Gender Past and Present

In 1620 Gian Lorenzo Bernini sculpted a quilted mattress of marble for the splendid sculpture of the sleeping hermaphrodite that was unearthed in Rome a decade earlier, a copy of a lost Hellenistic bronze of the 2nd century B.C. This rendering of an imaginary body, with female breasts and male genitals, is a concretization of Ovid’s story of a beautiful boy and girl who were said to have been fused into one person by the power of physical attraction. For centuries, Hermaphroditus rested on Bernini’s mattress, an erotic curiosity with no peers. But he/she is no longer alone. Experiments intended to satisfy the desire of some men to turn into women, and vice versa, have succeeded in creating a group of individuals who display characteristics of both sexes. Science is not art, however, and the human body is not made of stone. The sculpted genitals of the antique hermaphrodite are tumescent, but the treatments of gender medicine invariably damage and destroy the organs of sex. The sleeping hermaphrodites of the 21st century are waking up to find themselves eunuchs.

I grew up in Brisbane in the 1970s in a quiet suburb by the river. I loved the bright colours and musical sounds of my neighbourhood -the red, purple and yellow of poinciana, jacaranda and frangipani, and the calls of tropical birds. As a child I was what once was called effeminate, and now is called gender non-conforming. I liked to put on the prettiest of the dresses which my older sisters had outgrown or no longer wanted, and often wore them when I was playing in our back yard. I remember bouncing on our trampoline with one such dress billowing about me, a shock of psychedelic pink. I felt like a flower as the ballooning fabric encircled my small frame.

A more important piece of clothing was the antique satin dress my parents gave me as an item for my dress up box. It was a pale pink evening frock from the wardrobe of my grandmother. The bodice was sewn with sparkling cut glass beads attached by loose threads so that they trembled and shimmered against the fabric. Who knows what special occasions my grandmother had once attended in this garment? I felt like a guest at a grand ball when I wore it. As well as wearing dresses like these, I also tied ribbons to my long blond hair, and liked wearing high heeled suede boots.

When I was young, my eccentric behaviour was simply regarded as play. This was a time when all kinds of norms were being resisted. My breaking of gender stereotypes was part of a wider revolution that was being waged all around me against a multitude of unwanted values from the past. As a result, my cross-dressing did not attract very much attention. Even so, I knew that there was more to it than mere non-conformity. It had a sexual meaning. I first became aware of this during an incident which happened when I was about eight years old.

One day after school, I visited the house of a friend when his parents were away. He took me to his parents’ bedroom and opened the top drawer of their dressing table to reveal a neatly folded pile of silk squares - his mother’s impressive collection of Hermes scarves. I knew immediately that we must dress ourselves in these shimmering fabrics. As if reading each other’s minds, we stripped off our school uniforms and commenced to wrap our bodies in one scarf after another. Like fashion designers before a show, we arranged the silk against ourselves in outlandish and provocative combinations. As the activity progressed, the once pristine scarves were tossed and scattered around the room, and they became stained with our sweat. The extent to which I was aroused by this sartorial experimentation could not be concealed. I do not recall how the episode ended, but at the end of our game we were unable to put everything back as we had found it. The scarves were damaged, and I was never allowed to go near that dressing table again.

When I reached puberty, and started to feel sexual attractions to other people, I learned that it was exclusively to other boys and men that I was attracted. The idea of becoming a woman fascinated me because I didn’t see how I could satisfy my sexual desires without undergoing some kind of magical change of sex. Only by that means, I thought, could I become a suitable partner for the class of people whom I desired. Although I knew of the existence of homosexuality it had a marginal, criminal and shameful status in the culture around me and in my own imagination. On the other hand, I knew that a sexual metamorphosis of the kind I fantasized about was impossible. By the time I was eighteen, I had all but abandoned outward displays of femininity, and succumbed to the pressure to conform which I had discovered was more absolute for adults than for children. I gave one last performance, however, to mark a symbolic end to my open experimentation with gender.

At the conclusion of my first year at university, I reunited with an old school friend and we hit upon the idea of making a super 8 film together to pass the time between semesters. The story we agreed to tell concerned an Ophelia-like character, played by me, who would go mad and spectacularly drown herself in the wake of a failed romance. Dressed in a black gown with my face heavily made up, I was filmed casting myself into a local creek. In the final shot, I lay motionless with my dress billowing around me. My eyes stared up at heaven as broken flowers swirled around me in the ripples. The scene was inspired by the John Everett Millais painting in the Tate, but I see, looking back, that it was a deeply personal tableau. I was marking the end of the freedom I had once enjoyed to play openly with my expression of gender. If I had had the opportunity to become a woman at that moment, I would have taken it, but as I said before, no such transformation was or is possible.

Forty years passed and I did other things. I was pulled back into thinking about my own gender non-conformity quite suddenly when I noticed that something once exceedingly rare, the attempt to simulate the appearance of the opposite sex through surgery and hormones, was becoming a widespread cultural phenomenon. When I looked closer, I saw that a leap of faith had been made in the accepted idea of what transgender people were. Young women on testosterone were now calling themselves ‘dudes’, and ‘Transwomen are women’ had become the battle cry and mantra of a new movement. I saw that social media was awash with the soliloquies of young people describing their feelings about gender and their experiences of gender treatments.

So, I found myself listening to a young man who identified as female as she explained how she had come to know that she was indeed a woman. When she listed the signs that she interpreted as indications she should transform her body, I was mystified. She liked having long hair. She preferred Nintendo to Xbox. She didn’t like shopping for boys’ clothes. She felt uncomfortable undressing in changing rooms. She didn’t like sport, and she wasn’t interested in military history. None of these things, it seemed to me, would persuade a reasonable person to experimentally modify their sex organs. Then came the final revelation. She had never lusted after girls, but, rather, had felt a deep emotional attraction to them and had wanted to have lesbian relationships with them.1

This made more sense to me, for it reminded me of what I knew about Ray Blanchard’s research into sexuality. Blanchard is famous as the sexologist who coined the term autogynephilia to diagnose the subset of transsexual men who identify as heterosexual. Gay men, such as myself, have a practical reason for wanting to switch sexes which does not exist for heterosexuals. As a result, the heterosexual cohort of trans-identifying men has often perturbed clinicians. There was no unifying theory of what motivated their obsessive wish to become women before Blanchard came up with the concept of autogynephilia. After studying numerous case histories, he invented the term to describe a man’s erotic attraction to the idea of himself as a woman.2 An autogynephile, Blanchard thought, might be aroused by wearing women’s clothes, by knitting, or by fantasizing that he had breasts and a vulva, but in all cases the source of his excitement was a sexual attraction to the thought or image of himself as a woman. I do not know what such a sexual orientation would feel like, but I can see how it might create a powerful urge to want to change the shape of one’s body.

So, it seems there are at least two different classes of transgender men, the homosexual and the heterosexual, and they would appear to have little in common. Then there are the women. The first clinicians to experiment with medical gender treatments for adolescents (in the early years of this century) only accepted subjects who had shown persistent signs of gender non-conformity since early childhood. The few girls whom they treated were all same sex attracted and tomboys.3 Since then, however, the number of girls who identify as transgender has increased exponentially. The girls who are now receiving hormone treatments for what is called gender dysphoria outnumber the boys, and they include both lesbians and heterosexuals. Some of them show no signs of gender non-conformity before transitioning. Recent attempts to explain the phenomenon have focused less on sexuality than on environmental factors such as peer influence and media persuasion.4

A possible driver for the great number of girls now seeking medical gender treatments may be the very efficacy of the hormones they are prescribed. A common theme of many of the accounts of female to male transition now appearing online is the effect of testosterone on the female body. The growth of facial and body hair, the enhancing of upper body strength, the deepening of the voice, and the enlargement of the clitoris in the shape of a micropenis, are all described in lingering detail by a multitude of transitioners on YouTube. Indeed, testosterone is a more effective hormone than estrogen in reshaping the body, and the chances of passing for the opposite sex through hormone use alone are better for those who are born female than for those born male.

In this regard, it should be noted that aesthetics have played a central role in the rapid progress of the medicalisation of transgenderism over the past two decades. The Dutch clinicians who pioneered the prescription of puberty blockers and hormones to adolescents did so on the basis that their interventions would achieve more convincing cosmetic outcomes if they were made before rather than after puberty.5 A similar impulse seems to be motivating the increasing popularity of chest and genital surgeries, whose effects are more suited to the public and social sphere than the private, sexual one. A chest which has been operated on looks better when covered than exposed, and if patients opt for genital surgery the results will be more cosmetic than functional. The illusion of metamorphosis is best seen through a camera and presented on a screen. It does not matter if a trans man is shorter and smaller than other men if he can appear on social media in a controlled environment where no comparison to others need happen. If a trans woman has some incongruous masculine features, they can be minimized by lighting and make-up.

The superficiality of the transformation which medical treatment affords is underlined by the fact that if one follows the logic of transgender rhetoric then there should be no need for any man or woman who identifies as transgender to alter their body at all. If a person can be a man or a woman no matter what form their body takes, then why do they need to physically alter it to bring it into line with the gender they profess to be? And how can one have a masculine or feminine gender identity that is not informed by the cultural ways in which masculinity and femininity are constructed?

The novel expressions of gender now being broadcast on YouTube can only be understood in the context of changes in education and medicine which have happened quietly and steadily over the past two decades. A teaching resource from 2015, for example, shows how ‘transgender experiences’ are being explained to Australian students in years 7 and 8 as part of the Physical Education curriculum. One lesson plan directs teachers to initiate an investigation into masculine and feminine stereotypes by asking students to think about the different kinds of toys boys and girls play with, the different ways in which boys and girls are expected to express emotion, and the different types of movies and music which boys and girls typically like. The lesson appears to critique socially constructed gender stereotypes, and the teacher is directed to say that not all boys and girls mesh with the expectations of society, and nor should they be expected to. But the message is undermined when students are introduced to a transgender man called Nevo. They are told that ‘Nevo was raised as a girl and grew up feeling that this did not match who he really was. He is undergoing a transition, medically and socially, to make his external appearance more masculine and to make his life better reflect how he feels inside. This is also known as affirming one’s gender identity.’6

So, the lesson which purports to reject socially constructed gender stereotypes ends up by reaffirming them. Instead of telling girls that they can do whatever they want, it teaches a girl who wants to behave in ways classed as masculine by her society, that she might feel more comfortable if she altered her body to make it look more masculine to the outside world. Anyone, it insists, can become an electrical engineer, but they might want to grow a beard first. A more reasonable conclusion to draw from a lesson of this sort would be to say that to alter one’s body to make it conform to an idea of gender (whether it comes from inside or outside) is unwise because it causes permanent damage to our physical organs in response to something that is impermanent and transitory.

A girl who escapes sex discrimination by making herself appear masculine does not challenge the sexism in her society, but, rather, participates in and reinforces it. Girls who have medically transitioned and can successfully pass as male tell of feeling that they are more respected when they speak, and that they are safer and more confident when they walk on the street.7 But these experiences only serve to perpetuate sexual inequalities by expanding the number of the privileged male class while doing nothing to improve the status of women and girls.

Similarly, the transitioners who (as I might have done) attempt to alter their sex in order to sidestep their homosexuality, participate in a social stigmatization of same-sex attraction which reverts back to old fashioned prejudices. The activism of the second half of the twentieth century resisted the same negative stereotypes of homosexuality that are now being revived in the name of transgenderism. ‘Everyone thought I was a lesbian. To be fair, if I was female, then they’d be right,’ recalls one female to male transitioner.8 ‘I’m straight until I get horny’, confesses a young man who transitioned from male to female, and back to male again.9 Such attempts to avoid the label of homosexuality can only be a ticket back to the closeted world of the ‘love that dare not speak its name.’

Let us move now from education to medicine, and to the ‘Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents’ produced by the Royal Children’s Hospital in Melbourne. The treatments recommended by this document are intended to help young people, like Nevo, who say that their body doesn’t match who they really are. It calls for children and adolescents who feel incongruence between ‘their gender identity and their sex assigned at birth’ to be prescribed GnRHa drugs to suppress puberty, to be given estrogen or testosterone to promote the development of secondary sex characteristics contrary to what would develop naturally at puberty, and, where appropriate, to be referred for surgeries such as mastectomy, vaginoplasty and phalloplasty.10

The phrase ‘sex assigned at birth’ is disingenuous in this context because all of the medical interventions recommended by the Australian standards of care are dependent upon the understanding that the patient being treated is indeed the sex that the obstetrician said they were when they were born. Far from being assigned at birth, the proposed medical regime recognizes sex as an immutable fact without which puberty blockers, hormones and surgery would be unnecessary. If sex is assigned at birth, then the endocrinologist assigns sex again at puberty, agrees with the obstetrician, and sets about the task of trying to stop it from manifesting itself in the patient’s body.

There are serious risks associated with the recommendations made by the Australian standards of care, some of which are identified by the authors and some of which are not. Surprisingly, however, in the section headed ‘Avoid Causing Harm’ there is no mention of the dangers of genital surgery, or of the damaging effects of cross-sex hormones and puberty blockers on the body. Instead, the reader is warned that withholding gender affirming treatment may exacerbate distress, and that attempting to change a person’s gender identity is unethical. The footnote to this assertion cites a chapter on aversion therapy in a book published in1969, edited by John Money.11

Money is infamous as the sexologist who exploited and misrepresented the experience of David Reimer in the attempt to use him as an example of successful childhood gender transition, when, tragically, he was nothing of the sort. Money advised Reimer’s parents to raise him as a girl, a pretence which Reimer refused to submit to after he reached puberty. Despite this, Money published false accounts of his history in which he wrongly represented him as a happy transsexual.12 The reference to aversion therapy in the Australian Standards of Care is no less of a misrepresentation. It attempts to dissuade clinicians from exploring the factors that may lie beneath a patient’s feeling of dysphoria by falsely likening such a task to the now all but abandoned practice of administering electric shocks in order to produce conditioned responses.

Surprisingly, the injunction to ‘Avoid Causing Harm’ does not mention that GnRHa drugs are not licensed for the treatment of gender dysphoria and so have not undergone clinical trials to see if they are effective and safe for that purpose. Nor does it note that out of the initial group of seventy adolescents who were treated by the Dutch clinicians (on whose model the Australian standards of care are based) one died as a consequence of vaginoplasty.13 The boy who did not survive surgery on his penis, testes and intestines was, unfortunately, not the last to suffer as a result of this dangerous procedure.

The purpose of vaginoplasty is to make an artificial opening between the legs which, in most cases, is lined with inverted tissue from the penis, and skin grafted from the scrotum and/or intestines. It is a major and painful operation after which patients are required to regularly dilate the hole to prevent it from closing up. Bleeding, incontinence and ongoing pain are potential side effects. One young man who regretted having the operation as soon as he woke up from surgery lamented how quickly he had gotten a referral for it, saying, ‘I wish someone had challenged me’14

Herein lies a serious flaw in the Australian Standards of Care. They fail to acknowledge that the path they advocate from social transition, to puberty blockers, to hormones, to surgery is not guided by a set of independent choices but, rather, is made up of decisions which cascade from one to the next like dominoes. Once the first step is taken, the others will almost certainly follow.

The medical intervention to suppress puberty is motivated by an unease with the development of unwanted secondary sex characteristics which can only be exacerbated if a child has previously started to appear in public as a member of the opposite sex. The pretence of not belonging to one’s own sex becomes more difficult as puberty starts and the body takes on mature signs of masculinity or femininity. So, children who socially transition at an early age are placed on a path that predictably leads to puberty blockers. Georgie Stone, an ambassador for the Gender Unit at the Royal Children’s Hospital, experienced her approaching puberty as an urgent call to action after she had socially transitioned as a child. It was ‘a race against time to get a prescription for puberty blockers’, her father recounted, ‘If Georgie went through puberty, it would have been terrible’.15

Once a child starts taking puberty blockers a new process begins, bringing with it the justifications for moving on to testosterone or estrogen. A child held in an unnatural state of immaturity by GnRHa lacks the hormones they need for the next stage of their development. The Australian standards of care acknowledge that bone density will be lost as a consequence of taking puberty blockers. They also observe that because pubertal development is ‘occurring significantly behind expected norms’, adolescents prescribed GnRHa may experience difficulties with peer group relationships that are likely to push them towards commencing hormone treatment.16 This does not shake the authors’ conviction, however, that puberty blockers allow time to think before a decision is made about cross-sex hormones. As it happens, every study has shown that the proportion of patients who start taking puberty blockers and do not go on to take hormones is about 2%.

Because puberty blockers subvert the natural process of an adolescent’s physical and cognitive maturation, it is reasonable to think that they may prevent developments which would normally resolve feelings of gender dysphoria. Since the 1960s, GnRHa drugs have been used to treat male sex offenders due to their capacity to suppress libido. It has been hypothesized that the drugs switch off a central arousal mechanism, reduce the attention span for and the frequency of sexual fantasies, and diminish the quality of sexual feelings as a result of diminished tactile function in the penis.17 While it is known that at least three quarters of effeminate boys who experience gender dysphoria in childhood, and who are not given medical treatment, will grow up to be homosexual or bisexual, it is not known what is the impact of GnRHa drugs on the development of sexuality when taken during puberty. The leading gynecological surgeon, Marci Bowers, has noted that none of the boys she has worked with who were given puberty blockers from the onset of puberty have ever experienced orgasm.18

In 2012 two of the clinicians who invented the now internationally followed protocol for pediatric gender medicine noted that the vast majority of gender dysphoric children grow up to be homosexual, and that only a very small percentage become transsexual. They observed that gender variant children who meet the criteria for gender dysphoria prior to puberty usually lose their feelings of dysphoria as they grow up, and that ‘when and how gender dysphoria disappears or desists’ is not known. On the other hand, adolescents who start taking puberty blockers almost never grow out of their feelings of dysphoria, and almost always go on to take cross-sex hormones. But even as they observed all of this, the clinicians did not pause to wonder if puberty blockers might be the mechanism which was preventing the adolescents they were treating from growing out of their gender dysphoria.19

All of this indicates that the early intervention recommended by the Australian approach to pediatric gender medicine makes a reckless bet on what the future needs of the treated children will be. It should be clear that a child who is entering puberty is not capable of giving informed consent for the interventions recommended by the Australian Standards of Care. They cannot know how the loss of fertility and sexual function will affect their adult life because they have not yet experienced the developmental stages of adolescence -the cognitive and emotional milestones, and the discovery of sexuality, which are the pathway to adulthood. Nor, from the perspective of their healthy bodies, can they know or understand the limitations which will be placed on their adult lives by an ongoing dependence on medicine induced by hormonal interventions and invasive surgeries.

To make matters worse, the doctors who offer the treatments are themselves ignorant of the long term effects of their interventions. The authors of the Australian Standards of Care admit that, ‘the degree to which testosterone may reduce one’s reproductive potential when taken in puberty is unknown’, that ‘there is evidence that estrogen impairs sperm production although whether these effects are permanent remain[s] unknown’, and that ‘the long term impact of puberty suppression on bone mineralization is currently unknown’20 What they fail to acknowledge is that they are also unable to say if the treatments they offer have any measurable benefits to weigh against their known risks.

There is, in fact, no scientific basis for the claim that medical interventions are an effective treatment to ameliorate gender dysphoria. This is illustrated by the fact that the study most often cited as evidence in support of the medical treatment for gender distress in adolescents is flawed by a fundamental methodological error. The authors used two different sets of questions to measure the patients’ gender dysphoria before and after surgery. Although the completed questionnaires seem to show a marked decrease in feelings of gender dysphoria after surgery, this may be due to the fact that patients were asked questions about their actual bodies before surgery, and questions about the bodies they wanted to have (of the opposite sex) after surgery.21 The fact that such a fundamentally inconsistent measure could be treated as scientific is an indication of how little a role science has played in the promulgation of medical gender treatments in general.

Presently, the practice of gender medicine is at a turning point. In countries where systematic reviews of the evidence for pediatric gender medicine have been conducted, the UK, Sweden and Finland, treatment has been rapidly rolled back in response to the lack of evidence.22 In America the debate is mostly polarized along political lines, with one side advocating total bans while the other wants unfettered access for all. Despite the large numbers of young Australians who are currently receiving the same treatments now being restricted elsewhere, critical analysis of the costs and benefits of gender medicine is discouraged here. When I asked my local Member of Parliament if he thought there was cause for an independent review of medical gender services in Australia, he replied in the negative. His reasoning was that he trusted the experts. But the experts, increasingly, are in fierce disagreement. And so, I ask, which experts do you trust? And why?

1 Zealdrifter, 3 Feb 2022, ‘Am I trans? Signs I was Trans as a teenager’ [video] (YouTube)

2Lawrence, A., ’Men Trapped in Men’s Bodies’, Springer, New York, 2013 pp.6-7

3 De Vries, A., Steensma, T., Doreleijers, T., Cohen-Kettenis, P., ‘Puberty Suppression in Adolescents with Gender Identity Disorder’, Journal of Sexual Medicine, Vol.8, Issue 8, August 2011, pp.2276-2283

4 Littman, L., ‘Parent Reports of Adolescents and Young Adults perceived to show signs of Rapid Onset Gender Dysphoria’, PLOS ONE 14(3), 16 August 2018

5 Biggs, M., ‘The Dutch Protocol for Juvenile Transexuals: Origins and Evidence’, Journal of Sex and Marital Therapy, Vol. 49, 2023, Issue 4

6 Bush, C., Ward, R., Radcliffe, J., Scott, M., Parsons M., ’All of Us’, Minus18 [Education resource] 2015

7 Sweeney, A., ‘The Social Transition no one talks about/ FTM Transgender’, 19 August 2023 [Video] (YouTube); Delly, R., ’What are the Pros and Cons of Being a Dude?/ Trans FTM’, 12 October 2022 [Video] (YouTube)

8 beckettls, 22 April 2021, ’Realizing my Trans Identity’, [Video] (YouTube)

9 L., Alexander, 4 Sep 2023, ‘Autism and Gender Identity: Talking detransition, AGP, transmaxxing and HRT (with Ritchie Herron)’ [Video] (YouTube)

10 Telfer, M., Tollit, M., Pace, C., Pang, K., ‘Australian standards of care and treatment guidelines for trans and gender diverse children and adolescents’, Version 1.4, Melbourne, Royal Children’s Hospital, 2023

11Green, R., Money, J., (eds.), ‘Transsexualism and Sex Reassignment’, John Hopkins Press, Baltimore, 1969

12 Colapinto, J., ’As Nature Made Him, The boy who was raised as a girl’, Harper Collins, New York, 2000

13 Biggs, M., op.cit.

14 White, Sasha, 5 June 2024, ’Waking up after Botched Trans Vaginoplasty: Instant Regret and Horror’ [Video] (YouTube)

15Cohen, J. (Producer), ’Australian Story. About a Girl.’ 15 August 2016, Australian Broadcasting Corporation [Television Broadcast]

16 Telfer, M., et al., op.cit., p.17

17 Gijs, L., Gooren, L., ‘Hormonal and Psychopharmacological Interventions in the Treatment of Paraphilias: An Update’, The Journal of Sex Research, vol.33, no.4, 1996, pp.273-290

18 Duke Sexual and Gender Minority Wellness Program, ’Sexual and Gender Minority Health Symposium’, 21 March 2022 [Video] (Facebook)

19 de Vries, A., Cohen-Kettenis, P., ‘Clinical Management of Gender Dysphoria in Children and Adolescents: The Dutch Approach’, Journal of Homosexuality, 59, 28 March 2012, pp. 301-320

20 Telfer, M., et al.,op.cit., pp 13-15

21 Levine, S., Abbruzzese., E., Mason, J., ‘Reconsidering Informed Consent for Trans-Identified Children, Adolescents, and Young Adults’, Journal of Sex and Marital Therapy, 17 March 2022

22 Cass, H., ’Independent review of gender identity services for children and young people’, 2024