Sex, Gender, and Transgender Experiences: Part 1—Biological Sex

Sex, Gender, and Transgender Experiences: Part 1—Biological Sex
July 25, 2019

I’m going to do two things that I thought I’d never do: blog about gender and allow for comments. Don’t get me wrong. I love getting feedback, especially critical feedback. But as you might know, the comment section on blogs can be a dumping ground for dehumanizing rhetoric, and the topic of gender seems to especially attract the stench.


So here’s my contract with you. I’ll do my best to write in an honest, thoughtful, and humanizing manner, and all I ask is that you to do the same. I would love it if you would pushback, play devil’s advocate, point out holes in my thoughts or research. That’s precisely why I’m opening up the comment section. But if I see any comment that’s dehumanizing, belittling, condescending, or rude—it’s gonzo, gone with the wind, erased from all the world to see (you’re welcome, world). Some trolls, though, make such outrageous statements that they become entertaining. I might not delete these. Some trolls I keep as pets.[i]


Let me preface the following posts with two points.


First, the following series of posts are exploratory, not definitive. I believe it was Donald Miller who used to say, “before it’s a book, it’s a blog.” And that’s the approach I’ve taken for most of my writing career. One of the most dangerous things a writer can do, besides drinking too much Scotch while editing, is to email her thoughts directly from her computer to the publisher without airing them out for others to critique. That’s what I hope to do here. I’ve spent a few years wading through scholarly and popular literature on all things gender related, and I’ve interacted extensively with trans people all along the way.[ii] So now I want to step back, collect my thoughts, and air-out some ideas, and I truly would love your thoughtful and humanizing feedback.


Second, the focus in the following posts is more philosophical and scientific than ethical and relational. Now, if you’ve known me for more than 7 minutes, you’ll realize that I’m most passionate about the latter. I’d rather roll around naked in a room full of broken glass than to sit around in some ivory tower mulling over abstract concepts while ignoring the lives of real people scurrying below. Conceptual thinking should lead to the wholeness and flourishing of people. And as a Christian, I believe people best flourish when they are aligned with the Creator’s will. If you were to pinpoint one overarching ethical question hovering off in the distance, it would be this: how does God intend for humans to live as sexed and embodied image bearers? (Or in scholarly garb, the ethical implications of theological anthropology.)[iii] But we’ve got a conceptual jungle to hack through before we can get to a clearing and see that ethical question more sharply.    




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Relationally, my heart is a wreck on so many levels. Behind every word I write about concepts and terms and theories and studies are dozens of stories about friends who experience gender dysphoria or identify as transgender (or non-binary, etc.) who have been shamed, mocked, abused (spiritually and physically), or simply made to feel like sub-species of the human race, sometimes by so-called Christians. Trans people have been stigmatized, demonized, politicized, and terrorized by people inside and outside the church. It blows my mind that in spite of all this, some of my friends are still passionately following Jesus and belting out praises to Christ from the same pews where they have endured more trauma than most humans can endure. I have been challenged, convicted, and deeply loved by my friends who have experienced a life-long, unchosen, sometimes debilitating incongruence between their gender identity and biological sex. Few days go by when I’m not made to think, made to laugh, or made to cry (tears of joy; tears of pain) by my trans friends. And it’s because of them that I’ve devoted most of my waking hours over the past few years to studying and wrestling with the topic of sex, gender, gender incongruence, and the experiences and identities that follow.


There’s also the massive increase of parents who are watching their kids be bathed in nebulous and unscientific ideologies that are leading to a kind of legalized experimentation on children that would make George Orwell’s head spin. Stories of children have been led to hate their bodies, hate their parents, and agree to irreversible surgeries with lifelong consequences sounds like something out of the dark ages. And the growing number of wounded detransitioners with permanent scars, whose existence is enough to elicit death threats from those with power, makes me question whether we are actually living in a free society. Some parents are kicking their kids out of the house for simply struggling with their gender identity, while others are allowing medical professionals to experiment on their kids.


If I were to guess, you probably resonated with one of the previous two paragraphs more than the other. In our polarized society, it’s easy to be passionate about fighting against destructive ideologies and yet dispassionate about fighting for marginalized people. Or passionate about fighting against the social stigma toward trans people, yet unflustered at the destructive ideologies that are leaving many wounded people in its wake. My hope is that Christians would do both: Deconstruct destructive thinking (whether it comes from the right or the left) and fight for the inclusion of all people—especially those who have been shamed and shunned by the church.


Concepts affect people. It’s precisely because of people and the profound pastoral needs around the country that I’m going to take an extended journey through the conceptual discussions about sex and gender. Effective pastoral theology will be an informed and relational theology if it’s going to be a genuinely Christian theology.


A more immediate question I’m going to wrestle with is this: Is it possible for someone to be a gender that’s different from their biological sex? This question could be refracted into several others:


  • Can someone be born in the wrong body?
    • And does one’s personhood exist apart from their body?
  •   Do some people have male bodies yet female brains (or vice versa)?
    • And do brains come in two different sexes?
  • Do some people have female bodies but male souls?
    • And are souls sexed into male and female categories?
    • And—what is the “soul” anyway?
  • What’s the relationship between sex and gender?
    • And what’s the difference between gender role, gender identity, and masculinity/femininity?


Over the next several posts, I want to wrestle with all of these questions, but we’ll begin with the last one (sex and gender) and its sub-question.



Sex and Gender

My friend Dr. Peter Williams is one of the brightest scholars I’ve ever met. Ph.D. from Cambridge, fluent in several ancient and modern languages. Peter’s one of those chaps whose brain appears untouched by the Fall. I’ll never forget reading his Twitter profile, which included the phrase: “Sex: male. Gender: none.”


No gender? Can someone be a particular sex—in Peter’s case, male—and not have a gender? (His point was quite different from those who might identify as agender, by the way.) It all depends on what we mean by gender.


Peter has since erased this statement from his profile, which was probably a wise move. The problem is that “gender” (as a term and concept) is often used with bewildering variety and inconsistency in modern discourse both popular and academic. We’ll open up the can of gender worms in the next post (worms, by the way, are intersex). But let’s close out this post by making sure we know what we mean when we talk about sex. Or what I’ll refer to as biological sex.[iv]


Like most species, humans reproduce sexually, and the sexually dimorphic categories used to classify the respective roles humans play in reproduction are “male” and “female.”


Females are distinguished from males based on their different reproductive structures. Female humans will develop internal (e.g. ovaries, uterus) and external (e.g. breasts, vagina) anatomical features that are, in part, designed to contribute to reproduction. Males will also develop different anatomical features that contribute to reproduction (e.g. penis, testis).


Males and females have different levels of hormones that contribute to their sexual dimorphism. For instance, females have higher levels of estrogen and males have higher levels of testosterone. These respective “sex” hormones also lead to the development of various secondary sex characteristics, such as the development of breasts and wider hips in females and more muscle mass and facial hair in males. Sex hormones might also affect behavior, though the extent to which this is true is widely disputed.


Genetically, the presence of a Y chromosome distinguishes males from females. Most females have XX chromosomes while males have XY chromosomes. Some males and females might have an extra X chromosome (or 2-3 extra X chromosomes), which is one of several different intersex conditions, which occur in about 1 in every 100-4,500 people depending on who is considered to be intersex (the prevalence rates are widely disputed). Someone who is intersex has some atypical feature in their sexual anatomy, their sex chromosomes, or both. And there are over 16 different conditions classified as Intersex. Most of these conditions demonstrate some minor variation in one’s sexual anatomy. For instance, females with the intersex condition called Vaginal Agenesis have XX chromosomes and typically have no ambiguity in their biological sex, though the distant third of the vagina fails to develop. Males with Kleinfelder’s Syndrome have an extra X chromosome (XXY), are often infertile, and usually have smaller testicles. Some rare intersex conditions present significant atypical features in one’s sex and/or sex chromosomes, such as Androgen Insensitivity Syndrome (AIS), where the person is genetically male but develops female anatomical features. Most people who have an intersex condition are not ambiguously sexed.


The topic of intersex has its own set of questions and assumptions, and I find it more helpful to discuss intersex head on, rather than weaving intersex in and out of conversations about non-intersex persons. So, for the next several posts, when I’m discussing the relationship between sex and gender—and whether gender exists—I want to focus on humans that don’t have an intersex condition. My motivation for doing so is to honor my beautiful intersex friends, not to sideline them. It’s common for non-intersex people to bring in “intersex” as some faceless concept in service of an argument. But I find this rather dehumanizing to intersex people, and many of them do as well. I’d much rather talk about (and with!) intersex people extensively in a separate post before I consider how intersex relates to our sex and gender conversation. In short, my primary concern in these first few posts has to do with humans whose biological sex is unambiguous.[v]


Before moving to gender, I want to point out that everything I’ve said about sex thus far is widely accepted among scientists (or most scholars, for that matter). Sexual dimorphism among non-intersex humans is an established, observable, objective, scientific, “the earth is round and not flat” sort of fact. “[A]n organism is male or female if it is structured to perform one of the respective roles in reproduction” and “[t]here is no other widely accepted biological classification for the sexes.”[vi]


Now, the value we assign to being male or female, how we interpret our male and female bodies, and how males and females interact with each other is loaded with subjective, culturally-shaped, socially determined realities that include much, much more than biological structures of reproduction.[vii] All of that goes under the umbrella of “gender,” which we’ll cover in the following posts. But the fact that non-intersex humans are sexually dimorphic is an objective, 2 + 2 = 4 kind of fact—you wouldn’t exist if it were not true—and “male” and “female” are the accepted terms used when referring to those kinds of humans. Therefore, for the rest of my posts I will use the terms “male” and “female” to refer to the category of biological sex among non-intersex persons. When I use these terms, I make no further assumptions about the gender identity or masculinity/femininity of those who are male or female.[viii]


For those who think these widely accepted descriptions of male and female are too limited, I would honestly ask: “What terms should we use to describe the sexually dimorphic categories of humans?” Humans reproduce sexually through egg and sperm. And aside from some advances in technology that I’m unaware of, this happens when one kind of human produces sperm which fertilizes an egg that’s produced by another kind of human. The two different kinds of humans that are involved in this process have typically been labelled as male and female. To add clarity in a conversation weighed down with confusion, it seems best to use the terms male and female according to their widely agreed upon definitions.


And that’s pretty much where the agreement ends. Because when it comes to gender, few people agree on what it means, and even fewer seem to know what they’re even talking about.


What exactly is gender? How is it different from sex? Does it even exist?


We’ll continue our journey in the next post.

[i] I owe that last line to Karen Swallow Prior.


[ii] Throughout these posts, I’ll use the terms trans, transgender, or trans people as an umbrella term to refer to people who identify as trans or experience gender dysphoria. I’m not making any ontological assumptions about people (e.g. that one is actually a gender that’s different from their sex) when I use the terms.


[iii] Intersex persons are still sexed, even if some aspects of their sexual anatomy falls outside the typical pattern of how humans are sexed.


[iv] I’m already off to a controversial start, I know. Some people find the very phrase “biological sex” to be uninformed, if not oppressive. After all, our brains are an essential part of our biology and yet some brains are gendered differently from our sexual anatomy; or so the narrative goes. If this was your concern and nudged you to reach for this endnote, please keep reading. We’ll get into all of that fun stuff in due time.


[v] Please note: I am not trying to argue that all humans exist in the binary of male or female while tabling intersex persons in order to prove my case. That would be logically and socially irresponsible. Rather, I simply want to focus our initial few posts on non-intersex persons, since most people who claim a gender identity that’s incongruent with their biological sex are not intersex. In other words, my initial set of questions have to do with those whose biological sex is unambiguous, but in no way am I claiming that all humans are unambiguously sexed.


[vi] McHugh and Mayer, “Sexuality and Gender,” 90. I’m well aware that the very name “Paul McHugh” (less so Lawrence Mayer) can trigger some people. But again, the basic definition of biological sex is one of the only things that virtually everyone across the conservative/progressive spectrum agree upon. For instance, Hillary Lips is a renown psychologist and feminist who wrote one of the leading textbooks on sex and gender. She says that sex refers to “a person’s biological maleness or femaleness” and “is reserved for discussions of anatomy and the classification of individuals based on their anatomical category” (Lips, Sex and Gender,5-6). Feminist philosopher Rebecca Reilly-Cooper says that “The categories of female and male are thus general biological categories that apply to all species that reproduce sexually.” The American Psychological Association says: “Sexrefers to a person's biological status and is typically categorized as male, female or intersex. There are a number of indicators of biological sex, including sex chromosomes, gonads, internal reproductive organs and external genitalia.” Rebecca Jordan-Young uses the term “sex to refer to characteristics of the physical body” and “gender to refer to psychological attributes and social behaviors that are associated with masculinity and femininity.” She says that this is “the dominant usage” of sex and gender “in the humanities and social sciences as well as feminist biology” (Brainstorm, 15). 


[vii] If you believe that males are intrinsically better leaders, more aggressive, better at math and science, while females are more nurturing, passive, emotional, and better at elementary education and nursing, then these assumptions are culturally shaped. I’m not saying you might not be right, nor am I saying that there’s no biological evidence that males are generally more aggressive, etc. Maybe they are, maybe they aren’t. All I’m saying is that these assumptions are not only disputed but take us beyond the basic criteria of what constitutes a person as “male” or “female.”


[viii] I’m well aware that some influential scholars (Judith Butler, Anne Fausto-Sterling, and others) have argued that biological sex itself is a social construct. Typically, the focal point of this notion has to do with intersex persons and the doctors who “assign” them a particular sex, when their sex is ambiguous. In these cases, the doctors might be driven by cultural expectations that all humans must be clearly male or female, and so they quite literally construct a biological sex out of the child. Aside from intersex persons, constructionists will also point out that we can’t cleanly separate the physical from the social, nature from nurture, sex from gender. “As we grow and develop, we literally…construct our bodies, incorporating experience into our very flesh. To understand this claim, we must erode the distinctions between the physical and the social body” (Fausto-Sterling, Sexing the Body, 20). Moreover, it’s impossible for us to look at our sexed bodies and not interpret these bodies through cultural and social lenses. Sexed bodies don’t exist in a cultural vacuum. All of this is true, of course, but I still feel that Fausto-Sterling, Butler, and others are exploring the value that we assign to male and female bodies—and to masculinity and femininity—which goes beyond the cold hard fact that sexual dimorphism exists in humans. I may look at a 6-foot 4 chiseled male body and make all kinds of assumptions about the person. And when I find out that he’s a terrible athlete and sings soprano in the local gay men’s choir, my cultural assumptions might be challenged. But the bare fact that he is on the “male” side of the male/female dimorphism remains the same, whether he matched my cultural assumptions or not. My point is, I don’t think that the “sex is a social construct” view alters anything I’ve said thus far. From my vantage point, it sounds like they are smuggling in a bit of the gender conversation into their argument that sex is a social construct. Our interpretations of sex might be socially constructed, but sex itself is not constructed by society. 


Perhaps the following questions should be set aside until you address the issue of intersex. I understand if you'd like to ignore this comment until you address the subject of intersex, but since I think these questions are ultimately relevant to how we understand the sexual definition of male/female I will ask them now:

In this post you discuss male/female sex in terms of chromosomes, reproductive features, and anatomical features designed towards reproduction. As someone who doesn't know much about biology or genetics, the exact relationship between these terms is unclear to me.

So, at one point you say:

"Genetically, the presence of a Y chromosome distinguishes males from females."

And earlier you say:

"Females are distinguished from males based on their different reproductive structures."

Is the chromosomal definition a necessary and sufficient condition, necessary but not sufficient, or sufficient but not necessary? Or is this simply meant to be a general description (most males/females)?

Is there a distinct definition of "genetic sex" (chromosomes) that stands apart from "biological sex" (anatomical/reproductive features)? One thing you say which might suggest that there are distinct definitions is the following:

"Some rare intersex conditions present significant atypical features in one’s sex and/or sex chromosomes, such as Androgen Insensitivity Syndrome (AIS), where the person is genetically male but develops female anatomical features."

This suggests that either chromosomes or anatomical features are not sufficient per se. (Unless, perhaps, you mean that the anatomical features are only female-like and not female per se.) It is safe to say (I hope) that no one believes the anatomical features have to be properly functioning in order to be classified as one sex or the other, but your description above leaves me curious as to whether someone with AIS might have properly functioning female anatomy while being "genetically male." While non-functioning anatomical features would not suggest that the person is not female, it seems obvious that if the person with AIS does have functioning female anatomical features that these would be sufficient to consider the person to be female. In which case, it seems superfluous to have a category called "chromosomal/genetic sex."

Maybe the easiest starting point is this: Are the chromosomes determinative of the reproductive structures or contributory?

Hoping this doesn't make you regret your decision to open comments :)

prestonsprinkle's picture

Hey John, GREAT question! Goodness, you're setting the bar high. And like you, I'm neither a geneticist nor a biologist, so all I can do is try to get my head around what the experts say. 

For non-intersex persons, I don't think it's helpful to single out one or two criteria (sexual anatomy, chromosomes, gonads, etc.), since they are all linked. So, at conception, the embryo of non-intersex persons will either have XX or XY chromosomes. For the first 7 weeks of gestation, a male and female embryos look identical. At around the 8th week, if the embryo (or unborn person, I should say) has a Y chromosome, this acts as a "switch for 'maleness'" (Lipps, "Sex and Gender, 179), which most significantly,  differentiates the gonads into testis, which in turn secretes sex hormones (androgens), which form the internal and external reproductive system. If there is no Y chromosome, then the unborn will continue to develop female gonads and reproductive systems. Then, for XY unborns, there's the wash of testosterone in the third trimester along with another burst of T for males and Estrogen for females at puberty, which produces secondary sex characteristics. 

In short, I find it hard to single out one aspect and make it more crucial than the other. I guess you could say that the Y chromosome begins the whole process and is therefore the most significant. But if something goes wrong with the production of sex hormones, or how the cells process those hormones, then the rest of what constitutes someone as "male" will be impaired or non-existent. 

But your main question has to do with intersex; specifically AIS. To be clear, everything I said above holds true for most intersex persons. This is one of the main mistakes in the conversation. People will say things like "there is male, female, and intersex"--as if all people with an intersex condition are neither male nor female. According to one estimate, 99% of people with an intersex condition are clearly male or female; that is, males have a Y chromosome and a male reproductive system. While they might have some atypical feature in their sexual anatomy (small testicles, small penis, low testosterone), none of this would make their "maleness" ambiguous. Same with most females who have an intersex condition. 

Now, of course there are conditions like AIS where there there's incongruence between the genetics and the reproductive structures. Basically, with AIS, the cells don't respond to the body's androgens (sex hormones), so the "switch for 'maleness'" was flipped, but little to nothing happens, so the body continues to develop external female anatomy, though people with AIS don't develop a uterus and therefore are infertile (and don't have a clear reproductive structure). Long story short, I really don't know whether such a person should be deemed male or female. Most AIS people are more typically female in appearance, external genitalia, and gender identity, so they typically are raised female. Sometimes they may not even know they are intersex until after puberty when they aren't menstruating. 

I have a friend who has a very rare intersex condition where they have full male and full female anatomy and XX and XY chromosomes. They also believe in a traditional view of marriage. My friend is single and asked me, “So, who do you think I can marry?” My answer? 

Well, I’ll save the rest of the story for my post on intersex. But if you want a sneak peak, I had my friend on my podcast “Theology in the Raw” a few weeks ago, so you can hear their story there. 



We are talking about those who are born into bodies that match their DNA, not those people who are born with DNA mutations that caused fetuses to form incorrectly during gestation. In the discussion of gender, gender identity, transgenderism - Intersex serves as nothing but a red herring one must then put aside time deviating from the main point to discuss. Transgender advocates often throw in Intersex into the argument, with a great deal of ignorance. As Intersex people are not trying to identify out of their bodies, but rather live in the bodies they were born in. Medicine has had an ugly history of experimenting on, assigning sex of intersex children by medically altering genitals and use of hormones.

Intersex is a medical condition due to chromosomal development issues - like Downs Syndrome. The sex impacting DNA disorders ones such as Swyers Syndrome, Turner Syndrome, Klinefelter Syndrome have serious medical side effects, including infertility and bodies incapable of maturing fully into one sex or also develop traits of the other sex.

Hey Preston - Thanks for writing! One topic that could be cool to address is whether, biblically, sex precedes gender or gender precedes sex. In other words, does our sex determine our gender or does our gender determine our sex? Did God create our biological sex as a physical manifestation of our gender or did he create our gender as a psychological manifestation of our biological sex? And, how does that question relate to the topic of gender dysphoria/transgenderism? Or, maybe these questions are irrelevant to the discussion...anyways, would love to hear your thoughts!

prestonsprinkle's picture

Hey Travis, that's a great question! I think it all hinges on what you mean by gender. The term is often thrown around with little control over what it actually means. In any case, the next few posts will tease this out a bit more so hopefully, if you follow the posts, you'll be able to answer the question. But, since biological sex begins at conception, and since--as we'll see--many aspects of "gender" (gender role, gender identity, etc.) are connected with the general ways in which males and females behave, I'd say that sex precedes gender. 

Biblically, I don't think the authors would make a firm distinction betweent the two categories, since their anthropology is much more embodied and holistic than those of us in the modern west. For the biblical writers, our embodied self IS our self, so a disembodied concept of gender wouldn't make much sense--if indeed gender is disembodied. Anyway, stay tuned. Glad you're following along!



I love the way you think!

Hey Peter, if a vagina was located externally, there'd be a problem. The term you want is "vulva."

Whoops! Preston. So, yeah, it's easy to get names wrongs, especially when they start with the same letter. LOL

I'm eager to read and learn about this issue on all sides. Also, I know and love a good number of people who have been affected by gender identity issues, yet continue to have a heart for Jesus. One thing I know for sure, we are to love them scandelously.

I am so glad to listen to some conversation on this topic. I work full time at a Christian summer camp, volunteer in a local high school, and also volunteer leading an LGBTQ student group at a local college. The topic of gender and gender dysphoria is essential to be dialoguing about as society is swirling with ideas & answers.

Hi Preston,

I’ve listened to some of your videos and read some of your blogs. I think we can safely say that the church discussion regarding the LGBTQ spectrum boils down to how it all fits into God’s original design and intention for creation. I find defining God’s intention, as though we know his thoughts and ways, an area where the church has lacked humility. The Old Testament is filled with behaviors of the patriarchs that did not align with God’s original intention for marriage, or at the very least the church’s historical view of marriage. King David enjoyed multiple wives and concubines. The explanation I have always heard is that this was not God’s intention, but he allowed it.
Even though God didn’t “intend” for King David to have countless wives and concubines, he was considered his beloved. If God allowed something unintended in the story of King David, why should it be any different today?
Let’s entertain the idea that everything we see happening within the context of gender and sexuality is outside of God’s design. Why do we assume that God cannot consider this entire group his beloved, and bless them in the same way he did King David? This is a great article that shows gender is not at all binary as we have thought. There is so much to consider in this article.
Ultimately, to make a difference, we need to move past the discussion of what we believe God’s intention to be. The notion that acceptance, blessing and approval can only happen when we live inside the bounds of what God “intended” is a contingent message, it is not one of grace. It excludes and entire group of people who only want to express their humanity in the same ways that you and I do. David’s allowed behavior was excess. The LGBTQ community simply wants to live.