Sexuality and "Alternating Gender Incongruity"

In an article from the (somewhat) controversial journal Medical Hypotheses, researchers claim to have found a new neuropsychiatric syndrome called Alternating Gender Incongruity. A reporter from Scientific American commented on the article a few weeks ago, and the blog Neuroskeptic carried a short synopsis of the study the week before that. However, neither has commented on what I think are the two most fascinating (and perhaps troubling) aspects of this study.
Image Credit:
First, we have the way the researchers define sexuality. They say it is comprised of four facets: “gender identity (which sex you categorize yourself or see as others see you), sexual morphology, brain-based “sexual body image,” and sexual orientation (who you are attracted to).”[1] It is clear immediately that the term “sexuality” is used here to describe not sexual practice or identity, as it is generally used in my field, but to describe a large portion of what we call the sex/gender system.[2] What stands out to me, though, is aspect number four: sexual orientation. Once again, it seems to be a case of sexuality researchers relying on the concept of inversion, where it is assumed that sex/gender is linked to sexual orientation through a mixing, or a mistake, of internal sex/ gender identity.  (I commented on this in a previous blog).[3]  The reasoning behind this particular study, however, has the potential to be more nuanced: although the researchers assume that sex/gender identity includes sexual orientation as a matter of course (and at one point say that your sexual orientation might be incongruous with your sex/gender, thus implying that there is a congruent sexual orientation for each sex/gender), the way they phrase the question allows that sexual orientation may be a function of same/difference to self rather than fixed on a specific sexed/gendered object.

To explain: let us take the case of a homosexual man who becomes a woman, and after transitioning becomes a lesbian woman. In a same/difference sexual orientation model, her sexual orientation remained the same throughout the transition because it is the homo/hetero aspect that remains fixed rather than the sex of the object choice. As a homosexual man, he himself was male and he was attracted to the same sex as himself. When he changed to female, his orientation remained the same, and thus he became a homosexual woman. However, under the object choice model, this transwoman’s orientation changed during her transition from being oriented towards men to being oriented towards women. Whether sexual orientation remains “congruent” or “incongruent” through a transition, according to these researchers, would depend greatly on which model they use.[4] Unfortunately, the researchers in this study did not conduct a systematic survey of the sexual identity of the bigender individuals they studied, so it is almost impossible to tell which of these models they were working with.  Thus, although they imply there is a correct orientation for each gender, and are interested on whether orientation “switches,” it is not clear what the correct orientation is, or what switching would entail (is it a switch from homo to hetero? Or a switch from male to female object choice?)

The second point of interest to me is the fact that the researchers final hypothesis, that “alternating gender incongruity” is related to hemispheric switching, relies in part on what they call “ancient and modern associations between the left and right hemispheres and the male and female genders.”[5]  Later, despite acknowledging that “sex differences research rejects the existence of large differences in hemispheric specialization between the sexes,” and specifying that for the most part sex differences come in the different utilization of the hemispheres for certain tasks, in their conclusion they offer the following speculation:

In myth, art, and tradition throughout the world the left side of the body (and hand) – and therefore the right hemisphere – is regarded as more “feminine” – intuitive and artistic. One wonders therefore whether gender alternation may reflect alternation of control of the two hemispheres.[6]

Here, the authors have stumbled upon the same issue that Kristina and I discussed at this weeks’ journal club meeting: although the authors are explicitly arguing for a change in how we conceptualize sex/gender and sexuality, this claim works to reinscribe that very system. They have fully acknowledged that there is a lot of controversy (and even rejection of) particular types of sex differences, but then have gone on to rely on those sex differences to support their hypothesis. They have, in fact, incorporated particularly ancient and essentialist gender stereotypes- femininity is linked to intuition and art – and done so in an article that is meant to be arguing against explaining bigender experience through social constructionism.  That is, they have actually used a social construction of gender (femininity) and its cultural association with a brain hemisphere as an example of why Alternating Gender Incongruity may reflect a material difference.

Of course, in the end this is a paper that is arguing for the possibility of a neuropsychiatric condition based on survey responses, and as such generates more questions than answers. The authors will not know the extent of neurological involvement in Alternating Gender Incongruity, if any, until after they conduct further research. The Scientific American article indicates that some of this work is already underway and I have to say it sounds fascinating, and I am looking forward to seeing the results.

Want to cite this post?
Cipolla, C. (2012). Sexuality and "Alternating Gender Incongruity". The Neuroethics Blog. Retrieved on , from

[2] I assume this model of sexuality is not meant to be a comprehensive model of sexual identity because it doesn’t take sexual practice into account.
[3] I realize I am assuming that including sexual orientation as one aspect of sexuality means relying on inversion theory, as the authors of this study do not actually practice the form of inversion which I had described in the previous blog. However, I cannot think of any other reason to connect sexual orientation and sex/gender in this way – if you can, please let me know!
[4] I am somewhat uncomfortable with the idea that there is a particular “congruent” sexual object choice for any gender, but the authors’ use of incongruent seems to indicate “unexpected” rather than abnormal or pathological.
[5] It is also based on a prevalence of bipolar disorder in their sample.

Emory Neuroethics on Facebook

Emory Neuroethics on Twitter

AJOB Neuroscience on Facebook