Gender Identity: a dynamical neuro-psychical process

By Wal Torres# & Pedro Jurberg *

# Wal was a MS in sexology candidate, at UGF-Rio, Brazil
* Pedro Jurberg,PhD, is a neurobiologist from Instituto Oswaldo Cruz, Rio, Brazil.

Copyright © 2001 by All rights reserved.

Since 1955 John Money introduced the concept of "sex of rearing" as the determining factor for gender identity erection. Some authors as Diamond, Imperato-McGinley, Reiner, Freitas; and now the true hystory of David Reimer described by Colapinto --- the twin transgenitalized by Money as he reported in 1972/75; show that "sex of rearing" may not be that determining factor. Based in the evidence of the neural differentiation of basal neural nucleus in the human brain, consequently there is a psychic differentiation in the human fetus; in the differentiated hormone action in genital and neural basal tissues organization (hypothalamus, stria terminallis and amygdalas); and in the possible hormone differential action in AIS (androgen insensitivity syndromes), we propose a new model for gender identity formation: by an autonomous neuro-psychical dynamic process that ends priming the gender identity in the human child (from gestation to 3 years of age).That gender identity can't change by social or cultural rearing factors, social identifications or any other social pressure against the child. If the social pressure is syncronous or lightly assincronous with the neuro-psychical gender identity--- lived by the child as a deep feeling to be a boy or a girl--- the identity naturally stabilizes in a steady state. If the pressure of society is hard against nature, will happen a disturbance, the child becoming insecure, neurotic, probably aggressive. If the pressure is too hard, may happen chaotic feelings of destruction, mainly self-destruction . So we propose a revision in our gender concepts and evaluation of gender dysphorias (not anymore as GID's, based in Money's model), based in a neuro-psychical paradigm and not only in a genital paradigm. We hope that understanding (the dysphorias as a neural discord --- so a somatic, biologic and organical congenital problem) will also help gender dysphorics legal and social integration. Today no clinic, lab or scientifical result show this possibility may not be true.

Key-words: Gender identity/ brain's gender/ gender paradigm/ gender dysphorias/ hormones and gender/ intersex and transsex.

Freud, Money and the Myth

Based in Freud's concept of "bisexuality" of the psyché (see Freud 1905) --- really gender undifferentiation --- Money,Hampson,Hampson, 1955 proposed a social constructivist theoretical gender model, and a "sex of rearing" therapy for gender dysphorics. The child would "learn to be a boy or a girl, as learns a language" during the first childhood, gender being molded by the social rearing- that was Money's main idea.

In 1966, two identical twins suffered circuncision, and one of them was mutilated, having his penis almost entirely lost (Money & Ehrhardt 1972; Money & Tucker, 1975; Diamond & Sigmundson 1997; Colapinto 2000).

Money suggested the surgeons could reassign the genitals of the boy to the female, because the boy would learn to be a girl if its family, doctors and therapists would teach him continuously he was a girl--- and they agreed. The transgenital surgery was done, and they tried to teach the child to be a girl: he looked like a girl after the surgery, he was dressed with female clothes, was reared as a girl, with a girl's name, learning to play with girl's toys, learning girl's manners. The boy made an effort to be a girl: he don't knew what happened when he was a little baby. He tried hard and hard. But he was not a girl, he could not succeed.

Later, they start giving him female hormone therapy. The boy took estrogens, developed breasts, and as he today says (Colapinto 2000), he was psychically submitted to a torture. He lived a terror situation each time he would need to go with his parents visit Money at the Johns Hopkins Hospital.

With 14 he and his brother were informed about what happened when they were babies. They were shocked and he immediately start living as a boy, as he had the inner belief since his first childhood. His parents supported him. Later he get married with Jane, a normal woman; was transgenitalized to the male the best way possible, and took the name of David.

During more than 40 years that history was not showed to sexologists, psychologists, psychiatrists, endocrinologists and general public. What the academy and the general public knew was only Money's version, and never David's version of the efficiency of "sex of rearing therapy".

In 1994, Diamond found the twins - see Colapinto 2000 --- and Money started showing he was rethinking his "sex of rearing" ideas (Money 1994), recognizing for the first time the human brain was not gender undifferentiated as thought Freud, and could happen the dysphoria as a discord of gender between the neural and the genital biological organizations. Diamond 1996 and Diamond & Sigmundson 1997, started saying what really happened.

But for David and other boys reared and reassigned as girls, and for a lot of others prematurely surgically reassigned based in sex of rearing "therapy", it was too late --- see the more than 1500 intersex dysphorics of Intersex Society of North America (Fausto-Sterling 2000, Nussbaum 2000). The same happens with other gender dysphorics, without any recognized genital malformation at birth ("transsexuals").

Now that the truth about David Reimer is spread thru books, papers and internet, we need to rethink gender identity formation, considering new points of principle. We intend to show how the identity and its gender may be primed in the neural system, in harmony with the genitals or in discord with them. And we intend to show how important is to study gender and gender problems.

The human brain has a gender

Phoenix showed the guinea pigs had a gender differentiated brain, organized by steroid hormones during a defined time (see Phoenix et al 1959).

Later, other authors showed the same for primates (Resko et al 1988; Bonsall & Michael 1989). Some said hormones were important for animals, but not for gender identity of humans (Money & Ehrhardt 1972; Money & Tucker 1975; Ehrhardt & Meyer-Bahlburg 1981). Some said hormones were not important for gender identity, but perhaps only for gender roles! (Ehrhardt & Meyer-Bahlburg 1981).

In humans some neuro anatomical organizational gender differences were discovered (see Swaab & Fliers 1985; Allen et al 1989; Zhou et al 1995; Kruijver et al 2000). All those differences were discovered in the hypothalamus, stria terminalis and amygdalas--- a neural basal system named by Newman 2000 as the Social Behavior Network -SBN.

Zhou et al 1995 and Kruijver et al 2000 showed, in human stria terminalis, male nucleus are 1,5 times the female, and in normal and dysphoric females (female identities) those nucleus are female, and male in normal and dysphoric males (male identities); and no hormone or social condition could change that fact after birth.

Those facts suggest the gender identity formation depends on neuro-anatomy of SBN basal systems, and the neural organization of the SBN depends on:

I. The sexual hormones during SBN gender differentiation in fetal stage of human and other primates development (see Imperato McGinley et al 1979; Clark et al, 1988; Resko et al 1988; Bonsall & Michael 1989; Zhou et al 1995; Wilson 1999; Kruijver et al 2000).

II. For humans and other mammal species the gender differentiation depends on the action of testosterone-T thru the androgen receptor- AR and not on the action of dihydrotestosterone-DHT (see Imperato McGinley et al 1979; Resko et al 1988; Bonsall & Michael 1989) or the aromatization of T (see Ogawa et al 1997,1998a and b,1999).

III. For humans, the genital tract surely is only differentiated by DHT --- see Wilson et al 1980.

The independence between neural and genital gender is a consequence of those arguments. So we may say it is possible to happen the organic, biological, somatic discord between neural and genital gender, with or without genital malformation.

The relation between the neural and the psychical

If the human fetus is neural gender differentiated, that neural differentiation needs to promote a psychical expression --- see Damasio 1994 --- so the child is necessarily psychically gender differentiated since its fetus stage. But how the neural organization becomes psychical translation and expression?

Based in Damasio 1994, we may develop a model for gender identity formation simulation as a simple and first possibility--- certainly not the best, and surely not the last.

Gender Identity Modeling and Simulation

A good model is one that describes and simulates something with a desired precision.

The precision of the simulation may be established and later measured and verified by control conditions.

For the gender identity dynamical neuro-psychical formation model we establish here, we will use Damasio's neurobiological dynamics and as control conditions the dysphoric living and existence. If that model describes well a normal and a dysphoric gender identity formation, it will be a good model for that first stage of our proposal.

We know very well that all simulation model is a reduction of our possible knowledge of all phenomena --- but we may develop knowledge only by reducing the reality to our models--- that is an episthemologic basic principle.

Obviously we may be criticized because our model will be too simple and the neurobiology of Damasio is a knowledge still too incipient also; but surely as soon as possible other neuro-psychical models better than this one will be developed. That is only one of the models possible, and surely not the best: but its results show that for dysphoric's simulation it is a good first model for further developments.

With the development of neurobiology and neuropsychology, new models better than this one will surely be developed, but even this so simple one show good results for the present moment of our development --- much better, for example, than the results showed by Money's social constructivist model.

The model description and the simulation of a dysphoric identity formation is described as follows:

I.At birth, the SBN is gender differentiated. May be organized as male or female (really other possibilities exists- as showed Colapinto 2000 in people that feels as androginous, without female or male identities --- but our model don't consider that possibility). In the future, new and better models will consider what now we ignore.

II.The child always is exposed to an environment: as a fetus, its mother is its environment, and after birth, the world.

III.The environment is continuously introducing, thru the senses, stimulous to the brain. As the inner visceral and tissue's sensations are also continuously sending internal stimulous to the brain.

IV.Those stimulous to the fetus and the unconscient baby's brain is continuously stimulating autonomous answers of basal nucleus of the brain (see Damasio 1994). One of those systems is the gender differentiated SBN, that will answer autonomously a gender differentiated answer, depending only from its neural organization --- and not on the environment conditions (after the ending of the neural organization), or the genital conformation.

V.That answer will be continuously retained by the memories --- priming emotional memories --- in the limbic system, unconsciously.

VI.For example a female SBN will react autonomously with female-like answers: less aggressive, with more receptivity, more female sensibility --- in resume, autonomously in a female way.

VII.The same way, the male SBN will react in a more aggressive way, more assertivity, more activity. All those answers end priming the emotional memory, since gestation and first childhood.

VIII.Those gender differentiated answers will constinuously reinforce positively the memory of gender from the SBN, as a fetus and as a small child, just until 2,3 years of age, unconsciously. Later, that reinforcement will continue, forever.

IX.The female brain of the little child will predispose the child to like to play and have female manners: to play dolls and house, have "sissi" feelings, because has a female SBN; and fight and play boyish toys, and develop male manners and feelings if had a male SBN.

X.The genitals don't play nothing in that dynamic process that erects as a priming the gender identity as the feelings to be a girl or a boy.

XI.One day the child with 4,5 or 6 will feel consciously that identity, those memories and natural gender differentiated answers it lives since it was a fetus, always as a continuous positive reinforcement, as a belief and self-recognition and inner sensation as a certainty to be a boy or a girl.

XII.If it was a normal girl or boy, all will be in harmony with its genitals and rearing: that dynamical process is naturally lived and is not perceived.

XIII.But if the child's SBN is in discord with its genitals, at that moment and later on it will start living the torture to feel one gender identity, being socially recognized by the other gender. That discord between nature and rearing will certainly interfere with the emotional stability of the child, since its 5,6 7 years old and later --- and the uneasiness with the genitals of the gender dysphoric will start.

XIV. The dysphoric child will have the conscience of its situation and the courage to show others its reality, as a "primary" transsexual, for example.

XV. Or may hide its reality, and try to live as a non dysphoric one, hiding for itself its sufferings. One day, may show its reality as a "secondary transsexual" --- really a dysphoric that show others its gender reality only later.

XIV.That model, aplied to dysphorics show a very good and real simulation of their reality--- as themselves admit in a lot of testimonies --- and simulates very well all dysphoric feelings quoted in ICD-10, F.64.2, from World Health Organization-WHO, where are defined the dysphoric child's feelings. So, for our control conditions and criteria, even being a so simple model, based in so simple Damasio's neurobiological considerations, our model is a very good one for that moment and for the present stage of development of neuro-psychical possible translations.

The influence of the social environment

If the social environment and the sex of rearing is syncronous with the gender identity, and also the genitals naturally or surgically are in harmony, the child is normal, with no problem or dysphoria --- this way lives the great majority of humans. So nobody thinks in those dynamics, and seems if the genitals had automatically the power to promote masculinity or femininity in all systems and tissues. But some children are dysphorics: they had a gender discord between genital and SBN. In those situations, when the child start being conscient of itself, will perceive its feelings are in discord with its genitals, its name, its clothes, its social recognition. Starts the dysphoric feelings, that uneasiness with its body, its genitals, its social situation.

The child likes dolls and play house, and has a boy's name, genitals, social and civil identification. All will recognize in her, not the girl she always was sure she was, but a boy: a "gay boy", an effeminate boy, a "sissi boy". That will hurt the inner feelings of the dysphoric girl. Or vice versa for a dysphoric boy, with a vagina, natural or made by a surgeon as David Reimer's .

The social rearing can't change or form the gender identity, but may disturb the life of the gender dysphoric, if in assyncronicity with the neural gender identity. The social pressure in discord with the gender identity may cause neurosis and even psychosis and suicides.

How may be primed the gender neural organization?

Jeanne Imperato- McGinley et al 1979 had a very important idea: studying 5-alfa-reductase syndromes, they discovered that systematically, children with that kind of syndrome had gender problems.That syndrome means the enzime that metabolizes T in DHT don't works well. So, without DHT, the genital tract may not be masculinized and the genitals remain almost female. The children were reared as girls, and later, all around the world, in all cultures, after 7 they start showing they had male gender identities. Imperato-McGinley and her co-workers understood the neural system could be masculinized by T and not DHT as the genital tract, and be in discord. But in those days, the "sucessfull experience" of Money's twins don't gave the academy the opportunity to understand Imperato McGinley could be wright, and Money wrong.

Later, Resko et al 1988; Bonsall & Michael 1989; Diamond 1996; Freitas 1998; Wilson 1999 had the same Imperato McGinley's idea in other dysphoric situations: testosterone may masculinize the SBN as DHT masculinizes the genital tract--- by two totally independent processes. The congenital organical gender discord is possible, even in humans. After Diamond & Sigmundson 1997 and mainly Colapinto 2000, we hope all will agree Imperato McGinley may be right: T may be the responsible for neural gender differentiation, and that differentiation remains forever, erecting the gender identity dynamically, priming it naturally and biologically by the living of the nervous system by a somato- psychical translation .

Gender paradigm --- a question of Ethics and Science

Who really is a boy or a girl? (Torres & Jurberg 2000).

The best classification is decided by the genitals; the genitals and rearing; or the inner living of the certainty to be a boy or a girl?

Something neuro-psychical, independent from the genitals and the social rearing? What is the best way to understand gender, and to choose the best referential for gender social classification today?

In that subject, we need a revolution, as Copernicus and Kant made, for cosmologic and philosophic principles.

We think it is ideological and ethically better to respect the human being as a person, with its autonomous self-recognition, as a closure. Ethically humans have autonomy as a human right. So, the real gender is the self- reference, the certainty to be a boy or a girl, and not what others think we are, by what they see when we are babies, in a heteronomous way.

If we respect human autonomy, we will retain as gender referential the neuro-psychic neural gender organization, in harmony or not with the genitals. If not in harmony, we have today enough surgical technology and hormone therapy to correct the body to live the neuro-psychical reality in harmony, recognizing the neural (the self) prevails over the genital. Ethically the autonomous over the heteronomous.

No scientifical result nor existencial situation disagrees with that paradigm today, in normal and gender dysphoric people.

Why not change the civil law? Why not socially protect dysphoric children, respecting their autonomy as human beings? Respecting the way they see themselves, the way they feel and exists?

Dysphorics have not GIDs- gender identity disorders, as thought Money, ICD-10 and DSM-IV psychiatrical standards. Their psychical problems --- if they have any --- are consequence of the hardness of society against their inner nature since they were little children, and not the responsible of the ethiology of the dysphoria (see Cohen et al 1997). GID's as any psychiatrical disorder in gender dysphorics is a myth --- as the efficiency of sex of rearing "therapy" was a myth.

Sexologists, psychiatrists, psychologists, doctors, parents, pastors, priests, judges, authorities, governors: give the dysphorics a chance to be normal; being recognized, after its body corrections, as normal people.

Then, and only then, they will live in harmony with themselves, with their bodies and papers, and with society; feeling they are, as the others, socially accepted and respected as citizens. Possibly, as the others, they will live and possibly be happy.

Reference List

ALLEN,LS; HINES,M; SHRYNE,JE; GORSKY,RA (1989)---Two sexually dimorphic cell groups in the human brain, Journal Neuroscience 9(2), 497-506, 1989;

BONSALL,RW & MICHAEL,RP (1989)--- Pretreatments with 5alfa dihydrotestosterone and the uptake of testosterone by cell nuclei in the brains of male rhesus monkeys, Journal Steroid Biochemistry, 33(3),405, 1989;

CLARK,AS; McLUSKY,NJ; GOLDMAN-RAKIC,PS (1988)--- Androgen binding and metabolism in the cerebral cortex of the developing rhesus monkey, Endocrinology, 123(2),932,1988;

COHEN, de RUITER,C; RINGELBERG,H; COHEN-KETTENIS,PT (1997)--- Psychological functioning of adolescent transsexuals: personality and psychopathology, Journal of Clinical Psychology, 53(2), 187-196, 1997;

COLAPINTO,J (2000)--- As Nature Made Him --- Portuguese translation: Sexo Trocado- a história real do menino criado como menina, Ediouro, 2001;

DAMASIO,AR (1994)---Descarte's Error--- Portuguese translation: O erro de Descartes,, Cia das Letras, 1996;

DIAMOND,M (1996)--- Prenatal predisposition and the clinical management of some pediatric conditions, Journal of Sex & Marital Therapy, 22(3) 1996;

DIAMOND,M & SIGMUNDSON, HK (1997)--- Sex reassignment at birth: long-term review and clinical implications, Archives of Pediatric Adolescent Medicine. 151, 298-304, 1997;

EHRHARDT,AA & MEYER-BAHLBURG,HFL (1981)---Effects of prenatal sex hormones on gender related behavior---Science, v211, pp1312, 1981.

FAUSTO-STERLING,A (2000)---The Five Sexes, Revisited, The Sciences, 19-23,July/ August 2000;

FREITAS,MC (1998)---Meu Sexo Real: a origem inata, somática e neurobiológica da transexualidade, Editora Vozes, 1998;

FREUD,S---3 ensaios sobre a teoria da sexualidade (1905), Ed. Stand. Bras., vol VII, Imago,1972;

GOTTLIEB,B; PINSKY,L; BEITEL,LK; TRIFIRO,M (1999)---Androgen Insensitivity, American Journal of Medical Genetics (Semin. Med. Genet.) 89: 210-217, 1999;

IMPERATO-McGINLEY,J; PETERSON,RE; GAUTIER,T; STURLA,E (1979)--- Androgens and the evolution of male-gender identity among male pseudohermaphrodites with 5-alfa-Reductase deficiency, The New England Journal of Medicine, 300(22) 1233-1237, 1979;

KRUIJVER,FPM; ZHOU,JN; POOL,CW; HOFMAN,MA; GOOREN,LJG; SWAAB,DF (2000)--- Male to female transsexuals have female neuron numbers in a limbic nucleus, The Journal of Clinical Endocrinology and Metabolism, 85(5), 2034-2041, 2000;

MIGEON,CJ; BROWN,TR; LANES,R; PALACIOS,A; AMRHEIN,JÁ; SCHOEN,EJ (1984) --- A clinical syndrome of mild androgen insensitivity, Journal of Clinical Endocrinology and Metabolism, 59(4), 672-678, 1984;

MONEY,J; HAMPSON,JG; HAMPSON,JL (1955)---Hermafroditism: recommendations concerning assignmentt of sex, change of sex, and psychologic management, Bulletin of the Johns Hopkins Hospital 97, 284-300, 1955;

MONEY,J & ERHARDT,AA (1972)---Man and woman; boy and girl: The differentiation and dimorphism of sexual identity from conception to maturity, Johns Hopkins University Press, 1972;

MONEY,J & TUCKER, P (1975) --- Sexual signatures: on being a man or a woman, Portuguese translation as " Os papéis sexuais"by Editora Brasiliense, 1981;

MONEY,J (1994)--- The concept of gender identity disorder in childhood and adolescence after 39 years, Journal of Sex & Marital Therapy, 20 (3), 163-177, 1994;

NEWMAN,SW (2000)--- The medial extended amigdala in male reproductive behavior: A node in the mammalian social behavior network, Annals of the New York Academy of Sciences, 242-257, 2000;

NUSSBAUM,E (2000)--- A question of gender, Discover Magazine, Jan 2000;

OGAWA,S; LUBAHN,DB; KORACH,KS; PFAFF,DW (1997)---Behavioral effects of estrogen receptor gene disruption in male mice, Proceedings of the National Academy of Sciences of the USA, 94,1476-1481, 1997;

OGAWA,S; ENG,V; TAYLOR,J; LUBAHN,DB; KORACH,KS; PFAFF,DW (1998b)--- Roles of estrogen receptor-alfa gene expression in reproduction related behaviors in female mice, Endocrinology, 139 (12), 5070, 1998b;

OGAWA,S; WASHBURN,TF; TAYLOR,J, LUBAHN,DB; KORACH,KS; PFAFF,DW (1998a)--- Modification of testosterone dependent behaviors by estrogen receptor-alfa gene disruption in male mice,Endocrinology, 139(12), 5058, 1998a;

OGAWA,S; CHAN,J; CHESTER,AE; GUSTAFSSON,JÁ; KORACH,KS; PFAFF,DW (1999) --- Survival of reproductive behaviors in estrogen receptor-beta gene deficient (?erko) male and female mice, Proceedings of the National Academy of Sciences of the USA, 96(22), 12887-12892, 1999;

PHOENIX,CH; GOY,RW; GERALL,AA; YOUNG,WC (1959)--- Organizing action of prenatally administered testosterone propionate on the tissues mediating mating behavior in the female guinea pig--- Endocrinology, 65, pp. 600-667, 1959;

QUIGLEY,CA; DeBELLIS,A; MARSCHKE,KB; EL-AWADY,MK; WILSON,EM; FRENCH, FS (1995)---Androgen receptor defects: historical, clinical and molecular perspectives, Endocrine Reviews, 16(3), 271-321, 1995;

RESKO,J; CONNOLLY,PB; ROSELLI,CE (1988)--- Testosterone 5-alfa-reductase activity in neural tissue of fetal rhesus macaques, Journal Steroid Biochemistry, 29(4), 429-434; SWAAB,DF & FLIERS,E (1985)--- A sexually dimorphic nucleus in the human brain, Science 228, 1112;

TORRES,WF & JURBERG,P (2000)--- Ser homem ou ser mulher: a identidade neuro-psíquica de gênero como fator determinante, Scientia Sexualis, 6(3), 2000;

TORRES,WF & JURBERG,P (2001)--- PAIS and MAIS ligand-selective and the organic ethiology of gender dysphorias, paper presented at the 15th World Congress of Sexology, that same volume, 2001;

WILSON,JD; GRIFFIN,JE; GEORGE,FW (1980)--- Sexual differentiation: early hormone synthesis and action, Biology of Reproduction, 22, 9-17;

WILSON,JD (1999)--- The role of androgens in male gender role behavior, Endocrine Reviews, 20(5), 726-737;1999;

ZHOU,JN; HOFMAN,MA; GOOREN,LJG; SWAAB,DF (1995)--- A sex difference in the human brain and its relation to transsexuality, Nature, 378, 68-70, 1995.

Wal Torres is supported by Capes
Any correspondence, send to:
Wal Torres, Universidade Gama Filho, Rio, Brazil

Paper Presented at the 15th World Congress of Sexology, Paris 2001