From The Executive Summary Source: The New Atlantis, No. 50, Special Report: Sexuality and Gender (Fall 2016), pp. 7-9 Published by: Center for the Study of Technology and Society Stable URL: https://www.jstor.org/stable/43893423
Part Three: Gender Identity
- The hypothesis that gender identity is an innate, fixed property of human beings that is independent of biological sex – that a person might be “a man trapped in a woman’s body” or “a woman trapped in a man’s body” – is not supported by scientific evidence.
- According to a recent estimate, about 0.6% of U.S. adults identify as a gender that does not correspond to their biological sex.
- Studies comparing the brain structures of transgender and non-transgender individuals have demonstrated weak correlations between brain structure and cross-gender identification. These correlations do not provide any evidence for a neurobiological basis for cross-gender identification
- Compared to the general population, adults who have under- gone sex-reassignment surgery continue to have a higher risk of experiencing poor mental health outcomes. One study found that, compared to controls, sex-reassigned individuals were about 5 times more likely to attempt suicide and about 19 times more likely to die by suicide.
- Children are a special case when addressing transgender issues. Only a minority of children who experience cross-gender identification will continue to do so into adolescence or adulthood.
- There is little scientific evidence for the therapeutic value of interventions that delay puberty or modify the secondary sex characteristics of adolescents, although some children may have improved psychological well-being if they are encouraged and supported in their cross-gender identification. There is no evidence that all children who express gender-atypical thoughts or behavior should be encouraged to become transgender
Cecilia Dhejne1, Paul Lichtenstein2, Marcus Boman2, Anna L. V. Johansson2, Niklas La°ngstro¨m2,3, Mikael Lande´n1,2,4*; 1 Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden, 2 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, 3 Centre for Violence Prevention, Karolinska Institutet, Stockholm, Sweden, 4 Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
(Citation: Dhejne C, Lichtenstein P, Boman M, Johansson ALV, La°ngstro¨m N, et al. (2011) Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 6(2): e16885. doi:10.1371/journal.pone.0016885)
Context: The treatment for transsexualism is sex reassignment, including hormonal treatment and surgery aimed at making the person’s body as congruent with the opposite sex as possible. There is a dearth of long term, follow-up studies after sex reassignment.
Objective: To estimate mortality, morbidity, and criminal rate after surgical sex reassignment of transsexual persons.
Design: A population-based matched cohort study.
Setting: Sweden, 1973-2003.
Participants: All 324 sex-reassigned persons (191 male-to-females, 133 female-to-males) in Sweden, 1973–2003. Random population controls (10:1) were matched by birth year and birth sex or reassigned (final) sex, respectively.
Main Outcome Measures: Hazard ratios (HR) with 95% confidence intervals (CI) for mortality and psychiatric morbidity were obtained with Cox regression models, which were adjusted for immigrant status and psychiatric morbidity prior to sex reassignment (adjusted HR [aHR]).
Results: The overall mortality for sex-reassigned persons was higher during follow-up (aHR 2.8; 95% CI 1.8–4.3) than for controls of the same birth sex, particularly death from suicide (aHR 19.1; 95% CI 5.8–62.9). Sex-reassigned persons also had an increased risk for suicide attempts (aHR 4.9; 95% CI 2.9–8.5) and psychiatric inpatient care (aHR 2.8; 95% CI 2.0–3.9). Comparisons with controls matched on reassigned sex yielded similar results. Female-to-males, but not male-to-females, had a higher risk for criminal convictions than their respective birth sex controls.
Conclusions: Persons with transsexualism, after sex reassignment, have considerably higher risks for mortality, suicidal behaviour, and psychiatric morbidity than the general population. Our findings suggest that sex reassignment, although alleviating gender dysphoria, may not suffice as treatment for transsexualism, and should inspire improved psychiatric and somatic care after sex reassignment for this patient group.
This extract from my 2013 historical essay comparing slavery in the U.S. and the Ottoman Empire, included a discussion of the “hideous trade,” eunuch slavery, which involved the gelding of black male, Sub-Saharan African black children:
“A notable exception to the rule of much more limited demand for male black slaves was eunuch slavery, the aptly named hideous trade, dominated by Islamic societies in general, and, during the late 19th century, into the early 20th century, Ottoman Turkey, in particular. For example, Toledano documents that as late as 1903, the Ottoman imperial harem contained from 400 to 500 female slaves, supervised and guarded by 194 black African eunuchs. With regard to Turkish eunuch slavery, The Anthropological Society of London presentation, observed (Vol. 8, 1870-1871, pp. 85-96), “On the Negro Slaves in Turkey.”):
‘Eunuchs form, however, an exception, they being highly thought of; the Sultan of Turkey, the Sultan of Morocco, the Khedive of Egypt, all of them possess a staff composed of several hundreds of eunuchs, who are expected to fulfill the duties of guardian angels of the harem. The grandees of those different courts also employ these wretched beings with just as much ostentation as a European aristocrat prides himself on his chasseur’s feather cap. In the east, besides, the eunuchs are considered indispensable mediums between the harem and the outer world. The barbarous operation to which are submitted these unhappy creatures does not take place at Cairo or Constantinople: the negro lads of fifteen or sixteen are mutilated while stopping at the entrepôts, at Gondokoro, Khartum, etc. It seems that only one out of three survives the operation.’
A 1908 study by French physician, Richard Millant Les eunuques à travers les âges (“Eunuchs through the ages”) included a graphic description of the human gelding procedure by which eunuchs were “manufactured” before reaching Turkey, and the predictably horrific mortality rate of this barbarity, i.e., 90 percent, which exceeded the Anthropological Society of London estimate of two-thirds.
‘Castrators of Negroes buy them and then sell them, after having mutilated them, on the Turkish market, that is if the victim does not succumb to the operation or to its consequences. As to the methods used, they have remained as primitive as in the past. The child is spread out on the floor or a table, the sexual parts are tied at their base by a rope, and on these parts they operate with one vigorous movement of a razor, the wound is then dressed with some small shot [i.e., lead rifle shot?], with some astringent substances, boiling oil, or some warm honey. Once the bleeding stops, they fix a kind of lead nail two inches long, slightly curved and with a thickened end, in the urethra, until it is completely healed. This metal rod enters the bladder; it is connected by threads of linen tape which encircles the stomach and kidneys, and is kept in place by a piece of cloth attached to the belt in front and rear. The operation, as one can well imagine, is more or less well done, and it can leave ugly scars, or keloid scars [Keloids are the excess growth of scar tissue at the site of a healed skin injury]…Castrators sometimes use an even more barbaric method. Immediately after the removal of organs, they introduce into the urethra rather than a nail, a piece of reed protruding two inches, so that urinary functions are performed without interruption. Then a plaster is applied on the wound, and the patient is buried up to his neck in the warm and dry sand, while the assistants trample the ground around him. This maneuver reduces the mobility of the wounded one completely, [which] is considered an essential element of successful healing. Within a few hours, a high fever does not fail to manifest itself. For three days, the wounded one only imbibes water, before being fed “tonic and healthy liquids.” A week later, on average, he is unearthed. The bleeding is no longer to be feared, and one month after the healing is complete…Out of a hundred operated on, and it is mostly children aged six to twelve, ninety succumb [i.e., do not survive; emphasis added].’”