Les hormones sexuelles sont des objets hybrides et complexes à la frontière du sexe et du genre. Dès lors qu’elles sont synthétisées sous forme pharmaceutique, elles peuvent attribuer des caractéristiques sexuelles au corps de manière partiellement exogène à celui-ci. Il s’en suit que l’utilisation clinique qui en est faite est socialement réglementée. À travers une analyse de divers contextes d’utilisation des hormones observés à Bahia, au Brésil, cet article montre que le dualisme sexuel est le produit de pratiques de régulation (...) biomédicales qui visent à encadrer la circulation des hormones. Le sens du terme local « hormônio » n’est pas pleinement recoupé par celui d’hormone, qu’il excède. L’emploi commun qui est fait au Brésil du singulier procure au terme « hormônio » une qualité fluide et homogène. Dans ce contexte, les hormones sont comprises comme une sorte de substance qui peut circuler entre les corps. Cette conceptualisation des hormones comme une substance a des implications pour le statut ontologique des corps et révèle la relative plasticité de la relation sexe/genre. (shrink)

The original “Dutch Protocol”—the treatment model comprised of puberty blockers, cross‐sex hormones, and surgery—was intended to improve the mental and physical health of pediatric patients experiencing distress over their sexed bodies. Consequently, both researchers and clinicians have couched eligibility for treatment and measures of treatment efficacy in terms of the interventions’ effects on outcomes such as gender dysphoria, depression, anxiety, and suicide. However, recent systematic reviews have concluded that the scientific evidence supporting these interventions is uncertain, leading to significant international (...) differences in what treatments are offered to youth. Against this backdrop, a different argumentative approach has emerged in support of gender‐affirming care. This approach appeals not to reductions in patient morbidity or mortality but to patient autonomy, where medical intervention is pursued as a means to the satisfaction of a patient's “embodiment goals.” In this article, I raise objections to autonomy‐based justifications for pediatric gender‐affirming care, concluding that these arguments misunderstand the place of autonomy in clinical decision‐making and, consequently, put patients at risk of medical harm. (shrink)

Restoring our biological cycles to heal ourselves, our culture, and our planet Shows how, just like the tides and the moon phases, both women and men have biological cycles of growth and renewal necessary for healthy bodies and minds. Explains how the seclusion of women during menstruation and of men during vision quests offers a cleansing process for body and mind to awaken innate creativity and sensitivity, re-attune us with the deeper rhythms of the body and nature, and restore harmony (...) between the divine feminine and divine masculine. Reveals how the need for sacred retreat was forgotten when the divine feminine was suppressed by patriarchal culture. All of life is interwoven into a living system of cycles, from Earth's seasons to the enzymatic pathways that provide energy to a cell. Waxing and waning from times of growth to times of rest, renewal, and healing, cycles map the most auspicious time for everything in life. Both women and men have biological cycles of active growth and quiet renewal, led by our hormones. By understanding how everything in life moves in cycles, you can become more aware of and comfortable with your own cyclic nature, something that has been forgotten by the modern world's linear views of time. Drawing on the wisdom of ancient cultures, the natural cycles of life, and her own groundbreaking research, Pia Orleane, Ph.D., offers a template for how we can restore balance to our emotions and health, ease tensions between the sexes, and heal our fractured culture by honoring divine feminine consciousness and re-embracing natural cycles, including our innate need for rest and retreat. She explains the biology of how our bodies operate by hormones released in cycles and shows how balanced hormones help eliminate anger, depression, insomnia, anxiety, and fatigue. Exploring ancient traditions and rituals surrounding blood and sacred retreat, she explains how the seclusion of women during menstruation and of men during vision quests offered a cleansing process for body and mind, alone time to clear suppressed emotions, awaken our innate creativity and sensitivity, re-attune us with the deeper rhythms of the body and nature, and restore harmony between the genders and balance between the divine feminine and masculine. Outlining the sacred retreat process, the author explores dream cycles, divine sexuality, and practices for reconnecting to nature, increasing creativity and intuition, and clearing suppressed emotions. She also looks at the benefits for women and men of separate sleeping during menstruation. Through this wisdom, we can restore our natural cycles, allow the divine feminine to once again blossom alongside the divine masculine, and, with the return of balance, heal our world and our hearts. (shrink)

Gender dysphoria in children has become a hot-button topic; however, clinical data still remain sparse on the effects of hormone therapy and transitional surgery on the physical and psychological well-being of those children. The American College of Pediatricians cites studies indicating that anywhere from 77 to 94 percent of boys and 73 to 88 percent of girls desist in GD; that is, following puberty the majority of children who experience GD will identify with their assigned biological sex. After reviewing the (...) clinical studies, this paper addresses the notion of gender from a Thomistic perspective, locating gender as a differentiation in the matter of the person flowing from the essence of the soul, resulting from the power of generation as opposed to other differences such as sight, which functions the same regardless of material differences. As a result, the paper concludes that hormone therapy cannot be morally licit for children. (shrink)

This article explores how race, sexual attractiveness and ‘female nature’ are biologised in plastic surgery. I situate this analysis in relation to recent debates over the limits of social constructionism and calls for more engagement with biology in feminist theory and science studies. I analyse not only how the biological is represented by biomedicine, but also how it is experienced by patients and, most problematically, how it is entangled with social constructions of beauty, race and female reproduction. Drawing on ethnographic (...) fieldwork conducted in Brazil, I focus on plastic surgery, but also analyse how this specialty is linked to Ob-Gyn and endocrinology. I argue that medical procedures instantiate a biologised model of beauty I call ‘bare sex’ (Edmonds, 2010) that is defined in terms of racial traits, anatomy, reproductive processes, hormones and ‘secondary sexual traits’. While this is a historically specific model, it is also one that is inscribed on patients, altering anatomy and physiological processes. It thus has the potential to create a biological self-awareness that cannot fully be accounted for by a social constructionist analysis. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Feminist Studies 41, no. 3. © 2015 by Feminist Studies, Inc. 623 Jaye Cee Whitehead, Kath Bassett, Leia Franchini, and Michael Iacolucci “The Proof Is in the Pudding”: How Mental Health Practitioners View the Power of “Sex Hormones” in the Process of Transition In the United States today, popular discourse touts the power of “sex hormones” and hormone receptors in the brain to chemically produce gender expressions (manifested in (...) physical sex traits, behaviors, and attitudes) and identities (a sense of self as feminine or masculine). These accounts range from common assumptions that Western ideals of femininity (such as empathy understanding, cooperative orientation, nurturing behavior) and masculinity (rational/spatial understanding, competitive orientation, violent behavior) are produced by corresponding sex hormones, to studies that reduce complex gender identities and macrosocial economic phenomena to presocial, binary, hormonal processes.1 For sociologists, accounts that reduce complex identities to internal hormonal reactions are problematic for two primary reasons: first, they are inaccurate because they fail to examine how hormonal reactions are embedded in a complex cultural process of meaning and interpretation; second, they operate as bioreductive ideologies that obscure the social power inherent to the process of gender identity construction. In what follows, we extend both of these insights by examining mental health 1. For an example of a hybrid popular-scientific account of the power of sex hormones to destabilize economic structures, see Jon Coates and Joe Herbert, “Endogenous Steroids and Financial Risk Taking on a London Trading Floor,” Proceedings of the National Academy of Sciences 105, no. 16 (April 2008): 6167–72. 624 Whitehead, Bassett, Franchini, and Iacolucci practitioners’ divergent interpretations of the power of sex hormones in the process of gender transition.2 In doing so, we examine the cultural power of sex hormones in crafting gender identities without reproducing reductionist interpretations of trans embodiment. Perhaps what is most perplexing about the way we speak of sex hormones is that we know it is inaccurate to describe these hormones as sexed; scientists have acknowledged since the 1930s that they are neither sex specific in their function, nor in terms of their location in male or female bodies.3 In her extensive historicization of sex hormones, Anne Fausto-Sterling concludes that it is more accurate to call androgen- and estrogen-based hormones, “steroid hormones” as they have functions that are not confined to corresponding sexed bodies. In fact she urges scientists to “break out of the sex hormone straightjacket” and to look at steroids as just one of a number of components that are important to the creation of sex and gender, including environment and experience.4 Scholars also point to an inextricable link between the chemical operation of hormones and the social process of constructing meaning, both at the level of social interaction and macrocultural constructions of sex categories and gender ideologies.5 While brain organization/activation theory attributes sex and gender differences to hormonal interactions within the developing brain, Fausto-Sterling questions the distinction between activation and organization by pointing out how “the brain can respond to hormonal stimuli with anatomical changes…hormonal systems, after all, respond exquisitely to experience, be it in the form of nutrition, stress, or sexual activity (to name but a few possibilities ).”6 Drawing from Elizabeth Grosz, Fausto-Sterling argues that the power of hormones is best understood according to the model of the 2. “Gender transition” is a controversial phrase, as it implies that transgendered individuals who receive hormone therapy are changing identities. We are only using it for lack of clear alternative phrasing, not because we believe body modifications change gender identities. 3. See Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000); Rebecca Jordan-Young, Brainstorm: The Flaws in the Science of Sex Differences (Cambridge, MA: Harvard University Press, 2010); and Nelly Oudshoorn, Beyond the Natural Body: An Archeology of Sex Hormones (New York: Routledge, 1994). 4. Fausto-Sterling, Sexing the Body, 193–94. 5. Fausto-Sterling, Sexing the Body. 6. Ibid., 232. Whitehead, Bassett, Franchini, and Iacolucci 625 Möbius strip, wherein internal components of the self are always connected to and continuous with outer components such as culture and environment.7 In other... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Women and Health Research:A Report from the Institute of MedicineAnna C. Mastroianni (bio), Ruth Faden (bio), and Daniel Federman (bio)In recent years, claims have been made by segments of the research community and by women's health advocacy groups that clinical research practices and policies have not benefitted women's health to the same extent as men's health. Central to these claims has been an assertion that women have been inadequately (...) represented as subjects of clinical studies and that as a result neither health conditions unique to women—e.g., menopause—nor women's manifestations of health problems affecting both sexes—e.g., heart disease—have been investigated sufficiently.The scientific community, including federal agencies that sponsor and regulate clinical studies, is increasingly responsive to these claims and is taking steps to raise the level of women's participation in clinical studies. Controversy and concern have surrounded these actions, however. Two of the claims that have been made are: (1) that women are more difficult to study than men because of their cyclical hormonal changes; and (2) that conducting gender-specific subgroup analyses would increase the size of study populations, raise the cost of studies, and thereby reduce the number of studies that could be performed with the limited resources available. In addition, controversy over the inclusion of women of childbearing potential and pregnant women has been particularly salient. Concerns have been expressed about avoiding potential harm to existing or potential fetuses and about the possible legal and financial ramifications of such harm. A further concern involves the perceived difficulties in enrolling women in studies and retaining them for the duration of the studies.Against this backdrop, the Office of Research on Women's Health at the National Institutes of Health (NIH) asked the Institute of Medicine (IOM) in October 1992 to establish the Committee on the Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. The Committee's charge was to: (1) consider the ethical and legal implications of including women, particularly pregnant women and women of childbearing potential, in clinical studies; (2) examine known instances of litigation regarding injuries to research subjects [End Page 55] and describe existing legal liabilities and protections; and (3) provide practical advice on these issues for consideration by NIH, institutional review boards (IRBs), and clinical investigators.The 16 Committee members came from diverse backgrounds: bioethics, law, epidemiology and biostatistics, public health policy, obstetrics and gynecology, clinical research, pharmaceutical development, social and behavioral sciences, and clinical evaluative sciences.1 Chaired by two of the authors of this article, Ruth Faden and Daniel Federman, and coordinated by the third, IOM Study Director Anna Mastroianni, the Committee met five times over a fourteen-month period, convened a one-and-one-half day invitational workshop, and commissioned several background papers. The Committee's deliberations were complicated by the announcement of new federal policies late in its term. Specifically, the Food and Drug Administration (FDA) issued guidelines (FDA 1993) to replace its 1977 guidelines, which prohibited the inclusion of women of childbearing potential in early phases of most clinical drug trials. In addition, Congress passed the NIH Revitalization Act of 1993 (P.L. 103-43), which contains provisions mandating the inclusion of women and racial and ethnic minorities in NIH-sponsored clinical research. In February 1994, the IOM Committee publicly issued its final report and recommendations, Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, publishing the workshop presentations and commissioned papers in a separate volume.Deliberations of the CommitteeA number of issues arose at the outset as the Committee considered its charge. A few members initially believed that verification of the underrepresentation of women relative to men in clinical studies as a whole was a prerequisite to providing policy recommendations. Others believed that such an examination would be an important contribution to the knowledge base, but that it was not necessary for addressing the Committee's charge. As summarized in the Committee's report, the Committee's research indicated that firm conclusions about the relative underrepresentation of women could not be drawn from the available data because of the lack of systematic information... (shrink)

Ethical concerns have been raised about routine practice in paediatric gender clinics. We discuss informed consent and the risk of iatrogenesis in the prescribing of gonadotropin-releasing hormone...

In the context of transgender health, most people are not comfortable with allowing a twelve‐year‐old child with gender dysphoria to elect to undergo gender reassignment surgery. The likelihood is too high that the child would be unable to fully comprehend the scope of a decision that carries significant, permanent consequences, particularly because the decision to surgically change gender is based upon a conception of gender that can fluctuate during adolescent years. Conversely, however, most people would not contend that this fluidity (...) is reason to wholly deny certain medical care such as hormonal treatments to transgender youth, a demographic with extremely high rates of violent behavior, self‐harm, and suicide. This paper will explore ethical considerations to this emerging debate of what therapeutic options should be offered to transgender children and adolescents.Pediatric endocrinologists have been treating gender dysphoric adolescents with puberty‐suppressing drugs and, to a lesser extent, with cross‐sex hormone therapies for more than twenty years. Clinicians and thought leaders have mentioned ethical components of this emerging practice in the few cohort studies and clinical review articles about the subject. However, ethics have generally been a secondary consideration in the medical academic literature. In this paper, I will provide a brief overview of the practice, summarize the current research on hormone treatment for transgender minors, and provide an ethical analysis of the practice. (shrink)

BackgroundThe amount of research utilizing health information has increased dramatically over the last ten years. Many institutions have extensive biobank holdings collected over a number of years for clinical and teaching purposes, but are uncertain as to the proper circumstances in which to permit research uses of these samples. Research Ethics Boards (REBs) in Canada and elsewhere in the world are grappling with these issues, but lack clear guidance regarding their role in the creation of and access to registries and (...) biobanks.MethodsChairs of 34 REBS and/or REB Administrators affiliated with Faculties of Medicine in Canadian universities were interviewed. Interviews consisted of structured questions dealing with diabetes-related scenarios, with open-ended responses and probing for rationales. The two scenarios involved the development of a diabetes registry using clinical encounter data across several physicians' practices, and the addition of biological samples to the registry to create a biobank.ResultsThere was a wide range of responses given for the questions raised in the scenarios, indicating a lack of clarity about the role of REBs in registries and biobanks. With respect to the creation of a registry, a minority of sites felt that consent was not required for the information to be entered into the registry. Whether patient consent was required for information to be entered into the registry and the duration for which the consent would be operative differed across sites. With respect to the creation of a biobank linked to the registry, a majority of sites viewed biobank information as qualitatively different from other types of personal health information. All respondents agreed that patient consent was needed for blood samples to be placed in the biobank but the duration of consent again varied.ConclusionParticipants were more attuned to issues surrounding biobanks as compared to registries and demonstrated a higher level of concern regarding biobanks. As registries and biobanks expand, there is a need for critical analysis of suitable roles for REBs and subsequent guidance on these topics. The authors conclude by recommending REB participation in the creation of registries and biobanks and the eventual drafting of comprehensive legislation. (shrink)

Displacing the physiological model that had held sway in 19th-century medical thinking, early 20th-century hormone research promoted an understanding of the body and sexual desires in which variations in sex characteristics and non-reproductive sexual behaviours such as homosexuality were attributed to anomalies in the internal secretions produced by the testes or the ovaries. Biotypology, a new brand of medical science conceived and led by the Italian endocrinologist Nicola Pende, employed hormone research to study human types and hormone treatments to normalise (...) individuals who did not conform to accepted medical norms. Latin American medical doctors, eugenicists, and sexologists took up biotypology with enthusiasm. This article considers the case studies of Italy, Argentina, and Brazil, and analyses the work of medical doctors who adopted a biotypological mode of reasoning and employed to various extents hormone therapies in their practice. By focusing on hormone therapies that aimed to normalise secondary sexual characteristics and the sexual instinct, the article suggests that while the existence of normality was contested to the point that a number of medical scientists argued that no such thing existed, the pursuit of normality was carried out in very practical terms through the new medical technologies hormone research had introduced. (shrink)

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment (...) for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong. (shrink)

Policies that require male-female sex comparisons in all areas of biomedical research conflict with the goal of improving health outcomes through context-sensitive individualization of medical care. Sex, like race, requires a rigorous, contextual approach in precision medicine. A “sex contextualist” approach to gender-inclusive medicine better aligns with this aim.

In describing and explaining the sexes, medicine and science participated in the delineation of what was "feminine" and what was "masculine" in the Middle Ages. Hildegard of Bingen and Albertus Magnus, among others, writing about gynecology, the human constitution, fetal development, or the naturalistic dimensions of divine Creation, became increasingly interested in issues surrounding reproduction and sexuality. Did women as well as men produce procreative seed? How did the physiology of the sexes influence their healthy states and their susceptibility to (...) disease? Who derived more pleasure from sexual intercourse, men or women? The answers to such questions created a network of flexible concepts which did not endorse a single model of male-female relations, but did affect views on the health consequences of sexual abstinence for women and men and on the allocation of responsibility for infertility - problems with much social and religious significance in the Middle Ages. Sometimes at odds with, and sometimes in accord with other forces in medieval society, medicine and natural philosophy helped to construct a set of notions that divided significant portions of the world - from the behavior of animals to the operations of astrological signs - into "masculine" and "feminine." Even cases that seemed to exist outside the definitions of this duality, for example, hermaphrodite features or homosexual behavior, were brought under control by the application of gendered labels, such as "masculine women.". (shrink)

In its recent statement 'Sex Selection and Preimplantation Genetic Diagnosis', the Ethics Committee of the American Society of Reproductive Medicine concluded that preimplantation genetic diagnosis for sex selection for non-medical reasons should be discouraged because it poses a risk of unwarranted gender bias, social harm, and results in the diversion of medical resources from genuine medical need. We critically examine the arguments presented against sex selection using preimplantation genetic diagnosis. We argue that sex selection should be available, at least within (...) privately funded health care. (shrink)

The aim of this paper is to call the attention, especially that of feminists, to the current progress in biology. It appears gender studies still confine themselves to outdated ideas of sex chromosomes like XX, XY (§10). However, science has been making progress. It no longer sticks to such matters as XX, XY. Its interest is now in Sry, a kind of gene (§11), and MIS, a kind of sex hormone (§14). Abnormalities of sex chromosomes are no longer evidence to (...) deny the biological approaches, for example. We shed light on this fact, putting gender studies in the context of chronologies of science as well (§§2-9). (shrink)

Current clinical guidelines for the treatment of individuals who experience gender dysphoria include the administration of testosterone to women who desire to appear as men and estrogen to men who desire to appear as women. Despite the rapid and widespread adoption of this practice, strikingly little scientific evidence supports this treatment approach as a safe and effective medical intervention to prevent associated depression and suicide. Although low-quality, short-term studies have demonstrated a reduction of dysphoria, emerging evidence reveals significant bodily harm (...) from this practice and a lack of long-term benefit in preventing depression and suicide. From an ethical perspective, this practice distorts a proper view of human nature and violates bodily integrity by directly inducing sterility. The use of exogenous cross-sex hormones reinforces rather than alleviates underlying psychiatric dysfunction while significantly increasing the risk of other medical morbidities. Despite the valid goal of alleviating suffering, this practice cannot be justified by the use of the principles of totality or double effect. (shrink)

Purpose. Objectives of the study are as follows: to remove the reduction of women to a metaphysical subject, to the "castrated Other" through the correlation of postmodern strategies and gender medicine; to institutionalize gender medicine as knowledge and practical activities that improve the quality and span of life of women based on the methodological application of deconstruction, complementarity, differance, "double writing", X-subject treatment and biomedical innovations; the perspective of gender medicine development is the implementation of the concept of "sovereign writing" (...) of postmodern in individual treatment of a person. Theoretical basis. Shock value of the title means farewell to metaphysics in the complex of its derived concepts. The author criticizes the abstract, reduced, marginalized, deviant subject of classical metaphysics and its continuation in psychoanalysis, explores the correlation of postmodern philosophy strategies and biomedical innovations. The allusion to the masterpiece of world cinematography Pasolini’s "Ciao maschio" corresponds to the rhizomatic stylistics of the postmodern. Originality. After feminist transgressions, gender constructivism postmodern philosophy demonstrates a new subject and a new methodology, which formed gender medicine. Differance, distinction, complementarity, X-subject of treatment, chiasmatic movement, "double writing", "sovereign writing" organically turned over and reconstructed modern medicine in gender, biochemical, and hormonal innovative variations. Conclusions. 1. Based on the philosophy and biomedical innovations, a new direction has grown – gender medicine, which has removed the reduction of women to a metaphysical subject, "castrated Other", which has improved the quality of women’s health and span of life. 2. Gender medicine in organic combination with the strategies of deconstruction, complementarity, differance, distinction as hormonal distinction, "double writing" as a "dual protocol" of treatment for the same diseases of men and women, the treatment of X-subject turned out to be "new wisdom", which improves the quality of health and span of life in everyday practice. 3. The prospect of the gender medicine’s development is in the implementation of the "sovereign writing" as an individual treatment of a specific person. (shrink)

The first world wide symposium on the topic of gender-specific medicine provided the latest research on differences in sex and/or gender in medicine and medical care. The presentations ranged beyond the topic of reproduction to encompass the entire human organism. This report critically reviews three issues that emerged during the Conference: gender mainstreaming, the concept of sex/gender differences and the issue of men's health. It suggests that the interdisciplinary concept of gender-specific medicine has to be mirrored by the integration of (...) social and cultural studies into medical research and practice. (shrink)

Evidence has long suggested that ‘hardwiring’ is a poor metaphor for brain development. But the metaphor may be an apt one for the dominant paradigm for researching sex differences, which pushes most neuroscience studies of sex/gender inexorably towards the ‘discovery’ of sex/gender differences, and makes contemporary gender structures appear natural and inevitable. The argument we forward in this paper is twofold. In the first part of the paper, we address the dominant ‘hardwiring’ paradigm of sex/gender research in contemporary neuroscience, which (...) is built on broad consensus that there are important ‘original’ sex differences in brain structure and function, organized by sex-differentiating prenatal hormone exposures. We explain why this consensus is both unscientific and unethical. In the second part of the paper, we sketch an alternative research program focused not on the origins of sex/gender differences but on variability and plasticity of brain/behavior. We argue that interventional experiments based on this approach will address more tractable questions, and lead to much more satisfactory results than the brain organization paradigm can provide. (shrink)

This article examines how sex differentiation is invoked from body fat with a focus on how various monitoring devices participate in the construction of bodies. By using the concept of ‘local biologies’, denoting the linkage of the body to place with its local physical and social conditions, it argues against the ‘one-size-fits-all’ paradigm of modern medicine and critiques the mechanistic search for regularity in medical research. By looking at medical literature on obesity and how contemporary obesity researchers and clinicians link (...) body fat to sex, local biologies of bodies in a Swedish obesity clinic are contrasted to the universal biologies represented in medical research. The article also provides empirical examples of how fat has the potential to undermine traditional sex and gender binaries. (shrink)

BackgroundImportant sex and gender differences have been found in research on diabetes complications and treatment. Reporting on whether and how sex and gender impact research findings is crucial for developing tailored diabetes care strategies. To analyze the extent to which this information is available in current diabetes research, we examined original investigations on diabetes for the integration of sex and gender in study reporting.MethodsWe examined original investigations on diabetes published between January 1 and December 31, 2015, in the top five (...) general medicine journals and top five diabetes-specific journals (by 2015 impact factor). Data were extracted on sex and gender integration across seven article sections: title, abstract, introduction, methods, results, discussion, and limitations.ResultsWe identified 155 original investigations on diabetes, including 115 randomized controlled trials (RCTs) and 40 observational studies. Sex and gender were rarely incorporated in article titles, abstracts and introductions. Most methods sections did not describe plans for sex/gender analyses; 47 (30.3%) articles described plans to control for sex/gender in the analysis and 12 (7.7%) described plans to stratify results by sex/gender. While most articles (151, 97.4%) reported the sex/gender of study participants, only 10 (6.5%) of all articles reported all study outcomes separately by sex/gender. Discussion of sex-related issues was incorporated into 21 (13.5%) original investigations; however, just 1 (0.6%) discussed gender-related issues. Comparison by journal type (general medicine vs. diabetes specific) yielded only minor differences from the overall integration results. In contrast, RCTs performed more poorly on multiple sex/gender assessment metrics compared to observational studies.ConclusionsSex and gender are poorly integrated in current diabetes original investigations, suggesting that substantial improvements in sex and gender data reporting are needed to inform the evidence to support sex- and gender-specific diabetes care. (shrink)

Although serotonin, testosterone, and genes contribute to sociopathy, the relationships are probably indirect and subject to modifiers (e.g., present only under certain conditions of rearing and temperament). Age at menarche may be a marker variable as well as a causal factor. Since the genders differ in all four areas, sex differences in sociopathy represent a very complex interaction of these factors.

In lieu of an abstract, here is a brief excerpt of the content:Dwelling in the GapsGalen SanderlinHave you ever wondered what it would be like to be a mythical being? As a hermaphrodite, I exist in a culture that sees only male or female. Those of us who don’t fit into the rigid sex binary are left out of many of the protections offered to our cousins who more neatly fit the two categories. This leaves an enormous gap in cultural (...) definitions and societal acceptance of my fundamental being.My journey has three main threads: 1) My personal and often rocky self–development, as I have come to understand and accept what it means to be a hermaphrodite, and finding others of my tribe; 2) recognizing the harm done by my medical treatment and actively seeking to change how the medical system treats hermaphrodites, starting from birth onwards; and 3) identifying what was done to me as a human rights violation.I was born in January of 1975. No genetic test was done at the time. My body looked male and my assigned sex/gender was male. As a child, I gravitated toward “male” toys. In 1989, a rural– MD noted that I was not experiencing puberty like my peers and she recommended that my parents take me to a teaching hospital in Seattle for tests. A pediatrician referred me to the adolescent medical division, and from there I was referred to an endocrinologist. After conducting many invasive tests, including drawing blood and comparing my testicles to a bead ring of ersatz testicles, the endocrinologist diagnosed me with Klinefelter’s Syndrome and a karyotype of 47,XXY. I was prescribed testosterone injections to affirm and strengthen the male identity I was assigned at birth and to prevent my body from developing secondary female sex characteristics (breasts and hips).Soon after the shots started I bulked up, adding muscle and hair everywhere. I also became dangerously aggressive and moody. I began to have serious self–esteem issues and a drastic increase in risk–taking behavior as my body was subjected to medical intervention that my parents innocently followed.The prescribed hormone treatment fractured my psyche—what I know now to be a common defense mechanism experienced in trauma survivors. The portion of my consciousness that existed prior to testosterone became deeply buried to prevent harm, and I experienced the emergence of a new “entity.” With each change in prescription, new fractures occurred: testosterone cypionate to enanthate shots, to patches, to gels.The physicians did not consider my feelings or preferences during recommendations or treatment. I feel I was forced into a “male” body based on a medical emergency they created to ease societal concerns.Last February I decided to stop hiding. Tearing the mask off has brought a flood of emotions hidden behind old traumas. I’d been living openly as an intersex person, but still deeply closeted, if not from the public—worse, from myself.Here is the writing that came pouring out of me as I’ve been accessing my repressed memories:I felt the first stirrings of my existence in August of 1989, like a fleeting visage of a long lost lover passing just out of view. The timing of the universe—Out of the infinite we are born, but in this case the body we are to occupy was already housing many other souls. Is this some mistake? Asked to be patient I waited... Late in the year of 1989 I was borne on testosterone wings into an imaginary masculine role/body.Molded in the image of Adonis, Hermes was forced to submit. No longer sexless or ageless—lost in a sea of supposed pressures and roles. My assumed gender [End Page E10] was male. Why!?! Screaming, thrashing, and damaging all around me, no way to express the horror of being so brutally manhandled.My guide Galen/Juniper were excised from our psyche—lost behind a barrier. The only solace was a shared beat: 1,2,3,4 over and over. Was this the pounding of our heart? Thank god for our love of music least we lose ourselves entirely.Why do they insist on calling me Galen? I no longer knew who this was. I... (shrink)

The feminist movement was from its start in the 19th century involved in the struggle for better health care for women. The first feminists aimed at better information on birth control and sexuality. The second feminist wave focused on the unequal division of power roles between men and women. A lot of the problems women experienced could be seen as a consequence of their subordinate role in society. At the end of the 1980s and in the 1990s, the discipline women (...) and health or women and medicine was developed. In this introduction to the theme, the developments in this discipline are described. The starting points of the new discipline followed the principles of ‘women’s health care’. These principles can be summarized as the emphasis on control and autonomy by the patient, demedicalization, the importance of the psychosocial context of complaints, empowerment of women and good information and communication. The central issue of the article is: what is the actual scientific state of the art and what important changes have been made on the subject gender and health? The article ends with ideas for future research. (shrink)

Childfree females encounter greater obstacles in obtaining voluntary sterilizations than childfree males. This paper discusses what might explain this and it proposes that female patients encounter particular credibility deficits that undermine their ability to grant informed consent. In particular, the paper explores Miranda Fricker’s recent suggestion that members of structurally disadvantaged groups encounter a particular sort of injustice that harms them in their capacity as knowers: they sustain testimonial injustice. The task of the paper is to investigate whether and in (...) what sense this holds. (shrink)

As medical professionals, we outline the science underlying disorders or differences of sexual development (DSD), discuss the nuances of sex and gender and how terminology can differ based on medical vs. non-medical context, briefly review the evidence of the ergogenic effects of hyperandrogenism, and discuss the medical complications with the hormonal contraceptive use currently dictated by World Athletics to allow DSD athletes to compete in the female category.

This essay considers the creation of a gender identity clinic at Rikshospitalet, the National Hospital of Norway, in the early 2000s and its implications for the production of medical knowledge during that era. In the preceding decades, medical transition was overseen by an informal, self-organized, multidisciplinary team of medical experts, but this situation changed when a centralized gender identity clinic was established under psychiatric control. The essay argues that shifting institutional, societal, economic, legal, and bureaucratic circumstances redistributed expertise and authority (...) on trans medicine. Economic framing, institutional frictions, patient activism, and media attention restricted the doctors’ room for maneuver and created a scientific crisis of legitimacy in trans medicine. These processes changed medical knowledge regarding medical transition; eventually, “sex change” and, therefore, all that is denoted by “sex” became intertwined with and inseparable from the politico-bureaucratic processes of reforming a modern public health-care system and welfare state. By anchoring the analysis in the history of science and expertise, this inquiry offers a new focus on the role of bureaucratic practices in the production, structuring, and circulation of medical knowledge in the welfare state. (shrink)

This article traces the multiple enactments of sex in clinical practices of transgender medicine to argue against the presumed singularity of ‘transexuality’. Using autoethnography to analyse my own experience as a trans patient, I describe my clinical encounters with doctors, psychiatrists and surgeons in order to theorise sex as multiple. Following recent developments in science and technology studies (STS) that advance the work of Judith Butler on sex as performatively reproduced, I use a praxiographic approach to argue that treatment practices (...) produce particular iterations of what sex (and transexuality) ‘is’ and how these processes limit and foreclose other trans possibilities. I consider the ethical, political and material-discursive implications of treatment practices and offer a series of reflections about the effects and effectiveness of current clinical practices and the possibilities for intervening in such processes in order that, following Annemarie Mol, we might (re)make sex (and transexuality) differently. (shrink)

Although physicians have attempted for centuries to uncover the biological differences between men and women with regard to mental illness, they continue to face the challenges of untangling biological factors from social and cultural ones. This article uses examples from history to illustrate three common problems in trying to establish biological differences: identifying factors as sex-based when they are really gender-based; overlooking changes in masculine and feminine roles over time; and placing too great an emphasis on hormones. By using the (...) benefit of hindsight to identify problems from the past, we can think more critically about these issues in the present and the future. (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics (...) and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

This essay argues that the reigning medical and scientific understanding of the endocrine system, which insists on its fundamental biological plasticity, was historically constructed through a dual child–animal metaphor. The work accomplished by such organic metaphors, as Donna Haraway terms them, returns us to the endocrine laboratories and clinics in which they were built in Europe and the United States in the first half of the twentieth century. The child and animal metaphors implanted the concept of plasticity into the human (...) body to the effect of bringing sexed and gendered life under the jurisdiction of science and medicine, where it could not only be normalized in a sense long appreciated by transgender studies but also cultivated towards the ostensible “improvement” and “perfection” of the human. This is also, then, a history of the eugenic heritage of modern endocrinology, which has been largely ignored in recent discussions of plasticity and the body’s materiality. To interrogate the role of foundational organic metaphors in endocrinology is to open up plasticity not only to its historical context but also to radical contestation, making the contemporary assumptions of transgender medicine untimely, particularly the medicalization of the transgender child. (shrink)

Gender‐affirming care is almost exclusively discussed in connection with transgender medicine. However, this article argues that such care predominates among cisgender patients, people whose gender identity matches their sex assigned at birth. To advance this argument, we trace historical shifts in transgender medicine since the 1950s to identify central components of “gender‐affirming care” that distinguish it from previous therapeutic models, such as “sex reassignment.” Next, we sketch two historical cases—reconstructive mammoplasty and testicular implants—to show how cisgender patients offered justifications grounded (...) in authenticity and gender affirmation that closely mirror rationales supporting gender‐affirming care for transgender people. The comparison exposes significant disparities in contemporary health policy regarding care for cis and trans patients. We consider two possible objections to the analogy we draw, but ultimately argue that these disparities are rooted in “trans exceptionalism” that produces demonstrable harm.. (shrink)

Although medical providers rely on similar tools to “treat” intersex and trans individuals, their enactment of medicalization practices varies. To deconstruct these complexities, we employ a comparative analysis of providers who specialize in intersex and trans medicine. While both sets of providers tend to hold essentialist ideologies about sex, gender, and sexuality, we argue they medicalize intersex and trans embodiments in different ways. Providers for intersex people are inclined to approach intersex as an emergency that necessitates medical attention, whereas providers (...) for trans people attempt to slow down their patients’ urgent requests for transitioning services. Building on conceptualizations of “giving gender,” we contend both sets of providers “give gender” by “giving sex.” In both cases too, providers shift their own responsibility for their medicalization practices onto others: parents in the case of intersex, or adult recipients of care in the case of trans. According to the accounts of most providers, successful medical interventions are achieved when a person adheres to heteronormative gender practices. (shrink)

The Iowa Gambling Task (IGT) is a popular method for examining real-life decision-making. Research has shown gender related differences in performance, in that men consistently outperform women. It has been suggested that these performance differences are related to decreased emotional control in women compared to men. Given the likely role of emotion in these gender differences, in the present study we examine the effect of a humor induction on IGT performance and whether the effect of humor is moderated by gender. (...) IGT performance and parameters from the Expectancy Valence Model were measured in 68 university students (34 men; mean age 22.02, SD = 4.3 and 34 women; mean age 22.3, SD = 4.1) during a 100 trial-IGT task. Participants were exposed to a brief video before each of the IGT decisions available; one half of the sample (17 men and 17 women) was exposed to 100 humor videos, while the other half was exposed to 100 non-humor videos during the task. We observed a significant interaction between gender and humor, such that under humor, women’s performance during the last block (trials 80-100) improved (compared to women under non-humor), whereas men’s performance during the last block was worse (compared to men under non-humor). Consistent with previous work, under non-humor, men outperformed women in the last block. Lastly, our EVM results show that humor impacts the learning mechanisms of decision-making differently in men and women. Humor impaired men’s ability to acquire knowledge about the payoff structure of the decks, and as a consequence they were stuck in suboptimal performance. On the other hand, humor facilitated women’s ability to explore and to learn from experience, improving performance. These findings deepen our understanding of the mechanisms underlying IGT decision-making and differential effects of humor in men and women. (shrink)

This paper examines how the new field of neuroethics is responding to the old problem of difference, particularly to those ideas of biological difference emerging from neuroimaging research that purports to further delineate our understanding of sex and/or gender differences in the brain. As the field develops, it is important to ask what is new about neuroethics compared to bioethics in this regard, and whether the concept of difference is being problematized within broader contexts of power and representation. As a (...) feminist science studies scholar trained in the neurosciences, it seems logical to me that, as a growing field, neuroethics should reach out to the rich bodies of scholarship on the history of medicine, feminist theory and feminist bioethics while attempting to approach discussions of sex, gender and sexuality differences in the brain. What is also clear to me is that feminist scholars need to learn how to engage with neuroimaging studies on sex, gender and sexuality not just to critique, but also to productively contribute to neuroscientific research. The field of neuroethics can potentially provide the appropriate forum for this interdisciplinary engagement and create opportunities for shared perplexity. I suggest three possible points of departure for creating this shared perplexity, namely (i) is difference being measured in the study for the purpose of understanding difference in and of itself, or for the purpose of division?; (ii) is there an appreciation for biological complexity?; and (iii) is it assumed that structural differences can be conveniently translated into functional differences? (shrink)

As physicians encounter an increasingly diverse patient population, socioeconomic circumstances, religious values and cultural practices may present barriers to the delivery of quality care. Increasing cultural competence is often cited as a way to reduce healthcare disparities arising from value and cultural differences between patients and providers. Cultural competence entails not only a knowledge base of cultural practices of disparate patient populations, but also an attitude of adapting one's practice style to meet patient needs and values. Gender roles, relationship dynamics (...) and boundaries are culture specific, and are frequently shaped by religious teachings. Consequently, religion may be conceptualised as a cultural repertoire, or dynamic tool-kit, by which members of a faith adapt and negotiate their identity in multicultural societies. The manner in which Islamic beliefs and values inform Muslim healthcare behaviours is relatively under-investigated. In an effort to explore the impact of Islam on the relationship between patients and providers, we present an Islamic bioethical perspective on cross-gender relations in the patient-doctor relationship. We will begin with a clinical scenario highlighting three areas of gender interaction that bear clinical relevance: dress code, seclusion of members of the opposite sex and physical contact. Next, we provide a brief overview of the foundations of Islamic law and ethical deliberation and then proceed to develop ethicolegal guidelines pertaining to gender relations within the medical context. At the end of this reflection, we offer some practice recommendations that are attuned to the cultural sensitivities of Muslim patient populations. (shrink)

Sex reassignment surgery is a therapy for gender dysphoria standardly provided only upon a psychiatric authorization. Transgender scholars criticize this practice as unjustified medicalization and stigmatization of transsexual people. By demanding that sex reassignment surgery is not classified as therapy, they imply it should be classified as some kind of a biomedical enhancement. It is argued in this article that this reclassification is empirically and morally implausible because sex reassignment surgery is incompatible with two major views of enhancement. It is (...) incompatible with the nontherapeutic view because it does not improve or augment, above average, any physical or mental trait or function. It is incompatible with the welfarist view because this view, contrary to the transgender scholars’s demands, is compelled to retain the standard practice of providing sex reassignment surgery in order to ensure the optimal balance between its availability, beneficence, and possible harmfulness. (shrink)

[NOTE: I now disavow this essay, which was too accommodating of trans ideology.] Surprisingly, it follows from commonplaces about sex and gender that there is a widely-practiced variety of transgenderism achievable through sex/gender “exaggerating.” Recognizing exaggeration as trans---or at least its moral equivalent---has several important consequences. One is that, since most traditional cultures endorse exaggeration, trans lifestyles have often been mainstream. But more importantly, recognizing that gender exaggeration is trans (or its moral equivalent) reveals a number of sex- and gender-discriminatory (...) practices and intolerant attitudes: from pathologizing hypergender to legally restricting androgenic hormones, many people who consider themselves trans allies are less consistent in their support of transgender lifestyles than they realize. Thus, seeing exaggerators as trans not only follows from a better grasp of transgenderism, but also reveals new arguments in favor of greater gender freedom against gender-policing by both conservatives and progressives. (shrink)

Sexuality is a basic feature of human life. Gender, sexual and romantic attraction, sexual excitement, and sexual desire and fantasies all move in various degrees through our daily awareness. However, despite this pervasiveness, there is much disagreement surrounding the nature of such things and experiences. This book explores just these issues in an attempt to get clear about this enigmatic aspect of our existence. Through a series of interrelated essays, internationally acclaimed philosopher James Giles takes the reader on a fascinating (...) journey to the depths of experiential, social, biological, and evolutionary aspects of sexual life. Presenting his arguments and ideas in a clear and easy to follow language, Giles criticizes several popular views, clearing the way for his own unique vision of human sexuality. Often controversial, always engaging, these pages will prove to be absorbing reading for anyone who has ever pondered the nature of sexuality and why it fills our lives in the way it does. (shrink)

This book gives a socialist-feminist theory of the origins, persistence and reproduction of male dominance in systems of parenting/motherhood and sexuality. I create the concept of "modes of sex/affective production" which I see as analogous to and intertwined with modes of economic production to reproduce historically different systems of male dominance. I compare my Multi-system socialist-feminist theory to those of Liberal Feminism, Radical feminism, Marxist-feminism, Freudian feminism, and various types of lesbian-feminism. The concluding chapter presents a socialist-feminist vision of a (...) liberated society where class, gender and racial dominance have been eliminated. Historical, political and personal examples are discussed. (shrink)

Gender dysphoria (GD) is marked by an incongruence between a person’s biological sex at birth, and their felt gender (or gender identity). There is continuing debate regarding the benefits and drawbacks of physiological treatment of GD in children, a pathway, beginning with endocrine treatment to suppress puberty. Currently, the main alternative to physiological treatment consists of the so-called “wait-and-see” approach, which often includes counseling or other psychotherapeutic treatment. In this paper, we argue in favor of a “third pathway” for the (...) diagnosis and treatment of GD in youths. To make our case, we draw on a recent development in bioethics: the phenomenological approach. Scholars such as Slatman and Svenaeus have argued that the extent to which the body can (or should be) manipulated or reconstructed through medical intervention is not only determined by consideration of ethical frameworks and social and legal norms. Rather, we must also take account of patients’ personal experience of their body, the personal and social values associated with it, and their understanding of its situation in their life: their narrative identities. We apply this phenomenological approach to medicine and nursing to the diagnosis and treatment of GD in youth. In particular, we discuss Zahavi and Martiny’s conception of the phenomenological interview, in order to show that narrative techniques can assist in the process of gender identification and in the treatment of youth presenting with GD. We focus on two case studies that highlight the relevance of a narrative-based interview in relations between patients, HCPs, and family, to expose the influence of social ideologies on how young people presenting with GD experience their bodies and gender. (shrink)

Writing for non-specialists and students as well as for fellow philosophers, this book explores some basic issues surrounding sex and love in today's world, among them consent, objectification, nonmonogamy, racial stereotyping, and the need to reconcile contemporary expectations about gender equality with our beliefs about how love works. Author Patricia Marino argues that we cannot fully understand these issues by focusing only on individual desires and choices. Instead, we need to examine the social contexts within which choices are made and (...) acquire their meanings. That perspective, she argues, is especially needed today, when the values of individualism, self-expression, and self-interest permeate our lives. Marino asks how we can fit these values, which govern so many areas of contemporary life, with the generosity, caring, and selflessness we expect in love and sex. Key Features ofPhilosophy of Sex and Love: An opinionated introduction Offers a contemporary, problems-based approach to the subject, helping readers better understand and address current issues and controversial questions Includes coverage of sex and love as they intersect with topics like disability, race, medicine, and economics Considers not only the ethical, but also the broadly social and political dimensions of sex and love Includes a helpful introduction and conclusion in each chapter and is written throughout in a clear and straightforward style, with examples and sign-posts to help guide the student and general reader A comprehensive and up-to-date bibliography provides a valuable tool for anyone's further research P> Offers a contemporary, problems-based approach to the subject, helping readers better understand and address current issues and controversial questions Includes coverage of sex and love as they intersect with topics like disability, race, medicine, and economics Considers not only the ethical, but also the broadly social and political dimensions of sex and love Includes a helpful introduction and conclusion in each chapter and is written throughout in a clear and straightforward style, with examples and sign-posts to help guide the student and general reader A comprehensive and up-to-date bibliography provides a valuable tool for anyone's further research. (shrink)

Non-medical sex selection is premised on the notion that the sexes are not interchangeable. Studies of individuals who undergo sex selection for non-medical reasons, or who have a preference for a son or daughter, show that they assume their child will conform to the stereotypical roles and norms associated with their sex. However, the evidence currently available has not succeeded in showing that the gender traits and inclinations sought are caused by a “male brain” or a “female brain”. Therefore, as (...) far as we know, there is no biological reason why parents cannot have the kind of parenting experience they seek with a child of any sex. Yet gender essentialism, a set of unfounded assumptions about the sexes which pervade society and underpin sexism, prevents parents from realising this freedom. In other words, unfounded assumptions about gender constrain not only a child’s autonomy, but also the parent’s. To date, reproductive autonomy in relation to sex selection has predominantly been regarded merely as the freedom to choose the sex of one’s child. This paper points to at least two interpretations of reproductive autonomy and argues that sex selection, by being premised on gender essentialism and/or the social pressure on parents to ensure their children conform to gender norms, undermines reproductive autonomy on both accounts. (shrink)

This is a book on feminist theory from a socialist-feminist (materialist feminist) perspective. I categorize existing paradigms of Western feminist theory in the 1980s and contrast them with my own view, which adds to a critique of capitalism inspired by Marxism another system in which male domination persists, which I call the system of "sex-affective production" (inspired but going beyond Freud, Foucault and Deleuze and Guattari). I also discuss motherhood and sexuality using my paradigm personally, politically and philosophically.