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Review: Gender Identity Based in Biology, Not the Mind

by Kait Scalisi | Feb 27, 2015 | News, Sex Stories

By Kait Scalisi, MPH

For decades, transgender individuals have been referred to psychiatric treatment, told it’s all in their heads or it is something they can change. Behind the scenes, however, researchers have been looking for biological underpinnings of gender identity. Now a new study from Boston University has reviewed the existing data and reached one conclusion: there is a strong support for the biological nature of gender identity.

Before discussing the review itself, it is important to make a few notes. First, the available data on the biologic basis of gender identity is neither broad nor deep. It is limited in rigor, sample size, etc. Nevertheless, it is what we have right now and this review provides an important starting point and call to action to further examine the mechanisms of gender identity. It is the first step in educating healthcare providers to not simply refer transgender patients to psychiatry but rather to treat them medically (e.g. hormones, gender affirming surgery, etc).

Secondly, you may be wondering why it matters if we know why someone is transgender and why we can’t just accept people for who they are. This is a valid point, and certainly the hopes of transgender individuals and their allies, but it is also the ideal. Healthcare providers and public health professionals rely on data to inform their work. In addition, transphobic arguments often center around non-binary gender identities as being a choice. Having such data is the first step in ensuring transgender individuals have access to appropriate, informed, and compassionate healthcare.

Now that those potentially contentious points are out of the way, let’s look at the research.

The study looked at studies and examined different potential biologic bases for gender identity issues. These included:

Disorders of sexual development, such as penile agenesis
Neuroanatomical differences, such as in the amount of grey and white matter
Steroid hormone genetics, such as genes associated with sex hormone receptors.

From these three areas the researchers reached three major conclusions:

Abnormal hormone exposure may result in someone being transgender. This is not expected to be the norm as the bulk of transgender individuals have normal sexual differentiation.
There are transgender-specific neuroanatomical differences. Specifically, the sexual differentiation of the brain in transgender individuals differs from that of their physical body. So transmasculine individuals have brain structures that look similar to those of cis-gender men.
Genetic factors including abnormalities associated with steroid hormones, twin case studies, neuroproteins, and prenatal exposures may also lead to a transgender identity.

How does this review help? Physicians continue to be wary of treating transgender patients with surgery and hormones. This is likely due to a combination of personal biases, misunderstanding about trans identities, and a lack of research showing the need for such approaches. The researchers are transparent in sharing that the goal of the subject was to better establish this biological basis so they could then/with the hopes that physicians will then treat patients medically instead of just referring them to therapy. The study also hopes to solves step one—determining whether gender identity is biologic—so researchers can shift their focus to the underlying mechanisms of this biology while healthcare providers focus on how to best address the needs of transgender individuals.

The evidence presented in the article also fights against the idea that gender identity can be changed via psychotherapy/psych treatment. This places the burden of treatment on the medical/healthcare providers. As the study’s PI says:

“If you realize that gender identity, to a large extent, is a biologic phenomenon, then you aren’t going to say, ‘Oh you should just deal with it’ […] You’re going to want to know what is the most logical intervention based on success.”

The authors note that future research should focus on the best interventions and treatment approaches for transgender patients as well s more overall research on the exact biological mechanism by which gender identity and gender identity issues are determined.

Other Sexual Health News This Week

San Francisco cannot reverse STD rate increase (The Bay Area Reporter); meanwhile, a free condom-by-mail program is set to start in San Bernardino County. (The San Bernardino Sun)

NIH-Supported Trials to Evaluate Long-Acting Injectable Anti-Retrovirals to Prevent HIV (Science News Wire)

Proposed Bill: Couples Must Prove They Don’t Have STD’s Before Marriage In OK (News on 6)

Effect of Body Weight and BMI on the Efficacy of Levonorgestrel Emergency Contraception (Contraception)

Why You’re Still Paying for Birth Control Even Though It’s “Free” Now (Money.com)

Week-On, Weekend-Off Treatment Controls Viral Load in Young People (AIDS Map)

Drug Maker Resubmits Application for Women’s Sex Drive Pill to FDA (United Press International)

About 50 Clergy in Nebraska Pledge to Perform Same-Sex Marriages if Ban Overturned (Omaha.com)

Conference Proposals Due

The following conference proposals are due in March. Click on each name for more information.

2015 National Summit on HCV and HIV Diagnosis, Prevention and Access to Care, March 9.

NYSCHA/NECHA 2015 Combined Annual Meeting, March 10.

The Society for the Scientific Study of Sexuality, March 15.

California Family Health Council’s Women’s Health Update, March 23.

Upcoming Conferences

The following conferences take place in March. Click on each name fore more information and to registers.

Southern College Health Association Conference, March 4-7.

Association of Schools & Programs of Public Health, March 22-25.

Central College Health Association Annual Meeting, March 23-25.

Nuestras Voces (our voices) National Bilingual Sexual Assault Conference, March 26-27.

Catalyst Con East, March 27-29/

In Pap We (Still) Trust

by Kait Scalisi | Feb 14, 2015 | News, Sex Stories

By Kait Scalisi, MPH

A recent national survey shows distrust of new cervical cancer screening recommendations as well as a lack of knowledge and understanding among women about HPV, cervical cancer, and more.

Cervical Cancer Today: A National Survey of Attitudes and Behaviors, a collaboration between the National Association of Nurse Practitioners in Women’s Health (NPWH) and HealthyWomen (HW) surveyed over 2,000 women and nearly 1,000 healthcare providers to gain a better understanding of women and HCPS’s attitudes and decisions in the exam room. The major finding: we’re all resistant to change.

For example, the Pap test, long viewed as the gold standard of cervical cancer detection, although recently replaced/addenedumed by the HPV test, is highly trusted by both healthcare providers and women/patients. The newer HPV test, only recently approved as a first-line screening/primary screening tool, however, is not a preferred method.

Other major themes included:

Both women and healthcare providers like routine and time-tested screening. More likely this finding represents fear of the unknown rather than a love for the Pap test itself.
Women lack basic knowledge about their sexual and reproductive health, including how HPV actually works.
Race matters.

It is well established that many racial minorities have a distrust of the health care system due to systematic oppression and being taken advantage of (Henrietta Lacks may be the most well-known example, but certainly isn’t the exception or the only one). When it comes to their cancer screenings, African American and Hispanic women were even more concerned with cutting back on the number of tests or lengthening the time between tests, regardless of the type of test.

The survey also speaks to larger issues: policy changes being made without appropriate health promotion campaigns. Women reported being distrustful of lengthening the time between tests, a sentiment that the healthcare providers reported expecting. Public health professionals know that switching from annual Paps to once every three years is cost-effective and does not have much of an impact on incidence. However, when this is not communicated to the public clearly in places where they can ask questions or get more information (e.g. social media, doctor’s offices), it leads to the distrust reported in this survey. The question then is, how can medicine and public health work together to craft policies that are known to be effective, and then share them with the public in an accessible way?

Secondly, the survey’s results speak to the need for more factual and comprehensive sex education at all ages. A considerable percentage of the women surveyed did not know that HPV causes cancer, or that there are treatments for it. A representative from one of the sponsoring organizations notes:

“Healthcare providers need to help women understand the significance – or lack thereof – of an HPV infection[…]Women need comprehensive information about the meaning of both HPV and Pap tests when deciding how to protect themselves from cervical cancer.”

While this sentiment is true, it is also on public health professionals to push for programs and campaigns that meet women where they are, and help get them this information. This includes getting them the information as early as possible.

The issues with our health care system run deep—high burdens on providers, short appointment times, competing interests, etc.—and aren’t likely to change soon. Plus healthcare providers express hesitation in talking about sex and sex-related topics like STIs, HPV, and cervical cancer. The only solution is for public health and medicine to work together to further each other’s interests so that patients have reliable sources of health infomration from sources other than their providers, who simply cannot cover everything in one visit.