House has never shied away from controversial issues and issues related to gender identity are no exception. This article will examine what issues the series has examined and how it examined them.
Gender issues[]
Among the issues the article will examine are:
- Gender in biology. How the concept of gender is established by genetics and the interplay of several physical and physiological processes.
- Gender identity. How individuals, due to a combination of anatomical, endrocrinological, and psychological factors identify as belonging to a gender.
- Sexual preference. How individuals choose sex partners, a field where the biological and psychological factors are still very poorly understood, but which in humans appear to be largely fixed even before individuals become sexually active
- Gender expression. The factors that affect how a person expresses their identity in terms of gender "norms".
Gender in biology[]
Biology used to treat gender as binary - individuals were either male or female. However, modern medical and scientific thought recognizes that, although binary gender is incredibly common, it is by no means universal. In other words, although set congenital anatomical criteria can distinguish genders in the vast majority of cases, such criteria can be ambiguous.
In The Softer Side, Jackson Smith was born with ambiguous genitalia. His parents decided on early surgical intervention to make his genitalia conform to male norms and started to give him testosterone as he entered adolescence. However, he self-identified as homosexual and started to prefer activities that more closely conformed to female norms.
In the simplest case, each sperm cell contains either an "X" or a "Y" chromosome from the father (who has both). Egg cells only contain an "X" chromosome. In the vast majority of cases, if two "X" chromosome combines, the fetus will develop as a female with ovaries and a vagina. An "XY" combination will result in the fetus developing as a male with testicles and a penis.
However, fetal development is complicated and depends on a cascade of hormones that direct such development in uetero. If this normal development is curtailed for some reason, the fetus could develop with sexual characteristics that do not match the individual's genetic characteristics.
In Skin Deep, we are introduced to Alex a 15-year old "teenage supermodel" who seems to clearly conform to female anatomical norms with large breasts and hips and smooth skin. She clearly identifies herself as female and heterosexual. However, House becomes suspicious because, while some of her secondary sexual characteristics are normal for her age, others, such as a lack of pubic hair and underdeveloped ovaries are not. Further investigation finally indicates she has androgen insensitivity syndrome, a rare (1 in 10,000 births) condition where the body has no channel to process testosterone. Despite having an XY chromosome pair, and testicles (which failed to drop), her anatomy otherwise completely conforms to female norms.
Many other conditions occur because of unusual combinations of "X" and "Y" chromosomes such as:
- Turner syndrome (single X chromosome)
- 45,X/46,XY mosaicism (where the Y chromosome "goes missing" in early fetal development and is missing from many other cells)
- 46,XX/46,XY, a chimerism disorder where two different fertilized zygotes of two different sexes merge in utero
- Triple X syndrome, where a zygote has three "X" chromosomes
- Klinefelter syndrome, where there are two "X" chromosomes and a "Y" chromosome
- XYY syndrome, where there is one "X" chromosome and two "Y" chromosomes
- Tetrasomy X, where there are four "X" chromosomes
- XXYY syndrome, where there are two copies of each chromosome
- 49,XXXXY syndrome, with four "X" chromosomes and a Y chromosome
- Pentasomy X, with five "X" chromosomes
- XX gonadal dysgenesis, where the ovaries do not develop
- Swyer syndrome, where the testicles do not develop
- XX male syndrome, where a genetic female develops as a male
All of these conditions are rare. Some of them have few or no symptoms and some do not affect sexual development or fertility. As a rule, these conditions are caused when egg and sperm cells are formed improperly rather than by having a parent pass on the characteristics in their own cells. It is believed that the rarity of these conditions are increased by the fact that most fetuses with such a genetic make-up miscarriage. For example, in Turner's syndrome, it is believed almost all fertilized cells will spontaneously abort during development with a very low percentage developing to full term.
The modern term for individuals who have any sort of mismatch between genetic, hormonal and anatomical sexual characteristics is "intersex". However, as individuals who do not easily fit into a binary gender become more commonly known about, several other terms have been developed within the community to describe themselves.
Gender identity[]
Even when physical characteristics "match" a person's genetic gender, some individuals still perceive themselves as having a body that does not match their sex. By the 1930s, several famous cases such as Lili Elbe (the subject of the film The Danish Girl) came to light. The subject was seriously studied in Germany until the mid-1930s when much of the research was destroyed during the Nazi period.
However, in many cultures, including those in India, the Philippines, Thailand and among certain groups of American Indians, the concept of a "third sex", generally a male identifying as female, has been culturally recognized for centuries.
In medicine, this is now recognized as a condition known as gender dysphoria. Although it is classified as a psychiatric diagnosis, it is no longer seen as a psychiatric condition. Indeed, because the condition is now seen as being non-pathological, similar to homosexuality or masochism, even the name has been changed from the former "gender dysphoria disorder". That being said, the condition is still identified because psychiatrists and other mental health professionals still need diagnostic criteria to distinguish it from other behaviors. In addition, persons with gender dysphoria generally need support and reassurance both during the period of diagnosis and while options such as hormone therapy and gender reassignment surgery are discussed.
However, although it is well recognized that this condition is fairly common, it is poorly understood why some people have the perception that they are "the wrong sex". Despite social theories that proposed that gender identity is largely impressed upon individuals by societal pressures, modern research has shown that most young children resist being raised as the "wrong" sex and many eagerly embrace behavior, activities and clothing that "match" the sex they perceive themselves to be. So, in the same manner ,a typical young boy will resist wearing a dress, so will a biological female, of the same age, who will later exhibit gender dysphoria.
Transsexuality is the most common manifestation of gender dysphoria. Although House often jokes about Cuddy "having been a man", it's clear on the series that the characters do deal with staff and patients who now identify as the "opposite" sex to their biological gender. Although it is common for intersex individuals to go through such a transition, it is just as common for those of a binary gender to do so.
It should be noted that, although hormone therapy is common, sex reassignment surgery is rather less common. In addition, although many persons take great lengths to present themselves in the opposite "correct" gender, the vast majority of people with gender dysphoria take less drastic steps to change their appearance.
Sexual preference[]
Science and medicine's understanding of sex partner preferences has gone through leaps and bounds in the last sixty years as it's understandings of "norms", both for humans and non-humans, has been further studied and understood. Although homosexual sex has been known since ancient times, in the late 19th century, science's best understanding was that such relationships were for "convenience" when "appropriate" partners of the opposite sex were unavailable or, as with the ancient Spartans, where same sex relationships were seen as a way of controlling procreation. At this time, same-sex relations were generally criminal - a situation that didn't even begin to change until the 1960s. Science, medicine and the new field of psychiatry started to see those who sought out such relationship as exhibiting a pathology and were treated as if they were mentally ill. This is an attitude that persists in much of the world today.
House has not shied away from commenting on social norms in this regard, and has also explored our modern understanding of sexual preference which goes beyond "heterosexual" and "homosexual" classifications.
The beginnings of the modern understanding of sexual preference start with Kinsey, whose surveys showed that a large proportion of the members of both sexes had, on at least one occasion, has a sexual relationship with a person of the same sex. However, Kinsey himself largely rejected the idea of "homosexuality" and "heterosexuality" and instead advocated a sliding scale between attraction to the two sexes.
Modern approaches are broader and have developed the idea of pansexuality - being attracted to individuals without respect to their gender, gender identity or the other individual's sexual preference. This approach treats sexual preference as less of a "spectrum" as areas on a grid or regions in a matrix.
Naturally, the individual whose sexual preferences drew the most attention was Remy Hadley, an admitted bisexual who has had numerous liaisons with both men and women including Spencer and Eric Foreman.
However, in addition to the common depiction of a heterosexual relationship, several homosexual characters have also appeared on the series. The first of these was Kalvin Ryan, who had contracted AIDS through unprotected sex. Although Kalvin describes himself as a "party boy" who likes to have a good time, Allison Cameron pegs him as a person who finds it impossible to build a lasting relationship of any type and engages in self-destructive behavior to compensate.
But the complexity of sexual attraction is most clearly shown by Theodore Philip Taylor. Falling ill during his wedding ceremony to a beautiful young women, as the doctors treat him, it is revealed he underwent conversion therapy due to his belief that his homosexual behaviour was not a reflection of his true preferences. As his case proceeds, the doctors are presented with contrary information about Ted's sexual preferences based on information provided by both his fiance and his ex-roommate which appear to contradict his own declarations about his preferences.
But the show also makes it clear that House and Wilson are familiar with all types of variations, such as the asexual couple in Better Half and the discussion in Insensitive about the hospital lawyer who prefers transsexual partners.
Gender expression[]
Societies tend to see certain behaviors as "masculine" and others as "feminine". Possibly the most common of these gender -elated behaviorus are clothing style, but also include hair tyle, and whether or not someone wears make-up.
However, although most people conform comfortably to "gender norms", many people of both genders feel uncomfortable with such conformity and instead dress and act more closely to the norms of the other gender.
While it's fairly common for individuals with gender dysphoria to dress like the other sex, it certainly is not the only reason people do so. For example, Mary Edwards Walker (pictured) was one of the first women in the United States to qualify as a physician. She was awarded a Medal of Honor for her work during the Civil War (it was later disallowed, but it was restored by Jimmy Carter in the 1970s). During her lifetime, she usually dressed in men's clothes, finding that dresses interfered with her ability to perform her work.
But as we see with transvestites such as Sarah, gender expression can be totally independent of gender, gender identity or sexual preference. Although many transvestites who go through the necessary work to present in the manner Sarah did might be homosexual males or pre-operative transsexuals. However, it is still possible that they might be heterosexual males who simply prefer that manner of dress.