A Conference With More Than Parties

A Report on The Second International Congress
On Sex and Gender Issues, 1997

By Joan Rowe, ETVC, San Francisco


Yet another conference? Although conferences for the gender community remain fun and helpful, they can seem like old news. But the Second International Congress on Sex & Gender Issues, held June 19-22 in Valley Forge PA, was different: it's purpose was solely to jiggle the old grey cells. Dr. Sheila Kirk, a distinguished transgender medical specialist from Pittsburgh, organized the speaker's program, and JoAnne Roberts, of the Renaissance Education Association in King of Prussia, PA, who is also a partner at TGForum, sponsored and organized the meeting.

Bornstein and Gooren: Big Names in TG Community

Kate Bornstein, known for her play, Hidden: A Gender, and book, Gender Outlaw, radically portrayed the hell of growing up and living as a transsexual. Her performance resonated with many while frightening others. I loved her phrase ``our people'' when referring to how we feel and think, and how we experience sexuality. She is a courageous and innovative artist who is leading the emerging transgender culture. Kate presented the first plenary session, and also spoke at the congress' banquet.

Dr. Louis Gooren from Vrije University of Amsterdam, the Netherlands, presented the second plenary. He reported that a region of the hypothalamus in MTF (male-to-female) transsexuals is the same size as that in nontransgendered women. This region is smaller in both types of women than in heterosexual and homosexual nontransgendered males. He emphasized that the brain has hormone receptors, and that sexual differences develop in the brain as well as in other areas of the body.

Dr. Gooren's talk illustrated a continuum of cross-gendered phenotypes from anatomy through behavior. He views gender as developing sequentially from a chromosomal configuration (XX or XY) to gonad formation, to internal sex organs, to external sex organs, to gender identity, and finally to sexual preference. He hypothesizes that criss-crossing between pure male and pure female tracks, perhaps partly under genetic control, occurs all along this sequence, leading to a large variety of intersexual gender expressions. One intersexual gender expression is transsexualism, where the sex of the brain differs from the sex of the external genitalia. The medical view supposes that being pure male or pure female is normal---this is obtained by following the male or female developmental track without any criss-crossing. Any criss-crossing represents a developmental abnormality. Dr. Gooren argued that this view is politically successful is obtaining rights for transsexuals because they can be grouped with people having physical disabilities for whom antidiscrimination rights are already established precedent.

An alternative view is that Dr. Gooren's developmental sequence is a mechanism for producing phenotypic variation in gender expression, that the variation itself is what is normal and often adaptive, and that medical preoccupation with pure male and pure female reflects the gender polarization of our society.

According to this alternative view, classifying cross-gender behavior as a developmental abnormality is a mistake that may deny transsexuals their ultimate rights by winning short term political battles for the wrong reasons. Anyway, the evidence for organic correlates of transgender behavior is growing daily.

Many presentations took place outside the plenary sessions---I counted 65 abstracts in the program brochure. About half were by therapists. I was struck by the similarity of their presentations, and the near absence of disagreement.

Unanimity In Treatment Recommendations?

The therapists encounter about the same spectrum of gender variations in all parts of the country, and offer about the same recommendations. They seem unanimous that no therapy has ever converted a transsexual into nontranssexual. Instead, all offer therapy to promote self acceptance of transsexualism, and integration into society. Many of the therapists, such as the University of Michigan group directed by Sandra Cole, are now working in teams offering comprehensive care, beginning with counseling and diagnosis, continuing through hormones and surgery, speech and language tutorials, and postoperative follow-up. Many therapists lamented the conflict of interest they felt between providing psychological therapy and acting as gatekeepers to hormone and surgical therapy.

Dr. Evan Eyler, also on the Michigan team, reported demographic studies on transgender people, including an ``individually-based gender continuum'' which provides more categories for self-identification than previous work, and allows the shape of the distribution along the gender continuum to be quantified. Another group of talks was offered by transsexual MD's. In particular, Dr. Tonya White spoke about difficulties in drawing a clear distinction between nature and nurture in the development of the brain, Dr. Rebecca Allison discussed hormones and heart disease, and Dr. Ann Lawrence presented new results of surveys on the effectiveness of various sex-reassignment procedures and on the sexuality of post-op TS's. And yours truly, an evolutionary biologist, presented a paper on why there is sex at all, and on the importance of genetic variation in natural populations.

Jamison Green and Jude Patton were among the leaders of effective presentations by FTM transsexuals; and Ms Bob, David Seil, Sue Saffle, Holly Boswell, and Mariette Pathy Allen all presented aspects of transgenderism in art, religion and culture.

Dust-up Over GID

The final plenary, by Dr. Stephen Levine, chair of a committee revising the standards that dictate when the medical profession permits hormone and surgical therapy for a transsexual, was the most contentious. To my eye, there is not much operational difference between the proposed standards and the present standards---three months of therapy and/or living full time in the desired gender to obtain hormones, and one full year of living in the desired gender to obtain sex-reassignment surgery. Nonetheless, Dr. Levine, a psychiatrist, stirred the coals by raising, and then defending, his profession's premise that transsexuals have a mental illness, called the Gender Identity Disorder (GID).

When asked why transsexuals are considered to have a disorder, he stated that the medical profession needs to diagnose a disorder in order to prescribe a treatment, otherwise they cannot be involved.

He further stated that classifying transsexualism as a disorder would help secure funds for research, and that many transsexuals were deeply pained. Members of the audience responded that none of these points justified classifying transsexualism as a disorder, and that transsexuals were being stigmatized for the convenience of psychiatrists.

Another issue was the absence of a requirement in the proposed standards that transsexuals be advised to store sperm or eggs prior to undergoing sex-reassignment surgery. This surgery sterilizes a person, and patients receiving other sterilizing medical procedures, such as radiation therapy, are advised to protect their reproductive potential. Members of the audience also objected to new requirements singling out transsexuals as needing permission to have plastic surgery procedures available to the general public. Still others observed the relative inattention to transgender people who are not transsexuals. Dr. Levene did not explain the provisions in the proposed standard other than to state which topics did and did not receive a consensus of the committee members. So, even though the psychiatry profession received some knocks, the talk was provocative and appreciated.

I came away greatly enheartened that therapists are better understanding how to interact with transgendered people, that scientists are making progress with the developmental biology of human gender variation, and that transgendered people themselves are increasingly authoring works from art to science and medicine that express their own insights.

The congress will publish a volume of proceedings. The final manuscripts are due by the end of July, so the volume should be ready in the late summer. The proceedings will cost $18. A 3-cassette audio recording of the plenary sessions is available too, for $15. Send check or money order to Renaissance, 987 Old Eagle School Road. Suite 719, Wayne PA 19087.

You can email Joan Rowe for more information.


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