People used to talk about being “a woman trapped in a man’s body”. This sort of talk has been replaced more recently by the language of “gender identity”. In essence, the idea is that there is an inner, female self that is clothed in a masculine body. Treatment to feminise the body provides relief from gender dysphoria by aligning the corporeal structure that encloses the self with its internal sense of identity.
This is a controversial subject. I have spent a great deal of time reflecting on these issues. While I cannot claim close familiarity with the primary scientific literature, I have done some reading and my scientific training compels me to draw certain conclusions.
One reason that this subject provokes such heat and emotion is that it seems to many trans people to bear on the legitimacy of their status. The trans community is becoming a popular cause, particularly among younger people, but for most of us – especially those of us now in our middle years – we have become accustomed to being regarded as at best oddities and at worst, lunatics and perverts. It is not surprising that many find comfort in the idea that there may be a biological basis for the way they are: if my biology made me this way, then I can’t be either a pervert or a lunatic. Although the official position of the major professional organisations for psychiatrists in Europe and the US is no longer to define gender dysphoria as a disorder, some leading psychiatrists have perspectives in the condition that are controversial (for example, Ray Blanchard, who played a leading role in preparing the sections on gender dysphoria in the psychiatrist’s manual, the DSM). The continued assertion of a biological origin for gender dysphoria is a reaction against what is still perceived to be negative and judgemental thinking.
One of the oft-made arguments is that biological sex develops differently from gender in the foetus. An infant may become biologically male but as gender develops later, hormonal imbalances lead to the development of a female identity. Perhaps the best evidence in support of such an hypothesis is the documented correlation between raised incidences of gender dysphoria and the use of certain drugs (particularly, diethylstilbestrol) to treat morning sickness during pregnancy. The medicines concerned are hormonal, and were prescribed in the 1960s but are now banned because of the good evidence that they interfere with foetal development.
However, there is no evidence that this effect is widespread, or that it is caused by a mechanism that is more generally operative during development. It is a rather large leap to base general claims about the origin of gender dysphoria on this particular evidence.
There is a substantial literature dealing with the relationship between the brain and gender, but evidence for gender differences in brain structure and function appears to be at best controversial. Transgender activists often assert that such evidence exists, but my impression is that such claims are based on a selective reading of the literature. For example, studies have been done of male, female and transgender brains using magnetic resonance imagine (MRI). Claims have been made in some studies that there are differences between the physiology of male and female brains, and that transgender brains tend to match the characteristics of the assumed identity better than the biological identity at birth. As I noted above, I am not an expert working in this field. However, my understanding of the literature is that it is far from unequivocal. Comprehensive reviews of the literature suggest that there is not overwhelming (or even strong) evidence that male and female brains are different.
As a professional scientist who has been enthusiastic in supporting the advancement of women in science, I find the notion that there are innate differences between men’s and women’s brains very troubling. It seems to play to the prejudices of those who have stood in the way of women entering the sciences and other spheres traditionally dominated by men. All of my professional experience tells me that women and men possess potentialities that are so close that they are indistinguishable.
I do not believe that the self can be separated from its body. The mind-body problem is one of the oldest in philosophy. If one believes in a soul that exists independently of the body, perhaps it is easier to believe that the “inner self” can have a gender identity that exists objectively and independently of its body. But modern science tells us this is not the case, as do, indeed, many religions – Christians believe in a corporeal resurrection and in Christian theology the idea that a soul can exist independent of a body is arguably questionable.
Our understanding of the endocrine (hormonal) system provides clues to the way that corporeal biology influences brain function: other things being equal, men and women have different hormonal balances and we know that hormones exert a powerful influence on behaviour. It seems far more likely that any gender differences in behaviour result from the interaction between the self and its body, rather than from an innate difference in the internal function of the brain.
The most dogmatic that I’d like to be is to say that my brain believes itself to be feminine in some way. It doesn’t matter to me whether this feeling is physiological or psychological in origin; it is something that has been with me for as long as I can remember. Indeed, there is a risk that if we obsess about finding evidence for a biological basis for gender dysphoria, and such evidence fails to materialise, we may end up doing more harm than good, because to seek legitimacy in biology is in some ways to undermine the legitimacy of other explanations.
I know that I have a male body. I am biologically male. But my mind has, since its earliest days, felt it was nevertheless in some way feminine and I have for as long as I can remember wished I was born into a female body. It does not bother me whether this is called my “gender identity” or a “psychological disorder”. It does not matter to me whether my mind is objectively female or not. This feeling – whether physiological or psychological in origin – is innate; it doesn’t spring from a decision to embrace a particular lifestyle, and indeed, the sense that I ought to have been female manifested itself first when I was too young to have made such a choice consciously or to be aware of being different from other boys. I tried for several decades to cure myself. I suffered agonies. Fortunately, modern psychiatry now assures me that I have nothing to be cured of. It may all be in my mind, but it is no less real, or objective, or necessary to who I am than the colour of my eyes.