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Make Gender Reassignment Real - A Letter to Dr. Anthony Atala
Brian Hanley   Nov 10, 2015   Ethical Technology  

In graduate school I was warned not to touch anything to do with homosexuality or transgenderism. By that time I had learned that graduate school and high end science was not the open-minded inquiry I had expected. I was, however, convinced then that most transexuals were in part biologically female.

Some years after grad school, I wrote a paper about how it can be that an apparent man could have a woman’s brain, and vice versa.

In a nutshell, somewhere around 10%-15% of the population are probably natural chimeras. What that means is that two separate embryos merge into one, and are born as a single person. It’s the opposite of fraternal twins. If you think about it, you realize that half the time, those two embryos should have opposite sex. So, if one embryo forms the brain, then probably the other one will form the gonads. In animals, transplanting the brain bud of the notochord into an opposite sexed embryo causes sex behavior traits of the brain to manifest. There are other ideas about transgender people, and many of them hold water, but I think mine is the strongest.

How confusing and difficult that must be. A transgender person did not choose to be born this way any more than you chose to have feet or hair. I am certain that homosexuality and transgender identity are not a choice. The only thing that is a choice is reconciling with it or not.

Living in a body that feels wrong, growing up feeling different, facing prejudice, bullying, death threats and mockery isn’t easy. Even if a person is quiet and in the closet, it has profound effects to see all that happening. Then, gender reassignments are often late in life and the best years are felt to be past. In addition, gender reassignment surgery is more than a little wanting.

Those who undergo gender reassignment surgery and hormone treatments do not get a sex change. A male to female surgery today will not produce a full biological woman when it is done. A person will likewise not be a full biological man if changing from female to male. This can be very disappointing in a life filled with broken dreams, and people who get surgery can find that their field of potential partners has not expanded, it has narrowed. Transgender people face murder at the hands of both men and women with and without surgery.  Some adjust well enough, it is true, but the surgery is far from ideal.

Poor outcomes from gender surgery do not have to remain so. I spoke with Dr. Anthony Atala recently at a conference, advocating for more work on stem cell production of gonads and sex organs. This is no minor matter, don’t misunderstand me. Growing ovaries, follapian tubes, a uterus, vagina, and external genitalia, is an extreme challenge. We are not there yet. We are closer to growing a penis, or at least something penis-like, out of stem cells. For the rest of the male equipment, we are also not there yet.

My wish is that growing complete reproductive systems become a goal and that serious efforts be expended to fund the research. It won’t just help gender reassignment. There are women who have had hysterectomies because of cancer, endometriosis, or accidents who would want to be made whole. Similarly, there are men who have such needs as well. There is no reason why we should not try, regardless of the great difficulty involved.

I hope for a time in the not so far distant future when a person who gets gender surgery comes out of it as the sex that fits their mind. In theory, we can probably do it. In theory, it is possible to make those organs and make that person able to marry, have children, and be what they should have been born as in a more perfect world.

Brian Hanley is the founder of Butterfly Sciences, a company developing gene therapies for aging. He has a range of papers in biosciences, economics, policy and terrorism, in addition to a recent text on radiation treatment. He obtained his PhD in microbiology with honors from UC Davis, has a bachelors degree in computer science, is a multiple entrepreneur and guest lectured for years to the MBA program at Santa Clara University.


How about testing some transgender people to see whether they are really chimeras?

That’s a good idea, and in my referenced paper I laid out a program for that. It’s harder than it sounds, but blood tests could probably be suggestive.

While such a test would indeed be useful, there’s a great deal of concern in the transgender community regarding its potential for abuse. It’s already extraordinarily difficult to obtain transition related treatments in many areas. Multiple letters of recommendation, each written by separate mental health professionals, are often demanded. These evaluations frequently rely on outmoded gender stereotypes for determining legitimacy. This has lead to a thriving grey-market in hormones and occasionally even back-room castrations. There’s a perception in the community that such restrictions are primarily intended to enforce normative body standards rather than protect the individual. A test could potentially be used to augment the existing restrictions by supplying yet another justification for denying access.

How can such a test be utilized without endangering the morphological freedom of an already vulnerable population?

First of all, its prudent not to confuse intersex with transgender.

Its not the same. Yes some trans people can have physical intersex conditions or the unfortunately titled dsd’s. 

And the concept of “brain sex” is a silly one. Is it not simpler to say that ALL humans vary on the biological spectrum? That we all think or behave slightly differently? Sure there may be more going on. But simply stating brain sex is psuedo science and almost pandering to gender stereotyping.

I’ve been working on bioprinting myself, printing fingers for my thesis initially. Yes absolutely it is possible I believe to produce functioning reproductive organs of a more complex nature. Its easy enough already to create semi functioning facsimiles from tissue. The only thing that holds that work back is approvals.

Is it possible for someone with xx or xy or any other variation to have children in male or female capacity? I don’t see why not. We are all simply walking bioreactors anyway.

However is this wise? There are many children out there without parents. Why are we so obsessed with being able to reproduce?

As for blood tests, no its rarely that simple. Sometimes it is clear cut, most time s it is not. One has to take a number of samples from different tissues and extrapolate what the karyotype is and even then it can be pot luck.

One last point I would like to make is that most trans people can have children in some capacity. Many intersex people cannot. Its intersex people we should be helping primarily.

Viole - To properly do such a study would require extensive biopsies that I doubt would be acceptable to most. Such studies can be done without compromising privacy though. It is normally required by an IRB that privacy be strongly protected. There is not now a method that we can say with confidence is diagnostic.

holly_gram - This article is interesting in this regard. ttp:// Let’s not kid ourselves that transplant from a donor entails serious problems though.

Relative to brain sex, it’s not silly at all. There are well identified features that are sex linked, from size of corpus callosum to degree of lateralization. Read the paper. There is quite strong evidence for it. Click on Full Text.

It sounds like you have read Boklage.
An excellent book for others wanting to learn.

I get a text lay-out error on this page, lines are cut off.

It damn well is possible to create reproductive organs. If it’s possible to create new technology that can simulate reality then it is damn well possible to use stem cell research to help correct this defect. It’s true, transgender people do not have a choice, why would we “choose” to be this way? I think the reason most people are obsessed with reproduction is because that is what we are “programmed” for, it is a biological need. Anyway, I may not be a biological man even after genital surgery, but I would consider myself to be.

I don’t know how long ago this was, but I recently discovered that a group of researchers found a way to make females develop testes. The researchers discovered a gene known as “FoxL2”, present in females, that is responsible for the development of ovaries, and when deactivated, it causes the ovaries to drop and become testicles. All human embryos initially develop as female in the womb, so literally every “man” on Earth used to be a woman at one point.

I enjoyed reading this article and all of your comments. As a Male to Female transsexual, I would like to provide my own perspective on the ethics of making gender reassignment real.

Yes, it is considered taboo for a MTF(male to female) transsexual to become pregnant. Groups like the Westboro Baptist Church would have a field day on an individual who went under this type of procedure. I also believe that Viole makes some good points. There are many individuals in this world that deserve to be adopted. Viole also touched on the topic of grey market pharmacies. However, I would like to elaborate further on that topic.

I am an individual who has conducted business with these types of “grey pharmacies” in the past. For some trans individuals medication is out of reach due to too much red tape or lack of funds. Many of these transsexuals (myself included) would rather die than not being able to outwardly express our selves emotionally and physically. But this presents a new problem for these individuals. Most transsexuals have to take multiple types of medication daily. For me, I take large doses of Estrogen, and a water pill called spironolactone every day. Estrogen has been cited with-in my packaging stating that “Estrogen is a cancer causing.” Also the spironolactone I take can be dangerous. Spironolactone, also called the water pill, with holds liquids, potassium, and sodium in the body. This takes a toll on the individuals nervous system, liver, and kidneys. This also puts them on dietary restrictions. Even if a transgendered MTF, such as myself, gets a surgery to remove their gonads. It is still very likely that they will still need to take these medications.

I propose that it is more ethical to make gender reassignment real via stem cell research than the current standard. I would love to have any stem cell procedure where the outcome means that I no longer need to worry about taking medication for the rest of my life or the state of my health. I also would like to add that maybe in the future it would be possible to grow just the parts that create the necessary hormones with out the reproductive abilities. Creating a middle ground on a taboo subject.

Anonymous MTF trans, AKA AnonT3a

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