Friday, 22 May 2009
A letter I recently received from Dr Ecker, to whom many thanks:
Hi Zoe,
Yes, we gave our presentation to 60 plus psychiatrists from the
US, AU, FR, IT, EU, UK, Holland etc.
We spoke for 2 1/2 hours on why cross gender identity was a normal
inherited variation of humans. We showed how Transgender Brains think,
smell, and hear like the opposite sex. We presented internationally
accepted guidelines for hormonal treatment of transsexuals to be
published Summer 2009.
Here are my slides and with my participants' permission I shall
send you theirs. We are now in print in the APA Syllabus and soon in
the APA Journal this summer. I am checking if we were recorded.
My greatest personal compliment came from Frank Kruijver, from
Holland, whose research of the human brain in TSs started it all. He
thought we have taken his work very far in our understanding of the
human brain. Hope you can do something with this. Sid Ecker, M.D.
I will indeed endeavour to "do something with this".
Starting with publishing it, broadcasting it as far and as wide as I
can. This stuff needs to be known.
Dr Ecker is not a psychiatrist, he's a urologist, with very extensive
clinical experience in observing the effects of hormonal treatment of
a variety of patients, transsexual and otherwise. He has no particular
axe to grind, but he has seen so much misinformation, he wants to set
the record straight. To put some Science into the issue.
As the e-mail states, Dr Ecker was invited to give a presentation to
the American Psychiatric Association as part of a seminar at their
annual meeting. From their letter to him:
Symposium Title: The Neurobiological Evidence for Transgenderism
EDUCATIONAL OBJECTIVES:
The participants shall learn the current definitions of
Transgenderism, Gender Identity, Gender Expression, Gender Role
Behavior, Gender Dysphoria and Transsexualism and understand the
Standards of Care (WPATH) for treatment. The neurobiological evidence
for gender differences in the human brain and genetic inheritability
of Transsexualism will be presented. Current US medical practices in
the Treatment of GID in children, adolescents and adults will be
discussed.
SYMPOSIUM ABSTRACT:
The topic of Gender Identity Disorder is one of great controversy
in the world because of the diametrically opposite approach of
treatment advocated in different medical centers. The prevalence and
incidence of Transgenderism, which reflects the thinking and behavior
of the opposite genetic sex, cannot be known because the non-dysphoric
patient does not present for medical care for a multiplicity of
reasons. What we can estimate and understand is the mild to severely
dysphoric patient who seeks medical attention and is given a diagnosis
of Gender Identity Disorder under DSM-IV-TR. The panel shall present
the current scientific literature pertinent to our understanding of
the concept of a male, female or transgender brain. They shall discuss
the current research undertaken with Transsexuals, which lends
evidence to genetic inheritance and biological causation. Finally they
shall discuss the appropriate medical care that can help bring the
patient’s physical being into congruency with their Brain Gender
Identity. While treatment in the form of surgery or cross-hormonal
medication has been denied to these individuals at certain prominent
medical centers, the number of patients seeking help has increased. As
more patients see the psychiatric community as a welcoming entity
listening to their concerns, instead of trying to reverse or repair
their Transgender thinking, they will be encouraged to allow
psychiatry to join in the multi-disciplinary treatment of their
condition.
Title of Presentation: Brain Gender Identity
Abstract:
Gender Identity is that innate sense of who you are in this world
with reference to your sexuality and behavior, not necessarily
corresponding to your genitalia and reproductive organs. Transgenders
are atypical and “think” as the opposite gender. Certain areas of the
brain have been shown to be sexually dimorphic. They are different in
structure and numbers of neurons in males versus females. Protein
Receptors for the sex hormones in different areas of the brain (limbic
and anterior hypothalamic) must be present in sufficient numbers to
receive those powerful hormones. There are androgen receptors (AR),
Estrogen Receptors (ER), and Progesterone receptors (PRs). ARs or ERs
are predominant at different times in different parts of the human
brain. Hormone receptor genes have been identified in humans, which
are responsible for sexually dimorphic brain differentiation in the
hypothalamus. The groundwork in brain gender identity is gene-directed
and takes place by forming male and female hormone receptors in the
brain before the gonads and hormones can influence them. Multiple
genes acting in concert determine our sexual identity. The human brain
continues to make neurons and synaptic neuronal connections throughout
life. This contributes to Gender Role Behaviors making individuals in
the continuum of gender identity. Gender behaviors must be
differentiated from gender identity (Hines). Gender Identity cannot be
predicted from anatomy (Reiner). Brain gender identity is determined
very early in fetal development, but gender expression, expressed as
behaviors requires hormonal, environmental, social and cultural
interactions, which evolve with time. One cannot deny the profound
effects of Testosterone, Estradiol and other steroids on genital
differentiation in-utero or their effects on behavior from birth or
the physical and mental cross gender changes caused by exogenous
hormones, but gender identity is determined before and persists in
spite of these effects.
References:
1.DF Swaab, WC Chung, FP Kruijver, MA Hofman, TA Ishunina
Structural and functional sex differences in the human hypothalamus
Horm Behav. Sep, 2001; 40(2): 93-8. Review
2. DF Swaab
Sexual differentiation of the human brain: relevance for gender
identity, transsexualism and sexual orientation
Gynecol Endocrinol. Dec, 2004; 19(6): 301-12. Review.
3.IE Sommer, PT Cohen-Kettenis, T van Raalten, AJ Vd Veer, LE
Ramsey, LJ Gooren, RS Kahn, NF Ramsey
Effects of cross-sex hormones on cerebral activation during
language and mental rotation: An fMRI study in transsexuals
Eur Neuropsychopharmaco l. Mar 2008; 18(3): 215-21.
4.H Berglund, P Lindstrom, C Dhejne-Helmy, I Savic
Male to female transsexuals show sex-atypical hypothalamus
activation when smelling odorous steroids
Cereb Cortex. Aug 2008; 18(8): 1900-8.
A more complete list of his references is in this PDF file
http://cs.anu. edu.au/~Zoe. Brain/BGI REF 3.pdf.
Now onto the powerpoint presentation itself: Brain Gender Identity
mirrored at http://cs.anu. edu.au/~Zoe. Brain/BGI 3.3.2.ppt
I'll quote the first slide:
Most of our information on the Neurobiology of sex comes from
animal studies (Becker et al., 2005), but nearly all of what we know
about variations in human sexuality, including hetero- and
homo-sexuality, and disorders of gender identity (transsexualism)
comes from clinical material, anecdotes or even fiction (the three
overlap).
Herbert, J., (Brain, 2008)
And one of his meticulously reasoned conclusions, led to inescapably
by the biology of foetal and post-birth neural development:
Brain gender identity is determined very early in fetal
development, but gender expression, expressed as behaviors requires
hormonal, environmental, social and cultural interactions which evolve
with time.
The Logic is immaculate, the conclusions obvious when presented so clearly.
While there are still pieces of the puzzle missing, and many details
still to be determined, Dr Ecker has solved it - we now have the Big
Picture, incomplete, but still recognisable. All the things I had
observed and deduced had to be true on the basis of external
observation, Dr Ecker now shows the chain of causality, what happens
and when.
His exposition of the biology might even give me some clues as to my
own anomalous situation, which genes and which proteins to look at -
but this is of secondary interest to me. It's why I got into all this,
but now I'm in, it's others I'm more concerned about.
Dr Ecker's first communication with me on the first of March
follows:
Hi Zoe,
My name is Dr. Sidney W. Ecker, M.D., F.A.C.S. and it appears that
I have made it to your informative blog. I would ask you to stay tuned
for my Symposium at the American Psychiatric Association' s 2009 Annual
meeting in May as my abstracts and presentation is their property for
publication at the moment.
http://pn.psychiatr yonline.org/ cgi/content/ full/44/4/ 8
S10. The Neurobiological Evidence for Transgenderism
1. Brain Gender Identity Sidney W. Ecker, M.D.
2. Transsexuality as an Intersex Condition Milton Diamond, Ph.D.
3. Novel Approaches to Endocrine Treatment of Transgender
Adolescents and Adults Norman Spack, M.D.
What I am trying to do is to logically sequence the scientific
evidence to date that you quote and put it into an understandable form
for my peers and eventually the public. My current Reference list for
Brain Gender Identity is attached. This is certainly not "dogma" as
Dr. Zucker claims, but like you I possess the ability and education to
understand (biological) science. As a Urologist with a specific
interest and expertise in Prostate Cancer, I have administered DES,
Estrogens, LHRH agonists and Androgen Blockers to thousands of men for
PCa. I make the analogy that these men voluntarily took female
hormones to improve the quality of their lives much the same way
TransWomen do. Do you need to fear death or be suicidal to take
cross-gender hormones? Emphatically, No! Will they prevent eventual
death in either scenario? No!!
After the meeting I shall send you my PowerPoint Presentation, but
I must keep my powder dry for the moment.
You may publish my reference list, but I can't imagine anyone
could access all these articles as I have from the National Library of
Medicine's Reading Room. So we'll just have to wait to hear from the
opposition and peer review.
Thanks for your Web blog.
Sid Ecker
Thank you, Dr Ecker. I'll help as much as I can.
http://aebrain. blogspot. com/2009/ 05/brain- gender-identity- presentation- by.html
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