Sunday, February 15, 2015

Neurological Intersex?

Having talked a lot about the need to include trans voices in the conversation, I'm thrilled that one of my friends offered to do a guest post. Edie is a transgender Catholic studying for a Masters in Theology.

by Edie Fetch

Recently, Carlos Flores of UC Santa Barbara wrote an article that’s been making the rounds among those sectors of Internet Catholicism concerned about trans issues. I felt that, as a transgender Catholic who is at least making a healthy go of trying to be both, it would be beneficial to engage Flores directly.

This is obviously something deeply personal for me; it is not solely an academic question but speaks about my deepest experience of myself. It has been an ongoing existential challenge for me, and one which I spent years deeply resisting. I even spent a year in seminary as part of my attempt to reify and strengthen the hard walls of the strict binary which I found myself constantly straining against.

That said, my goal here is not polemic; neither is it entirely personal. I am addressing Mr. Flores as a fellow ethicist and traveler, and assume nothing but the best of intentions.

I want first to note that I don’t know Mr. Flores; I can see, though, scanning his brief bio, that he appears to be a devotee of Elizabeth Anscombe and a writer for Ethika Politika; both of these things speak strongly in his favor, as Anscombe has become something of a philosophical hero of mine, and EP is a remarkable magazine.

But Flores’ article is profoundly wanting. This isn’t to say everything in it is off-base – he is quite right to call attention to the epistemological question of how a trans person can make the internal movement by which one identifies an inner sense of self with something exterior. It’s a question that keeps me up at night, and has caused me not a small amount of distress. Maybe we can’t account for this movement. Maybe it’s just a brute fact. But the fact remains that, accounted for or not, it happens. It happens all the time. And that makes it relevant data about human nature.

Mr. Flores questions the relevance of a distinction between sex and gender: why should how I identify be catered to when it’s contrary to reality? After all, he rightly points out that to all exterior appearances I am a male; why ought my self-proclaimed female identity be respected? This seems an odd question for someone who presumably believes that something which appears in every way like simple bread and wine might really be the Body and Blood of Christ – clearly, appearances are not all that matter – however, Flores also does not meaningfully consider the possibility that the distinction isn’t between something physical and something immaterial, but between two material things.

Human sexual identity – maleness and femaleness – is not confined to our genitals. As the future Pope Benedict XVI put it in 2004, “‘Sexuality characterizes man and woman not only on the physical level, but also on the psychological and spiritual, making its mark on each of their expressions.’ It cannot be reduced to a pure and insignificant biological fact, but rather ‘is a fundamental component of personality, one of its modes of being, of manifestation, of communicating with others, of feeling, of expressing and of living human love…’” Men and women are meaningfully distinct in ways that are not merely reproductive, or entirely social. Indeed, there is ample evidence of neurological differentiation. Consider the possibility – just the possibility – that dissonance between body and brain sex is possible, that neurological intersexuality is possible.

This is the possibility I’d like, above all, for Mr. Flores to admit. There is no comparable phenomenon by which someone might theoretically have a “black brain” but a “Swedish body,” as in his absurd Gunther example. Bodily sex in itself is a very complex phenomenon which is known to be subject to difficulty in the form of intersexuality, the incidence of which is far higher than Flores assumes. Many intersex people do not even discover their intersexuality unless they undergo hormonal or genetic tests. Intersexuality goes beyond ambiguous genitalia and hermaphroditism; it encompasses people who are genetically male but phenotypically female alongside various chromosomal irregularities like Klinefelter’s syndrome. The incidence is as high as a solid one percent.

Flores is simply dismissive of both neurological sex and the possibility that intersexuality might offer reasonable insight into trans experience. He insists (wrongly) that intersexuality is both restricted to genitalia and so exceedingly rare as to warrant no meaningful philosophical investigation. More than anything, this bothered me: that he seems profoundly uncurious about one of the central questions. And what a question to be investigated! What does intersexuality have to say about maleness and femaleness? Does it say that sex is up for grabs? Does it paint a gradient? How does this affect Catholic marital theology? These questions fundamentally matter. They matter deeply, both because questions of sexuality are a serious flashpoint in ethical, philosophical, and theological discussion, and because we are talking about real human beings. This is relevant data which he simply dismisses because he cannot account for it. In the hard sciences, this is called confirmation bias. In the humanities, it’s plain foolishness.

Whether or not you think it’s ok to pursue gender transition, intersexuality exists in a wide variety of forms. Whether you want to attribute this to God or to transcription errors in cell division or to hormonal problems in utero, the hard division between male and female does break down in certain areas on the level of the human body. It is therefore not impossible that this is a neurological phenomenon as well.

At present, studies regarding transgender brains are not conclusive, however a number of studies do suggest that transgender brains are structurally closer in key areas to their identified gender. Flores account of this, that “acting female” somehow changes our brains structurally, is both dubious and bizarre. In any case, I highly doubt he wants to attribute sex differences in the brain entirely to behaviour.

In support of his position, Flores cites Paul McHugh’s findings on transsexuality. Although neither Flores nor I have the necessary qualifications to offer a full critique of McHugh's research, it must be acknowledged that McHugh is not representative of the consensus view within psychology. Does this make him wrong? Not in itself, but when the bulk of an academic field repudiates a view, it generally means either that the view is unfounded or insufficiently supported by subsequent research. Given that McHugh represents a minority view, I am struck with the suspicion that Flores sought data in support of a conclusion. Anyone interested in a critique of McHugh can find one here.

Flores presents his argument as though the only possible explanation for trans experience is opposition between a delusional mind and a real, physical body. But what if it's a matter of one part of the body struggling against another?

The question is very much "what is that which defines me?" It's not easy to address.

It is easy to be dismissive of a sex/gender distinction when you don't feel any tension between the two. Cis people don't readily perceive themselves as having a gender per se because they have no reason to tease that concept out, having never experienced it as a tension (on a personal note, I have a great deal of difficulty understanding how it can even be possible that most people don’t feel this way, so the separation is entirely intuitive to me).

I suspect that primacy of identity belongs in the interior experience of the self rather than in bodily configuration; this is the human living as a human and not as an animal. I think one could reasonably define an animal's sexual existence by their genitals; I think this is much harder to do for a human being. Beyond the wealth of nuance in sexual expression and interests, human beings live their sexuality as creatures possessed of ratio, the ability to reflect on and examine their own existence. I think that that's not something to be ignored. I spoke earlier about the interior movement in which trans people recognize themselves in the opposite sex; this movement, which I can't adequately describe, is part of that rational self-examination. Does this reduce people to their brains? Perhaps. But better that than their genitals. That is more respectful of the totality of their being, instead of addressing people as though they -- and their sexuality -- were merely instrumental in the production of further people. I think we can reasonably agree that the rational power of man is the thing that makes

The theological questions are there; they have to be addressed. They have to be addressed honestly and plainly in the full light of both revelation and lived experience. Trans lives offer a wealth of data to be considered and thought through and yes, theologized. But this must be done with respect for their experience, and not simply by addressing whether they fit into the system. Trans and intersex people are a challenge to Catholic sexual theology. This challenge needs to be squarely faced.


  1. I find myself in nearly 100% agreement with this post - everything from the invocation of Eucharistic theology to the discussion of neurology and sexual identification is wonderfully lucid - but there's one very, *very* sensitive part that needs clarification:

    "I think we can reasonably agree that the rational power of man is what makes"

    I'm sure the author of the post knows this, but even I, someone without a moral theology degree, can see an obvious challenge to this particular claim: the existence of various cognitive disabilities, Down's syndrome, "vegetables" and other people made in the Imago Dei who don't necessarily manifest the rational qualities that allow this very discussion to take place. They are, needless to say, still human. I genuinely appreciate the author's overarching concern, and we need to respect the God-given gift of rationality, but we need to be careful on this particular point lest we descend to some "I think, therefore I am" Cartesian absolutism.

    1. Hey Andy,

      I didn't want to get into tooooo much fundamental moral theology here, but to clarify: no, that's not what I (or moral theology in general) meant by the above.

      The rational capacity is a power of the *soul*, and is the defining mark of man's *form*, speaking Thomistically. This has nothing to do with whether or not a human person has a body which is entirely capable of embodying this power -- the power of the soul remains.

      Thank you for your kind comment, and I understand your concern in the above. It's certainly a reasonable thing to ask about, and I hope I have to some extent explained it comprehensibly.

  2. Flores errs in assuming Gender to mean either a) the same as Sex or b) the sex we identify as/feel like. Apart from that, his is a very good essay on transsexualism.

    Fetch errs in not recognising that sex pertains to the whole body, not a part of it. Therefore all parts of a male are necessarily male. There can be no such thing as 'a male with a female brain'. Instead, such a person would have to be described as 'a male with a female male brain'. A male cannot blink or sleep without doing so as a male.

    Intersex bodies are either male or female, with their relevant sex obscured to some degree. Again, nothing else is possible. It is the order of 'male and female' that allows us to recognise disorders of sexual development (DSD/'Intersex'). Far from challenging Catholic sexual theology, DSD confirms its correctness.

    Intersex conditions are of the body, whereas a 'Gender identity' is a state of mind with respect to a state of mind - no connection to the body.

    May God help us in these times of unsurpassed confusion and deceit.


    1. Daniel,

      The difficulty with your argument is that by asserting that "all parts of a male are necessarily male," you have created a circular definition. Such an argument would create the absurdity of saying, for example, that the vagina of a person with androgen insensitivity syndrome is a "man's vagina" because the person has XY chromosomes, or conversely, that the XY chromosomes are
      "women's chromosomes" because the person has a vagina. Either way, the logic is absurd.

      The difficulty here is that sexual differentiation is a multi-stage process during and after fetal development, in which chromosomal expression is turned on an off at various points during fetal development, causing in various physical (phenotypical) results. That is, there is a dynamic interplay between genotype, environment and chance that results in the glorious physical (phenotypical) diversity of people that we witness in our daily lives!

      And some of these people are intersexed, which means that they have a mixture of variously stereotypically male and female genital and secondary sexual characteristics.

      While it may appear to us that an intersexed person is predominantly male or predominantly female, it does a terrible disservice to them to try to force their subjective experience of their body into a rigid gender category for our mental convenience. Disrespecting an intersex person in that way is contrary to the gospel and church teachings that we are to honor the sacredness of each individual life.

  3. I agree with gentlemind. The part does not destroy the whole. A brain that processes information or emotions the way most female brains do doesn't really prove anything. Many women have large male typical hands they are still women. Many men have wide feminine hips they are still men. We have to avoid the typical mind fallacy. Just because we experience gender dysphoria it doesn't follow that the way we feel corresponds in any way to the way it feels to be the opposite sex. No one can say how it feels to be man or women in the abstract. All we can do is describe our own experience as male or female. We can only be what we actually are and thats ok. I would just add that I really do enjoy this topic and I have a great deal of respect for Fetch and his courage to discuss this very private issues as well as his fidelity to Christ. I would like to add that I don't think persons with gender issues are a threat to the faith at all. I remember hearing a talk by Fulton Sheen he mentioned the man with the water pot on his head in the gospel of Mark, he directed the apostles on where to hold the Passover. Sheen claims that sending the apostles to a man with a water pot on his head would have been like sending them to look for a man using a pink parasol. I don't think Our Lord is afraid to use gender benders and instruments of salvation.

    1. Hey Joe,

      There's a critical difference between the hand and the brain.

      Speaking theoretically, as that's all we can do, let's assume for the sake of conversation that I have a 100% female brain. Not saying I do, but just work with me for a second.

      *If* brain sex is real -- and there does appear to be neurological sex dimorphism so that does seem likely -- *and* it is possible due to endocrinological problems or whatever that a person could be born with a brain sex that *does not match* their physical sex, fundamentally, then we could expect some problems to arise.

      Let's take this a step into the absurd; let us say tomorrow, your brain were transplanted into someone of the opposite sex; would you feel you were "really" that new sex? Or would you feel a great deal of dissonance? I expect the latter.

      You keep talking about what one "really" is; but the phenomenon seems to be so much more complex than that. Intersexuality is increasingly know to be quite common; there does, in fact, appear to be a wide grey area between male and female, and the brain is itself a sexually differentiated organ. If I have a female brain, what am I? Is my identity determined entirely by my genitals?

    2. I'm not sure what you mean by a female brain. Do you mean a brain that behaves in much the same way most a cis woman's brain behaves? Or do you mean a brain made up of female genetic material but inside a genetic male body?

    3. Joe, there are significant problems with determining maleness or femaleness solely on the basis of "genetic material." For example, consider the case of a woman with complete androgen insensitivity: she has male-typical chromosomes, but her body type, external genitalia, and gender identity are all female. In some cases, women don't even know that they have this condition until puberty -- and prior to the discovery of modern genetics there would have been absolutely no way of knowing that such a woman had an intersex condition at all. The point that Edie is making is that intersex conditions point towards the fact that there isn't a single, universal biological factor that can be simply recognized in every case to determine whether a person is really male or really female.

    4. Yes to Edie real quick I don't mean to dismiss your very real and painful gender dysphoria. I know it is real I just think it is fallacious to jump to the conclusion that an experience of gender dysphoria necessitates or justifies a change in identity. For instance a person with autism has atypical neurology for most humans that in no way diminishes their identity as a human being. A man with atypical brain wiring is still a man even if the feels uncomfortable with that identity.

      Melinda thanks for your comment. Yes I agree persons with androgen insensitivity are a hard case. But you'll notice Im arguing from the totality of the person not just the genetics. Ironically a person with androgen insensitivity usually doesn't experience any kind of gender dysphoria until after the genetics are discovered.(Maybe wrong about that thought) She is certainly female because the part (genetics) don't destroy the whole (everything else about the person) As catholics we consider the person in totality or substantial form. Lets leave the errors to the atheist reductionists.

    5. Brains don't have sex or gender, people do.

  4. I know that this is barely on-topic and you can remove this comment if you want. However, have you seen those click-bating online headlines about Pope Francis supposedly comparing transgendered people to nuclear weapons? I'm certain that Pope Francis never had that in mind, especially in light of his meeting with a trans-man (pardon me if that's incorrect). Unfortunately, his alleged demonization of trans lives is gaining traction. I don't know if you can do anything to halt it, Melynda, but perhaps you could comment.

  5. Hi Melinda. Thanks for taking the time to share your thoughts. I'm generally supportive of whatever people want to do as long as it doesn't bother others (or themselves). Until I read Flores' article,I was completely pro trans-gender. I'm not saying I'm not now, but it did start me to thinking. His comparison to anorexia was compelling. Just because someone has a brain that tells them they are overweight, does not make it so. In fact,as a society, we try to "fix" these people. Or his analogy to the person with age dysphoria, where the 6 year old believes he is 16. Should we let him drive a car? Why don't we think the same thing of people that believe they are one sex, when they are not?

  6. The "brain sex" thing is not really very compelling, because the brain is so plastic that we cannot say which way causation runs: whether there's some physical basis for the psychological experience, or whether the psychological experience has impressed itself on the brain. (People with BIID have been neurologically shown to have less sensation in the limb that isn't "theirs," but we don't know whether that causes or is caused by their emotional rejection of the limb.) I think it is *less* compatible with the Church's doctrine to believe in a "gender" opposed to one's sex than to accept gay marriage; the former posits a radically dualist/gnostic anthropology in which your body is not really you.

  7. I'm curious if anyone has come across any research that attributes a lack of desire to bear children as being at all connected to an intersex/hormonal condition. Most women I know have some sort of biological desire to have kids; I never have. I am definitely female in my appearance, physicality but this is an area I have found odd.

    1. I also look feminine but have no interest in having kids. I recently came across a really interesting paper that correlated in utero testosterone exposure with female gendered behavior. Your question reminded me of it because the list of what counts as female gendered behavior includes many items that deal with kids (number of kids, importance of children, interest in baby care). I don't count as very feminine by their list, despite feeling feminine and "reading" as feminine (or so people tell me). But I do have shorter index fingers than ring fingers, which is also an indication of high in utero testosterone exposure. Anyway, the upshot of the study was that testosterone exposure in utero "immunized" women against social feminization, whereas women with less testosterone exposure were more easily influenced by social pressure. Here's the study if you're interested:

    2. I know a priest who said he always fell in love but ever wanted to settle down, have kids etc. He later discerned he has a spiritual gift or charism called Celibacy -- scriptural. I just wrote about this elsewhere here.

  8. "Let's take this a step into the absurd; let us say tomorrow, your brain were transplanted into someone of the opposite sex; would you feel you were "really" that new sex? Or would you feel a great deal of dissonance? I expect the latter."

    Let's suppose the body of a Parkinson's sufferer replaced the body of someone whose brain remained unaffected. How would that person cope with a degenerative disease that would seriously affect their lifestyle in terms of movement, balance and physical ability? Would it be harder to accept being forced to live in that body, which was vastly inferior to the replaced body, than it would to accept being forced to live in a healthy body of the opposite sex?

  9. I want to push back a little on this: "I think one could reasonably define an animal's sexual existence by their genitals." I work with laboratory mice, and they have what appears to be gendered behavior, even when the sexes are kept separate. And there are experiments in which manipulating the brains of female mice makes them act like males. Certainly gender is more complicated in humans than mice, and I doubt that mice have a personal identity, but they at least have something in the neighborhood of a gender

    1. Jennifer is quite right that many animals have gendered behaviors that exist beyond the most immediate concerns of procreation.

      I'd further like to point out two other biological errors in the article:

      1) "I think one could reasonably define an animal's sexual existence by their genitals;"
      If this was so, then all animals would be exclusively heterosexual in behavior. Yet, to quote a wikipedia article that cites several peer reviewed scientific articles, "as of 1999, about 500 species, ranging from primates to gut worms, have been documented engaging in same-sex behaviors."
      Therefore, even the sexual behavior of animals is not entirely dictated by their genitals.

      2) "I think we can reasonably agree that the rational power of man is the thing that makes"
      First, of course, it is rather absurd to use such gendered language in an article about transgender experience; the rational power of *human beings* is what makes *human beings* ... *human beings*. But furthermore, it suggests that other creatures do not possess some degree of ratio. Yet we have much documented research on other mammals, such as dolphins and some primates being capable of rational problem solving. While I don't think it was Edie's intent to demean the rational capacities of our fellow creatures, it's an inaccurate subtext that should be challenged.

  10. No trans person has ever experienced being the opposite gender. So how can they reliably know if they have a 'female brain'? Is Gender dysphoria not just a projection of your own personal idea of what a 'female' way of thinking is, and how it relates to your person? No one can deny that it exists, but whether it is something you cannot change or 'recover' from like say, autism or even homosexuality, is beyond the reach of current understanding afaik. The following verse in Romans (9:20) seems appropriate, but how to interpret it is not clear. Does one accept their 'intersex' identity as God-given, as many of our 'thorns' and struggles are, or does one try to reconcile their gender with their sex.

    'On the contrary, who are you—mere man that you are—to talk back to God? Can an object that was molded say to the one who molded it, "Why did you make me like this?"'

    and of course

    'He answered them, "Haven't you read that the one who made them at the beginning 'made them male and female''


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