You can’t

change your sex

Sydney Bockner

Sex cannot be changed by surgical operations. The term "sex change operation" is misleading. Cosmetic surgery can alter the appearance of the genitalia, hormones can enlarge the male breasts and change hair distribution. Make-up artists can alter a male face into a pouting female one. These have changed your sex, haven't they? Actually, no they haven't. The only things that have changed are your name, title, appearance and dress. Even without surgery it may be difficult at times to differentiate male from female, with both sexes wearing their hair long and dressed in similar attire. Looking up their genes is one way of distinguishing their sex.

In the first place it is genes which determine our sex. We humans have 23 pairs of chromosomes—one from the mother's ovum and one from the father's sperm in all our body cells. Genes (made of DNA) lie strung along our 23 pairs of chromosomes. Chromosome-pairs numbers 1 to 22 are microscopically identical, but chromosome pair number 23 the so called sex chromosomes are different. In the female number 23 has two paired large X chromosomes (so called because they resemble the letter X). In the male number 23 has one X chromosome paired with one small Y chromosome. It is this variation that determines sex differentiation (Diamond 1997). The ovum produces X chromosomes only, while the sperm produces both X and Y varieties.

Diagram 1 shows an X chromosome from the ovum paired (by chance) with an X chromosome from the sperm to produce a female. Diagram 2 shows an X chromosome from the ovum paired (again by chance) with a Y from the sperm to produce a male.

Other factors are involved—for example the steroid hormones and other hormones and enzymes, which play an important role in the later maturation of sex.

Clearly, no amount of surgery can change the 100 million million body cells to alter the chromosome combinations that determine our sex. So a sex change is impossible.

What may change is a person adopting the sex role of the opposite sex. There may be a psychological change, with the conscious, voluntary adoption of the demeanour of the opposite sex. This may degenerate into high (or is it low?) comedy, as recently reported in the British press, when a six foot two inch sergeant in the Parachute Regiment appeared on parade in high heels and a frock.

Persons desiring a "sex change" operation - more accurately - changing their gender role (Money 1955) have since the 1950s been classified transsexuals. Before this, and the advent of hormone therapy and modern surgical techniques they were all regarded as transvestites (persons who cross dressed). The term transsexual is used to mean a person having the characteristics of one sex and the supposed psycho-logical characteristics of the other.

Hoenig (1982) defined transsexuals as "persons born without physical abnormality in their genital organs, who are assigned to the opposite sex and reared in that sex. And yet in spite of all this, and often in the face of fierce resistance by parents and others, they develop usually from the earliest age, a paradoxical gender identity which is permanent and unchangeable. Most transsexuals pursue their aim of physical change with fanatical fervour, and the idea appears to dominate their entire existence".

Roberto (1983) states that transsexuals believe that they are members of the opposite sex, dressing and appearing in the opposite gender role. They perceive themselves as heterosexual, although their sex partners are anatomically identical. They have repugnance of their own genitals, and wish to transform them. There is a history of cross genital activities and a persistent desire for sex conversion surgery.

Transsexualism is three times more common in mails than in females (Eklund et al, 1988, Hoenig & Kenna 1994). The World Health Organisation classifies trans-sexualism as a psychiatric disorder (W.H.O. 1978).

Gender reassignment surgery is a cosmetic procedure, in some cases allowing alternative sexual practise. Although the level of sexual interest is often low, sexual orientation is homosexual, but considered heterosexual by the subject (Garden & Rothery 1992).

Gender reassignment surgery in the male consists of castration and neovagina construction. In the female the surgery encompasses excision of breasts, uterus and ovaries, and may include construction of an artificial penis. Patients are also given hormonal treatment both before and after surgery. Women find it easier to assume and be accepted as male than it is for males to adopt the female role. Women do not seem to have much trouble living a masculine life, and it appears to be more readily accepted by society than it is for males (Snaith1990). Further, the operations of mastectomy, hysterectomy and ovariectomy are commonly performed for other conditions and have no associated taboos.

Mate-Kole et al (1990) at the special clinic at Charing Cross Hospital in London found that the outcome of gender reassignment surgery was generally favourable. Successfully treated trans-sexuals are mostly self -supporting, and not a drain on society compared with unhappy people with unresolved gender problems. Though gender reassignment should remain an option, according to workers in this field the pitfalls are many, including loss of family and friends, of work and of esteem by others. Furthermore the end results may be worse than the former state. The outcome in male to female surgery was 50% satisfied, and female to male was 80% satisfied (Snaith 1990,1993,1994). Postoperative psychiatric support is advisable, but many refuse this help at rehabilitation into their new gender role (Kuiper et al 1988).

Occasionally nature makes mistakes. Rarely a male may have an extra Y chromosome forming XYYand resulting in 47 instead of 46 chromosomes in his body cells. This is associated with the psychiatric abnormality of aggressive personality disorder, (Bartlett 1968).

These males are also unusually tall, and have a significantly higher incidence of homosexuality (Daly 1969). The XYY pattern has also been found occasionally in transsexuals (Taneja et al 1992). Very rarely faulty chromosomal distribution results in abnormal genital anatomy as in hermaphroditism (Money 1955). However, these rare mutations should not influence our skepticism about sex change - which is impossible.

Bartlett, D.J. et al (1968) - Nature 219,351. On XYY Psychopaths.

Daly, R.F. (1969) - Journal of Nervous & Mental Diseases 149,318327

Diamond, J. (1997) - The Evolution of Human Sexuality Weidenfeld & Nicholson, London.

Eklund, P.L.E., Gooren, L.J.G., Bezerner, P.D. (1988) - British Journal of Psychiatry 152,638640. On the prevalence of transsexuals in the Netherlands

Garden, G.M.F. & Rothery, D.J.(1992) Br. J.Psychiatry 161,852854 Discusses the importance of social upbringing in transsexualism. They refute a simple genetic basis for the disorder.

Hoenig, J. & Kenna, J.C. (1974) Br. J. Psychiatry 124,181190. On the preva-lence of transsexuality in England & Wales.

Hoenig, J. (1982) "On Transsexualism", Recent Advances in Clinical Psychiatry Vol. 4, Edinburgh, Churchill Livingstone.

Kuiper, B. & Cohen-Kettenis, P. (1988) Archives of Sexual Behaviour 17,439-457. On sexual reassignment surgery in Holland. A studv of 141 Dutch transsexuals.

Mate Kole, C., Freschi, M., Robin, A. (1990) - Br. J. Psychiatry 157,261264.

Money, J. (1955) - Bulletin of Johns Hopkins Hospital 97,301319. Introduced the term gender role in place of sex change.

Roberto, L. (1983) – Archives of Sexual Behaviour 12,445473.

Snaith, R. P. (1990) - Journal of the Royal Society of Medicine, London. 83.125. Reviews transsexualitv.

Snaith, R.P., Tarsh, M.J., Reid, R. (1993) – Br. J. Psychiatry 162f681685.

Snaith, R.P. (1994) – Br. J. Psychiatry 165f4l7419.

Taneja, N. et al (1992) – Br. J. Psychiatry 161,698.

World Health Organisation (1978) - Mental Disorders. Classification (ICD9), Geneva. W.H.O.

Money, J. (1988) Gay, Straight & In-Between New York. Oxford University Press. Analyses the physiology, cultural and personal histories of transsexuals.