He/She/Thee/Me and How We Came to Be
Jakki RowlettLast summer I read a very interesting book called As Nature Made Him: The Boy Who Was Raised as a Girl. Bruce and Brian Reimer, normal identical twin boys, were born in Winnipeg, Canada, in 1965. Due to a circumcision procedure that went terribly wrong, Bruce's penis was burnt and destroyed. Eventually doctors at the Mayo Clinic in Minnesota, emphasizing the difficulties of reconstructing the organ, suggested to the parents, Ron and Janet Reimer, the possibility of raising Bruce as a girl. They were referred to Dr. John Money at John Hopkins, who was at that time considered an expert, albeit a controversial one, in the field of sexuality and gender. Known for pioneering the treatment protocol of assigning sex at birth to infants of ambiguous sexuality, Money assured baby Bruce's parents that sex re-assignment as a girl had every chance of success. It proved to be anything but (1) . The book was a rather sensationalized account, but the story was true, and I subsequently became interested in the case and I began to research it on the web. If the book had raised many questions in my mind about issues of nurture versus nature, of sexuality and gender, my research raised many more. But, perhaps the most interesting questions were those raised by the case of hermaphroditism, or intersexuality. By exploring what I thought were extreme cases of sexual ambiguity, I discovered that there are plenty of opportunities in biological sexual development for the lines that divide male and female to become blurred, and still be considered normal.
Particularly in the West, it is taken for granted that humanity comes in two mutually exclusive sexes, and that these are readily distinguishable at birth by the presence or absence of a penis which, in turn, signals a vast array of other permanent physiological and behavioral variations, both the time of birth and in the developmental future. Thanks to Freud, we Westerners also have a good deal of psychosexual baggage that we associate with that presence or ìlack.î The problem of intersexuality, biologically variant sexuality, disturbs our conventional notions of gender. We are typically educated to think in binary terms, with male and female at discrete opposite ends of the scale. Nevertheless, there are common medical conditions that move human beings away from the male and female norms. In order to fully discuss these, it would be necessary to look at what is considered ìnormal,î both at the biological level (i.e., sexuality) and the psychosocial level (i.e., gender). However, the primary focus of this paper will be the biological determinants.
The biological surface of things is what we actually look like. While typical male and female genitalia represent the familiar bimodal distribution, there is a full spectrum in between. The roots of sexual difference are to be found in embryology. To oversimplify, a baby girl is the default outcome of gestation, the developmental route taken unless androgenic hormones are present. For XY male embryos, a section of the Y chromosome induces the development of testes from undifferentiated gonadal tissue. The testes in turn produce virilizing androgens in sequences and quantities that can cause that which would otherwise become the labia majora to fuse into a scrotum, and cause that which would otherwise become the labia minora and clitoris to elongate and enlarge into a penis. In the absence of male hormones, which also inhibit feminization, the gonads become ovaries and the vagina and uterus develop. Apart from differences in size and shape, common visible anatomical variations for XY males include hypospadias, where the penis is open at some location other than at the end; divided scrotum; and undescended testicles (2) . Conversely, an XX female may have an enlarged clitoris, an absent or shallow vagina, or partially fused labia. In the end, external genitalia can be typically male, typically female, or virtually anywhere in between. A very large clitoris and a very small penis may be indistinguishable except for the term used to describe them. In addition, it is possible to have both ovarian and testicular tissues: true hermaphrodites have both. Gonadal tissue may also be undifferentiated in an adult: neither testicular nor ovarian or it may be of unclear character and formation. Or, gonadal tissue may be completely absent (3) . (2) .
Endicrinology plays a vital role in the process of biological sexuality, particularly hormone levels, their timing, and the body's responsiveness to them. Two examples of conditions that illustrate this point follow. The first is a condition called congenital adrenal hyperplasia (CAH) that causes some XX female fetuses to develop male-like external genitalia because their adrenal glands produce large amounts of androgens, virilizing the fetus. These children will sometimes menstruate through the phallus after puberty (3) . A second condition called androgen insensitivity syndrome (AIS) causes XY male fetuses to develop female external genitalia. Their normal testes produce androgens but, because of a cellular abnormality that inhibits response to the hormone, gestational development is unaffected they have a female external morphology at birth (4) .
Research into genetics yields another surprise. There are apparently several variations on the familiar XX and XY chromosomal pairings. In addition to XX and XY thereís also, for example, XO (Turners' syndrome, a sex chromosome missing), XXY (Klinefelter syndrome). Embryos can also develop with XX cells in one part of the body and XY or other type cells in another part called mosaicism (5) .
Hormones also organize the brain to bias an individual for future male-typical or female-typical behaviors. In a famous case, by a Kansas City Research team, laboratory experiments on guinea pigs elicited male behavior patterns in adult XX females after in-utero exposure to androgens at critical stages of fetal development (1) . Likewise, female behavior patterns have been promoted in XY male mammals by prenatal exposure to anti-androgens (6) . Analogous phenomena have been observed with humans (7) . This type of research supports the view that prenatal endocrinology biases psychosexual development by affecting the central nervous system.
While conceding that evidence is yet inconclusive as to how deeply our gendered behavior is neurologically hard-wired, there are at least three aspects of it that deserve consideration, according Dr. Milton Diamond, considered a hero among intersexed activists. Dr. Diamond was one of the first to challenge John Hopkins Universtiyís established protocol of sexual assignment of intersexed babies. While this protocol remains, adult ìsurvivorsî of sex reassignment are lobbying to change it (1) . To determine oneís gender he urges that, we first look at one's sexual identity. How does one see oneself at the deepest level? In addition to the categories of female and male, there are some who now self-identify as intersexed. The second calls attention to one's gender role. How does one present publicly in dress, speech, gesture and so on, as man or woman? And the third calls attention to sexual orientation. The condition of intersexuality precludes the application of terms like hetero- and homosexuality that conceive sexual desire, and its idealized object, in relation to the subjectís sex. Diamond recommends substituting the terms androphilic, gynecophilic, and ambiphilic (8) .
Because variation occurs independently at many of these levels, the total numbers of biological/psychosocial sexual possibilities are very large indeed. And while the study of intersexuality examines extreme cases, it forces us to look at all of these points of variation, and thus far from the view that humanity comes in two mutually exclusive sexes, readily distinguishable at birth by the presence or absence of prominent external genitalia. In the face of what seems to me to be an astonishing amount of variability, it appears impossible to draw any bright line that decisively and non-arbitrarily separates men and women.
WWW Sources1)2) Disorders of Sexual Differentiation , medical journal
3)Gender Identity , on Ask the Expert, May 1998
4)What is AIS?, , on the Medhelp website.
5)Genetic Disorders , Tulane University genetics website
6)Profile Christine M. Drea , on the Duke U. Biological Anthropology and Anatomy website.
7)The Feminization of Nature, , on tripodís Independant Consultants website
8)Similarities and Differences Between Intersex and Transsexual GID Under DSM IV & Societyís View Of Gender Identity , on the Gender Identity Talk website
Comments made prior to 2007
saw a report concerning chimera's. Is it possible individuals who
feel the have been the other sex since they could remember are a the
result of twins merged/absorbed into one? ... Cheryl 18 February 2006