Deena Emera and the Politicalization of Biology

 

In the July 24 "Ideas" section of the Boston Globe, Deena Emera, who is identified as a "senior scientist" at the "Center for Reproductive Longevity and Equality"  (a pretty loaded and packed name in itself) tells us that female elephant seals have "learned to mate in open water--not a trivial task--with males of their choosing" to avoid the "brutish 'beachmaster' who controls the harem of female seals on shore, where sexual intercourse ordinarily occurs, and at the discretion of the dominant male. 

One can only imagine Dr. Emera interviewing these female elephant seals about their motivation for free water frolic, and asking them if these extracurricular activities with non dominant males were really their choice, or whether they were simply accosted by off brand male elephant seals when the females thought they were freed from copulation obligations on shore.

Did Dr. Emera actually make direct observations, or did she simply read about all this?

Better yet, Dr. Emera tells us, female bottlenose dolphins, have devised an even more elaborate scheme to select who will be the biologic fathers of their children: "The dolphin vagina evolved elaborate flaps and folds that give a females some freedom of choice. Not the choice of sexual partner--male dolphins are aggressive and unrelenting--but of whose sperm she'll allow to fertilize her eggs. Females may position themselves during copulation , and contract or relax their vaginal muscles, to steer wanted sperm toward their eggs and unwanted sperm toward on of the end end folds."

And this, in the Boston Globe!

The Phantom has never fancied himself much of a scientist, but he has absorbed enough about the scientific method to wonder about those vaginal folds in the bottle nosed dolphin and how they work. The folds are, of course, anatomy. You can look at them, touch them, feel them, but you would need very special equipment and techniques, presumably, to be able to see them in action. Masters and Johnson, in their breakthrough research in human sexuality, had to position cameras and pressure sensors inside human vaginas. That required a great deal of cooperation from willing subjects, permissions, negotiations, special laboratories, and facilities. The Phantom can only imagine the difficulties doing these kinds of measurements cross species and in the water. Talk about dancing backwards in high heels.

And even if you could, somehow, trace the semen in its journey inside toward the eggs, and even if you could see that the semen from dolphin A gets diverted away from egg country, but semen from dolphin B gets directed toward the egg, you would still need to ask how the female dolphin does this, if it is a voluntary, conscious decision and for that, presumably, you would have to be able to interview the dolphin.

"These are just a few of the many examples in nature illustrating the choices that female animals are constantly making about reproduction and the lengths they go to make these choices...Males often have different interests and strategies for reproductive success, which may involve sexual intimidation, coercion and other methods to control female reproduction."

Having watched untold hours of David Attenborough's nature flicks showing aroused elephants, birds doing mating dances, frogs, wolves, buck deer, and most of all tigers (where sex can result in a dead male) and spiders, where the male is routinely devoured post coital by the female,  I was stunned to learn that, in nature, males are guilty of sexual intimidation, i.e. rape, of the female counterparts of their species.

But it is the last paragraph with illuminates Professor Emera's position:

"In the reversal of Roe v Wade, the Supreme Court's majority decided that abortion isn't deeply rooted in the history and traditions of the country, so it shouldn't bee protected by the Constitution. But in fact, female reproductive choice is one of the most deeply rooted 'traditions' of nature, one that can be traced back hundreds of millions of years."

So there you have it: Dobbs denies evolutionary history.

Dr. Emera

Dr. Emera has perhaps done such interviews with dolphins and elephant seals--her space in the Globe was limited and she could not cover all the details, but the Phantom remains dazzled by the idea of a bottlenose dolphin giving up her deep preference for dolphin B because, you know, he's just so cute, or maybe intelligent, or gentle and kind. 

Somehow, somewhere, the Phantom gets the idea that Dr. Emera's desire to come to the conclusion that females, ultimately, rule, throughout the phylum, across species, as an evolutionary imperative, guided her in the direction of seeing what she wants to see in her "science."

Gender and Public Policy (Season 2)

 Season 2: 

Episode 1: Medical Students Stumble on to Something in the Jungle

Students from Maria New's school were allowed, during their last year in school, to travel anywhere in the world they wished, in pursuit of medical experiences they might not find in New York City.  A few students wound up in the Dominican Republic, where they heard, in the rural clinic where they worked, of a group of villages in the mountains where the children were given gender neutral names. 

Hiking up to these villages, they confirmed that little girls born in these villages were given the Spanish equivalent of names like "Chris" or "Pat" or "Leslie" or "Robin" or "Terry."  When they asked why the girls were named this way, and not the baby boys, the villagers said the boys were born boys, and stayed boys,  but some of the babies who looked like girls at birth would grow a "penis at twelve" and were called "Pene a los doce." 

Asking to see some of these girls who changed into boys at age 12, they were, after some negotiations and reassurances, allowed to examine these boys. 

These photos appeared in the early papers about this phenomenon:

These boys, remember, were raised "gender neutral" until they "declared themselves."

The medical students rushed home to tell Dr. New about what they had seen and she assigned a fellow in the department of pediatric endocrinology, Dr. Julianne Imperato,  to investigate.  Imperato obtained blood samples from the Pene a los Doce patients and she did an exhaustive family tree on all the affected patients. This was in the early 1970's long before the Human Genome project or any genomic technologies beyond karyotyping (which is astonishingly low tech--requiring nothing much more than a microscope fitted with a polaroid camera.)

What Dr. Imperato discovered was there was a high level of consanguinity (intermarriage) among the families in these villages and when you have consanguinity, autosomal recessive traits can flourish and emerge. 

What she found from the blood, again run through Ralph Peterson's lab, was that these boys had an enzyme defect at the last stage of the testosterone hormone pathway: they made plenty of testosterone, but they could not convert that testosterone into dihydrotestosterone (DHT) and it's the DHT which actually masculinizes the external genitalia. At puberty, when you have a huge surge in testosterone, the traffic simply floods past the obstruction and enough DHT gets made to make the penis grow. 

This disorder, called "5 alpha hydroxylase deficiency" is the basis for the book "Middlesex." 

Of course, changes in sexual status is not unique to the species Homo Sapiens:

Red frogs can change sex. 

Some fish can change sex. (Clown fish, Hawkfish, Sea bass, seahorses)

Some snakes can. 

The Bicyclus anynana butterfly does it. 

https://animaltriangle.com/animals-that-can-change-gender/

And now, we need to step back and understand more about sexual differentiation.

The best, most concise explanation of the steps which differentiate little boy babies from little girl babies is in this wonderful youtube presentation by Armando Hasudungan:

https://www.youtube.com/watch?v=ciQjo7bj-uQ&t=15s

Episode 2:  When the Blood Hormone Levels are normal, but the Patient is Not

So now you see the way things normally go. But, in nature, things do not always go that way, so you sometimes get ambiguous genitalia, male pseudohermaphrodism, because of biochemical enzyme deficiencies.  In both cases presented, the reason the external genitalia, the male phenotype, did not develop normally was attribute to a lack of either testosterone or it's derivative, dihydrotestosterone. 

But then, there is the case of people who make testosterone perfectly normally, but still have a problem.

 

On the Metabolic Research Center, a ward at The New York Hospital, run by Dr. Maria New and Dr. Imperato (who became Imperato-McGuinley) about a dozen patients were admitted during my student days who came to the hospital because they had not had menstrual periods. Not ever. They had "primary amenorrhea."

On physical exam, they had blindly ending vaginas and no uterus. They looked to be completely normal females, otherwise, apart from sparse pubic and axillary hair.

But when their pelvises were surgically explored instead of ovaries, what was found were testes, and their karyotypes were 46 XY.

And the students were again asked: What do we tell the patients? Are they men or women? 

In this case, the students readily agreed these patients were women, XY chromosomes or not. They sure looked like women and they all functioned sexually as women. They had no doubts about their own gender and laying the "chromosomal sex" thing on them seemed absurd. 

But how did they get to be so phenotypically women with the "wrong" chromosomes?

Their testosterone levels were, in fact, in the normal male range, in fact often in the highest ends of that range.

For this you need another concept: How does a hormone work?

In a very simplistic analogy, most hormones are like keys and they search for a lock into which they fit, and once they fit into that lock, they can turn on the ignition with a flip of that lock.  What happens "downstream" from the key in the lock, is usually protein production and the cell, if it's a hair cell on your chin, hair will grow.  If it's a muscle cell, it will grow big and strong. If it's a bone cell, it will grow and become hard.

These women have a malfunction in that hormone/receptor interaction: They have "complete androgen insensitivity" which is to say, they cannot respond to male hormone (testosterone or DHT) at all.  They have "receptor dysfunction." The key goes in the lock, but no ignition occurs.

As a student, I thought, "Well, these are the most female people on the planet, because even if you try to masculinize them, you can't do it."

But what if the patient does not have complete insensitivity to male hormone, what if some cells have receptors which can respond at least a little or maybe half way? That would be "incomplete androgen insensitivity."

EPISODE 3:  PUBLIC POLICY, RIGHT WING STRIDOR, TWITTER STORMS 

There are two famous cases of individuals who have become the poster people for Tucker Carlson and the rest of his mob.

One is Caster Semenya, who is a person who likely has incomplete androgen insensitivity. 

I cannot know, never having seen her and having no access to her medical records, but she looks quite completely female with respect to her visible external genitalia although she has powerful, well defined and bulky muscles. But many female athletes at the most elite levels have big, powerful muscles.  And yet every time (or nearly every time) Semenya runs in a track event, she defeats even the most powerfully muscled women running against her and she  breaks all the women's world records for that event.

Now, the thing about female world records is this:  Apparently, if you look at any given world record in track, say the 800 meter or the 400 meter or the 100 meter races, there are, at any given time, about 1500 male athletes in high school or college or beyond, who run faster times. Ditto for swimming races.

High level male athletes simply obliterate female world records. 

Which is not to say these female world record holders would not obliterate most males trying to run or swim in those events, but at the upper levels, two standard deviations from the mean, among elite athletes, there is a divide.

These are data which are "hard data" and can be measured in seconds. 

Even subjectively, Serena Williams, said the best male players, like Roger Federer, are simply beyond her. And, in a very unscientific way, just observing casually, when you walk into a bar and see a basketball game on the flat TV across the room, you know immediately if it's men or women playing. Testosterone delivers a strength and quickness and power unavailable to those without the same level of it. 

Which is why, presumably, we have women's tennis, women's golf, basketball and swimming.

What's the fun in running a race where the best women will in the world still predictably come in only fifth out of 10?

So we segregate  sports into men's and women's sports. 

This is a choice we make, for practical and social reasons. 

It should be noted: Both women and men make testosterone. Men just make a lot more of it by a factor of nearly 10 and they make it from age 13 so by the time they are in high school, men's muscles and nerves and brains and joints have all been bathed in a very different bath from what most women have experienced. 

One might argue this segregation of sports is unfair. We do not separate male athletes who play basketball into different classes based on their heights. We do not say, well, it's not fair for short men to be made to compete with tall men,  when the tall men have that inborn advantage.  We do not have professional 150 pound football and heavy weight football.

We do, of course, have weight classes for boxing and for wrestling, however.  We make distinctions for those sports. In general, when the winner can win by superior skill, as in basketball--a small man like Step Curry can pop in a basket from 40 feet away--then the need to segregate for inborn advantages seems less important. But in boxing and wrestling, where the contest between two equally skilled athletes is determined by strength and power alone, segregation may be seen as appropriate and fair. 

Before puberty, well trained, skillful girls can and do defeat boys in wrestling matches. But as soon as puberty kicks in, even the best girls are pinned by boys with half their skills. 

The difference between lamb and mutton is puberty.

But,  if we separate women from men in sports, for the sake of competition among more or less equals, then what do we do with Caster Semenya? 

Is she a woman? Should she be allowed to compete with women? In what category do we place her?

If her muscles have been conditioned during puberty and after as a male's muscles, is she not at a competitive advantage?

Or, consider the transgender swimmer, Lia Thomas, who grew up a male but then underwent transgender therapy.  

And what transgender therapy did she undergo? 

That is not so easy to tease out on the internet. 

But, for the sake of discussion, let us suppose she underwent orchiectomy (removal of her testes) and then got estrogen, so if you saw her undressed, she may not look male.

But her muscles have developed for years with the advantage of testosterone.

And she is breaking long held women's records and she is nearly indomitable in women's swimming. And her muscles may well have benefited from years of testosterone.

So, when the Tucker Carlson crowd howl and the Gregg Abbott Texans growl, do we reject their arguments simply because we know they are, overall, knuckle draggers?

They may, it must be admitted, have a point. 

And much as I am loathe to find myself in any position other than complete opposition to that mob, I'm not sure, looking at the record books, and being a fan of women's sports--let me tell you about women's softball someday--I'm rather at a loss.

Gender and Public Policy: A Miniseries for Undergraduates (Season 1)

Season 1:  Sexual Differentiation 101

NB: Editor's Note

This series was conceived as a series of lectures to interested undergraduates. The course would be open to all, from freshman to graduate students and its class size limited only by the fact that no grades would be assigned, and no credit toward graduation. It is what educators call, "An enrichment course." Which is to say, it's likely to have little appeal to the ordinary student because there is no payoff in terms of GPA, professional school admissions or academic prizes. "Lectures" are planned to be interrupted by questions, but students who stand must ask a question, as opposed to making a speech.

Season  1:  Sex and Sexuality--The Hook

When I was 24 years old, in 1971,  and still a student, the faculty presented for consideration a case of a 16 year old patient who had not had a menstrual period.  In medical terms, her problem was that of "primary amenorrhea."

She was lucky because she had been brought to The New York Hospital in Manhattan, which did not have much of an endocrine department, but it was home to a stellar biochemist, named Ralph Peterson, and the pediatric endocrine department had Maria New. In a very real sense, this patient had come to the perfect place to make her diagnosis. 

This was before CT scans or ultrasounds, so her internal organs could only be examined by physical exam, and exploratory surgery, and she was found to have normal labia, a vagina which ended "blindly," which is to say, which had no cervix at the north end, and her clitoris was described as "a small phallus." She was sent to surgery where no uterus or fallopian tubes were found but gonads were located in the inguinal canals and on microscopic examination, "early spermatogenesis" was noted. Her breasts were normal pubertal female.

A karyotype, which is a picture (in those days, literally a photograph) of the patient's chromosomes, revealed the normal complement of 23 autosomes and an X and a Y chromosome.  

The 2 main questions our faculty presented the students were:

A/ What is this patient's sex and its corollary: is there a difference between "biologic sex" and gender?

B/ What gender should this patient be "assigned?"

As students, we had learned enough to understand two things even before this riddle was presented us:

1/ We knew that during fetal life the collection of cells which start to form tissues, and ultimately recognizable organs, are something like Playdough, or wet clay, which start out as nubbins of primordial structures and gradually take shape into forms which we can see form, as gestation progresses into a heart, brain, gut and sexual structures and organs.

2/ With respect to sexual differentiation of primordial genitalia, in the absence of the effect of male hormones on developing tissues, the tissues "develop along female lines," which is to say, female is the default mode for our homo sapiens species. This is an important concept: without the action of male hormone on the nubbin of tissue which can become either clitoris or penis, the wet clay goes clitoris. 

3/ The production of male hormones occurs as the downstream products of at least three separate assembly lines which occur in the ovaries, testes and adrenal glands. At the beginning of the line is cholesterol, sort like a base frame for an automobile, with protuberances where wheels, then tires can be added, and the rest of the product can be assembled at each station along the way, and what moves the thing along the line, at each step are workers called "enzymes." At certain points in the lines, the assembled structure can be diverted toward an SUV or a sedan or a sports car: working machines with very different functions, but the origins for all of these different end products has a common origin, cholesterol.

The key concept here is that if you throw a block anywhere along these assembly lines, or you may think of them as roadways, there is spill over into the other pathways, like cars bailing out of Rte 95 when an accident slows down traffic, or going back to the assembly line analogy, if the process runs into a slowdown at one point, the thing on the line gets diverted from the sedan route down another line to the SUV route, so a lot more SUV's get made in this factory than is normal.

What Ralph Peterson discovered, running this patient's blood through his lab, was that there was a block along the road to Testosterone because there was a deficit of a specific enzyme, and as a result precious little testosterone got made during the patient's gestation, and if not enough testosterone is not made, normal quantities of dihydrotestosterone, which is the next step beyond testosterone, are not  made.) The entire androgen pathway was at least partially blocked. 

The patient's parents told Dr. New  their daughter had been a normal little girl, although, her mother added, "a classic tomboy."  She had preferred playing with boys, chasing them around and shouting "Bang! Bang!" shooting them with her finger gun, and climbing trees and she liked her hair cut short and did not like dresses much. "I just never felt much like a girl," the patient said.

That, I thought, was perhaps a bit more than "classic tomboy" and her remark would come back to haunt me years later as the "gender dysphoria" discussion arose, where patients began to say they felt like a man trapped in a woman's body (or vice versa) but for this patient, there was no real note of desperation, just simple observation.  

What had happened to the patient's genitalia was easy enough to appreciate: No androgen (male hormone) , no penis, no scrotum.

But what about her mind? Why did she not feel "much like a boy." This feeling stuff goes beyond structure to behavior, from anatomy you can see with your eyes to electrical activity in the brain.

The faculty had a hypothesis for that, but only a guess, really. They could measure hormone levels in the blood, but the brain is a black box.

The hypothesis was this: During life we all remember going through puberty, around age 12, or thereabouts, and we remember what that felt like. But actually, there are "three puberties" in a way, or at least three times when a surge in male hormones occur: Once around 6 weeks gestation, once shortly after birth to about 6 months and then the one we all know 12 years later. 

The faculty guessed this girl had enough testosterone during fetal life to "condition" her brain in a male direction, and that was enough to cause "tomboy" behavior. They emphasized that this did not explain tomboy behavior in patients who had normal biochemistry, which is to say "normal tomboys" may be tomboys for any number of reasons, and often embrace their female roles enthusiastically, later on, but maybe this patient had just enough of a surge of male hormone at a critical time during fetal life to play a role in this particular patient.

So the answer to question A was clear enough. The patient's "phenotype" i.e., what she looked like, what her genitalia looked like, was different from her "chromosomal sex." When the phenotype does not match the chromosomes, or the internal glands,  this is called "pseudohermaphrodism."  When both female and male organs are found in one patient, that is called "hermaphrodism." 

But what about question "B," her "gender"? 

What should the doctors tell the patient, and her parents, about her gender? Is she a girl or a boy, will she grow into a woman or a man? What should she grow into? Or, in short, is she a "she" or a "he?"

In those days, there was no option for calling her a "they" or talking to the patient or her parents about "gender fluidity."

The students (90% male) voted for "male." She was "chromosomally male" we argued, so her "biology" was male and she should be raised a male and live her life as a male. 

But the faculty had a different point of view: What do we mean when we say a person is "biologically" or "chromosomally" a male? We know the Y chromosome plays a role in sexual differentiation, but it does that by directing the production of certain hormones, and if the hormones that chromosome affects cannot be made, is the biology not altered? If the Y chromosome, for whatever reason, fails to do its job in directing the timely production of the right amount of the right male hormones, who is to say the patient is "biologically" a male?

And then there was the practical consideration, beyond any theory about what nature defines as a male:   As one of the faculty members said, holding up her pinky, "If this patient's penis is never going to be any bigger than the tip of my finger, she is never going to function as a male."

The faculty had, in fact, done one more set of tests on the patient: they infused testosterone into her and she did respond to it by growing hair in male places, on her chin and face.  So she could respond to testosterone; she just couldn't make much on her own, so she had "developed along female lines."  

Defining her as "male" because she had a Y chromosome in every cell was narrow minded, the faculty argued. The Y worked through hormones and this patient could not make those hormones. The fact she had testes rather than ovaries meant she'd never be able to have a child, but she could have sex with the vagina she had. 

Of course,  in those days, the doctors felt they had to "assign" her a gender, but, even in 1971, ultimately, accepting that advice was up to the patient and her parents.