Skip to main content

Sexuality and “Alternating Gender Incongruity”

In an article from the (somewhat) controversial journal Medical
, researchers claim to have found
a new neuropsychiatric syndrome called Alternating
Gender Incongruity
. A reporter from
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

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.


  1. Interesting post.

    I think you're right that the authors "have, in fact, incorporated particularly ancient and essentialist gender stereotypes- femininity is linked to intuition and art" … and I wonder to what extent the same could be said of the bigender individuals themselves?


  2. I was glad to read this post and to hear these concerns expressed. I think you've struck an important issue when you question the researchers' assumptions about the nature of gender and about sexual orientation.

    As a bi-gender person who has done a lot of seeking out and learning from other bi-gender people, I'd like to add the additional concern that this is, as far as I've been able to tell, the only research being done on bi-gender people, and yet at least judging from the dozens of bi-gender people I've talked to, many of whom have taken a survey I put together, AGI relates to almost none of us. The concern I have is that if someone is trying to learn about being bi-gender, one of the few resources they're likely to come across is this study (or an NPR segment that references it). For most bi-gender people, as far as I can tell, that's going to be more misleading than anything. I'm not saying the study shouldn't be done; I'm just lamenting that there is so little information out there about being bi-gender.

    I also wanted to comment on the example in your post, where you said "let us take the case of a homosexual man who becomes a woman". I'd really like to suggest that this is not generally speaking what being transgender is: it's usually not that we are one thing and become another thing. It's that we are one thing, are told we're something else, have the anatomy of that other thing, and then eventually realize what gender or genders we actually are, and some of us change our bodies to conform to that gender. I know the phrasing sounds awkward, but I'd suggest the way to say what I think you were trying to say is "let us take the case of a woman assigned male at birth, with male body features, who has gender confirmation surgery."

    If you talk about a man "becoming" a woman–even though I know this is common shorthand for transgender people getting GCS–then you're reinforcing the idea that this person is "really" a man, because of body features, and they then become "really" a woman when their body features change–locating gender in anatomy and not in identity.

    I hope you won't mind me making a point of that, but it seemed like a discussion you might appreciate or at least have some interest in.

    James-Beth Merritt


Post a Comment

Emory Neuroethics on Facebook