This is a work in progress. Comments are welcome and can be sent to my-last-name at alum dot wellesley dot edu. Citations, in particular, are missing, and someday I will fix that.

What Price Normalcy?

Tim Chevalier
December 2007

"I try my best to be who I am
But everybody wants me to be just like them."
-- Bob Dylan

Take an apparently healthy, typical baby boy and remove his penis, surgically create a clitoris and vulva, and bring him up as if he was a girl, calling him a girl's name, dressing him in girls' clothes, and telling him that when he grows up he can look forward to being a mommy and baking cookies (waiting until puberty to break out the estrogen patches and fable about how he was born with a tragic birth defect that will render him unable to menstruate or become pregnant like the other girls -- but he's just the same as them regardless.) Take an apparently healthy, typical baby girl and operate to release her clitoris from the supporting ligaments and insert silicone implants in her labia majora, creating an (albeit small) penis and a passable scrotum, and bring her up as if she was a boy, calling her a boy's name, dressing her in boys' clothes, and telling her that when she grows up she'll be a daddy and maybe be a fireman or a physicist (waiting until puberty to break out the testosterone shots and fable about how, oops, she was born with a penis that's a lot smaller than that of the other boys in the locker room, and she'll never be able to get a girl pregnant, but don't worry, she's just as good as all of the other boys regardless.) Repeat a hundred or a thousand times. We'd all like to know whether gender identity is due to nature or nurture, wouldn't we? These experiments are the only way to find out with some degree of confidence.

Sounds unethical? Of course; that's why it's only happened once. Maybe you've read about David Reimer, the Canadian boy who was circumcised at the age of a few months old because both he and his twin brother had foreskins that wouldn't retract easily. The doctor slipped and burned off his penis; since it was thought that a boy could never grow up without a penis and be psychologically healthy, the decision was made, on the advice of renowned "gender" "scientist" John Money, to remove what was left of his penis and raise him as a girl. (At least some semblance of rationality was present insofar as the decision was made not to circumcise Reimer's brother, whose foreskin problem promptly cleared up on its own.)

This was a horrible mistake, as everyone was willing to admit later on except for Money. Reimer always seemed to have a subconscious sense that he was a boy regardless of what all the adults in his life tried to tell him, never acted in a manner befitting a little girl, and refused to pee sitting down. Yet the experiment continued until he was thirteen, so anxious was Money to prove his point that gender identity is completely malleable and that anyone can be successfully raised in any gender role if you just start young enough. Finally, Reimer convinced his parents that enough was enough, and he was allowed to start taking testosterone, get a phalloplasty, and try to live a relatively normal life as a man. This didn't do much good, as he committed suicide in his thirties.

If they weren't convinced already, Reimer's case was enough to convince most rational people that similar experiments should never be conducted again -- should never be conducted again on cisgender children, that is. Yet another experiment continues today: the experiment of denying hormone replacement therapy to transsexual kids.

Testosterone, given to an adult female-bodied person, will make them indistinguishable from a (possibly short) cisgender man as long as they keep their clothes on. Estrogen, given to an adult male-bodied person, doesn't go quite that far as to making them indistinguishable from a (possibly tall) cisgender woman, but can go a long way for some. After fifty years of administering hormone replacement therapy to transsexual people, we know it's effective, we know almost everybody who opts for it reports increased well-being as a result [1], and we have no reason to believe it isn't safe. But both hormones are far more effective in transforming the body of someone who has a subconscious feeling that their bodies ought to be more like those of the other sex -- that is, a transsexual person -- if given at puberty. Moreover, if a transsexual person who is aware of their identity before puberty is denied cross-sex hormones during puberty, the hormones that swamp them at puberty will cause irreversible or hard-to-reverse -- and, for a transsexual person, quite unwanted -- physical changes: a deep voice and tall stature for trans girls, breasts and short stature for trans boys. In short, a trans kid who is allowed to take cross-sex hormones at puberty will stand a much better chance of being able to live out their life in a body they can feel comfortable in.

Yet that isn't enough to convince some doctors and parents of trans kids that HRT at puberty is appropriate. "Why not adopt a wait-and-see attitude?", they ask. They insist that a twelve-year-old can't possibly be mature enough to make such a life-changing, irreversible decision. They suggest that for some kids, identification with the other sex is "just a stage" and "they'll grow out of it" and be a -- I wish I had a special font for this word -- normal adult, albeit one who might be a somewhat feminine man or masculine woman. They hesitate to let trans kids take cross-sex hormones because of the chance that it'll be regarded as a mistake later on, and that the kid will be scarred for life by the experience.

A word should be said about the idea that "well, maybe if little Johnny wants to be a girl, he'll just grow up and be a nice, normal feminine man or even a gay man, which would be okay as long as he entered into a monogamous partnership immediately upon having sex for the first time and basically acting like a straight man all the time except in his bedroom, which wouldn't ever admit anyone else except his monogamous partner." There is mass confusion between the ideas of gender role and what I'll call bodily identity, although that's a confusing and overloaded term. Gender role refers to whether you act masculine or feminine or a combination of both: whether guys in trucks call you a diesel dyke when you're walking down the street or ask you what you're doing tonight if you are usually taken to be female, and whether you get referred to as "sir" or "hey, faggot" if you are usually taken to be male. Bodily identity is what I'll call the sense that you ought to have a male body or a female body (or perhaps, for a few people, neither.) Almost everybody takes bodily identity for granted, because their bodily identities coincide with their bodies; they never have to think about the possibility that it could be otherwise. Transsexual people are people who have a strong sense that their bodily identity doesn't match their body. They have a feeling that their body "ought to be" the other sex, and the feeling doesn't go away with time, but if anything, gets stronger. Not all transsexual people know this consciously from a young age, but many do, and even those who aren't able to put words to the feeling until they become adults usually have some inklings of it from early on.

Gender role and bodily identity are orthogonal. Get it? Neither variable depends on the other. You can be a person who looks like a guy and has a penis and testicles but wants to have a clitoris and vulva but wants to be a lumberjack, wear flannel, and crudely hit on any potential sexual partners. You can be a person who looks like a guy and has a penis and testicles but wants to have a clitoris and vulva but wants to look like an Avon lady, have six cats, and talk about her feelings a lot. You can be a person who looks like a chick and has a clitoris and vagina but wants to have a penis and testicles and adopt Xena, Warrior Princess's life philosophy, wear high heels, and get called "ma'am". And you can be a person who looks like a chick and has a clitoris and vagina but wants to have a penis and testicles and wear business suits every day, get called "sir", and ignore his emotions. All of these are valid identities and combinations of personal feelings (not that any particular configuration of personal feelings can be *invalid*.) None of the four example people here are necessarily confused, deluded, or crazy just because of how they feel about their gender roles and bodily identities. This ought to be obvious; somehow, it's not. (Julia Serano deserves credit for explaining the distinctions involved more succinctly than anyone else I know of, in her book _Whipping Girl_.)

Now, that isn't to say that there's no statistical correlation between gender role and bodily identity. It's not too controversial to say that most people who are born with vaginas are happy expressing a gender role that's more feminine than masculine, and vice versa for people born with penises. But the point is that the gender role of any *individual* cannot be predicted accurately if you only know what body they believe they ougth to have, or vice versa.

So if who you think of as your little girl says "I want to have a penis," it's ineffective and dangerous to assume, "She's just a tomboy, and will grow up to be a happy, perhaps mannish woman, perhaps even a lesbian woman, but that would be okay because I'm a liberal who's supposed to tolerate that." Bodily identity rarely if ever changes over time, and it can't be cured or changed with therapy any more than sexual orientation can be -- perhaps even less easily than sexual orientation can be changed. If you're transsexual, and your feelings of bodily incongruence bother and upset you, it's unlikely that that feeling will go away by itself, and likely that a combination of hormones, surgery, and publicly expressing your desire to be acknowledged as a member of your preferred gender (not necessarily all of the above) will help. People don't grow out of this one; people who know when their age is in single digits especially don't grow out of this one. There is no evidence to the contrary.

Perhaps you think that wanting to have a penis if you have a clitoris, or wanting to have a clitoris if you have a penis, is disordered or delusional, that it's indicative of a mental disease that ought to be treated the way we treat mental diseases (i.e., ineffectually). Well, it's hardly "delusional"; trans people don't think they *have* the body parts they'd like to have, but rather, are acutely aware that they don't. And it's only disordered if you think that wanting to be a man, or wanting to be a woman, or both, are a sign of insanity. (If it's both, then a lot of us are in trouble.) Sometimes people compare being transsexual with feeling like you ought to have an arm or a leg removed: they say that allowing transsexual people access to surgery and hormones is like treating the person who feels they ought to have a limb amputated by amputating their limb. This is a poor analogy. Transsexual people wish to have healthy, complete male or female bodies, not bodies missing a part that almost all humans would deem essential for functioning. Almost no sane person would prefer to have an arm or leg absent than present; lots of sane people enjoy being women, and lots of sane people enjoy being men. There is nothing subjective or tricky about saying that the desire to be a man or to be a woman is a rational and reasonable one, and the desire to remove a functioning body part that is present in almost all humans is not.

Returning from the digression: In short, these particular doctors and parents share a working assumption and a hypothesis they'd like to prove. The assumption is that it's better to be cis than trans; that it's inexorably better to have your body, your hormones, and the role you present to the world all match up than to have some of them conflict. No one seems to question that assumption, or question whether anybody has a choice. The hypothesis is that transsexuality in young people is, indeed, frequently "just a stage"; the question to be answered experimentally is how many of these kids will "grow out of it" and live to thank their parents for their munificence in allowing them to be normal, healthy, happy men and women (if that is indeed possible for people who long to be in the other kind of body from a very early age.) The experiment consists of inflicting the wrong set of hormones on these kids, and seeing whether they grow up to be happy, well-adjusted members of their assigned sex; miserable people who never transition because they're afraid to change but spend their lives wondering whether it would help; or eventually successful trans people who eventually achieve congruence between what they are and what they long to be, but wish they'd been given the chance to transition before the wrong-sex hormones wrought their toll on their bodies. Note that I use the term "inflicting" to suggest that this is an active choice, even though the choice *not* to administer hormones to a kid and "allow" puberty to "naturally" take its course seems entirely passive and cautious. That's because the choice to do nothing is still a choice; there is no neutral course of action in this situation.

I repeat: this is an experiment. Trans kids are the subjects, and they're hardly being asked for their informed consent. When I started taking testosterone, I had to sign a form that stated I understood a list of things that the hormone would, might, and would not to do my body, and that many of them were irreversible. No one asks an avowed twelve-year-old trans boy to sign such a form before he is allowed to go through "natural" puberty as a female-bodied person. Why isn't everybody outraged that we're doing medical and psychological research on underage children without their consent? Is it because ethics only apply to cisgender people? Or is it that transsexual people aren't people at all? Consensus has rejected surgeries to "normalize" intersex babies, as such surgeries wreck sexual functioning and are meant to appease parents who are uncomfortable with the idea of raising a child whose sex is unclear rather than to enhance intersex childrens' lives. It does not seem at all extremist to consider the possibility that denying HRT to trans kids is a measure meant to placate parents who are uncomfortable with the idea of raising a transsexual kid; parents' anxiety is being put ahead of children's well-being. Could this be wrong-headed? Is it in fact worth mucking up the lives of the majority of kids who are transsexual -- kids who are truly transsexual in the way explained above, not just kids with deviant gender expression -- who grow up into transsexual adults in order to protect the welfare of the minority -- if it even exists at all -- of transsexual kids who, as adults, decide they're actually happy with their bodily geometry after all? How many trans kids' mental health is it worth sacrificing in order to save the mental health of one cis-kid-who-appears-to-be-trans? Do you think I'm half a person? A third? One-twelfth? What do you think? Or do you just hope that young, or not-so-young, trans people will simply disappear if you don't acknowledge we exist? If your kid spent their childhood telling you they felt they should be the other sex, how big a risk would you take of sacrificing their mental health for good in order to buy them how vanishingly small a chance of leading a normal -- i.e., cissexual -- life? Do you think that would be in their best interest? Or yours?

This is an experiment: an experiment to determine whether it's possible to turn deviant people into normal people. The dream of normalcy, of course, is only shared by the cis parents and doctors here. If you're trans, you know normalcy is never going to happen for you. In the worst case, you don't know that it's possible to change your sex or gender and you think you'll have to live with your feelings forever -- well, in the *really* worst case you get out of that through suicide. In the best case, you come out, you seek whatever medical interventions you feel will help, and you spend your life knowing all you can ever hope for is a series of imperfect adjustments, and you spend your life having your authenticity questioned by people who never had to think twice about theirs. Trans people know this. But those who have power over trans people, if they happen to be minors -- their parents -- generally don't, and many if not most would prefer their kids to conform. They don't understand their kids can't conform. In the best case, they want their kids to lead "an easier life" but don't understand that living your life in the wrong body is the harder life; if you're trans, easiness got written off before you were born.

So we're talking about an experiment being waged by normal people to try to confirm their dream that they can make everybody else be normal too. By people who at least pay lip service to diversity in most other human attributes, but see it as something to wipe out when it comes to gender and sexual identity. Thus diversity is not just a PC buzzword: in this case, and many other cases, whether diversity is celebrated or feared determines whether some people live out their lives or die (either physically or psychologically) at an early age.

This experiment is not just being carried out on kids, of course, but on adults as well. The so-called "standards of care" that require a self-identified trans person to "prove" their transsexuality before being granted hormones and surgery impose requirements that are not in place for any other elective medical procedures, in the name of protecting the very few cis people who might go through the transition process for delusional reasons if not protected from themselves, and jettisoning the well-being of many trans people who aren't able to fit the profile of the standard transsexual narrative and are thus denied care as a result. Here the decision makers are doctors and therapists, no longer parents, but the goal is the same: try to find out, if we can, whether it's possible to make people more normal. I think that those of us who believe that individual humans have worth and that diversity ought to be valued should object to this, too. But it's particularly objectionable that children are denied potentially life-improving treatment precisely during the time window when it would be most effective in the name of either continuing the experiment to see whether we can induce normalcy, or protecting normal people from the chance that they might accidentally fall into the trap of deviance. So if we as a society aren't prepared to kill and eat our children in the name of finding a cure for difference, we have to stop the experiment.


[1] "Many studies have shown that the vast majority of transsexuals are satisfied with the outcome of sex reassignment..." -- "Report of the Task Force on Gender Identity and Gender Variance", American Psychological Association, 2008 (p. 46).