Eastern Virginia Medical School, Norfolk, VA 23507, USA
The issue is whether to offer donor insemination (DI) to a couple in which the male partner is a transsexual. As mentioned by Brothers et al. (Brothers et al., 2000), the partner was a true transsexual, i.e. an individual whose own sexual orientation was contrary to the standard markers of sexual identity, i.e. chromosomes, anatomy of the external genitalia, anatomy of the internal genitalia, anatomy of the gonad, hormones milieu, and sex of rearing. Such patients are quite refractory to psychiatric therapy and, in addition to the sexual orientation problem, often exhibit other disorders, including antisocial behaviour.
Surgical sex reassignment has been used to ameliorate the terrible inner conflict these patients experience with regard to their own sexual orientation. Such surgery is quite often successful in handling the sexual orientation aspect of the disorder.
When I was active in the surgical aspect of sexual reassignment, it was the opinion and hope of the consultants in psychology that surgical sex reassignment might correct the associated disorders. I clearly remember one patient who seemed to be a typical transsexual but who engaged in petty thievery. It was the hope and expectation of our consultants that if we could correct the sexual orientation problem that the antisocial behaviour would also disappear. In actuality, we simply converted a male thief to a female thief.
The point of all this is that the matter of sexual orientation of the principal and of the offspring is not the entire issue. The question is what responsibility does a programme of assisted reproduction have for the entire orientation and welfare of any offspring. Studies of the surgical result as by Banzet and Revol (Banzet and Revol, 1996), quoted above, or of the sexual orientation of offspring as by Green (Green, 1978
), also quoted above, give us only partial information. It is necessary to realize that there are no studies (repeat no studies) which will inform a programme of the outlook for a child reared by a transsexual parent.
This is not to say that such patients should not be evaluated on an individual basis. It does say that the evaluation should include factors other than sexual orientation of the parent and prospective child, as most patients with transsexuality seem to have additional types of aberrant behaviour. It would be very likely that the rejection rate should be very high.
Notes
This debate was previously published on Webtrack on February 16, 2000
References
Brothers, D., Ford, W.C.L. and the University of Bristol Centre for Reproductive Medicine Ethics Advisory Committee (2000) Gender reassignment and assisted reproduction: An ethical analysis. Hum. Reprod., 15, 737738.
Banzet, P. and Revol, M. (1996) The Surgical Experience. Bull. Acad. Natl. Méd., 180, 13951402.
Green, R. (1978) Sexual identity of 37 children raised by homosexual or transexual parents. Am. J. Psychiat., 135, 692697.[Abstract]