A PAIS intersex with MtF situation letter
Dear Dr. Torres,
I am sure you are a very busy physician, but I have been looking at your web site and would like very much to discuss gender identity formation issues with you.
The reason for my interest is that I myself have partial androgen insensitivity syndrome (PAIS) and have changed my own gender role from male to female. I am very concerned that physicians are following the right principles in treating children with these conditions.
Yours Sincerely,
Deborah R. K.
Continuation of that same PAIS MtF discussion
Thank you for your email, Deborah.
See please, below, my comments.
Dr.Torres
Dear Dr. Torres,
Thank you for your prompt reply.
you asked,
When you were a child, you were reared as a boy.... and later you asked to change as MtF.... yes?
Did you have any genital surgery, at any time?
I had no genital surgery as a child because my "penis" was like a clitoris (the size and shape of a pencil eraser) and in my genitals I looked much more like a girl than a boy.
You say your genitals were more female than male, in a PAIS condition. That means you have XY chromossomes, and original testicles. But you said me not.... you were reared as a boy or as a girl? Deborah is your original name? Explain me better please.
(I did have mastectomy at age 13.)
So you were recognized as a boy and reared as a boy with a boy`s name? That is it?
After transition, I had breast reconstruction and had the partial fusion of the vaginal lips divided. I did not need clitoral reduction.
Why did you need a transition?
MtF transition..... why?
Explain me better that necessity of transition from M to F.... who desired that late transition?
You? Why?
Your parents?
Your doctor?
Who?
Say me all you would like to say about that subject {Gender identity] please.
Well, I read many accounts by transsexuals who say they feel like they have the brain of one sex in the body of another, but I myself never experienced gender identity that way.
Dear Deborah, some GID people we name MtF transsexuals, feel as if they had a female soul, and a male body, and vice versa.
Their psyche live a female behavior, and have XY chromossomes, testicles and the genitals were male, and vice versa for the FtM transsexuals.
The erection of the psyche is made in the brain, but it is function of a multitude of factors, as basal gender differentiated brain, environment and life!
We all experience.... men, women... intersex, hermaphrodites and transsexuals... our gender identity thru the brain.... because we experience our self thru the brain...
I always felt that it was my body that determined my correct gender, not my brain.
First.... the brain is a part of your body... brain is body...
Second... the self is generated by the brain, IN THE BODY... because brain is body.... the part of the body where the self and the identity, includding gender identity is formed...
Third... the rest of the body interfere on the brain... but the self and identity is determined and a product of the brain.... IN THE BODY.
Directly, without the brain, we have no self, no identity, no nothing... we were not humans... we could not live...
So, gender identity, as all identity and all our self experiences, are generated in the brain, by brain systems in contact with the rest of the body.
So, other parts.... genitals or legs... or nose.... could not directly determine any identity outside the brain...
I think that "gender identity" is a different experience and a different issue for transsexuals than it is for the intersexed.
No dear Deborah... for normal men and women.... for transsexuals , hermaphrodites and intersex... always gender identity is determined in the brain by the basal brain.
Obviously the brain is in a body, and the body is in an environment, social, cultural environment, and all those interconnexions are important for gender identity development... but all that happen in the brain, and the brain only has the possibility to define self existence and any identity and among others, gender identity.
What is good for transsexuals is not always what is good for the intersexed.
Sure dear! The same for humans and non human primates.... the same for Americans and Europeans... the same for whites and blacks.... the same for Christians and Muslims...
What is good for the rich, perhaps is not so good for the poor...
Obviously dear...
But gender identity, due to alot of factors, is generated in the brain, for all humans....and even for all primates...
My concern is that if doctors who treat intersex children believe in the idea of "brain sex", they will expect the child to decide his or her own gender based only on internal feelings.
Sure!
By DEFINITION gender identity IS AN INTERNAL FEELING erected in the brain, inside the body, in an environment...
The best for an intersex child is to preserve that internal feeling... and wait it is well established BEFORE ANY NON REVERSIBLE ACT against the body of the child.
Clothes, we may change.... also make-up, hair... but the body, sometimes after a surgery, you may not reverse if something was not perfect... so, the most prudent way is to wait and know the child reality. That is a question of general wisdom...
Let`s see your example...
Due by a PAIS condition, with XY chromossomes, testicles... you had undetermined genitals, more female than male...
But OTHERS classified you as a boy... THANK GOD NO ONE SUGGESTED YOUR PARENTS A GENITAL SURGERY "CORRECTION"... or they denied that suggestion... and you had a boy name and was reared as a boy...
With 13 you had a mastectomy....
BUT LATER, .... YOU FEEL YOU WOULD LIKE A TRANSITION FOR THE FEMALE... and started it, with the possible body corrections (breast implant after mastectomy, genital corrections for the female...)
YOU ARE THE EXAMPLE, THE BEST WAY FOR INTERSEX TREATMENT IS TO WAIT THE CHILD SHOW WHAT IS THE CORRECT SIDE...
You personally feel as a woman, and intended to have breasts, etc... because your brain is female... even having testicles, XY Chromossomes and a not perfect genitals... intersex ones. But someone said one day you were a boy, and classified you as a boy... you had at 13 a mastectomy.... and later you intended to have breasts...
So, the best option is to wait... wait and see... and define a little bit later what is really the gender identity, and work surgically to help to achieve harmony between all body tissues and that gender identity.
I think that instead, they should offer guideance and tell the child all about the limitations of treatment.
Sure... but not imposing a decision.... but waiting and respecting the child decision, and observing the child signs of masculinity or femininity... BEFORE ANY SURGERY AND ANY FINAL DECISION.
As you know, at 13 your mastectomy was AN ERROR... due to who?
You desired the mastectomy? You asked for it?
Your parents?
Doctors?
That mastectomy was an error... your late story show it clearly....
Who?
Best regards,
Deb K.
More of that PAIS and gender identity discussion
Dear Dr. Torres,
Thank you for your response. I'd be glad to answer your questions.
You were reared as a boy or as a girl? Deborah is your original name?
Deborah is my original name that I was given at age one month (by Catholic Baptism). At age 3 months I was renamed as a boy ("Thomas").
That is terrible... parents and doctors are insecure about the gender identity of intersex children, and play dice.... the first month... Deborah.... the third... Thomas... But who could really define it? Only the child.... so, wait.... wait some years.... wait for specific signs...
When I changed back at age 23, I took the name on my origninal baptismal certificate.
Good....YOU DECIDED THEN.... after 23 years!
Why did you need a transition? MtF transition..... why? Explain me better that necessity of transition between M to F.... who desired that late transition? You? Why? Your parents? Your doctor? Who?
I was the one who wanted the transition, because I was finding life as a male too difficult. I did not look like an adult male and I was sexually attracted to males. I did not think I could be a male homosexual because I thought that gay males wanted someone masculine, not someone feminine like me.
Sure dear.... you had a female gender identity... and then, only with 23 you had enough courage and strenght to say and show that gender identity openly!
We all experience.... men, women... intersex, hermaphrodites and transsexuals... our gender identity thru the brain.... because we experience our self thru the brain...
Of course that is true. All thoughts, perceptions and feelings are in the brain. What I meant was that I felt that the right sex for me to live in did not depend only on how I felt - it also depended on how well my body was adapted to it.
Sure dear Deborah... but your female feeling was your female gender identity. Your genitals and the rest of your body could help you show that gender identity socially or not.... but the femininity was there.... and with 23 you had enough courage and strenght to show it...
I ought to mention that for someone like me with PAIS (especially the form I have, which is close to CAIS), it is actually even more difficult to live as a male than it is for someone born with a normal female body. For someone with AIS, testosterone does not do anything to masculinize the body, so there is no choice except to look either like a girl or like an immature boy.
Sure.... and due to a hard PAIS, near to a CAIS, also the brain could not be masculinized, as the genitals and the rest of the body were not too... But who perceives the brain`s femininity?
Only our self... generated by the brain... a female brain, due a hard PAIS, almost a CAIS... and that femininity only you may live, and express...
Expressing femininity being considered socially a male is something very difficult.... and alot of times that difficulty erase alot of serious doubts... that explain why only with 23 you had enough courage to say... I am Deborah, and not Thomas...
The best for an intersex child is to preserve that internal feeling... and wait it is well established BEFORE ANY NON REVERSIBLE ACT..YOU ARE THE EXAMPLE, THE BEST WAY IS TO WAIT THE CHILD SHOW WHAT IS THE CORRECT SIDE... You personally feel as a woman, and intended to have breasts, etc... because your brain is female... even having testicles, XY Chromossomes and a not perfect genitals... intersex ones. But someone said one day you were a boy, and classified you as a boy... you had at 13 a mastectomy.... and later you intended to have breasts...
I know what you are saying and I agree EXCEPT that I don't think for intersex children (or adults) the feeling of gender identity is always as strong, or as clear, or as easy to figure out as it is for transsexuals.
Deborah dear... the MtF transsexuals have the same doubts you had about gender identity.... only, pressed by the more complete male body, they need to be more aggressive to show they are girls and not boys... They need to be more hard, but they have the same doubts... I evaluate intersex and transsexuals, and I feel in all, the same doubts, the same sufferings, the same pressures against them... and the reactions are very different, not between transsexuals and intersex, but as a human diversity... The stress is different, the intensity of the reactions may be different sometimes... but the doubts and uncertainties, and the need of good help is for all gender variants...
When doctors hear from a transsexual, it is always someone whose feelings about their gender are very strong and clear. If it were not so, if they did not feel so strongly about their gender, they would never bother to seek gender transition. They would do the easy thing and stay in their original gender. Only if they are willing to face all the difficult problems transsexuals go through do they tell a doctor about their feelings.
In the past, that was the way...
Not today.
In my clinic experience, I may say you, alot of transsexuals show me alot of uncertainties and doubts... but during my tests and anamnesis, we may see signs that show us who is the gender identity, and we may help the intersex or transsex person to discover his/her reality.
See at
www.gendercare.com/DUdownload10/
my 3 power point presentations about those subjects.... one of them show the self-diagnosis, and how the therapist may help the gender variant patient...
They have to really know what they want.
The same way, at 23 you really knew what you wanted.... some trans women discover very soon, almost all... that they have problems... but the quality of the problem sometimes they will discover later... and without help they may be forever in doubt about who they were... intersex and transsex...
What I am trying to say is that maybe not everyone has such strong gender feelings. I think that many intersex children (like myself at age 13), can be very confused and unsure of their own feelings.
Sure dear. You did not have a complete good help... some decades ago, almost no real help were provided by "experts"....
But today we may help more efficiently.... and I thru Gendercare I may help thru the web alot of people all around the world... because today we know better and better that gender formation process, and its complexity.
Some trans or intersex have soon a good gender identity awareness... other later... but if the child has our help, surely soon the child will be sure who he/she is.... and for good corrections, the sooner the better...
I think my doctors made a mistiake at that time because they thought that gender feelings are always obvious.
THAT IS THE POINT!
Due to old mistakes, alot of "experts" assume gender identity is easily perceived by all.... and that is not always true!
Most of times it is true.... but alot of times, for intersex and transsex that is not true...
So, as soon as parents know there may be a gender variance (intersex is vesible soon, but transsex sometimes it is not so visible), they need to look for help.... and start a gender therapy evaluation.... as we have our GID children progressive pack.... to study gender variant children, as soon as possible...
They thought that if I wasn't openly trying to tell everyone that I felt like a girl, that meant that I must really like being a boy. They didn't think they had to explain what choices I had because they thought that gender feelings were the only important thing and that gender feelings are always obvious.
Gender feelings ARE THE NOST IMPORTANT THING... but gender feelings are not always OBVIOUS FOR THOSE DOCTORS... that is the problem...
Sure... but not imposing a decision.... but waiting and respecting the child decision, and observing the child signs of masculinity or femininity...
I agree in principle, but one must remember that children are like everyone else. They will try to conform and please adults, so even if it looks as though they like the gender they are in, it may not be so.
Sure dear... and most of adults have no respect for children`s feelings... that medieval way of living, in most "Christian" families, is terrible.... tirant fathers.... hysteric mothers.... low self-esteem children...
The way is...
Freedon to express the reality, for all children... Respect for children`s feelings... And patience to know the children`1s reality first, and respect it... And knowledge to help the children self-diagnosis...
That is the way, Deborah...
...at 13 your mastectomy was AN ERROR... due to who? You desired the mastectomy? You asked for it? Your parents? Doctors?...
When I was about one year old my doctors figured out that I would have breast development at puberty and they decided then that I would have mastectomy. At 13 I thought that was my only real choice. It was only at age 18 that I found out more medical facts about AIS (and that most people with AIS are girls and women) that I realized it was a mistake.
They decided for you, as if you were a thing, an object... perhaps a cat, a dog.... perhaps a car... or a house... but not a human being... that was the problem...
We need to change those old ideas, to help children to not suffer the way you suffered dear Deborah...
What is your age today?
I was born in 1953 and I am 52. I live in Vermont, in the US.
Thank you dear Deborah... in the 50`s and 60`s, we were in the gender variance Dark Ages.... sorry dear.
Kind Regards,
Deborah R. K.
Thank you Deborah,
Dr.Torres
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