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Religious Tolerance logo

Additional information on transgender
individuals, transsexuals, & gender identity

Part 2:
Comparing cisgender persons with
others who don't fit neatly into the
male/female binary system. IRS conflicts

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This is continued here from the previous essay

Most people have a clearly defined sex:

For most, but not all people, their sex may be defined in terms of any one of the following four factors:

bullet Their genetic or biological sex: Every cell in a person's body contains sex chromosomes that determine a person's genetic sex. In almost all cases, these are XX chromosomes for females, and XY for males.
bullet Their gender identity: This involves their "internal sense of being either male or female." 1
bullet Their birth-identified or physiological gender: The genitalia of the vast majority of newborns are clearly either male or female, and remain so throughout life. Their appearance generally determines the sex that they are assigned on their birth certificate.

bullet Their internal brain structures: There are recently discovered structures near the center of the brain that, like ones genitalia, come in one of two types: male and female. They are of different sizes and neuron densities. These structures appear to be responsible for many transgender persons to say they have a female brain in a male body, or vice-versa.

From early childhood to the retirement years, about 99.2% of people feel that their biological sex, gender identity and physiological gender are in harmony. They are referred to as being cisgender.

For example: a typical woman will:

  • Have each cell in a her body containing 46 chromosomes including a pair of XX sex chromosomes -- commonly written 46,XX.

  • Identify as a female. By the age of one, she might show a preference for more feminine-typical toys. By age three she will probably have a definite sense of being a boy or girl. By age five, she will "... come to believe that sex is unchanging with time. This is the point at which many people think that a child's gender identity becomes fully established and fixed. Then the child's energy seems to focus on adopting behaviors consistent with that sex." 2

  • Have the genitals and internal reproductive organs commonly perceived as female.

  • Have brain structures typical of females.

The corresponding processes happens for cisgender males.

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People who don't fit neatly into the two gender binary system:

Not every person fits neatly into the binary female/male system. There are many exceptions.

  • Consider what genetic or biological sex can involve:

    • Rarely, a newborn will have 45 chromosomes including only one X sex chromosome referred to as 45,X. Other forms of DNA are 47/XXX, 48/XXXX, 49/XXXXX, 47/XYY, 47/XXY, 48/XXXY, 49.XXXXY, or 49/XXXYY.

    • Some newborns have different numbers of chromosomes in different cells within their bodies. This can be caused by complications in early cell division at the pre-embryo stage. When multiple sex chromosomes appear in the same body, they are called sex-chromosome mosaics. They may have combinations of normal male and female chromosomes, typically 46,XY; 45,X; or 46,XX, within their body.

    • Sometimes, an ovum with two nuclei will be formed in an ovary, be fertilized by two sperm, and grow into a chimera -- a person with two DNAs. One possibility is that they might have some 46,XX and some 46,XY (a normal female and normal male) chromosome configuration.

    • Sometimes two separate zygotes (fertilized ova) can fuse shortly after conception and develop into a single embryo with two different DNAs.

  • Consider gender identity:

    • Transgender adults constitute a 0.8% minority. They develop a sense of having a gender different from that with which they were identified at birth:
      • Most sincerely believe that they are currently female in spite of having been identified as male at birth of the opposite sex from their biological and physiological gender." 1 They may describe themselves as a man trapped in a woman's body, or having a man's body with a woman's brain. They experience Gender Incongruence. Gender Dysphoria -- strong feelings of anxiety and depression over gender -- are usually present.

    • Some people identify as both male and female, perhaps alternating over time.

    • Others identify as being "two spirited" or of having no gender at all.

  • Some will be intersexual. They will have an "anatomy or physiology which differ from cultural ideals of male and female." 3 Some will have genitalia which are ambiguous, others with both male and female components. Some will be missing external genitalia entirely. Still others will have a missing or malformed X sex chromosome in their cells.

Our cultures' tendency to divide people neatly into fixed males and females throughout their entire life span suddenly looks inadequate and over simplistic. A small percentage of individuals simply do not fit.

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Beliefs about sex, gender identity and gender dysphoria by transgender persons, transsexuals, social and religious liberals, secularists, human sexuality researchers, therapists, etc:

They are much more likely to accept the findings of genetics and human sexuality research and acknowledge that the fixed binary male/female classification is inadequate.

  • They recognize as female those transgender persons who were registered as male at birth but who made the transition to female later in life -- often referred to as MTF (Male To Female) transsexuals.

  • Similarly they recognize as male those female to male transsexuals (FTM) who have been registered at birth as female but who have transitioned to identify themselves later in life as male.

  • They also recognize a minority of transgender persons who view themselves as being both male and female, or as being neither male nor female.

Liberal/progressive Christians may quote one of the following passages:

  • Genesis 1:27: "So God created man in his own image, in the image of God created he him; male and female created he them." This can be interpreted as teaching that God is both male and female, just as some transgender persons regard themselves as both male and female. Some ancient Jewish traditions believe that God created Adam as having been both male and female.

  • Epistle to the Galatians 3:28: "There is neither Jew nor Greek, there is neither bond nor free, there is neither male nor female: for ye are all one in Christ Jesus." This can be interpreted as implying that gender is not be an important consideration for Christians.

Most accept the consensus among the large professional mental health associations that Gender Incongruence, homosexuality, and bisexuality are normal and natural sexual variations for a minority of persons. They cannot be "cured" through therapy and/or prayer. Persons with Gender Incongruence are not at all confused about their gender. They are totally convinced of their gender identity, and recognize that they cannot change it.

By comparison, most religious and social conservatives have an alternate belief system. They view transgender persons as being confused about their gender, and only need prayer or counseling to end their confusion and return them to a cisgender state. Conservatives often feel that males and females have definite fixed roles to play in the culture. They often restrict ordination to males. They view a man's main role is to protect and financially support his wife and family; a woman's role is to civilize her husband and to follow his lead in nurturing the children.

Most conservatives refer to transgender persons by their birth-assigned gender: a MTF transsexual is considered male, and a FTM transsexual is female. They often find the thought of a person switching genders as abhorrent, and view sexual reassignment surgery as body mutilation and offensive to God.

More details on the beliefs of conservative Protestants and the Roman Catholic Church are discussed elsewhere in this web site.

Gender Incongruence and the U.S. Government:

Rhiannon O'Donnabhain was registered as a male shortly after birth, enrolled in the Coast Guard during the Vietnam War, married, and fathered three children. O'Donnabhain divorced in 1992; four years later, she was diagnosed with Gender Incongruence and started the conventional hormonal therapy therapy. She changed her name and presented herself as female at work and home. Finally, she had Gender Reassignment surgery (GRS) -- now called Gender Confirmation Surgery -- in 2001.

She claimed the GRS cost of $25,000 as a medical deduction on her income tax. Initially she received the refund. However, as a result of an audit, the IRS decided that her surgery was cosmetic and not medically needed. The income tax law defines cosmetic surgery as:

"... any procedure which is directed at improving the patient’s appearance and does not meaningfully promote the proper function of the body or prevent or treat illness or disease."

The IRS demanded that she return the refund. She sued instead, and won an 11 to 5 decision in a U.S. tax court!

According to Wikipedia:

"The IRS issued a memorandum stating that:

'Whether gender reassignment surgery is a treatment for an illness or disease is controversial. For instance, Johns Hopkins Hospital has closed its gender reassignment clinic and ceased performing these operations.... In light of the Congressional emphasis on denying a deduction for procedures relating to appearance in all but a few circumstances and the controversy surrounding whether GRS is a treatment for an illness or disease, the materials submitted do not support a deduction.'

"In the clearest possible statement the US Tax Court declared that the IRS position was:

'... at best a superficial characterization of the circumstances ...[that is] thoroughly rebutted by the medical evidence."

"The IRS case was based on unverified studies by Johns Hopkins' Paul McHugh, who worked for the Catholic church. McHugh declared even before taking over Johns Hopkins that it was his intention to close out any department that had anything to do with gender reassignment. He ordered a study of what he could find of the 24 women the unit had treated. Of 2,000 applications made by reassignment only 24 were chosen and they were chosen entirely for looks. Many questions remain about the religious bias of the IRS, as the results of the follow up study were published in a Catholic journal the IRS would later quote to close out deductions for surgery." 4

This essay continues in Part 3

References used:

The following information sources were used to prepare and update the above essay. The hyperlinks are not necessarily still active today.

  1. "Psychological Dictionary," AllPsych Online, at:
  2. Gerad N. Callahan, "Between XX and XY: Intersexuality and the myth of two sexes," Chapter 9, Chicago Review Press, (2009). Read reviews or order this book
  3. The Intersex Society of North America maintained a home page at: They had a FAQ, which describes their newsletter and other materials on intersexuality. ISNA ended operations in 2008. A new non-profit organization, Accord Alliance, composed of health care and advocacy professionals, opened its doors in 2008-MAR. It will continue to lead national efforts to improve health care and outcomes for intersexual persons.
  4. O'Donnabhain v. Commissioner," Wikipedia, as at 2010-OCT-29, at:

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Copyright © 2007 to 2018 by Ontario Consultants on Religious Tolerance
Original posting: 2007-JUN-08
Latest update: 2018-AUG-08
Author: B.A. Robinson

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