Transgender Functioning: Is Gender Identity Biologically Hard-Wired?

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JACKIE JUDD: Eight-year-old Skyler Kelly is hoping for a career in the major leagues, and enjoys the privileges of being big brother to four-year-old Luke. It is not how life started for Skyler.

TIFFANY KELLY: I can totally see sitting on the hospital bed and days of a long labor and someone saying oh, what a sweet little girl!

JACKIE JUDD: At a remarkably early age, Skyler, who lives in Seattle, began to let his parents know that what he looked like on the outside, a girl, is not how he felt on the inside.

SKYLER KELLY: When people tried to brush my hair, I would try to push the brush away and I cried, screaming. It was hard in the mornings to even get ready.

JACKIE JUDD: Did you also have a fight over clothing, what to wear, what kind of clothes to wear?

SKYLER KELLY: Well, I was pretty much allowed to wear what I want except on school pictures. I had to wear a dress and I hated it.

JACKIE JUDD: So did you ever smile in those school pictures?

SKYLER KELLY: I smiled, but—

JACKIE JUDD: But inside?

SKYLER KELLY: I did not like it inside.

JACKIE JUDD: The why of Skyler's gender identity isn't fully understood. The long-held and now controversial medical view links being transgender to a mental disorder or emotional distress. However, new science is emerging pointing to a complex set of factors.

KRISTINA OLSON: If Jazz said, I'm a boy, that would be in the top category.

JACKIE JUDD: At the University of Washington, psychology professor Kristina Olson investigates the origins of being transgender.

KRISTINA OLSON: Your biology determines a lot of your psychology, and I think that's kind of where the feeling is right now, that there are probably biological contributors that make a big contribution towards our sense of gender identity, which is psychologically how we feel. Are we male or female or something else, something in between, neither?

JOSHUA SAFER: Ma'am, how are you doing today?

WOMAN: Dr. Safer, how are you?

JOSHUA SAFER: Good to see you.

JACKIE JUDD: Endocrinologist Joshua Safer at Boston University treats hundreds of adult transgender patients, and is a leader in the field. He firmly believes gender identity is hardwired in all of us.

JOSHUA SAFER: In most people, chromosomes, body parts, gender identity align. So somebody with a male chromosome, somebody with male body parts, is going to have male gender identity. That is the usual circumstance. All of these are independently controlled biologically, and therefore it is no surprise that in a given subset of the population, one part is not aligned, that whatever genes are controlling that happen to be different for that individual. And that's what's happening with transgender individuals.

JACKIE JUDD: Dr. Safer conducted the most extensive review to date of existing studies tying gender identity to biological factors. The most persuasive evidence he found was in experiments done over the past half century on people born with the male XY chromosomes, but with the rare condition of ambiguous genitalia. Soon after birth, they were surgically given female genitalia and then raised as girls.

JOSHUA SAFER: These kids were dressed in pink and given dresses and dolls and given estrogen when they hit puberty so that they had appropriate breast development and such. So we're talking about a pretty extreme approach that if any approach was going to work, it should have worked. But what happened instead is the majority of these kids, if you query, say that they have male gender identity despite that very, very extreme program.

JACKIE JUDD: The conclusion according to Dr. Safer is that gender identity cannot be manipulated or taught. A second set of data he reviewed involved the anatomy of the brain. Post-mortem testing of women and males at birth who transition to females found certain regions to be strikingly similar. Though Dr. Safer says more research is needed to determine if those regions are linked to gender identity. At this lab at the University of Washington in Seattle, a unique long term study is underway of transgender children, children as young as three years of age. With the support of their families, they have transitioned from the gender of their birth to what's called they're expressed gender.

SKYLER KELLY: It's my turn.

TEACHER: Skyler's turn!

JACKIE JUDD: Skyler, along with several dozen other kids, both transgender and not, went through a battery of tests in the first phase of the study to pinpoint how they see themselves.

TEACHER: All ready to go?

SKYLER KELLY: Yes.

TEACHER: Ready, go.

JACKIE JUDD: This very quick picture and word association called IAT, or implicit association test is intended to take a true measure of the strength of a child's identity.

KRISTINA OLSON: If there is a kid who at birth, the doctor said this kid is a girl, but later came to identify as a boy and that kid is living as a boy today, that kid will show the same results on the IAT any other boy and looks nothing like say, his sister or another random girl that we just pulled off the street.

JACKIE JUDD: Dr. Olson leads the study team.

KRISTINA OLSON: So this suggests that this isn't just a thing a kid is saying or pretending to be. This doesn't seem to be a kid being playful, or being ornery. This is really, truly how the child seems to identify themselves at this age.

JACKIE JUDD: Dr. Olson's research cuts to the core of the dilemma parents of transgender children face—how to know if this is real.

JOSH KELLY: I guess my concerns as it evolved and we were not at this stage of him being an affirmed male, my concerns are, are we jumping the gun? And I just wasn't comfortable with that whole thing.

JACKIE JUDD: Many people struggle with the same thing and believe transgendered children are just going through a phase. Dr. Olson says in two years of following the same group of youngsters, none has reverted to their gender at birth. Still, she encounters deep skepticism.

KRISTINA OLSON: We see a lot of people saying things like, my child thought that they were a dinosaur when they were four, but I didn't let them live as a dinosaur! And they didn't really think they were a dinosaur! These are kids who are saying, this is who I am. I am a girl or I am a boy.

JACKIE JUDD: The Kellys came to certainty one night when Skyler was about six and there was no denying what their child was trying to tell them.

TIFFANY KELLY: I remember—God, this one awful night, I can still picture us upstairs, and Skyler was just having a meltdown over nothing, but just a heartbreaking meltdown. Like the kind—you can tell the difference between a tantrum and I am just so emotionally unhappy. And Josh and I both just finally saying, what is it? Is there something that you're not telling us? And I said, do you want to whisper it to us? And he whispered, said, I want to start wearing boys' underwear.

JACKIE JUDD: And that is when Skyler transitioned, entering first grade as the person he knew himself to be.

KRISTINA OLSON: And then what do you say?

JACKIE JUDD: Dr. Olson now has about 100 transgender children in the study, and she hopes to follow them into adolescence and adulthood. And that by learning more, the too common trajectory of a transgender person's life can be changed.

KRISTINA OLSON: We all look at the news and we see those terrible statistics about what life is like for transgender adults, 41% of transgender adults attempt suicide. They have extremely high rates of unemployment and discrimination, violence. And what I want to know is, how do we change that? Is there a decision that could be made in a child's life, and instead put them on a path that's more like the other kids, that they go to school with and that are in their families, where they have just as good a chance as anyone else?

JACKIE JUDD: Of all these words, which words would you choose to describe yourself? Happy, angry, proud, sad? Which words?

SKYLER KELLY: Happy proud.

JACKIE JUDD: Happy proud? Why happy proud?

SKYLER KELLY: Because I'm happy now that I get to live how I want. And I'm proud because my parents understood it and they're great.

JOSH KELLY: He's super well-adjusted, very happy.

TIFFANY KELLY: He's braver than I've ever felt. And I hope that he can keep that and that the world doesn't break him of that.

JACKIE JUDD: The Kellys say the emerging science of gender identity is less important to them than their child finding acceptance and support. They know it may not be an easy life for Skyler, but it will be an authentic one. For The News Hour, this is Jackie Judd in Seattle.

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