Sunday, June 3, 2012

The Transgender Issue

This story came at a time when we were talking about such issues in neuroscience. True hermaphrodites (able to both father and mother a child) are extremely rare so the large majority are somewhere in between. Androgen insensitivity syndrome means a developing male fetus does not respond to the testosterone that the testes secrete. It's a well documented syndrome and there's a paper by Imperato-McGinley and Canovatchel in the 1992 issue of Trends in Endocrine Metabolism that discusses a few case studies as well as the proposed mechanism.

Around week 7 of gestation, the SRY gene on the Y chromosomes of genotypic males is expressed to stimulate normal testicular development. The testes then secrete two hormones: Mullerian inhibitting factor (which blocks the default development into female reproductive tracts) and testosterone. Testosterone is converted by 5-alpha reductase to dihydrotestosterone which causes the male genitals to develop. All of that can happen just fine, but if the receptor for dihydrotestosterone is defective, then a 46XY genotypic male with normal and elevated androgen levels will develop into a phenotypic female.

This 'female' will be unable to have children since MIF is secreted normally which disrupts formation of the uterus and most of the vagina. Since SRY gene is expressed normally she will have testes in the inguinal area. Since they appear as a normal female, they are usually only diagnosed once they come in to be treated for amenhorrea.

Likewise, genotypic 46XX females can present with male genitals if they were exposed to high levels of androgens during development from congenital adrenal hyperplasia or very high maternal levels.

We know that Adam fell and that brought about some sweeping changes. "Because of the fall our natures have become evil continually" (Ether 3:2), "that old serpent did beguile our first parents, which was the cause of their fall; which was the cause of all mankind becoming carnal, sensual, devilish, knowing evil from good, subjecting themselves to the devil" (Mosiah 16:3), "the fall had brought upon mankind spiritual death as well as temporal" (Alma 42:9). It's also implied that the fall brought pain, anguish, struggle, but also the possibility for growth, achievement, and work which allows us to increase our capacity.

To what extent the fall affected our identity, reason, intellect, genetics, physiology, biochemistry, and emotions is a question that begs asking but unfortunately for now, lacks an answer. As members of the Church of Jesus Christ of Latter-day Saints we know that "gender is an essential characteristic of individual premortal, mortal, and eternal identity." In the case of the 1,000 or so born in the United States each year with ambiguous genitals, which gender do you choose? The genetic one or the phenotypic one?

Trasngender operations make the issue even more complicated. How do you assign priesthood responsibilities? To what extend can you choose your gender?

1 comment:

  1. We had a case study about this in my Anat and Phys book, and I've thought about it.. You really put some interesting thoughts into it. I enjoyed reading it.
    It's good to hear about medical school and what it's like!