Understanding Transgender, for Cis Folks

It’s not a trend or a social construct. It’s biological reality….

 

Imagine you wake one morning to find a third arm, fully formed from the elbow down, extending from your solar plexus right in the center of your chest. It looks like your other limbs, you can move it just as easily, and it senses touch and hot and cold and pain just like the others.

And yet, it feels alien. Like something foreign that has been implanted inside of you and grown out on its own. Not really “your” arm at all.

What do you do?

Do you think, “Ah, well, now that’s convenient! Now I can type and drink coffee. This is super!” Or do you think, “My God, how can I get this thing removed?”

Chances are, it’s gonna be the latter. That’s because our physical apparatus is neurally wired to the brain, and any parts that don’t have a place in our brain’s “map” of our body will feel foreign and invasive. The sensation is so disturbing that we may risk doing great harm to ourselves attempting to detach them. By the same token, lost body parts often leave behind “phantoms”, very real physical sensations of pain or contact or the internal sense of its (nonexistent) location.

But what in the world does all this have to do with people who are transgender, whose sense of gender identity mismatches the bodies they were born with?

The answer has to do with that internal “map” which allows our brains to operate our organic machinery.

The brain’s body map develops independently and generically in the womb, and must customize itself to the actual body after birth. When you see a baby playing with its feet, or a puppy chasing its own tail, you are witnessing a young body physically synchronizing to its brain. And as long as the generic map within the brain is complete, and the generic template matches the body type, the process goes smoothly. But problems can arise if the body map in the brain has not fully formed, or if the template in the brain isn’t made for the body model it finds itself in.

In some people, bits of the map are missing at birth or are not connected to the neural pathways that allow them to be synched up with their respective parts. For reasons that are not yet understood, the lower extremities of limbs on the left side are the most commonly omitted. In other cases, brain trauma destroys sections of the map or the connecting neurons. There are records going back at least to the 18th century of physically healthy people seeking amputations in order to relieve the profound and unrelenting distress of body parts which they feel are “not mine”. And if they could find no surgeon to cooperate, some have attempted the procedure on themselves, or intentionally damaged the limb so as to make amputation a medical necessity.

For much of the 19th and 20th centuries, such conditions were treated as psychological disorders. Freudian analysis, for example, sought to ground them in childhood obsessions, attachments, and fantasies. But as the 20th century progressed, mounting evidence pointed to a neurological cause, perhaps akin to the much more widely known “phantom limb syndrome”, the persistence of sensation after amputation. For instance, people seeking removal of healthy limbs could typically indicate precisely where the feeling of “not belonging” or “overpresence” began, and were able to consistently identify the boundary points down to the millimeter across spans of months or years. The predominance of the left side and of lower arms and legs also suggested a physical rather than social or emotional source of the problem. And the overwhelming failure of psychological therapy to provide any relief, contrasted with the repeated satisfaction of patients who were granted amputations, convinced many physicians that neurology must be the culprit.

Around the turn of the 21st century, methods were developed to test these neurological theories. The neuroscientist V.S. Ramachandran, for example, noted that skin response in the “alien” areas of an affected limb was measurably stronger than in other parts of the body. In other words, a touch to the area that felt like it “didn’t belong” was more startling than elsewhere. But a great leap forward occurred when Ramachandran and his colleagues looked more deeply, into the activity of the brain:

Nerves for touch, muscle, tendon, and joint sensation project to your… somatosensory cortices in and just behind the postcentral gyrus. Each of these areas of the cortex contains a systematic, topographically organized map of bodily sensations. From there, somatosensory information gets sent to your superior parietal lobule (SPL), where it gets combined with balance information from your inner ear and visual feedback about the limbs’ position. Together these inputs construct your body image; a unified, real-time representation of your physical self….

My lab conducted a brain-scanning study on four patients… and compared the results with four… control subjects. In the controls, touching any part of the body activated the right SPL. In all four patients, touching the part of the limb each one wanted removed evoked no activity in the SPL — the brain’s map of the body didn’t light up, so to speak, on the scan. But touching the unaffected limb did. (Ramachandran, The Tell-Tale Brain, 2011)

 

In short, the “alien” areas of the body were not connected to any corresponding representation of those areas in the brain. There was a mismatch between the conscious self, or the person’s experienced identity, and the body. These patients were, in essence, amputee souls trapped in the bodies of non-amputees. Ramachandran gave the name “mismatch aversion” to this class of problems, in which the mind and the body were fundamentally at odds.

This neurological view of mismatch aversion has had profound repercussions for our understanding of several other types of body dysphorias. Among these is the feeling that a person’s gender identity differs from their body gender, which is gender dysphoria. Quite literally, the person is born with a mind, a soul, whose gender fails to match that of the body in which it finds itself:

During fetal development, different aspects of sexuality are set in motion in parallel: sexual morphology (external anatomy), sexual identity (what you see yourself as), sexual orientation (what sex you are attracted to), and sexual body image (your brain’s internal representation of your body parts). [These typically] harmonize during physical and social development… but they can become uncoupled, leading to deviations that shift the individual toward one or the other end of the spectrum of normal distribution. (Ramachandran)

 

It’s important to understand that this isn’t a binary situation. Sex and gender exist as a broad spectrum of manifestations, both in the body and the soul. (I am using the term “soul” here to refer to a person’s conscious experience, the sentient mind, because at the end of the day that is what souls are.) Yes, there is a bell-curve to it, and some physical and mental manifestations of sex and gender are much more common than others. But the point is, the experience of “being” a person of a certain gender  —  wherever on the spectrum that may fall  —  while having the body of a different sort of gender is rooted in biological reality.

So it is simply not correct to say that a person who is trans-male was born “biologically female” or that a person who is trans-female was born “biologically male”. Our brains and our genitalia are all part of our biology. What is correct is that they were born transgender.

It’s not possible to fully imagine what being a transgender person actually feels like if you are not one, just as it’s not possible to fully imagine what it’s like being any different gender. But imagining how you might feel should at least open the door to compassion and understanding for folks who are going through something which you haven’t, and are dealing with it and living their lives the best way they see to do so, according to their choices.

But where we, as a society, have the most trouble figuring out how to approach the reality of transgendered people is in dealing with children who experience mismatch aversion involving their sexual identities. On the one hand, our laws generally hold that prepubescent children cannot understand sexual maturity and therefore cannot be in a position to reasonably consent to anything having to do with it. Therefore, some people reason, it is a form of child abuse to begin any sort of gender transition in young kids who express their experience of feeling that they “are” a different sex than their genitalia would indicate. What if it’s just a phase? Or rebellion? What if they don’t understand the profound consequences of the process, that it’s not the same thing as playing dress-up?

On the other hand, we would do well to consider the very real terror of a gender-mismatched child with a boy’s body map, but a little girl’s body, facing the prospect of developing breasts and a uterus capable of bearing children. Or a gender-mismatched child with a girl’s body map, but a little boy’s body, anticipating the inevitable development of an enlarged penis and testicles, a deep voice, and a beard. If you are cis-gendered, imagine being told at that age that your own body was soon to grow into the adult form of the opposite gender, and knowing that the metamorphosis drew nearer with each passing day.

As long as outdated notions persist of gender mismatch as a social or psychological problem, rather than an innate issue of biology and neurology, of genuine and innate identity, we are passively dooming these kids to what is now at least a partially avoidable fate. And we are dooming ourselves to using inappropriate instruments to assess the situation and determine the best course of action in each individual case. This does not mean that we start prescribing hormone therapy to every tomboy who says “I hate being a girl” or to any little boy who says he’d rather join the Brownies than the Cub Scouts. It does mean that when children start indicating that they identify as a gender other than the one on their birth certificate, they are assured that they are not crazy, and we begin exploring the possibility that gender mismatch might be the issue.

And as cis-gendered adults, by understanding that gender mismatch is biologically real, we can start treating folks who gender-identify in different ways from ourselves with the respect and dignity they deserve as fellow humans. We can stop demeaning others and insisting that they’re seeking attention or in need of counseling to set them right. We can stop assuming that our own body-mind alignment is “correct” rather than merely common. And stop labeling a neurological configuration as a “sickness” or “perversion”.

The truth, it is said, shall set you free. And God knows we can all use a little more freedom from alienation and bigotry right about now.

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Header image courtesy of OpenClipart-Vectors