Science Vs - The Science Of Being Transgender

Episode Date: December 13, 2018

Recently we’ve been hearing a lot about transgender identity. That made us wonder… what makes us the gender that we are? And what should you do if your kid doesn’t fit the mold? To find out, we talked with endocrinologist Dr. Joshua Safer, psychologist Dr. Laura Edwards-Leeper, and psychologist Dr. Colt Keo-Meier. Check out the transcript: http://bit.ly/31k0oNk UPDATE 3/29/19 : An earlier version of this episode misinterpreted a study regarding the question of how many children who visited a gender identity clinic grow up to be trans. The episode has been updated accordingly. We've explained the change in detail in the transcript. UPDATE 1/17/19: An earlier version of this episode implied that all people who are intersex are born with indeterminate genitalia. This is incorrect and the episode has been updated. Selected references:  A paper from the 70s about shock therapy A review of the science behind the trans kids debateBest Practice Standards of Care for Trans PeopleRebecca’s podcast Trans Specific PartnershipThanks to our sponsor, Cole Haan. You can hear more of Wendy and other Gimlet hosts in conversation at ExtraordinariesOnTheMic.com, produced in partnership with Cole Haan. Credits: This episode was produced by Odelia Rubin and Meryl Horn along with Wendy Zukerman and Rose Rimler. Our senior producer is Kaitlyn Sawrey. We’re edited by Blythe Terrell. Editorial assistance by Rebecca Kling. Fact checking by Michelle Harris, Meryl Horn and Rose Rimler. Mix and sound design by Emma Munger. Music by Emma Munger and Bobby Lord.   A huge thanks to all the researchers we got in touch with for this episode - including Dr. Jack Turban, Professor Anne Fausto- Sterling, assistant professor Samantha Busa, Associate Professor Susan Stryker, Dr. Katrina Karkazis, Professor Neill Epperson, Paula Neira, Professor Michelle Forcier, and Professor Joan Roughgarden. And thanks to all the trans folks who shared their stories with us. Thank you! Also thanks to the Zukerman Family and Joseph Lavelle Wilson.  Learn more about your ad choices. Visit podcastchoices.com/adchoices

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New episodes drop every other Thursday, starting February 1st. Hi, I'm Wendy Zuckerman, and you're listening to Science Versus from Gimlet Media. On today's show, being transgender. What makes us the gender that we are? And what should you do if your kid doesn't fit the mould? Something that's been getting a lot of attention recently, the subject of being transgender. Recently, transgender people have been in the spotlight a lot.

There's all these trans characters on TV shows like Transparent and Orange is the New Black. I'm finally who I'm supposed to be. Do you understand? I can't go back. Caitlyn Jenner came out as trans just a few years ago to a flurry of publicity. How do you feel?

Fabulous. Yeah? Meanwhile, more kids are exploring their gender and coming out as trans. One study found that the number of kids seeking medical care for gender issues quadrupled in the last few years. For some, this is an exciting time with more support of transgender folks. But others are nervous about what's going on. They're saying, wait a minute, what's happening here? Why does it seem like there are more trans people around all of a sudden? And could all this focus on trans folks be endangering kids?

We're doing barbaric things by cutting body parts off and then jamming kids with hormone therapy. We're ruining people's lives. This all came to a head a few months ago when it was reported that the Trump administration is considering a new legal definition of gender for the federal government. It's one that basically says there's no such thing as being transgender, and the genitals you're born with pretty much define whether you're a man

or a woman. So what's going on here? Who's got the evidence to back up their claims? To find out, we're going to dive into the following questions. One, what makes us the gender that we are? Two, if a kid says they're transgender, what should you do? And three, if you change your body with hormones and surgery, what are the risks? When it comes to gender, there are lots of opinions, but then there's science. Actually, science has messed up its treatment of transgender people for decades. We'll talk about that too. Science Versus is coming up just after the break. Welcome back.

Today we're talking about the science of being transgender. And we wanted to start with this question of what makes us the gender that we are. Like, why do I think I'm a woman? And to find out, we headed to Mount Sinai Hospital in Manhattan to meet Joshua Safer. He directs the Transgender Medicine Center. Okay, fine. This is an amazing array that you have on your desk. A lot of stuff.

Yeah, well, you know how organized people are with a big mess. Everything's exactly where it needs to be. It's like a beautiful mind, what I'm looking at. And right after I gave Josh a hard time for his clutter, he started schooling me. Because I thought that not that many people were transgender. I mean, because it is rare. It's not rare.

No, that's false. We're talking about, by surveys, maybe a half a percent of the population. So that's one in 200 people. That's not rare. It's estimated that more than a million Americans are trans, which means their gender identity, that is how they feel, doesn't match the genitals they were born with. Like maybe you identify as a woman, but you have a penis.

And that idea can be a bit hard to wrap your head around because we often think about our genitals and our gender going hand in hand. You know, just like that expert on anatomy told us in the 90s. Boys have a penis, girls have a vagina. Okay, so that's from Kindergarten Cop. It is essentially what Trump is saying too, though. So, is it science?

If you have a penis, are you a man? So your genitals never defined your sex. And that narrow, narrow definition has not existed for decades. So even prior. For decades. Correct. That's just so wrong. And one of the reasons that Josh says it's so wrong is because there are people who are born without a clear penis or a vagina,

and yet many say they either feel like boys or girls. That is, they have a sense of their own gender, even if what's between their legs isn't obviously a penis or a vagina. There's also people who are born with no genitalia at all. And these people, they identify as something. So from this, scientists know and have known for a very long time that feeling like a woman doesn't live in your vagina. It did get me thinking, though, could gender be about chromosomes?

Like, if babies are born with an X and a Y, will they be males? And Josh says, not necessarily. We've got lots of evidence from other conditions where people have XY chromosomes, but they're women. Like, Josh told us about this one particular condition. You will be born with a very visible and conventional looking vagina. So even though these individuals are X, Y, do most of them identify as females? Yeah, that's exactly the point.

Almost all of them have female gender identity. Now, most people who are trans don't have these conditions. But the fact that these conditions exist tells scientists that your sense of your own gender doesn't simply live in an X or Y chromosome or even in your genitals, which raises the obvious question of where does it live? And it turns out that trying to answer this question

has led scientists down a path that caused big problems for transgender people for decades. And it all started with this idea that whether we feel like a boy or a girl or something in between was largely shaped by our environment. That is, that nurture was more important than nature. We were certain that was, in quotes, a known thing for decades. The reason that I think I'm a woman is because my parents

raised me as a woman. Yeah, exactly right. And so if they had raised me as a man, as a boy, and started calling me Bobby, I would have been perfectly happy with that. So yeah, exactly right. And so if they had raised me as a man, as a boy, and started calling me Bobby, I would have been perfectly happy with that. So yeah, exactly at that. This idea started to take off in the 60s and in the 80s when Josh was in medical school.

That's what he was taught. And for doctors like Josh, this wasn't just theoretical. They were acting on it. Josh remembers seeing baby boys whose penises hadn't formed properly, and more senior doctors would talk to the parents about what to do. You would say your child is healthy, but we have this slight abnormality, but don't worry because we can fix it surgically. The fix was simply turning a penis into a vagina.

And afterwards, they'd tell the parents, don't worry, gender is all about how you raise your kid. And you have a girl now. Here's what you do. Well, you want a very feminine name. You want to put them in dresses. You want to hand them a Barbie doll. You want to do whatever you can get away with.

And this was done? This is standard operating procedure. And Josh says that this standard operating procedure fed into the way that doctors treated trans people too. The fact that trans people were saying, I was raised as a man, but I feel like a woman. It just didn't make sense in a world where gender was basically shaped by your environment. And so to the medical community, the only possible explanation for trans people saying this was that they were sick. Now, not all doctors thought this way, but enough did that in 1980, the DSM, the psychiatrist's bible, first started labelling trans people as having a mental disorder. In fact, they put it under the same heading as pedophilia and bestiality.

And so trans people would be sent to therapists to be cured. Producer Meryl Horne asked Josh about this. And so what would happen when they went into that counselling? The goal of it was basically get yourself out of it. Yeah, convince yourself that actually that's just not true what you think. And this is your body and this is what you are. And the fact that you think you are otherwise is wrong. In some cases, trans people were forced into hospitals for months on end

or subjected to electric shock therapy. And so the medical establishment went on like this for years. But things started to shift in the 1990s and into the 2000s. There was this burst of activism from the trans community. They're not going to be fired for who and what they are. And protests across the country where trans people were saying, I know who I am. I'm not crazy. Listen to me. And then something happened that ripped the dogma to shreds. Reports started coming out about some of these kids

who were given vaginas by their doctors. And it turned out the Barbie dolls weren't working. A bunch of these kids who were raised as girls were saying, I'm a boy. One mum who went through this with her little kid went on Oprah in 2000. I had complete faith in the doctor. I believed it would be best. There were doubts along the way, but I couldn't afford to contemplate them

because I couldn't afford to be wrong. I couldn't have faced the alternative. That you'd made this horrible mistake? Yes. Just four years later, in 2004, her son killed himself. It was becoming clear that gender didn't just come from the environment. There was something inside these kids telling them the gender that they were. And for Josh, reading about these kids completely upended what he knew.

And now he says, We cannot change people's gender identity despite the most intense program for doing so, right? I mean, what is more intense than raising somebody? You know, it's like the Truman Show, right? Raising somebody from infancy to believe something, having their parents part of the plan, and surgically altering their body for the plan, and still it fails. If that's not going to work, I don't think anything is going to work to change your gender identity. So I'm calling that a failure. And where do you think doctors at the time got that confidence to just say, well, let's just make a vagina and make sure we call her Sally?

It felt logical. I can't claim that there was... Felt. Oh, yeah. The medical community has been wrong. The medical community was wrong about those babies and it was wrong about people who are transgender. In 2006, the full extent of how bad things were for trans people reached the scientific community. A large survey, the first of its kind, came out, and it showed that huge numbers of trans folks were attempting suicide. It is horrible. I mean, it's terrible. You know, people suffer in massive ways when we make mistakes. And that takes us to where we are now. Through this messed up history, we now know

that there is something hardwired that helps us feel like a boy or a girl or somewhere else in the gender rainbow. So our next question is this. What is that thing? So why is it that I think I'm a woman? The reason you think you're a woman is at least heavily because there is something in your brain that is programmed to tell you that you are a woman. And what is that thing in my brain? That we don't have worked out. Scientists have looked in the brain, but so far they haven't found a particular thing that always shows up in, say, people who identify as women. As of now, it's looking like I know I'm a woman, partly because of this complicated

dance between my hormones and my genes. And genes really seem like a big piece of this complicated dance between my hormones and my genes. And genes really seem like a big piece of this puzzle. In fact, one study published a few years ago looked at identical twins and found that when one twin was transgender, 40% of the time, the other twin was too. And in the land of genetics, that's a lot. There are even case reports of twins raised apart and then both coming out as trans. So even though we don't know exactly what makes up our

gender, we know that sometimes what's under our skirts and how we feel about ourselves doesn't match up. There is no question within those medical communities. Nobody raises their hand and says, oh, do we believe that transgender people are legit? That just isn't a thing anymore in a conventional medical community. So the idea that out there in the lay world that people think that there are doctors debating,

that's not true. Still though, it took a long time for science to work this out. The book that psychiatrists use to treat their patients, the DSM, it only stopped listing transgender as a mental disorder five years ago. The World Health Organization only made the switch this year. After the break, the newest controversy. If your child tells you they're in the wrong body, Mummy, I'm a boy, not a girl.

Kids who are saying things like, God made a mistake, or I want to cut off my penis. What should you do? That's coming up after the break. Welcome back. Before the break, we were talking about what makes us the gender that we are. And even though we don't know exactly what that thing is, it's clear that for some people, their gender identity doesn't match the body they were born with.

Amongst most scientists, that is not controversial. What feels controversial now, though, is how you handle kids who say they're transgender. What do you do if your two-year-old son says, I'm not a boy, I'm a girl? And this is what a lot of people have their knickers in a twist over, because some say that you need to trust your kid and do something about it, while others think, no, no, no, no, no. This is just a phase, and by indulging it, you'll ruin your kid's life.

They're going to make moves where the kid can't go back. Can't go back. Their life is over. You literally turned their life down a dark path. Children are having their normal psychological development interrupted. This is child abuse. Abuse. Abuse. And at the heart of this debate is this one question.

Can a child really know if they're transgender or not? Because if they can't, and a lot of these kids will just grow out of it, then it is kind of scary to think these kids might be put on life-changing drugs. So maybe our knickers should be in a twist. We talked this through with Laura Edwards-Leper, a kids' clinical psychologist and associate professor at Pacific University in Oregon. She was also one of the first clinicians in the US

to treat transgender kids. I was really, you know, the only psychologist in the United States who was starting to do assessments for transgender adolescents who were seeking medical interventions. So that part was, you know, pretty anxiety-producing. Laura has been working with trans kids for over a decade. In her career, she reckons she's worked with about 500 of them. So we took this question to her about whether this really is just a phase for trans kids.

Because there's a lot of numbers getting thrown around that make it sound like a lot of kids will just grow out of this. 80 to 95% of children would naturally grow out of it. 98% of the cases in boards. As many as 95% will come to embrace their bodies and identify. So we asked her, is it true? Did the majority of kids grow out of this? Well, the research doesn't show that. I'd say that's incorrect.

Laura told us that some studies seem to show that lots of trans kids will change their mind. And here's what those studies are doing. They take a group of kids from a gender clinic and follow them. And they find that most of those kids aren't trans when they grow up. But Laura says we have to be careful with what this means. Because a lot of these studies are just scooping up all the kids at the clinic, not just those who say they're trans.

And kids can end up at gender clinics for all kinds of reasons. They can be a boy and wear dresses and like sparkly things and, you know, that that doesn't mean that they're necessarily a girl. Well, they've just worked out dresses are really fun and many men are missing out. Exactly. So, you know, I think what sometimes has happened in the earlier research is they've lumped all of these gender diverse kids into the same category. Basically, Laura says that these studies are tracking all kinds of kids, gay kids, tomboys, boys who like nail polish, and then saying, hey, most of them are not trans.

True, but not particularly useful. Laura says you really need to zoom in on the kids who are having serious issues with their gender identity. And she's met a lot of kids like this. Sometimes we have these little kids who are so, like, just disconnected from their body and they just really feel so strongly that this is not the body I'm supposed to have. Now, we couldn't find any studies

that have tracked a lot of kids like this over time to figure out how many of them are trans when they grow up. And that means currently we do not know the percentage of these kids that will grow up to be transgender adults. With no good data, we asked Laura about her experience. In your practice, have you seen any kids that are super insistent and then do ultimately stick with the gender they were born with? Yes. Like they do switch ultimately. I have. Yep. Yep. I have. Not many, you know, not many of them.

But if we're talking about the kids who are saying things like, God made a mistake, or mommy, why did you make me this way? You know, or I want to cut off my penis. Oh my God. And you hear kids saying that stuff? Absolutely. I mean, those are the kids that tend to be more likely to continue. But Laura says that this whole argument over exactly how many kids will change their mind

is kind of missing the point. Because ultimately, no one can predict which way any kid will go. So you have to treat each little tacker as they come. And so we can't know from one child to the next what their ultimate identity is going to be. So, you know, I really think that this debate, we kind of need to just, you know, put that to rest a little bit because I don't think it's really helping the cause on either side. It's just confusing things. But even if kids are just exploring their gender, parents are still wondering, can they do any damage if they help their kids transition?

Because a lot of the talking heads on TV are yelling about giving kids hormones and yucky chemicals and surgery. So is any of that justified? Well, Laura says, calm down. No one should be putting young trans kids on hormones. Never. I mean, I'm not even sure, honestly, where they're getting that information. I mean, it's just not true. I don't know of a single place in the entire world

that would consider giving hormones to young children. I mean, that's crazy. The first step for a kid, if they want to, is to let them wear whatever clothes fit their gender. Let them pick a name that feels right for them and use pronouns. He, she, they, whatever your kid wants. This is called socially transitioning. And Laura says it can be huge for a kid. There is often a light switch that kind of changes everything and causes the child to just, you know, feel much better about themselves. And everyone we spoke to told us that not letting your kid do this

isn't a benign choice. Generally, trans kids have really high rates of depression and suicidal thoughts. Yet studies focused on just socially transitioned kids find their mental health was almost as good as non-trans kids. Plus, wearing a dress or cutting your hair. It's not exactly medically risky. OK, so this idea that young kids are being put on chemicals, it's bunk. In fact, the first time that a trans kid will be put on medication to help them transition will be when puberty kicks in and they're around 12 years old. And even now, they're not taking hormones.

They're taking something called puberty blockers. These meds suppress a hormone that triggers puberty, and this gives the kid more time to sort through their gender identity before their body really starts to change. And now, this sounds pretty hectic to stop puberty in its tracks. But actually, Laura told me that this is tried and tested. These puberty blockers have been used for more than 30 years. It's been used for years for kids with precocious puberty. So, you know, younger kids who start puberty at a young age, like six or seven or whatever. What a name, isn't it? Precocious puberty. So it's been used for a long time for that. Precocious puberty. It sounds like the Hermione Granger of puberty.

And because puberty blockers have been used since the 80s, we can see how the kids who used them turned out as adults. And as best as science can tell, these kids are healthy when they grow up. So it's really an incredibly safe intervention. Is it reversible? The blockers are extremely reversible. And as far as we know, you know, there are no negative side effects.

So far, so good. No life-changing decisions, no dangerous meds. The kid can get off the trans train any time. But there is a time when trans kids do have to make a life-changing decision. And that's when they're old enough to go on hormones. It usually happens when they're around 16. And this is a big decision. It means you're effectively using hormones, estrogen or testosterone, to change your entire body and your brain. So what are the risks now? To walk us through it, we're talking to Colt Gaumeier. He's a clinical psychologist in Texas. And Colt remembers what it was like to be one of those insistent kids who knew who they were at a young age. I actually have video at age three sitting on my mom's lap and we were watching Alvin and the Chipmunks.

And my dad was saying, oh, you know, you're sitting on your mom's lap. You love Alvin and the Chipmunks. When you become a mother, maybe you're going to watch Alvin and the Chipmunks with your children. And I looked at him and I said, no. I said, I'm not going to be a mother. He said, well, okay, you don't have to be a mother. I'm going to be a father.

He was like, you know what? Okay, if you work hard, you can be anything you want to be. Colt transitioned more than a decade ago, and now he helps others transition as well. And Colt told us that taking hormones can have dramatic effects all through your body. He says it's kind of like going through puberty again. Your skin, fat, muscles, voice, and even libido can change.

Colt told us about what it's like taking testosterone. So you get more of a gut, less hips, and then you'll also get increased muscle mass. And you'll find that when you work out, it actually like has real quick impact that you can see, which a lot of my friends would just kind of give me the eye and be like, how come now you can exercise and get all of these effects from it? And I was like, testosterone. They're like, I want that. And I was like, do you want a beard and a low voice? and be like, how come now you can exercise and get all of these effects from it? And I was like, testosterone. They're like, I want that. And I was like, do you want a beard and a low voice?

They're like, no. Producer Odelia Rubin spoke to a bunch of people about their transition and what it was like taking hormones. And everyone's experience was a bit different. Truly, there's like all these weird puberty things. Like what? Like hair in weird places. The like ever enjoyable voice cracking.

Now I'm able to participate in No Shave November right now. So that says something. Libido. That definitely goes through the roof when you first start hormones. I grew boobs and like was going downstairs and things were bouncing in different ways than I was used to. My experience of being sexual was, yes, yes, yes, nope, nope, that's not working. Yes, yes, yes, nope, nope, that's not working.

Yes, yes, yes, nope, yes, nope, finally! Yeah, so taking a bunch of hormones can have a huge effect on how you feel and it causes these major changes in your body. From the studies we have, though, the hormones actually seem pretty safe. They might increase your risk of cardiovascular disease like blood clots, but the big unknown here is actually how they affect your fertility. Here's Colt again. And so historically when folks started hormone therapy,

and this was my experience as well just 11 years ago, we were told that, you know, there's not enough research and just pretty much assume that once you start hormone therapy that you're rendering yourself infertile. So just make sure that you want to do this. And that's pretty terrifying, you know. But now we're actually seeing that there are trans men who, despite taking a bunch of testosterone,

have still gotten pregnant. We're seeing a lot of live, healthy births. People seem to be really happy. I'm connected on Facebook to hundreds of parents who happen to be trans, who have so many cute kids. So while we know that some trans men are getting knocked up, there is a big catch here. As far as we know, the only way a trans man can get pregnant

is if he transitioned after his body went through puberty. For both trans women and trans men, they need to go through puberty to be fertile. So this means for those kids who are going on puberty blockers and then straight onto hormones, they may be infertile. With all these unknowns and a risk to your fertility, you've got to wonder, do people regret this? Colts asks his patients all the time.

And the most common answer is no. And the second most common answer is yes. I wish that I would have known about this and started this way earlier in my life. Studies of adults who have transitioned using hormones and surgery find that the vast majority of people don't regret it. One of the largest studies of its kind, which surveyed thousands of transgender people, found that less than 1% regretted getting their testicles or ovaries removed.

Less than 1%. So when it comes to being transgender, what do we know? One, what makes us the gender that we are? While science doesn't know for sure, we do know that a lot of this is in our genes and the best evidence we have tells us that this is not a choice. You are the gender you are and sometimes it doesn't match your genitals. Two, if a kid says they're transgender, what should you do? Well, let your kid explore who they are. If they want, cut their hair or let it grow out. That's fine.

And if they're about to hit puberty, talk to your doc about puberty blockers. And three, if you decide to change your body with hormones and surgery, will you regret it? The best evidence we have says that very few people regret getting surgery or taking hormones. There is one big risk, though, and that's to your fertility, particularly for kids who go straight from puberty blockers to hormones. Still, though, while there might be some risks

with changing your body, with hormones or scalpels, something much scarier is looming over transgender folks. And that's suicide. A survey of more than 30,000 trans people found that 40% had attempted suicide in their lifetime. That's way higher than the general population. It's nine times higher. Here's Colt Gowmire. The transgender population has the highest rate of suicide attempts of any demographic in the United States.

And what we're learning now is that being transgender in itself doesn't seem to be bad for your mental health. Turns out what is bad for your mental health is the way trans people are often treated. They get bullied, kicked out of their home and attacked. And the science is telling us that it's this mistreatment that's the biggest problem for transgender people. It's not hormones or surgery.

Not surprisingly, when people don't get treated like garbage, it makes a big difference. And I think the best thing about transition was having my family and friends support me all the way through it and having my priest from small town Texas write me a letter about how brave I was and say I was always welcome in church. Yes, hormones are important and awesome, but in terms of like why I'm doing so well and so happy is because of all the sources of support that I've got. That's Science Versus. And by the way, this is Wendy from the future here. We've updated some facts in this show. For more details about what we changed, please check our transcript.

It's in the show notes. Okay, time for the citations. Hello, Adelia Rubin. Hi, Wendy. Hi, Meryl Horne. Hello. So how many citations in this week's episode? It's over 130 citations.

Oh, my God, 130. And, Adelia, if people want to read more, where can they find these citations? They can find them on our website, and they can find a full link to the script. Yeah, and I really recommend if you do have any questions, you want to know more about any of the topics we've mentioned, go to this script, check out the citations.

Thanks, guys. This episode was produced by Odelia Rubin and Meryl Horne, along with me, Wendy Zuckerman, and Rose Rimler. Our senior producer is Caitlin Sorey. We're edited by Blythe Terrell. Editorial assistance by Rebecca Kling. And by the way, if you want to hear more about this topic, you've got to listen to Rebecca's podcast.

It's called the Trans-Specific Partnership Podcast. Trans-Specific Partnership Podcast. It's great. We'll link to it in the show notes. You've really got to listen. Fact-checking is done by Michelle Harris, Meryl Horne and Rose Rimler. Mix and sound design by Emma Munger.

Music written by Emma Munger and Bobby Lord. Thanks to all of the researchers we got in touch with for this episode, including Dr Jack Turbin, Professor Anne Fausto-Sterling, Assistant Professor Samantha Boussa, Associate Professor Susan Stryker, Dr Katrina Karkazis, Professor Neil Epperson,

Paula Nehrer, Professor Michelle Forcier and Professor Joan Roughgarden. And thank you to all the trans folks who shared their stories with us. We really, really appreciate it. Plus, thanks to the Zuckerman family and Joseph LaBelle Wilson. Next week is the final episode of this season and we're following a cold case.

A man has been found dead with a stolen identity. The police don't know what to do. Can science save the day? I'm Wendy Zuckerman. Back to you next week.