Eenie Meenie Miney

I’ll be the first to admit that I have been left far behind in the vocabularic peculiarities that are now used to describe non-normative sexuality. Perhaps it’s Age, but more likely naïveté, that has led to this deficiency rather than lack of exposure.

I entered medical school in the mid-sixties when the youth were beginning to out themselves, and when some of the gloves were starting to come off -or maybe there was a growing awareness that a few of them had actually been wearing gloves. At the time -at least in my  school- Medicine seemed bicameral and only accepted two genders, male and female, with perhaps the door held slightly ajar for babies born with ambiguous genitalia or other genetic syndromes that made classification difficult.

For some of us, at least, it was a simpler time. Gender and sexual assignation were one and the same; preference as to which was really which was non-negotiable. But times and self-designation began to change; Medicine and the Law limped behind until the rift started to expose the consequences of their inaction.

I’d like to pretend that I saw these coming but, alas, I had no idea of the scope of the issue. In fact, in my mind, this straying from the norms was at best a marginal fashion. Anatomically, at least, we were what we had been assigned, and I assumed that perhaps the fullness of time and the machinations of society would iron any deviations into the acceptable crease. I had not reckoned with the discontent that enforced conformity might produce. When one has not experienced qualms, when one accepts the way the chromosomal dice have landed, it is not easy to grasp the uneasy restlessness of those few who will not play the game… or were not willing to join either team.

I say ‘few’ because I did not know; I did not understand. In time, of course, the discrepancies became too obvious to ignore in practice. At least in my gynaecological practice…

At first, there was confusion, I suppose -mine at first, perhaps- but theirs too. Not about their role, but mine. Initially, my lack of training forced me merely to listen, to empathize and then to help when and where I could. And, naïvely, I thought that was likely all that was required -and maybe all that they could reasonably expect. There was much psychological turmoil and disbelief that there was so little I could do, and yet I was relieved that I had heard them without disparaging their distress, or trivializing their problems.

But it soon became apparent that the eventual ramifications of their choices had the potential for far deeper consequences than either side had anticipated. And I’m not sure that I even appreciated the extent of the consequences of this disparity until after I retired. Only then, for example, did I come across an essay in the BBC Future series that touched upon some of the problematic issues. In an essay, Zaria Gorvett, a freelance science journalist for BBC, addressed the problem of why transgender people are ignored by modern medicine and what that might mean for their health:

‘[T]here are thought to be nearly a million transgender people living in the US… Rather than devising new ways to cope with changing social norms, transgender people are often shoehorned into inappropriate boxes instead.’

And the example she starts with is ‘a transgender man – he identifies as male but his biological sex is female. He has been living as a man for around 20 years… he is registered as a man on all his legal documents, from his passport to his medical records.’ All along, he had been taking small doses of the male hormone testosterone, but he suffered kidney failure and his condition deteriorated, therefore necessitating a kidney transplant. The criteria, for consideration of transplantation, however, differ between men and women and he lost valuable time in sorting out what criteria would apply to him.

As Gorvett points out, ‘When you factor in the large data gaps in everything from the average life expectancy of transgender people to the right dosages of medications for their bodies, along with the widespread lack of knowledge among doctors about how to address them – let alone treat them – and the high chance of them being refused treatment outright, it soon becomes clear that transgender medicine is in crisis.’

Indeed, in the UK, ‘“You can register as male or female, but you can still only choose between these two options – you can’t say if you are transgender or non-binary,” explains Kamilla Kamaruddin, a doctor who works for the National Health Service (NHS) and transgender woman. “So that’s quite difficult.” Or, if gender issues seem irrelevant to the visit, the patient may choose not to mention it, because of perceived stigma.

And, ‘The gender you’re registered as also dictates which screening tests you are invited to, meaning that thousands of transgender men could be missing out on potentially life-saving cervical (Pap) smears and breast exams, while transgender women could be missing out on abdominal aortic aneurism check-ups (or prostate cancer screenings, if they live in the US).’

Male and female physiology are different and many medications behave differently in each. ‘Females also have more sites for certain drugs to bind to, and are therefore more sensitive to them. They tend to clear them more slowly, so they are more susceptible to overdoses.’

Perhaps because of the stigma and subsequent lifestyle, ‘The group has higher rates of heart disease, certain cancers, mental health problems, suicide, smoking, and substance abuse than the general population – as well as an HIV prevalence which is  up to 42 times the national average. Transgender people are not only more likely to get sick, but less likely to seek treatment when they do.’

Still, I think we’re beginning to understand the problems they face. This gender dysphoria is an ancient condition, though, and actually gender fluidity may go back farther still. Gorvett writes about more enlightened recent attempts at assisting both with surgery and with hormonal replacement. The problem, however, is in the continuing stigmatization of those who are not mainstream. Those who do not fit neatly into societally condoned roles.

Maybe my age is tempering my reaction, or clouding my judgment, but I do wonder why there continues to be such marked antipathy to those who do not look like us, behave like us, or (gasp) think like us. Are we so insecure in who we are that we are threatened? And is it redress for the difference that we seek, an expectation of contrition? Do we really demand repentance, or is it homogenization?

I, for one, have come to think that the world would be a poorer place if we -the cis creatures- and we alone, were all that was on offer…

Overmastered with a piece of valiant dust?

I am by no definition an athlete. As a child in frigid Winnipeg, I played pickup hockey on an outdoor rink with wobbly skates, held upright by the stick I used mostly as a cane. The part I enjoyed most, though, was sitting in the little community center building after the game as my frost-bitten toes tingled gratefully in the warm sweaty air. I was never a particularly good skater, and I remember -even in those faraway times- the kidding I took for being knocked down by the one or two brave girls who always managed to be chosen for the other team. The same two girls showed up each Saturday, and they were tolerated, partly because they were as strong as the eleven or twelve year old boys around them, but mainly because they were such good players.

We moved further East from Winnipeg when I was fourteen, and the opportunity to play pickup hockey thankfully withered, although not only because of decreased opportunity, but, more likely, directly proportional to my size and talent. And there, any credible aspiration for sports fame withered in the already harvested field.

In the dying embers of middle age, I confess I tried rollerblade hockey in a local gym, but by then it was too late. It attracted people of my age, to be sure, but mainly those who had already played hockey for years, so it did not go well. There was an interesting parallel to my childhood experience, though. Although no gender restrictions were ever suggested, it was entirely an old-boys club –until, that is, two younger women who had played for a women’s ice hockey team showed up. The results were predictable; they outclassed the men so completely, the larger, older men began to exhibit their frustration by unfair physical contact –shoving, bumping, slashing with their sticks- all, no doubt, to compensate for their lack of prowess. But the women never showed up again.

At any rate, I began to wonder why there wasn’t some way of allowing gender mixing in sport. Clearly, there would have to be guidelines to even out the rink, as it were -maybe size, or weight, say, in sports like hockey, and coupled with a change of rules to discourage aggressive and disruptive behaviour. Other sports like track and field could perhaps be integrated even more easily…

I suspected these thoughts were likely the early signs of an impending dementia, though, until I came across a truly inspiring article in the Conversation

It was an article by Roslyn Kerr, a senior lecturer in Sociology of Sport, Lincoln University, in New Zealand. She argued that ‘[…]one way to move beyond problematic gender barriers is to eradicate sex segregation completely and replace it with a system similar to that used in Paralympic sport.’ As she points out, ‘Historically, women have been required to undergo humiliating sex testing procedures in order to compete in sport. More recently, such testing has been suspended owing to the lack of consensus about which traits make someone male or female. […] In 2012, several women underwent surgery in order to meet the requirements to compete in the women’s events at the Olympic Games, even though they had always identified as women and externally appeared to be women.

‘[…] Women are not the only group who receive a poor deal in sport. While weight classes in some sports allow smaller athletes a chance at success, there is no such consideration for other traits, such as height. This means that shorter athletes never have a chance in events such as high jump, volleyball and basketball.

‘Other athletes are lucky enough to have advantageous traits that do not lead to a ban. For example, they have greater aerobic capacity or stronger fast-twitch fibres (which contract quickly, but get tired fast). But it is not considered unfair for other athletes to compete against them, as it would be if their weight were too high or they were men rather than women.’

But, ‘Paralympic sport has been forced to deal much more closely with the issue of classification owing to the range of bodies that compete. In the 1990s, the classification system changed to one that was based on functional ability rather than on medical conditions. It continues today, where rather than labelling athletes as having a particular medical condition, they are placed in a racing category based on the movements their body can perform, related to the sport they compete in.’ So she suggests that ‘in able-bodied sport, it would similarly make sense to remove the label of male or female and replace it with categories based on the ability of bodies to move in that particular sport. In sport, movement is based on physical ability, which is not necessarily linked to sex. In each sport, it would be possible to identify the characteristics which make up successful athletes and create categories based on those rather than on sex.’

She gives some examples that might help with the integration: ‘[f]or example, for a 100m sprinter, the ideal athlete would perhaps be made up of muscle mass and fast-twitch fibres. Therefore, rather than classifying by sex, sprinters could be classified by their level of muscle mass and fast-twitch fibres. In another example, in sports such as high jump, volleyball and basketball, athletes could be classified according to muscle mass and height. Finally, in an endurance sport, athletes could be classified according to muscle mass and lung capacity.’

I realize that this may still be a hard sell to many. Egos are on the line I suppose, and privilege –sacred male traditions might be trampled underfoot. But things are changing –too fast for some, no doubt- and yet no amount of wishful thinking will bring back a Past that is not served by the Present. A past that was never exposed to current technology, current expectations.

But the integration of gender in sport makes sense. There are women fire fighters, paramedics, police officers –there are even women soldiers in combat, for goodness sakes. Come on guys…!

And what do we risk by trying it in a few sports to see how it unfolds? That people might actually enjoy it? That a day might come when children, perhaps yet unborn, will wonder how and why we ever separated the sexes…?

I can’t help but think of the words of Beatrice about men in Shakespeare’s Much Ado About Nothing: Would it not grieve a woman to be overmastered with a piece of valiant dust? to make an account of her life to a clod of wayward marl? A bit harsh, I guess, but she’s got the right spirit, don’t you think?