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 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 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.
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.