This document is a collaboration between @SkyMochi64 and @Nominal.Naomi based on the original Nominal.Naomi Research Masterdoc. This is an open source project, and collaborations are welcome. See contributing if you’d like to contribute. The GitHub for this project can be found here.
Many studies (even those included), due to age or biases, often times use ableist and/or transphobic language. Many studies discuss cisgender, neurotypical, and able-bodied individuals as “normal” or “typical” while referring to the contrary as “abnormal”, “atypical”, “not normal”, etc. This can be incredibly dehumanizing and exhausting to read these studies in depth. Please be cautious when doing so, and make sure to keep your mental health as your first priority. Articles that are especially egregious should be labeled with an asterisk. Articles with a bias towards eugenics should be excluded.
Sex: A collection of dimorphic biological characteristics associated with maleness and femaleness, including chromosomes, reproduction, hormones, anatomy, and brain structures. These characteristics are bimodally distributed along a spectrum.
Gender: The roles and expectations assigned socially to individuals based on their perceived maleness, femaleness, masculinity, femininity, and/or stated identity.
Gender Identity: An individual’s innate sense of being a man, a woman, and/or neither. This can differ from one’s gender assigned at birth, and through the process of social transition (which is often accompanied with medical transition), transgender people can make their gender align with their gender identity.
Woman: An individual who is assigned feminine roles and expectations by society based on their perceived femininity, femaleness, and/or stated identity.
GAHT Gender Affirming Hormone Therapy
HRT Hormone Replacement Therapy
SRS (outdated) Sex Re-assignment Surgery
Many aspects of biological sex can be changed through medical transition, though it is not a requirement to transgender identities.
For trans women on hormone replacement therapy (consisting of bioidentical estrogen and progesterone), they obtain a female hormonal profile, altering the sexually dimorphic gene expressions of their cells. Everyone’s cells have the potential to express both male and female traits which are encoded in their DNA, and these traits are turned on and off by your current hormone profile. Feminizing hormone therapy causes their genes to express female traits, causing the development of breasts anatomically identical to cis females. They are also capable of lactating within healthy and normal ranges for nutrient as is the case with examples such as Nominal.Naomi.
Further, hormone therapy helps trans women develop female skin texture, female body odor, female body fat distribution, female hair patterns in both body hair and head hair, female muscle mass, female bone density, and even female bone structure if they start early enough.
Hormones Changing Bone Structure Studies:
Bottom surgery reconstructs existing genitals into fully functional genitals of the opposite sex (functional genitals, not reproductive organs… although this is actively being researched!).
Medical transition can make trans people infertile, fertility banking should be encouraged for individuals seeking hormone therapy.
Hence, trans people can change their hormonal sex, the sex expression of their genes, their anatomical sex, and they can at least move over to the infertile category of reproductive sex.
X and Y chromosomal combinations are neither binary, nor a defining characteristic of one’s biological sex characteristics (Griffiths 2018) as evidenced by many examples:
Estimates for the prevalence of non-expected chromosomal combinations range between roughly 0.5% (Wellesley et al. 2012) (Lubs et al. 1970) to upwards of 2% (Paththinige et al. 2019) depending on time period and location.
0.5% of individuals have abnormal sex chromosomes, which accounts for millions of Americans alone and is about as common as being trans!
Biological sex is varied. This is a fact. However, many brush off this fact with the following argument:
“This is just the exception that proves the rule: e.g. we still say that humans have ten fingers even though there are some that don’t.”
Whenever a generalized rule is constructed, exceptions will always exist; however, general rules are not the same thing a defining characteristic. Humans generally have ten fingers, but someone is still a human even if they have an exceptional number of fingers. Similarly, an intersex female with exceptional XY chromosomes is still female and an infertile female is still female. Because all the other similar characteristics they share with other females, they are female. The same thing applies to trans females, who have hormonal levels, anatomical characteristics, and brain matter distributions in line with other females, not males.
The goal of scientists is to build the most accurate and complete models of understanding. Any model of human biology that fails to account for intersex people, who make up almost 2% of all humans, is an incomplete and inaccurate model. Incomplete and accurate models should be discarded if a better model can be constructed. Simple and incomplete models are good at introducing people, like children, to scientific topics. As cognitively developed adults that care about the truth, we should recognize that the simple model is simply the most intuitive and understandable, not the most complete and accurate. Modern day biologists account for intersex people by recognizing that biological sex exists bimodally distributed along a spectrum. This is just fact.
Figure: An example of a more accurate and complete visualization made by Amanda Montañez and Pitch Interactive for Scientific American detailing the bimodal distribution of sex from “typical biological female” to “typical biological male” including chromosomes, genes, hormones, internal/external sex organs, and secondary sex characteristics.
The human brain is an incredibly complex organ, with countless different structures specializing in different functions, but also adaptable (neuroplasticity).
For decades we considered the brain to either be male or female (as strictly sexually dimorphic), however, recent research has revealed different frameworks for interpreting the sex of a brain. This has complex and nuanced implications for transgender individuals.
Daphne Joel and Cordelia Fine, experts on the subjects of neuroscience and philosophy of science respectively, argue that 17th and 18th century European society constructed the notion that gender (& sex) are “meaningfully carved into two categories or “natural kinds,” that are distinct, timeless, and deeply biologically grounded,” a conception that has persisted into recent history. This has also been perpetuated by the ableist research into autism and other neurodivergent conditions describing autism as an “extreme male brain” (Joel & Cordelia, 2018)
2015 research from Joel et al. represents a picture of human brains as a “mosaics” constituting of more commonly male and more commonly female aspects. Brain sex cannot be binarized, or even visualized as a continuum, but as this mosaic.
Figure: Graphical abstract of the mosaic brain structure by Daphne Joel in Neuroscience & Biobehavioral Reviews.
Even with such a small window of sexually dimorphic brain variance, studies indicate that trans people’s brain structures are more in-line with the sex/gender they transition to, even prior to medical transition. (Zubiaurre-Elorza et al. 2013) (Luders et al. 2012) (Simon et al. 2013) (Rametti et al. 2011) (Kranz et al. 2014) (Hahn et al. 2015). In tasks where one sex does better on average, transgender people also show to preform closer to their gender identity even before transition such as verbal fluency (Soleman et al. 2013) (Cohen-Kettanis et al. 1998)*.
When looking holistically at the research, approximately 25% of research on transgender brains finds no correlation between trans identities and brain sex, leading to the interpretation that brain sex functions on either a continuum or a mosaic rather than a binary. (Ngyuen et al. 2019) Research accounting for pre-transition brain sex as a continuum has shown MRI scans of transgender individuals align more with their gender identity than birth sex (Kurth et al. 2022) (Manzouri et al. 2017) (Moody et al. 2021), including a study with almost 400 pre-transition transgender participants (Muller et al. 2021)
This research better helps us understand the neurological aspects of trans identities, and can help us better understand how to care for transgender individuals. Research based on our updated understanding of brain sex has helped us understand the unique and fascinating ways in which transgender people develop. (Wang et al. 2021)
The other side of the coin, however, is using this research for a biologically deterministic outlook on trans identities as pretext for eugenicist or discriminatory research such as is the case for trans people as well as neurodiverse people. This research has already been used to attempt to justify Ray Blanchards bunk studies (Guillamon et al. 2016).
Ultimately, brain structure is influenced by a complex combination of biological and sociological factors. The precise extent to which sexually dimorphic brain structures result from biological vs sociological factors is unknown, but this doesn’t change the fact that trans people’s brains are more like the sex and gender that they transition to.
Currently the largest and most well known and funded institution focusing on autistic individuals is autism speaks, an organization mired with countless controversies. Autism speaks abides by the medical model of autism, viewing autism as a medical issue, and seeking to “treat” and eventually “cure” autism. In 2016, Autism Speaks removed the overtly eugenicist language from its website, however, some argue its intense focus on the “solution” to autism being an extreme emphasis on biomedical research, rather than systematic social change, still displays a bent towards eugenics (Jones 2016). Autism Speaks, further, supports the use of conversion therapies for autistic children. Autism Speaks does not acknowledge its past, learn from it, and then seek to better itself - leading to a deepened distrust (Rosenblatt 2021) of the the largest organization purporting to fight for autistic people’s rights.
ABA (Autism Behavior Analysis) is a widely adopted and endorsed form of conversion therapy for autistic children (Wilkenfeld et al. 2020) (Pyne 2020), supported by many institutions such as the CDC and National Institutes of Health and APA. Studies show recipients of ABA are 86% more likely to meet the criteria for PTSD, with estimates showing 46% of ABA survivors meet the diagnostic criteria for PTSD (Kupferstein 2018). Further, a handful of states (including blue states such as CA, PA, ME, CO) have no license requirnments for ABA. ABA is primarily comprised of RBTs (technicians), a role which requires only 40 hours of training. Clinics such as AutismTherapies are 88% comprised of RBTs.
ABA has its roots in the 60’s, with the research of Ivar Lovaas. Lovaas’ main accomplishments were the creation of ABA, though he did also expriment with conversion therapy on trans and gender-diverse children (Rekers, Lovaas 1974)*. In 2020, the journal in which Lovaas published issued an “expression of concern” on Lovaas’ work in conversion therapy for gender nonconforming children, however, did no such thing for ABA studies. Further, recent research has demonstrated a pervasive issue of not disclosing conflicts of interests within ABA research, primarily not disclosing that pro-ABA research is primarily conducted by ABA practitioners (Bottema-Beutel, Crowley 2021).
ABA was built around using operant conditioning, later by Lovaas described as discrete trial training, which involved autistic children being commanded to do things they are typically uncomfortable with. During this time, physical punishments were used to reduce self-harm in autistic children, such as isolation, electric shocks, or slapping (Lovaas 1973)*. ABA was described by Lovaas as:
“Throughout, there was an emphasis on making the child look as normal as possible, reward-ing him for normal behavior and punishing his psychotic behavior, teaching him to please his parents and us, to be grateful for what we would do for him, to be afraid of us when we were angry, and pleased when we were happy. Adults were in control.” (Lovaas 1973)*.
ABA currently can consist of (McGill et al. 2020):
“And God created humankind in the divine image,
creating it in the image of God—
creating them male and female.” (The Contemporary Torah)
Some interpretations of Genesis center an androgynous in the creation of humanity (Imhoff 2023). Other interpreations of Genesis conclude that the context surrounding the creation of man and woman implies man and woman is a spectrum, rather than a binary (Hartke 2018).
“For there are eunuchs who were born that way from their mother’s womb, and there are eunuchs who were made eunuchs by men; and there are eunuchs who made themselves eunuchs for the Kingdom of Heaven’s sake. He who is able to receive it, let him receive it.” (World English Bible)
In traditional Jewish societies, eunuchs were a gender designated to castrated individuals, be they born that way, castrated by others, or castrated by themselves. Socially, they were not seen as men or women, and they were assigned gender roles and expectations distinct from men and women. In this verse, Jesus literally says that people can choose to alter their biological sex characteristics and go on to live as another gender–and that you should accept it.
Gender transition is not exclusive to hormones or surgeries, but can include legal name changes or social transition. However, this will mostly focus on medical transition. A study of over 27,000 transgender participants demonstrated that for those who want gender affirming hormone treatment and receive treatment demonstrate a 153% decrease in severe psychological distress and a 62% decrease in past-year suicide ideation compared to those who want gender affirming hormones but cannot receive treatment Turban et al. 2022. This section primarily focuses on dispelling miss-information those who want gender affirming hormones, but cannot access treatment.
An enormous systematic literature review out of Cornell demonstrated transgender people significantly benefit from gender transition. The breakdown of studies investigated showed the following:
Long term longitudinal studies also exist, such as Ruppin and Pfäfflin 2015 which spans 10-24 years and shows transgender people who undergo medical and/or legal affirmation have improved qualitative and quantitative outcomes in regards to mental health and overall well-being.
Another longitudinal study, Vries et al. 2014, spanning 7+ years on the effectiveness of puberty suppression, hormone treatment, and bottom surgery on transgender individuals demonstrated unambiguously positive results. Psychological functioning (gender dysphoria, body image, global functioning, depression, anxiety, & emotional/behavioral conditions) steadily improved with gender-affirming treatment. Overall wellbeing, both objective (social, educationa, & professional functioning) and subjective (quality of life, satisfaction, and happiness) was similar to or better than same-age young adults in the general population.
Steps to contribute to this project:
dev/example-researchwith example-research being the addition you’d like to make.
TBD. Currently you should use the original masterdoc. Once more complete, we will likely use CC-BY-4.0.