Introduction 1

Are Transgender people trapped in the wrong body or given the wrong mind?

Neither.

My body is my body. My hands are my hands, my toes are my toes. I'm not "trapped" in my body, it's my body. The entire "I'm an X trapped in a Y body" method of explaining trans identity, while it works at an extremely high level and crude model, doesn't really capture the nuance of the trans experience and when you start talking about science.... it's best to put those models away.

Here, let's science for a second:

During fetal development, the brain is influenced by sex hormones such as testosterone, estrogens and progesterone (17). From the earliest stages of fetal brain development, many neurons throughout the entire nervous system already have receptors for these hormones (9). The early development of boys shows two periods during which testosterone levels are known to be high. The first surge occurs during mid-pregnancy: testosterone levels peak in the fetal serum between weeks 12 and 18 of pregnancy (18) and in weeks 34-41 of pregnancy the testosterone levels of boys are ten times higher than those of girls (19). The second surge takes place in the first three months after birth. At the end of pregnancy, when the α-fetoprotein level declines, the fetus is more exposed to estrogens from the placenta, this exposure inhibiting the hypothalamus-hypophysial-gonadal axis of the developing child. Loss of this inhibition once the child is born causes a peak in testosterone in boys and a peak in estrogens in girls (20). The testosterone level in boys at this time is as high as it will be in adulthood, although a large part of the hormone circulates bound. During these two periods, therefore, girls do not show high levels of testosterone. These fetal and neonatal peaks of testosterone, together with the functional steroid receptor activity, are thought to fix the development of structures and circuits in the brain for the rest of a boy's life (producing "programming" or "organizing" effects). Later, the rising hormone levels that occur during puberty "activate" circuits and behavioral patterns that were built during development, in a masculinized and de-feminized direction for male brains or in a feminized and de-masculinized direction for female brains.

[...]

As sexual differentiation of the genitals takes places much earlier in development (i.e. in the first two months of pregnancy) than sexual differentiation of the brain, which starts in the second half of pregnancy and becomes overt upon reaching adulthood, these two processes may be influenced independently of each other. In rare cases, this may result in trans-sexuality, i.e. people with male sexual organs who feel female or vice versa. It also means that in the event of an ambiguous sex at birth, the degree of masculinization of the genitals may not always reflect the degree of masculinization of the brain (21-24). In addition, gender identity may be determined by prenatal hormonal influences, even though the prenatal hormonal milieu might be inadequate for full genital differentiation (25).[1]

As models go, instead of thinking about trans people as being "trapped" in one body or another, think about rockets for a moment.

Human development is kind of like a rocket. Everything happens in stages and most of the time, everything lines up, each stage triggering exactly when it should and exactly the way it should to keep the payload moving forward.

That said, it's entirely possible for something to go a little wonky at one stage or another which can send your rocket a bit off course.

When we're talking about sex and gender in human development, we're looking at three to four really distinct stages. Stage 1: Gonadal development (ovaries or testes), Stage 2: Pre-natal neurological organizing, Stage 3: Post natal hormone surge. Arguably you could include a Stage 4 at puberty with additional hormonal surges but research to date makes it questionable about whether anything actually changes at this stage or if things are just made apparent at this stage. Research on children with gender dysphoria found statistically significant correlation between hypothalamus response to stimulation in both prepubescent and adolescent youth, however there are differences in the observed data between prepubescent and adolescent youth.[2] In general, research participants were observed to respond to stimulation (in this case, an odor) in ways consistent with their experienced gender rather than their natal sex.

Truthfully, the more I study the past 20+ years of neurological research on trans people since Zhou's publication in Nature in 1995, I find myself nodding along more and more with Antonio Guillamon:

"Trans people have brains that are different from males and females, a unique kind of brain," Guillamon says. "It is simplistic to say that a female-to-male transgender person is a female trapped in a male body. It's not because they have a male brain but a transsexual brain."[3]

Ultimately, we are what we are. Our bodies are our bodies and our minds are just fine. Some parts of our development might be a little off courseand we may need to make a few corrections to move through life smoothly, but we're not trappedanywhere. We're right here, living our lives with everyone else (or at least, we're trying to.)

If you view trans people as a mismatch between neurological development and physiological development... six of one, half dozen of another which part you think of as being "wrong."

I've struggled to integrate that way of thinking about things with everything I know about transgender biology. It's a simple model that doesn't express a great deal of the subtle nuance of sexual and gender variance.

One thing I do know... the research points repeatedly at an important fact for how we think about appropriate care for people with gender dysphoria: There's no therapy or treatment you can give a transgender person to make them transgender, but the distress caused by gender dysphoria can be significantly reduced by acknowledging a trans person's identity and, for some, by helping them to bring their body back on course with the direction their mind is leading them.

(To be edited)