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Gender Confusion: Genetical or Hormonal?

“Read: In the name of thy Lord Who createth. Createth man from a clot. Read: And thy Lord is the Most Bounteous. Who teacheth by the pen. Teacheth man that which he knew not.” Surah Al-Alaq (1-5)

Recently the whole world saw the uprising of the Lesbian Gay Bisexual and Transsexual (LGBT) community demanding equalities in both nationality and law aspects. In Malaysia itself, a non-political, independent group terming themselves “Seksualiti Merdeka”, demanded certain tweaks in Malaysia’s federal constitution for the benefit of the sexually-unconventional minorities. It became the mass media’s focal issue, questioning the group’s functionality and motives. Some extreme political groups and religious movements even declared “war” against the cause. Politics aside, as professional members of the science field, doctors should further dig into the cause of these abnormalities; seek answers from a medical perspective.

Gender confusion, or scientifically phrased as “Gender Identity Disorder” (GID) is defined as “a conflict between a person’s actual physical gender and the gender that person identifies himself or herself as[i] ” – or in a simpler term, any individuals having the affinity to define him or herself as the opposite gender. A boy may feel or act like a girl, or vice versa. In this article, let us probe deeper into this sensitive and controversial issue.

The scope of GID is very big, perhaps too big to be discussed in this piece of literature review. There are cases of GID which involve deviations and aberrations of human chromosomal DNA, resulting in Klinefelter’s Syndrome, or sometimes called XXY syndrome (a human male having an extra X-chromosome[ii], forming XXY karyotype instead of the normal XY human male karyotype); Turner’s Syndrome (Genetic condition in which a female does not have the usual pair of two X chromosomes[iii], having just one X chromosome, instead of the normal XX female karyotype, or XY male karyotype). These two syndromes are often diagnosed early as some signs may appear during infancy, but it is commonly detected after puberty, when the secondary sexual characteristics do not develop as expected. However without DNA screenings, these two conditions could not be determined easily. Researches done regarding these two phenomenon strongly suggest that the two incidences are genetic disorders[iv],[v] resulting from various causes such as radiation, or hidden genetic mosaicism (a condition in which cells within the same person have a different genetic makeup[vi]).

However, not all GIDs are caused by Klinefelter’s or Turner’s Syndrome. There are other theories that support the occurrence of gender confusion. One of these is the effect of hormones on the physiological and psychological developments of an individual.

An endocrinology study by Garcia-Falgueras and Swabb states that in the intrauterine life, a foetus’ sexual organ is developed first, and later the brain is sexually differentiated under the influence of of hormones, mainly sex hormones such as testosterone, oestrogen, and progesterone. Garcia-Falgueras and Swabb also postulated that sexual orientation has a direct relation to the exposure of testosterone hormones on a developing brain[vii].

Studies on pre-natal hormones’ effects on sexual identity are still vague and inconclusive. The studies, though important, are not effectively done due to the worldwide ethical guidelines that prohibit tempering with pre-natal hormones which may produce undesirable effects on innocent lives. Researchers depend entirely on natural occurrence of hormonal disorders in foetuses and observe the outcomes. The most extensive studies were done in cases of Congenital Adrenal Hyperplasia and Congenital Androgen Insensitivity.

Female foetuses suffering from Congenital Adrenal Hyperplasia (CAH) are exposed to abnormally high amount of androgen. Observations done on these infants have shown that their play behaviours are more inclined towards balls, toy cars and machineries when relatively compared to female infants whom prefer dolls, soft toys and flowery objects. For male infants, however, deviations in their play behaviour during infancy have been largely associated with a syndrome called Congenital Androgen Insensitivity[viii]. These findings are ultimately inconclusive as the affected infants show abnormalities only in their playing behaviour. There is yet no conclusive evidence that the hormone androgen causes gender confusion.

Studies have also shown that males whom grew up without a father have higher affinity to be effeminate, and females growing up without motherly figures at homes tend to be emasculate. These findings were found to be related to hormonal changes in pre-puberty children

It is a common knowledge that secondary sexual characteristics such as the voice, body shape, hairlines, and sexual functions start after puberty. These secondary sexual characteristics are maintained by testosterones in males, and cyclic influx of oestrogen and progesterone in females. What would happen if the maintenance of these secondary sexual characteristics is disrupted?

Some over-ambitious sportswomen consume male hormones to enhance muscle development, strength and agility. When the level of testosterone in the body of a female is increased above normal, the female will start to show secondary sexual characteristics of a male. She may start to grow more hair, and later hair follicles would develop on the chest, face and back. Her larynx would widen, giving her a coarser voice, and her muscles would be more prominent. These changes are mainly physical at first. Studies have shown that in prolonged chronic cases, psychological changes may take place; she would start to show sexual interest in other females. This is believed to be caused by many factors, mainly the renewed way of people interacting with her. Normally, if we see someone with facial hair and prominent muscles, but with some effeminate features, we would treat the person like a man, for treating a ladylike man like a girl would be an insult.

When it comes to post-puberty intake of the opposite sex hormones in males, the cases were found to be mostly to be the result of prolonged gender confusion, most probably since childhood.

The world was once shocked with the news of the birth of a new technique to grow hens, by injecting them with oestrogen. Many postulated that these would cause the male consumers of these chickens would be effeminate. Studies have not yet proved this theory. However, scientific studies did prove that consuming soy milk would not make men effeminate, as soy milk does not contain oestrogen. It contains pro-oestrogen which has no effect on secondary sexual characteristics of humans.

Gender confusion has been widely associated with psychological deviation. The studies are done through behavioural observations and experiments. Though most of these studies are inconclusive; however, they give us explanations to some questions that boggle the minds of the gender-unconfused public. Why do they cross-dress? Why can’t they just be normal? And ultimately, don’t they believe in god?

A cross-sectional study has been done on some 300 people with GID. 60% believed that they were really the opposite sex, trapped inside their bodies. 30% felt comfortable cross-dressing in public, while over 83% felt comfortable to cross-dress in their homes. From the 300 subjects, 287 claimed to have religious faith. 43% of the 287 faithful subjects believed that they were committing sins[ix].

The most popular game for this case scenario – Who to blame? As usual, the society is quick to point a very long finger to the families, especially parents. This is over-generalizing. People with normal family backgrounds may turn up confused with their own gender identity too. A study has shown that adopted or surrogate children with two lesbian mothers or two gay fathers have no higher tendency to be attracted to the same sex than children with heterosexual parents[x]. However children with non-heterosexual parents were found to be more accepting towards the idea of same sex relationship.

Next in line in the blame game is the friends, peer pressure and education. Tasker and Golombok (1997) explained that there was no concrete evidence that social surrounding would affect one’s gender identity. However, social surrounding does show some impacts on one’s acceptance towards the gender-confused. A person who mixes with the sexually-unconventional people was found to be more open towards cross-dressing and same sex relationship for themselves. This budding idea in the society nowadays may be one of the biggest causes for the spreading of gender confusion syndrome.

Here comes the importance of faith. Religions promote the idea of ideas, but to a certain extent. Faiths bring us guidance and law. Without law and guidance, who are we to say we are the better species than animals. Referring to the Quranic verse above, it is obvious that Islam makes it compulsory for its disciples to read, or in other word, study. When we label a person “faggot”, “sissy, “tomboy”, or “gay”, do know that these people may have been born that way. Faith can guide us all.

Written by:

Syamsuddin bin Faruok

4th Year
Medical Faculty
Zagazig University