Has Helmer got a point?

Did you read this in the Daily Mail (yes, I know) today?

Roger HelmerHelmer says the NHS should be allowed to spend money on helping homosexuals become straight. He says it is no different to NHS sex-change operations and, bizarrely, compares it to homeopathy.

‘One person is unhappy with their physical sex and wants to change it and we say, “OK you can do it.”

‘You have a homosexual who says, “I’m homosexual, actually I’d rather be straight, is there a way of fixing it?” We say to the person who wants to change from a man to a woman or vice versa, “Please do that on the NHS.” We say to this guy, “That’s wicked, you’re not allowed to think about it.” ’

‘I don’t know if homeopathy works or not, but I will defend the right of anyone who believes it works to try it.’ He insists he is ‘taking a libertarian view’.

I’ve heard this argument made before and I think it’s quite interesting. Person A is male and wants to be female. For the moment let’s disregard why they want to be female. We seem to think that’s OK and we spend NHS money on helping them achieve their aim. Person B is homosexual and wants to be heterosexual. For the moment let’s disregard why they want to be heterosexual. Suddenly we are all up in arms and calling it an outrage.

You can see the surface appeal of the argument. And the vast majority of those who would say that what Person B wants to do is outrageous could not cite you one bit of scientific evidence to support their contention that Person A’s corrective desire is in any way superior to Person B’s.

But as you know, on this blog we like to be a bit more thorough.

Do we have any biological basis for supposing that Person A’s transgender desire is a valid choice? Well yes. There are a number of studies that have explored whether MTF (male to female) and FTM (female to male) brains are different from those who are “cisgender“. Some have been rightly criticised for assessing transgender patients once they have begun to take hormone replacements (for example this post-mortem study) but others have shown on pre-hormonal patients that interesting differences are present.

So on the medical ground we have a cause to contemplate transition, and on the mental health ground we also do as plenty of pre-transition transgender people report significant distress. Of course transiting might not be the only method of relieving this distress. Some of those with Gender Identity Disorder manage to dissipate this neurosis through therapyu and some of the leading researchers in the field held to a primarily psychological model of transgender formation though increasingly the evidence does point to a biological component.

Does transition work? Well we know that those post-transition do not have the same mental health profile as the average population. Transition does not provide a magic panacea to the issues around gender dysphoria and indeed for many more people than you might think it ends up being something they deeply regret.

One more thought. There is some very interesting twin study analysis that has been done on transgender people, which points us to the same kind of curious “nature / nurture” mix that we see in the twin studies on homosexuality.

Gomez-Gil et al. (2010) in their sample of 995 consecutive transsexual probands (677 male-to-female and 318 female-to-male) report 12 pairs of transsexual nontwin siblings (nine pairs of MtF siblings, two pairs of MtF and FtM siblings, and one pair of FtM siblings). These investigators claim that their data indicate that the probability that a sibling of a transsexual will also be transsexual was 4.48 times higher for siblings of MtFs than for siblings of FtM transsexual probands, and 3.88 times higher for the brothers than for the sisters of transsexual probands. Moreover, the prevalence of transsexualism in siblings of transsexuals (1/211 siblings) was much higher than the range expected according to the prevalence data of transsexualism in Spain (the country of their study). Their study strongly suggests that siblings of transsexuals have a higher chance of being transsexual than the general population and that the potential is higher for brothers than for sisters of transsexuals, and for siblings of MtF than for FtM transsexuals. An excellent review paper by Veale, Clarke, and Lomax (2009) offers a host of references of papers dealing with transsexual familiarity and, while concentrating on the role of genetics and prenatal hormones, also touches on the actual and possible aspects of the rearing environment. They conclude there appears to be a significant role for biology in transsexualism but conservatively caution that attention is given to rearing practices.

So let’s summarise all of the above – transgender issues seem to have some basis in biology but there is no evidence saying that is a key determinative factor and some experts want to suggest that nurture issues may also be involved. For those who do seek to transit we know that it isn’t really a “100%” success rate – genes in the transiting person remain the same and biologically hormone therapy may help to establish a new gender identity, but cut a little deeper and the person is just the same (i.e. the autopsy of a FTM transgender will reveal ovaries – unless they have been surgically removed and surprisingly a lot of FTM transgender people do not). Ultimately transgender transition is about providing a therapeutic and if necessary surgical framework within which the person who chooses to transit can live a life in coherence with his/her aspirations for personal fulfilment. There is never a medical necessity to transit, neither is there a clear biological indication that such a request for transit will be likely and there is no definitive gene or biological marker which predicts transgenderism. When the transition is made, for some people it will end up being a cause of distress and for others it will be a source of greater personal wellbeing.

Right, and now for sexual orientation change efforts (SOCE).

Many people who self-identify as homosexual / gay are dissatisfied with that and wish to transit to some form of heterosexual functioning. We know that there is a great degree of natural fluidity of sexuality to begin with (and as Lisa Diamond so clearly demonstrates in the link, the notion that these people are all “bisexual” is a scientific nonsense) and so the idea that some people might want to give that natural fluidity a helping hand is not an absurd one.  Of course, as Jones and Yarhouse point out from a longitudinal study, not all participants in SOCE actually see a significant shift in sexual orientation (and this can be seen as a comparison to the way that despite how a MTF transgender person has corrective surgery, their sex chromosomes remain XY). What we do find though (as Jones and Yarhouse did) is that through therapy and self-awareness and decisioning, many men and women establish a new sexual identity away from homosexuality which many of them manage to maintain (even into sexually and emotionally functioning heterosexuality) even with (for some) strong remaining homosexual attractions. Yes, some “ex-gays” do revert to a “gay identity” (my apologies – I couldn’t think of a better expression), but others do not. Others report harm from their SOCE (though as the RPA recognised this week there are no statistically robust measures of this harm and what Jones and Yarhouse looked at this as part of their controlled study using far better measures than Shidlo and Shroeder they found no evidence of harm) but this is exactly the same as post-op transgenders who also report anecdotal harm and distress from transiting.

Right then. Deep breath.

Where does this leave us? We have some people who exhibit distress at the incongruence of their desired gender and their sex (a condition that is still not fully understood but which seems to be a complicated mix of nature and nurture) who find that the way to resolve the distress is to engage in medicinal and surgical intervention, an intervention which doesn’t actually technically change their sex at all but simply provides them with the framework to live their lives in a much more emotionally healthy and belief congruent manner. A portion of these people then go on to label this transition as harmful. This transition is apparently a good thing.

We then have some other people who exhibit distress at the incongruence of their desired sexual behaviour and their sexual orientation and attractions  (a condition that is still not fully understood but which seems to be a complicated mix of nature and nurture) who find that the way to resolve the distress is to engage in therapeutic intervention, an intervention which might not substantially change their sexual orientation at all but provides them with a sexual identity framework within which to live their lives in a much more emotionally healthy and belief congruent manner. A portion of these people then go on to label this transition as harmful. This transition is apparently a bad thing.

Methinks Helmer may have a point.

Before I finish, may I remind readers that I have a cautiously open and positive position towards transgender issues so I am not “having a go” here at transgender motives. Rather, what I’m trying to do is apply the same kind of reasoning to the two issues.

What do we all think?