Atypical Gender development - gender dysphoria

Question 1

Zach Avery

Answer 1

Zach Avery has insisted on wearing girls’ clothes since the age of three. She is now five and was assessed as having Gender Dysphoria (GD) after worried parents Theresa 32, and Darren, 41, sought medical help.
Mrs Avery explained her child was a boy who liked Thomas the Tank Engine but became obsessed with Dora the Explorer, a television programme aimed at young girls.
She said: ‘She just turned round to me one day when she was three and said, “Mummy I’m a girl”. I assumed she was just going through a phase and left it at that. ‘But then it got serious and she would be upset if anyone referred to her as a boy. She used to cry and try to cut her willy off out of frustration.’
Initially, Zach’s parents believed she was autistic but, after several months, a child psychologist diagnosed her with GD when she was four.
Zach now attends her local primary school where the toilets have been turned gender neutral to support her.

Question 2

Gender Dysphoria

Answer 2

a condition where an individual’s gender identity does not match their biological sex.
e.g. where a person who biologically is male, with male genitalia, feels they are female, or a person vice versa.

Question 3

Gender Dysphoria affects males more than females.

Answer 3

It is estimated that up to 1 in 5000 people may have the condition

Question 4

What are the signs that an individual has Gender Dysphoria?

Answer 4

Children unhappy wearing clothes of their gender assigned at birth;

Children unhappy playing gender-stereotypical games

During adolescence, they may find the development of their body distressing as it is a physical sign of their ‘wrong sex.’

Question 5

How is Gender Dysphoria treated?

Answer 5

Treatment is specific to the individual, but tends to include psychological and medical interventions to reduce/remove the distress caused by the individual’s biological sex.
Medical interventions: masculinising or feminising hormones can be taken to alter physical features, with the ultimate remedy being gender reassignment surgery.

Question 6

How has the DSM-V changed the way they classify Gender Dysphoria?

Answer 6

Within the DSM-IV, an individual with this condition was classified under the clinical label of Gender Identity Disorder (GID), with gender dysphoria referring specifically to the personal experience of this discomfort.
The more recent DSM-5 classification system now refers to GID as Gender Dysphoria in order to remove the damaging label of people with the condition as ‘disordered.’
The APA have said that no gender identity can be ‘disordered’ so it would be wrong to label them as such.

Question 7

According to the DSM-V, what are some of the symptoms that must be present in order for a diagnosis to be made?

Answer 7

A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics.
A strong desire to be rid of one’s primary and/or secondary sex characteristics.
A strong desire for the primary and/or secondary sex characteristics of the other gender.
A strong desire to be of the other gender.
A strong desire to be treated as the other gender.
A strong conviction that one has the typical feelings and reactions of the other gender.

Question 8

In this topic, we will explore the biological and social explanations of gender dysphoria:

Answer 8

Biological Explanations:
- Genetic
- Biochemical
- Brain-sex theory

Social Explanations:
- Learning theory
- Social learning theory
- Mother-son relationships

Question 9

Biological Explanations for Gender Dysphoria:The Genetic Explanation

Answer 9

The genetic explanation sees the condition as an inherited abnormality.
Attention has centred on gene variants of the androgen receptor, which influences the action of testosterone and is involved in the masculinisation of the brain.

Question 10

Hare et al. (2009)

Answer 10

looked at the DNA of 112 MtF transgender participants and found they were more likely to have a longer version of the androgen receptor gene compared to non-transgender individuals.
The effect of this abnormality is reduced action of testosterone, and this may under-masculinise the brain in the womb.

However, this genetic explanation lacks explanatory power as it cannot explain why some people who are genetically female identify as male (FtM).

Question 11

The biochemical explanation sees a role for hormonal imbalances during foetal growth in the womb and in later child development.

Answer 11

(N.B. It may be that the genetic and biochemical explanations combine, with hormonal imbalances being genetically influenced).
Significant amounts of male hormones are secreted from the testes during the third month of pregnancy and again between 2-12 weeks after birth.
Such male hormonal surges must occur at the right time and in sufficient amounts for masculinisation of an infant to develop.
A lack of testosterone in an individual who is genetically male could result in a less masculinised brain (i.e. smaller SDN) and a female identity.

Question 12

Gladue (1985)

Answer 12

reported that there were few, if any, hormonal differences between gender-dysphoric men, heterosexual men and homosexual men, as evidence against the influence of hormones on gender dysphoria.
A social explanation may therefore be more fitting.

Question 13

Challenging research evidence for the biological explanations of Gender Dysphoria

Answer 13

There is research to suggest that most gender dysphoria occurs in childhood and for the majority of such children it does not persist after puberty.
However, those for whom it does persist tend to have stronger gender dysphoric symptoms in childhood.

Question 14

Zucker et al. (2008)

Answer 14

performed a longitudinal study on 25 gender-dysphoric females between 2-3 years of age. Only 12% (3) were still gender dysphoric at age 18.
Furthermore, a study on equivalent males found that only 20% were still gender dysphoric as adults, thus supporting the idea that the majority of people exhibiting gender dysphoria do so only in the short term.
This challenges the biological explanation which would otherwise state that gender dysphoria persists over the course of one’s life span.

Question 15

Biological Explanations for Gender Dysphoria:
The Brain-Sex Theory

Answer 15

The theory is based on the fact that male and female brains are different and transgender brains do not match their genetic sex.
The BSTc (bed nucleus of the stria terminalis) in the thalamus (located in the brain) has been implicated.
Generally speaking, the BSTc is twice as large in a heterosexual male brain compared to a heterosexual female brain, containing twice the number of neurons.
It may be the case that an individual with gender dysphoria has the BSTc that corresponds to their gender rather than their sex.

Question 16

Zhou et al. (1995) and Kruijver et al. (2000)

Answer 16

both found that the number of neurons in the BSTc/volume of the BSTc of MtF transgender participants was similar to that found in a female brain, and the BSTc of FtM transgender individuals was more similar to that of a male brain.

Question 17

Rametti et al. (2011)

Answer 17

studied the brains of FtM transgender participants before they started transgender hormone therapy. They found that the white matter was more similar to that found in males i.e. those who shared their gender identity rather than their biological sex.

Question 18

Transgender hormone therapy DOES cause changes to the size of the BSTc

Answer 18

Hulshoff Pol et al. (2006) found that transgender hormone therapy does influence the size of the BSTc.
This suggests that hormones can have an effect on the BSTc – even after it is supposedly fully developed at five years old.
This suggests that BSTc volumes/ neuron numbers found in post-mortem research were affected by hormonal therapy and not prenatal development as suggested.

Question 19

Changes in BSTc occur after feelings of gender dysphoria – the changes might therefore be a consequence of the condition

Answer 19

Chung et al. (2002) challenged the time at which the BSTc appears, claiming that the differences in volume and number of neurons does not develop until adulthood.
Chung argues that pre-natal hormones might remain dormant until adulthood and then trigger the change in the BSTc.
This therefore cannot explain why there are cases of children who are aware of their gender dysphoria at an early age e.g. Zach Avery.

Question 20

Operant Conditioning

Answer 20

could explain gender dysphoria - individuals may be reinforced (rewarded) for exhibiting cross-gender behaviour e.g. infant boys wearing frocks and jewellery, or girls playing with lego bionicles. The assumption is that parents have reinforced the condition by encouraging and complimenting their children for such behaviour.

Question 21

Social Learning Theory

Answer 21

suggests that gender dysphoria may be learned by observation and imitation of individuals modelling cross-gender behaviour.

Question 22

Rekers (1995):

Answer 22

reported that in 70 gender-dysphoric boys, there was more evidence of social than biological factors. In particular, there was a common factor of a lack of stereotypically male models, suggesting that social learning factors play a role in the condition.

Question 23

Bennet (2006)

Answer 23

Points out that while SLT explains the development of cross-gender behaviours, it cannot explain the strength of beliefs that individuals possess concerning being the wrong gender, or the resistance of such beliefs to therapy.
This indicates that the biological explanation is more likely because the social explanations are limited to explaining only superficial behaviours.

Question 24

Childhood Trauma/Upbringing

Answer 24

Researchers have suggested that gender dysphoria is linked to mental illness, which may be a result of childhood trauma or a difficult upbringing.

Question 25

Coates et al. (1991)

Answer 25

conducted a case study of a boy with gender dysphoria and concluded that this occurred as a result of his mother’s depression following an abortion. They argued that this caused the boy significant trauma when he was aged 3 and that this led to a cross-gender fantasy as a way of resolving the anxiety he experienced.

Question 26

HOWEVER Cole et al. (1997)

Answer 26

studied 435 individuals experiencing gender dysphoria and reported that there was no greater range of psychiatric conditions in families of such individuals compared to non-dysphoric populations.
Therefore gender dysphoria seems to be unrelated to childhood trauma or pathological families.

Question 27

Father-Daughter Relationships

Answer 27

Zucker (2004) – suggested that in FtM transgenders, females identify as males because of severe paternal rejection in early childhood. Unconsciously, they think that, if they become males, they might gain acceptance from their father.

Question 28

Mother-Son Relationships

Answer 28

Stoller (1975) – conducted clinical interviews with individuals diagnosed with gender dysphoria and found them to have overly close mother-son relationships, which they thought had led to greater female identification and a confused gender identity.

Question 29

Further research - Zucker et al (1996

Answer 29

studied 115 boys with concerns about their gender identity and their mothers. Of the boys who were eventually diagnosed with gender dysphoria, 64% were also diagnosed with separation anxiety disorder, compared to only 38% of the boys whose symptoms were subclinical.

This suggests some kind of disordered attachment to a mother as a factor in gender dysphoria, but it does only explain MtF transgender individuals.

Question 30

Sieber and Stanley (1988) define socially sensitive research as

Answer 30

studies in which there are potential consequences or implications, either directly for the participants in the research or for the class of individuals represented by the research’.

Question 31

Research on gender dysphoria has potential social consequences for the individuals represented by the research i.e. those with gender dysphoria

Answer 31

If a biological cause is identified, then this may help other people to be more accepting about the needs of transgenders i.e. ‘it is not a choice, it is in their biology.’
However, if a biological cause is identified, then how might this harm individuals with the condition?

Question 32

It might be assumed (wrongly) that gender dysphoria is inevitable.

Answer 32

Research that suggests a genetic basis to GD might lead to genetic screening of the population to identify this genetic susceptibility. Alternatively, research that suggests that children diagnosed with GD ‘grow out’ of the condition when they reach adulthood (Zucker et al, 2008) could have implications in terms of treatment.