Research on transgender brains may not be as helpful as you think

Transgender health care has a troubled history of gatekeeping.

CREDIT:  Derek Davis/Portland Press Herald via Getty Images
CREDIT: Derek Davis/Portland Press Herald via Getty Images

A pair of new studies suggests that the brains of transgender people are more like those of people from the gender group they identify with than people belonging to the gender group they were assigned at birth.

The findings — which held true even for children who have not yet begun puberty — further validate the legitimacy of transgender identities according to some, although many trans people and their allies expressed concern that such studies can do more harm than good.

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Dr. Julie Bakker from the University of Liège in Belgium presented the research this week at the annual meeting of the European Society of Endocrinology.

Brain scans of children and adolescents studied— some of whom had been diagnosed with gender dysphoria — showed that the brains of transgender and cisgender boys responded similarly to various stimuli. The same was true for the brains of transgender and cisgender girls.

Bakker suggested that brain scans could someday be used as a tool to help identify young people who might have gender dysphoria. “The earlier one can start with the treatment, including puberty inhibition…followed by cross-sex hormones, the better the outcome, ” she told the online magazine Inverse.

On one hand, such findings further delegitimize arguments conservatives use to justify their anti-transgender positions. After all, they have taken great pains to dismiss research showing that there are innate, biological components to transgender identities. They have to do this, because their primary arguments are based on the assumption that being transgender is akin to mental illness and that it should be possible to treat transgender people without affirming their gender identities. Biological evidence that gender identity is determined even before the hormones of puberty take effect would further undermine their reasoning for rejecting trans people for who they are.

But as Samantha Allen highlighted at The Daily Beast, it’s actually pretty unlikely that such research will change the minds of those who are inclined to reject transgender people. After all, it wasn’t research about the nature of homosexuality that shifted opinion on issues like marriage equality; it was actually knowing somebody who was gay, lesbian, or bisexual. Likewise, there’s already ample research regarding the legitimacy of transgender identities from multiple angles, and if those studies haven’t convinced people to respect trans people, then adding one more study to the pile probably isn’t going to change much either.

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As many trans people wrote on social media this week, the new brain scan research might actually interfere with the treatment transgender people receive and could even lead to harm for some transgender kids.

“These kinds of studies remind me of the Bob Dylan quote, ‘You don’t need a weatherman to know which way the wind blows,” Madeline Deutsch told ThinkProgress. As clinical director at the University of California San Francisco’s Center of Excellence for Transgender Health, she works with families to figure out the best treatment for transgender kids. “Finding a ’cause’ or ‘marker’ for gender dysphoria will just add more hoops for people to jump through, and limit access to diagnostic care to those who lack insurance coverage or access to advanced imaging techniques.”

Indeed, there’s a long history of “gatekeeping” in transgender care that gives them reason to be concerned.

Gatekeeping refers to the practice by healthcare providers of setting certain goalposts that transgender people have to meet before they’re allowed to receive care that allows them to pursue their transition.

Throughout history, this has often looked like therapists testing their trans patients to see if they’re “trans enough.” Under earlier standards of care, patients would often have to spend as long as a year or two living full-time as the gender they were hoping to transition to before they were provided any cross-hormone therapy to assist in that transition. For those who did not as easily “pass” as their gender identity, this could be particularly grueling.

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Getting past the barriers of gatekeeping also meant conforming to gender norms. This meant, for example, that transgender women would have to demonstrate heterosexuality and also present as traditionally feminine in clothes, appearance, and demeanor. If they didn’t fully embrace exaggerated feminine characteristics, they were denied treatment. While conservatives often accuse trans people of reinforcing gender norms, it was often their care providers that set these stereotypical demands which they required as proof of the seriousness of their gender identities.

While the World Professional Association for Transgender Health (WPATH) has largely done away with some of these forms of gatekeeping in its standards of care, a debate still rages in trans health care about whether doctors should be the final deciders as to the kind of care trans people receive. Some argue for an informed consent model, in which trans patients make such decisions for themselves without requiring a doctor to sign off first.

But that model is still not in place, which is why the mere possibility of brain scans that can confirm a person’s gender identity present a concern. Such scans could ultimately be used to decide if an individual is “trans enough” to undergo transition care — ultimately another form of gatekeeping. Indeed, they could actually increase the skepticism with which some people view transgender identities. Transgender people are simply asking to be believed that they are who they say they are. They don’t want another hurdle to “prove” that they’re transgender.

That’s why Dan Karasic, a psychiatrist who serves trans patients and also serves on the workgroup committee for the WPATH standards of care, was quick to dismiss the impact the new studies could have on treatment.

“Studies like this expand our knowledge of the brain and gender identity, but do not have clinical utility,” he told ThinkProgress. “There is more overlap in male and female brains than there are differences. The best way to determine gender identity is to ask.”

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Many others have highlighted Karasic’s point about the overlap. Brains are not easily distinguished as male brains and female brains. It’s just that some characteristics tend to be more common in male brains while others tend to be more common in female brains, but there are plenty of outliers across the spectrum.

YouTuber Riley Dennis published a video last year looking at a variety of similar brain scan studies and demonstrating how this overlap works. “So if someone hands you a brain and says, ‘Is this a male or female brain?’ you wouldn’t be able to tell,” she explains, unless — perhaps — the brain had characteristics from one of the far extremes of the indicators.

Twitter user Sophia Ray offered a simple chart using data from another recent brain scan study showing why such identification would be mostly impossible. A scan might provide some clues about the gender of the brain, but would not be able to discern one way or the other.

Of course, this entire model for assessing brains also operates on an assumed binary. This study does nothing to account for people who may identify as gender non-binary — some of whom may also take steps as part of a gender transition.

There’s also the possibility that Bakker’s vision of getting trans kids into treatment sooner could completely backfire. Even if a brain scan could give some indication that a child may be transgender, there’s no guarantee that the child’s parents would actually be supportive of that identity. It could well lead to more kids being sent to harmful conversion therapy that tries to correct their gender or that somehow prevents them from being transgender, even though there’s no scientific basis for doing so.

“Eugenics” was also a word some used when expressing concern about the study, referring to the fear that the easier it is to biologically identify transgender people, the easier it could be to erase them from the world entirely by preventing them from even being born. As Allen notes, cruel techniques have been used in the past to correct people’s queer identities in the past, including “hormonal injections, hysterectomies, shock therapies, and even ice-pick lobotomies.”

Short of a dystopian return to such approaches, there could be realistic political implications for transgender people. Conservatives in many states are still trying to dictate access to bathrooms and other facilities according to an individual’s “biological sex” — meaning their sex assigned at birth — while others have opposed efforts to make it easier for transgender people to update their birth certificates.

If brain scans are given too much weight in drawing conclusions about a person’s gender, they could become a way that opponents of trans equality create another barrier preventing trans people from moving through public life according to their gender identity.

It’s unfortunate that research that informs our understanding of humanity could still serve to undermine how certain people are treated. At a time, however, when transgender people are still subjected to rampant discrimination and violence and stigmatized as mentally ill and distrustful, these remain very real concerns.

Encouragingly, providers recognize these concerns. “I will continue to assess for gender dysphoria in my patients based on their presenting history and self-identification,” Deutsch promised.