Better at verbal skills. And that bys are better at spatial performance. So those are the ster why types, now what does the rel data show. The most recent data show actually that girls are tied with boys now in mathematical performance. Rose episode three of the charl yae rose brain series three underwritten by the shown Foundation Coming up. Funding for charlie rose is provided by american express. Additional funding provided by and by bloomberg, a provider of multimedia news and Information Services worldwide. From our studios in new york city this is charlie rose. Tonight we continue our exploration of the magnificent human brain with a look at gender identity and the biology of the brain. Gender identity ask a persons subjective experience of their own gender. It may or may not correspond to the sex assigned with them at birth. The term transgender describes someone who feels his or her body and gender do not match. It is estimated that about 700,000 transgender people live in the United States. One of them joins me today to share his experience, ben barres is professor and chair of neuro biology at standford, he lived and works add barbara barres until he changed his sex to male in 1997. Also here a Remarkable Group of scientists norman spack of boston Childrens Hospital kathryn dulac Melissa Hines and janet hyde of the university of wisconsin at madison. Im pleased to have all of them here and to begin this conversation with my colleague eric kandel. What are we going to talk about. Reporter were going to speak about gender identity and the biology of the brain. This is a marvelous topic. And i like it in particular because it shows how Brain Science can be a liberating influence in our life. As we understand the biology of our own gender identity better and become more comfortable with ourselves we become more empathic to somebody elses gender identity and we can understand if all of a sudden at age eight nine or ten a person says im in the wrong body. We really can sympathize with them and understand wass going on. But this is not only an interesting topic its an unbelievably timely topic. When you an i first began talking about this six months ago it was not on the radar screen. We were ahead of our time. Rose an here with vanity fair magazine. But now you cant pick up an issue of the New York Times or vanity fair without having a discussion of gender identity. An 17 Million People watched the diane sawyer interview. And what we can bring to bear on the subject is to the only a deep discussion of what the sort of psychological and social logical issues are but what the biological underpinnings of that is. When we begin to speak about the biological underpinnings we want to distinguish as you already implied two different concepts. Anatomical sex and gender identity. An tomorrow cag sex is the body parts associated with sexuality and reproduction. Againer identity is a more subtle complex image that is a sense of one ofs self as a male female or something else. Lets begin with the anatomical sex. Anatomical sex is determined not surprisingly by our genes. Genes are arranged in chromosomes and we have 23 pairs of chromosomes. We get half from our father we get one pair from our father and one pair from our mother. 22 of these are called odosomes and the difference between the fathers and mothers contributions are real but theyre modest. But the sex chromosomes the difference val quite profound. Women are xx and men are xy. The chromosomes are really quite different than the odosomes and they have a very important function in determining sex. Lets begin with a y chromosome and see how that determines the sex of the male. We were born with an undifferentiated gonad that can move in either direction it either can develop into t testes or ovaries, if there is a y chromosome there it has a region in it which is called the sex determining region of y that contains a gene that activates the differentiation of the undifferentiated gonad into the testes. If that y gene is not there you have an xx you have a female gonad develop. And each of those has profound consequences. Lets look at the male differentiation first the male testes. It develops within the first seven weeks in utero and if it pa tures as a result of the sex determining region of y the testes releases a massive amount of testosterone comparable to the level that you have as puberty in the adult. And that is responsible for giving you the male body form the brain characteristic of male functioning as well as having actions of sort of every aspect of your being. If this 6th determining region of y is not there if you have xx you have development of the ovary it in term secrets estrogen and were guest rone and gives you the female body form and gives you changes in the brain. So clarely these are extremly important changes. And thats the easy part. This is the anatomical part. The more subtle the more elaborate part is the gender identity. And thats why we brought together this spec tabling lar group of people to talk about that. As you pointed out, we have ben with us, ben say longterm colleague. Hes a major scientist in my field n brain finds also in catherines field. And he is chairman as you pointed out, department of standford, member of the National Academy of science an a transgender person. He made a decision in the 40s to undergo a bodily change and he can tell us what it is like before when he felt he was in the wrong body and how he feels now. He not only can tell us how he feels but interestingly enough since people naw him as a scientist before he yun went this change they can describe what he was like interacting with hims a woman an now interacting with him as a man. We have norman spack with us. He is one of the pioneers in the United States of pedestrian atic endocrinology without can help people make a decision as to whether or not they should go on with their idea that theyre in the wrong body and actually lead to transformation. And he has adopted a european strategy and really applied it in the United States of postponing puberty so people can think through what they actually want to do. And make the decision in an intelligent and thoughtful fashion. And the reason he wants to delay puberty is once puberty forms its a much more radical procedure than if you proceed before puberty. We have Catherine Dulac with us again an old friend who was here last time. Shes interested in how sex is represented in the brain. And she has found in mise amazingly that in the male mouse there is a representation of the female. And in the female there is representation of male. This is not a completely novell idea. Freud not working with pius but mice but working with people suggested were all bisexual and we develop that way in one aspect of the sexuality matures but the other one remains. And we certainly feel and heard about it in parenting, you pointed this out. There are men female components and there are women male kponants even in adult life. We have with us Melissa Hines who is interested in how kids differ boys and girls in the games they play and how they interact with each other and how hormoneal levels affect child play in the games they get involved with. And we have janet hyde. Janet hyde is interested in seeing what other differences in cog knittive capabilities between men and women, in Computer Science in mathematics and engineering. And her data pretty much suggests that there is very little difference between them. But as ive gotten to know janet a little bit better, i think that that is incorrect. The more i speak to her she majored in mathematics as an undergraduate. I have come to the conclusion that women are superior in mathematics and engineering an Computer Science. I think we are in for a fantastic program. Rose let me begin with ben. Tell me the experience that you went through share with us as much as you can about what lead up to your decision, how you carried forward, and the impact its had on your life. Sure. I think in many ways my experience is probably typical for other transgendered people. I was, i think only about four are five years old when i first started to have strong feelings that i felt more like a boy. I was born as a girl barbara. But i felt like a boy i played with little boys, i preferred boys toys. I remember dreadically wishing i could be in the cub scouts and boy scouts. Every halloween i would dress up as an army man or football player. This all just seemed very internationalal to me. I felt like a boy. But as i got into middle school, early teen years i did start to feel more and more uncomfortable with this. I didnt feel i should have breasts. I didnt feel comfortable at all wearing dresses makeup jewelry. And it became increasingly uncomfortable when i got into high school i started to be teetioned pore by kids. I just had a lot of kochb fusion about my gender and i felt very ashamed of it. I never spoke with friends or family about it at all ever once. Rose no one. No. I just felt very aasheimed and very confused. And dont forget this was in the days before the internet so there wasnt a lot of information about this sort of thing. So as i got into my 20s i you know i was doing well although i didnt feel good about pie gender i felt good about pay caer radio, i was doing training and i was increasingly uncomfortable and like many transpeople i started to think about suicide. I never actually attempted suicide but i thought about it a lot. And this is a picture of me back when i was barbara. I think i was 30 at that point and i was a bridesmaid at my Little Sisters weddingment and i can still remember vividly even though it was 30 years ago, just thing aonee i felt the discomfort putting on that dress, wearing juliry wearing makeup, and still through the years i still remember that but anyway i did complete my training and begin a job at standford about 20 years ago when i was age 40. And about two years into that i actually developed Breast Cancer and i was still very confused about my gender identity but i knew that i didnt like to have breasts. And so when the dk tore said he needed to do a mast eck me to remove the cancer which very fortunately was picked up early and i was cured of, i said while you are there, please take off the other breast. And he was quite horrified by this. Perhaps he was the first one i shared my feelings about gender identity. But since this cancer runs in my family, he did agree to remove the other breast. And i just cant tell you how therapeutic that was. I felt so relieved to have those breasts removed. And i recognized that that was a very different response than my mom had when she had her mast act me she saw this as a huge blow to her femininity. After the surgery the doctor talked to me about reconstructing the breasts and i was absolutely horrified. There is no way are you putting those things back on me. So this was sort of maybe an increasingly occurred to me that really there was something a little bit different about my gender it was only about a year later i was reading the San Francisco chronicle one day when i read a several page article about the life of james green an openly female to male transgender person in the bay area. And i realized for the first time in my life that there were other people that had experienced the same sorts of gender confusion that there were other people like me and that i might be transgender. So i went to see don lab a sxz change pioneer at standford and he ran the gender clinic. And indeed after they valuated me they told me that they thought i was transgener and offered me the possibility of changing my sex. Which was immediately irresistable to me and very quickly within weeks i decided to change sexment i already had the upper surge rae, the pastectomy i did not want lower surgery but so all that was needed was to take some testosterone and you can see the affects that it has had on me. It is powerful stuff. And one of the most surprising things about the testosterone was that i actually to my great surpass became much harder for me to cry. And male to females report that it now becomes much easier for them to cry so that was perhaps a surprising experience. But i think the main experience that i had is i just felt after i changed sex i cant, its hard to describe the intense relief that i felt just like this weightlifted off of my back and ive been so much happier since. Ive never had another suicidal thought. And i have to say that at the time i decided to do this i was as i was i had been a scientist at standford for several years. I was very worried that changing sex would harm my career. This was 20 years ago am but i have to say that everybody all my colleagues and friends and family were immediately supportive. And i have been very fortunate to have just my career continue. And to have lots of wonderful students and so forth. I guess the other thing that i would like to say is i think the other surprise after changing my sex is that i found that living as a man has dramatically changed the way that people react to me. And i can tell you a story about an experience that happened to me shortly after i changed sex a couple years later i was invited to give a seminar about my research at m. I. T. And one of my friends told me that after i gave the seminar one of his colleagues was talking to him about the seminar. And he said gee, that benn barres his work is so much better than his sisters, barbara. So i think that that experience sort of points out something that all of us transpeople whether female to male or male it female we have lived life as both genders. And we all share an intense anger at the different way that society treats men and women, simply based be their gender. And i think in general, i think we would all say that in general society with a man sort of assumes that theyre competent until proven otherwise and with women theyre considered incompetent until proven otherwise. So this creates terribly unfair barriers for talented women in sciencement so i now devote some part of my time to trying to help women in their careers. Rose let me turn to norman. Listening to that story it may be typical in terms of both someone whose questioning and to go from questioning to lacking for solutions in the experience of the reaction after you have changed. What does it is a about gender identity. Well i wish we naw more charlie. We certainly know it when we see it. I want to show you a very powerful example of identical twins who in this case one of the male twins. And we have proven that these twins are indeed shutly identical and born male. But one of them at age 3 started to say everything about being a girl. And in fact, if there was any issue that came up she turned it into an issue of gender. An she did some of those things that we consider hallmarks like wearing preferring tower female underwear and female pajamas and et cetera. And by the age of seven the family desidded with the help of a counselor to change her name to a female name and to have the child assume a female role. So here is twin sister with twin brother at the age of just about 89 9 to 10 years of age. And so they were fourth grade. And what i want to point out is that if i switch all the attachments to them, thearyings, the clothing the hair style the shoes you could basically switch one for the other. The fact of the matter is that kids with their clothes on are virtual leigh interchangeable prepuberty. And actually their hormoneal levels are virtual leigh at that particular point interchangeable. So everything happens really at puberty. So here they are at age 14. Now because it is so difficult to live in a againer different from your biologic sex when you have the toxic affects of your genetically hormone driven pub effort which would puberty, which what basically make twin sister lack exact leigh lake twin brother. And you can see that she looks still am like a nain or ten area old an there is a good reason for it she has had her puberty suppressed. The next slade shows the level of sex hormones across the human life span. Look at the blue line which is the male level of testosterone the hormone that ben was receiving and that some of us make. But that during fetal life especially in the mid trimester, the level of testosterone in a fetus rises to a level close to the full adult rang. And then it falls and then there is another blip up right after birth a kind of second puberty. And then things go completely dormant. In fact f they didnt go dormant wed have a whole bunch of pubertial looking fifth graders running around because everything is suppressed. When you are thinking about possible causes for transgender and ben and i spoke about this before wouldnt it be possible for some aberration in testosterone secretary res or estrogen secretion during intrauterine develop over there after might be one of the contributing factors. Its certainly possible. It is a very dynamic stage we still dont know what that second bump is right after birth or what role it plays or whether boys who are been without testes but are otherwise normal, show any differences as a result of that. The problem the problem eric is that when we want to look at a hormone we have to be able to measure it. We have to get it out and measure it. You cant get it out. Brain. The other problem is sometimes it isnt the hormone level that is important, but the affinity of the receptors for the hormone. And its very very difficult to measure such things. This is really defining really fascinating, to see what the biological underpinning of transgender identity. Compaq leigh. Because as you pint out its a so important because kids who are in the wrong sex, you know their incidence of Suicide Attempt is very serious. Its one of the highest risks of any. So there is really something we need to understand. In the pubertial process this whl system reawakens again. The system that had been awakened in utero suddenly comes back in which hypothalamic hor mens hitting the pitture tear cause the release of other hormones that strike the ovary or the testes and cause the release of what we call the sex steroid hormones which are testosterone and estrogen mainly. And those things produce the differences between the body of the male and the female associated with puberty. So we have been able to probably since the 1980s we have been able to block the release of the hormone from the hypothalamus to the pituitary and once you do that so far upstream everything downstream goes down to zero. And we have a record of this medication being completely successful in shutting them down until the appropriate time and also the fact that its completely reversible. Look how revealing this is. Because the twin sister affirms a female identity and the puberty is blocked for two years. Two years to get more time for counselling without the pressure of bofdee change. Thats very important. Because if were going to give her estrogen thats going to have permanent affects. So take a look what would happen to her if she hadnt been given this blockade she would look exactly like twin brother. And he is in early puberty for a 14yearold. But so would she have been. Because theyre identical. Now here are the twins at age 17. And age 14 just after that picture was taken she began estrogen. While at the same time having her male hormones blocked. With that our patients dont need breast surgery when they fem inize. Because feminize because it is so effective. And she is now in that picture entering junior Year High School as is her brother. And shes absolutely fabulous. This past october the dutch who taught us this reported the first followup of the patients, the 55 of whom whose pub ert was blocked and for whom sex steroids were later switched in the manner of our twin sister. The dutch group all had surgery at 18 at which point their gender disphoria, their total uncomfortableness with their gender disappeared. And the dutch found that the kids treated this way psycho socially functioning as well or better than the control group of nontransgender kids theyre being compared to. A powerful argument for surgery sm. Its a powerful argument for available surgery at the right time for the right people. But also i think one of the nice things about the dutch approach is that it delays puberty. Once puberty sets in you have as just pointed out physical changes that make it much pore difficult to reverse. So you prevent those physical changes of the other sex occurring. Moreover, in addition to the biological changes that it delays, it allows the child to think through whether this is the course they want to be on. Because some people say im in the wrong body. I want to be a man when theyre a woman. But change their mind after a few months. They think this is the wrong course that occasionally happens. This delay allows not only the physiological process to be handled in a more satisfactory way but the psychological evaluation to see whether this is the way the kid actually feels or if it is only a temporary decision in their minds. So the dutch gave me their protocol in 2006. And we started using it in boston Childrens Hospital at which time we were the only Major Medical center to do so. But were not that many years since 2006 and over 40 programs now are doing this. So it is now becoming the standard of care. Okay, now let me turn to catherine and talk about whether this is wired. So as we have just heard from ben and from norman humans have a very early and very strong sense of their gender identity. And this is really a critical component of our individual identity as humans. Now in animals as in humans male and females display clear differences in behaviors. Mostly but not exclusively related to sexual and social behavior. So for example a males and females have very distinct sexual and aggressive displays and weve seen in the previous episode that mothers of females are usually mat earn and males in millionals are usually attacking the pups. So how are these differences established and how are they maintained. The basic mechanisms in which the brain cole controls gender specific behavior cannot be studied in humans so instead my laboratory is using the mouse as a model system. Mice display clear differences gender specific behaviors. And the mechanism by which the brain control gender specific behavior in the mouse can be studied using all the modern tools and modern tools of molecular neuroscience and genetics. So sex typical behavior especially sexual a gressive and parental behavior are extremely maintained across different animal species. And so that suggests that the brain control of those behaviors is also very maintained a close animals. Now in contrast the signals that trigger these behaviors are usually extremely specific of a given species. So for example in the species of birds called the main flicker these only one sign that matters to trigger gender specific behavior. And that is the black mustache on the face of the male. And so if you remove the black mustache from the face of the male you mask it. Then the other males will attempt to copulate with that male without a mustache because they will assume this is a female. And similarly if you paint a muss tack on the face of a female then the other males will attack that female with the mustache because they will assume its a male. So i have a mustache im a male. I dont have a mustache im a female. Now mice in contrast use mainly olfactory cues called ferromoans pheromones and humans are sensitive to all and odd tore cue which has been exploited by the pornography industry. So what we know what are the signals that trigger gender specific behavior now we can look into the brainment how is the brain processing the signals and stebing these gender specific behaviors. As we have heard from norm spack, in young males they are very important release of hormone test toss ren and this release of testosterone has been shown to be absolutely essential to masculineize the brain and in contrast females do not have release of testosterone so in males the simpleest interpretation is that testosterone is essential to establish and maintain very specific set of circuit underlying male specific behavior and females organize their brain in a different way in order to control female specific behavior. Now in our log we have perform lab we have performed a number of genetic experiments that show that the situation is a little bit more complex. The experiment we did is actually very simple. We looked at mut ants for pheromone detection which is indicated by this little cross here on the structure of the brain called the olfactory, it is simply insensitive to sex specific pheromonal cues. And when we look at their behavior we found something extremely surprising. So here in gray is a female mut ant. And in black is a male. And as you can see this female is mounting the male which is a very male specific behavioral display t is a male specific sexual display. So these females, in other words, is displaying a male typical behavior. If we now look at the mut ant males who are male that is unable to detect pheromones, this male strangely instead of aing thatting pups is now retrieving an infant and bringing it to a nest that this male has build right before him so here again this males is displaying a female specific parental behavior. So what do we learn out of this . Well what we learn is that the brain of both males and females contained the representation of male and female behavior segments. So in females in normal animals, the male behave circuit is repressed by the pheromonal system and in male similarly the female specific circuit is normally repressed. But in the mut ant that we observed what is happening is that the repression of the opposite brain opposite sex behavior circuit does no longer exist. And therefore the female now is able to display both male specific behavior and female specific behavior. Similarly the male is able to display both a female specific behavior and male specific behavior. I think this is so beautiful. Not only because this is something that is but it really i think provides the way we can begin thinking and exploring a transgender identity. If in fact we have the circuits for both kinds of behavior. You can see how for one reason or another could exhibit to wanting to be another gender. I think this is very profound. Yes, so i think that exactly as eric mentioned where what this shows is that the brain of males and females are largely similar and that a specific hormoneal and genetic regulation leads to the predominant but not exclusive display of the behavior of a given sex. And these are physiologically extremely important. Because animals occasionally need to display the behavior of the other sex. We see in the previous episode that males are occasionally able to display parenting behavior many mammalian species and similarly in many species females are displaying mounting behavior as a scien of dominance. And so the brain has actually been shown to be by sexual in fish and many years ago in reptiles, more recently now in mice. And we think that these ability to have both its recommendation of the male and female brain could also be totally irrelevant to the primal gender identity in humans. Rose let me turn to melissa to talk about this. I studied the role of testosterone in human gender development. And we studied genetic conditions that cause people to have either higher or lower levels of testosterone during Prenatal Development than would otherwise be the case. And evidence from those people suggest that testosterone in humans also influences gender development, including gender identity. And to start it is useful to put this in context to expand our understanding of the dimensions of gender related behavior. Weve talked about anatomical sex and gender identity which is our sense of self as male, female or something else. But also people have Sexual Orientation and this is separate to gender identity it refers to our erotic interests in Males Females both or in some people neither. And finally theres a third class of behavior called gender roles behaviors. And these are all the other characteristics that differ on the average for males and females. And among these some are bigger than others. Some of the biggest ones are seen in childhood toy and activity preferences. The next image shows the sex difference in height and were all familiar with this males tend to be taller than females but theres some overlap so the males are the blue distribution and the females are the orange distribution. And the people where the overlap is would be people you wouldnt know their gender from knowing their height. And the next images show that these gender differences in play play with toys like vehicles or boys toys, play with toys like dolls or girls toys are similar in size to the sex difference in height and finally, we see the gender difference in identifying with the male gender. And we can see that this gender difference is even bigger. And theres almost no overlap between males and females but there are some people who are in the other distribution. And these include the people who want to change their gender. How does this come to be . Weve talked about these sex differences in testosterone some of which occur very early in life. And this corresponds to a period of very rapid brain development. And so it provides an opportunity for hormones to program the brain in ways that might have enduring influences across the life span including for instance on gender identification. So the next image shows data about women who had very high levels of testosterone before birth and about two percent of women who have very high levels of test toss rone before birth in adulthood decide to live as men. And you might says thats not very many only 2 . But its hundreds of times more than would otherwise do so. So this has increased many times over by being exposed to high testosterone prenatally. In the next image shows men. In this case xy individuals who are actually xy females. Because their cells cant respond to testosterone. So they have testes they are producing male typical levels of testosterone including prenatally but because their cells cant respond, they look like girls at birth and theyre raised as girls and in adulthood almost 100 of them 99. 9 want to live as women. Such profound findings because although we dont really know in the mass majority of cases what causes a desire to change sex, here we find one concrete biological explanation for a causative mechanism and it makes one realize this is not a social factor t is clearly a biological factor and probably with time we would be able to identify a significant number of other ones. I think having one example is very powerful. Yes, yes. And also going back to the toys children like to play with, when i began this work people thought that the these different interests in girls and boys were completely socially determined. But it turns out these are altered too by prenatal testosterone exposure. So the next slide shows the toy choices of girls and boys in general versus those in girls exposed to testosterone before birth. And boys spend most of their time paying with toys like vehicles shown by the blue, and girls spend most of their time playing with toys like dolls shown by the orange. And the girls exposed to testosterone prenatally are in between. So they spend about half their time playing with toys that boys normally choose and about 30 of their time a reduced amount of time playing with the toys that girls normally choose. These are different dimensions of behavior. And the influence on gender identify is identity is less powerful it appears than the influence of testosterone on childhood play so that leaves a the lo of unidentified factors perhaps genetic factors or social factors that contribute to gender identity outcomes. But finally this is not just testosterone acting on the brain before birth but also children who have had high levels of testosterone engage in different behaviors. And this has a affect on their brain development. So this becomes an increasing mechanism where their behavior is increasingly masculineized as they go through life. Thank you. Janet, talk about cognitive performance and ability. Right. Well certainly in our culture we have lots of stereotypes that there are gender differences and abilities. People believe that boys and men are better at math and that girls and women are better at verbal skills. And that boys are better at spatial performance. So those are the stereotypes. Now what does the real data show . Again were looking at distributions for male and female performance, blue for males and orange for females. What you see is that the most recent data show actually that girls are tied with boys now in mathematical performance. Many people find this surprising but i have data from millions of people showing this. In regard to verbal performance you can see that there is a female advantage but its teeny tinny, you can hardly see it on that graph. So these are very subtle slight differences. For spatial performance the difference is a little larger favouring males. And im showing you one particular kind of spatial performance which involves the ability to rotate three dimensional objects in your mind and think how they might look. Other kinds of spatial performance dont show this quite as large a gender difference. You need this kind of spatial ability if you want to be an engineer or an architect or if you want to use a map to navigate around new york city. So its important for some things but not everything. But i have to say that we get this gender difference in spatial performance in the absence of spatial curriculum in the schools. That is we teach kids lots of verbal skills and lots of mathematical skills. We dont teach them spatial skills. These are completely trainable. In some School Districts are now getting the message and starting to institute these programs. So if we want to do something to foster women getting into areas like engineer where there are very underrepresented underrepresente instituting a spatial curriculum might really do a lot to help. I also want to emphasize the importance of cultural context in shapingse gender differences. This is the percentage of ph. Ds awarded to women in the u. S. By decade beginning in the 1890s. Now it turns out i didnt know this. I dont know if you knew this. It turns out that even in the 1890s in 11 of the ph. Ds in math were going to women in the 1890s. It inches up a little bit in the 1930s. And then the percentage plummets in the 1950s. So the only five percent of the ph. Ds are going to women. Then its been inching up ever since so that actually today 31 of the ph. Ds if mathematics are going to women. Why did it plummet in the 50s. It was the 1950s, right. The men came home from the war. The women were delighted to see them. They moved to the suburbs and had lots of babies. So there is not some single biological force that causes women to be good enough to get a ph. D in math it has much more to do with cultural context. Well it is findings like these that i have shown you for verbal and math performance and so on that lead me to propose what i call the principal agenda similarities. Which is that males and females are actually quite similar on most not all but most psychological variables am you saw it for math and verbal performance which are widely stereotyped to show gender differences. And of course this has implications for women in science, technology, engineering and math careers. So this graph shows essentially what the gender similarity hypothesis is. Again we have the overlapping distributions normal distribution for males and feMales Females shown in orange and males in blue. You can see there is just huge overlap, areas where males and females are quite similar. Let me turn now to looking at psychological disorders. Because for some psychological disorders we do get very lopsided gender ratios. So on the left part of this graph you can see two disorders where many more men than women are affected. Those are alcoholism and autism. You see the blue bars is the preponderance of males. That is not to say that we dont have women alcoholics or girls with autism. But it is a preponderance of males. If we look at the right we can see for depression, and the eating disorder of anorexia here we have a preponderance of women shown in the orange bars. So we do have these lopsided gender ratios. We wonder why those are. Im most familiar my research has been on gender differences in depression. We can see that the gender difference in depression is not present in childhood. But it begins to emerge between 13 and 15 years of age, as you can see the orange bar is going up there. And then it widens between 15 and 18 years of age. So gender differences and depression emerge in adolescence. And if were going to crack its a 2 to 1 ratio, twice as many women as men depressed. If were going to crack this question we need to understand why the gender difference emerges in adolescence. Many factors are doubtless involved may have something to do with genes. We have a few genes that have been identified that have to do with depression. It may have to do with pubertyal hormones because the difference emerges just as puberty is coming be. It may have to do with other factors such as the medias inform sis on hyperskinny models and girls as they go through puberty, the bodies get farther away from the skinny models. Boys have the advantage because theyre adding muscle and that is the way the models look. So that may be a factor. We also know that there is plenty of peer Sexual Harassment in the schools and that may also contribute to this gender difference. Ben, let me just go back to this identify of how society is responding. Because we know from the cover of vanity fair, the New York Times story we know from Time Magazine did a cover story which im told was the second biggest selling Time Magazine cover story that year with one exception of the pope. Transgender is right behind the pope. Wasnt the its unfortunate that society often considers transsexuality to be a Mental Illness or an immoral choice. And because of this transgender people are still often denied basic human rights theyre often subject to violence and in many states transgender people can still be fired just for being transgender. But as we have heard today on this program, the brain has innate circuits that determine our gender identity. And so being transgend certificate not a choice that i made. But its how i was born. And i should mention something we havent really brought out yet, that there is a Broad Spectrum of transgender people. Some of them prefer not to change sex or even to be identified as male or female. But for some of us there is a compelling innate need to change sex and denied that possibility, 40 of us attempt suicide. And thats why i think that by helping transgender teens to avoid this agony dr. Spack and the dutch pioneers are such great heroes. You are advicing to them at standford. Yes. What role do you play what is it that you can provide. Its interesting catherine, just in recent years ive really been amazed at how many young lgbt lesbian gay transsexual students trainees, young scientists are reaching out to me. These days almost every time i visit a university to give a talk i often get emails in advance from young kids often still in the closet and very concerned about whether coming out will harm their caer radios. And they often want to meet with me and talk about this. I always advise them to be open and to live openly as who they are. People are very very accepting today. Sure there are are always going to be a if you bully a fuel people that are ignorant but never let other people define who you are. So what should parent does . I think the first thing that parents ought to do as with most things is sit down and take a deep breath. Okay. And realize that the prepubertyal child is in a state of exploration. Its no accident that both boys and girl goes to the boy toys and the girl toys in kindergarten. This is not gender identity expression by and large. This is almost always a gender role play, which is normal for children. Now of children who are fairly persistent in their cross gender play but are prepubertial only about 20 will go on to be transgender. 80 are not going to be transgender. But what i would say to parents is that if your child is getting close to puberty or worse is already in and is showing this kind of behavior, particularly underwear wearing and saying im the wrong gender and binding breasts, et cetera then you need to get help for that child fast. And that may be calling your pediatrician and ask for a gender specialist to meet with your child. Because a child who is according to the dutch and us and others a child who holds on to the belief that theyre in the wrong body at the onset of puberty feels like pinocchio becoming a donkey and may well take their life. So this is these are the kids who are the real deal. Rose over the series of three years with eric you an i have found a range of things that we traced to the brain and understood and some levels, in some cases the, what we understood about what was taking mace within the brain was large in some cases small. With dow put this . In terms of understanding what is going on. I think were at the very early stages in understanding what is going on. And i think the wonderful thing about this discussion it points out number one there really is a buy only biology. Its a challenging problem its extremely fundamental but our understanding is just very very modest. We talked about this before. Many times people have asked charlie and me how long do you think it will take before well have a really satz fact other understanding of the brain. And our position has been a century weve made a lot of progress in the last three contraries in the brain series alone but we are a long way to really understanding the brain systemically. Gender identity is so essential to who we are and our ability to be happy. I think we have a duty to be able to provide some type of explanationment but something really important too which is to understand that its not all black and white. Its important to remember that the differences are not disorders. And im proud to be transgender. I think that the different brains thrive innovation and different perspectives. And so i think the real question is why society persists in insisting that male brains are better brains which as weve heard tonight is definitely not the case. Thats right. I think one thing that would be interesting to see is as you function in a way that you are comfortable with it has freed you up is it possible on this case to answer this has it increased your creativity . Well, i think that it released a lot of Mental Energy that was devoted to confusion and feeling suicidal so i would say yes i felt some of happier and productive as a person. Thats wonderful. What percent of people also undergo anatomical change . The issue is were now in a state of flux about an operation that may cost 25,000 which is a female a male to female genitalplasty. And the reason i say that is because Insurance Companies are waking up to the idea that this is a medical condition. That it is entitled to be billable for surgical and medical aspects of their care, can be consider covered by insurance. And so its going to change everything. Because up until now people had to save all that up to have the surgery. And it starts from the top down. First you have to not make it a Mental Illness. You have to define it as a physical problem which it is. But hiding as being gay was prior to the 1973 what freed up people starting to see gay people as not having a psychiatric illness it was having it removed from the diagnosis and statistical manual of Mental Illnesses. So thats happening now. And we will just see. The colleges are doing it if thors selfinsured maybe even the college you went to, charlie, is paying for peoples everything. Because im going over to some of them and seeing it done. Thank you each of you very much for coming. It is, i think its there is enormous interest as you can see in the publications devoting attention to it and also the conversation taking place. Even i once once this subject was introduced in terms of a Television Program i remember someone came up to me and identified themselves as transgender you know and said they said that to me that the fact that it is getting so much attention made all the difference in their life. And so they felt not so isolated and not so different. I mean they felt like wonderful. That there had been identified as something so that they could add an appreciation of where they stood and what their options were. So what are we next time . We are going to continue to discuss Child Development which we discussed earlier. What are the consequences of growing up under very difficult circumstances. How does it affect the Cognitive Development of children, and is this passed on from generation to generation. So were going to learn a lot more about Child Development next time. Thank you. Thank all of you. And thank you. Well see you next time. For more about this program and earlier episodes visit us online at pbs. Org and charlie rose. Com. Captioning sponsored by Rose Communications captioned by Media Access Group at wgbh access. Wgbh. Org firnding for charl wree rose is provided by american express. Additional funding provided by . And at bloomberg the following kqed production was produced in high definition. [ music ] its all about licking your plate. The food was just fabulous. I should be in psychoanalysis for the amount of money i spend in restaurants. I had a horrible experience. I dont even think we were in the same restauran