Rainbows, Gender, Sex, and Good Doctors

Composed 28/05/2012, and posted today after much iteration, in honour of Dr. Martin Luther Kings birthday. May he be remembered forever, by a world that so desperately needs more people like him within it.

It’s that time of year again here in San Francisco, when the rainbow flags are strung up all over the city, and people begin planning for the Pride Parade just a few short weeks away. I’ve always been fond of this time, and not just because it’s the biggest party I know of on the entire west coast and happens to occur well within my reach. No, I’m fond of this time because it’s a great show of what can happen when people are willing to not only accept other people who are different than themselves, but support them for the simple sake of that very distinction. But I used to also wonder something. Specifically, I used to wonder just how it is people like me, who suffer from Gender Dysphoria, ended up such an integral part of this movement as to end up one of the first four letters.

That would be the T, for Transgender or Transsexual, depending on who you ask. For the record, either is technically correct, as far as the initialism is concerned. In hindsight, when considering the various challenges facing a Transgendered person and the rampant ignorance involving our predicament, the association makes sense. One could postulate that the modern situation of sex and gender being treated as if they were synonyms has a lot to do with it, and to borrow the phrase, everything rolls downhill from there. (Feel free to verify this with your favourite dictionary!) The resultant mess of conjecture, misinformation, and even downright disinformation in some cases, creates an artificial environment in which the most logical grouping for Transgendered people, the LGBT community, is in fact not scientifically correlated at all. This little factoid becomes dramatically apparent when you embark on even a cursory investigation into Transgenderism, which I will lead you through now.


The most accepted “explanation” for the desire to change your biological sex cites a psychological disorder known as Gender Identity Disorder. The American Psychiatric Association, in its Diagnostic and Statistical Manual of Mental Disorders, asserts that this diagnosis can be made by a trained professional (Remember, the DSM is not a self help book!) when the patient exhibits: a long standing and strong identification with another gender; long standing disquiet about their sex or a sense of incongruity in the gender assigned role of their sex; that the patient does not possess any biologically intersex characteristics; and finally, that there are significant clinical discomfort or impairment at work, social situations, or other important life areas (collectively referred to as Gender Dysphoria). That’s nice, but what does all of this mean?


Let’s break it down. Easiest of all is the third stipulation, that the patient not be intersex. What this means, is a person who has androgynous features up to and including mismatched genitalia, or what the layman might refer to as a hermaphrodite. Such individuals are covered elsewhere in the manual. So that leaves us with three, rather subjective criteria left, two of which are very closely related and end up listed separately as one of the quirks of Psychiatric practice. (Which prompts me to once again remind you, oh reader, that self diagnosis is foolish at best and dangerous at worst!) The odd man out, a long standing and strong identification with another gender, turns out to be relatively simple once explained. Put succinctly, a person who meets this criteria will want to check the box that says female, despite the presence of their penis (or male and vagina, in the other case). We usually can’t explain this urge, it just seems to rise from our very bones, the bottom of our hearts, or the depths of our soul. Trust me on this one, because I certainly can’t explain where it comes from, with all my mastery of the English language. It’s just a part of who you are, as intrinsic to you as the colour of your eyes, the tone of your skin, and the very much equally human blood in your veins.


Now, the last two, a long standing disquiet about your sex or a sense of incongruity about your sexes gender role, combined with significant clinical discomfort or impairment at work, out socializing, or other important areas of your life. Understanding exactly what this means is a simple matter of looking up the word dysphoria, itself. As the opposite of euphoria, a great sense of joy or happiness, dysphoria is the experience of great depression, discontent, sadness, or even unshakeable indifference, sometimes described as a nothingness, or emptiness. Sounds terrible, doesn’t it? Believe me, and anyone else who has ever suffered a diagnosable level of depression, it is. I got off lucky on this one, according to my fellow sufferers, as I merely have this vague sense of malaise and indifference that spikes when I see myself in a mirror, but I can typically ignore. There are people who grow so detached, so depressed, that they end their own lives rather than live in torment any longer. We’re especially vulnerable to a sharp drop after we’ve been given treatment for a length of time, and still fail to achieve acceptance for who we are.


Remember that I put the word, explanation, in quotes? You’re probably noticing that all we’ve been provided here is a list of symptoms, a description of the suffering without the reason for it. Sadly, at least for now, this is all we have to work with, yet we’re also lucky, because for the most part, in a practical sense, that’s all we really need. Armed with the knowledge to make a diagnosis, the professional health care provider can make the arrangements to attempt a treatment, yet in our highly politicized world, sometimes this practical level of understanding, just isn’t enough. Stood alongside the other letters on the rainbow flag, our collective detractors demand proof of what we tell them about ourselves, much like an abusive partner yelling at you to stop crying because, “you’re not really hurt.” They demand that we be poked and prodded in well meant psychoanalysis, dissected and studied by conscientious scientists who wish only to help (the people who supplied their funding), raped and tortured in the name of righteousness, according to a blasphemous interpretation of holy writ whilst cowering behind the label of “aversion therapy,” or in the most extreme of cases, summarily and coldly exterminated.


Luckily, there are people on the front lines of the issue, who view the situation with true humanity, a great care and desire to ease the suffering of others. One of these individuals, a clinical practitioner by the name of Dr. Carl Bushong, has proposed a more comprehensive model of gender than the simple binary understanding of two genders that perfectly match two sexes. As a clinical model, Dr Bushongs gender matrix is based on the observation of people treated at the Tampa Gender Identity Program, a part of the Tampa Stress Center, under his care and that of his colleagues. This is not some detached, double blind, super scientific and staged endeavor, but merely an effort to make sense of what was seen in more than twenty five years of actual practice and care. In this model, there are five different facets of a human being that align themselves according to gender, but only two of which have anything at all to do with sex.


The first of these, is easy: Genetic. Or as a homosexual co-worker of mine once said during a discussion of his orientation, “whether you have an innie or an outtie.” Okay, it’s a little more complicated than that, because there exists a wide variety of genetic disorders, but for our purposes we merely have to focus on whether or not a person was born with an innie or an outtie. (That would be a penis or a vagina, if you missed the metaphor.) The second element of Dr Bushongs gender matrix is the other sexual one, merely a reference to the current state of your biology: Do you still have the innie or outtie you were born with, or did you have it swapped or even removed? Pretty simple and straightforward, so far, but it’s about to get interesting.


Our third category, what the good doctor refers to as the “brain gender” (not a technical term, as you shall see) of a person. This is a more recent bit of understanding that comes from literally examining the various neurological structures within the human brain, and making associations. Ironically, and there’s a whole lot of irony involved in this subject, some of this research was even funded by our detractors in their quest to discover the thing that is “wrong” with people who say things like, they feel “like a man trapped in a womans body.” The short version of these incredibly preliminary results line up with something Dr Bushong had proposed previously, that the way we build our social connections may in fact be determined by biology, which is what he meant by “brain gender” when he proposed the idea, and whether you have a male or female brain gender is identifiable within mere hours of your birth.


Those infants who have a female brain will be more sensitive to sound and touch, and within a few days will be spending an average of twice as long looking back at an adults face and far more readily recognize that another infant is crying – and promptly begin crying themselves. Later, male brained individuals will show much greater levels of wakefulness and activity, and as they grow into toddlers and small children, this trend continues as they instinctively prefer exploring, taking things apart (whether they were meant to disassembled or not), and tend to select their playmates based on their functional utility. Meanwhile, female brained children will be more sedentary, prone to spending time in small gaggles listening and talking, and engaging in forms of play that feature collaboration or non-competitive attempts to complete a goal, such as the simple game that is hopscotch (the male brained having likely discovered the joy of tag or hide’n’go-seek by this time). This is also where we first see signs of social gender identity, with female brained boys being pushed around and male brained girls teased as “tomboys” and the like, but in no way does this indicate Transgenderism just yet – there are two more even more controversial elements of the matrix to explore!


Our fourth element is our Brain Sex with a sub element of our Sexual Orientation. Wait, but we already covered the two sex related elements didn’t we? Slow down a moment and ponder this with me: what we’re referring to in this case is not your preference for an innie or an outtie, but in the way you determine whose innie or outtie you’d like to interact with. This is our sense of eroticism, our love map, and the topic of such wonderful books as, Women are from Venus, Men are from Mars. Specifically, the male orientation is the behaviour mode in which a person has a strong orientation. For example, many men, with their male orientation express their gynephilic (sexual desire for the female body type) very strongly, with an analogous distaste for male genitalia that is not their own. The traditional heterosexual woman with this orientation is strongly androphilic (desiring frequent interaction with those of male genitals) and a strong distaste for the lower regions of their fellow women. The female orientation, which is naturally more common amongst genetic woman, is a bit different. In many ways, it could be said (this is currently scientific heresy to make this leap, for the record, but Dr Bushong and I agree with it anecdotally) that instead of a “sexual orientation”, the female love map manifests as a “sexual preference” for certain physical traits, but a stronger focus on emotional connections to their chosen sexual partners. The danger here is to suddenly shout, “well, that explains XYZ!”, because there is no real scientific research occurring in this area. That, and there’s at least five (yes, FIVE) specific sexual orientations/preferences we could go into, which may very well be better expressed as a continuum, a sliding scale, instead of boxes.


So, moving right along so as not to get sidetracked by musing on the relative acceptance levels of lesbianism versus gay men versus bi-sexuality, we come to our last and even less understood element: Gender Identity. This element is actually quite simple, yet simultaneously all but impossible to measure and study because it refers to each individuals own sense of themselves and their “proper” gender. Much like a doctor asking a patient to rate their level of pain on a scale of one to ten, we have virtually nothing but each persons own word to go on. This, at last, is the sole element in the gender matrix that defines a persons eligibility for the Gender Identity Disorder diagnosis. What the gender matrix model allows us, though, is a way to talk about some of the variations seen in people who suffer Gender Dysphoria, the very beginnings of an idea on how to accurately assess just how much, and what kind of, therapy a given individual will need.


I personally know an individual, for example, who is a man, with an XY chromosome pair, that exhibits a strong sexual orientation (towards other men), but quite definitely has a female brain type. He’s kind, and wise, and he thinks of people first, and their functions  or possessions second. He also happens to identify as male, and while he’s suffered for his more feminine traits, that suffering isn’t the same as Gender Dysphoria – it has no internal component  save for the direct results of bullying. He needs no therapy, no hormones, no counseling, and certainly no surgery. By contrast, another friend, a genetic woman, who has her natural womanly parts, also exhibits male pattern sexual orientation (very strongly towards men), male pattern “brain sex” by which she readily classifies people according to their level of functional aptitude, and would love nothing better to be a man, understanding full well that would make her a gay man. She’s fully accepted as a strong and powerful woman, who gets her way and gets things done… but she’s miserable. And too terrified of what might happen to her, if she leaves that “her” behind and embraces her clearly masculine nature. Therapy is helping, but there’s only so much therapy and support can accomplish when your own body causes you so much grief, that you can’t have any mirrors in your own home. (And no, she’s not ugly, actually she’s kind of hot. This is where I hope she doesn’t read this! >.> )

I suppose now would be a good moment to make a small confession. I don’t legally qualify for this diagnosis, either, even though my treatment is literally identical. I’m excluded by the Intersex clause, you see, under the rarest form of it. Specifically, had my well meaning doctors, shortly after my disastrously premature birth, left well enough alone, my two X chromosomes would of taken care of everything on their own. I might even have functional ovaries, children that I’ve brought into the world, and an entirely different life than I do now. I choose, though, to stand with my brothers and sisters in the LGBT community, upholding that T letter proudly.


Longing for what cannot be, never gets anyone anywhere. I have taken this life, that without those same mistaken doctors I would not even have at all, as a challenge. That challenge leads me to quote a great man, Dr. Martin Luther King, to provide it with context. “Darkness cannot drive out darkness, only light can do that. Hate cannot drive out hate, only love can do that,” he said. As a case in point, let’s go back to my dearly beloved rainbow brigade itself, and examine ironic cases of anti-transgender discrimination. That’s right, LGBT on LGBT discrimination. Unthinkable, perhaps, but very real: the closer you get to our community, the more apparent the divisions within it become. Kind of like an actual rainbow, in fact.


Ah, the Michigan Womyn’s Music Festival (the misspelled word is deliberate on the part of the event organizers). I actually didn’t believe this myself, at first, but the festival specifically forbids anyone who is not “womyn born womyn” from attending the event, subjecting anyone who is insufficiently feminine (according to whomever is working security at the time) to a volley of personal and prying questions, for which a reaction of indignation, however well deserved, results in being barred from the event. Naturally, this is terribly ironic as the ultimate goal of Male to Female Sex Reassignment Therapy is to render the patient indistinguishable from a genetic woman, while I sincerely hope that you, my dear reader, implicitly understand why a Butch Lesbian would be offended by such a crass inquiry into the form of her genitalia. It’s like asking men to whip out their outtie for a “Boyz only” concert or something!


Of course, there are more serious concerns than such comically flawed attempts to discriminate against us, and much like some other minorities, we’ve had people give in to the urge to lash out in retaliation, too. In a speech delivered at the March on Washington for Lesbian, Gay and Bi Equal Rights and Liberation in 1993, Lani Ka’ahumanu said, “What will it take for the gayristocracy to realize that bisexual, lesbian, transgender and gay people are in this together? We can and will move the agenda forward. But this will not happen, until public recognition of our common issues is made, and a sincere effort to confront biphobia and transphobia is made by the established gay and lesbian leadership in this country.”


Transphobia? Seriously? Because that’s totally been proven to help the situation, accusing the “other side” of a neurological disorder that makes them fly into a state of panic in your mere presence (which is what the word phobia actually means, for the record). Oh wait, it doesn’t. In many ways, such divisive and inflammatory rhetoric is just as destructive as the very serious efforts to marginalize us being made in the fringes of the scientific community. I could write an entire book about what is wrong with the book, The Man Who Would Be Queen: The Science of Gender-Bending and Transsexualism, but I’ll spare you the gory details and let one of the authors scientific contemporaries say it more succinctly, “He’s [Michael Bailey, author of the aforementioned] set back the field 100 years, as far as I’m concerned.”


It’s not all bad, though, once again like our beloved rainbow symbol. Many victories on the behalf of homosexuals simultaneously benefit transgendered people, given the prevalence of the ignorant perspective that we are merely “extremely gay.” After all, if people are prone to the assumption that a Transwoman (genetic male who is now biologically female) is merely an extreme homosexual, then people with that belief must concede that anything that protects a Gay or Lesbian must also apply to a Transgender. Alas for the all too frequently double edged sword employed in the quest for equality, then, when a population awakens to the notion of gender identity separate from the form of a persons genitals, and suddenly the Transexual finds themselves outside of the aegis of anti-discrimination laws that protect Gay and Lesbians.


But it is precisely this tragedy that we must willfully and knowingly endure, even as I write this. While it is no longer true that the overwhelming majority of Transgendered people must educate their own care providers about the condition, it is only by standing apart from the larger LGBT community that recognition of the subgroups therein is possible. As Jillian Todd Weiss wrote in GL vs BT, “The very creation of the ‘GLBT’ acronym suggests that gay and lesbian and bisexual and transgender are each clearly defined, separate and mutually exclusive categories – not one and the same.”


Ultimately, this is what our symbol, our one universal symbol of equality, is all about. Like the individual spectra of light, broken apart by atmospheric phenomena, yet beautifully and harmoniously aligned, our community now embraces sub groups and causes that are not strictly delineated in our charters, initialisms, and the individual laws we tirelessly lobby for. We fight for human rights, for all humans, all over the world. We stand for those who cannot stand for themselves. Separate and distinct, yet united, fighting for universal human rights is the most righteous of causes, not despite the self-contradictions inherent to a diverse populace coming together in the name of the individual.


But because of it.



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