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International Intersex Awareness Day: “Trans and intersex are not the same thing”

Updated: Dec 18, 2021

This article has also been published by Genspect.

October 26 is International Intersex Awareness Day. So it’s a good time to explain what intersex really means. Intersex, otherwise known by the broader term Differences of Sex Development (DSD), often comes up in the transgender debates. When asked to provide evidence for queer theory-based assertions about sex and gender, trans activists frequently refer to intersex biology as “proof” that sex is a spectrum. Although some intersex people have adopted queer politics, the conflation of trans and intersex has been a concern of many of us who do in fact have one of the known DSDs. Trans and intersex are simply not the same thing.

The word “intersex” is misleading. Not all DSDs lead to anatomical characteristics of both sexes. There are about 40 known conditions, which include atypical genetics, endocrine function, and/or physical characteristics not typical of the person’s sex. That is, there are men with DSDs and women with DSDs. Almost all DSDs are sex specific. A person may not even be aware they have a DSD unless there are clear anatomical signs. My ovotesticular disorder wasn’t discovered until I was a young adult, because there’d been no need for my internal anatomy to be examined until I started to have gynecological problems.

There are two possible ways in which DSDs and “classic” homosexual transsexualism might overlap.

Some DSDs are associated with a higher rate of same-sex attraction and cross-sex identification, likely due to atypical hormone levels during fetal development. Alhough there’s no evidence of a “male brain” versus “female brain,” per se, there are neurological differences between sexual orientations and associated traits. A female exposed to high levels of testosterone during development (e.g., Congenital Adrenal Hyperplasia or ovotestes) is more likely to be same-sex attracted and display more masculine personality traits and interests, which can lead to cross-sex identification (gender dysphoria). This would be evident from a very young age. (Note: Gender dysphoria in females is also correlated with other hyperandrogenic conditions such as PCOS.)

Some have hypothesized that transsexualism is a type of DSD, and so some transgender people refer to themselves as intersex, even though they don’t have one of the established DSDs.

I try to read medical studies without emotional attachment to any one hypothesis. It’s understandable to want the least stigmatizing explanation for our condition to be true. But, as a clinician, I also must be as objective as possible and not use evidence to support my own biases and preferences. The best available evidence indicates that gender dysphoria is not one thing but a psychological phenomenon with many possible pathways or causes. It seems likely that there are biological factors in some cases of gender dysphoria, but not so in other cases. We currently have no reliable, feasible way of measuring biomarkers on a case-by-case basis. But, if we could, it would be most accurate to say that we have males with GD and females with GD, just as some men have a DSD and some women have a DSD. Medicalization may be the most compassionate and ethical choice some of the time. However, neither intersex nor GD defies the reality of binary biological sex. There are simply some natural outliers in need of careful, thoughtful, evidence-based consideration for how we can best support their long-term well-being.

For more information about DSDs:

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