Complicating Biological Sex: Ethical Dilemmas – Gender Identity in Adolescence
Jocelyn Fine was kind enough to email me a personal story that fit very closely with one of the most
profound debates in gender: what to do about children who feel themselves to be trapped in the wrong
body. A good number of these children do not have any clearly recognizable genetic condition (like CAIS or
CAH). This may be a function of shallow understanding of how genetics influence gender or it could be that
these children’s desires to live in a gender different than their biological sex are not determined by genetics
but by something else.
Here is part of Jocelyn’s story (she will tell you the rest of it in class next week):
“My mother's friend from college, Julie, had a child who was born as female. The child's name was
Shayna. Shayna knew from as early as 9 or even before that, that "she" wasn't meant to be a "she" […]
When my mom visited Julie in California, and Shay[na] was only 9, Julie told my mom that Shay[na] was
already talking about not wanting to grow breasts […] her parents are very accepting, but at the same
time they knew it wouldn’t be easy for Shay[na] to grow up this way and said things to my mom like “It’d
be so much easier if she were just gay.” Shay[na]’s grandparents were not very accepting of Shay[na]’s
identity unfortunately and often make condescending or spiteful comments to Shay[na].”
As young as three years old, some children want to exhibit behaviors that connect strongly to the other sex:
boys who want to go to school in dresses and girls who want their hair shaved into buzz-cuts. Some
professionals and the Diagnostic and Statistical Manual of Mental Disorders label this behavior as “gender
dysphoria “ or “gender identity disorder.” (This is a source of unbelievably heated debate – many
transgender advocates insist that transgender is a “difference” not a “deficit” or “disorder”).
The question here is what parents/doctors/psychiatrists should do when young children present
with these desires. Should children be encouraged to conform to gender behaviors “appropriate” to
their biological sex? Should they be allowed to leave the house dressed in clothes associated with
the other gender? Should they be allowed to dress-up in the house?
With your group, discuss what advice you would give to parents/doctors/psychiatrists. What experiences
of ideas from your own life inform your decision? What is at stake here and why does it matter?
Remember, we are working on a “disconsensus” model so don’t be shy about recording a range of different
pieces of advice below:
Complicating Biological Sex: Ethical Dilemmas – Medical Interventions
There are currently three medical (as opposed to psychological or behavioral) interventions commonly
used with transgender children:
- children can be given contrasexual hormone blockers, which delay the onset of puberty. The prevailing
logic behind these treatments is that onset of secondary sex characteristics, like a deepening voice for boys
or the growth or breasts for girls, could be psychologically traumatic for children who have steadfastly
held to an gender identity different than their sex. By delaying puberty, they give these children another
few years to sort out their feelings about their gender identity. This therapy is reversible and has no long
term physical impacts. (The moment the blockers are removed, the child will develop secondary sex
characteristics).
- Sex Hormone therapy. This is the introduction of sex hormones that will produce secondary sex
characteristics associated with the child’s desired gender identity. Estrogen given to a boy wishing to live
as a girl will produce breasts; testosterone treatments given to a girl wishing to live as a boy will produce a
deeper voice and facial hair. Clinical trials have shown that this therapy is not without risks, including an
increased incidence of cancer and blood clots. Unlike the hormone blockers, sex hormone therapy is not as
readily reversed and sets in motion significant changes in the child.
- Sex reassignment surgery. This is surgery that involves removal or modification of primary sex features
to match that of the child’s felt gender identity.
All of these surgeries raise ethical issues, especially when it comes to children. Should parents and
their children be allowed to opt for sex hormone therapy beginning in a child as young as nine? At
what age, if at all, should sex reassignment therapy be legal?
With your group, discuss what medical standards you might establish for these procedures and spell out
your rationale. Remember, we are working on a “disconsensus” model so don’t be shy about recording a
range of different standards below.
Complicating Biological Sex: Ethical Dilemma – Facilities
Transgender children raise powerful questions for institutions such as schools. As a statistical minority at
high risk for bullying and depression, transgender children may already feel on the outside of their schools,
leaving these institutions to struggle with how best to respond to the needs of transgender children.
One particular site of controversy has been the question of bathrooms; specifically, whether or not children
should be allowed to use the bathroom associated with their perceived gender identity or whether they
should be compelled to use the bathroom of their biological sex. Put another way, should a seventh grade
XY-boy who dresses and sees himself as a girl use the girls’ bathroom, the boys’ bathroom, or a separate
bathroom all together? How about an XX-girl who dresses and sees herself as a boy?
With your group, what kind of school bathroom policy would you write up in regards to transgender
students? We are operating on a “disconsensus” model, which means it is okay, after serious discussion, to
propose two (or more) different proposals.
Please record your policy or policies below:
Complicating Biological Sex: Ethical Dilemma - Sports
As the science of sex typing has become more advanced, two conditions that have gotten a lot of attention in
the sports community are CAIS (Complete Androgen Insensitivity Syndrome) and CAH (Congenital adrenal
hyperplasia). The first condition results in boys who are born with genitalia that looks for all intents and
purposes like a woman’s (the testes are underdeveloped and often undescended). Because they lack the
receptors to translate testosterone into estrogen in the brain, they do not develop many of the secondary
sex characteristics associated with boys but still have the basic bone and body structure of a male. These
children are most often raised as girls and in a number of cases, neither doctors nor the parents are aware of
their condition.
CAH children are born with XX chromosome but produce significantly more testosterone, particularly in the
earlier months of life. This results in females developing much more masculine characteristics, including
muscle mass.
The question for debate is whether or not CAIS males, raised predominantly as girls, and CAH girls,
raised as girls but having been partially masculinized by production of extra testosterone, should be
allowed to compete in women’s sporting events. Further, should leagues use Gender Verification
Testing (GVT) on all female athletes and disqualify any women who has CAIS and/or CAH?
With your group, what kind of school sports policy would you write up in regards to these two conditions?
We are operating on a “disconsensus” model, which means it is okay, after serious discussion, to propose
two (or more) different proposals.
Please record your proposal(s) below:
1. Scenario Work in groups that I have created (20 minutes)
2. The Personal
* Jazz’s Story
(15 minutes)
3. The Scientific – access points: (20 minutes)
* The New American Article
* Two YouTube Videos – different points of view
* NPR.org – debate
4. Discussion
(20 minutes)
Barney’s Windows
http://www.youtube.com/watch?v=M9FL3cwdhFo