10 Gender and Sex – Transgender and Intersex
A binary gender perspective assumes that only men and women exist, obscuring both sex and gender diversity and erasing the existence of people who do not identify as men or women, as well as the existence of people who are not “either” male or female. A gendered assumption in our culture is that someone assigned female at birth will identify as a woman and that all women were assigned female at birth. While this is true for cisgender (or “cis”) individuals—people who gender identify in accordance with their sex assignment—it is not the case for everyone. Some people assigned male at birth identify as women, some people assigned female identify as men, and some people identify as neither women nor men. This illustrates the difference between sex assignment, which doctors place on infants (and fetuses) based on the appearance of external genitalia, and gender identity, which one discerns about oneself. The existence of transgender people, or individuals who do not identify with the sex they were assigned at birth, challenges the very idea of a single sex/gender identity. For example, trans women, women whose bodies were assigned male and who identify as women, show us that not all women are born with female-assigned bodies. The fact that trans people exist contests the biological determinist argument that physiological sex predicts gender identity. Transgender people may or may not have surgeries or hormone therapies to change their physical bodies, but in many cases they experience a change in their social gender identities. Some people who do not identify as men or women may identify as non-binary, gender fluid, or genderqueer, for example. Some may use gender-neutral pronouns, such as ze/hir or they/them, rather than the gendered pronouns she/her or he/his. As pronouns and gender identities are not visible on the body, trans communities have created procedures for communicating gender pronouns, which consists of verbally asking and stating one’s pronouns (Nordmarken, 2013).
The existence of sex variations fundamentally challenges the notion of a binary biological sex. Intersex describes innate physical variation in sex characteristics, such as chromosomes, gonads, hormones, or genitals. The bodies of individuals with sex characteristics variations do not fit typical definitions of what is culturally considered “male” or “female.” “Intersex,” like “female” and “male,” is a socially constructed category that humans have created to label bodies that they view as different from those they would classify as distinctly “female” or “male.” The term basically marks existing biological variation among bodies; bodies are not essentially intersex—we just call them intersex. The term is slightly misleading because it may suggest that people have complete sets of what would be called “male” and “female” reproductive systems, but those kinds of human bodies do not actually exist; “intersex” really just refers to biological variation, and sex is nonbinary for everyone, not only intersex people (Viloria and Nieto 2020). The term “hermaphrodite” is therefore inappropriate for referring to intersex, and it is also derogatory. There are a number of specific sex variations. For example, having one Y and more than one X chromosome is called Kleinfelter Syndrome.
Does the presence of more than one X mean that the XXY person is female? Does the presence of a Y mean that the XXY person is male? These individuals are neither chromosomally male or female; they are chromosomally intersexed. Some people have genitalia that others consider ambiguous. This is not as uncommon as you might think. The Intersex Society of North America estimated that some 1.5% of people have sex variations—that is 2,000 births a year. So, why is this knowledge not commonly known? Many individuals born with genitalia not easily classified as “male” or “female” are subject to genital surgeries during infancy, childhood, and/or adulthood which aim to change this visible ambiguity. Surgeons reduce the size of the external genitals of female-assigned infants they want to make look more typically “female” and less “masculine”; in infants with genital appendages smaller than 2.5 centimeters they reduce the size and assign them female (Dreger 1998). In each instance, surgeons literally construct and reconstruct individuals’ bodies to fit into the dominant, binary sex/gender system. While parents and doctors justify this practice as in “the best interest of the child,” many people experience these surgeries and their social treatment as traumatic, as they are typically performed without patients’ knowledge of their sex variation or consent. Individuals often discover their chromosomal makeup, surgical records, and/or intersex status in their medical records as adults, after years of physicians hiding this information from them. The surgeries do not necessarily make bodies appear “natural,” due to scar tissue and at times, disfigurement and/or medical problems and chronic infection. The surgeries can also result in psychological distress and the loss of pleasure sensations in sexual organs. In addition, many of these surgeries involve sterilization, which can be understood as part of eugenics projects, which aim to eliminate intersex people. Therefore, a great deal of shame, secrecy, and betrayal surround the surgeries. Intersex activists began organizing in North America in the 1990s to stop these nonconsensual surgical practices and to fight for patient-centered intersex health care. Broader international efforts emerged next, and Europe has seen more success than the first wave of mobilizations. In 2008, Christiane Völling of Germany was the first person in the world to successfully sue the surgeon who removed her internal reproductive organs without her knowledge or consent (International Commission of Jurists, 2008). In 2015, Malta became the first country to implement a law to make these kinds of surgeries illegal and protect people with sex variations as well as gender variations (Cabral 2015). Accord Alliance is the most prominent intersex focused organization in the U.S.; they offer information and recommendations to physicians and families, but they focus primarily on improving standards of care rather than advocating for legal change. Due to the efforts of intersex activists, the practice of performing surgeries on children is becoming less common in favor of waiting and allowing children to make their own decisions about their bodies. However, there is little research on how regularly nonconsensual surgeries are still performed in the U.S., and as Accord Alliance’s standards of care have yet to be fully implemented by a single institution, we can expect that the surgeries are still being performed.
What It’s Like To Be Intersex
Watch the video below then answer the following questions.
- How does the existence of intersex people prove that sex is not binary?
- Why do so many parents and doctors want to mark infants as either male or female?
- What does this desire tell us about the power of binary-thinking and the sex/gender/sexuality system?
The concepts of “transgender” and “intersex” are easy to confuse, but these terms refer to very different identities. To review, transgender people experience a social process of gender change, while intersex people have physiological characteristics that do not fit with the dominant sex/gender system. One term refers to social gender (transgender) and one term refers to physiological sex (intersex). While transgender people challenge our binary (man/woman) ideas of gender, intersex people challenge our binary (male/female) ideas of sex. Gender theorists, such as Judith Butler and Gayle Rubin, as well as biologists, such as Anne Fausto-Sterling and Caitlin E. McDonough, have challenged the very notion that there is an underlying “sex” to a person (or animal or plant), arguing that sex, too, is socially constructed. This is revealed in different definitions of “sex” throughout history in law and medicine—is sex composed of genitalia? Is it just genetic make-up? A combination of the two? Various social institutions, such as courts, have not come to a consistent or conclusive way to define sex, and the term “sex” has been differentially defined throughout the history of law in the United States. In this way, we can understand the sex categories of “male” and “female” as social constructions that reinforce the binary construction of gender.
Is “Sex” a Useful Category?
The existence of both trans and intersex people is not new, nor is the existence of nonhuman animals who do not fit neatly into the male/female sex binary. Historian of sex Beans Velocci is one of many scholars to document how Western European and American scientists have long recognized the complexity of sex. Each time scientists tried to codify a biological indicator for binary sex, they encountered numerous real life examples who did not fit their binary models, whether using the anatomical model (external and internal genitalia), the gonadal model (production of sperm or eggs), the hormonal model (androgens, like testosterone, and estrogens), or the chromosomal model (XX, XY, and more). Velocci (2024) documents how, despite extensive evidence refuting the notion that sex is binary, scientists developed elaborate systems to make every individual fit into one or the other of their conceptual categories (of male or female).
The belief that a person (or animal, or plant) can only be male or female persists—scientifically, legally, and culturally—generating grave dangers for people who do not identify as either a man or woman, whether due to gender identity (in the case of trans people), or innate physical variation (in the case of intersex people). Velocci argues that scientists’ (and policy makers’) insistence on making every organism fit the male/female binary, despite the fact that these binary categories do not exist in real life, is ultimately about power.
- First watch Velocci’s brief remarks, above, where they summarize their 2024 article “The history of sex research: Is ‘sex’ a useful category?”
- Then examine the “Spectrum of Sex” infographic published in a 2017 issue of Scientific American. What surprises you about the complexity of sex categories?
- Why do you think both scientists and non-scientists alike continue to believe in the existence of only two sexes, when data show otherwise?
- Velocci suggests that sex may not in fact be a useful category at all, because its definition has always been so incoherent. What do you think? Can you think of any circumstances under which we would absolutely need to know a person’s (or other organisms’) sex category? (Hint: Remember not to confuse sex with gender, nor intersex with trans.)
