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Transgender arguments hinge on sex versus gender—can you choose?

In response to landmark article on ‘transsexualism’, Male and female He made them …, correspondent Grant S., from Australia, submitted this comment:

The condition known as xenomelia can tragically lead sufferers to desire that perfectly functional limbs be amputated.

I am a born again Christian and I am taking exception to your recent attacks1 on Transgendered individuals.

This condition MAY be a result of the FALL (one of the MANY things to have gone wrong because of sin), but your assertions that gender is ONLY XX/XY, I fear, may be overlooking OTHER areas of gender dysphoria (such as CHEMICALLY, in the brain).

I refer to the case of “Emma Hayes” (you would, no doubt, know her story). Her case highlights the false assumptions you are making in your campaign against transgenders.

CMI articles posted on Facebook assert that the desire to change gender is rooted in “social/conditioning” influences. HOW do you explain Emma wanting to cut off her penis at age THREE. How can this be attributed to “conditioning”? Her parents had NOTHING to do with her deciding to change from boy to girl. (Yes, I use the feminine pronoun, because, how can you categorically state that those with the body of ONE gender but the MIND of another should make their mind “fit” their physical body?)

The difference between transgenderism and homosexual behavior is that the Bible DOES forbid THAT-and PLEASE don’t give me that verse in Deuteronomy which you like to quote, forbidding men wearing women’s clothing-look at the context, it refers to men dressing as women in order to avoid military service.)

Homosexuality differs because it is a case ot two minds of the SAME gender having a relationship.

If a TG M-F, for instance, dates a male, who LOOK like a male and THINKS like a male, then that is minds of two DIFFERENT genders having a relationship. Yes there are only TWO genders, and I believe that your gender is more about how your brain is wired than how your body looks.

Dr Kathy Wallace responds:

Yes. I agree. Gender can be a complex issue in this fallen world2. Yet there are only two sexes or two natal genders, as you rightly say. Firstly, I would like to clarify that my article “Male and Female He Made Them …” was in no way an attack on transgender or gender dysphoric individuals.

What we think our brains are telling us may not always be correct or real.

I feel that you strongly believe that one can rely on the brain as the final arbitrator on confusing issues. However, what we think our brains are telling us may not always be correct or real. I draw your attention to a strange anomaly where one’s own body parts are not recognised by the brain as part of one’s own body. I am, by the way, not suggesting that this is what young Emma Hayes has struggled with.3 This condition is known as Body Integrity Identity Disorder, or BIID, also called ‘apotemnophelia’( and no, that is not the name of an Egyptian pharaoh!) and also, more recently, called ‘xenomelia’,4,5 ‘xeno’ meaning foreign, ‘melia’ derived from the Greek word for limb, ‘melos’.

The rather sad fact about this condition is that its victims want to amputate perfectly healthy limbs. These folk are not suffering a psychosis, are deemed rational and are aware of the bizarre nature of their desire to amputate their limbs, usually the left lower limb. They explain that the limb, or body part, in question does not feel like it belongs to them, and feels foreign, and they express a strong desire to become an amputee. Indeed, several authors cite the eighteenth century case of a man with xenomelia who enforced the amputation of his leg from a surgeon at gunpoint.6,7 People have also been known to acquire similar delusions after a brain injury, as famously described by Oliver Sacks in his book, “The Man Who Mistook His Wife For A Hat”.8

The brilliant neurologist Oliver Sacks in his book The man who mistook his wife for a hat wrote of the terrible delusions afflicting victims of brain injury.

In a study of sufferers of xenomelia it was determined that:7

  1. The condition is rooted in early childhood
  2. It is associated with marked distress, often leading to self-inflicted amputation attempts
  3. There is a male predominance, and recent studies show that women are more likely to desire bilateral amputations
  4. It is, as a rule, accompanied by a socially non-conforming attitude toward and admiration of “handicapped” individuals’, especially amputees’, bodies.9

In this study conducted in 2005, seventeen per cent of the subjects with xenomelia had obtained amputations, with six of these reporting feeling better than they ever had afterwards, to the point of not desiring an amputation any longer. I would like to stress that sufferers reported they had a strong desire for amputation at a very early age.

As an interesting aside, the opposite experience is sometimes described by people born without arms or legs, but who are keenly aware from a very young age of ‘phantom’ limbs. The phenomenon of a phantom limb involves awareness of, and sensation, including pain, in a limb that is physically absent, and people who experience phantom limbs report using their non-existent limbs on hand-rails to climb stairs and even to reach out to pick up objects.10

It is touted in the literature that people with xenomelia have an unrecognised right parietal lobe syndrome, therefore a ‘brain related’ issue.11 Xenomelia’s striking similarity to gender identity disorder or gender dysphoria has not gone unnoticed.12 The management of xenomelia is controversial, but should we amputate healthy limbs in individuals expressing a strong desire to have this done? Clearly, the answer is a resounding ‘no’!

Then, why would anyone advocate the amputation of healthy genitals and breasts in order to satisfy a gender dysphoria?13 Similarly, if amputation is deemed appropriate, due to the unwavering demands of a gender dysphoric individual, then so must liposuction be advocated on someone struggling with anorexia.14 Clearly, the brain and emotions can’t be trusted as the defining authority on the human experience of sex. We must pay heed to our Creator in whose Word we are told … male and female He made them.

Sex versus Gender: Are they separate? Can gender be chosen?

Former psychiatrist-in-chief at Johns Hopkins Hospital in Baltimore, Paul McHugh,15 previously involved in preparing gender reassignment patients for surgery for babies born with deformed, ambiguous or damaged external genitalia, said this: “I have witnessed a great deal of damage from sex-reassignment.”16

Wrote McHugh in ‘First Things’ in 2004:

‘We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness’—Johns Hopkins Hospital surgeon Paul McHugh
“The children transformed from their male constitution into female roles suffered prolonged distress and misery as they sensed their natural attitudes. Their parents usually lived with guilt over their decisions—second-guessing themselves and somewhat ashamed of the fabrication, both surgical and social, they had imposed on their sons. As for the adults who came to us claiming to have discovered their ‘true’ sexual identity and to have heard about sex-change operations, we psychiatrists have been distracted from studying the causes and natures of their mental misdirections by preparing them for surgery and for a life in the other sex. We have wasted scientific and technical resources and damaged our professional credibility by collaborating with madness rather than trying to study, cure, and ultimately prevent it.”16

He describes a study in which, according to McHugh:

“I wanted to see whether male infants with ambiguous genitalia who were being surgically transformed into females and raised as girls, did, as the theory (again from Hopkins) claimed, settle easily into the sexual identity that was chosen for them. These claims had generated the opinion in psychiatric circles that one’s “sex” and one’s “gender” were distinct matters, sex being genetically and hormonally determined from conception, while gender was culturally shaped by the actions of family and others during childhood.”

He described:

“… the practice of surgically assigning femaleness to male newborns who at birth had malformed, sexually ambiguous genitalia and severe phallic defects. This practice, more the province of the pediatric department than of my own, was nonetheless of concern to psychiatrists because the opinions generated around these cases helped to form the view that sexual identity was a matter of cultural conditioning rather than something fundamental to the human constitution.
Several conditions, fortunately rare, can lead to the misconstruction of the genito-urinary tract during embryonic life. When such a condition occurs in a male, the easiest form of plastic surgery by far, with a view to correcting the abnormality and gaining a cosmetically satisfactory appearance, is to remove all the male parts, including the testes, and to construct from the tissues available a labial and vaginal configuration. This action provides these malformed babies with female-looking genital anatomy regardless of their genetic sex. Given the claim that the sexual identity of the child would easily follow the genital appearance if backed up by familial and cultural support, the pediatric surgeons took to constructing female-like genitalia for both females with an XX chromosome constitution and males with an XY so as to make them all look like little girls, and they were to be raised as girls by their parents.
Reiner discovered that the male children behaved like boys and were obviously different from their sisters and other girls despite being brought up like female children.
All this was done of course with consent of the parents who, distressed by these grievous malformations in their newborns, were persuaded by the pediatric endocrinologists and consulting psychologists to accept transformational surgery for their sons. They were told that their child’s sexual identity (again his “gender”) would simply conform to environmental conditioning. If the parents consistently responded to the child as a girl now that his genital structure resembled a girl’s, he would accept that role without much travail.”

A resident psychiatrist, William Reiner17 undertook a systematic follow-up of these children. He had been a paediatric urologist prior to training as a psychiatrist, thus was aware of the difficulties with such cases. He focussed his attention on the male children that were surgically assigned female genitals in infancy. He set out to determine just how sexually integrated they would become as adults. Dr Reiner picked the condition ‘cloacal exstrophy’18 for his intensive study, “because it would best test the idea that cultural influence plays the foremost role in producing sexual identity”.16

Astonishingly, Reiner discovered that the male children behaved like boys and were obviously different from their sisters and other girls despite being brought up like female children.

The results were published in the New England Journal of Medicine in 200419, and were as follows:

Reiner assessed all 16 genetic males in the cloacal-exstrophy clinic at the ages of 5 to 16 years. Fourteen underwent neonatal assignment to the female sex socially, legally, and surgically; the parents of the remaining two refused the advice of the paediatricians to do so, preferring to raise their sons as boys.



What role does family environment and upbringing play in gender affirmation or denial? In the light of undeniable evidence, leading psychiatrist Dr William Reiner now believes that children are born either male or female, and, irrespective of subsequent surgery or rearing, they retain their birth gender.

Eight of the 14 subjects assigned to the female sex declared themselves male, and the two raised as males remained male. Five subjects were living as females; three were living with unclear sexual identity, although two of the three had declared themselves male; and eight were living as males, six of whom had reassigned themselves to male sex. All 16 subjects had moderate-to-marked interests and attitudes that were considered typical of males. All sixteen of these people had interests that were typical of males, such as hunting, ice hockey, karate, and bobsledding. Reiner concluded from this work that the sexual identity followed the genetic constitution. Male-type tendencies (vigorous play, sexual arousal by females, and physical aggressiveness) followed the testosterone-rich intrauterine fetal development of the people he studied, regardless of efforts to socialize them as females after birth.16

Dr Reiner is quoted in the New York Times saying: “The larger point is that it’s been a monstrous failure, this idea that you can convert a child’s sex by making over the child’s genitals in the sex you’ve chosen. This began in the 1950’s, when surgeons who felt helpless when they encountered intersex children thought they were helping them with sexual reassignment. The psychologists were saying, ‘You can make a boy or a girl or anything you want.’ It wasn’t true. The children often knew it.”20

Reiner now believes children are born either boys or girls, and that no matter what happens to them, be it surgery or rearing, they remain that way.21

Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will.—Romans 12:2

Published: 1 December 2013

References and notes

  1. This comment was submitted in response to the article by Dr Kathy Wallace, Male and female He made them …, but the correspondent, Grant S., might also be referring to Dr Wallace’s subsequent response to another comment submitted to the article by French correspondent Tony B., which can be accessed here: George Jamieson /‘April Ashley’: A ‘model life’ for the ‘gender reassignment’ brigade? Return to text.
  2. www.mercatornet.com/articles/view/gender_bending_let_me_count_the_ways#idc-cover, 2011. Return to text.
  3. http://sixtyminutes.ninemsn.com.au/article.aspx?id=8674056. Return to text.
  4. Van Dijk MT, van Wingen GA, van Lammeren A, Blom RM, de Kwaasteniet BP, Scholte HS, Denys D. Neural basis of limb ownership in individuals with body integrity identity disorder. PLoS One. 2013 Aug 21;8(8):e72212. doi:10.1371/journal.pone.0072212. PubMed PMID: 23991064; PubMed Central PMCID:PMC3749113. Return to text.
  5. http://brain.oxfordjournals.org/content/early/2012/12/20/brain.aws316. Return to text.
  6. Johnston J, Elliott C. Healthy limb amputation: ethical and legal aspects. Clin Med. 2002 Sep-Oct;2(5):431-5. PubMed PMID: 12448590. Return to text.
  7. Hilti LM, Brugger P. Incarnation and animation: physical versus representational deficits of body integrity. Exp Brain Res. 2010 Jul;204(3):315-26. doi: 10.1007/s00221-009-2043-7. Epub 2009 Oct 25. Review. PubMed PMID: 19856177. Return to text.
  8. Sacks, O., The Man Who Mistook His Wife for a Hat (1985) Paperback, Touchstone Books, ISBN 0-684-85394-9. Return to text.
  9. First MB. Desire for amputation of a limb: paraphilia, psychosis, or a new type of identity disorder. Psychol Med. 2005 Jun;35(6):919-28. PubMed PMID:15997612. Return to text.
  10. Ramachandran, V K and Blakeslee, S, Phantoms in the Brain: Probing the Mysteries of the Human Mind, Sandra Blakeslee, 1998, ISBN 0-688-17217-2. Return to text.
  11. http://www.fortbildung.usz.ch/pdf/FS2013/2013_03_14-15_xenomelie.pdf. Return to text.
  12. Lawrence A. A., “Parallels between gender identity disorder and body integrity identity disorder: a review and update,” in Body Integrity Identity Disorder: Psychological, Neurobiological, Ethical and Legal Aspects, eds Stirn A., Thiel A., Oddo S., editors. (Lengerich: Pabst;), 154–172. 2009. Return to text.
  13. http://www.wnd.com/2013/10/amputating-healthy-organs-the-new-normal/. Return to text.
  14. http://www.dailymail.co.uk/news/article-2432956/Laura-Ferguson-Tragedy-showjumper-complained-headaches-dies-sleep-battle-anorexia.html. Return to text.
  15. http://en.wikipedia.org/wiki/Paul_R._McHugh. Return to text.
  16. http://www.firstthings.com/article/2009/02/surgical-sex--35. Return to text.
  17. http://www.oumedicine.com/urology/general-program-info/faculty/pediatric-urology/william-g-reiner. Return to text.
  18. ‘Cloacal exstrophy’ is an embryonic misdirection that produces a gross abnormality of pelvic anatomy such that the bladder and the genitalia are badly deformed at birth. The male penis fails to form and the bladder and urinary tract are not separated distinctly from the gastrointestinal tract. But crucial to Reiner’s study is the fact that the embryonic development of these unfortunate males is not hormonally different from that of normal males. They develop within a male-typical prenatal hormonal milieu provided by their Y chromosome and by their normal testicular function. This exposes these growing embryos/fetuses to the male hormone testosterone—just like all males in their mother’s womb. Return to text.
  19. Reiner WG, Gearhart JP. Discordant sexual identity in some genetic males with cloacal exstrophy assigned to female sex at birth. N Engl J Med. 2004 Jan 22;350(4):333-41. PubMed PMID: 14736925; PubMed Central PMCID: PMC1421517. Return to text.
  20. http://www.nytimes.com/2005/05/31/science/31conv.html?pagewanted=all. Return to text.
  21. http://www.jhu.edu/jhumag/0900web/babes.html. Return to text.

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