Trans and Intersex Children: Forced Sex Changes, Chemical Castration, and Self-Determination

Children’s lives lie at the center of social struggles over trans gender and intersex issues. If you talk with trans and intersex adults about the pain they’ve faced, the same issue comes up over and over again, from mirror-image perspectives: that of medical interventions into the sexed body of the child. Intersex and trans adults are often despairing over not having had a say as children over what their sexes should be, and how doctors should intervene. Meanwhile, transphobes and the mainstream backers of intersex “corrective” surgery also focus on medical intervention into children’s bodies. They frame interventions into the sexual characteristics of intersex children as heroic and interventions into the bodies of trans children as horrific.

The terms and claims that get tossed around in these debates are very dramatic. Mutilation. Suicide. Chemical castration. Forced sex changes.

We need to understand what’s going on here, because it’s the central ethical issue around which debates about intersex and trans bodies swirl. The issue here is the question of self-determination, of autonomy. Bodily autonomy is the shared rallying cry of trans and intersex activists, though we might employ it in opposite ways. Refusing it to us is framed as somehow in our best interests by our opponents.

In this post we will look at how four groups frame the issue: intersex people, trans people, the mainstream medical professionals who treat intersex people, and opponents of trans rights.

If you talk to people who were visibly sexvariant at birth, you hear a lot of pain and anger and regret about how their bodies were altered. This is crystallized in the phrase of intersex genital mutilation, or IGM. As a result of infant genital surgery, many intersex people suffer from absent or reduced sexual sensation—something mainstream Western medicine presents as unethical female genital mutilation (FGM) when similar surgeries are performed on girls in other societies. There are further sources of pain: as a result of “corrective” surgeries, intersex people can suffer a wide range of unhappy results, such as loss of potential fertility, lifelong problems with bladder infections, and/or growing up not to identify with the binary sex to which they were assigned. It is extremely painful to identify as female and to know one was born with a vagina that doctors removed with your parents’ consent, or to identify as male and to know one’s penis was amputated. Imagine if someone performed a forced change on you--would you not feel profoundly violated?

So the intersex perspective is that no one should medically intervene in a person’s body without that person’s full informed consent. Bodily autonomy is a fundamental right. Nobody except you can know how you will feel about your bodily form, whether you might want it medically altered, what risks of side-effects you’d consider acceptable. Routine “corrective” surgery performed on intersex infants is thus a great moral wrong.

When you speak with trans people, childhood medical intervention again comes up with an air of great regret, but now the regret is that one was not permitted to access it. Almost every person I’ve ever spoken with who wants to gender transition medically, whether they’re 18 or 75, has expressed the same fear to me: “I’m afraid I’m too old!” For a while this mystified me (how is 22 “old”?), until I realized what they meant was, “I’m post-pubertal.” For many trans people, childhood was awkward but tolerable, as children’s bodies are quite androgynous. Puberty, however, was an appalling experience. Secondary sexual characteristics distorted the body—humiliating breasts or facial hair sprouting, hips or shoulders broadening in ways no later hormone treatments could ever undo. Many trans people live with lifelong despair over how so much maltreatment and dysphoria could have been avoided if they could just have been permitted to avoid that undesired puberty.

So for trans activists, advocating for trans children so that they might avoid this tragedy is vitally important. The child’s autonomy is central, as it is for intersex advocates, but here the issue is getting access to medical treatment in the form of hormone suppressants, rather than fighting medical intervention. What trans activists seek is the right of children to ask for puberty-postponing drugs, to give the children’s families and therapists time to confirm that the children truly identify as trans, and fully understand what a medical transition involves. Then the individual can medically transition to have a body that looks much more similar to that of a cis person than can someone who has developed an unwanted set of secondary sex characteristics.

So for trans and intersex people, children’s autonomy is paramount when it comes to medical interventions into the sexed body. No child should have their sex (e.g. genitals, hormones, reproductive organs) medically altered until they are old enough to fully understand what is involved and actively ask for such intervention. Conversely, once a child is old enough to fully understand what is involved in medical interventions into the sexed body, and requests such intervention, then it should be performed—whether the child is born intersex or not.

This is not yet mainstream medical practice, however. Today, one in every 150 infants faces medical intervention into the sexed body to which they cannot object or consent. Doctors routinely perform such “corrective procedures” on babies with genital “defects” and “malformations.” Meanwhile, few trans-identified children are supported in their identities by families and medical practitioners—and great controversy and resistance swirls around them when it does happen.

So let’s look at the arguments made by mainstream medicine and transphobic activists. How do they counter the cry for autonomy, given that self-determination and freedom are such central ideals in Western societies? What we’ll see is that they employ two opposing claims based in medical ethics: the duty to save a life, and the duty to first do no harm. If we want to protect the rights of trans and intersex children, we have to understand these arguments and be able to counter them.

When intersex advocates try to fight the framing of intersex children’s bodies as “defective” and somehow in need of surgical “correction,” mainstream medicine responds with a claim of medical necessity. In some very rare cases, particular intersex conditions can be associated with actual functional problems such as an imperforate anus, clearly a serious medical problem that necessitates surgery. But the vast majority of medical interventions into intersexed bodies take place without any such functional, physical problem exsting. They are responses to a social issue (discomfort with sex variance) rather than a physical one. What doctors do, however, is reframe social issues into medical ones. “If we don’t do this surgery, this child will be mocked and humiliated—“he” won’t be able to stand to pee, “she” won’t be able to have “normal sex,” “it” will never be able to marry. The child will be a social pariah and thus be at risk for suicide.”

Through this line of argument, altering the body of the sexvariant infant is cast as a noble act that doctors perform out of their duty to save lives. To counter this, what we need to do is point out that actual studies of intersex adults show that while we do have a heightened risk of depression and suicide, these are caused by unhappiness with our medical treatment rather than prevented by it. Loss of sexual sensation, feelings of having been humiliated by doctors, pain from years of “repair” surgery after “repair” surgery, and for those who do not identify with the binary sex to which we were assigned, the vast sense of betrayal that those who were supposed to care for us subjected us to a forced sex change—these are what lead to an increased risk of suicide. What would really help is would be for doctors to follow the precept of “first do no harm,” to perform no procedures upon us without our full informed consent, and meanwhile, to provide intersex children and their families with social support.

Invocations of “primum non nocere,” first do no harm, and of despicable medical impositions on the lives of innocents are also raised by anti-trans advocates. Transphobic activists generally frame all medical transition interventions as mutilations, and this rhetoric rises to fever pitch when the issue of trans children arises. Recently, anti-trans rhetoric has framed the medical provision of puberty-postponing drugs as “chemical castration” (e.g. in this blog post).

“Chemical castration” is an odd concept. First off, if you read any medical article on the topic, you will find it starting by pointing out that the term is a misnomer, as none of the medications used in “chemical castration” destroy the gonads. The term is nevertheless employed due its specific history as a treatment being given by court order to “sexual deviants” to suppress their ability to have sex, where some prior courts had employed actual surgical castration. Today, some jurisdictions use “chemical castration” in cases of pedophilia, but it the past it was a treatment imposed on men convicted of sodomy—that is, to gay men in an era in which gay male sex was criminalized. Transphobic activists use the term “chemical castration” to evoke an aura of adult sexual deviance, in a manner calculated to frame doctors who provide puberty-suppressant drugs as sexually abusing children.

There is a curious twist in this matter of “chemical castration,” in that universally when court-ordered in the past, and often still today, it did not consist of testosterone suppression drugs as you would expect. Instead, injections of estrogen and/or progesterone were (and are) given. In essence, it caused a forced sex change. Thus, for example, when codebreaking British war hero Alan Turing was convicted of homosexuality in 1952 and sentenced to “chemical castration,” he found the unwanted sex changes in his body so horrifying and humiliating that he committed suicide two years into “treatment.”

In the case of trans-identified kids today, the use of the term “chemical castration” is thus a double misnomer. Firstly, no child is castrated—instead, puberty is simply postponed so that if the child, family, and therapist all agree later that a medical transition is appropriate, unwanted secondary sexual characteristics will not have developed. Plenty of adolescents are “late bloomers” by nature; in fact, puberty today occurs many years earlier than it did through most of human history, when human diets lacked sufficient fats and nutrients to support early puberties. So postponing puberty carries no significant dangers. Further, the point of hormone suppression is not to cause a sex change, in contrast to court-ordered “chemical castration treatments.” The point is merely to buy time to ensure that the trans child in question fully understands zir gender identity and the implications of medical transition.

So: we’ve seen a lot of charged language, of claims and counterclaims regarding mutilation versus vital treatment, cruel withholding of medical assistance versus the imposition of sex changes on unconsenting children. How should trans and intersex advocates respond?

What I would do is to point out that strange and conflicting ideas about children’s autonomy and free will are presented by our opponents. When specialists in intersex “corrective” treatments speak to parents or write in medical journals, they urge that genital surgery be performed in infancy, before age two and a half if at all possible. They claim that this way the child will not remember the treatment and will thus adjust well to the altered genitals and/or sex status. (As if medical monitoring and intervention did not often extend throughout the child’s life, and the procedures left no scars and caused no loss of sensation, so the child would “never notice.”) The age of two and a half came out of now largely-discredited ideas of a milestone of “gender constancy” occurring then, based upon notions of the developing brain that directly relate to autonomy. Before age 2.5, it was basically argued, the baby is irrational and lacks agency, and thus thinks magically about bodily sex, including accepting the “crazy” idea that the sex of the body can change. So, in urging very early intervention into intersex bodies today, conventional medicine is urging the total avoidance of the child’s rational thought and agency.

When it comes to treating trans children, on the other hand, instead of rushing things, all sorts of actors want to draw them out. Most doctors and clinics only provide transition services to legal adults. Those few who treat trans children are extremely cautious about providing any medical interventions other than the postponing of puberty.

Both of these approaches deny children autonomy over their bodies and their lives.

What we must urge is that society consistently respect the rights of children. No children should ever be subjected to sexual surgery without their consent. No children should be forced to have cosmetic surgery. But as children mature, they become able to consent to medical treatment that they do actively desire.

How old is “old enough” to agree to medical interventions into the sexed body? That answer depends on the given child—but 2.5 is certainly too young, and 18 is in most cases too old. What I suggest is that when addressing a medical practitioner urging genital surgery on an intersex infant, that we ask, “Would you perform a sex change on a child of this age who was not intersex?” Conversely, when facing transphobic activists saying that no one who is not a legal adult can be old enough to consent to medical transition services, we should ask if our opponent would say the same if the child were intersex. For example, a child with congenital adrenal hyperplasia may be born with a penis externally, and a uterus and ovaries internally. At around age 12 or 13, if there has been no medical intervention, that child can begin to menstruate through the penis, develop breasts, etc. Would the opponent argue that the child could not be old enough to say that he identifies as male and wants to take testosterone (or that she identifies as female and has decided that she wishes to have surgery to feminize her genitalia)? Would the opponent argue an intersex pubescent child should not at least be able to take puberty-postponing medications to avoid unwanted penile menstruation if they and their family and support professionals were still unsure whether to commit to any more permanent intervention?

What we must ask is that society treat intersex and trans-identified children consistently. We all raise our children to learn to make good decisions, so that they can lead good lives. We must nurture children’s autonomy as they grow, understanding that there are some decisions only they can make for themselves. To force a person to live in a sex with which they do not identify is cruelty; to impose unwanted bodily alterations unconscionable. Wishing happiness for our children, we must nurture and then defer to their right to self-determination over interventions into the sexed body.

On Sex/Gender Checkboxes

Day in and day out, sex and gender minorities are boxed in by being confronted with sex/gender checkboxes. This starts the moment we are born, when a binary sex must be checked on our birth certificates: “male” or “female.” For individuals who are born with visibly intersex bodies, this requirement causes a crisis. Families and doctors make hasty decisions about which box they'll force us into, and we have to live with the consequences all of our lives. Having checked off a binary “M” or “F,” those with authority over our infant bodies often feel that trying to reshape our bodies conform to the box they've picked is unavoidable. Thus, genital surgeries are routinely performed, despite the deep unhappiness so many intersex people voice about the results as adults. Great pain might be avoided if parents were allowed to acknowledge our physical truth on birth certificates which included an intersex checkbox, or if the gender marker requirement were simply removed.

For people who are trans gender, gender transitioning is made traumatic in large part due to the checkboxes we must face daily. Binary gender markers are everywhere: on our drivers' licenses and passports, on loan applications and job applications, and on websites everywhere (from Facebook to shopping sites to online radio stations). Once you've checked off one box, changing it is bureaucratically and legally difficult—and sometimes there's no way to change it at all. This leads to all sorts of hassles and embarrassment, as we're “outed” in odd contexts. Worse still, if the gender we're living in doesn't match the marker on our ID, we're subject to being banned from flying, arrested by bigoted police officers, and denied employment.

For folks who don't identify with a binary gender, the world of checkboxes constantly denies our very existence. We go institutionally unrecognized, with no way to even try to say “I am here!”

Sex and gender minorities have some protection in institutional settings that bar discrimination on the basis not only of sex, but of gender identity or expression. But often, such policies are adopted with no follow-through on what it really means for a university or company or city to protect gender identity and expression. Unaware of our needs, administrators think only of ensuring that trans people aren't being kicked out just for gender transitioning. While this is certainly important, there are many more needs that must be addressed. And central among these are that sex/gender checkboxes protect the rights of sex and gender minorities.

I have written a Best Practices guide that is under discussion at my university. It lays out a plan for rewriting sex/gender checkboxes that is meant to address the needs of intersex, trans gender, and gender variant people, in this case, in a university setting. There are some inevitable compromises in it between institutional desires for simplicity and brevity, and our desires as individuals to have our identities recognized in all of their fullness and uniqueness. But I wanted to share it here so that other people who are looking for a guideline to use in seeking to better the way institutions around them limit sex/gender choices would have something to start with. It doesn't address the problem of birth certificates, for example, since universities don't issue them. It does, however, address the question of how sex and gender and sexuality should be measured in research in some detail.

Please feel free to share and employ at will.

Best Practices for Identification of Sex/Gender

Compiled by Dr. Cary Gabriel Costello

I. Foundational Principles

Institutions which commit themselves to protecting against discrimination on the basis of sex and of gender identity or expression (GIE) must give individuals the right to self-identify their sex/gender.

Whenever data are gathered about sex/gender, the rights of GIE minorities (intersex individuals, trans men, trans women, and individuals with alternative gender identities) must be protected.

II. Definitions

“GIE minorities” include intersex individuals, trans gender individuals (trans men, trans women, and individuals with alternative gender identities), and people with variant gender expression.

Intersex Persons

While it is common to believe that sex is binary—that is, that all people are born either male or female—in fact, sexual characteristics exist as a spectrum. There is a great deal of variation in chromosomes (XX, XY, XXY, XYY, etc.), hormones (relative levels of estrogen, progesterone and testosterone), secondary sexual characteristics (breasts, hair distribution, etc.) genital configurations, and gonads (ovaries, ovotestes, testes). Intersex people are individuals whose sexual characteristics fall toward the middle of the spectrum. Approximately 1 in 150 people are intersexed according to medical diagnostic criteria. Most are very private about this status, though some are public about it.

Trans Gender Individuals

Individuals whose gender identity does not match the sex they were assigned at birth are deemed trans gender. A trans man was assigned female at birth but identifies as male; a trans woman was assigned male at birth but identifies as female; a genderqueer individual may identify as neither male nor female. Trans gender individuals often transition to their sex of identification, though they may do so in different ways. Some transition socially by changing name, pronoun, and dress. Others also take hormones (testosterone or estrogen/progesterone) to alter their bodies. In addition, some get surgery to change their chests or genitalia. Because surgery is quite expensive, may not be covered by insurance, and because it carries serious risks, many trans gender individuals in the U.S. do not seek or are unable to access surgical transition services.

Variant Gender Expression

People of any sex or gender may have an atypical gender presentation—male femininity, female masculinity, or androgyny.

III. Best Practices in Collecting Data about Sex/Gender

The best practices for collecting data about sex/gender depend on context. If collecting data about sex/gender serves no purpose for the individuals from whom it is collected, then eliminating the question is the best practice. If data are being gathered to protect the rights and well-being of individuals, then individuals should be given self-identification options that allow GIE minorities to self-identify. These options include a shorter form for ordinary uses, and longer forms to be employed in research contexts.

Eliminating Unnecessary Requirements for Individual Sex/Gender Identification

There are many institutional contexts in which people are routinely asked to identify their sex/gender based on common marketing practices or institutional tradition rather than an intent to protect the individuals from discrimination on the basis of their sex/gender. (For example, this is a common requirement in registering to use website services.) In this situation, the best practice is simply to eliminate the unnecessary requirement of declaring sex/gender.

Standard Best Practices Short Form for Sex/Gender Identifications

In contexts in which data is collected order to ensure equal treatment and respect for all, information about sex/gender should be collected in a manner that protects GIE minorities. The goal in implementing sex/gender categories for general data collection is to protect the rights of all people, whatever their physical sex status or gender identity, including intersex individuals, trans men and trans women, and individuals with alternative gender identities. Thus, the inappropriate single question (“Sex: Male__, Female__”) should be replaced with a three-stage approach.

1. Gender identity: Woman __, Man __, Alternate Self-identification (please write in) ______________.
2. Do you have an intersex condition (disorder of sex development)? Yes__, No__.
3. Are you trans gender? Yes__, No__.

In order also to ensure nondiscrimination on the basis of sexual orientation, best practices add a fourth question unrelated to GIE:

4. Sexual orientation: Heterosexual __, Lesbian__,  Gay__, Bisexual__, Queer__, Pansexual__, Asexual__, Alternate Self-identification (please write in) ______________.

AVOID poor practices which undermine individuals' identities instead of protecting them. A common poor practice is to use a single additional checkbox: “Male__, Female__, Transgender___.” This is inappropriate for several reasons. First, it does not allow intersex individuals a way to identify themselves. Secondly, it discriminates against trans men and trans women by framing trans gender identification as incompatible with “real” male or female status. And thirdly, it does not allow for recognition of the distinct needs and identities of individuals who identify as neither male nor female.

Best Practices Long Forms for Research Contexts

Data about sex and gender are often collected in the course of research. If data are to be analyzed along the dimensions of sex and/or gender, two sets of needs must be met. The first relate to the rights of research subjects, who must be protected from harm, including the harm of discrimination on the bases of sex, gender identity or gender expression. In conducting research with human subjects, researchers will inevitably recruit research subjects who are intersex, trans gender, or variant in their gender expression, and are ethically obliged to treat them with respect. The second issue relates to the need of the researcher to have research questions carefully worded in a manner that subjects will understand and respond to in a reliable and valid manner.

Many scientific studies today continue to use “sex” as an independent variable, and measure this in a binary fashion. This is a methodological flaw, as well as discriminating against GIE minorities. It does not allow the researcher to measure what actually accounts for observed variance in the dependent variable: is it physical sex status, internal gender identity, gender-conformity or nonconformity? Just as a study that uses religion as an independent variable is improved when it not only identifies subjects as “Christian,” but allows the subjects to identify a more specific denomination, asks them how religiously observant they consider themselves, and inquires as to how often they attend church, increasing the sophistication of sex/gender questions improves study results. The following measures are suggested:

1. What gender do you identify with? Man__, Woman__, Other (please write in the identity)________________.
2. What sex category were assigned at birth? Male__, Female__.
3. As far as you know, were you born with an intersex or sex variant body? Yes__, No__.
4. Please indicate how masculine or feminine you are in your dress and manner on the following scale: (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.

In order also to ensure the study is not discriminating on the basis of sexual orientation, and to gather better data, best practices suggest that subjects also be surveyed on their sexual identity. Problems are often raised by the traditional method of asking subjects if they are “heterosexual, homosexual, or bisexual.” For example, people who are gender transitioning or who identify as neither male nor female are often unable to use these sexual orientation categories to classify themselves. Furthermore, it is well established that there is a difference between how many people identify their sexual orientation and the sexual activities in which they actually engage. This may be addressed through questions such as the following:

1. To whom are you attracted, sexually and romantically? (1) only men, (2) mostly men, (3) a bit more toward men than toward women, (4) equally toward men and women, (5) a bit toward women than men, (6) mostly women, (7) only women.
2. With whom have you been sexually involved? (1) only men, (2) mostly men, (3) a bit more men than women, (4) equally men and women, (5) a bit women than men, (6) mostly women, (7) only women.
3. Are the people to whom you are attracted (1) very masculine, (2) moderately masculine, (3) a bit masculine, (4) androgynous, (5) a bit feminine, (6) moderately feminine, (7) very feminine.
4. Consider the idea of a partner who identifies as neither male nor female, but as some other gender such as “genderqueer.” Do you find that (1) very appealing, (2) moderately appealing, (3) a bit appealing, (4) I feel neutral about it, (5) a bit unappealing, (6) moderately unappealing, (7) very unappealing.

Researchers who choose specifically to study GIE minorities should consider them a vulnerable subject pool for IRB human subject protection purposes. In cases of studies recruiting intersex, trans gender, or gender-variant subjects, procedures should be set in place to protect these vulnerable subjects, and the questions asked about sex and gender carefully designed to accord all subjects with full respect for persons. Confidentiality should be strictly protected, data collected in a location where subjects will not be at risk of having others see or overhear their responses, and information sheets listing appropriate support groups and links to mental health resources distributed to those recruited to participate.

What is the name of my community?

The collective names used by marginalized people get "used up."

As new generations rise in marginalized communities, they often reject the collective term used by the previous generation, seeing it as saturated with the negative connotations given it by the privileged majority. So they assert a new collective term. Asian American, not Oriental. "Disabled people" replaces "people with disabilities," which replaced "the handicapped." There's a period of resistance, and the new generation is energized by the feeling they're really changing things as they struggle. The privileged majority squawks: “Why are you people always changing your names and expecting me to care and keep track of it? Why is saying 'colored people' offensive when 'people of color' is not?” Some do get educated as a history of inequality is explained to them, and this energizes the activists.

This period of struggle over a new collective term is not limited to fights with the privileged majority. The older generation of people within a marginalized community can also resist giving up the term on the banners under which they fought. Hence we still have the NAACP—the National Association for the Advancement of Colored People. When the Gay Community became the Lesbian and Gay Community, there was a lot of bickering. The struggle to expand that to Lesbian, Gay and Bisexual Community was vigorous. Getting large organizations that spoke in terms of “gay rights” to add trans people and speak of LGBT rights was a substantial battle. And these struggles continue, with intersex people and asexual people and others trying to expand the community umbrella to cover them, and the experiences of cis gay men and lesbians still centered.

I've been through many of these struggles myself, having been involved in queer community activism since the 1970s. And so when I hear a new generation, full of fire, claim that a new term should be used because it will Change Everything, I feel a bit old and jaded. I've seen new terms get accepted, a number of times—after which things settle down—and some change has been effected, but it's slow and incremental, and the group is still marginalized. Then a new generation rises under these conditions, sees the current group name as weighed down with bias, and seeks a new collective identity term.

Not that I'm arguing against changing collective names. I think it's an important part of the struggle of marginalized groups. Consider the reclaiming of the term “queer” in the 1990s. People got excited about asserting an identity as queer for several reasons. Some saw it as signifying a more rebellious, activist philosophy. Others saw it as joining fractured communities with their own names—lesbian, gay, bisexual—into a united whole. Some embraced queer theory, and the idea of destabilizing categories and identities, exploding possibilities for identification and subverting troublesome institutions. And some saw using the term as a way to bring trans people and gender transgressors into the center of the movement. All of which are things people still care about, and still fight for.

But it seems to me the power of the term “queer” is getting used up. Certainly there's been progress in the last 15 years—especially for cis lesbians and gay men. A majority of young people in the U.S. support same-sex marriage, “Don't Ask, Don't Tell” has been repealed, and more and more institutions give some benefits to domestic partners. But as for progress for sex and gender minorities—intersex and trans people—not so much. I get quite frustrated going to events that are advertised as “queer,” attended by people who describe themselves as “queer,” and at which trans people are marginalized. As my trans woman partner said to me, “If I'm going to go to a 'queer' event and still be treated as a freak, then I need a term beyond queer.” If people draw the acceptable querity line at lesbians showing up to a party in mass-produced commercial stick-on moustaches, “queer” isn't particularly radical.

I know the label queer still has powerful meanings for many people—I still like it, conceptionally. But as a matter of practice, it's not doing what I want it to do. The needs of queer people like me are not being met.

It's hard to get those needs met with the collective names we use today. I've been at meetings for several LGBT organizations where I've tried to get the group to add an “I” for intersex people, since, as an openly intersex person in a world in which most of us are still hidden and treated as medically disordered, I consider it my duty to make our presence and needs visible. And in ALL of these conversations, people who identify with the LGBT label objected that it would confuse people looking up the group, and justify the complaints of the majority that we have too many letters in our name. Then, a person or group who identified as queer argued that the term queer includes everyone, and should be used instead, so future marginalized others could also feel represented. I pointed out that based on my experience as an intersex trans person, the term queer as it is actually used is not the panacea people claim it is. The majority then asserted the term queer was too radical to be accepted by the university/LGBT center board/funding sources, and since there was no consensus that making the group name longer was a good idea, each group declined to include the “I” for intersex.

No term is a panacea. But new community labels do have a beneficial effect for a time, in shaking up assumptions and giving people an opportunity to assert unmet needs. Trans and intersex people have a lot of unmet needs that I want to see addressed. So, anyone out there in the new generation of rebels and activists have a better term? One that explicitly centers sex and gender diversity? I'm all ears.

Meanwhile, in my own writing and teaching, I'm using the term “queer” a lot less, and speaking more often in term of sex, gender and sexual variance.

Sex and Gender Terminology

[The following is a handout I use in the courses I teach. Feel free to make use of it yourself--just credit me, Cary Gabriel Costello.]

In order to gain expertise in a field, you need to learn the terms that are used by people who are knowledgeable about it. The more of the terminology you know, the more sophisticated you can be in discussing the field, which is empowering. For example, if you know nothing about how a car works, and you open up the hood, you may just see a bunch of unidentifiable chunks of metal and wire, and call it all “the engine.” If your car isn’t working well, you can’t do much about it. If you learn to identify a couple of basic things—say, the dipstick so you can check your oil, and the battery so you can jump-start your car—you’ll have some minimal competence to deal with common automotive issues, but you still won’t know how a car works. But if you are taught to identify the ignition system, the engine block and valves, the cooling system, the transmission, the fuel system, and how the components interrelate, you can have intelligent conversations about cars and car maintenance that will stand you in good stead if you need to buy or repair a car.

When laypeople don’t know a lot about a field and hear people with expertise use the field’s terms of art, the laypeople may consider the terms overly precise, obfuscatory, or simply irritating. Laypeople may snort when winetasters talk about the wine having a “nose,” a “shoulder,” or a “finish.” Those unfamiliar with American football may laugh at positions like “tight end” and “nose guard.” To the cooking novice, it may seem silly to distinguish between sautéing and searing, or roasting and braising. But if you want to learn to appreciate wine, follow a football game, or cook good food from scratch, you will find that the terms of art are actually very important.

In studying sex and gender, you will come to use language that is a lot more complex and precise than that used in ordinary streetcorner conversation. At first, the terminology may strike you as confusing, or making tiny distinctions that seem unnecessary. But as you move through the course and learn more, you’ll find the terms allow you to have much more sophisticated discussions.

That said, below you’ll find a guide to the terminology that will be employed in this course.

1. Sex Spectrum: an array of physical differences, defined by:

1. Primary sexual characteristics: those sexual differences present at birth:
   1. Genital characteristics: differentiation of the fetal phalloclitoris into penis/scrotum or clitoris/labia. The degree of differentiation varies.
   2. Gonadal characteristics: differentiation of the fetal ovotestes into testes or ovaries (which occasionally does not occur).

2. Secondary sexual characteristics: differentiation of the body under the influence of the sex steroid hormones (testosterone, estrogen, progesterone), typically at puberty. The body normally produces both masculinizing (testosterone) and feminizing (estrogen, progesterone) hormones—the ratio of these determines the relative masculinization/feminization of the body as follows:
   1. Testosterone effects: growth of bodily hair, growth of facial hair, increase in upper body width, increased muscle mass, growth of the larynx leading the voice to lower, fat deposition in abdomen, increased size of penis/clitoris, increase in libido, production of semen/lubrication, increase in sweat and oil production, increase in size of testes and sperm production, irritability.
   2. Estrogen/Progesterone effects: growth of nipples and breast tissue, increase in pelvic width, softened skin and ligaments, increase in subcutaneous fat, fluid retention, cholesterol regulation, fat deposition in hips and thighs, proper spermatogenesis/ovulation, regulation of menstrual cycle, irritability.

2. Sex Categories: a manner of dividing the sex spectrum into socially-recognized units. In Western societies, there are three sex categories, defined under the authority of medical science as follows:

1. Female: a person ideally possessing a vagina, labia, a clitoris of less that 0.5 cm at birth, ovaries, a uterus, XX chromosomes, and an estrogen-dominant hormone profile.
2. Male: a person ideally possessing a penis of length greater than 2 cm at birth, scrotum, testes residing in the scrotum, a prostate, XY chromosomes, and a testosterone-dominant hormone profile.
3. Intersex: a person whose intermediate position on the sex spectrum fits neither the ideal male or female category, including:
   1. those with intermediate phalloclitoral genitalia;
   2. those with internally ambiguous gonads and/or reproductive anatomy;
   3. those with chromosomal variation (e.g., XY individuals with ovaries, vagina, clitoris; those with atypical sex chromosomes such as XXY or Xo); and
   4. those whose hormone-dominance causes their secondary sexual characteristics to contrast with their primary sexual characteristics.

3. Social Sex Assignment: the assignment of an individual to a particular socially validated sex, usually at birth.
   1. Binary sex assignment: in Western societies, all infants must be categorized as either male or female on their birth certificates. Those classified as belonging to the intersex category must receive either a male or female assignment.
   2. Other sex assignment systems: other societies have nondaydic social sex assignment systems, such as triadic systems (male, female, other) and quadratic systems (male, female, both, neither).

4. Gender Roles: cultural norms applied to people of different assigned sexes in a given society, including occupational roles, appearance standards (clothing, grooming, cosmetics), emotional norms, and interests. Gender roles are categorized as:

1. Masculine: the collection of norms for male-assigned people in a given society
2. Feminine: the collection of norms for female-assigned people in a given society
3. Additional gender roles: neutral or additional gender roles specific to a given society

5. Gender Identity: the subjective experience of identifying with a gender role—the internal knowledge that one is a man, a woman, or a member of an alternative gender.

1. Cisgender identity: gender identity that matches one’s primary sex characteristics (e.g., a person born with vulva, ovaries and uterus who identifies as a woman)
2. Ipsogender identity: gender identity that matches one's social sex assignment at birth, when this differs from one's primary sex characteristics (e.g., a person born with intermediate genitalia who is assigned to the female social sex category at birth and grows up to identify as a woman)
3. Transgender identity: gender identity that does not match one’s social sex assignment at birth (e.g., a person born with phallus and testes who identifies as agender, genderfulid, a woman, etc.), which may lead to:
   1. Gender transition: to move from following one set of gender roles to another, changing characteristics such as clothing, grooming, cosmetics, pronoun used and gender listed on identification; sometimes accompanied by:
   2. Sex transition: to move from one social sex assignment to another through medical treatment with hormonal alteration of secondary sex characteristics, and/or surgical alteration of anatomic sex characteristics (chest, genital, gonadal, laryngeal, etc.)

6. Gender Expression: individual self-presentation as a member of a given gender, including:

1. Gender-conforming expression: self-presentation that is strongly in accord with the normative gender role expectations of one’s society;
2. Androgynous expression: self-presentation which does not align strongly with polarized male or female roles; and
3. Gender-transgressive expression: self-presentation that defies the traditional expectations for a person of a given gender identity (e.g. feminine men, masculine women).

7. Sexual Identity: the sex or gender alignment of partners in sexual attraction, including:

1. Dyadic sexual orientation frames: in which one must know the binary sex/gender of both individuals in order to classify them as:
   1. Heterosexual: being attracted to a person whose sex and gender are dyadically opposite of one’s own
   2. Homosexual: being attracted to a person whose sex and gender are the same as one’s own (i.e., gay men and lesbian women)
   3. Bisexual: being attracted to  both dyadic sexes
2. Directional sexual orientation frames: under which one need only know the gender of the person desired to assign the desiring person as:
   1. Androphilic: being attracted to people of male gender
   2. Gynephilic: being attracted to people of female gender
   3. Androgynephilic: being attracted to people who are androgynously gendered or intermediately sexed
   4. Pansexual: being attracted to people independent of any particular sex or gender status or identity
   5. Asexual: having limited or no interest in sexual relations, though romantic interests of any orientation may be as prominent as they are in those not asexual

Initially, the number of categories employed in sex/gender scholarship may seem overlarge to you. After all, you may reason, most people are born girls or boys, pronounced so at birth, identify as such, and generally follow their assigned gender role. In fact, however, the variance is wide, and the terms we’ll use will help us to describe varieties of different experience.

I will illustrate using myself as a guinea pig. One of the reasons I developed an academic interest in sex and gender is that I am among those with quite variant experience. I was born intersex, with atypical anatomy; since that anatomy included an ovotestis I am medically classified as "True Gonadal Intersex.” So, my sex category is intersex, but our American society practices dyadic sex assignment, and I was given a female sex assignment at birth. My gender identity, however, did not develop to match that sex assignment, being male. Although I had a trans gender identity, I continued to live within my assigned sex for decades before I began to gender transition, and later sex transition. My gender expression was androgynously feminine when I lived in my assigned female sex, and is androgynously masculine now that I have transitioned to male. As an intersex person, my sexual identity cannot be understood through the dyadic sexual orientation frame (how can a person who is of neither the male nor the female sex be either straight or gay?). Under the directional sexual orientation frame, I am classified as pansexual. My spouse is an intersex person who identifies as female.

Practice using this system of terms now by considering where your body falls on the sex spectrum, listing your sex category, sex assignment, and gender identity, considering social sex roles and characterizing your gender expression as conforming, transgressive or androgynous (along what dimensions of gender norm expectations do you conform or transgress?), and listing your sexual identity.

A Note on Pronouns

English contains three common gender pronouns: “he,” “she” and “it.”  Note that English-speaking society grants personhood through dyadic gender: people are called “he” or “she,” and only objects called “it.”  To call a person “it” is often considered insulting.  

 Note that many other world languages do not use gendered pronouns (including Polynesian languages, Farsi, Turkic languages, Bengali, Armenian, and many others).  Speakers of these languages do not face the difficulty of having to specify a person's gender in order to speak of that person.  

In the past, when a person's gender was not known, the English rule was to call the unknown person “he.”  This is now considered gender-biased.  Formal English writing typically uses “s/he” instead: “A child must be given the opportunity to tie his/her shoes by himself/herself so that s/he can learn.”  This formal solution is quite awkward.  In practical speech, Americans often use the gender-neutral plural pronoun “they” as a singular pronoun instead: “A kid needs the chance to tie their shoes if they're going to learn.”  This is often deemed ungrammatical and frowned upon in formal writing, but was in fact common in Shakespeare's day.  Grammar is always in flux, and the use of the singular “they” should be respected in its revived usage.

For those personally or grammatically uncomfortable with the singular “they,” gender-neutral pronouns have been introduced in English.  There are several alternatives now in use, such as ze/zir/zim instead of he/his/him or she/hers/her.  I will use ze/zir/zim at times in this course: “A child must be allowed to tie zir own shoes so that ze can learn.”

I encourage you to try using ze/zir/zim in your course writing when you speak of a person of unknown gender, to gain practice using alternative pronouns.