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Discussion with Meyer-Balburgh at WPATH
Dr.Heino Meyer-Bahlburg wrote:
The data available on gender dysphoria and patient-initiated gender change indicate that the rate is increased in 46,XX CAH above that in the general population, regardless of gender assignment to male or female (see Dessens et al., Archives of Sexual Behavior 2005). I am actually supporting such gender changes in several of my CAH patients.
The data on a masculinizing shift in gender development in 46,XX CAH, as well as on a shift towards gynecophilia, show an association with degree of prenatal androgen exposure (see Meyer-Bahlburg et al., Archives of Sexual Behavior 2006 and 2008).
Seeing the quality-of-life complications that come with genital ambiguity regularly in my clinical work, I wished we had an effective & side-effect free way of preventing the development of genital ambiguity. Prenatal DEX is usually prescribed only for that purpose - and I do not endorse any other purpose, in line with the Endocrine Society Guidelines (JCEM 2010) of which I am a co-author. It's potential adverse side effects are of significant concern, but the data available at present are too inconsistent and too limited for firm conclusions, and much more work needs to be done. That's why the EndoSociety Guidelines advise limitations in its use without advocating a ban altogether.
Heino F. L. Meyer-Bahlburg, Dr. rer. nat.
Director, Program of Developmental Psychoendocrinology
Associate Director, HIV Center for Clinical and Behavioral Studies
Professor of Clinical Psychology (in Psychiatry)
New York State Psychiatric Institute & Department of Psychiatry, Columbia University
1051 Riverside Drive, Unit 15
New York, NY 10032
Dr.Torres from Gendercare did answer:
Dr.Torres from Gendercare did answer:
If prenatal 46,XX Dexamethasone exposition may be important for gender identity development, surely where does the Dexamethasone act to trigger any gender identity lability or change?
In the basal brain.
So, the basal brain is the core part we need to study and consider when considering gender dysphorias - mainly when extreme events and intense conditions happen - inside the gender identity trans sprectrum.
Dexamethasone acting pre-natally in 46,XX fetuses is another source of evidences the brain is the core part - where gender identity forms - pre-natally in humans (and other primates).
DR.Heino Meyer-Bahlburg did answer:
Dear Dr. Torres:
1. What is your evidence that prenatal DEX affects gender identity development, lability, or change?
2. What is your evidence that this happens in the "basal brain"?
3. Which part of the "basal brain" do you refer to here?
4. What is your evidence that gender identity forms prenatally?
Heino F. L. Meyer-Bahlburg, Dr. rer. nat.
Let me try to resume an answer to you - for each of your points:
1. There are evidences - published evidences, since the 90's - that DEX 46,XX persons had a higher tendence for FtM gender dysphorias than non DEX 46,XX people.
That means not that necessarily a 46,XX person would be necessarily a FtM gender dysphoric - but DEX increased the probablity of FtM incidence.
2. The evidence that gender identity is related to the brain i believe we have plenty. Almost all in our perception - includding self-perception, happens in, through and based on brain activity.
So what we may say is surely we have plenty of evidences that all human perception happens through the brain - including self-perception.
But we have also plenty of research that shows us that self-percetion is something very deep inside the brain.
And gender identity is a deep self-perception - include even the most violent and deep amnesia is impossible to change gender identity.
And we have also the research of gender identity in the brain - the work of plenty of researchers as Dr.Gunther Dorner, Dr.Pfaff, Dr.Gorski, Dr.Swaab among others - that show that the basal brain is related to gender identity formation - in humans, non human primates, rats and etc..since the 60's of the last century!
You did publish some time ago - that "animals" have no gender identity, only humans have.That way Dr.Meyer-Bahlburgh, Dr.John Money and yourself did try to desqualify all the work -of good scientists as Pfaff, Gorski, Dorner, Bonsall, Resko and lots of others.
No Dr.Meyer-Bahlburgh, you and Dr.John Money were not right.
All "animals" as non-human primates and even rats - show gender identities.
Here we have different opinions only - and i am sure our opinion is very near the reality, as we know today surely non humans have identities - even personalities - and a gender self-perception surely!
So, due to the decades of works of these good scientists and authors i did mention, as Dorner, Pfaff, Gorski, and others, i believe we have plenty of evidences that gender identity in humans is related to the basal brain.
3.Which basal brain structures?
I refer mainly to the hypothalamus, and other structures near the amygdalas and the limbic system as a whole.
There are plenty of research showing the importance of these structures in the determination of the gender identity of rats, mice... birds... and mainly primates.
Lots of data since late 80's about primates, alive and dead ones, mainly by Resko, Bonsall, and others.
A very interesting study made by Clarke et al, in the 80's about the aromatization of T and reception through AR and ER in the basal brain parts in non-human primates,relating to age and structure.
These studies showed that the structural flexibility of these structures were mainly prenatal in primates, and so on.
So, men and women have different brains - not only in the laterality of the cortex - but also inside basal structures.
The same happens to male and female non-human primates, and other species.
4. About the time when it happens
Among primates all the work shows always - all happens prenatally.
Among rats, mice and birds, pre and peri-natally.
Among non-human primates we have also plenty of evidences - sisnce the 80's. Among humans we have also - not so plenty data - but Dorners, and others, that all happens prenatally in primates - including humans.
Some Final Comments Dr.Meyer-Bahlburgh
So Dr. Meyer - Bahlburgh, we have plenty of evidences to feed a serious development of the knowledge about gender identity - related to the basal brain prenatally in humans.
These are - at least enough evidences - to feed new serious research following that possibility - the stronger possibility we have nowadays.
Science is dynamic - we have no absolute truths - NOR ABSOLUTE DOGMAS - so we need serious research to understand more.
BUT BASED ON WHAT WE KNOW NOW - based on present day evidences, that is now the best way to research - and to spend money, time and effort.
DEX acting prenatally in the brain of 46,XX female phetuses - generating a higher amount proportionally of FtM male gender dysphorics points also at the same direction - that is what i did suggest.
My first language is PORTUGUESE. I would like to discuss complex matters as these in my language. Unfortunalely here i need to write in a foreign language for me.
I beg your pardon my language difficulties, imprecisions and possible lack of sense or diplomacy sometimes.
Thank you Please, if you would like to reply, let's continue discussing... i believe that is a very profitable subject to discuss!
Dr.Mayer-Bahlburg did answer:
Dear Dr. Torres:
1. There are no such data on prenatal DEX (= dexamethasone). I think you may be misunderstanding DEX as DES (diethylstilbestrol). Yet, even the statements regarding gender dysphoria and DES are just poorly substantiated claims, without epidemiological plausibility for causation, let alone proof.
2. We certainly agree that sex differences in behavior are likely to be based on sex differences in brain anatomy and function. Yet, please provide quotes and citations where any of the researchers you list state that (a) rats, birds, etc. have "gender IDENTITIES" and that (b) these are anatomjcally localizable in some basal brain structure, and what the evidence is for either.
Heino F. L. Meyer-Bahlburg, Dr. rer. nat.
Dr.Torres did answer:
Good morning Dr.Heino Meyer-Bahlburg
1.On your first comment:
46,XX fetuses with CAH (related to DEX) and mothers that take DES when pregnant of female original fetuses - have an increased probability to have FtM children - there are enough evidences about this - surely.
And these conditions increase that probability due to facts that happen during gestation, and inside the brains - also surely.
And in the brain - at basal parts - also surely.
So we have evidences - for some, mild ones - for others, strong ones - but evidences and facts - the increase of FtM probabilities.
So i believe, the basal brain and its development is a good target to study - to understand better how gender identity - and gender dysphorias - may happen.
2. On your second comments and questions:
About species that develop a gender identity, and species that don't develop any gender identity.
I will show you later, a few links to papers that show - apes have identities, they are sensient, intelligent beings. They develop identities, personalities and even cultures.
So we - human apes - we are not the only apes that develop some intelligence. And self-perception and gender identities.
A more in deep discussion is related to monkeys. Some believe apes have identities, but monkeys no - because they show not self recognition before a mirror.
That is a question now of faith - i believe they have - others believe they have not.
Who may answer that doubt?
Only the monkeys.
But I, THE SO INTELLIGENT HUMAN APE, I DO NOT UNDERSTAND MONKEY'S LANGUAGES!
Dr.Meyer-Bahlburg - we, the so intelligent human ape species - we had at least a century or more to understand a few aspects of other ape's languages!
They - through our computers - they learn much more about our languages than we learn about their languages!
Only now, we are starting to learn the languages of apes, monkeys, cats, dogs, rats...
The problem is - when we start learning the language of others - we say... they have not languages, but only BEHAVIOR. hahaha!
Probably, if we find Martians, or any other kind of ET life we would say - they have no languages, but strange behaviors! hahaha!
Their behavior - is their language - we may not understand completely! hahaha!
When a female rat or mice shows a lordosis position, in the presence of a male rat or mice - what she was telling him? hahaha!
We call her language - a female gender typical language - body-language, yes - as behavior... animal behavior... she is not showing a gender identity, but only an animal behavior.
I hope you understand that we are PLAYING WORDS ONLY, HUMAN APE WORDS.
So, through each species languages, each species communicate who each individual is - how each sensible and perhaps intelligent individual tells - about who he or she is.
APES, we have plenty of data nowadays about their identities, cultures, personalities and gender identities.Even differences considering sexual orientations, considering Pan trogloditas and Pan paniscus!
Monkeys we are now starting to learn their languages - identities, personalities and cultures.
The same of other species.
Wich is the main question here?
WHO WE ARE?
WE ARE NOT DERIVED FROM A GOD, or GODS professor, but from monkeys and apes. And if we have any sensience and intelligence - it is because we have common ancestrals that did bring that possibility for us - AND for THEM - since some billions of years ago, when did start life at the surface of that small planet.
If we understand ANIMAL BEHAVIOR - as human ape behavior - is a kind of a language - then all species may develop identities and gender identities.
If we understand we are special beings generated by a God - to use and exploit Nature and our ancestors apes and monkeys and other species, then we have special souls, intelligence, and probably other qualities (our imagination may have no limits - yes).
So we may have different opinions - faiths - and points of view.
But what is more scientific?
Who are we?
Sons of a God?
Science says surely - we are apes, we have near 99% the same genes a Pan paniscus has, and 98% as a Pan trogloditas has, and some 95% as a gorilla gorilla has.
So, i believe we have that main difference.
You know - as i know - and most of the people of WPATH nowadays know - gender identity is something related to the brain. The basal brain. In human apes, other apes, and other mammals and so on...
That gender identity we may express through our culture, personality... and language (behavior).
The same among other apes - i will link some papers below.
But the ANIMAL BEHAVIOUR - a language we still may not understand completely - shows other species also show - their gender identities.
And all brain research during decades showed in all species studied - gender identity is related to brains - to basal brains - hypothalamus, amygdalas, limbic systems... in all species.
Each species has its languages, its brains, its contingencies... but we may see a rule as a whole - as Dr.Dorner saw in the past... as i published in Portuguese in a book in Brazil published in 1998, as others understood for decades.
Sorry folks, i wrote too much! Pardon me!
See some simple links:
1. Follow the work - a great and detailed work about apes - by Frans de Waal, for example "Bonobo the forgotten ape" (with Frans Lanting, Oxford U Press i believe, 1996) and "our inner ape", Riverhead,2005, among much others.
2. Also follow Jane Goodall work with Pan trogloditas in Africa. You will see ape cultures, personalities, identities, and so on!
How apes show empathy
Animals show and recognize emotions
Apes show cultures
More about monkeys awareness
These are a small - 10 minutes search - about the subject of "animal behavior" and identity, culture and personality.
Pardon me - my language difficulties and the lack of diplomacy sometimes. I am a better diplomat in Portuguese!
Dr.Nora Grinberg did participate:
Dr. Torres writes: "All 'animals' as non-human primates and even rats - show gender identities."
This is a common misconception stemming from an essentialist view of gender as something that is added to a pre-existing biological basis. In fact, gender is an exclusively human phenomenon. Other animals may exhibit sex-typed behavioral and physical differences, but that is not gender. Gender is something else.
As Judith Lorber explains ("Night to His Day", in Paradoxes of Gender, 1994, Yale University Press), gender is not only behavior: gender is a social institution. Take something as elementary as mothering. Both animals and humans have mothers. However, with animals, mothers care for their offspring until the young are capable to fend for themselves, at which point the bond mother-offspring is severed. End of mothering. Period. Not so in humans. The bond mother-child remains long after the young is capable of surviving alone. In fact, the bond human mother-child survives even long periods of separation, and it is shaped and conditioned by various institutional arrangements and practices: kinship, incest taboos, inheritance, caring, mourning. There is no such thing among animals. There may be bonding between mother and offspring, but bonding is not kinship; mating is not ordered by marriage, and animals' dominance hierarchies are not the equivalent of human stratification systems. To quote Lorber, "Animals group on sex and age, relational categories that are physiologically, not socially, different. Humans create gender and age-group categories that are socially, and not necessarily physiologically, different." (p. 15)
The onset of puberty in animals means they are capable to impregnate or conceive. In humans it means being available for marriage; the onset of social adulthood is marked by rites that demonstrate marital eligibility. Humans have rituals that mark the passage from childhood into puberty and puberty into full adult status, as well as for marriage, childhood and death. Animals do not. Rituals of puberty, marriage and becoming a parent are gendered in ways that have no parallel among animals. Animal siblings and even parents and offspring mate and breed. Humans have incest taboos (which are subject to immense variation among cultures) - incest and kinship are the most fundamental gendered institutions. Gender rests on the uniquely human capacity for symbolic thinking. You cannot have gender without the capacity to imagine it, to conceptualize things such as masculinity and femininity, men and women, with all the symbolic and emotional baggage accompanying it. Gender's building blocks are carefully constructed, prescribed and culturally -dependent social statuses. There is no equivalent for any of these in the non-human animal world.
Western society legitimates gender by claiming that it all comes from biology, but we know (or ought to know) that gender and sex (or other biological characteristics, for this matter) are not equivalent, and gender as a social construction does not flow automatically from genitalia and reproductive organs. As for brain differences, the believers in the organizational-activational model still have to overcome a formidable barrier of theoretical and methodological obstacles before they can get from some (mostly hypothesized) sex-correlated structural differences to actual real-world phenomena such as gender feelings and norms, practices and institutions.
Gender Counseling and Support
Dr.Torres did answer Dr.Grinberg:
Good morning Nora Grinberg
Sex typed behaviors in animal species are not gender as expressed by human species.
Yes, we agree.
Human sense of gender only humans have.
As also Pan paniscus sense of gender only Pan paniscus have.
For humans, other species show strange behaviors - and strange languages - body languages, signs, sounds, movements, reactions - we may not understand.
As they may not understand our body signs, and languages.
So, human gender conceptions only humans have.
Human gender is not only human behavior - but a human social institution.
Yes, we agree.
Pan paniscus gender is also not only an individual behavior but also a social institution - in Pan paniscus sense, of course.
Frans de Waal described very well that species - their behavior, culture, personalities and social institutions. As a way a human ape may describe another ape society and behavior.
And gender has its big and enrooted impoirtance among Pan paniscus - our closest cousin.And Pan paniscus social institutions too!
I say the paniscus because we have lots of data - and that speciaes is very near human species.
But we have the same for Pan trogloditas, and even other monkeys species - as the Japanese macaques, and others.
About mother-offspring bonds - Pan paniscus and Pan trogloditas show the same as humans - a whole life bond.
So Dr.Grinberg, all we have as humans, other species have also. Not in the human sense. In their sense.
Mother-children bonds, puberty, etc... only we may not understand their languages - and most of the time they also may not understand ours.
But identities, personalities, social institutions, all species have.
At least among apes - including humans.
Or even primates, as a whole.
Probably more... much more.
Hugs dear friend.
We have here different opinions.
Ideological ones - based on religion, politics, and so on... all extremely human.
Science is a little bit different - we need to consider the point of view of the studied species - not human point of view i believe.
But that is only my opinion.