Who are Intersex People?
In our culture, there are two ways that people look at Intersex:
Way #1: Anyone can be Intersex, and it's very normal.
This is the correct way to look at Intersex people.
We used to think that sex is binary, a pole with “male” at one end, and “female” at the ‘opposite’ end. We used to believe that all the various ways of measuring sex would match up and be the same sex. We used to think that the way you told boys and girls apart was by looking in their pants. It turns out to be a lot more complicated than that. Science has replaced that binary with the idea of a spectrum of possibly overlapping male and female elements.
There are actually a number of ways to determine a person’s sex. Gonads, genes, hormones, internal structures yield precise, measurable data. The appearance of the genitals (pants check) and phenotype (general body shape) can only be assessed in terms of culture. These different ways of determining sex don’t always have to agree with each other, and show the same sex.
Whenever someone’s markers of sex do not all show the same sex, or overlap male and female elements in some way, this is termed an “intersex difference.” Some intersex differences create health concerns that require medical intervention, but science has conceded that most intersex differences are invisible and unsuspected.
In fact, so many intersex differences have been discovered by accident that science accepts that humans are simply not reliably or 100% sexually binary, and that the terms ‘male’ and ‘female’ cannot be strictly defined anymore, because of this potential overlap in all people of male and female sex characteristics. Science also tells us there is absolutely no way of predicting or assessing who is intersex ‘by looking,’ or by virtue of a ‘pants check,’ which is considered the least scientific way of assessing sex, as the answer depends entirely on cultural expectations. Science concedes it’s not possible to categorically rule out an intersex difference in anyone, not even if you tested every single cell in their body, because the genes of human sex determination have even been shown to change their sex over time.
What this means is that anyone could be intersex, and not even know it.
Way #2: Intersex People are tragic and rare; something has gone wrong in their bodies.
(This statement is true in terms of the preferred beliefs of our culture, but it would not be considered true for other cultures. Although this viewpoint is endorsed by medicine, it is not considered defensible in terms of biology or human rights.)
Our culture takes it for granted that males and females are separate and distinct classes of humans, easily told apart by looking at the shape of the genitals. This idea depends on a couple of shortcut assumptions, neither of which can be assumed to be true:
Assumption # 1: Genitals come in two basic shapes, “male” and “female.”
Genitals do not come in two basic shapes. Although most people’s genitals do tend to look the way our culture expects, they don’t always, nor do they have to. Like other determinants of sex, they can overlap or combine male and female elements. There is no precise line between male and female genital forms, and genitals can range over the entire spectrum between stereotypical male to stereotypical female genital forms. Even when they don’t look the way our culture would prefer, the underlying cause for ‘ambiguous’ genitalia can only ever be figured out 20% of the time. That doesn’t necessarily pose a problem, except in terms of our culture’s expectations for appearance and for social roles based on genital appearance.
Assumption # 2: a person’s genitals will match all their other markers of sex.
Nothing whatsoever can be assumed about a person’s other markers of sex from looking at their genitals. There are a number of different ways to measure sex. Genes, gonads, hormones, internal reproductive structures give quantifiable measurements. But classifying genitals and phenotype by appearance is the territory of culture, not biology, in terms of yielding useful data. The different ways of measuring sex don’t all have to agree with each other and be the same sex. Most often, intersex differences happen with no visible cues.
The pants check really only tells us how close or far an individual comes to our culture’s expectations for genital appearance, and nothing more. One can make no assumptions whatsoever about the other markers of sex based on a visual inspection of the genitals.
Most people’s genitals do tend to look like the far binary ends, where we find our culturally idealized forms. But not everyone’s genitals look like our culture’s idealized forms.
How is Sex Decided?
There are actually a number of ways to assess a person’s physical sex. Scientifically measurable ways are through assessments of the gonads, genes, hormones and internal reproductive structures, while the genitals and phenotype can only yield cultural assessments. If our system of sex were truly binary, these different ways to measure sex would all be the same sex – either unequivocally male, or unequivocally female. They would all match up.
This is the assumption our culture makes when we announce a baby’s sex at birth. We assume that sex is a binary system, that if a baby has a penis, all of the other ways of assessing sex will all match up and will also be male. If the baby has female-appearing genitalia, all of the other ways of assessing their sex will reveal themselves to be female, too.
Our expectation is that all the different ways of assessing or measuring a person’s sex will be the same sex.
But that isn’t always the case.
Beyond the Binary
It turns out the different ways of measuring sex (Genes, gonads, genitals, internal structures, hormones, phenotype) do not always have to agree with each other. Sex determinants can be either male or female, (for example, having one ovary and one testicle), can be both male and female (for example, having both male and female chromosomes or cell lines, or being a typical male, but with a uterus), or can combine male and female elements (for example, having mid-spectrum genitals or a combinatory ovotestis instead of pure ovaries or pure testicles).
These different ways to measure sex give different qualities of data. Gonads, hormones and internal reproductive structures can give precise, measurable data.
Genetic testing also gives precise, measurable data as well, but it is notoriously tricky to undertake. To show that one has multiple cell lines (i.e.: is twins or triplets fused in utero), at least two different kinds of tissue samples are routinely taken and compared, including blood, saliva, nails and hair. Because different cell lines can be distributed throughout the body in random and unpredictable ways, genetic testing can only be used to prove, but never to disprove an intersex difference. In genetic testing of this kind, absence of proof is not considered proof of absence because the evidence one is looking for may not be in the sample taken, even though it is present in the body. The genes of sex determination have been shown to change in humans over time, so even if one tested every single cell in the body, and did not find evidence of both male and female chromosomes, that could never prove sex-variant chromosomes were not present in the past.
How people classify genitals and phenotype, however, depends on which culture they live in: how their culture distinguishes between sexes, and how many sexes they perceive. There is no strict dividing line between male and female forms.
Science now acknowledges that human sex differentiation is best described as a spectrum of forms, in which male and female elements can overlap to any degree, most often without any visible cues or health concerns.