The expression “trapped in the wrong body” is prevalent both in trans communities and in the culture at large, and it informs how so many people think about trans and gender-nonconforming identity. The idea is that there is a mismatch between the gender of a person’s physical body and the gender in that person’s brain.
The concept of being “trapped in the wrong body” has influenced medical protocols and services provided to transgender people since the 1950s. Medical and mental health providers have based assessment and treatment of trans people on this notion, and many researchers still actively search the body and brain for signs that genetics or hormones lead trans people’s brains to be gendered separately from their bodies.
Although it may be popular, not all trans and gender-nonconforming people feel this theory accurately describes them, and to date, there is no conclusive scientific evidence of its validity. Where did this notion come from? How did it become so entrenched? And why are we so attached to the idea that trans identity is not a choice?
The history of “trapped in the wrong body” goes back further than most realize. Karl Ulrichs, a gay German author writing in the late nineteenth century, sought to understand his own same-sex desires in a culture with rigidly heteronormative ideas of sexuality and gender. Ulrichs’s work addressed topics of love and sex between men at a time when the word “homosexual” was first coming into use. Ulrichs was attempting to understand why some men were attracted to men and some women to other women. Ultimately, he concluded that some men had an innate “womanness”—that their spirit or psyche (sometimes translated as “soul”) was female and thus they were drawn to other men. He expressed this as “anima muliebris virili corpore inclusa,” Latin for “a female spirit trapped within a male body.” He also postulated that women were sexually attracted to other women because they had a male psyche.
When Dr. Harry Benjamin, an early pioneer in transgender medicine, began providing care to trans people in the 1950s, he worked from the “trapped in the wrong body” model. Benjamin presumed that trans individuals had an even more pronounced disparity than the one described by Ulrichs—a fully developed male brain in a female body or vice versa. This medicalization of trans people led to one conclusion: as the brain was inalterable, the only way to rectify the mismatch was to change the body.
Benjamin’s 1966 The Transsexual Phenomenon gave birth to the Harry Benjamin International Gender Dysphoria Association (later WPATH, the World Professional Association for Transgender Health), an organization that developed the original Standards of Care for the evaluation and treatment of transgender people. The initial protocols established a rigid timeline that involved psychotherapy and a “real life” test, in which a person had to live as a member of their desired gender for a year or more prior to any medical interventions (e.g., someone transitioning from male to female living publicly as a woman without yet beginning hormones). Only after these was a person given access to hormones and, later, surgery.
The Standards of Care set forth a series of questions by which individuals were evaluated to determine if they were appropriate candidates for treatment. Did they demonstrate that they had any ability to live as the gender they were assigned at birth? Were they showing grief or regret about their decision to leave behind the gender they were assigned at birth or their natal genitalia, or were they displaying a connection to the stereotypical interests of their assigned gender? Did they express sexual interests that might result in non-heterosexual identity after transition? Answering yes to any of these was considered proof that a person did not have the body/brain incompatibility that made them validly trans.
Unfortunately, this also limited possible identities and ensured that traditional binary and heteronormative social roles were maintained: people were permitted to transition only because transitioning made them “normal.”
Some in trans and gender-nonconforming communities were invested in the “trapped in the wrong body” narrative and considered it authentic to their experiences. They felt it provided them with a way to understand the agony and dysphoria they had struggled with for much of their lives.
Other trans people, less convinced by this theory, nevertheless tacitly accepted it in order to receive care. This created a cycle of cultural and medical reinforcement: trans people heard from other trans people that their care depended on this story, so they told it to professionals, who began to hear only this story, a narrative that became further entrenched until “trapped in the wrong body” developed into the only acceptable narrative of trans identity.
As this narrative took hold, so did unproven biological theories that reinforced it. The most popular of these is the idea that hormones in utero can affect the brain separately from the body. The idea is that, at a key point in development, the fetal brain undergoes a chemical bath that, under “normal” circumstances, differs for males and females. The brains of transgender people, proponents argue, are instead awash in chemicals appropriate for the “opposite” gender, and this is said to influence the developing brain to acquire structures more typical for the gender “opposite” that of their genetic makeup.
Because it would be unethical and risky to perform procedures to measure hormone levels in developing fetuses, prenatal hormone studies rely on “proxy markers,” such as finger-length ratios, thought to correlate to hormone exposure, and compare these markers in transgender and cisgender people. To date, there is no conclusive evidence that proxy markers of hormone exposure correlate with transgender identity. To add to the confusion, and despite the lack of evidence, identical theories including hormonal exposure and proxy markers for this exposure have been simultaneously used to explain both homosexual and transgender identities, but we know that these are not the same.
Another avenue of research aimed at understanding the influence of intrauterine hormones is the investigation of gender identity in intersex people—formerly known by the outdated term “hermaphrodites”—those whose physical makeup does not neatly match either male or female. Intersex people may have chromosomes that vary slightly from XX or XY, or they may have genitalia that do not match norms. Intersex people have long been the subjects of research, often against their will, and many have spoken out against their identities being used as evidence for particular theories. There are many ways to be intersex, and gender identity differs depending on the intersex condition, but there may be increased rates of desire for change from a birth-assigned gender among certain groups of intersex people. Still, overall, intersex people are most likely to identify with the gender they are assigned at birth, regardless of what we know about their hormone exposure.
Finally, researchers have also turned to animal studies to better understand the influence of hormonal exposure on gender identity. Animals whose hormonal exposure is manipulated in utero have been shown to demonstrate behaviors that researchers categorize as more typical of the other gender, such as female rats attempting to mount other rats. However, the nature of these behaviors complicates the picture. Is sexual mounting (i.e., the position an animal takes in a sexual encounter) a gendered behavior or a marker of some aspect of sexuality? Is a female rat that is exposed to “male” hormones and mounts other rats gay or transgender? What if she mounts male rats—is she heterosexual but domineering? Because we cannot ask animals about their inner thoughts and feelings, the utility of animal studies of gender identity and sexuality is limited.
In addition to research related to hormone exposure, genetics and brain anatomy have been targets of investigation. Transgender people, in general, have been shown to have the chromosomal makeup expected based on their gender assigned at birth. Scientists have also looked at particular genes that might be involved in transgender identity but have come up empty-handed.
Brain anatomy and physiology are popular areas of investigation today, both because they are in line with the “trapped in the wrong body” theory and because there has been limited funding for brain research. A few small studies have found differences in brain anatomy or functioning between transgender and cisgender people, but most have numerous flaws, including too few participants or confounding factors such as participants having taken hormones. There remain no conclusive studies linking transgender identity to brain structure or function. In addition, even those researchers with strong beliefs that the brains of transgender people are different from those of cisgender people argue that our current theories are not nuanced enough. According to the Spanish psychobiologist Antonio Guillamon, “Trans people have brains that are different from males and females, a unique kind of brain. It is simplistic to say that a female-to-male transgender person is a female trapped in a male body.”
Many social scientists interested in gender and sexuality have written about the ways in which our society attempts to apply a rigid notion of biological differences between men and women in order to enforce the gender binary. Molecular biologist Anne Fausto-Sterling argues that the belief that men and women have distinct, clearly differentiated brains is a fallacy. In her books she examines the literature and science of gender, concluding that men’s and women’s brains are virtually identical and that even neuroscientists have difficulty identifying one from the other. Additionally, she reports that there is greater variability within the brains of one gender than between those of men and women. Similarly, sociomedical scientist Rebecca Jordan-Young, author of Brain Storm: The Flaws in the Science of Sex Differences, asserts that we are all too quick to accept faulty studies that rely on unproven assumptions because they fit our theories that men’s and women’s brains are inherently different.
It is likely that gender identity is influenced by both biological and social factors, and that these forces impact each other in ways that we may never understand. Nevertheless, the politics of “trapped in the wrong body” remain with us, and contending with them is complex.
While some in trans communities believe that transness is biological and the foundation of their true selves, others feel that they have come to their trans identity out of an ongoing exploration of gender and that their understandings of themselves have been influenced by culture and gender norms.
This is not merely an abstract debate. Arguing that transness is not a choice has afforded us rights, including legislation granting access to appropriate bathrooms, antidiscrimination statutes, and protections for trans youth in schools. Identity categories to which a person belongs by no fault of their own, such as race and sex, generally receive more public support when it comes to antidiscrimination laws. Trans advocates are actively working to compel insurance companies to reimburse treatment, including hormones, surgeries, and sometimes procedures such as electrolysis and vocal training, with the argument that transness is biological. If we argued that trans people had a “choice,” insurance providers would likely categorize these interventions as cosmetic and not medically necessary. This would make transition financially unattainable for so many in our communities.
On the other hand, acquiescing to the idea that trans people have no say in their own identity, that they are driven entirely by their biology, strips them of their self-determination. The argument that being trans is not a choice also subtly gives power to the idea that being trans is a bad thing, something to be sought out in young children and eradicated in any way possible, something no one would choose if the choice was available.
“Trapped in the wrong body” remains a valid narrative for many people. But our community deserves more options.
Informed Consent philosophies of care, developed at LGBTQ+ health centers in the 1990s, do not rely on notions of a fixed medical narrative of being “broken” and seeking to be “fixed” but acknowledge the right of individuals to determine their own gender, whether their ultimate expression of gender matches cultural stereotypes or not. Informed Consent provides people more flexibility to understand their own identities in ways that seem comfortable for them and to make decisions about medical treatment as consenting adults, rather than by appealing to medical providers as judges. The modern WPATH Standards of Care have moved in this direction.
Some people think of transness as a natural human variation and see trans and gender-nonconforming people as representing the broad diversity of how human beings can express the gendered aspects of human identity. For them, it is not about being damaged but about being different. And many have set aside altogether the need to find a cause or justify our transitions through biology.
Today, many of us recognize that all people have the ultimate authority to decide about their gender. Gender is a part of human existence to be toyed with, explored, questioned, deconstructed, and lived in an infinite variety of expressions. We step outside social conventions of gender to wonder what gender might really be underneath the cultural constructions, what fundamental truths or novel understandings we might discover. We often defy easy classification.
For some, though maybe not for all, gender can be a choice. But any narrative of trans identity is valid.