Wie viele Geschlechter gibt es und kann man sie wechseln?

Zusammenfassung

Die Aufteilung des Menschen in zwei Geschlechter wurde in jüngerer Vergangenheit kritisiert, da es keine genaue Grenze zwischen beiden Geschlechtern gebe und weil die Vorstellung von der Existenz zweier Geschlechter selbst das Ergebnis eines sozialen Konstruktionsprozesses sei. Daher sei Geschlecht etwas, was eine Person nur für sich bestimmen könne, folglich Transsexualität/Geschlechtsdysphorie keine psychische Störung und die Ansprüche der Betroffenen nach selbstbestimmter Wahl geschlechtsangleichender Maßnahmen legitim.

In der vorliegenden Arbeit wird die klassische Auffassung der Zweigeschlechtlichkeit durch die Fortpflanzungsfunktion begründet. Die Unterschiedlichkeit von Samen- und Eizelle (Anisogamie) hat weitreichende Konsequenzen für die Lebenswirklichkeit des Menschen und begründet geschlechtstypische Verhaltensneigungen und Geschlechtsrollen. Der aktuelle Begriff Geschlechtsidentität wird kritisiert und einem anderen Identitätskonzept, das therapeutische Anknüpfungspunkte bietet, gegenübergestellt. Ferner wird erläutert, wie sich die Kritik am klassischen Geschlechtsbegriff nachteilig für die Sexualwissenschaft sowie auch für die Therapie geschlechtsdysphorischer Menschen auswirkt. Die Annahme, dass eine Psychotherapie der Geschlechtsdysphorie unethisch ist, wird diskutiert und den Ergebnissen neuerer Katamnesestudien gegenübergestellt. Unter Berücksichtigung neurowissenschaftlicher Studien werden Vorschläge für eine neue psychotherapeutische Strategie gemacht.

Abstract

The classical view of two sexes is nowadays criticized on the basis that there may be no clear boundary between the two sexes and because the perception of two genders may be socially constructed. In consequence, a person’s determination of their own gender, de-pathologizing of transgenderism and self-determined demands for sex reassignment surgery are regarded as legitimate. This paper justifies the conceptualizing of two sexes with regard to their reproductive functions. Anisogamy has far-reaching consequences for sex-dimorphic lived realities, behavioral tendencies, and gender roles. We criticize the current understanding of gender identity and suggest a concept of identity that offers starting points for psychotherapy. We further argue that a non-binary view of sex has negative consequences for sex research and for the treatment of gender dysphoria. Based on outcome and neuroscientific studies, we discuss whether the psychotherapeutic treatment of gender dysphoria is unethical, oppose this view with newer catamnesis studies, and offer suggestions for new treatment strategies.

Schlüsselwörter

Geschlechtsdysphorie - Geschlechtsidentität - Geschlechtsinkongruenz - Geschlechtsrollen - Transgender

Key words

gender dysphoria - gender identity - gender incongruence - gender roles - transgender

• Literatur

• Abé C, Johansson E, Allzén E. et al. Sexual Orientation Related Differences in Cortical Thickness in Male Individuals. PLoS ONE 2014; 9: e114721
• [APA] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Washington, DC: APA; 2013
• Asscheman H, Giltay EJ, Megens JA. et al. Long-Term Follow-Up Study of Mortality in Transsexuals Receiving Treatment with Cross-Sex Hormones. Eur J Endocrinol 2011; 164: 635-642
• Bailey JM, Triea K. What Many Transgender Activists Don’t Want You to Know and Why You Should Know It Anyway. Perspekt Biol Med 2007; 50: 521-534
• Barlow DH, Reynolds EJ, Agras WS. Gender Identity Change in a Transsexual. Arch Gen Psychiatry 1973; 28: 569-576
• Benjamin H. The Transsexual Phenomenon. New York, NY: The Julian Press; 1966
• Berenbaum SA, Snyder E. Early Hormonal Influences on Childhood Sex-Typed Activity and Playmate Preferences: Implications for the Development of Sexual Orientation. Dev Psychol 1995; 31: 31-42
• Berglund H, Lindstrom P, Dhejne-Helmy C. et al. Male-to-Female Transsexuals Show Sex-Atypical Hypothalamus Activation When Smelling Odorous Steroids. Cereb Cortex 2008; 18: 1900-1908
• Besser M, Carr S, Cohen-Kettenis PT. et al. Atypical Gender Development – A Review. Int J Transgend 2006; 9: 29-44
• Blackless M, Charuvastra A, Derryck A. et al. How Sexually Dimorphic Are We? Review and Synthesis. Am J Hum Biol 2000; 12: 151-166
• Blanchard R. Typology of Male-to-Female Transsexualism. Arch Sex Behav 1985; 14: 247-261
• Blosnich JR, Brown GR, Wojcio S. et al. Mortality among Veterans with Transgender-Related Diagnoses in the Veterans Health Administration, FY2000–2009. LGBT Health 2014; 1: 269-276
• Bockting CL, ten Doesschate MC, Spijker J. et al. DELTA Study Group. Continuation and Maintenance Use of Antidepressants in Recurrent Depression. Psychother Psychosom 2008; 77: 17-26
• Bockting W. Psychotherapy and the Real-Life Experience: From Gender Dichotomy to Gender Diversity. Sexologies 2008; 17: 211-224
• Bryant K. Making Gender Identity Disorder of Childhood: Historical Lessons for Contemporary Debates. Sex Res Social Policy 2006; 3: 23-39
• Burke SM, Manzouri AH, Savic I. Structural Connections in the Brain in Relation to Gender Identity and Sexual Orientation. Sci Rep 2017; 7: 17954
• Buss DM. Evolutionary Psychology: The New Science of the Mind. 3rd Edition. Boston, MA: Pearson, Allyn and Bacon; 2008
• Buss DM, Schmitt DP. Evolutionary Psychology and Feminism. Sex Roles 2011; 64: 768-787
• Butler J. Das Unbehagen der Geschlechter. Frankfurt/M.: Suhrkamp; 1991
• Butler J. Kontingente Grundlagen: Der Feminismus und die Frage der ‚Postmoderne‘. In: Benhabib S, Butler J, Cornell D. et al. Der Streit um Differenz. Feminismus und Postmoderne in der Gegenwart. Frankfurt/M.: Fischer; 1993: 31-58
• Butterfield N. Bangiomorpha Pubescens n. gen., n. sp.: Implications for the Evolution of Sex, Multicellularity, and the Mesoproterozoic/Neoproterozoic Radiation of Eukaryotes. Paleobiology 2000; 26: 386-404
• Cavalier-Smith T. Origins of the Machinery of Recombination and Sex. Heredity 2002; 88: 125-141
• Chapais B. Primeval Kinship. How Pair-Bonding Gave Birth to Human Society. Cambridge, MA: Harvard University Press; 2008
• Chapman E, Baron-Cohen S, Auyeung B. et al. Fetal Testosterone and Empathy: Evidence from the Empathy Quotient (EQ) and the “Reading the Mind in the Eyes” Test. Soc Neurosci 2006; 1: 135-148
• Coleman E, Bockting W, Botzer M. et al. Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People, Version 7. Int J Transgend 2012; 13: 165-232
• Connellan J, Baron-Cohen S, Wheelwright S. et al. Sex Differences in Human Neonatal Social Perception. Infant Behav Dev 2000; 23: 113-118
• Craig AD. How Do You Feel--Now? The Anterior Insula and Human Awareness. Nat Rev Neurosci 2009; 10: 59-70
• Denny D. Changing Models of Transsexualism. Journal of Gay & Lesbian Psychotherapy 2004; 8: 25-40
• de Waal FBM. The Thief in the Mirror. PLoS Biol 2008; 6: e201
• [DGfS] Deutsche Gesellschaft für Sexualforschung. Geschlechtsinkongruenz, Geschlechtsdysphorie und Trans-Gesundheit: S3-Leitlinie zur Diagnostik, Beratung und Behandlung. Berlin: AWMF; 2018. [Als Online-Dokument: https://www.awmf.org/leitlinien/detail/ll/138–001.html ]
• Dhejne C, Lichtenstein P, Boman M. et al. Long-Term Follow-Up of Transsexual Persons Undergoing Sex Reassignment Surgery: Cohort Study in Sweden. PLoS ONE 2011; 6: e16885
• Dilling H. Internationale Klassifikation psychischer Störungen: ICD-10. Kapitel V (F). Bern: Huber; 2004
• Dreger AD. The Controversy Surrounding “The Man Who Would Be Queen”: A Case History of the Politics of Science, Identity, and Sex in the Internet Age. Arch Sex Behav 2008; 37: 366-421
• Drescher J. Queer Diagnoses Revisited: The Past and Future of Homosexuality and Gender Diagnoses in DSM and ICD. Int Rev Psychiatry 2015; 27: 386-395
• Falkai P, Wittchen HU. Das Diagnostische und Statistische Manual Psychischer Störungen (DSM-5). 2., korrigierte Auflage. Göttingen: Hogrefe; 2018
• Fausto-Sterling A. Sexing the Body: Gender Politics and the Construction of Sexuality. New York, NY: Basic Books; 2000
• Fenson L, Dale PS, Reznick JS. et al. Variability in Early Communicative Development. Monogr Soc Res Child Dev 1994; 59: 1-173 discussion 174–185
• Feusner JD, Dervisic J, Kosidou K. et al. Female-to-Male Transsexual Individuals Demonstrate Different Own Body Identification. Arch Sex Behav 2016; 45: 525-536
• Flor-Henry P. EEG Analysis of Male to Female Transsexuals: Discriminant Function and Source Analysis. Clin EEG Neurosci 2010; 41: 219-222
• Fraune J, Alsheimer M, Volff JN. et al. Hydra Meiosis Reveals Unexpected Conservation of Structural Synaptonemal Complex Proteins across Metazoans. Proc Natl Acad Sci U S A 2012; 109: 16588-16593
• Frisén L, Nordenström A, Falhammar H. et al. Gender Role Behavior, Sexuality, and Psychosocial Adaptation in Women with Congenital Adrenal Hyperplasia due to CYP21A2 Deficiency. Clin Endocrinol Metab 2009; 94: 3432-3439
• Gallop Jr. GG. Chimpanzees: Self-Recognition. Science 1970; 167: 86-87
• Garcia-Falgueras A, Swaab DF. A Sex Difference in the Hypothalamic Uncinate Nucleus: Relationship to Gender Identity. Brain 2008; 131: 3132-3146
• Gizewski ER, Krause E, Schlamann M. et al. Specific Cerebral Activation due to Visual Erotic Stimuli in Male-to-Female Transsexuals Compared with Male and Female Controls: An fMRI Study. J Sex Med 2009; 6: 440-448
• Green R, Newman LE, Stoller RJ. Treatment of Boyhood “Transsexualism”. Arch Gen Psychiatry 1972; 26: 213-217
• Groeben N, Westmeyer H. Kriterien psychologischer Forschung. München: Juventa; 1975
• Gurven M, Hill K. Why Do Men Hunt? A Reevaluation of “Man the Hunter” and the Sexual Division of Labor. Curr Anthropol 2009; 50: 51-74
• Hacking I. The Looping Effects of Human Kinds. In: Sperber D, Premack D, Premack A. Hrsg. Causal Cognition: A Multidisciplinary Debate. New York, NY: Oxford Clarendon; 1996: 351-383
• Hayes S, Strosahl K, Wilson K. Acceptance and Commitment Therapy. The Process and Practice of Mindful Change. New York, NY: Guilford Press; 2012
• Heylens G, De Cuypere G, Zucker KJ. et al. Gender Identity Disorder in Twins: A Review of the Case Report Literature. J Sex Med 2012; 9: 751-757
• Hidalgo A, Ehrensaft D, Tishelman A. et al. The Gender Affirmative Model: What We Know and What We Aim to Learn. Hum Dev 2013; 56: 285-290
• Hines M, Constantinescu M, Spencer D. Early Androgen Exposure and Human Gender Development. Biol Sex Differ 2015; 6: 3
• Hofstede G. Culture’s Consequences: Comparing Values, Behaviors, Institutions, and Organizations across Nations. 2nd Edition. Thousand Oaks, CA: Sage; 2001
• Hulshoff Pol HE, Schnack HG, Posthuma D. et al. Genetic Contributions to Human Brain Morphology and Intelligence. J Neurosci 2006; 26: 10235-10242
• Jokela J, Dybdahl MF, Lively CM. The Maintenance of Sex, Clonal Dynamics, and Host-Parasite Coevolution in a Mixed Population of Sexual and Asexual Snails. Am Nat 2009; 174 (Suppl. 01) S43-S53
• Knickmeyer R, Baron-Cohen S, Raggatt P. et al. Fetal Testosterone and Empathy. Horm Behav 2006; 49: 282-292
• Kranz GS, Hahn A, Kaufmann U. et al. White Matter Microstructure in Transsexuals and Controls Investigated by Diffusion Tensor Imaging. J Neurosci 2014; 34: 15466-15475
• Kruijver FP, Zhou JN, Pool CW. et al. Male-to-Female Transsexuals Have Female Neuron Numbers in a Limbic Nucleus. Journal Clin Endocrinol Metabol 2000; 85: 2034-2041
• Kuhn A, Bodmer C, Stadlmayr W. et al. Quality of Life 15 Years after Sex Reassignment Surgery for Transsexualism. Fertil Steril 2009; 92: 1685-1689.e3
• Lawrence AA. Societal Individualism Predicts Prevalence of Nonhomosexual Orientation in Male-to-Female Transsexualism. Arch Sex Behav 2010; 39: 573-583
• Lev AI. Disordering Gender Identity: Gender Identity Disorder in the DSM-IV-TR. J Psychol Human Sex 2005; 17: 35-69
• LeVay S. A Difference in Hypothalamic Structure between Heterosexual and Homosexual Men. Science 1991; 253: 1034-1037
• Levita DJde. Der Begriff der Identität. Gießen: Psychosozial; 2002
• Li G, Kung KT, Hines M. Childhood Gender-Typed Behavior and Adolescent Sexual Orientation: A Longitudinal Population-Based Study. Dev Psychol 2017; 53: 764-777
• Lippa RA. Some Psychometric Characteristics of Gender Diagnosticity Measures: Reliability, Validity, Consistency across Domains, and Relationship to the Big Five. J Pers Soc Psychol 1991; 61: 1000-1011
• Lippa RA. Gender-Related Individual Differences and the Structure of Vocational Interests: The Importance of the People-Things Dimension. J Pers Soc Psychol 1998; 74: 996-1009
• Lippa RA. Gender-Related Traits in Gay Men, Lesbian Women, and Heterosexual Men and Women: The Virtual Identity of Homosexual-Heterosexual Diagnosticity and Gender Diagnosticity. J Pers 2000; 68: 899-926
• Lippa RA, Tan FD. Does Culture Moderate the Relationship between Sexual Orientation and Gender-Related Personality Traits?. Cross Cult Res 2001; 35: 65-87
• Luders E, Sanchez FJ, Gaser C. et al. Regional Gray Matter Variation in Male-to-Female Transsexualism. Neuroimage 2009; 46: 904-907
• Lutchmaya S, Baron-Cohen S, Raggatt P. Foetal Testosterone and Eye Contact in 12-Month-Old Human Infants. Infant Behav Dev 2002; 25: 327-335
• Mac Giolla E, Kajonius PJ. Sex Differences in Personality Are Larger in Gender Equal Countries: Replicating and Extending a Surprising Finding. Int J Psychol. 2018 doi: 10.1002/ijop.12529
• Manzouri A, Kosidou K, Savic I. Anatomical and Functional Findings in Female-to-Male Transsexuals: Testing a New Hypothesis. Cereb Cortex 2015; 27: 998-1010
• Manzouri A, Savic I. Cerebral Sex Dimorphism and Sexual Orientation. Hum Brain Mapp 2018; a; 39: 1175-1186
• Manzouri A, Savic I. Possible Neurobiological Underpinnings of Homosexuality and Gender Dysphoria. Cereb Cortex 2018; b; 29: 2084-101
• Marks I, Gelder M, Bancroft J. Sexual Deviants Two Years after Electric Aversion. Br J Psychiatry 1970; 117: 173-185
• [MDS] Medizinischer Dienst des Spitzenverbandes Bund der Krankenkassen e. V.. Hrsg. Grundlagen der Begutachtung. Begutachtungsanleitung. Geschlechtsangleichende Maßnahmen bei Transsexualität. [Als Online-Dokument: https://www.mds-ev.de/fileadmin/dokumente/Publikatio​nen/​GKV/Begutachtungsgrundlagen_GKV/07_RL_Transsex_2009.pdf ]
• Meißner H. Die soziale Konstruktion von Geschlecht – Erkenntnisperspektiven und gesellschaftstheoretische Fragen. Gender Politik Online: Freie Universität Berlin; 2008. [Als Online-Dokument: https://www.fu-berlin.de/sites/gpo/soz_eth/Geschlecht_als_Kategorie/Die_soziale_Konstruktion_von_Geschlecht_____Erkenntnisperspektiven_und_gesellschaftstheoretische_Fragen/index.html ]
• Meyer-Bahlburg HF. From Mental Disorder to Iatrogenic Hypogonadism: Dilemmas in Conceptualizing Gender Identity Variants as Psychiatric Conditions. Arch Sex Behav 2010; 39: 461-476
• Money J. Gender Role, Gender Identity, Core Gender Identity: Usage and Definition of Terms. J Am Acad Psychoanal 1973; 1: 397-402
• Mustanski BS, Chivers ML, Bailey JM. A Critical Review of Recent Biological Research on Human Sexual Orientation. Annu Rev Sex Res 2002; 13: 89-140
• Nawata H, Ogomori K, Tanaka M. et al. Regional Cerebral Blood Flow Changes in Female to Male Gender Identity Disorder. Psychiatry Clin Neurosci 2010; 64: 157-161
• Pauly IB. Male Psychosexual Inversion: Transsexualism: A Review of 100 Cases. Arch Gen Psychiatry 1965; 13: 172-181
• Ponseti J, Siebner HR, Klöppel S. et al. Homosexual Women Have Less Grey Matter in Perirhinal Cortex than Heterosexual Women. PLoS ONE 2007; 2: e762
• Puts DA, McDaniel MA, Jordan CL. et al. Spatial Ability and Prenatal Androgens: Meta-Analyses of Congenital Adrenal Hyperplasia and Digit Ratio (2 D:4 D) Studies. Arch Sex Behav 2008; 37: 100-111
• Pyne J. The Governance of Gender Non-Conforming Children: A Dangerous Enclosure. Annu Rev Crit Psychol 2014; 11: 79-96
• Rahman Q. The Neurodevelopment of Human Sexual Orientation. Neurosci Biobehav Rev 2005; 29: 1057-1066
• Rametti G, Carrillo B, Gómez-Gil E. et al. White Matter Microstructure in Female to Male Transsexuals before Cross-Sex Hormonal Treatment. A Diffusion Tensor Imaging Study. J Psychiatr Res 2011; a; 45: 199-204
• Rametti G, Carrillo B, Gómez-Gil E. et al. The Microstructure of White Matter in Male to Female Transsexuals before Cross-Sex Hormonal Treatment. A DTI Study. J Psychiatr Res 2011; b; 45: 949-954
• Rekers GA, Lovaas OI, Low B. The Behavioral Treatment of a “Transsexual” Preadolescent Boy. J Abnorm Child Pychol 1974; 2: 99-116
• Richards C, Bouman WP, Seal L. et al. Non-Binary or Genderqueer Genders. Int Rev Psychiatry 2016; 28: 95-102
• Savic I, Arver S. Sex Dimorphism of the Brain in Male-to-Female Transsexuals. Cereb Cortex 2011; 21: 2525-2533
• Schmitt DP. Sociosexuality from Argentina to Zimbabwe: A 48-Nation Study of Sex, Culture, and Strategies of Human Mating. Behav Brain Sci 2005; 28: 247-275
• Schöning S, Engelien A, Bauer C. et al. Neuroimaging Differences in Spatial Cognition between Men and Male-to-Female Transsexuals before and during Hormone Therapy. J Sex Med 2010; 7: 1858-1867
• Sigusch V. The Neosexual Revolution. Arch Sex Behav 1998; 27: 331-359
• Simonsen RK, Giraldi A, Kristensen E. et al. Long-Term Follow-Up of Individuals Undergoing Sex Reassignment Surgery: Psychiatric Morbidity and Mortality. Nord J Psychiatry 2016; a; 70: 241-247
• Simonsen RK, Hald GM, Kristensen E. et al. Long-Term Follow-Up of Individuals Undergoing Sex-Reassignment Surgery: Somatic Morbidity and Cause of Death. Sex Med 2016; b; 4: e60-68
• Smith YL, van Goozen SH, Kuiper AJ. et al. Transsexual Subtypes: Clinical and Theoretical Significance. Psychiatry Res 2005; 137: 151-160
• Steensma TD, Kreukels BP, de Vries AL. et al. Gender Identity Development in Adolescence. Horm Behav 2013; 64: 288-297
• Stoet G, Geary DC. The Gender-Equality Paradox in Science, Technology, Engineering, and Mathematics Education. Psychol Sci 2018; 29: 581-593
• Thornton J, Zehr JL, Loose MD. Effects of Prenatal Androgens on Rhesus Monkeys: A Model System to Explore the Organizational Hypothesis in Primates. Horm Behav 2009; 55: 633-645
• Trivers RL. Parental Investment and Sexual Selection. In: Campell B. Hrsg. Sexual Selection and the Descent of Man: 1871–1971. Chicago, IL: Aldine; 1972: 136-179
• van Anders SM, Hampson E. Testing the Prenatal Androgen Hypothesis: Measuring Digit Ratios, Sexual Orientation, and Spatial Abilities in Adults. Horm Behav 2005; 47: 92-98
• Victora CG, Bahl R, Barros AJ. et al. Lancet Breastfeeding Series Group. Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Effect. Lancet 2016; 387: 475-490
• Voß HJ. Biologisch gibt es viele Geschlechter. kultur & geschlecht 2010; a; 6: 1-7
• Voß HJ. ›Natürlich‹ gibt es kein Geschlecht – Von Theorien der Differenz und Gleichheit zweier Geschlechter hin zu vielen Geschlechtern. Argument 2010; b; 287: 386-395
• Wente M. Kids Pay the Price of Transgender Politics. The Globe and Mail. 19.01.2016 [Als Online-Dokumnt: https://www.theglobeandmail.com/opinion/kids-pay-the-price-of-transgender-politics/article28250068/ ]
• Werkmeister W. Basis and Structure of Knowledge. London: Greenwood Press; 1968
• West C, Zimmerman D. Doing Gender. Gend Soc 1987; 1: 125-151
• Whitam F. A Cross-Cultural Perspective on Homosexuality, Transvestism, and Trans-Sexualism. In: Wilson GD. Hrsg. Variant Sexuality: Research and Theory. Baltimore, MD: Johns Hopkins University Press; 1987: 176-201
• [WHO] World Health Organisation. ICD-11. International Classification of Diseases 11th Revision. Genf: WHO; 2018. [Als Online-Dokument: https://icd.who.int/en/ ]
• Winter S, Chalungsooth P, Teh YK. et al. Transpeople, Transprejudice and Pathologization: A Seven-Country Factor Analytic Study. Int J Sex Health 2009; 21: 96-118
• Zhou JN, Hofman MA, Gooren LJ. et al. A Sex Difference in the Human Brain and Its Relation to Transsexuality. Nature 1995; 378: 68-70
• Zubiaurre-Elorza L, Junque C, Gómez-Gil E. et al. Cortical Thickness in Untreated Transsexuals. Cereb Cortex 2013; 23: 2855-2862
• Zucker KJ, Wood H, Singh D. et al. A Developmental, Biopsychosocial Model for the Treatment of Children with Gender Identity Disorder. J Homosex 2012; 59: 369-397