Adult Human female – the sequel

I was delighted when someone commented on my blog post Adult Human female with a thoughtful and opinion-filled reply. In my original post I had carefully considered the impact of the spread of the theology of Gender Identity through society and responded to some of its claims.

Here’s what I wrote:

If you would rather not read all about it, please visit my Puffins instead.

The response from Dr Patterson was so rich with suggestions, arguments, facts, opinions and beliefs that I thought it really deserved a proper response, rather than being abandoned as a comment at the bottom of the original blog post. She also emailed with some details about herself. Here she is:

“My credentials are as follows, not in order of importance:

I am a Ph.D. level psychologist with 30 years of combined clinical practice and teaching. 
I taught university level Women’s Studies from 1995 to 2011, and ran a small program (truthfully, a faculty of 2 to 3) in a semi-rural community college setting.  
I sat on the  Women’s Committee for my union, the Federation of Post Secondary Educators of British Columbia, from around 2000 to around 2011, chairing this provincial-level committee for two of those years.
I served three years on general council of Affirm United, a nation-wide network of lgbtq+ affirming churches under the United Church of Canada denomination. 
I’m in my 60’s, a lifelong feminist. 
I came out as a lesbian in 1996 and have lived a happy life ever since. 
I make a point of fostering inter-generational connections in queer community, by engaging in projects that span the  age gap and by actively reaching toward friendship.
I take a deep avocational interest in the social history of people who have lived as gender and romantic “outliers”, under many labels and in every society, place and time in history.  I am endlessly fascinated by the myriad of ways that we have survived, recognised one another, built identities for ourselves, found love, found self-acceptance, and sometimes occupied positions of spiritual leadership, prophecy and power.
I take great pride  in the label “activist,” though I think lately I’m riding on my previous accomplishments.” 

In contrast, my only credentials are that I think logically and analytically and accept that the scientific method is the best way we have of knowing about our world. The scientific method doesn’t care about any ‘authority’ or ‘credentials’ or about any ‘lived experience’ I might have. Facts are facts and the truth is the truth however important or unimportant I might be. Men are men and women are women whether I have a PhD or not.

Here is Dr.Patt’s full response, copied directly from her comment on my blog, which I have interspersed with my responses.

Dr.Patt: There is too much “passion” and politics on both sides of this issue.  Do we know the long term outcome of gender-affirming medical care for teens–say ten, twenty years down the line? No, we do not; we cannot.  This is the first generation of minors to receive medical intervention for gender dysphoria.  Is it a bad idea, or a good idea?  We can’t know that. 

If “We can’t know that”, we shouldn’t do it, because there’s no evidence that it works. These are young people’s lives we are experimenting with, without the experimental evidence being collected. Young people should not be drugged, castrated, mutilated, sterilised or made anorgasmic in the hope or belief that it will be good for them.

Medicine and surgery is based upon evidence-based medicine, using the scientific method, to ensure the best outcomes from any intervention. Evidence-based medicine is not based upon wish-fulfilment or consumerism, it is based upon collecting facts. Evidence-based medicine ensures that we reduce the risk of harm to patients from what we do to them. We should not be undertaking procedures, especially irreversible ones, such as radical double mastectomies on teenage girls, without a comprehensive evidence base. That’s why all drugs and surgery for such severe emotional and identity problems are viewed as experimental, and will take place purely as part of clinical trials for the most extreme cases of distress, in the view of the interim Cass report, with full assessment and publication of results, not on a ‘try it and see’ basis. Personally I don’t think it’s ethical to surgically experiment on children, as they’re not capable of informed consent. Plastic surgery is unlikely to be an effective treatment for severe emotional problems, and leaving people scarred and sterile, without evidence that it will do them good, is fundamentally immoral.

Evidence-based medicine is science. Evidence-based medicine is not testimonials from satisfied customers, or providers’ promises to make you a satisfied customer, or trade bodies saying their fee-paying members are qualified to make you a satisfied customer. All of that is commercial marketing of a plastic surgery service. It is not medicine.

I’m concerned that you used the euphemism of “gender-affirming medical care” for life-altering drugs and surgery for distressed teenagers. Puberty blockers harm children’s mental and physical development, wrong-sex hormones severely impact sexual development, and surgery ends in sterility, significant self-harm, being a lifelong medical patient, and frequent anorgasmia.

Children cannot consent to being sterilised and anorgasmic, because they cannot possibly understand the lifetime consequences.

You say “There is too much “passion””. It’s not possible to be too passionate about child safeguarding. Safeguarding children is everyone’s responsibility. We are living through an era of legal human experiments on children. I’m willing to campaign against that, even if it makes me unpopular.

I agree with you about there being too much politics involved, in that it has become a party political issue. I’m particularly concerned that left wing politics has become embroiled in protecting identities rather than children. This is a public health issue. For something as contentious as gender identity to become a party-political issue rather than one of conscience is of real concern. It’s clearly a moral issue rather than one to follow the party line.

Dr.Patt: But we do know a few things.  A majority of adults who sought and received medical intervention (usually “top surgery” and/or hormonal treatments) are, decades later, happy with the result.  A minority are not, and many of these reverse the treatment.  For those who, for financial or cultural reasons, cannot access hormonal therapy to bring  their bodies in line with their gender identity, life is adulthood is very, very difficult and dangerous.

Except you don’t quote the comprehensive systematic reviews of the clinical studies which have been published in reputable journals, which is what science is based upon. It’s a few consumer opinion surveys, carried out non-independently, with results from the people who kept in touch with their doctors. The reply rate of desisters is too low and the answers are therefore clearly biased. The ‘knowledge’ you quote is not science, it’s marketing by commercial providers.

If you’ve been surgically castrated, what is the likelihood of admitting regret, when you know there is nothing you can possibly do to change it? It’s highly likely that many people could never admit to themselves that they made the wrong choice. It would destroy them mentally to accept, “I had myself castrated because I believed I was a woman born in a man’s body, but now I understand I was just gay and suffered from internalised homophobia and there’s nothing I can do about it”.

Stating that some people can ‘reverse the treatment’ is false. You can’t get your breasts back, you can’t breastfeed and you can’t have silicone implants if you’ve had a radical mastectomy. You can’t reverse the change to your voice if you’re a woman who has taken testosterone. You can’t reverse the uncomfortable growth of your clitoris if you’ve taken testosterone. You can’t get your fertility or orgasm back and you can’t get your penis back if it’s been surgically inverted.

Please don’t spread untruths that anything included within ‘gender affirming care’ is reversible. It isn’t.

You also can’t get back the brain development you lost out on when you’ve missed the puberty window.

Dr.Patt: Here is something else we know:  Gender is not entirely binary, nor is sex.  Not biologically.  

Saying ‘biological sex’ is like saying ‘wet rain’. It’s a tautology. Saying sex is not entirely binary is also wrong by definition. It’s like saying rainbows are made of just black and white.

Dr.Patt: Hear me out:  there are several steps involved in becoming a male or a female person, and each step has atypical events that can occur to create an atypical outcome.  

You are confusing the definition of sex with the determinants of sex. Two sexed bodies create two different types of gametes and join to fuse them to reproduce. Where’s this third gamete? The very definition of sex is that it’s binary, male and female. Sex is binary by definition in species with two gametes.

The determinants of sex, however, are as malleable as anything made of flesh and blood. Of course things go wrong with reproduction. Of course there are edge-cases.

Just because a coin has an edge, does that mean there’s no such thing as heads and tails?

Here’s an example of the faulty thinking you are employing. Humans are bipedal; they walk on two legs. Saying that does not mean that people born without legs, people who can’t walk, or people who have had amputations are not human. Human beings walk on two legs, that’s a fact, whether some have developed differently, or had traumatic experiences so they don’t, doesn’t change the facts. Nothing about how people develop or what happens to them changes the established fact that humans walk on two legs.

Do you agree that humans are bipedal? That they walk upon two legs? Here’s a man, Francesco Lentini, who was born with three legs:

Francesco Lentini

Does that mean that humans are not bipedal? Humanity is full of atypical outcomes. None of these atypical outcomes mean that humans are not bipedal. You can be born with no legs, one leg, two legs or three, or lose one leg or two, but humans are still bipedal. Humans are defined as bipedal. Whether individuals are bipedal or not depends upon the determinants of their development and life experiences.

How many legs one individual has doesn’t change the definition of how many legs humans have.

There are two sexes, male and female.

Dr.Patt: Usually, a zygote has one of two 24th chromosomal pairings:  an xy pair (male) or an xx pair (female).  But there are trimsomies (xxy, xyy) as well as single x (where the second of the pair is missing or partial), fragile x (where the x of an xy pair is missing or partial); and each of these combinations has a somewhat characteristic outcome that is viable if atypical in body-type and probably in brain development. 

Humans have 23 pairs of chromosomes, not 24. They have 22 autosomal pairs and one pair of sex chromosomes, with XX (female) or XY (male) as the typical outcomes of fertilisation. Females have two copies of the X chromosome, while males have one X and one Y chromosome.

Some people have atypical outcomes of fertilisation on their sex chromosomes, just like those with Down syndrome have an extra copy of chromosome 21. Here are some:

  • XXY is Klinefelter syndrome, something that only boys can be born with.
  • XYY syndrome is a rare chromosomal disorder that only boys can be born with.
  • X is Turner syndrome, that only girls can be born with.
  • Fragile X syndrome is something which both boys and girls can be born with.

None of these genetic disorders is a separate sex and all of them are clearly male or female. How do you think people with these genetic conditions feel about others acting as if they’re not male or female, or that they are somehow ‘between the sexes’. It’s a disgraceful insult to them. They are men and women with physical conditions which cannot be changed and about which they have no choice.

The existence of chromosomal differences is an irrelevance to ‘gender identity’ and their existence doesn’t mean you can choose to change your sex. Does the existence of Down syndrome mean people are justified in identifying as intellectually impaired, should take drugs to stunt their growth and have plastic surgery to remove the bridge of their nose? Obviously not. The same applies to the attempt to link transgender identities to genetic disorders of the sex chromosomes.

Dr.Patt: Chromosomes contain instructions for the development of male or female gonads, which secrete the hormones which will, to put it somewhat simplified, “masculinize” or “feminize” the fetal body–that is, determine the size and shape of genitalia, whether the child has ovaries, testicles, or undifferentiated gonads, and probably (and this is not definitive, but the evidence is consistent enough that we must take it seriously) affect subtle aspects of brain development that will much later influence gender identity, interests, activity levels, and sexual attraction. 

None of these are of any relevance to the definition of sex. Sex is binary. They are the determinants of sexual development. People are made of flesh and blood and everyone has to develop.

Your sex has nothing to do with how masculine or feminine you are. Your sex is your body type, either an egg-body or a sperm-body. A man is not anyone ‘masculine’ and a woman is not anyone ‘feminine’. These are vile, regressive stereotypes. Young people should be left to be themselves without being told that if they don’t meet societal sex stereotypes they are the opposite sex.

The “subtle aspects of brain development” you mention are so subtle that there is no evidence for them.

Dr.Patt: Prenatal hormones are analogous to a language through which the chromosomes “instruct” the body on how to develop prenatally, as well as during puberty.   But some bodies don’t “read the language”–a fairly common variation on the development of biological sex is the androgen-insensitive xy person; chromosomally male, they develop with external genitalia typical of female babies.  Inside, they have no uterus or ovaries.  Gonads are there,  but not descended as testicles and functioning to produce neither sperm nor ova.  The person may discover their status as an xy, androgen-insensitive person when they fail to menstruate and undergo tests or imaging.  In times and places where such tests don’t exist, they may never know why they don’t menstruate and can’t conceive.  In modern times, they sometimes discover the truth about their bodies in the course of athletic competition, when they “fail” the chromosome test and are thrown out of women’s sports.  

Your chromosomes aren’t your sex, just like the assembly instructions booklet in the flatpack box isn’t an Ikea table. You can have a page missing, an extra page or a duplicate page, or have wrong instructions. That doesn’t change what a table is. A table is a table, whatever the Ikea instructions say. It’s not a chair.

Girls born with XY chromosomes and complete androgen insensitivity grow up to be women because they develop as women’s bodies. They are not another sex. They are entirely women. That’s the truth about their bodies.

Dr.Patt: The case of androgen insensitivity is clear-cut.  But cases of babies being born with ambiguous genitalia (large clitoris? small penis? vulva or scrotum?) are not uncommon.  How uncommon is not known, because there is no requirement to report.  Until recently such babies were virtually always “corrected” with medically unnecessary (but socially determined) surgery to make them look like the “normal” version of one sex or the other.  In these cases, we can truly say that sex is “assigned”, because it’s guesswork to predict how the child we experience themselves as they grow.  Sometimes we get it wrong.

Sex is not ‘assigned’. It is a feature of your body, depending upon whether you have the body type which evolved to produce eggs or sperm. If your sexual characteristics have failed to grow as expected, that is not evidence of not being a boy or girl.

If you’ve got a clitoris, your genitals are not ambiguous, no matter how big. You’re female. If you’ve got a penis, your genitals are not ambiguous, no matter how small. You’re male.

Sex is not how we experience ourselves. It’s not a metaphysical, religious notion. Either you have the body type which usually produces large gametes or the body type which usually produces small gametes. There are no other types of body. A boy born with no penis is a boy and will grow up to be a man with no penis. Why would that make him anything other than a man and clearly male?

Women aren’t women because they ‘experience themselves as women’. Men can’t be women due to ‘experiencing themselves as women’. Being a man isn’t being stereotypically masculine and being a woman isn’t being stereotypically feminine. You can be any kind of man and any kind of women. Gender can be a horribly restrictive straight-jacket. Be yourself in any way in which you take joy from this life, but don’t expect others to deny the basics of human sexual evolution.

Dr.Patt: There are also girl babies whose bodies produce, and are sensitive to, masculinizing hormones.  These girls have been studied for decades, and they tend to be more “rough and tumble” in play than their female peers, and have higher-than-expected rates of lesbian attraction. 

They are girls. There are many types of girls, with all sorts of differences in sexual development. They are still girls. Tomboys are girls. Girls who will grow up to be lesbians are girls. Girls who love ‘rough and tumble’ play are girls. A girl is a girl because of her evolved type of body, not some regressive ideas of femininity. Being a woman is not decided by how you act or how you feel.

There is no wrong way for a young female to be a girl.

Dr.Patt: So, no, it’s not a strict binary. That, my friend, is what the science of gender and sex really tells us.  The two-box theory of gender and sex is a social construction, not a biological one.  It isn’t even culturally or historically universal.  There are, and have always been, outliers.

There’s one large gamete and one small gamete. There are only two. Sex is the most binary of systems imaginable. 

Dr.Patt: The question is how to square a concern for the well-being of people who would, at any time in history and in any culture, developed a trans-gender or non-binary identity (though not necessarily with those words to name it) with our concern for social contagion and the medicalization of gender dysphoria–especially when it is, culturally speaking, still very difficult to grow up female?  How do we know that some girls are not simply opting out of womanhood because patriarchy still sucks as much as it ever did?  

Transing history is clear revisionism and a vile insult to historic figures. Women who were successful in the past, despite overwhelming odds against then, in deeply misogynistic and sexist societies, are now viewed as non-binary or trans. Joan of Arc? Defender of the French nation in the siege of Orléans. Non-binary. Dr James Barry, a British army surgeon, pretended to be male to work as a surgeon. Trans. Women were incredibly successful against all the odds in ancient patriarchal societies because they were brilliant women. Not because they were trans. To say otherwise is misogyny on testosterone.

Dr.Patt: These are valid question, and I think it’s the one that J.K. Rowling is trying to bring to our attention.

 JK Rowling is an incredibly inspirational women’s rights campaigner whose depth of humanity shows in all of her work, especially her essay here:

Dr.Patt: I don’t think it can be squared.  Simply put, we cannot know the mind and heart of another.  Not long ago, there were many who insisted that being gay or lesbian was not a biological possibility, and that those who were attracted to their own gender were pretty much all of what you accuse transgender and nonbinary people of being–attention-seeking, confused, victims of ideology, sexual deviants, and groomers out to recruit others to our lifestyle.  Those folks were wrong, and most of us are learning that living in a live-and-let-live manner is better for all.  People have the right to self-determination on matters of  intimacy and personal identity. That includes the right to get it wrong, and to change. 

People who are attracted to the idea of themselves as the opposite sex are not the same as people who are attracted to others of the same sex. People aren’t “attracted to their own gender“.

At no point have I ever accused “transgender and nonbinary people of being– attention-seeking, confused, victims of ideology, sexual deviants, and groomers out to recruit others to our lifestyle.”

My view of other people’s sexuality has always been one of profound disinterest. Adults should enjoy having consensual sex with one another, whoever that is. Go and love people and enjoy your life, whatever your beliefs. Just don’t make your beliefs part of law or policy which affects how I live my life.

Dr.Patt: At what age does that right begin?  That’s the tricky part.  Yes, medical intervention is life-altering, and that is the point of it!  A 13 year old who is growing breasts may well feel like their life is an emergency in need of a timely course-correction.  

A 13 year old girl who is growing breasts who feels “their life is an emergency” needs love, support and therapy to accept her sexed body, not gender identity theology and a radical double mastectomy. Why do so many young girls who are in distress about their sexual development have a history of trauma, sexual assault and autism? Why aren’t we looking to help them with the root cause of their distress rather than offering surgery? Why were children referred to the Tavistock Gender Identity Service ten times more likely to have a parent on the Sex Offenders Register than average?

Many of these children have never played outside, have watched violent pornography, and been involved in online groups exerting huge social pressure, while being desperate for popularity and affirmation.

Dr.Patt: Personally, I predict than in a decade or two we will all wonder what all the heat was about.  Folks will refer to this as the “medicalization of gender debate of the 2020’s”, and lgbtq+  culture will have moved on somehow to new possibly identities, labels, ways of being.  We are an infinitely creative part of every society, and we evolve much faster, culturally, than the mainstream.  I hope to be around a few more decades to see how the children of today’s non-binary and trans youth challenge the solutions that their parents believed in.  I’ve lived long enough as a lesbian feminist to know that what makes us feel so young and new and iconoclastic in our twenties eventually gets us called “old school.”  

You are part of a system creating the greatest medical scandal of the Century and the judgement on your collaboration will be that the cause you support harmed thousands of vulnerable children who relied upon you to be the adult in the room. Instead, you followed fashion, attempted to be progressive and courted popularity amongst young people to gratify yourself and your own selfish desires not to be old and irrelevant.

Sadly, there won’t be any “children of today’s non-binary and trans youth” because they will be sterile.

Dr.Patt: Meanwhile, the plight of each and every gender dysphoric young person is a dilemma for them to figure out in the privacy of their own minds, their own family, and their own medical provider(s).  It is not, contrary to the shouting of strangers, taken lightly.  Nor should it be framed as the alternative to youth suicide–this argument amounts to holding parents hostage in a situation of extreme emotional blackmail.  Adults need not buy into this–we can simply listen, stay calm and accepting, offer many kinds of safety and support for the entire person in front of us–who is much more than their gender identity.  We can stress values and the importance of simply becoming a good and loving person.  We can suggest that they slow down, introduce them to queer elders, teach them lgbtq+ history.  We can join the young in challenging a society that has created enormous barriers to youth becoming functional adults–from the severe shortage of affordable housing to outlandish educational debts to a burning planet that may not sustain civilization for their lifetimes.  But ultimately we need to stop fighting them and start seeing the beauty of what they are suggesting–that a person is a person, and that if gender feels like a straightjackeet, then it is something one can say,”no thanks” to.  

There is no such thing as TQ+ history. It is all rewritten lies and re-gendered heroes. Incredible women who achieved amazing things in a dreadfully male dominated society are now being stolen from women and held out to be non-binary heroes. Women are, and have always been, brilliant in their own right and don’t need a fashionable new identity to be foisted on them.

Dr.Patt: Young folk feel helpless about so many things–because they are helpless to change so many things.  Can we be surprized that they assert extreme control over the one thing that they seem to own–their bodies?  Can we deny them even that?  

I think your reference to control is very telling. It’s the primary reason behind anorexia, cutting and self-harm. Those are also things we should help young people avoid.

Yes, we can deny ‘young folk’ control over their bodies while they are still children. It’s called safeguarding, and it’s everyone’s responsibility.

Dr.Patt: Yes, 14 year olds will make mistakes, and not all can be reversed.  But we romanticize childhood if we think that this is the first generation that has been able to make life-altering decisions before they were developmentally  ready.  Fourteen years olds can get pregnant, get into cars with drunks, jump off cliffs, and, in many parts of the world, become soldiers.  They can, and do, take dangerous jobs, sometimes because they have no choice.  They leave home to cross a desert, or a jungle, or a sea on a rickety boat, seeking opportunity or escape or even adventure.  Getting a double mastectomy is mild in comparison.  And as for pronouns, that should not even be an issue–if anything is reversable, it’s a pronoun.  

“14 year olds will make mistakes”, you say. Safeguarding them means helping them avoid harm. They are children. We’re not talking about a bad tattoo. We’re talking about sterility, anorgasmia, serious health consequences and a lifetime of medical support through hormones.

Why aren’t you curious? Why are you so accepting of the religious dogma? What about asking some adult questions of so-called ‘trans’ people. Like:

  • What was it about your parents finally having the boy they always wanted which made you and your sister come out as trans within two months of his birth?
  • What age were you when you started erotic cross-dressing in your sister’s knickers and how did your fetish develop to be all-consuming?
  • What was it about being sexually assaulted by your step-dad that made you hate your developing body and want to cut your breasts off?
  • When did your cross-dressing fetish develop to wishing your wife was dead so you could replace her?

Dr.Patt: There are solutions for the bathroom and sports team issues, and the “kids” are leading here.  They are creating their own inclusive spaces and leagues, and they are claiming privacy where bodies get naked (dressing rooms).  The old group-showers after gym class have needed to go the way of chalkboards and smoking lounges for a long time now–let’s be done with them.  Safety is important, and it does not depend upon humiliating the gender-outliers.  

Womens’ sports are a category for the most incredible achievements of women who are at the pinnacle of their physical existence and all the women who join them for fitness, competition, individual excellence, teamwork and social pleasure. Women’s sports are not the egg-and-spoon race for mediocre males to validate their fetishes. The idea that ‘people’ are men and that women are merely emotional support animals created to keep men company, look good and be objectified as breeding stock, is as old as human society and is articulated throughout The Bible (other Bronze Age superstitions are available).

Dr.Patt: We should take a chance on them actually having the wisdom to get this thing right, and if they get it wrong, we should still love the dickens out of them and stand by their side.

They are children and you are meant to be the adult. You are meant to be the wise one.

Young people are doing devastating harm to themselves, in a social contagion worse than cutting, anorexia or liking the music of The Sisters of Mercy. Being an adult means not giving in to childish impulses of people who have yet to develop a mature frontal cortex. Personally I would ensure no young person under the age of 25 and no person with mental health issues would receive wrong-sex hormones or surgery.

Thanks so much to Dr Patterson for being such a good sport and responding in such depth to my article. It’s been a pleasure to respond to each of her points. I hope that you have enjoyed our exchange.

Adult human female - The Hall of Einar
Adult Human female skeleton at the Natural History Museum, London.

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