Designated as disordered rather than just different, LGBTI people have been and continue to be victims of medical malpractice purely because they are neither Adams nor Eves. Psychiatrists, surgeons, endocrinologists, pediatricians, and other medical experts have subjected LGBTI people to bogus and horrific treatments with reckless disregard for patient health and well-being―all the while ignoring the basic tenets of medical ethics and the ever-growing scientific evidence showing LGBTI people to be natural variations. Beyond this, medical stigmatization of LGBTI people has contributed to their oppression in the world at large. This treatise will contrast the scientific evidence with the ongoing medical (mis)treatment of LGBTI people to vividly illustrate the insidious effect of the biblical creation myth. This presentation is from Chapter 12 of the anthology Christianity Is Not Great: How Faith Fails. John W. Loftus (editor), (Amherst NY: Prometheus Books, 2014). Paperback or Kindle version of the book here. http://www.amazon.com/Christianity-Is-Not-Great-Faith/dp/1616149566

1. The Gender Binary &
LGBTI People
Religious Myth
and Medical Malpractice
by
Veronica Drantz, PhD
Excerpted from Chapter 12 of Christianity Is Not Great: How Faith Fails
John W. Loftus (editor), Prometheus Books, 2014.
for
Northern Illinois University, April 9th, 2015
Thanks to the sponsors:
NIU Secular Student Alliance
NIU LGBT Studies Program
NIU Gender & Sexuality Resource Center

2. Religious Myth: The Gender Binary
 Only two sexes (male, female)
 Sex = Gender (male = man, female = woman)
 Only one kind of sexual attraction (heterosexual)

3. LGBTI People
L = Lesbian
G = Gay
B = Bisexual
T = Transgender
I = Intersex
This diverse collection of sexually different people shares one
feature—they innately defy the gender binary, not clearly
fitting into either the “Adam” or the “Eve” categories.

4. Public Views About Human Evolution

5. The Medicalization of LGBTI People
SIN to SICKNESS
This shift from religion to the medical domain was accompanied by
an important development, the creation of a category of person ― the
“homosexual”
Homosexuality was no longer just a behavior; it was now a kind of
identity ― a type of person

6. Medical (Mis)treatment of LGBTI
 Designated as disordered rather than just different
 Subjected to bogus and horrific treatments
 Reckless disregard for patient health and well-being
 Basic tenets of medical ethics ignored
 Ever-growing scientific evidence showing LGBTI people to be
natural variations ignored
 Contribution to LGBTI oppression in the world at large
This presentation will contrast the scientific evidence with the
ongoing medical (mis)treatment of LGBTI people to vividly
illustrate the insidious effect of the biblical creation myth

7. The Scientific Study of
Sexual Behavior
 Alfred Kinsey
 C.S. Ford and Frank Beach
 Evelyn Hooker

8. Alfred Kinsey
 Criticized scientists’ portrayal of homosexuals as “inherently different
types of individuals”
 Devised a scale from zero to six to represent the continuum along
which human sexual behavior or fantasy can be classified from
“exclusively heterosexual” to “exclusively homosexual”
 Kinsey’s work showed that homosexuality was more common than
previously thought
1948 1953

9. Ford & Beach
 Integrated information on sexual activity from 191 cultures
representing Oceania, Eurasia, Africa, North America, and South
America
 Significantly, homosexual behavior was accepted in 49 of the 76
cultures for which the relevant data were available
 Homosexual behavior in other mammals was reported as well
 This work indicated that homosexuality was widespread and natural
C. S. Ford Frank Beach1951

10. Evelyn Hooker
1957
 Exploited data from several projective tests, including the Rorschach,
that many clinicians believed to be the best method of assessing total
personality structure and that was employed for the diagnosis of
homosexuality at the time
 The failure of expert psychologists to distinguish nonpatient
homosexuals from nonpatient heterosexuals showed that
homosexuality occurs in persons who demonstrate normal
psychological adjustment, seriously challenging the view that
homosexuality was always associated with psychopathology
Evelyn Hooker, “The
Adjustment of the Male
Overt Homosexual,”
Journal of Projective
Techniques 21 (1957):
18–31.

11. Homosexual Behavior in Animal Kingdom
 Homosexual behavior has been found to be widespread in the animal
kingdom—from worms, insects, and frogs to mammals and birds

12. http://www.pbs.org/independentlens/two-
spirits/map.html
More Than Two Genders!
 Not just gay people but other gender-diverse people also are found all
over the world
 Worldwide the variety of gender expression is almost limitless, and
hundreds of societies have long-established traditions of three, four,
five, or even more genders
A Map of Gender-Diverse Cultures

13. North America
 Two-spirits – Native American
 Berdache – Illiniwek (Illinois)
 Muxes – Zapotec People, Oaxaca, Mexico
Two-spirits
Muxes

14. South America
 Travestís – Brazil
 Bichas
 Viados
 Guevedoche – Dominican Republic
 Quariwarmi – Incan
Viados
Travestís

15. Europe
 The Sworn Virgin – Balkans
 Catamites – Ancient Greece
 Mollies – Modern England
 Tertium genus hominum (a third
human gender) “eunuchs” –
Ancient Eastern Mediterranean
Sworn Virgin
Sworn Virgin
Catamites

16. Africa
 Ashtime – Maale culture of Southern Ethiopia
 Mashoga – Swahili-speaking areas of the Kenyan
coast, particularly Mombasa
 Mangaiko – The Mbo people, Democratic Republic
of the Congo
 Sḫt (”sekhet”) – Middle Kingdom of Egypt (2000-
1800 BCE)
Mashoga

17. Middle East
 The Kurgarûs – Sumer
 Zenanas – Arab
 Xanith or Khanith – Oman

18. Asia
 lyha – Mohave
 Hijras – India, Pakistan & Bangladesh
also known as: Aravani/Aruvani or Jogappa
Hijira (alt. sp.) – India
 Sādhi
 Kotis
 Sadhin – The Gaddhi in the foothills of the
Himalayas
Hijras

19. Asia continued
 Basivi – Madras (area of India)
 Tritiya-prakrti (third-nature) – Indic
culture of premodern India
 Ubhatobyanjanakas – Buddhist Vinaya
Pandakas
 Kathoey – Thailand
 Pandaka – Ancient
Buddhist Societies
Kathoey
Kathoey

20. Asia-Pacific
Polynesia
 Fa’afafine – Samoa Polynesia
 Fakaleiti – Tonga
 Mahu Wahine – Hawaii
 Mahu Vahine – Tahiti
 Whakawahine – Māori
 Akava’ine – Cook Islands
Fa’afafine

21. Indonesia
 Waria Kwolu-aatmwol –
Papua New Guinea
 PHILIPPINES
Bakla – Tagalog
Bayot – Cebuano
Agi – Ilonggo
Bantut – Tausug
Binabae
Bading
Lakin-on
Waria
Bakla

22. The Scientific Study of
Sexual Development
 How does this sexual diversity develop?
 Do we learn our core sexuality?
 Can core sexuality be changed?
 Answer – from the physiologists
– “Organization-Activation” mechanism
– Mechanism of sexual development in
mammals

23. Organization-Activation
Mechanism
 Sexual “organization” before birth
– Genetic control (XX, XY)
– Hormonal control (the presence or absence
of testosterone or other androgenic
substances during critical periods of fetal
development)
 Sexual “activation” at puberty
– Sexual maturation and functioning
– Caused by hormones from ovaries or testes

24. Sexual Development in Mammals
Figure 25-4 Embryonic differentiation of male and female internal genitalia (genital
ducts) from wolffian (male) and müllerian (female) primordia.
Figure 25-5 Differentiation of male and female external genitalia from
indifferent primordial structures in the embryo.

25. Sexual Development in Mammals
Figure 25-6 Diagrammatic summary of normal sex determination, differentiation, and development in humans. MIS, müllerian
inhibiting substance; T, testosterone; DHT, Dihydrotestosterone

26. Mechanism of Androgen Hormone Action
Figure 25-18 Schematic diagram of the actions of testosterone (solid arrows) and dihydrotestosterone (dashed arrows).

27. Males are Altered Females!
 Everybody is a variation on
the female theme
FemaleIntersexMale
(Unaltered) (Partly altered) (Fully altered)

28. More Than Two Sexes!
 Intersex people differ physically from
the “standard” male or female
Curtis Hinkle - Founder
Organization Intersex International

29. Intersex People
 There are many
different kinds of
intersex people
 Intersex people
demonstrate that the
organization-activation
mechanism works in
humans as it does in
other mammals

30. Androgen
Insensitivity
Syndrome
(AIS)
 XY chromosomes
 Testis secrete
testosterone
 No internal genitalia
 Partial AIS (2-5)
 Complete AIS (6/7)

31.  XX chromosomes
 Ovaries
 High production of androgen hormones from adrenal glands
Congenital Adrenal Hyperplasia (CAH)
Classical Type

32. Sexual Identity & Orientation –
Nature or Nurture?
 We don’t learn or choose our genitalia.
What about sexual behavior?
 Evidence for Organization-Activation
Mechanism in the brain
– Nonhuman mammals
– David Reimer story
– Sexuality of intersex people
– Human brain work (trans vs. cis, gay vs. straight)

33. Development Of Sexual Brain
– the “Animal Work”
 Brain-organizing action of fetal
testosterone discovered
C. H. Phoenix et al., “Organizing Action of Prenatally Administered
Testosterone Propionate on the Tissues Mediating Mating Behavior
in the Female Guinea Pig,” Endocrinology 65 (1959): 369–82.
 Over the years, evidence for the
“determining influence” of prenatal
hormones has accumulated in
numerous mammals

34. Hypothalamus
 Instinctive Drives &
Behaviors
– Hunger
– Thirst
– Sleep
– Body rhythms
– Sexual function
 Interconnected with
amygdala (emotion)
 Similar in all mammals
 Ancient Netter, Frank H. The CIBA COLLECTION OF MEDICAL ILLUSTRATIONS.
Vol I. Nervous System. Part I. Anatomy & Physiology. New York:
CIBA (1983)

35. Sexual Behavior Requires
Anterior Hypothalamus
 Sexually-dimorphic nuclei in this region
 Neurons have sex hormone receptors
Figure 25-28 Loci where implantations of estrogen in the hypothalamus affect ovarian weight and
sexual behavior in rats, projected on a sagittal section of the hypothalamus. The implants that
stimulate sex behavior are located in the suprachiasmatic area above the optic chiasm (blue area),
whereas ovarian atrophy is produced by implants in the arcuate nucleus and surrounding ventral
hypothalamus (red). MB, mamillary body

36. Mesolimbic Reward System
and Social Behavior Network
Are Found in All Vertebrate Brains
 Note: AH and BSNT
 AH and BSNT of mammal
brain have homologs in fish!
Figure 3. Evidence for homologies by hodology. Sagittal view of the projection
patterns of a social decision-making circuit are presented for each major
vertebrate lineage. Arrows imply directionality of the connection. Brain regions
within the social behavior network are colored yellow, brain regions in the
mesolimbic reward system are colored blue, and brain regions shared by both
networks are colored green.
The Journal of Comparative Neurology Volume 519, Issue 18, pages 3599-3639, 17 OCT 2011 DOI: 0.1002/cne.22735
http://onlinelibrary.wiley.com/doi/10.1002/cne.22735/full#fig3

37. Do We Learn Our Core Sexuality?
“Sexuality-at-Birth”
Theory
“Organization-Activation Mechanism”
-Evolutionary view
-Began challenging Money when only
grad student
“Psychosexual
Neutrality-at-Birth”
Theory
“Optimal Gender of Rearing policy”
-Requires conventional genitalia
-Requires patient deception about
sexual status at birth
John Money Milton Diamond

38. David Reimer Story
(“John-Joan” Case)

39. Phall-O-Meter
 Only an Adam or an Eve
 Never both, or neither, or in between

40. Sexuality of Intersex People
 Consistent with prenatal hormonal hypothesis
– CAIS: female sexual identity
– PAIS: sexual identity unpredictable
– CAH: majority are heterosexual women but
incidence of bisexual and lesbian orientations is
above controls and correlates with degree of
prenatal androgenization
– Cloacal exstrophy: genetically and hormonally
male-born children may identify as males despite
being raised as females and undergoing
feminizing genitoplasty at birth

41. Cloacal Exstrophy
Reiner, William G. and Gearhart, John P. Discordant Sexual
Identity in Some Genetic Males with Cloacal Exstrophy Assigned
to Female Sex at Birth. THE NEW ENGLAND JOURNAL OF
MEDICINE, 350:333-341 (2004)

42. Biology of Gender Identity
Fa'afafine
A broadly accepted social class in Samoa

43. Bed Nucleus of the Stria Terminalis (BNST)
Figure 2: Representative sections of the BNSTc innervated by vasoactive intestinal polypeptide
(VIP). A: heterosexual man; B: heterosexual woman; C: homosexual man; D: male-to-female
transsexual. Bar=0.5 mm. LV: lateral ventricle. Note there are two parts of the BST in A and
B: small sized medial subdivision (BNSTm), and large oval-sized central subdivision (BSTc)
 Necessary for sexual behavior in animals
 Size of BNST - not influenced by sex hormones in
adulthood
 Connects amygdala with anterior hypothalamus

44.  Male-to-female transsexual has
BNSTc in the female range
 S7: male, lifelong female
identity, never “treated”- within
female range
 FMT: number of neurons is fully
within the male range
2nd Study on BNST
Heterosexual Male Heterosexual Female
Homosexual Male Male-to-female Transsexual

45. Genetics of Transsexuality
 MtF – linked with longer version of
gene for androgen receptor that
weakens testosterone effect
 FtM - linked with gene variant for
an enzyme that causes higher
concentrations of androgens and
estrogen in developing brain

46. Biology of Sexual Orientation

47. Third Interstitial Nucleus
of Anterior Hypothalamus
INAH3

48. More Evidence For Innate Gayness
 2nd human study
confirmed INAH3
finding
 Gay sheep brains
– About 8% of rams
are exclusively
homosexual
– “Duplicated” human
INAH3 results

49. Anterior Hypothalamus Is
Activated by Sex Pheromones
 Positron emission tomography
(PET scans) of anterior
hypothalamus while subjects
smell sex pheromones
 Heterosexual – activated by sex
pheromones of other sex
 Homosexual – activated by sex
pheromones of same sex
AND = progesterone derivative 4,16-androstadien-3-one
EST = estrogen-like steroid estra-1,3,5(10),16-tetraen-3-ol
Subject
Activation of
anterior
hypothalamus
Heterosexual
males
EST
Homosexual
males
AND
Heterosexual
females
AND
Homosexual
females
EST

50. Genetics of Gayness/Lesbianism
 Evidence for genetic markers for gay
men and their gay brothers in the Xq28
region on the X chromosome
 Findings are consistent with a genetic
hypothesis for lesbianism
– Lesbians had significantly higher rates of lesbian sisters,
daughters, and cousins through a paternal uncle than did
heterosexual women
– Increasing rates of concordance of lesbianism from
nonidentical twins to identical twin pairs
– But lesbianism is not associated with the locus at Xq28
 Epigenetic mechanism also
hypothesized for sexual orientation

51. Summary of the Science
 “…gender identity and sexual orientation are
programmed or organized into our brain
structures when we are still in the womb”
 “…since sexual differentiation of the genitals
takes place in the first two months of pregnancy
and sexual differentiation of the brain starts in the
second half of pregnancy, these two processes
can be influenced independently, which may
result in extreme cases in transsexuality.”
 “This also means that in the event of ambiguous
sex at birth, the degree of masculinization of the
genitals may not reflect the degree of
masculinization of the brain.”
 “There is no indication that social environment
after birth has an effect on gender identity or
sexual orientation”

52. Medical Malpractice Against
LGBTI People
 The medical profession has pathologized
and stigmatized LGBTI people
 Medical policy has been to “fix” LGBTI
people - attempting to make them conform
to the gender binary

53. Medical Malpractice Against
Gay People
 Methods used in attempt
to change sexual orientation
– Hormonal treatments
 Castration
 Administration of
testosterone or estrogen
– Psychoanalysis
– Vomiting induced in combination with homo-erotic pictures
– Psychosurgery (hypothalamic lesioning)
– Electroshock treatment
– Chemical induction of epileptic insults
Alan Turing

54. Stonewall
Riots
(1969)

55. Frank Kameny & Barbara Gittings
Father And Mother of the LGBT Civil Rights Movement
In 1970 a group of thirty
gay activists led by Frank
Kameny and Barbara
Gittings broke into the
American Psychiatric
Association meeting in
Washington and turned
the staid proceedings into
chaos, with Kameny
shouting: “We are here to
denounce your authority
to call us sick or mentally
disordered!”

56. 1972 APA Meeting
Panel of psychiatrists to discuss homosexuality titled
“Psychiatry: Friend or Foe to Homosexuals: A Dialogue”
‘Dr. Anonymous’ is John E. Fryer
Gittings, Kameny, & Dr. Anonymous

57. Medical Malpractice Against
Gay People

58. New head of
World Psychiatric
Association has
come out as gay
 Says that psychiatry should apologize for the
harm done to gay and bisexual people
 Has vowed to fight reparative therapy and
the notion that still prevails throughout much
of the world that homosexuality is an illness.
Professor Dinesh Bhugra

59. “Reparative Therapy”
by Quacks Continues
 Therapy involves “…counseling to acting out
scenarios to in some cases shock treatment”
 American Psychological Association has reported that efforts
to change a person’s sexual orientation not only don’t work
but cause harm (loss of sexual feeling, depression, anxiety,
and suicidality)

60. Trans Activists
Confront the APA
Kelley Winters
at 2009 Annual APA Meeting
Requested that the APA
(1) “affirm in public policy statements that gender
identity and expression which differ from assigned birth
sex do not in themselves constitute mental disorder….”
(2) release “a statement clarifying the medical necessity
of hormonal and surgical transition treatments for those
who suffer distress with physical sex characteristics that
are incongruent with our gender identities,” and
(3) “encourage legal and social recognition of all people
consistent with our gender identity and expression.

61. Medical Malpractice Against
Trans People

62. Trans Activists’
Efforts Rewarded in
DSM-5
 Gender Identity Disorder has
been renamed
Gender Dysphoria
– Gender nonconformity itself is no longer a
mental disorder―just the clinically significant
distress associated with the condition
– New title is less pathologizing and
emphasizes the importance of distress about
the incongruity for a diagnosis
– The work group claimed that it didn’t remove
the condition as a psychiatric diagnosis, as
many activists had suggested, because to do
so would jeopardize access to medical care
– Has “exit clause” - cured by surgery on
genitalia and other nonbrain body parts!
Released May 2013

63. Canada Clinic Suspends Conversion
Therapy Services (March 2015)
Dr. Kenneth Zucker
"Gender Identity Service“
Center for Addiction and Mental Health
Toronto
Lynn Conway
Professor of Electrical Engineering and
Computer Science, Emerita
University of Michigan, Ann Arbor, Michigan
Member, National Academy of Engineering
versus
http://www.hrc.org/blog/entry/camh-suspends-conversion-therapy-services

64. Medical Malpractice Against
Intersex People
 “The basic problems faced by the
intersexed are socio-cultural in nature
and not medical and are a result of the
dogmatic fundamentalism inherent in
the current binary construct of sex and
gender”
 “Some intersexed individuals are
subjected to genital mutilation in
childhood as a result of this totalitarian,
sexist oppression”
 “Informed consent?”
 “First, do no harm?”
Curtis Hinkle
Founder:
Organization Intersex
International

65. Intersex Activists
Confront the AAP
 “…early surgical intervention leads to
more than ‘just’ physical scars and
sexual dysfunction”
 Lack of education and counseling for
intersexuals, their families, and the
community at large “does not lead to a
blissful, healthy, well-adjusted
ignorance. Rather, it too often leads to
a life-threatening shroud of silence,
secrecy, and self-hatred.”
 The AAP ignored the letter’s request
that representatives meet with the
activists, instead releasing a press
statement summarizing their John
Money–inspired medical policy for
intersex treatment
Max Beck
and
“Hermaphrodites With Attitude”
Boston, 1996

66. Genital “Normalization” Surgery - Dismal Outcomes
Researchers never asked: What if we did nothing?

67. Standards of Pediatric “Care”Diamond, M. Sex, gender, and identity over the years: a changing perspective Child And Adolescent Psychiatric Clinics Of North America 13:591-607 (2004).

68. Intersex Erasure
 New pathologizing terminology (DSD)
– AAP ignored the wish of intersex activists to be designated as
“intersex”
– In 2006 instead devised “Disorders of Sexual Development”
 Intimidation of patients to accept one-size-fits-all
treatments
– Testosterone treatment for XXY patients to make them into “Adams”―even for
those who don’t feel male or who like their bodies the way they are
– These treatments often change the patients’ bodies in ways they abhor
 Prenatal “intervention”
– Selective abortion
– Hormone treatment of fetus
(dexamethasone to prevent virilization in CAH)
 “Gender Dysphoria in DSD”
– DSM-5 includes a new form of craziness
– For intersex people who are unhappy with the gender assigned to them at birth!

69. Intersex in
Every Cell
 Four “transcriptional sexes” in
PBMC*
– XX/no T (female)
– XY/T (male)
– XX/T (intersex)
– XY/no T (intersex)
 157 genes of PBMC
expressed differently in males
vs. females
– Sex chromosome programming of 11 genes
– Androgen-dependent programming of 146
genes (not affected by circulating hormones)
 Intersex people have ‘intersex
physiology’ in every cell of
their bodies and thus have
their own health issues
*PBMC = peripheral blood mononuclear cells
Holterhus P-M, Bebermeier J-H, Werner R, Demeter J, Richter-Unruh A, Cario G,
Appari M, Siebert R, Riepe F, Brooks JD, Hiort O. Disorders of sex development
expose transcriptional autonomy of genetic sex and androgen-programmed
hormonal sex in human blood leukocytes BMC GENOMICS 10:292 (2009)

70. The Right to Your Own Body!
 On Human Rights Day 2013, Hida Viloria explained to
the United Nations that it’s very easy to discriminate
against intersex people because they are closeted.
“That’s why even though intersex is 1.7% of the population, as common
as having red hair, you don’t all know that you know an intersex person.
And the stigma against us is so great that right now―everyday, today, in
New York, in San Francisco, in the most liberal western cities in the
world―we are being cut up. Our bodies are being decimated to remove
our traits, and the discrimination is that great that it’s considered better
to do this to a baby than to let them have an intersex body.”
https://www.unfe.org/en/actions/human-rights-day-round-up
 In January 2014, The United Nations condemned
medically unnecessary normalizing procedures, such
as irreversible genital surgeries, saying evidence has
shown the procedures may be physically and
psychologically harmful, and infants and young
individuals cannot consent to them
Hida Viloria
President
American Chapter
International Intersex
Organization

71. Historic Lawsuit Against the
State of South Carolina
Pam and Mark Crawford, adoptive parents, and intersex child M.C.
His adoptive mother said, “By performing this needless surgery, the state and the doctors told M.C. that he
was not acceptable or loveable the way he was born. They disfigured him because they could not accept
him for who he was —not because he needed any surgery.”

72. Reform LGBTI Medical Care!
 Scientific message that “core sexuality is
innate” needs to reach everyone
 LGBTI people are natural variations -
different, but not disordered!
 Health and happiness of LGBTI patients
must be medical goal
 Healthcare providers must be educated
and given sensitivity training about
LGBTI people
 Ethical guidelines for medical treatment
of LGBTI people must be established

73. Medical policy
should be based on
scientific evidence and
ethical principles
- NOT religious myth!