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Archive for December, 2010

The Science of Sexuality Explained

I’ve been so caught up crafting my own lengthy posts lately that I neglected to point out that Dr. Veronica Drantz recently posted video of her excellent presentation “Myth and Science of Sexuality – Disordered or Just Different.

Here is what the presentation is about, in Drantz words:

 

This video and the slideshow “Myth and Science of Sexuality – Disordered or Just Different?” of my presentation to the Ethical Humanist Society of Chicago on October 10, 2010,  explain the development of diverse sexualities (as natural variations of the organization-activation mechanism), and show that LGBTI peoples suffer persecution due to a socio-cultural disorder resulting from the erroneous “gender binary” concept.

I’ve linked to the slide show alone previously, but it really is MUCH better when you can listen to the presentation along with it.

Dr. Drantz does a phenomenal job covering a VAST amount of scientific information in a comparatively short span of time. But the nice thing about posting the slides and video is that it allows people who may feel overwhelmed absorbing so much all at once to go back and revisit the material at their own pace.

Regardless of your interest in trans issues, the science here is fascinating. I super-extra recommend watching the whole thing.

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Mid-Holiday Reflection 2010

In some ways this is my favorite time of year. Christmas and all the associated stress has passed. But there is still another (less stressful) holiday yet to come – the celebration of the New Year. Therefore no one is really in the mood to get back into serious work mode – even if they happen to spend the week at work. I spent almost a decade consulting at various companies, and in all that time I didn’t encounter a single company where this inter-holiday week was anything other than “relaxed.”

Mind you I was personally very “un-relaxed” this time of year over the same time span. The Christmas holiday always brought melancholy, which was usually compounded by seasonal affective disorder (SAD). During my depressed years SAD set in late November and passed around the middle of January, compounding my general and growing malaise with a perpetual physical weariness. On top of that I was beset with fear that my work achievements were never good enough, so if I relaxed over the holidays that would be the final straw (just for the record – this was pure paranoia. my work reviews over this entire period were invariably stellar).

But now that I am experiencing life with a calmer, healthier mind, this is a most excellent time of year. The kids have new toys to play with. The adults have food and drink; parties and cookie exchanging.

I took some extra days off this week, partially just to enjoy the free time. One of them was today. I spent it at the mall. Lunch with a good friend (sushi and ceviche – yum!).  New purse. New earrings. A lot of ideas for outfits I’ll find at better prices elsewhere. Overall just a wonderfully low-key way to spend an afternoon. If this is what is meant by “peace on earth,” Hark me some Herald Angels! I’m a fan!

It’s hard to remember what this week felt like even a single year ago. Things had started getting better, for sure. But this ability to simply relax and enjoy a quiet, simple week was still completely foreign to me. The past year has brought me that much. One can only imagine what the next year may bring.

2010 has been a very good year for me. To those who read this blog, I hope your holiday season will be just as good… if not this year, then another one soon.

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Boy Genes

A new development in genetic research has uncovered yet another mechanism for male sexual differentiation without a Y chromosome.

Adelaide researchers have discovered a way of creating a male mouse without a Y chromosome by activating a single gene, called SOX3, in the developing fetus. SOX3 is known to be important for brain development but has not previously been shown to be capable of triggering the male pathway. …

Associate Professor Thomas and his colleagues have generated male mice with two X chromosomes by artificially activating the SOX3 gene in the developing gonads.

“These XX male ‘sex reversed’ mice are completely male in appearance, reproductive structures and behavior, but are sterile due to an inability to produce sperm,” he says.

In the popular mind, “science” says chromosomes define your sex. But ongoing research in molecular genetics is increasingly showing this to be a crude and oversimplified version of the truth. But when the facts consistently run against popular beliefs, eventually those beliefs are destined to change.

And lest we doubt that this research says something about the mouse’s bipedal, house-ape cousins, the researchers note…

Further collaborative research with Professor Andrew Sinclair at the Murdoch Children’s Research Institute in Melbourne and Professor Eric Vilain at UCLA (University of California Los Angeles) has also shown that changes in the human SOX3 gene are present in some individuals who are XX males.

“From a genetic perspective, cases of XX male sex reversal are particularly intriguing and are poorly understood,” Associate Professor Thomas says.

“This discovery provides new insight into the genetic causes of disorders of sexual development, which are relatively common in the community.

“For the future, this discovery will impact on the molecular diagnosis of these disorders and, ultimately, help us to develop therapies or technologies to improve clinical outcomes,” he says.

While some religious and social conservatives urge resistance to abandoning the chromosomal  XX = girl, XY = boy formulation, science marches on.

The march of scientific progress doesn’t always leave our pre-conceptions happily intact. Yet it can leave us happier still if we’re willing to show humility toward the facts.

There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.
Hamlet Act 1, scene 5, 159–167

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Note: This post is the continuation of a series regarding the current scientific understanding of transsexualism. It is intentionally light on scientific jargon and footnotes (though I can’t avoid them all), as it is an attempt at a narrative summary of complex underlying material. Some references are provided at the end, but none of these concepts are derived from a single source.

I left of the “Fact Not Opinions” series many months ago, so it probably makes some sense to summarize the series so far before proceeding.

The Story So Far

As the first post indicated, this series was motivated by my desire to get beyond the “X mind trapped in a Y body” analogy regarding transsexuals. After all the brain is a part of the body. If we mean “brain” when we say “mind,” then the truth we seek doesn’t lie in sharp rhetoric or forceful opinions, but rather in physical, empirical facts. Further, if these facts indicate that our bodies (especially our brains) do not match the gender we have been assigned, then our reality as transsexual beings cannot be a matter of opinion, nor can it be a matter of mental pathology. It must be a matter of fact.

The second post in the series reviewed the history of the psychiatric / psychological attempts to “cure” transsexuals by making their minds conform to their external bodies. A century of evidence strongly backs the conclusion that this approach doesn’t work. However when the alternative approach was finally attempted – using surgical reconstruction to make the bodies match the minds – it was met with success by all the relevant psychiatric measures. The psychologists still couldn’t explain why the one approach failed so conclusively, while the other approach succeeded. But evidence gradually overwhelmed disbelief, so that the “make the body match the mind” approach became the standard psychological treatment for a properly diagnosed transsexual.

The third post in the series began to explore the biological nature of gender formation. It reviewed the “nature versus nurture” controversy over the establishment of human gender identity. The two main views were represented by John Money, who believed that human babies are undifferentiated in terms of gender until many months after birth, and Milton Diamond, who believed that humans had their gender established via the Organization-Activation mechanism beginning in utero. The “John/Joan” case seemed to prove Money’s contention, while undermining any biological cause for transsexuality. However later followup studies exposed “John/Joan” as a fraud, discrediting Money’s contentions while simultaneously indicating that human gender conforms to the organization-activation theory, as Diamond predicted.

So now it’s time to get into organization-activation itself, and attempt to apply its mechanisms to understanding human sexual differentiation. But before we can do that we need to understand how organization-activation theory fits into the overall process of human sexual differentiation. And in order to do that, a primer on the topic is in order.

Beyond Chromosomes

Just about every educated person is taught that human sexual differentiation is a matter of chromosomes. If the chromosomes show an XY pattern, that indicates a male. If the chromosomes show an XX pattern that indicates a female. For the vast majority of humans this is certainly true.

But it can also be said that we know this is not true in every case. There are a number of known intersex conditions, ranging from people with rare chromosome patterns (e.g. XXY), to people born with with opposite physical anatomy than their chromosomes would indicate (i.e. XY girls, and XX boys), and this is only scratching the surface of medically known variations. In order to explain the alternative development patterns leading to these non-standard outcomes it is necessary to understand more than simply chromosome patterns. It is necessary to understand how the chromosomes themselves do the work of sexual differentiation and how, sometimes, they may not follow the expected pattern of development.

In 1947, French endocrinologist Alfred Jost demonstrated that both XX and XY mammals would develop as females if the XY mammals were castrated in utero before sexual differentiation. The implication of this work was that female represented the “default” state of sexual development in mammals. In other words, in the absence of additional factors driving a fetus to develop as a male, we get a female. But what were these additional factors driving male development? Jost’s work suggested the driving force was not  chromosomes, but rather the presence of absence of the male gonad. But as all fetuses begin without sexual differentiation – including their gonads – this begged the question. How and why was the gonad differentiated in the first place, and why was there such an overwhelming correlation with the presence of a Y chromosome?

Genetic Differentiation

Studying the Y chromosome, scientists first linked the development of male testes to a single region of said chromosome (a region known as TDY, for Testes Determining Region). Subsequent research isolated testes development still further to a single gene known as SRY (for Sex-determining Region Y). Most of this was discovered by studying XX male individuals; living demonstrations of just how little Y chromosome material was needed to cause a fetus to develop as male (genetic material from a Y chromosome can pass to an X chromosome due to  abnormal recombination during male meiosis). It is now believed that the SRY gene is the sole trigger which sparks an otherwise female mammal to develop as a male.

To extend the analogy of the trigger a bit further, if SRY is a “trigger,” what does it “fire?” Being a gene, SRY is essentially a blueprint for manufacturing certain proteins. So when the SRY gene is “fired,” production of SRY proteins begins. But what do these SRY proteins do?

Here we start to hit against the edge of current scientific understanding. We know that SRY proteins bind to certain genes. We don’t know exactly which genes they bind to. It is suspected that bound SRY acts as a transcription factor, causing other genes to be expressed. It is not certain which gene or genes these might be (it isn’t even known if SRY binds to one gene or multiple). In addition to causing some genes to be expressed it has also been hypothesized that SRY may cause other genes to be repressed. The exact mechanisms underlying all of this remain unknown. What is known is that both the timing and the level of SRY expression are critical. If either of these factors is off, it can lead to the development of an XY female.

In summary, the SRY gene, properly timed and expressed, will lead a mammal to develop testes. Absence or under-performance of this gene will lead a mammal to develop ovaries. The main role of both of these organs is the secretion of specific kinds of hormones.

Hormonal Differentiation

The importance of testes or ovaries in early sexual differentiation is keyed upon the hormones they secrete. Unfortunately our understanding of this at present is very one-sided.

Early research into sexual differentiation was based in the belief that the development of a male required biological processes triggered by hormones, while the development of a female merely required the absence of these hormones and processes. It is now known that this assumption was false. Both paths of development require distinct and equally complex biological processes triggered by the presence and/or absence of hormones. However there remain strong indications that one of the key roles of male hormones during fetal development is to counter certain “default” female development pathways. Nonetheless, our knowledge of hormones in male development is greater than the female equivalent at the present.

Hormones are often called the body’s  “chemical messengers.” They work by penetrating target cells and binding to specific receptors. Once a hormone finds its proper receptor it causes certain genes to be expressed, which in turn cause certain proteins to be created, which in turn trigger still further development. If a hormone cannot bind to its target receptor, it can have no effect. (So far we have followed a well researched path involving the development of hormone secreting glands. Keep in mind that the far less understood processes underlying the development of cellular hormone receptors are equally important to sexual differentiation.)

In mammalian sexual differentiation hormones first play an active role in the development of distinct sets of anatomical structures.

Anatomical Differentiation

A clear example of male hormones inhibiting an otherwise female direction of development involves MIS, the müllerian inhibiting substance (sometimes called AMH, or anti-müllerian hormone). Regardless of eventual sex, all mammals possess the building blocks for two sets of internal reproductive structures known as the Müllerian and Wolffian ducts. The Müllerian duct is capable of developing into female internal structures (fallopian tubes, uterus, cervix, etc.). The Wolffian duct is capable of developing into male internal structures (epididymis, vas deferens, seminal vesicle, etc.).  Once the male testes develop they begin to secrete the MIS hormone, which has the dual purpose of developing the cells which produce testosterone and causing the Müllerian duct to degenerate. In the absence of this hormone, the Wolffian duct will degenerate and the Müllerian duct will develop. This is one of many examples illustrating that ultimately it is the presence or absence of hormones driving the sexual differentiation of a bi-potential anatomy.

The continuing development of the male testes leads to the development of two additional key hormones, testosterone and dihydrotestosterone, or DHT. Testosterone triggers Wolffian duct development , and serves as a building block for the creation of DHT. DHT is responsible for the development of male internal and external anatomical structures. Further,  DHT is known to have a role in organizing (per organization-activation theory) sexual differentiation in the brain (more about that in a moment).

External genitalia are determined by the effect of DHT around the 9th week of fetal development. At this time the external genitalia consist of a bi-potential genital ridge rich in DHT receptors. In the presence of sufficient quantities of DHT, the genital ridge will develop into a scrotum and penis. In the absence of DHT (or if this is lacking in sufficient quantity), the genital ridge will develop into a labia and clitoris.

All the physiological sexual differentiation examined to this point is capable of speaking to the vast majority of currently known intersex conditions. But it still cannot explain transsexualism. In order to do this we need to take one further step.

Organization-Activation

We are now at the point of mammalian sexual differentiation where organization-activation theory comes into play. A quick definition:

The organization-activation theory posits that the nervous system of a developing fetus responds to prenatal androgens so that, at a postnatal time, it will determine how sexual behavior is manifest.

from the Abstract: Clinical implications of the organizational and activational effects of hormones. Diamond M., Horm Behav. 2009 May;55(5):621-32.

Lest this simple definition is unclear, I’d like to restate it. Diamond is suggesting that sexual differentiation in the brains of mammals – including humans – is accounted for by prenatal male hormones, exactly the same way they account for the development of earlier anatomical structures. This prenatal brain differentiation accounts for later differentiation in behavior between males and females.

This notion, if true, is directly applicable to exploring a biological basis for transsexualism. We have already established that if an XY individual lacks sufficient male hormones, that individual will develop the anatomy of a female. Conversely, if an XX individual begins producing sufficient male hormones, that individual will develop the anatomy of a male. Interruptions or variations in expected hormones cause interruptions of variations in expected sexual differentiation – causing total sexual reversal in extreme cases. Organization-activation suggests that this very same principle is at work in the sexual differentiation of an area of mammalian biology (i.e. the brain) linked to identity and behavior.

Or, in Diamond’s own words:

I believe that transsexuals are intersexed in their brains as others are or might be more obviously so in their gonads, genitals, hormonal character, receptor, enzymatic or chromosomal constitution. And it is this brain intersexuality that biases the person to assert his or her gender identity.

If Diamond is correct it should be possible to find sexually differentiated structures within the brain within which transsexuals match their stated gender identity while at odds with their chromosomes or external anatomy. But that’s getting ahead of ourselves. We’ll save that for another post.

In Summary

For those who stuck with the post this far, let’s sum up. Here is what we know about the process of sexual differentiation in mammals (including humans):

  1. Chromosomes carry sexually differentiating genes (chromosomal differentiation).
  2. These genes, once expressed, (genetic differentiation) …
  3. cause the development of hormone secreting organs . These distinct sets of hormones (hormonal differentiation)…
  4. … result first in the development of sexually differentiating anatomical structures (anatomical differentiation)…
  5. and later the same hormones play a role in sexual differentiation of the brain (organization-activation).

Further Reading:

Sex Determination and Gonadal Development in Mammals
Beginner’s guide to genetics: Sex and genetics
Chromosomal Sex Determination in Mammals
PowerPoint Slideshow: “DISORDERED OR JUST DIFFERENT? MYTH, SCIENCE AND SEXUALITY.”

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The Need for Makeup

Looking at the blog lately, I realize I’m not keeping very close to my mission statement. Ostensibly this is a blog about my thoughts about “navigating gender transition.” The last few posts have gotten a bit off the mark from that. I suppose it’s time to tap into my inner Juliet Jaques and dish on some of my ugly, awkward transition related details. Today’s topic… makeup.

It took me a long time to understand makeup.

Before I had my facial hair removed, makeup had the singular purpose of covering my disgusting beard shadow. In order to do that I applied a heavy foundation dolloped on with a virtual trowel. The end result was a face so overly caked up that it might belong to a figure in a wax museum. It looked and felt terribly unnatural, and I hated it.

I hated it so much that I didn’t really bother with makeup for years. Of course this meant I didn’t go out and socialize as a woman either. But I didn’t feel like I had another option. I refused to trowel on makeup like a drag queen just to go shopping or to have coffee with a friend. There was so much I needed to fix before I should even begin to worry about makeup, I told myself.

Then came the time for my real life transition and I realized I didn’t know what I was doing. I no longer had a beard to hide (yay!), but then what the heck was the purpose of makeup now? Why do women feel the need to make themselves up when they obviously “pass” as female without it? This may sound like I’m making a joke, but it was a serious problem I needed to face at that point. Before this point I needed makeup in order to have any chance to be seen as female in public. But now my need was much subtler.

And it was a real need, not simply a want. Women in my profession routinely wear makeup into the office – it’s a matter of everyday professional appearance. I may not need makeup at home, but the office was another matter. Mission number one for my workplace transition was to blend in, not to rebel against the conventions of beauty. I was going to be under enough of a microscope anyway. Others would find it easier to respect me if I could at least look like I knew what I was doing as a “normal” woman.

So at the age of… um… let’s just say at an age well beyond the norm for a woman, I found myself trying to learn how to apply makeup in an everyday manner. Much like any late-blooming girl I was doing this as a purely defensive act – I didn’t want to get laughed at for not knowing. And like any late-blooming girl I felt completely overwhelmed by the variety of products available, but embarrassed to ask for help.

I’ll skip past the gory details of how I learned to do things. But in essence I learned a few important lessons.

  1. Good skin equals less need for makeup.
  2. You don’t need a lot of different products for an everyday professional look.
  3. You don’t need to spend a fortune for an everyday professional look.
  4. Makeup looks best when it’s not obvious that you’re wearing it.
  5. It’s okay to be confused about the more elaborate (and optional in the everyday sense)  styles of makeup – most other women are just as confused.

But there was one other lesson I learned that was more important than all of those. I learned that makeup, like any other aspect of a woman’s appearance, relies upon a large component of being yourself. On the surface that may sound like a contradiction but it’s not. For example I have a friend of similar age who spends quite a lot of time and money on her everyday makeup and she looks fabulous. If I did the same I would look weird. It doesn’t suit my personal style.

Some people may laugh about someone “being themselves” with makeup. After all, isn’t makeup about making yourself look better than you really do? Yes, but so is clothing and we don’t walk around naked all day.

Anyway I still have loads to learn about makeup… just like I still have loads to learn about myself and my personal style. But at its heart I discovered that the basic need for makeup is easily conquered by taking ownership of my own appearance. After that the options are truly endless, and the only person who knows which of those options I personally need is myself.

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A lot of recent discussion about the scientific basis for transsexualism has gotten me in the mood to write about that topic. It’s not the first time. Last summer I wrote three posts as part of an ongoing series, “Transsexuals – Facts Not Opinions.”  (For those who missed them, here are the links: Part 1, Part 2, Part 3)

I left off part three with the following statement:

“Next post, I’ll start to explore some of [the] research attempting to describe the mechanisms involved in organization-activation within humans, and how this relates to transsexuals, intersexed people, and everyone else.”

In case it’s not self-evident, that was a rather ambitious goal for someone on the cusp of some fairly major life-altering events. Check that. It was a rather ambitious goal period. It became a laughably unrealistic goal considering said life-altering events. Or at least it was for a time.

But now that my life has calmed I’m starting to regain my capacity for digging deep into complex and unfamiliar topics. And wow, does this topic ever require that capacity!

When you look into the science underlying gender identity you get into areas which lie at the cutting edge of current scientific understanding. There is very little written for the easy consumption of the general layman with an interest in this topic. To get far beyond your high school biology basics – and this topic requires that we do – you’re mostly dealing with sources that involve scientists writing for other scientists within very specialized areas of research. It’s incredibly interesting but it’s also extremely difficult to assemble into any kind of “big picture,” which is the goal of my narrative.

I tried to rely upon the narrative instincts of Dr. Veronica Drantz as my unofficial guide. Dr. Drantz is a physiologist who put together a series of presentations (including this mega-presentation) attempting to address this topic for general audience, and in my opinion she does an excellent job of it. However I ran into a problem trying to draw from her approach. Drantz’s presentation relies heavily on visual illustrations to address some of the baseline physiology. When writing in narrative form I need to accomplish the same thing with words… and the words in question are things like “bipotential primordium,” “dihydrotestosterone,” and “5 * reductase receptors.” Since I can’t translate those into pictures I need to translate them into more easily understandable text.

To perform this textual translation I looked for assistance from two other sources. One is a journal intended for medical students, from which I identified a “Beginners guide to genetics: sex and genetics.” The other is a recent article about “sex determination and gonadal development in mammals” from the American Physiological Society.

One thing you’ll notice about both of these articles is that neither one is intended to speak specifically about gender identity, or transsexualism. These sources are focused, instead, on the basic mechanisms underlying sexual differentiation in mammals. In trying to build this narrative it became clear that  in order to understand the discoveries speaking to gender identity formation in trans people, we need to understand how it appears to be like or unlike what we know about sexual differentiation in the “standard” model. And, in case you didn’t know, the standard model of mammalian sexual differentiation is WAY more complex (and more of a mystery) than anything you learned in high school biology.

This is a long way of explaining that I am once again intending to put together, in as many posts as it takes, the promised narrative covering current understanding about the physiology underlying transsexualism. Right now I have something in my draft folder called “Big Ol’ Physiology Post” containing a lot of bullet points and quotes and a semi-coherent narrative sequence. Given enough time and cursing I should be able to turn that into some kind of post within the next week or two.

In the mean time, if anyone knows of other good examples of such work I might be able to draw upon, please let me know.

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The Burning Monk

In 1963 a Buddhist Monk in Saigon, South Vietnam wanted world attention to understand the persecution of Buddhists under South Vietnam’s Ngô Đình Diệm administration. So this monk, Thích Quảng Đức, went to a busy intersection in the heart of Saigon. Once there, with much buildup so that the cameras of reporters around the world could witness the event, he performed ritual suicide by setting himself on fire. The action was a success. The world turned its attention to Vietnam. Photographs of the self-immolating monk resonate to this day.

Much more recently, a trans woman embarked upon a mission at least as shocking, trying to call attention to the plight of trans women facing barriers to obtaining basic transition related medical procedures. She didn’t succeed at winning the world’s attention to the extent of the Buddist monk. But her attempt to do so was no less courageous or outrageous.

Jadis Illiana Argiope recently attempted to perform a self-orchiectomy (a.k.a. castration) while broadcasting the event on web-cam and publicizing it on Twitter.

Her description of the event (which she dubbed Operation Tranny Freedom) is NOT for the faint of heart. And yeah, this strikes me as insanely risky. And yeah, the parent in me would have caused me to try to stop her by any means at my disposal had I been aware at the time. And no, I’m not going to be cool with this if any of my friends or readers tries to repeat the procedure. But still.

I don’t want to read too much into Jadis’ motivation. Clearly most of it was about her personal trans anguish over being in the wrong body. But she was just as clearly ALSO motivated by trying to send a message to the medical establishment. Here’s an exerpt making it plain:

I didn’t get into any of this out of ego, I got into this out of desperation. I had to remember my mission, my purpose. I had to collect my bearing. Back to business then. I explained, how, where, and why I did all of this. I even made sure to mention that I was attempting this live on stickam, while tweeting, and talking to people on the phone, just to show how important this public service announcement of mine really was! T-Girls simply can’t get the help they need without sacrifising a great amount of their quality of life.

It’s a message the medical establishment needs to hear. Just like some women are going to have abortions even if you make them illegal, some trans people are going to take medical matters into their own hands if their medical providers play keep-away with their medical needs. Many of them will fare worse than Jadis and die as a result.

Transsexualism is not a medical condition that solely afflicts the wealthy. People of all ages and income levels are equally afflicted. Yet the current situation in the U. S. is to price access to trans surgery like a luxury commodity. It’s considered “cosmetic surgery,” akin to that sought by wealthy women in  Beverly Hills who turn themselves into living Barbie dolls by paying buckets of cash. That is the medical model applied to treating transsexuals with one exception… Transsexuals ALSO need to spend months in therapy to get “official” permission before they’re allowed to spend buckets of cash out of pocket on their medical procedures. That’s kind of funny if it’s only “cosmetic” surgery, eh?

I think what Jadis did was foolish, reckless, crazy, ill-advised, and horrifying. I also think it was brave, self-sacrificing, and understandable once you understand what transsexualism really is. And if you can’t understand it you clearly don’t know what transsexualism is.

No one should have to resort to this. But people will continue to do so until this condition is treated responsibly by the medical community at large.

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