Researching intersex & trans people's medical experiences

Michelle O'Brien

BA, DMA, MSc, HTCPD, PhD Candidate, Roehampton University, School of Business, Computing & Social Science
Gendys Conference, 2004



Up to the time of Magnus Hirschfeld (Hirschfeld, 1910/1991, Hirschfeld, 1914 /1991, Hirschfeld, 1923) the study of homosexuality, transsexuality and intersex were located together, so I set out by looking at these. I then focus on the two groups I am looking at in my research. I finish off by examining some of the work covered in my research so far.

Heternormative Context

Heterosexual binary gender system:

  • Seen as 'normal'
  • Problematic, implies others are 'abnormal'
  • Dominant form of sexuality/gender expression
  • Implies others are 'subordinate'

Notions of normality and dominance lead to discrimination and injustice

Diversity Context


  • Same-sex sexual orientation (gay or lesbian)
  • Male/female identification


  • Cross-sexed gender role/identity (body/mind mismatch)
  • Surgical Reassignment elected as adult
  • May identify as straight or gay

Classical cultures:

  • 'Self-made eunuch emerges from Roman grave' (Guardian 22/05/02)
  • Transgendered people have existed from the earliest times, as well as in cultures such as in India and Native North Americans.
  • As with homosexuals, attempts to pursue rights have met a backlash from religious right in Europe and America:
  • "New gender recognition law challenged as 'highly dangerous'"
  • Some Feminists argue that it is our society's gender stereotyping which causes gender dysphoria and results in radical surgery to change sex.


As for transsexual, but without surgery


People who identify as neither male or female (Krafft-Ebing, 1996)


Varied definitions, may be/have:

  • Biological condition
  • Usually identify as heterosexual
  • May identify as gay or transsexed
  • People born somewhere between the sexes
  • People with atypical chromosomes
  • People with hormonal anomalies
  • People with atypical genitalia


After 150 years of research, the reasons for sexual and gender diversity are not fully understood. The social and biological aspects are not clearly defined for any group. Intersex is a biological phenomena, but what is and isn't intersex is defined by people. For religious leaders, a biological cause of homosexuality and transsexuality is inconvenient undermining ideas about sin and choice. For the National Socialists biology was convenient. The views of some African leaders and Bishops about homosexuality echo those in Germany in the 1930's.

These three phenomena occur globally and throughout history, but are not always tolerated globally. To ask if homosexuality or transsexuality has some genetic or biological basis, or how it can continue to exist in evolutionary terms, is problematic: that is a political stance that assumes homosexuality is deviant, and thus needs explaining or justifying. When we discuss nature vs. nurture, we do not ask whether heterosexuality is produced this way because it is assumed to be normal.

Wherever we live or come from, problems about these issues are often problems of language: Science itself is often guided by the bias of the investigator, as are the interpretation of the findings, and implementation of policy that arises from it.

Human Rights

Amnesty International report (AI, 2000) highlighted that many people around the world are tortured, imprisoned and killed because of their sexuality or gender identity

Such minorities are often not tolerated in much of North and South America, the Middle East, Africa and parts of Europe. People are targeted for simply being who they are - and this is sometimes sanctioned by the state.


Figures are hard to establish, and for comparison I err on the cautious, between the most conservative and generous).


Estimates are between 3 and 10% of society I work on a figure of 5%.


Coming between the official figures, estimates from the USA on the internet and the incidence of Hijra in India, I work on a figure of 0.05%. Once the procedures in the Gender Recognition Act have been active for a few years, more detailed figures should be available for the UK.


There is a one hundred fold difference between the estimates of Sax & Fausto-Sterling (Fausto-Sterling, 2000, Sax, 2002). The latter figure is more in line with Skakkebaek's estimates of genital anomaly in the newborn in Western Europe and North America (Skakkebæk et al., 2001). I take a more cautious figure of 0.5%

Defining Pathologies

Three groups of people in study:

  • Intersex people
  • Transsexed people
  • People who appear to be both

Location of Communities & Pathologies

The following four diagrams map out four different ways of looking at three groups:

  • Lesbian, gay and other queer identified people
    (Historically pathologised as homosexuals)</
  • Transsexed people
    (Historically pathologised as transsexuals)
  • Intersex people
    (Historically pathologised as hermaphrodites)

Diagram 1:
Transsexuality, intersex and homosexuality are three separate things, but they are overlapping sets (individuals who are intersexed and homosexual, intersexed and transsexual, transsexual and homosexual, or intersexed and transsexual and homosexual).


Diagram 2:
Transsexuality, intersex and homosexuality are three separate things, which have nothing in common (being intersexed, it makes no sense to talk about changing sex or same/opposite sex sexual orientation)


Diagram 3:
Transsexuality is a form of intersex, which is separate from homosexuality, but they are overlapping sets in the form of individuals who are both intersexed and homosexual (usually intersex people reject this, while some transsexual people assert it)


Diagram 4:
Transsexuality is a form of homosexuality, and intersex falls under the general heading of Lesbian, Gay, Queer Identities (rejected by most transsexuals, and a lot of intersex people, but proposed by LGQ activists)

Location of information

The four locations identified by Dave King (King, 1993):

  • History and development of treatment for both groups
  • Narratives of people themselves
  • Medical scientists, practitioners & other academics
  • Media

Other locations:

  • Politics and debates within and between these communities
  • Internet: web-sites, support lists, pressure groups


  • Historical literature.
  • Archives and narratives.
  • Media
  • Autobiographies & biographies


I am developing an analysis of media coverage over the past ten years. The extent of reportage on transsexuality over the past ten years has increased substantially year-on-year. Coverage of intersex is relatively recent and is a fraction of that devoted to transsexuality.

Methods - Interviews

  • Semi-structured and informal
  • Many carried out on telephone
  • Duration 30 to 60 minutes.
  • List of guiding questions:
    • Used to get people started
    • Used as prompt when conversation flagged
    • Developed during interview process

Initial Findings

So far data collected, but analysis incomplete

Lesbian and Gay Archives
Revealed high level of cross gender identification in the lesbian and gay community.

Frequent social isolation and bullying

Effects of medical interventions discussed

Issues Raised

The Creation of pathologies.


  • Body/mind
  • Neurology/psychology
  • Male/female masculine/feminine
  • Normal/abnormal (deviance)
  • Queer/straight

Queer Theory.

Crip Theory.


It has been asked here whether the current interest in intersex issues is because some transsexed people have difficulty accepting themselves as such. Very few intersex people can be categorised as transsexed most maintain identification withthe sex of assignment and rearing. At Lübeck recently, Ken Zucker described research which showed that a very small percentage of intersex people with ambiguity assigned a sex in infancy went on to change gender role as adults. This is higher than the general population, but is still quite a low incidence. Some would question whether an intersex person can be transsexed, when there has been some question about assignment and some level of ambiguity.

One of the reasons I resist the current trend of trying to blur the lines between these phenomena is because intersex people are often accompanied by life-long medical problems. These problemshave been overlooked by assuming people are only "transsexed", and huge psychological discomfort has been caused by trying to fit people into an inappropriate pathology, just as much as an inappropriate gender-role.

I do look back to Hirschfeld, whose works are becoming increasingly available in translation after over 80 years, and read with surprising freshness. He described somatic and psychic hermaphrodites, the former being intersexed people, the latter included homosexuals and what he called transvestites (some of whom we would today see as transsexed people). This usage, it seems, would be very appropriate for a distinction and could be restricted to the two groups in question: physical and neurological intersex conditions.

Then where there is overlap, it can be accounted for, and the health needs of both communities could begin to be addressed properly.


  1. AI (2000) Crimes of hate, conspiracy of silence: Torture and ill treatment based on sexual identity, Amnesty International Publications.
  2. Fausto-Sterling, A. (2000) Sexing the Body Gender Politics & the Construction of Sexuality, Basic Books.
  3. Hirschfeld, M. (1910/1991) Transvestites: the erotic drive to cross-dress, Prometheus Books, Buffalo, New York.
  4. Hirschfeld, M. (1914 /1991) Homosexuality of the Male and Female, Prometheus Books, Buffalo, New York.
  5. Hirschfeld, M. (1923) Die Intersexuelle Konstitution, Jahrbuch fuer sexuelle Zwischenstufen, 23, 3-27.
  6. King, D. (1993) The Transvestite and the Transsexual: Public Categories and Private Identities, Avebury, Aldershot, Brookfield USA, Hong Kong, Singapore, Sydney.
  7. Krafft-Ebing, R. v. (1996) Psychopathia Sexualis, Creation Books.
  8. Sax, L. (2002) How common is intersex? A response to Anne Fausto-Sterling, Journal of Sex Research, 39, 174-178.
  9. Skakkebæk, N. E., Meyts, R.-D. and E; Main, K. M. (2001) Testicular Dysgenesis syndrome: an increasingly common developmental disorder with environmental aspects, Human Reproduction, v. n.5, 972.- 978.
Citation: O'Brien, M., (2004), Researching intersex & trans people's medical experiences, GENDYS 2004, The Eighth International Gender Dysphoria Conference, Manchester England.
Web page copyright GENDYS Network. Text copyright of the author. Last amended 07.07.06