In this context Dr. Murphy expressed his opinion that there is no
good theory on why Trans-sexuality happens. Many of the clearly
incorrect reasons he listed have also been proposed as causes for
homosexuality and cross-dressing. The only view Dr. Murphy presently
finds interesting is based on a recent article in the Journal of
Clinical Endocrinology.
In this article, post-mortem studies of brain structure suggested
that transsexual identification may have physical, genetic origins. Dr.
Murphy reproduced slides from the paper comparing a structure called the
stria terminalis in a normal heterosexual man, a gay man,
a normal woman and a male-to-female transsexual. The structures were the
same in the heterosexual man and the gay man. The female and M-T-F
transsexual also had comparable structures clearly different in size and
shape from the straight and gay men. When asked whether hormones could
have caused the brain structure to develop differently Dr. Murphy
mentioned that the stria of a man who suffered from an
estrogen producing tumor was comparable with those of the heterosexual
and gay men. Dr. Murphy emphasized that the number of cases examined was
far too small for study to be considered anything but speculative.
In further discussion of the DSM criteria, Dr. Murphy noted the
importance of the item on significant Disorder or Impairment. He pointed
out that in clinical practice doctors only see the people with
depression and other major problems. A person who has all the criteria
except a clinically significant Disorder or Impairment isn’t likely to
be seeking medical help and may have trouble getting it. This remark is
consistent with those of Candice Risen from UH that having some kind of
dysfunction in life identified is essential to getting insurance to
cover counseling in matters of sexuality, gender identity and similar
issues.
In response to a question Dr. Murphy noted that while there have been
some studies in which the various degrees of reassignment (hormones and
surgery) have been found to be ineffective, taken as a whole favorable
studies outnumber unfavorable. In Dr. Murphy’s 15 years of
professional experience, when a patient’s life is affected by
depression or other clinical disorder or impairment, reassignment is the
only therapy which provides a significant chance of providing a positive
outcome and allowing the patient the opportunity to live a normal life.
In response to another question, Dr. Murphy noted that about 85% of
transsexuals were male-to-female, while 15% were female-to-male. Other
topics presented included a detailed discussion of the what hormones
would and would not do, side effects, and the details of sexual
reassignment surgery.
