Intersex: What It Is And Is Not
May 2, 2019
by Andrè Van Mol, MD
Intro to Intersex
Intersex is a colloquialism for what is more formally titled Disorders of Sex Development (DSD). Per psychiatrist Karl Benzio in an article published in Today’s Christian Doctor in 2015: “Intersex – People who have anatomy that is not considered typically male or female or have anatomy not matching their genetic sex of XX or XY. Most come to medical attention because healthcare professionals or parents notice something unusual about their bodies or puberty or fertility isn’t normal, but some are not known until death/autopsy.”
The term intersex leans to the ideological, and clarity is needed here. A DSD consistently means a definable, objective underlying medical problem. We should not conflate a condition with an identity. California’s 2019 Assembly Bill 201 makes precisely that type of error in section 2295(a)(2): “Intersex people are a part of the fabric of our state’s diversity to be celebrated, rather than an aberration to be corrected.” That is both a straw argument and misdirection because a medical condition is something one has, not who one is. Celebrate the person, yes, and recognize that person’s disorder of sex development, which may or may not need correcting.
Sex
Sex is objective, identifiable and immutable biology, thus within the realm of science. Biological sex is established at conception, declared in utero, and recognized or not at birth. Every nucleated cell in our bodies has a sex. There are only two gametes, sperm and egg, that participate in the generation of new life. There is no third gamete active in that process. Sex differences are real and of consequence. More than 6,500 shared genes are expressed differently in human males and females. These differences impact our brains; organ systems; propensity for developing certain diseases; differing responses to drugs, toxins and pain; contrasting cognitive and emotional processes; behavior; and more. To offer one example, sotalol has triple the likelihood of provoking torsades de pointes in women compared to men. Sex matters.
Gender
Gender is an engineered term that reportedly debuted in the academic literature in 1955 in an article addressing “hermaphroditism” (as it was then known) by psychiatrist Dr. John Money of John Hopkins University. (Dr. Money would go down in ignominy with time, but I digress.) Gender identity refers to self-perception and feelings that are subjective and prone to change. Gender is most often used as a sex stereotype. My point is this: nouns have gender; people have a sex.
Intersex, Round Two
The nomenclature “intersex” acknowledges something between two sexes and not a third sex. The term is intersex and not “extrasex,” therefore acknowledging the binary nature of human sex. Biological sex rarely may be phenotypically unclear in a given individual, but this does not represent a third one.
Evolutionary biologist Colin Wright rejects the “sex is a spectrum” mantra with clear reasoning: “a spectrum implies a continuous distribution, and maybe even an amodal one (one in which no specific outcome is more likely than others). Biological sex in humans, however, is clear-cut over 99.98 percent of the time.” Dr. Wright continues, “any method exhibiting a predictive accuracy of over 99.98 percent would place it among the most precise methods in all the life sciences. We revise medical care practices and change world economic plans on far lower confidence than that.”
Intersex/DSD is Not Gender Dysphoria or Trans-identification
Intersex is not a subjective ideation. There is always an objective underlying medical origin. The DSM-5 Gender Dysphoria criteria states: “Specify if: With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 [E25.0] congenital adrenal hyperplasia or 259.50 [E34.50] androgen insensitivity syndrome).” Intersex is what they mean, and it is different than gender dysphoria.
Intersex/DSD is Rare
Wildly inflated claims of the prevalence of DSD are common, but untrue. Dr. Leonard Sax exposed the source of some of this in his article, “How common is intersex.” Dr. Sax writes that Anne Fausto-Sterling asserted in her 2000 book Sexing the Body: Gender Politics and the Construction of Sexuality that intersex totaled 1.7 percent of human births. However, Sax shows that she included in her calculations common conditions having nothing to do with DSD. Dr. Sax notes that congenital adrenal hyperplasia and complete androgen insensitivity syndrome are the most common DSDs, which is in keeping with the previously stated DSM-5 Gender Dysphoria specification. Dr. Sax concludes that DSD/Intersex, “far from being ‘a fairly common phenomenon,’ is actually a rare event, occurring in fewer than two out of every 10,000 births.”
Similarly, a 1992 Danish study found their rate of “testicular feminization syndrome” to be 1:20,400. A 2001 Dutch study stated their rate of androgen insensitivity syndrome “with molecular proof of the diagnosis is 1:99,000.”
And a 2016 Danish study examining all their known 46XY karyotype females (androgen insensitivity syndrome) born since 1960 found the prevalence at 6.4 per 100,000 live born females. Intersex/DSD is rare.
Conclusion
A disorder of sex development/intersex uniformly signifies the presence of a definable, objective underlying medical problem. Intersex is a condition—something someone has—and neither an identity nor a third sex. DSD/intersex represent rare conditions requiring highly individualized therapeutic approaches and timelines, not a blanket one-size-fits-all prescription.
Dr Van Mol, Thanks for a clear, understandable but fact-based explanation. In linguistics someone coined the term “Mytheme” referring to the basic worldview of the written piece of literture. Much modern understanding in my theological and human sciences fields is due to modern myths or “mythemes” that can prove and have proven very popular in a Politically Correct worldview.
Sorry, but my sex wasn’t determined at conception. At conception, my karyotype was 46,XY. At birth it was 46,XY/45,X. That matters a great deal.
I also have a friend who started out as two conceptions–one 46,XX and one 46,XY. Those two joined to become a single person. After conception.
Does it really matter how common or how rare we are? Would you deny that we are created in the image of God? Even if only one of us existed?
Arguments over the frequency of intersex are largely politically-motivated. If there were only two of us, would that justify treating us poorly? If we were more common than redheads, would that say anything at all about the ethics of homosexuality or transgender issues?
I would note that it was Dr. John Money who also theorized that gender identity could be changed if the child’s genitals were reshaped early enough and the parents allowed no doubt about the sex of their child. Running with his theories, feminists decided that gender was a social construct and learned. Unfortunately, that’s how Christians came to believe that gender identity was learn rather than rooted in biology. If you look at the consequences of Dr. Money’s policies, you’re find that an entire generation of intersex people were harmed by the medical implementation of his theories. Gender identity is rooted in biology.
Some of my cells have a Y chromosome. Others don’t. That resulted in a mixture of ovarian and testicular tissue. The medical term for my condition is Mixed Gonadal Dysgenesis. Fortunately, my mother was a nurse who kept me away from doctors. I was allowed to choose for myself whether boy or girl fit me best. I was allowed to choose whether or not to have surgery, and what type. Like most intersex people throughout the ages, I did fine without immediate medical intervention or coercion by my family’s faith community.
Unfortunately, Christianity appears to be moving away from allowing an intersex person to choose, preferring instead to reduce sex to a single parameter. The author of the Nashville Statement, for instance, reduces sex to the presence or absence of a Y chromosome. That would make a woman with Complete Androgen Insensitivity Syndrome male, which clearly goes against Scripture. But some Christians will say whatever they think will help them win the culture wars.
Dr. Megan DeFranza and I started Intersex and Faith in order to help churches minister to those born intersex and to their parents. In our years of support work, what we discovered was that the most serious issue for many of these parents wasn’t have a child whose sex was ambiguous. It was maintaining their relationship with a church that was ignorant of sex difference.
We’d love to help. We’d love to have a rational conversation.
Lianne,
I guess it depends what you mean by “treating us poorly.” It seems you are either gas-lighting (more likely) or naive (not likely, since you are an activist) to assert that the prevalence of this condition is irrelevant, when powerful persons and organizations are trying to elevate and advance a theory of gender fluidity on society. For objective persons, the conspicuous fallout from Money’s theories is related to the core of his theories and not merely to ancillary scientific and medical errors to which you allude.
From the information you’ve shared, your particular situation sounds authentically in need of sensitive application of biblical principles, but I reject the assertion that an overhaul of the Christian faith is warranted related to the intersex condition.
Please tell me where in the bible you have the right to judge anyone. Please provide book, chapter & verse . If you cannot find it, it means it does not exist
1 Cor. 5:12 tells us that we ARE TO JUDGE those who call themselves Christians.
1 Cor. 5:3 Paul speaks of a person who is committing a sinful act and Paul says “ As one who is present with you in this way, I have already passed judgment in the name of our Lord Jesus on the one who has been doing this.”
So, YES! We are to judge certain activity. If we don’t judge the actions of people, how could we ever speak to them about their sinful behavior? You have to make a judgment to understand if the person is involved in sinful behavior. ie, stealing, lying, committing adultery, etc.
Thanks Dr Van Mol for your article. It needs to be published everywhere. I am an adult with CAH and verilization. I appear male looking but I have the joy of having born children. As a Christian woman, I resist all attempts of those with an agenda to deny evidence based biology for political and other causes to label my medical condition as trans, third sex or homosexual. We need more Bible based support groups for those with these conditions.
Doloroes id like you to elaborate more if you could.
This is heart breaking to me. I have been a Christian for more than 40 years. I had a child 26 years ago, that was also 45X/46XY, gonadal dysgenesis. We were sent to a genetic counselor and told we had to make a decision to have the surgery and decide FOR this child whether they would be male of female. We could NOT complete a birth certificate without a gender assignment…… We ultimately out of ignorance, assigned female and proceeded with surgery, so that we could get a birth certificate, enroll her in school and all of the other SOCIAL norms that she had to conform to in order to go on with her life. She has never felt that she fit in, either in school, friends and most of all church. She has not felt girl nor boy. We were told, they are what you raise them which was the prevailing thought at the time, and is the biggest mistake we have ever made. I know God loves her more that I ever could. That he sees her as who she really is, not who decided for her to be. But because she is basically gender neutral (had surgery to be a girl at 3 months old, but has many likes, hobbies, tastes in clothes etc as a typical boy), she has been discriminated against and bullied in school, rejected in sports, (she was a semi pro snowboarder, but because she didn’t fit the typical girly persona, she was often overlooked for sponsorships, competitions, etc) So PLEASE tell me how a child goes on in life without an “assigned at birth” gender? What do we put on a birth certificate, how do we enroll them in school, how do they get a drivers license without a M or F gender assignment? She is biologically half male and half female. PLEASE explain how to apply this to real life, let alone to the Christian Community, that unless they adhere to one or the other, they are thought of as sinful because you cannot tell from their outward appearance, without wearing a sign on their backs, that they really were “born this way”. And the thought that some Christians, if they are not ignorant to this condition, tell them that because of the FALL, they are cursed with this because of sin. DO WE WIN THEM TO CHRIST as who they are, loved by our creator and savior, or do they have to first have official papers drawn up and notarized attesting to the FACT they have this genetic makeup? And by the way, I do not tell her she can not marry because she does not have a sex assignment as some Christians believe (being a eunoch as some would say). So in practical day to day life, how do you suggest they proceed? We should first and foremost, show them love and compassion because the road they have before them, which was NOT their choice, can be very difficult, disheartening, and confusing. So I am sorry, but we are NOT called to judge them, but to love them as Christ does.
Thankfully, at least one state (maybe others). Vermont, permits parents to place an “X” on a newborn’s birth certificate. The child may be intersex or they just want to raise their child in a gender-neutral way, having the certificate re-issued, if desired at some point, to reflect what the child affirms, not controlling adults. Birth certificates designate gender identity and don’t have to match biology. An “X” is non-binary. As a retired kindergarten teacher, I’m pleased with Vermont’s law. I taught children who were neither confused or suffering, not “felt” their gender identity…most kids that age KNOW (caps for emphasis) their gender identity, not their chromosomes, biology, etc. I’m quite sure several of my gender expansive students were trans. As adults, they don’t identify with the gender assigned at birth, regardless of their biology. When kids and people are lived, affirmed and supported, there’s joy, not suffering.
And I taught at least one intersex child who was lioved, affirmed and supported for how they self-identified. That’s what matters.
It’s significant that the author says there’s no one size fits all in regard to treatment of DSD/intersex children. The right-wing Family Policy Alliance produced the legislative bill model, titled “Help Not Harm” , that is being used to craft legislation to ban gender affirming healthcare in multiple states where Republicans have control. In personal correspondence, a representative of the Alliance admitted the section in these bills that gives doctors blanket permission , with or without an intersex child’s consent, to provide “services” to DSD minor children was requested for inclusion by the Christian Medical and Dental Association. This legislative section insures there will be no penalty to doctors who perform any medical intervention on intersex kids. This is a one-size-fits-all policy giving permission that allows mutilating, medically-unnecessary surgeries on intersex minors without their consent and is clearly contrary to the author’s declaration that “there’s no one size fits all” treatment of DSD/intersex minor children.
I’m offended when the author states having a medical Disorder of Sexual Development is a medical problem. Medical disorders dont equate with a “problem”. I’m 74 years old, have a congenital medical disorder that has never been regarded as a problem by me or my doctors. “Problem” is a subjective opinion of the author’s. He needs to retire from healthcare practice. I’d hate to have him practicing on me.