Gender Confusion, Genetical or Hormonal?
Understanding Gender Confusion
Our ancestors long ago easily identified a male as someone who has beard or moustache, physically and mentally stronger or typically one who leads the family. On the other hand, a female is someone whose movements more graceful, meticulous, motherly, associated with more indoor activities than outdoors and with sensitive instincts. William Shakespeare visualized a female’s beauty through his poem, ‘Sonnet 18’,
“…Shall I compare thee to a summer’s day?
Thou art more lovely and more temperate;
Rough winds do shake the darling buds of May,
And summer’s lease hath all too short a date…”
Throw a bit spice of twist into the famous Shakespeare’s masterpiece about young lovers, Romeo and Juliet. Juliet’s father forbidden their affections because Juliet was actually borne genetically and physically male. Too bad for Romeo, he never aware of the truth for the rest of his life. How pity. Romeo lived in lies and Juliet’s father had to be the bad guy for the whole story line. Would such dramas be sensible in society during that era? Well, it happens in this very age of Wifi and those overrated iPhones.
As much technologies and communication expand, mankind dilemmas got more complex. The Lesbian, Gay, Bisexual and Transgender (LGBT) activists stand upon principle that Gender Confusion is not a disease after all. They claimed ‘male’ and ‘female’ titles are just limited to social recognition whereas gender is another subjective entity relying to what one is pleased with. Therefore, what is a male? What is a female? These provocative questions challenged legislations and scientists to confront idea brought by several parties telling them to sort out gender identity descriptions from strict traditional criteria. Gender Confusion or Gender Identity Disorder frequently becomes a subject of discussion particularly among puzzled psychologists.
Literally, ‘gender’ is derived from Latin word, ‘genus’ meaning kind or race. Scientifically, ‘gender’ is defined as the sex of an individual (male or female) based on reproductive anatomy while ‘confusion’ is an impaired orientation with respect to time, place or person. Gender Confusion is a condition where a male or female feels a strong identification with the opposite sex despite having normal biological reproductive organs.
So far, intellectuals have not reached the exact cause of Gender Confusion. However, various theories are proposed.
“Hormones, magical chemistry.”
Biological theory is based on evidence that high levels of the male hormone testosterone are associated with high levels of aggression in boys and tomboyishness in girls.
At around third month of pregnancy, male differentiation takes place when newly formed male hormones flood the brain. Such hormonal surge will repeat between second and twelfth week after birth. No feminizing hormonal surge occurs in female intrauterine development. Both hormonal amounts and rate of surge affect masculinization. An incompletely imprinted male may emerge from inadequate testosterone and bad surge (too slow or too fast).
Interruption on hormonal surges originates from diverse sources. For example, toxic substances and disorder in the mother's endocrine system (such as hormone secreting tumor, common maternal stress and maternal medications).
“It’s in my gene. It’s innate”
Some opinions suggest certain genes are not influenced by hormones. In addition, genes are increasingly being put forth as reason for complex behavioural traits including sexuality and gender differences. Back to basics, all human cells (except gametes) contain 46 chromosomes. They include 22 pairs of autosomes and a pair of sex chromosomes (also called gonosomes) represented as X and Y.
Females have two X-chromosomes. One of the chromosomes is inactivated and converted into Barr body. Males have an X and Y-chromosome. By the presence of Y-chromosome, development is directed towards manhood. It is necessary for Sex Determining Region Y (SRY) gene localized on Y-chromosome to work collectively together with genes on other chromosomes in ensuring healthy testicles development.
Eric Vilain, professor of human genetics, paediatrics and urology at University of California, Los Angeles (UCLA)'s David Geffen School of Medicine had attempted to trace specific genes involved in gender identity by using laboratory animals, according to a report on WebMD Health News official website on October 20, 2003.
Foetuses were chosen for the investigation because the gonads were not yet to develop into testes or ovaries. Eric and his colleagues found no source of hormones when they analysed the mice foetuses brains but they found more than 50 genes expressed differently in males and females. The discovery opened up possibilities in which gender identity already existed in genes before reproductive organs are fully formed. Nonetheless, this assumption has its flaws since too many genes are involved and environmental factors still predominate.
“An evening with our therapist…”
Many studies support compelling relations between psychological development and Gender Confusion. Children’s gender-role behaviour is very much driven by their evaluation on males and females around them. Social Learning theory proposes that gender typing is the result of a combination of observational learning and differential reinforcement.
On October 17, 2011, FoxNews.com revealed a lesbian couple were giving their adopted son who wants to be a girl, Tommy hormone blockers that delay onset of puberty in order for him to get more time in confirming whether or not he wants to change his gender. Apart from the issue of administering such risky drugs to an under aged child, critics question if Tommy learnt to believe he is a girl by himself or from observation on his same sex parents. Besides synchronization of what he seen or heard with his own values, how a child’s parents attach to and treat him play significant contributing role.
Cognitive-Developmental theory denotes gender understanding follows a prescribed time line. In other words, children know they are either boys or girls by the age of two or three. Over time, gender identity is stable. By the age of six or seven, children learn that gender is also stable across all circumstances. During that stage, a little girl entering rough quarrel with boys of her age does not proof masculinity. In contrast, it is unsurprising to find an innocent girl diagnosed with Gender Confusion unable to remember the last time being female.
It is neither genetical nor hormonal. With no signs of solid cause, majority agreed it is classified as a type of mind disorder. Like other medical problems, identifying Gender Confusion aetiological aspects is extremely important for successful treatment. Authors of the Harry Benjamin International Gender Dysphoria Association's Standards of Care for Gender Identity Disorders, Sixth Version mentioned,
“To qualify as a mental disorder, a behavioural pattern must result in a significant adaptive disadvantage to the person or cause personal mental suffering. The Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) and The International Statistical Classification of Diseases and Related Health Problems 10 (ICD-10) have defined hundreds of mental disorders which vary in onset, duration, pathogenesis, functional disability, and treatability. The designation of gender identity disorders as mental disorders is not a license for stigmatization, or for the deprivation of gender patients' civil rights. The use of a formal diagnosis is often important in offering relief, providing health insurance coverage, and guiding research to provide more effective future treatments.”
The feeling of being in the wrong body describes such discomfort, anxiety and depression haunting these confused children and adults. Isolation is not the best choice though many peers and relatives choose this short cut to cope with shock or disgust. Family members support is profoundly vital in keeping Gender Confusion individuals’ inner strength, motivation and productivity in school, college or work. Clearly to say, within his or her biological gender.
Yes, everyone should be considerate and yes, people are free to express whoever they are. Freedom is not true freedom when it surpasses boundaries. In Gender Confusion case, some health professionals nod if a gender-confused adult requests for sex reassignment. Needless to speak about permanent effects and invasiveness, just how these surgeons are convinced it is a good alternative for this group?
Gender Confusion is commonly diagnosed by psychiatrist or psychologist. A detailed medical history and psychological exam are conducted to exclude other possible causes for the symptom. Gender Confusion is diagnosed when evaluation confirms persistent desire to be the opposite sex.
Misleading decision making by highly trusted knowledgeable figure sooner or later spins nature upside down. What if more intense psychological disturbance burdens a patient following genitoplasty and hormonal therapy? We cannot imagine one day Sandra wants to be Sean, then another day Sean wants to be Sandra back. This situation brings us to transgenderism issue.
Transsexualism is cursed by the Prophet Muhammad (Blessings and peace of Allah be upon him). Al-Bukhari narrated from Ibn Abbas (May Allah be pleased with him) as saying,
"The Prophet Muhammad (Blessings and peace of Allah be upon him) cursed the effeminate men (who imitate women) and the manly women (who imitate men).”
Any wise scientist must take attentive note of man’s brain limits. Infinite questions keep arising yet very few have been settled. A gigantic civilization without religion is not more than malignant cells. They multiply recklessly to tremendous number, aimless. Unaided human logics point us nowhere. We are in the urgency for wide exposure of Islamic perspectives about Gender Confusion so that Gender Confusion will not evolve into society confusion. Worst case scenario, human race menace.
Had we were given the chance to meet Ibnu Sina and other Muslim geniuses from the past, their voice could be loud enough in reminding physicians not to create hasty guessing in managing Gender Confusion individuals.
Siti Maryam Binti Mohd Sallehuddin
Kasr al-Ainy Faculty of Medicine,