BIOLOGICAL SEX ISN'T BINARY

The science is clear — sex is a spectrum.

Many people believe that biological sex is binary: either you’re male or you’re female which is so untrue. 

Just like gender isn’t binary, our biology isn’t binary either: it, too, exists on a spectrum. In fact, many people’s bodies possess a combination of physical characteristics typically thought of as “male” or “female.” As one example, some people with androgen insensitivity have XY chromosomes, internal testes, and external female genitalia. Traits, including hormone levels, can also vary widely both within and across sexes. But people who fall outside of what’s considered normal face discrimination. Take South African runner Caster Semenya, who was recently the subject of a ruling that ordered her to lower her naturally high testosterone levels to compete with other female runners — even though studies have shown that because testosterone levels are so highly variable, there’s overlap between the natural testosterone levels of men and women.

Students are often inaccurately taught that all babies inherit either XX or XY sex chromosomes, and that having XX chromosomes makes you female, while XY makes you male. In reality, people can have XXY, XYY, X, XXX, or other combinations of chromosomes — all of which can result in a variety of sex characteristics. It’s also true that some people with XX chromosomes develop typically male reproductive systems, and some people with XY chromosomes develop typically female reproductive systems.

When embryos first develop, they all start out with the same rudimentary reproductive tract — regardless of chromosomes or genes. Later on, during typical embryonic development, embryos with the SRY gene — usually found on the Y chromosome — then develop testes, seminal vesicles, an epididymis, vas deferens, and a penis. If the embryo has a functional WNT4 gene — found on chromosome 1 — and no SRY gene, its reproductive system instead develops into ovaries, a uterus, fallopian tubes, and vagina. 

But sometimes people end up with intersex traits, often referred to in medical settings as differences of sex development (DSD). People may choose to identify their sex as male, female, and/or intersex/with DSD, although many intersex advocates argue against the use of DSD as it implies that they need to be “fixed.” There are many ways people can be intersex. For example, XX embryos with an SRY gene will develop as typical males, while XY embryos lacking the SRY gene will develop as typical females. There are also other genetic variants in a number of genes that can alter hormone levels, resulting in a reproductive system that is neither strictly male nor female. These changes can cause someone’s reproductive system to not “match” their chromosomes. 

When a child is born with ambiguous genitalia, doctors commonly recommend reconstructive surgery to align the child’s anatomy more closely to typical male or female anatomy. It’s been estimated that babies with intersex traits account for up to 2 percent of live births, with this kind of surgery being performed in about 0.1 to 0.2 percent of live births — even though evidence suggests this can cause physical and psychological harm.

Laws and social attitudes can make it difficult for intersex, transgender, and non-binary people to receive adequate healthcare services, participate in sports, and be protected from discrimination.

A complicating problem is that j can lack experience treating bodies that are neither male nor female, making it harder for them to understand their patients’ needs. This is true not only for intersex people, but for transgender and non-binary patients as well, some of whom may be taking hormones so that their bodies more closely align with their gender identities. Some of these patients may not be seeking affirming medical interventions, and just want their pronouns respected. Both physical and psychological harm can be caused by the medical enforcement of a sex binary, making it harder for people to seek the medical help that they need in the future.

Harmful approaches to sexual traits carry over to gender because our society often thinks of sex and gender as interchangeable. Laws and social attitudes can make it difficult for intersex, transgender, and non-binary people to receive adequate healthcare services, participate in sports, or be protected from discrimination.

The idea that gender or sex are binary harms everyone by stigmatizing traits that lie outside of what society considers normal. Changing attitudes and social structures to recognize sex as a spectrum is a daunting task, but it is possible. To make real change, we need both public education about the biological sex spectrum as well as policy changes. We should ban surgeries on intersex people without their consent. 

The doctor’s office is often the first place people learn about being intersex, usually when it pertains to themselves or a child. If — instead of recommending that intersex children be raised as either male or female — doctors educated patients and parents about the sex spectrum, it would help people feel accepted in their bodies and change attitudes about what’s normal.  Simply teaching about the spectrum of sex can begin to break down stigma and healthcare.