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Dr. Harry Benjamin

Harry Benjamin Syndrome, also known as transsexualism, is a pseudo-scientific psychiatric and medical condition that proposes that transgender people have different brains to cis people.[1] It is part of the cissexist ideology of physician Harry Benjamin, from whom it takes its name.

The underlying pseudoscience behind Harry Benjamin Syndrome has been completely debunked. However, it and its legacy are nonetheless still used to oppress and marginalise trans people, especially non-binary individuals, both from inside and outside the trans community. Members of the trans community who believe in and advocate for Harry Benjamin Syndrome are sometimes referred to as HBSers.[2][3]

History

Harry Benjamin Syndrome was coined by members of the transgender community after Harry Benjamin, a pioneer in the field of transgender care.[4] He mistakenly believed that "transsexualism" (i.e., being trans) is a medical condition arising from a "mismatch" between brain development and assigned gender (e.g., "a woman trapped in a man's body").[1] Under this framework, trans women are described as people with "female" brains in "male" bodies and trans men are described as people with "male" brains in "female bodies" (no description or recognition for non-binary people is given).

In his opinion, the most appropriate treatment for this condition is a combination of hormone replacement therapy (HRT; e.g., testosterone blockers and estrogen for trans women) and gender reassignment surgery (GRS; e.g., surgery to create a neovagina). Under this theory this would help to "realign" their bodies with their so-called differently gendered brains.[1]

The reasoning behind this is deeply cissexist, based on flawed neurosexist assumptions. Unfortunately, such pseudo-scientific assertions are still widely believed, despite having been shown to be damaging to trans people individually, the trans community, and to all women, who often bear the brunt of neurosexist tropes.[5]

Details

Benjamin described three primary traits for "transsexualism", all of which are required in order for somebody to be classified as a "true transsexual:"[1]

Social transition is completed.

Hormone therapy provides "insufficient relief."

Immediate need or desire to undergo some form of GRS.

Benjamin further divided his definition of a "true transsexual" into two categories: "moderate intensity" and "high intensity" with the significant difference being in sexual orientation as defined by the Kinsey scale with a "moderate intensity" individual scoring 4-6 and possessing a low libido or being asexual and a "high intensity" individual scoring 6 and desperately wanting romantic and sexual relationships with "normal males" or being asexual.[1] Benjamin's classification scheme applied culturally heteronormative standards to a person's sexual and romantic orientations and focused heavily on trans women, hence the emphasis on romantic and sexual relations with "normal men" and further emphasis on passive sexuality. Trans men, when included, were described as having very high libido and being "ardent lovers, wooing their women as men do, but not as lesbians, whom they often dislike intensely."[1]

Under Benjamin's ideology, any transgender person who doesn't meet these criteria is not a true transsexual and is either suffering from a delusional state, a paraphilic sexual disorder, or is merely pretending to be transgender.[1] This includes all trans people with non binary identities, late transitioners, including trans people who did so because of a later realization of their being transgender, non-heterosexual trans people, trans people without dysphoria relating to their genitals or any dysphoria at all.

The traits laid out by Benjamin are, unsurprisingly, common gatekeeping criteria as Benjamin was a primary contributor to the codification and inclusion of the diagnostic criteria for transsexualism and gender identity disorder first published in the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).[6]

Criticism

The idea that underlies Benjamin's view, a form of neurosexism, reductionism and gender essentialism, has now been debunked. While so-called "male" and "female" brains might have some differences, as with everything to do with brains they are largely a function of socialisation, culture, experiences, and personality.[7][8][9] Brains show a significant lack of differentiation by gender in brain connectivity prior to age 14.[10] Prenatal brain development is largely undifferentiated as a function of presumed gender based on genitals.[11]

Had Benjamin's theory been a plausible account of how gender is represented in the brain and mind, significant and consistent differentiation would exist as a function of gender, with cis/trans women and girls clearly dissociating from cis/trans men and boys, and neuroimaging techniques such as functional magnetic resonance imaging (fMRI) would be able to be used to diagnose a person's gender regardless of their own external appearance, and self-identity. Both these predictions are the result of a deeply flawed understanding of how concepts in general, and specifically gender, are represented in the brain. Since gender is a social construct looking for neural correlates of such a social-level phenomenon will fail to find what the researcher is looking for, akin to looking for a gene for liking Pokémon. This is similar to non-neural gender essentialism, wherein gender is diagnosed as a function of reproductive organs at birth. Both kinds of essentialism lead to coercively enforcing gendered patterns of behaviour onto children, resulting in a reification of the gender binary. This causes both cis and trans people to internalise oppressive ideas about their own gender, body, and character.

See also