27/04/2023
DO NOT JUDGE SO HASTY !
Be informed .
“In four years of medical school, three years of residency training, and nearly 30 years in practice as a family physician I have never been asked “what is the definition of a woman?” Seems obvious that one could just look at the ge***alia. You’re either a boy or a girl, right? Well, not always. Although it’s rare, many people are born with ambiguous ge***alia. The OB/GYN and the pediatrician are simply unable to determine the s*x. Historically, in consultation with the family, a s*x would be assigned. Turns out that often as not the child would ultimately identify with the s*x they were not assigned. So it must be the chromosomes. The 23rd pair in humans is designated XX in females and XY in males. The Y chromosome determines male characteristics, so you are either a boy or a girl, right? Well, not always. In embryology the default setting is female. The Y chromosome normally triggers male development. Ever heard of testicular feminization syndrome, now more properly referred to as androgen insensitivity syndrome? Sometimes an XY baby is born with essentially normal female external ge***alia. The body simply does not respond to androgens associated with the Y chromosome. As the child grows and enters puberty there will be normal female breast development and other feminine characteristics. Unless genetic testing has been done at some point, the abnormality is not discovered until the teenage daughter presents to the doctor with concerns that menstruation has not started. Examination will reveal that the va**na ends in a blind pouch, no uterus, and undescended te**es. They are often very feminine - cheerleaders, beauty pageant contestants, etc. Nearly everybody is a “normal” XX or XY, has anatomy to match, and is perfectly at peace with themselves. But not everybody. Several studies have identified how the s*xual diversity between men and women does not exclusively involve the ge****ls, but also the development of different brain areas. And just as ge****ls can be ambiguous, or not match what XY would predict,so can the brain in some instances develop in a different direction than the ge****ls. Animal studies suggest this is likely due to atypical levels of s*x hormones in the womb. One of several such structures studied in the human brain have involved an area of the limbic system known as the nucleus of the terminal stria. The volume of this area appears to be influenced by the stimulation of s*x hormones during brain development, and in men the volume of this area is greater than in women. Scans of this area in transgender women (genetic/anatomic men who identify as females) resemble that of non transgender females. In this matter gender identity develops from the complex interactions between s*x hormones and brain during its development; moreover, this appears to be genetically predetermined and is not influenced by hormonal stimuli during the adult phase. It is important to understand that at this point it is not known for certain what causes gender dysphoria or incongruence, just as we don’t know for certain what makes someone gay or for that matter, left handed. Gender dysphoria often begins in childhood and can lead to severe distress, depression, and su***de. Treatment includes thorough psychological and medical evaluation and psychotherapy. Hormonal treatments in children are designed to delay puberty until decisions about desired gender characteristics can be made. The treatments are not permanent and are REVERSIBLE. Hormone treatments are not given to prepubertal children and in fact are not started until Tanner stage 2 of puberty. S*x change (gender reassignment) operations are not done on children. (Rare exception might be in the case of ambiguous ge***alia where surgery may be done to make ge***al appearance more consistent with the genetic s*x). Unfortunately there are many people who cannot or will not understand that someone different from themselves might really be different for a real reason... I hope the information provided here explains why that question is not quite as simple as it sounds. It is also unfortunate in Texas that people with political power seem to think that trans people just want to get on the girls' track team to win a lot of medals or get in the girls' rest room to watch them p*e. Governor Abbott, Lt Gov Patrick, and AG Paxton have shown profound ignorance and cruelty in decreeing treatment for these kids to be child abuse. Even right wing columnist Mona Charen called Abbott's behavior "malice masquerading as policy making". They are really no different than lunchroom bullies. The American Academy of Pediatrics, American Academy of Family Physicians, American Medical Association, American College of Obstetricians and Gynecologists, and the Endocrine Society have expressed outrage that government is inserting itself into a matter that should be left to families, patients, and their doctors. There are well established evidence based procedures that have been in place for decades. This is not a new phenomenon and it is not a fad. Treatment saves lives. Denying treatment is cruel. I would hope that someone will share this with a conservative friend. For most of us it seems ridiculous that a guy would think he is a woman, or a woman to think she is a man. The human brain and human body are complex and wondrous and get it “right” almost every time, but sometimes they get it different. And different should not be wrong, and different people and their families should not be attacked by their own government." - Joe McCreight, MD
