The etiology of this condition has remained and still remains shrouded in mystery. Is it a psychiatric disorder or a “real” phenomenon? Is it biological or caused by environmental events, such as how an individual is nurtured?
The psychoanalytic model was the lens through which it was originally viewed in the United States and Europe. Psychoanalysts maintained that the female-to-male transsexual demonstrated “serious object relations disturbances, notably an inability to separate on the part of both mother and child… led to an attempt to incorporate a female person” (Macvicar 1978). When it was shown that talk therapy did nothing to ameliorate the symptoms of transsexualism, psychoanalysis was abandoned as a legitimate way to describe and treat the condition.
Biological explanations have enjoyed popularity since the 1970s. Early versions included the H-Yantigen, temporal EEG abnormality, and shape and size of the selenium of the corpus callosum hypotheses. These were all disappointingly refuted.
Recent biological theories include gender transposition which describes hormonal changes at a critical gestational stage and neuronal pruning. There is an active pruning of the right hemisphere in the majority of individuals, but it appears that the alternative pruning of the left hemisphere may result in left-handedness, dyslexia, and transsexualism. One tantalizing theory purports that there are differences in the brains of male-to-female transsexuals compared to both homosexual and heterosexual males in an area of the hypothalamus known as the bed nucleus of the stria terminalis or BSTc.
Genetic markers for transsexualism are currently under scrutiny. Diamond and Hawk (2003) established a 48 percent concordance for transsexual identity in identical twins, and concluded that there may be a genetic contribution to gender identity disorder.
There is a current dispute among those who study the origins of transsexualism. Some believe that if a gene or genes for transsexualism is uncovered, that gene could be destroyed or fetuses aborted. The complexity of genetic expression renders this fear baseless; it is known irrefutably that “the impact on most human characteristics is a result of multiple effects of multiple genes.” (Ridley 2000).
The etiology of transsexualism is, at this point, unknown. Behavior in humans is complex and largely inexplicable. We do know, however, that treatment must be provided for those who seek medical intervention. Current treatment comprises changing the body to align with the internal sense of gender identity. White (1977) maintains that no matter the pathway, gender identity, “once crystallized…becomes as difficult to change as forgetting one’s mother tongue.”
Ettner, R., Monstrey, S., Eyler, 2007, Principles of Transgender Medicine and Surgery, Binghamton, NY: The Haworth Press.