The past couple of weeks have brought added stress to our trans, gender expansive/gender diverse, and intersex communities with the New York Times report on the Department of Health and Human Services efforts to establish a legal definition of sex defined as unchangeably male or female based on genitals present at birth. From my perspective as a medical clinician, this definition fails to account for the beautifully wide variations of nature. One often quoted article calculated the percentage of intersex people as 1.7% of the population (this is a challenging statistic to calculate, but let’s go with it). Genitals present at birth are affected by genes present on chromosomes, chromosomes present, and hormone exposure (among other things). Scientifically, we know of people with XY chromosomes who have genes on the Y chromosome that do not produce testis development in utero and will thus be born with external genitalia that appear like a vagina and clitoris. How will the HHS fit this into their narrow, unscientific definition which reads, “Sex means a person’s status as male or female based on immutable biological traits identifiable by or before birth. The sex listed on a person’s birth certificate, as originally issued, shall constitute definitive proof of a person’s sex unless rebutted by reliable genetic evidence.”? How will people with chromosomes XXY be classified? How will babies with more diverse genitalia be classified? Will more non-medically necessary surgeries with significant risks, side-effects, and no proven benefits be recommended in order to fit this narrow definition that is not based in our current understanding of genitalia, sex, and gender?
If we then consider the at least 0.6% of adults who are transgender in our population (again challenging statistic to calculate, but let’s go with it), how do we fit them into the HHS definition of sex? 1-2% of people in the world have red hair. Insisting on this narrow, falsely-binary definition of sex is like demanding red heads chose blonde or brunette on their identifying documents. As a non-binary person how do I even began to fill out your forms? (well, a lot of times I draw my own boxes, but that is usually ineffectual on a legal document) And why do we as a society care so damn much? (well, power) As a physician, I don’t care what sex the HHS wants to define you as or what sex you were assigned at birth. Humans don’t exist on a binary. (Not even when it comes to handedness, hello ambidextrous!) What matters to me as a physician to take care of you medically is:
- How do you want to wear your gender?
- What hormones does your body make more of?
- What genitals do you have currently and how do you use them? (to help me suggest appropriate medical screening tests like STD/STI testing)
- What genitals do you want?
- What organs do you have inside your body: prostate, cervix, uterus, ovaries? (again to help me suggest appropriate medical screening tests for early detection of cancers and such)
- What do you call your genitals and organs and what would you like me to call them?
Medically, this is what I need to know to offer you sound, evidenced-based information to help you make informed decisions about your body and your healthcare. As a physician, I find the HHS definition of sex woefully unscientific and medically inaccurate. As a queer person, I find the HHS definition frightening and hurtful. I hope the HHS chooses to see all of us humans with the diversity and dignity we deserve and to use a more scientifically accurate definition of sex.
PS- If you want to watch a short TEDx video on intersex, check out Intersex is Awesome!