Intersex Awareness: Newsletter July 2019
Nature presents us with sex anatomy spectrums. Breasts, penises, clitorises, scrotums, labia, gonads—all of these vary in size and shape and morphology. Even the so-called “sex chromosomes” vary quite a bit. So, nature doesn’t decide where the category of “male” or “female” ends and where “intersex” begins. In this edition of our monthly newsletter, we will look beyond the semantic game and take a pragmatic approach to understand the topic of “intersex.” We want to continue to build a world free of shame, secrecy, and unwanted genital surgeries for anyone born with non-standard sexual anatomy.
Intersex: The Complex Definition
Intersex is a term used for a variety of conditions in which a person is born with reproductive anatomy that doesn’t seem to fit the “classification” of female or male. For example, a person might be born with female anatomy, but having mostly male-typical anatomy on the inside or have genitals that seem to be in-between the usual male and female types. A person may also be born with mosaic genetics so that some of their cells have XX chromosomes and some of them have XY. There is little agreement on what counts as intersex and what doesn’t. Doctors’ opinions vary substantially and are at best ambiguous or outdated. About 2% of live births are thought to be intersex. (To the right: The Intersex Flag)
Intersex – Analyzing the Social Problem
The challenge: The commonly held belief among doctors was (and more-or-less still is) that gender was all about nurture. That you could make any child into a “real” girl or boy if you made their bodies look right early (before about 18 months of age), and made them and their parents believe the gender assignment. Many medical care providers lie and actively withhold medical history information from patients about their intersex histories. Surgeons perform cosmetic genital surgeries on intersex children without their consent, believing this is necessary and efficacious. Endocrinologists, meanwhile, manipulate patients’ hormones to try to get the bodies of patients do what they think is necessary, not only for physical health, but for psycho-social health (i.e., getting the body to look sexually “normal”).
This needs to change: Firstly, lying to patients is unethical; it’s bad medicine. Patients have had to take lifelong hormone replacement therapies, often with long-term disastrous consequences for their health. They also suffered psychologically because they got the message that they were somehow “abnormal.” Secondly, it’s sexist as it seeks to differentiate girls from boys. Thirdly, the “standards” used for genital anatomy have been arbitrary and illogical. For example, under the “optimum gender of rearing” model, boys born with penises doctors considered small were “made” into girls—despite other doctors’ belief (and evidence they could be raised as boys without castration, genital surgery, and hormone replacement). Girls with clitorises doctors think are “too big” still find themselves in operating theatres with surgeons cutting away at their healthy genital tissue.
What can be done: Paradoxically, though all medical experts agree the identification of intersex anatomy at birth is primarily a psycho-social (not medical) concern, it is still treated almost exclusively with surgery. There is substantial evidence that people who have been treated under the “optimum gender of rearing” model have suffered harm, psychological and physical. People who are intersex will tell you that the primary thing they’ve been harmed by is induced shame about their intersex. The best way to reduce shame, and thereby reduce harm to individuals and families coping with intersex, is to talk openly and honestly about intersex.
Intersex – Some Statistics
Intersex vs. Transgender
People who are intersex have anatomy that is not considered typically male or female. People who identify as transgender are born with typical male or female anatomies which do not align with their gender identity. For e.g., a person who identifies as transgender may have typical female anatomy but feel like a male and seek to become male by taking hormones or electing to have sex reassignment surgeries.
Many people confuse transgender people with intersex conditions because they see two groups of people who would like to “choose” their own gender. Most intersex people come to medical attention because doctors or parents have made an observation about their bodies. In contrast, people who are transgender have an internal experience of gender identity that does not align with their physical bodies. It’s also true, albeit rare, that some people who have intersex conditions also decide to change genders at some point in their life.
Recent Cases – Caster Semenya & Dutee Chand
In sports, the issue centers on verifying the eligibility of an athlete to compete in an event that is limited to a single sex. The elite South African intersex athlete Caster Semenya (image: right top) identifies herself as a woman, and has had to deal with allegations that her condition providers her an “unfair advantage” on the field.
Over the years numerous sex or gender tests have been used to verify athletes’ eligibility, ranging from physical examinations to chromosome testing and more recently hormone testing. In the wake of Semenya’s case in 2009, testosterone testing was introduced to identify cases where testosterone levels were elevated above an arbitrary level, termed hyperandrogenism.
That rule was in force until July 2015 and its reversal is among one of the key reasons why Semenya has returned to form in such emphatic fashion. The Indian sprinter Dutee Chand (image: right bottom), who was dropped from the 2014 Commonwealth Games at the last minute, successfully appealed to the court of arbitration for sport who ruled that there was insufficient evidence that testosterone increased female athletic performance, suspended the practice of testosterone regulation and challenged the IAAF to present better evidence by July 2017.
Chand’s lawyers insisted she was not to blame for her genetic advantages, that the existing law was discriminatory against women – because men are not screened for high natural testosterone levels – and were able to demonstrate that the threshold set by the IAAF was arbitrary, hence the need to present better evidence within two years. In the meantime, it allows Semenya, Chand and other intersex athletes to compete without needing to take hormones to lower their testosterone levels.
Famous Intersex Personalities
Hanne Gaby Odiele: The Vogue supermodel revealed she was intersex last year, disclosing that she was born with internal testes that were surgically removed when she was 10. She has androgen insensitivity syndrome (AIS) which means she has male chromosomes but her body has not responded properly to testosterone so the penis was not formed. She campaigns against Intersex Genital Mutilation and forced surgery.
Thea Hillman: Thea is an intersex author best known for her critically-acclaimed Lambda Award-winning book Intersex: For Lack of a Better Word in which she deals with memoirs regarding gender, sexuality and her career. She’s a San Francisco poetry slam champion, was Chair of the Intersex Society of North America, and she’s also a mother.
Pidgeon Pagonis: They are an intersex American activist, writer, artist, and consultant. They are an advocate for intersex human rights and against non-consensual intersex medical interventions. Pagonis was diagnosed with androgen insensitivity syndrome (AIS). They appeared on the cover of the January 2017 National Geographic “Gender Revolution” issue. Pagonis was one of nine LGBT artists honored as an Obama White House Champion of Change in 2015.
Dana Zzyym: Dana is an Intersex activist and former sailor who was the first military veteran in the United States to seek a non-binary gender U.S. passport. In Zzyym v. Pompeo, September 2018, a federal court ruled that the US State Department had exceeded its authority by denying Dana a passport that was gender neutral.
Rainbow View:
A monthly feature to shine light on the rainbow spectrum
Focus in July: “Demisexual”
Demisexuality is a subset of asexuality. Demisexuals do not experience sexual attraction unless they form a strong emotional connection with someone. A relationship for a demisexual typically starts as a friendship and may blossom into something more. Sex is still important; there’s nothing wrong with their sex drive. But what turns them on has to do with brains and personality rather than a toned physique. People who are demisexual can still develop serious, fulfilling, long-term relationships with others.