Last March, I engaged in a dialogue with Justin Lee about faith, sexuality, and gender in front of about 900 people. There was a lengthy Q & A at the end of the talk and all the attendees were able to text in their questions. I think we received over 100 questions in the first few minutes, and the questions were ranked in order from “most popular” to “least popular,” so that the first question was the most popular.
What was the first, most popular, question? “What do you guys think about intersex?”
Of all the questions related to faith, sexuality, gender, marriage, homosexuality, transgender identities, Romans, Leviticus, bisexuality, ex-gay therapy, church policy, church history, pastoral application, etc. etc. the number one question had to do with intersex—a term used to describe “a variety of conditions in which a person is born with”[i] atypical features in their reproductive or sexual anatomy.[ii]
I actually wasn’t too shocked that this was the main question almost everyone had. Whenever I give talks about the LGBTQ conversation, I often get questions about intersex and how this affects, or effects, one’s theology of gender and sexuality. The questions are usually quite broad and open ended—“But what about intersex?” Sometimes the questioner thinks they have disproven everything I’ve said (about marriage, sexuality, gender, etc.) simply by asking the question: “Yeah, but what about intersex?!”
I typically respond by asking for more clarity and specificity: “Which intersex condition are you asking about? Vaginal Agenesis? Androgen Insensitivity Syndrome (AIS)? Klinefelter’s? Micropenis? Late Onset Congenital Adrenal Hyperplasia? Turners Syndrome? Some of these? All of these? Which ones are you wanting me to address?”
While the crickets start chirping, I follow up with: “And what specific question do you have about these conditions? Are you wanting to know what causes AIS? Or about the spectrum of symptoms that might spring from Vaginal Agenesis? Or about certain medical malpractices that have given rise to intersex activism? Or whether certain intersex conditions constitute a ‘third’ sex beyond male and female? Or whether the existence of intersex persons validates a particular claim within a certain transgender ideology?”
Now to be honest, the last two bolded questions are usually what’s lying behind the open-ended question “but what about intersex?” But I really want to push us all to be very specific when we are asking questions about intersex and how it contributes to our understanding of sex, gender, and transgender experiences. It has become quite common for people to bring up intersex in arguments about a particular (affirming) view of the ontology of transgender identities; namely, that one’s gender identity reveals something more true about the person than their body, that if someone identifies as a woman, then this is a more accurate statement about reality than their body—even if their body is unambiguously male. Why? Because of intersex.
Most importantly, I want to make sure we don’t employ “intersex” as some faceless concept in service of an argument or ideology. I fear that this often happens from progressives and conservatives alike. Some progressives want to use intersex as a conversation-ending point that validates certain ideological assumptions, usually citing inflated percentages (like the famous 1.7%—the same as people with red hair) of people who are neither male nor female, which is factually inaccurate as we’ll see. Some conservatives respond in kind. They assert that intersex persons constitute such a low percentage of the population that they’re not even worth thinking about (or inviting into their homes and listening to and learning from, etc. etc.). They only engage intersex-related conversations in as much as they seek to refute progressives, who use intersex in their arguments. But once they’ve won the intellectual argument, why wipe their hands clean of intersex people—never to be thought of again until another person brings up intersex in an argument.
All of this is dehumanizing. And it must stop.
I’ve fallen prey to this myself, and I’m in a process of repenting from it, largely because I’ve gotten to know intersex persons and heard their stories and learned from their wisdom. If you’re interested in listening in on at least one of these conversations, you can listen to episode 743 of my podcast “Theology in the Raw” along with some future episodes where I will be dialoguing with intersex Christians.
Intersex people are people. Beautiful, wonderful, honorable people created in God’s image. And yet it’s so easy to ignore their voices since they represent a small percentage of the population. Evangelicals might not find any moral problems with people who simply are intersex. But these same evangelicals would probably hesitate becoming members of a church whose pastor is intersex with no real ethical reason why.
We fear the “other.” And the church can often “other” intersex persons, either by ignorance or by deafening silence.
It’s with much trepidation and caution, therefore, that I venture to talk about the conceptual relationship between intersex and transgender. But as I said in my first post, we need to understand the conceptual before the practical. We need to sort out our theology and anthropology so that we walk effectively with people toward the wholeness that’s available in Christ.
With that in mind, let’s dig into how intersex often gets tangled up in arguments about transgender identities.
Intersex and Transgender
Oftentimes, intersex is used as a logical springboard to justify the view that a person’s authentic self might be incongruent with their embodied self. Or more pointedly, that a biological female might actually not be a woman.
For instance, Dr. Megan DeFranza, a brilliant theologian, argues that a transgender person’s gender identity is a more accurate expression of their “authentic self” than their biological sex. She credits this view, in part, to her discovery that some people are born intersex:
I didn’t reconsider transgender experiences until I learned about the complexity of human biology…I needed a scientist to prove to me that bodies come in more varieties than the simple categories of male (XY chromosomes) or female (XX chromosomes) that I learned in eighth-grade health class.[iii]
Intersex becomes her primary piece of evidence that non-intersex persons who identify as transgender are who they identify as, even if this identity is incongruent with their unambiguously sexed bodies.
Likewise, transgender theologian Justin Sabia-Tanis says: “Male and female define two categories of humans, but they are not meant to be exclusive boxes that limit our individual expression.” We know this because of intersex persons. And because intersex persons exist, we know that there are more than two genders. Because there are more than two genders, “God calls some people to go on a journey that may include a change of gender, a transformative pilgrimage.”
Again, intersex is the foundation for affirming that gender identity is a more accurate description of a person’s authentic self than their biological sex, even if that authentic self is incongruent with their biological sex.
Time and time again, this is how the argument goes. It’s as predictable as a mega-church pastor’s attempt at relationally connecting with his audience for the first 2 minutes of the sermon. I honestly don’t think I’ve read a book or article that doesn’t argue along similar lines.[iv] The logic almost always proceeds as such:
- I used to think everyone was male or female
- But then I learned about intersex
- I now know that there aren’t only two genders (there’s almost always a subtle shift from sex to gender without precisely defining “gender”)
- Therefore, a person’s gender identity is a more accurate description of a person’s authentic self than their body
- Because we know intersex persons exist
- And therefore gender (definition please?) is not binary
This kind of logic raises many questions, but I want to focus on the weight placed upon “intersex” in the line of reasoning. The specific question I have is: does the existence of intersex persons validate the ontological claim (or assumption) that a non-intersex person’s gender identity is a truer revelation of their authentic self than their body? Or more simply: does intersex prove that a female might actually be a man (or vice versa)?
We can’t address these questions until we understand what we mean by “intersex.”
99% of Intersex Persons are Unambiguously Male or Female
For one, “intersex” does not mean “neither male nor female.” There are more than 16 different conditions classified as intersex, or more accurately “disorders of sex development” or “differences of sex development” (DSD’s).[v] These disorders/differences refer to atypical features in one’s sex-chromosomes, reproductive organs, or anatomical sex (or two of the three, or all three).
The prevalence of people who have an intersex condition range anywhere from 1.7% of the population to 1 in 4,500.[vi] It all depends on which condition is classified as intersex. Not all intersex conditions are the same. They range from mild to severe. Mild intersex conditions might be hardly noticeable or even go undetected throughout a person’s life. Most intersex persons have a mild condition where they are unambiguously male or female. Some severe intersex conditions make it virtual impossible to tell whether the person is male or female.
Biologist Anne Fausto-Sterling is well-known for saying that 1.7% of all human births are intersex (about the same as people born with red hair), and many people have reiterated this statistic and concluded—wrongly—that 1.7% of humans are neither male nor female.[vii] This is terribly misleading.[viii] In defining intersex (and arriving at her 1.7%), she includes various conditions where there’s little to no difficulty in identifying the person as male or female. For instance, Fausto-Sterling includes the following conditions in her 1.7%:
- Late Onset Congenital Adrenal Hyperplasia (LOCAH)—1.5 in every 100 births.[ix]
- Klinefelter Syndrome—1 in every 1,000 births.
- Turner Syndrome—1 in every 2,700 births.[x]
- Vaginal Agenesis—1 in every 6,000 births.[xi]
People with these conditions constitute the overwhelming majority of people with intersex conditions as a whole. These conditions are technically classified as intersex, but this does not mean they are neither male nor female. Almost everyone with these conditions typically experience no ambiguity in their biological sex.
For instance, 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 with LOCAH is another possible symptom. In short, there is no ambiguity in identifying whether a person with LOCAH is either male or female by all medical standards of identifying one as male or female (i.e. having an atypically large clitoris doesn’t mean you aren’t female). And yet people with LOCAH account for 88% of all the intersex persons that make up Fausto-Sterling’s claim that 1.7% of the population is intersex.[xii]
Klinefelter Syndrome is another common intersex condition. Males with Klinefelter’s have XXY sex chromosomes (or, more rarely, XXXY or XXXXY) and normal genitalia, though their testicles are typically small. They can achieve an erection and ejaculate, though most males with Klinefelter’s are infertile. Some males with Klinefelter’s may see an increase in breast tissue (called gynecomastia) due to lower levels of testosterone and/or higher levels of estrogen than seen in typical males.[xiii] Fertile males typically go completely undetected.
Since males are classified by the presence of a Y chromosome, systems of reproduction (whether they are functioning or not), and external genitalia, those with Klinefelter’s are unambiguously male, even if they might not fit the cultural stereotypes of what constitutes a masculine man (large testicles, chiseled chest, raging testosterone, etc.).
Vaginal Agenesis is a condition where a female has XX chromosomes and little to no ambiguity in their biological sex, though the vagina fails to fully develop (oftentimes the vagina is shorter) and they might not menstruate and/or they might experience infertility. In some cases, females with VA are born without a uterus.[xiv] In most cases, females who have opted for surgical intervention can engage in typical sexual relations and get pregnant (except in some cases where they are born without a uterus).[xv]
In no way should we minimize the psychological difficulties that a person with one of these conditions might experience. Not at all. These are ripe pastoral opportunities to embody the love and life of Jesus toward people who, for whatever reason, might feel “othered” by society (intentional or unintentionally) or by their own self-perception of what constitutes a “real” man or woman.
The conceptual point I want to make, though, is that most people with an intersex condition are unambiguously male or female by any basic standard of determining one’s biological sex. In fact, it’s been estimated that as many as 99% of people who have an intersex condition are unambiguously male or female.[xvi]
Now, some intersex conditions do exhibit more ambiguity in their biological sex. These include:
- Congenital Adrenal Hyperplasia (CAH)—1 in 13,000 births[xvii]
- Complete Androgen Insensitivity Syndrome (CAIS)—1 in 13,000 births[xviii]
- Partial Androgen Insensitivity Syndrome (PAIS)—1 in 131,000 births[xix]
- Ovotestes (also called true hermaphroditism)—1 in 80,000 births[xx]
Every human born into this world bears God’s image in unique and beautiful ways. We can’t highlight the rarity of some types of conditions in a way that could “other” certain people. But it’s misleading to reference the broad umbrella category of intersex conditions (almost all of which present little to no ambiguity in one’s biological sex) and use this to argue that intersex people are neither male or female.
But what about the 1% of intersex persons whose biological sex actually is ambiguous? Are they a third or other sex? I find it more helpful to say that such persons—beautiful persons 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 completely different from the categories of male or female. It may sound like I’m splitting hairs, but I think it’s more than semantics. When the Bible talks about humans as sexed creatures, it recognizes two categories: male and female. And some intersex people embody characteristics of these two biblical and scientific sex categories, male and female. But blending the binary is different than nullifying it. Male and female are the only two sex categories we have, and all humans exist in one, two, or both of these two binary categories.
Intersex conditions don’t prove that sex isn’t binary. They only question simplistic understandings of that binary.
For instance, non-intersex males have a penis and non-intersex females have a vagina. Most intersex persons also have a penis or a vagina. Some intersex persons, however, have both a penis (a male organ) and a vagina (female organ). But no intersex person has a flankerton—a sex-organ that’s 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 that there aren’t only two biological sexes. It seems more accurate to say that some people exhibit a combination of both—the only two—biological sexes.[xxi]
Is Intersex Caused by the Fall?
Some say that intersex conditions are caused by the Fall. Others think that intersex conditions were part of God’s original pre-fallen design.
I used to punt to the “Fall” whenever intersex conditions came up in conversation, but I’ve become a bit more cautious about doing this. Maybe it’s theologically true, maybe it’s not. I honestly wasn’t in the garden before Adam and Eve sinned, and I know less about the Fall and its impact on humanity than I thought I did back in my third year of seminary when I had it all figured out. Maybe the “Fall” caused a defect in an enzyme that leads to an excessive production of androgens in genetic (XX) females, which leads to Congenital Adrenal Hyperplasia. Or maybe it was because a woman’s husband left her when she was 8 weeks pregnant, causing all kinds of stress on the mother which may have caused the defect in the enzyme. (Is it nature? Or nurture? Or God? Or Satan? Or all?) Or maybe it was both. It’s hard to say.
I was born deaf in my left ear. Is this a product of the Fall? Or is it because my mom smoked three packs a day when she was pregnant. (I don’t blame her one bit; the Surgeon General wasn’t around back in the mid-seventies.) Is my deaf ear handed to me directly from the Fall? Or mediated through excessive nicotine consumption? Or both? Or neither?
We can identify some environmental causes for some intersex conditions, but—can we confidently say that those adverse environmental conditions are simply the “Fall?” Maybe. Maybe not. I simply want to urge us all to think long and hard about what we are saying.[xxii] And how much does it actually matter whether we are able to say “the Fall!” with theological confidence?
One thing I do know is that whenever I talk to intersex persons, it certainly feels incredibly dehumanizing to flippantly say that intersex conditions are a product of the Fall. One of my intersex friends recently told me: “When I hear people say that intersex is caused by the Fall, all I hear is that my entire existence is nothing but fallen since my entire existence is affected by my intersex condition on some level. It often feels like people are saying that I am fallen in more severe ways than non-intersex persons.” It just so happens that this particular friend is one of the most zealous, faithful, sacrificial, loving, wise, and generous Christians I’ve ever met. It breaks my heart to think that a flippant “intersex is caused by the Fall” statement could rub salt into deep wounds of societal dehumanization.
Now, most Christians believe that every human is touched by the Fall in some way. And if they believe that intersex conditions are caused by the Fall, they don’t actually mean that intersex persons are more “fallen” than non-intersex persons. But sometimes that nuance doesn’t always come through when we’re throwing around opinions about the Fall and intersex people. I want to encourage us all—especially myself—to exercise much more caution in how we speak about “conditions” and “issues” and “concepts” that are embodied in the lives of real people who already have many social cards stacked against them in ways that non-intersex persons will never truly understand.
Let’s finish up our discussion by addressing the main question we’ve been dancing around.
Does the existence of intersex persons validate certain ontological claims of some trans affirming arguments?
I thought long and hard about how to word that question and I’m still not satisfied with my choice. I don’t particularly love the phrase “trans affirming” since there are things I affirm about both transgender people and certain points made within “trans affirming” arguments. Until I can find better language, let me explain what I mean.
By “certain ontological claims,” I’m referring to the idea that someone could have an unambiguously male or female body and yet actually be, ontologically, a gender (man or woman) different from their male or female body.
As one commenter said in my first post, mentioning the existence of intersex persons to justify the above claim feels like a red herring—a distraction from the main point—when we’re discussing the ontological validity that a female might actually be a man (or vice versa). With transgender, we’re talking about the idea that an unambiguous female might not actually be a woman.[xxiii] All of the evidence used to validate this ontological claim (one’s self declaration, the brain-sex theory, the sexed soul theory, etc.) is subjective and problematic for various scientific and theological reasons that we discussed in the last few posts. But the ontological reality of intersex persons whose biological sex is ambiguous doesn’t have any of these evidential problems. The claims of their ontological reality—that their biological sex is ambiguous or blended—is indisputable and objectively verifiable. The claim that a female is actually a man is not. Both sets of claims (verifying the ontology of intersex and transgender persons) come with their own scientific, theological, ethical, and pastoral questions, most of which are beautifully complex. But these questions are quite different, and it’s unhelpful to map one upon the other, or use one to justify the other.
Or more bluntly, the fact that some people are born with a blend of female and male sexual anatomy does that validate the claim that an unambiguous male (sex) is a woman (gender).
But I could be wrong. Please—seriously—comment below if you can show me where I’m wrong. Because I might very well be.
[ii] There are several significant works on intersex and how it relates to our view of biological sex and gender. Anne Fausto-Sterling’s Sexing the Body is a classic and a must read. And even though I’m critical of some of her claims in this post, I found her book to be well written, thoughtful, challenging, and incredibly informative. Megan DeFranza’s Sex Difference in Christian Theology is a recent work examining intersex from a Christian perspective. It’s a very well-researched book and a must read if you’re a Christian interested in the topic. Other books on the Intersex Society of North America’s (ISNA) website are worth reading, especially the one by Alice Dreger: http://www.isna.org/books I mean, anything by Alice Dreger is worth reading. Beyond those, I’d highly recommend reading Leonard Sax’s article “How Common Is Intersex,” which is available for free if you Google hard enough. And the ISA website listed throughout these endnotes has a ton of helpful information. Most of all, get to know intersex persons. You probably already know some. If your church has 1,000 people, it probably also has 5-15 intersex persons.
[iii] From the forthcoming book Understanding Transgender Identities: Four Views.
[iv] The “because of intersex, therefore transgender” argument can be seen throughout the following: Austen Hartke, Transforming; Tara Soughers, Beyond a Binary God; Cheryl Evans, What Does God Think; several essays in Christina Beardsley and Michelle O’Brien (eds.), This Is My Body; Linda Herzer, The Bible and the Transgender Experience. I honestly don’t think I’ve read a “trans-affirming” argument that doesn’t make intersex a significant part of their argument.
[vi] A consensus statement constructed by a team of almost 50 specialists, who have analyzed all the data, concluded that about 0.22% of all live births are intersex; that is, 1 in every 4,500. See I.A. Hughes, C. Houk, S.F. Ahmed, P.A. Lee, and LWPES/ESPE [Lawson Wilkins Pediatric Endocrine Society/European Society for Paediatric Endocrinology] Consensus Group, “Consensus Statement on Management of Intersex Disorders,” Archives of Disease in Childhood 2 (2006): 1-11. www.archdischild.com.
[vii] Anne Fausto-Sterling, Sexing the Body: Gender Politics and the Construction of Sexuality (New York: Basic Books, 2000). Her statistic of 1.7%—approximately the number of people born with red hair—is repeated by many, including USA Today (https://www.usatoday.com/story/news/nation-now/2017/01/23/what-does-mean...) and the Washington Post (http://www.washingtonpost.com/sf/style/2017/10/05/the-intersex-rights-mo...).
[viii] See the critique by Leonard Sax, “How Common Is Intersex?” Journal of Sex Research (2002).
[x] Characteristics: Females missing an X chromosome; typically infertile; possible heart problems and diabetes.
[xii] Sax, “How Common is Intersex.”
[xiii] Gynecomastia actually occurs in around 70% of all adolescent males, though it typically goes away within 2 years without treatment.
[xiv] Since the uterus is one significant aspect of the female reproductive system, one could argue that such persons have an ambiguous biological sex. But since all the other features of female anatomy and chromosomes are present, I would hesitate saying that the person’s biological sex is ambiguous.
[xv] Mentioning surgery in the same sentence as intersex is extremely controversial, and I’m not advocating for surgery unless someone of age desires it. In any case, the success of surgical “correction” in cases of Vaginal Agenesis are disputed. According to Leonard Sax: “Surgical correction for vaginal agenesis is conceptually no different from surgical correction for cleft palate” (“How Common Is Intersex?”), while Megan DeFranza points out that this comparison is inaccurate since surgeries for VA are often much more complicated and “many of those who have had genital surgery or been sex reassigned neonatally have complained bitterly of the treatment” (Sex Difference, 40). DeFranza seems to believe that VA is characterized by the “absence of a vagina” and an “underdeveloped or missing” uterus. This might be true in some cases, but from everything I’ve read, an underdeveloped (not missing) vagina is much more common, and some (perhaps many) still have a functioning uterus.
[xvi] Sax, “How Common Is Intersex?”
[xvii] Characteristics: A defect in an enzyme leads to an excessive production of androgens in genetic (XX) females, which produces either male genitalia or genitalia that appear somewhere in between male and female.
[xviii] Characteristics: Genetic males (XY) are born with a defect in the androgen receptor and therefore the cells don’t respond to testosterone. Though genetically male, the person typically has female external genitalia, though no uterus and ovaries.
[xix] Characteristics: Similar to CAIS, people with PAIS typically have some atypical features in their sexual anatomy. Some may exhibit underdeveloped male and female sexual anatomy, while other less severe cases may be males with a very small penis and infertility.
[xx] Characteristics: As it sounds, people with ovotestes are born with both ovarian and testicular tissue.
[xxi] Okay, so I sort of made up the word “flankerton.” But if you must know, my kids have come up with all kinds of different made up names for the anatomy of our dog. It just so happens that they call his penis a “flankerton.” So my illustration actually breaks down once you know the actual meaning behind “flankerton.”
[xxii] For what it’s worth, even scholars and medical professionals, who don’t believe in “the Fall,” use language to describe intersex conditions which suggests that something “went wrong” in fetal development, which leads to a newborn who might be ambiguously sexed. Hillary Lips, for instance, is a world renown expert in theories surrounding sex and gender, describes CAH as a “genetically transmitted syndrome” that “causes the adrenal glands of the fetus to malfunction, resulting in a release of excess androgens from the prenatal period onward” (Lips, Sex & Gender, 192). Lips describes AIS as “a genetically transmitted disorder that makes their cells partially or completely unable to respond to their high prenatal levels of androgens” (Ibid., 196). Suzzane Kessler believes that the existence of intersex persons challenges the male/female sex binary, and she describes CAH as an “inherited enzyme deficiency condition, causing a malfunction of the fetus’s adrenal gland, which results in the overproduction of fetal androgen” (Kessler, Lessons from the Intersexed [New Brunswick: Rutgers University Press, 1998], 165-66, cited in DeFranza, Sex Difference, 30) And Christian theologian, Megan DeFranza, who also believes that male and female aren’t the only two sexes, says that “people with AIS are unable to process male hormones” and “their cells lack the proper receptors” (Sex Difference, 25). To say that intersex conditions are simply variations in a pristine creation seems to throw shade on the Creator, since most of these conditions have adverse—sometimes fatal—side effects.
[xxiii] According to the Intersex Society of North America, intersex persons and transgender persons “should not be and cannot be thought of as one. The truth is that the vast majority of people with intersex conditions identify as male or female rather than transgender or transsexual. Thus, where all people who identify as transgender or transsexual experience problems with their gender identity, only a small portion of intersex people experience these problems” http://www.isna.org/faq/transgender