LisaJ’s Danio’s (hangover error) posts about Usher Disease (I and II), as well as my own syllabus preparation for the upcoming semester, have gotten me thinking about issues of intersexuality. In particular, her noting of the geographic issues related to the prevalence of various forms of Usher disease reminded me of the concentration of five-alpha-reductase deficiency in parts of Turkey, Papua New Guinea and the Dominican Republic.
Some folks are probably asking, “What is this intersexuality thing?” Basically, it’s a range sexual development disorders in which people’s bodies develop in such a way as to place them in a “border region” of sex. Hermaphrodism is what people usually think of, but there is a wider range of conditions, including hypospadias and congenital adrenal hyperplasia.
If any of you have read the novel Middesex you already have an idea of what I’m talking about with five-alpha-reductase deficiency. People with this condition are genetically XY, but during fetal development something happens such that in many people the testicles may not descend, the scrotal sac may not fuse, and the penis can appear more like a clitoris (such an ambiguous thing is often called a microphallus). Because of these developmental issues, people with this condition are given a female gender designation at birth. Once puberty hits, though, the testicles descend, the penis may enlarge, the “labia” fuse to form a scrotum, and other male secondary sex characteristics appear. One of the things I find so interesting about this particular condition is the way that it has been routinized in the patterns of life and cultural systems in parts of the Dominican Republic. The people living in these areas have their own term for the condition, “guevedoce” (“eggs/balls at 12”).
In class, I often use a video produced by the Intersex Society of North America, an organization that shut its doors this years in favor of a different advocacy organization, the Accord Alliance. In particular, this segment of that video talks about, and interviews, someone who identifies as a guevedoce, as well as his family. (YouTube won’t allow it to be embedded.)
It’s this issue of how people with various conditions are integrated into social life that is my primary concerns. One of the things intersex activists have been challenging for the past decade or so is infant genital surgery. When children with some sexual development disorders are born with ambiguous genitals they are quite literally made to fit into one of the existing gender categories. “Fixing” them means surgery to make their genitalia more closely resemble “normal” genitals. If the phallus falls inside the middle range, where it’s “too long” for a clitoris or “too short” to be a penis, well, it’s snip-snip time. Many of the decisions to engage in surgery are based not on medical necessity, but social preference. Questions such as, “Will he be able to stand to urinate?” or “Will her partners be turned off by such a large clitoris?” or “How will the parents deal with looking at such a strange body while changing diapers?” can become more important issues when determining whether to operate than such things as “Will cutting part of the phallus off affect this child’s sexuality later in life?” (Ann Fausto-Sterling has an excellent discussion of these issues.)
Not surprisingly, surgeries do affect folks. Many report a loss of sensitivity from having such operations performed on them. (As one of my students once said to the other women in the class about the possibility of having half a clitoris and no sensitivity, “Wouldn’t it just make you tense all the time!”) It’s more than loss of sensitivity, though. There are often other complications that require more than one surgery. Ongoing pain or recurrent infections are not uncommon.
This is one of those spaces where I get all anti-normalization. These people’s bodies are being normalized–they are being reconstructed so they fit within normative assumptions about what genitalia must look like based on statistical averages. And, it’s done without their consent. Intersex activists have been successful in increasing awareness in the medical profession, but there are still issues. Many of these flow from the gender order we have in this society. The problem with such medically unnecessary genital surgeries isn’t these babies’ bodies, but social beliefs about what those bodies are supposed to look like.
I’m definitely on the side of preventing parents from mutilating their children’s bodies for cosmetic reasons (and that includes circumcision).
Paul Burnett says
“The problem with such medically unnecessary genital surgeries isn’t these babies’ bodies, but social beliefs about what those bodies are supposed to look like.”
Why is male circumcision okay in parts of the Western world, while at the same time many in the Western world criticize other parts of the world that practice female circumcision?
And it’s not just genital mutilation that’s “normal” – excess fingers or toes are snipped off, as are external vestigial tails.
I’m disappointed in you, MAJeff. You really need to start associating with a better class of people. ;)
Great post Jeff. This is a very interesting subject. I can understand how parents of a child who is born with such a condition must feel alot of pressure to make their child appear ‘normal’, and how difficult this must be to deal with when the child is first born. However, I absolutely agree that parents should not allow their children to be mutilated in this way. I just don’t understand how someone could think that deciding for your child if they are going to be a boy or a girl is in any way a good idea. Just let the child be and let them grow up into the person they really are.
Standing to urinate is a highly overrated ability.
This sounds a lot like Androgen Insensitivity Syndrome, in that the child is genetically male but appears somewhere in a range from 75% male up to 100% female in appearance. The biggest difference I see is that AIS seems to have a much higher rate of female gender identity (well over 90%), and 5-alpha seems to have more issues with changes due to puberty.
Michael Drake says
Interesting that being normalized also means being denatured. This fact should have caused heads to explode.
Tabby Lavalamp says
Paul Burnett wrote:
While both are wrong and originally based in religion, this is still comparing apples and oranges. If male circumcision involved removing the glans, then we can talk. As it is, removing the foreskin for the most part doesn’t even come close to the mutilation involved in female “circumcision” (though in some areas just the clitoral hood is removed, and that’s the only time it’s a fair comparison). But when partial or complete removal of the clitoris is involved, the comparison starts to fail, and the multilation only gets more horrific from there, depending on where it’s practised.
If I were a parent of such a child, my question would be: what options offer my child the best chance of physical and emotional health? I would want to read the relevant literature, talk with intersexed people and their families, as well as physicians in the relevant specialties.
These are the kind of inquiries that can only be done in an open, humane society. Parents of intersexed children and intersexed adults need answers, or at least enough information so they can ask the right questions.
Thanks, MAJeff, for being part of that informed dialogue.
Well, to be totally fair: it’s not done in the name of something as faceless as ‘statistical averages’. Statistical averages are certainly the cause of our belief in a bifurcation of genders in the first place — but those beliefs, and the norms that go with them, obviously have a rich and well-established cultural life of their own. It’s not so easy to just thumb your nose at all that. Not easy in terms of situating oneself as a person, certainly not easy in terms of being accepted or even comprehended by others. Which I’m sure you’re well aware of, anyway.
As someone with two intersexed friends, I can only agree, wholeheartedly. Both my friends went under the knife at birth for no other reason than that they didn’t appear “normal” enough, and both are deeply unhappy with their assigned gender nowadays. One is in the process of transitioning (f2m); the other is unable to do so due to unrelated medical conditions, and the fact that she’ll never be what she really is, so to speak, has left her heartbroken.
It’s an utter shame what has been and still is being done to people, all without their knowledge, their consent, or even so much as a reason.
Great post. Exremely thought-provoking!
What if the glans of the penis was originally an example of a clitoris that was appeared in men and was obviously selected for, or vice versa.
Normalization means that were actively muddying the waters of selection by making interesting genital configurations look exactly like the boring normal kind.
Who knows what kind of incredibly pleasurable genitalia we could adapt in a few hundred generations if we stopped this blind adherence to a narrow ideal of body image.
I for one would welcome a new race of humans with our tails back and new doubly pleasurable sex toys. We just have to breed with the right people, and if they are mutilated before we can choose, then we’re stuck with the boring average human forever :'(
Neural T says
Good timing. A documentary about David Reimer aired just a few weeks ago. It’s a fascinating tale. Really drives home the message that, contrary to feminist critiques of the 1970s, the mind is not a blank slate with regard to gender identity.
I’ve been fascinated by the intersex phenomenon for a long time. It is (or should be) an unfortunate problem for people who assert that the genders were created by God. No, sex and gender are adaptive reproductive strategies that can fail in development just like everything else. They are not immutable. They don’t even have clean boundaries.
It’s…uh…it’s because of…sin!
Probably the mothers had naughty thoughts while the kids were in utero or something. Or, no — the fetus did!
This blog, written by a rocket scientist, is a fascinating collection of information, both personal and scientific, regarding intersex, transsexualism and related psychosocial and psychosexual issues.
The author began to spontanteously transform from M to F in 2005 even though she is XY genotype.
It is erudite and heartfelt. Just read the posts about the passport issue. You won’t know whether to laugh, weep or crawl into a ball and rock gently in a corner – an amazing person.
Fernando Magyar says
Let me begin by putting my cards on the table face up. I’m a 55 year old heterosexual male in a great relationship with a wonderful hetero female. I grew up in Brazil where all forms of sexuality are in general not as big a deal as they are here in the USA. However as the father of a kid with Aspergergs I truly hate the term “normalization” wherever and however it may apply. BTW my grandfather was a doctor and he convinced my parents to have me circumcised at the ripe old age of six, I still have vivid memories of how painful it was to urinate through the bandages…
My question to you is how can we even begin to convince people that this is not like fixing a cleft palate, let alone that we might literally be crippling these people and therefore keeping them from experiencing the full pleasure of their sexual potential?! How the hell do you get it through the heads of those who pretend to be in a position to dictate morality to the rest of us that they are unequivocally and fractally wrong?
It’s really nice to see this issue brought up on Pharyngula.
Your post oversimplifies a very complex issue. First of all, the term “intersex” is no longer used. Now, the preferred term is “disorders of sex development” or “DSD”. “Intersex” is seen as ambiguous and stigmatizing and has been rejected by the affected communities and the medical community at large. http://adc.bmj.com/cgi/content/abstract/adc.2006.098319v1
Second, each disorder must be evaluated individually. The surgical issue affects each DSD differently. For instance, with congenital adrenal hyperplasia, the vast majority of women so affected have no gender dysphoria, and live normal female lives. They do not consider themselves to be “intersex” and do not relate to the discussions about genital surgery. They have a uterus, vagina and ovaries, but no vaginal opening and differing degrees of clitoral enlargement. Most adult women with CAH are happy that their parents chose surgical reconstruction and would not wish a similarly affected child to live with significantly gender atypical genitals, while expressing a desire to be very conservative in the surgical procedures. Clitoral reduction is discouraged and must be conservative when done, but not necessarily the creation of a vaginal opening. So, the issue is less whether it should be done, but the extent of the surgery and whether it preserves clitoral sensation. Self-esteem and overall mental health can be negatively impacted by significant genital differences in CAH and inability to engage in sexual intercourse.
In CAH, there are medical reasons for creating a vaginal opening, as proper childhood steroid treatment will allow the child to menstruate, and she needs a vaginal opening for the proper flow of blood. Moreover, reflux of urine into the vagina may cause infections, which can be life-threatening to those with CAH.
In addition, these women are fertile as females and most are heterosexual.
So, a more in-depth discussion of the topic may be warranted.
Greta Christina says
Excellent piece, on an under-discussed topic. Thanks!
Have they done studies where they follow a group of intersex individuals from birth who didn’t have reassignment surgery and then psychologically assess them to determine their satisfaction in life? If you can also do a comparative study on those with gender reassignment, we can have a better understanding on the actual differences with the quality of life in both groups. In the defense of doctors and parents who feel it necessary for reassignment, they’re doing it in hopes that the quality of life of the individual will turn out to be significantly better. With a comparative study, which I’m sure has been done (but I’m not aware of), these facts could be readily relayed to the parents. Otherwise, it comes down to fix them, or fix society.
I’ve always been fascinated with gender-identity issues and the way they’re approached in our society (usually with blunt-force ideals and little in the way of reason). Great post!
As far as circumcision goes, I still haven’t figured out how anyone equates the relatively benign procedure performed on males with the mutilation of female genitalia that is practiced by certain tribes in Africa and elsewhere. It really isn’t the same thing at all. The disgusting practice of destroying a woman’s body should be realized and talked about by our society, so that it can be ended once and for all. Male circumcision, I don’t know. It can be botched, I know, but I prefer it, simply because of hygenic reasons. I’m quite happy with my lack of foreskin, thank you! But maybe it should be left until the man decides whether he wants it or not, around the teen years, rather than being forced at birth.
David Marjanović, OM says
David Marjanović, OM says
What hygienic reasons?
What about the protection against infection that the foreskin provides?
And thirdly, why are only Muslims, Jews and Americans circumcised in the western world?
Logical error on line 1!
Given that I have never had a foreskin (since I can remember), I have a hard time comparing my current hygenic situation to what it would be like with one. Actually, check that – it’s not hard, it’s impossible. Same for you. You may be happy without, but how do you know you wouldn’t be happier with?
Moreover, even if it is cleaner, it’s good that we don’t use the same approach for other problems. To prevent cavities, we brush our teeth. We don’t pull them. We don’t amputate toes to prevent pernichia, we teach proper foot care.
But when it comes to the peepee? Chop it off!!!!!
Middlesex was one of the best books I had read in many years.
Whereas the ideas of normalization appear to have grown out of a need to “protect” these individuals from society, it is clear that it is society that wanted protection and instead needs to be normalized to the acceptance of the various degrees of sexuality.
Gregory Kusnick says
That cuts both ways. You can’t ask infants if they want surgery, but neither can you ask them whether they’re willing to be poster children for broad-spectrum sexual tolerance. There are negative consequences to either choice, and whichever way the parents decide, it’s necessarily done without the child’s consent. There’s no way around that.
I’m not sure where I fit on the spectrum.
I am physically female and heterosexual, never wanted children.
Apparently I “think like a man”, and always assumed to be male on the internet.
I have never wanted to “be a man”, have just wanted to be taken seriously even though I lack a penis.
Since menopause my dream have been various combinations of hetero, homo, and bi.
Maybe we (as a species) should stop trying to cram all our diversity into teeny little stereotypes.
There is genotype, phenotype, sexual orientation, secondary characteristics, social behavior, and dislike of housework.
What the hell is it about most cultures that gender roles have to be so well defined and limited? I look extremely feminine, but I feel fairly androgynous. At 19, my mother’s involvement with LGBT rights groups caused me to reconsider my sexual orientation. I had been defacto straight, but on a scale of 1 – 10 with 1 being hetero, I’m probably a 4. I HATE when people tell me or anyone else how to live their personal lives when it’s not hurting anyone, and I especially hate people being forced into a specific gender identity. Ladies and gentlemen, this is what we call sexism, and it is a detriment to our society. I could go on, but I feel that it’s all been said before, especially in this group.
Matt Heath says
If the PZminions had a permanent group blog it would be the best thing on the interwebs. Another great post.
personally, if I was going out with a girl and we got to the point where we were just about getting each others’ pants off and she said “We need to talk”, I’d freak out a little (mostly over “does she not like me enough?” but also just about every possibility in the space of about five seconds)
bringing these conditions into the open and normalising them would go a long way towards removing the possibility of that particularly head-sploding situation by making it possible to talk about it at the just-friends stage
and that’s my horny young male point of view.
That was a fascinating read. Thanks for posting it.
What do horny young males think about sex with a woman 20 or more years older?
Bravo, MAJeff! Awesome post on a very interesting topic. Given that these individuals are genetically male (XY) and most develop male secondary sex characteristics in puberty as a result of surging testosterone, it makes absolutely no sense to me to feminize them on the basis of superficial criteria (penis? clitoris? Where’s the imaginary line between the two?). It’s disappointing, but not surprising, that SCIENCE takes a back seat to popular opinion once again in the determination of how to treat these cases. The doctors serving these populations should be advocating more strenuously for the long term well-being of their infant patients, IMO.
Peter Ashby says
I agree with you MaJeff. The problem is that people see the massively skewed distribution of sexuality and anatomy in humans as a simple binary because they encounter ‘difference’ so little. So many of us are simply ‘normally’ heterosexual that anything different is merely characterised as ‘aberrant’ that people don’t think about fitting it into a distribution.
You see this in the politics of Gays where in some cases there is hostility to those who wish to see themselves as Bisexual. The wish to see a dichotomy (Gays and Straights) is again so strong that those who bridge between either get ignored or pressured into ‘choosing’ sides*. Our psychology has a lot to answer for.
*yes, I know much of it is driven by competition for scarce public resources, the criteria for which is very ignorant of things like Bisexuals and so there is no box they can fit in.
Nick Gotts says
On male circumcision, I’d say “don’t cut bits off people without a very good reason”, but I understand there is increasingly strong evidence that male circumcision reduces the chances of contracting HIV, because the virus is particularly good at getting into the body via the cells of the prepuce. Anyone with medical knowledge have comments on this?
Intersex people (and other babies!) should definitely be left unmutilated to make any such decisions over what they really are and should be for themselves, later. What I’ve mostly found is that people don’t even know what intersexuality is and that it happens at all. The mutilations and cover-ups just add to that public ignorance – as well as damaging the individuals concerned.
@ Nick #36:
Circumcision is nowhere near as effective (at reducing the chances of contracting HIV) as wearing a condom is! Plus the condom also protects a female from an infected male. Circumcision can only really provide a false and very one-sided sense of security. Just the sort of thing religious folks apparently love …
Nick Gotts says
I see your point, but on the other hand, once you’re circumcised you don’t have to have the operation again every time you have sex, while you do have to put on a condom every time – and there are often circumstances where a woman lacks the power to insist on the man wearing one. From an epidemiological point of view, it’s crucial to reduce the mean number of infections passed on per infected person to below 1. There is the question of “risk compensation” though (e.g. wearing a motorcycle helmet apparently increases the risks taken by the rider, though not enough, in that case, to cancel the advantage of wearing one), so the net outcome isn’t clear.
Nick Gotts #39
Back when I was young, dumb, and horny* I always wore a condom, even though I was circumcised as an infant. While HIV was not a concern in the late 60s and early 70s, other STDs and pregnancy were.
*Not like now, when I’m creeping into geezerhood, dumb, and nothing like as horny.
Curtis E. Hinkle says
Ambiguous Medicine and Sexist Genetics: A Critique of the DSD Nomenclature
By M. Italiano, M.B.B.S. (A.M.) and Curtis E. Hinkle
© Aug. 8, 2008
Online at: http://www.intersexualite.org/sexist_genetics.html
Many intersex persons around the world and their allies are concerned about the new nomenclature, DSD or “Disorders of Sex Development”, which has been endorsed by the Chicago Consensus (1) to replace the term “intersex”. We believe that the categories proposed are not only demeaning, but also scientifically flawed.
The age of chromosomes
The DSD nomenclature uses chromosomes, instead of gonads, as the most important classifier of an individual’s sex, such as “46,XY DSD” and “46,XX DSD”. This is no more helpful than using male pseudohermaphroditism or female pseudohermaphroditism which was based on gonads. (2) Instead of male pseudohermaphroditism and female pseudohermaphroditism, the new DSD nomenclature proposes “46, XY DSD” and “46, XX DSD” as replacements for the former taxonomy.
Furthermore, what was called true hermaphroditism is now dichotomized to fit more neatly within the binary. True hermaphroditism used to be called “true” because it meant that an individual had both ovarian and testicular tissue and gonads (ovaries and testicles) were considered to be the “true” determiner of one’s sex. Of course the word “true” was problematic because it suggested that all other forms of “hermaphroditism” were not legitimate, only “pseudo conditions”. Also, using the term “hermaphrodite” as a word to describe a person with an intersex variation has often been criticized as insulting and inaccurate. However, by replacing true hermaphroditism with “ovotesticular DSD”, we still have another problem. The DSD nomenclature now wishes to divide “ovotesticular DSD” (formerly true hermaphroditism) into “46, XY ovotesticular DSD”, “46, XX ovotesticular DSD”, or “chromosomal DSD” (of “46,XX/46,XY” chimerism or “45, X/46,XY” mosaic types). In effect, it gives an individual in the latter case two types of DSD, an “ovotesticular DSD”, and a “chromosomal DSD”. Also, we see the division based on chromosomes, which again exposes the preeminence of chromosomes as the “true” markers of an individual’s sex. Further, by combining “ovostesticular DSD” with a chimeric or mosaic karyotype, as it does, it also fails to provide a clear classification of so-called “ovotesticular DSD” which has 3 or more cell line types, isochromosomes, inversions, or ring chromosomes in the karyotype.
For individuals who have both 46,XX in some cells and 46,XY in other cells, and who are referred to as having a “chromosomal DSD” of “46,XX/46,XY(chimerism)” type, it is not uncommon for them to have male anatomy only (3) or female anatomy only (4) and they may also be fertile. In this new nomenclature they would be “diagnosed” as having a “chromosomal DSD” despite any practical relevance for them. Furthermore, although the DSD nomenclature is intended to be representative of congenital conditions, there are individuals who have become 46,XX/46,XY because their twin’s cells make up part of their own karyotype (5), or because an individual who is 46,XX received a bone marrow donation from someone who is 46,XY, as well as by many other means (6). In fact, a pregnancy may also lead to “false positives” for a DSD since fetal cells end up in a woman’s bloodstream. (5)
Likewise, individuals with a 45,X/46,XY karyotype are listed as having a “chromosomal DSD”, but with a parenthetical “mixed gonadal dysgenesis” or “ovotesticular” DSD. This is also confusing since many 45,X/46,XY individuals do NOT have mixed gonadal dysgenesis or ovotesticular tissue. Again, some have only typical male or female anatomy (some being fertile as such), and the XO cells are known to disappear during various stages of development. (7) Thus, predicting this type of “chromosomal DSD” in prenatal screening has been demonstrated to be hampered by a high rate of erroneous results, has provided unnecessary cause for alarm (by projecting birth defects which do not exist), has led to unwanted elective abortion, and is considered a serious problem in clinical genetics. (8)
Another problem is that the DSD proponents have misunderstood basic genetics (or intentionally distorted the information) and have assumed that XY chromosomes indicate that testicular tissue is expected. This assumption leads to another error in the new taxonomy because when gonadal dysgenesis is classified as a “46,XY DSD”, (see Table 2 in reference 1 http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/2/e488/T2 ) DSD proponents refer to it (parenthetically) as “testicular dysgenesis”. This is misleading and ambiguous because many individuals with 46,XY gonadal dysgenesis actually have OVARIAN dysgenesis. (9) It has been known for over 30 years now that in the presence of an unaltered Y chromosome, but in the absence of substances which would cause testicular differentiation and development, that ovaries start to form, not testicles. (reviewed in ref. 9). It is therefore deceptive to classify 46,XY gonadal dysgenesis as 46,XY testicular dysgenesis because testicular dysgenesis is the result on some occasions but at other times the result is ovarian dysgenesis. The type of treatment indications for dysgenetic testicular tissue may differ from that of dysgenetic ovarian tissue, and thus may unnecessarily confuse clinicians. Furthermore, the preeminence of chromosomes in this taxonomy is apparent and the idea that XY chromosomes somehow are the real “male” sex marker is the result of sexist genetics which produces more ambiguous medicine.
A basic problem with the DSD nomenclature is that it divides all the “disorders” into groups based on what are erroneously known as “sex chromosomes”. (10) This sexist interpretation of genetics, typical throughout this new nomenclature, leads to ambiguous medicine because there are individuals who have male anatomy only but have what appears to be XX chromosomes and are diagnosed as having a “46,XX DSD”. Likewise, there are individuals who have female anatomy with what appears to be XY chromosomes and are diagnosed as having a “46,XY DSD”. If these apparent XY individuals have a piece of the Y chromosome missing, (such as would include the SRY testis determining gene) they are still referred to as having a “46,XY DSD”, which is factually impossible since they are not XY, but X plus only part of the Y. Likewise, someone who is called XY (but in reality has an extra copy of an X chromosomal gene called DAX1) is also put in the category of having a “46,XY DSD”, even though this is impossible, since they are not XY, but are instead X (PLUS another piece of an X)+Y. Likewise, individuals who appear to be XX, but are actually XX (PLUS the Y chromosome-specific SRY gene) are listed as having a “46,XX DSD” and a disorder of gonadal (ovarian) development, both of which are technically inaccurate. The fact that the DSD proponents (1) have put a note next to some conditions which indicates whether a deletion or addition of some X or Y chromosomal material exists, further demonstrates the inconsistency of their listing these conditions in the binary categories of “46,XY DSD” or “46, XX DSD” and not that of “chromosomal DSD.” In these regards, the DSD terminology is in violation of the principles and accepted diagnostic nomenclature used by clinical and molecular cytogeneticists. (11) Why didn’t the DSD proponents put these in the “chromosomal DSD category”? One apparently needs an entire extra “sex chromosome” or to be lacking one, in order NOT to be put in the binary “EITHER XX or XY” category.
The DSD nomenclature is ambiguous and sexist in its understanding of genetics and it appears that this is necessary in order to preserve an “artificial binary”. People who have portions of the X or Y chromosome missing or added are neither XX nor XY. The DSD system again here is flawed. Technically, CAIS individuals do not have a so-called “46,XY DSD” (even though the proponents state that they do) because the androgen receptor gene on the X chromosome is altered so that, in fact, they are only “X”Y. The androgen receptor is certainly involved in sex development. Thus if it is not there or is altered, it is ambiguous and misleading to call these individuals XY. It is equally ambiguous and misleading to call CAIS individuals “genetic males”. Yes, they have the SRY gene and a typical Y chromosome, but the X linked gene sequences for androgen “action” are not something that they “have”. The same is true for an XY individual who has a female anatomy only, unaltered X and Y chromosomes, but an alteration on one of the many genes on one of the so-called “non sex chromosomes” (autosomes) which are certainly sex determining.
Sophia Siedlberg, Genetics Advisor to the Organisation Intersex International, came up with a polygenic model which explained the role of genes, not chromosomes, in sex determination. (12) This model has been misappropriated by others who don’t know how to interpret it correctly. We can be quite sure, that barring an environmental cause (such as a teratogen), if we have an XY individual who does not appear to be a male, but instead appears female or intersex, that this person CANNOT be a “genetic male”, “chromosomally a male”, “genetically a male” and vice versa for individuals who have XX chromosomes. How do we know this? By the simple rule of basic genetics, that
GENES (+ environment) = PHENOTYPE (observable trait)
Thus, the DSD model based on “sex chromosomal” divisions has failed. By using the umbrella term “development”, it has also misapplied the knowledge base from the field of (sex) “differentiation” and conflated it with that of “development”. (13) It is ambiguous and sexist (in that it prescribes what sex one should be and not what sex one is and it perpetuates gender and sexist stereotypes based on chromosomes). It promotes confusion and oppression. It is NOT scientific. It simply uses scientific terminology in such a way that is confuses those who have little knowledge of genetics and biology. In so doing, it victimizes intersex people while offering “unlimited immunity” to medical and psychological professionals who continue FORCED sex assignments, FORCED sex reassignments, and FORCED gender expression expectations.
DSD makes the central health issue one’s sex
A second big problem with the DSD Consensus is that it largely ignores the health issues of intersexed individuals. With its emphasis on “sex” divisions based on chromosomes, they have persons with non-intersexed conditions like labial adhesions, cloacal exstrophy of the bladder and absent penis in an otherwise typical male, (or absence of a vagina in an otherwise typical female), mixed in with endocrine conditions, such as congenital adrenal hyperplasia, or mixed in with other organ system conditions, such as Smith-Lemli-Opitz Syndrome, and Turner’s syndrome. These are then categorized as “sex development disorders”, thus taking this “distant commonality” of one symptom, i.e., sex, and placing all of these disparate conditions as a disorder of one’s sex, while the predominant health issues become categorically “secondary” and likely to be ignored by clinicians.
DSD lacks clinical relevance
Even without considering the fact that the DSD Consensus largely ignores health issues, its taxonomy is in many cases irrelevant for the purposes of clinicians, especially those with subspecialties. An XX male with testes, a penis, and no female reproductive organs, who finds out at the age of 30 that his chromosomes are atypical after an infertility check, is in the same category as an otherwise typical female with ovaries and a uterus who has vaginal atresia. Both have a “46,XX DSD”. The same holds true for a male, typical in every way but with isolated hypospadias (classified as having a “46,XY DSD”), whose clinician finds that they have given their prior patient, an XY female with streak ovaries, uterus, and vagina who has given birth after embryo donation the same diagnostic classification of “46,XY DSD”. Again, ambiguous diagnoses lead to ambiguous treatment implications and vice versa. This is ambiguous medicine.
Gender conformity based on sexist genetics
With disorders of sex development, which sounds like “sexual development” (and can be confused with psychosexual development or psychosexual disorders), we now see a pathologizing of gender, gender identity, gender role, sexual orientation, and its ties to (re)assignment. People with a so-called DSD, especially in the binary XX or XY categories, are expected to conform in the above categories according to a binary gender expression, as indicated by the expectations of the DSD category, as well as the whim of the person who enforces the assignment or re-assignment. Those who reject such enforcement can be labeled mentally disordered, and treatment can be instituted or re-instituted at the whim of professionals, and this can be enforced legally.
DSD is about ambiguous medicine, sexist genetics, body control, and mind control. It certainly is not a client centered consensus statement. The fact that almost no intersex people had input into this consensus is glaringly evident.
In effect, we have moved from the “age of gonads” to the “age of chromosomes” even though it has been established that “sex chromosomes” as portrayed do not determine one’s sex. (10) This is based on prescriptive notions about genetics, not a descriptive understanding of the role of chromosomes in sex determination. Genes, not “sex chromosomes”, determine sex, and most of the genes involved are not on the X and Y chromosomes. They are on the autosomes.
It appears to the authors of this article that the DSD nomenclature misinterprets genetics based on a sexist, binary male/female model and in so doing, it has erroneously pathologized and stigmatized intersex people in order to try to preserve the heterosexist male/female hierarchies that justify the oppression of many classes of people, not just those who are intersexed.
1) Hughes, I.A. et al. Consensus statement on management of intersex disorders. J. Ped. Urol., 2006, 3:148-162.
Available online at: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;118/2/e488/T2
2) DamianiI, D. & Guerra-Júnior, G. As novas definições e classificações dos estados intersexuais: o que o Consenso de Chicago contribui para o estado da arte? Arq Bras Endocrinol Metabol. 2007, 51: 013-7.
Available online at: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302007000600018
3) Gencik, A. et al. Chimerism 46,XX/46,XY in a phenotypic female. Hum. Genet., 1980, 55: 407-408.
4) Sudik, R. et al. Chimerism in a fertile woman with a 46,XY karyotype and female phenotype: Case Report. Hum. Rep., 2001, 16: 56-58.
5) Schoenle, E. et al. 46,XX/46,XY Chimerism in a Phenotypically Normal Man. Hum. Genet., 1983, 64: 86-89.
6) Ford, C.E. Mosaics and Chimaeras. British Med. Bull, 1969, 25:104-109.
7) Chang, H.J. et al. The phenotype of 45,X/46,XY mosaicism: an analysis of 92 prenatally diagnosed cases. Amer. J. Hum. Genet., 1990, 46: 156-167.
8) Robinson, A. et al. Prognosis of prenatally diagnosed children with sex chromosome aneuploidy. Am J. Med. Genet., 1992, 44: 365-368.
9) Wachtel S.S. & Simpson J.L. Sex Reversal in the Human. In Wachtel S.S. (Ed.) Molecular Genetics of Sex Determination., 1994, 287-309. Academic Press, Inc.
10) Italiano, M The Scientific Abuse of Genetics and Sex Classifications. Manuscript published July 17, 2008 © Organisation Intersex International.
Available online at: http://www.intersexualite.org/Genetics_1.html
11) Schaffer, L.G. & Tommerup, N. ISCN 2005: An International System for Human Cytogenetic Nomenclature (2005): Recommendations of the International Standing Committee on Human Cytogenetic Nomenclature., 2005. Karger, S.C. Publ.
12) Siedlberg, S. The Gender Genital Gene Genie. Manuscript published 2001.
Available online at: http://www.gender.org.uk/chstnuts/ggg.htm
13) Italiano, M. Some problems with the new terminology for intersex. Manuscript published July 13, 2008 © Organisation Intersex International.
Available online at: http://www.intersexualite.org/Terminology.html
@ Nick #36:
TBH, I don’t really believe these studies, I mean, in the past, circumcision has been the cure for just about everything they could think of, but it’s really just a stupid justification for a barbaric practice.
Recall that the African studies of AIDS transmission involved following circumcised adults for 6 months after they were circumcised. It is not clear how much of the difference in the rates of HIV infection were due to differences in transmission, and how much is due to the fact that recently circumcised men are not apt to be having a lot of sex, at least immediately.
That is my interpretation of the problems.
Moreover, it is not clear as to how they translate to the US, where things are different in terms of education and condom use.
Another awesome PZMinion post.
One thing that interests me here is how closely the issues MAJeff raises mirror those of people with all kinds of physical disabilities (note I’m not saying that intersex people are disabled).
My mum did some research with children and teenagers with disabilities a few years ago and a recurring theme was their distress at being put through lengthy and often painful treatments to make them appear more “normal”. i.e. instead of being left to scoot about in a wheelchair, they might undergo several rounds of surgery so that they could kind of walk. This would make them appear more normal, but actually leave them less able to keep up with their able-bodied friends.
Nick Gotts says
You could well be right. But exactly because I find it counter-intuitive, and wish it not to be true, I’m not willing to dismiss the studies, or forget them. Time will tell – probably.
@ Pablo #43:
There’s also the possibility that, if some of them were having circumcision as adult men (ie rather late as these things go) on the assumption it would protect them, they were necessarily more aware of the reality of HIV-AIDS and the risks of having sex than many in the control group – who might have had little education or even mis-education on the subject (there are some horrific examples of the various lies and disinformation put out by religious “authorities”). Hence the mindful group could well be taking fewer risks than some random control group.
It’s rather like some of the supposed health benefits misattributed to vegetarianism actually being down to that subset being somewhat more health-freaky overall (as they have to be to survive on an otherwise nutrition-poor diet) than the general population from which a typical control group might be drawn.
There would have to be good evidence that the people conducting the circumcision-HIV studies took care to ensure they matched the subjects in the groups for their level of (relevant) education and their relative risk-aversion (such that their behaviour other than over the circumcision decision was as similar as possible).
As one of my students once said to the other women in the class about the possibility of having half a clitoris and no sensitivity, “Wouldn’t it just make you tense all the time!”
Which brings up another kind of interesting point, really, which is that just because someone is fully one gender (physically and emotionally) and content that way, doesn’t mean all the parts are going to work ‘properly’. Frankly, I’d be a lot happier without that particular bit at all, because it would keep my partners from assuming it’s pleasurable to have it touched and going straight for it. It isn’t, and even yelling, “How many freaking times have we had this conversation about staying away from that thing?” doesn’t seem to discourage it.
But then, I’m a little more on the asexual/anorgasmic side of hetero (I have a definite orientation, but little real interest in the act and no ability to get off in the traditional fashion), and all I ever hear is, “Oh, honey, you just haven’t been done right yet. Someday, someone will be able to ‘fix’ you.”
*Sigh* Not broken. Just wired differently.
Nick Gotts says
Evidence that vegetarianism is a “nutrition-poor diet”?
Alan Kellogg says
I’ve known Zoe for some time now. I first met Alan through his contributions to the RPG APA Alarums and Excursions in the late 70s, and rediscovered him again when I learned about his blog, A.E. Brain
His journey began when his GP started him on Lipitor for cholesterol. The Lipitor worked, stopping cholesterol production entirely, and testosterone production as well. Along with eliminating fat deposits in the abdomen, which held years of estrogen production. In short, Alan found himself flooded with estrogen, and starting a sort of secondary puberty. There were a few months where Alan and his doctor were wondering just what the hell was going on. so Alan was referred to a endocrinologist, who ran a few tests. Alan learned the results of those tests when his doctor greeted her with, “Ms. Brain, I think we’ve learned what’s been going on.”
Since then she has gotten a new I.D. as a woman, a new name — Zoe Ellen Brain, and even a new Australian passport. Zoe is now working on her PHD, has a wife and child (married status doesn’t change because of a sex change under Australian Federal law), has blogged about her experiences, and blogs about space travel, rockets, neat stuff, and intersexed and transexual issues. She’s well worth keeping track of, and she can give you a more comprehensive account of her adventure than I ever could.
And to hype this Zoe Brain comment on Google, I’m going to repeat Zoe Brain a few times in a blatant attempt to get Zoe Brain over here to comment. BTW, when you do visit Zoe Brain’s blog have a look at the lady up at he upper left hand corner. That’s Zoe Brain. Zoe Brain is a cutie, and I’m saying that to embarrass Zoe Brain. :)
//But then, I’m a little more on the asexual/anorgasmic side of hetero (I have a definite orientation, but little real interest in the act and no ability to get off in the traditional fashion)//
Shadow,No 47 :
There is no such thing as an “asexual/anorgasmic side of hetero”,there is of course “different wiring” to every individual,and half the fun is to figure out which buttons to press on a person,isnt it(at least for me).
“Not interested in having my clit assaulted” is not an exclusively hetero thing tho by any means,why would it be limited to heterosexuals with a clit(if thats the bit you were referring to) ?
I have to side with the “wait and see and let the child/patient have a say”
As I recall (over my 20 years in medicine) the operating phrase in these sorts of cases was “It’s easier to dig a hole than build a pole” so the majority of the cases were assigned a female persona. A huge problem when they reached adolescence and secondary characteristics made themselves known.
Oh, I didn’t think it would be. I don’t think I was explaining myself well. *Scratches head* Lemme try again.
The question that was put forth pertaining to women and how having a partial clitoris and lack of sensitivity might make them a little nuts just reminded me of some statements that have been made to me on occasion. It’s ineresting to me that, among that people I have experience with personally (because I honestly don’t know what’s going on in the world at large), even those who appear to otherwise have a decent amount of understanding and acceptance as far as gender issues go don’t always seem to extend it to other aspects of sexuality. So while it might not phase them to hear of an individual might desiring reassignment surgery – or that an individual who’d had surgery performed at birth might want to correct issues stemming from that later on – it does seem to throw them to be presented with a woman who would, were it possible, potentially be interested in having one specific gender-related portion of her anatomy removed for the sake of feeling disconnected to and unhappy with it. I’ve been told in no uncertain terms that I’m ‘sick’ and ought to seek therapy, or that I’d be sorry afterwards because it would destroy my ability to experience sexual pleasure or have an orgasm (well, gee, I don’t have them anyway, so). It’s not the only thing I’d like to see gone (I’m almost phobicially freaked out by the fact that I’m technically able to reproduce), but it’s the one that’s the least expected, I guess.
In kind of a similar vein, I’ve been questioned as to why I’m not interested in dating, why I’m not interested (enough) in sex, told that my lack of drive is either abnormal or a result of denying myself – and that in either case, I ought to (again) seek professional help so that I can open up and experience the sort of pleasure I deserve. I absolutely understand that ‘asexual’ and ‘heterosexual’ are not necessarily terms that can or ought to be used together; it’s just that I’m lacking a word to properly express myself without having to go into spiels of detail. So I’m also quite sympathetic to the fact that none of the concepts I’ve described are restricted to women or heterosexuals – I was speaking purely of my own experiences.
And of course, I have no reason whatsoever to believe that the speaker in the mentioned classroom would be of similar opinion to the individuals I’ve encountered – it just happened to spark the thought that I find it interesting that even as we’re learning more about alternatives to ‘standard’ humanity and (hopefully) becoming more open to allowing their expression, we still seem to have expectations for the members of the ‘normal’ group that don’t necessarily fit any better.
Zoe Brain says
I added a welcome post to those here, and a few links to some of the articles most relevant to this post.
Daniel – re #16 –
Thanks! That’s such a glowing review, would you mind if I quoted it?
Kelly – re #19
10% of those 46xx individuals born with CAH identify as male. Many of the rest don’t identify as “Intersexed”, and rather resent that label. They’re just partly masculinised women, not poor gender-confused freaks (their words, not mine – I belong to a CAH support group).
As a general rule, the best practice would appear to be:
a) Neonatal Minimal surgery to ensure urinary continence etc, freedom from pain, and reduce immediate (rather than potential long-term post-puberty) cancer risk.
b) No other neonatal surgery until an age of informed consent is reached. In particular no surgery without consent that would either remove sensation or compromise fertility.
c) Then allow the patient to say what gender they are – M, F, N – and how they wish their body to be configured surgically and/or hormonally. They should be informed of potential cancer risks and other dangers of all alternatives.
Almost a mirror image of how I felt prior to transition. I had male peripherals and female device drivers, so functionality was limited. I could please, but not be pleased.
The surgery put the right nerves in approximately the right places. So although some sensitivity has to be lost in any surgery, effectively it’s been increased dramatically.
Women vary. About 1 in 5 are anorgasmic. Rather more than that get no kick out of clitoral stimulation, unless accompanied by other things, and sometimes not even then.
Alan K – re #49
You succeeded. In both getting me to comment, and in causing me to blush for the first time in living memory.
I thought after having a non-volitional sex change, *nothing* could embarrass me. I was wrong.
Oh BTW we tried using Lipitor again to see what would happen in a 3 month experiment – the condition wasn’t repeatable. So the current working hypothesis is having both masculinising NC-CAH and feminising CAIS Intersex conditions simultaneously, symptoms triggered by Lipitor. But we’re still guessing. The treatment for NC-CAH works though, so to be pragmatic, that’s all that matters.
Hm,I wonder,GPs give out Lipitor like lollies these days.Sounds like a few non-related random events had to coincide to cause what it did to Zoe,still,if you give it too enough people…..
I was aware of the number of 1 in 5 for anorgasmic females,didnt think it was purely attributable to a hardware problem tho.
thanx for clarifying that,I assumed that was how you meant it.
And dare I say that this:
//It’s not the only thing I’d like to see gone (I’m almost phobicially freaked out by the fact that I’m technically able to reproduce), but it’s the one that’s the least expected, I guess.//
would seem to indicate a few non-organic issues,that might be accessible to some sort of exploration through therapy.
But not my business at all,of course.
Well, I am a diagnosed head case or three, so… -g- I just don’t believe that that’s the sole root of the quirks downstairs. And I’m not so terrified of reproducing that I can’t function sexually in the ways that do interest me – I’m able to say, “Okay, I can take appropriate precautions and reduce the chances,” and I’m responsible enough to make sure I do. It’ll freak me out if I sit and think too much about it, but it’s not something I have a habit of dwelling on (whereas there are triggers for other anxieties I have a much harder time with). I do feel a definite disconnect from the ability and the organs, almost as if they’re incidental to my makeup rather than a necessary part of being female, and I’ve occasionally wondered if I’d feel more akin to the way I see myself in my head if they were gone – but it’s not something that’s of so much importance that I feel I need to be that altered to reflect it (but I thoroughly support the right of others to be modified in any way they see fit in order to be comfortable in their own skin).
And really, I’ve had such negative experiences with therapy (for other reasons) in the past that I’m a big fan of managing things myself when I can. I’m told that some of the “not okay, needs to be fixed” lines aren’t as firmly drawn now, but I’ve been so much better off since I drew the “not doing this anymore” line that I’m not willing to risk it.
Im sure youve been through all this a million times with yourself and others,I really shouldnt attempt to comment I guess….
Whatever works for you and makes you happy !
No worries. -g- I’m pretty willing to discuss with people who are reasonable about the whole thing, and the mere fact that I got a, “Whatever works for you,” from you suggests you’re a whooole lot more reasonable than some I’ve come across.
Alan Kellogg says
Zoe Brain, #53,
You can blush, you can have romantic thoughts. You can have romantic thoughts, wild crazy monkey sex is in your future.
As many a researcher into human sexuality has learned, a large part of sexual response is imagination. You can see yourself in a pleasurable sexual situation it eases a lot of problems. Blushing shows that you can see yourself in pleasurable sexual situations
While people with conditions like CAH and AIS might not present with gender dysphoria in appreciably higher numbers than the average “normal” population, people with Klienfelter’s Syndrome (47, XXY) *do* have gender issues in higher than average numbers…which shouldn’t really be much of a surprise if chromosomes have anything to do with gender ID- if “normal” means you have to pick only two, then someone with an XXY genotype could be either an XY male with and extra X, or an XX female with an extra Y.
But despite this possibility and well documented gender incongruities in many XXY people (who are almost all assigned as male based on that single Y), standard treatment is supplemental testosterone to force them into being as physically male as possible…which is fine if the individual’s gender ID is male, but for those whose innate sense of gender is androgynous or female, it is about the worst possible thing that could be done to them.
The saddest part of all of this is how criminally little attention is given to intersexed people’s innate sense of their own gender, not just in individual treatments but in medical literature and research…with very rare exceptions, there are practically no protocols that deal with helping IS people with associated gender dysphoria or for fixing failed IS “normalizations” where the individual knows that their birth assignment was wrong (because doctors are extremely unwilling to admit making such mistakes, let alone admitting that they happen often enough that standard protocols need to be developed)…these people more often than not are forced to take the same route as non-IS (at least by current standards) transsexuals which means seeking and accepting a diagnosis of having a psychological disorder…even though the DSM says that GID can only occur in the absence of an IS condition.
These people have to deal with the same kinds of medical, legal and societal hurdles that transsexuals do, and the biggest societal hurdle is the fact that the very same people in positions of authority and power who are the most adamant about forcing “normalization” involving hormone therapy and genital reassignment surgery on non-consenting children as a means of reinforcing the allegedly natural gender binary they consider ‘God’s Plan’, are often the same people who are most adamantly against anyone *willingly* getting hormone therapy and genital reassignment surgery as adults in an attempt to align their gender ID and physical body, because “God doesn’t make mistakes”…and this holds true not just for run-of-the-mill transsexuals but even when a mistake was *clearly* made by human doctors playing God.
It’s bad enough that IS people have to deal with their medical conditions and the issues surrounding them, but having to face this kind of utterly hypocritical doublethink and try to make sense of it is enough to ruin lives and drives many people over the edge into depression and suicide.
Samantha Vimes says
A woman does NOT need therapy because she is freaked out by the idea that at some point she may find herself trying to push a living being that could be over 9 pounds with a big head through an opening that only barely allows it, while in pain; or being freaked out by the many complications that can occur even before that point.
Would you suggest a man seek therapy if he has a heart condition that could result in a need of a bypass operation, and that freaks him out? Well, maybe. People don’t seem to be allowed to express normal anxieties these days.
The point is, knowledge of the dangers of childbirth combined with lack of maternal urge is not pathological. Many women fear pregnancy, or have gotten to a point where they don’t have to fear it (surgery or menopause). There are even mothers who started out with a rosy view of pregnancy but had bad enough experiences they gained a fear of it.
Being afraid of something that can kill you is not a bad thing. There are plenty of women who do volunteer to have kids; those of us who don’t make the world less crowded for the next generation.
I get what you mean by asexual heterosexual. In fact, I think that is a definite literal possibility. I’ve heard of asexual marriages where neither partner is interested in doing ‘the deed’, but they do love each other. Being attracted to someone doesn’t always equate to wanting sex with them. While in one hand I know I’ve sometimes hit a sort of dry spell where I thought of myself as borderline asexual, the next time things went really well I otherwise; on the other hand, I know that there is probably no part of human life where personal experience varies more. My successes in finding better results from sex don’t mean you could do the same.
Zoe Brain says
What Tina #59 said.
I’ve met some people in this situation. I’m friends with them. Some of them have had it very rough. Many don’t survive.
I was lucky. My condition was recognised as being effectively a form of IS, so the usual rules didn’t apply. Unfortunately, for some IS people, that means they get denied treatment completely. Others, like me, get “fast-tracked”. It depends on who your medical team is, the luck of the draw. I lucked out.
On another topic, I happen to fall neatly into the conventional gender binary – a gender identity unambiguously female. Ok, that was a problem when I looked like a linebacker rather than a cheerleader, but never mind.
There are many IS people – not a majority, but a substantial minority – and some non-IS people too who do not fit in the standard binary model. There’s not-males, not-females, asexuals, neutrius, androgynes.. and they should have the right to their identity too, not to have to conform to someone else’s ideas on what they should be, especially when often the “someone elses” disagree!
There’s a very good example of a very courageous person dealing with Swyer Syndrome over at eFeminate. So many quiet heroes and heroines…
@ Samantha,No 60:
//The point is, knowledge of the dangers of childbirth combined with lack of maternal urge is not pathological//
No,of course not,and I would never say that.
I was under the impression that shadow wasnt talking about the dangers of childbirth,however,and she didnt seem to take offense to my argument,so I think she and I were talking about the same thing,maybe youre not.
As to the asexual/anorgasmic thing,I am not sure what the definition is here,but it would appear perfectly normal to have a stretch where you cant be bothered,dont feel like it,and can just love your partner just the same without what you call “the deed”.
Again,I dont think she and I were talking about that.
@ Nick #48
The fact that (in the UK at least) vegetarians have to go to some considerable lengths to acquire calcium-enriched soya, nuts and similar foreign supplements to survive reasonably healthily and that most vegetarians allow milk, cheese, eggs, fish and poultry to count as “vegetables”. In Scotland there’s even less local non-animal foodstuff on which humans could survive than in England and vegetarianism is right out of order as an eskimo.
If world travel (and the ability to manufacture food supplements) ever breaks down, humans will have to return to being omnivores to carnivores in much of the world.
Gregory Earl says
First of all, I agree with Matt (#30) that the PZMinions should have their own group blog, preferably on ScienceBlogs.
MAJeff, your posts (and also your comments on PZ’s posts) are always thoughtful and enjoyable to read. There is not much that can be reasonably said against your pleas for diversity and acceptance of diversity in all aspects of human nature. However, you often argue as though there are no biological “norms”, as for example in this post, where you talk about male and female biological sexes as “statistical averages”. Now, and this is a real (not a rhetorical) question, do you honestly believe that male and female sexes are on the same level, from a biological perspective, as all the sexes that might exist between the two? Likewise, do you honestly believe that heterosexuality is on the same level as all other forms of sexuality, again, from a biological perspective?
To be clear: I am all for respecting diversity, for seeing the individual, not the category to which society assigns them, and for accepting that nothing is clear cut in biology, let alone in social constructions of biology. Yet it seems to me that there is a very real basic human intuition that male and female is biologically “normal” and everything else is a deviation, and that heterosexuality is biologically “normal” and that everything else is a deviation. This means, I think, that however society treats sexes that fall between (or outside) male and female, people with those sexes are going to have a hard time coming to terms with their in-between/outside-male-female sex (it may be different with sexual orientation). Interestingly, most people with an in-between/outside-male-female sex that I have read about (and the one person I know personally) seem to feel that they are “male” or “female”, not something in-between or outside. Yet, if no “normalizing” surgery is possible or desired or both, they are usually not going to look like “males” or “females” and thus they are not going to be treated as such. In other words, aren’t people who fall in-between/outside the “normal” sexes going to have identity issues in any case?
I normally post under another name, but I’m not going to do so for this particular post – it reveals stuff about me that I’d rather any future employers can’t just Google.
I thought that I might post to give my personal take on the whole ‘to operate or not on children’ question, as one of those concerned.
I’m one of the unlucky ones to be born with an intersex condition (that’s what they used as terminology when this was still an issue for me). However, my parents took the bold decision to leave me as is, let me figure stuff out for myself.
On external genital appearance, I was about 75% male (whatever that means!), but clearly not normal. For my entire childhood, I had to live with confusion and shame about my differences ‘down there’. Every time I had to go into change rooms at school for example, was a major stress for me. It played absolute havoc with my self-confidence. I grew up as a very timid child.
Of course, leaving a child unassigned physically changes nothing socially. Your parents still need to nominate a sex for you, for your birth certificate. They still have to choose a name for you, and they still have to buy clothes for you, which will reveal an identity of either male, or female.
In my particular case, I was raised male. It made sense, seeing as I appeared to have a mostly male phenotype as a child, and I had two brothers anyway. Trouble was, as time went on, it was clear that I was far from a typical male child – in primary school I often played with the girls rather than the boys – I’d generally get beaten up by the boys – they figured I was gay, I think…
By the time I got to high school, physical developments made it so that I was already borderline female in appearance – small shoulders, small breasts, overall slight build, I was a foot shorter than my two brothers, and I was the weakest ‘boy’ in my year, if performances in sport classes were anything to go by. Of course, all of this, along with the large amount of my time spent in the ‘girl’ classes at school (cooking and French were my two big choices, both had about 90% female class participation), led to the guys once again giving me a hard time because they perceived me as being gay. The truly cruel part of that was that I was most definitely attracted by women, not men – indeed, after all the physical crap that I’d had to deal with in the school yard had me mostly fearing guys, if not actively hating them.
Anyway, as luck would have it, I finally decided that I would be happier as a woman, and as a young adult (24 yrs), I had sex ‘reassignment’ surgery to make me a pretty good imitation of a normal woman – let me tell you that changing one’s gender identity in public is never a fun experience. I remember trying to change my name on my bank account, and the teller just kept repeating “Yes ma’am, I know you want to change the name on this account, but I need Mr xxxxx to come down here and do it in person” To which you can only reply, “but I AM Mr xxxxxxxx, it’s just that I’ve changed, you see, it’s right here on my change of name certificate!”. Very embarrassing, when you consider that banks, being quiet places generally, means that every other customer can hear your conversation. I ended up having to call for the manager on that one :-)
Anyway, I digress. All of this was just to make one point. When people take up the crusade to leave children alone, to not force them into a gender, I would like to say that I think that people are wrong. It is cruel to leave a child’s state hanging, whether you like it or not, their peers are going to put them into one box or the other. It will absolutely destroy their self-confidence if nothing else, and there is no guarantee (as my case proves), that the child in question won’t have to go through a sex reassignment in the future anyway. Spare them the childhood distress as a minimum, because you just can’t know how their gender identity is going to play out as an adult, so you can’t protect them from that. But you can make their childhood normal.
Zoe Brain says
Two separate issues.
The first is that if “normalising” surgery is forbidden in one jurisdiction, the patients who need it will go to another and get it anyway. It’s already quite usual for people to travel halfway round the world to get the surgery they need, there’s only a handful of specialists with a good reputation and extensive experience, and you only get one shot. Sex Reassignment costs about $20,000 and is usually explicitly excluded from insurance policies. The extra $3000 for travelling to Canada, Thailand or wherever is only a small additional burden. Facial Feminisation Surgery is even more expensive, up to double that, and again, not covered. Many need it in order to avoid active and violent persecution. Electrolysis takes years, and for some, is the most expensive part of the process. 400 sessions at $100 a session soon adds up.
Not everyone can afford it. They tend to die. Many are unemployable, and so engage in survival sex work. This is particularly true of the teenagers thrown out of home for “dishonouring the family name”. Most die from HIV or drugs, but murder and suicide are also leading causes of death.
In my experience, about 1 in 8 i this situation survive to age 30. I’ve seen far too many die this way. Parental support is a literal life-saver.
Those who do engage in survival sex work and live to tell the tale tend to start when they’re older, in their 30’s at least. Going from a 6 figure salary, then losing everything, pension, house etc in the divorce and having a huge alimony and child support debt, while not being able to get even a minimum wage job leaves little choice. While they’re pre-op, they’re “exotic” enough to command high prices. They save, then get the surgical works, and get a new “stealth” life, sometimes in their old careers.
The second issue is that, in general, those who don’t need surgery aren’t the ones who have “gender issues”, it’s everyone else who has issues with them.
Some are quite happy with their unusual situation, and if it wasn’t for all the legal and social hassles, there would be no problem.
I’ve always found the concept of “normal” a pretty useless one.
You only have to look at the people who rely on the idea and bandy it about to see that it is far more about enforcing behaviours – the “norm” bit – and about demanding that reality conform to a simplistic set of ideas than it is about explaining the facts. Cutting the foot to fit the shoe, if you will.
There is no mad scientist in a laboratory somewhere maliciously creating the Zoe Brains and M A Jeffs of this world. They happen naturally. Therefore they are normal.
Therefore, GE @ 64, your assertion that there are precisely two genders and that each is absolute does not fit the facts as known and may require of you a bit more thinking.
Steve LaBonne says
People often say this kind of thing and believe they understand what they’re saying. But what exactly are these “norms” and “level” of which you speak? Nobody who knows a fair amount about developmental biology would take such a dogmatic essentialist view. Biology (and certainly, the development of sexual characteristics in humans) is much more complicated and fluid than that. I’m afraid this kind of comment really represents a pre-scientific level of thought, one which unfortunately is deeply embedded in our social norms.
Jenny @ #65: I deeply respect the testimony of your personal experience. The trouble is, there are equally impassioned pleas AGAINST surgical gender assignment in childhood from people who ended up in what they deeply believe is the “wrong” gender for them. If I were a parent trying to make a decision on this for my child, I think I would be in despair at the conflicting advice from those who have actually “been there”.
But that’s very much part of the problem. There’s no genuinely good reason (just bad ones) why a birth certificate should have to have a sex on it at all. A name need not be gender specific (and the parents’ details belong to people allegedly adult enough to have a child and to have come to terms with their own identities and responsibilities). Sexual discrimination is made much more possible by the way sex is obsessively, and in some cases wrongly, documented.
I think Gregory understands that biologically the line between male and female is not as neat as we often think. But then, that would seem to be his point – it is practically accepted that you are either male or female. Most cultures don’t even have words to describe anything else, except as medical conditions. Think about it this way – when you see someone in the street, gender is practically the first attribute that you decide for them, as they come into focus, because it is such a pervasive way to see the world.
As for my own account, yes, I’m aware that there are plenty of people that were re-assigned as children that have made impassioned pleas to stop the practice – but there are several problems with this.
The first is that the data is anecdotal. there are not (as far as I am aware) any studies that have done systematic follow ups, so we don’t know how many people are perfectly satisfied by the intervention. The same works for the cases of non-intervention, only even more so.
The second is that non-intervention is a fairly recent approach to this problem. Or rather, there was a period starting in the 60s where we finally acquired the medical possibility to do something for intersexed cases, and from then until around about the mid-80s, it was standard procedure to intervene. My parents were fairly avant-garde, I was born in 1974, but they took the decision against the medical advice of the time to leave me as I was. Those that were left as is, like me, will be starting to appear in greater numbers as adults around about now, and I suspect that you’ll see a substantial increase in people echoing my experience, now that that approach has become more popular.
It is a rare child that has the strength of conviction to handle being ‘weird’ without coming through the experience without being screwed up in some way or another. This is probably the crux of the matter from my point of view – I always wonder if those that were re-assigned as children appreciate just how hard it is to grow up as ‘in-between’. They look back as adults and can say that they would have preferred that their parents had made another choice, but they can’t truly evaluate what it must be like to mature as I did. But I, as someone that had to change gender anyhow later on in life can tell you that that process is infinitely easier to handle than growing up a ‘freak’ (and yes, you do get called that, kids are very non-PC).
Anyway, I don’t think there is a right answer to this problem. Basically all the options available suck in one way or another. My post was made more because I feel that the perspective of those like me that weren’t reassigned as children has not yet been heard in this discussion.
Steve LaBonne says
And you made it heard very eloquently- thank you.
Zoe Brain says
Jenny #65 – sorry for asking personal questions, but at what age did you realise that the assignment as “boy” was inappropriate? I realise that it’s probably an age range, “suspected at age X, thought at age Y, knew at age Z”.
The reason I ask is that you shouldn’t have had to wait till age 24, if you knew at (say) 16. Or even 10.
If I had been on your medical team, I would have recommended you be allowed to change presentation as soon as the “boy act” became uncomfortable. That doesn’t mean surgery or hormones, except possibly gonadotrophins to put puberty (either way) in deep-freeze till you figured things out.
My condolences, anyway. I don’t know just how hellish it must have been for you, as my body is by no means petite. 5′ 6″ but a 45″ ribcage. My problem wasn’t not being unconvincing doing the boy act, it was that transition to look remotely normal was impossible, it would have taken a miracle. Which I got, but at age 47, not age 13.
Cross-gendered people, no matter what their appearance, do have problems at school though, anyway. They “vibe wrong”. I have some idea what you went through – see the very last part of BiGender and the Brain. It might also explain why I was never attracted to boys either. That didn’t change till I was 48.
And think on this – how much worse it would have been if you had been surgically mutilated to become a “normal male” shortly after birth, thereby making surgical transition to the correct gender more difficult, or even impossible. I deal with cases like that every day. They had all the difficulties you did as well.
I’m against surgery without informed consent. But you were able to give that consent long before you had surgery authorised. Both situations are wrong, and I’m so sorry you had to go through that. I can but hope that your life since then has made up for it, in part anyway.
Hyman Rosen says
One thing people should take away from this discussion is its correspondence to religion and atheism. It’s that regardless of how people would like things to be, the universe doesn’t give a fig for the categories that people invent. It goes along doing its own thing.
penis? clitoris? Where’s the imaginary line between the two?
To be purely mechanical about it, one encloses a urethra the other does not. Doesn’t it?
One thing I haven’t seen mentioned is the prostate, what is the female equivalent? How do AIS and all these other conditions affect its development?
I have a question about the Lipitor story. I am a little confused about why shutting down cholesterol production would only affect testosterone production and not estrogen. Aren’t both hormones derived from cholesterol? Just asking to clear up my misconceptions as I am just a EE with very little biology background.
My path was a bit more complex than my first post indicated – I was already living a very gender-ambiguous life by the age of 17 (as soon as I finished high-school I ditched the male persona, at least unofficially). I officially changed name/gender at the age of 22, and had surgery at 24, largely because it took that long to get the money together.
I don’t know that it would have been any better having the surgery a few years earlier. If you can’t avoid having to grow up in between, I feel you should probably wait until your hormones have settled down a little.
Anyhow, I came through it all more or less intact – I certainly have a life that is about as normal as that of my brothers – good career, stable relationships etc, so I guess you could say that that in itself is a validation of my parents decision. I just wish that the first 20 odd years didn’t have to have been so painful.
I’ve always found the concept of “normal” a pretty useless one.
“What is ‘normal’?”
“‘Normal’ is what everybody else is, and you are not.”
I can understand the sentiment that “normal” is often misused but it does have a useful meaning to identify an “feature” of the range of variation of something. The problem is when people start putting a value judgement on that “feature”.
You only have to look at the people who rely on the idea and bandy it about to see that it is far more about enforcing behaviours – the “norm” bit – and about demanding that reality conform to a simplistic set of ideas than it is about explaining the facts. Cutting the foot to fit the shoe, if you will.
There is no mad scientist in a laboratory somewhere maliciously creating the Zoe Brains and M A Jeffs of this world. They happen naturally. Therefore they are normal.
No, it means they are natural, not necessarily “normal”. The problem is that too many think that “not normal” is a Bad Thing. But that doesn’t mean we should abandon the concept of normal entirely, just the concept that “normal=better” or “correct”. Normal is just a statistical function that should not imply anything about someones value as a human being.
Not to diminish your story (it is a fascinating one, to be sure), but I think a lot of people would say this same thing. High school years are painful, in lots of ways and to different degrees, for a large number of people. Could it have been less difficult? Probably, but maybe not as much as you would hope. Moreover, there is the even more serious issue of, how much worse could it have been if you had had the wrong determinating surgery when were young? This is a good question, is it better to make a call and be half wrong and half right, or not make that call at all and always have the issue be there?
I’m glad you are doing well now.
thx for sharing this with us.
At that same age, I was already very masculine, I was already attracked to guys, but I didn’t want to be seen as gay, so I pretended to be straight. Which worked for about 15 years, until I couldn’t anymore.
I always ask myself, what would have happenned if I hadn’t had to fear the reactions of being known as gay.
Allthough our stories are completely different there is a common question : what would have happened if others could have simply accepted the way we were, different from the norm ?
Do you think that, if this were to be the case, not reassigning children is the right thing to do ?
Gregory Earl says
Jenny (#65, 70, 75), thank you for sharing your story. It seems that intersex conditions (or whatever else you call them) are going to cause identity issues whether or not they are surgically treated. If you don’t mind my asking, do you think it would have been easier for you if your parents and other people around you had simply not assigned any gender role at all to you while you were growing up, but had treated you as someone who is neither male nor female?
I see what you are getting at, and I have often remarked to myself that I only needed to go through surgery so that I was a better fit with what everyone else expected, not for any need of my own.
I note that in the rare societies where there is a recognised third sex, this is generally linked to a genetic abnormality that raises the probability of having an intersexed condition. In these societies, people are forced to confront the fact that male/female is not the whole story on a regular basis, and they have adapted to it. So yes, in this hypothetical situation, I would agree with you that the child should be left to develop naturally.
But I also note that where a society is not suffering from a genetic mutation that increases the rate of intersexed people, that anyone that doesn’t fit into the male or female boxes is treated as a pariah, an outsider. In such a society, I think it is a cruel thing to leave a child outside the social norms when you could make them fit in. If they decide later on in life that they want to change gender anyhow, I feel that we just have to hope that medecine is up to the task of making that possible for them.
I think my answer to negentropyeater at #80 answers your question too :-)
I think the cause of the LGBT people (and now I think of it, we should definitely add an I, LGBTI people), is a common cause, to get people to accept that there aren’t simply two boxes M, F, but so many with many shades of grey.
If we can succeed on doing this, even if the % of I in a society is very small, I don’t think there should be the need for normalization imposed by the parents.
Zoe Brain says
Using neurological criteria alone, there’s some reason to believe that reassignment to an arbitrary gender would be relatively successful 2 times out of 3.
You can up the odds a bit by taking into account other factors and the exact nature of the condition. For some conditions degree of masculinisation or feminisation biases the odds (eg CAH), but in others (eg 5ARD, 17BHDD) it makes zero difference.
The trouble is, the odds then gets decreased a bit by those who are naturally neither M nor F. A-gendered rather than Bi-gendered.
Wait until the child can tell us what gender they are, and the proportion of successes rapidly approaches unity.
Steve – re #74
Re urethra in the penis – not in the case of severe hypospadias (whether or not associated with hypogonadism), it isn’t. A male can be born “generously endowed” and have a urethral opening closely approximating a female position – which rather screws up the scrotal morphology.
The female equivalent(s) of the Prostate are the Skein’s glands. Wikipedia has a List of homologues, male and female equivalents.
As regards cholesterol and glandular shutdown – the adrenals stopped over-producing cortisol. This led to a rapid (> 1lb day) decrease in weight. Fat cells sequestrate oestrodiol, so I had a huge bolus of it enter my system. I had near-zero Testosterone production, near-zero oestrogen production, but many years worth of excess oestrogen dumped into my bloodstream, hitting cellular receptors that were chronically starved for any hormone. We think they are only sensitive to T-like analogs rather than Testosterone anyway, but if so, my adrenals were no longer producing those either. It was a hormonal “perfect storm” and it darn near killed me. It is conjectured that it may be more common than supposed, but surviving it is really rare.
This is all surmise and guesswork. To see the results, have a look at this sequence of photos. Now hormonally-triggered change can’t act that quickly, unless there’s something else anomalous.
Jenny – re #75
Surgery is not required to adopt a different gender role, though being pre-op can cause complications. Really, the best person to make the judgement is the patient, and the best thing a therapy team can do is to avoid permanent changes – including natural pubescent ones – until the situation clarifies. In your case, with hindsight, it would have been better if you had transitioned in a social sense earlier. You would have had a normal adolescence. In other cases, with the same external appearance to a therapy team, such an experimental transition to female would soon have been reversed, and either a male or andro role adopted. though that would be rare, I know of no cases past age 14, and few past age 10, where that’s happened, at least, when the cases were handled correctly. The Dutch team handles transitions as early as 10, and have had a 100% success rate.
Steve M – Re #76
I prefer “ordinary” and “extraordinary”. :) But I’ll answer to “abnormal”, “anomalous”, and in exceptional conditions, “Freak” too. The last time anyone called me that, it was my GP. We were laughing together in disbelief as we reviewed the time-series of blood-tests, showing a pattern not described anywhere in the literature.
I will never be an ordinary woman, and yes, I have some pangs there. I missed out on a normal girlhood, young womanhood, motherhood, and that last particularly pains me. Even though I was present at the birth of my son, and almost shrieked at seeing the epesiotomy scissors. It should have been me….. I got a triple dose of maternal instinct in my psychological makeup.
But I do have a son, regardless of exact mechanism, and considering how totally bollixed up my metabolism is, no matter whether you consider M or F to be the norm, that is miraculous.
I took the scenic route to womanhood. I’ll never be an ordinary woman – but I reckon I have a decent shot at being an extraordinary one.
… so that there’s no longer such a blight on the BLIGhT people. Hey, there’s even room for Heterosexual in that acronym – if y’all think heterosexual people also ought not to be treated as though they’re monstrous, strange or abnormal. ;-)
If buying enriched foods implies that people aren’t getting adequate nutrition, then vegetarian and vegan diets aren’t any more nutrition-poor than omnivores’. Calcium-fortified cereals, orange juice and breads and are not specialty items for vegetarians; they’re purchased by everyone. It’s difficult now to find cereals that are not calcium-enriched. Regarding calcium pills, for years “the message to women was that everyone over age 50 or so should be taking the supplements”, but that recommendation, and subsequent buying habits, have never implied that the average woman over 50 has an unusually poor nutritional intake. Your reasoning just does not follow.
In truth, most people have poor nutritional intake. Calcium intake among adults is “low enough for concern” according to the US HHS, and many doctors recommend multivitamins for everyone.
Most people in first-world nations do not take seriously the possibility that they might not be getting good nutrition, and should consider supplements. A nice thing about vegetarian diets is that they so often come with this caveat. Vegetarians should pay attention to their nutrition, but so should everyone else.
Anyone eating fish or poultry is not a vegetarian. Whatever their dietary needs, they are not part of this discussion.
Non-vegan vegetarians, who eat eggs and dairy, tend to do so out of an erroneous assumption that this diet is “enough” to help animals. That’s got nothing to do with nutrition, and everything to do with making excuses.
Liberal Atheist says
Thank you for this blogpost, very good.
That was actually my point if you go back and check! It’s quite a likely reason for vegetarians to appear to be healthier than omnivores in some studies – because the vegetarians are aware of the need to take greater care.
There was an informal TV experiment in the UK in which a prominent athlete gave up meat for a (carefully supervised) vegetarian diet, while a bunch of sporty vegetarians were supposed to try various meats over the same period. The athlete was quite surprised at how much worse he performed as a veggie. Meanwhile, only one of the vegetarians managed to behave properly at all and stick to the meat-eating deal – and she performed much better afterwards than previously on her all-vegetarian diet.
Whereas various others are equally vehement that the suggestion of normal people needing supplements is rubbish and quackery – and some studies (of normal people who were eating basically healthily) have supported that view. People with specific food/health issues are of course another matter and may well benefit from supplements.
Longtime Lurker says
Another great post by MAJeff,OM! I have been fascinated by this topic since becoming aware of the “guevedoce” phenomenon in the D.R. I have also been privileged to see a large collection of Lepidopteran “gynanders” while in school.
The dichotomous view of sexuality is based, like many wrong assumptions, on “common sense”, rather than rational consideration of the nature of gender. I think a “spectrum” view of sexuality is better than a dichotomous view of sexuality, but we only have a few millennia of authoritarian patriarchy to contend with. Just hearing how the media deals with nuance in politics makes me realize that ambiguity in gender is “not ready for prime time”. As far as gender assignment surgery goes, what if the parents get it “wrong”? Unfortunately, the shift in perspective that would give intersexed persons freedom from bigotry is a long time coming.
Not to seem flippant, but here’s “Androgynous” by the Replacements… sure, on first listen it seems like a novelty tune, but at its heart it is a plea for tolerance:
Gregory @#64 said:
“Now, and this is a real (not a rhetorical) question, do you honestly believe that male and female sexes are on the same level, from a biological perspective, as all the sexes that might exist between the two?”
Steve LaBonne’s response @#68 is well put, and I would like to add that in practically all sexually dimorphic plants and animals there are incidences of intersexuality/hermaphroditism, not to mention certain species where hermaphroditism is the norm and hermaphroditic self-fertilization can occur, as with the Banana Slug.
Even in higher mammals where intersex conditions often cause sterility, there is little if any evidence to suggest that those individuals are automatically shunned or otherwise treated as defective, and plenty of situations where secondary sexual characteristics of one sex are displayed naturally in the other with no ill effect, for example female Caribou who all have antlers, or birds who are born all the same color until their first molt or where the standard of drab females and brightly colored males is reversed.
Botanists have no problem with treating hermphroditism involving practically every conceivable combination of male/female reproductive organs as just a variation on a par with male and female dimorphism…
No, it is only in humans where the notion of a “natural” gender binary is strictly enforced by scientists, and to continue doing so requires an extremely unscientific refusal to look at the mounting evidence against a binary-only paradigm reserved for humans…it was easier back in the days before genetic/hormonal testing, and when religion was the unquestionable authority, but at some point the scales will tip and no one will be able to use “science” to impose this social construct of a strict gender binary on humans and remain credible.
This is a bit off topic, but it does touch upon the issue of the effect early and severe trauma to the sex organs can have in a person’s life.
The sensational (and gory) best-selling crime writer Patricia Cornwell wrote a (supposedly) non-fiction book about “Jack the Ripper”: Portrait of a Killer a few years back. Her thesis is that the identity and history of that killer is now known and that a substantial contributing factor why he turned into such an anti-social freak was a congenital defect of the urethra, which had been repeatedly and painfully “repaired” by clumsy, savage, even sadistic surgery, leading to permanent damage.
Of course, other contributing factors to his hideous crimes were social conditions in general of London and the Victorian Empire at the time.
The story seemed rather convincing to me, but I never tried to research the background or the sources myself. Ms Cornwell can certainly write gory enough fiction tales when she wants to, so she probably has her bases covered here.
I have actually posted here under a different (my real) name, and MAJeff actually knows me in Real Life, and he also knows that I am intersex (his was one of the most amazing reactions when I told him, not to mention knowledgeable … I am so used to having to explain things to people, including doctors, that it was wonderful not to have to go into the background of things for once). I am slowly outing myself as intersex, but I am not quite ready yet to be totally out, hence the pseudonym.
I have AIS, Androgen Insensitivity Syndrome, or in a nutshell, it means my biology doesn’t react to Androgens (including testosterone) despite having XY chromosomes. The most major subcategories within the diagnosis at CAIS (Complete AIS) and PAIS (Partial AIS), I have the latter.
What this means is that thanks to having a slight sensitivity to testosterone in-utero I actually popped out and was identified as male, albeit on the really small side of things in terms of male-type genitals. And as I grew up, it pretty much stayed the same size as well, and I was brought up as a boy. However, this never really took so much, and I had a really stable internal gender identity as female.
Then puberty hit. Or rather, it didn’t. It hit for all my friends, and I got a smidge of some stuff, but otherwise not much. You can see pics of me in my late teens and I look like a 13 year old. A really androgynous 13 year old. Eventually as I started college my doctor noted that I had really high testosterone levels, but nothing seemed to be happening. I decided I wanted to take female hormones and become the chick I had always thought myself to be. So I did. Within a few months of taking the estrogen I changed all my documents and got my name changed. I was so close to presenting as female that it was kinda a non-issue anyway.
I was kicked out of home and disowned by my parents. Also I identified as lesbian, which was equally disgusting in their eyes. Nonetheless, I worked my arse off, and put myself through college, getting two bachelors degrees (one in physics!), a masters, scholarships, and am now finishing off my PhD.
The thing is, I still have the genitals I started off with. I want corrective surgery to fashion a vagina as I don’t feel comfortable with what I have. Not that there is anything wrong with having really small male genitals (think of it, guys, as putting your genitals through a xerox-machine on ‘Reduce’), it’s just not what I want.
I kinda see myself as what intersex/DSD activists are wanting. I (luckily!) wasn’t operated on, so I got to chose what I wanted and feel comfortable with. The problem isn’t surgery vs. no-surgery, but rather informed choice vs. uninformed force. The pain the majority of intersex people feel isn’t a pain based on gender, but rather in having our bodies violated, often with horrendous results, of being lied to and led astray.
Unfortunately, I simply do not have the money for surgery. I’m still a phd-student after all, and as anyone that has been through grad school will know, money is one of the least things we have in excess (along with free-time lol). The situation sucks, but insurance considers it an elective procedure … hell, grad student insurance won’t even pay for the detailed tests needed for an exact diagnosis of what exactly I have. Intersex/DSD conditions are so incredibly new that all the variations haven’t even mapped out yet.
But MAJeff is right, this is horrible surgical mutilation if it is not chosen by the individual involved. We need to fight this and expose our culture to the range of sexual embodiments, because even those that fit within the statistical averages would benefit, lessening the connection of gender to genitals, size or whatever.
I am slowly outing myself as intersex to my friends and loved-ones, having crafted a life just as a chick with no one the wiser (well, aside from the women I date, who I kinda have to tell before they see my genitals), but there are some really cool things. Despite presenting according to norms of conventional femininity (I always get seen as the straight female friend in gay events! Gah!), I do like the fact that I, for instance, can put on muscle faster than my female friends (though still not as fast as most guys) and so love my athleticism.
However, I do wish more science-based blogs would take this up, as it is really a case where scientific reality is being twisted and ignored by what is deemed culturally acceptable. And as we all know, religion has played a huge role in this.
I just wanted to add, on the general subject of “normalcy”, this wonderful synopsis by the late, great Robert Anton Wilson in his essay on the founding of a “Committee for Surrealist Investigation of Claims of the Normal”:
“No normalist has yet produced even a totally normal dog, an average cat, or even an ordinary chickadee. Attempts to find an average Bird of Paradise, an ordinary haiku or even a normal cardiologist have floundered pathetically. The normal, the average, the ordinary, even the typical, exist only in statistics, i.e. the human mathematical mindscape. They never appear in external space-time, which consists only and always of nonnormal events in nonnormal series.
Thus, unless you’re an illiterate and malnourished Asian with exactly 1.04 vaginas and 0.96 testicles, living in substandard housing, you do not qualify as normal but as abnormal, subnormal, supernormal, paranormal or some variety of nonnormal.”
David Marjanović, OM says
Read any of the previous circumcision threads. There has perhaps been a dozen here on Pharyngula.
Let me just second that. Having red hair (outside of Ireland) and being a nerd, I was the target of constant derision for the first eight to nine years of school. I’m actually surprised that nobody ever claimed I was gay — I’m an asportual male and very clearly on the wimpish end of things. (While homophobia over here AFAIK isn’t what it’s like in the US, due to the lack of religious overtones, I bet my dear classmates of both genders would have jumped at any perceived opportunity to make endless fun of any perceived possible gay.) Take-home message: if you aren’t very close to the average of your self-proclaimed peers in all respects, you will be made fun of in school, and that likely for years and years.
Heck, even if not, you can expect high school to be hellish. It certainly doesn’t help that it overlaps a lot with adolescence.
It’s just an awkward time of life for anyone. Even if you aren’t being laughted at, it is common to feel as if you are.
Nick Gotts says
The fact that (in the UK at least) vegetarians have to go to some considerable lengths to acquire calcium-enriched soya, nuts and similar foreign supplements to survive reasonably healthily and that most vegetarians allow milk, cheese, eggs, fish and poultry to count as “vegetables”. – SEF
Neither of these “facts” is actually true, AFAIK. Most vegetarians do eat milk products or eggs, but someone who eats fish or poultry is not a vegetarian; and few in my experience eat much soya – that’s a meat eater’s myth, based on the belief that if you don’t centre a meal on a piece of meat, you must centre it on a meat substitute like a soya “steak”. I suggest you take a look at “Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets”:
I quote from the abstract: “A vegetarian, including vegan, diet can meet current recommendations for all of these nutrients. In some cases, use of fortified foods or supplements can be helpful in meeting recommendations for individual nutrients. Well-planned vegan and other types of vegetarian diets are appropriate for all stages of the life cycle, including during pregnancy, lactation, infancy, childhood, and adolescence. Vegetarian diets offer a number of nutritional benefits, including lower levels of saturated fat, cholesterol, and animal protein as well as higher levels of carbohydrates, fiber, magnesium, potassium, folate, and antioxidants such as vitamins C and E and phytochemicals. Vegetarians have been reported to have lower body mass indices than nonvegetarians, as well as lower rates of death from ischemic heart disease; vegetarians also show lower blood cholesterol levels; lower blood pressure; and lower rates of hypertension, type 2 diabetes, and prostate and colon cancer.”
As for your “informal TV experiment” (a) That’s worth precisely zero scientifically and (b) athletic prowess is not the same as health: women have on average less athletic prowess than men, but live longer. Ditto for short people (within the normal range) and tall ones.
Disclosure: I’m not a vegetarian, but don’t eat tetrapods – I just prefer not to eat close relatives.
Yet they self-identify as such! Any who only add the milk and eggs are also not “true” vegetarians either (for which one would really have to be vegan – and even then need a special dispensation to allow fungi to count!) but there are many more of these types than there are vegans.
Perhaps that’s a UK vs US difference then, since the ones I know here do eat soya – though not at all necessarily soya made into fake meat (as you seem to be implying). Just soy products in general – soy milk, beans, tofu etc.
ie necessary cheating – of a form which is only possible at all in the modern artificial environment.
Some references, which might be appropriate:
A while back, I found this. The website itself is long since gone, but the archive remains.
Androgyny RAQ (Rarely Asked Questions), by Raphael Carter.
Also, in Armand Leroi’s Mutants there is a chapter called “The Desire and Pursuit of the Whole”, on development and gender.
Zoe Brain says
Hi Rebecca! Re #92
Congrats on getting this far, and good luck with the thesis. I’m doing a PhD myself, but after over 25 years in Industry. The medical issues that cropped up in 2005 put a dent in my savings, and the surgery wiped out the rest, so I feel your financial pain. I’m on a subsistence-level scholarship, nicely calculated to be $200 per annum above what I’d need to qualify for social security (equivalent of food stamps etc).
TMI WARNING – Lurkers may not want to read further –
As you may have found out, the matter of which surgeon to choose is often one of religion. Every woman claims that her surgeon is “the best”. You do only get one shot at this, after all.
For those with normal anatomy, I recommend either Brassard in Canada, or Suporn in Thailand. Chettawut and Sanguan in Thailand are also good choices.
For those of us with a depth rather than a length though, IMHO Suporn is, if not the only choice worldwide, certainly the best. He’s the most expensive surgeon in Thailand, but you get rather more than you pay for. Depth may not be that important to you because of your orientation, but he’s unparalleled for both sensation and cosmesis. The procedure is rather more invasive than most though, so recovery times are longer. He re-structures the whole area, changing the geometry. You really need to spend the full 4 weeks in Thailand.
His pre- and post-surgical care is wonderful, the best, no question. He also gives a lifetime guarantee of his work – he fixes any problem free, and will even give cosmetic touch-ups likewise.
My anatomy at full extension was approximately the size of the surgeon’s thumb according to the photos. Usually fully retracted internally. So hypogonadism is not a problem for him, while it can require bowel resection (ewwww) and other heroic techniques with other surgeons. His website gives more details. Budget on about $20,000, so it will probably be out of reach for the immediate future. But please keep him in mind. He really is the best for those of us with PAIS or similar conditions.
Post-operative orgasmic response is historically 90% for those orgasmic pre-operatively, and 40% for those who were anorgasmic pre-operatively, like me. I lucked out :) and now see what all the fuss is about sex. As in OMG!!!!
You may have read that about a third of women change orientation after surgery, most often about 6 months after, usually from lez to straight or bi. You have to be prepared for the possibility. Yes, that happened to me too, and I wasn’t. Prepared that is. I thought that couldn’t possibly happen to me. Oops. Fortunately Dr Suporn managed to give me a 7.5″ depth. Most other surgeons would have given perhaps 4″, and only be using a section of the colon, with attendant risks. NOT recommended.
As regards letters of authorisation, the Standards of Care etc, while Dr Suporn really prefers at least one letter from a specialist, he’s flexible, and it only has to cover the facts, not conform to any particular format. This is especially true in cases of Intersex, where the proper DSM-IV diagnosis is GIDNOS not GID, and the SOC isn’t supposed to apply. He follows the spirit of the SOC very closely, but not the letter, seeing it as the guide it’s supposed to be.
You may find other surgeons, especially in the US, are rather more .. inflexible. But I’m sure you know all this.
Feel free to contact me with any questions you might have. Surgery may seem a long way off, but you really need to start preparing and researching well in advance.
I’ve, er, seen 4 Suporn results and 5 Brassard results “in the flesh” as it were. That’s more than most, as you can imagine. The shots at Anne Lawrence’s of comparative SRS results are accurate, though I think Brassard has better cosmesis on average than his examples would suggest, comparable with Suporn.
And if anyone had told me in 2004 that within just 4 years I would be doing research and even giving advice on this subject, I would have considered them absolutely insane.
Alan Kellogg says
How do you feel about taking donations? Zoe largely financed her surgery through donations.
If donations are fine by you, what are the best ways to send money to you for the surgeries?
How is your PHD work coming along?
My apologies for not replying earlier, but my old ibook is in getting a new fan installed (amazing the crashing overheating repeatedly causes) so I had to wait for my roommate to get home with her computer.
I’m never really completely fine with accepting money (ask anyone I know, I am totally a cliff-bar and yoghurt eater if need be) but in certain cases I know I need to suck up my pride and do what is necessary for my future. Hence accepting donations. However, I honestly don’t know what the best way to send me money is though, as I don’t have a paypal account at all, even under my real name.
Does anyone have any suggestions? Do you, Alan? I’d welcome any ideas.
As to the PhD, it’s going okay. I am about to defend my dissertation proposal, which will make me ABD, giving about a year and a half to go till I am all done hopefully (with a bit of added wiggle-room if necessary), and I am instructing/lecturing. Honestly, I just want to be done, which I am sure a lot of people here will appreciate *smile* I’m a bit over being a student. Not to mention the ‘poor’ aspect is getting a little long in the tooth.
Neg: “now I think of it, we should definitely add an I, LGBTI people”
if we get another vowel in there we can make it into a pronouncable word. I don’t think BLIGHT is right, SEF… entirely the wrong message.
Khan: sorry it took me so long to reply… two of my best friends, who I flirt with all the time and who would long ago have put a permanent grin on my face if they didn’t live half a world away, are 15 years older than me (I’m 20). Age isn’t important. Attitude is.
Zoe Brain says
Alan K Re #99
Er.. the donations helped. They paid about 1/6 of the costs of the medical tests before surgery, about $800. I’m not complaining, and there are informal donation funds to help people. They tend to run into the hundreds of dollars though, rather then the tens of thousands.
People will often offer unsecured no-interest loans for surgery to good prospects, with the proviso that they repay to the next gal who needs surgery, a revolving fund. This way those with good employment prospects don’t have to wait till they’ve accumulated funds, but can get surgery (and take the time off) before starting a new job.
Well the obvious one you’re missing is A for Asexual – people with no particular sense of gender and/or with no interest in any sex. However, GLBTIA has no particularly good anagrams. Though TAGLIB is at least pronounceable.
PS It’s a shame you don’t like “BLIGhT” because it leads nicely to things such as BLIGhT-Ed (education on BLIGhT issues). But it’s undoubtedly one of those “can’t please all of the people all of the time” situations.
Trying out the addition of Asexual while still allowing Heterosexual to be included:
GLIB HAT (ie Gay, Lesbian, Intersexual, Bisexual, Heterosexual, Asexual, Transexual)
or, letting in extra letters for slogan purposes, perhaps “HALT BIGotry”?
Grammar RWA says
The letter A sometimes does double duty, sometimes for Asexual people, more often for straight Allies.
It doesn’t really matter how you call it, once people accept that humans don’t naturally just come in 2 boxes, one M = “normal male with a 4-8 inches erect penis, attracted to normal female”, and one F= “normal female with a clitoris, attracted to normal male”, most of these issues will be solved…
Hyman Rosen says
I invite you to notice, especially those of you who are of the “religion is the root of all evil” bent, how group formation and inter-group hostility and doctrinal purity are showing up in this thread.
“Vegetarians who eat dairy are making excuses/common”
“normal people needing supplements is rubbish/common”
“circumcision is/isn’t like FGM”
Just saying. You might want to be aware of the mote in your own eye before heading off to de-beam someone else’s.
but seriously… the difference is that our group has people in it who say stuff like that, and DON’T get shouted down for heresy, except in really sarcastic cases.
Nick Gotts says
The fish/poultry stuff must be another US/UK difference, because I’ve never come across any. And talk of those who eat eggs/milk products not being “true” vegetarians is just silly – you’re just trying to change the meaning of the word, when there’s a perfectly good word “vegan”, that has the meaning you want to change it to.
I used that one too – go back and read properly.
Because that isn’t true. So evidently you don’t get it at all! The truth might not matter to you but it does matter to me.
Incidentally, my sympathies are actually more with the fruitarians – since I don’t regard vegetables as being willing to be eaten any more than animals are. I happen to be an obligate carnivore because of my unusual circumstances (I’m really and truly not in the remotest bit normal on just about anything you might care to measure) but I do aim for a minimum of waste of all kingdoms of life.
If a lion doesn’t care if what it eats is willing to be eaten, I won’t either.
Nick Gotts says
I know you did. That’s what’s so silly – you’re trying to make two words that mean different things, mean the same. As to you not disliking vegetarians, I just don’t believe you. What you’ve said has made your dislike quite clear.
Nick Gotts says
If a lion doesn’t care if what it eats is willing to be eaten, I won’t either. – wazza
Right. And presumably, you think it’s OK to acquire sexual partners by violence against their former partners, then kill your new partners’ young children – because lions do that too.
To be clear, I’ve absolutely no problem with non-vegetarians, being one myself – I just dislike stupid arguments like wazza’s and SEF’s.
Except that it’s a matter of fact that you are wrong on this. So your ability to judge is clearly very poor.
Once again, since mine aren’t stupid and yours are, it’s your own ability to judge which is defective.
Here’s a UK example from the BBC:
but I happen to know it is/was true of Indian “vegetarians” too.
The only reason the term “vegan” had to be invented at all is because so-called vegetarians have nearly always routinely cheated on what they, by the nature of the terminology, should have been doing. And the different ways in which they cheat according to local expediency is very reminiscent of the “Christian” church, eg beaver = fish! Basically, anyone calling themselves a vegetarian may be consuming quite a lot of animal material which will differ from the subset consumed by another self-styled vegetarian. The term borders on meaningless (like Christian).
Nick Gotts says
Your point about the BBC-reported survey is valid – I can only think I haven’t come across a fair sample.
The only reason the term “vegan” had to be invented at all is because so-called vegetarians have nearly always routinely cheated on what they, by the nature of the terminology, should have been doing.
This is the basic nonsense that you keep repeating. Since there are a lot of people who don’t eat flesh, but do eat eggs and/or milk products, a term is needed to describe them. That term happens to be “vegetarian”. In fact, you have the history and etymology hopelessly wrong. Here’s what the International Vegetarian Union says (
The term ‘Vegetarian’ was coined in 1847. It was first formally used on September 30th of that year by Joseph Brotherton and others, at Northwood Villa in Kent, England. The occasion being the innaugural meeting of the Vegetarian Society of the United Kingdom.
The word was derived from the Latin ‘vegetus’, meaning whole, sound, fresh, lively; (it should not be confused with ‘vegetable-arian’ – a mythical human whom some imagine subsisting entirely on vegetables but no nuts, fruits, grains etc!)
Prior to 1847, non-meat eaters were generally known as ‘Pythagoreans’ or adherents of the ‘Pythagorean System’, after the ancient Greek ‘vegetarian’ Pythagoras.
The original definition of ‘vegetarian’ was “with or without eggs or dairy products” and that definition is still used by the Vegetarian Society today. However, most vegetarians in India exclude eggs from their diet as did those in the classical Mediterranean lands, such as Pythagoras.
In fact, we need more distinct terms, to cover those who don’t eat tetrapods, like me, or don’t eat mammals. I imagine that is why some people who are not vegetarians by the original and still most common definition, use the term of themselves. Your fixation on terminology, and insistence that anyone who doesn’t use it in the (historically and etymologically unjustified) way you prefer is “cheating”, is absurd.
Your original claim was that a vegetarian diet provided poor nutrition. When I gave a reference from relevant experts showing this was not the case, you shifted to arguments about terminology, an implicit claim that “can be useful” means the same as “necessary”, an explicit claim that using dietary supplements is “cheating”, and irrelevancies such as the fact that the diet of most modern vegetarians would not have been available in the past. Those are what I mean by stupid arguments. The only consistency has been an apparent aim to discredit vegetarians in some way, hence my conclusion that you dislike them, which is justified by the evidence no matter what you may say.
that’s your objection to my throw-away line?
I can think of maybe ten objections that work better…
SEF: you need to actually prove that your arguments are better before you can say they’re better.
Personally, I’ve always favoured the majority rules view of language: whatever most people use wins. And vegetarian, to everyone I know, is someone who won’t eat any product that was produced by killing an animal, but will eat something produced by another animal, such as eggs and milk (both of which are enormously surplus if the farmer knows what he’s doing)
Eggs, for example, are just produced by chickens regardless of whether they’re fertilized or not. Keep a whole lot of hens in a pen and feed them (don’t forget a little crushed shell to keep their calcium way up) and you can guarantee that they’ll produce an egg just about every day. Something’s got to eat those eggs, or they’ll be wasted, and it might as well be the humans who are providing their food. Symbiosis, you see? We give them basic food, they process it into proteins and give it back to us in concentrated, delicious packages. We also protect them against predators, and in return, maybe, every once in a while, we predate them ourselves, in a quick, clean and merciful manner. Maybe.
They hadn’t actually been proven faulty in the first place. The healthy vegetarians are the ones who have to go to great modern cheating lengths to be healthy. Nick did nothing to disprove that at all. He merely claims, falsely, to have done so.
That can’t possibly be the definition since then everyone would be a vegetarian – since they either do or don’t consume eggs and/or dairy products! :-D
That bit’s a strawman invention of the vegetarian society. The traditional game of animal-vegetable-mineral makes it clear that any plant product would count. Additionally, it’s entirely reasonable to allow vegetarians the inclusion of minerals such as water and salt since (in that old hierarchical view of things) they are of lower status still. Plus I’ve already mentioned the understandable miscategorisation of fungi.
However, the reality of the situation was and is that self-styled “vegetarians” around the world not only consume dairy and eggs but also fish, poultry and, I think, insects and quite possibly crustaceans(?). The coastal “vegetarian” Indians routinely eat fish (or other sea food). The inland ones would eat chickens – just not to the overconsumption extent apparently seen in the obscenely rich West. I didn’t pay enough attention to the insect consumption myself and don’t recall my grandfather remarking on that either from nearly a century before.
Which in the real world I know means including fish and poultry (variably) too.
Nick Gotts says
The link to the IVU I provided showed that the etymology of “vegetarian” is NOT what you thought it is, and that the word when first used, included those who ate milk products and/or eggs, so people who call themselves “vegetarian” but eat these things are not “cheating”. You evidently think you have the right to impose your preferred definitions of words on everyone else, despite both history and current usage. News flash: you don’t. The dietetic link I provided showed that vegetarian and vegan diets are nutritionally fine, and indeed are associated with lower levels of various health problems, with the minor caveat that supplements “can be useful” to reach recommended levels of certain nutrients. Not “are essential”. Plenty of vegetarians don’t use them, and remain healthy. In any case, since nothing in vegetarianism precludes the use of supplements, using them is not “cheating”, provided they are made without the use of animal products acquired by killing the animal.
NB, in case it isn’t obvious to the hard of thinking, that’s also a somewhat dubious start to such a definition since it should evidently include whole, sound, fresh and lively oysters etc. Whereas “vegetables” (ie all plants) are considerably less lively and not necessarily fresh, sound or whole either (indeed rhubarb would be rather poisonous whole!).
Untrue. I’m the one who is talking about the real historical and the real current usage, whereas you are the one trying to impose one particular “authority’s” view. Real self-styled vegetarians around the world (including the religious types which existed long before the term was coined) did and do variably include fish and poultry etc in their diets. Modern ones include artificial aids.
Not cheating on being a vegetarian (since “minerals” are already obviously valid inclusions) but cheating on the being healthy with it. You are still dishonestly arguing a strawman version of my actual position (and having to go to considerable lengths to do so, since my actual posts are fairly clear on the matter).
PS I’d better repeat this part too since I’m sure you’ll be ignoring it: also cheating in the health stakes by obtaining foods from around the world in an unsustainable (unhealthy for the planet and ultimately the individual) manner.
The question goes back to why someone might regard themselves as being morally superior for being “vegetarian” (as well as the thread-topical issue of what constitutes a “normal” vegetarian). The milk and egg inclusions are already morally dubious since they generally come from the same harmful-to-animals practices as the milk and eggs of non-vegetarians.
Nick Gotts says
Real self-styled vegetarians around the world (including the religious types which existed long before the term was coined) did and do variably include fish and poultry etc in their diets.
The term “vegetarian” was first used, and defined, in 1847. So no-one before then could possibly be a “self-styled vegetarian”. When coined, it meant those who do not eat animal products obtained by killing the animal, but its etymology is nothing to do with “vegetable”. Even the survey you cited showed that the majority of vegetarians surveyed do abide by the original definition, so it is, in the UK at least, where the term originated, also the common usage among those calling themselves “vegetarian”. What on earth can you possibly mean by “cheating on the being healthy with it”? The simple fact is that you can be healthy on a vegetarian diet, including one without any supplements, as if that were relevant. Cooking is artificial – so all the meat-eaters who don’t take their meat raw, are by your lights “cheating on being healthy with it”! I’m done responding to your idiocy here.
Untrue – you even already admitted yourself that the concept of vegetarianism existed before someone decided to try and claim ownership of it. Hoist with your own petard! And, as previously mentioned, I find their claimed word derivation highly contrived and inappropriate for what they wanted it to signify anyway (like the typical very contrived acronym to make a word). The fact remains that neither historically nor currently does that “authority” genuinely own what vegetarianism means to real people in the real world.
About the only consistent element to vegetarianism is the abstention from meat in the sense of the flesh of mammals. Which, interestingly enough (and perhaps even suspiciously so) matches up very well with the way ill-educated and unthinking people will only generally list mammals when challenged to name N animals – and the really silly ones will go further and deny that worms, snails (or whatever else you point out to them that they’ve missed) is an “animal” at all. Yes, these people are out there in the real world and probably closer to being the norm among humans than you are.
Not necessarily even in that particular subgroup. All we know is that about 30% admitted to the fish and fowl. We don’t know what the others were really doing (perhaps quite unaware of it themselves or unaware that it was something they should admit or something they were willing to admit). The only way round we can be moderately sure about things is that the ones who did confess were probably not making it up – because they clearly understood the issue over the definition and are unlikely to have had any motivation to claim they ate those things if they didn’t do so.
People who think this way don’t care about the clitoris, just the vagina and the uterus for making the babies.
SteveM: do they even know it exists?