Nutt, who has a background as a science writer, makes it a project of her book to remedy the potential ignorance surrounding transgender people among her readers, as there is still little scientific data or common knowledge about being transgender. She shows how complicated both gender and sex can be, and how frequently they can fall outside the binary categories of man and woman. Nutt brings in scientific data to help people understand that gender identity runs along a wide spectrum, is innate, is not always determined by sex. With this context in mind, the book ultimately argues that being transgender should be treated as a physical medical condition rather than a psychiatric one.
Nutt includes hard scientific facts about gender identity to show how many factors contribute to what constitutes gender. Genetically, chromosomes make a person male (XY) or female (XX), but there are 50 genes that play a part in sexual identity. Sexual anatomy, on the other hand, is determined by hormones. Testosterone fuels the development of male genitalia, while the absence of testosterone prompts an embryo to develop female genitalia. Nutt describes several variations: some individuals have the chromosomes of one gender but the sex organs of the opposite gender. Others have male genitals and testes, but internally have a womb and fallopian tubes. Others have atypical chromosomal configurations. Thus, even on the chromosomal level, sex and gender can vary greatly. In addition, different balances of hormones can also create differences in sexual development independently of chromosomes. “No one thing determines sex […] small changes or interruptions can lead to nonbinary results, neither wholly male nor wholly female.” She writes that according to Brown University gender researcher Anne Fausto-Sterling, as many as one in 100 infants are born with sexual anatomy that differs from standard male and female anatomy. Nutt therefore challenges the idea that sex is binary, contrary to what many people understand.
In addition to the variations that can arise in sex and anatomy, Nutt also relates that the development of this anatomy and the development of sexual identity, however, are distinct processes. Thus, Nutt shows how one’s genitals and gender identity do not always match up, which provides a scientific explanation of how someone can come to be transgender. Studies have shown that there are differences between men and women in an area of the brain called the bed nucleus of the stria terminalis (BNST) which is responsible for sex and anxiety responses. It is twice the size in males as in females. The BNST in the brains of transgender females look exactly like the BNST in the brains of cisgender females. This area is not affected by hormonal treatments or sex reassignment surgeries. Thus, this study provides neurological evidence of how people’s brains can biologically resemble a different gender, regardless of their hormonal makeup or anatomy, which gives scientific validity to people’s claims of feeling like they are a different gender. In 2008, Australian researches discovered a genetic variation in transgender women: the receptor gene for testosterone was less efficient than in gender-conforming males, resulting in a more “feminized” brain. Again, Nutt emphasizes that gender identity has a biological basis outside of a person’s sexual anatomy. The relatively new scientific field of epigenetics looks at environmental influences on a person’s genetic makeup as they are developing in the womb. Drawing on epigenetic studies, Nutt addresses how identical twins could share the same DNA but be so different. Each fetus has its own amniotic sac and umbilical cord, resulting in differing amounts of hormones to reach each embryo. This also explains why twins have unique fingerprints. Nutt includes this to counteract confusion about Jonas and Nicole’s specific situation, to show how even though Nicole and Jonas share the same DNA as identical twins, there can still be biological reasons that Nicole is transgender while Jonas is not.
All of Nutt’s scientific evidence argues that gender identity is just as innate as sex. Thus, she argues, being transgender should not be treated like a psychiatric illness, but instead as a physical medical condition. In a 1966 survey of medical and psychiatric professionals in the United States, an overwhelming majority believed “transsexuals” were “severely neurotic.” But, faced with new evidence, this thinking has evolved to understand that transgender’s people’s unease stems from their assigned anatomy and how other people treat them—not an insecurity in their identities. In 2015, Boston University School of Medicine released the results of the first “comprehensive review of the scientific evidence regarding gender identity as a biological phenomenon.” It found that for treatment, “the best outcomes for these individuals are achieved with their requested hormone therapy and surgical sexual transition as opposed to psychiatric intervention alone.” In other words, the best treatment is not found in therapy, but instead in medical care and surgery. By coupling Nicole’s heartfelt story about transitioning with Nutt’s logical arguments and scientific explanations, Becoming Nicole enables readers to have a more informed and nuanced consideration of transgender individuals on the whole.
Gender, Sex, and the Scientific Community ThemeTracker
Gender, Sex, and the Scientific Community Quotes in Becoming Nicole
In other words, our genitals and our gender identity are not the same. Sexual anatomy and gender identity are the products of two different processes, occurring at distinctly different times and along different neural pathways before we are even born. Both are functions of genes as well as hormones, and while sexual anatomy and gender identity usually match, there are dozens of biological events that can affect the outcome of the latter and cause an incongruence between the two.
Their receptor gene for the male sex hormone testosterone was longer than in gender-conforming males and appeared to be less efficient at signaling the uptake of male hormones in utero, resulting in a more “feminized” brain.
Researchers in epigenetics seek to explain the no-man’s-land between nature and nurture where environment influences a person’s genetic makeup. This happens when changes in the environment trigger some genes to activate and others to deactivate. Identical twins may have the exact same DNA, but not the exact same molecular switches. Those switches often depend not only on environmental influences outside the womb—what the mother does, how she feels, what she eats, drinks, or smokes—but inside the womb as well.
Her good friend Lexie texted, “HOW U FEELIN?” And then, “YOU’RE LIKE ARIEL,” the little mermaid who emerged from the sea in the form she’d always longed for.
Nicole’s transition was now complete. She would still need to take female hormones the rest of her life, and she would never be able to have her own children, but she knew she wanted to marry a man some day and adopt.