tag:theconversation.com,2011:/global/topics/intersex-2174/articlesIntersex – The Conversation2023-10-23T12:25:17Ztag:theconversation.com,2011:article/2146902023-10-23T12:25:17Z2023-10-23T12:25:17ZBiological sex is far from binary − this college course examines the science of sex diversity in people, fungi and across the animal kingdom<figure><img src="https://images.theconversation.com/files/554094/original/file-20231016-21-1wrv5k.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2169%2C1382&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Biological sex comes in many more forms than just male or female.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/watercolour-illustration-of-male-and-female-symbols-royalty-free-image/1209433697">Yifei Fang/Moment via Getty Images</a></span></figcaption></figure><figure class="align-right ">
<img alt="Text saying: Uncommon Courses, from The Conversation" src="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=375&fit=crop&dpr=1 600w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=375&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=375&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=471&fit=crop&dpr=1 754w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=471&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/499014/original/file-20221205-17-kcwec8.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=471&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em><a href="https://theconversation.com/topics/uncommon-courses-130908">Uncommon Courses</a> is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.</em> </p>
<h2>Title of course:</h2>
<p>Diversity of Biological Sex Characteristics</p>
<h2>What prompted the idea for the course?</h2>
<p>Most people view biological sex, or the physical features related to reproduction, as <a href="https://www.pewresearch.org/social-trends/2022/06/28/americans-complex-views-on-gender-identity-and-transgender-issues/">simple and binary</a> – either male or female. Even those who recognize that gender – referring to cultural norms around biological sex, or a person’s internal feeling of being masculine, feminine or both – can be complex and nuanced don’t see biological sex in the same way. Many also regard variability in sex and gender as exclusive to people – not found in nonhuman animals.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=OaEmJXAAAAAJ&hl=en">behavioral neurobiologist</a> who has been teaching human physiology since 1998. Over the past several years, I have <a href="https://theconversation.com/brain-scientists-havent-been-able-to-find-major-differences-between-womens-and-mens-brains-despite-over-a-century-of-searching-143516">focused my reading and writing</a> <a href="https://www.psychologytoday.com/us/blog/governing-behavior">on the biology of sex</a>. It struck me that many of my students had misguided assumptions about sex characteristics, including that all people are physically either 100% male or 100% female. </p>
<p>A <a href="https://ari.oucreate.com/4873-5873_syllabus.pdf">course on biological sexual diversity</a> in both nonhuman animals and people could challenge these assumptions.</p>
<h2>What does the course explore?</h2>
<p>First, we examine <a href="https://doi.org/10.1002/dvg.1020150303">why sexual reproduction evolved</a> in any species. This question is <a href="https://theconversation.com/why-did-sex-evolve-researchers-edge-closer-to-solving-longstanding-mystery-55407">still hotly debated among biologists</a> because sex is inefficient. It requires time and energy to find a suitable mate and unite your sex cells, plus it allows you to pass on only half your genes to your offspring.</p>
<p>In comparison, <a href="https://openstax.org/books/biology-2e/pages/32-3-asexual-reproduction">asexual reproduction</a> – essentially cloning yourself – is much more efficient. You don’t have to find a mate, and everyone can produce offspring themselves because there are no males. In biology, “male” refers to an individual that makes small sex cells like sperm, and “female” refers to an individual that makes large sex cells like eggs.</p>
<p>Next, we explore <a href="https://www.ucpress.edu/book/9780520280458/evolutions-rainbow">nonhuman sexual diversity</a>, including fungi that have <a href="https://doi.org/10.1016/j.fbr.2015.08.002">thousands of sexes</a> and aphids that <a href="https://doi.org/10.1016/S0169-5347(01)02331-X">reproduce asexually most of the year</a> but sexually once each fall. Among many others, we also learn about fish that are male or female at <a href="https://doi.org/10.1016/B978-0-12-800049-6.00160-8">different times of their lives</a>; <a href="https://doi.org/10.1016/j.isci.2020.101652">intersex crayfish</a>; and <a href="https://doi.org/10.1016/j.yhbeh.2005.07.013">female spotted hyenas</a> that have a penis.</p>
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<figcaption><span class="caption">Sex characteristics manifest in different ways across the animal kingdom.</span></figcaption>
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<p>We then transition from nonhuman animals to people, via the brain. We learn about <a href="https://doi.org/10.1177/1073858419867298">a few small</a> <a href="https://doi.org/10.1007/s00359-019-01376-8">brain structures in vertebrates</a> that likely have reproductive functions and are differently sized in females versus males on average. We also learn that most people have some brain structures that are more typically male, others that are more typically female and still others that are intermediate – in other words, <a href="https://doi.org/10.1073/pnas.1509654112">most people are mosaics</a> of female-typical and male-typical brain sex characteristics.</p>
<p>Finally, we focus on the biological sex characteristics of <a href="https://doi.org/10.1038/518288a">intersex people</a>. The <a href="https://doi.org/10.1038/nrendo.2014.130">chromosomes and reproductive organs</a> of intersex people have <a href="https://www.ted.com/talks/emily_quinn_the_way_we_think_about_biological_sex_is_wrong#t-781094">some typically female and some typically male characteristics</a> or are intermediate between them.</p>
<p>Students then build on their knowledge of the diversity of biological sex characteristics to discuss whether intersex infants should have <a href="https://aeon.co/essays/people-born-intersex-have-a-right-to-genital-integrity">surgery to “correct” their genitals</a>, as well as <a href="https://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html">who should be allowed</a> <a href="https://doi.org/10.1080/15265161.2012.680533">to compete in</a> <a href="https://theconversation.com/striking-a-balance-between-fairness-in-competition-and-the-rights-of-transgender-athletes-159685">girls and women’s athletics</a>.</p>
<h2>Why is this course relevant now?</h2>
<p>Perhaps more than ever, there is a debate about how to treat people who do not fit neatly into a female or a male box. Many assume that biological sex is binary and regard transgender and nonbinary people as mistaken or confused. In addition, for many decades, <a href="https://theconversation.com/gender-affirming-care-has-a-long-history-in-the-us-and-not-just-for-transgender-people-201752">intersex infants</a> have undergone surgical procedures to make them appear more typically male or female. Even those who support transgender, nonbinary and intersex people often assume that biological sex is binary. But this assumption is not anchored in evidence.</p>
<h2>What will the course prepare students to do?</h2>
<p>Students often say that before they took this course, they had no idea biological sex characteristics could be so diverse, despite having taken several biology courses. </p>
<p>An improved awareness of the complexity of biological sex may help shape the research and teaching of future biologists. This will help them design experiments that take account of the diversity of their subjects and be more <a href="https://theconversation.com/trans-students-benefit-from-gender-inclusive-classrooms-research-shows-and-so-do-the-other-students-and-science-itself-204777">inclusive in their teaching</a>. It may also help all students ask better questions and make better judgments about social and political issues related to sex and gender.</p><img src="https://counter.theconversation.com/content/214690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ari Berkowitz receives funding from the Oklahoma Center for the Advancement of Science and Technology and has received funding from the National Science Foundation and the National Institutes of Health.</span></em></p>Spanning evolutionary biology, genetics, development, neurobiology, endocrinology and psychology, as well as current events and sports, students explore the complexities of the biology of sex.Ari Berkowitz, Presidential Professor and Director of Graduate Studies, Biology; Director, Cellular & Behavioral Neurobiology Graduate Program, University of OklahomaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047772023-08-31T12:20:15Z2023-08-31T12:20:15ZTrans students benefit from gender-inclusive classrooms, research shows – and so do the other students and science itself<figure><img src="https://images.theconversation.com/files/541976/original/file-20230809-15-2j6fem.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teaching sex and gender more accurately can counter gender stereotypes and encourage all students to study STEM.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/girl-in-denim-t-shirt-with-rainbow-symbol-wear-royalty-free-image/1365444357">Iurii Krasilnikov/iStock via Getty Images Plus</a></span></figcaption></figure><p>Across the U.S., legislators are debating how and when sex and gender should be discussed in the classroom and beyond. Specifically, <a href="https://www.transformationsproject.org/state-anti-trans-legislation">these bills</a> are considering whether anything beyond male or female can be included in library books and lesson plans. These bills are part of a larger debate on how to define and regulate sex and gender, and there are no immediate answers that satisfy everyone.</p>
<p>Many of the bills draw on science to make claims about sex and gender. For example, <a href="https://www.flsenate.gov/Session/Bill/2023/1069">Florida House Bill 1069</a>, which legislates pronoun use in schools, assumes that all of a person’s sex markers – listed as sex chromosomes, “naturally occurring” sex hormones and internal and external genitalia at birth – will align as female or male “based on the organization of the body … for a specific reproductive role.” The bill claims that “a person’s sex is an immutable biological trait and that it is false to ascribe to a person a pronoun that does not correspond to such person’s sex.”</p>
<p>Invoking biology is a way to sound objective, but it’s not so simple. Science itself is still grappling with the nature of sex and gender.</p>
<p>My co-author Sam Long and I are <a href="https://doi.org/10.1525/abt.2021.83.7.427">high school</a> and <a href="https://scholar.google.com/citations?user=rZ-cbGUAAAAJ&hl=en">college science educators</a> who research how to <a href="https://www.genderinclusivebiology.com">increase student motivation, interest and retention in biology</a>. Our work and that of our colleagues show that teaching sex and gender more accurately in classrooms benefits not only gender-diverse students but all students and the field of science.</p>
<h2>Science of sex and gender</h2>
<p>Bills like Florida’s define sex as a binary set of biological traits. But scientists know that sex is far more complicated.</p>
<p>In nature, there is a <a href="https://doi.org/10.1371/journal.pbio.1001899">huge diversity</a> in how sexes are arranged within bodies. For example, the sex of some organisms is classified by the size of their gametes, or sperm and eggs. Some species produce both gametes in one body. Some change whether they produce sperm or eggs over their lifetime. Others technically don’t have a sex at all.</p>
<p>Sex in humans is actually an <a href="https://doi.org/10.4324/9780203127971">amalgamation of many traits</a>, which include the type of gametes a person produces as well as their reproductive tract anatomy, hormone levels and secondary sex characteristics like hair growth and chest shape. These traits are determined not just by a few genes on the X and Y chromosomes but also by a <a href="https://doi.org/10.1038/s41598-019-53500-y">myriad of genes</a> on other chromosomes as well as the <a href="https://doi.org/10.1038/s41598-019-53500-y">developmental environment</a>. When <a href="https://courses.lumenlearning.com/wm-biology1/chapter/reading-polygenic-inheritance-and-environmental-effects/">many genes</a> contribute to a trait, it appears as a continuum.</p>
<p>The continuum of human sex is illustrated by the experiences of intersex individuals. For nearly two out of every 100 people, a binary definition of sex <a href="https://www.hachettebookgroup.com/titles/anne-fausto-sterling/sexing-the-body/9781541672895/">would not work</a>. People <a href="https://theconversation.com/not-everyone-is-male-or-female-the-growing-controversy-over-sex-designation-172293">who are intersex</a> don’t have chromosomes, hormones or internal and external genitalia that completely match cultural expectations of what males and females should look like. Under these bills, what pronouns would they be allowed to use? There is <a href="https://doi.org/10.1038/518288a">no universal scientific rule</a> for pronoun assignment.</p>
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<figcaption><span class="caption">Sex is a spectrum.</span></figcaption>
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<p>If sex is not binary, then <a href="https://theconversation.com/sex-and-gender-both-shape-your-health-in-different-ways-98293">gender</a> – or personal perceptions of masculinity, femininity, a mix of both, or neither – cannot be either. A 2022 Pew Research Center survey found that roughly <a href="https://www.pewresearch.org/short-reads/2022/06/07/about-5-of-young-adults-in-the-u-s-say-their-gender-is-different-from-their-sex-assigned-at-birth/">1.6% of U.S. adults</a> describe their gender as not aligned with their sex assigned at birth, which can be captured by the terms transgender or nonbinary.</p>
<p>Overall, science <a href="https://doi.org/10.1086/692517">does not have a definitive answer</a> for how to define sex and gender in people that lawmakers can draw upon – science only indicates that these traits are nuanced and complex.</p>
<h2>Limiting teaching on sex and gender affects everyone</h2>
<p>Bills limiting how sex and gender are taught exacerbate the disproportionate obstacles that transgender students already face. The 2019 National School Climate Survey of over 16,700 students in the U.S., conducted by national education nonprofit Gay, Lesbian and Straight Education Network, or GLSEN, reported that trans teens in <a href="https://www.glsen.org/research/2019-national-school-climate-survey">schools without gender-inclusive curricula</a> experienced more bullying, a decreased sense of belonging, poor academic performance and low psychological well-being.</p>
<p>Restrictive bills also discourage LGBT students from studying science. The 2013 GLSEN Network National School Climate Survey found that LGBT teens were <a href="https://www.glsen.org/sites/default/files/2020-03/GLSEN-2013-National-School-Climate-Survey-Full-Report.pdf">less interested in majoring in STEM</a> and the social sciences when the high school classes they took in those fields were not taught with inclusive curricula. </p>
<p>I and my colleagues found similar downstream effects on <a href="https://doi.org/10.1187/cbe.21-12-0343">college students</a>: Trans and nonbinary students reported feeling isolated and uncomfortable in biology courses that teach sex and gender only as a binary. They felt they couldn’t form relationships with their teachers or peers, and this lack of a supportive personal network prevented them from requesting letters of recommendation or getting involved in research. Some dropped out of STEM, and many others contemplated it.</p>
<p>Limiting gender-inclusive curricula in schools can ultimately have negative effects on all students. Children begin <a href="https://doi.org/10.1146/annurev.psych.093008.100511">developing and testing</a> their understanding of sex and gender starting as young as 2 years old. Erasing gender diversity even in elementary schools reinforces <a href="https://doi.org/10.1037/amp0000307">inaccurate conceptions of sex and gender</a> that can last a lifetime. For example, a 2018 study of 132 college students found that those who read a paper emphasizing binary sex and typical gender roles exhibited <a href="https://doi.org/10.1007/s11199-017-0786-3">increased prejudice against transgender people</a>. A 2019 study of 460 eighth through 10th grade students found that those taught an oversimplified and inaccurate definition of sex – as defined by sex chromosomes – had increased beliefs about the genetic basis of sex and in <a href="https://doi.org/10.1002/sce.21502">stereotypes about men and women</a>, including unchangeable sex differences in intelligence and scientific ability. These studies suggest that teaching oversimplified narratives about sex and gender influences not only how students conceive sex and gender but also beliefs about their own and others’ abilities.</p>
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<span class="caption">People rally in front of the Kentucky State Capitol on Mar. 29, 2023, to protest the passing of Senate Bill 150, a ‘Don’t Say Gay’ bill that bans gender-affirming care for trans youth, limits discussion of LGBTQ topics in K-12 schools and allows teachers to misgender students.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/people-many-of-whom-are-adolescents-gather-during-a-rally-news-photo/1249909096">Jon Cherry/Stringer via Getty Images</a></span>
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<p>The trans and nonbinary college biology students we interviewed suggest there is another long-term harm of oversimplifying sex and gender: <a href="https://doi.org/10.1187/cbe.21-12-0343">lack of preparation</a> for a future career in science or medicine. An oversimplified understanding of sex and gender does not train students to work with the diverse patients and clients they might encounter, and it can <a href="https://mashable.com/article/transgender-healthcare">worsen health disparities</a> for trans people.</p>
<p>Lack of exposure to a broader range of sex and gender roles also limits potential scientific discoveries. Being taught only binary sex and genders biases the research questions scientists consider and the way they interpret their findings.</p>
<p>The study of <a href="https://theconversation.com/women-have-disrupted-research-on-bird-song-and-their-findings-show-how-diversity-can-improve-all-fields-of-science-142874">birdsong</a> offers one example of how this bias can influence research. A common stereotype is that male birds are more competitive than female birds. Because competition occurs partially through song, researchers studied birdsong only in males for a long time. Some scientists recently challenged these beliefs about sex roles by finding that females sing in <a href="https://doi.org/10.1098/rsbl.2019.0059">about 64% of songbird species</a>, opening doors to greater understanding of the function of birdsong.</p>
<h2>What educators and scientists can do</h2>
<p>When science is being misrepresented to justify oversimplified ideas about sex and gender in schools, scientists and science educators have an important role to play. </p>
<p>Sharing perspectives about gender diversity with school boards and elected officials can make a difference. Bringing conversations about sex and gender into the classroom can help all students feel seen and reduce gender stereotypes. Through his work with educators, my co-author, Sam Long, knows it can be intimidating to get into these conversations, but they do not have to be fights about who is right or wrong. Encouraging curiosity about human variation and questioning the portrayal of any trait as pathological simply because it is different or uncommon can help students think critically about sex and gender in respectful ways. </p>
<p>Disability advocates offer an <a href="https://odpc.ucsf.edu/clinical/patient-centered-care/medical-and-social-models-of-disability">inclusive approach</a> that focuses on changing the environment to fit the person rather than changing the person to fit the environment. Physical and mental variations do not inherently reduce a person’s ability to thrive; instead, it is environmental and culture barriers that are limiting or disabling. Educators can pose questions that encourage students to explore this idea. For example, red hair is as rare as intersex traits. Of the two, why are only intersex traits often framed as a disorder? Likewise, human height varies across people. How are buildings, products and services designed to accommodate a spectrum of heights? Why haven’t other physical variations been accommodated in the same way?</p>
<p>Initiatives like <a href="https://www.genderinclusivebiology.com/">Gender-Inclusive Biology</a>, <a href="https://projectbiodiversify.org/sex/">Project Biodiversity</a>, and <a href="https://welcomingschools.org/resources">Welcoming Schools</a> offer additional resources to help adapt the curriculum to acknowledge and celebrate variation in the living world. My co-author Sam is a founding member of Gender-Inclusive Biology.</p>
<p>Encouraging students to think critically about the complexity of sex and gender will encourage everyone to pursue their passions regardless of gender stereotypes, promote creative thinking in science and medicine and support trans students. In this way, teaching about sex and gender complexity can benefit everyone.</p><img src="https://counter.theconversation.com/content/204777/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Eddy receives funding from the National Science Foundation.</span></em></p>‘Don’t Say Gay’ bills claim to use science to justify a binary definition of sex based on certain traits. But the biology of sex and gender is not so simple.Sarah Eddy, Assistant Professor of Biological Sciences, Florida International UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2017522023-03-27T12:25:04Z2023-03-27T12:25:04ZGender-affirming care has a long history in the US – and not just for transgender people<figure><img src="https://images.theconversation.com/files/516795/original/file-20230321-2376-1glr1q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2953%2C1971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex and cisgender children.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctors-carrying-newborn-baby-girl-at-hospital-royalty-free-image/668808357">Javier Valenzuela/EyeEm via Getty Images</a></span></figcaption></figure><p>In 1976, a <a href="http://lgbthistory.pages.roanoke.edu/wp-content/uploads/sites/40/2020/02/Long-Road-from-Man-to-Woman.pdf">woman from Roanoke, Virginia, named Rhoda</a> received a prescription for two drugs: estrogen and progestin. Twelve months later, a local reporter noted Rhoda’s surprisingly soft skin and visible breasts. He wrote that the drugs had made her “so completely female.” </p>
<p>Indeed, that was the point. The University of Virginia Medical Center in nearby Charlottesville had a clinic specifically for women like Rhoda. In fact, doctors there had been prescribing hormones and performing surgeries – what today we would call gender-affirming care – for years.</p>
<p>The founder of that clinic, <a href="https://www.washingtonpost.com/local/obituaries/milton-edgerton-trailblazing-plastic-surgeon-for-children-and-transgender-patients-dies-at-96/2018/07/16/28bcae0a-8836-11e8-8aea-86e88ae760d8_story.html">Dr. Milton Edgerton</a>, had cut his teeth caring for transgender people at Johns Hopkins University in the 1960s. There, he was part of a team that established the nation’s first university-based Gender Identity Clinic in 1966.</p>
<p>When politicians today refer to gender-affirming care as new, “<a href="https://www.advocate.com/health-care/mississippi-governor-ban-transgender-care">untested</a>” or “<a href="https://www.desmoinesregister.com/story/news/politics/2023/03/07/iowa-lawmakers-approve-gender-affirming-care-ban-for-transgender-youth/69980950007/">experimental</a>,” they ignore the long history of transgender medicine in the United States. </p>
<p>It’s been nearly 60 years since the first transgender medical clinic <a href="https://www.scientificamerican.com/article/the-forgotten-history-of-the-worlds-first-trans-clinic/">opened in the U.S.</a>, and 47 years since Rhoda started her hormone therapy. Understanding the history of these treatments in the U.S. can be a helpful guide for citizens and legislators in a year when <a href="https://www.vice.com/en/article/5d378d/anti-trans-bills-2023">a record number of bills</a> in statehouses target the rights of transgender people.</p>
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<a href="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Christine Jorgensen standing before a set of microphones at a press conference" src="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/516765/original/file-20230321-2462-civ0ma.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Christine Jorgensen, who received gender-affirming treatments in the 1950s, was one of the first trans celebrities in the U.S.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/new-york-new-york-christine-jorgensen-arriving-at-idlewild-news-photo/515992248">Bettmann/Getty Images</a></span>
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<h2>Treating gender in every population</h2>
<p>As a trans woman and a <a href="https://gsrosenthal.com">scholar of transgender history</a>, I have spent much of the past decade <a href="https://uncpress.org/book/9781469665801/living-queer-history/">studying these issues</a>. I also take several pills each morning to maintain the proper hormonal balance in my body: spironolactone to suppress testosterone and estradiol to increase estrogen.</p>
<p>When I began HRT, or hormone replacement therapy, like many Americans I wasn’t aware that this treatment had been around for generations. What I was even more surprised to learn was that HRT is often prescribed to cisgender women – women who were assigned female at birth and raised their whole lives as women. In fact, many providers in my region already had a <a href="https://uncpress.org/book/9781469665801/living-queer-history/">long record of prescribing hormones to cis women</a>, primarily women experiencing menopause.</p>
<p>I also learned that gender-affirming hormone therapies have been prescribed to cisgender youths for generations – despite what contemporary politicians may think. Disability scholar Eli Clare has written of the history and continued practice of <a href="https://www.dukeupress.edu/brilliant-imperfection">prescribing hormones</a> to boys who are too short and girls who are too tall for what is considered a “normal” range for their gender. Because of binary gender norms that celebrate height in men and smallness in women, doctors, parents and ethicists have approved the use of hormonal therapies to make children conform to these gender stereotypes <a href="https://www.penguinrandomhouse.com/books/292342/normal-at-any-cost-by-susan-cohen/">since at least the 1940s</a>.</p>
<p>Clare describes a severely disabled young woman whose parents – with the approval of doctors and ethicists from their local children’s hospital – administered puberty blockers so that she would never grow into an adult. They deemed her mentally incapable of becoming a “real” woman. </p>
<p>The history of these treatments demonstrates that hormone therapies and puberty blockers have been used on cisgender children in this country – for better or for worse – with the goal of regulating the passage from girlhood to womanhood and from boyhood to manhood. Gender stereotypes concerning the presence or absence of secondary sex characteristics – too tall, too short, too much body hair – have all led parents and doctors to perform gender-affirming care on cisgender children.</p>
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<figcaption><span class="caption">Enforcement of binary gender norms has led to unwanted medical interventions on intersex children.</span></figcaption>
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<p>For over half a century, legal and medical authorities in the U.S. have also approved and administered surgeries and hormone therapies to force the bodies of intersex children to conform to binary gender stereotypes. I myself had genital surgery in infancy to bring my anatomy into alignment with expectations for what a “male” body should look like. In most cases, intersex surgeries are <a href="https://doi.org/10.1001/amajethics.2021.550">unnecessary for the</a> <a href="https://www.wgbh.org/news/science-and-technology/2019/10/24/medically-necessary-or-cruel-inside-the-battle-over-surgery-on-intersex-babies">health or well-being</a> of a child.</p>
<p>Historians such as Jules Gill-Peterson have shown that <a href="https://www.upress.umn.edu/book-division/books/histories-of-the-transgender-child">early advances in transgender medicine</a> in this country are deeply interwoven with the <a href="https://theconversation.com/trans-kids-in-the-us-were-seeking-treatment-decades-before-todays-political-battles-over-access-to-health-care-157481">nonconsensual treatment of intersex children</a>. Doctors at Johns Hopkins and the University of Virginia practiced reconstructing the genitalia of intersex people before applying those same treatments on transgender patients.</p>
<p>Given these intertwined histories, I contend that the current political focus on prohibiting gender-affirming care for transgender people is evidence that opposition to these treatments is not about the safety of any specific medications or procedures, but rather their use specifically by transgender people.</p>
<h2>How transgender people access care</h2>
<p>Many transgender people in the U.S. have deeply complicated feelings about gender-affirming care. This complexity is a result of over half a century of transgender medicine and patient experiences in the U.S.</p>
<p>In Rhoda’s time, medical gatekeeping meant that she had to live “full time” as a woman and prove her suitability for gender-affirming care to a team of primarily white, cis male doctors before they would give her treatment. She had to mimic language about being “<a href="https://doi.org/10.1177/1363460717740258">born in the wrong body</a>” – language invented by cis doctors studying trans people, not by trans people themselves. She <a href="https://ojs.stanford.edu/ojs/index.php/intersect/article/view/2056">had to affirm</a> she would be heterosexual and seek marriage and monogamy with a man. She could not be a lesbian or bisexual or promiscuous. </p>
<p>Many trans people still need to jump through similar hoops today to receive gender-affirming care. For example, a diagnosis of “<a href="https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria">gender dysphoria</a>,” a designated mental disorder, is sometimes required before treatment. Many trans people argue that these preconditions for access to care should be removed because being trans is an identity and a lived experience, not a disorder.</p>
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<figcaption><span class="caption">Transgender people undergo more evaluations to obtain gender-affirming care than do cisgender people.</span></figcaption>
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<p>Feminist activists in the 1970s also critiqued the role of medical authority in gender-affirming care. Writer Janice Raymond decried “<a href="https://www.worldcat.org/title/transsexual-empire-the-making-of-the-she-male/oclc/29548586">the transsexual empire</a>,” her term for the physicians, psychologists and other professionals who practice transgender medicine. Raymond argued that cis male doctors were making an army of trans women to satisfy the male gaze: promoting iterations of womanhood that reinforced sexist gender stereotypes, ultimately ushering in the displacement and eradication of the world’s “biological” women. The origins of today’s gender-critical, or <a href="https://theconversation.com/why-the-words-we-use-matter-when-describing-anti-trans-activists-130990">trans-exclusionary radical feminist</a>, movement are visible in Raymond’s words. But as trans scholar Sandy Stone wrote in her <a href="https://doi.org/10.1215/02705346-10-2_29-150">famous reply to Raymond</a>, it’s not that trans women are unwilling dupes of cis male medical authority, but rather that we have to strategically perform our womanhood in certain ways to access the care and treatments we need.</p>
<h2>The future of gender-affirming care</h2>
<p>In many states, especially in the South, where I live, governors and legislatures are introducing bills to ban gender-affirming care – <a href="https://www.washingtonpost.com/nation/2023/02/28/anti-trans-bills-gender-affirming-care-adults/">even for adults</a> – in ignorance of history. The consequences of hurried legislation extend beyond trans people, because access to hormones and surgeries is a basic medical service many people may need to feel better in their body.</p>
<p>Prohibitions on hormone therapy and gender-related surgeries for minors could mean ending the same treatment options <a href="https://www.nbcnews.com/think/opinion/gender-affirming-care-isnt-just-for-trans-people-rcna54651">for cisgender children</a>. The <a href="https://www.courier-journal.com/story/opinion/2023/03/06/kentucky-anti-trans-bill-impacts-intersex-kids-forces-gender-choice/69965192007/">legal implications for intersex children</a> may directly clash with <a href="http://www.kslegislature.org/li/b2023_24/measures/documents/sb180_00_0000.pdf">proposed legislation</a> in several states that aims to codify “male” and “female” as discrete biological sexes with certain anatomical features. </p>
<p>Prohibitions on hormone replacement therapy for adults could affect access to the same treatments for menopausal women or limit access to hormonal birth control. Prohibitions of gender-affirming surgeries could affect anyone’s ability to <a href="https://www.cbsnews.com/news/texas-bill-ban-gender-affirming-care-transgender-adults/">access a hysterectomy or a mastectomy</a>. So-called cosmetic surgeries such as breast implants or reductions, and even facial feminization procedures such as lip fillers or Botox, could also come under question. </p>
<p>These are all different types of gender-affirming procedures. Are most Americans willing to live with this level of government intrusion into their bodily autonomy? </p>
<p>Almost every <a href="https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-4-26-Bill-McBride-opposing-anti-trans-bills-Final.pdf">major medical organization</a> in the U.S. has come out against new government restrictions on gender-affirming care because, as doctors and professionals, they know that these treatments are <a href="https://doi.org/10.1016%2Fj.xcrm.2022.100719">time-tested and safe</a>. These treatments have histories reaching back over 50 years.</p>
<p>Trans and intersex people are important voices in this debate, because our bodies are the ones politicians opposing gender-affirming care most frequently <a href="https://www.nbcnews.com/nbc-out/out-politics-and-policy/arkansas-lawmaker-hearing-asks-transgender-woman-penis-rcna70787">treat as objects of ridicule and disgust</a>. Legislators are developing policies about us despite the fact that most Americans say they <a href="https://www.pewresearch.org/fact-tank/2021/07/27/rising-shares-of-u-s-adults-know-someone-who-is-transgender-or-goes-by-gender-neutral-pronouns/">do not even know a trans person</a>. </p>
<p>But trans and intersex people <a href="https://www.washingtonpost.com/dc-md-va/2023/03/23/transgender-adults-transitioning-poll/">know what it is like</a> to have to fight to access the care and treatment we need. And we know the joy of finally feeling comfortable in our own skin and being able to affirm our gender on our own terms.</p><img src="https://counter.theconversation.com/content/201752/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>G. Samantha Rosenthal is co-founder of the Southwest Virginia LGBTQ+ History Project</span></em></p>The first transgender medical clinic opened in the US in the 1960s. But cisgender and intersex children began receiving similar treatments even earlier – often without their consent.G. Samantha Rosenthal, Associate Professor of History, Roanoke CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1864712022-07-07T07:29:52Z2022-07-07T07:29:52ZWomen’s Afcon final stage is underway with a new challenge - testosterone testing<figure><img src="https://images.theconversation.com/files/472824/original/file-20220706-23-ypurl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nigerian star forward Asisat Oshoala has suffered injuries in Morocco.</span> <span class="attribution"><span class="source">Lluis Gene/AFP via Getty Images</span></span></figcaption></figure><p>The 2022 Women’s Africa Cup of Nations (<a href="https://www.cafonline.com/totalenergies-womens-africa-cup-of-nations/">Wafcon</a>) <a href="https://www.cafonline.com/totalenergies-womens-africa-cup-of-nations/news/2022-totalenergies-wafcon-opening-ceremony-a-powerful-celebration-of-the-beauty-">opened</a> in Morocco with several storylines that include challenges to perennial giants, broadcast to a global audience, increased monetary payout to the winner and an expanded number of finalists. There are 12 teams <a href="https://theconversation.com/womens-afcon-2022-nigeria-sweats-as-morocco-and-cote-divoire-usher-in-new-era-177844">left standing</a>. </p>
<p>The competition is the biggest women’s football tournament on the continent and it has brought excitement before sizeable stadium crowds and those watching via television all over the world. Morocco is one of the teams expected to challenge for the title that Nigeria has dominated since winning the debut edition of the tournament in 1991.</p>
<p>It’s the biggest and most talked-about Wafcon yet, but the 2022 competition in Morocco is also going to be remembered for the introduction of the enforcement of testosterone tests for players.</p>
<h2>The introduction of testosterone testing</h2>
<p>For <a href="https://www.theguardian.com/world/2010/nov/26/equatorial-guinea-footballers-gender-row">years</a> there have been controversies surrounding claims of teams sporting men footballers disguised as women. These cases are not all straight forward fraud. The issue of testing testosterone levels is <a href="https://theconversation.com/olympics-namibias-sprinters-highlight-a-flawed-testosterone-testing-system-165676">complex</a>. </p>
<p>Testosterone testing in <a href="https://theconversation.com/olympics-namibias-sprinters-highlight-a-flawed-testosterone-testing-system-165676">sport</a> is used to verify gender and – controversially – determine whether female athletes with high testosterone levels have an unfair advantage.</p>
<p>In the early years, Nigeria’s <a href="https://www.bbc.com/news/av/world-africa-49851991">Iyabo Abade</a> faced such claims and was eventually dismissed from the competition after she was discovered to be <a href="https://isna.org/faq/what_is_intersex/">intersex</a>. An intersex person can be born with a combination of male and female biological traits, but there are several different intersex conditions, falling into a broader range of what are known as <a href="https://www.nhs.uk/conditions/differences-in-sex-development/">Differences of Sexual Development</a>. Today, Abade identifies as a man, <a href="https://www.bbc.com/news/av/world-africa-49851991">James Johnson</a>, and is in the process of transitioning surgically. </p>
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Read more:
<a href="https://theconversation.com/olympics-namibias-sprinters-highlight-a-flawed-testosterone-testing-system-165676">Olympics: Namibia's sprinters highlight a flawed testosterone testing system</a>
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<p>South African athletics star <a href="https://www.vox.com/identities/2019/5/3/18526723/caster-semenya-800-gender-race-intersex-athletes">Caster Semenya</a>, also born intersex, and other African women track and field athletes are now required to reduce their naturally high testosterone levels or are prevented from competing. But reducing testosterone levels <a href="https://www.bmj.com/company/newsroom/new-testosterone-rule-for-female-athletes-risks-setting-an-unscientific-precedent-warn-experts/">weakens athletes</a>, compromising their ability to compete.</p>
<p>Wafcon now faces the same debate. For the first time, the Confederation of African Football (Caf) – deferring to the gender <a href="https://www.theguardian.com/football/2022/jun/21/fifa-to-review-its-gender-eligibility-regulations-in-wake-of-fina-ruling">rules of</a> world football body Fifa – has taken the matter a step further. </p>
<p>It is using testosterone tests to determine who is eligible to participate. As should be expected, this has brewed controversy. Zambian top scorer and star, Barbra Banda, 22, has been <a href="https://www.goal.com/en-ug/news/awcon-2022-zambia-to-seek-redress-after-caf-decision-on-captain-banda-kamanga/blt48bdeb3c49933c81">deemed ineligible</a> after she <a href="https://www.bbc.com/sport/africa/62057259">reportedly</a> tested above the limit for testosterone levels.</p>
<p>Banda failed to suit up for her country’s opening game against Cameroon, yet much of Zambia’s hope of success lies on her shoulders. She is her country’s most decorated participant and led the Chinese Super League with 18 goals in 13 games on her debut season. She scored <a href="https://www.eurosport.com/football/tokyo-2020/2021/tokyo-2020-two-hat-trick-zambian-barbra-banda-makes-history-but-still-winless-olympic-women-s-footba_sto8434067/story.shtml">two hat tricks</a> at the Tokyo Olympics. Zambia was also reportedly <a href="https://chicagotoday.news/sports/controversial-exclusion-of-the-crack-of-zambia-in-the-africa-cup/">warned</a> about two other players, Racheal Nachula and Racheal Kundananji, who recorded high testosterone levels.</p>
<p>Zambia is not the only team affected. Media reports <a href="https://bestchoicesports.com.ng/exclusive-francisca-ordega-disqualified-from-2022-womens-africa-cup-of-nations/">indicate that</a> 10 other players from various countries are also affected. They include Nigeria’s Francisca Ordega, Morocco’s Nahla Rakkach, Botswana’s Nondi Mahlasela and Lesego Radiakanyo, Burkina Faso’s Charlotte Milligo, Burundi’s Saffira Guinand and Cameroon’s Claudia Dabda.</p>
<p>This is no doubt just a foretaste of the controversy that will follow the implementation of testosterone testing at Wafcon. But it hasn’t drowned out the news off the pitch.</p>
<h2>Changing of power</h2>
<p>In the early action involving the 12 teams that have made it to the final stage, Morocco dominated its opening game but only won with a set piece goal in a game that they should have won by a wider margin.</p>
<p>Defending champions Nigeria, winner of 11 championships, <a href="https://www.bbc.com/sport/africa/62049929">lost</a> its opening game 1-2 to South Africa. Nigeria pulled a goal back very late in a game that was dominated by the South African team. Perennial power team Cameroon could only <a href="https://www.goal.com/en/news/2022-wafcon-wrap-cameroon-held-by-zambia-tunisia-and-senegal-off-/bltc2ad034a41d8e408">tie</a> 0-0 with Zambia even with the Zambians missing suspended star player Banda. </p>
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Read more:
<a href="https://theconversation.com/womens-afcon-2022-nigeria-sweats-as-morocco-and-cote-divoire-usher-in-new-era-177844">Women's Afcon 2022: Nigeria sweats as Morocco and Cote d'Ivoire usher in new era</a>
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<p>These results underline the <a href="https://theconversation.com/womens-afcon-2022-nigeria-sweats-as-morocco-and-cote-divoire-usher-in-new-era-177844">changing of power</a> in women’s football in Africa. The expanded final tournament (up from eight to 12 teams) will help improve competition and narrow the gap between the top teams and the others.</p>
<p>South Africa has now beaten Nigeria in consecutive games and in domineering fashion. One of those games was <a href="https://guardian.ng/sport/banyana-banyana-overrun-super-falcons-to-win-aisha-buhari-cup/">at a competition in Nigeria</a>. The days of Nigeria coming into the competition as automatic favourites are quickly disappearing. Clearly, the investments that other African nations are making in women football are beginning to pay off and several teams are already showing promise. Both hosts Morocco and Senegal have already qualified from Group A after winning two of their opening games each. </p>
<p>The testosterone testing debate will continue to wage in later Wafcons and across women’s sports for some time off the field. On the field there is no doubt that the 2022 edition is taking Wafcon to another level.</p><img src="https://counter.theconversation.com/content/186471/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chuka Onwumechili does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The thorny issue of testosterone testing has made news, not just the growing skills on the field.Chuka Onwumechili, Professor of Communications, Howard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1845662022-06-15T04:43:53Z2022-06-15T04:43:53ZACT releases Australian-first draft law to protect intersex children from irreversible medical harm<figure><img src="https://images.theconversation.com/files/468925/original/file-20220615-19-h6i1yn.jpg?ixlib=rb-1.1.0&rect=0%2C5%2C3958%2C2624&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/children-playing-with-balloons-on-green-grass-field-6299265/">Pexels</a></span></figcaption></figure><p>The Australian Capital Territory government has <a href="https://www.cmtedd.act.gov.au/policystrategic/the-office-of-lgbtiq-affairs/variations-in-sex-characteristics-bill">released</a> a consultation draft law to protect the rights of intersex people.</p>
<p>If passed, the bill would ban deferrable medical interventions on children with intersex traits until they’re old enough to decide treatments for themselves. There will be exceptions for emergency and urgently necessary procedures. The bill will criminalise unnecessary medical interventions, and create an independent body to determine whether other proposed procedures are urgently necessary.</p>
<p>Following the consultation period, a bill is likely to be introduced into the ACT parliament later this year. The ACT is the first Australian jurisdiction to move ahead with such laws. It delivers on long-standing community demands, and recommendations by the <a href="https://humanrights.gov.au/intersex-report-2021">Australian Human Rights Commission</a>.</p>
<p>So far, only a handful of jurisdictions such as <a href="https://www.ohchr.org/en/documents/tools-and-resources/background-note-human-rights-violations-against-intersex-people">Malta, Portugal, Germany and Iceland</a> have passed similar reforms, making the ACT a global leader. </p>
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<h2>What are intersex traits?</h2>
<p>Innate variations of sex characteristics include a wide range of traits affecting chromosomes, sexual anatomy or hormones. They’re also referred to as “intersex” traits or “differences of sex development”. For example, these include people born with both testicular and ovarian tissue, and people born with atypical genitalia.</p>
<p>Because these characteristics are stigmatised, children with intersex traits are at <a href="https://ihra.org.au/36471/intersexion-mdscx-2020/">risk</a> of medical interventions in early childhood.</p>
<p>In some situations, the presence of a visible intersex trait at birth can raise questions about sex assignment. In these situations, some Australian doctors consider surgical options to be an acceptable factor in determining sex assignment. This presumes sex assignment for children with visible intersex traits must always be reinforced by early irreversible surgeries. In countries like Australia, this frequently leads to female assignment, on the basis it’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293350/">easier</a> to construct female-typical anatomy than male-typical anatomy.</p>
<p>Early surgeries are aimed at changing appearance or function in line with social and cultural norms for female and male bodies. </p>
<p>For example, in <a href="https://morgancarpenter.com/intersex-dsd-australian-data/">Australia</a>, girls with intersex traits have been subjected to cosmetic surgeries to “<a href="http://www.theage.com.au/national/it-takes-more-than-two-20130619-2oj8v.html">enhance</a> the appearance” of their genitalia.</p>
<p>Infant boys may undergo surgeries to ensure they’re able to urinate “<a href="https://www.abc.net.au/news/2021-03-14/push-to-outlaw-gender-assignment-surgery-on-intersex-children/13234680">appropriately</a>” – that is, while standing.</p>
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Read more:
<a href="https://theconversation.com/intersex-children-in-new-zealand-are-routinely-undergoing-unnecessary-surgery-that-needs-to-change-168936">Intersex children in New Zealand are routinely undergoing unnecessary surgery – that needs to change</a>
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<p>Sterilising surgeries have been performed to reinforce sex assigned or observed at birth, and gender identity. For example, in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293350/">one case</a>, the sterilisation of a pre-school child was justified by reference to her long, blonde hair and enjoyment of Barbie toys, and prior surgery that had according to the judge “enhanced the appearance of her female genitalia”.</p>
<p>Some surgeries are performed in the belief they can improve bonding between parents and child, produce certainty about future identity, or reduce risks of stigma. </p>
<p>There’s poor evidence for such medical interventions, and they’re often grounded in gender stereotypes.</p>
<p>They’re also poor substitutes for psychological and social support.</p>
<p>Early surgeries <a href="https://doi.org/10.1080/19419899.2021.1938189">can cause</a> <a href="https://humanrights.gov.au/intersex-report-2021">lifelong harm</a>, including impaired sexual function and sensation, shame, and a need for ongoing interventions or treatment.</p>
<p>Until now, the law <a href="https://www.unswlawjournal.unsw.edu.au/wp-content/uploads/2017/09/39-2-3.pdf">has been</a> <a href="https://doi.org/10.1007/s11673-018-9855-8">complicit</a> in supporting early interventions before a child is old enough to express their own preferences.</p>
<h2>Building on a long history</h2>
<p>The intersex movement has been challenging such interventions for decades, in Australia and internationally. It has won allies and increasing recognition from human rights institutions. </p>
<p>The ACT government made a commitment to reform in 2019. It builds on a 2017 intersex community declaration known as the <a href="https://darlington.org.au/statement">Darlington Statement</a>. </p>
<p>It also responds to a 2013 Senate committee <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index">report</a>, statements to Australia by <a href="https://ihra.org.au/35665/australia-crc-crpd-harmful-practices/">UN Treaty Bodies</a>, and international norms expressed in the <a href="http://www.yogyakartaprinciples.org/principles-en/yp10/">Yogyakarta Principles plus 10</a>.</p>
<p>It implements recommendations of a <a href="https://humanrights.gov.au/intersex-report-2021">landmark 2021 report</a> by the Australian Human Rights Commission on promoting health and bodily integrity for people born with variations of sex characteristics.</p>
<figure class="align-center ">
<img alt="A group of people smiling at the end of an event where they drafted the Darlington Statement, an intersex community declaration for Australia and Aotearoa New Zealand." src="https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=352&fit=crop&dpr=1 600w, https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=352&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=352&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=442&fit=crop&dpr=1 754w, https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=442&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/467891/original/file-20220609-25-vmhhoj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=442&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The group that drafted the Darlington Statement, a community declaration to support the human rights and health of intersex people.</span>
<span class="attribution"><a class="source" href="https://darlington.org.au/statement">Dr Phoebe Hart</a>, <span class="license">Author provided</span></span>
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</figure>
<p>If the law passes, families and their clinical teams will be able to develop individual treatment plans for their children, or rely on general treatment plans. </p>
<p>General treatment plans are intended to facilitate access to low-risk treatments, or treatments that preserve options for the future. An example might be surgery for undescended testes, to relocate testes in the scrotum to help to preserve future fertility.</p>
<p>All treatment plans will be evaluated by a panel of experts in medicine, ethics, human rights, psychological and social support, people with intersex traits and parents of children with intersex traits. This is intended to provide accountability and transparency, while protecting the privacy of people undergoing treatment.</p>
<p>The laws will provide a detailed definition of “consent to treatment” for the first time in the ACT. In line with the Convention on the Rights of Persons with Disabilities, it represents an important shift towards supported decision-making, in place of substitute decision-making where parents or carers <a href="https://doi.org/10.1177/0022146518802460">make decisions</a> about treatment.</p>
<p>Supported decision-making processes respect that we all need information, resources and support in order to make informed decisions for ourselves. Some people, including youth, may need access to additional supports to work through such information to reach a balanced and authentic decision.</p>
<p>The reforms have been developed through consultation with community as well as clinical, ethics, human rights and legal experts. They are part of a package aimed also at improving access to peer support for individuals and families.</p>
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Read more:
<a href="https://theconversation.com/will-things-be-better-for-lgbtiq-people-under-labor-heres-what-the-new-government-has-promised-184139">Will things be better for LGBTIQ+ people under Labor? Here's what the new government has promised</a>
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</p>
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<h2>Where to next?</h2>
<p>The Victorian government has <a href="https://www2.health.vic.gov.au/about/publications/factsheets/i-am-equal">committed to similar reforms</a>. The New South Wales government has acknowledged a need to respond to these developments in its first <a href="https://www.health.nsw.gov.au/lgbtiq-health/Pages/default.aspx">LGBTI Health Strategy</a>.</p>
<p>All Australian jurisdictions should engage in legislative reform programs.</p>
<p>The federal government must proactively support these reforms and ensure national consistency. It should act to improve information and peer support access for parents and individuals. Reforms by states and territories need to be underpinned by <a href="https://ihra.org.au/39860/call-for-action-2022/">changes</a> to paediatric Medicare codes, and support for development of national standards of care that affirm human rights.</p>
<p>More can also be achieved through meaningful inclusion of accurate information about intersex traits in <a href="https://www.shfpact.org.au/news-and-updates/418-including-intersex">schools</a> to reduce stigma, and promote better understanding amongst youth and future parents.</p><img src="https://counter.theconversation.com/content/184566/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aileen Kennedy Is a Director on the Board of Intersex Human Rights Australia (IHRA) </span></em></p><p class="fine-print"><em><span>Alice de Jonge is a director on the board of Intersex Human Rights Australia (IHRA). </span></em></p><p class="fine-print"><em><span>Morgan Carpenter is the executive director of Intersex Human Rights Australia, a national charity which is funded by foreign philanthropy and a service contract with the Victorian Department of Health. He has been contracted to the ACT government in connection with this legal reform project.</span></em></p>Early surgeries can cause lifelong harm, including impaired sexual function and sensation, shame, and a need for ongoing interventions or treatment.Aileen Kennedy, Lecturer in Health Law, University of New EnglandAlice de Jonge, Senior Lecturer, International Law; Asian Business Law, Monash UniversityMorgan Carpenter, PhD candidate in bioethics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1722932022-02-04T13:09:35Z2022-02-04T13:09:35ZNot everyone is male or female – the growing controversy over sex designation<figure><img src="https://images.theconversation.com/files/441210/original/file-20220118-13-l32vzy.jpg?ixlib=rb-1.1.0&rect=0%2C26%2C5906%2C3904&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Although the medical establishment is now recognizing that sex is not binary, society as a whole has been slow to embrace the concept.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/small-beautiful-child-lies-on-the-bed-on-his-royalty-free-image/1300384940?adppopup=true">Vera Livchak/Moment via Getty Images</a></span></figcaption></figure><p>Check out your birth certificate and surely you’ll see a designation for sex. When you were born, a doctor or clinician assigned you the “male” or “female” label based on a look at your genitalia. In the U.S., this has been <a href="https://doi.org/10.1056/nejmp2025974">standard practice for more than a century</a>. </p>
<p>But sex designation is not as simple as a glance and then a check of one box or another. Instead, the overwhelming evidence shows that <a href="https://doi.org/10.1002/ase.2002">sex is not binary</a>. To put it another way, the terms “male” and “female” don’t fully capture the complex biological, anatomical and chromosomal variations that occur in the human body. </p>
<p>That’s why calls are growing to remove sex designation from birth certificates, including <a href="https://thehill.com/changing-america/respect/equality/566767-ama-doctors-experts-recommend-removing-sex-designation-from">a recent recommendation</a> from the American Medical Association. </p>
<p>I am a <a href="https://www.bumc.bu.edu/busm/profile/carl-streed/">professor of medicine</a> who has worked extensively <a href="https://scholar.google.com.au/citations?user=Rv-dZJ4AAAAJ&hl=en">on lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) issues</a>. My co-author is a <a href="https://www.childrenshospital.org/directory/physicians/g/frances-grimstad">professor of gynecology</a> who is deeply involved in the health of people who are trans and intersex. </p>
<p>Our research and clinical experience show that sex designation is not something to take for granted. For those who don’t fit neatly into one of two categories – <a href="https://doi.org/10.1002/(sici)1520-6300(200003/04)12:2%3C151::aid-ajhb1%3E3.0.co;2-f">and there are millions</a> – an inappropriate classification on a birth certificate can have consequences that last a lifetime.</p>
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<figcaption><span class="caption">What does intersex mean?</span></figcaption>
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<h2>The problems with sex designation</h2>
<p>Variations in genital anatomy happen more frequently than you might think; <a href="https://doi.org/10.1002/(sici)1520-6300(200003/04)12:2%3C151::aid-ajhb1%3E3.0.co;2-f">they occur in 0.1 to 0.2% of births annually</a>. In the U.S., that’s about 4,000 to 8,000 babies each year. </p>
<p>Other sex traits don’t necessarily help either. Doctors examining the reproductive organs <a href="https://doi.org/10.1038/518288a">can find people</a> born with both a vagina and testes, and also those born without any gonads. And when evaluating an individual’s estrogen and testosterone hormone levels, long defined as key determinants of female and male bodies, doctors find some people with vaginas still produce <a href="https://doi.org/10.1016/S0140-6736(12)60071-3">significant amounts of testosterone</a>. Because of this, testosterone is not a great indicator for defining sex; higher amounts of testosterone do not necessarily make someone male. </p>
<p>Even karyotyping – a laboratory procedure used since the 1950s to evaluate an individual’s number and type of chromosomes – doesn’t tell the whole story. While we typically expect people to either have XX or XY pairs of sex chromosomes, <a href="https://doi.org/10.1038/518288a">many people have variations</a> that <a href="https://dx.doi.org/10.1159%2F000499274">do not fit either category</a>. These include <a href="https://www.mayoclinic.org/diseases-conditions/turner-syndrome/symptoms-causes/syc-20360782#">Turner syndrome</a>, in which a person is born with a single X chromosome, and <a href="https://www.mayoclinic.org/diseases-conditions/klinefelter-syndrome/symptoms-causes/syc-20353949#">Kleinfelter syndrome</a>, which occurs when a person is born with a combination of XXY chromosomes. </p>
<p>In short, human diversity has demonstrated that the binary categories of male and female are incomplete and inaccurate. Sex designation, rather than “two sizes fit all,” <a href="https://doi.org/10.1089/lgbt.2021.0018">is on a spectrum</a>. Up to 1.7% of the U.S. population – that’s more than 5 million Americans – have an anatomy and physiology that present intersex traits.</p>
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<figcaption><span class="caption">What it’s like to be intersex.</span></figcaption>
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<h2>Binary designations can be damaging</h2>
<p>Those with intersex traits who <a href="https://doi.org/10.1371/journal.pone.0240088">are assigned at birth</a> to be female or male can <a href="https://www.amnesty.org/en/latest/campaigns/2017/05/intersex-rights/">experience medical care that harms them</a>, both physically and psychologically. </p>
<p>Sometimes physicians perform surgeries to align bodies into binary categories. For example, those born with a larger than typical clitoris <a href="https://doi.org/10.1089/lgbt.2021.0018">may have it reduced in size</a>. But some who have this childhood surgery suffer as adults from pain and difficulty having sex.</p>
<p>[<em><a href="https://memberservices.theconversation.com/newsletters?nl=science&source=inline-science-corona-important">Get The Conversation’s most important coronavirus headlines, weekly in a science newsletter</a></em>]</p>
<p>Additionally, governments sometimes limit those with intersex traits from fully participating in society. For instance, in Australia, <a href="https://ihra.org.au/16808/annulment-marriage-due-intersex-marriage-falsely-called/">marriages have been annulled</a> because governments have previously ruled that an intersex person – someone not seen to be “100% man” or “100% woman” – cannot be legally married.</p>
<p><a href="https://stillmed.olympics.com/media/Documents/News/2021/11/IOC-Framework-Fairness-Inclusion-Non-discrimination-2021.pdf">Private entities</a> often do the same. The International Olympics Committee uses <a href="https://www.wired.com/story/caster-semenya-and-the-twisted-politics-of-testosterone/">cutoffs of hormone levels</a> to determine who plays in women’s sports. As a result, some athletes have been barred from participation. </p>
<p>And for those with a gender identity that differs from the sex designation on a government document, <a href="https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf">discrimination, harassment or violence</a> can result. </p>
<p>State governments have begun to acknowledge sex diversity. Some let gender-diverse people change their designation on birth certificates, <a href="https://www.lgbtmap.org/equality-maps/identity_document_laws/birth_certificate">although there are restrictions</a>. Medicine too <a href="https://doi.org/10.1089/lgbt.2021.0018">is changing</a>. For example, some pediatric centers have stopped performing surgeries on newborns with <a href="https://protect-us.mimecast.com/s/jNAuCVOrlMC8Dq3vuQEnoR?domain=them.us">differences in sex development</a>. Still, society at large <a href="https://www.cnn.com/2017/09/20/health/geas-gender-stereotypes-study/index.html">has been much slower to move beyond</a> the use of strictly binary categories. </p>
<p>As clinicians, we strive to be accurate. The evidence shows that using male and female as the only options on birth certificates is not consistent with scientific reality. Evidence shows that removing this designation will tell new parents that it’s not sex assignment that’s most important at birth but rather the celebration of a healthy and happy baby.</p><img src="https://counter.theconversation.com/content/172293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carl Streed receives funding from the National Heart, Lung, and Blood Institute and the American Heart Association. He is affiliated with the US Professional Association for Transgender Health and the American Medical Association. </span></em></p><p class="fine-print"><em><span>Frances Grimstad does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Millions of people do not fit neatly into male or female sex designations at birth, and wrong identification can set them up for a lifetime of physical and mental harm.Carl Streed Jr, Assistant Professor of Medicine, Boston UniversityFrances Grimstad, Assistant Professor of Gynecology, Harvard UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1689362021-10-25T19:50:18Z2021-10-25T19:50:18ZIntersex children in New Zealand are routinely undergoing unnecessary surgery – that needs to change<figure><img src="https://images.theconversation.com/files/427915/original/file-20211021-13-wticee.jpg?ixlib=rb-1.1.0&rect=15%2C23%2C5160%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Until very recently, people with intersex variations have often been unseen, stigmatised and routinely discriminated against. <a href="https://interactadvocates.org/intersex-awareness-day/">Intersex Awareness Day</a> today (October 26) is therefore an opportunity to examine how much progress has been made and how far we still have to go.</p>
<p>It’s estimated <a href="https://www.amnesty.org/en/latest/news/2018/10/its-intersex-awareness-day-here-are-5-myths-we-need-to-shatter/">1.7 to 4%</a> of people globally are intersex – meaning they don’t fit within typical female or male norms. </p>
<p>In particular, the rights of children with intersex variations are coming under scrutiny. </p>
<p>With surgery in infancy or early childhood still considered an option,
<a href="https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2fPPRiCAqhKb7yhsrXsJ3pRx9xOCak0Ed1mLElSXcY5e%2bSYJ4cCIPH2iPOgLuEWmnttJAXCYk1WXW5fu9WagFa0bDhf72L%2fqDxeYU66nhVpJwtkgNIsCxADWOks">questions</a> are now being asked about how to ensure no child is subjected to unnecessary procedures or treatment, and that the child’s consent is obtained for necessary interventions. </p>
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<h2>Surgery can be delayed</h2>
<p>Intersex people have <a href="https://www.ogmagazine.org.au/20/4-20/intersex-variations-in-sex-characteristics/">variations in sex characteristics</a> that can occur naturally at the level of chromosomes, hormones and/or anatomy. </p>
<p>There is a wide range of variations. Hypospadias, where the urethral opening appears on the underside of the penis, is most common. Although not a health problem, surgery to alter the hypospadic appearance is “routine” in many places, including Aotearoa New Zealand.</p>
<p>The latest <a href="https://www.health.govt.nz/publication/publicly-funded-hospital-discharges-1-july-2017-30-june-2018">Ministry of Health data</a> shows that in 2017-18, 265 people aged under 15 were diagnosed with hypospadias, with 206 surgical operations performed – 85% of those operations performed on children aged under five. </p>
<p>These surgeries could be delayed until the children are older and able to give or refuse consent. There is no clear biomedical basis for such surgery, it is not lifesaving and it puts the child at risk (as surgery inevitably does). </p>
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Read more:
<a href="https://theconversation.com/surgery-to-make-intersex-children-normal-should-be-banned-76952">Surgery to make intersex children 'normal' should be banned</a>
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<p>While there are some <a href="https://www.cincinnatichildrens.org/health/m/mixed-gonadal-dysgenesis">gonadal variations</a> (affecting the development of ovaries or testes) that can be life-threatening and require surgical treatment, few variations in sex characteristics are life-threatening in infancy. </p>
<p>Surgery on children with genital variations might appear to promote wellbeing but research highlights the harmful effects of any surgery intended to produce a more “<a href="https://pubmed.ncbi.nlm.nih.gov/31971496/">male</a>” or more “<a href="https://pubmed.ncbi.nlm.nih.gov/30272250/">female</a>” genital appearance. </p>
<p>Like their overseas counterparts, Aotearoa New Zealand <a href="https://www.stuff.co.nz/life-style/gender-and-society/125333190/queens-birthday-honours-intersex-advocate-mani-bruce-mitchell-on--doing-the-mahi">intersex people</a> who have spoken publicly have opposed the interventions they underwent as children.</p>
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<h2>Who gives consent?</h2>
<p>The issue of genital surgery has implications for the <a href="https://www.renews.co.nz/we-cant-forget-new-zealand-still-discriminates-against-rainbow-communities/">legal rights</a> of New Zealanders with variations in sex characteristics, including their right to <a href="https://www.legislation.govt.nz/act/public/1990/0109/latest/DLM224792.html">refuse</a> medical treatment, and the rules around informed consent. </p>
<p>The young age at which most surgeries are carried out means consent is provided by parents, who have the right and responsibility to decide on important matters affecting the child, including non-routine <a href="https://www.legislation.govt.nz/act/public/2004/0090/latest/whole.html#DLM317233">medical treatment</a>. </p>
<p>With such decisions, the best interests and welfare of the child in their particular circumstances must be the <a href="https://www.legislation.govt.nz/act/public/2004/0090/latest/DLM317240.html">paramount</a> consideration. The right to be <a href="https://www.hdc.org.nz/your-rights/about-the-code/code-of-health-and-disability-services-consumers-rights/">fully informed</a> is contained in the Code of Health and Disability Services Rights. </p>
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Read more:
<a href="https://theconversation.com/choosing-childrens-sex-is-an-exercise-in-sexism-45836">Choosing children's sex is an exercise in sexism</a>
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<p>In essence, every New Zealander has a right to an explanation of their condition and an explanation of the options available, including risks, side effects, costs and benefits of each option, and honest and accurate answers to questions, including the results of research. </p>
<p>But <a href="https://www.facebook.com/renewsnz/videos/168623591785700/">intersex advocates</a> in Aotearoa New Zealand argue that they and their families have been isolated from sources of information and from others in similar situations.</p>
<p>And there is the added complexity of current responses to intersex variations being <a href="https://www.hrc.co.nz/files/9615/2270/4142/HRC_Intersex_Roundtable_2017.pdf">insensitive</a> to cultural contexts, reflecting as they do binary Western constructions of gender that categorise individuals as either male or female.</p>
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<h2>International progress</h2>
<p>The issue of genital surgery is gaining traction in international law. For example, the right to be protected from <a href="https://www.ohchr.org/en/professionalinterest/pages/cat.aspx">degrading treatment</a> was extended to <a href="https://www.ohchr.org/documents/hrbodies/hrcouncil/regularsession/session22/a.hrc.22.53_english.pdf">health-care settings</a> in 2013, with the call from a UN special rapporteur for states to repeal any law allowing genital-normalising surgery when “enforced or administered without the free and informed consent of the person concerned.” </p>
<p>Overall, the <a href="http://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=4slQ6QSmlBEDzFEovLCuW1a0Szab0oXTdImnsJZZVQfQejF41Tob4CvIjeTiAP6sGFQktiae1vlbbOAekmaOwDOWsUe7N8TLm%2BP3HJPzxjHySkUoHMavD%2Fpyfcp3Ylzg">right to health</a> is violated when states fail to take steps to prevent young children from undergoing medically unnecessary, irreversible and involuntary surgery and treatment.</p>
<p>In 2016, the <a href="https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2fPPRiCAqhKb7yhsrXsJ3pRx9xOCak0Ed1mLEkIUHtKTSHNWA9ddXmo8oiUgGuB9JUoxS6ES4ymmXawE3W7Z52o%2b4tn33VBe09mSo1Rr6ta1lLVkTxmo%2fSYUATQ">UN Committee on the Rights of the Child</a> recommended Aotearoa New Zealand develop and implement a healthcare protocol for intersex children, based on children’s rights, setting the procedures and steps to be followed by health teams. </p>
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Read more:
<a href="https://theconversation.com/beyond-the-binary-how-teaching-children-about-gender-could-help-reduce-sexism-113140">Beyond the binary: how teaching children about gender could help reduce sexism</a>
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<p>This followed a submission to the committee from Aotearoa New Zealand’s <a href="https://www.hrc.co.nz/files/6814/7426/0090/Supplementary_Report_of_NZHRC_for_CRC_73rd_session_NZ.pdf">Human Rights Commission</a>. The UN committee called on the country to ensure no one is subjected to unnecessary medical or surgical treatment during infancy or childhood, and to guarantee the child’s right to bodily integrity, autonomy and self-determination. </p>
<p>In response to the <a href="https://docstore.ohchr.org/SelfServices/FilesHandler.ashx?enc=6QkG1d%2fPPRiCAqhKb7yhsrXsJ3pRx9xOCak0Ed1mLEkIUHtKTSHNWA9ddXmo8oiUgGuB9JUoxS6ES4ymmXawE3W7Z52o%2b4tn33VBe09mSo1Rr6ta1lLVkTxmo%2fSYUATQ">recommendations</a> of the UN committee, as well as domestic advocacy, the Ministry of Health directed the Paediatric Society to set up an <a href="https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/monitoring/uncroc/reporting/sixth-report/issues/rights/violence/harmful-practices.html">intersex working group</a> to develop <a href="https://starship.org.nz/guidelines/differences-of-sex-development-atawhai-taihemahema/">guidelines</a> for infants born intersex. </p>
<p>But this has so far failed to make significant changes to the practice of surgical intervention on children’s genitalia. </p>
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<strong>
Read more:
<a href="https://theconversation.com/what-are-gender-pronouns-and-why-is-it-important-to-use-the-right-ones-169025">What are gender pronouns and why is it important to use the right ones?</a>
</strong>
</em>
</p>
<hr>
<h2>Aotearoa New Zealand can do better</h2>
<p>Meanwhile, <a href="https://www.renews.co.nz/we-cant-forget-new-zealand-still-discriminates-against-rainbow-communities/">advocates</a> continue to call for legislation to defer interventions until children themselves are capable of consenting or expressing their own views. </p>
<p>Central to any policy, legislative or medical development must be the child’s right to be free from discrimination. </p>
<p>Children have the right to have their voices heard. This means, with the exception of life-saving treatment, any interventions should be postponed until a child is competent to decide. </p>
<p>Where necessary, a skilled, independent advocate should be appointed to represent the child’s interests. Current medical practice in Aotearoa New Zealand falls well short of those goals.</p>
<hr>
<p><em>The authors are grateful to the contribution of researchers Craig Dempster and Sam Johnston, and to members of the Intersex Health and Well-Being Working Group (Incentive), who gave feedback on an earlier draft.</em></p><img src="https://counter.theconversation.com/content/168936/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With no clear biomedical basis for most early surgery on intersex children, interventions should be postponed until a child is competent to decide for themselves.Claire Breen, Professor of Law, University of WaikatoKatrina Roen, Professor of Sociology, University of WaikatoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1702052021-10-25T19:11:49Z2021-10-25T19:11:49ZAnatomy texts should show sex as a spectrum to include intersex people<figure><img src="https://images.theconversation.com/files/427945/original/file-20211022-23-1fe6s5b.jpg?ixlib=rb-1.1.0&rect=34%2C42%2C5622%2C3711&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/choosing-changing-gender-concept-figure-teenager-1903637947">Shutterstock</a></span></figcaption></figure><p>Scientists are learning more and more about human biological variation, including of sex characteristics. But <a href="https://youtu.be/guruBUvmfBA">images of the human body in anatomy</a> remain mostly muscular, white, and male with limited diversity, including of sex.</p>
<p>Intersex people represent just under <a href="https://www.amnesty.org/en/latest/news/2018/10/its-intersex-awareness-day-here-are-5-myths-we-need-to-shatter/">2% of the population</a> – a comparable percentage to people born with red hair. Yet <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953617301879">anatomy textbooks used in Australian medical schools</a> almost completely stick to the male-female sex binary. In our earlier research we found intersex was included in only five of 6,004 images across 17 texts. This marginalises intersex people, who have been <a href="https://humanrights.gov.au/our-work/lgbti/about-sexual-orientation-gender-identity-and-intersex-status-discrimination">persistently discriminated</a> against within the health-care system.</p>
<p>The <a href="https://intersexday.org/en/">intersex community</a> is the often forgotten “I” in LGBTQI+. <a href="https://ihra.org.au/">Intersex Human Rights Australia</a> highlights the need for increased visibility and to <a href="https://www.abc.net.au/news/2021-10-17/intersex-reform-sex-normalisation-surgery-children/100538054">prevent unnecessary surgeries</a>. Now there are fresh calls for health and medical students to learn about <a href="https://pubmed.ncbi.nlm.nih.gov/32735387/">sex characteristics as a continuum</a> rather than as male or female.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/marriage-equality-was-momentous-but-there-is-still-much-to-do-to-progress-lgbti-rights-in-australia-110786">Marriage equality was momentous, but there is still much to do to progress LGBTI+ rights in Australia</a>
</strong>
</em>
</p>
<hr>
<h2>Development of sex in utero</h2>
<p>Sex development in utero is complex, involving at least <a href="https://www.ncbi.nlm.nih.gov/books/NBK279001/">70 different genes</a>.</p>
<p>Our sex is defined by our genes (Y or X chromosome), gonads (ovaries or testes), reproductive tract, and external genitalia.</p>
<p>Whether a foetus develops female, intersex or male characteristics is determined by four key elements. These are the Y chromosome and its sex-determining gene (<a href="https://theconversation.com/we-discovered-a-missing-gene-fragment-thats-shedding-new-light-on-how-males-develop-147348">SRY gene</a>), and two hormones (anti-Mullerian hormone and testosterone).</p>
<p>A foetus with all four elements will develop male sex characteristics.</p>
<p>At 6–7 weeks gestation, the SRY gene on the Y chromosome signals the gonads to develop into testes. About 2–3 weeks later, secretion of two hormones by the testes directs further sex development. Anti-Mullerian hormone stops female sex characteristic development. Testosterone stimulates development of the male reproductive tract and external genitalia.</p>
<p>When all four elements are absent, female sex characteristics develop.</p>
<p>Without a Y chromosome and its SRY gene, the gonads develop into ovaries. Without anti-Mullerian hormone or testosterone production, the female reproductive tract and external genitalia develop.</p>
<p>The presence of some but not all of these elements results in the development of intersex characteristics.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1451201777483665415"}"></div></p>
<h2>The spectrum of sex variation</h2>
<p>Intersex can include both or a combination of male and female sex characteristics, depending on variations in chromosomes, genes or hormones. This represents the <a href="https://theconversation.com/beyond-male-and-female-time-for-a-non-specific-sex-category-20159">continuum of the sex spectrum</a> between the male and female binaries.</p>
<p>Known <a href="https://sitn.hms.harvard.edu/flash/2016/im-xy-know-sex-determination-systems-101/">variations</a> in the Y and X chromosomes include XY (genetic male), XXY (Klinefelter syndrome), X (Turner syndrome), XX (genetic female). Variations in the gonads include the presence of both ovaries and testes, or only partial development of either. Other intersex variations include a combination of male and female genitalia, and external genitalia that differs in sex to the genetic sex.</p>
<p>Intersex traits are <a href="https://www.apa.org/topics/lgbtq/intersex.pdf">not always visible at birth</a>. Individuals may not realise they are intersex until puberty, or only if they undergo assessment for infertility or genetic testing.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pMAk8mBrVK4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">‘When I first went through puberty, a lot of things went a little different to what most people expect …’</span></figcaption>
</figure>
<h2>Lingering stigma</h2>
<p>There is a tragic history of irreversible surgical interventions in intersex infants and children. This was often without their consent, or with <a href="https://www.abc.net.au/news/2021-10-17/intersex-reform-sex-normalisation-surgery-children/100538054">parents coerced to consent</a>. </p>
<p>These surgeries have been to “normalise” external genitalia to a male or female binary. The impact of <a href="https://theconversation.com/surgery-to-make-intersex-children-normal-should-be-banned-76952">these procedures</a> may violate human rights. They can be devastating for intersex people’s lifelong physical and mental <a href="https://www.headtohealth.gov.au/supporting-yourself/support-for/intersex#:%7E:text=Historically%2C%20intersex%20people%20and%20the,surgical%20and%20other%20medical%20histories.&text=But%20surgery%20cannot%20resolve%20such,mental%20health%20consequences%2C%20including%20trauma.">well-being</a>.</p>
<p>The <a href="https://www.ohchr.org/EN/Issues/LGBTI/Pages/IntersexPeople.aspx">UN Office of the High Commissioner for Human Rights</a> description of intersex is having sex characteristics that “do not fit typical binary notions of male or female bodies”. But even this pathologises intersex by indicating that intersex people “do not fit”.</p>
<p>Normalisation of sex variation and increased visual representation of intersex in anatomy is necessary to reduce stigma.</p>
<p>The minimal visual representation of intersex people in anatomy textbooks can affect students’ attitudes towards this. We have previously found viewing gender-biased images of anatomy <a href="https://journals.sagepub.com/doi/full/10.1177/2332858418798832">is associated with higher implicit gender bias</a>. Today’s students are our next generation of doctors and health-care workers.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-gender-pronouns-and-why-is-it-important-to-use-the-right-ones-169025">What are gender pronouns and why is it important to use the right ones?</a>
</strong>
</em>
</p>
<hr>
<h2>Teaching the continuum</h2>
<p>Teaching sex characteristics based on a male-female binary is inaccurate and outdated. We’ve also shown it <a href="https://anatomypubs.onlinelibrary.wiley.com/doi/abs/10.1002/ase.2002">negatively influences</a> the healthcare of intersex individuals.</p>
<p>Both the University of Wollongong and the University of New South Wales are developing inclusive anatomy curricula within their medicine and health degrees. <a href="https://edib.harvard.edu/addressing-bias-medical-education-through-inclusive-anatomical-representation">Harvard Medical School</a> and <a href="https://www.youtube.com/watch?v=fLfLS_iDtsE">University of British Columbia</a> are also developing online, accessible resources to promote inclusive anatomical representation in medical education.</p>
<p>Inclusive teaching and knowledge of sex variation can be transformative beyond anatomy.</p>
<p>Teaching sex characteristics as a continuum will increase the visibility and understanding of intersex. Removing the stigma associated with sex (and other) variations in anatomy, and medical and health education is essential for optimal health, well-being, belonging and connection for everyone.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/P2jZmyufBjk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An international group – that includes people of different academic disciplines and generations, seeks to address anatomical representation bias.</span></figcaption>
</figure><img src="https://counter.theconversation.com/content/170205/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Around two in every 100 people have sex characteristics between the male-female binary definitions. Training for doctors and other health workers needs to reflect this.Theresa Larkin, Senior Lecturer Medical Sciences, University of WollongongAlison Rutherford, Senior lecturer, University of WollongongGoran Štrkalj, Associate Professor, biological anthropologist and anatomist, UNSW SydneyNalini Pather, Professor, Medical Sciences, UNSW Medicine & Health & Co-Director, UNSW Scientia Education Academy, UNSW SydneyRhiannon Parker, Research assistant, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1574812021-06-01T12:48:20Z2021-06-01T12:48:20ZTrans kids in the US were seeking treatment decades before today’s political battles over access to health care<figure><img src="https://images.theconversation.com/files/403172/original/file-20210527-17-in7gw7.jpg?ixlib=rb-1.1.0&rect=0%2C200%2C1227%2C1050&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Boy Wearing a Wig,' Wilhelm von Gloeden (1900).</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Gloeden,_Wilhelm_von_(1856-1931)_-_n._1734.jpg">Wikimedia Commons</a></span></figcaption></figure><p>In 1942, a 17-year-old transgender girl named Lane visited a doctor in her Missouri hometown with her parents. Lane had known that she was a girl from a very young age, but fights with her parents over her transness had made it difficult for her to live comfortably and openly during her childhood. She had dropped out of high school and she was determined to get out of Missouri as soon as she was old enough to pursue a career as a dancer. </p>
<p>The doctor reportedly found “a large portion of circulating female hormone” in her body during his examination and suggested to Lane’s parents that he undertake <a href="https://www.saintlukeskc.org/health-library/exploratory-laparotomy">an exploratory laparotomy</a> – a surgery in which he would probe her internal organs in order to find out more about her endocrine system. But the appointment ended abruptly after her father refused the surgery, feeling “the doctor did not know what he was talking about.” </p>
<p>I first encountered Lane’s story buried among the papers of an endocrinologist, but her brief encounter with a doctor during her teenage years was typical of many transgender children like her in the early to mid-20th century. These stories form a key thread of the first several chapters of my book, “<a href="https://www.upress.umn.edu/book-division/books/histories-of-the-transgender-child">Histories of the Transgender Child</a>,” and they point to the tremendous obstacles these kids faced in a world where the word “transgender” <a href="https://theconversation.com/whats-in-a-word-the-challenges-of-transgender-38633">didn’t even exist</a>.</p>
<h2>The living laboratories of gender</h2>
<p>In the first half of the 20th century there was nothing like today’s <a href="https://pediatrics.aappublications.org/content/142/4/e20182162">gender-affirming pediatric care model</a>, which involves building a social support network and can include treatments like hormone blockers. Doctors simply did not allow trans patients to transition. </p>
<p>That doesn’t mean doctors and researchers weren’t interested in seeing children like Lane as patients. But instead of supporting their wishes and hopes, doctors tended to see them as canvases for experimentation – to see how their growing bodies responded to various surgeries or hormonal cocktails. In my research I tracked several decades of this kind of medical research, beginning in the early 20th century at research hospitals like the Johns Hopkins Hospital in Baltimore.</p>
<p>In fact, medical researchers were particularly interested in treating still-developing LGBTQ youths as a way to refine their techniques for forcing a binary sex <a href="https://www.usatoday.com/story/opinion/2017/08/09/intersex-children-no-surgery-without-consent-zieselman-column/539853001/">on intersex children</a> or carrying out conversion therapy – which aims to coerce a heterosexual or gender-confirming behavioral outcome – on gay children.</p>
<p>In this climate, Lane’s father may have unwittingly saved her from a harmful attempt at “corrective” surgery or hormones to try to prevent her from being trans. Even though Lane left home at age 18 to live as a woman, she would have to wait over a decade before finally obtaining access to hormones and surgery in the mid-1950s.</p>
<h2>Trans childhoods before trans medicine</h2>
<p>The struggles of trans children in the era before <a href="https://theconversation.com/im-a-pediatrician-who-cares-for-transgender-kids-heres-what-you-need-to-know-about-social-support-puberty-blockers-and-other-medical-options-that-improve-lives-of-transgender-youth-157285">modern transgender medicine</a> show not just how trans youths are far from a new phenomenon, but also how tenacious and forward-thinking they were compared with their parents and doctors.</p>
<p>Two stories of other trans people like Lane show how clinicians’ refusal to let them transition never stopped them from being trans. Both of them found their way to the Johns Hopkins Hospital, which, during the first seven decades of the 20th century, was widely regarded as the one institution in the U.S. for people with questions about their sex and gender.</p>
<p>When psychologists at Johns Hopkins interviewed a retired trans woman from the Midwest in 1954, she told them about her childhood in the 1890s. Even then, without any concept or term for being trans, this woman – by then in her 60s – told them it was obvious to her that she was a girl. </p>
<p>“I wanted a doll and buggy very much,” she reminisced of her intense attachment to the toys given only to girls. While her wish to be a girl never waned, her life had never afforded her the opportunity to transition to living full time as a woman until she retired.</p>
<p>Five years later, the clinicians at Johns Hopkins met a trans man who was then in his 30s. He had come to them seeking top and bottom surgery. Growing up in rural upstate New York in the 1930s, he had been forced to drop out of school “because of the excruciating sense of embarrassment at being obliged to wear girls’ clothes.” </p>
<p>Unlike the trans woman from the Midwest, this trans man, as a teenager, found a path to living openly as a boy: manual labor at a lumber mill. By working in a men’s profession and proving his masculinity through showcasing his strength, his presentation as a boy was embraced by his community. Decades later, he sought out the doctors at Hopkins only to confirm what had long been true in his life: that he was a man.</p>
<h2>Growing up despite every obstacle</h2>
<p>Each of these three children – like the countless more from this early 20th-century era – had to wait until adulthood to finally transition. </p>
<p>Yet the failure of doctors and other gatekeepers to stop them from transitioning as children, and their inability to access any form of gender-affirming medical treatment, hardly prevented them from being trans or growing up to be trans adults. </p>
<p>This is all the more remarkable given that before the 1950s, very few Americans had access to any concept or information about trans life. While small communities of adult trans people <a href="https://www.sealpress.com/titles/susan-stryker/transgender-history-second-edition/9781580056908/">are evident as far back as the turn of the 20th century</a>, most children would not have had access to these discreet social worlds, which tended to exist in major cities like New York and San Francisco. Without any media to supposedly influence them and without role models, these remarkable young people were able to stay true their inner feelings en route to living trans lives. </p>
<p>They’re a reminder that conversion therapy, attempts to suppress or limit transness and gatekeeping through legislation don’t work. </p>
<p>They didn’t work a century ago and they won’t work today.</p><img src="https://counter.theconversation.com/content/157481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jules Gill-Peterson does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Few trans kids in the early 20th century had access to information about trans life. That they still faced down the judgment of parents and doctors is a testament to the truth of their dysphoria.Jules Gill-Peterson, Associate Professor of English and Gender, Sexuality, and Women's Studies, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1473482020-10-02T05:59:19Z2020-10-02T05:59:19ZWe discovered a missing gene fragment that’s shedding new light on how males develop<figure><img src="https://images.theconversation.com/files/361307/original/file-20201002-14-1d9hcq7.jpg?ixlib=rb-1.1.0&rect=61%2C88%2C5827%2C1677&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s one of the most important genes in biology: “Sry”, the gene that makes males male. Development of the sexes is a crucial step in sexual reproduction and is essential for the survival of almost all animal species.</p>
<p>Today in the journal <a href="https://science.sciencemag.org/content/370/6512/121">Science</a>, my international collaborators and I report the surprise discovery of an entirely new part of the Sry gene in mice — a part we had no idea existed.</p>
<p>I co-discovered Sry <a href="https://pubmed.ncbi.nlm.nih.gov/2374589/">in 1990</a>. It is the gene on the Y (male) chromosome that leads to the development of male characteristics in mice, humans and most other mammals. Since then, Sry has been the subject of intense study worldwide because of its fundamental role in mammalian biology. </p>
<p>We have come to understand, in some detail, how Sry acts to trigger a cascade of gene activity that results in the formation of testes, instead of ovaries, in the embryo. Testes then stimulate the formation of other male characteristics.</p>
<p>But it’s clear we don’t have all the answers just yet. Our results published today take us one step further in the right direction.</p>
<h2>Hidden in plain sight</h2>
<p>For 30 years, we have understood the Sry gene is made up of one “exon”, a segment of a gene used to code for amino acids, the building blocks of proteins. This can be compared to a computer file consisting of one contiguous block of data, on a hard disk.</p>
<p>Our newest research reveals there’s actually a second exon in mouse Sry. This is like finding a whole new separate block of previously hidden data. </p>
<p>The mouse genome, like the human genome, has been extensively characterised due to the availability of advanced <a href="https://www.genome.gov/about-genomics/fact-sheets/DNA-Sequencing-Fact-Sheet">DNA sequencing</a> and related technologies. Researchers <a href="https://pubmed.ncbi.nlm.nih.gov/30124169/">commonly assume</a> all the genes and all the parts of the genes have already been discovered.</p>
<p>But earlier this year, scientists in Japan uncovered what looked like a new piece of the Sry gene in mice. New sequencing approaches revealed what appeared to be two versions of Sry: a short, single-exon form and a longer, two-exon form. They called this two-exon version “Sry-T”. </p>
<p>They collaborated with my group at the University of Queensland and removed the new exon using <a href="https://www.sciencealert.com/crispr-gene-editing">CRISPR</a>, a gene editing tool that lets researchers alter DNA precisely. Together we discovered this prevented Sry from functioning: XY mice (which would normally develop as males) developed as females instead. </p>
<p>Conversely, adding Sry-T to fertilised XX mouse eggs (which would normally develop as females) resulted in males. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two mice hang from a wooden bar." src="https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361300/original/file-20201002-20-bnwrzk.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">On the left, an XY mouse lacking Sry-T that developed as female. On the right, an XX mouse carrying the Sry-T gene that developed as male.</span>
<span class="attribution"><span class="source">Makoto Tachibana, Osaka University</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Implications for human sex determination</h2>
<p>Importantly, although human Sry does not have the added exon, our discovery may reveal new functions that might be shared between mouse and human Sry. </p>
<p>The DNA sequence of the new exon in Sry-T may point us towards discovering some of the genes and proteins that interact with Sry, something that has been elusive up till now. </p>
<p>And interactions we find in mice may also occur in humans. Studying what human Sry interacts with may help explain some cases of differences in human sex development, otherwise known as <a href="http://www.dsdgenetics.org/index.php">“intersex” development</a>. This is a common but poorly understood group of <em>mostly</em> genetic conditions that arise in humans. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Symbols used to indicate 'male', 'female' and 'intersex'." src="https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/361320/original/file-20201002-21-f70nsk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Intersex refers to people who are born with genetic, hormonal or physical sex characteristics that are not typically ‘male’ or ‘female’.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Currently, we don’t know the genetics behind a large proportion of intersex conditions. This is partly because we don’t yet know all the genes involved in the human sex development pathway.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-genes-the-y-chromosome-and-the-future-of-men-32893">Sex, genes, the Y chromosome and the future of men</a>
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<h2>Towards a better understanding of male sex development</h2>
<p>Scientifically, this discovery is a bit like discovering a new cell type in the body, or a new asteroid in the Kuiper belt. As with many scientific discoveries, it challenges what we thought we knew and raises many questions. </p>
<p>What is the function of the new exon in Sry-T? </p>
<p>Currently, we only have part of the answer. It turns out the first exon of Sry, the one we already knew about, contains “instability sequences” at its end. These are sequences that cause proteins to fray and degrade. </p>
<p>An important function of the newly discovered second exon is to mask the instability sequences, seal the end of the Sry protein and prevent it from degrading. In other words, this second exon is crucial to the development of male babies. </p>
<p>What’s more, this protection mechanism represents an unusual and intriguing evolutionary mechanism that has acted to help stop vulnerable Y-chromosome genes from literally falling apart.</p>
<p>But it’s early days yet. The challenge now is to understand whether there are more functions hidden within the newly discovered exon. </p>
<p>If so, this information may provide some of the missing links that have stood in the way of our full understanding of how Sry works at a molecular level and of how males and females come to be.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-education-about-gender-and-sexuality-does-belong-in-the-classroom-102902">Why education about gender and sexuality does belong in the classroom</a>
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<img src="https://counter.theconversation.com/content/147348/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter Koopman is Emeritus Professor of Developmental Biology at the University of Queensland. He has previously received funding from the Australian Research Council and the National Health and Medical Research Council of Australia.</span></em></p>A new finding in mice rewrites the textbook explanation of the male sex-determining gene, Sry. It might also help us better understand how males and females come to be.Peter Koopman, Professorial Research Fellow, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1435162020-08-06T18:58:07Z2020-08-06T18:58:07ZBrain scientists haven’t been able to find major differences between women’s and men’s brains, despite over a century of searching<figure><img src="https://images.theconversation.com/files/350524/original/file-20200730-27-xlocql.jpg?ixlib=rb-1.1.0&rect=212%2C206%2C3804%2C3347&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Are there innate differences between female and male brains?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/human-brain-illustration-royalty-free-image/1190796464">SebastianKaulitzki/Science Photo Library via Getty Images</a></span></figcaption></figure><p><em>Leer <a href="https://theconversation.com/el-cerebro-de-los-hombres-y-las-mujeres-realmente-es-diferente-144257">en español</a></em></p>
<p>People have searched for sex differences in human brains since at least the 19th century, when scientist <a href="https://doi.org/10.1126/science.347573">Samuel George Morton poured seeds and lead shot into human skulls</a> to measure their volumes. <a href="https://www.penguinrandomhouse.com/books/558415/gender-and-our-brains-by-gina-rippon/">Gustave Le Bon found men’s brains</a> are usually larger than women’s, which prompted <a href="https://doi.org/10.1037/h0076948">Alexander Bains</a> and <a href="https://en.wikisource.org/wiki/Popular_Science_Monthly/Volume_31/July_1887/Mental_Differences_of_Men_and_Women">George Romanes to argue</a> this size difference makes men smarter. But <a href="https://www.gutenberg.org/files/27083/27083-h/27083-h.htm">John Stuart Mill pointed out</a>, by this criterion, elephants and whales should be smarter than people.</p>
<p>So focus shifted to the relative sizes of brain regions. <a href="https://doi.org/10.1037%2Fh0076948">Phrenologists suggested</a> the part of the cerebrum above the eyes, called the frontal lobe, is most important for intelligence and is proportionally larger in men, while the parietal lobe, just behind the frontal lobe, is proportionally larger in women. Later, <a href="https://doi.org/10.1037%2Fh0076948">neuroanatomists argued</a> instead the parietal lobe is more important for intelligence and men’s are actually larger.</p>
<p>In the 20th and 21st centuries, researchers looked for distinctively female or male characteristics in smaller brain subdivisions. As a <a href="https://scholar.google.com/citations?hl=en&user=OaEmJXAAAAAJ">behavioral neurobiologist</a> and <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674736900">author</a>, I think this search is misguided because human brains are so varied.</p>
<h2>Anatomical brain differences</h2>
<p>The largest and most consistent brain sex difference has been found in the hypothalamus, a small structure that regulates reproductive physiology and behavior. At least one hypothalamic subdivision is larger in male <a href="https://doi.org/10.1016/0006-8993(78)90723-0">rodents</a> and <a href="https://doi.org/10.1523/JNEUROSCI.0750-19.2019">humans</a>. </p>
<p>But the goal for many researchers was to identify brain causes of supposed sex differences in thinking – not just reproductive physiology – and so attention turned to the large human cerebrum, which is responsible for intelligence. </p>
<p>Within the cerebrum, no region has received more attention in <a href="https://doi.org/10.1016/s0149-7634(96)00049-8">both race and sex difference research</a> than the corpus callosum, a thick band of nerve fibers that carries signals between the two cerebral hemispheres. </p>
<p>In the 20th and 21st centuries, some researchers found the <a href="https://pubmed.ncbi.nlm.nih.gov/3733478/">whole corpus callosum is proportionally</a> <a href="https://doi.org/10.3758/BF03332028">larger in women</a> on average while others found <a href="https://doi.org/10.1126/science.7089533">only certain parts</a> <a href="https://doi.org/10.1093/brain/112.3.799">are bigger</a>. This difference drew <a href="http://content.time.com/time/subscriber/article/0,33009,974689,00.html">popular</a> <a href="https://www.basicbooks.com/titles/anne-fausto-sterling/sexing-the-body/9781541672895/">attention</a> and was suggested to <a href="http://doi.org/10.1073/pnas.1316909110">cause cognitive sex differences</a>.</p>
<p>But <a href="https://doi.org/10.1093/cercor/7.1.48">smaller brains have a proportionally larger corpus callosum</a> regardless of the owner’s sex, and studies of <a href="https://doi.org/10.1016/s0149-7634(96)00049-8">this structure’s size differences have been inconsistent</a>. The story is similar for <a href="https://doi.org/10.1523/JNEUROSCI.0750-19.2019">other cerebral measures</a>, which is why trying to explain supposed cognitive sex differences through brain anatomy has not been very fruitful.</p>
<h2>Female and male traits typically overlap</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Chart showing that male traits in blue and female traits in pink overlap quite a bit." src="https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=526&fit=crop&dpr=1 600w, https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=526&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=526&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=661&fit=crop&dpr=1 754w, https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=661&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/351128/original/file-20200804-18-1bml5sp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=661&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A chart showing how measurements that often differ between sexes, like height, substantially overlap.</span>
<span class="attribution"><span class="source">Ari Berkowitz</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>Even when a brain region shows a sex difference on average, there is typically considerable overlap between the male and female distributions. If a trait’s measurement is in the overlapping region, one cannot predict the person’s sex with confidence. For example, think about height. I am 5’7". Does that tell you my sex? And brain regions typically show much smaller average sex differences than height does.</p>
<p>Neuroscientist <a href="https://doi.org/10.1073/pnas.1509654112">Daphna Joel and her colleagues examined MRIs of over 1,400 brains</a>, measuring the 10 human brain regions with the largest average sex differences. They assessed whether each measurement in each person was toward the female end of the spectrum, toward the male end or intermediate. They found that only 3% to 6% of people were consistently “female” or “male” for all structures. Everyone else was a mosaic.</p>
<h2>Prenatal hormones</h2>
<p>When brain sex differences do occur, what causes them?</p>
<p>A <a href="https://doi.org/10.1210/endo-65-3-369">1959 study</a> first demonstrated that an injection of testosterone into a pregnant rodent causes her female offspring to display male sexual behaviors as adults. The authors inferred that prenatal testosterone (normally secreted by the fetal testes) <a href="https://doi.org/10.1210/endo-65-3-369">permanently “organizes” the brain</a>. Many <a href="https://doi.org/10.1007/s00359-019-01376-8">later studies showed this to be essentially correct</a>, <a href="https://doi.org/10.1177/1073858419867298">though oversimplified</a> for nonhumans.</p>
<p>Researchers cannot ethically alter human prenatal hormone levels, so they rely on “accidental experiments” in which <a href="https://www.psychologytoday.com/us/blog/governing-behavior/202006/our-biology-is-not-binary">prenatal hormone levels or responses to them were unusual</a>, such as with <a href="https://www.dukeupress.edu/fixing-sex">intersex people</a>. But hormonal and environmental effects are entangled in these studies, and findings of brain sex differences have been inconsistent, <a href="https://www.hup.harvard.edu/catalog.php?isbn=9780674063518">leaving scientists without clear conclusions for humans</a>.</p>
<h2>Genes cause some brain sex differences</h2>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A zebra finch showing male plumage on one side and female plumage on the other side." src="https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=798&fit=crop&dpr=1 600w, https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=798&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=798&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1003&fit=crop&dpr=1 754w, https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1003&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/349758/original/file-20200727-37-4wgrfm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1003&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A half male, half female zebra finch, 2003.</span>
<span class="attribution"><a class="source" href="https://www.pnas.org/content/100/8/4873.figures-only">Copyright 2003 National Academy of Sciences</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>While prenatal hormones probably cause most brain sex differences in nonhumans, there are some cases where the cause is directly genetic.</p>
<p>This was dramatically shown by a <a href="https://doi.org/10.1073/pnas.0636925100">zebra finch with a strange anomaly</a> – it was male on its right side and female on its left. A singing-related brain structure was enlarged (as in typical males) only on the right, though the two sides experienced the same hormonal environment. Thus, its brain asymmetry was not caused by hormones, but by genes directly. Since then, direct effects of genes on brain sex differences have <a href="https://doi.org/10.1523/JNEUROSCI.22-20-09005.2002">also been found in mice</a>.</p>
<h2>Learning changes the brain</h2>
<p>Many people assume human brain sex differences are innate, but this assumption is misguided.</p>
<p>Humans learn quickly in childhood and continue learning – alas, more slowly – as adults. From remembering facts or conversations to improving musical or athletic skills, learning alters connections between nerve cells called synapses. These changes are numerous and frequent but typically microscopic – less than one hundredth of the width of a human hair.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man studying massive maps of London" src="https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=389&fit=crop&dpr=1 600w, https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=389&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=389&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=489&fit=crop&dpr=1 754w, https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=489&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/350636/original/file-20200731-16-15z1z5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=489&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some London taxi drivers do not use GPS – they know the city by heart, a learning process that takes three to four years on average.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/student-ponders-while-drawing-routes-on-a-map-of-london-in-news-photo/166336979">Carl Court/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Studies of an unusual profession, however, show learning can change adult brains dramatically. London taxi drivers are required to memorize “<a href="https://tfl.gov.uk/info-for/taxis-and-private-hire/licensing/learn-the-knowledge-of-london">the Knowledge</a>” – the complex routes, roads and landmarks of their city. Researchers discovered this learning <a href="http://doi.org/10.1016/j.cub.2011.11.018">physically altered a driver’s hippocampus</a>, a brain region critical for navigation. <a href="https://doi.org/10.1073/pnas.070039597">London taxi drivers’ posterior hippocampi</a> were found to be larger than nondrivers by millimeters – more than 1,000 times the size of synapses. </p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p>
<p>So it’s not realistic to assume any human brain sex differences are innate. They may also result from learning. People live in a fundamentally gendered culture, in which parenting, education, expectations and opportunities differ based on sex, from birth through adulthood, which inevitably changes the brain.</p>
<p>Ultimately, any sex differences in brain structures are most likely due to a complex and interacting combination of genes, hormones and learning.</p><img src="https://counter.theconversation.com/content/143516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ari Berkowitz receives funding from the National Science Foundation. </span></em></p>Attempts to find brain structures responsible for supposed cognitive sex differences have not succeeded.Ari Berkowitz, Presidential Professor of Biology; Director, Cellular & Behavioral Neurobiology Graduate Program, University of OklahomaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1224132019-08-28T07:09:06Z2019-08-28T07:09:06ZRecognising intersex people opens access to fundamental rights in Kenya<figure><img src="https://images.theconversation.com/files/289630/original/file-20190827-184240-1m9wg0n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People buy food at the Githurai market in Kiambu, Kenya. The country is doing a census that is breaking new ground in Africa.</span> <span class="attribution"><span class="source">EPA/Daniel Irungu</span></span></figcaption></figure><p><em>Kenya has become the first country in Africa to collect data on intersex people in its national census which runs to the end of August. Intersex refers to people born with physical characteristics that do not fit the typical definitions of male or female. Boniface Ushie responds to questions on the context and significance of Kenya’s decision.</em></p>
<p><strong>Kenyan law does not recognise intersex as a separate gender. So why has the Kenya Bureau of Statistics classified intersex as a “third gender”?</strong></p>
<p>It’s true that the law does not generally recognise intersex. But its inclusion in national data is a giant stride by the Kenyan government. It means that, in future, society may become less troubled by those who do not fit cultural sex and gender norms. </p>
<p>Labelling intersex as a third option on the census form seems to be the safer option for the government. It has certainly won over intersex advocacy actors, and for those individuals who sleep and wake up and live in those very bodies.</p>
<p>The recognition is of critical importance in other ways. As the first country in Africa to officially include intersex in its population census, Kenya has set the pace for other African countries. Secondly, the decision to include intersex also portends hope for other people of diverse sexual orientation and gender identity and expression. It holds the promise of inclusivity and liberalisation of the legal and policy environment. </p>
<p><strong>What could have prompted the policy shift?</strong></p>
<p>Over the years, <a href="https://www.knchr.org/Our-Work/Special-Interest-Groups/Intersex-Persons-in-Kenya">numerous court petitions</a> have been lodged to address the exclusion of intersex people in various forms. The petitions have cited marginalisation and discrimination such as denial of birth papers, and national IDs. </p>
<p>These cases have been championed by advocacy groups, such as the <a href="https://www.intersexkenya.org/about/">Intersex Persons Society of Kenya</a>, as well as individuals, who have brought civil lawsuits against the systemic discrimination of sexual and gender minorities.</p>
<p>In 2009, a Kenyan woman made <a href="https://www.nation.co.ke/health/Kenya-moves-to-resolve-intersex-conundrum/3476990-5062876-j5uy52/index.html">headlines</a> when she went to court after doctors wrote a question mark instead of a gender on her child’s birth papers. Among her demands were birth papers for the child to be able to join school. It became a prime example of the need to clearly and legally recognise intersex people.</p>
<p>In addition, civil society and advocacy groups have engaged in sustained public sensitisation and policy advocacy to remove the discrimination and stigma associated with being intersex in Kenya.</p>
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Read more:
<a href="https://theconversation.com/attitudes-to-gender-and-sexual-diversity-changing-global-trends-117684">Attitudes to gender and sexual diversity: changing global trends</a>
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<p>The exclusion and marginalisation of intersex people have significant consequences for the members of this group in many ways. The question of identity and recognition is one of the critical implications of the nonrecognition of the intersex community. Without a precise categorisation of an individual, it becomes impossible to obtain identification documents such as national identity cards and passports. This means that access to fundamental rights such as education and employment is either denied or curtailed.</p>
<p>Historically, intersex people were referred to, often derisively, as “hermaphrodites” owing to fact that they have both male and female sexual organs or chromosomes. In recent years, the term hermaphrodite has been replaced with “intersex” in appreciation of the fact that this particular group of people does not fit the typical normative “male” and “female” sex classifications. </p>
<p>For a long time, they were often viewed as a mythical notion, with many never really believing in their existence. The atypical nature of the sexual organs of intersex people tended to create a perception that they were cursed and were harbingers of evil.</p>
<p>Intersex must not be seen as a medical problem, but a naturally occurring phenomenon. Around <a href="https://www.intersexequality.com/how-common-is-intersex-in-humans/">1 in every 100 people</a> is born with intersex features. That means that there are approximately 60 million people around the world who are intersex. Sadly, some parents of intersex children have sought clinical surgery as a way of “correcting the error”. </p>
<p>According to a <a href="https://www.ohchr.org/Documents/HRBodies/HRCouncil/RegularSession/Session22/A.HRC.22.53_English.pdf">2013 report</a> by the United Nations Special Rapporteur on Torture, “genital normalisation” or “gender assignment” surgeries are akin to torture, especially if not done with the full decision-making right of the intersex person.</p>
<p>The mainstream societal definition of what is morally “good” and “normal”, in addition to the notion of hermaphrodites as mythical beings, has led to the discrimination and marginalisation of intersex individuals.</p>
<p>The notion that there is diversity in sexual orientation and gender identity and expression has been <a href="https://theconversation.com/why-anti-gay-sentiment-remains-strong-in-much-of-africa-42677">fiercely opposed</a> in many African countries. </p>
<p>Owing to its “otherness” intersex has been erroneously classified together with the sexual orientation and gender identity and expression categories. These include lesbians, gays and bisexuals. As such, the discrimination and hate directed at these individuals and groups are equally targeting intersex people.</p><img src="https://counter.theconversation.com/content/122413/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Boniface Ushie does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Kenya’s decision holds the promise of inclusivity and liberalisation of the legal and policy environment.Boniface Ushie, Associate Research Scientist, African Population and Health Research CenterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1164482019-05-09T20:07:52Z2019-05-09T20:07:52ZTen ethical flaws in the Caster Semenya decision on intersex in sport<figure><img src="https://images.theconversation.com/files/273417/original/file-20190508-183103-1eva5jd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caster Semenya is legally female, was from birth raised as female and identifies as a female.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/ciamabue/7968832970/in/photolist-d9bmpU-6WYxJP-gbWqNq-faB1Ei-d2L35o-QYHomP-aciLfF-X6bjAG-27BHwNd-doMJTN-cT2bCb-RNztaz-cTaov7-74mBHV-cUT2rq-dXYK7q-cRCJDY-cQ9hZQ-RoFRBk-24xxRw2-8RuT7h-cUSVzh-dyUu74-dyUuRP-o4j6Zs-d6XYyN-74qwom-cUT6A5-d6XYpL-dyZXuN-6Rdv6M-d6XYw5-a9coyA-6YGtw4-dyZZsS-dyUuyt-d6XYdN-dyUuKK-25Xb6zb-dyZXsq-dyUuWM-25Xb5Zd-dyZXKL-dyZY9s-dyZXvw-dyZYfL-dyZXES-dyUtKa-dyZXq7-dyZXLW">Jon Connell on flickr </a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p><em>This essay is part of our occasional series <a href="https://theconversation.com/au/topics/zoom-out-51632">Zoom Out</a>, where authors explore key ideas in science and technology in the broader context of society and humanity.</em></p>
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<p>Middle-distance runner Caster Semenya will need to take hormone-lowering agents, or have surgery, if she wishes to continue her career in her chosen athletic events.</p>
<p>The Court of Arbitration in Sport (<a href="https://www.tas-cas.org/en/index.html">CAS</a>) <a href="https://www.tas-cas.org/en/general-information/news-detail/article/semenya-asa-and-iaaf-executive-summary.html">decided last week</a> to uphold a rule requiring athletes with certain forms of what they call “disorders of sex development” (DSD) – more commonly called “intersex” conditions – to lower their testosterone levels in order to still be eligible to compete as women in certain elite races. </p>
<p>The case was brought to CAS by Semenya, as <a href="https://theconversation.com/caster-semenyas-impossible-situation-testosterone-gets-special-scrutiny-but-doesnt-necessarily-make-her-faster-116407">she argued discrimination</a> linked to a 2018 decision preventing some women, including herself, from competing in some female events. </p>
<p>This ruling is flawed. On the basis of <a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">science and ethical reasoning</a>, there are ten reasons CAS’s decision does not stand up. </p>
<p>But first let’s take a quick look at the biology involved.</p>
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Read more:
<a href="https://theconversation.com/caster-semenya-how-much-testosterone-is-too-much-for-a-female-athlete-116391">Caster Semenya: how much testosterone is too much for a female athlete?</a>
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<p><a href="https://www.bbc.co.uk/sport/athletics/48128682">Semenya underwent medical testing in 2009</a>: at the time she was told it was a doping test. The results are confidential, but it has been widely reported that she does have an intersex condition. It seems reasonable to assume she has XY chromosomes, as she is covered by the CAS ruling. Her testosterone levels have not been disclosed, but since the ruling applies to her, they must almost certainly be in what they classify as the “male range”.</p>
<p>According to CAS, the DSD regulations require athletes who want to compete in some female events, who have XY chromosomes and in whom testosterone has a biological effect to reduce their natural testosterone levels to an agreed concentration (below 5 nmol/L). </p>
<p>In women referred to as “46 XY DSD” – the most common intersex condition among female athletes – the presence of a Y chromosome causes the development of testes. These do not descend from the abdomen but do produce testosterone. However the receptors for testosterone are abnormal, with the result that the individual develops as female with a vagina, but no ovaries or uterus. Circulating testosterone may have no biological effect in the case of complete androgen insensitivity syndrome (AIS), or some effect in partial AIS.</p>
<p>Now let’s consider what’s wrong with the ruling. </p>
<h2>1. It confuses sex with gender</h2>
<p>Sex refers to biology, and gender refers to social role or self-identification. In sport, the definition of male and female used to be based solely on sex. <a href="https://bjsm.bmj.com/content/39/10/695.info">This was assessed anatomically in the 1960s</a>, then by biological tests such as the presence of a structure called a “Barr body” in cells (found only in genetic females), or the gene for testicular development. </p>
<p>Sex determination was abandoned in the 1990s in favour of gender. From the 2000 Sydney Olympics forwards, <a href="https://bjsm.bmj.com/content/39/10/695.info">there were no tests of gender other than self-identification</a>. </p>
<p>Caster Semenya’s gender is uncontroversially female. She is legally female, was from birth raised as female and identifies as a female. So, on the current definition, Semenya is a female. Indeed, there has been no question of her gender.</p>
<p>Sex determination itself is not simple, with chromosomal, gonadal (presence of ovaries or testes), or secondary sex characteristics (physical) all possible definitions that would include or exclude different groups. </p>
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Read more:
<a href="https://theconversation.com/what-makes-you-a-man-or-a-woman-geneticist-jenny-graves-explains-102983">What makes you a man or a woman? Geneticist Jenny Graves explains</a>
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<p>The CAS decision relates to “XY females with disorders of sexual development.” XY denotes the male sex chromosomes. This reverts back to the old biological categories. Behind this ruling is the view that Semenya is really a man competing in the women’s category. This view is embodied beautifully in an article entitled “<a href="https://quillette.com/2019/05/03/a-victory-for-female-athletes-everywhere/">A victory for female athletes everywhere</a>.” </p>
<p>But Semenya is a female by the rules used by the International Association of Athletics Federations (<a href="https://www.iaaf.org/home">IAAF</a>) – so she should be allowed to compete to the best of her potential in her category.</p>
<p>An alternative is to retreat to the old sex-based definition based on the presence of a Y chromosome. But that carries its own questions on definitions, and also comes at great political and individual cost. It would imply that Semenya is a male with a disorder of sexual development. </p>
<h2>2. It discriminates against some forms of hyperandrogenism</h2>
<p>Hyperandrogenism is a term used to describe high levels of testosterone. </p>
<p>But the CAS decision does not cover all forms of hyperandrogenism. It only refers to women who have XY chromosomes, such as <a href="https://www.nhs.uk/conditions/androgen-insensitivity-syndrome/">partial androgen insensitivity syndrome (AIS)</a>. </p>
<p>It does not cover a condition called <a href="https://rarediseases.info.nih.gov/diseases/1467/congenital-adrenal-hyperplasia">congenital adrenal hyperplasia</a>, which can cause elevated levels of testosterone in women with XX chromosomes. </p>
<p>The implication is that XX females are real women, while those with XY chromosomes are not. </p>
<h2>3. It’s based on inadequate science</h2>
<p>The significant problem in partial AIS is that although testosterone is elevated in the blood, the receptors for testosterone do not respond to the hormone in the usual way. That is why these individuals have typical external female physical characteristics. </p>
<p>While the testosterone may have some impact on how the body works, it is impossible to quantify how much effect it is having. For example, the difference testosterone makes between males and females in all events is estimated to be <a href="https://sportsscientists.com/2019/05/on-dsds-the-theory-of-testosterone-performance-the-cas-ruling-on-caster-semenya/">up to 12% (all other items being equal)</a>. But Semenya’s best time is only <a href="https://shows.pippa.io/the-science-of-sport-podcast/episodes/the-caster-semenya-decision-explained">2% faster than her competitors</a>. It is not possible to determine how much of this 2% is due to testosterone, and how much due to other factors about her as an athlete, or her psychology.</p>
<p>The study on which the current decision is based contains only correlations and is flawed in several ways, with a call for its <a href="https://doi.org/10.1007/s40318-019-00143-w">retraction on scientific grounds</a>. It is a single study, conducted by the IAAF and the full data have not been released for independent replication. The sole ground for the claim that Semenya derives “material androgenizing effect” (that is, biological impact) appears to be the “statistical over-representation of female athletes with 46 XY DSD” in the relevant events, as documented in this single, poorly conducted study.</p>
<p>Even if Semenya’s times were to drop after the reduction of testosterone, this could be a side-effect of the drugs used to reduce testosterone, or a function of reductions in mental or physical functions which are themselves legitimate entitlements of the athlete. </p>
<p>Her body has grown up in the presence of a certain level of testosterone of uncertain function. Our bodies are complex, and still poorly understood. A change of this kind may lead to unexpected results. Some of these reductions in functions may be unjust. </p>
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Read more:
<a href="https://theconversation.com/testosterone-why-defining-a-normal-level-is-hard-to-do-113587">Testosterone: why defining a 'normal' level is hard to do</a>
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<p>No one has given a complete description of the role of testosterone in someone like Semenya, nor how much it ought to be reduced to achieve a supposedly fair outcome. The comparisons are only with XX chromosome women, who have a very different physiology and normal functioning testosterone receptors. </p>
<p>Put simply, a level of 5 nMol/L testosterone is meaningless in Semenya’s case because the receptors are not responding in the usual way. It does not achieve a “<a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">level hormonal playing field</a>”. </p>
<p>This is an example of “decimal point science smokescreen.” There is the impression of much greater confidence and sensitivity than the science warrants by appealing to figures with multiple decimal points. The science around testosterone in intersex conditions is poorly understood, let alone as it applies to individuals. This is a level chosen for convenience, not a level that will negate any perceived advantage, but go no further.</p>
<h2>4. It’s inconsistent with values of sport and human rights</h2>
<p>The self-professed values of sport include the <a href="https://www.wada-ama.org/sites/default/files/resources/files/wada_ethicspanel_setofnorms_oct2017_en.pdf">development of one’s own talent</a> . </p>
<p>Yet Semenya is asked to cobble her natural potential as a female competitor. She must take risky biological interventions to reduce her performance. </p>
<p>The United Nations Human Rights Council has stated that the regulations <a href="https://theconversation.com/its-not-clear-where-human-rights-fit-in-the-legal-ruling-on-athlete-caster-semenya-116417">contravene human rights</a> “including the right to equality and non-discrimination […] and full respect for the dignity, bodily integrity and bodily autonomy of the person”. </p>
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Read more:
<a href="https://theconversation.com/its-not-clear-where-human-rights-fit-in-the-legal-ruling-on-athlete-caster-semenya-116417">It's not clear where human rights fit in the legal ruling on athlete Caster Semenya</a>
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<h2>5. It’s inconsistent with treatment of other athletes</h2>
<p>Other women with disorders resulting in higher than expected levels of testosterone, such as congenital adrenal hyperplasia, are not required to reduce their biological advantage.</p>
<p>Competitors with genetic mutations causing increases in red blood cell mass, and who experience enhanced oxygen-carrying capacity as a result, are not required to reduce their biological levels. </p>
<p>The Finnish skier Eero Mäntyranta had a genetic mutation that boosted his red blood cell count by 25-50% (he produced more blood hormone erythropoetin, or EPO). He and won several Olympic medals with this <a href="https://bjsm.bmj.com/content/bjsports/37/3/192.full.pdf">natural form of doping</a>. </p>
<h2>6. It’s unjust</h2>
<p>The decision is unjust in several ways. </p>
<p>Firstly, it was the IAAF which moved from sex to gender definition of female in 1990s. Semenya has entered competition, trained and competed fairly under the rules. To change them now will be undermine her capacity to compete, work and live, after a lifetime of investment. </p>
<p>If the rules are to be changed, they should not affect athletes who agreed to the current rules, but future athletes. There should be a “grandmother clause” for current athletes, like Semenya or else they are unfairly burdened by the bungles of the IAAF. Even if these rules could be considered justified, they should apply to future athletes as soon as possible after puberty.</p>
<p>Secondly, justice is about giving priority to the worst off in our society – but this ruling adds disadvantage to the worst off. Those with intersex conditions are already stigmatised, discriminated against, in many cases cannot bear children even if they want to. They are the socially disadvantaged. This ruling adds further discrimination and disadvantage.</p>
<p>Thirdly, it sets back integration of intersex people, by stigmatising and marginalising them. We have told them: be yourself, society will accept you. But this sends the message: you are really male, we don’t accept you, you should be castrated.</p>
<h2>7. It is an inappropriate reaction to fear of a ‘slippery slope’</h2>
<p>At the heart of this decision is the fear of displacement of cisgender women on the podia by increasing debate over transgender athletes. <a href="https://quillette.com/2019/05/03/a-victory-for-female-athletes-everywhere/">The concern is</a> that if “XY females” are allowed to compete in the female category, formerly male transgender females will follow and rob cisgender women of their medals. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-does-it-mean-to-be-cisgender-103159">Explainer: what does it mean to be 'cisgender'?</a>
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<p>This is a separate issue. Transgender athletes have normal testosterone receptors and would have grown up in the presence of male levels of testosterone acting on normal receptors. Intersex athletes have not grown up in this way and are typically raised as female.</p>
<p>The perceived problem of transgender domination of female sports can be dealt with by separate rules that do not disadvantage existing intersex athletes, though they will raise contentious issues of their own. </p>
<h2>8. It is disproportionate and unreasonable</h2>
<p>All methods of reducing testosterone involve some risk. For example, the administration of <a href="https://www.ncbi.nlm.nih.gov/pubmed/2960241">high-dose birth control medication</a> involves risk of clots, including fatal lung clots. </p>
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Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
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<p>These interventions interfere with a normally functioning organism for highly uncertain benefits to other people. This is disproportionate and unreasonable.</p>
<h2>9. It can’t be implemented</h2>
<p>The World Medical Association has advised doctors <a href="https://www.wma.net/news-post/wma-reiterates-advice-to-physicians-not-to-implement-iaaf-rules-on-classifying-women-athletes/">not to administer</a> testosterone-lowering interventions, describing the regulation as “<a href="https://www.wma.net/news-post/wma-urges-physicians-not-to-implement-iaaf-rules-on-classifying-women-athletes/">contrary to international medical ethics and human rights standards</a>”. </p>
<p>Their use would be “off label” and is for purposes other than the athlete’s health. The rules involve “strict liability” which means the athlete is responsible for any failure to comply, even if unintentional and outside of the athlete’s control.</p>
<h2>10. There are fairer, safer alternatives</h2>
<p>I have argued athletes <a href="https://www.bmj.com/content/347/bmj.f6150">should be able take performance-enhancing substances</a> within the normal physiological range. This would mean cisgender female athletes could take testosterone up to 5 nMol/L. This would reduce any advantage Semenya may have.</p>
<p>It would also deal with the problem that <a href="https://link.springer.com/article/10.1007/s40279-014-0247-x">up to 40%</a> of elite athletes are currently doping anyway. Semenya received the <a href="https://www.olympic.org/london-2012/athletics/800m-women">London 2012 800m gold medal</a> after the <a href="https://www.reuters.com/article/us-doping-russia-savinova/savinova-stripped-of-london-games-800m-gold-for-doping-idUSKBN15P1EO">original winner was disqualified for doping</a>. It is highly likely that some of her current competitors are also doping.</p>
<p>No doubt part of the resistance to allowing Semenya to “naturally dope” is that it will encourage other athletes to engage in doping. But they already are, and a better approach to “de-enhancing” Semenya is to <a href="https://www.bmj.com/content/347/bmj.f6150">regulate and monitor the enhancement of other athletes</a>. </p>
<h2>Spectacular fail</h2>
<p>Rarely does a public policy fail so spectacularly on so many ethical grounds. </p>
<p><a href="https://www.tas-cas.org/fileadmin/user_upload/Media_Release_Semenya_ASA_IAAF_decision.pdf">CAS acknowledged</a> that its decision constituted discrimination: </p>
<p>“The panel found that the DSD Regulations are discriminatory but the majority of the panel found that, on the basis of the evidence submitted by the parties, such discrimination is a necessary, reasonable and proportionate means of achieving the IAAF’s aim of preserving the integrity of female athletics in the restricted events.”</p>
<p>The UNHRC <a href="https://documents-dds-ny.un.org/doc/UNDOC/LTD/G19/072/46/PDF/G1907246.pdf?OpenElement">has refuted this claim of proportionality</a>: “there is no clear relationship of proportionality between the aim of the regulations and the proposed measures and their impact”.</p>
<p>This ruling is neither necessary, reasonable nor proportionate. It is simply unjust discrimination.</p>
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Read more:
<a href="https://theconversation.com/caster-semenyas-impossible-situation-testosterone-gets-special-scrutiny-but-doesnt-necessarily-make-her-faster-116407">Caster Semenya's impossible situation: Testosterone gets special scrutiny but doesn't necessarily make her faster</a>
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<p><em>Thanks to Michelle Telfer and Ken Pang for comments</em></p>
<p><em>This article builds on arguments presented in the paper <a href="https://www.ncbi.nlm.nih.gov/pubmed/20702382">Time to re-evaluate gender segregation in athletics?</a>.</em></p><img src="https://counter.theconversation.com/content/116448/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julian Savulescu receives funding from Uehiro Foundation on Ethics and Education and the Wellcome Trust. </span></em></p>Athlete Caster Semenya will need to take hormone-lowering agents, or have surgery, if she wishes to continue her career in her chosen events. But the decision to ban her is flawed on many grounds.Julian Savulescu, Visiting Professor in Biomedical Ethics, Murdoch Children's Research Institute; Distinguished Visiting Professor in Law, University of Melbourne; Uehiro Chair in Practical Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1140272019-04-17T08:31:37Z2019-04-17T08:31:37ZCaster Semenya v IAAF: ruling will have big implications for women’s participation in sport<figure><img src="https://images.theconversation.com/files/267598/original/file-20190404-123400-1dcum2m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caster Semenya leads the women's 800 metres at the Rio 2016 Olympics.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/rio-de-janeiro-brazil-august-20-729098803">CP DC Press/Shutterstock</a></span></figcaption></figure><p>When can a woman not compete with other women? This is, in essence, the question at the heart of the hearing currently before the <a href="https://www.tas-cas.org/en/index.html">Court of Arbitration for Sport</a> (CAS), the international body that helps settle disputes related to sport. The ruling in <a href="https://www.nytimes.com/2018/06/18/sports/caster-semenya-iaaf-lawsuit.html">the case</a> of Mokgadi Caster Semenya and Athletics South Africa v International Associations of Athletics Federations (IAAF) is due at the end of April. </p>
<p>The case centres on the legality of <a href="https://www.iaaf.org/news/press-release/eligibility-regulations-for-female-classifica">a 2018 IAAF eligibility regulation</a> for women with differences of sex development (intersex women), defined by the IAAF as women who have testosterone levels of over five <a href="https://www.convertunits.com/info/nanomole">nanomoles</a> per litre of blood (nmol/l) and whose bodies can ostensibly use that testosterone better than other women can. Under these rules, women athletes with differences of sex development would have to reduce, and maintain, their testosterone levels to 5nmol/l or less in order to compete. The reasoning behind the regulation is that women with naturally high testosterone levels, and whose bodies are apparently highly sensitive to that testosterone, have a significant performance advantage over their peers in certain events. </p>
<p>However, this assertion has to be called into question. First, because research has been unable to prove a direct, causal relationship between testosterone levels and athletic performance – given that so many other factors play a role. And second, because there is no valid laboratory test to determine a woman’s degree of sensitivity to testosterone. Currently, the IAAF mandates physical, gynaecological, and radiological imaging to determine physical signs (such as an enlarged clitoris) as a proxy for testosterone sensitivity. However, this approach is <a href="https://www.bmj.com/content/348/bmj.g2926.long">not reliable</a>, liable to false interpretation and subjectivity, and widely viewed as inappropriate and an invasion of privacy. </p>
<h2>The case so far</h2>
<p>In 2015, following <a href="https://www.tas-cas.org/fileadmin/user_upload/award_internet.pdf">another case</a> before the CAS, a previous iteration of the regulation was suspended and the IAAF was given a deadline to produce new evidence to uphold regulating women’s participation in this way. The IAAF subsequently developed the now contested 2018 regulation on the basis of <a href="https://bjsm.bmj.com/content/51/17/1309">a new study</a>, which showed a supposed “performance advantage” for specific track events. </p>
<p>However, as my co-author and I argued in a <a href="https://www.bmj.com/content/364/bmj.l1120">BMJ editorial</a>, this study <a href="https://link.springer.com/article/10.1007/s40318-019-00143-w">was shown to be flawed</a> and the authors subsequently acknowledged errors in the data used for the research. This is <a href="https://www.sportsintegrityinitiative.com/call-bermon-garnier-2017-retracted/">a red flag</a> of the “science” that underpins the 2018 IAAF regulations. It draws into question the justification for the regulation for these, and indeed any, athletic event. It is against this background that we arrive at the 2019 CAS hearing.</p>
<h2>Testosterone levels</h2>
<p>Sports organisations have been grappling with the question of eligibility for years now. In reality, however, the science of this issue is quite clear. From a scientific and medical standpoint, we know that testosterone is not the only – or even primary – indicator of sports performance. Indeed, there are many other factors at play – including training, funding, and access to resources – in the development of a winning athlete. </p>
<p>Further, in non-athletes, testosterone ranges between <a href="https://www.ncbi.nlm.nih.gov/pubmed/30136295">0.4-2.0nmol/l</a> in girls and women. In elite women athletes, the testosterone range has been shown to be between <a href="https://www.ncbi.nlm.nih.gov/pubmed/24593684">0.4-7.7nmol/l</a>, and that women can and do have much higher levels than that, which can also overlap with men’s ranges. So an arbitrary 5nmol/l limit for women could have the effect of capturing and regulating a much larger group of female athletes than intended, including women with polycystic ovarian syndrome (who naturally have high levels of testosterone). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/267632/original/file-20190404-123434-1jqvcl2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Lab results.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/abnormal-low-testosterone-hormone-test-result-1121149955">Jarun Ontakrai/Shutterstock</a></span>
</figcaption>
</figure>
<p>In a rebuttal to our BMJ editorial, Stéphane Bermon, a director in the IAAF Health and Science Department, <a href="https://www.bmj.com/content/364/bmj.l1120/rapid-responses">wrote</a> that the IAAF regulation testosterone cut-off point of 5nmol/l is not arbitrary, but rather aims to <em>include</em> women with polycystic ovarian syndrome but to <em>exclude</em> women with differences of sex development. The glaring inconsistency here is that we simply cannot distinguish between these groups based on blood testosterone alone, never mind determining who is sensitive to testosterone and so has a supposed “performance advantage”. </p>
<h2>The ‘sex testing’ of women athletes</h2>
<p>Just because regulations exist does not mean that they are evidence based, ethical, or even effective. The crux here is that this kind of regulation has its legacy in the <a href="https://www.nytimes.com/2016/07/03/magazine/the-humiliating-practice-of-sex-testing-female-athletes.html">long and problematic history of “sex testing” women athletes</a>. It is no accident that the vast majority of athletes affected by these regulations <a href="https://muse.jhu.edu/article/702853/summary">are black women and women of colour from the global south</a> who do not conform to Western ideals of femininity. </p>
<p>We don’t yet know what full evidence, beyond <a href="https://academic.oup.com/edrv/article/39/5/803/5052770">a review</a> from Bermon and colleagues, before the current CAS panel is. But we do know that sex and gender are incredibly complex. Historically we have defined humans as binary “male” or “female”, based on what we knew then about genes and anatomy. This was a clear and useful way of categorising sports participation. But 21st-century medical and social sciences have since progressed, and we now know that both biological sex and sociocultural gender are much more complicated than that. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-olympic-athletes-copping-so-much-abuse-it-all-comes-down-to-gender-63858">Why are Olympic athletes copping so much abuse? It all comes down to gender</a>
</strong>
</em>
</p>
<hr>
<p>In the animal kingdom, there are many species that are hermaphrodite, and in humans we now know there is a spectrum of sex (that includes people who are intersex) and gender (that includes people who are transgender). The complexity of sex in particular as a melange of genes, hormones, anatomy, biology can no longer be classified simply with a binary definition of male or female. It is, therefore, unfair and unethical for the IAAF to make new regulations for women’s sport – to the effect of excluding some women - based on outdated definitions and understandings.</p>
<p>It’s important to also understand the unintentional outcomes of regulations such as the one in question, including the ways in which regulations <a href="https://undocs.org/A/HRC/40/L.10/Rev.1">may potentially breach human rights</a>. The <a href="https://www.uniglobalunion.org/sites/default/files/files/news/official_udpr.pdf">Universal Declaration of Player Rights</a>, which deals with the intersection of sport and human rights, reminds that an athlete’s right to participate in sport cannot be limited by gender (or any other identity-related factor, including sex). So we must understand both this history and unintentional outcomes of policy, including the ways in which regulations may entrench existing power relations. </p>
<p>Given that sport is currently organised according to the binary, and that this is unlikely to change in the near future, then men’s and women’s categories should be predicated on inclusivity. As <a href="https://thesportspectacle.com/2016/08/16/capturing-semenya/">Jennifer Doyle writes</a>: “Women’s sports is not a defensive structure from which men are excluded so that women might flourish. It is, in fact, the opposite of this: it is, potentially, a radically inclusive space which has the capacity to destroy the public’s ideas about gender and gender difference precisely because gender is always in play in women’s sports in ways that it is not in men’s sports.” </p>
<p>The IAAF case matters because it is fundamentally about all women’s rights to participate in sport. If we do begin to regulate the participation of women with differences of sex development, then it will in effect stigmatise women athletes by categorising, labelling, and excluding them without scientific evidence or ethical consideration. Women should be allowed to compete with women, period. Otherwise we’re starting to talk about genetic superiority with no basis in truth, or humanity.</p><img src="https://counter.theconversation.com/content/114027/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sheree Bekker does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Arbitration case between athlete Caster Semenya and the IAAF centres on eligibility to compete based on testosterone – but there are other factors in play.Sheree Bekker, Prize Research Fellow, University of BathLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1151262019-04-09T20:04:10Z2019-04-09T20:04:10ZAdventurous identities: intersex soldiers and cross-dressing women at war<figure><img src="https://images.theconversation.com/files/268264/original/file-20190409-2901-zqnsuz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A copy of an engraving of Count Casimir Pulaski published in 1871.</span> <span class="attribution"><span class="source">Wikimedia Commons</span></span></figcaption></figure><p>A documentary from the <a href="https://www.bbc.com/news/world-us-canada-47842307">Smithsonian Institute</a>, examining new DNA and physical anthropology evidence, suggests the famous cavalry officer Casimir Pulaski (1745-1779) might have been a woman, or intersex.</p>
<p>Pulaski is a hero of the struggles for Polish and American independence. He is credited with saving George Washington’s life in battle and with establishing the first American cavalry force. According to the documentary, <a href="https://www.bbc.com/news/world-us-canada-47842307">DNA testing has confirmed a female-appearing skeleton is indeed Pulaski’s</a>. This new evidence is the first hint that Pulaski – who seems to have lived as male from childhood – was anything other than a cisgendered man.</p>
<p>We may never know if Pulaski was intersex (that is, his body didn’t fit neatly into either male or female categories) and did not question his gender. Or if he was, in fact, born female but chose to live as a man. </p>
<p>In either case, Pulaski would be the most senior military officer we know of to have female anatomical characteristics before the late 20th century. But he certainly wouldn’t have been the only one on the battlefield.</p>
<p>The history of intersex men and women is one that requires more research. The lives of intersex people have often been made invisible throughout history. I hope that when more evidence comes to light Pulaski can be claimed as an inspirational intersex hero.</p>
<p>We know quite a bit, however, about women dressing as men and joining the military in the 18th and 19th centuries. There were famous women such as the British marine <a href="https://en.wikipedia.org/wiki/Hannah_Snell">Hannah Snell</a> (c.1723-1792) who, disguising herself as James Gray, signed up to fight in Scotland against the Jacobite invasion of 1745. Snell was later wounded trying to capture a French colony in India. </p>
<p>After revealing her gender, she was granted a pension by the king and made a living performing military exercises on stage. She also briefly kept a pub called “The Female Warrior”. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=708&fit=crop&dpr=1 600w, https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=708&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=708&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=890&fit=crop&dpr=1 754w, https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=890&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/268265/original/file-20190409-2918-1mbe67e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=890&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A portrait of Hannah Snell, circa 1750.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>In contrast to Snell’s self-promoting confidence, the Anglo-Irish military physician James Barry (c.1789-1865) kept the secret of his female birth all his life. Dressing as a man, Barry completed medical studies in Edinburgh and went on to have a long and distinguished career. Only after Barry’s death was his sex discovered.</p>
<p>“William Brown” was the name taken by a black woman from Edinburgh who served aboard HMS Queen Charlotte from 1804 until after 1816, through the end of the Napoleonic Wars. She exhibited <a href="https://www.amazon.com/Female-Tars-Women-Aboard-Ship/dp/1591145724">“all the traits of a British tar</a> (slang for a sailor) and takes her grog with her messmates”, according to a contemporary report. </p>
<p>The discovery of Brown’s sex by her crew doesn’t seem to have interrupted her career: she re-enlisted on the same ship after news broke that she was female.</p>
<p>Then there is the story of Jeanne Baré, who was not a soldier, but became the first woman known to have circumnavigated the globe (1766-69). She dressed in men’s clothes to work as an assistant to Philibert Comerçon (she may also have been Commerçon’s mistress), who was the botanist to French admiral and explorer Louis Antoine de Bougainville.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=959&fit=crop&dpr=1 600w, https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=959&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=959&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1205&fit=crop&dpr=1 754w, https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1205&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/268275/original/file-20190409-2909-1m02ulj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1205&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Portrait of Jeanne Barret (1740-1807) by Cristoforo Dall'Acqua (1734-1787).</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<p>Baré was found out when the ships made it to Tahiti. While she had passed as a man with the crew, her disguise didn’t fool the Tahitians, who pointed her out to Bougainville.</p>
<p>Why would women disguise themselves as men and join the army and navy? One major reason was that men were paid far better than women. For a working-class woman, despite the dangers of a military or naval career, the money might have looked too good to pass up.</p>
<p>There were prohibitions against women wearing men’s clothing in the period, but prosecutions were relatively rare. The army and the navy were desperate for recruits and tended not to inquire too closely. As Snell’s career shows, being brazen about one’s cross-dressing adventures might be a ticket to a comfortable life.</p>
<p>Young women might also be inspired by the many popular ballads narrating the military and naval careers of cross-dressing women. One, The Ballad of Jack Monroe, exists in several surviving versions:</p>
<blockquote>
<p>She went into the tailor shop<br>
And dressed in men’s array,<br>
And went into a vessel<br>
To convey herself away.<br></p>
</blockquote>
<p>For women as well as men, joining the army or navy might be a rare opportunity to see the world. For an adventurous spirit, living in disguise may have added to the excitement. </p>
<p>But for many of these cross-dressing adventurers, there must have been one further reason: they just felt more comfortable, more like themselves, fighting and living not only alongside men, but as men.</p><img src="https://counter.theconversation.com/content/115126/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Olivia Murphy does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>New evidence suggests the 18th-century cavalry officer Casimir Pulaski was a woman or intersex. While we know little of intersex soldiers, there is a fascinating history of women dressing as men to fight.Olivia Murphy, Postdoctoral research fellow in English, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1063202018-11-05T22:37:26Z2018-11-05T22:37:26ZTrump’s efforts to redefine gender and sex<figure><img src="https://images.theconversation.com/files/243966/original/file-20181105-74754-se5l5k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A sign denouncing transphobia is held up in front of the U.S. Supreme Court at a protest in June 2016. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Title IX was among the education amendments brought into law in the United States in 1972 and enforced by the Department of Education’s civil rights office. It ensured <a href="https://www2.ed.gov/about/offices/list/ocr/docs/tix_dis.html">no Americans would be discriminated against based on their sex.</a> </p>
<p>Donald Trump’s White House is now seeking to <a href="https://www.nytimes.com/2018/10/21/us/politics/transgender-trump-administration-sex-definition.html?module=inline">amend Title IX to define sex as immutable, determined by a baby’s genitals</a> and unchangeable at any later point in life.</p>
<p>Efforts to change the law are just another attempt to fire up the Republican base for the mid-term elections, similar to Trump’s rhetoric against the migrant “caravan.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-the-migrant-caravan-exist-and-how-did-it-come-to-be-105781">Why does the migrant ‘caravan’ exist? And how did it come to be?</a>
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<p>It’s all aimed at instilling just enough fear to energize Republican supporters and get them to the polls.</p>
<p>But the White House can’t just announce that gender (defined differently in different cultures) is now sex (genitals that appear to be male or female), irrespective of self-identity. What’s next? Will Trump soon declare that apples are now oranges? </p>
<p>Amending Title IX to require that everyone is either male or female is reassuring to those who want to <a href="https://link.springer.com/article/10.1007/s11199-017-0860-x">protect the social-cultural status-quo</a>, who are frightened or threatened by “<a href="https://www.wiley.com/en-us/Modernity+and+Ambivalence-p-9780745612423">the Other</a>.” </p>
<h2>Gender versus sex</h2>
<p>This is wrong in so many ways. First, there is the basic physiological reality that <a href="https://www.apa.org/topics/lgbt/intersex.pdf">one in 1,500 babies are born intersex</a>. Intersex babies may be born with external genitals from both sexes, others have external genitals of one sex and the internal anatomy of the other sex (e.g. ovaries in a baby that otherwise looks like a boy).</p>
<p>Second, proponents of amending Title IX are missing the point of gender — that it’s socially constructed and fluid. Gender identity can be, and often is, independent of sex (male/female). So a person with the genitalia of a male may identify as a woman. </p>
<p>Gender cannot be rigidly defined by external signs and symbols. It is deeply integrated in the culture we are raised in, the historical period we are living in and our personalities.</p>
<p>Gender was developed to describe self-identity in people who did not identify with their biological sex. John Money, <a href="https://doi.org/10.1080/00926239408403428">a pioneering gender researcher, explained</a>: </p>
<blockquote>
<p>“Gender identity is your own sense or conviction of maleness or femaleness; and gender role is the cultural stereotype of what is masculine and feminine.”</p>
</blockquote>
<p>People now define gender is many ways: “Feminine,” “masculine” and “androgynous,” “bi-gender,” (expressing two distinct gender identities), “gender fluid” (adjusting gendered behaviour to suit the situation) and “agender” — or “undifferentiated”(genderless), among others.</p>
<p>The Trump administration is hardly the only entity to try to use sex and gender as synonyms. Many health researchers have equated them in their studies – claiming to be <a href="https://www-emeraldinsight-com.proxy.queensu.ca/doi/full/10.1108/S0275-495920180000036014">measuring gender when they are actually referring to sex</a>. By forcing people into limited categories of sex as male or female, there’s an assumption that these are homogeneous groups, that males will all be similar to one another and females will be alike. </p>
<h2>Gender affects health</h2>
<p><a href="https://www.emeraldinsight.com/doi/full/10.1108/S0275-495920180000036014">My research</a> and that of many others demonstrates that gender plays a different role than sex in our health outcomes. <a href="https://academic.oup.com/ije/article/36/3/612/654160">For example, males (their sex) who are more feminine (their gender) are less likely to get coronary artery disease</a>; people of either sex who are <a href="https://www.sciencedirect.com/science/article/pii/S1550857912001908?via%3Dihub">more masculine have a greater risk of cardiovascular disease than those who are more feminine</a>; and gender, not sex, can predict <a href="https://link.springer.com/article/10.1007%2Fs00702-005-0285-5">quality of life for androgynous men and women with Parkinson’s disease</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sex-and-gender-both-shape-your-health-in-different-ways-98293">Sex and gender both shape your health, in different ways</a>
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</em>
</p>
<hr>
<p>So why now, and why gender? </p>
<p>The Republicans’ mid-term campaign efforts, <a href="https://www.cnn.com/2018/10/30/media/reliable-sources-10-29-18/index.html">with an anti-diversity, anti-immigration and anti-media rhetoric</a> promoted by Trump, have catered to the extremists among the base and their <a href="https://doi.org/10.1007/s11199-017-0860-x">need for a predictable world</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/243934/original/file-20181105-83638-o3susv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Protesters in Asheville, North Carolina, demonstrate against a North Carolina law in April 2016 that restricted the rights of transgender people.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Trump’s supporters are often people with a high <a href="https://doi.org/10.1007/s11199-017-0860-x">need for closure</a>, meaning they want things to be predictable with clear answers. They dislike ambiguity and <a href="https://link.springer.com/article/10.1007/s11199-017-0860-x">frequently express right-wing attitudes</a>. </p>
<p>The Trump administration’s efforts to amend Title IX to equate sex and gender with genitals at birth is comforting to those who are uncomfortable with ambiguity. <a href="https://link.springer.com/article/10.1007/s11199-017-0860-x">People who challenge the notion of absolute, fixed gender identities (i.e., transgender individuals)</a> make them very uncomfortable. </p>
<p>Ironically, the most effective way to change these deeply held attitudes is for people to have <a href="http://journals.sagepub.com/doi/10.1177/1368430217716750">positive experiences with “the Other”</a>, suggesting that the best way to evolve towards positive change is to get to know those who are different from us.</p>
<p>This fear-based rallying cry by Trump Republicans — focused on keeping out migrants, refugees and immigrants and ensuring that transgender people are forced into strict sex-based categories - seems intended to drive Republican voters to the polls. We’ll know soon if it was successful.</p><img src="https://counter.theconversation.com/content/106320/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Donald Trump is seeking to amend laws that prevent discrimination against Americans based on their sex. It’s all just another attempt to fire up the Republican base for the mid-term elections.L.F. Carver, Post Doctoral Fellow, Queen's University and Ageing + Communication + Technologies (ACT) (SSHRC funded), Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1016772018-09-13T20:34:25Z2018-09-13T20:34:25ZGender diversity is more accepted in society, but using the pronoun ‘they’ still divides<figure><img src="https://images.theconversation.com/files/234718/original/file-20180904-41735-a8fxix.png?ixlib=rb-1.1.0&rect=263%2C0%2C3371%2C2000&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Wes Mountain/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>In recent months, there has been much heated discussion about the way gender-neutral pronouns (they, them, theirs) are being introduced as alternatives to the more conventional “he” and “she” in offices, schools and public institutions. </p>
<p>Earlier this year, for instance, <a href="https://www.news.com.au/finance/business/travel/qantas-staff-told-to-avoid-gender-inappropriate-terms-like-wife-and-husband/news-story/068e9769c30a180b182ab8020a2d0e50">Qantas</a> encouraged staff to adopt gender-inclusive language with customers, using the term “partner” instead of “husband” or “wife”. </p>
<p>The Victorian state government backed a similar <a href="https://www.vic.gov.au/equality/inclusive-language-guide.html">initiative</a> for public servants, and the Department of Health and Human Services’ Pride Network launched a <a href="https://www.sbs.com.au/news/they-day-victorian-government-backs-gender-neutral-pronouns">“They Day” campaign</a> on the first Wednesday of each month to encourage awareness of gender-neutral pronouns.</p>
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<p>And last year, the Australian Defence Force <a href="http://www.defence.gov.au/ADFA/Docs/%20LGBTI_Guide.pdf">issued a guide</a> with recommendations on how to appropriately address gender-diverse members of the force.</p>
<p>Some critics argue that these language changes are radical and politically motivated, and are being forced upon unwilling employees. </p>
<p>After the ADF launched its guide on gender-neutral language choices, The Telegraph <a href="https://www.dailytelegraph.com.au/news/nsw/australian-defence-force-guide-bans-soldiers-from-saying-him-and-her-to-avoid-lgbti-offence/news-story/2f1ab6ee4d4285d0da17d2f6186062f2">claimed</a> the organisation was banning the use of “him” and “her” – an assertion the ADF quickly <a href="https://www.outinperth.com/defence-forces-denies-plans-ban-words/">dismissed</a>.</p>
<p>Australian universities were also <a href="https://www.sbs.com.au/news/universities-reject-claims-of-banning-gender-specific-language">forced to defend</a> the launch of similar guides for staff and students after another <a href="https://www.dailytelegraph.com.au/news/nsw/university-of-sydney-insists-on-nondiscriminatory-language-even-if-it-is-grammatically-wrong/news-story/bac401778e67d5fc68fb29f8bb4c1758">Telegraph story</a> accused them of banning the words “mankind” and “manpower”.</p>
<p>There’s been vocal opposition to these moves from Liberal leaders, as well. The new deputy leader, Josh Frydenberg, <a href="https://www.theaustralian.com.au/national-affairs/they-day-slammed-as-political-correctness-gone-mad/news-story/f22001647b589da6046e2e3faae478c7">dismissed “They Day”</a> as “political correctness gone mad”, while Home Affairs Minister Peter Dutton decried “invading the minds of young people with this sort of garbage message.”</p>
<h2>Increasing acceptance in society</h2>
<p>Guides for respectful and inclusive language protocols are not new, nor are they aimed at erasing existing gender-specific pronouns. </p>
<p>The debate over gender-neutral language actually dates back to the mid-1980s, when ungendered job titles became more popular (for example, “firefighters” instead of “firemen”) and the pronouns “he/she” or “they” began appearing in texts instead of default “he” when the gender of the person being referred to is not known. </p>
<p>In recent years, the use of the pronoun “they” to refer specifically to non-binary people has become increasingly accepted by media outlets. The Washington Post, for example, <a href="https://www.poynter.org/news/washington-post-will-allow-singular-they">updated</a> its style guide in 2015 to include singular “they” for people who identify as neither male or female. The New York Times has <a href="https://observer.com/2015/11/the-new-york-times-adds-mx-to-the-honorific-mix/">introduced</a> the new honorific Mx. And the Associated Press followed with <a href="https://www.cjr.org/language_corner/stylebooks-single-they-ap-chicago-gender-neutral.php">its own change</a> to the venerable AP Stylebook last year. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/friday-essay-transgenderism-in-film-and-literature-71809">Friday essay: transgenderism in film and literature</a>
</strong>
</em>
</p>
<hr>
<p>Not only does incorporating gender-neutral pronouns into the public sphere allow for more inclusivity, it can also bring standardisation to government functions, such as official documents and surveys (such as the census). </p>
<p>This enables more accurate self-identifications and brings greater visibility to previously unseen (and uncounted) groups of gender-diverse people.</p>
<p>The 2016 census was the first to allow an option for gender other than male or female on a special online form. The ABS provided the online form to a pilot group of 30,000 households to test their reactions. Gender-diverse people outside the pilot group were also able to access the form, but only if they sought it out on their own. </p>
<p>In total, 1,260 people in Australia were counted as gender diverse, but the ABS <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2071.0%7E2016%7EMain%20Features%7ESex%20and%20Gender%20Diversity%20in%20the%202016%20Census%7E100">acknowledges</a> this was probably lower than the actual figure due to fear of stigma and lack of widespread awareness over the new self-identifying option.</p>
<p>Still, the ABS found people in the pilot were over 50 times as likely as those outside the pilot to identify as gender diverse. Arguably, this suggests that simply offering the new option will provide an incentive for all gender-diverse people to choose how they are categorised and counted.</p>
<h2>Higher counts in other surveys</h2>
<p>Perhaps not surprisingly, there’s increasing acceptance of gender diversity among young people. In the US, a 2017 <a href="https://www.glaad.org/blog/new-glaad-study-reveals-twenty-percent-millennials-identify-lgbtq">report</a> by GLAAD indicated that 12% of Millennials (aged 18-35) identify as transgender or gender non-conforming – double the percentage of people in Generation X (people aged 35-51). </p>
<p>In 2016, <a href="https://www.jwtintelligence.com/2016/03/gen-z-goes-beyond-gender-binaries-in-new-innovation-group-data/">research</a> by the trend-forecasting Innovation group also found that 56% of American Gen Zers (aged 13-20) know someone who uses gender-neutral pronouns. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-australian-trans-stories-on-our-tv-screens-please-88556">More Australian trans stories on our TV screens, please</a>
</strong>
</em>
</p>
<hr>
<p>In our 2016 <a href="https://scrollingbeyondbinaries.com/">national survey</a> of more than 1,200 young people aged 16-35, we found a proliferation of gender-diverse identities on <a href="https://theconversation.com/theres-something-queer-about-tumblr-73520">online platforms like Tumblr</a>, where discussion of gender non-conformity is the norm and the possibility of curating multiple identities is routine. </p>
<p>Overall, 20% of our participants identified as non-binary or chose to define their own gender identities as “other” than male or female.</p>
<h2>Slowly adapting bureaucracy</h2>
<p>Despite these changes, some workplaces, schools and social service providers have been slow to embrace change and provide exclusive spaces for gender-diverse people. </p>
<p>For example, bathrooms remain overwhelmingly binary and inflexible. Part of the problem are inconsistencies in the laws and policies at the state and national level and between organisational stakeholders. For example, sporting bodies such as AFL, NRL and Cricket Australia defer to <a href="https://www.theaustralian.com.au/news/nation/transgender-push-for-genderneutral-bathrooms-at-sports-grounds/news-story/808d7186629ae8c45f9bc9996d2fa2ee">individual venues</a> to make decisions on gender-neutral spaces. </p>
<p>There are obstacles to accommodating gender diversity in official identification documents, as well. In Australia, we have a mix of approaches for gender registration, with passports and marriage certificates dealt with at the Commonwealth level, while birth certificates are issued by states and territories. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/using-she-and-he-reinforces-gender-roles-and-discrimination-of-women-92998">Using 'she' and 'he' reinforces gender roles and discrimination of women</a>
</strong>
</em>
</p>
<hr>
<p>Gender-diverse people have been able to <a href="https://www.sbs.com.au/news/new-passports-allow-third-gender">choose an “X” category</a> in passports since 2013 (with supporting documentary evidence from a doctor or psychologist). But changing one’s gender on birth certificates is still only possible in ACT, NSW and SA. (It’s also currently being <a href="http://www.starobserver.com.au/news/national-news/queensland-news/qld-gender-neutral-birth-certificates/168005">debated in Queensland</a>.) </p>
<p>These difficulties in reconciling different forms of identification can act as barriers to employment, accessing medical treatment and higher education and travelling internationally. </p>
<p>Social change can be facilitated by making new categories available, whether that’s in architectural design (gender-neutral bathrooms) or digital infrastructures (non-binary options for official documents and surveys). </p>
<p>Using the pronoun “they” or allowing for more gender options in the public sphere isn’t political correctness gone awry. It’s just a small shift in the evolution of how we understand, categorise and define gender. </p>
<p>Most people inhabit multiple identities during their lives, such as daughter, student, professional and mother. The contradictions between some of these categories are evident in our online profiles - for example, we display a different version of ourselves on LinkedIn compared with Facebook or Instagram. </p>
<p>Gender is just another type of identity. We shouldn’t restrict this to binary terms, but rather embrace the diversity of all the perfectly valid “in-betweens”.</p><img src="https://counter.theconversation.com/content/101677/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Son Vivienne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Allowing for more gender options in the public sphere isn’t political correctness gone awry. It’s just a small shift in the evolution of how we understand, categorise and define gender.Son Vivienne, Post-Doctoral Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/982932018-06-21T21:55:06Z2018-06-21T21:55:06ZSex and gender both shape your health, in different ways<figure><img src="https://images.theconversation.com/files/224310/original/file-20180621-137717-6m9mqe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are now many gender categorizations, from the traditional 'masculine' and 'feminine' to 'gender fluid' and 'undifferentiatied.' Health researchers can work with these to gain a more accurate understanding of disease susceptibilities. </span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>When you think about gender, what comes to mind? Is it anatomy or the way someone dresses or acts? Do you think of gender as binary — male or female? Do you think it predicts sexual orientation?</p>
<p>Gender is often equated with sex — by researchers as well as those they research, especially in the health arena. Recently I searched a database for health-related research articles with “gender” in the title. Of the 10 articles that came up first in the list, every single one used “gender” as a synonym for sex.</p>
<p>Although gender can be related to sex, it is a very different concept. Gender is generally understood to be socially constructed, and can differ depending on society and culture. Sex, on the other hand, is defined by chromosomes and anatomy — labelled male or female. It also includes <a href="http://www.isna.org/faq/what_is_intersex">intersex people</a> whose bodies are not typically male or female, often with characteristics of both sexes.</p>
<p>Researchers often assume that all biologically female people will be more similar to each other than to those who are biologically male, and group them together in their studies. They do not consider the various sex- and gender-linked social roles and constraints that can also affect their health. This results in <a href="https://dx.doi.org/10.1177%2F00333549111260S304">policies and treatment plans that are homogenous</a>.</p>
<h2>‘Masculine?’ ‘Cisgender?’ ‘Gender fluid?’</h2>
<p>The term “gender” was originally developed to describe people who did not identify with their biological sex. John Money, a pioneering gender researcher, explained: “<a href="https://doi.org/10.1080/00926239408403428">Gender identity is your own sense or conviction of maleness or femaleness</a>; and gender role is the cultural stereotype of what is masculine and feminine.” </p>
<p>There are now <a href="https://dx.doi.org/10.1037/h0036215">many terms used to describe gender</a> — some of the earliest ones in use are “feminine,” “masculine” and “androgynous” (a combination of masculine and feminine characteristics). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224116/original/file-20180620-137711-1mm4jcz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Research shows that gender, as well as sex, can influence vulnerability to disease.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>More recent gender definitions include: “Bigender” (expressing two distinct gender identities), “gender fluid” (moving between gendered behaviour that is feminine and masculine depending on the situation) and “agender” or “undifferentiated” (someone who does not identify with a particular gender or is genderless). </p>
<p>If a person’s gender is consistent with their sex (e.g. a biologically female person is feminine) they are referred to as “cisgender.” </p>
<p>Gender does not tell us about sexual orientation. For example, a feminine (her gender) woman (her sex) may define herself as straight or anywhere in the LGBTQIA (lesbian, gay, bisexual, transgender, queer or questioning, intersex and asexual or allied) spectrum. The same goes for a feminine man.</p>
<h2>Femininity can affect your heart</h2>
<p>When gender has actually been measured in health-related research, the labels “masculine,” “feminine” and “androgynous” have traditionally been used. </p>
<p>Research shows that health outcomes are not homogeneous for the sexes, meaning all biological females do not have the same vulnerabilities to illnesses and diseases and nor do all biological males. </p>
<p>Gender is one of the things that can influence these differences. For example, when the gender of participants is considered, “higher femininity scores among men, for example, are associated with lower incidence of coronary artery disease…(and) <a href="https://dx.doi.org/10.1177%2F00333549111260S304">female well-being may suffer when women adopt workplace behaviours traditionally seen as masculine</a>.” </p>
<p>In another study, <a href="https://link.springer.com/article/10.1007%2Fs00702-005-0285-5">quality of life was better for androgynous men and women with Parkinson’s disease</a>. In cardiovascular research, <a href="https://www.sciencedirect.com/science/article/pii/S1550857912001908?via%3Dihub">more masculine people have a greater risk of cardiovascular disease than those who are more feminine</a>. And research with cancer patients found that both <a href="https://dx.doi.org/10.1080/07347330903438917">patients and their caregivers who were feminine or androgynous were at lower risk of depression-related symptoms</a> as compared to those who were masculine and undifferentiated.</p>
<p>However, as mentioned earlier, many health researchers do not measure gender, despite the existence of tools and strategies for doing so. They may try to guess gender based on sex and/or what someone looks like. But it is rare that they ask people. </p>
<h2>A tool for researchers</h2>
<p>The self-report gender measure (SR-Gender) I developed, and <a href="https://doi.org/10.3390/geriatrics3010003">first used in a study of aging</a>, is one simple tool that was developed specifically for health research. </p>
<p>The SR-Gender asks a simple question: “Most of the time would you say you are…?” and offers the following answer choices: “Very feminine,” “mostly feminine,” “a mix of masculine and feminine,” “neither masculine or feminine,” “mostly masculine,” “very masculine” or “other.” </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=455&fit=crop&dpr=1 600w, https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=455&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=455&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=572&fit=crop&dpr=1 754w, https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=572&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/224306/original/file-20180621-137717-1m2wgx7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=572&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Self-report gender tool.</span>
<span class="attribution"><span class="source">(Lisa Carver)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The option to answer “other” is important and reflects the <a href="http://itspronouncedmetrosexual.com/2013/01/a-comprehensive-list-of-lgbtq-term-definitions/">constant evolution of gender</a>. As “other” genders are shared, the self-report gender measure can be adapted to reflect these <a href="https://lgbtqia.ucdavis.edu/educated/glossary.html">different categorizations.</a> </p>
<p>It’s also important to note that the SR-Gender is not meant for in-depth gender research, but for health and/or medical studies, where it can be used in addition to, or instead of, sex. </p>
<p>Using gender when describing sex just muddies the waters. Including the actual gender of research participants, as well as their sex, in health-related studies will enrich our understanding of illness.</p>
<p>By asking people to tell us their sex and gender, health researchers may be able to understand why people experience illness and disease differently.</p><img src="https://counter.theconversation.com/content/98293/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>L.F. Carver does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Bigender, gender fluid, cisgender? Emerging gender categorizations are important – for your health.L.F. Carver, Post Doctoral Fellow, Faculty of Arts & Science & Research Associate, Department of Medicine, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/769522017-07-04T20:09:18Z2017-07-04T20:09:18ZSurgery to make intersex children ‘normal’ should be banned<figure><img src="https://images.theconversation.com/files/175546/original/file-20170626-32724-121ds44.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1497%2C992&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Intersex people are born with sexual anatomy that doesn't fit binary notions of male or female bodies. </span> <span class="attribution"><span class="source">Boston Public Library/flickr</span></span></figcaption></figure><p>Questions in the proposed new citizenship test that address family violence, <a href="http://www.smh.com.au/federal-politics/political-news/malcolm-turnbull-targets-labor-over-australian-values-citizenship-quiz-20170419-gvo9jn.html">child marriage and female genital mutilation</a> imply opposition to these is an Australian value.</p>
<p>Indeed most Australians would agree female genital mutilation is an appalling breach of a girl’s right to bodily integrity, and that safeguarding children from violence is a vital goal in modern society. But protection from genital cutting should not only be granted to girls, but to all children. </p>
<p>While condemning female genital mutilation, Australian society appears to broadly accept routine circumcision of young boys, and genital modification surgeries on intersex children where the child’s genitals are reconstructed to resemble those typical of either a male or female. These procedures are legal and supported by Medicare.</p>
<p>In most cases, circumcisions and intersex surgeries occur without medical necessity or urgency: the children are healthy and no adverse medical consequences will arise if the surgery is not carried out immediately. Importantly, children undergoing such surgeries are often too young to understand what is happening to them and are legally too young to provide their consent. </p>
<p>Human rights concerns about underage male circumcision <a href="https://theconversation.com/infant-male-circumcision-stop-violating-boys-human-rights-8517">have been discussed in the past</a>, yet infringements suffered by intersex children are an emerging area of controversy. Medically unnecessary, non-consensual intersex genital modification should be made <a href="http://www.legislation.nsw.gov.au/#/view/act/1900/40/part3/div6/sec45">illegal in Australia in the same way</a> as female genital mutilation.</p>
<h2>Children with intersex variations</h2>
<p>Intersex children are <a href="https://unfe.org/system/unfe-65-Intersex_Factsheet_ENGLISH.pdf">born with sex characteristics</a>, including genitals, gonads (testes and ovaries) and chromosome patterns, that do not fit typical binary notions of male or female bodies. </p>
<p>Nearly 2% of Australia’s population have <a href="https://oii.org.au/16601/intersex-numbers/">intersex variations</a>, which may not always be apparent at birth and may reveal themselves at puberty or later in life. While some intersex people may have atypical external genitalia, others may not. </p>
<p>Intersex variations describe physical or bodily traits – they do not describe gender or sexuality. Like non-intersex folks, intersex people may identify with any number of gender or sexual identities.</p>
<hr>
<p><strong><em>Read more: <a href="https://theconversation.com/boy-girl-or-dilemmas-when-sex-development-goes-awry-49359?sr=7">Boy, girl or …? Dilemmas when sex development goes awry</a></em></strong></p>
<hr>
<h2>Genital “normalising” surgery</h2>
<p>Many intersex children undergo what proponents call genital “normalising” procedures, which implies these children’s bodies are abnormal. The procedures, intended to make the children conform to social norms of male or female bodies, often include irreversible surgical modification of sexual organs. These may result in sterilisation by removal of their gonads (testes or ovaries), and life-long hormone treatments. </p>
<p>Those who advocate for these procedures to be carried out when children are still young often argue the chances of medical success are higher and the children will be able to grow up with a consistent gender identity. However, this ignores the human rights of these children to independently develop a gender identity and decide for themselves whether they want their bodies to be altered irreversibly. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175550/original/file-20170626-32724-1tot11t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Safeguarding children from violence is a vital goal in modern society.</span>
<span class="attribution"><span class="source">Man-wise/flickr</span></span>
</figcaption>
</figure>
<p>There are many examples of intersex people who, as children, were subjected to “normalising” procedures without their consent. In the 1970s, intersex advocate <a href="http://www.abc.net.au/local/stories/2014/12/01/4135509.htm">Georgie Yovanovic</a> went through forced medical examinations, hormone treatments, surgery to descend her testicles, and ultimately a unilateral mastectomy without her consent or any explanation from doctors when she was a child and teenager.</p>
<p>Alice Springs-based musician <a href="http://www.abc.net.au/local/stories/2014/12/01/4140196.htm">Shon Klose</a> was born without internal female organs. As a teenager in the 1980s, she was pressured into having medical treatment to create a vagina to have a more typical female body capable of heterosexual penetration. She did not receive any medical counselling, support or information.</p>
<p>Genital “normalising” procedures on young children still occur in Australia today. The recent <a href="http://www.theaustralian.com.au/national-affairs/health/carlas-case-ignites-firestorm-among-intersex-community-on-need-for-surgery/news-story/7b1d478b8c606eaa611471f70c458df0">Family Court of Australia</a> case of five-year-old Carla is an example. Carla was born genetically male but with the external appearance of a female child and had undergone early childhood surgery to enhance the appearance of her genitalia. </p>
<p>In 1992, the High Court of Australia had established a precedent in <a href="http://www.austlii.edu.au/au/cases/cth/high_ct/175clr218.html">Marion’s Case</a>, that parents cannot consent on behalf of their children to have certain types of medical procedures, which therefore require court authorisation. Consequently, in 2015 Carla’s parents, who were raising her as a girl, sought permission to have her gonads surgically removed, which the Family Court granted. </p>
<h2>Human rights violation</h2>
<p>Greater visibility of intersex people is driving increasing resistance to these procedures. There is now growing global criticism of genital modification procedures on intersex children as a violation of human rights. </p>
<p>In 2013, Europe’s leading human rights organisation, the Council of Europe, <a href="http://semantic-pace.net/tools/pdf.aspx?doc=aHR0cDovL2Fzc2VtYmx5LmNvZS5pbnQvbncveG1sL1hSZWYvWDJILURXLWV4dHIuYXNwP2ZpbGVpZD0yMDE3NCZsYW5nPUVO&xsl=aHR0cDovL3NlbWFudGljcGFjZS5uZXQvWHNsdC9QZGYvWFJlZi1XRC1BVC1YTUwyUERGLnhzbA==&xsltparams=ZmlsZWlkPTIwMTc0">identified intersex genital modification</a> as a non-medically justified violation of children’s right to physical integrity. The Council encouraged states to “guarantee bodily integrity, autonomy and self-determination” to intersex people. </p>
<p>In 2015, <a href="https://rm.coe.int/168045b1e6">Malta became the first country</a> to explicitly outlaw the practice. No other country has done so at the time of writing. In the same year, the United Nations Office of the High Commissioner for Human Rights (OHCHR) <a href="http://www.ohchr.org/EN/NewsEvents/Pages/Astepforwardforintersexvisibility.aspx">held a conference</a> to address what it called the human rights violations faced by intersex people. As the first of its kind, the meeting broadened global awareness of intersex issues and genital modification specifically. </p>
<p>Shortly after this, twelve UN entities including the OHCHR, UNICEF and the World Health Organisation, <a href="http://www.ohchr.org/Documents/Issues/Discrimination/Joint_LGBTI_Statement_ENG.PDF">released a joint statement</a> condemning anti-LGBTI discrimination and violence. They specifically pointed out that LGBTI persons may face </p>
<blockquote>
<p>abuse in medical settings, including unethical and harmful so-called “therapies” to change sexual orientation, forced or coercive sterilization, forced genital and anal examinations, and unnecessary surgery and treatment on intersex children without their consent.</p>
</blockquote>
<h2>So, what about Australia?</h2>
<p>There is growing awareness in Australia of the potential human rights abuses on intersex children. </p>
<p>A 2013 federal senate inquiry into the <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/index">involuntary or coerced sterilisation</a> of intersex people found there is no medical consensus regarding how and when genital “normalising” surgery should be conducted. </p>
<p>Among the <a href="http://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Involuntary_Sterilisation/Sec_Report/b01">committee’s recommendations</a> was that all intersex medical procedures be managed by multidisciplinary teams in a human rights framework, and require authorisation by a court or tribunal. These recommendations did not lead to policy changes or legislative reform. </p>
<p>In 2016, Australian Human Rights Commissioner Ed Santow <a href="https://www.humanrights.gov.au/news/stories/intersex-rights-are-human-rights">endorsed international calls</a> to end medically unnecessary procedures to safeguard the human rights of intersex children. </p>
<p>In February 2017, the Rationalist Society of Australia – a secular free thought organisation – published its <a href="https://www.rationalist.com.au/campaigns/genital-autonomy-2/">white paper on genital autonomy</a>. This condemns all forms of medically unnecessary, non-consensual genital modification as violations of human rights. The white paper calls for the criminalisation of these procedures on equal footing with the prohibition of female genital mutilation.</p>
<p>Despite increasing international and national awareness of the human rights violations caused by genital modification procedures, Australia has not reformed its laws. Yet rights to bodily integrity and autonomy should be protected for all children. Until we safeguard every child from all forms of violence, opposition to genital cutting will not be an Australian value.</p><img src="https://counter.theconversation.com/content/76952/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cornelia Koch is on the Advisory Board of the Australasian Institute for Genital Autonomy. </span></em></p><p class="fine-print"><em><span>Travis Wisdom is an associate member of Organisation Intersex International Australia Limited (OII-Australia) and is the co-author of the Rationalist Society of Australia white paper, 'Genital Autonomy.' </span></em></p>Until we safeguard every child from all forms of violence, opposition to genital cutting will not be an Australian value.Cornelia Koch, Senior Lecturer in Law, University of AdelaideTravis Wisdom, PhD Candidate, International Human Rights Law, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/775692017-05-15T09:56:12Z2017-05-15T09:56:12ZHow different are female, male and intersex genital cutting?<figure><img src="https://images.theconversation.com/files/169144/original/file-20170512-3689-5q8xv0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Model Hanne Gaby Odiele (in white) has been outspoken about experiencing life as intersex.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Three members of the Dawoodi Bohra sect of Islam <a href="https://www.justice.gov/usao-edmi/pr/three-indicted-female-genital-mutilation">were recently indicted</a> on charges of “female genital mutilation” (FGM) in the US state of Michigan. In Norway, meanwhile, one of the major political parties <a href="http://www.independent.co.uk/news/world/europe/norwegian-ruling-progress-party-ban-circumcision-men-under-16-years-old-vote-annual-conference-a7723746.html">has backed</a> a measure to ban childhood male circumcision.</p>
<p>Fearing that objections to female forms of genital cutting will be applied to male forms, some <a href="http://www.eurasiareview.com/01052017-female-genital-mutilation-crime-not-circumcision-oped/">commentators</a> have rushed to draw a “clear distinction” between them. Others, however, have <a href="http://www.startribune.com/we-re-appalled-at-genital-mutilation-of-girls-what-about-boys-and-circumcision/422052673/">highlighted the similarities</a>. </p>
<p>In fact, childhood genital cutting is usually divided not just into two, but three separate categories: “FGM” for females; “circumcision” for males; and “genital normalisation” surgery for <a href="http://www.isna.org/articles/ambivalent_medicine">intersex children</a> – those born with ambiguous genitals or mixed sex characteristics.</p>
<p>In Western countries, popular attitudes towards these procedures <a href="https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-article-MB">differ sharply</a> depending on the child’s sex. In females, any medically unnecessary genital cutting, <a href="https://www.researchgate.net/publication/280238965_Female_Genital_Alteration_-_A_Compromise_Solution">no matter how minor or sterilised</a>, is seen as an intolerable violation of her bodily integrity and human rights. Most Westerners believe that such cutting must be <a href="http://www.npwj.org/FGM/UN-General-Assembly-Adopts-Worldwide-Ban-Female-Genital-Mutilation.html">legally prohibited</a>. </p>
<p>In intersex children, while it is still common for doctors to surgically modify their genitals without a strict medical justification, there is <a href="http://digitalcommons.law.yale.edu/cgi/viewcontent.cgi?article=1423&context=ylpr">growing opposition</a> to non-essential “<a href="https://www.researchgate.net/publication/279180849_Should_surgery_for_hypospadias_be_performed_before_an_age_of_consent">cosmetic</a>” surgeries, designed to mould ambiguous genitalia into a “binary” male or female appearance. </p>
<p>Belgian model Hanne Gaby Odiele, for example, has <a href="https://www.washingtonpost.com/news/arts-and-entertainment/wp/2017/01/25/a-supermodel-reveals-she-is-intersex-was-subjected-to-traumatizing-and-unnecessary-surgeries/">spoken openly</a> about the negative impact of the “irreversible, unconsented and unnecessary” intersex surgeries she was subjected to growing up.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=597&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=597&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169300/original/file-20170515-7019-z7n00z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=597&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sensitive issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cropped-image-man-jeans-closeup-on-368677379?src=KpG5FfP8iW_h4PN3sU6O6g-1-20">Shutterstock</a></span>
</figcaption>
</figure>
<p>In male children, by contrast, the dominant view is that boys are not significantly harmed by being circumcised, despite the loss of <a href="http://onlinelibrary.wiley.com/doi/10.1002/tre.531/abstract">sensitive tissue</a>. Some even point to potential health benefits, although <a href="https://www.researchgate.net/publication/316527603_Cultural_bias_in_American_medicine_The_case_of_infant_male_circumcision">most doctors agree</a> that these benefits are not enough to <a href="http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896">outweigh</a> the risks and <a href="http://pennjil.com/brian-earp-robert-darby-circumcision-sexual-experience-and-harm-reply-to-stephen-r-munzers-secularization-anti-minority-sentiment-and-cultural-norms-in-the-german-circumcision-cont/">harms</a>. Even so, many people believe that parents should be allowed to choose circumcision for their sons, whether for cultural or religious reasons.</p>
<p>But these attitudes are starting to change. Over the past few decades, and even more strongly in <a href="http://www.tandfonline.com/doi/abs/10.1080/23269995.2013.804757">recent years</a>, scholars of genital cutting have <a href="http://heinonline.org/HOL/LandingPage?handle=hein.journals/hmax11&div=19&id=&page=">argued</a> that there is too much overlap in the physical effects, motivations, and symbolic meanings of these three practices – <a href="https://www.dovepress.com/female-genital-mutilation-and-male-circumcision-toward-an-autonomy-bas-peer-reviewed-article-MB">when their full range across societies is considered</a> – for categorical distinctions based on sex or gender to hold up.</p>
<h2>Making comparisons</h2>
<p>Take the Dawoodi Bohra case. The defendants claim that, like male circumcision, female “circumcision” is <a href="http://www.metrotimes.com/news-hits/archives/2017/04/22/muslim-sect-known-for-female-genital-mutilation-responds-to-charges-against-local-docs">required by their religion</a>. In the Western popular media, this claim is usually <a href="https://www.researchgate.net/publication/316505694_Reason_and_paradox_in_medical_and_family_law_Shaping_children%27s_bodies">dismissed as mistaken</a>, because neither male nor female circumcision is mentioned in the Quran, the central scripture of Islam. </p>
<p>But both practices <a href="http://heinonline.org/HOL/LandingPage?handle=hein.journals/twls1994&div=9&id=&page=">are mentioned in the Hadith</a> (the sayings of the prophet Mohammed), which is another important source of Islamic law. </p>
<p>Based on their reading of the Hadith, some <a href="https://islamqa.info/en/60314">Muslim authorities</a> state that “circumcision” of both sexes is recommended or even obligatory, while others draw a <a href="http://theislamicmonthly.com/a-tiny-cut-female-circumcision-in-south-east-asia/">different conclusion</a>. But there is no “pope” in Islam to make the final call: whether a practice counts as religious, therefore, depends on the local community and its interpretation of scripture. </p>
<p>Motivations for genital cutting and associated “symbolic meanings” <a href="https://www.sfog.se/media/295486/omskarelse_rapport.pdf">differ widely</a> from group to group. The claim that female genital cutting is always about <a href="https://humdev.uchicago.edu/sites/humdev.uchicago.edu/files/uploads/shweder/Disputing%20The%20Myth%20of%20the%20sexual%20dysfunction%20of%20cicumcised%20women.pdf">sexual control</a>, while male genital cutting <a href="http://www.cirp.org/library/psych/boyle6/">never is</a>, is an <a href="http://www.tandfonline.com/doi/abs/10.1080/10532528.2000.10559787">oversimplification</a> based on stereotypes – most anthropologists who study these practices <a href="https://www.sfog.se/media/295486/omskarelse_rapport.pdf">regard</a> this claim as false.</p>
<p>As they emphasise, nearly <a href="https://www.sfog.se/media/295486/omskarelse_rapport.pdf">every society</a> that practices female genital cutting also practices male genital cutting, often in parallel and for similar reasons. When the cutting is part of a rite of passage into adulthood, for example, diminishing sexual experience is <a href="http://www.tandfonline.com/doi/abs/10.1080/10532528.2000.10559787">not typically the intention</a> for either the boys or the girls. Instead, the goal is to ceremoniously “transform” the youths into mature adults, in part by having them show courage in the face of discomfort.</p>
<p>What about the physical effects? These range widely, too. Some groups practice a female <a href="http://theislamicmonthly.com/a-tiny-cut-female-circumcision-in-south-east-asia/">“ritual nick”</a>, which involves cutting part of the foreskin or “hood” of the external clitoris. Although this procedure <a href="https://www.researchgate.net/publication/280238965_Female_Genital_Alteration_-_A_Compromise_Solution">does not usually remove tissue</a>, it may certainly be painful and traumatic, and we have <a href="https://www.researchgate.net/publication/285578712_In_defence_of_genital_autonomy_for_children">argued elsewhere</a> that it should not be done on non-consenting minors. </p>
<p>Nevertheless, despite being federally prohibited in the US, this form of “FGM” is actually less invasive than either male circumcision or cosmetic intersex “normalisation” surgeries – both of which are also painful and can be <a href="http://www.cirp.org/library/psych/boyle6/">traumatic</a>, and neither of which is medically necessary.</p>
<h2>Informed consent</h2>
<p>Based on these and other points of overlap, the <a href="http://www.tandfonline.com/doi/abs/10.1080/23269995.2013.804757?journalCode=rgld20">emerging consensus</a> among some scholars is that the ethics of genital cutting should not be based on the apparent sex of the child (as judged by their external genitalia). Instead, it should be based on their age and ability to give <a href="https://www.researchgate.net/publication/249753235_Female_Genital_MutilationCutting_in_the_UKChallenging_the_Inconsistencies">informed consent</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/169186/original/file-20170513-3689-gykwfc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Consent issues.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nyc-june-29-2014-anticircumcision-photos-201938419?src=viEH0-YW6i-vaY6y34rz-g-5-1">Shutterstock</a></span>
</figcaption>
</figure>
<p>Now that “binary” conceptions of both <a href="https://www.nature.com/news/sex-redefined-1.16943">sex and gender</a> are generally understood to be too limited to capture the full reality, judgements based on perceived maleness or femaleness will be increasingly hard to defend. For example, at what point along the <a href="https://en.wikipedia.org/wiki/Quigley_scale">intersex spectrum</a> does a small penis (legal to cut) become a large clitoris (illegal to cut)? Any such distinction would be subjective and arbitrary.</p>
<p>In <a href="http://euromind.global/brian-d-earp-and-rebecca-steinfeld/?lang=en">a recent paper</a> for the European Parliament, we spelled out these arguments in greater detail. We encourage you to <a href="http://euromind.global/brian-d-earp-and-rebecca-steinfeld/?lang=en">give it a read</a>. In it, we ask: what are the policy implications of taking a gender-neutral approach to genital cutting? </p>
<p>In other words, what happens when moral considerations centre around medical necessity, autonomy, and respect for the bodily integrity of all children – regardless of their sex or gender? We see three practical advantages to this approach: </p>
<p>1) It deflects accusations of sexism by recognising that boys and intersex children – just like girls – are vulnerable to genital alterations that they may later come to seriously resent.</p>
<p>2) It reduces the moral confusion that stems from Western-led efforts to eliminate only the female “half” of genital cutting rites in communities that practice both male and female forms in parallel.</p>
<p>3) It neutralises accusations of cultural imperialism and anti-Muslim bias by avoiding <a href="https://www.researchgate.net/publication/249753235_Female_Genital_MutilationCutting_in_the_UKChallenging_the_Inconsistencies">racially tinged double standards</a>. </p>
<p>This is because the same moral concern would apply to medically unnecessary genital cutting practices that primarily affect white children in North America, Australasia and Europe, as to those affecting children of colour (and immigrants) from Africa, the Middle East and Southeast Asia.</p>
<p>Adopting such an approach does not necessarily mean “banning” all pre-consensual forms of non-therapeutic genital alteration. History shows that attempting to pass <a href="http://onlinelibrary.wiley.com/doi/10.1111/dewb.12135/full">strict legal prohibitions</a> before cultural readiness can backfire, creating intense resistance among those who are dedicated to modifying children’s genitals for whatever reason, and often driving such practices further underground. </p>
<p>Prohibition of female genital cutting, for example, has been largely unsuccessful in many countries where it is customary and deeply culturally embedded (rates are higher than 90% in Egypt, for instance, where it has been <a href="https://www.theguardian.com/world/2015/feb/06/female-genital-mutilation-egypt">illegal since 2008</a>); and recent attempts to criminalise circumcision of boys, such as in <a href="http://newsfeed.time.com/2012/06/29/german-court-bans-male-circumcision/">Germany</a> in 2012, have been blocked, <a href="http://www.sun.ac.za/english/faculty/healthsciences/cmel/Documents/After%20Cologne%20male%20circumcision%20and%20the%20law.pdf">overturned</a> or ignored. </p>
<p>There are many levers that societies can pull to discourage unethical practices: the law is only one among them, and not necessarily the most desirable or effective. Some authors <a href="http://jme.bmj.com/content/39/7/459">have proposed</a> step-wise regulation of medically unnecessary childhood genital cutting, along with <a href="https://bmcinthealthhumrights.biomedcentral.com/articles/10.1186/1472-698X-14-13">community engagement</a> and education, as alternatives and/or supplements to formal prohibition. </p>
<p>Whatever specific policies are implemented, it is clear that fundamentally different treatment of female, male and intersex children, in terms of their protection from non-therapeutic genital alteration, will become increasingly difficult to justify in the years to come.</p><img src="https://counter.theconversation.com/content/77569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rebecca Steinfeld received funding from the Brocher Foundation in Geneva to support this research.</span></em></p><p class="fine-print"><em><span>Brian D Earp received funding from the Brocher Foundation in Geneva to support this research.</span></em></p>There are some striking physical and symbolic similarities.Rebecca Steinfeld, Visiting Research Fellow, Goldsmiths, University of LondonBrian D Earp, Associate Director, Yale-Hastings Programme in Ethics and Health Policy, Yale UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/629352016-08-15T10:14:17Z2016-08-15T10:14:17ZSo what if some female Olympians have high testosterone?<p>On August 12, Dutee Chand became just the second female sprinter to represent India at the Olympic Games. Her road to Rio has been anything but easy.</p>
<p>In 2014, the International Association of Athletic Federations banned her from competition on the grounds that her body naturally produced too much testosterone, a condition called hyperandrogenism. It wasn’t her fault, the organization explained. But her condition gave her an unfair edge over other female athletes, according to the IAAF policy.</p>
<p>Chand appealed the ruling, and in July 2015, the Court of Arbitration for Sport determined <a href="http://www.tas-cas.org/fileadmin/user_upload/Media_Release_3759_FINAL.pdf">that the IAAF</a>:</p>
<blockquote>
<p>“was unable to conclude that hyperandrogenic female athletes may benefit from such a significant performance advantage that it is necessary to exclude them from competing in the female category.” </p>
</blockquote>
<p>Arbitrators gave the IAAF two years to produce enough evidence to justify its policy. Until then, the organization must suspend the hormone test. The International Olympic Committee also complied, allowing Chand and other hyperandrogenic women to compete at the 2016 Olympic Games without having to lower their hormone levels.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"761493947285774336"}"></div></p>
<p>The Chand case is the just the latest chapter in the long history of sex-testing female athletes in elite sport, something <a href="http://www.press.uillinois.edu/books/catalog/58ctr3rx9780252038167.html">I’ve been studying</a> for a while. Although the tests have changed over the years, the intent – to ensure that female athletes are sufficiently female – has not. </p>
<p>With all due respect, I think asking if elevated levels of testosterone give female athletes a competitive advantage is the wrong question. Instead, we should ask: “So what?” </p>
<h2>The long history of sex-testing female athletes</h2>
<p>As the prestige of international athletics grew during the 20th century, critics worried that male athletes might commit “gender fraud” in pursuit of sporting glory. In 1946, for example, the <a href="http://dx.doi.org/10.1016/j.endeavour.2010.09.005">IAAF required</a> female competitors to submit medical certificates to verify their sex. </p>
<p>At the European Athletics Championship in 1966, the IAAF subjected female competitors to a “nude parade” past three gynecologists. This was because, as Life magazine <a href="https://books.google.com/books?id=jFYEAAAAMBAJ&pg=PA63&lpg=PA63&dq=%E2%80%9Cthere+had+been+persistent+speculation+through+the+years+about+women+who+turn+in+manly+performances.%E2%80%9D&source=bl&ots=jAZWikIlN_&sig=TgyZcnJJrnAPsMkz8aW0LON0V6U&hl=en&sa=X&ved=0ahUKEwiY1ou91ajOAhUJ34MKHeDvCX4Q6AEIITAB#v=onepage&q=%E2%80%9Cthere%20had%20been%20persistent%20speculation%20through%20the%20years%20about%20women%20who%20turn%20in%20manly%20performances.%E2%80%9D&f=false">reported</a>, “there had been persistent speculation through the years about women who turn in manly performances.” That same year female athletes at the Commonwealth Games had to undergo gynecological exams to prove their sex. British pentathlete Mary Peters <a href="https://www.amazon.com/Mary-Autobiography-Wooldridge-Ian-Peters/dp/0099123304">would later refer to it as</a> “the most crude and degrading experience I have ever known in my life.” </p>
<p>In 1967 the IAAF <a href="http://dx.doi.org/10.1001/jama.1972.03200220032008">turned to a</a> “simpler, objective and more dignified” laboratory-based chromosome assessment, typically obtained by swabbing the inside of every female athlete’s cheek (the IOC followed suit for the 1968 Olympic Games). An XX result effectively established femaleness. Anything else spelled an end to the woman’s career. But there are a host of genetic and biological variations that complicate the seemingly tidy split between male and female.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=484&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=484&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=484&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=608&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=608&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133864/original/image-20160811-11853-1gl46tp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=608&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ewa Klobukowska.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/smithsonian/5494508884/in/photolist-9nwN4N">Smithsonian Institution</a></span>
</figcaption>
</figure>
<p>Polish sprinter Ewa Klobukowska, for instance, was summarily dismissed from sport in 1967 because she had “one chromosome too many.” The IAAF nullified all of her victories, struck her name from the record books, and rescinded her medals, including the gold and bronze from the 1964 Olympics, all because of a naturally occurring condition that probably had little bearing on her success. </p>
<p>At 21 years old, her athletic career was over. “It’s a dirty and stupid thing to do to me,” she said at the time. “I know what I am and how I feel.”</p>
<p>Then there are women with XY chromosomes, such as Spanish hurdler <a href="http://www.thelancet.com/pdfs/journals/lancet/PIIS0140673605678415.pdf">María José Martínez-Patiño</a>. She successfully challenged her 1985 disqualification on the grounds that she also has androgen insensitivity syndrome, a condition in which her body cannot respond to testosterone, either natural or synthetic. </p>
<h2>Objections to mandatory testing grow</h2>
<p>The results of the tests are supposed to be confidential, so we don’t know exactly how many women have been drummed out of sport as a result. Researchers <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1478807/">estimate</a> that <a href="http://rua.ua.es/dspace/handle/10045/15015">between 1972 and 1990</a>, sex-testing procedures disqualified approximately one in 504 elite athletes. An untold number of women competing at the lower levels of sport met a similar fate, or else abandoned competition altogether based on fears that they might not meet the standards for femaleness. </p>
<p>From the beginning, there were protests about the ethics, validity and reliability of the tests. By the early 1990s, objections had <a href="http://www.tandfonline.com/doi/pdf/10.1080/00336297.2011.10483678?needAccess=true&redirect=1">reached a fever pitch</a> and, in May 1992, the IAAF announced an end to systematic chromosomal testing. The IOC did the same in 1999. However, both organizations reserved the right examine athletes if someone were to “challenge” their femaleness. The ostensibly progressive protocol ultimately discriminates against women who do not look or perform in accordance with certain “feminine” ideals. This is what happened to South African runner <a href="http://link.springer.com/chapter/10.1007/978-0-230-36746-3_28#page-1">Caster Semenya</a> in 2009 and to Dutee Chand in 2014. </p>
<h2>Caster Semenya and Dutee Chand</h2>
<p>Just hours before Semenya cruised to victory in the finals of the 800-meter race at the 2009 World Championships in Athletics, the IAAF <a href="https://books.google.com/books?id=e-7kAgAAQBAJ&pg=PA118&lpg=PA118&dq=jaime+schultz+%22concerns+that+she+does+not+meet+the+requirements+to+compete+as+a+woman%22&source=bl&ots=fc9EPAcz_p&sig=5imIubO9b21ex7v2dVX-9QfgonY&hl=en&sa=X&ved=0ahUKEwigkduM0r7OAhUG9x4KHQzDALAQ6AEIIjAB#v=onepage&q=jaime%20schultz%20%22concerns%20that%20she%20does%20not%20meet%20the%20requirements%20to%20compete%20as%20a%20woman%22&f=false">confirmed</a> “concerns that she does not meet the requirements to compete as a woman.”</p>
<p>Never clarifying what those requirements were, officials requested Semenya abstain from competition. She obliged for a <a href="http://www.bbc.com/sport/olympics/36991646">disquieting 11 months</a>, during which experts worked to determine her sex. She was noticeably slower upon returning to the track (although she won a silver medal in the women’s 800 meter at the London Games in 2012), leading to speculation that she must have undergone some intervention to lower her testosterone. The IAAF’s subsequent <a href="https://www.iaaf.org/news/iaaf-news/iaaf-to-introduce-eligibility-rules-for-femal-1">policy on hyperandrogenism</a> bolstered those opinions. </p>
<p>This new policy ruled any female athlete exhibiting <a href="https://www.iaaf.org/news/press-release/hyperandrogenism-regulations-cas-dutee-chand">10 or more nanomoles</a> of functional testosterone per liter of blood (which they consider the lower end of “normal” male range) ineligible for competition.</p>
<p>Women could apply for reinstatement if they sufficiently reduced their testosterone levels below the 10 nanomole threshold. This can be done surgically, often through the removal of internal testes, with hormone-suppressing medication or through a combination of both. Women with androgen insensitivity syndrome are exempt from this policy.</p>
<p>These guidelines took the place of the earlier “gender verification policy.” Indeed, the IAAF, IOC and affiliated federations erased all mention of sex testing from their rule books and instead initiated the hormone test “to protect the health of the athlete.” </p>
<p>It’s worth noting that male athletes don’t seem to need similar protection. There is no upper limit to the levels of natural testosterone allowed in their bodies. In fact, male athletes with low testosterone can apply for a “<a href="https://www.wada-ama.org/en/what-we-do/science-medical/therapeutic-use-exemptions">Therapeutic Use Exemption</a>” that allows them to take medically prescribed steroids to augment their androgen levels. </p>
<p>The Court of Arbitration for Sport’s decision in Dutee Chand’s case suspends, <a href="https://www.theguardian.com/sport/2016/aug/11/caster-semenya-sebastian-coe-iaaf-cas-testosterone-olympics?CMP=share_btn_fb">at least</a> for the 2016 Olympic Games, any testing or exclusion of women on the basis of hyperandrogenism. This creates an incredible amount of interest in the performances of Chand and Semenya and, quite possibly, any female athlete who does not conform to the traditional standards of femininity.</p>
<h2>Question of testosterone is missing the point</h2>
<p>Dutee Chand <a href="http://www.thehindu.com/sport/other-sports/rio-olympics-2016-brief-glimpse-of-olympics-but-all-worth-it-for-dutee-chand/article8984186.ece">did not win medal in Rio</a>, but Caster Semenya, who has grown increasingly faster in past months, is an odds-on favorite to take home the gold in the 800-meter race. </p>
<p>So does excess testosterone actually confer a competitive advantage? </p>
<p>My question is if it does, so what?</p>
<p>Elite sport is built on the back of inequality. We love the myth of a level playing field, but it doesn’t exist. Of the 207 nations competing in Rio, 75 have never won a medal. Wealthy, powerful countries dominate the Olympic Games, while conflicted, war-torn, impoverished countries simply lack the resources to promote sport to the level that will produce Olympic champions. That’s a clear disparity that raises little outcry.</p>
<p>But what we’re talking about in the case of hyperandrogenism is an innate condition that potentially enhances athletic performance. And, as scientists are just beginning to understand, elite sport is riddled with similar endowments. </p>
<p>Researchers associate physical performance with over <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993978/">200 different genetic variations</a>. More than 20 of those variants relate to elite athleticism. These performance-enhancing polymorphisms – PEPs – can affect height, blood flow, metabolic efficiency, muscle mass, muscle fibers, bone structure, pain threshold, fatigue resistance, power, speed, endurance, susceptibility to injury, psychological aptitude, and respiratory and cardiac functions, to name just a few. </p>
<p>We don’t disqualify athletes with these types of predispositions. We celebrate them.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133862/original/image-20160811-28926-gxs06d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eero Mantyranta at the Innsbruck Olympic Games in 1964.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File%3AEeroMantyranta.jpg">Jussi Pohjakallio, via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>With seven Olympic medals, Finland’s Eero Mäntyranta, for example, is among the all-time greats of Nordic skiing. It’s a sport that requires incredible stamina – a trait assisted by an abundance of red blood cells, which carry oxygen to the muscles. That’s why so many endurance athletes try to boost their hemoglobin by training at high altitudes, sleeping in altitude chambers, or through illegal measures like blood doping or taking a synthetic version of the hormone erythropoietin (EPO).</p>
<p>Mäntyranta, who died in 2013, didn’t need any of that. He had a condition called primary familial and congenital polycythemia, associated with a variation in the EPOR gene, which caused his body to produce 65 percent more red blood cells than the average male. David Epstein, author of “<a href="http://thesportsgene.com/">The Sports Gene</a>,” calls Mäntyranta’s EPOR variant a “gold medal mutation.”</p>
<p>How is this different from a woman’s body that naturally produces more testosterone? Why is primary familial and congenital polycythemia a genetic gift and hyperandrogenism a disqualifying curse? Unless athletic authorities want to take on all conditions that might result in an unfair advantage – biological, genetic, social or otherwise – it seems arbitrary to focus on testosterone in female athletes.</p><img src="https://counter.theconversation.com/content/62935/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jaime Schultz does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Some women naturally produce high levels of testosterone. Why is this innate condition treated differently from other conditions that potentially enhance athletic performance?Jaime Schultz, Associate Professor of Kinesiology, Penn StateLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/619042016-07-27T10:44:33Z2016-07-27T10:44:33ZAll the Olympics are a stage, and all the athletes merely players: the rich history of the modern Games<p>The Olympics transfix us. Six in every ten people in the world – including both you, dear reader, and me – watched the London 2012 Olympics. Use of the word Olympics increased in relative frequency 3,300% between 1924 and 1984. But what are the Olympics to us, how are we to read them socially and politically?</p>
<p>The Olympic Games are a theatre — sometimes farce, sometimes tragedy, theatre of the absurd, opera buffa, reality TV, morality play or soap opera — where geopolitical, social and technological dramas are played out. </p>
<p>The Olympic village (which first appeared in the 1932 Los Angeles Games) is itself a microworld, where all nationalities, creeds and colours come together and everyday dramas of sex, politics, human achievement and human weakness are played out. </p>
<p>Olympic competition is itself a media-constructed reality.</p>
<h2>The Olympics as cinema</h2>
<p>There’s always been an easy spillover between the Olympics and the mass media. Athletes have slipped seamlessly into media celebrity. Olympic weightlifter Harold Sakata won a silver medal in the 1948 London Olympics, but became better known as Oddjob in the James Bond film Goldfinger. </p>
<p>Less known is British freestyle wrestler Ken Richmond, the bloke who bangs the huge bronze gong at the start of J. Arthur Rank films. Appropriately, he won a bronze medal at the 1952 Helsinki Olympics.</p>
<p>But cinematic links with the Olympics go much further back. Norwegian figure skater Sonja Henie (gold medallist in three successive Olympics from 1928) became one of the highest-paid actors in the world. </p>
<p>Buster Crabbe (US gold medallist swimmer 1932) appeared in over 100 movies. Like Crabbe, shot-putter Herman Brix (silver medal, Amsterdam 1928), swimmer Johnny Weissmuller (five gold medals 1924-1928) and decathlete champion Glenn Morris (1936) all appeared as Tarzan, the last <a href="https://en.wikipedia.org/wiki/Tarzan%27s_Revenge">alongside US Olympic swimmer Eleanor Holm</a> (1928 and 1932). </p>
<p>Weissmuller, fondly remembered by children of my generation as Jungle Jim, featured in Tarzan’s celebrated <a href="https://www.youtube.com/watch?v=6Bc7KDyLV80">nude swim</a>, ostensibly with Maureen O’Sullivan, but actually with stand-in Olympic and world champion swimmer Josephine McKim.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=423&fit=crop&dpr=1 600w, https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=423&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=423&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=532&fit=crop&dpr=1 754w, https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=532&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/131918/original/image-20160726-31198-zdapaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=532&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Buster Crabbe, US gold medallist, in Tarzan the Fearless (1933).</span>
<span class="attribution"><span class="source">Tom Simpson/Flickr</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>The Olympics have also been the subject <em>of</em> film. Glenn “Tarzan” Morris also appeared in Leni Riefenstahl’s superb documentary of the 1936 Berlin Olympics, <a href="http://www.imdb.com/title/tt0030522/">Olympia (1938)</a>, considered one of the best films ever made. </p>
<p>The classic <a href="http://www.imdb.com/title/tt0082158/?ref_=fn_al_tt_1">Chariots of Fire (1981)</a> was a morality play looking at the clash of spiritual and worldly values, when the evangelical Scottish athlete Eric Liddell refused to run on Sunday and sacrificed his chance of winning the 100-metre sprint. Liddell later returned to his birthplace in China as a missionary, only to die in a Japanese internment camp weeks before the liberation. </p>
<p>Spielberg’s dark <a href="http://www.imdb.com/title/tt0408306/?ref_=fn_al_tt_1">Munich (2005)</a> explored the massacre of Israeli athletes in the 1972 Munich Games, and more recently <a href="http://www.imdb.com/title/tt0106611/?ref_=fn_al_tt_1">Cool Runnings (1993)</a> and <a href="http://www.imdb.com/title/tt1083452/">Eddie the Eagle (2016)</a> have recounted some of the farcical aspects of the Games – the equally improbable efforts of a Jamaican bobsleigh team and an English ski-jumper.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/Jpdg5XOZZDY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
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<p>Even Olympic venues are like film sets, scattered across the world’s most exotic destinations from Paris to Rio. Just like film sets, they’re often improvised and dismantled soon after the Games have finished. </p>
<p>Hitler’s architect, Albert Speer, improvised the 1936 Olympic stadium using 152 anti-aircraft searchlights pointed straight upwards. The <a href="http://archiv.ub.uni-heidelberg.de/artdok/37/3/Teil_2.pdf">Lichtdom</a>, said British ambassador Sir Nevile Henderson, was “like being inside a cathedral of ice”. </p>
<p>Hermann Göring, never a fan of high art (“Whenever I hear the word ‘culture’, I reach for my revolver”), was unimpressed; Speer had commandeered all the anti-aircraft searchlights in Berlin, leaving the city unprotected. </p>
<p>The Berlin Olympic Village was converted to military barracks soon after the Games; perhaps the Allies should have read the signs. </p>
<h2>… as political drama</h2>
<p>In the ancient Olympics, warring states agreed to lay down their arms and establish an Olympic peace — Pax Olympica. In the modern era, the Games become a stylised working out of geopolitical tensions. </p>
<p><a href="http://www.orwell.ru/library/articles/spirit/english/e_spirit">George Orwell</a> famously described sport as “war without the bullets”:</p>
<blockquote>
<p>If you wanted to add to the vast fund of ill-will existing in the world at this moment, you could hardly do it better than by a series of football matches between Jews and Arabs, Germans and Czechs, Indians and British, Russians and Poles, and Italians and Jugoslavs, each match to be watched by a mixed audience of 100,000 spectators.</p>
</blockquote>
<p>The Olympic nations represent a kind of global geopolitics in miniature, shifting, coalescing and dividing as global politics change. The old Soviet Union is now represented by 15 national Olympic committees, the former Yugoslavia by seven, and the two Germanies by one. </p>
<p>There are, in fact, more Olympic “nations” – 206 – than there are countries in the <a href="http://www.un.org/en/member-states/">United Nations – 193</a>. </p>
<p>The International Olympic Committee (IOC) crystallises and provides the imprimatur for new geopolitical realities: accepting Japan back into the fold of civilised nations in 1952, and Germany in 1956; rehabilitating South Korea after the <a href="https://en.wikipedia.org/wiki/Assassination_of_Park_Chung-hee">10.26 assassination</a> of president Park Chung-Hee by awarding it the 1988 Games; acknowledging the Soviet Union and Communist China in 1952; and refusing recognition of the Japanese puppet state Manchukuo in 1936. </p>
<p>While the IOC Charter strictly forbids direct political interference in national Olympic committees, there is a wide gap between theory and practice. After the Soviet soccer team lost to heterodox Yugoslavia at the Helsinki Games in 1952 (a 5-5 draw; then 1-3 in the replay), Stalin disbanded the team, who were provided with new homes “inside the Arctic Circle”. </p>
<p>He had a historical precedent: in 1912, Tsar Nicholas dissolved the Russian soccer team after their 16-0 loss to Germany in the 1912 Stockholm Olympics. Clearly, Stalin set the bar a bit higher than the tsar.</p>
<p>The Games have also been the stage for celebrated political set pieces. I was 10 months old when there was <a href="https://en.wikipedia.org/wiki/Blood_in_the_Water_match">blood in the water</a> during the waterpolo clash between the Soviet Union and Hungary in the 1956 Melbourne Games. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=840&fit=crop&dpr=1 600w, https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=840&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=840&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1056&fit=crop&dpr=1 754w, https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1056&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/131921/original/image-20160726-23692-1y7moqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1056&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">American sprinters John Carlos and Tommie Smith’s black power salute at the 1968 Mexican Olympic Games.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:John_Carlos,_Tommie_Smith,_Peter_Norman_1968cr.jpg">By Angelo Cozzi via Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>The Hungarians, on their long sea voyage to the Antipodes, were unaware of the Soviet invasion of their homeland. The clash was a bloody affair, with the Hungarians ultimately winning 4-0 and going on to win the gold medal. </p>
<p>In 1968, the Mexican military killed at least 49 students protesting against the Games in the Tlatelolco Massacre. Mexico also saw the Olympic podium used to stage the celebrated black power salute by John Carlos and Tommie Smith, with the Australian silver medallist Peter Norman stood by.</p>
<p>In 1972, militants from the Palestinian Black September movement murdered 11 Israeli athletes in the Munich Games village. </p>
<h2>… as feminist realism</h2>
<p>Women first appeared in the 1900 Olympics. The 22 women among the 997 athletes were limited to ladylike sports: tennis, sailing, croquet, equestrian and golf. Over the years, the number of sports open to women has gradually increased, bringing, in 2016, the unthinkable — women’s rugby. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=838&fit=crop&dpr=1 600w, https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=838&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=838&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1053&fit=crop&dpr=1 754w, https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1053&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/131924/original/image-20160726-31195-19n1x4y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1053&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">English tennis player Charlotte Cooper, who, in 1900, became the first female Olympic champion.</span>
<span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Charlotte_Cooper.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Today, women constitute about 40% to 45% of Olympic competitors.</p>
<p>There is one unisex sport (equestrian), although at various times both sailing and rifle shooting have been unisex. And there is one sport where, thankfully, men have not been allowed to compete: synchronised swimming. </p>
<p>In others sports, there are odd historical hangovers of sex differences: there is no 1,500-metre swim for women; women compete in the heptathlon rather than the decathlon; and men’s and women’s gymnastics are radically different. </p>
<p>One can only say that there’s been a long march towards gender equality, but we wouldn’t want to take things too far too fast, given that the Australian Matildas, one of the best women’s soccer teams in the world, were recently <a href="http://www.huffingtonpost.com.au/2016/05/25/matildas-beaten-7-0-by-newcastle-jets-under-15-boys-team/">beaten 7-0 by an under-15 boys’ team</a>.</p>
<p>Gender issues have been played out in the Olympic theatre in other ways. Indeed, the Olympics have more than anything brought into question the whole notion of binary gender and what it means to be a man or a woman. </p>
<p>This issue poses a particular quandary for the Olympics. On the one hand, as the Matildas well know, it’s just not fair to have men competing against women in most sports. On the other hand, it’s not the place of the IOC to be telling people what sex they are.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=752&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=752&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=752&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=945&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=945&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132111/original/image-20160727-7058-qk84aw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=945&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Mary Edith Louise Weston in 1936, before gender change operations.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Mark_Weston_(athlete)#/media/File:Mary_Edith_Louise_Weston_1936b.jpg">Unknown via Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>Sex testing was first requested by IOC executive member, and later president, Avery Brundage in 1936, over concerns about British javelin and discus champion Mary Louise Edith Weston. In 1936, Mary had a sex change to become Mark. It ran in the family; a year later, Mark’s elder sister Hilda also had gender re-assignment treatment. </p>
<p>The most famous transgender athlete — until Caitlyn Jenner — was Stanislawa Walasiewickz, a Polish sprinter who won the gold medal in the 100-metre dash in the 1932 Olympics, and silver in Berlin. Later, living as an American under the name Stella Walsh, she was found upon her death (she was shot during an armed robbery in 1981) to have male genitalia.</p>
<p>At the same Games, German Dora Ratjen competed in the high jump, finishing fourth, but was later found to be intersex.</p>
<p>Sex testing initially consisted of a physical examination, literally a “nude parade” of women. Chromosomal testing was introduced in 1968, and in 2012 hormonal testing for abnormal levels of testosterone began. </p>
<p>The official IOC position is that rather than sex testing, this is a test to determine if certain athletes are “unfairly advantaged” by an accident of birth. One can only say that this is a tricky position to maintain: just about every athlete is unfairly advantaged by an accident of birth, certainly relative to you and me, at least. That’s why they’re elite athletes.</p>
<p>In 2009, after South African runner Caster Semenya won gold in the women’s 800-metre run, the International Amateur Athletics Federation began receiving emails from people who had doubts about Semenya’s gender because of her masculine appearance. Some unkind commentators even pointed out that her name was <a href="http://www.mirror.co.uk/news/uk-news/caster-semenya-gender-storm-is-the-answer-790360">an anagram of “Yes, a secret man”</a>. </p>
<p>The results of chromosomal tests were never released, but Semenya was cleared to run again. After winning the silver medal in London, Semenya will be among the favourites in Rio. Watch this space.</p>
<h2>… as romcom</h2>
<p>The Olympic stage is a theatre of sex in another way: it is a festival of youth where the athletes compete, celebrate and fornicate. And <a href="http://www.forbes.com/sites/johnclarke/2012/07/16/who-will-win-the-sex-olympics/#7e6efd6d18c6">fornicate they do</a>, by all accounts. </p>
<p>The London Games provided 150,000 condoms — 15 per athlete — for the 17-day event. That’s enough for 30 couplings per pair, or 1.7 couplings per day. </p>
<p>But Olympic love has flourished even in condom-less environments, and in those more innocent days when men’s and women’s living quarters were separated, as they still are for Muslim athletes. </p>
<p>In 1956, US gold medal hammer thrower Hal Connolly met and fell in love with Czech discus champion Olga Fikotová, a cross-Iron Curtain romance that blossomed into a marriage. </p>
<p>The scenario was repeated 48 years later in Athens when gold medallist rifleman Matt Emmons (US) fell for Czech riflewoman Katerina Kurková. Perhaps it was a shotgun wedding. </p>
<p>There are, in fact, dozens of Olympic lovers, most famously legendary Czech distance runner Emil Zatokpek and his wife Dana, a gold-medal-winning javelin thrower, who were witnesses to the Connolly wedding.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=856&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=856&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=856&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1075&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1075&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132115/original/image-20160727-5645-ovimdh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1075&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Pierre de Coubertin, founder of the modern Olympic Games.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Pierre_de_Coubertin#/media/File:Pierre_de_Coubertin_Anefo2.jpg">Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>… as morality play</h2>
<p>The founder of the Games, <a href="https://en.wikipedia.org/wiki/Pierre_de_Coubertin">Pierre de Coubertin</a>, envisaged them as a competition between gentleman amateurs, playing fairly and competing on a level playing field, figuratively and literally. </p>
<p>Native American athlete Jim Thorpe was relieved of his two gold medals from the 1912 Stockholm Games when it turned out he had accepted money for playing baseball. </p>
<p>But the myth of professionalism, freighted with classist assumptions, was a lost cause from the start. Gradually, begrudgingly, the Games were opened up to full professionals. </p>
<p>Fairness also proved to be an elusive ideal. </p>
<p>Over 50 Olympic athletes have been stripped of their medals, mainly for doping. Most famously, they included US swimmer Rick DeMont at the Montreal Games, Canadian sprinter Ben Johnson at Seoul, US sprinter Marion Jones, who lost her five medals from Atlanta and Sydney, and US cyclists Lance Armstrong and Tyler Hamilton in Sydney and Athens. </p>
<p>The vexed question of artificial performance enhancement has plagued the Olympics, and raises a basic moral question: what does “natural” mean? What is the difference, one might ask, between taking the blood-booster EPO and training in altitude tents, which has the same effect, or for that matter having a natural genetic variant? </p>
<p>Although we think of cheating mainly as a pharmacological indiscretion, there have also been interesting cases of “technology doping”. </p>
<p>Boris Onishchenko, a Russian pentathlete, rigged his electrofoil at the 1976 Olympics to mark a score before he actually hit anyone, eliciting a protest from the British. He was known thereafter as “Boris Disonishchenko”. Soviet President Brezhnev was not happy, and Onishchenko was last seen working as a taxi driver in Kiev.</p>
<p>The issue of technological performance enhancement was raised again when the “blade runner” Oscar Pistorius became the first disabled track and field athlete to compete at the able-bodied games. Several sports scientists argued that his blades provided him with an unfair advantage, allowing a greater return of elastic energy. </p>
<h2>After the theatre</h2>
<p>By September, the stage will be dismantled, and our revels will be ended. Our athletes will melt into air, into thin air. The cloud-capp’d towers, the gorgeous palaces shall dissolve and, like this insubstantial pageant faded, leave not a rack behind. </p>
<p>All that will remain will be the cold wind whistling through the empty stadiums and the athletes’ Potemkin villages. Until, that is, we switch on our televisions for the Tokyo 2020 Olympic Games.</p><img src="https://counter.theconversation.com/content/61904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Olds receives funding from the ARC and the NHMRC. In the past he has also been funded by the Australian Sports Commission.</span></em></p>The Olympic Games are a theatre — sometimes farce, sometimes tragedy, reality TV, morality play or soap opera — where geopolitical, social and technological dramas are played out.Tim Olds, Professor of Health Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/623072016-07-18T19:53:56Z2016-07-18T19:53:56ZLGBTI vote at the UN shows battle for human rights is far from won<figure><img src="https://images.theconversation.com/files/130414/original/image-20160713-12358-zm87op.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Reuters/John Vizcaino</span></span></figcaption></figure><p>The world has edged closer to placing the same value on the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people as it does on human rights. Sadly, not all states, including many African countries, are on the same page. </p>
<p>The 47-member Geneva-based United Nations Human Rights Council has adopted a <a href="http://www.un.org/ga/search/view_doc.asp?symbol=A/HRC/32/L.2/Rev.1">landmark resolution</a> on “Protection Against Violence and Discrimination Based on Sexual Orientation and Gender Identity”. For the first time an independent monitor will be appointed with the mandate to identify the root causes of discrimination against people because of their sexual orientation and gender identity.</p>
<p>The expert will, like other special rapporteurs, be tasked with talking to governments to protect LGBTI rights. She or he will have the power to document hate crime and human rights violations. The monitor, however, will not have a mandate to recommend sanctions.</p>
<p>The main initiative was taken by a core group of seven South American states – Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico and Uruguay. Forty-one additional countries co-sponsored the text. A record 628 nongovernmental organisations from 151 countries supported the effort. Notably, some 70% were from the global South.</p>
<p>But the resolution was adopted by a narrow margin: only 23 member states voted in favour, 18 against. Six abstained. African countries remained opposed or reluctant to take a stand. Ten of them voted against the resolution and four <a href="http://webtv.un.org/watch/ahrc32l.2rev.1-vote-item3-41st-meeting-32nd-regular-session-of-human-rights-council/5009164455001#full-text">abstained</a>.</p>
<p>The strongest resistance to the resolution came from the Muslim and African member states of the council. After all, half of the more than 70 countries that still criminalise same-sex relationships and behaviour are in <a href="https://theconversation.com/why-anti-gay-sentiment-remains-strong-in-much-of-africa-42677">Africa</a>.</p>
<h2>Champions and villains</h2>
<p>The final text was considerably softened and watered down after a controversial and, at times, <a href="http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20220&LangID=E">heated debate</a>. A last-minute amendment stressed that</p>
<blockquote>
<p>the significance of national and regional particularities and various historical, cultural and religious backgrounds must be borne in mind.</p>
</blockquote>
<p>But the resolution also states:</p>
<blockquote>
<p>It is the duty of States, regardless of their political, economic and cultural systems, to promote and protect all human rights and fundamental freedoms.</p>
</blockquote>
<p>As the International Commission of Jurists <a href="http://www.icj.org/hrc32sogi/">stressed</a>:</p>
<blockquote>
<p>Although a number of hostile amendments seeking to introduce notions of cultural relativism were adopted into the text by vote, the core of the resolution affirming the universal nature of international human rights law stood firm.</p>
</blockquote>
<p>Voting in favour were: Albania, Belgium, Bolivia, Cuba, Ecuador, El Salvador, France, Georgia, Germany, Latvia, Macedonia, Mexico, Mongolia, Netherlands, Panama, Paraguay, Portugal, Republic of Korea, Slovenia, Switzerland, United Kingdom, Venezuela, Vietnam. </p>
<p>Voting against were: Algeria, Bangladesh, Burundi, China, Congo, Côte d’Ivoire, Ethiopia, Indonesia, Kenya, Kyrgyzstan, Maldives, Morocco, Nigeria, Qatar, Russia, Saudi Arabia, Togo, United Arab Emirates. Abstentions were from: Botswana, Ghana, India, Namibia, Philippines, South Africa.</p>
<p>While ten of the African council members voted against, the other four abstained. Those that abstained argued that the resolution – despite several far-reaching amendments curbing the power of the expert – remained divisive and would impose cultural-specific (read Western) values. </p>
<h2>The puzzling case of South Africa and Namibia</h2>
<p>Ironically, South Africa was the first country in the world to include protection on the <a href="https://theconversation.com/science-alone-cant-shift-anti-gay-prejudice-in-africa-43007">grounds of sexuality</a> in its constitution. It championed gay rights in a lead role when the Human Rights Council adopted a first resolution in <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G11/148/76/PDF/G1114876.pdf?OpenElement">2011</a>. It remained committed to the cause when voting for the next <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G14/177/32/PDF/G1417732.pdf?OpenElement">landmark resolution</a> adopted by the Human Rights Council three years later.</p>
<p>But even then it was beginning to show <a href="https://theconversation.com/behind-south-africa-reluctance-to-champion-gay-rights-on-the-continent-44321">signs of reluctance</a>. South Africa’s abstention this time sent shock waves through the LGBTI communities, not only <a href="http://www.mambaonline.com/2016/07/04/watch-south-africa-sell-lgbt-people-un/">at home</a>.</p>
<p>As a South African legal expert has <a href="http://www.dailymaverick.co.za/opinionista/2016-07-04-south-africas-great-lgbti-failure/#.V4Itt65Q87C">observed</a>, South Africa’s approach</p>
<blockquote>
<p>was focusing on maximum unity within the council. … Thus, our lives as gay men, lesbians, bisexuals, intersex and transgender people are less important to the government than maintaining maximum unity within the UN Human Rights Council. … it appears as if our government believes that our lives are pretty worthless. Who cares about LGBTI people being assaulted and murdered across the world if caring about it will upset the unity within the Human Rights Council?</p>
</blockquote>
<p>As he pointed out, homophobia, rather than free choice of sexual preferences, has been historically a construct of (19th century) Western imperialism and missionary zeal in Africa. This was imposed and legally codified in the colonised societies.</p>
<p>Put differently: while those opposing the freedom of sexual preferences argue these are Western values and a form of ideological imperialism, true decolonisation would actually – just as in the case of South Africa’s constitution – require them to abandon homophobic legislation. After all, countries voting in favour of the resolution – such as Bolivia, Cuba, Mexico, Venezuela and Vietnam – can hardly be classified as neo-colonial agencies of the West.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/130418/original/image-20160713-12389-1w9i14p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shutterstock.</span>
</figcaption>
</figure>
<p>Similar criticism was articulated against <a href="http://www.namibian.com.na/Namibia-and-Human-Rights/42721/read">Namibia</a>. The country’s abstention was already some progress compared with its outright “no” vote in 2014. (Then, South Africa – albeit reluctantly – voted for the adoption of the Human Rights Council’s <a href="https://documents-dds-ny.un.org/doc/UNDOC/GEN/G14/177/32/PDF/G1417732.pdf?OpenElement">second resolution</a> on “Human Rights, Sexual Orientation and Gender Identity”.) </p>
<p>Namibia defended its stance to abstain this time on the grounds that any kind of discrimination against any person in Namibia is regarded as unconstitutional. Thus, it was in full compliance with the intentions of the resolution. </p>
<p>But, instead of voting “yes” based on such an understanding, in a kind of 180-degree turnaround, Namibia bemoaned that, in the absence of international human rights law, it remains questionable what would guide the independent expert when assessing the compliance of states. Therefore, this mandate would allow interference in sensitive issues at national level. Hence Namibia would abstain.</p>
<p>The abstention was motivated more drastically by South Africa than Namibia. Despite its constitutional principles, <a href="http://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=20220&LangID=E">the explanation of its vote</a> declared that the draft resolution would – despite the significant compromises watering down the mandate – be unnecessarily divisive and “an arrogant approach. Recklessness and point scoring would not take anyone anywhere.” </p>
<h2>The battle for rights has always been divisive</h2>
<p>Divided lines seem to be by nature an integral part of the battle for human rights and dignity. After all, the promotion and protection of human rights has been divisive throughout history.</p>
<p>Take the campaign to abolish the slave trade. Or the ongoing fight for the adequate recognition of equal rights for women and the promotion of children’s rights. And campaigns for indigenous minorities.</p>
<p>Fighting racial and other forms of discrimination, including the fight for religious freedom, remains divisive. Advocating human rights and dignity will remain a contested matter.</p>
<p>But states have to make choices. Abstaining from the promotion of human dignity is a choice too, but a bad one.</p>
<p>As UN Secretary-General Ban Ki-Moon <a href="http://www.un.org/press/en/2010/sgsm13311.doc.htm">once declared</a>:</p>
<blockquote>
<p>As men and women of conscience, we reject discrimination in general, and in particular discrimination based on sexual orientation and gender identity. When there is a tension between cultural attitudes and universal human rights, rights must carry the day.</p>
</blockquote><img src="https://counter.theconversation.com/content/62307/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Henning Melber is a member of SWAPO since 1974. </span></em></p>The strongest resistance to the United Nations resolution to promote LGBTI rights came from Muslim and African states. Many of these countries still criminalise same-sex relationships.Henning Melber, Extraordinary Professor, Department of Political Sciences, University of PretoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/493592016-03-10T19:19:19Z2016-03-10T19:19:19ZBoy, girl or …? Dilemmas when sex development goes awry<figure><img src="https://images.theconversation.com/files/107975/original/image-20160113-8424-17zxxuu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many babies are born with a genetic variant that leads to ambiguous sexual development.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/27166175@N00/4085719732/in/photolist-pPS6GJ-pPS6By-q7oo7f-pavGoc-pPUZnW-q75Kfx-pPQ4ya-q75JCv-q7omcU-pPS6SJ-q7fq4F-q7foBn-q7omr1-pPQ2ZP-pPQ3cH-pavFVP-q5a9sU-pasTx3-q7fp1t-q7onff-pPQ4DR-4YNV9Z-7SB4Nb-85z3hw-8eGDQN-5JfxoF-dXWhgA-aJyEu-dhZMNK-dhZSJr-dhZPEn-dhZELj-dhZWzp-dhZVaZ-dhZR9K-dhZH1M-dhZJxh-dhZHrY-ad4vM8-7AJXxR-5LvMCb-7e3o8E-aCZj8k-e8h3qN-tmC31-tmCmT-7mQ9Ad-nqA7an-rgyUaP-7DgSS4">.gsr./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Some babies are born with a genetic variant that leads to atypical sexual development. It can result in the child being neither a typical boy nor girl. </p>
<p>Estimates of this <a href="https://oii.org.au/16601/intersex-numbers/">occurring range from</a> one in 1,500 or 2,000 births, to 4% of all births, depending on what definitions are used.</p>
<p>Whether surgery, hormone treatment or both are necessary, or whether they represent child abuse and it’s better to do nothing, has stirred considerable debate.</p>
<h2>Chromosomes and sex development</h2>
<p><a href="https://theconversation.com/differences-between-men-and-women-are-more-than-the-sum-of-their-genes-39490">Genetic differences between men and women</a> lie in sex chromosomes. Women have two X chromosomes and men have a single X (from their mother) and a male-specific Y (from their father).</p>
<p>In typical male development, a single gene (SRY on the Y chromosome) kick-starts a cascade of genes that make a testis. The embryonic testis makes hormones, and hormones make the baby male. </p>
<p>In an XX fetus with no SRY, other <a href="http://www.ncbi.nlm.nih.gov/pubmed/25246082">genes become active</a> to make an ovary in an embryo that will become a girl.</p>
<p>Both cascades <a href="http://www.ncbi.nlm.nih.gov/pubmed/24290348">involve many genes</a> in a network of checks and balances. So far we know of about 30 that must work together to build a normal testis or ovary. </p>
<p>Other genes control development of the genitals and secondary sexual characteristics such as breasts and body hair. It takes many genes to make a penis from flaps of skin that have to come together in the right way, or to zip up the labial folds to make a scrotum.</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=872&fit=crop&dpr=1 600w, https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=872&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=872&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1096&fit=crop&dpr=1 754w, https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1096&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/114575/original/image-20160310-31877-1ceb5za.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1096&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Genetic differences between men and women lie in the sex chromosomes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/davidascher/2829645/in/photolist-fv9Z-cXgtkC-cXgvn1-cXgr8Q-5K8531-4MANi9-d8TPNJ-d8TLhy-d8TTRG-d8TXrd-d8U5tu-d8U1Y1-d8TGKQ-d8TD4f-7h4s5i-a89o3q-a86uDn-7QGzVL-e757VL-grJD37-2T3jJo-48azws-rRsF3G-gzyFXY-dMYZ7J-5vdWth-e7Zrsm-e7TKXZ-s8ZYWT-rRAYFx-rPJcxF-agYAD-s6L8Am-s945ix-rPJ7jV-955pjE-gkZ4s6-zshQH-s8UPDW-s8UPi5-s8ZRKD-s8ZWoB-rc42Zy-s8UREu-rPJ5ik-s6L4vN-rPJ71D-rRtXs5-rc41G3-rRsF8b">David Ascher/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Like any complex process, sex determination can go awry. </p>
<h2>Atypical sex development</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/25942653">Different conditions</a> result from variants in one of several genes controlling sex development. </p>
<p>Some can lead to minor anatomical differences, such as the opening of the penis appearing at an unusual site; others to ambiguous genitals. </p>
<p>For instance, loss or alteration of a gene in the testis-determining pathway prevents testes from forming, and may produce an XY baby with masculinised female genitals (an enlarged clitoris, for instance). Some of these children may become more masculine when hormones rev up at puberty.</p>
<p>Other gene variants can reverse sex altogether, as in cases of <a href="http://ghr.nlm.nih.gov/condition/androgen-insensitivity-syndrome">androgen insensitivity</a>. A variant in a gene for male hormones will cause an XY baby to develop as a female, even though she has testes.</p>
<p>At the tragic end of the spectrum are mutations that disrupt more than sexual development. Deletion of a gene controlling sex as well as bone formation can cause bone deformities so severe that babies can’t breathe and die within hours.</p>
<p>It’s impossible to lump this spectrum of conditions into a single category. The term intersex, for instance, describes those with ambiguous genitals, or gonads with both testis and ovarian tissue. But it doesn’t apply to others, such as XY girls with androgen insensitivity. </p>
<p>Disorders of sex development (DSD) is the term adopted medically. Not surprisingly, <a href="oiiinternational.com/2524/term-intersex-term-dsd">patients quail at labels like this</a> that denote a disease and invite discrimination. </p>
<h2>Normal vs abnormal?</h2>
<p>In genetic variation, the border between what is normal (short and tall people) and abnormal (dwarfism and gigantism) is often fuzzy.</p>
<p>Everyone <a href="http://www.ncbi.nlm.nih.gov/pubmed/7842008">carries genetic variants</a> that are lethal or cause malformation if you have two copies. For instance, I have a gene variant that causes slight webbing of toes, two copies of which would leave me without toes or fingers.</p>
<p>Whether or not variations in sexual development can, or should, be treated depends on the condition. </p>
<p>Many children with atypical sexual development show varying degrees of genital abnormalities, some of which can be corrected surgically. A penis can be repaired and a vagina can be fashioned for girls with androgen insensitivity.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=891&fit=crop&dpr=1 600w, https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=891&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=891&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1120&fit=crop&dpr=1 754w, https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1120&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/114586/original/image-20160310-31871-do59mf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1120&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Genetic variation can be seen in height differences.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/basilb/2418288998/in/photolist-4FGn4U-98CooS-dfniRP-5JsMuP-aVJFE2-9azHke-2a35gS-bJNz4a-5rJXtZ-6Fn6bG-7s67B-6rFiRH-fYyrcW-oz2gpM-oyNk6-6SVhTZ-aXvNLz-Eosi7-t3kjZW-jfUiF2-9XNgBv-72CY8-5qvar6-3eC3R1-6geTdu-6VfbEz-6ibdsu-jbNZ-8x7DTQ-9oTxv4-69BhwG-nqecf5-9KYoa-cADL9y-jubguZ-pQSyZQ-6Pd2GR-bH54ja-5LDsRZ-8pWd2N-rRpmAh-roCJtM-6ibbYQ-7evv9k-hD8PjF-5D5r9z-qWK6yu-aUZjht-pviKqo-6YzJXD">Basil & Tracy Brooks/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Some conditions may be life-threatening if not recognised early. For instance, children with CAH (congenital adrenal hypoplasia) <a href="http://www.apeg.org.au/Portals/0/resources/Hormones_and_Me_8_CAH">make too much androgen</a> but not enough of another two vital hormones. Without prompt treatment, they may die from losing too much salt.</p>
<h2>Is it better to treat?</h2>
<p>It’s possible to assign babies of uncertain sex to either a boy or girl and use hormone treatment to reinforce the gender choice. Whether this is appropriate <a href="http://www.dsdgenetics.org/index.php?id=13">has been vigorously debated</a> by patients, doctors and advocacy groups.</p>
<p>For decades, <a href="http://www.jurology.com/article/S0022-5347(05)62356-7/abstract">surgeons advocated operating</a> early because it had better medical success and provided a consistent gender identity. This was often successful and many patients reported living satisfying lives.</p>
<p>But it raised problems of informed consent, as parents made the decision on their child’s behalf as to which sex they would be. What if they got it wrong and the child grew up hating who they were?</p>
<p>Now, the trend is to be <a href="http://www.health.vic.gov.au/neonatalhandbook/congenital/index.htm">supportive, conservative and avoid removing genital tissues</a> if the condition is not life threatening. </p>
<p>But there are no universal answers. In a perfect world, it wouldn’t matter if a child was a boy, girl or a happy intersex. But our society is sexualised and children can be cruel to those even trivially different. </p>
<p>Adults are sometimes no more accepting; in some Asian and African countries <a href="http://www.ncbi.nlm.nih.gov/pubmed/18633712">families with DSD children may be ostracised</a> and children neglected or killed. </p>
<p>Developed countries are moving in the right direction in their treatment of DSD people and community <a href="https://www.humanrights.gov.au/.../about-sexual-orientation-gender-identity">attitudes</a> are slowly improving.</p>
<p>Hopefully we can become more accepting of genetic variation, whether it be towards webbed toes or sex determination.</p><img src="https://counter.theconversation.com/content/49359/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jenny Graves has received funding from ARC and NHMRC. </span></em></p>Many babies are born with a genetic variant that can result in the child being neither a typical boy or girl. There has been considerable debate about whether the child should be treated.Jenny Graves, Distinguished Professor of Genetics, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/458362015-08-23T19:52:52Z2015-08-23T19:52:52ZChoosing children’s sex is an exercise in sexism<figure><img src="https://images.theconversation.com/files/92679/original/image-20150821-8346-14feriq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The idea of 'family balancing' is based on the belief that children come in two genders that have essentially different traits. </span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/jasonpratt/2347428960/">Jason Pratt/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em><a href="http://theconversation.com/why-we-should-consider-whether-its-time-to-allow-sex-selection-in-ivf-nhmrc-46399">Click here to read</a> the National Health and Medical Research Council’s view of why it’s time to consider allowing sex selection with IVF.</em></p>
<hr>
<p>Australian guidelines for the ethical use of IVF allow <a href="https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e78.pdf">selecting a child’s sex for medical reasons</a>. But <a href="http://consultations.nhmrc.gov.au/files/consultations/drafts/artdraftethicalguidelines150722.pdf">draft guidelines that are now open for public submissions</a> raise the possibility of extending this and allowing the choice for social reasons. </p>
<p>The draft guidelines recognise that sex selection is a controversial practice; it’s banned in several states of the United States, in Europe, New Zealand and in parts of Asia. It acknowledges that it can reinforce gender stereotyping and that legalising the selection of a child’s sex could open up the way for choosing a range of other non-disease traits. </p>
<p>But it also recognises the importance of respecting reproductive autonomy and choice, and that some parents travel abroad to access sex selection at overseas clinics. </p>
<h2>Examining choice</h2>
<p>To stimulate public discussion, the draft offers five case studies that involve issues around “family balancing”, selection to “replace” a dead child, reproductive tourism, parental autonomy, and “slippery-slope” claims. </p>
<p>These case studies provide examples of sex selection that suggest two arguments in its favour: first, that sex selection for family balancing is ethically more permissible than selection based on a strong gender preference. And second, that parents have the right to select their child’s sex based on respect for reproductive autonomy. </p>
<p>But are these arguments convincing? </p>
<p><strong>1. Family balancing</strong></p>
<p>The argument for family balancing suggests the practice is ethically permissible because it entails no harm from sexism; the concept is based on the idea that a family is “balanced” when it includes children of both sexes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92683/original/image-20150821-8350-jztjz5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The argument for family balancing suggests the practice is ethically permissible because it entails no harm from sexism.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/stwn/18550359565/in/photolist-ugerBB-hz9Egk-5JcFKv-bvW5ap-4GV9Rj-6uJvsx-6uJvdP-4FMdFr-aCkXAB-pnAG1K-2Spscy-6uJuVe-tbf1U-5aTH9F-i1524-6JxCzW-38r8Ps-78zutY-38mzwz-3Qsi6A-8ziVMi-boPnzK-s7raP1-dFpRTw-dxbCJt-dZVzL2-4FKdCc-4FPnD5-dRhpPG-dRbRgg-5QL8X2-5cbYiG-8WMqaG-r7tHfx-suzirh-pzPHwp-bXx6Fd-34hgAo-4YxfLb-mraBX-5DPXgo-dRbRba-6TTARf-5EHaQi-qwfJ8W-sPuQJo-sPvzk5-h5xvKG-4FPTS3-3QnvTd">stwn/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Such families are presented as diverse and as offering more enriching experiences to all family members. And since parents seek children of both sexes, it’s plausible there’s no gender bias of the sort that might lead to skewed sex ratios. But is family balancing really gender egalitarian? </p>
<p>In 2013, I conducted a small study as part of my doctoral studies interviewing nine Australian women who selected or wanted to select their child’s sex. All participants had several sons and desired daughters because they longed for a strong mother-child relationship and were convinced that such a bond was only possible with a girl. </p>
<p>In the interviews, girls were described as necessarily more family-oriented and more inclined to emotional connection, while boys were associated with independence and adventure. These interviews showed family balancing is based on the belief that children come in two genders that have essentially different traits. </p>
<p>To the extent that family balancing is based on the selection of children to fulfil preconceived binary gender roles, it reinforces sexism. And, by reinforcing a gender binary, it denies rather than creates diversity within families. </p>
<p><strong>2. Reproductive autonomy</strong></p>
<p>The argument for reproductive autonomy holds parents have the right to choose their child’s sex and that should be respected. Advocates argue that some parents have strong preferences for their child’s sex, which justifies their pursuit of sex selection. </p>
<p>But parental autonomy is not the only thing at stake. Other important values include the autonomy and well-being of the future child. </p>
<p>The risk of harm in sex selection stems from the fact that parents don’t desire any child, they want a child of a particular sex. And the child is presumed to develop characteristics within the limits of binary gender roles. </p>
<p>This view doesn’t take a child’s individuality into account, and can hinder the development of her attributes and skills. What if a daughter is independent and a son wants a close bond with his mother? </p>
<p>And what about children who don’t fit traditional expectations about sex, such as those with <a href="https://oii.org.au/allies/">intersex variations</a>, and gender, such as transgender and gender-diverse children? </p>
<h2>Reducing diversity</h2>
<p>The paradox of preconception sex selection is that prenatal genetic diagnosis allows for selecting sex chromosomes – but it cannot unambiguously guarantee a child with a particular gender identity, traits or behaviour. </p>
<p>While some may argue that all parents have gender expectations, those who select their child’s sex are not just making assumptions, they’re acting on their preferences and seeking to create children to fit them. </p>
<p>Children who don’t fulfil selectors’ expectations might face parental disappointment or pressure to conform to stereotypical gender roles. This can limit their freedom to develop autonomous gender identities and reduce their well-being. </p>
<p>And let’s not forget that the harm from sexism associated with sex selection also manifests on a social level. The practice sends out the message that it’s justifiable to create children for particular gender roles. And it re-affirms the idea that sex is a trait of fundamental importance in a child, one that may even be viewed as a condition for parental appreciation. </p>
<p>What’s more, legalising sex selection would be a retrograde step if we consider recent legal and policy developments regarding gender. </p>
<p>In 2013, <a href="https://theconversation.com/why-norries-court-victory-is-a-leap-forward-for-everyone-25200">the High Court ruled</a> that a person can formally identify as having an unspecified gender. The ruling effectively institutionalises a third category of non-specific gender in Australia. </p>
<p>The court’s decision signifies a step away from the dominant binary understanding of gender insofar as it acknowledges the diversity of gender identities. But any deregulation of preconception sex selection would represent a move back towards the binary understanding of sex and gender. </p>
<p><em><a href="http://theconversation.com/why-we-should-consider-whether-its-time-to-allow-sex-selection-in-ivf-nhmrc-46399">Click here to read</a> the National Health and Medical Research Council’s view of why it’s time to consider allowing sex selection with IVF.</em></p><img src="https://counter.theconversation.com/content/45836/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tereza Hendl's PhD research was funded by the International Postgraduate Research Scholarships provided by the Australian Government. </span></em></p>The risk of harm in sex selection stems from the fact that parents don’t desire any child, they want a child of a particular sex, who is to remain within the limits of binary gender roles.Tereza Hendl, Research assistant at the Faculty of Health Sciences, University of SydneyLicensed as Creative Commons – attribution, no derivatives.