the medical questions of studying the transgendered

With the media fascinated by Bruce Jenner’s transition from male to female and Laverne Cox’s photo shoot for Allure intended to inspire others struggling with gender identity issues, there’s a rare discussion of what it means to be transgendered. More importantly, if someone decides to transition to another gender, what can science do to make this person feel comfortable in what would basically be a new body after all the hormone therapy and surgeries? And what can the kind of technology still in infancy, but barreling towards clinical testing, offer in the foreseeable future? Could modified viruses for gene therapy turn males into females and vice versa? Could printing new organs produce an entire new reproductive system? In short, would gene therapy and printed organs and tissues make the transition more complete?

Despite offering us a way of manipulating the fundamental building blocks of life, they would be dealing with an entire body which developed not just from reading the genome and translating the codons into proteins, but from environmental cues, triggers, and anomalies. Even using the same homebox genes to define our body plans doesn’t quite get you a full instruction set for a human body so changing these genes after the body is formed is unlikely to have much effect. Such genes are like Lego blocks you get to arrange once. Each gets you a finger, a toe, a foot, or a leg, etc. During development you could use chemical signals to tweak them and assemble them how you want. But after they’re finally locked into place, things are more of less done and the formed structures would need to be modified mechanically, i.e. surgically.

We don’t yet know if it’s possible to change a Y chromosome to an X, only that it’s possible for our modified viral agents to silence or promote gene expression. And even if we could, there’s not going to be a mechanism for a penis to suddenly become a vagina or the other way around because, again, these structures are now in place. Surgery would still be the only way to make this step of the transition until we can figure out some sort of nanotechnology to do this, though we could argue that this will also be a form of surgery, just a much less outwardly invasive one than scalpels and saws. And by now it should really go without saying that we couldn’t naturally induce a different reproductive system to grow. But what if we print one, or grow one, using the patient’s modified stem cells, then implant it? Would this work?

From an engineering standpoint, it seems like it would, and after extensive hormonal therapy, they might work as they should, and allow something as radical as a trans-man to impregnate his partner or a trans-woman to become pregnant or give birth. However, there’s a catch. We know how to make the organs but have no guarantee that such complex organs could grow in the lab and function without a hitch. Creating viable germ cells and supporting a gestation don’t seem so complicated to us at first blush because it seem so natural as to be troublesome and leads us to trying to figure out how to stop both until we want them to happen. But consider the fact that if we knew what’s necessary to support a pregnancy, we could create artificial uteri to allow premature babies to develop fully rather than place them in incubators to support them in development and hope for the best. A uterus grown in a lab would seem like a good shortcut at first blush, what ethics board would permit the necessary experiments for clinical studies?

So what’s the takeaway here? For those struggling with gender identity and wanting to make a transition to another sex, there’s a lot of promise in new medical technologies being developed today and on paper, it looks like a complete biological transition could be in the cards. But this technology is not quite there yet and there are so many questions to answer that it will be more than a decade at the very least before we can even think about using them in clinical practice. I would say though, that helping and studying transgender issues raises so many interesting and widely relevant questions, it would be a disservice to the future of medicine not to explore them because answering them will help us understand that does being male or female mean, as well as offer treatments to many reproductive conditions and anomalies, like infertility, ED, or even replace reproductive systems destroyed by cancerous tumors with a brand new one. In other words, transgender people could be a reproductive researcher’s Rosetta Stone…