The Intersex Roadshow

Breaking Human Rainbows into Binaries

2022-08-14T01:20:00.027-05:00

I often explain to people that physical sex is a spectrum. But what does that mean? Well, to understand, lets talk about color instead.

Colors exist on a spectrum. Nature gives us the rainbow, each color sliding into the next. So, how many colors are there?

Of course, there’s no “correct” answer. Some societies don’t even have a word for color, and describe an object’s color by analogy: “that ball resembles ginger flowers.” Some societies name a binary: dark or light. Some name three color categories: dark, light, or red. In Western civilization, Aristotle stated there were seven colors: black, white, red, yellow, green, blue, and purple. Today, Western science names a different seven as constituting the color spectrum, revealed when a prism splits light into a rainbow: red, orange, yellow, green, blue, indigo and violet.” ROY G. BIV,” as you may have learned at school.

I know that when I learned ROY G. BIV, it was in science class, and I presumed there was an objective reason for scientists to divide the spectrum into 7 colors. But there isn’t. Isaac Newton established these 7 colors during his research with prisms in the 1700s. He added two colors that Aristotle didn’t see in the rainbow: orange and indigo. Orange wasn’t a color recognized in European languages until the introduction of the sweet orange fruit around 1500. Newton added indigo because it was extremely significant as a color reserved for European royalty at the time, made from rare, very expensive dyes.

Today, when children in the U.S. learn to name colors, they learn to recognize orange—but not indigo. Dark blue-purple is no longer culturally significant—it’s not fabulously expensive to dye cloth such a color, and there are no longer special colors reserved for the nobility. And when you look at the contemporary classic rainbow flag, you’ll see it only pictures six colors, not seven, having abandoned indigo:

As I believe will be clear by now, there is no “correct number of colors” in the rainbow. In reality, the rainbow is a continuous phenomenon, blending across the spectrum. We can choose to cut it into five color categories, or seven, or a thousand.

Still, though the dividing lines are social and subjective, they do have power. As someone raised in the U.S., playing with the classic Crayola basic set of 8 large crayons for young children, I was taught to recognize blue and purple, but not indigo. And I just don’t see it in the natural spectrum, or it seems to me odd that we would name a tiny slice of the rainbow indigo, but not name the wider band of turquoise I see when I eyeball one:

This brings to mind some family history. Throughout my entire youth, my mother and her own mother had a running argument about whether turquoise was a type of green, or a type of blue. They would sometimes try to rope others into their lifelong debate, one demanding, “Look at the stone on this necklace; you agree with me that it’s blue, right?” Or “Look at this shirt—don’t you agree it is green?”

By the time I was 6 or 7, it was clear to me that this was a pointless debate. Turquoise is a color that is intermediate between blue and green. You could say my mother and grandmother were both right—turquoise is sort of green, but it’s also sort of blue. Or you could say they were both wrong. Both were able to identify turquoise as distinct from “regular” blue or green. Either way, arguing about it was a waste of time. Enjoy the pendant, appreciate the shirt, and stop trying to force their color into different boxes for adjacent ones considered more "pure"!

A friend told me that their sisters always argued about whether saffron should be considered “really yellow” or “really orange.” (It’s a yellow-orange color.) So it’s not just my relatives. You, however, may never have encountered such a debate. But imagine if you grew up instead in one of the world societies that just divides colors into a binary of “light” and “dark.” You can bet there’d be a lot more arguing, if you and your family were forced to negotiate whether to place a pile of color swatches into the light or dark pile! Maybe you’d agree that a crimson swatch goes in the dark pile, while pastel pink goes in the light pile. But what about a bright magenta?

I bet my family would debate such a color-sorting task into a binary of light and dark for hours! Or really, for life, since that is what they did with the color turquoise.

Dividing a spectrum up into a binary is extremely arbitrary. It’s bad enough doing it with color swatches. But you know what's worse? Trying to do it with people.

We’ve had battles over this for centuries now, when it comes to people’s colors. In reality, human skin comes in a wide spectrum of colors of beige and tan and brown and sepia. But in the U.S., under racial slavery, people were divided instead into a binary of black versus white, in areas colonized by the British. In Louisiana, colonized by the French, a 5-category spectrum of black/white racial categories was used (black, mulatto, quadroon, octaroon, white). In the West and Southwest, colonized by the Spanish, a rubric of mestizaje was used to define a 16-caste spectrum of privilege, depending on a person's blood quantum of Spanish, Indigenous, and African ancestry. These French and Spanish systems were both white supremacist, but they recognized different degrees of privilege and marginalization. However, in the East and South, colonized by the British, a person was assigned to a binary of “black” or “white,” subjected to or free from racial enslavement.

But where to draw the line separating the privileged from the oppressed? To ensure that a when slaveholder impregnated a person he enslaved, he produced, not an heir to his property, but a child considered his human property, the British colonies devised the “one-drop rule.” This said that anyone with “one drop” of African blood was black. After generations of such impregnation, by the time of the Civil War, many enslaved “black” people were mostly European by ancestry, and might have lighter skin than many people classified as “white.” All of the individuals in this photo, for example, were enslaved until the end of the Civil War, and classified as “black”:

We in the U.S. today inherit this history. Most African Americans have at least some European ancestry. And Americans continue to see people with mixed European and African ancestry as “black”, even when they are very pale of skin.

That said, today many more Americans of mixed racial and ethnic backgrounds are rejecting a binarized vision of race, and claiming their mixed heritage. In the year 2000, the U.S. Census finally allowed Americans to check off more than one race/ethnicity to identify themselves, and the number of people doing this has surged. Many people are relieved and proud to be able to have the rich complexity of their backgrounds recognized. They want to locate themselves on the vast spectrum of human ancestry positions. They want to say no to participating in arguments over whether, for example, a person whose mother is Korean and whose father is Nigerian is “really Asian” or “really Black.”

And here’s where we get to intersex people. Today, a child born in the U.S. must be identified on their birth certificate as being either “male” or “female.” Physical sex is legally defined by a binary, and we are taught in our high school biology classes that this is scientific fact. But that is false. Sex, like the rainbow or the range of human skin colors, is a spectrum. There exist a wide range of intersex positions on the sex spectrum. Chromosomes, hormones, genitals, and gonads can each vary independently. There are many genotypes other than XX or XY (XXY, XXYY, Xo, XX/XY, etc.). People of all sexes all make, and need, the full range of sex steroids (estrogen, progesterone, testosterone, etc.), and the balance of these hormones varies widely. People are born with a full spectrum of phalloclitoral forms between the expected norms of penis or vulva. All of this is true of all animals as well. The sex spectrum is a part of nature.

But Euro-American society has been trying to squash that rainbow of bodily forms into a binary since the high Middle Ages. It’s always arbitrary and subjective and awkward—yet like my mother saying that turquoise is “obviously blue," people have often believed firmly that they know how to classify someone intermediate into the “correct” binary box. Who gets to make that decision? In prior centuries, the church, then civil courts, and since the Victorian era, medical doctors. And on what basis? Church authorities and civil courts tended to focus on external genital appearance and lived gender. Doctors scoffed at this, and said the “true [binary] sex” was established by some principle laypeople could not observe, and only "medical men of science" could. Victorian doctors based their determinations on post-mortem dissection of the gonads, viewing them under the microscope, with testes making one “truly male” even if they were in the ovarian position, and the individual had vulva, substantial breasts, and did not grow facial hair. Early 20^th century doctors based one’s “true [binary] sex” instead on the newly-discovered testosterone and estrogen, based on the false presumption that people produced one or the other, which, it became quite clear, was incorrect. So that regime was replaced by a focus on sex chromosomes as soon they were discovered. But that chromosomal rule was soon displaced by a psychological and surgical focus on childhood sex reassignment surgery, with the intent to eliminate genital variance and produce a heterosexually-oriented, endosex-appearing patient.

Each group of authorities believed that they had discovered the “true dividing line” between male and female binaries. Each discarded the system employed by the prior set of authorities. And every one of them was equally wrong. There is no true, correct dividing line between light and dark colors, between humans being classified as “black” or “white, or between intersex people being pushed into male or female boxes. Whatever binary dividing line you argue for, it is equally wrong, because spectra are the reality. Intermediate positions are real.

And when you let someone else with power over an intermediate person decide what binary box to force them into, it’s always coercive and morally wrong. The one-drop rule may have been extremely clear and easy to apply—but that’s exactly the problem. It was used to enforce enslavement and allow slaveholders to benefit from sexual abuse.

Today, transphobic individuals who conceive of themselves as feminists—the TERFs—are seeking to impose a new one-drop rule on intersex people. We see this emerging in the realm of athletics. We need to be able to examine and critique that, so let's explore.

Over time, various groups claiming authority under the regime of binary sex to decide who was “really male” and who was “really female” have drawn the line in different places in the middle of the spectrum. You might imagine that a rainbow of sex diversity would just be split evenly down the middle:

But that’s not what doctors do. To some extent, their binary sex assignment choices are driven by the fact that physical sex has multiple dimensions--genitals, gonads, chromosomes, hormones—each of which can vary independently. This creates more of a complex multidimensional space in which physical sex is located. But their decisions are not just based on some preponderance of sex traits. They are driven by a principle of avoiding the surgical result of an “inadequate penis,” in service to the social phenomenon of fragile masculinity. In certain cases, they are driven by an aim of possible fertility, when ovaries are present, though they sacrifice testes without compunction. For many decades, the primary driver of binary sex-assignment decisions was to satisfy the principle of compulsory heterosexuality (and this lingers, long after queerness officially lost its label as a “disorder”). And from the 1970s-2010s, U.S. doctors claimed that it is generally better to assign intersex babies female, both to avoid psychological harm caused by fragile masculinity, and because, I kid you not, a surgical adage that “it is easier to make a hole than a pole.” So if we look at the binary sex assignments given to intersex infants by doctors, we get a strange patchwork, like this:

However arbitrary this may seem, it was presumed that doctors chose the medically correct, “true” or “best” binary sex assignment. Often, the fact that the children had born intersex was kept secret from them, because this was believed to ensure they did not question their status as girls or boys. Their “disorder of sex development” had been “cured,” and should no longer be relevant to their lives. Nobody but the doctors and parents need ever know. Concealment in a closet so deep even the person in it was unaware of that fact was deemed ideal.

But now TERFs claim that they have the authority to decide who is “really male” and who is “really female.” And their core principle is not to conceal a person’s intersex status. They want it revealed to the world. Their core principle is that “biological females” need to be protected from “biological males,” who are held to pose a sexual and social threat to them. Thus, they claim, anyone with male sex characteristics must be kept away from cisgender endosex women and girls. Intersex and trans women “do not belong” in women’s bathrooms or girls’ changing rooms. And intersex and trans girls and women must not be allowed to compete in sports with cis endosex females. It doesn’t matter, say the TERFs, if the trans and intersex women have received hormonal or surgical medical treatments, because they were born with “male sex traits,” and this can never be undone.

In other words, TERFs follow a “one-drop rule” when it comes to deciding where to cut the sex spectrum in half to divide it into male and female. Any hint of sex variance permanently renders one male. As the racial one-drop rule supposedly protected white “purity,” so the TERFs’ body policing is intended to protect “female purity.” That results in a scenario like this:

Yuck.

The thing about purity rules is that they always wind up harming the group they claim to protect. They cause moral harm to that group, by getting them deeply invested in exclusion and boundary policing and a search for traitors and infiltrators. And they wind up oppressing many within the group, as they are found to be impure in one purge or another.

Consider: about 10% of all cisgender women have PCOS, polycystic ovary system, which makes them produce testosterone well above the “normal female range.” This doesn’t make them magically into athletes, but according to the TERF female purity rule, people exposed to high testosterone have an unfair advantage that cannot be erased by medical treatment, and should be excluded from participation in women's sports. So there goes 10% of the population of people assigned female at birth. . .

And consider this: by the time she is age 40, the average cis woman has XY chromosomes in her body. That’s because the average woman will have, by that time, gestated, at least for a while, an XY fetus, and fetal genetic material crosses through the placenta into the mother’s body and implants there. (Also, XX genetic material from a gestator passes into the fetal body and implants there as well, but TERFs don’t care about whether men have XX chromosomes in their bodies.)

Should every woman who has been pregnant for any time with an XY fetus be excluded from playing in women’s sports? There are some scientists who posit that this implantation of XY chromosomes somehow prepares a woman to raise sons by making her more competitive. Many others roll their eyes at this as a just-so story of gender essentialism backed by no real empirical evidence. But that story very much fits with TERF reasoning about any "impurity" imparting a male taint that must be kept away from the biologically pure women.

If you slice the rainbow of human sex characteristics aggressively, paring off all deviations from the “pure female,” this violent act doesn’t just toss out women who were recognized as intersex at birth or assigned male at birth. It tosses out more and more women who were assigned female at birth without any controversy. (This is true of Olympian Caster Semenya today.)

Purity policing instills shame and secrecy. It does violence to the psyche. It harms not just people who have always known of their variance, but those who thought themselves pure, and benefited from that--until they are revealed to be "tainted", or they train to be an athlete, and then strike others as "too muscular."

Just look at life for people of mixed race under the American regime of the one-drop rule of white racial purity. Is that what we want to emulate, with regard to physical sex? It’s so very much better to recognize spectra. To embrace our mixed ethnic heritages, name them, take pride in them. To accept physical sex spectra in all their complexity. To celebrate human rainbows.

Let’s do that!

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

2022-08-03T20:59:00.001-05:00

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.

Understanding the Biblical Binary of "Male and Female"

2022-07-23T09:10:00.000-05:00

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

The Silly Idea of Your "Real" Binary Sex

2021-09-12T13:06:00.016-05:00

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.

Protecting a Baby Born with Three Penises

2021-04-27T18:32:00.004-05:00

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.

Intersex Experience and Fears about "Gay Genetics"

2019-09-02T14:42:00.000-05:00

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.

What If We Treated White Femme Celebrities Like Caster Semenya?

2019-05-12T11:55:00.000-05:00

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.

The Department of Inhumanity and Ideological Services

2018-10-22T01:56:00.000-05:00

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.

Nonconsensual Intersex Surgery as Physical Conversion Therapy

2018-08-20T22:07:00.002-05:00

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.

Conservative Evangelicals Embrace Intersex Genital Mutilation

2017-09-02T11:52:00.000-05:00

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."

The Problematic Ideology of Natural Sex

2016-08-10T16:03:00.001-05:00

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 20^th 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 21^st 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 20^th 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 20^th 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.

Intersex Athletes of the Times

2016-06-28T14:34:00.000-05:00

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.)

When Intersex People are Collateral Damage in Transphobic Battles

2015-02-25T17:14:00.003-06:00

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.

Trans-Exclusionary Radical Feminists and Intersex Experience

2014-09-09T15:19:00.000-05:00

Recently I spent several days in a public internet group for "gender critical" people, after a few intersex friends voiced some positive things about this line of thinking. Feminists who call themselves "gender critical" are a controversial bunch, but their critique of the term "cis gender" had caught the interest of some intersex people I respect. The term "cis gender" is an awkward one to use in the context of intersex people, which was the subject of my last blog post. So I wanted to approach this branch of feminism with an open mind, and see if there was theorizing or political advocacy I could use in my intersex work. The group I joined promised respectful listening to people of varying beliefs, and banned personal attacks, so I had high hopes.

My hopes, I'm afraid, were naive. The group turned out to be completely dominated by "TERFs," trans-exclusionary radical feminists, and when it came to intersex topics, not people I would consider good allies in the least. So, since I know there are other intersex advocates who've presented "gender critical" politics in a positive light, I wanted to write a post about why I consider this a bad idea.

First, since I suspect that a good number of readers may be unfamiliar with the terms "gender critical" and "TERF," I will present an overview of the beliefs involved, in the form of a handy numbered-list primer.

A TERF Primer

1. Calling themselves "radfems" or "gender-critical feminists," and named TERFs by radical-feminist-identified people who are not transphobic, these are cis women who oppose the inclusion of trans women in feminist organizations, women's spaces, and female facilities. TERFs do not describe themselves as cis women, however, but as women-born-women, natal women, or (unmodified) women. They assert that the terms "TERF" and "cis" are slurs. Generally they just refer to one another in discussions as "feminists" and as "women," as if anyone who is a feminist would agree with all that they say, and as if their female status should go unmarked, as the normative or "real" female status.

2. Trans-exclusionary radical feminists believe that sex is a natural binary, innate and immutable: men have penises, women have vaginas and uteri. They note that gender is a relationship of power, in which men seek to control women's uteri, reproductive capacities and lives. The ultimate expression of this patriarchy is the use of the penis to rape. As a result, "gender critical feminists" make the strong claim that anyone who denies that sex is a binary and that genitals determine gender is ignoring the terrorizing of (natal/cis) women by rapists.

3. TERFs argue that sex cannot be changed: trans women are really and eternally men, and trans men are really and eternally women. Identifying with a gender that doesn't match one's genitals is a delusion or mental illness. The phrase "gender critical" denotes being critical of (or more bluntly, rejecting) the concept of gender identity--most especially the fundamental precept of trans gender advocacy, which is that when gender identity and legal sex conflict, this provides pragmatic and ethical justification for a change of legal sex.

4. TERFs deny that they are transphobic, and say they have compassion for men under the delusion that they are women, which they present as equivalent to believing one is really a horse or a space alien. Dysphoria with one's body, they point out, is not a special characteristic of trans people, but a near-universal, and the solution is to accept one's body. Accepting one's body means accepting that one cannot call oneself a woman while having a penis. (Nor can sex be altered through genital reconstructive surgery , which is a radical mutilation to no purpose, as genes can't be changed and binary sex is essential. But in most of the discussion threads I read, it was assumed that trans women all have penises, making them dangerous, as penises are rape weapons. In fact, I've never read the word "penis" so often outside of a urology blog.)

5. TERFs are not just binary sex essentialists, they also have a theory of gender socialization. Their vision of gender socialization is bleak: boys are socialized to dominate, control, and rape women; girls are socialized to submit to this and embrace their oppressors and call this "femininity." Clearly this is bad, and feminism is a movement of (natal/cis) women that teaches women to recognize and resist this programming. Men, however, are presented as inevitably and eternally shaped by their socialization into patriarchy, as it advantages them. Trans women are men, and while they may claim they do not enjoy being treated as men, this just illustrates their blindness to their own privilege. Trans women are inevitably socialized to try to control "natal" women, as evidenced by their belief they should be able to force cis women into supporting their gender delusion and treating them as sisters.

6. Thus, this conclusion about trans people: trans women are confused men, fetishists of the feminine, who are prompted by their male socialization to seek to control women--in this case, due to their delusion that they are women, to control feminism and women-born-women's spaces. Trans men are less of a problem, since they pose no threat to anyone, lacking both penises and socialization into the role of the oppressor. Trans men are just sad: women who don't understand that it's ok to be a butch woman or a lesbian, victims of Stockholm syndrome identifying with their oppressor. Women who are deluded into thinking they are men should be pitied and exhorted to return to the fold. But men who delude themselves that they are women are a serious problem. They must be stopped: with exclusionary policies, taking back feminism from a trans-obsessed trend; by fighting antidiscrimination clauses that would let trans women and girls use women's bathrooms; through telling the world that supporting trans children in their identities is child abuse.

7. Feminists who are trans allies and transfeminists counter each of these points. They state that sex is not a natural binary, but naturally a spectrum (i.e., intersexuality happens). They point out that many cis women lack uteri, yet are still considered women by everyone, even TERFs. They note that gender socialization is complex and variable, that it is shaped by the gender with which one identifies, and that acknowledging both these facts is in no way a denial of the reality of patriarchy. They assert that it is important, however, to acknowledge the intersectional nature of marginalization and privilege, and speak not just of patriarchy but of kyriarchy, taking into account race, age, sexual orientation, (dis)ability, and other dimensions along which power is distributed. And one of these dimensions is the axis of cis privilege and trans marginalization. Trans women--particularly those who are poor, of color, and/or have a disability--suffer huge levels of social stigma, violence, employment discrimination, etc. Cis women need to acknowledge that while they are marginalized as women, they are privileged as cis people.

8. TERFs respond to trans allies with anger. They say trans allies are dupes, following a trend that counters basic logic, biology, nature, and the English language when they accept the idea that a person with a penis can be called female. (Quoting the dictionary is popular to "prove" that genitals determine gender.) They discount all the statistics about violence against trans women (and to a lesser extent trans men) as manufactured and overstated. They assert that a woman can never oppress a man, and trans women actually being men, "natal" women cannot oppress them. The TERFs repudiate being termed cis gender, equating the term "cis" with gender-conforming and unenlightened femininity, and regularly linking it to the violent phrase "die cis scum," which they assert is the core sentiment of men who think they are women, as if trans women's goal is to kill off all cis feminists so that trans women can have every feminist organization that exists all to themselves. Finally, they equate acknowledging cis privilege with asserting a belief that women are not oppressed.

Intersex People and "Gender Critical" Politics

It's clear that I view TERFs, in a word, as bigots. Their mission is to discriminate against and exclude a marginalized group. I hoped I might encounter something less stark and more nuanced in the "gender critical"internet discussion group I joined, since some other intersex advocates have had some positive things to say. But that's not what happened, and a couple of days spent reading and attempting to have conversations left me feeling depressed and sullied. There were a few positive moments, but they were vastly outweighed by slogging through a lot of LOLing about how stupid a person must be to think they can call themselves female when they were born with a penis.

So, my first question is, why have a few intersex friends had anything good to say about TERFs? I think I can point to a few things.

1. The phrase "gender critical" sounds appealing. My intersex friends are critical of the way sex and gender are understood and enforced in the contemporary West, since this involves unconsented-to surgery performed on intersex infants' genitalia with lifelong ramifications that can be quite negative (loss of genital sensation, loss of fertility, loss of a source of natural sex hormones, and sometimes assignment to a sex with which the child does not grow up to identify). A group that says they critique gender from a feminist perspective certainly sounds like it would make a reasonable ally.

2. Intersex people are often uncomfortable with the application of the terms "cis" and "trans" to intersex experience. The terms apply very poorly because they presume that physical sex is binary (even if gender identities may be nonbinary). That is, if a person is born genitally intermediate, surgically assigned female, and grows up to identify as a woman, is she "trans gender" because she was surgically genitally altered to become female, or "cis gender" because she identifies with the sex she was assigned at birth? Either term winds up misrepresenting something about her experience. (I've suggested the term "ipso gender" in my last post as an alternative.) In any case, TERFs reject the term cis gender, and this may appeal to an intersex person frustrated with this terminology.

3. In recent months, there have been a series of "mainstream" articles and online posts in which TERFs' positions have been sympathetically expressed. For example, one article mentioned by an intersex friend critiqued the term "cis privilege" by caricaturing it as meaning "having a female body is a privilege." Clearly this is false: because of patriarchy, female bodies are sexualized, framed as weak, and subjected to surveillance. Tons of cis women don't enjoy getting periods or feeling constantly at risk of an unwanted pregnancy. Having a female body is not a privilege--but it is also not how trans advocates define cis privilege at all. Trans people actually define cis privilege as "the benefits one derives from being seen as a 'real' and 'natural' member of one's identified sex" (lack of public scrutiny of one's primary and secondary sex characteristics, being able to use a public bathroom with relative ease, having an ID that matches one's identity, etc.). Nor do trans people deny, as the linked article claims, that cis people also suffer from gender policing. Someone who identifies as a woman yet who is very butch can suffer from bathroom panic, and a male-identified person who is quite feminine may face a great deal of street harassment. That is why trans advocates always fight for laws banning discrimination on the basis of gender identity or gender expression. But if you read the linked article and took it at face value--why, the arguments of trans women sound regressive and ludicrous and enforcing of binary gender stereotypes. Trans women are telling "natal" women their privilege is to enjoy being pretty and silent and submissive and having lots of babies, says the author! If that were true, transfeminists really would be revealed to be patriarchal oppressors in disguise. Only. . . it's not true. It's a false characterization on par with saying that "feminists are man-haters."

OK, now we have some ideas about why intersex people might think that "gender critical" camp could be reasonable allies for intersex people. The next question to address is what did I actually find TERFs to say about intersex issues when they were raised in group discussions? Clearly the "gender crits" aren't trans allies, but are they nonetheless intersex ones?

The first thing I really want to acknowledge is that it's not all bad. A couple of points came up where "gender critical" positions did align with intersex advocates'. Most centrally, since TERFs believe that the "natural" sexed body should be accepted rather than medically altered, a good number of commenters were opposed to performing genital surgery on intersex infants, seeing it as mutilation. That's a good thing. And secondly, when I posted about Dutee Chand, an athlete who has been excluded from international sports due to sex-policing of her natural levels of testosterone, I found that at least in situations in which a person was born with vulva, raised as a girl, and has XX chromosomes, the TERF posters believed she should be allowed to compete in women's sports despite having testosterone levels that were considered "male." Also good!

Well, those positions sound heartening! Why then do I say that the "gender critical" partisans are not good allies for the intersex community? Because of these numerous other positions of theirs:

1. There was a total consensus among the trans-exclusionary feminists that sex is naturally a binary. The fact that people are born sexually intermediate was somehow said not to undermine this assertion, because intersexuality was presented as a disorder, and, I was informed, "you can't take a disorder and call it a sex." All intersex people were held to have a true binary sex. While doctors shouldn't perform cosmetic genital surgery, TERFs asserted they should examine the infant and assign them to the correct binary sex on their birth certificates. I was told that the correct sex would be based on capacity to reproduce in the "very rare" situations in which that would be possible without surgery, and otherwise on genes.

2. Removing sex-markers from birth certificates generally, or making a preliminary sex marker amendable at will at maturity to M, F, or a nonbinary category--as suggested by intersex advocates--were thus framed as crazy. It could confuse the child into believing they are members of a third sex, while "real" intersex people identify as women or men, discussants claimed. It was presumed to be bad for intersex children, while encouraging trans genderqueer fantasies. Since TERFs see gender identity as a sort of delusion or myth, the idea that families and society should allow the child to mature to develop and assert their own gender identity (male, female, or something else) is basically incomprehensible.

3. Nobody on the site at the time I was on it seemed aware what the result of the sex assignment scheme they described would be. For example, people with CAIS, born with typical vulvae and developing female secondary sex characteristics at puberty if unaltered by gonadectomy, would be understood as permanently and naturally male, being infertile and having XY chromosomes. Yet CAIS is often not diagnosed until late childhood or puberty, so either CAIS teens would be forced into gender transitions--a process the "gender crits" frame as impossible--or the TERFs would have to accept XY women. Meanwhile, people born with a phallus fully masculinized by CAH would be permanently assigned female based on having XX chromosomes, while left surgically unaltered. Given that the most central tenet of TERF politics is that a person with a penis cannot be female, this is a particularly strange outcome.

4. I was surprised to find myself repeatedly informed that "intersexuality is a derail" when I raised concerns in conversations. One reason for this is that being born intersex was framed as vanishingly rare. Basically this argument held that half the population is made up of "natal women" under threat from men trans-deluded into thinking they have a right to enter women's spaces, while intersex issues only impact a handful of people, and concerns about a minor edge case shouldn't come to dominate a discussion about masses of women-born-women.

5. The main reason I was told that TERF group members were "far beyond the point of reasonable frustration or tolerance for the intersex derail in conversations about gender identity" is that it was supposedly "only ever brought into conversations" as a distractor by men (that is, trans women) trying to deny the reality that genitals determine immutable binary gender, that "natal" women are oppressed rather than privileged, and that trans women are privileged rather than oppressed. The fact that I, who am intersex and not a trans woman, was the person raising intersex issues was glossed over. Intersexuality is presented as a straw man issue beloved by trans women.

6. Another thing I was told is that most people claiming to be intersex are actually trans gender pretenders. Now, I as an intersex advocate have spoken before about there being an issue of "intersex wannabes"out there, a problem for our community when they present physically-impossible stories--such as having been born with a full set of female reproductive organs and a full set of male ones--that contribute to disinformation. But I do not appreciate being told that most people who say they are intersex are liars, and that the "tiny minority" of people who actually are intersex are being used by these men-who-caricature-women, proof that real intersex people should revile trans people. I can make my own determinations about the true prevalence of intersex status, and who is supporting or exploiting me. Not to mention that asserting that most people who identify as intersex are in fact lying itself contributes to disinformation about our community.

7. The main situation in which intersex concerns were actually treated as relevant was in the context of discussions of trans-identified children. (A particularly overwrought conversation in the group discussed an article which bore the blaring title "Toddler Aged 3 Assessed for Sex Change at London Clinic," which actually just reported that a 3-year-old was assessed for gender identity issues, not that the child was offered any sort of hormonal or surgical treatment.) A claim made in the discussions of trans-identified children was that for parents to "indulge" this "fantasy" by bringing them to a clinic to be diagnosed, changing the pronoun they used to refer to the child, and/or having the gender marker on their ID changed was analogous to forcing genital surgery on intersex children, and thus a human rights violation that should be banned. I don't see an analogy at all, but rather an inversion: forced genital surgery performed on infants violates their autonomy, while validating a child in their gender identity supports the child's autonomy. I see TERFs appropriating intersex concerns about unconsented-to genital surgery to advance their goals.

So: I followed a recent suggestion that "gender critical" politics might be useful to intersex people, and spent several days reading posts and participating in a group for "gender critical" partisans. What I found was something that left an awful taste in my mouth: a lot of transmisogyny, a denial of the lived reality of trans people of all genders, and an insistence on an immutable sex binarism that frames intersex people as disordered. I was told that most people who say they are intersex are trans pretenders, using a tiny minority to advance their nefarious goal of insisting that gender identity should be respected and genitals treated as nobody's business other than the person bearing them and their intimate partners. And I found the intersex community's concerns being co-opted to vilify parents who support their children in identifying with a gender other than that on their birth certificates.

They may call themselves by the intriguing moniker "gender critical," but I believe these trans-exclusionary feminists make very poor allies for the intersex community.

Cis Gender, Trans Gender, and Intersex

2014-08-05T13:50:00.002-05:00

Today, the Intersex & the City blog asks, "Is it impossible for intersex people to be cisgender because it is impossible in society to live completely as in intersex person with no male or female legal checkbox?"

In my experience, what you find when speaking with intersex people about this is an interesting split based upon gender identity. Intersex people who do not identify with the binary sex they were coercively assigned at birth tend to see all intersex people as forced to live trans lives. Intersex people who do identify with the binary sex label they were given at birth instead generally see themselves as cis people, and only frame as trans gender those intersex people who gender transition or who assert a nonbinary gender identity.

Personally, as an intersex gender transitioner, I fall into the camp that does not view intersex people living in our society as cis gender, even if their gender identity matches their assigned sex. Intersex children are born neither male nor female, but are forced into a binary sex category by a contemporary social ideology that says this is mandatory. Many are then subjected to infant sex assignment surgery to try to make their bodies conform to their assigned sex. What is that other than a forced sex change? Just because a person grows up to identify with the sex they were assigned at birth does not mean they will feel surgeries they were subjected to were appropriate. Loss of potential fertility and loss of capacity for sexual sensation are prices that they may not consider worth the result of a somewhat-more-sex-conforming body--note that many people who gender transition by choice choose not to get genital surgery. Thus, I believe, framing medical interventions into the reproductive organs and genitals of intersex people as trans interventions, not "corrections," is important, as it will force doctors to give us agency over what is done to our bodies, and prevent them from removing the very sexual features we may most identify with.

The problem with my framework politically is that a majority of intersex people today do live in their assigned binary sexes, growing up as we do in a society in which that is the norm. The percentage of us who mature to gender transition or assert a nonbinary gender identity is much higher than is the case for nonintersex people, although we don't know the exact degree of the difference because doctors are emphatically not collecting data on us, their sex-assignment "failures." Still, a majority do live their lives in their assigned sexes (often completely in the closet about being born sex-variant, as doctors have urged parents to train their children to be). And most such people do not identify at all as "forced to live a transgender life." That is, they identify as cis gender.

If someone says, "I was assigned female (or male) at birth, and I identify as female (or male)," then we usually call such a person cis gender. So intersex people who understand themselves as cis gender have a very valid basis for framing themselves that way. Certainly this is the way the medical field treats the situation, in claiming to assign us to what they used to call our "true" sex, and now call our "best" sex. Doctors view themselves not as imposing sex changes upon unconsenting infants, but as revealing our "real" binary (cis) sex.

I feel that understanding all intersex people who have been assigned a binary sex (which, in the US today, is all of us) as trans is useful, because it gives us a way to oppose unconsented-to infant genital surgeries. I view those intersex people who are happy in their assigned sexes as no different from people who are not intersex, but gender transition by choice and are happy as a result.

At the same time, I don't feel I have a right to tell an intersex person who identifies as cis gender that they can't do that. After all, as trans gender advocates note, every person is coercively assigned to a binary sex at birth. A person who grows up to identify as genderqueer, or with the binary sex they were not assigned, is forced to struggle with medical and legal and social forces to have their identity recognized, whether sex variant by birth or born with a body considered normative. So, viewing all cis people as coercively assigned to the sex with which they identify makes calling intersex people who identify with the sex they were assigned "cis gender" reasonable, from a trans-affirming perspective. (Of course, many people are not trans-affirming, and transphobia can motivate rejection of being labeled trans gender. But I do not believe it is either charitable or necessary to assume that an intersex person who identifies with their birth-assigned sex and rejects being labeled as trans is motivated by bigotry.)

I just feel that labeling anyone who is medically altered to change the sex characteristics of their body as trans makes the most sense, and is useful from an advocacy standpoint.

UPDATE:

I've done some additional thinking about this topic, and would like to have people consider approaching gender identity in intersex people by acknowledging that we can never address intersex experience well through binary terminology. What we may really need to do is to introduce another term.

what I would suggest doing is adding to the terms "cis" and "trans" another term often used in scientific terminology. In chemistry, which gives us the language of cis and trans isomers, there are chemicals based upon a ring structure, called arene rings. When a chemical substitution is made in the same place on the ring, this is referred to as "ipso" substitution.

If we were to add the term "ipso gender" to trans and cis gender, we could perhaps describe intersex experience more accurately. A cis gender intersex person would be one with an intermediate gender identity, since that "matches" their birth sex. An ipso gender intersex person would identify with the binary sex they were medically assigned (the social sex substituted for their intersex birth status being the same as their identified sex). And a trans gender intersex person would be one who identifies with the binary sex other than the one they were assigned by doctors.

This terminology solution is not without its drawbacks. Usually people who are genderqueer in identity are considered to fall under the trans umbrella, but in the case of intersex people, they'd fall under the cis heading, which could prove confusing. But it's also possible that confusion would itself prove productive.

It's certainly worth considering.

On Eugenic Abortion of the Intersex

2014-04-29T13:17:00.000-05:00

A century ago, eugenics, the science of breeding "better" humans, was considered the "queen of the sciences." Then came the Holocaust, in which millions of Jews, LGBT+ people, people with disabilities, "Gypsies" and others were murdered by the Germans in the name of purifying the Aryan race.

The first to be sent to the gas chambers were those deemed "lives not worth living": people with disabilities and "deformities."

Germany lost WW II, and afterwards, eugenics was abandoned in the polite sciences, and replaced with genetics. No longer was it considered ethical to speak of breeding better humans by eliminating "undesirables;" instead, genetics was to improve life by addressing itself to pure science or to curing medical suffering.

But eugenics never really went away, and it's operating today through various reproductive technologies such as selective implantation of embryos, and, quite commonly, through prenatal screening for "disorders," which are then "treated" via "therapeutic abortion." Among those characteristics that can been screened for and eliminated are those forms of intersexuality with a genetic origin.

Our medical ethicists today state that selective abortion of female embryos is unacceptable, because there is no medical condition, simply a social preference. Yet termination of pregnancies involving intersex fetuses is deemed ethical, because we are deemed disordered. In essence, this "ethical" position is that it's ok for doctors to select fetuses with disabilities for termination, as it's rational for us to be considered "lives not worth living."

OII Australia has submitted the following comment on guidelines for the use of assisted reproductive technologies in Australia, which you can find here. It argues that intersexuality is not a "disorder," but rather a natural variation. It further argues that medically selecting against intersex pregnancies is akin to selecting against female pregnancies, being based on social biases, and should be considered unethical.

I'm all for that, but I'd go further. I'm pro choice, and believe a pregnant individual should have the ability to terminate an early pregnancy at will, based on her assessment of her readiness and ability to carry a pregnancy to term. But I have grave moral reservations about eugenic abortion--a termination of a pregnancy based on the characteristics of the fetus as determined by doctors. Elective abortion at will relates to people's reproductive autonomy, but eugenic abortion focuses on what types of people are considered valuable or disposible. And, as someone who is Jewish, LGBT+, and intersex, I see a clear continuity between my being a candidate for the gas chamber were I living in Nazi Germany, and my being a candidate for selective abortion were I conceived today. I cannot countenance eugenics.

Testosterone and the Sex Policing of Athletes' Bodies

2014-04-10T13:40:00.000-05:00

New policies for Olympic and other international athletes set an upper limit to the amount of testosterone considered "normal" for a woman, and require those women who have natural levels of T that are higher than this to have medical interventions to lower their levels. If the women are found to be intersex, these interventions include surgical removal of their gonads, and (though this has NO relation to testosterone production) surgical reduction of their clitorises if these are deemed "enlarged."

This is just crazy. Some facts: first, levels of testosterone vary a lot. Tests of elite athletes show that about 17% of male athletes have testosterone in the "female range" and 14% of female athletes have testosterone in the "male range." Secondly, there is no direct correlation between levels of T and athletic performance; that's simplistic and nearly magical thinking. And third, it makes no sense to define the range of "normal" T levels for women very narrowly (15 - 70 ng/dL) and for men very broadly (300 -1,000 ng/dL), in essence saying that there's no such thing as a natural level of testosterone too high in a man, but there is such a thing for a woman.

Bodies vary a great deal. Why do we focus obsessively on policing the sexed body of athletes, rather than on other "abnormalities?" Basketball players are abnormally tall, which actually does enhance their performance. Many gymnasts are double-jointed and abnormally flexible. In fact, most any sport rewards people with atypical bodies, and we *celebrate* that. But when it comes to sex variance, a variation that is associated with high performance more in fantasy than in fact is suddenly subject to extreme bodily policing, and that's just wrong.

A Seasonal Thought

2013-12-21T20:50:00.000-06:00

Apparently 0.8% of American mothers report that they became pregnant as virgins.

The likelihood that some of these mothers had in fact had classical penile-vaginal intercourse, but didn't wish to report it, is indicated by the fact that these self-proclaimed virgin mothers were twice as likely to have taken an abstinence pledge than were other mothers.

But others of these virgin mothers were likely telling the technical truth: that they had not yet engaged in penetrative intercourse when they became pregnant. Sperm, you see, swim, and if they are deposited on the exterior of a person's body, they can make their way inward all by themselves. Thus, pregnancies regularly result from "outercourse."

As an intersex person, I think about this a lot, because doctors often claim that genital surgery is not cosmetic but functional, as without an "adequate" vagina or "repaired" penis, we will be infertile. To which my sophisticated academic rebuttal is: nuh uh! You need the right hormonal balance to go with the gametes, and some way in or out, but it certainly doesn't need to be a vagina that can "accept" a penis, or a phallus that is large and has the urethral opening at the tip.

Hypospadias: Intersexuality and Gender Politics

2013-02-20T15:09:00.000-06:00

If you are looking around for information about intersexuality, one of the first things you're likely to read is that "most intersex children are assigned female at birth." This is in fact false.

In the U.S. today, according to the CDC, one in 125 children assigned male at birth is surgically modified to fit that binary sex status. The percentage of children assigned female at birth who are genitally altered in infancy to feminize their genitalia seems to be lower. Exactly how much lower is very difficult to determine, since nobody is gathering the data we'd need to have. The reason we know the 1-in-125 figure is because these children assigned male are all given the same diagnosis: hypospadias. Hypospadias is the diagnosis given to most children born with intermediate genitalia who have external testes. Rates of hypospadias have been increasing, and the CDC is collecting data due to concern about that.

The reason people continue to say that few intersex individuals are assigned male is that doctors term hypospadias a "penile malformation" rather than an "intersex condition."

I've written about this before in this post. I noted there, "medical diagnostic categories are not logical, despite our ideology that they should be so. The majority of individuals born with intermediate sexual anatomies [and surgically assigned male] are not given an intersex diagnosis. I believe that what underlies this is gender ideology. And that gender ideology is this: masculinity is fragile, especially when it comes to what a man has in his pants. To live as a man with an inadequate penis is seen as intolerable. To have one's status as a 'real man' challenged is viewed as psychologically crushing. Thus, doctors feel, if they were to categorize someone as intersex and then assign them male, they would be acting cruelly. Women, on the other hand, are perceived as more gender-flexible. After all, it's reasoned, a woman isn't shamed by wearing pants or taking on a power career. [Doctors view] female-assigned people as more comfortable with androgyny and as better at dealing with emotional challenges." Because of assumptions about fragile masculinity and flexible femininity, doctors feel more at ease assigning children they designate as intersex female. Those they regularly surgically alter to conform to binary male sex norms, they wish not to label intersex.

I was contacted by some people after writing that prior post challenging my assertion that hypospadias is an intersex condition. They countered that it was simply a minor displacement of the male urethra. So I wanted to make my case more clearly.

Let's start with some illustrations.

All children start out in the womb with the same set of genitals, an intersex form. As a rule I will not post photos of children's actual genitalia because it is exploitative, but in this case, I feel a medical image of the standard genital form of a fetus isn't going to cause additional emotional trauma to any particular child, so here's a photo:

Our society expects this intermediate genital form to differentiate before birth into two "opposite" binary sex forms (penis and testes, or vulva), but in fact, babies are born with genitals on a full spectrum between these two socially idealized poles. Let's look at how medical professionals illustrate this sex spectrum.

When a child is diagnosed as having some form of XX, CAH, congenital adrenal hyperplasia, the sex spectrum is described by the "Prader scale," and the "stages" of the "condition" evaluated using this chart:

When a child with XY chromomes is diagnosed as having a form of AIS--partial or complete Androgen Insensitivity Syndrome--the sex spectrum is termed the "Quigley scale," and is illustrated like this:

You can see that both of these illustrations include 6 forms, although they number them in reverse order and with different numerals. What they both show is that between a genital form considered typically female and one considered typically male, there is a common spectrum of intermediate forms.

This is equally true for children who are diagnosed as having hypospadias.   But medical illustrations of hypospadias are very different. They do not picture the genitals as intermediate in form.

Instead of picturing the same range of in-between forms shown in the Prader and Quigley scales, medical illustrations of hypospadias variations show something odd: a carefully illustrated "normal penis" with a series of dots superimposed upon it to indicate the level at which the urinal meatus/ vaginal opening are located.

The penis is always illustrated as erect, and often with a lot of illustrative detail to emphasize the "reality" of this imaginary ideal penis existing instead of the intermediate genitals actually present in intersex individuals who have external testes.

Let us be clear here. A child diagnosed with hypospadias of an "advanced degree," be it termed perineal or posterior or scrotal, will have an intermediate phalloclitoral form with a substantial invagination, not a large, erect phallus with a dot at the bottom. They'll look more like the Prader 2 or Quigley 4. I'd illustrate such a child's genitals more like this:

Why would medical illustrations of intermediate genitalia be representationally accurate in the case of intersex children diagnosed under the rubrics of AIS or CAH, but inaccurate if highly detailed in the case of intersex children diagnosed under the rubric of hypospadias? Only gender ideology can explain this. Children diagnosed with CAH and AIS are routinely assigned female. But children with hypospadias are surgically "corrected" to male, and to undermine the "adequacy" of a male's phallus is treated as untenable. Parents (and doctors!) must be reassured by looking at the erect, large, ideal penises drawn in the hypospadias illustrations that the genitally intermediate flesh of the child they see is illusory, and that an excellent penis will soon be revealed by the scalpel.

So: medical illustrations of hypospadias, and the medical assertion that it is not really an intersex condition, relate to our ideologies of masculinity.

The differences in medical approaches to intersex children routinely assigned female and routinely assigned male extend further than illustrations and terminology. They also determine all the tests and evaluations the child will receive. If an intersex child lacks external testes--the determining characteristic of a hypospadias diagnosis--that child is routinely subjected to a battery of tests: genotyping, endocrine screening, medical imaging scans. This is not the case when an intersex child has external testes. In fact, even suggesting that a child with intermediate genitalia but palpable testes receive any sex-related tests at all is considered "controversial" by doctors. Since hypospadias is defined as a penile malformation that is not an intersex condition, why would anyone wish to test sex chromosomes, hormone levels, or internal reproductive structures? It's presented as an unacceptable waste of time and money, in an affronted tone.

In fact, individuals born with hypospadias do commonly have other sex-variant characteristics. An example is the presence of what is termed a substantial "prostatic utricle," a uterine structure that may be small or full-sized that connects to the vaginas present in these children at birth. While the "pseudovaginae" are removed and closed during infant genital "normalizing" surgery, doctors do not test for the presence of a uterine structure. People diagnosed with hypospadias and their doctors generally only become aware that there is a utricle present if something goes wrong, such as the development of uterine cancer or painful cysts--and then usually by accident during imaging scans for some other presumed cause of the patients' symptoms.

I want to note that many intersex people assigned female at birth complain of all the invasive tests and screenings and procedures to which they are subjected in childhood, so the fact that intersex children with hypospadias diagnoses avoid these is not necessarily a bad thing. But not even thinking of checking for a uterine structure in someone born with hypospadias who presents to a doctor with pelvic pain could have very negative health consequences.

It is clear is that intersex children diagnosed with hypospadias are treated very differently than children with other intersex diagnoses. Rather than being treated as bizarre and interesting medical cases that require a lot of medical study and intervention, they are treated as normal boys with a little urethral displacement issue.

The thing that children diagnosed with hypospadias have in common with other intersex children is that they are subjected to genital normalizing surgery that can have many negative consequences. Medical texts list as unwanted consequences of hypospadias "repair" surgery urethral fistulae, strictures, and diverticulae, recurrent urinary infections, "excess skin," hair-bearing skin, persistent chordee, erectile difficulties, erectile persistence, chronic inflammation, and a condition called balanitis xerotica obliterans. Textbooks are oddly silent on the issues of loss of genital sensation that are very common, and the fact that children born with genitals in the middle of the sex spectrum are particularly likely not to identify with the sex they are surgically assigned at birth.

Some children who are diagnosed with hypospadias have genitals that are quite close to the binary male ideal in our culture. For them, medical interventions may be fairly minor, and the side effects may be modest. They are very likely to see themselves as typical males, and are probably unlikely to wish to be identified as intersex because they share our society's pattern of fragile masculinity. I am empathetic with their position. But we should be able to support the gender identities and dignity of people born with hypospadias who identify as men without resorting to inaccurate medical illustrations and illogical medical taxonomies.

Hypospadias is an intersex condition. The surgeries we perform on unconsenting intersex children without their consent have lifelong consequences. These can be profoundly negative for children whose genitals are dramatically altered--something that intersex advocates decry all the time. But we should also question why we routinely risk the loss of sexual sensation in the glans of the male-assigned child whose urethra is in a slightly atypical place.

All of us born intersex deserve to be recognized as such, and to be granted autonomy to make our own decisions about what "normalizing" surgical alterations we wish, if any. Putting an end to the routine genital reconstructive surgery performed on the many thousands of children diagnosed with hypospadias each year should be considered an important point of intersex advocacy.

Just-So Stories about Hermaphrodite Fish

2013-01-02T14:50:00.000-06:00

A central issue that makes life hard for intersex people is invisibility. Most people are unaware of how common intersex individuals are, something I’ve often discussed on this blog. But there’s a larger setting in which the fact that sex is a spectrum gets erased, and that’s in descriptions of biology and the animal kingdom as a whole. One way this happens is when biology textbooks fail to mention the fact that instances of intersexuality are found in all animals. Another way it happens is through what we’re taught about those species in which hermaphroditism is the norm. It’s the latter that I want to illustrate for you today, by examining about how we talk about a fish, the bluebanded goby.

The bluebanded goby is a small and colorful fish, bright orange-red with iridescent blue stripes. Bluebanded gobies are hermaphrodites, with the ability to produce either eggs or sperm. Each bluebanded goby can switch from producing eggs to sperm or vice versa in the space of about two weeks; externally, there’s very little difference between an egg-laying or sperm-producing bluebanded goby. They have a “sexual papilla” through which they can release egg or sperm, and it is a bit pointier when in sperm-producing mode and a bit wider in its opening when in egg-laying mode. Most bluebanded gobies spend most of their lives in egg-laying mode. They live in mating groups, and typically only one member of each group produces sperm, with the rest laying eggs, maximizing the number of offspring the mating group can produce. It’s a neat arrangement. It’s also not one that you’re likely to hear about if you are visiting an aquarium or keeping fish.

The intersex nature of the bluebanded goby is erased or distorted in most descriptions of the fish, because our society is so invested in the idea that sexual dyadism is natural and universal that we can’t see evidence to the contrary right in front of our eyes. We don’t hear about it in our educations. Say, for example, you’re a schoolchild going for an educational trip to an aquarium, and you see the pretty gobies there. Here’s all you’d learn at the Cabrillo Aquarium in San Pedro, California about the sex of bluebanded gobies: “Recognized by an elongated robust body and two dorsal fins, males have longer dorsal spines and a suction-like disc that is formed by the connection of its pelvic fins.” (See here.) You’d hear yet another example of the “natural, universal fact” that all animals are male or female, not evidence of the sexual diversity of the natural world. Not only does the hermaphroditism of the gobies go unmentioned, the “masculinity” of bluebanded gobies in sperm-producing mode is exaggerated—they are said to have “longer dorsal spines,” a phallic and aggressive description of a nonexistent difference. In fact, scientists determining whether a bluebanded goby is in egglaying or sperm-productive mode do not look for any difference in dorsal spine length, only at the shape of the sexual papilla. (Generally, a sperm-producing bluebanded goby will be on the large side for the species, and hence will have largish fins—but egglaying bluebanded gobies that are large have the same size dorsal spines, and the dorsal fins on a given fish do not change size when it moves between egglaying and sperm-producing modes.)

When popular educational sites do mention sex variance in the bluebanded goby, they don’t explain the fact that all bluebanded gobies are hermphrodites, capable of producing eggs or sperm. They instead tell a story of rare and fascinating “sex changes” in fish that are otherwise binary in sex: “Males and females are similar in coloration, however, males have a longer dorsal fin than the females do. One interesting fact about blue-banded gobies is that if there is no male present, the dominant female in a group of blue-banded gobies has the ability to change her sex to that of a male.” (See here.) This description frames bluebanded gobies as sexually dyadic, existing as males and females, except for the occasional female who goes through a “sex change” in desperate times. The fact that all of the bluebanded gobies are hermaphrodites, and that each time they move from group to group they have the ability to move from egglaying to sperm-producing mode or vice versa, goes unmentioned. Rather than undermining the ideology of a natural sexual binary, the story of the rare “sex change” actually bolsters it. “How bizarre and rare is this deviation, a one-time move between natural binary sexes!”

Not only do educational sites teach that bluebanded gobies are almost always “normal males and females” rather than always hermaphrodites, the way they present goby “sex changes” reflects ideas about human gender roles. The BBC Science and Nature website states that bluebanded gobies “live in small groups with a single male and multiple females. If the male leaves or dies, the largest female changes sex.” (Link here.) The story is one of a large, dominant male with his harem of smaller females, and a burly female fish changing sex to “rise” to male status and take over the harem. This is how the story is told by most scientific articles about bluebanded gobies that’s I’ve seen. Let me quote a passage from a 2005 article in the Biological Bulletin on “sex reversal” in bluebanded gobies, so we can examine this in more detail:

“Larger size often equates with increased success in aggressive encounters and therefore social dominance, providing a proximate mechanism for the size advantage hypothesis. In protogynous sex changers, the most reproductively significant resource that dominance affords is “maleness”; thus the reproductive payoff for dominance is extremely large, and females would be highly motivated to increase their aggressive behavior in times of social instability (i.e., in the absence of a dominant male).” (See here.)

I’ll now restate that passage in clearer English and make overt its hidden assumptions: “Sex is binary but in some rare species ‘sex reversal’ can occur. When it does occur, it is from female to male, because everyone knows it’s better to be male. To be male is to be dominant and aggressive, which is good. Usually in species where ‘sex reversal’ can occur, males keep the females in their place, but if there’s no male around, the females will all want to battle because the winner will get to be the male.” This just-so story reaffirms all sorts of human gender stereotypes—and in so doing vastly distorts the objective reality of bluebanded goby life.

The first way the scientific fable distorts reality is by calling hermaphroditic gobies “males” and “females,” imposing binary sex language on fish that are born hermaphrodites and can shift back and forth between egglaying and sperm-producing modes multiple times in the course of their lives. The term “sex reversal” also implies two opposite sexes rather than one sex continuum. It would be much more reflective of objective reality to speak in terms of shifts in reproductive modes among hermaphrodites than about sex reversals between females and males.

The term “protogynous” used to describe gobies in the article means “starting out female,” which not only implies that the fish are not really intersex by nature, but also frames shifts in reproductive mode as only occurring in one direction: from “female” to “male.” In fact, bluebanded gobies shift just as easily from sperm-producing to egg-laying modes when entering a group with multiple sperm-producing fish. (See here.) The idea that every bluebanded goby “wants to be the male” is a projection of human ideologies onto fish behavior. The majority of bluebanded gobies at any given time are living in egglaying mode because this conveys a reproductive advantage for the group. One could just as easily say that it’s obvious that most gobies “want to be female” since that’s what most of them do, but that one of them has to make the sacrifice and “be male” for the good of the group. That would also be projecting emotions and motivations onto the fish, of course. In fact, bluebanded gobies are just hermaphrodite fish reproducing in the most efficient way possible by operating in egglaying mode more often than sperm-producing mode. But the story we read is one of enforced, devalued feminization and aspirational maleness, because that affirms sexist human gender ideologies.

Entwined with these male-privileging gender ideologies is a story about dominance and submission. As the story goes, high status fish are dominant; low status fish are submissive. The most aggressive and dominant bluebanded goby “gets to be the male,” while the rest have lower status that accords with their more timid female nature. This narrative is so familiar in patriarchal society that scientists seem not to notice it’s an ideology they’re imposing on nature in their research and writing.

Here is what we do know about bluebanded goby reproduction, stripped of human gender ideologies. In this hermaphroditic species, the greatest number of offspring are produced when most of the fish are laying eggs. So they form mating groups or families, typically of 3-7, in which one of the gobies’ bodies shifts to sperm-producing mode, and the rest shift to egg-laying mode. The fish that takes on the inseminating mode needs to be robust, because it must continuously mate with the rest of the fish. When mating groups form or change, the members all swim about actively, zipping toward one another. (Actually, this behavior is quite common, and regularly occurs between all of the bluebanded gobies, including the egglaying ones in established groups.) What determines which goby in a new group will take on the sperm-producing role is the behavior of the other fish. A goby being zipped at by a zippier fish will dodge out of the way. This gets called “submission” by scientists, but could just as well be termed “peacekeeping,” and would most accurately be simply called “getting out of the way.” By engaging in this dance of zipping about, a new group of gobies determines which of the fish is the most energetic and robust. Often it’s a large fish, but that’s not always the case. That fish shifts to sperm-producing mode (unless it is already in that mode), and the others shift to egg-laying mode (unless that is already the case).

Oh, and by the way, bluebanded gobies that are in sperm-producing mode don’t “fight harder” to stay in that mode because they “don’t want to be female.” If a group of bluebanded gobies is assembled completely out of fish that are in sperm-producing mode, all but one of them shift to egglaying mode. This takes the same amount of time as it does for one sperm-producer to emerge from a group that is assembled out of gobies that are all in egglaying mode, and leads to the same rate of fertility. (See here.)

So: by nature, bluebanded gobies are intersex fish that form efficient mating groups of multiple egglayers and one inseminator, and shift reproductive modes as they move from group to group. This is an interesting part of the wide diversity of sexual arrangements in nature. I believe that teaching people about this natural diversity would make the world a better place for intersex people, as it would make it less likely for us to be perceived as “unnatural” and “disordered.” But instead of teaching children about sexual diversity, educational sites either completely deny that bluebanded gobies are hermaphrodites, or only mention it as a story of rare and odd sex changes from dyadic female to dyadic male. And scientists, educated like the rest of us in this context, impose all sorts of ideologies about binary gender roles onto what they observe about the fish, perpetuating the problem of distortion.

Nature is so much more interesting than the stories we tell ourselves about it. It’s time to stop obscuring the objective fact of sexual diversity.

Images and Musings Available on Tumblr

2012-07-28T18:58:00.000-05:00

Sometimes I run across images related to intersex matters that make me want to applaud, or to go hide under my bed. I've decided to start sharing some of these pictures and my thoughts on them on Tumblr, so if that sort of thing interests you, feel free to visit The Intersex Roadshow Reports.

Trans and Intersex Children: Forced Sex Changes, Chemical Castration, and Self-Determination

2012-05-06T14:54:00.000-05:00

Children’s lives lie at the center of social struggles over trans gender and intersex issues. If you talk with trans and intersex adults about the pain they’ve faced, the same issue comes up over and over again, from mirror-image perspectives: that of medical interventions into the sexed body of the child. Intersex and trans adults are often despairing over not having had a say as children over what their sexes should be, and how doctors should intervene. Meanwhile, transphobes and the mainstream backers of intersex “corrective” surgery also focus on medical intervention into children’s bodies. They frame interventions into the sexual characteristics of intersex children as heroic and interventions into the bodies of trans children as horrific.

The terms and claims that get tossed around in these debates are very dramatic. Mutilation. Suicide. Chemical castration. Forced sex changes.

We need to understand what’s going on here, because it’s the central ethical issue around which debates about intersex and trans bodies swirl. The issue here is the question of self-determination, of autonomy. Bodily autonomy is the shared rallying cry of trans and intersex activists, though we might employ it in opposite ways. Refusing it to us is framed as somehow in our best interests by our opponents.

In this post we will look at how four groups frame the issue: intersex people, trans people, the mainstream medical professionals who treat intersex people, and opponents of trans rights.

If you talk to people who were visibly sexvariant at birth, you hear a lot of pain and anger and regret about how their bodies were altered. This is crystallized in the phrase of intersex genital mutilation, or IGM. As a result of infant genital surgery, many intersex people suffer from absent or reduced sexual sensation—something mainstream Western medicine presents as unethical female genital mutilation (FGM) when similar surgeries are performed on girls in other societies. There are further sources of pain: as a result of “corrective” surgeries, intersex people can suffer a wide range of unhappy results, such as loss of potential fertility, lifelong problems with bladder infections, and/or growing up not to identify with the binary sex to which they were assigned. It is extremely painful to identify as female and to know one was born with a vagina that doctors removed with your parents’ consent, or to identify as male and to know one’s penis was amputated. Imagine if someone performed a forced change on you--would you not feel profoundly violated?

So the intersex perspective is that no one should medically intervene in a person’s body without that person’s full informed consent. Bodily autonomy is a fundamental right. Nobody except you can know how you will feel about your bodily form, whether you might want it medically altered, what risks of side-effects you’d consider acceptable. Routine “corrective” surgery performed on intersex infants is thus a great moral wrong.

When you speak with trans people, childhood medical intervention again comes up with an air of great regret, but now the regret is that one was not permitted to access it. Almost every person I’ve ever spoken with who wants to gender transition medically, whether they’re 18 or 75, has expressed the same fear to me: “I’m afraid I’m too old!” For a while this mystified me (how is 22 “old”?), until I realized what they meant was, “I’m post-pubertal.” For many trans people, childhood was awkward but tolerable, as children’s bodies are quite androgynous. Puberty, however, was an appalling experience. Secondary sexual characteristics distorted the body—humiliating breasts or facial hair sprouting, hips or shoulders broadening in ways no later hormone treatments could ever undo. Many trans people live with lifelong despair over how so much maltreatment and dysphoria could have been avoided if they could just have been permitted to avoid that undesired puberty.

So for trans activists, advocating for trans children so that they might avoid this tragedy is vitally important. The child’s autonomy is central, as it is for intersex advocates, but here the issue is getting access to medical treatment in the form of hormone suppressants, rather than fighting medical intervention. What trans activists seek is the right of children to ask for puberty-postponing drugs, to give the children’s families and therapists time to confirm that the children truly identify as trans, and fully understand what a medical transition involves. Then the individual can medically transition to have a body that looks much more similar to that of a cis person than can someone who has developed an unwanted set of secondary sex characteristics.

So for trans and intersex people, children’s autonomy is paramount when it comes to medical interventions into the sexed body. No child should have their sex (e.g. genitals, hormones, reproductive organs) medically altered until they are old enough to fully understand what is involved and actively ask for such intervention. Conversely, once a child is old enough to fully understand what is involved in medical interventions into the sexed body, and requests such intervention, then it should be performed—whether the child is born intersex or not.

This is not yet mainstream medical practice, however. Today, one in every 150 infants faces medical intervention into the sexed body to which they cannot object or consent. Doctors routinely perform such “corrective procedures” on babies with genital “defects” and “malformations.” Meanwhile, few trans-identified children are supported in their identities by families and medical practitioners—and great controversy and resistance swirls around them when it does happen.

So let’s look at the arguments made by mainstream medicine and transphobic activists. How do they counter the cry for autonomy, given that self-determination and freedom are such central ideals in Western societies? What we’ll see is that they employ two opposing claims based in medical ethics: the duty to save a life, and the duty to first do no harm. If we want to protect the rights of trans and intersex children, we have to understand these arguments and be able to counter them.

When intersex advocates try to fight the framing of intersex children’s bodies as “defective” and somehow in need of surgical “correction,” mainstream medicine responds with a claim of medical necessity. In some very rare cases, particular intersex conditions can be associated with actual functional problems such as an imperforate anus, clearly a serious medical problem that necessitates surgery. But the vast majority of medical interventions into intersexed bodies take place without any such functional, physical problem exsting. They are responses to a social issue (discomfort with sex variance) rather than a physical one. What doctors do, however, is reframe social issues into medical ones. “If we don’t do this surgery, this child will be mocked and humiliated—“he” won’t be able to stand to pee, “she” won’t be able to have “normal sex,” “it” will never be able to marry. The child will be a social pariah and thus be at risk for suicide.”

Through this line of argument, altering the body of the sexvariant infant is cast as a noble act that doctors perform out of their duty to save lives. To counter this, what we need to do is point out that actual studies of intersex adults show that while we do have a heightened risk of depression and suicide, these are caused by unhappiness with our medical treatment rather than prevented by it. Loss of sexual sensation, feelings of having been humiliated by doctors, pain from years of “repair” surgery after “repair” surgery, and for those who do not identify with the binary sex to which we were assigned, the vast sense of betrayal that those who were supposed to care for us subjected us to a forced sex change—these are what lead to an increased risk of suicide. What would really help is would be for doctors to follow the precept of “first do no harm,” to perform no procedures upon us without our full informed consent, and meanwhile, to provide intersex children and their families with social support.

Invocations of “primum non nocere,” first do no harm, and of despicable medical impositions on the lives of innocents are also raised by anti-trans advocates. Transphobic activists generally frame all medical transition interventions as mutilations, and this rhetoric rises to fever pitch when the issue of trans children arises. Recently, anti-trans rhetoric has framed the medical provision of puberty-postponing drugs as “chemical castration” (e.g. in this blog post).

“Chemical castration” is an odd concept. First off, if you read any medical article on the topic, you will find it starting by pointing out that the term is a misnomer, as none of the medications used in “chemical castration” destroy the gonads. The term is nevertheless employed due its specific history as a treatment being given by court order to “sexual deviants” to suppress their ability to have sex, where some prior courts had employed actual surgical castration. Today, some jurisdictions use “chemical castration” in cases of pedophilia, but it the past it was a treatment imposed on men convicted of sodomy—that is, to gay men in an era in which gay male sex was criminalized. Transphobic activists use the term “chemical castration” to evoke an aura of adult sexual deviance, in a manner calculated to frame doctors who provide puberty-suppressant drugs as sexually abusing children.

There is a curious twist in this matter of “chemical castration,” in that universally when court-ordered in the past, and often still today, it did not consist of testosterone suppression drugs as you would expect. Instead, injections of estrogen and/or progesterone were (and are) given. In essence, it caused a forced sex change. Thus, for example, when codebreaking British war hero Alan Turing was convicted of homosexuality in 1952 and sentenced to “chemical castration,” he found the unwanted sex changes in his body so horrifying and humiliating that he committed suicide two years into “treatment.”

In the case of trans-identified kids today, the use of the term “chemical castration” is thus a double misnomer. Firstly, no child is castrated—instead, puberty is simply postponed so that if the child, family, and therapist all agree later that a medical transition is appropriate, unwanted secondary sexual characteristics will not have developed. Plenty of adolescents are “late bloomers” by nature; in fact, puberty today occurs many years earlier than it did through most of human history, when human diets lacked sufficient fats and nutrients to support early puberties. So postponing puberty carries no significant dangers. Further, the point of hormone suppression is not to cause a sex change, in contrast to court-ordered “chemical castration treatments.” The point is merely to buy time to ensure that the trans child in question fully understands zir gender identity and the implications of medical transition.

So: we’ve seen a lot of charged language, of claims and counterclaims regarding mutilation versus vital treatment, cruel withholding of medical assistance versus the imposition of sex changes on unconsenting children. How should trans and intersex advocates respond?

What I would do is to point out that strange and conflicting ideas about children’s autonomy and free will are presented by our opponents. When specialists in intersex “corrective” treatments speak to parents or write in medical journals, they urge that genital surgery be performed in infancy, before age two and a half if at all possible. They claim that this way the child will not remember the treatment and will thus adjust well to the altered genitals and/or sex status. (As if medical monitoring and intervention did not often extend throughout the child’s life, and the procedures left no scars and caused no loss of sensation, so the child would “never notice.”) The age of two and a half came out of now largely-discredited ideas of a milestone of “gender constancy” occurring then, based upon notions of the developing brain that directly relate to autonomy. Before age 2.5, it was basically argued, the baby is irrational and lacks agency, and thus thinks magically about bodily sex, including accepting the “crazy” idea that the sex of the body can change. So, in urging very early intervention into intersex bodies today, conventional medicine is urging the total avoidance of the child’s rational thought and agency.

When it comes to treating trans children, on the other hand, instead of rushing things, all sorts of actors want to draw them out. Most doctors and clinics only provide transition services to legal adults. Those few who treat trans children are extremely cautious about providing any medical interventions other than the postponing of puberty.

Both of these approaches deny children autonomy over their bodies and their lives.

What we must urge is that society consistently respect the rights of children. No children should ever be subjected to sexual surgery without their consent. No children should be forced to have cosmetic surgery. But as children mature, they become able to consent to medical treatment that they do actively desire.

How old is “old enough” to agree to medical interventions into the sexed body? That answer depends on the given child—but 2.5 is certainly too young, and 18 is in most cases too old. What I suggest is that when addressing a medical practitioner urging genital surgery on an intersex infant, that we ask, “Would you perform a sex change on a child of this age who was not intersex?” Conversely, when facing transphobic activists saying that no one who is not a legal adult can be old enough to consent to medical transition services, we should ask if our opponent would say the same if the child were intersex. For example, a child with congenital adrenal hyperplasia may be born with a penis externally, and a uterus and ovaries internally. At around age 12 or 13, if there has been no medical intervention, that child can begin to menstruate through the penis, develop breasts, etc. Would the opponent argue that the child could not be old enough to say that he identifies as male and wants to take testosterone (or that she identifies as female and has decided that she wishes to have surgery to feminize her genitalia)? Would the opponent argue an intersex pubescent child should not at least be able to take puberty-postponing medications to avoid unwanted penile menstruation if they and their family and support professionals were still unsure whether to commit to any more permanent intervention?

What we must ask is that society treat intersex and trans-identified children consistently. We all raise our children to learn to make good decisions, so that they can lead good lives. We must nurture children’s autonomy as they grow, understanding that there are some decisions only they can make for themselves. To force a person to live in a sex with which they do not identify is cruelty; to impose unwanted bodily alterations unconscionable. Wishing happiness for our children, we must nurture and then defer to their right to self-determination over interventions into the sexed body.

How Common is Intersex Status?

2012-03-13T00:31:00.030-05:00

If you poke around the internet trying to find out how common it is for a person to be intersex, you may well wind up frustrated that nobody seems to have a precise figure to give you. You'll probably encounter some commonly-cited odds: 1 in 2000, or 1 in 2500. People have passed these figures around for a number of years, until, by repetition, they've come to seem generally accepted. I used to repeat these figures myself, before I learned more about how they were generated. Being born intersex is presented as rare; less common, say, than being born with Down's syndrome.

These estimates are off by more than a factor of 10.

A true, conservative estimate is that more than 1 in 150 people are born with intersex bodies. In this post, I'm going to explain why the true commonplace of intersexuality is so widely underestimated. And yes, I'll justify my 1 in 150 estimate by the end.

There are two main reasons reasons why nobody can give you an exact figure for how many people are intersex. The first is that there is nobody gathering this data. And the second is that in trying to come up with an estimate, people rely on medical diagnostic categories that purposefully deny that many people with sexually-intermediate bodies are “really intersex.”

Let's begin with the matter of gathering data on who is intersex. A central problem we run into is that nobody is funding a cross-condition population study of sex variance. This is the case in part, ironically, because being intersex is perceived as a rare thing. In addition, being intersex is framed as a “treatable medical condition.” Thus, there's little sense of intersexuality being an urgent matter to prompt government or private entities to fund a large exploratory study. But even if a large study of all physical sex variance were to be funded, you'd run into problems with people not wanting to disclose their bodily statuses. Some intersex conditions are obvious at birth when children have visible genital variance. But these children are immediately assigned a dyadic sex, male or female, on their birth certificates. The children and their parents are told by doctors that they must conceal the childrens' “defect.” With both the medical profession and our society at large treating intersex status as something freakish and shameful, people who are born visibly intersex are usually extremely closeted about their status, and don't want to be studied, outed, exposed. They are unlikely to want to take part in studies.

Furthermore, many people are intersex without it being genitally obvious. Some people are chromosomally sex-variant: they have a genotype such as XYY or XXY that is not associated with a significant disability, or they are XY women or XX men. Such people may never find out that they are intersex—after all, have you ever had your sex chromosomes screened? Other people have variant internal reproductive organs. I, for example, had an ovotestis, a gonad intermediate between an ovary and a testis. I'd been told I had a supernumerary ovary after pelvic exploratory surgery, and it was only years later, after I'd had my internal reproductive organs removed, that a pathologist informed me it was actually an ovotestis. What this illustrates is that in order to do a mass study of the frequency of intersexuality, you can't just rely on interviews and on existing medical records. One would have to do extensive medical testing, including biopsies, of all the people studied, which would be very invasive.

Even if you were somehow able to get a large, representative, random subpopulation of people to agree to be genitally examined, hormone-screened, genotyped, CAT-scanned, and to have their gonads biopsied, the frequency of intersexuality would be drastically underestimated. And that is because of the second problem I mentioned: that of medical diagnostic categories.

Let's think commonsensically and rationally for a moment.

What does it mean to be intersex? Logically, it means that a person has a body that is intermediate between the idealized male and female poles of the sex spectrum. All of us start out in the womb with an intersex form, having a phalloclitoris, labioscrotum, and ovotestes (you can read more about this in this post). It's expected that these should differentiate as we develop, but in fact one or more elements of the sexual anatomy may stay fully intermediate, or may differentiate only partially. Any person who has a body that is not fully sex-differentiated is, logically speaking, intersex.

But medical diagnostic categories are not logical, despite our ideology that they should be so. The majority of individuals born with intermediate sexual anatomies are not given an intersex diagnosis. I believe that what underlies this is gender ideology. And that gender ideology is this: masculinity is fragile, especially when it comes to what a man has in his pants. To live as a man with an inadequate penis is seen as intolerable. To have one's status as a “real man” challenged is viewed as psychologically crushing. Thus, doctors feel, if they were to categorize someone as intersex and then assign them male, they would be acting cruelly. Women, on the other hand, are perceived as more gender-flexible. After all, it's reasoned, a woman isn't shamed by wearing pants or taking on a power career. Viewing female-assigned people as more comfortable with androgyny and as better at dealing with emotional challenges, doctors believe that if they diagnose someone as intersex, they should assign them to the female category.

Thus, under current the current regime of medical diagnosis and treatment, the large majority of people labeled by doctors as intersex are assigned female at birth. People who are diagnosed under the rubric of “female pseudohermaphrodites" (a ridiculous term devised in the 19^th century for intersex people with ovaries and intermediate genitalia or a phallus) are assigned female, and their phalli are surgically removed. People who are diagnosed under the rubric of “male pseudohermaphrodites,” with internal testes and genitals that are intermediate or vulvic, are also assigned female, and their testes removed.

Under this regime, most people—including academic gender scholars, doctors, and even a substantial number of intersex activists—believe that “almost all intersex people are assigned female at birth.”

You'll find this statement oft-repeated, but it's not true. At least as many babies with sex-variant bodies are assigned male at birth. It's just that the majority of them are not diagnosed as “true hermaphrodites” or “pseudohermaphrodites.” Many, for example, are characterized as “real boys” with a "urethral malformation." The diagnosis they receive is “hypospadias.”

Hypospadias occurs when a person develops testes, but the phalloclitoris is intermediate in form. People with hypospadias can fall anywhere on the sex spectrum from having fully intermediate genital configurations to having forms little different from what is considered typically male. (You can find illustrations midway down the page here.) In cases of what is termed “first degree hypospadias,” the person has close to idealized male anatomy, but the urethra opens on the underside of the penile glans. As the degree of hypospadias increases, the opening is lower on the phallic shaft, and is larger and more vulvic in form. In perineal hypospadias, there is a substantial vagina, the phalloclitoris is intermediate in structure, and the testes may be internal. And the bodily variance is not limited to the external genitalia. Hypospadias is associated with an enlarged prostatic utricle, which may vary from a slight enlargement with low degree hypospadias, to a full-sized uterus in high degree hypospadias.

Rationally speaking, people with hypospadias are intersex. They share with other intersex people not only sex-variant anatomy, but the common experience of imposed genital-normalizing surgery in childhood, and the unwanted consequences of loss of sensation, infections, scarring and fistulae. And while individuals with mild hypospadias appear to be almost as likely to identify with their assigned sex as individuals with typical phalli, those with advanced degrees of hypospadias are much more likely to suffer from gender dysphoria with their male assignment. For medicine not to acknowledge that hypospadias is an intersex condition seems not only nonsensical, but often cruel. It may be true that people born with hypospadias who identify as male don't want to be publicly labeled intersex, just as male-identified people don't often buy T-shirts that say “Ask me about my erectile dysfunction!” or “Just call me Cocktail Wiener.” But our cultural obsession with male-classified people having large erections and unquestionable male status should not dictate medical diagnostic categories.

Now, here comes the kicker.

According to the CDC, hypospadias occurs in the U.S. in one in 125 children labeled as “boys,” or 1 in 250 births. In other words, if we looked only at this one condition, the minimum rate of intersexuality is 1 in 250.

There are other intersex conditions that are not diagnosed as such, though they are medically treated in the same way as other intersex conditions. Consider “clitoromegaly” and “micropenis,” the diagnostic terms for people with a clitorophallus of intermediate size. A child born with clitoromegaly is assigned to the female category, and today in the U.S. is given “clitoral reduction” surgery in the same way that a child diagnosed as a “female pseudohermaphrodite” is altered. Children born with micropenis in the U.S. are classified as boys, and must often endure surgical and hormonal interventions (sometimes even what is officially termed infant sex reassignment to female status). Yet individuals with clitoromegaly and micropenis are often not diagnosed as “offically intersex.”

So let us just look at individuals born with genitally intermediate bodies who are assigned male at birth. Micropenis occurs in 0.6% of male-classified people, or 0.3% of the population. Hypospadias occurs in 0.8% of male-classified people, or 0.4% of the population. Just looking at these two conditions, 0.7% of the population is born sex-variant. In other words, translating to odds, 1 in 142 people has either hypospadias or micropenis. That's more than 1 in 150.

We now see what happens when we employ the rational rule of classifying anyone who is genitally, gonadally or chromosomally intermediate as intersex. We logically include people with hypospadias and micropenis in the intersex category instead of excluding all conditions in which infants are assigned male. Now, for the sake of argument, let's just accept at face value the assertion that all other intersex statuses are so rare that the chances of having any other variation in gonads, genitals or chromosomes is 1 in 2500. I consider this extremely unlikely, but we'll just go with it. In fact, for the sake of our argument let's accept the ridiculous assertion a medical student once made to me: that there have only been 7 “real hermaphrodites” ever encountered in all of recorded medical history. By this logic, the chance of having any other intersex variation is 1 in a billion, or to simplify, basically 0. But we're still left with a minimum of 1 in 142 individuals having an intersex body.

That puts being intersex about on par with the likelihood of having green eyes.

Personally, I believe the rate is much higher. I do think it's unlikely we'll ever come up with an unquestionable exact number of intersex people, even if we get study funding and widespread permission from study populations, and even if medical diagnostic categories cease to be so irrational. Sex is a spectrum, and any way we slice up a spectrum is arbitrary and open to debate. (I remember my mother and grandmother perpetually arguing over whether the color turquoise was “really blue” or “really green,” and one could have similar endless arguments over the point at which an intermediate phalloclitoris is sufficently large-headed to “count” as a penis or sufficiently small-headed to “count” as a clitoris.) But at a very conservative minimum, more than 1 in 150 people have sexually intermediate bodies.

So the next time someone tells you that intersexuality is extremely rare, tell them otherwise. The next time you see a book about pregnancy that talks about uncommon complications and rare infant differences but never mentions how often babies are born intersex, raise a fuss. If you hear the old saw that “all intersex people are assigned female at birth,” clear up that misunderstanding. Be aware and help make others aware that the problems facing intersex people are not sad rarities, but burdens faced by many (over 2 million in the U.S. alone). And if you yourself are intersex and living a life in closeted shame, I urge you to stop believing you must live your life isolated and alone. You have a lot of siblings out there.

On Sex/Gender Checkboxes

2012-02-05T14:58:00.006-06:00

Day in and day out, sex and gender minorities are boxed in by being confronted with sex/gender checkboxes. This starts the moment we are born, when a binary sex must be checked on our birth certificates: “male” or “female.” For individuals who are born with visibly intersex bodies, this requirement causes a crisis. Families and doctors make hasty decisions about which box they'll force us into, and we have to live with the consequences all of our lives. Having checked off a binary “M” or “F,” those with authority over our infant bodies often feel that trying to reshape our bodies conform to the box they've picked is unavoidable. Thus, genital surgeries are routinely performed, despite the deep unhappiness so many intersex people voice about the results as adults. Great pain might be avoided if parents were allowed to acknowledge our physical truth on birth certificates which included an intersex checkbox, or if the gender marker requirement were simply removed.

For people who are trans gender, gender transitioning is made traumatic in large part due to the checkboxes we must face daily. Binary gender markers are everywhere: on our drivers' licenses and passports, on loan applications and job applications, and on websites everywhere (from Facebook to shopping sites to online radio stations). Once you've checked off one box, changing it is bureaucratically and legally difficult—and sometimes there's no way to change it at all. This leads to all sorts of hassles and embarrassment, as we're “outed” in odd contexts. Worse still, if the gender we're living in doesn't match the marker on our ID, we're subject to being banned from flying, arrested by bigoted police officers, and denied employment.

For folks who don't identify with a binary gender, the world of checkboxes constantly denies our very existence. We go institutionally unrecognized, with no way to even try to say “I am here!”

Sex and gender minorities have some protection in institutional settings that bar discrimination on the basis not only of sex, but of gender identity or expression. But often, such policies are adopted with no follow-through on what it really means for a university or company or city to protect gender identity and expression. Unaware of our needs, administrators think only of ensuring that trans people aren't being kicked out just for gender transitioning. While this is certainly important, there are many more needs that must be addressed. And central among these are that sex/gender checkboxes protect the rights of sex and gender minorities.

I have written a Best Practices guide that is under discussion at my university. It lays out a plan for rewriting sex/gender checkboxes that is meant to address the needs of intersex, trans gender, and gender variant people, in this case, in a university setting. There are some inevitable compromises in it between institutional desires for simplicity and brevity, and our desires as individuals to have our identities recognized in all of their fullness and uniqueness. But I wanted to share it here so that other people who are looking for a guideline to use in seeking to better the way institutions around them limit sex/gender choices would have something to start with. It doesn't address the problem of birth certificates, for example, since universities don't issue them. It does, however, address the question of how sex and gender and sexuality should be measured in research in some detail.

Please feel free to share and employ at will.

Best Practices for Identification of Sex/Gender

Compiled by Dr. Cary Gabriel Costello

I. Foundational Principles

Institutions which commit themselves to protecting against discrimination on the basis of sex and of gender identity or expression (GIE) must give individuals the right to self-identify their sex/gender.

Whenever data are gathered about sex/gender, the rights of GIE minorities (intersex individuals, trans men, trans women, and individuals with alternative gender identities) must be protected.

II. Definitions

“GIE minorities” include intersex individuals, trans gender individuals (trans men, trans women, and individuals with alternative gender identities), and people with variant gender expression.

Intersex Persons

While it is common to believe that sex is binary—that is, that all people are born either male or female—in fact, sexual characteristics exist as a spectrum. There is a great deal of variation in chromosomes (XX, XY, XXY, XYY, etc.), hormones (relative levels of estrogen, progesterone and testosterone), secondary sexual characteristics (breasts, hair distribution, etc.) genital configurations, and gonads (ovaries, ovotestes, testes). Intersex people are individuals whose sexual characteristics fall toward the middle of the spectrum. Approximately 1 in 150 people are intersexed according to medical diagnostic criteria. Most are very private about this status, though some are public about it.

Trans Gender Individuals

Individuals whose gender identity does not match the sex they were assigned at birth are deemed trans gender. A trans man was assigned female at birth but identifies as male; a trans woman was assigned male at birth but identifies as female; a genderqueer individual may identify as neither male nor female. Trans gender individuals often transition to their sex of identification, though they may do so in different ways. Some transition socially by changing name, pronoun, and dress. Others also take hormones (testosterone or estrogen/progesterone) to alter their bodies. In addition, some get surgery to change their chests or genitalia. Because surgery is quite expensive, may not be covered by insurance, and because it carries serious risks, many trans gender individuals in the U.S. do not seek or are unable to access surgical transition services.

Variant Gender Expression

People of any sex or gender may have an atypical gender presentation—male femininity, female masculinity, or androgyny.

III. Best Practices in Collecting Data about Sex/Gender

The best practices for collecting data about sex/gender depend on context. If collecting data about sex/gender serves no purpose for the individuals from whom it is collected, then eliminating the question is the best practice. If data are being gathered to protect the rights and well-being of individuals, then individuals should be given self-identification options that allow GIE minorities to self-identify. These options include a shorter form for ordinary uses, and longer forms to be employed in research contexts.

Eliminating Unnecessary Requirements for Individual Sex/Gender Identification

There are many institutional contexts in which people are routinely asked to identify their sex/gender based on common marketing practices or institutional tradition rather than an intent to protect the individuals from discrimination on the basis of their sex/gender. (For example, this is a common requirement in registering to use website services.) In this situation, the best practice is simply to eliminate the unnecessary requirement of declaring sex/gender.

Standard Best Practices Short Form for Sex/Gender Identifications

In contexts in which data is collected order to ensure equal treatment and respect for all, information about sex/gender should be collected in a manner that protects GIE minorities. The goal in implementing sex/gender categories for general data collection is to protect the rights of all people, whatever their physical sex status or gender identity, including intersex individuals, trans men and trans women, and individuals with alternative gender identities. Thus, the inappropriate single question (“Sex: Male__, Female__”) should be replaced with a three-stage approach.

Gender identity: Woman __, Man __, Alternate Self-identification (please write in) ______________.
Do you have an intersex condition (disorder of sex development)? Yes__, No__.
Are you trans gender? Yes__, No__.

In order also to ensure nondiscrimination on the basis of sexual orientation, best practices add a fourth question unrelated to GIE:

Sexual orientation: Heterosexual __, Lesbian__, Gay__, Bisexual__, Queer__, Pansexual__, Asexual__, Alternate Self-identification (please write in) ______________.

AVOID poor practices which undermine individuals' identities instead of protecting them. A common poor practice is to use a single additional checkbox: “Male__, Female__, Transgender___.” This is inappropriate for several reasons. First, it does not allow intersex individuals a way to identify themselves. Secondly, it discriminates against trans men and trans women by framing trans gender identification as incompatible with “real” male or female status. And thirdly, it does not allow for recognition of the distinct needs and identities of individuals who identify as neither male nor female.

Best Practices Long Forms for Research Contexts

Data about sex and gender are often collected in the course of research. If data are to be analyzed along the dimensions of sex and/or gender, two sets of needs must be met. The first relate to the rights of research subjects, who must be protected from harm, including the harm of discrimination on the bases of sex, gender identity or gender expression. In conducting research with human subjects, researchers will inevitably recruit research subjects who are intersex, trans gender, or variant in their gender expression, and are ethically obliged to treat them with respect. The second issue relates to the need of the researcher to have research questions carefully worded in a manner that subjects will understand and respond to in a reliable and valid manner.

Many scientific studies today continue to use “sex” as an independent variable, and measure this in a binary fashion. This is a methodological flaw, as well as discriminating against GIE minorities. It does not allow the researcher to measure what actually accounts for observed variance in the dependent variable: is it physical sex status, internal gender identity, gender-conformity or nonconformity? Just as a study that uses religion as an independent variable is improved when it not only identifies subjects as “Christian,” but allows the subjects to identify a more specific denomination, asks them how religiously observant they consider themselves, and inquires as to how often they attend church, increasing the sophistication of sex/gender questions improves study results. The following measures are suggested:

What gender do you identify with? Man__, Woman__, Other (please write in the identity)________________.
What sex category were assigned at birth? Male__, Female__.
As far as you know, were you born with an intersex or sex variant body? Yes__, No__.
Please indicate how masculine or feminine you are in your dress and manner on the following scale: (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.

In order also to ensure the study is not discriminating on the basis of sexual orientation, and to gather better data, best practices suggest that subjects also be surveyed on their sexual identity. Problems are often raised by the traditional method of asking subjects if they are “heterosexual, homosexual, or bisexual.” For example, people who are gender transitioning or who identify as neither male nor female are often unable to use these sexual orientation categories to classify themselves. Furthermore, it is well established that there is a difference between how many people identify their sexual orientation and the sexual activities in which they actually engage. This may be addressed through questions such as the following:

To whom are you attracted, sexually and romantically? (1) only men, (2) mostly men, (3) a bit more toward men than toward women, (4) equally toward men and women, (5) a bit toward women than men, (6) mostly women, (7) only women.
With whom have you been sexually involved? (1) only men, (2) mostly men, (3) a bit more men than women, (4) equally men and women, (5) a bit women than men, (6) mostly women, (7) only women.
Are the people to whom you are attracted (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.
Consider the idea of a partner who identifies as neither male nor female, but as some other gender such as “genderqueer.” Do you find that (1) very appealing, (2) moderately appealing, (3) a bit appealing, (4) I feel neutral about it, (5) a bit unappealing, (6) moderately unappealing, (7) very unappealing.

Researchers who choose specifically to study GIE minorities should consider them a vulnerable subject pool for IRB human subject protection purposes. In cases of studies recruiting intersex, trans gender, or gender-variant subjects, procedures should be set in place to protect these vulnerable subjects, and the questions asked about sex and gender carefully designed to accord all subjects with full respect for persons. Confidentiality should be strictly protected, data collected in a location where subjects will not be at risk of having others see or overhear their responses, and information sheets listing appropriate support groups and links to mental health resources distributed to those recruited to participate.

Intersex Fertility

2011-09-07T22:12:00.009-05:00

My daughter was not of woman born. That is a concept that has fascinated people through the ages.

My daughter's gestation was perfectly “natural,” I should point out--but I carried her, and I was never of the female sex; I am diagnosed as "true gonadal intersex.” I was assigned female at birth, and was living as such when I gave birth to her, but I never identified as a woman, and am now legally male.

A lot of myths circulate around the topic of intersex fertility, many of them perpetuated by doctors. They all relate to the current Western insistence on the ideology of sex dyadism. That ideology holds that there are two and only two sexes, and that this is required by “nature” in order to perpetuate the human species. In fact, sex is a spectrum (see here and here for more information). About one in 150 people has some intersex characteristic. However, in contemporary Western society we are hidden away, medically “corrected,” erased. And often this erasure is bound up in rhetoric about fertility.

One way in which medical textbooks frame intersex people as “tragic” is by presenting us as usually infertile. I'm not going to spend time critiquing the idea that a person must procreate to be a fully mature and valid adult, though I certainly don't believe that to be true. What I want to address from an intersex perspective is the fact that many of us are capable of reproducing. In fact, doctors often take surgical steps to “normalize” our bodies that render us infertile. For example, children born with external testes but absent or very small phalli are often surgically assigned female. The removal of their testes of course renders them infertile. Doctors frame these children as being born “incapable of reproduction” because of their small or absent penises, but this is laughable. Deep penetration is not necessary for pregnancy to occur via intercourse. Size really is irrelevant to the delivery of sperm. In fact, the availability of in vitro fertilization means that intercourse itself is unnecessary. What doctors are doing is conflating having a large phallus with fertility and with male identity. It's magical thinking—but it is used by supposedly rational scientists to justify surgical castration of children with variant genitalia.

In framing intersex individuals as usually infertile, doctors present procreation by intersex people as a medical curiosity, justifying the publication of medical journal articles about a “case.” And they frame facilitating such a procreative act as a sort of “medical miracle,” in which the doctor treating the patient is the hero. Wishing to be seen in such a light, doctors wind up putting a lot of pressure on those of us whom they know to be intersex and potentially fertile to reproduce. This sort of external pressure is uncomfortable and almost coercive, as I myself experienced. I was told by doctors that my fertility would probably decline over time, that my atypical uterus would probably eventually “have to come out,” and I was regularly urged not to postpone trying to have a baby. Though I love my kid immensely, I see the pressure that was put on me to conceive as unethical. My road to parenthood was painful, involving a series of miscarriages, a difficult pregnancy, and a labor, with my atypical uterus, that lasted 53 hours and left me with injuries that took several years to fully heal.

In facilitating an intersex conception or gestation, doctors frame themselves as heroic in two ways. First, they are heros for making this new life possible (as if they were the ones doing the procreating). Doctors present themselves in this way in all sorts of infertility treatments, not just in the case of intersex patients. But the second heroic framing is unique: the prior doctors who chose a dyadic sex for the intersex person are presented as having done a brilliant thing. Doctors treat a successful fertilization as validating the intersex person's sex assignment. If an intersex person assigned female becomes pregnant (or an intersex person assigned male successfully inseminates), then doctors presume they made the “right choice” in the sex assignment. Thus, if an intersex patient expresses unhappiness with their sex of assignment, doctors may put even more pressure on them to procreate. Unhappiness with one's assigned sex implies a critique of the medical professionals who made it, which makes many doctors uncomfortable. Rather than questioning the practice of surgical sex assignment in infancy, doctors want the critique to go away.

This pressure placed on unhappy intersex individuals to procreate in order to validate the medical sex assignment that is causing the person unhappiness is unfair—and also bizarre. It follows the pattern of medically assessing a “correct assignment” through sexual activity. If a person is assigned female, then all is well if they are able to “accept a penis” in vaginal intercourse—and if they can actually become pregnant through this, hark—the herald angels sing the savior doctors' praises. As someone who was assigned female and did eventually have a successful pregnancy, I can tell you that this assumption did not work for me. For me, as for many, what mattered most in my sex assignment is gender identity. I did not identify as female, and thus I was uncomfortable in my assigned sex. Experiencing a pregnancy did not relieve my discomfort. Carrying a child did not “cure” my gender dysphoria with my assigned sex. It didn't make me “feel like a real woman.” It just made me feel pregnant.

I'm glad that I was able to become a parent, but believing that this should have “cured” me of my distress with my assignment is magical thinking along the lines of believing that procreating will “cure” a lesbian or gay man and make them heterosexual. Gender identity, sexual orientation, and procreative status are independent characteristics. Lesbians and trans men and intersex individuals aren't mystically “converted” by pregnancies. Gay men and trans women and intersex individuals who inseminate someone aren't thereby made straight or cis or dyadically-male-sexed.

Sometimes intersex people assigned to the female sex inseminate a partner, or male-assigned intersex people become pregnant. In the first half of the 20^th century, when intersex children were rarely if ever surgically sex assigned, and doctors wrote about “cases of hermaphroditism” they encountered as adults, this was a popular topic in medical journal articles, but such is not the case today. Since there is no reason why intersex people should be born with less capacity for fertility that in the past, there are two possible explanations. Either medical interventions are rendering more intersex individuals infertile, or doctors have no incentive to publish about what they would deem “sex assignment failure.” A person a doctor has assigned female is not “supposed” to impregnate anyone, thereby supposedly providing embarrassing proof they should have been assigned male. The idea that someone might actually be happy with a female sex assignment and also pleased to be able to contribute to the conception of a child by providing sperm in the way their body permits does not enter the picture at all. The dyadic gender ideology doctors impose awkwardly onto intersex people is again revealed.

I believe that the framing of sex as dyadic also contributes to the everpresent popular question about fertility and “hermaphrodites”: can we impregnate ourselves? The answer is that it is extraordinarily unlikely, but I believe the reason this tired old query nevertheless comes up again and again is due to how people, having no idea at all of what intersex bodies are actually like, have to use their imaginations. Given the dyadic sex ideology, they figure that if a “hermphrodite” is both male and female, they must have both sets of “organs,” meaning a penis and vagina and testes and uterus and ovaries. Truly, if you ever want to despair of the level of ignorance about intersex bodies, just do an internet search for “hermaphrodite impregnate”. . . I find it hard to decide whether to laugh or cry reading people's musings on this topic.

But I can't really blame people on the street for the depth of their ignorance. People don't know about intersex bodies and experiences because we are hidden from them. Our sex status is erased by the legal requirement that we be declared male or female at birth. Our bodies are redacted by doctors trying to remove the evidence of our physical “deviance.” Information about intersex statuses is not taught in high school biology classes. The fact that sex variation is so common is a fact kept, for some reason, secret. And the large majority of intersex people are well-schooled to keep our “disorders” in the closet.

So I'm less bothered by the tediously-repeated “if you're a hermaphrodite, could you get yourself pregnant” question than I am by magical thinking on the part of medical practitioners. Intersex people are not tragic figures due to infertility. Some of us don't want children, and some of us adopt. Some of us do indeed produce children ourselves. We've done this throughout all of human history, not just recently due to medical miracles. Many of us who do reap the rewards of fertility do this in private, with no medical journal articles trumpeting a star in the east. In fact, some medical “corrections” of our physical differences render us infertile, and I don't see why that's treated as unimportant when doctors are so very willing to write articles about their “cases” who do prove fertile. And the magical thinking behind the idea that doctors can validate a sex assignment through the intersex person contributing the “correct” component, egg or sperm, to a conception just boggles my mind.

It's time for some more sophisticated thinking about intersex fertility.