Wednesday, August 3, 2022

When Bigots Claim One Thing to Exclude Trans Athletes, and the Opposite to Exclude Intersex Athletes

This is Caster Semeya. Caster was assigned female at birth, without controversy, and raised as a girl. She always loved athletics. She found her calling as a runner, and trained hard, day after day, for years. In 2009, at age 18, she won gold in the World Championships 800 meter race. She was elated. But a competitor claimed to the officials that she did not believe Caster was really a woman. Caster was subjected to “sex verification” by an endocrinologist, a gynecologist, an internal medicine expert, an “expert on gender” and a psychologist. And it was found that she has an intersex status. In fact, the media found out before she did.

Caster has had to live her life under a gender-policing spotlight ever since. She’s been forced to take drugs to suppress her body’s naturally-high levels of testosterone, and had constant social media attention paid to how she dresses, the fact that she is a lesbian, and debates over whether the muscularity of her Black, athletic body reveals her admirable hard work and dedication to her sport, or some intolerable natural advantage.
Lately, transphobic “feminists”, otherwise known as the TERFs, have really been piling on Caster Semenya, in ways that reveal deep hypocrisy. Consider:

TERFs: There are only two sexes, you’re assigned one at birth, and that is your real eternal sex.
Also TERFs: I don’t care if Caster Semenya was assigned female at birth, he’s a man.

TERFs: Being raised as a girl socializes you to be a woman. Being raised as a boy socializes you to be a man. That determines your personality for all eternity and cannot be changed.
Also TERFs: You can tell just by looking at Caster that any attempt to raise him as a girl failed. Caster’s father says that as a child, Caster hated wearing dresses and liked to play sports with the boys.

TERFs: Trans boys are just girls who are tomboys with transgenderist parents! Their parents hate gender transgression and want to convert their inconvenient toyboy daughters into gender-conforming sons! Feminists must stand up for butch girls and save them!
Also TERFs: Caster Semenya walks like a man, dresses like a man, makes muscles like a man, and therefore is a man.

TERFs: When someone says a child or teen is a trans boy, the truth is that the youth is a lesbian, and their parents reject that and are forcing conversion therapy on their lesbian daughters to try to make them appear heterosexual by convincing the poor girls that they are really straight boys! We must stand up for lesbians!
Also TERFs: Caster Semenya married a woman, and the partner wore the white dress while Caster wore pants! Therefore Caster is a man.

TERFs: Prescribing medication to suppress someone’s sex hormones is pointless, as it doesn’t change who you really are. Also, it’s experimental, goes against nature, and is an intolerable thing to suggest to anyone.
Also TERFs: It is absolutely vital that Semenya be made to take testosterone suppressants, and be tested before every race.

TERFs: Taking testosterone or estrogen can’t change your sex. You are the sex you were assigned at birth.
Also TERFs: It’s irrelevant that Caster Semenya was assigned female at birth. Caster’s body was flooded with testosterone at puberty, making him male.

TERFs: Transgenderism is based on enforcing gender stereotypes. It equates being a woman with looking pretty and delicate and wearing makeup and being submissive. That’s evil misogyny!
Also TERFs: I can tell who is really a woman by looking at them, and that’s not a real woman. Caster’s too muscular, never wears makeup, is aggressive, and looks like a man. It’s not misogyny if *I* do the gender-policing.

There’s so much hypocrisy in all of this. And lest we forget, in Caster Semeya’s case, a whole lot of racism as well. The competitors who have challenged Caster’s right to compete have all been white women, crying white-women tears for the cameras. The TERFs who’ve been serving as talking heads in media interviews? Also a bunch of white women. There’s one who seems to find every Twitter conversation on the topic and post photos contrasting women athletes she claims are “really men” due to presumed intersex status—every one of them Black or brown—with women she says have been cheated of their rightful medals—all white.
(This makes me recall the weird racist claims made by a certain fringe about Michelle Obama—that she was really a trans woman or intersex, because she was too strong, and seemed to the racist detractors to have overly-broad shoulders.)
In the end, what we see are that trans-exclusive “feminists” are largely white women who believe they have ownership of the category of woman by right. And they seem to have no problem with deploying one set of arguments to exclude trans women, and totally opposite arguments to exclude intersex women. It’s sad and it’s ugly.
Yet Caster Semenya continues to rise up to compete, enduring intrusive media questions about her genitals, endless discussions of her dress and demeanor, and years of being forced to take testosterone-suppressant drugs against her will in a way that no person competing in men’s sports, no matter how high his natural testosterone levels, has ever been forced to do. Sometimes she’s allowed to compete and sometimes barred from competition, depending on rules that keep being changed for how typical a woman’s body must be in order for her to qualify for the Olympics.
Remember this: virtually every person competing in the Olympics has an atypical body. These athletes may be endowed with atypical levels of fast-twitch muscle, or unusually flexible joints, or huge lungs, or extraordinarily long legs. We don’t 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.
And it’s all based on magical thinking about what testosterone does. Ten percent of cisgender women have PCOS, which makes them produce high levels of testosterone, but doesn’t magically make them athletic. And 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.
I myself am an intersex man, who has been taking testosterone for many years. My athletic abilities? Well, they’re better than those of a potato. But they are poor. What sort of feminist would argue that I should not be allowed to compete against women Olympians, because I have an innate male advantage over them and would win? That’s magical thinking, of a sort that posits a binary of male superiority and female inferiority. And it’s ridiculous.
The last thing a feminist should be doing is gender-policing women, telling them if they get too strong and muscular, they are no longer women. That refusing to wear dresses makes them men. That marrying a woman discredits them.
That’s not feminism, friends.

Saturday, July 23, 2022

Understanding the Biblical Binary of "Male and Female"


According to certain Christians, the fact that the Bible states "male and female created He them" means that God only recognizes two genders, those assigned at birth. To be trans or nonbinary is unacceptable, and intersex status a tragic birth defect that must be corrected.

Of course, the Bible also says "the Lord makes poor and rich." This binary of rich and poor appears multiple times in biblical language. Do conservative Christians therefore say it is an abomination to be middle class?

Or consider the verse, "He will bless his loyal followers, both young and old." You'll find this binary of young and old many times. Yet there is no Christian movement to declare that people cannot be known as middle-aged, but must either be designated as old or as young.

The phrase "male and female created He them" comes from the book of Genesis, in what Christians call the Old Testament and Jews call the Torah. Christianity started as a Jewish sect, reading Jewish Torah scrolls, and practicing Jewish religious traditions. Many of these traditions were relinquished fairly early in Christianity, such as the requirement of circumcision. By 300 years in, kosher dietary laws had been abandoned.

But many other Jewish traditions lasted much longer. One of these was recognition of intersex babies. Under the Jewish religious rules of halacha, babies were not just classified as male or female, but under a four-sex system that also designated babies androgyne (both) or tumtum (neither). People born androgyne were to perform the religious duties assigned to both men and women; people born tumtum were not required to practice either set of duties. Jewish tradition also recognized additional categories for those whose gender status changed, due to intersex characteristics manifesting at puberty, or to never experiencing puberty at all, or to human intervention such as surgery--all categories later Christians would lump together as "eunuchs."

For many centuries, Christians recognized androgynes, tumtums, and eunuchs as well as men and women. The Church canonized saints with these designations. It was not until the Middle Ages that the novel idea arose that the phrase "male and female created He them" was not a poetic dyad, but a limitation the Church should implement in categorizing human beings. And the courts immediately started dealing with a stream of cases involving people assigned to one binary sex at birth, but living as the other, or living in their birth-assigned sexes but having intersex bodies that they or the community felt was more like the sex to which they were not originally assigned.

This shift from accepting sex and gender diversity to squashing it into a binary was awkward from the very first. And violent, too: some intersex people were burned at the stake, like witches. The categories of witch, intersex person, and gender-transgressor were often conflated. It was a ugly time in history--witness the Inquisition--in which all sorts of people who deviated from norms were tortured and burned alive in the name of God.

Today, Christians are not in the witch-burning business. That period of history is viewed as one of superstition and terrible persecution. Yet some conservative Christians continue to revile people who are gender expansive, deem gender transition illegitimate, and demand that intersex babies receive forced genital reconstruction. They claim they must impose an eternal binary, for the Bible tells them so.

But there's no need for that. The phrase "male and female created He them" is a poetic dyad, just like the phrases "rich and poor" or "old and young."

Persecuting the socially marginal is the exact opposite of what Jesus called on Christians to do. Justifying such persecution by referencing a snippet of poetic Biblical language is not just nonsense. It is a great moral wrong

Sunday, September 12, 2021

The Silly Idea of Your "Real" Binary Sex


Today, a lot of people insist that they can tell you what your "real (binary) sex" is. Let's talk about how strange that is.

Intersex is a fact of nature, found throughout the animal kingdom and across all of human history. Today, in Western societies, being assigned a binary sex at birth is a legal requirement--you need an M or F selected on birth certificates in most countries. This is so taken-for-granted that people are often astonished to learn that this is historically and culturally strange--that most world societies have traditionally recognized more than two sexes, allowing them to recognize and provide cultural places for intersex babies, and social roles for gender-variant people. This includes, by the way, Judeo-Christian societies, up until the Middle Ages. Jewish tradition recognizes four birth sexes: female, male, both (androgyne), and neither (tumtum), and early Christians followed this tradition.

But in the Medieval period, Christian authorities decided to abandon the Jewish halachic approach. They decided that the Biblical phrase "male and female created He them" was not a poetic phrase, but a prescriptive one: God demanded binary sex. 

The problem, of course, is that intersex people continued to be born. So you find court cases and church records in which judges and priests tried to decide what to do when there was a conflict over whether an intersex person (or even animal) was living in the "correct" binary sex, or "violating the law of nature" by being a man who menstruated or a rooster who laid eggs. Parties often fought vigorously, because the fact of the matter is that an intersex person or animal cannot be fit into the category "male" or "female" by definition, and what to do about that was a perpetual issue.

Then, in the 19th century, medical doctors seized on this issue and the social fascination with nature belying human ideologies of binary sex. The field of medicine was professionalizing and gaining status. And medical practitioners realized that they could gain social respect by claiming to be able to answer questions that laypeople could not. They said laypeople were confused when they saw a person with mixed sex characteristics, and could not categorize them as male or female. But medical doctors framed themselves as having impressive skills and arcane knowledge that laypeople lacked. They could dissect a person's body after death, examine their gonads, and usually, decide that those appeared to be ovaries or testes, only in rare cases finding those organs impossible to assign a binary sex status as indeterminate ovotestes.

Nineteenth century medical doctors seized on this process, as it proved successful in generating fascination and deference from the public. They proclaimed themselves teratologists (a term that literally means "having knowledge of monsters"), and declared that where unschooled laypeople saw intersexuality in a body before their eyes, doctors could determine a person's "true sex." And to do this, they announced that it was scientific law that one's "true sex" was defined by one's gonads. A person with a penis who had ovaries they named a "female pseudohermaphrodite," and a person with vulva and internal testes, a "male pseudohermaphrodite." Only people with ovotestes so intermediate doctors could not assign them as ovaries or testes, or those with one ovary and one testis, were "true hermaphrodites"--and this was rarely the case. 

And thus, long before they developed the ability to perform sex reassignment surgeries on intersex infants, medical doctors erased intersex people through classificatory sleight of hand. And in so doing, they both increased their professional prestige, and propped up dedication to binary sex ideology in the face of its obvious factual refutation.

Then, in the 1930s, scientists discovered the "sex hormones"--testosterone, estrogen, progesterone, etc.. Gonads as anatomical organs lost their luster, as it was the hormones they produced that were the new subject of fascination. And for the next several decades, the idea that testosterone was the "essence of maleness" and estrogen the "feminine essence" was all the rage. Doctors made all sorts of strange assertions: they could "cure" an abrasive, nagging, shrewish wife with estrogen therapy! Homosexuality was caused by a hormone imbalance, as men with too little testosterone mimicked female behavior and desired a husband to dominate and penetrate them! Testosterone "causes" leadership, and high testosterone would make one a politician or CEO or general! Meanwhile, low testosterone would impede mathematical ability or the capacity to read maps!

Only it turns out that people of all sexes produce and require all of the sex steroid hormones. And that women who are housewives tending young children produce more testosterone than women who are employed outside the home in business careers. And that there are no hormonal differences between people of differing sexual orientations. Yes, testosterone causes the growth of facial and body hair, and estrogen the growth of breasts and hips. But there are endosex cis men with very low testosterone who are elite competitive athletes. As a way to determine supposed "true (binary) sex," hormones didn't cut it.

So, scientists and medical doctors dropped sex hormone levels as the way to determine the "true sex" of an intersex person. And they switched their focus instead to chromosomes--particularly, the presumption that all females have the XX genotype, and all males XY.

Now, we should note that by this point, there were doctors and scientists arguing that no single factor could determine a person's "true sex." This camp would go on to develop the language of "best sex" rather than "true sex" in choosing a binary sex assignment for intersex infants (which sounds nice enough, though the outcome was the same--by this time, forced surgical sex reassignment was presumed "necessary" by doctors across the spectrum).

But there was great appeal to framing a person's "true sex" as based on their chromosomes for medical professionals desiring to hold onto the claim that their scientific abilities made them into oracles, able to perceive and proclaim a "true binary sex" where laypeople saw a spectrum. Chromosomes cannot be seen with the naked eye, so they make an impressive divination prop. Take a cheek swab, subject it to esoteric technical tests, and mysteriously out would pop the answer: XX or XY, female or male.

In fact, the claim of a neat binary sex division in chromosomes also proved quite false. There are so many variations, including people with the genotypes XXY, XYY, XXYY, XYYY, Xo, and more. There are people who are XX/XY, having some body cells with XX chromosomes and some with XY. This "macrochimerism" is accompanied by totally normative "microchimerism" in people who have gestated. It turns out that fetuses and their gestating parents exchange genetic material, so a typical XX woman who has gestated an XY baby will have XY cells found scattered throughout her body. Then there are people who have typical-appearing male bodies who are XX, and vice versa. 

In short, whatever tool medical science devises to divide the sex spectrum into two will always fail, because sex is not a binary.

However, there are those who are intensely devoted to the ideology of binary sex. These people have made a religion of it, and indeed, in the U.S. today they are often white evangelical Christians. But it can also be a secular faith--as we can see exhibited by TERFs. These are the trans-exclusionary radical feminists who screech that sex is an inborn binary that creates predator males and victim females, and frame trans women as males in dresses who pose a sexual threat to cis women. TERF ideology holds that sex cannot be changed, and that no matter what hormone therapies or surgeries a trans woman accesses, she will always remain "truly male" due to having an XY genotype that cannot be changed. This is a position of transmisogynistic bigotry, framed as "scientific fact." (That's hardly novel--the tactic of claiming one's bias is just a statement of scientific fact proved very potent in eugenics, culminating in the Holocaust. It's morally repugnant--but it's also effective.)

TERFs like to say that they have great sympathy for intersex people. They claim that most of us are disturbed by our status, and desire nothing but to have it corrected and to keep this medical past quiet, so we can lead normal lives. This position is the exact same one taken by doctors whose imposition of unconsented-to surgeries on intersex infants intersex advocates deplore. It also allows TERFs to frame intersex people who oppose their assertion that chromosomes determine "true sex" as at best unrepresentative, and as more likely charlatans--trans people pretending to be intersex to try to excuse their "delusional mindset."

But an intersex person need not be at all unhappy with their binary birth sex assignment to be appalled by Christian fundamentalists and TERFs championing the idea that one's "true sex" is determined by chromosomes. Consider a person with CAIS (complete androgen insensitivity syndrome). She has been assigned female at birth, having been born with typical vulva. Inside, she has no uterus, and what lie in the typical position of ovaries are testes. But because her body cannot respond to testosterone, and because some of the testosterone that those testes begin releasing at puberty is naturally converted to estrogen, she has developed breasts and broad hips in the course of a typical feminizing puberty, though she does not get a menstrual period. Her birth certificate says F, she was raised as a girl, her body looks like that of an endosex female, and she identifies as a woman. But according to the TERFs, because her chromosomes are XY, she is "really" a male.

This is just like how a 19th century teratologist would approach our intersex individual. Dissecting her body after death, they'd find that her gonads were actually testes, and declare her a "male pseudohermaphrodite." 

And this is violence. Sex policing and misgendering are always violence.

The fact remains that no matter what scheme devotees of binary sex ideology dream up to try to force the nature of sex into two boxes, it will always be silly, and it will always fail. By nature, sex is a spectrum of great diversity. Our intersex bodies are real, and they are not evidence of disorder or failure, but rather of the beauty and complexity of all of the natural world. Any claims that science can determine our "true (binary) sex" deserve no more than eyerolling.

Tuesday, April 27, 2021

Protecting a Baby Born with Three Penises


This story has been circulating through media and social media a lot over the past month.
A child was born with three penises: a typically-sized one in the usual place, and two smaller ones down lower. So media and social media have been full of people going, "Wow! 3," because a lot of people find both penises and atypical bodies fascinating.
What happened to the baby? Why, doctors "excised the supernumerary phalli" and then got lots of fame and attention publishing a report that they had performed the first such procedure on a triphallic infant ever, as the "condition" is "extremely rare."
And there's been basically zero pushback. People just circulate the story uncritically. It is taken for granted that if you are born with more than the typical number of fingers or toes or penises, the "extras" must be surgically removed.
Why? A surgery performed on a child without their consent should be functional, not social or cosmetic in nature. "Extra" fingers or penises are not dangerous; on the contrary, they can give a person extra, special abilities. Twelve fingers can make for great piano playing or baseball catching. And more than one penis can provide extra functionality as well ("wow, 3!").
I strongly believe that in a situation where a person is born with a body that is atypical in a way that is not hurting them physically, a decision about whether to make their body look more "normal" must be left up to them. All of us deserve autonomy over our bodies. Some babies born with 12 fingers may grow up to feel unhappy about their atypicality, and wish to have their hands surgically normalized. Some will grow up to love their special hands, and be grateful for the way their "extra" fingers enable them to, say, play guitar.
This is even more the case when it comes to genitals. So many intersex people who have had surgery imposed on them as children grow up feeling betrayed and mutilated, as doctors advised and parents consented to surgeries that turned out not to be what the child matured to want. Our genitals are our own business. Decisions about changing them should be ours alone, never imposed on us when we are infants. Only we can know, as we mature, what will make us feel most at home in our own bodies.
This story of the triphallic boy is not just some medical curiosity tale. It is an example of an approach to genital atypicality that is unethical. And we must criticize the presumption that doctors can usurp a child's autonomy to impose aesthetic normalization on special bodies.

Monday, September 2, 2019

Intersex Experience and Fears about "Gay Genetics"

Recently, results of a major genetic research study were published to substantial media attention. "Many Genes Influence Same-Sex Sexuality, Not a Single 'Gay Gene,'" wrote the New York Times.

The study, by Andrea Ganna and his large team, found that five genes were statistically significant in their correlation with whether a person reported ever having a same-gender sexual experience. But none accounted for more than 1% of the genetic association with same-gender sexual behavior. The study authors estimated that the total genetic contribution to same-gender sexual behavior was 8-25%.

The study was hugely controversial, and this is no surprise. In our society today, discrimination against people who are queer and/or trans and/or nonbinary is justified by bigots with claims that only cis heterosexuality is natural, and all else is disorder or sin. Opposing this, LGBT+ people employ "born this way" rhetoric, summarized in the Lady Gaga anthem: "No matter if you are gay, straight or bi/ Lesbian, or transgender life/ You are on the right track, baby/ 'Cause God makes no mistakes/ You was born this way, baby."

So, many LGBT-supportive groups fear that if scientific studies find that sexual orientation or behavior is not biologically set at birth, this will be used to justify homophobia. And that fear is rational; as soon as the Ganna study results came out, homophobic conservatives were claiming that they justified embracing conversion therapies, since people are "not born that way after all."

At the same time, other scientist-advocates fear that finding genetic markers associated with same-gender sexual activity would be terrible. They dread a eugenic outcome. That is, they fear that tests will be developed to screen for the marker genes, and parents will use selective abortion or selective embryo implantation to avoid having "gay babies."

Some reporters seem befuddled by the apparent contradiction here: LGBT-supportive commentators both fear that a genetic "cause" for same-gender attraction will be found, and that it it will not be found? So. . . is there something for everyone in this study, which found a genetic component to sexual behavior, but also found that it is pretty small in size? Actually, said some scientific critics, what the controversy shows is that this study should never have taken place. The findings were sure to have results that explained little, with the actual result would be that "a historically marginalized group has been left more vulnerable."

Well, the study took place and was published, and you can't undo that. For what it is worth, the study authors worked with LGBT+ groups to try to ensure the results would be presented in a respectful way. The authors stated that it was important that they do this study, if for no other reason than to preempt people with less sensitivity or active malicious intent from doing it instead.

So, how was the study finding of a small genetic effect "spun" in the media? Most of the major mainstream media and popular science reports on the study headlined the idea that there is no "gay gene." "No' Gay Gene' Can Predict Sexual Orientation, Study Says," wrote CNN."Search for 'Gay Genes' Comes Up Short in Large New Study," said NPR, and "The 'Gay Gene' is a Total Myth, Massive Study Concludes," announced LiveScience. As predicted by Forbes, the media chose to focus on the fact that there is no single gene determining sexual orientation, while all the complexities of why people might have the identities they do appeared, to use the newspaper metaphor, "below the fold;" that is, further down in the articles where only the careful or invested reader will bother to read or scroll.

So we know how the results were spun. But the debate remains: which finding would "really" hurt people who love people of the same gender? Would finding a "gay gene" protect people from discrimination? Or would it justify eugenic attempts to eliminate querity?

And here is where intersex experience can step in and advise LGBT groups about whether finding a biological "cause" for sexual orientation or gender identity would be a good thing or a bad thing. What our experience shows is that neither finding would be protective.

Intersex experience shows that the idea that finding a "gay gene" would protect people from discrimination is very naive. Our sex variance has nothing to do with identity or "choice," and there is zero doubt that we are "born this way." Has that made society embrace us? No, our birth status is flatly termed a disorder. Has knowing we didn't choose to be born intersex stopped the imposition of cruel conversion therapies? Absolutely not--the opposite is true. We are subjected to the cruelest of all conversion therapies: surgical sex changes imposed on us as children without our consent.

I wish more of the people who embrace the "born this way" LGBT advocacy position would learn about intersex experience, because we could show them that they are wasting their time. To be sure, it's not just intersex experience that can demonstrate that. Consider the Holocaust, during which millions of Jewish people were murdered because they were "born that way" (and so, for example, practicing Christians who were born to Jewish parents or grandparents were sent to the gas chambers, as "biological degeneracy" rather than religious belief was what counted in the eyes of Nazi eugenicists).

So, the "born this way" crowd is wrong, and the LGBT-affirming group with eugenic fears is right. Look what happens with respect to intersex traits. Some intersex statuses are genetic, and can be detected via amniocentesis. Selective abortion of these fetuses has caused the number of children born with genetic intersex statuses to fall substantially. Again, it's not just us; consider Down syndrome. Selective abortion of fetuses with Down syndrome has led the birth of affected babies to decline by a third in the U.S., and to be virtually nonexistent in some countries like Denmark.

I have no doubt that if there were a prenatally-detectable marker identified for same-gender attraction, and especially for trans identity, it would be employed eugenically by some parents to avoid producing children with such a marker.

My question for the Ganna et al. would be: what would have happened if you had actual made a dramatic discovery of the thing you sought?

To be sure, I think that is impossible, because looking for a "gay gene" is like looking for a "democratic socialist" gene or a "libertarian gene." The reasons people have the desires and interests and worldviews they do are immensely complex. There may be some biological contribution to those, but it will be small and indirect. For example, one of the Ganna et al. findings was that a gene linked with a tendency toward risk-taking was one of the five they found linked with subjects' reporting having had a same-gender sexual experience. The explanatory power of the gene was tiny--it explained less than 1% of why people reported having a same-gender experience. And I will bet you that the reason there is a linkage has nothing to do with whether people experience same-gender attraction, but with how likely they are to be willing to risk reporting it to a researcher, given that the British study subjects were all older people who grew up when homosexuality was criminalized in Great Britain.

That said, hypothetically, what would have happened if Ganna's group had found that five genes explained, not 1% or less of the variance each, but could collectively predict if a person had a same-sex encounter, say,  70% of the time? I know that Ganna's team worked with advocates to try to present the results in a manner that would be supportive of people with same-gender attractions. I'm sure they would have said, "Look! People are pretty much born this way! Therefore they deserve social respect and legal protection."

But I would ask Ganna's team: is having good intentions enough, given the evidence provided by intersex experience? Being known to be born this way means that the large majority of intersex people identified at birth are subjected to mutilating physical conversion therapies. Intersex people, indubitably born this way, are much more likely to be in the closet than endosex LGBT people. We live with crushing shame and secrecy, imposed by doctors and parents.

What would you have done, how would you have felt, if the result of your research was that same-gender-loving individuals experienced the same high levels of medical intervention that intersex suffer? If eugenic selective abortions became commonplace based on "gay genes," as they are today for genetic intersex statuses?

It's probable that the Ganna team would say this would never happen, because they were careful, and gay rights have progressed so far, and we will never go back. This is a hopeful but seriously naive position. LGBT rights are being eroded every day today, by state and federal actions.

Still, I expect Ganna's group would say, in the end, science requires us to understand the world, and we simply must know more about human identities and behaviors. But if a general desire for genetic knowledge is so strong, why are teams like Ganna's not looking for genetic causes of homophobia, or of a desire to police others' sex and gender variance? How about the genetic markers for people who seek simplistic explanations for complex human behavior? Those are phenomena that cause a great deal of social harm, and deserve at least as much scrutiny as why people experience same-gender attraction.

Perhaps I sound very cynical. But one of the fundamental lessons of intersex experience is that doctors and scientists will tell people they are acting in your best interests, while cutting up your genitals and lying to your face about what they did and why. That's why I may be a social scientist, but I am distrustful of scientists when they act in the realms of sex, gender identity, and sexuality.

Some LGBT people, particularly white, upper-middle-class ones, may not yet have had the bubble of privilege popped--the one that lets people believe that social institutions will always act to protect them. And they are still rooting for scientists to find a set of biological causes--genes, prenatal hormone exposures, physical anomalies--that will prove they were "born that way."

But intersex people know better.

Sunday, May 12, 2019

What If We Treated White Femme Celebrities Like Caster Semenya?

South African track star Caster Semenya has been barred from competing in her races in the Olympics because her body naturally produces higher levels of testosterone than is considered typical for women. Oh, but this is not discrimination, says the International Association of Athletics Federations, because she is welcome to compete in the men's races instead!

I've written at length before about why policing women's naturally-produced testosterone levels and banning them for being intersex is both morally wrong and nonsensical. Testosterone is not a magic elixir of male superiority--that's a ridiculous myth. And even if we imagined that it were, all Olympic athletes have atypical bodies. Swimmer Michael Phelps, world recordholder of 28 Olympic medals, has been the subject of lots of reporting celebrating him as a "mutant." (He is double-jointed, with very unusual body proportions, huge lungs, and muscles that only produce half the amount of lactic acid when exercising than normal.)

But let's not go over all that again. I want to address another issue: that the women being singled out, tested, and excluded for having high testosterone are vastly disproportionately women of color from the global south who are perceived as "too masculine." And often, it is feminine white women competitors who have demanded that they be tested. "Experts" relied upon in Semeya's case have used explicitly racist imagery in their presentations of her as posing some sort of threat to "normal" feminine white women competitors.

It seems pretty glaring that the reason Caster Semenya is being policed so intensely is that she is a queer black woman who is strong and muscular, and not interesting in performing femininity with long hair or nails for the comfort of certain others. And by "certain others," I mean all those policing bodily binary sex and gender expectations: misogynists who deem athleticism in women to be unattractive, and bigots like homophobes, transphobes, and those who deem intersex bodies horrifying.

So let's think about the outcome in a different context. Instead of strong brown athletes, let's look at women who are white feminine celebrities. Let's imagine that before we let them take women's roles in movies or television shows, we tested their natural levels of testosterone.

All of the women I've shown here would fail, because they all have high testosterone caused by PCOS, polycystic ovarian syndrome. Each of them has spoken to the media about it. Emma Thompson has talked about her struggles with infertility related to PCOS; Sasha Pieterse has explained that PCOS caused her to gain weight; Daisy Ridley has shared with fans that she battles PCOS-related acne; and Jillian Michaels has talked about her path to adoption after years of attempting to conceive despite her PCOS.

Each of these celebrities has a natural testosterone level outside the norm for women. Why then do we not classify them as having "hyperandogenism," as we do women excluded from athletic competitions? Why, because they are paragons of white femininity in the public eye! Daisy Ridley did acquire a misogynist hate-following from men who were angry at her Star Wars character Rey. But they were angry because they didn't want a "girl" to be the hero Jedi, they wanted a masculine white man. Jillian Michaels might have gotten a backlash because she has a strong, muscular body--something we associate with high testosterone. But she performs the role of the feminine personal trainer, and spent years policing the bodies of fat people on The Biggest Loser, so she got a pass. Sasha Pieterse was widely mocked and trolled in social media about her body--but this was fat-shaming, not policing femininity. Like many people with higher levels of testosterone, she found out that what this made her was fat, not "buffed," and her curvy body never triggered the stereotypes that high testosterone must make you butch.

So, these celebrities with atypical hormones have not faced the testosterone police yet--but imagine if they did. Imagine if some group started challenging women celebrities, claiming that some were bad role models, or taking acting roles away from "real" women, because they had "male" levels of testosterone, which gave them an unfair advantage. Those making this claim could back it up with a wide array of empirical evidence: actors who are men are given more speaking parts in movies; they are paid more; directors are much more likely to be men. They could claim men have a natural advantage due to testosterone giving them more assertiveness and "drive," making them by nature more compelling actors, more competent directors, and naturally running the entertainment industry.

Yes, that would seem obviously bizarre and nonsensical. But people used to make just this argument; it's simply no longer accepted. We no longer buy the old scientific studies, controversial but widely believed in their day, that it is their high testosterone that causes men to dominate politics, business, academia and the arts.

So imagine that each of these celebrities were treated like Caster Semenya, or Duttee Chand, or Maximila Imali, or Evangeline Makena, and had the same experience as these strong brown athletes. They would be excluded due to naturally high levels of testosterone, shamed, and presented as "cheaters." They would be framed as not really women, despite having been assigned female at birth, raised as girls, and identifying as women today. And they would be highly unlikely to feel comforted by being told they were free to try out for men's roles.

If you think it would be nuts to tell Victoria Bechkam or Emma Thompson that they are not really women because they have high T, then you should think the same about Caster Semenya.

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."