Intersex: Male and Female

Several years ago I read an article with an intriguing title: Man Admitted to Hospital for Kidney Stone, Discovers He’s a Woman. The man in the article, Steve Crecelius, had been married for 25 years to his wife Debbie when he received life-changing news. After reviewing his ultrasound scans, the nurse said, “You’re female.” She had seen female sex organs.

Steve believed this news “validated everything I had always felt inside.” It also made sense to Debbie, who had noticed Steve’s female traits during their marriage.

Soon afterward, Steve changed his name to Stevie and started living as a woman while remaining married and living with Debbie. Their six adult children—Steve’s two biological children are from a previous relationship—immediately accepted his new identity. (For more on this story, see the article above and here and here. You can also find interviews on YouTube.)

Although I had known that intersex individuals were “persons who do not fit into standard medical descriptions of male or female” (DeFranza, 23), I had not heard of a case like this. I also didn’t know the variety of disorders or differences of sex development (DSDs). For example, Persistent Müllerian duct syndrome results in males with “normal male reproductive organs, though they also have a uterus and fallopian tubes, which are female reproductive organs.”

Disorders of Sex Development

Other DSDs include:

Androgen Insensitivity Syndrome (AIS) – Persons born with XY chromosomes (typical male) but cannot process male hormones (androgens) so they develop female external genitals. Affects roughly 1 in 13,000.

Congenital Adrenal Hyperplasia (CAH) – Persons born with XX chromosomes (typical female) with androgen levels similar to males. This can lead to a clitoris looking like a penis and labia looking like a scrotum. This condition can also start after age five, known as late-onset congenital adrenal hyperplasia (LOCAH). Affects roughly 1 in 13,000 to 1 in 36,000.

Ovo-Testes – Persons born with one ovary and one testis or a combination that includes both ovaries and testis. Affects roughly 1 in 100,000.

Swyer Syndrome – Persons born with “minimally developed gonad tissue present in place of testes or in place of ovaries” (35). This may cause an XY baby to look like a typical female.

In total, there are about 40 intersex conditions. More examples can be found here. If you want a deeper dive into sex differences in humans and DSDS, see the resources at the Paradox Institute.

Statistics

Full agreement on the frequency of intersex conditions has been elusive, but Megan DeFranza notes that a statement by “almost fifty medical practitioners specializing in intersex, records a frequency of 1 in 4,500 (approximately 0.22 percent of live births)” (44). Since controversy surrounds which conditions to include, DeFranza believes that it is safest to opt for a range—.02 percent to 1.7 percent. Using the most conservative statistic of .02 percent, she concludes there are “at least ‘about 50,000 true intersexuals living in the United States’ at this time” (44). At the highest end of the spectrum the intersexual community in the U.S. reaches about 6 million people. How should these individuals be treated?

Modern Treatment

Let’s begin in infancy. What happens to infants born with a DSD? “Should a person with external female genitalia who has XY chromosomes and testes be considered male, female, or intersex? How large does a clitoris need to be before it is considered a micropenis? These decisions are made by humans, typically by doctors” (24).

After the decision is made, doctors often recommend surgery to define the gender. These surgical corrections have been performed in the U.S. for decades.

In the 1950s, a team of medical specialists at Johns Hopkins University developed what has come to be called the “optimum gender of rearing” system for treating children with intersex. The notion was that the main thing you had to do in cases of intersex was to get the gender assignment settled early, so kids would grow up to be good (believable and straight) girls and boys. Under the theoretic leadership of psychologist John Money, the Hopkins team believed 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. Though the Hopkins team wrote early on that children should be told the truth about their intersex histories in age-appropriate ways, in practice many medical care providers lied to patients or actively withheld medical history information from them. Medical textbooks frequently gave doctors advice about how to lie to patients with intersex. As the Hopkins model spread throughout the developed world, surgeons performed cosmetic genital surgeries on intersex children without their consent, believing this was necessary and efficacious. Endocrinologists, meanwhile, manipulated patients’ hormones to try to get the bodies of patients to do what they thought was necessary not just for physical health, but for psycho-social health (i.e., getting the body to look sexually “normal”). So what was wrong with this model? To start with, lying to patients is not only unethical, it is bad medicine. (ISNA)

In response to the standard medical treatment, Cheryl Chase, an intersex individual who had unwanted sex surgery, founded the Intersex Society of North America (ISNA) in 1993 “to end shame, secrecy, and unwanted genital surgeries.” (Like Stevie Crecelius’s story, Chase’s story is worth reading.) Unless a life-threatening condition exists, ISNA advocates for a halt on sex surgeries until the child is old enough to give consent. I find it difficult to argue with this basic ethical impulse. After all, we are talking about sex surgery in infancy.

Instead of promoting a third gender, though, ISNA says, “All children should be assigned as boy or girl, without early surgery.” The intersex label, it is believed, could cause trauma to the child. Moreover, despite the variations, almost all intersex people have a body plan clearly geared toward male or female reproduction.

Others, however, believe it is best to give intersex individuals the option to identify as intersex, rather than forcing them to choose between male and female. (ISNA closed in 2008 and was succeeded by interACT and Accord Alliance. interACT has recently launched a bill in California that “would delay intersex surgeries until an individual can provide informed consent.”)

For the sake of clarity, it’s important to note that intersex is not the same as transgender. Transgender people have a clear sex at birth, but at some point their gender identity changes from their birth sex. Intersex individuals have ambiguous sex, usually at birth.

So far I have focused on the modern analysis and treatment of intersex individuals, but what did ancient people think about this?

Ancient Statements

First of all, the concept of a blended sex was known long ago.

• Intersex individuals or persons with DSDs were formerly known as hermaphrodites, named after the Greek god Hermes and the goddess Aphrodite who had a child of mixed gender.
• Aristotle (384-322 BC) speculated on the origin of hermaphrodites or persons of mixed sex.
• Pliny the Elder, who lived in the first century, says,

Individuals are occasionally born, who belong to both sexes; such persons we call by the name of hermaphrodites; they were formerly called Androgyni, and were looked upon as monsters, but at the present day they are employed for sensual purposes. (The Natural History, 7.3)

Pliny’s statement shows that those “who belong to both sexes” were outcasts—”looked upon as monsters” and sexually abused.

• Augustine (354-430) writes,

As for the Androgyni, or Hermaphrodites, as they are called, though they are rare, yet from time to time there appears persons of sex so doubtful, that it remains uncertain from which sex they take their name; though it is customary to give them a masculine name, as the more worthy. For no one ever called them Hermaphroditesses. (City of God, Book 16.8)

According to Augustine, these individuals were labeled as males.

• “Early Jewish commentators on the creation of Eve out of the rib of Adam proposed that the first human was a hermaphrodite, and only in the separation of the woman from the adam (the human) did sexual differentiation come into being” (DeFranza, 46).
• Most importantly for Christians, after referring to the creation story when God made humans male and female, Jesus said,

For there are eunuchs who were born that way, and there are eunuchs who have been made eunuchs by others—and there are those who choose to live like eunuchs for the sake of the kingdom of heaven. (Matt 19:12)

Note the three types of eunuchs: (1) “born that way” (i.e., disorder of sex development), (2) “made eunuchs by others” (i.e., forced castration), and (3) “those who choose to live like eunuchs for the sake of the kingdom of heaven” (i.e., vow of celibacy). Rather than calling into question the existence of males and females, this recognition “created space for those who did not fit neatly into the sex categories of male or female” (66).

Although these statements are general in nature, they do reveal an ancient awareness of a group of people who were misfits.

Questions

How should the existence of intersex people affect our view of humanity? Should we remove all gender distinctions because some are born with an ambiguous sex? Of course not. That would be using a small minority to redefine the vast majority. Kathleen Stock writes,

Over 99 per cent of humans fall unambiguously into one category or the other, including most people with DSDs. As binaries in nature go, the sex division is one of the most stable and predictable there is. In the vast majority of cases, sex is not ‘assigned at birth’ but detected—in most cases via observation at birth, and in a few cases later on. (Material Girls, 76)

What about the less than one percent? They have experienced a problem in the development of their sex traits. This is similar to babies born with six toes on one foot. As a rule, human feet have five toes, but there are a small number of exceptions. Those exceptions, however, don’t overturn the rule. Hence, the rule of sex categories must be acknowledged—male and female—and we can also acknowledge those born with genetic or biological disorders. Moreover, even the vast majority of intersex people align more closely with either male or female on a reproductive level—they produce either ova or sperm. In sum, we must do two things: hold firm to the biological rule and make room for exceptions. In the ancient world, these exceptional individuals whom we call intersex were called androgyni or hermaphrodites or “eunuchs who were born that way.”

Why has Western society at large supported sex surgery on infants? We know there is a desire to help intersex children assimilate into society, but could there also be a desire to eradicate this category of people? If so, is this attitude any different than ancient people who viewed hermaphrodites as “monsters”? We have a natural fear of those who are different so we label and dismiss them. Has our fear response also involved performing surgeries to change people without their consent?

Within the Christian community, why do some close their eyes to the rights and dignity of intersex individuals when Christ explicitly referred to people “born that way?” Perhaps it is because intersex has been lumped together in the LGBTQIA+ acronym. But we should remember that the intersex is a unique biological condition that can be scientifically verified.

Further, how can anyone judge intersex persons for their sexual orientation? If their sex has been ambiguous from birth, who can say to whom they should be attracted? How can a non-intersex person make a judgment on an intersex individual’s sexual orientation? Finally, allow me to connect this issue to a broader issue. Without medical knowledge of an individual, how do we know that someone who appears to be gay is not intersex?

Maybe I’m missing something, but for me the existence of intersex people is an encouragement to be less judgmental of those who don’t seem to fit within the typical sex categories.