Medicine
The sex-change hoax John Linklater
The transvestite male is usually satisfied by wearing female clothing at intervals, whilst maintaining a clear inner concept of his own male identity, but transvestism presents a continuous spectrum of varying degrees of deviation from strict normality. At one end we find the young man who is amused to dress himself up as a woman, for a joke, with virtually no sexual association. We then find the more extreme examples of transvestism in which intermittent disguise is necessary in order to achieve sexual satisfaction and, finally, the most severe cases in which the transvestite seeks to undergo surgical metamorphosis by having his external genitalia removed, becoming a eunuch and permanently adopting a female role.
A number of such "sex change" operations have been performed in recent years and the patient has subsequently been registered as a woman, notwithstanding that he remains a man without genitalia. The sex of an individual is irrevocally fixed at the moment of conception when a paternal sperm fuses with the maternal ovum. All ova contain an X chromosome, while spermatozoa are equally divided into those which carry an X chromosome and those which carry a Y chromosome.
If the successful sperm carries an X chromosome, the child has an XX constitution and is female but, if the sperm is a Y sperm, fusion produces an XY male. Every cell of the new individual's body is derived from the first cell so produced, and carries the same chromosomes. The difference between the sexes is therefore fundamental, and extends to the most minute and intimate parts of the structure and function. Plastic surgery is thus unable to change sex, and it is a curious flaw of logic which appears to allow the law to recognise a change where none exists.
Transvestism is the product of a psychological hangup, probably in early infancy, and is therefore related to homosexuality and other sexual deviations, but is not related to physical constitution. However much we may sympathise with the transvestite in his dilemma, nothing can alter the fact that every cell in his body contains the XY pattern. Surgery can only alter the superficial appearance, and chemotherapy, by drenching the tissues with large continuous doses of stilboestrol or other synthetic female hormones, can only temporarily alter the emotional response, and activate the mammary glands. Such activation and enlargement of the breasts is often produced as a troublesome side-effect when a man is being treated with drugs (Or carcinoma of the prostate; but he remains a male, nonetheless. Society today is pervaded by a tendency to reject the simple, commonsense and well tried attitude in favour of anything new, and to adopt imprecise terminology which confuses thought. The sex change operation fulfills both criteria. It is also in line with the modern, unisex trends of confusing hairstyles and ambiguous Clothing and with women's liberation ideas which blur the essential differences between the role of male and
• female; if sex can be changed on demand, then both sexes are surely equal. There is, of course, the possibility that an individual might be born with a mosaic pattern of chromosomes, having external male genitalia and internal female genitalia, each completely developed. It would, in such a case, be surgically possible to remove either the male, or the female organs and thus to choose either sex at will. It is
• doubtful, however, whether such a 'true human hermaphrodite has ever existed and the operations _which make headlines from time to time are performed on physiologically functional and anatomically normal males suffering from a sad emotional fixation. The sex change operation therefore continues to be a misnomer and the God-baiting surgeon implies that he is achieving an end product which he knows full well to be .a hoax.
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