Monday, October 22, 2018

The Department of Inhumanity and Ideological Services

A memo was recently leaked from the Department of Health and Human Services. In it, the HHS defines sex as a binary determined by chromosomes (presumed to come in only two forms, XX or XY), and states that sex cannot be changed.

The memo has caused outrage, because its goal is to define gender transition out of existence. Its aim is to discriminate against trans people, declaring them to be deluded or deceptive, their lived genders irrelevant. In so doing, it ignores the conclusions of every mainstream medical and psychological association, which is a bizarre position for a department supposedly aimed at recognizing and supporting medical treatment paradigms to take. Unrecognized as yet is how this proposed policy would also work to shatter the lives of intersex people. As is so often the case, intersex people's lives and needs go unrecognized, so in this post I will try counter that.

First, we need to understand where this memo is coming from. The Director of the HHS Office of Civil Rights is currently Roger Severino. He used to work for the Heritage Foundation. He has no special knowledge of medical issues--he was hired by the Trump administration to please conservative Christian groups. He is an advocate of conversion therapy for LGBT people. He says being LGBT is "against biology." He believes in a radical conservative Christian ideology that states that patriarchy, heterosexuality, and cisgenderism are compelled by the Bible and nature, and that Christians are forbidden from tolerating gender egalitarianism or LGBT people. Unsurprisingly if very sadly, rather than doing his job as Director of the HHS Office of Civil Rights, which is to see that the medical needs of all people, as understood by the medical profession, are met, he is seeking to impose his ideology. Rather than fostering humanity and human services, he seeks to advance discrimination and a radically conservative ideology of sex and gender.

What's especially insidious is that this extremist political position is not being proposed for debate--not that human rights recognized by the UN and international community should be debatable. But by inserting its bigoted assertion--that sex is a binary determined by chromosomes that cannot be challenged or changed--into the HHS definition, radical conservative Christian ideology is disguised as scientific fact. This is a common tactic today in that segment of the far American right that seeks to dismiss scientific consensus. They find some person of supposed authority who will ignore what the vast majority of experts affirm to be true, and present the assertions of that person as "disproving" the voice of the vast majority--this is very evident when we look at their approach to defying the national and international consensus of climate scientists.

In this case, the action is even more radical. The idea is to have the institution created to protect people's rights to health simply declare gender transition invalid. Many Americans will be unaware of the politicization of what is supposed to be a scientific body. They will believe that the medical profession actually opposes recognition of trans people's identities based on scientific study. Therefore, they will believe they need feel no guilt when gender policing people, and discriminating against those whose appearance strikes them as insufficiently conforming to binary sex and gender expectations.

As an intersex person who has gender transitioned, I can attest that if this proposed policy becomes law, trans people--some of whom are intersex--will suffer greatly. This is the aim of the radical conservative Christians who have been given an outsized voice by the Trump Administration. I have lived a decade in my identified gender as a man. My wife, an intersex woman, started her gender transition over two decades ago, as soon as she turned 18 and could control her own medical destiny. These decades of our lives, our gender identities, and the understandings of our friends, families and colleagues would all be declared lies. Humiliating us by misgendering us would be proclaimed "healthy." Discrimination against us would be declared justified.

But many more people than just trans people would suffer. The majority of intersex people in the U.S. today do not gender transition. But all of us have been fighting for social acceptance, for an end to infant genital surgeries that rob us of the capacity for sexual sensation, and against the stigmatizing and concealment of physical sex variance. Our battle as intersex people has been for recognition of the sex spectrum, and for respecting our physical sex diversity.

Think what will happen to us now. Consider, for example, those of us who have complete androgen insensitivity syndrome, born with female-typical genitalia but XY chromosomes. Virtually all people with XY, CAIS are assigned female at birth and are raised as girls--but suddenly, they'd be declared men. This would disrupt not only their lives, but those of their parents, their spouses, their neighbors and friends. Or consider all the children born with intermediate genitalia. Doctors have forced surgeries onto so many, basing their decision on factors like gonads, or surgical convenience. Suddenly, many intersex people would find that the surgeries forced on them took away the parts of their bodies that the new HHS policy declares to be the ones that should have been kept under the new chromosomal standard. This will compound their trauma--and perhaps lead to a further round of unwanted surgical interventions.

For those of us intersex people whose chromosomes are XX or XY, this new policy would counter all of our efforts to push back against forcing sex reassignment surgeries onto us, mutilating our genitals. Instead, the policy would declare that these are not sex reassignment surgeries at all, because our penises are "false penises," our vaginae "fake." And for those of us who have one of the many other sex genotypes this policy fails to recognize--XXY, XYY, Xo, XX/XY, etc.--ironically, even if our bodies have appeared typical enough that we've escaped surgical mutilation or social stigma, suddenly, we become the "true intersex," our lived genders falsified, leading to confusion, discrimination and shame.

The intersex community's central goal for many years has been to put an end to nonconsensual infant genital reconstructions. And our best bet for seeing this happen has been to educate parents--to let them know that intersex status is fairly common and in no way a tragedy, so long as children have the respect and support of their communities. This HHS policy would undo our good work in parental education by declaring to parents that what we've been telling them is false. The HHS policy says that only binary sex can be recognized, physical sex variance is intolerable, and "corrective" surgery a necessity. This is a tragedy for our community.

The deepest irony here is that we as intersex people have bodies that prove that this proposed HHS policy is, to be blunt, complete BS. Sex is not a binary--empirically speaking, it is a spectrum. If you look at world societies over history, most have recognized more than two sexes. This is not because until the modern West appeared with its binary gender ideology, everyone was deluded--it's because there have always been intersex people. The capacity to attempt to erase us surgically is only a century old, and other societies dealt with us very differently--by recognizing and accommodating us. Sadly, binary gender ideology is so passionately adhered to in our society that most Americans are unaware of both this world history of diversity in social sex categories, and of the prevalence of intersex people today.

And what this proposed inhuman policy does is attempt to codify that ignorance, declaring binary sex ideology the law of the land. The aim is to trample upon trans people--but the victims will include intersex folks, and empirical truth.

Monday, August 20, 2018

Nonconsensual Intersex Surgery as Physical Conversion Therapy

Today, most people think of conversion therapy as a discredited practice of the past. Back in the bad old days, being "homosexual" was considered a mental disorder that psychologists tried to cure. But being gay was depathologized by the American Psychological Association back in 1972, and today, same-gender couples are socially accepted and have the constitutional right to marry. A small number of evangelical Christian "therapists" still attempt conversion therapy on LGBT people, but they are considered quacks by the medical profession and most of American society. The days of conversion therapy are seen as basically over.

They are not.

I am going to argue to you that "corrective," "normalizing" surgeries performed on intersex children who cannot give or withhold consent are conversion therapies. They are motivated by the same constellation of  ideas that produced conversion therapies aimed at LGBT people. And they take place way more often than most people think. Conversion therapies are alive and well and being imposed every day on unconsenting children in the U.S., harming them.

Mainstream medical practitioners in America today distinguish between LGBT conversion therapies and intersex "corrective" procedures. They frame conversion therapies for sexual or gender identity as wrong because they now agree there is nothing pathological about being queer, trans, or gender-nonconforming. These are minority identities, and trying to "cure" them is akin to doctors attempting to cure people of identifying as Jews or Muslims. It is not the place of the medical profession to impose the majority religious or sexual ideology on patients, and doctors who try to do so are violating professional ethics.

Intersex status, on the other hand, is pathological according to contemporary Western medicine. Physical sex variations are medically classified as "disorders of sexual development." It is the job of doctors to cure disorders. They sat that intersex people are born with tragic malformations, and we will live as social outcasts unless the medical profession heroically steps in to save us by converting our abnormal intersex bodies into endosex-appearing, normal bodies.

A Brief History of Conversion Therapies

The mid-20th century was the heyday of conversion therapies. This was an era of conformity, of faith in medical authority, and of optimism that social ills could be cured by science. It was taken as an article of faith that doctors should seek to convert deviance to normalcy. Funds were directed to developing a wide array of innovative medical interventions toward that end.

A key arena for the development of therapies was producing "normal sex." This midcentury umbrella term encompassed a wide array of matters related to sex, gender and sexuality. The goal was to ensure "natural sex relations." According to the scientific ideology of the time, evolutionary biology required that humans come in two opposite sexes--dominant, competitive men and gentle, nurturant women--who would be drawn by heterosexual attraction to form stable marital units, the necessary basis for parenting. The survival of humanity was believed to require bodies of binary sex, people who conform to binary gender stereotypes, and compulsory heterosexuality.

In the 1950s and 1960s, the medical profession made great investments in developing and institutionalizing conversion therapies, both psychological and physical. These therapies became mainstream and widespread. Doctors aimed to cure "hermaphroditism and pseudohermaphrodism" (i.e. intersex status), "sexual deviance and transvestism" (i.e. LGBT status), and gender nonconformity (under many labels, including "sissy boy syndrome" and  "neurotic penis envy").

The therapies doctors developed were deeply interventionist--often traumatizing and painful. To be converted from deviant to normal was seen as a positive outcome that justified a steep personal price. People with nonconforming sexual orientations, gender identities, and gender expressions were often institutionalized. Some were given electroconvulsive shock treatments. Many were treated with aversion therapies--for example, being given painful shocks, perhaps to their genitals, while being shown same-gender erotica. These "treatments" amounted to torture, and while they could not change people's identities, they could render people incapable of arousal or of sexual relationships. Today, we see such an outcome as tragedy, but at the time, being incapacitated by panic and nausea when triggered by sexual arousal was viewed as better than being able to engage in same-gender sexual relations.

In this same time frame, "corrective" surgeries on intersex children became the norm. The goal of these surgical, hormonal, and other interventions was to produce a person who appeared endosex and was capable of engaging in penetrative penile/vaginal intercourse. Sexual sensation, freedom from pain, and issues of gender identity were dismissed as irrelevant. The goal was to enforce "normal sex" by creating a person who appeared to be of binary sex, was gender-conforming, and who had heterosexual intercourse, whatever the costs. This was very much in line with the painful treatments being imposed on LGBT people at the time.

Prettying Up Conversion Therapies

After the Stonewall uprising in 1969 and the rise of second-wave feminism, conversion therapies came under attack for enforcing compulsory heterosexuality and gender conformity. Lesbian and gay advocates successfully got homosexuality removed from the DSM, the "bible" of psychological diagnoses, in 1972. And supposedly, since then, nonconsensual conversion therapies became a thing of the past.

But in reality, conversion therapies persisted--they just put on an acceptable mask. Homosexuality was no longer classified as a mental illness, but being unhappy about being gay was (this was "ego dystonic homosexuality"). So therapists could still practice conversion therapies on LGB people, so long as they got the patients' consent--or, if they were minors, their parents gave consent and told the therapists their children's "homosexual tendencies" were causing depression.

Meanwhile, mainstream sexual orientation and feminist advocacy organizations of the 1960s-1980s largely ignored or actively opposed trans people's rights. So being trans remained classified as a mental illness, "gender identity disorder." A small number of fortunate trans women and a tiny number of trans men were able to use this diagnosis to access gender transition services during these decades. These individuals had financial resources, bodies that doctors deemed would not be visibly trans after hormonal and surgical treatment, and a demeanor and gestural repertoire that would be gender-conforming after transition, in accordance with the ideology of natural sex/gender binarism doctors were still enforcing. But most trans people were refused access to transition services by medical gatekeepers. Having failed one or more of the enforced gatekeeping criteria, they were instead treated with conversion talk therapies intended to resign them to living in their birth-assigned genders.

As for physical intersex conversion therapies, to the extent they appeared at all on the radar of progressive political activists in the post-Stonewall decades, it was in a positive light. Dr. John Money became something of a celebrity in this period. Money performed intersex "normalizing" surgeries, but became most famous for "treating" one of a pair of identical twin baby boys. This child was the victim of a botched circumcision, in which he lost the head of his penis. Money gave that infant sex reassignment surgery and had the parents raise the child as a girl. In his reports on the case, Money claimed that by enforcing strong gender stereotypes in their parenting, the end result was that the identical twins became a happy girl and a happy boy, both of them gender-conforming. In fact, that was not the case--the surgically reassigned child was never happy, gender transitioned back living as a boy in his teens, and committed suicide in his 20s. But in the 1970s, feminists and progressives saw the case as a cause célèbre, because it was framed as illustrating that gender is socially constructed and not some natural or innate matter.

Money became so famous as a result of this that his paradigm for the treatment of intersex infants became universal in the West. Money held that visibly intersex children should receive genital reconstruction as early in life as possible, so that their parents would raise them as "normal girls and boys," producing well-adjusted heterosexual women and men. So unlike sexual orientation conversion therapies, which had to become much more polite and consensual, intersex conversion therapies actually became more invasive, ubiquitous, and less consensual. 

The Spread of Resistance to Conversion Therapies

In the final years of the 20th century, advocacy movements for sex, gender and sexual minorities pushed back at the persistence of conversion therapies. Sexual orientation advocacy organizations did this overtly. They fought active campaigns against the idea of conversion therapy for LGB people, and in 1987 "ego dystonic homosexuality" was removed from the DSM. Conversion therapy aimed at LGB people was officially disclaimed by the American Psychological Association.

Trans advocates also overtly pushed back at conversion therapies. They focused particularly on the diagnosis of Gender Identity Disorder of Childhood. There being no protocols for social transition for children at the time, children given the "GID of Childhood" diagnosis were all treated with conversion therapies. Some of these children we'd recognize today as trans kids, but often the youths being "treated" had never expressed a trans identity--they were your classic feminine boys and tomboys, or LGB teens whose parents opposed their sexual orientations. Many were institutionalized against their will by their parents. And punitive aversion therapies, often involving physical punishments, were commonplace. The goals of these treatments were to produce complete conformity to the child's assigned binary gender. Trans advocates pushed back against this, and were joined in this instance by LGB and feminist activists.

Trans groups were also engaging in other advocacy efforts that amounted to fighting conversion therapies, but were not framed as such. Trans people were struggling against the gatekeeping by doctors that kept so many trans-identified people from accessing transition therapies. They were pushing for a different pathway to accessing transition services--one now called the "risk reduction approach," in which a patient signs a declaration attesting to their gender identiy and is then allowed to access services after some simple screenings. This advocacy was pushing back at the channeling of a majority of patients wishing to gender transition into cisgender conversion therapies instead of their desired transition treatments. Success in this advocacy let to the bypassing of extensive medical gatekeeping, which in turn led to rapid growth in the number of people accessing transition services. Especially empowered were those who were excluded in the past because they had nonbinary gender identities, would be LGB or gender-nonconforming after transition, and/or would remain visibly transgender after accessing hormones and the surgeries they desired and could afford. For many, conversion talk therapies were replaced with access to transition services.

This pushback against conversion therapies in the 1990s led to the burst of trans visibility in the 21st century. But intersex people still remain largely invisible.

That's because our fight against conversion therapies lags decades behind LGBT battles on these issues. The first major intersex advocacy group wasn't even founded until the 1990s. Having heard no intersex voices of protest, most endosex progressives entered the 21st century thinking of intersexuality as vanishingly rare, and of infant genital reconstruction as some cool proof of the flexibility of gender.

21st Century Intersex Advocacy

Most people today remain unaware of how common intersex status is. I explain its prevalence here: about 1 in 150 Americans is diagnosed with a "disorder of sex development." The fact that people aren't aware of how commonplace intersex status is illustrates the effectiveness of repressive conversion therapies. The very point of intersex surgeries performed in infancy without our consent is to render us invisible. For decades, the treatment paradigm included keeping our medical histories secret from us--lying to us about the nature of our treatments to hide our intersex status even from ourselves. For decades, our parents were told that if anyone learned of our secret, our lives would be ruined, so we must be taught never to talk about our differences. There's been more openness in the last decade--but doctors' diagnostic categories themselves continue to seek to convert us to endosex by concealing the nature of our differences. Rather than being told we are intersex, these diagnostic terms often label us "boys with a penile deformity" or "girls with clitoromegaly." We're told these are embarrassing issues, but ones doctors can cure for us with a few simple surgeries, so nobody will ever know and we'll never have to have the embarrassing problem revealed.

We live in a culture of shame and stigma in which intersex people are still taught that if our variance becomes known, potential friends and mates will be repelled and we will be doomed to lives of isolation. Doctors present us with a solution: physical conversion therapy to erase our physical sex variance, and silence about this ever having occurred. And it works, at least on one level. Few contemporary Americans are aware of how many intersex people are all around them.

But conversion therapies continue to come at a severe cost. For us, these include physical costs: the loss of sexual sensation that accompanies so many infant genital reconstructions; pain; infections. We are forced to show our genitals over and over to strange adults who poke and prod us, and then we are expected not to talk about it, which is a great training regimen to make us vulnerable to sexual abuse. And there's the fundamental issue of agency and self-determination over our physical sex characteristics. For those of us who don't grow up to identify with the binary sex we were coercively assigned at birth, there's the betrayal of knowing our bodies once better matched our identities, but then doctors cut off parts of us with which we identify, and our parents just went along with it. And even if we are in the majority that do grow up to accept our assigned binary sex, all intersex children whose genitals and gonads are surgically altered have endured a forced sex change--something our society would find horrific in endosex children, but accept in our case--and that is very hard to deal with.

And the thing is, conversion therapies never solve the fundamental problem. The problem is that the patient is a member of a stigmatized group. Even if a perfect conversion of a patient to endosex, to cisgender identity, to heterosexuality, or to gender conformity were possible, it only allows that specific patient to escape a social problem that persists. The real solution is to end stigma and discrimination against the minority group, so that every member of the group benefits.

Rather than reducing stigma and discrimination, conversion therapies strengthen them. They naturalize the discrimination and blame the victim.

The young intersex advocacy movement has tried several approaches to addressing the social problems we face. We've formed support groups. We've tried to work with doctors, hoping that if we are polite and educated and assimilated and attractive, they will listen to us and at least delay surgeries to allow children to mature enough express an opinion about whether they want them. The medical profession has been happy to co-opt us and present their uninterrupted intervention practices as having our seal of approval. We've tried confronting doctors individually. They call us atypical malcontents who received outdated surgeries, while they present current surgeries as cutting edge and advanced, with zero data to show any improvement in outcomes. We've tried analogizing infant genital "normalizing" surgeries to the cultural practices Western doctors call "female genital mutilation" and deem barbaric. Both are medically unnecessary cosmetic practices meant to make our bodies appear culturally acceptable to potential mates that traumatize us and deprive us of sensation. This convinced the U.N. to call for an end to unconsented-to medically unnecessary infant genital reconstructions, but basically only tiny Malta banned the practice. In the U.S. and most wealthy industrialized nations, medical interventions continue unabated. Doctors just frame every surgery they do as medically necessary to correct "disorder."

Doctors will only stop performing infant genital reconstructions to enforce their ideology that bodies must conform to binary sex expectations when parents stop consenting to it. In the 21st century we've been trying to educate the population about intersex issues, so parents will cease consenting. But it's been hard to get traction. One problem is that the medicalization of sex variance turns every conversation about intersex issues into a complex story of 17 diagnostic categories, and what each means, and how to evaluate twisted medical claims that surgeries they perform are necessary to enhance fertility (which they mostly reduce) or prevent cancer (which occurs at rates way, way lower than breast cancer--and we don't preemptively remove all breasts like doctors want to remove all internal testes and ovotestes). Medical terminology confuses most average people, and we are trained to defer to medical authority, so listeners often give up trying to process what we are saying.

That's why I suggest we make clear what intersex surgery is. It is a conversion therapy. Doctors say it's necessary to cure disorder and prevent stigma. But they said exactly the same thing about LGBT conversion therapies, until social movements made them relinquish these (lucrative) practices. LGBT conversion therapies were practiced in service to the ideology of "natural sex;" the same is true of intersex physical conversion therapies. But homosexuality is not "unnatural;" same-sex sexuality is found throughout nature. Trans identities are not "unnatural;" gender-crossing is found throughout history. And intersexuality is not "unnatural;" empirically speaking, sex is naturally a spectrum and not a binary.

The public doesn't have to enter a debate about multiple complex medical treatment paradigms any more than the public needed to read psychological journal articles comparing the efficacy of different aversion therapies.

The simple fact is that no person should ever be forced to endure a conversion therapy. No intersex child should be forced to have medical interventions to convert their bodies to appearing endosex. Genital reconstructions should only be performed on mature people who ask for them--whether intersex or endosex, cis or trans.

Having an intermediate phalloclitoris is no more inherently medically dangerous than having a penis or vulva. The danger that comes with having intermediate sex characteristics is purely social and comes from living in a society that discriminates against people whose bodies don't conform to binary sex expectations. The way to protect people from that is to ban the discrimination, not to try to conceal an individual's nonconformity so that that one individual escapes the discrimination.

Stop nonconsensual intersex surgeries. They are conversion therapies, and they are wrong.



Saturday, September 2, 2017

Conservative Evangelicals Embrace Intersex Genital Mutilation

Something frightening happened this week that may have a profound impact on intersex infants and the intersex community. In the midst of the constant bombardment of news of political and natural disasters that is the state of things in the U.S. today, you may not have even noticed. But you need to know about it. A large group of conservative evangelical Christian leaders signed and released a document they call the "Nashville Statement." To the extent that it got media attention, it has mostly been because it says true Christians must oppose same-gender love and marriage, and refuse to acknowledge gender transition or even that gender identity exists.

But while morally repugnant--including to a huge number of Christians--there's nothing new in that part of the Nashville Statement. We knew conservative evangelical activists oppose LGBT rights. What's new is that this declaration officially puts intersex advocacy in the very same boat. Intersex advocates are sinners now, officially, they say. And this is going to infuse a blast of energy into attacking us politically that our small but growing movement has not experienced before.

So we need to be prepared. We need the help of allies. And we need to understand what this Nashville Statement says.

What is the Nashville Statement?

The Nashville Statement was written by the Council on Biblical Manhood and Womanhood, a group that has been around since the 1980s. Its original focus was on fighting feminism, but it expanded its mission to opposing same-gender marriage, and then to denying recognition of trans identities and gender transition. The Nashville Statement is a manifesto, and the 187 conservative evangelical leaders who initially signed it intend it to serve a number of purposes. One is stop the spread of tolerance in their own followers by declaring acceptance of sex/gender/sexual variance to be a sin in itself. Another is to create a document to use in legal battles seeking to oppose LGBT+ rights by making claims to a "religious freedom" to discriminate. And a third is to try to frame variance in sex, gender, and sexuality for the public as disorder. It is, they say, on one level an issue of physical or mental disorder. But more importantly, they claim, it is evidence of a general social disorder, an international shared sickness, based in rejection of God's order of creation.

It's in this context that the Nashville Statement frames intersex status, calling it a "physical disorder of sex development." And as an intersex advocate, I find this both frightening and fascinating, because it is adopting what we call "DSD" language, and doing this explicitly to attack intersex advocacy.

What is "DSD" Language and Why Does it Matter?

Prior to 2005, the term "intersex" was used by medical practitioners and by people born sex-variant alike. But late in that year, the term "Disorders of Sex Development" or "DSD" burst onto the scene. It came out of a big conference that involved medical professionals and some intersex advocates. The goal of the intersex participants was to stop doctors from rushing to cut up the genitals of babies born sex-variant. And, ironically, it was at the urging of some intersex advocates that one of the things that came out of this big conference at the last moment was the statement that people should stop using the term "intersex," and start using "Disorders of Sex Development" instead.

Those intersex individuals who helped introduce DSD language thought that it would slow down the rush to surgery. Their reasoning was that the term "intersex" evokes sexual perversion, queerness, and radicalism. But "DSD" just sounds like any other medical condition, and so, they hoped, would cease freaking out parents and doctors. Instead of stigma and shame, there would be medical conditions that could be treated calmly, deliberately, and with the minimum intervention necessary. Sex-variant people would be empowered in interactions with medical professionals, and sex-variant advocates seen as reasonable people. Those were good intentions.

But that's not how things worked out.

In fact, what happened is that most out intersex advocates quickly rejected DSD language as repugnant. We didn't see ourselves as "disordered." We saw the problems we faced as socially and medically produced. The forced genital surgeries and other treatments imposed on us without our consent didn't "save" us, they caused us terrible suffering. They constituted intersex genital mutilation. Our problem did not lie in our sex-variant bodies, it lay in a society that framed such bodies as horrifying rather than just an eternal part of natural human diversity.

But you know who loved DSD language, and rushed to embrace it? The medical community, which used it to justify continuing, even intensifying interventions into sex-variant bodies. Disorders, after all, should be cured! Oh, and many parents of intersex kids quickly adopted DSD language, too, after hearing it from doctors, because it supported their desire to have their children "cured" and become "normal." These parents and doctors alike had a shared vision of intersex children being transformed into "regular" girls or boys who would gratefully grow up to be genderconforming and happily, heterosexually, married.

So in 2017 what we find is that in the U.S., we have two competing terms being used to describe those born sex-variant. Advocates call ourselves intersex, as do human rights organizations supporting us, while the medical community and those seeking medical "cures" use DSD language.

Right under the surface of the embracing of DSD language by doctors and many parents has been a great deal of homophobia and transphobia, though that has remained a subtext. It is that subtext that we now see revealed in the Nashville Statement, as conservative evangelical Christians have climbed aboard the DSD boat. Let's look at the Nashville Statement language to see how they deploy the language of disorder, and why.

The Nashville Statement and What it Means

I'll give you the most relevant text from the Nashville Statement for you to read yourself, but I have to warn you--it's written in evangelicanese. What the words mean for the conservative evangelical Christian activists who wrote them may not be at all apparent from the words as they are understood in ordinary English. So what I'll do is give you the text, and then a translation into everyday English.

Here is the most relevant language, from Articles IV-VI of the Nashville Statement:
  • Article IV: We affirm that divinely ordained differences between male and female reflect God’s original creation design and are meant for human good and human flourishing.
  • Article V: We affirm that the differences between male and female reproductive structures are integral to God’s design for self-conception as male or female. We deny that physical anomalies or psychological conditions nullify the God-appointed link between biological sex and self-conception as male or female.
  • Article VI: We affirm that those born with a physical disorder of sex development are created in the image of God and have dignity and worth equal to all other image-bearers. They are acknowledged by our Lord Jesus in his words about “eunuchs who were born that way from their mother’s womb.” With all others they are welcome as faithful followers of Jesus Christ and should embrace their biological sex insofar as it may be known. We deny that ambiguities related to a person’s biological sex render one incapable of living a fruitful life in joyful obedience to Christ.
Translated from the evangelicalese, this says something like this: "God requires binary sex and gender, and forbids homosexuality or gender transition. LGBT people are all sinners. Being born intersex is not the individual's fault, so it's not a sin. It is, however, a medical disorder, and if a doctor can be found who will assign an intersex child male or female, then infant genital surgery must be embraced, and the individual must identify with their assigned sex and as heterosexual or they become a sinner."

Oh, and thus under Article X, which compels rejection of sex, gender and sexual variance, parents who fail to seek out intersex genital mutilation for their children, or who accept it if their intersex children do not identify as straight members of their medically-assigned binary sex--those parents are committing a terrible sin and cannot call themselves Christians.

Intersex Advocacy as Sin

What the Nashville Statement reveals is that intersex advocacy is now fully on the radar of conservative evangelicals, who oppose it.

The main goal of intersex advocacy is to stop doctors from being allowed to impose unconsented-to sex change surgeries on babies. Our society would never allow this for the endosex babies it frames as "normal," and should not allow it in the case of intersex ones. Medical interventions aimed at changing the sex characteristics of someone's body should only be performed if a fully informed, sufficiently mature individual requests them of their own will. (Yes, of course, if an infant has a functional impairment that endangers their physical health, parents should be able to consent to medical treatment limited to fixing that impairment--but the vast majority of intersex genital surgeries are performed without the child having any functional problem.)

After this core priority, the goal of intersex advocacy is to ensure intersex children can grow up in a family, community and medical regime that treat intersex bodies and healthy and beautiful. We want to ensure intersex children full freedom to explore and assert their own gender identity, whatever it may be. We want them to have access to any medical interventions they mature to desire, but to make decisions about any medical interventions completely free from coercion, in a context where choosing to access no interventions is fully supported.

The Nashville Statement calls this sin.

According to the Nashville Statement, part of submitting to the will of God means, in the case of intersex individuals, submission to the will of doctors. Doctors are treated as agents of God's will in determining a binary sex to which to assign a poor benighted, disordered intersex infant. It may seem quite strange for religious authorities to declare medical authorities diviners of God's will, but in fact this partnership between religion and science in enforcing binary sex/gender ideology has been around for centuries--you can read my prior post discussing that here. It was perhaps at its height during the heyday of European colonialism, when Christian missionaries partnered with European scientists and doctors to pathologize and dismantle nonbinary sex categories among colonized peoples. But there's an ongoing religious and scientific partnership in proselytizing the ideology of "natural sex," and we see that very clearly in the case of the Nashville Statement.

Here, we see conservative evangelical leaders joining doctors in framing intersex as disorder. Intersex people must be medically assigned to a binary sex and have their bodies altered to conform to it as much as possible. To object to this is now not simply to fail to respect medical authority-- it is now proclaimed to violate God's will.

What Does This Mean for Intersex Advocacy?

I believe that what this means for us is that a storm is coming. In the past, conservative evangelical opposition to variance in sex, gender and sexuality hasn't focused on intersex advocates. We've been dismissed as pitiful, freakish, and rare, and conservative religious approaches to us haven't been consolidated.

Well, now they have been. And in terms of advocacy, for me the main takeaway here is that the Nashville Statement answers the questions of whether intersex advocacy should be making common cause with LGBT advocates.

For many years, intersex communities have been divided over whether we should be placed "under the LGBT+ umbrella." Intersex support groups where parents of intersex children have had a strong voice have tended both to embrace DSD language and resist the idea of allying with LGBT communities, because their goal has been one of assimilation. The have desired to to distance the community from people viewed as radical and queer and present intersex people (or "people with DSDs") as "normal." This tendency is likely to continue. There's a growing number of parents who have been educated by trans and intersex advocacy who oppose surgical alteration of their intersex babies' genitalia, but for the larger group that view intersexuality as a curable disorder, the Nashville Statement is actually likely to be fairly resonant.

But then there are those of us who are out intersex advocates fighting the pathologizing and mutilation of our bodies. And among us, while opinion about whether to ally with LGBT advocacy groups has been much more positive, there are still those of us who have been against it. This is not because of an assimilationist desire, but out of frustration with LGBT+ organizations that have demonstrated poor allyship. I will acknowledge that there's been a substantial amount of ally failure. Common examples include organizations that put an "I" in their group acronym (such as LGBTQIAA) without having any out intersex people in their group; treating sex variance as an abstract concept to use to advance an LGBT group's agenda without recognizing us as actual people around them who need to be understood and aided; misunderstanding intersex community needs as being primarily about respect for gender identity instead of ending IGM and other forced medical interventions; and denying that physical sex has any reality as a tactic for fighting transphobia, which makes it impossible to even articulate our mutilation and suffering.

But whether we are satisfied with how we have been treated by LGBT organizations and advocates or not, we are all in the same boat in the eyes of those who would cause us vast suffering and call it "Christian love." And because our community is most likely to be in the closet, our organizations younger and smaller, and our suffering least understood by the general public, we really really need the aid of LGBT community partners.

So: it is time for us to do a whole lot more educating--of both LGBT advocates with whom we share common cause, and of the general public. And it is time to prepare for the active opposition of conservative evangelical groups that have announced in the Nashville Statement that opposition to IGM is now right up there with advocating marriage equality or support for gender transition as acts that claim "ruin human life and dishonor God."

Wednesday, August 10, 2016

The Problematic Ideology of Natural Sex

What is human nature?

In the Western world today, science and religion are often understood to be enemies. It’s believed they offer two competing explanations of how the world works. What I want to show you is how when it comes to understanding human nature, Christianity and Science are in fact complete bedfellows. They both are deeply invested in a belief system, which I will call the Ideology of Natural Sex. And both have been shoring up that ideology, enforcing it brutally, and imposing it by force on others around the globe, for centuries.

What is this Ideology of Natural Sex? What do authorities from the Pope to our medical and scientific textbooks jointly believe, and insist we believe, about sex? It’s their unified theory of sex, gender and sexuality, and it goes like this:

“As ordered by God/evolutionary biology, humans come in two and only two physical sexes. This is the nature of things because a male and a female make a reproductive unit. The purpose of sexual interaction is reproduction. Thus, the determinative factor in dividing men from women is genitalia. Genitalia determine gender—the way society organizes people through gender roles, and the way people should properly identify and understand their place in the world. And this world is one in which men are (by God’s design or by biological imperative) the dominant sex, the sexual “aggressor,” while women’s interests center on nurturing families and offspring.”

Four things that are central to my own life pose challenges to this ideology. The first is that the empirical reality of physical sex is that it is a spectrum, and people, like myself, have always been born intersex. The second is that people around the world and throughout history have identified with genders other than male or female, and/or have been assigned to one sex at birth, and felt called to move to live in another. The third is that people engage in sex all the time that is not procreative. This is true of people who are infertile, people in same-sex pairings, and fertile men and women who do not wish to conceive with one another at the time of their sexual interaction. And the last is the reality that gender inequality is not inevitable. Patriarchy, the privileging of men over women, is a form of inequity that is successfully being reduced.

How have religious and scientific authorities dealt with these challenges over the past several centuries? They have periodically declared them to be “unnatural.”

Now, if ever you want to know when to suspect an ideology is at work, you can be sure it is the case when someone tells you something is unnatural and should not occur. Because here’s the thing about true natural laws: they function whether you want them to or not. Nobody needs to urge or force anyone else to obey them. Consider gravity. It’s a natural law, so nobody needs to enforce it. No religious tracts or psychological textbooks have been written urging people to obey the principle of gravity and refrain from floating about bumping into ceilings. Or consider this example: people may argue over vegetarianism, and whether it is healthy. But you have never seen a letter to the editor or an internet comment war complaining about how kids these days are engaging in the unnatural practice of giving up both meat and vegetables and choosing to engage in photosynthesis instead.

There is no #PhotosynthesisIsUnnatural hashtag because it truly is unnatural for people to turn green and live off sunlight directly instead of eating things for energy. Truly unnatural things do not occur, so they generate no outrage squads decrying their transgression.

As for the “laws of natural sex”—well, it’s another story.

Around the world, over the past four or five hundred years, people have been cajoled, threatened, forcibly re-educated, beaten, imprisoned, locked in mental hospitals, put in the stocks, publicly humiliated, mutilated, and burnt at the stake for violating one or more of the precepts of “Natural Sex.” That’s the sure sign of enforced ideology, not a true natural law.

And it’s not just a story of superstitious, ignorant days gone by. There is a war being waged over the ideology of “Natural Sex” today. And in that war, religion and science stand hand in hand on the same side. Who stands on the other?

Intersex people whose genitals are surgically mutilated without their consent to force their bodies to resemble binary sex expectations.

Trans people who are treated as having a mental illness, as delusional, as perverted, as pariahs.

People in same-gender relationships, who have made great strides in the West recently in terms of a right to secular marriages, but who are still not permitted to marry in many religious denominations, and who are not protected from perfectly legal discrimination of many sorts in many places.

Oh, and women pursuing sexual pleasure. Religious authorities frame women in particular as ruining themselves through seeking sex outside the context of marriage. Meanwhile, scientists continue to frame female orgasm as a puzzle as they state it is “unnecessary,” since women can conceive without it. Women, according to both religion and science, should want babies, and only engage in sex to make them, not for fun.

The extraordinary thing is, with so many groups fighting and suffering for recognition denied them under the ideology of “natural sex,” how incredibly powerful that ideology is, how amazingly resilient. We are taught the Ideology of Natural Sex so early, by parents and media and schools and churches, that we believe in it at the same fundamental level that we believe in things like gravity.

And even when individuals are persecuted in some way under the Ideology of Natural Sex, very often it never occurs to them to challenge the whole, as that seems unthinkable, but only one small part of the ideology impacting them particularly. Thus we have women who decry female genital mutilation as cruelly enforcing the belief that women should not have sex for pleasure, yet who see similar surgeries being performed on intersex babies as appropriate, as heroically “correcting malformation.” We have gay men and lesbians who frame themselves as natural and normal, wanting only to marry and reproduce like anyone else, while disdaining trans people as "crazies" who are making gay people look bad by association under the LGBT umbrella. We have people born with sex-variant bodies who reject the label intersex, and wish only to be referred to as “people affected by disorders of sex development.” Why? Because they are worried that the term “intersex” will make others associate them with trans people or think they have nonbinary identities or otherwise find them disturbingly transgressive of the Ideology of Natural Sex, and God forbid, they don’t want any of those things to be thought of them.

And everywhere, everywhere, we have ignorance of the long and violent history of the imposition of the Ideology of Natural Sex under European colonialism.

The genius behind framing an ideology as “natural” is that its history erases itself. Why would anyone study the history of something natural and eternal? We don’t study the history of covalent bonds in chemistry or cumulus clouds in meteorology.  And so we don’t study the spread of European binary sex ideology under colonialism. If you do, you’ll find that all over the world before European colonialism there were societies recognizing three, four, or more sexes and allowing people to move between them—but that’s a subject for another post. Suffice it to say that societies were violently restructured under European colonialism in many ways, and one of those was the stamping out of nonbinary gender categories and stigmatization of those occupying them as perverts.

Meanwhile, missionaries and European scientists spread the word that nonprocreative sexual practices—same-gender relationships, oral sex, masturbation—violated God’s will or the scientifically known purpose of sex, and were thus both sinful and sick. Christian missionaries even taught that the only acceptable intercourse involved a married man atop his wife, other positions being “unnatural.” Scientists concurred, saying that only in the missionary position would gravity lead semen to the uterus. Nature, colonized peoples were taught, requires men to be on top--of society, and in sexual activity, literally.

Most people today are ignorant of this history of the ongoing struggles to impose the Ideology of Natural Sex on reluctant nations and social groups. This ignorance allows each generation to believe that those who do not fit under the ideology, such as intersex and trans people, are rare freaks—or, if there are many challenging the ideology at that time, such as feminists demanding access to birth control and abortion, or the gay pride movement, as a brand new threat to an until-then-eternal system.

And for a system that is presented as eternal and inevitable, the Ideology of Natural Sex is also strangely framed as fragile and endangered, requiring vigorous defense. One example: the 20th century claim that “homosexuality is unnatural, and if it is tolerated, the human species will go extinct as procreation will stop.” This claim was made by opponents of the so-called gay liberation movement, many of them religious conservatives, but using the language of science. And after all, for many years, scientists had been claiming that homosexuality was a medical disorder that must be cured.

The really weird thing about the end-of-the-species claim, if you think about it, is that it presumed that if same-gender sexual activity were tolerated, then nobody would ever have mixed-gender sex again. Why would people who presumably happily identified as heterosexual think something like that? Well, it’s because each of the precepts of the Ideology of Natural Sex are seen as inextricably linked. The purpose of sex is reproduction; this requires men and women; people must accept their assigned gender roles. Allow two men or two women to have sex, and the other precepts will fall as well. Society as we know it will collapse, and in fact, we’ll die out as a species as we won’t reproduce anymore. Our nature will be destroyed and humans will suffer an apocalypse.

Today, in the early 21st century, intersex and trans issues are coming to the fore. And the same patterns emerge, as they have in the past of which we are unaware.

From science and medicine, what we see is the framing of bodies, identities and behaviors that fall outside the Ideology of Natural Sex as disorders to be classified and treated. The goal is to restore the “natural order” through techniques developed by science: eugenic programs, surgical “normalization,” and psychotherapies. Consider intersex status right now. There is a growing social movement of intersex people to put an end to the nonconsensual genital surgeries that have been imposed on intersex children since the 20th century. But doctors are extremely resistant to this movement. Living with a sex-variant body is presented by doctors as a fatal condition. It will lead to social death, which may lead in turn to suicide. Without a body that conforms to binary sex expectations, it will be impossible to find a mate, so even if one lives, it will be an empty life, a painful one full of strange nonconforming behavior and self-loathing. Surgeons claim they are compelled to continue intersex genital mutilation to preserve life and quality of life, dismissing the cry of intersex advocates that these “treatments” in fact degrade their quality of life.

From the religious side, what we see is an assertion that Natural Law created by God must be affirmed by all human laws. To do otherwise is not only an offense to God, but will destroy humanity. Speaking recently of the supposed danger of the trans rights movement, Pope Francis said, "We are experiencing a moment of the annihilation of man as the image of God." Natural law, understood as decreed by God, requires binary sex, and that gender conform to that binary sex. Worldly laws must not be enacted to acknowledge and support people's gender identities. In fact, say religious conservatives, to speak of gender at all is to offend God. There is only sex, and never before have humans suggested that one also has a gender identity and should express its inner truth! (The fact that gender identity recognition and gender transition are as old as humanity is a history that we’ve already seen has been erased by the “natural law” framing.) And fascinatingly, the Catholic church evokes science to “prove” its position. Sex, the Church states, is determined by DNA. DNA, unlike clothing or hormones or genitals, cannot be changed. Thus, one can never change one’s “true” sex. Gender transition is a wicked lie, a deception, and according to Pope Francis, as dangerous to humanity as nuclear weapons. It must be stopped and “nature” defended.

So science and religion walk arm in arm, trumpeting the ideology of the Natural Law of Sex. This gives everyone in the general population something to latch onto in framing the oppression of some group as necessary and good. Are you a socially conservative religious person who finds trans people disgusting? Claim that the statement “male and female created He them” in Genesis is not a generalizing poetic phrase but a morally prescriptive statement that must be socially enforced. Are you a radical cis feminist who disdains the Pope, but shares with him disgust for trans people?  Claim that DNA determines sex, that gender identity is a delusion, and that trans women are thus sick male threats to the safety of “biological women.”

There’s something for everyone.

What makes the Ideology of Natural Sex so powerful is that, like all deeply effective belief systems, it is so taken-for-granted that it is like water to a fish. Most people are unaware of the very concept of a sex/gender ideology. And therefore, merely to ask the question “How many genders are there in your society?” strikes them both infantile and very offensive. Show them a drawing of intermediate genitalia and they gasp in profound shock. Present them with a visibly trans body and they laugh or gag or feel incited to commit violence.  These strong negative reactions occur because having your ideology challenged is bad enough, but when you didn’t even know it was an ideology in the first place, it makes you question everything. And sadly, most people don’t want to do that at all.

But we have to do it.

If we truly believe in science, in a rational world where we look objectively at what is, rather than impose our beliefs onto reality, then we need to reject the Ideology of Natural Sex. We need to see the reality of the sex spectrum and stop framing intersexuality as a rare disorder that somehow violates natural law. We need to understand that different societies have divided the sex spectrum up into different numbers of social sexes, and that binary sex is no more or less arbitrary than trinary or quartic sex systems. We need to give up the silly idea that sexual interactions only serve reproductive purposes, when it is massively evident in nature that nonprocreative sex is everywhere in social species. We need to become aware of the omnipresent world history of gender transitioning, and let go of the myth that not until the 20th century introduced modern surgical transition procedures did “real” gender transitions occur.

And if we truly believe in religion, then we must adhere to the precepts of compassion that all religions teach, and stop using religion to oppress minorities or spread hate.

Intersex people, trans people, queer people, lusty women. . . we don’t violate natural law. In fact, we’ve always been a part of human nature. And accepting and respecting us as we are will not cause the end of the world. At all.

It could, however, spell the start of a kinder and fairer world. So please, just let go of the Western Ideology of Natural Sex.

Tuesday, June 28, 2016

Intersex Athletes of the Times

The NY Times Magazine is running a story on the binary sex policing of intersex athletes. Well, I should say, intersex woman athletes--nobody is testing to find out if men who are competing in international sporting competitions have intersex traits. Because what is really at stake here is ideology, not fact. And that ideology is that sex is binary when it is really a spectrum, and that the line being drawn between women and men is dividing lesser people from greater ones. Intersex men, framed not as "real men" but as lesser, are seen as pathetic. But intersex women are portrayed as unduly powerful, and a threat.

It's time for me to write another post on intersex athletes, as Dutee Chand's case is in the news. Because this issue keeps coming up. Because we, intersex people, continue to be out there, and contemporary Western society continues to frame us as violating the order of things, instead of a part of the natural order.

It's strange, the way we in the contemporary West collapse all the variety in human bodies into a sex binary. We're used to a trick of mind that allows us to say and believe "men are taller than women," while encountering plenty of women who are taller than plenty of men. Height, you see, is a spectrum, but the sexed-height-difference we speak of references just average heights. We ignore the spectrum and speak of the average difference when distinguishing women and men. Now, there are adult men who are under three feet tall, and there are men over eight feet tall. That's a five-foot range of difference. The difference in average height between women and men in the U.S. is five inches--a tiny amount in comparison. And this is true of all physical sex characteristics, including not just height or lung capacity or average hand size, but genital configuration and levels of sex hormones. The characteristics run along a spectrum, but we speak of them as a binary: "men's hands are bigger than women's" and "men have higher testosterone than women." The range of differences within a socially-imposed binary sex category is huge, while the average difference between those categorized as men and women is small. And the overlap between women and men is wide.

People of all sexes typically produce testosterone and estrogen and progesterone, and our bodies rely on all of them--though you might not know this by the way we say all the time that "men have testosterone and women have estrogen." You might imagine doctors and scientists would think less magically than laypeople when it comes to the idea that "T is for boys and E is for girls." After all, they should be aware of facts like estrogen being needed not just for ovulation in women, but also for spermatogenesis in men. But no. Doctors and scientists consulting with the Olympics have been speaking of testosterone in very magical ways. They have decided upon a "normal female range" of testosterone, and banned women who naturally produce more from competing.

Consider these facts:

1. Men competing in elite international sporting competitions do not have limits placed on how much testosterone they naturally produce. Women who produce higher-than-typical amounts of testosterone are treated as "cheating," men who do are not.

2. Actually, when studied, it turns out that 17% of elite male athletes have testosterone levels below the bottom of the "male range." These men are not disqualified as "cheating by being intersex." They aren't regulated at all, probably because it's presumed that their low testosterone must be a disadvantage. Yet these men with low testosterone are not lesser athletes; they are just as extraordinary in their performance as the men with typical testosterone levels. This illustrates how there's no direct relationship between the amount of testosterone a person produces and their athletic abilities.

3. Bodies vary widely in how sensitive they are to testosterone. Some intersex women have "complete androgen insensitivity syndrome." These are individuals with XY chromosomes who are born with female-typical genitalia due to their body's inability to respond to testosterone. They have internal testes where most women have ovaries, and these produce testosterone at puberty, but their bodies can't use it, so they develop breasts like other typical girls do, not beards. And focus on this fact: their bodies are insensitive to testosterone. The idea that they have some sort of athletic advantage due to having higher testosterone than typical girls is ridiculous--because they can't respond to testosterone.

4. People do not compete in athletic competitions using their genitals. Yet as the Times article discusses, girls with large clitorises are being told to submit to surgery to remove the "excess tissue" if they want to compete in the Olympics. When similar surgeries are performed on girls with average-sized clitorises for social reasons, this is deemed the outrage of female genital mutilation by the international community. Why is it acceptable to impose this on intersex girls? And what could be more magical thinking than saying that how your genitals look determines how fast you can run? By this logic, the longer the penis, the faster a man can run.

5. All Olympic athletes have atypical bodies. As one Olympian says in the article, they're all "freaks of nature." They may be endowed naturally with atypical levels of fast-twitch muscle, or unusually flexible joints, or huge hands, or extraordinarily long legs. We do not police these biological differences, or require that to compete in the Olympics, you must have an average body. We don't randomly pick citizens of each nation to compete in international sporting events--we get to see average people running for the bus all the time. We don't find this exciting, and it's the very atypicality of elite athletes' bodies that enthralls us. It's only this very specific type of atypicality--being a woman with hormonal or genital or chromosomal variance--that has been policed. And it's policed intensively, intrusively, punitively.

6.  The "science" being used today to exclude intersex women athletes is as amazingly full of biases and magical beliefs and unsupported assertions as it was many decades ago. Consider this: scientists testifying as to the supposed necessity of continuing to police intersex bodies recently claimed that a woman competing in Olympic track and field events is 140 times more likely to have a Y chromosome than the rest of the population. This is ludicrous, because we have no idea how many women in the general population have Y chromosomes. We don't test the general population for this--only women competing in elite athletic events. Right now, all over the world, there are millions of intersex people who have no idea of their intersex status--it's not like you can see your chromosomes. 

7. This reminds me of the magical thinking that went into the "supermale" theory in the 1950s and 60s. Scientists discovered that some men had XYY chromosomes, and decided that if one Y chromosome makes you a man, two must make you hypermasculine. So they went around testing the chromosomes of men who were imprisoned or institutionalized, and lo! they found out that a significant number had XYY chromosomes. There was a media frenzy about the powerful, predatory XYY superman. Only. . . nobody had done a comparison study. It turns out that when you test men who are not imprisoned or institutionalized, the same number have XYY chromosomes. Men with XYY chromosomes don't produce more testosterone than XY men. They aren't stronger, or more aggressive, or hairier. You're much more likely to be a sweet, tubby old history teacher than a serial killer if you are an XYY man.

What all of this makes clear is that scientists and doctors are just as immersed in our culture as anyone else. And our culture has been deeply invested in an ideology that sex is a binary--and that by virtue of being a male, a person is stronger, faster, more dominant, more assertive. It may be 2016, but our society continues to view women athletes as suspect, because they are strong, fast, and highly competitive. What is really at stake is patriarchy, and its positioning of men as superior to women. Powerful, nonconforming women still get pushback in the form of sex and gender policing, through street harassment, or poor work evaluations, or medical surveillance. And so we continue to scrutinize the bodies of women athletes, and to punish those whose bodies are deemed "too male" in certain ways. While we acknowledge that height is a spectrum, we insist that hormone levels require a no-gender's-land between acceptably female and acceptably male. And really, it would make no less sense to tell every woman athlete that women cannot be taller than 5'9", and that taller women must have their leg bones reduced until their height is in the female range or be banned from competition.

Sex and gender policing always pretend to be protecting "real women" from "fake ones" who would somehow hurt them. But in fact, they boil down to preserving the power that has been given to people categorized as male, by insisting that "real women" are vulnerable, small, submissive, weak.

Sex is a spectrum. Bodies don't cheat. If we really, truly, actually believed that testosterone levels determined ability, then we would test athletes of all genders and assign them to competition classes by testosterone levels. (The outcome of such a practice would immediately falsify the ridiculous premise.) If we really, truly believed that the size of the phalloclitoris corresponds to athletic ability, then we'd have the competition classes "small clitoris, medium clitoris, large clitoris, intermediate phalloclitoris, small penis, medium penis, large penis." That would be ludicrous, but would at least have the upside of being equally humiliating to men as it has been for all the women who have been forced to face genital inspections to get their "gender certificates" over the years.

Since sex is a spectrum, the division of it into a binary will always be arbitrary. We've been trying to hide the fact that sex is a spectrum, but it's time to grow up. And that means we have two choices. If we really think that bodily characteristics must define competition groups, then stop dividing athletes into men's and women's sports, and create competition classes based on leg length, or lung capacity, or body mass, or flexibility, or whatever is most central to a given sport. Or, if we insist on continuing to separate sports into binary gender categories, then stop policing the bodily characteristics of athletes. People who identify and live as women should compete as such, and the same for those who identify and live as men. People with nonbinary gender identities would have to just flip a coin or something, which would be cruel to them, but at least we would have stopped forcing people to submit to genital surgery they didn't want in order to run.

Dutee Chand was assigned female at birth and has always lived and identified as a woman. She has overcome amazing barriers to reach her level of competition, growing up in extreme poverty and running barefoot with no way to afford even a pair of sneakers. She is only 5 feet tall, and competing against women gifted by genetics and nutrition with much longer legs. To say she has an unfair advantage against her competitors because her higher-than-average testosterone level for a woman trumps all the advantages they have over her is ridiculous. Let Dutee run.

(P.S.--Whenever I post on this topic, inevitably I get an outcry from people who believe that simply letting people compete in their lived genders would mean that cis women would be pushed out of sports, which would be overrun with "men pretending to be women." This is the hysteria that has always driven sex policing in sporting competitions. It completely ignores reality. Cis men do not want to live their lives as women. Trans women face huge amounts of social stigma and violence that nobody wants to experience, and that negatively impact their ability to train or compete. And no one is proposing that a person who has lived their whole lives as a man can announce they identify as a woman and run in the women's marathon the next week, then say "oops, changed my mind" after they have a medal in hand. The rules for international sporting competitions in fact actively address this, by saying that in order to compete in women's athletics, a trans woman must have legally gender transitioned (a slow process), and continue to live as a woman for a least four years before any records or medals she wins are permanently awarded. So please, just let go of the myth that the humiliation and exclusion of intersex and trans women is necessary to protect innocent and deserving women from some ominous threat.)

Wednesday, February 25, 2015

When Intersex People are Collateral Damage in Transphobic Battles

As intersex people, we have to deal with a host of issues because our bodies lie between the socially-expected bodily norms of male and female. Our bodies are treated as disordered, as problems to be solved by the medical profession. Doctors and people on the street alike treat intersexuality as freakish and fascinating, both intriguing and repellent.  Our bodies are surgically altered without our consent as children, and we must live with the lifelong aftereffects of limited sensation and ongoing genital atypicality. We are taught to view our differences as shameful and to keep them secret. Very often we hesitate to enter romantic relationships, fearing rejection because our bodies challenge the very ideas of heterosexuality and homosexuality through which most people understand themselves. We may be pursued, however, by sexual fetishists.

It's a lot to deal with, for many of us.  And then, on top of the challenges we're already facing, we find ourselves targeted by people who don't even recognize we exist: transphobic activists.

Today, trans gender people are making some social progress in securing protection from discrimination--but they face resistance. A central tactic of those who oppose trans gender rights in the U.S. is to propose legislation prohibiting trans people from using particular gendered facilities such as bathrooms, changing rooms, or locker rooms. Those proposing the legislation argue that the new law will protect  (cis) women and children from being harassed, attacked by sexual predators, or made to feel unsafe or uncomfortable.  Now, we should note a couple of things--first of all, proposed laws like these are aimed at trans women and girls--not even trans men, let alone intersex people. Those drafting the legislation clearly aren't imagining the situation in which an intersex teen using a school locker room is greeted by uncomfortable stares, or imagining that a trans man using a men's bathroom will make cis men flee the facility in fear. The proposed laws are transmisogynist: aimed at trans women, who are framed as "really men" who are some sort of sexual perverts. Secondly, sexual harassment and assault are already illegal, in bathrooms or elsewhere, so the only thing the proposed legislation actually accomplishes is to transform informal policing of the ideology of the sex/gender binary into formal policing. Those whose bodies don't clearly conform to expectations for what a woman's body is "supposed" to look like now become literal criminals.

But the drafters of transphobic bathroom laws run into a problem. People police binary sex/gender norms all the time, but they do so informally. The drafters have to come up with objective language to put into their proposed legislation.  Early efforts banning people from using bathrooms tended to require a person challenged upon entering a gendered bathroom to show ID with that gender listed on it. Of course, as part of the process of gender transition, large numbers of trans people have the gender listed on their driver's license or other ID changed. So the transphobic activists proposing these laws switched to using language of "birth certificate sex." But in some states, people who medically gender transition are able to change the sex listed on their birth certificate.

And that's why recent proposed bathroom-exclusionary language has moved to requiring people who use gendered facilities to have a matching "biological sex at birth" or even matching binary genotype of XX or XY.

Now, all forms of sex-policing bathroom bills, while aimed at trans people, are bad for at least some intersex people who are ipso gender (that is, who identify with the binary sex they were assigned at birth). An intersex person may be assigned female at birth, and identify as a woman, but have substantial amounts of bodily and facial hair, leading her to have to deal with a lot of sex and gender policing. Such an individual is likely to face many of the same issues of bias and outrage that visibly trans women encounter when they try to use women's bathrooms.

But the bills making it illegal to use a single-sex bathroom unless one was born with the anatomy expected for people of that sex basically declare it illegal for intersex people--by definition born with bodies that are neither male nor female--to use gendered bathrooms at all.

Further, the Texas law basing bathroom use on genotype specifically states, "If the individual's gender [sic] established at the individual's birth is not the same as the individual's gender [sic] established by the individual's chromosomes," that their gender for bathroom-use purposes would be determined by chromosomes. Just think about what this means for, say, a woman with CAIS, complete androgen insensitivity syndrome. She is born with female-typical external genitalia and assigned female at birth. She's raised as a girl and identifies as one.  At puberty she develops breasts, but no menstrual cycle, and it's only when tests are done to determine why that she finds out she has XY chromosomes, no uterus, and internal testes (whose testosterone her body cannot respond to). The Texas law tells her she must use the men's room, because her Y chromosome trumps her physical appearance, genitalia, birth certificate, sex of rearing and gender identity.  This law is telling her she is "really" a man.  If she uses a women's room, it's a class-A misdemeanor for which she could get a year in jail. And if her employer finds out she has CAIS--something that her medical records reveal--well, then, if he lets her repeatedly use the women's bathroom at work, then he is committing a felony, punishable by two years in jail and a $10,000 fine.

So what should we as intersex people do about this?

It's very unlikely that we are the intended targets of these proposed laws--we're just collateral damage. Some may argue that few ipso gender intersex people look androgynous enough to trigger enforcement--that nobody's going to call the cops on us.  But some of us *are* physically androgynous and genitally different and regularly have to cope with gender-policing. Furthermore, it's now becoming popular to have provisions in bathroom-panic legislation that either put employers and facility owners at risk of fines, like the Texas law, or give third parties who see a person of the "wrong sex" in the bathroom, locker room, etc. the right to sue the school or business and get guaranteed recompense. For example, high school students in Kentucky who see a student whose sex is "incorrect" in the bathroom or locker room would be entitled to sue the school for $2500 for each time they catch the student in the facility.

Imagine what could happen to an intersex high school child in Kentucky who has a visible genital difference under a scheme in which classmates could earn $2500 each time they complained they saw their "incorrect" genitals.

These proposed laws give people a financial incentive to scrutinize our intersex bodily differences and to report them to authorities. They give employers and businesses a financial incentive to increase their sex and gender policing, lest they face a fine.  They are a bad thing for us.

Now, one solution some might propose would be to educate transphobic legislators about the difference between intersexuality and transsexuality. We could ask that the laws being proposed include exemptions for people born intersex, based on the presumption that if transphobic lawmakers understood what intersexuality is, they would express sympathy rather than bigotry toward us.

I think not only is this naively optimistic, but that it would be a terrible mistake.

Now, I acknowledge that relations between the intersex and trans communities are not always the best.  I validate the complaints of many intersex people that trans people are quick to use evidence of our existence to try to break down the ideology of immutable binary sex/gender--but slow to act as allies, and understand our community's needs, and include us appropriately in their antidiscrimination regulatory proposals.

But I believe we must consider trans issues to be our issues.  Firstly, because the portion of the intersex community that gender transitions is much higher than the proportion of nonintersex people who gender transition. There are a lot of intersex trans folks--like myself, like my spouse--who are active in the intersex community.

Beyond that, it's rational for us to stand side by side with nonintersex trans folks in battles like these precisely because we are impacted just as they are. So many people in our society think intersex people are trans people that transphobia constantly impacts us, even those of us who are ipso gender rather than trans.  We are fighting against our own mistreatment.

Ultimately, I believe that even those of us who, pragmatically speaking, are likely never to be personally impacted by bathroom-panic laws--because our bodies and genitals and birth certificates and chromosomes and gender identities all fortunately align and our intersex differences are not visible--all of us should stand against transphobic laws. We should do so as ethical human beings, opposed to all inequality and bias, not just those forms of bigotry that negatively impact us personally.

Now, all that said, I need to have a word with our trans allies, with whom I hope our community will stand. And that is: please, nonintersex trans people out there, don't try to use us without including us. Though we're taking collateral damage, we're not the primary targets in the bathroom wars.  If you think that femme CAIS women would make great mouthpieces for delivering talking points about how cruelly these laws would impact "innocent" women like them (and I've seen the calls and requests), fine.  But don't use members of our community or the very idea of intersexuality as a way to win your battles--without making an equal effort to fight for our rights, especially the right of intersex people to be free of unconsented-to surgery.

With all these things said--intersex and trans siblings, let's stand together against sex and gender policing laws.