But first a note of explanation and kind of an apology

I decided to write this post because David Lewis engaged me on Twitter last night on the topic. I assume he saw my other post on transfolk and Dr. Peikoff because Diana linked to it in her WTFerfuffle WTFuffle post. Whatever brought him there, we tried having a Twitter conversation about it, but the format is all wrong for such a complex topic. Because Diana’s post and all those other topics are so fresh in my head, I thought it would be best to address the topic a bit more completely and calmly and non-snarkily.

In my last post on this topic, I was definitely snarky toward Dr. Peikoff’s comments on the topic. I’m not sorry for that; I firmly believe that if someone, anyone, says something that is so ridiculously divorced from reality as, “they don’t have the pleasure part connected to the nervous system,” I can pretty much guarantee I am going to laugh in their face. Aside from the mockery of those remarks, I find it incredibly frustrating and infuriating that a man as intelligent and accomplished as Dr. Leonard Peikoff would find it at all acceptable to issue extreme moral pronouncements against people (Like nazis?! REALLY?!?) on a topic of which he clearly has extremely little knowledge. So, I want to be clear: I find Dr. Leonard Peikoff’s remarks on transfolk utterly unacceptable, wildly inappropriate, unjustified, and unjust. And I think he really ought to have done at least a little bit of research to get some of the basic info before making a public statement on the topic.

But I do want to be clear: even though I make jokes at Dr. Peikoff’s expense and even though I strenuously disagree with him on this and other topics, this does not mean that I think he’s a horrible human being and unworthy of respect and admiration.  It is undeniable that he has done much for Objectivism and even though my experience Objectivism has had relatively little direct exposure to Dr. Peikoff and his work I am grateful for what he’s done. My personal attitude toward him is much like I might have for a well-loved grandparent who sometimes says crazy things. If I didn’t value his opinions and insight greatly, it probably wouldn’t bug me so much when he gets it wrong.

I know some people believe I am disrespectful toward Dr. Peikoff when I make so many jokes about things he says. I suppose that is true enough, but I have never and would never claim to love everything about Leonard Peikoff without reservation, qualification, or limitation. There are things about him that I really don’t much like.  Fortunately, as far as I am presently aware, those things are as far as I am concerned without much significance or consequence in light of the sum of who he is and what he’s accomplished.

So, if I have made light of Dr. Peikoff’s virtues or mocked what is good about him or lead someone to believe that the summation of my estimate of the man is anything less than “extremely impressed and eternally grateful for his work,” I would offer my sincerest apologies and look for some way that I could try to make that right. It is a matter of justice to make it clear that I do hold that esteem for his life’s work and accomplishments.

And as a rule I’m going to try to make a better effort to be more patient and respectful of those who disagree with me in general. (I can’t promise that I’ll stop making irreverent jokes, because that’s how I do, but I will make an effort to be a bit more judicious with them.) I’m sure sometimes I will be wrong as I have been wrong in the past and I would appreciate if my friends would set me right as best they are able with patience and respect as well.

***

Before I get into this, I do want to qualify my remarks by saying I am not an expert on this topic.  I have at least one person whom I regard as a friend who is a transwoman and an Objectivist. I watched a discussion panel in college that discussed trans issues and experiences. And the rest of my knowledge comes from my own research and exposure to information from friends, the internet, the media, etc.  I maintain that the basic, essential facts around transsexuals are readily available to those interested in doing a little digging for it and I think if one is going to issue some moral pronouncements on the matter one ought to get some of that information straight.

This post is intended to make a little of that research easier for those interested in the topic. It’s not intended to be a comprehensive resource, though, so if you’re very interested, do keep researching.

A Few Resources

How Gender Reassignment Works – There’s a podcast that corresponds to that link which can be found in the iTunes store on the Stuff You Should Know podcast. Here’s a direct link to the MP3 if you like. It originally aired on 10/19/2010, I believe. I listened to it on my drive to Pennsylvania over the holidays. The best part about this site and the podcast is that it is very easy to understand and accessible to the casual reader/listening.  Unfortunately, that does make it seem like it’s light on real facts or science, but don’t be fooled; the end of the article contains a rather long list of sources and resources for additional information.

American Psychological Association on Transgender – I find the interface for this site tedious and it’s somewhat boring to read, but it’s the APA, so I regard the psychological information there as being authoritative. (Did you notice that I’m not a psychologist or any form of brain doctor? Well, I’m not, so I trust the brain doctors on such topics.) Here’s a link to the APA’s policy statement on non-discrimination against trans folk.

Kinsey Institute – That is a page that discusses gender terminology, but Kinsey is a great resource for all things related to sex.

Inner Discovery Network – I don’t know what this is, but it seems to be written by a transgender person and I found it remarkably robust in the way it considers all sides of the discussion.

Wikipedia – Hey, it’s a good starting place!

Dr. Anne Vitale – She’s a licensed psychologist who seems to do a lot of work on gender. Her site has a ton of info including this FAQ section. It’s kind of fuzzy and vague on some points, but I found it somewhat useful, so I thought I’d share.

Dr. Anne Lawrence – You can find pictures of SRS here. Do I need to warn you about what you’ll see there? OK. WARNING: NOT SAFE FOR WORK.

DSM 5 – This is the section on Sex and Gender Disorders. Try not to get distracted reading about all the strange disorders that are out there.

A Few Terms

Sex: Yes, this might refer to sex acts, but here I want to draw a distinction between sex and gender and when I say “sex” I want you to yell “OH YEAH!” I kid. (I didn’t say I wouldn’t stop making jokes altogether!) But seriously, when I say “sex” I’m referring to whether or not someone is biologically male or female. Sounds simple, right? Well, not so fast.  I will discuss the challenges here in a bit.

Gender: I know many will likely scold me for not drawing a distinction between gender identity and gender expression, but for the sake of simplicity I am going to assume that most of the time our expression matches our identity or, if they don’t match, then we are working to correct that in some way. So, when I refer to gender, I’m broadly referring to how one conforms to our expectations about how men or women should look or act.  The adjectives for this are “masculine” and “feminine” and you all can readily see that there’s a haziness around those terms and there’s a spectrum along which people fall in various aspects of their lives.  What you need to note is that some men are rather feminine and some women are rather masculine.  So, gender and sex are distinct concepts referring to two separate things.

Sexuality: This is sexual identity. You know, gay, straight, bisexual, whatever. I’m listing here so that you’ll just note that there are various “mis-alignments” between sex, gender, and sexuality that affect how people identify themselves. So, someone might be a straight male who likes to dress as a woman. Or someone might be a gay female who is very girly and effeminate. And so on and so forth.

Cis-: This prefix signifies the opposite of trans-. I looked it up and apparently it’s a Latin prefix meaning “on the same side [as].” Basically, if you are a man whose gender identity is also male, then you’re a cismale.

Trans-: If you’re transgendered, your gender identity doesn’t conform to your sex. A man who is “trapped in a woman’s body” is a transman. I believe use of this prefix also implies that the subject is pursuing a life in some degree or another that conforms with their gender identity.

SRS: Sex-Reassignment Surgery

Gender Identity Disorder (GID): This is the formal diagnosis that doctors use to describe people who are unhappy with their biological sex.

A Few Facts

Transgender people have a real issue with which they must deal.

I am not a psychologist or a brain doctor or anything like that, but there is a real and actual problem in their lives and until it is resolved they cannot pursue happiness and fulfillment. This issue is called “Gender Identity Disorder,” but simply because you see the word “disorder” it is not proper to assume that it is also pathological. “Disorder” here just means something is “out of whack and needs to be fixed” and a pathology would mean that it causes injury or disease. I would not presume to suggest the cause of this issue, but I would challenge the presumption that being transgender is the result of some conscious choice to wage a war on reality. Recent studies have even suggested that some transfolk have structural differences in their brains even before hormone therapy, so it seems like biology may even play a role in some cases.

Part of the problem is that this is not a simple question. People with GID frequently have other psychological issues that need to be addressed. This isn’t surprising, though. If you’re cis- can you imagine the trauma you would feel if you woke up tomorrow with the body of the opposite sex?

Some people are wrong

As far as I am able to determine, the best approach to dealing with this is to start with therapy on any other issues such as depression, substance abuse, etc. before moving on to gender identity therapy.  Beyond that, the psychologist would work through the gender issues to determine if transitioning makes sense or if any alternative approaches are available.  The process seems to take quite a long time, years even.

I struggled to find any resources that say that sometimes people go into therapy with GID and are able to reverse it. Such situations seem to be implied, but not stated outright. But there are some people who go all the way through SRS and transition but later regret it.  Some of those people get even more depressed or attempt to commit suicide.  Unfortunately, you can’t reverse SRS completely, so it can be a big problem. Of course, there are a great many more who do not.

So, it’s not easy to say the thousands upon thousands of individuals who have gender dysphoria and say that they are all faking, mistaken, mis-integrated, or waging a war on reality. Some may be those things and more.  But there seem to be a sizable number of people for whom transitioning to the other gender is the best solution available to them. As with so many things in life, it would seem that one’s individual context is critically important to deciding what the best way to approach the problem is.

SRS works… kinda sorta

First, it bears pointing out that male-to-female and female-to-male sex reassignment is not the same. They each have their own challenges and levels of success. And it also bears pointing out that there is a whole host of procedures that can be done, not just the one or two that you’re thinking of.

From Stuff You Should Know:

Male-to-female patients may have several genital surgeries including orchiectomy, penectomy, vaginoplasty, clitoroplasty and labiaplasty. A transwoman might also choose reduction thyroid chondroplasty, suction-assisted lipoplasty of the waist, rhinoplasty, facial bone reconstruction (which may include hairline correction, forehead recontouring, brow lift, rhinoplasty, cheek implants, lip lift, lip filling, chin recontouring, jaw recontouring or tracheal shave) and blepharoplasty. Some patients have vocal cord surgery or voice training.

Genital surgery for female-to-male patients may include hysterectomy, salpingo-oophorectomy, vaginectomy, metoidioplasty, scrotoplasty, placement of testicular prostheses and phalloplasty (the creation of a neophallus or surgically constructed penis). A transman may also undergo elective surgeries like liposuction to reduce fat in hips, thighs and buttocks.

So, it’s no simple matter.

But from what I can tell, Male to Female (MtF) procedures usually produce better, more natural-looking results and FtM is also often prohibitively expensive.

But can post-operative transsexuals experience orgasm? Yes.

Obviously, there are limitations to how successful the procedures are depending on the individual’s medical conditions and the desired results. There’s a link in the resources section above with pictures. Yes, pictures, so please don’t act all shocked when you see surgically altered genitals there. I warned you.

A Few Philosophical Notes

Morality and Transsexuals

In order for us to consider whether or not it is moral to pursue sex reassignment, we have to know whether or not these individuals have a choice in the matter. I think it’s pretty clear that having GID is not a matter of choice, but the question is: when an individual is going through therapy for GID, do they have a viable choice not to undergo SRS and still live a rational, happy, fulfilled life?

There’s no simple answer to this question as far as I’m able to determine.  As mentioned above, according to medical and psychological professionals, SRS is not right for everyone, but it is the best solution for some.

Some transfolk cannot afford surgery. Hormone therapy is expensive in itself and some of them seem to seek contentment with that and simply living as the opposite sex without the surgeries.  Unfortunately, this means that they cannot really enjoy a sex life the same way they could if they did have the procedure. Dr. Peikoff even said once that being celibate is “a fate worse than death” and I am inclined to agree.

So, if someone consults with their doctors and the consensus is that the best course of action is SRS, and they can afford it and everything, should they do that or should they continue to pursue other, costly alternatives that their healthcare professionals agree will be less satisfying ultimately? I cannot see why they should not pursue SRS.

Morality and Doctors

Given the reasons and the conclusions outlined above, I think it’s obvious that I think in the proper context the doctors who help transfolk with the treatments best suited for their individual conditions up to and including surgical intervention are doing the moral thing.

Complaints about Completeness

One of the complaints that some Objectivists and others may have about transfolk is that their condition leads them to deny the facts of reality. Usually, men are born with an XY sex chromosome pair and women are born with an XX pair. No amount of surgery, no matter how successfully performed or natural the results will change that.  So, if someone with an XY pair starts telling people that they’re “a woman,” then it is argued that they are lying. This complaint gets a bit louder when you consider the fact that the surgical options don’t result in a body that is completely indistinguishable from natural-born genitalia and many transfolk don’t even get the surgery due to expense or other reasons.

This complaint attempts to cast transfolk as attempting to pit the man-made, their own vision of their gender, against the metaphysically-given, their biological sex. This is indeed a serious concern, but is that really what’s going on? I don’t think so.

I think the first thing to note on this point is that transfolk aren’t in denial or denying that they were born the way they are. They acknowledge that and they also acknowledge the fact that they also have a condition which makes the way they were born unsuitable for pursuing happiness and so they seek to change it as well as medical technology and their resources allow.

Transfolk aren’t unhappy with their DNA as such. They’re unhappy with the way their DNA has expressed itself in the form of their body. I can’t think of another situation in which someone is judged by the content of their DNA, so it isn’t clear to me why this particular chromosomal pair is of importance by itself. As humans, individuals the valuable parts of us are not our DNA even if the majority our physical existence is primarily the result of how our DNA works. The valuable parts of us are our minds and the character we foster in ourselves.  It is how we apply our minds and bodies toward our values including in sex.  And we show blatant disregard for what our DNA has to say about things in other contexts, so why should this be any different? I had corrective surgery on my eyes in 2001 because my DNA had some notion to inconvenience me. Well, I shows it! A friend of mine had some genetic testing done that showed an extremely high probability that she would get breast cancer. Do you know what she did? She got new boobies! And she likes the new ones better, so yay!

And what if someone were born with the sex chromosomes of one sex and the genitals of the other?  Consider this article: Girl with Y chromosome sheds light on maleness

The girl has the normal chromosome count – 46 – and should be male. Other children who have the male sex chromosome but do not appear to be boys have been found to have gene mutations that temper the Y chromosome’s effects. However this child doesn’t have ambiguous gonads, shrivelled testes or other developmental defects. She instead has a normal vagina, cervix and set of ovaries.

I would argue that outside of some pretty rarified medical or scientific circumstances she is female. So, of what significance is it if the same result comes of medical intervention?

Another point to consider is that post vaginoplasty the transwoman has a vulva and a vagina. Structurally speaking, even if they appear malformed, they are still present and functional for sex and urination. One would not deny someone their gender over a birth defect, so why do it when the “defect” is man-made particularly when these new structures both function satisfactorily and help resolve a far larger problem?

After considering the above, I am inclined to call this complaint about completeness something of a rationalization wherein the person posing the complaint refers to some definition of “woman” or “man” and without regard to context.

In Conclusion…

This is definitely not an easy topic.  There seems to be a lot that is unknown about sex, gender, and sexuality yet, which puts people who have GID at a tragic disadvantage. I would not blame anyone for wishing for more information, better science, clearer definitions, better technology, or anything to make this less ambiguous.

What makes the topic so clear in my mind is the fact that I think it is undeniable that GID is a real problem and for some people — by the estimates of the best doctors in the field — the best solution for them is SRS.   But before someone second-guesses that recommendation and calls transfolk unkind names like “freaks,” they need to have some of the basic facts straight.  I hope some of the information in this post is helpful to anyone looking for some of those basics.