The Riddle of Gender

ergotism and is recognized as a consequence of “the human body’s misreading of a fungal signal.” In the Middle Ages, individuals exhibiting the bizarre symptoms of St. Anthony’s fire were thought to be possessed by the devil. “This level of knowledge was consistent with the unpleasant consequences usually visited on such individuals,” McLachlan notes dryly. In later centuries, they were incarcerated in mental institutions. Eventually, the disorder was shown to result from eating moldy rye bread, and an understanding of the biochemical etiology of the condition led to a public health solution—“prevent mold from developing in rye flour or, if it does, don’t make bread from it.”

No one believes that an understanding of the manner in which gender identity develops will be so simple— nor do many believe that gender variance itself is a problem requiring a solution. Milton Diamond, for example, objects to the characterization of the different forms of gender variance as “anomalies” and prefers to term them simple variations. Still, science liberated the victims of St. Anthony’s fire from the stigma of mental illness, just as I am certain it will eventually reveal the actual biological mechanisms that produce the wide range of anatomical and neurological intersex conditions. Many of the anatomical conditions, of course, have already been elucidated. The “natural” genetic and/or biochemical mechanisms that produce Klinefelter’s syndrome, CAH, Turner’s syndrome, AIS, and various enzyme deficiencies that produce anomalously sexed bodies were identified decades ago. Yet there is still resistance in some quarters to accepting that many individuals born with these conditions are fine as they are—that they don’t need to be “fixed” to conform to some rigid aesthetic or medical concept of what “normal” genitals or “normal” human beings look like.

“More people are coming around,” says Milton Diamond. “They have to. The data is accumulating. I gave a talk at the American Academy of Pediatrics in ‘98 and I really thought they would throw stones at me. I was telling them that, first, I thought that what they were doing [intersex surgery on infants and children] was wrong; number two, that they have to do the research to discover the effects of what they were doing; and number three, they have to be honest. Well, they didn’t want to hear any of that. Now I have to give them credit. They did listen. In 2000, they changed the standard procedure. I gave a similar talk in England in 2000 and in 2001 they changed their procedure.” The current guidelines, he points out, “basically say, ‘think twice’” before correcting anomalous genitals. Diamond and legions of intersex activists would like physicians to wait permanently—or at least until the child expresses a gender preference. In many cases, the children might opt to stay exactly as they are.

The challenges faced by transgendered and transsexual people in their dealings with scientists and physicians are even more daunting. Like the general public, most hear the word “transsexual” and immediately visualize an episode of the Jerry Springer Show. They don’t conceive of gender variance as a medical condition, nor do they view it as a legitimate focus of research. Not many people are well acquainted with the kind of professional transpeople whom I interviewed for this book or with the data that point to a biological etiology for gender variance. In many ways, the scientific and medical professions mirror the prejudices of society at large with respect to trans people. No wonder so many trans people show little interest in participating in research and avoid seeking medical care. The history of interactions between trans people and health care providers has been a complicated one, as this book indicates. Arrogance, paternalism, dishonesty, manipulativeness—the accusations fly back and forth while the civil status and health status of transgendered people hang in the balance. Many in the trans community recognize that their efforts to achieve civil protections are somehow bound up with scientific and medical perceptions of their condition, while others heatedly deny that science and medicine will make any contribution at all to their efforts to gain job protections, to marry, to retain custody of their children, and to achieve the degree of social acceptance that has thus far eluded them.

Dr. Dana Beyer believes that further research combined with activism is essential. “People need to understand why this happens; they need to understand about DES and the effects of EDCs, and that this isn’t going away. This is personal for me. I live with this twenty-four—seven. But as a society we’ve got a real problem. Fish changing sex? Hermaphroditic frogs? But they don’t make the connection. And then when a story comes out, local sperm counts down 20 percent, they just sort of ignore it.”

The only way that the scientific community will accept the possibility that exposure to DES and other endocrine-disrupting chemicals is driving a silent epidemic of gender variance is if (a) epidemiologic studies show a clear correlation between an exposed population and a statistically significant increase in manifestations of gender variance; or (b) laboratory studies illuminate the mechanisms by which exposure to estrogenic chemicals might produce changes in sex-dimorphic brain structures and consequently in gender-specific behavior. Of course, this latter point raises another provocative question—what is gender-specific behavior and how might it be affected by exposure to EDCs?

In 2003, Simon Baron-Cohen, a professor of psychology and psychiatry at Cambridge University in the United Kingdom, published a book that attempts to anchor readily observed differences in male and female behavior in the brain. In The Essential Difference: The Truth about the Male and Female Brain, Baron- Cohen admits that “the subject of essential sex differences in the mind is clearly very delicate” and that his theory could “provide grist for those reactionaries who might wish to defend existing inequalities in opportunities for men and women.” Nonetheless, Baron-Cohen believes that compelling data exist to show that the brains of the average man and woman are skewed to perceive and respond to the world differently. On average, he says, females spontaneously empathize (identify and respond to another’s emotions and thoughts and respond to them with an appropriate emotion) to a far greater degree than males. The average male, on the other hand, spontaneously systematizes (analyzes, explores, and constructs systems) to a greater degree than the average woman. Baron- Cohen is quick to point out that neither of these modes of interacting with the world is better or worse than the other—they are just different.Systematizing and empathizing are wholly different kinds of processes. You use one process—empathizing—for making sense of an individual’s behavior, and you use the other—systematizing—for predicting almost everything else. To systematize you need detachment in order to monitor information and track which factors cause information to vary. To empathize you need some degree of attachment in order to recognize that you are interacting with a person, not an object, but a person with feelings, and whose feelings affect your own. Ultimately, systematizing and empathizing depend on independent sets of regions in the human brain. They are not mystical processes but are grounded in our neurophysiology.

Calling the two types of brains E for empathizing and S for systematizing, Baron-Cohen stresses that not all women have the E type and not all men have the S type. The evidence does suggest that more women are E and more men are S, however, and Baron-Cohen marshals much behavioral data to support his claim. When it comes time to explain the neurobiological mechanisms that might create this difference, he cites some of the same evidence that I have presented in this book, including the effects of hormones on the sexual differentiation of the brain. Indeed, he points to studies of DES sons that found the youngsters “likely to show more female-typical behaviors—enacting social themes in their play as toddlers, for example, or caring for dolls.” Studies of male-to-female transsexuals show “a reduction in ‘direct’ forms of aggression (the physical assaults that are more common in males),” Baron-Cohen points out, and “an increase in indirect or ‘relational’ aggression (the style of aggression that is more common in females). This is strong evidence that testosterone affects the form the aggression takes,” he concludes. He also explores evidence for an anatomic and/or genetic basis for the E/S distinction.

Most provocatively, Baron-Cohen characterizes autism, a relatively rare condition in which a person shows abnormalities in social development and communication and displays obsessional interests, and As-perger’s syndrome, a more common and less disabling version of autism, as extreme cases of the male (systematizing) brain. Autism is diagnosed ten times more often in males than in females. Indeed, Hans Asperger, an early researcher on autism, suggested in 1944 that “the autistic personality is an extreme variant of male intelligence.” This “monumental” idea, Baron-Cohen says, went unnoticed for nearly fifty years, and it wasn’t until 1997 that researchers began exploring this “controversial hypothesis.” Diagnoses of autism, like those for gender identity disorder, have been rising steadily over the past few decades, and though Baron-Cohen does not suggest any linkage between environmental factors and autism, one does wonder what might explain the sudden upsurge in cases of autism and Asperger’s syndrome.

Baron-Cohen’s research and his book, which was the subject of a cover story in Time magazine, provide another indication that the theory of psychosexual neutrality in particular and social construc-tionist views in general are steadily being eroded in both scientific and popular accounts of gender. A few months after Baron-Cohen’s research was highlighted in Time, a cover story in the New York Times Magazine inquired, “Why Don’t More Women Get to the Top?” The answer: “They Choose Not To.” Author Lisa Belkin concluded that “as women look up at the ‘top,’ they are increasingly deciding that they don’t want to do what it takes to get there,” namely neglect their families