Gender Assignment Surgery

Human research has made it likely that prenatal sex hormones influence, but do not by themselves fully determine, the development of gender-role behavior (22), and there is a large body of evidence in support of marked effects of social and psychological factors on normal human gender development (23).

Human research has made it likely that prenatal sex hormones influence, but do not by themselves fully determine, the development of gender-role behavior (22), and there is a large body of evidence in support of marked effects of social and psychological factors on normal human gender development (23).

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The present comments are mostly confined to the gender question.It was the case known as “John/Joan” (24) that received the greatest public attention; it is also the case with the most data available.This child had been born a normal male and was so assigned (“John”).Apparently, a given gender identity can accommodate wide variations in gender role behavior, a conclusion that should resolve at least some of the interpretive discrepancies between gender-role-behavior-based criticisms of the optimal-gender policy by biological determinists and gender-identity-focused statements by the policy’s defenders.In 1974, Imperato-Mc Ginley (18) reported on a newly identified syndrome of 46, XY patients with 5α-RD; their external genitalia looked female at birth and they were so assigned, but they markedly virilized in adolescence.Gender dysphoria is a mental health condition that can arise when a person lives with ongoing feelings of being physically incongruous with his or her birth sex — and medical intervention may be beneficial.Identifying as transgender, itself, is considered by scientists to be, at least in part, biological and not a mental illness [source: HRF].Early surgery for maximizing the gender-appropriate appearance of the external genitalia was recommended to facilitate gender-appropriate rearing.This policy was later extended to 46, XY cases with nonhormonal genital abnormalities (, Ref. In the original formulation of the optimal-gender policy, consideration of the sexual differentiation of the brain did not play a role because nothing was known about it at that time, and the intersex data then available were interpreted as showing that “psychologically, sexuality is undifferentiated at birth and that it becomes differentiated as masculine or feminine in the course of various experiences of growing up” (10), which is often referred to by others ( (14) demonstrated that perinatal sex hormones had a major organizing effect on the sexual differentiation of brain and behavior in guinea pigs, and these observations were soon replicated in other species.In the late1960s, Ehrhardt (15–17) reported gender-role behavior shifts in the direction of masculinization in prenatally androgen-exposed 46, XX girls and women and demonstrated thereby that the pre-/perinatal sex hormone theory applied to the human species, at least to some extent.It is important to note, however, that also in the presence of markedly masculinized gender role behavior, gender identity usually remained female, even in the extreme situation of late-treated women with congenital adrenal hyperplasia who, in addition to prenatal masculinization, also showed massive postnatal virilization (16).