The intersex

Religious leaders may find that defining biological sex is more complicated than they think.

On June 11, at a press conference at the Archbishop’s House in Port of Spain, several religious leaders called for the Marriage Act to be amended to ensure that a marriage could only be between a biological male and a biological female. They also called for no amendments to the Equal Opportunity Act to facilitate the LGBTQIA community.

LGBTQIA stands for lesbian, gay, bisexual, transgender, queer or questioning, intersex, and asexual or allied, and it is the intersex aspect that could cause some problems with this move.

Typically, people with the XX chromosomes are female with ovaries, a uterus, vagina, and clitoris; and those with XY chromosomes are male with a scrotum, testicles and a penis. However, there are women with XY chromosomes, men with XX chromosomes, and men with XXY chromosomes.

Intersex is an umbrella term to cover biological variations where people are born with reproductive or sexual anatomy issues relating to chromosomes, gonads, sex hormones, or genitals, that do not fit the typical definitions of female or male.

According to the Intersex Society of North America, “A person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside.”

“Or a person may be born with genitals that seem to be in-between the usual male and female types – for example, a girl may be born with a noticeably large clitoris, or lacking a vaginal opening, or a boy may be born with a notably small penis, or with a scrotum that is divided so that it has formed more like labia. Or a person may be born with mosaic genetics, so that some of her cells have XX chromosomes and some of them have XY.

“Though we speak of intersex as an inborn condition, intersex anatomy doesn’t always show up at birth. Sometimes a person isn’t found to have intersex anatomy until he or she reaches the age of puberty, or finds himself an infertile adult, or dies of old age and is autopsied. Some people live and die with intersex anatomy without anyone (including themselves) ever knowing.”

While studying at the Willy Brandt School of Public Policy at the University of Erfurt in Germany, Adrian James, public policy practitioner with the Intersex Public Policy Development Alliance, conducted research for his thesis, Intersex in TT.

He said people involved in law, medicine, sport, and policy are usually the ones aware that gender and sex is not as simple as some people would like others to believe. He said rather than building marriages and family, religious leaders would be tearing these things apart.

“In fact, what they are proposing would lead to even more confusion. Are they intending to test persons’ chromosomes before they get married? Even then you could have an individual with complete Androgen Insensitivity Syndrome (the body is insensitive, or unresponsive to androgen, a male sex hormone). What are they going to do?... Because our system is a westernised, binary system that has recognised historically male and female, to the exclusion of others, we have a challenge. It is not a ‘gay agenda.’”

This binary system, he said, is especially unfortunate in the medical field. He said at the birth of a child, many attendants are not properly informed about intersex genitals so their responses are sometimes of surprise or revulsion. People, who are supposed to be medical professionals, often lay their own “religious baggage” on the parents and child believing and expressing that the intersex anatomy is a failing on the part of the parents, or a sign of evil.

He said even some doctors who are supposed to know about intersex anatomy, often believe there are only two ways to be, so if a person is in the middle they need to be “helped.” Therefore, they often provide “normalising” surgery without any health-related reasons. “What happens is they would perform surgeries on the child’s genitals. So when a child appears to have, to their mind, a larger than normal clitoris, they will do a reduction. In the past they even did amputations.”

He believes the local medical fraternity should be more open to the issues involving gender and sexuality, and intersex anatomy should be taught in medical schools.

In a social media video, one man (not a Trinidadian) explained that he was born with internal testes. At the age of 13 his testes were removed even though he always identified as a boy. His mother began to dress him as a girl and he was put through hormonal treatment – estrogen and progesterone. He said he was not happy but he conformed until, at the age of 25, he had had enough.

Locally, James told Sunday Newsday about a mother who related her story about her child who had intersex genitals. The child was assigned a female gender but when she started to go through puberty, she began to produce more testosterone. The child’s body masculinised and the genitals became more male-like.

He also told of a young man with Congenital Adrenal Hyperplasia. He was born with XX chromosomes but his adrenal glands were producing high levels of androgen. While still in the womb, his genitals developed as ‘male-like’ so when he was born the doctors pronounced him a boy.

However, when it was time to have him registered, the doctors told the parents he was female as he had a small penis and a scrotum but no testes. “Because of this high level of testosterone, their body would have masculinised. It means that the testosterone created a fusion of the labia to become a scrotum,” James explained.

Later on, after an ultrasound, it was discovered that he had ovaries and a uterus but they were undeveloped so that he could not get pregnant.

The young man told James the doctors decided that having XX chromosomes made him a female and they persuaded his mother to allow for an operation to “make the genitals more female-like.” During puberty they gave him hormone treatments, which resulted in him growing breasts, which felt like an alien entity attached to his body.

However, as he grew, his physical stature became very masculine and, according to James, so has his deep voice and “stereotypical male interests.”

“This is the complication and nuance of gender and sexuality. This individual, by the lay person’s standards, is in no way female and even the doctors admit that, in the womb, this child’s brain would have been masculinised by the testosterone.”

James said the man experienced a lot of discrimination from the general public over the years because he, like many intersex people, were sometimes mistaken as transgender or transsexual because of their appearance. People would ask, behind his back or for him to hear, if that is a boy or girl, or call him a “bullerman.” He also had issues getting a job and encountered problems when voting.

He said the last time the young man went to vote, an electoral officer thought he was trying to conduct some kind of fraud because his national ID said he was female but his appearance was clearly male. He had to explain his medical situation to a supervisor who then allowed him to vote.

“There is no reason a child should suffer the indignity of having to carry around an ID that does not reflect who they are... Because there is no possibility of changing one’s assignment, one is compelled to stay in the sex that was given. In the cases where there is a change at puberty, where a natural process is going to occur, you hijack that by surgery and medicine.”

“Because there is no understanding that there is a mid-ground between male and female, people think you are a freak, that you are something so unbelievable and perhaps you made yourself so because they can not interpret your body. And because of all of the silence and secrecy around it, many families hide their children because they fear for their lives.”

James believes it is important to create an organisation to give support, provide public education, advocacy, and education-based research. Therefore, he and several others are in the process of registering a non-profit organisation whose members, so far, include a psychiatric social worker, attorney-at-law, registered nurse, and a public policy officer.

He said their first line was not litigation in cases of mis-assigned gender, although there had been successful cases in other jurisdictions. Instead, they would like to, one day, create policies that would allow for vital documents to be changed by the individual, and legislation that recognises the middle ground so there is a readjustment of expectations with service providers at health institutions.

“These priests are making statements but they are ill-informed or partly informed... There is no gay agenda here. In fact many of these families are shocked and surprised and have to deal with it. Some are from very conservative, religious backgrounds but they have to deal with it in the only way they can – secrecy and concealment – and we want to move beyond that.”

He stressed that each condition is different and presents differently. He believes it is time that TT’s culture and law recognise that sex is not simplistic, and adopt a more modern view on the unique biology of intersex people.

SEX DISORDERS

Disorders of sex development that sometimes involve intersex anatomy:

5-alpha reductase deficiency

Androgen Insensitivity Syndrome (AIS)

Aphallia

Clitoromegaly (large clitoris)

Congenital Adrenal Hyperplasia (CAH)

gonadal dysgenesis (partial & complete)

hypospadias

Klinefelter Syndrome

micropenis

mosaicism involving “sex” chromosomes

MRKH (Mullerian agenesis; vaginal agenesis; congenital absence of vagina)

ovo-testes (formerly called “true hermaphroditism”)

Partial Androgen Insensitivity Syndrome (PAIS)

Progestin Induced Virilisation

Swyer Syndrome

Turner Syndrome

Information from www.isna.org