Campus, News

BU researchers find biological basis for transgender identity

Researchers at the Boston University School of Medicine found evidence that gender identity is biological, according to a Friday press release. GRAPHIC BY SAMANTHA GROSS/DAILY FREE PRESS STAFF
Researchers at the Boston University School of Medicine found evidence that gender identity is biological, according to a Friday press release. GRAPHIC BY SAMANTHA GROSS/DAILY FREE PRESS STAFF

Researchers from the Boston University School of Medicine published a review concluding that there is a biological basis for transgender identity, according to a Friday press release.

The review, published in the journal Endocrine Practice on Feb. 9, contests the notion that transgender people choose what gender they prefer. Evidence that gender has a biological basis may improve health care, including surgery and hormone treatment, for transgender patients, the release stated.

Joshua Safer, the lead researcher and a professor at BUSM, said doctors are often overwhelmed when dealing with transgender patients. Medical practitioners often prefer to direct such patients toward psychological counseling, he said.

“It is still the case that the largest barrier for transgender [individuals] getting medical care is the lack of access to physicians who are knowledgeable and comfortable providing that care,” he said. “What’s concerning these providers is a sense that [treating them] is too complicated, and that they think this is a mental health concern.”

Gender identity disorders affect as many as 1 in 100 people, the release stated.

A second-year BUSM student who also worked on the study, said the most difficult part of the study is the current nature of the field.

“There is not enough research being done currently on the health of gender identity minorities, including those who identify as transgender, and hopefully we can see this change in the future,” he wrote in an email.

Safer said this conclusion could alter the way physicians work with transgender patients or patients that are born with a gender they do not align with.

“If you realize that gender identity, to a large extent, is a biologic phenomenon, then you aren’t going to say, ‘Oh you should just deal with it,’” he said. “You’re going to want to know what is the most logical intervention based on success.”

The BUSM research team for this review will head to Washington, D.C. in May to attend a conference at the National Institutes of Health to present their findings and request funding for further research, Safer said. Members of the NIH are hoping to develop a national database of transgender people to see what trends appear from different types of intervention.

“They want to know what kind of things we could be learning over the next five or ten years depending on how much money is available for research, and the purpose of this conference is to set that strategy and create some priorities for NIH,” he said.

Several BU students said they were not surprised by the review’s findings and agreed that being transgender is more biological rather than psychological.

“More power to them,” said Annabel Kupke, a sophomore in the Sargent College of Health and Rehabilitation Sciences. “I do think there’s a biological basis to being transgender. I don’t think it’s a choice. It’s nice to see that people have backed that up.”

Emily Lawson, a senior in the College of Arts and Sciences, hopes this research reaches people who are not so familiar with transgender identity.

“I would hope that this makes an impact on those outside of the [LGBTQ] community,” she said. “They are the people that need to be aware of this kind of thing, not the people inside the community.”

CORRECTION: A previous version of this story misquoted Joshua Safer in his first quote. The story has been corrected to reflect this change.

CORRECTION: A piece of identifying information has been removed at the request of the interviewee.  


  1. Jerome Klobutcher, MD

    Please provide the link to the journal article so that I can see the whole thing. Thanks.

  2. Jerome Klobutcher, MD

    That is concerning the Boston U. article’s review of a possible biologic association with transgender.

  3. There are a number of identities with in the transgender community and the largest part of the community those that identify as cross dressers will most often not present with problems. The smallest portion of the community those that identify as transsexuals receive virtually all of the attention and research.
    Not correctly citing the original research makes it difficult to tell if this was done properly.

  4. Sandra, I agree. With the continuing morphing of the language around transgenderism, I sit here wondering if their research concentrated on transsexuals or the entire spectrum. If it is the entire spectrum, then their 1 in 100 seems low based upon some recent statistics from several school districts accommodating trans students.

  5. Agreed that “We need to reverse this trend of transgender people receiving inadequate and uniformed care.”
    There are a plehtora of organizations and individuals doing good work to inform and educate on Transgender needs. There needs to be more work on best practices for health providers working with transgender and gender non-normative people.
    On a local level here on the central coast of California Max Rorty facilitates trainings for large and small groups of professionals eager to provide transgender sensitive care. She is the author of Transgender Patients and Their Families, and co-author of Trans-Safe Employee Space.
    On the State level there is an ongoing study “The California LGBTQ Reducing Mental Health Disparities Population Report.” “First do no Harm: Reducing disparities for LGBTQ and questioning populations in California.
    Sorry for the long winded title.

  6. Dr. Klobutcher; if you click on “The review” (first words of the second paragraph in this article), it is a link to the journal paper.

  7. I also would like to see the Journal article. Just coming into this with my Grandchild who now is 6 but knew at 3, I can see people are mixed up when I talk to them. I need something concrete to explain and how to direct their minds out of the realm of “gay”, cross-dresser, “no the parents did not do this to her”. To “can my child catch this? so we won’t invite her to the birthday party till we find out…” I myself was ignorant on the fact that there was a word “transgender” and responded with “what’s that?” This is where most people are still coming from in my area which incompases Michigan and Ohio. The beginning facts of knowledge are still not out there enough. We need to be educated from the beginning not from the middle. Perhaps the Article will help us on this. I also don’t like to hear from smart, educated people say, “I THINK being transgender is Biological and not Psychological” Come on, your the educated ones sitting there saying “I THINK?” when you should be saying by now “I KNOW”. At lease say “I BELIEVE,” How can we be confident in our explainations to people if you don’t have your own confidence. THANKS FOR ALL YOUR ARE DOING.: A CONCRENED GRANDMA

  8. “Evidence that gender has a biological basis…”

    What other basis would there be? Spiritual? Magical and superstitious nonsense. “psychological?” The mind is what the brain does and the brain is biology. Psychopathy and depression have biological basis too. Saying that there is a biological basis that has been uncovered that is associated with transgender identity does not prove causation or that the state can’t be a pathological.

    The sad fact is that those who are intersex are getting ignored and overlooked due to the often selfish antics of many who identify with a transexual identity. This reminds me of why I don’t stand with the so called LGBT “community” crowd though I am bisexual. That community is often extremely unwelcoming of bisexuals and the way they slap the B in there is so disingenuous it beggars belief and the T was slapped on with even less consideration. The amount of prejudice among many of its members show it to be the last place to find a real approach to equal rights and social justice.

    • I believe the transgender condition to be of a neurological intersex nature. I myself am transgender and have read the peer reviewed articles on brain structure differences and the like. It is the most likely cause.

      As for the LGBT crowd, I’ve found it similar to how you describe. As a somewhat androgynous transwoman, I found myself being told that I couldn’t be a woman because I don’t do all these stereotypical woman things (never mind that I don’t do stereotypical man things either). Why people have to fit into perfect little boxes to be accepted by a community that claims to accept us all is beyond me. I’m sorry for your experience, regardless.

    • Amen to that. I don’t think the “gay” community cares anything about what those words mean in LGBTQ unless you’re talking about being gay. And if someone, especially celebrities, appear bisexual, all they want to do is try to out them as gay. John Travolta is one who they consistently scream as “gay” and want him to come out of the closet. First, it’s his business. Second, you NEVER hear people suggest he may be bisexual. What hypocrisy.
      And, I love your statement “Saying that there is a biological basis that has been uncovered that is associated with transgender identity does not prove causation or that the state can’t be a pathological.”

  9. The hyperlink “review” in the article takes you to the source where the complete research paper can be downloaded for $30. The first page of the study is available for free and gives important information in the abstract and introduction which are complete on this first page. The “study” was not original research, but simply a review of current literature. Apparently, there is nothing new scientifically that substantiates a biological origin for the transgendered condition.

    Again, we have been fed a Major Headline that promises more evidence for something but turns out to be a re-packaging of old conjectures.
    Here’s what the Abstract says:
    Objective: To review current literature that supports a biologic basis of gender identity.
    Methods: A traditional literature review.
    Results: Evidence that there is a biologic basis for gender identity primarily involves (1) data on gender iden- tity in patients with disorders of sex development (DSDs, also known as differences of sex development) along with (2) neuroanatomical differences associated with gender identity.
    Conclusions: Although the mechanisms remain to be determined, there is strong support in the literature for a biologic basis of gender identity. (Endocr Pract. 2015;21: 199-204)

    • The article says it’s a literature review, and that’s exactly what it is. There’s no need to say it’s a “study” in scare quotes as if that’s a misrepresentation; literature reviews are a completely legitimate component of modern scientific writing.

  10. If transgender identity is biological, doesn’t that suggest further research could find a medical cure that did not require surgery? Many illnesses that are caused by chemical imbalances (biological) have been cured by medication, not surgery. When that possibility is put to the transgender community, the response is one of shock and dismay. Transsexuals are horrified at the idea of living at peace within their God-given/nature-given bodies.

    • Note the connection between “biological” and “nature-given”.

      The other key word you use is “identity”. I.e., this is what defines you as a person, your inner soul. How would you feel if medical professionals declared your soul as inherently faulty, and started trying to cure it? Doesn’t that strike you as unethical?

    • The “cure” isn’t surgery. Do more research.

      If there was a magical cure that could align my biological sex and gender identity, I’d be all over it. Many of us would.

  11. A more likely response is abortion if the condition can be identified prenatally. I wonder what percentage of expectant mothers would choose to have an abortion if they were told that their baby had an elevated risk for being transsexual?

  12. “Gender Identity Disorder” is obsolete terminology that marginalizes trans people. Difference is not a disorder.

  13. The fact that there is biological basis for GID does not necessary mean it may be cured by medication, the same as you know a fire is the cause of a burnt tree does not make you capable of resurrecting the tree.

  14. Annabelle Bradley

    Firstly, the very fact that such a response is so strong should make you realise how important it is to get proper medical attention. The best we have at hand is counselling, hrt and possible surgery. Do you aim to deny medical intervention until a “cure” is discovered?

    Secondly, there are many biological conditions that remain treatable but not curable. Again, would you deny these people treatment until they are “cured”?

    You’re very post suggests that you have difficulty in allowing people to change their appearance to feel more comfortable with themselves, or take medication to improve a biologically based depression.

    I am sure you are not strict enough to rewuest people never shave or wear clothes. So wjat was your problem with transgender people again?

  15. Proud lgbtq member

    There may be a biological base to gender identity but gender identity is in my belief on a spectrum for gender and sex are not synonymous. I have a few interesting studies on the topic, if i am not mistaken “Judith Lorber” was the author found on EBSCO host.
    Either way my thoughts are such. The have found a biological base great i guess except now with More research they will attempt to find a cure through medication.that is quite disconcerting given the fact that the trans community just want to be accepted in the skin they are in. What of the story of david reimer….did we forget the tragic tale where lets be honest that made Dr.Money famous…
    A very good friend of mine is a openly trans woman and i my friends am a lesbian. Often our conversations go to how inadequate she it’s made to feel which is quite unfortunate. This society needs understanding and acceptance. Not an explanation. If she feels like a woman call her one and as i do with my good friend just like all woman like call her beautiful. Remove the stratification don’t compartmentalize and try to understand. Support them their journey it’s a difficult one too often ending in depression or as the story “the boy without a penis” suicide.

    Be their family or friend

  16. This is meaningless. The “study” was simply a review of available literature. Any fool can read the available (though limited in scope) science and understand that Transsexualism is biological in nature.

  17. A.Female, fact is that male and female brains are physically different. Men’s brains and women’s brains are actually composed of different types of tissue and they use different parts of the brain for different things so it’s not as “simple” as a chemical imbalance.

  18. Doesn’t the fact that researcher admits to being part of the community that is being researched invalidate it? Unfortunately research is always subject to precept bias & when this is present we often see what we want to see & find what we want to find.

  19. I consider myself to be a Gender Queer man. Like the 20+% of Transsexuals in the country, I did serve in the military when I got out of High School. I’m pretty Conservative unless we’re talking about LGBT issues and the Environment. I have loved fashion since I got out the military and had time to reflect on me. It’s been 16 years since I got out… and only 2 years since I’ve been more accepting of me being me. Would I prefer to be a woman? I certainly think so, but due to current technology levels…I think I’ll wait for my next life. It’s quite an odd feeling being attracted to a say…a Victoria’s Secret model and also not minding being the model. I’m thin, take care of myself, dress wearing skinny jeans and Sperry’s mostly and occasionally add makeup that’s appropriate for the setting. I’m a classy guy. LOL
    I like to say… if you liked David Bowie back in the day, you’ll love me.

    There’s an issue with Medical care, true… But I feel the biggest threat for Transgendered people is employment. Currently back in school finishing up a Business Degree, I’m worried how hard it’ll be for me to get a well paying job that promotes on ability, not on the fact that I may put on a colored nail polish from a salon. The ability of being me, is hugely important as I feel that my anxiety needs the release. Which is why I’m looking to open my own business. Time will tell.

    ( What I learned just this past year, is kinda a biggie with all this… My father had 4 sisters and while the family has split up over the years, what came to light to me recently, is that my lesbian cousin, came out as transgendered to me and I also found out another cousin has been living as a man (FtM) for the past few years and is married to a woman. All three of us, are the eldest child born to each parent. )

  20. I’m a trans woman. I can’t believe the level of misinformed opinions in the comments above. If you don’t know something, please stop stating your opinion as fact! Instead of sounding like a dummy, ask questions, do some research.

  21. Another trans woman here. My case should provide an interesting point for differential analysis since I feel complete indifference towards the social construct of gender; in other words, although my mind sees me as a woman when it comes to implicit associations, the fact has no correlation with how I express myself (through choice of clothing, behavior, or interests, all of which are largely androgynous). My issue is only with the body, and even more specifically with the hormone levels.

    I used to have a bad case of gender dysphoria related to my body. Before starting HRT I thought that it works by making the external appearance more congruent with the internal image, thus reducing dysphoria. This might be a relevant mechanism for some people, but when it came to my case there was a huge surprise ahead. There aren’t any externally observable changes during the first few months of HRT, but despite that it took only about two weeks for my severe dysphoria to turn into equally intense euphoria. While that initial rush eventually subsided, at least mostly, the general well-being and sense of being in harmony with my body endures. The difference in the quality of life is so large that I couldn’t possibly survive a reversal to that pre-HRT existence.

    After all the gender deconstructing that I have done the bottom line is this: the single most important sex-differentiated trait that describes me is that having testosterone in my system makes me feel utterly miserable and disconnected from my body, whereas having estrogen in my system makes me love my corporeal existence. Everything else is negotiable. I don’t much care which labels other people apply on me based on that, because those labels tell more about the particular applier than about me, anyway.

    So, as a reply to A.Female: yes, there is a medical cure to my dysphoria and I’m using it right now, with spectacular results. Getting a bit prettier along the way is just an added bonus. And concerning that surgery, although it isn’t a high priority issue to me I’ll probably go for it at some point, if for no other reason than the fact that my brain is hard-wired to expect female anatomy (long story) and the incongruent body configuration feel rather distracting.

  22. “There aren’t any externally observable changes during the first few months of HRT, but despite that it took only about two weeks for my severe dysphoria to turn into equally intense euphoria.”

    Kinda begs the question if there could be a Placebo Effect involved here. Don’t get me wrong, Terhi: I’m happy for your happiness (however acquired)!

  23. Tell us something we didn’t already know!