Gender Reassignment


The Science of Gender is complicated. We are all assigned a Gender at conception. Humans have 23 pairs of chromosomes made of the double helixes of DNA strands, 46 chromosomes altogether. They, in turn, harbor some 20,500 genes identified by the Human Genome Project. Males have the XY and females have the XX configuration. Every one of our cells has either one or the other configuration. To speak of Gender Reassignment is a bit disingenuous, for to truly change our Gender, every cell needs to be changed to one or the other configuration. That would be 32.7 trillion cells that would have to change their Gender, an impossible task. To cut off the penis and make a vagina and give that person some hormones to grow breasts and a few other hormonal manipulations, for example, the suppression of facial hair growth or drugs that prevent secondary sexual development of puberty does not make that individual a female and is a feeble attempt to mimic nature. Surgical manipulation to imitate one or the other sex is not all that different than cross-dressing which is a feeble attempt to assume the attributes of the opposite sex. Boys that put on a dress are still boys and girls that wear pants are still girls. The cells continue to be either XY or XX. XY muscles will remain stronger than XX muscles regardless of hormonal influences. Just because a Transgender person has external genitalia that resembles a male or female does not mean that the muscles or neural tissues act accordingly. That is why the athletic competition allowing XY genotype individuals to compete in female athletics is ridiculous from a scientific viewpoint. You might as well paint pink XX letters on a boy’s forehead and let him be on the girl’s volleyball team. Not only is that farcical but it is very unfair. Girls will work their whole life toward achieving certain athletic goals that, given the same level of training, can be surpassed because having different cells that have the XY chromosomes will and have outdone the XX cells in strength, speed, and endurance. School Boards, educators, and politicians who make public policy that endorses and supports transgender athletic competition are challenged, not only in scientific understanding but also in the ethics of fair competition.
     Gender change operations are more or less permanent and cannot be reversed all that easily. For that reason, I believe the individual who undergoes such dramatic treatment needs to be evaluated very carefully and by multiple fields, including psychological, emotional, maturational, intellectual, and secondarily, anatomical/ surgical aspects. I also think a significant waiting period should be mandatory, as people do change their minds. There needs to be a whole set of rules and regulations with legal input and oversight to protect the individual who wishes to undergo this transformation, as well as protect society as a whole. This would include athletics, laws involving privacy such as bathroom access, civil rights of men, women, and children, and age discrimination mores and practices. The treatment of minors in this controversy is another issue. Vanderbilt University has just put a hold on all gender reassignment operations for individuals under 18 years of age.
     There are numerous conditions, some due to chromosomal changes and some due to hormonal aberrations, that can cause ambiguous genitalia or phenotypically normal external genitalia but of the opposite sex of the individual’s genotypical sex. For example, a normal appearing female may in fact be a genetic male of XY configuration. This is due to the insensitivity to testosterone and is called Testicular Feminization Syndrome. In my business as a surgeon, I am aware of some very famous “women” in the entertainment business that have achieved great success in part by their physical appearance but are males genetically. HIPPA laws prevent me from naming names, as they should. But these individuals are unable to procreate and do not have the internal organs to carry a baby. The testes that have not descended are at high risk of becoming cancerous and must be removed. Some hormonal conditions, such as Congenital Adrenal Hyperplasia, will cause a genetic female to look more like a male, and this can also occur with tumors of the adrenal gland. The goal of treatment for these individuals should be, first of all, to cure any life-threatening condition, but secondarily to create a functioning human being that is happy with their appearance, and if possible one that can enjoy a normal life with normal functional sex organs that may even give them normal fertility in certain circumstances. Many chromosomal X or Y anomalies do not have serious brain dysfunction but some are devastating, such as Fragile X Syndrome. Here too, there must be the participation of multiple specialties to choose the right path in terms of selecting a sex for that individual and the correct upbringing, education, and psychological development. This too relates to gender assignment and must have some of the same legal, medical, and surgical inputs to reach the best outcome for that individual.
     Gender reassignment is a new trend in human thinking and behavior. This has not been possible in the past because we did not have the technology to achieve this, nor is it anywhere near perfect at this point. Because it is new, with little experience in judging eventual outcomes, we need to be very careful and proceed with great caution. Vanderbilt University did the right thing.