Dysphoria, Sexual Assault, PCOS, and Autism: Connecting the Dots

This post is a pastiche of various articles that you can find linked below.

The standard narrative of men who become women goes something like this: “I have always felt that I was born in the wrong body. I have always been feminine in my interests and feelings. My desire to change sex is about my gender identity and not my sexuality.”

This narrative has been termed “the feminine essence narrative,” and it represents both what most laypeople believe to be true, as well as what transsexuals are likely to say publicly. The narrative has been extended to an etiological theory, which has been called “the brain-sex theory of transsexualism.” The transsexual advocacy website, transsexual.org, puts this theory succinctly:

A transsexual is a person in which the sex-related structures of the brain that define gender identity are exactly opposite the physical sex organs of the body.
Put even more simply, a transsexual is a mind that is literally, physically, trapped in a body of the opposite sex.
IN A NUTSHELL: Transsexuality means having the wrong body for the gender one really is.

The standard, feminine essence narrative, and the associated brain-sex theory are incorrect, in the sense that they do not represent reality, even if they do correspond with many transsexual individuals’ beliefs and identities.

The Proceedings of the National Academy of Sciences effectively put to rest the theory that such a thing as a female and male brain even exists:

Whereas a categorical difference in the genitals has always been acknowledged, the question of how far these categories extend into human biology is still not resolved. Documented sex/gender differences in the brain are often taken as support of a sexually dimorphic view of human brains (“female brain” or “male brain”). However, such a distinction would be possible only if sex/gender differences in brain features were highly dimorphic (i.e., little overlap between the forms of these features in males and females) and internally consistent (i.e., a brain has only “male” or only “female” features). Here, analysis of MRIs of more than 1,400 human brains from four datasets reveals extensive overlap between the distributions of females and males for all gray matter, white matter, and connections assessed. Moreover, analyses of internal consistency reveal that brains with features that are consistently at one end of the “maleness-femaleness” continuum are rare. Rather, most brains are comprised of unique “mosaics” of features, some more common in females compared with males, some more common in males compared with females, and some common in both females and males. Our findings are robust across sample, age, type of MRI, and method of analysis. These findings are corroborated by a similar analysis of personality traits, attitudes, interests, and behaviors of more than 5,500 individuals, which reveals that internal consistency is extremely rare.
Our study demonstrates that, although there are sex/gender differences in the brain, human brains do not belong to one of two distinct categories: male brain/female brain.

It is physically impossible to be born with a brain – or any organ, really – of the sex opposite the sex you are. The brain-sex theory of transsexualism can thus be discarded.

That done, to determine the etiology of transgenderism it is useful to look at twin studies.

Twin studies are instrumental in elucidating the degree to which a trait is biologically determined before birth. Since monozygotic twins are conceived with exactly the same DNA and are exposed to the same prenatal environment, traits that are solely determined by genes and/or by the prenatal environment, will manifest in both identical twins 100 percent of the time. Race is an example of a trait that identical twins share 100 percent of the time because it is solely determined by genes.

The largest transsexual twin study to date examines 110 twin pairs and was published by Dr. Milton Diamond in the May 2013 issue of the International Journal of Transgenderism. 19 Table 5 documents that the number of monozygotic twin pairs concordant for transsexualism is greater than that of dizygotic twin pairs. This suggests a possible biological predisposition for gender dysphoria. The most significant data entry, however, is the low number of concordant monozygotic twin pairs. Only 21 monozygotic twin pairs out of a total of 74 monozygotic pairs, or 28 percent, were concordant for transsexualism; the remaining 72 percent of identical twins were discordant for transsexualism. This means that at least 72 percent of what accounts for transsexualism in one twin and not in the other occurs after birth and is not biological. Only 28% is genetic.

For comparison, twin studies reveal that additive genetic factors account for approximately 40% to 60% of liability to anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED).

Such a high discordance rate among identical twins proves that no one is born pre-determined to have gender dysphoria let alone pre-determined to identify as transgender or transsexual. The low concordance rate also supports the theory that persistent GD is dues predominantly to the impact of non-shared environmental influences upon certain biologically vulnerable children. At the same time, there is no single family dynamic, social environment, adverse event, or combination thereof that has been found to destine any child to develop GD. There are many paths that may lead to GD in certain predisposed children.

The overlap between childhood gender discordance and an adult homosexual orientation has long been acknowledged and I’ve already discussed it in depth in my previous post, today I want to focus on other factors I have not yet mentioned (I will not discuss sexologist Dr. Ray Blanchard’s transsexualism typology, and what it means. For more information on autogynephilia, see The Elephant In The Room and Anne A. Lawrence’s book Men trapped in men’s bodies).

I want to start with a Finnish study, published in April of 2015 in the journal Child and Adolescent Psychiatry and Mental Health, which found that girls presenting to gender clinics in that country have an increased rate of autism spectrum disorder as well as other mental health problems. The researchers found a 26% incidence of ASD in the study cohort.

Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common. […] In the majority of the applicants, gender dysphoria presented in the context of wider identity confusion, severe psychopathology and considerable challenges in the adolescent development.
Of the applicants, 57% had been significantly bullied at school. […] Of those who had been victims of bullying, 73% had been bullied before they came to think about their gender identity. […] Of those bullied, 27% reported that bullying had been related to gender presentation or sexual identity, and 73% had been bullied due to some other reasons.
Of the applicants, 45% had presented with periods of isolation from peer relationships; 32% before and 40% after the onset of gender dysphoria, and 43% were socially isolated during the SR assessment.
Seventy-five per cent of the applicants had been or were currently undergoing child and adolescent psychiatric treatment for reasons other than gender dysphoria when they sought referral to SR assessment. […] Sixty-four per cent were having or had had treatment contact due to depression, 55% due to anxiety disorders, 53% due to suicidal and self-harming behaviours, 13% due to psychotic symptoms, 9% due to conduct disorders, 4% due to substance abuse, 26% due to autism spectrum disorder, and 11% due to ADHD. One severe case of anorexia nervosa was noted. Of the applicants, 68% had had their first contact with psychiatric services due to other reasons than gender identity issues.

The overlap between autism spectrum disorders and gender dysphoria has been recognized before. In a Dutch gender identity service, 9.4% of adolescents presented with autism spectrum disorder. In our sample, 26% of the adolescent SR applicants were diagnosed to be on the autism spectrum. […]
Gender identity issues could arise from autism spectrum people’s predisposition toward unusual interests, or gender dysphoria in ASD could represent OCD rather than genuine gender identity issues. […] Our clinical impression is that a long-standing feeling of being different and an outsider among peers could play a role in ASD children developing gender dysphoria in adolescence. In our clinical sample of gender dysphoric adolescents, autism spectrum disorders by far exceeded the prevalence of 6/1000 suggested for general population

It turns out that the link between ASD and GD has been noted by many other researchers, clinicians, and, many parents as well. Poor social and/or communication skills, a hallmark of ASD, as well as a tendency to have obsessive interests, to isolate socially and spend inordinate and unusual amounts of solitary time on the Internet, have been noted by both professionals and parents.

A 2014 study from Washington, DC found that:

Children and teens with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) are much more likely to express a wish to be the opposite sex compared with their typically developing peers, new research shows. […]
Compared with normally developing children, young people with ASD were nearly 8 times more likely to express a desire to be other than their biological sex — a phenomenon the authors describe as “gender variance.” Those with a diagnosis of ADHD had more than 6 times the odds of communicating gender variance, according to parent-reported data.

In 2016 there was a documentary on British TV about the London-based Tavistock and Portman ‘gender identity clinic’, which revealed some terrifying statistics:

This gender clinic “treats” children as young as three. (”Three children aged three were referred to the clinic in the past year, compared with none in the previous year.”)
“Ten years ago, the Tavistock received 40 referrals a year; in 2016 it is 1,400 [as of 2020 it’s close to 3000]. Boys were once the majority – now around 1,000 of its patients are girls.” In one year – 1,400 children. 400 boys, 1,000 girls. The number of children referred in 2015 was more than double the 2014 number. That’s a 100% increase.
And while: “The latest prevalence studies of autism indicate that 1.1% of the population in the UK may have autism.”
50% of the children referred to the Tavistock gender clinic – two thirds of which are girls – are on the autism spectrum.

One comment on a 4thwavenow’s post submitted by a teen girl who says she is autistic, appears to support some of these findings.

I’m autistic and a LOT of autistic girls my age (teenagers) I know from support groups (to learn social skills, etc) are questioning their gender/thinking about transition. I mean a much much higher percentage than not-autistic girls I know… The majority of girls in those groups consider themselves genderqueer/bigender/nonbinary & some talk about transitioning or at least “presenting” as a boy…
I wonder if the number of transgender/gender questioning autistic girls is bc autism makes all this gender stuff really hard – there’s hypersensitivity to touch/smell/etc which means many of us can’t shave, can’t wear makeup or tight-fitting feminine clothing, can’t have long hair (bc it touches your skin in unpleasant ways), wear nail polish (it smells too strong) etc.
Also ppl think girls have better social skills than boys… so a lot of autistic teenage girls end up feeling like they’re “not girl enough”, like all the other girls can do those things easily and they can’t & that probably means they should be a boy.
Idk if this explanation is too simple, there’s probably more to it, but I’m really noticing how MANY autistic girls are in this situation, of wanting to be called “he”, to pass as a boy, to get breast surgery, etc, compared to not-autistic girls my age, and I wish the links between autism and transgender/discomfort with gender were explored more, so we could better help them. If autistic/other disabled people are more affected by dysphoria than the general population, we really should be wondering why? instead of just “accepting that their body is wrong for them”… Why would so many autistic girls’ bodies be WRONG? For no reason???

“Why would so many autistic girls’ bodies be WRONG? For no reason???” As you might suspect, trans activists don’t appear to be much troubled by such questions.

In March 2020, Stonewall published a new schools guide ‘An Introduction to Supporting LGBT young people’, replacing the guide of the same name published in 2015 which is no longer available from the website. They advise that teachers reinterpret behavior characteristcs typically associated with autism as a sign that the child might be transgender:

Often a child or young person’s words or actions are automatically attributed to their SEND without considerations of other factors, such as their orientation or gender identity. This might include: preferences for clothing types or hair length being seen as a sensory need; fear of change at puberty; behaviours described as a new special interest, fascination, curiosity or phase.

The belief that we have been mis-diagnosing children as autistic and that really these children have been transgender all along, is a belief of another of the most extreme proponents of gender theory in the US, Johanna Olson-Kennedy, and by the CEO of Mermaids, Susie Green.

In a live Facebook event during Olson-Kennedy’s visit to the UK last year, on the subject of autistic children she claims “there are people whose symptoms of autism go away when they are affirmed in their gender.”

The completely unevidenced claim that transition is a magic cure for autism has also been heard in the UK from GIRES in their response to the NHS public consultation in 2016:

Anecdotally, young people who have been successfully treated, are often described as having no residual ASD. The symptoms have disappeared once the dysphoria has been treated.

There is a strong movement from the most fervent believers in gender ideology to re-diagnose everything from common adolescent angst to diagnosable conditions, including autism, as evidence of hidden gender dysphoria. This is a slide from Aydin Olson-Kennedy’s presentation at the EPath conference last year, enthusiastically tweeted by Mermaids, which suggests that anything and everything may be a sign that a child is ‘transgender’.

Do I need to provide commentary on this?

I will say one thing: Fifteen years ago, Lupron was peddled as a cure for autism.

Moving on.

This study, “Association between polycystic ovary syndrome and female-to-male transsexuality”was done in Japan and examined 69 participants who presented themselves to a Japanese gender clinic. None of them had received any hormone treatment.

Polycystic ovary syndrome (PCOS) is characterized by chronic anovulation, polycystic ovarian morphology, and biochemical and/or biological signs of hyperandrogenism (The Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group, 2004). Most women with PCOS also exhibit insulin resistance and hyperinsulinaemia, which is independent of obesity (Dunaif et al., 1989). Insulin resistance is defined as a diminished ability of cells to respond to the action of insulin and predisposes one to type 2 diabetes mellitus. In addition, insulin resistance is associated with hypertension, dyslipidaemia, obesity and atherosclerotic cardiovascular disease (DeFronzo and Ferrannini, 1991).

What’s the association between FTM transsexuality and PCOS? How many in this study were diagnosed with it?

On the basis of the Rotterdam 2003 criteria, 40 of the 69 FTM transsexual patients (58.0%) participating in this study were diagnosed as having PCOS.

58%. Fifty-eight per cent.

Want to know the normal incidence rate of polycystic ovary syndrome? Of course, you do. It’s 4–12%.

Our findings show that many cases of FTM transsexuality are associated with PCOS and hyperandrogenaemia, which suggests that they are important factors in the pathogenesis of FTM transsexualism. In addition, our findings also suggest that when administering androgen therapy to FTM transsexual patients, it is important that practitioners keep in mind that this treatment worsens insulin resistance.

How does that not establish a causal link between FTM transsexualism and polycystic ovary syndrome? Why not treat the PCOS first, rather than making it worse with hormone therapy that increases insulin resistance? Could gender dysphoria in these patients simply be a psychological result from PCOS? Why treat the GD instead of the PCOS? If you treated the PCOS, would the GD resolve?

This study Female Gender Scheme is Disturbed by Polycystic Ovary Syndrome: A Qualitative Study From Iran claims

Women with PCOS are challenged in their perceptions of themselves as “feminine” because of their hairy appearance, irregular menses and lack of fertility and this influences their gender roles. Medical practitioners must understand how PCOS precisely affects women’s roles and initiate management aimed at reconstructing their “womanhood”, along with their medical treatment.

Now what these authors meant by “reconstructing their womanhood”, I do not want to know. But I do see dots that need connecting here.

Finally, it is a well-established observation that individuals suffering from gender dysphoria (GD) demonstrate an increased prevalence of mental health issues when compared to the general population (1). One theory that explains the link between GD and mental illness is the minority stress model (2,3). Gender-non-conforming and GD youth experience elevated rates of victimization, discrimination, and prejudice. According to the minority stress theory, these adverse experiences are the primary cause of the poorer mental health status of GD individuals.

There are two issues which contradict the minority stress theory. First, evidence shows that mental health issues often precede the onset of gender identity concerns (4–6). Second, long-term studies have not been able to demonstrate lasting mental health benefits of “gender-affirmative” (hormonal and surgical) interventions (7–9). These findings do not support the argument that minority stress is the primary reason for the high co-occurrence of GD and other psychiatric disorders.

An alternative explanatory model for the co-occurrence of GD and other forms of distress and mental illness is that both arise as a result of a complex interplay of biological, relational, and cultural factors (10–14).

In January 2021, Frontiers in Psychology published a study from the Children’s Hospital at Westmead and the University of Sydney Medical School which examined the quality of attachment patterns in children and adolescents presenting for care to a gender service. It assessed 57 GD children and adolescents presenting for care at a newly established gender service. The majority of the GD study subjects had prepubescent onset of GD. This GD group was compared with children with other psychiatric disorders but no GD (n = 51), as well as a group of healthy controls (n = 57). The researchers examined the quality of their attachment patterns, the number of reported adverse childhood events (e.g., instability, parental psychiatric disorders, financial stressors, maltreatment, etc.) and the rates of unresolved loss or trauma.

Various key findings emerged from the analyses:

88% of children and adolescents from the GD group had a comorbid mental health diagnosis. Approximately 50% of them had a history of self-harm and reported suicidal ideation; 60% had experienced bullying. Global level of functioning was also affected, with impaired overall health and well-being.
When compared to healthy controls, youth with GD reported significantly more adverse childhood events and higher rates of unresolved loss/trauma. Moreover, they were mostly classified into at-risk attachment categories, whilst healthy controls mostly displayed normative (low risk) patterns of attachment.
However, when comparing the GD youth to the group of youth with other psychiatric disorders but no GD, no difference was found between the two with regard to rates of unresolved loss/trauma, adverse childhood events or the quality of attachment patterns.
GD youth with at-risk patterns of attachment were more likely to come from families with a low socio-economic status, and more likely to have experienced maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, and exposure to domestic violence).

The study adds to previous studies reporting high rates of at-risk attachment patterns and early traumatic experiences among individuals with GD (10–14).

This emerging evidence suggests that multiple and seemingly unrelated factors can converge into specific forms of emotional distress, including GD.

And interesting is the whole of Brian Belovitch’s memoir Trans Figured: My Journey From Boy to Girl to Woman to Man.

At the dawn of the disco era, in those early days I was beginning to feel a stronger desire to alter my identity. The decision to begin transitioning to the opposite sex was one of great joy, but it also came with an incredible sense of reckless apprehension. The excitement I felt was tempered with a healthy dose of skepticism that I was unable to express to anyone. This was coupled with an unbearable amount of sadness from the rejection that I knew I would ultimately experience. Still, I wasn’t able to change the course I’d set for myself. I had this uncontrollable desire to fit in and if it meant changing my gender to do so, then so be it.
As a somewhat effeminate gay boy, my prospects for love were practically non-existent. Gay men of the 1970s were looking to meet other men on the more masculine end of the spectrum. Some guys might have found me attractive as a boy, but it seemed I got way more attention when I dressed in drag. It became a way for me to hide the loneliness I felt as an awkward slightly chubby young man. Sure, I found a way to have sex with other guys, but for the most part it felt that no one was ever going to want to be with me the way I was, which in retrospect was not necessarily true. However, I didn’t have the maturity or the self-esteem to see any future life as a gay man. Dressing as female caused much more of a sensation. There were a whole slew of bisexual or closeted men who preferred me in drag. What started out as a fun expression of creativity became a more serious manifestation of my wanting acceptance and approval outside of myself. I became hooked on the drug of adoration and acceptance of others for how I looked externally, but not for who I was as a person.

Belovitch grew up in an abusive, homophobic family, he was sexually assaulted as a teenager and bullied relentlessly for being gay. He decided to transition because he thought he’d have a better time living as a woman. He lived as a trans woman for 15 years, he was big in the NY gay and drag scene. He struggled with alcohol and substance abuse and engaged in street prostitution. Eventually he got clean and started going to therapy, learned he was HIV positive and detransitioned to live as a gay man. He’s now happily married to another man and works as an addiction councelour.

So why does all of this matter? What is the point of this post?

Well, maybe, just maybe, those other issues need to be addressed. They should be addressed before hormones are administered. What if the other, very common, comorbid disorders and traumatic experiences are actually the cause of the body dissociation that is now celebrated and promoted as “gender identity”?

I highly reccomend the book Cracked: Why Psychiatry Is Doing More Harm Than Good where James Davies argues that psychiatry, as an institution, by giving promince to certain disorders in the DSM, can help endorse the idea that that disorder is a legitimate way through which young people can express distress. He makes use of a very interesting metaphor – that of the “symptom pool”. Each culture possesses a metaphorical pool of culturally legitimate symptoms through which members of a given society can choose, mostly unconsciously, to express their distress.

This idea helps explain, among other things, why symptoms that are very common in one culture are not in another. Why, for example, do men in south-east Asia experience what’s called koro (the terrifying certainty that their genitals are retracting into their body), but not men in Wales or Alaska? Or why do menopausal women in Korea experience hwabyeong (intense fits of sighing, heavy feeling in the chest, blurred vision and sleeplessness), but not women in New Zealand or Scandinavia?

If enough people begin to talk about a symptom as though it exists, and if this symptom is given legitimacy by an accepted authority, then, sure enough, more and more people will begin to manifest that symptom. As our symptom pool alters, we are given new ways to embody our distress, and as these catch on, they proliferate.

This idea implies that certain disorders we take for granted are actually caused less by biological than cultural factors – like crazes or fads they can grip or release a population as they enter or fade from popular awareness. This is not because people consciously choose to display symptoms that are fashionable members of the symptom pool, just that people seem to gravitate unconsciously to expressing those symptoms high on the cultural scale of symptom possibilities. And this of course makes sense, as it’s crucial that we express our discontent in ways that make sense to the people around us otherwise we would risk not being taken seriously or not being cared for – human beings seem to be invested with a developed capacity to mold their bodily experiences to the norms of their cultures, they learn the scripts about what kinds of things should be happening to them as they fall ill and about the things they should do to feel better, and then they literally embody them.

There needs to be a discussion about the pathways that can lead to gender dysphoria. Of course, in order to do that, we need first to acknowledge that there is no innate gender identity, and this trans activists refuse to do.

But couldn’t it be that we have it exactly backwards? It’s the brain that is mistaken–not the body.

Sources:

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