TRANSGENDERISM
GENETICALLY ASSIGNED ANATOMICAL SEXUAL IDENTITY VS BRAIN ASSIGNED GENDER IDENTITY -
WHAT IS THE DIFFERENCE? WHICH ONE TAKES PLACE FIRST?
“I am human, and I think nothing human is alien to me.” - Terence (195 – 159 BC)
These questions took me many years back to my gastroenterology training. My teacher and mentor, Dr. Eddy Palmer, in one of his lectures quoted the above saying from the famous Roman-African playwright Terence. He told us that, “we as doctors should train and prepare ourselves, never to have any bias or prejudice against any human being no matter who they are, what they are and, what is their race, creed, skin color, social class or sexual orientation. Because they are all, as human beings, the subject of our profession. Nothing about human beings should be alien to us.”
I was deeply inspired by Dr. Palmer’s teachings and tried to follow them during my many years of medical practice. I have seen and have taken care of many types of patients without any qualms, but I had a hard time understanding L.G.B.T.Q+ patients because of my upbringing and cultural norms. However, I was especially interested in transgenderism. I wanted to know how and why a person could refuse their already established genetically assigned anatomical sexual identity.
For many people sexual identity and gender identity are the same and these terms are frequently used interchangeably. But, as I see it, there are distinct differences between them. Every person’s genetic sexual identity is already established by the X and Y chromosomes at the time of insemination. But gender assignment is established after the birth by the brain in very early childhood, between the ages of 18-to-24 months, when human brain development is in the most rampant phase. Gender identity could be defined as personal feeling, psychological sentiment and concept of oneself being male or female, regardless of their anatomical sex identity. If gender and anatomical sex identities do not match, then transgenderism becomes a rule. Because our brain rules over our body, then gender identity rules over sexual identity.
How the brain determines gender identity is a mystery. According to Social Learning Theory, children develop their gender identity by observing and imitating the gender-linked behaviors of their parents, sibling and peers. I strongly disagree with this theory, since very early childhood is too young to observe and to imitate gender-linked behaviors. I believe how our brain assigns gender identity is impossible to know, because it’s lost in the immense complexity of human brain’s anatomical and functional complexities.
Just like a mental illness, even a minute and very difficult to detect neuro-chemical abnormality in the brain may cause psycho-behavioral abnormalities.
Many different gender identities have been described, including male, female, transgender, gender neutral, non-binary, agender, pangender, genderqueer or a combination of the above.
Transgenderism, if not addressed in a proper manner with gender-affirming and age proper medical care, could cause the development of severe gender dysphonia which can be described as a constant feeling of discomfort and a strong desire to become the other person by constantly trying to prevent physical signs of unwanted gender, like facial hair, enlarged breasts, changing voice, etc.
Gender dysphonia could easily become an endless source of psychological, emotional and mental health problems. Social isolation, unemployment and suicide become commonly encountered occurrences.
Because of cultural taboos, lack of knowledge and understanding, it is unfortunate that many parents nor society in general, the government or medical establishment are ready to accept that transgenderism is not a conscious choice of any person. Transgenderism, just like any other anomaly, occurs randomly and should be handled with care and any necessary corrective actions should be properly rendered.
There are two school of thoughts and models as how to approach, diagnose and render gender-affirming appropriate medical and surgical care to transgender people:
The first one is the medical gate keeping model. Many insurance companies insist that transgender people undergo extensive assessments and documentation by expert doctors to show that patients are truly transgender. Because there are fraudulent trans people or non-binary people, and not all non-binary people identify as transgender.
The second model is self-ID model. It solely depends on the transgender person’s feelings, expressions and desire. In recent years, the self-ID model has become the law in 15 countries.
So, it appears that transgenderism is a poorly understood, very complex and universal human issue. It is not their fault the way they are. They beg for understanding and tolerance from the heterosexual world.
