Atypical gender development
Gender identity disorder (GID) is a condition in which the external sexual characteristics of the body are perceived as opposite to the psychological experience of oneself as either male or female. The personal experience of this discomfort is referred to as gender dysphoria. About 1 in every 5,000 people have the condition, with more males affected than females. Prejudice and negative feelings of anxiety and distress are often experienced, leading to depression, self-harm and even suicide. Most gender dysphoria occurs in childhood, but for the majority it does not persist after puberty. However, those for whom it does persist tend to have stronger gender dysphoric symptoms in childhood. Social explanations see GID as learned through operant conditioning, where individuals are reinforced (rewarded) for exhibiting cross-gender behaviour, with parents encouraging and complimenting their children for such behaviour. Social learning may also play a part, with the disorder being learned by observation and imitation of individuals modelling cross-gender behaviour. Biological explanations are more supported by evidence, with research suggesting a genetic vulnerability to the condition. The biochemical explanation sees a role for hormonal imbalances during foetal growth in the womb and in later childhood development. The two explanations combine, with hormonal imbalances being genetically influenced.
Fig 10.6 Gender identity disorder affects individuals unhappy with their biological sex
Garcia-Falgueras & Swaab (2008) investigated the possibility of GID being a biological condition caused by abnormal hormonal activity during the masculinisation/feminisation of the brain process. The researchers collected and compared post-mortem data from 17 deceased individuals who when alive had undergone gender reassignment surgery with 25 controls who had not undergone such surgery. It was found that the hypothalamic uncinate nucleus brain area was similar in male-to-female gender-reassigned participants to female controls and was similar in the one female-to-male gender-reassigned participant to male controls. The results support the idea of GID having a biological origin, with structural differences in brain areas, such as the hypothalamic uncinate nucleus brain area, possibly occurring due to abnormal hormonal activity during masculinisation and feminisation of the brain.
• Gladue (1985) reported that there were few, if any, hormonal differences between gender-dysphoric, heterosexual and homosexual men. As similar findings are reported for women, it suggests that a social rather than a biological explanation may better explain gender dysphoria.
• Rekers (1995) reported that in 70 gender dysphoric boys there was more evidence of social than biological factors, as there was a common factor of a lack of stereotypical male role models, suggesting that social learning factors play a role in the condition.
• Hare et al. (2009) examined gene samples from male gender dysphorics and non-dysphorics. A correlation was found between gender dysphoria and variants of the androgen receptor gene, implying the gene to be involved in a failure to masculinise the brain during development in the womb, supporting a biological explanation.
Hines (2004) argues that the strong, persistent desire to change sex, and the willingness to undergo surgery and hormone treatment despite formidable obstacles, such as prejudice, bullying and even job loss, point to a biological explanation for atypical gender development.
Most people with GID who are given hormonal therapies to reduce the distress they experience in feeling they are of the opposite gender to their biological sex see their treatment as successful. This supports the idea of a biological basis to the disorder. Green & Fleming (1990) found that treatment of individuals with GID by hormonal therapy was 87 per cent successful in females reporting gender dysphoria and 97 per cent in males.
GID is a sensitive area for research, so researchers investigating the phenomenon must take care not to cause psychological harm to what are often confused and vulnerable individuals.
Although research suggests that the influence of hormones and genetics are the main causes of GID, there is little evidence to suggest a totally biological explanation and other interacting psychological factors are likely to be involved too.
More research is needed to identify what types of psychological factors are required to elicit an influence and the biological processes through which genetic effects may be operating.
As research suggests that GID is mainly a biological condition, with a large role for abnormal hormonal levels, this has allowed the condition to be addressed with hormonal therapies that enable individuals to undergo successful gender reassignment so that their external biological sex matches their internal feelings about their sex.