Transcript of In The Beginning

When I originally recorded this episode, I used the microphone from my headset and sound quality wasn’t very good, therefore I decided to invest in a dedicated podcast microphone.

Also on the original recording, the series was called, “Trans Strong”, however after discussing my ambition for this Podcast with my psychotherapist, Dr Kenneth Demsky, I changed the name to, “Trans Wise Trans Strong”, as I believe it is through wisdom that strength comes.

So as well as a series name change, I have also taken the opportunity, with this second recording to expanded both the introduction, and conclusion.

And before I begin, perhaps I should say what inspired me to produce, “Trans Wise Trans Strong”, well, along with other LGBTQIA+ Podcasts, its aim is to provide a counter to the ill-informed views and opinions about our community, and hopefully be entertaining.

And without much further ado.

Welcome to “Trans Wise Trans Strong”, I am Carolyne O’Reilly.

Episode one, “In The Beginning”

Let me begin with a statement.

We all begin female!

Well strictly speaking it is more a case that male and female foetuses initially appear to be same, and whilst the majority will develop and become either male or female, there is a condition called Differences of Sex Development, which raises question about what it means to be male or female and I will explore different forms of this condition.

Then I will look at a medical case from the mid-sixties where the then theory on gender identity was eventually called into question.

So as mentioned male and female foetuses look the same and this is case for the first 8 weeks of development, however at around 8 weeks, the internal sex organs begin to differentiate, and then at about 11 weeks, the external genitalia, also begin to differentiate.

But for a foetus with X and Y chromosomes, usually associated with being male, to develop into a male foetus, requires a functioning SRY gene on the Y chromosome.

The SRY gene, it starts a cascade of changes, including instructions for the production of Sex-determining Region Y protein, which initiates the development of male sex characteristics.

If the SRY gene is faulty, guess what, the foetus follows the default path which is female, even though the foetus has a X and Y chromosome.

The X and Y chromosomes are referred to as the sex chromosomes, and usually there are 2, either XX or XY, and in addition to these, there are another 44 chromosomes, which are the autosome chromosomes, and together this set of chromosomes is called the karyotype of a species.

It is usually written as karyotype 46, XX, or karyotype 46, XY, where XX is usually associated with being female, and XY as I have just mentioned, usually associated with being male, and related to an individual’s karyotype, are the observable characteristics, which is their phenotype.

I have said usually several times, in respect of the sex chromosomes, that is because there are a number of rare conditions, whereby an individual may have more than 2 sex chromosomes, or in the case of one condition, just a single sex chromosome.

Also an individual’s phenotype, may not be as expected, based on their karyotype.

These conditions are referred to as Differences of Sex Development (DSD), which was previously referred to as Intersex conditions, and there are some with this condition who still prefer the term Intersex, possibly because sometimes DSD is referred to as, Disorders of Sex Development, and frankly who would like to be thought of as a disorder.

A faulty SRY gene, is one cause of a DSD condition called, complete gonadal dysgenesis, or Swyer syndrome, in fact a faulty SRY gene is responsible for only about a fifth of the cases of Swyer syndrome, the rest is due to other genes.

Although Swyer syndrome’s karyotype is 46, XY, based on this alone one might expect male genitalia, the phenotype is female, as the external genitalia are typically female, as are the internal sex organs.

There is another DSD condition, even rarer, which in a sense is the opposite of Swyer syndrome, it is XX male syndrome, also known as, de la Chapelle syndrome, and as the name implies, the karyotype is 46, XX.

In 90 percent of cases, it is due to an SRY gene found on the Y chromosome, becoming attached to a X chromosome from the father, combining with a normal X chromosome from the mother, and like Swyer syndrome, the phenotype is the opposite of what one would expect based on the karyotype only.

The external genitalia are typically male, although in every case of XX male syndrome, the individual is sterile, which would not come to light until they seek a cause for infertility.

Swyer syndrome, and XX male syndrome, are two of about 40 plus DSD conditions, and as mentioned, some of these are due to differences in a of number of sex chromosomes.

Klinefelter syndrome is perhaps the most common, with an occurrence of 1 in 500 births assigned male, and its karyotype is 47, XXY.

The addition of an extra X chromosome may result in some or most of the following; undescended or a single testicle, a small penis, being taller than other family members, anxiety, impaired social skills, enlarged breasts, erectile problems.

There are a number of DSD conditions with different numbers of sex chromosomes; the 3 of Klinefelter, 4 or even 5, albeit with greater rarity of occurrence, and the ratio of X and Y chromosomes also varies.

Karyotype 47, XYY, is Jacobs syndrome, an it has fewer symptoms than Klinefelter’s, and people with Jacobs syndrome are taller than average, and have some learning difficulties.

Karyotype 47, XXX, also known as trisomy X, may result in learning difficulties, being taller than average, wide-spaced eyes and curved little fingers.

I mentioned a DSD condition, where instead of extra sex chromosomes, there is only a single sex chromosome, and its karyotype is 45, X0, it is Turner’s syndrome, and only occurs in females.

Symptoms of this syndrome are; shorter than average height, underdeveloped ovaries, not having periods, infertility and a slightly shorter life expectancy.

As well as DSD conditions related to the sex chromosomes, there is a condition due to an error on an autosome chromosome, and it is due to a mutation in the SRD5A2 gene which is responsible for encoding the enzyme 5 alpha-Reductase type 2.

It only affects karyotype 46, XY, usually associated with being male, and it is 5 alpha-Reductase 2 deficiency.

It is 5 alpha-Reductase 2, that is responsible for transforming testosterone (T), to 5α-dihydrotestosterone (DHT), and it is DHT, that has a major role in the sexual differentiation of the external genitalia.

5 alpha-Reductase 2 deficiency results in; marked genital ambiguity, a micro penis and hypospadias, where the urethra does not open on the head of the penis; however puberty is unaffected as it is due to testosterone.

As well as faults with the chromosomes and genes, another cause of DSD, is the sex hormones, and a couple examples of these are.

Complete Androgen Insensitivity Syndrome, which has the same karyotype as Swyer syndrome, 46, XY, and the external genitalia are likewise, typically female, but unlike Swyer syndrome; the uterus, fallopian tubes and ovaries do not develop, and the vagina will have a shorter depth.

The other is, Congenital Adrenal Hyperplasia, which affects both karyotype 46, XX and 46, XY, and there are two main forms which account for 95% of cases; Classic and Nonclassic.

Nonclassic is the mildest form, whereas Classic is more serious, and can result in ambiguous genitalia, where in female babies, the external genitals resemble to a degree, male genitalia, whereas in male babies, they look typically male, albeit sometimes enlarged.

However, unlike Complete Androgen Insensitivity Syndrome, for female babies the internal sex organs are typically female, and for male babies they are typically male.

There is one last DSD condition I would like to described, as it does not involve the; chromosomes, genes or sex hormones, it is, Mayer-Rokitansky-Küster-Hauser syndrome, which thankfully can be abbreviated to MRKH syndrome, and it is an agenesis of the Müllerian ducts, its cause though is unknown, and it exists in two forms; Type I and Type II.

Its karyotype is 46, XX, usually associated with being female, and both forms result in; the vagina not fully developing, no cervix, and in most cases the absent of a uterus, although the ovaries are present, producing eggs and female hormones.

In addition to these characteristics, Type II may result in, variation in; the urinary tract and kidney development, difficulty with hearing and or changes to the bones.

Now consider again, Swyer syndrome and Complete Andrian Insensitive Syndrome, both have the karyotype 46, XY, usually associated with being male, yet, their phenotype is female, with typically female external genitalia.

Now when it comes to assigning sex, it is usually based, on the external genital anatomy, therefore a baby with Swyer syndrome or Complete Andrian Insensitivity Syndrome, would in all likelihood be assigned female.

So does that mean their gender identity would also be female.

Probably, but not necessarily in all cases, as assigned sex and gender identity are separate aspects, and it is only as the child develops that they will become aware of their gender identity.

It is from about 18 to 24 months, that a child becomes aware of gender labels and not until about 3 years that they may have settled on their gender identity.

I said, “may have”, as for a very small minority of children, their gender identity may differ from the sex they were assigned at birth.

There is a belief called cisnormativity, that asserts that the sex assigned at birth and gender identity are one in the same, however I would suggest that this is a reductive view, as it does not consider that gender identity is an aspect of an individual’s psychology, whereas assigned sex is an aspect of their physiology.

Further, I would suggest that DSD conditions, although rare, illustrate that we are not a strictly binary species, given that with some conditions there is a mismatch between the karyotype and phenotype, or the internal reproductive organs may not be as expected, or fully developed, as in the case of MRKH syndrome.

Now coming back to gender identity, whilst it was found by the 2021 UK census, that 99.5% who answered the voluntary gender identity question, said their gender identity matched the sex they were assigned at birth, 0.5% said that it didn’t.

Such an individual would be considered transgender, as opposed to being cisgender which would be the case for the 99.5%.

The prefix trans is from the Latin, meaning “on the other side as”, and the prefix cis also from the Latin, means “on the same side as”.

An individual’s gender identity, is an inherent sense of self, and even if a child is told and brought up as one gender, a trans child as they develop will become aware that this gender, does not reflect what they know to be their true gender.

I believe the life of David Reimer, illustrates this inherent sense of self, in respect of gender identity.

David was born in 1965, one of twin identical brothers; David was then named Bruce, with a brother Brian.

They had a minor medical condition called, Phimosis, where the opening of the foreskin narrows and causes difficulty in urination, and their doctors decided that a circumcision should be performed.

Bruce was the first to be operated on, and instead of a knife, a cauterising needle was used, but there was a malfunction, and it’s unclear as to the cause, but, there was a surge of current, that severely burned nearly the whole of their penis, causing most the tissue to die.

Needless to say Brian’s operation was cancelled, and his Phimosis soon cleared, therefore the tragedy of what befell Bruce, need not have happened, if only the doctors had waited.

Bruce’s parents where in utter despair not knowing what to do, and one evening they were watching the television, and there was a programme, on which a Doctor Money was describing his theory that gender could be imposed on a child, and that gender identity was determined by nurture, not nature.

Doctor Money was the lead psychologist at the Johns Hopkins Medical Centre.

Bruce’s parents contacted Doctor Money, and he invited them to see him with Bruce, and suggested they raise Bruce as a girl.

For Doctor Money, given that Bruce had an identical twin brother, meant that there was a built in control, Doctor Money genuinely believed that gender could be imposed and accepted by a child, as long as the process was started before they were 18 months old.

At 17 months Bruce was renamed Brenda, and at 21 months they had a procedure called an orchiectomy, which is the surgical removal of the testes, and later at an appropriate age, they were started on female hormone therapy.

Doctor Money stressed, for Brenda to accept their new gender, they must never be told that they were born a boy, nor should their brother be told either.

The theory of Doctor Money, was developed for the treatment of children born with a DSD condition, which then would have been referred to as an Intersex condition, and the case of Brenda was used as a justification for his treatment of Intersex children.

Doctor Money met Brenda once every year, and in 1975 published a paper, about his treatment of Brenda, although their identity was concealed, stating his treatment had been a complete success, but this was not true, Brenda was deeply unhappy.

When Brenda reached puberty at 13, they were feeling suicidal and they had no interest in anything feminine and they were also bullied.

Brenda’s parents decided to stop seeing Doctor Money and shortly after told Brenda that they had in fact been born a boy, and within weeks Brenda changed their name to David.

David had re-construction surgery, and subsequently married.

David’s wife already had three children, and he became a step-father to them, he also found employment in a well-paid factory job.

However David was unaware that his treatment by Doctor Money, which had become known as the John/Joan case, was still being referenced to as a medical success.

When he became aware, he felt a sense of disbelief, that what had happened to him was being considered a success and was used as a justification in the treatment of others similar to him, and also children with an Intersex condition.

In March 1997, a paper authored by Milton Diamond and Keith Sigmundson was published, which stated that David had never accepted the gender imposed on them, and they repudiated Doctor Money’s theory on assigning gender.

Later that year David went public, and in December 1997, John Colapinto, published an account of David’s life in Rolling Stone magazine.

By his late thirties David had become depressed, lost his job and had separated from his wife.

In early 2002, David’s brother, died from a drugs overdose of antidepressants, and two years later on the forth of May 2004, David committed suicide.

What conclusions can we draw from David’s life.

Well here was someone whose anatomy was surgically altered to resemble a girl’s and for the first thirteen years of their life they were told by those closest to them that they were a girl and likewise so did the medical profession in the form of Dr Money.

Yet, as they grew older they sensed that they didn’t feel like a girl, and the older they grew, this sense of disconnect with their body increased.

For trans and non-binary children, as they grow and develop they also will experience the same disconnect between their body and the gender label assigned to them, and whilst David was not transgender, I feel this psychological desinence that I suspect David felt is relevant, as it demonstrates that gender identity is an internal sense of self.

It did not matter that those around David said they were a girl, they knew that they didn’t feel like a girl, and for trans and non-binary children being told they are either a girl or a boy just feels wrong and as they grow older and become more fully aware of the meaning attached to gender label, this sense that the wrong gender label is being applied to them does not go away.

I feel that by accepting and supporting trans and non-binary children’s gender identity, will give them the chance as the grow and develop to be happy and flourish.

This episode was written and presented by me, Carolyne O’Reilly, thank you for listening.

Next time, “Take Pride In Your Flag”.