What makes a man, a man?

I've already posted about Thomas Beatie, a pregnant transgender man, here. Thomas was born physically female, but decided to transition to a male in his twenties. He underwent a double mastectomy and weekly testosterone injections, but decided to keep his uterus and ovaries so he could eventually have biological children.

Although Thomas' pregnancy is an unusual situation, all comments that I have encountered, both on and off the blog, have been positive. Then I came across this opinion-editorial by Jeff Jacoby in the online version of The Boston Globe. By reading the article, it is painfully obvious that Mr. Jacoby does not understand the concepts of transgenderism, intersexuality, gender, gender identity and gender expression. Worse still, even though Mr. Jacoby is entitled to his opinions (it is an op-ed piece after all), he lacks the common decency to refer to Thomas by his preferred gender pronouns, instead referring to Thomas as a "bearded pregnant woman." Conveniently, Mr. Jacoby throws in a few medical terms to beef up his article, but falls back on the age-old method of juxtaposing alternative lifestyles with morally reprehensible crimes like rape and incest. Surprising, he refrains from making the ever-so-popular allusion to bestiality.

Mr. Jacoby seems to have figured out what has eluded physicians, researchers and psychologists for centuries. Contrary to what Mr Jacoby believes, gender is not a "male-female dichotomy." Perhaps Mr. Jacoby needs some lessons in fetal development, genetics, physiology and psychology.

Most of us start out with 46 chromosomes: 44 autosomes and 2 sex chromosomes. We get 23 chromosomes from our mother and 23 chromosomes from our father, encoding everything from eye color to predispositions for diseases. Typically, an embryo's sex chromosomes are XX (female) or XY (male). Surprisingly, the sex chromosomes don't seem to play much of a role for the first few weeks of fetal development. An XY fetus develops the same way as an XX fetus, until a gene on the Y chromosome activates the production of testis-determining factor (TDF).

TDF induces the undifferentiated gonadal tissue to develop into testes instead of ovaries. As the testes develop, they begin to produce testosterone and a hormone called Mullerian-inhibiting substance (MIS). Testosterone induces the virilization of the external genitalia; the structure that could have formed the clitoris elongates into a penis, and the structures that could have formed the labia fuse into a scrotum. At the same time, MIS causes the Mullerian ducts to regress, preventing the development of the uterus, fallopian tubes, and upper part of the vagina. In the absence of TDF, testes, testosterone and/or MIS, genital and reproductive structures default to a female phenotype. This amazing tutorial from the University of Toronto is a great way to learn more about sexual differentiation of the fetus.

It's extremely important to realize that fertilization and subsequent fetal development don't always go so smoothly. For instance, sometimes embryos develop with XO, XXY, XYY or XXX chromosomes. Other times, certain hormones and genetic signals are missing or go unrecognized by the developing fetus. These differences can have physical, mental and/or behavioral effects on the resulting child. In some cases, a child can be born with one of several intersex conditions, with varying degrees of ambiguous genitalia. Historically, physicians took a "best guess" approach, and chose a gender for the baby. Any anatomical structures that did no fit the assigned gender were simply removed, and parents were instructed to discourage behavior that strayed beyond the assigned gender. Everything was done in the best interest of the child, often with catastrophic results. Children were often never informed of their medical conditions, fostering feelings of confusion and shame. Some adolescents began to realize that they were assigned the wrong gender, and that structures meant for reproduction and sexual satisfaction had been arbitrarily removed.

So how did we start off with a discussion about a pregnant man, and end up with a discussion about intersexuality? Not only do genes and hormones determine our external genitalia and internal reproductive organs, but they also effect our brains and mental gender identity. You know that internal dialogue that goes on in our own heads? Suffice it to say, the mind is infinitely more complicated than structures that ultimately amount to plumbing.

The point is, not everything can be scientifically measured or mathematically calculated. After all, we're flesh and blood, mind and spirit, not stone and mortar. How about we weigh and measure what we can, but not impose artificial measurements on things we can't? I choose to take people at their word, especially when they're talking about what's going on in their own heads. It's absolute arrogance to casually invalidate the personal thoughts, feelings, emotions and experiences of others. Shame on Mr. Jacoby for doing so.

Not everything is so black and white. What gender would Mr. Jacoby consider an individual with XY (male) chromosomes, with complete androgen insensitivity syndrome, who is externally phenotypically female and who identifies as such? What about an individual with Klinefelter's Syndrome whose chromosomes are XXY? What about a woman who has had a hysterectomy and double mastectomy due to cancer? What about a girl who "suddenly" grows testicles at the age of twelve due to 5-alpha-reductase deficiency, or a boy who loses his penis due to a horrible accident?

Congratulations to Mr. Jacoby for having it all figured out, but when discussing gender and gender identity, he should speak only for himself and not assign roles to anyone else. In the meantime, he should respect the wishes and gender identities of others without passing judgment, like when referring to Thomas Beatie's elation at being pregnant and feeling comfortable in his own male-ness; Mr. Jacoby asks, "Could anything be more incoherent or sad?" My reply is yes, your article.