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By Root 1919 0

to analyze the connections between environmental estrogens and gender variance, says that available data simply do not support the theory that GID is a psychiatric disorder. “There’s all this empirical data, exceptional data, data that doesn’t fit their [psychiatric] theory. The U.S. military, for example, has generated a whole set of body measurements that include about thirty different things that they’ve characterized over a large population, and they have curves that describe what the distributions look like for height, for proportion, for all these various body measurements. For 90 percent of them I’m right on the female mean. Now, I’ve yet to see any psychologist explain how it is that I managed to change my skeleton if this [transsexualism] is in fact due to some sort of a mental pathology. The fact is that I’m an exception, an anecdote, and they are not willing to explain it. They are treating me as an exception, and that’s fine, but it still doesn’t support their theory. If there’s unexplainable data, that’s something they need to address.”

High rates of polycystic ovary syndrome (PCOS) in female-bodied persons diagnosed with GID are another anomaly that cannot be explained using the psychopathology paradigm. PCOS is an endocrine disorder affecting women of reproductive age and has been associated with excess production of androgens by the ovary. Researchers currently view PCOS as a developmental disorder in which fetal or pre-pubertal overproduction of androgen causes “hypoandrogenism” in adulthood. Though most women with PCOS are not gender-variant, the fact that many female-bodied persons diagnosed with GID have a history of PCOS would seem to indicate that the two conditions are related and may have a common etiology. Such suggestive connections and potential avenues for research are masked by the common view that GID is a psychopathology, however. The same is true of the overlap between various intersex conditions and GID; I know of at least two transmen who were diagnosed with congenital adrenal hyperpla-sia (CAH) in childhood, for example. In CAH, excess androgens create ambiguous genitalia in XX babies, who are born with an enlarged clitoris and a fused labia. However, the literature provided to parents of CAH babies fails even to mention the possibility that prenatal exposure to excess androgens may affect gender identity.

The DSM has nothing at all to say about the etiology, or causes, of the various psychopathologies it describes; it is a purely descriptive nosology. Moreover, its overall validity and reliability are questioned by people who are not particularly supportive of transgender activists’ agenda. Just because something is in the DSM, that doesn’t make it a real disease, they say. “Listen, there are things in the DSM that are false. The DSM is only a nomenclature,” says Dr. Paul McHugh, retired chief of psychiatry at Johns Hopkins Hospital. “This is a dictionary in which various experts have been given the license by the American Psychiatric Association to say ‘what are the criteria by which they choose to call this’ and they get the names up. If we still believed in witches, witches would be in DSM-IV! Because these are operational criteria. That’s the whole point. You can put anything in, if you can get enough guys to agree that it exists without any other proof than that you think it exists in the way that you claim.”

For all of the reasons noted above, many people argue that the GID diagnosis should be either revised or retired. “I think that it [gender identity disorder] should not be in the DSM any more than homosexuality should be in the DSM,” says Dr. Ben Barres, of Stanford. “I think that it’s offensive. I don’t think I need a DSM diagnosis. I think that I’m perfectly healthy. I did need some medical help to deal with my transition, but there are lots of things requiring medical help where you don’t need to be in a book of mental pathologies.”

“To the extent that it is in the DSM, I don’t think that it should be applied to everybody,” said a male-to-female attorney I interviewed