Transgender people are born. We are created in the womb during the second trimester. We represent a rare but normal birth difference in people. A vast amount of scientific research confirms this finding. In this section you will find information on why transgender people are who they are and what creates them. You will also find “how to’s” on many things to help you with you or your family member’s transition. For a transgender person, transitioning is both frightening and wonderfully affirming. Helping a transgender person transition is a rewarding and life changing event. Thank you for helping us to live real, authentic lives.
-Karen Adell Scot, Founder, TransCare.org.
Transgender people are Supported. Every major medical organization in the United States and most other countries of the world support the reality of transgender people. Other organizations also support the reality that transgender people are real. Some organizations are:
The American Medical Association, The American Psychiatric Association, The American Psychological Association, The American Academy of Family Physicians, The American Academy of Physician’s Assistants, and the World Professional Association for Transgender Health (WPATH.)
Transgender People feel Gender Dysphoria.
Gender dysphoria involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify. People with gender dysphoria may be very uncomfortable with the gender they were assigned, sometimes described as being uncomfortable with their body (particularly developments during puberty) or being uncomfortable with the expected roles of their assigned gender.
People with gender dysphoria may often experience significant distress and/or problems functioning associated with this conflict between the way they feel and think of themselves (referred to as experienced or expressed gender) and their physical or assigned gender.
Diagnosis of Gender Dysphoria.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults.
In adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning. It lasts at least six months and is shown by at least two of the following:
- A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
- A strong desire to be rid of one’s primary and/or secondary sex characteristics
- A strong desire for the primary and/or secondary sex characteristics of the other gender
- A strong desire to be of the other gender
- A strong desire to be treated as the other gender
- A strong conviction that one has the typical feelings and reactions of the other gender
In children, gender dysphoria diagnosis involves at least six of the following and an associated significant distress or impairment in function, lasting at least six months.
- A strong desire to be of the other gender or an insistence that one is the other gender
- A strong preference for wearing clothes typical of the opposite gender
- A strong preference for cross-gender roles in make-believe play or fantasy play
- A strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
- A strong preference for playmates of the other gender
- A strong rejection of toys, games and activities typical of one’s assigned gender
- A strong dislike of one’s sexual anatomy
- A strong desire for the physical sex characteristics that match one’s experienced gender
For children, cross-gender behaviors may start between ages 2 and 4, the same age at which most typically developing children begin showing gendered behaviors and interests. Gender atypical behavior is common among young children and may be part of normal development. Children who meet the criteria for gender dysphoria may or may not continue to experience it into adolescence and adulthood. Some research shows that children who had more intense symptoms and distress, who were more persistent, insistent and consistent in their cross-gender statements and behaviors, and who used more declarative statements (“I am a boy (or girl)” rather than “I want to be a boy (or girl)”) were more likely to become transgender adults.
The exact causes of Transgender People are still not exactly known. Studies however, show much scientific evidence that the causal agent pointed to is genetic. Science shows the result that creates Transgender People although the exact causal agent(s) may still be elusive.
“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 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 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.”
There is something unique about the Transgender brain. This article was published in Scientific American in 2016 by Francine Russo.
Is There Something Unique about the Transgender Brain?
Imaging studies and other research suggest that there is a biological basis for transgender identity
Some children insist, from the moment they can speak, that they are not the gender indicated by their biological sex. So where does this knowledge reside? And is it possible to discern a genetic or anatomical basis for transgender identity? Exploration of these questions is relatively new, but there is a bit of evidence for a genetic basis. Identical twins are somewhat more likely than fraternal twins to both be trans.
Male and female brains are, on average, slightly different in structure, although there is tremendous individual variability. Several studies have looked for signs that transgender people have brains more similar to their experienced gender. Spanish investigators—led by psychobiologist Antonio Guillamon of the National Distance Education University in Madrid and neuropsychologist Carme Junqué Plaja of the University of Barcelona—used MRI to examine the brains of 24 female-to-males and 18 male-to-females—both before and after treatment with cross-sex hormones. Their results, published in 2013, showed that even before treatment the brain structures of the trans people were more similar in some respects to the brains of their experienced gender than those of their natal gender. For example, the female-to-male subjects had relatively thin subcortical areas (these areas tend to be thinner in men than in women). Male-to-female subjects tended to have thinner cortical regions in the right hemisphere, which is characteristic of a female brain. (Such differences became more pronounced after treatment.)
“Trans people have brains that are different from males and females, a unique kind of brain,” Guillamon says. “It is simplistic to say that a female-to-male transgender person is a female trapped in a male body. It’s not because they have a male brain but a transsexual brain.” Of course, behavior and experience shape brain anatomy, so it is impossible to say if these subtle differences are inborn.
Other investigators have looked at sex differences through brain functioning. In a study published in 2014, psychologist Sarah M. Burke of VU University Medical Center in Amsterdam and biologist Julie Bakker of the Netherlands Institute for Neuroscience used functional MRI to examine how 39 prepubertal and 41 adolescent boys and girls with gender dysphoria responded to androstadienone, an odorous steroid with pheromonelike properties that is known to cause a different response in the hypothalamus of men versus women. They found that the adolescent boys and girls with gender dysphoria responded much like peers of their experienced gender. The results were less clear with the prepubertal children.
This kind of study is important, says Baudewijntje Kreukels, an expert on gender dysphoria at VU University Medical Center, “because sex differences in responding to odors cannot be influenced by training or environment.” The same can be said of another 2014 experiment by Burke and her colleagues. They measured the responses of boys and girls with gender dysphoria to echolike sounds produced by the inner ear in response to a clicking noise. Boys with gender dysphoria responded more like typical females, who have a stronger response to these sounds. But girls with gender dysphoria also responded like typical females.
Overall the weight of these studies and others points strongly toward a biological basis for gender dysphoria. But given the variety of transgender people and the variation in the brains of men and women generally, it will be a long time, if ever, before a doctor can do a brain scan on a child and say, “Yes, this child is trans.”
My Story – Karen Adell Scot.
I absolutely knew I was female when I was nearly three years old. My mother told me, “Come into the front room little boy” and I looked at her and said, “No mommy, I not boy, I girl.” Each night I would tuck my little boy plumbing back between my legs and wish it would be gone by morning. I completely knew I was female. My father used an electric shear to buzz off all my platinum blonde hair and I countered with putting on a scarf to feel like I had long hair. I asked my mommy what my name would have been if I was born girl and she said, “Karen Adell.” So I WAS Karen Adell. That is my name now that I have transitioned.
This is called “Early Onset Transgenderism.” Those transgender people know totally that they are not the gender their body resembles at a very young age.
Other transgender people feel dysphoria all of their lives but fight against it due to cultural pressures to conform as the gender they are expected to present. They finally transition later in life.
This is called “Late Onset Transgenderism.” Those transgender people find that they simply cannot fight against the strong pull of Gender Dysphoria and must transition to their real gender, even if late in life, even if shunned, ostracized and dumped by their families.
(More to come… Still under construction. – Karen Adell Scot)