Sugar and Snails: An Introduction
Confronting The Irrational.
When it comes to issues of "gender" and "anatomical sex" there seems to be an irrational belief that says "people are only allowed to exist within a given boundary". This is irrational because in the past few years there has been a strong emphasis placed on "sexing" people according to a set of rules. Biological rules, social rules, received "wisdom" and so on. It becomes absurd when you witness a weak, old man standing aside for a fit healthy woman to run past him in order to escape a fire. My point being she could help him escape too, but the irrational says, this cannot be so. I was faced with this situation and the old man in question would not move until I was out of the building. So I picked him up and carried him out. I had no time at this point for his chivalry, just a responsibility to my fellow human beings to ensure that they were safe as well as myself. However the irrational did not end there, he was initially very upset that a woman had carried him out, when I pointed out the horrors of burning to death, which he would have himself witnessed during the second World War, he seemed to understand, but a few others did seem very critical of my un-ladylike behaviour. Worse still one radical feminist said he wasn't worth saving because he was a man.
I then pointed out to her that I am an intersex, and that I do not play by the irrational rules of what is termed "the two sex system" Also as an intersex I have the right to challenge the assumptions of the two sex system whenever I choose to. As it happened there was no fire in the end, it was a false alarm, but this illustrated to me just how deep the irrationality seems to be.
So the real question in my mind now, some five years later, is what are the foundations of the irrational, and how can they be confronted. Well I would like to start with the popularist divisions between "male" and "female" and to see if they do indeed stand up to scrutiny. With a rash of books being published in the 1990s espousing the "Biological effects" of this irrationality, books such as Men are from Mars, Women from Venus, by John Gray seem to owe their success to the fact that they pander to the irrational.
But what is the irrational that confronts everything that opposes it with the derisory term "Politically Correct?" The irrational is basically a need to define life by a set of certainties that are founded on falsehoods. Are men all rapists, and are all women victims? To say yes to that question will invite scorn, mainly from men, but the irrational will come from under the breath of both sexes. "well men are rapists and women are all victims" the contemporary cornerstones of this irrationality, are often boiled down to a gene on the "Y" chromosome called "SRY" and a steroidal hormone called "Testosterone", you could expand on this by claiming that a peptide called "oxytocin" makes women all nurturing. Only the levels of this compound is almost equal between the two sexes. Yet you still hear popular science citing Oxytocin as the "sensitivity and nurturing hormone".
So the irrational has reduced humanity to a DNA sequence, (Human SRY) A steroid, (C19H28O2), and a peptide (H-Cys-Tyr-Ile-Gln-Asn-Cys-Pro-Leu-Gly-NH2). While I can see why this simplistic approach has been taken by all and sundry, I cannot see the scientific value of it or a number of the underlying concepts that are written between the lines. These are the scientific equivalent of urban myth, plausible but not empirical. I have witnessed University lecturers discussing the shapes of peoples fingers. I have seen well paid consultants in hospitals discussing fingerprints and left handedness. For what end? To re-enforce the irrational. I have even read a Pub-med entry that suggests intervening using somatic gene therapy to "correct" a single gene that happens to be part of a polygenic expression, to ensure that SRY is seen as the last word with respect to "true gender". I have known of perfectly sane surgeons, being quite prepared to physically mutilate an intersex child in order to force them into one or the other sex, while at the same time they define adults who undergo sex reassignment surgery as "all that rubbish" Simply because transsexual people in themselves challenge the assumptions laid down by the irrational.
In a sense what disturbs me is the plain fact that science has been mixed with political belief. This in itself seems to be for all the wrong reasons. For example, people wish to use bio-deterministic argument to shore up or challenge the irrationality of the two sex model. It seems to be used in a very strange way. Feminism gave us the idea that gender is the essential problem, and to use biologically deterministic arguments to define women in stereotypical terms. The claim was that gender is a social construct, and that, as such, anatomical sex is not a relevant reason to exclude women from numerous activities. In just the same sentence you will hear them decry transsexual women, (M to F) and then start laying down biologically deterministic arguments (including gender identity) by saying that they are inherently male, on a biological basis, therefore they think as men do. The opt out on this is to do with upbringing, but this does not wash when they are confronted with a woman who has Androgen Insensitivity Syndrome, and as such "XY" chromosomes in the 23rd pair. The claim here being that the presence of the "Y" chromosome makes them men, and think like men. The reality of course varies, some people with AIS self identify as male and others do not. So if feminism claims on the one hand that "gender identity" is a social construct, why the contradiction in saying that "Gender identity is governed by the "Y" chromosome"? Politics seems to override scientific reasoning for a number of reasons. It is evident that "Gender identity" is not determined by the "Y" chromosome. At the same time, it is also evident that there are biological mechanisms involved in "Gender identity" but that may well, and does, include people self identifying as asexual or androgynous.
This contradiction is all well and good for keeping certain boundaries (As if these boundaries have any meaning, which as far as I am concerned they don't) on a social level, but it ceases to have any real value as a means to determine the mindset of any given individual. The recent findings of Professor D.F. Swaab brought one thing into the open, how the irrational will only support the biologically deterministic argument when it suits the irrational. For example, a study conducted in 1998 by one Professor Skuse seemed to imply that people with Turners Syndrome were men because they did not have a "Sensitivity gene" on the "X" chromosome. This claim was not based on any work at all with respect to sequencing, sampling, or whatever. The only work that was done involved a questionnaire handed out to parents of children with Turners syndrome, to see if they showed any stereotypically "male" behavioural traits. As these were girls, it seems that they only had to "act in a way not expected of a girl" for professor Skuse to claim that they lacked the sensitivity gene on the basis that they had only one "X" chromosome. This research was embraced in the media with headlines like "Men and women are mentally wired differently, we knew it all along, men (one X) are emotional cripples and women (two X chromosomes) are all sensitive. Note this was based on a study group of people with one "X" chromosome. and as such tried to say that the 23rd pair determined gender identity, or psychological traits associated with the two sexes/genders. When a study that stated the same thing, from Professor Swaab, stated that "Gender identity was biological in origin" but this did not involve the 23rd pair, but the interactions of hormones on nervous tissue during development, it was continually criticised. The burning question in my mind is "Why?"
Well there is an underlying thread of reasoning here, called the "genital supplementation" This is the rule that if you can't define someone by genitalia, and get away with incarcerating them in the prison of irrationality, then use another simplistic dogma instead to achieve the same effect. The 23rd pair of chromosomes fulfill that role in the minds of the ignorant. The reality however, as many Intersex conditions, as well as Transsexual variations, prove, is that "XX/XY" does not indicate anything other than the increased probability of a given phenotype that fits the pattern of one or the other "sex" as defined by the irrational. This is genital supplementation. And has little or no real scientific validity.
The core argument of the following articles is a common one, that there are many, many examples of where paradigm has to give way to alternative explanation. Take the zoological approach for example, where the irrational is fostered by the paradigms enshrined in socio-biology, essentially stereotypical behaviours are explained as "healthy or normal biologically determined traits" whereas non stereotypical or cross gendered behaviours are seen as "biologically deviant". The problem with this is that the alternative viewpoint, (Which is not dependant on socialisation) would say that the "aberrant" behaviours are also a part of evolution. This is because evolution itself does not solely depend on the transmission of genetic material via reproduction. Also that evolution does not stop at the point of birth and then continue when reproduction takes place - only one aspect of genetic variance takes place. I could for example cite the more extensive role played by RNA than is currently described. Not through some radical idea but through simple observation of the way such biochemical mechanisms actually work.
There is also the most challenging concept to undermine the irrational, and this is the now emerging evidence that sex is just as much determined in the autosomes as it is in the 23rd pair.
I can mention the deep confusion that can be felt by a teenage girl who walks into her local G.P.s surgery with a small but significant worry about not menstruating. There she is, in front of her G.P. who plainly sits there and as calm and as matter of fact as you can get he comes out with "You have an XY chromosomal pairing, you are a man, not a woman" and the next thing you know she is taking a walk to Beachy Head. Oh what an admirable bedside manner! This story is becoming less common. It has been known to happen though.
A great many misdiagnoses were made on this basis. For example we have the buccal smear test, it is quite simple. You take a smear from the lining of the mouth, you look for a Barr body. (The result of an inactive X chromosome) and if it is there it is logical to assume the individual is "genetically female". So simple. Well no - it is far from that simple. Back to our woman in the G.P.s surgery, she has some form of A.I.S. most likely "Grade 6 or 7 A.I.S." (As she presents as a female with little or no confusion before now). It is the simplistic and arbitrary labels and tests that have been so endemic within the medical profession for so many years and most importantly the way they have been used that are to blame. In theory, you can have a woman, with most internal female organs, who has the 46XY pairing.
The "Y" chromosome is only a part of the story when it comes to resulting in a male phenotype. The SRY gene, (About 4k-bases in length) is seen as the only gene responsible for producing a male phenotype, reducing something as complex as sex differentiation and gender identity to one gene. Anyone who studies genetics will tell you that attributing complex elements of the human condition to a single gene is simply bad science. I can think off the top of my head of at least 10 genes that can effect the expression of SRY to such an extent that would render SRY useless. Then again if a gene called KIAA0396 did not express, the differentiation from an initial female phenotype would not take place. Were this gene and SRY compromised, you can theoretically have a female, with a uterus, and partial ovaries but also with "XY" chromosomes. In plain English the potentially female bits would not die off in a developing fetus and the male bits would not develop. O.K. that is a bit theoretical and really the preserve of specialists in that field.
The theoretical possibilities are limitless, in practice they do and that essentially is that. Yet this seems to cause society a lot of discomfort. "Such births cannot happen." Very helpful if you are a parent of such an individual or are such an individual yourself. There is a "grading" system for people with A.I.S. as this is really an umbrella term for numerous conditions that "Feminise" an "XY Male" (To use the paternalistic line). But we really need to look at it another way. It is so complex it does my head in. In essence it is quite simple, there is Grade 1 (Fully male with a few open ended hormone issues) to grade 7, (Just next to the KIAA0396 extreme). So if KIAA0396-SRY mutation were found, that would be Grade 8 I imagine. (Though grade 8 does not appear to exist right now) To me this is a bit of a "Pheno meter" to match the infamous "Phalo meter" (The dubious practice of "sexing" an intersex child with a tape measure placed against the enlarged clitoris/undeveloped penis) In the hands of the wrong people. Such as paternalistic medical professionals.
There is a serious point here though, it isn't the grading system that upsets me, it the degree of "perceived maleness or femaleness" it may engender and how some people may misuse it. For me at least there is a streak of scientific purism in my outlook. I have seen numerous leaflets with scales like this. And without a visit to an endocrinologist who knows exactly how to apply this system, or a patient group who have adopted it. The real debate here is how far people are from the "Expected status" of someone with an XY pairing, and this is the inherent problem with these grading systems.
In fact when you look at it from a genetic standpoint you may be surprised. I want to concentrate on a variant of P.A.I.S. because it is perhaps the condition that is most fraught with negative assumptions. It is perhaps best to explain in more depth exactly what it is that makes the differences on a genetic level. I will begin with "5 alpha reductase deficiency". This is not the same as "Full blown" A.I.S. (Meaning that the causal variables were different that is all). But it is a classic example of what mathematicians call a "Butterfly effect". Essentially the gene that produces 5 alpha reductase, needed to convert Testosterone to Dihydrotestosterone. (Which is more potent). needs to be "Correct". If the gene (this is an interesting case for the single gene merchants). Is compromised the result is either intersex or outwardly female. With "5 alpha reductase deficient A.I.S." Missense mutations occur when a single base in a codon (3 base triplet) so the codon does not code for the correct amino acid in a polypeptide chain.
Ok. In English: There is as I said a gene. this is a portion of DNA composed of four "Bases" these are themselves "Amino acids" denoted A (adenine) T (Thymine) C (Cytosine) and G (Guanine). or (ATCG).
When they make "Polypeptide chains" three letters or triplets (Such as TTT) will code for an amino acid in the polypeptide chain. A daisy chain of amino acids if you like, of which there are 20 to choose from this time. These are the main subunits of proteins and enzymes. TTT as DNA codes for the amino acid "Lysine", for example. A Missense mutation is where one letter in the triplet is replaced by another. So for example if "TTT" becomes "TCT" as DNA it will code for another amino acid called "Arginine". So what was
A section of DNA that is active is known as an "Exon". So with one variant of 5 Alpha Reductase deficiency what would otherwise be categorised as a "male" can in fact be categorised as an intersex or female. A transition at the second nucleotide of codon 85 in exon 1 (GGC --> GAC - Quoted as DNA not m RNA) substituting glycine for aspartic acid, can occur .(Vilchis F, Mendez JP, Canto P, Lieberman E, Chavez B. 2000). Now this is just one amino acid's difference from the "Norm" One base on the nucleotide and one resulting amino acid in the enzyme (Polypeptide chains make an enzyme) rendering it non expressive. There are tens of thousands of bases in some genes, the alteration of one results in such a drastic variation. It certainly puts the Y chromosome on shaky ground as a reference point for "maleness" More interesting is the fact that the gene that is involved (SRD5A2) occurs on chromosome (pair) 2, an autosome, not a sex linked chromosome.
Now there are many variations of 5 Alpha A.I.S. and this is down to two things. How the expression of other alleles (variation of a given gene) are effected and what the allele of SRD5A2 is. There are many alleles of SRD5A2. some with missense mutations in different places along the gene. The interesting point to make with this example is that the sex is effectively decided by an autosome. Not a sex chromosome.
Other types of AIS involve mutations in many different genes. some in the X chromosome, others in the autosomes. The positive thing for any A.I.S. individual who feels comfortable as a woman is that no one can say that she is "Genetically male". In fact no one can say "The sex chromosomes make you male or female by themselves" They are subject to the final say of genes lying in the rest of the chromosomes. The interesting point though, when discussing the "Single gene" argument is this. We are looking at a single "letter" in one gene radically altering the "Expected outcome" but it has to be seen in context. The manifestation of this depends on the activities of other genes. You cannot say "This gene will always have this outcome" all you can say is "This gene expresses to this degree" and, if the conditions are right for such a tiny effect to be made manifest, then this gene is at the root of the "Butterfly Effect". Paradoxically this in itself undermines the idea of single gene dogmas, and thus undermines the notion that SRY for example will always result in a "male" phenotype. It can be any phenotype, and the individual can identify further in many ways.
The Gender agenda:
How many times have I heard someone saying that A.I.S. women must really think like men because they have 46 XY. I remember hearing one woman with A.I.S. saying "Oh I hate it when some doctors find out that I am XY. They expect me to want to jump up and play football or something" Well she had pointed out the greatest urban myth about women with A.I.S. that is cited. SRY does not code for gender identity. It codes to the differentiation of gonads into testis. Another interesting (Contradictory) quote for those who believe that gender identity is biological and "Hardwired". A few years ago something from an unlikely source took gender identity out of the XY domain altogether. Now I know that a number of intersex people find comparisons between themselves and the transgender community can be a cause of distress or unease (It often winds me up when someone tries to define me as transgendered) but something I found interesting happened a few years ago. Something about the way evidence seems to take this elusive "Gender identity" away from chromosomes 45 and 46. Many in the transgendered communuty were going on about the size of a part of the brain called the "Bed nuclei of the Stria Terminalis" This was of course the study by Professor D.F. Swaab in 1995 on a number of transsexuals brains during post mortem produced evidence of the size of the BSTc being concurrent with gender identity. The smaller it was the more female the gender identity. Much of that "Brain sex" stuff came from these studies as well.
Having said that the studies conducted by Professor Swaab in 2000 have produced something that is perhaps relevant to A.I.S. women confronted with negative assumptions about their "Gender" identity on the basis of the XY myth. Enabling them to reply to the XY =Male mind myth. As I say it is not the presence of the "Y" chromosome that makes any difference, it is something more complex than that . A number of AIS people do identify as male. But they suffer unfair hostility from AIS women who seem to think that the AIS men, are being used to define them as male. Back to the non chromosomal model. A lot of Professor Swaabs critics challenged him to explain why the size of the BSTc was different between males, females and transsexuals. They suggested that the medication taken by transsexuals caused a change in the size of the BSTc. Well hormones are involved, but during fetal development. In 2000 when all the transgender politics moved on. Professor Swaab came up with a possible answer to that question. By this time transgender was no longer the issue.
Well The latest information to come from Professor Swaab gives the following hypothesis; that the anterior portion of the BSTc undergoes apoptosis (A number of cells within that region die off) Androgens actually seem to inhibit this process of cell death, giving a larger (lets say masculine) BSTc. The absence of certain androgens and lack of receptors can cause the apoptosis to continue. So if you are insensitive to androgens? Personally I think that Gender identity is more complex than that. But the XY =Male mind myth simply does not stand up to the evidence. XY =Male mind, XX =Female mind is a paternalistic myth, that has no evidence to support it.
I may as will be honest - I dont like football, but I dont attribute that to some tiny part of my brain or my specific genetic make up. I don't like football because I find it boring! - something that both the transgender community and the paternalistic practitioners of medicine don't seem to understand. But the idea of gender identity, when applied to intersex people, cannot really be attributed to either nature or nurture. If anything, that is the core of my argument about the gender agenda. People don't seem to listen to anyone without having tried to find an explanation that divorces an individual from themselves in some way.
If I have a point to make here it is not that I don't entertain Professor Swaab's research - quite the opposite I find it interesting. It is that I find the way people read it soon upsets me, as it often translates into some kind of medical policy. Even with the best intentions, any study can have very unfortunate consequences. For example, my favourite targets of criticism - Dr John Money and Professor Milton Diamond. The argument with these two is simple. Dr John Money decided one day to have a theory, and published a paper which says that "Gender identity is social" and then proceeds to assign every infant male and intersex patient with even the most minor of problem to female by surgical means. It is naturally an outrage. There is no consent, just a form of genital surgery being arbitrarily undertaken. Some years later these children grow up and a number of them are not happy about what was done to them. But then what happens. Enter Professor Milton Diamond. It is classic. "These unfortunate boys were forcibly feminised. they are boys!" (XY lurks insidiously in the background). Now there is evidence beginning to emerge, slowly that a larger number of intersex children were assigned to male than were thought - as well as the fact that many are unhappy with that. But the implication now is that, because it is difficult to masculinise an infant's genitalia (true) no such cases will exist, (but they do) and surely they would be happy to have been boys, because these victims of Dr John Money identify as male. This is not strictly true, because all are individuals.
This is where I think the irrational can get into the most rational. A lot of people will wrongly think that I am unjustly critical of Professor Milton Diamond. In fact when publishing the little I have, there has been a tendency to say "Ah but you criticised Milton Diamond." In reality I am trying to define a clearer picture. To my mind as an intersex patient myself, the issue of having been given surgery against my will as a child is only half of the issue. The other half was the legacy of that surgery, the rearing. I go further than those who just object to the surgery, I object to the socialisation that was forced on me as well. Milton Diamond does advocate the gendered upbringing of intersex children. When I discuss his guidelines in more depth I will put what I see into a clearer context and hopefully the problem of people thinking I am being very critical when I am only being concerned about something he says in Paragraphs 5 and 9. The fact remains that I was born sexless and that needs to be respected, in a social as well as "medical" context. For me gender as it stands is part of the irrational.
The difficulty arises not from the basic science but how it is understood and used. Back to the surgery, where the G.P. has the woman back in as she expressed how upset she was at his insensitive remarks. She sits there waiting for a clear explanation of what he meant by that remark. He could quote all the good labelling methods, the bad labelling methods. He could insist on theories that are proven or unproven. He can say whatever he likes, however good or bad the science is behind it. But how she feels about herself has been deeply compromised, that is very obvious.
Many patients do go to great lengths to find out exactly what they have. They look up all the literature available. The internet, while far from perfect, does give more information. Paternalism states that the patient is a passive entity. Their body, if you like, is property of the medical profession while the patient is unwell, as Dr John Money and Professor Milton Diamond seem to illustrate only too well. While Professor Milton Diamond is trying to give control to the patient it does seem to be on terms dictated by unknown variables that have been translated into biological determinism - or "XY" determinism. (Considering the input from Mr Colapinto) If only people could understand that ownership of oneself and the principle of consent are paramount, and most importantly, let no one tell you that you are something that is alien to you. What you know of yourself is what the underlying reality will without doubt actually be. It may seem a bit of a cliche but how you live, is what matters, not someone else's idea of what your chromosomes are supposed to be saying, or how some clinical practice will dictate how you "should" behave or how your upbringing was conducted. That applies to everyone. I am deeply critical of people like Dr John Money because they had no consideration for the individual whom they surgically altered. For people like Professor Milton Diamond, I am only saying that the backdrop that refuses to accept that an "intersex identity" as being valid, is a backdrop built of the irrational. The irrational hatred of anything that does not conform to male or female. The cause of the problem, that resulted in Money and his surgical intervention is not being addressed here. And that problem is that which says "Not Neuter".
Hopefully there will be a time when the broader picture will be seen and the narrow irrationalities of things like "The two sex system" and "genital supplementation" will give way to a more holistic approach to the complex and often not so obvious subtleties of the whole condition we call living.
Other articles by Sophia Siedlberg:
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