In our continuing Chat series, Dr. Skye Sturgeon (SS) and Yvonne Lau (YL) return to talk about Yin & Yang as it relates to LGBTQ+
Go to Yin & Yang Part 1: This and That
Go to Yin & Yang Part 2: Yin & Yang in TCM
Yvonne Lau (YL): Hi folks, many of you have probably already listened to previous episodes where Skye and I chat about Qi, Yin and Yang, and Blood, and I'll let you in on a little secret: Skye and I are good friends and can chat about all manners of things for hours. So in the prior episodes, there's a lot of stuff we edited out for length and conciseness. Parts of this episode are actually from one of those removed bits of conversation. Skye has also added some information here so that it'll be more complete. We thought it would be appropriate to share during Pride Month, so please enjoy.
Skye Sturgeon (SS): I always tell my students that when you're making an assessment, one of the primary aspects of eight principles is Yin and Yang. And you have to, by your methods, by your mind, make an assessment: Is this a problem of Yin, or is this a problem of Yang? And knowing that there's no such thing as pure Yin or pure Yang, it's always a mixture.
So the job of the practitioner is to weigh the evidence and determine the preponderance of Yin and Yang and develop a treatment plan accordingly. And then you pay attention to the effects of your treatment plan, and you adjust it based upon what you observe regarding the changes that occur when you push in this direction or you push in that direction.
What happens when you do that, because you're trying to find—and one of the things that is implicated by this assessment of Yin and Yang—is there a place of balance? In medicine, we might call it homeostasis, where the organism is fine. It's just working as well as it can given the condition of the organism, its age, its musculature, its nutrition, rest, you know, all the things that we talk about.
YL: So on a macro level, does Yin and Yang duality take gender into account? Now that we know there is potential infinite gradations between, and depending on how you define that, does it define men and women at the start of the diagnostic process? Because you are talking about organisms and homeostasis of an organism, but when we're applying that to people from a diagnostic standpoint, should we define men and women at the start of the diagnostic process? Because that would give you some basis for understanding like, okay, this is a middle-aged woman, for example, so she probably has these things. So do we start from there, or is it purely based on a gender-neutral concept first? And everything is just this person, this being's balance of Yin and Yang based on pulse diagnosis and everything else?
SS: I think these things are important questions for a practitioner to consider. Regarding gender and sex, this brings up several interesting observations. You can imagine there is a dualism between male and female.
YL: Okay.
SS: The first principle is that nothing is purely Yin or purely Yang. Let's look at that. Biologically speaking, we can designate male and female based on genes. The human genome is not only comprised of 46 chromosomes, 23 of which are contributed by each parent. Two of these pairs are considered the sex chromosomes and are designated X and Y. The presence of a Y chromosome means that the organism will be determined to be male. The absence of a Y chromosome means that the organism will be female.
Technically, the zygote formed will contain 46 chromosomes, and males will have a pair designated XY, and females will have a pair designated XX. However, due to the possibility of several abnormal circumstances during the creation of the zygote, such as translocation, the fertilized egg may have 45, 46, or 47 chromosomes. If the extra chromosome is one of the sex chromosomes, several genetic variants are possible.
If the chromosomes are designated X naught, XX, or XXX, the organism will be female. A male organism's chromosomes may be XY, XXY, XYY, or even XYYYY. Naught Y is not viable.
Research has demonstrated that one gene, the sex-determining region of the Y chromosome, called SRY, was the master regulator of sex determination. However, XY individuals with an inactive SRY gene on their Y chromosome will exhibit a female phenotype, including a normal vulva, although their gonads are non-functional and will fail to experience puberty.
In many cases, an individual born with X naught, XYY, or XYYYY karyotype may be designated intersex, and their genitalia at birth may be ambiguous. So this clearly shows that there are variations from a pure Yin or pure Yang in regard to biological sex.
The next principle to explore is how these seemingly opposite or contrary forces create each other, are interconnected, and how they may give rise to each other as they interrelate to one another. What does this look like when we examine the sexual aspects of Yin and Yang? What is a male, or what is a female? Masculinity and femininity exist along broad scales of expression.
The secondary sex characteristics of any individual are the result not only of their primary sex assignment, but their hormonal expression of their gonads, the development and regulation of which includes several endocrine glands, developmental physiology, physical, emotional, and psychological changes during puberty, nutrition, phenotype, society perceptions, and cultural norms.
So, let's take a male. Is there some male that is 100% male? And what does that mean?
YL: Yeah, so what would that mean?
SS: There's a spectrum, okay. I suggested that there are an infinite number of degrees between any Yang and Yin pair. There are different kinds of males. There are different kinds of females. How many different kinds of males are there? There's over 8 billion people on the planet and roughly half are males. What does he look like? Do all males have the same musculature? Angular features? Facial hair? Temperament? Is it true that males are primarily thinkers rather than feelers? Do all males have lower pitched voice? There are so many things to explore. Other than genitalia and the accompanying gonadal hormones, and there's even variants of these, we can only speak generally since the sheer number of variants is beyond imagination and categorization.
Likewise with females. How many different females are there? Do all females have an hourglass figure? The same shape and size breasts? Is every vulva the same? Variants that exist on many continuums are the rule and not the exception.
And importantly, I can make an erroneous clinical assessments based upon a fixed idea of what it means to be male or female. For example, I can imagine a patient that is the middle-aged woman you mentioned. Let's say she's 46 years old. And so, if I presume that a 46-year-old woman is peri or pre-menopausal, I have basically made an error in my judgment because I have assumed something as being true. Because, she can be a 46-year-old female who is not pre-menopausal because when she was 38 years old, she had a complete hysterectomy. So her hormones may be completely functioning in a different way. She certainly is going to have a different balance between the four hormones involved in a woman's cycle. They can be present or absent, they can be different proportions, and they can, any one of them can actually cause a disease or a dysfunction in that female's optimal health.
And we can imagine certain things like that can happen with men as well. Some men have a heavy musculature. They have different hormone levels. We sometimes blame aggression on testosterone. We can imagine men, various men having different levels of testosterone, different levels of aggression, different levels of drive, and all of these kinds of things. These days it is popular to suggest that some men are identified as low T. And are given testosterone or other androgens as therapy. The results are not necessarily therapeutic but can also cause adverse effects. Idealizing the man based on his primary sexual hormone is not determinative of maleness. Preconceived ideas can prevent a practitioner from seeing the person in front of them.
You'll get variations. And I always believe that people should just be who they are, and you need to make an assessment, a careful assessment, of who that person is. And then you have to decide the preponderance of the various criteria that you're looking at. And you would make a prescription based upon your assessment of that preponderance. In my opinion, this is one of the strengths of Chinese medicine.
Over the years, I have had the opportunity to treat a significant number of LGBTQ+ people. And I have found it vital to assess individuals where they are and not what I might think they should be. I remember the first trans man that I treated needed assistance with the effects of his testosterone therapy on his menstrual cycle.
Finally, you mentioned gender. These days gender can elicit some strong opinions. Sex and gender used to be considered interchangeable. Now, gender refers to socially constructed roles, behaviors, activities, and expectations associated with femininity and masculinity, and importantly, how a person identifies rather than simply adhering to expectations associated with their sex identified at birth. Along with sexual behaviors and sexual orientations, gender does not lend itself to a simple binary. Understanding the infinity of expression between the poles of Yin and Yang leads to compassion and acceptance of the sheer variety of humans we encounter. Perhaps we can appreciate the uniqueness of people and cultures by embracing the French expression, viva la différence.
