Evaluating The Concept of

“Transgenderism” Biologically
and Psychiatrically

A.C. Madison
25 November 2017
 Abstract
The concept of “transgenderism” commonly
perpetuated by many within the LGBT community is a
primarily fictional one. No biological evidence exists
than supports the notion that one can simply change
their gender. Those who desire to be “transgender” are
always going to be the sex determined by their sex
chromosomes (XX or XY). In regard to the
determination of biological sex, genetic mutations may
occur and lead to the development of “intersex”
individuals, however, these mutations do not affect the
genotype of the individual, thus allowing a definitive
determination to made regarding the individual's
biological sex.
A common contributing factor in regard to the
concept of “transgenderism” is the psychiatric disorder
known as gender dysphoria. This disorder is
accompanied by a plethora of other co-morbid mental
disorders such as anxiety and depression. The latter of
the 2 most definitely correlates to the high suicidality
rate among “transgender” individuals.
This research paper seeks to thoroughly
evaluate the topic of “transgenderism” utilizing
objective substantiations such as biological information
as well as psychiatric references.
Fundamental Concepts of Biological Sex
Determination
As established by Joe Hin Tjio1 and Albert
Levan in December 1955, Humans (Homo Sapiens)
2
possess 23 paired chromosomes (22 autosomal
chromosome pairs and the sex chromosome pair). The
23rd chromosome pair, or more specifically the 46th
chromosome (X or Y), determines the individual's
biological sex. Males possess one X chromosome and
one Y chromosome (XY), whereas females possess two
X chromosomes (XX). The Y chromosome is unique in
that it alone possesses the genetic material required to
produce the proteins needed to form the Male
reproductive system, Male gametes, as well as Male
secondary sexual characteristics.
Directly after fertilization occurs, the two
gametes from each parent (ovum from the mother and
spermatozoa from the father) contribute the 23
chromosomes they carry individually in order to form
the 46 chromosome karyotype normally possessed by
Humans. The gamete that determines the sex of the
child is the male spermatozoa as it will either contain an
X chromosome or a Y chromosome. Should the sperm
cell possess a Y chromosome, then the zygote will
develop into a male. According to the National Genome
Research Institute, “The presence or absence of the Y
chromosome is critical because it contains the genes
necessary to override the biological default - female
development - and cause the development of the male
reproductive system.”3
When analyzing the Y chromosome, the
structure of the chromosome establishes why it is a
crucial component in regard to sex determination. The Y
chromosomes possesses approximately 50 to 60 genes
that are responsible for synthesizing proteins4, thus
making the Y chromosome relatively gene poor (in
comparison, the X chromosome possesses
approximately 1000 genes39). A majority of the genes
found on the Y chromosome are “restricted to gonadal
and genital development.”39 The specific genes on the Y
chromosome that are responsible for sex determination
are the SRY and TDF gene (the TDF gene is equivalent
to the SRY gene in terms of genetic and developmental
criteria)39. Without the presence of the SRY/TDF gene or
should the SRY/TDF gene lack proper functionality, “the
female sex differentiation pathway ensues”39 thereby
developing the fetus into a female. Other genes found
on the Y chromosome such as those within 3
pseudoautosomal regions/Yq regions (AZFa, AZFb, and
AZFc) are known as azoospermia factors and contribute
towards male fertility.39
Genetic Mutations and “Intersex”
During the processes of DNA synthesis
(transcription and translation), mutations may occur
that interfere with normal biological development and
lead to an “intersex” individual. As defined by the U.S.
National Library of Medicine, “Intersex” is a group of
conditions (commonly caused by genetic mutations)
which cause a discrepancy between the external
genitalia and the internal genitalia.5 Although mostly
1
accurate, this definition could be extended to include In summation, biological sex is determined
the discrepancy between the sex chromosomes (XX or genetically via the 23rd chromosome pair (XX or XY).
XY) and the external genitalia. “Intersex” merely means that the external genitalia do
not correspond with the sex chromosome pair of the
A notable type of genetic mutation involving individual. For example, should an individual possess
the male gamete is the mutation known as 46, XX the chromosome pair XX and external male genitalia,
testicular disorder of sex development. The frequency the individual would be a biological female with genetic
of this mutation is approximately 1 per 20,000 abnormalities. The aforementioned genetic
individuals. 46, XX testicular DSD is the result of a abnormalities are clear when considering infertility. A
translocation of the SRY gene onto an X chromosome . relatively normal individual can only procreate should
7

Upon receiving an affected X chromosome, the female they possess functional chromosomes, otherwise the
fetus will most likely develop male characteristics such individual will most certainly be infertile.
as external male genitalia. “[Those possessing the
affected X chromosome] generally have small testes and Gender Dysphoria and Suicidality
may also have abnormalities such as undescended
testes (cryptorchidism) or the urethra opening on the
Gender dysphoria is a psychiatric disorder
underside of the penis (hypospadias).”7 It is also
which consists of “...a conflict between a person's
possible, though uncommon, that the female may
physical or assigned gender and the gender with which
develop ambiguous genitalia (“...external genitalia that
he/she/they identify.”11 Effected individuals possess a
do not look clearly male or clearly female”7). Moreover.
strong desire to be the opposite gender and are greatly
the individual shall be infertile as they do not possess
displeased with their current physical attributes
the required genes necessary for proper
(external genitalia, secondary sexual characteristics,
spermatogenesis. Upon entering adolescence, most
etc.). This contempt towards their biological sex usually
individuals require testosterone treatments in order to
leads to significant and prolonged distress and likely
induce the development of male secondary sex
causes suicidal thoughts.
characteristics (growth of body hair, deepening of voice,
etc.). Hormone treatments may also prevent
Based on the correlation with suicidality, gender
gynecomastia (enlargement of breast tissue).7
dysphoria seems to be a prevalent occurrence in the
“transgender” community as evident by the 41%
Another prevalent genetic mutation that leads
suicide rate among “transgender” individuals
to possible “intersex” is Androgen Insensitivity
compared to the 10-20% homosexual suicide rate and
Syndrome, which has a frequency of approximately 1
the 4.6% average overall lifetime suicide rate for the U.S.
per 10,000-20,000 individuals. The individual affected
Population according to the Williams Institute10. Many
by AIS is genetically male (XY), however, they possess
(such as ThinkProgress in their article No, High Suicide
the external sexual characteristics of a female. AIS is
Rates Do Not Demonstrate That Transgender People
caused by mutations in the AR gene. The function of the
Are Mentally Ill40) attribute this high rate of suicide
receptor protein, “specified by the normal allele at the
directly to sociological discrimination. However, when
X-linked androgen receptor (AR)”, is to form a complex
evaluating statistics this notion is quite inaccurate.
with testosterone and dihydrotestosterone39. The
aforementioned mutations inhibit the normal
In regard to youth and adolescents, according to
production and function of androgen receptors which
the Centers for Disease Control and Prevention (CDC),
are necessary for the cells to be able to respond to male
the bullying itself is usually not the direct cause of
sex hormones such as testosterone. A key identifier of
suicide as “[m]ost youth who are involved in bullying
AIS is the presence of undescended testicles (“...testes
do not engage in suicide-related behavior”13, rather it
are present either within the abdomen or in the inguinal
exacerbates the already existing condition. It is worth
canal, where they are sometimes mistaken for hernias in
noting that approximately 27.8% of students age 12-18
infants who otherwise appear to be normal females”39).
experienced bullying throughout their years in school

2
according to the National Center for Education attempted suicide in 201410. It should also be noted that
Statistics14. The suicide rate (including all suicide in 2010 rape, physical violence, and/or stalking by an
motivations such as substance abuse and mental illness) intimate partner was prevalent in approximately 42% of
was 2.05 per 100,000 for individuals ages 10-14 and 11.4 cases involving homosexual individuals. Based on the
per 100,000 for individuals ages 15-24 in 2014.19 If homosexual rate of suicide in 2014, it would be a
bullying was the primary contributing factor in regard reasonable estimation that the homosexual rate of
to youth suicide, the rate of suicide in 2014 would have suicide in 2010 would be roughly equivalent or slightly
theoretically been much higher (approximately 41.02 less then that of 2014 as evident by the trend observed
per 100,000 for individuals ages 12-18). Therefore, the in the overall US rate of suicide from 1999-2014.19 If
claim that discrimination is a primary contributing suicidality had a direct correlation to discrimination,
factor of the high suicide rate among young individuals then the percentage of suicide would have been
is quite misleading. significantly higher in the homosexual community.

More specifically, in the case of gender In order to fully comprehend the predisposition
dysphoric individuals, the distress caused by the illness to suicidal tendencies faced by those suffering from
makes them more vulnerable to victimization as gender dysphoria, one must understand the nature of
“...preoccupation with cross-gender issues can interfere chronic depression. According to the American
with daily activities and cause problems in relationships Psychiatric Association, “Depression (major depressive
or in functioning at school or work”11 and sociological disorder) is a common and serious medical illness that
discrimination merely exacerbates the preexisting negatively affects how you feel, the way you think and
condition due the already existing mental instability of how you act.”31 One of the more severe symptoms of
the individual (“...higher risk of emotional and depression are suicidal thoughts. As noted by the
behavioral problems, including anxiety and American Association of Suicidology, “Those suffering
depression”11). Proper accountability of mental health from depression are at 25 times greater risk for suicid[e]
status and history is important as “[they] have been than the general population.”23 In regard to gender
identified as important risk factors for both attempted dysphoria, depression is most likely caused by the
and completed suicide in the general population.”10 As individuals extreme dissatisfaction and disagreement
noted within the William's Institute study, “...research with their biological sex/assigned gender. “People with
has shown that the impact of adverse life events, such as gender dysphoria may often experience significant
being attacked or raped, is most severe among people distress and/or problems functioning associated with
with co-existing mood, anxiety and other mental this conflict between the way they feel and think of
disorders.”10 themselves (referred to as experienced or expressed
gender) and their physical or assigned gender.”11 This
This concept can also be observed when contempt toward their biological sex and the
analyzing hate crime statistics. The number of reported accompanying effects of said contempt on the
hate crimes due to bias against transgenders and gender individual's mental state is reiterated when evaluating
nonconforming individuals in 2014 was 109 with a the statement made by Dr. Stacee Reicherzer while
victim count of 109. In comparison, the number of providing commentary for the series Dr. G: Medical
reported hate-crimes against homosexuals and Examiner, “It wouldn't surprise me for a transsexual to
bisexuals in 2014 was 882 with a victim count of 924. choose her looks over her life. There's a fear of going
Based on this, if sociological victimization was indeed back to a time when life was hell.”30
the primary contributing factor in regard to suicidality,
then the percent of attempted suicides among the In summation, the mental disorder gender
homosexual community should have been dysphoria, or more specifically the characteristics of the
approximately 8.5 times larger than that of the disorder such as preoccupation with cross-gender
“transgender” community. However, this is simply not issues, anxiety and depression, predispose individuals
the case. “29.4% of LGB youth [15-24] attempted to suicidal tendencies. Attributing this suicidality to
suicide”24 in 2014 whereas 45% of “trans” youth (18-24) sociological discrimination and not the underlying

3
psychiatric disorder(s) is intellectually dishonest and increased risk of gallstones.36 Likewise, the effects of
detrimental to those suffering from the effects of gender testosterone on female physiology are quite detrimental.
dysphoria. In contrast to the muscular atrophy caused by estrogen
in males, testosterone causes an increase in muscle mass
Gender Nonconformity and Health Risks of when interacting with female physiology.
37

“Transitioning” Furthermore, testosterone also possesses a number of

significant side effects and health risks such as an
overall decrease in HDL (good cholesterol) and an
In contrast to gender dysphoria, gender
increase in LDL (bad cholesterol), an increase in visceral
nonconformity is not a mental disorder due to the
fat deposits, an increase in blood pressure, a decrease in
absence of debilitating distress. Rather, gender
the body's sensitivity to insulin, an increase in
nonconformity is merely a deliberate choice made by an
frequency of headaches/migraines, as well as an
individual to portray themselves as the opposite gender.
increase of erythrocytes and hemoglobin.37
According to the DSM-5, “[g]ender dysphoria should be
distinguished from simple nonconformity to
As for endocrine suppressors, these medications
stereotypical gender role behavior by the strong desire
also possess a number of potential health risks and side
to be of another gender than the assigned one and by
effects. In males, these health complications include an
the pervasiveness of gender-variant activities and
increased risk for low blood pressure, an increased risk
interests.”38
for cardiac arrhythmias, a loss of bone density, a likely
increase in visceral fat deposits, a loss of muscle mass
In simple terms, a gender nonconforming
and strength, as well as a probable decrease in the
individual desires to be the opposite gender, therefore
production of erythrocytes and spermatozoa.41 In
the individual (also applies to sufferers of gender
females, suppressing estrogen effects several aspects of
dysphoria) shall prefer clothing, hairstyles, and other
their physiology. According to the University of
aesthetic characteristics typical of the opposite gender,
Rochester, “[i]n addition to regulating the menstrual
will likely participate in activities stereotypical of the
cycle, estrogen affects the reproductive tract, the urinary
opposite gender (such as sports, childhood games, etc.),
tract, the heart and blood vessels, bones, breasts, skin,
and will most likely ask to be referred to by a name
hair, mucous membranes, pelvic muscles, and the brain.
typical of the opposite gender.38 In more extreme cases,
Secondary sexual characteristics, such as pubic and
those who choose to portray themselves as the opposite
armpit hair, also start to grow when estrogen levels rise.
gender may desire extensive anatomical augmentation
Many organ systems, including the musculoskeletal and
(artificial breast implants, inhibition of normal
cardiovascular systems, and the brain are affected by
endocrine functionality, cosmetic alterations to genitalia
estrogen.”42
via surgery, etc.). These synthetic alterations (especially
endocrine alterations) are particularly harmful as they
As with the mental disorder gender dysphoria,
interfere with the normal functionality of human
the biological sex of the individual does not change in
physiology. The most common hormone replacement
any capacity. The only variability that occurs is in
treatment utilized by males attempting to “feminize”
regard to how the individual desires to be perceived by
themselves is estrogen. One of the most prominent
others. The extent some are willing to go to achieve this
effects of estrogen on male physiology is a “decrease in
goal is quite dangerous. Based on this, the decision to
muscle mass and increase in body fat.” Also of note,
36

undergo these procedures should only be made by the

estrogen possesses a number of significant side effects
individual when they enter into adulthood (≥21 years of
and health risks when interacting with male physiology
age). Subjecting children and adolescents (<21 years of
such as an increase in blood pressure, an increase in
age) to these hazardous procedures is borderline
frequency of headaches/migraines, an increase in
neglect, especially considering “[f]or many children the
frequency of nausea and vomiting, an increased risk of
feelings do not continue into adolescence and
blood clots, an increased risk of diabetes and heart
adulthood.”11 Tampering with human physiology is not
disease, an increase in visceral fat deposits, as well as an
something that should be taken lightly, the best option

4
is to allow the individual to complete puberty and fully restriction”, “All other applicants [not for initial
mature, thereby providing an adequate amount of time appointment as commissioned officers] must meet the
for proper deliberation. As previously mentioned, many standards of [height and weight] tables”, as well as
children shall no longer desire to portray themselves as “[s]ymptoms or behavior of a repeated nature that
the opposite gender upon entering puberty. impaired social, school, or work efficiency”35.

Sociological Implications As previously established, these conditions are

either caused by the genetic mutations that lead to the
After analyzing the biological and psychiatric development of “intersex” individuals or are caused by
aspects of “transgenderism”, it is apparent that the the procedures utilized to artificially “transition”.
concept is primarily sociological in nature. As Therefore, it makes no logical sense to allow
previously mentioned, gender dysphoria and gender “transgender” individuals into the armed forces.
nonconformity stem from a desire to be perceived as the
opposite gender as a result of a staunch disagreement Conclusion
towards biological sex/assigned gender. This desire
manifests itself in current issues now debated across the As gender is determined by genetics, those who
sociopolitical spectrum. These issues include the claim to be “transgender” are never going to be the
utilization of gender pronouns, medical accessibility for opposite gender. Rather, these individual shall merely
“transgender” individuals, eligibility for military make aesthetic alterations in order to portray
service, sex education curriculums including the subject themselves as the opposite gender. Furthermore, based
of “transgenderism”, as well as many others similar on the rates of suicide of the “transgender” community
topics. in comparison to those of the homosexual community,
the likely commonality between “transgender”
When evaluating these topics, the best option is individuals is the mental disorder gender dysphoria.
to examine each of them objectively in terms of biology The high rates of suicide are most likely caused by the
(measurable aspects of human physiology) and comorbid psychiatric disorders that accompany gender
psychiatry rather than subjective emotions. For dysphoria (depression and anxiety). Sociological
example, when evaluating eligibility for military discrimination merely exacerbates the condition of
service, many factors need to be considered. These gender dysphoric individuals. In other words, it is the
factors include the mental stability of the individual as straw that breaks the camels back.
well as the physical conditioning of the individual
(whether or not individual possesses any debilitating Moreover, the various artificial physiological
preexisting health conditions). According to alterations desired by gender dysphoric and gender
Military.com, disqualifications related to nonconforming individuals pose a serious risk to their
“transgenderism” include “[u]terus, congenital absence health. Endocrine inhibitors are the most dangerous.
of, or enlargement due to any cause”, “[a]bsence of both These procedures possess a plethora of significant side
testicles, either congenital, or acquired, or unexplained effects. Unless the individual is well into adulthood (≥21
absence of a testicle”, “[m]ajor abnormalities and years of age) and clinically diagnosed with the mental
defects of the genitalia such as a change of sex”, disorder gender dysphoria, any “transitioning”
“...deficient muscular development that would interfere procedures should be highly discouraged or prohibited
with the completion of required training”, as they are not medically necessary.
“[h]ypertensive vascular disease, evidenced by the
average of three consecutive diastolic blood pressure Finally, all sociopolitical issues involving the
measurements greater than 90 mmHg or three topic of “transgenderism” must be approached
consecutive systolic pressure measurements greater objectively. Straying away from measurable biological
than 140 mmHg. High blood pressure requiring data and psychiatric analyses is detrimental for society
medication or a history of treatment including dietary as well as for those affected by gender dysphoria. The

5
only true way to help gender dysphoric individuals is to
inform them that they likely possess the illness and
encourage them to seek help from a licensed
psychiatrist. “Transgenderism” is not normal and
should not be treated as such.

6
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