Until seven years ago, when she was 40, Nancy Nangeroni lived as a man, which was not all that surprising, given that she was born, as she puts it, with standard male plumbing.
Unlike many transgendered people, who feel they are male but trapped in a female body or female stuck with male anatomy, Nangeroni felt she was male. But she hated it.
“From the time I was very young, I resented the restrictions that were placed on me because I was not a woman,” said Nangeroni, her skirt and long hair blowing in the breeze one warm, fall afternoon in Cambridge. Now, she said, she takes female hormones, lives with a woman (though she doesn’t “presume” to call herself a lesbian), and feels somewhere in between male and female.
But Nangeroni, a leading figure in the transgender movement and the host of the GenderTalk radio show, has not had sex-change surgery. Instead, she said, “I reserve the right to change my gender tomorrow. That’s part of the freedom that transgenderism advocates for.”
For most of us, answering the question, “What sex are you?” is simple. We feel sure we’re male or female, and we’ve got the anatomy to prove it.
Indeed, throughout the animal kingdom, most creatures fall neatly into one of two categories: Males, who make sperm and usually carry one X and one Y chromosome, and females, who make eggs and usually carry two X chromosomes.
But it’s the exceptions that make biology interesting – and make life difficult for people who don’t fit so clearly into one category or another. Gender, researchers increasingly realize, encompasses a host of possibilities including men who feel like women and vice versa, and people who are a little bit of both.
Transgendered individuals, who say they comprise about 1 to 2 percent of the population, usually face a conflict between their gender identity (the “Who am I?” question) and sex as defined by their anatomy. In short, many of them feel like they got the wrong sexual plumbing, perhaps because of some misfire in the complex process by which the fetal brain becomes masculinized or feminized. The idea that men and women have different brains is far from roven, although scientists do know that sex hormones do play a role in brain development.
Some seek a sex-change operation to end the conflict, but others live with it, appearing to the world as ordinary heterosexuals.
For Nancy Nangeroni, gender expression certainly involves an element of choice, but it’s not just a political decision. “It’s a very personal decision,” said Nangeroni, who holds a degree in electrical engineering from the Massachusetts Institute of Technology.
As a young person, Nangeroni spent years dressing as a woman, “something I did as a compulsion.” Then, in her late 20s, she said, “I had a terrible motorcycle accident. And the accident was a direct result of the terrible depression and self-hatred that I had because I was cross-dressing in secrecy and great shame. With that accident, I recognized that it was really important for me to do something about the gender issues. I had to make some kind of change.”
Eventually, she decided to live openly as a woman. But it wasn’t easy, and she never felt that “after living for 38, 39 years as a man that I could just flip a switch and all of a sudden be a woman.”
For other transgendered people, the issues are physical as well. Some people are born intersexed, that is, with features of both male and female anatomy, an agonizing situation in which parents and doctors sometimes try to figure out which tendency is dominant and surgically make the child’s body conform to that.
In some African populations, there are also true hermaphrodites, people with two X chromosomes (the typical female genetic pattern), but who look male because they have penises and testicular tissue (though they have ovarian tissue as well.).
There are even cultures, such as in the Dominican Republic, where people recognize three sexes: male, female and people who are born looking female (they have no penis or visible testes) but at puberty produce so much testosterone, a male hormone, that the clitoris turns into a penis.
To many lay people, the idea that something as seemingly basic as sexual and gender identity can be so complicated is often disturbing. And scientists are far from being able to explain why there can be such variation. But they do have some clues.
In a basic sense, sexual fate is set at the moment of fertilization by the incoming sperm. The sperm carries either a Y chromosome, which determines maleness, an X chromosome, said David Page, a geneticist at the Whitehead Institute in Cambridge. (The egg always contains one X chromosome, resulting in XY chromosomes for boys and XX for girls.)
The fascinating thing, though, is that “for the first six or seven weeks of development after the egg is fertilized by the sperm, XX and XY embryos look exactly alike. There are no differences,” Page said. A 6-week embryo has the full potential to become either a male or a female.
At this stage, the embryo has both male and female internal structures. One of these – the Mullerian ducts – has the potential to become fallopian tubes and a uterus; the other – Wolffian ducts – has the potential to become the sperm-making machinery and tubes to carry sperm.
Early embryos also contain primitive gonads that are capable of turning into either ovaries, which make eggs, or testes, which make sperm. “But, at about seven weeks, the embryo sort of takes stock of whether it got that Y chromosome seven weeks back at the moment of fertilization,” Page said. On the Y chromosome lies a key gene called SRY, which stimulates the primitive gonads to become testes. If the SRY gene is not present, the gonads become ovaries.
Once testes form, they begin pumping out the male hormone, testosterone, which causes the Wolffian ducts to become the sperm production and transport system. The testes also pump out a chemical called MIS that causes the Mullerian ducts to shrivel up, so they cannot form fallopian tubes and the uterus.
As fetal development continues, male and female hormones then imprint the brain, nudging it toward masculinization or feminization. “One of the things we believe is that it is more common for men to become female in transgender change than for females to become men,” said Dr. Marshall Forstein, medical director of Fenway Community Health in Boston. “If something goes wrong in [the fetal development] process, or something is variable in that process, some of the brains of those men don’t become masculinized at the appropriate development time: Their brains are female, even though their bodies are male.
“So far, however, the idea that incomplete brain imprinting causes transgenderism is merely a hypothesis, and it makes some transgendered people like Nancy Nangeroni and Joan Roughgarden, a Stanford University biologist who now lives as a woman but was born male, cringe because it suggests that there might be something wrong with them. They also strongly dispute that men are more likely to be transgendered than women.
“Medical people are the worst,” Roughgarden said. `They don’t know any biology or zoology. They just superimpose their preconceptions on the data. They try to construct a norm and pathologize all states that differ from the norm.”Instead of speaking of one gender or another, people should think in terms of a “gender rainbow,” she said. Transgendered people “view rigid categories as tools of oppression.”
Nancy Nangeroni agreed: “There’s not just black and white. There’s every color of the spectrum. Likewise, there aren’t just two genders.”The real mission of the transgender movement, she said, is to challenge the way we think of gender and the gender restrictions that we put on individuals.Ultimately, she said, “gender expression is a form of speech. It’s not spoken, but it’s a form of speech that should be constitutionally protected.”
Judy Foreman’s column appears every other week in Health-Science. Her past columns are available on Boston.com and myhealthsense.com. Her e-mail address is foreman@globe.com.
SIDEBAR: Identity, Orientation Issues Cause Confusion
Many people confuse the terms sex, gender identity and sexual orientation.Sex usually refers to physical characteristics, such as a penis or vagina; sometimes it also refers to the chromosomes – XY for males, XX for females.”Gender identity is how people describe themselves. `I’m a man’ or`I’m a woman,’ ” said Dr. Marshall Forstein, medical director of Fenway Community Health. “So, the term gender is filled with all sorts of social customs.”Sexual orientation is about whom one is attracted to. And “gender identity is a totally separate issue from sexual orientation,” said Laura Berman, a sex therapist in the department of urology at the UCLA Medical Center.In other words, Berman said, a person can have a mixture of traits: “You can be male but feel female and be attracted to either men or women. You can be female and feel male and be attracted to either men or women. You can be male and feel male, but be attracted to men. And you can be female, feel female and be attracted to women.”
Cross-dressing, that is, dressing as the opposite sex, can also cut across categories. For some straight men, dressing as a woman may be erotic. For some transgendered people, it may be the first step in living fully as the opposite sex.