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Medical Information about Transwomen in Sports

Mar9

The following was put together by Transadvocate, a trans advocacy website, on their Facebook page. In order to not lose track of it, I am putting it here. This is not my work! I am copying it for ease of reference! Thank you Transadvocate and Rehan! If I find another link to this, I will add it here for completeness as well.

In regards to the Crossift HQ refusal of Chloie Jonnson’s participation at the games here are some facts that should be considered before any sensationalistic claims are made without proper knowledge.

First of all the XY vs XX argument is invalid and not sufficient. There are well documented cases of XX males and XY females. The SRY gene region is normally found on the Y chromosome but is not a reliable method of testing since not only is not always found on the Y chromosome it also triggers a gene cascade not well understood by scientists yet that in turn affect other tissues during development which may lead to altered sexually dimoprhic traits in individuals, such as brain structure.

This is evidenced by scientific literature cited

Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus
http://press.endocrine.org/doi/abs/10.1210/jcem.85.5.6564

and

Sexual differentiation of the human brain: relevance for gender identity, transsexualism and sexual orientation

Read More: http://informahealthcare.com/doi/abs/10.1080/09513590400018231
http://informahealthcare.com/doi/abs/10.1080/09513590400018231

and

Sexual Differentiation of the Bed Nucleus of the Stria Terminalis in Humans May Extend into Adulthood
http://www.jneurosci.org/content/22/3/1027.short

and

A sex difference in the human brain and it’s relation to transsexuality.
http://depot.knaw.nl/821/1/15106_285_swaab.pdf

with subsequent study by Dr.Swaab et al. And Kruijver et al. showing differences in the Bed Nucleus of the Stria Terminalis, SDN, Hypothalamus and gray matter volume underlining the importance of brain physiology.

http://www.sciencedirect.com/science/article/pii/0165380688902313

http://www.sciencedirect.com/science/article/pii/S1053811909003176

http://www.tandfonline.com/doi/abs/10.1300/J082v28n03_07#.UxoCwRbPPFI

http://books.google.ca/books?hl=en&lr&id=JFpq6hYQRhQC&oi=fnd&pg=PA41&dq=brain+dissection+transgender+Dr.+Swaab&ots=FjtewJ28wz&sig=8F-QOG1Q5QCEIMe1oQwqlWNb9ko#v=onepage&q&f=false

http://www.hawaii.edu/PCSS/biblio/articles/2005to2009/2006-atypical-gender-development.html

Also studies showing it to be irreversible

http://aace.metapress.com/content/nm510264636815vk/

There is also an article linking hormone related genes to the atypical sexual dimoprhism. Genes CYP19 (Aromatase responsible for testosterone to estrogen conversion), AR (androgen receptor, the “key” hole for the cell that the testosterone “key” acts on to elicit it’s effects) and ESRB (Estrogen Receptor Beta which is responsible for the initiation of differentiating gene cascades in the fetal brain during fetal hormonal “washes”)

here

http://www.sciencedirect.com/science/article/pii/S0306453005000454

Continuing on the topic of performance and gender testing the IOC released a statement before the 2012 summer Olympics.

“The new rules state that a panel of independent medical experts will examine through a blood test the testosterone levels in a woman and will then make a recommendation about whether she could be eligible to compete.”

The IOC and NCAA have decided after extensive research (independently) that Hormone profile is the primary determining factor for gender qualification in sport.

The Olympics requires 2 years post surgery before being allowed to compete at an INTERNATIONAL event.

The NCAA requires only one year of HRT.

This was determined the minimum to not have any unfair advantage as evidenced by the quotes from respective authorities below.
“Requiring sex reassignment surgery before allowing participation for the high school or collegiate student athlete is medically unnecessary and not linked to competitive equity IOC regulations requiring surgery for Olympic transgender athletes have been controversial and it would be unreasonable to”make this requirement for high school and college students”
ERIC VILAIN M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Research suggests that androgen deprivation and cross sex hormone treatment in male-to-female transsexuals reduces muscle mass; accordingly, one year of hormone therapy is an appropriate transitional time before a male-to- female student athlete competes on a women’s team
ERIC VILAIN: M.D., PH.D., PROFESSOR, DIRECTOR OF THE CENTER FOR GENDER-BASED BIOLOGY AND CHIEF MEDICAL GENETICS DEPARTMENT OF PEDIATRICS, UCLA
“Transgender student athletes fall within the spectrum of physical traits found in athletes of their transitioned gender, allowing them to compete fairly and equitably”
DR. NICK GORTON
AMERICAN BOARD OF EMERGENCY MEDICINE, MEDICAL LEGAL CONSULTANT, TRANS HEALTH CARE

Further more, the difference need to be put into perspective when transgender women are compared with cisgender women they fall within a female range after the required time period (1 year NCAA, 2 years post-op IOC).
“Differences within the sexes are considerable and often times larger than differences between the sexes ”
DR. WALTER BOCKTING, PH.D.
PRESIDENT OF WPATH, ASSOCIATE PROFESSOR, UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

These facts are presented based on scientific literature as cited
here
Elbers JM, Asscheman H, Seidell JC, et al. Effects of sex steroid hormones on regional fat depots as assessed.
here
Australian Sports Commission. Transgender in sport.www.ausport.gov.au/fulltext/2001/ascpub/women_transgender.asp (accessed 22 Mar 2005).

here
as contrasted between these two
↵ Stamm R, Veldre G, Stamm M, et al. Dependence of young female volleyballers’ performance on their body build, physical abilities, and psycho-physiological properties. J Sports Med Phys Fitness 2003;43:291–9. [Medline][Web of Science]
↵ Viitasalo JT. Anthropometric and physical performance characteristics of male volleyball players. Can J Appl Sport Sci1982;7:182–8. [Medline]
and here
Pilgrim J, Martin D, Binder W. Far from the finish line: transsexualism and athletic competition. Fordham Intellectual Property Media & Entertainment Law Journal2003;13:495–549.
And the rest of these studies

↵ Federation Internationale de Volleyball. Medical regulations, ed. 2004. http://www.cev.lu/mmp/online/website/main_menu/downloads/file_28430/fivb_med_regulations_-_revised_7.pdf (accessed 23 Mar 2005).
↵ Lausanne Declaration on Doping in Sport (adopted by the World Conference on Doping in Sport). 1999.www.sportunterricht.de/lksport/Declaration_e.html (accessed 23 Mar 2005).
↵ Ritchie I. Sex tested, gender verified: controlling female sexuality in the age of containment. Sport History Review2003;34:80–98.
↵ Batterham AM, Birch KM. Allometry of anaerobic performance: a gender comparison. Can J Appl Physiol1996;21:48–62. [Medline]
Thomas JR, French KE. Gender differences across age in motor performance: a meta-analysis. Psychol Bull1985;98:260–82. [CrossRef][Medline][Web of Science]
↵ Shepard RJ. Exercise and training in women. Part I. Influence of gender on exercise and training responses. Can J Appl Physiol2000;25:19–34. [Medline][Web of Science]
↵ Dickinson BD, Genel M, Robinowitz CB, et al. Gender verification of female Olympic athletes. Med Sci Sports Exerc 2002;34:1539–42. [CrossRef][Medline][Web of Science]
↵ Simpson JL, Ljungqvist A, de la Chapelle A, et al. Gender verification in competitive sports. Sports Med 1993;16:305–15. [Medline][Web of Science]
↵ Introducing the, uh, ladies. JAMA1966;198:1117–18.
↵ Doig P, Lloyd-Smith R, Prior JC, et al. Position statement. Sex testing (gender verification) in Sport. Canadian Academy of Sports Medicine. 1997. http://www.casm-acms.org/PositionStatements/GendereVerifEng.pdf (accessed 23 Mar 2005).

There is no “residual” advantage and often times transgender athletes are at a disadvantage due to severely lowered testosterone levels in comparison to native females. Cisgender women have a higher testosterone than transgender women who have had reassignment surgery and the related information.
http://transathletes.org/hormones.php

Other issues that arise in the form of practicality

1) Her numbers pale in comparison to other female athletes

Crossfit profile comparison between her and CLB:http://games.crossfit.com/compare/161983/8404

Back Squat: 225 lb Clean & Jerk: 165 lb Snatch: 125 lb Deadlift: 275 lb

These numbers pale in comparison to the top competitors as well as compared to many other regional athletes.

2) Let her compete, if she has an unfair advantage it will be very apparent and provide evidence for these as of yet unfounded claims of unfair advantage. There are yet to be any instances of a transgender athlete dominating competitions if this were to be so likely.

3) Saying this will open the door for other males to “become” transgender and dominate is very short sighted. Firstly they would have to adhere to the strict protocol involving Hormone Replacement Therapy which would remove that advantage. Secondly transgender people face a MASSIVE amount of discrimination not to mention the amount of money and physical pain of procedures that need to be endured to complete the requirements. The transgender suicide rate is 41%, forcing someone to live as the opposite identity is devastating psychologically and would also be true of someone trying to “fake” it. (Remember once the surgery is done it is a PERMANENT change, is winning crossfit that important?)

4) Having larger bone structure and lowered muscle mass constitutes a disadvantage.

5) Furthermore there is no consistent testing policy in crossfit for PED’s. A cis-female using AA has a much larger and much more distinct advantage which could be considered universally as an “unfair advantage”.

The most shocking thing is the completely deplorable and inappropriate reply from Crossfit HQ, who seem to be the ones lacking in understanding of the human genome and biology.

Why Transition is the Overwhelming Treatment of Choice

Mar2

Recently, at a forum where I am involved, a poster asked about evidence for non-transitioning therapies for transsexuals. Now on that forum are a tiny number who consistently pound an anti-transition drum. But as I demonstrated in my reply, their position is not congruent with the position of the medical community today. Here is what I wrote, with minor edits to make it more appropriate for this blog.

__________________________________________________

The AMA is now overwhelmingly on board with fundamental brain differences being the root cause of transsexuality. And the APA (both of them) both state that the most effective therapy statistically for transsexuals is transition.

One of the most important of these is brain differences concerns the BST in the hypothalamus. “In the hypothalamus, the bed nucleus of the stria terminalis (BST) is thought to be important for gender identity. One study showed that male-to-female transsexuals had decreased BST staining identical to that for genetic XX female subjects (8). In contrast, genetic XY male subjects had significantly increased BST staining. BST staining was not influenced by sexual orientation or sex hormone levels.”

These differences can be seen below:

MTF_Brain_Scan_differences

In addition, further brain structure differences are being identified as well that impact transsexuals.

This NIH document references the study (by van Kesteren PJ, Gooren LJ, Megens JA. An epidemio-logical and demographic study of transsexuals in The Netherlands. Arch Sex Behav. 1996;25:589–600) that sex reassignment as overwhelmingly statistically successful in addressing the needs of the transsexual community. Given the size of the TS community the size of the study is significant. If the rates of transsexuality are as high as 1 in 600 as has been suggested by various studies, and if 1 in 2500 actually undergo SRS which have been suggested by direct analysis of number of surgeries in the US per year, then the size of the study in question was almost 25% of the SRS population of the Netherlands and 3% of the overall Netherlands TS population. If the rates of transsexuality are lower, then the size of the study is even more significant because it represents an even larger cross section of the TS population!

Here is the NIH position:

Quote

__________________________________________________

Treatment options for patients with gender identity at variance with physical appearance can be evaluated in the order of extent of invasiveness. The least invasive intervention would be counseling such patients to accept the circumstance. As already noted, however, no available data support the success of such therapy. The next least invasive approach might be a targeted treatment of the underlying problem. The medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it.
Although current transgender treatment is relatively invasive and does not address the problem completely, it is the most successful intervention available. Studies report very high transgender patient satisfaction with sexual reassignment. Thus far, the largest evaluation has been a survey of Dutch transgender patients (10). Among the 1,285 patients surveyed, 1,280 were satisfied.

__________________________________________________

As noted, “no available data support the success” of counseling patients to simply accept their circumstances. The second discussed option, manipulating the brain to become more accepting of the body, is not currently possible because the “medical community, however, has little knowledge about the brain region associated with gender identity, and even less is known about techniques for manipulating it“.

This leaves transitioning as the primary therapy for dealing with GID. As has been noted in the past here, there are people who do manage to live out their lives without transitioning to live in a new gender role. Good for them. But they are also the statistical minority among patients suffering from significant GID. For that category of patients, the number one therapy of choice today is transitioning (aside from suicide and I think we all agree that suicide is a bad option, yes?).

Therapists will assist a patient in trying to meet their personal goals but a transsexual suffering from significant GID ought to be prepared to discover that non-transitioning treatments are very likely to fail to bring them to a level of comfort with themselves that allows them to live a full and fruitful life. Certainly there will be those cases that do succeed at this, but as the NIH document notes, the medical community’s primary treatment therapy today is transition, including HRT, and optionally including surgeries to further assist the body to conform to the expectations of the mind.

Therefore, in answer to the original poster’s question – you are unlikely to find any large scale answer to your question of non-transitioning treatments that work. In almost every case where that does occur, the patient has developed their own unique regimen for coping with their GID that is specific to that patient. The single treatment option that does work and which is medically and statistically supported at this time by the medical and psychiatric and psychological communities is transition.

To the original poster, if you choose to not transition, it’s pretty much you and your therapist in uncharted waters. It’s possible you will succeed. Good luck if you choose that path. I will not dissuade you from taking whatever path you choose but I will stand by the statements in this post that transition is the proven most effective treatment for transsexuals suffering from severe GID.

P.S. This is the reason that there is so-called “cheerleading” for transition in the community – because it works. And because it is overwhelmingly statistically successful. Those are facts.

__________________________________________________

The above was the body of my response in that discussion thread.

Some Religious Arguments Against Gender Surgery Addressed

Feb26

Recently I commented on an article about Trans Medical Treatment and Faith at Transadvocate. The article began with what one Christian transwoman said about her condition.

“I am trans but also religious. Although I live as a woman, I was born with boy parts. In my opinion, to have surgery would imply that God made a mistake. I do not believe that God is capable of making a mistake, which means that I have the body I was meant to have. I believe that God gave me a challenge and that I am playing the hand that I was dealt. I am trans and proud, but I will not second guess the Almighty. I hope there is room for that, and I love and respect those who believe differently. We are all in this together.”

First, there is always room among us for one to live as they wish and if this woman does not wish gender confirmation surgery (GCS), then she should not seek it. But she should not avoid GCS for incorrect religious reasons. Her argument has several problems and I will dissect those here.

The first problem with this argument is it ignores that babies are born with medical issues every day. From cleft palates to club feet to intersex children to defective hearts to all sorts of other medical issues, the argument that “God doesn’t make mistakes” rings totally hollow. As a pastor I knew once said, this is a fallen world so all sorts of fallen things can occur, even in the womb.

But beyond that are actual Biblical passages that support people being born with problems, not even because of sin, but because that condition can eventually glorify God in some manner, and that Jesus himself accepted those who had voluntarily been castrated (feminized) which is a direct contradiction of the law in Deuteronomy that bans the castrated and their descendants from the temple of the Lord for ten generations.

Here was my comment to the article:

“John 9:1-11 and Matthew 19:11-12. Your Christian friend ought to read both those passages very carefully because they utterly destroy the basis of his argument and both of those passages are from Jesus Christ himself, assuming you accept the New Testament Gospels as accurate, which that person should.”

You need to read those passages to get the full impact but John 9:1-11 is about a man born blind from birth, and Christ reassuring that no one had sinned to cause him to be born blind but that he had been born that way for a purpose of God. Matthew 19:11-12 are about Jesus himself accepting the castrated (feminized) into the kingdom of heaven. So the argument that you shouldn’t do that to your body rings rather hollow when Christ himself accepted people who had surgically altered their genitals.

But beyond that was a wonderful comment from another poster that elaborated even further on this:

“Matthew 19:12 is a reference to Isaiah 56:5, which is clearly a refute of the very early single sentence prohibition in Deut 23:1 against damaging one’s testicles (important for all those Abraham-begets). But then the message in Isaiah and Matthew is again repeatedly referenced and played out very clearly in Acts 26-40. All three time periods, cross referenced. To a Biblical scholar, those three passages stand out as a clear instruction to specifically accept by name, people with intersex conditions, transsexuals and male eunuchs. To a historian, it’s interesting to note that the Church was accepting of eunuchs for much of its early history, even after they were replaced with virtual eunuchs (ie , the vow of chastity) perhaps a thousand years later. Castration’s feminizing effects had been known since the technique was first used on livestock possibly thousands of years prior; it clearly would have been the best available hormone therapy and surgery of the time. Almost as important, though, is that documented ‘eunuchs’ in Rome and elsewhere were recorded as living with the other women, as women. I’m fairly certain they used the (translated) word ‘eunuch’ differently than we do in our post-Freud world.

I’ve met several women who transitioned in the 70’s and 80’s who had their names successfully changed in their local parish Registry. However, that was before the late 1990’s / 2000 when anti-trans Paul McHugh was brought in as the Vatican’s “sex and science adviser”. And clearly before the Pope’s 2007 or 8 Xmas breakfast speech to the Curia regarding “protecting the human ecology”. Accordingly, the bishops have weighed in on issues such as CA’s AB1266 but followed the prior Pope’s position, not Canon, and we don’t know the new Pope’s views.

Perhaps, though, the pendulum is swinging back again:
Transgender Talks Hosted By Two Syracuse Catholic Churches
Parents of Transgender People Share Stories at All Saints Parish“

What the careful reader can learn and see very quickly is that the fundamentalist obsession with genitals was not an obsession of the early church or of Christ himself and that surgical alteration of one’s genitals was an accepted thing.

Christians who struggle with this question should, in my opinion, realize that Christ does not care if you have gender surgery or not. It’s not a Biblical issue to torment yourself over. Thus it comes down to one thing and one thing only – do you personally need to do this to be at peace with yourself. If you do, seek the surgery. If you do not, then skip the surgery.

But there is no Christian argument that I can see about gender confirmation surgery (GCS, sometimes referred to as SRS) that should give any trans person pause from aligning their body with their spirit and mind to achieve wholeness.

Whichever choice you make, make it based upon your medical needs, not upon someone else’s interpretation of religious doctrine. You are free to make the choice that you need, whatever choice that is.

Peace be with you, each and every one of you.

Second E3000 Session Results

Feb15

As promised, I am visually documenting my progress with E3000. I forgot to take an immediate pre-session before photo so I grabbed one at the 1.5 hour break mark. By that time the upper lip was largely cleared and work had also begun on the lower right side of the chin but it still conveys the amount of facial hair which was about the same as session one. I was told not to expect significant decrease in facial hair overall until we’ve completed at least four sessions but I will remark that there were more small “bald” spots on my face this time meaning less overall hair total.

E3000_session2_before_after_resized

 

The above were taken February 13th, 2014, in Dallas. The before photo was about 1.5 hours into the session and the after photo was immediately upon arrival back at my hotel around 5pm.

Second E3000 Session This Week!

Feb9

My second E3000 session will be later this week. I’ll be sure to take some before and after photos and try this time to get an immediate after photo to show the usual swelling as a reference.

I got a very nice PM from one of my daughter-in-laws. She’s so very sweet. I really wish I could see my new grandson but I know that will never happen. It’s something I have to move past. But I am thankful that she at least acknowledged me this once.

I’m going to be going to Memphis, Tennessee in March to see a very very dear friend and hopefully a second who may be coming down from Madison, Wisconsin that same week. I’m excited!

The ethinyl estradiol continues to work and better than the prior estrogen form I was taking. I’m finally noticing more feminization occurring so this is a good thing!

A friend of mine finally joined Facebook. I hope I can make her presence there more comfortable.

Life proceeds apace. I’m gathering materials to have handy for my coming out to HR and management in early March.

Small steps, baby steps, but onward I go.