Intersex Experience and Fears about "Gay Genetics"

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

But intersex people know better.

Nonconsensual Intersex Surgery as Physical Conversion Therapy

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

They are not.

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

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

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

A Brief History of Conversion Therapies

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

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

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

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

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

Prettying Up Conversion Therapies

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

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

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

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

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

The Spread of Resistance to Conversion Therapies

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

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

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

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

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

21st Century Intersex Advocacy

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

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

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

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

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

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

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

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

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

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

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

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


 

 

Do I Have the Right to Marry Anyone?

On Sexual Identity and Intersex Experience

I'm married. I wonder if I'll be sent to jail.

DOMA, the Defense of Marriage Act, states that the U.S. federal government defines marriage as a legal union between "one man and one woman." My home state of Wisconsin goes further, providing that residents other than "one man and one woman" who go out of state to marry can be fined up to $10,000 and/or imprisoned for up to 9 months.

My spouse and I got married out-of-state.

The law scares me--because I'm intersex by birth.

My spouse, for whom I thank my lucky stars, is also intersex. We have very different bodies, different "conditions," but we share key experiences that bind us closely. And one of those shared experiences is a constant feeling of unease with regulations and categorizations--marriage laws, for example. If you were born neither male nor female, and you were looking at laws banning marriage unless it joined "one man and one woman," how would you feel? Unacknowledged, uncomfortable, socially unmoored? The people who wrote these discriminatory marriage laws had other aims--the existence of intersex people probably did not cross their minds when they were putting the bills together. But that's how a million regulatory regimes impact us. You are required to declare a dyadic sex, supposedly to protect your identity or serve your needs. That's why you have to check off an "M" or an "F" box to get a driver's license, or open a credit card account, or fill in a Facebook survey. True, these checkboxes conflate together physical sex and gender identity. I'm intersex, but my gender identity is masculine, so I can just check the "M" box on the Facebook survey about blue jeans.

But marriage is different. There's an inquiry into your "true sex"--supposedly to protect society at large.

The furor focuses on "same-sex marriage."

Conservative opposition to "homosexual activism" is what has driven the enactment of DOMA and the 29 separate state laws limiting marriage to "one man and one woman." I'm sure you're familiar with the rhetoric, which tends toward Biblical one-liners: "Male and female created He them;" "God created Adam and Eve, not Adam and Steve." There's the constant quotation from Leviticus, "You shall not lie with a male as with a woman. It is an abomination" (with the constant nonquotation of other passages from Leviticus, like the prohibition against wearing fabric mixing linen with wool, or eating pork, or trimming one's beard).

According to this simplistic interpretation of the Bible, God made men and women to be opposite and distinct, intended for procreative marriage, with a husband leading the household and a wife practicing submission to him. Heterosexual marriage based on these principles is said to be the foundation of society. Straying from it, we are warned most stridently, will undermine both morality and social order.Advocates of same-sex marriage have written many eloquent defenses of allowing gay- and lesbian-identified couples to wed. I certainly agree with them that male couples and female couples should be able to marry.

But where do I fit in this picture, as an intersex individual?

Last year I had a conversation with the leader of a proselytizing Christian group that had taken over the central plaza on my college campus. They were holding up signs saying that any sex outside the context of a marriage between one man and one woman damned a person to hell. I'll give them this: they were coherent in their sexual beliefs. They were also holding up signs about masturbation earning one eternal damnation (an assertion that did not win them a lot of converts in the college audience).

I stepped aside with the leader, and asked him respectfully what his religious precepts would advise for me. I explained that while I lived as a man, and he saw me as one, I was born with an intersex condition and was assigned female at birth. Since I was neither male nor female, how was I to follow a command that marriage only be contracted between a man and a woman?The religious leader stared at me for a bit, then rallied. He said that he wanted to tell me that he had great pity for me, and that God did not intend that I be born intersexed. "Birth defects," he explained, "exist because of Adam's fall. Original sin warped God's creation, and that's why tragedies such as the birth of a baby with crippled legs or like you occur." He explained that when Jesus came again, all of this disorder would be purged, and there would be no more people like me. I mustn't be angry at God but at sin for putting me in my position.

I told him that I believed that I was born exactly as the universe intended, and was not angry at God. What upset me was how I was treated by my fellow human beings. In any case, given that I did exist as an intersex person, whom did he believe I was permitted to marry?

He asked me what the doctor had put on my birth certificate, and I said "female." He gave me a grave face, and told me, "I'm sorry, but then that is what you are. You may look like a man but you are not, and you can't marry a woman. It's like the case of a transsexual, even though it is not your choice." So, according to this religious leader, sex assigned at birth governs marriage law, and there can be no sex transitions, for intersex people or for those born with normative genitalia. (Nonintersex trans people get the extra distasteful twist of the lip for a "choice," but the end result is the same.)

I then asked the religious speaker if he thought I should marry a man. He looked very uncomfortable and just shook his head. I said, "So you don't think I can marry anyone?" He suggested that I dedicate myself to God's will and eliminating sin rather than dwelling on my personal situation.

I guess that's what monks and nuns do: dedicate themselves to God, and live a life of celibacy. And since he didn't think I could marry anyone, and sex is only allowed in marriage between a woman and a man trying to procreate, celibacy is what he felt God required of me.

In the parlance of my Jewish ancestors, Feh.

I did ask him one more thing: why did he think that the doctors had picked the "right" dyadic sex for me? Couldn't I be trusted to look into my heart and know myself better than they? He just said that doctors are the ones who know, because they have the technology and the tests.

I don't know when or how doctors became the oracles of divine will for good Christians. In fact, I'm sure that when doctors declared that masturbation was healthy, the members of the group I encountered rejected that promasturbation prescription vehemently. . .

The majority of Americans would see the group I encountered as rather extreme. Yet the majority of Americans have enacted marriage laws that reach the same conclusion for intersex people: marriage is only acceptable between a "man" and a "woman." The fact that I'm neither by birth is some sort of unfortunate, bizarre accident. Doctors can be relied upon to pick the right sex for intersex babies, and that should clear the whole problem up.

But even doctors aren't so sanguine.

Doctors warn of a "risk of homosexuality" for babies born intersex.

Yes, you heard that right. Just read about some "DSD" or other and you'll see it there. Take congenital adrenal hyperplasia, or CAH, which is often manifested in the birth of a child with a penis outside and uterus and ovaries inside. Medical texts regularly state that "even with surgical and pharmacological treatment, CAH girls are at risk of homosexuality." In fact, there is now a highly controversial prenatal treatment program led by endocrinologist Dr. Maria New, intended to influence genital growth in CAH XX infants, so that they're born looking more like a typical female--and it is being reported not as an attempt to prevent intersex births, but as an attempt to "prevent homosexuality." You can check that out here. What a confusion of intersexuality and homosexuality! (And how eugenic. . .)

I have to ask you, from the perspective of birth sex, how can an intersex person be homosexual--unless they only have sexual relationships with other intersex people? Of course, birth sex does not dictate how sexual orientation is experienced . . . but doctors misapprehend how this works.

What the doctors really mean with regard to children born with XX, CAH is this: they take babies born with what are often totally average-looking penises, but internal "female" organs, and they cut their penises off. (The call this "clitoral reduction" nowadays.) They prescribe the children testosterone-suppressant drugs. They tell their parents, "See, you have a girl!" But the parents know the children are intersex--they saw them born with phalli. The children know they're intersexed--they bear the scars, they take the daily meds, and are forced to show their genitalia to doctor after doctor. Of course these children often grow up with gender identities and behavior that differ from "normal girls."

Apparently we intersex people often freak doctors out once we're not cute little tots over whose bodies they have vast power. They take an intersex baby with CAH, give hir sex assignment surgery, and want to believe that having sculpted a vulva-shape in hir flesh they'll have guaranteed hir a future of "normal womanhood," stereotypically defined as involving no great interest in sports, but lots of interest in fashion and boys. Sometimes their patients grow up into the pink feminine heterosexual icons of the doctors' imagination, expressing nothing but gratitude for the removal of those embarrassing "pseudophalli."

And sometimes CAH intersex patients show up in the doctors' office as depressed or angry teens in short hair and jeans. Maybe they identify as male, or as genderqueer, or as tomboys--doctors don't seem to ask about gender identities or if anyone wanted to keep that penis they had been born with. What they do ask about is sexual activity, and if the patients are involved with boys or girls or both.

The data they collect is pointless.

Without knowing gender identity, you can't tell someone's sexual orientation. Take two people with the same CAH bodily configuration, and one can grow up to identify as female and the other as male. If a person identifies as male and only wants female partners, his sexual orientation is heterosexual. But the doctors will label this person "homosexual," because they assigned him to be female, and they don't ask if that's the gender identity he actually grew up to have.

Doctors are acting just like the Christian sectleader I spoke with at my university. Intersexuality is a mistake, they say, unintended by nature. Doctors have the godlike power to divine the "right" dyadic sex for intersex babies, and correct their faulty bodies. And the "normal" thing for these intersex children to grow up and do is to marry a person of the sex other than the one the doctors picked for the child.

What does this all mean for me?

My spouse and I were both born intersex. I was assigned female at birth, and she was assigned male (I escaped surgical intervention but she was surgically misassigned, to her lifelong regret.) According to the sexes doctors put on our birth certificates, we are a "heterosexual" couple, though we share a physical status. Had we both grown up to identify with the sexes we were assigned, our intersexuality would be invisible to society--as both doctors and Christian antigay activists would wish it to be. We could have married and disappeared into the suburbs. Biologically speaking, we would not qualify as "one man and one woman" for marriage, but nobody would ever have raised a stink, so long as we accepted our lot and kept quiet about our birth status.

But we did not identify with our sexes of assignment. Eventually, we both found the strength and resources to enter the gender transition process. This has come as a great relief to us both, though it hasn't made our lives easy (read my last post to hear more about that). If transphobia were not the huge barrier that it is, and gender transition services could be easily accessed, and insurance covered the medical expenses, and the legal hurdles weren't so high, my spouse and I could have done a simple if ironic do-si-do and would now be married as a man and a woman.

Gender transition being the long, drawn-out, expensive, legally-convoluted process that it is, however, according to our birth certificates, we're both "male." No matter that my spouse was never biologically male. No matter that she has breasts and gets a menstrual period. No matter that she has identified as female since the age of 3 or 4. No matter that her driver's license reads "F."  Because she already had genital surgery in infancy, and is considered a "poor candidate" for further surgery, and wouldn't want it in any case, given the sensation she already lost in the first round, she can't change her birth certificate, and in Wisconsin, sex for marriage purposes is based upon birth certificate sex.

So: one thing we're dealing with now, despite the fact that we live as a married man and woman, is we are currently, according to our birth certificates, in a same-sex marriage. At the time we got married, my legal documentation still listed me as female, so getting hitched was unproblematic--but at the moment we look different on paper. And since we went to San Francisco to get married, someone could now threaten us with that $10,000 fine and/or 9 months in jail Wisconsin law allows. We share this unhappy situation with other LGBT couples in Wisconsin who found routes to marriage, and I have great sympathy for them all.

Even if we were able to change my wife's birth certificate some day, and we're no longer a same-sex couple on paper, we won't be safe. Because we're open about having been born intersex. Because we gender transitioned, and people know that. Because we're visible, we'll always be vulnerable to harassment by some bigot who wants to argue we're not "one man and one woman" and try to invalidate our marriage.

Intersex people having to deal with marriage restrictions is not some abstraction or game.

It's nervewracking stuff, and it's my lived experience. Sometimes well-intentioned people who want to construct arguments against "same-sex marriage bans" bring up the idea of intersex people like some sort of abstract theory. Take, as just one example, this post entitled "Common Arguments Against Gay Marriage." A section titled "Hermaphrodites" poses intermediately-sexed bodies as a hypothetical and asks how "feminized" a "hermaphrodite" must be to be permitted to marry a man. The blogger gets excited about this just-so story, and states, "This is a type of sorites paradox. Traditional sorites paradoxes involve asking how many grains of sand you have to remove from a pile before it stops being a “pile,” or how many pounds a fat person has to lose before they are no longer “fat.” These are paradoxes because they involve characteristics which are vague — it’s not clear where a pile or fatness begins and ends."

Yes, this hypothetical of the Incompletely Feminized Hermphrodite follows the slippery slope, sorites paradox argument format. But we are not mythic creatures in some ancient Greek story Zeno might tell of arrows that get halfway to their targets. We are not some illustrative fable. In writing about intersex experience and one-man-one-woman marriage limits, I have to raise this issue, because I know there are other intersex people who are livid at how people who are supposedly our allies treat us--so angry that they think the intersex community should refuse to enter public discussions about how marriage restrictions affect us. I agree that we have been treated rudely, our bodies seized upon as fodder for arguments by people ignorant of our painful real life experiences. It's depressing.

But the fact that our lives have been appropriated by others should not silence us. And so I am speaking out, and asking for something simple.

I am a human being, and I ask for respect.

All bodies deserve respect. Intersex variations are not lusus naturae, medical defects, the wages of sin, or mistakes unintended by God. Sex is a spectrum by nature, and everyone's body is a gift.

All loving relationships deserve social support. To believe that it is ungodly of me as an intersex person to get married to a man or to a woman because the sex I was assigned at birth did not match the gender identity I developed--that is a failure to understand and embrace a God of Love. To grant or deny people the right to marry based on their sex or their gender is simply wronghearted. All people--straight and queer, trans gender and cis gender, intersex and dyadically sex-normative--should be treated with dignity when they commit to love.

For a person to be threatened with imprisonment for daring to marry . . . now that is moral evil.

Does It Get Better?

This post is intersex-related, but is more broadly addressing LGBTI issues that arose in conjunction with Wear Purple Day events in the U.S.

On October 20th, thousands of Americans wore purple as part of the campaign to show support for young people who are being bullied because they are perceived to be lesbian, gay, bisexual, transgender or intersex. I am grateful to all of those who put on purple as a show of solidarity. Thank you for caring and for making this gesture of support. In the homophobic and transphobic cauldron of many American schools, large numbers of LGBTI teens are driven to despair, and some to its ultimate expression in suicide.

The Wear Purple Day campaign is affiliated with the “It Gets Better” project, in which adults record video messages to LGBTI teens to tell them that while they may despair now, they should keep hope alive, because life will get better when they get older. This too is a project that is well-intended, and I appreciate all the people who have made and contributed videos intending to support our youth.

But there is a problem with the framing of the “It Gets Better” project. Living with homophobia and transphobia does not magically disappear when one is handed a high school diploma. The title of the project implies that dealing with harassment and disrespect and violence is a phenomenon of childhood, as if “kids will be kids” and act immaturely, so we just need to wait it out and things will be fine. It focuses attention on the victim’s “not giving in” to mistreatment—which frames despair and depression as a sort of failure of the victim’s spirit, as weakness. (Notice that it is not a video campaign entitled, “Don’t Be a Jerk” aimed at homophobic, transphobic bullies.) It tells us to “be strong,” and we’ll be granted the prize of acceptance and respect when we grow up.

And that, I’m sorry to say, ain’t necessarily so.

There have been some dramatic incidents of anti-LGBTI violence against adults in the press of late. I think especially of the brutal homophobic beating and gang rape with baseball bats of three gay men in New York this month. These incidents are horrible and we must decry them. The possibility of being subject to such hideous attacks keeps many LGBTI people living in fear. But to focus our attention on hyperviolent acts like this directs the public eye away from the more quotidian experience of disrespect and veiled threat that many of us live with every day. While the number of us who will be gang-sodomized, let us pray, is few, thousands upon thousands of us continue to face, as adults, the sort of sneering and bullying that are common in high schools. And we too suffer low self-esteem, depression, despair. It is this that I want to address.

For some of us, being LGBTI in America today is not that bad. Those who are white, and middle-class, and gender conforming, and live in major urban areas may feel pretty comfortable. Even those in this privileged group still have to deal with people nudging one another and tittering at times, with marriage prohibitions denying them benefits, and with the insecurity of never knowing when they’ll be treated with disrespect—at a parent-teacher conference, or at a tax-return preparation service, or at a gas station. Even the conventionally attractive, young, white, churchgoing, well-educated suburban homeowners among us, apparently iconic ideal Americans, are usually aware of being second-class citizens. To say that this group’s lives got better after high school may be true, but it’s sad for the definition of “the good life” to be, “Well, I haven’t been subject to constant fear of violence since high school.”

And that’s the privileged group.

Let us be honest. The LGBTI youth who are subject to the most bullying are the ones who are less privileged. A middle-class gay white male high school jock is likely to face less maltreatment than an androgynous, poor kid of color. If you are a feminine boy (no matter what your sexual orientation), you are at high risk of bullying. If you are out as trans gender, you are at high risk. If you are marginalized already because you have a visible disability, or you wear out-of-style secondhand clothing because you are poor, or you are one of the only kids of your race/ethnicity at your school, your risk of maltreatment is much higher. And sadly, this does not magically melt away when you graduate from high school.

I’ve been thinking about this a lot today because yesterday was not a good one for my family in terms of LGBTI mistreatment. So I’m going to share this story with you. My family is suburban and middle class and middle American. My spouse and I are white (though our kid isn’t), I’m employed as a professor, we own a house and we keep the lawn mowed. My spouse and I are both trans gender, but as a trans man married to a trans woman, we have privileges many trans folk dream of. Our lives are supposed to be in the “it got better” category. But we still live with daily trouble with antiLGBTI bias.

It was my spouse who suffered directly yesterday. She’s intersex by birth, was surgically assigned male as an infant, but knew by the time she was four that she did not identify with her sex assignment. Rather than reassigning her female, however, she was treated with years of "gender therapy" intended to change her gender identity to fit her sex of assignment. This involved requiring her to do a lot of pushups, play football, and be physically punished for crying and other "girly" behavior. The “treatment” did not change her gender identity, but it did make her childhood miserable. She was not able to begin to gender transition until she was a legal adult, and by that time, without medication to postpone pubertal changes from testosterone, her body had masculinized. Starting hormone therapy did not reverse changes such as her having grown to be 6’3” and broadshouldered. (Because she has uterine tissue, however, it did start her menstrual cycle, made awkward by the masculinizing genital surgery she had as a child.) As a result of her history, my spouse must live her life in a body that will forever be androgynous, and here where we live, in the supposedly polite Midwest, this means constant street harassment.

For those of us who are gender-transgressive in appearance, whether we have chosen to be seen as genderqueer or would like nothing better than to be able to be gendernormative, but must live with physical androgyny, harassment does not end in high school. Especially when we are read as androgynously male, we are the butt of endless jokes and the subject of constant hostile stares. All my spouse and I have to do is go to our local Midwestern Walmart, and it’s like the circus came to town. People stop, and stare, and shake their friends’ elbows, and point. Sometimes there’s a supportive smile, and sometimes people pay us no mind at all, but we can never go without some people snickering and staring. Walking around in our suburb, my spouse has had to deal with parents yanking their children away from her as if she were about to abduct them on her afternoon constitutional. If she goes out walking at night to avoid these encounters, the police often curb crawl in a car behind her until she gives up and comes home. Going out to a restaurant we have to listen to people at the next table have an open conversation speculating on our genders and asking one another what’s wrong with people today. Every trip to a public bathroom exposes my spouse to danger of outrage or violence or police intervention, so she rarely ever uses one.

Gender transitioning has in some ways made our lives infinitely better than it was in high school. Living in a gender one does not identify with, with a body that gives one gender dysphoria, is terribly painful. But we are not now free from maltreatment and harassment, and my spouse suffers daily indignities. I’m androgynous too, but since I grew a beard I have more “passing privilege” and am usually read dyadically male, at least from the front. Also, I’m only 5’2”, and my spouse at 6’3” seems to trigger in young men out to prove their masculinity a lot more competitive transphobia.

But it’s not just individual harassment we have to deal with—it’s institutionalized transphobia. Yesterday, my spouse went to see her doctor to get her prescriptions refilled. It was not a good office visit. First, the receptionist loudly called her “Ma’am? Sir? Ma’am? Sir?” in front of the crowd of waiting patients. Of course, she was then subject to a sea of stares while she waited. And then the doctor refused to refill her prescription for estrogen, because her cholesterol was at 201, a point above the “normal” range. So my spouse has suddenly had the rug pulled out from under her medical therapy—medical therapy that is vital to her wellbeing.

I respect our doctor a lot, but she has never had a trans gender patient before (that she is aware of). Her reference point for estrogen therapy is menopausal women getting HRT. With them, denying a refill as a goad to lower cholesterol might be a nuisance, but that’s not the appropriate analogy. This is more like taking a person who was suicidal and is now doing better on antidepressants, and saying “I refuse to prescribe you any more antidepressants until you quit smoking.” But our doctor has had no training in dealing with caring for trans people, a failure of our medical schooling, and doesn’t understand how vital hormonal therapy is for a trans person. In a way, the doctor acknowledged that the issue was her lack of training. She said that she could not in good conscience continue to prescribe estrogen for my spouse, but that she’d give her a referral to see an endocrinologist with more expertise in hormone therapy.

The thing is, there is no endocrinologist our doctor knows of with training in dealing with trans people. There is no such endocrinologist in our health plan. Our health plan, in fact, refuses to pay for any trans gender care, and even though my spouse is intersex, and gets a menstrual period, they say she is “male” because that was what was put on her birth certificate—yet another example of the way we as LGBTI people are failed by institutions. There is no LGBTI health clinic in Wisconsin that can take over care. So, suddenly, we are caught without appropriate health care and a ten-day supply of estrogen left in which to fight to get access to someone who will treat my spouse with knowledge and respect. I’m staring at the number of the endocrinology office the nurse gave us. I asked the nurse if she could inquire if anyone there had ever treated a trans person, and she just sputtered uncomfortably and told me I could do that if I wanted to.

Would you want to be referred to a doctor who had never treated anyone like you, not knowing if that doctor in fact thought that people like you are “sick” and treating your condition a mistake? Not knowing if you would be sent home having been humiliated, with no treatment, and a large doctor’s bill your insurance plan refuses to cover? If as long as you didn’t get beaten up on the way home, would you say life is now good?

So, I wore purple on the 20th, and I extend appreciation to all the others around America who did so as well. But I have this to say: if you really want to help out, don’t just send smiling messages that life for LGBTI folks is fine after high school. Teach your children to respect all gender expressions and sexual orientations. Speak out against the way we are maltreated by institutions. Confront people on the street when you see them harassing us. Challenge school officials and parents and police officers who do nothing to stop the harassment. Be our good neighbors. Demonstrate your respect for all of us—not just to middle class married gay white suburban couples with 2.3 dogs. When you see someone who is visibly LGBTI on the street, smile at us. Advocate for same-sex marriage, yes, but remember the “T” and the “I” and also advocate for an end to sex assignment surgery on intersex infants, and for the respectful provision of medical care to trans folk. If you employer gives you health insurance, ask your HR department to negotiate for coverage of gender transition services. Take a step to ensure that life really does get better for your LGBTI fellow travelers. Please. . . wear purple, but do more than make a fashion statement.