by Bruce Dunlavy
(My blog home page and index of other posts may be found here.)

Over two years ago, in my first post on this blog, I explored the subject of same-sex marriage (then still an unresolved issue on the national level).  Examining the scientific basis (or lack thereof) for gender determination, I pointed out that there is no “law of the excluded middle” in gender determination, meaning there is no restriction to just male or not-male, female or not-female.

The Supreme Court, in the 2015 decision of Obergefell v. Hodges, affirmed that marriage is contract open to all couples, and may not be denied on the basis of gender.  Any two people may marry, subject to restrictions on bigamy, consanguinity, and other factors not related to the sex or gender of the two individuals. Since then, same-sex marriage has become a routine and – with the occasional flare-up of resistance in backward parts of the country – accepted occurrence.

Once they are begun, civil rights battles typically turn into larger human rights battles. When Obergefell opened the door to recognition that some people are gay and want to be recognized as having the same rights as everyone else, other issues relating to the treatment of members of the LGBTQ community came forward.  Most notably, the status of transgendered individuals provoked a series of back-and-forth arguments and laws attempting to establish an “official gender” as stated on one’s birth certificate.  I took issue with that in an earlier post.
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The basis of the Gender Wars is a dispute about whether a person must be one of two things – male or female – and whether the initial decision recorded on a birth certificate is binding for life.  A sizable portion of the American public contends that every person is either wholly male or wholly female, and that gender assignment is accurately based on the appearance of the external genitalia at the time of birth. They believe that everyone is born with an obvious penis or an obvious vagina, that this is the result of either/or genetics, and that it cannot be changed.

Science has of late suffered a downgrade in appreciation and trust, but that does not alter its fundamental verities. One of those is that sex/gender is not clear-cut.  No amount of appeals to pseudo-reason, religious support, or personal belief will change that.  Most people who believe the “two-gender” idea are aware that genetic makeup is the pre-eminent factor in the male/female decision. Their argument goes like this: normal number of chromosomes carrying the DNA that make each person unique is 46, aligned in 23 pairs.  Pair 23 consists of one X chromosome from the mother and one X or one Y chromosome from the father. An XY pairing results in a male baby with male genitalia, and an XX pairing results in a female baby with female genitalia; the observation is made and recorded.

Genetics, however, is not so restrictive. Many people are born with more than 46 chromosomes.  One of the most widely-known of these supernumerary conditions is Trisomy 21, better known as Down Syndrome. Those with Down Syndrome have 47 chromosomes, with pair number 21 having an extra copy added to the standard two.  Any other chromosomal pair can also show trisomy, but in most cases the result is a miscarried pregnancy.  Few that result in a live birth produce a child with a life lasting more than a few months or years.

Consider the 23rd pair of chromosomes, which are usually sex-determining.  Trisomy may occur there, with any combination of X and Y chromosomes.  There are two ways an extra X chromosome can affect the pair.  XXX trisomy (Triple X Syndrome) occurs in about one in 1000 girls, resulting in a range of physical and mental conditions. A trisomy of XXY, Kleinfelter’s Syndrome, is perhaps twice as common as Triple X, and those who have it usually do not possess all male attributes, such as the ability to produce spermatazoa.  An XYY arrangement, Jacob’s Syndrome, occurs in about one in 1000 boys.  The effects are not generally obvious.  In addition to trisomy, the 23rd grouping may have four or more chromosomes – XXXY, XYYY, XYYYYY, etc.

Even having the usual chromosomes can’t guarantee conventional “maleness” or “femaleness.”  Here are some examples:

Androgen Insensitivity Syndrome  – persons who have this condition have typical male genetic makeup (XY), but do not develop male characteristics.  Every embryo starts out female, and in males a big rush of the male hormone androgen during gestation activates the development of penis, testicles, etc.  Sometimes the androgen doesn’t “take.”  Genetically male people with complete AIS are to all outward appearances female, they and everyone else think they are female, and their XY chromosome pairing is unknown until discovered during genetic testing for something else.

5-alpha reductase insufficiency – those with this condition have XY chromosomes, but may be born with external gentalia that appear female, male, or ambiguous. The condition is caused by the body’s inability to produce enough dihydrotestosterone hormone, resulting in unusual sexual development before birth and then again at puberty.  Some are brought up female and some male.  Some later adopt a male persona, and some a female one.

Congenital Adrenal Hyperplasia – this condition affects both genetic females (XX) and males (XY), and is caused by an insufficiency in the production of the hormone cortisol.  Females with the condition often have external genitalia that appear male but are not.

Swyer syndrome – affected individuals have no functioning gonads (glands producing sex hormones), resulting in persons with an XY chromosome pairing who have female sexual structures. They are typically raised as female and believe that they are female.

There are numerous other conditions (Disorders of Sexual Differentiation or DSD) that present either an ambiguous sexual identity or a false one. There are men who have ovaries or other female organs within their bodies but are completely unaware of it until they are examined for some internal problem.  So-called “true hermaphrodites” may have a mixed-tissue “ovotestis” or an ovary on one side and a testicle on the other.

Conditions such as these are surprisingly common – as many as one in one hundred births may result in a baby of ambiguous gender of some sort.  “Intersex” is a status that has been recognized in the medical community for quite some time.  In Germany and France, a birth certificate has three options – male, female, or indeterminate. The intent is to allow for a change in the way ambiguous genitalia are dealt with at birth.  The practice has traditional been to perform gender-assignment surgery right away, but problems may arise later in life, particularly at puberty.  The third option allows for delaying gender assignment (and possible surgery) until the affected individuals are old enough to decide for themselves. [Update: Arguments for delaying gender-assignment surgery are increasing, and at least one country has banned them for infants.]

There was a time, not to terribly long ago, when it was believed that there were distinct “races” among humans, and that a person had to be one and only one of them. Science has advanced beyond that untenable idea, as have modern-thinking lay people.  Nothing about gender status or identity is that simple, either. It’s time to get over our obsession with assigning everybody one sexual identity at birth that must be maintained until the end of life.