When I give talks about the LGBTQ conversation, I often get questions about intersex and how this affects, or effects, a theology of gender and sexuality. The questions are usually quite broad and open-ended: ‘What about intersex?’ Sometimes they’re asked in a ‘gotcha’ sort of way: ‘Yeah, but what about intersex!? Ha!’
When I get these questions, I typically ask for more specificity: ‘Which intersex condition are you asking about? Vaginal Agenesis? Androgen Insensitivity Syndrome (AIS)? Klinefelter’s? Late Onset Congenital Adrenal Hyperplasia (LOCAH)? Some of these? All of these? Which ones?’
What about intersex? is a vague question. But typically, people want to know two things:
- Does the existence of intersex persons support the ontological claim that a person’s internal sense of self (i.e. their gender identity) determines whether they are a man or woman (or neither)?
- Do intersex conditions prove that biological sex is not a binary, that male and female aren’t the only two categories of sex?
We’ll address both of these questions below, but first, we need to understand a bit more about intersex.
What is intersex?
Intersex is a catch-all term that’s used to describe what medical professionals call ‘Disorders (or Differences) of Sex Development’ or DSDs. There are at least 16 different kinds of DSDs ranging from mild to severe.
An example of a mild intersex condition would be Late Onset Congenital Adrenal Hyperplasia (LOCAH), which affects about 1.5 in every 100 births.1 People with LOCAH usually have typical genitalia that match their chromosomes – XY babies have male genitalia, XX babies have female genitalia. The most common symptom in males (and they are classified as males) is a thinning scalp, which appears in 50% of males with this condition. Some females (about 10%) with LOCAH have a larger clitoris than females without this condition. Infertility in both males and females is another possible symptom.
We can quickly note that people with LOCAH are not ambiguously sexed. They are clearly male or female based on any basic definition of biological sex. (Having a thinning scalp doesn’t mean you’re not a man.) This is important to keep in mind when determining how many people are intersex (or have a DSD). Biologist Anne Fausto-Sterling is famous for saying that 1.7% of the population is intersex, and many have wrongly concluded that 1.7% of the population is neither male nor female.2 In fact, people with LOCAH account for 88% of all intersex people.3
Other common DSDs are Klinefelter Syndrome (1 in every 1,000 births), Turner Syndrome (1 in every 2,700 births), and Vaginal Agenesis (1 in every 6,000 births). In almost every case, there is little to no ambiguity as to whether a person with these DSDs are male or female. There might be some atypical features in the person’s sexual anatomy, systems of reproduction, or chromosomes, but these features rarely make it difficult to determine the person’s biological sex. And all of these milder DSDs account for approximately 99% of all intersex people.
More severe DSDs include Congenital Adrenal Hyperplasia (CAH) (1 in 13,000 births), Complete Androgen Insensitivity Syndrome (CAIS) (1 in 13,000 births), Partial Androgen Insensitivity Syndrome (PAIS) (1 in 131,000 births), and Ovotestes (1 in 80,000 births). Androgen Insensitivity Syndrome, for instance, occurs in people with XY chromosomes (typically male) but their cells are ‘partially or completely unable to respond to their high prenatal levels of androgens’,4 which results in someone who is ‘genetically male’ (i.e. they have a Y chromosome) but develops female anatomy. Are they male, since they have a Y chromosome? Or female since they have female anatomy? Well – it’s complicated. I’m quite comfortable saying they are both. After all, Genesis 1 says God created humans male and female, not male or female. Most humans are either one or the other, while some are both. All are created in God’s image.
Since intersex, therefore transgender
Let’s return to our first question above: Does the existence of intersex persons support the ontological claim that a person’s internal sense of self (i.e. their gender identity) determines whether they are a man or woman (or neither)? I call this the ‘since intersex, therefore transgender’ line of reasoning, and it has been the primary argument used to answer ‘yes’ to our question.
On an emotional level, some of my trans*-identified friends have found great comfort in learning about intersex. ‘When I heard the definition of intersex…it made me feel at peace’, one friend of mine told me. ‘It made me feel better that there was a physical condition that existed that may point to some validation of my psychological disconnection of internal self and physical body.’ My friend found much emotional comfort in some parallels between gender dysphoria and DSDs.
Just as we should never treat trans* as merely a concept and so dehumanize trans* people, so we should never use intersex as some faceless concept to help furnish an ideology.
On a conceptual level, I don’t think the existence of intersex persons supports the idea that a person’s internal sense of self is more indicative than their bodies of who they really are. We’re dealing with two different ontological realities that shouldn’t be quickly mapped onto each other. There’s no question about whether intersex persons have an intersex condition. They factually are intersex. The same is true for males or females who experience gender dysphoria. They factually do experience gender dysphoria. Both intersex and gender dysphoria are certainly very real and one’s lived experience is very much affected. But some ontological claims made in response to gender dysphoria – that a biological male might actually be a woman, for instance – cannot be proven by appealing to intersex alone. The claim that a person’s gender identity is more indicative of who they are than their body is relies on several questionable assumptions about human nature, the relationship between the body and God’s image, and the role that biological sex plays in determining identity. Employing intersex to accomplish all of this is questionable.
Not to mention, it might be dehumanizing. Just as we should never treat trans* as merely a concept and so dehumanize trans* people, so we should never use intersex as some faceless concept to help furnish an ideology. ‘Stop using me as a weapon in your pursuit of a political, not scientific, ideology’, writes intersex activist Claire Graham. ‘You are not helping the intersex community. You do us more harm than good.’ Graham goes on to note: ‘every single intersex org has been clear that intersex is nothing to do with gender nor identity’, pointing to examples from these intersex orgs: IHRA, Accord Alliance, the ISNA and dsdfamilies. If we want to talk about intersex, then let’s talk with, not just about, intersex persons.
Bye bye binary?
Our second question is: Do intersex conditions prove that biological sex is not a binary, that male and female are not the only two categories of sex?
Again, we have to remember that 99% of intersex people are male or female. So, intersex should not be used as some catch-all category that means ‘neither male nor female’. Again, if we listen to actual intersex people, we won’t make this mistake; almost every intersex person identifies as either male or female. ‘[M]ost people born with intersex conditions do view themselves as belonging to one binary sex or another’, writes Emi Koyama, founder of the Intersex Initiative. ‘They simply see themselves as a man (or a woman) with a birth condition like any other.’6 The ‘since intersex, therefore sex is not binary’ line of reasoning is a bit sloppy and dehumanizing, and it invites the immediate question: ‘which intersex condition are you talking about?’
99% of intersex people are male or female. So, intersex should not be used as some catch-all category that means ‘neither male nor female’.
Now, when it comes to the more severe DSDs experienced by about 1% of all intersex persons, I’m still not sure even these should be considered outside the binary of biological sex. I find it more helpful to say that such people – beautiful people created in God’s image and worthy of respect, value, and admiration – are a blend of the two biological sexes rather than a third sex. It may sound like I’m splitting hairs, but I think this is more than semantics.
When the Bible and science talk about humans as sexed creatures, they recognize two categories of sex: male and female. If some intersex people embody traits from both categories, there are still only two categories of sex.
For example, non-intersex males have a penis and non-intersex females have a vagina. Most males and females with an intersex condition also have a penis or a vagina, while some intersex persons have both a penis and a vagina. But no intersex person has an innovative new sex organ called a ‘plankerton’ (or whatever) that’s neither penis nor vagina, neither male nor female. They may have atypical features in their male or female anatomy, or they might have a blend of male and female parts. But this doesn’t mean there are more than two biological sexes. It seems more accurate to say that some people exhibit a combination of both – the only two – biological sexes.
Some things are black and white. Some things are gray. Most people are male or female. Some people are both. And all people are loved by God and so to be loved by his followers. We can’t just care about intersex when it comes up in an argument. Intersex people are people – image bearers of the Divine and gifts to the Church.
This post is a shortened version of chapter 7 in Preston’s book Embodied: Transgender Identities, the Church, and What the Bible Has to Say (David C. Cook, 2021)
- For the breakdown of how common each condition is and for a description of each, see Leonard Sax, ‘How Common Is Intersex?’ Journal of Sex Research 39, vol. 3 (2002) Accessed 8 March 2021: 174-8, and Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (Basic Books, 2000). See also the Intersex Society of North America’s website (www.isna.org) for more information. Even though the ISNA closed down in 2008 (and the website hasn’t been updated since then), it still remains a good source for understanding intersex conditions.
- For the 1.7% statistic, see Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (Basic Books, 2000). This 1.7% statistic has been repeated in many news outlets, including USA Today (Susan Miller and Mary Bowerman, ‘What Does It Mean to Be Intersex?’ USA Today and Nora Caplan-Bricker, ‘Their Time,’ The Washington Post. Accessed 8 March 2021.
- Sax, ‘How Common’. Accessed 8 March 2021
- Hilary Lips, Sex and Gender: An Introduction (Waveland, 2008), p.196.
- Claire Graham, ‘An Open Letter to Prof. Alice Roberts on the Subject of DSDs and Kindness’, @MRKHVoice ̵ The Blog of Claire Graham. Accessed 12 February 2021.
- Emi Koyama, ‘From “Intersex” to “DSD”: Toward a Queer Disability Politics of Gender’, Intersex Initiative. Accessed 12 February 2021.