Vernon A. Rosario

“Qué joto bonita!”: Transgender Negotiations of Sex and Ethnicity

SUMMARY Recent transgender literature has been sharply critical of existing medical models of the psychosexual development of transsexuals and of the treatment of Gender Identity Disorder. Transgender authors have pointed out that subjects have deliberately falsified their reports in order to conform to medical and psychiatric models for the sake of gaining access to services. In newer transsexual narratives, gender and sexual orientation development appear far more fluid and ambiguous over the life span. This paper reviews the nosological history of gender atypicality, from nineteenth century “sexual inversion” to transvestitism and transsexualism, examining how deviations of gender identity, gender role, sexual object, and sexual aim were often collapsed together. These imbrications continue to persist in both the medical and popular literature on transsexualism. A topic that has especially been neglected is the relationship of ethnicity to the development of gender and sexual identity. Presented is case material gathered from dynamic psychotherapy with a Latina, transgendered sex worker which illustrates the articulations of ethnicity, gender, and sexuality in both the transgendered subject and her heterosexually-identified male partners.

African-American Transgender Youth

The author, a child and adolescent psychiatrist, discusses his experience working with minority transgender youth in Los Angeles. He describes two cases of adolescents he has treated in Los Angeles at a clinic which serves sexual minority youth who are often wards of the foster care and criminal justice systems and who often have chaotic and traumatic family histories. Unlike the classic descriptions of transsexuals, these youth are often varied and fluid in terms of their gender identities, expression, and sexual identities and orientation.

Hurdling Over Sex? Sport, Science, and Equity

Between 1968 and 1999, the International Olympic Committee (IOC) required all female athletes to undergo genetic testing as part of its sex verification policy, under the assumption that it needed to prevent men from impersonating women and competing in female-only events. After critics convinced officials that genetic testing was scientifically and ethically flawed for this purpose, the IOC replaced the policy in 1999 with a system allowing for medical evaluations of an athlete’s sex only in cases of “reasonable suspicion,” but this system also created injustice for athletes and stoked international controversies. In 2011, the IOC adopted a new policy on female hyperandrogenism, which established an upper hormonal limit for athletes eligible to compete in women’s sporting events. This new policy, however, still leaves important medical and ethical issues unaddressed. We review the history of sex verification policies and make specific recommendations on ways to improve justice for athletes within the bounds of the current hyperandrogenism policy, including suggestions to clarify the purpose of the policy, to ensure privacy and confidentiality, to gain informed consent, to promote psychological health, and to deploy equitable administration and eligibility standards for male and female athletes.

The GAP Online LGBT Mental Health Curriculum

The authors describe the development and publication of an online curriculum to teach psychiatry trainees about important topics in LGBT mental health (www.aglp.org/gap). The curriculum was written by members of the LGBT Committee of the Group for Advancement of Psychiatry (GAP, www.ourgap.org). This paper outlines the history and mission of GAP and the history of the GAP LGBT Committee. The rationale for the curriculum and its structure are discussed, as well as suggestions for its use.

Gender Variance: An Ongoing Challenge to Medico-Psychiatric Nosology

An array of gender variant behaviors and identities among youth has been identified in many historical periods and diverse cultures around the globe. The cinaedos in Ancient Rome have been well documented: groups of young men who performed female-typical activities such as dancing and playing music and performed receptive sexual intercourse (Richlin, 1993). In the New World, Spanish explorers since the 16th century described a widespread institution among the natives of the “berdache”: biological males who dressed and behaved as women, some even marrying masculine men. There is historical documentation throughout the Americas of parents gendering certain boys as girls and to a lesser extent of girls as boys (Trexler, 1995). More recent ethnography describes the continued presence of such cross-gendered people among North American natives (Roscoe, 1991), and in the 1990s gay and lesbian Native Americans adopted the term “two-spirit” people to describe the phenomenon. Neurologist William Hammond (1828–1900), former surgeon general of the U.S. Army, described with amazement and some revulsion the “mujerados” or “bote” he had observed in 1851 as a U.S. Army medical officer in a Pueblo village in New Mexico. According to Hammond, these young men had been feminized through repeated masturbation. Their genitals had atrophied and they possessed enlarged breasts; furthermore, they dressed and behaved fully as women. He concluded that this was a form of “mental alienation” due to “sexual impotence” (Hammond, 1882). Hammond’s medical ethnography was written just as European and American doctors were “discovering” a new disorder they struggled to classify. Physicians variously labeled it “contrary sexual sensation,” “psychosexual hermaphroditism,” or “sexual inversion” (Rosario, 2002).

“Is It a Boy or a Girl?” Introduction to Special Issue on Intersex

Since the 1990s, medical and psychological treatments of intersex conditions have increasingly become controversial topics. Insofar as the controversy involves socially constructed–and contested–notions of masculinity and femininity, as well as issues related to patient rights, the editors of the Journal of Gay & Lesbian Psychotherapy believe the subject should be of great interest to our readers. Since antiquity, individuals with genital variations have been known as hermaphrodites, the term presuming, or at least suggesting the presence of both male and female reproductive organs. With developments in histology in the nineteenth century, a further distinction was made between true hermaphroditism (when both ovarian and testicular tissue are present in the gonads) and pseudo-hermaphroditism (all other cases, when the gonadal tissue is of one sex type or undeveloped). The term intersex was first used in this context by Richard Goldschmidt (1917) in a discussion of the endocrinology of hermaphroditism. The various terms are still employed in the professional and lay literature, with “intersex” increasingly becoming the most widely used umbrella term. A new term, “disorders of sex development” (DSD), is currently being considered (Dreger et al., 2005). Not surprisingly, given the nature of the subject, today the term intersex and its boundaries are highly contested. The frequency of intersex conditions is difficult to determine, in part because there is no mandated reporting, but also because of ambiguity in what to include in the category. Blackless et al. (2000) estimated the prevalence to be 0.1-1 percent of live births. The smaller figure is an estimate of the frequency of “ambiguous” genitalia among live births, i.e., where atypical genital anatomy makes it challenging to determine