eighth grade, we’ll take him to the [endocrinologist] and get the blockers, and no one will ever know. He’ll just sail right through.”

Sail right through. Sure.

She can be so cavalier about the future happiness of her child because she knows exactly why her child is confused. It’s because although her child’s sex is female, in his mind, his gender is male. This parent and people like her believe that gender is determined, their kids are hardwired to see themselves as a particular gender, regardless of what their bodies might indicate otherwise. Describing the history of one of the kids that the article focuses on,

She insisted on peeing standing up and playing only with boys. When her mother bought her Barbies, she’d pop their heads off. Once, when she was 6, her father, Mike, said out of the blue: “Chris, you’re a girl.” In response, he recalls, she “started screaming and freaking out,” closing her hand into a fist and punching herself between the legs, over and over. … When Chris turned 11 and other girls in school started getting their periods, her mother found her on the bed one night, weeping. She “said she wanted to kill herself,” her mother told me. “She said, ‘In my head, I’ve always been a boy.'”

The hormone treatment seems to be successful. “According to Dr. Peggy Cohen-Kettenis, the psychologist who heads the Dutch clinic, no case of a child stopping the blockers and changing course has yet been reported.” At a transgender convention, the older transgendered wish they’d had the chance, and the younger ones (the 10 year olds) look forward to it.

The problem, of course, is that even when life is horribly, wretchedly complicated, sometimes it’s even more mystifying than we thought.

But about a month after that, everything began to change. Chris had joined a softball team and made some female friends; her mother figured she had cottoned to the idea that girls could be tough and competitive. Then one day, Chris went to her mother and said, “Mom, I need to talk to you. We need to go shopping.” She bought clothes that were tighter and had her ears pierced. She let her hair grow out. Eventually she gave her boys’ clothes away.

Now Chris wears her hair in a ponytail, walks like a girl, and spends hours on the phone, talking to girlfriends about boys. Her mother recently watched her through a bedroom window as she was jumping on their trampoline, looking slyly at her own reflection and tossing her hair around. At her parents’ insistence, Chris has never been to a support group or a conference, never talked to another girl who wanted to be a boy. For all she knew, she was the only person in the world who felt as she once had felt.

Chris’s parents didn’t purse hormone treatment. They went to an opponent of early hormone treatment, Dr. Zucker. Now chris seems happy and adjusted. Her childhood was difficult, but she’s grown and is making her own choices. Dr. Zucker,

explains gender dysphoria in terms of what he calls “family noise”: neglectful parents who caused a boy to over­identify with his domineering older sisters; a mother who expected a daughter and delayed naming her newborn son for eight weeks. Zucker’s belief is that with enough therapy, such children can be made to feel comfortable in their birth sex. Zucker has compared young children who believe they are meant to live as the other sex to people who want to amputate healthy limbs, or who believe they are cats…

Dr. Zucker treats children with a kind of hyper-Freudian therapy:

They turned their house into a 1950s kitchen-sink drama, intended to inculcate respect for patriarchy, in the crudest and simplest terms: “Boys don’t wear pink, they wear blue,” they would tell him, or “Daddy is smarter than Mommy—ask him.” If John called for Mommy in the middle of the night, Daddy went, every time.

Such rigid gender roles seem archaic and absurd to a modern liberal ear, but Zucker’s therapy reports results. The participants in this therapy don’t actually believe what they’re saying to their kids, they’re just trying to mold them. Which, really, is exactly what the parents who begin hormone treatment are trying to do. In both cases, the parents are trying to impose an identity on the child, either in an effort to make the gender match the sex or vice-versa.

Which brings us to the case of David Reimer. David was born a boy, but a botched circumcision destroyed his penis. His parents saw a profile of John Money, a psychologist who argued that gender identity was a purely social construct. Under Money’s guidance, David was fully castrated and his parents raised him as a girl. Money reported the case as successful and published his results to much acclaim, but that was a lie. As Rosin notes,

Reimer had never adjusted to being a girl at all. He wanted only to build forts and play with his brother’s dump trucks, and insisted that he should pee standing up. He was a social disaster at school, beating up other kids and misbehaving in class. At 14, Reimer became so alienated and depressed that his parents finally told him the truth about his birth, at which point he felt mostly relief, he reported. He eventually underwent phalloplasty, and he married a woman. Then four years ago, at age 38, Reimer shot himself dead in a grocery-store parking lot.

For more on David Reimer, There’s John Colapinto’s 1997 story in Rolling Stone. Wikipedia here. Book here. More here.)

It took 25 years for the failed experiment that ultimately cost David Reimer his life to be fully discredited. Hormone blocking has been performed on pre-teen adolescents for less than 10 years. The simple truth is that we don’t know what adulthood will bring for these children.

In all this discussion of transgendered children, queers, and he-shes, there’s only one thing that’s really taboo: individual agency.

The debate is torn between two positions. Gender is either a social construct or it’s biologically hardwired into the brain. The possibility that it could be both, or some different combination of the two for any given person is unthinkable. I suspect that introducing individual agency into the debate would shake too many shibboleths. The above quote above, comparing the transgendered child “to people who want to amputate healthy limbs, or who believe they are cats…” is only a partial quote. It continues,

, or those with something called ethnic-identity disorder. ‘If a 5-year-old black kid came into the clinic and said he wanted to be white, would we endorse that?” he told me. “I don’t think so. What we would want to do is say, ‘What’s going on with this kid that’s making him feel that it would be better to be white?'”

The idea of a doctor giving a 10 year old child drugs to lighten the color of his skin and alter his facial features so that he could pass as white is almost impossible to imagine. It is simply understood that racial heritage is always and everywhere a significant and necessary component of identity. It is also understood that racial identification is absolutely non-optional.

We have completely accepted the idea that individuals are no more than the sum of collective interests. We are no longer individuals, we are black-lesbian-atheist-democrats, white-transgendered-wiccan-environmentalists, and Asian-male-catholic-republicans. Our identity is now defined by a trailing list of categories to which we have been assigned. Whether that assignment is made by society or determined in utero by a combination of hormones, we are sure that whatever the mechanism, we should submit to the identity to which we have been assigned.

So the question is now, “What should Brandon be?” Rather than, “What does Brandon want to do?” Rather than treat Brandon’s gender as a part of an emerging identity that he can shape and create as he grows, his gender is treated as a fixed and determinate given. It is not something that he designs, but rather something that his parents, doctors, and psychologists must divine. If he’s a “boy” then he should play with trucks and guns and have a penis. If he’s really a “girl” then he should wear dresses and play with dolls, suffer hormone treatments, and off goes his willy. But why can’t he be herself, whatever that is?

It is too easy to believe that David Reimer’s story is a caution about the dangers of social conditioning, and that therefore, the biological determinists are making sound choices for their children. But the real lesson in David Reimer’s story is that these decisions are far too intimate, far too personal for anyone other than the affected individual to make. David Reimer’s story is a caution against authoritarianism. The tragedy of David Reimer’s life is that the opportunity to shape his identity was stolen from him.

These children are in pain. They are undoubtedly troubled. But they don’t all suffer from the same condition. For some the problem is social identity, as one parent said, “We call it the disorder we cured with a skirt.” For others it might lie deeper; a fundamental issue with self-identification. For some it will be a temporary phase while others will battle with questions of gender and sexuality for the rest of their lives.

Childhood is difficult. Growing up is hard work, and it’s largely work that the child needs to do on his own. If Brandon wants to be called Bridget, then call him Bridget. Buy him dresses, use the feminine pronoun, but don’t foreclose on the idea that she might decide, on her own, to go back to he.

The Intersex Society of North America says it succintly,

In cases of intersex, doctors and parents need to recognize, however, that gender assignment of infants with intersex conditions as boy or girl, as with assignment of any infant, is preliminary. Any child—intersex or not—may decide later in life that she or he was given the wrong gender assignment; but children with certain intersex conditions have significantly higher rates of gender transition than the general population, with or without treatment. (ISNA)

We don’t think we can ever predict, with absolute certainty, what gender identity a person will grow up to have. What we can predict with a good degree of certainty is that children who are treated with shame, secrecy, and lies will suffer at the hands of medical providers who may think they have the best of intentions and the best of theories. (ISNA)

For most of us, our gender, sex, and sexuality are defining parts of our identity. For some of us, however, one or some or all of those aspects of life matter less, or are more a source of confusion and turmoil than markers for a stable identity. If confusion does reign, then trying to force a decision is bound to be disastrous. There’s no reason to assume that for all people and all children that a person’s gender must match their sex, or that their sexuality should be determined by either.

One of the parents in Rosin’s article says, “the biggest sex organ is not between the legs but between the ears.” That gets it exactly wrong. The sex organs are what they are. The brain is an organ of choice, volition, ideas, and identity. Nurture those characteristics and let adults decide how their sex organs should look.