"There should be no escape for medical and legal authorities
that these definitions ought to be corrected and updated when new information becomes available, particularly when our outdated
definitions bring suffering to some of our fellow human beings."
-Professor Louis Gooren, MD, 2004
Definition and Aetiology.
Harry
Benjamin’s Syndrome (HBS) is an intersexual condition occurring in the early stages
of pregnancy that affects the process of sexual differentiation in the brain between male and female.
This happens when the brain develops in the manner appropriate to a particular sex,
but the rest of the body takes on the physical characteristics of the other sex. The difference between this and most other intersexual conditions is that there is no apparent evidence of it at birth,
and it only manifests itself much later, with an onset as late as adolescence.
In the past, there were many different names for HBS, the most common of which was
Transsexuality. However, HBS is NOT transsexuality. The current definition of Transsexualism offered in the
ICD-10 clearly shows this difference.
HBS is a congenital intersexual condition that has a pre-natal development, and it
involves the differentiation of the male and female gender identities in the brain. The estimated incidence of HBS is one
in 100.000 live births overall.
To put it simply, a girl with HBS would have a female neurological gender identity, whilst the genitalia would be male. Conversely, boys with this condition have female genitalia coupled with a male neurological gender identity.
At present, it is not possible to diagnose this condition at the time of birth. Therefore,
the children are raised in the gender role opposite to that of the neurological gender identity. This often leads to psychological
problems unrelated with the HBS itself.
Gender identity is a purely neurological function, with no psychological factors appended. Therefore, neurological factors determine gender identity, not the anatomical structures of the genitalia. The physical structure of the brain, such as the CNS, fix gender identity.
Since there is no apparent evidence at the time of birth, it is difficult for doctors to diagnose the condition, quite unlike
other intersexual conditions.
Diagnosis and Medical Treatment.
Early detection and treatment of HBS can eliminate virtually all symptomatic signs of the condition.
The prescribed and normative treatment regimen for re-assigning the person’s body to the proper physical
structure congruent with neurological gender identity consists of two stages.
The first stage is Hormone Replacement Therapy (HRT), where the administration of appropriate hormones results in the start of the desired somatic changes. This phase of
treatment usually affects secondary sexual characteristics only.
The treatment culminates with Sex Affirmation Surgery (SAS), where the surgeon modifies the anatomical structures of the genitalia to be in congruence with the neurological
gender. This is NOT "sex-change" surgery, as the gender of the affected individual never changes.
Unfortunately, many still consider HBS as being identical to "transsexualism", and this creates difficulties
in the proper diagnosis and treatment of the condition. Too many people link the word transsexualism to psychopathology
and mental illness. They see it as a case of "men wishing to be women".
Some MDs still describe this condition as transsexuality. At times, it appears as though doctors are ignoring
the latest research on neurological gender identity. This ignorance leads to physicians retaining the use of such outmoded
terms as transsexuality.
The current medical system can treat HBS very well, but the ignorance of individual practitioners leads to inaccurate diagnoses and treatment. The lack of information concerning
the latest neurological research leaves many general practitioners struggling with past myths and misconceptions.
Psychological therapy is useful for the diagnosis of the condition, but only a treatment regimen of HRT and SAS
can correct the gender anomaly.
It is important to keep in mind that HBS is a physiological, not a psychological, condition. Psychological
intervention is useful for a limited number of patients, especially younger ones. The most important members of the treatment
team are the endocrinologist and the surgeon. The psychologist plays an ancillary role only.
Classification and Terminology.
In the past, doctors considered HBS to be a psychopathological condition where an individual had delusions
of being of the opposite sex. Practitioners considered the condition aberrant, and many considered it an "unexplainable" fancy.
(see Caldwell, Pyschopathia Transexualis, 1949)
However, there has been much detailed and technical research
in the last two decades devoted to the origins and treatment of HBS. Researchers have concluded that HBS is a physiological condition, and there is no link to psychopathology whatsoever. Today, the term transsexualism is
outmoded in its’ ability to properly describe the condition.
Research now documents the fact that neurological events undergird the existence
of HBS. The old psychological construct known as transsexualism is now passé. Thus, those with HBS have the objective neurological
gender identity of their sex of subjective identification.
Recent studies tell us that neurological gender identity, not anatomical genital structures,
determines the actual sexual identity of an individual. Therefore, someone born with HBS is already a member of the "opposite" sex. This overturns the term transsexualism because there is no "change of sex". Rather, one only does corrective surgery on
physical structures.
Someone with HBS is already a member of their identified sex biologically, as their neurological structures are of the identified sex, not of the genital sex. Simply put, their neurological sex is opposed to that of their genital sex.
Therefore, we see that HBS is actually an intersexual condition, and the old idea of transsexualism becomes
outdated. The idea of a neutral and physiological neurological basis for the conundrum replaces the obsolete idea that transsexualism
was a psychological disorder.
Thus, we see that HBS is not a personality aberration or a mental orientation towards a particular sexual
identity. Such a physiological condition demands early diagnosis and treatment, so that the affected individual can live a
normal and adjusted life. One cannot delay it for reasons of "psychotherapy", which is of dubious utility in any case.
The old term of transsexualism urgently needs a radical revision.
We must leave the old superstitions regarding HBS in the past. Too many negative connotations surround transsexualism: stigma,
superstition, media distortion, and back-alley medical treatment. It does not describe the somatic condition adequately, and
so we must discard it at the first opportunity.
We have a responsibility to bring the facts to light. We must stop the continual sensationalism in the mass
media, and we must do our part to halt the spread of misinformation concerning HBS. Only then, shall we see HBS as it is in
reality: a neutral and somatic condition, no different from any other physical condition.
"Transsexualism
(HBS) is now regarded by the world’s leading experts in the field as another of the many biological variations that
occur in human sexual formation: an intersex condition: where the sex indicated by the phenotype and the genotype is opposite he morphological sex of the brain. People with the condition of transsexualism
(HBS) are therefore born with both male and female characteristics and, like many others with atypical sexual development,
seek rehabilitation of their phenotype and endocrinology to accord with their dominant sexual identity; an identity which
is determined by the structure of the brain. Transsexualism (HBS) is about being a particular sex, not
doing it. It is also about recognising gender norms, not challenging them."
Karen Gurney and Eithne Mills, 2005
Murdoch University Electronic Journal of Law, Volume 12,
nr 1 & nr 2
