Why Science Supports Transgender Rights

It was either this or a picture of Tim Curry in a labcoat

An Important Disclaimer
     Right now transgender issues are, if you'll excuse the pun, coming out of the closet.  We’re living through an unprecedented cultural shift in the Western world as the T of LGBT is given more coverage in the media since ever.  It’s an important discussion.  Two things I need to clear up though. 
    First, as always, I ask you to keep an open mind.  By all means disagree, challenge and question what I say.  But if you’ve already made your mind up about transgender issues and nothing could alter your view, there’s no reason for you to read this. 
     Second, I need to clarify why I don’t consider this an “inappropriate” topic to post about.  I am well aware that a lot of young people read my blogs and I have a responsibility to make sure my writing is family-friendly.  That’s why my blogs are free of things like swearing.  The topic of transgender Science however, is Biology and as part of Biology we have to discuss differences between men and women.
    Young people today are growing up in a different world to the one their parents grew up in.  Transgender issues are not in the shadows anymore; children hear the words, see the coverage and they have questions.  It’s not my job to persuade people what to think but it is my job to present people with facts and let them make their minds up about the implications.  As I’ve said before, young people are quite capable of disagreeing with something they read on the internet. 
    Let’s also point out something important: some young people reading this may be transgender.  The last thing you want to do is refuse to let anyone talk about it because it’s “not polite”.  It's a complicated topic sure, but it's one that does need to be discussed as part of modern Science.  Which is why, as a Science writer, I'm doing so. 
    Transgender isn’t a dirty word and it shouldn’t be something we’re afraid to talk about.  It's a Biology word and we can discuss it in that context.  However it is still considered a controversial subject by many so I should probably make this clear as well:

What I post here does not necessarily represent OR disagree with the views of any institution I am associated with.  I am writing from my own curiosity and a desire to explore Biological complexity. 

  So, with that in mind...

Walking the Line
    I got the idea to write this article several months ago when I came across the website of Michael Brown (stream.org).  Some of his blogs have titles like “Why LGBT’s war on gender must be resisted” and “it’s time to stand up to transgender activism”.  It’s tempting to dismiss his words as propaganda, but there is a solid theme to his writing.  One I happen to agree with: wanting to be something doesn’t make you that thing. 
    Brown actually seems fine with people describing themselves as transgender because he considers it “real”.  He talks about “the rare few” who suffer from being born in the wrong body but thinks the trans community is pushing things too far by introducing a lot of complicated sex and gender terms.  Things like genderqueer, genderfluid, cisgender, bigender, third gender etc. etc.  This, he argues, is “cultural insanity”.
    After all, if a five foot person “identifies” as being six feet tall, this doesn’t make them taller.  Brown is correct that we need to accept reality and can’t change what’s true by wanting it.  Sure, you have a right to believe whatever you want but as a member of the human race you also have a responsibility (just as important) to believe what is true only.
    As I’ve said before and will undoubtedly say again: reality isn’t a choice.  If it’s sunny you don’t get to believe it’s raining.  Reality forces you to a conclusion whether you like it or not.  It’s harsh but it’s the Scientific method and it’s the best thing we’ve got. 
    Opinions and gut feelings should never be the guiding light on deciding what’s true.  So, let’s take Michael Brown at his word and decide that yes ok, a line should be drawn and that line ought to be reality.  If a person claims to be an aeroplane that doesn’t make them an aeroplane.  
    This doesn’t make us intolerant by the way.  Being tolerant is not the same as agreeing to everything.  Ultimately 2 + 2 = 4 and while a person is allowed to say 2 + 2 = 5 there is no reason you have to accept it. 

                       Facts are facts and they can only be challenged with evidence, not opinion.

    You could argue that if a person wants to identify as a different sex then this is basically fine and why should it even be important?  We have to be honest though, transgender rights are complicated and raise some difficult questions which Science cannot answer.  What Science can do, however, is help people make informed decisions by trying to establish what the facts are.  The last thing we should do is make snap judgements. 

Some movements want transgender people to use the bathroom which matches their birth certificate...

...meaning this Men's Health star (Ben Melzer) would be using the girl's bathroom.

    Michael Brown’s “where do we draw the line?” question does need to be discussed.  So, let’s do it.  How many of these gender and sex identities are “real” phenomena and how many are just people wanting to be something else? 

The Wisdom of Children
    When I was a child here’s basically what I thought I knew: there are girls and there are boys which is 99.99999% of the population.  Then, there was a tiny, microscopic, insanely rare number of people who thought they were born in the wrong body. 
    These people often wanted to get operations to change their bodies but a lot of them lived to regret it.  There was even some debate as to whether it was a real condition or whether they were making it up. 
    Most of these “transsexuals” (as they were called) were mentally ill and this desire to switch gender was a side-effect of their mental illness.  But it didn’t really matter because “transsexuals” were so rare I wasn’t likely to ever meet one.
    It’s possibly the school I went to, but transgender issues weren’t talked about and on the occasions they did get mentioned they were treated as a taboo playground joke: “your mum’s a tranny lol”.   
    This is what I was led to believe so I understand, I really do, that it can be a shock or surprise when you come across the rainbow of genders and sexes the trans community talks about.  It’s a normal human reaction to go “nope” when presented with something that challenges a deeply held belief, especially one we learn in childhood.
    The idea of “boys and girls” is one of the first, most fundamental things we learn.  If someone told me there’s a whole new bunch of colours for instance, I’d balk at the suggestion.
    But, to be a Scientist means keeping an open mind to the possibility that our childhood convictions (even things which seem obvious) may have been over-simplified or downright wrong. 
    For example, when we’re young we assume all stars in the night sky are the same type of thing.  They certainly look that way.  When we discover there are dozens of different varieties of star throughout the cosmos, we don’t put fingers in our ears and say “well that’s just getting silly”.  We accept that things are more subtle and nuanced than we previously thought. 
    Why should gender identity be any different?  After all, the principles governing star formation are relatively simple compared to the complexity of a human brain.  86 billion neurons with trillions of connections between them?  It would be surprising if all human brains fitted into simple categories. 

Don't take this literally, the people top right don't have transgender legs.

All the colours of the Genderbow
    I remember once asking a friend of mine who was a member of the LGBT society at University what happened at their group meetings.  She said, half-jokingly, “we sit around arguing about what all the different words mean”.  To add to her point, the society later changed its name to the LGBTQ society, and then to LGBTQA.
    Consider the words of Cory McCloskey of the Fox 10 news channel who, after hearing a report about a transgender woman responded live on air with: “What is a Transgender woman, what does that even mean now?  I can’t even keep up any more!”  Although it’s easy to mock him, he really does speak on behalf of many people.
    This feeling of confusion is not uncommon and, if I’m honest, the first time I came across all these words I probably raised an eyebrow myself. However, whether you’re a member of the trans community or not, this discussion is important and you need to be aware of what the terminology means - whether you agree to use it or not.  Yes, it’s different to what you learned in school, but suck it up.   Simply saying “well that’s a lot of words” isn’t a meaningful objection. 
     At the moment this new vernacular can be difficult however because we’re in a period of linguistic turmoil and the words are still up for grabs.  The LGBT community is publicly deciding its own terminology and, as a result, some words mean different things to different people. I don’t want to upset anyone from the trans community but I’m going to outline what the words mean as I understand them.
    Below are some generally accepted definitions, but some trans people will disagree with them and even find them hurtful.  I'm sorry if that's the case, but hopefully you can appreciate that I need to have a common reference and it’s impossible to please everyone.  Please be patient if I say things you don’t like.

Sex:  Your anatomy.  Man or woman.  This is the thing a doctor can identify by looking at you the moment you’re born.

Intersex: When your body is not clearly man or woman, or has features of both.  The old-fashioned term was “hermaphrodite” but that word isn’t used anymore, unless you’re in Biology class talking about garden worms.

Gender: What you internally feel you are.  Male or female.  This is your personal sense of identity, the way you would classify your mind.

Cisgender: Someone who has a male gender in a man’s body or a female gender in a woman's body. 

Transgender: A person whose gender does not match the gender/sex identities specified above i.e. male in a woman's body or female in a man's body.  The old fashioned word for this was “transsexual” but that word has also fallen from favour, so don’t use it (unless you’re watching The Rocky Horror Show). 

Bigender: People who feel they have characteristics of both genders.  The gender-equivalent of intersex.  These people feel partly male and partly female and not necessarily in a 50:50 ratio.  Richard O’Brien himself (the author of Rocky Horror) stated in an interview that he considers himself 70% male and 30% female. 

A revelation which shocked absolutely no-one.

Agender: People who feel they are lacking in a gender and are neither male nor female.

Third Gender: This one is a little difficult for many to imagine but these people feel they have a gender (so they’re not agender) it just isn’t male or female.  If you imagine blue = male, red = female, bigender would be purple, agender would be black and third gender might be something like green, not belonging on the same scale.

Gender Fluid: People whose gender identity is not constant i.e. they can be male for one week, female the next, moving back and forth along the spectrum, perhaps even being agendered or bigendered in between.

Sexuality: This refers to who you are attracted to.  This is where words like heterosexual, homosexual and bisexual come into play.  Although there is still a bit of confusion.  After all, does your sexuality refer to the sex you’re attracted to or the gender?  Fortunately, this isn’t the issue we’re talking about in the blog, so I’ll leave sexuality there for now.

Queer: While this word used to be a derogatory word for gay it has now been reclaimed as a term for the entire buffet of genders, sexes and sexualities.  Anyone who isn’t a cisgendered heterosexual is “queer”.

Genderqueer: A subsection of the queer community concerned with all the non cis-genders: trans, bi, a-, fluid etc.  It’s ignoring the issue of sexuality.  It is, in fact, the focus of this blog.

Transition: A genderqueer person will often go through a process of making the world aware of their genderqueer identity, and deciding how to express it themselves.  This is called the transition and it is different for everyone.  For some people it can be a name change, for some it can involve surgery to change sex.  Some genderqueer people wish to advertise and celebrate their transition, others do not. 

Trans: A casual word for someone who is transgendered.  The same way you might use “gay” to refer to “homosexual”, it’s a more relaxed, informal and less clinical term.

Tranny: An insulting term for someone who is trans.  Like calling a gay person “fag”.  Don’t use it.

Cross-dressers: This term often gets lumped in with the others because the term used to be “transvestite”.  It refers to a man who wears clothes typically associated with women i.e. dresses and skirts.

Ally: A non-queer person who supports genderqueer rights i.e. they are cisgendered themselves, but supports the genderqueer movement.

    Yes, there’s a lot to take in there (and this is an incomplete list).  But it takes a couple of days to start getting your terms right.  It only seems like a headache if you decide it’s overwhelming.  Occasionally you'll slip up, as with learning any new vocabulary, but it's really worth making the effort.  And when it comes to pronouns ("he" or "she") there's a simple rule to find out which you should use: whatever the transgender person asks you to use!
    I have, much to my embarassment, occasionally used the wrong pronoun when talking to a transgender student.  I've always been grateful when they've shrugged it off and said "don't worry about it", because I know it is actually quite a big deal to them.  So thank you to all the transgender people who are patient with us cisgendered people as we do our best to keep up.

Is being genderqueer an illness?
     Many genderqueer people, understandably, do not like the implication that there is something “wrong” with them or that cisgendered people are “correct" in some way. But many people from the LGBT community do suffer as a result of being genderqueer.
    There is, just to confound things, a medical condition called “body dysmorphia” in which a person feels a sense of discomfort/dissatisfaction for their anatomy.  This isn’t the feeling everyone gets when they look in the mirror and think “I look awful”, this is the feeling that your body is not what it’s supposed to be. Naturally, a lot of genderqueer people suffer from body dysmorphia but it’s worth mentioning that some do not and are perfectly at ease with being "female in the body of a man" or however you wish to phrase it.
    Some people would argue that the depression felt by genderqueer people is the result of social stigma and bullying, while others might say it arises from the brain rejecting its body.  A female person born in a man’s body can often feel out of place in her own skin, so perhaps this does need to be called an illness because it causes suffering?
    On the other hand, perhaps the only reason a female person in a man’s body feels unhappy is because we tell children men are male and women are female, so a transgender person feels they are conflicting with what they are taught they “should” be.  It’s a tough semantic discussion and I’m hesitant to cast my lot one way or the other. I just want everyone to feel comfortable in their own skin is all.
    What’s significantly easier to answer however is whether these things are real.  The answer is very much yes. 
    As surprising as this may be, and difficult for some to swallow, it does seem to be the case that most of these genderqueer identities are biologically “authentic” and need to be treated as such.  In fact, according to many Scientists who study sex and gender, the idea of a simple dichotomy is misleading even though familiar (imagine that, a familiar idea turning out to be wrong).
    In 2015, the Scientific journal nature ran a whole issue dedicated to these issues and found that society is woefully behind the curve of evidence.  If you want a comprehensive summary of the issues look up the flagship article by Claire Ainsworth (18th February 2015), but for now let’s take a brief look at some of the main genderqueer identities.

Intersex
     Being intersex means the person has biological features of both sexes and there are five main ways this can happen.  1) X and Y chromosomes being mixed up, 2) hormone levels corresponding to more than one sex, 3) internal organs e.g. uterus and prostate, 4) external genitals, 5) gonads (testes and ovaries).  Some people have a mixture of these features and there isn’t really a debate about whether it exists.
     I mean, technically speaking, the reason men have nipples is because babies start off with less obvious sex features and the man/woman thing only gets decided later.  The gonads of a baby stay where they are for a woman but drop down for a man.  The vagina remains open for a woman baby and closes for a man baby, forming the scrotum (which is why the scrotum has a dividing line going up it).  In a sense, every man has features of the other sex.  Is it possible to have a human born with these features not clearly formed one way or the other, or to have both?  Of course it is.
     Intersex people are easily identified by medical scans and people with more than one external set of genitals have been known about since at least the first Century B.C.  Intersex isn’t controversial and it’s absolutely real.

Some intersex people. Most of them are not CGI.

Transgender
     In 1995 Jiang-Ning Zhou showed that a particular region of the brain - the central subdivision of the bed nucleus of the stria terminals (BSTc for short) - is large for men and small for women. 
    What’s really interesting is that Zhou discovered transgender females (i.e. people who identify as female but have a man's body) have a BSTc which matches that of a cisgender woman.  And vice-versa for men! In other words, your gender correlates pretty reliably with the size of your BSTc and some people’s BSTc size doesn’t match the anatomy commonly associated with that sex.
     In 2002 Wilson Chung found similar results and in 2004 so did Dick Swaab, as did Alicia Garcia-Falgueras in 2006. 
    There is some controversy about these findings and it doesn’t explain everything (for instance, how transgender people often know they are transgender from an early age, before the neurological difference is significant) but that’s compelling evidence pointing in a similar direction.
     The precise cause and effect of being transgender is still not known, but the facts do seem to be piling up.  It is a real thing and transgender people aren’t "choosing" it.  It is who they are neurologically and it might even turn out to be something as simple as the size of one particular brain region.
     There’s also the fact that transgender people who transition are often a lot happier after the process than before (which is the opposite of what you’d expect if it was made up).  You might have been told that most transgender people live to regret their transition and that most transgender people have a history of mental illness prior to coming out as transgender.  Actually, this doesn't match the data.
     In 2014 Annelou de Vries analysed the psychiatric health of transgender people who had been given puberty blockers at age 13 and surgery at 20, finding that every single one of them was just as mentally healthy as cisgendered people.  In other words, being transgender doesn’t seem to be a “side effect of being mentally ill” as some think, it’s possible to be perfectly sane, not suffering from any psychiatric illness, and also be female in a man's body or vice versa.
     Furthermore, Annika Johanson (2009) found that 95% of transgender people are happier after the transition.  Murad (2010) and Ainsworth (2011) found the same result.  Pfafflin (2003), Kuiper (1998), Junge (1998), Smith (2005), Dhenjne (2014), Krege (2001) and De Cuypere (2006) also found that the number of transgender people happier after the transition ranged from 96-100%.
     In other words, the person who thinks they’re transgender and regrets the decision later in life is rare.  It does happen, but the overwhelming majority of people who identify as transgender are more happy once they’ve transitioned. So if you happen to be one of the people who considers being transgender an illness...the cure might be to let these people actually transition.

Some of my jokes are subtle.

Bigender
     Little research has been done on this topic but it’s well known that the BSTc doesn’t come in two sizes exclusively.  It can be in between.  What this means is that a person whose BSTc is halfway between male and female will quite possibly feel they have features of both genders. 
    In fact, just an out-there hypothesis, perhaps subtle distinctions in the size of your BTSc might explain why some men are ultra-male alpha types while some men have a lot of effeminate features but still consider themselves male.  Being transgender or bigender doesn't immediately put you in a simple box.  You can be a transgender man (anatomically a woman) and still be quite a feminine man.  There's a lot of complex things which determine your gender so it's no surprise there's a lot of scope for variation. 
    I, for instance, am not a sport-playing hyper bloke.  Some of my personality traits could be even be described as feminine...I cry at a ton of movies.  Perhaps my BTSc is 99% toward the male end (which is why I feel I’m definitely male) but I’m not one of those super-masculine guys like a fireman, a builder, a cop, a biker, a sailor or a cowboy...some of my jokes are less subtle.

Genderfluid
    This one is particularly interesting and although it’s a new field, the picture emerging seems to be that genderfluidity is a real thing too.
    The medical term used is “alternating gender incongruity”, a term coined by V.S. Ramachandran, who has shown that in some people the hemispheres of the brain can switch their roles back and forth, which leads to changes in personality or thinking patterns, most likely including gender. 
    The brain’s ability to rewire itself spontaneously and at random is well known.  People suffering from bipolar disorder for instance find themselves with two different brains at different times in their life.  People with seasonal affective disorder find their serotonin levels dropping in the winter and so on.  In fairness, the jury is still out on this but given the fact that everything else about people’s brains has been known to switch back and forth, it would be surprising if the only thing which never alternated was gender.

Agender
     There is, at the time of writing, no available research I can find on this topic.  So I shall have to stick with Scientific honesty and say I don’t know about this one.   

Third Gender
    There is, at the time of writing, no available research I can find on this topic.  So I shall have to stick with Scientific honesty and say I don’t know about this one. 

How common is it?
    Remember earlier I said that everyone assumes these things are rare?  Well they are, but nowhere near as rare as you might think.  It’s hard to get solid numbers because people may not want to identify publicly as genderqueer, but the stats look something like this...
    Around 1-2% of people are born intersex (M. Blackless March 2000 American Journal of Human Biology).  The average person knows around 600 other people so potentially twelve of the people you know are intersex.  It’s uncommon, but it’s not 1 in a million.
    Transgender is a bit harder to count as there aren’t clear figures, but most sources I’ve checked estimate the number to be somewhere around 0.2% of the population.  In other words, 1 in every 500 people.  So, again, assuming you know 600 people the chances are you know somebody who is transgender.
    Meanwhile, other non-binary genders are (according to practicalandrogyny.com) common to around 0.4% of the population.  That's roughly 1 in every 250 people. 
    In a school of 1,700 students for example, statistically there will be approximately three transgender pupils, around seven genderfluid/agender/third gender pupils and somewhere between 17 and 34 intersex pupils (that’s an entire class).
     If you’re carrying around the assumption that genderqueer people are extremely rare you might need to think again.  The reason you probably haven’t realised the numbers are this high is because a) it’s only recently that genderqueer people have felt comfortable expressing it, b) a lot of people are still discriminated against, so they never say anything and c) it’s not really anyone else’s business. 
    Transgender people aren’t required to wear a sign, so the transgender people you know...there’s a chance you don’t even know about it.  But genderqueer people are not made up, they’re not making their identity up, they are real and you probably know several.

Pandas are rare, genderqueer people are not.

“Oh, it’s just a phase”
    Some people go through a period of self-uncertainty and identity crisis in their teen years.  Adolescence is a biologically complicated process, during which the brain changes significantly.  So is it possible some people who identify as transgender in their teens will grow out of it later on?  Well, yes, of course it is. 
    This is one of the reasons medical organisations don’t just immediately give surgery or puberty-blocking medication to anyone who comes along asking for it, particularly when they’re young.  As we noted earlier, around 4% of people who transition do regret it later. I personally know at least two people who transitioned during adolescence but re-transitioned/de-transitioned back to cisgender later. It happens.
    Many would argue however: so what?  If a person does think they’re transgender but then changes their mind later on, is that truly a big deal?  Besides, even if it does turn out to be a phase this doesn’t mean the person was making it up. It’s possible for the brain to switch features throughout life. Are you the same person you were when you were a teenager? I'm certainly not...thank goodness...I was a total jerk!
     As a Scientist you have to keep your mind open and wait until the facts are in.  If someone tells you they’re genderqueer, why jump to the conclusion that they’re making a mistake?  Why not give them time to find out?  After all, if it’s a phase they’ll grow out of it without you telling them they need to.  And if you want a tragic example of what can happen when you force someone to be a gender they are not, look up the story of David Reimer.

Remember when we all thought pokemon was just a phase? Well look how that turned out.

"Fakers”
     I went to school with a very unusual boy.  He was an attention seeker in ways you can’t even imagine.  And not just because he wanted people to listen to his opinion, he wanted to be different.  He also liked to be the victim or the outsider.  Some people’s sense of identity is just like that. 
     Several years later I found out he was in the process of transitioning to become a transgender woman.  One of two things are possible here: either she had been transgender all along (which perhaps accounted for her sense of being an outsider) or she was faking being transgender as her latest attempt to garner attention from people who were getting bored of her usual antics.
    I don’t know the answer.  As we’ve discovered, a small percentage of the genderqueer community really are making a mistake.  Even some genderqueer people are critical of other people who are not "genuinely transgender". One of the transgender people I know talks at great length about how much she hates "the fakers".
    What I do know is that the percentage of these "fakers" is pretty low.  So if you meet someone who is genderqueer there is at the lowest estimate a 95% chance they’re sincere about it.  Perhaps you ought to take them seriously, it’s statistically sensible to do so.

How do you know?
     As a cisgender person I often find it difficult to imagine how a genderqueer person knows they’re genderqueer.  I suppose the idea is so alien to me, so different to my own experience, that I can’t help but wonder “how did you know?”
    Some genderqueer people claim to have known since early childhood while others began to realise during adolescence.  It’s different for everyone, the same as sexuality.  As someone who’s not genderqueer I have no reference, but that is 100% my point.  Because I’m happily male in a man’s body I’ve never had an inkling in my mind that I’m different in some way.  The very fact I find it hard to identify with genderqueer people is because I am cisgendered. 
    I’ve never wondered about my gender identity so maybe that’s a good reason to trust a genderqueer person:  I’m so confident of my own identity it would take something incredibly powerful to make me question it.  I’d have to be pretty convinced something was up.  Well, maybe, that’s what it is like to be genderqueer? 
    As a teenager I was far from happy.  I’d never repeat my adolescent years if you paid me and, aside from a few friends who stuck by me, I was utterly miserable for a long time (by the way, don’t worry about me, I’m doing fine now!) 
    Thing is, I would have given anything to change who I was and many other teenagers feel the same today.  But I never questioned my gender.  I was unhappy and didn’t like who/what I was, but I knew I was an unhappy boy.  Transgender people aren’t just unhappy with themselves and want to be different.  They are transgender irrespective of their happiness/unhappiness.
    Transgender people aren’t “unsure of their gender”.  They are the exact opposite.  That’s the point. 

Does Science support transgender rights?
     Science shows, pretty clearly, that genderqueer phenomena are real.  It’s not a side-effect of mental illness either; transgender people are typically as mentally healthy as anyone else.  They’re also not faking it or self-deluding usually.  It’s not a choice, it’s not a lifestyle and it’s not something you can be persuaded out of.  It’s the way you are.  And it’s also not as rare as you might have thought.
     Yes it can be daunting to hear about all these things we aren’t usually told in school, but this is the way nature is.  If you don’t like it, find another Universe!  Genderqueer people are here, they are queer, and you have to get used to it. 
    Science doesn’t make moral comments however, it simply shows what the truth is.  So Science doesn’t technically support or un-support transgender rights which presents an ethical question: how should we treat people who are biologically different to the norm?  The answer to that should be obvious.

This is the transgender flag. I'm proud to display it. You can call me Ally!

I would especially like to thank Lu Mather for his advice, consulting and editing of the blog.  He helped me with terminology and tone.

Image credits:
Trans symbol: wikimedia
Anti-trans guy: theatlantic
Ben Melzer: stuff
Richard O'Brien: thumbs
Intersex group: Oii
Nail in the coffin: tryredemption
YMCA: alphacoders
Panda: Wikimedia
PokemonGo: Saferinternet
Trans flag: Wikimedia