"(You Make Me Feel Like a) Natural Woman"
—Written and sung by Carole King, also sung by Aretha Franklin
The term "natural woman" is heard in popular music, commercials for beauty and skin-care products and in women-directed magazines. But what is a natural woman? Is it genetic? Hormonal? Cultural? It's an age-old question: What defines our gender, nature or nurture?
Is it Biology?
First, consider this: You can be a genetic male, but be born looking like a girl and develop like a girl. How does this happen? If a fetus with the male chromosome cannot produce testosterone or is resistant to the effects of testosterone, it would not develop male genitals. Estrogen's effects then take over so that the fetus develops external genitals like a woman. In fact, men are frequently surprised to learn that women and men don't differ that much in the amount of estrogen they produce. The big difference is the amount of testosterone.
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Is it Hormonal?
Some men feel like they have been a woman in a man’s body all their lives, something called gender dysphoria. Before men can have a sex change operation, they must demonstrate that they are ready for this big step. First, they must meet with a mental-health professional. Then, they start to cross-dress to see what it's like to look and act like a woman and feel comfortable with that.
The next step is more dramatic; the man will experience hormonal changes. As a doctor, I know that prescribing estrogen hormones to a man, starting low and gradually increasing the dose, will make body changes happen. But as a woman, I often feel uncomfortable that all it might take to become a woman is some hormones and surgery.
Could it really all just be hormonal? The truth is, these men feel like they have been female all their life and finally begin to feel that their body is matching their mind. By taking estrogen, a man can start developing breasts and grow less hair. The extra estrogen suppresses testosterone production.
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Is it Cultural?
When I was in college, I remember a particular conversation with a professor about whether playing with guns was a learned behavior for boys or if it was somehow genetically or hormonally programmed. Believing that women and men must be the same to be equal, I fought against the idea that a boy was born with a different behavioral drive. The professor believed that boys played differently from the beginning. Now that I have a young son, I am a little more accepting of the idea that testosterone just might explain why my son has been banging on things since he discovered he can control the use of his hands.
However, I would still argue that culture plays a considerable role in how boys and girls develop their sense of gender. After all, there are symbols all around us that indicate how our society defines masculinity and femininity. Gender influences how we decorate our nursery, what toys and clothes we buy, and even the different ways we talk to our children. Whether your boy plays with dolls or your girl plays with guns, your attitude towards their behavior is important. They learn from us.
So the next time you hear Carole King's beautiful song, you might consider the complexity of what it takes to feel like a natural woman.
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Alice Y. Chang, M.D. is a former instructor in medicine at Harvard Medical School. She is currently associated with University of Texas Southwestern Medical Center. Her clinical interests and experience are in the fields of primary care, women's health, hospital-based medicine and patient education.