A transsexual is defined as a person who believes that he or she is a person of one sex trapped in the body of the opposite sex. Since the mental sex cannot be changed while the sexual attributes of the body may be altered by hormone treatment and surgery, the only solution to the dilemma of a transsexual is to change the body. Transsexualism is a sex reversal, an inversion of sex role, since the untransformed transsexual tries as much as possible to behave as the sex he or she craves to be. Actual sex change, as opposed to sex reversal, is the result of outside intervention by the surgeon and endocrinologist, assisted by the psychiatrist and the former transsexual now becomes a person of the opposite sex.
Male to female change
On her fortieth birthday Deborah checked herself in the mirror, as she always did before leaving for work. She liked what she saw: a trim figure in a dark burgundy dress and jacket, cut from good cloth, a white silk blouse with a pussycat bow, sheer pantyhose, burgundy pumps with two inch heels. She leaned forward to check her makeup, discreet, almost invisible except for the pale brown-tinged lipstick, no eye makeup, carefully plucked eyebrows. Her hair was impeccable, a shoulder-length page-boy cut with a fringe to her eyebrows, thick, auburn, and lustrous. She wore no jewelry, except tiny stud earrings. She looked at her ringless hands with their short nails matching her lipstick, and pulled on her gloves. She looked what she was, a middle manager, successful and efficient. In fact she was director of laboratory services at a large urban hospital. She was not pretty, but what woman of forty was? She was not even beautiful, but (at least in her own opinion) she had a pleasant face and a good figure, a bit thick in the waist perhaps, but by no means plump. She knew she had reached the glass ceiling and would rise no higher, but she was contented with her job; it was interesting and well-enough paid. She thought about Hiram, her predecessor in the job, and about the mess he had made of it. Her laboratory was now a productive and happy place to work, and she was well-respected for her skills, even though she had no real friends there.
That evening a few friends were throwing a party for her birthday. When she arrived home from work she stripped and hung up her clothes with somewhat obsessive neatness and ran a bath, with scented bath-oil, while she put out her clothes for the evening, black strapless bra, satin and lace panties, sheer black pantyhose, a black taffeta cocktail dress. Soaking in the bath she pushed two fingers up her vagina and, flicking her clit, masturbated until she came, playing with her breasts with the other hand. Her breasts were small and dainty, but at least they did not droop; she was glad now she had not had those implants she had contemplated a few years ago. Still in the bath, she shaved her legs, glad that she did not have to shave anywhere else.
For evening she would wear heavier makeup, first mascara, eyeliner and brownish eye shadow, foundation, powder, blusher, and a darker lipstick, matching the long artificial nails she would wear. After powdering her body, she applied perfume to the pressure points and dressed with care, after brushing her hair and spraying it with hair lacquer. She was going to enjoy this evening and wondered if she would make it with her date. Her plain, black dress had a dropped waist, flaring out from the hips in a short full skirt reaching hardly below mid-thigh, a little short, perhpas, for a woman of her age. She pirouetted before the mirror, wearing her new black patent pumps with three-inch heels, wishing that her legs were longer--all her height was in her long torso--and then put in her dangling earrings, added the matching necklace and bracelet and then cursed as she struggled to fasten her evening watch clasp. She picked up her tiny beaded evening purse, threw her mink stole around her shoulders and set off to the party.
Hiram's thirtieth birthday, some years earlier, had been quite different. He had been in his job at this hospital for barely a year and although his laboratory skills were outstanding he had only survived the probationary period with difficulty, since his relationship with his staff and with the hospital administrators had been so bad. He arrived at the hospital looking as if he had slept in his clothes. A short flabby individual, he seemed to care nothing for his appearance. Despite his flabbiness he was thin and rat-like, scurrying around the place. He carried a great chip on his shoulder, feeling that every man's hand was against him. He bridled at the faintest criticism from seniors, threw temper tantrums with his own technicians, and was wickedly sarcastic with everyone with his shrill scolding voice.
That day, his thirtieth birthday, work in the laboratory was slack, and he felt a migraine coming on. He returned home early, to find his wife in bed with her lover. He had been expecting this for some time really, and was only thankful that his two sons were at school, not due home for another hour at least. He was almost impotent and he sometimes marvelled that he had managed to father two children; it was at least six months since he had last made love to his wife. That did not stop him from tongue-lashing the pair of them and stomping out of the house. The next day he saw a lawyer and filed for divorce.
Hiram and Deborah are, of course the same person, ten years apart. Was Hiram "really" a man? Was Deborah "really" a woman? There can be no doubt that Hiram was a man, and had fathered two children. Immediately after filing for divorce he finally admitted to himself that he was transsexual and set about correcting, as he saw it, his sexual status. He had married, he now realized, simply to prove that he was truly a man, choosing a girl taller than himself, who tended to mother him, a mother substitute in fact. They had only consummated the marriage with difficulty, but there was no doubt about the paternity of his two sons. With the laboratory facilities at his disposal he had examined his own sperm and carried out a karyological examination of his chromosomes. He had normal sperm, fully motile, and no visible abnormality of his chromosomes, the normal XY complement. His hormone levels were within normal ranges, though the androgens were toward the low side of normality. Only his psychological profile differed from that of a normal man. He did not consider himself in any way homosexual, having no desire for any kind of sexual encounter with a man (unless that man were to accept him fully as a woman, but that was for the future). In fact he had never had a homosexual encounter or fantasy of any kind. All-in-all, Hiram was male in every sense of the term, admittedly a man with low libido, but nevertheless a man.
I knew both Hiram and Deborah, with whom I worked as a colleague Before I discuss whether Deborah was "really" a woman I must give a few definitions, since the word "sex" has so many meanings.
Aristotelian Sex
Aristotle thought that sex should be defined by the act of copulation. Animals that did not copulate did not have distinct sexes in his view. A male in his scheme of things was defined as an animal that produced a secretion, semen, and passed it to the female; a female was defined as an animal that received this secretion. We may thus define the Aristotelian sex of a person by the mating behaviour. An Aristotelian male is one that passes semen toward another's genitalia, and an Aristotelian female is one that receives semen for the purpose of fertilizing ova.
Notice that in homosexual coupling between males, one member of the couple may be regarded as an Aristotelian male and the other as an Aristotelian female. It is not clear from Aristotle's own writings if he considered this possibility. Aristotle regarded children as sexless since they were incapable of copulation.
Chromosomal sex and genetic sex
The XY chromosomes are familiar enough as determinants of sex, but they are far from universal. In fact, the XY chromosomes are characteristic only of mammals (or only of some mammals, for relarively few have ever been examined). Among mammals, including our own species, a typical male possesses one Y chromosome and one X, while a female possesses two X chromosomes and no Y. I repeat, this is true only of the mammals.
The determination of sex by environmental cues is quite common. Other sex determinants include temperature. This is particularly clear in crocodiles, alligators, and some other reptiles. A crocodile egg incubated at a higher temperature will hatch out as a male, while one hatched at a low temperature will produce a female. As a result, a nest high on the river bank, where the sand is hotter and drier, will hatch only males, while one lower down, in damp cooler sand, will produce only females. A hot year will favour the production of males, and a cool one of females. Inevitably many nests produce a mixture of the two sexes. I wonder how sex was determined in dinosaurs.
In birds the chromosomal determination of sex is the reverse of that in mammals: males have two identical chromosomes (sometimes termed X chromosomes, but more often W chromosomes, to distinguish them from the mammalian condition); a female either has only a single W chromosome, or, in other species, one W and one Z chromosome. Thus the genetic constitution of a cock bird is WW (or XX) and that of a hen bird is either W0 or WZ, depending on the species.
The concept of chromosomal sex is therefore only useful in mammals, birds, and a few other animals. Sex may be under genetic control (as it certainly is in bees), but this is not necessarily, or even usually, evident in the appearance of the chromosomes. Thus chromosomal sex and genetic sex are not simply two names for the same phenomenon; they are distinct, though chromosomal sex may reflect genetic sex in those animals (including man) in which sex is genetically determined. Thus a genetic female is an animal that possesses the genetic constitution for the production of ovaries, while a genetic male is a n animal that possesses the genetic constitution necessary for the production of testes. A chromosomal male is an animal that possesses the chromosomes considered characteristic of a male, (XY in the human species) while a chromosomal female is one that possesses the chromosomes considered characteristic of females (XX in women).
We may also note that in those animals that change sex the chromosomes (and the genes) remain constant and do not change when sex changes. This point is important when we come to consider human sex change.
Gonadal sex
The primary reproductive organs are defined in anatomy as the gonads, that is, the ovaries and testes, or the ovotestis where this occurs. Accordingly, we may define gonadal sex (sometimes called primary sex, though this can be ambiguous) by the possession of one or other of these organs. A gonadal male is the possessor of testes, a gonadal female is the possessor of ovaries, and an hermaphrodite is defined as the possessor of both, or the as possessor of an ovotestis. Put another way, a gonadal male is a producer of sperm, and a gonadal female a producer of eggs. A neuter is an animal that has lost its primary reproductive organs for some reason. This agrees with common usage, in which a neutered cat is regarded as sexless, as is a eunuch. A post-menopausal woman, whose ovaries have totally degenerated, is, however, not regarded as sexless, nor is a woman who has had a hysterectomy combined with ovariectomy.
Apparent sex and legal sex
Apparent sex may sound trivial, but it is not. When a baby is born the obstetrician will examine it and pronounce its sex. "It's a girl!" he will perhaps declare. The sex decided in this way is the apparent sex--the sex that the baby appears to be at first glance. It is on the basis of this pronouncement that the legal sex of the infant is decided, the sex that is entered on the birth certificate and on all subsequent documents. Mistakes do occur, even with perfectly normal babies, but more often with those with some underdevelopment. As a result, British common law (and those legal systems which are based on common law) permits subsequent corrections of legal sex if it is established that the apparent sex in later life is not in agreement with the sex that appears on the certificate of birth. Traditionally most such corrections of legal sex have happened in the first few years of childhood, especially in the first year of life, but this is not mandatory. This is not true of all countries, only in those whose legal code is based upon British common law, countries such as Canada, Australia, and the United States of America (but not Louisiana). In other countries the legal basis of sex may be different. Germany, for instance, until recently, allowed no changes at all on the registration of birth, even the correction of misspelt names.
Let me suggest a most improbable scenario: someone points to a gay couple and asks me what is their sex. To be fully honest I must answer that they are both chromosomal males, both gonadal males, both apparent and legal males, but that only one of them is an Aristotelian male, while the other is an Aristotelian female. That may sound a little far-fetched, but far more complicated situations occur, both in animals and in the human species.
What, for instance, are we to make of a person who has an XXY karyotype? That is to say someone who has two X-chromosomes and one Y chromosome? A woman has two X-chromosomes, a man has one X and one Y-chromosome. Is such a person a man or a woman? Is he a man since he possesses a Y chromosome? Or is she a woman, since she possesses two X chromosomes? The answer may depend upon the apparent sex or the Aristotelian sex, rather than the chromosomal sex.
Endocrine or hormonal sex
In such species as man the female is characterized by the possession of an array of oestrogenic and progestogenic steroidal hormones, while the male possesses androgenic hormones. In fact women may also have low titres of androgens and men low titres of oestrogens. Endocrine sex is thus defined as the possession of titres of these hormones falling between certain arbitrary limits. Anything outside these arbitrary limits is considered an hormonal imbalance.
Functional sex
This term is used to define the sex in which an animal is actually functioning at any one moment. An animal copulating as a male is functioning as a male, even if it possesses ovaries or an ovotestis. An animal actually in the process of laying eggs or gestating a foetus is functioning as a female, even if it possesses testes. This is not as far-fetched as it sounds and some animals may seem extreme in these regards. Thus the shrimp called Calocaris cannot copulate as a male until it has developed ovaries and lost its testes, using sperm that it has stored from an earlier stage in its development.
Mental sex
This is a term that can strictly only be applied to human beings, since we can know nothing of the mental state of other species. An individual may actively believe himself or herself to belong to the opposite sex from the attributes of the body. An individual who bears all the attributes of a male may believe himself to be a female, or a person with all the female attributes may believe herself to be male. We call such individuals transsexuals. In their own eyes transsexuals are persons of one sex trapped in the body of the opposite.
Now for a few other definitions.
The primary reproductive organs are the gonads--the testes, ovaries or ovotestis.
The secondary sexual characteristics are other organs necessary for reproduction, such as the penis, the uterus, or the sperm ducts and oviducts.
The accessory sexual characteristics are any other feature distinguishing one sex from the other, such as the beard, the Adam's apple, the pitch of the voice.
The genitalia are those organs used in mating, both primary and secondary sexual organs.
The external genitalia are t hose genitalia visible on the outside of the body, such as the vulva, the penis and the scrotum.
The internal genitalia are those genitalia confined within the body, such as the ovaries, the uterus and the fallopian tubes.
Sex reversal is reversal of sex roles, as when a male undertakes duties normally undertaken by the female, or vice versa. The term sex reversal has sometimes been used as a synonym for sex change. This is ambiguous, and it is better to use the term to mean change of sex role. In the human species transvestites and transsexuals show reversal of sex roles.
Sex change is the change of sex from male to female or from female to male.
Since 'sex' has many meanings, it is always necessary to be clear about the meaning in which we are using the term. One thing is quite clear--the chromosomal sex of an animal will never change, only some other aspect of sex. This is true both of the natural change of sex of many species of animals and of human reassignment of sex by surgical and hormonal means.
Now let us return to an analysis of Deborah's sex. On her fortieth birthday was Deborah a woman? First, let us consider Deborah's apparent sex. An external examination would reveal nothing to show that she was not female: her facial features are female (after cosmetic surgery and electrolysis of her beard), her voice is a pleasant contralto, she has no Adam's apple (reduced by surgery), her breasts, vulva, and vagina are all apparently normal. Her torso is a little long for a woman, but many women are long-waisted; she is thick in the waist and has slender hips; her hands are rather large for a woman; but none of this makes her appearance any less feminine. One must conclude that her apparent sex is female. Based on her apparent sex, and with an affidavit from her medical advisors, her legal sex is now also female. She has been issued with a new birth certificate, driving license, citizenship certificate, passport, social insurance card, degree certificates (B. Sc.., M. Sc.., Ph. D.), and certificates of professional affiliation, all showing her sex as female.
Deborah is sexually active, more so than Hiram ever was, and claims that she usually has an orgasm. She also frequently masturbates, something that Hiram never did. Evidently then her Aristotelian sex is female. Her hormone levels are well within the range for a woman, and Deborah takes care to keep them so, checking her own blood chemistry frequently and adjusting her hormone dosages accordingly.
Short of an internal examination there is nothing about Deborah, other than her body proportions, to suggest that she is not a woman. Only a karyological examination of her chromosomes would reveal the presence of a Y chromosome, and show that her chromosomal sex is male. The first stage of sex-reassignment surgery was castration, so Deborah has no gonads at all. It cannot be said that her primary or gonadal sex is now male; her gonadal sex is neuter.
Let me tabulate all this:
Hiram Deborah
Gonadal sex Male Neuter
Chromosomal sex Male Male
Apparent sex Male Female
Legal sex Male Female
Aristotelian sex Male Female
Hormonal sex Male Female
Mental sex Male Female
In everything but that invisible chromosomal sex Deborah is female. She lives, works, and plays as a woman, makes love as woman, and is legally a woman. To me it is apparent that Hiram has "really" changed sex to become Deborah. Hiram was an unsuccessful, unhappy, neurotic man; Deborah is a successful, happy, contented woman. It is nonsense to say that the sex change was not "real." We must also remember that in all the cases of sex change in animals there was no change of chromosomes when the animal changed sex.
Let me emphasize at this point that a transsexual is a person (usually, though not always, a man) who considers himself to be of one sex, trapped inside a body of the opposite sex. The female transsexual is rarer, though cases have been reported, and I will confine my discussion for the moment to the male transsexual, who believes himself to be a woman trapped in the body of a man. Once the body has been altered by surgery and hormone therapy to fit the inner persona, such a person is now a woman, though it is correct to refer to her as a former transsexual. The chromosomal sex of such a person as Deborah remains male, with one X-chromosome and one Y-chromosome. Her apparent sex is female, as is her legal sex; her Aristotelian sex too is female. In most countries of the developed world today the legal sex depends upon the apparent sex, though this was not always true. The common term "post-op transsexual" is inappropripriate, since a transsexual is a person trapped in the body of the wrong sex. Once the body has been changed by surgery and hormones - the post-operative condition - the person inside is no longer trapped in a body of the wrong sex and therefore no longer transsexual.
Sex Reversal
Sex reversal is defined as a reversal of sex role or behaviour, without any change of sex. An American family in which the wife goes off every day to an office while the husband stays home to look after the children and clean the house, shows reversal of sex roles. Such reversals are common in our society, though they are often a subject of some disdain. They are less common in other societies, though sex reversed individuals may have an accepted role in some societies.
The subject of whistling raises some queries. In most societies whistling is a masculine activity. This old saw reflects the altitude of the traditional Englishman to a whistling woman:
A whistling woman and a crowing hen
Are neither good for God nor men.
In hunting societies generally (except perhaps for the Inuit) whistling is used between hunters as a signalling system. First nation hunters of North America used bird calls and whistles to communicate with one another when hunting, whether they were hunting animals or enemies. During the Mau-Mau troubles in Kenya pn the 1950s the rebels communicated by whistling. Whistling has magical connotations: "Whistle and I will come unto you," is one of the most terrifying phrases in the English language to many people, denoting the threatened arrival of a ghost. English seamen whistled for the wind when they were becalmed. Today, yachtsmen will still whistle for the wind (an animus or spiritual being), and on board a steamship it is the gravest impropriety to whistle. But only a man may summon a ghost or the wind by whistling. In European society ladies do not whistle; to do so is a reversal of sex roles, common enough nowadays, but frowned upon until recently.
Swiss mountaineers communicated over long distances by whistling and yodelling. This too is a masculine activity. Whistling may take on ceremonial overtones, accompanying some ceremonies in India, for instance, where once more only men whistle.
Drumming and flute-playing too may be male preserves in many societies. The drums and flutes of the ceremonies of First Nations peoples of the American southwest are always played by men. The women may have their own drums, for their own private ceremonies, usually much smaller drums than the ceremonial drums of the men, but they do not play the public drumming, and never use the flute. In the northern Sudan too, drums are strictly segregated by type between men and women. Men play drums in public and often encourage womens' drumming and singing at community dances in Berber towns. At weddings women play drums in the presence of male guests to accompany "dove dancing" and praise singing by women. On these occasions the drumming is often led by the madame of the brothel where the groom received his induction into adult sexual techniques; she is accompanied by two of her entourage, playing on smaller drums, and her knowledge of many songs and drum rhythms is admired as a skill of considerable importance. She will often whistle to punctuate the verses. Other than this both drums and whistling are male preserves in this society.
Communication over longer distances is often by an extension of the whistling codes used by hunters. I have already mentioned the yodelling of Swiss mountaineers, which carries farther than simple whistling. In the Nuba mountains of the Sudan, messages are transmitted by drum or by cow-horn trumpet from one hilltop village to the next. Both trumpet and message drum are played by men, who invoke the spirits before touching them. Not only are women forbidden from playing long-distance signal drums, but they must not touch them on pain of dreadful sanctions, often involving destruction of the instrument itself, desecrated by the touch of a woman's hand. Yet in the upset of the civil war that has gripped the Sudan for so many years, it is often the women who are the instrumentalists. I have heard a young refugee woman from the Nuba mountains of southern Sudan, isolated in a hostile northern town, play haunting melodies on a simple flute made from copper plumbing piping; each short melody carried a different message.
Such behaviour could be considered a reversal of sex role in certain societies, but it is certainly not sex change.
All societies have specific roles for men and women, which may change over the years. Throughout most of Africa agriculture is carried out by women; in some places men will never touch a hoe or weed a field, for that would be woman's work, but men must clear the land and protect family ownership, among many traditional male duties. Yet once western style farming has been introduced to a region it is the men who drive the tractors and perform a mechanized version of the function of hoeing. Is this sex reversal? Not really. It is rather a clash between two sex behaviour roles--the female role of hoeing and weeding, and the male role of driving machinery. Every established role changes over time, and today women in Africa are trained to drive and repair tractors, in rural areas in Cameroon, for instance, and in many other African countries, while men have begun recently to take on traditional female roles in marketing, which were once the monopoly of women.
Sex roles in the human species are not fixed, as they are in so many other species, but change over the generations. A change in sex role is only considered a sex reversal in those few individuals who are the initiators of change; later their sex reversal may become the normal behaviour mode in that society. Nevertheless, society may look askance at anyone who disregards current sexual taboos.
When I was a young boy growing up in the Outer Hebrides of Scotland only men knitted; the women of my island never knitted. One of my early memories, from preschool years is of sitting in a shack with my grandfather and his cronies, all of us knitting. Each man would have a pint of beer at one hand and a dram of whiskey at the other. They would swap stories and each of the younger men would be trying to devise a new flamboyant motif to impress his girl friend. I remember the smell of the peat smoke and the moment when one of the men would help me with my own knitting. I still knit, often quite elaborate garments, but now, if I pull out my knitting in an airport for instance, while waiting for a delayed plane I am liable to receive odd stares and even derogatory remarks. What was a male sex role when I was a boy is now, in a different society, considered a female sex role and worthy of stares when carried out by a man.
Hermaphroditic and pseudohermaphroditic states in man; castration
Hermes and Aphrodite had an affair. This drew frowns from the other gods, who all, except Zeus who enjoyed his own peccadilloes, felt that two of their own number should be role models to the mortals. Not only was the relationship somewhat incestuous but Aphrodite was married at the time to the lame smith-god Hephaestus. They did not even practice safe sex, and were quite blatant about it all. Aphrodite conceived a child. As gods it was straightforward for them to influence the sex of any offspring, and that was where the trouble really started.
Hermes was in origin a phallic god, and indeed every Athenian home of any consequence had his statue, in the form of a stone phallus, standing outside the front door, as an invocation to sexual potency and to fertility. Venus was not merely the goddess of love but also of fecundity. Both were strong-willed.
Hermes felt that any offspring he fathered should be endowed with a manly phallus, not a piddling wee affair, but one of godly proportions. Venus felt that her love-child should be a girl, with beautiful features, delicate breasts, rounded curves and waist, swelling hips. With two such impetuous and strong-willed personalities neither would give in, and both got their desires.
The parents named the unfortunate child of this union Hermaphroditus, and she did indeed have a feminine form, sweet feminine features, gently swelling breasts, spreading hips, just as desired by Aphrodite. But the pubic region was provided with a god-sized penis. At least Hermaphroditus had no beard, for Hermes concentrated just on the single organ that symbolized his godhead, but in other respects had the attributes of both sexes. He/she was man and woman at the same time.
In classical Greek art Hermaphroditus is shown with an essentially feminine body and demeanour, but with male genitalia. We cannot tell from any of the statues whether the artists believed that there was also a vagina, but literary sources seem to suggest that the femininity was complete, and that Hermaphroditus could function equally well as a man or as a woman.
Modern scientists have seized upon the name of this personage to denote an individual combining both sexes in one, but in strict usage the term 'hermaphrodite' now means specifically an individual who carries both testicular tissue and ovarian tissue.
True hermaphrodites possess both ovarian and testicular tissue. In the human species they are invariably sterile, at least in part because the hormones produced by testicular tissue inhibit ovarian and female function, while those produced by the ovarian tissue inhibit male function. The Aristotelian sex of a hermaphrodite is thus nil; the apparent and the legal sex may be either male or female; the endocrine sex is indeterminate.
An hermaphrodite is an individual who possesses both testicular and ovarian tissue, either in the form of an ovotestis, or else as one testis and one ovary. An individual who has some of the features of both sexes but has the gonads only of one sex is known as a pseudohermaphrodite.
Hermaphrodites
We may usefully divide human hermaphrodites into two main classes, those with the normal complement of sex chromosomes and those with an extra one.
The Possession of Three chromosomes
The possession of a third chromosome of any pair is, with few exceptions, generally fatal. An embryo conceived with an extra chromosome-1, that is to say possessing three chromosomes-1 instead of the usual pair, will never be brought to term, but will instead die in utero, resulting in a spontaneous abortion, often so early that the mother will never even realize that she had been pregnant.
The major exception is chromosome-21. An embryo conceived with three chromosomes-21 will develop into a child with Down's syndrome. We have no statistics on the frequency of formation of extra chromosomes of other pairs, but in the absence of any theoretical reason why a third chromosome-21 should occur more often than any other chromosome, we may suppose that these others too become triples just as often as chromosome-21. If this is so then as many as 50 per cent of all conceptions must include an extra chromosome of one pair or another, resulting in spontaneous abortion of the foetus or embryo.
The sex chromosomes represent no exception. It seems probable that they too are present in excess numbers just as often as chromosome-21. An extra sex chromosome--an extra Y or an extra X chromosome--is not fatal but may have quite profound effects.
Men with an extra Y chromosome
The chromosomal constitution of an individual with an extra Y chromosome would be written as XYY. What effect would such a constitution have upon the phenotype of the resulting man?
Twenty years ago and earlier, Britain had a number of "Hospitals for the Criminally Insane" (the system has since changed). These were institutions for the incarceration "at the Queen's Pleasure" (that is to say, indefinitely) of men who were guilty of repeated crimes of violence and seemed incapable of realizing that they had done any wrong; this is the definition of insanity under the infamous Mcnaghten Rules. Several studies have been made of the men in these "hospitals." Not unexpectedly, considering their repeated crimes of violence, the population of such a hospital consists chiefly of exceptionally large muscular men, well above average both in height and in muscular development. Compared with the normal prison population very few of them had ever married or fathered children. On the other hand none of them confessed to being gay. The general impression I have received when I have visited such a "hospital" is of a beefy macho group of men who would not have been out of place as Marine Commandoes.
A surprise came when we studied the chromosomes of the men in such a hospital. More than 50 percent of the men possessed an extra Y chromosome (this has since been confirmed in other studies). Not one of these XYY men was less than 182 centimetres tall (six feet). The mean height was around 190 centimetres (6'3"), and they had the torsos of boxers, extremely muscular. They all had aggressive personalities, and lost their tempers easily. All had a history of repeated crimes of violence, rape, and murder or attempted murder.
We have no knowledge of the frequency of this XYY syndrome in the population at large, but such individuals are certainly not frequent. Considering the physique of the XYY hospital populations that have been studied, one might expect that a number of athletes might have this syndrome, professional football defencemen (American football, not soccer) perhaps, and above all some heavyweight boxers. The history of violence shown by some professional boxers seems compatible with this syndrome.
The possible existence of such chromosomal abnormalities among athletes is one reason why the Olympic games have now abandoned sex chromatin tests. It is regarded as discriminatory to debar women who possess a Y chromosome from the games if men with an extra Y chromosome are not also debarred, since the latter is known to affect physique.
Women with an extra X-chromosome
We have no statistics at all on such women, possessing three X-chromosomes, merely anecdotal accounts of a few cases that have come to the notice of physicians as a result of gynaecological abnormalities. All such women who have been studied have had menstrual problems, and seem invariably to be sterile.
Persons with two X-chromosomes and one Y-chromosome
One definition of a woman is a person with two X-chromosomes (defining sex in chromosomal terms). Such individuals are therefore female. But by the same criterion of chromosomal sex, a person with a Y-chromosome is a man. Thus a person with the karyological type XXY can, on chromosomal grounds, be considered either male or female, or both at once.
Quite a large group of these individuals have been studied medically. Most who have been studied are asexual individuals (Aristotelian sex), short in stature, lacking any male distinguishing features on external inspection. The apparent sex is thus female, and so is the legal sex. They possess an external urinary meatus in the female position, but many have no vagina. They never menstruate. There is no female breast development and they lack body hair. A scrotum may be present, and the clitoris is often enlarged, looking almost like a small penis. Many are mentally disabled.
Internal inspection will usually indicate the presence of undifferentiated gonads, neither ovary nor testis, but rudiments of either. Technically they are pseudohermaphrodites, possessing a mix of sexual characteristics.
But this is not the only possible outcome of the XXY constitution. A few individuals have been described who are apparent males, though generally of short stature. One or both gonads may be descended into the scrotum, and they possess a penis. Once more they are asexual in the Aristotelian sense. They lack body hair and they never go through puberty. Biopsy of the gonads sometimes reveals the presence of an ovotestis, an organ with both testicular and ovarian tissue. Thus these individuals are true hermaphrodites, even though they are unable to function in either Aristotelian sex. In others the descended gonad in undifferentiated.
In one case, a single testis was present in the scrotum and the child was an apparent male. He never passed through puberty, however, and remained of small stature. When he was castrated as a result of shrapnel in wartime the remaining gonad, which was internal, began to develop, no longer repressed by the secretions of the testis. On examination he was found to possess a single ovary, a uterus and one Fallopian tube, but no vagina. This individual too was a true hermaphrodite, with a XXY constitution, but unlike the other cases with an ovotestis he was a bilateral hermaphrodite, possessing a testis on one side and an ovardy on the other.
It is quite possible that other individuals like this exist, young men with a single descended testis and sexual dysfunction, but unless they are accidentally castrated it is unlikely that they will ever be diagnosed
Gynaecomastia
Gynaecomastia is the swelling of the mammary glands of a male mammal to resemble those of a female. The human breasts are unique among mammary glands in that they remain in a distended state throughout the adult life of a female. We are so used to seeing the outline of a woman's breasts under her dress that it sometimes comes as a surprise that other mammals have swollen mammary glands only when they are lactating. A female chimpanzee is as flat-chested as a male unless she is actually suckling her young. As soon as she stops nursing the breasts regress until in a few weeks she is flat-chested once again. Domestic milk cows are a partial exception, possessing somewhat swollen udders even before they start yielding milk, but then they have been bred and selected for this characteristic.
A consequence of the unique nature of the human breasts is that our species is the only one in which gynaecomastia is possible without concomitant milk production. In other species in which gynaecomastia has been recorded, enlargement of the mammary glands of the males is always accompanied by milk production. When I was a teenager, I was shown a herd of goats in East Anglia (U.K.) in which the males were regularly milked, producing about a third as much milk as the females. I do not know if this herd still exists. Here gynaecomastia is hereditary, and presumably under genetic control. The stimulus to lactation is the act of milking by the herdsman, an action that simulates suckling. A similar lactating male goat was the subject of a recent report (1995) emanating from Israel. This goat, owned by a Palestinian, had become his main source of income, for the local men were willing to pay high prices for the milk, believing that it was a specific for ensuring potency.
In the Malaysian fruit-eating bat Dyacopterus spadiceus all the males examined had mammary glands swollen with milk, and, at the time of the study (1993), were lactating. Because of the difficulties of observation, it is not yet known if these male bats suckle their young, nor is the cause known. It is possible that this is normal in this species, or it may be a result of a diet rich is some phytosteroid. Suckling remains the only known stimulus that will initiate lactation, so it seems probable that these male bats suckle their young.
A very limited number of species are actually capable of showing gynaecomastia, since the males of most species lack mammary tissue behind the vestigial nipples. Without this tissue there would be nothing to respond to whatever stimulus provokes the phenomenon, nothing to grow and swell. As far as we are aware, the only species in which the males possess mammary tissue are man, goats, rats, and bats.
One stimulus to breast development in the female is the act of suckling. In many species a virgin female--an honorary aunt, as it were--will give suck to a litter, helping the mother with maternal care. This has been especially well studied in rats, where such an aunt will begin to produce milk within five to seven days of the commencement of suckling. Under unusual circumstances a male rat can also be induced to suckle young, and will begin to lactate after a slightly longer period, usually eight to ten days. During this period his blood steroid hormone levels remain normal, though the blood level of the pituitary hormone prolactin rises, as it does in the female.
A few similar cases have been reported in men. The best documented case is that of an early nineteenth century missionary, whose wife regularly produced twins. While his wife was nursing one twin of the first pair she produced, he habitually held the other to his breast to keep it quiet, a reversal of sex role. By the time the second pair of twins arrived he was taking an equal share in breast-feeding his children. Other similar cases have been documented. Cases like this are certainly the result of suckling, just as in rats. But unlike rats, in which the mammary glands regress once suckling ceases, a man with gynaecomastia as a result of nursing a baby retains the enlarged breasts, just as a woman does when she weans her baby. The human species is the only one in which the breasts may remain distended when not actually lactating.
Suckling is not the only cause of human gynaecomastia, nor even the commonest. At one time, between the first and second world wars, chemical workers in Germany and Switzerland were showing signs of gynaecomastia, associated in them with impotence. This was traced to handling synthetic or natural oestrogenic hormones, just then beginning to be marketed for medical purposes.
A more common trigger for gynaecomastia appears to be exposure to plants that produce copious amounts of phytosteroids, possessing oestrogenic properties. The best-known such plant is the so-called Madagascar periwinkle (Lochnera species), which today is cultivated as a source of the raw material from which contraceptive pills are manufactured. It is not restricted to Madagascar, but widely distributed throughout central Africa. In many African languages its vernacular name may be translated as widow wort, and only widows (or women past the menopause, the older meaning of the word 'widow') may collect it for use in tribal medicine. Its abortifacient properties are well-known to the local people. In a man, repeated ingestion of widow wort, or even the use of the plant as a poultice, will induce impotence, shrinkage of the testes, and gynaecomastia, as a result of the high levels of phytosteroids. Widowwort (spelled as a single word) is an older English name for the parasitic plant dodder (Cuscuta species), whose golden threads were used at one time as a contraceptive and as an abortifacient. Under the name "golden threads" it figures in this capacity in Jean Auel's series of novels about Pleistocene life. In many languages from different parts of the world plants containing phytosteroids with contraceptive and oestrogenic properties may only be gathered by widows or by women past menopause, and are called by names that may be translated as widow's plant, or widow wort.
In many African or Siberian tribes a witch-doctor, priest or shaman is expected to possess attributes of both sexes. Sometimes boys with clear transsexual tendencies are chosen for training as shamans, but some tribes in Africa and in the southwestern United States make deliberate use of widow wort to induce the development of breasts in candidates for priest/witch doctor (or do I mean witch doctorate?). In some of these tribes in central Africa, a candidate must first prove his manhood. He then eats a diet rich in widow wort, and his breasts are dressed with a paste of the same plant. Gynaecomastia quickly ensues. The candidate now possesses the attributes of both sexes, bearded (for in most tribes he does not shave, as most of the hunters of the tribe do; in later life the beard ceases to grow), possessing penis, testes, and scrotum (organs whose efficacy has already been tested in the initiation ceremony), but also the breasts of a woman. This is reported briefly here simply as an example of gynaecomastia induced by widow wort.
Among the Dogon of Mali, a country which lacks widow worts, gynaecomastia is also valued as an attribute of tribal elders. This is clearly shown in their wood carvings, in the so-called hermaphrodite figures, which are not actually hermaphrodite, but merely gyanaecomastic males, bearded and phallic. These people suffer from an unusual form of malaria. In common malaria the blood parasite usually takes up residence in the cells of the liver, and death of the patient is most often a result of liver damage. In the form of malaria endemic in Falaise de Dogon in Mali the parasites avoid the liver (and so are not particularly deadly), but instead reside in various other glandular structures, including the prostate gland, the spleen, and, less frequently, in the mammary glands, resulting in gynaecomastia. Men in which this has occurred enjoy a special status in Dogon society and in the religious ceremonies which play such a profound part in tribal life over a sixty-year cycle.
Other causes of human gynaecomastia include tumours (adenomata) which secrete oestrogenic hormones, most commonly tumours of the testis (testicular feminization syndrome), but also adenomata of the adrenal glands. Other tropical diseases besides malaria may also be implicated in gynaecomastia, though the evidence for this is largely circumstantial. A side effect of certain anti-hypertensive medications, such as spironolactone or aldactone may be gynaecomastia.
At puberty in most boys the breasts enlarge slightly and become tender. Boys often find this embarrassing. In perhaps as many as ten percent of boys this transient gynaecomastia of puberty proceeds to the point at which a small amount of milk (or rather colostrum) is produced, staining the shirt. An old term for this is "witch's milk", and, inevitably, magical properties were ascribed to the phenomenon, and many superstitions were attached in medieval times. The gynaecomastia of puberty endures for a relatively short time, generally less than a year, and the breasts soon shrink again to their eventual masculine form.
Pseudohermaphroditic states in man
Pseudohermaphrodites are individuals with the gonads of a single sex--either testes or ovaries--but with either the secondary and accessory sexual characteristics of the opposite sex or else with a mixture of male and female secondary and accessory sexual characteristics. They are invariably sterile, and generally sexless in the Aristotelian sense.
A male pseudohermaphrodite
Melissa's mother brought her to the sex clinic because she had not started menstruation and showed no other signs of puberty. At 16 years of age she appeared, except for her stature, like a young girl of about 10 years old. She had no pubic or axillary hair and no breast development. On examination she was found to possess a vulva, vagina and cervix, consonant with the development of the other organs. Endocrine examination showed an absence of oestrogens, compatible with the state of sexual development, but a somewhat elevated androgen level. Laparoscopy indicated the presence of a small uterus and Fallopian tubes, but the gonads were not located in the normal female position, but rather in the groin. Biopsy showed that Melissa possessed a pair of undescended testes, not ovaries at all. Karyological examination showed an XY karyotype - a chromosomal male.
Melissa's sex was thus mixed. Her gonadal sex was male, as was her chromosomal sex. Her secondary and accessory sexual characteristics were wholly female. Her Aristotelian sex was female, since she possessed a vagina. At this stage it was clear she was some kind of male pseudohermaphrodite, who had been reared as a girl.
Hormone response tests carried out in vitro showed that her tissues were quite unable to respond to androgens, and that there was no trace of androgen receptors at the cellular level. The tissues were, however, able to respond appropriately to oestrogens. It was clear that Melissa's tissues could not respond in any way to the hormones being produced by her inguinally situated testes (the testes were producing at low levels, since they were undescended), and that all her anatomy was feminine. When the situation as fully explained to her, she opted for regular oestrogen administration and for ablation of the useless testes. Technically this was castration, of course, but this was not how she saw it.
After a year of hormone therapy Melissa had developed breasts somewhat small for her age, and pubic and axillary hair. She was becoming a woman instead of a girl, though she had not yet menstruated. At this point she was switched to cyclic (21 days on, seven days off) administration of oestrogens, just like the regime of a woman using the contraceptive pill. After two months this resulted in breakthrough bleeding, and Melissa (and her mother) was delighted at this first sign of normal feminine function.
After four years Melissa appears to be a normally adjusted young woman, who bleeds on a regular cycle. She knows she will never be able to have children, and that she must continue indefinitely to take "the pill," but she is happy with that. She expresses a desire ultimately to have children, if knowledge of endocrinology advances to the state when that might be possible. Meanwhile, her internal female organs are now as large as the average woman's.
A female pseudohermaphrodite
Martin's case was almost the mirror image of Melissa's. He had been brought up as a boy, but had never gone through any kind of puberty. Examination revealed a small though complete penis, a scrotum containing no testes, and a generally pre-puberal body, without beard, pubic or axillary hair, and a child's voice. Internal examination showed that the undescended gonads were inguinal in position, still within the body cavity, not even into the inguinal canals. Hormone titres at first seemed consonant with testes in this position, with low androgen levels, but further tests showed that there was a high (feminine) titre of oestrogens.
Karyological examination indicated an XX chromosome pairing. At this point it seemed advisable to carry out a laparoscopy. The gonads proved to be juvenile ovaries, not testes. A small tumour of the adrenal gland was the source of the male sex hormones. Tissue tests showed that Martin's cells were unable to respond to oestrogens and at the cellular level oestrogen receptors were missing. The general conclusion was that Martin was a chromosomal and gonadal female, whose tissues were unable to respond to female sex hormones. Only the longstanding adrenal tumour had produced enough androgenic hormones, starting before birth, to masculinize the external genitalia.
The options were clear. There was no chance of bringing Martin's body into line with his gonads and chromosomes, since his body could not respond to oestrogens. Additionally the adrenal tumour, which was precancerous, had to be removed, as well as the ovaries. A course of androgen therapy then began. Martin slowly developed male accessory characteristics, such as beard and body hair. He received an implant of silicone spheres into the scrotum to simulate testes, though it was quite unlikely that he could ever have sexual intercourse.
The majority of individuals in Martin's situation look more feminine than he did, and are generally reared as girls. It was only the masculinizing tumour of the adrenal gland that produced enough development of the external genitalia to make Martin appear male at birth. Other individuals we have examined have appeared externally like Melissa, amenorrhoeic females. Their situation is more unfortunate than that of Martin, for Martin had been reared as a boy, and since his tissues were able to respond to androgens a course of these hormones soon resulted in adult masculinization. These other female pseudohermaphrodites had bodies unable to respond to oestrogens, and therefore could not be fully feminized by hormone administration. At the same time they thought of themselves as girls, and indeed, possessed the XX chromosomes, the ovaries and some of the secondary and accessory characteristics of girls. Yet they could never develop into women, nor could hormone therapy help them to do so. In the absence of the slight masculinization that Martin possessed they could not be masculinized either.
Multiple sex chromosomes in Pseudohermaphrodites
With rare exceptions individuals with an XXY chromosomal constitution are sterile asexual pseudohermaphrodites. An exception to this is discussed in above. In most of them the general conformation of the body is that of a pre-puberal female, often marred by some male development, such as a small penis instead of a clitoris, even though the vagina is patent. The gonads are usually indeterminate in form, neither ovary nor testis, though rarely an ovotestis may be present. They are generally retained within the body, in the female position, though sometimes they are found descended into a scrotum, even if no penis is present.
Help to such individuals is generally best given by feminization, since they have almost always been reared as girls; only in the rare cases who have been reared as boys is the converse better. Feminization may involve surgical reconstruction of the genitalia in order to remove excess parts, such as an unformed penis or a scrotal sac, and administration of oestrogenic hormones. In the few cases where masculinization is called for, generally in those who have a closed vagina and a well-formed, though immature penis, then the reverse surgical intervention and androgen therapy are appropriate. The sooner such cases enter into medical care, preferably well before puberty, the better are the results.
Congenital Adrenocortical Hyperplasia
This condition, whose acronym is CAH, occurs in about one in 10,000 or 20,000 female children. The cause is unknown. Hyperplasia of the adrenal cortex begins shortly before birth, and may subside naturally later in childhood. The enlarged active adrenal cortex secretes excessive quantities of steroids, including some with androgenic action. The result is that the unborn fetus is exposed to an unusually high level of blood androgens, late in pregnancy.
By this time in development the female reproductive system is fully formed, so that the child is born with no physical abnormality of the genitalia. Her apparent sex is clearly female, as are her legal sex, her chromosomal sex and her gonadal sex.
Even those children in whom the hyperplasia does not subside naturally can be helped, either by administration of drugs that suppress the adrenal cortical activity, or else by surgical intervention. The children will then pass through menarche in a perfectly normal manner, and may go on to marry and have children. Thus, there is no physiological abnormality.
CAH children and adults are, however, marked by one significant difference from normal girls and women: their behaviour is masculine. As children they scorn dolls. They prefer to play with toy guns and swords. They play the more macho of boys' games. They are aggressive tomboys. They may refuse to wear skirts, preferring trousers. As adults they may excel in masculine sports, such as target shooting. Even in the first 72 hours of life those few that have been tested show the reactions of boys rather than girls, so the difference seems to be innate rather than learnt, at least in part. An unusually high proportion of these girls grow up to be lesbians. It is perhaps stretching a point to regard them as pseudohermaphrodites, but if we regard behavior as an accessory sexual characteristic then that is what they are, behavioral pseudohermaphrodites.
They should perhaps be compared to experimental female rats that have been injected with a single dose of testosterone shortly before birth, while still in utero. These rats showed masculine behavior and male aggression. As adults some of them attempted to mount other females, even though their physical and physiological development was perfectly normal. The fine anatomy of the brain of these rats was male, rather than female. It seems that the "hard wiring" of the brain was established while the organ was under the influence of the androgenic injection and had not altered while the rest of the body developed as a female.
Castration and eunuchs
Castration is not strictly an intersexual state, but it plays such a large role in the care of male transsexuals that it must be discussed.
A eunuch is a male human being who has been castrated, that is whose testes have been cut off. Sometimes the penis too is removed, but this is not part of the definition of a eunuch. The earliest references we have to castration is as a form of punishment in Syria in the second millennium B. C. It is still a punishment in Sharia Law, the law of Islam, and still carried out in those countries which follow the Sharia (sharia means 'road' or 'way'). In Sharia law castration is the punishment prescribed for attempted, but unsuccessful adultery. Adulterers caught in the act are stoned to death.
Castration was almost unknown in the northern warrior tribes of Europe, and hence in the successor states, such as Germany, England and France. This is probably a result of the doctrine of mayhem. In other nations of Eurasia eunuchs have been common throughout history, and into the second half of the present century. Eunuchs were a conspicuous feature of the courts of emperors and local rulers in China until 1912, and in Istanbul until the 1920s.
For a century, from about 1830 to the 1920s, the Mossi people of Bourkina Fasso were the chief purveyors of eunuchs to the slave markets of Istanbul, until Kemal Ataturk's reforms stopped the practice. Before the first quarter of the nineteenth century the rulers of the Mossi, the Mogho Nanamse (nanamse is the plural of naba, which means chief; the Mogho Naba was the paramount chief, or king) obtained much revenue from the sale of slaves, most of whom were captured from surrounding tribes; the remainder were criminals who had repeated their offence. The earlier Mogho Nanamse raided only for slaves for their own use as agricultural workers, until Mogho Naba Baongo, who reigned around 1800, found a lucrative market outside his country. He sold most of these captives to passing slave caravans.
Many of these slaves, including all the recidivist criminals, were castrated before sale, since a eunuch fetched a much higher price. Under nineteenth century African conditions 90 percent of slaves failed to survive castration, so that the price for a eunuch was ten times that for an intact male slave. The Mossi specialists, however, of the village of Teemetanga, in the Koubri district, some 20 kilometres south of the capital, reduced the mortality to a mere 10 percent and were thus able to corner the market.
After the abolition of slavery in the British possessions and North America, the main market for these eunuchs was in Turkey. After Ataturk abolished this market too, the Mossi ceased to export them, utilizing eunuchs only for their own court functions. In the courts of both great and petty nanamse, even today, eunuchs guard the chiefs' wives, while the royal diviner of the Mogho Naba is the chief eunuch known as Pwe Naba. In January 1995 an official of the Government of Bourkina Fasso informed me that the Mossi courts still own eunuchs.
The majority of eunuchs were (and still are) slaves, often castrated in boyhood, though sometimes after puberty. In the days before literacy became common, most scribes and accountants, generally slaves in Byzantine Rome, for instance, were eunuchs. With no offspring to whom they could leave their estates, they were considered less liable than whole men to accept bribes or to betray secrets for reward.
In those cultures where the harem flourished, chiefly Muslim countries, the servants of the harem were always eunuchs, for reasons that require no explanation. Prepuberal castration has also long been practised to produce catamites. Some catamites, such as those of the Roman Emperor Tiberius, were unaltered boys, usually transvestites, either by choice or else by coercion, but many were youths who were castrated before puberty. Alexander the Great is said to have had such a catamite "The Persian Boy" (who gives his name to a novel by Mary Renault) whom he dearly loved, and who remained with him until Alexander's death. This practice continues in southern India until the present day.
The Higras of South India were either a caste of naturally eunuchoid boys, or else they were castrated in boyhood; it is not clear which. They dressed in womens' clothes as their successors do today. A further reason for castration is to worship a deity. The priests of the cult ofthe Roman goddess of revenge Ate and of the Greek goddess Nemesis worshipped their goddess by self-castration and thereafter dressed as women. Other cults have been described where similar practices were performed. In the Christian religion the most famous exemplar is the second century Origen, who castrated himself (as an adult) in order the better to worship his God and to keep himself free of the temptations of the flesh. A century later a Christian sect arose in Rome called the Valesii. These men not only castrated themselves to the greater glory of God, but also castrated any visitors to their monastery. Thus freed from the temptations of women they could, they believed, worship God more fully. Even into the latter half of the twentieth century priests of some religions are still castrated
Until 1878, when the practice was abolished, choristers in the Vatican choir were castrated as boys so that they could continue to sing as "divinely as angels", thus providing, in the view of the church hierarchy, a better form of worship of their God. Many of these boys left the church choir and took up lucrative careers as opera singers, so that the male lead of many of Handel's operas, for example, was written for such castrati. One such castrato made a recording in 1904 that is occasionally played on radio classical music programs.
There is a long-continuing tradition of self-castration by young men who have been jilted. The most recent occasion of which I am aware was in Rome in 1994. Fortunately this extreme response to unfulfilled love is rare.
Consequences of castration
The most obvious effects of castration are upon the sexual development of the man or boy. If the operation is carried out before puberty, as it was for the production of catamites and castrati, the voice remained in the treble range, more specifically in the mezzo-soprano range, both for speaking and for singing. The youth continued to grow in stature, reaching full adult male size (unless castration was performed before the age of about five years, when growth was slightly stunted). Their faces remained hairless. These eunuchs rarely attained the upper body strength of an adult male, and hence were useless for warfare before the inception of the gun. Most of them grew stout with advancing years, though this was not always true; a proportion remained slim.
Eunuchs who were castrated as adults already had the deeper voices and the beards of men, and often also the upper body strength, but since the operation reduced their tendency to violence they too were considered useless for warfare. The libido quite disappeared, and eunuchs neither desired nor were able to couple, once the initial period of adjustment was over. For a few weeks or even months after castration a eunuch may still be able to obtain an erection and so to copulate, even producing semen from the prostate, but this ability soon diminishes. In the harem of the Turkish sultans the women sometimes mated with eunuchs. The sultan never objected to this, for he could be sure that any children they bore were his.
The so-called castration syndrome is characterized by the various side effects that castration may have upon an adult male. In addition to the effects upon the libido and upon the ability to copulate, the side effects include a tendency to obesity and to copious sweating; this has sometimes been compared to the "hot flushes" of some post-menopausal women. Eunuchs have often been thought to walk with a peculiar gait. This is not part of the castration syndrome, but rather arose from the discomfort caused by the infection that often followed the crude operation. Combined with the obesity this often resulted in a waddling gait. As the years passed by a eunuch's beard gradually became sparser and sparser, often ceasing to grow after about ten years. Conversely, a eunuch never became bald, since this affliction of men is a result of the action of androgens produced by the testes.
A major pathway for development of the castration syndrome is through the pituitary gland. Once this is no longer exposed to the androgenic hormones produced by the testis it may begin to malfunction. One of the effects of androgens upon the pituitary is inhibition of gonadotrophic action. Castration removes this inhibition so that the pituitary begins to secrete excessive gonadotrophins. This may be the cause of the "hot flushes." It also leads to obesity.
One objective of hormone therapy of male transsexuals is to balance the treatment in such a way that the more unpleasant side effects of castration are kept under control. The castration syndrome is not of itself a direct concern of the physician in these cases, since hormone treatment will almost always start long before surgical castration is undertaken, but he must always be aware of the symptoms and be prepared to alter the therapy to prevent the syndrome developing.
Circumcision and related interventions
Circumcision is removal of the prepuce or foreskin (circum- = around; -cision = cut). In parts of the Middle East and of Africa this is medically advisable; elsewhere it is not and may, indeed, have adverse effects. For some inexplicable reason it has become the norm in the U.S.A., and to a lesser extent in Canada, where it is normally performed just after birth. In many African tribes circumcision is a rite of passage, carried out to mark the advancement of a male from one age grade or status level to another. Most commonly it is performed in a public ceremony soon after puberty upon those boys who are deemed acceptable to advance from hunter to warrior status, as we find among the Sao of Cameroon, for instance. Among the Kanso of Ethiopia circumcision occurs much later, marking the advance of grandfathers from priestly families to the final age grade of elders. Here it is a remnant of a ritual in which priests were once castrated at this age and thereafter regarded as women of high status. Circumcision later in life may be involved in ritual change of sex of priests, not just among the Kanso.
Female circumcision, infibulation or clitoridectomy
I am not aware that this has ever been involved in sex change. It is today a peculiarly Muslim practice, which unfortunately has spread into non-Muslim Africa and even into North America. At an early time, "Pharaonic circumcision " of females was common in Egypt. It involves the ritual ablation of the clitoris and labiae majores of girls at puberty, followed by sewing up the tissues leaving only a small aperture for urination. This is carried out in the belief that a young woman should not enjoy sexual foreplay or intercourse and she should be easily shown to be virgin to the groom and to his relatives at his wedding, since marriage is considered to be an economic contract between consenting adults. A woman so treated is not always more enjoyable to a man because of pain and traumatic response of the woman during intercourse.
In most countries this practice is unlawful, but it is nevertheless continuing, very often because older traditional women insist that it shall be done among their relatives, having it performed in private instead of publicly as was done formerly. In many cultures older males concur with the traditional women in compelling female circumcision, wherever young women are used as domestic slaves. This is because they believe the young women are then more submissive and hence more easily manipulated. The United Nations has not succeeded in applying sanctions against this desperate problem.
Second circumcision, subincision or subcision
Among some of the Australian aboriginal peoples of Arnhemland subcision is carried out as a rite of passage for a boy from youth to adult. In this operation, which is performed in a public ritual, the urethra is slit open in the perineal area. The cut runs from the base of the penis, just behind the scrotum, to a point just in front of the anus. It is then prevented from closing by dressing the wound with ashes. Once this has healed, the youth urinates through this new opening, rather than through the urinary meatus at the tip of the penis. Similarly, upon ejaculation, semen is discharged through this same opening, though a small proportion may reach the tip of the penis. Subcision thus serves as a form of contraception, since in copulation semen is discharged outside the vulva, instead of inside the vagina, near the cervix. In the harsh environment of Arnhemland the birth rate is only about one third of that of the peoples' relatives in lusher parts of Australia. Apparently, when a couple wish to conceive the woman uses her fingers during copulation to close this subcised opening and thus to force ejaculation to occur deep inside her.
In other parts of the world the second circumcision (which is the term favoured by my informants) is used as part of the ceremony of feminization of a male transsexual. Second circumcision iplays and important role in the feminization of the transsexual berdache or bederache of North America, and in the ceremonial initiation of shamans, priests and witch doctors.
Peotomy
Peotomy is cutting off the penis. It is an essential part of feminization of transsexuals, whether under modern surgical conditions or under ritual or obsessive conditions. The trauma of peotomy performed under non-surgical conditions is far greater than that of simple castration and leads to a greater mortality.
In the Sublime Porte of Ottoman Turkey some of the eunuchs of the harem guard were peotomized as well as castrated, though many retained the penis. A few were peotomized but not castrated. It is difficult to imagine their frustration.
Pregnancy in men
The possibility of pregnancy in men is a question that has received some airing in the media in recent years, notably in an article in the New York Times Sunday Magazine section in January, 1995. Hollywood has also made a film on this topic, entitled Junior, starring Arnold Schwartzeneggar.
This is a question which can be resolved into two parts. The first is: can a man undergo a successful ectopic pregnancy? The second is: could a man receive an implantation of uterus and ovaries and then undergo a 'normal' pregnancy?
Ectopic pregnancies occur in women from time to time and are sometimes viable, though birth must ultimately be through an incision, comparable to a caesarean section. In normal functioning of the ovaries at ovulation, the egg is received into the fimbriated funnel of the Fallopian tubes. The funnel is not fused with the ovary, but merely envelops it, so that there is a finite possibility that the egg may escape into the general body cavity. Fertilization of the egg usually occurs during its passage down the Fallopian tube to the uterus, but may occur also in the uterus itself, depending on the time of copulation relative to ovulation. If, however, copulation occurs approximately 14 hours before ovulation the sperm may reach the fimbriated funnels just as ovulation takes place. Fertilization of the egg may then take place in the funnel itself. The most probable outcome of this event is that the fertilized egg will pass down the Fallopian tube in the normal way and implant in the wall of the uterus. But it is also possible for the fertilized egg to escape into the general body cavity and implant into the first available surface, leading to an ectopic pregnancy. The rate of such pregnancies is about four per 100,000.
The outcome of such a pregnancy depends chiefly on the surface into which the egg implants. Implantation into the surface of the intestine or of the bladder is usually fatal to the developing embryo, implantation into the surface of the liver is likely to be fatal to the mother, unless a surgeon intervenes early enough. An embryo that implants into peritoneum or into the intestinal mesentery stands a good chance, with adequate modern medical care, of surviving to term. The greatest success rate is for embryos implanted into the omentum, or mesenteric membrane that supports the stomach, especially if the site of implantation is near to the major blood supply of the stomach.
This has suggested to some sexologists that it should be possible to inject an ovum that has been fertilized in vitro into the abdomen of a man (or of a former transsexual) into a location near to a suitable portion of the mesenteric membrane so that the probability is high that it would implant there. Suitable endocrine preparation of the subject would be needed to ensure proper implantation, followed by careful monitoring and adjustment of the endocrine status.
The various technologies are now sufficiently advanced for this to be possible. In vitro fertilization is now routine, the hormonal conditions at various stages of pregnancy are well-enough known, and successful implantation would lead to the production of a placenta, that itself would serve in part to control the hormonal secretions of the pituitary gland. The main pre-requirement is suppression of secretion of androgens by the testes.
Beginning in 1988 the National Institutes of Health in Bethesda Maryland, received grant applications for experimental male pregnancies, so far had the knowledge advanced. There were plenty of volunteers for this procedure, chiefly transsexuals and former transsexuals. All applications were refused on ethical grounds. The sexologists concerned then tried to obtain funding from private sources and received promises of about $1,000,000. This time the Ethics Board of the hospital declined permission. This is how the problem stands: the technology is probably adequate; the danger to volunteers is probably slight; the chances for a successful male ectopic pregnancy are quite high. The ethical question, however, remains. It seems to me probable that this procedure will soon be attempted in some other country where ethical codes are different, perhaps Morocco. I have heard unsubstantiated reports that it has been attempted in Brazil. The demand from transsexuals and former transsexuals is so great that the pressure to carry out the procedures that might make male pregnancies possible are too high for no attempt to be made somewhere.
The second question posed in this area is the possibility of transplanting a uterus, Fallopian tubes and ovaries from a brain-dead woman into a former transsexual. The ethical questions do not loom so large in this problem. Transplants of kidneys and other organs are now routine, and transplantation of a total female reproductive tract would be no more difficult. The problem is rather one of rejection of the transplant. Every patient who has received a transplanted organ must live for the rest of life on a daily regime of anti-rejection medication, which has the major side-effect of leaving the recipient extraordinarily susceptible to side infections. This is because the body's mechanism for rejection of the transplant is also part of the mechanism for destruction of invading pathogens. A kidney transplant is a life-saving procedure, and the attendant risks are acceptable because otherwise the patient's life would be lost. This is not true of a potential transplant of a reproductive tract, whether to a woman or to a transsexual. The risks are generally considered too great. It is unlikely that such a transplant will be undertaken until the general problem of graft rejection has reached a better resolution than at present. Until that happens the only transplants are likely to be the ones needed to save lives. Since writing this I have heard a report that it has been attempted in South America but I have no details.
© 1996
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