Preview of coming attractions

Here is a preview of posts for the next couple of weeks.
1. New research – Commenter Evan pointed out two new studies of interest, one a twin study and the other related to the the role of gender atypical behavior in adult mental distress. In additional to those two papers, there are two other studies on childhood gender nonconformity that I want to review as well.
2. Q&A with Michael Bailey – Dr. Bailey will comment on the new Finnish twin study. He will also speak about the mistakes those on the right and left make in interpreting these studies.
3. Rebuttal to the Pink Swastika – I will be providing a guest post, a difficult to locate response to arguments which form the basis for the Pink Swastika and primary sources which contradict Scott Lively’s view that the Nazism was animated by homosexuality.
I suspect those posts will lead to several follow ups that should keep us busy.

A conservative defense of sex research

During the Saddleback Civil Forum, if Rick Warren had asked the candidates about funding sex research, it might have gone like this.
Warren: What is your position on researching sex?
McCain: (with resolve and without hesitation) – Missionary!
Obama – Uh, well, it depends on how you define “sex” and “research.” Scientifically and politically, it is above my pay grade to determine what my position is in that arena.
Pure fiction, of course. I doubt sex research will come up in this year’s election. However, the topic has become a concern to some politicians. According to an ABC News report, “Sex, massages and taxpayer dollars,” some legislators are bothered by some NIH grants to universities to study sexuality. Some of Michael Bailey’s work aroused more than curiosity. To wit:

A few years ago, NIH gave a $147,000 grant to a Northwestern University psychology professor who was paying women to view pornography while a device measured their sexual responses.
That study didn’t go over too well in the halls of Congress.
Arizona Rep. Jeff Flake was among 20 Republicans to sign a letter to NIH’s director asking for an explanation for why taxpayer money was going for such a study. They called it “a bizarre spending decision.”
Today, Flake believes Congress has failed to properly oversee NIH and its spending.
“It’s Congress’ job to set guidelines for how NIH and other agencies spend taxpayer money and then exercise oversight to ensure that those guidelines are being followed. “However, over the last several years, Congress has neglected its oversight function,” Flake’s office told ABC News. “It’s difficult for Congress to criticize NIH for wasteful grants when Congress itself is earmarking billions of dollars every year on similarly wasteful pet projects.”

I have to disagree with Rep. Flake and his colleagues. As a social conservative, I am very interested in research which helps us better understand how sexuality works. Regarding sex research, I think Guggenheim Fellow Alice Dreger raises a valuable point when she argues:

What about the studies that look into things like which kind of pornography stimulates women versus men? Useless and prurient? I don’t think so. I know this sort of research horrifies conservatives, but they should really wake up to the fact that research into sexual stimulation can actually help promote family life by helping married couples understand how to have satisfying sex lives within the context of monogamy. (Is it better that a guy cheat on his wife with a prostitute, or better that he learn a vibrator and some massage might make his wife a lot more receptive? I vote for the latter.)

Of course, an unexciting sex life does not force anyone into seeking prostitutes, but I think Dr. Dreger’s argument should be taken seriously. Counselors know that otherwise solid couples, yes even very religious couples, are not exempt from sexual questions and concerns. Better that counselors are armed with good science on sexuality than the latest issue of Cosmo. Reading the Song of Solomon, while quite, uh, interesting, might not be enough to help overcome issues which would benefit from basic information. Lay people might be surprised that research is needed to better understand sex and attraction, but such science is important for reasons that might not seem apparent.
In my work, I have found the research coming out of the Bailey lab to be very helpful. His research informs my work with people on a regular basis. I often consult with heterosexually married, same-sex attracted men who wish to maintain their marriage. Bailey’s (and other researchers’) brain research, for instance, provides significant insight into how the brain responds to sexual cues. This is valuable information for those who seek insight into why they respond as they do. And many of them use this information to pursue their values and beliefs to avoid sex with men and enhance their marital adjustment with their wives.
I guess the bottom line for me is that funding sex research doesn’t mean advocating an anything-goes stance toward sex. Studies done solely for prurient interests should be questioned, but basic science of sexual attraction and arousal can have positive, and even conservative, applications.

Multiple factors involved in sexual orientation, part 2

I posted 2 weeks ago about this twin study but it is now making the media.
Here is the abstract of the article from Archives of Sexual Behavior:

There is still uncertainty about the relative importance of genes and environments on human sexual orientation. One reason is that previous studies employed selfselected, opportunistic, or small population-based samples. We used data from a truly population-based 2005–2006 survey of all adult twins (20–47 years) in Sweden to conduct the largest twin study of same-sex sexual behavior attempted so far. We performed biometric modeling with data on any and total number of lifetime same-sex sexual partners, respectively. The analyses were conducted separately by sex. Twin resemblance was moderate for the 3,826 studied monozygotic and dizygotic same-sex twin pairs. Biometric modeling revealed that, in men, genetic effects explained .34–.39 of the variance, the shared environment .00, and the individual specific environment .61–.66 of the variance. Corresponding estimates among women were .18–.19 for genetic factors, .16–.17 for shared environmental, and 64–.66 for unique environmental factors. Although wide confidence intervals suggest cautious interpretation, the results are consistent with moderate, primarily genetic, familial effects, and moderate to large effects of the nonshared environment (social and biological)
on same-sex sexual behavior.

Reactions are mixed but not really along any ideological grounds that I can see. For instance, from ScienceNOW:

J. Michael Bailey, a psychologist at Northwestern University in Evanston, Illinois, who led earlier twin studies of sexual orientation, calls the new study “good, important, and one unlikely to be bettered in the near future.” But Jonathan Beckwith, a geneticist at Harvard Medical School in Boston, says that the new work fails to overcome a number of problems faced by previous twin studies. He notes that the final sample included only 12% of the males in the Swedish registry, leaving open the possibility of recruitment bias. And Beckwith says that the failure to control for family environment could inflate estimates of genetic influence.

Co-author Qazi Rahman, was quoted by the Washington Post:

“This study puts cold water on any concerns that we are looking for a single ‘gay gene’ or a single environmental variable which could be used to ‘select out’ homosexuality — the factors which influence sexual orientation are complex. And we are not simply talking about homosexuality here — heterosexual behavior is also influenced by a mixture of genetic and environmental factors,” study co-author Dr. Qazi Rahman, a leading scientist on human sexual orientation, said in a prepared statement.

I intend to devote at least one more post to this study as I agree with Michael Bailey that it is an important study. I think along with the other 2 population based studies (Bailey’s in 2000 and Kendler’s also in 2000), it provides a picture of modest genetic effects along with a major role for non-shared enviromental factors. Many roads lead to a similar result. Nothing in this study provides a clear picture of what those environmental factors are but a simple environmental explanation (e.g., poor parenting) or genetic source (single gene, or uniform action of several genes) is not supported here.
Rahman added in the Post article:

“Overall, genetics accounted for around 35 percent of the differences between men in homosexual behavior and other individual-specific environmental factors (that is, not societal attitudes, family or parenting which are shared be twins) accounted for around 64 percent. In other words, men become gay or straight because of different developmental pathways, not just one pathway,” Rahman said.

Gender identity disorder research: Q & A with Kenneth Zucker

As a follow up to the recent broadcasts by NPR and several posts regarding gender identity, here is a Q & A involving J. Michael Bailey and Ken Zucker recently posted on the SEXNET email list. Dr. Zucker is the Head of the Gender Identity Service, Child, Youth, and Family Program and Psychologist-in-Chief at the Centre for Addiction and Mental Health in Toronto, Ontario, Canada. Dr. Zucker is the chair of the newly appointed Sexual and Gender Identity Disorders working group for the 5th edition of American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-V). Dr. Bailey is Professor of Psychology at Northwestern University, prolific sexual orientation researcher and moderator of the SEXNET list. As the NPR article noted, Dr. Zucker has extensive clinical and research experience with persons who experience gender dysphoria. This interview was conducted by Dr. Michael Bailey via email and has been slightly edited for posting here. Both Drs. Bailey and Zucker have reviewed and approved it.

Bailey: Both NPR shows used the phrase “a girl trapped in men’s bodies.” How common is this concern over body image?
Zucker: I would say that, in general, there has not been a lot of good empirical research on body image issues in pre-pubertal children with GID. In adolescence, the Dutch group has reported clear evidence of body image dissatisfaction as one finds in adults. One of my PhD students has a dissertation that should be defended later this year in which we studied body image in boys with GID compared to clinical and community controls. We did detect significant body image differences among the three groups: body image in general and in relation to gender-specific anatomic dysphoria. The boys with GID had a poorer body image in general and, of course, with regard to gender-specific anatomic dysphoria. It is only a first pass at this issue and I will report on this down the road after the dissertation is defended.
Bailey: The case on the second NPR show is of a child (natal boy) who had extreme temper tantrums when not allowed to engage in feminine behaviors. Is this common in the kids you see, or is there something unusual about these kids?
Zucker: This is not uncommon. Some parents will report that if they try to limit cross-dressing that this can be very distressing for the boys. Some parents describe it as “he needs his fix.”
Bailey: You are more familiar than anyone else I know with the difference between the British and Dutch treatment centers that yielded the findings that only 20% of the British kids but 100% of the Dutch kids pursued sex reassignment eventually. Did the Dutch center focus on older children (who were less likely to change their minds)? To the extent that the samples were comparable, it is a shocking difference in outcome.
Zucker: I don’t think the British group has published their data yet. But, yes, the Dutch group data are on adolescents and I think that the British group is talking about clients first seen in childhood, not adolescents. The Dutch group now has a paper that is close to being “in press” on their first follow-up of GID children and then followed up later. The GID persistence rate for their boys was about 20% and the persistence rate for girls was 50%. Their persistence rate for boys appears to be similar to what I have summarized for the boys seen in my clinic (Zucker, 2005), but higher than the 12% rate for girls that we published earlier this year (Drummond et al., 2008). The Dutch group speculates that their girls were, at initial presentation, more extreme in their cross-gender behavior than the girls that we reported on, but that will require more careful analysis.
Bailey: The NPR show, and some people on it, kept implying that some of these kids are “really” transgender, and others are not. I suspect you don’t agree with this way of thinking about it, although you recognize that some kids are more likely to become transgender adolescents and adults than other kids are. Can you remind us which factors are associated with persistence of GID from childhood?
Zucker: I don’t think we know yet. Two possible candidates are age at initial evaluation (later age associated with greater persistence rates) and quantitative metrics of cross-gender behavior in childhood.

By persistence rate, Dr. Zucker is referring to the percentage of GID children who are still GID at a later assessment. In the Dutch group, as well as in Dr. Zucker’s research sample, most boys who want to be girls in childhood, end up as men who do not want to be women. For women in the Dutch sample, half remain GID. I think the assessments of low persistence of GID provide some helpful information to parents who wonder about puberty delay and behavioral interventions with their GID children.
Thanks to Drs. Bailey and Zucker for permission to post this conversation.

60 Minutes Science of Sexual Orientation mother of twins, part 2

At last, I am posting some follow up comments made by Danielle, mother of the twin boys featured in the 60 Minutes segment, Science of Sexual Orientation. Part one is here and should be read first.
Danielle said this in her initial email:

I often wonder “if” I had told Adam that “yes” he could be a girl when he became old enough would he have stayed on that track of thought? However, at the urging of his therapist I told him I understood he was a girl yet he was really a boy and couldn’t be a girl.

Wanting to be clear, she wrote to elaborate:

This was my response when he was three years old. We thought it would be confusing for that age of a child to hear he could be a girl but not until he was older. Later in his life I was up late watching a tv show about transgender surgery. Adam had awaken and was watching the show behind me – I didn’t know he was there. I heard a gasp. When I turned around there was my Adam staring intently at the tv. He asked me in a shocked whisper “Can I do that surgery and be a girl?” I told him “yes” he could but not until he was 18 years old. He became very excited. You have to understand the differences in his age. I believe the information I gave him at each step was based on age appropriate responses. He did stare at me for a bit and asked me if I would really let him do something like that if he wanted. I assured him I would if it would make him happy. He wanted to know why I would help him change his body. I informed him because I loved him and I didn’t want him to be sad or hurt. He asked me if I really loved him that much. My response was a very sound “yes!” that seemed to please him very much.
The last time Adam and I talked about him being able to change his body into a girls body Adam was indecisive. Again, I believe it’s the age/stage of his life and awareness of all around him. This conversation occurred after Tyra Banks had issued an invitation to be on her show. At that time Adam advised me he wasn’t sure what he wanted to do. He didn’t know if he should change his body so he could be a girl, stay with a boys body, if he was straight sexually or gay. Again, I believe his answer and confusion to be age appropriate. I declined the show offer because I didn’t want him to expose himself when he was so unclear about his future. I didn’t want to “lock” him into any particular role. That was when I decided to proceed with the hormone therapy to give him more time and maturity to decide what he wanted for himself. However he was already fully into developing so we decided not to go ahead with the treatments.
We are in the process of working on another television project. I am allowing Adam to participate because I believe the show will allow him to show his confusion and be himself as he is for a 12 year old. This lead us to another conversation about the issue. For all of his wise wisdom he informed me he still didn’t know what he wanted to do. “After all Mom, I’m only 12. I’m not suspose to know 100% for sure where my sexuality belongs. I’m suppose to be able to explore and decide later” And that’s where I have left it. For him to be a normal 12 year old child, maturing, developing and exploring the possibilities of his future. I’m here to guide him, support him, and show him all the possibilities of the future. I can love him, hold him, praise him and catch him if he falls. That’s my role as a parent.

I then wrote to her to clarify how these thoughts related to her parenting decisions, specifically with his name and school. She said:

The issue of what name to use during school was never really discussed. I wouldn’t have allowed him to use a girls name at school even if he had pushed me to do so. He was “Adam” and that was that.
During school hours he could wear what he wanted as long as it followed the school dress code. He only asked to wear a dress to school a few times. My response was always that his brother couldn’t wear his fireman clothing so he couldn’t wear his dresses to school however, he did wear them around the house. He did wear a girls black sweater with gold thread for two years. He wore girls tennis shoes all his life because of the color and sparkles and still wears them. He would wear girl shirts; however, in today’s fashion world, sometimes it’s difficult to tell the difference except in color. In his younger years, he wore girl jeans with sparkles but only for about an year then he didn’t want to wear them anymore. But the really feminine clothing was only at home. My life was easier dealing with this issue because I had twins. His twin wanted to be a fireman. He had everything to do with a fireman just like Adam had everything to do with being a girl. My rule was that the girl clothing (dresses, heels, jewelry, skirts, femme blouses, makeup) and the fireman clothing stayed home when we went to the library, grocery store, grandma’s, church, school and so on. My main reason for my restrictions were due to my parents who are totally against Adam’s gender issues. However, his Nana didn’t care what he wore so he could take his dresses to her house and wear them over there. I did have an issue at school once where the principal asked me if I could get Adam a different book bag (his was pink) and buy him different shoes (his were white with a pink logo on them). I advised her that he wasn’t breaking any rules by his choices so I wouldn’t make him give them up. I told her I could give in to him and allow him to wear dresses to school if she really wanted to push me since there isn’t a dress code that says he can’t. She backed off after that. However, I wouldn’t have ever allowed him to wear a dress to school anyway. Yes, I had restrictions about what he wore and did in society but he did have a bit of freedom by his choice of shoes.

I again want to thank Danielle for her candid comments. I have received emails from parents and professionals who are glad for this glimpse into how one parent reasons through these difficult issues.

The Man Who Would Be Queen – Chapters 1 & 2

Several commenters have mentioned and quoted from Michael Bailey’s book, The Man Who Would Be Queen.
Click this link to read the first two chapters of the book.
The Man Who Would Be Queen is published by Joseph Henry Press.
Would be Queen
PS – Much has gotten in the way of the second part of Danielle’s remarks on gender identity issues, but they are coming soon…

60 Minutes Science of Sexual Orientation: An update from the mother of twins


Recently, I posted a link to a NPR broadcast outlining two approaches to treating children who are gender non-conforming in their play and activity preferences. In light of that broadcast and the controversies surrounding these different approaches, I provide an update from Danielle, the mother of twin boys first featured in a 60 Minutes broadcast originally aired on March 12, 2006. The segment, titled Science and Sexual Orientation, was by any measure a provocative program. The producer answered numerous questions about the show on the CBS website and many blogs, including this one, provided commentary. I still use the clip in some of my classes to illustrate a variety of issues regarding how the media interprets sexual orientation research.

One of the most interesting aspects of the show was Leslie Stahl’s interview with twin 9-year-old boys, Adam and Jared. Recently, the mother of the twins, Danielle, wrote researcher Michael Bailey with an update regarding her son, Adam. Dr. Bailey and Danielle allowed me to share the note on the blog. She does not preach or lecture but rather reports on her experience. First, to set the stage, I want to reproduce an excerpt of the 60 Minutes segment introducing Adam and Jared:

The bedrooms of 9-year-old twins Adam and Jared couldn’t be more different. Jared’s room is decked out with camouflage, airplanes, and military toys, while Adam’s room sports a pastel canopy, stuffed animals, and white horses.

When Stahl came for a visit, Jared was eager to show her his G.I. Joe collection. “I have ones that say like Marine and SWAT. And then that’s where I keep all the guns for ’em,” he explained.
Adam was also proud to show off his toys. “This is one of my dolls. Bratz baby,” he said.

Adam wears pinkish-purple nail polish, adorned with stars and diamonds.

Asked if he went to school like that, Adam says, “Uh-huh. I just showed them my nails, and they were like, ‘Why did you do that?'”

Adam’s behavior is called childhood gender nonconformity, meaning a child whose interests and behaviors are more typical of the opposite sex. Research shows that kids with extreme gender nonconformity usually grow up to be gay.

Danielle, Adam and Jared’s mom, says she began to notice this difference in Adam when he was about 18 months old and began asking for a Barbie doll. Jared, meanwhile, was asking for fire trucks.

Not that much has changed. Jared’s favorite game now is Battlefield 2, Special Forces. As for Adam, he says, “It’s called Neopets: The Darkest Faerie.”

Asked how he would describe himself to a stranger, Jared says, “I’m a kid who likes G.I. Joes and games and TV.”

“I would say like a girl,” Adam replied to the same question. When asked why he thinks that is, Adam shrugged.

In this email, Danielle reveals that at one time Adam thought he would like to be a girl. In fact, she considered puberty delaying drugs to allow Adam more time to reflect about his gender identity. At one point, he wanted to be a girl and bear a child via his own body.

With this update, Danielle discloses that Adam is not as definite about wanting to transition as he once was. She reports that he has adopted a male identification, albeit a somewhat unconventional one. Here is her update:

Adam has changed since we did the 60 Minutes show. He is the same yet different. From the research done a gazillon years ago about children like him- he’s basically following the guidelines as they were told to me. One day I would love to get my hands on the actual research papers! Anyway, he turns 12 on [recently]. He still shows a preference for society labeled “girl” items, yet he no longer states he wants to change his body into a girl. He no longer talks about having a baby from his actual body or wanting to know when he will start to grow his breasts.

I think most of these changes are due to society (school peers) and his awareness of the actual facts of life. His favorite color is now purple instead of pink and he still prefers to buy “girl” tennis shoes. He dreams of becoming an actor/model and being a professional chef. As I stated, from what I know of this past research, he’s reaching the age where he’s blending in with his peers. I expect the next two years of Middle School to be difficult ones. Then he goes into High School where differences are just a way of life. I’m thinking he may actually find out who he is some time towards the end of High School. Again it follows what I know of this mysterious research paper.

I belong to several email groups with other families that have children like Adam. I don’t participate much because I’m not sure if most of them are following the right path with their children. I often wonder “if” I had told Adam that “yes” he could be a girl when he became old enough would he have stayed on that track of thought? However, at the urging of his therapist, I told him I understood he felt he was a girl yet he was really a boy and couldn’t be a girl. A lot of the parents are allowing their children to grow long hair, dress 100 % as a girl, and go to school with a girl name and girl clothing. Therefore they are totally embracing their child in the opposite sex role. The children are living that role and that life style. So have I done my son an injustice by telling him that he has a boy’s body and even if he wants to be a girl during school hours he had to be the boy as his body was made? Then again, I have allowed him to wear just about anything he was comfortable wearing.

It’s a dilemma that I don’t think we will know the end of until this generation of children grows up. What happens if some of these children that have male bodies but are living life as a girl all through grade school finally reach an age where they decide they really don’t want to have a sex change and be a physical girl? Then what will the ramifications be on that child because of the parents’ actions?

It’s not like my child has Down syndrome and I can go to the library and check out 100s of books to get guidance on how to raise him. There just isn’t much out there for parents who face raising a child like my Adam. I have so many questions about parenting him and very little answers. So I go with my gut and wonder daily if I have made the wrong decision or if these other parents are making the wrong decision. Then again, what may be the wrong decision for one child in this situation may be the right decision for the other. Ah, what a world we live in! Fifty years ago we wouldn’t even be having these types of conversations or email groups.

I have to share something about Adam. I have often wondered how these other kids are developing compared to Adam. Many in the groups have started hormone therapy to stop puberty in the kids. That way the kids have more time to mature and make the final decision about the course of their lives. For the boys they won’t develop the deeper voice and the Adam’s apple and male characteristics. If they decide to transition the theory is that it will be easier without these developments. I made an appointment for Adam to have some baseline tests done. I was seriously thinking about doing the hormone therapy for him to give him more time too. However, much to my surprise he was ready deep into puberty. The doctor said we could still proceed with it but I really couldn’t expect to have undone what was already there. He was developing much earlier than expected. Now his twin, Jared, still hasn’t started into puberty. So, my question is – with boys that follow gender non-conformity – do they start developing earlier than their peers? I realize we won’t have the answer for many, many more years to come.

First of all, I am grateful to Danielle and Dr. Bailey for permission to reproduce this communication. Second, I think it is important for clinicians and advocates alike to reflect on what we can learn from this experience. As far as I can determine from available research, most boys who want to be girls later become men who don’t want to become women. Using the new paradigm with Adam may have altered his future in ways that could have added significant complication to his life.

Given that this email was sent to Dr. Bailey, I asked him for commentary.

Danielle is an admirable and unusual mother. She went to great lengths to protect Adam and to show him that she loved him regardless of his gender-related behavior and self-concept. She let Adam express his femininity (e.g., fill his room with “girls'” toys), while providing him with honest feedback about the likely results of his choices, outside their home. She also hesitated–in my view sensibly so–from encouraging Adam to begin a gender transition during childhood. I have met Adam, and I have read Danielle’s updates. I would be surprised at this point if Adam decides to change his sex. He seems a happy boy, and I expect he will become a happy young gay man.

I wonder, with Danielle, about the implications for gender-atypical children whose parents take the other, emerging, approach: allowing children to change their genders preliminary to biological sex changes in adolescence. Children like Adam start showing their behavior early (Adam at 18 months). All evidence we have suggests that only a minority (20% or fewer) of boys like Adam become women eventually. But if parents let boys become girls at childhood, will this drive up the probability? It seems highly plausible that it would. Sex reassignment is not minor medical intervention. It involves major surgery and lifelong hormonal treatments. All other things being equal, sex reassignment is something to be avoided. Of course, not all other things are equal. If a 6 year old boy wants to be a girl, it will cause him more short-term pain to refuse than to acquiesce. The costs and benefits are hard to estimate, and Danielle has been frustrated in her search for data-supported answers. It would be a fitting reward to her admirable example if people could set aside their differences (and the government could uncharacteristically support research on a controversial topic relate to sex), and begin to collect and share requisite data.

Danielle and Adam should remind us that even if treated liberally, gender-atypical children will not necessarily choose sex reassignment. Indeed, perhaps the most liberal goal of all is to allow gender-atypical children to be comfortable in their own (non surgically altered) skin. By all appearances, that is what Danielle has accomplished.

Since this email, I have corresponded more with Danielle. She has added some additional detail which I will report tomorrow. Specifically, she describes how she has responded to Adam when he has expressed questions about transitioning.

APA issues statement regarding GID and the DSM-V

The American Psychiatric Association released a statement on Friday regarding some “inquiries about the DSM-V process.” I suspect many of those inquiries have focused on the disputes over treatment highlighted by the recent NPR broadcast on gender identity, often involving Dr. Ken Zucker. I asked Ken Zucker and Michael Bailey for their reactions to this press release from a transgender advocacy group. Dr. Zucker declined to comment, but sent the following APA statement. Dr. Bailey’s comment follows.

APA STATEMENT ON GID AND THE DSM
May 9, 2008
The American Psychiatric Association has received inquiries about the DSM-V process, particularly concerns raised about the Sexual and Gender Identity Disorders Work Group.
The APA has a long-standing mission to provide guidelines for the diagnosis and treatment of mental disorders, based on the most current clinical and scientific knowledge. Through advocacy and education of the public and policymakers, the APA also affirms it commitment to reducing stigma and discrimination.
The DSM addresses criteria for the diagnosis of mental disorders. The DSM does not provide treatment recommendations or guidelines. The APA is aware of the need for greater scientific and clinical consensus on the best treatments for individuals with Gender Identity Disorder (GID). Toward that end, the APA Board of Trustees voted to create a special APA Task Force to review the scientific and clinical literature on the treatment of GID. It is expected that members of the Task Force will be appointed shortly.
There are 13 DSM-V work groups. Collectively, the work group members will review all existing diagnostic categories in the current DSM. Each work group will be able to make proposals to revise existing diagnostic criteria, to consider new diagnostic categories, and to suggest deleting existing diagnostic categories.
All DSM-V work group proposals will be based on a careful, balanced review and analysis of the best clinical and scientific data. Evidence accumulated from work group members and hundreds of additional advisors to the DSM-V effort will be considered before final recommendations are made.
The Sexual and Gender Identity Disorders Work Group, chaired by Kenneth J. Zucker, Ph.D., will have 13 members who will form three subcommittees:
– Gender Identity Disorders, chaired by Peggy T. Cohen-Kettenis, Ph.D.
– Paraphilias, chaired by Ray Blanchard, Ph.D.
– Sexual Dysfunctions, chaired by R. Taylor Segraves, M.D., Ph.D.
Each subcommittee will pursue its own charge, provide ongoing peer review, and consult with outside experts. The DSM-V is expected to be published in 2012.

Regarding the Transactive organization’s statement about the DSM-V, Dr. Bailey took strong exception to this statement:

“Zucker has stated that a secure gender identity possibly prevents the development of later homosexuality. This raised several red flags for those of us who work with gender non-conforming children, youth and their families. TransActive’s position is that “prevention of homosexuality” should not be the concern of childhood gender identity specialists.”

To which, Bailey said:

This is an utterly false characterization of Zucker’s position. He has no desire, stated or otherwise, to prevent homosexuality. Experience and logic suggest that when people have reasonable and sound positions, they do not need to mischaracterize the positions of others they disagree with.

I agree with Bailey, I have seen nothing which would suggest Zucker has a stake in the eventual sexual orientation of children. And I certainly agree with the last sentence which has some special significance to me in light of the cancellation of the APA symposium.
In my opinion, there are some advocates who implore various audiences to trust science but really do not want this unless the outcome suits their advocacy goals.

Ken Zucker compares ethnic identity conflict and gender identity conflict

Ken Zucker, a psychologist featured in the NPR series on gender identity, recently posted the following on the SEXNET listserv. Are ethnic identity conflict and gender identity conflict analogous? In this post, Dr. Zucker addresses the topic and I thank him for giving me permission to re-post it here:

In the interview I had with the NPR journalist, Alix Spiegel, I posed the question: How would a clinician respond to a young child (in this instance a Black youngster) who presented with the wish to be White? I had already sent Ms. Spiegel an essay that I published in 2006 in which I had presented this analogy and she told me that she was intrigued by the argument.
In this post, I list some references that I have accumulated over the years that discusses issues of ethnic identity conflict in children and adults. In the 2006 paper, I was particularly influenced, rightly or wrongly, by an essay Brody (1963) wrote many years ago. I think it is worth reading. Thus, I did not invent the analogy out of thin air. I had been influenced by three things: first, I was aware of this literature on ethnic identity conflict and I thought it had some lessons in it; second, I had observed, over the years, that some kids that I have seen in my clinic who had a biracial ethnic background also sometimes struggled with that (e.g., wanting to be White, like their mother, and not wanting to be Black or non-white Hispanic, like their father) or wanting to be an American (and not a Canadian) or wanting to be a dog (and not a human). I have thought about these desires as, perhaps, an indication of a more general identity confusion. Third, I was influenced by a remark Richard Pleak made in a 1999 essay, in which he wrote that the notion that “attempting to change children’s gender identity for [the purpose of reducing social ostracism] seems as ethically repellant as bleaching black children’s skin in order to improve their social life among white children” (p. 14). I thought about his argument and decided that it could be flipped. Thus, in the 2006 essay, I wrote:
This is an interesting argument, but I believe that there are a number of problems with the analysis. I am not aware of any contemporary clinician who would advocate “bleaching” for a Black child (or adult) who requests it. Indeed, there is a clinical and sociological literature that considers the cultural context of the “bleaching syndrome” vis-a-vis racism and prejudice (see, e.g., Hall, 1992, 1995). Interestingly, there is an older clinical literature on young Black children who want to be White (Brody, 1963)–what might be termed “ethnic identity disorder” and there are, in my view, clear parallels to GID. Brody’s analysis led him to conclude that the proximal etiology was in the mother’s “deliberate but unwitting indoctrination” of racial identity conflict in her son because of her own negative experiences as a Black person. Presumably, the treatment goal would not be to endorse the Black child’s wish to be White, but rather to treat the underlying factors that have led the child to believe that his life would be better as a White person. As an aside, there is also a clinical literature on the relation between distorted ethnic identity (e.g., a Black person’s claim that he was actually born White, but then transformed) and psychosis (see Bhugra, 2001; Levy, Jones, & Olin, 1992). Of course, in this situation, the treatment is aimed at targeting the underlying psychosis and not the symptom.
The ethnic identity literature leads to a fundamental question about the psychosocial causes of GID, which Langer and Martin do not really address. In fact, they appear to endorse implicitly what I would characterize as “liberal essentialism,” i.e., that children with GID are “born that way” and should simply be left alone. Just like Brody was interested in understanding the psychological, social, and cultural factors that led his Black child patients to desire to be White, one can, along the same lines, seek to understand the psychological, social, and cultural factors that lead boys to want to be girls and girls to want to be boys. Many contemporary clinicians have argued that GID in children is the result, at least in part, of psychodynamic and psychosocial mechanisms, which lead to an analogous fantasy solution: that becoming a member of the other sex would somehow resolve internalized distress (e.g., Coates, Friedman, & Wolfe, 1991; Coates & Person, 1985; Coates & Wolfe, 1995). Of course, Langer and Martin may disagree with these formulations, but they should address them, critique them, and explain why they think they are incorrect. I would argue that it is as legitimate to want to make youngsters comfortable with their gender identity (to make it correspond to the physical reality of their biological sex) as it is to make youngsters comfortable with their ethnic identity (to make it correspond to the physical reality of the color of their skin).
On this point, however, I take a decidedly developmental perspective. If the primary goal of treatment is to alleviate the suffering of the individual, there are now a variety of data sets that suggest that persistent gender dysphoria, at least when it continues into adolescence, is unlikely to be alleviated in the majority of cases by psychological means, and thus is likely best treated by hormonal and physical contra-sex interventions, particularly after a period of living in the cross-gender role indicates that this will result in the best adaptation for the adolescent male or female (e.g., Cohen-Kettenis & van Goozen, 1997; Smith, van Goozen, & Cohen-Kettenis, 2001; Zucker, 2006). In childhood, however, the evidence suggests that there is a much greater plasticity in outcome (see Zucker, 2005a). As a result, many clinicians, and I am one of them, take the position that a trial of psychological treatment, including individual therapy and parent counseling, is warranted (for a review of various intervention approaches, see Zucker, 2001). To return briefly to the ethnic identity disorder comparison, I would speculate that one might find similar results, i.e., that it would be relatively easier to resolve ethnic identity dissatisfaction in children than it would be in adolescents (or adults). Although I am not aware of any available data to test this conjecture, I think of Michael Jackson’s progressively “white” appearance as an example of the narrowing of plasticity in adulthood.
Two caveats: first, the literature on psychosis and ethnic identity conflict that is cited in no way was meant to imply that transgendered people are psychotic; the comparison is to a very small number of people who have “delusions” of gender change in which the primary diagnosis is Schizophrenia. This was first noted in the DSM-III and remains in the DSM-IV text description; second, I can criticize my own argument along these lines: “Well, this may all be true, but surely there is no evidence for a biological factor that would cause a Black person to want to be White, but maybe there is a biological factor or set of biological factors that either predispose or cause a person with the phenotype of one sex to feel like they are of the other sex (gender).” And to that I would say fair enough.
Bhugra, D. (2001). Ideas of distorted ethnic identity in 43 cases of psychosis. International Journal of Social Psychiatry, 47, 1-7.
Brody, E. B. (1963). Color and identity conflict in young boys: Observations of Negro mothers and sons in urban Baltimore. Psychiatry, 26, 188-201.
Brunsma, D. L., & Rockquemore, K. A. (2001). The new color complex: Appearances and biracial identity. Identity: An International Journal of Theory and Research, 1, 225-246.
Fuller, T. (2006, May 14). A vision of pale beauty carries risks for Asia’s women. New York Times.
Goodman, M. E. (1952). Race awareness in young children. Cambridge: Addison-Wesley.
Hall, R. (1992). Bias among African-Americans regarding skin color: Implications for social work practice. Research on Social Work Practice, 2, 479-486.
Hall, R. (1995). The bleaching syndrome: African Americans’ response to cultural domination vis-B-vis skin color. Journal of Black Studies, 26, 172-184.
Lauerma, H. (1996). Distortion of racial identity in schizophrenia. Nordic Journal of Psychiatry, 50, 71-72.
Levy, A. S., Jones, R. M., & Olin, C. H. (1992). Distortion of racial identity and psychosis [Letter]. American Journal of Psychiatry, 149, 845.
Mann, M. A. (2006). The formation and development of individual and ethnic identity: Insights from psychiatry and psychoanalytic theory. American Journal of Psychoanalysis, 66, 211-224.
Russell, K., Wilson, M., & Hall, R. (1992). The color complex: The politics of skin color among African Americans. New York: Harcourt Brace Jovanovich.
Sanders Thompson, V. L. (2001). The complexity of African American racial identification. Journal of Black Studies, 32, 155-165.
Schneck, J. M. (1977). Trichotillomania and racial identity [Letter to the Editor]. Diseases of the Nervous System, 38, 219.
Stephan, C. W., & Stephan, W. G. (2000). The measurement of racial and ethnic identity. International Journal of Intercultural Relations, 24, 541-552.
Tate, C., & Audette, D. (2001). Theory and research on ‘race’ as a natural kind variable in psychology. Theory & Psychology, 11, 495-520.
Ken Zucker

Genes and sexual orientation: Tale of two activists

Over at Americans for Truth About Homosexuality (AFTAH), Pete LaBarbera alerted his readers that he was on WGN last night in connection with a story about “gay genes.” He noted in a mass email yesterday (did anyone see it?):

Americans For Truth will be featured tonight in a story on the cable super-station WGN-TV, based in Chicago, concerning the latest academic pursuit of the “gay gene.” It will air between 9:00 and 10:00 Central Time on WGN which reaches across the country. You can learn more about the (liberal biased) Northwestern U. “genetic homosexuality” study at www.gaybros.com. As you know, pro-homosexual advocates are seeking to prove that homosexuality is genetic — with the hope of then declaring the issue outside the bounds of moral debate.

While this is not a strong denouncement of the project, it appears that AFTAH believes the research led by Alan Sanders is biased from the start. LaBarbera is right that some activists would like to prove a genetic source of homosexuality (case in point below). However, what if there are genetic components to sexual orientation? Is there any way to discuss or research these factors without being considered “liberal” and/or “biased?” Isn’t a blanket dismissal of pre-natal factors just as biased?

On the other hand, as if to prove LaBarbera’s point, enter Wayne Besen’s new videos from Dean Hamer and Jack Drescher.  To Dean Hamer, Besen poses the question, “Is homosexuality inborn?” Hamer replies that “there is more and more evidence that sexual orientation has a strong biological component.” Hamer then points to two “population based studies of twins.” One is Kendler’s study in the US and the other is Bailey and Martin’s study in Australia. Hamer says these studies “have shown that genes are the single most important factor in whether a person is gay or straight or somewhere in between.” He said the studies have been replicated and are convincing. I will save for another post a detailed response to those statements, but for now I will say that I do not agree with Dr. Hamer’s characterizations. For instance, in the Australian study, the actual concordance of homosexuality among male identical twins was only 11%. Kenneth Kendler and colleagues in 2000 found a higher concordance (31.6% combining males and females), but did not designate genetics as being a determining factor. About his study of twins, Kenneth Kendler told the BBC,

By no means is sexual orientation genetically determined but clearly genes are playing some role by interacting with a range of environmental factors.

Dr. Drescher’s video provides a more nuanced and I think accurate reading of research. About those who say they know what causes sexual orientation, Dr. Drescher says, “The truth of the matter is, we don’t know, nobody knows, and anybody who says that they know is lying to you.” Drescher also presents a reasonable view of the role of sexual abuse saying that for individual people, such abuse could play a role but as a general rule, believing abuse to be at root is an unfounded stereotype.

Now, coming full circle back to the website LaBarbera noted in his email – gaybros.com, we find a nuanced and I believe accurate view that cuts between activists Besen and LaBarbera. Here are a couple of excerpts:

At the present time, there is no uniformly accepted theory of why some men and some women develop a sexual orientation that is more or less exclusively focused on members of their own sex.

and

Most contemporary researchers believe that sexual orientation – the general disposition of people toward homosexuality, bisexuality, or heterosexuality – is the result of both biological factors and psychological experiences. Most researchers do not believe that sexual orientation is the result of nature (biology, including genetics) alone or nurture (environment) alone. What researchers want to know is how specific factors in biology and psychology interact to guide sexual development. These researchers therefore look for biological and psychological differences between homosexual and heterosexual people, both men and women.

Then after listing the many studies which find biological factors correlated with sexual orientation (e.g., finger length ratio differences, brain differences, etc.), the website says this:

These studies are designed to show a correlation between a trait and sexual orientation. This is not the same as showing that a trait causes sexual orientation. What is not yet known is whether these traits and sexual orientation have a common origin in genetics or other biological influences on development, though these hypotheses are being pursued. In any case, these lines of research are suggestive rather than definitive. Among other factors, it is these and other uncertainties that prompt continued research.

These statements sound anything but biased to me. All concerned would do well to heed them. Working hard to spin what is known may play well to activists but saying homosexuality is or isn’t all “genetic” or “inborn” or “environmental” does not well represent what is known. We need to follow the research where it leads and hold our theories loosely.